Consultation outcome

Plain English version: Work, health and disability green paper

Updated 30 November 2017

Ministers’ statement

From Damian Green, Secretary of State for Work and Pensions and Jeremy Hunt, Secretary of State for Health.

This government wants a country that works for everyone.

Whoever you are and wherever you are from you should be able to get the right healthcare and the right help and support so you can do the best you can.

The things someone can do well and their hopes should be taken into account.

A disability or a health condition should not stop a person from doing the things they want to in life, or in the workplace.

Our health systems and welfare systems don’t always help people to do the best they can.

Too many people stop work when they get ill or when they have a condition that is getting worse. They then find it very hard to return to work.

When a person isn’t working:

• their health and wellbeing can get worse
• employers miss out on their skills
• costs to health services increase

This has to change. We know that the right type of work has a positive effect on people’s physical and mental health.

Good health and the right support helps people in the workplace.

Our welfare and health systems need to take this into account.

We need to give:

• the chance to get a job to everyone who can work
• help and support to everyone who could work
• care to anyone who can’t work

This country has a good track record with disability rights.

The NHS gives the best support to people with poor health. But millions of people are not given the chance to do the best they can with their life.

It is now time for us to change this.

We hope we can make these changes. We will need new ideas and we will need to make changes to the way our systems work.

We must change the way people act and speak so that everyone is treated fairly and in the same way. We will need to make these changes in the welfare system, in the health system and in society.

This is why we are having this consultation.

We want to know what it will take to improve the chances of disabled people and people with long-term health conditions getting a job.

We want to make changes. But we can’t do it alone. Please join in with us. Together we can make a healthier, working nation.

Summary

We know that only 48 out of every 100 disabled people are in paid work. But 80 out of every 100 non-disabled people are in paid work. The gap between these 2 figures is too big. We want to halve this.

There are 4.6 million disabled people and people with long-term health conditions who are not working. This is wrong. We need things to change.

We know that many people with long-term health conditions do not see themselves as disabled.

We know that health is important for everyone.

We want to help everyone to have better health, be independent and to feel happy. This is more likely to happen when people have a job.

The longer a person does not have a job, the more likely it is that their health and wellbeing will suffer. Having the right type of job is good for a person’s mental and physical health. Having a job can also make people feel better about themselves and develop their social skills. Many disabled people and people with health conditions already have a job. Many more people want to work and feel better because they are working.

We’re running this consultation because we want to:

• make the welfare system better so we can get more disabled people and people with mental health conditions into work
• make sure that people get financial support in a simple way that is easy to understand
• find ways to make the health and welfare system’s assessment process better

Our aims

There are more people in work now than there have ever been.

It is not fair that there are nearly 4 million disabled people out of work. We want to help get many more disabled people into work.

Having all these people out of work is a waste of talent and potential that the country can’t afford.

We need to understand why disabled people may not be able to get a job, or keep a job. We also need to understand the wide range of conditions disabled people have to deal with.

The area people live in can affect their health and also their chances of getting a job. There can also be barriers to getting a job, like finding it hard to use transport, and finding it hard to get in, or move around, buildings.

People who have certain health conditions can be worse off than other people. For example, only 32 out of every 100 disabled people with mental health conditions have a job.

Many health conditions get better or worse over time. But once someone is out of work because of a health condition and claims Employment and Support Allowance, their chance of finding another job is low.

Employment and Support Allowance is a benefit for disabled people and people who have a health condition. Most people will talk to a Jobcentre Plus worker who will help them get ready for work.

We know that some people will not be able to work and will need financial support, like Employment and Support Allowance.

But some people who start to claim benefits like Employment and Support Allowance will be affected by not working. This can make their health problems worse.

This is a problem that cannot be fixed quickly or easily.

We need to make a system in which helping people is the main target. The new system must give everyone the chance to do the best they can.

What the green paper says

This green paper looks at how employers, the welfare system and health services can work together to keep people healthy and in work.

Disabled people and people with long-term health conditions can work with employers to make changes in their workplace.

These changes could be that disabled people and people with long-term health conditions play a bigger part in conversations about how well their employer is doing. Employers could also arrange for help and support to be given to workers when it is needed.

Employers can give their workers the power to manage their own health conditions. This will help disabled people and people with long-term health conditions do the best they can.

We want to work with many different people to bring about change. We want to work with the voluntary sector as they are experts in helping and supporting disabled people and people with long-term health conditions.

We also want to support carers as they play a big part in helping and supporting disabled people and people with long-term health conditions.

