Occupational Health Service Camden Council Edinburgh Napier Occupational Health Service Attendance Management and the role of Occupational Health Margaret

Occupational Health Service

Camden Council

Edinburgh Napier Occupational Health

Service

Attendance Management and the role of

Occupational Health Margaret Laurie – Regional Operations Manager

Connaught Compliance

Consultancy Division

Aims and Objectives

• Overview of Connaught and Services

• To raise awareness of what Occupational Health is and what it is not.

• To provide information on the function of Occupational health in workplace attendance management.

• To promote collaborative working with Management, HR and Health and Safety to safeguard the health, safety and welfare of employees.

Connaught - within the OH sector

• Leading UK provider of OH services

• Operate in all sectors of industry and commerce

• Wide range of proactive health management strategies– robust management of sickness absence– health surveillance to meet legal/statutory requirements– wellbeing programmes to improve health

• Offer a range of innovative service delivery methods

• Work across multi-site operations

• 72 OH Advisors/225 OH Physicians

• Robust triage system

• Business focussed whilst adhering to medical ethics

• Principal provider of outsourced solutions to HSE

Service Provision for the University

Having taken into account all service requirements, number of activities and timing of activities, the OHS will be delivered in a new highly effective way.

Staffing Levels:

• OH Advisor – 2 days per week on site

• Administrator – equivalent to1 day per week

• OH Physician – 1 x 3-hour session per month

The OH service will be delivered from:

• Existing University facilities

• Remotely using our remote (telephone) case management service/online services

Services to be provided to the University

Scope of services includes:

• Pre-employment health assessments

• Health surveillance

• Management Referral

• Self Referrals

• Vaccinations/immunisations including travel and COSHH

• Occupational Health guidance and support

• Defibrillation Service Provision

• Health & Safety Training and Support

• First Aid Training and Procedures

• Management Review Meetings

• Health Records

• Administration Services

Occupational HealthDoes this sound familiar?• OH do not understand the nature of our work.

• OHS have advised she is fit to return to work but she is clearly still not able to do the job fully, how can she be fit for work?

• OHS have advised light duties, we do not have light duties in our department.

• Sickness absence is a health matter therefore it should be dealt with by OHS.

• I am too busy to deal with attendance management

• The advice given by OHS makes it difficult for me to run my service.

Occupational Health

DEFINITION: Occupational Health is the promotion and maintenance of the highest degree of physical, mental and social well-being of workers in all occupations by preventing departures from health, controlling risks and the adaptation of work to people, and people to their jobs. (ILO/WHO 1950)

© Connaught Compliance Ltd

The Costs of Absence

• An estimated 175million working days lost to sickness absence in 2006.

• Annual costs of sickness absence and worklessness associated with working age ill-health were over £10 billion

Source- NICE Managing long term sickness absence and incapacity for work.

Issued March 2009


Role of OHS in Attendance Management

Advisory.

Opinion on fitness to work of an individual and advice on workplace adjustments.

Provide objective and clear advice & support to employers with regard to managing health at work

Help to promote & maintain healthy lifestyles amongst the workforce


Occupational Health vs GP Roles

• GP and other primary care professionals have a therapeutic role

• Main role is provision of continuing care

• Needs of family and local community taken into account

• GP is patient’s advocate

• Occupational health professionals are required to give an impartial opinion to 3rd parties.

• Main role is to advise on fitness for work & potential for work to cause illness

• Consideration of health and safety of workforce and members of public and needs of employer

• OH professionals have to remain impartial due to nature of role.


Collaborative approach to care

• Both primary care and OH teams promote good health

• Contact and communication between primary care and OH teams can reduce the risk of ill-health leading to long-term absence and unemployment

• Primary care and OH teams have access to different resources all of which are important components of care.


What Occupational Health cannot do

• Eliminate high levels of sickness absence within an organisation.

• Police non-attendance.

• Make business decisions e.g Dismissal

• Provide primary care.


