Publication
Medical Assessments
From Office of the Civil Service Chief Medical Officer
Published on
Last updated on
From Office of the Civil Service Chief Medical Officer
Published on
Last updated on
Most new entrants to permanent civil service positions are recruited by the Public Appointments Service (PAS). Individual departments also recruit their own staff independently of the PAS, once they obtain a licence from the Commission for Public Sector Appointments (CPSA).
Office based job applicants are asked to complete what is known as a “self-declaration form” by their employing department. This is a statement of whether they have a medical condition or disability.
If they indicate that they have a medical issue, they complete a more detailed online pre-employment health questionnaire on this website. This is accessed by clicking on the blue tab marked “pre-employment medical form” at the top right of this website’s public facing home screen. On receipt of a completed questionnaire, we may look for a doctor’s report and/or arrange an appointment, and then advise.
For technical/professional positions and positions with a manual work component (e.g. service officers, general operatives), candidates automatically complete a confidential pre-employment health questionnaire.
For a small number of positions, a physical examination is also required in addition to a health questionnaire. This mainly applies to prison officers.
Some positions require a baseline pre-employment audiogram. These are conducted by a nationwide panel of audiologists (not GPs). It is the candidates own responsibility to arrange this and submit this test. If you contact the CMO’s Office, we can advise on which of the three types of medical assessment (self-declaration only/health questionnaire/health questionnaire and medical examination).
Prison officers undergo a very detailed pre-employment medical. Prison officers complete a confidential health questionnaire and physical examination. The CMO’s office has specific published medical fitness standards for prison officers. There are specific standards in relation to vision and body mass index. They may be required to attend the CMO’s office for further evaluation.
(1) Establish whether the applicant requires a self-declaration/health questionnaire/health questionnaire and physical examination. The CMO’s office can advise on this.
(2) If they give a “yes” response to one or more of the questions on the self-declaration or their position automatically requires a health questionnaire, please ask them to complete this online. This can be completed by going to www.cmo.gov.ie, and clicking on the tab marked “Pre-Employment Medical Form” on the home screen.
(3) Once we receive this, we will advise you further on their fitness for their position. We may seek a doctor’s report and/or request them to attend for an appointment if there is a medical issue.
The main circular for sickness absence management Circular 12/2023 Management of Sick Leave. All HR professionals should be familiar with this. Sickness absence can broadly speaking be divided into two different categories, namely repeated short term absences and long term absences.
Where a civil servant has a pattern of short-term absence that has been identified as a matter of concern, they may be referred to the CMO as part of the overall management process.
Specifically, the CMO may assist management by clarifying whether the treatment of any chronic medical condition has been optimised, and assess whether any practicable work modification may help reduce absence.
Line managers and local HR units must be able to demonstrate proactive management measures in advance of making a referral, including holding at least one sick leave review meeting with the civil servant and supplying the CMO with the outcome of same.
Long term absences are generally defined as a continuous absence of longer than one month, although sometimes they are defined as a continuous absence of longer than two weeks. Circular 12/2023 requires automatic non-discretionary referral to the CMO’s office of all long term sickness absence cases after a maximum of 4 weeks duration. Where absences are attributed to work, they should be referred after 2 weeks duration and post maternity leave/career break absences should be referred immediately. Please note that the CMO’s office is not involved in location of work issues such as transfers or Working From Home (WFH) versus Working Onsite. It is for management to determine an employee’s location of work based on their business needs.
Employees may avail of a maximum of 6 months sick pay in a rolling 4 year period. This is made up of 3 months of full pay and 3 months of half pay. Once they have exhausted their 6 months of sick pay, they may receive up to 18 months of Temporary Rehabilitation Remuneration (TRR). Payment of TRR is predicated on there being a reasonable prospect of resumption with regular and effective service. This has both a medical aspect and a non-medical aspect. Hence, sick pay may extend to a maximum of 2 years.
However, if they are deemed to have a critical illness, they may receive enhanced benefits. Firstly, both full sick pay and half sick pay are extended from 3 months to 6 months (thus one year in total). TRR is then payable for a further one year, but may be extended by an additional two years. Thus, sick pay may extend to a maximum of 4 years if the absence is deemed to be a critical illness.
