Treating The Workforce Crisis: The Keep Britain Working Review Explained

Britain is facing a workforce crisis. The record numbers of those out of work due to ill health carry significant costs for individuals, businesses, and the wider economy. The government's Keep Britain Working Review proposes a more joined-up approach to managing health at work. But with major reforms still some way off, what practical steps can employers take now to build healthier, more resilient workplaces?

5th November saw the publication of the government commissioned report, the Keep Britain Working Review. This lays bare the enormous impact ill health absence is having on both individual businesses and the wider economy. We consider the three "interlocking changes" proposed to address this, which together aim to provide a more collaborative approach to both preventing and addressing ill health absence. However, it's clear that any systemic changes are years off. What lessons can employers take from findings in the more immediate term?

What's the history?

The statistics cited in the Review are stark: over 1 in 5 working age people are now out of work and not looking for work, and this is rising. This has a huge financial and emotional cost to the individual who is out of work; it costs the average business £120 per day in lost profit; and costs the economy the equivalent of 7% of GDP.

Managing ill health absences is a real challenge for employers. When signing someone off, GPs are not required to provide detailed information about why someone is not fit to work and they naturally advocate for their patient. Compounding this, access to reliable occupational health advice is patchy and it's often not clear to employers how best to support staff back into work. However, the likelihood of someone returning to work falls dramatically the longer they are off, so the pressure to support a return is real. The radical rethink proposed by this review might be just what the doctor ordered.

What was assessed?

The Keeping Britain Working Review followed a nine-month review process that engaged a range of employers and stakeholders. It also assessed international comparators, serving as interesting illustrations of what an alternative approach could look like.

This is of course not the first review of this nature. Dame Carol Black's 2008 review, "Working for a Healthier Tomorrow", also identified that early intervention in health issues can prevent long-term absence. However, the Fit for Work service created after this was short lived. More recently, the 2019 government consultation, 'Health is Everyone's Business', also considered reducing ill health related job losses and proposed reforms that aimed to ensure earlier workplace-centred interventions. And only two years ago, the (previous) government published the outcome of consultation into Occupational Health, aimed at improving uptake and quality of these services.

It's not yet clear whether these proposals will prove to be more enduring than previous initiatives. However, the current proposals aim to introduce an integrated operating model, designed to support its gradual implementation and provide the infrastructure to sustain it.

What's the diagnosis?

The Review identifies three core problems relating to health and disability within the workplace in Britain at the moment:

• A culture of fear: this is experienced by both employees and employers, particularly line managers. It inhibits early disclosure of problems, as well as constructive conversations and support. Contributing to this are complex laws relating to health, disability, and work, and also an adversarial tribunal system. In our experience, managing adjustments for neurodivergent employees can be a particular challenge, with uncertainty around when a condition amounts to a disability under the Equality Act and what sort of adjustments are reasonable. This can result in a damaging breakdown of communication and collaboration, and absence for mental health reasons.

• A lack of effective and consistent support system: the lack of an effective system to manage health and tackle barriers faced by disabled people is potentially compounded by the existing fit note system.

• Structural challenges: Compared to some other countries, the UK does not have robust mechanisms to support disabled people in work.

The proposed reform aims to fundamentally shift the management of health at work from one largely left to the individual and the NHS, to one where it becomes a shared responsibility between employers, employees and health services. What it will also shift, though, is the costs. Unlike previous state funded services, this would be funded by employers.

What's the treatment?

The initial trial – or Vanguard - phase will establish a 'life cycle' of best practices that aim to reduce absence and improve return to work rates. An improved support system and a data infrastructure would support employers and drive adoption of these practices.

In more detail, the Review recommends three "interlocking changes":

• Healthy Working Lifecycle

This would be a framework that sets expectations for how employers, employees and health services can collaborate to improve outcomes across 5 phases in the working lifecycle. Those outcomes are reducing sickness absence (both keeping people in work and reducing the length of absences); improving return to work rates; and increasing participation and representation of disabled people in work.

The Review identifies four themes that underpin successful delivery of those outcomes.

