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Introduction

• economic developments - Increasing globalisation and the economic policies of successive Tory governments have resulted in rationalisations, redundancies and high levels of job insecurity. The pressures on those fortunate enough still to be in employment are enormous but they are so fearful for their jobs that they are afraid to complain when excessive workloads start to make them ill. A survey carried out by the Sheffield Occupational Health Project, for example, found that in one engineering company alone, 45 percent of those responding said that they regularly took painkilling drugs in order to keep on working.
• political developments - The Tory government’s drive for more and more deregulation and their massive cuts in the resources available to the health and safety enforcing authorities have made it easier for poor employers to get away with breaking health and safety law. Furthermore, Jenny Bacon, the Health and Safety Executive’s Director General has announced that HSE’s enforcement policy for the future is for self-regulation by employers and that preventive inspections are to be cut by a third. Health and safety at work has been threatened even further by the Tories’ concerted attack on the trade union movement and the removal of whole areas of fundamental employment rights, which has made many workers reluctant to take action through their trade unions to protect themselves.
• evidence that RSI is a continuing problem - A number of surveys, including the government’s own Labour Force Survey, have revealed that musculoskeletal disorders, including RSI, are now the largest category of work-related ill-health. Over 200,000 people each year take time off because of RSI and the TUC estimate that at least as many again are suffering in silence and working through the pain. A recent study has suggested that the true costs of RSI may be two or three times the actual compensation costs and that hidden costs include lower work performance and decreased motivation of RSI sufferers. The TUC have estimated, on the basis of official data, that RSI now costs £96 million in lost income for sufferers, £65 million in benefits to sufferers, £343 million in loss of amenity, adaptations and NHS treatment, £278 million in lost production because of time off, £135 million in lost production because of reduction in efficiency and £88 million in employers’ insurance, sickness absence and recuiting and training costs.
• increasing awareness of RSI - Public awareness of RSI has grown considerably over the last few years, helped by some well publicised legal cases, by information campaigns run by the Hazards Centres, the TUC, trade unions and the HSE and by the work of support groups such as the RSI Association. Employees now have greater expectations that something will be done to reduce the incidence of RSI.
• developments in the treatment of RSI - RSI sufferers are reporting that new specialised physiotherapy techniques, developed in Australia, appear to be very effective in the treatment of RSI. Other holistic approaches based on Australian experience and involving physiotherapy and psychology are also reported to be producing positive results, particularly in chronic cases.
• developments in health and safety law - New health and safety legislation deriving from European Directives has placed a much clearer obligation on employers to assess the risks of work activities which can cause RSI and implement measures to prevent or minimise them.
• developments in case law - There have been a number of important legal cases on RSI and sufferers have won substantial settlements both in and out of court. Employers are facing increased pressure from insurers to take steps to prevent RSI or be charged higher premiums.

Hidden harm from overuse - the misery of RSI

Every year thousands of workers suffer RSI as a result of their work. Many become permanently disabled, no longer able to perform simple everyday tasks. Around 40% lose their jobs because they can no longer do the work they were employed to do. Because their injuries are usually invisible their condition is often not believed. They may be labelled hysterical, particularly if they are women, or inadequate individuals whose pain is all in the mind. Or they may be accused of being malingerers, whereas all the evidence shows that RSI sufferers are more likely to be hard working over-achievers.

Many of the sufferers are women, who tend to be concentrated in the sorts of job that carry a risk of RSI. They often work in repetitive jobs, on long shifts and on piece rates. They are rather less likely to be in a union and are more likely to allow themselves to be put upon without complaining. They may be the sole earner in the household and so dependent on the job however bad the conditions. Women workers are also less likely to be able to rest once they return home from work. However many articles there may be in politically correct journals about new men, the reality is that it is still women who bear the burden of housework.

The London Hazards Centre hears many tragic stories about the misery RSI brings to people’s lives. One concerns a woman keyboard worker in a small non unionised workplace who was required to work at a rate of 17,000 key depressions per hour. She developed severe pains in her arms, hands and wrists and was eventually diagnosed as having a frozen shoulder and tennis elbow. This woman is profoundly deaf and relies on signing to communicate. Her condition is so bad that it has become too painful to manipulate her hands and fingers to sign so she is now totally unable to communicate with family and friends.

Many sufferers have described their lives full of pain and the radical changes they have had to make to their daily routines in order to cope. Typically, after a sleepless night, sufferers face problems from the moment they get up - how to turn on the taps, to wash, to grip a toothbrush and clean their teeth, to comb their hair, to put on and fasten their clothes without causing pain. Pride in their appearance has to take second place to comfort - with short easy-care hairstyles and loose elasticated clothing. Pride in one's home also becomes a thing of the past, with daily cleaning routines giving way to weekly or monthly routines. Putting clothes into the washing machine may be manageable, but manipulating the controls, hanging up wet and heavy washing on the line, gripping and pinching clothes pegs cannot be managed without pain. Tableware has to be replaced by plastic as the inability to grip things firmly means increasing breakages of precious crockery and glassware. Sufferers are always on the lookout for aids and gadgets to help them carry out the most simple household tasks. Meals may be inadequate or skipped altogether when the sufferer is in too much pain to prepare them for themselves. "One day I had to resort to calling in a neighbour to make me a sandwich," said one sufferer. Picking up, cuddling or bathing your baby are tasks which are impossible or too risky to perform and many parents have described the heartbreak that this has caused. Even pleasure in the family pet may be denied. "I couldn’t even stroke my cat without my hands hurting," revealed another sufferer, sadly. Hobbies which could provide a welcome distraction from the pain may also have to be abandoned because they involve using the affected part.

To all this physical pain is added further psychological distress: anxiety about the future and whether they will lose their job; financial worries if they are unable to work; guilt at having to rely on family, friends and neighbours to do so many of the tasks that they can no longer perform; the trauma of being passed around the medical profession without getting a proper diagnosis or without being believed; or the stress of trying to win compensation for the injury that has been caused them.

About this handbook

Employers who do nothing to prevent their employees from developing RSI and who allow them to suffer are breaking the law. Health and safety legislation places legal duties on employers to carry out risk assessments of RSI in their organisations and implement measures to prevent RSI. However, a survey carried out by the Labour Research Department (LRD) in 1996 found that only 58 per cent of employers in organisations where cases of RSI had been found had carried out risk assessments under the relevant health and safety legislation.

Health and safety law now requires almost all employers, as a standard approach, to identify the hazards in their workplace, to assess the risks to employees and to implement measures to prevent or control those risks. This handbook begins by describing in more detail those legal requirements as they apply to RSI. The chapters which follow will look at identifying the hazard (what is RSI and what are the symptoms?), assessing the risks (why does RSI occur and who is at risk?) and preventing or controlling the risks (preventing RSI - what employers must do).Other chapters will deal with trade union action in the workplace and what safety representatives can do, diagnosis and treatment, what compensation is available and what action sufferers can take. Future campaigning priorities are also included.

Although we hope that the handbook will provide useful information for those unfortunate enough to be suffering RSI already, the emphasis throughout the book is on prevention. We have aimed to provide practical information to empower workers to organise and take action in their own workplace to ensure that their employer makes it RSI-free.