THE CHARTERED SOCIETY OF PHYSIOTHERAPY
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HEALTH AND SAFETY
HEALTH AND SAFETY BRIEFING PACK NO 1
WORKPLACE STRESS
MAY 2004
Employment Relations & Union Services
TABLE OF CONTENTS
PAGE
INTRODUCTION
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DEFINITION
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CAUSES OF STRESS
- Physical Conditions & Work Environment
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Job Design
Contractual/Work Organisation
Relationships
Balancing Demands
THE EFFECTS OF STRESS
- Physical Signs/symptoms
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Pscho-social symptoms
Emotional/Mental Health Symptoms
THE EFFECTS OF STRESS ON THE ORGANISATION
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THE NHS
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THE CSP
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WHAT IS THE HSE DOING ABOUT STRESS
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- Enforcement Activity on Stress
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Revitalising Health and Safety Strategy
Securing Health Together
Stress and Rehabilitation
STRESS RESEARCH
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WHAT EMPLOYERS CAN DO
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REGULATION/LAW/STRESS
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- The Health ad Safety At Work Act 1974
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The Management of Health and Safety At Work Regulations 1999
Proposed Approved Code of Practice (ACOP) on Stress
Working Time Regulations
Disability Discrimination ACT (DDA) 1995
Safety Representatives and Safety Committees Regulations 1977 (SRSC)
Workplace (Health, Safety and Welfare) Regulations 1992 (WHSW)
Common Law Duty of Care
Case Law
KEY FINDINGS/LEGAL FRAMEWORK/CASE LAW
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COURT OF APPEAL RULES ON STRESS CASES
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NEGOTIATION FOR PREVENTION OF STRESS
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- Aims
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Common Obstacles
Common Proposed Solutions
Principles
Stress Audits/Surveys
Stress Agreements/Policies
Stress Management Training
TACKLING STRESS – WHAT CSP SAFETY REPRESENTATIVES CAN DO
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USEFUL PUBLICATIONS
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SUMMARY AND CONCLUSIONS
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REFERENCES AND RESOURCES
24-25
APPENDIX 1 – STRESS CASES
26-30
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APPENDIX 2 – MODEL STRESS POLICY
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APPENDIX 3 – MODEL STRESS QUESTIONNAIRE
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APPENDIX 4 – STRESS AT WORK SURVEY RESULTS (JULY 1997)
42-47
INTRODUCTION
“A certain amount of stress is necessary to motivate people”.
Management often try to justify stress in those terms and by doing so they are confusing
the issue by mixing terminology.
Many things, at home and at work can put someone under pressure – and yes, a certain
amount of pressure can be seen as motivational. However, pressures become ‘stress’,
when they reach the level at which people feel they can no longer cope with those
pressures. People’s ability to deal with pressure and the point at which it becomes
harmful to health varies between individuals.
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For many years, workplace stress was not recognised. Once recognised, it was for a long
time badly misunderstood and to suffer or have suffered from it carried an undeserved
stigma that was hard to shake off.
However, more recently, stress has slowly been accepted as a mainstream cause of work
related ill health. Large amounts of research have emerged to show that there is a clear
link between poor work organisation and subsequent ill health.
Health and Safety Executive (HSE) commissioned research has indicated that:
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About half a million people in the UK experience work-related stress at a level they
believe is making them ill;
Up to 5 million people in the UK feel ’very’ or extremely’ stressed by their work; and
Work-related stress costs society about £3.7 billion every year (1995/6 figures).
Within the UK Working population, the Trades Union Congress (TUC) revealed a
staggering twelve-fold increase in new cases of work-related stress. A total of 6,428
cases were reported in 2000, compared to just 516 the year before (TUC, 2002).
More NHS physiotherapists than ever are suffering from the effects of work related stress.
The CSP is increasingly concerned about this issue as stress is now the single biggest
cause of ill health in the workplace.
Trade Union Approach
Given this situation, organisations ranging from the HSE and International Labour
Organisation (ILO) to the TUC and health service trade unions, are taking steps to ensure
that tackling stress at work is a priority.
This briefing paper aims to help individual members and workplaces tackle the issue of
stress at work. It examines the causes of stress, its effects on health and the symptoms
to look out for. It sets out the legal duties of employers to prevent stress and gives
practical advice to safety representatives on how to use their legal rights to ensure that
stress is taken seriously.
DEFINITION
Stress is a term with which we are all familiar, yet it is notoriously difficult to define.
There are many definitions in the literature, and the term is often used to describe feelings
of fatigue, distress, and inability to cope.
The HSE defines stress as:
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“The adverse reaction people have to excessive pressure or other types of demand placed on
them”.
We have chosen a description based on a popular working definition, which is used by the
TUC, and is taken from a London Hazards Centre publication, Hard Labour (1994):
“When the demands and pressures placed on individual workers do not match the resources
which are available, either from the organisation or within the individual, stress can occur and
endanger that person’s health and well-being”.
Whatever definition is used to define stress, there can be no doubt that many workplaces,
particularly the NHS are stressful organisations to work in.
Stress is closely related to control. Many workplaces have changed, resulting in less
control for members to direct their own work. Less or low control over job tasks is
associated with high stress levels.
CAUSES OF STRESS AT WORK
In itself stress is not an illness, but if it is excessive and prolonged, it can lead to mental
and physical ill health, including depression, nervous breakdown and heart disease.
We feel stress as a result of demands that are placed upon the mind and the body. Our
reaction is called the Generalised Stress Response (CUPE, 20031). Factors that cause
this response and make us experience stress are called stressors.
Before examining these effects in more detail, it is important to first identify what the
possible factors are that cause stress at work:
Physical Conditions & Work Environment
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Noise – whether external (traffic etc), or internal (machinery, open plan working)
Incorrect temperature – too hot or too cold
Poor lighting and / or ventilation
Overcrowding
Badly designed furniture and equipment / dangerous equipment
Poor maintenance
Use of VDU’s
Poor canteen, toilet, and rest facilities
Exposure to possible violence/danger
Job Design
 Unrealistic targets
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Enough Workplace Stress: Organising for change. Canadian Union of Public Employees, 2003.
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Boring or repetitive work
Incorrect use of skills
Poor/insufficient training
Inadequate rest breaks
Lack of/too much supervision
Shift work
Too much/too little work
Isolation
Lack of direction
Lack of decision making
Lack of control over the job
Poor opportunities for peer support
Work with VDU’s and other machinery
Time pressures
Responsibility for lives
Uncertainty about responsibilities
New technology
Contractual/Work Organisation
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Lack of job security/promotion prospects
Too much unnecessary or badly planned change
Poor communication from management
Inadequate staffing levels
Long hours culture
Low pay
Job insecurity
Temporary/short term contracts
Unsocial hours
Continuous changes in work organisation
Financial constraints
Flexible working
Rigid hierarchies
Punitive disciplinary procedures
Excessive overtime
Relationships
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Harassment/discrimination
Bullying
Poor relationships with colleagues/managers
Conflict between home and work responsibilities
Unsympathetic management
Denial of training, assistance, support
Complaints by patients
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 Poor communication
 Social isolation
 Impersonal treatment
Balancing Demands
 Poor childcare/other care facilities
 Inflexible attitudes of management
 Need to take time off to care for children and other dependants
It is worth examining a few of the causes in more detail:
1.
Violence
Workers who experience violence, threat of violence, or anxiety about violence show
high levels of stress.
A third of safety reps cited violence as a cause of stress in the TUC’s 1998 stress
survey.
Violence and aggression at work can take many forms, and originate from many
sources, but lead to high levels of stress-related symptoms.
The Department of Health (DH) has a programme of work including a Zero
Tolerance campaign to tackle violence against NHS staff. For more information see
the CSP Health and Safety briefing paper No 2 on Violence At Work.
2.
Excessive/Unsocial Hours
Physiotherapists are in short supply and many work considerable amounts of unpaid
overtime on top of their daily on-call and weekend contractual commitments.
Physiotherapists and Assistants are also increasingly required to work ‘flexibly’ both in
terms of hours per day, and days themselves, for example with more and more
trusts looking to introduce flexible working arrangements i.e. 7 day working and
extended shifts. There are demands to provide more on-call/emergency duty
services.
These can all cause stress due to overwork and juggling other non-work
commitments.
3.
Physical Hazards
Some physical hazards include noise, vibration, toxic substances, temperature,
ventilation, and lighting. These can cause stress both by anxiety of serious
damage, e.g. industrial deafness, eye strain, and by interfering with concentration
and energy levels, e.g. persistent noise and excessively high temperatures.
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One of the most common physical hazards in physiotherapy departments which is
associated with stress is space.
In September 2002, the Employment Relations and Union Services department at the
CSP conducted a survey via the safety reps network on physiotherapy Work
Environment, and found space to be the single most pressing work environment
issue for members .
Many physiotherapy departments are cramped, and there is inadequate space for
storage, note-writing and for undertaking treatments. More information on the Work
Environment can be found in the Safety Reps Information Manual.
4.
Women and Stress
Many stressors are compounded for female workers. The female workforce is
predominantly characterised by people who work part time, have little job security
and are low-paid. They show high levels of lack of control over work, and are
subject to far greater levels of sexual harassment than male workers. The majority
of women workers also have another job involving responsibility for children or other
dependants.
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Men and Stress
Although there are no research findings on this specific aspect, the CSP has an
increasing amount of anecdotal evidence regarding men and stress.
Physiotherapy is a female dominated profession, but there is an increasing number of
examples of male physiotherapists finding it extremely hard to state openly that they
are suffering from work-related stress.
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Harassment & Bullying
