Mandatory health checks for workers when they start a new job have been proposed as a key measure to tackle the rising tide of ill health driving people out of the UK workforce, a government-commissioned review has recommended. Sir Charlie Mayfield, the senior Labour adviser and former chairman of the John Lewis Partnership, said the UK should follow the example of countries such as Finland and Japan and introduce compulsory health assessments for new employees, with further checks at trigger points such as after a long period of sickness absence.
Phased introduction and international comparisons
The proposal forms part of Sir Charlie’s “Keep Britain Working” review, which warns that more than one in five working-age adults are now out of the workforce due to health problems. Without intervention, a further 600,000 people could leave work for health reasons by the end of the decade. To test the idea, Sir Charlie has called for a phased introduction of staff health MOTs, starting with large employers or specific regions as an initial pilot, with the scheme overseen by the Government. He pointed to long-established systems in Finland, where employers are legally required to arrange preventive occupational health care for all employees including health checks at the start of employment, and Japan, where the Industrial Safety and Health Act mandates annual health examinations conducted by a physician for every worker.
The review emphasises that early action is critical. Sir Charlie told BBC Radio 4’s Today programme that employers must “act early, talk to them early” and develop what he calls “stay in work plans” – making adjustments to allow employees to remain in work while they recover, rather than waiting until they leave. He said the aim is to “establish a norm, which is that employers are on the pitch when it comes to health issues”. The review estimates that if just 1% of the 33 million people currently off work sick – some 330,000 individuals – were able to return to work, that would be the equivalent of adding the workforce of the whole city of Cardiff to the economy. “You wouldn’t have had to build a single house, you wouldn’t have to open a new channel of immigration, you wouldn’t have to wait for a cohort of young people to join the workplace,” Sir Charlie said. “This is basically growth hiding in plain sight.”
Safeguarding sensitive health data
The most critical element of the proposal, Sir Charlie acknowledged, is how the sensitive health information collected from employees is handled. “We are very conscious of the challenges surrounding the collection of health and work-ability data,” he wrote in the report. “Confidentiality, consent and trust, particularly around sensitive health data, will be central concerns.” He has stated plainly that there must be strong safeguards to ensure no individual data would be shared with employers. To address this, the review advocates for a “trusted intermediary” to collect and manage the data, rather than leaving the responsibility with employers. This intermediary could help navigate the legal and ethical complexities, including issues of consent validity – given the inherent power imbalance between employer and employee – gaps in data, disparate data sources, and the strict requirements of GDPR.
Sir Charlie stressed that if these challenges can be properly addressed, the potential is significant. “There is a strong case for a trusted intermediary to collect this data, rather than expecting employers to deliver this,” he said. “If these challenges can be addressed the potential is significant: a powerful national data asset capable of driving a step change in system performance, and outcome-based policymaking.” The report also notes a broader “culture of fear” among workers and employers that currently prevents early disclosure of health issues and constructive conversations about adjustments. The proposed health checks are intended to break that cycle by normalising workplace health support from day one, but only if the privacy framework is robust enough to earn public trust.
The review recommends a fundamental shift towards shared responsibility for health at work – between employers, employees and health services – rather than leaving it primarily to the individual and the NHS. It proposes a new model of “Workplace Health Provision” (WHP), a non-clinical case management service to support employees and line managers across what it calls the “healthy working lifecycle”. A three-year “Vanguard Phase” from 2026 to 2029 is planned to test new approaches, involving employers, providers and regions. The review also calls for reform of the GP fit note system, which it says is not working as intended.
The economic cost of poor health
The economic rationale for the proposal is stark. The Keep Britain Working review found that poor workplace health already costs the UK around 7% of economic output and costs employers an estimated £85 billion a year. That figure is broken down into £10 billion for sick pay, £47 billion for lost output, £21 billion for presenteeism – the productivity lost when employees work while unwell – and £7 billion for conflict, litigation and recruitment costs. Separate analysis from the Trades Union Congress (TUC) has put the cost of work-related ill health on economic output at £21.6 billion in 2022-2023, while the Health and Safety Executive (HSE) estimates total costs of workplace injuries and ill health at £22.9 billion for 2023/24, with ill health accounting for 72% of that (£16.4 billion). Wider estimates compiled by the review suggest the cost to the state of economic inactivity due to ill health is £212 billion per year, including £2 billion annually for the NHS, and that lost economic output from long-term sickness alone is at least £130 billion.
The scale of presenteeism is growing: employees now lose an average of 44 days of productivity due to working through sickness, up from 35 days in 2018, according to data cited in the research. Poor mental health in UK workforces is costing organisations £51 billion annually, with presenteeism contributing £24 billion of that, and work-related stress costs businesses up to £28 billion a year. Sir Charlie’s initial report, released in November, identified mental ill-health rising sharply among young people and musculoskeletal conditions affecting older workers as key drivers of economic inactivity, alongside structural barriers for disabled people. The review is part of the Government’s broader effort to reduce the number of people leaving the workforce prematurely due to ill health each year, and aligns with Labour’s push for stronger worker protections, including proposed legislation for statutory paid leave for health screenings.
