Adopting an overhauled employer-led shared responsibility approach to employee health at work and cutting sickness absence could save up to £18bn a year when fully running, according to the Keep Britain Working Review.
The government must also research and develop evidence to then deploy a full range of targeted incentives potentially including tax relief, sick pay rebates and National Insurance adjustments as part of the approach.
Incentives and support to secure employee buy-in are also required such as overhauling the present Fit Note system and enacting policies that maintain contact and build trust between employee and employer.
The review led by Sir Charlie Mayfield has recommended a series of changes to put employers at the heart of employee health, alongside employees and the government.
It is proposing a “fundamental shift from a model where health at work is largely left to the individual and the NHS, to one where it becomes a shared responsibility between employers, employees and health services.”
To be successful the authors said a phased approach is required “working with willing employers and providers to develop and prove what works, before embedding and extending it across the wider economy over the next three-to-seven years.”
Employers must do more
Employers will need to do more as they are uniquely placed to act on prevention, to support rehabilitation, and to remove barriers for disabled people, the report said.
They also stand to gain most from higher productivity and lower costs and much of what is required is not additional expenditure in health and wellbeing but they need greater clarity on what works.
Employees too, the review noted, have responsibilities in recognising that work can be demanding and setbacks are part of life.
However, disengaging from work and potential support leads to detachment and dependency, but staying connected to work supports recovery and resilience.
Meanwhile the government’s role is to reset the system – to enable and incentivise employers and employees to act.
“That means tackling barriers such as the fit note system, rewiring incentives, and building a strong evidence base,” the review added.
Three persistent problems in relation to health and disability within the workplace were identified that must change. They are:
- A culture of fear, that is felt by employees and, differently, by employers, especially line managers. This creates distance between people and discourages safe and early disclosure, constructive conversations and support just when they are needed most.
- A lack of an effective or consistent support system for employers and their employees in managing health and tackling barriers faced by disabled people. This lack of support is sometimes compounded by a ‘fit note’ system that is not working as intended.
- Structural challenges for disabled people, creating barriers to starting and staying in work. Compared to international comparators, the UK lacks systemic levers to support disabled people in work, leaving them disproportionately excluded and talent wasted.
Three key deliverables
As a result, the review targeted an initial vanguard phase with three deliverables including a major overhaul of the model for keeping people in work or returning them to work:
A Healthy Working Lifecycle
Establish, with employers and providers, a Healthy Working Lifecycle which defines the practices that drive the best outcomes in reduced sickness absence, improved return to work rates and better participation and inclusion of disabled people. Develop the Healthy Working Lifecycle as a certified standard, which becomes the basis for general adoption of a common, outcome-based philosophy around work, health and disability across the UK.
Better Workplace Health Provision (WHP)
Build, with existing providers and practitioners, the support employers and employees need to deliver the Healthy Working Lifecycle, focusing initially on new ‘stay in work’ and ‘return to work’ plans within the lifecycle, and on improving faster access to support. Work with providers and practitioners to ensure this provision is affordable and effective, and establish certified standards for a multi-provider marketplace that expands access to high-quality support for all employers.
Evidence of what works to underpin incentives for adoption
Create a Workplace Health Intelligence Unit (WHIU) to aggregate and analyse data, guide continuous improvement and provide leadership, as a movement HQ, across the new system. Develop the WHIU into a high-value data asset to guide certification and provide the evidence base to support targeted incentives – financial, operational, legal, and cultural – to accelerate adoption.
Enormous value at stake
The review emphasised that the value at stake is enormous as employers face an estimated £85bn a year in lost output and costs linked to ill-health, while the additional state burden in welfare payments and NHS demand is around £47bn annually.
On top of this lies the wider cost to the economy of lower participation, and the human and social costs of lost opportunity, stalled careers, and reduced life chances.
“The potential benefits of change are therefore substantial – financially, socially, and in terms of opportunity,” it said.
Initially the report estimates direct benefits across employers and the state of £3-8bn per year, but over time, as reforms take hold and adoption broadens, the benefits could rise significantly.
“Once the system reaches general maturity – with lower flows into inactivity and higher employment among disabled people – the total potential benefit could reach £9-18bn annually,” it added.
“These figures are indicative, not precise. They contain inevitable uncertainty, but they also exclude the cumulative and compounding effects that would build over time.
“Taken together, they point clearly to one conclusion: the scale of the opportunity is vast, and the case for urgent action is overwhelming.”
‘Concerning and encouraging’
The review argued that these reforms would deliver for everyone involved.
“For employers they will lift an existing burden, reduce risk, improve resilience, and generate measurable returns,” it said.
“For employees they will create safer, more supportive, inclusive workplaces with earlier and fairer access to help to ensure they are able to thrive in work.
“For government they will ease NHS and welfare pressures while supporting growth and opportunity through higher participation and social cohesion.”
Summing up, Sir Charlie explained: “What I’ve seen is both concerning and encouraging.
“Concerning, because ill-health has now become one of the biggest drivers of economic inactivity in the UK. Encouraging, because so many employers, providers and local leaders are ready to help change that.”
He added: “The good news is that the groundwork is already laid. Across the country, employers, local leaders and providers are stepping forward to act as vanguards of change.
“With their energy, and with government backing, we can build a healthier, more inclusive working life for millions.”