Improving Lives: The Work, Health and Disability Green Paper

Published: 31 Oct 2016

NRAS has been pleased to be a part of the government's Expert Advisory Group on work, disability and health for several months (the EAG comprises a wide range of individuals representing long term health conditions, patient organisations, employers and others). The launch of a new green paper today is an important step towards challenging the attitudes, prejudices and misunderstandings that have become engrained in many policies and minds of employers, within the welfare state, across the health service and in wider society

In the 2015 Conservative party manifesto there was a commitment to work towards reducing the disability employment gap. Under 50% of ‘disabled’ people who want to and have the ability to work are in work and there is widespread recognition that not only does this have a simplistic economic impact in terms of lost productivity to UK plc but that it is also hugely damaging to everyone who is able to work, wants to work and yet cannot get back into a job. At the current rate of progress, it is calculated that it will take 200 years before we close this ‘disability employment gap’, something must be done swiftly. We and many others involved in healthcare have long argued that a joined-up approach whereby work is understood to be a health outcome is the only way forward, indeed we argued this when we met with the Prime Minister and the then Secretary of State for Work and Pensions, Stephen Crabb, in June this year. As long ago as 2004 in our survey of members entitled ‘Beyond the Pain’ it was clear from our members’ responses to the survey that those with RA who were in work had significantly lower incidence of depression than those out of work and the majority felt that having a job helped them to cope with their RA.

The government has just published: Improving Lives: The Work, Health and Disability Green Paper. A green paper is a consultation document from government which sets out their findings on a topic and asks for contributions towards answering some questions they pose on how we can collectively move forward and improve the current system. Once the paper is published, this triggers the start of a consultation period. This is where The Government invites the public, and all stakeholder groups including charities like NRAS, employer organisations and others to answer the questions posed in the Green paper and provide feedback, ideas and give suggestions as to how issues might be better designed in future.

Sometimes green papers and other consultations from government can seem as if they have only been released when the minds of ministers and civil servants have already been made up. This is not so with this green paper as there are many wide-open questions for employers, patient organisations, healthcare professionals and any individual with an interest (that means you!) to answer.

This green paper comes from the Joint Work and Health Unit, a cross-government team reporting to both the Department for Work and Pensions and the Department for Health. You may be aware that earlier this year, our Chief Executive, Ailsa Bosworth, was appointed to the Joint Work and Health unit’s Expert Advisory Group and has given us a direct opportunity to feed in on behalf of people with RA/JIA for several months now. We are delighted that the first case study in the document, in Chapter 1, focuses on Susannah Everington, an NRAS Member who shared with us her story of living with RA and working. Ensuring decision makers think of RA and adult JIA when considering the impact of long-term health conditions on work is a coup for everyone who lives with this invisible and poorly understood disease.

The focus of the green paper is largely on supporting people who have fallen out of work due to disability/ill-health to return to the workforce (if they are able to and want to). Sadly, for many who do want to get back to work, the majority of people who have been out of work for more than 6 moths never return so we, and many others involved, are calling for early intervention to support people who fall out of work. Return to work support is vitally important and yet we are a little disappointed that the joint Work and Health Unit and consequently this green paper has not addressed more fully the ways to support those already in work to remain in employment. Staying in work, with adaptations to work hours or the working environment that make it possible to carry on with your life despite your long-term condition is hugely important to people with RA/JIA and we hear this on a regular basis from callers to our helpline and through our social media platforms. There have been some inferences in social media that people who can’t work are being forced back to work. This is certainly not our experience having worked with the Joint Work and Health Unit in recent months. It’s about helping people back to work who want to get back to work but are struggling to find a way and supporting those in work who may be worried about being able to stay working, remain in employment for as long as they are able and want to.

One of the suggestions within the Green Paper that may help support ‘staying in work’ is a shake-up of the current system of GP fit-notes. It is widely believed that the current binary system of either being fit or unfit to work with no grey area in-between is totally inappropriate for the modern workplace and the lives of those with long term conditions. The Employment & Support Allowance (ESA) and, in particular, the means of deciding who is eligible for each component of it, the Work Capability Assessment (WCA), is agreed to also be too narrow in its outlook. The government seeks answers on how to reform the WCA to better capture the spectrum of experience of people with disabilities but it is worth emphasising that this is only one part of a much broader consultation and we need to consider all aspects of the Green Paper in addressing the questions asked.

Once the consultation is complete, it will be for the government with the help of the Work and Health Unit and its Expert Advisory Group, to decide next steps. Employers may consider legislation of any kind to be heavy handed but it would not be out of step with the statements made by Theresa May in her first few days as Prime Minister when she made clear she was not afraid to challenge employers. It is fair to say that there is no shortage of ‘guidance’ on best practice and something more concrete may be needed to effect real change, especially in small/medium sized employers (SMEs) who sometimes struggle to commit resource to make changes to support disability in the workplace. The responses from people with disabilities and long term conditions to this consultation will inform the government about how far the current system of soft-nudging works and whether they should be pursuing more active measures.

The consultation will last until mid- February, we will update you on the ways in which you can respond as soon as possible, at which time we would encourage as many as possible who are directly affected, to participate in this important consultation. NRAS will of course be submitting a response on behalf of all affected by RA and adult JIA and we shall be seeking your help and input in due course and will let you know more about how you can get involved very soon. In the meantime, we are here to help anyone who may have queries about the process so that as many with RA/JIA can make their views and their voice heard.

Link to Green Paper