Why ill health is keeping people out of work and what can be done to tackle it

Matthew Taylor

Hello and welcome to Health on the Line from the NHS Confederation, the organisation that represents members from across the health and care sector in England, Northern Ireland, and Wales.  

Today I'm joined by Sir Charlie Mayfield, former boss of John Lewis. Charlie has led a government-commissioned review, which is recently published, looking at how we can keep Britain working. 

Charlie popped in for a chat to discuss the policy levers and solutions we need to help people with long-term illnesses or disabilities stay in employment.  

But before we get into all that, let's discuss the state of integrated care systems at the Confed. We produce an annual report about the state of ICS is, and well, what a big year this has been to produce such a report. 

On the one hand, these are organisations that have been subject to a pretty catastrophic process of cuts and mergers. On the other, they're organisations absolutely critical to the delivery of the 10 Year Health Plan. So how on earth are leaders out there in those systems thinking about things?  

To discuss this, I'm joined by Sarah Walter, who's the director of our Integrated Care System Network, and also a deputy director of the NHS Confederation. 

Sarah, welcome to Health on the Line.  

Sarah Walter

Thanks very much for having me, Matthew.  

Matthew Taylor

Now, how on earth you summarise what must be an incredibly conflicted state of mind out there? I don't know, but what are your key takeaways from the survey findings?  

Sarah Walter

It is a mixed bag in terms of the survey finding, I'd say, Matthew. Definitely some areas of positivity, which we can focus on, but understandably, given the situation that ICSs and ICBs in particular have faced in 2025, so clearly some really significant areas of concern and risk. But also lots of optimism about the future, I think.  

So just as a bit of a kind of overview of some of the survey and some of the key findings, as you say, this is an annual survey and report that we produce at the NHS Confederation, which reaches out to ICB chairs and chief executives and also ICP chairs to get their kind of view on how ICSs are developing, their response to the kind of changing policy landscape, and then this year, clearly we've also tested views in response to the 10 Year Health Plan.  

And we've got responses from 34 of the 42 systems represented within this survey. So it's a reasonable kind of proportion of the overall ICS community.  

And I think it's fair to say people are confident overall about the opportunity for change. Four in five ICS leaders are confident that they can fulfil the four core purposes that have been set out previously for ICSs. Lots of optimisms. So over half are talking about the progress that they're making on the government's three shift and lots of positivity and enthusiasm, I think also for the 10 Year Health Plan, in particular the kind of intention to shift spend into the community, the importance of neighbourhood health. 

I think people can see the opportunity for change and improvement and are positive about some of the things that the government kind of set out through the 10 Year Health Plan.  

But it is clearly a very challenging environment to be delivering that. When we talk to ICS leaders about some of the barriers for change, we were not be surprised to see that the NHS restructures and in particular the significant cuts to ICB running cost and running in programme costs are a massive concern. 

So, 95 per cent of respondents were either very or fairly concerned about the impact of those cuts and clearly concerned about other areas of the system as well - social care, funding, resources within the NHSR, are areas that people highlight within the survey.  

Matthew Taylor

So I'd kind of summarise that Sarah, having read the report as a kind of give us the tools and we will do the job, seems to me to be the way I would kind of capture this as a kind of steely determination to get on with things. 

A recognition, actually, that ICBs as strategic commissioners are absolutely critical to the challenge of how it is we combine recovery and reform in the context of limited resources where, you know, difficult decisions have to be made.  

Now you and I are optimists at heart. Some people listening to what you've said will kind of go, well, hang on, you're putting a brave face on this, aren't these organisations just absolutely on their on their knees? How possible do you think it is, Sarah, for ICSs to get ICBs to get through the kind of morass they're involved at the moment in terms of restructuring, merger, and actually get onto the opportunities of the ten-year plan and building the capabilities that they need to do commissioning and get commissioning right. 

Sarah Walter

Well, I think those are the, some of the key asks that come out of the report. So there are some practical, almost kind of hygiene factors that need to be in place. You know, we know that the last few months have been ICSs and ICBs, in particular, have been impacted by the lack of clarity about the cost of redundancies involved in ICB restructures. 

Some of the communication and the kind of pace of communication from the centre at times hasn't been what we might have wanted. But there is a really clear commitment that comes through the report to the future rollers, strategic commissioners, and a real sense of possibility and opportunity that if commissioners and if ICBs are properly backed, then they can see a way through for delivering really quite kind of radical transformation to the way that the service is delivered in a way that kind of reflects what's set out within the 10 Year Health Plan.  

