NHS Employment Issue - AIBU to want a referral to Occy Health

[Folicky]

I am a senior clinician in the NHS and team lead living in the north of England. Have had poor managers above me over the years, who rarely backed me up when I was trying to manage the team I lead. They had a 'keep them happy' style of management but staff only doing what they want to do has led to cherry picking of caseloads, only seeing a small number of patients, taking on only straightforward cases, etc etc. Invariably the complex work, greater caseloads fell to me and because I knew I wouldn't get support and my staff would complain if I tried to get them to do their share, I did this for a while but it wasn't sustainable. I have asked them to do what they should be doing before and then let them complain but the process took a lot out of me and the senior managers seemed hassled by the whole thing and almost blamed me for bringing that to their door. Eventually a new manager came in but it appears she was briefed by her predecessor and is following suit. I need a referral to an occupational health physician. I have asked my manager for a referral but she has said it is just stress and that doesn't go to the occupational health physicians but to contracted counsellors who can't make recommendations for changes in the workplace. I have sourced and I pay for private psychological therapy so more counselling is not what I need. What I do need is someone to take an overview of how problems and issues in my job are impacting my health and that of my family. One day before one of these meetings several years ago, my toddler was badly injured in an accident which I know would not have happened without the stress of this crap. It is only now that treatment can be undertaken to do something about the injuries and now this shite is raising its head again as it does every two years. I can't take it anymore. I have been treated abominably but without moving area or taking on a long commute I'm stuck. My query is am I being unreasonable to seek a referral to an occupational health physician as they can take an overview of the situation and have experience in this sphere? Also how do I word that request so I get to the Occ Health physician and not send to HR who have been of limited use and vary in their advice.

Can you not refer yourself. Not sure if that's an option. I'm NHS myself not surprised by your story. It's toxic.

I've worked for four different trust in extremely minor roles

With every one of them, one could self refer

If you are this stressed then you are unwell. Have you had time off? I bet if you hit sickness triggers they would haul you to Occ Health so fast your head would spin...

Yes just remembered talking to a colleague the other day she is self referring. It is a definite option. Goodluck.

You should be able to self refer.

Can you speak to your trade union rep? They should be able to support.

You should be able to self refer.

I ended up in OH after work stress issues put me in hospital. I will never forget the words of the consultant "Do less work more slowly"

It sharply bought priorities into focus with regards to work /life balance.

Hope you see someone and you get listened to. You should also have a freedom to speak up champion?

That sounds awful, both the poor manatement and the refusal to refer you to OH. Also it is wrong to say they can't help if it's stress - of course they can, that's the whole reason they exist, to help staff manage health issues!

Have you had your stress discussed with your GP? Not that it should matter, but if you have a health problem registered with them then that might give you more ammunition to get an OH referral?

I was signed off with stress several years ago by my GP and before my manager even started to help me through the supported return to work they insisted on an OH referral to support me and to guide them. I spoke to an OH doctor on the phone (covid times so not f2f) and they were really helpful.

I have also referred one of my supervisees to OH for their health issue and it was really straightforward. I am not sure who she sooke to, ie doctor or not, but she got advised in how we could help supprt her with changes to workplace.

Maybe email to your manager and copy in their manager making a formal request for OH to support you, as per your sickness policy.

I wonder whether you have an employee assistance program that offers counselling as our trust does and we can self refer to that. Does your manager maybe think you are asking about that?

Different public service but OH in place.

It isn't the help I thought it would be.

It didn't resolve anything because the practitioner didn't have enough knowledge of my role. The risks that needed to be changed, OH couldn't see a way forward. ( because I couldn't).

For instance one of my issues was insomnia and having to drive on an hours sleep. I know if I am wfh I can start later and finish later, so it's not affecting work.
I also know that if I was due to make a visit to a ‘customer’ after little sleep, a cancellation that morning would have a big the impact on them. OH had no ideas to help me work through that so it wasn't addressed.

All they reported back to my employer was the arrangements/adaptations I had already worked out for myself.

There are two issues here:

1. You mental health and whether it renders you able to fulfil your role with or without adjustments and whether you are covered by the EA (2010). An OH assessment, through your employer, is highly unlikely to confirm that your role has caused your ill-health and may be regarded as a personal injury.

1. If your team members will not do work it is a conduct issue. If they do not have the competencies to do the work it is a performance issue. You need coaching and support to implement the appropriate procedures. The NHS must start to deal with issues like this.

I absolutely love the do less work more slowly advice from OH. I've never heard of a Freedom to speak up Champion.... but will look that one up. Thank you

While I think my job has caused me intolerable levels of stress over the years I didn't think Occ Health would make a judgement on that. But I thought they might be able to advocate for me to get support in my management role. I simply can't do my job in the high risk area that I work in without managerial support.

In my hospital they are saying the referral has to go through my manager but I find my manager is trivialising and blind to the issues, part of which are with her

Have you been off sick or are you asking for this in a preventative way, which is how it sounds? What do you want this OH referral to achieve? Although there are aspects of this situation that sound rubbish, it's common that senior clinicians see more of the most complex or difficult patients. If the team lead can't, who does? And why can't your team take their share? Inevitably, their share may be less than yours and they may need supervision or support to manage complex cases, but they should see some in order to develop.

However, rubbish management is also why I don't work in NHS anymore so I sympathise

Agree there should be a match between complexity and competence ..... that was the issue, highly trained staff seeing low complexity cases. I didn't mind doing my share, just couldn't do everyone's.
Not off sick yet
Lucky you to have left

I think you have misunderstood the role of Occ Health. It is to ascertain if you are fit for your role and to see if there are any recommendations about reasonable adjustments that may be required for the benefit of your health.
Whilst Occ health can make recommendations, they cannot dictate to the employer that these must be implemented.
You have a workplace issue and unfortunately, it will continue because the managers think they can continue to treat you this way.

Can you reach out to HR and ask for a workplace stress risk assessment? Or raise a grievance?

It really isn't the role of OH to advocate for you to have management support. They will recommend a stress risk assessment and possibly a wellness plan and both of those are conducted by the manager. If you were to agree, they might note that you feel your issues are trivialised and you would prefer those meetings to take place with another manager, usually the manager's manager. Only you can know if that would be helpful or if you would veto the report. If the latter, it's all a bit pointless isn't it?

Whilst I think it's poor practice to insist the report can only be raised by the manager as there are sometimes confidentiality issues most adjustments have to be implemented by the manager and two way channels of communication are important.

If there is an issue with your manager, can you speak with their manager to try to seek a resolution?

If you are managing the team that won't or can't work, what evidence do you have of their non compliance? Notes of 1:1 meetings, performance reviews, standard setting, etc. I do realise that toxic teams exist and they are very tricky to turn round.

Grievances are rarely successful. They fracture already brittle relationships and mostly recommend stuff that minimises risk for the institution: mediation, training, 1:1 meetings, etc. Rarely a cultural review. If patients are suffering you could of course blow the whistle but I suspect immense strength and resilience is required for that.

If this has been an ongoing issue for a number of years then leave. Transfer to another dept or provider. No job is worth unhappiness. Tell them in your exit interview.

It's hard to say from the outside and with limited knowledge. It may be a distinct pocket of toxicity impacting patient care, and there have been enough to reach the press to know they exist, or it may be that you are a square peg in a round hole and would do better elsewhere.

No job is worth years of unhappiness. From what we are told the NHS has vacancies everywhere so apply fir one and see if somewhere else is different.

Good luck

If you are medical, can you go to your medical director? Or deputy? Or Chief of service?