Occupational Health Reference Manual Prepared for: Marsh McLennan November 2014

1.

Communication and Contact Details

Our contact details are as follows: Address for Health Management Health Management – City 63 New Broad Street, London EC2M 1JJ Telephone: 0845 504 1000 Fax: 0845 504 1066 www.healthmanltd.com Website:

Hours of Business Monday to Friday 08.30 - 17.30hrs

Health Management Team Dr. Mark Harvey - will be your Chief Medical Officer for: � � �

Strategic advice and support Review of long term sick cases with Income Protection providers Full clinical support is provided to your organisation via our team of Occupational Health Advisors (commonly referred to as CLCM) and our Occupational Health Physicians, alongside Dr Harvey.

Team 5 - will be your Clinical Team Administrators for: � � � �

Independent Medical Assessment – appointment cancellations / rearrangement requests General enquiries in relation to your organisation’s cases (referrals and questionnaires) When further advice is required by the CMO. Contact Details: E-mail - [email protected] Direct Tel – 0845 504 1035 Fax – 0845 504 1066

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2.

Chief Medical Officer Advice and Telephone Support

As part of the Occupational Health Service (OHS), Marsh McLennan Companies is provided with a Chief Medical Officer (CMO) who is responsible for providing advice on medical issues and policy formulation for occupational health issues such as sickness absence and drug abuse. Your CMO is available to discuss, amongst other matters, any current occupational health issues and regulatory compliance and will also provide medical advice in relation to reducing health risks to employees and in particular will look to reduce the risk of employee litigation. HR/Managers may also have particular employee medical issues that need to be dealt with quickly and the telephone support is provided for this purpose. HR / Line Management should call this Support Line to discuss: � � � � �

General occupational health issues in the business Specific employee health concerns When they are developing new policies and procedures Employment Tribunal advice General Health & Safety issues related to the health of employees

Telephone support is available 08.30am – 5.30pm Monday to Friday by calling: 0845 504 1000. Alternatively, you can send queries or ask for advice or clarification of medical issues by email to the dedicated CTA Team who will pass it to the relevant clinician managing your case. How it Works There are always members of the clinical team available in the office to handle your enquiries. If you wish to speak to a particular clinician (perhaps to discuss a case they have been advising you on), and they are not immediately available, we will arrange for them to call you back as soon as possible.

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3.

How to Use the Services:

3.1

Health Assessment Questionnaire Screening

The review of medical information about new entrants ensures that the organisation is meeting its obligations under health and safety and disability legislation. It is important to ensure that prospective employees are not placed in a situation where a pre-existing medical condition could be aggravated by their required work activities within their new job role. Your organisation must be equally vigilant in ensuring that all possible measures are taken to ensure that the health and safety of all employees is not put at risk. Screening provides a documented record which has been evaluated by trained medical personnel of an employee’s health when entering the organisation. This may prove useful if any compensation claims arise as a result of ill-health in the future and also to prevent an employee being put at risk due to their state of health. All prospective employees / night workers of the organisation are required to complete a health assessment / night workers questionnaire. The standard procedure for both questionnaires using the online system is outlined below.

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Health Assessment Questionnaire Flowchart Employee Generated Model

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Medical Confidentiality Medical confidentiality will prevent Health Management from providing you with any clinical details, although details of any recommendations together with restrictions and their time span may be given. In some cases a review after a few months will be recommended, e.g. to monitor absence record. It is important for HR / Line Management to act on recommendations, if the appointment goes ahead.

