The UK has a generational opportunity to improve workforce health – it’s time to act

The UK has been sliding into a public health crisis. Each year, around 300,000 people leave work because of ill health. Today, 3.2 million people are out of work long-term – an increase of 800,000 since 2019. Without a change of course, a further 600,000 people could be forced out of the workforce by 2030.

This crisis carries profound economic, fiscal and human costs. Employers and the wider economy experience an estimated £150 billion a year of productivity loss. The pressure on public finances is comparable to the entire defence budget, totalling 
£57 billion. And for many people who fall out of work because of sickness, the damage to their prospects and quality of life can be severe and irreversible.

Sasjkia Otto: "The current Vanguard phase of reform is a promising turning point."

This is an evolving challenge that demands new solutions. The factors pushing people out of work are biological, psychological and social. They reflect disabilities and health conditions, but also pressures both inside and outside work. As the nature of work and the workforce has changed, these challenges have become more complex. Yet the systems designed to support workers have not kept up – leaving more people slipping through the net.

The Government has just announced the first phase of an initiative seeking to modernise the UK’s approach to managing workplace health. Following the publication of the Keep Britain Working Review, a new cohort of 70 ‘Vanguard’ employers have volunteered to lead a ‘race to the top’ by building the evidence on how employers, workers and health services can work together to make work healthier and more inclusive.

This evidence will be collated over the next three years to inform future action. A new independent ‘Workplace Health Intelligence Unit’ will work with employers and workplace health providers to define a ‘Healthy Working Lifecycle’ of best practice to reduce sickness absence, help people return to work when they have been off sick, and make work more inclusive for disabled people. It will also consider the role of professional ‘Workplace Health Provision’ – building on the existing occupational health ecosystem – to support employers and employees throughout this Lifecycle.

Crucial shift

These initiatives embody a crucial shift for managing workforce health – towards a focus on partnership between employers, workers and the state. Partnership can help address the complex roots of ill health at work, and ensure that everybody shoulders their fair share of the responsibility. But under the status quo, responsibility to keep workers well lies largely with individuals and the NHS, while employers are left on their own when deciding how to support their workforce.

Fabian Society research has proposed a blueprint for a National Occupational Health Service. Photograph: iStock

This fragmentation leaves everybody disempowered to help. Fabian Society research, published earlier this year, found that healthcare professionals use the medical tools available to them – diagnosis, treatment and signing patients off work. But this does not always tackle the root causes of ill health – including how people are supported at work. Meanwhile, many good employers do their best, and spend a lot of money, without seeing results. They lack the information, support and tools to help workers in all the ways they need. And poor clarity on what is required of them leaves many exposed to legal risk.

Building evidence on what works is the right first step to addressing this fragmentation. Attempts to improve health at work too often fail because they are not sufficiently evidence based. Spend on occupational health provision in the UK totals nearly £1 billion per year. But a survey of workers with long-term health conditions found that only about a quarter thought this intervention helped. And the fit note, introduced in 2010, still functions much like the sick note that preceded it: 97 per cent of people signed off sick are not offered advice on how they could be supported to be fit for work. 

But the real test of success will be momentum. The last major government review into health at work, published in 2008, did not deliver its full potential. Progress stalled in the aftermath of the global financial crisis and the transition to a new government in 2010. The new government favoured a more voluntary, employer-led approach to supporting the workforce.

But employers lack the collective mechanisms to build national occupational-health infrastructure – meaning coverage is currently just 45 per cent. And history has shown that most employers treat minimum requirements as a target to aim for. Those with limited resource and HR capabilities are significantly less likely to do more than expected by law. This resulted in a lost decade, that saw the UK fall significantly behind comparable countries on workforce health.

Promising turning point

The current Vanguard phase of reform is a promising turning point – and the employers who have signed up should be commended. But there are 1.5 million employers and 32 million workers in the UK. Each should have access to effective occupational health support when they need it.

They should have clear rights and responsibilities on how to use this support to keep workers well. And the costs and risks should be shared fairly. 

Fabian Society research has proposed a blueprint for a National Occupational Health Service that can achieve these aims, building on existing strengths while fixing the weaknesses of the current system. 

A model developed through piloting and robust evaluation during the Vanguard phase could be scaled nationally, delivering consistent, high-quality support for all workers and employers.

To seize this generational opportunity, the government must now act with urgency. It must implement the Vanguard phase quickly, ensure it generates robust evidence over the next three years, and commit to having a clear plan to scale national reform by the end of this Parliament. Doing so will require building consensus across sectors, regions and political parties, and ensure that the Government has the capacity to deliver – because meaningful reform will require legislation, investment and long-term commitment.

The Government has a critical window to help more people stay healthy and in work, support businesses to thrive, and relieve mounting pressure on public services. Whether this moment becomes a turning point, or another missed opportunity, will shape the future of the UK’s workforce, economy and public services for a generation.

The report, Nye’s Lost Legacy, is at:
fabians.org.uk/publication/nyes-lost-legacy
Follow the work of the Fabian Society at:
fabians.org.uk
@thefabians
Follow Sasjkia Otto at:
@sasjkia
@sasjkia.bsky.social
fabians.org.uk/about-us/our-people/the-team

Sasjkia Otto is Senior researcher at The Fabian Society