‘The Mayfield Review could lead to a healthier, happier workforce and lower welfare costs’

A key issue continues to plague Britain’s economic recovery – how do we support the millions of people who are out of work due to ill-health or disability back into meaningful employment? This year, the government commissioned a review to address this very question.

Concerningly, the number of people out of work due to long-term sickness has risen sharply since the pandemic – from around 2.1 million in 2020 to over 2.8 million today. 

Tackling inactivity

Economic inactivity has quietly become one of the biggest drags on UK growth. With a sickness and disability welfare bill set to exceed £100 billion per year by the end of the decade, this needs urgent action. That’s why the Society of Occupational Medicine warmly welcomes Charlie Mayfield’s detailed and thorough Keep Britain Working review. 

Digging behind the unemployment statistics reveals a complex mix of chronic illness, mental health strain, insecure work and a welfare system designed for a different era. Mayfield’s review aims to tackle this complexity head-on, proposing a reset of how employers, government and the health system must share responsibility for keeping people in – and connected to – work.

READ MORE: ‘A Labour blueprint for inclusive growth’

At the heart of the plan is a shift from the reactive to the preventative. Too often people are left to drift out of work, with few touchpoints with their employer during sick leave. This turn makes it far harder for those off sick to return to their jobs. Yet supporting people to remain in employment, for example through occupational health, can often be one of the best ways to support recovery – providing structure, purpose and support. 

Mayfield’s recommendations rightly focus on early intervention before someone is off sick or very shortly after. Where time off is needed, regular communication with employers and easy access to practical support really helps. Continuous engagement with work before the risk of more permanent detachment sets in is critical.

To make that happen, the review calls for dedicated non-clinical workplace health caseworkers. These would help people on long-term sick leave plan their return, and ideally help prevent people going off on sick, bridging the gap between employers, Jobcentres and healthcare providers. 

This is work that the Society of Occupational Medicine fully supports; we are in the process of developing standardised training, and supervision, for non-clinical workplace health practitioners. This is not about adding layers of cost and bureaucracy. Instead, this would integrate personalised support into the system for those who it will help, and in turn should improve business productivity and profitability. 

The review also urges reform of the ‘fit note’ system to shift focus away from what people can’t do to what they can do. Work and health expertise must sit at the heart of any fit note reform. This should ease the burden on GPs by providing independent work-focused clinical advice either within primary care or at workplaces, with access to occupational health services.

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The review also calls for employers to focus on the health promotion of their workforce. Business groups support these measures and employers’ responsibilities to focus on health at work. Earlier this month, Tesco, the UK’s largest private sector employer, announced it aims to join a group of trailblazing companies that would work closely with DWP to prevent people drifting into economic inactivity. 

A further issue is that Britain’s statutory sick pay system offers some of the weakest protections in Europe, covering only a fraction of lost income from illness. By contrast, the Dutch model, which requires employers to provide sick pay and occupational health input for up to two years, has achieved far higher return-to-work rates. This model is unlikely to be directly implemented in the UK, but the UK needs a system that rewards businesses for investing in occupational health and early intervention. This could replicate some of the best elements of the Dutch system – for example, through tax relief for smaller businesses to invest in occupational health. 

Supporting employers and workers

Supporting smaller businesses to make these changes is vital. Small and medium businesses employ the majority of the country’s workforce, but are the least likely to have access to occupational health services. Pooling, or regional models, which allow these employers to share resources and access professional advice, could be transformative.

Cultural change will be just as important as institutional reform. Employers need to feel empowered to keep in contact with staff on long-term sick leave, without fear of legal repercussions. Silence only breeds mistrust and isolation, potentially turning temporary absence into a permanent exit. ‘Keeping-in-touch days’, like those offered to women on maternity leave, are one example of how communication can be maintained positively and constructively.

Embedded within all of this must be access to high-quality work and health expertise for both employers and employees. By putting occupational health clinicians at the heart of the system, there is an opportunity to take strain off GPs, reduce NHS pressures and deliver reforms consistently across the United Kingdom.

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We know this will not happen overnight. But with the right focus from the government, the prize is immense: a healthier and more engaged workforce, lower welfare costs, and a stronger economy that values what people can do and their active participation. 

The Mayfield review is a reminder that work and health are not competing priorities; they are two sides of the same coin. If Britain wants growth that lasts, it must start by helping more people back into good, meaningful work – and keeping them there.

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