Stress - from Hazards at Work book

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Hazards at Work bookThis is an excerpt from the TUC book "Hazards at Work: Organising for safe and healthy workplaces", the best-selling guide to health and safety at work.

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Basic facts about stress

What is stress?

The HSE says: "Work-related stress is the adverse reaction people have to excessive pressures or other types of demand placed on them at work. There is a clear distinction between pressure which can be a motivating factor, and stress, which can occur when this pressure becomes excessive."

The European Agency for Safety and Health at Work explains that "stress can be said to be experienced when the demands from the work environment exceed the employee's ability to cope with (or control) them".

The TUC endorses both these definitions and safety representatives can use the HSE version as a working definition.

There are no accurate statistics for stress; the HSE statistics for 2013/14 contain estimates from the self-reported work-related illness (SWI) questionnaire of the Labour Force Survey (LFS). The latest estimates from that survey show:

  • The total number of cases of work-related stress, depression or anxiety in 2013/14 was 487,000 (39 per cent) out of a total of 1,241 000 cases for all work-related illnesses.
  • The number of new cases of work-related stress, depression or anxiety in 2013/14 was 244,000.
  • The rates of work-related stress, depression or anxiety, for both total and new cases, have remained broadly flat for a decade but in fact they are markedly up on the previous year.
  • The total number of working days lost due to stress, depression or anxiety was 11.3 million in 2013/14, an average of 23 days per case of stress, depression or anxiety – slightly up on the previous year.
  • The industries that reported the highest rates of total cases of work-related stress, depression or anxiety (three-year average) were human health and social work, education and public administration, and defence.
  • The occupations that reported the highest rates of total cases of work-related stress, depression or anxiety (three-year average) were health professionals (in particular nurses), teaching and educational professionals, and health and social care associate professionals (in particular welfare and housing associate professionals). "Stress-Related and Psychological Disorders in Great Britain 2014".

Stress on the increase

Numerous surveys by trade unions, professional organisations and academic researchers have confirmed that work-related stress is endemic in the public sector, is damaging the lives and physical and mental health of vast numbers of workers and is an increasing epidemic. Spending and job cuts in the public sector and job insecurity throughout the economy (including increases in temporary and zero-hours contracts), plus increasing hours of work and workloads, excessive monitoring, accountability, performance management, target setting, badly managed change and bullying management are all identified as causal factors. In jobs that involve working with clients, pupils and the public, violence and aggression are also big stressors. In the public sector, education, health care and the administration of welfare benefits especially, dealing with the effects of austerity on pupils, patients and clients is adding more stress to workers. Maintaining a reasonable healthy work-life balance is becoming more difficult for most, and impossible for many.

In the TUC 2014 safety representatives' survey, stress was by far the most frequently identified hazard, with 67 per cent of safety representatives citing it, similar to the 69 per cent in 2012. Stress was identified by 75 per cent of safety representatives in the public sector compared to 59 per cent in the private sector. Stress was cited as a top five hazard by two-thirds of all safety reps and has risen to alarming levels in central government, cited by 87 per cent (compared to 80 per cent in 2012), in education (84 per cent), in health services (78 per cent) and local government (77 per cent).

Allied to stress, bullying and harassment has become a key hazard, with 46 per cent of safety representatives citing it. Overwork is also linked to stress, and 36 per cent of representatives listed it as a top five concern, compared with 33 per cent in 2012 and 29 per cent in 2010. Again, overwork is more prevalent in the public sector, with 42 per cent of representative identifying it compared to 27 per cent in the private sector. Long hours also contribute to stress and this has risen to 26 per cent of representatives citing it, compared to 21 per cent in 2012. Stress is cited as the first or second most important hazard in all sectors.

Psychosocial Risks in Europe: prevalence and strategies for prevention, published in October by the European Agency for Safety and Health at Work (EU-OSHA) and the European Foundation for the Improvement of Working and Living Conditions (Eurofound), reported that a quarter of workers in Europe report feeling stressed at work all or most of the time, and a similar proportion say that work affects their health negatively. Because work-related stress is a big issue across Europe, EU-OSHA and its partners made 'raising awareness of managing stress and psychosocial risks at work' the theme of its annual European health and safety weeks.

