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DOccMed · Core Wisdom · Scope & ethics

OH advises, the employer decides

Core Revision
12 July 2026 · 2 min read

The occupational health clinician gives advice; the employer makes the management decision. Describe function, risk and options — and then step back.

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If you learn one sentence for this exam, make it this one. The occupational health clinician gives advice; the employer makes the management decision. You do not dismiss anyone, you do not redeploy anyone, and you do not sign anyone off. You describe function, risk and options — and then you step back.

It sounds like a technicality. It is actually the answer to a whole family of MCQ stems: the manager who asks you to declare someone unfit so they can end the contract; the worker who asks you to insist on a transfer; the HR lead who wants a diagnosis to justify a decision they have already made. In each case, the correct move is the same. Give clear, functional advice; make the options and their risks explicit; leave the decision where it belongs.

It also protects you. Under the Health and Safety at Work etc. Act 1974 the duty to provide a safe system of work sits with the employer, not with you. Your job is to give them the health information they need to discharge that duty, in language they can act on. “This worker can do X, cannot currently do Y, and is likely to be able to do Y again in around eight weeks with these adjustments” is useful advice. “Unfit” is not.

The corollary matters too: if the employer disregards your advice, that is their decision to record and defend. Document what you advised, and why.

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