Poor health means poor work prospects

What do you think:

  • Improving health and upskilling must be part of helping people to get back to work?
  • If better education improves skills leading to better jobs with less health risks, would we increase overall employment?
  • Are failings in education the root cause of high unemployment for people with long-term health conditions?
  • Is there any point in employment support without tackling poor health?

Catching up on summer reading, the Joseph Rowntree Foundation June report reveals just how significant poor health and low skills can be when unemployed people try to get jobs, stay in work, increase their wages and progress to full-time, permanent employment.  All of this resonates with current thinking that there needs to be much closer links between Jobcentres and the NHS when tackling unemployment.

Having a disability isn’t necessarily always associated with “poor health” (as many Para Olympians demonstrate) but there’s no doubt that many of those claiming benefits due to long-term health conditions will say that their health is poor.  We would all want them to have a better chance of working – with all the financial and social benefits that this can bring.  But the report suggests that work is not always going to lift them out of poverty because:

  • When people with poor health are employed, their jobs are more precarious, lower paid and more likely to be part-time and temporary.
  • People with poor mental health or drug/alcohol misuse can fare even worse.

However, it seems that having more skills can offset the disadvantages of poor health.  Which does beg the question as to whether having skills in the first place (and so avoiding those jobs with higher health risks) helps reduce the likelihood and/or consequences of poor health.  Perhaps it all goes back to the success (or not) of the education system?

Here are a couple of quotes from the report (the layout is mine):

  • “individuals who report poor health are significantly more likely to move
  • from employment to unemployment,
  • from permanent to temporary contracts,
  • from full-time to part-time work and
  • from activity to inactivity.
  • Similarly, they are significantly less likely
  • to stay in employment,
  • to move from unemployment to employment,
  • to move into a full-time job and
  • to move into a permanent job.

This section (of the report) also presented evidence which highlights that individuals with poor health are less likely to move out of low-pay employment and are more likely to move into low-pay employment.”

“Although this does not establish a causal relationship between poor health and labour market disadvantage, it is nevertheless informative and revealing about the importance of good health in relation to the labour market performance of individuals in Britain.”

“A more sophisticated statistical investigation than the one presented here would be needed to investigate the causal impact of health and qualifications on the labour market performance of individuals. Nonetheless, the results reported here suggest that while having poor health is not the only issue associated with relatively unfavourable labour market transitions, it is a principal one, and a lack of qualifications exacerbates the problem. Putting it differently, having some formal qualifications can mitigate the adverse relationship between poor health and labour market performance.

The evidence presented here suggests that for some labour market transitions (such as those involving movements from unemployment to different employment types) the lack of skills seems to be more important than poor health.

However, for other transitions, such as for staying in employment, as well as for the passage from activity to inactivity, health seems to matter more than skill.

However, no clear picture emerges from this analysis of whether qualifications or health status is more important for transitions into low-pay and into temporary work.

One thing that can be said with a little more certainty is that the presence of qualifications seems to have a mediating effect on the negative labour market experiences associated with ill health.

Also, as in the previous section, the results are stronger when mental health is used as the health indicator than when physical health status is used.”

If you are involved in employment support or public health, the report’s Section 7 covering Summary, conclusions and policy implications is worth a read.

Penny Melville-Brown

Disability Dynamics ltd www.disabilitydynamics.co.uk

Helping disabled people to work since 2000

Public health support disability employment

What do you think? • Funding from Public Health is the way to get more disabled people back to work? • Or is strong leadership focused on outcomes for disabled people the real answer to reducing their cost to the State? • Blind design in pewter is OK but the molten metal is probably a step too far!

The Institute for Public Policy Research (IPPR) has new ideas about using Public Health money to help more disabled people work – it sounds rather like a return to the old DHSS (Department for Health and Social Security for you young ones!).  A key difference is that they suggest that local Councils lead: “holding the budget, brokering or commissioning provision, and being held to account for performance”.

Our Help to Work activities (www.helptowork.org.uk) have already successfully tested the IPPR vision of partnership delivery:  “to draw together a range of services and support – across employment health, housing, skills, substance abuse and so on”.  Our Steps to Success model shows the different types of help that might be needed – and it is clear that no one delivery organisation can do it all.  To succeed, we know that delivery partners often need to adapt their support for disabled clients:

  • Personal.  One-to-one support tailored to individual needs; flexibility about timings, duration and location of support; building in reasonable adjustments and alternative formats from the outset.
  • Holistic.  Able to coordinate a range of different help without clients becoming lost during “hand-offs”.  Reducing “creaming” and “parking” by valuing outcomes other than just jobs/self-employment.
  • Specialist.  Fully trained and experienced staff; case loads planned on client needs rather than the budget.
  • Local.  Recognising that disabled and disadvantaged people can’t or won’t travel; targeting realistic individual travel-to-work labour markets.

This could all look expensive but is far more achievable if cost is spread across the public sector bodies that will reap the benefits.  IPPR suggests funding from DWP, the health sector (about 7% of Public Health funding plus contributions from Clinical Commissioning Groups), European funds plus social investments.  But this may be not ambitious enough.  There is clearly a case for contributions from other parts of the State that will also see benefits from more disabled people in work: From less re-offending, more tax and NI payments, more skills etc.

Localism is core so the IPPR idea of future Combined Authorities taking the lead could be risky: just new levels of bureaucracy amongst Councils covering large areas with little knowledge or experience of employment support across the diversity of disabilities.  Most important is that they don’t waste time and money on re-inventing the wheels that so many of us have been successfully turning for years.  It may be too optimistic to just bolt on new tasks to existing structures that already have long-term priorities.  Instead, many Councils may need new employment support movers and shakers to drive the vision forward.  If all the experience and target-driven culture of Jobcentres, Work Programme and Work Choice have failed, it is going to take more than different funding streams, devolved responsibilities and partnerships to succeed.   Strong leadership focussed on outcomes for disabled people has more chance than simply moving the deckchairs.

The paper’s recommendation to increase the obligations of both employers and employees to return to work is probably overdue but not demanding enough.  Indeed, they seem to suggest that the Equality Act 2010 is failing: “There are also few requirements on employers to make adjustments to work duties or working conditions or to offer an alternative job, to facilitate a return to work”.  Perhaps there needs to be a sanctions regime as tough as that for benefit recipients that is applied to employers’ unlawful behaviour – without having to go to employment tribunals?  A fairer balance of obligations and consequences faced by both employers and employees would be a valuable step forward – but perhaps there is little political appetite for challenging employers when the vulnerable are easier targets.

Click to read the full report

Finally, on the vexed issue of benefit sanctions, surely most of us agree that there need to be some obligations placed on those claiming benefits (“conditionality”) but equally penalties for failing to fulfil such must be fair and just – see the Guardian article

Bouquet of the week.

Disability creativity

Disability creativity

Goes to Fleur for helping me turn my clay models in to useful little pewter objects.  She did all the complicated pouring of molten metal and soldering while I made moulds with Lego.  It was a good start but I’m going to do better.


Penny Melville-Brown

Disability Dynamics ltd www.disabilitydynamics.co.uk

Helping disabled people to work since 2000

150216 - Pewter picture with PMB card 2