Rationale for performing pre-employment medical screening -

a comparison of the perceptions of OH and HR professionals

Louise Wade

RGN, BSc, MSc,

Setting the context

• Securing health together (HSE 2002)

“to improve work opportunities for people not currently in employment due to ill-health or disability”

• Health, Work and Well-being (HM Government 2005)

“to remove barriers to starting, returning to, or remaining in work”

• Disability Discrimination Act 1995

Disabled job applicants should be treated no differently than non-disabled applicants

• 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

• 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)

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?

Dissertation

• Context

• Literature review

• Methodology

• Results

• Conclusion and recommendations

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

• 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”.

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

Results

• 74 questionnaires returned (51.38%)

• All respondents, except one HR professional, were aware that their organisation carried out PEMS

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

Respondents NHS service

Human ResourcesOccupational Health

Professional Group

50

40

30

20

10

0

Cou

nt

16 years or more

11 to 15 years

6 to 10 years

1 to 5 years

Less than 1 yearNHS Service

Is it a worthwhile procedure? 

Belief that PEMS is worthwhile Total

Yes No

Professional Group

Occupational Health

35 (85%) 6 (15%) 41

Human Resources29 (90%) 3 (10%) 32

Total64 9 73

Are applicants turned down? 

Frequenc

y PercentValid

PercentCumulative

Percent

Valid Less than 1%49 67.1 67.1 67.1

Between 1% and 5%9 12.3 12.3 79.5

Between 6% and 10%1 1.4 1.4 80.8

Don't know14 19.2 19.2 100.0

Total73 100.0 100.0

 

• Whitaker & Aw (1995)

- only 0.7% of NHS applicants found unfit for work

Is it cost-effective?Only 56% of OH professionals believed it was

 

Belief that PEMS is cost-

effective Total

Yes No

Professional Group

Occupational Health

23 18 41

Human Resources25 7 32

Total48 25 73

 

Are applicants completely honest?

Human ResourcesOccupational Health

Professional Group

50

40

30

20

10

0

Co

un

t

No

Yes

Belief in honesty ofapplicants

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

• 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

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”

• 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”

• 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”

• 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”

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.”

• “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”

What are they not honest about?

• Mental health problems (13x)

• Musculo-skeletal problems (8x)

• Disabilities (1x)

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

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