Why employers are now responsible for employee health: what the Keep Britain Working review means for HR

Executive summary

• More than 1 in 5 UK working-age adults are now economically inactive, with 2.8 million out of work due to long-term ill-health, 800,000 more than in 2019.
• Poor workplace health costs employers an estimated £85 billion a year, and sickness absence sits at a 15-year high.
• The Keep Britain Working review, led by Sir Charlie Mayfield and published in March 2026, sets out how to reverse this decline.
• Its central argument moves health from the individual and the NHS toward shared responsibility between employers, employees, and health services.
• For HR leaders, the direction is prevention, early support, and certification, which makes acting now the sensible position rather than waiting for mandates.

What is the Keep Britain Working review?

The government commissioned the Keep Britain Working review to answer a specific question. Why are so many people leaving the workforce because of ill health, and what can employers do about it? Sir Charlie Mayfield, former chairman of the John Lewis Partnership, led the work, and the final report landed in March 2026.

Three government departments backed the review jointly. The Department for Work and Pensions, the Department for Business and Trade, and the Department of Health and Social Care each hold a stake in the outcome, which tells you how the government sees the problem. Ill health at work sits across welfare policy, economic policy, and the NHS at once.

The review is a response to measurable decline, not an academic exercise. Over one in five working-age adults are now out of work and not looking for work, and 800,000 more people are out of work due to health problems than in 2019. Left unaddressed, projections point to a further 600,000 by 2030. Mayfield's central argument reframes who owns the problem. Health at work has been left largely to the individual and the NHS, and the review argues employers must now share that responsibility.

The scale of the problem: why economic inactivity demands employer attention

More than 1 in 5 working-age adults in the UK are now out of work and not looking for work, and health is the reason a growing share of them cannot return. Long-term sickness affects a record 2.8 million people, accounting for over 30% of the economically inactive population. That figure has climbed by 800,000 since 2019, and current projections add a further 600,000 by 2030 if nothing changes. These are not people cycling briefly between jobs. They are leaving the workforce and staying out.

For HR leaders, the macro numbers translate directly into cost you can measure. Employers lose an average of £120 per day in profit for every sickness absence, and absence itself sits at a 15-year high. Across the economy, ill-health costs employers an estimated £85 billion a year in lost output. A single 22-year-old who falls out of work for health reasons could be more than £1 million worse off across their lifetime, with the state carrying a comparable loss. Prevention is not a soft benefit when the alternative carries a bill of that size.

The international comparison is what should worry UK employers most. The Netherlands runs an inactivity rate of 14.5%, Sweden 15.9%, and Denmark 17.7%, all well below the UK. Health-related worklessness is not a shared feature of modern economies that every country simply absorbs. It is a specific outcome the UK has produced and that comparable countries have avoided. The Keep Britain Working review treats that gap as evidence the current approach has failed, and it puts employers at the centre of closing it.

The three problems the review identifies in UK workplaces

The Mayfield review traces most workplace health failures back to three structural problems. Each one describes a dynamic you have probably watched play out inside your own organisation, even if you never named it.

1. A culture of fear. Employees stay quiet about a health condition because they worry it will mark them as unreliable. Line managers avoid the conversation because they fear saying the wrong thing or triggering a legal risk. That mutual caution delays disclosure until a manageable issue has become a long-term absence. By the time anyone talks openly, the window for early, low-cost adjustment has usually closed.

2. No consistent support system. Employers and employees managing a health issue have no coherent path to follow, and the fit note makes the gap worse. Over 90% of fit notes certify someone as "not fit for work" rather than "may be fit for work" with adjustments, so the one document meant to guide return to work almost always signals absence instead. The review calls the fit note system "not working as intended" and wants alternatives tested with GPs. For an HR team, this means the formal process offers no practical steer on how to keep someone in work or bring them back safely.

3. Structural exclusion of disabled people. Disabled people are excluded from work at twice the rate of non-disabled people, and the UK lacks the systemic support levers that peer countries use. The barrier is rarely one employer's bad decision. Recruitment processes, physical environments, and rigid role design quietly filter disabled candidates out before any individual manager makes a call. The review argues employers are well placed to remove those barriers, but most currently lack the tools and evidence to do it consistently.

Each problem compounds the others, and none resolves through goodwill alone.

