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Occupational Health Standards.

Frequently Asked Questions

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The Royal College of Physicians provides detailed guidance for occupational health practitioners 1 which incorporates all applicable legal and medical practice requirements.  This guidance defines mandatory minimum standards and offers best practice suggestions which make the occupational health assessment process largely standardised and repeatable from one occupational health practitioner to the next.  The Management Referral and Employee Consent forms, carefully and comprehensively completed by the referring manager, are fundamental to this process.

Occupational Health Standard

Referring managers do need to invest in learning and complying with the process.  For the first one or two referrals it can feel unfamiliar, even over-engineered, but it is necessary to meet minimum standards.

The amount of investment required by the referring manager to learn the process can be significantly reduced by occupational health providers who:

  • Invest in familiarising themselves with the referring manager’s prior level of knowledge, learning and working styles and adapting accordingly.
  • Make their practitioners available to familiarise the referring manager with their process and make time to discuss the application of the process to new and complex cases.
  • Reflect on how each case progressed and use lessons learned to streamline, refine and improve their process for next time.
  • Use technologies with which the referring manager is already likely to be familiar.

At best, the occupational health practitioner has an incomplete brief to satisfy.  At worst, the employee provided consent without knowing the purpose for which their health information will be processed; a breach of the Data Protection Act.

Occupational health standard.  The occupational health practitioner should return the referral form to the referring manager and request that they specify the questions to which they require answers.  The occupational health practitioner should also offer their guidance where needed (e.g., a quick telephone call) to help the referring manager define the questions they need answering.

This is a common dilemma which features regularly in occupational health practitioner discussions.  Other “off the record” disclosures include; employees coming into work hung over, posting active attendance at a social or sporting event on Facebook or having a second job whilst sickness absent, etc.   It’s a dilemma because:

  • The referring manager is disclosing information about the employee which is not on the referral form and that means the employee has neither consented to sharing it nor to the expansion of the scope of the assessment.
  • The information can often indicate a conduct issue (i.e., a breach of the employee’s contract of employment or company policy) rather than a health condition relevant to the referral and is something which should be addressed directly by the line manager rather than indirectly by the occupational health practitioner.

Occupational health standard.

The occupational health practitioner should ask the referring manager to document the information either on the referral form or another document / email and obtain their employee’s consent to its disclosure prior to sending on to the occupational health practitioner.   The occupational health practitioner should also offer their guidance where needed (e.g., a quick telephone call) to help the referring manager position or frame the information in the referral form.  Otherwise they must decline to include the information in their assessment or to change the scope of the assessment.

Of course, the employee may volunteer this information during the assessment, and if it is relevant to the health conditions being assessed (e.g., it is causing or aggravating the condition) then it might usefully inform the assessment and be included in the assessment report subject to the employee’s consent.

The referring manager is forewarning / describing how the employee may behave during the assessment, e.g., the employee may become highly emotional about a certain subject or they may be defensive, etc., 

Occupational health standard.

The employer is sharing their own opinion rather than confidential information about the employee so there isn’t a breach of confidentiality.  Such information can be very useful for the occupational health practitioner in preparing for a successful assessment. 

Occupational Health Standard.  The employee has consented to this question being asked, so the occupational health practitioner can seek and disclose this information to the extent that it is relevant to the employee’s health condition, its impact upon their performance, and any recommended adjustments.

As best practice, the occupational health practitioner should also offer the employee the option of having advance sight of the assessment report and the opportunity to request the deletion of confidential information before consenting to the release of the report to the referring manager.

The occupational health practitioner cannot assess the employee’s competencies, skills and experience, this is the responsibility of the manager.

Occupational health standard.  The occupational health practitioner should assess the employee’s fitness for work and report this assessment and any recommendations for adjustments back to the manager.

The occupational health practitioner cannot recommend dismissal or re-deployment, even if this question is asked on the referral form.  It is for the employer to decide whether their employee’s capability is so impaired that there is no alternative but to re-deploy or dismiss.

Occupational health standard.  The occupational health practitioner should advise which job functions the employee is incapable of performing after considering all possible adjustments and may offer the opinion that the employee is unfit to do the job if no adjustments can be recommended or after there has been a reasonable attempt to make adjustments.

Analogous requests can also include, “Can you flag which adjustments are must haves and which are nice to haves?” and “can you remove the recommended adjustment because we don’t want to discuss it with our employee”. 

Occupational health standards.

