People have the right to be involved in discussions and make informed decisions about their care, as described in NICE's information on making decisions about your care.

Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off-label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

1.1 Organisational commitment

These recommendations are for employers, senior leadership and managers, human resource teams and all those with a remit for workplace health.


Make health and wellbeing a core priority for the top management of the organisation. Value the strategic importance and benefits of a healthy workplace. Employers should encourage a consistent, positive approach to all employees' health and wellbeing. [2015]


Establish the business case for ensuring employees' health and wellbeing. Make clear the link between employees' health and wellbeing and improved productivity. [2015]


Ensure all managers in the organisation, including directors and board members, are committed to the health and wellbeing of their workforce and act as good role models. [2015]


Incorporate health and wellbeing in all relevant corporate policies and communications. For example, by ensuring employees work reasonable hours and have regular breaks. [2015]


Make communication clear to ensure that employees have realistic expectations of what's possible, practical and affordable. [2015]


Be aware that a return to work from sickness does not necessarily indicate that an employee's health and wellbeing has improved. When developing return to work polices, take into account that aggressive return to work procedures can encourage presenteeism to the detriment of the organisation. [2015]


Recruit managers who have the positive leadership traits associated with improved employee health and wellbeing. These traits include being open and approachable and encouraging new ideas. [2015]


Ensure health and wellbeing policies are included in any induction, training and development programmes for new staff. [2015]


Have a proactive and visible commitment to health and safety and its role in improving the health and wellbeing of employees, that is, view health and safety as part of the culture of a caring and supportive employer – not only a statutory requirement. [2015]

1.2 Physical work environment

These recommendations are for employers, senior leadership and managers, human resource teams and all those with a remit for workplace health.


Develop and implement workplace policies and procedures to reflect statutory requirements and existing best practice (for example, manual handling and display screen equipment). [2015]


Ensure all facilities and equipment are clean, safe, well maintained and of a good standard. [2015]

1.3 Mental wellbeing at work

These recommendations are for employers, senior leadership and managers, human resource teams and all those with a remit for workplace health.


Create a supportive environment that enables employees to be proactive when and if possible to protect and enhance their own health and wellbeing. [2015]


Develop policies to support the workplace culture such as respect for work–life balance. For example, in relation to stress organisations could refer to the principles of the Health and Safety Executive's Management Standards for work related stress. These cover the following 6 aspects of work and the process for assessing and managing these:

  • demands (workload, work patterns and work environment)

  • control (how much say the employee has in the way they do their work)

  • support (from the organisation, line manager and colleagues)

  • relationships (promoting positive working to avoid conflict and dealing with unacceptable behaviour)

  • role (if employees understand their role within the organisation and whether the organisation ensures that they do not have conflicting roles)

  • change (how change is managed and communicated in the organisation). [2015]

1.4 Fairness and justice

These recommendations are for employers, senior leadership and managers, human resource teams and all those with a remit for workplace health.


Ensure any unfair treatment of employees is addressed as a matter of priority. [2015]


Ensure line managers know how to direct employees to support if the employee feels that they are being treated unfairly. [2015]


Treat each employee as an individual and avoid making stereotypical assumptions. For example, don't assume that an older employee may find learning new tasks difficult or that younger employees are less dependable. [new 2016]

1.5 Participation and trust

These recommendations are for employers, senior leadership and managers, human resource teams and all those with a remit for the workplace.


Ensure employees feel valued and trusted by the organisation by:

  • offering support and training to help them feel competent

  • promoting team working and a sense of community. [2015]


Encourage employees to have a voice in the organisation, and actively seek their contribution in decision‑making through staff engagement forums and (for larger organisations) by anonymous staff surveys. [2015]


Value and acknowledge employees' contribution across the organisation. If practical, act on their input and explain why this action was taken. If employees' contributions are not acted on, then clearly explain the decision. [2015]


Encourage employees to engage with trade unions, professional bodies and employee organisations whenever possible. [2015]

1.6 Senior leadership

These recommendations are for senior managers, employers and those with a leadership responsibility in workplace health.