Attendance Management•The manager is the key in

pro-active absence

management.

• OH Services, HR and

Health & Safety provide

support in the decision

making process.

•RTW interviews and OHS

involvement regarded as

effective methods.

•Consistency and action.


When to refer employees to OHS

• Frequent short term absences where the level or pattern meets the trigger points in the Sickness Absence Policy

• Change in performance, behaviour or attendance.

• Refer immediately, absences of 3 days or more in the case of industrial injuries.

• Frequent Medium term absence where the level or pattern meets the trigger points in the Sickness Absence Policy

• Cases of long-term absence (4 weeks or more in one episode)

• For advice on disability –related health problems.

• Referrals MUST be in line with existing policy and procedure to avoid any discrimination claims


Importance of early Referral• Key to getting employees back to work

• Rehabilitation should start on day 1 of absence

• Ensures OHS are able to work with treating physician to assist employee to return to work in a timely way.

• The longer an individual is off work, the less likely they are to return to work. Fewer than 50% of people return to work after absence of more than 6 months.

• Long-term absence is multi-faceted. Sickness absence and incapacity associated with one condition may lead to further complications


Completion of Referral Form• What are your reasons for referring this employee?

• What is the diagnosis on Med Certificate if absent from work?

• Do you have any background information which may be useful to know? Has employee had this condition before? how long ago? Previous sickness absence due to same?

• Include details of the range of duties the employee would be expected to undertake. Outline specific tasks.

• Outline whether any adjustments or modifications to work practice have been made prior to this referral. Were they successful, if not, what further difficulties was the employee experiencing?

• Outline what adjustments, modifications and flexibility you could reasonably support and for how long to facilitate a return to work.

• It is useful to include Sickness Absence history, Risk Assessments and any other relevant information.


Case Scenarios

Please take 5 minutes to provide answers to the following Case Scenarios


• Case 1

Peter is a 35 yr old admin assistant, he has called you this morning to say that following an appointment with his GP he has been signed off work for 2 months with an ‘acute stress reaction’.

You are aware that he has been having some relationship problems and over the last few weeks his work has been affected. During the telephone conversation Peter assures you that there are no problems at work.

How would you handle this absence and why?


• Case 1

Urgent referral to OH, although Peter has not raised any concerns regarding work, his ability to work has certainly been affected.

An early referral to OH is vital in order to commence the rehabilitation programme.

Evidence shows that the best treatment for Depressive/Anxiety conditions is counselling (CBT) +/- drug therapy and progressive normalisation, which includes phasing work into rehab plans.


• Case 2

Emma is a 23 year old secretary who has had over 23 days absence in 15 periods over the last 12 months.

Last month she was referred to OH for an assessment that indicated she had ‘no underlying medical condition that could attribute for the absence’

Emma has since had a further 3 absences in 2 periods.

How would you manage Emma’s case?

Should you refer Emma back to Occupational health and why?


Case 2

• It is often tempting to want to refer back to OHS, but this can prolong progression of the case.

• Follow guidelines laid out in the Employee Support Procedure relating to short-term absenteeism.

• Emma has already had a referral indicating a lack of any medical condition, it would therefore be advisable to manage under the University’s Employee Support Procedure ensuring Best Practice guidance is followed and Emma is given a chance to improve her attendance and appropriate warnings are issued.

• Offer support and assistance to Emma to help her improve her attendance where applicable.


• Case 3

Chris a 38 yr old driver has been reviewed by OH during a long term absence, he is now nearing the end of his sick pay allowance.

OH have advised that Chris may return to work on half days, but will be unable sit for prolonged periods or lift more than 10 kg.

Due to the nature of his role you are unable to accommodate such an adaptation without significant impact on the business.

Chris is demanding he be allowed to return to work as advised by OH.

How would you handle Chris’s demands?


Case 3

• Advice from OH is exactly that - advice

• In this instance they are advising the nature of adaptations to allow Chris to return, if this is unsustainable or impractical you are at liberty to decline to implement them and explain your reasons to Chris.

