Medical Intervention Scheme

The Medical Intervention Scheme was established to support employees and provide
prompt treatment to assist in maintaining fitness for work, aid recovery from illness or
injury and help facilitate a return to work. This provision also assists in reducing
sickness related absence thereby allowing the Service to maintain operational resilience
and continue to provide high quality services to our communities.

The scheme primarily covers short term interventions such as physiotherapy and
chiropractic treatment but may also fund scans, private consultations with Specialists,
treatment costs and may, in exceptional cases, pay a partial contribution towards the
costs of a private operation.

HR and Occupational Health will promote the scheme and seek to ensure staff and line
managers are aware of the assistance available.

1 GENERAL

1.1 For the purposes of this document:

 The Medical Intervention Scheme will be known as “the Scheme”.

 Any medical intervention or treatment being applied for (for example, a course
of treatment, consultant referral, medical procedure, investigation or test) will
be known as “the intervention”.
 A “medical professional” may be a GP, consultant, specialist, or qualified
healthcare or treatment practitioner.

1.2 The Scheme is open to all staff.

2 PRE-APPLICATION ACTIONS

2.1 Individuals who have concerns over their health must first consult their GP who
will initiate any intervention considered necessary through NHS channels. The
individual is expected to fulfil the usual requirements associated with that
intervention which, in most cases, will result in a return to good health achieved
in a reasonable period of time.

2.2 In the event that there are excessive NHS delays or there are particular
advantages in specific early intervention that could not otherwise be obtained on
the NHS, the GP may indicate that private intervention would be an advantage. It
is at this point that application for assistance through the Scheme can be made.

2.3 Employees wishing to apply for assistance through the Scheme must first read
this document in its entirety so that they are fully aware of what will be required of
them, the process for applying, and any personal financial (tax) implications their
application may have.

(October 2015)
2.4 It is important to note that retrospective payments will not be made, therefore
application must be made before any intervention takes place. It must also be
noted that, in cases of high expense, the Service may only be able to part-fund
the cost of the intervention, the remainder being paid by the individual.

3 MAKING AN APPLICATION

3.1 To apply to the Scheme the individual must first familiarise themselves with the
Scheme process, obtain the necessary Scheme Application Form (available on
the Intranet), and gather sufficient written evidence to support their application.

3.2 As supporting evidence the individual must obtain a letter from their GP (or other
medical professional, for example a physiotherapist, Chiropractor, Consultant,
Specialist) outlining the following (where applicable):-

(a) the medical condition/diagnosis;

(b) the current NHS waiting time for the required intervention;
(c) the benefits of a prompt private intervention;
(d) the proposed private intervention (including details of the treatment or
tests needed, recommended Consultant/Specialist and where they
practice);
(e) the estimated cost of the proposed private intervention;
(f) the likely recovery time in comparison with an NHS intervention;
(g) any other information relevant to the case.

3.3 The individual must submit the above supporting evidence to Human Resources
along with a completed Scheme Application Form. Human Resources will make
a decision based on the information provided and inform the individual of the
outcome. If successful, arrangements can then be made for the intervention to
take place.

3.4 In the event that the above mentioned supporting evidence is not available, the
individual is to submit the completed Scheme Application Form to Human
Resources with as much information as possible. Human Resources will then
refer the individual to Occupational Health for a medical opinion on the
appropriateness and likely success of the intervention being requested. Please
note: if you are not off sick you may be required to attend this appointment in
your own time and at your own expense as waiting for an on-duty appointment is
likely to delay your application.

3.5 Once Occupational Health has considered the case and sought any further
supporting information (if necessary), a recommendation will be made in principle
as to whether the intervention should be financially supported through the
Scheme.

3.6 On receipt of the Occupational Health report Human Resources will make a
decision on whether or not to financially support the intervention. Among the
factors taken in consideration will be:

(a) Independent medical opinion (Occupational Health) of condition and

treatments available, anticipated success of treatment, recovery period and
likely return to duty.

(October 2015)
 (b) Availability of private treatment compared to NHS waiting timescale.
(c) Cost of private treatment compared with anticipated time off sick without
private medical intervention.
(d) Role performed and future potential.
(e) Available budget within the Scheme and consistency of expenditure with
other similar cases.

3.7 The decision, once reached, will be communicated by e-mail to the individual,
and if successful, arrangements can then be made for the intervention to take
place.

4 PAYMENT

4.1 Individuals must obtain and provide an estimate of the total cost of the
intervention so payment can be made on receipt of the appropriate invoice.

4.2 If the treatment is provided by one of our regular suppliers who are already set
up on the Agresso system, HR will pay the provider directly on receipt of the
invoice, after the intervention has taken place. In cases where a one-off provider
is found (for example, if the employee resides outside of the Service area and
requires treatment in their home location) then it will be standard practice for the
employee to pay the costs up-front and claim reimbursement. HR advice should
be sought to ascertain the most efficient method of payment.

4.3 In exceptional circumstances, if payment is required before the intervention, an

invoice to that effect must be obtained and advance payment will be made for
which a receipt will be required.

4.4 The Service will pay for, or contribute towards, the cost of providing evidence in
support of an individual’s application (for example, GP letters) based upon the
standard fees charged.

4.5 Retrospective applications for support will not be accepted. Individuals must not
enter into any financial commitments prior to formal agreement by the Service.
To do so will leave the individual liable for the payment of any amount due.

