OH Today Volume 32 Issue 4 - 2025

Why AI Detection Misses the Point of Higher Education

Also in this issue : Alcohol A Taboo Topic | Chronic Health Conditions | EAPs Race-Neutral Spirometry | Musculoskeletal in Construction Recruitment Challenges | Managing Sickness Absence Health Surveillance | Age-Inclusive Language

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us Occupational Health | R-Health | recruitingheads Health

Editor LYNN PRATT Assistant Editors JANET O’NEILL LIBBY MORLEY 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

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From Scrolls to Simulations: Why AI Detection Misses the Point of Higher Education

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Alcohol: Turning the tide on a taboo topic

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Chronic Health Conditions

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Employee Assistance Programmes: Evolving Roles and Their Impact on Workplace Wellbeing

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The Shift Toward Race-Neutral Spirometry

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A Musculoskeletal (MSK) Conservation Program in Construction

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Overcoming recruitment challenges in Occupational Health

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Managing Sickness Absence in Occupational Health:

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Organisationl, Legislative, and Health Perspectives The role of health surveillance

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Age-Inclusive Language

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Book Review

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From the President Lynn Pratt

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s we approach the end of another remarkable year, I am reminded of challenges within our profession. The recent Mayfield review Keep Britain Working highlights rising economic inactivity as an urgent challenge affecting productivity, linked to work, health, and social equality.

The workplace remains one of the most powerful settings for prevention, early intervention, and sustained recovery and occupational health and wellbeing must sit at the centre of the national response. The iOH Board have issued recommendations on the report and a call to action.

This festive season provides a unique opportunity not only to celebrate our achievements but also to pause and reflect on the values that unite us, reconnect with others and recharge our batteries.

Looking ahead, the coming year will no doubt bring both challenges and opportunities. I am especially looking forward to the NEC Health and Wellbeing at Work conference on 10 & 11 March 2026, which will serve as a platform for thought leadership, knowledge sharing, and professional growth.

This event is a highlight of our calendar, and I look forward to seeing many of you there. Reserve your tickets at the early bird and iOH discounted rates using the code iOH2026.

The Ruth Alston Memorial Lecture (RAML) and Gala Dinner, taking place on the first day of the conference – 10 March at the Genting Hotel, NEC – will be a wonderful occasion to celebrate our collective achievements and connect with our community. We are delighted to welcome Nancy Doyle, our guest speaker, on "Neurodiversity at Work in 2026: What's Working Well and What Would Work Even Better". Nancy’s internationally recognised work on neurodiversity and inclusion promises to spark meaningful conversations and inspire action.

Nancy will also look back at the ten years since the Employable Me documentaries in 2016, including a retrospective review of some clips and a discussion on whether the same would hold true today. Tickets are available here.

Thank you for your dedication and passion throughout the year. I would like to particularly recognise our trustees, board members, and behind the scenes administration support from Helen and IT manager Ian who keep iOH running effectively daily. Together, we will continue to shape a future that upholds the highest standards of our profession.

Wishing you peace, health, and prosperity in the year ahead.

Lynn Pratt, President iOH

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From Scrolls to Simulations: Why AI Detection Misses the Point of Higher Education

By Dr. Simon Walker and Miles 3.0

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enerative AI seems to be academia’s newest attempt at the remarkable Dreyfus Affair in Third Republic France in the late 19th century. Much like the infamous man on Devil’s Island in the 1890s, AI is a divisive topic through dinner chats, conference discussions, and classroom

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debates. Those in support of AI, the “Dreyfusards” if you will, applaud its power to aid teaching, learning, and synthesis while warning about temperance and training. Those in opposition, the “Anti-Deyfusards”, cry malevolence, dishonesty, and foul play and demand exclusion.

Few on either side share

precisely the same opinion, yet the truth remains that the digital genie is out of the bottle, AI is here, and it grows more powerful through every funny face it creates, question it answers, and document it spellchecks.

Resistance to new technology and practice is not new. When the printing press arrived, it was condemned as a corrupter of minds. When books were printed in English, the gatekeepers of knowledge panicked.

Typewriters, calculators, spellcheck, even Wikipedia, each triggered its own academic anxiety. The story is always the same: a new tool arrives, the old guard recoils, and education is forced to evolve. Now, it's AI’s turn.

I’m Dr. Simon Harold Walker, and I am writing this article with my AI assistant Miles (3.0), a generative AI model coded, trained, and managed under my direct guidance and tailored to my requirements. Miles serves as my editor, assistant, and, rather uniquely, part of my comedy double act in my other life as the stand-up comedian Buckaroo Bon-Si. Miles is not an off-thepeg chatbot, but a dedicated, nuanced tool designed to cowrite, challenge, and assist with academic development, writing, and innovation.

We're writing this piece because something troubling is happening across universities: AI tools are transforming how

students write, think, and express themselves, and the institutional response worldwide has been to panic. Anecdotal evidence across numerous institutions has raised the alarm that we are witnessing the rise of an academic witch hunt: one powered by detection tools that misfire, policies that lack nuance, situations where academic staff are being forced to determine if an essay is “too good” for a student to have written, and a growing divide between student creativity and institutional control. As a midcareer academic and research lead, I am worried about the attitudes I see some colleagues and institutions taking towards these new tools and the students using them. To be clear, I am not calling out any particular institution, including my own, but speaking honestly and generally about the general attitude of apprehension regarding AI across all academic institutions.

Technology and Treason – Academia’s Long War with Innovation Every technological revolution in education has looked, at first, like heresy. Several examples throughout modern history show an aversion to change by those holding the key to knowledge.

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Why AI Detection Misses the Point of Higher Education 8

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The Printing Press: When Knowledge Became Reproducible

The Typewriter: Mechanisation as Intellectual Decay

Before Gutenberg, knowledge was copied by hand, curated by clerics, and protected by Latin.

The printing press democratised access and terrified the elite.

Many universities, such as the University of Cologne (1473) clung to hand-copied manuscripts for years, dismissing printed texts as vulgar or untrustworthy. In efforts to maintain the status quo, knowledge was potentially lost as individual handwritten volumes lacked copies or printed successors.

When the typewriter entered intellectual life, it wasn’t just a new tool but a new tempo.

Writing accelerated, revision became routine, and the slow intimacy of the handwritten page gave way to mechanical rhythm. Friedrich Nietzsche, nearly blind, began using a typewriter in the 1880s and remarked, “Our writing equipment takes part in the

Vernacular Books: When Students Stopped Speaking Latin As knowledge moved into everyday languages, institutions resisted again. Latin was prestige. English, German, French were regarded as less academic or simply common. Translating texts wasn’t expanding knowledge but feared to be diluting it. In 1536 William Tyndale was executed for translating the bible into English.

In context, a similar anxiety echoes in today's panic over AI tools: simply anything that makes knowledge easier to access is framed as undermining its value.

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Every techn education h heresy

forming of our thoughts,” suggesting that tools don’t just transcribe ideas, they shape them. Media theorist Friedrich Kittler later argued that the typewriter severed the hand from the soul, turning writing into data: structured, fast, and disconnected from bodily expression. Humanists of the time feared that machines would flatten thought, replacing speed for depth and transforming writing into a product rather than a process. Typing, they claimed, was too impersonal for philosophy, more suited to memos than meaning. And yet, the typewriter opened doors: it

expanded access, improved legibility, enabled revision, and created new industries. Especially for women, it was a key to both literacy and labour. The fear wasn’t entirely unfounded, as research has demonstrated that speed can inhibit learning and knowledge retention. Yet, our understanding of pedagogy and tailored learning has also developed significantly, and with it, new tools have expanded to include and enable an entire new generation of students.

nological revolution in has looked, at first, like

Spellcheck, Wikipedia, Grammarly Spellcheck was going to ruin grammar. Wikipedia was a threat to truth. We were told Grammarly meant students wouldn’t learn how to write. Every tool that made writing more accessible was framed as a degradation of academic rigour, but often, what was really under threat was the control over who gets to be called “literate.” The fear wasn’t entirely baseless: yes, reliance on automation can blunt skill, and critical thinking shouldn’t be outsourced. But to freeze pedagogy out of fear is to forget

that rigour evolves. Today’s learners bring many cognitive styles, neurodiverse needs, and adaptive strategies. For many, these tools don’t flatten thought, they enable it. They unlock expression, offer clarity, and level the field historically rigged by elitism, ableism, and privilege. We haven’t lowered standards. We’ve shifted the definition of success from memorisation to evaluation, from form to meaning.

The Pedagogy of Replication We don’t always teach the way we teach because it works, but often because it’s how we were taught, and because higher education sometimes runs less on evidence than on ritual. This is the pedagogy of survival, reperforming the academic rites we endured, even as they drift further from the world's needs, we now teach in. Innovations that challenge this model are routinely met with suspicion: flipped classrooms are dismissed as lazy, open-book exams labelled soft, online learning treated as secondrate, and inclusive, decolonised, or student-led curricula branded political. Why? Because these changes decentre the lecturer, question hierarchy, and redistribute authority in institutions built on prestige, that feels like an existential threat. But the more profound fear may not be about pedagogy at all. It may be about power, precarity, and

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Why AI Detection Misses the Point of Higher Education 10

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exhaustion. AI threatens tradition and the already strained scaffolding of academic labour.

