Keeping Britain Working

We have spent years treating ill health as something employers respond to after it becomes a problem. Keep Britain Working asks a much more interesting question: what if the workplace became part of the prevention system?

In January this year, Phil Canale invited me to a roundtable at the House of Lords to discuss the Keep Britain Working Review. Phil is Head of Workplace Wellbeing at MindForward Alliance and has spent a great deal of time bringing senior business leaders together around what better workplace mental health can look like in practice.[1]

It was one of those meetings that stays with you, partly because of the subject and partly because of the people around the table. Sir Charlie Mayfield, who led the Keep Britain Working Review, opened the discussion, with Lord Nigel Crisp and Dame Carol Black helping to host it. Phil subsequently publicly tagged a group of people who had been there including Poppy Jaman OBE, Alison Unsted, John Binns MBE, Susan Bright, Helen Oldfield, Kate Erman, Edward Thurman, Lisa Witney, Kate Laird, Farimah Darbyshire, Henrietta Frater and me.[1] Poppy founded MindForward Alliance, Alison is its Chief Executive, and John Binns has spent many years working at the intersection of business and mental health following his own senior career at Deloitte.[2]

It was an impressive room, but what I remember more than the names was the tone of the conversation. This wasn’t another discussion about whether employee wellbeing matters. I think we are largely past that point. The much harder question was what employers should actually be responsible for doing when somebody’s health begins to affect their ability to work.

That distinction has stayed with me.

The final Keep Britain Working Review had actually been published a couple of months before that meeting, in November 2025. The House of Lords conversation was looking ahead to the Vanguard phase and what implementation might require. Eight months later, I am genuinely pleased to see how much of that conversation is turning into something tangible rather than becoming another very good report sitting on a shelf.[3]

More than 250 employers, providers and other organisations have now been involved in workshops and development work. Thirty Vanguard organisations have taken part in employer-led sprints, another 70 have been involved in feedback groups, regional workshops have brought smaller businesses into the discussion, and the British Standards Institution is now involved in developing the proposed workplace-health standard.[4]

That matters because the problem the review is trying to address is enormous. But I think its implications for men are particularly important.

The numbers are difficult to ignore

Keep Britain Working describes a labour market in which 2.8 million working-age people are economically inactive because of health conditions, around 800,000 more than in 2019. It estimates the annual cost to employers of poor workplace health at around £85 billion through lost output, sickness and turnover, while the more recent implementation update puts the wider annual economic cost of health-related inactivity at an estimated £212 billion.[3][4]

One of the most worrying changes is among younger adults. Between 2019 and 2024, the number of 16-to-34-year-olds with a mental-health condition who were economically inactive because of long-term sickness increased by 190,000, a rise of 76%.[3]

Those are economic statistics, but we should be careful not to let the size of the numbers remove the people from the story. Leaving work because of ill health can mean lost income, lost confidence, lost routine, reduced connection and the loss of something that, for many people, has become part of their identity.

Research supports that relationship, although, as always, the reality is more complicated than saying that employment is automatically good for mental health. A 2025 systematic review and meta-analysis of longitudinal studies concluded that unemployment appears to increase the risk of mental-health problems and that re-employment may reduce that risk, although the authors rated the certainty of the evidence as low and called for stronger longitudinal research.[5]

At the same time, a large body of occupational-health research shows that poor-quality work can itself damage wellbeing. A systematic review and meta-analysis published in BMC Public Health found associations between features such as low decision latitude and job strain and later depressive symptoms.[6]

That gives us an important principle which I think needs to sit at the heart of this discussion. The ambition cannot simply be to keep people in work at any cost. It has to be to help people remain in good work that supports rather than damages their health.

Why I think this is particularly important for men

Keep Britain Working is not a men’s health report and it should not be presented as one. But put it alongside England’s first Men’s Health Strategy and suddenly there is a very interesting overlap.

The Government’s call for evidence for the Men’s Health Strategy received more than 6,500 responses. Among men sharing their own experiences, 54% said there had been an occasion during the previous three years when they had not sought medical help for a health concern. Reasons included waiting times, avoiding dealing with the issue and believing it did not require medical attention.[7]

The workplace findings are equally interesting. Among respondents whose health conditions or disabilities affected their working lives, 68% identified increased stress, 65% an impact on mental health and 65% an impact on productivity. Suggestions from respondents included better workplace cultures, manager training, safe spaces and normalising conversations around men’s health.[7]

None of that means all men behave in the same way or that men are uniquely reluctant to seek help. We should be very careful about turning useful gender evidence into lazy stereotypes. But it does suggest that if we want to improve men’s health, waiting for every man to independently recognise a problem, contact healthcare and ask for help is probably not a sufficient prevention strategy.

