University of Kent Comprehensive Occupational Health Information and

Guidance to Line Managers on Conducting Management Referrals

The University of Kent employs a small team of Occupational Health (OH) staff to help it fulfil its OH responsibilities for staff. They are located in Keynes College as part of the Safety, Health and Environment Unit. Occupational Health is a specialist branch of medicine and healthcare that focusses on the interaction between an individual’s health and the work he/she does. All OH services in the UK operate systems whereby management can obtain guidance on employees’ health issues. There is a standard format and practice which is used, even though parameters and paperwork vary according to an organisation’s processes.

A. Why do a Management Referral to OH?

  1. The principal trigger for referral is when the manager is concerned that an employee’s health is affecting their ability to do their job as expected
  2. The most common relationship between health and work that triggers a Management Referral is when someone has a long period of absence, frequent occurrences of absence, or a combination of both
  3. The parameters and trigger points which denote that the level of attendance is concerning are laid down in the University’s Managing Sickness Absence Procedure, (Managing Sickness Absence Procedure)and are:
  4. three or more absences in any three-month period
  5. six or more absences in any 12-month period
  6. 14 working days absence in any 12-month period
  7. If the problem is frequent occurrences of absence, there is opportunity to discuss these at Return to Work Interviews, (see Section 9 in the Managing Sickness Absence Procedure). These might occur for weeks or months running up to an eventual referral
  8. The University’s standard paperwork used for Return to Work interviews prompts managers to consider the level of absence and whether a trigger point has been reached. It therefore gives opportunity for managers to discuss with individuals when they are approaching a trigger level and that a Management Referral may be considered if this happens
  9. In respect of frequent occurrences of absence, a Management Referral should not come as a surprise to the person being referred
  10. If the attendance issue is related to total number of days lost, this is also something that can be discussed at Return to Work interviews
  11. However, a trigger level may be reached when an individual suddenly becomes ill and is absent for a prolonged period, longer than 14 days. On this occasion a manager may need to explain the Management Referral process and the reason for referral
  12. A manager should never solely undertake a Management Referral simply because of a trigger level; there should be some connection to why advice on the employee’s health will assist a problem or difficult situation, for example:
  13. The individual is struggling to perform tasks/targets in their job because of poor attendance
  14. The team is suffering because of the impact of an individual’s absence(s)
  15. The individual is clearly unwell and is still coming into work, even though they are clearly struggling to do so. In these circumstances they continue to attend work because of high levels of motivation or because of fear of repercussions, (commonly known as presenteeism)
  16. If team members are concerned for a colleague and bring this to the attention of the manager, with due regard for confidentiality
  17. If a person is to have or has had surgery, temporary adjusted duties may be indicated or required to assist him/her back to work safely. It is always worthwhile considering a Management Referral prior to any planned surgical procedures, if the manager is aware of this, as it can be very useful in planning rehabilitation. It can be reassuring to the individual concerned to realise that their post-surgery needs will be taken into account
  18. An individual presents a Fit Note which indicates that he/she is affected by serious or significant illness which will affect his/her ability to attend work regularly or at all and advice is needed to determine whether cover should be arranged, whether the individual will need adjusted duties on potential return, whether the individual may be considering other options available to them, such as ill-health retirement
  19. All of the above in Point 9 are indicators for a Management Referral to OH even if a trigger point has not been reached

B. What information to include in a Management Referral?

  1. When a manager is completing the Management Referral documentation and having the conversation with the individual about the Management Referral he/she will probably begin to appreciate that this process takes time. IT IS THEREFORE IMPORTANT THAT THE MANAGER KNOWS WHY IT IS BEING DONE AND WHAT IS TO BE GAINED FROM DOING IT
  2. With this in mind, it is best if the manager incorporates as much relevant information as possible. This may mean the inclusion of separate documents in addition to the Management Referral form if this helps, e.g. attendance data; GP Fit Notes
  3. Details of current work situations can be helpful especially if the manager has already made adjustments to try and assist someone
  4. If the Referral is relative to a chronic health issue, whether it is causing absence or not, then it is good to include how long the situation has been in existence. The problem may go back longer than the current manager has been managing the person; if so, impart that information. Referencing relevant details of conversations with the individual about the problem should be considered, especially Return to Work interviews
  5. This information helps inform the OH practitioner who can use it as a framework to discuss with the individual; this is very helpful and should assist in a more meaningful report back to the manager and HR
  6. The manager will need to discuss the Management Referral documentation with the individual before it is sent to OH; the individual needs to sign that he/she is happy to be referred.
  7. NO REFERRALS WILL BE ACCEPTED IN OH WITHOUT THE REFERRAL HAVING BEEN DISCUSSED. Sometimes we are told that the content of the form has been discussed and the individual will sign it when he/she comes to OH. Usually this goes according to plan, however, there have been occasions when the individual has not been happy with what is on the form and the OH interview ceases immediately
  8. Managers can contact OH and HR for advice on what to include on the form, however, verbally giving information which is then not on the form is of limited advantage because it cannot be discussed with the person at the OH interview, (effectively it does not exist)

