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Work, health and growth: A guide for local councils

Work health and growth - a guide for local councils
This briefing provides local councillors with a strong business case to improve work and health and economic growth outcomes in their local council. The focus is on supporting people to stay in work; helping people return to work; and helping people who are not in work to find employment.

Foreword

There is strong evidence that work is good for people’s health and, that when people are in good health, they are more likely to find, remain in and be productive at work.

Conversely, unemployment and economic inactivity through long-term sickness are associated with worsening health outcomes with a negative impact on individuals, communities, and wider society. Once economically inactive through ill health, the data shows us that few people move back into employment. Therefore, reinventing – or managing – ill health at work and supporting people who experience ill health to get back into work is critical for improving population health outcomes, tackling health disparities and realising the wider economic benefits that come from increasing participation in the labour market.

Improving work and health outcomes for everyone across the country requires effective action by local and national government. Action must be tailored to local needs and involve partners across the health and welfare systems and wider industry. 

Local councils play a key role in this as major employers, leaders of local economic development and, as commissioners and providers of services. 

It is for this reason that the LGA and the Office for Health Improvement and Disparities (OHID) have produced this updated guide on 'Work, Health and Growth'. By setting out the evidence base on the relationship between work and health, and providing case studies on existing good practice, we hope that this guide will enable a better understanding of how local authorities and their partners can support work and health outcomes in their communities. 

By working in collaboration, we can help people to find, remain in and be productive at work, improving their health and benefiting society as a whole. 

David Fothergill and Dr Jeanelle de Gruchy

 

Dr Jeanelle de Gruchy
Deputy Chief Medical Officer for England 
Co-Lead of the Office for Health Improvement and Disparities

Councillor David Fothergill
Chair
LGA Community Wellbeing Board 

Office for Health Improvement and Disparities and the Local Government Association logo side by side

1. Introduction

Creating healthy workplaces entails supporting disabled people and people with long-term health conditions in their work settings. It is also important to ensure the health and wellbeing of healthy employees who do not have existing health conditions is maintained - work and the workplace can play a pivotal role in prevention. 

As adults in employment spend a large proportion of their time in work, our jobs and our workplaces can have a big impact on our health and wellbeing. In fact, employment can impact both directly and indirectly on the individual, their family and community. Therefore, there is a significant opportunity to promote positive healthy behaviours in the workplace, reducing the numbers of people who develop health conditions and improving productivity.

Work and health is central to the story of people and place. We need to increase participation in the labour market and improve productivity. Helping people with health issues to gain, retain and progress in work supports economic growth and is a crucial part of the wellbeing of every community.

What is the cost of ill-health?

There is strong evidence that, in general, work is good for health and long-term unemployment is consistently associated with poor health outcomes. Ill health among working-age people costs the economy around £100 billion a year. It can also affect people’s participation in the labour market, with over 300,000 people annually, falling out of work and onto health-related welfare. Once people fall out of work due to long-term sickness, they are very unlikely to move back into employment.

Following a historic low prior to the pandemic, the economic inactivity rate increased from 20.2 per cent  (8.37m) in Dec 19 – Feb 20 to 21.6 per cent  (8.73m) in Jan 23 – Mar 23. This is an increase of 360,000, of which, 330,000 were aged 50 to 64 (by far the biggest increase of any age group) and 440,000 stated that their main reason for being inactive was long-term sickness - this has been offset by a fall in the number of people who are looking after family/home and retired. This is now the most common reason for being economically inactive, but this trend started in 2019 - prior to the pandemic. The economic inactivity rate increased by 0.1 percentage points on the quarter, to 21.1 per cent in May to July 2023. The increase in economic inactivity during the latest quarter was driven by people aged 16 to 24 years. Those inactive because of long-term sickness increased to another record high. Meanwhile, those inactive because they were looking after family or home decreased to a record low.