We will work with the governments of Scotland, Wales and Northern Ireland and also local councils to improve the support that people are able to get.

Making sure the changes last

Making these changes will take a long time. We want to work with others to see which parts of the system we should look at.

We will invest £115 million to develop new and better ways of supporting people with work and health needs.

We want to make sure that we make the right changes and that these changes last for a long time.

How we’ll make these changes

We want to:

• help and support more people into work
• improve assessments for benefits for people with health conditions
• help and support employers so they are happy to employ more disabled people and people with health conditions
• support employers to help disabled people and people with health conditions to stay in work
• make sure everyone gets high-quality health care to help them get into and stay in work

We will explain how we can all play a part in making these changes and how you can answer the questions in this consultation at the end of this plain English version.

Helping people into work

We want everyone to have the chance to work. If people want to work we should help them do so. Universal Credit has already started to improve some things by putting people first and giving support that is targeted at each person.

A new Personal Support Package

We are starting a new Personal Support Package. This will allow work coaches to give people a new type of work support that is made just for them and will meet their needs.

Helping work coaches improve

It is very important that a work coach gets on well with the person they are helping.

From 2017 we are creating better training courses for work coaches. Work coaches will be better able to support people with mental health conditions. They will also be more confident when they need to talk to employers about mental health.

We are going to recruit 300 more Disability Employment Advisers for Jobcentres. They will help work coaches to support claimants with health issues.

We will also recruit about 200 people from other groups and organisations, especially from the voluntary sector, to help our work coaches. They will be called Community Partners.

These people can tell us about the barriers disabled people come across when they want to find and stay in work.

We will increase the number of Journey to Employment job clubs to 71. These job clubs are run by disabled people. They give support to groups of people.

We are going to try having a work coach, a health care professional like a doctor or a nurse, and a person who has been put in the Work Related Activity Group of Employment and Support Allowance working together.

We want to see if this will help work coaches get the right help and support for people. If it does work we will try this in other places.

Employment and Support Allowance

We have set up a new Health and Work Conversation that will be conducted soon after a person claims Employment and Support Allowance. This is when a work coach and an individual talk about what the individual can do to move closer to work at the same time as looking after their health condition.

Disabled people and people with a health condition may have to take part in the Health and Work Conversation. But whatever they agree to will be voluntary. Any agreement will be written in a new Claimant Commitment.

A Claimant Commitment sets out what you have agreed to do to prepare for and look for work, or to increase your earnings if you are already working.

Employment support for disabled people and people with long-term health conditions

People with health conditions will be able to get a wide range of employment support.

The new Work and Health Programme will help disabled people get past barriers to work. It is aimed at people who, with help, are likely to find a job within 12 months.

Disabled people can ask to take part in this programme at any time.

People can get advice, guidance, training, work placements and work experience from the Specialist Employability Support programme. This programme will continue until 2018.

The Specialist Employability Support programme helps disabled people find a job. Once they are working they are given help and support so they can do the best they can.

Disabled people and people with long-term health conditions who want to start their own business can get help from the New Enterprise Allowance scheme.

The New Enterprise Allowance scheme can give people, including disabled people and people with long-term health conditions, money and support to help them set up their own business.

We will keep working with local councils to test supported employment for people with a learning disability or autism who are known to adult social care or are in touch with specialist mental health services.

Supporting people with mental health conditions

We are testing new ways to give specialist support to people with mental health conditions.

This will help us to improve the support that we give people with mental health conditions.

Supporting young people

Not enough young disabled people or young people with health conditions get a job after they finish at school, college or university.

We want to give these young people better help and support.

We will do this by:

• looking at and testing a supported work experience programme for people who can only do a few types of work
• making it easier for young people with a learning disability to get apprenticeships
• giving all young people with an Education Health and Care Plan the chance to study with an employer to learn the skills they will need at work. This is called a supported internship.

Making it easier to get employment support

We want employment support services to be tailored for each person.

We know that some people may not be interested in employment support at the moment, but they may be interested in the future.

We will learn how to work with people in the Support Group. We will also test different ways of giving people employment and health support.

At the moment people in the Support Group do not need to stay in touch with the Jobcentre. We are thinking about introducing a ‘keep-in-touch’ discussion between these people and work coaches once a year.

We will explain how we can all play a part in making these changes and how you can answer the questions in this consultation at the end of this plain English version.

Assessments for benefits for people with health conditions

We want people to be able to get the help they need. This includes financial support given, in a simple, straightforward way, especially if they have a severe disability or health condition.

