OH Today Volume 33 Issue 3

Workaholicism

Also in this issue : Professional Independence | Clinical Supervision Occupational Medicine Insights | Beyond the Clinic | Night work Psychological Trauma | Trauma - informed practice Health Surveillance

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Friends of iOH : Asclepius Occupational Health | Flex Insight Workplace Health | R - Health | recruitinghea Visualise Traing and Consultancy | Wellbeing

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Editor JANET O

’NEILL

Assistant Editor LIBBY HASSANALI 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

5

Workaholicism: Why It Matters for Occupational Health Practice

8

Maintaining Professional Independence in Private Occupational Health Practice: Navigating Governance, Leadership and Organisational Pressures

15

Clinical Supervision in Occupational Health

25

Occupational Medicine insights for those new to the profession

31

External OH Provision: The Benefits, Challenges and Changing Landscape

38

Beyond the Clinic: Uniting Occupational Health and Hygiene for a Safer Workplace

48

Three ways to be wrong about night work! A research study

56

Psychological trauma, application of theory to practice

66

Trauma - informed approaches in practice: Perspectives from a Workplace Wellbeing Lead

74

Health surveillance: Why quality data matters at every stage

80

From the President Lynn Pratt

A Privilege to Serve Dear Members, As I write this final President's column for OH Today , I find myself reflecting on what has been an immensely rewarding three and a half years leading iOH. My tenure as President will cease from the forthcoming AGM on 8th October, creating the opportunity for a new President to lead the charity into its next chapter.

It has been a privilege to work alongside our trustees, board, partners and members. I remain fully committed to supporting an orderly and positive transition.

When I took on this role, I could not have anticipated the pace of change that our profession would experience. Occupational Health and Wellbeing continues to evolve, responding to changing workplaces, new health challenges, advances in technology, and growing recognition of the importance of employee wellbeing.

One of the greatest strengths of iOH is its community.

We are a diverse profession, bringing together practitioners from different backgrounds, disciplines and sectors, yet united by a common purpose: helping people to be healthy, safe and productive at work.

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Whether supporting individuals through illness, promoting wellbeing, preventing harm, or influencing organisational culture, the work undertaken by Occupational Health and Wellbeing professionals has never been more important.

I am particularly proud of the way iOH has continued to grow and develop during my time. Through the commitment of our members, trustees and board members, we have become a registered UK charity, strengthened our governance, broadened member engagement, expanded educational learning opportunities, and raised the profile of Occupational Health and Wellbeing through our activites. None of this would have been possible without the dedication and generosity of those who give their time and expertise to support the association.

I look forward to watching iOH continue to grow, innovate and thrive in the years ahead, building on the strong foundations we have created together.

Lynn Pratt President iOH

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Introducing your new Editor

Janet O ’Neill

I am so proud to be taking over this role from Lynn Pratt who has done an amazing job over many years. She has brought OH Today from a general newsletter into what you see today. Big shoes to fill, but as I have been supporting for a few years now, a challenge I relish. I am continually astounded by the depth and breadth of articles and how the publication charts and measures the progress of workplace health and wellbeing. I am fortunate to have the support of Libby Hassanali, who has an eagle eye for detail but also an objective view for what makes a good read. Plus, Lynn, fortunately is not moving too far away and will continue to support, providing, not only her experience of OH Today but also the values of iOH into the publication.

We look forward to many years of reading and learning from you as writers, sharing thoughts and wisdom with our audience.

Introducing your new Assistant Editor I ’m delighted to introduce myself as the new Assistant Editor of OH Today . I ’ve been providing background support to the journal for quite some time, so I ’m really pleased to formally take on the Assistant Editor role.

Libby Hassanali

I ’ve worked in occupational health for many years, with a particular interest in mental health and stress management, and I ’m particularly interested in how evidence, data and innovation can help demonstrate the value of occupational health and shape our future.

I ’d like OH Today to continue being a place where practitioners can learn from one another, challenge thinking and share good practice.

I ’m especially looking forward to hearing from you — our readers. If there are topics you ’d like to see covered or work you think deserves a wider audience, please get in touch. I ’m excited to be part of the next chapter of OH Today .

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Workaholicism Why It Matters for Occupational Health Practice

By Gail Whitelaw

Introduction Workaholism has been described as “an obsessive -compulsive disorder that manifests itself through self imposed demands, an inability to regulate work habits, and over indulge in work to the exclusion of most other life activities ” ( Robinson, 2013 ).

Although the concept has been discussed for decades, interest has grown significantly in the past fifteen years, with research now emerging across multiple countries.

Yet, despite this global attention, workaholism remains poorly recognised in the United Kingdom, particularly within Occupational Health practice.

This article explores what workaholism is, how it affects employee wellbeing, and what Occupational Health professionals can do to identify and manage it.

The aim is to support Occupational Health practitioners, HR teams and managers to better understand this behaviour and its implications for workplace health.

What Do We Mean by Workaholism?

The earliest definition came from Oates, who described workaholism as “the compulsion or uncontrollable need to work incessantly ” ( Oates, 1971 ). Since then, researchers have debated whether workaholism is a positive or negative behaviour. Some argue

it is harmful because it stems from compulsion rather than motivation (Shimazu et al., 2015 ), while others suggest it may appear positive due to high work engagement (Lichtenstein et al., 2019 ), However, a consistent scientific definition is still lacking ( Loscalzo & Giannini, 2019 ), Workaholism is not currently recognised as a clinical condition in the UK and is absent from ICD‑10 (Durand -Moreau et al., 2018 ). The WHO has acknowledged the role of work in mental health and plans to include work -related factors in ICD -11 (Health Protection Scotland, 2018). Some researchers argue that workaholism may be linked to obsessive -compulsive personality disorder and requires further systematic investigation et al., 2020 ).

(Atroszko

Impact on Employee Wellbeing Across the literature, workaholism is consistently associated with occupational stress, depression, Insomnia and work –family conflict (Loscalzo & Giannini, 2019 (Durand Moreau et al., 2018

).

In the workplace, it may contribute to reduced performance, sickness absence and even aggression towards colleagues ( Loscalzo & Giannini, 2019 ). Several studies also link workaholism to burnout and exhaustion ( Molino et al., 2016 ).

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A Danish study found that work addiction is associated with

(Shimazu et al., 2015 ). A two -year longitudinal study found that

emotional stress and reduced quality of life (Lichtenstein et al., 2019 ). Individuals may ignore symptoms of fatigue or illness, prioritising work over their physical and mental health.

workaholism predicted poorer health, while work engagement predicted improved wellbeing and performance ( Shimazu et al., 2015 This reinforces the need for organisations to avoid assuming that high output equals good health.

Technology has intensified this pattern. With constant access to work emails, laptops and smartphones, boundaries between work and home life have blurred.

Employees may continue working during evenings, weekends or annual leave, increasing the risk of burnout and family conflict (Atroszko et al., 2020 ).

Despite these concerns, prevalence rates are difficult to establish due to inconsistent measurement tools across countries. Most validated scales originate from Holland, Poland, Italy and the USA, highlighting the need for UK specific research ( Molino et al., 2016 ; Loscalzo & Giannini, 2019 ; Durand -Moreau et al., 2018 )

Workaholism vs Work Engagement It is important to distinguish workaholism from work engagement. Work engagement reflects high effort combined with positive wellbeing, whereas workaholism reflects high effort driven by compulsion and associated with poorer wellbeing

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What do OH professionals need to be aware of?

A French qualitative study is the only research directly exploring OH management of workaholism (Durand -Moreau et al., 2018 ). It highlights several workplace factors that may reinforce workaholic behaviour, including bonus systems based on quantity and quality of output, performance grading and organisational cultures that reward excessive commitment.

Systems which may unintentionally encourage unhealthy work patterns.

Recognising Workaholism in Practice Employees who work excessively are often valued by managers and may be reluctant to take breaks or annual leave ( Lichtenstein et al., 2019 ). However, OH professionals should consider: ➢ Whether the employee is using work to avoid personal issues

).

➢ Co -existing addictive behaviours (alcohol, smoking, eating disorders) ( Durand -Moreau et al., 2018 ) ➢ Environmental factors such as workload, culture and expectations For Occupational Health professionals, Loscalzo et al. (2019) developed the W1 -10 inventory to assess both workaholism and work engagement. Although promising, this tool is not yet validated for UK use. Screening could help identify employees at risk and support early intervention.

Supporting employees OH interventions to support employees may include ( Molino et al., 2016 Durand -Moreau et al., 2018 ): ➢ Education on healthy work balance

–life

they may be assessed as temporarily unfit for work and require structured support

Why This Matters for UK Occupational Health Workaholism is not formally recognised in the UK, and neither WHO nor HSE currently provide guidance specific to this behaviour.

This limits the ability of Occupational Health professionals to introduce structured health promotion or evidence -based interventions ( Atroszko et al., 2020 However, the evidence clearly shows that workaholism can contribute to: ➢ Stress ➢ Fatigue ➢ Family conflict ➢ Substance misuse ➢ Burnout

➢ Stress management and time management training

➢ Suicide risk ( 2019 )

➢ Encouraging regular breaks and annual leave

Given the rise of remote working and 24/7 digital access, workaholism is likely to become more prevalent. Occupational

➢ Referral to counselling or CBT (Cognitive Behavioural Therapy) ➢ Meditation or relaxation strategies ➢ Advising managers on reducing excessive job demands

).

Lichtenstein et al.,

Health professionals are well placed to lead awareness, early identification and supportive management.

If an employee ’s mental or physical health is significantly impaired,

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Recommendations for OH Practice 1. Raise awareness: Introduce health promotion activities to educate employers, employees and managers about workaholism and its risks.

2. Assess holistically: Include questions about work patterns, technology use, personal stressors and addictive behaviours during Occupational Health assessments.

3. Develop UK -validated screening tools: A cross -sectional study within Occupational Health departments could help validate assessment tools for UK practice.

Conclusion Workaholism is a complex behaviour with significant implications for employee wellbeing. Although not formally recognised in the UK, evidence shows clear links to stress, burnout, mental health issues and reduced quality of life. Occupational Health professionals have a vital role in identifying risks, supporting employees, and influencing organisational culture.

4. Support managers: Provide guidance on workload, expectations, and recognising unhealthy work patterns.

Further UK -based research is essential to develop validated assessment tools and evidence -based interventions. As workplace expectations evolve, recognising and managing workaholism will become an increasingly important part of Occupational Health practice.

5. Advocate for national recognition: Encourage collaboration with public health bodies to support future inclusion of workaholism in UK guidance.

AI was used in structure only.

All content was formulated by the author

Gail began her career as an Occupational Health Nurse in 2013.

In 2021, she enrolled at the University of the West of Scotland (UWS) in Paisley to complete her Occupational Health Advisor training, qualifying in 2024 and achieving Part 3 SCPHN registration.

She has recently been promoted to Senior Occupational Health Advisor, reflecting her continued professional development and commitment to occupational health practice. To further enhance her knowledge and career progression, she has also been accepted onto a Travel Medicine programme with the Royal College of Physicians and Surgeons.

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Maintaining Professional Independence in Private Occupational Health Practice: Navigating Governance, Leadership and Organisational Pressures

By Niamh Watson Introduction Occupational Health professionals (OHP) play a pivotal role in safeguarding employee health, supporting fitness for work, and providing clinical guidance within complex organisational environments. At the core of this role is the requirement to maintain professional independence while operating within effective systems of clinical governance. These principles are essential not only for ensuring safe and ethical standards, but also for maintaining trust between the OHP, the employee, and the organisation ( Nursing and Midwifery Board of Ireland, 2025; Nursing and Midwifery Council, 2018) . ioh.org.uk

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Maintaining Professional Independence

Clinical governance has been defined as “a framework

that the governance structures, leadership

through which organisations are accountable for continuously improving quality and safeguarding high standards of care ” ( Scally and Donaldson, 1998 ). While this definition provides a strong theoretical foundation, its application within Occupational Health (OH),

dynamics, and corporate positioning in these settings present distinct challenges in maintaining professional independence. It draws on critical analysis of governance, leadership, and organisational pressures to explore how professional independence can be maintained in practice.

particularly within private sector settings, is often more complex in practice.

