Employee health & benefits Health & benefits

Keep Britain Working: What Works in Practice

This article is based on a roundtable discussion between Marsh and the Department for Work and Pensions (DWP).

The scale of the challenge

In 2025, the Labour Force Survey estimated 148.8 million working days were lost because of sickness or injury – around 4.4 days per worker. There are 800,000 more people out of work because of health problems compared to 2019, with a further 600,000 projected by 2030. This is not just a workforce problem; it is an economic one, with consequences in backfilled roles, skills shortages, delayed projects, and pressure on teams left to absorb the gap.

Published in November 2025, Keep Britain Working (KBW) – an independent review commissioned by the DWP and the Department for Business and Trade (DBT) – argues that the UK cannot sustainably improve productivity or labour market participation without making it easier for people to access healthcare and stay connected to work when ill.

As part of KBW's Vanguard stakeholder research, we brought together senior clinicians, workplace health specialists, large UK employers, and DWP representatives to surface what is actually working – and what is not.

The honest truth about what isn't working

Most organisations offer some mix of support: an Employee Assistance Programme (EAP), occupational health (OH), group risk benefits, perhaps a wellbeing app or private medical insurance (PMI). Yet many continue to report rising mental health absence and persistent musculoskeletal (MSK) issues. Four factors explain this:

Coverage is uneven

PMI is often limited to a subset of employees; those most exposed to health risks are frequently the least likely to be covered.
Behaviour is shifting

Long NHS waits and changing attitudes are driving out-of-pocket spend; employer expectations must keep pace with consumer healthcare norms.
Health risks vary across workforce cohorts

Without a clear picture of their workforce profile, employers default to generic wellbeing approaches that miss the groups at highest risk.
Engagement often fails

Complexity, confidentiality concerns, and poor signposting mean take-up remains low, particularly in dispersed or frontline workforces.

From patchwork benefits to a navigable pathway

Many employers have accumulated a patchwork of solutions – multiple apps, providers, and entry points, with little clarity on what to use when. Pathway design provides a clear route to the right support at the right time: a defined starting point (e.g. virtual GP, EAP, nurse triage), clear escalation to clinical services, closer integration between OH and HR, and communications linked to moments that matter – first sickness absence, return to work, or a manager initiating a welfare conversation.

Making whole-of-workforce support real

A tiered model can close the health gap: low-cost support for all employees (virtual primary care, structured referral pathways for mental health and MSK); enhanced support for higher-risk sites or roles; and broader PMI for senior populations where appropriate – without creating a two-tier culture. Integrated benefit design makes the difference in delivering equitable access.

Turning data into decisions

Most employers hold plenty of data – absence, EAP utilisation, claims, turnover, engagement scores – but it sits in silos. Treating absence data as a health risk dashboard, rather than performance compliance, helps highlight hotspots by location, role, or demographic; flag trends early; and connect health investment to operational outcomes.

Start with what you have

A diagnostic review of existing support can identify gaps in coverage, duplication, access barriers, cultural barriers (stigma, low trust), manager capability gaps, and missing baseline metrics – often more valuable than a procurement exercise.

Line managers remain the operational hinge

Line managers shape workload, flexibility, psychological safety, and whether support is activated early or late. Many are underprepared – not through lack of care, but because they fear saying the wrong thing, lack guidance, or face competing delivery pressures. Practical responses include clear escalation routes, real-scenario training, and policies that make early action easier than waiting.

The business case: speaking finance's language

What lands with finance teams is evidence tied to business costs: reduced absence duration, better return-to-work outcomes, lower turnover in key roles, fewer escalations to long-term absence, and productivity measures meaningful to the specific business.

What action looks like

Progress does not require a perfect system. It requires four things: design clear pathways to care; make them inclusive, especially for lower-paid, higher-risk roles; make them measurable so the organisation can see what is working; and make them operational by giving line managers the tools, time, and backing to intervene early.

Ready to close the health gap in your organisation?

The employers seeing the greatest progress aren't waiting for a perfect system – they're starting with a diagnostic review and building from there.

Our team at Marsh has supported leading UK organisations through this journey, combining clinical expertise, occupational health insight, and operational experience to design benefits that actually work for real workforces.

Find out how we can help your organisation

References & Sources

1. Labour Force Survey 2024, Office for National Statistics (ONS), 2024.

https://www.ons.gov.uk/employmentandlabourmarket/peopleinwork/labourproductivity/articles/sicknessabsenceinthelabourmarket/2025

2. Keep Britain Working Independent Review, DWP & DBT (Led by Sir Charlie Mayfield), November 2025

https://www.gov.uk/government/publications/keep-britain-working-review-final-report/keep-britain-working-final-report

Mercer is becoming Marsh.