Lancaster University Work and Health Forum

We are a new cross-faculty, interdisciplinary forum comprising academic staff, health professionals, policy leaders, local council leaders and local citizens to develop new research-based approaches towards enabling people with long term physical or mental health conditions to maintain or enhance their work productivity.

The Work and Health Forum (WHF) involves colleagues from all four faculties at Lancaster University (Health & Medicine; Science & Technology; Management School; Arts & Social Sciences). As such, it benefits from exciting opportunities to explore key issues using expertise drawn from a diverse array of academic disciplines. Its global links with government and other policymakers via the Work Foundation, and with the NHS and other health organisations and networks via the Lancaster Health Hub, provide the WHF with a highly distinctive profile of skills and perspectives with which to develop collaborative projects and other joint initiatives.

The WHF is linked closely to the new ARUK/ MRC Centre for Musculoskeletal Health and Work, of which Lancaster University is a key partner, and also to the North West Coast Academic Health Science Network (NWC AHSN), whose role is to drive NHS innovation across the region.

The overall purpose of the WHF is to provide:

  • A focus for driving and facilitating cross-faculty collaborative projects and funding bids for research and innovation within this field.
  • A platform for connecting all key sectors (including the business sector and the third sector) to the university’s academic strengths, both to advance knowledge and to enable its adoption and impact.
  • A vehicle for engaging with regional and national networks and organisations (including the CMHW and the AHSN), as well as with EU partners.
  • An environment to support local staff and postgraduate students seeking to develop their professional skills and potential to contribute to and/or lead this growing field.

The lead convenors for the WHF are Professor John Goodacre and Dr Paula Holland, supported by Nicky Sarjent.



  • Dr Alison Collins

    Lecturer in Organizational Health and Wellbeing, Lancaster University

    Dr Alison Collins has a background in occupational psychology and management and is interested in the area of organizational health and wellbeing. Her research centres upon the implicit and explicit contracts employees have with their organization and employee social and work relationships. Her research has primarily been in the field of organizational health and safety, recent studies have included a mixed-methods study examining presenteeism and its consequences on employee health and wellbeing and a qualitative study exploring the health and wellbeing benefits of conservation work for older volunteers. Previous research has explored issues surrounding homeworking and work-life-balance; shift work; accidents, fatigue and injury in the offshore oil industry; organizational culture; and leadership.

  • Maciek Dobras

    PhD Candidate, Lancaster University

    Maciek graduated with a BSc (Hons) degree in Biomedical Sciences from Queen Mary, University of London in 2009 and then read for a postgraduate degree in Public Health at the University of Sheffield. After graduation (2011) he took up the post of a researcher at the Nofer Institute of Occupational Medicine in Poland. He has worked as an expert in a number of public health projects as well as provided expertise for the EC. Towards the end of 2015 he benefited from a study visit to HIVA (Research Institute for Work and Society) at the University of Leuven (Belgium), during which he worked on a project concerning employers' willingness to invest in workers' health. His current research interest is sickness certification, though he is also interested in health literacy, as well as in participatory approaches to health at work.

    In 2016 Maciek commenced a PhD (Lancaster University), sponsored by Arthritis Research UK and the Centre for Musculoskeletal Health and Work. His work is supervised by Professor John Goodacre and Dr Paula Holland and seeks to identify citizens' perspectives on sickness certification and the utility of the fit not during citizens' discussions about return to work with their employers.

  • Professor John Goodacre

    Professor of Musculoskeletal Science and Associate Dean for Engagement for the Faculty of Health and Medicine, Lancaster University
    Honorary Consultant in Rheumatology, Lancashire Care NHS Foundation Trust
    Medical Director, North West Coast Academic Health Science Network

    Professor John Goodacre believes there is an urgent need to understand better the complex relationships between work and health, and to develop better services and solutions for people with musculoskeletal conditions, as well as for people with other types of long term physical and mental health conditions. The interdisciplinary strengths across Lancaster University, combined with an extensive array of skills, knowledge and experience within the local NHS and third sector, offer a timely and exciting opportunity for locally-led collaborations to drive important advances in this field. Furthermore, Professor Goodacre's leadership role in the new national ARUK/MRC Centre for Musculoskeletal Health and Work, as well as in the Innovation Agency - Academic Health Science Network for the North West Coast, will enable the Forum to readily connect and extend its research and innovation activities and outputs to larger regional and national networks.

