Book excerpt: Every year 140 million working days are lost to sickness absence. Most end with a swift return to work, but over 300,000 people a year fall out of work onto health-related state benefits. This Review aims to stop as many people as possible from needlessly moving away from work because of ill health, and to find ways of improving the coherence, effectiveness and cost of the system for managing sickness absence. There are potential major gains for employers, who spend £9 billion a year sick pay and associated costs, and the state, which spends £13 billion annually on health-related benefits. Currently the majority of people seeking a medical certificate are signed off as completely unfit. Until this is addressed, employers cannot make adjustments to help those people whose illness is compatible with a return to work. The central recommendation is that the Government should establish an Independent Assessment Service (IAS) which would provide an in-depth assessment of an individual's physical and/or mental function. It would also provide advice about how an individual could be supported to return to work. The service would replace GP certification. Other recommendations include: tax relief for expenditure by employers on medical treatment/vocational rehabilitation; abolishing the Percentage Threshold compensation scheme and the record-keeping obligations under statutory sick pay; introduction of a job-brokering service for long-term sick employees; end the Employment and Support Allowance assessment phase so as to improve and speed up the benefits system; improved processes in Jobcentre Plus.