Examining the Work, Health and Disability Green Paper

The government’s Green Paper on work, health and disability proposes a plan for helping disabled people into employment. This was an ambition that initially appeared in the Conservative Party manifesto in 2015.

The overarching aim is to close the disability employment gap. Of the 5.7 million disabled people of working age, 4 million are working but a further 1.3 million who have the potential to work are unemployed. A significant part of the reason is that employers resist taking on disabled people. Only 8% of employers report recruiting a worker with a long term disability in the course of a year and a Cardiff University study found that the recent recession affected disabled people more – with their pay being frozen and overtime restricted more than for other workers. In the case of people disabled by cancer, for example, Macmillan say that the top issues raised by people affected by cancer were the need for reasonable work adjustments to let them cope at work, discrimination, and unhelpful and unsympathetic employers.

The Green Paper encourages action and innovation by employers and commits the government to understanding what works with a view to longer-term reform. The Paper proposes to provide the support needed to recruit and retain disabled people, and to consult on evolving current government schemes and on the barriers to take-up of Group Insurance products. It also aims to help employers manage sickness absence, including by consulting on reform of Statutory Sick Pay. An important area of the Green Paper regards changing culture to improve workplace wellbeing and the retention of disabled employees.  Consultation will occur on how government can: best provide and publicise accessible information and guidance; facilitate employer networks; empower employees to manage their condition; and help employers make relevant adjustments such as providing flexible working hours. Encouragement will be provided to employers to collect data on disability and ill-health, build the business case for investing in supporting health and disability in the workplace and the government will also aim for the public sector to be an exemplar.

For health services, the Green Paper aims to help people access the right support at the right time by:

• Reviewing the Fit Note (a document signed off by the GP after 7 days off sick), and looking at options for referrals to a health professional to carry out Occupational Health assessment and advice e.g. to a GP with a special interest in occupational health, or to a consultant in occupational medicine for complex cases

• Trialing mental health support in new settings such as in Job Centres and via the Increasing Access to Psychological Therapy service

• Consulting how Occupational Health, vocational rehabilitation and related provision can be better matched to individuals’ needs

• Increasing access to psychological therapies and doubling the number of Employment Advisers in talking therapies

• Consulting on developing and testing new and more effective pathways of care for MSK conditions

A core aim of the Green Paper is to embed work as a health outcome, including through building workforce capability and capacity. The Green Paper also indicates a wish to support joined-up health and employment services, which are locally designed and delivered, consulting on:

• An intention to set a standard for employment information in NHS health data sets, to monitor working-age health and employment

• Plans to provide a basket of health and work indicators at local level

• Improved sharing of health and employment data, innovation, co-location and local networks, all to support local service integration

However, while the challenge set out in the Green Paper is welcome, one may be sceptical about it in several respects.

Firstly, on current trends it will take until 2065 to close the disability employment gap! It assumes the UK economy can deliver these jobs, and disabled people can access these jobs, but more needs to be done to address these issues effectively.

Secondly, employers, particularly small employers, need to get the right support at the right time to enact change positively. Current arrangements don’t work well for small employers in particular, and new approaches need the same level of carrot and stick focus as workplace pensions to really be effective. Does the government have the will (and will it commit the budget) to make such changes?

Thirdly, the heavy focus on helping people into work means that there is a lack of focus on job retention, a point well made by a report last year by the Resolution Foundation. And as Scope point out, people who acquire a impairment as adults are 4 times more likely to fall out of work than non-disabled people.

A fourth important unaddressed issue concerns the workforce capacity of occupational health professionals. This will need to be expanded to deliver the new occupational health models that are required by the Green Paper. The occupational health profession must take a leadership role in creating employers that are “disability-sensitive”.

The Green Paper also leaves a number of outstanding questions:

• Should other health professionals be able to issue fit notes? If so, which ones and what qualifications / training would we expect them to undertake?

• Can the fit for work service be improved – or does something very different need to replace it?

• What is the role of insurance to help recruitment and retention of disabled people?

But, it is worth remembering that while cost of course matters, disability-sensitivity does not necessarily drive up costs. And, the Green Paper does not talk about mandating people to treatment and into work (despite press reports when the Green Paper was launched cynically suggesting this was the case).

Overall, the Green Paper also has a wider significance. It issues a challenge to society: we can no longer ignore or underplay the multiple barriers that influence entry into work, return to work and health in the work place. It is not about assuming exit, with a redundancy package (or without one). The Paper will help challenge assumptions about work, health and disability, and spread awareness of good practice. Disabled people have as much right as everyone else to good work and change should start now.