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House of Commons Hansard

Long-term Health Problems and Work Outcomes

18 April 2017
Volume 624

    [Mr Philip Hollobone in the Chair]

  • Will Members not staying for the next debate please be kind enough to leave quickly and quietly? We now come to the important subject of the role of employers in improving work outcomes for people with long-term health problems.

  • I beg to move,

    That this House has considered the role of employers in improving work outcomes for people with long-term health problems.

    It is a pleasure to serve under your chairmanship on this very interesting day, Mr Hollobone. The Prime Minister has promised that her Government

    “will do everything we can to help anybody, whatever your background, to go as far as your talents will take you.”

    Today, I intend to focus on what that means for employers of people with long-term health problems and disabilities. In all the very welcome debate about how the Government can best achieve their aim of halving the disability employment gap, the critical role of employers in supporting people to stay in work and, more positively, to reach their potential has been relatively neglected. “Improving Lives”, the Green Paper on work, health and disability, is an excellent foundation to start filling that gap. The Department for Health and the Department for Work and Pensions are to be commended for working in partnership and shining a light on the role employers can play in preventing people from falling out of work through ill health.

    Some 83% of disabled people acquire their disability during their working lives. We all know friends, colleagues, family members and constituents who had a job and then suffered a serious health problem. We have seen how, once the shock of diagnosis starts to dull, people quickly ask themselves whether they will be able to keep working and how they will support themselves and their loved ones. When ill health stops someone from working long term, getting back to work can be a key milestone in their recovery and a big step towards them feeling themselves again.

    Effective support from employers can make an enormous difference to people’s physical, mental and emotional health and to their chances of returning to work. But sadly, the reverse is also true. Many employers do not create a culture where employees can even disclose health problems. Groundbreaking campaigns such as “Time to Talk” and those run by Heads Together have done much to make it easier for people to speak about their mental health, for example, but too many people are still too scared to speak to their employer and too few employers are ready to respond in the right way.

    Research by the Mental Health Foundation last year found that 45% of working people with a diagnosed mental health problem had not disclosed it to their employer in the past five years. Of those who had told their employer, only half reported mainly positive consequences. As one of the people who took part in the research said,

    “no one is able to say, ‘I have a mental health problem and I can’t come to work today’”.

    As co-chair of the all-party parliamentary group on breast cancer, I have heard at first hand how hard many people find it to tell their employer that they have cancer. I suspect that may be even more of an issue for those types of cancer that are more common among men. Research by the charity Maggie’s found that one in five men with cancer find it so difficult to tell their employer that they put it off until they have to leave work to seek treatment. One in 10 do not tell their employer at all. If employees do not feel they can disclose a health problem, employers cannot hope to put in place the right support.

  • I congratulate the hon. Gentleman on bringing this important matter forward for debate. Does he agree that one way of doing it would be for the Government to create an index of employers based on how they support staff with disabilities and health conditions? Companies could be encouraged to consider how best to promote disability inclusion. Further, the Government could look at how employers’ legal and tax obligations could be changed to incentivise them to engage more proactively with the health of workers.

  • The hon. Gentleman is right, and I will touch on tax incentives later. There are lots of opportunities there. The Green Paper is a good and innovative start in looking at how we can move things forward.

    The earlier those open supportive conversations between employers and employees happen, the more effective the support will be. Well-managed employees can focus on their recovery and are more likely to successfully come back to work when they are ready.

  • By 2035, one in two people will get cancer. In the two short years I have been in Parliament, I can think of perhaps half a dozen colleagues across the House who have had cancer. Cancer is often defined by its survivorship, such as the great work that Macmillan does. Does my hon. Friend agree that a more open dialogue allows people to be helped through that illness—which is not necessarily a long-term condition or a terminal illness—so that they can return to work and enjoy fulfilling careers and supporting their families?

  • I thank my hon. Friend for that intervention. I know she speaks from experience. She is a few steps ahead, mind-reading my speech. I will come to the valid point she makes, but I definitely agree with her comments.

    Obviously such conditions can have many knock-on effects for families. When someone gives up work for health reasons, their partner will often cut back or stop working to become their carer. That can double the financial impact. Employers clearly have an enormous role to play in the health and working lives of disabled people and those with long-term health conditions. As the number of working people living with chronic health problems grows, the impact employers have on the population’s work and health outcomes—both positive and negative—will grow, too. Around 21 million people of working age in the UK will have at least one long-term condition by 2030. By the same year, the number of working-age people with cancer is set to increase from the current figure of 750,000 to an estimated 1.7 million. Ensuring that employers retain as many of those people as possible and support them to progress their careers will also help the Government to tackle some of the other big challenges facing our society.

