Understand the links between work, health and well-being, and the role of stakeholders in adopting an organisational approach to employee well-being
Occupational health seeks to promote and maintain the health and well-being of employees, with the goal being to ensure a positive relationship between an employee's work and health. There are many benefits to occupational health; managing the health and well-being of people at work and having access to specialist occupational health practitioners is key to unlocking these benefits.
The factsheet outlines the benefits of occupational health services and looks at the professional groups providing specialist services, from doctors and nurses to physiotherapists and psychologists. Confidentiality and consent are central to the relationship between occupational health professionals and employees, and it's essential that employers uphold the legal and ethical guidelines surrounding the confidentiality of employee health. The factsheet concludes with a look at pre-employment health queries and what is legally permissible.
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HR professionals play a critical role in convincing organisations of the competitive benefits to be gained from proactive strategies. Effective management of the health and well-being of people at work contributes to performance improvement and increases competitive advantage, reduces unacceptable losses associated with ill health and injuries, lowers absenteeism, improves morale and reduces litigation costs. It also helps individuals with long-term health conditions and disabilities to fulfil their potential at work and assists employers in meeting their legal duties under equalities legislation.
We recommend the implementation of practical occupational health policies, tailored to circumstances. Senior managers must demonstrate commitment and provide leadership in formulating strategy, developing policies and monitoring performance. They must also ensure the necessary resources are available to implement policies. Health policies do not apply to large organisations alone; small and medium-sized enterprises need to tailor their response based on culture and resources.
What is occupational health and what are its benefits?
Occupational health (OH) is about how work affects a person’s health and how someone’s health affects their work.
Forward-thinking organisations recognise that managing their people is just as important as controlling financial and capital resources. Developing a healthy workplace culture and adopting a systematic approach to OH will contribute to an organisation’s success. For example, evidence suggests that there is a link between stock market price growth and having a great employee well-being programme.
The evidence review of Waddell and Burton has conﬁrmed that being in work is generally better for health and well-being than being out of work. Those in healthy and safe work (the majority) will live much longer than those out of work. If individuals move from work to worklessness, their risk of mortality rises and if they move back into work, it falls. Thus, individuals’ job (or jobless) level determines their life expectancy. Of course, this is the role of OH services to support employees in remaining at work or returning to work earlier – and thus contributing to the employees’ physical and psychological well-being.
Who provides occupational health services?
OH encompasses a range of professions from different disciplines. 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, occupational hygienists, ergonomists and OH technicians.
Only large organisations are likely to employ their own in-house OH professionals. Some, particularly those working in hazardous or safety-critical areas, may have a team comprising full-time OH nurses, physicians, technicians and administrative staff. Others may employ one or more full-time OH nurses, who might be supported by a part-time occupational physician carrying out medicals and other assessments. Many organisations, including some large employers in both the public and private sectors, 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.
Commercial OH providers range from individual sole practitioners, who often provide services to smaller firms, to large sophisticated companies delivering multidisciplinary support according to the client’s needs. 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. But 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. Both in-house and commercial services can be accredited.
The types of occupational health services that may be offered
The range of OH services an organisation decides to offer will depend on the nature of the employer’s business, but can include:
- assessing employees on long-term sick leave, advising on the likely timescale of the absence and promoting an effective return to work
- using a ‘biopsychosocial’ approach to recovery from sickness to help recognise the psychological, social and work issues that can act as barriers or facilitators to returning 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
- advising on ergonomic issues and workplace design
- introducing programmes to support the wider health and wellbeing of the workforce
- providing confidential health advice and counselling to employees
- 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
- assessing where a person’s work has affected their health and what action should be taken both to support the individual and prevent recurrence in other workers
- 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.
OH professionals may also advise employers on issues such as alcohol and drug misuse by employees, signposting individuals for external support in dealing with addiction, and offering confidential advice. However, it’s generally considered good practice that a third-party organisation is contracted if the employer introduces drug and alcohol testing to minimise the potential impact of loss of trust. The OH service will, however, be able to advise on the legitimacy and practicalities of drug or alcohol testing, the development of policy and on contacting respected third-party testing firms.
Generally speaking, OH doctors and nurses do not ‘treat’ patients – an exception being immunisation of healthcare workers – and do not duplicate the work of general practitioners (GPs). That said, there might be occasions where the OH doctor or nurse needs to liaise with an employee’s GP on issues relating to fitness for work. An employee will always need to agree to their GP 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.
