As a nation, we are working longer into old age, and often under deteriorating conditions—higher workloads, longer hours, and growing insecurity. The stresses of today’s labour market are showing up not only in our declining health but in productivity and economic participation. The much-anticipated Final Report of Sir Charlie Mayfield’s 'Keep Britain Working' Review confronts these workforce health challenges – and while it moves the debate forwards, it also needs to go further.
The Review’s strength is its structural focus. It aims to shift from a system where ill-health and disability are managed primarily by individuals and the NHS, toward one in which employers, in partnership with government, share responsibility for prevention, accommodation, and rehabilitation. This focus aligns well with the social model of disability: barriers arise largely from environments, systems, and cultures—not from individuals’ impairments.
The Mayfield Review places responsibility on employers to remove these barriers by creating inclusive working conditions, implementing reasonable adjustments, and defining what “healthy work” should look like. But it doesn’t go far enough in dealing with what is perhaps the most pervasive barrier. We more commonly think of barriers as prejudiced attitudes, or steps to a building – but the rigid norms of the office 9-5 are such engrained barriers that we don’t even perceive them as exclusionary.
There are several reasons why flexible working must be foregrounded:
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Flexible working is the most commonly requested reasonable adjustment. This was the conclusion of a large evidence review. Moreover, disabled workers are as likely—or more likely—to request working-time flexibility and home working than non-disabled workers.
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It strongly predicts retention. Employees who experience a health setback are 3.7 times more likely to leave the labour market when they lack control over hours, pace, or task order.
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Yet flexible working is often denied, including when requested as a reasonable adjustment.
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We have limited evidence on which types of flexibility matter most, for which groups, and why they are so effective. Further research into what works should therefore be at the forefront.
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Flexible-working policy rarely centres disability; most developments have been driven by gender equality or family-friendly policy.
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The pandemic provided a natural experiment, showing that when barriers such as commuting and rigid hours were removed, many disabled people could enter or stay in work.
The Flex Plus Model
My recent research at King’s College London, with Professor Ben Geiger and Professor Kim Hoque, focused on the barriers to a disability-centric Flex Plus model of work. The Flex Plus concept itself grew out of my own lived experience. I was excluded from work for decades because my skills could not be accommodated within a conventional 9-5 office structure. Only later, through policy and campaigning work, did I realise how widely shared this predicament is—especially among people with fluctuating, energy-limiting conditions.
Through the Chronic Illness Inclusion Project (CIIP), I found that people with chronic illness do not lack work ethic or motivation. What they needed—but almost never found—were adjustments to time, pace, and place of work that allowed them the autonomy to fit their health management strategies around employment. Subsequently in my work with the employment-support organisation Astriid, the same pattern emerged. Many people came to us wanting to move back into work after they developed a long-term condition. But relative few were applying for the roles we advertised. A survey confirmed why: 75% said they were looking for jobs explicitly offering flexible hours or location. Over 70% required home working, work-time flexibility, or part-time hours as adjustments.
From this grew the Flex Plus concept: a multi-dimensional form of flexibility that offers autonomy over time, pace, and place of work. It enables people to align work with fluctuating symptoms, pacing needs, and rest cycles—and therefore to contribute their skills sustainably. While Flex Plus originated in research with individuals with fluctuating and energy-limiting conditions (FELCs), but it also resonates strongly with people with mental-health conditions and neurodivergence. Crucially, research for DWP indicates by around two-thirds of people receiving health or disability benefits require one or more of its components—the very group government aims to support into work.
There is, of course, a caveat: disabled people are a diverse group, and home working or part-time hours are not universally suitable. But labour-market data—and my experience at Astriid—show that jobs offering Flex Plus conditions are rarely available at the point of hire.
What Scope for Flex Plus Working in the Mayfield Report?
The central question is therefore whether the Mayfield Review creates real scope for flexing work around health needs. Does it address the structural disconnect between policy ambition and the current labour market, in which Flex Plus-style roles are extremely rare?
Encouragingly, the Mayfield Report places flexibility at the heart of its concept of a “Healthy Working Lifecycle.” This lifecycle spans recruitment, onboarding, wellbeing, sickness absence, return-to-work, and re-employment—mirroring the dual focus on retention and recruitment that underpinned our Flex Plus research. The Review especially emphasises flexible working as a rehabilitation tool, through graded returns to work and part-time re-entry for people recovering from illness.
What it does not explore in any depth is flexibility as a proactive inclusion tool for people living long term with fluctuating or energy-limiting health conditions. Nor does it unpack the different types of flexible working—and which cohorts benefit most from each form. This remains a major gap in research and policy.
A lack of concrete policy measures
Those hoping for immediate remedies to well-documented failings in disability employment policy will find limited detail. The Review does not propose reforms to Access to Work, nor address the shortcomings of the Disability Confident scheme, nor recommend mandatory disability workforce or pay-gap reporting—tools many believe are essential to changing employer behaviour and driving accountability.
Instead, the Review offers a set of financial incentive mechanisms intended to nudge employers toward healthier practices: procurement advantages, sick pay rebates, tax relief on workplace-health investments, and potentially National Insurance adjustments. Beyond this, the Review stresses that the current evidence base on workplace health and employment outcomes is too weak to justify sweeping reforms.
