- The review is shifting the national approach from signing people off to keeping them in work, underpinned by better data and shared responsibility.
- Around 2.8 million people are out of work due to long-term sickness – a pool of skill and experience employers can help retain.
- The practical tools are unglamorous but proven: early intervention, well-supported line managers, and structured stay-in-work and return-to-work plans.
- Smaller employers aren't exempt from where this is heading. Getting ahead of it now is far easier than catching up later.
A major independent review, commissioned by the government, has put hard numbers behind something most employers already sense: too many capable people are slipping out of work because of ill health, and too little is being done to keep them in. Sir Charlie Mayfield – the former John Lewis chairman who led the Keep Britain Working review – published its final report in November 2025, and the work is now being carried forward through a three-year phase working directly with employers. In an update in early July 2026, he set out the next stage, with a striking figure at its centre. Around 2.8 million people are currently out of work because of long-term sickness. His argument is that helping even a fraction of them stay in or return to work would be, in his words, "growth hiding in plain sight". For employers, the direction of travel is now unmistakable, and it points squarely at earlier, better-organised workplace health support.
What the review is asking of employers
The central idea is a shift in mindset. For years, the system has been built to respond after someone becomes ill or leaves work, rather than acting early to prevent it. Keep Britain Working wants to move that emphasis forward – towards prevention, earlier support, and a genuine sharing of responsibility between employers, employees, health services and government, rather than leaving it to the individual and the NHS to sort out alone.
Two themes run through the latest update. The first is shared responsibility: the review is clear that keeping people well and in work is not solely the worker's problem to manage, and that employers have an active role to play. The second is better data. A new Workplace Health Intelligence Unit is being created to collect standardised information on sickness absence, return-to-work outcomes and disability participation – making workplace health performance visible, and comparable, for the first time. Sickness absence has long been tracked inconsistently, and return-to-work outcomes have rarely been measured at all. That is set to change.
There is also work underway on a standard for employers who provide a certain level of workplace health support, pitched at a level intended to be affordable. In other words, the expectations placed on employers around health at work are being defined more clearly – and that will eventually shape what "good" looks like across the board.
"This is growth hiding in plain sight." – Sir Charlie Mayfield, Keep Britain Working review
From signing off to staying in work
Perhaps the sharpest theme is a rethink of the fit note. Ministers backing the review have argued that handing someone a fit note without any further support too often closes doors rather than opening them, and that what people usually need is a plan to stay in work or return safely – not simply a period signed off. The principle underneath it is one occupational health has long recognised: for most people, good work is good for health. Prolonged, unsupported absence rarely helps recovery, and often makes a return harder the longer it goes on.
For an HR team, the practical takeaway is that a fit note is the start of a conversation, not the end of one. When a GP indicates someone "may be fit for work", that is an invitation to discuss adjustments and a phased return – exactly the sort of structured support the review wants to see become standard practice.
What good looks like in practice
None of this requires a grand programme or a big budget. The measures that keep people in work are well-established and, frankly, unglamorous. What matters is doing them early and doing them consistently.
In practice: An employee begins taking scattered days off with a recurring musculoskeletal problem. Rather than waiting for it to tip into a long absence, the manager has an early, supportive conversation, a timely occupational health referral clarifies what the person can and can't do, and a few modest adjustments keep them working while they recover. The absence that never happened is the cheapest one of all.
The building blocks employers can put in place are straightforward:
- Spot and act on the early signs. A cluster of short absences or a struggling employee is a prompt to engage, not to wait and see.
- Equip line managers. They are the day-to-day face of support. They need the confidence to hold a kind, practical conversation about health – and to know where their role ends and a clinician's begins.
- Make timely occupational health referrals. Independent, work-focused advice on what someone can do, and what would help, turns uncertainty into a plan.
- Build structured return-to-work plans. Phased returns and reasonable adjustments, set out in writing with review points, are what make a return stick.
- Measure what's happening. Even simple tracking of absence and return-to-work outcomes tells you where to focus – and gets you ready for the kind of benchmarking the review is moving towards.
Where occupational health fits
This is precisely the territory occupational health exists to cover. Stay-in-work and return-to-work plans, early intervention before short-term sickness becomes long-term absence, objective advice on fitness and adjustments – these are the core of good OH practice, not an add-on to it.
There's a further point worth the attention of any employer thinking about how to gather health information responsibly. As the review pushes employers towards collecting more data on health and absence, the questions of confidentiality, consent and trust – especially around sensitive health data – become unavoidable. This is exactly the territory occupational health is built for. A good OH service gives an employer the practical advice it needs – what the person can do, what support would help, whether the Equality Act may apply – without handing over confidential clinical detail the employee would reasonably expect to remain private.
Key point: Employers don't need to become health experts, and they shouldn't try to hold clinical information they aren't equipped to manage. The role of occupational health is to sit between the two – giving employers the guidance to act, while keeping sensitive health data appropriately confidential.
Prevention matters here too. Health surveillance where the work demands it, sensible pre-employment assessment, and accessible support all help catch issues early – which is where the review keeps returning: acting sooner, not later.
Getting ahead of it
The organisations already working with the review are, for the most part, very large employers. But the expectations they are helping to shape will filter outward, and the underlying case is the same whatever your size: keeping an experienced person in work is almost always better – for them and for you – than replacing them.
If you want a sensible starting point, look at how quickly your organisation responds when someone's health starts to affect their work. Do managers know what to do, and who to call? Is there a clear route to occupational health advice? Is anyone keeping an eye on your absence patterns? Getting those basics right is the practical heart of everything the review is asking for – and it is well within reach of employers of any size.
If you'd like help putting earlier, better-organised health support in place – from management referrals and absence support to health surveillance and pre-employment assessment – Medwyn Occupational Health works with employers across the South East to do exactly that.
This article is general guidance for employers and is not individual medical or legal advice. If you are unsure how it applies to your organisation, contact our team.