This becomes even more important when we look at the most serious mental-health outcomes. ONS figures for deaths registered in England and Wales in 2024 show a male suicide rate of 17.6 per 100,000 compared with 5.7 for women. Men aged 50 to 54 had the highest age-specific male rate, at 27.5 per 100,000.[8]

These are precisely the years when work, identity, financial responsibility, relationships, caring responsibilities, physical health and thoughts about ageing can collide. For many men, the workplace is one of the few environments they enter consistently, week after week, throughout that period of life.

That makes work potentially more than somewhere we earn a living. It makes it a possible gateway to prevention.

One of the most important findings is about fear

For me, one of the most insightful parts of Keep Britain Working is not one of the big economic numbers. It is the section describing what the review calls a “culture of fear”.

Employees told the review that they worried about disclosing health conditions because of stigma, discrimination or the possible impact on their careers. At the same time, managers admitted that they were sometimes frightened of doing the wrong thing, asking the wrong question, causing offence or creating an employment-law problem.[3]

So both sides retreat.

The employee says nothing because they do not know what will happen if they speak. The manager says nothing because they do not know what they are allowed to ask. Something which might have been manageable when it first appeared then becomes more difficult, absence begins, contact reduces and eventually a person can become almost completely disconnected from the organisation.

I recognise this from years of working in large organisations and from being a Mental Health First Aider. Most managers I have known are not uncaring. Quite the opposite. Often they desperately want to help, but compassion without confidence can still result in inaction.

Keep Britain Working cites examples of employees being off sick for months with almost no contact from their employer, not necessarily because anybody wanted that outcome but because everyone was worried about getting the conversation wrong.[3]

This matters for men because the threshold for beginning that conversation may already be high. If the employee is waiting for somebody to notice while the manager is waiting for the employee to disclose, early intervention becomes almost impossible.

Managers should not become therapists

This is where I think the conversation about workplace mental health sometimes gets confused. Asking managers to play a larger role in prevention does not mean turning them into amateur psychologists, doctors or counsellors.

A good manager does not need to diagnose depression. They need to notice that someone who was normally engaged has withdrawn, recognise that performance has suddenly changed, be able to have a sensible human conversation and know where appropriate support sits.

There is a huge difference between saying, “I have noticed you don’t seem yourself and I wanted to check how you are doing,” and trying to decide what clinical condition somebody may have. Organisations need to make that boundary clear because otherwise managers either overreach or, just as damagingly, do nothing.

The Keep Britain Working proposals recognise this. One of the central recommendations is the development of better Workplace Health Provision: largely non-clinical case management which can sit between the employee, manager, HR, occupational health and healthcare where necessary. The idea is to provide a pathway rather than expecting the line manager or the employee to navigate a fragmented collection of services alone.[3]

That feels very sensible to me. Many large companies already have an EAP, occupational health, private medical insurance, mental-health champions and various wellbeing programmes. The problem is often not that nothing exists; it is that somebody experiencing the beginnings of a problem has absolutely no idea which door they are supposed to open.

The EAP cannot be the entire strategy

I am a supporter of Employee Assistance Programmes. They can provide valuable confidential support and they have helped an enormous number of people.

But putting a telephone number on an intranet and waiting for someone to become sufficiently concerned about themselves to call it is not prevention. It is an important safety net, but it is still largely dependent on the individual recognising that they need to use it.

Keep Britain Working is suggesting something much more ambitious. Its Healthy Working Lifecycle starts while someone is healthy, moves through the point at which a condition begins affecting them at work, then through absence, rehabilitation and return.[3]

That changes the basic question from “What do we do when someone goes off sick?” to “What could we have done three months earlier that might have helped them remain well enough to stay?”

For men’s wellbeing, I think that could be transformational. Many of the things affecting men in midlife do not arrive as a dramatic crisis on a Monday morning. Sleep deteriorates, weight increases, blood pressure creeps upwards, alcohol consumption can change, relationships come under strain, caring responsibilities increase, purpose starts to shift and work that once provided status or excitement can begin to feel very different.

Mental and physical wellbeing are mixed together throughout all of that. An effective workplace-health strategy needs to recognise the whole person rather than waiting until one part of their life becomes serious enough to generate a fit note.

Stay in work, not simply return to work

One of my favourite ideas in the report is remarkably simple: Stay-in-Work Plans.

