OH Today Volume 33 Issue 1 - 2026

Advancing Neurodiversity in the Workplace: Development of a Strategic Transition Framework for Employment

Also in this issue : Proprioception | Cardiovascular Disease | Absence Management Organisational Safety | Aeromedical Issues Work and Personal Pressures | Work-SMARTey | Digital Fatigue Occupational Health Value

iOH Partners

Friends of iOH : Asclepius Occupational Health | Flex R-Health | recruitingheads | Sparta Health | Well

s

x Occupational Health Ltd lbeing Lead Academy

Editor LYNN PRATT Assistant Editors JANET O’NEILL LIBBY MORLEY Production Editor IAN GARNER

Copyright © iOH 2026 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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Advancing Neurodiversity in the Workplace: Development of a Strategic Transition Framework for Employment

8

Proprioception at Work: The Invisible Sense That Shapes Safety, Performance, and Recovery

23

Summary of “Occupational Health Referrals for Cardiovascular Disease in the Rail Industry”

30

Absence Management

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The Silent architecture Of organisational safety:

44

An Occupational Health perspective Aeromedical Issues in the Workplace: An Occupational Health Perspective

52

Managing Work and Personal Pressures

60

Work-SMARTey: Physical Pain, Role Demands, and the overlooked need in the UK early years sector

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Digital Fatigue: The occupational health implications of prolonged screen time and virtual work.

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From Fixing Defects to Systemic Prevention Harnessing Lead Indicators to Redefine Occupational Health Value

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From the President Lynn Pratt Dear Members,

M

arch is one of the busiest months in our calendar and this Spring edition mirrors the direction we’ve been driving together at iOH -

Prevention first, Data-driven insight, and Psychologically safe, inclusive workplaces.

As we head to Health & Wellbeing at Work conference (10–11 March, NEC) – don’t forget to use your member code IOH2026 when booking your ticket - and we hope you will join us at our Ruth Alston Memorial Lecture and Gala Dinner with Dr Nancy Doyle to continue these conversations on the evening of 10 March.

Across the issue, your submissions reinforce iOH’s new offers and partnerships. Launching on 2 March, a 24/7 Health & Wellbeing Helpline and Wellness platform from PAM and the Career Self-Coaching Portal give timely support that complements pieces on workload, recovery and capability—helping members translate insight into everyday practice and progression.

A strong thread is the move from reactive casework to systemic

prevention. The rail sector’s rise in CVD referrals highlights the case for consistent screening and integrated health intelligence, while the shift to lead indicators strengthens OH’s organisational impact—both themes we’re amplifying in member learning and events. Clinical features deepen this: proprioception in sustainable return to work, digital fatigue in hybrid teams, and aeromedical fitness for frequent flyers and safety critical roles.

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Culture matters Articles on sickness absence and the “silent architecture” of organisational safety underline how compassionate, consistent leadership turns OH advice into action—exactly the behaviours we champion across iOH networks. The new EAP offering from PAM and their Wellness piece on personal pressures reinforces why round the clock support is so valuable.

Inclusion runs throughout This edition’s neurodiversity framework aligns with our RAML focus and was echoed at IGPP Manchester where Lucy Kenyon and Janet O’Neill showcased OH’s role in neuroinclusive, prevention focused workplaces—evidence of iOH’s growing national voice.

Finally, we will continue to enable practical change through our CPD partnerships.

Warmest wishes

Lynn Pratt, President iOH

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Introduction Neuroinclusion is not a charitable gesture but a strategic necessity.

As the first generation of formally diagnosed neurodivergent adults enter the workforce, organisations face growing pressure to support cognitive diversity through meaningful, structured strategies that create equitable, psychologically safe, and inclusive environments. Sniderman et al. (2023) note that students who were part of neuroinclusive

classrooms 10 to 20 years ago are now progressively joining the labour market.

The concept of neurodivergence, introduced by Australian sociologist Judy Singer in the 1990s, reframes conditions such as autism, ADHD, dyslexia, dyspraxia, dyscalculia, OCD (obsessive compulsive disorder), and Tourette’s syndrome as natural variations in how people think and process information. Despite representing 15–20% of the global

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population (World Metrics, 2025), neurodivergent individuals experience disproportionately poor employment outcomes.

In Ireland, only 32.6% of people with disabilities are employed, nearly twenty points below the EU average, while in the UK the rate is 53.1%, leaving a 28-point gap compared to non-disabled workers. Globally, unemployment among autistic adults exceeds 80%, and in the UK only around 30% are employed. (Disability federation Ireland, 2024; DWP, 2024; Disability Policy center, 2025) Recent findings from the Dublin City University Institute of Education indicate that around one quarter of employees in corporate settings are neurodivergent, based on a survey of more than 1,500 workers across three different organisations. The study shows that these employees either self identify as neurodivergent or have received a formal diagnosis (Gormley et al, 2026).

“Neurodivergent Employees in Ireland: Key Evidence from 1500 employees (DCU, 2026)” • 25% (1 in 4) of employees were found to be neurodivergent.

• 18.5% show significant depressive symptoms.

• Only 40% feel supported at work.

• 80% need accommodations, but only 25% request them.(All DCU findings.)

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Advancing Neurodiver

Recent Occupational Health data reinforce this disparity: A PAM Group analysis of 135,000 OH referrals (April 2024–March 2025) identified neurodivergence as the third leading reason for referral, following mental health and musculoskeletal conditions Personnel Today, 2025), highlighting rising diagnosis rates and persistent workplace challenges.

This qualitative research emerged from growing concerns within Occupational Health (OH) that organisations remain underprepared, lacking the capability to effectively support and leverage neurodivergent talent, a gap that threatens workforce resilience, retention, and innovation. Without adequate strategies, businesses risk losing access to a significant talent pool and undermining diversity-driven performance advances, while leaving individuals vulnerable to isolation, burnout, and career breakdown. Evidence suggests deficiencies in support at this phase, impacting the transition into the workforce, employment, and employee retention.

Kim et al, (2022) note that the merit of a neurodiverse workforce is acknowledged and gaining traction with employers, but the lack of support complicates the employment process and retention. A report by AsIAm and IrishJobs in 2023 found that 94% of employers believe that with the appropriate support, neurodiverse individuals can be valuable assets to any business or organisation. In a 2023 study conducted by Birkbeck’s UK Research Centre for Neurodiversity at Work, the research team surveyed 1,117 people, including 127 employers and 990 neurodivergent employees. It

reported remarkable capabilities and work strengths within the neurodivergent workforce, and employers agreed: over 80% reported hyperfocus, 78% creativity, 75% innovative thinking, 71% detail processing, and 64% of people being authentic at work.

(McDowall et al 2023).

The research investigations originated at the university-to-employment transition; as the research broadened, findings revealed systemic issues spanning all stages of employment. Semi-structured interviews across industry and academia stakeholders,

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rsity in the Workplace

including industry leaders, HR professionals, university access specialists, learning and development experts, and neurodivergent talent recruiters, produced thematic insights. Results highlight the benefits of neurodiverse workforces, including innovation, productivity, and team performance, yet persistent challenges remain around disclosure, recruitment bias, onboarding, progression, organisational-

environment and culture.

Drawing on these insights, the proposed seven-pillar Strategic Transition Framework (STF) spans • pre-employment collaboration, • inclusive recruitment, personalised support systems, • workplace adaptability, leadership engagement, • continuous improvement, and • integration within health, safety, and wellbeing strategies.

The framework positions neuroinclusion as a strategic asset central to talent retention, innovation, and corporate responsibility.

Research Question: The overarching research question to be answered was ‘What are the benefits, barriers, and best practices for

implementing a workplace transition program for neurodivergent employees transitioning to and within the workplace?’

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Advancing Neurodiver

Methods The research design implemented a qualitative methodology through interviews with

business and specialist stakeholders to explore how neurodivergent employees transition within the workplace. The research was based on a constructivist approach, using inductive reasoning to build understanding. Semi-structured interviews were conducted to explore organisational practices and challenges related to neurodivergent inclusion. Goal-directed sampling ensured a cross-sectional representation of business, neurodiverse organisations and perspectives. Participants were drawn from both industry and academia to capture a broad perspective on the university‑to‑employment transition and wider employment lifecycle. Stakeholders

included senior organisational leaders, HR professionals, university access specialists, learning and development experts, and recruiters specialising in neurodivergent talent.

Interviews were conducted using open questions to allow participants to elaborate on experiences, barriers, and strategies for inclusion. Data was collected until thematic saturation was achieved. All interviews were recorded, transcribed verbatim, and anonymised to ensure confidentiality.

Thematic analysis was applied to identify recurring patterns and insights, following Braun and Clarke’s six-step approach. Coding was repetitive and reflective, with themes refined through constant comparison and peer review to enhance validity.

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Findings The thematic analysis revealed three key areas in developing a strategic framework for supporting neurodivergent employees:

Benefits: • Stronger cross-functional communication through strategic thinking.

• Greater innovation driven by diverse perspectives.

• Improved collaboration and problem-solving.

• Overall increase in productivity.

Barriers: • Reluctance or fear around disclosure • Recruitment processes that are not tailored to neurodivergent needs • Inadequate or inconsistent onboarding experiences • Cultural resistance within organisations to change or adapt

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Advancing Neurodiver Effective strategies (best practice): • Early collaboration with universities to support neurodivergent students transitioning into work • Inclusive recruitment practices that reduce bias • Targeted training for managers to build awareness and confidence • Flexible work accommodations tailored to individual needs • Structured supports such as Employee Resource Groups (ERGs), to provide peer connection and advocacy.

Securing leadership commitment: The key to success The responsiveness of leadership teams is important for integrating neuroinclusion into the workplace, especially when reviewing strategic business blueprints for the future. Neuroinclusion may be dismissed as not essential or a “nice to have.” The impact on workplace innovation, creativity, and overall team performance must be emphasised as a direct correlation to business success (Kim et al., 2022; McDowall, et al 2023). These concerns can be conquered with a strategic mindset by preparing for the demanding situations that workplaces will come across in establishing a neuroinclusion shift in the workplace. (Davies et al, 2023, McDowall et el, 2023, Sniderman et al 2023, Stenn, T. et al. 2023).

Bias, stigma and disclosure Bias and lack of awareness of neurodiversity are a potential barrier when implementing a transition program. The lack of awareness and understanding from all members of an organisation would require support and education to increase knowledge and empathy and reduce discrimination, as it could impede the transition program's success. In the 2023 study conducted by Birkbeck’s UK Research Centre 65% of neurodivergent employees expressed fear of discrimination from management, while 55% were apprehensive about facing discrimination from their 14

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rsity in the Workplace colleagues. These results emphasise significant barriers and the need for greater awareness and support (McDowall et al., 2023). The program’s successful outcome would require acceptance and inclusion, otherwise any discrimination may limit opportunities for the graduates.

AsIAm and IrishJobs 2023 report highlighted that 6 in 10 autistic people are afraid to disclose their diagnosis in the workplace. In the findings of a UK study of 238 autistic individuals, Romualdez et al, (2021) report that the literature on disclosure shows mixed outcomes and rarely gives voice to autistic people. Conflicting with this argument Turnock, et al, (2022) identify that there is growing evidence that diagnostic disclosure can lead to more positive attitudes, more positive affective responses, and greater acceptance of inappropriate social behaviours, as well as reduced stigma.

