Why do occupational health referrals need to be discussed with the employee being referred?

You are a team leader worried about a colleague. They have had some recent sickness absence and, since returning to work, they do not seem themselves. They seem to be on edge and the quality of their work has reduced. 

You have heard about occupational health and would like to refer them. You understand that occupational health is a clinical and confidential service and believe it would be appropriate for this colleague to be assessed by occupational health to ensure they receive the right level of support around their work and health. You want to respect your colleague’s confidentiality and do not want to intrude. Can you send an occupational health referral without raising it with your colleague? 

Occupational health referrals must be discussed with the individual being referred. In fact, consent from the individual being referred is generally necessary for the referral to go ahead. Employees can decline to be reviewed by occupational health. This means, it is down to the individual whether they are willing to be reviewed by occupational health or not. 

Why is it important to discuss an occupational health referral with an employee?

Discussing a referral with an employee you believe would benefit from occupational health is important because it will help the individual prepare for and participate in the consultation. Discussing a referral is a useful opportunity to have a dialogue whereby you raise the concerns you have with them. It may even be the first opportunity the individual has had to consider these concerns. In general, discussing concerns locally is a useful starting point. This is different to having a detailed conversation about a colleague’s health or asking them to disclose confidential health information. 

A further reason for discussing a referral before sending it is to seek employee consent to the referral being sent. This relates to the medical ethical principle of autonomy, a cornerstone of ethical medical practice. It means that each individual’s decision making around their health must be respected. People cannot be forced to undertake care that they do not want to, even if people around them disagree.

The principle of autonomy also relates to medical confidentiality that is important in occupational health. People should generally be given autonomy over their health information and this means they have the right to decide what they want to share and what they do not want to share. In an occupational health context, employees must consent to share the occupational health report that summarises the outcome of their consultation with their employer, and can decline to do this.

Another advantage of discussing an occupational health referral with the employee being referred is they may wish to contribute to the information provided. They may want to add detail or their own perspective to the referral which could help with the occupational health assessment. 

Are there any exceptions? 

There are always edge cases, grey areas and exceptions in medicine. These may filter down to occupational health and the workplace in certain scenarios where managers or HR may seek OH advice around referral without employee consent. Two examples, around risk and capacity, are detailed below. 

1- Risk 

If concerned an employee is at risk, or their colleagues or clients are at risk due to an employee’s health and that individual declines OH referral, it could be appropriate to speak to OH about your concerns. This could also be relevant if you are concerned that asking a colleague about an occupational health referral would escalate a risk to themselves or others. However, depending on the type of risk you are concerned about and whether it is an imminent risk it may be more appropriate to contact emergency services for immediate support.

2- Capacity 

Mental capacity is a complex concept relating to an individual’s ability to understand, retain and weigh up information and communicate back a decision. Mental capacity is ‘decision specific’ because the level of function required to make a decision differs according to the complexity of the decision. Certain health conditions can impact an individual’s capacity. For example, somebody may have capacity to make many day to day decisions but not more complex health-related or financial decisions. If you are concerned an employee does not have the capacity to consent to an occupational health referral it may be appropriate to speak to occupational health about your concerns. 

In conclusion, occupational health referrals generally need to be discussed with the individual prior to referral. This provides the opportunity to discuss concerns locally and also to improve the quality of referral by including information from the employee should they wish to contribute this. Ensuring employee consent to referral also means the medical ethical principle of confidentiality is maintained. There are always exceptions, and risk and capacity can be relevant to this. If concerned, your occupational health service can provide more specific guidance around edge cases. 

Need guidance on making an occupational health referral?

A well-managed referral starts with an open conversation and clear, relevant information. Insight Workplace Health can support managers and HR teams throughout the referral process, from deciding when a referral is appropriate to providing practical, work-focused advice following an assessment.

Find out more about our occupational health referral service or contact our team to discuss how we can support your organisation.