Debra Clark: The NHS challenge – modern health epidemics and the role of employers

‘A great and novel undertaking’ was how Labour health secretary Aneurin Bevan described the inception of the NHS in 1948. A few years post-war, the country had a renewed need to be able to treat huge swathes of the population for illness and injury, and so the NHS was born.

That’s the simplified version, but really nothing about the creation of the NHS – or the way it functions 75 years on – is or has been simple, especially not when it comes to demand. The very first year the NHS opened its doors cost £140m more than estimated at a total of £248m.[1] Similarly, at its inception the NHS set aside £1m for opticians, but by the end of the year the cost came to £32m.[2]

Still, despite staggering underestimations of costs, the NHS did precisely what it set out to do: delivering healthcare to everyone in the UK, regardless of sex or income or age. Indeed, mass immunisation made possible by the NHS has protected children and people from life-threatening diseases like smallpox, tetanus, measles, polio, and so much more.

The UK could not, however, have foreseen the revolutionary medical advancements that would be made – nor could it have realised the steep costs that would be incurred as a result of those advancements. At the same time, a dramatic transformation of the average person’s lifestyle was also taking place, leading to costs at the same scale or greater than the aforementioned diseases.

The average person in the UK has a diet and lifestyle that is not, as research has shown time and time again, conducive to healthiness. Our generally sedentary lifestyles and disproportionate intake of processed foods are understood to be two key drivers of the obesity and diabetes epidemic.

So, while people in the UK are immunised against diseases that once took the lives of so many people decades ago, and it’s also much easier to seek treatment for ailments today compared to in the 1940s, today the country must contend with the cost of its modern-day epidemics: diabetes, obesity, and poor mental health.

And so, for all the undeniable splendours the NHS has given UK people, the biggest downfall of a free at point of delivery healthcare system is that it is effectively the government writing a blank cheque, forever. The key word here is government; when the country does well economically, the NHS should run as expected. But when a country experiences hardships, so too does its NHS.

The NHS has been subject to relentless pressure cooking

In recent years, the UK has been rocked by crises. A cost-of-living crisis, a global pandemic, soaring mental health issues, the obesity epidemic, poor food literacy rates. The NHS has had no other choice but to absorb these epidemics, and as a result we are now in a position of healthcare delivery made sluggish by demand far, far exceeding supply.

The NHS is the largest employer in Europe and the envy of many nations.[3] Still, it’s been used by critics of the welfare state in other countries as an example of how socialised healthcare is built to fail. But in actuality not enough credit is given to the NHS for weathering the unforeseen storms of the past decade and, through it all, still managing to deliver an exceptional level of service and care that many UK people could not fathom going without.

The NHS’s response to the Covid-19 pandemic was nothing short of incredible: despite staff shortages and high bed occupancy rates, they were able to speedily administer inoculations to the country, and create new ways of working that incorporated more distance, masks, and increased hygiene protocols. At the same time, the pandemic led to a vast backlog of scheduled routine checks, treatment and missed appointments in virtually every health sector. The NHS is still dealing with the fallout from the pandemic today.

If that wasn’t enough, then the NHS also has to contend with labour market shortages. The NHS is not new to labour market shortages, and has been struggling with this in one form or another for all of its 75-year history. Whether due to over-reliance on overseas staff – which Brexit complicated further – or due to dissatisfaction over wages, or something else, to date the NHS has staff shortages of 154,000.[4]

As well as this, thousands of NHS workers have been engaging in historic strikes this year in protest over low wages; ‘overworked and underpaid’ featured on many of the pickets of protesters. Just under three quarters of a million appointments have been rescheduled in the past eight months due to strikes.[5]

Employees’ health – the employer’s responsibility?

The government’s role in making NHS workers’ lives easier is anything but straightforward now that the UK is in the throes of a cost-of-living crisis. The government is reluctant to alleviate the strain on the NHS by incentivising healthiness and penalising unhealthiness, as they did with smoking over fifteen years ago, because there’s already considerable pressures on the average UK household.

Yet if the government doesn’t do anything, lifestyle-driven health issues are unlikely to abate. But more than this – even if the government did take action, the NHS is unlikely to have the resources to treat these conditions to a point where they no longer pose a significant problem to the country as a whole.

Employers, equally if not more so than the government, have every incentive to make sure their workers are happy and healthy. If just one of these boxes is unchecked, the results would prove critical to any business. The cost of employee disengagement is estimated to cost as much as £340bn per year when factoring in recruitment, training costs, sick days, and a loss of creativity and innovation.[6]

The impact an employee benefits package has, not only on the quality of the talent being attracted to the business but also on the behaviour of existing employees, cannot be overstated. Employees assume that their total benefits package – not just their income – is a reflection of their value to their employer. It’s not surprising, then, that 74% of employees say they will work harder for an employer who cares about them.[7]

But beyond employer-employee relationships, you’ll find that within a good benefits package employees will find precisely the resources they need – that otherwise currently lie at the end of often months’ long waiting lists for treatment – to live healthy lives, even during times of economic struggle.