Effects of stress

Stress is a natural reaction to excessive demand or pressure. When we feel pressured, hormonal and chemical defence mechanisms are triggered in the body. Often called the 'fight or flight' reaction, it evolved to equip us for life-threatening situations. Mobilised for action, we begin to perspire, blood vessels to the skin constrict, blood vessels to the muscles swell, and the stress hormones adrenalin and cortisol are released. Immediate physiological changes occur If we cannot 'release' that tension, including dry mouth and throat, butterflies in the stomach, moist palms, sweating, pounding heart, increased blood pressure and muscle cramps, and the hormonal/chemical mechanisms can have serious long-term effects on both physical and mental health.

If pressure is prolonged, too frequent or out of control, physical health problems may develop, such as loss of appetite, comfort eating, weight gain or loss, indigestion or heartburn, constipation or diarrhoea, sleeplessness, bouts of sweating, headaches, back pain, nausea, breathlessness, fainting spells, impotence or frigidity, fatigue and eczema.

Stress can also cause emotional and mental health problems. Society's attitudes to mental ill health are still very different from those to physical ill health and the stigma adds to the pressures on stressed individuals. Because of these attitudes, people may try to hide their emotional and mental symptoms and not ask for help until their problems are seriously out of control.

Stress can also cause emotional and mental health problems. Society's attitudes to mental ill health are very different from those to physical ill health and add to the pressures on stressed individuals. When this is the case, people may try to hide their emotional and mental symptoms, not asking for help until their problems are seriously out of control.

Psychological conditions triggered by prolonged stress include fatigue, anxiety, panic attacks, depression, hostility and aggression, psychosomatic complaints and neuroses. The symptoms can be irritability, indecision, suppressed anger, loss of concentration, inability to complete one task before starting another, feelings of paranoia, feelings of inadequacy, tearfulness at minor problems, lack of interest in people and things outside work, constant tiredness and a feeling that sleep is ineffective. Short-term symptoms can develop into much more serious long-term ill-health conditions.

Stress can play a role in problems with:

  • the heart and circulation – hypertension (high blood pressure), coronary thrombosis (heart attack), heart disease, strokes
  • digestion – peptic ulcers, colitis (inflammation of the bowels), vomiting, diarrhoea
  • the immune system – lowered resistance to infections, chronic asthma, chronic dermatitis, possible increased risk of cancer
  • mental health – depression, chronic anxiety, mental breakdown, suicide, social isolation.

The coping mechanisms that people use to deal with stress, such as smoking, over consumption of alcohol and comfort eating, can themselves lead to ill-health. Chronic work-related stress can cause very serious long-term health problems and increase the risk of the sufferer dying prematurely from a stroke or heart attack. Large-scale studies found a 50 per cent increase in the risk of heart diseases among those who had reported work-related stress compared with those who hadn't. Hazards magazine estimates that there are about 20,000 premature deaths from heart disease each year, many of these from stress, overwork, long hours and impossible work demands. In addition, it is estimated that between 150 and 300 people commit suicide each year as a result of intolerable work-related stress, and the suicide rate generally has increased by 10 per cent since the beginning of the recession. Employers will, of course, deny there is any link between a suicide and work circumstances, even when workers leave messages that this was the case. It is extremely hard to gain compensation: only 293 people received civil compensation for work-related stress, depression or anxiety in 2011/12.

Causes of work-related stress and employer responses

The causes of work-related stress are a complex interaction of factors about the way the workplace and the work is managed and how workers are treated by managers and employers. The cause may be easy to identify and its effects immediately obvious – a bullying boss, two people having to do the work previously done by 10, an impossible deadline – but often it is more difficult and can be complicated by the presence of external stress factors. Clearly these can contribute, but trade unions are concerned about those factors at work that are under the employer's control.

Employers will say that individuals often react differently to the same situation due to genetic susceptibilities, temperament and physical make-up. Employers may resist undertaking risk assessments to the required "suitable and sufficient" standard, arguing that you cannot do such assessments because of these differences. This is nonsense as not everyone who smokes will develop lung cancer; not every worker who is exposed to asbestos or silica will develop mesothelioma or silicosis; not all nurses lifting patients will be injured; and not all computer workers will develop a work-related upper limb disorder. But these are hazards with a huge potential to cause workers' harm and it is accepted that they should be eliminated or controlled. Stress should be dealt with as a work hazard like any other.

Some academics have gone further and claim there are personality traits that make some people 'natural bullies' and others 'natural victims', but this kind of explanation also confirms for many employers that they should treat stress as an individual issue or casework problem rather than a collective issue that affects the whole workforce. There is evidence that some employers deliberately adopt a bullying culture towards managing staff, using euphemisms like 'robust managerial style' to mask this bullying; they clearly don't believe the conventional wisdom that bullying per se is counterproductive.

