The UK’s recent Improving Lives Green Paper offers a window of opportunity for much-needed change in health-related unemployment. Its proposed reforms, however, are inadequate, writes Adam Whitworth. He highlights the central role of capacity, conditionality, and connectivity in bringing about genuine change.

Health-related unemployment and sickness absence are key challenges in the UK, as in many nations. At 32%, the UK’s disability employment gap is amongst the largest across the advanced economies – 81% for individuals without a disability compared to 49% amongst individuals with a disability. Around 70% of the UK’s working age population who are unemployed and in receipt of key out-of-work benefits have a health condition or disability. Yet despite years of policy attention health-related benefit caseload remains stubbornly high, benefit exit rates remain woefully low, and the employment aspirations of many individuals continue to go by unfulfilled.

The present government have sought to respond. Government has committed itself to the ambitious target of halving the disability employment gap, has penned the Improving Lives Green Paper and formed the innovative joint Work and Heath Unit between Department for Health and Department for Work and Pensions to help achieve it. All welcome. But ultimately lacking the ambition and honesty to engage with the real issues underpinning this disappointing context and, as a result, doomed to failure.

Despite the fanfare the government’s present approach to health-related unemployment (and, indeed, effective support for wider groups with more severe and/or complex support needs) is woefully inadequate in four key areas: capacity, connectivity, conditionality and co-production. Many other key issues remain but these four are at the absolute root of the policy problem.

So what is needed across these four elements to begin to deliver an effective employment support system for these types of service user?


The vast majority of the UK’s unemployed benefit-receiving population are in receipt of health-related Employment and Support Allowance (ESA). Just in crude financial terms ESA benefits cost £15bn per annum. Yet, astonishingly, these individuals currently receive no (ESA Support Group) or virtually no (ESA Work Related Activity Group) offer of employment support at all. Individuals with health issues are largely abandoned. It does not take an academic expert to point out that this is madness. The gradual shift to Universal Credit changes the terminology but nothing else fundamentally.


A related problem is that effective employment support for individuals with more complex support needs will also need to involve coordinated support from a range of wider support services – mental and/or physical health needs, housing, transport, skills and experience, self-esteem, families, and so on. This connectivity of local support services around the core employment offer is however largely absent in the system due to the UK’s unusually high degree of policy centralisation and the Department for Work and Pension’s (DWP) reluctance to work collaboratively in genuine partnership with local areas and key local services to these shared central-local objectives.


The UK’s austere conditionality and sanctions regime has for some time been running well ahead of the evidence. Good work is known to be good for health and most unemployed benefit claimants with health issues wish to work. But they may not feel ready to work right now, they do not wish to accept ‘bad’ work that does not fit in with their needs and/or that harms their mental or physical health, and they do not wish to be mandated to work where this harms rather than helps their health and quality of life. Nor do their health practitioners want this, and this is important for DWP because these local health partners are key to engage in terms both of sourcing referrals as well as providing health support alongside and coordinated with core employment support. But health colleagues, all too often, with good reason, have concerns around whether engaging their patients in the DWP activation regime as it currently stands is in the best interests of their patients. Both for the interests of service users and the engagement of health partners, therefore, at least for these types of cohorts the UK activation regime must be voluntary in nature and involve no risk of sanction.


There is a need to fundamentally restructure employment support interactions and journeys in more positive and personalised ways via their co-production between service users and employment advisors. Indeed, these ideas of meaningful co-production and re-centering the employment system around the service user speaks to a wider need to rethink DWP’s current standard view of what employment support does and should look like. At present the employment support regime is dominated by an under-resourced, process-driven Jobcentre Plus alongside a relatively small contracted-out model of very large contract geographies, a small number of Prime providers and an over-reliance on a strong payment-by-results model to drive desirable behaviours and outcomes. A raft of literature has highlighted the significant limits of each to make meaningful in-roads into health-related and more complex support needs.

There are several distinct problems in each model, yet a shared problem of each approach is the marginalisation of the voice, role, desires and well-being of service users who are cast as passive objects to be acted upon by providers. In contrast, the effective motivation, engagement, well-being and sustained outcomes for service users within employment support programmes requires them instead to be treated as active and equal partners co-producing their support needs and journey in their own interests with their employment advisor as their equal partner. Health-specific activation models such as Individual Placement and Support that follow these principles are well-evidenced internationally to be effective.


Employment support policy alone cannot provide all the solutions to the UK’s sizeable health-related (un)employment challenge. But well-considered, evidence-based employment support models tailored to, and effective for, the needs of service users will inevitably be a necessary part of any positive transformation. The current government’s position is welcome but hopelessly limited. Old habits, inflexible policy thinking, Brexit bandwidth, shrinking budgets and detachment from academics and evidence make a challenging context for policy-makers to deliver the type of radical change in approach required. But there is a recognition that continuation of the status quo is neither desirable nor affordable. Windows for change will open up and it is important that the academic community is ready and waiting with the right kinds of evidence and engagement to seize the opportunity when it does.


Note: the above draws on the author’s published work in The Journal of Poverty and Social Justice.

About the Author

Adam Whitworth is Senior Lecturer in Human Geography at the University of Sheffield.




All articles posted on this blog give the views of the author(s), and not the position of LSE British Politics and Policy, nor of the London School of Economics and Political Science. Featured image credit: Pixabay/Public Domain.

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