We want to make sure people get employment support and financial support.

The Work Capability Assessment for Employment and Support Allowance and Universal Credit does not lead to the kind of employment and health support service that we would like.

We would like employment and health support services that are made for each person.

The assessment that people get at the moment puts people into set groups. More than 1.5 million people are put into a group where they get no support to find a job. Often they do not speak to a work coach at all.

These people should get still extra help with money. But they should not all be treated in the same way as they have a wide range of health conditions and needs.

Changing the assessment process

We need to decide if the Work Capability Assessment is the right way to choose what help and support with work someone gets.

This is important if we are going to make sure that people can get tailored support at the same time as any financial support that they need.

We could just use assessments to decide if a person should get extra financial support. Decisions about employment support could be made separately.

Work coaches could decide what employment support. They could target this help and support to each person.

This would mean that people get support that is made just for them and that is based on their needs. This would be separate from the assessment that decides their financial support.

Improving the information we use to assess financial support

It is important that services that give financial support to people in need work well with each other. Also, we must use the information we have so that people get the best service possible.

The Department for Work and Pensions uses information from the Service Medical Board if it can.

This means that a severely disabled person does not have to have extra examinations to claim Employment and Support Allowance.

We think it may be possible to use this kind of system to help members of the armed forces even more in the future.

If a person leaves work because of a health condition or disability, they may be using services run by the National Health Service and other support like adult social care.

They may also claim other benefits like Employment and Support Allowance, Universal Credit, Disability Living Allowance or Personal Independence Payment.

Disability Living Allowance is money that someone with a disability or a health condition may be able to get to help them pay for the extra costs of being disabled.

Personal Independence Payment is money that someone with a disability or health condition may be able to get to help them pay for the help and support they need.

These benefits have different assessment processes. This means people often have to give the same information to claim the benefits. Sometimes this can’t be avoided, but we need to look at sharing information across the benefit processes.

This will make it easier for people who have to give the same details over and over again.

A starting point for sharing information could be between Employment and Support Allowance, Universal Credit and Personal Independence Payment, as long as the information is up to date.

This would mean that once someone has given information about their health condition to one part of the welfare system the same information can be used if they make a claim to a different benefit.

We will also look to see if the assessment process could use information that is already held by the NHS or local councils.

People with the most severe lifelong conditions

Some people have severe lifelong health conditions and disabilities that will never get better. These people need a lot of care.

We have decided that from next year if people claim Employment and Support Allowance and have a severe condition they will not need to have any more assessment after their first Work Capability Assessment.

We want to know if there should be a simpler more straightforward way for people with severe health conditions and disabilities to ask for help and have an assessment.

We could use information that is already held by the NHS to help us make a decision.

We will explain how we can all play a part in making these changes and how you can answer the questions in this consultation at the end of this plain English version.

Helping employers get new workers and healthy workplaces

We want a future where being disabled or having a health condition does not stop anyone doing well in their job.

We know there are employers who give jobs to the best people, whether they are disabled or have a health condition or not. They also help their workers stay healthy at work. This will help employers get the most from their workers.

We want more employers like this. Having disabled people and people with health conditions working for them will help their business. We would like to hear what you think about this and how to do it.

How we want employers to act

We want the public sector to take part in the changes.

We will make sure the public sector check the way they run their businesses. We will take action if we find any issues.

We want all public sector employers to join the Disability Confident employer scheme over the next 12 months.

The Disability Confident employer scheme helps employers understand how they can do more for disabled people and people with health conditions.

We will get the public sector’s suppliers and those who get public funding to do more to help and support more disabled people and people with health conditions into work.

Getting people to talk about their disability or health condition

Employers can help people start or stay in work if they know about a disability or a health condition.

A lot of health conditions are hidden and some people may not want to tell their employer about it.

Also, employers may not be comfortable talking about a person’s health condition or disability.

But if an employer is told about a person’s disability or health condition they can work with the person to help them do the best they can in their job.

It also means that employers can make changes to the workplace to make it easier for people to manage their disability or health condition.

We want to have workplaces where workers feel confident about telling their employer about any disability or health condition.

We also want to see employers using that information to improve the health of their workers.

Helping employers

Some employers may not do anything about health and wellbeing because they do not know enough about it, or they do not have anyone to help them.

There is a lot of information available to employers and we want to know how we can make it easier for employers to get hold of it.

We will look at how to bring all of this information together in one place.