Workplace harassment and bullying is often characterised by employees being shouted
at or chastised in front of colleagues, or having areas of responsibility taken away
etc.
Dr Cary Cooper, a leading stress researcher, of the University of Manchester Institute
of Science and Technology (UMIST), estimates that between a third and a half of
work-related stress is caused by bullying.
Bullying can lead to victims suffering from stress-related illnesses including anxiety,
tension, depression, lack of concentration, headaches and deterioration in personal
relationships.
For further information, please refer to Health & Safety briefing paper No 5 – Bullying at
Work.
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THE EFFECTS OF STRESS
The immediate effect of stress on the body is the fight-or-flight response. However, this
leads on to a variety of other short and long term symptoms. As many of these symptoms
are generalised, and may be caused by other factors, they have long been ascribed to the
characteristics of a particular person, rather than to work-induced stress.
However, mounting evidence now shows that workplace stress is the common thread linking
a number of physical, emotional, and psychological symptons. These can be characterised
as follows:
Physical Signs/symptons
Short Term
Headaches/migraine
Colds & respiratory infections
Backache
Poor sleep
Indigestion
Menstrual Disorders
Effects on pregnancy
Lethargy
Muscle tensions/cramps
Neck Ache
Chest Pains
Racing Pulse
Tooth/Jaw Pain
Palpitations
Long Term
Heart Disease
Hypertension
Ulcers
High Cholesterol
Risk of Cancer
Diabetes
Asthma
Karoshi (death from overwork)
Pscho-social Symptoms
Short Term
Increased consumption of alcohol, drugs,
cigarettes
Increased sickness absence
Accidents
Insomnia
Loss of appetite
Overeating
Long Term
Relationship breakdown
Society isolation
Domestic violence
Alcoholism
Suicide
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Emotional/Mental Health Symptoms
Short Term
Long Term
Fatigue
Anxiety
Irritability
Boredom
Depression
Poor concentration
Low self-esteem
Emotional outbursts
Fear and Panics
Nightmares
Withdrawal
Chronic depression
Chronic anxiety
Breakdown
Post Traumatic Stress Disorder (PTSD)
Obviously, not everyone under stress at work will exhibit all or even any of these
symptoms, but managers should be aware of the early symptoms of stress, to enable them
to identify individuals in need of assistance.
THE EFFECTS OF STRESS ON THE ORGANISATION
In addition to the effect on individuals, work related stress also affects the organisation.
The Department of Health estimates that between five and six million working days are lost
every year as a result of stress. The employers’ organisation, The Confederation of
British Industry (CBI) estimates that a third of all sick leave is stress related; and the
HSE estimates that stress related illness costs the UK £7 billion each year.
Stress can cause:
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Increased sickness absence; high absenteeism
Reduced productivity/work performance
Increased accident rates
Poor timekeeping
Customer/patient complaints
Conflict between managers, staff, colleagues, clients/patients
Increased turnover of staff
Poor staff morale.
By properly addressing the causes of stress at work, organisations can increase efficiency
and hold on to their staff, reducing recruitment and training costs as well.
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With settlements in legal cases for compensation running high (in the case of Walker v
Northumberland County Council, a worker was awarded £175,000 in damages for the
effects of stress caused by work, see Appendix 1), employers can also protect themselves
from costly court cases.
The NHS
The health sector as a whole and health professionals as a group are at higher than
average risk of suffering from conditions related to stress.
The NHS is variously reported as being the most, or one of the most, stressful industries
in which to work. It is unsurprising that this has risen sharply in the last few years,
following radical reform in the Health Service.
A survey undertaken by the Southampton Institute of Higher Education showed almost a
third of NHS employees taking medication that was in some way linked to stress.
Additionally workers expressed concern about keeping pace with change while being illinformed; 67% said they suffered stress from having to do things which conflicted with
personal values, and 70% were worried about the financial position of the Health Service.
Major causes of stress cited included lack of understanding of work by managers, lack of
consultation, internal politics, and changes in polices and procedures. Health Service
workers also exhibit a high level of post traumatic stress disorder.
The CSP
The CSP believes tackling stress should be a priority for the NHS and for Physiotherapy
Managers. Looking at trends throughout the UK, the CSP has seen a marked increase in
the number of members coming forward for advice on work-related stress.
The biggest single factor is overwork and workload pressures. There are also issues
around constant organisational change, and lack of control of members over their work and
workload. Stress caused by bullying at work is also a significant factor.
Members need to come forward for advice as early as possible. The CSP advises against the
practice of asking your GP to put something other than stress on a sick note, as this masks the
problem.
Following a resolution at Annual Reps Conference some years ago, the CSP decided to
undertake a stress survey of its own members, and the report of this is included in
Appendix 4.
The survey revealed two thirds of CSP members working under high or very high levels of
stress, and identifying an increase in stress levels over the last five years. One in eight
CSP members has had time off work with stress, and members are exhibiting a range of
the short and long-term effects of stress.
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While around a quarter of members have access to some form of counselling, only a tiny
proportion have workplace measures in place which address the root causes of
organisational stress, such as risk assessments and prevention of stress polices.
During summer 2003, the Employment Relations and Union Services department conducted
some primary research in to work-related ill health and musculoskeletal disorders (MSDs)
amongst 10% of the CSP membership.
Section B, of the questionnaire asked questions around general injury/ill health (nonmusculoskeletal) and found that 67 members said they suffered from stress which led to a
diagnosed medical condition (eg clinical depression) and 100 members said although they
did not receive a clinical diagnosis, their stress levels were so high that it necessitated
taking time off work as a result.
WHAT IS THE HSE DOING ABOUT STRESS?
The Health and Safety Executive (HSE) is the Government body which is responsible for
advising employers and others on health & safety matters and for enforcing health & safety
law.
In order to help employers tackle this challenging issue in their own workplaces, HSE has
a programme of work in place to develop guidance, training materials etc.
Following a public discussion exercise in 1999, the HSE announced a new strategy for
tackling-work related stress:
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Develop “standards of good management practice” for preventing a range of stressors
Better equip enforcement officers to handle the issue routinely
Encourage a more comprehensive approach to preventing work related stress
Conduct a publicity drive to inform employers about what they could already be doing to
prevent work related stress.
This is being delivered through a range of activities by the HSE itself and with partners.
In June 2001, the HSE delivered the first output from the strategy: new guidance for
managers in organisations employing more than 50 people.
The HSE are developing “standards of good management practice”, against which
organisations can measure their progress in tackling work-related stress and target action
where it is most needed.
These standards are intended to represent goals to be
achieved, and will be supported by an information pack which will build on the HSE
guidance Tackling Work-related stress: A Manager’s guide providing further support and
practical advice to managers on such areas as:
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Developing a business case
Gaining employee and trade union commitment;
Identifying and targeting the key issues within your organisation; and
Reviewing progress and success.
The standards will be in seven broad areas, covering the main causes of work related
stress:
 Culture – i.e. things that define how people and the organisation relate, including, for
example, how supportive the organisation is;
 Demands – i.e. the load placed on individuals and their capacity to handle it;
 Control – i.e. the amount of say an individual has in how their work is carried out;
 Support, training and individual factors - i.e. the need to provide a supportive
environment and to consider individual circumstances in designing work, including training;
 Relationships – i.e. covers how people relate to one another in the workplace, and
includes bulling and harassment;
 Role – i.e. the need for employees to be clear about their place in the organisation;
and
 Change i.e. the effects of change management on workers.
Draft Management Standards were published on 16 June 2003 and are currently being
piloted in a variety of organisations.
The draft management standards and supporting materials are now publicly available on
HSE’s website, http://www.hse.gov.uk.
The CSP believes that the pilot of the standards can be the first step to encourage
enforcement activity by health and safety inspectors on stress. For over a decade there
has been a legal obligation on employers to conduct (and take preventative action
following) risk assessments of all the risks that may affect their employees. Despite this,
enforcement action on stress, in the form of either improvement notices or prosecutions,
has been negligible.
The Health and Safety Commission has signalled it’s intention to take a tough line with
organisations that persists in ignoring the growing problem of stress at work.
It has pledged to work towards a 20 per cent reduction in stress related absence from
work within 10 years. (see below).
Enforcement Activity on Stress
The main focus of inspections on
complete a suitable and sufficient
measures to deal with the risks.
of stress such as under-staffing
counselling for stressed workers.
stress issues is to help and encourage employers to
risk assessment and then to implement any necessary
It is vital that control measures address the root causes
not just , for example, the effects of providing
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Inspectors will use their judgement when advising upon the most appropriate action to take.
In some cases, formal enforcement action may be taken e.g. serving an Improvement
Notice (IN).
HSE has recently served an IN on West Dorset General Hospitals NHS Trust. The IN
was served following an investigation by an HSE inspector into concerns raised about
certain aspects of the control of work related stress at the Trust. The inspector discussed
with the Trust measures needed to tackle the problem and agreed a deadline for
compliance. The inspector has written to the Trust to explain why the IN was served and
will continue to advise and assist the Trust in this matter.
Revitalising Health and Safety Strategy
The Revitalising Health and Safety Strategy (RHS) was launched jointly by the Government
and Health and Safety Commission on 7 June 2000. This 10 year strategy seeks
significant improvements in workplace health and safety by setting, for the first time,
challenging targets aimed at reducing:
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The incidence of work-related ill health;
The number of fatal and major injuries; and
Working days lost caused by injuries and ill health.
Securing Health Together
Securing Health Together is the HSC’s 10 year occupational health strategy for Great
Britain which compliments the Revitalising Health and Safety strategy. Below are four key
elements of the strategy:
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To work with partners to develop clear, agreed standards of good management practice
for preventing Work Related Stress (WRS).
To better equip enforcement officers to handle the issue in their routine work.
To facilitate a comprehensive approach to managing WRS.
A publicity drive to help educate employers about what they can already be doing to
prevent WRS.
Work related stress is one of HSE’s eight priority areas. They have set themselves a
goal of meeting by 2010, key targets relating to work related stress (as outlined in
Securing Health Together) including:
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A 20% reduction in the incidence of work related ill health;
A 30% reduction in the number of work days lost due to work related ill health; and
That people not working due to ill health or disability are given opportunities for
rehabilitation back in to work or offered opportunities to prepare for and find
employment.
Stress and Rehabilitation
The HSE has published a new research report on stress prevention and rehabilitation,
summing up current best practice and suggesting practical steps employers can take to
prevent stress.
The report, Best Practice in rehabilitating employees following absence due to work related
stress, suggests employers should make contact with workers who are off sick with stress
within a week – but only to give support and not discuss treatment.
Researchers suggest referral to occupational health for a health assessment should start
after four weeks. The importance of employee involvement in a successful rehabilitation
plan is emphasised. Employers should also allow workers to return to work on a gradual,
phased basis and to adjust their work to ease the transition.
STRESS RESEARCH
Two new research projects funded and published by the HSE revealed that there is a clear
link between job design and employee stress.
Key findings from ‘The Scale of Occupational stress: The Bristol Stress and Health at work
study’ were:
 One in five workers reported feeling very or extremely stressed by their work – the
research team estimates this equates to about 5 million workers in the UK.
 There was a link between reporting being very stressed and a range of job design
factors, such as having too much work to do or not being supported by managers.
 Reports of high stress levels were also linked with a range of health outcomes, such
as poor mental health and back pain; and health-related behaviours, such as drinking
alcohol and smoking.
Study 2
Key findings from ‘Work related factors and ill health: the Whitehall II Study’ were:
 Not having much say in how work is done is associated with poor mental heath in
men and a higher risk of alcohol dependence in women.
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 Fast paced work and the need to resolve conflicting priorities is linked with a higher
risk of psychiatric disorder in both sexes and poor physical fitness or illness in men.
 A combination of putting high effort in to work and poor recognition by managers is
associated with increased risk of alcohol dependence in men, poor physical fitness or,
illness in women, and poor mental health in both sexes.
 Aspects of poor work design were also associated with employees taking more sickness
absence.
The main findings of the 2001/2002 HSE’s survey of self-reported work related illness
(SW1), which is part of the Labour Force Survey found, of the 2.3 million people in the
UK with a work related illness, 563,000 cases are caused by stress at work; this
represents almost a quarter of all industrial ill health.
TUC research shows that stress is Britain’s number one workplace health hazard.
Workers exposed to stress for at least half their working lives are 25 per cent more likely
to die from a heart attack, and 50 per cent higher odds of suffering a fatal stroke. These
facts are
exposed in the ‘Modern workers health check’; featured in the August 2003 edition of TUC
backed Hazards magazine. It reveals:
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Workers with stressful jobs are more than twice as likely to die from heart disease.
An individual’s mental health deteriorates when a change in workload results in higher
demands, less control and reduced support.
Once again, a survey published in July 2003, conducted by the Chartered Institute of
Personnel and Development) has found stress to be the most common cause of long term
sickness absence among non-manual workers. Absence is higher among public sector
workers and nearly two-thirds of public sector organisations identify stress as their leading
cause of long term absence. This is twice the percentage of private sector employers
giving the same reason.
Interventions to control stress at work in hospital staff – Contract Research Report
Research funded by the public services union UNISON and the Royal College of Nursing in
partnership with the HSE, looked at applying a risk management approach to dealing with
the problem of work-related stress among hospital staff.
The report highlights the benefits that good management practices can have in terms of
working conditions and staff well being and found that:
 healthy workplaces were those that had a regular forum for communicating information
and discussing and solving problems (eg. regular team meetings or problem solving
workshops);
 staff who had the autonomy of having a high degree of control over how they did their
job had high levels of staff satisfaction;
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 healthy workplaces were also those with good work environments - where equipment
was kept up to date and well maintained and systems were in place to ensure its
condition and availability was monitored;
 the authors of the report recommend that the risk management approach to tackling the
problem of work stress offers a practicable way forward for hospitals to comply with
their legal duties with regard to preventing and managing work-related stress.
WHAT EMPLOYERS SHOULD DO
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Good sickness absence data collection and monitoring is a key aspect of identifying the
problems with stress at an early stage. If a particular team or unit demonstrates high
sickness absence, the employer needs to investigate the causes to find out if staff are
having to take time off due to stress.
The key message is to talk to staff and safety reps to allow staff to talk about stress.
Conduct exit interviews. If staff turnover is high, the employer needs to know why
people are leaving.
Improve communications (e.g. by introducing regular team meetings).
Have a comprehensive negotiated prevention of stress policy.
Conduct risk assessments and put risk control measures in place which address the root
causes of stress.
REGULATION/LAW AND STRESS
Although there is no specific law dealing with stress, existing laws, such as the Health and
Safety at Work Act 1974 and other legislation are relevant to tackling work-related stress.
The Health and Safety at Work Act 1974
The main relevant legislation is in section 2 of the Health and Safety at Work Act 1974:
“ It shall be the duty of every employer to ensure, so far as is reasonably practicable,
the health, safety and welfare of all his employees”.
This does not only mean physical health, but mental health as well.
is a health and safety issue like any other workplace hazard.
Occupational stress
The Management of Health and Safety at Work Regulations 1999.
The most important Regulations which can be used to protect members are the
Management of Health and Safety at Work Regulations 1999. These require employers to
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assess the nature and scale of workplace risks to health and ensure that there are proper
control measures in place to avoid these wherever possible, and reduce them so far as
possible, where not.
Every employer must conduct a suitable risk assessment in every workplace by law.
These risk assessments are the key to preventing illness through stress. The HSE
guidance “Stress at work: a guide for employers”, demands that ill health from workplace
stress be treated the same as ill health due to the other, physical causes when “assessing
possible health hazards, looking out for developing problems, and being prepared to act if
harm to health seems likely”.
The guidance goes on to state that ‘Employers have a legal duty to take reasonable care
to ensure employees’ health is not placed at risk through excessive and sustained levels of
stress arising from the way work is organised, the way people deal with each other at
work (managerial styles, or harassment etc) or from the day to day demands (of work)’.
In other words there is nothing special about stress that makes it different from other
hazards. It must be identified, and then removed or controlled in order to ensure a safe
workplace. If stress is a potential hazard it should be identified in risk assessments the
same way as physical hazards such as dangerous chemicals or fire risks.
Proposed approved code of practice (ACOP) on stress
Trade Unions have been campaigning for several years for the introduction of an Approved
Code of Practice or regulations to tackle stress at work. The CSP believes that as workrelated stress is now the single biggest cause of occupational ill health in the UK, there
should be specific legislation in the form of an Approved Code of Practice to structure
enforcement action in this vital area.
An ACOP could be used as evidence in court if a case is taken against the employer.
Employers would have to demonstrate that effective measures, at least equal to those set
out in the code, have been taken to deal with the risks of stress.
A new ACOP on stress was proposed by the Health and Safety Commission (HSC) in
1999, but was put on hold as it claimed since there are no agreed standards of
management practice against which an employer’s performance in managing a range of
stressors could be measured. Without such standards the HSC says an ACOP would be
unenforceable.
The HSE is to provide these standards. The HSC says that although it does not believe
that an ACOP is the right way to deal with stress at the moment, the need for an ACOP
will be kept under constant review.
The CSP is therefore keen to see that the management standards pilot will be meaningful,
involving a wide range of different organisations and thereby producing useful comments,
information and results. The CSP remains firmly of the view that the work done on
19
production and piloting of the management standards can be used to assist in the effective
introduction of an Approved Code of Practice in the near future. The Society submitted a
motion to this effect to TUC Congress in Brighton in September 2003.
Working Time Regulations
Working long hours and shiftwork are both linked to stress. The Working Time Regulations
1998 limits working time and outlines rest periods and also makes paid holidays a legal
entitlement.
These may alleviate some of the worst causes of stress – long hours and lack of rest.
The CSP has produced guidance on the Working Time Regulations – Briefing paper no 22.
Disability Discrimination Act (DDA) 1995
The Disability Discrimination Act (DDA) 1995 makes it unlawful for organisations with 15
or more employees to treat a disabled person less favourably, without a justifiable reason.
In relation to health and safety, the most important part of the Act is in section 6. This
requires employers to make reasonable adjustments to working conditions or to the
workplace to avoid putting disabled workers at a substantial disadvantage. Failing to do so
is unlawful discrimination and an employer dismissing a disabled worker, where no
adjustments have been made can be held liable in a discrimination or unfair dismissal
case.
Complaints about the disability discrimination go to an employment tribunal which can award
compensation and recommend action for the employer to take within a specified period.
For more information, please see our factsheet no 27 on the Disability Discrimination Act.
Safety Representatives and Safety Committees Regulations 1977 (SRSC)
The SRSC Regulations give safety representatives extensive legal rights to investigate and
tackle workplace stress.
Where there is a recognised trade union, the members are legally entitled to elect at least
one representative.
Under the Regulations, safety reps have the right to:






Investigate potential hazards;
Inspect the workplace and talk to members in confidence;
Take up members’ health and safety complaints;
Be consulted by the employer about health and safety matters;
Obtain health and safety documents held by the employer; and
Take time off to carry out their functions.
Safety reps will be able to gather information from management on issues such as sickness
and accidents, which may be useful in identifying patterns of stress.
20
They can conduct membership surveys to build up awareness of stress and reveal the
extent of the problem. They can also organise inspections to identify the causes of stress.
Workplace (Health, Safety and Welfare) Regulations 1992 (WHSW)
These regulations cover workplace conditions such as ventilation, temperature, lighting,
cleanliness, space and drinking, washing and rest facilities. Failure to provide and maintain
these facilities can be a source of workplace stress.
Common Law Duty of Care
This is an area of law concerned with compensation claims.
Under Common Law the employer owes a general duty of care to each individual, for
example to provide a safe system of work and protect employees from foreseeable risks.
An employer’s common law duty also operates as an implied term of the contract of
employment. Any contract which imposes an absolute obligation on an employee to work
an excessive number of hours on a regular basis may be void under the Unfair Contract
Terms Act 1977 as it may be regarded as an attempt by the employer to avoid liability for
death or personal injury. There is a fundamental implied duty of mutual trust and
confidence in every contract of employment.
This duty may be breached as a result of serious or consistent abuse directed at an
employee by the employer, or a failure by the employer to protect employees who are
subject to abuse from other colleagues.
It should be pointed out as a warning that, because of the different effects of pressure on
individuals, the courts are not easily persuaded that an employer has breached this duty of
care. In the case of Walker v Northumberland County Council, Mr Walker was successful
only because
of the fact that he had a second breakdown caused by stress and was able to show that
his employers should have taken action following the first, to prevent further damage (see
Appendix 1).
Case Law
In addition to statute and common law, civil case law is important in cases of work-related
stress. Some useful cases where employees have sued their employer over breach of duty
of care, lack of training, overwork, job transfer, bullying and harassment etc have been
listed in Appendix 1.
KEY FINDINGS/LEGAL FRAMEWORK/CASE LAW
21
There have been several court of appeal decisions where the employee has been
unsuccessful in their claim for compensation (see stress cases in Appendix 1) and these
court of appeal decisions, against a background of rising levels of work related stress serve
as a reminder of how vital it is to approach the problem in the right way:
 Have a negotiated policy which aims to prevent stress.
 Have a comprehensive risk assessment programme in place, which assesses risks of
work stress.
 Make sure that control measures identified in risk assessments are actually put in place.
 Report overwork, changes in work demands and other stressors as early as possible
and in writing.
 Report the adverse effects of such changes e.g. stress-related symptoms in the same
way.
 Make sure employers are aware that an individual’s problems are related to stress at
work if this is the case.
 Seek advice from the CSP whenever you need it.
COURT OF APPEAL RULES ON STRESS CASES
A House of Lords ruling in April 2004 (Barber v Somerset Country Council, see Appendix
1), confirmed that employees can win damages for workplace stress only if their employer
knew that they might suffer mental damage, or had been warned that this might occur.
Even though the House of Lords allowed the appeal of Barber, the law lords backed the
Court of Appeal’s guidance on when to award damages for stress. This makes it clear
that workers can win damages for stress at work only if:
 The employer knows the employee has suffered a previous mental breakdown; or
 The employee has told the employer that they think they are going to suffer ill health
through stress at work.
The Court of Appeal has set some useful guidelines for lower courts to follow:
 Employers can usually assume that employees can cope with normal pressures of their
jobs unless they know that a particular employee is vulnerable. This highlights the
importance of making employers aware of excessive demands and the effects these are
having.
 Employers are only expected to take steps if indications are clear that an employee is
likely to suffer harm from occupational stress. Once again this underlines how important
it is that members are open about the causes of any problems or absence from work.
22
 If work stress is not the sole cause of the ill health, employers are only liable for the
proportion which is attributable.
 An employer who offers a confidential counselling service is unlikely to breach their duty
of care. This point is unhelpful, particularly as person-based interventions such as this
have been shown to be largely ineffective in reducing stress in organisations as they do
not tackle the root causes.
The above points illustrate once more how difficult it remains to pursue a civil claim for a
stress related injury.
NEGOTIATING FOR PREVENTION OF STRESS
First and foremost, stress is a trade union issue. Stress must be recognised as an
organisational problem which effects individuals and not vice-versa. It is the result of poor
work environments, job design, or work organisation, not of weak or incompetent individuals.
Stress can be approached by trade unions in the same way as any other occupational
hazard:
Aims
a)
b)
c)
d)
e)
f)
g)
h)
Recognition by the employer that stress is an organisational problem.
Recognition that employees are experiencing work related stress.
Employer commitment to fulfilling their legal obligations and reducing occupational stress.
Finding out the extent of the problem, usually by a joint management/union anonymous
survey (see below).
Negotiation of a prevention of stress policy (see below).
Clear identification of preventative measures
Clear and trusted reporting systems
Clear and sympathetic ways of helping employees experiencing stress.
Common Obstacles
a) Management will not acknowledge the problem within their workforce; this can be dealt
with by general or sample surveys, case studies, requesting risk assessments for stress,
inspection reports etc.
b) Management see stress as an individual problem requiring individual solutions; a wealth of
literature is now available to counter this argument (see references at the end of this
document).
c) Management claim lack of resources to tackle stress; the Health and Safety at Work Act
1974, and Management of Health and Safety at Work Regulations 1999, impose a legal
obligation on employers to reduce risks of stress and, although they are only required
to do what is “reasonably practicable”, the resource argument alone is not a “get out”
clause. In addition, while cost benefit assessments should only be used to assess
which preventative measures should be implemented first, there are strong “cost
arguments” where stress is concerned. The obvious one is reduction in days lost
23
through sickness absence, and this can be dramatic where root causes of stress are
addressed. However, there are also savings on the “hidden” costs of high accident
rates, inefficient and unproductive working, low morale, poor health amongst employees,
high turnover rates, and recruitment and retraining costs.
Common Proposed Solutions
Initial responses by employers to the issue of stress are often “person-based”. They
include stress counsellors, helplines, gym facilities, lifestyle advice, stress management
techniques, relaxation, and looking at stressors outside the workplace.
While these measures may not be harmful, and indeed some are helpful, they perpetuate
the view that stress is an individual problem, and thereby the personal stigma that many
still feel is attached to stress.
Any of the above may form a small part of helping someone who is experiencing workrelated stress, but these are the very measures which have been shown to be the least
effective in reducing stress; this is because while they may mitigate the worst effects of
stress, they do not address the root cause. (ILO, 1992).
Principles
The European Union sets out these principles for preventing stress in the workplace:
a)
b)
c)
d)
e)
f)
g)
Planning and design which accounts for health.
Participation of users; joint initiatives are the key to success.
Better work organisation; greater control and autonomy by workers over work tasks etc.
A holistic approach to the environment.
Quality of working life.
Attention to workers with special needs, e.g. shiftwork, older workers etc.
Economic feasibility.
Stress Audits/Surveys
a)
Audits/surveys can help to show staff that the problem of stress is being addressed.
It is possible to analyse them in a way as to compare stress levels between
grades, or jobs, areas of the organisation or between male and female employees.
They can determine the stress level within an organisation as a benchmark to
measure the effectiveness of a strategy. They are not, however, a solution in
themselves and must only be used as part of a wider strategy to tackle stress.
24
b)
Employees must be prepared for the questionnaire and must be educated/reassured
as to its purpose.
c)
Model questionnaire attached in Appendix 3.
Stress Agreements/Policies
A stress policy demonstrates management’s intentions on stress. It can be used to lay
out a progressive approach to tackle the problems of stress. An agreement or policy will
also help to communicate the message to managers and staff that stress is viewed as a
problem for the organisation to tackle and not as a weakness in individuals.
An effective policy on stress should:







recognise that stress is a health and safety issue;
recognise that stress is about organisation of work;
be jointly developed and agreed with workplace unions;
indicate commitment from top management;
be signed by the employer
guarantee a ‘blame free’ approach; and
apply to everyone.
An example of a model policy is included in Appendix 2.
Safety reps must be consulted on the contents of any stress policy and have the
opportunity to comment and make suggestions for change.
Stress Management Training
Stress management training comes in various forms. It usually teaches people to cope
better with the pressures they may come across; because it focuses on the individual, it
tends not to tackle the causes of stress at work. However, it can be useful as part of a
‘bigger plan’ to tackle work-related stress.
TACKLING STRESS – WHAT CSP SAFETY REPS CAN DO
Raising the profile of stress with both members and management are important first steps.
1. Discuss the issue with members;
2. Ask what action management are taking to tackle stress;
25
3. Is stress considered as part of the risk assessment process and is the employer
undertaking them?;
4. Is training in stress awareness /stress management available – if so, is it available to
all staff, not just management grades?;
5. What support is available to members feeling under excess pressure?;
6. Check to see if your employer already has a policy on stress. If not, use the
appropriate channels to suggest that one is negotiated with the union;
7. If there is a policy, check that it is followed properly in your workplace;
8. Does the policy adopt a risk assessment approach to the problem?;
9. Does the policy meet union guidelines for a good stress prevention policy?;
10. Does the risk assessment correctly identify the main causes of stress where you work?.
If not, use the procedures to have the risk assessment reviewed;
11. Carry out a questionnaire survey or talk to members to identify the specific work related
causes which they consider important and to see if they have any suggested solutions;
12. If the employer has a policy on stress at work, ask for regular updates on the way the
policy
is being implemented;
13. Safety reps have wide-ranging rights under the Safety Representatives and Safety
Committee Regulations 1977 (see section on stress law in this paper). You should
use these rights to investigate and take up problems of work-related stress. For
example, details of sickness absence records which you can use to see if a particular
area or department has higher or lower rates of absence;
14. Raise members’ awareness of workplace stress as a health and safety issue. Circulate
information on stress, e.g. information contained in this briefing paper;
15. Encourage members to discuss stress openly at meetings;
16. Let members see that the CSP believes that stress is not an individual problem but a
workplace issue that can be dealt with collectively;
17. When you carry out your next workplace inspection:
- include potential stressors in your list of things to check
- make sure you have enough time to stop and talk to members.
- you have the right to facilities for private discussions with members during your
inspections. Find out if they think that any aspects of their work are particularly
stressful;
18. Make sure that individual members know how to contact their union representative if
they have a particular problem which is causing them stress;
19. Use the grievance procedure and /or other appropriate procedures to help individual
members who are suffering as a result of stress;
20. Seek advice and assistance from the CSP, whenever necessary.
USEFUL PUBLICATIONS
There are many publications that acknowledge the occupational stress hazards in the allied
health professions.
26
1.
A Kings Fund report, The Last Straw (2000), recommends that employers do not
rely on staff loyalty but find ways of recruiting and retaining staff. The report
further recommends that consideration is given to pay and conditions, particularly
accommodation, leisure, transport and flexible family-friendly employment practices.
Recommendations are made for staff development, the tackling of discrimination in
the workplace and an integrated approach to the issues that lead to stress in the
workforce.
2.
There are recommendations available called The Provision of Counselling Services for
staff in the NHS (NHSE, 2000). Information is given on setting up a service or
buying in a service. Recommendations are given for audit, monitoring and
evaluation, as well as examples of good practice.
3.
The Improving Working Lives Standard (2001) is an NHS document which
recognises that improving the working lives of staff contributes directly to better
patient care. The way NHS employers treat staff will be part of the core
performance measures and linked to the financial resources that they receive. It is
a commitment to invest in NHS staff.
One of the indicators looks specifically at measures to address stress, although this
focuses on providing counselling services.
SUMMARY AND CONCLUSIONS
Stress is difficult to measure. Employers often portray stress as an individual problem
rather than one affecting the whole workplace and often claim that it is caused by
problems outside of work. While it is true that there are sources of stress other than the
27
workplace, this does not mean that workplace stress is not a hazard or that it is the
product of a worker’s imagination.
The complexity of stress means that it is not usually helpful or possible to make
distinctions between stressors in and outside of work and what proportion of each is
contributing to high stress levels; the important thing is that the issue is tackled effectively.
Employers for too long have sought to address the issues of stress only at an individual
level. Provisions of Welfare or Employee Assistance Services and the increasing use of
stress awareness and stress management courses are good in a well developed strategy to
counter stress at work but not as the sole solution. The causes of stress must be
tackled, if conditions are to improve.
Stress is a health and safety hazard – plain and simple. The CSP believes that
employers should tackle stress as an organisational issue. Like any other health and
safety hazard, it should be dealt with by a systematic approach based on employers
assessing risks and taking practical steps to remove or minimise them.
Unions have been at the forefront of action to tackle stress for many years. Unions have
continued to campaign on the issue with employers and the HSC, and to support members
affected by stress.
Stress related illness and absence from work is preventable and it is the legal responsibility
of employers to take all reasonable steps to prevent it.
It is vital that stress is properly regulated. It is essential and cost effective for employers
that the problem of stress amongst workers is effectively tackled and, most importantly, it is
essential for those workers whose lives are being made a misery by suffering from stress
at work.
According to the International Labour organisation, successful anti-stress programmes are
those which attempt to change the work environment, where management is willing to
relinquish some control over work organisation and which involve trade union and worker
participation.
28
REFERENCES AND RESOURCES
Bristow S (2001) Tackling work-related stress. Occupational Health Review.
Communication Workers Union. Stress Survey (2001).
Labour Research Department.
Cox T (1993) Stress Research & Stress Management: putting theory in to practice. HSE
Contract Research Report No. 61/1993.
CUPE (2003) Enough Workplace Stress:
Public Employees.
Organising for Change.
Canadian Union of
Developing a holistic policy to manage work pressure
and stress in a multi-faceted organisation (undated).
Department for Work and Pensions:
Earnshaw J & Cooper C (1997) Stress and Employer Liability.
Hard Labour, Stress, ill health and hazardous employment practice (1994). London
Hazards Centre.
HSC (2003) Delivering health and safety in Great Britain.
Health and Safety Commission.
Annual Report 2002-2003.
HSC (2000) Securing Health Together – A long-term occupational health strategy for
England, Scotland and Wales. Health and Safety Commission.
HSC & DETR (2000) Revitalising Health and Safety – Strategy Statement.
of Environment, Transport and the Regions.
HSE (undated) Stress Essentials:
Practical Solutions That Work.
http://www.hse.gov.uk
HSE (2002) Interventions to control stress at work in hospital staff.
Report 435/2002.
HSE (2003) Occupational Stress Statistics – Information Sheet.
Executive.
29
Department
Contract Research
Health & Safety
HSE (2003) Practical Solutions to Tackle Stress At Work.
http://www.hse.gov.uk/press/2003.
IDS Studies (2002) Stress Management. Vol. 732 July. Incomes Data Services Ltd.
IPMS (1996) Work-related stress – members’ guide.
and Specialists.
Institute of Professionals, managers
PCS (undated) PCS guide for tackling Stress at Work.
http://www.pcs.org.uk
Preventing Stress at Work (1992) Conditions of Work Digest, Volume II. International
Labour Office.
Preventing Stress at Work: an HSE guide (1995).
Health & Safety Executive.
Revitalising Health and Safety (2002) –
http://www.hse.gov.uk/revitalising/progress/summary.htm
RCN (2001) Managing your stress – a guide for nurses.
Royal College of Nursing.
Risk Assessments and Hazard Control – a trade unionists guide (1993).
Labour
Research Department.
Sparks K & Cooper C (undated) Organisational awareness and response to workplace
stress – a survey of TGWU health and safety representatives. Trade Union Congress.
Stress at Work – a trade union response (1994).
Labour Research Department.
Stress at Work 1: Statutory & Common Law Duties of Care (1995).
Review & Report. No. 527.
Industrial Relations
Stress at Work 2: Contractual and employment protection issues (1995) Industrial Relations
review & report. No.528.
Stress at Work – guide for employers (1995).
Stress in the Workplace (1992).
Health & Safety Executive.
Hygiea No.6.
Stress at Work – a guide for Safety Reps
(undated) UNISON.
Surveys and Questionnaires (1994) Hard Labour Part 3 – section 8.
Centre. http://www.lhc.org.uk.
30
London Hazards
Sunley K (2001) Getting action on work related stress – a guide for GMB safety
representatives. GMB General Union.
Tackling Workplace Stress – a guide for safety reps (2000).
Labour Research
Department.
Thompson L & Neathey F and Rick J (2003) Best Practice in Rehabilitating Employees
Following Absence Due to Work-related Stress. Health & Safety Executive.
TUC (2003) Heart attacks and strokes – diseases of the modern worker.
http://www.tuc.org.uk
TUC (2002) Work overload is main cause of stress at work.
http://www.tuc.org.uk
TUC (1999) Stressing the Law – TUC response to the Health and Safety Commission’s
Management of Stress at Work Discussion Document. Trade Union Congress.
TUC (2000) A TUC dossier – Work smarter – an end to burnout Britain.
sensible regulation to tame the modern workplace. Trade Union Congress.
The case for
Work-Related Stress (1999) Usdaw.
Work-related Stress –
http://www.hse.gov.uk
Workplace report (2003), No.7. Stress and breach of contract.
Department.
WorkStress.Net.
The Labour Research
The Law and Work-Related Stress. http://www.workstress.net/law.htm
Working on Stress (2002) European Agency for Safety and Health at Work.
Appendix 1
31
STRESS CASES
STRESS CASES
a)
Walker v Northumberland County Council
John Walker, a UNISON member, was a senior social worker who, despite repeated
pleas to his managers for support, carried an enormous workload which eventually
led to a nervous breakdown. On his return to work he received extra help, but
this was gradually withdrawn, after which he had a second breakdown. This led to
enforced retirement on the grounds of ill-health.
32
Mr Walker claimed against his employer (Northumberland County Council) for breach
of their duty of care to him. The judge concluded that, although Mr Walker had
cited stress as a problem, the employer could not have foreseen that this would
lead to the first breakdown. He found, however, that they should have foreseen a
second breakdown in similar circumstances, and had breached their duty of care.
The case was settled out of court in early 1997, for £175,000, while awaiting
appeal.
Since the Walker case, there have been a number of successful union-backed
compensation claims relating to stress. Recent cases include the following:
b)
Randy Ingram v Worcester County Council
Randy Ingram, a former warden at travellers’ sites in Worcester, retired from his job
when he was only 39 after suffering stress-related ill health. UNISON said that the
county council failed to manage the warden service properly after it took over
responsibility for the running of the sites and as a result Mr Ingram became the
subject of violent and abusive behaviour, which led to his illness.
UNISON, secured a £203,000-plus payout for stress in an out-of-court settlement
from Worcester County Council in January 2000.
c)
Beverley Lancaster v Birmingham City Council
In July 1999, a former housing officer with Birmingham City Council was awarded
more than £67,000 in compensation for work-related stress caused by a job
transfer. This case made legal history as it was the first time an employer accepted
liability for ill-health caused by stress in a British court.
Beverley Lancaster sued the council after she became depressed and demoralised,
and eventually retired on medical grounds after taking long periods of sick leave.
She had been moved from her job as draughtswoman to work as a neighbourhood
housing officer. In addition to dealing with members of the public who were often
intimidating and abusive, she was not given sufficient administrative support, and had
a high workload, partly as a result of an unfilled vacancy. She said she was
expected to do the job without ever having been given proper training.
33
d)
Cath Noonan v Liverpool City Council
Also in July 1999, Cath Noonan, a domicilary care manager for Liverpool City
Council for 11 years accepted an out of court settlement for £85,000.
Cath Noonan had been bullied, harassed and intimidated over a number of years,
and had finally taken ill health retirement in 1997 after suffering a breakdown. Her
union UNISON, reported that “despite requests from herself, her GP, and even her
employer’s own welfare and counselling advisor, the council had failed to take any
remedial action”.
e)
Leslie North v Lloyds Bank
