FOHN outlines top questions around consent

The Faculty of Occupational Health Nursing has published a list of frequently asked questions (FAQs) designed to help registered nurses working in occupational health better understand the principles and practice of obtaining consent and maintaining confidentiality.

The document, ‘Consent and confidentiality in OH’, has been built from the Nursing and Midwifery Council Code, the Faculty of Occupational Medicine’s Ethics Guidance for Occupational Health Practice, common law, and data protection regulations.

It unpicks criticial OH questions such as, what is the legal basis for maintaining OH records and writing OH reports?

It outlines what we mean by ‘informed’ consent, namely, as the guide puts it: “When you see a worker for an OH consultation, it is essential that they give ‘informed consent’ for the consultation and the subsequent report. For consent to be ‘informed’, the worker must understand:

• the purpose of the assessment and what the role of OH is
• how any information they give to OH will be used
• the content of your report including any professional recommendations
• who the report is to be sent to and who else it might subsequently be shared with
• what the implications of your report might be, and the implications if you do not provide a report

“The worker should understand that they can withdraw consent to proceed at any time,” it adds.

Other questions covered by the guide include whether a worker should see an OH report before it is sent and whether consent is required for health surveillance.

On the latter question, for example, the guide states: “It is good practice to obtain consent from a worker to conduct health surveillance under, for example, the Control of Substances Hazardous to Health Regulations 2002, and share the outcomes.

“However, if necessary, FOM ethics guidance is that basic information regarding whether a worker is fit/not fit/fit with adjustments may be provided to the employer without consent since health surveillance imposed by regulations is a statutory duty on both employer and employee.

“This must not include clinical information. The information provided should form part of the health record, a non-medical document to be kept by the employer,” it adds.

Equally, the document outlines whether consent is required for night worker health assessment.

As it states: “Night worker health assessments are a statutory requirement for the employer to offer, but they are not mandatory for the worker to undertake (reg 7, Working Time Regulations, 1998). A report that a worker is fit for night work can be made without consent.

“If a worker is not well suited for night work e.g. because it will make it more difficult to manage an underlying condition, this must not be disclosed without consent. If a night worker assessment shows a worker is unsafe to undertake night work because they could pose a risk to others, this might be disclosed without consent in the public interest… although it should be discussed with the worker first to allow them to disclose themselves,” it adds.

The document also discusses the role of subject access requests and explains the Caldicott Principles, among other points of note.

Finally, it runs through a number of anonymised case studies covering areas such as obtaining verbal consent to provide a report and what should happen if consent is withdrawn, among other examples.