3.2

Online Management Referral Process

HR / Line Management may request that an employee be assessed by the Occupational Health Service, so that appropriate medical advice can be given to HR / Line Management and the employee. Our clinical team will send you a report giving clear advice, which will cover: �

Fitness to work

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Restrictions or adaptations on employment

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Prognosis on returning to work

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Implications of the Disability legislation

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Appropriate attendance or capability targets

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Likelihood of further absences

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Eligibility for Permanent Health Insurance (PHI) or ill health retirement, if applicable

Recommended triggers for when to use this service There are a number of occasions when your organisation could benefit from referring an employee to us for a medical opinion. The typical events that trigger a referral include: Early Referral 1. Day 1-3: all absence cases, particularly mental health (stress, anxiety, depression) or musculoskeletal cases. 2. An employee has frequent incidences of short-term absence with one or more reported illnesses. 3. An employee has had an accident at work and an accurate clinical record of their injuries is required, including RIDDOR incidents. Please note once verified all RIDDOR cases must be reported by your organisation to the HSE. Long Term Sick Referrals 4. An employee has been, or is likely to be, off sick for longer than 4 weeks or where there is no foreseeable return-to-work date. Other Reasons to Refer

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5. A manager believes that an employee’s health is being affected adversely by his/ her work (e.g. stress, upper limb disorders or back pain). 6. An employee is about to be transferred to another job or is about to be promoted and a medical assessment is required. 7. An employee’s performance at work may be compromised because of ill health. 8. An employee is diagnosed with a critical illness such as psychiatric ill health, cancer or heart disease. 9. An employee is thought to be suffering from alcohol, drug or substance misuse. 10. An employee has notified you that they are concerned about their own ill health, particularly if they believe their health is being affected by work. 11. Advice is required on rehabilitation programmes for sick or disabled employees. 12. You require a report regarding an employee’s fitness to attend a disciplinary or grievance hearing. If you are unsure if a referral is required please contact our Advice Line to discuss the case on 0845 504 1000.

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Management Referral Process Flowchart

*DNA Did Not Attend Appointment

4.

HealthMatters Website

As part of our ongoing commitment to help employers support and encourage the health and wellbeing of their employees, Health Management has developed the HealthMatters employee health and wellbeing website. It is designed to be accessed through your organisation’s intranet or via the web and provides unlimited access for all employees on a wide range of health related issues and topics. Your bespoke website is available to view using the link below: http://www.healthmanltd.com/healthmatters/mmc

The site has five main areas of interest which in turn give access to a series of guidance and briefing notes. The information can be accessed on line or downloaded as PDF files, and covers Healthy Eating, Fitness, Smoking and Drinking, Travel, Well being as well as Health at Work. These are all topics focusing on subjects which are likely to be of interest to your employees. We will update the web site on a regular basis and inform you of the highlights in the form of regular electronic briefings and posters which you may then choose to market to employees as part of an ongoing wellness campaign or simply allow them to review as and when.

We have also included a further section on occupational health which will help your staff understand how their occupational health service works and can help them and their colleagues by providing access to a wide range of services and programmes. Health Management’s clinical team carries out research on publicly available sources of information to support employees’ health, well being and rehabilitation. HealthMatters provides links to a range of preferred and selected websites. This will help your employees to find out more about topics of specific interest to them without having to spend hours looking for “official” or “approved” websites.

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5.

Confidentiality and Medical Ethics

Occupational Health services are subject to a range of statutory restrictions that ensure patient confidentiality and protection of sensitive medical information. We have summarised some of the key points below: Medical reports from us will not include clinical details about diagnosis, treatment or symptoms without the informed consent of an employee. Managers will receive reports from us in relation to the referred employee only in the following areas: � � � � � � � �

Is fitness for work related to an underlying medical condition? Is any ill-health absence worsened or caused by work? When is the likely return to work date? Do any restrictions apply to the employee? What reasonable adjustments could be made to the job, hours of work or work environment, which would help the employee attend and perform well What is the future likely attendance pattern going to be? Is the employee fit for promotion? Is the employee eligible for ill-health retirement benefits/ permanent health insurance when appropriate?

