Ireland: Employment opportunities for people with chronic diseases

  • Observatory: EurWORK
  • Topic:
  • Labour market policies,
  • Work organisation,
  • Disability and chronic disease,
  • Offentlige serviceydelser,
  • Working conditions,
  • Social policies,
  • Published on: 20 november 2014



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Disclaimer: This information is made available as a service to the public but has not been edited by the European Foundation for the Improvement of Living and Working Conditions. The content is the responsibility of the authors.

According to the data, the labour force participation rate of people with chronic diseases/illnesses is 27%, which is higher than the 13% participation rate for the total number of people with disabilities. A number of Government and social partner initiatives have been put into effect over the last 10 years to raise awareness and facilitate the retention of employees with a disability/ illness. The fall in the rate of discrimination of people with a disability in the workplace between 2006 and 2011 – while the rate for people without a disability increased – as well as enhanced legislation to protect the employment of people with a disability reveals an increasing awareness of disability/illness at work in general.

Block 1: Concept, definitions, sources of information and methodological issues on chronic diseases and work from the national perspective

1.1. National definition of chronic disease

The Health Service Executive (HSE) defines ‘chronic illness’ as “long term conditions which can be treated but not cured.” It lists diabetes, heart failure, chronic obstructive pulmonary illness, dementia and mental health problems, asthma, muscoloskeletal diseases as examples of such. The HSE adds that key features of chronic illnesses are: complex and multiple causes; usually have a gradual onset; occur across the life cycle, being more common in older age; can cluster in individuals by virtue of age, common risk factors, and possible common systemic responses; compromise quality of life through physical limitations and disability; long-term persistent, leading to a deterioration in quality of life; costly in terms of service provision; a significant perpetuator of health inequalities; and the common cause of premature death.

In terms of employment law, chronic disease/illness is encompassed within the definition of ‘disability’. The Employment Equality Acts 1998-2011, lists ‘disability’ as one of nine grounds which protects employees against discrimination in the workplace. Disability is defined as "the total or partial absence of a person's bodily or mental functions, including the absence of a part of a person's body; the presence in the body of organisms causing, or likely to cause, chronic disease or illness; the malfunction, malformation or disfigurement of a part of a person's body; a condition or malfunction which results in a person learning differently from a person without the condition or malfunction; a condition, illness or disease which affects a person's thought processes, perception of reality, emotions or judgement or which results in disturbed behaviour”

The Irish Government for its recently devised Critical Illness Protocol for public sector workers – designed as part of a reform measure to reduce absenteeism in the public sector – avoided a definitive list of ‘critical illnesses’ but included in its criteria several requirements to merit the Protocol’s application, such as “chronic progressive illness, with well-established potential to reduce life expectancy.”

1.2. Information on national sources of statistical information dealing with the issue of chronic diseases and their relation to employment and working conditions

The primary statistical source that gathers data on chronic diseases in employment is the Census conducted by the Central Statistics Office (CSO). The most recent survey, Census 2011, gathers data on on a range of disabilities; data on chronic diseases is located by the attribute: ‘Other disability, including chronic illness.’ It does not define a list of chronic illnesses for the survey. It asks the question: “do you have a difficulty with pain, breathing, or any other chronic illness or condition?” This does not include ‘psychological or emotional condition’, which is asked in a separate question.

The survey asks the employment situation of respondents, whether they are in the labour force, employed or unemployed; the broad industrial group of employment; the intermediate occupational group; and, if unemployed, whether the respondent is looking for a first regular job, or whether they have lost or given up their previous job.

The Census is conducted at households and it accounts for everybody in the country. It is conducted every five years.

The CSO also conducts a National Disability Survey (NDS), the most recent such completed survey was in 2006. The NDS asks detailed questions about the nature of difficulty the respondent has due to their disability, such as Seeing; Hearing; Speech; Mobility and dexterity; Remembering and concentrating; Intellectual and learning; Emotional, psychological and mental health; Pain; and Breathing.

Within these categories of difficulty it lists illnesses/conditions such as Retinosa pigmentosa; Retinal detachment; Glaucoma; Cataracts; Diabetes; Multiple Sclerosis; Cerebral Palsy; Arthritis (all forms); Heart conditions; Polio or post-polio; Alzheimer's disease or dementia; Epilepsy; Stroke or hemiplegia; Anxiety disorder, including phobia or neurosis; Depression; Bi-polar disorder; Addiction to alcohol or drugs; Schizophrenia; Cancer; Migraine; Cardiovascular disease; Bronchitis; Cystic fibrosis; Emphysema; Asthma; Chronic Obstructive Pulmonary (or lung) Disease (COPD). These illnesses/conditions are listed in relation to the aforementioned difficulties the respondent experiences.