Disclosure would enhance effective communication channels for employees as social interactions may be difficult for them, and team dynamics and workplace communication could also prove challenging. Flexible work arrangements and reasonable adjustments would be essential for neurodivergent employees and may be a barrier in each organisation business model.

A strategic transition framework for neurodivergent employees The fourth theme from the analysis of the research was recommendations, which directly informed STF development.

A structured approach to fostering inclusion, empowerment, and long-term success

for neurodivergent talent.

The framework offers a structured approach with seven pillars to span the entire employment lifecycle, from Corporate Social Responsibility (CSR), graduate transition, and pre-employment collaboration to continuous improvement.

Unlike existing approaches, this framework offers a scalable, strategic pathway for organisations to support neurodivergent employees across all career stages.

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Advancing Neurodiver

1. Foundation & CSR commitment Leadership buy-In: Establish clear organisational values around neurodiversity > leadership championing.

Policy integration: Embed neurodiversity into HR policies, diversity statements, and

strategic plans.

CSR & brand value: Align neuroinclusion with corporate social responsibility and employer branding.

2. Inclusive recruitment & onboarding Clear, bias-free job ads: Use inclusive language and avoid jargon that may deter neurodivergent applicants.

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rsity in the Workplace Alternative assessments: Provide options beyond traditional interviews, such as work trials or portfolios.

Disclosure-safe processes: Create safe environments for candidates to disclose neurodivergence.

Customised onboarding: Adapt onboarding processes to individual needs for

smoother transitions.

3. Pre-employment collaboration University partnerships: Collaborate with universities to identify and transition neurodivergent talent early.

Outreach & access programmes: Develop initiatives that improve visibility and access opportunities.

Tailored placements: Offer internships and mentorships designed to accommodate neurodivergent needs.

4. Personalised support systems OH needs-assessment: Conduct assessments to identify individual support requirements.

Individual transition plans: Develop tailored plans to guide employees through their early career stages.

Mentorship & peer networks: Connect neurodivergent employees with mentors and structured preceptorship programmes to support professional growth and confidence.

Referral pathways: Provide access to specialist services such as occupational therapy and neurodiversity consultants who avail of Work & Access supports & Grants.

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Advancing Neurodiver 5. Workplace adaptability Flexible work arrangements: Consider remote work, flexible hours, and autonomy where possible.

Sensory-friendly spaces: Design universal workspaces that reduce sensory overload and promote comfort for all.

Inclusive communication: Use clear, direct communication and provide information in multiple formats.

6. Career development & retention Manager & team training: Educate teams on neurodivergence and inclusive collaboration.

Career progression opportunities: Ensure neurodivergent employees have access to

growth pathways.

Feedback loops & employee resource groups (ERGs): Foster psychological safety establish feedback mechanisms and employee resource groups for ongoing support.

7. Continuous improvement & impact Data & metrics: Track pre- & post-engagement outcomes to measure success, participation & satisfaction.

KPI success: Retention, Promotion, Accommodation Fulfillment, Absenteeism Reduction •

Engagement: Training Participation, Neurodiversity Champions, ERG Growth, Inclusivity Initiatives

•

Satisfaction: Survey Scores, Psychological Safety Index, Response Rates, Anonymous Feedback.

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rsity in the Workplace • Review & Adaptation: Regularly update practices based on feedback and evolving needs.

• External Validation & Societal Change: Seek accreditation and contribute to broader inclusion efforts.

Conclusion Creating inclusive workplaces for neurodivergent employees requires more than isolated initiatives! It demands a sustained cultural and strategic shift. This research demonstrates that effective support must be embedded across organisational systems, with leadership commitment, inclusive recruitment, personalised adjustments, and continuous improvement at the core.

Dr Nancy Doyle’s work through Genius Within provides organisations with a platform of consultancy, coaching, and evidence-based tools to embed universal design into

HR and workplace systems, reducing reliance on disclosure and enabling neurodivergent employees to thrive. In Ireland, the new WIDE platform developed by AHEAD and Employers for Change offers a national, government-funded framework that employers can use to access evidence-based guidance and self -review tools.

These support them to implement and optimise inclusive recruitment pathways, workplace adjustments, and mentoring supports. While Genius Within operates as a practice-based consultancy model and WIDE functions as a systemic employment initiative, both give organisations structured platforms to strengthen neuroinclusion.

Together, they demonstrate how research-driven practice and national policy can align to create a continuum of support for neurodivergent employees across the employment lifecycle.

For OH professionals, the findings highlight both the risks of underprepared workplaces and the opportunities of structured neuroinclusion. OH plays a dual role: supporting individuals through confidential, person-centered assessments while also helping employers turn policy into practice. By guiding leadership, equipping

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Advancing Neurodiversity in the Workplace managers, and fostering psychologically safe environments, OH can ensure that neurodivergent employees feel understood and supported. In doing so, organisations not only protect wellbeing but also unlock resilience and innovation across their teams.

Ultimately, neuroinclusion is not a charitable gesture but a strategic necessity.

Companies that embrace universal design and integrate neurodiversity into their culture gain a competitive advantage, fuel creativity, and future-proof their workforce.

The challenge now is one of intent: will organisations lead proactively, embedding neuroinclusion into their systems, or remain reactive and risk losing access to a vital talent pool? The answer will shape not only workforce resilience but the future of innovation and organisational success.

Niamh Watson | Linkedin Niamh is an experienced occupational health nurse manager with 30 years of clinical, occupational health, acute, and critical care nursing experience. She has a proven track record in designing and managing comprehensive health programs across industries like medical devices, chemical manufacturing, FMCG, and distilleries. Her work across the UK and Ireland has resulted in high-impact initiatives that significantly enhance workplace safety and employee health.

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Proprioception at Work: The Invisible Sense That Shapes Safety, Performance, and Recovery

By Olawale Faleye

W

hen we talk about work-related health, the conversation usually centres on posture, ergonomics, workload, and fatigue. Yet there is a quieter system

underpinning all these factors, one that is rarely named but constantly at work.

That system is proprioception.

Proprioception is our body’s ability to sense position, movement, and force without conscious effort. It allows a person to know where their limbs are in space, how much effort to apply, and how to move efficiently without constantly watching themselves.

In the workplace, this “invisible sense” plays a critical role in safety, task performance, and injury resilience.

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Proprioception in Everyday

How Proprioception Becomes

Work Tasks

Compromised at Work

Most occupational tasks rely on proprioception more than we realise. A warehouse worker lifting a box, a nurse repositioning a

Several workplace-related factors can negatively affect proprioception: • Pain and injury: Pain alters

patient, an office worker reaching

sensory feedback. When a joint

repeatedly for a mouse, or a driver

or muscle is painful, the brain

coordinating foot pressure between

receives distorted information,

pedals, all of these depend on

reducing movement accuracy

accurate sensory feedback from

and control.

muscles, joints, and connective

• Fatigue: Prolonged physical or

tissue.

mental fatigue dulls sensory

When proprioception is functioning

awareness, increasing reaction

well, movements are smooth,

time and reducing coordination.

efficient, and well-coordinated. The

• Prolonged static postures: Long

body automatically adjusts to small

periods of sitting or standing

changes in load, speed, or surface

reduce joint movement and

without the worker needing to think

sensory input, leading to poorer

about it. This is what allows

body awareness over time.

experienced workers to perform tasks confidently and with minimal strain. However, when proprioception is reduced or disrupted, the body becomes less precise. Movements may feel clumsy, effort increases, and the

• Previous injury or surgery: Even after tissue healing, proprioceptive deficits can

persist, particularly around the spine, ankle, knee, and shoulder.

• Reduced physical conditioning:

risk of overload or injury rises, even

Low activity levels and

during routine tasks (Gianatti,

deconditioning weaken the

2019).

sensory-motor system needed for precise movement control.

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Importantly, a worker may appear

individual physically capable yet

“fit for duty” on paper while still

functionally vulnerable. This gap

operating with compromised

often explains why some

proprioception, especially in roles

employees “relapse” despite

that demand balance, precision, or

apparently successful

rapid responses.

rehabilitation.

Why Proprioception Matters

Supporting Proprioception

for Occupational Health

in the Workplace

From an occupational health (OH)

The good news is that

perspective, proprioception

proprioception is adaptable. With

influences three key areas:

the right approach, it can be

1. Injury risk

retrained and strengthened at any

Reduced proprioception increases the likelihood of slips, trips, manual

stage of working life (2015; Valdes et al, 2024, Winter et al, 2022).

handling injuries, and re-injury

Effective strategies include:

following return to work. The body

• Movement variability rather than

simply reacts more slowly and less accurately to unexpected demands.

prolonged static positions.

• Graded balance and

2. Task tolerance and confidence

coordination exercises as part of

Workers with poor proprioceptive

rehabilitation and conditioning.

awareness often report feeling

• Task-specific training that

unsure, stiff, or guarded in their

mirrors real work demands.

movements. This can reduce confidence, increase avoidance behaviours, and prolong recovery.

3. Sustainable return to work A return-to-work plan that restores

• Early movement exposure following injury, where appropriate, to restore sensory feedback.

• Education that helps workers

strength, but neglects

reconnect with body signals

proprioception may leave the

rather than overriding them.

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In office-based roles, this may be

Proprioception is the bridge between

as simple as regular posture

physical capacity and functional

changes and movement breaks. In

confidence at work. With supported

physically demanding roles, it may

proprioception, workers move better,

involve structured conditioning and

feel safer, and remain productive for

functional task rehearsal.

longer.

A Shift in How We Think About Work and the Body Proprioception reminds us that the body is not just a mechanical system needing correct positioning but a sensing system that must stay engaged and responsive.

When we ignore this, we may address symptoms without addressing the underlying cause of

repeated strain or injury.

For OH professionals, acknowledging proprioception adds depth to assessment, rehabilitation, and workplace design. It helps explain why two people can perform the same task with quite different outcomes and why recovery is not just about healing tissues but also about restoring trust and awareness within the body.

Olawale Faleye | Linkedin Olawale is a specialist

musculoskeletal and occupational health physiotherapist. Olawale helps people move better, feel stronger, and stay productive, whether that is in the clinic, the workplace, or everyday life. With years of experience across both NHS and private sectors, he

combines evidence-based rehab, acupuncture, and occupational health principles to support individuals and organisations in reducing pain, preventing injury, and optimising performance.

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Summary of “Occupational Health Referrals for Cardiovascular Disease in the Rail Industry” (RSSB, Oct 2025)

By Niamh McMahon

Introduction This discussion paper examines a recent rising trend of occupational health (OH) referrals for cardiovascular disease (CVD) within the UK rail industry. In January to

June 2025, 9.09% of OH referrals were due to cardiovascular disease. Drawing on benchmarking data from the Rail Safety and Standards Board’s (RSSB) Health Insights platform and input from biannual workshops, the paper explores potential contributory factors, current practices, emerging debates, and opportunities for improvement. The aim is to support more effective prevention and management of cardiovascular risk among rail workers.

