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
Lynn Pratt
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
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.
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 critical roles, confides that 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
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.
Safety-critical roles include aviation, healthcare, emergency response, transportation, construction, energy, and manufacturing, any work where performance lapses can endanger lives or infrastructure.
Cannabis, particularly THC-containing products, can affect concentration, depth perception, reaction time, and judgement. These effects matter deeply in safety-critical environments. But impairment isn’t binary, and our current tools for assessing risk are limited.
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.
None of these methods reliably determine functional fitness for duty. Yet they remain the primary tools in many workplace drug policies.
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 detectable levels.
Relying solely on time-based or test-based criteria does not account for these complexities.
Stakeholder Frustration is
• Workers using prescribed cannabis may feel 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.
Around the world, safety-critical jobs are frequently filled by lower-paid, physically demanding roles, roles often held by migrant workers, ethnic 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.
International approaches vary:
• Some jurisdictions (e.g., Canada, parts of the US, Germany) permit medicinal cannabis in safetysensitive occupations with certain restrictions or risk assessments.
• European and North American regulators are exploring the use of performance-based impairment testing; validation is ongoing.
• Global guidance is fragmented. No universally accepted threshold for workplace THC impairment exists. In most places, policy is being shaped reactively, often by legal precedent rather than scientific consensus.
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.
Raising the threshold, say, to 50 ng/mL or higher under supervision could help differentiate between therapeutic use and unsafe impairment. While not perfect, it could be a more proportionate and pragmatic interim 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.
Rather than relying on toxicology alone, the future lies in combining:
• Impairment-based assessments –cognitive, behavioural, or taskspecific evaluations tailored to safety -critical roles.
• Collaborative policy development –involving occupational health, legal, regulatory, and worker representation.
• Education and guidance for prescribers – with a focus on functional risk, not just clinical symptoms.
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.
Done well, we can create a future where medicinal cannabis use and safetycritical performance are not incompatible, but rather, managed transparently and safely.
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.
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.
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.
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.
OBy Helen Musgrove Head of Consulting
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.
Why might there be such a disparity between the support that employers think they are providing, and how it is perceived by employees?
In our experience it is because support is often reactive, put in place at an individual level once something has gone wrong due 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
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 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.
Employers often ask us for our advice on 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 solving, and opportunities to create real change
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 psychological safety is a big issue for employers as well as employees.
Research tells us that fostering psychological safety especially for neurodivergent employees requires system-wide strategies. These include leadership commitment, inclusive policies, line manager training, and a supportive organisational climate. Essentially, there has to be a high degree of 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
strengths and challenges in workrelated skills. Organisations may 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.
We have already established that 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 through to talent development.
Employers may be missing out on 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 disadvantaged by out-dated processes that 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.
Once in role, neurodivergent employees are less satisfied with their careers than neurotypical employees, with the biggest driver being psychological safety, followed by support from staff and managers, and knowledge of neurodiversity in the organisation.
Just 19% of employers have reviewed people management policies to make them neuroinclusive and only 56% say HR staff feel capable and confident to support neurodivergent individuals. Given this, it is perhaps unsurprising that 13% of UK organisations responding to a survey by City and Guilds said that they have been involved in an employment tribunal related to neurodiversity.
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 where barriers might exist, and identify the practical action required to address them. This can help ensure fairness, reduce legal and financial risk and strengthen organisational compliance and credibility.
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
issues around performance, wellbeing or adjustments proactively
It is important to ensure that HR professionals have the confidence to communicate clear performance expectations and to support neurodivergent individuals and managers in a way that does not compromise standards. We recommend that HR professionals receive comprehensive training on neuroinclusive recruitment, talent and performance management, as well as practical toolkits bespoke to their organisational requirements, which enable them to implement neuroinclusive processes in practice.
Organisations can also help individuals to optimise their performance through digital solutions, such as the Genius Finder Pro psychometrics platform. This evidencebased platform helps employees to understand their workplace strengths and challenges, and identify the practical strategies to address them. For many employees, the self-serve strategies, along with support from a confident and competent manager and/or coach, is sufficient.
However, there remains an important role for occupational health professionals and specialist neurodiversity providers in supporting those neurodivergent employees who do need more targeted help 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.
Even where an organisation does walk the talk on neuroinclusion, there will still be some cases that are more complex, where an HR professional needs additional expert advice to make sure that they are doing the right thing by the individual and by the organisation. Our Complex Case Advice Service does just that, enabling HR professionals to get the practical advice and support they need from one of our highly experienced Chartered Occupational Psychologists, particularly those with Expert Witness qualifications.
It won’t come as a surprise that 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,
provide clean feedback and manage team dynamics. This comes down to training, a safe space to ask questions and practise, a practical toolkit to support implementation and support structures so that a manager never feels alone. For those managers who need more support, or who are dealing with more complex cases, manager or co-coaching can help too.