The Reality of Practice in the Private Sector

In practice, OH services frequently operate within environments influenced by corporate priorities, commercial drivers, and leadership expectations. This

While governance frameworks provide theoretical clarity, the realities of OH practice present more complex and less straightforward challenges in day -to -day application . From a practitioner perspective, OH

can create ongoing tension, as practitioners may be required to balance clinical responsibilities with broader operational demands.

Evidence suggests that professional independence is shaped not only by individual accountability but also by organisational culture and leadership structures ( Pursio et al., 2021 ; Malik and Elorrio, 2023 ; Peach and Vargas Prada, 2025 ).

This article focuses on OH practice within in -house services in private sector organisations, recognising

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practice in the private sector often involves navigating competing demands between clinical judgement and organisational expectations.

In many organisations, OH services are operationally aligned with Human Resources (HR), in absence management, or employee relations functions. While this supports organisational integration, it can also influence how OH advice is interpreted and applied in practice, reflecting both HR processes and the wider organisational priorities and expectations set by leadership.

In operational contexts, this may present as pressure to provide

both employee trust and clinical integrity ( Pursio et al., 2021; Malik

outcome focused recommendations, alongside challenges in managing requests for clinical information that do not align fully with professional or legal obligations. Practitioners may be asked to clarify or justify decisions in ways that align with business priorities, even where clinical evidence remains uncertain ( Pursio

and Elorrio, 2023

et al., 2021; Mrayyan et al., 2024 ; Palmer and Brown, 2021 ). A common scenario involves requests for increased detail in reports or

engagement, and organisational culture rather than policy alone.

clarification of clinical findings that extend beyond what is appropriate to disclose. In these situations, the OHP must carefully balance clinical judgement, confidentiality, and employer expectations.

This reflects the dual -client nature of OH, where the employer commissions the service, while the employee remains the patient (Kloss, 2020; Heikkinen, Launis and Leino -Kilpi, 2006) . Maintaining professional independence within this context requires consistent judgement, clear boundaries, and strong adherence to ethical and legal standards, particularly in balancing dual -client responsibilities. Without protected professional independence, OH risks shifting from a clinically governed service to an operational function, potentially undermining

).

Clinical Governance Versus Organisational Reality Clinical governance frameworks are designed to support safe, accountable, and high -quality clinical care. However, their effectiveness is dependent on implementation, leadership

Traditional governance approaches are often hierarchical and compliance focused, emphasising policies, procedures, and performance monitoring. While these provide an important framework, they do not always reflect the complexity of real -world application . In OH, practitioners frequently operate within dynamic organisational environments where decision -making is influenced by multiple competing priorities.

This reveals a gap between governance theory and implementation (Veenstra et al., 2017; Redinger and Levine, 2021).

Governance frameworks may exist formally but do not fully support practitioners in managing ethical dilemmas or operational pressures in practice. As a result, responsibility for maintaining professional standards often falls heavily on the individual

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Maintaining Professional Independence

practitioner, rather than being fully embedded within the

reinforces the need to reposition OH as a core

system. In many private sector OH settings, formal governance structures may not be clearly defined within the organisation. Instead, governance is grounded in professional codes of conduct, and practitioners draw on their training, experience and ethical responsibilities to

component of organisational strategy and employee value proposition.

guide their practice. In this context, maintaining professional independence is not just expected, but something practitioners must actively uphold in their day -day work.

practitioner and the employee.

OHPs routinely handle sensitive personal health information, which is classified

OH TODAY

Confidentiality is fundamental to OH practice and central to maintaining trust between the

-to

This underscores a key limitation of traditional governance approaches, which often prioritise compliance and documentation, but do not fully account for the influence of organisational power dynamics and competing operational priorities ( Malik and Elorrio, 2023 ; Veenstra et al., 2017 ).

Evidence also suggests that OH is often positioned as a reactive or compliance led function rather than a strategic clinical service (Society of Occupational Medicine (SOM), 2026 ). This limits its influence within strategic decision making and

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Confidentiality, Data Protection and Legal Accountability

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as special category data under the General Data Protection Regulation and the Data Protection Act 2018 (European Union, 2016; Government of Ireland, 2018 The Information Commissioner ’s Office (2024) emphasises that such data must be processed lawfully, fairly, and transparently, with both a lawful basis and a specific condition for handling health information.

Importantly, organisational requests alone do not constitute a lawful basis for disclosure, and practitioners must ensure that any disclosure of health information is legally justified and proportionate (Kloss, 2020).

).

This can create a clear point of tension, as business expectations

understanding of legal frameworks are essential to support defensible

may be framed as operational requirements, but do not meet the legal threshold for disclosure under data protection legislation.

and ethical decision‑making. In practice, these processes also provide a clear way of demonstrating clinical governance, particularly in the absence of formal oversight structures, showing how practitioners maintain accountability, transparency, and compliance. This may include appropriate audit of clinical

Professional codes reinforce these principles. The Nursing and Midwifery Council (2018) states that practitioners must respect and protect confidential information, sharing it only where there is a clear justification. Similarly, the Nursing and Midwifery Board of Ireland (2025) emphasises the importance of confidentiality, professional judgement, and accountability when handling sensitive health information. These obligations are further supported within OH law, which emphasises the legal risks associated with inappropriate disclosure of health information (Kloss, 2020). Guidance from the Faculty of Occupational Medicine (2026) additionally highlights the importance of informed consent and maintaining confidentiality within OH practice.

In practice, this creates situations where OHPs must refuse or challenge organisational requests for information. These decisions can carry perceived risk, particularly where business expectations conflict with legal and ethical obligations.

Clear documentation, informed consent, and a strong

records, consent, and confidentiality practices, in line with quality assurance expectations within frameworks such as SEQOHS (Faculty of Occupational Medicine, 2023 ).

Risks and Implications for Practice Failure to maintain professional independence has significant implications across multiple areas of delivery and governance.

For employees, a lack of confidence in confidentiality or independence may reduce disclosure during consultations. This increases the risk of incomplete health assessments and unsafe workplace decisions arising from inaccurate or incomplete information ( Palmer and Brown, 2021 ; World Health Organization, 2022 ).

For practitioners, repeated exposure to organisational pressure and ethical conflict can result in stress, moral distress, and ioh.org.uk

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burnout, particularly where they are required to continuously navigate tension and defend professional standards ( Ferreira et al., 2025 ).

Maintaining Professional Independence

There are also potential legal, regulatory, and financial risks where professional standards or data protection requirements are not upheld.

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Leadership and Organisational Influence Given these challenges, the role of leadership becomes critical in shaping how OH operates in organisational settings. Effective leadership recognises OH as a clinically governed service operating within defined legal and ethical frameworks, rather

At the level of both the employing organisation (the employer commissioning the service) and the in -house OH function, governance structures and boundaries may at times be unclear or inconsistently applied. This can lead to challenges in decision making, as well as increased

than solely as a support function ( Peach and Vargas Prada, 2025; Porter -O ’Grady, Rollins and Bailey, 2025 ).

Leaders influence organisational priorities, culture, and the extent to which governance frameworks are actively implemented across the organisation ( Malik

legal exposure and potential reputational damage.

Breaches of confidentiality or inappropriate handling of health data can undermine trust and create long -term business risk. These implications demonstrate that professional independence is not solely an individual

and Elorrio, 2023; Porter O ’Grady, Rollins and Bailey, 2025 ).

responsibility, but a critical component of organisational governance and risk management, requiring active leadership support rather than reliance on individual practitioners alone.

objectives, including in situations where these may not fully align with professional standards.

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Where OH is viewed primarily as an operational or support function, its clinical and ethical role may not always be fully recognised. This can lead to pressure for practitioners to align with organisational

In such environments, professional independence may become increasingly

difficult to maintain, particularly where leadership does not actively

aligns with legal and ethical standards.

reinforce the clinical and ethical boundaries of OH practice.

Leadership also plays a key role in setting organisational expectations.

By clearly defining boundaries around confidentiality and clinical judgement, leaders can reduce inappropriate requests and support practitioners in maintaining professional standards.

Equally, organisations that demonstrate strong leadership in governance and ethics create conditions in which practitioners can exercise independent clinical judgement with confidence.

Leaders who understand these principles are better positioned to support professional independence, reinforce appropriate boundaries, and ensure that decision making

Ultimately, leadership determines whether governance frameworks function as meaningful support structures or remain as theoretical policies with limited impact.

Practical Recommendations for Occupational Health Practice Supporting professional independence in OH requires a structured and integrated approach. In private sector settings, this often depends on a practitioner ’s ability to apply governance principles within their day -to -day clinical practice. Situations such as requests for clinical information based on organisational interpretations of legal grounds can highlight the ongoing tension between clinical responsibilities and organisational priorities. Addressing these challenges requires both structural and cultural change.

1. Strengthen Governance Frameworks Governance structures should clearly define the independent role of OH, including boundaries around confidentiality, consent, and disclosure. Where formal governance structures are limited, this requires clear recognition of the practitioner ’s accountability for clinical decision -making, confidentiality, and maintaining professional standards in practice.

2. Enhance Leadership Understanding Leaders should have a clear understanding of the legal and ethical frameworks governing OH and actively support their application.

3. Establish Clear Escalation Pathways Practitioners should have access to clear processes for managing situations organisational requests conflict with professional obligations.

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4. Improve Consent and Communication

Employees should be fully informed about how their information is used and disclosed, supporting transparency and trust.

5. Reposition Occupational Health Strategically OH should be recognised as a core component of organisational wellbeing and risk management strategy, rather than a purely reactive or transactional service (SOM, 2026) , aligning its role within the wider employee value proposition.

6. Support Defensible Practice

Maintaining Professional Independence

Clear documentation and justification of clinical decisions are essential for maintaining accountability and reducing risk.

7. Evidence Clinical Governance in Practice OHPs should actively demonstrate governance through robust documentation, clear consent processes, defensible clinical reasoning, and appropriate use of escalation or peer support where ethical challenges arise.

Key Actions for Practice or Recommendations • Maintain clear boundaries around confidentiality and disclosure • Ensure all clinical decisions are clearly documented and defensible • Use escalation pathways

where organisational expectations

conflict with professional obligations • Obtain and confirm informed consent for all disclosures • Seek leadership support where governance challenges arise

• Ensure decisions are based on independent clinical judgement and are clearly justified

Conclusion Maintaining professional independence within OH roles remain a complex and ongoing challenge, particularly in private sector environments where organisational and commercial pressures are significant.

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Practitioners are required to navigate competing demands while upholding clinical, ethical, and legal standards. While clinical governance frameworks provide an essential foundation, their effectiveness depends on leadership engagement, organisational culture, and practical implementation. Without these elements, governance may exist in principle but fail in real world situations.

Ultimately, professional independence relies not only on governance structures but on the ability of practitioners to exercise confident, evidence -based clinical judgement and uphold professional standards, even where this may conflict with organisational expectations ( Nursing and Midwifery Council, 2018; Nursing and Midwifery Board of Ireland, 2025 ; Pursio et al., 2021 ).

This reinforces the need for a shift from policy supported, practice‑based governance.

