Workplace Health Review Dr Munna Roy
Topics • Integral OH Services • Absence attributed to sickness • Self certifications and the ‘Fit Note’ • Stress and Depression • Individual Stress Risk Assessment (ISRA) • Absence pending disciplinary action
Topics • Performance or Illness? • Equality Act 2010 • Ill health termination of employment • Conflict of opinion
About IOH • Glasgow and Edinburgh City Centre locations • High ratio of Occupational Physician staffing • Clinically managed organisation • Experience across all sectors
OH Physicians • Specialist medical training • Revalidation • Ethical framework
• S afe, E ffective, Q uality OH S ervice o Relationships with Workers o Relationships with Purchasers o Business Probity o Information Governance o Staff and Facilities
What conditions we see Disease Categories MH MSK GI Cardiac Resp Neuro Urological Infectious Other 1% 0% 9% 8% 2% 2% 44% 1% 33%
Work Status Percentage of referrals 37% 63% In Work Off Sick
Integral Services • OH Physician Consultations – F2F and Tele-consult • Pre-placement Medical Assessment • Vaccination (Hep B and Influenza) • Advice on workplace health matters • Health promotion
How to access services • www.integraloh.com ‘make a referral’ • Central appointing from Glasgow – 0141 331 4199 • Data Sharing Agreement • Please provide absence record • Identify any specific issues
What is covered in reports • Reports are all bespoke – not standard template letters • Care taken with language and tone • Functional • Temporal • Rehab plans and adjustments to consider • Prognosis • Uncertainties
Third Party reports • OH Physicians request GP or Specialist reports in a small minority of cases • …..but sometimes necessary for safe management - Termination of employment - Uncertain treatment plan
Common referrals to OH • Depression absence • ‘work - related stress’ • Absence pending disciplinary action • Poor performance or illness? • Ill health termination of employment
Absence in the UK
Characteristics associated with absence
Absence attributed to sickness • Not the same as ‘incapacity due to medical illness’ • Where there is ill health it is often not the main issue • Manager interventions have a greater effect on sickness absence levels than medical interventions
Non-medical interventions which reduce sickness absence • Improved monitoring • Provision of statistics to line management • Sickness Absence management policies which are implemented consistently
Certifications for absence – Self certificate • Up to 7 days • High levels often not due to medical incapacity • Employee may be applying discretion as to whether to attend or not • Pointing out high absence usually leads to future reductions
Med 3 (Fit Note) • Removed option saying patient is fit for work • Added option ‘May be fit for some work taking account of the following advice’ • Space for comments on the functional effects and tick boxes for adjustments
What has changed (2)? • During first six months, new statement can be issued for no more than 3 months • Day of assessment, telephone consultation, written reports, previous assessments all valid to issue the note. • GP does not have to see patient at the end of the period but can elect to do so.
Certifications for absence – Med 3 • GP’s are not taking any liability – SSP purposes only • No ‘signing back’ line • Vague ‘diagnoses’ are allowed • ‘Medicalisation’ of non -medical absence
What is the difference between stress and depressive illness? It does really matter.
Definition of stress • Stress occurs when the perceived demands placed upon an individual exceed that individuals resources to cope. • Adverse reaction to pressure • It is NOT a medical condition (not in ICD-10)
Modern Stress Theory Stress Reaction Our appraisal Stressor of the stressor Coping
Depression is….. • Common • Treatable • ……and commonly not treated • Co-morbidities
….a neuropsychiatric condition
What works? • Talking therapies • Managed Medication • Exercise
Most people get better • Prompt assessment and treatment • Reduced secondary problems • Maintain risk controls • Treatment resistant depression is not common
Q. What is the difference between stress and depressive illness? A. Stress does not have a medical solution, but depression does
The Link Mental Illness Stress Reaction Our appraisal Resolves Stressor of the stressor Coping
Barber v. Somerset County Council (2001) • Workload increased, 70 hours per week • ‘autocratic and bullying head teacher’ • In May 1996, 3 week absence due to “Stress/Depression” • “all staff are under stress” • September 1996 – left work never to return • Employer failed to investigate solutions
Sutherland v. Hatton 2002 • ‘Employers do not need to make searching enquiries but should not ignore obvious indicators’ • Once foreseeability is established, reasonable steps must be taken • Penelope Hatton failed the ‘foreseeability’ test with the CoA overturning her £90K award for damages.
Managing a Stress Presentation Your actions should defend against this: “I told the employer I had a stress problem. They did nothing about it. I am now ill because of it.”
Managing a Stress Presentation • Speak to the employee ASAP • Is there a simple solution? If not, arrange an ISRA. • Is the absence medicalised? • Decide if you need OH input
Possible Outcomes • Genuine Medical Illness – Unfit • Genuine Medical Illness – Fit • Work Stress present – Individual Stress Risk Assessment (ISRA) is needed – but Medically Fit
Individual Stress Risk Assessment • Investigate the claim objectively • Reasonable steps to be taken to reduce the risk Barber vs. Somerset County Council • Use the Individual Stress Risk Assessment template
6 Steps to ISRA • The employee should state what they perceive as the stressors • The employee should state what they think potential solutions could be • The employer should have an initial meeting and clarify their understanding of the employee’s stated stressors.
6 Steps to ISRA • The employer considers what they can or cannot do about the issues raised i.e. what is reasonable • A second meeting is convened in which the employer explains what the final position is • The employee decides whether they wish to accept the risks of the role or not – but cannot stay off ‘sick’ as stress is not a medical condition
What if risk cannot be reduced? • Only reasonable steps need to be taken • OH advise of the residual stress risk • If risks cannot be reduced – employee can choose to accept the risk, employer not liable Hatton v Sutherland
Hatton vs. Sutherland Court of Appeal Guideline If the only reasonable and effective way of safeguarding the employee would be to demote or dismiss him, the employer will not be in breach of duty in allowing a willing employee to continue in the job. It has to be for the employee to decide whether or not to carry on in the same employment and take the risk of a breakdown in his health, or whether to leave that employment and look for work elsewhere before he becomes unemployable.
Benefits of ISRA • Ensures that employees are clear with their complaints • Is a good written record of investigating the allegation • Advises employees of Residual Risk • Reaches an ‘end point’
Absence pending disciplinary (1) • Commonly medicalised scenario • No doubt distressing • Conclusion is the way to resolve stressor • Most people are fit to engage
Absence pending disciplinary (2) • Understands right from wrong • Can understand the allegations • Can at least instruct someone on their behalf • Can follow the process, even with more time
Absence pending disciplinary (3) • Written submissions • Advance notice of questions • Accompanied • Neutral venue
Performance vs Illness algorithm Is performance at the minimum standard? NO Is the shortfall due to NO YES illness? Medically unfit until Performance able to meet Management performance standard
Equality Act 2010 – Disability Provisions • Wider coverage than the workplace • Must be a ‘Disabled Person’ - old DDA definition • Must be a disadvantage in the workplace attributable to the disability • adjustment must mitigate the disadvantage
Equality Act 2010 – Potential Adjustments • It is for the employer to decide if they are ‘reasonable’ • Should be sustainable – not just during rehabilitation • More usually around hours and restrictions rather than equipment and environmental adaptations • ISRA can identify potential adjustments – only if ‘reasonable’
Ill health termination of employment (1) • Most people get better – so shouldn’t be common • Usually those that may not get better are identified early • Almost all will be covered under the Equality Act 2010 •
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