Hi Catherine
I agree with much you have said and don't like the blanket 4 question approach either. As I understand it the Madden research was based on the NHS, as many of us are aware in other industries there are other factors to be considered. 

I have posted this previously but will do so again - In my opinion there is a balance to be had based on the risks of the business. In some industries e.g., food, mental health, it would an intrinsic functional part of the job and a legal requirement to not carry infectious diseases (food industry)  or be able to carry out restraint and hold procedures (mental health) - this is where I add extra questions to the simple question set normally asked and design it for the risks of the business and any regulations they need to comply with - so it is bespoke. I also think that the judgement of the Cheltenham Borough Council v Laird [2009] EWHC 1253 HC case needs to be considered as one of the problems with that case was that too few questions were asked in the pre-employment questionnaire.

Best regards
Karen




-----Original Message-----
From: [log in to unmask] [mailto:[log in to unmask]] On Behalf Of Catherine Tye
Sent: 11 March 2015 09:30
To: [log in to unmask]
Subject: Re: [OCC-HEALTH] Preplacement Health Questionnaire

Dear All,

Interesting discussion so far.......... One of the down sides of JISC is that if only positive answers are ever posted then we can think we are doing things the 'right' way because that is the way the responders are doing it. Also, many of the points mentioned so far are key but may lack detail for less experienced Jiscers to improve/adapt their practice.

I have to say I disagree (and feel strongly about it) with the lone 4 question approach, it is simply a good starting point - all on-employment or possibly pre-employment paper and/or face to face screening and its content whether or not for safety critical work should be down to risk assessment - i.e. what is foreseeable that could go wrong for this employee or their clients/colleagues if they were to become ill from a pre-existing condition, only when this is known and discussed openly between OH and the employee can informed guidance be given to the employee and the employer with consent. Even at a basic level of having a 'bad back' and needing a supportive chair.

It is beneficial for the employer to know about certain health conditions if (usually if active or if they could suddenly become unwell) because we make assumptions about, in this case what a child care worker's role involves in a nursery (although this may be reduced by the 'hazard' tick-box approach - but this can make us complacent - you need to know the working environment and the 'actual' not assumed realities of that applicants job role). 

The employer can then complete a risk assessment i.e. complete their bit and agree any adjustments and make clear their expectations of the employee if their condition is to change - this is what the Equality Act requires. I would expect the customer to be able to complete this and provide the risk assessment and information back to OH for review and comments. This is very reassuring for the employer and in my opinion part of the OH role.

This type of screening most of the time is a tick box approach for OH and I would invite jiscers to reflect as to whether that is good enough and whether in providing this service your questionnaires and process add enough value. I think we risk putting both the employer and the employee, and our own professional reputation at risk if we only have a one-size fits all.

As usual there are no 'right or wrong' approaches, no set way - basically you can ask pertinent questions if you have a good reason for asking them - in this case you do - these staff are working with vulnerable children - they may be lone working, driving cars or minibuses, working with children with disabilities who may or may not have road sense or challenging behaviours, take children swimming etc.

From a legal perspective it is the 'pre-employment' bit which is generally not allowed i.e. you cannot ask before a job offer is made and under data protection then it is about asking 'pertinent questions'.

The format of the 4 key questions came from the work done by Madden in the NHS and one of the benefits was that it aimed at reducing unnecessary and costly (time and money) and reduced delays for recruitment when NHS staff are moving jobs (which is very frequent for certain groups of staff) such as doctors rotation. They viewed that OH and admin time could be better spent elsewhere. However, some of this was probably due to a lack of electronic systems which are now more common and prevent applicants information from having missing parts. Have a read you can download the report in pdf:- 

Google - ira madden williams research nhs at work pre-employment

Many providers use the basic 4 questions plus additional for certain hazard groups in this case I would suggest a question set aimed at meeting the needs of vulnerable clients. The care setting plus DWP drive for people applying for jobs means that I see more applicants who are very vulnerable themselves.

Why do I feel so strongly about this? It helps the employer manage their staff and prevent problems before they happen - in the last 3 years:

- 2 x electricians with colour deficiency - one of whom said 'I can tell the colours of the balls on a snooker table by the number of reds) - GULP!! - one didn't know as he had never had an eyetest (not all opticians actually test..... sigh) the other 'knew but did not think it a problem' so didn't put it on the form (which I have to admit was worded too generally so allowed him to be vague).

Colour vision deficiency is not covered by the Equality Act. In good OH/HR practice, this is where the 'may be fit/suitable for role' - it is for the Company to decided whether they are willing to take on this risk based on advice from HR & OH with management and safety, based on a robust risk assessment of their site, plant, his specific role - think about what it looks like inside a machine that is 20yrs old, is oily and dirty and has broken down at 0200 - even those with normal colour vision will struggle with shades of colour of old, faded wiring, in dim lighting covered in grease and dirt .....

- 2x 18 yr old electrical apprentices who had successfully finished a 2-year courses (think new, shiny wiring in good lighting under no pressure) and were about to start jobs with big companies. (Not all colleges require an eyetest before starting studies, sigh - neither had had an eyetest for years). Both could do some Ishihara but failed the City vision test (checked and interpreted by an optician)

- epileptic - not a problem in itself - who had succeeded in getting a support worker role with vulnerable people (learning dis) - turns out on discussion that she was unstable and the DWP had formally assessed her husband as 'her carer'. GULP! - The company completed a risk assessment with her and it was the role and location-specific risk assessment process involving HR, manager, safety and OH that deemed there were no adjustments that they could make to ensure her safety and that of her clients. They also identified that this applied to their other sites. So her job offer was rescinded but she had met her benefit responsibilities under DWP rules.

- diabetic FLT driver - not a problem in itself - however, the OHA didn't phone him when he put IDDM on his form. 3 months in he had a near miss and a management referral was made - turns out his control wasn't as good as it should have been, partly, because his employer didn't know and he was struggling in his allotted break to rest, go to toilet, eat, keep hydrated, check BM and administer insulin. This could have been prevented - a risk assessment was completed, longer breaks agreed, secure and suitable insulin location provided, expectations set to carry food on his person and at strategic locations, wear medic-alert at work, supervisor and first aiders informed (with consent) and reminded what to do in event of being unwell and when to dial 999, employee to provide copy of his 3 monthly blood monitoring result to OH for average BM to review overall control. 

That is how on-employment health screening could work, a win-win all round ... there is too much risk-averse behaviour in OH focusing on unnecessary worry about the Equality Act - this screening should enable employers/people to work more safely and with confidence not the other way round. I believe it was one of the aims of Madden's work but the message got lost somewhere.....

Anyway that is my view, hope it helps, have a good day!
Catherine

Catherine Tye RN SPOH PgDipOSH
Health, Safety and Wellbeing Practitioner

Harmony Health and Wellbeing Limited | mobile: 07730 985926 

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