• Encouraging supportive relationships
• Clear signposting to support
• Clear policies and contractual arrangements, including the use of occupational sick pay.
• Making the workplace as inclusive as possible.

Interestingly, fit notes, that mainstay of managing sickness absence, are identified as a barrier to contact. They can serve to take the employer out of the loop rather than encouraging its participation in any supportive steps. Under the proposed system, plans facilitated by the Workplace Health Provision service (see below) would reduce reliance on fit notes and encourage better collaboration.

The ultimate aim is for this life cycle to become a certified standard, encouraging a "race to the top". Previous experience and the proposed timeframes inevitably raise questions about whether this system will be realised as intended.

• Workplace Health Provision

The second recommendation is the widespread adoption of the Workplace Health Provision service. This will be an external non-clinical case management service that would offer guidance and support for employers or managers. The service would also help create Stay-in-Work or Return-to-Work Plans and would provide quick access to support for common conditions. Although this service would not take on clinical responsibility, it should eventually be integrated into the NHS app and, over time, the services provided should come to reduce reliance on fit notes.

A key function of the WHP would be to support the agreement and implementation of reasonable adjustments. Interestingly, recognising that these conversations can be difficult, the WHP would have a function of facilitating mediation. This is just one example of the emphasis on alternative dispute resolution in the Review.

Unlike the state funded Fit for Work service, this would be employer funded, with the Review proposing pooled funding models to ensure affordability for smaller businesses.

• Workplace Health Intelligence Unit

The Intelligence Unit would provide data led support for adoption and also to justify incentives that will be offered to both employers and employees for adopting these good practices. In effect, it is intended to act as the backbone of the new system, underpinning the wider service by gathering, analysing, and sharing data to drive evidence-based decision making.

What's the recovery time?

Given the level of systemic change needed, the time scales proposed do not offer a quick fix. The phases proposed are:

1. Vanguard phase – years 1-3: a group of employers, who have already volunteered to participate, would test and refine the 3 outcomes underpinning the Healthy Working Lifecycle and the future certification standard.

2. Expansion of uptake – years 2-5: this phase will see the roll out of the certification standard, reform to the fit notes system, and the introduction of incentives.

3. General adoption – years 4-7: this stage envisages the normalisation of the healthy and inclusive working stands, widespread use of the WHP service, and integration with the NHS app.

Will the treatment be effective?

The proposed model certainly seems comprehensive, and could deliver significant benefits at societal, workplace, and individual levels. However, it's important to recognise that this is not the first attempt to address these challenges, and there are lessons to be learned from previous initiatives that proved unsustainable.

For example, the Fit for Work assessment service, which offered a helpline and website for advice on health and work, as well as support with the creation of Return-to-Work Plans, experienced low uptake. Research suggests that recommendations from this service were often not adopted because they were impractical or not sufficiently tailored to the specific circumstances.

This highlights the importance of context-specific support and recommendations. The effectiveness of the future WHP service will depend on its ability to engage meaningfully with the actual requirements of particular roles, the unique needs and capabilities of individual employees, and also what is affordable and achievable for that particular employer. If the WHP ends up offering very basic and generic advice which fails to grapple with the realities of the working environment, then it won't deliver any meaningful change.

The fact that the service is not going to be clinical is also a potential key drawback. Many cases will need input from clinicians - especially in more complex and difficult situations. The extent to which the WHP will operate as a go between – liaising with the employer and relevant clinicians – is unclear. As a minimum, the Review anticipates information sharing via the NHS app, but how much it will co-ordinate different parties is unclear and likely to be important in practice.

Lessons to learn now

While the full implementation of the Keep Britain Working Review's recommendations may be years away, there are several practical lessons that employers can take on board immediately:

• Prioritise early intervention: The evidence is clear that the longer an employee is absent, the less likely they are to return to work. Although there will be times when absent employees need to be given space and not contacted, employers should avoid assuming this as the default approach. Early, proactive engagement with absent staff, ensuring regular, supportive contact and exploring adjustments or phased returns should be explored where possible. Often, managers are reluctant to contact employees on sick leave, fearing that they will do or say the wrong thing and this can leave the employee feeling isolated. It is good practice for employers to set out a clear framework for how frequently they will engage with absent employees and upskill managers in having these conversations. Entitlement to sick pay should also be clearly explained, providing clarity for all parties and helping to avoid misunderstandings or suspicion.