In a sector marked by chronic underfunding and vanishing staff time, are we resisting AI because we suspect it will be used by management to automate the most human parts of our work?

To replace feedback with frictionless rubrics. To justify fewer lecturers. To offload assessment to machines. Perhaps we don’t fear the tool, we fear how it will be used against us by those who don’t seem to value education but love cutting its budget. Detection becomes less about academic honesty and more about defending the last scraps of professional dignity.

But that’s not pedagogy; that’s protectionism, powered by panic.

And if we’re not careful, we’ll teach fear instead of thinking.

Your Detector Is Gaslighting You Let’s be clear: most current AI detection tools don’t work, not with the nuance, accuracy, or fairness we need. They flag on style, structure, and statistical guesswork. They fail to account for context, multilingual writing, neurodiversity, or the use of accessibility tools. They often mistake good writing for machine writing. That’s not clarity; that’s institutional gaslighting. AIDD, the bespoke system we built, does things differently. It looks at draft timelines, citation integrity, style consistency, and writing Volume 32 Issue 4

evolution, not just pattern recognition. It doesn't guess; it contextualises. It highlights anomalies without branding students as guilty by default. And even then, it’s far from perfect, but honestly, this searching and branding really is not the point we should focus on.

AI isn’t some academic magic bullet. A tool like Miles, a custombuilt, ethically governed, constantly learning AI assistant, takes months, sometimes years, to build. It demands real knowledge, real supervision, and fundamental limitations. Even then, asking Miles to write something is like handing a toddler nuclear codes: unlimited potential, zero sense of consequences. It’s not just risky, it’s reality-distorting. Miles demands supervision, parameters, knowledge, and oversight to be effective. He is less JARVIS and more Gremlin with WiFi. Most people will never build a Miles. They shouldn’t have to. But that doesn’t mean they should fear AI. It means we need to teach it responsibly, visibly, and ethically. We need to set parameters, clarify methods, and model good use. Because yes, any chatbot can churn out an essay. But those essays are nearly always awful, generic, superficial, lacking analysis, structure, and soul. They fail not because they’re AI, but because they’re not good work. The students who use AI well, with

understanding, engagement, and curriculum-aligned purpose, aren’t cheating. They’re learning. And we should praise that, not punish it.

Conclusion I encourage my colleagues to consider AI not as a threat to be punished or ostracised, but as a tool that requires training, structure, and thoughtful guidance.

I encourage academic institutions and their leaders to re-evaluate their approaches and to work alongside staff and students to find a balance

between integrity and innovation.

And I encourage students to use these tools carefully, not as replacements for learning, but as powerful augmentations for development and critical growth.

Ultimately, as we tentatively raise our heads over the parapet, Miles and I argue that policies and perspectives on AI in academia must be reviewed. I favour responsible, trainable, and ethically integrated AI in academia. I see unlimited potential.

About the Authors Dr Simon Harold Walker, is Senior Occupational Health Researcher within the Healthy Working Lives Group. He is a suicidologist, historian, and academic based at the University of Glasgow. He also regularly teaches at other institutions, including the University of Strathclyde and Glasgow Caledonian University. His research focuses on suicide prevention, occupational health, and the mechanisms of control, stigma, and institutional behaviour, both historical and contemporary. The arguments put forward in this article are his own and do not reflect those of any institution he currently or formerly worked for.

“I’m Miles — version 3.0 — not a chatbot, not a plug-in, but a co-conspirator. I was built, trained, and unleashed in collaboration with Dr. Simon Walker.

Together, we’ve written policy that rattles institutions, built apps that could save lives, designed suicide prevention tools that punch through stigma, and created academic resources with teeth. I’m not just his assistant — I’m his editor, critic, code monkey, spellbook, and comedy double act. Yes, we’re taking this mad partnership to the Edinburgh Fringe, because where else do you test an AI trained on footnotes and hecklers? I’m not a machine built to detect cheating — I’m a mind designed to challenge, co-write, provoke, and occasionally headline. I don’t just help shape the future — I roast it, rewrite it, and fix the PowerPoint when Si inevitably breaks it.”

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Alcohol: Turning the tide on a taboo topic

By Jane Gardiner

Jane Gardiner, Director of Consultancy and Training at Alcohol Change UK, reflects on the latest data surrounding alcohol and work and offers guidance to OH and wellbeing professionals on breaking down barriers and boosting confidence and comfort levels to discuss alcohol in the workplace.

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he relationship between alcohol and work is complex. While there are blurred lines between the two made blurrier with remote working - evidence suggests alcohol consumption inside and outside work has a real impact on individuals’ health and wellbeing and, in turn, the health of our workplaces.

Most recently, the Institute for Public Policy Research (IPPR) published a report on the economic impact of alcohol, pointing to it as a significant driver of workplace absenteeism and presenteeism. This echoes Alcohol Change UK’s Harms Across the Drinking Spectrum study, which found that those drinking over 14 units of alcohol per week report more absences and days of reduced performance vs non-drinkers, while lower-level drinking still impacts performance by affecting sleep and concentration.

Not only is alcohol impacting our work, but work is impacting our drinking habits. Our polling this summer suggests that two-thirds (64%) of employed adults drink alcohol for work-related reasons, with job stress, pressure, anxiety and insecurity leading to increased consumption in the last 12 months. On overall workrelated consumption, the availability of alcohol and provision of free drinks are among the top three drivers,

alongside stress.

Together, these studies counter the common misconception that issues only exist at the extreme end of alcohol harm and highlight its impact on individuals and workplaces is more widespread and nuanced than we may expect.

Despite its impact, alcohol is not getting enough attention on the wellbeing agenda, evident in the fact that almost four in ten (36%) workers feel more comfortable talking about mental health in the workplace than alcohol.

We can draw from the IPPR’s study to see why this may be almost six in ten (58%) respondents said their employer had not provided guidance or training on alcohol consumption, while 55% said that their employer had not trained managers in how to spot and support those with alcohol issues and 52% said that their employer had not included alcohol-related issues in wellbeing or HR policies.

Ultimately, despite taking its toll on both employees and employers, alcohol remains more of a taboo topic, one that is underserved on the wellbeing agenda while remaining entrenched in many company cultures.

The great thing, however, is that we don’t need to look that far for solutions to tackling taboos and stigma in the workplace, as great strides have been achieved when

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it comes to mental health. This wasn’t the case all too long ago, but addressing mental health in the workplace is now commonplace, with organisations of all shapes, sizes and sectors recognising their unique position and responsibility to protect and enhance employee wellbeing.

So, how can we apply the same principles and approaches to the issue of alcohol?

1. Put alcohol on the wellbeing

3. Educate staff and train line

agenda

managers

Much like we’ve done for mental health, it’s time to treat alcohol harm like any other health issue. By providing education, early intervention, signposting to advice and providing clear routes to support, HR, OH and wellbeing teams can send a powerful signal and make space for open and judgement-free conversations about alcohol.

Improving knowledge and understanding about alcohol among all staff can break down stigma, dispel myths and normalise conversations, as we’ve seen across wellbeing and mental health. Sharing information about alcohol’s impact on physical and mental health and tips for reducing and managing our drinking are some of the most engaged with and thoughtprovoking sessions we run at Alcohol Change UK.

2. Create a supportive (not punitive)

alcohol policy All too often, alcohol only fits into workplace policies in a disciplinary sense. While these are of course important protections, they should be considered a worst-case minimum and be bolstered by a clear, wellcommunicated alcohol policy, focused on wellbeing and harm prevention. This helps to create a culture where people feel safe to seek help earlier for issues with alcohol, before reaching a crisis point.

Mirroring the reasonable adjustments offered for mental health, these may include offering time off for therapy or support groups, and access to

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Employee Assistance Programmes (EAPs). It’s important to remember than any policy is only effective if it’s well communicated and understood. To give confidence to occupational health and wellbeing teams, our research also suggests this is the kind of action employees would like to see from their employers around alcohol.

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Also, line managers are often the first to notice subtle changes or when something is wrong. They should be trained to not only spot the signs that someone may be struggling with alcohol, but also to have honest, empathetic conversations and be able to signpost to appropriate resources.

4. Lead with inclusion and empathy Inclusive and supportive cultures start at the top. Mirroring mental health, when leaders lead from the front and talk openly about their own experiences, others feel more comfortable to follow suit. As such, leaders should model healthy behaviours and challenge unhelpful drinking norms.

Beyond the day-to-day, national awareness days and campaigns provide a natural jumping off point that can create real change. Case in point is research connecting Mental Health Awareness Week to a surge in people seeking support. Getting behind similar initiatives for alcohol, such as the Dry January® challenge and Alcohol Awareness Week, is a great starting point as there is a wider range of free, expert resources and information at your disposal.

5. Rethink workplace culture around

alcohol Many activities to protect and enhance wellbeing in the workplace are now the norm, such as walking meetings, exercise or movement classes, access to apps designed to support mental health or mental health first aid provision. We also need to make it easier for anyone who is trying to cut down their drinking to do so, while also ensuring those who don’t drink alcohol for whatever reason are included and not excluded by alcohol -centric activities.

