Occupational Health for the multi-disciplinary professional: Keeping up to date with the guidance.

In 2021 the HSE issued guidance to employers on buying cost-effective and competent support from Occupational Health (OH) professionals. This does not yet embrace the wider multi-disciplinary team (MDT) that I have seen emerging over the last 6 years as professional educator for the NHS National Performance Advisory Group, and subsequently being truly embedded in the wake of COVID-19. I am a passionate advocate for the opportunities afforded to us by the skills and approaches exemplified by our MDT colleagues.

I hope that sharing my learnings and experience as an independent practitioner operating as a micro-business, will generate some lively discussions and debates on our professional networking groups about the information and observations that I have shared in this article.

Questions that I find myself regularly contemplating include:

• How do you feel about the pace of change in the OH landscape?
• How do you get early notification of changes that might have an impact on your practice? Do you have a junk email box full of notifications that might contain important news?
• Do you feel confident of your evaluation and recommendations?

While preparing for my  forthcoming course modules, I have reviewed the OH landscape and evidence to update my materials and practical sessions.

New and updated standards relevant to OH

NHS – Self-management programmes should include:

• Structured education;
• Defined relevant outcomes that can be demonstrated and achieved.

NICE – Standard operating policies and procedures (SOPs) can be a challenge for sole practitioners and micro-businesses.

NICE have a published guide to selecting and prioritising quality standards, which I have adapted for my own business as follows:

1 Create a long-list of topics from the published quality standards and accredited guidelines;

2 Review and update existing SOPs for updates based on 1 above;

3 Shortlist to:

• Align with national priorities;
• Impact outcomes for employees and their employers;
• Reduce impact of impairment(s) for occupational health, safety and wellbeing;
• Reduce premature disability and mortality;
• Improve quality of life and work-life balance;

4 Discuss with stakeholders;

5 Communicate feedback versions to stakeholders.

Recent guidance relevant to OH

GOV.UK

A new online employer’s Employee health and disability tool was released by the government last year.

HSE

Code of Practice (COP) on the prevention and control of infections and related guidance on the prevention and control of infections and related guidance

All commissioners and service users of a registered healthcare provider will have access to information and guidance on the standards they should expect. This is particularly relevant to OH services providing health screening and surveillance tests involving equipment.

Effective communication6

ICO

Triage protocols and automated decision-making

Since the advent of the NHS 111 service, this has become a fascinating area of digital health that will be developing organically and rapidly. If you use any automated triage systems, set up an alert to notify you of updates and changes to the ICO’s guidance.

GDPR and consent are common hot-potatoes in discussion threads and I would refer you to the excellent articles that Diana Kloss has compiled on these matters.

NHS

Supported self-management

OH health records need to document encouragement, support and empowerment provided during the consultation to enable employees “to manage their ongoing physical and mental health conditions themselves.”

Discussion

Fitness certificates – Ambiguities that lead to confusion

The term ‘certificate’ can imply confidence that a specific fitness threshold has been met. How many of us have had a frustrated employer on the line about an employee’s health-related problem within the first 6 months of employment? This confusion can be avoided by using the terms ‘statement’ and ‘guidance’ or ‘recommendations’.

Tribunal decisions

Those of you who know me personally will recognise the importance I attach to the  Gallop v Newport City Council when it comes to supporting employers who might have “constructive knowledge” of a disability even though they have no “direct knowledge”.

A recent review of this case⁹, highlighted the importance of employee cooperation with adjustments, and this highlights the importance of delivering supported self-management within OH consultations, to ensure that the individual has sufficient information to understand and manage workplace health risks.

Since 2019, employers have had to consider whether OH reports contain sufficient information and evidence to support any decision that the Equality Act does not apply and, therefore, whether they can rely on the report when deciding that adjustments are not reasonably practicable. The report therefore needs to contain an evaluation of the individual’s ability to self-advocate and recommendations for the support they need to manage workplace risks to their health.

OH consultations – the information that employers now expect

OH outcomes need to closely aligned to those of our Occupational Therapy colleagues and advice should:

• Communicate how the employee’s condition affects them⁴;
• Aspects of daily work activities that they do not currently need support or help with⁴;
• Help the employee “to overcome challenges completing every day work tasks or activities”⁹;
• Provide “a plan of goals and adjustments targeted at achieving a specific set of activities”⁹;
• Give the employee “a renewed sense of purpose”⁹;

Summary

Key features that employers will now be looking for in reports⁴ include:

• Information to help them consider any circumstances which suggest that they may be disabled and need support;
• Advice on talking to the employee about their health condition or disability;

When compiling a report, uppermost in my mind is how I can support and assist employers to meet their legal duty to “consider reasonable adjustments”. Employers can, of course, only consider which adjustments are reasonable if they have received from us clear recommendations from us on the arrangements that are likely to:

1. reduce the impact of work demands or increase capacity to cope with them, and
2. reduce adverse physical forces and demands.