    The Government’s report “Fuller Working Lives: a partnership approach” and the recent independent review of the state pension age by John Cridland are both responses to our ageing workforce. Demographic change is sometimes presented as a problem for the long term, but we need to confront some implications now. In five years’ time, there will be 763,000 more people in the UK aged 50 to 64 and 292,000 fewer aged 16 to 49. One in eight people stop working before reaching the current state pension age due to ill health or disability, and raising the pension age will only increase that figure. It is inevitable that as people age, they are more likely to have health problems—half of over-50s have a long-term health problem—but it is not inevitable that so many should be forced to give up work.

    More flexible and understanding employers would retain a greater amount of those people, and it would also mean that people would retire with bigger pension pots. The DWP has said that if the average earner worked to 65 instead of 55, they could have more than £200,000 in extra income and increase their pension by 60%. It would also be good for people’s health and the sustainability of the health service. The “Five Year Forward View” for the NHS in England recognises the need for “new partnerships” with employers to help people

    “get and stay in employment”

    as part of a

    “radical upgrade in prevention and public health”

    to protect

    “the sustainability of the NHS, and the economic prosperity of Britain”.

    I am pleased that the Government prioritised the critical role of employers in the Green Paper, which also makes a strong business case for employers to invest in inclusive workplaces and health and wellbeing. It would reduce the £9 billion direct cost of sickness absence and boost productivity through healthier, more engaged employees. The Green Paper includes welcome plans to ensure that the public sector

    “leads the way in developing employment practices that allow disabled people and people with health conditions to flourish.”

    But it is the Government’s proposals for the 26 million people working in the private and third sectors that could have the biggest impact on work and health outcomes, and it is on those that I wish to focus. The Green Paper asks how those employers could be incentivised to invest in the things we know create healthy workplaces and prevent people from falling out of work. How can we create a culture where people feel confident about disclosing health problems? How can we ensure employers have regular conversations with employees who are off work to agree steps to support their return? How can employers put in place timely access to occupational health and vocational rehabilitation support? The Green Paper proposes sensible reforms to statutory sick pay to ensure that people are not penalised financially by returning to work. It also proposes putting in place a one-stop shop for employers with information on the different things they can do to support staff and the return on investment they can expect to see from such measures.

    While such measures would be welcome, they would not alone bring about the vision set out in the Green Paper of a society where everyone is ambitious for disabled people and those with long-term conditions, where jobs actively support and nurture health and wellbeing and where everyone at risk of long-term absence or falling out of work due to ill health gets early action as needed to stay in or return to work. The Government acknowledge that much more needs to be done.

    The Green Paper is a call for bold, ambitious ideas and I understand the response from individuals, charities, employers and others has been very encouraging, with thousands already putting their views forward. That momentum must not be lost. Making progress towards the Government’s vision will bring enormous benefits to working people who live with long-term health problems, and to their families, employers, the economy and taxpayers. My first question to the Minister is therefore how the Government will involve those outside Parliament who have engaged so valuably up to now and have so much to bring to the debate.

    My second question relates to one of the bold ideas put forward to rapidly improve the ability of employers to provide effective early support for those at risk of long-term sickness absence. The Green Paper includes a section on group income protection insurance, recognising that it not only provides an income to those who are too ill to work, but also includes vocational rehabilitation and practical support for employers, which together prevents and reduces sickness absence and stops people from falling out of work altogether. Group income protection insurance is purchased by employers, who cover their staff. One virtue of that is that, save for the very highest earners, there is no medical underwriting, which means that insurers do not ask any questions about employees’ medical history or existing conditions. People with health problems are covered at no additional cost.

    The evidence is that group income protection is highly effective. The Green Paper cites a report from the Centre for Economics and Business Research, which found that such insurance reduces the length of sickness absence by an average of 16.6%. Research from one provider, Unum, found that seven out of 10 people with serious health problems who used its return-to-work service got back to work with the same employer. The most common conditions for those returning to work were mental health and musculoskeletal problems, which are the two health problems prioritised in the Green Paper.

    Currently, just 7% to 8% of employees have group income protection from their employer. The Green Paper states that the Government think group income protection insurance has a much greater role to play. Coverage is particularly low among female workers and those working for small and medium-sized employers, yet both are most likely to benefit from the support it provides. Rates of sickness absence and disability are higher among female workers than men, yet for some reason employers fail to protect them in equal numbers.

    SMEs are less likely to have experience of managing someone with a serious health problem or to have access to human resources, occupational health or vocational rehab expertise. As a former small business owner myself, I know what an impact it has when one of a small team needs to take time off. I know how difficult it can be to try to support an employee with a long-term condition, while also meeting legal obligations and keeping a business on track.

