This document outlines our approach to occupational health services and the role of confidentiality and consent in discussing an employee’s health. It also describes at the end the protocol we will follow to procure and arrange OH.
Introduction
Occupational health seeks to promote and maintain the health and wellbeing of employees and office holders, with the aim of ensuring a positive relationship between our employee's/office holder's work and health. Occupational health (OH) is about how work affects a person’s health and how someone’s health affects their work.
Benefits
We recognise that managing and developing the people with whom we work is just as important as controlling financial and capital resources. We hope that by developing a healthy workplace culture and adopting a systematic approach to OH will give greater confidence to all within the DBF and see the role of OH services to support employees and office holders to remain at work or return to work earlier thus contributing to physical and psychological wellbeing.
There are many benefits to dioceses making proper use of occupational health advisers. These include:
- helping keep clergy and staff in active ministry/work
- supporting clergy and staff back to work after sickness
- providing advice in cases of long-term sickness
- assisting with adjustments where a full- time (stipendiary) role might no longer be applicable
- advising on early interventions in cases of disability
- providing supporting evidence in cases when the capability procedure is being used and there is there is a possibility of retirement.
Our diocesan occupational health scheme will include anyone whose health is likely to be affected by their delivery of ministry or support work and those whose ministry / working life could be affected by ill health. This is likely to include:
- all clergy who are office holders on common tenure (who are subject to the capability procedure);
- all clergy on freehold who have not opted to go onto common tenure (although they are not subject to the capability procedure and cannot be required to undergo a medical examination);
- stipendiary licensed lay workers and stipendiary readers.
- DBF employees
What should OH provision cover?
- a facility for providing clergy with counselling or someone to listen where this is the most suitable option. (Listening Ear will continue to be used for this purpose in the Diocese of Lichfield.)
- a facility for providing the bishop with advice on cases where individual clergy have mental health issues (including anxiety, depression and work-related stress).
- statistics to assist in learning about key health issues which affect clergy and staff where these are available.
- As part of the appointments process, health questionnaires to be utilised after the offer of a post has been made. These will include advice on whether, in order to take account of a medical condition, any reasonable adjustments would need to be made to the tasks to enable the role to be undertaken and sustained without detriment to the health of the person to whom the offer has been made.
- a facility for medical referral of clergy and staff to a local occupational health doctor or nurse, when required by a bishop, archdeacon or other responsible person, to include:-
- clear diagnosis of the individual’s condition;
- prognosis and information on the individual’s likely pattern of recovery;
- signposting suitable local NHS providers when someone is receiving treatment provided by the NHS;
- information on whether the individual would be fit to perform all aspects of their role;
- guidance on rehabilitation, phased returns to work and other adjustments which might be recommended in a GP’s Statement of Fitness for Work;
- guidance and support for bishops in cases where the rehabilitation or return to work period may take place over a longer period of time – for example following surgery, a major illness or accident;
- ongoing guidance through any consequent process following medical advice, including ill health retirement or capability procedure;
- guidance on circumstances where the Equality Act 2010 and other relevant legislation may apply (either where it might directly apply to clergy, or where we may wish to ensure that we are treating clergy in an equivalent way to those covered by such legislation);
- suggestions on reasonable adjustments that it might be appropriate for a parish or diocese to make to assist someone’s recovery or accommodate their condition (this may sometimes involve the parish in additional expenditure).
The DBF is too small to employ its own in-house OH professionals and seeks to outsource OH to a commercial provider as and when needed. This could be an individual sole practitioner or a larger company like Beneden who can deliver multidisciplinary support. We wish to offer high quality OH provision that meets appropriate professional standards with the SEQOHS (Safe, Effective, Quality Occupational Health Service) scheme. We will ensure the provider has:
- nurses and doctors with specialist accreditation (the minimum standard required would be the Diploma in Occupational Health Medicine);
- an evenly-spread network of accredited occupational health nurses and doctors to cover the diocese so that clergy do not have to travel too far;
- access to a network of qualified consultants and specialists (for example orthopaedic, ENT) for provision of assessment and advice (but not treatment);
- to be able to provide suitable stress counselling and support and advice for mental health issues;
- an effective and accountable clinical governance system, with delegated responsibilities between occupational health professionals clearly documented;
- a good reporting system for clients, including the provision of data such as annual referral statistics to enable the identification of trends and patterns relating to health issues;
- a system of monitoring and reviewing the quality of service provided;
- confidentiality and efficiency in storage and management of health records;
- clear and effective guidance in complying with relevant health and safety and disability legislation and best practice;
- an understanding of the Church of England and the implications of office holder status of clergy (information on this will be provided in a letter for those tendering);
- an awareness of the particular types of health risk arising from clergy work activities;
- an awareness of some of the other provision that is available for Church of England clergy, for example from St Luke’s (www.stlukeshealthcare.org.uk) or the Society of Mary and Martha (www.sheldon.uk.com).
