This is what we put in all our reports – I think I actually found it on this site originally.

 

 

My opinion regarding the Disability Discrimination Act 1995 / 2005 is that it is likely / unlikely to apply. Please note that this is my opinion regarding the DDA, and it is ultimately a legal and not a medical decision as to whether the DDA applies. The tolerance of sickness absence would be a management decision. It is ultimately a managerial and not a medical decision as to whether the adjustments necessary are reasonable and your operational requirements must be balanced against the needs of the employee.

 

 

-----Original Message-----
From: [log in to unmask] [mailto:[log in to unmask]] On Behalf Of N. Rostami
Sent: 16 October 2009 12:48
To: [log in to unmask]
Subject: Re: [OCC-HEALTH] Employee consent for reports - GMC guidance

 

Anne,

 

Thank you for this. How about when the employer asks you to specify which one of the absence reasons is likely to fall under the DDA. This is because they want to under the DDA, give reasonable adjustment in adjusting the absence tolerance levels and although I never make any comments or recommendations on this I have to give them the breakdown of for instance absence due to headache, feeling unwell, viral infection and etc…  

 

 

These are just three examples from my own practice experience. I could list lots more from trans-gender issues to severe mental health disorders.

With regard to diabetes – I encourage those with diabetes to disclose this to their manager, first-aiders etc in view of a hypo at work  which requires urgent first aid treatment. I have never had anyone refuse to do so. Once they have informed their manager of their condition then it is no longer confidential. Someone who has well controlled diabetes may decide not to inform their manager - if they choose not to declare and provided there are no safety implications then that is their business.

What can be revealed to management are the implications eg:

• the individual has a health condition and reveal the implications eg the person must have access to regular meals (could be an issue on night shifts).
• An employee who is newly diagnosed and is treated with insulin may not be fit to undertake extensive business travel to remote areas of the world. Again inform management that the individual has a health condition which currently precludes them from.....  undertaking ABC and  should be reviewed in X weeks.

With regard to HRT – why does the manager need to know that the individual is receiving HRT unless the employee chooses to tell them? If the employee is experiencing side effects from the medication which impacts on work again the employer would only need to know how it affects them in the  workplace.

With regard to an inflammatory  condition prone to flare ups (eg Reiters syndrome as per my last email)– well that is the information that can be given to management , they have an inflammatory condition affecting their joints, this is how it affects them in the workplace and these are the modifications which are required to support them - end of problem. The results of blood tests, the fact they may be experiencing  urogenital problems such as dysuria, vulvovaginitis etc are totally irrelevant to manager in relation to their employees return to work.

Usually it just takes a bit of thought to consider an appropriate response to management which gives the implications of the condition without overstepping boundaries.
Anne  


On 16/10/09 11:45, "N. Rostami" <[log in to unmask]> wrote:

Anne,
 
Your examples are great and to be honest they are exceptional cases, I think Jane’s example about Diabetes or lets say HRT, Depression, Asthma and some inflammatory conditions prone to flare-ups, is where it is difficult to give explanation about how the condition affects employee’s functionality and attendance issues without referring to the  symptoms. So how would you tackle these?
 

From: [log in to unmask] [mailto:[log in to unmask]] On Behalf Of [log in to unmask]
Sent: 16 October 2009 11:26
To: [log in to unmask]
Subject: Re: [OCC-HEALTH] Employee consent for reports - GMC guidance

Hello Jane

You raise some valid points. There professional will sometimes differ in their views and debate is healthy. I totally agree with your first point but would challenge your second. If the receptionist, manager and HR are already aware of a diagnosis via med certification or because the employee has themselves told them then I have no problem including the diagnosis in the report. That information is no longer confidential. If this has not already  been revealed to the employer then diagnosis is irrelevant as are the results of any investigations– but they do need to know the implications of the condition in relation to the person’s functional ability.

