Occupational health reports do not define workplace adjustments

Occupational health can identify that support is needed. However, it cannot always specify what that support should be.

A fitness-for-work report is not an action plan. It was never designed to be one. Somewhere along the way, plenty of HR teams have started treating it as though it were, filing it, closing the case, and quietly hoping the adjustments sort themselves out.

Here is roughly how it goes. An employee discloses a visual impairment or hearing loss. Occupational health reviews it, confirms they are fit to continue in the role provided reasonable adjustments are made, and sends the report back. HR files it. Nobody quite knows whose job it is to work out what ‘reasonable adjustments’ actually means for this specific person doing this specific job, so for a while, nobody does anything at all.

That is not because occupational health failed. OH is answering one question: is this person fit to work, and are there medical considerations that need managing. It answers that question well. It was never built to answer a second, entirely different question: given this exact job, in this exact office, with these exact systems, what specifically gets in someone’s way, and what fixes it. That is a functional question, not a clinical one, and it needs a different kind of assessment to answer it.

What the report does not say

Picture an employee with progressive sight loss working in an administrative role. Their OH report says they are fit to continue with reasonable adjustments. What it does not say is that the shared spreadsheet everyone works from is colour-coded in a way that falls apart under 400% magnification, and that for months this person has been quietly missing entire categories of information rather than admit it. Nobody lied. Nobody failed to comply. The report was accurate. It just was not detailed enough to be useful.

This is where a lot of cases genuinely die, not through anyone’s negligence, but through everyone assuming somebody else has the practical details covered. HR has the report. Occupational health has done its job. The line manager has good intentions and no specialist knowledge. And the employee is the one left working around a barrier that a proper assessment would have caught on day one.

It does not only happen with sight loss. I see the same gap with hearing loss just as often. An OH report might confirm someone is fit to continue in a customer-facing role with reasonable adjustments, without ever touching on the fact that their team’s daily huddle happens standing up in a noisy open-plan area with three people talking over each other, which is precisely the environment where lip-reading and hearing aids both struggle most. Again, the report isn’t wrong. It’s just not the document that was ever going to catch that.

The actual trigger point

The signal to bring in a specialist workplace assessment is not a new diagnosis. It is the fitness-for-work box being ticked while the employee is still visibly struggling, or adjustments existing on paper without changing anything in practice. That gap is the trigger, not a fresh referral back to OH.