-driven governance to actively

Protecting professional independence is fundamental to ensuring safe, ethical, and high -quality OH services. Strengthening governance, leadership, and organisational understanding will be essential to support practitioners and maintain the integrity of OH in the future. Without this, there is a real risk of compromised clinical decision making and a gradual erosion of professional standards in practice.

-

AI statement AI tools were used to support editing and condensation of the authors' original paper into an article format. All content/analysis is the author's own and referenced accordingly.

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 manufacturing,

FMCG, and

medical devices, distilleries.

UK and Ireland has resulted in high

chemical

Her work across the

-impact initiatives that

significantly enhance workplace safety and employee health.

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Clinical Supervision in Occupational Health

By Libby Hassanali

O

ccupational Health (OH)

support and learning which enables

practitioners are exposed to many situations that may challenge their psychosocial health. These might include a complex or triggering mental health case, expectations from HR, managers and unions, or decisions on fitness to work.

Alongside this there may be a high volume of work, or lone working with minimal day to day support from

individual practitioners to develop knowledge and competence, assume responsibility for their own practice, and enhance consumer protection and safety of care in complex clinical situations ” ( Davenport, 2013 ).

peers.

The process can further help staff to consider what they would like to do/ happen differently next time, and so support the reflective process required for revalidation.

Clinical Supervision (CS) for nurses began in the 1990’ s and was swiftly embraced in the mental health setting (Butterworth, 2022 ). The 1993 Department of Health definition, set the standard and describes CS as “... a formal process of professional

CS has a solution focused approach which focuses on resources, abilities and strengths for the individual, wider relationships and within organisations.

Whilst supervision is compulsory for accredited counsellors and psychotherapists, it is not a

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requirement or consistently available for nurses.

The Royal

support from colleagues; including improved retention

College of Nursing (2022), however, places CS as best practice and the Nursing and Midwifery Council (2018) code, requires reflective practice and continuous professional development; clearly CS can support this requirement.

through support of staff working in isolation reduced stress and anxiety through the sharing of skills, knowledge and resources in a supportive environment.

Nationally there has been growing support for restorative clinical supervision, and the NHS Professional Nurse Advocate (PNA) programme in England includes access to restorative clinical supervision to improve retention, quality of care and practitioner wellbeing.

The benefits of effective supervision include:

• improved quality of patient care through professional practice and reflection, helping to develop insights, maintain and refine care standards and increase confidence • continued patient safety, through ensuring that staff work within their scope of practice and competence • improved productivity through continuous professional development (CPD), ensuring that skills and knowledge are up to date • enhanced job satisfaction, staff retention and wellbeing through improved team relationships and 26

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The Foundation of Nursing Studies (FoNS) course, Resilience Based Clinical Supervision (RBCS), is a 13 hour “champion and cascade ” training, delivered over five sessions, and aims to increase an individual ’s ability to respond positively to the emotional and psychological demands of their role. The training provides a supportive and confidential safe space that uses a structured framework for guided reflection and learning, focussing on the relationship between actions and feelings. The course emphasised that CS is not about giving advice or judgment on practice, nor is it an appraisal or a type of counselling.

It can however be a therapeutic process.

The training refers to three emotional regulation systems that include Drive (achieving and activating), Threat (protection and safety seeking) and Affiliative (Gilbert, 2009 ).

In CS it is the affiliative (safe and soothing) system that we need to engage with. To access this system, each session in CS begins with sharing a positive highlight or

-

“golden moment ” from the previous few weeks, followed by a

Unlike many other clinical specialties, occupational health

“grounding ” exercise; this helps a change in mindset and enables our attention to move away from the previous, possibly chaotic, working environment. Once the focus has shifted to a calmer and open system, each person “checks -in ” by sharing a prominent emotion or feeling based on a particular and recent situation. After each person

practitioners work at the interface between employee health, wellbeing and organisational priorities, often navigating conflicting expectations of different stakeholders.

has spoken for up to two minutes, the facilitator leads the conversation into a reflective discussion, where common themes or one person ’s situation can be expanded on. Here, encouragement is given to consider others involved in the scenario and what emotions could be driving their own response or actions. Time is spent exploring which emotional system could be prominent (drive, threat, affiliative) and how ones inner and critical voice might be influencing the situation.

Contributions from the whole group are welcomed and typically lead to a reduced sense of isolation and feeling supported. The process enables guided reflection that is affirming yet safe to ask open questions or be challenged. An important aspect of the CS process is that it is self -driven and owned, supports personal accountability and is a place to be compassionate to oneself and others.

The demands on occupational health practitioners are becoming increasingly complex with rising levels of mental ill health, neurodiversity, long -term health conditions, and the increasing workload expected from large providers. At the same time, practitioners frequently find themselves balancing competing expectations from employees, managers, HR professionals, trade unions and employers, while remaining professionally independent and delivering evidence -based advice.

Occupational health practitioners can be expected to resolve issues that have developed over many months or years because of organisational culture or ineffective management practices. The emotional labour required to balance these demands alongside creating legally defensible reports cannot be underestimated.

CS offers a structured, psychologically safe space to develop insight, enhance professional judgement, build resilience and reduce professional ioh.org.uk

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isolation. As occupational health continues to evolve and the

benefits the organisations they support, the employees they care

demands placed upon practitioners increase, clinical supervision should be viewed not as a luxury but as an integral component of safe, compassionate and effective occupational health practice.

Investing in the wellbeing and development of occupational health practitioners ultimately

for and the profession.

For further information about the impact of FoNS courses, including Clinical Supervision, please head to https://www.fons.org/wp -content/ uploads/2026/05/FoNS -Impact Report -2025.pdf Libby Hassanali is Director of

Mental Health and Assistant Editor of OH Today; an Independent Occupational Health Nurse Practitioner and workplace trainer specialising in stress and mental health. She is the author of Mental Health in the Workplace: A Practical Guide for Occupational Health Practitioners on Consultation and Report Writing.

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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

Occupational Medicine insights for those new to the profession

By Dr Anthony Le &

Dr Osas Utubor

1. My Pathway into Occupational Medicine: Research, Networking, and Reaching Out By Dr Anthony Le After receiving numerous messages from keen medical students interested in the field of occupational medicine, I wanted to reflect on my own pathway into the specialty and share the advice I wish I

’d had at the start.

My interest in occupational medicine began as a medical student, but like many, I couldn't see an obvious route in. The specialty was never mentioned in my medical school curriculum, nor were there any occupational health clinicians within the faculty whom I could speak to for guidance.

What worked for me and what I'd recommend to anyone curious about the field, comes down to three key actions: research, networking, and reaching out.

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1. Do Your Research Start by understanding what occupational physicians do day -to day, the diverse sectors they work in, and the necessary qualifications.

You can do this with a simple Google search, or by reading articles on trusted sources like the iOH and the SOM. I booked myself onto a SOM Careers Conference in London, which allowed me to meet members of the OH community in person and kickstart my networking journey.

them to help me find the time to book these shadowing days.

3. Navigate the Qualifications The next big step for me was the Diploma in Occupational Medicine.

It's a highly realistic qualification to pursue alongside a training programme, and the revision perfectly consolidated everything I'd seen in clinic. It was hard work,

2. Reach Out and Shadow

but sacrificing evenings and weekends was worth it, as it ’s often a mandatory step to open the door to occupational medicine work.

The next step is to find occupational physicians in your area and reach out. This felt daunting at first, but I found the OH community remarkably

Note: Another option is to apply for specialty training directly at the ST3 level (after successful completion of CT2/ST2 in a UK core or specialty training programme),

generous with their time. By making direct contact and simply asking, I was able to join two different occupational physicians in clinic: one working in a corporate setting, and the other with the police force.

which can be done without the diploma.

Seeing the specialty in two very different sectors was invaluable: same core clinical principles applied across completely different working environments, risks, and organisational cultures.

I managed this alongside my Foundation Year training by utilising my study days. I let my Educational Supervisor know about my interest early on, which allowed 32

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4. Find a Mentor and Stay Connected The connections I made through shadowing didn't just end there; they bloomed into real job opportunities. I now work regularly part -time as an occupational physician alongside my other commitments.

However, my most important piece of advice is once you have the diploma and have secured a job as an Occupational Health Physician, firstly congratulate yourself, but secondly have a mentor . An

experienced occupational physician you can go to, discuss cases with,

discuss cases, and learn from each other. The specialty is small enough

and escalate concerns to is essential. Ideally, you want a clear point of escalation to a consultant for the most complex cases.

Occupational medicine can feel isolating in its early stages, particularly in sessional work, and a strong support structure is what keeps your practice safe and your development on track.

that the community truly becomes your continuing education.

If you're a medical student or a doctor in training with even a passing curiosity about occupational medicine: do the research, network, and reach out.

That's how I got here, and the door is much more open than you think.

Finally, stay connected. Keep in touch with other OH physicians,

2. Finding My Path in Occupational Health

By Dr Osas Utubor

(AFOM) Unlike most people, I deliberately sought out Occupational Health, during the COVID 19 pandemic. Shadowing wasn't possible until my very first day as an Occupational

-

Health Physician. A gamble, but one I clearly don't regret.

Like all doctors, I rotated through specialties early on, taking the obligatory occupational history as a tick -box exercise (and sometimes not even asking the question), never quite knowing what to do with it. What drew me in was the question that history never answered: what is this person's working life doing to them?

Occupational health sits at the crossroads of medicine, law, public health, and the workplace. For this reason, I find it a fascinating speciality. No two cases are ever quite the same.

The CESR Route: How to get started (CESR and AFOM) CESR (Certificate of Eligibility for Specialist Registration) is the route for doctors without a traditional UK training number who can otherwise evidence competencies against the Occupational Medicine, Specialty

Specific Guidance (SSG) curriculum.

It sounds administrative. It is. It's one of the hardest professional undertakings I've faced - because there's no cohort, no rota, no one keeping you on schedule. I ’m currently undergoing it but here's what I ’ve learnt so far:

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• Get a supervisor or mentor

(MFOM/FFOM): this is the single most important step. A good supervisor tells you what evidence counts, how to frame it, where your gaps are, and to also help guide your revision for the MFOM Part 2/AFOM exam. If you don't have one, find one before you do anything else: ask your employer, approach the FOM/ SOM, contact consultants and network on LinkedIn. • Know the curriculum before you start collecting evidence: map every curriculum learning outcome against what you already have and what you're missing, early. Retrofitting evidence to fit a learning outcome after the fact is far harder than working the other way round. Keep the GMC SSG open and refer to it on a regular basis. CESR is a true test of your organisation skills and resilience.

• Speak to others:

there will

always be a colleague near or far undergoing CESR. Exchange tips, advice and support to help you achieve your competencies. The beauty of CESR is that it is quite flexible and there are many ways to achieve the curriculum learning outcomes.

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The MFOM Part 2/AFOM exam: How to get started and pass The MFOM Part 2 examination is the second and final exit exam for occupational health physicians in the UK, and it's also the route to becoming an Associate (AFOM) for physicians who aren't in an approved training post but want formal recognition of competence in the field.

At the time of writing this article, the exam has two components, and you must pass both: • SBA (Single Best Answer) exam.

Each question presents a clinical vignette followed by five answer options, and your task is to select not necessarily the only correct option, but the most appropriate response given the specific scenario described. In my opinion, I find these significantly harder than Multiple Choice Questions where there is only one right answer.

• OSCE. A practical, structured clinical exam with various stations, testing applied competence. Depending on your background, you may be very familiar with OSCE ’s or not at all.

I had the great pleasure of doing several OSCE ’s in each year of medical school.

The SBA and OSCE are marked separately, and you're required to

because this is a practical examination where you must

pass both to pass the exam overall.

speak. You must be comfortable with your verbal communication, especially your introduction speech in the station.

How to Prepare and Pass • Start from the curriculum: Questions are mapped against the OMST 2022 curriculum, so your revision should be too.

