Maintaining momentum to Keep Britain Working

Blog posts

11 Nov 2025

Naomi Clayton, Chief Executive Officer

The Keep Britain Working Review presents a compelling vision and blueprint for a healthier, more inclusive workforce – one where employers, employees, and government work together to support people with long-term health conditions and disabilities to stay in or return to work. With sickness absence at its highest level in 15 years and 2.8 million people out of work due to long-term illness, the case for action is urgent and undeniable.

The review identifies three core challenges that must be addressed:

1. A culture of fear. Our research on young people’s mental health in the workplace has shown that nearly half (46%) of young people with a mental health condition do not disclose it to their employer due to discomfort or fear of stigma. This prevents access to support and perpetuates exclusion.
2. The lack of an effective or consistent support system. Responsibility for workplace health often defaults to GPs, who are not funded or trained for this role, or to occupational health professionals, whose advice may lack relevance to specific job demands.
3. Structural exclusion. The employment gap between people with and without health limitations in the UK is among the widest in Europe. This is not just a social issue – it’s an economic one, with millions of people sidelined from the workforce.

A new partnership between employers, employees and government

The review rightly calls for a new partnership – one where employers lead, employees remain engaged, and government enables and incentivises. Working with employers to develop the evidence and the business case for new standards and support is essential. Encouragingly, hundreds of employers have already volunteered to participate in the ‘Vanguard phase’, which will: test and refine new approaches; develop the Healthy Working Lifecycle as a certified standard; develop a multi-provider, certified system of affordable and effective workplace health support; and create a new Workplace Health Intelligence Unit (WHIU).

Building the evidence on what works

The Vanguard phase is designed to test, benchmark, and build a strong evidence base for ‘what works’. We have evaluated the impact of numerous interventions and unpicked the processes and practices that contribute to employee health and wellbeing. We know that job redesign, for example, can have a transformative impact on sickness absence. But many of the interventions we’ve explored lack robust evaluation (e.g. control groups, validated outcome measures), making it hard to assess impact. The Vanguard phase is a sensible step, giving the opportunity to build evidence on what works and to pilot Workplace Health Provision (WHP) and assess how the service operates in different workplace settings.

While there are clear differences, the Fit for Work (FFW) programme, a caseworker-led model launched under the last Labour government, offers valuable insights and raises important research questions for the proposed WHP; which appears more proactive and ambitious, encouraging early disclosure and involving ‘stay-in-work plans’, as opposed to support being triggered only after absence.

Other key distinctions include WHP being employer-funded rather than government-funded and FFW case managers being clinically trained, whereas WHP would be a largely non-clinical service.  Testing the role of clinical input during the Vanguard phase will be important to ensure that workers can access specialist advice when needed, and that employers feel confident in the guidance provided.

Evidence from Fit for Work showed that line managers made a real difference: when they understood the advice and were confident to put it into action, outcomes improved. The Vanguard phase should help identify the types of guidance and support that managers need to make WHP effective in practice.

The focus on young people within the review is also welcome – as is the new Alan Milburn review on young people and economic inactivity that has a particular focus on the impact of mental health conditions and disability. Our previous survey found that 30% of young people had either left a job or were planning to leave due to its impact on their mental health. Low-cost interventions, such as flexible working arrangements and peer support or buddy systems, can make a difference. But, given the lifelong scarring effects of young people being out of work for any significant period, it is vital that we improve understanding of the actions that employers can take to protect young people’s health and wellbeing.  

Taking a whole-system approach and embedding good work as a foundation for health

The review emphasises that delivery of the Healthy Working Standard and Workplace Health Provision must go hand-in-hand with employer incentives and adjacent reforms to the fit note, Access to Work, Disability Confident and dispute resolution. Improvements to employer support should also extend to the wider employment support system. Despite the central role of employer engagement in models like Individual Placement and Support (IPS), our evaluations (including Health-Led Trials) have found that employer engagement is often inconsistent and largely dependent on individual relationships, rather than being systematic or embedded. As a result, evidence of employers becoming more willing or confident to employ disabled people or people with long-term health conditions is limited.

A cross-government approach is needed to reduce work-related illness and absence. While we should build on the wealth of good practice and foster a ‘race to the top’, we must also raise the floor, ensuring that all work meets minimum standards that support health, productivity and retention. Poor quality work, including insecure contracts, excessive or irregular hours, high demands with low control, and weak workplace relationships, can be as damaging to health as unemployment. Groups who are already disadvantaged in the labour market, including people with chronic health conditions, are overrepresented in types of work that pose health risks. Work-related ill-health is also a significant problem in public service sectors, including health and education, where the government has greater leverage to be able to influence working conditions.

The government must act quickly to maintain momentum

Our recent analysis shows that by 2035 there could be a 5% increase in cases of work-related ill-health with 1.3 million more days lost each year, costing the economy an additional £1bn compared with 2025. The risks are growing – and so is the cost of inaction.

The review is right to recommend a phased approach and to focus on achieving lasting change, but the government must now act swiftly to implement the Vanguard phase, building on the momentum and support secured from employers. This phase must start with what we already know, build on existing evidence, and scale quickly. Wider adoption will depend on getting the incentives right and ensuring that expectations for employers are clear and support mechanisms effectively reach and engage them.

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Any views expressed are those of the author and not necessarily those of the Institute as a whole.