1. Capability assessment Roger Cooke

2. What is capability? the power or ability to do something. the extent of someone's or something's ability. "The job/ work is within his/ her capabilities“ Important legal distinction from “application”

3. Who determines capability? Individual Employer Medical carers DWP Courts, lawyers and insurers Occupational health

4. Models of assessment Gut feeling, google, etc Medical Occupational health Bio psycho social DWP

5. DWP Work capability assessment Designed to triage into Fit for work Not fit for work but fit for training Not fit for work or training At appeal 20-25% of fit to work decisions were overturned At tribunal a further 15% were overturned i.e total of 40% of decisions were determined to be inappropriate

6. Applying the medical model Recovery from the medical condition indicates capability to return to work Eg Royal College of Surgeons - http://www.workingfit.com/Surgery/FitnessSurgery.html http://www.workingfit.com/Surgery/FitnessSurgery.html Legislative ( eg drivers, pilots) Fitness assessments ( eg vO2 max for firefighters, mines rescue) All useful indicators but ignore other potential factors

7. Illness behaviours Identifiable continuing illness may or may not be present Potential gain from persistence of symptoms Psychological disease, institutionalisation or lack of application?

8. health Occupational health Work and environment

9. The multi factorial ( holistic) approach “The Need for a New Medical Model: A Challenge for Biomedicine” Engel Science 196 (1977) 129–136

11. Using the holistic biopsychosocial model LIST 5 non medical factors affecting capability 5 employment or work related factors affecting capability

12. What are the barriers to work? Medical Psychological Social Occupational & environmental

13. Model for capability assessment Medical model Psycho-social model Identify barriers Resolve barriers so far as possible (reasonable adjustments?) Define capability - use functional assessmenmt / review process to refine

14. Use of “red flags” Part of the medical model Can they be part of the holistic model?

15. Red flags – accepted for back pain Symptoms Non-mechanical pain (worse at restc pain Fevers/ rigors General malaise Urinary retention Signs Saddle anaesthesia Reduced anal tone Hip or knee weakness Generalised neurological deficit Progressive spinal deformity Urinary retention

16. Features, signs and symptoms in a patient with back pain which indicate serious spinal pathology Features Previous history malignancy (however long ago) Age 16 50 with NEW onset pain Weight loss (unexplained) Previous longstanding steroid use Recent serious illness Recent significant infection

17. Cardio-vascular red flags an electrocardiogram (ECG) abnormality heart failure (history or physical signs) transient loss of consciousness during exertion family history of sudden cardiac death in people aged younger than 40 years and/or an inherited cardiac condition new or unexplained breathlessness a heart murmur. NICE clinical guideline 109, recommendation 1.1.4.2

18. Non-medical red flags? Who addresses these in OH setting? Psychological Social Workplace Ethical

19. A life with work in the broadest sense of the word, meaning occupation and meaningful activity, is not something that in itself would make his condition worse….. ……and in fact as for anyone bringing value and meaningful activity and structure to their day is a positive thing.