The individual response is not the trade union response and it should be challenged and rebutted whenever it arises. Safety representatives need to be able to identify exactly what it is in the way in which work is organised or managed that creates stressful conditions and has the potential to damage all workers, and to deal with the causes using trade union organisation and methods – just as they would deal with any other hazard.

Distressing failure

"Workplace stress causes heart and other chronic diseases, higher rates of sickness absence and suicides. So why are the Health and Safety Executive (HSE) and employers doing nothing to tackle the bad management practices at the root of the problem?", asks the TUC's Hugh Robertson, in a Hazards magazine article called "Distressing Failure". "When it comes to stress, everyone seems to agree on two things. Firstly that the effects of workplace stress are a major problem in the UK with nearly half a million people suffering from stress-related illnesses caused by their work every year. Secondly, that the solution is to remove or reduce the stressors." Yet there is little or no action by employers, government or the HSE to reduce and prevent stress,

There is no shortage of authoritative advice on how to reduce stress. The HSE's stress management standards (SMS) were published in 2004, over 10 years ago. These give a simple and clear process for prevention, with useful easy-to-use, downloadable tools to carry out risk assessment and benchmarking and suggestions on approach. The arbitration service Acas also has excellent advice on stress. HR managers can access advice on how to prevent stress from their professional body, the CIPD. There is even a British Standards Institute (BSI) standard, based on the HSE's materials.

A number of employers, mainly larger public sector organisations, have found the HSE's SMS to be an effective tool. While the HSE itself has not published any reports showing where the use of its SMS have made a difference, some organisations have: Blackpool, Wyre and Fylde NHS Foundation Trust reported that related interventions contributed to a 40 per cent reduction in cases of work-related stress; Aberdeen University reported that, after one year of implementing the standards, the average days lost per person due to stress reduced by 21 per cent; Scottish Power achieved an 11 per cent reduction in stress-related sickness absence.

Despite these successful uses of the HSE SMS tools, the incidence of stress is not falling. According to the HSE's Stress-Related and Psychological Disorders in Great Britain 2014 published in October 2014: "The rates of work-related stress, depression or anxiety, for both total and new cases, have remained broadly flat for more than a decade." The overall result is that after 10 years of stress management standards there has been no big change in employers' behaviour in preventing, reducing and managing work-related stress. In this report, the HSE does not mention that the rates of new cases and working days lost due to stress have actually increased in 2013/14 over the last available LFS figures for 2011/12, and so things are actually becoming worse. Overall sickness absence has gone down – but mainly because of an increase in 'presenteeism' as people fear taking sick leave. And the problems caused by stress and the cost of presenteeism is widely acknowledged to be more than that caused by sickness absence.

The recession and the government's austerity cuts have also played a major role in the increase in pressure on workers, especially in the public sector. In tandem with the government's dismantling of employment rights, a managerial offensive is taking place on the frontline of work. If the financial crash of 2008 and the continued state of perma-recession have given the government the spurious rationale for austerity and the blitz on welfare, they have also provided an ideological justification for a massive intensification of work. The reality today for very many workers is acute insecurity, intolerable pressure and mental ill-health. Although this offensive has several distinct elements, notably lean working, performance management and punitive sickness absence management, these are often experienced seamlessly by workers as an integrated assault (see Workplace Tyranny: the new normal).

Still, the benefits of prevention using the HSE SMS just don't seem to be making any contribution to the reduction in sickness absence. And the reason is that most employers are doing nothing or, where they are, they are not addressing the real problem. The use of the management standards seems to have fallen dramatically in recent years as the HSE has stopped promoting them, and an issue such as stress is no longer a priority, despite it being the biggest work-related ill health problem. Employers taking no action do not need to fear the HSE as it makes clear that its approach to stress is not enforcement led.

It is not just the TUC and trade unions who are critical of the HSE's role in failing to promote and enforce its own SMS. In the February 2013 government-ordered Triennial Review of the HSE, Making Health and Safety Work for Business: removing unnecessary health and safety burdens, the report author Martin Temple, noted:

It was put to me that 10 years ago HSE was very active in research and publishing of new guidance on these areas. For example, the HSE management standards for work-related stress published in 2004. Following that, HSE has reduced the resources invested in these topics. It was alleged that HSE has lost control of its 'brand' in this area and that others, including other government bodies such as Public Health England (PHE), the National Institute for Health and Care Excellence (NICE) or the Advisory, Conciliation and Arbitration Service (ACAS), have stepped into this space to provide advice to businesses. In doing so, the messages for businesses and for individual workers about taking action on stress have become conflated and confused.
I would go even further and say that for many employers stress is not considered to be a prevention issue like chemicals or musculoskeletal disorders (MSDs). When employers talk about tackling stress nowadays they see it as being a 'well-being' initiative, not a health and safety one.