CVD has become a growing focus for OH services in rail. This is set against a wider public health backdrop in which 7.6 million people in the UK live with heart or

circulatory conditions and where CVD remains a leading cause of death and economic burden.

It is worth noting that there was a different sample group in this round due to new

1

joiners submitting data and original pilot companies not being able to submit this round. This factor could be a contributor to the significant change observed.

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Background and Context Health Insights is the rail industry’s platform for recording and analysing health data, and the Health Insights Benchmarking workshops bring together representatives from

GB rail (train operating companies, infrastructure and supply chain organisations, and freight operators), to discuss health data trends and share best practice. The discussion on CVD referrals emerged due to recent increases in referral rates and concerns about under‑recognised cardiovascular risk in rail.

CVD covers a wide spectrum of conditions—including coronary heart disease, atrial fibrillation, heart failure, congenital heart disease, stroke, and heart attacks—many of which have subtle or asymptomatic onset, making early detection challenging.

The economic and societal consequences are significant: • Healthcare costs associated with CVD are estimated at £12 billion annually.

• The total economic impact—including premature death, disability, and informal care—is around £28 billion.

• Individuals with heart disease are more likely to leave the workforce, with a 22% exit rate, higher than for those with cancer or mental health conditions.

These trends reinforce the importance of proactive CVD management within safety critical‑critical industries like rail. ioh.org.uk

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Key Insights from

interventions and enhanced health

Benchmarking Discussions

monitoring for specific groups

1. Rising referral rates and affected groups An uptick in CVD referrals was noted in this round of reporting where several patterns emerged: • Ethnic minority employees: one organisation observed increased CVD referrals among Black, Asian, and Minority Ethnic (BAME) workers. This aligns with national evidence that some ethnic groups experience higher rates of hypertension, diabetes, and associated CVD risk.

within the workforce.

2. Potential contributory factors Several factors may be contributing to the observed increase in CVD referrals within rail.

Risk factors for CVD can be

prevalent among rail employees, where sedentary work, poor dietary habits, insufficient physical activity, chronic stress, and inadequate sleep collectively elevate the risk of hypertension, metabolic syndrome, and, ultimately, cardiovascular events. These modifiable risk

factors are well-established

• Younger employees: one

contributors to CVD and are often

organisation reported an

exacerbated by the structure and

increase in stroke cases among

demands of contemporary work

younger employees, highlighting

routines.

growing concerns about shifting epidemiological patterns.

National data verifies this trend,

with stroke rates among adults under 55 rising by 67% between 2002 and 2018, while rates among older adults declined.

Stress, which was mentioned during benchmarking discussions can also play a role in cardiovascular health

outcomes. Prolonged stress has been linked to increased blood pressure, elevated cortisol levels, and adverse cardiac outcomes. A

The patterns emerging from the

2024 study published by Harvard

Health Insights platform suggest a

Health further confirmed that

need for targeted health

individuals reporting work-related

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stress had significantly poorer

4. Variability in preventative and

cardiovascular health metrics.

investigative practice

These interrelated factors highlight

Approaches to CVD screening

the need for the industry to

varied widely across rail companies

consider a more holistic and

and include:

preventative approach to

• Service biometric screening

workplace cardiovascular health.

(e.g., proactive health

3. Surveillance and data

screening which enables

challenges

employees to voluntarily monitor

Barriers to accessing and collecting

biometric indicators such as

appropriate health data appear to

body mass index, blood pressure,

be hindering the effectiveness of

and QRisk scores)

CVD prevention and management

• Intensive screening models

strategies in rail workplace

which incorporate routine

settings. These barriers include:

electrocardiograms (ECGs) and

• Insufficient investigation into

cardiology referrals

this issue.

• limited proactive or preventative health monitoring.

• Inadequate data capture.

This lack of integration makes it

• Minimal referral activity where most cases are managed through temporary workplace adjustments.

5. Emerging debates

difficult to report in clear and

This benchmarking group

consistent ways and could limit the

discussion highlighted increasing

ability to identify emerging CVD

interest in GLP‑1 receptor agonists

risks at a population level. It could

such as semaglutide (Ozempic,

also undermine efforts to

Wegovy, Mounjaro), widely

implement targeted interventions.

publicised for their effectiveness in treating obesity and type 2 diabetes (both linked to CVD).

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Clinical trials show these drugs:

underscoring the need for early,

• Reduce cardiovascular events.

long-term data collection and

• Produce significant weight loss.

• Improve metabolic health.

However, there are wider concerns with these drugs including: • Lack of clarity around long-term safety remains remains

evaluation frameworks.

Implications and Challenges The rail industry appears to face several challenges in managing CVD risk through OH pathways.

1. Current lack of integrated data

uncertain.

• Effects may diminish when treatment stops.

• Access and cost are variable.

• They should supplement — not replace — lifestyle interventions.

NICE guidance echoes these concerns, emphasising that medication should be paired with long-term diet and physical activity programmes.

systems Poor integration across healthcare and OH limits the ability to track individual cases or identify emerging population level ‑level risk patterns.

2. Variation in OH practices across rail Differences in referral criteria and the consistency of health promotion efforts create an uneven landscape

Beyond medication, organisations reported modest gains from internal health promotion initiatives

for managing CVD risk.

3. Complex diagnosis pathways

and cardiovascular risk scoring

Establishing a direct link between

through tools like QRisk and

CVD, or indeed other health

SCORE2. However, it was

conditions, and occupational

acknowledged during

exposures is often difficult. This

benchmarking that measurable

challenge can delay appropriate

outcomes in relation to CVD may

interventions and complicate

take years to materialise,

decisions about fitness for duty in relation to CVD risk.

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4. Socioeconomic factors Employees may enter the industry

These measures should be

complemented by targeted

with existing CVD risk factors, such

interventions focusing on diet,

as hypertension or poor diet, or

physical activity, smoking

develop these during employment,

cessation, and stress management

which may not be identified or

to support uptake. These measures

addressed through standard health

should be complemented by

screening assessments.

targeted interventions focusing on

Together, these challenges highlight the opportunity for a more coordinated, standardised approach across the sector.

Step approach to tackling CVD risk in rail.

diet, physical activity, smoking cessation, and stress management to support long‑term cardiovascular health.

2. Support high risk ‑risk groups Prioritise support for high-risk groups, including senior managers

Four practical steps are proposed

experiencing high levels of stress,

below that could be used to tackle

BAME employees, and newly

CVD risk more effectively across

appointed shift-based staff, as

the rail industry:

evidenced in international research.

1. Improve health screening and

Use demographic segments from

promote healthy habits

RSSB’s Health Insights platform to

Introduce consistent checks for

support categorisation.

blood pressure, heart health, and

3. Review medication use

QRisk scores across the industry.

Monitor the use of drugs like

Data sharing across system health

Ozempic for obesity and diabetes

providers (i.e. NHS, consultants,

through trusted self-report systems.

and OH) would support earlier

Combine medication advice with

detection and suitable follow-up.

lifestyle advice to support longer

Portable health kiosks (e.g., SiSu)

term and sustainable impact to

can be used to facilitate regular

avoid over-reliance on these

health checks.

interventions. ioh.org.uk

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4. Collaborate across the industry Share data and best practice

Despite the availability of

screening tools and emerging

across the industry. Attend industry

pharmacological interventions, the

discussion forums to explore

effectiveness of current practices is

implications and challenges and

limited by fragmented data

share best practice with sector

systems, inconsistent referral

peers and other rail organisations.

protocols, and a current lack of

Additionally, insights and best

long-term outcome tracking.

practice from other sectors and OH

To respond effectively, the industry

can be brought into rail through

could look to strengthen screening

these forums.

frameworks, target high-risk groups with tailored interventions,

Conclusion

and promote preventative

CVD presents a growing challenge for the rail industry, reflecting both broader public health trends and sector-specific risk factors. The benchmarking insights gathered through the RSSB Health Insights platform underscore the opportunity to address CVD through a coordinated, evidencebased workplace health strategy.

Rising referral rates—particularly among senior managers, ethnic minority workers, and younger employees— highlight the complex interplay between lifestyle, psychosocial stressors, and workplace conditions.

interventions through integrated behavioural and clinical approaches.

This industry discussion highlighted that a shift in the management of such health conditions from reactive case management to proactive, system-wide prevention and early intervention may be needed. This would help ensure that cardiovascular health along with

other common chronic health conditions that affect rail employees become a core component of occupational wellbeing screening, promotion, and interventions in the rail industry.

36

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Read the complete paper here Niamh McMahon is a Senior Health and Wellbeing Specialist at RSSB. Follow Niamh on LinkedIn

ioh.org.uk

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37

By Cathy Bro

T

he recently published CIPD

There is clear evidence that work is

report (2025) indicates that

good for people (Waddell & Burton,

UK sickness absence rates

2006). Being in work is better for

are at their highest level for 15

health and wellbeing than being

years, with long-term mental health

out of work.

being a major contributing factor.

When looking at sickness absence

Current absence levels were

data and thinking about strategies

reported at an average of 9.4 days

for reduction, it must be

per employee, incurring significant

understood that not all sickness is

costs for employers.

avoidable. We are human, and humans will get sick from time to

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multifactorial reasons contributing

to people working when they are unwell (Kinman & Grant, 2025). Is it possible to bring down sickness absence rates without driving up presenteeism?

Absence Targets Many organisations use sickness

absence targets to support their absence management programmes, often with an arbitrary 3% figure as a target. It

ough

needs to be understood that this is a management tool and not a legal requirement. The 3% is a benchmark, often formed using

industry averages.

Within that average there will be different extremes. If someone has time. People who are recovering post-operatively or acutely unwell may be genuinely unable to work.

Data suggests that 78% of the

reported average number of UK sick days relate to short-term absence (CIPD, 2025) There is evidence that presenteeism is a significant cost to organisations in terms of loss of productivity (IPPR, 2024), with

a surgical procedure and needs even a conservative two-week recovery period, they will likely breach this. An individual with an underlying health condition may also breach a 3% target, whereas another individual may have no sickness absence at all.

Getting to the 3% marker shouldn’t be an automatic trigger for an occupational health (OH) referral, and any nominated target needs to ioh.org.uk

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39

be treated intelligently. While it can

indicator of workplace culture

be a useful tool to measure against

issues. Higher levels of sickness

and to facilitate supportive

absence in certain areas of a

conversations, it should not be

business might be evidence of a

punitive, and it should not become

systems issue there. Use of data

an administrative burden

can identify high-risk areas,

generating unnecessary

allowing leaders to identify

disciplinary hearings or OH

actionable insights and tackle

referrals.

culture issues. Effective people

Absence Management

management can be key in

Good absence management should

leadership should drive attendance

not be about pushing people back

rather than simply process absence.

to work before they are ready; it should be about:

absence management; effective

Stretched teams with tight margins and unrealistic workloads are likely

Removing barriers to people

to experience increased stress and

returning to work

be less resilient. If a team member

Using absence data and incident

takes genuine sick leave, stretched

reports to help inform prevention

teams may fall more quickly.

and action

With some long-term sickness,

Having a compassionate approach

especially relating to mental health

including return to work

or musculoskeletal problems, there

conversations

may be early signs of issues

Both the Health and Safety Executive (managing absence and disability) and NICE offer guidance

developing, such as ad hoc missed

days, signs of stress, or reduced function in comparison to usual.

on best practice in relation to

People who feel valued as part of a

managing sickness absence and

team are likely to be more

supporting people back to work.

committed and less likely to take

Sickness absence is not necessarily an isolated issue; it can be an 40

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unnecessary sick leave.

