OH Today Volume 32 Issue 3 - 2025

Medicinal Cannabis and Safety-Critical Work: Time to rethink the threshold of safety?

Also in this issue : The Neuroinclusion Illusion | EOPH Conference Preview 2026 Making Occupational Health Work | Pernicious Anaemia Hidden Support - caba | 10-year Health Plan for England

iOH Partners

Friends of iOH : Asclepius Occupational Health | Flex Occ

s

cupational Health Ltd | Sparta Health

Editor LYNN PRATT Assistant Editors JANET O’NEILL CAROLYNA FRANKLIN Production Editor IAN GARNER

Copyright © iOH 2025 Registered Charity No. 1205635 Published by iOH, The Association of Occupational Health and Wellbeing Professionals

ioh.org.uk

email: admin@ioh.org.uk

Views expressed in OH Today are those of the contributors and not necessarily those of iOH.

Nor does iOH necessarily endorse any of the products or services mentioned or advertised in the publication.

CONTENTS From the President

5

Medicinal Cannabis and Safety-Critical Work: Time to rethink the threshold of safety?

6

The Neuroinclusion Illusion: Closing the Gap Between Employer Perceptions and Employee Experience

10

EOPH Conference Preview 2026 - staying ahead in Occupational Health

18

Making Occupational Health Work: From quality referrals to effective outcomes

26

The Hidden Struggle: My Journey with Pernicious Anaemia

39

Could your clients be missing out on hidden support?

44

Response to the 10-year Health Plan for England: An opinion piece

49

The benefits of PC-based audiometry

54

Book Review

58

From the President Lynn Pratt

I

n July 2025, the government released Fit for the Future: The 10-Year Health Plan for England, defining a new direction for the NHS. The plan aims to make the NHS more responsive, preventative, and focused on patient needs over the next decade, particularly

the emphasis on new technologies, medicines, and innovations to improve patient care.

In the plan the Prime Minister acknowledges the current crisis within the NHS and its widespread impact on society, causing significant pain and suffering to families and affecting people's ability to work. It's promising to see this mentioned; however, the plan barely touches on Occupational Health (OH) services, which play a crucial role in preventing ill health, promoting health, and supporting individuals with health conditions to remain in or return to work. It's disheartening to see OH not given the same prominence as other specialist areas, especially when one of the plan's "radical shifts" is from sickness to prevention.

The dwindling number of OH specialists is concerning. To be truly effective, the status of OH and staff morale must be considered. The lack of understanding, recognition, and respect for OH's role continues to be a challenge, even among healthcare professionals and decisionmakers.

The plan's focus on community-based healthcare, including the rollout of Neighbourhood Mental Health Centre’s, is a positive step. However, it's crucial that OH is included as a vital component of the health plan.

OH should be given greater recognition and integrated into the NHS 10-year health plan, as OH specialists are essential in managing workplace wellbeing and supporting the return of individuals to work through collaborative, multidisciplinary approaches.

Sir Charlie Mayfield will be discussing the plan at the forthcoming Labour Party Conference 2025. iOH has been working with the Institute of Occupational Safety and Health (IOSH) to add our voice to the discussion on the core challenges, opportunities and recommendations on behalf of members. Recommendations reflect a combination of strategies from the Pathways to Work Commission, and the Get Britain Working White Paper .

In addition, iOH has recently contributed members’ views on a roundtable on chronic pain in Parliament, supported by Susan Murray MP and exploring the findings and recommendations of the Fabian Society’s Nye’s Lost Legacy report which was commissioned by UNISON and written by Fabian Society examining the case for instituting a National Occupational Health Service as a way of keeping people well in work. Inside this edition you can explore additional thoughts on the plan, other insightful articles, forthcoming webinars and partners resources.

Join online on 24 September for the iOH AGM followed by an insightful webinar by Dr Julie Denning on Health Psychology. All welcome!

Lynn Pratt, President iOH ioh.org.uk

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Medicinal Cannabis and Safety-Critical Work: Time to rethink the threshold of safety?

By Dr Mary Obele, Occupational and Environmental Physician

Medicinal cannabis is no longer an emerging issue; it is an established reality in many health systems. But across the globe, workplace drug testing policies, occupational safety protocols, and regulatory frameworks have lagged behind.

As medicinal use becomes more common, particularly for chronic pain and mental health conditions, we must find a balance between patient care and safety-critical performance at work.

A Monday Morning Challenge

I

t’s early in the week, and you're the only health and

safety advisor in a busy

industrial facility. A trusted employee, who works solely in safety-critical roles, confides that they’ve been prescribed medicinal cannabis (THC and CBD). Your organisation's policy covers drugs and alcohol broadly but says nothing about prescribed cannabis. Management is unsure.

A quick online search yields inconsistent, country-specific advice. Colleagues disagree. What do you do?

This scenario isn’t fictional. It’s representative of a growing grey zone in workplace health, where medical, legal, and operational frameworks are out of sync.

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The 8-Hour Rule – A Red Herring?

Safety-Critical Work and Impairment Risk Safety-critical roles include aviation, healthcare, emergency response, transportation, construction, energy, and manufacturing, any work where performance lapses can endanger lives or infrastructure.

Some clinical guidelines suggest that safety-critical workers should abstain from work for 8 hours after using THC. I think this “8-hour rule” is overly simplistic. Cannabis effects vary based on individual metabolism, dosage, delivery method, co -morbidities, and other medications. In some cases, impairment may persist beyond 8 hours; in others, there may be no meaningful impairment even at

Cannabis, particularly THC-containing products,

detectable levels.

can affect concentration, depth perception, reaction

Relying solely on time-based or test-based criteria

time, and judgement. These effects matter deeply in safety-critical environments. But impairment isn’t

does not account for these complexities.

limited.

Stakeholder Frustration is Growing

Testing Does Not Equal Safety

• Workers using prescribed cannabis may feel

binary, and our current tools for assessing risk are

Most workplace testing protocols detect the presence of THC metabolites in urine or saliva.

These indicators show that cannabis has been consumed, but not when or whether the individual is currently impaired. In fact: • Urine tests reflect exposure days or even weeks after use.

• Saliva tests may detect recent use but have no proven correlation with cognitive or motor impairment.

• Blood tests, while more specific, are invasive

and impractical for routine workplace screening.

unfairly penalised, especially if they have transitioned from more impairing substances such as opioids or benzodiazepines.

• Clinicians face ethical tension. They may support cannabis for therapeutic reasons but lack occupational health guidance to advise on work fitness.

• Employers are caught between ensuring safety and respecting medical confidentiality, often with little regulatory clarity.

A Question of Equity Around the world, safety-critical jobs are frequently

None of these methods reliably determine

filled by lower-paid, physically demanding roles,

functional fitness for duty. Yet they remain the

roles often held by migrant workers, ethnic

primary tools in many workplace drug policies.

minorities, or those with fewer healthcare choices.

A rigid approach to cannabis testing, devoid of context, risks deepening existing disparities and undermines trust in workplace health systems.

Cannabis effects vary based on individual metabolism, dosage, delivery method, co-morbidities, and other medications.

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What Are Other Countries Doing?

Innovating Around Impairment

International approaches vary:

Rather than relying on toxicology alone,

• Some jurisdictions (e.g., Canada, parts of the US, Germany) permit

the future lies in combining: • Impairment-based assessments –

medicinal cannabis in safety-

cognitive, behavioural, or task-

sensitive occupations with certain

specific evaluations tailored to safety

restrictions or risk assessments.

-critical roles.

• European and North American

• Collaborative policy development –

regulators are exploring the use of

involving occupational health, legal,

performance-based impairment

regulatory, and worker

testing; validation is ongoing.

representation.

• Global guidance is fragmented. No

• Education and guidance for

universally accepted threshold for

prescribers – with a focus on

workplace THC impairment exists. In

functional risk, not just clinical

most places, policy is being shaped

symptoms.

reactively, often by legal precedent rather than scientific consensus.

Raising the Threshold?

My Practical Proposal Current urine THC metabolite thresholds for a “positive” result (commonly 15 ng/mL) are based on outdated data. Clinical use often results in detectable levels well beyond this, without impairment.

Why This Matters If we fail to evolve policy in line with

evidence and equity, we risk: • Wrongfully excluding capable workers.

• Exposing employers to legal and reputational risk.

• Eroding confidence in occupational health guidance.

