Britain is facing what many describe as a quiet crisis in work, health and economic inactivity. Millions of people are out of work or struggling to stay in work because of illness, and the cost to employers is substantial. IOSH’s recent report, “Fixing Sick Britain: getting people back to work through good occupational health and safety”, pulls together expert insight and a YouGov survey of 1,100 workers to explore how better occupational safety and health (OSH) could help address this.
The question we are exploring today is:
Does IOSH have the answer, and what does it mean for health and safety competence and training in UK workplaces?
Firstly, what problem is IOSH trying to solve?
The report sits against some particularly concerning statistics. Economic inactivity due to long-term sickness has risen sharply, with millions of working-age adults out of work or on the edge of the labour market because of health conditions.
At the same time, access to good-quality occupational health support is patchy, particularly for smaller employers.
IOSH’s core argument is that if we treat OSH and OH as strategic levers rather than compliance exercises, we can keep more people healthy, in work and productive.
What are workers saying?
Key findings from IOSH’s YouGov survey of 1,100 workers:
- Only 2 in 5 workers say their managers receive any mental-health training or support.
- 3 in 4 believe such training should be mandatory for all businesses.
- Fewer than half feel their employer treats mental and physical health equally.
- Many think smaller businesses offer less health support than larger ones.
- A clear majority back wider access to occupational health services and the ability to self-refer rather than depend on manager referrals.
The worker survey findings highlight some clear gaps in competence, confidence and support around health at work.
Only around two in five workers believe their managers receive training or support on mental health. Yet a strong majority think mental health training for managers should be mandatory for all businesses. Fewer than half feel their employer treats mental and physical health equally, suggesting that “health” in health and safety is still skewed towards physical risks and injuries.
There is also a perceived support gap between larger and smaller organisations. Many workers think employees in small businesses are less likely to receive the help they need for health issues than those in bigger employers. Alongside this, there is strong backing for wider access to occupational health services and the option for employees to self-refer, rather than relying solely on manager or employer referral routes.
Overall these findings suggest that line managers and organisations are not yet consistently equipped to deal with the scale and complexity of mental and long-term health issues at work.
What does IOSH propose?
1. Robust OSH management systems
IOSH argues that every workplace should have a proportionate OSH management system that integrates leadership, worker involvement, competence and culture, and covers both physical and psychosocial risks.
Rather than treating health and safety as a set of standalone policies or occasional training courses, it should be an ongoing plan–do–check–act cycle that actively manages risk and supports people to stay in work.
2. Prevention as the default
The report calls for a shift from reactive, case-by-case handling of sickness to a prevention-first approach. That means building holistic risk assessments that include stress and mental health, intervening early when issues arise, and viewing workplaces as places that can enable better health as well as create risk.
Rehabilitation and return-to-work planning are presented as part of the same preventative mindset, not something that only begins once someone has been absent for a long period.
3. Stronger occupational health provision
IOSH proposes expanding access to quality occupational health services, with clearer standards and more consistent coverage across sectors and organisation sizes. The ambition is that more workers should be able to access OH support when they need it, including in smaller businesses that currently lack any in-house provision.
The report also emphasises better integration between OH, OSH and public health so that people do not fall between systems or wait too long for support.
4. Building skills, training and competence
A major focus is on capacity building. IOSH highlights the need for competent OSH and OH professionals and, crucially, for line managers who are trained and confident in dealing with health-related issues, including mental health.
The report argues that mental health training for managers and employees should be a standard part of organisational OSH arrangements, not an optional extra or a one-off campaign.
5. Leadership and worker voice
Finally, IOSH places strong emphasis on leadership and worker voice. Senior leaders are expected to show visible commitment, allocate adequate resources and accept clear accountability for health and wellbeing outcomes.
At the same time, workers should have a genuine say in how risks are identified and managed, and how support is designed, rather than being consulted only in name. This combination is presented as critical to building a culture where people feel safe raising issues early and engaging with solutions.
So, does IOSH have the answer?
IOSH’s roadmap is compelling because it recognises that there is no single fix. It connects regulation and standards, organisational systems and culture, access to OH, and competencies at every level of the organisation.
From a health and safety perspective, there are three particularly useful strengths.
- First, the report firmly places mental health and psychosocial risk inside the core OSH management system, rather than treating them as peripheral.
- Second, it focuses on competence and capability, not just on having policies or support schemes in place.
- Third, it recognises the particular challenge for SMEs and the need for scalable, practical approaches.
There are, however, some open questions. Time and budget for training and occupational health support remain constrained in many organisations.
Other surveys suggest that, in practice, large numbers of line managers still receive little or no mental health training despite the recognised need. And while IOSH can recommend and influence, it cannot legislate; progress may depend on a mix of voluntary action, regulatory pressure and clear business incentives.
So, although IOSH has set out a strong framework within their report, whether it “works” in practice depends on how willing organisations are to embed it into their management systems, invest in competence and join up their data and decision-making.
What can organisations do now?
The report provides a useful lens for organisations to review their own arrangements and identify practical next steps.
Audit your OSH management system
- Are mental and physical health genuinely treated together in our policies and plans?
- Do our risk assessments explicitly cover psychosocial risks like stress, workload, bullying etc?
- Who is clearly accountable at leadership level for health and wellbeing outcomes?
- Are we using a structured plan–do–check–act approach?
Define and map competencies
- Have we clearly defined what “competent” looks like for OSH/OH professionals, line managers and safety-critical roles?
- Do job descriptions and role profiles reflect those competence expectations?
- Where are the gaps between our defined competencies and people’s current training, qualifications and experience?
- Are we still relying on generic training that doesn’t match actual risk or role?
Prioritise line manager capability
- Do all line managers receive training on mental health, reasonable adjustments and sensitive conversations?
- Are managers confident in recognising early warning signs and knowing what to do next?
- Is mental health capability built into management development programmes?
- How do we check that managers are applying these skills in day-to-day practice?
Join up data and systems
- Can we currently link incident data, absence, risk assessments, training records and OH referrals?
- What patterns or hotspots would we want to see that we can’t easily see today?
- Are we using digital tools to provide a single, auditable view of risk, support and outcomes?
- How often do we review this combined data at leadership or board level?
Strengthen worker voice
- How do employees currently feedback on stressors, workloads and health-related risks?
- Do people feel safe raising concerns about health, capacity and competence gaps?
- Are workers involved in designing controls and support options, or only consulted after decisions are made?
- What regular forums (surveys, focus groups, safety committees) do we use to listen and respond?
You can read the full IOSH report here