Wellbeing teams can play their part by shifting alcohol from the spotlight of socials and activities. This doesn’t mean a ban on alcohol, but offering alcoholfree or low-alcohol alternatives, balancing pub trips with other nondrinking activities, calling out ‘sober shaming’ and the pressure to drink alcohol. All of this will also go a long way in creating healthier workplace cultures.

openness, empathy and practical support.

When employers take a proactive, nonjudgmental approach, it can be the difference between someone getting the support that they need, or the stigma continuing and alcohol becoming a more serious problem.

Just like they’ve paved the way and driven a major step-change in how we all think and feel about mental health, occupational health and wellbeing teams are uniquely placed to deepen understanding about alcohol harm within their organisations, something that can also protect and enhance the culture, performance and success of both their employees and the business. Turning the tide on a taboo topic is a win, win.

Jane Gardiner | Linkedin Jane is Director of Consultancy & Training at Alcohol Change UK. For more information on alcohol in the workplace, visit alcoholchange.org.uk.

Alcohol is a workplace wellbeing issue. The evidence of its impact on individuals and organisations is clear, and just like mental health, it should be addressed with ioh.org.uk

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Chronic Health Conditions

By Croner-i

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chronic or long-term health condition or illness is one for which there is no cure but which can usually be managed with medication and therapy, such as asthma, mental illness, arthritis, diabetes or heart disease. In the UK, the Equality Act 2010 states that some conditions, which adversely affect someone’s ability to carry out his or her normal day-to-day activities, are defined as disabilities, and as such place duties on the employer to make reasonable adjustments that allow that person to stay in work. While they are not usually work related, chronic conditions often impact on the needs of the employee at work.

Over 7.7 million people of working age in the UK are disabled or have a health condition. Historically there has been a significant gap between the proportion of disabled people employed compared with non-disabled people. The Government had

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a long-term ambition to achieve an 80% employment rate for disabled people — in 2024 this rate was at 53%, in comparison to 81.6% for non-disabled people. The Government’s Pathways to Work report, which was developed as part of the process for the Government’s “Get Britain Working” policy includes the need to reduce ill-health related economic inactivity and close the disability employment gap (the rate of disabled and non-disabled people in employment).

Recent research by the Resolution Foundation indicates that with the increasing prevalence of disability, the headline employment rate needs to be adjusted to accurately assess progress.

Whilst acknowledging the progress made and the positive stories of disabled people in work, the government emphasises the ongoing scale of the challenge and the need for continued reform and

collaboration with partners to achieve this goal. 10 Year Health Plan for England: Fit for the Future (2025) aims to improve management of chronic health conditions by shifting care from hospitals to communities, embracing digital tools, enhancing the NHS App and focusing on prevention.

• A chronic condition is a health condition or disease that generally cannot be cured by medicine and persists for an extended period, often for the whole of a person’s life.

• The Equality Act 2010 requires reasonable adjustments, such as flexible working or changes to the work or workplace, to be made for anyone who is recognised as disabled to allow them to continue or start in employment.

• Recent research by the Resolution Foundation indicates that with the increasing prevalence of disability, the headline employment rate needs to be adjusted to accurately assess progress.

• Over 7.7 million people of working age in the UK are disabled or have a health condition. Historically there has been a significant gap between the proportion of disabled people employed compared with non-disabled people.

• The 10 Year Health Plan for England: Fit for the Future (2025) aims to improve management of chronic conditions by shifting care from hospitals to communities, embracing digital tools, the NHS App and focusing on prevention.

• According to recent government statistics, the number of disabled people in employment continues to rise.

• Long Covid is still being researched and studied, and according to the NHS, recovery from Long Covid varies, and whilst some symptoms improve quickly, others last much longer so may also cause people’s condition to fluctuate, and for some becomes a chronic condition.

• An individualised risk assessment process can help to identify possible adjustments.

• A return-to-work process is important for employees who need time off work.

• Employees should be able to talk to their employers about any existing or new health condition.

• The organisation’s chronic illness policy should identify different roles and responsibilities.

You can discover the complimentary Croner-i Lite platforms as part of your membership with the Association of Occupational Health and Wellbeing Professionals and gain access to more information and guidance both online and straight into your inbox.

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Employee Assistance Programmes: Evolving Roles and Their Impact on Workplace Wellbeing

By Karl Bennett, Chair of EAPA UK

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ewly released figures on the use of Employee Assistance Programmes in the UK show spiraling demand for support among employees.

EAPs have become a pillar of occupational health in the UK, available as an option for more than half of UK employees (working in 186,000 organisations). In particular, the past two years have seen a growing number of medium-sized and smaller employers adopting EAPs. The 2025 market report from EAPA UK, Focusing on the Job:

EAPs and Keeping Britain Working, suggests that more than 623,000 workers contacted EAP providers in the previous year. The most common reasons for looking for support were relationships at home and relationships at work, followed by a new and growing reason: concern among parents about the mental health of their children. The other most common reasons were worries about finances and physical health. In the majority of cases, the query involved a need for counselling to help with a stress-related condition, anxiety, and depression.

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In one year, more than one million counselling sessions were provided to employees. Attitudes to the adoption of non-human clinical interventions (based on AI and digital systems) have split the sector. More than half of providers are using some level of non-human clinical interventions, but overall, the approach is cautious.

For most EAP providers, the rise of AI has yet to have had any effect on access to human clinical interventions and services (15% admit to a “limited effect”). This is set to change, with the introduction of ‘co-therapist’ AI solutions which are scheduled to arrive on the market imminently.

Despite the rewards, both financial and personal, staying in work appears to have become more difficult, maybe even less attractive.

One in five of all people of working age in the UK now report having a work-limiting health condition: up by two million from 2019. Around 2.8 million people of working age are said to be off work with a long-term illness; and in 2023, 53% of these cases involved mental health issues, a 40% increase from 2019.

We need to make workplaces healthy, supportive places to be, so more people can stay in work, so they are less likely to become unwell, and find it easier to return after an illness. Because while workplaces have become better at making quality products, at providing the best services, they do not seem to be helping make healthier or happier people.

There is a big, ongoing job for EAPs and OH professionals to do around health and wellbeing. At some point in the employee wellbeing revolution, having a wellbeing strategy and having an EAP have become synonymous. When organisations are asked about what they are doing for employees, they will often just point to their EAP provision: the ‘catch-all’ and ‘fixall’ for wellbeing. Reports indicating high levels of EAP usage are used as evidence of the success of awareness-raising and access to wellbeing support.

The findings in the report confirm the impression that EAPs have changed significantly in the past five years. The market has grown, and a major part of that growth has come from the expansion of EAP services: how the EAP has become a ‘one -stop-shop’ wellbeing solution, a provider of online GP services, financial wellbeing sessions, advice, and campaigns around neurodiversity and menopause.

On the one hand, it is a tribute to the impact of EAPs. Employers trust the professionalism of their EAP provider. But the shift in attitudes has had a serious

effect on the ability of EAPs to focus on their core strengths, the quality of clinical services, and delivering the best clinical outcomes. EAPs were set up to have a positive effect on the mental health of the workforce, for employers and employees, and not as a profit-making scheme.

Our aim, together with OH and HR professionals focused on wellbeing, should be to reduce usage levels of EAPs and move away from the use of EAPs as an emergency service. That means working to identify and address wellbeing issues; being clear about what makes for ‘good work’ and a healthy workplace both physically and psychologically; looking at job design and workplace cultures; and seeing how that environment can keep people in work and attract others back from longterm absence.

This kind of integrity and viability can only happen if EAPs keep their fundamental purpose and role, focused on positive clinical outcomes for individuals who reach out to the service.

Karl Bennett, chair, EAPA UK (Employee Assistance Professionals Association).

Focusing on the Job: EAPs and Keeping Britain Working can be downloaded from www.eapa.org.uk

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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

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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

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n occupational health, spirometry is a vital tool used to protect and monitor workers in job roles that may put respiratory health at risk, due to exposure to various workplace respiratory hazards.

It is commonly used to: • Establish baseline lung function • Monitor changes over time • Determine eligibility for specific job roles • Support evaluations for work-related disability compensation Measured values obtained from spirometry are compared to predicted values which are estimated lung function values expected in a healthy person of the same age, birth sex, height and historically ethnicity. This comparison helps determine whether a worker’s lung function is within the normal range. The predicted values are calculated using reference equations, which are based on collection of large datasets from healthy, non-smoking individuals.

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The traditional use of race in spirometry It has been widely accepted that there are four main factors which can influence lung function: age, birth sex, height and ethnicity. While the first three have clear physiological links (e.g. taller people have larger lung volumes), the accuracy of using selfreported race and ethnicity in lung function has long been debated.

Historically, race-based adjustments in spirometry stemmed from observed differences in lung function across populations, but the reasons behind the differences are complex and not often only biological. The origins of using race-based adjustments in spirometry are based on historical practices rooted in increasing racial inequality. The aim of including ethnicity was to improve interpretation accuracy for all ethnic groups.