    As such, this Forum provides a stimulating, powerful and distinctive platform for bringing together university staff and students with interests in this field, for planning and facilitating joint projects and other initiatives with partners in a range of public and private sector organisations, and for enabling the outputs of this work to make a significant difference to people with long term health conditions.

  • Dr Harry Gray

    Founder and Executive Chair, Grove Higher Education

    Harry Gray has spent a lifetime in higher education with experience in both the public and private sectors. Starting his career as a secondary school teacher his particular interest is in how adults learn and how they gain capability for dealing with later life. He has held visiting professorships at Salford and Chester universities in the UK and at the Ontario Institute for Studies in Education (OISE) in Toronto, Canada. For nine years he was a Higher Education Adviser to successive UK government departments dealing with employment and education. He is an authority on innovation in higher education and senior management development in universities

    In 2010 Grove Higher Education (GHE) was set up as a private company offering a range of services in higher education in a global context using advanced contemporary approaches to mature learners. The Grove NICHE programme was initiated in 2016 in association with the Centre for Age Research (C4AR) at Lancaster University to draw on the expertise of retired professionals and the university in socio-economic development. It functions as a research and development consultancy on short term assignments internationally.

    Harry has written widely on education at all levels and edited several collections of papers on issues in policy and management in higher education. His academic interests are grounded in organisational psychology including stress, dysfunctionality and strategic leadership.

  • Dr Paula Holland

    Lecturer in Public Health, Lancaster University

    Dr Paula Holland's research focuses on the causes and consequences of social inequalities in health. In particular she is interested in the links between health and work: how working conditions and employment status affect health, and how chronic illness can adversely affect individuals’ ability to work. Underpinning both aspects of the health/work relationship is a concern with how socioeconomic position and occupation influence health and employment outcomes.

    Dr Holland is a co-investigator in the Arthritis Research UK/Medical Research Council Centre of Excellence for Musculoskeletal Health and Work, a consortium of 9 universities and partners whose work aims to find cost-effective ways of reducing work disability among people with musculoskeletal disorders. Her previous research has included qualitative research on the role of workplace adjustments and organisational policies in supporting the employment of people with musculoskeletal disorders; the analysis of Swedish register data to investigate social inequalities in employment and income among people with musculoskeletal disorders, ischaemic heart disease and mental illness; and the analysis of international datasets to explore social inequalities in labour market participation among disabled and chronically ill people in the UK, Denmark, Norway, Sweden and Canada.

  • Glyn Jones

    Innovation Programme Manager, Lancashire Care NHS Foundation Trust
    Innovation Scout, The Innovation Agency

    Glyn Jones has 30 years of experience of enabling change in a range of industries through software, product and business development. For the last 2½ years he has been the Innovation Programme Manager at Lancashire Care NHS Foundation Trust (LCFT) where he has led on establishing a culture of innovation and entrepreneurship. He is one of The Innovation Agency’s Innovation Scouts and runs a monthly Innovation Breakfast bringing staff, academia and business together to support innovative projects. A recent success has been the securing funding to establish an NHS Innovation Test Bed in the North West which will evaluate supported self-care approaches for the frail and elderly and those with dementia leading to reduced hospital admissions. This Test Bed alliance is hosted by LCFT and includes the North West’s 2 NHS Vanguard Sites, Lancaster University and a range of commercial organisations led by Philips.

    As a Community and Mental Health Trust, the area of Work and Health are of specific interest to LCFT both as a health and wellbeing service provider and a large employer, with over 6,500 staff. LCFT provide a range of Community Restart and Rehab services and an ongoing focus on Work and Health will inform those and new services.