This sounds like a lot – is it really worth it?
This may sound like a lot of effort, and I am not going to pretend it is easy, but it is worth it, and we are here to help! An effective organisational approach to neuroinclusion can create a competitive advantage for organisations, with HR 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.
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.
Data driven
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.
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 Get in touch to find out more.
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.
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
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.
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.
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.”
“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.”
“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.”
“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.”
each speaker and topic as follows:
Katrin
“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.”
“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.”
“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.”
“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.”
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.
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/
By Amanda Dowson
Occupational 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.
An early referral to OH (whether workplace performance, wellbeing, or absenteeism) supports an earlier resolution and helps positive working relationships between the employee and management (NICE, 2019; PAM Group, 2023).
An effective referral includes relevant context, consent, transparency, and communication (FOM, N.D.). The referral should be clear, factual, and focused on the workplace implications of health, not clinical diagnosis (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.
When referrals lean too heavily into medicolegal territory, they can dilute the value of the report, leaving everyone involved frustrated and without clarity. OH professionals are here to support both managers and employees, collaborating to find practical solutions for work and health. A well-framed referral sets the tone for a constructive, collaborative outcome.
➢ Employee consents to the referral
The referral should be shared and 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.
Be specific! Avoid generic or medical questions; OH is there to assess fitness for work, not to diagnose or treat.
Consider:
• Can the employee safely conduct their role?
• What adjustments can the employer put in place to support a sustained return to work?
• 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 underlying disability or identify an unusual pattern of absence, informing 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.
• A factual summary of any management concerns or operational difficulties observed, such as performance issues related to fatigue or mobility concerns.
• 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
clinician and time allocation. Either being affected could lead to an ineffective assessment, compromising the consultation and report. Leading to frustration for all parties.
Example: HR requested an assessment focused solely on the employee’s fatigue 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
• Keep the tone neutral and professional.
• Referrals perceived as disciplinary or 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.
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 opinion where requested, based on available clinical evidence. The final determination of disability status rests with the courts or tribunals, except for those automatic disabilities of cancer, HIV, blindness, and Multiple sclerosis (MS).
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
What this means:
The employee is fit to resume their role without restrictions.
OH report includes:
• 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.
Outcome 2: Fit for work with adjustments, restrictions, or redeployment (temporary or permanent)
What this means:
The employee can return to work with temporary or permanent adjustments, restrictions or redeployment measures to support a safe and sustainable return.
OH report should include:
• Functional limitations (e.g., avoid heavy lifting, limit standing).
• 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 reasonably practicable to implement; occupational health can advise on options, but the final decision rests with the employer.
Management action:
• Discuss the recommendations with the employee and decide whether adjustments (temporary or permanent) in line with advice are reasonably practicable in the specific circumstances. If not, 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.
• 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.
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.
• Any workplace exposures that the employee needs to avoid or workrelated 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 not achieve a return to work as anticipated.
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 value and that their absence is genuinely felt within the team.
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.
OH report should include:
• Evidence of functional limitations or incapacity.
• Likelihood of sustained inability to conduct any relevant suitable work.
• Likelihood that functional limitations will change even with treatment, within a stated period or foreseeable future.
• 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 ongoing ill health or a breakdown in trust and working relationships. Management may need to consider initiating a capability process leading
to a ‘compassionate dismissal’, exploring a mutually agreed 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 outstanding holiday pay as a tax-free lump sum (ACAS, 2013) and the 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 scheme.
OH report should include:
• 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).
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.
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.
When OH provide a comprehensive report, the model empowers managers to identify 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 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.
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.
Iwas 38, a professional in-house lawyer and mother of two, when finally diagnosed with Pernicious Anaemia. It took over a decade to get a diagnosis, after which I was simply given 12 weekly B12 injections and sent 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
medical gaslighting, and in professions like law, the pressure to overperform can be immense. PA is often wrongly dismissed as a simple nutritional deficiency; unfairly implying patients are responsible for their condition.
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
is to educate others, raise awareness, and improve understanding. In this role, I encounter countless individuals who, like me, are reluctant to disclose their condition or seek workplace
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. Patient journeys: diagnosis and treatment of pernicious anaemia -
Many PA symptoms significantly
Impacts concentration, productivity, and attendance.
Difficulty with memory, focus, and decision-
Struggling to find words or form coherent sentences, leading to feelings of
Neurological Symptoms: Numbness, balance issues, mood changes, anxiety, and apathy. Symptoms vary, making "good" or "bad" times
Treatment is lifelong intramuscular B12 injections, but the NHS system often applies NICE guidelines inconsistently. Many patients don't receive sufficiently
frequent injections and are not allowed to self-inject this non-toxic, life-saving vitamin (unlike those on more dangerous drugs like heparin or insulin). This forces them to take time off for additional health care appointments and leads many to seek private injections or self-inject simply to function. Many live in fear of their treatment being reduced or stopped.