C. How to do a Management Referral

  1. Guidance is available in the Managing Sickness Absence Procedure (link as above)
  2. The manager should give some time and thought to producing, in his/her own words, a written document with the reasons for the Referral, (see points A&B above). If, as a manager, you find yourself in the position of being unsure about why you are doing the Referral, stop and talk to someone: your manager; your Employee Relations Adviser; OH professional
  3. Once the manager hasworked through the process and understands it, he/she should print off the Management Referral form or complete on line. It will be easier to do once there has been preparation as at (2) above
  4. A meeting should be arranged with the individual to discuss the referral. Enough time for this to be completed without hurry or distress should be factored into both diaries
  5. If the individual is on sick leave the Referral discussion may need to happen by telephone. If this is so, it should be remembered that the form will need to be sent to the individual for signature, he/she will need to send it back to the manager and it will need to be forwarded to OH. This timing should be factored into the preparation

D. What to expect from OH

  1. When the Management Referral form arrives in OH, the OH Technician will organise an appointment for the individual concerned to meet with one of the OH specialist nurse practitioners. If the person has already met with one of the practitioners previously, it is preferable if he/she sees the same person. This is so that old ground does not need to be recovered. This may affect the speed of appointment time
  2. Another factor affecting the timing of the appointment is the level of work passing through OH. It is not uncommon for 3 Management Referrals to arrive daily in OH, especially in persistently busy periods. Every effort is made to ensure that individuals are given appointments as soon as possible
  3. OH do not work to a service level agreement on appointment times but individuals who require appointments through Management and Self Referrals are usually seen within 10 days
  4. GIVEN THE ABOVEIF,AS A MANAGER, THE REFERRAL YOU ARE MAKING IS RELATIVE TO SOMEONE RETURNING TO WORK AFTER PROLONGED ABSENCE WHOM YOU BELIEVE WILL NEED A GRADUATED REHABILITATION BACK TO FULL DUTIES PLEASE REFER BETWEEN 2-4 WEEKS PRIOR TO ANTICIPATED RETURN DATE
  5. The OH practitioner meets with the individual referred and spends quite some time getting a full history of present health issues, past medical history, any factors in his/her life that are causing stress or anxiety either work or non-work related, and information on health habits and social background. All OH practitioners work to the bio-psycho-social model framework; it is not intrusive; it is necessary for a comprehensive assessment
  6. All information discussed is confidential and remains in the individual’s OH file. Some of the content will be eminently relevant to the individual’s health position and their work so the OH practitioner discusses with the person what elements it is necessary or prudent to share with the manager to enable safe working; this is of benefit to the individual as well as the organisation
  7. Relevant and pertinent information will be relayed back to the manager by way of a report. The content will have been fully discussed with the individual so they know what the content will be. The individual will have a chance to see the report prior to it bring sent to the manager, if they wish. The manager should be aware that this may mean a report may not arrive immediately after the person has been seen in OH
  8. Reports will be sent by email and encrypted. The password for the report will be the date of birth of the individual that the report concerns: DDMMYY
  9. The level of clinical information, if any, in the report, will be kept to a minimum. It will always be at a level with which the individual is comfortable
  10. The OH report will endeavour to answer all the questions raised by the manager.
  11. The relevant HR professional is ALWAYS copied in on reports to managers
  12. It may be that the OH practitioner believes that additional medical information is necessary and she/he may ask for the individual’s consent to get a report from his/her GP or consultant. This process is governed by the Access to Medical Reports Act and involves the individual giving signed consent which is sent with a letter from the OH practitioner to the medical practitioner
  13. Medical reports can be notoriously difficult to obtain sometimes. Reports take between 2-24 weeks to obtain; please be aware that some surgeries are very bad at supplying reports
  14. The OH practitioner can decide to keep an individual under review and might continue to meet with that person while he/she rehabilitates back to full duties or to support the person while health problems are ongoing. The manager and HR will receive a report each time the individual is reviewed
  15. Some cases are more complex medically or protracted in terms of resolving. With such cases, the OH specialist nurse may decide to refer the individual to the OH consultant physician. OH specialist consultant support is provided by a contracting doctor who visits the University every 2 weeks for a half day clinic. The doctor’s appointments are managed through OH administration. The OH Manager decides who sees the OH consultant

