Who Pays for the Nation's Health? Employers, Prevention and the Quiet Reallocation of the Bill

Is it just me, or is the job of keeping the nation well moving, a little at a time, from the health service to the workplace? Each new announcement on its own seems perfectly reasonable, and several are overdue. Taken together, though, they add up to something that deserves a name, and a conversation about who is expected to pay for it.

A workplace health system, and a pattern

The latest step came this week, when Sir Charlie Mayfield set out plans for what People Management describes as Britain's first "workplace health system" (Mayne, 2026). Under the approach now being tested, employers would speak to employees within five working days of a health issue being raised, make first contact during sickness absence no later than day three, prioritise return-to-work plans for absences expected to last more than four weeks, and track whether people are still in work six months later. More than 200 organisations are already trialling the measures ahead of a British Standards Institution employer standard, and eleven regional vanguards, from Hull to the West Midlands, are working with government on the detail (Mayne, 2026). To be fair to the architects, the timings are described as "early examples" rather than firm requirements, and the ambition is backed by a serious diagnosis: the Keep Britain Working review estimated that working-age ill health costs Britain £212bn a year, including £132bn in lost output (Mayne, 2026).

On its own, this is sensible, humane and hard to argue with. But it does not stand on its own. Since April 2024, employees have had a statutory right to a week of unpaid carer's leave from their first day in a job (Carers UK, n.d.). Since April 2026, statutory sick pay has been payable from the first day of absence rather than the fourth, with the lower earnings threshold removed altogether (Business.gov.uk, 2026). Large employers with 250 or more staff are being asked to publish action plans that include at least one measure to support employees through the menopause, voluntary this year and mandatory from spring 2027, subject to secondary legislation (Wren, 2026). And just last week the government announced a new day-one right to bereavement leave from April 2027, including two weeks' leave following pregnancy loss (King, 2026).

Each of these has merit, and several correct long-standing injustices. Yet the direction of travel is unmistakable. Employers are being asked, by statute, by standard and by gentle exhortation, to take on a growing share of prevention, early intervention, rehabilitation and support that we might once have thought of as the business of the health and care system and the welfare state.

Mental health: where the pattern is clearest

Nowhere is this shift more visible than in mental health. The legal starting point is long established: the Health and Safety Executive states plainly that "Employers have a legal duty to protect workers from stress at work by doing a risk assessment and acting on it", the same duty that applies to any other health and safety risk (HSE, 2024). Employers are expected to manage six areas of work design that drive stress (demands, control, support, relationships, role and change), to develop individual action plans for workers who are struggling, and, as part of their first aid needs assessment, to consider how they would support someone who becomes ill at work because of a mental health issue (HSE, 2024).

The scale of what this duty now covers is considerable. HSE's latest figures show that 964,000 workers reported stress, depression or anxiety caused or made worse by work in 2024/25, and that "Mental health conditions remain the primary driver of work-related ill health" (HSE, 2025). Unum's contribution to the Keep Britain Working announcement noted that 31 per cent of the economically inactive population are now classified as long-term sick, with mental health "the leading cause of absence" (DWP, 2025). Little wonder that the workplace health system places so much emphasis on early conversations, and that the menopause action plan guidance lists access to occupational health advice and manager training among its recommended actions (Wren, 2026).

There is an important distinction here, and it cuts both ways. Preventing harm that work itself causes, through sensible workloads, decent management and a culture in which people can say they are struggling, is unarguably the employer's business, and has been for decades. But the apparatus that has grown up around it, from employee assistance programmes and counselling lines to mental health first aiders and wellbeing apps, increasingly catches distress that begins well beyond the workplace: in debt, in caring responsibilities, in bereavement, in loneliness. That is support we might once have expected the health service, or the community around a person, to provide. Employers who offer it deserve credit, and many do so because it is good for their people and their business. The question is whether we have noticed that the workplace has quietly become one of the main front doors to mental health support, and whether that front door is open to everyone.

For health and social care, the point is sharper still. This is emotionally demanding work, carried out by people who spend their days absorbing other people's distress. A large NHS trust typically has occupational health and staff wellbeing services it can draw on. A small care provider, whose staff may be dealing with end-of-life care, challenging behaviour and lone working, often has little more than a line manager and goodwill. The legal duty to assess and manage stress is the same for both; the capacity to meet it is not.

Not so much stealth as a stated strategy

I was tempted to ask, with a raised eyebrow, whether this is a carefully planned stealth strategy for shifting the question of who pays. Having read the source material, I am not sure the eyebrow is needed. The government has been admirably candid. Its own announcement of the Keep Britain Working partnership lists, among the benefits of the reforms, that they will "Reduce pressure on the NHS by preventing conditions from worsening" and "Lower welfare costs by stemming the flow onto health-related benefits" (DWP, 2025). The NHS Confederation's chief executive, Matthew Taylor, welcomed the review in the same release, observing that "Health leaders know that employers have a vital role to play in delivering the shift from treatment to prevention" (DWP, 2025).