Check out the MFOM Part 2 SBA Blueprint and ensure each learning outcome is covered.

• Practise SBA technique specifically: SBAs reward a specific skill - reading the vignette closely enough to spot the detail that changes the "best" answer, then working through the distractors systematically rather than jumping at the first plausible option. Practising large volumes of vignette -style questions builds the pattern recognition needed to do this quickly under time pressure. A lot of candidates underestimate the importance of the SBA technique.

• Practise the OSCE against the actual blueprint.

The OSCE tests structured applied reasoning e.g., explaining a fitness for work decision. Rehearsing against official station blueprints and sample scenarios, out loud , with a colleague, study partner or even a family member, matters far more than reading about it. I emphasise rehearsing out loud

• Use structured revision courses or question banks.

A few providers run courses specifically aligned to the current SBA/OSCE format and OMST 2022 curriculum. You can pass without enrolling in a course, but I do recommend you do one. Question banks built specifically for this exam, with detailed explanations per question, are also useful for the sheer volume of vignette practice needed. My colleague and I have even created one due to the lack of resources for practice.

• Don't revise in isolation.

A study group matters more for this exam than it did for the MFOM Part 1/DOccMed, in my opinion.

The exit exam is more difficult, more rigorous and the curriculum is vast. Working with others ensures you are continuously benchmarking and finding gaps in your knowledge.

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On a final note

…

We need the next generation of Occupational Health Physicians. Occupational health remains underappreciated largely because most doctors never properly encounter it and the speciality is not mentioned enough in the mainstream media. It is clear to see that there is a rising sickness absence rate in the UK and Occupational Health referrals are becoming increasingly complex and challenging.

It is a brilliant speciality which offers variety, real autonomy and the chance to influence health across whole organisations.

If you're already established in the speciality, consider who you might reach out this week, month or year. That's how the specialty grows: one conversation at a time.

Dr Anthony Le |

Linkedin

Dr Le is an Occupational Health Physician with a diploma in Occupational Medicine. He works part time as an OHP, alongside being a Specialty Registrar in General Practice.

He is also a passionate medical educator, having worked as a medical tutor for aspiring medical students over the last 5 years

Dr Osas Utubor |

Linkedin

Dr Osas Utubor is an Occupational Health Physician based in Manchester. A graduate of Norwich Medical School, he holds the Associate of the Faculty of Occupational Medicine (AFOM) qualification and is currently pursuing CESR. Having worked in occupational health for several years, he has developed a particular interest in supporting the fire service.

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External OH Provision: The Benefits, Challenge

By Pippa C

Occupational health (OH) has always been shaped by change.

From Paracelsus recognising the relationship between mining and ill health in the 15th century, through to the appointment of Phillipa Flowerday as the first industrial nurse in 1878 and the many forms of provision seen today, the speciality has continually evolved ( Grandjean, 2016 ; Thornbory & Everton, 2018).

The nature of work and the populations we support are also changing; consequently, OH provision too must continue to adapt.

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es and Changing Landscape

Crouch From the

‘Pippa Show

’ to managed provision

When I established Global OHS, it was primarily designed as a ‘one -stop shop ’. Clients booked blocks of my clinical time, and, within them, I delivered whatever was reasonably required: health surveillance, management referrals, immunisations and anything else within my competence and the time available.

I believed there was an opportunity to challenge the conventional provider model. It began with considerable ambition and, although many of those original aspirations remain, experience has taught me that aspiration must coexist with commercial reality. ioh.org.uk

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Fifteen years ago, external provision appeared to consist

vulnerable: if I was absent, delivery could stop altogether,

largely of established providers supported by independent practitioners subcontracting through them.

Single -handed practitioners developing their own provider businesses certainly existed, but in my experience, they were relatively uncommon.

and the model was difficult to scale. However, the move from the ‘Pippa Show ’ to managed provision was not straightforward. The challenge was how to retain that relationship and organisational understanding while enabling different people to deliver the same

As Global grew, it became clear that not every OHA could, or should, do everything. We broadened our workforce, incorporating technicians, physicians, and administrative staff. We moved from predominantly site -based clinic days towards a blended model of onsite services, remote assessments, centralised systems, and multidisciplinary support. This reflected a concern I later explored when writing about the OH technician role: with declining specialist numbers, we needed to think creatively about how qualified OH expertise was deployed, while maintaining clear competence, supervision and governance (Crouch, 2022 ).

The original concept offered exceptional continuity: the client knew me, and I knew and understood the business.

However, it was also

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service to the same standard.

The move from the ‘Pippa Show ’ to managed provision was not straightforward.

With growth, we discovered what I describe as an “anti economy of scale ” or diseconomies of scale. As the number of fee -earning clinicians grew, so too did the need for additional administration, account management, technology and more clinical oversight.

In some respects, this has taken us back towards the traditional provider structure we were initially so determined to avoid.

A changing provider market The growth of external OH provision has been accompanied by increasing commercialisation.

The UK market is valued at approximately £1.5 billion (annual growth rate of 6%). Outside the military and NHS, more than 95% of OH provision is outsourced.

Several recent high -profile mergers and acquisitions have consolidated the upper tier, while the remainder remains fragmented: micro providers employing up to nine people account for approximately 43% of providers, with sole traders representing a further 17% (Mansfield Advisors, 2024 ).

Alongside this, the specialist workforce is contracting.

NMC data as of the 31 st March 2026 recorded 2,634 UK registrants with an SCPHN occupational health nursing qualification, (compared with 3,527 in 2013) a reduction of approximately 25%. These figures do not capture every nurse working in OH, nor confirm that every registrant is practising in the field, but they indicate increasing pressure on the workforce.

COVID -19 accelerated remote delivery and also changed professional expectations.

Undertaking remote case management offers greater flexibility, removes regular travel and may provide comparable or sometimes higher earnings than

site -based work. We have consequently found it harder to recruit experienced clinicians for roles involving travel, fixed clinics and responsibility for more risk based onsite activity.

-

These pressures have helped drive managed, multidisciplinary provision: providers are increasingly expected to supply a complete OH solution rather than isolated clinical services.

What external provision makes possible One of the key advantages of external provision is its independence, enabling practitioners to offer impartial advice that supports unbiased decision -making and enhances trust.

Additionally, external provision can also bring transparency and accountability. The scope, performance expectations and governance arrangements should be clearly defined within the contract, allowing activity, outcomes, complaints and performance to be scrutinised. That commercial accountability can be uncomfortable, but it should keep providers responsive and require them to demonstrate value.

A further strength is breadth. A provider can bring together nurses, physicians, technicians, mental health practitioners, ioh.org.uk

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physiotherapists and other specialists within a single

OHS has done this on several occasions. It is not

service. This gives employers access to expertise that may be difficult to sustain internally, particularly for smaller organisations, and allows work to be directed to the professional with the appropriate competence rather than expecting every OHA to do everything.

commercially risk -free, but it protects our independence and professional integrity.

Providers can also respond to fluctuating demand, cover absence and support employers across multiple locations. Their cross -sector experience allows for best practice and learning to be shared. For practitioners, this makes the work varied and

team to observe how work is undertaken or speak with employees on the shop floor.

Good providers must address this deliberately through continuity of practitioners, regular site visits and meaningful engagement with employees, managers and safety representatives. The

engaging; for example, a single week might involve a complex mental health case, health -surveillance clinics, vaccinations and advice about shift patterns. Likewise, there is often greater scope for career development.

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Building relationships from the outside External provision can create distance from the workplace.

We may have fewer informal opportunities than an internal

strongest relationships combine an outsider ’s objectivity with an insider understanding of the workplace.

’s

A broader and evolving OH offer

Perhaps most importantly, an external provider retains the

The OH brand is also changing.

Our offer is broader than ever:

ability to walk away. Where a client repeatedly disregards clinical advice, refuses to engage with appropriate governance or expects us to act contrary to our professional ethics, we can terminate the contract. Global

multidisciplinary provision can encompass neurodiversity, women ’s health, mental health, and the implications of artificial intelligence and new ways of working. This breadth enables OH to respond to changing workforce

Volume 33 Issue 3

expectations while retaining its essential focus on the relationship

repeated attempts to develop an affordable offer for smaller

between work and health.

employers, with limited success.

Too often, an SME approaches OH only when a case has reached crisis point and wants an immediate answer to absence, performance or capability concerns rather than a preventive relationship.

Government figures indicate that only 18% of small employers provide OH, compared with 92% of

However, the boundaries of workplace health are becoming increasingly crowded, with wellbeing platforms offering employee benefits, and digital health products, HR and health and safety providers all offering elements of support. OH has an important opportunity to hold the ring by bringing together health, work, prevention and clinical governance so that services complement each other rather than operating in silos.

WISE -QM , the Wellbeing Initiatives and Services for Employees Quality Mark, developed jointly by the Society of Occupational Medicine and the Royal College of Psychiatrists, is a welcome development. It aims to provide an evidence -informed benchmark for workplace wellbeing services and help purchasers make more informed decisions. Its development reflects the need for greater transparency and assurance in a rapidly expanding market.

Making external provision work Providing access to smaller employers remains one of the sector ’s greatest opportunities and frustrations. There have been

large employers ( Department for Work and Pensions and HM Treasury, 2023 ).

Providing access to smaller employers remains one of the sector ’s greatest opportunities and frustrations.

Running an external clinical service also means running a business.

Clinical expertise does not automatically provide the skills needed to recruit and manage people, understand finance, generate business, negotiate contracts and what can feel like a hundred other functions that are essential but do not directly generate income.

There is perhaps a version of the Peter Principle here: being an excellent clinician does not necessarily make someone an ioh.org.uk

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effective business owner.

Practitioners/ providers must

another. Each change risks disrupting clinical continuity,

develop those capabilities or recognise when to bring in others whilst balancing affordability with the true costs of safe, resilient provision.

employee trust, organisational knowledge and longitudinal health -surveillance records. It can affect outcomes when emerging patterns or previous concerns are lost between systems and providers.

Procurement presents another challenge because OH is not always understood by those purchasing it. Tender exercises can reduce complex clinical services to unit prices, volume and turnaround times. This creates ‘vending -machine OH ’: what is the price of one audiogram or one management referral? The more important questions are how many assessments can be

understand the work, its risks, the people delivering it and their challenges, management styles and unwritten culture before we can move beyond reactive advice and influence prevention. In my experience, meaningful cultural influence may take five to seven years, often longer than the initial

completed safely, whether the clinician understands the workplace, what governance supports the service and what happens when an abnormality or significant risk is identified.

As such, low unit prices may conceal unrealistic workloads, fragmented subcontracting, inadequate escalation and

procurement cycle. Drucker argued that organisational culture is highly persistent and should be worked with rather than assumed it can be replaced ( Drucker, 1991 ). We cannot understand or influence a culture if we are replaced before the relationship has matured.

poor continuity, contributing to a race to the bottom.

The market also lacks consistent service -level regulation. Whilst clinicians are regulated by their professional bodies, provider organisations are not universally subject to the same external assurance.

SEQOHS offer an important

That race can also shorten provider relationships.

Employers may retender frequently and move between providers as though one service can be exchanged for

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An effective OH relationship takes time. We need to

Volume 33 Issue 3

accreditation framework, although participation remains voluntary,

success depends on providers remaining commercially

leaving some purchasers to compare services with potentially very different levels of governance and professional support.

sustainable without surrendering the values that make services work.

The challenge of change, therefore, is not merely to grow, but to preserve what was valuable in the model we have left behind while remaining relevant to the world of work ahead.

Partnership, not outsourced responsibility External provision works best when the relationship is a genuine partnership. Simply appointing a provider does not transfer or abrogate the employer ’s responsibility for workplace risk assessment, management decisions or acting on appropriate advice.

