Keep Britain Working – The Story So Far (March 2026)

A personal reflection

I recently attended a Council for Work and Health meeting, alongside colleagues from ACPOHE and CSP, and it was a useful reminder that while there is huge ambition in this space, the system itself is far from simple.

Multiple roles.
Overlapping responsibilities.
Clinical and non-clinical professionals all contributing but not always with clarity on where responsibilities start and stop.

It’s an area with real potential, but also one that feels fragmented and, at times, difficult to navigate. That context makes the Keep Britain Working work even more relevant.

The scale of the challenge is significant. Over 1 in 5 working-age adults are out of work and not looking for work, largely due to long-term health conditions now around 2.8 million people.

This isn’t just a health issue.
It’s an economic issue.
A workforce issue.
And ultimately, a system issue.

What’s becoming clear is that this isn’t about more services, it’s about how the system works.

We still see:

• A culture that delays early conversations
• Inconsistent access to support
• Systems that struggle to keep people in work, not just return them once they’ve left

And a Fit Note approach that too often defaults to “not fit for work,” rather than enabling people to stay engaged where they can.

There is progress. The Vanguard Phase is starting to test what good looks like across prevention, stay-in-work, and return-to-work pathways bringing employers, providers and regions into the same conversation. That is a positive step.

But it also highlights how much coordination, clarity and consistency is still needed if this is going to work at scale.

There are also some encouraging examples emerging in musculoskeletal care. A recent MSK pilot demonstrated that targeted intervention can reduce waiting times and improve access in the short term.

But what is equally important is what followed. Once the initial funding and programme support were withdrawn, waiting lists began to rise again. Alongside this, variation in delivery, data quality challenges, and structural differences between systems all impacted outcomes. It reinforces a key point short-term improvement is possible. Sustained change is much harder.

(Further details here: https://gettingitrightfirsttime.co.uk)

A separate reflection - Rewired

I also spent time at Rewired this year. As expected, there was no shortage of innovation, particularly around AI and digital tools. There are some strong examples emerging, especially where solutions are co-designed and properly implemented. But stepping back, the same challenges remain.

We are still debating the fundamentals:

• Is it stable?
• Is it secure?
• Does it solve a real problem?

And even when something is approved, adoption is still a problem.

(I shared some more immediate reflections from the event here.

What felt clearer this year is where AI genuinely adds value. I may have mentioned it before….

It is strongest in the background, streamlining processes, reducing friction, and taking pressure off clinicians. But we need to be more disciplined. Not using technology because we can but where it is genuinely needed. And where it is patient-facing, patients should be there from the outset, not brought in later to validate.

Final reflection

Across both areas, the message feels consistent.

We are not short of ideas.
We are not short of technology.

But we are still working through how to make it function, consistently, safely, and at scale.

For me, it comes back to something simple:

We need technology to do what technology is good at
and people to deal with people.