Stress - from Hazards at Work book

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Hazards at Work book​This 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.

Buy a copy of the book (if you are a safety representative on a TUC training course please speak to your tutor about getting a discounted copy)

Basic facts about stress

What is stress?

According to the HSE, stress is "the adverse reaction people have to excessive pressure or other types of demand placed on them". The HSE explains: "Pressure is part and parcel of all work and helps to keep us motivated. But excessive pressure can lead to stress which undermines performance, is costly to employers and can make people ill".

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". See its Factsheet 31.

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

Incidence of work-related stress

There is no really accurate way that the government or the HSE collect stress-related absence figures. HSE stress statistics for 2010/11 contain results from the self-reported work-related illness (SWI) questionnaire of the national annual Labour Force Survey (LFS) which reveal that:

  • The total number of cases in 2010/11 was estimated at 400,000 people who had worked in the past year and believed they were experiencing work-related stress at a level that was making them ill, giving a prevalence rate for Great Britain as a whole of 1,330 per 100,000 workers. This breaks down by country to:
    • 352,000 in England (prevalence rate of 1,350 per 100,000)
    • 16,000 in Wales (prevalence rate of 1,160 per 100,000), and
    • 32,000 cases in Scotland (prevalence rate of 1,210 per 100,000).
  • The number of new cases at the time was estimated at 211,000 people who had worked in the previous year first becoming aware of work-related stress, depression or anxiety in the previous 12 months, which gives an incidence rate of 700 per 100,000 workers.
  • The prevalence and incidence rates have remained broadly similar over the previous five years at 1,330 per 100,000 for total cases, and 700 per 100,000 workers for new cases and are similar across England, Scotland and Wales.
  • Working days lost in Great Britain are estimated by the LFS at 10.8 million days with each person suffering work-related stress taking an average 27 days off work.
  • The cost of work-related stress is very difficult to estimate. The UK WorkStress Network quotes the CBI reporting that in 2004 it reached £ 12.25bn, while the HSE said only £ 3.7bn in the same year. The National Institute of Clinical Excellence in 2009 reported the cost to be £ 28bn – a quarter of the UK total sickness bill.

There are age and gender-related differences. For instance, in 2010/11:

  • Male workers took an estimated 4.9 million days off work and female workers an estimated 5.9 million days off work due to work-related stress ill-health, with women having a higher number of new cases than men.
  • The age group with the highest rate of new cases is 45–54 for women, and for men the over-55 age group has the lowest incident rate.

The following groups did particularly poorly: heath and social welfare service managers (2,050 cases per 100,000)

  • social welfare associate professionals (2,050 per 100,000)
  • teaching professionals (2,160 cases per 100,000).

New case reports over the previous 12 months were reported by:

  • health and social welfare workers (1,250 cases per 100,000)
  • caring professionals (1,070 per 100,000)
  • teaching professionals (1,240 cases per 100,000).

Stress-related and psychological disorders in Great Britain (GB) and the Labour Force Survey.

In the TUC 2010 safety representatives survey, stress was by far the most frequently identified hazard in 2010, as in the previous three biennial surveys, despite the more limited description (overwork was listed separately in 2010):

  • More than six out of ten safety representatives (62 per cent) identified stress as a top five concern, and 29 per cent identified over work as a top five hazard compared to 60 per cent identifying 'overwork and stress' in their top five in 2008.
  • Twenty-seven per cent of safety representatives, over a quarter, cited stress as the most important hazard in their workplace.
  • Stress is widespread across all types of workplace; it was one of the top five hazards in 13 out of 14 sectors and was the top hazard in 12 out of 14 sectors.
  • Stress was the top concern for safety representatives in banking and insurance (reported by100 per cent of representatives); voluntary sector (86 per cent); education (85 per cent); central government (82 per cent); health services (72 per cent); local government (70 per cent); energy and water (67 per cent); other services (62 per cent); leisure services (61 per cent); transport and communications (59 per cent); and agriculture and fishing (35 per cent).
  • A shocking 100 per cent of safety representatives said stress is a hazard, compared to 57 per cent who said 'overwork and stress' were a concern in 2008.
  • Fifty-two per cent of safety representatives in workplaces with under 50 employees cited stress as the main hazard, rising to 71 per cent in workplaces employing over 1,000 workers.
  • Stress is more prevalent in the public sector where over two thirds, 68 per cent, of safety representatives identified it as a major concern, compared with 54 per cent in the private sector.