Temple, the chair of the manufacturing industry group EEF, identified a problem the TUC and trade unions have complained about, that as the HSE has withdrawn from enforcing and promoting the SMS as part of the legal requirements of health, safety and welfare at work, the field has been taken over by non-health and safety government bodies. And also by commercial health and safety organisations, which have subverted the issue of the collective prevention and management of work-related stress factors into an individualised health-promotion, lifestyle issue under the guise of 'stress management' programmes such as 'well-being' and 'resilience'.

He issued an explicit warning against this. "Those who promote well-being in the workplace should not allow it to be confused with health and safety requirements," he noted. "I recommend that HSE should ensure its own guidance sets out clearly what employers must do to control work-related health risks and be prepared to challenge others if they inadvertently misrepresent what the law requires to promote the wider wellbeing agenda."

In "Distressing Failure", Hugh Robertson clearly lays out the TUC approach:

The number of employers seriously dealing with the prevention of stress through applying the management standards appears to have plummeted since the HSE stopped promoting them. The number introducing what they call 'stress management' programmes, however, has risen massively. I went through four of these, introduced by a university, an energy company, a health trust and a manufacturer. In each case the model was the same. Stress is identified as a major problem so they introduce an employee support programme aimed at those workers who get stress-related sickness. This is usually a few sessions of cognitive behavioural therapy or counselling aimed at helping them "cope" with stress and return to work. Secondly they provided general training on how to deal with stress (usually through e-learning). This often also includes 'awareness-raising'. Thirdly was information or training to line-managers on how to recognise and support those with a stress-related condition. All four linked the programme to 'well-being' initiatives. Two of the programmes also introduced 'resilience' training. Only one actually linked to risk assessment and it only indicated that the assessments would be used to identify individuals at risk so that they could be offered support.
To put it another way, what they all had in common was focusing on the effects of stress – not the problem. In each case the employer claimed that this was a stress-prevention programme yet at no time was the working environment being changed. The causes of the stress were exactly the same, only the symptoms were being addressed. This is comparable to the management in a factory where a lot of the workers were getting back pain because of the lifting and twisting on a production line introducing access to a physiotherapist rather than reducing the manual handling. Supporting people with stress is not wrong. Unions should welcome it and work with employers in introducing measures to help workers who are ill, whether it is work-related or not, but that is nothing to do with their legal duties on health and safety.

He also points out the nonsense of resilience:

Can you imagine opening a newspaper and seeing a report from the food industry claiming that, according to scientific evidence, it was no longer necessary to worry about food hygiene as the real problem was the customers? They were just becoming sick too easily and what we needed to do was learn how to cope with the effects better so that we did not feel so sick after we ate food that had been contaminated by E Coli, salmonella and other infections. My guess is that you would not be very impressed. Well, that is what we are now seeing with workplace stress.

This new 'resilience industry' is fast becoming a buzzword among managers, invading the workplace with a mission to make feeble workers 'man-up', to shrug off the stresses and strains of work, to become more resilient rather than make workplaces more healthy. Consultants are promoting packages aimed at improving workers' resilience. Even professional bodies like the CIPD, which represents personnel staff, and IOSH, the UK body for health and safety professionals, are promoting it (see Resilience).

It is of course important that trade unions ensure their employers support those who are ill because of stress, but not while also allowing the work causes of that stress-related illness to continue.

The law on health and safety at work is quite clear: it says that the employer must remove or reduce the hazards that make workers ill. Stress is a workplace hazard and employers have a legal duty to reduce the risk to workers "so far as is reasonably practicable". The HSE is the regulator that is meant to be enforcing that requirement and employers have to use either the standards or something at least as effective, or else face prosecution.

However, the HSE website has a question: "Will HSE initiate enforcement action for those organisations who obtain a satisfaction rating below that in the Stress Management Standards?" The HSE answer is unequivocal. "No. HSE's approach to tackling work-related stress is not enforcement led." However it does add: "Where appropriate, HSE will investigate complaints relating to work-related stress and enforcement action may be taken if there is clear evidence of a breach of health and safety law, and a demonstrable risk to the health and safety of employees."