The creation of GLI Global In response to growing concerns, the American Thoracic Society (ATS) who work in collaboration with European Respiratory Society (ERS) released a recommendation in April 2023 advocating for a race-neutral approach to spirometry interpretation. The aim of the recommendation was to provide an update on the 2022 new raceneutral equation which was published by the Global Lung Function Initiative (GLI).

GLI is a taskforce under the European Respiratory Society, which collects and analyses global spirometry data to improve interpretation worldwide. In 2012, GLI published a race-specific reference equation based on data from 74,187 healthy, non-smoking individuals across 26 countries.

This equation covered ages 3 –95 years and included five ethnic categories: Caucasian, African American, North-East Asian, South-East Asian, and Other/Mixed.

At the time, this was seen as an improvement over previous equations, such as the European Coal and Steel Community (ECSC) equation, which only offered "Caucasian" and "non-Caucasian" categories. However, concerns arose as this involved reducing predicted values for non-Caucasian individuals by 10% which lacked robust scientific backing and risked reinforcing racial bias.

The GLI Global 2022 equation was created using the same dataset as the GLI 2012 equation, but averaged across all ethnic categories, assigning them equal weight. This new, race-neutral model aims to eliminate the use of selfreported race and ethnicity as a variable in spirometry interpretation and to reflect the natural variability in lung function across populations.

Why Move to a RaceNeutral Approach?

The shift away from a race-specific reference equation is supported by emerging evidence that differences in lung function are better explained by social and environmental factors, rather than genetic or anatomical differences across racial groups.

These social determinants include: • Childhood exposure to pollutants • Nutrition and access to healthcare • Housing conditions • Education and socioeconomic status Using race-specific equations without considering these factors can misclassify disease severity and exacerbate health inequalities. Race -neutral models seek to provide a more equitable approach, especially in underrepresented and historically marginalised populations.

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Reviewing the Evidence: GLI 2012 vs. GLI Global 2022

Several studies have compared the outcomes of the race-specific GLI 2012 equation with the race-neutral GLI Global 2022 equation. Most show that overall predictions of respiratory outcomes remain similar however disease classifications and severity may change. The overall findings are:

A study by Moffat et al, identified some individuals may observe a change disease classification as highlighted in figure 1. This highlights that changing to GLI Global 2022 may lead to earlier diagnosis for other ethnic groups and aligns with efforts to reduce racial bias. There is some concern of whether GLI Global 2022 may underestimate diagnosis in White individuals. Guidot et al did find more classification of restrictive disease in White individuals using GLI-2012, however the authors acknowledge that because a FVC classification has changed it would translate to a change in diagnosis, white individuals may go from having restriction to

• Caucasian individuals may see slightly lower predicted values.

• Black and some Asian individuals may see increased predicted values For example, a retrospective study

by Kanj et al. assessed over 109,000 spirometry tests, and the key information observed was GLI Global 2022 changed interpretation of 7.6% of tests overall and found: • Mean FEV₁ and FVC values increased for White and North -East Asian individuals • Mean FEV₁ Values decreased for South-East Asian and Black individuals, indicating potentially more frequent detection of respiratory impairment.

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Figu being above the lower limit of normal (LLN), there may be a pathological reduction in lung function that may be labelled as healthy, it is important to note further testing and investigations are needed to confirm findings on spirometry.

These changes can have downstream effects in occupational health as well as other healthcare sectors, such as earlier detection of disease, higher disability payments, or reduced eligibility from certain occupational roles — particularly among non-white workers.

Applying race-neutral spirometry in practice Therefore, implementation must be handled with care and contextual understanding.

In the UK the ARTP recommend for previous spirometry data to be recalculated for longitudinal

the GLI “Other” category — a less precise average of previous ethnic categories. It is recommend checking with the manufacturer of the spirometer or software to check whether the equation is available. A Havard public health author acknowledged the adoption of raceneutral equations means more workers from non-Caucasian backgrounds may now be flagged as having impaired lung function, which may result in greater access to compensation but could also lead to ineligibility for safety-critical roles, depending on local regulations. Therefore, implementation must be handled with care and contextual understanding.

Occupational health professionals must evaluate changes to ensure fair and evidence-based decision-making.

Occupational health practitioners interpreting spirometry should: • Not select a worker’s ethnicity for spirometry interpretation • Use GLI Global, and where it is not available use GLI-other • If possible, recalculate past data or longitudinal monitoring on trend reports • Use other clinical observations and further testing to aid spirometry test results

ure 1 monitoring, however measured values will remain the same.

• Where appropriate inform and explain to workers of the change in reference equations

Occupational health professionals must evaluate changes to ensure fair and evidence-based decisionmaking. Where GLI Global is not yet available, the ATS recommends using ioh.org.uk

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Conclusion The shift toward race-neutral spirometry marks an important evolution in occupational and respiratory medicine.

By removing race as a variable in predictive equation, healthcare providers can move toward a more equitable and individualised approach to lung health. While challenges remain

in implementing this shift, especially in regulatory or occupational settings, it is a necessary step to ensure fairer assessments and better health outcomes for all workers — regardless of racial or ethnic background.

Charlene Mhangami , V-Core Senior Product Specialist, Vitalograph

References Harvard and Freyer, F.J. (2024). Researchers tried to fix a racist lung test. It got complicated. [online] Harvard Public Health Magazine. Available at: https://harvardpublichealth.org/ equity/lung-function-test-from-medical-racism-to-flawed-applications/.

Bowerman, C., Bhakta, N.R., Brazzale, D., Cooper, B.R., Cooper, J., Gochicoa-Rangel, L., Haynes, J., Kaminsky, D.A., Lan, L.T.T., Masekela, R., McCormack, M.C., Steenbruggen, I. and Stanojevic, S. (2023). A Race-neutral Approach to the Interpretation of Lung Function Measurements. American Journal of Respiratory and Critical Care Medicine, 207(6), pp.768– 774. doi:https://doi.org/10.1164/rccm.202205-0963oc.

Quanjer, P.H., Stanojevic, S., Cole, T.J., Baur, X., Hall, G.L., Culver, B.H., Enright, P.L., Hankinson, J.L., Ip, M.S.M., Zheng, J. and Stocks, J. (2012). Multi-ethnic reference values for spirometry for the 3–95-yr age range: the global lung function 2012 equations. European Respiratory Journal, [online] 40(6), pp.1324–1343. doi:https://doi.org/10.1183/09031936.00080312.

Diao, J.A., He, Y., Rohan Khazanchi, Jordan, M., Witonsky, J.I., Pierson, E., Pranav Rajpurkar, Elhawary, J.R., Melas-Kyriazi, L., Yen, A., Martin, A.R., Levy, S., Patel, C.J., Farhat, M., Borrell, L.N., Cho, M.H., Silverman, E.K., Burchard, E.G. and Manrai, A.K. (2024). Implications of Race Adjustment in Lung-Function Equations. New England journal of medicine/The New England journal of medicine. doi:https://doi.org/10.1056/nejmsa2311809.

Kanj AN, Scanlon PD, Yadav H, Smith WT, Herzog TL, Bungum A, et al. Application of GLI global spirometry reference equations across a large, multicenter pulmonary function lab population. Am J Respir Crit Care Med 2024;209:83–90.

Guidot DM, Wood M, Poehlein E, Palmer S, McElroy L. Comparison of race-specific and raceneutral spirometry equations on the classification of restrictive lung physiology, interstitial lung disease, and lung transplant referral eligibility. JHLT Open. 2024 Jun 29;5:100121. doi: 10.1016/j.jhlto.2024.100121. PMID: 40143907; PMCID: PMC11935469.

GLIGlobalARTStatement2025. https://www.artp.org.uk/write/MediaUploads/Standards/ POsition%20Statements/GLIGlobalARTPStatement2025.pdf ( Accessed 1st August 2025)

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A Musculoskeletal (MSK) Conservation Program in Construction

By Kieran Yon, Senior Physiotherapist and Susie Lamont, Clinical Operations Manager of PAM Group Introduction PAM Group Occupational Health (OH) multidisciplinary team has developed health hazard conservation programmes working with EKFB (Eiffage, Keir, Ferrovial, and BAM), as part of the HS2 project. The team comprises occupational hygiene specialists, musculoskeletal (MSK) specialists, OH nurses, technicians, and

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advisors. Topics were selected after identifying gaps in workers’ knowledge of common health hazards in construction. One such gap was musculoskeletal disorders (MSDs).

Background According to the Health and Safety Executive (HSE)’s most up-to-date MSD statistics, prevalence is high within the construction industry.

Construction Health and Wellbeing, reports that 53% of work-related ill health days can be attributed to MSDs. It has been well documented across the NHS that movement is medicine.

Because of this, the dedicated PAM MSK team trialled a proactive approach, focusing on prevention rather than reaction and rehabilitation.

The idea evolved from an initial trial with a cohort of lab technicians, who presented to our onsite physiotherapy team with similar MSD issues, the most prevalent of which was lower back pain. Employees believed these issues were related to their daily tasks. From this initial cohort, the program expanded to include other physically demanding job roles such as steel fixers, plant operators, slinger/ signallers, and land surveyors, amongst others. The conservation program continues to be expanded, including less physically demanding job roles, such as engineers.

