By Human Factors Consultant and Croner Author, Robert Stuthridge.

The Health and Work Service (HWS) is scheduled to be introduced in England and Wales on 31 October 2014, with full implementation by 31 March 2015. In England and Wales this service will be provided by a single “independent” supplier, Health Management Limited, part of the Maximus group, which will operate under the supervision of the Department for Work & Pensions (DWP) on a maximum budget of around £170 million over five years. This budget will be derived from scrapping Statutory Sick Pay Percentage Threshold Scheme (PTS) reimbursements to employers. In Scotland the service will be operated directly by the Government.


The HWS is part of the Government’s stated strategy to reduce the burden of more than 130 million working days reportedly lost to sickness, the majority of which are attributed to musculoskeletal and mental health problems. The DWP estimates that sickness absence annually costs the UK economy £15 billion, with employers paying out an additional £9 billion in sick pay and associated costs, employees losing a further £4 billion in earnings, and the State paying out around £13 billion in health-related benefits.

The DWP estimates that the HWS will save employers £70—£160 million annually in sick pay costs, the Government will save welfare costs of £20—£40 million and will earn an additional £40—£100 million in increased tax and NI revenues from increased earnings, while the UK in general will see economic output increase by £240—£520 million.

The HWS is part of a wider “cross-government” initiative entitled Health, Work and Wellbeing, that “aims to improve the general health and wellbeing of the working-age population and to support more people with health conditions to stay in work or enter employment”.

In achieving these aims, the DWP intends to work with employers, trades unions and healthcare professionals “to create healthier workplaces, improve occupational health services and rehabilitation support, and increase employment opportunities for people who are not in work due to ill health or disability.”

HWS: assessment and advice

The HWS comprises two service elements; assessment and advice. If employees have reached or are expected to reach four weeks of sickness absence, they can be referred by their GP to the HWS for an online or telephone assessment by an occupational health professional (OHP). If a GP has not already referred employees to the HWS, their employer may do so if they have already been absent for four weeks. Therefore, the only way to obtain an assessment from the HWS within four weeks of the onset of any illness or injury is via a GP.

After verifying the employee’s eligibility for the service, this OHP is required to identify all of the issues preventing the employee from returning to work before providing the employee with an RTWP with recommendations selected on the basis of evidence that he or she will facilitate a return to work without delay. The RTWP will also provide the employee (and his or her employer and/or GP, if the employee consents) with information on how to get appropriate help and advice. Health-related interventions recommended by the HWS attract an employer tax exemption up to £500.

If the HWS does not consider a single-step assessment will result in an effective RTWP, it may “provide a more intensive service” that can include an in-depth assessment and specialist advice from an “appropriate health professional (HP)”. Within the HWS supplier tender specification, the HWS names only the following as “appropriate” HPs: occupational physicians, occupational health (OH) nurses, nurses with OH experience, occupational therapists, physiotherapists and mental health specialists.

Employers, employees and GPs will also be able to access general occupational health advice through a phone line and website. Such websites are already operated by the NHS in the target HWS areas of England, Wales and Scotland.

Critiques and questions

The HWS has elicited a mixed response from potential users. HR managers responding to a study by insurer PMI Health Group consider the HWS too limited, failing to help them monitor the ongoing health of their staff or develop preventative methods to reduce absence.

Hugh Robertson, Senior Policy Officer for Health and Safety at the TUC, while wary that the HWS is simply a scheme designed to force sick workers back to work prematurely, is generally in favour of the service. He points out that the TUC would prefer “a comprehensive occupational health service provided through the NHS,” rather than a limited scope scheme through an independent provider.

The position of the British Medical Association (BMA) is that the HWS falls short of the UK’s obligation to provide effective support to its workforce.

What the impact will be on small businesses only time will tell.