How do we maintain fulfilling and productive working lives in the face of ill health or disability? The question covers the whole of working life – preparation for and entering work, support when sickness or injury supervene, return to work, and sustaining working life despite impaired heath – and is relevant for an ageing workforce.
Underlying the question is the conviction that everyone benefits from safeguarding the health of working-age people, and supporting them when they are not wholly fit.
This brings responsibilities to many agencies – in public health, in healthcare, in social care and other local authority activities, on those who administer the system of welfare, and on employers. It places on individuals a personal responsibility for protecting and improving their health as far as they can.
There is a growing realisation of the need to support people in a personalised way as they enter and move through the health, social-care, welfare, and employment systems. This thought runs through Improving Lives – the recent work, health and disability Green Paper.
We now have a better appreciation of the impact of health conditions on the way we function in daily life. We also recognise the importance of appropriate work to maintaining health and wellbeing.
Importantly, these aspects have come to be accepted by health professionals as essential elements of clinical practice. That is why the fit note is important. Unlike the sick note that it replaces, the fit note gives a new emphasis to what someone who is not wholly fit can do if sufficiently supported and motivated. It offers an early opportunity to advise patient and employer on the ways to recovery, rehabilitation and return to work. Regrettably, I have to say that the potential of the fit note has yet to be realised.
Mental health is probably the most important – though often hidden – factor underlying sickness and disability. It is a major factor in continuing to work even when unwell.
Although factors outside the workplace come to bear on mental health, often before working age, it is clear that the working environment has a major impact.
A welcome shift in thinking has brought a much-needed emphasis on seeing physical and mental, not as separate domains, but as inseparable parts of health. Although common mental-health problems may exist alone, often they compound the effects of long-term physical conditions.
There is also fuller recognition of the fact that many common disorders fluctuate in their expression and impact. This is difficult to explain to employers. It may be even more difficult for employers to appreciate the impact and the kinds of accommodation that might be necessary to enable the employee to perform at their best.
It is almost expected that, as people age, long-term work-limiting conditions will develop. Experience shows that with the right support and sufficient workplace adaptation, most can maintain sustained and fulfilling work.
Naturally, employers seek to ease the burdens and costs of impaired health. Each organisation has a role in protecting and nurturing the health of its employees – to develop, one might say, a culture of health. Placing the employee at the heart of an organisation is key. It falls to the leading figures in the organisation to ensure this happens.
This article was first published in Reform’s ‘NHS reform at pace and scale’ conference brochure.