Britain faces what Sir Charlie Mayfield has called a “quiet but urgent crisis” — one in five working-age adults now outside the labour force, many because of health conditions or disability. The government’s Keep Britain Working Review, published on 5 November, sets out a wide-ranging plan to reverse that trend and reshape how the UK supports people to stay in work.
The 120-page report, commissioned by the Departments for Work and Pensions and for Business and Trade, argues that ill-health is now the leading cause of economic inactivity. Since 2019, an additional 800,000 people have left work because of health problems, bringing the total cost of inactivity to an estimated £212 billion a year — roughly 7 per cent of GDP.
The Review calls for a new deal in which employers, employees, and government share responsibility for health at work. Its proposed reforms include:
- A Healthy Working Lifecycle — a certified national standard defining best practice in prevention, early intervention, rehabilitation, and inclusion.
- The creation of Workplace Health Provision — new, non-clinical support services to help employees and line managers manage sickness and return-to-work plans.
- A Workplace Health Intelligence Unit, operating as a “movement HQ,” to analyse outcomes, build the evidence base, and underpin future incentives.
The model would be tested through a three-year “vanguard phase” led by more than 60 major employers and local authorities, before wider rollout to 2029.
Mayfield’s report stresses that “there is no viable scenario where more public spending alone can solve this,” instead urging government to enable and incentivise employers and employees to act. The potential prize is up to £18 billion in annual economic benefits if participation and retention rise to OECD levels.
Sector reaction —
Sarah McIntosh, Chief Executive of Mental Health First Aid England, said the Review “sends a clear message: we can’t grow the economy if we don’t look after our people.” She welcomed its emphasis on prevention and confident leadership, describing it as completely aligned with MHFA England’s mission.
“For nearly two decades, we’ve been helping organisations move from fear to confidence, training over 800,000 Mental Health First Aiders and thousands of managers to spot the signs of poor mental health, start supportive conversations, and take action early. Every day, we see the difference this makes — from major employers like EY, Thames Water and the NHS, to small businesses and councils.”
McIntosh added that the organisation’s Set the Standard: Mandate the change campaign — calling for Mental Health First Aid training in every workplace — could play a key role in delivering the Review’s Healthy Working Standard. “For every £1 invested in workplace mental health, employers see an average return of £5 to £6,” she said.
Peter Cheese, Chief Executive of the CIPD, also endorsed the Review’s direction but warned that success would depend on “the extent to which these recommendations are understood by business in driving positive outcomes and backed by policy makers at a national and regional level.”
He added: “The report makes a compelling case for action by government and employers to address rising levels of sickness absence and ill-health. Its recommendations have the potential to support and incentivise many more employers to make the changes in people-management practices that can improve health at work.”
While broadly welcomed, some commentators have questioned the voluntary nature of the proposed standards and the feasibility of consistent uptake among smaller businesses. Occupational health bodies have also urged stronger focus on workplace hazards, not only on personal health management.
Still, with employers, unions, and providers already volunteering to act as vanguards, momentum is building. Sir Mayfield’s opening note in the Review closes with a simple proposition: keeping Britain working “is good for people, good for employers, and good for the country.”
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