Britain stands at a crossroads. With over one in five working-age adults now out of the labour force—800,000 more than in 2019 due to health reasons—the Keep Britain Working Review, commonly known as the Mayfield Review, has sounded an urgent alarm about the nation’s economic inactivity crisis. Led by Sir Charlie Mayfield, the review presents both a stark diagnosis and a roadmap for transformation, positioning occupational health professionals as essential architects of a healthier, more productive workforce, particularly within small and medium-sized enterprises (SMEs).
The Scale of the Challenge
The statistics paint a concerning picture. Long-term sickness has pushed economic inactivity to unprecedented levels, rising from approximately 2.1 million people in 2020 to over 2.8 million today. The financial implications are staggering: the sickness and disability welfare bill is projected to exceed £100 billion per year by the end of the decade, with the NHS alone bearing £2 billion annually in costs related to economic inactivity. For employers, the impact is equally devastating, with businesses losing £85 billion a year from sickness, turnover, and lost productivity.
The Mayfield Review fundamentally challenges the current reactive approach to workplace health, calling instead for a “fundamental shift” toward prevention, early intervention, and shared responsibility between employers, employees, and health services. This transformation requires moving away from a system where health at work is “largely left to the individual and the NHS” toward one where workplace health becomes a collective societal responsibility.
The SME Gap: A Critical Vulnerability
The review reveals a troubling disparity in workplace health support across different business sizes. While 86% of large employers offer some form of occupational health provision, only 30% of SMEs do so. This gap is particularly concerning given that SMEs account for three-fifths of all employment in the UK—approximately 16 million people—representing about half the turnover within the private sector.
Research has consistently shown that employees in SMEs face significant disadvantages in accessing workplace health support. They are less likely to have access to structured workplace health and wellbeing products (16% in SMEs compared with 31% in larger companies), occupational health services (16% versus 29%), and structured return-to-work programmes (16% versus 31%). Moreover, SME employees report lower confidence in accessing financial support during long-term illnesses—only 30% feel “very confident” compared to 41% of employees in larger organizations.
This disparity isn’t merely about resources. Many SMEs lack dedicated HR functions and therefore miss the professional expertise to recognize the importance of occupational health. Operating in what has been described as “fire-fighting mode,” these businesses often rely on overstretched GPs for health and wellbeing support, creating inefficiencies for both the business and the healthcare system. Research indicates that only two-thirds of small business owners fully understand their legal obligations regarding employee rights, further compounding the challenge.
The Occupational Health Solution for SMEs
This is precisely where occupational health professionals can make their most profound impact. The Society of Occupational Medicine emphasizes that too many employees leave jobs unnecessarily because employers lack access to expert work and health advice. Occupational health professionals represent a unique and specialized resource—experts who understand both health and work, capable of bridging the gap between medical care and workplace support.
Prevention and Early Intervention
The Mayfield Review’s core recommendation centers on shifting from reactive to preventative approaches. Occupational health professionals are ideally positioned to implement this shift in SMEs through several key mechanisms:
Health surveillance and monitoring: Rather than waiting for crises, occupational health professionals can establish proactive health surveillance programs tailored to the specific risks and resources of SMEs. These programs need not be expensive or complicated but can provide crucial early identification of health issues before they escalate into long-term sickness absence.
Workplace assessments: Occupational health professionals can conduct targeted workplace assessments to identify hazards and health risks specific to the SME’s operations. Given that Health and Safety Executive figures show 1.7 million people have their health worsened by poor workplace management, this preventative work addresses root causes rather than symptoms.
Health promotion and education: By delivering targeted health promotion initiatives—focusing on areas such as musculoskeletal health, mental wellbeing, and chronic disease management—occupational health professionals can help SMEs build a culture of health awareness without requiring extensive internal resources.
Practical Support Through Workplace Health Provision
The Mayfield Review proposes a new Workplace Health Provision (WHP) model—an affordable case-management service designed specifically to make occupational health accessible for small and medium employers. This model represents a significant opportunity for occupational health professionals to deliver practical, cost-effective solutions to SMEs.
The WHP framework envisions two complementary approaches:
Stay-in-Work Plans: These plans focus on keeping healthy employees productive through preventative measures, regular health checks, and early identification of potential issues. Occupational health professionals can develop streamlined, scalable protocols that don’t overwhelm SME resources while providing genuine health protection.
Return-to-Work Plans: When employees do become ill, occupational health professionals can provide expert guidance on phased returns, workplace adjustments, and ongoing support. The review suggests these plans could eventually replace the current fit note system, which has been widely criticized for lacking the nuanced understanding of workplace contexts that occupational health professionals possess.
Addressing Common SME Concerns
One of the most significant barriers to SME adoption of occupational health services is cost perception. However, evidence demonstrates that investing in employee health is not just a moral imperative but an economic necessity. Decreased productivity, high levels of sickness absence, and unnecessary loss of experienced staff cost the UK economy billions annually. The impact on SMEs, with their smaller workforces, is proportionally greater—losing even one experienced employee can significantly disrupt operations.
Occupational health professionals can address these concerns by:
Offering flexible, scalable services: Rather than proposing comprehensive, resource-intensive programs, occupational health professionals can develop modular services that SMEs can adopt progressively as needs and budgets allow. This might include telephone consultations, pooled services shared across multiple SMEs, or digital health platforms that reduce costs while maintaining quality.