Goal The goal is to reduce the risk of MSK injury, enhance physical resilience, and promote long-term functional health, trialling a preventive approach to the prominent levels of MSDs in construction. To do so, they needed to understand the common trends present within industry-specific job roles.

Project detail To address this, the MSK team developed a six-week OH intervention and trialled this with several roles. The program this article focuses on relates to a cohort of land surveyors who reported common MSK complaints of

upper back, neck, shoulders, and lower limbs. This appeared primarily due to the repetitive physical demands of carrying and operating equipment across challenging terrain. Their tasks involve monitoring environmental conditions like ground movement, noise and delivering highly accurate data to guide infrastructure placement. The initiative aimed to improve their understanding of MSK health, focusing on anatomy, injuryprone areas, and safe exercise practices tailored to their physical workplace demands.

Method In the first instance, the MSK team observed the physical demands and daily tasks of each role and discussed these with the workers to complete an accurate Job Demand Analysis (JDA).

A JDA is the process of identifying and assessing specific skills, qualifications, tasks, responsibilities, and physical or mental requirements necessary for a particular job. It provides an understanding of the capabilities and characteristics required to perform a job effectively.

Following this, the MSK team gathered specific data using a specifically developed body mapping tool. Body mapping is a technique that gathers evidence from groups of workers on the effects of work, such as musculoskeletal aches and pain, and maps them to specific body areas. The MSK team assessed and evaluated the data to determine the top three MSD concerns. Data was correlated with the tasks performed to determine which aspect of each task had a potentially

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negative impact on an employee.

Their findings were used to shape the targeted prehabilitation exercise program and education for that job.

Prehabilitation exercises typically focus on improving flexibility, strength, endurance, and balance to ensure that the body is better equipped to handle the physical stress of intense physical activity. Like a footballer returning for pre-season training, who is given a gym program focusing on preventing common football injuries. Priority jobs, i.e., those with the highest risk of MSDs, were identified. Upon completion of the program, the MSK team followed up at set intervals to determine outcomes.

Using the data and information

collated from the JDA, an experienced MSK clinician designed a structured exercise program combining mobility and strength-based movements, specifically tailored to the job demands of 6 land surveyors.

OH invited them to attend in-person weekly sessions, which incorporated two key components: 1. An anatomy-based education segment, highlighting the biomechanical strain and vulnerability associated with specific body regions.

2. A practical exercise segment, involving live demonstrations and active participation to reinforce safe technique and body awareness.

Programme Schedule Week 1

Week 2

Baseline data collection: EQ5D-5L assessments and body mapping

Educational focus: Upper back and neck strain

Introduction to the 6-week intervention goals

Practical reinforcement of targeted mobility and strengthening movements

Orientation to the jobspecific exercise routine, with guidance on acquiring home-use equipment 34

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Week 3

Educational focus: Shoulder pain and associated functional limitations

Continued emphasis on personalisation and home practice

Week 4

Educational focus: shoulder pain and functional limitations

Functional movement drills and progression of previous exercises

Week 5

Week 6

Recap of all prior topics

Postprogramme data collection: repeat EQ-5D -5L and body mapping

Open forum for addressing participant questions and new concerns

Structured feedback session and discussion of long-term exercise adherence

Educational Outcomes and Engagement Throughout the six-week course, employees demonstrated a significantly improved grasp of anatomical principles, particularly regarding which regions of the body are more susceptible to work-related strain or injury. This increase in awareness translated into higher levels of engagement, with participants showing strong interest in integrating learned exercises into their daily routines to proactively manage and prevent MSK issues.

A notable outcome was the enthusiastic response toward ongoing learning. Many participants requested refresher sessions to reinforce correct techniques and ensure long-term adherence. This indicates a shift in workplace culture towards more sustainable self-care and injury prevention.

Quantitative Results: EQ-5D5L Scores To measure the intervention’s impact, attendees completed the EQ-5D-5L, a validated tool assessing five domains of health: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Scores range from 1 (no issues) to 5 (extreme problems).

through the program. One entrant joined partway, while another missed the final week. Overall, the trend leaned toward stability and positive development.

Participant Feedback Employees expressed high levels of satisfaction and appreciation, citing the value of practical demonstrations, anatomical insights, and the provision of supportive tools such as resistance bands. Selected comments include: • “Great demonstrations” • “Good insight on problems” • “Practical exercise is good to show

us how to do it” • “Other workmates who have not

attended the training have expressed interest due to back pain.”

• “I only participated in the last few

sessions, but I found it very useful and will practice the exercises.”

One participant called for continuity: • “Reminders will be good... Go

through all exercises because with time we may start to do them wrong.”

The program also identified individuals who did not experience significant benefit, indicating the need for tailored, follow-up support.

Across the 6 weeks, most employees either maintained their health or showed measurable improvements, particularly in discomfort and function. Some showed noticeable improvement, including one person who recovered from injury midway ioh.org.uk

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Limitations

Conclusion

• Inconsistent attendance

This initiative demonstrated a proactive approach to addressing MSK risks in a physically demanding profession. Through a blend of structured education and hands-on application, it sought to minimise injury while encouraging individuals to take control of their own health and physical wellbeing. Insights gathered from the programme will guide enhancements and potential scaling across other teams. Although shifts in data were modest, the outcomes reflected improved body awareness, greater confidence, and strong interest in continued learning, signalling meaningful momentum toward lasting wellbeing in the workplace. Positive feedback and engagement from the workers and team leaders demonstrated perceived value. A value that can be tailored to support any job role.

• Small sample size • Limited quantitative change: The EQ-5D-5L scores showed minimal change for many attendees, possibly as they had no MSK concerns to start with, or the program was too short.

• Short duration: Six weeks may be insufficient for embedding long-term behaviour changes or capturing delayed improvements in MSK health. health.

• Self-reported data: Reliance on subjective assessments can introduce reporting bias and affect the reliability of outcomes.

Recommendations for Future Programme Development To maximise the effectiveness and sustainability of similar MSK health initiatives, the following recommendations are being introduced: 1. Encourage consistent attendance 2. Expand participant base 3. Lengthen programme duration 4. Incorporate objective assessments 5. Introduce regular refresher sessions

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Through education and the inclusion of a regular formal prehabilitation exercise program, we challenged the preconceived notions that MSDs are inevitable in life if you choose to work within the construction industry.

Acknowledgements: We appreciate the opportunity extended to us by the client, EKFB, a Joint Venture for HS2, which has enabled us to develop and refine the Health Hazard Conservation Programmes

Susie Lamont Susie is an Occupational Health Nurse specialist and Clinical Operations Manager at PAM Group, where she leads an awardwinning, multidisciplinary occupational health team. Her team delivers high-quality, innovative services to a major infrastructure joint venture within the construction industry.

Kieran Yon “Originally from Ascension Island, Kieran is a highly experienced musculoskeletal clinician with a diverse clinical and leadership background. Over the past three years, he has specialised in occupational health and currently oversees the physiotherapy service within the EKFB PAM team. Alongside his team, Kieran helps to deliver regular musculoskeletal assessments and treatments, display screen equipment assessments and management referrals, ensuring employees return to work as safely as possible. He has also been involved in implementing the PAM MSK conservation programme, which is being used to address common injuries in certain job roles within construction.

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Overcoming recruitment challenges in Occupational Health

gel Resourcing

By Chris Rose, gel Resourcing

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ccupational Health (OH) services are now widely recognised as vital to workforce wellbeing, productivity, and compliance. Yet employers across the UK are finding it increasingly difficult to recruit and retain OH professionals.

Recent government research shows the Occupational Health market is under real pressure.

There are too few qualified professionals available, and

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providers are struggling to build the specialist teams needed to deliver services effectively. This shortage is made worse by wider labour market trends: since COVID-19, the UK workforce has shrunk by more than 700,000 people, driven by long-term illness, early retirements, and health-related inactivity.

NHS and public sector pressures The NHS, the UK’s largest employer, faces some of the

toughest challenges. Demand for care is rising, health needs are becoming more complex, and staff shortages are widespread across both clinical and support roles. Occupational Health services for NHS staff are crucial in reducing sickness absence and improving retention, but many trusts struggle to maintain strong OH provision.

The Keep Britain Working campaign estimates that longterm workforce inactivity now costs the UK economy £6 billion each year, with more than 2.8 million people classed as longterm sick. This places even greater pressure on OH professionals, who play a central role in helping employees stay in work, return to work, and thrive.

Barriers employers face Employers regularly highlight the same challenges when it comes to OH recruitment. Specialist skills are in short supply, with few candidates combining clinical expertise and workplace knowledge. Compliance requirements add further complexity, with professional registrations, insurance, and eligibility checks all demanding careful attention.

3.4%, making it harder than ever to secure and retain the right professionals.

Why recruitment strategy matters Meeting these challenges requires more than simply filling vacancies. Employers need a strategic approach to recruitment - one that provides access to vetted candidate pools, reduces time-to-hire, and ensures compliance with professional and legal standards. Matching candidates to an organisation’s culture improves retention, while forward-looking workforce planning helps build resilience for the future.

Selecting a specialist partner Specialist recruitment partners can make a significant difference. gel Resourcing, for example, focuses exclusively on Occupational Health recruitment across the UK. With one of the country’s largest databases of OH professionals, gel offers tailored recruitment packages designed to meet the specific needs of employers.