A former bank worker was awarded more than £100,000 in an out of court
settlement in August 2000 after suffering post-traumatic stress disorder, the first
such case in the banking industry.
Leslie North, a former financial advisor, was diagnosed as suffering from posttraumatic stress, after being put under intolerable pressure to meet increasing sales
targets by his managers at Lloyds Bank (now Lloyds TSB). He complained to his
managers, but was offered no support. The case is expected to lead to similar
claims in the industry.
f)
Muriel Benson v Wirral Metropolitan Borough Council
A teacher who was forced into early retirement as a result of work-related stress,
was awarded £47,000 in an out of court settlement from the local education
authority, in September 1999.
Muriel Benson, backed by the teaching union NUT, claimed that Wirral Metropolitan
Borough Council had exposed her to a foreseeable risk of injury, even though she
had complained about her workload, amounting to 66 hours a week, and warned
that she was under too much stress.
g)
In another case involving the NUT, a teacher who suffered a nervous breakdown
after being bullied by a head teacher was awarded £300,000 in a record out of
court settlement negotiated by the union.
The teacher said that the head teacher shouted at him, criticised him to pupils,
allowed discipline in the school to collapse. The union says that his complaints,
and those by other members of staff, to the county council concerning the running
of the school were ignored.
34
h)
A former post office manager, backed by the CWU communications union, was
awarded £175,000 compensation for stress in an out of court settlement in February
2000.
The manager had suffered panic attacks and had been diagnosed with depression,
before being medically retired in June 1995, after more than 30 years’ service with
the post office. He claimed that the introduction of a new business development
plan, which meant that he was given new managerial tasks, had greatly increased
the pressure he was under.
i)
Pocock v North East Essex Mental Health NHS Trust
In 1998, the widow of Richard Pocock, a mental health nurse driven to suicide
through stress, received a £25,000 settlement from North East Essex Mental Health
NHS Trust. UNISON had argued that he was subjected to a vindictive, oppressive,
ruthless and macho style of management; and that whilst management were made
aware that Mr Pocock was suicidal, they failed to do anything about it.
j)
Willans v Reckitt and Colman
Transport and General Workers’ union (TGWU) member, Barry Willans, of Stretton,
Staffordshire, became the first ever individual to take a private firm to court for
stress.
After 32 years with Reckitt and Colman in Derby, he was its longest serving
employee (and had represented it at Buckingham Palace) when he was sacked for
alleged ‘incapability’ in 1994. He had worked his way up from the shop floor to
become manufacturing superintendent. Then, in 1991, he was given increased
responsibilities and reduced support staff. Stress-induced anxiety and depression was
diagnosed as being produced ‘by an increased amount of pressure at work’.
The case went to Derby County court, which ruled that the stress was caused by
pressure to meet performance targets set for him.
The company should have adjusted his duties or offered assistance to avoid him
being under dangerous stress, it added:
‘The defendants knowing that Mr Willans’ problems might have had their origins in
pressure of work, continued to subject him to that pressure and, indeed, took steps
that had the effect of increasing it’.
35
However, in another case a nurse was unsuccessful in her attempt to win damages
from her employer:
k)
Rorrison v West Lothian College Regional Council
This case was reported in Income Data Services (IDS) Brief 655, February 2000,
the nurse claimed she had suffered stress-related illness as a result of being bullied
by her line manager at the college.
The Court of Session in Scotland ruled that employees who suffer from stressrelated illness are only entitled to damages if they have a recognised psychiatric
disorder. It also said that the duty on employers to safeguard employees against
psychiatric injury only arises where it is reasonable foreseeable that stress or anxiety
is being suffered to such an extent that is likely to lead to a psychiatric disorder.
Stress and breach of contract
l)
Marchall Specialist Vehicles v Osborne EAT/29/30
Ms Obsorne resigned bringing a constructive dismissal claim against her employer.
She said that the failure to take action to reduce her workload, which was causing
her stress, amounted to a breach of the implied duty of care.
An employment tribunal ruled in her favour and the employer appealed.
The Employment Appeal Tribunal (EAT) rejected the claim. It held that although
every contract has an implied duty of care, this does not mean that there is an
obligation incorporated in to every contract that the employer must take any
reasonable steps to comply with an employee’s request for a reduced workload.
The duty is one of taking “reasonable care” of the employee. The job for the
tribunal is to define the nature of the duty on the employer, question whether the
employee’s loss was foreseeable, define the nature and extent of the breach of the
duty and consider whether it was the breach that caused the injury to the employee.
m)
Pratley v Surrey CC, Court of Appeal, April 25 July 2003.
The Court of Appeal has agreed with a High Court ruling in the case of Pratley v
Surrey CC. It has held that an employer was not liable for the stress caused to
an employee whose health it had been recognised would be at risk if no steps were
taken, but for whom it could not have been foreseen that the employee’s health
would suffer an immediate and unforeseeable collapse.
36
n)
Barber v Somerset County Council [2004] UKHL 13
Mr Barber was a school teacher who had suffered a mental breakdown at school in
November 1996, since then he was unable to work again as a teacher. Following
a restructuring of staffing at the school in 1995, he had worked long hours, and
towards the end of 1995, he had begun to feel the strain. He had consulted his
doctor about “work stress” and had been off work due to “overstressed/depression”
for three weeks in May/June 1996. He had spoken to the headmistress and her
two deputies about his troubles, but he had been treated with inadequate sympathy
and nothing had been done to assist him.
The original tribunal ruled that Barber had been given little help even though the
school’s senior management was aware of the stress he was under. In 2002, the
Court of Appeal found that Barber’s employers had not breached their duty to him
and said that the school had not been required to check whether he was still
suffering from stress, despite knowing of a previous illness. It quashed the original
award of £101,041 in damages and interest.
That decision has now been overturned by the House of Lords, which awarded
Barber £72,547 in damages.
The majority of the House of Lords, in a 4-1 judgement decided that the Court of
Appeal was wrong to conclude that Mr Barber’s employer was not in continuing
breach of the duty of care by failing to lessen the job-related stress from which he
was suffering.
Appendix 2
37
MODEL STRESS POLICY
Model Stress Policy
38
Introduction
The X NHS Trust is committed to protecting the health and safety and welfare of its
employees. X NHS Trust recognises that workplace stress is a health and safety issue
and acknowledges the importance of identifying and reducing workplace stressors.
This policy will apply to everyone in the X NHS Trust. Managers are responsible for
implementation and the Trust is responsible for providing the necessary resources.
Definition of Stress
The Health and Safety Executive defines stress as “the adverse reaction people have to
excessive pressure or other types of demand placed on them”.
This makes an important distinction between pressure, which can be a positive state if
managed correctly, and stress which can be detrimental to health.
Policy
 The Management of Health and Safety Regulations 1999 require employers to assess
health and safety risks, including stress, and to introduce prevention and control
measures based on those risk assessments.
 The X NHS Trust will consult with trade union safety representatives on all proposed
action relating to the prevention of workplace stress.
 The X NHS Trust will provide training for all managers and supervisory staff in good
management practices.
 Employees suffering from stress and stress-related illnesses will be offered paid time-off
to attend stress counselling sessions, so that staff can make arrangements for
counselling outside their working hours if they do not wish to draw attention to their
need for counselling. The names of stress counsellors and how to contact them will
be posted on notice boards.
 Counselling will be offered by independent and trained counsellors. This service will be
strictly confidential between the counsellor and member of staff. No details or records
will be disclosed without the written permission of the member of staff concerned.
 The X NHS Trust will provide adequate resources to enable managers to implement the
Trust’s agreed stress prevention and management strategy.
 Priority will be given to assessing the causes of stress at work and introducing
measures to reduce or prevent it.
 If stress causes deterioration in job performance, this will be treated as a health
problem and the sufferer will be encouraged to seek help under the terms of this
policy. There will be no discrimination against individuals suffering from stress.
 This agreement for dealing with stress at work forms part of the employer’s Health and
Safety Policy, and should be read in conjunction to it.
39
 This policy and its effectiveness will be regularly reviewed jointly by the staff unions and
management. The initial review will take place 6 months after this policy comes in to
effect and at intervals of not more than 12 months thereafter.
Responsibilities
Manager
 Conduct and implement recommendations of risks assessments within their departments.
 Ensure good communication between management and staff, particularly where there are
organisational and procedural changes.
 Ensure staff are fully trained to carry out their duties.
 Provide information and training to all employees, including: the causes of stress, a
copy of this stress agreement, details on how to seek help, and information on the
arrangements for reporting causes of stress and work-related illnesses.
 Ensure staff are provided with meaningful developmental opportunities.
 Monitor workloads to ensure that people are not overloaded.
 Monitor working hours and overtime to ensure that staff are not overworking. Monitor
holidays to ensure that staff are taking their full entitlement
 Attend training as requested in good management practice and health and safety.
 Ensure that bullying and harassment is not tolerated within their departments.
 Be vigilant and offer additional support to a member of staff who is experiencing stress
outside work e.g. bereavement or separation.
 If an employee becomes ill through stress, identify the causes of stress and eliminate
them through changing the postholder’s duties or working environment. Employees
unable to continue in their job because of stress-related illnesses will be offered
alternative suitable posts, subject to agreed procedures for relocation, Relocation will be
considered as a last resort, unless requested by the member of staff concerned.
Occupational Health and Safety Staff
 Provide specialist advice and awareness training on stress
 Train and support managers in implementing stress risk assessments
 Support individuals who have been off sick with stress and advise them and their
management on a planned return to work
 Refer to workplace counsellors or specialist agencies as required
 Monitor and review the effectiveness of measures to reduce stress
 Inform the employer and the health and safety committee of any changes and
developments in the field of stress at work.
Human Resources
40
 Give guidance to managers on the stress policy.
 Assist in monitoring the effectiveness of measures to address stress by, for example,
collating sickness absence statistics, conducting joint surveys.
 Advise continuing support to managers and individuals in a changing environment and
encourage referral to occupational workplace counsellors where appropriate.
Employees
 Raise issues of concern with your safety representative, line manager or occupational
health department.
 Consider opportunities for counselling when recommended.
Function of Safety reps
 Safety representatives will be meaningfully consulted on any changes to work practices
or work design that could precipitate stress.
 Safety representatives will be able to consult with members on the issue of stress
including conducting any workplace surveys.
 Safety representatives will be meaningfully involved in the risk assessment process.
 Safety representatives will be allowed access to collective and anonymous data from HR.
 Safety representatives will be provided with paid time away from normal duties to attend
any Trade Union training relating to workplace stress.
 Safety representatives will be able to conduct joint inspections of the workplace at least
3 months to ensure that environmental stressors are properly controlled.
 The joint safety committee will perform an essential role in ensuring that this policy is
implemented.
 The safety committee will oversee monitoring of the efficacy of the policy and other
measures to reduce stress and promote workplace health and safety.
Signed by:
Director of Personnel/Human Resources
Date:
Employee Representative
Date:
41
Appendix 3
Model Stress Questionnaire
A model questionnaire is attached on the next page. Please adapt the questionnaire to
suit your workplace. You may for example, want to add Department/Work Area or Grade if
your members work in a large hospital and you want to find out if stress levels differ in
different departments and grades of staff. You should also always send the questionnaire
with a cover letter, explaining the purpose of the questionnaire to members and stress that
42
it is a confidential questionnaire and that under no circumstances will any personal details
be released to the employer.
Model Stress Survey
Confidential Questionnaire
Symptoms of Occupational Stress
1.
Do you suffer from any of the following?