The NDS is conducted at both home and at the workplace, and is based on Census data and a randomised survey, interviewing 17,000 respondents across all ages.

The former National Centre for Partnership and Performance, in 2006, identified a data deficit and fragmentation of data problem in relation to worker health and well-being. One significant factor with the accuracy of data on chronic illnesses in the workplace is that there is no obligation on the part of the person suffering from the illness to disclose it to the employer, therefore the data captured may not encompass workers who do not wish to disclose their illness.

Block 2: Prevalence, recent evolution and effects of the problem of chronic diseases among workers and companies

2.1. People affected by chronic diseases and employment

The Census 2011 reports the following statistics:

  • 3,608,662 people in the country (age 15 and over).
  • 2,232,203 people make up the total labour force (TLF). 1,778,400 are in work
  • 257,306 people identified having a disability as ‘other disability, including chronic illness.’ This is 7% of the total population.
  • 72,227 of people with a chronic illness are in the TLF. This is 3.1% of the TLF.
  • 52,299 of people with a chronic illness are in work. This is 3% of all people in work.
  • 19,039 of people with a chronic illness are classified as ‘unemployed, having lost of given up previous job’
  • 889 of people with a chronic illness are classified as ‘unemployed, looking for first regular job’

The labour force participation rate of people with a chronic illness was 27% in 2011. This compares to 28% in Census 2006. The employment rate of people with a chronic illness (within the labour force of people with a chronic illness) is 72%

The breakdown of people in work with a chronic illness across broad industrial group (and the percentage of people with a chronic illness of the total people in work in each broad industrial group) is:

  • Agriculture, forestry and fishing (A)                                                           3,310   (3.6%)
  • Mining and quarrying (B)                                                                136      (2.5%)
  • Manufacturing (C)                                                                          4,084   (2.2%)
  • Electricity, gas, steam and air conditioning supply (D)                                275      (2.5%)
  • Water supply; sewerage, waste management and activities (E)                    232      (2.5%)
  • Construction (F)                                                                              1,893   (2.2%)
  • Wholesale and retail trade; repair of motor vehicles and motorcycles (G)  6,733   (2.5%)
  • Transportation and storage (H)                                                                    2,404   (3.1%)
  • Accommodation and food service activities (I)                                           2,547   (2.5%)
  • Information and communication (J)                                                            2,028   (3%)
  • Financial and insurance activities (K)                                                         2,269   (2.5%)
  • Real estate activities (L)                                                                              213      (2.6%)
  • Professional, scientific and technical activities (M)                         2,483   (2.7%)
  • Administrative and support service activities (N)                                        1,855   (3%)
  • Public administration and defence; compulsory social security (O)            3,626   (3.3%)
  • Education (P)                                                                                              5,383   (3.3%)
  • Human health and social work activities (Q)                                               7,128   (3.7%)
  • Arts, entertainment and recreation (R)                                                        1,038   (3.5%)
  • Other service activities (S)                                                              1,334   (3.4%)
  • Activities of households as employers        (T)                                           69        (4%)
  • Activities of extraterritorial organisations and bodies (U)                           24        (3.2%)
  • Industry not stated                                                                          3,235   (3.3%)
  • Total at work                                                                                               52,299 (3%)

The breakdown of people in work with a chronic illness across intermediate occupational group is:

Occupational group Number of people (%)
  • Corporate managers and directors

3,270   (2.7%)

  • Other managers and proprietors

1,681   (3.3%)

  • Science, research, engineering and technology professionals

2,169   (2.7%)

  • Health professionals

2,938   (3.3%)

  • Teaching and educational professionals

2,910   (2.7%)

  • Business, media and public service professionals

2,504   (2.8%)

  • Science, engineering and technology associate professionals

1,047   (2.7%)

  • Health and social care associate professionals

911     (4.1%)

  • Protective service occupations

600     (2.2%)

  • Culture, media and sports occupations

1,170   (3.9%)

  • Business and public service associate professionals

3,186   (2.8%)

  • Administrative occupations

5,972   (3.2%)