For the first time overwork was included as a separate category in the 2010 TUC safety representatives survey, previously included with stress:

  • Safety representatives identified it as the fifth hazard to be a major concern, with almost a third (29 per cent) of safety representatives citing it.
  • Almost two thirds of safety representatives in Education (60 per cent) identified overwork as a major concern, in addition to 85 per cent identifying stress, making the two hazards the number one and number two concerns.
  • Overwork was the third most serious concern of safety representatives in leisure services (reported by 33 per cent of safety representatives) and the voluntary sector (50 per cent), fourth in health services (33 per cent), and fifth in central government (37 per cent) and local government (32 per cent).
  • Overwork was slightly more common in workplaces of over 1,000 workers and is also more prevalent in London and the South East.
  • Overwork was identified by a third of safety representatives in both private and public sectors (33 per cent and 32 per cent).

Stress on the increase

Numerous surveys by trade unions, professional organisations and academic researchers have confirmed that spending cuts in the public sector and job insecurity throughout the economy after the banking crisis are causing increasing levels of stress.

UCU survey find stress is getting worse

Stress levels in further and higher education are on the rise, according to a report published by the lecturer's union UCU. A survey of UCU members found four- fifths (81 per cent) of those working in universities reported their job was job stressful in 2010 compared to three quarters (74 per cent) in 2008. For FE college staff, 84 per cent found their job stressful in 2010 compared to 80 per cent in 2008. In universities, staff said a lack of time to undertake research and excessive workloads were the main reasons behind the increase in anxiety. College staff said excessive workload was the top problem, with two-fifths (39 per cent) reporting they were often or always set unachievable deadlines. UCU's report, The Growing Epidemic: Work-related stress in post-16 education, found that the well-being of staff was considerably lower than recommendations from the Health and Safety Executive in a number of key areas, including support from managers. UCU general secretary Sally Hunt said it was "not acceptable" that at least four-fifths of university and college staff found their jobs stressful. Universities and colleges "are getting a reputation as stressful places to work and this report reveals that the problem is getting worse," she said. UCU press releases.

Work pressure makes school staff sick

Teaching unions warned in April 2012 that school workers are falling ill as a result of the pressure of their jobs. ATL said in that current academic year four in ten education staff have visited the doctor and a quarter taken sick leave because of work pressure. NUT said excessive working hours are taking a toll on teachers' mental health. A survey by ATL found staff felt overwhelmingly that their job has a negative impact on their health and well-being (73 per cent). The main contributing factors were their workload (84 per cent), working long hours (69 per cent), the pressure of OFSTED inspections (47 per cent), and the pressure of classroom observations (40 per cent). The ATL survey found 43 per cent of all staff believed their workload has increased over the last two years, and for 36 per cent it has increased significantly. Half of all those surveyed said they usually work more than 50 hours a week. Just over 80 per cent of staff rated their current workload as high to extremely high. ATL general secretary, Dr Mary Bousted, said: "The government doesn't seem to care about teachers' workloads or their mental health and is showing a callous disregard for teachers' well-being in many of its policies. Schools and the government must work together to ensure the introduction of well-being programmes and better policies to look after the health of their staff." NUT general secretary Christine Blower, whose union's 2012 conference passed a motion warning of the impact on staff of spiralling workloads, said: "Despite the government's supposed commitment to ensure that the pressure on teachers to work excessive hours is reduced there is no evidence to show that this is happening. Many classroom teachers, heads and deputies work in excess of 50 hours a week, which inevitably takes its toll not only on home life but also on teachers' mental health." Risks Bulletin 547.

