Warning: this is a long one. TL:DR at the bottom!
A new government report has landed with a confident title: “Keep Britain Working.” On the surface, it presents itself as hopeful, modern and practical, built on the idea that people with health conditions should be supported to stay in work rather than fall out of it. The logic sounds reasonable. The tone sounds compassionate. The intentions sound… fine.
However, when you read it through the eyes of someone living with energy-limiting chronic illness, fluctuating disability, or a body that comes with its own list of medical warnings, the picture looks rather different.
I approached the report with the kind of cautious curiosity you develop after years of dealing with systems that promise “support” while quietly redesigning the rules underneath you. The more I read, the clearer one thing became: this is not just about helping people. It is also about reducing the number of sick and disabled people who leave work, access benefits, or cost the state money.
If you are someone who lives with ME/CFS, POTS, Hypermobility, chronic pain, or anything else that hijacks your energy without warning, this matters more than the government would like you to notice.
What the report says it wants to do
The headline message is simple: too many people are out of work because of ill-health, and that is bad for individuals, employers and the country. The solution, according to the report, is a new shared responsibility model where employers, employees and the health system all work together to keep people in work for longer.
This includes ideas like:
- Early conversations when health issues begin
- Better “stay in work” and “return to work” plans
- Less reliance on GP sick notes
- New employer-led health services to “bridge the gap” between work and the NHS
- Data-driven incentives to push employers to adopt the model
If that sounds slightly vague, that is because it is. The language is polished, the tone is collaborative, and the gaps are left wide enough to drive an HR department through.
Where this becomes worrying for people with fluctuating illness
The report never says outright that sick and disabled people are a “burden”, but the implication is not difficult to spot. Everything comes back to cost, productivity, and reducing the number of people claiming sickness benefits. The framing is less “how do we improve people’s lives” and more “how do we stop people leaving the workforce.”
Which would be fine, if this system was being designed for conditions with clear timelines, predictable recovery, or support that actually works. But that is not how ME/CFS works. Or POTS. Or chronic fatigue. Or joint instability. Or post-exertional crashes that appear days after a seemingly normal task.
This report assumes illness is stable, linear, and fixable through the right workplace interventions. Many of us live in bodies that do not behave that way.
The reality outside policy papers: the hostility is getting louder
It would be easier to trust reports like this if the public conversation around disability in the UK was healthy, respectful, or even neutral. It is not. We are living through a time where disabled people are spoken about as costs, burdens, scammers, or people who should be grateful for whatever crumbs the system throws their way.
If you spend time online, you already know the tone: “Why should I pay for people who don’t work?”, “Everyone’s pretending to be disabled now”, “If you can tweet, you can work”, “People on benefits live better than the rest of us.” The narrative has shifted from suspicion to resentment, and from resentment to open hostility.
It does not stop at words. A friend of mine recently had their car windscreen smashed because someone decided they “didn’t look disabled enough” to have a Blue Badge. That is the point we have reached: people feel entitled to judge, punish, and police disabled strangers in car parks.
It is not just strangers, either. I have lost count of the number of stories where someone asks for workplace adjustments and is met with disbelief, or where colleagues assume “must be nice to have time off all the time.” Even some charities have softened into the language of “helping disabled people reach their potential”, which sounds supportive until you realise the unspoken ending is “in a way that doesn’t inconvenience anyone else.”
In that context, a government plan built around “keeping people productive” is not happening in a vacuum. It is happening in a country where disabled people are already treated as suspicious by default, where we are expected to work until collapse, and then apologise for collapsing.
So when policymakers say “shared responsibility”, you can understand why many of us hear something different: “You will carry more of the blame if this system doesn’t work.”
The worst-case scenario (and not a far-fetched one)
If this policy becomes reality without proper safeguards, here is what it could mean:
- Your GP may no longer be the person who decides whether you are fit for work
- Employer-linked “health services” may decide instead – and they are not medically neutral
- “Sick leave” may be reframed as time you should “stay connected and productive”
- If you cannot engage fully, it may be recorded as “non-participation” rather than illness
- Long-term disability benefits could become harder to access because “workplace support now exists”
- Fluctuating conditions may be treated as poor attitude, not medical fact
- You may be expected to work through illness because the new system says “work is good for health”
We have watched versions of this happen before. ESA assessments. Universal Credit. “Work capability” tests designed without any understanding of fatigue-based disability. The pattern is always the same. A reform begins as “supportive” and ends as “mandatory”.
There is nothing in this report to guarantee that will not happen again.
The lived experience missing from the report
There is no meaningful acknowledgement of conditions that get worse with exertion, that require pacing, or that leave people functional one day and collapsed the next. There is no recognition that for many disabled people, working is not a question of motivation, but of biology.
There is also no mention of the emotional labour of constantly having to self-advocate, justify symptoms, or negotiate with people who think “a bit more effort” would fix things. If anything, the report quietly reinforces the idea that sick people must try harder to stay in work, even when doing so actively harms them.
That is not support. It is pressure with a softer tone.
Why this matters now
This report is not law yet. It is not policy yet. It is a blueprint, and blueprints become legislation. Once something like this is described as “modernising support” and “reducing dependency”, it starts to appear in government press releases. Then consultation documents. Then benefit reforms.
If chronically ill and disabled people are not included from the beginning, we will only be included at the end, when the rules are already written and the appeals process is already clogged.
So what do we do with this?
We do not panic. We do not assume the worst is guaranteed. We also do not wait politely until the worst is already happening.
The people who drafted this report talked to employers, unions, and health providers. They clearly did not talk to enough of us: those who have lived through system after system that promised support but delivered scrutiny.
Our voices are not an optional extra. They are the missing data.
Final thought
I am not against support that helps people stay in work: when it is safe. I have worked through illness for years, in ways that were both empowering and punishing. When work is flexible, thoughtful and human, it can be a lifeline. When it is forced, measured and monitored, it becomes another form of harm.
The difference between those two versions is not intention. It is power. Right now, most of that power is still in the hands of the people who do not live in bodies like ours.
TL:DR
The “Keep Britain Working” report claims to support people with health conditions to stay in work, but it’s built around reducing benefit use and keeping disabled people “economically active”. It ignores fluctuating illness, risks shifting power to employers, and lands in a climate where disabled people are already seen as suspicious or lazy. Without safeguards, this won’t be support: it’ll be pressure in softer language.