We are very familiar with return-to-work conversations because they happen after somebody has already been absent. Keep Britain Working asks why we do not apply the same discipline earlier, while the employee is still there.[3]

That could mean temporarily changing workload, providing flexibility around treatment, making a reasonable adjustment, dealing with a damaging team situation or simply agreeing what support somebody needs for the next few weeks. None of those things is particularly revolutionary, and good managers have been doing them informally for years.

What is different is making early intervention part of the system rather than something dependent on whether an employee happens to have an exceptional boss.

That is especially important because access to workplace-health support is very uneven. The review found that some form of occupational-health provision was available in 86% of large employers but only 30% of SMEs.[3]

If we genuinely believe prevention matters, it cannot become another benefit available primarily to people lucky enough to work for large, well-resourced corporations.

We need to measure whether any of this works

This links directly to another issue I keep coming back to in workplace wellbeing: measurement.

Keep Britain Working is unusually strong on this. Its proposed Workplace Health Intelligence Unit is intended to build a much better evidence base around sickness absence, return-to-work outcomes, inclusion and which interventions genuinely improve results.[3]

The implementation work has gone further. Employers are being encouraged to “measure and improve outcomes, not just inputs”, and the programme is exploring Work and Health checks at important points in the employee lifecycle so emerging risks can potentially be identified earlier.[4]

That phrase — outcomes, not inputs — should be written across a lot of corporate wellbeing strategies.

We are very good at measuring how many people attended the wellbeing day, how many managers completed the course and what score the speaker received afterwards. Those are useful operational measures, but they do not tell us whether more people stayed healthy, whether someone sought support earlier, whether managers made better adjustments, whether absence shortened or whether fewer people eventually left the organisation because of ill health.

If employers are going to take on a greater role in workforce health, the standard of evidence needs to rise with the level of responsibility.

Health data could help, but trust comes first

The development work is also exploring something I think could be enormously valuable and enormously dangerous if handled badly: better workforce-health data.

The current proposal envisages independent Work and Health checks with employers receiving aggregated organisational information rather than individually identifiable health data. The aim would be to understand trends and identify where support is needed while protecting the individual’s confidentiality.[4]

For men, I can see the attraction immediately. If we know that a particular workforce has poor engagement with preventative health, high cardiovascular risk, increasing mental-health absence or particular difficulties at certain career stages, organisations could target support much more intelligently.

But this only works if employees trust it.

The moment a man thinks that telling somebody about his mental health, blood pressure, alcohol consumption or personal circumstances could affect his promotion, redundancy risk or reputation, the quality of the data collapses and the whole system becomes counterproductive.

So privacy is not a technical detail. Trust is part of the intervention.

We also need to be careful about one assumption

There is a danger in a programme called Keep Britain Working that we accidentally start talking as though employment is always the solution and the individual simply needs to be kept attached to it.

The academic evidence requires more nuance.

Unemployment is associated with poorer mental-health outcomes and re-employment may improve them.[5] But poor psychosocial working conditions are also associated with depression, and research has repeatedly identified factors such as low control, excessive demands and job strain as risks.[6]

Sometimes the right intervention is helping somebody cope better. Sometimes it is treatment. Sometimes it is an adjustment. But occasionally the most important wellbeing intervention is changing the work.

That distinction matters enormously.

We should not teach somebody resilience so they can tolerate an impossible workload indefinitely. We should not use an EAP to compensate for bullying. We should not celebrate a successful return to work if the person returns to exactly the conditions that contributed to their absence.

Keeping Britain working has to mean making Britain’s work healthier too.

What I would want an organisation to ask

If I were helping an organisation respond to this agenda, I would start much earlier than sickness absence. I would want to understand what happens between somebody being completely well and them eventually disappearing from work for three months, because that space is where prevention lives.

I would want to know whether managers can recognise change and have a conversation without panicking about saying the wrong thing. I would want to know whether employees actually trust the support being offered and whether they understand where to go before their problem becomes severe.

I would look at whether men engage differently with the services already available and whether the organisation has ever asked those who do not use them why. I would want to understand the pressure points by age, career stage and occupation, because the needs of a 23-year-old man entering his first job may be very different from those of a 52-year-old managing a team, ageing parents, teenage children, financial pressure and changes in his own health.

I would also examine the work itself. What is happening with workload, autonomy, connection, management behaviour, flexibility, purpose and psychological safety? There is little point building an excellent pathway back into an unhealthy job.

