Insert practitioner name

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Getting the most from the Management OH referral

• Insert practitioner name

• 9 January, 2017

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Purpose of the session

• At the end of the session attendees will
  understand
• The role of O.H. in attendance management
• The steps in the referral process
• What constitutes a good referral
• The format of an outcome summary report
• Steps to take to clarify their understanding of
  a report
• The possible outcomes as a result of a referral
• The factors that influence health
• What constitutes a Disability under the Equality
  Act 2010

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Attendance management
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Attendance management
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Attendance management

• Occupational health practitioners do NOT
  undertake any of the following
• Manage sick absence or performance
• Tell managers what to do
• Predict sick absence or deciding how many days
  should be tolerated
• Disclose medical information that isnt relevant
• Diagnose and treat medical conditions
• Act without informed consent of the patient

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When to refer to Occupational Health?

• Short Term Absence
• Aberdeen City (trigger levels)
• 12 months- 10 days on 3 separate occasions
• 24 months- 15 days on 5 separate occasions
• Aberdeenshire (trigger levels)
• 6 months- 10 days on 3 separate occasions
• 12 months- 16 days on 5 separate occasions

Referral likely to be beneficial Unknown reason or unusual or repeated pattern of absences?
Referral likely to be beneficial Employee progressing through attendance management process and likely to lead to dismissal
Referral unlikely to be beneficial Reason known to manager
Referral unlikely to be beneficial Self-limiting condition where straight forward reasonable adjustments can be made
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When to refer to Occupational Health?

• Medium Term Absence (2-4 weeks)

Referral likely to be beneficial I think it is going to be a long time before Ill be able to come back to work
Referral likely to be beneficial I think I need to come back on light duties
Referral likely to be beneficial Work is making me ill
Referral unlikely to be beneficial Expects to return to work soon, no adjustments or modifications required
Referral unlikely to be beneficial Routine operations, procedures or simple fractures and recovering as expected
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When to refer to Occupational Health?

• Long Term Absence (Continuous absence of at leat
  4 weeks or above)
• No planned return date
• Not recovering as expected
• Multiple factors contributing to absence
• Rehabilitation or return to work plan required
• Restrictions, adjustments or modifications
  required

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What information should be included?
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What information should be included?
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Example Questions

• Sample questions should be specific and not cover
  something already addressed in the report
• Will Mr X be able to undertake specific activity
  (e.g. climbing a flight of steps every hour) on
  his return to work?
• Will Mr. X be able to work shift patterns on
  return?
• Would a change from night work to evening shift
  be more medically suitable for Mr. X?
• Is Mr X medically well enough to attend a
  disciplinary hearing?

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(No Transcript)
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The consultation
Preparing the employee for the consultation
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Expectations at the consultation
At the consultation the practitioner will review

• Client details
• Previous employment history.
• Past medical history
• Lifestyle/hobbies/family social aspects
• Summarise current health problem
• Clarify recent events, treatments, tests,
  referrals
• Assess how ill health affects daily activities
• Assess the client - pain levels, mobility, eye
  contact, mood
• Agree case progression with client and return to
  work time scales, if appropriate
• Discuss and agree rehabilitation programme
• Maintain clients electronic OH records
• Agree report with the client and review dates, if
  necessary

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Structure of the Report (OSR)
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What to do with the Report

• Read it carefully and make sure you fully
  understand the advice
• If you are unsure on any point, telephone the
  author of the report for clarification
• Consult with HR if planning to take action
• Discuss with the employee
• Agree and implement action plan
• Review regularly
• Contact OH for further advice if needed

