With the government pledging the ‘biggest reimagining of our NHS since its birth’, Nic Paton highlights that employers will need to recognise the health service may not always be able fully to support unwell employees, meaning workplace-based healthcare is only likely to become more important.
Prime minister Keir Starmer this week outlined his vision for fundamental reform of the NHS in the wake of the publication of the latest independent review of the service by Lord Ara Darzi.
Key among Sir Keir’s reform agenda will be to work to pivot the NHS more towards preventative medicine, including more digital healthcare solutions and more community-based healthcare rather than a service simply focused on primary or secondary care.
In his speech at the King’s Fund to launch the review report, Sir Keir argued there was a need to “turn our National Health Service into a Neighbourhood Health Service”.
That would mean “more tests, scans, healthcare offered on high streets and town centres”, improved GP access, more digital consultations for those who want them, and more patients looked after in their own homes.
Occupational health reform
Occupational health reforms need proper regulatory oversight, warns BOHS
He argued the nation needed an NHS “where we can deal with problems early, before people are off work sick and before they need to go to hospital”.
It also needed to be a service that was “much bolder in moving from sickness to prevention”, the prime minister said.
In his wide-ranging review, surgeon Lord Darzi argued that the NHS “is in serious trouble”. This was not only because of what has happened to the service in the past decade or so but because the health of the nation has deteriorated, he said.
“Many of the social determinants of health – such as poor-quality housing, low income, insecure employment – have moved in the wrong direction over the past 15 years with the result that the NHS has faced rising demand for healthcare from a society in distress,” he pointed out.
“There has been a surge in multiple long-term conditions, and, particularly among children and young people, in mental health needs. Fewer children are getting the immunisations they need to protect their health and fewer adults are participating in some of the key screening programmes, such as for breast cancer,” he added.
People are struggling to see their GP, waiting lists for community services and mental health have surged, he recognised. A&E is in “an awful state”, waiting times for hospital procedures “have ballooned”, the review concluded.
Being in work is good for wellbeing. Having more people in work grows the economy and creates more tax receipts to fund public services. There is therefore a virtuous circle if the NHS can help more people back into work.” – Lord Darzi
Cancer care lags behind other countries, care for cardiovascular conditions “is going in the wrong direction” and too great a share of the NHS budget is being spent in hospitals and too little in the community.
“At the start of 2024, 2.8 million people were economically inactive due to long-term sickness. That is an 800,000 increase on pre-pandemic levels with most of the rise accounted for by mental health conditions,” Lord Darzi argued.
“Being in work is good for wellbeing. Having more people in work grows the economy and creates more tax receipts to fund public services. There is therefore a virtuous circle if the NHS can help more people back into work.
“More than half of the current waiting lists for inpatient treatment are working age adults. And there are long waits for mental health and musculoskeletal services, too, which are the biggest causes of long-term sickness. Improving access to care is a crucial contribution the NHS can make to national prosperity,” he added.
A further factor was staff sickness and absence within the NHS itself, Lord Darzi highlighted. “There is also compelling evidence that, post-pandemic, too many staff have become disengaged, and there are distressingly high levels of sickness absence – as much as one working month a year for each nurse and each midwife working in the NHS.
“The experience of the pandemic was exhausting for many and its aftermath continues to reverberate. NHS staff not only mourned deaths of their colleagues on the frontline but were at the sharp end of the Covid rules. They had to insist that mothers gave birth alone and that elderly and other patients had to die without the comforting touch of their loved ones. The result has been a marked reduction in discretionary effort across all staff groups,” Lord Darzi argued.
Role of insurance-based healthcare
So, what should HR, occupational health and employers all be taking away from all this, from this ambitious NHS reform agenda?
Respected wellbeing benefits professional Steve Herbert surely hit the nail on the head when, in a response on LinkedIn, he highlighted how employers need to recognise turning round the NHS is not something that is going to happen overnight.
“As I have been saying since the early days of the pandemic, the waiting lists currently being experienced will take many years to come down to a sustainable level,” he wrote.
The country’s ongoing demographic changes mean employers will probably need to adjust their thinking around what we mean by a ‘healthy’ life expectancy, essentially meaning that far more older workers may now be in need of medical and wellbeing support during the typical working lifetime if they are to remain healthy, fit, and (importantly) at work.
The need for better company-sponsored health and wellbeing tools (and ideally a preventative strategy to avoid ill health in the first place) should be an employer priority to maintain productivity as the nation seeks a sustained return to growth.” – Steve Herbert
“When these two issues are taken together it is apparent that employers should now accept that the NHS is (at least for the duration of this parliament) unlikely to provide an adequate safety net to return ill employees quickly to the workplace,” Herbert argued.
