Former John Lewis boss Sir Charlie Mayfield’s report found that poor workplace health costs UK employers around £85 million a year.
He said both employers and employees had a duty to tackle the growing number of people taking time off owing to ill health.
Sir Charlie said a “supportive workplace” is important – but so is “personal responsibility.”
He said: “Life is full of setbacks – it is just life and happens to us all, and we have a responsibility to work through them.”
Sir Charlie said there is “broad recognition that Britain is facing a quiet but urgent crisis”.
Quite a moment. The Mayfield review has calculated the lifetime cost of writing people off as long-term sick; it’s £1m in lost earnings for 22yo “with the state incurring a similar cost”. pic.twitter.com/MFXW7XJHGc
— Fraser Nelson (@FraserNelson) November 5, 2025
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.
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.
Employees must give their employer a ‘fit note’ (sometimes called a ‘sick note’) if they have been ill for more than 7 days in a row and have taken sick leave. This includes non-working days, such as weekends and bank holidays.
Which conditions are accepted for time off work in the UK?
Employees can take time off work sick if they’re ill; this can be any type of condition confirmed by health professionals.
Fit notes and proof of sickness
According to the government , employees must give their employer a ‘fit note’ (sometimes called a ‘sick note’) if they have been ill for more than 7 days in a row and have taken sick leave. This includes non-working days, such as weekends and bank holidays.
The fit note will say the employee is either ‘not fit for work’ or ‘may be fit for work’.
If it says the employee ‘may be fit for work’, employers should discuss any changes that might help the employee return to work (for example, different hours or tasks). The employee must be treated as ‘not fit for work’ if there’s no agreement on these changes.
Employees can get a fit note from the following healthcare professionals:
- GP or hospital doctor
- registered nurse
- occupational therapist
- pharmacist
- physiotherapist
Does it depend on the length of sickness?
If employees are off work for 7 days or less, they do not need to give their employer a fit note or other proof of sickness from a healthcare professional.
Employees who are off work sick for more than 4 weeks may be considered long-term sick. A long-term sick employee is still entitled to annual leave.
If you’re treated unfairly or dismissed for taking time off work
According to the CAB, an employer shouldn’t treat you unfairly or dismiss you for taking time off work when you have a right to do so.
Your employer also shouldn’t discriminate against you. This means treating you unfairly for reasons connected to who you are.
As a last resort, employers can dismiss an employee who is long-term sick, but before they can do this, employers must:
- consider if an employee can return to work, such as by working flexibly or part-time, doing different or less stressful work (with training if necessary)
- consult with employees about when they could return to work ,and if their health will improve
An employee can take their case to an employment tribunal if they think they have been unfairly dismissed.
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Sir Charles continued: “Work can be demanding. Setbacks are part of life. Health and work are not always easy partners, but they are mutually reinforcing.”
He also 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”.