The president of the National Union of Teachers (NUT) speaking at the annual conference in April 2012 summed up the situation faced by teachers, and one that will be familiar to many workers, when she said: "Pressure, more pressure, exam targets, league tables, more pressure, Ofsted, academies, free schools, forced academies, yet more pressure, no pay rise, job losses, bigger classes, fast track capabilities procedures, attacks on pension provision, work until you're 68, die at your loom, sorry, desk."

Strain on NHS takes its toll on staff

UNISON says the government's handling of the health service is leaving staff facing soaring stress levels. UNISON was commenting on the publication of the official NHS staff survey findings for 2011, and warned its own research had revealed the problem could be considerably worse. UNISON head of health Christina McAnea said, "The NHS staff survey reveals the increased levels of stress being heaped on staff by a combination of government cuts, the Health and Social Care Bill and the continuing pay freeze. The staff survey reflects some of the pressures felt by staff, but our own survey paints a much bleaker picture. It shows that 85 per cent experienced an increase in workload and 83 per cent suffered an increase in stress over the past year. The increase in workload is not a coincidence, it is down to cuts in staffing and to a lack of cover for staff on sick or on leave. And it is not just staff who suffer – the increase in workload and stress is felt by patients and by workers' families." Patient frustration could be directed at staff, the union believed. "Violence and harassment should have no place in our NHS and it is a disgrace that nurses, paramedics and other NHS staff should be threatened going about their work trying to help the sick and injured. It is time that a clear message was sent to those members of the public that attack NHS workers, they will be prosecuted and if found guilty they should receive tough sentences." TUC Risks No. 548.

Civil servants suffering too

A study published in February 2012 carried out by the Universities of Ulster and Nottingham, surveyed tens of thousands of civil servants in workers in Northern Ireland before the recession in 2005 and again in 2009 after the economy was severely hit. They found that that work-related stress increased by 40 per cent, affected one in four and there was a 25 per cent increase in workers taking sick leave. Total time off due to these types of psychological problems increased by more than a third during a slump. Sarah Page, health and safety officer at the union Prospect commented: "When workers face reduced job security and an increased workload it is no surprise that depression and anxiety increase, along with absences from work. People feel afraid, uncertain, less supported by managers, and less in control of their lives. Previous studies of civil servants had shown that if organisational changes occur without consulting and involving the workforce, the effects on individuals are far more damaging." This is an issue where government, employers and unions can make a difference by working together. Employers have a duty to ensure workers' health, safety and welfare at work, and that includes mental health. It shouldn't be about trying to mop up the mess when it's too late, but about assessing risk and introducing preventive measures and support networks before changes are planned and implemented.
Large new study shows recession increases work-related stress by 40% and TUC Risks No. 544.

Ill-treatment in the workplace

A study by the University of Cardiff and Plymouth Business school Insight into Ill-Treatment in the Workplace: patterns, causes and solutions, published in November 2011, surveyed 4,000 workers on their experience of work over the last two years, and found that half the workforce is ill-treated at work, with nearly 30 per cent complaining of impossible deadlines and unmanageable workloads. The report estimates that between seven and eight million British workers suffer from "impossible workloads" and "not being listened to". Managers and supervisors were blamed for two-thirds of incidents of unreasonable behaviour. Professor Ralph Fevre of Cardiff University, one of the report's authors, said: 'Sadly, our study shows that violence, ill-treatment and unreasonable behaviour are all too common in Britain's workplaces." He added: "Many managers saw staff welfare as low on their list of priorities, while some even felt ill-treatment of staff was expected of them." TUC Risks Number 530.

CIPD absence management survey

The Chartered Institute of Personnel and Development (CIPD)/Simplyhealth absence management survey of employers in October 2011 found stress was the number one cause of long-term absence across a workforce increasingly affected by job insecurity. The survey concludes that stress is for the first time the most common cause of long-term sickness absence for both manual and non-manual employees, replacing musculo-skeletal injuries. A link between job security and mental health problems is also revealed in the survey. The survey found that employers planning to make redundancies in the forthcoming six months were significantly more likely to report an increase in mental health problems among their staff, with 51 per cent reporting problems compared to 32 per cent who were not planning redundancies. For manual workers, stress was now level with acute medical conditions and had overtaken musculoskeletal problems to become the top cause of long-term absence.

