Most people who leave work because of ill health do not leave suddenly. There is usually a stretch of weeks, sometimes months, when an employee is struggling but still coming in, or is off for a few days at a time. What happens during that period often decides whether they stay in work or leave for good.
The UK is now testing this idea at scale. Through the Keep Britain Working review, led by Sir Charlie Mayfield, more than 250 employers, including BP, Sainsbury's, Google UK and Tesco, are working out how to act earlier. Their aim is not to manage long-term absence better, but to stop it from starting.
Maggie Nelson, Head of People and Operations at Court Case Finder, sees this window clearly in her own work. "Most people don't go from fine to off sick overnight. There is nearly always a period where a manager notices something has changed," she says. "Our job is to make sure that manager knows what to do with what they've noticed, instead of waiting for a fit note to arrive."
This article is for HR teams and line managers who want to use that early window well. It covers what to say in the first conversation, how to record and review temporary adjustments, and when to bring in occupational health.
What the Keep Britain Working Review Found
The numbers explain why the government is paying attention. UK workers lost an estimated 148.8 million working days to sickness or injury in 2025, according to the Office for National Statistics. The review puts the cost to employers at around £120 in lost profit for each sickness day. Across the economy, health-related inactivity costs an estimated £212 billion a year, and nearly 3 million people of working age are now out of work because of ill health.
The review's most useful finding, however, is about timing. Support today often arrives too late, after someone has already been away for months. Employees told the review they had little or no contact with their employer during long absences. They also described falling into gaps between HR, employee assistance programmes and occupational health, with no one clearly in charge.
Research from the Work Foundation shows why those early weeks matter so much. In a study of more than 9,000 UK workers, nearly half of those who left work after their health declined did so within the first 12 months. "The evidence is clear that once someone leaves work due to ill health, it becomes increasingly more challenging to help them back," said Ben Harrison, Director of the Work Foundation at Lancaster University.
The opportunity is large. The review estimates that keeping just 1% more of the workforce in work would add economic capacity equal to a city the size of Cardiff.
The Gap in the Guidance: What Happens Before the Formal Systems Start
Most of the review's recommendations describe systems. They include case management, return-to-work plans and better access to occupational health. These matter, but they usually start once an absence is already under way. The weeks before that point belong mainly to one person: the line manager.
The professional body for managers has made the same point. "It's the manager, not employers or ministers, who ultimately decides whether a bad back means a phased return or a lost career," wrote Petra Wilton, Director of Policy and External Affairs at the Chartered Management Institute. "Ninety-seven per cent say they need line management training to do it well, yet only a third get it."
The review also explains why many managers hold back. Employers told it they worry that raising a health issue might cause offence, lead to a grievance or end in a tribunal. As a result, many managers say nothing and wait. The rest of this article gives them a simple process to use instead, built around three steps: talk early, write it down, and know when to hand over.
Step 1: Have the First Conversation Early
The first conversation should happen as soon as you notice a change, not after a set number of sick days. That change might be more short absences, missed deadlines, or someone who seems tired or withdrawn. Choose a private place, keep it informal, and make it clear that you are asking because you want to help, not because of performance.
The key rule is to talk about work, not diagnosis. You are not a doctor, and the employee does not have to tell you what their condition is. What you need to understand is how they are coping and what would make work easier. Open questions work best:
- "How are things at work for you at the moment?"
- "Is anything making your job harder than usual?"
- "What would help you over the next few weeks?"
- "Is there anything you'd like me to keep between us?"
- "Would it help to speak to someone with more expertise, such as occupational health or our employee assistance programme?"
Some questions are best avoided, even with good intentions. Asking "What's wrong with you?" or "Have you seen a doctor about that?" can feel like pressure, and guessing at a condition can damage trust quickly. It is also worth knowing that the legal duty to make reasonable adjustments for disabled staff, under the Equality Act 2010, can apply even if someone has not shared a diagnosis.
End the conversation with one small, agreed next step and a date to check in again. That date is what turns a single chat into ongoing support.
Step 2: Record Temporary Adjustments and Review Them
After the conversation, most support will take the form of small, temporary changes. These might include a later start time, fewer client-facing hours, more breaks, working from home on certain days, or handing a heavy task to a colleague for a month. A fit note from a GP that says someone "may be fit for work" often suggests changes like these.
The problem is that many adjustments are agreed verbally and then forgotten. "An adjustment that only lives in a manager's head disappears the moment that manager changes roles or goes on holiday," says Nelson. "Writing it down, even in a few lines, is what turns a kind gesture into real support."
The record does not need to be long. One page covering these points is usually enough:
|
What to record |
Example |
|
What was agreed |
Start at 10 a.m. instead of 8 a.m. |
|
Why, in work terms |
Mornings are hardest; output is better later in the day |
|
Start date and review date |
Starts 1 June, review on 15 June |
|
Who is responsible |
Line manager arranges cover for early shifts |
|
What happens next |
Keep, change or end the adjustment at review |
Notice that the record describes the effect on work, not the medical condition. This keeps private health information out of general HR files and focuses everyone on what can actually change.
Review each adjustment every two to four weeks. Some will no longer be needed, and that is a good outcome. Others may need to become permanent, which is a sign to involve HR more formally.
Step 3: Know When to Bring in Occupational Health
A line manager's role is to notice, listen and make simple changes. It is not to manage a health condition alone. Knowing when to hand over is part of doing the job well, and the review gives a useful guide on timing. It recommends that return-to-work plans are agreed from two weeks into an absence, and no later than six weeks.
In practice, it is time to involve occupational health or HR when:
- An absence is approaching two weeks, or short absences keep repeating.
- The adjustments you agreed have not helped by the first review.
- The condition may affect the employee's safety or the safety of others.
- You are unsure whether the person might be disabled under the Equality Act.
- The employee asks for more specialist support.
Access is the main barrier, especially for small businesses. Many do not have an occupational health provider at all. Peter Cheese, Chief Executive of the CIPD, welcomed the review but warned that its success depends on follow-through. "It will be crucial that the first phase of implementation leads to the provision of more cost effective and accessible quality occupational health services for SMEs," he said.
Until that happens, smaller employers still have options. An employee assistance programme, the GP's fit note and the government's Access to Work scheme can all support the next step. The important thing is that the hand-over is planned, and that the manager stays in contact throughout.
Small Steps, Taken Early
The Keep Britain Working review is still testing what works, and the formal systems it describes will take time to build. The good news is that the most important part does not need to wait. A short conversation, a one-page record and a clear point for handing over are things any manager can start this week.
Nelson believes this is where the real change will happen. "Managers don't need to become health experts," she says. "They need permission to have the conversation early, a simple way to record what they agree, and to know who to call when it's beyond them."
If more employers give their managers those three things, fewer people will have to choose between their health and their job.