This has a huge cost to the individual, families, communities, employers and public services. There is a strong economic argument to address health-related worklessness, across public expenditure, the wider economy and personal and household income. It is estimated that having one extra disabled person in full-time work, rather than being out of work longer term, would mean Government could save and re-invest £15,000 a year. Alongside this, the value of coordinating provision across ‘place’ is critical. A cost benefit analysis of the LGA’s Work Local reveals that by using existing national investment more effectively, the number of people improving their skills or finding work could increase by 15 per cent.

What local benefits can ‘good work’ bring?

There is a clear relationship between health, work and growth, which is illustrated in Figure 1: good health contributes to high productivity and successful enterprises which supports economic prosperity, and the social wellbeing and wealth of communities.

Figure 1: Health and Work Cycle

Health and work cycle; a healthy and happy workforce has synergistic benefits for: workplaces, productivity and the economy. Good worker health pointing arrow to productivity at work pointing to business competitiveness pointing to economic development and prosperity pointing to social wellbeing and weath.

 


Good quality work is supportive of an individual’s health and wellbeing and protects against social exclusion through the provision of income, social interaction, a core role, identity and purpose.

Jobs need to be sustainable and offer a minimum level of quality, which should include:

  • a decent living wage
  • opportunities for in-work development
  • flexibility to enable people to balance work and family life
  • protection from adverse working conditions that can damage health.

Conversely, poor quality work and jobs with low job security are associated with increased risk of common mental health problems and physical health conditions, such as musculoskeletal health conditions.         

Supporting Good Work: Good Work Project

The LGA has produced an online resource to help councils and combined authorities to support good work in their local area, including outlining what local benefits good work can bring and advice on how local government can support good work and top tips for supporting this. Councils could support good work by promoting good work charter schemes, creating social value through procurement and grants, giving and offering local business support. 

What role can local government play in improving health and work outcomes?

As strategic leaders of people and place, councils have wide-ranging functions and expertise that are vital to facilitating system change and to enabling more people to get into good work. These include:

  • Civic and political leadership - as trusted convenors of partners, LAs work across the system and span all public services, private and charitable sectors to deliver whole-system change, efficiency and unlock economic growth to meet local need. Increasing numbers of councils have devolved responsibility through city, growth and devolution deals.
  • Direct deliverers of services - councils are responsible for public health, links with health provision and many other services including Family Information Services, Universal Support for Universal Credit Delivered Locally (USDL) and local advice services. LAs provide support for people, including those with complex barriers, so they can be training or work ready.
  • Large employers and commissioners – LAs are direct and indirect employers of members of their own community, and work with the public and private sector to deliver added-value employment and skills opportunities through social value.
  • Knowledge of the local economy – through their economic development functions, working with employers and businesses of all sizes, connections with further education providers and data analysis to ensure national and local provision is targeted and used to develop growth.
  • Ability to integrate – through their services, strategies and wider civic engagement, LAs provide added value by integrating locally commissioned employment provision and encouraging collaboration between agencies and skills providers. They also connect and promote multiple national employment, training, skills and economic growth initiatives; developing their own offer to address gaps or integration in the system.

Top tips for local government to support good work

  • Lead by example - get internal stakeholders on board and ensure that your own organisation is actively supporting good work in the same way that you are asking others to. 
  • Keep it simple - depending on what works for your local business community, focus on a specific issue. Whether it be developing a public procurement framework to promote social value, introducing a Living Wage or developing a local 'good work' charter. Embed it in everything you do from recruitment to procurement strategies to work programmes. 
  • Spread the word - segment your employer market and work out ways of reaching and engaging them with the support of clear message and high-profile ambassadors.
  • Plan long term - this won't happen overnight. Work out what you need to make your approach sustainable in the long-term and ringfence sufficient resources to deliver your vision. 

Further information on these top tips can be accessed here. 