Equally, we must take the time to understand the organisation, its people, its work, culture and limitations. Generic advice may be clinically correct; it offers little value if it cannot be implemented.

The strongest relationships combine our independence, breadth and cross -sector experience with the employer ’s knowledge of its workplace. Both parties must be prepared to hear difficult advice, act on emerging risks and invest in prevention rather than waiting for a crisis.

External provision offers enormous potential: access for smaller employers, multidisciplinary expertise, varied and rewarding work for practitioners, resilience for organisations and a genuinely independent clinical voice. Its

References and supporting sources Nursing and Midwifery Council (2026), Freedom of Information response: SCPHN occupational health nursing register data, March 2026.

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

, 2nd edn, Oxford:

AI use statement ChatGPT was used to support the organisation of the author ’s original content, language editing, grammar checking and reference formatting. All factual content, professional opinions, personal experiences and conclusions are the author ’s own. The author reviewed and verified the final content and cited sources and retains full responsibility for the integrity and originality of the submission. ioh.org.uk

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Pippa Crouch |

Linkedin

Pippa Crouch MA (Law), BSc (Hons), SCPHN (OH), RN, Clinical Director, Global Occupational Health Solutions With over 15 years of experience in the field, Pippa has a strong focus on employee wellbeing and preventative measures. Her published works include research on Hand Arm Vibration Syndrome (HAVs), substance misuse, the evolving culture in occupational health, and the origins and education of occupational health technicians. She holds a BSc

in Public Health, am a registered Special Community Public Health Practitioner, and have an MA in Medical Law and Ethics. Her career spans both public and private sectors, across various industries, with a particular interest in driving continuous improvements in occupational health practices.

Correspondence:

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pippa@globalohs.com

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Beyond the Clinic: Uniting Occupational Health and Hygiene for a Safer Workplace

By Mark Holehouse

“Prevention is better than cure is a principle that sits at the very heart of occupational hygiene.

The profession is grounded in the principles of anticipating, recognising, evaluating, and controlling workplace health hazards. However, true prevention is rarely achieved in isolation. To this end, the holy grail of Occupational Health must be collaborative working; the close co -operation of Occupational Medicine, Occupational Hygiene and other health -related disciplines, to bring together the skills of all parties to achieve and maintain a

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, Paxidia Chirau and

”

Ieuan Orton

fit and healthy workforce. However, in the modern workplace this close co -operation and communication is not always possible as these functions tend to be separated, contracted out or provided by ad hoc consultants rather than delivered as a single, embedded service in -house.

In its delivery of an integrated Occupational Health Service for EKFB (joint venture for the HS2 project), PAM Group has bucked this trend and has provided a multi disciplinary team to successfully influence and benefit workers ’ health protection. The Client, EKFB, is responsible for a large rail

-

-

infrastructure and construction project, covering rural locations

implemented controls and ensure that exposure levels have been

stretching approximately 80 km in length. The PAM Occupational Health/Hygiene team is embedded within key locations across the geographical area and regularly engages with operational sites, both participating in and leading a range of health improvement initiatives.

reduced to acceptable limits is easily achieved.

The service is integrated within the wider Health and Safety framework, ensuring the effective delivery of Occupational Hygiene activities and close alignment with client teams. This collaborative approach supports not only the collection and interpretation of exposure monitoring data, but also the implementation of

be able to work within such a diverse team. Through effective cross communication within the groups, it has been possible for all to have a greater understanding of the bigger workplace picture and to achieve a proactive rather than a reactive approach to worker health.

recommended control measures.

out by the PAM OH Team and the added value benefits these have delivered to the Project. This really

From the point of view of an Occupational Hygienist, within a multidisciplinary PAM OH Service comprising Occupational Health, MSK / Physiotherapy, Wellbeing, Counselling, Drug and Alcohol Testing, it is particularly pleasing to

Below are some examples of the types of co -operative work carried

Traditionally, a consultant would not have such close integration with Health & Safety teams.

However, this is a key advantage of our in -house role, enabling a much stronger and more direct working relationship. This integration allows actions to be raised across a variety of platforms and assigned directly to relevant duty holders and Health & Safety teams, ensuring a timely response and the efficient implementation of improved control measures. Follow up surveys are also more easily conducted, as access to site to verify the effectiveness of

-

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This hands -on experience provides a genuine appreciation of real working practices and conditions.

As a result, clinicians can engage more effectively with workers, as their knowledge of the workplace is significantly enhanced.

Ergonomics – Working closely with the MSK/Physiotherapy team, driver ergonomics assessments and risk factor tools are used alongside

demonstrates the 2 -way street where Health Practitioners inform Occupational Hygiene and vice versa: Regular team site visits – Clinical teams can go beyond the clinic by accompanying the Occupational Hygiene team on site visits. This allows them to experience the working environment first -hand and gain a deeper understanding of the tasks carried out across various job roles on the project.

During these visits, the Occupational Hygiene team emphasises the importance of overall health and wellbeing.

Clinicians can observe workers in their natural working environment, which helps them better understand how and why exposure to workplace hazards may occur during routine activities.

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Whole Body Vibration (WBV) monitoring to accurately characterise exposure risks for plant operators during earthworks activities. This approach enables the early identification of risks and supports the prompt implementation of effective mitigation measures, which is critical in preventing prolonged exposure.

MSK teams also can visit sites and experience the range of plant cab designs and features first -hand, providing them with a realistic understanding of the condition ’s operators are exposed to. This insight is invaluable when treating plant operators, as it allows clinicians to deliver more targeted rehabilitation and treatment strategies based on a clear understanding of the specific demands and exposures associated with their working environment.

By integrating data from Occupational Hygiene reports, fit for work medical assessments and

physiotherapy appointments, MSK body mapping can be developed to identify key trends and risk areas.

This information is then used to design targeted MSK Conservation Programmes. These programmes aim to address specific ergonomic risk factors associated with individual job roles across the project, focusing on both prevention and early intervention to reduce the likelihood of musculoskeletal disorders and improve long -term workforce wellbeing.

Trends Any trends identified from Occupational Health appointments are shared with the Occupational Hygiene team for further investigation. This includes the anonymised results of health surveillance activities such as audiometry, spirometry, health screenings, and early indicators of ill health.

exposure monitoring.

Likewise, the OH Team can acknowledge the main risks of occupational exposure based on the information provided by Occ Hygiene surveys from specific work location/site and job roles and determine exactly what biological screening or targeted health surveillance to perform. Surveys are just snapshots of the work activity, but results can be extrapolated for the same activity carried out at different locations across the Project to ensure all workforces are covered and good practice is applied across all the projects.

Education Learning is supported through knowledge sharing from Occupational Hygiene to our clinical teams. Structured training sessions ensure a consistent

This collaborative approach enables a clearer understanding of potential workplace hazards, helping to prioritise on -site assessments and inform the selection, implementation, and evaluation of appropriate control measures. It also supports the early identification of situations where urgent Occupational Hygiene intervention may be required, including the review of existing controls and the need for additional ioh.org.uk

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traditional verbal Toolbox Talks.

Professional Development (CPD) sits at the heart of the educational support we provide to the Health and Safety teams. Through focused training sessions, we deliver a deeper understanding of construction -related hazards and exposures, helping colleagues develop the knowledge and confidence needed to identify and manage health risks effectively on site.

delivery of evidence

-based

information, while also enhancing clinicians ’ understanding of key occupational hygiene principles, including the application of the hierarchy of controls for different health hazards encountered on site.

Occupational Hygiene monitoring results are translated into targeted education sessions by the Occupational Health team, creating opportunities to engage effectively with individuals in both small group settings and larger forums. Health hazard training programmes and Toolbox Talks are delivered as interactive awareness sessions, focusing on the potential health impacts of workplace exposures and the importance of adhering to site procedures and robust risk assessments. These sessions have proven to be highly effective, generating significantly greater engagement compared to 52

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We believe that the word Health appears first in the phrase Health and Safety for a reason. Protecting workers from long -term health risks is just as important as preventing immediate safety incidents. By increasing awareness of occupational health hazards and recognised good control practices, we enable H&S teams to confidently challenge traditional construction methods and promote healthier ways of working.

Collaboration is a key part of our approach. We have delivered several joint training sessions alongside members of the H&S team, demonstrating the value of an integrated approach to worker protection. These co -delivered sessions help colleagues better understand the role of Occupational Hygiene within the wider health and safety framework, strengthening cross -disciplinary working and supporting a shared

commitment to protecting workforce health and wellbeing.

Health Risk Register Occupational Hygiene survey results can be incorporated into the development of a Health Risk Register, enabling effective health risk profiling across projects. This involves characterising likely exposures and their severity for different job roles and similarly exposed groups. This information supports the development of a more informed and targeted health surveillance matrix, ensuring delivery aligns with regulatory requirements and is specific to the risks identified.

In addition, detailed data can be captured, contributing to the development of robust databases such as those used for HAVS and WBV exposure monitoring during task -specific activities involving various plant and hand -held tools.

Collectively, this data strengthens the evidence base for more robust, task -specific risk assessments, supporting EKFB in implementing effective control measures.

By integrating clinical evaluations and assessments with Occupational Hygiene and Wellbeing, this multi disciplinary model successfully shifts worker health from a reactive fix to a proactive, preventive

-

strategy. Ultimately, uniting these disciplines ensures hazards are identified and controlled effectively, while providing workers with holistic, on -site support to thrive both professionally and personally, and all achieved in a cost -effective manner. In doing so, organisations can move beyond compliance and towards excellence, creating safer workplaces, healthier employees, and better overall outcomes.

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People Assets Management (PAM Group) & EKFB

Ieuan Orton (Occupational Hygienist

– AFOH)

Mark Holehouse (Occupational Hygiene Lead

– CMFOH)

Ieuen was a Peripatetic OHT after completing his BSc and MSc in Sport and Exercise Science and Nutrition. During his time as an OHT, he developed a strong passion for protecting workers' health, which inspired him to transition into Occupational Hygiene, where he has been working for over three and a half years.

Mark Holehouse is a Chartered member of the Faculty of Occupational Hygiene and has over 40 years of experience in the profession. His career has included work in consultancy as well as pharmaceuticals, oil and gas, and the NHS. The last 5 years have seen him providing Occupational Hygiene support within this large infrastructure project.

P axidia Chirau (Occupational Hygiene Technician

Paxi is an Occupational Hygiene Technician working on the EKFB rail construction project. Her career began in the NHS as a surgical nurse before moving into occupational health nursing in construction in 2021. This transition reshaped her understanding of health and the importance of early intervention in preventing illness. This motivated her to pursue a career in Occupational Hygiene. Although still early in her career, she is passionate about helping workers understand how effective control of workplace hazards protects their long -term health."

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– AFOH)

Three ways to be wro A researc

By Pablo

One bias hides' harm. One invents it. The method I built to detect th

In one hospital's routine surveillance, rotating shift workers came out with less than half the cardiovascular risk of day staff, a number that contradicts every prospective cohort in the literature. This is what happened when I took it apart: two biases pulling in opposite directions, and the collapse of the diagnostic I had built to demonstrate the first. Two of those biases live in surveillance data almost every occupational health service holds. The third lives in the analyst.

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ong about night work! ch study

o Llamas

he first did not survive contact with the third.

