What must happen for the work, health and disability Green Paper to succeed

The Government’s recent work, health and disability Green Paper sets an ambitious target for closing the disability employment gap. Nick Pahl, CEO of the Society of Occupational Medicine, looked at what needs to be done in Personnel Today.

The work, health and disability Green Paper goal of closing the disability employment gap is a welcome initiative. The gap is the difference in employment rates between disabled and non-disabled people. Currently about 48% of disabled people are employed compared with 78% of non-disabled people. The disabled have work aspirations like anyone else and feel especially vulnerable at work.

The UK has an ageing workforce, with increasingly complex health needs. People are usually of working age when they develop their disabilities, and once they are out of work, the chance of finding work is slim. In December 2016, Cardiff University published research that found the economic recession affected disabled people more – with pay being frozen and overtime more restricted (Fevre et al, 2016).

The Green Paper has an ambitious target – to half the disability employment gap within the next 10 years, a challenge that initially appeared in the Conservative Party manifesto in 2015. As a society we can no longer ignore or underplay the multiple barriers that influence entry into work, return to work and health in the workplace. Employers should not assume that disability will necessarily lead to dismissal, with or without a redundancy package.

Cancer survivors are 1.4 times more likely to be unemployed than the general population, despite 65% of people affected thinking it’s important to continue to work, according to the charity Macmillan. Key work issues for people with cancer are reasonable adjustments, coping at work, discrimination and unhelpful and unsympathetic employers. We know that appropriate work has a very positive affect on health, and we can improve access to timely support to help people stay in work.

So, what can we do to stop people with disabilities leaving work, help them into work, and prevent disability surfacing as a disciplinary issue or grievance? People need a simple and user-friendly approach. Employers, particularly small employers, need the right support at the right time. We need the right employment culture (and the public sector needs to lead by example).

Understanding the disadvantages disabled people face is a good place to start, before addressing the workplace practices responsible. We need to reduce the variation experienced by disabled people in employment, with a greater sense of partnership between health professionals, as well as working with job centres and business. We need to standardise our approaches and create networks to enable sharing of good practice. Government and agencies need to bring in performance indicators – not just for employment but to monitor pay and ensure work is seen as a health outcome.

Action has already begun. In November 2016 the Government announced new personal support within Jobcentre Plus and investment in coaches in skills and capabilities for work to help people with disabilities.

But the disability employment gap target is ambitious. Based on current trends, it will take until 2065 to close it, assuming the UK economy can deliver these jobs, and disabled people can gain access to them. If the Government is to deliver, a step change is needed to alter perceptions about health and work, and it cannot achieve this alone.

Three outstanding questions are raised by the Green Paper:

  • Should other health professionals be able to issue fit notes? If so, who and what qualifications and training would we expect them to undertake?
  • Can the fit for work service be improved – or does something very different need to replace it?
  • What is the role of insurance benefits in supporting the recruitment and retention of disabled people?

OH professionals often report that their advice is ignored. They experience role ambiguity as they work on behalf of both employers and employees. Frequently, they find their work is contracted out so they are remote from the workplace (so becoming “de-contextualised”). It is important that new OH models are developed and HR practitioners are given tools that are “disability-sensitive” with recommendations appropriate to individual needs.

The Green Paper is reassuring in two particular areas. It makes it clear that being a disability-sensitive employer does not necessarily drive up employment costs – although that does not mean failing to invest in OH provision. The document also addresses the issue of “mandation”, by making it clear disabled people should not be forced into return to work programmes.

We need to stop seeing disabled people as a problem. They have the same right as everyone else to work. Facilitating any person into work benefits us all so we need to seek solutions. We need to understand and challenge assumptions in this area, and spread awareness of employment rights.

There are also some quick wins. Some interventions to close the disability gap will be particularly effective, eg ensuring employers have access to good quality advice on fitness to work. Such interventions can achieve a workplace free of discrimination.

The “Work, health and disability” consultation closes on 17 February.


Fevre R, Foster D, Jones M, Wass V. (2016) “Closing Disability Gaps at Work – deficits in evidence” Cardiff University.

“Work, health and disability: consultation”. October 2016. Department of Health.

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