The Keep Britain Working review, published in November 2025, is the government’s plan for tackling ill-health-driven worklessness, and it puts employers at the centre of the answer. Nearly everything written about it so far has been aimed at big corporates.
A lot of our clients aren’t big corporates. So here’s the version for a 25-person business: nothing is mandatory for you yet, the direction is clear, and the sensible preparations are things worth doing anyway.
Why the government is acting
The numbers are stark. There are now 2.8 million people economically inactive due to health conditions, 800,000 more than in 2019, with another 600,000 projected by 2030 without action. Sickness absence is at a 15-year high, costing employers an estimated £85 billion a year. Replacing someone who leaves typically costs over £11,000.
For a small business those national figures get very concrete very fast. One person off long-term is 4% of a 25-person workforce. Their work lands on everyone else. And if they don’t come back, you’re into recruitment costs that would have paid for a lot of early support.
What the review proposes
The core idea is a shift: from health at work being left to the individual and the NHS, to shared responsibility between employers, employees and health services. The main pieces are:
A Healthy Working Lifecycle Standard: a defined set of employer practices shown to reduce sickness absence and improve return-to-work rates, currently being developed with employers.
Better workplace health provision: making quality occupational health support easier to access, especially for smaller employers who’ve historically gone without.
Signal actions expected of employers, including stay-in-work and return-to-work plans for people managing health conditions.
The government is testing all of this through a three-year Vanguard phase with volunteer organisations and regions before anything gets set nationally. So there’s no new legal duty on a 25-person business today, and realistically nothing mandatory for a while.
Why “wait and see” is still the wrong response
Two reasons.
First, the practices being formalised are just what good employers do already, and they pay for themselves whatever the government eventually requires. Staying in touch with someone who’s off sick, planning their return properly, making early adjustments instead of waiting for a crisis: these shorten absences now.
Second, when a standard does arrive, the employers who scramble will be the ones who never built the basics. And the basics aren’t expensive. None of them need an HR department.
The realistic starting list for a small business
Know your absence picture.
You can’t manage what you don’t record. Even a simple log of reasons and durations tells you whether you’ve got a short-term sniffles pattern or a long-term absence problem. They need different responses.
Get in touch early, and kindly.
The evidence is consistent: the longer someone’s off, the harder coming back gets. Early contact isn’t pressure. Done well, it’s what stops a four-week absence quietly turning into four months.
Write return-to-work plans down.
A phased return agreed verbally is a misunderstanding waiting to happen. A simple written plan (hours, duties, review dates) protects both sides, and it’s exactly the kind of thing the review expects to become standard.
Get occupational health advice at the right moment, not the last one.
The pattern we see most often is the referral that arrives six months into an absence, when the options have narrowed. A referral in week three or four gives everyone more room: clearer advice, more adjustment options, better odds of a lasting return.
None of this needs a wellbeing programme or a big budget. It needs someone whose job it is, doing it consistently.
Where this goes next
The Vanguard phase runs for three years, and the standard and provision models will firm up as it goes. We’ll keep covering what it means in practice as things emerge.
The honest summary for now: the review is betting that employers who act early on health keep more of their people. For a small business, keeping one experienced person you’d otherwise have lost is the whole business case.
If you’d like help setting up simple absence management, or advice on a current long-term absence, this is what we do, and we’ve been doing it since 1995. Call 023 8047 5000 or email support@occupationalhealthltd.co.uk.