So this is not a secret. It is an explicit policy choice to enlist the workplace in the NHS's own strategic shift from treatment to prevention. That is not necessarily wrong. It is, however, a reallocation of effort and cost, and reallocations deserve to be discussed as such rather than presented purely as good news for everyone.

From public to private

There is a second, quieter dimension. When employers take on responsibility for their employees' health, they tend to buy it in, and much of what they buy comes from the private sector. Private healthcare admissions in the UK reached a record 953,000 in 2025, with insured admissions, largely employer-funded, also at a record 670,000 (Cueto, 2026). Broadstone's head of health and protection, Brett Hill, put the employer mindset plainly: healthcare benefits such as private medical insurance "are increasingly being viewed less as a perk and more as a core tool for protecting workforce resilience" (Cueto, 2026).

A glance down the list of organisations that expressed interest in becoming Keep Britain Working vanguards makes the same point. Alongside retailers, banks and NHS trusts sit AXA Health, Bupa UK, Nuffield Health and Spire Healthcare, several of them participating both as employers and as providers (DWP, 2025). There is nothing improper in that; these organisations have real expertise in occupational health and rehabilitation, and Zurich's contribution to the same release notes that nine in ten employees return to work when they have access to vocational rehabilitation, but only three in ten have it (DWP, 2025). The point is simply that "workplace health" is, in practice, often a route by which the costs of care move from the public purse to employers, and some of the delivery moves from the NHS to private providers. A person's access to timely physiotherapy or mental health support may increasingly depend on who employs them.

The case for: this is what good employers should do anyway

Before this becomes a lament, the other side deserves its strongest hearing, because it is a strong one. The evidence that early intervention works is compelling. The latest Keep Britain Working update finds that an employee absent for four to six weeks has a 96 per cent chance of returning to work, but after a year fewer than half do. As the report puts it, "The cheapest intervention is always the earliest one" (Mayne, 2026). Employers are also the people best placed to act early. They see their staff every day; the GP, in many cases, sees them only when things have already gone wrong.

There is a business case too. The Keep Britain Working review estimated that employers lose £85bn a year to sickness, turnover and lost productivity (DWP, 2025). Timewise, which has worked on job design for more than two decades, reports that its evidence shows better-designed jobs "pay for themselves after just three years in most sectors" (DWP, 2025). On this view, the legislation is not shifting a burden so much as nudging employers towards something that is already in their own interest.

And this is hardly a new idea. When Titus Salt moved his alpaca mill out of an overcrowded and insanitary Bradford in the 1850s, he built not just a mill but a model village: houses with proper drainage, water and gas, a dining hall, schools, a park, and in 1868 an infirmary and dispensary with six beds, together with 45 almshouses whose tenants lived rent free and received a weekly pension (Saltaire Collection, n.d.). A few decades later George Cadbury developed Bournville around his chocolate factory, founding Bournville Village Trust in 1900 so that its homes, parks and open spaces would continue to benefit the community after his death (Bournville Village Trust, n.d.). Both men understood, long before anyone coined the phrase "wellbeing strategy", that healthy, well-housed workers were more productive than those left to the mercy of the sweatshop and the slum. (It is tempting to say they would have made excellent Chief People Officers, although one suspects their board papers would have been rather shorter.)

Why the Victorian parallel only goes so far

The Victorian model villages are a lovely story, and a useful one, but the parallel needs handling with care. Salt and Cadbury acted in the absence of a welfare state. There was no NHS, no statutory sick pay and no public health system worthy of the name, so an enlightened employer who provided an infirmary was filling a vacuum. Today, we already fund a national health service through general taxation, and employers contribute to it through National Insurance. When the state now asks employers to provide early intervention, rehabilitation and support in the name of reducing pressure on the NHS, it is not filling a vacuum. It is asking the same employers to pay twice, once through their taxes and once through their HR budgets, for outcomes the public system is struggling to deliver.

It is also worth remembering that the model villages were the exception, not the rule. For every Saltaire there were a great many mills whose owners felt no such obligation. Paternalism depended on the character of the individual employer, which is precisely why the twentieth century chose to build universal public provision instead. A system in which access to health support depends on the goodwill, or the balance sheet, of one's employer risks rebuilding exactly the inequality that the welfare state was designed to remove. Interestingly, the government seems to accept this logic when it suits: announcing the new bereavement right, its spokesperson noted that while most employers already go further, "there needs to be a safety net beyond this discretion" (King, 2026).