Health and Work: The local picture

There is considerable variation in health and health-related employment outcomes across the UK. The latest information can be accessed from the Fingertips Tool: Wider Determinants of Health - Work and the labour market resource page

Regional unemployment rates aged 16 years and over (seasonally adjusted, May 2023 to July 2023): 

  • West Midlands 5.0 per cent
  • London 4.8 per cent
  • North East 5.2 per cent
  • East 4.3 per cent
  • North West 5.3 per cent
  • East Midlands 4.1 per cent
  • South East 3.9 per cent
  • South West 3.6 per cent
  • UK average 4.3 per cent.

Difference between the employment rate (percentage points) for people with a physical or mental health long term condition and the employment rate for the general population by region [2021/2022].

England 2021/22 9.9
North East region 2021/22 13.8
North West region 2021/22 12.2
London region 2021/22 11.4
Yorkshire and the Humber region 2021/22 10.1
South West region 2021/22 10.1
East of England region 2021/22 9.0
East Midlands region 2021/22 10.2
West Midlands region 2021/22 8.9
South East region 2021/22 8.1
 

Sickness absence rate, by region of residence, UK, 2022

Great Britain 2.6%
England 2.5%
North East 3.1%
North West 2.6%
Yorkshire and The Humber 2.6%
East Midlands 2.7%
West Midlands 2.7%
East of England 2.2%
London 2.1%
South East 2.3%
South West 2.7%

 

2. Work and health agenda: key terms

What is the working age population?

The working-age population is individuals aged 16 to State Pension age (SPA). SPA for women equalised with SPA for men at 65 in November 2018. Both men’s and women’s SPA then increased from 65 to 66 between December 2018 and October 2020. The Pensions Act 2014 brings forward the increase in the SPA for men and women to 67, provided for in the Pensions Act 2007, to between 2026 and 2028.

What is health-related worklessness?

People not in employment for a health reason. Technically it can be defined as people claiming out-of-work welfare for a health reason or, being otherwise unemployed or economically inactive due to ill health.

Who is classified as unemployed?

The unemployed population is “people who are without a job, want a job, have actively sought work in the last four weeks and are available to start work in the next two weeks or, are out of work, have found a job and are waiting to start it in the next two weeks.”

What is economic inactivity?

People not in employment who have not been seeking work within the last four weeks and/or are unable to start work within the next two weeks

What is disability employment rate?

Difference in employment rate between disabled people and those who are not disabled. For example, the disability employment rate was 52.6 per cent  in July to September 2022, compared to 82.5 per cent  for non-disabled people.

What is the definition of disability under the Equality Act 2010?

You’re disabled under the Equality Act 2010 if you have a physical or mental impairment that has a ‘substantial’ and ‘long-term’ negative effect on your ability to do normal daily activities.

What is workplace health and what are workplace health interventions?

Workplace health is promoting and managing the health and wellbeing of staff and includes managing sickness absence and ‘presenteeism’ (a person physically at work but not fully productive). Workplace health interventions are activities undertaken within the workplace by an employer or others to address these issues; it also includes action to address health and safety risks.

How do you create a healthy workplace?

Creating healthy workplaces entails supporting disabled people and people with long-term health conditions in their work setting. It is also important to ensure the health and wellbeing of healthy employees who do not have existing health conditions is maintained - work and the workplace can play a pivotal role in prevention.

Being in good employment reduces the risk of mental health conditions such as depression and psychological distress but, for some people, can also be a cause of stress and common mental health problems. Line managers play a vital role in determining the health, wellbeing and engagement of their teams. By improving their management capabilities, managers can achieve better results, improving their own wellbeing as well as that of their teams, achieving better results and benefiting the organisation as a whole.

The 2017 independent Stevenson/Farmer review of mental health and employers makes a number of recommendations for the public sector, government and employers on managing mental health at work. The Business in the Community Employer Toolkit suite provides employers of all sizes with a roadmap to improve workplace health.

What is the evidence that health and work are linked?

  • employment is a primary determinant of health, impacting both directly and indirectly on individuals, their families and communities
  • long-term unemployment is associated with an increased risk of mortality and morbidity, including limiting illness, cardiovascular disease, poor mental health, suicide and health-damaging behaviours
  • individuals unemployed for more than six months have lower wellbeing than those unemployed for less time.