So, I think people see that it can be done and they really are seeking the backing and the opportunity and the support in terms of development of some of those strategic commissioning capabilities to make it so. 

Matthew Taylor

Yeah. I'm speaking later this afternoon to Penny Dash, chair, obviously of NHS England. I heard Penny say that, you know, ICBs strategic commissioning is absolutely central to making the hard choices that have to be made. And I think from that float, kind of two points for you, Sarah, which I'm interested to see how the survey reflects this. 

The first is that, you know, when it comes to commissioning, this is not our first rodeo. We have tried commissioning before. And we've trial for similar kinds of reasons that it would lead to more challenge to providers. It would lead to a focus on, you know, outcomes. And it hasn't really worked, and it hasn't worked for a variety of reasons, but probably amongst the most, is that the commissioners have not had sufficient kind of power, capability, confidence to do that tough stuff. 

Or that the things they've been asked to do don't really align with national policy priorities that are often a bit more kind of short term, a bit more activity focused. So I'm kind of interested in the degree to which you think ICBs understand the history of commissioning and their capability to do this differently. What do they need to do differently?  

And then the other question. One of the things that shifted between previous rounds of commissioning, and this one is the relationship with local government. Mayors will be on ICBs, they might even be chairing them. Our work with local government gives us the opportunity not just to join up around commissioning and health, public health, social determinants, but also potentially to rest on the legitimacy that local government has when it comes to making difficult choices about priorities. 

Sarah Walter

So, on your kind of first point, I think the importance of really backing commissioning and, and seeing what commissioning can deliver again, I think comes through really strongly. There was a report published by the Nuffield Trust back in September that was focused around lessons on moving care close to home, kind of international lessons, and that really describes also commissioning as a key enabler for achieving that strategic shift. And if you really do want to be rebalancing care, looking at where resources are going, reducing inequalities, ensuring value, then commissioning is a, can be, a hugely effective tool for doing that. But you really need to kind of back it and support that capability building as well.  

The relationship with local government has always been a core part of the Confed's ICS Network and our work with ICS leaders. Within this report we've kind of tested how people see that relationship developing in the context of strategic authorities and the role of mayors.You know, in the context of the 10 Year Health Plan, talking about integrated care partnerships no longer being a kind of statutory requirement. And I think, clearly there's a huge amount of change happening within local government.  

Also at the moment, and we do need to take care that the combination of NHS restructure and local government reform is one where we stay true to the population that we're here to serve. You know, the structures can sometimes get in the way of some of these things. And so really focusing, as I think ICS leaders are committed to doing, to the people that we are here to serve and the ways in which we can better integrate, get more bang for our collective buck across in different kind of public service providers and really kind of make a difference, I think, at a local level. 

Matthew Taylor

So, we know you run out of time, Sarah, but I want to end up by being first positive and second provocative. You know, that's me, that's my style.  

On the positive front, the report is full of, people may again be surprised by this, but examples of good stuff that people are doing, things that they think that they have made progress on. 

Just give us a feel for what it is that ICB leaders are proud of.  

Sarah Walter

There's some fantastic examples in the report. We can look at kind of examples in North Central London, in Manchester, where people are, in particular I think within that kind of neighbourhood health space, looking at developing those place-based arrangements, developing those kinds of neighbourhood arrangements in a way that much better reflects the full breadth of partners that can operate within a system context. They're not just looking at within the NHS, but within local government, connecting with voluntary sector partners. So there's a huge amount that can be done there.  

Matthew Taylor 

And the provocation, I guess I've got, not for you, but for those in in power who may be listening, is that one of the things ICBs have suffered from the very beginning has been an ambivalence at the centre. There are being people at the centre who don't really understand what ICBs are, or they just really don't like commissioners. They're just continuously kind of sceptical. And then of those are the kind of people who I suspect are applauding when ICBs aren't really given the support that they need to be able to do their jobs. So it becomes a self-fulfilling prophecy. These ICBs are no good. We're not going to give them the tools they need. We're not going to give them the autonomy they need. Oh, look, they're not succeeding. That proves our point. I mean, I have actually heard people in the centre be as facile as that. We just can't kind of go on like this. ICBs are absolutely critical to, to the ten-year plan.  

What's your kind of final message, Sarah, that comes out of this report and leans forward into where we need to go? 