Raising the threshold, say, to 50 ng/mL

Done well, we can create a future where

or higher under supervision could help

medicinal cannabis use and safety-

differentiate between therapeutic use

critical performance are not

and unsafe impairment. While not

incompatible, but rather, managed

perfect, it could be a more

transparently and safely.

proportionate and pragmatic interim

A Call for Global Dialogue

step.

Such an approach would require robust medical oversight, education, and clear documentation—but it would acknowledge both clinical realities and the needs of modern workplaces.

This challenge is not unique to one country or sector; it’s a global issue. It will take multi-stakeholder collaboration to develop workable, culturally appropriate, and legally sound frameworks.

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Occupational health professionals have a critical role to play in leading this discussion. Let us

engage with industry, regulators, clinicians, unions, and patient advocates to build policies that are grounded in science, fair in practice, and adaptable to the real world.

References American College of Occupational and Environmental Medicine (2023) – Legalisation of cannabis – implications for workplace safety.

British Medical Journal (2023) - Medicinal cannabis and implications for workplace health and safety Canadian Centre for Occupational Health and Safety – Workplace strategies: risk of

impairment from cannabis 2018 European Monitoring Centre for Drugs and Drug Addiction (2024) – Cannabis laws in Europe International Civil Aviation Organization – Cannabis and aviation safety.

National Institute for Occupational Safety and Health (2024) – Cannabis use and workers.

WorkSafe Western Australia (2025) – Medicinal cannabis in the workplace.

Dr Mary Obele | LinkedIn As a Specialist Occupational and Environmental Physician, Dr Mary Obele has been a doctor for over twenty years, specialising in health and work. She does medical assessments for various industries, advises on hazards and risks, consults for organisations, lectures at universities and mentors new doctors. She is a member of various health committees and panels. At home, her family often has bits of engines in the lounge.

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The Neuroinclusion Illusion:

By Helen Musgrove Head of Consultin

O

ver the last few years, neurodiversity has entered public consciousness with a bang. You can’t open a newspaper or scroll through social media without it popping up, and the business world is no exception.

Employers increasingly recognise the prevalence of neurodivergence within the workforce, and happily, the value that neurodivergent people can bring to their organisation (e.g. strengths in creativity, honesty, integrity, critical thinking and hyperfocus). Research by the Chartered Institute of Personnel and Development (CIPD) in 2024 found that 60% of employers say neuroinclusion is a focus for their business and 61% that their organisation genuinely values neurodiversity and will support neurodivergent individuals to perform at their best. However, the same research found that just 38% of employees say their organisation provides meaningful support to neurodivergent individuals, and only 31% feel comfortable to tell HR or their manager they are neurodivergent.

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Closing the Gap Between Employer Perceptions and Employee Experience

confidence and retention. It leaves neurodivergent individuals, their managers and employers feeling frustrated, and unsure how to handle the tricky situations that can arise. And whilst occupational health professionals and specialist service providers do have vital role to play in some individual cases (I will come to this!) we simply do not have the capacity to diagnose, assess and support every neurodivergent employee. Cases have risen exponentially.

Fortunately, there is a better way!

At Genius Within, we want to challenge

and support organisations to go further, moving beyond basic legal compliance, and even beyond deliberate inclusion, towards systemic neuroinclusion. This means removing the organisational barriers which can hold back neurodivergent talent, and creating the conditions where people

ng Genius Within

feel safe to be themselves and can meet their potential. Our aim is to place the individual at the heart of an organisational approach to neuroinclusion.

Why might there be such a disparity between the support that employers think they are providing, and how it is perceived by employees?

Employers often ask us for our advice on

In our experience it is because support is often reactive, put in

solving, and opportunities to create real

place at an individual level once something has gone wrong due

change.

what systemic neuroinclusion looks like in practice, what they should prioritise and why. We recommend focusing on three key areas, where evidence suggests there are problems that need

to the systemic barriers that neurodivergent individuals can experience at work. This downstream intervention can be costly, both in financial terms, and in reduced productivity, employee

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1. Developing a neuroinclusion strategy and building psychological safety Psychological safety means the ability to take risks and raise concerns without fear of reprisal. It is much wider than neuroinclusion, but has a big impact on neuroinclusion strategy. For example,

neurodivergent individuals are less likely than neurotypical colleagues to feel psychologically safe at work, and as referenced above, a third have not told their employer they are neurodivergent. This can impact the individual’s access to support, wellbeing and performance.

Psychological safety also predicts organisational performance,

innovation and retention, so a lack of

also benefit from expert advice on what they are doing well, and where there are gaps. And for that strategy to have an impact, it needs to have multi-stakeholder buy-in. This includes neurodivergent employees (often represented by an Employee Resource Group) as well as the senior leaders across the

organisation who can influence organisational culture, and make stuff happen. Making stuff happen also requires a concrete plan that translates the strategy into action, and clear accountability for its delivery. Finally, it is vital to monitor progress and evaluate impact, refreshing the strategy to reflect learning.

employers as well as employees.

Research tells us that fostering

We have already established that

psychological safety—especially for neurodivergent employees—requires system-wide strategies. These include leadership commitment, inclusive policies, line manager training, and a supportive

neurodivergent people can bring real strengths to organisations but to optimize their performance, we must embed neuroinclusion and universal design principles across the employee lifecycle, from recruitment

organisational climate. Essentially,

through to talent development.

there has to be a high degree of

Employers may be missing out on

congruence between what you say you do (policies) and what managers and leaders actually say and do in practice. So a strategic plan, which embeds neuroinclusion proactively – rather than reactively – is key to sustainable workplace change.

For a neuroinclusion strategy to

truly meet the needs of an organisation, it needs to draw on evidence from its own people - their experiences at work and their OH TODAY

related skills. Organisations may

2. Performance optimisation for neurodivergent talent

psychological safety is a big issue for

12

strengths and challenges in work-

Volume 32 Issue 3

neurodivergent talent because of bias in recruitment processes. Research commissioned by Zurich found that 49% of neurodivergent adults said they had been discriminated against by a hiring manager/recruiter because of their neurodivergence and 51% felt they could or should not

disclose neurodivergence to prospective employers due to stigma.

They can be wrong-footed by vague job descriptions which don’t

accurately reflect the role and

issues around performance, wellbeing or

disadvantaged by out-dated processes that

adjustments proactively.

test generalist skills such as communication and presentation, rather than the more specialist skillsets that might make a neurodivergent candidate a great fit for the role in practice.

It is important to ensure that HR professionals have the confidence to communicate clear performance expectations and to support neurodivergent individuals and managers

Once in role, neurodivergent employees are

in a way that does not compromise

less satisfied with their careers than

standards. We recommend that HR

neurotypical employees, with the biggest

professionals receive comprehensive

driver being psychological safety, followed

training on neuroinclusive recruitment,

by support from staff and managers, and

talent and performance management, as

knowledge of neurodiversity in the

well as practical toolkits bespoke to their

organisation.

organisational requirements, which enable

Just 19% of employers have reviewed people management policies to make

them to implement neuroinclusive processes in practice.

them neuroinclusive and only 56% say HR

Organisations can also help individuals to

staff feel capable and confident to support

optimise their performance through digital

neurodivergent individuals. Given this, it is

solutions, such as the Genius Finder Pro

perhaps unsurprising that 13% of UK

psychometrics platform. This evidence-

organisations responding to a survey by

based platform helps employees to

City and Guilds said that they have been

understand their workplace strengths and

involved in an employment tribunal

challenges, and identify the practical

related to neurodiversity.

strategies to address them. For many

Many organisations would benefit from a deep dive into their recruitment and talent/ performance management processes to test out how they work in practice, understand

employees, the self-serve strategies, along with support from a confident and competent manager and/or coach, is sufficient.

where barriers might exist, and identify the

However, there remains an important role

practical action required to address them.

for occupational health professionals

This can help ensure fairness, reduce legal

and specialist neurodiversity providers

and financial risk and strengthen

in supporting those neurodivergent

organisational compliance and credibility.

employees who do need more targeted help

A lot rests on the shoulders of HR professionals, and whilst many have the best intentions, they can be nervous about doing or saying the wrong thing. This might mean they say ‘yes’ to all requests from neurodivergent individuals, which can be impractical and cause tension within

teams. Or that they outsource - referring all neurodivergent employees for assessments. Most problematically, it can lead to paralysis – a failure to address

to improve work-related health or optimise performance. The Genius Finder Pro

can

be a useful triage tool to help identify those employees who would benefit from a workplace needs or diagnostic assessment.

It can also provide useful ‘guard rails’ within a workplace needs assessment, helping the individual to articulate strengths and challenges, and informing practical recommendations for adjustments.

