Audit of pre-employment health assessment in the national health service

Seventeen (77 per cent) of the 22 NHS occupational health departments in the West Midlands Region replied to a postal questionnaire about pre-employment health assessment. In only 5 departments (29 per cent) was the decision whether to interview and examine a prospective employee dependent on the results of a self-administered questionnaire. All departments were asked how many prospective employees had been screened and how many rejected/restricted over a 2 week period. Departments which interviewed/examined all prospective employees tended to have higher rejection/restriction rates than departments operating a selective policy: 6 (2.6 per cent) out of 232 versus 16 (1.4 per cent) out of 1140, relative risk 1.6, 95 per cent confidence interval 0.8 to 3.4, P=0.31. In departments which did not automatically interview/examine prospective employees, the median proportion seen by nurses was 56 per cent, and by doctors was only 12 per cent. Within one NHS Region we have documented wide variation in what constitutes a pre-employment health assessment. A selective approach would release a significant amount of occupational health staff time.