Sarah Walter

And I think given the backing and I think some of those kinds of development support, and I know NHS England is currently working on a strategic commissioning development programme, which will be welcomed. But given that kind of backing and space, I think ICBI leaders have the ambition, have the kind of the sense of what's possible to really make substantial change to the way that services are delivered and are really behind the ambition set out in the 10 Year Health Plan.  

So I think if we do want to be radical and if we do want to achieve actually kind of something quite transformational in terms of how services are delivered, then I would argue that ICBs are in exactly the right place to be able to lead that. 

Matthew Taylor

Give them the tools and they will do the job. Sarah, thank you so much for joining us on Health on the Line.  

Sarah Walter

Thanks very much.  

Matthew Taylor

Now returning to the main topic of this episode, I heard from Charlie Mayfield all about his government review and how we can help people stay healthy, supported, and employed. 

Here's how our conversation went.  

Charlie, welcome to Health on the Line.  

Charlie Mayfield

Thanks, Matthew. Good morning and nice to be with you.  

Matthew Taylor

So, Charlie, I want to kind of go through the report, go through the story. I want to start with the problem. Now I'm interested in, you know, we all kind of know the kind of headlines here. There are a lot of people who are of working age who aren't in work. The biggest reason for that often cited is, is health and care. But I was reading a piece in the FT last week that said, actually overall, our activity rates aren't that dissimilar from other parts of Europe.  

So what really is the story here, Charlie? What is the problem?  

Charlie Mayfield

So I think the problem is that we, as a society, are seeing a rising incidence of ill health, and that is obviously playing out in the workplace. And we are undoubtedly seeing an increase in the number of people who are leaving the workplace for reasons of ill health and also occasionally for disability reasons. 

And that is driving a level of inactivity, which is basically bad for individuals, it's bad for employers and it's definitely bad for the country.  

The international comparisons are always a bit tricky and a bit complicated, not least because people measure these things in different ways. 

But our figures suggest that if we were to get to the same levels of activity, economic activity, that you see in in other countries, other sort of advanced economies, you could be looking at something in the region of a million to even as many as 2 million more people being in work. So, the scale of the gap is significant and obviously the potential, if we can fix that, is huge. 

Matthew Taylor

The important thing here is also the kind of trend, isn't it? There are, I think, 800,000 more people of working age are economically inactive for health reasons than there were before covid. If you carry that line on, even if it kind of dips a bit, but it continues in the same direction,that's what we should really be worried about, isn't it Charlie? 

Charlie Mayfield

Absolutely. So, I mean, the issue is, I think, as Lord Darcy said, we're getting older and we're getting sicker sooner, and therefore this is a societal issue that is playing out in the workplace. And, you know, at a very fundamental level, if we don't do a better job of supporting people to remain in work, and indeed of course what we should be trying to do is prevent them from getting sick in the first place, then that will spill over into a continuation of the trend that we've seen. And of course with it comes pressure on resources and the whole system can start breaking down. So you end up with a very serious problem.  

But what we're saying in the report is that none of that is inevitable. This is a serious but flexible problem. 

Matthew Taylor

So, let's look at the kind of key ideas in the report, which is a splendid piece of work. And I think the thing that that is going to strike our members in the Confederation, and I think please us, is that what you are wanting to start off by saying, is that when we think about this problem, we've made the mistake of seeing it as being primarily the responsibility of the individual who's suffering a health or care challenge and the NHS. And you want to say, if we continue to rely on the NHS and the individual, we won't get to the heart of this poem.  

Unpack that idea for me.  

Charlie Mayfield

Absolutely. And, and I think at the core of what we're recommending is a reset. It's essentially saying that we have got to have a partnership between employers, individuals, and health services in order to tackle the issues that we're facing. 

And really what lies behind that is that obviously human health is complex and so the issues that come up are many and varied. But in most cases, health issues develop gradually over time and they can reach a point where they become acute. And at that point, obviously people that are not able to work then have to have absence system work or enter into various stages of treatment. 

But there's a truth, which is that the more you can prevent people from getting into that position, the better. And when you think about prevention in the context of health and work, employers have a unique role, really, in terms of prevention.  

If you take something like mental health, which has been a huge driver of the rising incidents of ill health across the population as a whole, particularly amongst young people. In many cases, not all, but in many cases, you know what starts off as sort of fairly low-level anxiety or some fairly early-stage, even non-diagnosable, non-clinically diagnosable mental health conditions. 