We will run some campaigns for employers about work and health so they know what to do to help more disabled people and people with health conditions.

Helping people do well at work

We don’t just want more disabled people and people with health conditions to get into work. We also want to help more people do as well as they can at work.

We will get employers to talk to each other so they can swap ideas and share their best ways of working. We may also include charities and workers in these groups.

We will set up a Disability Confident Business Leaders Group to talk about disabled workers. We will start with the top 250 companies.

Finally, we want to get employers to understand why they should put money into workplace health and wellbeing.

Getting employers to try new things

We want to know if an incentive would get employers to make new jobs or try something new to support more disabled people and people with health conditions in work.

Some incentive schemes have already been set up. We want to know what you think about incentives and what type of scheme you think we should use in the future.

We will explain how we can all play a part in making these changes and how you can answer the questions in this consultation at the end of this plain English version.

Moving into work

When employers are looking for new workers, they can make sure their process includes disabled people and people with health conditions.

We have lots of schemes to help and support people into work, including Access to Work.

Access to Work can help pay for a support worker, or the extra costs a disabled person might have in travelling to and from work. It can also help pay for things like special computers a disabled person might need to help them do their job.

Staying in a job or going back to work

When a person becomes ill or their health condition or disability gets worse, they need help and support from their employer.

The help and support an employer gives to people can be the difference between the person staying in work or having to leave their job because they can’t cope.

Occupational health services are teams of people that keep workers well at work. They will help to keep workers healthy and safe while dealing with any risks in the workplace that may make people ill.

Occupational health services can help employers tell people about health and wellbeing. They can also help workers look after a health condition or disability while they are working.

But occupational health services are not offered to people as often as they should be.

We want to know how we can get employers to offer occupational health services to their workers.

Time off work because of sickness and Statutory Sick Pay

If people are allowed to change to flexible working it can help them look after or recover from a health condition and go back to work. Flexible working allows people to make changes to the way they work. For example, they can start work and finish work at different times during the week, they can share a job with another person or they can sometimes work from home.

We know that it can help people to come back to work if employers keep in touch with workers who are off sick.But Statutory Sick Pay and fit notes from the doctor can also stop employers talking to workers who are off work sick. This is because the employer thinks that the person can be off work until the Statutory Sick Pay or the fit note runs out.

Statutory Sick Pay is a payment that is paid to a person who earns more than the lower earnings limit of £112 a week and is off work sick for 4 days or more. The employer pays Statutory Sick Pay. It lasts up to 28 weeks.

Statutory Sick Pay and fit notes should not stop an employer from talking to a worker about staying in their job or going back to work.

We want to change the Statutory Sick Pay system to support employers talking to workers who are off work sick.

We also want to change the Statutory Sick Pay system to support employers talking to workers who are off work sick. We also want to change Statutory Sick Pay to help employers give workers who have been off work sick the chance to slowly go back to full-time work.

Statutory Sick Pay is only paid if someone is not working at all. One thing we could do is to encourage employers to top up the wages of workers to the amount of Statutory Sick Pay if the worker goes back to work on fewer hours.

This would mean that the worker would get the same amount of pay even though they were slowly going back to full-time work.

Getting employers to take out income protection insurance

Employers can take out insurance to help them deal with the risks and the effect of sickness. This insurance is called group income protection insurance.

The insurance usually includes activities to stop sickness, give help and support for workers and employers and an amount of money, after an agreed period of time, when a worker cannot work.

We think this insurance should be used more to help employers look after their workers’ health and wellbeing. Most small and medium sized businesses do not take out the insurance. We would like to know why this is and how to change it.

We will explain how we can all play a part in making these changes and how you can answer the questions in this consultation at the end of this plain English version.

Health and high quality care for everyone

We want people to get the right health and care support, in the right place, at the right time. This will let them get the most out of their job and keep them healthy.

We want this care and support to start with the person and to meet their health needs and help them to get work and stay in it.

We know that services do not always work well together, which means people can miss out on support.

We want everyone to work together, to stay as healthy as possible and to prevent ill health. This includes patients. We want patients to be able to look after their own care.

Giving people more control over their health

If someone is working and has health problems, their workplace can support them.

This means it is more likely that the person will stay in their job, which is good for both their finances and their health.

Having better conversations about fitness for work and fit notes

Doctors can work out if a person is fit to work.

Doctors can also see if there is any support that means someone can stay in work, like slowly going back to full-time work over a set period of time, or having reasonable adjustments made to the workplace.

