Insert practitioner name

Getting the most from

the Management

OH referral

19 April 2023

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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 isn’t 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 occasions24 months:- 15 days on 5 separate occasions

Aberdeenshire (trigger levels):6 months:- 10 days on 3 separate occasions12 months:- 16 days on 5 separate occasions

Referral likely to be beneficial

Unknown reason or unusual or repeated pattern of absences?

Employee progressing through attendance management process and likely to lead to dismissal

Referral unlikely to be beneficial

Reason known to manager

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 I’ll be able to come back to work”

“I think I need to come back on light duties”

“Work is making me ill”

Referral unlikely to be beneficial

Expects to return to work soon, no adjustments or modifications required

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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The consultation

Preparing the employee for the consultation

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Expectations at the consultation

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

At the consultation the practitioner will review:

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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)EnvironmentParticipation

Psychological:Activity LimitsPersonal Factors

Biological:ImpairmentsBody 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’

‘If I go back to work it’s going to make it worse’

‘My manager’s got it in for me’

‘I can’t go back until my grievance is resolved’

‘They’ve not even phoned me from work’

Social (home, work, society factors)

‘My husband can’t go back to work – he’s disabled, I have to do everything for him

GPs (largely) don’t understand the effect of a 6 month sick note…

Manager unable to accommodate restrictions

Rehabilitation not available at work “He’s no good to me until he’s fully fit”

‘I’ve got my disability, and then I find that my daughter’s 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

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

Convey message that employee is valued Promote image of a caring and responsible employer

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

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

Build up confidence in mental and physical abilities

Challenge psychosocial barriers

Gradual introduction back into workforce

AdvantagesEarlier return back to full duties

Positive employee relations

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Equality Act 2010

Came 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 practitioner’s 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 practitioner’s role to advise that:

The Equality Act does or does not apply

o 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 person’s 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 someone’s 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 employer’s resources

Extent of disruption

Assistance

In any situation, relevant documentation and consultation must take place.

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Questions?