The duty came first; the evidence arrived afterwards Regulation 7 of the Working Time Regulations 1998 entitles every night worker to a free health assessment and consideration of a transfer to day work where a doctor advises that night work is harming their health. ¹ The HSE's Managing shift work (HSG256, 2006) treats shift work as a hazard requiring formal risk assessment. ² The legal architecture was complete by 2006, while the chronic -disease evidence arrived afterwards: the Nurses' Health Study analysis in 2016, ³ UK Biobank in 2022, ⁴ and the largest synthesis to date, 23 cohorts and 3.34 million participants, in 2025. ⁵ Precaution was a reasonable basis for legislating. But we inherited a duty while the numbers that would size the problem are still settling, and we are asked about those numbers constantly. ioh.org.uk

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A note on this study: The hospital is Spanish; unwell night workers are moved off shifts under occupational health (OH) legislation rather than regulation 7. The mechanism is structurally equivalent, but not identical. Regulation 7 requires transfer to day work only where possible. With no vacancy, the UK road can end in capability dismissal, if adjustments under Equality Act 2010 duties (if applicable) are not possible. Therefore, leaving the worker invisible to cross -sectional data, as opposed to one who moves to day shifts. Second, this is a public -hospital healthcare workforce with high job security: dismissal and resignation are uncommon, so exits are usually internal transfers; which this dataset partially observes. One local feature that has no UK counterpart and matters later: staff may claim exemption from night work from age 55 regardless of health.

Bias one: The survivor effect hides harm Among 1,896 workers aged 40 –69, 34.3% of day workers carried a ten year fatal cardiovascular risk of 1% or more, against 14.0% of rotating shift workers. Crude odds ratio 0.31 (95% CI 0.24 – 0.40). A pparently, rotating shifts being more than three times protective.

Nobody believes that! The healthy worker survivor effect, (Arrighi and Hertz -Picciotto, ⁶) is the reason: workers who develop disease, selectively leave the higher exposure job, so the cross -sectional residue is enriched with survivors.

In a regulated system, the mechanism is not incidental but mandated. Every time we correctly move an unwell night worker to days, we move a case from the exposed column to the reference column. The bias makes night work look safer than it is.

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Using one variable at a time to adjust: crude 0.31, then 0.59 on age and sex, then 1.24 on occupation then 1.06 on seniority; on the continuous scale, rotating shift carried an 8.9% higher geometric mean risk (p=0.002). The fully adjusted contrast was not significant (p=0.31), so these data do not demonstrate excess risk, only that the apparent protection is not real.

Note where it stops being real! Not at the demographic step but at the occupational one.

In this dataset, the inversion happens almost entirely at adjustment for occupation. The survivor effect is a mechanism I can argue for on regulatory grounds and whose direction I can sign; it is not something I measured here.

,

Bias two: Occupational confounding invents harm Shift work is not randomly assigned. It tracks occupation, and occupation tracks class, job control and health behaviour. In our hospital the overlap was near -total: Cramér's V between shift and occupation was 0.72, with 81% of rotating workers being nurses and auxiliaries and 90.4% of them women.

We looked at psychotropic drug use, which has a shorter latency than atherosclerosis. Ascertainment came from the service medication reconciliation file, which covered 1,181 of 2,105 eligible workers and records non -users as well as users, so absence means "not checked" rather than "takes nothing". We ran it both ways. Among the 1,181: 28.0% versus 17.6%, crude OR 1.82 , unchanged by age and sex (1.74), and 1.35 (0.87 – 2.09), p=0.18 once adjusted for occupation. Across all 2,105, treating absence as non -use: 1.58, then 1.56, then 1.31 (0.87 – 1.97), p=0.20 . Gone, either way.

(Absence from the file did not differ by shift once occupation was accounted for: adjusted OR 0.99.)

Watch it happen once more, because this is what the trap looks like properly dressed. A pre specified family of four drug classes with false discovery rate control, adjusted for age and sex, gave significant results for

antidepressants (OR 1.57; p_FDR=0.045) and anxiolytics (1.95; p_FDR=0.045). Carried through the same occupational adjustment, neither survives; - 1.36 (p_FDR=0.34) and 1.73 (p_FDR=0.34). A pre -specified family, multiplicity control, two significant classes, a plausible mechanism, and nothing left once the job is accounted for.

The counterweight deserves its due: UK Biobank adjusted for socioeconomic and work -related factors and the association survived .⁴ Shift work is not harmless. It is that the crude number in front of you, in either direction, is almost never the answer.

Bias three: the instrument is an estimator too I wanted to show that the remainder was specifically selection , and thought I had a way.

In day workers, cardiovascular risk rose with years of service (Spearman r = +0.148; n=1,252); in rotating workers it fell (r = −0.118; n=644). Fisher's z = 5.50, p = 3.8 × 10

-

8

, with an adjusted shift × seniority interaction agreeing (p<0.001). Two estimators with different assumptions, converging on a p value with seven zeros. I wrote it up as a portable diagnostic any service could run.

Then a colleague asked the

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question I had not answered. The risk score is dominated by age; years of service correlate with age; so the gradient may be an age gradient in disguise. And if seniority tracks age tightly in one group and loosely in the other, you get the divergence with no selective exit at all .

The premise held: seniority –age correlation was +0.371 in day workers and +0.174 in rotating workers . So I ran the stratified analysis I had been telling readers to run.

Age band

r, day (n)

r, rotating (n)

Fisher's z

p

40 –49

+0.012 (380)

−0.066 (311)

1.02

0.31

50 –59

−0.012 (514)

−0.174 (222)

2.03

0.042

60 –69

+0.007 (261)

−0.541 (64)

4.31

1.7 × 10 -5

The 40 –49 band is the clean test: narrow age range, and the exemption does not begin until 55. It is null. The only strongly significant band is 60 –69, resting on 64 rotating workers, in exactly the range where the non -health -related exemption operates.

Removing age from both variables finishes it:

Subset Whole cohort, Excluding

40 –69

60 –69

Excluding age

≥55

Ages 40 –49 alone

Fisher's z

p

2.90

0.004

0.84

0.40

−0.70

0.49

−0.00

0.996

Below 55 the sign reverses. The adjusted interaction in that subset is β = −0.0003 (p=0.79). Once age is handled properly and the exemption - affected band removed, the dataset shows no interpretable survivor signature at all.

A null is not an exoneration either. The 40 –49 band had 94% power against a divergence of the magnitude originally reported ( Δr ≈ 0.27) but only 80% against 0.21; add the 209 examined workers with no computed score, who were older and

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Δr ≈

more often rotating, and the honest conclusion is that these data cannot answer the question .

Stratification does not refute the pooled statistic; it reinterprets it, by showing that the quantity it measured was largely age.

I report this rather than deleting it because a bias -detection instrument is itself an observational estimator, and can be confounded by exactly the variable it was built to see past. Worse: my two "independent" methods agreed because they shared the same unexamined assumption.

Convergence between methods is not robustness against a confounder both methods share.

The same lesson caught something else. I described five markers, smoking, BMI, FINDRISC (Finnish Diabetes score), glycaemia and waist –hip ratio, as negative controls showing rotating workers were not genuinely healthier. They are not negative controls: shift work plausibly affects every one of them. They are falsification markers lying outside the transfer criterion, which supports a narrower claim. No advantage shows where the transfer rule cannot be. That is not the same as saying these workers are not healthier.

What this means for practice If you cannot run the test, that is your finding.

For many services the honest result of attempting this will be discovering that the statutory night worker assessment produces a completed questionnaire and no analysable variable at all. A recurring legal health check that describes no population is worth raising with your board.

Record the reason for the transfer. If someone comes off nights on health grounds, that should be a retrievable field, not free text. Without it the single most informative event in the system is unanalysable, and the movement of people between exposure groups is the data, not the housekeeping.

Stop reading cross - sectional comparisons as evidence about the hazard. They are not evidence about night work. They are evidence about who is still doing it.

And treat your own methods the way you treat other people's findings. Building instruments to see what routine data hide, is the job. Trying to break them before someone else does the same job.

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Limitations Cross -sectional and single -centre: no temporal or causal inference. The cohort is the end of a cascade, 3,092 eligibles, 2,105 examined in window, 1,896 scored. Leaving 209 (9.9%) examined but unscored, who were older and more often rotating, and no individual -level data with which to weight for them. Exits by resignation, self -selection out of employment entirely, are unobservable in a dataset of current workers; in settings where leaving is easier than a public hospital (manufacturing, for instance), that channel may dominate, and these findings would understate it. We used the older SCORE chart rather than SCORE2, HDL being recorded in too few files. The age -55 exemption means part of the exit at older ages is entitlement rather than selection, which turned out to matter more than any other feature of the data. And the near collinearity of shift and caring role that makes this hospital a clean illustration of bias two is what stops it settling anything about bias one.

CPD box null

— One screen, one test, and a worked example that came out

You need: shift group; years of service in that pattern; any numeric risk index you already calculate; occupational category; age.

The screen (not a test).

Within each shift group separately , correlate years of service with the risk index (Spearman), then compare the two with Fisher's z: z = (arctanh r ₁− arctanh r ₂) / √[1/( n₁−3) + 1/(n ₂−3)]. Treat the result as uninterpretable on its own your index contains age — QRISK3 does — a large divergence can be produced entirely by seniority tracking age more tightly in one group. In my data this screen returned p = 3.8 × 10 -8 and meant nothing.

The test. Repeat within ten -year age bands, and on the residuals after regressing both variables on age. Exclude any age range where staff can leave nights by a route that is not health -related. Report the stratified result; the screen is not the finding.

The worked example.

Mine came out null. That is what you should expect, and it is not a failure of the exercise: it means your surveillance data cannot answer the question, which is worth knowing before you build policy on them.

Test two — is your finding about the job?

Run it crude, then adjusted for age and sex, then adjusted for occupation restricted to occupations containing both shift patterns. If it collapses at that last step, you were measuring the job.

Two cautions.

Do not interpret correlations from small cells — my strongest apparent signal came from 64 people. And compute the divergence your stratum can actually detect before you read anything into a null.

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. If

References

6. Arrighi HM, Hertz -Picciotto I. Epidemiology 1994;5(2):189 –96.

1. Working Time Regulations 1998, SI 1998/1833, reg. 7.

7. Härmä M, Gustavsson P, Kolstad HA. Scand J Work Environ Health 2018;44(3):225 –8.

2. Health and Safety Executive.

Managing shift work: health and safety guidance . HSG256. HSE Books, 2006.

8. Dicom AR, Huang X, Hilal S. Environ Res Public Health 2023;20(3):2047.

3. Vetter C, Devore EE, Wegrzyn LR, et al. JAMA 2016;315(16):1726 –34.

Int J

9. Buckley JP, Keil AP, McGrath LJ, Edwards JK. Epidemiology

4. Ho FK, Celis -Morales C, Gray SR, et al. Int J Epidemiol 2022;51 (2):579 –90.

2015;26(2):204 –12.

10.VanderWeele TJ, Ding P. Ann Intern Med 2017;167(4):268 –74.

5. Xi J, Ma W, Tao Y, et al.

Front Public Health 2025;13:1668848.

Competing interests.

The author is founder and shareholder of a company developing occupational health surveillance software, including tools that compute the analyses described here. No funding was received and the company had no role in this work.

A methodological panel covering the falsification -marker design, the E -value, the handling of quasi -separation and a 500 -replication sensitivity analysis of a contested exposure coding is available as online supplementary material.

Pablo Llamas |

Linkedin

Pablo Llamas, MD, is a specialist registrar in occupational medicine at a Spanish tertiary teaching hospital, where his work concerns quantitative methods for occupational health surveillance, and the founder of Metsias PRL SL, which develops occupational health software. He designed and carried out the analyses described (Python 3.11); code and the pseudonymised dataset are available to readers wishing to replicate the methods, subject to ethics committee approval. The study was approved by the institutional research ethics committee and conducted on pseudonymised routine surveillance data under EU Regulation 2016/679. With thanks to the colleague who asked the question in section three, and then the harder one after it.

