1. Rationale for performing pre- employment medical screening - a comparison of the perceptions of OH and HR professionals Louise Wade RGN, BSc, MSc,

2. Setting the context Securing health together (HSE 2002) “to improve work opportunities for people not currently in employment due to ill-health or disability”

3. Health, Work and Well-being (HM Government 2005) “to remove barriers to starting, returning to, or remaining in work”

4. Disability Discrimination Act 1995 Disabled job applicants should be treated no differently than non-disabled applicants

5. Pre-employment medical screening Guidance Note MS20 (HSE 1982) Recommends selectivity in PEMS Only perform PEMS where there is a specific hazard and a reliable screening process by which to identify susceptibility to that hazard Or as a baseline for future health surveillance

6. Safer Recruitment (NHS Employers 2006) Management of Health, Safety and Welfare issues for NHS Staff (HSC 1998/064) requires blanket pre-employment screening of all new NHS applicants ? In light of Beverley Allitt (Clothier report), Amanda Jenkinson (Bullock report), and Dr Shipman (Smith report)

7. Confusion!!!! Why are we doing it? Should we by doing it or not? Who should do it? Is it reliable? Can we turn anyone down? Is it cost-effective?

8. Dissertation Context Literature review Methodology Results Conclusion and recommendations

9. Literature review Purpose of performing PEMS -ascertain fitness for particular tasks, either safely or effectively -Baseline for future health surveillance -Identify applicants unfit to do the job -To identify those who may be a danger to themselves or others -Identify appropriate adjustments etc under DDA -Reduce litigation, insurance or compensation cost -Reduce sickness absence, private medical scheme, ill-health retirement costs -To detect health conditions previously unknown

10. International perspective -not allowed by law in Netherlands without special permission from the OH unit -Australia and America similar Disability legislation as in UK -ILO (1998) “PEMS should only take place where it is used as a measure to prevent occupational diseases in workplaces where preventative measures have reached maximum effectiveness but a heath risk for susceptible applicants remains, not as a routine procedure to weed out potential (financial) risks”.

11. Methodology Postal questionnaire -sent out to NHS OH nurses in Greater Manchester SHA -asked to complete one themselves and pass a further 2 on to colleagues in either OH or HR -144 sent out Follow up small sample of semi-structured interviews SPSS

12. Results 74 questionnaires returned (51.38%) All respondents, except one HR professional, were aware that their organisation carried out PEMS

13. Profile of respondents 56.2% respondents were OH professionals and 43.8% HR professionals 36% or OH and 50% of HR professionals had worked in the field of OH or HR in excess of 10 years 51% of the OH professionals and 68% of the HR professionals had specialist qualifications in their field of work

14. Respondents NHS service

15. Is it a worthwhile procedure? Belief that PEMS is worthwhileTotal YesNo Professional Group Occupational Health 35 (85%)6 (15%)41 Human Resources 29 (90%)3 (10%)32 Total 64973

16. Are applicants turned down? Frequenc yPercent Valid Percent Cumulative Percent ValidLess than 1% 4967.1 Between 1% and 5% 912.3 79.5 Between 6% and 10% 11.4 80.8 Don't know 1419.2 100.0 Total 73100.0

17. Whitaker & Aw (1995) - only 0.7% of NHS applicants found unfit for work

18. Is it cost-effective? Only 56% of OH professionals believed it was Belief that PEMS is cost- effectiveTotal YesNo Professional Group Occupational Health 231841 Human Resources 25732 Total 482573

19. Are applicants completely honest?

20. For whose benefit is PEMS performed? 75% of all respondents thought that PEMS is carried out for the benefit of the employer rather than the applicants 34% of the OH professionals and 43% of the HR professionals thought that PEMS was performed to eliminate applicants who may have excessive sickness absence 90% of both groups thought PEMS was also performed to eliminate applicants who may be a health and safety risk to themselves

21. But only 80% thought that the purpose of PEMS was to eliminate applicants who were a H+S risk to others 43% of the HR professionals thought that PEMS could be used to eliminate applicants who may become unwell in the future (to reduce costs) Very poor knowledge of whether PEMS had to be carried out because of DOH guidance, insurance policy requirements or NHS pension scheme requirements

22. Quote from the interviews HR professionals (in support) “Will sift out unsuitable applicants with poor attendance records” “Long term sickness is a drain on resources”

23. HR professionals (against) “Takes too long and delays recruitment” “Takes lots of time and other resources without giving equivalent in terms of information” “It is very difficult to sign anyone as “unfit because of the DDA”

24. OH Professionals (in support) “ As an opportunity to update vaccinations” “Provide a baseline for future health surveillance” “Reduction in claims against the trust because we can provide information about health and safety risk, for example needle stick injury management” “Opportunity to provide health education advice”

25. OH professionals (against) “Only provides a snapshot of information, very subjective” “Because of the DDA we have to take everyone anyway” “It is very difficult to sign anyone as “unfit”” “Some unnecessary interviews are carried out because of tradition”

26. Why are applicants not honest? “Worried they may not get the job if they disclose an illness” “May not declare some health issues that they feel may jeopardise offer of employment” “Some people say the symptoms are not as bad as they really are, so as not to detriment their case” “Most are (honest) but at times people are found to omit information in belief that they would not be employed otherwise.”

27. “Undeclared health conditions are discovered once they have commenced employment” “Comparisons of health questionnaires submitted by the same person, at different times or for different jobs reveal contradictory information”

28. What are they not honest about? Mental health problems (13x) Musculo-skeletal problems (8x) Disabilities (1x)

29. Conclusions General belief that PEMS is worthwhile, but lack of confidence in applicants honesty, cost-effectiveness, purpose and HR and OH roles in the process

30. Recommendations Shift from fitness screening to adaptation of the workplace to suit successful job applicants. Greater emphasis From OH professionals in working with H+S professionals in ensuring that hazards to health are controlled in the workplace rather than screening out those that may be more susceptible