OH Today Volume 32 Issue 2 - 2025

iOH Partners

From the President

Lynn Pratt

In an era defined by rapid technological evolution, Artificial Intelligence (AI) is emerging as a transformative force across industries and occupational health (OH) is no exception. Once considered the domain of futuristic speculation, AI is now actively reshaping how we understand, deliver, and optimise workplace health and safety.

AI is already being used in OH in many ways for example in pre-placement screening, wearable health monitoring, and the automation of routine assessments offering both efficiency and consistency in service delivery. The integration of AI into OH is not without complexity. It demands careful navigation of data governance, ethical considerations, and the nuanced role of human expertise in clinical judgement. AI is not a distant future it is a present reality, and it’s reshaping occupational health from the inside out.

In this edition we explore AI and the digital workplace and the implications for Occupational Health Practice. iOH

are also working in in conjunction with the National School of Occupational Health, The University of Manchester and supporting an AI in OH volunteer group. You can register for the AI in OH Group website to keep up to date with developments. In addition, The University of Manchester would also be grateful for your input to their AI survey exploring current perspectives, challenges and opportunities related to the OH sector. Closing on 4 July 2025. You can also register for the International Conference on AI in Occupational Health on 9 July 09001630 hours. This free event will explore crucial topics such as ethics, data protection, and quality, while engaging with expert panels and participating in thought-provoking discussions. Register for free.

Inside this edition you will explore many other topics too, forthcoming webinars and partners resources. Enjoy!!

Lynn Pratt, President iOH

AI and the digital workplace -

Implications for Occupational Health Practice

By Nikki Cordell

The use of Artificial Intelligence (AI) and how it impacts our workplaces is high on every organisation’s agenda. It is being increasingly covered in the media and the UK Government wants, in the words of the Prime Minister, to see AI “turbocharge economic growth and kickstart a decade of national renewal.” This means that, whatever your view of AI might be, from excited to feelings of apprehension, it can’t be ignored. All of us are going to need to gain a greater knowledge of what AI means for the workplace, and with this, the delivery of occupational health services.

Indeed, the Government sees AI as having a role to play in OH and in 2024 allocated investment to support AI driven OH software development in areas involving monitoring health trends and the detection of early signs of illness. But, as I’ll cover in this article, AI isn’t the only new technology reshaping our workplaces and impacting on the health of employees. It is perhaps currently the most visible, but we’ve been becoming more ‘digital’ in the way we work for some time.

What do we mean by AI and digital in the workplace?

If you ‘ask Google’ for a definition of AI you’ll get, rather appropriately, an ‘AI overview’ so let’s start here. “Artificial intelligence (AI) refers to the ability of computer systems to perform tasks that typically require human intelligence, such as learning, problem-solving, and decision-making. In essence, AI aims to create machines that can think and act intelligently, mimicking human cognitive abilities.”

In our organisations we are seeing this in the of use of virtual assistants, image recognition software, AI recruitment screening and some might argue it represents the start of a less human workplace. In healthcare, AI is being used for disease diagnosis and drug discovery and in the workplace can be used to improve safety by using predictive analytics that identify the risk of accidents and occupational diseases occurring in the first place. And there are many more applications.

Alongside AI, the workplace has seen digital developments that include online platforms and tools that help with productivity, robotics that can remove workers from hazardous situations, virtual and augmented reality that adds immersive information given to the worker, 3D printing, ‘big data’ that helps with speed of data processing. It’s a long list that when considered alongside AI, demonstrates just how much digital change is impacting our working lives.

Advantages and anxieties

Change always comes with pros and cons and as OH professionals, we need to be aware of how AI and transformational digital processes impact on the employees in our organisations. Fear of losing employment is top of the concerns for many who might see AI as a threat to their jobs and are asking the question ‘will I lose my job to AI’? Naturally, anxiety is a product of this change but job security is just the tip of the iceberg. Consider these OH scenarios:

Online platforms and tools: They offer more autonomy and flexibility, reduce commuting and allow workers with a disability greater access to work. But they run the risk of blurring boundaries between work and private lives and can create feelings of isolation impacting on mental health of lone workers in particular. They may also increase sedentary working and reduced physical activity in the working day.

Robotics: Safety levels increase as workers are removed from hazardous situations and more disabled people may work in these fields due to reduced physical demands. However, mental health issues may increase due to less human contact and bring the risk of increased repetitive injuries as humans keep pace with robots.

3D printing or ‘Additive Manufacturing’: This might open up new markets as the cost and time of producing parts comes down. But employers need to be aware that this technology comes with manufacturing hazards through the use of dangerous substances.

AI and ‘Big Data’: The many benefits in terms of productivity and reduction in ‘routine’ tasks need to be balanced against the anxiety many feel, the stress of retraining in new technologies and the very real risk that AI is still learning itself - and can make mistakes that aren’t always apparent at the time. This can mean missed symptoms leading to potentially wrong conclusions.

Implications for Occupational Health Practice

As Occupational Health professionals, we need to understand the impact of AI and digital in workplaces on health to provide quality advice that minimises harm to the workforce. In addition, understanding how the health benefits can be harnessed for the workplace and the worker, providing evidence-based advice on adjustments and wider organisational change.

Implications for OH delivery

There is an increasing requirement to assess all potential working environments which will need a greater range of assessment tools and knowledge in their use e.g. video assessment of DSE set up in a home environment. That same extension of knowledge applies to the interpretation of data. AI is being used in the field of noise control and health surveillance by continuously monitoring workplace noise levels and alerting workers and employers if exposure exceeds safe limits. This offers the potential to predict the likelihood of future occupational hearing loss - but this depends on our ability to make effective

decisions based on our understanding of what the data is telling us.

What’s more, time taken to understand the workplace to tailor information to the needs of the organisation will be key to success and not just provide generic advice from a clinic or home working setting. All of this creates an opportunity to focus on proactive delivery of occupational health rather than reactive, with wider geographical reach and use of technology to enhance current clinical delivery models.

Easier access to observational data

For example, the introduction of Smart Personal Protective Equipment (PPE) and wearables can provide real time monitoring of hazards such as harmful exposures, stress and health problems. Feedback from such devices can be used to influence behaviour and provide evidence-based information on risk at both an individual and organisational level. We have a role in supporting businesses interpret this data from a health perspective and advise on changes to work and workplace design.

Pattern identification or recognition

The use of large data sets combined with statistical and machine learning techniques can be used to identify patterns and create decision-making models. Such information can be used to better understand the working environment and what interventions deliver benefit to the organisation and can be used to improve efficiency and effectiveness of clinical delivery. Implementing effective data input control and audits is crucial in workplace AI development.

Predicting mental health issues

While the arrival of AI in the workplace comes with a certain amount of anxiety for some, one area where pattern identification or recognition helps is actually with mental health. AI will enable us to predict who is most likely to experience mental health issues, before such potential major crises develop. This will enable earlier intervention and support, enabling the allocation of wellbeing and OH resources. For example, AI is already being used to pick up clues from the way questionnaires are answered to identify concerns with morale, wellbeing and early signs of ill health.

In conclusion

I believe that digital innovations and the arrival of AI aren’t only improving productivity and innovation, they present OH physicians and nurses with a number of opportunities. We can help employees and their leaders better understand the risks present in the work they do, prevent occupational injury and diseases and learn valuable new skillsets. But, as we use the technology and realise the benefits, we need to be mindful that our colleagues, both in the profession and in other roles, may be apprehensive of where AI in particular may be taking us. In truth we don’t yet know but need to remember that. as we work with AI and digital tools, we are still humans working in organisations run by humans.

Dr Nikki Cordell is CEO of Cordell Health Ltd and Educational Director of EOPH Ltd.

Nikki is an experienced specialist occupational physician, researcher and educator, passionate about developing further understanding of employee health, wellbeing and performance and its links to productivity.

Compassionate Dismissal in Disability Cases: A Legally Sound and Empathetic Approach

By Lucy Kenyon Occupational Health Director

Introduction

In occupational health (OH), the concept of “compassionate dismissal” may seem contradictory. Yet, when applied with empathy, legal rigour, and commitment to employee dignity, it can be a fair and humane resolution particularly in cases involving long-term disability.

In my practice, our recommendations are designed to support both employees and employers through complex decisions. Compassionate dismissal is not about expediency; it is about dignity, support, and lawful process.

What Is Compassionate Dismissal?

Compassionate dismissal occurs when an employee, due to enduring health limitations, is no longer able to fulfil their role even after all reasonable adjustments have been explored. In such cases, dismissal may be the most humane option, enabling the individual to obtain fast-track access to appropriate benefits and support systems such as Personal Independence Payment (PIP) or Employment and Support Allowance (ESA).

