The Mayfield Review: can better workplace health bridge the UK’s Employment Gap?

What is the Mayfield Review?

Commissioned by the UK Government in late 2024 and led by Sir Charlie Mayfield, former chairman of John Lewis, the Mayfield Review explores economic inactivity associated with ill-health and disability. The report estimates the annual cost of such economic inactivity at £212 billion, reflecting lost output, increased welfare payments and additional pressure on the NHS.

Since 2019, nearly 800,000 additional people have become economically inactive for health reasons, representing a 40% rise. Currently, one in five working-age adults report a condition that limits their ability to work. The review sets out recommendations for employers and the government to address these challenges.

Key developments from the review

1. Employers’ role in prevention

The final report, published in November 2025, identifies employers as central to prevention and early intervention. It suggests that strengthening workplace health provision could reduce reliance on reactive NHS treatment and better support ongoing wellbeing.

2. Fit note reform

The report highlights concerns with the current fit note system. Evidence shows that 93% of fit notes state individuals are “not fit for work,” often without considering phased returns or reasonable adjustments.

GPs, who lack occupational health training and time, may issue generic notes, thereby delaying a return to work. Employees often need multiple appointments to secure phased return notes, adding strain on the NHS and causing stress for individuals. Recommendations include introducing greater flexibility and promoting open discussion among employers, employees and healthcare professionals.

3. The Vanguard Initiative

More than 60 major employers, including British Airways, Google, Sainsbury’s, BUPA and Holland & Barrett, have committed to a three-year programme (2026-2029) to test and refine workplace health strategies. The initiative aims to develop a Healthy Working Standard and comprehensive Workplace Health Provision by 2029. Objectives include improving retention of employees with health conditions, supporting longer working lives for older workers and strengthening assistance for disabled individuals.

4. Wider adoption

Following the vanguard initiative, certified standards for workplace health and fit note reform are expected to be introduced nationally. Incentives such as tax relief, sick pay rebates and procurement advantages may encourage engagement. The review outlines a seven-year plan towards normalising inclusive working standards and integrating workplace health provision with NHS records.

5. Managing absence and facilitating return to work

The report recommends structured return-to-work planning, involving both the employee and manager. Phased returns, temporary adjustments and ongoing support can ease reintegration and reduce the risk of grievances.

What does this mean for employers?

• Early adopters: vanguard organisations will pilot approaches and share data to inform national standards.
• Incentives: certified organisations may benefit from financial and procurement advantages.
• Cultural change: employers are encouraged to reduce stigma and support rehabilitation plans.
• Data-driven practice: benchmarking and outcome sharing will help demonstrate the impact of workplace health initiatives.

The Mayfield Review signals a shift towards integrated workplace health standards. For employers, this is an opportunity to strengthen compliance, improve retention and reduce risk. By adopting proactive measures now – such as early intervention, flexible return-to-work planning and open communication – organisations can prepare for future requirements while creating a more resilient and inclusive workforce.