MFOM Equality Act Revision Guide

The Equality Act 2010 is an important topic for occupational medicine because it governs protection from disability discrimination and the duty to make reasonable adjustments in relevant circumstances. For MFOM revision, focus on the legal definition of disability, the different forms of discrimination, the employer’s responsibilities, and the occupational health physician’s role in providing practical, evidence-based advice without making assumptions about an individual’s legal rights.

The key exam skill is applying the legal principles to a workplace scenario. You need to distinguish a medical diagnosis from the statutory definition of disability, identify potential barriers at work, recommend appropriate adjustments and recognise when a legal conclusion requires more information.

What does the Equality Act 2010 protect against?

The Equality Act 2010 provides a legal framework for protection against discrimination and other prohibited conduct in specified areas, including employment. It protects people against discrimination because of certain protected characteristics, one of which is disability.

The Act is relevant to occupational health because health conditions can affect recruitment, attendance, performance, promotion, redeployment and continued employment. Occupational health advice may help an employer understand the functional effects of a condition and consider appropriate support.

The protected characteristics under the Act are:

• Age.
• Disability.
• Gender reassignment.
• Marriage and civil partnership.
• Pregnancy and maternity.
• Race.
• Religion or belief.
• Sex.
• Sexual orientation.

The precise legal provisions and their application depend on the circumstances. For exam questions, concentrate on the protected characteristic involved, the conduct described and the legal test relevant to that situation.

Why is the Equality Act relevant to occupational health?

An employer may refer a worker to occupational health because of recurrent sickness absence, a long-term condition, a change in functional ability or difficulty meeting particular job requirements. The occupational health physician can help clarify the health-related issues and identify options for supporting the worker at work.

For example, a worker with an inflammatory condition may have fluctuating symptoms and fatigue. Another worker with a musculoskeletal condition may struggle with prolonged standing but remain able to undertake other duties. The occupational health assessment should explore the actual functional impact rather than treating the diagnosis as an automatic indicator of fitness or disability status.

Occupational health advice may cover:

• The nature and likely course of the health condition, where known.
• The effect of symptoms on the worker’s ability to perform relevant duties.
• Potential workplace barriers and adjustments.
• Whether a phased return or temporary modification of duties may help.
• Whether further clinical information is needed.
• A suggested review period where the clinical situation may change.

The employer makes employment decisions and remains responsible for meeting its legal obligations. Occupational health provides impartial clinical advice to inform those decisions.

What is the difference between a medical diagnosis and disability under the Act?

A medical diagnosis does not automatically establish that a person is disabled under the Equality Act. Equally, a person does not necessarily need a particular diagnostic label to meet the statutory definition.

The legal test concerns the effects of an impairment on the individual, rather than the name of the condition alone. A person with a condition that appears relatively minor may experience substantial and long-term functional effects, while another person with the same diagnosis may experience few limitations.

In an exam scenario, avoid statements such as “the employee has arthritis, so they are disabled” or “the employee has recovered sufficiently, so they cannot be disabled”. Neither conclusion follows from the diagnosis alone.

How is disability defined under the Equality Act 2010?

Under the Equality Act 2010, disability generally means a physical or mental impairment that has a substantial and long-term adverse effect on a person’s ability to carry out normal day-to-day activities. For exam purposes, understand each part of the definition and apply it to the facts given.

The statutory definition is a legal test. Occupational health can provide relevant clinical information about impairment, duration and functional effects, but should not assume that a clinical opinion alone determines the legal question.

What does substantial adverse effect mean?

“Substantial” means more than minor or trivial under the statutory framework. The question is whether the impairment has a meaningful adverse effect on normal day-to-day activities.

Relevant activities may include walking, lifting, carrying, reaching, manual dexterity, concentrating, communicating and carrying out ordinary personal tasks. The examples in a question will determine which limitations are most relevant.

For example, a worker with a shoulder condition may find it difficult to dress, wash their hair, reach shelves or carry objects. The occupational health physician should explore these effects rather than focusing only on whether the worker can perform their usual job.

Work activities can provide useful evidence of functional limitation, but the statutory test is not simply whether someone can do a particular job. Normal day-to-day activities and the relevant legal guidance must be considered.

What does long-term mean?

The statutory definition generally treats an effect as long-term if it has lasted for at least 12 months, is likely to last for at least 12 months, or is likely to last for the rest of the person’s life.

The duration of the impairment and the duration of its effects are important. A condition may have started recently but still be relevant if its effects are likely to continue long enough to meet the statutory test.

