Dr Maze


regular comment for managers on workplace health issues

Fit for work – What does it mean?

Here is the outline of my lecture last week. Hopefully it will help you to make best use of your business OH resource.

What  we need to consider:

  • Purpose of medical standards/guidance
  • Job description
  • Employee’s medical condition
  • Scope for job modification
  • Legal compliance
  • Business Protection /Reputation Protection /Loss Control

If we get it wrong:

  • Sickness Absence
  • Accidents
  • Legal & Insurance Claims
  • Poor Decision Making
  • Poor Customer Service
  • Difficult Working Relationships
  • Low Morale & High Staff Turnover
  • Low Productivity & Poor Quality
  • Lack of Innovation & Creativity

Costs of ill health to the employer:

  • Sick pay, pension fund contributions if IHR
  • Recruiting, training, assessing replacement
  • Management and investigation of absence
  • Insurance, litigation and compensation
  • Loss of experienced and skilled staff
  • Low morale

Costs of ill health to the employee:

  • Physical and mental pain and distress
  • Financial loss short/long term
  • Possible career loss
  • Loss of social standing and interaction
  • Loss of daily/weekly structure

“Fit” – to do what?

  • Attend/Handle Pressure?
  • See/Listen/Talk?
  • Sit/Stand/Walk?
  • Think/plan/Make decisions?

 The referring manager should:

  • provide a Job Description that lists the activities and tasks of the role
  • clearly and realistically distinguish between essential vs non-essential elements
  • indicate the scope for job modification
  • indicate the scope for alternative roles/redeployment

 Do the Job Tasks involve:

  • Standing / Walking/ Lifting / Carrying
  • Confined Spaces /Climbing Ladders / Working at Heights
  • Chemicals / Biological Agents
  • Skin or Respiratory  Irritants / Sensitisers
  • Dangerous Machinery / Vibrating Tools
  • Dust or Fumes
  • DSE  / Computer Work / Prolonged Sitting
  • Travel  – UK or Abroad / Vocational Driving
  • Work Pressure / Demanding Job

Legal compliance:

  • The legal position of medical standards
  • Disability Discrimination Act 1995
  • Human Rights Act
  • Health & Safety at Work Act 1974
  • Management Regs 1999
  • Working Time Regs
  • Sex Discrimination Act 1975
  • Employment Rights Act 1996
  • Freedom of Information Act
  • Maternity & parental leave Regulations
  • Pension schemes
  • Common law (Personal Injury Claims)
  • Relevant Case Law

Disability Discrimination:

  • Who decides? – Employment Tribunal; OH can only offer a tentative opinion
  • Definition of disability
  • Direct and indirect discrimination
  • Conflict with other legislation – H&S and criminal law have precedence
  • Reasonable adjustments
  • Disability related discrimination
  • When does the DDA not apply?

Individual variation:

  • Individual assessment
  • Risk assessment
  • Tolerance of symptoms
  • Reasonable adjustments

An Acceptable Risk?

You have to weigh up:

  • Cost of sickness absence
  • Cost of training vs loss of performance
  • Cost of medical support or assessment
  • Cost of IHR or injury awards
  • Opportunities for redeployment
  • Pressure to avoid IHR or reduce sickness absence

What can OH assessment offer? At:

  • Recruitment
  • Absence
  • Rehabilitation after absence
  • Health surveillance
  • Health promotion
  • Retirement


  • Know workplace
  • Assess job requirements
  • Liase with management
  • Establish standards
  • Review health declarations
  • Examine as required
  • Advise on disability
  • Advise on job adjustments

Sickness Absence

  •  Early meaningful advice helps; so refer early, rather than late
  •  Early intervention
  •  Influence early return (employee, health providers, manager)
  •  Remove the barriers to resuming work
  •  Managed rehabilitation
  •  Focus on ability not disability
  •  Functional ability assessments
  •  Adjustment assessments (DDA)
  •  Identify IHR cases early
  •  Case Conferences (Attendance Reviews)
  •  Review patterns
  •  Consider policies
  •  Agree parameters
  •  Assess referrals
  •  Liaise with GP/specialist
  •  Submit reports
  •  Monitor & review
  •  Case conferences
  •  Job modification
  •  Graduated return to work

