Comment Blog 27 March, 2024

Rather than joining-up broken public services, we need big picture reform

Florence Conway

In a recent interview with The Times Liz Kendall, the shadow Work and Pensions Secretary, said that JobCentres will be made to work with the NHS in an effort to get rising numbers of people suffering with long-term illnesses back to work: “I want JobCentres to actually have some duties to collaborate with the NHS and other bodies”. She went on to say that the joining up of public services to improve outcomes for the economically inactive will be vital to the success of a future Labour government: “I know how important this is, primarily for people, but really for the mission of the next Labour government.”

She is right to draw attention to the worrying level of long-term sickness and economic inactivity. According to the February ONS Labour Market data, 2.8 million people aged 16-64 are not in the workforce due to ill health — a one-third increase on the 2.1 million before the Covid-19 pandemic. These figures mean that the UK is the only G7 country with a lower employment rate than before the pandemic. What is more, Resolution Foundation analysis shows that the current levels of economic inactivity are “very far from normal” and that the rise “due to long term sickness…stand[s] out”; something they note as being particularly concerning for the future both in terms of the health of the nation and the fiscal cost.

Kendall is also right that economic activity and ill health cannot be tackled in isolation, which means considering how services like JobCentre can be geared towards addressing the link between the two. One’s health and their ability to work are inextricably linked; disability and poor health affect whether and how someone can work, while bad and unsupportive workplaces can affect health.

But having JobCentres work with a primary care system which is itself failing to meet the growing burden of ill health is unlikely to be a silver bullet.

Currently, our model of care is not fit for purpose. The NHS operates as a poor ‘national sickness service’. More specifically, the primary care system does not intervene enough in the upstream stages and fails to support people before they are forced to leave the labour force.

We cannot just join up broken systems and expect a better result. Simply stating that JobCentres and the NHS should work together will not automatically reduce the 2.8 million people who are not in the workforce due to ill health, especially without the health service becoming much better at prevention.

If a future Labour government is set on having a joined-up agenda to achieve transformative outcomes, then this must be accompanied by genuine public service reform. Policy should look to better understand and confront why it is it that so many people are in ill-health in the first place and cannot work.

This means directly addressing the health system’s inability to cope with current demand, and a continued rise in long-term and multimorbid conditions. It also requires an approach that no longer assumes that general practice will be the front door to primary care but instead incentivises the earliest possible intervention and is focused on health creation.

Luckily for whoever might lead a future government, Reform’s 'Reimagining Health' programme is producing a paper that will rethink primary care. Watch this space to see Reform’s proposed model and, if you are interested in fixing our broken public services — get in touch!