Here is the outline of my lecture last week. Hopefully it will help you to make best use of your business OH resource.
What we need to consider:
- Purpose of medical standards/guidance
- Job description
- Employee’s medical condition
- Scope for job modification
- Legal compliance
- Business Protection /Reputation Protection /Loss Control
If we get it wrong:
- Sickness Absence
- Accidents
- Legal & Insurance Claims
- Poor Decision Making
- Poor Customer Service
- Difficult Working Relationships
- Low Morale & High Staff Turnover
- Low Productivity & Poor Quality
- Lack of Innovation & Creativity
Costs of ill health to the employer:
- Sick pay, pension fund contributions if IHR
- Recruiting, training, assessing replacement
- Management and investigation of absence
- Insurance, litigation and compensation
- Loss of experienced and skilled staff
- Low morale
Costs of ill health to the employee:
- Physical and mental pain and distress
- Financial loss short/long term
- Possible career loss
- Loss of social standing and interaction
- Loss of daily/weekly structure
“Fit” – to do what?
- Attend/Handle Pressure?
- See/Listen/Talk?
- Sit/Stand/Walk?
- Think/plan/Make decisions?
The referring manager should:
- provide a Job Description that lists the activities and tasks of the role
- clearly and realistically distinguish between essential vs non-essential elements
- indicate the scope for job modification
- indicate the scope for alternative roles/redeployment
Do the Job Tasks involve:
- Standing / Walking/ Lifting / Carrying
- Confined Spaces /Climbing Ladders / Working at Heights
- Chemicals / Biological Agents
- Skin or Respiratory Irritants / Sensitisers
- Dangerous Machinery / Vibrating Tools
- Dust or Fumes
- DSE / Computer Work / Prolonged Sitting
- Travel – UK or Abroad / Vocational Driving
- Work Pressure / Demanding Job
Legal compliance:
- The legal position of medical standards
- Disability Discrimination Act 1995
- Human Rights Act
- Health & Safety at Work Act 1974
- Management Regs 1999
- Working Time Regs
- Sex Discrimination Act 1975
- Employment Rights Act 1996
- Freedom of Information Act
- Maternity & parental leave Regulations
- Pension schemes
- Common law (Personal Injury Claims)
- Relevant Case Law
Disability Discrimination:
- Who decides? – Employment Tribunal; OH can only offer a tentative opinion
- Definition of disability
- Direct and indirect discrimination
- Conflict with other legislation – H&S and criminal law have precedence
- Reasonable adjustments
- Disability related discrimination
- When does the DDA not apply?
Individual variation:
- Individual assessment
- Risk assessment
- Tolerance of symptoms
- Reasonable adjustments
An Acceptable Risk?
You have to weigh up:
- Cost of sickness absence
- Cost of training vs loss of performance
- Cost of medical support or assessment
- Cost of IHR or injury awards
- Opportunities for redeployment
- Pressure to avoid IHR or reduce sickness absence
What can OH assessment offer? At:
- Recruitment
- Absence
- Rehabilitation after absence
- Health surveillance
- Health promotion
- Retirement
Recruitment
- Know workplace
- Assess job requirements
- Liase with management
- Establish standards
- Review health declarations
- Examine as required
- Advise on disability
- Advise on job adjustments
Sickness Absence
- Early meaningful advice helps; so refer early, rather than late
- Early intervention
- Influence early return (employee, health providers, manager)
- Remove the barriers to resuming work
- Managed rehabilitation
- Focus on ability not disability
- Functional ability assessments
- Adjustment assessments (DDA)
- Identify IHR cases early
- Case Conferences (Attendance Reviews)
- Review patterns
- Consider policies
- Agree parameters
- Assess referrals
- Liaise with GP/specialist
- Submit reports
- Monitor & review
- Case conferences
- Job modification
- Graduated return to work
Rehabilitation after absence
- Assess
- Investigate
- Functional evaluation
- Intervention
- Co-operation
Health Surveillance
- Identify risks
- Education
- Screening
- Modification of exposure
- Monitor & review
- Risks:
- Noise
- Lead
- Ionising radiations
- Asbestos
- Driving
- Diving
- Manual handling
- Heights
- Shifts
- Allergens
Health Promotion may influence attendance at work
- Identify target population
- Identify issues
- Coronary risks / Mental health / Musculoskeletal / Diet
- Screening
- Workplace / Consultations / Courses / Ad hoc
- Education
- Leaflets / Reports / Special campaigns
- Referrals
Retirement
- Know pension regulations
- Company policies
- Criteria
- Assess
- Diagnosis
- Reports from GP/specialist
- Review treatment
- Prognosis
- Advice to management
- Job adjustments
- Monitor & review
- Recommendation
Types of Referrals & Reports
- Referral to Occupational Health
- Referral to Occupational Physician
- Referral to Specialist
- Reports from GPs
- Reports from Specialist
When To Refer
- Sickness and Absence
- Recurrent short spells of absence causing commercial concern
- Prolonged sickness and absence
- Combination of both
- Fitness for Work
- Report After Accident at Work
- Before Job Transfer / Modification / Promotion
- Suspicion that health may be impacting on work performance.
- Suspected Alcohol or Drug Misuse
Referring manager should provide:
- Date when sickness absence commenced
- Attendance record
- Diagnosis on medical certificate (if known)
- Other relevant information, particularly if the employee is unlikely to mention it
- Specific requests
What managers should ask
- Is the employee fit to undertake their current role?
- If the individual were not fit to fulfil their role, would adjusted duties or temporary redeployment apply?
- Is the performance significantly affected by ill health and how long is this likely to continue?
- Is the ill health work-related?
- Likely date of return to work?
- Is the employee likely to render reliable service in the future?
- Is it likely that an employment tribunal would consider that this case falls within the scope of the Disability Discrimination Act and if so what adjustments should be considered?
- If the individual is not fit to return, is ill health retirement appropriate?
What NOT to ask
- What is the precise medical diagnosis? You need to know what he can/can’t do.
- Can we fire this skiver?
- If the individual is not fit to return, is ill health retirement appropriate?
- What treatment is this person on?
- GP says he’s not fit, but we need him to do xyz, can you make him fit?
Reports requested by OH from treating doctors
- Request a medical report on the present condition and further information on:
- Guidance on a diagnosis
- Progress of the current condition
- Any current residual disability
- Ongoing medical review &/or treatment
- Sight of appropriate specialist reports relating to the current condition
- Any further advice that we can give the company, such as a rehabilitation programme
- Likely return to work date
Management Reports
These are advice to the manager on medical capability and should not contain personal medical information. They should give advice/opinion on whether:
- the employee is fit to work in their contractual/current role, in a restricted role (list adjustments required) or is unfit for all work at present (if possible, estimate date for return to work)
- the employee is permanently incapacitated [recommend ill health retirement]
- a rehabilitation programme is recommended (give details)
- the employee needs treatment/review by a physiotherapist/counsellor/specialist
- the company should consider funding this referral or whether the employee should seek referral via his GP
- a medical report was requested from the employee”s GP/Specialist
- the ill health is likely to be work related
- there is/is not an underlying ill health problem that may affect future performance
- the employee has have a disability that is likely to be considered to fall within the scope of the Disability Discrimination Act
- a risk assessment should be undertaken (give details)
- a further review is necessary (when?)
Fit For Work? – Over To You!
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