Recurrent headaches/migraines/anxiety
43











2.
Chest pain/palpitation
Indigestion or nausea
Poor disrupted sleep
Recurrent backache
Recurrent neckache
Irritability/loss of temper
Gastro-intestinal disorders
Feelings of guilt, fear or panic
Skin problems
Feelings of not being able to cope
Have you suffered from any of the above for a period of 12 months or over?

3.
Muscle tension
Yes

No
Do any of the following cause problems for you at work? (please tick those which
make
you uncomfortable, anxious, annoyed etc)
The Work Environment













Noise
Poor lighting
Too hot
Badly designed/inadequate/poorly maintained furniture
Poor canteen/inadequate rest or changing facilities
Poor ventilation
Too cold
Poor access to toilets/lack of staff-only toilets
Dust or fumes
Poor maintenance of building
Not enough space
Inadequate equipment
Non-applicable
Job Design

Exposure to violent/aggressive or traumatic incidents
44














The under-utilisation of your skills
Too little interesting work
Pressure to perform (deadlines etc)
Lack of decision-making
Too much or too little supervision
Working with VDU’s and other machinery
Boring or repetitive work
Too much work
The pace of work
Lack of feedback
Lack of control
Job isolation
Change or the pace of change
Non-applicable
Contractual problems











Job insecurity (fear of redundancy/temporary contracts/government targets etc)
Unsocial hours
Insufficient breaks at work
Inadequate pay
Excessive hours
Excessive workload
Insufficient holiday
Staff shortages
Threats of violence from patients
Lack of breaks after on-call
Non-applicable
Work Relationships









Harassment and/or discrimination and/or bullying
Sexism
Racism
Bad relations with supervisors
Bad relations with work colleagues
Impersonal treatment at work
Working with the public
Patient complaints
Lack of communication from management
45
4.
At work do you feel? (please tick under never, sometimes or often)
Irritated
Angry
Frustrated
Anxious
Helpless
Confused
Depressed
Unable to concentrate
Bored
Over tired
Happy
Enthusiastic/motivated
5.
Never
Sometimes
Often




































During the past 12 months, have you experienced any of the following?
(Please tick under Never, Sometimes or Often)
Never
Sometimes
Often


















Loss of motivation/
Commitment
Working increasingly
long hours
Erratic or poor time
keeping
Increase in error rates
Poor decision-making
Deterioration in planning
and control of work
46
Increase in sickness
absence
Poor relationship with



patients
Tension and conflict












with colleagues
Tension with Managers
Increase in complaints
or disciplinary problems
6.
Do you ever use the following to help with the symptoms above?
Tobacco
Alcohol








Yes

No
Are risks of stress considered in those risk assessments?

9.
Often
Have any risk assessments been carried out in your work area?

8.
Sometimes

Drugs
7.
Never
Yes

No
If yes, have measures to reduce stress been put in place as a result of the risk
assessment?

10.
Yes

No
If yes, were/are these measures effective?

Yes

No
47
Health Effects
11.
In your opinion, has the quality of your work suffered because of workplace stress?

12.
No

Sometimes
Increased
Decreased
Remained the same
Don’t know/can’t say
Yes, always
Sometimes
Rarely
No, never
Don’t know
Yes

No

Sometimes
During the past 12 months, have you taken sick days because of stress (even if
you didn’t identify those days as “stress related” on your leave forms)?

17.

Do you ever stay late or come in early to complete work (i.e. work unpaid outside
of your regular hours of work)?

16.
Yes
When staff are away from work because of holidays, sick leave or any other
reason, are replacement staff provided?





15.
No
In the 12 months, have the staffing levels in your work area or workplace?:




14.

In your opinion, has your job satisfaction declined because of workplace stress?

13.
Yes
Yes

No
If you have taken time off sick due to stress in the past two years, how many
working days were you away from work?


1-3 days
4-6 days
48



18.
15+ days
Yes

No
If you have taken time off because of stress using your annual leave, how many
working days were you away from work?





20.
10-14 days
During the past 12 months, have you taken time off using your annual leave due to
the health effects of stress?

19.
7-9 days
1-3 days
4-6 days
7-9 days
10-14 days
15+ days
Have you had difficulty taking your holiday time off because of your stress levels?

Yes

No

Sometimes
Policy Issues
21.
Does your workplace have a stress policy?

22.
Yes

No

Don’t know
In the past 12 months, have you raised stress concerns with any of the following?
(please tick as many as apply to you)







Co-workers
Safety rep
Manager/Employer
Family
Occupational health
GP
Other
49
23.
What measures do you think would help to reduce stress in your workplace?
……………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
…………………………………………………………………….
General Information
Anything written on this questionnaire will be treated with the strictest confidence.
do not give your name.
24.
Are you?

25.

Female
less than 20 years
20-29 years
30-39 years
40-49 years
50 or more years
Do you work?




