Keep Britain Working Review: latest update and work in progress

The Keep 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 due to ill health, placing huge pressure on the NHS, including costs of £2 billion annually. This impacts the country’s ability to grow, create good jobs and provide sustainable funding for the NHS. It also results in more people requiring, or being referred to, treatment in the NHS, where earlier intervention with their employer could have prevented their condition worsening.

The final report of the Keep Britain Working Review, published in November 2025, called for a shared responsibility for workplace health between employers, employees and the NHS.

Since that report, the review has continued to build and test its evidence base with employers, providers and others. The review has now published a major update, A National Growth Opportunity, which outlines proposals for a workplace health system made up of better, more inclusive workplaces, accessible workplace health provision and trusted intelligence.

Workplace health system

The crux of the review’s update is the workplace health system (WHS). This is pitched as a new way of bringing together government, employers and employees to build more inclusive workplaces, offer better workplace health provision and enable better intelligence across the system.

The update emphasises the unique role that employers have in preventing ill health by creating healthy and inclusive workplaces. It sets out a series of principles, including acting early to prevent issues and maintain supportive contact during sickness absences. The key to success, it argues, will be employers and employees sharing responsibility and engaging on a range of issues, including by participating in conversations about health and support, working together on plans and adjustments, and raising concerns about health or work early.

On workplace health provision, the update sets out the need for a trusted, impartial work and health adviser to coordinate appropriate support, including through stay-in-work or return-to-work plans, offering advice and guidance to employees and their managers, early support and treatment and using broader insights to improve the workplace support offer. This adviser does not have to belong to an external organisation, although there is potential for integration with WorkWell or within regions.

Lastly, the update highlights the significant gaps in workplace health intelligence, with employers often discovering a health problem only when an employee goes off sick. Organisations measure sickness absence in different ways, disability participation is poorly understood, and there is little insight on what interventions work. With better intelligence, employers could be on the front foot. For the NHS it means potentially identifying emerging mental health and MSK challenges rising across a team, a ward or hospital, or a particular trust having a lower disability participation rate than others.

Considerations for the government

Like the 2025 report, this update draws heavily on the experiences in the Netherlands and Denmark. While the health and employment systems are not directly comparable to the UK, the Netherlands achieved this best practice, in part, by creating strong employer financial responsibility for sickness absence in the form of sick pay. The NHS Alliance would encourage the review and the government to further consider whether reforms to statutory sick pay could better align employer incentives.

While not mentioned in the update, the development of a workplace health provision model presents an opportunity for the government to consider how best to integrate NHS and state-sponsored interventions, including WorkWell, Connect to Work, the Health and Growth Accelerators and the fit note pilots. Each demonstrates both the power of collaboration in reducing economic inactivity and the need for access to personalised, well-connected work and health support.

NHS workplace health in action

As the largest employer in the country, the NHS has a role to improve its own workplace health support to enable staff to thrive in good-quality NHS jobs

With sickness absence rates at 5.3 per cent, up to 6 per cent in some regions, supporting the health of the NHS workforce is the right thing to do for hard-working staff and is also crucial to NHS recovery and improving productivity.

Excellent work is already happening across the system. NHS Alliance 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. At a recent NHS Work and Health Forum event, three NHS organisations shared how they were investing in workplace health.

Northumbria Healthcare NHS Foundation Trust

The trust has embedded workforce wellbeing within its wider social value programme titled The Community Promise, recognising that many staff come from communities facing significant health inequalities. Using staff health needs assessments and workforce data, it takes a population-health approach to identify where support is most needed and design targeted interventions.

Its offer includes subsidised staff gyms, health MOTs, physical activity programmes, menopause services, maternity support, wellbeing ambassadors and financial wellbeing advice. Nearly 4,000 staff use the gyms, and staff report improvements in physical activity, mental wellbeing and their ability to remain in work. Sickness absence has fallen in the year to August 2026, illustrating how a combination of data-driven planning, accessible support and strong organisational commitment can improve workforce health outcomes.

NHS North East and North Cumbria Integrated Care Board

The ICB established a wellbeing hub to provide rapid mental health and wellbeing support to health and social care staff across the region. Staff can self-refer through a simple process, receive contact within a day, and access an appointment with a mental health professional within five days. The model is built around early intervention, with support often beginning immediately and designed to prevent problems escalating into longer-term absence.

The hub offers a broad range of services, including brief interventions, counselling, cognitive behavioural therapy, group programmes, neurodiversity support, menopause support and musculoskeletal services. Independent evaluation found that nine out of ten users felt the service helped them stay in work or return more quickly, while demand has grown substantially over time. A key lesson is that rapid, easy-to-access support can deliver significant benefits for both staff wellbeing and workforce retention.

Humber Teaching NHS Foundation Trust

The trust reframed sickness absence as a symptom of wider organisational issues rather than simply an attendance management problem. Analysis of high-absence teams highlighted links to workforce instability, vacancies, turnover, leadership pressures and team culture. In response, it launched Towards a Healthier Workforce, a programme focused on prevention, leadership capability, psychological safety and better manager conversations, alongside continued use of formal absence policies.

A key element of the initiative is a rapid-response intervention model that reviews teams with high absence rates using a range of workforce metrics, not just sickness data. Where wider issues are identified, targeted organisational development support, wellbeing services and leadership interventions are deployed. Early results show improvements not only in absence levels but also in staff engagement and turnover, while staff health MOTs have helped identify previously undiagnosed health conditions and encourage earlier support.

Further information and resources

For more detail on the examples in this article and ways you can incorporate their learning, contact conor.jackson@thenhsalliance.org

NHS Work and Health Forum

The NHS Work and Health Forum provides a space where national and local leaders can co-design the NHS’s role in reducing economic inactivity.

Run by the NHS Alliance in partnership with NHS England, the Department for Work and Pensions and the Department of Health and Social Care, the sessions are open to anyone leading work and health initiatives locally, whether in the NHS or wider systems.

To find out more, go to the NHS Work and Health Forum web page or contact conor.jackson@thenhsalliance.org

Health and wellbeing resources

NHS Employers provides a range of tools to help NHS organisations support the health and wellbeing of their staff.

Get involved

To take part in the vanguard phase of Keep Britain Working and help shape national workplace health reform, contact kbw.vanguards@dwp.gov.uk  for information on how to get involved.