During a long term absence, a CMO referral is only one component of successful workplace rehabilitation. Circular 12/223 requires both management and the employee to maintain regular contact with each other during the sick leave absence period. When the employee returns to work following a long term sickness absence, a return to work interview is mandatory to facilitate workplace reintegration. The longer an individual is out of work, the less likely their chances are of successfully resuming work.
Therefore employees should be encouraged to consider a gradual return to work as soon as they are fit to do so. Generally, an employee does not have to be 100% recovered from their condition to resume work.
The aim of workplace rehabilitation is to facilitate the early return to work of employees provided they are medically fit to do so. This is particularly important where an absence is attributed to work such as a workplace injury. We assist human resources in managing sickness absence and the employee with workplace re-integration.
The CMO’s office adopts a much broader approach than eligibility for sick pay and actively explores not just the medical but also the psycho social aspects of absence. Our consultations are typically much longer than a GP/hospital outpatient appointment and certain other occupational health services. If necessary, CMO staff also liaise with treating doctors to help resolve any differences of medical opinion. Hence, our approach is often different to regular medical consultations. In addition, we have knowledge of the workplace and have an ability to engage with the workplace that is not available to treating doctors.
Following a consultation, the CMO’s office can offer HR/management advice on:
Treating doctors are required to act as patient advocates. Where there is a conflict between the advice of the treating doctor and the CMO’s office about medical fitness for work, it is for management to decide whether sick leave is granted, whether paid or unpaid (Circular 12/2023). Thus, production of a medical cert does not imply an automatic entitlement to initiation or continuation of paid or unpaid sick leave.
1. Complete a CMO Case Referral Form and email this to the referrals email inbox
2. The importance of up to date background workplace information cannot be stressed enough, particularly if the absence is being attributed to a workplace issue. Lack of background workplace information can lead to significant difficulties. Where there are work performance issues, details of recent PMDS should be provided.
3. Based on the workplace information you provide us with, we will then triage the case into either a doctor or nurse appointment. It is for the CMO doctor or nurse to decide if a consultation should take place Face to Face or over the telephone. Certain types of sick leave referral will always require a Face to Face appointment.
4. Generally, we will advise that the individual is either temporarily medically unfit for work, fit for work or fit for work with accommodations. It is important to emphasise that if we reference possible workplace accommodations in our report, our medical report is advisory only, and the final decision on whether this is feasible or practicable lies with management. We have no difficulty with our report being routinely provided to an employee and we actively encourage this. You do not need to seek our permission to do so.
5. Where we recommend that management meet with a person, this should happen in a timely fashion. Particularly where there are workplace issues, the longer an individual stays out the greater the risk of disengagement and deconditioning from work.
6. It is vital in a long term sickness absence that management and employees maintain regular contact with each other either face to face or by telephone.
7. Once an individual has been found medically fit for work by the CMO’s office, with or without temporary accomodations, we generally do not see them for a future review appointment. Where an individual continues to submit certs it is for management to decide whether sick leave continues to be granted, whether paid or unpaid.
1. As per Circular 12/2023, management need to first meet with the employee to discuss their absence pattern, prior to CMO referral. Repeated short term absences should only be referred to the CMO office where following a meeting with the individual, they are attributing their absences to an ongoing medical condition.
2. Complete a CMO Referral Form. If the employee attributes their absences to work, we need details of this in the background workplace information section.
3. We can then advise as to whether they have an underlying chronic ongoing medical condition that may/may not result in their sickness absence being higher than normal, whether their treatment is optimised, and whether any work accommodation not already identified may be appropriate. It is important to mention that whilst an individual may be medically capable of regular and effective service, their previous absence pattern may continue. This is because in certain instances repeated short term absence patterns may relate to non- medical issues.
Standard sick pay for an employee is 3 months of full pay and 3 months of half pay in a rolling 4 year period. This may be followed by 18 months of Temporary Rehabilitation Remuneration (TRR). Hence, total allowable sick pay extends to 2 years. However, if an employee is deemed to have a “critical illness”, the duration of sick pay can be extended.
Firstly, full sick pay and half sick pay are extended from 3 months to 6 months (thus one year in total). Secondly, Temporary Rehabilitation Remuneration (TRR) is then payable for a further one year as per normal sick leave arrangements, but may be further extended for an additional two years (three years in total). Thus, overall sick pay may extend to a maximum of 4 years. The full Critical Illness Protocol (CIP) including the appeal process is summarised in Circular 12/2023 Management of Sick Leave.