What is the cost of ill health?

  • The total economic cost of lost output and extra health costs among working age people is estimated to be around £100bn a year
  • £53-56 billion annual cost of poor mental health to UK employers
  • £18.8 billion annual cost to society in workplace injuries and ill health.

In 2022, 185.6 million working days were lost because of sickness or injury in the UK equivalent to 5.7 days per worker. 

What are the benefits of being in work for people with long-term conditions?

  • Good quality employment
  • promotes recovery and rehabilitation
  • leads to better health outcomes
  • minimises the harmful physical, mental and social effects of long-term sickness absence and worklessness
  • reduces the chances of chronic disability, long-term incapacity for work and social exclusion
  • promotes full participation in society, independence and human rights
  • reduces poverty.

What is the scale of health-related worklessness?

  • In November 2020, 3.5 million working-age people were claiming a benefit with a health condition.
  • In Q1 2023, the disability employment rate was 53.7 per cent, compared to 82.7 per cent  for non-disabled people
  • The disability employment gap was 29.0 percentage points in Q1 2023.

What is the health of the working age population?

  • One in five people aged 16 to 64 in the UK are classed as disabled
  • One in three people aged 16 to 64 in the UK report having a long-term health condition.
1 in 3 working age people in the uk have a health condition, 1 in 6 adults will have experienced a common mental health disorder in the past week and 1 in 10 employees in the uk reported having a musculoskeletal condition.

 

Ill health in employment

  • One in four UK employees reported having a physical health condition, and one in five of employees with physical health conditions also reported having a mental health condition.
  • In 2022, minor illnesses were the most common reasons for sickness absence, accounting for 29.3 per cent of occurrences of sickness absence. This was followed by "other" conditions at 23.8 per cent, musculoskeletal problems at 10.5 per cent, respiratory conditions at 8.3 per cent  and mental health conditions at 7.9 per cent.

What are the benefits of businesses investing in workplace health?

  • reduction in absence and increased productivity
  • return on investment mental health at work – return of £5 every £1 spent
  • reduced staff turnover and associated reduction in recruitment costs.
Employment and treatment outcomes

Employment is associated with improved treatment outcomes as well as less severe and less frequent relapse for people with a history of substance misuse. For people in employment at the start of treatment and at their six-month review, the average number of days they were in employment in the last 28 days increased. This rose from 17.6 days at the start of treatment to 17.7 days at their review.
 

3. What services are available to help people with health conditions or disabilities back into work?

The Government operates various schemes that practically and financially help support employment among people experiencing ill health:

Disability Confident – The Disability Confident scheme supports employers to make the most of the talents disabled people can bring to the workplace. It provides employers with the knowledge, skills, and confidence they need to attract, recruit, retain and develop disabled people in the workplace. The scheme provides support for employers who might lack the confidence to recruit disabled people or might need guidance to support an employee who has acquired a disability during their working life. 

Access to Work – can help an individual get or stay in work if they have a physical or mental health condition or disability.

Adjustment Passport – to support transitions into employment. Access to Work is supporting a series of Adjustment Passport pilots. The passport will provide a living document of workplace adjustments, reduce the need for assessments, support the holder to have confident conversations about their disability and adjustments. The pilot should actively raise awareness of Access to Work.

The Work and Health Programme (WHP) – provides voluntary employment support, for disabled people and disadvantaged groups who are motivated to work and expect to find work within 12 months. Participants receive personalised and tailored support for up to 15 months followed by six months’ light- touch, in work support.

Better Health

Better Health is one of the Government’s flagship public health campaigns, aimed at contributing to improved health outcomes and reducing health inequalities. It exists to motivate and enable the nation to enjoy better health, encouraging and supporting people to take steps to improve their physical and mental wellbeing.

