1. Occupational Health Line Manager Training Session
Delivered by Jackie Doolan, OH Assist
July 2018

2. Key Objectives Gain a better understanding of Occupational Health
Learn how to create a good OH referral through the OH portal
Opportunities to discuss line manager experience of accessing OH Services
For OH Assist to take away from today’s session Line Manager suggestions & recommendations for Occupational Health Service Improvements

3. What is Occupational Health?
Simply put Occupational Health is the possible affects of work on health and health on work, including the safety, health, and welfare of people at work as well as preventing harm from any incidental hazards, arising in the workplace.
Occupational Health deals with all aspects of health and safety in the workplace including the physical, mental and social well-being of any employee.

4. Attendance management – OH Role
Occupational Health
Work with manager to improve attendance and performance
Perform an impartial and objective assessment of the reasons for absence (medical and non-medical)
Provide a report with the most important features of the assessment, a professional opinion and advice on measures which will facilitate attendance
Support Managers to make good decisions
Work with NWR line managers (LM) and HR to improve attendance and performance
Perform an impartial and objective OH clinical assessment of the reason/s for absence (medical and non-medical) using clinical knowledge of the condition and the normal clinical pathway of treatment and recovery.
Provide an OH report to the LM with a clinical/medical professional opinion and advice on measures which will facilitate attendance
Support LMs to make good decisions by giving direction as to the actions to be considered by the manager and employee to progress the case.

5. Manager Prompts-Absence Management
Have they sought medical advice from their GP?
Is the absence caused by injury or illness as a result of work?
Mental health-Is the employee receiving any EAP
services? If not provide details so they can self
refer to EAP, Has an OH referral been made?
Get an understanding of the
Nature of the Absence
Length of expected absence –
does the employee think they
will return to work within the week?
Musculoskeletal – Are they receiving treatment
via their GP? Would a referral for short term
physiotherapy through RHW be useful?

6. Reasons to Refer to Occupational Health
Mental Health Conditions/Anxiety/Stress/Low Mood
Accidents/Injuries/Diseases
Recurrent Short Term Absences
Musculoskeletal (MSK) : OH referral or Physiotherapy referral?
Other health conditions/symptoms impacting on employee’s fitness to perform their substantive role
Health conditions and/or symptoms impacting on the employees ability to undertake their duties.
All long-term sick absence - any period exceeding 20 days.
Cases where there are multiple medical factors contributing to the absence.
OH Advice on workplace Restrictions, adjustments or modifications is required
Any other Reasons you may refer as a Line Manager to Occupational Health?
Stress, depression, anxiety or other psychological or psychiatric conditions – if possible referral to be made on the day management are made aware of the health issue
Accidents, injuries, or diseases contracted in the workplace - if possible referral to be made on the day management are made aware of the health issue.

7. Pre Referral Support
Pre referral support available for NWR Line Managers-prior to submitting an OH referral-helps to understand if OH is the best route and to help form the line manager questions
A Pre-referral session case conference session can be booked on the portal or alternatively line managers can phone the administration helpdesk to request that a pre referral appointment slot is scheduled.
Verbal consent from the employee is required before arranging the pre referral support call.

8. What information should be included in an OH referral?
Medical condition impacting on attendance/performance
What action has the manager has already undertaken?
Ongoing issues at work that could be an obstacle to return. e.g. disciplinary , grievance
Success or otherwise of any rehabilitation or adjustments already made?
What aspects of the employees work are most affected?
MEDICAL CONDITION IF KNOWN:
ACTION TAKEN ALREADY: eg extra breaks at work, internal stress risk assessment
ONGOING ISSUES eg employee waiting outcome of disciplinary or ?? Raised a greivance
PREVIOUS REHAB OR ADJUSTMENTS: have they been successful? Has the employee failed a RTW plan?
ASPECTS OF WORK AFFECTED: work output, performance, inaccuracy, timing

9. Without the Line Manager having to ask-The OH Report will always include:
Advice on the employee’s current health status
A prognosis, where possible, for the condition and / or resumption of activity
An indication of the likely return to work date or return to full duties
Advice on the current functional ability/fitness of the employee. If work duties are affected, advice will be provided on whether any impairment is likely to be short term, long term or permanent
Details of a specific rehabilitation plan and advice on adjustments, if appropriate, with clear timescales
Advice to the organisation regarding disability in accordance with relevant UK legislation
Advise where a return to work is unlikely, on a permanent basis
Line Managers have the option to add 3 additional specific questions within the
Occupational Health Referral

