A report that says an employee is ‘fit with reasonable adjustments at work’ is not yet a useful Occupational Health opinion. The real value lies in translating a health condition, functional restriction and job demand into recommendations an employer can understand, test and review. Done well, this supports work participation without minimising risk or making promises that the workplace cannot realistically deliver.
For Occupational Health practitioners, reasonable adjustments sit at the meeting point of clinical assessment, employment practice, equality law, job design and practical problem-solving. They are also a common source of vague recommendations, confidentiality errors and avoidable disagreement. A structured approach makes decisions clearer, more defensible and more likely to help the employee remain in meaningful work.
Under the Equality Act 2010, employers have a duty to make reasonable adjustments where a worker is disabled, or where the employer knows or could reasonably be expected to know about the disability. Disability has a specific legal meaning: a physical or mental impairment that has a substantial and long-term adverse effect on normal day-to-day activities.
Occupational Health does not decide whether an employer has met its legal duty. Nor should the clinician present a legal conclusion as though it were a medical diagnosis. The Occupational Health role is to provide clear clinical evidence about functional impact, likely prognosis, relevant workplace risks and adjustments that may reduce disadvantage.
The purpose is not to create a special arrangement simply because someone has a diagnosis. It is to remove, reduce or manage the particular disadvantage created when a health condition interacts with the role, workplace or working pattern. Two employees with the same diagnosis may therefore need entirely different support.
For example, migraine may be managed effectively through predictable breaks and reducing exposure to particular lighting or screen glare for one employee. For another, the key issue may be a safety-critical driving role where sudden symptoms, medication effects and attack frequency require a more cautious assessment.
A diagnosis provides context, but it rarely tells you what adjustment is needed. An effective assessment explores what the employee can do, what they cannot currently do reliably, and which work demands create difficulty.
Ask about the tasks that matter. Can the employee concentrate for sustained periods, work at pace, travel, climb stairs, communicate with customers, use display screen equipment, lift safely, cope with noise, attend early shifts or respond to unpredictable demands? Establish the severity, frequency and duration of symptoms, including variation over a working week.
Then understand the actual job. A generic job title is not enough. “Administrator” may mean quiet home-based work for one person and continuous front-desk work in a busy clinical setting for another. “Driver” may involve local daytime routes, long-distance driving, loading duties, lone working or safety-critical responsibilities.
This is where clinical reasoning becomes practical. Consider the relationship between:
The distinction between essential and non-essential duties is especially valuable. Some tasks may be fundamental to the role and difficult to remove permanently. Others may be redistributed, delayed, adapted or performed differently with little impact on service delivery. Occupational Health should avoid assuming either outcome without understanding the workplace context.
A recommendation such as “consider flexible working” may be well intentioned but gives little practical direction. Better reports describe the functional reason, the proposed change, an appropriate timescale and a review point.
For an employee returning after a depressive illness, a more useful recommendation might be a temporary phased return with agreed hours, a gradual increase in workload, protected breaks and regular managerial check-ins. If open-plan noise and interruptions exacerbate concentration difficulties, suggest access to a quieter workspace or planned focus periods rather than simply stating that the employee is stressed.
Adjustments commonly fall into several areas: hours and patterns of work, duties and workload, equipment or physical environment, communication and management support, and time away from work for treatment or rehabilitation. The best option is often a combination of small changes rather than one dramatic intervention.
Be precise about whether an adjustment is temporary, trial-based or likely to be ongoing. A phased return is usually a rehabilitation measure, not an indefinite arrangement. Conversely, assistive software for dyslexia or a suitable ergonomic chair may be a longer-term adjustment with limited need for repeated clinical review.
Avoid presenting a recommendation as medically mandatory unless there is a clear clinical or safety basis. Use language that reflects the evidence: “may assist”, “is likely to reduce symptom exacerbation” or “a trial of the following adjustment is advised”. This allows the employer to consider operational realities while retaining the clinical rationale.
Reasonableness is context dependent. The same adjustment may be straightforward for a large organisation and difficult for a small employer with limited cover. Cost matters, but it is not the only factor. Practicality, disruption, available resources, the effectiveness of the adjustment, health and safety, and the nature of the role may all be relevant.
This does not mean that Occupational Health should reject useful recommendations because an employer might find them inconvenient. It means recommendations should be realistic, proportionate and connected to a defined disadvantage.
Consider an employee with inflammatory arthritis whose morning stiffness affects an early shift. A later start time may be effective where work can be covered and output is not time-critical. In a role requiring a fixed handover at the beginning of a safety-critical shift, other options may be needed, such as amended duties during the most difficult period, adapted equipment or a different working pattern.
Where a proposed adjustment could introduce risk, identify the risk and how it can be controlled. Do not use “health and safety” as a blanket reason to exclude someone from work. Risk assessment should be individualised and evidence-based, particularly where the concern relates to epilepsy, insulin-treated diabetes, medication, mental health or cardiovascular disease.
The employee’s informed consent should guide what health information is disclosed. Managers generally need to understand functional restrictions and recommended support, not every clinical detail. A report can explain that a condition has a fluctuating impact on concentration, fatigue or mobility without naming a diagnosis where this is unnecessary.
At the same time, overly vague reports can prevent useful action. The aim is relevant disclosure: enough information for the employer to understand the workplace implications and consider adjustments fairly.
Encourage a conversation between the employee and manager. Occupational Health recommendations are strongest when they support, rather than replace, that dialogue. The employee often knows which aspects of work are most difficult and which solutions are likely to work. Managers understand the workflow, available flexibility and team impact.
For complex cases, a planned review meeting can be more effective than a report alone. This is particularly true where symptoms fluctuate, relationships have deteriorated, absence has been prolonged or adjustments have already been tried unsuccessfully.
An adjustment that is right in week one may be unhelpful by month three. Recovery, treatment response, job changes and workload pressures all alter the picture. Every recommendation should therefore include a sensible review point.
Review does not mean repeatedly asking the employee to justify their condition. It means evaluating whether the adjustment is achieving its purpose. Is attendance improving? Are symptoms stable? Can duties increase safely? Is the arrangement creating an unforeseen issue? Has a temporary restriction become unnecessary, or does the employee now need a more sustainable solution?
Document the original functional problem, the agreed adjustment and the outcome of the review. This creates a clear clinical and workplace record and improves the quality of future decisions.
For learners developing confidence in Occupational Health, reasonable adjustments are a useful reminder that good practice is rarely about finding a single correct answer. It is about asking the right functional questions, understanding the job, communicating proportionately and revisiting the plan when evidence changes. That is how a clinical opinion becomes a practical route back to sustainable work.