  • Secretarial and related occupations

1,444   (3.4%)

  • Skilled agricultural and related trades

3,448   (3.9%)

  • Skilled metal, electrical and electronic trades

2,405   (2.6%)

  • Skilled construction and building trades

3,002   (2.9%)

  • Textiles, printing and other skilled trades

1,996   (3.2%)

  • Caring personal service occupations

3,578   (3.7%)

  • Leisure, travel and related personal service occupations

1,479   (3.1%)

  • Sales occupations

3,986   (3.0%)

  • Customer service occupations

781     (3.4%)

  • Process, plant and machine operatives

2,470   (2.9%)

  • Transport and mobile machine drivers and operatives

3,025   (3.6%)

  • Elementary trades and related occupations

1,864   (3.6%)

  • Elementary administration and service occupations

5,338   (3.6%)

  • Other/not stated

8,164   (4.1%)

The NDS 2006 reports that out of 173,600 adults who said “disability limited or affected them before the age of 65”, 29,200 people were currently at work – an employment rate of 17%.

The breakdown of people whose disability affected or limited them before the age of 65 is as follows:

 

A

B

C

D

E

F

G

H

I

total

Adults

29,200

1,100

7,000

19,600

83,300

15,600

4,000

9,100

4,700

173,600

Adults %

17

1

4

11

48

9

2

5

3

173,600

18-34

31

3

9

0

37

5

10

-

5

30,600

35-44

28

1

6

0

52

10

1

-

4

28,200

45-54

19

0

5

4

62

7

1

-

2

34,600

55-64

11

-

2

15

61

9

1

1

1

43,500

65 & over

2

-

0

31

25

14

-

24

3

36,700

Key-code:

A = Working for payment or profit;

B = Looking for first regular job;

C = Unemployed;

D = Retired Early;

E = Unable to work illness/disability;

F = Looking after family/home;

G = Student/pupil;

H = Retired at normal age;

I = Other

Of those in work, 52% worked in the private sector, 31% in the public sector, 8% on a job scheme, 8% in a ‘sheltered workshop’

Some 45% of males worked 40 hours or more per week; 34% of males worked between 25-39 hours per week; 21% of males worked 1-24 hours per week.

Some 22% of females worked 40 hours or more per week; 40% of females worked between 25-39 hours per week; 38% of females worked between 1-24 hours per week.

Adults at work whose main disability was Hearing (47%), Breathing (44%) or Remembering & concentrating (41%) had the highest proportion of adults who usually worked 40 or more hours per week.

No surveys specific to chronic disease/illness within the Irish employment sphere were identified. There have been a number of disability studies conducted in recent years, including work done by the National Disability Authority (NDA) and the Economic and Social Research Institute (ESRI).

The NDA note that, based on research conducted by the ESRI, that 66% of men and 42% of women with a disability found their disability ‘considerable/severe’ to restricting their participation in the labour force. Census 2011 records 33% of people with a disability experiencing “difficulty with working at a job, business or attending school or college.” The NDA also states that, based on CSO data, the participation rate is much lower for mental, nervous or emotional disabilities (22%) compared to that of diabetes and skin conditions (both 59%). It finds mobility to be a major issue; even though very occupations do not require the ability to walk, people with a disability related to their hands or feet are 33% less likely to be in work.

The NDA’s Niamh Fawl says that 1 in 4 employers have formal employee retention policies, the majority of which are large companies.

Beatty & Joffe (2006) suggest that employees with a chronic illness “generally leave an organization without asking for the additional flexibility that could have helped them stay at their jobs.” They note that in later career stages, “people are constrained by earlier career choices and investments in training”; that there is reluctance to “drop back” to their earlier career, which means “they struggle to stay in higher-level positions that require them to work long hours or perhaps do tasks that are harmful to their health.” They stress having “an understanding and supportive supervisor is the most significant factor contributing to successful work experience.”

2.2. Working conditions of employed people affected by chronic diseases

No one (NACE) sector of employment stands out as having a disproportionately higher rate of chronic diseases amongst the workforce of that sector. According to Census 2011 data, the level of people with people with chronic illnesses ranges from between 2.2% to 4%. However, these statistics do not account for the cause of the chronic illness amongst the workforce, only the level of chronic illnesses amongst workers in each sector.