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Even where an organisation does

provide clean feedback and manage

walk the talk on neuroinclusion,

team dynamics. This comes down to

there will still be some cases that are

training, a safe space to ask

more complex, where an HR

questions and practise, a practical

professional needs additional expert

toolkit to support implementation

advice to make sure that they are

and support structures so that a

doing the right thing by the

manager never feels alone. For those

individual and by the

managers who need more support, or

organisation. Our Complex Case

who are dealing with more complex

Advice Service does just that,

cases, manager or co-coaching can

enabling HR professionals to get the

help too.

practical advice and support they experienced Chartered Occupational

This sounds like a lot – is it really worth it?

Psychologists, particularly those with

This may sound like a lot of effort, and I

need from one of our highly

Expert Witness qualifications.

3. Neuroinclusive Management in Practice

is worth it, and we are here to help! An

It won’t come as a surprise that

advantage for organisations, with HR

managers play a critical role as ‘first

responders’ for their neurodivergent team members. They can be an important source of practical support, and of the psychological safety that empowers people to access it. However, managing relationships and performance in teams can be complex. Only 46% of employers and 46% of neurodivergent employees felt their managers were capable and confident to support neurodivergent individuals.

Sometimes managers worry that they do not know enough about specific conditions to support neurodivergent team members, but I want to emphasise that they don’t need to be experts. What is more important, is that they get to know the individual

– what makes them tick, shine, switch off or panic. And they need to have the skills and resources to communicate effectively, be flexible,

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am not going to pretend it is easy, but it

Volume 32 Issue 3

effective organisational approach to neuroinclusion can create a competitive professionals citing benefits for

employee performance, engagement, wellbeing and retention; and for innovation, customer service and the quality of people management.

As trusted advisers for employers, the occupational health profession is well placed to support organisations on this journey to systemic neuroinclusion. It is the right thing to do, the smart thing to do and the necessary thing to do. And it

will enable you as an occupational health professional to focus your valuable interventions where they will have the greatest impact.

How can Genius Within help you?

Through our consultancy services and the Genius Finder Pro

platform we

take you from insight to action. As a Community Interest Company we do things differently, supporting you with the data and expertise to deliver long-

term solutions for neuroinclusion that meet

the specific needs of your organisation and its people. We pride ourselves on being:

Proactive and cost effective Addressing systemic barriers upstream enables you to design-in neuroinclusion at the group level, so that costs are predictable and planned.

Scalable We work with organisations of all sectors, shapes and sizes in the UK and globally

Integrated Our consultancy services can be easily integrated with other Genius Within services, providing comprehensive support at an individual, team and organisation level

Data driven

Get in touch to find out more.

We use data on the strengths, challenges and experiences of your own people to co-design the solutions that are right for you

Expert and tailored Our highly qualified psychologists combine professional expertise with lived experience.

Your dedicated psychologist will take the time to get to know you.

Helen Musgrove is the Head of Consulting at Genius Within C.I.C. and a Business Psychologist.

She has extensive experience helping employers around the world create more neuroinclusive workplaces through evidencebased organisational change programmes and training. Helen is passionate about celebrating neurodiversity and empowering neurodivergent people to thrive at work, drawing on experience from her own family, as well as her professional expertise.

Prior to her career as a Business Psychologist, Helen worked for many years as a Senior Civil Servant, leading strategy and delivery of UKwide social policy programmes to increase inclusion and support for marginalised groups.

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Occupational Health Undergraduate Placement Toolkit NSOH and SOM have developed a toolkit to support OH departments in hosting undergraduate placements. Most universities with undergraduate programs will have a placement lead who will be more than willing to help. The toolkit supports OH teams in setting up meaningful and structured student placements for nursing and AHP students. For more information, please contact janet.oneill6@nhs.net

What’s Included: 1. Example Student Induction Document (Northamptonshire) 2. Template student objectives (University of Manchester) 3. Sample digital weekly planner 4. Example of a placement learning contract (University of Derby) 5. Timetable example (Newcastle NHS OHS)

6. Sample HEI partnership learning agreement (University of Derby) 7. SOM NSOH OH placement workbook 8. How we did it: Newcastle OHS 9. Confidentiality NDA shadow placement agreement template

How to Use: -

Download the Toolkit from the NSOH website https://eastmidlandsdeanery.nhs.uk/occupational-health/nsohtraining-education-placements OR SOM careers > placements https://www.som.org.uk/careers

-

Adapt documents to suit your needs and the type of student. Always get support from your HEI placement

lead -

Link students to specific learning opportunities such as audits or training days

Contacts for Support: -

Placement Learning Lead at your local university

-

ICS Practice Learning Facilitator (for NHS teams)

Available Training: Online Supervisor and Assessor Course- Anglia Ruskin University and Northamptonshire University. These flexible, self-paced courses provide the essential skills and knowledge required to supervise and assess students in clinical placements. https://www.aru.ac.uk/business-employers/practicehub/online-supervisor-assessor-course Allied Health Professional Educator Training | Practice Education Update

EOPH Conference Preview 2026 staying ahead in Occupational Health The third annual EOPH conference takes place in Birmingham in February 2026.

With a programme put together for occupational health professionals, it will once again be delivered by leaders and specialists from across the profession.

We spoke to EOPH’s Director of Operations Rachel Dare, to discover more about the topics to be covered and the expert speakers they have lined up so far. As well as being a look ahead to the event itself, it also serves to highlight some of the issues and trends that EOPH see as important learning points for those wanting to develop their skill sets within occupational health.

Background to the event and EOPH EOPH is a not-for-profit social enterprise committed to providing high quality education for both occupational health professionals and organisations who want to improve workplace health and wellbeing. Their courses are designed to promote best practices in occupational health, ensuring that professionals are equipped with the latest knowledge and skills.

The conference programme was developed and launched in 2024. The idea was to deliver practical insights but also to enable those in the profession to meet, network and connect. Last year’s event, also in Birmingham, saw attendance double from the first year, suggesting that the formula of experts and knowledge sharing is creating a strong learning community.

Practical application of learning Rachel explains how EOPH chose the content and who they have speaking. “The USP of our conferences is that they are interactive and that they lend themselves very much to how to apply the practice in an occupational health setting. So, while some topics link to current trends and challenges, the main reason is that we believe delegates will come away both with a greater understanding of the issues but also with practical skillsets they can use when they get back to their organisations.”

So, who is speaking, and what topics are they covering?

“We are still adding speakers, but so far we are thrilled to have some of our speakers from last year, returning with new topics, as well as several new to the EOPH family. For example, Dr Emma McCollum joins us for the first time, she’s a Consultant at University Hospitals Plymouth NHS Trust and has a special interest in neurodiversity. And we’re delighted to have Professor Helen Dawes, a movement and posture specialist who leads the Rehabilitation team in the National Institute for Health Research in Exeter. Another new name is Dr Adrian Hirst, a Chartered Occupational Hygienist who has 35 years’ of practical experience. They are joined by Dr Finola Ryan covering voice-related occupational health risks, clinical dermatologist Dr Katrin Alden covering skin health and Dr Jo Szram covering occupational lung diseases - all of whom spoke last year.”

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Rachel expanded on e

Dr Emma McCollum: Neurodiversity in the Workplace, rethinking Inclusion and Workplace Adjustments

“This is a big topic and one that should be important to every employer. With an estimated 15% of the UK population having a neurodivergent condition, employers that aren’t able to make adjustments risk losing the unique skills and contributions neurodiverse people bring. Dr McCollum has developed a toolkit for employees and managers to help to facilitate support and inclusion at work. Her presentation will explore occupational health referrals for neurodivergent employees via case presentations and she's also going to do an overview of the toolkit that she's created.”

Dr Finola Ryan: Voice-related occupational health risks

“Our voices are perhaps one of the things we take for granted, yet voice-related occupational health risks are often overlooked. Workers in voice-intensive roles face increased risks of vocal fatigue, strain, and disorders that can impact job performance and quality of life. This session will explore the physiological demands of workplace voice use, identify key risk factors including environmental conditions and vocal loading, and present evidence-based strategies for reducing voice-related injuries. Delegates will learn practical approaches to voice conservation, workplace adjustments, and early intervention techniques that protect workers' vocal health. Dr Finola Ryan is a Consultant Occupational Health Physician with a special interest in Performing Arts Medicine. She is also an Honorary lecturer at University College London.”

