The Keep Britain Working review is urging employers and workplace health professionals to engage with it about what works and doesn’t work when it comes to healthcare interventions.

As part of its ‘discovery phase’ report published earlier this week, the review, being led by ex-John Lewis Partnership chairman Sir Charlie Mayfield, said it wanted to hear about activity and initiatives employers and occupational health professionals are undertaking to prevent health issues occurring in the workplace.

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It wanted, similarly, to gauge how barriers preventing people with disabilities from sustaining work can be removed. The review is looking for written evidence, intends to hold roundtable panel discussions and conduct focus groups as part of its evidence gathering.

“We are keen to understand initiatives being undertaken to improve access to support and treatment for employees (both in terms of the range of support and speed of access), again including evidence of how effective these initiatives are,” the report said.

“We want to hear from occupational health and healthcare providers about innovations in interventions that yield better results, along with evidence of the impacts of these initiatives,” it added.

Experiences from employers and employees of effective case management and what supported this to work well and, again, what barriers exist were a further area of interest, the Keep Britain Working review report said.

“A key to prevention is supporting people early. We are keen to explore examples and evidence of where employers have been able to work with employees to identify and manage health conditions and disabilities earlier and more effectively,” the report emphasised.

“We would like to understand evidence of where closer collaboration and engagement between employers, employees and other parties like occupational health or healthcare professionals have been achieved and the impact of that collaboration,” it added.

When it came to both these issues – effective intervention and effective case management – the review report highlighted that, too often still, when people experience ill health or disabled people face barriers at work, there is a time lag before they can access effective support. Delays in this support can exacerbate and deteriorate conditions, so creating longer absence from work.

Between July 2023 and June 2024, 1.5 million people experienced a period of long-term sickness absence from work, it pointed out, with a causal relationship between the length of time people are off work because of ill health and the likelihood of them leaving employment.

“The longer that people are away from the workplace the lower the likelihood of a successful return to work. Generally, when someone is out of work for more than a year, they are more likely to leave employment than return,” the report argued, which it also illustrated through the graphic below.

Moreover, people whose long-term sickness absence was caused by a mental health condition are less likely to return to work compared with those with musculoskeletal or other conditions.

While the first port of call for help during periods of ill health, fluctuating conditions or when dealing with additional barriers was most commonly GP or other healthcare professional in primary care, the ability of general practice to play this first-line support role was “much more questionable”, the report highlighted.

“General practice staff are not generally qualified in occupational health. Additionally, they will not be well versed in a patient’s workplace dynamics and are unlikely to have the time to get to the bottom of the barriers they are facing in the workplace,” it said.

This was one reason why 93% of fit notes issued by general practice simply ended up recommending that the employee was not fit for work rather than interventions to help them stay in, or manage, their work, it pointed out.

“There is also a disparity between the level of detail that many employers might expect from fit notes if the system worked as intended (to support them in helping the employee) and the type of detail that health care professionals offer,” the report highlighted.

Furthermore, waiting times to see specialists were much too long. “Demand for treatment or interventions for musculoskeletal and mental health conditions, the two most common workplace-related health issues, has significantly exceeded supply,” the report said.

When it came to workplace-provided support, many employers did provide forms of OH services, vocational rehabilitation and employee assistance programmes (EAPs), the report conceded.

“Around three in ten employers provide occupational health services or vocational rehabilitation, covering around half of the workforce,” it highlighted.

However, as has long been recognised, by and large this sort of support was only offered by larger employers. “These types of schemes are much more common in larger employers (89%) than in smaller companies (28%) and vary across sectors. Around 13% of employers offer EAPs, which often include access to a variety of services including virtual GPs, therapists, and financial advisors. This can be dependent on the programme, however,” the report said.

“These types of schemes are relatively widely available; however, we have not yet seen clear evidence of the levels of uptake by employees or their impact on absence and economic inactivity. These schemes are also more focused on rehabilitation than prevention,” it added.

Finally, when it came to case management of workplace health issues, the report highlighted that, again, this was “often performed by over-stretched general practice staff”.

Occupational health services can provide case management function. However, we have also had feedback from employers and employees that recommendations for adjustments and interventions can be ineffective”

While well-placed to case manage clinical conditions, they were not occupational medicine professionals and are not funded to perform OH case management and support employers. “It is not their job,” the report stated, bluntly.

“Occupational health services can provide case management function. However, we have also had feedback from employers and employees that recommendations for adjustments and interventions can be ineffective and are made without a good understanding of the nature of the characteristics of the work,” it said.

It highlighted research from the Business Disability Forum that suggested only 22% of disabled employees and 25% of managers said occupational health had helped support the employee in managing barriers at work or understand the adjustment that would help.

“Effective case management and support should focus on interventions that incorporate early and sustained employer contact and support, coordination between employee employer and the healthcare system, and appropriate adjustments to the role or workplace,” the report recommended.

In terms of the practicalities of getting this feedback and evidence, the review has an online portal on the gov.uk website that sets out key questions it is looking to answer. There is also a direct email address that people can feed into, at [email protected]

The plan beyond that is there will be a series of events and in-person roundtable discussions held around the country in the coming months, as well as virtual events to explore these areas in more detail.

Finally, the review said it intends to hold a series of focus groups and research to gather feedback and understanding from individuals with lived experience of these issues.

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