Consider a worker who has developed a significant neurological condition. Although the diagnosis is recent, the expected functional effects may be long-term. It would be inappropriate to conclude that the Equality Act cannot apply simply because the worker has not yet experienced symptoms for 12 months.

Conversely, a short-lived injury with limited expected effects may not meet the long-term criterion, although other legal and employment considerations may still apply.

How do recurring and fluctuating conditions fit the definition?

Some conditions have symptoms that vary over time. Examples may include inflammatory arthritis, epilepsy and certain mental health conditions.

The assessment should not consider only how the person feels on the day of the occupational health consultation. It may be necessary to consider the effects when the condition is active and the likely pattern of recurrence, in line with the relevant statutory provisions and guidance.

For example, a worker with a fluctuating condition may have periods of relatively good function followed by episodes of substantial limitation. A single examination showing normal movement or no obvious symptoms does not necessarily capture the overall impact of the condition.

Ask about the pattern, frequency, severity and duration of episodes, treatment and the effect on ordinary activities. Avoid assuming that intermittent symptoms are unimportant simply because they are not continuously present.

Are some conditions treated differently under the Act?

The Equality Act contains specific provisions for certain conditions, including a provision relating to cancer, HIV infection and multiple sclerosis, under which a person is treated as disabled from diagnosis.

This is an important exam distinction because it means that the usual analysis of substantial and long-term adverse effects may not be required in the same way for these conditions.

Do not extend the special rule to every serious or life-limiting diagnosis.

What are the main types of disability discrimination?

MFOM questions may ask you to identify the form of discrimination suggested by a particular employer action. The critical skill is recognising what happened, why it happened and whether the relevant legal requirements are met.

Type	Core concept	Example in employment
Direct discrimination	Less favourable treatment because of disability	Refusing a promotion specifically because the employee is disabled
Indirect discrimination	A provision, criterion or practice that puts people sharing a protected characteristic at a particular disadvantage, with the relevant legal tests applying	A workplace rule that disadvantages disabled workers and cannot be justified under the applicable test
Discrimination arising from disability	Unfavourable treatment because of something arising in consequence of disability, subject to the relevant statutory conditions and defences	Disciplining a worker for disability-related absence without properly considering the legal position
Failure to make reasonable adjustments	Failure to comply with an applicable duty to make reasonable adjustments	Not considering a suitable adjustment where the statutory duty applies
Harassment	Unwanted conduct related to a protected characteristic that has the relevant purpose or effect	Repeated disability-related humiliation at work
Victimisation	Detriment because a person has done, or is believed to have done or may do, a protected act	Treating an employee badly because they raised a discrimination concern

These are simplified descriptions for revision. The precise legal tests, exceptions and defences differ between categories and should be checked against current legislation and authoritative guidance.

What is direct discrimination?

Direct discrimination generally involves treating a person less favourably because of a protected characteristic. In a disability scenario, the question is whether the unfavourable treatment occurred because the person was disabled.

For example, if a manager refuses to consider a worker for a development opportunity explicitly because of their disability, direct discrimination may be relevant.

Do not assume that every adverse employment decision involving a disabled worker is direct discrimination. The reason for the treatment and the facts of the case matter. An employer may have concerns about specific job tasks, but those concerns still need to be considered within the relevant legal framework.

What is discrimination arising from disability?

This form of discrimination concerns unfavourable treatment because of something arising in consequence of a person’s disability, rather than necessarily because of the disability itself. The statutory conditions and possible justification defence are important.

For example, an employee may have repeated absences related to a long-term condition. If the employer imposes a penalty because of those absences, discrimination arising from disability may need to be considered.

A common exam trap is confusing this with direct discrimination. The immediate reason for the treatment may be absence, reduced productivity or another consequence of the condition, rather than the disability itself.

The employer may have a defence if the relevant statutory requirements are met, including objective justification where applicable. Do not assume that every decision connected with disability-related absence is automatically unlawful, or that an employer can disregard disability-related factors without considering its obligations.

What is indirect discrimination?

Indirect discrimination may arise where a provision, criterion or practice is applied to people generally but puts people sharing a protected characteristic at a particular disadvantage, places the individual at that disadvantage, and cannot be justified under the applicable legal test.

An example might involve a rigid working arrangement that disproportionately disadvantages a group of disabled workers. The exact facts would determine whether the legal test is met.

For exam questions, identify the workplace rule or practice first. Then consider the group disadvantage, the individual disadvantage and any relevant justification. Do not label a situation indirect discrimination simply because a policy affects a disabled person.