  • Dr Jane Martindale

    Extended Scope Physiotherapist and Therapy Research Lead, Wrightington, Wigan and Leigh NHS Foundation Trust
    Honorary Researcher, Lancaster University

    Dr Jane Martindale currently works as an Extended Scope Physiotherapist and Therapy Research Lead at Wrightington, Wigan and Leigh NHS Foundation Trust. Since completing her NIHR Clinical Lectureship which was based at Lancaster University, in her honorary researcher capacity, she has continued to have an interest in musculoskeletal conditions and the impact that medical conditions have within the work place. Her special interest is with Ankylosing Spondylitis (AS) and she recently presented a poster at the British Society of Rheumatology meeting which highlighted the many challenges people with AS face both before and following diagnosis within the work place.

    In Dr Martindale's clinical role she is increasingly aware that people have disclosure issues, and also hears in clinical practice many frustrations around a lack of understanding from colleagues and managers alike. She has co-written a chapter on the impact of AS on work productivity with Professor Goodacre which explores the paucity of our current knowledge around work issues in AS. This has increased her interest in exploring the many ways that research in this field can have to identify and respond to the multifaceted challenges that people with musculoskeletal conditions face within their work place.

  • Karen Palmer

    Clinical Research Nurse Manager, Lancashire Care NHS Foundation Trust

    Since starting work at Lancashire Care NHS Foundation two years ago, Karen Palmer has had the privilege of guiding a nationally recognized, award-winning nursing and AHP research team, with a shared philosophy to provide high quality care whilst delivering internationally renowned research in clinical specialities such as rheumatology, dementia and mental health. With over ten years’ experience, she has a wealth of knowledge in delivering both clinical physical and mental health research within the NHS landscape. Working for a community, mental health and wellbeing trust, she is keen to see how the Work and Health topic can help to cross over clinical specialities to improve the physical and mental health of service users particularly in relation to work.

  • Dr Ana Porroche-Escudero

    Research Associate, Lancaster University

    A feminist medical anthropologist working with Jennie Popay on an NIHR CLARHC NWC-funded project, Dr Ana Porroche-Escudero's research interests include health inequalities, women's health, critical health literacy, political economy of breast cancer and qualitative methodologies. At the heart of her research lies a concern with how women's narratives can be used 1) as an epidemiological tool to document health problems which often escape the gaze of clinical tests, and 2) as a tool to conceptualise complex phenomena such as contested illnesses.

    Dr Porroche-Escudero's doctoral research on breast cancer used ethnographic methods to examine the social inequalities which arise from barriers to access to social and financial support in Spain, which won the prestigious Barbara Rosenblum Dissertation Scholarship awarded by Sociologists for Women in Society (2012). Her current research focuses on understanding the neglected links between breast cancer treatments and the experience of disability, unemployment and poverty. She weaves together women's accounts with policy analysis and intersectional framework, and has found that the social values underlying the practice of biomedical organisations and social and health policies determine women's (lack of) access to employment and illness certificates, and impact upon their economic wellbeing. She has co-authored a chapter on this subject which will appear in a book she is co-editing on Breast Cancer and Feminism (January 2016).

  • Dr Allan Rennie

    Senior Lecturer in Manufacturing Engineering, Lancaster University

    Dr Allan Rennie is a Senior Lecturer in Manufacturing Engineering and since 2002, has been Head of the Lancaster Product Development Unit within the Engineering Department, responsible for many of the Departments activities with industry and other external bodies. Dr Rennie has been an active researcher in the area of computer aided engineering and additive manufacturing (or “3D Printing”) since the mid-1990s, assisting in the formation of one of the UK’s first commercial additive manufacturing bureaux in 1995, when it was a relatively unknown technology. In recent years, and due to the widespread publicity and acceptance that additive manufacturing technology is gaining, Dr Rennie has seen the potential for these manufacturing techniques make their way into many sectors, but particularly in medical and healthcare applications where he has collaborated with colleagues in the Lancashire Teaching Hospitals NHS Trust.

