Hi Sarah, I was playing devil's advocate to a degree although I believe you can decline employment to someone who refused to have the immunisations/ screening required by your policy. There may be allowances where someone really can't comply because of health reasons/ pregnancy etc. I suspect there may be similarities between this and pre-employment drug testing - as long as candidates are advised in advance they can self-select if they don't wish to comply as long as there is no breach of anti-discrimination law. Paul Paul D'Arcy Clinical Nurse Leader Occupational Health Imperial College Healthcare NHS Trust 2nd Floor Hammersmith House Hammersmith Hospital Du Cane Road London W12 0HS Tel 020 8383 3063 UK's first Academic Health Science Centre incorporating St Mary's and Hammersmith Hospitals, in partnership with Imperial College London ________________________________ From: [log in to unmask] [mailto:[log in to unmask]] On Behalf Of Ramskill, Sarah Sent: 23 February 2009 11:43 To: [log in to unmask] Subject: Re: [OCC-HEALTH] TB screening at pre employment Hi Paul Am a bit unsure of employment law, but had assumed that as no vaccination was compulsory refusal of employment could not follow. SArah ________________________________ From: [log in to unmask] [mailto:[log in to unmask]] On Behalf Of Darcy, Paul Sent: 23 February 2009 11:20 To: [log in to unmask] Subject: Re: [OCC-HEALTH] TB screening at pre employment Why can't you refuse employment for someone who won't/ can't comply with screening requirements? Paul ________________________________ From: [log in to unmask] [mailto:[log in to unmask]] On Behalf Of Ramskill, Sarah Sent: 23 February 2009 11:14 To: [log in to unmask] Subject: Re: [OCC-HEALTH] TB screening at pre employment No, we can't refuse to employ an individual who refuses vaccination as no vaccination is compulsory however we would advise a risk assessment of where they were going to work etc to assess the risk of exposure. We would also routinely advise of signs symptoms etc. I am aware of the poor effectiveness of the BCG in comparison to other vaccines (I think it was about 75% effective and the immunity wanes after 15 years) but we do follow the DOH guidance laid down for clearance of healthcare workers, particularly those new to NHS settings. ________________________________ From: [log in to unmask] [mailto:[log in to unmask]] On Behalf Of McGrath, Deborah (UK Centre) Sent: 20 February 2009 16:55 To: [log in to unmask] Subject: Re: [OCC-HEALTH] TB screening at pre employment Just a thought... ask are you going to declare someone unfit for work if they refuse to have the mantoux or don't have evidence of BCG? (I would be the one who would refuse based on the medical evidence) The BCG vaccination does not protect against pulmonary TB and to my knowledge research hasn't concluded that how effective the BCG vaccine is or how long the vaccine lasts. Education about close contact, sign and symptom recognition may be more appropriate rather than unnecessary testing! Deborah From: [log in to unmask] [mailto:[log in to unmask]] On Behalf Of Ramskill, Sarah Sent: Friday, February 20, 2009 4:24 PM To: [log in to unmask] Subject: Re: [OCC-HEALTH] TB screening at pre employment I work for a large mental health trust and we Mantoux all new employees prior to passing fit for employment. We've been lucky though and no-one has yet refused one! Regards Sarah Ramskill OHN Mersey Care NHS Trust 0151 471 2451 ________________________________ From: [log in to unmask] [mailto:[log in to unmask]] On Behalf Of Brenda Proud Sent: 20 February 2009 11:02 To: [log in to unmask] Subject: [OCC-HEALTH] TB screening at pre employment Dear All Wonder if any of you can be of help - as you will all be aware the most recent health clearance document for healthcare workers asks that those new to healthcare are screened or can provide evidence of TB immunity at pre employment. If an individual does not have a visible BCG scar or has not provided documentary evidence of prior vaccination or positive skin test - are you carrying our mantoux Skin testing prior to passing fit for employment? I look forward to hearing what others are doing. 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