There is now quite strong evidence for a set of preconditions that help determine the effectiveness of worker representation and consultation in improving health and safety outcomes. One of these preconditions is a regulatory framework that defines workers' rights to representation and employers' obligations to respond. Using the United Kingdom as its focus, this article explores developments at the national policy level. It shows how long-awaited legislative reforms to improve provisions for worker representation in health and safety have so far failed to materialize and, instead, government strategy has concentrated on promoting voluntary approaches. The author reviews the evidence of what makes worker representation in health and safety effective and suggests that, far from abandoning approaches to legislative reform, the U.K. agencies should be seeking to make improvements to the British provisions if they are to provide the necessary stimulus and support for worker representation in health and safety at work. Such improvements need to address long-standing weaknesses in existing provisions and their relevance to the changing world of work. The arguments presented here apply to the essential role of regulatory support for worker participation in all advanced market economies if it is to improve health and safety outcomes.