Hi David

Healthy debate is never wrong and I think many share the frustrations you have expressed.

I generally agree with the principle at looking at people as individuals as some human beings will overcome the obstacles posed by their conditions and make a good go of things and others allow their conditions to overwhelm them and so nothing really works well. I also believe we do need to have a critical perspective on some of the standards that we have so assiduously applied over the years especailly given that in some instances they have been proven to being overly cautious or unnecessary.

In my opinion, if we had a better system that allowed people to try some jobs with a no fault, no compensation approach (Temp work or try before you buy)if this doesn’t work we both walk away (yeah right like's that going to happen) the impact of some conditions on work would be easier to prove.

Driving a car - well lives at risk aren't they and alongside the high frequency of opportunity for the hazard to occur in some conditions is why the DVLA has right on their side. So there are some things that clearly cannot be allowed to proceed.

But for all the rest, the best I can come up with is some practical testing scenarios in line with the real work tasks instead of the paper and theoretical tasks and prove the point one way or another. We undertake a hearing assessment on site for student nurses with hearing problems. It is carried out by the Student practice facilataors and consists of them identifying equipment alarms, taking messages on a phone, copying verbal reports accurately and when they obtain their special stethescopes, they are tested for accuracy on counting baby heart rates. I had one student with hard of hearing issues who told me they didn’t understand that the standards for hearing their friends chatter was different to hearing a baby's fast heart rate!!! So they were passed unfit on the failure of a work based test, the results of which could not be challenged.

If you try you can find good stats to back your opinion for instance. 'On medication the chance of reoccurrence of this epileptic fit is reduced to x% and therefore they do not need to be restricted from ….'

I believe that a lot of the time we get too prescriptive on RtW programmes and not enough on pre-employment when the same criteria virtually applies. I think it would be better if we make it clear to differentiate on the 'absolutely necessary adaptations' from the would be helpful' advice and the consequences of both. By this I mean e.g.

'This person must have xxxx in order to complete the task of the role without which they will not be able to undertake the key components of this role. This is likely (or not) to be considered a reasonable adjustment. Further assistance could be available to them and the organisation under the government's Access to Work Scheme as their condition is also likely to be covered under the Equality Act as a disability. They would also benefit from ……….…. which would enable them to produce more consistent reliable and effective service'

Everyone needs to be comfortable with the wording of their reports but it behooves one to be aware that a small change in wording can give you the way to express yourself decisively enough without thwarting any legislation.

Cheers

and let the debate flourish

Please be advised that all e-mail communication relevant to assisting in the management of the OH process will be printed and entered into the individual's OH file or copied and added as an electronic note on their electronic OH record. This may therefore be disclosed under the Data Protection Act (1998).

From: [log in to unmask] [mailto:[log in to unmask]] On Behalf Of [log in to unmask]
Sent: 27 March 2012 12:41
To: [log in to unmask]
Subject: Re: [OCC-HEALTH] Job Offer subject to satisfactory medical

Hi Susan
my point is:
we are so occupied trying to be politically correct and fear the consequences of our actions, trying not go against Equality Act, be show to discriminate against, and being taken to court or reported to the MNC.
Do we really give a professional opinion any more, do companies get a decision they are paying for and deserve we are SPECIALISTS and we know if a person is fit for a role or NOT but we never say they are NOT FIT.

If you take a car for an MOT and they pass it with worn tyres, excessive emissions and poor brakes and the garage say well its a car it works but not roadworthy up to you if you drive it on the road, however the good news is its OK for a demolition derby would that be valued information when you kill someone if not yourself. Do we say your only a mechanic and that's your opinion? NO They have standards that need to be met just like us and if the car doe's not meet it it fails, just like having a medical with set standards.
Lets get out of cloud cuckoo land and give clients valued opinions, we should not sit on the fence and look like nodding donkey's. We get called by HR and manager's alike at times for saying someone is capable of some kind of role that they have to adapt, and I have heard and been asked from these "what's the point sending them to OH" is it any wonder why new blood and more demand for OH services is unavailable, we are at many sites for statutory requirements and a luxury item than a professional service.

Well that's my soap box stance, can sit back and wait for the bullets.

David Hallam
RN1, OHND, B.Med.Sci(Hons)
Specialist Occupational Health Nurse Practitioner

From: Susan Gorton <[log in to unmask]>
To: [log in to unmask]
Date: 27/03/2012 10:03
Subject: Re: [OCC-HEALTH] Job Offer subject to satisfactory medical
Sent by: [log in to unmask]

I think that it may be wiser to say 'Fit for some work not involving driving a HGV' or they might think you don’t know the DVLA requirements….

We say this a lot with surgeons who don’t provide the correct Dept of health evidence. They are 'fit for any work not involving EPP' (surgery in other words)

Up to them to find them other work, or not as the case may be

Susan Gorton | OH Nurse Manager | Occupational Health Department | Great Ormond Street Hospital NHS Trust | Level 3, Ormond House, 26-27 Boswell St., London WC1N 3JZ |020 7450 9200 Ext 0247 | DD to OHD 020 78138554 | Direct Fax 020 78138355 | Mobile 07833294568

From: [log in to unmask] [mailto:[log in to unmask]] On Behalf Of [log in to unmask]
Sent: 27 March 2012 09:22
To: [log in to unmask]
Subject: Re: [OCC-HEALTH] Job Offer subject to satisfactory medical

I agree Ann,
so Dawn when you get a HGV driver apply for a job with,
uncontrolled hypertension, BMI 38, cataract problems, unstable diabetes and epilepsy, we can say "Fit for role with the following restrictions" should avoid driving any HGV
Now it's up to you HR and Manager.

David Hallam
RN1, OHND, B.Med.Sci(Hons)
Specialist Occupational Health Nurse Practitioner

From: Anna <[log in to unmask]>
To: [log in to unmask]
Date: 23/03/2012 13:58
Subject: Re: [OCC-HEALTH] Job Offer subject to satisfactory medical
Sent by: [log in to unmask]

Hi

I would suggest no. As it not OH role to exclude someone from a job. Our
role is to be one of the advisors who offer opinion on the adjustments that
could be made to enable the individual to do the job to the best of their
ability. It is then up to management and HR to decide if the adjustments are
able to reasonably be put in place. So the term "medically fit" I would
argue does not really suit this and should be changed to "are adjustments
needed or not" and "does the EqA apply".

Anna Harrington
Specialist Community Public Health Nurse (Occupational Health)
www.harringtonenterprises.co.uk
07816212836
----- Original Message -----
From: "Dawn V" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, March 23, 2012 1:40 PM
Subject: [OCC-HEALTH] Job Offer subject to satisfactory medical

Dear Wise and Wisdom,

I have been given a question which is-

Can you offer a job subject to a being cleared as medical fit. In other
words is that legal?

My view was yes as if a person has some health issue that could be
exacerbated or aggravated by the role the would not be fit....

Over to you all for your view. But some evidence to support your answer
would be ideal pretty please on a Friday afternoon.

Tas all

Dawn

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