Workplace Health Is Shifting From the NHS to Employers

Around 33 million working-age people are employed in the UK. Nearly three million are out of work because of ill health.

The government’s answer to that gap is being designed right now, and it puts a set of duties inside the employment relationship that are not there today.

The June update on the Keep Britain Working review, published on 4 August, sets out how far that design has got.

What Employers Would Actually Be Signing Up To

The framework describes a set of shared responsibilities, and the employer column is the substantial one.

Employers would take accountability for workforce health and inclusion. They would provide workplace health provision, including work and health checks. They would embed stay-in-work plans, implement return-to-work plans, and track and share outcome data with a new central body.

Read that list against what most UK employers do now and the distance is considerable. Statutory sick pay, an occupational health referral when something has already gone badly wrong, and a return-to-work conversation is roughly the current standard. What is proposed is continuous, documented and measured.

The employee column is shorter but not trivial. Employees would engage with workplace health provision, participate in health checks and stay-in-work or return-to-work plans, and accept accountability “through contractual arrangements”. That last phrase is doing a lot of work, because it locates health engagement in the contract of employment rather than in a voluntary benefit.

Health Checks at Onboarding and After Absence

The most concrete new mechanism is the work and health check, which the update says draws on models used in Finland and Japan.

These would be introduced at onboarding and at trigger points such as absences. They could be delivered digitally by an independent entity, with employers receiving aggregated rather than individual insights, and the update is explicit that strong safeguards over personal data would be required. A phased rollout is envisaged, starting with larger employers or specific regions.

The aggregation point is the crux, and it is where the scheme will be won or lost with employees. A check that tells an employer that 22% of a site reports musculoskeletal pain is a planning tool. A check that tells an employer which individuals reported it is something else entirely, and no amount of framing would stop staff treating it that way.

The update recognises this. It records cultural trust issues and data compliance tensions among the problems identified in work with Vanguard organisations, the Business Disability Forum, the DWP Independent Disability Advisory Panel and the Disability Charities Consortium. It also names limited line manager capability, which is the quieter risk: a well-designed process delivered by an untrained manager becomes whatever that manager makes of it.

Who Is in the Room

The scale of employer involvement is the part that makes this more than a consultation document.

More than 250 organisations are involved in developing the Healthy Working Lifecycle standard. Thirty Vanguard organisations took part in employer-led sprints, with a further 70 providing broader feedback. Ten regional workshops were held across strategic and mayoral combined authorities, each involving 20 to 30 SMEs.

The named Vanguards span most of the economy: BT Group, British Airways, Tesco, Sainsbury’s, Marks and Spencer, John Lewis Partnership, Lloyds Banking Group, Google UK, ByteDance, PwC UK and EY UK, alongside health providers including Bupa UK, Nuffield Health, Aviva and AXA Health, and public bodies including NHS trusts, Transport for London and the DWP itself.

Regional Vanguards include Greater Manchester, the Greater London Authority, Liverpool City Region, the West Midlands, West Yorkshire, South Yorkshire, the North East, the East Midlands, the West of England, Cornwall Council and Worcestershire County Council.

A standard drafted with that much employer participation is unlikely to be one employers cannot implement. It is also unlikely to be one designed primarily around the smallest firms, which is why the update says the BSI drafting panel, chaired by Valerie Todd, is focused on making the standard feasible and proportionate for SMEs. That is the right instinct, and it is worth watching whether it survives contact with a standard built largely by very large organisations.

The Small Firm Problem

The ten regional workshops each involved 20 to 30 SMEs, which is a deliberate correction to the composition of the Vanguard list, and the gap it is correcting is real.

Most of the duties described assume infrastructure. Tracking outcome data assumes someone whose job includes tracking. A stay-in-work plan assumes a manager with the time and training to build one, and a return-to-work plan assumes cover for the person returning. A firm of twelve people has none of that as a separate function, because the person who would do it is also doing three other jobs.

Small firms are not worse at this in every respect. They often notice a struggling colleague sooner than a large employer does, and they can adjust someone’s work informally in an afternoon where a big organisation would need a process. What they lack is not attention but slack: when one person in twelve is off, the work does not get absorbed, it gets dropped.

That distinction matters for how the standard should be written. Requiring documentation of something a small employer already does informally adds cost without adding health. Requiring cover that a small employer cannot fund adds nothing at all. The useful version for that end of the market is probably access to shared provision, an occupational health service a ten-person firm can buy into rather than build, plus a light reporting obligation.

Whether the standard lands there is the single most consequential detail still open, because SMEs employ the majority of the private sector workforce. A scheme that works only above a few hundred employees would leave most of the problem untouched.

The Central Unit Is the Real Change

The Workplace Health Intelligence Unit is the piece with the longest reach.

Its planned functions are standard setting for measuring performance and health data, collecting data from employers and providers across the UK, secure guardianship of individual health profiles, aggregation by organisation, sector and region, confidential benchmarking, evaluation of interventions, and evidence-based policy recommendations.

Benchmarking is what changes employer behaviour here, more than any duty. A firm that learns its absence and retention outcomes sit in the bottom quartile of its sector has a reason to act that no guidance produces on its own, and a firm in the top quartile has something to say in recruitment.

Guardianship of individual health profiles is the more sensitive function, and the update pairs it with the requirement for strong safeguards. The design question is not whether the data is useful. It plainly is. It is whether a central repository of working-age health records can be built with governance that employees find credible, and that is not a technical problem.

Why the Arithmetic Is Attractive to Government

The framing in the update is straightforward. Health-related economic inactivity costs an estimated £212 billion a year in lost productivity, welfare spending and NHS pressure, a figure that sits behind the wider cost of ill health to the economy.

Against that, retaining just 1% more of the working population, about 330,000 people, is described as adding economic capacity equivalent to a city the size of Cardiff.

That comparison is doing persuasive work, and it repays a moment’s scepticism. One per cent is a small-sounding number attached to a large-sounding outcome, which is a reliable sign that the framing has been chosen carefully. It is still a fair way to express the leverage: retention is cheaper than recruitment, and someone kept in work does not appear in either the welfare figures or the productivity gap.

What Happens Next

The immediate work is the BSI standard, drawing on the sprint findings on prevention, staying in work and returning to work. Alongside it, the review is working with unions and employee representative bodies, engaging employees directly, and running work with Liverpool University exploring the health check concept through citizen assemblies. There is also collaboration with the Rail Safety and Standards Board on existing health check approaches and with the Milburn Review on young people not in education, employment or training.

No implementation deadline is set in the update. The final report recommended a three-year Vanguard phase to test and then scale what works, which means the shape of the obligation will be clear well before it binds anyone.

For employers, the practical read is that the direction is settled even though the detail is not. Health at work is moving from something the NHS deals with after the fact to something the employer is expected to manage continuously, measure, and report. Firms that already run decent occupational health will find the standard describes much of what they do. Firms that treat sick pay as the whole of their obligation have a larger adjustment coming, and several years in which to make it.

About The Author

Will Lisil

Founder of MW3.biz, building technology that empowers creators and democratising access to digital tools.

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