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each speaker and topic as follows:

Dr Katrin Alden: Caring for working skin

“This will be an interactive live quiz and use real learning and case studies so that delegates can increase their knowledge, skills and confidence. And she's going to be looking at the legislative, clinical and adjustment aspects of skin health at work too. Last year’s presentation was both insightful and enjoyable and her experience in this area speaks for itself. Dr Alden is the Chair of the Society of Occupational Medicine skin specialist interest group, a Fellow of the Academy of Medical Educators and a NHS tutor for SAS doctors and dentists.”

Professor Helen Dawes: Movement and posture toolkits to assess, prevent and treat. Improving posture and movement to benefit health, wellbeing and productivity in the workplace.

“We all know that musculoskeletal conditions are a major cause of workplace sickness absence and lost productivity, in fact the NHS think that they can cause up to 30 million lost working days each year. So, we are pleased to welcome Professor Dawes, another new speaker for 2026. She’s a clinical academic physiotherapist and she is presenting on a toolkit which helps to assess movement and posture so that clinical practitioners can help to prevent or treat musculoskeletal conditions. It’s a very advanced computer program which has been developed specifically for use with physiotherapists in particular, but the learning is relevant to anyone with an interest in musculoskeletal conditions. It’ll be a very interactive session on posture and movement assessment and intervention considering different workplace contexts.” ioh.org.uk

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Dr Jo Szram: Occupational lung diseases

“In our 2025 conference, Dr Jo Szram delivered a very topical presentation on the common contemporary issues in occupational lung disease. At the time, there was a lot of coverage of silicosis and Dr Szram illustrated this by covering the impact of inhaling silica dust, with the risks associated with cutting engineered stone worktops being in the news. We look forward to more of her insights as she again covers occupational lung diseases, highlighting that workplace exposures cause and/or contribute significantly to conditions like asthma, COPD, silicosis and hypersensitivity pneumonitis. At EOPH 2026 she will also explore the modern challenges faced by occupational health practitioners and the evolving landscape of workplace-related respiratory conditions seeking to work towards preventability of these diseases. Her credentials really are an asset to the conference, being a consultant in occupational lung disease and asthma based at Royal Brompton Hospital. She is also an honorary senior lecturer at the National Heart and Lung Institute, Imperial College London.”

Dr Adrian Hirst: Exploring the gaps between Occupational Health and Hygiene

“We are delighted to welcome Dr Hirst to the agenda for 2026. He brings a wealth of occupational health experience as his work has covered a broad range of industries including construction, chemical, petrochemical, manufacturing and service sectors. In his talk, Adrian will explore the gaps between occupational health, health promotion and occupational hygiene. He will describe what an occupational hygienist can do, using case studies to explore the differences between the professions and what the gaps between them look like. The talk is intended to inform the audience about occupational hygienists and consider how better they can work with them.”

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What else do you have planned?

“As well as the speakers mentioned so far, we are still adding to the schedule. We will also be joined by Dr Robin Cordell as we were last year. Dr Cordell will act as host and facilitator and will add his thoughts to many of the presentations. We’ll also have a number of exhibitors so delegates can find out about some of the products and services available to occupational health practitioners, some of which may be new to the marketplace. It’s really going to be a value packed day and of course the programme is CPD accredited.”

When and where?

The 2026 EOPH conference takes place on 27th February 2026. We’ll be returning to the Conference Aston, Birmingham which also has discounted accommodation and parking, with an on-site restaurant.

How can delegates book?

The conference site has more information, as well as a booking form. Please visit the EOPH site at https://eoph.co.uk/eoph-conference-2026/

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A comprehensive overview : ➢ Making a good referral

➢ The 5 outcomes

By Amanda Dowson

O

ccupational Health (OH) plays a crucial role in enhancing employee health, workforce productivity,

and business performance: assisting organisations in meeting their statutory and ethical responsibilities (Society of Occupational Medicine (SOM) 2017). The impact of OH interventions,

however, hinges significantly on the quality of the referral process and assessment, which requires effective communication and partnership between OH and Management (Faculty of Occupational Medicine (FOM) 2017).

For OH to provide meaningful and actionable guidance, referrals must contain clear direction, relevant clinical detail and workplace information (FOM, 2017). Similarly, OH professionals must understand the operational pressures and objectives driving referrals. This ensures recommendations are relevant, practical and useful to the organisation (O'Neill, 2020).

This article outlines the principles of a high-quality OH referral and introduces the structured framework, the Five Key Outcomes Model. This model directs managers to the information they must include at the point of referral; supports consistent, evidence-informed OH assessments and therefore reports that provide a clear direction for action.

Making a good referral: laying the foundations for a successful OH assessment

When referrals lean too heavily into medico-

An early referral to OH (whether workplace

to support both managers and employees,

performance, wellbeing, or absenteeism) supports an earlier resolution and helps positive working relationships between the

legal territory, they can dilute the value of the report, leaving everyone involved frustrated and without clarity. OH professionals are here

collaborating to find practical solutions for work and health. A well-framed referral sets the tone for a constructive, collaborative

employee and management (NICE, 2019; PAM

outcome.

Group, 2023).

What does a good referral look like in practice?

An effective referral includes relevant context, consent, transparency, and communication (FOM, N.D.). The referral should be clear,

➢ Employee consents to the

factual, and focused on the workplace

referral

implications of health, not clinical diagnosis

The referral should be shared and

(FOM, 2017). When referrals lack these elements, reports can become limited, overly cautious, or insufficiently targeted to meet the referrer’s needs. Poorly constructed referrals hinder the clinician’s ability to address the specific occupational issues and risks, misalignment with the needs of the business and the employee.

As an OH clinician, there is nothing more disheartening than receiving a poor referral.

Together, we should focus on the person’s functional abilities, health limitations, possible adjustments, and realistic timescales.

discussed with the employee under data protection rights (ICO, 2018) before submission. Transparency ensures informed consent and helps preserve trust.

Employees will engage constructively if they understand the process and feel it is fair, thereby reducing the risk of consent being withdrawn or the consultation not proceeding.

➢ Define what you need to know Be specific! Avoid generic or medical questions; OH is there to assess fitness for work, not to diagnose or treat. ioh.org.uk

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clinician and time allocation. Either

Consider: • Can the employee safely conduct their role?

ineffective assessment, compromising the consultation and report. Leading to

• What adjustments can the employer put in place to support a sustained return to work?

frustration for all parties.

Example: HR requested an assessment focused solely on the employee’s fatigue

• What are the likely timeframes for recovery or review? ➢ Provide relevant and factual

information Ensure the referral includes: • A full list of absence dates and reasons, particularly where there are concerns about attendance patterns.

This allows the clinician to consider an

and not contributing factors such as sleep issues, menopause, or anaemia, believing these were irrelevant. However, clinically considering these issues led to selfmanagement strategies in reducing fatigue and improving health and, therefore, performance. ➢ Keep it supportive and

objective

underlying disability or identify an

• Keep the tone neutral and professional.

unusual pattern of absence, informing

• Referrals perceived as disciplinary or

further questions

• All known outcomes of individual risk assessments, if already completed.

• A list of any adjusted duties or returnto-work arrangements already trialled, with dates and outcomes, and any potential adjustments that can be considered (with timescales), but remain flexible.

• A clear outline of the functional demands of the role, e.g. standing for

prolonged periods, handling machinery, materials handling, and concentration needs. Avoid relying solely on HR job descriptions.

punitive can undermine trust and create barriers to open communication between the employee and clinician due to defensiveness, hindering effective outcomes.

• A supportive referral is more likely to lead to a collaborative and beneficial outcome for all parties. ➢ Disability under the Equality

Act It is the employer’s responsibility to make enquiries as to whether an individual is likely to be disabled under the Equality Act 2010. OH professionals have a responsibility to provide an informed

• A factual summary of any management

opinion where requested, based on

concerns or operational difficulties

available clinical evidence. The final

observed, such as performance issues

determination of disability status rests with

related to fatigue or mobility concerns.

the courts or tribunals, except for those

• All relevant health and lifestyle issues

an employee is experiencing. Not doing so will risk an ineffective triage and undermine the value of OH input.

Triage determines the appropriate

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being affected could lead to an

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automatic disabilities of cancer, HIV, blindness, and Multiple sclerosis (MS).

Understanding the five potential OH outcomes Frustrations with OH assessments often arise when reports lack clear direction, leaving managers unsure how to act.

The Five Outcomes Model is a practical framework designed to support clinicians and managers by bridging the gap between clinical advice and workplace action. By aligning clinical recommendations with operational realities, the model helps drive better decisions, more efficient processes, and stronger outcomes for employees, teams, and organisations alike.

