Medicalising disability? Regulation and practice around fitness assessment of disabled students and professionals in nursing, social work and teaching professions in Great Britain.

Purpose: The reliance on medical information and on occupational health (OH) professionals in ascertaining fitness of applicants and registrants within the educational and employment contexts may lead to the medicalisation of disability. The Disability Rights Commission's Formal Investigation into the regulation of three public sector professions of nursing, social work and teaching in Britain sheds light on the nature of regulatory fitness requirements and how these are implemented in practice.

Method: The multi-pronged investigation included a review of relevant statutory and regulatory frameworks, formal written and oral evidence submitted by key stakeholder organisations and research into formal and informal fitness assessments within the education and employment contexts.

Results: There are varied and vague fitness requirements in all three professions. OH professionals figure prominently in formal and informal decision-making around fitness within education and employment settings, regardless of regulatory prescriptions. There is a multitude of approaches. There are, however, particular issues in the deployment of OH expertise within the employment setting.

Conclusions: The determination of fitness should not rely solely on medical information. Blanket fitness requirements that are not contextualized against specific competencies for particular jobs are inappropriate. More collaborative and integrated working is necessary, particularly in exploring how reasonable adjustments may be provided to enable safe and effective practice. The positive spirit of the disability equality duty should be embraced.