Finally, I would measure outcomes. Not because every human experience can be reduced to a dashboard, but because if we genuinely want to know whether our interventions help people, we have to look beyond how busy our wellbeing calendar is.

Why I came away from the House of Lords optimistic

Looking back at that meeting in January, what encouraged me was that the conversation had already moved beyond awareness. Nobody around that table needed convincing that mental health or workforce health mattered. The discussion was about what employers could actually do differently.

That is why I am pleased with where Keep Britain Working appears to be heading. It has not finished — in many ways the difficult part is only beginning — but the transition from a review into Vanguard testing, standards, workplace-health provision and better data is important.[4]

For men, there is a particularly significant opportunity here. England now has a Men’s Health Strategy explicitly recognising workplaces as one of the settings in which health can be improved, while Keep Britain Working is simultaneously trying to move employers from reacting to ill health towards preventing it.[7][9]

Those two agendas should speak to each other.

We know many men do not engage with traditional healthcare as early as we would like. We know work occupies a huge part of adult life and can provide income, identity, purpose, relationships and routine. We also know that work can become a source of stress and ill health when it is badly designed or badly managed.

The opportunity, therefore, is not to turn employers into healthcare providers. It is to make the workplace one of the places where a problem is more likely to be noticed early, where a conversation feels safe, where appropriate support is easy to reach and where the work itself is designed to give people a reasonable chance of remaining healthy.

That would be a substantial change from where we have been.

For years, much of workplace wellbeing has started with the question, “What support can we offer people who are struggling?” Keep Britain Working encourages us to ask a better question: “What can we do while people are still well enough for struggling not to become leaving?”

For men’s health in particular, I think that shift from rescue to prevention could be one of the most important changes we make.

References

[1] Canale, P. (2026). LinkedIn post on the MindForward Alliance senior-sponsor conversation at the House of Lords in response to the Keep Britain Working Review. Phil’s post identifies Sir Charlie Mayfield, Lord Nigel Crisp and Dame Carol Black and publicly tags attendees including Ben Idle, Poppy Jaman OBE, Alison Unsted, John Binns MBE and Susan Bright. (LinkedIn⁠)

[2] MindForward Alliance. Organisational history and leadership information. Poppy Jaman is the organisation’s founder and Executive Vice Chair; Alison Unsted is Chief Executive; John Binns MBE is a trainer, coach and consultant and former Deloitte partner. (mindforwardalliance.com⁠)

[3] Mayfield, C. (2025/26). Keep Britain Working: Final Report. Department for Work and Pensions and Department for Business and Trade. The report sets out the scale of health-related economic inactivity, the Healthy Working Lifecycle, Workplace Health Provision, Stay-in-Work and Return-to-Work Plans, the Vanguard phase and the proposed Workplace Health Intelligence Unit. (GOV.UK⁠)

[4] Keep Britain Working (2026). The story so far — June 2026, updated 4 August 2026. The implementation update describes engagement with more than 250 organisations, Vanguard sprints, development of the BSI standard, the emphasis on shared responsibility and outcome measurement, and proposals for Work and Health checks with confidentiality safeguards. (GOV.UK⁠)

[5] Sterud, T. et al. (2025). Mental health effects of unemployment and re-employment: a systematic review and meta-analysis of longitudinal studies. Occupational and Environmental Medicine. The review concluded that unemployment appears to increase mental-health problems and re-employment may reduce them, while rating the certainty of the evidence as low. (PubMed⁠)

[6] Theorell, T., Hammarström, A., Aronsson, G. et al. (2015). A systematic review including meta-analysis of work environment and depressive symptoms. BMC Public Health, 15, 738. The review found prospective evidence linking aspects of adverse psychosocial working conditions with subsequent depressive symptoms. (PubMed⁠)

[7] Department of Health and Social Care (2025). Men’s Health Strategy for England: Call for Evidence — Summary Report. The report includes findings on delayed help-seeking, mental health, the impact of health conditions in the workplace and calls for healthier workplace cultures, manager training and normalisation of men’s health conversations. (GOV.UK⁠)

[8] Office for National Statistics (2025). Suicides in England and Wales: 1981 to 2024. The 2024 registration rate was 17.6 per 100,000 males and 5.7 per 100,000 females; males aged 50–54 had the highest male age-specific rate at 27.5 per 100,000. (Office for National Statistics⁠)

[9] Department of Health and Social Care (2025). Men’s health: a strategic vision for England. The strategy places prevention, access, stigma reduction and healthier settings — including workplaces — within the national approach to improving men’s health. (GOV.UK⁠)