The occupational health practitioner will recommend possible adjustments.  All recommended adjustments will help to reduce disadvantage experienced by your employee due to their health condition or help to reduce a risk to their health.  It is the employer’s responsibility to decide which of these adjustments they will implement (i.e., which adjustments they deem reasonable) based upon their; detailed understanding of the job, the team, the needs of the organisation, cost and feasibility.  The section elsewhere on this page entitled How to Use Your Occupational Health Assessment Report provides guidance on how to make the decision.

This is a frequently encountered dilemma which often leaves the occupational health practitioner feeling conflicted.  It includes situations where the employee:
  • Confides that their line manager is a cause of stress or is likely to be antagonistic towards implementing the adjustments.
  • Is concerned that the adjustments will significantly reduce their contribution to the organisation and their career prospects.
Occupational health standard. The occupational health practitioner should first assess whether this is an exceptional situation where the adjustments are clearly in the employee’s interest, to ensure their safety from themselves or from others (e.g., suicide, self-harm or abuse).  If yes, then the occupational health practitioner has an ethical duty to override the employee’s demand and communicate the recommendations to the referring manager. However, in the vast majority of situations, job adjustments are unlikely to minimise such exceptional levels of risk.  So the occupational health practitioner is left with no option but to accede to the employee’s demand and omit the recommendations from the assessment report.   But in doing so, the occupational health practitioner should:
  • Ensure that the employee has made an informed choice by carefully explaining the risks of not recommending and implementing the adjustments.
  • Record clear and specific clinical notes of such advice including the risks which have been explained.
  • Satisfy themselves that they will be able to justify their decision to an employment tribunal or regulating body, should the employee regret their instructions at some stage in the future and bring a health related claim against their employer.

Occupational Health Standard

The assessment and recommendations contained in the report should balance a number of considerations including:

  1. Legal Compliance.  An opinion or recommendation which is necessary for the referring manager to meet the standards defined by legislation such as the Health and Safety or Equality Acts or applied by enforcement agencies such as the Health and Safety Executive should be included, even if it makes for difficult reading.  Providing a reference to the relevant standard or court judgement can help with understanding and acceptance.
  2. Compliance with medical standards, ethics and professional codes of practice.  Collectively this means that the occupational health practitioner has a “hippocratic oath” to recommend sufficient adjustments to protect and care for the health and wellbeing of the employee or reduce any disadvantage caused by a health condition.  At the same time, the occupational health practitioner will be careful to limit their recommendations to what might be reasonable for the referring manager to implement.  The occupational health practitioner identifies these limits by keeping up to date with adjustments typically implemented by employers and / or regarded as reasonable by employment tribunals and enforcement agencies.  Even so, the occupational health practitioner might still make a recommendation which exceeds an organisation’s capacity to implement.  If it does, then the organisation can decide not to implement it.  The section on this page entitled How to use your Occupational Health Assessment Report provides guidance on how to make that decision.
  3. Impartiality.  The first step in ensuring impartiality is for the referring manager to carefully and comprehensively complete the referral form, this will help to counterbalance the information, emphasis and context the employee will be providing directly to the occupational health practitioner during the assessment.  The second step is for the occupational health practitioner to ‘validate’ the information provided on the referral form and by the employee against their own medical understanding of the condition, any available GP or treating specialist letters and reports, and by using relevant health assessment tools.  In addition, as a third step, the occupational health practitioner typically adopts a non-judgemental approach when assessing information provided by the employee, but where information sources appear inconsistent or the employee appears in any way insincere, the occupational health practitioner should probe more deeply to establish a reliable and impartial assessment.  In some situations the occupational health practitioner may recommend commissioning a specialist report or examination.
  4. Satisfying the referring manager. Occupational health practitioners are mindful that an assessment or recommendation which makes for difficult reading risks being the last referral they ever receive from an organisation.  The occupational health practitioner will only take this risk when they deem it to be absolutely essential to protect the interests of the employer and the employee and of course, to protect their own continued ‘licence to practice’.

Line managers are responsible for their employee’s health whilst at work, for deciding what adjustments and support are reasonable, for ensuring reasonable adjustments and support are implemented and for monitoring their effectiveness.  To dispense this responsibility they can call upon support from functions such as; human resources (HR), health and safety, legal services and occupational health (OH).  Line managers might try and shift some of their responsibility onto an OH practitioner, particularly when the OH practitioner is in-house, always visible and apparently, always available.  However, whether in house or not, the role of OH does not extend to being a directly available, on demand, point of contact for employees or for working across the organisation to advocate and procure adjustments and support on behalf of the employee.  Reasons cited by OH practitioners include;

  • The requirement for OH to remain independent and not to support or advocate either one of the employee or employer more than the other.
  • The difficulty, for the OH practitioner, of anticipating the information they are likely to disclose on behalf of the employee prior to each communication with the line manager or other colleagues across the organisation, identify which of this information requires the employee’s explicit consent to disclose and then obtain the employee’s explicit consent to disclose it.
  • The dangers of the OH practitioner agreeing or being perceived to have agreed adjustments and support with the employee which are then rejected by the line manager and / or HR.
  • The dangers of OH becoming the target of complaints or grievances because of accidental or willful misunderstanding arising out of:
    • Separate communication threads between the line manager, the employee other colleagues across the organisation and the OH practitioner.
    • Different expectations of the scope of the role of the OH practitioner across line managers and other colleagues.