Among non-manual staff, stress had moved ahead of acute medical conditions. Job insecurity was also reported as a more common cause of work-related stress in the public sector, where the 24 per cent stress reporting rate was about double that for the private sector, mirroring the relative redundancy risk identified in the survey. Commenting on the CIPD findings, former TUC general secretary Brendan Barber said: "These figures show that the cuts, job losses, restructurings and pay inequalities are having more than just an economic effect. They are having a serious impact on people's health." He added: "Unfortunately there is still a tendency amongst many employers to think of it as 'just stress' but this is a real issue which can devastate people's lives and tear apart families. Stress is also avoidable and the TUC endorses the view of the CIPD that more needs to be done at both senior and line manager level to prevent it."

Management weaknesses revealed

The CIPD employee outlook survey published in May 2012 reported that almost three-quarters of workers said there was a distinct lack of leadership and management skills in their organisations, and believe that too many managers have an inflated opinion of their own abilities.

The report suggested that there is a significant "reality gap" between how good managers think they are in their roles and how effective they actually are. The research also highlighted contrasts between how managers said they manage their people and the views of their employees. Sixty per cent of managers said that they meet each person they manage at least twice a month to talk about their workload, meeting objectives and other work-related issues. However, only 24 per cent of employees say they meet their managers with such frequency. While eighty per cent of managers said that they think their staff are satisfied or very satisfied with them as a manager, only 58 per cent of employees agreed. More than 90 per cent of managers said that they sometimes or always coach the people that they manage, only 40 per cent of employees agreed. And, while 75 per cent of managers said they always or sometimes discuss employees' development and career progression during one-to-one meetings, only 38 per cent of employees said this was the case.

The CIPD believes that too many employees are promoted into people management roles because they have good technical skills, then receive inadequate training and have little idea of how their behaviour impacts on others. From there, too many managers fall into a vicious circle of poor management; they don't spend enough time providing high-quality feedback to the people they manage, or coaching and developing them or tapping into their ideas and creativity, which means they then have to spend more time dealing with workers who experience stress leading to increased absence or conflict and the associated disciplinary and grievance issues.

The CIPD concluded that this "reality gap" is important because of the link between employees' satisfaction with their manager and their willingness to "go the extra mile" for their employer. Even a small increase in capability among UK managers could make a significant contribution to productivity and growth. Perhaps more importantly, better trained and higher skilled managers would reduce the problems that cause work-related stress.

UK workers are not alone

Workers across Europe expect work stress to increase. The second European opinion poll on occupational safety and health, conducted by Ipsos MORI on behalf of the European Agency for Safety and Health at Work (EU-OSHA) in 2012, measured the opinions of over 35,000 members of the general public in 36 European countries. It found eight in ten (80 per cent) of the working population across Europe think the number of people suffering from job-related stress over the next five years will increase, with over half (52 per cent) expecting this to "increase a lot". "The financial crisis and the changing world of work is making increased demands on workers, therefore it is unsurprising that work-related stress is at the forefront of people's minds," commented Dr Christa Sedlatschek, director of EU-OSHA. "Regardless of age, gender and organisation size an overwhelming majority of people believe that work-related stress will rise." Greeks were most concerned about rising stress, reflecting the country's economic turmoil and echoing the findings of a European study in 2011 that found Greece had the largest increase in recession-related suicides at 40 per cent. TUC Risks Number 549

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. This is often called the 'fight or flight' reaction. It evolved so that we are better prepared to deal with dangerous or life-threatening situations. Mobilised for action we begin to perspire, blood vessels to the skin constrict, muscle blood vessels swell, the stress hormones adrenalin and cortisol are released. If we cannot 'release' that tension, the hormonal/chemical mechanisms can have serious long term effects on both your physical and mental health. Immediate physiological changes occur, including dry mouth and throat, butterflies in the stomach, moist palms, sweating, pounding heart, increased blood pressure and muscle cramps.

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

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; and constant tiredness and a feeling that sleep does no good.

