Sue Parkyn-Smith of the Health and Safety Executive is right when she says ('Taking the strain', Special Report, 29 January) that it is how an organisation manages and how it uses staff - 'not too many or too few demands' - that have significant effects on stress and health at work. It is not just a question of employing more staff, as Robert Davies suggest.

The organisational factors are potentially as influential on health at work as the lifestyle factors that Mark Crail reported ('In sickness, not in health', News Focus, page 10, 15 January). Certainly organisations have more responsibility and opportunity to do something about the management of work, jobs, communications, training, working hours, safe working conditions etc. It is striking that, in a survey about health at work, most staff asked for more open communications and for managers to be more sensitive to staff concerns. There is not such an open-door invitation over lifestyle factors.

Does this mean that when resources are scarce, managers, human resources and occupational health professionals should direct their efforts to work design and organisational practices rather than interventions on exercise, diet, alcohol etc, which others can provide? Should, for example, trust funds and sports/social clubs provide lifestyle facilities and support to supplement what the employee can obtain on the open market or through the NHS in its non-employer capacity?

If, because of resources, it's a question of either/or as regards health at work activities, boards may be wrong to think they can become a 'good employer' by investing in lifestyle activity for staff if they don't take radical action on organisational factors.

Let's hope the Health Education Authority's research into the impact of health-at-work initiatives and the ministerial interest in the subject, will stimulate more NHS employers to build health into work.

With the right lead from the HEA - and HSE - the next few months could provide the opportunity for good practice to be publicised and built on, as Bernadette Friend rightly suggests.

Paul Henry,

Partner,

People Business Strategies,

London SW11.