A strategy to reduce sickness

do they follow them sensitively

absence needs to be multifactorial

and consistently?

and include

Prevention: • Are workloads realistic and achievable?

• Are appropriate tools, equipment, and training provided to carry out required tasks?

• Is there good team morale?

• Do staff surveys indicate workers are happy in their work?

Access to Support: • Is there provision of early access treatment options, and do workers know how to access them? This may include access to mental health support (CBT /

counselling) or MSK support (physiotherapy) or even cashback health schemes or private medical insurance.

• Is there an agreed method and frequency of contact with

• Is it a good place to work?

someone when they are off sick

Early Intervention:

for more than a few days?

• Are people managers trained to spot early signs of someone struggling, and are they aware of available support resources to signpost workers to?

• Do people managers have adequate time in their job plans to manage effectively?

• Have people managers been trained to have sensitive and well -meaning conversations?

• Do people managers understand their organisation's policies, and

Access to Occupational Health: • Is this available and used appropriately?

• Is any referral discussed with the worker prior to being made?

• Is adequate information provided on the referral to help inform the consultation?

• Are relevant questions asked to support management of the worker?

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• Are workers supported in

attending the appointment?

• Is time made to go through the outcome report with the worker afterwards to discuss recommendations and adjustments?

• This can be compassionate while still business focused.

• Support adjustments when reasonable to do so.

• Develop policies and procedures

Return to Work: • Are compassionate return-towork conversations carried out to include: -

that reflect relevant laws.

• Have set business boundaries, including absence targets.

• Follow policy fairly and

• Asking how the worker is • Making sure they know they

consistently, even if this leads to dismissal.

• Keep robust records to spot

were missed.

• Asking if there is anything the employer can do to help • Assessing if the absence is possibly work-related • Assessing for any pattern to absences

trends.

To support a reduction of sickness absence, a holistic approach is needed, coupled with an investment in an organisation's culture, the development of people manager capability, and a clarity

• Ensuring robust documentation

of process. Sickness absence

to allow monitoring of absence

management should be

trends.

streamlined and efficient but also

• Putting in place any required support measures or adjustments

42

Effective management:

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effective and compassionate.

CathyBrough | Linkedin Cathy is a SCPHN Occupational Health Nurse with more than 25 years' experience across NHS and commercial organisations. Cathy currently works as Health Benefits Manager at John Lewis Partnership.

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

ioh.org.uk

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43

The Silent architecture

Of organisational safety: An Occupational Health perspective

O

ccupational Health (OH)

signals, the emotional

has always existed at the

infrastructure, and the everyday

intersection of safety,

leadership behaviours within

culture, and human experience.

organisations, that shape how staff

While the visible elements of an OH

experience work and health. It

service, immunisation clinics, health

influences whether they speak up

surveillance, case management,

about risk, disclose health

risk assessments, and policies and

conditions, feel psychologically

others form the outer structure, it is

protected, and trust the systems

the silent architecture beneath

designed to keep them safe and

these functions that truly

healthy at work.

determines whether an

In the NHS, one of the most

organisation is safe, inclusive, and

complex workforces in the world,

healthy.

this isn’t optional. It is the

This silent architecture consists of

foundation of effective

the unwritten norms, the cultural 44

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Occupational Health practice. If the

structure long before others do.

culture does not support openness,

They see:

fairness, and trust, even the best

• where culture suppresses

designed OH strategies will struggle to deliver impact. But when the culture is strong, Occupational Health becomes far more than a service it becomes a

incident reporting • where inequities influence sickness absence • where blame culture affects

driver of workforce resilience, safer

return-to-work conversations

care, and long-term organisational

• where staff do not feel confident

health.

This article explores the structural elements of organisational safety through an OH lens, highlighting what leaders, practitioners, and systems must understand to build safer, more equitable and effective workplaces.

1. Occupational Health: Where safety, culture and

raising safety concerns • where psychological safety is fragile • where governance frameworks exist “on paper only” • where lived experiences

contradict leadership narratives These insights are not always visible in dashboards or board papers, but they are embedded in

behaviour converge

the emotional and cultural

OH services are uniquely positioned

landscape of the workforce, and

within organisations. Unlike many

this is precisely where the silent

clinical services, OH does not

architecture becomes critical.

simply treat; it prevents. It does not

2. Safety begins where

only respond; it anticipates. It does not serve patients; it serves the entire workforce ecosystem.

Because of this, OH professionals see the gaps in the organisational

policy ends Policies, procedures, and SEQOHS standards provide an essential framework for OH, but they cannot create safety alone. Safety is an ioh.org.uk

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outcome of behaviour, not

Thus, the work of OH does not need

documentation.

to be only clinical but can also be

OH teams repeatedly encounter

cultural, looking at the space

this gap when policies say one

between policy and lived

thing, but practice reveals another:

experience and feeding insights

• A risk assessment is completed but never embedded.

• A vaccination policy exists, yet

3. Emotional Infrastructure: The real foundation of

uptake is low due to mistrust or

health at work

messaging failures.

Organisations invest heavily in

• A sickness absence policy

physical and digital infrastructure,

outlines supportive processes,

yet the greatest predictor of staff

but line managers default to

health outcomes is emotional

punitive approaches.

infrastructure, the psychological

• Equality data is collected, but inequity persists in disciplinary

and interpersonal environment that shapes everyday experience.

outcomes or return-to-work

For OH, emotional infrastructure

pathways.

determines:

The silent architecture is how leaders act, not what documents say, and it determines whether the policy is alive or static.

OH practitioners often serve as the early warning system. They recognise when the culture contradicts the written framework.

They feel the strain when staff do not feel psychologically safe to engage honestly in clinical OH

OH TODAY

• Whether staff disclose mental health challenges • Whether managers have compassionate conversations • Whether teams trust OH advice and recommendations • Whether individuals attend health surveillance “in good faith” • Whether staff feel safe reporting an incident or needlestick injury

consultations.

46

back to the organisation.

Volume 33 Issue 1

• Whether return-to-work plans

succeed or fail This infrastructure is formed quietly, through: • Relational leadership • Trauma-informed interactions

While inspections, compliance

checks, and audits are important, safety is constructed through leadership behaviour, not oversight.

Leaders in the NHS and across healthcare often operate under

• Transparent communication

immense pressure, but it is

• Fairness in processes

architecture, not inspection, that

• Visible care for staff wellbeing • Responsiveness to concerns • Cultural humility OH clinicians are acutely aware of how emotional infrastructure affects clinical outcomes. A

workforce that feels valued will seek support earlier, engage more openly, and recover, returning to work more quickly.

This is where OH holds organisational mirrors to leadership. Emotional safety must

defines the culture.

Great leaders enable Occupational Health influence. a. Design clarity Unclear expectations fuel anxiety, poor decision-making, and inconsistent management responses. When managers do not understand their role in attendance management, health surveillance, vaccination, or risk mitigation, this can compromise safety. b. Anticipate pressure points

be engineered intentionally brick

In organisations, winter pressures,

by brick through everyday

campaign cycles (flu, COVID-19),

leadership behaviours.

staff shortages, and rising caseload

4. Leadership as architects, not inspectors Leadership has a profound

complexity can be predicted.

Failure to plan for these predictable stressors leads to burnout, backlogs, and risk.

influence on organisational safety.

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c. Embed equity

conversations with suspicion rather

Leadership must ensure equitable

than support, recovery is delayed

access to OH services, fair

and trust erodes.

treatment in sickness and

Leaders who model respect,

disciplinary processes, and

curiosity, and fairness create the

unbiased return-to-work pathways.

conditions where OH advice can

Data repeatedly shows ethnicity

work. When leaders respond to

disparities in outcomes. Leaders

absence with inquiry rather than

must confront these patterns, not

blame, when they act consistently

explain them away.

on OH recommendations, and when

d. Model respect and

they treat wellbeing as part of

psychological safety

operational risk management

Staff watch closely how leaders respond to difficulty and to sickness absence, to errors, to

rather than a side issue, they strengthen both safety and performance.

complaints, and to challenging

Psychological safety is therefore

feedback. These moments shape

not "soft." It is a risk control

whether people feel safe to speak

mechanism. It determines whether

openly about their health,

hazards are surfaced early, whether

workload, and concerns.

reasonable adjustments are

For OH, psychological safety is not an abstract leadership concept. It directly affects clinical engagement and outcomes. When staff fear judgement or career consequences, they under-report stress, delay disclosing health conditions, minimise symptoms in OH consultations, or avoid attending health surveillance. When managers approach absence 48

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implemented properly, and whether return-to-work plans succeed. OH can advise and recommend, but leadership behaviour determines

whether those recommendations translate into safer working conditions.

5. The architecture of

that staff seldom share elsewhere.

silence in healthcare

When culture suppresses voice,

Silence is one of the most dangerous elements in healthcare culture, and OH sees it more clearly than most.

health deteriorates, and risk escalates.

A silent workforce is never a safe workforce!

Silence emerges when staff:

6. Data as a structural beam

• Fear judgement or consequence

in OH systems

• Believe nothing will change

Data is one of the strongest

• Have been dismissed previously • Experience discrimination or microaggressions • Feel they must “just cope” • Perceive OH as management’s

structural supports in modern OH practice. It enables: • Trend analysis • Risk identification

7. Conclusion: Turning

tool rather than an independent

insight into architecture

service

OH sits in a unique position within

This silence impacts everything

healthcare systems. It sees the

from incident reporting to mental

data, the patterns, the inequalities,

health disclosures to return-to-work

and the lived experiences that do

honesty. Silence is not passive; it is

not always appear in performance

structural. It is engineered by

reports. It hears what staff will not

culture, reinforced by power

say elsewhere.

dynamics, and sustained by a lack

The question for leaders is not

of psychological safety. OH plays a

whether this insight exists; it does.

pivotal role in identifying and

The question is whether they are

dismantling silence.

prepared to use it.

From staff surveys to casework notes to informal conversations, OH professionals hear the truth ioh.org.uk

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Leaders can strengthen

The silent architecture of

organisational safety by:

organisational safety is built daily

• Treating sickness absence as a

through behaviour, decisions, and

workforce capacity signal, not

culture. Occupational Health is not merely a service within that

just a cost pressure.

architecture; it is one of its

• Inviting OH into strategic conversations, not just case

structural beams.

When leaders tap into OH insight

management.

• Acting on patterns in health data, not waiting for crises.

and act on it, safety stops being performative and becomes structural.

• Modelling fairness, respect, and curiosity in everyday leadership moments.

Author: Nicola Bullen, Director, Occupational Health Liaison, iOH/ Deputy Chair, The NHS Health at Work Network/Associate Director, Occupational Health and Wellbeing, Nottingham University Hospitals NHS Trust.

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Are you looking for new job opportunities?