Who can actually afford to comply?

This is where the argument becomes most pressing for health and social care. National employment policy tends to be designed around large organisations with HR departments, occupational health contracts and the capacity to absorb new duties. The CBI's response to the Mayfield review was diplomatic but pointed, noting that "the cost of employing people" is "already a barrier to creating jobs" (DWP, 2025). The British Chambers of Commerce welcomed the review's interest in exploring a Statutory Sick Pay rebate for small firms, adding that "at a time of surging business costs, support and incentives are crucial" (DWP, 2025).

Timewise made the sharpest observation of all, calling for particular support for frontline sectors, "including retail, transport, construction, health and social care", where individuals "work shifts with less flexibility, and little predictability" (DWP, 2025). For a large NHS trust, much of the new agenda is a policy refresh supported by an existing occupational health service; several trusts are, indeed, vanguards themselves (DWP, 2025). For a small domiciliary care agency or a 30-bed care home, operating on thin margins with a largely low-paid workforce and fees often set by local authorities, day-one sick pay, early-contact expectations and return-to-work planning are real and immediate costs. They land on the very sector the NHS depends on to discharge patients and keep people well at home. It would be an irony worthy of a Victorian novel if a policy designed to relieve pressure on the NHS ended up weakening the social care providers whose capacity determines how quickly hospital beds are freed.

Towards an honest settlement

None of this is an argument against employers taking health seriously. The evidence is clear that early, humane intervention keeps people in work, and that is good for them, for their employers and for the public finances. But if the workplace is to become a formal part of the nation's prevention infrastructure, the settlement should be explicit rather than accidental. That means being honest that costs are being reallocated, not simply reduced; designing support that is proportionate to what different employers can carry, with pooled provision and rebates for small employers treated as essentials rather than afterthoughts; and ensuring that people who work for small firms, or who are not in work at all, do not find themselves on the wrong side of a new two-tier system.

For health and social care in particular, it means recognising that employers in the sector are both the providers of care and the employers of carers, and that remedies designed around large, well-resourced organisations will not reach the small providers on which the whole system depends. Salt and Cadbury built their villages because it was good business and because they believed it was right. The question for our time is not whether employers should care about the health of their people, but whether we are prepared to say openly how much of the nation's health bill we now expect them to pay.

I'd be interested to hear how others see it: a sensible shift towards prevention, or a quiet reallocation of the bill?

References

Bournville Village Trust (n.d.) Foundation of Bournville Village Trust. Available at: https://www.bvt.org.uk/about-us/foundation-and-legacy/foundation-of-bournville-village-trust/ 

Business.gov.uk (2026) Your sick pay rights. Department for Business and Trade. Available at: https://www.business.gov.uk/campaign/employment-changes/employee/statutory-sick-pay/ 

Carers UK (n.d.) The Carer's Leave Act. Available at: https://www.carersuk.org/help-and-advice/work-and-career/the-carers-leave-act-2023/ 

Cueto, J. (2026) 'Insurance in the spotlight as private health admissions hit new high', Insurance Business UK, 2 June. Available at: https://www.insurancebusinessmag.com/uk/news/life-insurance/insurance-in-the-spotlight-as-private-health-admissions-hit-new-high-577373.aspx 

Department for Work and Pensions (DWP) (2025) Employers join forces with government to tackle ill-health and keep Britain working. Press release, 5 November. Available at: https://www.gov.uk/government/news/employers-join-forces-with-government-to-tackle-ill-health-and-keep-britain-working 

Health and Safety Executive (HSE) (2024) Work-related stress and how to manage it. Available at: https://www.hse.gov.uk/stress/overview.htm 

Health and Safety Executive (HSE) (2025) HSE publishes annual workplace health and safety statistics. Press release, 20 November. Available at: https://press.hse.gov.uk/2025/11/20/hse-publishes-annual-workplace-health-and-safety-statistics/

King, C. (2026) 'Government extends legal right to bereavement leave', HR Magazine, 23 September. Available at: https://www.hrmagazine.co.uk/content/news/government-extends-legal-right-to-bereavement-leave 

Mayne, M. (2026) 'Plans unveiled for Britain's first "workplace health system"', People Management, 24 September. Available at: https://www.peoplemanagement.co.uk/article/1970830/plans-unveiled-britains-first-workplace-health-system 

Saltaire Collection (n.d.) The foundation of Saltaire. Available at: https://www.saltairecollection.org/story-of-saltaire/foundation-of-saltaire/ 

Wren, A. (2026) 'New gender pay gap and menopause action plans: what employers need to know', Farrer & Co, 12 March. Available at: https://www.farrer.co.uk/news-and-insights/new-gender-pay-gap-and-menopause-action-plans-what-employers-need-to-know/