OH reports therefore must contain the following information:

• Identify changes at work:
• Aspects of the job or workplace might need changes⁴;
• Ways of working;
• Work environment;
• Extra help or support;
  • Provide guidance on
  • Any specific communication needs to support the employee and let the conversation develop gradually⁴;
  • Words or vocabulary that the employee understands or prefers to use⁴;
  • The type and frequency of monitoring by the manager to make sure any support is still working⁴.

Finally, with the majority of OH professionals operating as independent practitioners, the new and updated standards and guidance outlined above is invaluable to help us to create robust systems and enable us to inform individuals about the information we are processing and documenting and why, alongside the information we are retaining and offer simple ways for them to access the information and challenge our professional opinion.

References  

1. HSE. (2021). Occupational health – Buying support from occupational health professionals. Retrieved 9 January 2023, from https://www.hse.gov.uk/health-surveillance/occupational-health/buying-support-from-professionals.htm
2. QISMET. (2020). Supporting the self-management sector to achieve excellent quality. Retrieved 9 January 2023, from https://www.qismet.org.uk/qis-2020/
3. NICE. Selecting and prioritising quality standard topics. Retrieved 9 January 2023, from https://www.nice.org.uk/standards-and-indicators/selecting-and-prioritising-quality-standard-topics#review
4. GOV.UK. (2021) Support with employee health and disability Retrieved 9 January 2023, from https://www.support-with-employee-health-and-disability.dwp.gov.uk/is-employee-currently-at-work
5. GOV.UK. (2021) Support with employee health and disability Retrieved 9 January 2023, from https://www.support-with-employee-health-and-disability.dwp.gov.uk/is-employee-currently-at-work
6. DHSC. (2022). Health and Social Care Act 2008: code of practice on the prevention and control of infections and related guidance. Retrieved 9 January 2023, from https://www.gov.uk/government/publications/the-health-and-social-care-act-2008-code-of-practice-on-the-prevention-and-control-of-infections-and-related-guidance/health-and-social-care-act-2008-code-of-practice-on-the-prevention-and-control-of-infections-and-related-guidance
7. Rights related to automated decision-making including profiling. (2023). Retrieved 9 January 2023, from https://ico.org.uk/for-organisations/guide-to-data-protection/guide-to-the-general-data-protection-regulation-gdpr/individual-rights/rights-related-to-automated-decision-making-including-profiling/
8. NHS England (2020). Supported self-management. Retrieved 9 January 2023, from https://www.england.nhs.uk/personalisedcare/social-prescribing/supported-self-management/
9. Gallop v Newport City Council [2013] EWCA Civ. 1583 https://assets.publishing.service.gov.uk/media/618a5142d3bf7f56077ce880/Mr_A_Thomas_-v-_Quad_Recruitment_Ltd___Others_1601506.2019__-_Judgment_with_reasons_..pdf
10. Kelly v Royal Mail Group Ltd UKEAT/0262/18/RN (2019). Retrieved 9 January 2023, from https://www.gov.uk/employment-appeal-tribunal-decisions/mr-r-kelly-v-royal-mail-group-ltd-ukeat-0262-18-rn

BIBLIOGRAPHY

ACAS. (2023). Using occupational health at work. https://www.acas.org.uk/using-occupational-health-at-work

CIPD. (2023). Occupational Health | Factsheets | Retrieved 9 January 2023, from https://www.cipd.co.uk/knowledge/culture/well-being/occupational-health-factsheet#gref

HSE Occupational health – Overview. (2023). Retrieved 9 January 2023, from https://www.hse.gov.uk/health-surveillance/occupational-health/index.htm

ILO. (2023).  International Labour Standards on Occupational Safety and Health . Retrieved 9 January 2023, from https://www.ilo.org/global/standards/subjects-covered-by-international-labour-standards/occupational-safety-and-health/lang–en/index.htm

ISO (2018). Occupational health and safety management systems — Requirements with guidance for use. Retrieved 9 January 2023, from https://www.iso.org/standard/63787.html 

NHSE (2022). Workplace health and safety standards. (2023). Retrieved 9 January 2023, from https://www.nhsemployers.org/publications/workplace-health-and-safety-standards