Short-term symptoms can develop into much more serious long-term ill-health conditions. Stress can play a role in:

  • heart and circulation – hypertension (high blood pressure); coronary thrombosis (heart attack); heart disease; strokes
  • digestion – peptic ulcers; colitis (inflammation of the bowels); vomiting; diarrhoea
  • 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.

Stress is also linked with health-damaging habits, such as smoking, over-consumption of alcohol and escapist eating, all of which are associated with other diseases.

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 such a high blood pressure and heart disease, and increase the risk of the sufferer dying prematurely from a stroke or heart attack. A meta-analysis by Kivimaki found a 50 per cent increase in the risk of heart diseases among those reporting work stress compared with those who don'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 100 and 250 people commit suicide each years 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, of course, always deny there is any link between a suicide death and work circumstances, even when workers leave messages that this was the case.

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. Sometimes the cause is easy to identify and its effects are immediately obvious – a bullying boss, two people having to do the work previously done by ten, an impossible deadline – but often it can be more difficult to identify them. The issue can be complicated by the fact that it can be difficult to establish the real cause of an individual worker's stress if there are external factors. Clearly these can contribute, but trade unions are concerned about those factors at work which are under the employer's control.

Employers will say that individuals often react differently to the same situation due to genetic susceptibilities, temperaments, 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. Clearly, 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. The hazards of stress are no different.

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, and they use euphemisms like 'robust managerial style' to mask this bullying; they clearly don't believe the conventional wisdom that bullying per se is counter-productive.

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 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.

The individualised (often "blame the individual") approach adopted by some employers, academics government and regulators also leads down other blind alleys which, by labelling the issue as 'stress' rather than 'work-related stress', and confusing it with general health, not occupational health, can lead to a circumvention of health and safety law and statutory requirements. In this way 'stress' can become part of some more general, vague 'well-being' or 'resilience' health promotion programme in the workplace with trade union safety representatives excluded from involvement. The work of Dame Carol Black, who was appointed as the government's Director for Health and Work in 2006, in her government commissioned report Working for a Healthier Tomorrow published in 2008, contributed to the confusion by portraying health at work issues not as primarily caused by work, but as general health problems that impact on the health of workers, and which therefore must be managed for the benefit of employers and the wider economy.

The report ignored the real causes of work-related stress and the lack of enforcement of measures to prevent occupational ill health, and focused instead on voluntary programmes of advice and exhortation to tackle workers' lifestyle issues using health promotion methods. This has often led to ill-defined 'well-being' programmes being developed in workplaces, which focus on general health and lifestyle issues, de-linked from occupational health and safety structures, consultation and negotiating. It has also led to the idea of training workers to develop coping mechanisms as a way to endure the stresses of work, rather than identifying and removing the causes of that stress. Well-being, 'engagement' and 'resilience' programmes are not the way to tackle deep-seated and damaging work-induced heath problems. Trade unions have no objections to employers promoting a healthier lifestyle, or help workers to give up smoking, but that should be done with worker and safety representative involvement, not just be imposed on them. But most importantly, such an approach must not be used as a substitute for removing the workplace hazards that cause stress and related illness.

Safety representatives should be aware of ways employers might try to avoid dealing with the causes of work-related stress, of the lack of effective enforcement, and how a close focus on work-related stress may be undermined by introducing factors that dilute a clear analysis of the problems. Since May 2010 government attacks on health and safety regulation and enforcement have driven occupational ill-health even further off the agenda by classifying the majority of workplaces as low-hazard and banning proactive inspections that helped at least to allow the enforcing agencies to be aware of the problems.

Employers must treat stress as they would treat any aspect of work, and undertake suitable and sufficient risk assessments. The factors that cause work-related stress are hazards, and who is at risk from them needs to be identified, the level of risk assessed and then eliminated or minimised and controlled in exactly the same way as any other workplace hazard. Only after eliminating or controlling the factors that cause work- related stress should employers look at an individuals' personal health issues where it is affecting their work. That may then require reasonable adjustments to be made under equality legislation to enable someone to continue in work.

This approach led to the development of the HSE Stress Management Standards in late 2003, which form the basis of the HSE Toolkit and guidance to stress risk assessments.

