For the past year, the number of working-age adults who are economically inactive due to long-term ill health has remained around 2.8 million, approximately 700,000 more than before the start of the COVID-19 pandemic.

This trend is not only upending the lives and prospects of the individuals affected, but is also corroding an already weak economy by driving down productivity, reducing labour market participation and pushing up welfare spending.

The prognosis of Sir Charlie Mayfield, the Chair of the Government backed Keep Britain Working Review, is that we are sliding into an ill-health economic inactivity crisis. However, Mayfield argues the crisis is “fixable” if we transition to a new approach to worker health, that encompasses the entirety of a person’s health in work journey and shares responsibility between employers, employees, and the health services.

The review does not provide much immediate information on the specific interventions that will facilitate this transition, as it argues the required evidence base on health and employment is currently too weak. Instead, it has a proposed seven-year, three phase roadmap for tackling the crisis.

This process has already commenced with the Vanguard Phase (2026-29). A partnership between Government, Mayoral Authorities, and ‘Vanguard’ employers. It will test approaches and generate evidence on the effective delivery of workplace interventions to sustain healthier working lives. Its findings will then be used to create a set of best practices that will be codified in a new certified health standard, the Healthy Working Lifecycle.

The Work Foundation, together with Lancaster University’s Centre for Organisational Health & Well-being, has been undertaking research into the complex web of health and employment challenges facing the UK workforce. This article draws on newly released analysis of a nationally representative Survation survey of 1,138 working age adults with long-term health conditions, which formed part of a larger survey of 3,796 working age adults. Its aim is to provide strategic insights on where the Vanguard Phase should focus its efforts and to contribute to the evidence base it is collating on how best to support workers with long-term health conditions remain in employment.

Focus on what people with long-term health conditions say works

Given its relatively short time span and fiscal resources of the initial Vanguard phase, policymakers will have to think carefully about where they choose to focus attention and what types of health interventions they will look to prioritise. We would strongly urge they start by listening to what workers with long-term health conditions say is already working for them.

In our survey, we asked workers with long-term health conditions which interventions they had been provided with to help them manage their health conditions at work, and then to rate how helpful they had found the interventions (if they had received them).

Our results revealed that the interventions that were rated as being most helpful by their recipients related to their employment conditions: more control over their work (73%), paid sick leave (71%), and flexibility over location (69%), working hours (68%), and job role (68%).

Figure 1: Perceived effectiveness of workplace interventions among workers with long-term health conditions that had received them.

Source: Work Foundation analysis of nationally representative survey 1,138 working age adults with long-term health conditions (May 2025).

Further analysis revealed that participants who had been provided with more control over their work, paid sick leave or flexibility over their job location or description, were more likely to report that overall, their employer’s actions had supported them to stay in work, compared with participants with long-term health conditions who had not received these types of support.

Figure 2: Workers with long-term health conditions’ perception that overall, their employers’ actions had supported them to stay in work, by access to workplace health intervention.

Source: Work Foundation analysis of nationally representative survey 1,138 working age adults with long-term health conditions (May 2025).

We found similarly positive results for workers who had been provided with flexibility over their working hours. With 68% reporting that overall, their employers’ actions had helped them to stay in work. Unfortunately, due to an insufficient sample size, we are unable to provide a direct comparison.

The Keep Britain Working Review does acknowledge the important role of flexible working can play in supporting the recovery of people who have fallen out of work, through phased return to work measures. However, the Final Report does not explore the critical role that flexible working can play as a preventative intervention to support workers to manage health conditions in work.

Similarly, the Review does not fully explore the important role of Statutory Sick Pay (SSP). Noting that the SSP rate in the UK is much lower than in many advanced economies and states it is sympathetic to raising the levels, but that simply increasing it is unlikely to drive the level of change needed. And there is not a single mention of worker autonomy in the Final Report.

Our findings demonstrate the clear need for the Vanguard Phase to meaningfully engage with nature of workers employment. Through evaluating interventions that empower workers in ill-heath to adapt the circumstances of their working lives to better accommodate their health conditions, such as flexible work, greater autonomy, and enhanced sick pay.

The Vanguard Phase must target workers who are most likely to miss out

Addressing the workforce health crisis not only rests on establishing what types of support are most effective. There is also a need to understand which worker cohorts in the labour market are currently not being provided with the right support, to discern where attention is most needed, and the nature and extent of the interventions required to shift employer practice.

Our analysis revealed that workers with long-term health conditions situated in more precarious parts of the labour market were more likely to miss out on support. This cohort was comprised of two subgroups: those who worked in non-professional roles* and low-income earners (earning less than £25,000 per year).

We found these cohorts were less likely to report that overall, their employers’ actions had supported them to stay in work, with around a half of low income workers (47%) saying their employer had supported them compared to 68% of mid-high income earners. We also found that this cohort that was less likely to have received the most effective forms of support as identified in our research.

Figure 3: Workers with long-term health conditions’ perception that overall, their employers’ actions had supported them to stay in work, by income and professional status of employment.

Source: Work Foundation analysis of nationally representative survey 1,138 working age adults with long-term health conditions (May 2025).

Figure 4: Access to support amongst workers with long-term health conditions, by income and professional status

Source: Work Foundation analysis of nationally representative survey 1,138 working age adults with long-term health conditions (May 2025).

Over the next three years, the Vanguard Phase aims to build the evidence base required for the development of the Healthy Working Lifecycle. Sir Charlie Mayfield will lead this phase in collaboration with Government and selected employers who have signed up as ‘Vanguards’, before the rollout to wider adoption in later years.

It is encouraging that more than 60 employers have signed up to this process. However, many are large organisations already recognised for offering relatively good quality work such as Axa Health, PwC UK and Marks & Spencer. If the Vanguard Phase is to make a meaningful difference, it must prioritise robust evaluation and focus its limited resources on workers least likely to experience healthy jobs.

That means testing interventions in sectors and frontline settings where poor health and insecure work are more common, and engaging employers with fewer resources. It also means targeting groups of workers in low wage, non-professional roles within existing Vanguard organisations, such as those working the fryers of Burger King, the warehouses of Currys or the factory floors of Ford.

What do these findings mean for the Vanguard Phase?

Our findings offer two key lessons that could help turn Keep Britain Working’s vision of workplace health into a reality.

Firstly, it must explore how interventions such as greater flexibility, enhance autonomy, and paid sick leave can be effectively utilised to enable workers in ill-health to re-shape the nature of their employment to better accommodate their health conditions.

And secondly, it will also need to ensure that its moves beyond an information-sharing exercise among committed employers and instead builds evidence about what works where challenges are greatest. Without this, the evidence base risks reflecting what is possible in jobs that are already of a higher quality, instead of what is needed where the problem is most acute.

The next Work and Health Forum - run by the Centre for Organisational Health & Well-being & the Work Foundation at Lancaster University – is on Wednesday 25 March 2026 from 11.00-12.30. For more information and to sign-up, please see: Work and Health Forum: Early employer interventions to Keep Britain Working.

Notes:

* Professional roles were defined as: ‘professional occupations’, ‘associate professional occupations’, ‘administrative and secretarial occupations’, and ‘corporate managers and directors’. Non-professional roles were defined as: ‘skilled trades and occupations’, ‘caring and personal service occupations’, ‘sales occupations’, and ‘process, plant and machine operatives’.

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