Lone workers: Outcast?

Almost two-thirds of remote and isolated workers (64%) report psychological distress, according to new research1 for the British Occupational Health Research Foundation (BOHRF). This group also experiences higher levels of general health symptoms than other employees, in particular, neck, shoulder and lower back pain.

The risks to physical safety faced by remote and mobile workers – particularly verbal and physical assaults in the case of health workers and others in public-facing roles – have long been on the political and policy agenda. However, this latest analysis suggests that occupational health (OH) professionals need to pay more attention to the impact of working alone on health, and mental health in particular.

Lead researcher on the BOHRF-funded project, Dr Joanne Crawford of the Institute of Occupational Medicine (IOM) at Edinburgh, points out that remote workers are a “hot-spot” for the management of stress. Her project, which involved a systematic literature review, interviews with remote workers, and quantitative research in two companies employing high proportions of lone workers, found that these employees report higher levels of general health symptoms than other staff. In particular, she found elevated reporting of chronic fatigue, and a complex relationship between symptoms of fatigue, stress and work-based factors, such as contact with fellow workers.

Actions to protect the mental health of remote workers

The British Occupational Health Research Foundation (BOHRF) recommends that employers, line managers and OH professionals take the following evidence-based actions to reduce stress and other mental ill health in remote workers, particularly drivers:

  • Improve the effectiveness of journey- and call-planning to minimise the miles driven by mobile workers

  • Build in time for rest breaks – ideally, a break should be provided in every two to three hours of driving time

  • Ensure decision-making levels of authority are clear

  • Foster a supportive management style, particularly when managers make contact with mobile/remote workers, to build trust

  • Encourage physical fitness to help reduce chronic fatigue

  • Ensure drivers use hands-free mobile phone equipment

  • Encourage contact with colleagues and peers, through face-to-face contact at meetings and training sessions, and by mobile phone.

Remote workers distressed

The headline from the survey part of the IOM research for the BOHRF is that 64% of remote workers report mental ill health above the level defined as “psychological distress” (General Health Questionnaire (GHQ)-28 validated, binary score above 4). According to Crawford this is significantly above the level reported in the general working population, and also significantly above the level reported in previous research. Self-reports of stress rise in association with chronic fatigue, and reports of other, adverse health symptoms. Stress is also linked with high mileage among drivers in the remote worker group.

“The levels of psychological distress reported in our research reinforces that we really have to get the message across to remote workers that it is OK to report mental health problems, and to get help.” Crawford believes there is a big role for OH in this area. “We need to develop innovative approaches for this group, and get their health and wellbeing on the agenda. There is no doubt that increased distress is linked to time on the road, in the case of drivers, but we are not sure why – we need interventional research into this, and quickly.”

Poor mental health in remote and mobile workers is linked to longer weekly working hours, higher numbers of customers per month in the case of those in public-facing roles, high psychological demands, low decision authority, and other factors linked to weak management style (for example, lack of role clarity, and role conflicts). The research review concludes that providing remote workers with more time to deal with customers is linked to better mental health (see box above for BOHRF guidance on management of the wellbeing of remote workers).

Links were also discovered between work factors and the self-reported ill health of remote workers. For example, there is moderately strong evidence that back symptoms among mobile workers are associated with low levels of interaction with colleagues and feeling overworked.

Other linkages discovered by the research in part reflect those identified for the wider working population – for example, Crawford and her colleagues report that neck symptoms are associated with high work demands, low control and high levels of perceived competition at work.

Just under half (45%) of the remote drivers surveyed had suffered road rage at least once in the past year and 11% had been assaulted. Crawford stresses the importance of employers encouraging remote workers to report such incidents, and the need for training and support to be offered to those who show signs of stress or trauma in the aftermath.

Access to OH

Crawford emphasises the importance of providing remote workers with the same access to OH provision as exists for other employees. Such access was not generally a problem among the groups she studied, because the companies surveyed were relatively large and offered a full range of OH support, although remote workers did report difficulties in accessing training opportunities.

However, she accepts that access to workplace health support is an issue for employers of mobile workers with limited or no OH provision. In particular, these organisations will need to develop methods for keeping health records up to date, and for ensuring that remote workers receive appropriate health and safety training. She suggests OH needs to work closely with HR on data collection, which might lead to an exploration of why lone workers are less likely to take up training places. “This is all part of assessing and reducing risk”, Crawford adds.

In other areas, OH teams will need to think creatively. For example, encouraging employees to increase levels of physical fitness is a “huge cultural issue” across the UK, and one in which OH can play a part. But some of the more conventional methods organisations use – for example, lunchtime walking clubs or subsidised gym membership – may not be appropriate in the case of mobile and remote workers, Crawford points out.

OH professionals have a “major role” to play in managing the health risks faced by remote workers, she believes. Employers have to trust lone workers to manage their time and tasks, but also have a legal duty to look after their health and wellbeing, and need to know they are safe and working healthily. “This must be handled sensitively so employees do not feel ‘snooped’ on”, Crawford adds.