Health and wellbeing: a competitive advantage

Responsibility for the health of employees is increasingly falling to the employer in the same way employee pensions did. But over time, because of the cost to manage and the limited benefit to the employer during the employee’s tenure, the responsibility for pension provision has been passed onto the employee.

Unfortunately, this same pattern probably won’t be seen when it comes to healthcare. In the current climate of economic hardship and increased mental ill-health rates, the employee may not have the means or the desire to change their lifestyle to be more healthful.

There’s another way the health of the employee is different to the pension provision situation: in trying to achieve healthiness and positive wellbeing, both the employee and employer benefit. Happy, engaged workforces outperform their unengaged counterparts by 202%.[8]

It goes without saying that employees cannot be happy or engaged if they’re preoccupied, unwell, and unsure how to access the support they need in light of the extensive wait times for treatment under the NHS. From a business perspective, you want to give your employees the tools and resources they need to be well not just as a ‘nice to have’ – but because of the competitive advantage.

As well as this, it’s frankly far, far more expensive for an employer to treat illness and injury than it is to prevent in the first place.

Can businesses afford the cost of treating illness vs preventing it?

The challenge for the employer is knowing where to start. If you asked three different people on the street what ‘wellbeing’ means, you would receive three different answers. The same would be true if you asked three different employers.

There’s no consensus on what ‘wellbeing’ is or what it means. From the strategic point of view of the employer, then, this is tricky: how do you strategise to achieve something as diffuse as ‘wellbeing’ in order to reap its numerous business benefits?

A good place to start is by mirroring your approach towards health and safety risks. The same way you deploy different levels of focus depending on the areas that need work at your company, you could look across all the four pillars of wellbeing – emotional, physical, social, and financial – and adapt your strategy to your workforce’s particular strengths and weaknesses.

This of course does not have to mean a pricey and complex benefits package. On the contrary, we find that benefits communication is the single biggest change you can make to improve benefits uptake and encourage healthiness. Many employees are simply not aware of the benefits they have, or how to access them. Ensuring this is clearly communicated with workers at regular intervals, and that there is clear signposting, will ensure your existing benefits roster packs its best punch.

Whether it’s in aid of emotional, physical, social or financial health, employers are deploying a number of mix-and-match solutions that fit the needs of their company and workforce. Here are just a few of the services being offered by companies under each pillar of wellbeing.

For mental health/emotional wellbeing:

• An employee assistance programme (EAP) either standalone or embedded in an existing insurance policy
• In-patient or out-patient mental health benefits as featured in a private medical insurance plan
• Implementing mental health first aiders
• Neurodiversity support
• Line manager training on supporting staff better

For physical health:

• Gym and fitness discounts
• Cycle to work schemes
• Fresh fruit or healthy food options at work
• Private medical insurance
• Cash plans
• Dental policies
• Menopause support groups
• Nutritional support

Social wellbeing:

• Reward and recognition schemes
• Clubs, e.g., yoga club, walking club, gardening, etc
• Work events
• Volunteering days
• E, D & I community groups

Financial wellbeing:

• Pension schemes
• Group life insurance
• Group income protection
• Critical illness
• Retail discounts
• Financial education webinars and 1-2-1 sessions.

Our wonderful, weary NHS

To anyone fortunate enough to access the NHS, one thing is clear: despite hiccups in the provision of services and accessing treatment, few could imagine a more valuable service, and even fewer still could imagine a UK in which the NHS didn’t exist.

Our NHS must be protected, but it’s clear that even with the current government NHS resource plan, it’s going to be some years before equitable access to treatment on a timely basis is restored. In the meantime, companies that fail to act in bridging the gap between employees and healthcare resources are likely to suffer in the long-term, while companies who do invest in their employees in this way are likely to perform better, be more productive, boost engagement, and elevate their business success.

On this basis, we see that employers have little choice but to take action. The question, then, isn’t ‘should I invest in employee wellbeing as a key business decision over the coming years?’ but ‘how should I invest to achieve the greatest effect?’

[1] The Birth of the NHS – July 5th 1948 | Nursing Times

[2] The Cabinet Papers | Origins of the NHS

[3] NHS Long Term Plan » Chapter 4: NHS staff will get the backing they need

[4] NHS staff shortages in England could exceed 570,000 by 2036, leaked document warns | NHS | The Guardian

[5] NHS England | NHS England publishes data on latest junior doctors strike

[6] Three in five workers are disengaged and costing UK economy billions, study finds | People Management

[7] Half of employees would sacrifice pay for personalised benefits, report reveals | People Management

[8] Employee Engagement Statistics | Clear Review