HSE stress management standards

The HSE stress management standards were developed out of a consultation process which began 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 responded by developing 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 stress management standards 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. In other words, they cover 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. More information is available from the HSE.

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. This means it is important for safety representatives to understand each of the six factors and 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.

The Management of Health and Safety at Work Regulations 1999

The main causes of stress must then be treated in the same way as any other workplace hazard. Employers should conduct a risk assessment for work-related stress, by identifying the hazard, evaluating the risk, and implementing protective and preventive measures to comply with the law. Provisions in the 1999 Regulations that are important for tackling stress include:

Regulation 3: Risk assessment

  • Making suitable and sufficient assessment of risks
  • Identifying measures needed to comply with legal requirements
  • Reviewing the risk assessment
  • Recording the assessment where there are five or more employees

Regulation 4 (and Schedule 1): Implementing preventive and protective measures

On the basis of:

  • avoiding risks
  • evaluating the risks which cannot be avoided
  • combating the risks at source
  • adapting the work to the individual, especially as regards the design of workplaces, the choice of work equipment and the choice of working and production methods, with a view, in particular, to alleviating monotonous work and work at a predetermined work- rate and to reducing their effect on health
  • adapting to technical progress
  • replacing the dangerous by the non-dangerous or the less dangerous
  • developing a coherent overall prevention policy which covers technology, organisation of work, working conditions, social relationships and the influence of factors relating to the working environment
  • giving collective protective measures priority over individual protective measures
  • giving appropriate instructions to employees

Regulation 5: Health and safety arrangements

Making arrangements for the effective planning, organisation, control, monitoring and review of the preventive and protective measures.

Regulation 6: Health surveillance

Ensuring that employees are provided with health surveillance having regard to the risks to their health and safety which are identified by the assessment.

Paragraph 18 (f): Approved Code of Practice

The risk assessment should take account of the way in which work is organised, and the effects this can have upon health.

Paragraph 80: Approved Code of Practice

When allocating work to employees, employers should ensure that the demands of the job do not exceed the employees' ability to carry out the work without risks to themselves or others.

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. See the following chapters of this book:

  • SRSC Regulations 1977 – Chapter 2, with reference to safety representatives' rights and consultation
  • Health and Safety at Work etc. Act 1974 – Chapter 10, 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 17
  • Working Time Regulations – Chapter 46
  • Civil law, which places a duty of care upon employers to their employees – Chapter 53
  • Management of Health and Safety at Work Regulations 1999 – Chapter 13 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 is outlined in the box below, and the HSE Stress Management Standards toolkit is the recommended way to conduct such risk assessments.

HSE management standards for work-related stress

The Management Standards define the characteristics, or culture, of an organisation where the risks from work-related stress are being effectively managed and controlled.

The standards link directly to the risk assessment process as required under the Management of Health and Safety at Work Regulations, and the HSE has developed a toolkit to help employers take effective action to address the problems. The standards recognise that stress is a collective or cultural problem, and that the resolution lies in identifying the causes and applying control measures to remove those factors causing the problem, which in turn enables the employer to meet the duties on them in respect of workers' health.

The six aspects of work that the HSE standards identify are listed in the box.

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.

The European Commission, reporting on progress since the 2004 EU framework agreement on work-related stress, believes that there is room for improvement at both national and EU level, in areas such as extending protection, and developing adequate responses to the challenge of work-related stress. It concludes that implementation of the agreement has not yet ensured a minimum degree of effective protection for workers from work-related stress throughout the EU and therefore all stakeholders need to consider further initiatives to ensure that this goal is achieved.

The HSE's latest report into psychosocial working conditions in Britain in 2009 concluded that the psychosocial working condition for British workers have not significantly changed since the Stress Management Standards were introduced in 2004. "The survey results from 2004 to 2009 indicate that psychosocial working conditions have not generally changed over this period to any great extent, although the scores on the Change scale and on Managerial Support show a significant upward trend (i.e. an improvement). In the 2007 report it appeared that an improvement in population level working conditions may be emerging, however the 2008 and 2009 results do not show a continuation of that trend. There is no longer a downward trend in the number of employees reporting that their job is very or extremely stressful and little change in the number of employees aware of stress initiatives in their workplace or reporting discussions about stress with their line managers."

