Occupational Health

What is Occupational Health?

Occupational health (OH) is a specialist branch of healthcare concerned with the health of employees. The OH professional’s aim is to prevent work impacting on staff health and make sure that staff are fit to undertake the role they are employed to do both physically and emotionally.

Occupational Health is a service provided by the Oxford Health NHS Foundation Trust to support our employees and employees from outside contracts, offering advice, support and a proactive approach to overcoming barriers to work for those with health issues.

Work Health Assessment guidance

A Work Health Assessment (WHA) typically includes several components to assess a candidate’s physical and mental fitness for a specific role and is typically performed by an occupational clinician (nurse/physiotherapist).  The OH Clinicians are however a multidisciplinary team which includes, consultant physicians and nurses with specialist OH qualifications, nurses, physiotherapists, and clinical psychologist, all supported by an administrative team.

The components of a WHA include health questionnaires to gather information about the individual’s medical history, lifestyle, and any existing health conditions.

The purpose of these assessments is to ensure that a candidate is fit to perform the requirements of the job and to identify any potential health concerns that may impact their ability to work safely. However, it’s important to note that these assessments should not be used to exclude individuals from a role based on a disability or health condition.

The Equality Act places a duty on employers to make reasonable adjustments to accommodate individuals with disabilities, and WHA should not be used to discriminate against candidates based on their health status. Legalities surrounding WHA assessments vary by jurisdiction, but generally, employers must adhere to anti-discrimination laws and make reasonable adjustments for candidates and employees with disabilities.

Reasonable adjustments may include modifying the assessment process or providing accommodations to ensure that all candidates have an equal opportunity to demonstrate their abilities.

What is a work health assessment?

A WHA refers to the processes undertaken to assess whether the individual will be in a suitable role and working environment and its primary purpose is to help prevent work-related illnesses, injuries and the spread of disease or infection. The extent of the work health assessment will be dependent on the requirements and risks associated with the role and what the impact will be on the health and wellbeing of either the individual carrying out the role and/or any patients they may have contact with.

Importance of a work health assessment

Employers have a duty of care to their employees to ensure that they, and their workplaces, are in line with health and safety obligations and equality law.  Work health assessments help employers to identify and consider early on, any health condition or disability that may require:

• adjustments being made to the workplace to enable the individual to safely carry out the duties of the role
• restrictions being placed on their duties, for example, exposure prone procedures (EPPs) for workers who have a blood borne virus which may impact on patients in their care.

Minimum requirements – Complying with the Equality Act

When carrying out a work health assessment, employers must consider the requirements of the Equality Act. It is unlawful for employers to ask about an applicant’s health or disability prior to making an offer of appointment, for any reason other than the exceptional circumstances outlined within the Equality Act.

The Act also places a duty on employers to consider any reasonable adjustments (as far as practical) to ensure that people with disabilities are not disadvantaged during the recruitment process and, are treated fairly when considering working arrangements and the working environment.

The assessment process

It will be for the occupational health practitioner (or other suitably trained professional depending on local protocol) to ascertain whether there are any additional requirements or reasonable adjustments, that should be considered to ensure the safety and wellbeing of the individual and/or any patients they may be providing services to/or will have contact with. In more difficult or complex cases, successful applicants may need to be assessed by the occupational health service.

Occupational health will then process this information and send a clearance certificate to human resources to confirm the following:

• the individual can start work
• the individual can start work with reasonable adjustments being made – this will also include recommendations outlining what adjustments may need to be considered
• any immunisation and/or EPP clearance (where applicable to the role).

If no recommendations have been made by occupational health, the process should end at this point, and the appointment decision confirmed with the individual.

If a more in-depth WHA is needed, you will be contacted by an OH administrator to arrange either a face-to-face, MS Teams or telephone appointment.  The OH team determines what method of contact they feel is most appropriate for their assessment but will take into consideration any preferences you have where possible. Assessments usually last between 30-60 minutes. If you offered an appointment method you may find difficult to undertake, you can contact the department to discuss whether an alternative will be possible.

An OH clinician will ask you about any health problems or concerns you have and what treatment you are receiving.  They may ask you to describe the work you do currently and any difficulties there are at work due to your physical / mental health or other reasons.  They will also ask about your life outside of work. You may be referred directly to an Occupational Health Physician (OHP) for a clinical opinion on some occasions or following another OH clinicians’ assessment for further assessment and advice.  The OHP is a doctor with specialist expertise in Occupational Medicine.

