A better way

Local authorities present particular challenges for good occupational
health  provision, in part because of
the wide diversity of staff they employ. Coventry City Council’s occupational
health team drew up protocols to help ensure a consistent and focused approach
to managing health across the organisation, by Angela White

Ensuring that good workplace practices are applied consistently has always
been an area of difficulty within local authorities. Health management is one
such area that presents its own unique problems in this respect.

The process for managing OH within Coventry City Council, as in many
organisations, has evolved since the instigation of the service over 25 years
ago.

Although policies and guidelines had been written, such as a sickness absence
policy, in the main, health management remained undocumented and personnel
officers and departmental managers operated on established custom and practice.
With the usual turnover in staff and decentralisation, there were many grey
areas that resulted in a loss of continuity and some mismatch of expectations
across the organisation. This was having a detrimental effect on the management
of health.

Lack of understanding

Coventry City Council’s occupational health unit interacts with all departments
(see box), and the difficulties they were experiencing became apparent. The
occupational health unit was frequently called upon to resolve the problems
that resulted. Furthermore, managers often made it clear that they did not
fully understand the role of occupational health and anticipated different,
sometimes unrealistic, outcomes from employee referrals.

It was recognised that a lack of specific guidance often left personnel
sections and managers in a difficult and sometimes confrontational position.
This created unnecessary operational tensions that detracted from good health
management.

Problems that repeatedly arose ranged across the occupational health
spectrum, included; pre-employment health clearance, health assessments,
rehabilitation, disability management, ill health retirement, work-related ill
health and health surveillance.

A high proportion of individuals were starting work prior to medical
clearance, for example, with an expectation from personnel and managers that
pre-employment clearance could be obtained at any time, even 12 to 18 months
after employment.

Misunderstandings continually arose with regard to confidentiality, with
some managers and personnel officers convinced that knowing a diagnosis was the
only means of effectively managing that employee’s ill health. There was also
lack of clarity on redeployment and rehabilitation, with departments applying
different criteria to similar situations.

Inappropriate referrals

Incomplete referral forms and inappropriate referrals were often received by
the occupational health unit, complicating the management of cases. These cases
clogged the system and delayed appropriate health assessments.

In many instances, the reasons given for the referral were general, and
specific questions were not being asked. Job descriptions and other pertinent
information were not being attached to employee referrals as a matter of
course. This made the process less constructive, affecting its overall value,
and reducing the usefulness of the information going back to departments.

In addition, referrals were often made to the OH unit with unrealistic
management of regarding what could be achieved. Disappointment was often
expressed that some situations were not instantly resolvable.

Having received a report from the occupational health unit,
managers/personnel officers often showed reluctance to take action, especially
if the outcome was likely to be controversial or difficult, terminating
employment on the grounds of health-related capability, for instance.

Furthermore, employees frequently complained that the reason for the
referral to the occupational health unit had not been explained to them.
Discussions between the employee and the manager/personnel officer, before a
health referral, appeared to be ad hoc, increasing the opportunity for conflict
and misunderstandings.

Introducing protocols

Having recognised the need for a more consistent and focused approach to
managing health within the authority, the occupational health unit developed a
comprehensive set of guidelines outlining the role of managers, personnel
officers and occupational health professionals. These protocols were adopted by
the city council in April 2002, with instructions that all those involved in
the process must operate them.

The protocols give clear guidance to key players in the organisation’s
management of health, with the aim of making the process more transparent,
efficient and effective and they should encourage valuable dialogue between
stakeholders. With effective dialogue comes clarification, which will assist
managers and human resources personnel in applying the advice given by the OH
unit. It will also contribute towards the development of better working
relationships between managers, HR staff and OH professionals, especially in
respect of health-related capability and the management of sickness.

Development

To develop the protocols a working party was set up with key personnel,
including HR and the legal department. Opinion was sought from departmental
managers, personnel officers, employees and trade union representatives. The
draft document then progressed through a full consultation process over a
period of 18 months, including a review by the management board, before
agreement.