E. Adjusted Duties

  1. The OH practitioner may recommend that an individual would benefit from working adjusted duties because of health needs. Some examples of this are working reduced hours, avoiding manual handing tasks, or working from home, but there are a wide number of facilitative adjustments that could be recommended
  2. The final decision lies with management as to whether OH recommendations on adjusted duties are reasonable and can be implemented. HR are copied in on all OH reports to management and will discuss the content with management and assist them in the decision making process.
  3. Usually, schools and departments can facilitate adjusted duties, particularly if these are for succinct, short periods of time, e.g. up to three months. This is typical of when someone is returning to work following absence. The aim then is to return someone to full duties
  4. Sometimes health conditions are more complex and recovery is protracted. If any rehabilitation programme sees an individual remaining on adjusted duties for longer than 3 months then a Case Management meeting should be arranged between the individual, the manager, HR and OH; any of the parties concerned can arrange this. The individual may wish to have additional support available from union representation. The purpose of the meeting will be to formulate a plan, taking all needs into account, both that of the individual and the team/department
  5. Some recommendations on adjusted duties are related to chronic health problems and may be permanent in nature. Such recommendations are likely to be made under the scope of the Equality Act. A Case Management meeting for the same purpose as above could well be indicated in response to OH recommendation of permanent adjustments for chronic health problems

F. The Equality Act

1.The official government website gives an overview of the Equality Act as follows:

“The Equality Act 2010 legally protects people from discrimination in the workplace and in wider society.

It replaced previous anti-discrimination laws with a single Act, making the law easier to understand and strengthening protection in some situations. It sets out the different ways in which it’s unlawful to treat someone.”

  1. In respect of medical and health issues, the Equality Act protects those individuals with chronic health problems which are specifically defined as disabilities under the Act; it does this by putting a responsibility on employers to make reasonable adjustments so that such individuals are operating on a level playing field with colleagues who do not have disabilities.
  2. Such adjustments could encompass the following:

o Making adjustments to premises
o Allocating some of the disabled person’s duties to another person
o Transferring him/her to fill an existing vacancy
o Altering his/her hours of work or training
o Assigning him/her to a different place of work or training
o Allowing him/her to be absent during work or training hours for rehabilitation, assessment or treatment
o Giving, or arranging for, training or mentoring (whether for the disabled person or any other person)
o Acquiring or modifying equipment
o Modifying instruction or reference manuals
o Modifying procedures for testing or assessment
o Providing a reader or interpreter
o Providing supervision or other support.

  1. The dictates of the Equality Act are not ABSOLUTE in this regard; employers and managers can assess whether a recommended adjustment is REASONABLE. Small businesses are often unable to facilitate the level of adjustment possible for a larger organisation.
  2. At the University, Schools and Departments are usually able to facilitate recommendations made by OH in respect of adjustments, but this is not always the case. If this is the case, management should arrange a meeting to discuss with the OH professional and their Employee Relations Adviser before a discussion with the affected individual.
  3. Sometimes affected individuals experience exacerbations or “flare-ups” in conditions and require adjustments for a temporary period. As in section E4 above, if this persists beyond 3 months a Case Management meeting should be arranged between all parties to discuss.
  4. It is worth noting that the Equality Act does not suggest that it is a reasonable adjustment for people with disabilities to be permanently paid full time hours when they are actually only able to work part-time because of their condition
  5. There are three medical conditions that are automatically defined as disabilities under the Equality Act:
  6. Cancer
  7. HIV
  8. Multiple Sclerosis

The criteria in respect of reasonable adjustments apply to people affected by these conditions in the same way as others defined as disabled using the Equality Act’s specific criteria

  1. The Equality Act asserts the following criteria to define disability: “A person has a disability for the purposes of the Act if he or she has a physical or mental impairment and the impairment has a substantial and long-term adverse effect on his or her ability to carry out normal day-to-day activities.” The Guidance attached to the Act states that: “It is important not to consider any individual element in isolation”.
  2. It is further worth noting that, under the Act, the associated Guidance states that:

“The definition of disability for the purposes of the Act is a legal definition and it is only adjudicating bodies which can determine whether a person meets that definition.” ‘Adjudicating bodies’ means Employment Tribunals (ETs), Courts of Appeal etc.

  1. This notwithstanding, it is common and acceptable for OH professionals to be asked by employers to comment on whether an individual has a chronic illness that falls under the scope of the Equality Act and ETs accept and expect this in relevant cases.
  2. It is worth being aware that recent ET decisions have asserted that the manager/employer should be able to form an opinion as to the whether a colleague’s health issues constitute a disability because they are in close contact with the person on a daily basis and can see the impact of any ill health. An OH professional meets with an individual for a limited period of time and largely bases his/her conclusion on what is observed at that point of interaction, what the person tells them about the health condition and, possibly, medical information from the individual’s treating physician.

For more information on the Equality Act please follow this link HM Government Office of Disability Issues Guidance on the Equality Act 2010

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