Types of occupational health interventions
The Board will consider a range of OH interventions that could include:
- Assessing employees on long-term sick leave, advising on the likely timescale of the absence and promoting an effective return to work.
- Using a ‘biopsychosocial’ approach to recovery from sickness to help recognise the psychological, social and work issues that can act as barriers or facilitators to returning to work.
- Assessing fitness to work regarding ill-health capability dismissal or ill-health retirement.
- Helping employers fulfil their duties under the Equality Act 2010 (including disability, pregnancy and age discrimination).
- Advising on temporary or permanent changes to the work or workplace (‘reasonable adjustments’) to enable someone with a physical or mental health condition or disability to work effectively and safely.
- Carrying out specific assessments to determine fitness for work.
- Introducing programmes to support the wider health and wellbeing of the workforce.
- Advice and counselling to employees.
- Assessing where a person’s work has affected their health and what action should be taken both to support the individual and prevent recurrence in other workers.
Triggers for a referral to a medical practitioner
Medical referrals should be initiated by the archdeacon/bishop or responsible person in the individual’s diocese. It is desirable to identify health problems early so that prompt action can be taken. The archdeacon/bishop or responsible person would receive the advice resulting from a medical consultation once it had been sent to the patient to verify factual information (in accordance with General Medical Council requirements). It is suggested that any of the following could trigger a health referral:
- major surgery
- surgery that has a short-term impact on sight, balance, or physical ability
- an ongoing medical condition (unless the condition is stable or improving)
- continuous sickness of one month or longer
- persistent or repeated short term sickness absence
- where there is a need for advice on reasonable adjustments relating to disability
- concerns by the bishop about someone’s health/mental health/ability to cope.
Confidentiality and consent
Within the DBF, OH professionals will liaise with our HR team but line managers, bishops and archdeacons will be enabled to approach OH to discuss concerns and issues. Any discussions about an individual employee’s health will be restricted to issues relevant to their fitness to work. Managers are being made aware that any conversations they have with OH might be noted in an OH record. It’s inappropriate for managers to have ‘off the record’ discussions about an employee’s health and it’s not the role of OH to find a spurious health reason for a dismissal when the issue should be dealt with by management.
Any formal referrals by a manager of an employee to OH should be made with the individual’s informed consent with open and full disclosure of the reason.
The Board understand that there are both legal and ethical issues on maintaining employee health confidentiality information. Registered healthcare professionals, OH physicians and nurses are required by their regulatory bodies to preserve medical confidentiality and only reveal health information to third parties with the individual’s informed consent. The exception to this is by court order or ‘disclosure in the public interest’ where the individual has refused consent to disclose information and there’s a genuine risk to the safety of others. Examples could include where child abuse is suspected or where an individual ignores explicit medical advice that they are unfit to drive.
An employer or manager will sometimes request OH to assess an employee’s fitness for work and produce a report. An employee must consent to the assessment and also to the sending of the report. However, if the employee refuses consent, then the DBF is entitled to make a management decision without it, which could, of course, be to the detriment of the individual.
Anyone undergoing an OH assessment should be clear about its purpose and what will be reported, for example to the employer or pension scheme. There should be no 'surprises’. As the Faculty of Occupational Medicine advises: ‘The most transparent method of avoiding surprises is to explain the content of the report during a consultation and to offer to show the worker a copy before sending it to the recipient’.
There are occasions where OH or HR require a medical report from an employee’s GP or treating physician (such as a consultant psychiatrist or orthopaedic surgeon). Only relevant information will be requested (not the whole GP/medical record) and again the employee must consent.
Procurement protocol
For clergy
- Area bishop /archdeacon to discuss the need for an OH assessment with the individual and agree what sort of intervention is required and get their consent to begin the procurement process. (The Director of Ministry may also be involved in the case of a curate needing an appointment)
- A member of the area team to contact HR to source an appropriate provider who can fulfil the criteria named above.
- HR to contact the bishop or archdeacon with a suggested provider. They in turn will pass the details of the provider to the clergy
- Consent form to be signed by the clergy directly with the provider, noting any medical records will be held by the provider. Any reports generated by the provider for the diocese will also need consent so that we may retain on clergy blue file / DBF personnel file and pass on to subsequent dioceses / employers if applicable.
For Lay Staff
- As above but line managers rather than bishops and archdeacons to alert HR.
JMJ
September 2022