Occupational Health Staffing can help connect you with roles that match your skills, experience, and career goals. Whether you’re ready for a change or just starting out, they work with a wide range of industries and employers who are actively hiring. www.ohstaffing.co.uk info@ohstaffing.co.uk

020 8952 6278

Aeromedical Issues in the Workplace: An Occupational Health Perspective Dr Clare Hunter BSc MB BS DAvMed MRAeS MRCGP DOccMed

Introduction Air travel is now a routine part of working life for many employees, including business travellers, offshore and maritime workers. Aeromedical issues also apply to those working in the aviation sector and those involved in drone and remotely piloted aircraft operations. Occupational health (OH) professionals may be asked to advise on fitness to fly, manage health risks associated with air travel, and assess workers whose roles have aviation safety implications.

While aviation medicine is a specialist field, many of its principles overlap with core OH practice. A working understanding of the physiological, psychological, and regulatory aspects of flight can help OH clinicians provide clearer, safer, and more consistent advice. This article outlines key aeromedical issues relevant to occupational health.

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-specific and journey-specific,

taking into account flight duration, aircraft type, altitude exposure, and lack of access to medical support.

Physical Hazards of Air Travel Commercial air travel exposes

individuals to reduced barometric pressure, vibration, noise, cold, and relative immobility. Pressure changes may cause sinus, middle ear, or dental issues.

Relative immobility, particularly on

What Does “Fit to Fly”

flights longer than four hours, is

Mean?

associated with an increased risk of

The term fit to fly is often used imprecisely. It may refer to fitness to travel by air as a passenger, or fitness to perform a specific role during flight, such as pilot, cabin crew member, or air traffic

controller.

These meanings are not interchangeable. An individual may be fit to fly as a passenger but not fit to undertake aviation duties. OH advice should therefore be role

venous thromboembolism (VTE), estimated at approximately 1 in 6,000 passengers. Risk mitigation includes regular movement. There is no evidence to support routine aspirin use for travel-related thromboprophylaxis. Compression stockings or anticoagulation may be appropriate in selected higherrisk individuals following specialist haematology assessment (NB overthe-counter compression stockings are not the same as surgical compression stockings).

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Figure 1 Physiological Effects of

alveolar and arterial oxygen

Altitude

tension.

At sea level, atmospheric air contains approximately 21% oxygen, but oxygen delivery depends on the partial pressure of oxygen, which decreases with altitude as barometric pressure falls.

Commercial aircraft cabins are pressurised to the equivalent of around 6,000–8,000 feet.

Although oxygen concentration remains unchanged, reduced partial pressure leads to lower 54

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Healthy individuals compensate through increased ventilation and cardiac output.

Those with respiratory or cardiovascular disease, anaemia, or reduced physiological reserve may have limited compensatory capacity. Symptoms of altitude-related hypoxia include dyspnoea, fatigue, headache, impaired concentration, impaired colour vision and even collapse.

The oxygen–haemoglobin

can significantly affect

dissociation curve, see Figure

survivability. Conditions

1, explains why small

impairing cardiorespiratory

reductions in oxygen pressure

reserve, cognition, vision, or

at cabin altitude can cause

mobility may therefore be

clinically significant

relevant not only for routine

desaturation in susceptible

travel but also for emergency

individuals. Those with pre-

scenarios.

existing hypoxaemia may

Cosmic Radiation

operate on the steeper portion of the curve, where small pressure changes lead to disproportionate falls in oxygen saturation. This underpins the need for careful clinical assessment and, in some cases, in-flight supplemental oxygen, guided by specialist advice such as

Exposure to cosmic ionising radiation increases with altitude, latitude, aircraft type, and flight duration. A transatlantic flight delivers approximately 0.08 mSv, compared with an average UK

annual background dose of around 2.7 mSv.

the British Thoracic Society

Under the Ionising Radiation

guidance on air travel

Regulations 2017, workers

https://www.brit-

exposed to radiation in the

thoracic.org.uk/quality-

course of their duties require

improvement/clinical-

appropriate risk mitigation,

statements/air-travel/

with particular consideration

Altitude physiology also intersects with emergency egress. Rare evacuation events demonstrate that smoke exposure, cognitive impairment, limited mobility and normal human behaviour

for pregnant workers. For occasional business travellers, exposure is small, but OH professionals advising frequent flyers should be aware of cumulative exposure and regulatory responsibilities.

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Biological and Chemical

crossed. Daylight exposure

Hazards

and sleep scheduling are key

Aircraft cabins are enclosed environments, raising potential concerns about airborne infection transmission. Modern ventilation systems are highly

management strategies.

Melatonin may benefit some individuals but is not licensed in the UK. Flying-Related Anxiety

effective, and infection risk is

Flying anxiety ranges from

best managed using standard

mild anxiety to true phobia.

public health principles.

Common fears include

Hypoxia remains the principal chemical hazard of flight. The concept of aerotoxic syndrome is occasionally raised but remains controversial, with limited supporting evidence.

Psychological Hazards

crashing, confinement, loss of control, and the unknown.

Management may include behavioural strategies or fearof-flying courses.

Benzodiazepines are generally

not recommended due to impaired reaction time, paradoxical effects,

Jet Lag Jet lag results from circadian rhythm disruption and commonly presents with

interaction with alcohol, and reduced ability to respond in emergencies.

insomnia, fatigue,

Medical Support in

gastrointestinal disturbance,

Flight

and impaired cognitive performance. Westward travel is generally better tolerated than eastward travel, with recovery taking approximately 1–1.5 days per time zone

Commercial aircraft carry Emergency First Aid Kits for cabin crew use and Emergency Medical Kits, which may be opened only with the captain’s authority and are intended for use by medical professionals.

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Equipment and medications

employers on travel planning

are limited and vary by

for employees with complex

regulator/operator/aircraft.

medical conditions.

Most airlines have access to

Regulatory Medicine

ground-based medical

and Occupational Roles

advisory services, such as MedAire or MedLink, providing real-time advice and guidance on diversion decisions. In-flight medical care should not be equated with hospital-level support.

In-Flight Incapacitation and Medical Diversions Despite preventive measures, in-flight incapacitation can occur. Screening opportunities include pre-flight medical declarations and informal observation at check-in or boarding.

Medical diversion decisions are made by the aircraft captain,

informed by medical advice.

Considerations include the suitability of diversion airfields,

Aviation medicine is regulated by bodies including the UK Civil Aviation Authority (CAA),

EASA, ICAO, and IATA, underpinned by UK legislation such as the Air Navigation

Order 2016 and UK Part-MED regulations.

Pilots and Air Traffic Controllers Medical certification is regulated by the CAA and undertaken by approved Aeromedical Examiners (AMEs). Applicants are considered unfit until evidence demonstrates the required standard is met, reflecting the

very low acceptable risk of incapacitation.

availability of medical

Cabin Crew

facilities, aircraft performance

Cabin crew medical standards

limitations, and fuel

are regulated by the CAA and

management. These factors

may be assessed by AMEs or

may be relevant when advising ioh.org.uk

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authorised occupational

in policy development. A practical

health medical practitioners.

understanding of aviation-related

Standards are broadly

hazards and regulatory frameworks

comparable to DVLA Group 1,

can enhance the quality and safety

with a higher acceptable

of OH advice.

incapacitation rate due to team-based working.

Drone Operators Medical requirements for drone operators are outlined within CAA CAP 722 https://

www.caa.co.uk/data-andpublications/publications/ documents/content/cap-722/.

These emphasise fitness principles similar to those

applied to driving and represent an expanding area of OH practice.

Conclusion Aeromedical issues intersect with occupational health more frequently than is often

recognised. While specialist aeromedical assessments remain the responsibility of those with the appropriate skills, OH professionals play a key role in advising on fitness to fly, managing travel-related risk, and supporting employers 58

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Dr Clare Hunter is an occupational physician with experience across military maritime and aviation, commercial aviation, the NHS, and local authority sectors. A former GP and CAA Authorised Medical Examiner, she now works as an independent practitioner and part-time with EOPH. She holds the Diploma in Aviation Medicine and is currently undertaking an MSc in Organisational Psychology, with an interest in human factors and safety-critical work.

Managing Work and Personal Pressures

By David Umpleby, Managing Director PAM Wellness

I

n today’s fast-paced world,

managers, the challenge is not

the boundary between work

simply “work-life balance” but

and personal life is

navigating a complex ecosystem of

increasingly blurred. Technology

responsibilities, relationships, and

keeps us connected 24/7,

expectations. When problems arise

workplaces often expect high

at home, the effects often spill into

performance under pressure, and

the workplace, influencing

our home lives are full of emotional,

performance, wellbeing, and team

logistical, and relational demands.

dynamics. It is tough to “leave

For many employees and their

problems at the door.” In a fast-

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paced world, the boundary

impact concentration, decision-

between work and personal life is

making, and the ability to manage

increasingly blurred. Technology

complexity, critical skills in most

keeps us connected to life balance,

roles. In the case of older

but navigating a complex

generations in the workforce, they

ecosystem of responsibilities,

are often dealing with all these

relationships, and expectations.

things at the same time, the so-

When problems arise at home, the

called “sandwich generation,”

effects often spill into the

making the ability to manage

workplace, influencing

complexity a critical skill in most

performance, wellbeing, and team

roles.

dynamics.

Relationships are deeply

Understanding these challenges is

intertwined with emotional

the first step toward building

wellbeing. When relationships

healthier teams and more resilient

become strained through conflict,

organisations. PAM’s work with

communication breakdowns,

clients suggests there are several

separation, or divorce, employees

drivers for personal stress that

can experience heightened anxiety,

employers and managers should be

sleep disruption, and reduced

aware of:

resilience. These emotional

Families can be a major source of

pressures follow people into the

emotional support, but they can

workplace, even when they are

also be a significant source of

trying to compartmentalise. For

stress. Issues such as caring for

managers, understanding that

parents, financial pressures, or

emotional stress is not something

navigating family conflict can

an employee can simply “switch

create an ongoing mental load.

off” is essential to providing

When these stressors accumulate,

support.

it becomes harder for employees to

Parenting is rewarding, but it is

maintain focus and energy at work.

also demanding, unpredictable,

Emotional fatigue will certainly

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and often exhausting. Illness,

work. The reality, though, is stress is

behavioural issues, school

not just an emotional state; it has

pressures, childcare problems, and

physiological effects that directly

the constant juggle of schedules

influence cognitive function. When

can create chronic stress. A recent

individuals are worried or

study by the pan-European

distressed, the brain allocates

campaign group Make Mothers

energy to emotional regulation

Matter found that 71% of UK

rather than higher-order thinking.

mothers feel overloaded, 47%

This can manifest as forgetfulness,

suffer from mental health issues,

difficulty concentrating, slower

and 31% feel motherhood has a

problem-solving, and poorer

negative effect on their careers. I

decision-making.

imagine the outcomes for dads are equally stark.

When employees are struggling personally, their mental bandwidth

Many parents feel guilty on both

decreases. Tasks take longer,

sides, worrying they are not present

mistakes become more frequent,

enough at home while also fearing

and creative thinking suffers.

they are not performing optimally

Employees who normally contribute

at work. This dual pressure can lead

ideas and energy may become

to burnout, distraction, and a sense

withdrawn or disengaged. In

of overwhelm. More recently we are

extreme cases, personal stress can

seeing an increasing number of

lead to absenteeism or

issues from parents who are

presenteeism. Physically present

struggling to manage work

but mentally distant.

alongside children who have behavioural issues.

