Former John Lewis boss Sir Charlie Mayfield’s report found that poor workplace health costs UK employers around £85 million a year.
Sir Charlie said there is “broad recognition that Britain is facing a quiet but urgent crisis”.
The review found a culture of fear among workers around ill health, a lack of an effective or consistent support system for employers and employees in managing health, and structural challenges for disabled people.
Second day of being off on sick and I’m already so bored.
— Edgar Allan Ho (@ItsEdgarAllanHo) November 4, 2025
He has proposed a new approach where responsibility for health at work is shared between employers, employees and health services rather than being left to the worker and the NHS.
Sir Charles wrote: “Work can be demanding. Setbacks are part of life. Health and work are not always easy partners, but they are mutually reinforcing.”
Sir Charlie said that while supportive workplaces matter, “so does personal responsibility”, as he warned that disengaging from work and potential support “leads to detachment and dependency”.
He described fit notes – sometimes known as sick notes – as “often problematic”, becoming a “barrier to contact, further embedding distance between employer and employee”.
Sir Charlie said GPs are being asked to assess both the treatment needs of a patient and their capacity to work “despite most lacking occupational health training and time to get into sufficient detail”.
Previously published statistics show that more than one in five working-age people are now out of work and not looking for work – higher than many comparator countries – and that bringing the UK employment rate to 80% would add two million people to the workforce.
There are 800,000 more people out of work now than in 2019 due to health problems
The review states, “without decisive action to address this trend, projections show we are on track to add another 600,000 by 2030”.
It adds that the increase in 16 to 34-year-olds with a mental health condition who are economically inactive due to long-term sickness is “particularly concerning”, rising by 190,000 (76%) between 2019 and 2024.
Barriers to work for disabled people are “particularly stark”, the review said, with only 53% of this group in work.
The review said the economic cost at stake “is enormous”, citing the estimated £85 billion a year in lost output to employers, as well as the additional burden in welfare payments and NHS demand of around £47 billion each year.
It noted the “wider cost to the economy of lower participation, and the human and social costs of lost opportunity, stalled careers, and reduced life chances”.
Sir Charlie said: “Britain is sliding into an avoidable crisis. Ill health has become one of the biggest brakes on growth and opportunity. But this is not inevitable.”
Among its recommendations, the review called for the adoption of a workplace health provision, which it described as a non-clinical case management service supporting employees and line managers across a so-called healthy working lifecycle.
It said this approach, offering support and advice and early intervention, could be integrated with the NHS App and reduce or replace the need for the current fit note.
The Government said more than 60 employers – including the British Beer and Pub Association, Burger King, John Lewis and Google UK – have expressed interest in becoming so-called vanguard employers to pioneer the overall new approach.
This would involve a three-year phase focused on how to address mental health at work, retention of older people in work and improved participation and retention of disabled people in work.
Sir Charlie said: “Employers are uniquely placed to make a difference, preventing health issues where possible, supporting people when they arise, and helping them return to work.
“If we keep Britain working, everyone wins – people, employers, and the state.
“That’s why the action the Government is taking forward from my review is so important.
“I’m looking forward to working with them and with employers, large and small, to keep people in work, unlock potential and build a healthier, more prosperous Britain.”
Work and Pensions Secretary Pat McFadden said Sir Charlie’s message is “crystal clear: keeping people healthy and in work is the right thing to do and is essential for economic growth”.
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He added: “Business is our partner in building a productive workforce – because when businesses retain talent and reduce workplace ill health, everyone wins.
“That’s why we’re acting now to launch employer-led vanguards as part of the plan for change, driving economic growth and opportunity across the country.”
Business Secretary Peter Kyle said: “Many more people could remain in work if they receive the right support – and that’s exactly what today’s action is about.
“That’s why Keep Britain Working is bringing together the expertise of leading UK businesses to help prevent ill health at work wherever possible, and to support those affected (to) stay in work.”
The Society of Occupational Medicine also expressed support for the review’s recommendations, saying: “Helping people remain in good work is a win-win-win situation for employers, employees and for the nation.”
