Keep Britain Working

 Keep Britain Working is the final report of the Mayfield Review into the issues surrounding ill-health and disability in the workplace. Earlier this year, I wrote, with Ian Tasker of Scottish Hazards, a paper for the Jimmy Reid Foundation, Tackling the Causes of Working Age Ill Health, covering similar ground.

We share a common understanding of the problem. As the report says, "Over one in five working-age adults are out of the workforce, substantially because of health problems. Mental ill-health among young people is rising sharply. Older workers are leaving too early. Disabled people remain locked out of work at twice the rate of non-disabled people." It is also true that other countries do better. 

We also have common ground in diagnosing the problem. He found three persistent problems:

• a culture of fear, that is felt by employees and, differently, by employers, especially line managers. This creates distance between people and discourages safe and early disclosure, constructive conversations and support just when they are needed most
• a lack of an effective or consistent support system for employers and their employees in managing health and tackling barriers faced by disabled people. This lack of support is sometimes compounded by a ‘fit note’ system that is not working as intended
• structural challenges for disabled people, creating barriers to starting and staying in work. Compared to international comparators, the UK lacks systemic levers to support disabled people in work, leaving them disproportionately excluded and talent wasted.

The Mayfield solution is "a fundamental shift from a model where health at work is largely left to the individual and the NHS, to one where it becomes a shared responsibility between employers, employees and health services." This includes a recognition that employers need to do more. This was the core message in our paper. Sadly, the Mayfield Review paints too rosy a picture of existing occupational health provision. As we pointed out, very few employers (as low as 3%) invest in the wider range of services that occupational health professionals can provide. For too many employers, the solution to ill health at work is increasingly punitive absence management systems and dismissal. The review also almost entirely ignores the role of safety in the workplace and cuts to the HSE.

The Healthy Working Cycle recommended in the report is fine, as far as it goes. The major failing in the report is the lack of a structural change to ensure it actually happens. His solution is "the development of a Workplace Health Provision (WHP) which is built from the range of existing provision but looks to amplify, expand and improve the availability of it."

The report's delivery option is "a flexible, market-led solution, with employers funding the provision and choosing certified providers that meet their needs. Providers will be assessed against national standards – possibly stewarded by government – giving employers access to a wide range of trusted options." There is very little stick and a marginal carrot in this solution, other than "Over time we would expect that this provision would be formalised and certified." The question any reasonable person would ask is, when we look at where we have got to under the current arrangements, what makes you think employers and their totally inadequate occupational health providers will change?

I don't disagree that employers should fund improved occupational health, as it is their statutory duty, albeit one that is little enforced. However, we recommended "An integrated approach to working-age health, underpinned by including occupational health and vocational rehabilitation in mainstream health care, which no longer relies on inadequate private sector providers." This could be funded in a similar way to the Apprenticeship Levy, which ensures that all employers, regardless of their performance, contribute.

The Mayfield Review claims its changes are ambitious. Sadly, they fall well short of that. Having correctly diagnosed the problem, their recommendations are a hope that employers will change their ways. The cultural change that is needed should have a statutory underpinning; otherwise, in another ten years, we will be asking the same questions, with thousands more workers excluded from work due to ill health. The taxpayer will be picking up the bill, with economic growth a pipe dream.