Self certifications and the Fit Note Stress and Depression - - PowerPoint PPT Presentation

Workplace Health Review Dr Munna Roy

Topics

• Integral OH Services
• Absence attributed to sickness
• Self certifications and the ‘Fit Note’
• Stress and Depression
• Individual Stress Risk Assessment (ISRA)
• Absence pending disciplinary action

Topics

• Performance or Illness?
• Equality Act 2010
• Ill health termination of employment
• Conflict of opinion

• Glasgow and Edinburgh City Centre locations
• High ratio of Occupational Physician staffing
• Clinically managed organisation
• Experience across all sectors

About IOH

OH Physicians

• Specialist medical training
• Revalidation
• Ethical framework

• Safe, Effective, Quality OH Service
• Relationships with Workers
• Relationships with Purchasers
• Business Probity
• Information Governance
• Staff and Facilities

What conditions we see

44% 33% 1% 2% 2% 8% 1% 0% 9%

Disease Categories

MH MSK GI Cardiac Resp Neuro Urological Infectious Other

Work Status

37% 63%

Percentage of referrals

In Work Off Sick

• OH Physician Consultations – F2F and Tele-consult
• Pre-placement Medical Assessment
• Vaccination (Hep B and Influenza)
• Advice on workplace health matters
• Health promotion

Integral Services

• www.integraloh.com ‘make a referral’
• Central appointing from Glasgow – 0141 331

4199

• Data Sharing Agreement
• Please provide absence record
• Identify any specific issues

How to access services

• Reports are all bespoke – not standard

template letters

• Care taken with language and tone
• Functional
• Temporal
• Rehab plans and adjustments to consider
• Prognosis
• Uncertainties

What is covered in reports

• OH Physicians request GP or Specialist reports

in a small minority of cases

• …..but sometimes necessary for safe

management

• Termination of employment
• Uncertain treatment plan

Third Party reports

• Depression absence
• ‘work-related stress’
• Absence pending disciplinary action
• Poor performance or illness?
• Ill health termination of employment

Common referrals to OH

Absence in the UK

Characteristics associated with absence

• Not the same as ‘incapacity due to medical illness’
• Where there is ill health it is often not the main

issue

• Manager interventions have a greater effect on

sickness absence levels than medical interventions

Absence attributed to sickness

• Improved monitoring
• Provision of statistics to line management
• Sickness Absence management policies which are

implemented consistently Non-medical interventions which reduce sickness absence

Certifications for absence – Self certificate

• Up to 7 days
• High levels often not due to medical incapacity
• Employee may be applying discretion as to whether to attend
• r not
• Pointing out high absence usually leads to future reductions

Med 3 (Fit Note)

• Removed option saying patient is fit for work
• Added option ‘May be fit for some work taking account of the

following advice’

• Space for comments on the functional effects and tick boxes

for adjustments

What has changed (2)?

• During first six months, new statement can be issued for no

more than 3 months

• Day of assessment, telephone consultation, written reports,

previous assessments all valid to issue the note.

• GP does not have to see patient at the end of the period but

can elect to do so.

Certifications for absence – Med 3

• GP’s are not taking any liability – SSP purposes only
• No ‘signing back’ line
• Vague ‘diagnoses’ are allowed
• ‘Medicalisation’ of non-medical absence

What is the difference between stress and depressive illness? It does really matter.

Definition of stress

• Stress occurs when the perceived

demands placed upon an individual exceed that individuals resources to cope.

• Adverse reaction to pressure
• It is NOT a medical condition (not in ICD-10)

Modern Stress Theory

Stressor

Our appraisal

• f the

stressor

Stress Reaction Coping

Depression is…..

• Common
• Treatable
• ……and commonly not

treated

• Co-morbidities

….a neuropsychiatric condition

What works?

• Talking therapies
• Managed Medication
• Exercise

Most people get better

• Prompt assessment and treatment
• Reduced secondary problems
• Maintain risk controls
• Treatment resistant depression is not

common

• Q. What is the difference between

stress and depressive illness?