Emotional stress often makes people more sensitive, reactive, or

During a recent PAM webinar on

withdrawn. Employees dealing with

this issue, a comment surfaced that

turmoil at home may have less

suggested we should keep work

patience, be more prone to conflict,

and personal lives separate. We

or communicate less effectively.

should not raise these issues at

This can affect team cohesion and

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collaboration, sometimes creating

overload and create space to

tensions that have nothing to do

recover emotionally. This is

with the work itself.

particularly important for some

Chronic personal stress combined

neurodivergent colleagues.

with workplace pressure

Seek support early. Talking to a

significantly increases the risk of

trusted colleague, a manager, or an

burnout. The body can only operate

HR representative can make a

in a heightened stress state for so

significant difference. PAM offers

long before physical symptoms

an Employee Assistance

begin to surface, such as

Programme (EAP) as well as

exhaustion, headaches, illness, and

counselling resources and wellbeing

sleep disruptions. Left

platforms. Often EAPs are seen as a

unaddressed, these issues

last resort, but using these services

compound and can result in long-

early helps prevent problems from

term leave or decreased job

escalating, often to a point where

satisfaction. I wonder how often

they are more difficult to treat.

managers have been quick to flag

Practice self-care. Sleep, exercise,

underperformance without thinking

healthy eating, and time for

to connect it to any or all the above

hobbies are not luxuries, they are

In terms of how to best manage

fundamental to emotional

this, there is not, sadly, a silver

resilience. Employees often

bullet, but there are things that we

deprioritise these activities during

can consider making lives easier.

personal crises, but doing so only

Set healthier boundaries. It is

deepens stress. Even small,

important for employees to define

consistent habits can help rebuild

personal boundaries both at home

stability and mental clarity.

and at work. That may include

Communicate openly. Employees

limiting after-hours work, creating

do not need to share personal

quiet time for family or rest, or

details but letting managers know

communicating availability more

that they are experiencing a period

clearly. Boundaries help reduce

of increased stress can create room

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for understanding. Simple

conversations, and wellbeing

adjustments, such as flexible hours,

awareness can make a profound

redistributed tasks, or temporary

difference.

workload reductions, can relieve

Offer flexibility where possible.

immediate pressure.

Flexible schedules, remote work

What managers can do to

options, and autonomy over

support their teams

workload can dramatically improve

Foster a culture of psychological

safety. When employees feel safe to raise concerns, share challenges, or admit when they are struggling, it creates an environment where problems can be addressed early.

Managers who listen with empathy and without judgment build trust that pays dividends when stressful

situations arise. Moreover, leaders who openly share their own concerns will give others permission to do the same.

Train leaders in emotional awareness. Managers do not need to be therapists, but they do need emotional intelligence. Recognising signs of stress, including withdrawal, irritability, fatigue, and missed deadlines, enables managers to intervene constructively before performance

an employee’s ability to manage personal challenges. When flexibility is built into team culture, employees feel empowered to balance home responsibilities without compromising professionalism. Work options and autonomy over workload can dramatically improve an employee’s ability to manage personal challenges.

Promote fair workloads and realistic expectations. During times of personal strain, even high performers may need temporary adjustments. Managers can redistribute tasks, extend

deadlines, or prioritise essential work to prevent burnout. This approach not only supports the individual but also protects team performance in the long term.

deteriorates. Training in active listening, compassionate ioh.org.uk

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65

Encourage use of support

needs and care for their wellbeing.

resources. Many employees do not

Managers and organisations, in

use wellbeing programs because

turn, have a responsibility to build

they are unsure what’s available or

cultures where people can thrive

are uncomfortable seeking help.

even when life outside the office

Managers who openly champion

becomes challenging.

these resources and normalise their

By promoting openness, flexibility,

use help break down stigma and

and emotional awareness,

encourage healthier habits.

organisations can create

Work and personal life will always

workplaces where people feel

influence each other. The key is not

supported as whole human beings.

to eliminate this overlap but to

In doing so, they not only protect

understand it, acknowledge it, and

performance and productivity but

manage it with compassion and

also help individuals navigate some

clarity. Employees have a

of life’s most stressful moments

responsibility to communicate their

with confidence and resilience.

David Umpleby | Linkedin David is a member of the Institute of Employability Professionals and chair of the Board of Trustees for Unity Works Social Enterprises as well as managing director at PAM Wellness. He is a senior leader with broad experience developing and leading skills and employability operations across DWP, DfE, and EFA.

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Work-SM Physical Pain, Role Demands, an early yea

By Dr Alist 68

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MARTey: nd the overlooked need in the UK ars sector

tair Turvill ioh.org.uk

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Work-SMARTey: Physical Pain, Role Demands, and

T

hose working in the

robust evidence base is the

field of Occupational

essential foundation upon

Health (OH) know that

which change and

workplace challenges are

improvement are built.

highly diverse, shifting

This article is the first in a

according to the role, the

series telling the story of the

environment, and the

‘Work-SMARTey’ (Supporting

individual.

Musculoskeletal Awareness,

Consequently, creating

Research and Training, in the

effective, positive change for

Early Years) project. It

workers and organisations can

describes one such example of

be an often a complicated

considerable workplace risk

task.

that is both widely overlooked

In some cases, occupational hazards are well understood, surveilled, and managed. This attention can reduce risk of injury and improve outcomes such as workforce attendance, productivity, and retention.

However, many other risks do not receive the same degree of

and misunderstood -

musculos

(MSD’s) in the Early Years

(MSP) are

sector. Demonstrating how

leading

discernible risks are often

disability

‘hiding in plain sight’, adding significant harm and contributing to wider systemic issues in the workplace.

The scale and burden of

Moore’s ‘Knowledge to Action’

musculoskeletal

disparity stating that: before

disorders

effective action can occur,

Musculoskeletal disorders

knowledge must first be

(MSDs) and musculoskeletal

developed and synthesised. A

pain (MSP) are among the

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disorders

Musculoskeletal Disorders

awareness or intervention. theory (2018) helps explain this

Muscul

d the overlooked need in the UK early years sector

loskeletal

s (MSDs) and

skeletal pain

leading causes of disability

largest single contributing

worldwide, with an estimated

factors in the development of

1.7 billion people living with

MSDs (WHO & ILO, 2021).

these conditions (Cieza et al.,

Concurrently, work-related

2021). Low back pain alone

MSP has predominantly been

accounts for nearly half a

approached from a

billion cases, representing the

biomechanical perspective,

single largest contributor to

identifying physical load and

years lived with disability in

tissue strain as the primary

many nations (Vos et al.,

drivers of pain and injury

2020).

(Pomarensky et al., 2021).

In the workplace, MSDs remain the primary health challenge, accounting for

approximately 60% of OH

e among the

complaints across the EU (EU-

g causes of

OSHA, 2019). Closer to home,

y worldwide

work-related MSDs in the UK affect around 543,000 workers annually, leading to 7.8 million lost working days (HSE, 2024).

When broader musculoskeletal conditions are included, this figure rises to nearly 30 million days lost (Public Health England, 2020; NHS England, 2024). Global data shows ergonomic risks in the workplace to be one of the

Consequently, workplace regulations and guidance tend to focus on acute, visible risks

(such as heavy manual handling, falls from height, or machinery operation) and on task-specific standards designed to prevent ‘catastrophic’ harm (HSE, 2024) These are important measures that have been

crucial in reducing serious traumatic injuries. However, the risks posed to workers by smaller but more common and frequent injuries can also be the cause of considerable strain, physical demand and

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Work-SMARTey: Physical Pain, Role Demands, and injury. Particularly in cases

The UK Early Years

where individuals are routinely

sector

required to work in ergonomically challenging positions or environments. Yet these risks are not given the same oversight and guidance.

These figures underscore the immense impact MSDs and MSP have on an individual’s ability to work and participate fully in daily life. Beyond the personal toll, they are a major driver of work limitation,

reduced labour market participation, and substantial economic cost (Public Health England, 2020; House of Commons Library, 2024). It is accurate to say these data present a stark picture of the problems and challenges

faced, but they also offer a clear and realisable opportunity to improve the working lives of millions.

Exposure to small physical demands such as those mentioned above is routine in Early Years education, where the role demands physical closeness, responsiveness, and interaction at the child’s level (Department for Education, 2025). Research into the daily reality of nursery and childcare workers highlights a pattern of frequent lifting, working at low tables or on the floor, repeated kneeling, stooping, and twisting, often within cramped spaces designed for children rather than adults (Grant et al., 1995; Tsuboi et al., 2002; Shi et al., 2022). The health risks associated with repeated exposure to these cumulative demands are well established (da Costa & Vieira, 2010).

International research supports this, reporting widespread MSP, particularly

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Kindergarten staff reported of low back, n and arm pain staff workin child

d the overlooked need in the UK early years sector

n and nursery d higher rates neck, shoulder, n compared to ng with older dren

among those working with the

associated with frequent

youngest children. A US study

lifting, high workload, and

found that 61% of Early

poor working conditions,

Childhood Education workers

further underlining the

reported back pain linked to

cumulative nature of the risk.

awkward or heavy lifting and

In the UK, anecdotal reports

static postures (Grant et al.,

of work-related pain are

1995). Notably, staff caring for

commonplace among

infants (six weeks to 18

practitioners. However, at the

months) performed more

inception of this project, it

lifting and adopted more

became apparent that no

awkward postures than those

independent research had

working with older children (3–

specifically investigated the

4 years). Although small in

scale and nature of this

scale, this study highlighted

problem in the UK Early Years

clear physical strains and the

population. The closest

urgent need for environmental

available measure was the

and occupational change.

Labour Force Survey (LFS) for

Larger studies from Japan

Education workers in England

mirror these findings.

and Wales which reported an

Kindergarten and nursery

MSD incidence rate of just

staff reported higher rates of

0.9% (HSE, 2022). Compared to

low back, neck, shoulder, and

the global data reported

arm pain compared to staff

above, this number appeared

working with older children,

strikingly low. Closer

with the highest prevalence

inspection of the LFS

again found among infant

methodology helped explain

caregivers (Tsuboi et al., 2002;

this discrepancy: the survey

Ono, 2002). Here, pain was

only records cases where an

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Work-SMARTey: Physical Pain, Role Demands, and individual formally takes sick

The study design also allowed

leave due to an MSD. It fails to

for key comparisons between

capture the incidence of

those in leadership or

actual health events and the

management positions and

reality of "presenteeism" (staff

those in primarily ‘practitioner’

continuing to work while

roles. Furthermore, the

managing significant pain).

application of regression

Without accurate data, the

analyses enabled the work to

problem remains invisible, and

identify specific factors that

the path to addressing it

predict an increased likelihood

remains obscured. The Work

of MSDs.

SMARTey project set out to

A cohort of 196 Early Years

begin addressing this blind

practitioners and leaders was

spot and begin developing a

recruited from across the UK

foundation of knowledge upon

and invited to complete an

which change and

online questionnaire. This

improvement might be built.

survey explored their work-

Project Approach:

related pain experiences, their

Over the following months, the team designed and delivered the UK’s first empirical study into work-related MSP in the Early Years sector. Beyond simply establishing prevalence, this study gathered detailed measures on pain severity, frequency, duration, onset, and crucially 'bothersomeness'.

