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2
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
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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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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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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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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