This approach aligns with the Equality Act 2010 and the Employment Rights Act 1996, which require employers to act reasonably and fairly when considering dismissal on health grounds.

Legal Precedents: When Employment Tribunals Uphold Fair Dismissals in Disability Discrimination Cases

Employment tribunals have consistently upheld dismissals as fair when employers prove a thorough, compassionate, and legally compliant process in managing disability-related absences or capability issues. The following cases show how employment tribunals evaluate an employer’s compassion, i.e., ‘fairness’ and ‘reasonableness’ in their decision-making:

In Mrs. M Leeks v UCL Hospitals NHS Foundation Trust (UCL) (2200214/2018), the tribunal found

that the Trust had acted fairly in dismissing an employee with a long-term health condition. UCL had made extensive efforts to accommodate the employee’s needs, including adjustments and redeployment attempts, before concluding that dismissal was necessary. The tribunal noted UCL’s reliance on occupational health advice and the transparent consultation process as key factors in its decision.

In Mr. T Mendez v Advisory, Conciliation and Arbitration Service (ACAS) (2302348/2022), the case involved claims of constructive unfair dismissal and disability discrimination. While a number of Mr. Mendez’s claims were upheld, the tribunal found that ACAS had taken reasonable steps in managing Mr. Mendez’s condition and had not acted unlawfully in the dismissal process. The judgment highlighted the importance of keeping open communication, documenting efforts to make reasonable adjustments, and the rationale behind decisions that an adjustment is not ‘reasonably practicable.’

In Mr. D Hughes v Alten Ltd (Alten) (1306316/2023), the tribunal considered multiple claims, including disability discrimination and redundancy. The tribunal found that Alten had followed a fair redundancy process and had not discriminated against Mr. Hughes on the grounds of disability. The decision emphasised the need for objective selection criteria and the inclusion of medical evidence in redundancy assessments.

These cases reinforce the principle that fairness in dismissal particularly where disability is involved depends on

process, documentation, and empathy. Employers who engage with occupational health early, explore all reasonable adjustments, and communicate clearly are more likely to succeed in defending their decisions.

Case law demonstrates positive outcomes with early Occupational Health engagement

Impairments of Daily Living and Work Leading to Functional Disability

Functional disability can arise from a variety of impairments that affect an individual's ability to perform daily living and workrelated tasks. These impairments can be physical, cognitive, or psychological in nature, and they often result from long-term health conditions. Understanding these impairments and their impact on work is crucial for employers in making informed decisions about compassionate dismissal.

Common impairments of daily living and work include (Edemekong et al, 2025):

• Cognitive impairments: Issues with memory, concentration, problem-solving, or decision-making

• Hearing impairments: Difficulty in hearing conversations, alarms, or other important sounds in the workplace

• Manual dexterity impairments: Challenges in using hands and fingers for tasks such as typing, writing, or operating machinery

• Mobility impairments: Difficulty in walking, climbing stairs, or moving around the workplace

• Psychological impairments: Conditions such as anxiety, depression, or PTSD that affect emotional well-being and the ability to cope with work-related stress

• Visual impairments: Limitations in sight that affect the ability to read, recognize faces, or navigate the environment

These impairments can be caused or triggered by a range of long-term health conditions (Thomas et al, 2022) including:

• Chronic illnesses: Conditions such as diabetes, heart disease, and arthritis that have a long-term impact on health and functioning

• Mental health conditions: Disorders such as depression, anxiety, bipolar disorder, and schizophrenia that impact mental and emotional well-being

• Musculoskeletal disorders: Conditions such as back pain, repetitive strain injury, and fibromyalgia that affect the muscles and joints

• Neurological conditions: Diseases such as multiple sclerosis, Parkinson's disease, and epilepsy that affect the nervous system

• Sensory impairments: Conditions such as glaucoma, cataracts, and hearing loss that affect the senses

The Role of Occupational Health (OH)

A good OH service should work in partnership with employers to ensure that decisions around dismissal, particularly those involving disability, are grounded in fairness, empathy, and legal compliance. Multidisciplinary assessments provide clear, evidence -based insights into an employee’s functional ability, the impact of their condition on work, and the feasibility of adjustments or redeployment. A good service also supports employers in documenting their decision-making process, aligning with the expectations of employment tribunals. By combining clinical expertise with a deep understanding of workplace dynamics, a good OH service helps organisations navigate complex cases with confidence and compassion.

A good OH service should provide tailored assessments that help employers understand the full scope of an employee’s condition and the

arrangements that need to be in place to remove barriers and reduce disadvantages and facilitate continued employment. Reports should include:

• Functional ability evaluations

• Clarification of any impairments, signs, symptoms, and vulnerabilities that the employer needs to understand and monitor to ensure a safe working environment

• Recommendations for occupational adjustments and support that are likely to remove barriers or reduce disadvantages

• Recommendations for adjustments that will facilitate access to and engagement with health improvement programmes

• Guidance on benefit eligibility and employability pathways (e.g., supported employment, vocational rehab)

This evidence-based approach ensures that decisions are not only compassionate but also defensible in legal terms.

Conclusion: A Pathway to Dignity

Compassionate dismissal should never be a first resort but when all avenues have been exhausted, it can be a respectful and lawful way to support an employee’s transition. By grounding decisions in OH expertise and legal precedent, employers can uphold both fairness and humanity.

Lucy is a Specialist OH Nurse Consultant and digital health entrepreneur.

Lucy Kenyon | Linkedin

She is an Honorary Senior Lecturer at the University of Chester and has been teaching and mentoring in Occupational Health since 1996 for the RCN, Universities of Birmingham, Chester, Coventry, Derby and West of Scotland.

She delivers professional development courses for the National Performance Advisory Group, Cordell Health and employers, for whom she researches and develops evidence-based practice.

She has been a member of the iOH board since 2014, President from 2017 - 2020 and a NonExecutive Director since 2021.

She has a Master of Medical Science and the International Certificate in Occupational Hygiene from Birmingham, where she has taught and worked on research projects.

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In the evolving landscape of occupational health and wellbeing, professionals are increasingly seeking qualifications that not only enhance their expertise but also ensure credibility. There are many options, with providers claiming their course is ‘endorsed by’, or ‘accredited’; but for those who are not in the learning and development sector, it can be confusing to know what these terms mean.

This is a guide to key qualifications that stand out for their relevance and formal accreditation. The aim is to support professionals in workplace health and wellbeing roles to make an informed choice about development and where to invest time and money.

For those looking for introductory qualifications, these online or one-day certifications from leading Health and Safety organisations are a fantastic place to start.

1. NEBOSH Working with Wellbeing

A one-day course introducing the NEBOSH 'Wellbeing Tree,' which focuses on six key areas: interaction, exercise, mindfulness, nutrition, kindness, and learning. This qualification is ideal for human resources or health and safety professionals looking to develop their knowledge, and managers or those working in health and wellbeing roles looking to positively influence employee wellbeing in their organisation.

• Duration: One day or self-directed

• Mode: E-learning

• Find out more: NEBOSH Working with Wellbeing

2. NEBOSH HSE Certificate in Managing Stress at Work

Developed in collaboration with the Health and Safety Executive (HSE), this course equips learners with the skills to identify and manage workplace stressors. It covers the HSE’s Management Standards approach and provides practical strategies to create a healthier work environment. The Certificate in Managing Stress at Work provides a qualification equivalent to a Level 4 qualification on the Regulated Qualifications Framework (RQF) in England and Wales.

• Duration: One Day or self-directed

• Mode: E-learning

• Find out more: NEBOSH Managing Stress at Work

3. IOSH Managing Occupational Health and Wellbeing

This course offers practical advice for those seeking to support employees’ physical and mental health, fostering a productive workplace. It includes tools for assessing fitness for work, managing health changes, and promoting positive mental health.

• Duration: One Day

• Mode: Face to face, or online

• Find out more: IOSH Managing Occupational Health and Wellbeing

There are also more substantial qualifications, which might be suitable depending on the nature of your role, and organisation.

1. Level 3 Community Health and Wellbeing Worker Apprenticeship

Also known as the Wellbeing Champion Apprenticeship, this is a formal qualification designed to equip individuals with the skills and knowledge to promote health and wellbeing within their organisation. It focuses on practical, evidence-based approaches to supporting physical, mental, and emotional wellbeing, and is ideal for those new to a workplace wellbeing role, or tasked with supporting wellbeing initiatives in their workplace.