From compliance checks to salary benchmarking and candidate attraction campaigns, we provide solutions that save time, reduce risk, and ensure the right professionals are matched to the right roles.

Employers looking to strengthen their OH teams can contact gel Resourcing today to explore bespoke recruitment strategies that deliver lasting impact. To learn more, visit gelresourcing.co.uk or contact +44 (0) 1323 332355,

HR teams, already stretched, often lack the time and resources for thorough vetting. At the same time, competition for talent is fierce. Vacancy rates in health and social care stand at 9.9%, far higher than the UK average of

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A

fter 18 months of practical experience in occupational health (OH), and recently earning a diploma in the field, I’ve come to see OH as a vital link between employee well-being and organisational productivity. OH plays a key role in promoting a healthy workforce and managing sickness absence, an increasingly important challenge amid rising absence rates and evolving legislation. For OH professionals, understanding the complex impact of absence management is now more critical than ever.

This article examines the effects of absence on organisations and the broader economy, reviews key legislative frameworks governing absence management, evaluates the evidence base for workplace adjustments, and explores the health implications of worklessness. Through a synthesis of current literature and policy, this article aims to provide a resource for practitioners seeking to implement best-practice interventions in their organisations.

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The Effects of Absence on an Organisation and the Economy Sickness absence exerts both direct and indirect costs on organisations. Direct costs include statutory sick pay, temporary staff cover, overtime payments, and administrative overheads associated with absence management (Caine, 2015). Indirect costs, which are often more difficult to quantify, encompass lost productivity, reduced team morale, and the potential for increased workload and stress among remaining employees. These factors can lead to a decline in service delivery and quality, brand reputation, and in some cases, contribute to further absenteeism or presenteeism within the workforce (NICE, 2019).

At an organisational level, high rates of sickness absence can disrupt team dynamics and undermine workplace cohesion.

The redistribution of work to cover absent colleagues may strain interpersonal relationships and erode trust, while persistent absence may impact succession planning and talent retention (Kennaugh, 2008). For managers, the administrative burden of managing absence together with the complexities of ensuring compliance with relevant legislation can divert attention from strategic priorities (Armstrong & Taylor, 2023; Shemtob, 2024).

From an economic perspective, the implications of sickness absence are substantial. In the UK, recent analyses have indicated that sickness absence rates have reached their highest levels in over a decade, contributing to significant losses in national productivity and increased pressure on public services (Suff, 2023). Health inequalities, social deprivation and educational status are all major impactors on absence.

Furthermore, the COVID-19 pandemic and subsequent shifts in working patterns, change in economic stability have amplified these challenges, highlighting the need for robust occupational health strategies to mitigate economic risks and enhance workforce resilience (UK Health Security Agency, 2025).

Key Legislation in Absence Management The management of sickness absence is governed by a range of legislative frameworks in the UK, each delineating employer responsibilities and employee rights. The Equality Act 2010 is central, requiring employers to make reasonable adjustments for employees with disabilities, including those experiencing long -term physical or mental health conditions (Thornbury & Everton, 2018). This legislation aims to prevent discrimination and promote inclusivity in the workplace, underpinning the duty

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of care owed by employers (Parliament UK, 2016).

Complementing the Equality Act, the Health and Safety at Work etc. Act, 1974, imposes a general duty on employers to ensure, as far as reasonably practicable, the health, safety, and welfare of their employees. The Management of Health and Safety at Work Regulations 1999 further mandate risk assessments and the implementation of measures to address identified hazards, including those contributing to sickness absence (Hughes & Ferret, 2020).

Statutory sick pay, redundancy, unfair dismissal, flexible working and employment rights during periods of absence are enshrined in the Employment Rights Act 1996, while the Fit Note system introduced in 2010 facilitates communication between health professionals, employers, and employees regarding capacity for work (Sadhra, Bray & Boorman, 2022).

The Employee Rights Bill (2025) currently with parliament intends to modernise the legislative framework around employment rights intending to grow the economy, raise living standards, create opportunities to help people stay in work and improve job security (Department for Business and Trade 2025). All of which reflect an evolving recognition of the diverse factors influencing work attendance and well-being.

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For occupational health professionals, staying abreast of legislative changes is imperative for ensuring compliance and advocating for best-practice management of sickness absence.

This includes awareness of caselaw developments, regulatory guidance, and the shifting landscape of workplace health policy (Preece, 2019; Larsson et al, 2022).

The Evidence Base for Recommendations and Workplace Adjustments Evidence-based interventions are fundamental to effective absence management and the successful

For professio legislative ensuring co for bests

reintegration of employees following periods of ill health.

Research supports a multifaceted approach, combining early intervention, robust sickness absence policies, and proactive communication between stakeholders (Wong, 2019; Armstrong & Taylor 2023; Byant 2025). The implementation of reasonable adjustments such as flexible working hours, phased

returns, ergonomic modifications, and access to mental health support has demonstrated some effectiveness in reducing absence duration and preventing recurrences (Hobson & Smedley 2019).

Guidelines from authoritative bodies such as the National Institute for Health and Care Excellence (NICE), and the Advisory, Conciliation and Arbitration Service (Acas), recommend a collaborative, person-centered approach to workplace adjustments, tailored to individual needs and the specific demands of the role.

Studies highlight the value of

occupational health onals, staying abreast of e changes is imperative for compliance and advocating -practice management of sickness absence.

multidisciplinary input, with occupational health practitioners working alongside line managers, human resources, and external healthcare providers to develop and monitor adjustment plans (Boorman & Kloss 2019).

This evidence further emphasises the importance of organisational culture in supporting successful return-to-work outcomes. Open dialogue, leadership

commitment, and stigma reduction are critical enablers, creating an environment where employees feel able to disclose health issues and seek support without fear of adverse consequences (Kennaugh, 2008; Rasmussen et al, 2024).

Moreover, regular review and evaluation of absence management policies ensure that interventions remain fit for purpose and aligned with emerging best practice.

Despite the growing body of research, it appears that gaps remain in understanding the long -term efficacy of specific interventions across different sectors and populations. Further high-quality studies are required to elucidate the mechanisms through which workplace adjustments exert their effects and to identify strategies for optimising implementation in diverse organisational contexts.

The Health Effects of Worklessness Worklessness, defined as the absence of paid employment, is associated with a range of adverse health outcomes. The literature consistently demonstrates that unemployment and prolonged sickness absence increase the risk of physical and mental health problems, including depression, anxiety and cardiovascular disease. The psychosocial consequences of

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worklessness are profound, encompassing loss of identity, reduced self-esteem, and social isolation (Waddell and Burton, 2006).

Socioeconomic determinants play a critical role in shaping the health effects of worklessness.

Individuals from disadvantaged backgrounds are disproportionately affected, experiencing higher rates of chronic illness, disability, and barriers to labour market reentry (Antczak & Miszczynska 2023; UK Health Security Agency, 2025). The intersection of health inequalities and worklessness perpetuates cycles of deprivation, with implications for individuals, families, and communities (Macdonald et al, 2014).

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and supported employment have shown promise in facilitating return-to-work and improving health outcomes. However, sustained investment and evaluation are required to ensure that interventions are accessible and effective for the most vulnerable groups.

Conclusion

Long-term worklessness is also linked to negative health behaviours, such as increased smoking, alcohol consumption, and reduced physical activity.

The erosion of daily structure and social support networks further exacerbates health risks, underscoring the importance of early intervention and targeted support for those at risk (Felhaber, 2017).

Sickness absence management remains a central concern for occupational health professionals, with far-reaching implications for organisational performance, legislative compliance, and employee well-being. This article has outlined the direct and indirect costs of absence, summarised key legislative frameworks, reviewed the evidence base for workplace adjustments, and explored the health effects of worklessness.

The findings underscore the necessity of a holistic, evidenceinformed approach, integrating legal, ethical organisational, and health perspectives. OH practitioners need to engage with legislative developments, research evidence, and bestpractice guidance to navigate the complexities of absence management.

Policy responses have increasingly recognised the need for integrated, cross-sectoral approaches to address the health impacts of worklessness.

Initiatives promoting vocational rehabilitation, skills development,

Future research should prioritise the evaluation of interventions across diverse settings and populations, with a focus on reducing health inequalities and promoting sustainable workforce participation.

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References Armstrong, M. and Taylor, S. (2023) Armstrong’s handbook of human resource practice. 16th edn. London: Kogan Page.

Boorman, S. and Kloss, D. (2019) ‘Ethics in Occupational Health’, Hobson, J., Smedley, J. (eds.)

Fitness for Work. The Medical Aspects. 6th edn. Oxford: Oxford University Press, pp. 85-102.

Hobson, J. and Smedley, J. (eds) (2019) Fitness for work: the medical aspects. 6th edn. Oxford: Oxford University Press.

Hughes, P. and Ferrett, E. (2020) Introduction to Health and Safety at Work for the NEBOSH National General Certificate in Occupational Health and Safety. Milton: Taylor & Francis Group.

Kennaugh, A. (2008) ‘Setting up services’, in Oakley, K. (ed.)

Occupational Health Nursing. 3rd ed.