Given the diagnostic struggles, inadequate treatment, and constant fear of treatment cessation, coupled with symptoms like anxiety and panic, there are many reasons why individuals with PA remain silent in the workplace (Cotton and McCaddon, 2023)
• 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," "hormonal," or "mental health 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?" when they need ongoing treatment for this lifelong condition. Living with PA means accepting it can worsen over time and with stress, pregnancy, or other health issues, but
that there is a lack of research and education available about these challenges (Pernicious Anaemia | NIHR JLA.
• Worry about being seen as less capable or a "burden": Many, like me, work hard to achieve senior positions and want to continue carrying their share of responsibility. This fear can lead to overcompensation, working excessive hours to mask symptoms.
• 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, created a strong deterrent to disclosure.
• Concerns about performance management due to symptoms: The worry that symptoms will be misinterpreted as poor performance, leading to formal processes, is a significant barrier. I was fortunate to receive positive feedback, largely because I worked exceptionally long 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.
• Distrust in HR/Occupational Health: A fear exists that sensitive information will be shared without consent. While my personal experience with HR/OH was positive, I understand why others might have concerns, stemming from past experiences or a desire for privacy.
• Scepticism about appropriate adjustments: Employees fear that disclosing will not lead to support but rather to negative repercussions. I supported someone who requested a simple adjustment to a weekly meeting timing issue due to PA symptoms being more challenging for her later in the day and who was instead given a performance warning, refused adjustments, and ultimately terminated, leading to a legal claim.
Non-disclosure carries a significant cost for both employee and employer.
• For the employee: Symptoms can worsen due to lack of support and stress. Reduced engagement, lower job satisfaction, and unnecessary performance issues are not something any employee wants. “You don’t look disabled” - it's everyone's journey
• For the employer: Decreased productivity and efficiency may go unnoticed initially due to overcompensation. There's an increased risk of absenteeism or "presenteeism" (being at work but not fully productive), and ultimately, the loss of valuable talent and experience.
Raising awareness of chronic and invisible illnesses like Pernicious Anaemia is crucial. Campaigns like "Not Every Disability Is Visible" are excellent
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
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
By Donna Curtis, caba
When 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.
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.
These findings offer valuable insight, but they only tell part of the story. With just 28 responses so far, we’re keen to hear from more Occupational Health 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 missing, and how charities like caba can help. Survey link here
One respondent noted:
“Mental health support is there but uptake is poor. Support for physical therapieslike rehabilitation or personal trainingcould 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.”
However, these comments reflect a broader issue: many professionals are unaware of the help available to them, and OH professionals may not have the time or tools to explore every option.
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.
Ola Opoosun, Head of Support Services caba :
“We regularly support professionals who are facing unexpected life challengeswhether 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.”
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.
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.
The survey revealed that OH professionals support a wide range of professions - not just accountants. That’s why caba is exploring partnerships with other occupational charities to create a more unified support network.
Donal Watkin, Chief Executive, The Association of Charitable Organisations (ACO):
“We regularly support professionals who are facing unexpected life challengeswhether 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.”
These partnerships could help OH professionals save time, reduce stress, and offer more targeted support to clients who may be struggling silently.
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 aid, mental health support, or career guidance can make a real difference, especially when the right charity is tailored to their profession.
• Bookmark a list of occupational charities relevant to your client base.
- ACO (the Association of Charitable Organisations) – directory of occupational charity members from Accountants to Healthcare, Education and Public sector
- 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 alreadyyour 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
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.
Let’s make hidden help visible.
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.
to the 10-year Health Plan for England: An opinion piece
By Tracie McKelvie
The NHS 10-year health plan (Fit For The Future) talks about the provision of health care services for our populations by ‘seizing the opportunities provided by new technologies, medicines, and innovations to deliver better care for all patients’. Included in the focus are ‘3 radical shifts’, one of which is ‘from sickness to prevention’
The plan focuses on staff recruitment and retention, which is vital to rolling out the ambitious objectives set out within. It rightly focuses on looking after NHS staff, ensuring that staff feel valued, cared for at work, recognised and rewarded for good work. But is this not applicable to all working people, regardless of their role or who 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.
lots of the what, and decidedly less of the how
In considering that (based on an approximate 50-year full-time working life) around 29.4% of our adult lives are spent at work, OH provision is applicable and should be accessible to both NHS and non-NHS staff. As noted on page 105 of the plan, the workforce is important, and the occupational ‘ venue’ provides the perfect opportunity to support [nursing/healthcare] staff and to promote better health; however, what about the rest of the nation’s working population? As an OH Nurse Specialist, it is rather disappointing and demoralising to see that the provision of OH does not appear to be on the same ‘pedestal’ as other specialist areas of nursing, especially since one of the 3 ‘big shifts’ is ‘from sickness to prevention’.