  • Dr Rudresh Shukla

    Academic Clinical Fellow in Rheumatology, Lancaster University

    Dr Rudresh Shukla is one of the Academic Clinical Fellows appointed in Rheumatology in the North Western deanery and Lancaster University in August 2014. He have previously completed foundation training in South Thames Foundation School, after completing Graduate Entry Medicine from Imperial College London in 2012.

    Dr Shukla's area of interest lies in studying the impact of inflammatory arthritis on work with particular interest in individuals with ankylosing spondylitis and how to improve their working lives. He is currently undertaking his Core training in the North Western deanery and is a member of the Royal College of Physicians.

  • Karen Steadman

    Research and Policy Manager, Health and Work Programme, The Work Foundation

    Karen Steadman leads the health and work research and policy programme at The Work Foundation. Karen is a leading researcher specialising in chronic conditions and employment – exploring ways to improve employment outcomes for people with chronic conditions, in terms of seeking, retaining and progressing in work, and the way that the workplace influences employee health and wellbeing. Karen leads the Fit for Work UK coalition, a coalition of expert stakeholders looking at the relationship between chronic conditions and particularly musculoskeletal disorders and employment, as well as the Health at Work Policy Unit, a programme of work designed to influence and improve workplace and working age health policy at a national, local and organisational level.

  • Dr Emmanuel Tsekleves

    Senior Lecturer in Design Interactions, Lancaster University

    Dr Emmanuel Tsekleves is a Senior Lecturer in Design Interactions at Imagination Lancaster, Lancaster University. He has been working in the co-design of digital tools in the areas of health, ageing and wellbeing; and is especially interested in designing for behaviour change through the use of playful artefacts and interactions that link the digital with the physical world.

    Dr Tsekleves is currently working on research projects with people in the early stages of Dementia, with families of children with autism and in the area of public health on the design of playful interventions and interactions. He is a co-editor of the Ashgate Design for Healthcare book to be published in 2016 and blogs regularly for The Guardian and The Conversation on the design and use of technology in Health.

  • Jacqueline Winstanley

    Chair, Fluidity (UK Forum for Hidden and Fluctuating Conditions)

    Jacqueline Winstanley is an internationally recognised expert in Diversity and Inclusion having a particular interest in developing and implementing organisational change frameworks and increasing Inclusive Economic Growth. Her interest in the Work and Health Forum stems directly from her own experience of developing a health condition whilst in work, and the journey she has travelled since.

    Following an enforced career break after being diagnosed with Fibromyalgia, sheer determination and a can-do attitude led Jacqueline to adapt her earlier work in the development of Inclusive Services to encompass Inclusive Economic Growth particularly considering workforce retention, and Inclusive Entrepreneurship particularly for disabled people. Her development of the Workforce Retention Programme 2009 has seen a reverse in the percentage of members of Fluidity who had previously found themselves out of work following a medical diagnosis, to a position where members are now remaining in employment or are moving into entrepreneurship as a real alternative to life on disability-related benefits. This has led to a programme in the UK which introduces disabled people to the benefits of entrepreneurship.

    A member of a number of advisory groups to the DWP in respect of the rights of disabled people to be supported in work, Jacqueline's solution-based approach is gathering pace, particularly in respect of Inclusive Economic Growth.


Tab Content: Work productivity

Work productivity: What are the key issues for people with ankylosing spondylitis?

Ankylosing spondylitis (AS) is a chronic inflammatory condition affecting the skeleton. It affects approximately 200,000 people in the UK with the main symptom being back pain. It typically affects people from a young age, often having a detrimental impact on health and wellbeing, and is associated with significant risk of limiting work productivity over the life course.

Relatively little attention has been paid to issues regarding work productivity in AS. Consequently, there is an urgent need not only to understand better the different perspectives of people with AS, of health professionals, of health service managers, and of employers, but also to embed issues pertinent to work productivity as a routine element of healthcare.

One major issue is that people with AS may face uncertainty as to whether to disclose to family, friends and or work colleagues that they are suffering from back pain due to a fear of stigmatization. We have now explored the aspect of disclosure, especially within the workplace, to help develop a better understanding of the experiences that people with AS face in sharing their diagnosis.

