Who Holds the Responsibility for Inclusion? Employers, Government, or Individuals? Navigating Chronic Illness in UK Workplaces

A Rising Challenge for UK Workplaces

The UK is facing a workforce health crisis. Long-term sickness is at record levels, with nearly 2.8 million people economically inactive due to ill health (IPPR, 2023). This surge is largely attributed to chronic health conditions, including musculoskeletal disorders, mental health issues, and long COVID (Boutry et al., 2024). The economic cost is stark:

presenteeism and absenteeism combined cost UK employers £103 billion annually (IPPR, 2023). The government has responded with controversial reforms to disability benefits and Personal Independence Payment (PIP), aiming to save billions while tightening eligibility for new claimants (UK Government, 2025).

Against this backdrop, the question arises: whose responsibility is it to ensure inclusion for employees managing chronic conditions? Employers argue that government policies must incentivise work participation. Campaigners highlight systemic discrimination and underfunded occupational health systems. Meanwhile, individuals often feel caught between limited statutory protections and rigid workplace norms.

This article explores the shared responsibility debate through a UK lens. It draws on occupational psychology research to outline practical strategies employers can adopt, examines the implications of government reforms, and asks whether current policy shifts risk transferring too much burden to employees.

The Scale and Complexity of Chronic Illness at Work

A Hidden Epidemic

Chronic conditions affect a growing share of the UK workforce. The rise in mental health-related absence and musculoskeletal disorders mirrors global trends, but the UK’s long COVID prevalence, 869,000 people with symptoms lasting beyond 12 weeks, adds a unique layer of complexity (Boutry et al., 2024). These conditions often fluctuate, making linear return-to-work (RTW) programmes ineffective.

A TUC (2023) survey revealed that two-thirds of long COVID sufferers experienced disadvantage or discrimination at work, such as reduced hours without consultation or pressure to resign. Similarly, chronic pain and fatigue conditions remain under-acknowledged, leading employees to hide symptoms for fear of stigma (Teborg et al., 2024).

The Economic Toll

According to IPPR (2023), ill health is costing the UK economy billions in lost productivity and increased welfare spending. While PIP reforms seek to curb benefit dependency, critics warn that cuts may exacerbate poverty and reduce employment prospects for those with severe health issues (The Guardian, 2025). Employers already facing talent shortages cannot ignore these dynamics: inclusive strategies are not just ethical but essential for sustainability.

Organisational Barriers, Why Aren’t Employers Doing More?

Despite the clear business case, many UK organisations lag behind. Rigid attendance policies, lack of managerial training, and performance metrics prioritising presenteeism create structural barriers (Work Foundation, 2024). Employees report that flexible working requests linked to health are sometimes treated as favour-seeking rather than necessity (TUC, 2023).

The psychological contract, the implicit expectation of mutual trust between employer and employee, often breaks down when workers feel unsupported. This breach drives disengagement, turnover, and mental distress (Rousseau, 1995; McGonagle et al., 2024).

A Managerial Knowledge Gap

Many line managers fear saying “the wrong thing” about health conditions. Research shows that managers rarely receive formal training in occupational health or psychosocial safety, despite these being critical factors in reducing sickness absence (Dollard & Bailey, 2021).

Wellbeing Programmes That Miss the Mark

UK employers have poured money into wellness apps, gym subsidies, and resilience training. Yet these interventions often fail to tackle job design, workload, and support structures, the real drivers of stress and ill health (Agars & DeOrsey, 2024). In short, employers risk investing in “well-being theatre” while structural issues persist.

The Government’s Role, Support or Shift of Responsibility?

The Equality Act 2010 provides a legal baseline, requiring “reasonable adjustments” for disabled employees, including those with chronic conditions. However, enforcement is inconsistent, and employment tribunal cases for disability discrimination remain high.

Recent government reforms, such as halving Universal Credit supplements for new claimants and tightening PIP eligibility (UK Government, 2025), signal a policy shift from income replacement toward “activation.” While intended to encourage employment, critics argue these cuts risk penalising those least able to work (Scope, 2025).

Labour’s U-turn in June 2025, protecting existing claimants after political backlash, highlights the tension between fiscal prudence and social equity (Community Care, 2025). Meanwhile, employers warn that without government investment in occupational health infrastructure, they lack resources to manage complex cases effectively.

This raises a provocative question: Are policy changes unintentionally shifting the responsibility of workforce health from state to employer, without adequate support, or even to individuals?

The Individual Burden, Is Self-Management Realistic?

Advocates of self-management argue employees should play an active role in pacing work, requesting adjustments, and engaging in vocational rehab programmes. Indeed, occupational psychology emphasises job crafting, employee-led adaptation of tasks, as a well-being booster (Tims & Bakker, 2010).

However, the reality for many UK workers is constrained by power imbalances. Employees fear disclosure due to career penalties, especially in competitive sectors. Lower-income and gig-economy workers often lack both bargaining power and statutory sick pay beyond the minimal £116.75 per week (Work Foundation, 2024). Expecting self-management without systemic support risks perpetuating inequality.

What Employers Can Do, Evidence-Based Strategies

Occupational psychology offers robust, UK-tested frameworks to guide employers beyond tokenistic measures:

 1. Embed Flexible Work Design

• Expand statutory flexible work rights to all roles, not just “white-collar” jobs.

• Use phased RTW programmes tailored to fluctuating symptoms, weekly capacity reviews rather than fixed timelines (Boutry et al., 2024).

