Get Britain Working: A Response to the White Paper
The government’s recent publication of the Get Britain Working White Paper offers an overview of the challenges driving economic inactivity in the UK, alongside a range of proposed solutions.
The Paper succeeds in accurately framing the interconnectedness of the challenges faced in the UK, and underscores the scale of the task ahead. Among the key issues identified are:
Demographic shifts impacting workforce composition.
Worsening mental and physical health across the population.
The burden of unpaid care and its effect on caregivers’ ability to participate in the workforce.
The need for proactive, prevention-based interventions to mitigate these problems before they escalate.
While these challenges are relatively common across developed nations, the White Paper recognises that their cumulative effect has placed the UK in a uniquely difficult position by comparison. Why this may be, is not interrogated.
The Value of Economic Activity
The Paper recognises the value of economic activity for individuals and communities. However, it does not connect this up to the elephant in the room: the severe funding constraints facing public services, and how this is inextricably linked to economic inactivity by way of reduced tax revenues.
By framing economic inactivity as a public service failure requiring a public service solution, the White Paper presents a narrow view. While public sector reforms are undoubtedly part of the equation, I do not believe they can deliver the scale of change needed to address these multifaceted challenges.
Why Public Service Reform Alone Isn’t Enough
There are limits to what public service reform can achieve in solving these challenges, and over-reliance on this approach risks misallocating increasingly precious resources. Here’s why:
Declining health:
Public services are already being stretched by increasing need. Can they keep expanding fast enough to meet these demands? Just this week, NHS Scotland was found to have an unsustainable level of spending. Prevention is definitely part of the solution here, but is not something public services have delivered on historically.
Changing attitudes to work and health:
Societal norms around work-life balance, flexibility, and health have shifted since the covid-19 pandemic, requiring a broader cultural response. A decline in purchasing power has moved the goalposts on people’s approach to work and earnings. Economic activity takes different forms for an increasingly wide range of people.
The role of market forces
Market forces often drive innovation and improvement faster than public services alone. Employers that understand and prioritise the connection between work and health are already creating supportive workplaces to leverage the mutual benefits of a healthy and productive workforce.Shifting the narrative
The communication surrounding work and health must evolve. We need a narrative that empowers individuals to view economic activity as a positive factor in their health, and understand that health and function can be dynamic and relate to psychosocial factors as well as pathophysiology. A shift from a deficit-focused narrative, with punitive messaging to one of autonomy, opportunity and partnership will be essential to engaging both individuals and organisations in this mission.
Missed Opportunities: Where Is Occupational Health?
One glaring omission from the White Paper is any mention of occupational health. This is a significant oversight, as occupational health is the seat of evidence and expertise when it comes to the relationship between work and health. Given the scale of the challenges outlined in the Paper, failing to leverage this expertise is disappointing.
Lara’s take: Work and health are not static
Reassessment is key in questions of work and health. This is something I communicate to workers, HR and managers in my occupational health practice all the time. In life, our wider psychosocial situations, health, function and work situations can be fluid. This month, things may be impossible, next month things could be better. Or, next month, things could deteriorate. Of course, there are periods of stability, but oftentimes when people are in a period of sickness absence there are some moving parts. The only way to keep momentum up in the right direction, with a view to building up function is frequent dialogue.
Reassessment is most useful where the professional involved has expertise in work and health, and expertise in consulting skills, drawing on tools from a range of techniques, for example motivational interviewing and coaching. There needs to be opportunity to use each contact to signpost people out to what could help. This can include, but is not limited to, medical treatment. The other resource that is important in these dialogues is time, the lack of which can be a barrier to effective use of the fit note in General Practice.
Opportunities for reassessment, dialogue and support are part of the puzzle in supporting people to leverage their own relationship between work and health for productivity. But in order for this to be effective, our societal position on work and health has to change. We must get better at communicating that the ability to work is rarely a binary concept. Health and function can deteriorate, and can also get better. External factors, including stressors in work and outside of work are relevant, and may even be where the greatest leverage for improvement lies.
