Recruitment and health screening in the NHS

The NHS may welcome the demise of pre-employment health screening, but the OH facility must still assess employees’ needs. Nic Paton reports.

It’s time-consuming, costs money that could probably be better spent elsewhere and has long been recognised as having the potential to create unnecessary conflict and misunderstanding. Pre-employment health screening (PEHS) within the NHS is not much loved by occupational health practitioners and is unlikely to be much missed.

It’s not yet set in stone that PEHS as we know it within the NHS will disappear but, assuming the Department of Health and NHS Plus accept the recommendations made in an NHS-Plus-commissioned review published in June, OH practitioners can expect significant changes to the current recruitment and health screening regime within the NHS.

Evidence from NHS Plus review

The review was written by Dr Ira Madan, consultant and honorary senior lecturer in occupational medicine at Guy’s and St Thomas’ NHS Foundation Trust and King’s College, London, and Dr Siân Williams, consultant in occupational medicine at the Royal Free Hampstead NHS Trust and clinical director of the Health and Work Development Unit at the Royal College of Physicians in London. Its aim was to assess the purpose of PEHS within the NHS in England and carry out a systematic review of the evidence for its effectiveness.

Its conclusions certainly do not pull any punches. There is very little agreement, it concludes, on why PEHS is done or what it achieves. More often than not, employers and employees tend to see it as one thing – a management or recruitment screening tool – whereas OH professionals see it as a tool to identify individuals who might require adaptations to the workplace.

“There are situations out there where the expectation is that the PEHS process will somehow screen out staff who are going to take more sickness absence than managers would like them to take,” Williams tells Occupational Health.

“What can happen is people simply do not declare health problems that, in fact, could be supported.

“Prospective employees will of course still need to have the opportunity to discuss any issues confidentially with occupational health – any special needs, requirements or modifications and so on – but that is a very different process from PEHS,” Williams says.

The review found little empirical evidence that PEHS was particularly effective at assessing fitness to work, preventing sickness absence or even in identifying individuals who might require adjustments to their work. It concluded: “The paucity of evidence for the effectiveness of PEHS and its high cost, combined with the ethical and legal implications of screening, suggest that the current processes and procedures require revision.”

The end for pre-employment health screening

To some extent the writing has been on the wall for NHS PEHS for some time. First, the Equality Act has now made it illegal (except in a few very restricted circumstances) to carry out PEHS before a job offer has been made although, to be fair, this was something that rarely, if ever, happened within the NHS anyway.

Perhaps more importantly in the context of the NHS and OH, the Department of Health, in its response to the Boorman Review last year, made it clear that: “Pre-employment health screening should be reduced to essential cases only, and undertaken through online questionnaires where possible, to reduce the burden on occupational health staff.”

What’s needed now, Williams argues, is simply clear and consistent national guidance on where, when and in what form PEHS should still take place.

She explains: “Pre-employment health screening should only be for those where there are explicit health critical issues for that job, rather than having individual trusts beavering away. The big message from our review is that PEHS as we know it – universal pre-employment health screening for all staff – can stop.”

For many OH departments that are looking nervously at the financial climate ahead (even given the Government’s assurances of NHS ring-fencing), action on this is unlikely to come soon enough.

“OH departments and trusts are desperate to free some funding to implement the Boorman Review recommendations, and PEHS is something that eats up resources and OH services,” concludes Williams.

Key recommendations

  • The national guidance on PEHS within the NHS should be updated, with the new guidance “sufficiently prescriptive and detailed to ensure consistency in practice between NHS trusts”.
  • Only jobs where there are clear, explicit health criteria should result in PEHS. The screening should assess only the criteria identified as being essential for the job, with those jobs and criteria published by employers in a publicly available document and included within the job description.
  • Each NHS employer must state explicitly, again in a publicly available document, the purpose of any health screening applied to new or transferring employees, and the practical arrangements they have put in place for such screening, both to demonstrate transparency
    and reduce the risk of discouraging disabled applicants.
  • All health screening processes being applied to new employees must comply with legislation, including the Data Protection Act and the Equality Act. This means ensuring sensitive personal information collected is relevant, accurate, proportionate and destroyed when no longer required and that all health screening should take place only after confirmation of an appointment.
  • All jobs should be risk assessed, and specific workplace exposures identified, before being advertised and should be compliant with relevant infection control processes.
  • All new staff should receive an invitation to discuss with the OH department any concerns they may have about their health in relation to the job to ensure they have appropriate support or that adjustment can be made.
  • Where an appointing manager has a specific concern about the health of the new employee, a detailed referral to OH should be made. Managers should always have the right, where there are legitimate concerns about the health of a prospective employee, to seek advice from the OH department.

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