How should the government (and employers) get people back into work?

The Keep Britain Working Review led by Sir Charlie Mayfield, addresses one of the UK’s most pressing labour market challenges: health-related economic inactivity. 

The final report makes depressing reading: over one in five working age adults are currently out of the work, with ill health being a major driver. Mental health issues among younger people are rising sharply, older workers are leaving employment prematurely, and disabled individuals remain excluded from work at twice the rate of non-disabled people. 

The scale of the problem

Ill health is now a leading cause of economic inactivity in Britain. For individuals, leaving work often results in a lifetime of reduced income, poorer health, and diminished opportunities. Employers face disruption, higher costs, and loss of experience due to sickness and staff turnover. Nationally, this translates into weaker economic growth, increased welfare spending, and mounting pressure on the NHS.

The financial impact is substantial. According to the report workplace health costs the UK approximately £212 billion annually. These figures include: 

• Employers paying £10 billion in statutory and occupational sick pay
• Employers losing £47 billion in lost output when employees cannot work
• £45 billion being paid out every year in health-related benefits, (and set to rise another £20 billion by 2030)
• £132 billion of lost output due to working-age ill-health; and
• £37 billion of lost output from unpaid carers looking after sick relatives and friends.

What needs to change? 

The review highlights three key issues that need to be tackled. 

1. Encourage parties to be open about ill-health

The report suggests there is a culture of fear around employees telling their employers about health conditions. They worry about stigma, discrimination and the damage it may cause their career prospects. Employers aren't always as open as they can be either because they are worried that raising a health issue might cause offence and result in grievances.

2. Lack of support

The sense of fear is heightened by the absence of strong support systems for both employees and their managers. The report reveals significant inconsistencies in the level of assistance provided with occupational health concentrated among large employers (86%) versus SMEs (30%), and fit notes, 93% stating “not fit for work”, often blocking phased returns. 

3. Structural exclusion

Barriers are built into the way systems, policies, and organisational practices operate, which result in disabled people being systematically disadvantaged or left out of employment opportunities. These barriers leave disabled people with an employment rate of just 53%. They are also more likely to be self-employed because of lack of other options.

Key recommendations

The review calls for system-wide change to improve outcomes for individuals, employers, and the state, while boosting economic participation. To deliver this, the review recommends three major changes:

Establish the Healthy Working Lifecycle 

This framework sets out best practice across five stages of employment: recruitment, healthy in work, unwell in work, absence and return, and exit or re-employment. The goal is to embed a certified standard that employers can adopt, ensuring consistent approaches to prevention, inclusion, and rehabilitation. The lifecycle aims to deliver reduced sickness absence, improved return to work and greater participation and representation of disabled people. To successfully deliver these outcomes, the review suggests four themes of best practice:

• Encouraging supportive relationships
• Clear signposting to support
• Clear policies and contractual arrangements
• Making the workplace as inclusive as possible

Develop better Workplace Health Provision (WHP) 

The review proposes building a multi-provider marketplace offering affordable, high-quality services to help employees stay in work or return after illness including: 

• Providing practical guidance and tailored support for employees and their managers, starting from the earliest signs of difficulty and continuing through recovery, return to work, or transition into a new role.
• Creating Stay-in-Work and Return-to-Work plans to enable employees to stay at work, or if absence is necessary, to return to work smoothly; and
• Providing quick access to help for common conditions, like early signs of mental health issues or musculoskeletal problems. 

The aim of WHP will be to reduce pressure on GP’s and health professionals. Fit notes will remain in use at least initially, but the idea is that they will become less important as Stay-in-Work and Return-to-Work plans become established. Clinical responsibility should continue to rest with GPs and local health services, which will remain the referral point for any required medical support 

Drive adoption with evidence and incentives

The review proposes creating a Workplace Health Intelligence Unit (WHIU) to collect, analyse, and share data to guide adoption. It will provide confidential benchmarking, conduct deep dives into what works across sectors, and drive innovation through the use of predictive analytics and AI. This evidence base will be used to support certified standards and guide targeted incentives to encourage employers and employees to adopt best practice.

Potential employer incentives include procurement advantages, tax relief, sick pay rebates, and National Insurance adjustments. For employees, incentives could include allowing protected time off for treatment and rehabilitation, linking the Stay-in-Work Plan to eligibility for Occupational Sick Pay and supporting flexible approaches to managing fluctuations in long term health conditions and disabilities

How quickly will this happen? 

The review believes that it will take up to seven years to implement the plan and suggests the following phased approach:   

• Phase one: the “Vanguard Phase” (Years 1 to 3) focuses on action and learning, engaging willing employers and providers to test solutions, build evidence, and tackle priority issues such as mental health, retaining older workers, and including disabled people.
• Phase two: “Expansion” (Years 2 to 5) increasing adoption, rolling out certified standards for the Healthy Working Lifecycle and Workplace Health Provision, alongside reforming fit notes and targeting incentives informed by WHIU data.
• Phase three: “General Adoption” (Years 4 to 7) to normalise healthy and inclusive working practices, integrate workplace health with NHS systems, and embed continuous improvement through legal, financial, and cultural levers. 

Next steps

The review wants the government to: launch a three-year Vanguard phase to develop employer-led solutions and a Healthy Working Standard by 2029; establish an independent Workplace Health Intelligence Unit to collect evidence and drive new ideas. Change the way incentives work so that government tools, welfare changes, and NHS partnerships encourage good practice and make workplace health support easy for all employers to access.

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