Given the sensitive nature of medical information, the organisation and Health Management must comply with the following provisions: Medical Records All medical records are held by us. These are held centrally, securely and confidentially in accordance with the regulations relating to the Data Protection Act and the Access to Medical Reports Act. Access to clinical data will be restricted to occupational health professionals only. Written Consent Informed written consent of employees is required before access to clinical information may be granted to others, unless disclosure is required by law, or is in the public interest. Health Assessment Questionnaire (HAQ) Medical information provided by prospective employees is confidential and should be forwarded directly to us rather than to the organisation. Management Referrals It is good practice for managers to inform employees, when and why they are referring them to us. There is a space on the Referral Form to confirm that this has occurred. Reports from us will be given in general terms and only in relation to an employee’s fitness for work. Obtaining GP / Specialist Reports This is covered by the Access to Medical Reports Act 1988. employee’s rights is provided on the Consent Form.

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A summary of the

Employee access to Medical Reports Under the Data Protection Act patients have access to their medical records. In most cases this will also include management reports prepared by us. Independent Medical Assessments The examining physician is responsible for obtaining consent from the employee at the time of the medical examination to prepare a report for Health Management.

6.

Employee Rights and Consents

Employees have certain rights under the Access to Medical Reports Act 1988 and the Data Protection Act 1998 which are explained below. This section explains these rights and the consents required by us to obtain and process health related data from an employee or a GP/ Consultant. Data Protection Act 1998 and Access to Information The general information we ask about employees is known as “personal data”. Information about health, medical history and any treatment received is known as “sensitive personal data” and due to the sensitive nature of this data a number of procedures need to be adopted: 1. Informed consent is required in writing to obtain and process any health related information. Before personal and sensitive information can be processed a Consent Form must be completed. A summary of the employee’s rights is provided on the Consent Form (HM40). 2. An employee can ask for a copy of their medical reports, and this may include a copy of the independent medical assessment report, if one has taken place. 3. If an employee wants access to their medical records, the request must be made in writing to Health Management. A security check will be made to verify the identity of the employee seeking the information and a charge may be made for the release of information. 4. If an employee believes their medical records are inaccurate or misleading they can request that the record is corrected or that an amendment is attached to the record. Access to Medical Reports Act 1988 These are the employee’s rights, which should be carefully explained to the employee before they are referred to us and give their written consent to a report being provided to us by their GP/Consultant. An employee can withhold their consent to us having access to any medical report. However, it is in the employee’s best interest to provide consent otherwise a medical opinion may have to be formed on limited information. The employee can see the report before it is sent to us and during the six months after completion of the report, if they wish. If they want to see the report before it is sent to us, we will tell the doctor in writing when the request for the report is made and will Occupational Health Service

notify the employee directly of the date of the request. Management Referral report we issue to you.

This may delay the

We will tell the GP/Consultant that: � �

The report must not be released in under 21 days unless the employee has written that he does not want to see it; or The employee has seen the report, consented to its being supplied (and, if relevant, has attached a statement to it).

If 21 days have passed since the date of the request and the employee wants to see the report before it is sent to us, it is the employee’s responsibility to liaise directly with their GP/ Consultant. The GP/Consultant can make a charge if a copy of the report is required. If the employee changes their mind and wants to see the report after it has been provided to us, the employee has the right to seek access to it from the GP/Specialist at any time up to six months after it was supplied. Exemptions in the Access to Medical Reports Act 1988 The GP/Consultant is not obliged to show the employee any part of the medical report if that disclosure would, in the GP/Consultant’s opinion, be likely to cause serious harm to their physical or mental health. Similarly, if a report reveals information about a person other than the employee, that part of the report will not be disclosed. Where the exemptions apply, the GP/Consultant must inform the employee in writing that access is being denied but that access is still allowed to any part of the report not covered by the exemptions. Difference between the types of information The reason why different access rules apply between a GP/Consultant’s report and our report is because the GP/Consultant’s report relates to medical reports created by those directly responsible for treatment and care. Independent doctors who examine the employee to form an opinion and record it in a report to us are not responsible for treatment and care. However, you should be aware that the information forms part of an occupational health record and the employee has a right to see this under Data protection legislation. Independent Medical Assessment Consent If an employee is asked to attend an independent medical assessment by an occupational physician who is not directly responsible for their care, the purpose of the examination must be explained to the employee. The employee will be asked to sign an IMA Consent Form at the time of the appointment: � To agree to the examination being carried out. � To authorise the examining occupational physician to directly release medical information from the assessment to the OHS and for the OHS to interpret the information to be released to the Manager at the organisation. � To authorise the OHS to release medical information from the assessment to their GP/ Consultant and other medical specialists, if necessary. Occupational Health Service

