Sir Charlie Mayfield’s Keep Britain Working Review has published its final report, setting out a roadmap for overhauling the role of UK employers in supporting workers to remain in work when they fall ill.

The timing of the report is critical. The UK economy continues to be held back by near record levels of health-related economic inactivity, and the latest data from DWP suggests that we currently have a ‘one in, one out labour market’ – for every disabled person who enters employment, one already in work is leaving.

The reality is that while so much political attention has focussed on supporting those who have left work due to ill health to return, this is likely to be highly challenging to achieve – particularly for many older workers who have been out of the labour market for some time. To bear down on economic inactivity, action is also required to stem the flow of people leaving work due to ill health in the first place.

In this context it’s highly significant that the Review recognises that the nature of work itself is a key determinant of health. It argues that ensuring people can stay healthy in work, and that work itself supports good health, is a shared responsibility of Government, employers and employees.

But it is equally clear that there are unlikely to be many quick fixes on offer, and reforms will require long- term commitment and investment during the remainder of this Parliament and beyond.

Why the status quo isn’t working

The Review sets out that current levels of workforce sickness and attrition is costing UK employers £85 billion a year, while individuals themselves face significant loss of earnings and impacts to their well-being if they are unable to sustain employment.

When Sir Charlie Mayfield spoke at the Work Foundation and Lancaster University’s Work and Health Summit in June 2025, he identified a number of factors that underpin this picture that feature in the final report. These include:

• a culture of fear surrounding disclosure of and support for ill health in the workplace which risks individuals becoming disconnected from employment;
• a lack of an effective or consistent support system for employers and their employees in managing health and tackling barriers faced by disabled people; and,
• wider structural challenges for disabled people which create and reinforce barriers to starting and staying in work.

To address these issues, the Review proposes a ‘Vanguard’ phase of exploration and practice development, driven by more than 60 employers committed to driving improved workplace outcomes.

This phase will be underpinned by the development of a new Healthy Working Lifecycle framework, to be co-designed by Government, employers and healthcare providers. This framework will seek to define the practices that drive the best outcomes in reducing sickness absence, improving return to work rates and better participation and inclusion of disabled people in the labour market.

The ‘Vanguard’ phase will also see the introduction of more effective Workplace Health Provision focussed initially on new ‘stay in work’ and ‘return to work’ plans, and on providing faster access to workplace health support. The long-term aim is to establish a non-clinical case management service that supports employees and line managers, ensuring that small and medium sized employers who lack funds for occupational health provision can access some support.

Finally, the Review also recommends better monitoring of workforce health data across sectors via a new Workplace Health Intelligence Unit, with a mandate to identify problem areas early and prevent avoidable health related job loss.

Is this approach likely to be effective?

While the recommendations stop short of mandating employers to act, it is welcome that there is an early emphasis on co-production with employers, and on developing the ‘business case’ for increasing early intervention and prevention to support healthier working lives. Work Foundation longitudinal analysis has shown that one in ten employees who experience a decline in their health leave work, and that most of this attrition happens within one year of falling ill.

The Review’s recommendations for a personalised, case management approach for employees and line managers, the development of stay-in-work and return-to-work plans and targeted early support are also welcome, and if implemented effectively, could each help support more people who fall ill remain connected to work in the future. The Work Foundation has previously recommended establishing a UK-wide workforce health service, offering funded services and integrated with public health, to provide employers and their workforce, especially SMEs, with a base level of support. This would include targeted support for people who are at risk of leaving work and also continued support if they do.

Modernising workforce health data by improving forecasting and monitoring is important. This could involve establishing a cross-governmental approach to key indicators, integrating Health and Safety Executive (HSE) reporting with other, improved labour market datasets, and requiring large employers to report relevant health and disability related data; including attrition. The Fair Work Agency and HSE must be empowered and resourced to act on instances of malpractice.

The risks to realising the potential of the Keep Britain Working Review

However, while it’s positive that the Review has assembled a group of 60 employers to lead the next phase of work and encourage a ‘race to the top’ on employee health, it is vital that the Government also continues its efforts to drive up minimum employer standards. This should include through its Employment Rights Bill and as a major employer and procurer of services itself.

Evidence suggests that low-income workers and those in insecure employment are most likely to miss out on workplace policies that can protect their health. A recent Work Foundation survey noted that nearly half of low-income workers would not even feel comfortable talking to their employer about their physical or mental health.

Ultimately, the long-term success of the Keep Britain Working review will now depend on how the Government ensures the momentum behind this agenda is maintained. In particular, it’s important that Government provides clarity soon on how it intends to support employers facing wider commercial and financial pressures to participate in new schemes, either via the co-funding of initiatives or specific financial incentives and rebates.

And as the report rightly outlines, it will take several years to deliver the systemic change required. It’s therefore critical that Government does not make things more challenging in the meantime for those struggling with their health. Any moves to restrict access to health-related benefits at the forthcoming Budget would risk pushing more people into jobs that aren’t sustainable, leading to further churn that helps neither employers or individuals.

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