Feedback indicates OH clinicians structure their reports with greater clarity, consistency, and relevance to the working environment. Providing managers with a straightforward interpretation of what the advice means and the steps they should take in response. Employees have more control to make informed decisions about their health, work and future planning.

Every OH report should support one of five broad outcomes. Understanding these helps management frame their expectations and ensures the referral generates actionable advice.

The five potential OH outcomes Outcome 1:

Fit for Work

Outcome 2:

Fit for work with adjustments, restrictions, or redeployment (temporary or permanent)

Outcome 3:

Temporarily unfit for work

Outcome 4:

Employment ends (Voluntary exit, capability dismissal, or settlement)

Outcome 5:

Permanently unfit – eligibility for ill health retirement

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Outcome 1 : Fit for Work What this means: The employee is fit to resume their role without restrictions.

OH report includes:

Understanding the five potential OH outcomes

• Clear statement of fitness.

• Date from which the employee is fit.

• Confirmation that no adjustments

are needed.

• Recommendation to undertake regular welfare meetings if they have continuing health problems.

Suggestions for managers: • Confirm return-to-work arrangements.

• Return to normal duties with ongoing management review to ensure everything remains on track and their health status.

• No further support or adjustment required unless new issues emerge.

• Recommended adjustments (e.g., low-risk manual handling tasks with limited vertical lifting range, reduced hours, seated work).

• Recommended self-management.

• Timescales and whether adjustments are temporary or permanent.

• What workplace exposures need to be avoided, or work-related issues

that need to be investigated and managed.

• Psychosocial issues may be a barrier to returning to work or require consideration (e.g. carer’s duties, spouse or dependents' serious health issues, childcare challenges).

• Whether the health condition may

fall under disability provisions of the Equality Act if asked.

It is the responsibility of management to determine whether any recommended adjustments are

Outcome 2: Fit for work with adjustments, restrictions, or redeployment (temporary or permanent)

reasonably practicable to implement;

What this means:

• Discuss the recommendations

occupational health can advise on options, but the final decision rests with the employer.

Management action:

The employee can return to work with

with the employee and decide

temporary or permanent adjustments,

whether adjustments (temporary

restrictions or redeployment

or permanent) in line with advice

measures to support a safe and

are reasonably practicable in the

sustainable return.

specific circumstances. If not,

OH report should include: • Functional limitations (e.g., avoid heavy lifting, limit standing).

decide what is feasible and confirm expectations regarding the length of time of adjustments, review periods and whether contractual changes are required, ensuring compliance with the Equality Act 2010 where applicable.

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• Regularly review and monitor the effectiveness of the adjustments.

• Consider re-referral to OH if the temporary adjustments have been implemented and the employee is unable to resume substantive duties within confirmed expectations.

Outcome 3: Temporarily unfit for work What this means: The employee is currently unfit to return to work due to illness or recovery needs, but OH anticipate a return.

OH report should include: • Estimated recovery timescale.

• Current treatment or rehabilitation activities, including potential impact of additional employer-funded support options.

• Potential for rehabilitative return in the future, what temporary or permanent adjustments or restrictions may be required to support the return to work and the likelihood of sustained attendance on return.

It is the responsibility of management to determine whether any recommended employer-funded support options or adjustments are reasonably practicable to implement; occupational health can advise on options, but the final decision rests with the employer.

Management action: • Maintain contact and manage in

line with sickness absence policy.

• Discuss the recommendations with the employee, decide whether they are reasonably practicable in the specific circumstances, ensuring compliance with the Equality Act 2010 where applicable.

• Consider recommended support options (e.g. EAP, physiotherapy)

• Schedule a review OH assessment if the employee has not achieved the return to work in the anticipated timescale.

Management should consider how long they can reasonably sustain a continuing absence and have open, honest conversations with the employee to avoid any surprises.

Employees must understand their

• Any workplace exposures that the

value and that their absence is

employee needs to avoid or work-

genuinely felt within the team.

related issues that need to be investigated and managed.

• Any psychosocial issues may be a barrier to return to work or require consideration (e.g. carer’s duties, spouse or dependents' serious health issues, childcare challenges).

• Suggestions for reassessment if applicable or the employee does

Outcome 4: Employment ends (Voluntary exit, capability dismissal, or settlement) What this means: The employee is unlikely to return in the foreseeable future, and medical

evidence supports an exit from employment.

not achieve a return to work as anticipated. ioh.org.uk

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OH report should include: • Evidence of functional limitations or incapacity.

• Likelihood of sustained inability to conduct any relevant suitable

Understanding the five potential OH outcomes

work.

• Likelihood that functional

settlement, as appropriate, while the employee may also choose to explore resignation.

A mutually agreed settlement may reduce management time and reduce the risk of future litigation. Offering the employee their notice period and

treatment, within a stated period

outstanding holiday pay as a tax-free

or foreseeable future.

lump sum (ACAS, 2013) and the

• Attempts made to support the employee.

• Neutral, factual language (not a dismissal recommendation).

• Whether the health condition may fall under disability provisions.

Management action: • Begin formal process under

capability or HR policy.

• Ensure transparency throughout the consultation process.

• Ensure all adjustments or alternative roles have been explored.

• Seek HR and legal advice where appropriate to ensure compliance with the Equality Act (Gov, 2010)

and the Employment Rights Act (Gov, 1996).

• Manage all communications sensitively.

In some cases, an employee may be unable to return to work due to

potential for a negotiated, pre-agreed reference.

A compassionate dismissal occurs when an employee is no longer able to continue working due to significant health impairments, and, after all reasonable adjustments and support have been considered, when “applied with empathy, legal rigour and

commitment to employee dignity”, the dismissal is deemed the most humane, fair and pragmatic outcome.

Aligning with UK government guidance on Personal Independence Payment (PiP), Employment and Support Allowance (ESA), and employability (Kenyon, 2025).

Outcome 5: Permanently unfit – eligibility for ill health retirement What this means: The employee is permanently unfit for work and meets the eligibility criteria for ill-health retirement under their identified pension

ongoing ill health or a breakdown in

scheme.

trust and working relationships.

OH report should include:

initiating a capability process leading

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exploring a mutually agreed

limitations will change even with

Management may need to consider

32

to a ‘compassionate dismissal’,

Volume 32 Issue 3

• Clear confirmation of permanent

incapacity.

• Collated supporting medical evidence (with consent) and includes confirmation that the individual has exhausted all treatment options if appropriate.

• Alignment with specific pension scheme criteria • Functional impact and prognosis.

Management action: • Ensure all adjustments or alternative roles have been considered that are reasonable • Consult with the employee, follow a transparent process, and ensure the provision of PIP, ESA information, and other sources of financial support.

• Begin the ill-health retirement process with pension administrators.

• Consult with OH for submission of final evidence.

For a dismissal on the grounds of ill health to be legally fair and defensible, employers must follow a fair and compassionate capability dismissal process. This remains necessary even where an employee qualifies for ill health retirement. This is a pension scheme matter and not a substitute for a fair dismissal procedure. If dismissal is the outcome, statutory or contractual notice must still be given, unless there is payment in place of notice. Failure to follow this process could render the dismissal legally unfair, even where medical evidence supports the decision (Gov, 1996).

A shared understanding: aligning OH and management roles For OH reports to be useful and legally robust, both the referring manager and the OH professional must understand each other’s responsibilities: OH must: • Provide clear, functional advice aligned to the referral question.

• Use accessible, non-technical language.

• Avoid making management decisions but give enough evidence to guide/support them.

• Uphold consent, confidentiality, and impartiality.

Managers must: • Make focused, supportive referrals with relevant information.

• Respect clinical boundaries and not seek diagnosis or treatment information.

• Act based on advice within employment law and HR frameworks.

• Use OH input to guide, not to outsource decision-making.

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Conclusion A strong occupational health process begins with a well-constructed and informative referral guided by the Five Outcomes Model. This ensures OH receives the full context necessary to conduct a robust assessment, resulting in a clear, actionable report that directly supports workplace decision-making.

Understanding the five potential OH outcomes

When OH provide a comprehensive report, the model empowers managers to identify

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key issues and make confident, informed decisions. This approach helps fulfil legal obligations and fosters a supportive, compliant, and productive working environment.

A clear, structured and collaborative approach, combining expertise, helps ensure that decisions are well-informed, timely, and balanced, leading to better outcomes for individuals and the workplace.