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Psychological trauma, application of theory to practice

By Katie Amis

- Hughes

This article continues the themes of the previous article (OH Today May 2026: Psychological Trauma: Why it is Relevant to the Workplace ), examining psychological trauma in more detail and asking what the theory means for our daily practice. These reflections are driven by evidence informed professional opinion.

Two key areas are discussed, ➢ being trauma informed in Occupational Health (OH) and ➢ being trauma aware in our assessments.

Trauma informed practice Trauma informed practice was introduced in OH Today (May 2026) by Sam Langford, who discussed the different paradigms of trauma informed work, specifically safety, trustworthiness and transparency, choice, collaboration, empowerment, and cultural consideration (Office for Health improvement and disparities 2022).

Within OH we can build our work within this framework; from protocols to assessments.

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The OH assessment The assessment starts when the manager triggers the referral. Commonly, referring managers misunderstand OH. Therefore, the first part of our work should be the education and understanding of the role of OH and how to make a good referral. The foundations of the trauma informed process starts by obtaining the employees consent to the referral, consent to the information contained in the referral and ensuring they are aware of the purpose of the referral. Thereby instilling trust, transparency, and safety in the referral process. Building awareness of OH and its purpose is key to building knowledge, creating boundaries, and promoting transparency.

The next step is contact with the individual, commonly the appointment email or letter. It is an opportunity to present an introduction and welcome to OH, written in an approachable manner. The letter should set out the expectations for the appointment, include key information such as location, name of the practitioner who will contact them, the duration of the appointment and what to expect. This removes uncertainty and starts to build a sense of safety and trust in the relationship. Most letters include a statement on confidentiality and the consequence of not attending. Language is important, promoting cooperation and collaboration, rather than authoritative instruction.

The consultation The principles suggested by Langford (2026) create a safe environment for an individual to engage. It is helpful to begin with a clear and structured introduction including an ID check, practitioner introduction, and seeking clarity that they are in a private location so they can speak easily (remote assessments).

Setting expectations and boundaries of the consultation process is crucial in creating a trusting and safe relationship.

OH need to obtain information to appraise and give advice, providing explanations for certain questions are asked. Adding value by offering rationale for why they may be experiencing a symptom. Actively listening to concerns allows the individual to feel heard and can be a springboard to individual empowerment. Taking a few moments to understand the holistic picture enables individuals to feel that they are in a safe place. A supportive conversation creates a connection, which then transitions to exploring choices for the individual in a collaborative and empowering way. Careful conversations align with choice, collaboration, and empowerment paradigms of trauma informed practice.

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Psychological trauma, application of theory to practice

Experience is drawn from working in policing, where police officers are naturally cautious. The first few steps of an assessment are especially important in creating a safe environment and building rapport. An individual may present with arm pain yet also have a history of trauma.

Creating the right environment can put employees at ease and improve engagement, the alternative being limited outcomes, and the individual ’s perception of OH may be unfavourable.

The report The use of supportive and plain language is important, especially avoiding stigmatising phrases. The effect of the phrases in the report such as ‘the employee is experiencing, ’ rather than ‘the employee is suffering from, ’ or the ‘employee described finding the situation difficult to manage ’ rather than ‘the employee failed to cope. ’ provide a more positive message. The report is an important opportunity to promote respect yet still deliver the key messages.

How to assess trauma in occupational health.

The following reflection is a demonstration of how knowledge and experience of trauma can be applied to OH assessments. The process adapts as the situation allows and a flexible approach can offer the most value to the assessment process.

What?

The practitioner needs to be aware of the signs and symptoms to be able to identify and assess the functional impact. There is not a specific tool designed for this, except for PTSD itself. There are limits to using tools as they create too much of a focus on the results rather than our whole assessment.

OH use a biopsychosocial approach, looking at the individual as a whole. This approach allows the practitioner to explore somatic symptoms , to support curiosity with the employee and empower self -care. As Buxton (2023) identifies, people want more than a box to tick, they want to be seen and heard.

So what?

Functionality should be applied. The Trauma Screening Questionnaire (TSQ) ( Brewin et al 2018 ) may be useful as a guide, when exploring activities of daily living, how symptoms manifest and if there has been change since the index event. See table for a suggested structured assessment: -

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Sleep patterns

Getting to sleep and staying asleep, nightmares and hypervigilance preventing sleep, upsetting dreams, feeling rested after sleep.

Appetite

Motivation to eat, have eating patterns changed, have energy levels changed.

Social support

Who is around that they could talk to, do they talk to them, do they feel isolated. Have they been out to busy places such as supermarket, shops, restaurants and how did it feel – looking for hypervigilance and if they feel safe in these environments?

Concentration

Is it harder to concentrate, can they complete a task, watch tv and follow the program. Engage in a conversation with more than one person (manage/tolerate this). Any periods of not feeling themselves, not engaged in the task, reduced memory.

Temperament

Have they been more irritable, angry, shouty. Is this normal or a new behaviour. Are they struggling or do they struggle making and maintaining relationships?

Feeling more on edge

Feeling jumpy, how does this feel, exploring sweating, increased heart rate, etc. any triggers to this.

Have they have been sighing more, or yawning more (being huffier puffy), this can represent the body feeling more on edge trying to recalibrate.

Suicidal thoughts!

Avoidance

The presence of flashbacks or thoughts of the event; do they block these or allow them to run. Any other avoidance such as going to places, seeing people, or daily tasks like avoiding sleep.

New physical problems

Fatigue, pain, aches, dizziness. Chronic pain, (this is more common in historical trauma).

Consider changes to functionality, in daily life both at home and work and frequency of the symptom/behaviour. Enquire how the individual feels about their symptoms and situation as this opens the discussion for observing changes with the individual.

Using knowledge of trauma and how the brain responds, offer rationale for some of these symptoms and behaviours. Validating the individual can reduce isolation and offer reassurance.

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Note on self - care

Psychological trauma, application of theory to practice

Understanding the nature of the event (not details) can inform our onwards advice for example avoiding tasks that could be retriggering or cause further traumatisation. Explain that the focus is on impact and support moving forwards.

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What now?

Offering a rationale or explanation for symptoms, creates some validation and connection, building trust and safety. This serves to offer the individual choice with their support moving forwards and empowers them to regain control and self -care. Self -care starts with basic activities and can start with a grounding exercise. Through the assessment, judge how to pitch the advice. Establish what is important for the individual in regaining some control. A technique to help them feel calmer could be simple breathing exercises, wiggling toes in their shoes, or a grounding exercise such as the 5, 4, 3, 2, 1 technique (Van der Kolk 2014 ). They may want to learn more about how trauma impacts individuals, seeking to move away from feeling isolated. When needed, make a referral to further psychological support.

Key adjustments include steps to create a safe, predictable, or routine environment and to avoid re -traumatising. In policing this is often removing them from frontline duties for a period while they access support. It can also be invaluable to provide advice to managers to widen their understanding. Finally, create a plan for their individual and proposed workplace support, and acknowledge that the conversation may have been difficult or challenging and thank the individual for working with OH.

Conclusion OH professionals are in a key position to show we care. Individuals who are managing trauma may feel daunted or intimidated by the management process or intervention; we are in a key position to show that care. Making the OH journey accessible and approachable creates a sense of safety and trust, which can lead to a more positive experience.

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Katie Amis

- Hughes

Katie is an experienced occupational health nurse advisor; she has worked in occupational health for over 18 years. During this time, she has worked as a nurse advisor and at management levels. Most of her work has been within policing, and she has presented different topics at national and regional conferences. She is qualified to a master's level in occupational health and has been awarded the prestigious Queens Nurse title in 2018. She has supported many students through the SCPHN -OH pathway, which she finds rewarding.

Most recently, she has completed a PG Certificate in Psychological Trauma, allowing her to learn more about her passion of building awareness, support and compassion for those managing psychological trauma.

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Trauma-informed approaches in practice: Perspectives from a Workplace Wellbeing Lead Sam Langford MSc. Director of Workplace Wellbeing, iOH

T

his article continues our series on trauma -informed approaches exploring how it translates into practice in a workplace setting, and how Wellbeing Leads can carry the principles forward into their own organisations.

designed to reduce unnecessary distress rather than unintentionally contribute to it ( The National Forum for Health and Wellbeing at Work, 2026 ).

For organisations, becoming trauma -informed represents a move towards a more transparent and psychologically safe culture: one where there is greater understanding of how trauma can shape behaviour, and where systems and environments are

empowerment and choice, collaboration, peer support, and cultural awareness, and this article focuses particularly on where Wellbeing Leads, Human Resources (HR), Occupational Health (OH) and line managers can work together to improve

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We've previously covered the six principles of trauma -informed practice; safety, trustworthiness,

communication and build trust to improve workplace culture for all.

information; it is about recognising where overly formal language, or

As we ’ve discussed in the previous articles, we may never know whether someone has experienced trauma, and they should not have to disclose it. Taking a trauma informed approach across the organisation, for every employee, can reduce unnecessary distress and create a better experience for all.

complex explanations can increase uncertainty and sense of threat, particularly for someone who has been controlled, dismissed or not believed.

While there is not a list of words to use that will be safe for everyone, using active language to make clear who is responsible for what action, and explaining simply why they are required, can help reduce fears. For example, absence management policies should do more than set out reporting requirements and thresholds. There are benefits for building trust and transparency when the policy also explains that recording the amount and reason for absence helps the

Foundations A good place to start is with the organisation ’s foundations, and this means looking at policies, processes, and procedures.

Working with HR colleagues to review policies such as performance and absence management, return -to -work, and flexible working to consider how they might be perceived and whether language, tone or structure could inadvertently lead to or exacerbate a trauma response ( National Trauma Transformation Programme, 2023 Is the policy clear about what will happen, who will be involved and why information is needed? Does it explain what support is available as well as what the employee is required to do? Could any of the language sound unnecessarily judgmental or threatening?

Rewriting policies with trauma in mind, is not about removing the legal responsibilities or key

organisation to understand if there are underlying health issues, consider support and adjustments, and work to support employee health proactively.

Building trust ).

Reviewing policies is an important first stage to becoming trauma informed, but wider communication work is also necessary. This is where an organisation can really build trust among employees.

Policies are now clear about what will happen and why, but the communication and actions also need to mirror this. A Wellbeing Lead is often well placed to help organisations communicate the ioh.org.uk

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role of occupational health in a positive way. For many employees,

understanding why, they may perceive the process as

the first time they encounter occupational health is when a referral is made, perhaps due to long -term absence, and so it is not surprising that it can feel a little threatening. For someone with prior trauma, this uncertainty may increase their sense of threat and make it more difficult to engage with the process. By working to be

inconsistent or unfair.

Organisations can explain that fairness doesn ’t mean treating everyone in the same way. A trauma -informed approach has consistency in how it listens to and considers individual needs, while recognising that everyone has different health needs, roles, and personal circumstances. For those

more trauma -informed, organisations can begin to change perceptions of HR and OH by making them more visible and understandable, before they are needed; explaining what happens, and crucially, why it happens.

Simple suggestions here include videos on company intranet pages introducing the people within these

of us routinely involved, we know that these processes can take time, and some delays cannot be avoided; but by providing the employee with regular updates and clear explanation, we can prevent uncertainty from adding to distress.

Put simply, trust is built when what people experience matches what the organisation has said will

departments, simple explanations of what each does and having frequently asked questions alongside policies. The organisation also needs to collaborate with line managers, ensuring they have the confidence to explain the process in a compassionate and supportive manner, so that this builds on the trust established by the policy.

happen.

Alongside trust, comes transparency about the process, but also the purpose and outcomes and being honest about the limits of what can be offered. When employees see colleagues receiving different outcomes without

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Collaboration is key A trauma -informed approach is built on collaboration, both among those responsible for organisational policies and processes and with the employees who experience them.