The report goes on to say: "Psychosocial working conditions for British employees have not generally significantly changed between 2004 and 2009. The predicted improvement in working conditions as a result of the HSE's roll-out of the Management Standards for work-related stress has not materialised as yet, and the number of workers reporting that their job is highly stressful is no longer steadily decreasing. The lack of impact to date of the Management Standards could reflect the long latency between organisations first implementing the process and benefits being realised. Equally, with so many other economic and social factors affecting worker perceptions of their working conditions, any effect may be masked. Only in combination with other evidence can the effects of the Management Standards be better understood."

A report published in October 2010 by Tarani Chandola (pdf), commissioned by the British Academy to examine the effects of the economic crisis on work-related stress, concluded that there is very consistent evidence that work-related stress has severe implications for employee health, not only increasing anxiety and depression but leading to an estimated 50 per cent increases in the risk of heart disease and has significant economic consequences through cost to employers of sickness absence and partly through cost to wider society of treating the ill-health that work- related stress produces. Chandola says that the UK has tended to adopt a relatively non-interventionist approach to work-related stress, relying on trying to encourage employers with advice, and via the use of guidance like the HSE stress management standards, and he concludes that this has had little effect, though accepting the situation might have been much worse without such limited interventions as had been made.

These findings support the TUC and trade union approach that the real problem is the lack of enforcement of the management standards and employer action to reduce work stress. The HSE topic inspection pack for inspectors tells inspectors that formal regulatory actions are limited. 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, or having undertaken one, has failed to act on the findings. HSE inspectors have issued three such notices since 2003, two in NHS trusts and one to a university. Search at HSE Public Register of Notice History and HSE Public Register of Enforcement Notics

An HSE extended project to encourage employers to undertake positive risk assessment programmes in the sectors identified as the five worst for work stress- related absence began in September 2006, and wound down in 2008. No report of this project is available, but anecdotal evidence suggests that the results show little impact, concurring with the findings of the 2007, 2008 and 2009 Psychosocial Working Conditions reports. In the tertiary education sector, for example, University and College Union safety representatives in further education colleges and universities have reported little if any change.

The 'business case' carrot, that it is in employers' interests to look after employees and prevent all occupational ill-health, has little impact on the epidemic of work-related stress, despite state agencies like the HSE and Acas, business and professional organisations, lawyers, consultants and academics promoting the positive elements of the business case. For example, the CIPD issued some serious and detailed guidance to employers in Building the Business Case for Managing Stress at Work, in 2009. In part, this is because the greater proportion of the cost of ill health caused by stress (and all work- related illness) is borne by the individual worker and their family (55 per cent), then the state (24 per cent), with employers picking up only about 21 per cent of the bill for the harm they cause. There is also a suspicion that, because there has been little enforcement action taken against employers when they fail to use the stress management standards to carry out risk assessments and take steps to manage stressors, employers cannot see any economic or financial benefit accruing by becoming compliant, only the cost of achieving that status. Neither can they see any serious risk of penalty by continuing to fail, especially in a climate hostile to employer regulation. In cases where damaged employees make compensation claims, costs and compensation are covered by the employers' insurance.

Using the HSE Stress Toolkit

The HSE Stress Management Standards toolkit is designed to help employers undertake suitable and sufficient risk assessments. The toolkit is neutral, it is universally applicable, it adopts a general approach which helps employers see the broad areas that need to be addressed, and it can be used by anyone after some brief training.

The toolkit can be downloaded. 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 stress management standards 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. The group should also consider the results and recommend appropriate responses to control the problems, and to play an active part in tackling the problems. The steering group should include adequate trade union representation.

It also recommends that the employer establish 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.

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 HealthyWorkingLives 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 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

Following on from research commissioned by the HSE, this additional tool was introduced into the toolkit early in 2009.

Line managers play a vital role in the identification and management of stress within an organisation. 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.

The HSE stress microsite contains the toolkit, access to free leaflets, case studies and other information and resources.