The GMC guidelines introduced in 2009 Although not law, the guidelines introduced by the General Medical Council (GMC), have been adopted by Health Management as they ensure we always work within best practice protocols. These guidelines now allow employees the option to see their advice report before it is released to the Client (or third party) however it does not give them any rights to request or demand changes to the advice report. Health Management’s protocols allow employees to state their preference to see the report before their employer, at the same time as their employer or not to see it.

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7.

Appendices 8.1 An Employee Guide to “The Independent Medical Assessment” 8.2 Terminology and Acronyms

Occupational Health Service

7.1

A guide to your Independent Medical Assessment (IMA)

What is occupational health? The occupational health service is an independent, confidential health service provided by Health Management Ltd. Your company has a duty to care for your health and safety at work and is committed to developing a healthy workforce. The occupational health service is delivered by a team of health professionals who have training in occupational medicine, the branch of medicine that deals with the relationship between your work and your health. Working to high professional standards, you can expect the team to treat you courteously and with respect for your privacy and dignity. Our aims are to: � � �

Enable the rehabilitation of employees returning to work following ill health. Assist employees to achieve good health by providing health advice and support. Prevent employees from becoming ill as a result of the work they do.

The occupational health team will also work in partnership with you and your employer to resolve issues in the workplace that might have an adverse effect on your health. Together we hope to ensure that your well-being at work is maintained and given the priority it deserves. Will this assessment replace the care I am receiving from my doctor/specialist? No, the OH service is not responsible for your medical care. That continues to be the responsibility of your own GP or Specialist. The OH team may co-ordinate with your GP to ensure continuity of care but they do not replace his/her service. However this will only ever be done with your consent. Your appointment details If you have been referred to the occupational health service, Health Management will arrange an appointment for you to see a doctor close to where you live or work. Sometimes it may be necessary to travel further depending on the availability of appointments in your area. Consultations take between 30 minutes and an hour. Sometimes a little longer if the issues are complex. Your HR or line manager will pass you details of your appointment confirming the date, time, location and name of doctor. Should you require assistance upon arrival at your IMA please inform us prior to the appointment and we will organise the appropriate provision. If you are not sure why you have been referred, please ask your HR/Manager to clarify this. Your HR/Manager will also have additional information regarding confidentiality of your information and your rights which they will share with you.

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Prior to your assessment Health Management may have written to the doctor who is due to see you (an occupational physician or, in some cases, a different type of specialist) to explain the circumstances to your referral and to clarify the questions that the consultation is intended to address it. If you are not happy for this to occur then you should advise your line manager or your HR representative immediately, but this may mean that Health Management is not able to gather the information that they would need in order to advise on your case and in those circumstances your employer would not have the benefit of occupational health advice which is unlikely to be in your best interests. Please note should you not arrive for your appointment we will inform your HR/Line Manager. What information should you take? In order to obtain the best advice from the medical assessment we would recommend where possible you consider taking the following information for the examining doctor: 1.

Details of any current prescription medication from your doctors.

2.

Copies of any relevant health information, such as diabetic glucose monitoring diaries, peak flow diaries for asthmatics, mood diaries for psychological disorders if relevant.

3.

Names of any specialists you are under the care of and details of any forthcoming outpatient appointments or operation dates awaited.

