Education And Debate


BMJ 1996; 313 doi: (Published 12 October 1996) Cite this as: BMJ 1996;313:934
  1. William Davies
  1. The ABC of Work related disorders is edited by David Snashall, clinical director of Occupational Health Services, Guy's and St Thomas's Hospitals NHS Trust, London.

    Assessments of fitness for work can be important for job applicants, employees, and employers. Unfitness due to an acute illness is normally self evident and uncontentious, but assessing other cases may not be straightforward and can have serious financial and legal implications for those involved. Commercial viability, efficiency, and legal responsibilities lie behind the fitness standards required by employers, and it may be legitimate to discriminate against people with medical conditions on these grounds. Unnecessary discrimination, however, is counterproductive if suitable staff are overlooked and may be costly in cases of unfair dismissal. In addition, the Disability Discrimination Act 1995 makes it illegal for employers of 20 or more staff to discriminate without justification against those with disability as defined by the act.

    Fortunately, balancing these often complex socioeconomic and legal issues to achieve a sustainable decision on fitness is not primarily a medical responsibility. Doctors do, however, have responsibilities to assess the relevant facts competently and provide helpful medical advice when required.

    Sociolegal implications of assessing fitness for work

    • Security of employment

    • Rejection at recruitment

    • Occupational ill health or injury

    • Justifiable or unfair discrimination

    • Retirement due to ill health

    • Termination of contract

    • Claim for unfair dismissal

    • Industrial tribunal

    • Medical appeals

    • Litigation for personal injury

    • Criminal prosecution

    • Professional liability

    Basic principles and responsibilities Staying on track

    This article deals with assessing fitness for “identified employment.” To avoid confusion with related issues, the following points should be noted at the outset:

    • Fitness for work in relation to retirement benefits for ill health will depend on the specific provisions of the pension scheme, and general guidance is available1

    • The recently introduced “all work test” of fitness is not related to identified employment but concerns entitlement to social benefit (incapacity benefit) and is the responsibility of the Benefits Agency Medical Services' doctors2

    • The Disability Discrimination Act 1995 does not in principle change good medical practice …

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