• Duration: Typically 14 months

• Find out more: Wellbeing Champion Apprenticeship

2. Level 5 Mental Health and Wellbeing Culture Change Diploma

for Workplace Wellbeing Leads – Wellbeing Lead Academy

If you are looking for the opportunity to gain a formally recognised qualification while you are working, utilising work products as evidence of your understanding, and gaining valuable insights into formulating strategy and empowering your organisation to drive culture change, the Level 5 Diploma is for you.

This is the only nationally accredited diploma in workplace health and wellbeing and is designed for HR professionals and wellbeing leads seeking to develop strategic knowledge and tools for workplace wellbeing. The taught elements of the Diploma span six weeks, covering topics such as wellbeing strategy, relevant legislation, embedding a wellbeing culture, leading impactful mental health peer support initiatives, effective health campaign planning for behaviour change, and evidencing return on investment. Delivered by professionals with extensive experience as Workplace Health and Wellbeing Leads, and with a range of assessment methods utilised, this is a great option for those who want to learn and develop as they work.

• Duration 12 month

• 37 Learning Credits (under the UK Qualifications and Credit Framework (QCF))

• Find out more: Wellbeing Lead Academy

For those seeking an advanced academic pathway, the MSc Workplace Health and Wellbeing (Distance Learning) offered by the University of Nottingham is an exceptional choice.

MSc Workplace Health and Wellbeing – University of Nottingham

This online program is specifically designed for professionals who want to develop expertise in creating healthier workplace environments. The course combines scientific theory, evidence-based approaches, and practical skills to address workplace health and wellbeing challenges.

This is an advanced course, with exceptional credibility. Students can choose a 2-year option of a Post Graduate Diploma, or complete an independent research project, which will deepen their understanding, to achieve the Master of Science qualification.

• Duration: Up to 36 months (part-time)

• Mode: Remote with some face to face

• Find out more: University of Nottingham MSc Workplace Health and Wellbeing

These qualifications provide a robust foundation for professionals committed to advancing workplace wellbeing. By investing in accredited training, you not only enhance your skills but also contribute to creating healthier, more productive workplaces.

Beyond Diagnosis: A Needs-Led, Stepped Model for Neuroinclusion

By Dr Nancy Doyle, Genius Within

In recent years, the workplace conversation around neurodiversity has shifted dramatically. What was once a niche topic has evolved into a strategic business concern. Awareness campaigns, toolkits, and training sessions now fill HR calendars, driven by good intentions but often producing limited practical outcomes for neurodivergent employees. As employers attempt to do the right thing, many are discovering that traditional diagnosis-based approaches are not only cumbersome they may be counterproductive. Instead of attempting to identify or “diagnose” neurodivergent individuals at work, businesses need to focus on recognizing and enabling individual strengths across the board. It’s time for employers to rethink neuroinclusion not as a compliance issue, but as a core component of performance, productivity, and workplace equity.

The Pitfalls of a Diagnostic Approach

Since the pandemic, interest in neurodiversity has soared, but the results haven’t kept pace with the energy. Research from Birkbeck, University of London (2024), involving 1,400 neurodivergent employees and their colleagues, revealed that despite increased policies and awareness training, overall wellbeing and engagement actually declined from the year before. The disconnect between training efforts and real-world impact points to a deeper issue: we’re still stuck in a medicalized, deficit-based model.

In workplaces today, neurodiversity initiatives often hinge on formal diagnosis. Employees are expected to “declare” their condition and then wait for reasonable adjustments. This process is slow, fraught with stigma, and often demoralizing. It reinforces the idea that neurodivergence is a problem to be

solved, rather than a natural variation in how people think and work. Worse, this approach can make neurodivergent individuals feel like burdens rather than contributors. What many leaders haven’t yet recognized is that the reliance on diagnosis is not scalable, nor is it strategic. With 20% of the population considered neurodivergent the demand for personalized support is growing. Yet, relying on labels, assessments, or medical gatekeepers only delays progress.

The Genius Finder A Strategic Shift from Labels to Leverage

At Genius Within we have created an online assessment with support from the Big Issue Social Impact Fund and Birkbeck University. The Genius Finder is a tool designed to identify individual working preferences, strengths, and cognitive styles without needing a diagnostic label. Unlike traditional neurodiversity frameworks that hinge on deficits or medical documentation, the Genius Finder celebrates diversity in thinking as a business asset. It doesn’t ask if someone is ADHD, autistic, dyslexic, or otherwise it asks how they do their best work.

This distinction is vital. It allows employers to act immediately, rather than waiting for evidence or justification. The Genius Finder removes the gatekeeping, streamlines the support process, and shifts the narrative from “supporting a problem” to “enabling performance.” It helps employees articulate what they need such as low-distraction environments, written instructions, or flexibility in communication without having to justify their needs based on pathology.

As Susan Scott-Parker, founder of Business Disability International, explains, “We don’t ask our left-handed CFO to get a diagnosis before giving her a left-handed mouse. Why would we require that for someone who needs noise-cancelling headphones or flexible hours?”

Being Cost Effective

The Genius Finder can act as a first line response, where case managers can review the impact of a potential neurodivergent condition on functional everyday performance. They are then directed to a personalised selection from 430 strategies that we know work for our clients, from our many years of experience delivering coaching and assessment. We then triage – our research is showing us that a Genius Finder review with an OH professional is sufficient for 50% of cases and that only 10% need assessment afterwards. The remaining 40% are signposted to coaching or technology straight from the Genius Finder review. This reduces the cost significantly and ensures that more money is spent on the interventions that work, rather than the cost of identifying the problem.

Inclusion Should Be JobEmbedded, Not Diagnosis-Dependent

What we need is a paradigm shift: away from diagnosis as a prerequisite for support, and toward inclusive job design that benefits everyone. The Genius Finder does exactly this. It surfaces practical information about how people work best and integrates it into team practices, performance management, and career development. It doesn’t wait for a crisis. It builds in accessibility from the start.

This benefits not only neurodivergent individuals, but also people in perimenopause, with long covid, older workers, people recovering from illness, and those with fluctuating mental health. In short, it helps create a more agile, productive workforce something every business needs.

Moreover, inclusive practices driven by understanding not compliance build trust. Employees feel seen, not judged. They contribute more, stay longer, and innovate freely. That’s not a side effect of good intentions it’s a business outcome.

From Awareness to Action

The neurodiversity movement was never meant to be a checklist exercise. Its goal was always to open doors, remove arbitrary barriers, and reimagine what good work looks like. But without practical, strategic tools, we’ve fallen into the trap of performative inclusion. Awareness weeks, employee resource groups, and training sessions are not enough without systemic change.

The Genius Finder provides that systemic bridge. It translates awareness into action and shifts neuroinclusion from HR to business strategy. It asks not who needs help, but how everyone can do their best work. In doing so, it dismantles the “us vs them” mindset that fuels backlash and confusion.

Because when we see neurodiversity not as a problem to manage, but as a resource to unlock, everyone wins.

Dr Nancy Doyle | Linkedin

Dr Nancy Doyle is a Chartered Psychologist, HCPC registered and a Visiting Professor of Occupational Psychology, co-directing the Centre for Neurodiversity at Work at Birkbeck, University of London.

Her BBC documentary ‘Employable Me’ helped Neurodiversity hit the mainstream in 2016 and 2016, and she founded one of the world’s leading Neurodiversity consultancies, the nonprofit b-Corp, “Genius Within”.

Nancy is a proud neurodivergent herself, Forbes columnist, author and dynamic presenter, with the UN, the UK parliament, Stanford University, Imperial College London, Amazon, Google and Microsoft in her list of Keynotes.

Find out more about the services Genius Within offer.

Podcast Interview:

ADHD Psychologist warns: “It’s not safe to diagnose people online” - The Hidden 20% | Podcast on Spotify

Forbes Contributor: Dr. Nancy Doyle

Lung Function Over Time: Monitoring and Interpretation in Occupational Health

By Charlene Mhangami, V-Core Senior Product Specialist

Spirometry is a valuable and commonly used lung function test. It measures the volume and flow of air a person can inhale and exhale in one breath. Measurements obtained from spirometry facilitate interpretation of lung function and assess a worker's respiratory health. Commonly used reported values are Vital Capacity (VC), Forced Expiratory Volume in one second (FEV1 ) , Forced Vital Capacity (FVC), and FEV1/FVC ratio. These measurements are essential for monitoring lung function and identifying relevant early changes. This is particularly important in occupational settings where workers may be exposed to various substances and chemicals that affect respiratory health.

Monitoring lung function in occupational health

Regular monitoring of lung function using spirometry is essential for early identification of changes in lung function, which could suggest onset of disease or worsening of already confirmed disease, such as occupational asthma.

