Health, Work and the Missing Middle

Why the NHS’s New Priorities Demand a More Connected Approach

For too long, musculoskeletal (MSK) health, women’s health and employment have been treated as separate challenges.

MSK has largely been viewed through the lens of NHS demand, waiting lists and service capacity. Women’s health has focused on inequalities, access and unmet need. With economic inactivity seen as a workforce and productivity issue, this separation no longer reflects reality.

Across government and the NHS, policy is converging around supporting people earlier, enabling self-management, moving care closer to home and helping people stay healthy enough to remain in work. The challenge now is not simply improving individual services but changing focus to connect them around the person.

For Integrated Care Systems (ICSs), this presents a significant opportunity. It also highlights a growing need for infrastructure that bridges the gap between health and work, rather than expecting individuals to navigate fragmented pathways themselves.

Three priorities. One challenge.

The new NHS England Adult Community Musculoskeletal Service Specification signals a shift in what good MSK care looks like.

The emphasis is no longer solely on treatment. Instead, the focus is on supported self-management, digital access, self-referral, meaningful outcomes and stronger links with work and health programmes. It recognises that MSK health and employment are intrinsically linked, with MSK conditions affecting more than 17 million people in England and contributing to millions of lost working days every year. Alongside mental health, they remain one of the biggest causes of health-related absences from work.

The question for modern MSK services doesn’t ask just how quickly someone can access treatment, it is whether they can access the right support at the right time, build confidence in managing their condition and continue participating in everyday life, including work. We are seeing a similar shift is underway in women’s health.

The Women’s Health Strategy places greater emphasis on prevention, self-management and supporting women throughout their lives. Just as importantly, it strengthens the connection between women’s health and economic participation.

Conditions such as pelvic health disorders, menopause symptoms and MSK problems do not stop impacting people when they enter the workplace. Their effects are felt through mobility, confidence, sleep, productivity and long-term employment.

Early intervention can improve both health outcomes and workforce participation. Viewed alongside the Government’s focus on reducing economic inactivity, the message is that helping people remain connected to work is increasingly becoming a health outcome. MSK and women’s health sit at the centre of this challenge.

The missing middle

Despite growing alignment between national strategies, a gap remains between policy ambition and people’s lived experience.

If someone develops back pain, or a woman begins experiencing pelvic health symptoms or challenges associated with menopause, they may visit their GP, be referred to physiotherapy, receive a Fit Note, engage with occupational health, or be signposted to a WorkWell programme. Each service may be doing the right thing, but the individual experiences one problem, not multiple pathways.

The missing middle is the support that sits between healthcare, self-management and employment services, helping people act early while ensuring they are connected to the right interventions when needed. Without it, people can spend weeks or months moving between disconnected services. Often receiving meaningful support only once their condition or work situation has deteriorated.

From digital self-management to digital infrastructure

This is where the role of digital technology is evolving. The future is unlikely to be shaped by standalone apps and isolated digital programmes. Instead, success will come from using technology to connect services, streamline pathways and create a more coordinated experience for individuals.

Digital self-management remains important, but the bigger opportunity is creating a digital front door that connects healthcare and work. People can access trusted support immediately rather than waiting passively for their next appointment. They can develop knowledge, confidence and self-management skills while understanding when further clinical intervention may be required.

At the same time, digital pathways can help connect people to local NHS services, occupational health provision, WorkWell programmes, Fit Note pathways and wider employment support. The result is a more joined-up experience that helps individuals navigate complex systems while reducing fragmentation across services.

Rethinking waiting

There is also an opportunity to rethink what happens while people wait for care. Waiting for physiotherapy should not mean waiting for support. The new MSK specification actively encourages self-management and evidence-based digital support, creating an opportunity to provide immediate intervention alongside traditional pathways.

People referred into an MSK service can begin managing their condition from day one. Progress can be monitored, outcomes measured and those requiring additional support identified earlier, shifting waiting lists from passive queues to actively managed populations.

When work-related measures are incorporated into that approach, systems gain an additional advantage. Individuals at risk of losing connection with employment can be identified earlier and connected to appropriate support before problems become entrenched. That benefits both health outcomes and local economic resilience.

Measuring what matters

The final piece is measurement. The new MSK specification encourages use of patient-reported outcomes, patient experience measures and employment-related indicators. At the same time, health and work programmes are calling for clearer evidence of impact, creating an opportunity to move beyond measuring activity alone.

Instead of asking:

• How many appointments were delivered?
• How many referrals were processed?

Systems can ask:

• Did the person improve?
• Did they feel more confident managing their condition?
• Did they require additional healthcare intervention?
• Were they able to stay in or return to work?

These outcomes matter more to individuals and the outcomes that increasingly matter to healthcare systems. Supporting the growing demand and workforce pressures.

One investment. Multiple priorities.

The strategy has now evolved for Integrated Care Systems. The next step is not proving that health influences work but focusing on designing systems that recognise the two are inseparable. It is important to show that the policy direction is increasingly aligned, the economic case is strengthening, and the technology already exists.

The bigger opportunity is investing in infrastructure that supports multiple priorities simultaneously. A connected digital platform can enable earlier intervention, support self-management, reduce avoidable demand, connect people with local services, capture meaningful outcomes and bridge the long-standing divide between health and work. Offering better health outcomes, a more sustainable NHS and a healthier working population.