So, even though nearly half a million are suffering illnesses due to work-related stress every year, the HSE has taken no prosecutions. HSE inspectors are told they cannot prosecute an employer on stress. The HSE's directions for inspectors says the only formal enforcement action open to them is an improvement notice where an employer has failed to undertake a suitable and sufficient risk assessment for stress or, having undertaken one, has failed to act on the findings.

Additionally, since 2011 the majority of workplaces where stress is rife – including local and national government, education and health services – have been classified as 'low risk' and so banned from being proactively inspected by the HSE or local authorities. So inspectors are unlikely to know what is going on in most stressful workplaces until something goes very wrong.

Hugh Robertson says:

HSE inspectors have issued a small number of improvement notices since 2002 where stress has been mentioned, usually as part of a more general problem. But there have been none in the past five years. If this was any other hazard and any other condition I think there is little doubt that the HSE would be taking a different approach. This lack of action means that employers are getting away scot-free. The problem is that tackling stress can mean changing working practices, increasing staffing levels or changing management systems and so it is clear that the majority of employers are just sticking their head in the sand and hoping the problem will go away, or instead, are trying to fix the workers. The result is hundreds of thousands of workers have to live with totally avoidable depression or anxiety.

TUC General Secretary Frances O'Grady said:

It's shocking that so many employers are breaking the law and putting their staff at risk of illness and accidents by their sheer negligence. Not only does this put people in danger while doing their jobs, the consequences also carry a high cost for British businesses and public services because it results in lower productivity and more staff spending time off sick. Stress remains the top concern for health and safety workplace reps. It's a particular problem in parts of the public sector like the NHS and local government that have been hit by cuts and top-down reorganisations. Sickness and absence from stress is one of the false economies of public sector austerity.

The TUC calls for more enforcement of health and safety, but whether the HSE enforces or not the law is the law and employers are under a legal duty to prevent harm to workers' health from work-related stress, and trade union organisation on stress is crucial to stop work making us sick.

Legal and other standards for prevention and control

There is no specific law dealing with stress. However, there are a number of laws that apply and these are referenced in other chapters of Hazards at Work:

  • SRSC Regulations 1977 – Chapter 2, with reference to safety representatives' rights and consultation
  • Health and Safety at Work etc. Act 1974 – Chapter 9, dealing with the general duties of employers and employees under Sections 2–9. Generally, the employer has a duty to ensure the health, safety and welfare of employees, and this includes mental as well as physical health
  • Disability Discrimination Act – Chapter 12
  • Working Time Regulations – Chapter 34
  • Civil law, which places a duty of care upon employers to their employees – Chapter 40
  • Management of Health and Safety at Work Regulations 1999 – Chapter 11 and below.

The risk assessment duty in the Management of Health and Safety at Work Regulations is the starting point for the regulation of work-related stress. The duty in these Regulations and the HSE Stress Management Standards toolkit is the recommended way to conduct such risk assessments.

HSE stress management standards (SMS)

The SMS developed out of a consultation process begun in 1999 by the HSE responding to the prevalence of stress-related illness and absence. The consultation resulted in a majority view from both unions and employers for some effective regulations or at least an Approved Code of Practice on stress. The HSE response was the management standards to help employers conduct effective risk assessments for work-related stress and set up appropriate measures to deal with the issues identified.

The SMS cover six key areas of work design that, if not properly managed, are associated with poor health and wellbeing, lower productivity and increased sickness absence – the primary sources of stress at work. They represent a set of conditions that, if present, reflect a high level of health, wellbeing and organisational performance. The standards came into effect in 2004.

Stress reactions can be caused by a single factor – as in the case of bullying, for example – but they are often the result of a combination of factors. It is important for safety representatives to understand each of the six factors and to be able to identify them in the workplace, as this can influence the degree of stress an individual experiences. Specific factors identified under the six main headings will contribute to the development of stress-related symptoms in many workers. The six areas are:

  • demands – this includes issues such as workload, work patterns and the work environment
  • control – how much say the person has in the way they do their work
  • support – this includes the encouragement, sponsorship and resources provided by the organisation, line management and colleagues
  • relationships – this includes promoting positive working to avoid conflict and dealing with unacceptable behaviour
  • role – whether people understand their role within the organisation and whether the organisation ensures they do not have conflicting roles
  • change – how organisational change (large or small) is managed and communicated in the organisation.
  1. Demands

    The standard is that:

    • employees indicate that they are able to cope with the demands of their jobs
    • systems are in place locally to respond to any individual concerns.