Those conditions can be managed and actually if they're dealt with well, and they're people that feel supported in the context in which they're working, they can not only not develop, but they can actually significantly improve because these are very closely associated with issues such as sort of your personal self-esteem, the extent to which you feel valued, the extent to which you feel you belong. And all of those things are aspects that can be addressed and developed by employers in the workplace. And the difference that they can make, therefore, at that very early stages of prevention are huge.  

But it's also true for other ill health conditions. I mean, let's just imagine somebody who's perhaps in their fifties who has developed some kind of osteoarthritis or some kind of musculoskeletal problem. They will be obviously, understandably, concerned about their health issue and probably they'll be thinking first and foremost about the importance of getting that to improve. If they work in an employer who is essentially supportive of them going through that journey, then they're much more likely to stay and work. 

On the other hand, if they're not in a supportive environment or they don't have the opportunity to make some sensible adjustments and have some flexibility, they're much more likely to conclude that they're not really able to work anymore.  

I think as individuals, as human beings, you know, obviously the health issue is happening to us individually, but it's within the context of a workplace and it is almost always, not always, but almost always, better that we try to keep people healthy in work or keep them working while they're recovering and support them through that rather than having them leave work. 

Because as soon as you become detached from work and you become detached from that purpose and the sense of fulfilment that you could get from work, there is pretty clear evidence to show that many health conditions can then deteriorate from there and you get comorbidities building up. So, this whole issue about prevention and in keeping people engaged in work is very important both to them in terms of their development of their health conditions and hopefully the resolution of those, but also it's very much in the interest of employers.  

Matthew Taylor

And this takes us, Charlie, to some of the kind of other big concepts in the report in terms of the strategies that employers need to take in relation to how they best manage this issue because, you know, we've been talking primarily about the effect on the individual, but of course the effect on the employer of people taking time off work because they're sick, or people who they've invested in, who are experienced and skilled dropping out, that has a big impact on the employer as well.  

So share with us the, the kind of concepts you have around how employers need to think about the kind of strategies they need to adopt here. And also about how government needs to support and work with employers to develop a different kind of mindset here.  

Charlie Mayfield

The first thing I would say is that it's important before we talk about sort of where we need to go, I think it's important to talk a little bit about where we are today. 

And so in the course of the review, we found a number of things coming up consistently. And the first is that there's a huge amount of fear that surrounds this whole arena. So if you are somebody who has a health condition, quite often you will be fearful of disclosing that to your employer because you worry about being judged, you worry about potential discrimination. And I think it's a fairly natural and understandable thing to feel that way. But it’s important to point out that that fear is also felt by the employer. So a line manager dealing with a health condition, one amongst one of their team, he's very often fearful about actually talking to that person about it. 

I mean, I've spoken to so many people who have said, you know, they were off work for months and they never had a call from their line manager. On the whole, that is not, I think, because the line manager is an uncaring person, it's because they're afraid of stepping into something which they feel is a personal space for an individual.They don't want to cause offense. They certainly don't want to give rise to any kind of complaint, let alone a grievance or a tribunal.  

But the significance of this issue of fear is that it creates distance between people just at the point when you really need them to be talking to one another. And so, what we have is, the situation we have at the minute is one where when people get ill, more often than not, they don't talk to each other rather than do. 

And of course, that means that the opportunity for resolution, the opportunity for flexibility, the opportunity to make sensible adjustments is often lost and can become adversarial very early on in the process, which just exacerbates all those issues.  

The second big thing that we found is that the level of support that's available to individuals and to employers in the workplace, and particularly line managers, is highly, highly varied. 

You know, you have some employers that have really extremely good systems and support, and they achieve really very good outcomes with very high returns on investment and return to work rates, but you have others where there's very little.  

And then on top of that, we have a system, the fit note system, where, quite understandably, the lead primary care provider for an individual is their GP. 

And so when somebody gets ill, they will go to see their GP. And what is happening in that situation is the GP is being asked to do two things. They're being asked firstly to diagnose the health condition of the patient in front of them and to suggest what they need to do to improve that and get better. 

But the second point that we're being asked to do with the fit notes specifically is to assess the extent to which that individual can work while they are ill or while they're in recovery. And what GPs have told us consistently is that they can do the first, that's absolutely their role, but they can't do the second. 