Activity is focused on a number of health behaviours including weight loss, physical activity, mental health and quitting smoking. Campaigns promote evidence-based tools and advice to show adults and families the simple steps they can take to make and sustain changes to improve their health. This includes the NHS 12-week Weight Loss app, Couch to 5K, Mind Plan and Active 10.

Local government can support Better Health in the workplace by ordering resources

Activity is focused on a number of health behaviours including weight loss, physical activity, mental health and quitting smoking. Campaigns promote evidence-based tools and advice to show adults and families the simple steps they can take to make and sustain changes to improve their health. This includes the NHS 12-week Weight Loss app, Couch to 5K, Mind Plan and Active 10.

Local government can support Better Health in the workplace by ordering resources

The LGA has conducted its own analysis of national employment and skills-related provision for its member authorities to help them navigate the provisions available. This includes employment support for people with health conditions such as Access to Work and Intensive Personalised Employment Support. 

 

4. How local councils can improve work and health outcomes

Local councils, as employers, can take actions to ensure that the health and wellbeing of their workforces is looked after, regardless of the size of their organisation or the sector in which it lies. These actions range from ensuring workplace health is prioritised by senior members of staff, to encouraging healthy behaviours in the workplace such as taking regular breaks and eating well.

Local councils already have existing governance mechanisms in place such as their Employment and Skills Boards (ESBs) which aim to bring partners together to encourage collaboration and provide intelligence to national agencies and delivery partners. These could also be used to further improve health and work outcomes in their communities. Alongside ESBs, it would be useful to engage with:

  • Health and Wellbeing Boards (HWBs)
  • Integrated Care Boards and Integrated Care Partnerships
  • Devolution partners where relevant
  • Employers of all sizes, their regional representatives and new Employer Representative Bodies (ERBs) established to develop Local Skills Improvement Plans
  • Employees
  • Voluntary and Community Sector Enterprises
  • Jobcentre Plus (JCP)/Department Work and Pensions.
Work and health: Integrated Care Systems (ICSs)

The Health and Care Act 2022 builds on the work of non-statutory Integrated Care Systems (ICSs) by establishing Integrated Care Boards (ICBs) and requiring the creation of Integrated Care Partnerships (ICPs). This will empower local health and care leaders in the NHS, and with local authorities to join up planning and provision of services and help improve health outcomes.

ICPs are a joint committee of the ICB and their partner Local Authorities. ICPs are responsible for producing integrated care strategies, and both LAs and ICBs must, so far as relevant, have regard to the strategy when exercising their functions. In July 2022, DHSC published guidance on the preparation of integrated care strategies - GOV.UK (www.gov.uk). This encourages ICPs to consider the importance of employment as a wider determinant of health, and consider engaging with employers and employment support services on this agenda.

ICSs have four key aims: improve outcomes in health and healthcare; tackle inequalities in outcomes, experience and access; enhance productivity and value for money; and help the NHS support broader social economic development.

Unlocking the NHS’s social and economic potential produced by the NHS Confederation sets out in detail what social and economic development is, why it matters to the NHS and vice versa, how ICSs might deliver against this purpose for the benefit of its populations and where next this form of broad, strategic partnership working might lead system thinking.

Leadership:

  • promote this agenda to partnerships within which they operate and, in management of their own staff
  • use their unique position to bridge the gap between the health and economic agendas, linking HWBs and economic agencies to help them develop joint approaches and programmes, and contributing to Integrated Care Partnerships
  • help shape the social norms and expectations of the public and professionals regarding health and work so that everyone expects, and wants, to work in a ‘good job’
  • use devolution powers and any changes in business rates to drive action to improve health outcomes.

Engagement:

  • promote and encourage take up of services and initiatives led by national Government (Access to Work, Adjustment Passport, Intensive Personalised Employment Support, New Enterprise Allowance and the Work and Health programme)
  • promote close working with JCP and local health services
  • promote efforts by supplier companies within the local government supply chain to employ and retain people with disabilities or health conditions 
  • foster a vibrant charity and social enterprise sector to develop creative and innovative projects to help people with disabilities or health conditions back into work.