Spirometry is conducted at pre-employment or within the first six weeks of the worker beginning the job role to establish a baseline measurement. This baseline result will be used as a comparison point for tracking changes over time. Serial spirometry measurements are repeated at intervals that are in line with the individual's level of risk due to the nature of their work. In the UK, the Health and Safety Executive (HSE) provides guidance on substances and job roles which are known to be linked to respiratory risks. By comparing serial measurements to the baseline measurement, occupational health practitioners can determine whether a worker’s lung function remains stable or shows signs of decline. An example set of serial measurements is shown in Figure 1.

Understanding natural changes over time

Like other organs within the human body, the lungs will naturally change with age. Lung function will increase from birth, reaching a peak in early adulthood around the age of 25, and then enter a gradual declining aging phase. In healthy, nonsmoking individuals an average annual reduction is estimated to be 30ml in both FEV1 and FVC according to Ponce et al, 2023.

It is crucial that occupational health professionals can distinguish between this normal age-related decline, and decline related to developing disease due to workplace exposure. Figure 2 shows this natural aging process of the lungs. Awareness of this pattern can aid with the interpretation of serial measurements over time.

Figure 2.

Lung growth from birth and the aging process after the age of 25.

Figure 1. Trend data Vitalograph Spirotrac 6 software.

Interpreting lung function results

In occupational health, spirometry results have traditionally been assessed using percent predicted values. Thresholds such as an FEV₁/FVC ratio below 70% or FEV₁ or FVC values falling below 80% of predicted have historically prompted referrals. However, this method is increasingly viewed as statistically flawed. The percent predicted approach assumes homoscedasticity, meaning equal variance across all ages and body sizes, which is not supported by current evidence.

Lung function values vary significantly with height, age, sex, and ethnicity. Taller or younger individuals typically exhibit higher absolute lung volumes than shorter or older individuals. This variability, known as heteroscedasticity, undermines the reliability of percent predicted values across diverse populations.

To address this, the use of z-scores is now recommended. A z-score reflects how many standard deviations a measurement lies from the mean for a healthy reference population. A z-score of -1.645 (5th percentile) is generally used as the lower limit of normal. Unlike percent predicted values, z-scores adjust for demographic differences, providing a more standardised and statistically valid method for assessing lung function.

Assessing Meaningful Changes in Lung Function

When evaluating whether changes in lung function are clinically significant, it is essential to consider several factors. Practitioners should first determine if previous spirometry results are available. Next, they should assess how the current measurements compare within the normal distribution, evaluate the variability in past results and analyse the overall rate of change.

Assessing variability is important, as in patients with low variation in measurements, smaller changes in function are meaningful and for those with already variable lung function at baseline, much larger levels of decline are required to detect change.

It is also vital to account for clinical factors such as symptom development, changes in medication, test quality, and the inherent limitations of spirometry. The presence of respiratory symptoms or other clinical signs may necessitate action even if spirometry changes do not meet statistical thresholds.

Quantifying Change Over Time

Lung function decline can be assessed through various methods. One common approach is the slope method, which involves plotting serial measurements to calculate a trend line over time. This requires multiple data points and may be affected by variability in test performance.However, to determine whether such changes are meaningful, the coefficient of variation (CoV) should be calculated. This represents the extent of variability relative to the mean baseline measurement. In healthy individuals, short-term CoV is typically around 5%. Over longer periods, such as one year or more 11–15% in FEV₁ or FVC may be expected.

The expected normal decline should be considered a study by Thomas (2018) observed annual FEV₁ declines of 43.5 mL in men and 30.5 mL in women over periods exceeding three years, supporting the need to consider sex -specific norms in long-term surveillance.

Appointment-to-appointment comparisons can also be informative, allowing for the observation of absolute changes in millilitres or percentage between visits.

Accelerated annual decline in FEV1 overtime as follows is a drop in FEV1 over 1 year of 500mls or more is significant or FEV1 fall over 5 years of 500mls (an average of 100mls per year each year) is also significant.

Early recall for Spirometry is recommend for FEV1 decline over one year of 200mls or FEV1 fall over two consecutive years of 200mls.

The American Thoracic Society and European Respiratory Society (ATS/ERS) 2020 statement by Bonini et al states FEV1 changes greater than ≥ 20% over short-term trials of weeks in duration is clinically significant and FEV1 changes ≥ 15% in long-term measurements ≥1 year are clinically significant.

In the UK, the Association for Respiratory Technology and Physiology (ARTP) released guidance in 2020 stating that an FEV₁ decline of 20% or more in short-term trials, and 15% or more over periods exceeding one year, should be regarded as clinically meaningful. Nonetheless, if lung function declines alongside relevant symptoms or clinical changes, practitioners should act promptly, even if these thresholds have not yet been met.

The Importance of Monitoring Lung Disease

Spirometry plays a vital role in the early detection and monitoring of occupational asthma. In affected individuals, FEV₁ may decline rapidly, by approximately 100 mL per year, while exposure to the causative agent continues. Upon removal from exposure, the rate of decline typically slows and returns to a pattern more consistent with normal aging.

Frequent and accurate monitoring improves the precision with which decline rates are estimated. For slowly progressive diseases such as chronic obstructive pulmonary disease (COPD) or pneumoconiosis, spirometry every two to three years may suffice. However, for conditions that can progress more rapidly, such as occupational asthma, more frequent testing every six to twelve months is appropriate.

Regular spirometry is essential for assessing and protecting respiratory health in the workplace. Detecting clinically meaningful changes requires consideration of Spirometry interpretation and clinical context. With ongoing surveillance and accurate interpretation, occupational health practitioners can intervene early, improving outcomes and reducing the burden of occupational respiratory disease.

Charlene Mhangami, V Core Senior Product Specialist

Navigating Change: What Employers Need to Know About the Employment Rights Bill and Umbrella Company Reforms

Occupational Health Staffing is more than a recruitment agency. It is a committed partner to both employers and candidates across the occupational health landscape, offering guidance, insights, and clarity when navigating complex industry developments. As the UK government rolls out sweeping reforms set to impact employment practices over the coming months and years, Occupational Health Staffing stands at the forefront, equipping clients with the knowledge they need to prepare effectively and remain compliant.

The Employment Rights Bill: A New Era for Employers

The newly introduced Employment Rights Bill, set to take full effect in 2026, represents one of the most significant overhauls to UK employment law in decades. With wide-ranging implications for recruitment, management practices, and workplace rights, employers must begin reviewing their policies now.

Key reforms include:

• Day One Rights: Employees will gain protection against unfair dismissal from their first day on the job. Enhanced leave entitlements including paternity, parental, and bereavement leave will also be available from day one, alongside immediate eligibility for Statutory Sick Pay (SSP).

• Zero-Hours Contracts: Employers will be required to offer guaranteed hours to employees regularly working a set pattern, based on a 12-week reference period. Short-notice shift cancellations will need to be compensated.

• Fire and Rehire Restrictions: Dismissals based on refusal to accept contract changes will automatically be deemed unfair, except under severe financial hardship.

• Flexible Working: The new default. Employers must justify rejections with reasonable evidence.

• Collective Redundancies: Redundancy consultation thresholds will now apply across all sites, not just single establishments, when 20+ employees are affected within a 90-day window.

• Sexual Harassment Liability: Businesses will be responsible for preventing workplace harassment, including from third parties such as clients or contractors.

• New Fair Work Agency: This central enforcement body will ensure compliance with rights around holiday pay, minimum wage, and fair working conditions, with inspection powers and authority to impose penalties.

• Gender Equality Reporting: Larger organisations (250+ employees) will be required to publish annual action plans to address gender pay gaps and better support employees through life transitions such as menopause.

• Six-Year Record-Keeping: Employers must retain holiday pay and entitlement records for a minimum of six years or risk criminal penalties.

Occupational Health Staffing recommends that all employers begin reviewing internal policies and documentation now. Proactive preparation will avoid costly disruptions when the legislation becomes enforceable.

Umbrella Company Reform: What It Means for You

In addition to employment law changes, reforms affecting umbrella companies are poised to significantly shift employer responsibilities and financial considerations, especially for those engaging temporary or contract staff.

Effective April 2025:

• Employer NI Increase: The employer’s National Insurance rate will rise from 13.8% to 15%.

• NI Threshold Reduction: The threshold will drop from £9,100 to £5,000 per year.

These changes will drive up employment costs for umbrella companies. Unless assignment rates are renegotiated, these added costs may eat into worker pay or lead to shifts in hiring strategy.

From April 2026, the responsibility for managing PAYE and National Insurance Contributions (NICs) will shift:

• To Recruitment Agencies, if they place the worker.

• To End Clients, where no agency is involved.

This marks a major departure from current practices and is designed to address tax compliance issues and prevent unexpected liabilities for workers.