And as a consequence, what you see is, you know, there's lots of stats around, but 93 per cent of fit notes say that people are not fit for work. And one of the effects of this is, the fit note can act as a bit of a firewall between the employer and the employee.  

So, if you have this issue of fear, which is already creating a degree of separation, the addition of a fit note that says you cannot work simply exacerbates that separation. And it makes it very difficult for there to be a dialogue between the different parties that are required to resolve this issue.  

So, we've ended up in the situation we're in, where we're not talking about health issues as early as we should do with the people who need to talk about them. When people then do, do something about them, we're often than not, it creates more separation rather than connection between the employer and the employee. And then we have a highly varied level of support that can then help people to find resolutions and get back into work and to recover well. 

So what we are essentially saying is that we've got to change that we need to rehumanise the workplace. We need to make it a bit less procedural, less about risk management and more about dealing with people. What we need to do for that is we need to have employers recognising that they've got this really very significant opportunity to play in the prevention space by creating the right environment, first of all, for people to feel safe, to share and to talk about issues, but also providing support that's readily available for both individuals and line managers in the moments when something happens people have someone to turn to who can help them to figure out what they can practically do about it.  

And you know, we perhaps haven't got time to go into all the detail, but we've spent quite a lot of time looking at what the nature of that could be. We've also found many examples of where that's already happening.  

So, in essence, what we're saying in the report is we need employers on the pitch. We need them playing across the full lifecycle of employment and being more engaged in health issues. We need to improve the level of support that's available that supports individuals and employers. And, critically, we need to also improve the level of data and the evidence base around what works, because the other key factor we found throughout the review is there isn't very good data. And of course the problem with that is issues become intractable without visibility and insight.  

Conversely, if we can change that, we think we can make them very addressable indeed.  

Matthew Taylor

And this, you are advocating this new approach to the kind of healthy workplace, to rehumanising work, as you put it, which is a phrase I love, by the way. You've done really great work, Charlie, in identifying a whole number of employers who want to take this forward. You call them the ‘’vanguards, a number of NHS organisations amongst those vanguards. 

So tell me a little bit about what you're hoping from what have they committed to? And I'm particularly interested in the kind of response you've had from the NHS, which of course is the single biggest employer in the country.  

Charlie Mayfield

One of the things that we shouldn't walk past is the simple fact that we've had so many employers stepping forward to say they want to be a part of. 

This is, in itself, I think a really significant and important point. I think what it, it signals pretty clearly is that employers recognise this is a problem, which needs to be addressed, and they want to play a part in figuring out how to do that. And so we've been enormously encouraged by the reception we've had. 

I could almost say to say that we've almost not had a single employer saying they're not interested in this. And I think some people say, oh, is this just employers being asked to do yet more because they've already got lots of burdens and they've seen taxes rising and all this kind of thing. 

But my response to that is actually employers are already feeling burdened by this. They're already seeing it. I've yet to meet an employer not worried about mental health amongst their workforce. And they're finding it difficult to deal with. So the opportunity to then work with us to figure out how do we come up with practical evidence-based solutions that help everybody to manage these things better is something that a lot of the people have jumped at, which is terrific. 

And as you said, we've had a great response from a lot of employees, including NHS trusts, and indeed the NHS organisation as a whole. So that's been terrific.  

What we're asking of those employers is essentially to say, look, what we want you to do in the first instance is embrace the fact that you have a big role to play in health, particularly around prevention and rehabilitation. 

We've sort of, I mean, it's pretty straightforward, but we've conjured this notion of this lifecycle that people, they get recruited, they get onboarded, they hopefully have a long period of rather healthy in work. They have sometimes when they get ill and they're in work, but they've got some kind of health condition. 

They may then have a period of time when they're absent from work because of a health condition. They hopefully return from that. And then at the end of that lifecycle, they may find themselves in a position where they can't return to the work they were doing. And then we need to find a more constructive, better alternative. 

And the point we're making to employers is, look, you play across the whole of that spectrum, and we want you to think and engage across that spectrum. That's the first thing we're asking them to do.  

Very importantly, what we've decided not to do is to take a very prescriptive approach where we sort of take each step of that lifecycle and then come up with 15 things that each employer should be doing in every area for the simple reason that that just becomes unworkable. And actually, for a lot of employers, they just look at it and think, well, this is just not, clearly not for me.  

So instead what we're advocating is that we want people to embrace the lifecycle and measure some key outcomes. And those outcomes are: absence rates, return to work rates, and participation by disabled people in work. 