27.
Male
What is your age?





26.
Please
Full time
Part time
Temporary
Other ………………………
Please use the space below to write any remarks you might have about stress that
you feel have not been addressed in this questionnaire, or any other comments that
you might have about stress as a health and safety issue.
……………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
…………………………………….
50
Thank you for completing this questionnaire.
Please return the completed questionnaire to your CSP safety representative.
Appendix 4
Stress At Work
Survey Results
July 1997
51
Stress at Work – Survey Results
INTRODUCTION
In 1995, the following resolution was passed at annual representative’s conference:
“Conference calls upon the CSP to undertake a survey to bring to light the true extent of stress
in all tiers of the physiotherapy profession”
The CSP’s Health and Safety sub-committee was then delegated the task of considering
the resolution. Over the next few months, the current data available on stress in
healthcare workers was explored. However, it rapidly became apparent that it wouldn’t be
possible to extrapolate data on physiotherapists and assistants from the existing studies.
The committee therefore decided to undertake a CSP survey on stress amongst members.
METHODOLOGY
The health and safety sub-committee considered at length the type of survey appropriate to
obtain the required information. The discussions particularly focussed on the purpose of
establishing the incidence of stress amongst members and what the data would be used for
afterwards.
52
It was agreed that there was a considerable amount of published information on stress at
work, and that the picture had considerable commonality across industries, employment
sectors etc. For example, levels of work-related stress are high and increasing across the
economy, and stress is now more widely accepted than half a dozen years ago.
Additionally, causes of stress are also remarkably similar, with intensification of work, lack
of understanding of work by the employer and job insecurity being three of the most
common.
The committee considered that the results for CSP members would show similarities with
information from other areas of the economy. A “snapshot” of the current situation,
covering the basic levels, causes and effects was therefore what was needed, rather than
an in-depth study to establish new information.
Therefore the following representative sample was identified:
 100 NHS Safety Reps (1in 7). These would then survey all the members they
represent (3-75).
 10 Stewards in the education sector, who would survey all their members.
 10 stewards in independent hospitals, who would survey their members.
 10 individual members of the Association of Chartered Physiotherapists in Occupational
Health.
 30 individual members of the Organisation of Chartered Physiotherapists in Private
Practice. This last group received a slightly amended questionnaire, to account for the
different employment setting of private practice i.e. being an employer, or self-employed
person. These results are separate and do not form part of this report.
A short survey was decided upon; 10 questions were asked covering absolute and relative
levels, causes and effects of stress, time-off with stress, and support and preventative
measures available at work.
RESULTS
As usual with surveys of CSP members there was a good response rate; because of the
nature of the sample it is complex to analyse this accurately. However, results were
received which covered 1300 CSP members (4% of the membership). Some were
received individually and others in the form of collated results from stewards and safety
reps. Salient points from the results are summarised below:
A
Levels of Stress
Respondents were asked to categorise their stress levels at work as very high, high,
not very high, or low. 62% reported either high or very high stress levels, while
only 5% identified their stress levels as low.
53
They were then asked how their stress levels compared with one and five years
ago. Over half (51.5%) said their stress levels were either higher or much higher
than one year ago. An even higher proportion (63.5%) said this in relation to five
years ago.
B
Causes of Stress
Members were asked to identify their three main causes of stress from a list of
twelve.
By far the greatest stressor for CSP members is intensification of work. Two Thirds
of respondents identified excessive workload as their primary stress factor, with the
next largest group (6%) citing lack of available cover for e.g. annual, sick, or
study leave absences.
However, when the top three stressors are considered together the picture is slightly
more evenly spread. More than three quarters mention workload in the top three,
while 41% mention lack of cover. Meanwhile, around a fifth cite constant changes,
poor management, low pay, and lack of involvement in decision making as major
causes of stress at work.
C
TIME-OFF
Members were asked whether or not they had taken time off due to work related
stress, if so, if they had informed their employer that stress was the reason.
One in eight CSP members (12.3%) had had time off due to stress at work, but
less than half of these (5.5%) had been open with their employer about the reason.
In an average physiotherapy department of twenty five people, therefore, three staff
members are likely to have had to take time-off with work related stress. This
supports the anecdotal picture formed from members’ enquiries to the Society.
Certificates for long term absences may openly cite work stress as the reason, but
are just as likely to identify depression of a non-specific reason for absence. Short
term absences often go unexplained if less than three days, or identify a range of
common causes, such as ‘flu’, colds, headaches, being run-down etc.
D
EFFECTS OF STRESS
Respondents were asked both about feelings and physical symptoms they experienced
as a result of stress at work. They were asked to categorise the factors as
experienced never, sometimes and often. Some examples of typical findings are
given below.
54
77% of respondents sometimes feel angry or irritable as a result of stress at work,
two-thirds sometimes have problems with concentration; 59% are sometimes fatigued,
while a quarter often feel fatigued.
57% of members feel anxious due to stress at work sometimes, while 1 in 10 often
feel this way, and almost 40% sometimes feel helpless because of stress.
When considering the physical symptoms, slightly over half the respondents are
sometimes experiencing headaches, anxiety symptoms, problems sleeping and
exhaustion as a result of stress at work; around 1 in 10 are experiencing such signs
often.
While the figures for other symptoms are lower, some remain of great concern. For
example, almost a third of members sometimes suffer depression due to stress at
work and quarter have sweating, indigestion and altered appetite.
There is also a range of members with more serious physical symptoms such as
raised blood pressure (8%) palpitations (17%) asthma and stomach ulcers 93%).
E
SUPPORT AND PREVENTATIVE MEASURES
The sample was first asked how supportive they felt various people were in relation
to stress at work. An encouraging 87% felt their colleagues were supportive, and
57% that their line manager was. However, less than 1 in 10 (9%) thought the
personnel function was and only 13.8% that senior management was supportive on
the issue. Significant numbers also answering “don’t know” suggests that many
employers do not have a clear and well-communicated stance on workplace issues
such as stress.
Finally, respondents were asked about any measures their employers had taken to
combat stress in the workplace. As expected, the highest level of intervention
related to counselling. A quarter of CSP members have access to counselling
through the occupational health department and 15% to external counselling.
22% had received training on stress awareness and management. However, beyond
these person-based interventions levels of action dropped dramatically.
Although nearly a fifth had contributed to a stress survey of some form at work,
less than 1 in 10 members had favourable arrangements for returning to work after a
period of leave due to stress, only 1 in 12 were covered by a stress policy of any
sort, and as few as 6% of CSP members had had stress risks included in a risk
assessment of their work or department.
This question also showed significant levels of people saying they did not know what
was available; therefore, if there are measures in place they are clearly not well
known and therefore not accessible and useful to staff.
55
SUMMARY
 Two-thirds of CSP members have high or very high levels of stress at work.
 Over half say their stress levels have increased in the last year.
 The greatest cause of stress is intensification of work, with two thirds identifying
excessive workload as their primary stressor.
 One in eight CSP members has had time off work with stress, but less than half
of these have said that stress is the reason.
 Members exhibit a range of the short and long term effects of stress, including
irritability, fatigue, anxiety, headaches and high blood-pressure.
 While 87% feel their colleagues are supportive on the issue, only 9% say the
same of the personnel function, and only 14% of senior management.
 A quarter of CSP members have access to counselling via occupational health.
 A fifth have received training on stress awareness and/or management.
 Only 8% of members are covered by a stress policy of any sort.
 Only 6% have had stress risks included in risk assessments at work.
CONCLUSIONS
The results of the CSP stress survey are in line with expectations formed from the
anecdotal experience previously held. A high proportion (11.8%) are under significant stress
at work, which has been increasing over the last five years.
Workload issues are the greatest contributor to stress levels. Covering areas such as
caseload and lack of cover. This is a predictable result, based on our knowledge of
recruitment and retention problems (a national vacancy rate of 12%), changes in the
health services in recent years, and the general trend in the European economy of
intensification of work.
The other significant factors identified also occur with other studies, both within and outside
healthcare. These are constant change, pay rates, management style, and marginalisation
in decision making.
It is clearly of concern that 1 in 8 CSP members has had to take time off with stress. It
is of greater concern, however, that most of these have not felt able to be open about
the reason for absence. This would seem to suggest that the “stigma” surrounding stress
still exists and that members anticipate an unsympathetic response to stress issues. This
would concur with responses to a later question which indicated low numbers of members
feeling that personnel and senior management were supportive about stress at work.
56
This low level of reporting of stress problems/absences raises an additional issue; it is
impossible for the problem to be tackled either preventatively at source or remedially if the
real cause is unknown. It is hard to argue that an employer should be tackling a stress
situation if they haven’t been informed of it!. Furthermore the costs of stress masked and
appear as general sickness problems, making cost-benefit arguments less useful. However,
it is unrealistic to expect to improve reporting levels until members feel more confident of a
sympathetic and constructive reception.
The effects of stress illustrate a familiar picture, with significant proportions of members
experiencing a range of the recognised short-term symptoms of stress, and rather fewer
exhibiting long-term problems, such as stomach ulcers and high blood pressure.
The final section of the questionnaire produced very interesting, if expected, results.
“sticking plaster” answers to stress were by far the most common measures taken in the
workplace. Remedial, person-based interventions such as counselling and training on
coping strategies were relatively common, even though a number of studies have found
them to be ineffective in reducing stress levels because they fail to address the root cause
and change the way in which the organisation functions.
Organisational solutions to organisational stress were disappointingly rare. Risk assessmentbased intervention and policies aimed at preventing stress at work cover only a tiny minority
of CSP members.
Overall, the CSP survey has produced results which are broadly in line with surveys carried
out elsewhere in healthcare, and also in other sectors and industries, and confirms our
previous opinion that stress levels are worrying and meaningful solutions woefully lacking.
RECOMMENDATIONS
1.
The health and safety sub-committee should consider the results and formulate an
appropriate action plan.
October 1997
2.
The results should be publicised, in Frontline and through other contacts, as widely
as possible.
June
1997
3.
The results should be sent to all safety reps, and included as an addition to an
updated Stress at Work briefing pack.
July
1997
4.
Action points determined by the health and safety sub-committee should be
implemented without delay.
57
REFERENCES
 “Stress at Work; a trade union response”, Labour Research Department.
 “Hard Labour-Stress, ill health and hazardous employment practices”, London Hazards
Centre.
 “Stress Prevention in the Workplace”, European Foundation for the Improvement of
Living and Working Conditions.
 “Stress and Employer Liability”, Jill Earnshaw and Cary Cooper.
58