4.6 It must be borne in mind that, although support for intervention may be approved,
any future or longer term treatment will not be included in the original agreement,
therefore individuals must consider applying for longer term assistance through
their GP or funding this privately themselves.

4.7 In cases where additional intervention is recommended by the medical

professional (for example, if further sessions of treatment are recommended in
order to ensure the effectiveness of the intervention), the individual is to apply in
writing to HR, including a progress report from the medical professional or
practitioner, and a decision will be made on whether this will be supported.

5 TAX LIABILITY

5.1 With effect from 1 January 2015, medical treatment recommended by a medical
professional for the purposes of assisting an employee to return to work after a
period of sickness absence (ill health or injury) is to have no tax implications for
the employee.
(October 2015)
5.2 Medical treatment is defined as being “all procedures for diagnosing or treating
any physical or mental illness, infirmity or defect”.

5.3 There is an annual cap per employee, and any costs in excess of this cap will be
subject to tax in the normal way. At the time of writing, this cap rests at £500 per
year.

5.4 To be eligible for tax-free medical treatment employees must satisfy a number of
conditions.

 Before the recommendation for medical treatment is made the employee

must be either:

o absent from work due to injury or ill health for at least 28 consecutive
days, or
o deemed unfit for work for at least 28 consecutive days by a health care
professional (who expects that, without treatment, the employee will be
unfit for work for at least four weeks).

 The recommendation for treatment is to be made by Occupational Health or

an appropriate healthcare professional.

 The recommendation for treatment is to be provided for the purposes of

assisting the employee to return to work.

 The recommendation for treatment is to be in writing, provided to both the

employer and employee, and specifying the treatment recommended.

If you do not meet these criteria, which is set up HMRC, then the funding will be
taxable (see below).

5.5 Any taxable payments (ie above the cap) to be met by the individual will be
notified to Finance who will process it as a ‘Benefit in Kind’ (P11d). This will
enable any tax liability determined by the Inland Revenue to be spread over the
following tax year that will ease the financial impact.

6 RETURN TO WORK

6.1 Individuals are expected to heed any medical advice and co-operate fully with
exercise plans or other recommendations made by the treating practitioner in
order to maintain their recovery and fitness for work and reduce the likelihood of
any relapse in their condition.

6.2 If, following a return to work, there is a need for further intervention a new
application will need to be considered.

7 EXCLUSIONS

7.1 Major areas of medical treatment and specifically those that are life threatening
(for example heart surgery, brain surgery, and cancer treatment) are catered for
by the NHS and are therefore are not included in the Scheme.

(October 2015)
7.2 Dental and cosmetic procedures are not included in the Scheme.

7.3 The Scheme has to maximise the benefits across the whole Service and as a
result where the cost of individual support is judged to be prohibitively expensive,
it will not be supported.

8 RESPONSIBILITY

8.1 The individual is the focal point for principle actions and activities up to and
including the intervention. The Service is only responsible, once agreed, for the
financial support for the medical intervention process. The employee is
responsible for making sure they fully understand any surgical implications, risks
and possible outcomes before agreeing to the treatment.

8.2 It is the responsibility of employees to apply for the Scheme however HR,
Occupational Health or the line manager may suggest this option as a supportive
measure.

8.3 The Service will not accept any liability for the success or otherwise of any
intervention or guarantee that it will support further intervention should that be
considered necessary at future dates.

8.4 Staff who apply for and are accepted for financial support will be expected to go
through with it. Any costs incurred (for example, cancellation fees, missed
appointments) would be passed on to the individual.

8.5 Individuals are expected to do all that they can to ensure their own speedy return
to work. Those who are deemed to have failed in this duty will be dealt with on an
individual basis, but may jeopardise their right to full or half pay entitlements.

8.6 The individual must give their GP (or other medical professional or practitioner)
written permission to disclose relevant medical information to Occupational
Health and any consultant. Occupational Health must be advised of this to allow
the free flow of medical information, in confidence, between medical
professionals.

9 FURTHER INFORMATION

9.1 The Medical Intervention Scheme budget is reviewed annually. In the event that
the budget is exhausted, the HR Manager will raise this with the Service
Management Board and Fire Authority to seek a funding review.

9.2 The Scheme will be reviewed regularly to ensure its effectiveness and whether it
represents best value.

9.3 There will be some cases where financial support is not agreed. The HR
Manager’s decision on the application of this Scheme is final, and there is no
right of appeal once a decision has been reached and notified to an individual.

(October 2015)
9.4 Where the NHS and other recognised bodies provide treatment in a reasonable
time then this will be used to the maximum extent before the provisions of this
Scheme are applied. Medical intervention becomes an option where the time
taken to achieve a satisfactory outcome is excessive (as defined by the Service)
or where an early intervention has a particularly therapeutic advantage and
would result in a speedy return to duty thereby a benefit to the Service by
improving attendance and efficiency at work.

9.5 In cases where physiotherapy or chiropractic treatment is the recommended

intervention, the Service will endeavour to refer the individual to a professional
practitioner in their area or of their choice, subject to cost and to the practitioner
meeting the necessary professional checks and qualification requirements. It is
the responsibility of the employee to ensure that any practitioner used is
appropriately qualified and insured to carry out the treatment.

9.6 By signing the Scheme Application Form the individual is giving consent for the
Service to share information about them with any provider contracted by the
Service to provide them with medical advice and/or treatment.

9.7 Any questions regarding the Scheme should be raised with Human Resources;
please see the Intranet for the relevant point of contact.

(October 2015)