Provide consistent leadership from the top, ensuring the organisation actively supports a positive approach to employee health and wellbeing and that policies and procedures are in place and are implemented. This should be part of the everyday running of the organisation, as well as being integrated in management performance reviews, organisational goals and objectives. [2015]


Consider helping employees to access screening and other health services to which they are entitled. This could include providing information about services such as cervical screening and eye tests and allowing time off to attend appointments. [new 2016]


Provide support to ensure workplace policies and interventions for health and wellbeing are implemented for line managers, so that they in turn can support the employees they manage. [2015]


Ensure line managers are aware that supporting employee health and wellbeing is a central part of their role, for example by including it in line managers' job descriptions and emphasising it during recruitment. [2015]


Display the positive leadership behaviours that are asked of line managers, such as spending time with people at all levels in the organisation and talking with employees. [2015]


Act as a role model for leadership and proactively challenge behaviour and actions that may adversely affect employee health and wellbeing. [2015]

1.7 Role of line managers

These recommendations are for employers, senior leadership and managers, human resource teams, and all those with a remit for workplace health.


Recognise and support the key role that line managers have as the primary representative of the organisation and seek their input. Use line managers as a 2‑way communication channel between the employee and organisation, and to encourage staff to be motivated and committed to the organisation. Regularly seek line managers' views on staff morale and staffing and human resource issues. [2015]


Acknowledge that line managers have an important role in protecting and improving the health and wellbeing of employees through involvement in job design, person specifications and performance reviews. Give line managers adequate time, training and resources to ensure they balance the aims of the organisation with concern for the health and wellbeing of employees. [2015]

1.8 Leadership style of line managers


Adopt a positive leadership style that includes:

  • encouraging creativity, new ideas and exploring new ways of doing things and opportunities to learn

  • offering help and encouragement to each employee to build a supportive relationship; acting as a mentor or coach; being open and approachable to ensure that employees feel free to share ideas; recognising the contribution of each employee

  • having a clear vision which can be explained and made relevant to employees at all levels; ensuring employees share the same motivation to fulfil their goals

  • becoming role models who are trusted and respected by employees

  • providing a sense of meaning and challenge, and building a spirit of teamwork and commitment. [2015]


Use the following approaches:

  • consult regularly on daily procedures and problems

  • promote employee engagement and communication

  • recognise and praise good performance

  • work with employees to produce and agree employees' personal development plans

  • be proactive in identifying and addressing issues and concerns early, and take preventive action at the earliest opportunity, identifying sources of internal and external support. [2015]


Avoid negative behaviour such as:

  • detachment from colleagues and ignoring employees' suggestions

  • failure to monitor and manage employees as a group

  • showing no interest in employees' ideas and projects

  • feeling threatened by competent employees

  • being guarded in communications, such as withholding information from colleagues and not keeping them fully informed. [2015]

1.9 Training

These recommendations are for employers, senior leadership and managers, executive teams, human resource teams, and all those with a remit for training.


Ensure line managers receive training in:

  • effective leadership (see section 1.8)

  • the importance of maintaining people's health and wellbeing at work and what this entails

  • the effect of health and wellbeing on improved organisational performance

  • keeping up to date with changes in the legal obligations and official advice to employers

  • the implications of organisational change and how to manage it

  • communication skills, including how to have difficult conversations with employees

  • developing people's skills and resolving disputes

  • how to support employees by agreeing relevant and realistic targets

  • how to recognise when someone may need support (for example, because of problems achieving a work–life balance, demands of home life or unfair treatment at work) and awareness of the services they could be directed to

  • how to use stress risk assessment to identify and deal with sources of stress, as well as develop workplace solutions to reduce this risk

  • the internal and external causes of stress, such as excessive workload, financial worries, work–home conflict or family issues

  • how to give advice to employees about further support for stress both in and outside the workplace

  • equality and diversity training on employee health and wellbeing

  • how to manage sickness absence in line with NICE's guideline on workplace health: long-term sickness absence and capability to work. [2015]