The Vanguard Phase: explore, test, evaluate
Rather than legislate immediately, the Report proposes a 3–5 year programme to explore and evaluate what works, delivered through a partnership between government and committed employers.
At the centre is a proposed three-year Vanguard Phase (2026–29), in which a group of early-adopting employers—from both large organisations and SMEs—would test a new model of workplace health across the employee lifecycle. They would co-design and trial practices around prevention, accommodation, sickness absence management, and return-to-work. A new Workplace Health Intelligence Unit (WHIU) would gather data, analyse outcomes, and build the evidence base government says is currently missing.
This creates a valuable opportunity: a structured testing ground in which flexible working arrangements—designed around the needs of disabled people—can be developed, trialled, and rigorously evaluated. It opens the door to further testing of the Flex Plus model.
Crucially, the Review commits to designing solutions with disabled people. The Vanguard Phase includes “deep dives” with different employee cohorts, enabling co-production with people whose lived experience of mental health conditions, fluctuating or energy-limiting conditions, neurodiversity, or other impairments offers insight into the specific forms of flexibility they need. This goes beyond the generic debate the merits of home vs office working, or the limited lens of the statutory Right to Request.
How our research aligns with Mayfield’s ambitions
In making concrete recommendations, it is crucial for us to understand the barriers to FlexPlus working that our research uncovered. In our interviews with HR professionals, line managers, and DEI leads, employers understood the need for the Flex Plus model and its potential benefits. Yet they identified clear constraints in offering the three elements of Flex Plus—remote working, part-time hours, and worktime autonomy—either separately or in combination. These fell into three categories:
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Operational barriers, ‘the needs of the job.’ These vary strongly by role and sector. Some jobs legitimately require physical presence or fixed hours.
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Cultural barriers, ‘that’s not how we work.’ These arise not from operational reality but from organisational norms or ideology.
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Implementation barriers, ‘we struggle to make this a reality.’ Even where good policies exist, outcomes depend on line managers’ discretion, knowledge and skill.
Across these barriers runs two common themes: flexible working is still too often treated as a perk—a discretionary reward—rather than an essential enabler of performance for disabled employees. And flexible working policies are not designed around health and disability and often leave this cohort of workers behind.
Our most striking finding was that even in progressive organisations that accommodate flexibility for existing staff, Flex Plus arrangements are generally considered too difficult to offer at the point of hire. This produces a stark two-tier system. People already inside organisations may eventually secure Flex Plus adaptations. Disabled jobseekers outside the workforce almost never can.
This structural disconnect is evidenced in analysis by Timewise of how few job vacancies are advertised with any form of flexible working.. The result is a miscategorisation of people as “inactive,” when in reality they are willing and able to work—just not able to work under existing conditions.
What should be tested within the Vanguard framework?
Despite these barriers, most employers wanted to do more. Over three-quarters of interviewees expressed interest in actively helping to design solutions—particularly around recruiting people directly into Flex Plus roles.
This is exactly what the new Workplace Health Intelligence Unit could facilitate: the collection and sharing of real-world data on what works, building an evidence base strong enough to shape national policy and employer practice.
Our “39 Steps” report sets out a series of recommendations that would naturally lend themselves to trial within the Vanguard framework:
1. Systematic Flex-Plus job analysis
HR departments could identify roles with potential for Flex Plus—through job carving, redistributing tasks within teams, or enabling location flexibility. This could create a bank of accessible roles available when employees’ circumstances change, due to health or other commitments.
2. Training for line managers
Managers need skills in:
- job carving and task redistribution;
- managing remote and hybrid teams;
- implementing reasonable adjustments;
- understanding long-term conditions;
- creating safe cultures for disclosure and requests.
This is essential to move from policy-on-paper to practice-on-the-ground.
3. Reimagining job design and recruitment
Testing new recruitment models—where Flex Plus options are transparently available from the outset—would directly address the exclusionary two-tier system. This could feed into employment support initiatives such as Connect to Work, helping match disabled jobseekers to roles designed with their needs in mind.
Conclusion: A Call to Action
We have a rare window to experiment with new working models that address workforce health and promote disability inclusion. The Mayfield Review creates meaningful space for a deep dive into flexible working for health and disability, co-produced with disabled people rather than borrowed from frameworks designed for other groups.
Flex Plus is a disability-centric model with the potential to reshape standards for good work and healthy workplaces. It could help prevent the onset of work-limiting conditions, support retention, and reduce the burden of work-related ill-health. It should be embedded in future standards for disability-confident employers and healthy work practices.
The concern, of course, is that without stronger regulation or mandates, progress may remain uneven. Voluntary uptake alone will not be enough.
But if government fully backs the Vanguard approach; if it maintains momentum; if evidence is translated into clear incentives, regulation, and certified standards—the outcomes could be transformative. Employers are willing, disabled workers are clear about what they need, and the policy moment is ripe.
We must not lose it.
Catherine Hale is an Associate Researcher at the ESRC Centre for Society and Mental Health and Founder of Disability Insight.
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