The protocols establish an improved process for managing pre-employment
clearance and confidential sickness reporting, with the aim of reducing the
amount of time occupational health professionals spend on administrative tasks.

This enables professional staff to provide a more valuable service, focused
on preventing work-related ill health and reducing sickness absence, both of
which have a financial impact on the city council.

Without such protocols consistency and continuity in the management of
occupational health was lacking.

Not all managers or HR personnel followed the same course of action. One
employee may have been given the opportunity to have a discussion with his or
her manager before being referred to the OHU, for example, and another may not.
Operating with clear and concise protocols not only helps to avoid employer
discrimination which could result in litigation, but also helps to ensure the
fairness and consistency of medical advice.

It was also essential that all those involved in the management of health issues
fully understood and appreciated the restrictions placed on OH professional
staff. The protocols establish the requirement for confidentiality embodied
within the strict professional codes of conduct.

The protocols remain a ‘live’ document, and their effectiveness will be
monitored over the coming months, with changes and improvements being
incorporated as the need arises.

Further reading

1. Handy CB (1985) Understanding Organisations. Middlesex: Penguin.

2. Occupational Health and Organisational Effectiveness. Institute of
Personnel Development.

3. English National Board, Department of Health (1998) Occupational Health
Nursing. Contributing to a Healthier Workplace. Luton: Chiltern Press.

Angela White RGN (Hons) OH is principal occupational health adviser,
Coventry City Council

To obtain a copy of the protocols and the following supporting guidelines,
which have been produced by Coventry City Council’s occupational health unit,
please send a large stamped addressed envelope to: Occupational Health Unit,
Little Park Street, Coventry CV1 2JZ.

– Health Assessment while in Employment Guidelines

– Phased Returns to Work: Guidelines for Managers and Personnel Officers

– Work-Related Ill-Health Conditions: Guidance on the Reporting Procedure

Where any of the documents are to be adopted by your organisation, it is
requested that the source is acknowledged as ‘Coventry City Council’s
Occupational Health Unit’.

Packs are available at a cost of £23.00, which also covers postage and
packing.

The meaning of best value

Local authorities are currently
focused on ‘best value’ and sickness absence management. Best value is a
statutory duty placed on local authorities by the Government, with the aim of
achieving continuous improvement. The most appropriate and efficient use of
services is one of the fundamental requirements of best value, along with
cost-effectiveness and quality. The clearly established guidance embodied in
its health management protocols will help Coventry City Council in this
endeavour. Better management of health at work will remove some of the
ambiguity and conflict that currently besets the process.

Coventry City Council’s OH unit

The unit is managed by the principal occupational health
adviser, supported by three part-time medical officers, four full-time equivalent
occupational health advisers, two health promotion nurses and three
administration/clerical support officers.

The principal OH adviser is also responsible for the provision
of counselling and support and physiotherapy services.

As part of its role, the occupational health unit carries out
pre-employment clearance; employee health assessments; health surveillance and
health protection programmes; departmental audits and training – including
first aid; health education and health promotion.  

The OHU is centrally based in the Civic Centre and provides a
full occupational health service not only to the city council, but also to
Coventry University, further education colleges, Whitefriars Housing Group,
Coventry and Solihul Waste Disposal Company and various other small enterprises
and outsourced areas. Teaching and support staff at primary and secondary
schools are also part of the remit.

Approximately 17,000 staff work for the city council, serving a
population of around 300,000. Services it provides include road maintenance,
street lighting and cleansing; refuse collection, sports and leisure
facilities, including libraries and museums; city planning, and the promotion
of trade and tourism. These services are divided between six departments.
Employees, many of whom interact directly with the public, undertake a wide
range of activities including building and road work, catering, horticulture,
mechanical and electrical repairs, plumbing, carpentry, pest control,
laboratory work, driving, community care and administration.

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