Demonstrating return on investment: By collecting and presenting data on reduced absence rates, improved productivity, and lower staff turnover, occupational health professionals can build compelling business cases that resonate with resource-conscious SME owners.
Simplifying access: The growth of smaller, commercial occupational health providers has made comprehensive OH provision more viable for SMEs than ever before. Occupational health professionals can position themselves as accessible partners rather than expensive consultants, offering practical guidance on health monitoring, back-to-work schemes, and preventative measures.
Supporting the Healthy Working Lifecycle
The Mayfield Review introduces the concept of a “Healthy Working Lifecycle”—a framework that considers health support at every stage of employment. For SMEs, occupational health professionals can operationalize this concept through:
Pre-employment and onboarding: Providing guidance on health assessments that identify potential workplace adjustments early, ensuring new employees start with appropriate support in place.
Ongoing employment: Establishing regular touchpoints for health reviews, particularly for employees with chronic conditions or those in high-risk roles, while maintaining confidentiality and trust.
Sickness absence management: Offering expert advice on appropriate workplace adjustments, ensuring that recommendations are practical and context-specific rather than generic. The review noted common feedback that occupational health advice sometimes “misunderstands the working environment, resulting in reasonable adjustments that are generic or ill-suited to the context of the work.” This criticism presents an opportunity for occupational health professionals to deepen their understanding of specific SME contexts and tailor their advice accordingly.
Return to work: Facilitating communication between employees, employers, and healthcare providers to ensure smooth, sustainable returns that benefit all parties.
Building Capacity Through Pooled Services
One innovative approach highlighted in the Mayfield Review is pooled access to employee health support in the workplace. For SMEs, this model offers particular promise. Rather than each small business attempting to establish its own occupational health infrastructure, groups of SMEs—perhaps organized by sector, geography, or trade association—can share access to occupational health professionals.
This pooled model addresses several SME constraints simultaneously: it reduces costs through economies of scale, provides access to specialist expertise that individual SMEs couldn’t afford, and creates opportunities for shared learning and best practice development across multiple organizations. Occupational health professionals can facilitate these arrangements, potentially working with sector bodies, chambers of commerce, or regional business networks to establish sustainable, accessible services.
Addressing the Implementation Challenge
The Institution of Occupational Safety and Health (IOSH) has noted that while the Mayfield Review presents an ambitious vision, it may overlook critical components of the solution—specifically, the integration of professional occupational health and wellbeing expertise at the center of the national response. The proposed Workplace Health Provision model has been criticized for lacking a defined role for occupational health professionals, despite their proven impact on workforce health, productivity, and retention.
This gap represents both a challenge and an opportunity. Occupational health professionals must actively advocate for their central role in implementing the Mayfield recommendations, ensuring that any new frameworks incorporate appropriate clinical governance, professional standards, and specialized expertise. The Society of Occupational Medicine has emphasized that helping people remain in or return to good work is “a win-win-win situation for employers, employees and for the nation,” but this can only be achieved through proper involvement of occupational health professionals who are experts in work and health.
The Path Forward: Practical Steps for Occupational Health Professionals
To effectively support SMEs in implementing the Mayfield Review recommendations, occupational health professionals should consider the following strategic actions:
Engage with the Vanguard Phase: More than 60 major employers and many small businesses have joined the three-year “vanguard phase” to develop and refine workplace health approaches. Occupational health professionals should actively participate in this initiative, contributing expertise and helping to build the evidence base for what works in SME contexts.
Develop SME-specific resources: Create practical, accessible guidance materials that SME owners can understand and implement without requiring extensive health and safety knowledge. This might include simple health risk assessment tools, template policies, or decision-making frameworks for common workplace health scenarios.
Build partnerships: Collaborate with business support organizations, trade associations, and sector groups that already have trusted relationships with SMEs. These partnerships can facilitate access and credibility while addressing SMEs’ concerns about additional burdens.
Advocate for supportive policies: The Mayfield Review recommends exploring a Statutory Sick Pay rebate for SMEs and pooled access to workplace health support. Occupational health professionals should actively support these policy recommendations while proposing additional measures that would facilitate SME engagement with occupational health services.
Demonstrate flexibility and understanding: Recognize that SMEs operate under significant constraints and time pressures. Occupational health interventions should be proportionate, practical, and designed to integrate seamlessly with existing business operations rather than creating additional administrative burden.
Invest in continuing professional development: Ensure that occupational health professionals understand the unique challenges and contexts of SMEs, moving beyond a one-size-fits-all approach to deliver genuinely tailored advice and support.
Conclusion
The Mayfield Review presents a transformative vision for workplace health in Britain—one that recognizes prevention and early intervention as essential to economic prosperity and individual wellbeing. For this vision to become reality, occupational health professionals must step forward as central actors in the implementation process, particularly in supporting the millions of employees working in SMEs who currently lack adequate workplace health provision.
The challenge is significant, but so is the opportunity. By developing innovative, accessible, and cost-effective approaches to occupational health support, professionals in this field can help SMEs transform from being the weak link in Britain’s workplace health infrastructure to becoming exemplars of good practice. In doing so, they will contribute not only to individual health and business success but to the broader goal of keeping Britain working, productive, and thriving.
As the review emphasizes, work and health are not competing priorities—they are two sides of the same coin. Occupational health professionals, with their unique expertise spanning both domains, are uniquely positioned to ensure that this fundamental truth shapes the future of work for SMEs across the nation.