Keep Britain Working Review: what you need to know

Overview

The Keeping Britain Working Review, led by Sir Charlie Mayfield, responds to the UK’s rising economic inactivity crisis, driven largely by ill health and disability. Over one-in-five working-age adults are out of the workforce, with ill health now the biggest driver of economic inactivity. This is increasing pressure on the NHS, as more people leave work due to health conditions, and the NHS is forced into a reactive role, treating illness rather than supporting prevention. The cost to the state of economic inactivity due to ill health is estimated at £212 billion per year, including NHS costs of £2 billion annually. 

The review highlights how the fit note system, as currently designed, is often a barrier to early intervention and return to work. 93 per cent of fit notes declare individuals ‘not fit for work,’ often without exploring phased returns or adjustments. Reform is needed to shift from sickness certification to holistic work and health support. 

Vanguards

The review proposes a long-term reform programme to reposition workplace health as a shared societal responsibility, arguing that a healthy working lifecycle and improved workplace health provision are central to the reform. Employers are seen as uniquely placed to act on prevention and early intervention, while the NHS should focus on diagnosis. 

The programme includes a three-phase approach over seven-to-ten years, starting with a Vanguard Phase to test and evidence new models. The Vanguards will develop employer-led healthy working standard and workplace health provision by 2029: a framework of evidence-based practices that improve retention of people with physical or mental health conditions and those who are neurodivergent; longer, healthier working lives for older workers; and stronger support for disabled people. The Vanguard Phase will also involve close collaboration with the NHS to test new approaches to fit note reform. 

Workplace Health Provision

The review proposes a Workplace Health Provision (WHP), a non-clinical, employer-funded case management and support for employees and line managers that aims to complement NHS provision. It aims to reduce reliance on fit notes by facilitating early conversations, supporting reasonable adjustments, and coordinating with GPs and neighbourhood health services. The WHP would coordinate with the NHS to ensure that ‘stay-in-work’ and ‘return-to-work’ plans are aligned with clinical care, reducing duplication and improving outcomes. 

Over time, WHP should integrate with the NHS App to provide a functional alternative to fit notes, freeing up GP capacity and improving outcomes for employees. It proposes that, as more responsibility shifts to employers and WHP, NHS resources could be reallocated to focus on acute care and complex cases, potentially improving efficiency and patient outcomes.

Delivery

The NHS will be involved in strategic leadership, alongside the Department for Work and Pensions and the Department for Business and Trade, to ensure that workplace health is embedded in broader health and economic strategies. The review proposes the integration of workplace health into neighbourhood health strategies, making sustained employment a core health outcome

The review also proposes establishing a Workplace Health Intelligence Unit (WHIU) to co-ordinate and support the vanguards. The WHIU would aggregate and analyse data, including NHS data, to develop outcome measures for the Healthy Working Standard guide continuous and guide improvement and inform policy, including at the next Spending Review.

Integrating WHP with NHS systems and ensuring data sharing will require significant coordination and investment. Both the NHS and employers will need to adapt to new roles and responsibilities in managing workplace health. It will take time to ensure that all workers, including those in small and medium enterprises (SMEs) and the self-employed, have access to WHP and NHS support.

Analysis  

The NHS Confederation warmly welcomes the  findings of the Keep Britain Working Review into how to stem the flow into economic inactivity. The £2 billion cost of economic inactivity to the NHS hampers efforts to recover NHS services and put the NHS on a sustainable footing – and the NHS has a role to play in addressing it. Health leaders recognise that employers have a vital role to play in shifting from treatment to prevention by creating healthier workplaces and supporting staff to stay well and in work. 

Fit note reform is crucial. The review rightly recognises that GPs and other healthcare professionals are asked to assess both treatment needs and work capacity, despite most lacking occupational health training and time to get into sufficient detail. We welcome the review’s proposal for employers to work with GPs and health services to explore improvements and replacements to the fit note system that recognises capacity and expertise constraints and to help develop Workplace Health Provision.

As the largest employer in the country, the NHS has a role to improve its own workplace health support and supporting staff to thrive in good-quality NHS jobs. With over 620,000 days of mental-health-related sickness in June, supporting the health of the NHS workforce is the right thing to do for hard-working staff and also crucial to NHS recovery and improving productivity.  There are some good examples of this approach already being demonstrated across the NHS that can be built on. 

We welcome the government’s quick response to move ahead now with Vanguard sites, which NHS organisations can apply to join. However, stretching operational and financial targets as well as ICB reorganisations risk taking away time and attention that NHS leaders need to help deliver the review’s proposals. Delivering reform is also dependent on wide and deep engagement of employers, as well as investment in their workplace health. 

Excellent work is already happening across the system. Our members are working closely with employers and other partners on prevention, keeping people well at work, and helping people return to, and remain in, work. Initiatives such as the Health and Growth Accelerators and WorkWell demonstrate the power of collaboration in reducing economic inactivity, which the NHS Work and Health Network is helping to share and scale up. By working together across sectors, we can reduce economic inactivity and improve population health. 

Key actions for NHS leaders

• Consider submitting an expression of interest to join the Vanguard Phase and help shape national workplace health reform by contacting kbw.vanguards@dwp.gov.uk.
• Review internal policies and practices around workplace health, especially in relation to disability, absence and return-to-work support.
• Promote open conversations and inclusive practices that support early intervention and retention of staff with health conditions.
• Join the NHS Work and Health Network to co-design the NHS’s role in reducing economic inactivity with national and local leaders.
• Utilise NHS Employers’ tools to support the health and wellbeing of your staff.

How we are supporting members

• The NHS Confederation runs the NHS Work and Health Network in partnership with NHS England, the Department for Work and Pensions, and the Department of Health and Social Care.
• The network provides a space where national and local leaders can co-design the NHS’s role in reducing economic inactivity.
• The sessions are open to anyone leading work and health initiatives locally, whether in the NHS or wider systems.
• Sir Charlie Mayfield will be speaking at our next session on 20 November. You can sign up on our website:
• NHS Employers providers a range to tools to help NHS organisations to support the health and wellbeing of their staff.