Ensure the above skills and behaviours are set out in any documents outlining the skills and knowledge line managers need, and in their performance indicators. [2015]


Ensure line managers receive training to improve their awareness of mental health and wellbeing issues. This includes increasing their awareness of how they can affect the psychological wellbeing of employees. It also includes equipping managers to identify when someone may have a mental health problem, for example learning to identify signs and symptoms and looking for changes in behaviour and performance. Ensure line managers can give employees advice on where to get further support. [2015]


Line managers should offer older employees the same training and development opportunities as other employees. [new 2016]


Offer or support older employees, in the same way as other employees, to undertake training if their job role changes. [new 2016]


Tailor training programmes to meet employees' individual needs, learning style and ability. This could include providing:

  • a training needs analysis

  • work‑based, practical on‑the‑job training

  • mentoring or one‑to‑one sessions

  • opportunities for reflection. [new 2016]


Encourage and help employees, including older employees, who have few qualifications, or who may have received education and training some years ago, to make the most of learning and development opportunities. This includes giving them the necessary time off for training. [new 2016]

1.10 Job design

These recommendations are for line managers.


Encourage employees to be involved in the design of their role to achieve a balance in the work demanded of them. Allow them to have a degree of control, appropriate to their role, over when and how work is completed. This should take into account the resources and support available. [2015]


If possible, and within the needs of the organisation, be flexible about work scheduling, giving employees control and flexibility over their own time. [2015]


When implementing flexible working, balance the needs of the business with the workloads and needs of other employees. [2015]


Take into account the effect on physical health when designing jobs. This could include, for example, ergonomic reviews, and giving advice on posture and on moving and handling physical loads. Design jobs to promote and improve the physical health of employees by, for example, helping people to be physically active in their working day. See NICE's guideline on physical activity in the workplace. [2015]


Address the needs of older employees as part of a broad diversity policy to support retention of older employees. This should include recognising key life stages and life events and taking into account that caring responsibilities may change as people age. This policy could include:

  • providing timely and appropriate support, for example, flexible working policies or carer's leave

  • communicating working time options and eligibility clearly and without jargon, and providing information on the financial implications of flexible working if relevant

  • planning and resourcing the policy effectively, including early liaison between HR and pensions fund staff if appropriate. [new 2016]


For each employee, identify and address issues affecting their health, wellbeing and ability to do their job. This includes the impact of shift work, and in particular of night working. [new 2016]

1.11 Monitoring and evaluation

These recommendations are for employers, senior leadership and managers, human resource teams, and all those with a remit for workplace health.


Regularly monitor and evaluate the effect of new activities, policies, organisational change or recommendations on employee health and wellbeing and identify and address any gaps. [2015]


Ensure managers regularly review their own progress in promoting workplace health and wellbeing and acknowledge any gaps in their competencies. Organisations should support line managers in this activity. [2015]


Identify and use reliable and validated tools to monitor impact. [2015]


Give line managers a role in monitoring impact. [2015]

Terms used in this guideline

Health and wellbeing

Health relates to a person's physical or mental condition. Wellbeing is the subjective state of being healthy, happy, contented, comfortable and satisfied with one's quality of life.


The action of leading a group of people or an organisation, or the ability to do this. The ability of an organisation's management to make sound decisions and inspire others to perform well.

Line manager

A person with direct managerial responsibility for an employee.


An organisation employing fewer than 10 people.

Occupational health service

A service established either in‑house or externally to:

  • protect employees against health hazards from their work or working conditions

  • support the physical and mental wellbeing of employees

  • conduct medicals and monitor the health of new and existing employees

  • help organisations manage short‑ and long‑term sickness absence.


Inappropriately continuing to go to work despite health problems. It also describes someone's attendance at work without performing all of their usual tasks (regardless of the reason). When employees feel the need to attend work although they are not functioning fully it can result in losses in productivity. Presenteeism can also make health problems worse.

Vocational rehabilitation

Helping people who are finding it difficult to obtain, stay in or return to work because of a physical or mental impairment.