Transcript Managing Absence An Occupational Physicians view

Medical Fitness for Work in UK
Fire Services
Dr Tok Hussain
Consultant Occupational Physician –
Healthwork Ltd
ALAMA Fire Services Representative
Dr Tok Hussain
07/07/2015
Standards – pre 2004
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Godber report 1968
Joint working party appointments
provisions 1988
Blanket bans
ALAMA
Dr Tok Hussain
07/07/2015
Influences
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DDA 1995 (as amended 2005)
 Oct 2004
Fire Service Act 1947 replaced by Fire and Rescue
Services Act 2004 (Oct 2004)
2004 DCLG ‘Medical and Occupational Evidence for
Recruitment and Retention in the Fire and Rescue Service’
Evolving consensus based standards – ALAMA
Equal ops and employment rights
Dr Tok Hussain
07/07/2015
Problems with standards
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Discriminatory if too prescriptive
Non-individualised
Blanket bans discriminatory
Diversity issues
Can lead to over-rejection and excessive IHR
Dr Tok Hussain
07/07/2015
Why have standards?
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Uniformity of medical advice
Easier to select and manage individuals
Operational efficiency
Risk reduction?
Dr Tok Hussain
07/07/2015
Current Practice
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Individualised approach
Evidence based
Risk based
Multi-disciplinary involvement including
management
Functional tests
More flexible approach – not old rigid approach
Dr Tok Hussain
07/07/2015
Doc is he fit?
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Chronic conditions
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Chronic back pain
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Is work likely to make him worse?
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Fit but sickness absence of 4 episodes per year of
2 weeks per time
Asthma BA use
Acceptability of risk
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Epilepsy seizure risk
Dr Tok Hussain
07/07/2015
Diabetes
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Type 1 and type 2
Hypoglycaemia
Diabetes UK
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Survey and guidelines
ALAMA, CFOA, DRC, DUK, FBU
Guidelines launch Oct 2008
Driving
Coping strategies
Importance of general fitness
Dr Tok Hussain
07/07/2015
Asthma
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BA use
Exposure to smoke and fumes
Restricted BA use
Individual assesment based on asthma control
Ongoing work – Paul Cullinan (Brompton)
Concerns in current asthmatics or
severe/moderate childhood asthma
Exercise testing for asthma
Dr Tok Hussain
07/07/2015
Vision
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2002 Review (ODPM fire division, CFOA)
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Corrected VA 6/9 binocularly minimum 6/12
worst eye
Uncorrected standard 6/18 and 6/24
Aids to vision
Contact lenses
Colour vision
Laser eye surgery
Dr Tok Hussain
07/07/2015
Hearing
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Audiometry and questionnaire
3 yearly
Functional testing
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validation
Dr Tok Hussain
07/07/2015
Epilepsy
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Risk assessment
DVLA 2% per annum risk of seizure
acceptable in group 2 drivers
Dr Tok Hussain
07/07/2015
Mental Illness
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PTSD
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Strict diagnostic criteria
CBT or EMDR
Usually recover
CISD
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Nice guidelines
Dr Tok Hussain
07/07/2015
Joint Replacements
 Knee
 problematic
 Hip
 Birmingham
 Spinal
 Wear
Dr Tok Hussain
disc
of joint is a concern
07/07/2015
Medical management of ill
health
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Early OH assessment
Early interventions
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Physio, counselling, etc
Funded investigations
Funded treatment
Case conference approach
Dr Tok Hussain
07/07/2015
Rehabilitation
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Early rehabilitation
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Other duties
Reduced hours, reduce duties
Graded return to work
Alteration of duties temporary
Reasonable adjustments
Permanent alteration of duties
IHR
Dr Tok Hussain
07/07/2015
ANY QUESTIONS ?
Dr Tok Hussain
07/07/2015