Rehabilitation after absence

  • Assess
  • Investigate
  • Functional evaluation
  • Intervention
  • Co-operation

Health Surveillance

  • Identify risks
  • Education
  • Screening
  • Modification of exposure
  • Monitor & review
  • Risks:
    • Noise
    • Lead
    • Ionising radiations
    • Asbestos
    • Driving
    • Diving
    • Manual handling
    • Heights
    • Shifts
    • Allergens

 Health Promotion may influence attendance at work

  • Identify target population
  • Identify issues
  • Coronary risks / Mental health / Musculoskeletal / Diet
  • Screening
  • Workplace / Consultations / Courses / Ad hoc
  • Education
  • Leaflets / Reports / Special campaigns
  • Referrals


  • Know pension regulations
  • Company policies
  • Criteria
  • Assess
  • Diagnosis
  • Reports from GP/specialist
  • Review treatment
  • Prognosis
  • Advice to management
  • Job adjustments
  • Monitor & review
  • Recommendation

Types of Referrals & Reports

  • Referral to Occupational Health
  • Referral to Occupational Physician
  • Referral to Specialist
  • Reports from GPs
  • Reports from Specialist

When To Refer

  • Sickness and Absence
  • Recurrent short spells of absence causing commercial concern
  • Prolonged sickness and absence
  • Combination of both
  • Fitness for Work
  • Report After Accident at Work
  • Before Job Transfer / Modification / Promotion
  • Suspicion that health may be impacting on work performance.
  • Suspected Alcohol or Drug Misuse

 Referring manager should provide:

  • Date when sickness absence commenced
  • Attendance record
  • Diagnosis on medical certificate (if known)
  • Other relevant information, particularly if the employee is unlikely to mention it
  • Specific requests

 What managers should ask

  • Is the employee fit to undertake their current role?
  • If the individual were not fit to fulfil their role, would adjusted duties or temporary redeployment apply?
  • Is the performance significantly affected by ill health and how long is this likely to continue?
  • Is the ill health work-related?
  • Likely date of return to work?
  • Is the employee likely to render reliable service in the future?
  • Is it likely that an employment tribunal would consider that this case falls within the scope of the Disability Discrimination Act and if so what adjustments should be considered?
  • If the individual is not fit to return, is ill health retirement appropriate?

What NOT to ask

  • What is the precise medical diagnosis? You need to know what he can/can’t do.
  • Can we fire this skiver?
  • If the individual is not fit to return, is ill health retirement appropriate?
  • What treatment is this person on?
  • GP says he’s not fit, but we need him to do xyz, can you make him fit?

Reports requested by OH from treating doctors

  • Request a medical report on the present condition and further information on:
  • Guidance on a diagnosis
  • Progress of the current condition
  • Any current residual disability
  • Ongoing medical review &/or treatment
  • Sight of appropriate specialist reports relating to the current condition
  • Any further advice that we can give the company, such as a rehabilitation programme
  • Likely return to work date

 Management Reports

These are advice to the manager on medical capability and should not contain personal medical information.  They should give advice/opinion on whether:

  • the employee is fit to work in their contractual/current role,  in a restricted role (list adjustments required) or is unfit for all work at present (if possible, estimate date for return to work)
  • the employee is permanently incapacitated [recommend ill health retirement]
  • a rehabilitation programme is recommended (give details)
  • the employee needs treatment/review by a physiotherapist/counsellor/specialist
  • the company should consider funding this referral or whether the employee should seek referral via his GP
  • a medical report was requested from the employee”s GP/Specialist
  • the ill health is likely to be work related
  • there is/is not an underlying ill health problem that may affect future performance
  • the employee has have a disability that is likely to be considered to fall within the scope of the Disability Discrimination Act
  • a risk assessment should be undertaken (give details)
  • a further review is necessary (when?)

Fit For Work? – Over To You!

Filed under: Uncategorized

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