The Keep Britain Working Review is the final report of an independent Government‑commissioned review into how employers can help reverse the UK’s rising levels of health‑related economic inactivity. Led by Sir Charlie Mayfield, the review was launched in response to a clear and urgent trend: more working‑age people are leaving work due to ill health, and too few are able to return.

Over one-in-five working-age adults are out of the workforce, with ill health now the biggest driver of economic inactivity. Since 2019, about 800,000 more people have left work due to health and, without change, another 600,000 could follow by 2030. 

The review highlights the scale of the opportunity - increasing the UK employment rate to 80%, bringing it in line with leading OECD countries, would add two million people to the workforce, boost productivity, and reduce the wider economic cost.

At its core, the report argues that the current system isn’t working and identifies three key issues: 

  1. A culture of fear around discussing health at work
  2. Inconsistent and ineffective support systems 
  3. Persistent barriers for disabled people and those with long-term conditions

To fix this, the review calls for a fundamental shift - moving from a system that relies heavily on individuals and the NHS to one based on shared responsibility between employers, employees and government. 

Crucially, employers are positioned as central to preventing ill health, supporting early intervention, and enabling people to stay in or return to work.

The review’s centrepiece and the most practical tool offered to employers is the healthy working lifecycle.

The Healthy Working Lifecycle

The healthy working lifecycle is a simple, practical way to improve outcomes across the entire employee journey. It recognises that health risks don’t begin and end with absence; they accumulate, or can be prevented, across the lifecycle. 

Below is a practical breakdown of the five stages and what “good” looks like in each.

Stage 1 - Recruitment and onboarding

Aim: Set the right culture from day 1.

What “good” looks like:

  • Early, open conversations about a new starter’s health or disability needs 
  • Adjustments identified and put in place quickly 
  • A clear message that health is part of how work gets done

Early conversations build trust, reduce the risk of issues escalating later, and establish a supportive culture from the outset.

Stage 2 - Healthy in work

Aim: Reduce onset or escalation of work‑related or work‑limiting conditions.

What “good” looks like:

  • Proactive prevention, managing known risks such as stress, workload and fatigue 
  • Early intervention, not waiting for problems to worsen 
  • Line‑manager capability to hold early, supportive conversations 
  • Access to rapid clinical triage or occupational health advice before problems crystallise

The review stresses employers are uniquely placed to “do prevention” in ways the NHS cannot, by shaping jobs, workloads, processes and culture. 

Stage 3 - Unwell in work

Aim: Keep people connected to work during health episodes to speed recovery and avoid detachment.

What “good” looks like:

  • Personalised “stay‑in‑work” plans (adjusted duties/hours, equipment, phased treatments)
  • Clear responsibilities between employee, line manager, and any clinical/occupational health support
  • Fast access or rehabilitation interventions
  • Data‑light but outcome‑rich tracking - focused on recovery, function and whether adjustments are working, rather than gathering unnecessary ‘data for data’s sake’

This stage is key to preventing short‑term issues from becoming long‑term absence

Stage 4 - Absence and return to work

Aim: Maintain a supportive, structured link with the employee; reduce unnecessarily long absence durations.

What “good” looks like:

  • Safe, regular contact with agreed frequency and tone; avoidance of both neglect and over‑pressure
  • Evidence‑based fit note reform, aligning clinical advice with work‑focused plans rather than binary “unfit/fit”. (The report argues the current fit note system doesn’t work as intended, so testing alternatives is essential.)
  • A case management system to coordinate treatment, adjustments and expected return date.
  • Phased returns guided by condition‑specific pathways and reasonable adjustments implemented quickly and reviewed (hours, tasks, environment, tech) with skills refresh or re‑onboarding where time away was lengthy
  • Shared metrics (time‑to‑RTW; sustained RTW at 3/6 months; functional outcomes)

The lifecycle’s aim is to make these practices normal and consistent, not dependent on individual managers.

Stage 5 - Exit and re-employment

Aim: Minimisation of time out of work and encouragement of re-deployment.

What “good” looks like:

  • Robust identification of cases where employees are no longer able to perform their role, even after reasonable adjustments
  • A supported transition to an alternative role within the organisation or to re-employment elsewhere
  • Pathways to re‑employment externally, where appropriate
  • Using insight from exits to strengthen earlier lifecycle stages

The aim is to reduce the long‑term scarring effects of time out of work.

How Organisations Can Use the Lifecycle in Practice

Make UK’s own research shows a familiar and similar pattern - organisations often have policies, risk assessments and training but they aren’t consistently understood or experienced.

A lifecycle lens reveals gaps that task‑based or initiative‑based approaches miss.

Look at each lifecycle stage listed above and ask: 

  • What do we intend to happen?
  • What do employees actually experience?
  • Where are the gaps in visibility, consistency or ownership?

For example, a business may have strong right-to-work process but weak early intervention. 

Ultimately, the healthy working lifecycle gives employers a practical way to: act earlier, prevent more avoidable ill health, improve consistency, and retain more people in productive, meaningful work.

The Make UK State of Wellbeing report offers a broader picture of what’s happening across the sector, including the gaps between leadership intent and employee experience. Read the report here.

If you’d like support assessing your own lifecycle, or closing the gaps you’ve identified, get in touch – [email protected]. We’re here to help you build a clear, confident picture of where you stand.