Our qualitative study (Shukla et al., 2017) found that participants had discussed their diagnosis and symptoms to varying levels with employers, family members, friends and healthcare professionals. They had decided on the level of disclosure after assessing the risks and potential benefits. On a positive note, they were able to find support from work colleagues and family but this was sometimes riddled with challenges. In addition, the specialist physiotherapy team were able to offer much needed physical and psychological support. However, despite disclosing their diagnosis, participants remained fearful of stigmatisation especially at work, resulting in psychological distress, which was amplified by the lack of awareness about the condition.

We would recommend that employers, healthcare professionals and family members should not underestimate the challenges faced by individuals when deciding whether to disclose this ‘hidden disability’. Offering support and encouragement to empower individuals with AS/Axial SpA to successfully disclose their diagnosis should they choose to should be taken into account as a routine element of clinical care.

Research Team

Dr Rudresh Shukla, Academic Clinical Fellow in Rheumatology, Lancaster University
Dr Jane Martindale, Extended Scope Physiotherapist and Therapy Research Lead, Wrightington, Wigan and Leigh NHS Foundation Trust; and Honorary Researcher, Lancaster University
Dr Paula Holland, Lecturer in Public Health, Lancaster University
Professor John Goodacre, Director, Lancaster Health Hub

Tab Content: Employee sickness absence

Employees' journey through sickness absence: from certification back to work

Sickness absence is an event that occurs to the vast majority of working people at some stage of their career.

Changes to sickness certification were introduced with a view to facilitate return to work (RTW). In 2010 the sick note was replaced with a Fit Note. Although departure from the old statement was generally welcomed by the key stakeholders (GPs, employees and employers), previous research has largely focused on GPs’ and employers’ experiences of the Fit Note. There is a paucity of studies that have explored the perspectives of ‘the certified’ and it is them – as transmitters of information from the GP to the employer - who play a pivotal role in the process. In fact, very little is known about employees’ perspectives on communication with their GP during sickness certification, and whether the Fit Note does indeed facilitate RTW discussions with the employer.

Of the studies that have explored employees’ perceptions of the Fit Note, the majority have failed to disaggregate employees’ views of the Fit Note by their health condition, occupation, etc. It is therefore unknown if the perceived utility of the Fit Note varies depending on employee characteristics or if certain employee groups find it more useful than others. Previous studies have also failed to explore employees’ perspectives on the actual use of their Fit Note during discussions with employers. This study will aim to address this gap and seek to answer the following research questions:

  1. What do employees expect from the GP during the sickness certification process?
  2. What do employees report on communication about return to work with their GP?
  3. What are employees’ views on the outcome of their discussions about return to work with GPs and employers?

These questions will be answered through a mixed method study of employed adults recently issued with a Fit Note and residing in Lancashire and Cumbria. The participants will be identified at three GP practices, contacted by post and asked to complete a questionnaire about their Fit Note consultation. A sub-sample will be then selected for individual interviews. The interviews will be conducted after the participant has returned to work (or at least has had the chance to talk to their employer about their return). The findings from this work will help gain a better understanding of employees’ perspectives on sickness certification, including on their communication about health and work with GPs and employers. The findings will also help explore how the Fit Note system can be improved for the employees in the future.

The research is funded by the ARUK/MRC Centre for Musculoskeletal Health and Work and findings from this study will make an important contribution to the work of the Centre.

Research Team

Maciek Dobras, PhD Candidate, Lancaster University
Dr Paula Holland, Lecturer in Public Health, Lancaster University
Professor John Goodacre, Director, Lancaster Health Hub



  • Let's talk about Inflammatory Back Pain: A qualitative study regarding experiences of disclosure in people with Ankylosing Spondylitis/Axial Spondylitis
    • Dr Rudresh Shukla, Academic Clinical Fellow in Rheumatology, Lancaster University
    • Dr Jane Martindale, Extended Scope Physiotherapist and Therapy Research Lead, Wrightington, Wigan and Leigh Foundation Trust; and Honorary Researcher, Lancaster University
    • Dr Easwaradhas Gladston-Chelliah, Consultant Rheumatologist, Wrightington, Wigan and Leigh Foundation Trust
    • Professor John Goodacre, Director, Lancaster Health Hub