Three examples :

1. An individual who has had surgery following bowel cancer, has a stoma in situ and whose job role involves moving and handling loads. On return to work elements of their role may need to be adjusted – but does the employer really need to know that the individual  now has a stoma. All the employer needs to know is that the person has returned to work following surgery and then indicate what modifications are required in order that they can return to work effectively and a time scale for review. Had I been returning to work following the above surgery I would not want my manager nor colleagues to know I now had a stoma. I would be horrified if OH revealed this and my trust in them would be gone and that is not in the interest of any party.

2. A  client had been absent from work for more than 6 months – the diagnoses included on med certs indicated that he had a variety of viral and post viral conditions. When he attended for a management referral the client asked me whether he had to declare the diagnosis of his medical condition. I responded that he was under no obligation to do so but it may not be in his interest to withhold that information as I would be unable to give appropriate advice to management. I confirmed that the manager did not need to know the diagnosis  but would need to be aware of the implications of his condition in relation to work. Client then revealed he had AIDS – I had already guessed that. Management did not need to know that diagnosis, they only needed to know that he had a serious illness, was not currently fit to return to work and was unlikely to be fit to return to his post and that the employee would like to consider retirement on the grounds of ill-health. Manager and employee both happy with that response and he duly  retired.

3. A client has Reiter’s Syndrome an auto-immune condition also known as reactive arthritis. Unless this has been included on a med cert why does the manager need to be informed? The fact the condition affects the joints and eyes is relevant to their return to work– if the manager chose to look it up on the internet they would discover that there can be a sexual transmission to this condition and it is also known as venereal arthritis. Could lead to significant office gossip.

Anne






On 16/10/09 10:27, "JANE COOMBS" <[log in to unmask]> wrote:
I am going to put the cat amongst the pigeons again but really cannot help myself!!  So here goes....
 
Point 1

I know there is guidance from many quarters on confidentiality and the reasons for it but Occ Health it is a slightly different situation than in clinical practice.  OH departments serve two masters - both the employee and employer; OH Doctors (as opposed to nurses/advisers), usually get the more difficult situations to deal with - employees can be in conflict with employers, they may be requesting ill health retirement on weak clinical grounds - how can this be dealt with if the employee witholds consent?  What about situations where the employee is known to have misled the company by having bogus days off - this is fraud?  Many companies now video long term absence cases. Situations that are fraught with complex considerations are dealt with by the OHP.
 
I believe that OH advisers roles are easier to keep to the principles of Access to Medical Reports Act than OH Physicians.  In my team we employ the OHP's for the really complex, high profile and 'likely to go to ligitation' cases.  This new guidance (and it is only guidance) will certainly affect the service they would be able to provide.  Our OHP is on the board of large professional body and has been talking with the GMC about these situations in detail.  Currently we are not changing our practice but may be - depends on the outcome of the lobbying.
 
Point 2

Medical details in reports to management/HR are, in my opinion, totally necessary nowadays (sorry Ann).  To withhold this information in today's climate of enlightenment and education, I believe, can be seen as obstructive and patronising.  There is little point in witholding knowledge that is known by the everyone including the receptionist? What about the diagnosis on the med 3 - how silly do we look if we don't allude to this?  Saying that, I would choose what to say, in conjunction with the employee (patient) and with consent, as how best to help their particular situation. We, in Occ Health, should know our organisations and speak their language - so that we can assist both the employee and employer to negotiate a way through a difficult situation.
 
In order for OHA's to break down the barriers within companies and to become part of the fabric, we need to move away from 'medicalising' situations and become more like mediators.  Gaining the trust of both employees and employers and moving the situation forward in a win/win way.
 
An (shortened version) example of how this proved beneficial was when a member of my team was dealing with a diabetic who could have hypo's and needed sugar pdq.  
She wrote (quite correctly) that there was a medical condition which could result in sudden loss of consciousness if the correct treatment was not administered quickly.  Management were frightened to death of the consequences - after consent from the employee, the diagnosis and situation was revealed and peace was restored.
 
I know what I am suggesting is quite radical but I believe OH needs to change to meet the challenge of extinction.  We cannot afford to marginalise ourselves by taking an unnecessary stance on the subject of confidentiality (lets face, it employees have no idea about our professional code until we go to great lengths to explain it to them) I have seen so many OHA's paint themselves into a corner about this, when a bit of common sense would have sorted it out easily.  Now before you all reach for your keyboards - I readily acknowledge that there are situations when confidentiality is utterly crucial, but these are few and far between, I say lets move with the times.
 