Amanda Dowson | Linkedin Amanda is a consultant occupational health nurse and director at Dowson Occupational Health Consultancy and Training. She is a Specialist Practitioner in Occupational Health Nursing and Chartered Member of IOSH, with over

30 years occupational health experience managing health risks in a wide variety of industries.

Volume 32 Issue 3

The Hidden Struggle: My Journey with Pernicious Anaemia

By Katrina Burchell

Pernicious Anaemia (PA) often remains hidden in the workplace, causing significant challenges for affected employees and leading to missed opportunities for employers. This autoimmune condition, which results in a B12 deficiency, is frequently misunderstood and misdiagnosed, particularly in women.

I

was 38, a professional in-house

medical gaslighting, and in professions

lawyer and mother of two, when

like law, the pressure to overperform

finally diagnosed with Pernicious

can be immense. PA is often wrongly

Anaemia. It took over a decade to get a

dismissed as a simple nutritional

diagnosis, after which I was simply

deficiency; unfairly implying patients

given 12 weekly B12 injections and sent

are responsible for their condition.

away. It took another ten years for symptoms like fatigue, anxiety, panic attacks, peripheral neuropathy, tinnitus, brain fog, nominal aphasia, and breathlessness to diminish. This extended suffering was partly due to inadequate B12 injection frequency and an undiagnosed iron absorption issue, but also because I wasn't told I had a chronic, manageable condition.

Symptoms of PA develop gradually and overlap with other conditions, making diagnosis difficult. There is a lack of sensitive tests and research. Mid-career women, particularly mothers, often face

My health decline was stark. I went from

a confident, organised manager running a global team, participating in 5K/10K races, and maintaining an active social life, to a barely functional employee. I hid panic attacks, overcompensated for fatigue and brain fog, and spent two or three times longer on simple tasks. I withdrew from everything beyond my job. Despite being an empathetic leader, I never disclosed my condition at work.

My journey to accepting my condition and its fluctuating limitations ultimately led me to leave law and become CEO of the Pernicious Anaemia Society. My goal ioh.org.uk

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is to educate others, raise awareness,

frequent injections and are not allowed

and improve understanding. In this role,

to self-inject this non-toxic, life-saving

I encounter countless individuals who,

vitamin (unlike those on more

like me, are reluctant to disclose their

dangerous drugs like heparin or insulin).

condition or seek workplace

This forces them to take time off for

accommodations.

additional health care appointments and

One-third of patients experienced symptoms for up to 1 year before diagnosis, 22% had to wait 2 years, 19% for 5 years and 4% for 10 years for an accurate diagnosis. 14% of individuals experienced symptoms for more than 10 years before arriving at their diagnosis.

leads many to seek private injections or self-inject simply to function. Many live in fear of their treatment being reduced or stopped.

The Fear Factor: Why Employees Stay Silent

Patient journeys: diagnosis and

Given the diagnostic struggles,

treatment of pernicious anaemia -

inadequate treatment, and constant fear

PubMed

of treatment cessation, coupled with symptoms like anxiety and panic, there

Understanding the Workplace Impact Many PA symptoms significantly affect daily work.

• Fatigue: Impacts concentration, productivity, and attendance.

• Cognitive Fog: Difficulty with memory, focus, and decisionmaking.

• Nominal Aphasia: Struggling to

(Cotton and McCaddon, 2023)

Stigma and Misunderstanding • Lack of awareness: There's a significant information void among healthcare professionals regarding B12 deficiency and PA. Misinformation is common; patients often encounter dismissive comments like "just tiredness,"

sentences, leading to feelings of

"hormonal," or "mental health

• Neurological Symptoms: Numbness, balance issues, mood changes, anxiety, and apathy.

• Fluctuating Nature: Symptoms vary, making "good" or "bad" times unpredictable.

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PA remain silent in the workplace

find words or form coherent inadequacy.

40

are many reasons why individuals with

issues." People are told to "just eat more steak or liver" or "take a tablet," despite PA preventing B12 absorption from food.

• Fear of being perceived as "lazy" or "unreliable": Employees worry about comments from line managers like "aren't you over that problem yet?"

Management: Treatment is lifelong

when they need ongoing treatment

intramuscular B12 injections, but the

for this lifelong condition. Living

NHS system often applies NICE

with PA means accepting it can

guidelines inconsistently. Many

worsen over time and with stress,

patients don't receive sufficiently

pregnancy, or other health issues, but

Volume 32 Issue 3

that there is a lack of research and

education available about these challenges (Pernicious Anaemia | NIHR JLA.

Job Security Concerns • Worry about being seen as less

Lack of Reasonable Adjustments • Scepticism about appropriate adjustments: Employees fear that disclosing will not lead to support but rather to negative repercussions.

capable or a "burden": Many, like

I supported someone who requested

me, work hard to achieve senior

a simple adjustment to a weekly

positions and want to continue

meeting timing issue due to PA

carrying their share of responsibility.

symptoms being more challenging

This fear can lead to

for her later in the day and who was

overcompensation, working

instead given a performance

excessive hours to mask symptoms.

warning, refused adjustments, and

• Fear of being overlooked for promotions or facing redundancy: Witnessing, as I did, colleagues being "managed out" due to health issues, even those unrelated to performance,

ultimately terminated, leading to a legal claim.

The Cost of NonDisclosure

created a strong deterrent to

Non-disclosure carries a significant cost

disclosure.

for both employee and employer.

• Concerns about performance

• For the employee: Symptoms can

management due to symptoms:

worsen due to lack of support and

The worry that symptoms will be

stress. Reduced engagement, lower

misinterpreted as poor performance,

job satisfaction, and unnecessary

leading to formal processes, is a

performance issues are not

significant barrier. I was fortunate to

something any employee wants.

receive positive feedback, largely

“You don’t look disabled” - it's

because I worked exceptionally long

everyone's journey

hours to ensure nothing slipped.

Former colleagues were oblivious to

my struggle, but there is a significant toll on mental health because of masking behaviours.

• For the employer: Decreased productivity and efficiency may go unnoticed initially due to overcompensation. There's an increased risk of absenteeism or

Confidentiality Breaches

"presenteeism" (being at work but

• Distrust in HR/Occupational

the loss of valuable talent and

Health: A fear exists that sensitive information will be shared without

not fully productive), and ultimately, experience.

consent. While my personal

Building Trust

experience with HR/OH was positive,

Raising awareness of chronic and

I understand why others might have concerns, stemming from past experiences or a desire for privacy.

invisible illnesses like Pernicious Anaemia is crucial. Campaigns like "Not Every Disability Is Visible" are excellent

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examples. For me, witnessing positive

disclosure experiences, such as a former colleague with Parkinson's who had only positive workplace support after disclosing, is invaluable (Parkinson's Disease: The Last Workplace Secret).

Hopefully, this article will bring PA onto the radar, reducing stigma and barriers to disclosure. A key shift would be for HR/OH to focus on helping employees "thrive" regardless of their

circumstances. Creating safe spaces or wellness sessions to discuss or hear speakers on invisible illnesses could encourage earlier disclosure.

For more information for both employees and employers, please visit the Pernicious Anaemia Society website.

Pernicious Anaemia Society | Improving the Diagnosis & Treatment

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Katrina Burchell Chief Executive Officer, Pernicious Anaemia Society Katrina has third-sector experience running a patient advocacy and support group. She is a senior executive with a proven track record of individual and team development and leadership. She is also a personal branding consultant, writer, and blogger https://repurposement.substack.com

Could your clients be missing out on hidden support?

By Donna Curtis, caba

W

hen an Occupational Health professional is faced with a client in crisis - financially, emotionally, or professionally-the instinct is to help. But where do you signpost them?

Many turn to well-known charities like Mind or Citizens Advice. These organisations do vital work,

but they’re not always equipped to offer sector-specific support - especially when it comes to financial aid, career guidance, or tailored wellbeing services.

That’s where occupational charities come in. These lesser-known organisations exist to support professionals in specific fields, offering everything from emergency grants to mental health counselling and some even include legal support as well as career support. But according to a recent survey, awareness of these charities is still surprisingly low.

What we learned from the survey We asked 1,400 Occupational Health professionals to share their experiences. While the response rate was modest (28 responses), the insights were telling: • 68% had recommended a charity to a client - but mostly general ones like Mind, Macmillan, or Citizens Advice.

• Only 2 respondents rated themselves as “very knowledgeable” about occupational charities.

• Most support 30+ professionals per month across sectors, including healthcare, education, law, construction, and accountancy.