Confidentiality and consent
Within an organisation, OH professionals will liaise with HR and health and safety managers. It’s also important that line managers feel able to approach OH to discuss concerns and issues; however, 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 and it is not the role of OH to find a spurious health reason for a dismissal when the issue should be dealt with by management. Any formal referrals by a manager of an employee 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 confidentiality of employee health information and it must be understood that as registered healthcare professionals OH physicians and nurses 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 is a genuine risk to the safety of others. Examples might include where the health professional suspects child abuse or where an individual ignores explicit medical advice that they are unfit to drive.
Employee health records must be kept separate from personnel records and should only be accessed by qualified health professionals, (OH clerical staff should sign confidentiality agreements in the same way as administrative staff at a GP surgery). It’s inappropriate for HR, health and safety 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 again this must be with their consent. Where disclosure consent is denied for something that may, for example, affect the employee’s safe operation of machinery, the OH professional may simply have to tell the employer that the employee is unfit for work.
An employer or manager will sometimes request OH to carry out an assessment of 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 for the report to be sent, then the employer or manager is entitled to make a management decision without it, which could, of course, be to the detriment of the individual.
Anyone undergoing an OH assessment should be clear about its purpose and what will be reported, for example to the employer or pension scheme. There should be ‘no surprises’. As the Faculty of Occupational Medicine advises: ‘The most transparent method of avoiding surprises is to explain the content of the report during a consultation and to offer to show the worker a copy before sending it to the recipient’.
There are occasions where OH or HR requires a medical report from an employee’s GP or treating physician (such as a consultant psychiatrist or orthopaedic surgeon). The OH or HR professional should only request relevant information (not the whole GP/medical record) and again the employee must consent to the report being written and sent. The Access to Medical Reports Act 1988 (AMR) applies to such reports and has specific rules about consent. The AMR applies where the doctor is responsible for the ‘clinical care’ of the worker, so does not normally apply to reports written by OH. However, OH reports are covered by similar duties of confidentiality and consent under professional codes of practice and data protection law with associated guidance from the Information Commissioner.
Pre-employment health enquiries
The employer may wish to make enquiries 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, data protection law and, importantly, the Equality Act 2010.
Under the Equality Act, questions concerning the health of job applicants should not be asked until a job offer is made which could be contingent on successful health clearance. The reason is that before the legislation came into force, an employer could ask any number of questions which might reveal an applicant’s health condition or disability and could (consciously or unconsciously) make a decision not to shortlist the individual based on stereotypical assumptions before the individual had been given the opportunity to demonstrate their capability to do the job. It is appropriate, however, to ask applicants if they need reasonable adjustments to the job-application process or interview (for example because they have a hearing or mobility impairment).
The health assessment should be fit for purpose and only ask for information relevant to the job. For example, for low-risk clerical jobs a simple health declaration may be appropriate. A more extensive health questionnaire (or even medical examination) should in general only be needed where there are specific health requirements – such as safety-critical work, healthcare and food preparation.
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.
Useful contacts and further reading
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.
GILBEY, A. (2014) The business case for OH. Part 1: making the business case for occupational health. Occupational Health [at Work]. Vol 11, No 2. pp14-16.
GILBEY, A. (2014) The business case for OH. Part 2: long live the ROI – making the data work for you. Occupational Health [at Work]. Vol 11, No 3. pp22-26.
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This factsheet was written by Dr John Ballard FFOM (Hon), editor of the journal Occupational Health [at Work] and last revised by the Society of Occupational Medicine.
The Society of Occupational Medicine (SOM) is the largest and oldest nationally-recognised professional organisation of individuals with an interest in health and work.
SOM membership is for anyone working in and around occupational health. SOM membership demonstrates a commitment to improving health at work, enhancing our members’ reputation and employability. Members are part of a multidisciplinary community – including doctors, technicians, nurses, health specialists and other professionals - with access to the information, expertise and learning needed to keep at the forefront of their role. Our members benefit from career development opportunities alongside practical, day-to-day support and guidance, through local and national networks that are open to all. SOM membership demonstrates a commitment to improving health at work, enhancing our members’ reputation and employability. Through its collective voice, SOM advances knowledge, raises standards and increases awareness to influence the future of occupational health.
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