Managing a critical case

A critical case is an exceptional one that requires extra support, has become entrenched or is not making progress. There may be a specific risk, or an existing problem, that will be resolved or better managed by joined up working across team, departmental, or organisational boundaries.

Once you have identified that this intervention is needed, you can arrange for either of a Case Management Meeting or Case Conference to take place.

Case Management Meeting

A Case Management Meeting (CMM) is a proactive management meeting. The individual and their representative would not attend a management meeting.

A CMM enables key managers and professionals to collaborate, make decisions and agree actions that enable them to achieve a more timely and appropriate outcome for a critical case. A CMM would typically take place to prevent an issue escalating, or to resolve a problem that has arisen. Without this intervention, individuals may experience prolonged underperformance or attendance issues that have a detrimental impact on their health and wellbeing, and service performance. The CMM enables the manager to manage the capability or attendance issue in the most effective way.

Case Conference

A Case Conference is a proactive meeting which requires or would significantly benefit from the individual (and their representative) being involved. The individual (and/or their representative) are invited to attend a conference.

A Case Conference may be organised as a result of a Case Management Meeting or as a standalone meeting. It enables the manager and key professionals to work with the individual (and/or their representative) to make decisions, agree actions and achieve a more timely and appropriate outcome for a critical case.

Without this intervention the individual wouldn’t be involved in or be able to make key decisions or take action affecting their health, wellbeing and future service.

The Case Conference enables:

• open conversation with professional leads in the room together
• the individual and their manager to be fully involved in managing their capability or attendance issue in the most sensitive and effective way

When a meeting is triggered

A Case Management Meeting or Case Conference may be triggered by one or more of the following circumstances (this list is not exhaustive):

• where there has been a life changing event
• complex, challenging or sensitive ill health retirement cases
• terminal illnesses
• where there is risk of harm to individual(s)
• where there are other (often formal) overlapping or linked processes affecting the individual
• where a process has or is at risk of becoming stuck, blocked or significantly delayed
• a failure to implement actions / adjustments will have a significant negative impact on the individual and / or the organisation
• where there are multiple or repeated referrals indicating a more complex or intractable case
• where there is a major disconnect/disparity in the information or understanding between Occupational Health/EPS/Line Manager (noting that this would normally be prevented, or resolved at the point of referral, by the manager attending the end of the occupational health Appointment or seeking additional advice and support on receipt of the occupational health report)
• where there is a real risk of litigation relating to disability discrimination
• where the issue has been ongoing for some time with no clear pathway to resolution

Arranging a Case Management Meeting or Case Conference

A Case Management Meeting or Conference can be triggered by either the manager, OH or HR.

The person/team that identifies the need for a meeting/conference, will take the lead on organising the meeting/conference.

If a conference is prompted by the individual, or the individual’s representative, then EPS will typically take the lead on organising the meeting.

Venue

The conference/meeting will be at a venue suitable to the circumstances. This may be a work base location, home, Occupational Health or a neutral venue. Where any costs are incurred e.g. for room hire, these are paid by the department. External venues should be booked through the appropriate routes.

Duration

The expected duration must be communicated to all attendees with the invite.

Disclosure

A Case Management Meeting where the individual is not present is disclosable in a court of law, as is a case conference where the individual is present. Both meetings must be conducted fairly and in accordance with good practice, relevant HR policy/guidance, GDPR principles and with due regard to remaining within the bounds of medical confidentiality on matters of consent.

Draft agenda

This should be driven by the specific issues that have given rise to the need for the meeting. However the following agenda items are proposed and are covered in the Case Management Meeting or Conference template:

• introduction of everyone present
• explanation of roles and responsibilities and matters of consent - what can and cannot be disclosed by Occupational Health (which will depend on whether the individual is present). In a CMM, the OH clinician will not have previous knowledge of the case and will provide generic information only. A case conference will usually be attended by the OH clinician who has been involved in the case who can provide advice for which they have consent to disclose
• confirmation of why this meeting has been called and reiterate what needs to be achieved by the end of it (this should have been communicated in any invitation)
• provide an update on the current situation and the key issues that need to be discussed; this might include a chronology of key dates
• discuss each issue:
  • identify the blockage or issue; and underlying cause
  • consider whether any further advice or information is needed
  • consider any options or recommendations on how to mitigate or resolve any blockage or issue; this should be risk based
  • determine what decisions and actions need to be taken to effectively manage the individual’s capability or attendance
• summarise all decisions and agreed actions and next steps; ensure that all decision and actions are recorded as appropriate

Role and responsibilities

Referring Manager's role and responsibilities

The Referring Manager's role and responsibilities during or following a Case Management Meeting or Conference:

• overall accountability for making decisions and determining what actions need to be taken to effectively manage an individual's capability or attendance
• determine the reasonableness of any adjustments in the context of the operational needs of the service and organisational policies
• have due regard to the individual's health and wellbeing in accordance with specialist advice, good practice and EPS policy
• consider advice received from Occupational Health and the impact of the medical condition in relation to the workplace and role
• consider advice received from EPS in accordance with the relevant organisational EPS policies, procedures and practice
• consider the input or representations from the individual or their representative
• seek additional organisational or management advice and support, as appropriate from Senior Managers and other providers and agencies where available (such as Access to Work, the school’s IT provider)
• accountable for implementing any management actions agreed in the meeting

Occupational Health Clinician role and responsibilities

The Occupational Health Clinician's role and responsibilities during or following a Case Management Meeting or Conference:

• provide professional Occupational Health advice to enable the manager to determine what management actions or decisions need to be taken to effectively manage an individual's capability or attendance; with due regard to remaining within the bounds of medical confidentiality on matters of consent about the disclosure of medical information
• provide advice on the potential impact of the medical condition on the individual and any work place and role adjustments that can be considered
• provide further clarification or explanation on the Occupational Health advice and recommendations provided in Occupational Health reports
• recommend whether further Occupational Health or medical specialist advice may be needed to effectively manage an individual’s capability or attendance; where this may be appropriate to do so
• accountable for implementing any Occupational Health actions agreed in the meeting

EPS Caseworker's role and responsibilities

The EPS Caseworker's role and responsibilities during or following a Case Management Meeting or Conference:

• provide professional HR advice to enable the manager to determine what management actions or decisions need to be taken to effectively manage an individual's capability or attendance; in accordance with HR policies, procedure and practice
• provide employee relations advice and support to the manager to effectively engage with the individual or their representative or both where necessary to do so
• provide risk-based options to enable the manager to decide on how to move the case forward
• recommend whether further HR/EPS or legal advice may be needed to effectively manage an individual’s capability or attendance; where this may be appropriate to do so
• accountable for implementing any HR actions agreed in the meeting

Individual's role and responsibilities

The individual's role and responsibilities during or following a Case Management Meeting or Conference:

• represent themselves at the case conference
• attend and positively engage in the case conference to effectively manage their capability or attendance
• provide any necessary and relevant information or information that they want to be taken into account by the manager when determining decisions and actions
• accountable for implementing any individual actions agreed in the meeting

Individual's representative role and responsibilities

The individual's role and responsibilities during or following a Case Management Meeting or Conference:

• represent the individual at the case conference
• attend and positively engage in the case conference to effectively manage the individual’s capability or attendance
• have due regard to the individual's health and wellbeing in accordance with Occupational Health / EPS advice and within organisational policies
• provide any necessary and relevant information or information that they want to be taken into account by the manager when determining decisions and actions
• accountable for implementing any representative actions agreed in the meeting; and supporting the individual in implementing their actions