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specific daily duties, and the link between their roles and their work-related MSP. We also investigated the wider

professional impact of MSP, asking participants about sick leave, reporting procedures, and whether pain had led them to consider leaving the sector entirely.

d the overlooked need in the UK early years sector Project findings: Our analysis of the findings revealed a situation more severe and widespread than we had anticipated. A staggering 98% of participants

reported experiencing workrelated pain, with the lower back being the most common site (89%). This was not fleeting discomfort; for most, the pain had a long history (onset >12 months ago), recurring on average every 7– 14 days, with episodes lasting on average 1–2 weeks.

Regression analysis provided further insight: frequent exposure to physically demanding tasks significantly predicted both higher pain frequency and earlier onset.

Notably, we found that the longer an individual works in the Early Years sector, the greater the number of painful body locations they report.

Crucially, this finding was independent of the

practitioner’s age; while older participants did report longer durations of pain events, the data showed that the spread of pain across the body was associated with job demands, not by aging.

Finally, while leaders and practitioners both reported performing high-risk musculoskeletal activities at similar frequencies, their perceptions of workplace safety differ. Practitioners

expressed a strong need for greater protective measures.

In contrast, leaders who possess more years of service (median 22 years vs. 18) were more likely to believe adequate safety resources are already available.

The occupational impact of this is profound.

Unsurprisingly, intense pain and high-risk activities (such as lifting, stooping, or working at floor level) were identified as major drivers of sickness

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Work-SMARTey: Physical Pain, Role Demands, and absence. Furthermore, and

sector, the data suggests that

particularly worrying for the

generic manual handling training

sector, the combination of

is insufficient. Instead,

frequent, bothersome pain and a

interventions must be sector-

perceived lack of protective

specific, acknowledging the

action from employers emerged

unique ergonomic reality of the

as a significant factor in staff

Early Years environment where

considering leaving the profession

working at low heights and lifting

entirely.

moving children are unavoidable

In sum, the results provided a

tasks.

clear and strong indication of

To reduce the burden of MSDs,

what many had already known.

the sector requires a

There exists a significant and

"prehabilitative" approach,

unmet need for many working in

shifting focus from reactive

the Early Years sector regarding

management of injury to

the risks faced and harm

proactive prevention. This relies

associated with the demands of

on development in several key

their roles and working

areas:

environments. For the first time in the UK, we had robust data to back up those suspicions.

Standard assessments are illsuited for nursery settings. We

Recommendations and

need protocols that specifically

actions

evaluate "low-height working"

The findings from the quantitative phase of the ‘Work-SMARTey’ project provide a clear mandate

76

• Tailored Risk Assessment:

and tasks such as floor-based play.

• Ergonomic Investment:

for change. For Occupational

Providing ergonomically

Therapists (OTs) supporting this

congruent supports and

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d the overlooked need in the UK early years sector furniture for adults (such as low

may have attracted individuals

-height stools with lumbar

with more pain experiences.

support) can significantly

Finally, the sample was

reduce the cumulative strain of

predominantly female (97%),

static postures.

although it is also fair to say that

• Leadership Education:

Our data indicated a discrepancy between the

this accurately reflects the gender

composition of the UK Early Years workforce.

support leaders believed they

What questions remained

provided and the protection

While this study successfully

practitioners felt they received.

indicated the scale of the problem,

Closing this gap requires

wider questions remained

training leaders to recognise

regarding other aspects of the

the early warning signs of MSDs

nature of this phenomenon.

and to foster a culture where reporting pain is encouraged, not stigmatised.

Crucially, the data highlighted a paradox: despite very high levels of pain reported, sickness absence

Study Limitations

rates remained relatively low. This

As is essential in all research, it is

may suggest a high degree of

important to acknowledge the

"presenteeism," where staff

limitations of this study. As a cross

continue to work through the pain.

-sectional survey, it provides a

Why do skilled educators remain in

snapshot of the workforce at a

roles that are physically breaking

single point in time, meaning we

them? Why do so many choose not

cannot yet causally link specific

to report their pain to

tasks to the development of pain

management? And how does the

over time (only report their strong

"culture" of a nursery setting

association). Additionally, the

influence an individual’s decision

sample was self-selected, which ioh.org.uk

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Work-SMARTey: Physical Pain, Role Demands, and the overlooked need in the UK early years sector to seek help or suffer in silence? To answer these questions, we must look beyond the statistics and listen to the lived experiences of the workforce. In the next article in this series, we will explore the qualitative study and findings of the ‘Work-SMARTey’ project, uncovering the "safety silence" that pervades the sector and the human

stories behind the numbers.

You can find a full, open-source copy of the published academic report described in this article by searching for the following reference: Turvill, A. J., Sheffield, D., & Taylor, L. (2024). Musculoskeletal pain and working practices in the UK early childhood education workforce. Safety Science, 178, 106592. https://doi.org/10.1016/j.ssci.2024.106592

If you would like a fully copy of the reference list for this article, please email the author directly at AlistairTurvill@ResearchWell.co.uk Following 13 years as a Senior Academic leading curriculum development for health and research-focused provision across a range of programmes at the University of Derby, Dr. Alistair Turvill now specialises in the synthesis and application of data through empirical and secondary investigation at the research consultancy he founded, Research Well, offering expertise within the health and education sectors.

Work SMARTey is a multi-partner project that includes the University of Derby, The Early Years Alliance, The National Education Union, and Jolly Back, with contribution and support also offered from the UK Health and Safety Executive.

For more information or if you have any questions about Work SMARTey, visit www.researchwell.co.uk.

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Digital Fatigue: The occupational health implications of prolonged screen time and virtual work.

D

By Dr Riya John igital fatigue is evolving

screen-based tools. While these

as a crucial occupational

changes offer flexibility and

health concern, with

efficiency, they also introduce a

persistent screen time and virtual

growing occupational health

work contributing to physical,

challenge. The term “digital

cognitive, and emotional strain.

fatigue” encompasses various

This article explores its

dimensions, including mental

implications, underlying

exhaustion, reduced productivity,

mechanisms, and strategies for

and physical strain due to

mitigation, grounded in recent

prolonged screen time and

research.

constant connectivity. In recent

The digital transformation of the

years, remote work and hybrid

workplace has enhanced

work models have exacerbated this

dramatically in recent years, driven

phenomenon, as employees are

by remote work, virtual

increasingly expected to manage

collaboration, and the ubiquity of

multiple digital communication channels (Supriyadi T, 2025). ioh.org.uk

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Understanding digital fatigue Digital fatigue is not merely a subjective feeling of tiredness, it incorporates a collection of symptoms including eye strain, headaches, irritability, reduced

attention span, and sleep disturbances (Paigude, 2024). It arises from continuous engagement with screens, multitasking across digital platforms, and the cognitive load of processing vast amounts of information.

Key contributors include: • Blue light exposure from screens, which disrupts circadian rhythms and contributes to sleep issues.

• Lack of physical movement, as virtual work often reduces opportunities for walking, stretching, or changing posture.

• Cognitive overload, due to constant

notifications, multitasking, and virtual meetings.

• Social isolation, which can exacerbate stress and reduce emotional resilience.

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Occupational Health Implications 1. Visual and Musculoskeletal Strain Prolonged screen use is associated with Computer Vision Syndrome (CVS), characterized by dry eyes, blurred vision, and neck or shoulder pain (Acosta, 2024).

Poor ergonomics and static postures further contribute to musculoskeletal disorders, especially in the neck, back, and wrists.

2. Mental Health and Cognitive Decline Digital fatigue can impair executive functioning, reduce productivity, and increase the risk of burnout. A study by Murugan and Rashadh (2024) found that remote workers experiencing digital fatigue reported higher levels of anxiety, reduced job satisfaction, and impaired decision-making.

3. Sleep Disruption and Circadian Misalignment Exposure to screens late into the evening suppresses melatonin production, leading to insomnia and poor sleep quality. This not only affects recovery but also impairs daytime performance and increases susceptibility to chronic conditions.

4. Reduced Engagement and Workplace Productivity Employees suffering from digital fatigue often experience decreased motivation, lower engagement, and increased absenteeism. The constant cognitive demand of virtual work can lead to emotional exhaustion, undermining team cohesion and innovation (Paigude, 2024)

Vulnerable Populations • Remote workers especially those without dedicated workspaces or ergonomic setups.

• Knowledge workers who rely heavily on digital tools for communication and analysis.

• Young professionals, who may lack boundaries between personal and professional screen use.

• Older adults, who may experience greater visual strain and cognitive fatigue.

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Organisational impact From an occupational health perspective, digital fatigue poses risks not only to individual wellbeing but also to organisational performance. It can lead to increased healthcare costs due to stressrelated illnesses, sickness absence, presenteeism and

analytics to track screen time

and engagement patterns.

According to Paigude et al.

(2024), organizations that integrate digital wellbeing into their occupational health frameworks report higher employee satisfaction and lower burnout rates (Mbata, 2024).

musculoskeletal complaints,

Strategies for mitigation

higher turnover rates, as

1. Ergonomic interventions

employees seek roles with a better work-life balance, and reduced innovation, as cognitive overload stifles

creativity and problemsolving.

Employers should provide guidance on ergonomic workstation setups, including adjustable chairs, screen positioning, and keyboard placement. Regular posture

Policy and leadership

breaks and stretching routines

considerations

can reduce physical strain.

Occupational health policies

2. Digital hygiene and

must evolve to address digital

boundaries

fatigue. This includes risk

Encouraging screen breaks,

assessments for screen-

limiting meeting durations,

related hazards, training

and promoting simultaneous

programs on digital wellbeing,

communication can reduce

leadership modelling, where

cognitive load. Tools like the

managers demonstrate

Pomodoro Technique or

healthy digital habits and data

scheduled “focus time” help

monitoring, using anonymised

manage attention and reduce multitasking.

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Occupatio

policies m

to addre

fati

3. Blue light management/

and reduced screen

education

dependency. Encouraging

Using blue light filters, adjusting screen brightness, and education on avoiding screens before bedtime can mitigate sleep disruption.

Some organisations provide blue light-blocking glasses as part of wellness initiatives.

outdoor meetings, walking calls, or tech free brainstorming sessions can reintroduce physical movement and social interaction.

Future Directions As technology continues to

4. Mental health support/

shape the workplace, future

education

research should explore the

Access to employee assistance

longitudinal effects of digital

programs (EAPs), mindfulness

fatigue on cognitive health, as

training, and virtual

well as the potential of AI-

ess digital

counselling can help workers

driven tools to monitor and

igue.

manage stress. Creating a

enhance digital workloads.

culture of openness around

There is also a need to

mental health reduces stigma

examine personalised

and fosters resilience.

interventions, tailored to

Education on managing

individual screen use patterns

optimal mental health as a

and health profiles. The

prevention, use of the HSE

integration of wearable

management standards to

technology, biometric

reduce work related stress and

feedback, and adaptive

stress risk assessments to

scheduling may offer new

identify work related factors.

avenues for managing digital

onal health

must evolve

5. Flexible work design

fatigue proactively (Bondanini, 2024).