In January 2012, the International Labour Office (ILO), part of the United Nations Organisation, published a useful manual, Stress Prevention at Work Checkpoints, produced with guidance from experts including TUC's senior policy officer for health and safety, Hugh Robertson. Robertson says the document does not provide detailed direction on the organisational change required to deal with stress at work effectively, "but what it does propose is extremely practical and sensible" and could be useful to union reps. The checklists are good on the key stress risk factors, integrate into overall health and safety systems and are good on involvement and consultation of workers and safety representatives. The 50 checkpoints in this volume are good practice for enterprises and organisations in general, and they are especially useful for companies and organisations that wish to incorporate stress prevention into their overall occupational safety and health policy and management systems. Each of the checkpoints describes an action, indicates why it is necessary and how to carry it out, and provides further hints and points to remember. The checklists cover:

  • leadership and justice at work
  • job demands
  • job control
  • social support
  • physical environment
  • work/life balance and working time
  • recognition at work
  • protection from offensive behaviour
  • job security
  • information and communication.

These parallel the HSE Management standards, but expand and develop them in a practical way.

What can safety representatives do?

Safety representatives need to intervene at the primary level. 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.

To do so the safety representative should ensure that:

  • the employer has an effective stress control policy in place
  • the implementation of the policy and its effectiveness is monitored
  • the employer is using the management standards and toolkit correctly
  • suitable and sufficient risk assessments are conducted, taking stress into account as a hazard
  • real control measures are in place to eliminate factors that cause stress
  • safety representatives are fully involved in dealing with stress-related issues
  • any partnership in the stress management project is a true partnership, and
  • the safety committee monitors and checks that any problems are under control.

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 can survey their members using the TUC Stress MOT to identify which stressors are the biggest problem. This will help to identify the areas of the workplace and the stressors which most need risk assessments.

Safety representatives can also use mapping techniques to identify problems. (See the Hazards workers' guide to body mapping, risk mapping and interactive hazards detective).

Safety representatives should report their concerns and those of their members to management in writing. Use Chapter 6 for ideas on how you can make sure that management gets things done.

Stress policy

Safety representatives can negotiate a work-related stress prevention policy with their employer, preferably as part of the overall health and safety policy. An effective policy on work-related stress 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 co- operative 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 (pdf) can be found on the HSE website.

Coping with stress

Trade unions should ensure that members suffering from stress are represented and cared for. 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 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 only be considered 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 showed that levels of stress in FE and HE were worse than comparable occupations and below HSE targets. The survey results for further, higher and prison education are available.

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 Tool produces 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)

British Academy

Tarani Chandola Stress at Work

European Agency for Safety and Health at Work

Factsheet 31: Practical Advice for Workers on Tackling Work-Related Stress

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 factsheets

  • No 92: A Job to Die For
  • No 83: Drop Dead – Overwork
  • No 78: Get a Life! Work–life Balance
  • No 77: Drugs and Alcohol Policies
  • No 70: Bullying at Work
  • No 69: Not What We Bargained For: Changing Workplaces
  • No 65: Sickness Absence Policies
  • No 59: DDA and Work-related Ill Health
  • No 49: Overwork: Fatigue, Long Hours and Pressure

£ 3.75 each for union subscribers; £ 7.00 for non- subscribers.

Hazards magazine website

HSE priced and free publications on work-related stress

  • For all the latest documents containing general standards and guidance on stress, go to the HSE web page.
  • The HSE has now made about 250 of its priced publications freely available on their website. This is a valuable resource, as many of the most important HSG and Legal series are now available, and we recommend that safety representatives download all those that are appropriate for their workplace. All documents currently available.
  • The HSE no longer produces a paper version of their publications catalogue, but you can download an electronic version (PDF). If the HSE document you want is not freely available from the online source, many of the priced publications can still be ordered from HSE Books by telephoning 01787 881165.

HSE work-related stress website

The HSE has a specific web page which draws together HSE information on work-related stress in one place.

International Labour Organisation

Labour Research Department


Trade union information

The UK National Work-Stress Network

News, networking and resources.

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