“That in turn suggests the need for better company-sponsored health and wellbeing tools (and ideally a preventative strategy to avoid ill health in the first place) should be an employer priority to maintain productivity as the nation seeks a sustained return to growth,” he emphasised.
Steve Iley, chief medical officer at Jaguar Land Rover (JLR), highlighted the need for businesses to begin working more in partnership with the NHS. JLR is one of the companies that it was announced over the summer will be piloting offering NHS Health Checks within the workplace, with work on this likely to be beginning from the new year.
“This type of work might help with efficiency, new ways of delivery of care, especially preventative work and increase enjoyment for staff,” said Iley in a speech following the prime minister.
Paul Schreier, chief executive at Simplyhealth, emphasised that employers needed to be an important part of this healthcare reform conversation. “Government must collaborate with businesses, starting with acknowledging low cost in-work health support, such as health plans, as a proven method to help prevent and tackle in-work sickness,” he said.
“Additionally, the excessive tax burden based on health cover products must be reduced to better support wellbeing at work and drive economic growth. This burden dulls the incentive for workplaces to further support their people’s health. Our research shows that employers recognise their role in providing this support, and doing more of this would reduce the costs of downstream treatment in the NHS.
“We also need to see urgent attention on improving access to dentistry across the country. This must start with reform of the dental contract, considering the role of mixed and private practice in providing better access, alongside oral health education campaigns,” added Schreier.
Sammy Rubin, chief executive and founder of insurance company YuLife, argued that, alongside the changes the NHS needs to make from within, businesses can and must play a role in bolstering the health and wellbeing of their employees.
“Lord Darzi’s report into the state of the NHS identifies a number of pain-points that have been apparent for some time, including a surge in long-term conditions, mental health issues and long wait times for treatment. This is not just felt on an individual level – businesses have borne the brunt of these with growing absenteeism and lowered productivity,” he said.
“The challenges facing the NHS affect the whole of society, and national reform will take time; therefore, there is shared value in businesses stepping in to help address this in the following ways.
“Businesses must help incentivise and support employees to manage stress and care for their physical and mental wellbeing – a walk at lunchtime, or 10 minutes of meditation to start the day. These steps are in businesses’ own interest as well as for the social good, and can go a long way towards alleviating the strain on the NHS,” Rubin added.
Responses to the report and the government’s vision for NHS reform were broadly positive, if recognising the scale of the challenge when it comes to turning things round.
Mark Ridler, director of programmes at the Spinal Injuries Association, said: “Services are completely fragmented with no shared vision of what good looks like or how to deliver those services efficiently, effectively and equitably across the four nations. There has never been a better time to come together and forge that vision.”
William Roberts, chief executive of the Royal Society for Public Health, said the government’s ambitions on prevention were likely to be key.
Businesses must help incentivise and support employees to manage stress and care for their physical and mental wellbeing” – Sammy Rubin
“Keeping people well, out of hospital, and off waiting lists is the single most effective way of reducing pressure on the health service. We already have the expertise at our disposal to bring preventative public health services into our communities,” he said.
“It is welcome to see Lord Darzi’s report recognises the importance of the prevention, protection and promotion of health. Investment in the public health workforce will payoff many times over. We’ve got nothing to lose and everything to gain. We all stand to benefit from living in a healthier society,” he added.
Professor Martin Green, chief executive of Care England, highlighted the need, alongside NHS reform, to address the country’s social care crisis.
“Ministers must recognise that investing in and reforming social care is not just a separate issue. It is integral to the survival and success of the NHS. Right now, 13% of NHS beds are occupied by patients awaiting social care support. These delays are not just numbers; they represent people who deserve timely care in the right setting. Until we address this backlog in social care, we will continue to see pressure mount on hospitals and the NHS,” he said.
Sarah Woolnough, chief executive of the King’s Fund, highlighted that the devil will be in the detail of what NHS reforms actually look like on the ground.
“Having set out the diagnosis, the government now needs to develop a detailed strategy for reform. That plan will need to model how greater investment in primary and community services will be implemented. It must also describe how ministers will embrace a truly cross-government approach to improving the nation’s health,” she said.
Finally, Andy Bell, chief executive of the Centre for Mental Health, emphasised that mental health support and services must not be overlooked in any shift to a more community-based, prevention-focused care model.
“Today’s report yet again talks about the need for a shift towards preventing illness, and a move away from hospital to community care. We’ve heard this so many times before in reviews of the NHS. Now we need assurances that it will be different this time,” he warned.
“That we will get investment in public health and social care – not just platitudes. That we will have fair funding for mental health services that is ‘locked-in’ and ‘irreversible’ to grow and support the wellbeing of our mental health workforce. And that we will begin a shift away from relying on hospital care when community support would be better to meet people’s needs,” he added.
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