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 several barriers for registered nurses to specialise in OH; it certainly doesn’t appear to be an easy transition in comparison to other areas of health care! As noted in the Independent Nurse Nick Timmins (known as the UK’s most astute commentator on health policy) states there is ‘lots of the what, and decidedly less of the how’ . 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
GPs, are a patient’s advocate, and within a short appointment time, their role is to assess the patient’s circumstances, their level of functional ability, and their overall ‘copability’. When an individual presents with complex needs, the GP’s instinct is to (rightly) remove any influential/ perceived negatives or barriers to promote recovery. This commonly includes time away from 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 and educate, a lack of understanding, recognition and respect for the OH specialism continues. This includes our healthcare workforce, allied healthcare colleagues, government officials and decision-makers. There are times when OH is used in attempts to avoid management decisions, which undermines our effectiveness, and some expectations placed upon OH professionals to ‘fix 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.
As OH specialists, we know that there is much evidence to support that (good) work is good for health, and the presentation of a fit note can often create a disconnect. Employers are looking for bespoke advice about workplace adjustments and employee support. OH has time to consider the individual and their circumstances, whilst considering the operational needs of the organisation.
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
signpost to OH should be included. The workplace can have a profound impact on an individual’s health and wellbeing, addressing this at an early stage is vital.
A positive step within the plan is a focus on community-based health care where ‘Nurse consultants and consultant midwives will play a vital role in the Neighbourhood Health Service…’. As it stands, the rollout of the first 24/7 Neighbourhood Mental Health Centre has been launched in Tower Hamlets. Will OH feature? 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.
Specifically focusing on mental health, Chris Hampson, CEO of Look Ahead (one of the delivery partners at the Tower Hamlets site), makes a poignant statement: ‘This new centre represents a major step forward in making vital, genuinely holistic mental health support more accessible within local communities’. To be holistic, work must be included. For some, it can be a lifesaver! OH, having an indepth knowledge of medical complexities AND the 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
healthcare profession. There is a clear recognition of advanced practice and the evident evolution of clinical skills. However, OH specialist nurses could be considered advanced practitioners and already lead in the management and delivery of effective workplace health and wellbeing strategies for both employees and employers.
OH are the essential infrastructure to an organisation, and not an optional add-on. To ‘bag’ the status OH deserves, it must be a respected specialism by the healthcare profession and other decision makers/policy holders! This is not yet evident from the lack of consideration within the 10 -year plan.
I have worked collaboratively with multidisciplinary colleagues to proactively support people back into work. This way of working is incredibly favourable for both individuals and employers. I struggle to understand why there is still such an obvious disconnect between primary and secondary healthcare services and OH?
Tracie Mckelvie
In today’s digital landscape it's essential to be able to run medical services from a PC. Whilst this isn't a new requirement, the need for accuracy, efficiency and ease of use is more prevalent than ever.
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.
Despite these benefits, many users still use hardware-based audiometers to perform audiometry.
By using both software and hardware, occupational health can access better, cheaper, and more flexible solutions. The result is a more efficient, connected and streamlined workflow. Some of the key advantages include:
Traditional audiometry uses manually controlled devices and lots of paperwork, which can be incredibly time consuming. 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.
Traditional audiometers usually have high upfront costs. This is especially true for models with many features or special abilities, like bone conduction testing or speech audiometry.
However, users can update PC-based 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.
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 results to the subject.
With the introduction of GDPR, data collection and storage has become much more regulated. Along with this, there's been a greater emphasis on making this data digital.
In the past, there was more focus on physical reports and record files. These weren't easy to access across larger systems. We now have cloud storage and remote data locations for servers, providing speed, security and accuracy.
Every subject has different needs. PC-based systems allow for personal preferences, making the overall workflow more tailored.
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.
A traditional audiometric test often requires the operator to interpret results during the testing process, which could introduce bias or inconsistency. Many PC-based audiometric
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 healthcare providers.
Since operators store the test data digitally, they can also easily track changes in a patient’s hearing over time. This long-term data is extremely useful for tracking hearing loss.
Furthermore, PC-based systems often allow operators to generate customised reports. These reports can be easily printed, emailed, or uploaded to the subject’s digital health record, reducing administrative workload.
The integration of PC-based audiometers with EMR and office management systems also streamlines data management. It reduces the need for manual entry and the risk of potential errors. This seamless connectivity allows for 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 accuracy, efficiency and patient care. Visit www.amplivox.com to learn about our PCbased audiometry solutions.
An opportunity for OH and wellbeing professionals to reflect, connect, collaborate and shape the future of iOH
Affordable Healthcare Compliance and Training Courses. Get affordable healthcare compliance, training courses including PMVA and Occupational Health
By Michelle Moorst
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).
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