What is the duty to make reasonable adjustments?

The duty to make reasonable adjustments is central to disability discrimination law and occupational health practice. In relevant circumstances, an employer must take reasonable steps to avoid substantial disadvantage experienced by a disabled person compared with people who are not disabled.

The duty is not satisfied merely by acknowledging that a worker has a health condition. It requires consideration of practical steps that may remove or reduce the disadvantage, subject to the legal framework.

What kinds of adjustments might be reasonable?

The appropriate adjustment depends on the person, their role, the workplace and the disadvantage that needs to be addressed. Possible adjustments include:

• Altering working hours or shift patterns.
• Allowing additional breaks or flexibility for treatment.
• Providing specialist equipment or adapting a workstation.
• Modifying selected duties or the way tasks are allocated.
• Changing the method of communication or instructions.
• Allowing home working where compatible with the role and operational requirements.
• Providing a phased return after sickness absence.
• Considering redeployment to a suitable alternative role where appropriate.
• Adjusting a workplace policy or procedure where doing so is reasonable and addresses the disadvantage.

These are examples rather than a prescribed list. An adjustment that is effective and reasonable for one worker may be unsuitable for another.

For instance, a worker with a musculoskeletal condition may benefit from a sit-stand workstation and opportunities to alternate tasks. A worker with a fluctuating mental health condition may benefit from predictable scheduling, temporary changes to workload or agreed flexibility for treatment.

The aim is to address the disadvantage, not simply to provide the same intervention to every worker with the same diagnosis.

How should an occupational health physician recommend adjustments?

Recommendations should be specific, practical and linked to the functional problem. Vague advice such as “the employer should make reasonable adjustments” provides little help unless it is accompanied by examples relevant to the worker.

A useful recommendation explains:

• The relevant functional limitation.
• The task or workplace feature creating the difficulty.
• The adjustment that may reduce the disadvantage.
• Whether the adjustment is temporary or may need to continue.
• When the arrangement should be reviewed.
• Any uncertainty that requires further information or a workplace assessment.

For example, rather than writing “avoid stress”, identify the particular work factors that appear to aggravate symptoms and consider whether workload, task prioritisation, supervision or working arrangements could be modified.

Occupational health should not guarantee that an adjustment is legally required or reasonable in every circumstance. The employer must consider the legal duty and operational context. However, advice should be sufficiently clear to allow a meaningful assessment of available options.

Does an employer have to implement every adjustment recommended by occupational health?

No. Occupational health recommendations are clinical advice, not automatic legal instructions. The employer must consider its obligations and the individual circumstances, including whether a proposed adjustment is reasonable and effective.

Where one adjustment is impractical, alternatives may still be available. For example, if a particular change to working hours cannot be accommodated, modified duties, a different work pattern or another suitable measure may reduce the disadvantage.

The absence of one preferred adjustment does not necessarily mean that no adjustment is possible. Equally, the occupational health physician should not recommend an intervention without considering whether it addresses the relevant functional issue.

How should occupational health assess disability-related sickness absence?

Repeated or prolonged absence can create difficult decisions for workers and employers. Occupational health should distinguish the medical issues from the employment decision and consider whether the worker’s condition, treatment or workplace circumstances are contributing to the pattern of absence.

What should the assessment cover?

A useful assessment considers:

• The underlying condition and current symptoms.
• The pattern, frequency and likely duration of absence, where this can be estimated.
• Treatment, rehabilitation and prognosis.
• Whether the worker can undertake some or all of their usual duties.
• Potential workplace triggers or barriers to attendance.
• Adjustments that could support sustainable attendance.
• Whether further medical information is needed.
• A realistic review plan.

Avoid assuming that recurrent absence is evidence of poor motivation or that a worker with a long-term condition will inevitably remain absent. Equally, do not promise that adjustments will eliminate future absence.

How should an employer manage disability-related absence?

The employer should consider the relevant legal obligations before making decisions about absence management, performance or dismissal. Disability-related absence may engage the duty to make reasonable adjustments and the rules on discrimination arising from disability, depending on the circumstances.

Occupational health can explain whether absence appears related to the health condition, whether changes might improve attendance and whether the worker may be able to return with adjustments.

For example, a worker with a condition requiring periodic treatment may benefit from flexibility for appointments. Another worker may need a phased return and a temporary reduction in demanding duties. These options should be considered individually rather than applying a rigid absence rule without considering the circumstances.

Occupational health should not decide whether an employee should be dismissed. It should provide impartial clinical advice, identify relevant risks and explain the limitations of its opinion.

