When one of the 19,000 employees at the UK energy group Centrica calls in sick, the company’s occupational health service swings into action.
An engineer with a back problem from fixing boilers in cramped spaces can be referred for physiotherapy within five days. A call centre worker cracking from dealing with distraught customers will receive mental health support within 48 hours. All workers, without exception, receive a questionnaire probing their diet, weight, sleeping habits and lifestyle on the first day of absence.
When the company began developing the system, almost a decade ago, some staff found it intrusive, acknowledges Sandra Dyball, Centrica’s director of health, wellbeing and benefits. But swift access to treatment mostly unavailable on the NHS has both slashed sickness absence and become “a great tool to attract talent”, she argues — adding that many staff have also proved open to making lifestyle changes.
“We’ve had some great feedback. We had one guy who drank 18 cans of Coke a day and was worrying about why he couldn’t sleep,” she said.
UK ministers are hoping more employers will invest in preventive services like these, as they seek to stem a health-related exodus from Britain’s workforce. According to official data, 2.8mn working-age adults in Britain say they do not have a job because of a long-term condition, and more than 200,000 people left work specifically for health reasons in 2023-24,
Getting sick and disabled people back into the labour market is easier said than done. The Labour government is facing a backbench rebellion over plans to slash health-related benefits, which it had hoped would spur claimants into work. With those plans in jeopardy, it is all the more important to stop people falling out of work when they first become sick.
The risk of further outflows is stark. One-fifth of respondents to a recent survey by Lancaster University’s Work Foundation said they were in poor health and 6 per cent believed they might leave their job within 12 months as a result. Almost a quarter of 16 to 24-year-olds said they had poor mental health.
“We saw a huge rise in workforce health as a material risk to companies post-Covid,” said Alice Martin, head of research at the Foundation. “That risk has remained.”
However most employers are not equipped to give staff the support they need to stay in work when they first start to struggle with their health.
A “rising wave” of ill health and disability is “landing on a system which has never been particularly well suited or designed to deal with it”, according to Charlie Mayfield, former boss of the John Lewis retail group, who is leading a government review of ways to keep ill and disabled people in work.
In the UK, an employee with health issues typically goes to see an overworked GP, who lacks the time and expertise to explore how they could return to work. Instead, they sign them off sick — often repeatedly — leaving many to fester at home with little contact from line managers.
Mayfield contrasts this laissez-faire approach with the structured system in countries such as the Netherlands — where employers must continue paying wages for up to two years after an employee goes off sick.
Along with this financial obligation comes a clear process for employers and employees to agree and comply with a back to work plan, with the involvement of a company doctor and support to help people return to their original job or find alternative employment.
Whereas a GP is responsible only to their patient, this company doctor, or “bedrijfsarts”, sees his duty as being “60 per cent about the individual, 30 per cent about the company and 10 per cent about society”, said Mayfield — who wants to nudge the UK in the Dutch direction.
This would be a big culture change in UK workplaces, where employees are often wary of disclosing conditions that could compromise their career and line managers worry they will say the wrong thing.
For occupational health to be effective both staff and bosses “have to have the belief that it works”, said one multinational’s chief medical officer, who declined to be named. Interventions had sometimes been used “as a mechanism for managing people out”, but “in good organisations, it’s seen as independent advice . . . to do the right thing,” he said.
Large employers increasingly see a case to step up health provision.
Adam Davison, group director of corporate affairs at Holland & Barrett, says staff turnover has dropped from 40 per cent to 26 per cent since the health and wellness retailer overhauled its wellbeing programme in 2021.
He believes this is in large part due to a package of preventive healthcare services ranging from free folic acid for future parents and wearable fans for store workers with menopausal symptoms, to virtual GP appointments, physiotherapy and mental health advice.
“We’re a wellbeing company . . . we can’t talk about prevention to customers without doing it for staff,” said Davison, who sees healthcare as part of a wider benefits package encompassing pay, hardship loans and efforts to tackle the rise in retail crime.
Justin Ash, chief executive of the hospital operator Spire Healthcare, says occupational health is now among the fastest growing areas of its business, as employers seek to lower the costs of sickness absence and recruitment.
Relatively straightforward interventions such as talking therapy pay off, he argues, adding: “The NHS doesn’t prioritise employment. Employers give us a KPI of getting people back to work.”
But cost is still a big barrier to the expansion of occupational health — whether it is funded through insurance, directly by employers, or with contributions from employees or taxpayers.
A low-cost employer assistance programme — offering advice through chatbots, apps, helplines and sometimes counselling sessions for those most in need — typically costs around £5 to £15 per employee per year in the UK market, Spire says.
Combining this with annual health checks, manager training on mental health and flu vaccination could cost from £1,500 to £5,000 per organisation per year. Employers who go further might pay £300-£500 per employee for a course of physiotherapy, or up to £1,600 per employee for therapy in cases of moderate to severe anxiety or depression.
Even in large companies such as Centrica, which pays for services directly through a healthcare trust, the need to treat provision as a taxable benefit can affect take-up by lower-paid staff, Dyball says. Centrica’s opt-in rate is 95 per cent.
Meanwhile smaller companies — where they offer occupational health at all — are more likely to have a bare-bones employee assistance programme.
Sam Atwell, policy and research manager at the Health Foundation think-tank, says experts are “often quite sceptical” about how much value these more minimal EAPs can offer, given they provide little more than online advice.
By the autumn, Mayfield will have recommendations for ministers on what a more rigorous system could look like, and how to pay for it — though he has made it clear he does not see the full Dutch model, which would significantly increase financial pressure on employers, as viable for the UK.
But both Martin and Atwell warn the impact of occupational health provision will be limited if an employee’s real problem is an unmanageable workload, bad boss or difficult home life.
Giving workers more control over their place and hours of work, building flexibility into job design and allowing staff to attend medical appointments in office hours could all help, Martin said.
“It’s the culture of the organisation that matters most. If [it is] trusting and open . . . people are quite willing to disclose and have those conversations and get a referral,” Atwell added. “Employers could make sure they are not making people sicker.”
