The number of people unable to work because of their health had been ticking upwards for some years, but Evans says the real jump came after Covid. Part of this is likely to have been the knock-on effects of the virus itself, with long Covid continuing to cause problems for many workers, for example.
But Evans says a key driver has been the increasing number of people unable to work because they are struggling with their mental health. “There is a big rise in people citing mental health conditions, so that’s making up a much bigger proportion than in the 90s, say, when you still had some of the legacy of industrial changes in the 1980s,” he says. “With mental health, I think people are more willing to say they have a mental health condition – there’s more openness about this stuff and more knowledge and awareness – and there may well be a rising prevalence as well.”
Where physical health is concerned, musculoskeletal conditions such as back and neck pain are the leading cause of being unable to work, whether as a result of heavy lifting or being scrunched over a computer screen.
Long delays for treatment of both physical and mental conditions, as the NHS creaked and waiting lists lengthened in the aftermath of the pandemic, appears highly likely to have increased the number of workers struggling with their health.
Turning things around
The potential benefits of turning around the increase in nagging long-term health conditions are significant.
The Learning and Work Institute estimates there are an extraordinary one million fewer people in the workforce than projections before the pandemic might have suggested.
The UK is an outlier here – we are the only G7 nation whose employment rate has not returned to its pre-Covid level, in part because of these health pressures. And without intervention, the IPPR’s analysis suggested the number of people out of work because of long-term sickness could hit four million.
Evans points out that one in five of this group say they would like to work. He argues that proportion might rise, with better health and employment support.
“The proportion who say they want to work is relatively low, but that’s partly because no one ever talks to them about the kind of work available, or flexibility. So it’s not like a fixed number,” Evans says. As it stands, only 1% of people out of work due to long-term sickness are in work six months later.
Getting Britain working
Labour came to power pledging to tackle some of these challenges. Liz Kendall has announced a target of an 80% employment rate – in other words, 80% of the working-age population in a job. More details are expected to come in a white paper on how to “get Britain working”.
With the current rate stuck at 75%, Evans says that would mean an extra 2.4 million people moving into a job, whether from sickness or off the unemployment roll.
“There is an economic prize here. We believe the 80% employment rate could boost the economy by at least £23bn,” he said. That is the dividend in additional GDP growth as inactive people return to work. Evans argues there would also be a direct benefit to the Treasury of £8bn, as workers paid tax and claimed fewer benefits.
The upfront costs might be £200m a year, the Learning and Work Institute suggests. That may make it sound like a no-brainer; but Evans adds that it is likely to be a decade-long challenge, while the Treasury’s horizon tends to be shorter.
“One of the challenges is the current fiscal rules look at debt in five years’ time. This is about long-termism. Getting to 80% is a really good idea but it will take10 years to get there.”
Best avoid benefit reforms
Evans says Labour will need to take action across a range of fronts, to help coax some of the long-term sick back into the workforce.
Health secretary Wes Streeting’s plans to reform and reinvest in the NHS will have to be part of the solution – and the economic benefits of getting people back into work provide a powerful rationale for getting that right.
Reducing the poverty and inequality that can leave people more vulnerable to health conditions – as the pandemic showed – is another part of the puzzle. The IPPR has pointed to the importance of combating obesity as a health but also an economic challenge.
Evans warns against another lever it may be tempting for ministers to use – benefit reforms. “I think benefit reform is a bit like squeezing a balloon and if you halt it in one area it pops out in another. So I would say the better thing is to improve health and inequality, sort out the health service, but also have some high-quality support on offer to people,” he says.
Some local authorities already run back-to-work schemes that help people to confront health challenges and support them back into a job. Evans suggests Labour make that approach much more widespread and easy to reach.
“You find people where they are: it could be the community centre, the GP surgery, the library, the shopping centre.” He adds: You can’t just tweak the benefits system and get there: you also need to look at what employers do, how the NHS is operating, levels of poverty – you need to look at all of those things together.”