How do confidentiality and consent apply to Equality Act assessments?

Disability-related occupational health referrals often involve sensitive medical information. The need to advise an employer about work capability does not mean that all clinical information should be disclosed.

The worker should understand the purpose of the assessment, the information likely to be shared and the intended recipients. Consent and information handling should follow the applicable professional and legal requirements.

A management report will commonly focus on functional limitations, fitness for work, relevant adjustments and review arrangements. A detailed diagnosis or treatment history should not be disclosed unnecessarily.

For example, an employer may need to know that a worker requires flexibility for treatment or has restrictions affecting a particular task. It may not need the full details of the worker’s medical history to implement that recommendation.

The occupational health physician should also explain the limitations of the assessment. If the available information is insufficient to advise on a specific issue, say so rather than making an unsupported legal or clinical conclusion.

For further revision, see MFOM Ethics and Confidentiality Revision.

How should you approach Equality Act questions in the MFOM exam?

Equality Act scenarios often combine clinical information, employment decisions and legal principles. A structured approach helps prevent you from jumping to a conclusion based on the diagnosis alone.

Use the following sequence:

1. Identify the protected characteristic and the employment situation.
2. Establish whether disability is relevant and what information is available about impairment, duration and functional effects.
3. Identify the employer’s action, policy or failure to act.
4. Decide which legal concept may apply: direct discrimination, indirect discrimination, discrimination arising from disability, harassment, victimisation or failure to make reasonable adjustments.
5. Consider the relevant statutory conditions, exceptions or defences.
6. Identify practical adjustments that could reduce the disadvantage.
7. Distinguish the occupational health physician’s clinical advice from the employer’s legal responsibilities.

What are the common exam traps?

Assuming diagnosis equals disability: A named condition does not automatically establish the statutory definition, apart from specific provisions that apply to certain conditions.

Assuming recent diagnosis excludes disability: The likely duration and effects of an impairment may be relevant even when symptoms began recently.

Confusing direct discrimination with discrimination arising from disability: Ask whether the treatment occurred because of disability itself or because of something arising in consequence of it.

Treating adjustments as optional good practice only: In relevant circumstances, reasonable adjustments are a legal duty, not merely a favour offered by an employer.

Assuming every requested adjustment must be granted: The employer must consider what is reasonable in the circumstances and whether effective alternatives exist.

Making the employer’s decision for them: Occupational health should provide clear, evidence-based advice but should not present its recommendation as a definitive legal ruling.

Ignoring confidentiality: The employer generally needs work-related advice, not unrestricted access to the worker’s medical information.

If you want to consolidate the wider legal framework, revise MFOM Occupational Health Law Revision.

Frequently asked questions

Does having a long-term medical condition mean someone is disabled under the Equality Act?

Not automatically. The statutory definition generally requires a physical or mental impairment with a substantial and long-term adverse effect on normal day-to-day activities, subject to specific provisions and exceptions. The functional effects and relevant legal rules must be considered.

Who decides whether an employee is disabled under the Equality Act?

Whether the statutory definition is met is ultimately a legal question, not a medical one. Occupational health can provide relevant clinical evidence about the impairment, its likely duration and its effects on day-to-day activities and can suggest if the employee is likely or unlikely to be covered under the Equality Act. The employment tribunal will ultimately decide.

What is the difference between reasonable adjustments and discrimination arising from disability?

Reasonable adjustments concern steps that may be required to avoid or reduce substantial disadvantage experienced by a disabled person in the circumstances covered by the Act. Discrimination arising from disability concerns unfavourable treatment because of something arising in consequence of disability, subject to the relevant legal conditions and defences.

Can an employer dismiss an employee because of disability-related absence?

The legal position depends on the facts, the applicable statutory duties and the steps considered before the decision. Disability-related absence may raise issues involving reasonable adjustments and discrimination arising from disability, so the employer should consider the relevant legal framework and obtain appropriate advice.

Must an employer follow every occupational health recommendation?

No. Occupational health provides clinical advice, while the employer must consider its legal responsibilities and operational circumstances. Recommendations should explain the functional problem and practical options clearly enough to support a reasoned decision.

What is the most important Equality Act principle for MFOM revision?

Do not treat a diagnosis as the answer to the legal question. Identify the functional effects, the workplace disadvantage, the conduct or policy involved, and the relevant legal test before recommending practical action.

To test your understanding, practise applying these principles to occupational health scenarios using our free sample questions and explore our pricing for further revision practice.