Management:

  • undertake a needs analysis to profile health issues within the local workless population and develop services and support to address these needs.

How can local government improve workplace health in their local area?

  • identify champions for this work amongst elected members and key local businesses
  • ensure a workplace wellbeing scheme for employers is in place
  • ensure your local health risk reduction and promotion programmes (e.g., NHS Health Checks, NHS Stop Smoking Services) are maximising opportunities to partner with employers for delivery within, or linked to, workplaces
  • use levers including provision of advice, partnership working, incentivisation and accreditation, enforcement of employer legal obligations, and contractual levers of procurement using the Social Value Act 2012, focusing especially on those within the supply chain to the local authority
  • promote efforts by supplier companies within the local government supply chain to employ and retain people with disabilities or health conditions
  • promote and increase awareness of the NICE Quality standard [QS147] Healthy workplaces: improving employee mental and physical health and wellbeing  and guideline [NG212] Mental Wellbeing at Work .
  • prioritise employment through the HWB, including consideration in the JSNA and Joint Health and Wellbeing Strategy (JHWS), with links to the Employment and Skills Boards (ESBs) which aim to bring partners together to encourage collaboration and provide intelligence to national agencies and delivery partners
  • co-commission health and employment services between the local authority and NHS ICBs
  • share and access good practice among local authorities through the LGA and the Office for Health Improvement and Disparities
  • promote and increase awareness of national programmes, guidance and legislation on employment of those with long-term or fluctuating health conditions.
  • encourage employers to offer expert work and health support, such as occupational health services, to staff. Evidence shows that occupational health (OH) can support people to return to and thrive in work but access and awareness levels vary, particularly for small and medium sized enterprises (SMEs) and self-employed.

5. Improving workplace health case studies

 

6. Local case studies of partnership working and approaches to support workless people

 

7. Resources for local government

NICE guidelines:

Mental wellbeing at Work (NG212) 

Tobacco: preventing uptake, promoting quitting, and treating dependence

Promoting Physical Activity in the Workplace (PH13)

Workplace policy and management practices to improve the health and wellbeing of employees (NG13)

Evidence reviews and briefings

LGA guidance:

Work Local: Unlocking talent to level up

Good Work Project

Learning for Life: the role of adult community education in developing thriving local communities

Government resources:

What Good Health at Work Looks Like

Health inequalities: place-based approaches to reduce inequalities

Guidance on the preparation of integrated care strategies

Health matters: health and work

Using the Social Value Act to reduce health inequalities in England through action on the social determinants of health

Improving working conditions/job quality PHE evidence reviews and briefings

Local healthy workplace accreditation guidance

Inclusive and sustainable economies: leaving no-one behind

Data tools:

Health and Work: infographics

Work, worklessness and health: local infographic tool

Movement into employment: return on investment tool

Health and Safety Executive guidance:

Working together to prevent sickness absence becoming job loss. Practical advice for safety and other trade union representatives

How to tackle work related stress

Working together to reduce stress at work

Making the best use of lifting and handling aids

Managing upper limb disorders in the workplace

Don’t mix it: a guide for employers on alcohol at work

Drug misuse at work

Consulting employees on health and safety

HSE: Information about health and safety at work

Health and safety for disabled people at work

Managing sick leave and return to work - HSE

Health surveillance and occupational health - HSE

Managing drug and alcohol misuse at work - Overview - HSE

Home working - HSE

Employer resources

Developing and evaluating workplace health interventions: employer toolkit

BITC Health and Wellbeing Toolkits

Support with employee health and disability

Mental Health At Work

Disability Confident employer scheme

Access to Work

NHS Employers Health and Wellbeing

ACAS Health and Wellbeing

CIPD Health and Wellbeing at Work

References

  • M.Marmot, J.Allen J, P.Goldblatt , T.Boyce, D.McNeish, M.Grady, et al. Fair society, healthy lives: strategic review of health inequalities in England post 2010. London: The Marmot Review; 2010.