To further safeguard fair employment practices, the government also plans to introduce a formal regulatory framework for umbrella companies, placing them under the oversight of the Employment Agency Standards Inspectorate, which will eventually fall under the authority of the Fair Work Agency.

What Should Employers Do Now?

Occupational Health Staffing advises taking the following steps to prepare for the changes:

1. Review Contracts: Ensure clarity in agreements with umbrella companies and recruitment agencies regarding tax and employment responsibilities.

2. Assess Financial Impact: Factor in the increased cost of Employer NI contributions when planning future budgets.

3. Stay Updated: Keep abreast of legislative progress and upcoming deadlines to ensure compliance and avoid penalties.

Your Trusted Guide Through Uncertainty

With these changes on the horizon, Occupational Health Staffing continues to reinforce its position as a reliable, forward-thinking partner in occupational health recruitment and compliance.

By combining specialist recruitment expertise with a proactive approach to legislative awareness, we empower employers and professionals alike to move forward with clarity and confidence.

For tailored guidance, up-to-date insights, or to discuss your occupational health recruitment needs, get in touch with the team today.

 Call: 020 8952 6278  Email: enquiries@ohstaffing.co.uk  Website: www.ohstaffing.co.uk

THINK: A Leadership Framework for Sustainable Growth and Wellbeing

By Joanne Young

Leadership today is often relentless. Senior leaders and CEOs face mounting pressure, isolation, decision fatigue, and the emotional toll of constantly being "on." In a climate where wellbeing and performance seem at odds, many ask: How can I lead effectively without compromising my wellbeing or my team's?

The answer lies not just in doing more, but in thinking differently. This is where the THINK methodology comes in, a human-first leadership framework I developed by integrating Emotional Intelligence (EQ-i 2.0®), the Thinking Environment and over three decades of experience in Occupational Health (OH). My experience has spanned across a

range of sectors, and I have seen the shift from physical health concerns to a rise in psychological issues and emotional burnout. Traditional leadership training does not appear to be working as effectively as it could. I have been finding it extremely frustrating seeing clients in the occupational health setting with the same issues year after year, with no change in how they are managed. Many find they do not get support and end up leaving that employment.

This framework has relevance not only for leadership development but also for wellbeing professionals, including those working in integrated OH and wellbeing services.

What is THINK?

THINK is a values-based leadership methodology that draws on the metaphor of a thriving garden, where leadership grows through enriched soil, deep roots, intentional growth, and mindful maintenance. Each letter in THINK represents a foundational leadership pillar:

T – Transformation (Soil): Building emotional self -awareness and values-led clarity.

H – Human Connection (Roots): Creating inclusive, listening-based cultures.

I – Impact & Influence (Growth): Leading with empathy and emotional regulation.

N – Nurture (Tendering): Fostering wellbeing as a leadership competency.

K – Knowledge (Maintenance): Encouraging reflective, insight-driven decisions.

The methodology is grounded in the combination of three primary evidencebased frameworks:

Emotional Intelligence (EQ-i 2.0®) and the Thinking Environment are foundational to enabling Mental Fitness.

Emotional Intelligence provides the inner awareness and empathy needed for self-regulation, while the Thinking Environment sets the external conditions for others to think freely and safely. One supports the internal world of the leader, the other transforms the culture around them. Together, they create the resilient, reflective conditions required for sustained mental wellbeing, leadership effectiveness, and organisational growth, underpinned by mental fitness.

What is Emotional Intelligence (EQ-i 2.0®)?

Emotional Intelligence refers to the ability to recognise, understand, and manage your own emotions and to recognise, understand, and positively influence the emotions of others. The Emotional Intelligence model, developed by Dr. Reuven Bar-On and published by Multi-Health Systems (MHS), measures five composite areas:

1. Self-Perception

2. Self-Expression

3. Interpersonal Relationships

4. Decision Making

5. Stress Management

Reference:

Bar-On, R. (1997). The Emotional Quotient Inventory (EQ-i 2.0): A Test of Emotional Intelligence. MultiHealth Systems. ISBN: 978-0965842005.

What is the Thinking Environment

The Thinking Environment developed by Nancy Kline, is a relational and organisational framework that cultivates independent thinking by creating conditions of psychological safety. It is based on 10 Components, including:

• Attention (listening without interruption)

• Equality (no judgment)

• Ease (removing urgency to allow deeper thought)

• Encouragement (replacing competition with generosity)

• Feelings (welcoming emotion as part of the thinking process)

References:

Kline, N. (1999). Time to Think: Listening to Ignite the Human Mind. Cassell. ISBN: 9780706377453.

Kline, N. (2020). The Promise That Changes Everything: I Won’t Interrupt You. Penguin Business. ISBN: 978-0241423514.

What is Mental Fitness?

Mental Fitness refers to the capacity to respond to life’s challenges with clarity, flexibility, and emotional regulation, rather than ruled by stress, self-doubt, or reactive behaviour. It involves strengthening “mental muscles” that support resilience, self-awareness, and resourceful decision-making.

Reference:

Chamine, S. (2012). Positive Intelligence: Why Only 20% of Teams and Individuals Achieve Their True Potential. Greenleaf Book Group. ISBN: 978-1608322787.

Though less formally regulated than other fields, the growing body of workplace wellbeing literature supports the value of mental fitness training in leadership development and psychological resilience. Cultivating these internal capacities is just as essential as physical or mental health provision.

Gallup's 2025 State of the Global Workplace report emphasises the critical role of managers in employee engagement and wellbeing. The report highlights that 70% of a team's engagement is influenced by the manager. Therefore underscoring the importance of effective leadership in fostering a positive work environment.

Additionally, Gallup's research indicates that organisations investing in leadership development and wellbeing initiatives see improvements in employee resilience and overall performance.

Reference:

CIPD (2023) Health and wellbeing at work. London: Chartered Institute of Personnel and Development

Why Workplace Wellbeing Needs a Rethink

Many current workplace wellbeing strategies from Employee Assistance Programmes (EAPs) to mindfulness apps are well-intended but often feel like surface solutions or temporary relief, a sticking plaster. Without addressing the root causes of stress, disconnection, and poor decision-making, the same issues persist:

• Burnout

• Low psychological safety

• Disengagement

• Mental health strain

• Siloed, reactive thinking

This is echoed in the CIPD’s 2023 Health and Wellbeing at Work Report. This found that despite increased employer investment, many wellbeing strategies are undermined by poor implementation, lack of leadership buy -in, and an absence of real cultural change. For instance, the report notes that 69% of organisations have a formal wellbeing strategy, but only 25% believe their approach is effective. This discrepancy suggests that wellbeing initiatives may not achieve their intended outcomes without genuine leadership buy-in and a supportive culture.

As noted by the Society of Occupational Medicine (SOM), the work environment and leadership culture are key determinants of employee wellbeing (The value proposition, 2023). This supports a broader shift in Occupational Health and wellbeing services: moving from reaction to prevention, and from policy to culture.

The THINK Framework: Explained by Pillar

T – Transformation: From Surviving to Leading with Clarity

Leadership starts with self-awareness. This pillar aligns with EQ-i 2.0’s Self-Perception composite, helping leaders shift from reactive habits to intentional, values-based action.

➢ Shift: From surviving the role to leading with clarity and confidence.

H – Human Connection: From Control to Inclusion

This pillar promotes cultures of psychological safety through listening, appreciation, and inclusion a core principle of both OH best practice and Thinking Environment methods.

➢ Shift: From top down control to environments where people feel seen, heard, and valued.

I – Impact & Influence: From Urgency to Purposeful Leadership

Doing more is not always leading better or achieving more. This pillar integrates EQ-i 2.0 competencies like empathy and emotional regulation to support meaningful, energising influence.

➢ Shift: From urgency to purpose led influence that energises others.

N – Nurture: From Burnout to Resilience

Wellbeing is not a programme; it is a leadership skill. When leaders model self-care and emotional sustainability, teams thrive. This echoes Gallup’s finding that leaders with high wellbeing scores drive better engagement and retention (Gallup, 2025).

➢ Shift: From exhaustion to sustainable performance for both leader and team.

K – Knowledge: From Information Overload to Wisdom

In today’s noisy world, wisdom comes from reflection. This pillar encourages emotional insight, clarity, and slow thinking, essential in complex decision-making.

➢ Shift: From information overload to insight led leadership.

Cultural Habits That Reinforce THINK

To make THINK real in everyday culture, these five habits can be embedded in meetings, 1:1s, and team practices:

1. Thinking Rounds: Ensure everyone is heard without interruption.

2. Start with Appreciation: Begin meetings by naming one thing that is going well.

3. Rotate Roles: Equalise power by sharing facilitation, note-taking, or agenda ownership.

4. Ask Better Questions: Shift from “What’s wrong?” to “What do you think?” or “What are you feeling?”

5. Model EQ-i 2.0 Daily: Practise curiosity, reflection, and self-regulation, especially under pressure.

These small habits foster psychological safety, trust, and higher-quality thinking.