Bookies face lone working worry

More than 60% of staff working for bookmakers Ladbrokes are “worried” or “very worried” about working alone, according to a survey by the Community Union. The union carried out the research in response to a Ladbrokes decision to introduce single staffing in December 2009. According to the union, betting shop workers at the firm will be required to work a minimum three-hour single staffing period on some Sundays, historically the highest-risk day for armed robberies due to the high volume of cash held on premises.

Evidence-based actions

What should employers and OH professionals do to ensure that remote working does not adversely affect the health and wellbeing of employees? Employers have legal duties towards lone workers under the Health and Safety at Work etc Act 1974 and the Management of Health and Safety at Work Regulations 1999, and must take steps to assess and deal with any risks before people are allowed to work alone.

Meena Nanavati, managing director of consultants Occupational Medicals, argues that more employers should carry out specific lone worker medicals as part of ongoing risk assessment. Her organisation’s protocols for lone worker medicals cover “all the usual” areas, such as an individual’s weight and height, and factors linked to musculoskeletal disorders, but also look at current medication, and any history of mental ill health in order to explore any underlying medical conditions that may affect an employee’s ability to perform a role alone or remotely.

Nanavati believes that many employers assume they can re-deploy an employee into a lone working role without assessing the implications for general health and wellbeing. “There’s not enough publicity in this area, and employers are reluctant to carry out risk assessments,” she says. The situation is complicated by an absence of role clarity – is this assessment the responsibility of HR or OH and safety teams? “Also, when they do happen, the focus of many assessments is on safety, rather than health,” Nanavati confirms.

Health and Safety Executive (HSE) guidance2 recognises that establishing a healthy working environment for lone workers can differ from organising the health and safety of other employees. Lone workers face particular risks and extra control measures may be needed – for example, employers need to examine whether it is possible for just one person to control the risks of a job, and may need to adapt supervisory methods.

The role of line managers in maintaining contact with, and supervising, remote workers is vital to their health and wellbeing. Business Link3 recognises that, although it is not possible to continuously supervise lone workers, communicating with them and checking working conditions and practices plays an important part in cutting risks. It advises that employers increase the supervision of employees new to remote working, or who are undertaking a job that presents special risks. In particular, face-to-face contact with colleagues can help lone workers to feel part of a team and be good for their mental wellbeing, Business Link suggests.

Risk assessment should be used to determine whether changes in supervision are necessary, according to the Trades Union Congress (TUC), which produced a guide to lone working for health and safety representatives last autumn.4 The TUC argues that, too often, employers use standard checklists for risk assessments, and assess only the job and tasks to be performed by the lone worker, rather than including factors specific to the working environment.

Are employees with medical conditions able to work alone?

The HSE advises employers to check that lone workers have no medical conditions that may make them unsuitable for working alone, and to seek medical advice if necessary. Line managers and occupational health advisers need to consider both routine work and foreseeable emergencies that may impose additional physical and mental burdens on an individual.

Source: HSE

NHS safety focus

The psychological health and wellbeing of lone workers is not as high a priority in the NHS as physical safety, which continues to be a major issue, particularly for the growing numbers of health service staff working alone in the community or in NHS buildings during unsocial hours: 54,758 physical assaults were reported in the care sectors in 2008-09 and, although separate figures are not collected, it is likely that lone workers are disproportionately affected.

Sue Frith, deputy head of the NHS Security Management Service (SMS)5 – the national body responsible for staff security – told Occupational Health about a recently launched comprehensive lone worker services initiative. The latest move follows several years of work by the SMS, including guidance and the launch of a variety of schemes to protect the physical wellbeing of staff – for example, buddy systems.

However, all of these fell short of a truly comprehensive protective system, prompting the latest lone worker services initiative. The service is delivered through a contract with private sector provider Reliance, and backed by £29m of government funding. It is based on a national framework agreement, through which trusts and other NHS bodies can buy technical devices, such as mobile phones and alarms, designed to protect staff security, in a cost-effective way.

For example, Frith points out that the true cost of the main device on offer is about £29 per month per person, but the NHS has negotiated a price of less than £10 a month. The devices include a system for reporting verbal and physical assaults, which will improve the data collected on such incidents.

The NHS hopes to allocate 30,000 Reliance devices in 2009-10. Take-up from health service employers so far has been “OK, but slower than we would like”, acknowledged Frith. But she is confident the early adopters will persuade others to follow, and that more than 50% of employers will have bought into the lone worker service by the end of 2010-11. The SMS is also working closely with an NHS partnership of occupational safety and health practitioners on further guidance on lone worker policies and practices.

Despite the NHS’s continued focus on the physical safety of lone workers, Frith is very interested in the BOHRF research and will look at whether aspects of it can be reflected in her organisation’s work.


1 ‘Health and wellbeing of remote and mobile workers’, forthcoming (summer 2010)

2 ‘Working alone: health and safety guidance on the risks of lone working’, Health and Safety Executive

3 Ensure the safety of lone workers, Business Link

4 ‘Lone working: a guide for safety representatives’, TUC, November 2009

5 Lone workers, NHS Security Management Service

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