This extended sick pay scheme may be accessed under the medical criteria route as advised by the CMO’s office (which has a medical appeal mechanism) or through a separate management discretion route (which as a management appeal mechanism). The medical criteria route is explained here. The management discretion route is outside the remit of the CMO’s office.
The case must have already been referred to the CMO’s office for occupational medical advice. The employee should ordinarily be under the current or recent clinical care of a hospital consultant. This excludes attendance at consultants for report preparation purposes or medico legal reports. Thus, it is not an absolute requirement that they be under consultant care, but it is quite unlikely that they have a critical illness if they are not under consultant care. The employee must have been deemed medically unfit for work by an Occupational Physician, and the medical condition must have at least one or more of the following characteristics-
There is an appeal mechanism for CMO CIP medical advice. The employee applies to their HR section, and then a new CIP Appeal Referral is made to here by HR. The appeal of CMO medical advice is by referral to an outside Specialist Occupational Physician.
Either the employee or management can initiate the CIP process. The employee applies to management using the proforma CIP application form. This is then referred to the CMO’s office for medical advice. Alternatively, if HR is of the view that the employee’s absence is due to an illness likely to meet the CIP criteria, HR can initiate the CMO Referral. Please note that there is no self –referral by employee’s for CIP. HR need to first establish that the employee is eligible to apply and then refer the case here.
Where an individual does not meet the above medical criteria, provided that an Occupational Physician has found them medically unfit for work, management still have the discretion to award extended pay. The criteria and process for this including the appeal process is outlined in Circular 12/2023. The CMO’s office is not involved in this process. Thus, although a person may not meet the above CIP medical criteria, provided the CMO’s office finds them medically unfit for work, management can still award extended pay under the protocol by using managerial discretion.
1. Complete a CMO Case Referral Form and email it to the CMO referral inbox
2. The CMO’s office will advise on whether the applicant is medically unfit for work, and whether they meet the medical criteria under the Critical Illness Protocol.
3. If we advise that the applicant does not meet the medical criteria, management still have the discretion to award extended pay under the management discretion protocol.
4. If the applicant wishes to appeal the CMO medical CIP decision, the process is set out in Circular 12/2023 Management of Sick Leave.
Retirement on the grounds of permanent medical disability is a major decision for both the employee and the employer. The cost to the employee is often substantial due to a significant future reduction in income, as well as the loss of the structure, social contact and purpose that work provides. The cost to the employer can also be substantial. Therefore, all applications are thoroughly assessed to ensure that fair and robust medical advice is given.
Nowadays, it is usually possible to offer workplace accommodation to enable the employee to continue at work, particularly office employment. With advancements in medical technology, thankfully it is now quite rare that an employee is permanently medically incapable of work on physical or psychiatric grounds.
The medical criteria for Ill Health Retirement (IHR) are detailed in Part 1 of Circular 22/2007. This circular is available under the “Health Circulars” section of this website. The criteria are
What these medical criteria mean is that the employee has a permanent physical or psychiatric condition that likely results in them being permanently incapable of work.
Please note that slightly different medical criteria apply to applicants who are members of the Single Public Service Pension Scheme introduced for new entrants from January 2013.
IHR refers to employees who are permanently medically unfit for work. A person who is temporarily medically unfit for work or who has not completed treatment does not meet these medical criteria. An employee can apply for IHR by contacting their HR section. HR then decides on the employee’s eligibility to apply for IHR. For example, there are minimum pensionable service requirements.
If the CMO’s office is seeing an employee on long term sick leave whom we feel meets the medical criteria for IHR, we will advise them to apply for ill health retirement. Ordinarily applicants for ill health retirement have been attending the CMOs office for an extended period of time, and workplace rehabilitation has been unsuccessful.
1. Clarify their entitlement if necessary to apply for IHR with Civil Service Pensions section as certain minimum periods of service are required. Note that different pension scheme rules apply to prison officers and post January 2013 new entrants.
2. Email case referral form to email referral inbox, with details of the applicants attendance, work performance including PMDS and if relevant interaction with others at work if relevant.
