Guest blog by Maria Paviour, Occupational Psychologist
I enjoyed attending the recent Policy Liaison Group for Workplace Wellbeing Roundtable on the Keep Britain Working review, chaired by Gethin Nadin with an esteemed group of people in the room, including Professor Dame Carol Black. The conversation was geared towards prevention and towards the fact that much of what we have known to be true for over 50 years is still not consistently happening in workplaces. With the HSE's role now actively moving from education to enforcement, I started wondering: where does occupational health (OH) fit into this picture?
Let me offer a provocation. What if the ambition for OH were not to see more people, but fewer? Not because OH matters less, but because organisations are finally catching problems before they become cases. That is the shift this moment demands of us, and it is what drew me to write this.
As the Chief Psychologist at Optimism Consulting, I have spent the past year working with my team on research that I think gets to the heart of why prevention keeps failing. The Upside-Down People System report, published in June 2026, covers 23 organisations and around 130,000 employees across private, public, and third sectors. It asks why organisations are investing heavily in well-being surveys, EAPs, mental health first aiders, wellness platforms - and still ending up reactive, stretched, and unable to demonstrate that any of it is working.
Consider what lands on OH's desk. The latest HSE figures show that work-related stress, depression, and anxiety now account for 52% of all work-related ill health - 964,000 workers in 2024/25, with 22.1 million working days lost. Mental ill health is now the leading cause of long-term absence. Add musculoskeletal disorders - themselves frequently rooted in chronic stress and sustained pressure - and you have the vast majority of what OH is asked to manage. Most of it is, in principle, preventable.
So why isn't it being prevented? The report's answer is blunt: the architecture is wrong. Organisations are not failing through lack of care or investment. They are managing people through systems that cannot see what matters early enough to act. The data is retrospective. Surveys measure what people choose to disclose, and in high-pressure cultures, people manage how they appear rather than admitting how they actually feel. Wellbeing budgets go to provision nobody can prove is working. The cycle repeats.
The report introduces the concept of Human Capital Intelligence: the organisational data infrastructure that would allow people decisions to be made with the same rigour applied to financial ones. Every board tracks its financial position in real time. Almost no one can see human capacity quietly eroding before it surfaces as absence, a referral, or a formal case. That gap between when strain begins and when it becomes visible. That is exactly where OH practitioners work every day.
And that is where our role becomes critical, not as the end point of a failing system, but as the profession best placed to help change it. We understand, clinically and occupationally, what organisations are producing: the burnout, the anxiety, the musculoskeletal presentations that follow months of sustained stress. We see behind the brave face. We know what early looks like because we have seen what late looks like too often.
The argument I would make to my OH colleagues is this: let us use that expertise not just to treat the outcomes, but to help organisations build systems that produce fewer of them. Reducing referrals by genuinely improving health upstream does not diminish the value of OH - it is the highest expression of it. Healthier people need us less for the wrong reasons, and more for the right ones. That's good for individuals, good for organisations, and good for the long-term standing of our profession.
The Upside-Down People System sets out evidence for what is broken and what a different system looks like. I was genuinely surprised by some of the findings, and I think you will be too. I do urge you to read it.
The Upside-Down People System 2026 is available here.