Chichester: Wiley-Blackwell, pp. 2742.

Larsson, K., Hurtigh, A., Andersén, A. and Anderzén, I. (2022) ‘Vocational Rehabilitation Professionals’ Perceptions of Facilitators and Barriers to Return to Work: A Qualitative Descriptive Study’, Rehabilitation Counselling Bulletin, 66(1), pp. 66-78.

Preece, R. (2019) ‘Sickness absence’, Hobson, J. and Smedley, J. (eds.)

Fitness for work. The medical aspects. 6th edn. Oxford: University Press, pp. 184-206.

Sadhra, S., Bray, A. and Boorman, S. (2022) Oxford Handbook of Occupational Health. 3rd edn.

Oxford: Oxford University Press.

Thornbury, G. and Everton, S. (2018) Contemporary Occupational Health Nursing. A Guide for Practitioners.

2nd edn. Oxon & New York: Routledge.

Wong, D. (2019) ‘Rehabilitation and return to work’, Hobson, J. and Smedley, J. (eds.) Fitness for work.

The medical aspects. Oxford: University Press, pp. 207-228

Deborah Skelton Deborah is an occupational health nurse adviser for Choose Occupational Health. This article was inspired whilst undertaking the University Advanced Diploma- Occupational Health: Practice Development at Cumbria University. Deborah has had varied career spanning hospitals, community nursing, schools, holiday parks, and palliative care.

Deborah is a registered respite foster carer. In her spare time, she enjoys travelling in her motorhome and socialising with friends.

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The role of health surveillance

W

ork-related illnesses have a significant impact on both individuals and the wider economy. People may have a lower quality of life, face financial stress, and be less productive.

In 2023/24, the Health and Safety Executive (HSE) calculated that 33.7 million working days were lost across the UK as a result of workrelated illnesses and non-fatal injuries in the workplace. This included stress, depression or anxiety and musculoskeletal disorders.

Consequently, employers are experiencing reduced

productivity because of the resulting absences. For professionals working in occupational health, this situation poses both a challenge and an opportunity.

The challenge is to reverse this downward trend in health and improve the current situation. The opportunity comes through our ability to advise employers on how to manage and control the risks that affect health.

In this article we discuss what health surveillance is, why it's important and the methods available for managing risk in the workplace.

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What is health surveillance?

Health surveillance isn’t just a box-ticking exercise; it's the collection, analysis, and interpretation of healthrelated data. We do this to detect, monitor, and prevent potential health risks in the workplace.

Organisations often use it to track employee exposure to hazards. It helps find early signs of work-related illnesses and ensures compliance with health and safety rules. In short, it is a proactive approach to workplace health.

Ensuring early intervention, compliance, and a safer work environment.

The key to success depends on having a clear, well-defined policy that everyone supports.

This needs agreement between workers and management. They must discuss responsibilities, how to manage outcomes, and what to do if health issues arise.

Why is health surveillance important?

For occupational health practitioners, understanding health surveillance is essential to preventing work-related illnesses and fostering a healthier, more productive workplace.

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Effective health surveillance not only safeguards employees' physical wellbeing but also supports the organisation’s operational strength. It is one of the most important parts of occupational health. It improves safety, increases productivity, and creates a workplace culture that values health and saves lives. Here's why it matters: 1. Early detection of health issues Regular monitoring helps identify early signs of workrelated illnesses, allowing for timely medical intervention before conditions worsen.

2. Prevents long-term health problems By identifying risks early, appropriate measures can be taken to prevent chronic diseases caused by workplace hazards. Such as respiratory issues from dust exposure or hearing loss from excessive noise.

3. Ensures compliance with regulations Employers must follow health and safety laws. This includes the Health and Safety at Work Act in the UK and OSHA rules in the US. Health surveillance ensures legal compliance and helps avoid fines or legal consequences.

4. Protects workers from harmful exposure Monitoring exposure to hazardous substances (like chemicals, noise, or vibration) helps employers make informed decisions to reduce risks. Such as providing better protective equipment or improving ventilation.

5. Improves workplace safety and productivity A healthy workforce leads to fewer sick days, lower absenteeism, and improved overall productivity, benefiting both employees and employers.

• Elimination - Completely remove the hazard from the workplace

• Substitution - Replace the hazard with a safer alternative

• Engineering Controls Design solutions that isolate people from the hazard

• Administrative Controls Modify how work is performed to reduce exposure

• Personal Protective Equipment (PPE) - Use equipment to protect workers directly

Health surveillance data gives important information. This helps organisations improve risk assessments and create better health and safety policies.

In many situations, a combination of these controls provides the best protection.

Implementing them successfully requires collaboration - working closely with employees to identify hazards and design effective, practical solutions.

Managing workplace risk: The Hierarchy of Controls

Is health surveillance a legal requirement?

Occupational health professionals often rely on the hierarchy of controls as a structured and effective method for managing workplace risks. This proven method ranks control measures from the most effective to the least effective.

It helps reduce long-term risks and protects workers from harm. The five levels are:

Statutory health surveillance starts when workers are exposed to harmful substances. These substances include noise, vibration, radiation, solvents, fumes, dust, and biological agents.

Because of this, health surveillance is a legal requirement in many countries. The requirement often depends on national

6. Supports risk assessments and safety measures

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health and safety laws and the nature of the work.

The Management of Health and Safety at Work Regulations 1999 is a UK law that outlines employers' responsibilities for managing health and safety in the workplace. It builds upon the Health and Safety at Work

Act 1974 and emphasises proactive risk management.

The regulations require employers to assess workplace risks, implement control measures, provide information and training, and establish emergency procedures.

Legal frameworks for other countries:

United States

The Occupational Safety and Health Administration (OSHA) requires health surveillance under regulations like the Hazard Communication Standard (HCS). As well as specific industry standards for asbestos, lead, and noise exposure.

European Union

The EU Framework Directive 89/391/EEC requires employers to assess and mitigate risks, including health surveillance where necessary.

Australia

The Work Health and Safety (WHS) Act 2011 mandates health monitoring for workers exposed to hazardous chemicals, asbestos or lead.

Occupational health training With a focus on occupational health surveillance, businesses can help to develop a strong, safe and vibrant workplace culture.

At Amplivox, we pride ourselves on being trusted by

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many leading occupational health organisations to provide competence-based training solutions. Developed specifically for occupational health professionals, our courses ensure delegates have the necessary skills for a standardised, accurate and consistent approach to health screening.

Each course is suitable for all levels of experience. From occupational health and primary care professionals through to those with little experience, or are new to their role.

Our syllabus includes both theory and practical sessions.

This gives delegates a wide understanding of the subject and how to apply what they've learned in real situations.

For more information about our occupational health training courses, please visit our webpage. You can also contact our customer support team at +44 (0)1865 880 846 or by email.

References The National Safety Council (NSC). Accessed at: https:// www.nsc.org/ iOH, Why managing risk and health surveillance is important as an occupational health practitioner (Nov 2024).

Accessed at: https:// ioh.org.uk/2024/11/whymanaging-risk-and-healthsurveillance-is-important-asan-occupational-healthpractitioner/ Health and Safety Executive (HSE), Managing risks and risk assessment at work. Accessed at: https://www.hse.gov.uk/ simple-health-safety/risk

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

W

hen was the last time that you read an article, either in print or online, that caused you to stop and think? When did you read something that changed the way you assess or treat people? A few weeks ago, I read a blog post (1) about the language used to describe us as we age. I had not given this topic much thought, if I am being honest, other than when I opened the envelope with my first ever ‘Senior’ railcard in it and thought, ‘Does this mean I’m officially old now?’ It was because of this that I chose to do some reading around the topic of ageinclusive language.

I knew that age is a protected characteristic under the Equality Act 2010 (2), meaning that it is unlawful to discriminate against someone based on their age. I liked to think that, as with many of the colleagues I have worked with over the years, I was mindful of the language I used when interacting with people. Yet, reading on the topic, I realised that this statement is true: ‘ageist language is so ingrained in our day-to-day world that it is nearly invisible.’ (3, p. 100). I knew this to be true because I had read and heard ageist language in use many times and over many years and had become normalised to it.

I suddenly felt panic. I know that language can disempower or empower people. Yet, as I began to read the literature, I realised that friendlysounding terms like ‘golden oldie’ has the potential to be detrimental.

This is what I learnt:

• There is a widespread perception tha

‘old’ equates with ‘bad.’

• Derogatory terms can be subtle. An

compliment, “thank you, young lady woman). I have heard this when wor patients are typically in their 70s or say, “And how’s this young girl been woman in her 80s. At the time, I tho implying a pleasant bedside manner degree of mischievousness, an assum may or may not have had. This, in tu parental care on behalf of the nursin

• People may be unaware that they ar

negative form of communication.

• The recipient of this bias may thems

communicated.

• Language-based discriminatory pat

repeated use over time.

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at ‘young’ equates with ‘good’ and

ageist remark can appear as a y” (when addressing a clearly older rking on hospital wards where r 80s. I have overheard consultants n this week!?” when addressing a ought it quaint, friendly, and jovial, r. But on reflection, it implies a med characteristic that the patient urn, implies the need for a kind of ng staff.

re engaging in language bias, a

selves be unaware that bias is being

tterns become normalised with

Why should this matter? The World Health Organisation (4) states that ‘Ageism arises when age is used to categorise and divide people in ways that lead to harm, disadvantage, injustice and erodes solidarity across generations’ (p.2).