The Health & Safety Authority (HSA) have developed a workplace health promotion guide, following an expert group report on developing a workplace health and well-being strategy. Workplace health and well-being was defined as a “state of being for each employee and employer which enables each individual to reach their full potential in the workplace by ensuring their work ability through the promotion of mental, physical, emotional and psychological health and well-being. It includes the prevention of all types of illness and disease in these areas, the promotion of workplace health activities and the rehabilitation of individuals who experience such illness and disease so as to facilitate and support their return to employment”

The workplace health promotion campaign is targeted at small business (less than 50 employees). The campaign includes encouragement of stress audits, developing a work-life balance policy, health screenings, and healthy food options in canteens.

The ESRI shows that the risk of work-related discrimination for people with a disability has dropped from a rate of 11% in 2004 to 6% in 2010. In contrast, the risk rate of work-related discrimination for people with no disability increased from 4.8% in 2004 to 5.5% in 2010. A breakdown of those with a disability who experienced work-related discrimination is as follows:

 

2004

2010

Pay

13%

6%

Promotion

17%

9%

Work conditions

20%

24%

Bullying/Harassment

25%

29%

Other

25%

32%

Employees are protected from discrimination on the grounds of their disability through the Employment Equality Acts 1998-2011. The protections include equality in the following aspects of employment: advertising vacancies; equal pay; access to employment; vocational training and work experience; terms and conditons of employment; promotion or re-grading; classification of posts; dismissal; collective agreements.

The Acts confer an obligation of ‘reasonable accommodation’ on the part of the employer to ensure people with disabilities have access to employment; can participate or advance in employment; and undertake training. This can involve adapting equipment or premises, giving time off to attend medical appointments; consulting with an employee to accommodate a return to work; substituting duties of an employee.

Reasonable accommodation does not mean an employer is obliged to recruit, promote, retain or provide training to a person who does not have the capacity to do a particular job. However, an employer cannot assert a person’s incapacity to do a job without considering whether appropriate measures can be taken to support the person to carry out the duties involved.

The employer does not have to put in place approporiate measures that would impose a disproportionate burden on the organisation, i.e. financial cost.

There is a common understanding amongst social partners that early intervention is key for managing disability/chronic illness in the workplace. According to the NDA there is a ‘tipping point’ of six weeks, whereby the employee affected is less likely to return to work without active intervention and support. It is encouraged that retention policies be integrated into absense management policies.

Hernandez and McDonald (2010) found that there was very little difference on overall job performance between employees with a disability and those without, in a study conducted in the health care, retail and hospitality sectors.

Block 3: Policies and measures adopted by public and private agents to favour the employment situation and working conditions of people with chronic diseases

3.1. Description of main policy measures/initiatives developed by public authorities or social partners

State support for private sector employers to encourage keeping people with chronic illnesses in jobs comes in the form of the Employee retention grant. With this grant an employer can receive 90% funding for specialist support to identify what adjustment/accommodation/training measures are needed to retain or retrain an employee with a chronic illness. The grant is provided in two stages: stage 1 can offer up to €2,500 towards the retention of one employee; stage 2 offers up to €12,500 for the retention of one employee.

There is also a workplace equipment/adaptation grant, provided by State support service Solas (formerly Fas), which is goes up to a maximum of €6,500. There is a personal reader grant for visually impaired workers, which is worth the equivalent of 640 hours at minimum wage (€8.65 per hour)

The Department of Social Protection has also recently introduced a ‘partial capacity scheme’ which provides benefit to workers who have an illness but can work in some capacity. It is targeted at people who have been out of work on illness benefits for over six months.

The Irish Congress of Trade Unions (ICTU) has developed a code of practice – funded by the Equality Mainstreaming Unit (which in turn is funded by the European Social Fund 2007-2013 and the Equality Authority) - that gives practical effect to the Employment Equality Acts. It has also in place a guidance document for trade union officials on negotiating disability measures in the workplace. It covers the question of whether a person with a disability should disclose her/her condition. Disclosure of a disability/illness is not an obligation, however, to avail of the the protections of the Employment Equality Acts 1998-2011, a disclosure is required – the sooner the better, so as to provide for planning. The guidance document notes that is the disability/illness in question does not affect work performance, work attendance, or work relationships, then it may be unnecessary to disclose the condition. It also asks if not disclosing the illness would create pressures or tensions. ICTU also runs a Disability Champions @ Work campaign, which covers the same ground as in the code of practice and which facilitates further awareness of disability in the workplace issues.

