Occupational health and safety (OHS) is under-researched in the sociology of work and employment. This deficit is most pronounced for white-collar occupations. Despite growing awareness of the significance of psychosocial conditions – notably stress – and musculoskeletal disorders, white-collar work is considered by conventional OHS discourse to be ‘safe’. This study’s locus is clerical processing in the UK public sector, specifically Her Majesty’s Revenue and Customs, in the context of efficiency savings programmes. The key initiative was lean working, which involved redesigned workflow, task fragmentation, standardization and individual targets. Utilizing a holistic model of white-collar OHS and in-depth quantitative and qualitative data, the evidence of widespread self-reported ill-health symptoms is compelling. Statistical tests of association demonstrate that the transformed work organization that accompanied lean working contributed most to employees’, particularly women’s, ill-health complaints.