• Foster a supportive culture: The Review highlights a culture of fear around health and disability at work. Employers can begin to address this by training line managers to have open, constructive conversations to encourage employees to feel comfortable sharing information about health or disability at an early stage. Too often, an employee takes sick leave because they do not have the necessary support in work - early conversations about adjustments can significantly improve an employee's performance where their health or disability is affecting their ability to do the job. Putting in place disability passports, which record reasonable adjustments and ensure continuity if an employee changes roles or managers, can be a useful way to open up these conversations and encourage a two-way dialogue about barriers faced by disabled employees. Disability passports are documents that your adviser at Lewis Silkin can certainly help with.

• Think about flexible working: As employers require more staff to return to the office, many are facing an influx of flexible working requests. It's important to remember that such a request may in fact amount to a request for reasonable adjustments, but also that a flexible working arrangement can be an effective means of reducing sickness absence. The figures quoted in the review mask generational differences in sickness absence which suggest that Gen Z has a lower short term absence rate. This could potentially be related to the greater value they place on flexible worker. However, higher rates of mental health absence among that sector of the workforce point to other factors employers need to consider, such as difficulties in switching off.

• Engage effectively: The aim of the WHP is partly to improve employers' access to advice. Now, the advice received back from occupational health can be frustrating but is often as good as the instructions behind it. Targeted questions and detailed background information can be an effective way to get more tailored advice. However, employers should also consider whether engaging with another professional who is already treating the employee, such as a counsellor, is a better option.

• Focus on inclusion: How inclusive is the workplace? Employers can audit their practices and physical environments, and seek feedback from staff, to identify and remove barriers to participation. Culture reviews can be an effective tool for gathering information from employees about themes affecting their health or wellbeing. Listening exercises and focus groups not only show that an employer is taking their employee wellbeing seriously but also provide employers with valuable data to enable to them to identify themes or patterns within the business that need addressing. Lewis Silkin's Worksphere team can support with these culture reviews.

• Embrace alternative dispute resolution: The Review's emphasis on mediation and early resolution of workplace issues is a reminder that conflict can often be managed more effectively outside of formal processes. Conflict at work has an unsurprising correlation with sickness absence and given research by the CIPD in 2024 indicated that 25% of workers had experienced conflict at work, this is likely to have a significant impact on absence. Managers are the key to ensuring early resolution and are on the front line when it comes to identifying issues as they arise. By training them to have sensitive conversations with employees at an early stage, it's possible to stop an issue developing into greater conflict, which in turn can help reduce sickness absence levels.

The new Intelligence Unit will be gathering evidence on ADR techniques and promoting what works, but it's already clear that this is likely to be a key future direction of travel. Lewis Silkin's Worksphere team offers an alternative route to resolving conflict, The Solutions Pathway, which helps businesses train their managers and HR teams in the skills needed to resolve conflict effectively and provides an offering of workplace mediators to encourage early resolution. Where conflict does arise, encouraging employees to have a facilitated conversation or informal mediation with the party they are at odds with not only opens the door for earlier resolution but also fosters a culture of openness where employees are less likely to allow issues to fester, ultimately impacting their mental and physical health.

• Don't forget about the Employment Rights Bill: The Employment Rights Bill will see the right to Statutory Sick Pay kick in from the first day of absence, rather than the fourth day as it stands. The removal of the lower earnings limit will also give around 1.3 million low-paid workers access to sick pay. While many employers already offer company sick pay from day one (on a contractual or discretionary basis), this change will significantly increase costs for those employers who do not do so. Employers should consider using this legal change to review their approach to sick pay more generally.

Taking these steps will help employers navigate future reforms but also strengthen workplace health and resilience in the meantime.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.