    What should be happening/states to be achieved:

    • the organisation provides employees with adequate and achievable demands in relation to the agreed hours of work
    • people's skills and abilities are matched to the job demands
    • jobs are designed to be within the capabilities of employees
    • employees' concerns about their work environment are addressed

  2. Control

    The standard is that:

    • employees indicate that they are able to have a say about the way they do their work
    • systems are in place locally to respond to any individual concerns.

    What should be happening/states to be achieved:

    • where possible, employees have control over their pace of work
    • employees are encouraged to use their skills and initiative to do their work
    • where possible, employees are encouraged to develop new skills to help them undertake new and challenging pieces of work
    • the organisation encourages employees to develop their skills
    • employees have a say over when breaks can be taken
    • employees are consulted over their work patterns.

  3. Support

    The standard is that:

    • employees indicate that they receive adequate information and support from their colleagues and superiors
    • systems are in place locally to respond to any individual concerns.

    What should be happening/states to be achieved:

    • the organisation has policies and procedures adequately to support employees
    • systems are in place to enable and encourage managers to support their staff
    • systems are in place to enable and encourage employees to support their colleagues
    • employees know what support is available and how and when to access it
    • employees know how to access the required resources to do their job
    • employees receive regular and constructive feedback.

  4. Relationships

    The standard is that:

    • employees indicate that they are not subjected to unacceptable behaviours, e.g. bullying at work
    • systems are in place locally to respond to any individual concerns.

    What should be happening/states to be achieved:

    • the organisation promotes positive behaviours at work to avoid conflict and ensure fairness
    • employees share information relevant to their work
    • the organisation has agreed policies and procedures to prevent or resolve unacceptable behaviour
    • systems are in place to enable and encourage managers to deal with unacceptable behaviour
    • systems are in place to enable and encourage employees to report unacceptable behaviour.

  5. Role

    The standard is that:

    • employees indicate that they understand their role and responsibilities
    • systems are in place locally to respond to any individual concerns.

    What should be happening/states to be achieved:

    • the organisation ensures that, as far as possible, the different requirements it places upon employees are compatible
    • the organisation provides information to enable employees to understand their role and responsibilities
    • the organisation ensures that, as far as possible, the requirements it places upon employees are clear
    • systems are in place to enable employees to raise concerns about any uncertainties or conflicts they have in their role and responsibilities.

  6. Change

    The standard is that:

    • employees indicate that the organisation engages them frequently when undergoing an organisational change
    • systems are in place locally to respond to any individual concerns.

    What should be happening/states to be achieved:

    • the organisation provides employees with timely information to enable them to understand the reasons for proposed changes
    • the organisation ensures adequate employee consultation on changes and provides opportunities for employees to influence proposals
    • employees are aware of the probable impact of any changes to their jobs. If necessary, employees are given training to support any changes in their jobs
    • employees are aware of timetables for changes
    • employees have access to relevant support during changes.

HSE Stress Management Standards

Using the HSE Stress Toolkit

The HSE SMS toolkit is designed to help employers undertake suitable and sufficient risk assessments. It is neutral, is universally applicable, adopts a general approach to help employers see the broad areas that need to be addressed, and can be used by anyone after some brief training. It emphasises the need for senior management commitment to identify, lessen and control risks, and argues for effective partnerships with employees, their representative organisations and safety representatives.

The main part of the kit is a questionnaire for employees linked to an analysis tool (a computer spreadsheet) into which the results of the questionnaire can be input. This then calculates the responses, and indicates the scale of any problems the survey has identified. The results are presented in 'traffic-light' format, so that:

  • Green indicates the employer is doing enough to comply but needs to maintain that performance.
  • Blue indicates better than average, but still needs improvement.
  • Amber indicates below average and not nearly good enough and needs even more improvement.
  • Red indicates serious problems that need to be tackled as a matter of urgency.

Even full compliance with the SMS does not mean that all workers are protected. The standard is based on achieving a position where 80 per cent of workers are protected.

The HSE recommends that the employer establishes a steering group to monitor and oversee the process, consider the results, recommend appropriate responses to control the problems, and play an active part in tackling the problems. The steering group should include adequate trade union representation.

It also recommends that the employer establishes focus groups to facilitate employee participation in the process. This will demonstrate the employer's commitment to a participative process in managing the risk and give staff an opportunity to express their views and feed in information and reactions to the process to enable it to be refined and developed.

