Local authorities present particular challenges for good occupationalhealth provision, in part because ofthe wide diversity of staff they employ. Coventry City Council’s occupationalhealth team drew up protocols to help ensure a consistent and focused approachto managing health across the organisation, by Angela White Ensuring that good workplace practices are applied consistently has alwaysbeen an area of difficulty within local authorities. Health management is onesuch area that presents its own unique problems in this respect. The process for managing OH within Coventry City Council, as in manyorganisations, has evolved since the instigation of the service over 25 yearsago. Although policies and guidelines had been written, such as a sickness absencepolicy, in the main, health management remained undocumented and personnelofficers and departmental managers operated on established custom and practice.With the usual turnover in staff and decentralisation, there were many greyareas that resulted in a loss of continuity and some mismatch of expectationsacross the organisation. This was having a detrimental effect on the managementof 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. Theoccupational health unit was frequently called upon to resolve the problemsthat resulted. Furthermore, managers often made it clear that they did notfully 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 personnelsections and managers in a difficult and sometimes confrontational position.This created unnecessary operational tensions that detracted from good healthmanagement. Problems that repeatedly arose ranged across the occupational healthspectrum, included; pre-employment health clearance, health assessments,rehabilitation, disability management, ill health retirement, work-related illhealth and health surveillance. A high proportion of individuals were starting work prior to medicalclearance, for example, with an expectation from personnel and managers thatpre-employment clearance could be obtained at any time, even 12 to 18 monthsafter employment. Misunderstandings continually arose with regard to confidentiality, withsome managers and personnel officers convinced that knowing a diagnosis was theonly means of effectively managing that employee’s ill health. There was alsolack of clarity on redeployment and rehabilitation, with departments applyingdifferent criteria to similar situations. Inappropriate referrals Incomplete referral forms and inappropriate referrals were often received bythe occupational health unit, complicating the management of cases. These casesclogged the system and delayed appropriate health assessments. In many instances, the reasons given for the referral were general, andspecific questions were not being asked. Job descriptions and other pertinentinformation were not being attached to employee referrals as a matter ofcourse. 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 unrealisticmanagement of regarding what could be achieved. Disappointment was oftenexpressed 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, especiallyif the outcome was likely to be controversial or difficult, terminatingemployment on the grounds of health-related capability, for instance. Furthermore, employees frequently complained that the reason for thereferral to the occupational health unit had not been explained to them.Discussions between the employee and the manager/personnel officer, before ahealth referral, appeared to be ad hoc, increasing the opportunity for conflictand misunderstandings. Introducing protocols Having recognised the need for a more consistent and focused approach tomanaging health within the authority, the occupational health unit developed acomprehensive set of guidelines outlining the role of managers, personnelofficers and occupational health professionals. These protocols were adopted bythe city council in April 2002, with instructions that all those involved inthe process must operate them. The protocols give clear guidance to key players in the organisation’smanagement of health, with the aim of making the process more transparent,efficient and effective and they should encourage valuable dialogue betweenstakeholders. With effective dialogue comes clarification, which will assistmanagers and human resources personnel in applying the advice given by the OHunit. It will also contribute towards the development of better workingrelationships between managers, HR staff and OH professionals, especially inrespect 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 departmentalmanagers, personnel officers, employees and trade union representatives. Thedraft document then progressed through a full consultation process over aperiod of 18 months, including a review by the management board, beforeagreement. The protocols establish an improved process for managing pre-employmentclearance and confidential sickness reporting, with the aim of reducing theamount of time occupational health professionals spend on administrative tasks.This enables professional staff to provide a more valuable service, focusedon preventing work-related ill health and reducing sickness absence, both ofwhich have a financial impact on the city council. Without such protocols consistency and continuity in the management ofoccupational health was lacking. Not all managers or HR personnel followed the same course of action. Oneemployee may have been given the opportunity to have a discussion with his orher manager before being referred to the OHU, for example, and another may not.Operating with clear and concise protocols not only helps to avoid employerdiscrimination which could result in litigation, but also helps to ensure thefairness and consistency of medical advice. It was also essential that all those involved in the management of health issuesfully understood and appreciated the restrictions placed on OH professionalstaff. The protocols establish the requirement for confidentiality embodiedwithin the strict professional codes of conduct. The protocols remain a ‘live’ document, and their effectiveness will bemonitored over the coming months, with changes and improvements beingincorporated as the need arises. Further reading 1. Handy CB (1985) Understanding Organisations. Middlesex: Penguin. 2. Occupational Health and Organisational Effectiveness. Institute ofPersonnel Development. 3. English National Board, Department of Health (1998) Occupational HealthNursing. 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 isrequested that the source is acknowledged as ‘Coventry City Council’sOccupational Health Unit’. Packs are available at a cost of £23.00, which also covers postage andpacking. The meaning of best valueLocal authorities are currentlyfocused on ‘best value’ and sickness absence management. Best value is astatutory duty placed on local authorities by the Government, with the aim ofachieving continuous improvement. The most appropriate and efficient use ofservices is one of the fundamental requirements of best value, along withcost-effectiveness and quality. The clearly established guidance embodied inits health management protocols will help Coventry City Council in thisendeavour. Better management of health at work will remove some of theambiguity and conflict that currently besets the process.Coventry City Council’s OH unitThe unit is managed by the principal occupational healthadviser, supported by three part-time medical officers, four full-time equivalentoccupational health advisers, two health promotion nurses and threeadministration/clerical support officers. The principal OH adviser is also responsible for the provisionof counselling and support and physiotherapy services. As part of its role, the occupational health unit carries outpre-employment clearance; employee health assessments; health surveillance andhealth protection programmes; departmental audits and training – includingfirst aid; health education and health promotion. The OHU is centrally based in the Civic Centre and provides afull occupational health service not only to the city council, but also toCoventry University, further education colleges, Whitefriars Housing Group,Coventry and Solihul Waste Disposal Company and various other small enterprisesand outsourced areas. Teaching and support staff at primary and secondaryschools are also part of the remit.Approximately 17,000 staff work for the city council, serving apopulation of around 300,000. Services it provides include road maintenance,street lighting and cleansing; refuse collection, sports and leisurefacilities, including libraries and museums; city planning, and the promotionof trade and tourism. These services are divided between six departments.Employees, many of whom interact directly with the public, undertake a widerange of activities including building and road work, catering, horticulture,mechanical and electrical repairs, plumbing, carpentry, pest control,laboratory work, driving, community care and administration. Previous Article Next Article A better wayOn 1 Sep 2002 in Personnel Today Comments are closed. Related posts:No related photos.