• A. Stress does not have a medical

solution, but depression does

The Link

Stressor

Our appraisal

• f the

stressor

Stress Reaction Coping Resolves Mental Illness

Barber v. Somerset County Council (2001)

• Workload increased, 70 hours per week
• ‘autocratic and bullying head teacher’
• In May 1996, 3 week absence due to

“Stress/Depression”

• “all staff are under stress”
• September 1996 – left work never to return
• Employer failed to investigate solutions

Sutherland v. Hatton 2002

• ‘Employers do not need to make searching

enquiries but should not ignore obvious indicators’

• Once foreseeability is established, reasonable

steps must be taken

• Penelope Hatton failed the ‘foreseeability’ test with

the CoA overturning her £90K award for damages.

Managing a Stress Presentation

Your actions should defend against this: “I told the employer I had a stress

• problem. They did nothing about it. I

am now ill because of it.”

Managing a Stress Presentation

• Speak to the employee ASAP
• Is there a simple solution? If not, arrange an

ISRA.

• Is the absence medicalised?
• Decide if you need OH input

Possible Outcomes

• Genuine Medical Illness – Unfit
• Genuine Medical Illness – Fit
• Work Stress present – Individual Stress

Risk Assessment (ISRA) is needed – but Medically Fit

Individual Stress Risk Assessment

• Investigate the claim objectively
• Reasonable steps to be taken to reduce the

risk

Barber vs. Somerset County Council

• Use the Individual Stress Risk Assessment

template

6 Steps to ISRA

• The employee should state what they

perceive as the stressors

• The employee should state what they think

potential solutions could be

• The employer should have an initial meeting

and clarify their understanding of the employee’s stated stressors.

6 Steps to ISRA

• The employer considers what they can or

cannot do about the issues raised i.e. what is reasonable

• A second meeting is convened in which the

employer explains what the final position is

• The employee decides whether they wish to

accept the risks of the role or not – but cannot stay off ‘sick’ as stress is not a medical condition

What if risk cannot be reduced?

• Only reasonable steps need to be taken
• OH advise of the residual stress risk
• If risks cannot be reduced –employee can

choose to accept the risk, employer not liable

Hatton v Sutherland

Hatton vs. Sutherland Court of Appeal Guideline

If the only reasonable and effective way of safeguarding the employee would be to demote or dismiss him, the employer will not be in breach of duty in allowing a willing employee to continue in the job. It has to be for the employee to decide whether or not to carry on in the same employment and take the risk of a breakdown in his health, or whether to leave that employment and look for work elsewhere before he becomes unemployable.

Benefits of ISRA

• Ensures that employees are clear with their

complaints

• Is a good written record of investigating the

allegation

• Advises employees of Residual Risk
• Reaches an ‘end point’

Absence pending disciplinary (1)

• Commonly medicalised scenario
• No doubt distressing
• Conclusion is the way to resolve stressor
• Most people are fit to engage

Absence pending disciplinary (2)

• Understands right from wrong
• Can understand the allegations
• Can at least instruct someone on their behalf
• Can follow the process, even with more time

Absence pending disciplinary (3)

• Written submissions
• Advance notice of questions
• Accompanied
• Neutral venue

Performance vs Illness algorithm

NO Is performance at the minimum standard? Is the shortfall due to illness? NO YES Performance Management Medically unfit until able to meet performance standard

• Wider coverage than the workplace
• Must be a ‘Disabled Person’- old DDA definition
• Must be a disadvantage in the workplace attributable to the

disability

• adjustment must mitigate the disadvantage

Equality Act 2010 – Disability Provisions

• It is for the employer to decide if they are ‘reasonable’
• Should be sustainable – not just during rehabilitation
• More usually around hours and restrictions rather than

equipment and environmental adaptations

• ISRA can identify potential adjustments – only if ‘reasonable’

Equality Act 2010 – Potential Adjustments

Ill health termination of employment (1)

• Most people get better – so shouldn’t be

common

• Usually those that may not get better are

identified early

• Almost all will be covered under the Equality

Act 2010

Ill health termination of employment (2) Criteria

• Person cannot meet the minimum

requirements and

• likely to remain the case…….
• ….for a timescale the employer can no

longer sustain

Conflict of opinion

• GP says ‘unfit’
• OH Physician says ‘Fit’
• GP continues to certify as ‘unfit’
• Employer can rely on its OH Physician advice

‘Conflict of opinion’ case law

• Heathrow Express Operating Co Ltd vs Jenkins

(2007 UKEAT/0818/04)

• First Manchester Ltd v Kennedy

(2005 UKEAT/0818/04)

• Jones v The Post Office

(2001)