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Common challenges faced by clients included:

These findings offer valuable insight, but

However, these comments reflect a broader issue: many

they only tell part of the story. With just

professionals are unaware of the help available to them, and OH

28 responses so far, we’re keen to hear

professionals may not have the time or tools to explore every

from more Occupational Health

option.

professionals.

If your experience looks different - or echoes what’s here - please take a few minutes to complete the survey. Every response helps us build a clearer picture

of what support is being used, what’s

A hidden network of support Occupational charities, including benevolent associations, are often sector-specific, meaning they understand the unique pressures of a profession. One such benevolent charity is caba,

which supports ICAEW chartered accountants and their families.

missing, and how charities like caba can help. Survey link here One respondent noted:

Ola Opoosun, Head of Support

“Mental health support is there but uptake

Services caba :

is poor. Support for physical therapies like rehabilitation or personal training could help people stay in work longer.”

Another shared: “Staff often don’t realise what their organisational sick pay policy actually covers. Too few people read their contract of employment.”

“We regularly support professionals who are facing unexpected life challenges whether it’s financial strain, redundancy, mental or physical health issues.

Occupational charities like caba exist to offer tailored, practical support and guidance that general services may not be able to provide.”

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Take the case of a chartered accountant who found themselves in an unexpected and

challenging situation. Following a period of extended sick leave due to workplace stress and bullying, compounded by a relationship breakdown, they were suddenly single, caring for young children, and in urgent need of housing and employment support.

That’s when caba stepped in - providing a shortfall grant to cover essential living costs while they waited for social support. Legal advice was offered to help them navigate their situation, and funding was made available for car repairs – enabling them to manage childcare and attend job interviews. Career coaching was also arranged, which ultimately helped them secure a new role and begin rebuilding their life.

This is just one example of how targeted support can change lives - but only if people

know where to find it.

Who are OH professionals supporting?

The survey revealed that OH professionals work with a wide range of professions. The most frequently mentioned included: 1. Healthcare professionals 2. Public service workers 3. Engineers 4. Teachers and academics

5. Retail and sales staff 6. Construction and transport workers 7. Solicitors and lawyers 8. Chartered accountants

This diversity highlights the need for a joined-up approach to support. No single charity can meet all needs - but together, occupational charities can form a powerful safety net.

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Why broader collaboration matters

What You Can Do • Bookmark a list of occupational charities relevant to your client base.

The survey revealed that OH professionals support a wide range of professions - not just accountants.

-

ACO (the Association of Charitable

That’s why caba is exploring partnerships with other

Organisations) – directory of occupational

occupational charities to create a more unified

charity members from Accountants to

support network.

Healthcare, Education and Public sector -

Donal Watkin, Chief

Executive, The Association of Charitable Organisations (ACO): “We regularly support professionals who are facing unexpected life challenges whether it’s financial strain, redundancy, mental or physical health issues. Occupational charities like caba exist to offer tailored, practical support and guidance that general services may not be able to provide.”

turn2us – grant search - grant giving charities available for all, including occupational charities

• Share this article with colleagues to raise awareness.

• Complete the survey if you haven’t already your insights help shape future resources.

• Reach out to caba or ACO if you’d like to explore partnership opportunities or receive materials to support your work

Final thought!

Occupational Health professionals are already doing incredible work. But with the right tools and knowledge, you could unlock even more support for your clients - especially the kind they didn’t know existed.

These partnerships could help OH professionals save time, reduce stress, and offer more targeted support to clients who may be struggling silently.

Why this matters now

Let’s make hidden help visible.

The end of the school holidays and summer often signifies a return to full schedules, rising caseloads, and renewed pressures. For Occupational Health professionals, that means supporting dozens of individuals each month - each with their own complex challenges. It’s emotionally demanding work, often carried out with limited time and resources.

In the midst of this, having quick access to the right support pathways isn’t just helpful - it’s essential.

Knowing where to signpost someone for financial

Donna Curtis works in stakeholder engagement at caba, the benevolent association ICAEW accountants and a member of ACO. With a background in mentoring emerging leaders, she’s passionate about connecting professionals with timely, tailored support - driven by the belief that no one should face challenges alone.

aid, mental health support, or career guidance can make a real difference, especially when the right charity is tailored to their profession. ioh.org.uk

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Response to the 10-year Health Plan for England: An opinion piece

By Tracie McKelvie

T

he NHS 10-year health plan

In considering that (based on an

(Fit For The Future) talks

approximate 50-year full-time working

about the provision of health

life) around 29.4% of our adult lives are

care services for our populations by

spent at work, OH provision is

‘seizing the opportunities provided by

applicable and should be accessible to

new technologies, medicines, and

both NHS and non-NHS staff. As noted

innovations to deliver better care for all

on page 105 of the plan, the workforce is

patients’. Included in the focus are ‘3

important, and the occupational ‘venue’

radical shifts’, one of which is ‘from

provides the perfect opportunity to

sickness to prevention’.

support [nursing/healthcare] staff and to promote better health; however, what

The plan focuses on staff recruitment

about the rest of the nation’s working

and retention, which is vital to rolling

population? As an OH Nurse Specialist,

out the ambitious objectives set out

it is rather disappointing and

within. It rightly focuses on looking

demoralising to see that the provision of

after NHS staff, ensuring that staff feel

OH does not appear to be on the same

valued, cared for at work, recognised

‘pedestal’ as other specialist areas of

and rewarded for good work. But is

nursing, especially since one of the 3

this not applicable to all working

‘big shifts’ is ‘from sickness to

people, regardless of their role or who

prevention’.

they work for?

I read with interest the Prime Minister’s opening statement, which states that the current government inherited an NHS facing its worst crisis in history, and that this has had an impact across the whole of society.

There is recognition that the strain on health care services “causes huge pain and suffering to families”, and that “it prevents people from working, putting them in a precarious position”.

However, when looking at the objectives and deliverables of the plan, except for a brief mention of Occupational Health (OH) on page 105, OH as a specialist service provision that plays a key role in preventing ill health, promoting health and supporting those with health conditions to remain in or return to work, does not seem to feature anywhere else within this 167page document. Sadly, this appears to be a historical trend.

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lots of the what, and decidedly less of the how

Focusing on NHS staff, the plan (page

105) states that sickness absence rates are higher in the NHS (5.1%) than in other industries. As such, one of the aims of the plan is to reduce sickness absence rates to the lowest recorded national average (approx. 4.1%). To achieve this, the intention is to introduce a high-quality OH service for all NHS staff.

Whilst it is of course pleasing to see that

there is some recognition of the important role that OH has in supporting people at work (if they work for the NHS, that is), I am intrigued as to how the government intends to ensure the successful implementation and retention of a ‘high-quality’ OH service.

Who will drive and govern this? What does or will this look like? And what about the funding for such great

aspirations? The fact is that as specialists in the field of OH, we are already dwindling in numbers. We know that currently, specialist/training

courses are few and far between, and there are

GPs, are a patient’s advocate, and within a short

several barriers for registered nurses to specialise

appointment time, their role is to assess the

in OH; it certainly doesn’t appear to be an easy

patient’s circumstances, their level of functional

transition in comparison to other areas of health

ability, and their overall ‘copability’. When an

care! As noted in the Independent Nurse Nick

individual presents with complex needs, the GP’s

Timmins (known as the UK’s most astute

instinct is to (rightly) remove any influential/

commentator on health policy) states there is ‘lots

perceived negatives or barriers to promote

of the what, and decidedly less of the how’.

recovery. This commonly includes time away from

For the government to fully recognise the important role OH has to play, to be truly effective, the status of OH and staff morale must be

work. However, GPs will not be familiar enough with their patients’ place of work or policies that may be in place to support an individual back to

work.

With advances in medical intervention and technology, and ageing populations remaining in work, OH should be a vital component of this 10-year health plan.

considered. Despite lobbying to raise awareness

As OH specialists, we know that there is much

and educate, a lack of understanding, recognition

evidence to support that (good) work is good for

and respect for the OH specialism continues. This

health, and the presentation of a fit note can often

includes our healthcare workforce, allied

create a disconnect. Employers are looking for

healthcare colleagues, government officials and

bespoke advice about workplace adjustments and

decision-makers. There are times when OH is used

employee support. OH has time to consider the

in attempts to avoid management decisions, which

individual and their circumstances, whilst

undermines our effectiveness, and some

considering the operational needs of the

expectations placed upon OH professionals to ‘fix

organisation.

things’ are often unrealistic and unfair. While OH should be seen as a partner in workplace wellbeing

strategies, it is not for OH to solely address or to try to resolve work-related/management issues. If there is a lack of appropriate leadership and line management support for OH clinicians in managing this, clinicians could be left frustrated, undervalued and unsupported.