And the reason we've chosen just three is because, again, we think simplicity is a virtue. And also because if an employer is measuring those things and trying to get better, they will very probably be doing some, if not all, of the right things in their context. And so it's better that we sort of focus on the concept and the outcomes, and we leave the practices a bit more to those employees in the first instance. 

The second thing we're then saying is, but within that lifecycle we think there are some changes that we want you to embrace. And the first of those is really the counter to the point I made previously about people being off work and becoming disengaged from work. It's not okay to be off work and not in touch with your workplace.You know, it's not generally helpful to anybody in terms of getting to the outcomes.  

So, what we're essentially saying is we want you to develop the notion of return-to-work plans. And what we mean by that is sometime between two weeks and six weeks in absence, there should be a meeting between the employer, the employee and a workplace health professional to come up with a plan which says, right, so you are off sick, you've got this issue. We're going to develop a plan for how you can return to work, which could include flexibility, could include phased returns, whatever it may be. So, we think that's an important addition in that landscape.  

And then the other point, which we feel is very key is we want employers to embrace the concept of a stay-in-work plan. Because the point I've been making all along about prevention is that the earlier you can get people to flag that they've got some issue, the earlier you can start to engage with it. And hopefully in many instances you can actually prevent people from needing to leave work at all. Just by having a dialogue around it. 

And so we think the idea of a stay-in-work plan is also a helpful concept that we want these vanguards to explore. And of course in order to get that to happen, you've got to think about some of the human aspects of the workplace. You've got to create an environment where people feel safe enough to say something earlier than they are today, perhaps. 

You've also got to have the mechanisms in place to support the line manager to be able to do something practical about that when it happens. And so we're advocating again for, you know, people to sort of disclose early, develop a stay-in-work plan, which includes adjustments and the like, supported by a workplace health professional, in order to get to that all as part of improving that landscape. 

But we've deliberately kept this fairly, sort of high level at this stage because the idea of the approach is that, we're very clear, we need to move to a position where we change fundamentally the way that health is handled in the workplace. But we can only get there by working with employers and therefore by taking this approach and working with the Vanguard employers, what we're going to be doing is, is doing deep dives with different employers to figure out what specific practices work best and generate the best results across this landscape so that we can then codify those. We can actually then reach a position in about two to three years' time where we can then define a standard for what workplace health should look like. That we can then encourage adoption for, and at this point, this is where the government then starts to play a key role around how they incentivise and assure the outcomes. And that's what we want to do with those vanguards.  

Matthew Taylor

I absolutely sign up to your model of change Charlie, which is, let's start with kind of voluntary action in order to start to build the kind of muscles of confidence amongst employers and government. Get the data and then think about, okay, how can we think a bit more concretely about the incentives that would be needed to bring those who may not be leaning into this to it? 

We're, kind of running out of time, but I've just got two or three final questions for you, Charlie.  

One, is there an intriguing reference in your report around health and work being part of the neighbourhood health offer that the NHS makes now? I absolutely agree with this. You know, it is very clear to me, to us in the Confederation, that part of the challenge for the health service is that people, we, medicalise problems which are actually primarily not medical problems and one of those ones is indeed around employment, about people dropping out of work, about people feeling they can't get work. 

And there are pockets of good practice. There's a place I visited recently where a Jobcentre Plus has somebody who does sessions at the local primary care centre so that the GP can refer, or other members of the primary care team, can refer that person to members of staff from Jobcentre Plus to talk about how it is they can get re-engaged in the labour market. 

So there's something here isn't there, about a more holistic offer for those people whose challenges span the health and employment experience?  

Charlie Mayfield

The first thing, and in terms of the experience, the reference to neighbourhood health is something that I really welcome within the NHS ten-year plan is the recognition within that work is generally positive for health. 

So, and I think this is an important sort of, it might seem like a fairly high-level shift, but it's an important one because one, there's a lot of evidence to suggest that is true. But secondly, I think it creates, I hope, a sort of direction within the NHS to look to encourage outcomes whereby continuing work is part of the therapeutic journey to getting better rather than it being separate, which is, I think the situation we face at the minute. 

But I think the other thing to say is that one of the things that we're very keen to do as part of the work we're doing with within the vanguards is work with some of the pilots that you've described, whereby you've got some GP surgeries with work coaches and other support services in there. The Work Well pilots for example, have got many different, I think, quite positive aspects. 