10. Why Complete Telephonic Assessments?
There is robust evidence from numerous sources that telephonic methods can be used to assess the clinical and participation needs of people with common health problems, and can be as effective as face-to-face approaches
More than 80% of a diagnosis is formulated from the clinical history taken - there is growing evidence that this history can be gained just as effectively through a telephone assessment as it can through the traditional F2Fapproach.
Many GP practices now use telephone triage to increase their use of time effectively.
If a face-to-face assessment is required, the telephone assessment acts as a triage quickly moving the case on to F2F.
Significantly shortened waiting times.
Example of Referrals suitable
for telephone assessments:
Short term Absence referrals,
Advice on fitness
to work whilst on medication,
Assessing employees that are
at work,
Assessing employees
with new symptoms-for
example 1st episode of stress,
anxiety, low mood, migraines
Clinical information entered on to standard templates for both clinical notes and reports reduces the wait for a separate administrator to type up a dictated report.
Enhances return-to-work outcomes and encourages self-care. Early telephonic delivery of work-focused information and advice can orient the employee towards return to work, thus aiding decisions about how and when to return.
The use of standard templates enables consistency of approach/information gathered to inform fitness advice.
Analysis of OH Assist’s return to work rate following telephone assessment compared to face-to-face referral has shown that the return to work time after the occupational health assessment was 2 days quicker following a telephone assessment than a face to face assessment.
Ease of access: less stressful for the employee as they don’t need to travel.
Telephone triage and advice has been shown to be acceptable to most patients, offering reassurance and advice without the inconvenience and disruption of travel and the potential anxiety-provoking visit to the workplace when off work with long-term sickness.
Strong evidence that psychological therapies such as cognitive behavioural therapy (CBT) can be delivered very effectively by telephone

11. Deep Dive Case Conference Sessions
Key aim is to reduce lost days from work
Focus on reviewing the longest absence cases
Attended by the OH Assist Clinical Operation Lead & HRBPs
Managers attend to present their LTA cases
15 minutes allocated per case up to 28 cases in a session
Joint action plan is agreed and the next actions
OH or Line Manager agreed for each case and circulated
Weekly calls to closely monitor the cases

12. Network Rail Line Manager Support
Hyperlinks for our line managers
OH Assist Escalation and Complaints Process
Flexible Working Arrangements Policy & Procedure
Diversity and Inclusion homepage (on intranet)
Reasonable Adjustments Policy
Everyone Managing - Disability in the Workplace (reasonable adjustments guide)
Reasonable Adjustment Discussion Template
Reasonable Adjustments - Interactive Navigator Toolkit
Line manager guides:
Guidance for managing disability in the workplace - Dyslexia
Guidance for managers on supporting staff with HIV and AIDS, developed by our LGBT staff Network, Archway
Guidance for managers on supporting staff with Asperger’s syndrome
Everyone - Managing Bereaved Employees
Everyone - Managing Menopause in the Workplace

13. Performance and Attendance Mgt
Services Delivered
Performance and Attendance Mgt
Provide impartial advice to managers to allow them to make informed management decisions regarding their employees
Offer advice on the capability of an individual to perform their role in relation to their health and well-being in a way that is equally fair to the employee and the business
Pre Placement
Advise on appropriate support measures for applicants where they have identified a functional limitation through pre-placement health screening process.
Evaluates the fitness of an applicant’s declared health in relation to the hazards and risks of the job, environment or activities.
Assess fitness for work to evaluate an employee against set criteria for fitness to perform a role
Health Surveillance
Health Surveillance (HS) is a control measure that may be required where health risks cannot be eliminated or adequately controlled.
HS is about putting in place systematic, regular and appropriate procedures to detect early signs of work-related ill health in employees exposed to recognised health risks and acting on the results.
OH Assist advises on and implements appropriate HS schemes and carry out the routine procedures associated with them., including HAVS, Noise, Respiratory, Asbestos and Skin
Health Assessment
Assess employees to meet certain medical fitness standards to do their job safely, including those that need Sentinel cards (Competency Specific Medicals), HGV drivers, buggy drivers and air observers.
All medicals are performed in line with all associated Network Rail Standards

