A Government-commissioned review has recommended a major expansion of workplace health support to address rising economic inactivity linked to long-term sickness. Led by Sir Charlie Mayfield, the Keep Britain Working review estimates employers would need to spend about £6bn annually across the economy, with potential benefits to the exchequer of up to £18bn if recommendations are adopted at scale.
Rising inactivity and costs
The review highlights the increase in working-age adults who are neither in work nor seeking work, with long-term sickness a significant driver. Official data show around 9.08 million economically inactive people aged 16–64 in July–September 2025 (a 21% inactivity rate). The report frames this as a “quiet but urgent” crisis with large economic and fiscal implications.
The final report cites an estimated £212bn annual cost to the state from ill-health-related inactivity, covering lost output, higher welfare spending and additional pressure on the NHS. Employers, meanwhile, face substantial costs from absence and turnover, which the review argues could be reduced through earlier intervention and better workplace support.
What the review proposes
The review sets out a phased programme centred on three pillars: a “Healthy Working Lifecycle” standard for employers, improved Workplace Health Provision (WHP) to support employees to stay in or return to work, and a new Workplace Health Intelligence Unit to build the evidence base and guide incentives. A three-year “Vanguard” phase would test and refine these approaches with willing employers and regions before wider expansion.
Indicative costs for WHP are put at £5–£15 per employee per month, which the review suggests could fall over time with digital tools, pooled funding for small employers and economies of scale. This spending is presented as an investment with potential returns through lower absence, higher retention and productivity gains.
Possible incentives and system changes
To drive adoption, the report outlines options for Government incentives tied to evidence of impact. These include procurement levers, targeted tax measures and reforms to reduce disputes and litigation risk. The review also envisages reducing reliance on fit notes over time, integrating workplace health plans with NHS services, and using the NHS app to support information-sharing where appropriate.
Ministers have signalled that more than 60 employers, alongside regional mayors and smaller firms, are expected to participate in a vanguard programme over the next three years. The goal is to establish practical models that can be scaled nationally if they demonstrate impact and value for money.
What this could mean for employers and finance teams
For employers, the review points to a shift towards prevention, earlier conversations about adjustments and structured return-to-work planning. Finance teams may wish to model potential WHP costs against current absence, turnover and recruitment spend, and consider cashflow and tax implications if incentives are introduced. The review’s emphasis on data suggests future reporting and benchmarking requirements could emerge during the vanguard and expansion phases.
For policymakers and advisers, the report indicates the Government will use pilots to build an evidence base before deciding on broader adoption. Accountants advising SMEs may be asked to assess affordability, pooling options and ROI, particularly where margins are tight but absence costs are material. Engagement with sector bodies and local programmes during the vanguard phase may help firms access shared services and funding models.
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