The role of union safety representatives is emphasised at all stages in the process: during the assessments; in steering and focus groups; and in determining effective controls (see below).

The HSE toolkit gives comprehensive advice on developing a stress policy, which strongly emphasises the role of safety representatives in developing stress management initiatives.

The HSE toolkit gives comprehensive advice on developing a stress policy, which strongly emphasises the role of safety representatives in developing stress management initiatives.

In Scotland, Work Positive, part of the Health Scotland initiative and the Healthy Working Lives programme, has developed its own toolkit, using the HSE's as a foundation. This one contains an expanded version of the HSE questionnaire, which includes the HSE's 35 questions, and then adds an extra 32, plus a 'write-in' option for Q68. The Work Positive additional questions cover a range of other conditions-of-service issues or aspects of the employment relationship and collective bargaining issues that can contribute to increasing employee stress.

Stress management competency indicator tool

Line managers play a vital role in the identification and management of stress. They are likely to witness problems caused by stress first hand, and will be in the best position to notice changes in staff behaviour that may indicate a stress-related problem. They are also the first point of contact when an individual feels stressed.

It is essential that line managers are equipped with the correct skills and behaviour to be able to manage these situations. The HSE worked with the Chartered Institute of Personnel and Development (CIPD) and Investors in People to design this tool to allow managers to self-assess whether they currently have the behaviour identified as effective for preventing and reducing stress at work. Its aim is to help managers reflect on their behaviour and management style.

Safety representatives could also use the questionnaire to assess line manager competence as part of an inspection or monitoring process.


Download the Stress Checklist (PDF)

What can safety representatives do?

Safety representatives need to intervene at the primary level: prevention. They should act to address the causes of stress and so prevent workers developing stress-related symptoms and illness, which in turn may lead to absence and, in the worst cases, nervous breakdown, mental illness and even suicide.

Safety representatives must beware of and resist 'well-being' programmes, resilience training and other individual, lifestyle-blaming health promotion plans that only treat symptoms but do not prevent the causes of work-related stress, when they are used instead of employers complying with legal duties under health and safety law. These include: resilience training and mindfulness plus also healthy eating; exercise; smoking cessation; drugs and alcohol counselling; Indian head massage. All or some of these may help improve some individual worker's health, but should not be considered until the factors that are making workers ill are removed or reduced by primary collective action on work-related stress that protects all workers (see TUC checklist).

The TUC says union representatives should remember that well-being at work initiatives can be very popular with workers, and unions should also use them as a way of recruiting new members and getting new activists – but they are no substitute for primary prevention. Work and Well-Being: a trade union resource (PDF).

To help safety representatives, the TUC has produced Tackling Workplace Standards Using the HSE Stress Management Standards: guidance for safety reps. This explains the SMS from the worker's viewpoint and then the practicalities – what you and your employer need to do. It covers setting up a group, the initial questionnaire/survey to establish the extent of the problem, and the process of risk assessment, analysis and implementation of solutions. The TUC suggests that all members of the group are trained but that safety reps also attend specific TUC training via the short course programme. Contact your TUC Regional Education Officer.

Stress policy

As part of the SMS to tackle stress, safety representatives can negotiate a work-related stress prevention policy with their employer. This should:

  • recognise that stress is a health and safety issue
  • recognise that stress is about the organisation of work
  • be jointly developed and agreed with unions
  • have commitment from the very top
  • guarantee a blame-free approach
  • apply to everyone.

The objectives of a work-related stress policy should be to:

  • prevent stress by identifying the causes of workplace stress and eliminating them
  • recognise and deal with stress-related problems through consultation, participation and cooperative working
  • ensure that managers, supervisors and employees are trained to deal with and prevent work-related stress
  • rehabilitate employees suffering stress through the provision of independent confidential counselling.

The policy should contain agreed arrangements for joint monitoring and review to assess its effectiveness. An example of a stress policy.

Monitor the workplace

Safety representatives need to keep in regular contact with their members and check that stress problems are under control. Ensure that there are suitable procedures for members to report problems, and that any problems can be tackled by representatives without exposing the members concerned to risk of victimisation.

Safety representatives need to use their rights under SRSCC Regulations to be informed and consulted about any aspect of work, or changes, that may cause or increase stress and so affect their members' health and safety. These include changes to contracts, pay, hours, workload, work organisation, monitoring, staffing levels and working hours/time. Safety reps should ensure that risk assessments of these issues for stress should be conducted.

