Not so long ago employers were frightened of ill health.
Good employers were concerned that being in work would cause some harm.
Responsible employers acted to protect people, keeping them off work until they were fully recovered.
But perversely they may have been doing more harm than good.
We now understand that work is not necessarily bad for you.
People with physical or mental health conditions do not need to be protected from work and sometimes maintaining some form of working life can aid recovery.
This understanding was first put forward by Aaron Antonovsky.
It was expanded upon by Waddell and Burton.
And helpfully formed an evidence base upon which I developed my welfare reform report.
Work provides more than just an income. Employment can also give people a sense of purpose, some structure to their lives. It can also be an important part of people’s social lives.
Quite simply good work is good for you.
In Government we are beginning to measure employment as one of the positive results we can expect from treatment for people with long-term physical or mental health problems.
In business, organisations are beginning to see work as part of the solution and change the way they manage sickness absence as a result.
Some of the firms doing this best, organisations like BT, Royal Mail and Boots are seeing dramatic reductions in the number of days lost to sickness absence and the number of people out of work on long term sick.
With this new approach forming the basis of our understanding, I want to outline for you today the action the Government is taking to support people at work.
Firstly, I want to talk about how we are helping unemployed people, including those with long-term health conditions, into sustainable work.
And secondly, I will outline our efforts to support people who become ill whilst working to maintain contact with the workplace.
Starting with those who are out of work.
There are five million people claiming the key out of work benefits.
Just over half of those are claiming Incapacity Benefit or its successor Employment and Support Allowance.
Of those 43 per cent are claiming because of some form of mental health condition or behavioural disorder.
Many of these people could be accommodated in the workplace.
But they have been signed off sick for so long, become so indoctrinated in the benefits regime that now their barriers to work are substantial.
We do not believe that it is acceptable to write people off to a lifetime on benefits because they have a health condition or impairment.
Unlike old-style inactive incapacity benefits, the Employment and Support Allowance recognises the importance of work and is specifically designed to help people move towards employment.
This support is not just available to new claimants.
We have put in place a practical process of assessment and migration.
Those found able to work will move on to a more active benefits regime so they can start preparing for work.
One and a half million people will go through this process.
Crucially, the assessment looks at what someone is able to do - focusing on capability rather than incapacity.
It’s not perfect but we prepared to make improvements.
We will continue to make improvements to ensure the assessment delivers an accurate evaluation of ability.
For example, we recently amended the rules so people waiting or in-between certain chemotherapy treatments will be exempt from seeking work.
People who are found able to work will receive specialist employment support provided through Work Choice or the new Work Programme.
We have contracted the best of the private and voluntary sector to provide this support.
The Work Programme has a unique payment structure which means providers will be paid almost entirely by results.
And those payments will vary according to the level of support needed - with the hardest to help attracting the highest fees.
For those at the really tough end of the scale this could be almost £14,000 per person.
However, the bulk of these payments will only be made when providers successfully get someone into sustainable employment.
This means for some claimants, providers will only receive full payment of their fee after the claimant has been in employment for more than two years.
The black box nature of the Work Programme **means providers are completely free to design the support they offer in order to maximise success. However, we will rigorously hold their performance to account.
What we will find, as the Work Programme progresses, is that providers will not only support claimants into employment but, in order to secure the larger fees, will continue to deliver support for some time after people start work.
For the hardest to help, which includes many of those with long term health conditions, this support is likely to include help with condition management.
I believe this will lead to providers developing new ways to support people with health conditions at work.
With 43 per cent of incapacity benefits claimants citing a mental health condition or behavioural disorder as the reason they cannot work, finding effective ways to support this group must be a priority for Work Programme providers.
They need to understand which forms of support are effective and at what cost.
So, earlier this year I organised a seminar for Work Programme providers and mental health specialists.
On the back of this session, some of them have formed a group to identify the interventions which support sustained employment for people with mental health problems.
Waddell and Burton’s evidence demonstrated that more than 90 per cent of people with common health problems can be helped back to work by simple healthcare and workplace management measures - so we’re not talking here about complex interventions.
There are almost entirely untouched pools of very talented people that have so far been locked out of the labour market by our inability to find ways to properly support them at work.
Ultimately this affects the bottom line for employers. They miss out on good people because process or prejudice stops people with long term health conditions from being successfully hired.
The best way to engender change is to show employers what they are missing out on.
Over the summer I established an employer-led working group to increase the employment rate of people with autism.
Working with Research Autism, the National Autistic Society and companies with experience of having autistic employees, we are developing ways to raise awareness of the benefits of hiring an autistic person.
But our approach is not just about getting people into work, it’s about keeping them there.
So, I’d like to move on to the work the Government is doing to support people who become ill to keep in touch with the workplace.
Sickness absence is a major issue for Government and employers.
It costs the economy £10 billion per year.
There are 140 million days lost to sickness absence per year.
Over a quarter of which are as a result of long term absence.
Too many of these people fall out of the labour market all together and are caught by the safety net of the benefits system.
But I think more could be done before the point at which people become the responsibility of the state.
By the time someone starts to claim benefits they may have been out of work for many months.
In that time their skills decline, they lose confidence and it becomes harder to get them back into employment.
We are finding, through the Fit for Work Service, that working with employers, health professionals and employment specialists we can transform people’s lives with a few small practical changes.
Employers are obviously key; we need to ensure they have the right attitudes, processes and working practices in place to support people with health conditions at work.
I asked Dame Carol Black, the National Director of Health and Work, whom you shall be hearing from later, and David Frost, the former Director General of the British Chambers of Commerce to look at the sickness absence system.
They are finding that there is a real variation in the nature and levels of occupational sick pay arrangements over and above the minimum required.
Meanwhile the costs of sickness absence are distributed between employers, the state and employees in an arbitrary way which doesn’t necessarily create the right incentives for an early return to work.
The gap between an individual becoming ill and receiving support is too long and the process is not coherent.
Employers are concerned that they are not receiving the right kind of advice on how to help employees who are long-term sick.
But when the right advice is provided and employers are able to draw upon the support of specialist clinicians it makes a real difference to the rehabilitation of patients, speeding up recovery times.
This evidence has obvious interest for Work Programme providers as they seek to support people with health conditions in to work.
Given how crucial it is to have the right support and advice in place my biggest concern is that we are not using the services of the support industry effectively.
Services like occupational health and clinical specialities like physiotherapy and occupational therapy are under used.
And I am not convinced that as our understanding of the interaction between health and employment develops we have the support in place to act upon the knowledge gained.
My prediction is that demand for support services will rapidly increase over the next few years.
We need a larger, more integrated pool of professionals to meet that demand, it is only then that we will be ready to tackle the strategic challenges of the future.