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Bio-psychosocial model of illness behaviour
Social ICF (WHO 2001) Environment Participation
Psychological Activity Limits Personal Factors
Biological Impairments Body Structures and
Functions
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Outcomes
Barriers to return to work
Biological (Physical effects of condition) Functional limitations caused by condition (may, in reality, be minor)
Psychological (beliefs, disaffection with circumstances) I must limit what I do because my back aches
Psychological (beliefs, disaffection with circumstances) If I go back to work its going to make it worse
Psychological (beliefs, disaffection with circumstances) My managers got it in for me
Psychological (beliefs, disaffection with circumstances) I cant go back until my grievance is resolved
Psychological (beliefs, disaffection with circumstances) Theyve not even phoned me from work
Social (home, work, society factors) My husband cant go back to work hes disabled, I have to do everything for him
Social (home, work, society factors) GPs (largely) dont understand the effect of a 6 month sick note
Social (home, work, society factors) Manager unable to accommodate restrictions
Social (home, work, society factors) Rehabilitation not available at work Hes no good to me until hes fully fit
Social (home, work, society factors) Ive got my disability, and then I find that my daughters pregnant
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Outcomes
Rehabilitation to work
Aim A comprehensive approach for the return of ill/injured employee back into the workplace as soon as they are medically fit to function without harm to themselves or others
Aim To enable and/or support an employee to return to their usual working pattern, whilst incorporating any aspects of job redesign, adaptation or adjustment
Benefits Support to management
Benefits Convey message that employee is valued Promote image of a caring and responsible employer
Benefits Compliance with Health and Safety legislation
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Return to work plans
Aim Return employee back into the workplace as soon as possible without harm to themselves or others
Aim To enable and/or support an employee to return to their usual working pattern, whilst incorporating any aspects of job redesign, adaptation or adjustment
Bio psychosocial factors Build up physical strength and condition
Bio psychosocial factors Build up confidence in mental and physical abilities
Bio psychosocial factors Challenge psychosocial barriers
Bio psychosocial factors Gradual introduction back into workforce
Advantages Earlier return back to full duties
Advantages Positive employee relations
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Equality Act 2010Came into effect 01 October
2010

• Protected Characteristics
• Age
• Disability
• Gender reassignment
• Marriage and civil partnership
• Pregnancy and maternity
• Race
• Religion or belief
• Sex
• Sexual orientation

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Disability - the Equality Act

• Physical or mental impairment
• Long term i.e. has lasted or is likely to last
  for 12 months or more
• Has a substantial effect upon normal day to day
  activities

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OH Advice on Disability

• It is the OH practitioners role to advise the
  employer of
• With this information, the employer is then able
  to make a decision as to whether the condition
  constitutes a disability under the Equality Act.

Whether there is likely/unlikely to be an impairment
If they are not impaired would they be so if they were not on treatment
Whether the impairment has a significant impact on their ability to undertake normal day-to-day activities
The likelihood and severity of a recurrence
what adjustments are appropriate to alleviate the adverse effects of the impairment.
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Limitations of the OH Practitioner

• It is NOT the practitioners role to advise that
• The Equality Act does or does not apply
• Except where specifically classified HIV,
  Multiple Sclerosis and Cancer
• An adjustment is or is not reasonable
• That it may be reasonable to discriminate by not
  making adjustments

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Reasonable Adjustments

• Reasonable adjustments will vary according to the
  situation and the persons particular needs.
  However, things to consider could include
• A phased return to work if someone has been off
  for a long while.
• Part-time or flexible hours if someone is finding
  full-time working difficult.
• Changes to premises, such as installing a ramp,
  improving signs, or moving someones desk nearer
  essential office equipment.
• Provision of additional equipment, such as
  specific computer software or hardware if this is
  relevant to their job.
• Additional support (for example, a part-time
  reader for someone who has a visual impairment to
  help manage the volume of written information
  which they have to get through).
• Reassigning some elements of their job to another
  member of staff or transferring them to another
  role in your organisation.

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When is an adjustment reasonable?

• The following are a number of factors an employer
  may consider
• Effectiveness
• Practicality
• Cost versus employers resources
• Extent of disruption
• Assistance
• In any situation, relevant documentation and
  consultation must take place.

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Questions?