Hybrid models that combine remote and in-person work allow for greater autonomy ioh.org.uk

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Conclusion Digital fatigue is a multifaceted occupational health issue that demands attention from employers, clinicians, and policymakers. By recognising its symptoms, understanding its mechanisms, and implementing targeted interventions, organisations can foster healthier, more sustainable virtual work environments. As we navigate the digital age, prioritising human wellbeing alongside technological

advancement is not just ethical, it’s essential for long-term productivity and resilience.

References Acosta, Z. (2024). Digital Fatigue: The Hidden Threat to Workplace Productivity and Well-being. . EOS Global Expansion.

Bondanini, G. G. (2024). The Dual Impact of Digital Connectivity: Balancing Productivity and Well-Being in the Modern Workplace. International Journal of

Environmental Research and Public Health, 845.

Mbata, O. (2024, November). The Impact of Prolonged Visual Display Screen Exposure

on Worker Health and Workplace Productivity. Retrieved from LinkedIn: https:// www.linkedin.com/pulse/impact-prolonged-visual-display-screen-exposure-workeronyinye-mbata-buwpe/ Murugan, K. R. (2024). A Study on Reducing Digital Fatigue in Remote Work.

International Journal of Foreign Trade and International Business, 153-159.

Paigude, S. P. (2024). Occupational Health in the Digital Age: Implications for Remote

Work Environments. ResearchGate.

Supriyadi T, S. S. (2025). The Impact of Digital Fatigue on Employee Productivity and Well-Being: A Scoping Literature Review. Environment and Social Psychology 2025;.

ResearchGate , 10.

Dr Riya John is a Medical Assessor for the Department for Work and Pensions. Follow on LinkedIn

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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/occupationalhealth/nsoh-training-education-placements OR SOM careers > placements https://www.som.org.uk/ careers

-

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

-

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

Contacts for Support: -

Placement Learning Lead at your local university

-

ICS Practice Learning Facilitator (for NHS teams)

Available Training: Online Supervisor and Assessor Course- Anglia Ruskin University and Northamptonshire University.

These flexible, self-paced courses provide the essential skills and knowledge required to supervise and assess students in clinical placements. https://www.aru.ac.uk/business-employers/practicehub/online-supervisor-assessor-course

O

ccupational Health (OH)

changed person back into the same

professionals have long

environment and expect the

been indispensable in

change to hold.” Fixing the

ensuring the productivity and

component only to return it to the

welfare of the UK workforce. Yet

malfunctioning system is a

the traditional model of OH

predictable path to future failure—

engagement, often characterised

the environment will win every

by remedial case management

time.

following illness or injury, limits the

The timely publication of Sir Charlie

profession’s strategic potential. As

Mayfield’s Keep Britain Working

Dr. Dee Edington famously urged in

Review further underscores this

his seminal work Zero Trends ,

urgency, framing workforce health

organisations must stop operating

as a vital component of national

on a model of “waiting for defects

economic strategy, with ill-health-

and then fixing the defects”. His

related economic inactivity costing

observation highlights the futility of

the UK an estimated £ 212 billion

viewing an impaired individual

per year. The review calls for a

merely as a faulty component. As

"fundamental shift" where

Edington warned, “You can't put a

employers must lead on prevention

1

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From Fixing Defects to Systemic Prevention Harnessing Lead Indicators to Redefine Occupational Health Value

By Mike Tyler Chairman and Co-founder, Fruitful Insights

and early intervention, emphasising the need for robust data to guide continuous improvement and support the creation of a Workplace Health Intelligence Unit.

The Imperative of Foresight Lag indicators, such as accident statistics, absence rates, and

utilisation of clinical services, only quantify what has already gone

For OH to truly deliver its mandate,

wrong. The enduring scale of work-

the promotion and maintenance of

related ill-health in the UK,

the highest degree of physical,

exemplified by the millions of

mental, and social wellbeing of

working days lost annually due to

workers, it must move beyond

non-fatal injuries and

remediation and adopt systemic

musculoskeletal disorders,

prevention. This requires

demonstrates that this reactive

transitioning the evidentiary basis

model is failing to identify and

of OH practice from reactive lag

neutralise underlying systemic

indicators to proactive, high-quality

risks.

lead indicators.

By contrast, lead indicators offer foresight. High-quality, validated data allow OH professionals to

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intervene strategically before

In addition to informing

individual health declines or

organisational interventions, lead-

organisational performance

indicator data also equip OH

deteriorates. The quality of this

providers to more accurately scope

data is paramount; in the field,

the scale of work required within

flawed data inevitably leads to

client organisations. By

flawed outcomes.

understanding which cohorts are

Defining Data Quality and

most at risk and the trajectory of

Actionable Intelligence

future demand, providers can resource their Multidisciplinary

For data to serve as the foundation

Teams (MDT) efficiently and offer

of a new generation of OH practice,

clearer expectations around

it must adhere to three defining

workload, capacity, and timelines.

characteristics:

Benchmarking across employers

• Dual Perspective

further strengthens this predictive capability, enhancing both planning

• Granularity

and value delivery.

• Continuity

Crucially, data alone does not drive

Dual Perspective ensures that the subjective experience of the employee combines with objective organisational and environmental data. Granularity is the critical ability to segment risk and identify those cohorts (by age, tenure, or work type) most severely affected. Collecting the data regularly facilitates continuity, i.e., the trend analysis required for a genuine cycle of continuous improvement.

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improvement; insight does. The OH professional’s unique clinical role involves translating complex analytics into actionable intelligence, evidence that directly informs targeted interventions. This requires evolving the professional role from case manager to strategic data interpreter, capable of distinguishing between individual vulnerabilities and organisational root causes.

Volume 33 Issue 1

The Data-Driven MDT -

systemic changes with measurable

Collaboration Over Silos

impact.

The evidence is clear that a whole-

The Economic Case for

system approach achieves

Multidisciplinary Risk

improved health outcomes. This

Prevention

demands an MDT approach, recognised as the "gold standard" in care delivery, integrating OH

with HR, leadership, and financial risk management.

The lens of long-term disability (LTD) prevention demonstrates the necessity of collaboration. LTD claims represent severe, chronic system failures. By using predictive

Lead indicator data acts as the

data that links systemic inputs (e.g.,

objective common language for the

extreme work demands,

MDT. It moves conversations

inadequate recovery patterns) to

beyond philosophical agreement to

potential output metrics (attrition,

targeted operational

presenteeism, claims), OH can

implementation. For example, by

proactively advise on systemic

quantifying the link between

adjustments.

leadership practices and reported stress levels, OH professionals gain the evidence needed to influence HR policy or leadership accountability. This objective evidence is essential to counter the phenomenon of "wellbeing washing," where organisations implement tokenistic, unproven initiatives (the "Spangle Trap") that lack verifiable return on investment (ROI). Data quality provides the necessary rigour to ensure employers direct investment toward

Partnerships with the insurance sector illustrate this shift effectively. Use of aggregated wellbeing data can identify systemic risk factors influencing LTD claims. This allows OH to deploy expertise for earlier support, enabling better claim prevention and precise risk management. This collaboration exemplifies a fundamental shift from simply insuring risk (risk pooling) to actively reducing it (risk prevention), generating shared ioh.org.uk

OH TODAY

93

value for the employer, the insurer,

the operational map needed to

and the employee. This model

translate data findings into

validates OH as a strategic, value-

organisational action. If data

adding function, rather than merely

reveals poor leadership alignment,

a cost centre.

for instance, the MDT knows that

Applying Data for Systemic

organisational change must target

Change - The Role of the OH Professional The responsibility of the OH professional in this new landscape

the management layer rather than offering a generalised EAP service.

A Call for Literacy and Accountability

is to use quality data not just to

Embracing a data-driven,

identify a problem but to prioritise

preventive model will enhance the

its solution and frame the

future success of OH. This

necessary organisational action.

transformation requires two critical

The Prioritisation Matrix (Figure 1,

components: organisational

the Four-Box Wellbeing Grid) allows

accountability and professional

the immediate triage of

data literacy.

organisational issues by measuring

Organisations must accept

the interplay between performance

accountability for the systemic

and the variability of responses.

conditions that affect employee

Issues with low scores and high

health, moving past the impulse to

variance signal acute, concentrated

merely fix individuals’ health

risk, demanding immediate and

issues. Concurrently, OH

focused OH intervention in specific

professionals must invest in the

cohorts, whereas low scores and

requisite analytical skills. As

low variance signal a companywide

evidenced by specialised

generalised issue.

certification programs now

Furthermore, conceptual

available in data literacy for the

frameworks like the SCALE

health and safety sector, the skills

approach (Self, Cohort, Alignment,

to interpret, communicate, and

Leadership, Environment) provide

apply complex data are essential.

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OH TODAY

Volume 33 Issue 1

Figure 1

Identifying wellbeing priorities Source - Fruitful Insights

By championing data quality, adopting lead-indicator frameworks, and collaborating cross-functionally, the OH profession secures its status as a critical strategic partner. It gains the tools necessary to fulfil Dr.

References 1. Edington, D. W. (2009). Zero Trends: Health as a Serious Economic Strategy. Ann Arbor, MI:

Health Management Research Center, University of Michigan.

Edington’s enduring principle and move beyond the 'break-fix' cycle to enable systemic improvement, ensuring people thrive and allowing organisations to prosper.

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95

Pillar

Action Focus

Example Inte

S (Self)

Individual clinical and behavioural support

Offer personalise acute personal s

C (Cohort)

Localised interventions based on specific risk segmentation and group needs.

Run bespoke me stress. Targeted

A (Alignment)

Strategic integration of wellbeing goals with overall business strategy and values.

Integrate key we between OH, HR

L (Leadership)

Manager training and accountability for supportive, data-informed management practices.

Mandatory traini manager perform

E (Environment)

Systemic policy changes (e.g. workflow design, autonomy, workload management).

Review and adju scores. Support j

Figu

Turning data into act

Source - Fruitful Insigh

Mike Tyler is the Chairman and Founder of Fruitful Insights, a UK-based organisation pioneering data-

driven approaches to workplace wellbeing. Drawing on a career spanning occupational health, insurance, actuarial/benefits consulting and organisational performance, Mike advocates for evidence-based methods that connect employee wellbeing, productivity, and business sustainability.

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Volume 33 Issue 1

ervention

ed guidance on recovery (sleep/nutrition) or targeted clinical referral for employees with stress.

ental resilience workshops for Fee-Earners, employees under 30 identified with acute training for managers of high-attrition teams.

ellbeing indicators into executive business KPIs/ESG reporting. Formal MDT collaboration R, and Finance to manage long-term disability risk.

ing for all managers on fostering "safe and early conversations" about health issues. Link mance reviews to team workload balance scores.

ust workload policies or increase autonomy in departments reporting consistently low job crafting approaches across the business

ure 2

tionable intelligence

hts SCALE Framework

Fruitful Insights is an independent digital, data and analytics company specialising in the

measurement and analysis of corporate workplace wellbeing. The company partners across all business sectors to provide actionable intelligence designed to help companies precisely identify and target wellbeing issues. info@fruitfulinsights.co.uk

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