OH Standard

The OH practitioner could describe the role of occupational health to the employee as a way into requesting that their line manager considers a formal referral to occupational health. 

The OH practitioner could also make an offer to their main organisational contact (usually someone with HR responsibility) to provide relevant content for inclusion in; internal communications, management education and training, and organisational policies and procedures.

Features of an effective occupational health assessment include:

  • Empathy; the employee feels listened to and taken seriously.
  • Support; the employee feels that guidance and advice they received during the consultation and recommendations for adjustments and support included in the assessment report are helpful.

If the employee feels that their line manager and / or HR are not so empathetic and supportive then they may revert back to the OH practitioner for advice or even to request intervention on their behalf.

The OH practitioner should not offer to intervene on behalf of an employee;

  • The practitioner must remain independent and not support or advocate either one of the employee or employer more than the other.
  • The practitioner may not be fully aware of discussions, agreements and disagreements between the employee, line manager and HR since the previous assessment and by intervening they risk adversely affecting internal processes as well as adversely affecting their own credibility.

Occupational Health Standard

The OH practitioner could describe the role of occupational health to the extent that it supports the following advice to the employee:

  • The employee should raise their concerns with their line manager / HR.  They might also request another referral to occupational health where the effectiveness of adjustments and support implemented to date can be assessed and any further recommendations can be made.
  • The practitioner will await receipt of a formal referral.  In the meantime the practitioner they will not proactively inform the line manager / referring manager that the employee has contacted them for advice and support.

The HSE are clear that your legal obligations continue to apply when your employee is working from home2.  The HSE state that homeworker DSE-Workstation assessments are required for employees who:

  • work at home on a permanent or long-term basis;
  • routinely split their time between their workplace and home (sometimes called hybrid working).

We are unable to find any regulation or legal precedent which defines “permanent or long-term” or “routine” homeworking.  The closest approximation we’ve found is a Unison distinction between “ad hoc” and “regular” homeworking where regular homeworkers spend 50% or more of their contracted hours working from home3.

Work Wellness recommend that you apply the definition of a DSE user provided by the Health and Safety (DSE) Regulations 1992, as someone using DSE daily and / or continuously for an hour of more.  So under this definition  a homeworker DSE workstation assessment would be required for an employee operating DSE workstation equipment at home for at least 1 hour per day.

One argument is that the Health and Safety at Work Act (1974) only places obligations on employers as far as it is reasonably practicable to do so and that it is unreasonable to expect employers to address every home working arrangement which risks or is causing discomfort and musculoskeletal injury.  The same commentator also points to Section 2(2)(d) of the Act which, when read in isolation, limits the employer’s obligations to “any place of work under the employer’s control” which apparently frees the employer from any obligation regarding DSE located in the employee’s home.

An alternative argument is that the wording of the Act reflects an age when homeworking wasn’t a consideration.  Recent statements from the HSE suggest that the Act is due for an update:

  • “Employers have the same health and safety responsibilities for employees working from home as for any other employees, including the duty not to charge for things done or provided pursuant to their specific requirements. If you have staff working at home, you must still manage the risks to their health from display screen equipment (DSE).4
  • “… companies need to make sure their (homeworking) staff have the ‘right kind of kit’ to prevent issues such as back injuries sustained from hunching over laptops.”
  • “… if companies need to provide particular kit and facilities for their employees to work from home safely and without injuring themselves, then ultimately they will need to do that and we will take enforcement action if they are unable to do that or choose not to.”

In the meantime it would be unwise to fall back on a literal interpretation of a single, out of date, Act and leave it to employment tribunals to determine whether that was sufficient to comply with all of your legal obligations.

  1. Ethics Guidance for Occupational Health Practice.  Faculty of Occupational Medicine of the Royal College of Physicians.  November 2018[]
  2. Protect home workers.  HSE.  Web site.  Last checked 28/06/2021[]
  3. Homeworking Guide.  Unison. June 2017.[]
  4. Working safely with display screen equipment.  6. Homeworking” HSE.  Web site.  Last checked 05/07/2021.[]