The aim is to collect sufficient information to be able to give an accurate, objective, and useful advice and an OH opinion on your fitness to do your job and any adjustments to support you in work. 

Other information

Sometimes it is not possible to give advice and a clear opinion on your fitness after a single assessment.  The OH clinician may need information from your treating GP and/or Specialist. When further information from your treating GP or Specialist is required, for example about diagnoses, treatment plans, or prognosis, this will be discussed with you, and you will be given the opportunity to ask questions so that you give your informed consent and sign the necessary form for this Medical Report.  You have the right to see and comment on the report from your treating GP or Specialist before it is sent to occupational health. Access to the report will be provided by your GP or specialist. You are able to refuse for this report to be released to OH.

Considering reasonable adjustments

The Equality Act places a duty on employers to make reasonable adjustments for applicants or employees who have a disability. The aim of making reasonable adjustments is to reduce as far as possible, any significant disadvantages that may be presented to an individual with a disability that would not affect an able-bodied person. This may include reviewing how the employment is structured, removal of physical barriers or providing additional support to the individual, such as:

• making practical adjustments to the premises
• altering the person’s working hours
• allowing absences during working hours for medical treatment
• giving additional training
• providing special equipment or modifying existing equipment
• changing instructions or reference manuals
• providing additional supervision and support.

In most cases, adjustments will be easy and inexpensive to implement. Further information about the factors employers will need to consider can be found in Appendix 1. Additional guidance on making reasonable adjustments can be found on the Equality and Human Rights Commission website and there are many examples of adjustments detailed in guidance available on the NHS Employers website.

Risk assessment

Employers are also legally required to undertake the necessary assessments to effectively manage any risks to the health and safety of employees, patients, and others on their premises, under the Health and Safety Act. A risk assessment should:

• identify any hazards that exist in a workplace
• assess how likely these hazards are to cause harm to workers, patients, and others on the premises
• identify any preventative or control measures that will need to be considered.

For more information on managing risk visit the health and wellbeing section of the NHS Employers website.

Additional considerations

Immunisations: requirements for healthcare workers

Employers have an obligation to ensure that healthcare workers do not pose a risk of infection to patients. Similarly, it is essential to ensure that workers are protected from infection by patients.

The requirements to ensure immunisation against common communicable infections and biological hazards will be dependent on the individual’s role and the risks of exposure that their role may pose.

Employers must refer to the Department of Health and Social Care’s Green Book which sets out the standards that determine which vaccinations are required for different healthcare workers.

Health professionals and immunisation practitioners themselves can register to receive a vaccine update from UK Health Security Agency England on vaccination requirements.

Further information relating to infectious diseases and their prevention can also be found on the NICE website.

Exposure prone procedures

Additional screening may be needed for workers involved in exposure prone procedures (EPPs), patient care, patient contact or body fluid sample handling. This screening should be relevant to the job hazard and risk profile and, must be undertaken in accordance with the relevant guidance.

Individuals carrying out EPPs have a professional duty to ensure that they are tested and assessed for HIV, hepatitis B and hepatitis C. If at any time they should acquire or be at risk of acquiring any of these infections, they must refrain from carrying out any work that involves an EPP and inform (in confidence) a member of their occupational health team. All testing must be carried out with the individual’s informed consent.

Access to Work Scheme

In addition to attending occupational health, if you need significant adjustments, Access to Work is a government organisation who helps employees with physical or mental health conditions or disabilities. The support you may get depends on your needs and you make any application directly to them. In some cases, financial assistance is made available through the scheme which will help the employer take steps which may have otherwise been unreasonably expensive to consider. This is something that may also be discussed at your appointment. Further information about Access to Work can be found on the gov.uk website.

Decision making

Occupational health has a duty to provide specialist and confidential advice to both the prospective employee and the employer. The decision to appoint an individual ultimately sits with the recruiting manager, therefore they will need to ensure that:

• the health clearance process has been completed and all relevant information has been considered
• a risk assessment has been carried out to identify any reasonable adjustments that may need to be considered for the post
• advice has been sought from all the relevant departments such as, HR, occupational health, and health and safety to ensure all reasonable adjustments have been fully considered and, where appropriate can be put in place.

If the recruiting manager chooses to appoint an individual, despite concerns being expressed by the occupational health service, the manager will need to record their justification for any such decision.