Hi Tracy,
The only extra bit I can add is that if the person has any children at home or caring responsibilities, there could be additional support from the local safeguarding team and the contact should be via social services. We do have a duty
to act if we believe vulnerable others may be at risk from a situation away from work. Saying this, the external agencies you mentioned already – police etc would have started these processes if there was a risk to others from this dreadful situation.
In the past for a similar situation I have written a “to Whom it May Concern” letter for an employee to give to whoever they wish where the effect of a social situation on security of employment was a grave concern but otherwise it
isn’t something I’d get involved with.
There may be other sources of support at work from HR such as from a welfare fund or through other workplace policies. For example it may be that the employee can’t afford to move to alternative accommodation so a salary advance for
a deposit or for temporary accommodation could help?
It sounds as though this chap has had excellent care but is still in a vulnerable position that is outside your control or influence.
Paul
Imperial Health at Work has been accredited as a Safe, Effective, Quality Occupational Health Service www.seqohs.org
-----Original Message-----
From: [log in to unmask] [mailto:[log in to unmask]] On Behalf Of Karen Coomer
Sent: 18 June 2014 10:14
To: [log in to unmask]
Subject: [MAYBE SPAM] Re: [OCC-HEALTH] occupational halth boundaries vs duty of care
Hi Tracy
I think what this case demonstrates is the biopsychosocial approach to OH and the identification of the social issues that are the barriers to this case progressing, as you rightly say an impact assessment on OH involvement is therefore
necessary.
Good discussion!
Karen
-----Original Message-----
From: [log in to unmask]
[mailto:[log in to unmask]] On Behalf Of Huguenel, Tracy
Sent: 18 June 2014 09:31
Subject: Re: [OCC-HEALTH] occupational halth boundaries vs duty of care
Hi Karen and all,
Thank you for your responses. It is a very complex case, and in my 17 years of OH experience is probably the only one that I have considered contacting external agencies in this way.
My client is proactive and has taken all possible steps to resolve their situation, but is facing barriers that I am fully aware I cannot remove.
The responses to this thread have been really helpful, as I needed to 'air' my concerns.
I have also spoken to a contact in employment law to get their perspective on this case, and on whether my employer is likely to be impacted if I decided to put my concerns in writing - which they feel is unlikely.
I think that the answer to this particular dilemma is that the request for further assessment of the clients social issues (which appear horrendous - but I do only have one side of the story) should not come from me - but it doesn't
sit comfortably - I am finding this a bizarre case!
It has so many levels of impact involved for the client - physically, psychosocially, socially - but on a positive note, they are back in work, they have been supported by their manager on a graduated return which initially involved
just getting them through the door for a couple of hours, and they are due to return to full time very soon.
The social issues could potentially undo the progress that has been made so far, which fuels the dilemma to a degree.
I keep coming back to the question I pose to my team - is this a necessary action or a nice to do? - I know the answer I would give them.
Thanks again to everyone for your input.
Tracy
Tracy Huguenel, RGN, SCPHN (OH)
Deputy Head of Occupational Health
01268 524900 Ext 3591 or 3820
Fax 01268 534127
www.basildonandthurrock.nhs.uk
-----Original Message-----
From: [log in to unmask]
[mailto:[log in to unmask]] On Behalf Of Karen Coomer
Sent: 17 June 2014 21:22
Subject: Re: [OCC-HEALTH] occupational halth boundaries vs duty of care
Hi Tracy
I have been following this thread with interest because I have a different view from what seems to be the majority.
I suspect you are considering the following statement from the NMC code of practice; You must act as an advocate for those in your care, helping them to access relevant health and social care, information and support.
I think this comes down to what you consider your scope of practice and therefore how you practice OH - I don't think there is a right or wrong answer. I have at times acted as an advocate for people who are clearly too ill to do it
themselves and contacted outside agencies and helped set up care/action for them. I am fully aware that this is seen by the majority of OH professionals as 'outside the remit' of OH but the times I have done it I have made sure that I have at least tried
to involve as many professionals as possible - In these frugal times primary care is sometimes lacking. I think as others have said you don't want to be drawn into something which creates dependency or expectations that a letter from you will resolve the
issue. The way I have done it in the past is to make it clear to the client what I am prepared to do and what I am not - you need to decide what that is before you commit to any actions and also think through the consequences of the actions you are going to
take. I personally don't see any issue with flagging up your concerns as a professional just make it clear that you have only his/her side of the story but what you do know is that it is affecting work and it is from the perspective of a health professional
in the workplace that you are writing .
Good luck whatever you decide to do
Karen
-----Original Message-----
From: [log in to unmask]
[mailto:[log in to unmask]] On Behalf Of Tracy Huguenel
Sent: 17 June 2014 15:02
Subject: [OCC-HEALTH] occupational halth boundaries vs duty of care
Dear All,
I am dealing with a complex case, the clients social situation is having a detrimental impact on their existing health condition. Police & Local Council - are involved with this case - client informs me that actions taken are ineffective
or too slow, and verbal abuse and damage to their property is on-going. I am considering writing to these external agencies to request their input/ review of the case. Before putting this into action I would appreciate your views on the following:
Duty of care - I am aware that the social situation seems to be escalating, and if I do not at least try to raise awareness, am I failing in my duty of care to my client?
As this is having an impact on functionality in work - client is not sleeping - in part due to fear of further attacks on property, impacting on concentration etc - and I am aware the resolution is outside my remit, is this outside of
the boundaries of OH? - should I leave this with the client, who is already vulnerable, to follow up or - Is it appropriate to write and use a statement along the lines of "Whilst this is not within the remit of Occupational Health to action, I am duty bound
to bring this to your attention in accordance with the Nursing and Midwifery Council Code of Conduct"
I should add that the client is happy to consent for external agencies to be contacted if deemed appropriate.
I look forward to your responses, and am happy to be contacted on or off list.
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