On 5 November 2025, the Government published the final report of the independent Keep Britain Working review. The review proposes a phased rollout of major reforms to managing health and disability in UK workplaces.
The review comes in response to rising economic inactivity in the UK, with ill-health being identified as the main driving factor. Over 20% of working-age adults are out of the workforce, costing employers an estimated £85bn annually.
The review identifies three core challenges contributing to the decline in workforce participation.
- A culture of fear surrounding ill-health. While employees fear disclosure of health conditions, employers fear doing the wrong thing. This mutual apprehension fosters a reactive approach to managing health and disabilities in the workplace.
- Inadequate support structures. Existing systems are falling short, with the current fit note process cited as a particular weakness. Long delays in obtaining fit notes and limited communication during absence create barriers for both employees and employers.
- Disproportionate exclusion of disabled people. Disabled people are especially affected by the combined impact of fear and weak support, leading to higher rates of exclusion from the workforce.
What are the proposed changes?
The review recommends three major changes to tackle declining workforce participation.
A Healthy Working Lifecycle framework
The introduction of a ‘Healthy Working Lifecycle’ seeks to transform how employers support employee health and inclusion. The proposed model encourages collaboration between employers and employees across key stages of employment: recruitment, healthy working, managing illness in work, absence and return, and exit or re-deployment. The lifecycle aims to empower employers to act proactively with employees to reduce sickness absence, improve return to work and increase the participation of disabled people. Over time, the lifecycle is intended to evolve into a formal accreditation and standard.
Introduction of a Workplace Health Provision (WHP)
The WHP will be a non-clinical case management service designed to offer early intervention and tailored support plans to help employees stay in or return to work. The WHP is intended to reduce reliance on fit notes by offering more workplace-focused solutions, while still working in partnership with GPs and the NHS. The intention is that the WHP will be employer funded, with the Government anticipating monthly costs of £5- £15 per employee, with options to explore pooled funding. Over time, the WHP is expected to become a certified service, integrated with the NHS app.
Driving adoption through data, intelligence and incentives
To encourage adoption of the changes, the review explores financial incentives such as procurement advantages, tax relief and sick pay rebates. In addition, the review considers risk reduction incentives in the form of reducing tribunal exposure and integration with ADR. The review proposes to establish a Workplace Health Intelligence Unit (WHIU) to collect, analyse and share data on workplace health.
How will the changes be delivered?
The review acknowledges that these wide-ranging changes will take time to introduce and enforce, and it proposes a phased rollout approach.
- The Vanguard phase. The first one to three years will focus on engaging willing employers to pilot the Healthy Working Lifecycle, WHP and fit note reform. This phase will be supported by the proposed WHIU to generate evidence, refine standards and build momentum.
- The Expansion phase. In years two to five, the focus will be on scaling up adoption of the changes, shaped by evidence obtained in the Vanguard phase. Incentives will be introduced based on early evidence to encourage further adoption of the changes.
- The General Adoption phase. In the final four to seven years, the focus will shift to embedding the changes and practices across the UK workforce, supported by stronger incentives, integration with NHS systems and targeted interventions where uptake is low.
Next steps for employers
Over 60 major and many smaller employers have signed up to the launch of the initial Vanguard phase as ‘early adopters’, to develop and refine workplace health approaches over the next three years. Sir Charlie Mayfield, who led the Keep Britain Working review, will co-lead a ‘Vanguard Taskforce’ alongside government ministers to develop the interventions and build evidence for what works.
The proposals in the review represent a significant shift in the culture of workforce ill-health and the expectations on employers to do more to manage absence and disability. Expectations around prevention, early intervention and inclusion are likely to increase. The introduction of new frameworks, standards and data collection initiatives appears burdensome. However, the phased approach indicates that employers will have time to adapt to the changes.
Whilst ambitious in scale and scope for change, it remains to be seen whether this latest government initiative to deal with high levels of workplace absence and persistent ill health will make a significant impact on what is a growing problem for the UK economy.
Key Contacts
The content of this article is for general information only. It is not, and should not be taken as, legal advice. If you require any further information in relation to this article please contact the author in the first instance. Law covered as at November 2025.