The social partners, ICTU and Ibec (the group that represents Irish business), started the Workway initiative in 2004. This initiative was not designed to get people with disabilities into the workplace per se; rather it has a long-term focus on “changing attitudes at a fundamental level by raising awareness and developing guidelines and solutions to address the underlying issues and problems associated with the continued high level of unemployment among people with disabilities”, according to former Ibec director general Turlough O’Sullivan. ICTU secretary general, David Begg noted one of the reasons for setting up the Work way initiative was to target the problem of people with disabilities losing their jobs “in the first few weeks due, primarily, to a lack of appropriate management, knowledge or collaboration.”

Ibec, in association with Arthritis Ireland, has formed the Fit for Work Coalition initiative, which is largely focused on managing muscoloskeletal disorders. Through this work, it was identified that although 88% of employers measured absence, 52% offered an employee assistance programme and 45% had an occupational health service in place – which are more common in large employments. Ibec’s head of HR development, Mary Connaughton, says that the initiative encourages employers to think about supporting employees to be in attendance. The coalition has developed a template ‘return to work’ interview. Ibec also has a Nutrition and Health Foundation, which communicates evidence-based information on nutrition, health and physical activity. There is an Employee Wellbeing policy as part of this Foundation as well.

3.2. Examples of enterprises and/or collective agreements implementing initiatives or establishing clauses to support people with chronic diseases

Some examples of where early and appropriate intervention in managing illnesses was successful can be seen at Irish Life Corporate Business, the Dublin Airport Authority (DAA) and Abbott Vascular.

In Irish Life, following the introduction of a follow up service by its HR deparment, the business reduced its absence rate from 2.25% to 1.75%.  The DAA absence management programme achieved a 25% reduction in the absence rate and a 62% reduction in long-term absence. At Abbott Vascular in Clonmel, Co Tipperary, an early intervention programme was introduced, which is triggered after five days of absence by an employee due to illness. The programme provides occupational health support onsite, as well as a comprehensive preventative programme that focuses on health and wellbeing of its employees. As a result of the programme, Abbott saved 213 workdays between January and June 2012, which would otherwise have been lost through sickness.

Commentary

That the rate of discrimination for people with disability at the workplace has fallen suggests increasing cognisance on the part of employers and colleagues in the workplace to concerns of people with disabilities and illnesses. The rise in discrimination for people without disabilities (the majority of workers) shows that discrimination is not falling in general. According to Census data, the labour force participation of people which a chronic illness has increased between 2006 and 2011. This would suggest that the economic crisis has not negatively impacted on workers with a chronic illness. Revision of the Employment Equality Acts in 2011 (to take consideration of mental illnesses) further suggests there has been increased awareness of workplace health issues over the past four years.

However, available data on the level of chronic illness amongst the workforce may entail restrictions, due to the non obligation of disclosing illnesses. The economic and jobs crisis since 2009 may have a discouraging effect on disclosing illnesses for fear of jobs security.

References

Beatty & Joffe (2006) ‘The career effects of chronic illness’ in Organizational Dynamics, Vol. 35, No. 2, pp. 182-195

Census 2011, Profile 8 ‘Our Bill of Health’

Equality Authority, Equality and mental health: what the law means for your workplace, 2011

Ibec/Arthritis Ireland, Fit for Work Ireland Position Paper, April 2013

ICTU/Ibec,Workway Disability and Employment Guidelines, 2004

ICTU, Guidance for Trade Union Representatives on Negotiating Disability in the Workplace, August 2004

ICTU, Disability Champions @ Work Guidelines

ICTU, Code of Practice for Trade Unions, 2011

Health Service Executive (HSE) Transformation Programme, Chronic Illness Framewor, July 2008

HSE (2008) ‘Health Status of the population of Ireland’

Hernandez & McDonald (2010), ‘Exploring the costs and benefits of workers with disabilities’, Journal of Rehabilitation, vol. 76, no. 3, pp. 15-23

National Disability Authority (NDA), ‘Disability and work: the picture we learn from official statistics’ in Disability Research Studies 1, 2006

NDA, Literature Review for guidance on retaining employees with a disability, 2006

NDA, ‘Retaining employees who acquire a disability’ lecture by Niamh Fawl, April 2012

National Disability Survey, 2006

Watson, Kingston & McGinnity (2010) ‘Disability in the Irish Labour Market’. ESRI

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