In my previous article, I wrote that workplace well-being is good management. This month, I want to focus on the people who make workplace health real day to day: managers. In most SMEs, there is no in-house well-being team or occupational health department. There is a line manager. Often, it is the business owner. They see the team every day, they notice when something has changed, and they are usually the first port of call when someone is having a difficult time.

That puts managers in a powerful position. Not as health experts. That is not their role. But as the people most likely to spot the early signs that someone is struggling, and to have a supportive conversation before things escalate into absence, conflict or someone leaving.

This reflects a wider shift in thinking. The government-commissioned Keep Britain Working review, has placed a strong focus on employers helping people stay in work, rather than stepping in only once someone is already off sick. Early intervention starts with the manager.

Workplace health – recognising when someone may be struggling

Most people do not announce that they are struggling. More often, it shows up quietly. A change in behaviour. Work that starts to slip. Someone who used to join in, now keeping to themselves.

Managers in SMEs often know their teams well, which is a real advantage. The key is to notice patterns rather than one-off bad days, and to treat what you see as a prompt to check in. It is not a reason to make assumptions about someone’s health. Hybrid and remote working can make these signs much harder to see, so regular one-to-ones, even short ones, matter more than ever.

Signs someone may be struggling: a quick checklist – workplace health

• Changes in mood or behaviour: more irritable, withdrawn, tearful or unusually quiet
• A dip in performance: missed deadlines, more mistakes, difficulty concentrating
• Changes in attendance: frequent short absences, lateness or leaving early
• Working longer hours than usual, or struggling to switch off
• Coming into work unwell rather than taking time off
• Tiredness, low energy or mentions of poor sleep
• Increased tension with colleagues or customers
• Mentions of pressure outside work, such as caring responsibilities, money worries or a bereavement

One sign on its own does not necessarily mean anything. But several together, or a change that persists over a few weeks, is a good reason to start a conversation.

Having a supportive conversation

This is often the part managers worry about most. What if I say the wrong thing? What if they get upset? What if it opens up something I cannot deal with? These concerns are understandable. But in my experience, the conversation that does not happen usually does more harm than an imperfect one that does. You do not need a script, and you do not need all the answers. A simple framework helps:

• Prepare – Find a private space and enough time. Keep it separate from performance reviews or a busy team meeting.
• Open gently – Describe what you have noticed, without judgement, and ask an open question.
• Listen – Let them talk. Resist the urge to fix everything straight away.
• Agree a next step – Even a small one: a follow-up chat, a temporary change to workload, or signposting to support.
• Follow up – Check in again as agreed. This is where trust is built.

Be clear about confidentiality from the start, and do not ask for medical details. If someone chooses to share a diagnosis, that is their choice. Your focus is on how work is going and what might help.

Example questions to use

Opening the conversation

• “I’ve noticed you’ve not seemed yourself lately. How are things?”
• “You seem to have a lot on at the moment. How are you finding it?”

Understanding what is going on

• “Is anything at work making things harder at the moment?”
• “Is there anything outside work that’s affecting things that you’d like me to know about?”

Exploring support

• “What would help most right now?”
• “Is there anything we could change, even temporarily?”
• “Would it help to talk to someone else, such as our employee assistance programme or occupational health?”

Agreeing next steps

• “Shall we catch up again next week to see how things are going?”
• “Is there anything you’d like me to keep between us, or anyone you’d like me to involve?”

What this can look like in practice

Sam is a supervisor in a small logistics business. Over a few weeks, his manager, Rachel, notices he is arriving later, snapping at colleagues and staying behind to catch up on paperwork. He has also had three single days off sick in two months.

Rather than treating it as an attendance issue, Rachel books a quiet half-hour and tells Sam he has not seemed himself lately. Sam explains that he has been caring for his father most evenings, while trying to get to grips with a new rota system at work.

Together, they agree a later start twice a week for the next month, and Rachel takes the rota back for now. She reminds Sam about the employee assistance programme, and they agree to meet again in two weeks. When Sam mentions ongoing back pain from long drives, Rachel suggests an occupational health referral to look at whether any adjustments would help.

Nothing here is complicated. But a short, well-timed conversation may well have prevented a longer absence and kept a valued team member engaged.

Practical support for workplace health and when to involve occupational health

Many effective adjustments are small and simple. Flexible start or finish times. Temporarily re-prioritising workload. A short-term change of duties. More regular breaks. They do not need to be permanent to make a real difference. Managers should also know where to signpost people, whether that is an employee assistance programme, mental health first aides, their GP or Access to Work.

There are times, though, when it is right to bring in occupational health:

• absence is recurring, or looks likely to become long term
• a health concern is affecting someone’s ability to do their role safely or well
• adjustments are needed, but it is not clear what is reasonable or appropriate
• there may be a disability under the Equality Act 2010
• you need advice on a safe and sustainable return to work

A good referral asks clear questions, is discussed openly with the employee and has their consent. Occupational health then provides independent, evidence-based advice, so managers are not left guessing.

Supporting the managers themselves

Managers are under pressure too. In SMEs, they are often balancing an operational role alongside line management, with little or no training in having these conversations. Asking managers to support others without supporting them is unlikely to work.

This does not need to be complicated. Basic training in mental health awareness and supportive conversations. Clear policies, so managers know what they can offer. A route to HR or occupational health advice when they are unsure. And recognition that managers need someone to turn to as well. The HSE Management Standards list support as one of six key areas of work-related stress, and that applies to managers as much as anyone.

Conclusion: Small conversations make a big difference

Managers do not need to be health experts. They need to notice, ask, listen and know where to turn. When they feel confident doing this, small concerns are far less likely to become long-term absence, and employees feel genuinely supported to stay well and stay in work.

For SMEs, this is one of the most practical and cost-effective investments you can make in workplace health.

Your next step is to start that conversation. If you would like support building manager confidence, whether through manager training, advice on a specific situation or an occupational health referral, contact me to discuss how tailored occupational health support can help your business.