A shift in responsibility: what the review is actually asking of employers

The review's central argument reframes who owns workforce health. For years, keeping people healthy at work was left largely to the individual and the NHS. The Mayfield report rejects that split and argues for shared responsibility across employers, employees, and health services. Employers sit in a position no other party can occupy. You see people daily, you control the conditions of the job, and you decide whether someone returns to a role adjusted to their needs or leaves the workforce entirely.

That is why the report describes employers as uniquely placed to act on prevention, support rehabilitation, and remove barriers for disabled people. Prevention means catching health risk before it becomes absence. Rehabilitation means keeping the door open when someone is recovering. Inclusion means designing roles so a disability does not become an exit route.

The fit note data shows exactly where the current arrangement breaks down. More than 90% of fit notes certify people as "not fit for work" rather than "may be fit for work" with adjustments. A GP signs someone off, the employer receives a document that offers no route back, and both parties are left without a plan. The system meant to support a modified return instead confirms absence and does little else. The review calls the fit note "not working as intended" and wants alternatives tested with GPs and health services.

Shared responsibility does not remove the NHS or the individual from the picture. It adds you to it, formally, with expectations attached. In practice, that means building the internal capability to spot risk early, hold constructive conversations, and offer a genuine path back to work rather than waiting for a fit note to decide the outcome.

The Healthy Working Lifecycle and what the review proposes

The review does not stop at diagnosis. It proposes a three-year Vanguard Phase built around three deliverables, and hundreds of employers, mayoral authorities, and providers have already expressed interest. That level of early sign-up tells you this is moving from report to practice faster than most policy work does.

The first deliverable is the Healthy Working Lifecycle, a certified standard that defines the practices proven to reduce sickness absence, improve return-to-work rates, and include disabled people at work. Think of it as a benchmark you can measure your organisation against. The review intends it to become the basis for adoption across the UK, so the certification you earn during the vanguard is likely to become the standard everyone is held to later.

The second deliverable, Better Workplace Health Provision, tackles the support gap directly. It builds two things you can actually use: structured stay-in-work plans that catch problems before they force an absence, and return-to-work plans that bring people back on modified terms rather than leaving them signed off indefinitely. The review also proposes certified standards for a multi-provider marketplace, so you can buy this support with some confidence about quality.

The third deliverable, the Workplace Health Intelligence Unit, sits behind the other two. It aggregates evidence, guides the certification standards, and informs the incentives, financial, operational, and legal, that will nudge employers to act. It reports annually to the vanguards and to ministers, which means the data you contribute shapes the rules you will eventually work under.

For an HR Director, the practical reading is straightforward. A certified standard is coming, the support infrastructure to meet it is being built now, and the employers shaping it are the ones who joined early.

What this means for HR leaders right now

The review points toward certified standards and clearer employer accountability, so the sensible move is to audit your own position now rather than wait for the vanguard phase to set the terms. Four questions surface most of what matters.

Do you actually know where health risk is building? Many People teams can report last quarter's absence figures but cannot say which teams, roles, or age groups are heading toward long-term sickness. Aggregate absence data tells you what already happened. Early risk signals tell you what to prevent, and the review's proposed Intelligence Unit exists precisely because that data is usually missing.

Are your line managers equipped to have early conversations? The culture of fear the review describes lives in the gap between a manager noticing someone is struggling and knowing what to say. Managers who lack a script, a clear escalation route, or basic confidence tend to stay silent until a formal absence forces the issue.

Do you have a coherent return-to-work process, or a series of ad hoc decisions? A named owner, a documented plan, and modified duties agreed in advance are the difference between someone returning sustainably and someone cycling back out within weeks.

Are you treating workplace health as prevention or as reaction? The £120 lost per day of absence accrues after the fact. The Healthy Working Lifecycle rewards employers who reduce absence before it happens, so the organisations that build prevention into their operating model now will meet certification from a position of strength rather than scrambling to comply later.

Conclusion

The Keep Britain Working review reframes employee health as something employers help produce, not something the NHS repairs after the fact. With 2.8 million people out of work through ill-health and an £85 billion annual cost to employers, standing still carries its own price. The direction is clear, and the review rewards the organisations that see health risk early and act before it turns into absence or exit.

Platforms like Champion Health help organisations understand where workforce health risk is building across teams before it escalates. That prevention-first view matches what the review asks employers to do, giving HR leaders evidence to act on rather than absence figures to explain after the fact.