Safety representatives can survey their members using the TUC stress MOT (PDF). This will help to identify the areas of the workplace and the stressors that most need risk assessments.

Safety representatives can also use mapping techniques such as body mapping and risk mappingto raise awareness of the links between work-related stress and ill-health among members as a start to organising for prevention.

Coping with stress

Trade unions should ensure that members suffering from stress are represented and cared for by employers. Individual grievances must be dealt with effectively and special arrangements negotiated to protect their needs.

Some employers have:

  • introduced employee assistance programmes (EAPs) or counselling services
  • tried to reduce the symptoms and effects of stress by lifestyle changes and other methods such as promoting positive lifestyle choices – for example healthy eating, reducing drinking, stopping smoking and improved personal fitness – or providing stress management courses, mutual support groups or yoga sessions etc.

Although these may help some workers relieve the immediate strains caused by stress, they can never remove the sources of stress and should not be accepted as substitutes for real action. Trade unions demand employers do what the law requires: make primary interventions to remove the causes of stress at work. The actions described above are secondary interventions that deal with a problem that has already been created and, like personal protection, should be considered only once everything has been done to protect everyone by removing and managing the hazards at source.

Ten points on work-related stress

A checklist for UCU safety representatives

A quick checklist for UCU representatives on things to do to ensure your employer takes appropriate action on the causes of work-related stress. The 2008 UCU survey (PDF) showed that levels of stress in FE and HE were worse than comparable occupations and below HSE targets.

Don't allow your employer to dilute the issue by including external factors – we are here concerned with those factors at work, under the employer's control that collectively affect employees; not factors related to a specific individual. Stress is an issue that should appear on the main bargaining agenda, not be sidelined as a peripheral or safety committee only issue.

Finding out about stress

  1. Ensure basic risk assessments are properly conducted, and include the identification of stress-related issues as one element.
  2. Where the basic assessment indicates there is or may be a problem, conduct a specific stress risk assessment to determine more fully the extent and causes of work-related stress. The HSE Indicator Toolproduces convincing data, and is independent. UCU can help you set this up.
  3. Ensure that trade union reps are involved in the risk assessment process, to monitor and constructively criticise the process, ensure all risks are identified and proposed control measures appropriate.
  4. Identify where workers are already suffering from work-related stress. Ensure employers collect and present sickness absence figures in ways that enable any absence "hot spots" and causes to be identified. Encourage everyone to record accurately the reasons for absence – some are reluctant to have "work-related stress" or "stress-related illness" as a cause on a medical certificate.
  5. Encourage employees to report stress-related issues to both the union and the employer. Ensure the employer has a non-threatening procedure and environment for such reports. Consider establishing a special procedure for this if necessary, as many employers have for reporting bullying. Focus groups are the forum suggested by the HSE – there should be trade union input into focus group meetings.

    Taking action over stress

  6. Establish a stress management steering group as the HSE recommend. Ensure this has full trade union involvement, not just a token presence. Make sure that the employer permits union reps sufficient time-off from their day job to not only attend group meetings, but to do the necessary associated work between meetings.
  7. Use the steering group to oversee the whole stress identification and management process, and to ensure the trade unions participate fully in identifying and prioritising problems, and to agree appropriate action plans to monitor the situation and eliminate and manage the causes of stress.
  8. Ensure the steering group makes regular reports to both senior management and the joint safety committee, and that the safety committee makes appropriate reports and recommendations to the employer (the governing body of the institution) on measures necessary to eliminate and reduce the causes of stress.
  9. Aim to eliminate the causes of stress wherever possible, rather than just reduce or manage the risks. If necessary, emphasise the risk element of the risk – cost balance that employers may use if they argue their actions are "reasonably practicable", and limit the action they take as a result.
  10. Ensure that risk assessments are reviewed when stress related illness or absences are reported. The assessment may well have under-estimated the risk or failed to identify a stress factor, so it will not be suitable and sufficient.

Further information

(in alphabetical order)

European Agency for Safety and Health at Work

Psychosocial risks in Europe: prevalence and strategies for prevention

European Trade Union Institute for Research, Education and Health and Safety

Stress at Work – special edition of TUTB newsletter September 2002 Issue No. 19-20

Hazards magazine website

HSE work-related stress webpages

International Labour Organisation

Resources on stress

Labour Research Department

  • Tackling bullying and harassment £4.95
  • Stress at work £4.70


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Trade union information

The UK National Work-Stress Network

Useful news, networking and resources.

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