I am going now - please be gentle with me.....!
 
Jane Coombs

Date: Mon, 12 Oct 2009 22:19:09 +0100
From: [log in to unmask]
Subject: Re: [OCC-HEALTH] Employee consent for reports - GMC guidance
To: [log in to unmask]

The requirements of AMRA apply to a report written by a physician responsible for the care of the employee in conjunction with employment or insurance issues. It does not  apply to a report written by a nurse and it could be disputed whether it generally applies to a report written by the OH physician as they are not responsible for the clinical care of the client. Even though AMRA does not apply to reports I have written to Management, I routinely show the report to the client before it is sent. I have nothing to hide and they have the legal right of access to their health records anyway.

I question the view that reports written by an OH physician “tend to contain description of clinical detail”.  Clinical detail included within a response to management is totally inappropriate, no matter who writes that report. Management have no need to know clinical detail. They only need information regarding the implications of the client’s clinical condition in relation to workplace issues; clinical detail is unnecessary.

Anne

On 7/10/09 17:31, "N. Rostami" <[log in to unmask]> wrote:
Kim,
 
AMRA (1988 )does not apply to nurse’s report as their reports should not contain any clinical details and must only deal with the impact of the UMC on the functional capacity of the subject and thus the advice for adjustments. Refer to this document: page 9 , paragraph 3):
 
Holland-Elliot K, Harrison J, East J, Leeser J, Graham-Cumming A, Skidmore A, and Batty L (2007), Guidance for Occupational Physicians on Compliance with the Access to Medical Reports Act, www.facoccmed.ac.uk/library/docs/atmra_may08.pdf <http://www.facoccmed.ac.uk/library/docs/atmra_may08.pdf>

 
Bearing in mind that the OP reports tend to contain some description of the clinical details when for instance justifying a case for IHR, I think that it is good practice to comply with this Act at all times. I am aware that this can cause a lot of logistical issues in terms of the delay in the release of the OH report to the referrer until it is seen by the subject. As per the Act (and when obtaining a GP report)the subject has a choice to peruse the report prior to its release to the employer. The implication for the employer is that they have to arrange to obtain the employee’s written consent. We know that all written correspondence with an employee on long term absence are subject to delay and difficulties. However, in complying with this Act the employer has to discuss fully the reason for the referral to OH with the employee before getting their written consent, rather than just refer the employee to OH without their prior knowledge and the understanding of the reasons.
 
Perhaps, this will be a good reason for why the OH work for the functional assessment/ reasonable adjustments (with no reference to clinical details) will have to  be carried out by an OHA for efficacy of time! Whereas all complex cases and IHR cases will naturally be allocated to OP as the timescale for the receipt of the report may not necessary affect the absence length.
 
This said, it is good practice for the OHA to ask the subject if they would prefer to see the report before it is sent to the manager. It is possible to even read out the report to the subject over the phone to ensure that there are no inconsistencies, nor errors in the e.g. dates of the future interventions and such…

From: [log in to unmask] [mailto:[log in to unmask]] <mailto:[log in to unmask]> On Behalf Of Kim Scaysbrook
Sent: 07 October 2009 12:06
To: [log in to unmask]
Subject: [OCC-HEALTH] Employee consent for reports - GMC guidance


One of our OP's came in today and has been to a seminar on consent. As I understand what he was saying - the GMC have now interpreted OP role as providing care to individuals (even through they don't prescribe etc) and therefore all reports should have employee consent to release before they go to manager/HR etc on a similar basis to that used under AMRA ie they have the right to see the report and withdraw consent for it's release. He is going to discuss this with the other OP's and the Nurse Manager on Friday.



Alan  - have you heard anything about this?


At present, it doesn't seem to have filtered to the NMC for the OH Nurses but I imagine that their will be implications for us as well.



Your thought's appreciated





Kim

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