Employer approaches to workplace healthcare are coming under increasing scrutiny as rising economic inactivity, longer NHS waiting lists and growing absence levels expose the limits of traditional benefit models.
In this exclusive, Georgina Howe, Chief Executive Officer at Teladoc Health UK, considers the findings of the Keep Britain Working Review and the implications for employers, highlighting the need for earlier intervention, more flexible support, and a fundamental rethink of how workforce health provision is structured.
Last November, Sir Charlie Mayfield published the findings of the Keep Britain Working Review. Its conclusion was stark: over one in five working-age adults are now out of the workforce, with ill health the biggest driver of economic inactivity, costing an estimated £212 billion a year.
The review was clear that employers have a critical role to play alongside the government and the health system. It highlighted persistent cultural barriers in workplaces, including stigma and a lack of confidence in managing health issues, which can discourage early disclosure and prevent supportive conversations.
The problem is compounded by the challenges facing the NHS. As of January 2026, the waiting list stood at 7.25 million cases, with a median wait of 13.6 weeks, nearly double the pre-pandemic figure. Employees who need support cannot rely on the health service to provide it quickly. That gap falls to employers to fill, whether they are ready for it or not.
Our Chief Medical Officer, David Griffiths, comments:
“As a GP, I see many patients whose health is affecting their ability to work; my sense is that their managers are often struggling to help them stay in work. Sometimes it sounds like a lack of competence, occasionally it sounds unfairly punitive but, often, the manager is clearly a caring person who lacks any levers to pull to help their colleague deal with their problem”.
The problem with one-size-fits-all
Most employer health strategies are linear. A set of benefits goes out to the whole workforce, and that is broadly that.
But the health pressures employees face shift significantly across a working life, and the standard model rarely accounts for this. A worker in their twenties is dealing with long hours, poor sleep and lifestyle disruption. By their thirties, fertility, pregnancy and the demands of early parenthood often dominate.
In their forties, perimenopause, increasing seniority, family pressures and accumulated stress come to the fore. By their fifties, musculoskeletal symptoms, caring responsibilities and chronic conditions begin to compound.
The traditional PMI model was never designed to absorb sustained demand across all of these stages. It works well for acute, high-cost events like surgery or cancer treatment. It is far less effective as a gateway for the frequent, lower-cost interventions that make up a growing share of what employees actually need day to day.
Musculoskeletal problems, mental health challenges and metabolic conditions are among the biggest drivers of absence and lost productivity. None of them are particularly well served by insurance built for catastrophic events.
The mental health and absence crisis
The scale of the challenge is significant and worsening. According to the CIPD’s Health and Wellbeing at Work 2025 report, employees in the UK took an average of 9.4 days’ sickness absence per year, the highest level recorded since the CIPD began tracking in 2010. Mental ill health is the leading cause of long-term absence, with rates rising year on year.
These are not abstract figures. Behind them are people who needed support earlier and did not get it, and organisations now managing the consequences.
The fit note system, intended to support return to work, isn’t working. The Keep Britain Working Review found that 93% of fit notes declare individuals not fit for work, frequently without exploring phased returns or adjustments.
The issue is rarely purely medical. Working environment, management culture and job design all play a role, and none of this is something a fit note can fix. My clinician colleagues tell me that writing effective fit notes is difficult and ideally requires specialist, occupational health skills and knowledge.
Prevention only works if it comes early enough
There is broad agreement in principle that prevention is better than cure. In practice, most employer health provision still skews toward reactive treatment.
By the time someone is signed off with burnout or their back pain has become chronic, the human and financial cost is already significant. The opportunity lies in catching problems before they escalate. For example, a physiotherapy consultation before back pain becomes debilitating, or a mental health check-in before someone reaches a crisis point.
Virtual care models, when well designed, make this kind of early intervention genuinely achievable. Employees are far more likely to use a service that is convenient and discreet, and the earlier a problem is caught, the simpler it is to address. The Keep Britain Working Review made exactly this point: prevention and early support, not just treatment, need to sit at the heart of how employers think about workforce health.
The equity gap is widening
As employer-funded healthcare grows, so does the risk of a two-tier system where access to good care becomes increasingly tied to employment status.
The CIPD has raised concerns that traditional benefit models often exclude lower-paid employees and those with pre-existing conditions, creating barriers for the groups already most vulnerable to health problems. Within workforces, the gap can be equally stark. Digital literacy, language and access to devices all affect whether an individual will benefit from employer health programmes.
A benefit that is technically available across the whole organisation but practically inaccessible to a significant portion of it is not an equitable provision.
The opportunity
The employers who will get this right are those who stop treating healthcare as a cost to be managed and start treating it as an investment in workforce resilience.
That means building strategies that reflect the real diversity of employee health needs at different life stages, prioritising early intervention, and holding health partners to account on outcomes rather than access alone.
The Keep Britain Working Review has put this issue firmly on the national agenda. The question now is whether employers will use this moment to genuinely rethink their approach, or wait until the cost of inaction becomes impossible to ignore.