    In my role as chair of the all-party parliamentary group on insurance and financial services, I have received representations from across the sector that make the case for tax incentives for employers to invest in group income protection for their staff. Insurers, their trade bodies and employers, through EEF, make the case that a tax incentive for employers would be the most effective way to increase coverage. They argue it would raise awareness of the benefits of providing the insurance, would act as a signal from the Government that group income protection is something good that employers should consider investing in, and would stimulate demand for and supply of this insurance.

    Working with its members, the Association of British Insurers has produced an economic evaluation highlighting the gains to taxpayers if a modest incentive increased coverage. Fewer people would fall out of work or would require state support. Those in work and those who were too ill to work and so receiving an insured income would continue paying taxes on their salaries. Will the Minister explain how the Government intend to support a much greater role for group income protection insurance? Are they minded to consider the case for a temporary tax incentive for employers, particularly SMEs, to invest in it?

    The Green Paper vision is rightly ambitious and I am sure it will have broad support from those inside and outside the House who follow the debate. The Green Paper talks of a 10-year plan to achieve that, but there is clearly potential to make great strides in a much shorter timeframe. The Government can take action now that will make a huge difference to the lives of working people with long-term health problems, their families, employers and the taxpayer.

    Janey, a solicitor who shares her story in a guide from the British Heart Foundation, was 35 when she was diagnosed with a serious heart condition after giving birth to a baby boy. Janey’s employer communicated with her and together they agreed a successful plan so she could return slowly and steadily to her job, starting after a long absence on a two-day week and building up to four days a week over six months. She got back to work doing longer hours, but always making sure she was home in time to be with her son. That is the kind of positive experience we want everyone to have. So my final question is how the Government will measure success in delivering their vision. What are their top priorities in supporting employers to improve the work and health outcomes of people with long-term health problems?

    I welcome the Government’s approach to this important subject. There are some exciting opportunities for innovative solutions to help those with long-term problems to remain in work. I look forward to the Minister’s response.

  • I know we are talking about long-term health issues, but I can see that the Minister is in some discomfort with a short-term health issue. It would be perfectly in order if she would like to give her speech sitting down.

  • Thank you, Mr Hollobone. It is a pleasure to serve under your chairmanship. I shall start standing, but will take you up on your kind offer if it becomes too much.

    I congratulate my hon. Friend the Member for North Warwickshire (Craig Tracey) on securing this debate on a critical issue that faces the country, at an opportune moment, with the Green Paper consultation having just finished. I also thank the hon. Member for Strangford (Jim Shannon) and my hon. Friend the Member for Bury St Edmunds (Jo Churchill). We have had a lean but fit debate, and I thank them personally for their contributions.

    As has been stated, the Department for Work and Pensions and the Department of Health published the “Improving Lives” Green Paper in October last year, to start a national discussion about how we can support more disabled people and people with health conditions to get into work, stay in work and have full and fulfilling careers. The consultation ended in February and we have received a huge response from a wide range of employers, disabled people, people with health conditions and organisations with an interest. I thank Members who held events during the consultation period, and healthcare professionals who have also responded. We are now taking stock of what we have heard and will decide the next steps on this important agenda.

    In moving forward, we want to continue working with stakeholders—that includes employers—to build on those contributions to the debate and to keep the momentum going. It was always going to be tricky to give my hon. Friend satisfaction about exactly when a White Paper would appear; it is even more tricky bearing in mind announcements made earlier today. I can assure my hon. Friends that we want to seize the momentum that the Green Paper has built and bring forward a White Paper very swiftly. Work can continue outside of the civil service, in the private sector and the third sector, which will play a critical role in delivering the support. We want those organisations to continue thrashing out the issues so that we can arrive at a White Paper in good time.

    Let me focus on the case for employer action. It is clear that there are compelling reasons for employers to take action on health and work. Employers who invest in inclusive workplaces and in the health and wellbeing of their staff can expect wider access to talent and skills, improved engagement and retention of employees and consequential gains for the performance and productivity of their businesses, reduced sickness absence and also reduced presenteeism, which is an issue, although it is not often spoken about. They will be more able to capitalise on the purple pound’s nearly £250 billion of spending power in this country because of the insight that their workforce will have.

    Employers will increasingly need to help their employees remain healthy and manage their conditions if they are to benefit as much as possible from the skills and experience of our ageing population, which my hon. Friend the Member for North Warwickshire referred to. Older people will make up an even greater part of the workforce in the future. In the next five years, it is estimated that the number of people aged 50 to 64 will increase by 800,000, while the number of people aged 16 to 49 will fall by about 300,000. We know that older workers bring great benefits to businesses by drawing on their knowledge, skills and experience, and can help businesses to remain competitive.

    My hon. Friend the Member for Bury St Edmunds spoke about cancer, which is becoming a chronic condition. Although we are living longer, we are living more years in ill health. There is clearly a correlation between our ageing population and the increased prevalence of long-term chronic conditions and multiple health issues, so this is an incredibly important agenda for the nation.