• It is also however worth considering whether alternative options may be available outside the normal working role to help in the return to work process.

• Any advice in the report is provided to guide managers, it is neither binding nor compulsory. Managers however do need to consider all reasonable options in returning an individual to work which will reduce the overall absence.


• Case 4

Fred is a 40 yr old technician working in the same role for 10 years. Due to organisational changes his role has taken on considerable new responsibilities.

Fred has contacted you to let you know his G.P. has signed him off work for 4 weeks with stress, which he attributes to the changes in his role.

How would you handle this absence?

What are the things you would need to consider as his manager?


Case 4

• It is clear from the limited information given, that Fred hold’s his absence as work related stress.

• An early referral to Occupational Health is vital to determine whether there are any underlying medical conditions that should be considered i.e. history of depression

• It is important not to ‘medicalise’ the issue unnecessarily.

• Stress at work has to be dealt with as a management issue. Whilst OH can provide guidance on underlying issues to consider, a manager should

proactively seek to find resolution with the employee.

• Managers need to identify areas that potentially are highly stressful and an action plan formulated to address issues as practicable.

• Management of the stressors should continue during absence as a proactive route to early return.

• Managers should not be afraid to involve other parties such as HR to discuss stressors as it may be possible that the employee perceives the manager as a stressor


Best practice Cases

Ronald has an uncomplicated MI at age 44 with no obvious risk factors. He is taking a cocktail of drugs, his angiogram and stress test have been satisfactory. He is to attend a coronary rehabilitation program.

Unhelpful practice

He visits his GP who issues him with a sick note for 8 weeks and tells him he should anticipate being off work for 3-4 months in total.


Best practice• Manager contacts him to find out how he is

doing and refers to OHS.

• OHS liaise with coronary rehabilitation unit with Ron’s consent. Both agree that under the right circumstances he could return to his office –based role within the next 4 weeks.

• A phased RTW and reduced hours are negotiated with his manager.


Best practice Cases

Maria works as a cleaner. She has had 2 weeks off with LBP, her GP has seen her initially, excluded serious underlying pathology and advised her positively about remaining active and early return to work. Maria feels much better although still in some pain and would like to return to work. GP signs her back to work.

Unhelpful practice

Within 48 hours Maria returns to her GP. Her Supervisor has said that he is not happy with her returning to duty until she is fully fit. He has asked her to see her GP for another certificate


Best PracticeMaria sees OHS before she returns to work and the department liaise with her Manager to ensure that her return to work is phased and that her role is adapted as necessary.

NOTEBack pain is common (lifetime prevalence of 60-80%)

A lot of people with Back pain can continue with activity until it settles.

There is little difference in pathology between those who stay in work and those who do not. Differences are mainly psychosocial.

RCGP and FOM have produced back pain guidelines that are evidence-based and stress early intervention and RTW improves speed of recovery and outcomes.


Role of OHS in these cases.

1. Assess functional capabilities of individual against requirements of job.

2. Advise on duties the individual will be able to cope with, in order for manager to be able to consider restricted duties.

3. To devise a structured rehabilitation programme which may include

Phased RTW Gradual re-introduction of more manual aspects of

job. Temporary change of shift pattern


In Summary

• Work is generally good for physical and mental health, therapeutic and

an important part of rehabilitation.

• Long periods out of work are harmful for physical and mental health

• Two-thirds of SA, long-term incapacity and IHER are due to

mild/moderate “common health problems” much of this should be

preventable.

• RTW Interviews and involving OHS at an early stage are regarded as

the most effective method of managing sickness absence.

• Common health problems can often be accommodated at work, if

necessary with appropriate adjustments and support

• Planning & supporting RTW are important parts of clinical

management


Documents

Occupational Health Service Camden Council Edinburgh Napier Occupational Health Service Attendance Management and the role of Occupational Health Margaret