And what we want to do as part of the work we're going to be doing over the next few years is work with those pilots to figure out how do we actually leverage some of those resources and those capabilities that have been put in there so that it can help us to get to a better outcome. Because I think on the one hand, it's a good thing that we're saying that work is good for health, but what we also have to do is think about how do we support the health system to generate outcomes which reflect that, and we won't get there without putting in place some of the resource and some of the practices that we're advocating for in the report.  

Matthew Taylor

Now Charlie, you are in the process of promoting your report, I'm sure government's going to be very supportive of your work. So probably this isn't a time to be critical of government, but nevertheless, as someone who, you know, I will have a future role chairing a work-related agency, the Fair Work Agency. 

One of the things I've been saying to ministers is, how can we join up better across government in relation to work? Because you and I have looked at this from the kind of productivity angle when we were thinking about industrial strategy. You are looking at this now from the kind of angle of worklessness employability. I'll be looking at it from the kind of context of compliance and enforcement. It feels as though it's hard to join this up. We've worked really hard in the con and we've actually got somebody here, as you know, who's been on secondment from DWP working with us on work and health. And I remember when I first approached DWP and said, look, lot of our members would like to do work in this health and workspace. They were delighted because it's really actually not very easy in wire hall to lean out from your department into other departments.  

So, without being critical of government, it would be good, wouldn't it if there was a bit more kind of joining up around a kind of cross governmental or strategy in relation to work. 

Charlie Mayfield

I think that's basically true and my sense in the government from the conversations I have is there's a real recognition and openness to doing that. I also would just take back, go back to what you mentioned before about the way you drive change. I mean the reality is that the territory we're talking about, whether it's what you are talking about, about sort of the workplace and good work, et cetera, and what I've been focusing on here, which is about health in work. 

It is complicated, and it'd be nice if it was simple and you could come with some very simple solutions to it, but it isn't. And so the only way to actually drive change here is to create a process for change and a momentum and bring with you a lot of supporters and a lot of people engaging in that. And then work on it and you and gather data and gather evidence and create groupings of people who really do then get into the detail of how do you join up all these different aspects. 

And one thing I'm excited about in the next phase of the review is we've got the opportunity to do exactly that. And I think, you know, one of the things that I, I did when I first took on responsibility for leading this review is I read a lot of the previous reviews have been done in this area. And I'm pleased to say that actually if you look at some of the things that Carol Black has said, and Paul Farmer and Dennis Stevenson, there's a lot of read across between what they said they have said previously and what we're saying today. 

And what we've tried to do is sort of say, well, so quite a lot of the challenge is therefore not so much about what you have to do, it is about how you do it. And so a big part of what we're saying in our report is let's look at how do we create the momentum for change and how do we build the engagement and the participation opportunities in change such that we can actually make this happen? 

Because if we don't, we're going to lose a lot as a country. If we do frankly, everybody can win from this and it feels doable, but we need to be persistent and we need to be participative in terms of how we go about driving it. And I think there's an opportunity, frankly, to work closely with a lot of other areas. 

I think some of the areas around that you are going to be covering will have a read across into the territory that we're talking about.  

Matthew Taylor

Well, Charlie, that's great. You've kind of pre-empted my final question, which was the point about these reviews, as you and I both know, and in a way the fact that you've referred to other reviews that have said similar things makes this point is it's not about getting to the data publication and then feeling the job is done. The real work is the work that is done after publication, which is quite challenging often because some of the kind of infrastructure of support you've had in the process of producing the report isn't there. But it's actually about building a movement.  

And, I'm delighted that you are going to be joining the Confed's, work and health network in a few days' time. We had the first meeting of that network, Charlie, a couple of weeks ago, and there were 250 people there from trusts, from systems, from local government, from the third sector, real momentum. So I do hope that you'll work with us and with our work and health network because we build momentum behind the really important ideas in your report. 

Charlie, thank you so much for joining us on Health on the Line.  

Charlie Mayfield

Thank you, Matthew.  

Matthew Taylor

I am afraid that's all we've got time for in this edition of Health on the Line. We'll be back with our next episode in a couple of weeks, but in the meantime, please do follow us and leave us a rating or review wherever you get your podcasts. 

And if you have an exciting or innovative program of work that you want to tell us about, talk about on Health on the Line, well do please contact us. You can do that through HealthCommsPlus@nhsconfed.org. Thanks for listening and goodbye.