2. Build Psychosocial Safety Climate (PSC)

• PSC, employees’ perception that mental health is prioritised, correlates with lower presenteeism and turnover(Dollard & Bailey, 2021).

• Measure PSC regularly using validated tools (e.g., COPSOQ) and integrate findings into leadership KPIs.

3. Train Managers for Empathic Leadership

• Equip line managers with mental health literacy and structured RTW dialogue protocols (SOM, 2023).

• Encourage “health check-ins” as part of performance reviews to normalise support conversations.

4. Provide Health-Related Leeway

• Allow autonomy over work pacing, flexible deadlines, and task redistribution during symptom flare-ups (McGonagle et al., 2024).

5. Formalise Inclusion in HR Policy

• Embed health inclusion in recruitment, promotion criteria, and disability networks (Scope, 2025).

• Monitor impact using diversity and retention metrics, not just absence rates.

 Whose Responsibility Is It, Employer, Government, or Individual?

The answer is shared accountability, but the balance is contested.

• Employers: Control the work environment and can prevent health-related exits through flexibility and culture change. However, SMEs need incentives and guidance.

• Government: Sets the legal floor, funds vocational rehab, and influences employer behaviour via tax incentives or penalties. Current reforms risk prioritising cost savings over inclusion unless paired with proactive support measures.

• Individuals: Should engage in reasonable self-management, but within systems that empower rather than penalise disclosure.

Occupational psychologists argue that structural solutions, not individual resilience, drive sustainable outcomes. Without coordinated policy, employer action, and employee empowerment, the UK risks deepening labour shortages and social inequality.

Future Directions

• Legislation: Expand statutory right to flexible work from day one, with enforcement mechanisms.

• Policy Incentives: Tax relief for employers offering robust occupational health schemes.

• Research: Longitudinal UK studies on hybrid work and chronic illness outcomes.

• Measurement: Mandate PSC audits as part of ESG reporting.

From Compliance to Commitment

UK workplaces stand at a crossroads. Employers cannot ignore the chronic illness challenge, nor can government rely on punitive benefit reforms to drive participation. Inclusion demands more than compliance, it requires commitment to cultural change, informed by occupational psychology, supported by policy, and shaped by shared responsibility.

If the UK fails to act, we risk entrenching health-related inequality, undermining productivity, and exacerbating the very welfare costs reforms aim to cut. Conversely, a strategic, collaborative approach can transform chronic illness from a barrier into a blueprint for more humane, adaptable, and productive workplaces.

References:

Agars, M. D., & DeOrsey, M. (2024). Supporting workers with chronic illness: The role of psychosocial safety climate. Journal of Occupational Health Psychology. Advance online publication. https://doi.org/10.1037/ocp0000371

Boutry, C., Patel, P., Holmes, J., Radford, K., Bolton, C. E., Evangelou, N., & Morriss, R. (2024). Returning to work with long COVID in the UK during lockdown and other COVID-19 restrictions: A qualitative study. PLoS ONE, 19(8), e0307062. https://doi.org/10.1371/journal.pone.0307062

Community Care. (2025, June 27). Existing PIP claimants to be protected from cuts in disability benefits after U-turn. https://www.communitycare.co.uk/2025/06/27/existing-pip-claimants-to-be-protected-from-cuts-in-disability-benefits-u-turn/

Dollard, M. F., & Bailey, T. S. (2021). Building psychosocial safety climate in turbulent times: The case of COVID‑19. Journal of Applied Psychology, 106(3), 315–325. https://doi.org/10.1037/apl0000919

Equality Act 2010, c.15. (2010). https://www.legislation.gov.uk/ukpga/2010/15/contents

Institute for Public Policy Research (IPPR). (2023). Health and prosperity: A new economic agenda for the UK. IPPR Commission on Health and Prosperity. https://www.ippr.org/research/publications/health-and-prosperity

McGonagle, A. K., Milczarek, M., & Shaw, W. S. (2024). Chronic health conditions in the workplace: Work stressors and quality of working life. Journal of Occupational Health Psychology, 29(2), 112–126. https://doi.org/10.1037/ocp0000335

Rousseau, D. M. (1995). Psychological contracts in organizations: Understanding written and unwritten agreements.Sage Publications.

Scope. (2025, March 28). What you need to know about the new bill to change disability benefits. https://www.scope.org.uk/news-and-stories/what-you-need-to-know-about-the-new-bill-to-change-disability-benefits/

Society of Occupational Medicine (SOM). (2023). Long COVID and mental health: Priority workplace health guidance.https://www.som.org.uk/long-covid-and-mental-health-priority-workplace-health

Teborg, S., Hünefeld, L., & Gerdes, T. S. (2024). Exploring working conditions of employees with disabilities: A scoping review. Journal of Occupational Medicine and Toxicology, 19(1), 15. https://doi.org/10.1186/s12995-023-00397-z

The Guardian. (2025, March 26). More than 3m Britons to lose out from benefits cuts. https://www.theguardian.com/society/2025/mar/26/more-than-3m-britons-to-lose-out-from-benefits-cuts

The Work Foundation. (2024). Making flexible work the default: Policy solutions for an inclusive labour market.Lancaster University. https://www.theworkfoundation.com/publications/

Tims, M., & Bakker, A. B. (2010). Job crafting: Toward a new model of individual job redesign. South African Journal of Industrial Psychology, 36(2), 1–9. https://doi.org/10.4102/sajip.v36i2.841

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World Health Organization. (2022). Mental health at work: Policy brief. WHO and ILO. https://www.who.int/publications/i/item/9789240053052