Reasonable adjustments include when a change is made to a building, a work area or to the way something is done. The change makes it easier for a disabled person to do their job, or for a disabled customer to get better services.

The fit note was designed to get doctors and their patients to talk about work and health. The fit note can be important in helping a person look after their condition, stay in work or go back to work. A doctor can also send the person to the Fit for Work service. The Fit for Work service gives many kinds of advice and support. For example, health services and advice about money, housing and help to stay in work.

At the moment the fit note does not always do what it is supposed to do. In many cases the decisions that are made do not show that a person can work if they have the right support. We want a system where people:

• get support to understand their health condition
• get the treatment they need

We also want employers to get information that can help them support their workers.

We want healthcare professionals to:

• have the right skills and know about health and work
• understand that work is important for health
• use fit notes well
• use the Fit for Work service

We are going to look at how fit notes work. Then we will look at whether we should let more healthcare professionals, as well as doctors, issue fit notes to people.

Mental health and musculoskeletal services

Too many people with common mental health conditions, like anxiety or depression, stop work. And too many people with common musculoskeletal conditions, like back pain or arthritis, stop work. Too often people with common conditions cannot get the services when they are needed.

Many of these people end up getting sickness benefits and never go back to work.

The Improving Access to Psychological Therapies programme helps more people use the services for common mental health conditions. We are going to expand this programme so that more people can use it.

We are going to look at new ways of using musculoskeletal services.

We will link help and support for work more closely with treatment. We will also make it easier to send people to the service.

We will collect information about patients with musculoskeletal conditions more often.

Making work and health services for individual people

Occupational health services and vocational rehabilitation services keep people healthy and safe in work. They also manage risks in the workplace that may cause ill health.

At the moment these services do not work together and they are not easy to use. Also, these services are not made for each person taking account of their needs.

Only some employers give people occupational health support.

Many health professionals do not know enough about occupational health.

We want occupational health services to meet the different needs of people. Whether they are off sick from work, out of work, or self-employed.

We want to make some changes to occupational health services. We want everyone who can be sent to occupational health services to be sent, unless it would be against the law or it is not right to do so.

We will look at how we can get the occupational health services working with the health and social care systems.

Local health and employment support

We want health services and employment services to work together in local areas.

This could mean just one service giving people health and employment support. Or it could mean joining local services together.

Sharing information

Sharing information can help people stay healthy and in work.

We will work with others to collect information about whether people are in work or not.

We will find out how well local areas are helping people to stay healthy and in work.

We will also look at how we can bring together evidence about work and health in one place so people can use it when making new services.

Work is good for people’s health

We know that work is good for people’s health. We want to make sure that all health and care professionals are able to make this part of their everyday work and when they are training, they are taught that work is good for people’s health.

Patients as partners

Patients and those people who use services should be partners in their care.

We can support this in different ways:

• give better information about using the employment and healthcare systems
• give people the chance to refer themselves to services
• help people to understand how to look after their conditions better

Taking action together

Getting many more of the 4 million disabled people who are out of work into work is a big challenge.

We will make changes quickly. But only when we are sure that it will help.

We need other people, groups and organisations to work with us. We want to:

• change the way people think and act towards disabled people
• talk to a wide range of people, groups and organisations who are interested in disability
• set up a 10-year programme of work to make the changes

Changing the way people think and act towards disabled people

We want the way people think and act towards disabled people to change.

We want a society where disabled people and people with long-term health conditions are always helped and supported into work.

We want other people, groups and organisations to join us and understand the way work, health and disability are linked.

Whatever support a person gets, they must always be met and treated in the right way.

Making a 10-year plan

We want to help many more disabled people and people with long-term health conditions who do not have a job get into work.

We know that this will be hard to do and that it will take time. Bit it is important because we want a country that works for everyone.

About this consultation

We want people to answer the questions so that we can bring together all the answers we get.

We will then start talking to lots of people, groups and organisations to work out how to make changes and what we need to do.

Different people will need or want to answer the questions in different ways. We have made ways for them to do this:

• We will have face-to-face talks that are run by charities and employers to talk about the ideas we’ve described
• You can give us your answers online
• You can send an email to workandhealth@dwp.gsi.gov.uk
• You can send a letter to this address:

The Work, Health and Disability Consultation,
Ground Floor, Caxton House,
6-12 Tothill Street,
London,
SW1H 9NA

We will be happy to get your suggestions, personal experiences and ideas.

This consultation will end on Friday 17 February 2017. Anyone can send us their answers.