Occupational health (OH) is about how work affects a person’s health and how someone’s health affects their work.

The evidence review of Waddell and Burton has confirmed that being in work is generally better for health and wellbeing than being out of work. If individuals move from work to worklessness, their risk of mortality rises and if they move back into work, it falls.

For more on issues related to OH, see our factsheets on health and safety at work, absence measurement and management, wellbeing, mental health and stress.

OH encompasses a range of different professions. The two most visible are OH doctors and nurses, who should have specialist qualifications in either occupational medicine or OH nursing. Others include OH physiotherapists, occupational psychologists and occupational hygienists.

Most organisations outsource their entire OH function to one of the many commercial OH providers. Others will engage the services of a provider as and when needed. A minority of large organisations have an in-house OH service.

The decision of whether to employ an in-house service or outsource to a commercial provider will depend on many factors, not least the size of the business, nature of the work and the location and distribution of the workforce. To ensure high-quality OH provision that meets appropriate professional standards employers can look for services accredited with the SEQOHS (Safe, Effective, Quality Occupational Health Service) scheme.

The range of OH services an organisation decides to offer will depend on the nature of their business, but can include:

• Assessing employees on long-term sick leave and promoting an effective return to work.
• Assessing fitness to work regarding ill-health capability dismissal or ill-health retirement.
• Helping employers fulfil their duties under the Equality Act 2010 (including disability, pregnancy and age discrimination).
• Advising on temporary or permanent changes to the work or workplace (‘reasonable adjustments’) to enable someone with a physical or mental health condition or disability to work effectively and safely.
• Undertaking and interpreting pre-employment or pre-placement health assessments (see below).
• Carrying out specific assessments to determine fitness for work in safety-critical environments – such as transport, food safety and clinical healthcare.
• Introducing programmes to support the wider health and wellbeing of the workforce.
• Advising employers on preventing or minimising exposure of workers to hazardous agents – such as noxious chemicals or excessive noise.
• Undertaking ‘stress audits’ and advising employers on measures to control risks to mental health, such as excessive pressure at work, bullying and harassment.
• Performing statutory health surveillance where this is required by law, such as when workers may be exposed to hazardous substances, noise or vibration.
• Helping compliance with other health and safety regulations, including duties to report occupational injuries and diseases under RIDDOR.

Generally, OH doctors and nurses do not ‘treat’ patients – an exception being immunisation of healthcare workers – and do not duplicate the work of GPs (general practitioners). However, there might be occasions where the OH professional needs to liaise with an employee’s specialist medical practitioner about their fitness for work. An employee will always need to agree to providing information to OH (see below).

Treatments recommended by an OH service to help absent employees return to work are free from income tax or national insurance up to an annual cap of £500 per employee.

Within an organisation, OH professionals will liaise with managers and HR within the bounds of patient confidentiality. Managers can approach OH to discuss concerns and issues, although discussions about an individual employee’s health should be restricted to issues relevant to their fitness to work. Managers should be aware that any conversations they have with OH might be noted in the OH records. It’s inappropriate for managers to have ‘off the record’ discussions about an employee’s health. Any formal referrals by an employee's manager to OH should be made with the individual’s informed consent with open and full disclosure of the reason.

There are both legal and ethical issues on maintaining the of employee health confidentiality information. Registered healthcare professionals are required by their regulatory bodies to preserve medical confidentiality and only reveal health information to third parties with the individual’s informed consent. The exception to this is by court order or ‘disclosure in the public interest’ where the individual has refused consent to disclose information and there’s a genuine risk to the safety of others.

Employee health records must be kept separate from personnel records and should only be accessed by qualified health professionals. It’s inappropriate for HR and line managers to have access to employee health records, and information about an employee’s health should only be disclosed to them with the individual’s express and informed consent. It may often be in the best interests of the individual for information to be disclosed, for example, to be able to make a ‘reasonable adjustment’ to help overcome the occupational effects of a disability, but their consent is crucial.

An employer or manager will sometimes request OH to assess an employee’s fitness for work and produce a report. An employee must consent to the assessment and also to the sending of the report. However, if the employee refuses consent, then the employer or manager is entitled to make a management decision without it.

There are occasions where OH or HR require a medical report from an employee’s doctor or treating physician (such as a consultant psychiatrist or orthopaedic surgeon). Only relevant information should be requested (not the whole medical record) and again the employee must consent. OH reports are covered by similar duties of confidentiality and consent under professional codes of practice and data protection regulations.

Pre-employment health enquiries

An employer may wish to ask about the health and fitness for work of a job applicant using a pre-employment or pre-placement health questionnaire. Once again, the employer and an OH service carrying out the assessment must ensure compliance with medical confidentiality and data protection law.

Health questionnaires should be designed and interpreted by OH professionals. Non-healthcare managers (including health and safety practitioners) should not be involved in the interpretation or even the initial screening of pre-employment health assessments. Many commercial OH providers will be qualified to undertake such assessments if there is no in-house resource, and the work can readily be outsourced to them.

Contacts

Acas - Using occupational health at work

Council for Work and Health

Royal College of Surgeons (advice on returning to work after surgery)

Society of Occupational Medicine

Books and reports

Faculty of Occupational Medicine (2017) Good occupational medical practice 2017. FOM.

Kloss, D. and Ballard, J. (eds) (2012) Discrimination law and occupational health practice. London: The At Work Partnership.

Journal articles

Howlett, E. (2019) Majority of UK workers don’t have access to occupational health. People Management (online). 4 July.

CIPD members can use our online journals to find articles from over 300 journal titles relevant to HR.

Members and People Management subscribers can see articles on the People Management website.