Occupational health: what the specialty covers, fitness for work and workplace health

Occupational health aims to prevent work-related illness and injury, assess whether people are fit for the work they do or want to do, and support those with health problems or disabilities to stay in or return to work. The Faculty of Occupational Medicine describes its vision as healthy working lives for all and says everyone of working age has the right to benefit from work without putting themselves or others at unreasonable risk.

The workforce includes occupational physicians, who are doctors with specialist training in occupational medicine, occupational health nurses, occupational hygienists, physiotherapists and psychologists. The HSE points employers to guidance on buying support from occupational health professionals and on assessing their competence, which is a reminder that quality varies between providers.

Occupational health practitioners advise employers and workers; they are not your treating clinician. Their role is to explain how health affects work and what adjustments could help, with your consent for what is shared.

• Pre-employment and pre-placement health questionnaires or assessments for roles with physical, mental or safety demands.

• Health surveillance for workers exposed to hazards such as noise, vibration, dust, chemicals or skin irritants.

• Fitness-for-work and fitness-to-drive assessments in safety-critical roles.

• Management referrals for people with sickness absence, long-term conditions or workplace stress.

• Advice on reasonable adjustments and phased returns after illness, injury or surgery.

• Vaccination and exposure management, for example for healthcare staff or lab workers.

• Health promotion, including ergonomic and wellbeing programmes.

The HSE sets out that employers are required by law to prevent physical and mental ill health in workers that might arise from business activities, with risk assessment as the starting point. This includes implementing health or medical surveillance when necessary, ensuring workers are medically fit to do the role, and reviewing the risk assessment when a worker returns following sickness absence or declares a health condition.

Equality legislation also applies. Where a worker has a health condition or disability, employers are expected to consider reasonable adjustments, and occupational health advice helps to define them.

The HSE also says that actions aimed at general wellbeing should not be prioritised over the legal duties and should be based on workers’ needs and evidence.

Assessments vary with the job and hazard. Common elements are a health questionnaire, blood pressure, height and weight, vision and hearing tests, and lung function testing for dust, fume or allergen exposure. The NHS describes spirometry as a test that measures how much air you can breathe out in one breath, done by a healthcare professional using a spirometer with a mouthpiece and a nose clip, and notes it may involve repeating the test several times.

Preparation for spirometry may include not smoking for 24 hours, avoiding a large meal for 2 hours and avoiding alcohol for 4 hours beforehand, according to the NHS. Other surveillance tests include audiometry for noise, skin checks for dermatitis and symptom questionnaires for hand-arm vibration.

GOV.UK explains that since 27 January 2022 a fit note is needed after 7 days of sickness to claim benefits or Statutory Sick Pay, and that fit notes can be certified by doctors, nurses, occupational therapists, pharmacists and physiotherapists. A fit note can say you are not fit for work or may be fit with changes, such as phased return, altered duties, amended hours or workplace adaptations.

Occupational health can bridge between the fit note and the workplace by explaining what is realistic in the job, suggesting adjustments and advising on a return-to-work plan. A report should only go to the employer with your agreement, and you may ask to see it first. It is advisory; the employer decides what to do.

Occupational health is mostly arranged by employers, either in-house or through an external provider. Large NHS trusts and public bodies have their own departments, while many private-sector firms buy services from an occupational health company. Individuals do not usually self-refer, though some independent providers offer private assessments for fitness certificates, pre-employment checks or second opinions.

If your employer does not have occupational health, ask your GP or practice team for advice, and ask your employer whether they could commission a referral. Check who the client is, what will be reported, what is confidential and whether you have a right to see a report before it is sent.

Occupational health is not an emergency service. For a workplace injury, chemical exposure, severe breathlessness, chest pain or collapse, call 999. For suicidal thoughts, use 999 or A&E, or call NHS 111 and choose the mental health option. If you have breathing problems or skin changes that you think are work-related, see a GP and report them to your employer or safety representative.