In terms of partnership working, OH practitioners have been openly vocal in advocating for OH to be embedded within primary care/community support hub settings. This will proactively support those

who are struggling at work, and will help close the cyclical fit note gap, reducing absence and subsequently the likelihood of falling out of work.

Integrating OH into neighbourhood health service centres To address this disconnect and to close the gap in workplace sickness absence, OH should be integrated into other specialist areas of healthcare, for example, within the proposed neighbourhood health service centres to form part of a collaborative multi-disciplinary workforce, providing an all-round health care service to meet all needs. Where appropriate, this would offer

other specialisms such as Mental Health Practitioners, Occupational Therapists, Health Visitors, Practice Nurses, etc. The opportunity to

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signpost to OH should be included. The workplace

healthcare profession. There is a clear recognition

can have a profound impact on an individual’s

of advanced practice and the evident evolution of

health and wellbeing, addressing this at an early

clinical skills. However, OH specialist nurses could

stage is vital.

be considered advanced practitioners and already

A positive step within the plan is a focus on community-based health care where ‘Nurse consultants and consultant midwives will play a vital

lead in the management and delivery of effective workplace health and wellbeing strategies for both employees and employers.

role in the Neighbourhood Health Service…’. As it

OH are the essential infrastructure to an

stands, the rollout of the first 24/7 Neighbourhood

organisation, and not an optional add-on. To ‘bag’

Mental Health Centre has been launched in Tower

the status OH deserves, it must be a respected

Hamlets. Will OH feature? With advances in

specialism by the healthcare profession and other

medical intervention and technology, and ageing

decision makers/policy holders! This is not yet

populations remaining in work, OH should be a vital

evident from the lack of consideration within the 10

component of this 10-year health plan.

-year plan.

Specifically focusing on mental health, Chris

I have worked collaboratively with multidisciplinary

Hampson, CEO of Look Ahead (one of the delivery

colleagues to proactively support people back into

partners at the Tower Hamlets site), makes a

work. This way of working is incredibly favourable

poignant statement: ‘This new centre represents a

for both individuals and employers. I struggle to

major step forward in making vital, genuinely holistic

understand why there is still such an obvious

mental health support more accessible within local

disconnect between primary and secondary

communities’. To be holistic, work must be included.

healthcare services and OH?

For some, it can be a lifesaver! OH, having an indepth knowledge of medical complexities AND the

Tracie Mckelvie

practical demands of different roles, is an essential component. It makes sense!

Other aspects of the plan create uncertainty. There is a suggestion that nurses will be given opportunities to lead, but with the long-standing financial and educational/training constraints within healthcare, how will this be driven forward?

The plan proposes that by 2035, ‘half of all healthcare interactions will be informed by genomic insights and other predictive analytics. Is this safe and effective? How will this impact our populations, and where does OH come in? As health professionals, we know that the delivery of all healthcare is important and should be personalised. However, I am aware of professionally ‘ageing’, and conscious of the value of researched evidence and best practice. I therefore wonder whether these new technical

aspirations and innovations scare me.

It is worth considering that the UK’s workforce is the country’s biggest asset. The plan has great aspirations for both our communities and for the 52

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Volume 32 Issue 3

Tracie McKelvie | Linkedin Tracie is an Independent Specialist Nurse Practitioner in Occupational Health, Queens Nurse and Founder of TJM Occupational Health and Wellbeing.

Contact Tracie tracie@tjm-ohw.co.uk

The benefits of PC-based audiometry

I

n today’s digital landscape it's essential to be able to run medical services from a PC. Whilst this isn't

Efficiency and convenience

a new requirement, the need for

Traditional audiometry uses manually

accuracy, efficiency and ease of use is

controlled devices and lots of paperwork,

more prevalent than ever.

which can be incredibly time consuming.

Over the years PC-based audiometry has seen significant advancements. It now offers better features, more user support, and fits seamlessly into clinical practice. It also stores data quickly and easily, helping to prepare for the next step in a subject’s rehabilitation.

PC-based audiometers simplify these tasks by preparing and automating behaviours upfront, then prompting the next steps. This means hearing health professionals can focus more of their attention on the subject and less on the technology.

Despite these benefits, many users still

Cost-effectiveness

use hardware-based audiometers to

Traditional audiometers usually have

perform audiometry.

high upfront costs. This is especially true

By using both software and hardware,

for models with many features or special

occupational health can access better,

abilities, like bone conduction testing

cheaper, and more flexible solutions.

or speech audiometry.

The result is a more efficient, connected

However, users can update PC-based

and streamlined workflow. Some of the key advantages include:

systems more easily and less expensively than hardware-based systems. Software updates, troubleshooting and repairs are all typically done quickly and remotely.

These updates often include additional or

new features too.

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User-friendly interface Many PC-based audiometers have userfriendly interfaces. They can include touch screens, simple menus, and clear instructions.

This helps occupational health professionals learn how to operate the system without the need for lots of training and easily explain test

systems now have built-in tools which help

analyse and present hearing data in different formats.

This minimises human bias in interpreting thresholds and leads to more objective findings. It also makes it easier to communicate the results to subjects and other

results to the subject.

healthcare providers.

Easy data management

Since operators store the test data digitally,

With the introduction of GDPR, data collection

patient’s hearing over time. This long-term

and storage has become much more regulated.

data is extremely useful for tracking hearing

Along with this, there's been a greater

loss.

emphasis on making this data digital.

they can also easily track changes in a

Furthermore, PC-based systems often allow

In the past, there was more focus on physical

operators to generate customised reports.

reports and record files. These weren't easy to

These reports can be easily printed, emailed,

access across larger systems. We now have

or uploaded to the subject’s digital health

cloud storage and remote data locations for

record, reducing administrative workload.

servers, providing speed, security and accuracy.

Third-party integration

Flexible and customisable

The integration of PC-based audiometers with

Every subject has different needs. PC-based

streamlines data management. It reduces the

systems allow for personal preferences,

need for manual entry and the risk of potential

making the overall workflow more tailored.

errors. This seamless connectivity allows for

Test protocols and parameters can also be applied over wide computer system installations. This ensures all users are operating in the same way within an organisation.

Analysis and reporting

EMR and office management systems also

immediate access to patient data, facilitating timely and informed decision-making.

Ultimately, this provides a bespoke end-to-end workflow focused on the task.

All these benefits reflect a broader trend

towards integrating advanced technology into audiometric practices, aiming to improve

A traditional audiometric test often requires

accuracy, efficiency and patient care. Visit

the operator to interpret results during the

www.amplivox.com to learn about our PC-

testing process, which could introduce bias or

based audiometry solutions.

inconsistency. Many PC-based audiometric

 - www.amplivox.com  - +44 (0)1865 880 846  - hello@amplivox.com

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Affordable Healthcare Compliance and Training Courses. Get affordable healthcare compliance, training courses including PMVA and Occupational Health

BOOK REVIEW By Michelle Moorst

Chemically Imbalanced: the making and unmaking of the serotonin myth by Joanna Moncrieff Dr Joanna Moncrieff is a Reader in Critical and Social Psychiatry in the Division of Psychiatry at University College London. She also works as a consultant psychiatrist with a Community Mental Health Team. Moncrieff's Chemically Imbalanced: The Making and Unmaking of the Serotonin Myth challenges the widespread belief that depression is caused by a "chemical imbalance." This book is based on her important 2022 research review. Moncrieff found that there is not enough evidence to support that low serotonin levels cause depression.

Moncrieff argues that anti-depressants alter how the brain functions and may reduce the intensity of emotions. In addition, she argues that depression should be viewed as a complex

condition caused by psychological, social, and biological factors interacting together. The book stresses that patients should be informed about the benefits and risks of anti-depressants, as well as alternative treatments.

This book raises important questions that warrant serious consideration. Moncrieff's systematic review of the lack of evidence for serotonin deficiency in depression is compelling. While the debate around anti-depressants continues, Moncrieff’s book highlights the importance of having a holistic understanding of mental health issues.

Could it be that in our rush to medicalise emotional distress, we are missing opportunities to address the root causes of our mental health challenges through meaningful changes in our daily lives, relationships, and environments?

Michelle Moorst is an Occupational Health Specialist (RN).

Follow Michelle on LinkedIn.

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