    Introduction: Ankylosing spondylitis/axial spondyloarthritis (AS/Axial SpA) is a chronic inflammatory condition that typically affects younger people and often has a detrimental impact on their ability to work. There is little awareness of the condition among family, friends and employers which makes it difficult for those with AS/Axial SpA to have fulfilled working lives. We aimed to conduct in-depth semi-structured interviews with participants to identify the experiences regarding the disclosure of AS/Axial SpA to employers, colleagues, family and healthcare professionals which also included factors perceived as barriers or facilitators associated with this issue.

    Further information at the Rheumatology Journal.

  • “Whenever I can I push myself to go to work”: a qualitative study of experiences of sickness presenteeism among workers with rheumatoid arthritis


    Purpose: UK government policy emphasizes the importance of continuing to work for recovery from poor health, yet sickness presenteeism (going to work whilst ill) is commonly regarded as having negative consequences for organizations and individuals. Our study explores experiences of working after onset of rheumatoid arthritis (RA), a chronic musculoskeletal disorder characterized by high rates of work disability.

    Materials and methods: An exploratory qualitative study consisting of in-depth interviews and six-month follow-up with 11 men and women with RA employed at disease onset.

    Results: We expand upon previous models of sickness presenteeism by distinguishing between presenteeism that occurs voluntarily (wanting to work despite illness) and involuntarily (feeling pressured to work when ill). RA onset affected participants’ ability to work, yet motivation to remain working remained high. The implementation of workplace adjustments enabled participants to stay working and restore their work capacity. Conversely, managers’ misinterpretation of organizational sickness absence policies could lead to involuntary presenteeism or delayed return to work, conflicting with the notion of work as an aid to recovery.

    Conclusion: Workplace adjustments can facilitate voluntary sickness presenteeism. To reduce work disability and sickness absence, organizational policies should be sufficiently flexible to accommodate the needs of workers with fluctuating conditions.

    • Implications for rehabilitation
    • Individuals with rheumatoid arthritis (RA) are at high risk of work disability.
    • Individuals’ motivation to remain in work following onset of RA remains high, yet sickness presenteeism (working while ill) has received largely negative attention.
    • It is important to distinguish between voluntary and involuntary forms of sickness presenteeism.
    • Workplace adjustments facilitate voluntary sickness presenteeism (wanting to work despite illness) and improve job retention and productivity among workers with RA.
    • Involuntary presenteeism (feeling pressured to work while ill) may occur if organizational policies are not sufficiently flexible to accommodate the needs of workers with RA.

    The full article is published at

    Disability and Rehabilitation, DOI: 10.1080/09638288.2016.1258436

  • The impact of ankylosing spondylitis/axial spondyloarthritis on work productivity
    • Dr Jane Martindale, Extended Scope Physiotherapist and Therapy Research Lead, Wrightington, Wigan and Leigh Foundation Trust; and Honorary Researcher, Lancaster University
    • Dr Rudresh Shukla, Academic Clinical Fellow in Rheumatology, Lancaster University
    • Professor John Goodacre, Director, Lancaster Health Hub

    Introduction: Ankylosing spondylitis (AS)/axial spondyloarthritis (axial SpA) typically affects people from a young age, it often has a detrimental impact on health and wellbeing and it is associated with significant risk of limiting work productivity over the life course. Despite this, relatively little attention has been paid to issues regarding work productivity in this condition. Consequently, there is an urgent need not only to understand better the different perspectives of people with AS/axial SpA, of health professionals, of health service managers and of employers but also to embed issues pertinent to work productivity as a routine element of health care. Exciting opportunities now exist to bring together the key sectors to develop innovative solutions and processes to drive such advances, and to enable the potential of people with AS/axial SpA to succeed in workplace settings to be fully realised.

    The full article is published in Best Practice & Research Clinical Rheumatology 29(3), pp. 512-523.