I approached NHS, Heal Thyself! with considerable interest, particularly because it appeared to acknowledge an issue that many of us working in occupational health regularly encounter: the lack of formal line management training for clinicians.
Both the GMC and NMC expect registrants to work within their competence. Yet across the NHS, many doctors and nurses find themselves undertaking line management responsibilities without receiving any meaningful education, instruction, or development in people management. In some cases, clinicians are unclear who their own line manager is; in others, they are unaware that they themselves hold line management responsibilities. This creates challenges not only for managers and staff but also for occupational health professionals trying to support both parties effectively. It raises an important question: how has such a significant gap in workforce development been allowed to persist within one of the world’s largest employers?
The report highlights several issues familiar to NHS staff and contains recommendations focused on sickness absence management, occupational health involvement, and return-to-work processes. These are valuable discussions to have, and many of the proposed interventions align with secondary and tertiary prevention approaches.
However, I was struck by the relative lack of emphasis on primary prevention. While the report discusses sickness absence, stress, burnout, and management capability, there is comparatively little attention given to modifying the underlying work environment that contributes to these outcomes in the first place. There is limited discussion of psychological safety, fatigue management, violence and aggression reduction, organisational justice, workload design, staffing pressures, or the HSE Management Standards.
Occupational health evidence consistently demonstrates that preventing harm is more effective than managing its consequences. Early intervention and return-to-work support are important, but they cannot fully compensate for organisational environments that continue to generate ill health. Importantly, prevention is not the sole responsibility of occupational health. Occupational health can provide clinical expertise, advice, and data, but the determinants of workforce health sit across the organisation. NHS leaders, line managers, learning and development professionals, health and safety practitioners, organisational psychologists, HR teams, and workforce planners all have a role to play in creating healthy work.
If we are serious about reducing sickness absence in the NHS, we need to place as much emphasis on preventing avoidable ill health as we do on managing absence once it occurs. The most sustainable workforce strategy is not simply helping people return to work sooner—it is creating workplaces where fewer people become unwell as a result of work.
Workplace health is ultimately an organisational outcome, not just an occupational health outcome.
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