Final Thought: The Real Return on Investment of Better Thinking

When leaders think clearly, they lead wisely. When teams feel heard, they perform better. When wellbeing is embedded into how we think, organisations grow from the roots up. You do not need another initiative. You need a different lens.

Joanne Young | Linkedin

Joanne is the founder of Joanne Young Consultancy. With a clinical background in Occupational Health and a specialist focus on wellbeing in leadership, she developed the THINK framework to support sustainable change across sectors. She is a certified EQ-i 2.0® Profiler and Time to Think Coach and Facilitator. Joanne delivers interactive leadership workshops and reflective spaces for CEOs, senior leaders, and wellbeing professionals who want to embed psychological safety, EQ-i 2.0, and mental fitness into their culture.

We are looking for:

We have exciting opportunities to join our team Heddlu Dyfed Powys Police as an Occupational Health Advisor. Are you a Registered General Adult Nurse? Can you promote healthy choices and provide advice to those who need it?

If you possess the necessary skills and experience, and share Heddlu Dyfed Powys Police’s values and commitment, we want to hear from you.

Occupational Health Advisor to promote healthy choices, manage sickness absence consultations for Police officers and Police staff and formulate rehabilitation programmes to help maintain health and wellbeing.

Benefits you’ll receive:

All new starters will have a buddy/mentor to support you when you join

Flexible working

Training opportunities are provided within the force and externally, to help you grow in confidence and progress within the field.

24 days annual leave (rises to 29 days with 5 years’ service) plus 8 bank holidays

Access to on-site gyms and fitness classes

Discounts from various retailers via the Blue Light Scheme

Staff support networks and more

If you have the knowledge and experience for this opportunity visit ‘Dyfed-Powys Police jobs’ today or contact recruitment@dyfedpowys.police.uk for more information.

Making every contact count Health Coaching and Health Promotion

By Dr Aaliya Goyal, Occupational

The recognition of work as an important social determinant of health and good work as a key lever in tackling health inequalities, reinforces the importance of occupational health (OH) in the provision of holistic care. This compounds the challenges employees face in accessing preventative healthcare advice and health screening in the community setting. The combination of the amount of time spent in work and the rising pressure on NHS primary care services, makes community access more challenging

The role of OH professionals is evolving beyond a focus on workplace illness prevention, regulatory compliance, fitness for work, and managing sickness absence. The ageing workforce is increasingly experiencing chronic conditions, mental health challenges, and lifestyle -related diseases. This leads to a growing recognition that OH can, and should, play a more proactive role in promoting overall health. Incorporating health coaching and health promotion into OH practice is an opportunity to enhance employee wellbeing, improve workplace productivity, and reduce long-term healthcare costs.

The Case for Health Promotion in Occupational Health

Health promotion encompasses a range of activities to empower individuals to take greater control of their health. These include education, behavioural change interventions, and supportive environments that facilitate healthier choices. In the workplace, health promotion can address risk factors such as poor nutrition, physical inactivity, stress, smoking, and substance misuse, which often underlie or exacerbate occupational health issues.

Employers are increasingly looking to their OH providers to proactively promote wellness rather than take a reactive approach to ill health. This aligns with public health goals and government strategies1, 2 to ensure the health service remains fit for the future. For OH, embracing this preventive focus offers a strategic opportunity to engage with key stakeholders in the community and the local health system, while improving employee engagement3 .

Long-term sustainability requires a demonstration of return on investment (ROI). This is achieved through

count in Occupational Health: Promotion to improve outcomes for all

Occupational Health Physician

comprehensive programme evaluation, which could include participation rates, session completion, goal achievement, and employee satisfaction scores. These metrics provide insight into engagement and identify areas for refinement. Linking these outcomes to health risk assessments, absenteeism rates, or biometric data may also allow continuous improvement and support the business cases for investment in proactive health strategies.

Health Coaching in OH Consultations

Health coaching is a personcentred, evidence-based approach that supports individuals in making lasting behavioural changes. By fostering autonomy, motivation, and accountability through a collaborative relationship between the OH professional and the employee. The employee is recognised as the expert on their own life circumstances, preferences, and motivations.

A key component of health coaching is motivational interviewing (MI), which allows the employee to identify their priorities, goals and solutions.

In the OH setting, health coaching can be particularly

effective for exploring self-management techniques for stress management, weight loss, smoking cessation, physical activity, and chronic disease selfmanagement. This empowers employees to take ownership of their health goals, which can lead to higher engagement and better outcomes.

Traditional occupational health interventions often focus on identifying risks without providing the behavioural support necessary for meaningful modification. Health coaching bridges this divide through structured, goaloriented conversations. These empower employees to take ownership of their health journey, through promoting selfreflection and insight rather than simply gathering information for clinical decision-making.

Integration into OH Practice

Incorporating health promotion and coaching into OH practice begins with awareness of the opportunity that OH provides. As health professionals, we should always be mindful of the mantra to “make every contact count” with small but meaningful shifts in conducting consultations to maximise the impact we have with employees during what could be a rare contact with a health professional. OH professionals often undertake a comprehensive health

risk assessment that extends beyond traditional occupational hazards to include lifestyle factors and psychosocial risks. This naturally provides the foundation for personalised health promotion strategies, which OH can take one step further.

OH nurses, allied health professionals (AHP), and doctors can integrate coaching techniques into routine assessments. Using open-ended questions such as “What changes would you like to make to improve your health?” or “What has worked for you in the past?” to initiate a coaching dialogue may help. These brief interactions, even if only for 10 minutes, can be impactful and implementable, producing significant behavioural changes when delivered consistently over time. Or at least plant the seeds for motivation and action beyond the OH consultation.

Pilot projects can test new approaches on a small scale before broader rollout.

Develop Targeted Health Promotion Campaigns

Workplace health campaigns, on topics such as mental health awareness, healthy eating, or self-examination for breast and testicular cancer, as appropriate, can be led or supported by OH teams. When aligned with organisational priorities and employee demographics, campaigns can shift culture and behaviours across entire workplaces.

Challenges and Considerations

Barriers to implementing health coaching and promotion in OH may include training, time, and resource limitations. OH professionals may need additional skills in behavioural science and coaching techniques, alongside organisational support to embed these approaches.

This could represent an opportunity for organisations to invest in professional development opportunities, which often enhance job satisfaction among occupational health staff.

The Future of Occupational Health

The future of occupational health lies in an integrated, holistic approach that bridges the gap between clinical care and lifestyle support. Health coaching and promotion are key tools in this evolution. By incorporating these elements into routine practice, OH professionals can enhance their role as health advocates, not just assessors of fitness for work, and create new partnerships to enhance the business case for OH. Collaborative working, with multidisciplinary referrals to health coaches, wellbeing coordinators, physiotherapists, and psychologists, can offer comprehensive support, which employers may support as part of broader wellbeing strategies to maximise workforce wellbeing and organisational outcomes.

For occupational health (OH) doctors, nurses, and AHPS, this is also an opportunity to help shape the future of the profession and contribute to OH remaining agile in response to ongoing demographic, technological, and cultural changes. These risks increase healthcare costs and employee expectations for holistic wellbeing support. By embracing health promotion and coaching, OH professionals can deliver greater impact, enhance individual health and organisational performance, and create a ripple effect, contributing to a healthier society.

References

1. https://www.gov.uk/government/publications/independent-investigation-of-the-nhs-in-england/summaryletter-from-lord-darzi-to-the-secretary-of-state-for-health-and-social-care

2. https://www.gov.uk/government/publications/road-to-recovery-the-governments-2025-mandate-to-nhsengland/road-to-recovery-the-governments-2025-mandate-to-nhs-england

3. https://www.gov.uk/government/news/over-130000-people-to-benefit-from-life-saving-health-checks

Dr Aaliya Goyal | LinkedIn

Dr Aaliya Goyal is an Occupational Health Physician, is on the NHS Health at Work Board, and is the Society of Occupational Medicine, West Midlands Regional Group Secretary and Deputy Chair. She was the 2023 Society of Occupational Medicine Highly Commended Occupational Health Practitioner of the Year.

Introduction

Work-related stress and burnout are consequences of today's fastpaced working environment, potentially impacting all employees. This article explores how using a well-validated psychometric tool for measuring burnout, namely the Oldenburg Burnout Inventory (OLBI), can help employers meet their legal requirements for worker welfare by enhancing health needs assessment, surveillance and policies and procedures for a better organisational culture.