4.

If you have had any recent reports of investigations, blood tests, X rays or scans, it would be very helpful to know if these demonstrated any abnormalities. (you may wish to ask your GP about this).

5.

Details of how long your current medical certificate runs if relevant.

When you arrive Please ensure that you bring your appointment letter to your assessment. Please try to arrive in good time for your assessment. If you are delayed it may not be possible for the doctor to see you that day and another booking may need to be made. This will result in a cancellation fee being incurred by your employer. Your medical assessment The doctor will first ask you to complete a consent form, which asks for your consent to release a medical report about the assessment to Health Management and designated officers within your organisation. Without this, the appointment cannot proceed. The doctor will have received details from Health Management concerning your illness and reasons for the referral. They may well ask you questions about your job role and then they will assess your specific health issues. In many cases, the consultation will include only a relatively short medical assessment and will rarely require a full physical examination.

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Is the assessment confidential? As with all medical professionals, the occupational health team work within strict guidelines regarding medical information and confidentiality. Your explicit consent is required for all the stages identified on the consent form without which an Occupational Health Report cannot be produced to your employers. Your line manager/HR has additional information on this point should you require any clarification What happens next? Following the consultation, a medical report will be sent to Health Management, normally within 5 working days, which will be interpreted by the occupational physicians at Health Management who will have detailed knowledge of your organisation and work practices. The Health Management Occupational Health Doctor will provide a report without unreasonable delay and in a manner which is not biased towards the employee or the employer. He or she will send a report to your HR/Manager, or designated referrer which will answer the questions raised in the referral, and usually contain a brief description of your illness, recommendations about the sort of work for which you are fit and any reasonable adjustments to your duties which are needed on medical grounds. Usually the report will cover questions about the likelihood of you rendering reliable service and attendance to your employer in the future and whether your case can be managed administratively in line with the organisation’s procedures and policies. The examining doctor will summarise his/her conclusions to you at the end of the consultation; and in the case of HML run clinics may write directly to your employer covering the issues above. Should you wish to receive a copy of the management report before Health Management sends it to your employer, please let the examining doctor have your email address so that this can be added to the consent form. If you do not have an email address please advise the examining doctor of your postal address.

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7.2

Terminology and Acronyms

AMRA

CMO

Access to Medical Reports Act. Allows employees to see any report produced by their GP or Specialist before it is sent to us. Chief Medical Officer. You have a nominated CMO who advises you on particular cases, policy and protocol development, risk management and OH procedures.

CTA

Clinical Team Administrator. Your day to day contact with the OH service.

DNA

Did not attend. Failed to cancel or attend arranged appointment.

DSE

Display Screen Equipment. Compliance with this regulation requires an organisation to offer eye tests to all employees who regularly use monitors/screens as part of their everyday work, if requested.

FME

Further Medical Evidence. Where the clinician may seek further clinical assessment or report.

GP / SPECIALIST REPORT

A medical report obtained from either the employee’s GP or Specialist Consultant that will require written consent to obtain and falls under the Access to Medical Records Act.

HAQ

Health Assessment Questionnaire. A pre-placement health assessment questionnaire provided to all new starters.

HASAW

Health and Safety at Work Act. Including Management Responsibilities introduced in ’92.

IMA OHA / OHNA

OHP

Independent Medical Assessment. Carried out by our network of OH Physicians under instruction from the CMO. Occupational Health (Nursing) Advisor. An OHA will carry out pre-employment screening and health surveillance programmes. Occupational Health Physician. We use OHPs from our nationwide network to ensure your employees receive an independent assessment from a physician trained in occupational medicine.

OHS

Occupational Health Service. Provider of occupational health services.

RTWI

Return to Work Interview. Recommended as part of the employees re-introduction or rehabilitation back into the workplace after a period of absence.

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WTD

Working Time Directive. EU legislation that impacts on nightworkers as well as a range of other employee issues.

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