A recommendation about redeployment versus ill health retirement can shape a person’s income, identity and future relationship with work. It can also expose an employer to avoidable risk if the process is rushed, poorly evidenced or framed as a purely medical decision. For Occupational Health practitioners, the task is to provide clear, functional advice that helps all parties consider whether work can continue safely and sustainably.
The central question is not simply, “Can this employee do their current job?” It is whether they can perform the essential duties of that role, with reasonable adjustments where appropriate, or whether there is another realistic role that matches their capabilities. Ill health retirement may be appropriate in some circumstances, but it is usually considered only after meaningful alternatives have been explored.
Redeployment is a workplace solution. It involves moving an employee into a suitable alternative role because they can no longer undertake their substantive post, either permanently or for the foreseeable future. The new role may have different physical, cognitive, psychological, sensory or safety demands. It should be a genuine vacancy or an established suitable role, not a theoretical possibility.
Ill health retirement is different. It is a contractual and pension-related route that may allow employment to end because of incapacity due to ill health. Eligibility is determined by the relevant employer and pension scheme rules, which vary considerably. Some schemes require evidence that the individual is permanently incapable of their own role; others use a higher threshold, such as incapacity for any comparable employment or all regular employment.
Occupational Health should not determine pension entitlement unless appointed specifically as the scheme’s medical adviser. Even then, the assessment must apply the scheme’s criteria rather than a general judgement that the employee is unwell or unlikely to return soon. In routine management referrals, the Occupational Health clinician’s role is to describe functional capability, prognosis, workplace restrictions and the likelihood that adjustments or alternative work could succeed.
A diagnosis rarely answers the employment question on its own. Two people with the same condition may have very different capacities depending on symptom control, treatment effects, job demands, working pattern and available support.
A high-quality assessment therefore translates clinical information into work-relevant function. Consider stamina, mobility, dexterity, concentration, memory, communication, tolerance of pressure, shift tolerance and reliability. Where the role is safety-critical, assess whether symptoms, medication or fluctuations in health could create an unacceptable risk to the employee, colleagues or the public.
The job description is essential, but it may not reveal the reality of the role. Ask what tasks are genuinely essential, how frequently they are undertaken and whether they can be redistributed without fundamentally changing the job. For example, a warehouse worker with restricted lifting capacity may remain able to carry out stock control or goods-in administration. A clinician with a condition affecting sustained concentration may not be fit for long on-call shifts, yet could be capable of structured daytime work with appropriate safeguards.
Be specific in your report. “Not fit for current duties” provides little practical value. “Fit for sedentary work up to four hours daily, with no lone working, no night work and review in six weeks” gives managers a usable framework while preserving appropriate clinical confidentiality.
Redeployment is most relevant when an employee is unlikely to return to their substantive role within a reasonable timeframe, but retains capacity for another role. It can also be considered where a return is possible only with restrictions that the current role cannot accommodate.
A redeployment discussion should follow a proper consideration of adjustments to the existing post. Under the Equality Act 2010, employers have a duty to make reasonable adjustments for employees who meet the definition of disability. The duty is individual and fact-specific. It does not require an employer to create a role or remove the fundamental purpose of a job, but it may include altered hours, equipment, modified duties, a phased return, home working, workplace support or transfer to a suitable vacancy.
A useful Occupational Health opinion separates what is clinically advisable from what is operationally feasible. For instance, a recommendation to avoid all customer-facing work may be medically understandable during acute anxiety symptoms, but an employer may have limited non-customer-facing roles. Equally, saying that redeployment is “not possible” without knowing the organisation’s vacancies, job families and recruitment process falls outside the evidence available to Occupational Health.
Instead, explain the broad parameters of potentially suitable work. These may include predictable daytime hours, minimal manual handling, reduced exposure to respiratory irritants, limited driving, access to regular breaks or a low-conflict environment. Managers and HR can then test those parameters against actual vacancies.
A suitable role needs more than a compatible job title. The employee must meet the essential requirements of the post, with reasonable training where this is proportionate. Pay, status, location, hours and travel can all affect suitability. A role involving a substantial pay reduction may still be offered, but the implications should be transparent and the employee should have the opportunity to consider them.
Time also matters. A short, time-limited trial can be helpful where prognosis or capability is uncertain. It should have agreed restrictions, objectives, review points and a clear route for raising concerns. A trial is not a way to defer difficult decisions indefinitely, nor should it place the employee in work that is unsafe or predictably unsustainable.
Ill health retirement may be considered where medical evidence indicates a long-term or permanent inability to undertake the role, adjustments have been explored, and redeployment is either unavailable or unsuitable. It may also become relevant where the employee meets the specific threshold in their pension scheme.
The word “permanent” needs care. It does not necessarily mean that a condition will never improve. In pension contexts, it often concerns whether recovery sufficient to resume the relevant employment is reasonably likely before normal pension age or within the period defined by the scheme. This is why prognosis should be expressed carefully, including the basis for the opinion and any uncertainty.
Some clinical situations make this route more likely to arise: progressive neurological disease, severe and treatment-resistant mental illness, advanced cardiopulmonary limitation, substantial cognitive impairment or persistent symptoms despite appropriate treatment and rehabilitation. Yet even in these circumstances, assumptions should be avoided. An employee may be unable to undertake frontline emergency duties but remain capable of advisory, educational or administrative work.
A report supporting consideration of ill health retirement should not imply that the employee has no capacity for any activity unless that conclusion is clinically justified and relevant to the scheme test. Distinguish between being unfit for the current job, unfit for work in the organisation, and incapable of all regular employment. These are very different conclusions.
Good decisions are built through a fair process, not a single consultation. The clinician should obtain consent, review relevant medical evidence where needed, understand the referral questions and assess the employee’s own account of capability and barriers. The report should then answer the employment question without disclosing unnecessary diagnostic detail.
Where capability is complex, it is often useful to set out three practical scenarios: return to the current role with specified adjustments; possible alternative work within defined functional limits; and circumstances in which ongoing absence or an ill health retirement application may need to be considered. This structure helps prevent an artificial choice between immediate return and employment ending.
Avoid language that oversteps the Occupational Health role. Do not state that dismissal is justified or that an employee “should be retired”. Those are management and, where relevant, pension-scheme decisions. More appropriate wording is that, on the medical evidence available, the employee is unlikely to regain capacity for their substantive role within a stated period, and that redeployment should be explored subject to suitable vacancies and scheme criteria.
Consistency is also crucial. Similar cases do not always lead to identical outcomes because jobs, risks, organisational resources and pension rules differ. However, the reasoning should always be transparent: what the employee can do, what they cannot safely or reliably do, what may change, and what workplace options remain open.
Before finalising a report, ask whether the restrictions are proportionate to the evidence, whether the prognosis is sufficiently clear, and whether the job demands have been understood. Consider whether disability and reasonable adjustments have been addressed, whether treatment or rehabilitation could materially alter capacity, and whether the employee has been signposted to appropriate clinical support.
For an ill health retirement referral, clarify who is making the decision, which pension scheme applies and what medical criteria must be addressed. A clinician can provide excellent evidence and still be unable to answer a scheme question if the criteria have not been supplied.
The most useful Occupational Health advice does not force a binary outcome. It gives the employee, manager and HR team a clear map of capability, risk and realistic next steps. When redeployment is explored properly and ill health retirement is considered against the right evidence and criteria, difficult decisions become more humane, more defensible and more likely to support safe work participation wherever it remains possible.