Not widely used in Occupational Health (OH) practice, this article explores whether this tool could enhance OH advice.

A brief history

The awareness of work-related stress and burnout has gained traction in today's fast-paced working environment. As businesses work to maintain output while guaranteeing worker welfare, the input of OH can provide crucial advice in promoting and maintaining worker physical, mental, and emotional well-being. To do this, it is important that well-validated assessment tools are used to guide advice.

The World Health Organisation (WHO) (2003) defines stress at work as the reaction people may have to pressures and demands. Stress can keep people motivated and maintain vigilance to avoid risk. Excessive stress can weaken people and impair their capacity for adaptation and coping. It can negatively impact relationships, functioning, physical and mental health, and even lead to financial difficulties. Both employee health and company performance can be negatively impacted by stress. With constant pressure at work, burnout is possible.

The 11th Revision of the International Classification of Diseases (ICD -11, 2024) recognises burnout as a workplace problem, but not a medical condition. Burnout is a phenomenon thought to be brought on by poorly managed work-related stress and can be characterised in three ways:

- emotions of tiredness or low energy,

- feelings of disconnection from one's work or

- sentiments of pessimism about one's work, and as diminished professional efficacy (Pelayo-Terán et al, 2024).

Burnout leads to emotions of stress, tiredness, and fatigue in the workplace. It is considered a significant occurrence (Heinemann & Heinemann, 2017) and a predictor of staff turnover and absenteeism (Anadkat & Joshi, 2023). According to Sainsbury's Centre statistics (2007), stress and mental health disorders may be responsible for as much as 5% of employee turnover.

Can the Oldenburg sessment tool be an OH assessment?

By Rebecca

Oldenburg burnout asbe used within assessment?

Rebecca Sudell

Employers have a "duty of care" to safeguard their staff members against the dangers of workplace stress under the Health and Safety at Work Act of 1974. All employers are required by the Management of Health and Safety at Work Regulations of 1999 to conduct a "suitable and sufficient assessment" of the risks to their workers' health and safety at work (Thornbory et al, 2018).

Validity

Christine Maslach and her colleagues independently investigated and developed "Burnout,” a term popularised by Psychologist Herbert Freudenberger. Consequently, "the Maslach burnout inventory (MBI)," was developed. A popular and extensively utilised self-reporting tool for evaluating burnout in a range of occupations. Research initially focused on health care professionals, but findings demonstrated that burnout is not exclusive to these types of occupations (Anadkat & Joshi, 2023). The MBI is regarded as the standard instrument for research in this field (Maslach & Leiter, 2016). However, there are challenges with MBI, which OLBI addresses, particularly in language.

A systematic review ranked the OLBI as the second most reliable due to its use of balanced language, comprehensive understanding of burnout, validity and reliability Shoman et al (2021) and Halbesleben and Demerouti (2005). It is also publicly accessible in multiple languages and is shorter than MBI.

Description

The OLBI assesses exhaustion and disengagement via a 16-point self -assessment questionnaire. A version can be found within the BMJ. Exhaustion is the state of being depleted of physical, emotional, and mental resources and is an important indicator of an individual's general wellbeing and capacity to carry out their duties. Disengagement measures the degree to which an individual feels cut off from their work, their coworkers, and workplace culture (Reis et al, 2015).

The OLBI scores on a 5-point scale, with 1 being strongly disagree and 5 strongly agree. Higher disengagement scores (22+) suggest a stronger propensity for people to disconnect themselves from their work and form unfavourable attitudes towards their profession, whereas higher exhaustion levels (23+) indicate greater physical, affective, and cognitive fatigue. High scores in both areas suggests a high risk of burnout (Halbesleben et al, 2005). Results can highlight how both exhaustion and disengagement impact on job satisfaction and performance. Subsequently, strategies for improving workplace culture, and action plans for team meetings and appraisals, can be

developed (Anadkat & Joshi, 2023). Repeating the survey, after actions are taken, can demonstrate any improvements.

Use in OH

There is little clinical evidence regarding its effective use by OH professionals. An explanation may be that work-related stress is typically considered a management issue! Research by Llaloo et al (2018) demonstrated that while occupational hazards such as stress were a priority for OH, it was outranked by other issues such as cost effectiveness and research. There was also little agreement on effective preventative strategies.

What can OH do?

OH can make suggestions on altering work habits, learning coping mechanisms, obtaining social resources, encouraging good health, and referral for therapeutic techniques for better resilience to job pressures (Maslach & Leiter 2016) and encourage managers to undertake a stress risk assessment (HSE management standards) if perceived work related stress is identified. OH practitioners may assess the psychological distress and fatigue arising from workrelated stress using tools such as PHQ-9 and GAD 7 and a fatigue assessment scale (FAS). While these may offer insight into symptomology, this could be considered reactive rather than proactive.

OLBI is a tool specifically useful to screen and monitor individuals and groups for burnout. Furthermore, it may better support suggestions for reasonable adjustments and supportive management.

Anadkat & Joshi (2023) identify individuals and organisations for burnout interventions; -

- Individual-level therapies to improve a person's ability to cope with pressures at work.

- Organisational level intervention strategies focusing on eliminating or reducing organisational pressures.

The bulk of research has shown that organisational changes have a greater effect on burnout than individual ones, yet changing an organisation is more costly and time-consuming than changing a person (Anadkat & Joshi 2023).

Employers must take steps under health and safety legislation to ensure that employees' work does not negatively impact their physical and mental health and that employees are medically capable of performing their jobs safely. This comprises undertaking health surveillance, risk assessment and ensuring medical fitness to undertake work tasks (Thornbory et al, 2018).

OLBI may :offer a structure for mental health surveillance add value when undertaking a health needs workforce population and support subsequent development of guidelines workforce welfare.

surveillance and risk assessment. needs assessment of a guidelines and strategies for

Cautionary Note

It is important to note that OH must follow strict business and biomedical ethics (Hobson and Smedley, 2019). This includes working within the parameters of both professional registration and business policies and procedures. Because these questionnaires measure symptoms that the ICD has not (yet) precisely defined, they are based on limited albeit ever-growing research.

There isn’t a quick and seamless application of OLBI in OH, but it does pose interesting questions that warrant further exploration.

Conclusion

OLBI could help employers meet their legislative requirements regarding managing and tackling stress through risk assessment and surveillance.

Use of the tool could lead to the development of policies, procedures and strategies that aim to manage stress proactively, promote the psychological safety of a workforce population and develop a positive organisational culture.

The tool can identify individuals who are experiencing or at risk of developing stress. Therefore providing focused occupational advice and supporting dialogue with managers and the organisation.

As the tool is not widely used by OH practitioners, exercising caution is advised. Further research is warranted. The questionnaire is available for self-assessment via the British Medical Association.

Reference:

Thornbory G, Everton E, Anderson-Cole L, Mogford, RomanoWoodward D. Contemporary Occupational Health Nursing: A guide for practitioners 2018 2nd ed. Oxon: Routledge.

Biography:

Rebecca Sudell has been an occupational health nurse advisor with PAM Group for 4 years. She completed her OH degree in 2024. Before joining PAM, Rebecca gained years of nursing and midwifery experience in hospital and community settings.

Most people can’t even say Ergonomics without stumbling over the pronunciation! So, what is it?

As with most things in occupational health (OH), interchangeable language is used. Some people may associate ergonomics with DSE (Display Screen Assessments) assessments, others with equipment design, and others with manual handling. However, it can include all of these.

The CIEHF (Chartered Institute of Ergonomics and Human Factors) defines ergonomics and human factors (EHF) as "The scientific discipline concerned with the understanding of interactions among humans and other elements of a system, and the profession that applies theory, principles, data, and methods to design to optimise human well-being and overall system performance." - The International Ergonomics Association. Sounds complicated, but the real goal is ‘simplicity.’

Why ergonomics?

I qualified as a nurse in 1993 and ended up working in OH via A+E and the RAF. By some strange twist of fate, I found myself helping my wife (also a nurse) and her sister run their small OH startup in approximately 2009. We noticed quickly that referrals from customers were increasingly focused on musculoskeletal (MSK) issues and display screen equipment (DSE) assessments, and these DSE assessments were becoming increasingly complex and varied.

From Curiosity AN OH Nurse’s foray

By Chris

One day, I was asked to assess a workstation in an engineering firm, and this worked well; I enjoyed researching possible solutions. Realising that this was a little more in-depth than the usual OH work, I looked for training and education. I initially did a three-day course, which made a huge difference to my ability to solve workplace problems. Getting the bit between my teeth, I joined the CIEHF and undertook a postgraduate certificate with Nottingham University. Although more academic in style, it broadened my understanding of different aspects of ergonomics.