14. Services Delivered Admin Helpdesk Case Conferencing Deep Dive
Suitable for complex cases where the referring manager/HR representative can discuss the employee’s case history with a qualified clinician to explore the options to progress the case.
Deep Dive
Key aim is to reduce lost days from work
Focus on reviewing the longest absence cases
Attended by the OH Assist Clinical Operation Lead & HRBPs
• Managers attend to present their LTA cases
15 minutes allocated per case up to 28 cases in a session
Joint action plan is agreed and the next actions
• OH or Line Manager agreed for each case and circulated
Weekly calls to closely monitor the cases
Admin Helpdesk
The administration helpdesk provides support to managers pre and post referral, the helpdesk is the first point of escalation for all queries, administration and clinical
The OH Assist Helpdesk can be accessed by calling
Option 1 – Medication Enquiry Line
Option 2 – For Cause Drug and Alcohol
Option 3 – Validium
Option 4 – OH Assist Helpdesk (Admin and Clinical)
Option 5 - Rehabworks
Medical Helpdesk
On contacting the admin helpdesk should medical information be required, the admin helpdesk will facilitate a warm transfer to the clinical helpdesk
The helpdesk will discuss general medical issues but cannot specific cases
Give advice on communicable diseases and workplace exposure advice
Advice on the appropriate referral progression

15. Accessing the OH Portal-Portal Demonstration

16. Portal Demonstration-Logging On

17. Creating A Referral

18. Creating A Referral

19. Selecting the Correct Referral Type

20. Completing Employee Details

21. Contact Details

22. Employee Availability

23. Reason for Referral

24. Current Duties
When you have completed all referral information on the portal-prior to submitting the
referral you will require to tick that you have gained verbal consent from
the employee to refer and that the employee is aware of the reason for OH referral,
any specific questions asked and who will receive a copy of the OH report.

25. Additional Information
We have included a few additional slides for managers to look through following this session-the slides are additional information that you may find helpful. Please refer to the next slides in the slide pack:

26. The OH Assessment
It is always good for you to understand as a line manager what information OH practitioners obtain and assess against when completing the OH Assessment/Consultation. Details below:
ID & Consent:
Previous employment history.
Past medical history
Lifestyle/hobbies/family social aspects
Summarise current health problem
Clarify recent events, treatments, tests, referrals
Assess how ill health affects daily activities
Assess the client - pain levels, mobility, mood
Agree case progression with client and return to work time scales, if appropriate
Discuss and agree rehabilitation programme
Maintain clients electronic OH records
Agree report with the client and review dates, if necessary

27. Structure of the Report (OSR)1
Description of relevant medical issues  2
Current capacity for employment 3
Outlook 4
Answers to specific questions 5
Advice on Disability
Fitness for Work: At work and managing role and duties etc Fit for a return to work on normal role and duties and when Unfit for work in any capacity Fit to return to work with adjustments eg RTW plan- this should be time limiting OUTLOOK: The outlook for the condition: short/long term chances of recurrence If the OHA/OP cannot predict an accurate outlook then this should be documented

28. OH Advice on Disability
It is the OH practitioner’s role to advise the employer of:
With this information, the employer is then able to make a decision as to whether the condition constitutes a disability under the Equality Act.
Whether there is likely/unlikely to be an impairment
If they are not impaired would they be so if they were not on treatment
Whether the impairment has a significant impact on their ability to undertake normal day-to-day activities
The likelihood and severity of a recurrence
what adjustments are appropriate to alleviate the adverse effects of the impairment.

29. Examples of Referrals Suitable for Telephonic Assessments
Short Term Absence Review Cases
Common Mild to Moderate Mental Health Conditions i.e. anxiety, stress, depression
Advice on fitness to work when taking prescribed medication.
Condition would be worsened due to travel i.e. early onset musculoskeletal conditions/symptoms such as knee/ back pain/ Injuries
Employees experiencing symptoms of a known medical condition e.g. Diabetes, arthritis, migraines, asthma
Individual has access to a telephone during their shift (if at work).
Referrals suitable for telephone assessments include short term
Absence referrals, advice on fitness to work whilst on medication,
Assessing employees that are at work, assessing employees with new symptoms-for example stress where there is not a past medical history of mental health symptoms

30. OH ABBREVIATIONS! OH = Occupational Health
OHA = Occupational Health Adviser
OP = Occupational Physician
COP = Consultant Occupational Physician
FME = Further Medical Evidence (Dr report either from GP or Specialist)
BRF = Business Referral Document
SAR = Sickness Absence Record
OSR = Outcome Summary Report