  • Cancer is often referred to as a generic, but various forms present very differently. The TUC has a great campaign called Dying to Work, which is driven by someone with metastatic cancer. They have a limited lifespan, but they want to carry on working. That is part of this agenda. If a person feels fit and able, whatever their condition, the Government should be doing all they can to encourage them.

  • My hon. Friend makes a very good point. Part of the importance of the Green Paper is that it tries to push the concept of work as a health outcome. Whatever someone’s circumstances, meaningful activity is a key part of keeping them healthy, and it benefits their emotional wellbeing.

    We can already move forward with many of the things we trailed in the Green Paper. The one-stop shop will be not just a passive repository for Government information to support employers, but a shop window to the third sector and other organisations that can provide the expert, bespoke support that employers want. If, for example, a business has employed someone with autism, it will want expertise and expert advice, so we want to move forward with that immediately. The Disability Confident scheme is gathering pace, and there are many other things we can do to improve services, such as Access to Work.

    On the issue of statutory sick pay and income protection, through the consultation we have been exploring how employers can actively promote health and wellbeing and manage sickness absence, including whether statutory sick pay should be reformed to better enable supportive consultations and a phased return to work. We also know that group income protection insurance, which offers preventive programmes, wellbeing services and income protection elements, can offer benefits and has the potential to help employers retain disabled employees and those with health conditions.

    Analysis by the Centre for Economics and Business Research indicates that long-term absences among employees who have access to and use early intervention and rehabilitation services tend to be nearly 17% shorter than those among employees who do not. We want employers to do more to invest in their employees’ health and wellbeing, and thereby to reap the benefits that such investment brings. That includes actively considering whether group income protection could be part of the answer in promoting the health and wellbeing of their workforce. That was a key focus of the Green Paper, and we want to focus on it as we go forward.

    We welcomed the responses to the consultation, in which we asked questions about the role the insurance sector should play in supporting the recruitment and retention of disabled people and people with health conditions. We also asked for feedback on the barriers and opportunities for employers of different sizes when adopting those insurance products for their staff. In particular, we asked why larger employers are not making better use of such protection schemes, and how take-up among SMEs in particular can be encouraged. We are now reviewing the full range of opinions expressed in the consultation, and we look forward to continuing to work with the industry to consider how those barriers can be overcome. We will consider what role the Government might play in reducing those barriers to take-up, and what the industry might need to do. We welcome offers to continue to work with the Government on these issues to encourage wider employer action to help employees stay in or return to work.

    A number of health trials are going on at the moment, and we wish to run further trials with our innovation fund. Many of them touch on the incentives for employers to make the investments and follow good practice in their workplace. For example, one trial is introducing a wellbeing premium—a reduction in local business rates provided the business puts in place particular things to support the mental health and emotional wellbeing of its staff.

    As we explore what works and what is good practice for employers, we need to remember that we are already asking employers to do a lot. They have done a lot on pensions, and some of them are doing a lot on the apprenticeship levy. Those are really good things, and businesses clearly see the merits of investing in them. We must also bear in mind that we want employers to create jobs, so we have got to get the balance right. That is why I think this is one of the interesting parts of the Green Paper consultation and the White Paper that will follow.

    It is important that any efforts to improve opportunities and outcomes for disabled people and those with long-term conditions also focus on mental health. Only one in three disabled people with a mental health condition is in employment, and 49% of the 2.4 million employment and support allowance claimants have a mental health condition as their primary condition.

    In January, the Prime Minister announced the first steps in our plan to transform the way we deal with mental health problems at every stage of a person’s life—not just in our hospitals, but in our classrooms, at work and in our communities. An important strand of that plan is to support mental wellbeing in the workplace. That is why Dennis Stevenson, who has campaigned for a better evidence base for mental health for many years, and Paul Farmer, the chief executive of Mind, have been commissioned to review how employers can better support all employees, including those with mental ill health or poor wellbeing, to remain in and thrive through work. They are considering best practice across the full range of employers, and engaging with individuals with lived experience. They will present evidence and recommendations for employers and the Government to consider.

    My hon. Friend the Member for North Warwickshire made a point about measurement, which will clearly be a focus for us as we bring forward our ideas in the White Paper. Although we will continue to report the labour market statistics and look at the disability employment gap and other such numbers, we need locally driven solutions in health and employment services and education, so we need to focus on the current unmet need, whether in healthcare or employment support. By looking at the local numbers and getting local ownership so the different stakeholders can wrap support around the individual, we will get really good things to happen at a local level. That is what we need to enable and encourage—so expect some of those targets, which will look at the actual numbers, and formulas surrounding the disability employment gap. Once again, I thank my hon. Friend for securing this important debate and all hon. Members who took part in it.

    Question put and agreed to.