And that’s where things started to develop. Since then, I have assessed everything from boats (fast patrol vessels), heavy plant vehicles, industrial work processes, and small tool

In a workplace fitting the work worker rather than way around

Curiosity to Expertise: foray into ergonomics

Chris Terry

assessment. I’m currently developing our ‘Ergonomic team’. Members have a mixed skill set, such as occupational hygiene and ergonomics, OH advisor and ergonomics, or neurodiversity and ergonomics. I place a high importance on visiting the workplace and actually ‘walking through’ the role with the employee and getting an accurate feel for the difficulties they face and what could be done.

Why does it help, and who does it help?

In a workplace sense, we are fitting the work to the worker rather than the other way around (which generally leads to difficulties). This type of approach is especially important these days, as post -Covid much OH work has moved to an online approach, plus we have case law

such as Mitie V Lee to consider. Fortunately for me (and my team), this leads to interesting work (another ergonomic principle!) Often, I can find myself in fascinating circumstances: the inside of a large road bridge, at the bottom of an open-cast coal mine, heavy industry settings, clearing drains and sewers, to name but a few. I think it’s difficult to suggest you are a ‘workplace expert’ if you have done a qualification and then sat in an office for the rest of your career. There is no substitute for going and looking at a job role.

I’m obviously biased, but I believe that ergonomics is a fantastic ‘bolt-on’ to our OH skills. It is more about ‘fully understanding’ as opposed to just gaining knowledge.

How can you do this?

The CIEHF has online learning pathways for various sectors. These are an excellent starting point, comprehensive and cost-effective.

I would also consider the ACPOHE course Introduction to Applied Ergonomics. This is a one-day online course with a few hours of reading beforehand. It is a great start and seems to transfer well to the type of work that an OHA would be asked to do.

Learning to carry out DSE assessments is also a good place to start. Many OHAs will have already covered this in their training, but if not, I can recommend DSE Scotland for one-day online courses that are CIEHF-accredited.

The next level to this would be the fiveday ergonomic course with Matt Birtles of the HSE at Buxton. The participants on this course could be varied and commonly include health and safety officers who need to operate as in-house workplace sense, we are work to the than the other around

ergonomic practitioners. There is also an alternative course (but similar in content) offered online by an academy that is certified by the British Occupational Hygiene Society (BOHS).

And finally, you could proceed to the academic route. There are several universities offering both postgraduate certificates and MScs.

Added value

Some examples of where my ergonomic knowledge has been advantageous to my OH work are:

Assessing a stonemason with reduced grip. We modified his work plan and sourced alternative grips for his tools.

A cleaner who had a knee replacement and was having difficulty with using a Hoover and cleaning buckets. We changed the Hoover and modified the sluice drain for emptying water.

A ground worker who was having difficulty with her shoulder. It was found that the leaf blower she was using was designed around anthropometric measurements for a man. We changed her work pattern and sourced a different leaf blower, which was lighter and had an improved harness.

Where else do ergonomists work?

In real terms, there are few people with well-honed ergonomic skills. You will find ergonomists in the nuclear, rail, aviation, and automotive industries, as well as increasingly in healthcare and construction.

Overall, I can see ergonomics and human factors (EHF) becoming more visible to employers in the future and being used daily. Having a health-based

background certainly lends itself well to physical ergonomics and can also provide an advantage when looking into the cognitive side of the subject. Certainly, traditional EHF knowledge can appear complex (and often it is), but once you understand the principles and how to apply them, they can be used in anything from properly setting up your desk to designing more efficient working practices or even investigating who was responsible for not emptying the bins in the office!

Associated

Links.

Homepage | CIEHF

Association of Chartered Physiotherapists in Occupational Health and Ergonomics | Association of Chartered Physiotherapists in Occupational Health and Ergonomics

Course: Ergonomics

DSE Scotland - DSE risk assessment & training specialists

Ergonomics Essentials (including Manual Handling and DSE) M506 (replaces W506 OHTA course) - British Occupational Hygiene Society (BOHS)

Chris Terry | Linkedin

Chris Terry is a director at Insight Workplace Health, a private outsourced occupational health provider based near Swansea. The team consists of physicians, nurses, technicians, neurodiversity assessors, a psychologist, and an ergonomic team.

BOOK REVIEWS

Iselected these three books in conjunction with Mental Health Awareness Month, held in May explaining essential topics in mental health in simple terms and providing practical tips that

"The Stress Solution: the 4 steps to a calmer, happier, healthier you" by Dr Rangan Chatterjee is a helpful book that explains what stress is and how to manage it in everyday life. Dr Chatterjee focuses on four main areas: purpose (finding meaning), relationships, the body, and the mind. He demonstrates how making small changes in these aspects of life can help reduce stress and improve overall well-being. One of the best things about this book is that it is easy to read and understand. Dr Chatterjee uses simple language, so readers don’t need any special knowledge to follow his advice. The book offers many practical tips that are easy to try, such as establishing a good morning routine, spending quality time with friends and family, taking breaks from screens and phones, practising meditation, and incorporating breathwork. These small steps

can have a significant impact on how stressed you feel. The book also looks at stress from different angles, which helps readers see the complete picture of what causes stress and how to handle it. Dr Chatterjee writes in a friendly and positive way, sharing stories that make the advice feel real and encouraging, making the book enjoyable and motivating.

However, the book does not deeply explore the science behind stress. If you want detailed scientific explanations, this book might not meet your needs. For those who wish to explore further, there is a reference list at the end of the book. Furthermore, some of the ideas, such as practicing mindfulness or gratitude, may seem familiar if you have read other self-help books.

In summary, "The Stress Solution" is a good choice for anyone seeking simple, holistic and practical ways to reduce stress and improve their well-being. It is easy to understand and full of useful ideas that you can start using right away.

By Michelle Moorst

May each year. I find these books useful and practical, not only for myself but also helpful in that I can apply in my practice.

"The Gift: 12 Lessons to Save Your Life" by Dr Edith Eger is a book that draws deeply from her extraordinary life as both a Holocaust survivor and a clinical psychologist. Dr Eger structures the book around twelve "mental prisons", which include victimhood, avoidance, self-neglect, unresolved grief, resentment and hopelessness. One of the strengths of the book is its accessibility. Dr Eger writes in a way that is easy to understand. Her approach is compassionate, as she combines her personal stories with cases from her clinical practice. This combination of memoir and guidance makes the lessons feel relatable and grounded in real human experience. The book provides practical advice to help readers overcome these mental barriers. Each chapter concludes with exercises and reflective questions that encourage readers to engage. The book's overall message is hopeful and empowering, reminding readers that healing, finding meaning, and achieving freedom, even in the face of suffering, is possible.

However, readers may find some of the advice familiar, particularly those who have read other works on trauma and resilience. While Dr Eger's personal stories are compelling, readers seeking a more clinical or academic approach may find this book not for them. Nevertheless, for me, this is a book of wisdom drawn from her unique personal life experience and professional practice.

In summary, The Gift" is a compassionate and inspiring guide to overcoming life challenges. Dr Eger's unique perspective, shaped by her own survival and decades of helping others heal, makes her advice especially valuable and resonant.

Why Has Nobody Told Me This Before? by Dr Julie Smith is a practical and straightforward guide to understanding and taking care of your mental health. Dr Smith is an experienced clinical psychologist who wants to make mental health advice accessible for everyone, not just people in therapy. The book is written in short, clear sections, so readers can quickly find help that is relevant to them, whether it is related to low mood, emotional pain, anxiety, grief, or self-doubt.

The book is a combination of knowledge, wisdom and practical techniques that can be applied when navigating through difficult times. For example, Dr Smith explains how thoughts can affect feelings, and she provides easy ways to challenge negative thinking. She also discusses how simple habits, such as breathing exercises or practising gratitude, can make a big difference in mood and confidence. The tools provided in the book are mostly taught by Dr Smith in her own clinical practice.

One of the key strengths of this book is the friendly and understanding approach of Dr Smith’s writing. She discusses mental health in a way that feels supportive and non-judgmental.

The book encourages you to take small steps to look after yourself and reminds you that mental health is equally important as physical health.

However, for those who already have a good understanding of mental health, the list of resources provided for each chapter of the book may be helpful. The book is best suited for individuals who seek straightforward, everyday tools rather than comprehensive solutions for complex problems.

Overall, Why Has Nobody Told Me This Before? is a helpful, easy-to-read book that gives you the essential tools for looking after your mental health. It’s a great starting point for anyone who wants to feel better and gain a deeper understanding of themselves.

Michelle Moorst is an Occupational Health Specialist (RN).

Follow Michelle on LinkedIn.