Work-Related Stress: HSE Management Standards for Health and Care Employers

Health and care work is demanding, and staff stress is one of the main reasons people leave or go off sick. In Great Britain, employers have a legal duty to protect employees from stress at work, and the Health and Safety Executive (HSE) provides a framework to do it: the Management Standards for work-related stress. This guide explains the framework, the six areas it covers and how managers in care homes, hospitals and community services can apply it. It is general education, not legal advice, and it applies to Great Britain. Northern Ireland and Ireland have their own regulators.

What is the legal duty?

The HSE states that employers have a legal duty to protect employees from stress at work by doing a risk assessment and acting on it. That means stress should be treated like any other workplace hazard. It is not enough to offer a helpline or a wellbeing day. The HSE’s approach is a step-by-step risk assessment, and following it provides a suitable and sufficient way to assess stress risks. Keeping records of what you assessed and what you did serves as evidence that you took the duty seriously.

The six Management Standards areas

The HSE describes six areas where poor management can lead to stress:

1. Demands. Workload, work patterns and the work environment. In care, this includes staffing levels, shift patterns, emotionally demanding work and time pressure.
2. Control. How much say people have in how they do their work. Rigid rotas and no input into decisions reduce control.
3. Support. The encouragement, resources and backing that staff get from their organisation, line managers and colleagues.
4. Relationships. Promoting positive working and avoiding conflict, including dealing with unacceptable behaviour.
5. Role. Whether people understand their role and whether their responsibilities conflict.
6. Change. How organisational change is managed and communicated.

What do these look like in health and care?

• Demands: short staffing, double shifts and moving between sites. Repeated exposure to distress, death and aggression.
• Control: little say over rota changes or care routines.
• Support: no debrief after a death or incident, or supervision that never happens.
• Relationships: bullying, tension between teams or abuse from people using services.
• Role: unclear boundaries between care, nursing and domestic tasks, or being asked to cover roles without training.
• Change: sudden changes to staffing, ownership or processes with little warning.

A practical step-by-step approach

1. Identify the hazards. Use the six areas to look at what is causing stress. Consider sickness absence, turnover, exit interviews and incident reports.
2. Decide who might be harmed and how. Look for patterns by team, shift or site rather than by individual.
3. Gather views. Use staff surveys and short team discussions. Make it safe to be honest.
4. Evaluate and plan. Decide which risks matter most and agree actions, owners and dates.
5. Act. Make the changes, such as fixing rota rules, restoring supervision, clarifying roles or improving communication.
6. Review. Check whether the actions worked and record the outcome.

The HSE offers a free workbook with checklists and practical advice for this process. Using it makes it easier to show you followed a recognised approach.

How does this link to burnout and moral injury?

Stress risk assessment deals with the conditions that lead to harm. Burnout is one result, and our guide to healthcare burnout explains the warning signs. Moral injury, which comes from acts that conflict with a person’s values, is related but different, as our article on moral injury in healthcare workers explains. Both are easier to prevent when the six areas are managed well.

Mental health first aiders are not enough on their own

Many employers appoint mental health first aiders. They can help, but they cannot replace risk assessment. A first aider supports individuals after harm has occurred. The Management Standards aim to remove or reduce the causes. For guidance on the first aider role, see our mental health first aid at work guide.

What should managers do now?

• Check whether you have a documented stress risk assessment and when it was last reviewed.
• Look at your sickness and turnover data for patterns.
• Hold short, regular team check-ins and act on what you hear.
• Make sure supervision, debriefs and handovers actually happen.
• Talk about changes before they happen, not after.

Frequently asked questions

Is stress a health and safety issue?

Yes. According to the HSE, employers have a legal duty to protect employees from stress at work by assessing the risk and acting on it.

Do the Management Standards apply to small care providers?

The duty applies to employers generally. The approach can be scaled to the size of your team.

Is a wellbeing helpline enough?

No. Support services help individuals, but the risk assessment looks at the causes of stress at work.

Key takeaways

• Employers must assess and act on work-related stress.
• The HSE Management Standards cover demands, control, support, relationships, role and change.
• Record what you assess and do, and review it regularly.

To support your team, explore our healthcare CPD courses.

Sources

• HSE: What are the Management Standards?