3. The CMO’s office will request that the applicant’s treating doctor completes an IHR (1) medical report form, and may also request an accompanying medical report. The cost of provision of medical reports lies with the applicant.
4. Almost all applications for ill health retirement are seen for a Face to Face appointment in Dublin.
5. The CMO’s office will then advise the employing department of whether the pension scheme medical criteria for ill health retirement are met.
6. If the CMO’s office advises that the applicant does not meet the medical criteria for IHR, then the applicant needs to be advised of their right of medical appeal within 30 days. See Section 7 Circular 22/2007. If the applicants appeal is unsuccessful, then the IHR process/CMO involvement is concluded
In circumstances where the medical criteria for IHR are not met, and the individual has decided not to return to work, they may wish to consider the Cost Neutral Early Retirement Scheme. The CSEAS (Civil Service Employee Assistance Service) or HR may be able to advise them in this regard.
In order to be promoted, transferred to another location or made permanent (established), a Civil Servant’s sick leave must be less than 56 days or 25 absences over a 4 year period. These limits apply on a pro rata basis to part time workers, or to individuals who have been employed on a full-time basis for less than 4 years. Discounting is detailed in Circular 13/2023 Assessment of Promotion and Higher Duties Allowance.
As set out in the Circular, almost all decisions on discounting are made locally by HR, and only very difficult or complex cases are referred to the CMO’s office. We cannot consider cases for discounting unless the case has been referred by a HR department, and the person is actually due to be promoted, is due Higher Duty Allowance or is involved in a transfer through central mobility. We cannot discount sick leave whilst someone is currently on sick leave. CMO advice is purely advisory, and the final decision rests with the employing department who factor in a series of other factors set out in the Circular.
1. Complete a case referral form and email to the referral email inbox. We can only advise on discounting certified sick leave where a promotion/Higher Duties Allowance/transfer under mobility is under active consideration.
2. Only refer especially complicated or difficult cases. Most decisions can be made locally.
3. Please attach an up to date current 4 year sick leave printout to the case referral form. This needs to detail the total duration of each absence, whether it was certified or uncertified, and what the certified diagnosis was.
4. If we request a medical report, this needs to detail the diagnosis and treatment for each individual absence the employee is seeking to have discounted, specifying the exact start and end dates. The treating doctor should be provided with a 4 year sick leave printout to facilitate this. A generic medical report that does not describe the medical reasons for individual absences is not helpful.
5. CMO advice is advisory only. The final decision lies with management who consider CMO advice alongside a series of other factors set-out in Circular 13/2023.
If a civil servant or prison officer sustains an injury at work and management designate this as an Occupational Injury/Disease (OID), the employee may be eligible to up to 6 months full pay and 6 months half pay, provided certain criteria are met. This is separate to their existing sick leave entitlement, but cannot be combined with Critical Illness Pay.
The employee is ordinarily required to complete an accident report form (ARF) which is also completed by local management. The role of the CMO’s office is to advise on whether any certified absence(s) are potentially linked to an OID.
When referring an OID, the background information section is crucially important. We cannot provide useful medical advice without full background workplace information. Where there is a time gap between the date of the OID and the date of commencement of sick leave, we need clarification on whether the employee resumed work in the meantime, or simply was not rostered on those days/was on annual leave etc.
On occasion, we receive medical reports that are written quite some time after the OID. It can be unclear as to whether the doctor examined the officer at the time, or is examining them for the first time now. Such reports are not helpful in advising whether certified absences are related to OIDs, incur expense for employees and use up treating doctor time.
Hence, instead we have a proforma medical report form for completion by the treating doctor that seeks to clarify whether they examined the officer at the time of the OID , what their findings were, and whether the condition has resolved or not. This is available for download from the “CMO Publications and Forms” section of this website. This proforma medical report form should be completed by the treating doctor. A generic medical report is not helpful.
1. Complete a CMO Case Referral Form and email to the referral email inbox.
2. We require a description of the incident, confirmation that the incident took place and a copy of the ARF (Accident Report Form)
3. If we request a doctor’s report, provide their treating doctor with our proforma OID medical report form for each OID episode. A generic medical report is unhelpful and should not be requested.
4. Our role is to advise on whether certified sick leave is related to an OID. The decision on whether an OID has occurred and whether to grant OID pay lies with management.