Responsibility for managing an individual case will usually remain with the line manager and HR, with OH providing independent clinical advice. Collaboration does not mean involving everyone in every conversation; it means being clear about each person ’s role and bringing in relevant knowledge and

support when it may be helpful. In this instance, it can mean how

reduce the number of times they have to repeat what has happened

these departments can all work together to make the journey from line manager to HR to OH, and back into the organisation, more human. If the employee is repeating themselves at every step and doesn ’t understand why, the perception that the departments involved aren ’t communicating with each other, can heighten their

and help make the process feel more joined up. Is it possible to build on this by offering the employee a choice of communication methods to understand what helps them to feel most safe. Essentially, does the process feel joined up for the employee?

sense of threat. This can be particularly true for those with chronic health conditions or hidden disabilities, who may have gone through years of medical appointments before a diagnosis.

Managers can really help start this process by beginning with curiosity, seeking to understand what has been happening and acknowledging that it might feel like a scary process. This may identify whether the process itself is increasing distress and create an opportunity to explain what happens next, consider adjustments or seek support for the process.

Equally, does each subsequent stage of the process start with recognition of the information that has been shared before and an explanation of what is going to happen next, and why certain questions are being asked?

Ensuring that we discuss with the employee what information would be helpful to share, who it will be shared with and why, can help

Collaboration is as important following the OH consultation as it is leading up to it. While the line manager and HR will usually maintain responsibility for considering OH recommendations, there are opportunities for advisory involvement from organisational Wellbeing Leads. Often, the Wellbeing Lead has a broader understanding of support options, both internal and external, and where they may be sourced from, and can assist Human Resources in considering options. To ensure trust, the employee should be kept updated on progress, and it may also be appropriate to offer them internal peer -support alongside the process. It should be made clear about when this support may be offered, and the role it plays. It might be most useful when several departments need to consider options, or where an employee is finding the process difficult to navigate. Peer -support, being another important element of a trauma -informed approach, should ioh.org.uk

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not depend on an employee disclosing prior trauma. The

processes ( Sweeney and Taggart, 2018 ). Feedback from employees

support and regular updates can reduce fears and uncertainty about decisions being made without them. Often, employee assistance programmes, group income protection, health insurance, or opportunities for vocational rehabilitation may be overlooked, or the full extent of their provision is not known, and this is where a

can help organisations understand where communication was unclear, what felt supportive and what could be improved. Organisations can significantly improve trust by also communicating these findings, and what will or has changed as a result. Trauma -informed practice is not a finished process; it develops by listening, learning and

Wellbeing Lead can assist by bringing their knowledge to a case management process.

responding.

A key element of trauma -informed organisations is collaborating with those who use the service, and in this context that means listening to those who have experienced these

While this is not an exhaustive step by -step guide, hopefully it highlights where simple changes can make substantial differences to employees ’ experiences, and organisational culture.

Samanth Langford |

LinkedIn

Sam has an MSc in Workplace Health and Wellbeing and is the owner of Gaia Workplace Wellbeing. She is a workplace health & wellbeing professional, a TRiM manager, coordinator, and associate trainer. She is passionate about supporting trauma, grief, loss, and bereavement in the workplace.

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Health surveillance: Why quality data matters at every stag

By Nikki Cordell,

CEO of Cordell Health Ltd and Educational Director of E

ge

EOPH Ltd

H

ealth surveillance has an important role to play in

protecting workers from preventable work -related ill health. But simply having a health surveillance programme in place is not always enough. Its effectiveness depends on the quality of the information being collected, how reliably tests are carried out, how results are interpreted and, crucially, whether the data leads to appropriate action.

OH TODAY

This article looks at the importance of quality health surveillance data and uses workplace hazard scenarios and some of the tests involved to bring context to some of the points made.

What health surveillance is what it isn ’t

– and

Good data therefore matters at every stage.

Where insufficient information is available at the planning stage, there is a risk that health surveillance is not

The Health and Safety Executive (HSE) describes health surveillance as a system of ongoing health checks, and reminds us that, as employers, we must make sure workers ’ health is not impacted by their work.

Health

correctly targeted, resulting in exposed individuals being omitted and unexposed individuals being tested unnecessarily. If testing is not carried out to an appropriate standard, results may be misleading or unreliable. Even good -quality test results may be of limited value if they are

surveillance may be required by law where workers are exposed to substances or hazards that can cause identifiable health effects, where there is a reasonable likelihood that these could occur under the particular conditions of work, and where valid techniques are available

not analysed and interpreted by a suitably competent clinician.

to detect indications of the effect.

For occupational health professionals, the challenge is not simply to collect health surveillance data, but to ensure it is accurate,

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Crucially, this requirement applies even where controls are in place and health surveillance helps confirm that those controls are working as intended. This distinction is

important. Health surveillance isn general health screening, health promotion or simply monitoring people ’s health. It should be risk based and undertaken where workplace exposure makes it necessary.

’t

-

At its heart is prevention. In many areas of medicine, tests are undertaken because a person already has symptoms to identify

This is where health surveillance provides another layer of protection. Emerging health effects can indicate that controls need to be reviewed and potentially strengthened.

Consider noise exposure in a workshop. Appropriate controls may have been introduced following a risk assessment, but subsequent audiometry identifies a

the cause. Health surveillance is different: it looks at ostensibly healthy people who may be exposed to a workplace hazard and aims to identify signs of an adverse health effect at the earliest possible stage. Ideally, surveillance finds nothing. But if it does identify change, that information provides an opportunity to act before the

deterioration in hearing among workers. This should not simply be recorded as an individual clinical issue. It is potentially important data about the workplace.

problem progresses.

in the way the work is organised?

Surveillance is part of the control system

There can also be interaction between risks. Someone working around noisy machinery may simultaneously be exposed to vibration and solvents, some of which may themselves have ototoxic effects. Effective health surveillance therefore needs to

Health surveillance doesn ’t replace good risk management. Employers must first identify hazards, assess exposure and put appropriate control measures in place.

However, even well -designed control measures can fail.

Equipment can deteriorate.

Working practices can change. PPE may not be used or fitted correctly.

People can move around a workplace or spend longer in an exposed area than anticipated.

For example, has machinery become noisier? Are people spending longer close to it? Are hearing protection arrangements effective? Has something changed

consider the worker and their exposure in context rather than looking at an individual test result in isolation.

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Right person, right time, right test

Questionnaires are data too

Deciding who needs health surveillance in the first place depends upon good -quality information.

Health surveillance is sometimes associated primarily with the clinical test: an audiogram for hearing or spirometry for respiratory surveillance. Yet questionnaires completed by workers can provide equally important information and

A workplace risk assessment might, for example, identify a respiratory hazard affecting employees working directly with a particular substance.

sometimes an opportunity to take required action earlier.

But what about a colleague working nearby? Their job description and title might suggest little or no exposure, while the reality of the working environment could be very different.

A respiratory questionnaire covers symptoms including coughing, wheezing, runny eyes or nasal symptoms and whether these change according to whether someone is at work or away from it.

These symptoms can precede

Occupational health can only advise effectively on who requires health surveillance when it has reliable information about the workplace, the hazards and the likely routes and levels of exposure. This may require input from occupational hygienists and workplace exposure measurements.

The principle should be right person, right time, right test Achieving that starts with accurate information.

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changes in lung function.

But once again, quality matters. Questionnaires need to be completed accurately, and practitioners need to recognise when an answer warrants further exploration or clarification. The value isn ’t simply in having a completed .

form; it is in obtaining meaningful information.

The health surveillance appointment can also provide an opportunity to check understanding of PPE, discuss fit or usage concerns, reinforce training and provide

relevant health advice. These activities are not themselves the

being something applied retrospectively.

purpose of health surveillance but can complement a well -designed programme.

The real value comes from trends

A test is only as good as the data it produces Spirometry demonstrates particularly clearly why data quality matters.

A technically poor test can produce numbers, but that does not make those numbers useful. The person undertaking the test needs appropriate training, must recognise when results are of inadequate quality and should be able to troubleshoot and coach the worker to try to achieve an acceptable result. Equipment quality checks, standardised procedures and quality assurance processes matter too.

The same principle applies more widely across health surveillance. If the data isn ’t reliable at the point of collection, sophisticated analysis later will not make it reliable. Or in plain language, if poor data goes in, poor results will come out.

Poor -quality data can result in a genuine problem being missed, an unnecessary referral being made contributing to employee anxiety or a misleading conclusion being drawn. Quality assurance therefore needs to begin at the point where data is generated, rather than

One result can provide useful information, but health surveillance becomes particularly powerful when good -quality, repeatable data is collected over time.

In spirometry, for example, a single measurement has limitations.

Comparing today ’s result with previous measurements can identify gradual deterioration that might otherwise be missed, or stable function over time, even if it is outside the normal range, which can be reassuring.

This applies at two levels. At an individual level, longitudinal data can reveal a change in someone health. At a workforce level, grouped data can reveal patterns that prompt wider questions.

’s

If three people experience similar workplace exposure and one begins to show an adverse effect while the other two do not, the information shouldn ’t automatically be viewed in isolation. Is that person working differently? Are they more highly exposed? Do they have factors that make them more vulnerable? Does their experience provide an early warning of a risk that could eventually affect colleagues?

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Good group -level data can help occupational health and

Technology can support competent practitioners,

employers ask better questions about risk assessments and control measures.

particularly by reducing administrative workload and making longitudinal patterns easier to see. However, it should not compensate for poor -quality source data or replace appropriate clinical judgement.

Making better use of digital data There is considerable scope for technology to make this longitudinal analysis more effective. And AI may eventually have a role too, but automation should not be confused with quality assurance.

In some settings, comparing results over time can still involve manually transferring figures into spreadsheets or tables and calculating differences. Digital health surveillance systems offer the potential to automate more of this work, flag significant changes and make trends easier to identify across both individuals and whole worker populations.

However, if a test is somehow offering poor quality data, the ideal time to identify that is while the worker is still in the room and the test can be repeated. Discovering weeks later through an automated analysis that the data did not meet appropriate standards is of limited value.

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Protecting confidentiality while learning from the data Using workforce -level information also requires careful attention to confidentiality.

Health surveillance exists to protect workers, not to disadvantage someone because they have developed an adverse health effect following workplace exposure.

Employers need sufficient information to manage risks and improve controls without being given inappropriate access to an individual ’s confidential medical information.

Grouped, anonymised data can be particularly valuable here. It allows occupational health to identify patterns and give employers meaningful intelligence about potential workplace risks while maintaining appropriate confidentiality.

Final thoughts

- from data collection to prevention

Ultimately, collecting measurements alone does not constitute effective health surveillance.

A successful programme creates a chain: good quality information about the workplace and the processed being carried out determines who requires surveillance; competent practitioners with appropriate training collect reliable and repeatable data; results are considered alongside symptoms, medical and exposure history; longitudinal analysis identifies changes; and findings feed back into risk assessments, workplace controls, appropriate follow -up and liaison with treating clinicians, as required.

A weakness at any point reduces the value of everything that follows.

For occupational health, that makes data quality much more than an administrative or technical consideration. It is fundamental to prevention.

The objective isn ’t to accumulate ever larger quantities of health data. It is to collect the right data, from the right people, at the right time, to an appropriate standard and then use it intelligently.

Because when health surveillance works well, good -quality data doesn describe what has happened. It helps prevent what might happen next.

Nikki Cordell |

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’t simply

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Dr Nikki Cordell is co -founder and CEO of Cordell Health. An experienced specialist occupational physician, she passionately believes in improving the health of workers, pursuing excellence and bringing innovation to the way that health and wellbeing is delivered in the workplace.

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