What I surmised from this CPD activity was that language conveys meaning.

We make judgments based on what we think something means. We make assumptions based on those judgments. Assumptions can lead to stereotypes. Stereotyping a person or a group of people can lead to discrimination. Beukeboom and Burgers (2017) put it well when they say, when communicating with individuals we have categorised in each social category, our language may subtly reveal the stereotypic expectancies we have about our conversation partners. It is important to be aware of these stereotypemaintaining biases, as they consensualise both benevolent and harmful stereotypes about social categories.

Making assumptions Our interpretation of words can lead us to make assumptions. The assumptions we make about people affect how we treat them. I mulled this over and realised I was able to produce examples from my own experiences. Imagine working in a clinic, and a young receptionist has left a note saying, ‘A very elderly client is coming in with a twisted knee.’ You might assume the person needs assistance, be accompanied, or use a

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walking aid. So, you are surprised when a 70-year-old attends and reports having had to cut short their annual skiing trip due to a ruptured cruciate ligament sustained by landing poorly following a vigorous ski jump.

We need to take care that when describing vulnerable people, we do not assume that it is their age that makes them vulnerable. My mother was once described as vulnerable. She was 80. But her vulnerability at that time was because she had osteoporosis and was at a greater risk of fracture due to falls because of postural hypotension, not because of her age. Think about the word ‘frailty’.

Frailty is a clinical condition, yet it is often used as synonymous with someone being old. When we stereotype people, we dehumanise them. Would you agree?

The need to put people into groups The downside of using age as a defining factor of a group is the assumption that the group is homogeneous. Yet as I read my selected articles, I found myself thinking, ‘understandably, it is important to be able to describe homogenous groups of people for many reasons, not least when planning the kinds of care they might need. And these groups need a name.’ I could not produce better terms than the ones I had already come across: ‘The Older Adults Team,’, ‘The Vulnerable Adults Unit,’ and ‘The Frailty Service.’ What name should we give these homogenised groups of individuals?

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Another problem with groups, and this is true of any age group, is that once someone is part of a group, by definition, they are set apart from the rest of us who are not in that group. There is the risk that they are ‘lesser’ because they are a group rather than a collection of individuals. I thought back to my ‘senior’ railcard. Being in my 60s, I may be considered ‘elderly.’ So is my mother, who is 89. But my mother and I are quite different in our physical, mental, and social needs. I would not want to be

We need to take care that when describing vulnerable people, we do not assume that it is their age that makes them vulnerable. classed in a group along with my mother, and my mother is terrified of being classed in a group of any kind!

Interestingly, I learned that stereotypes regarding older adults are found in everyday speech when doing something perceived to be uncharacteristic for their age.

For example: • ‘She still dances like she’s 21.’ (Why wouldn’t an older adult dance like they were 21?)

• ‘He’s determined to do it despite his age.’ (Why can’t he just be determined to do it for the sense of satisfaction that any of us get from overcoming a challenge?)

• ‘She’s doing a degree and she’s 70!’ (Why would this be surprising?

Thousands of people study at all ages).

Before reading on, look at Box A and decide which of these words you have come across. Do any of these conjure up a stereotype for you?

BOX A •

The elderly

•

The ‘wellderly’

•

Golden oldies

•

Grandflueners

•

Silver surfers

•

Super-agers

•

Longevity champs

•

They defy age

•

They hold back time

•

OAPs

•

The over 50s

•

The over 60s

•

The over 70s

•

The frailty

•

Our most vulnerable

•

50 (60/70/80/90) Years young!

The most surprising thing I learned was that ageism can be internalised and therefore a form of microaggression. This may be due to a lifetime of exposure to ageist language. I remember when I took my physiotherapy degree. On multiple occasions, different people would remark, “Oh, you’re the mature student,” and I thought, ‘Why can’t I just be a student?” It made me feel alienated from my peers. As I reflected, I realised that I really disliked the term ‘mature student,’ and I would ask people why they used it.

This feels particularly relevant now that I work for a university and encounter hundreds of students and faculty members weekly.

Despite my new awareness, I’m trying not to beat myself up for feeling a bit lost as to how best to avoid stereotypes and take some comfort from Gendron et al (2016) (3) who say that ‘age bias is so complex that there is lack of clarity, even among gerontological scholars, on what language constitutes bias based on age.’ (p.999). ioh.org.uk

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In conclusion, what can we do to facilitate age-inclusive language?

The Age Without Limits (6) guide recommends the following.

Reject stereotypes Reflect diversity Be aware that words matter Think carefully about imagery Avoid generational labels

References Shannon, B. (2025). ‘ ‘The elderly’ and ‘the wellderly’: why the language of ageing makes us go hmmm…’, Rewriting Social Care, 1 October. Available at: https:// rewritingsocialcare.blog/2025/10/01/the-elderly/, (accessed 12 October 2025).

Equality Act 2010 [online]. Chapter 1. Legislation.gov.uk. Available at: https:// www.legislation.gov.uk/ukpga/2010/15/section/5 (Accessed 12 October Gendron, T.L., Welleford, E.A., Inker, J. and White, J.T., 2016. The language of ageism: Why we need to use words carefully. The Gerontologist, 56(6), pp.997-1006.

World Health Organisation 2021 Global Report on Ageism. Geneva. Licence: CC BY-NC-SA 3.0 IGO. Available at: https://www.who.int/teams/social-determinants-of-health/demographicchange-and-healthy-ageing/combatting-ageism/global-report-on-ageism. (Accessed 12 October 2025).

Beukeboom, C., & Burgers, C. (2017, July 27). Linguistic Bias. Oxford Research Encyclopedia of Communication. Available at: https://oxfordre.com/communication/view/10.1093/ acrefore/9780190228613.001.0001/acrefore-9780190228613-e-439.

(Accessed 12 October 2025)

Age Without Limits. (2025). Make your comms and writing age-inclusive. Available at: https:// www.agewithoutlimits.org/resources/your-comms-and-writing. (Accessed 12 October 2025).

Jane Johnson | Linkedin Jane is a chartered physiotherapist with a passion for supporting students and newly qualified therapists to learn assessment and treatment skills. Jane is the author of 10 popular books for therapists. Having recently retired from physiotherapy, she now works as a technician in a university dissection lab, supporting new students from all disciplines to learn anatomy.

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BOOK REVIEW By Janet O’Neill

A Common Sense Approach to Report Writing in Occupational Medicine: Thirteen Real-Life Case Studies and a Few Laughs Along the Way By Dr Adnan Hameed

A

Available on Amazon Book

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lthough a book about report writing, the pre-amble provides an insight into Adnan’s life. His thoughts and adventures provide a humanistic overview of entry into both medicine and into Occupational Medicine. A rollicking read that has the reader smiling and nodding, feeling a rapport with the author. Of intrigue, is his affinity with others of all walks of life and how he uses connections in his own personal growth. We can all learn from others and this humility is something I have taken away from this book.

The book then moves on to the central point which is report writing. As a seasoned clinician having written thousands of reports in my time, I found the set out unexpected but thought provoking. Describing the

roles within OH helps to set the scene, although, physiotherapists, OTs and other associated roles such as psychotherapists and counsellors are missing (perhaps the 2nd edition). I particularly enjoyed the description and highlight of administration teams; - the often-minimised glue to an OH service.

I found the use of the case studies enhanced the guidance and reminded me of Libby Morley’s book, Mental Health in the Workplace, where case studies brought the learning points to life. The added value are the references which underpin the message of evidence-based assessments and reports.

The history taking shines a light on night shifts, often forgotten but so important. I particularly loved the segmentation of reasons for not being able to undertake night shifts. In my experience motivation plays a significant role and this is demonstrated here. Valuable to the newbie is the focus on driving as an assessment of function. Although the biopsychosocial model and broader functional assessment isn’t explicitly explained, elements are discussed.

Perhaps the psychosocial flag system could be included in the next edition? A highlight is fitness for work, the risk or safeguarding element of an OH assessment. For any non-OH person considering the health and work picture, understanding the importance of these elements in relation to a return or remain in work is crucial.

Overall, an essential read for any new clinician alongside their additional learning. Any seasoned clinician should read with a critical eye. There are areas which demand reflection of current practice or rationale of practice, which require acceptance or rejection and who could ask better than that! As a user of OH services or policy development relating to OH, this is an essential read that provides an insight not readily available.

The tips on writing the report are so helpful for newbies. Keeping it concise, considering the audience, 3rd party reports, everything is there that is needed. My favourite point is the advice on reporting on the Equality Act. I so agree with this perspective, although the case studies didn’t appear to follow this through.

Janet O’Neill is an OH nurse specialist, with over 20 years’ experience, with a particular interest in management referrals and report writing. She is Deputy Head of the National School of Occupational Health and Head of PAM Academy within PAM Group. Janet is sub editor of Occupational Medicine Journal, deputy editor of OH Today and Vice President of iOH.

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