UK: Employment opportunities for people with chronic diseases

  • Observatory: EurWORK
  • Topic:
  • Labour market policies,
  • Work organisation,
  • Disability and chronic disease,
  • Public services,
  • Working conditions,
  • Social policies,
  • Published on: 14 November 2014



About
Country:
United Kingdom
Author:
Helen Newell
Institution:
IRRU

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.

In recent years the UK has taken steps aimed at promoting the inclusion of people with physical or mental impairments into all aspects of public life, with special emphasis on the workplace. Measures intended to encourage and support employment of those with chronic diseases and disabilities have been introduced, most recently in the Equality Act 2010. Despite these measures, research shows that in the UK more than 50 per cent of people with a ‘physical or mental impairment’, which has ‘a substantial and long-term adverse effect on their ability to carry out normal day-to-day activities’ are out of work and that those in work often work far below their potential. Young people who fall into this category are twice as likely as their peers to be not in education, employment or training. Most importantly, people who have such an impairment report that others routinely under-estimate what they can do.

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

Major changes to the law surrounding chronic illness and employment have been introduced in the UK over the last few years..  The definition most commonly used is the broad one set out in the Equality Act 2010:

A person has a disability if:    

  • they have a physical or mental impairment; and
  • that impairment has a substantial and long term adverse effect on their ability to perform  normal day to day activities.

‘Substantial’ is more than minor or trivial – e.g. it takes much longer than it usually would to complete a daily task like getting dressed. ‘Long-term’ means 12 months or more – e.g. a breathing condition that develops as a result of a lung infection. There are special rules about recurring or fluctuating conditions, for example, arthritis.  Under the guidance to the Act it is made clear that the terms mental or physical impairment should be given their ordinary meaning. Any disagreement is more likely to be about the effects of the impairment rather than the existence of an impairment. 

One of the key approaches to research in this area has been the idea that people are disabled not by their impairment, but by the barriers to participation that they experience – from low expectations to inaccessible IT or the built environment.

What concrete chronic diseases are included in these national definitions?

The guidance to the 2010 Equalities Act sets out the wide range of possible impairments from which a disability can arise. These include chronic illnesses, for example:

  • sensory impairments, such as those affecting sight or hearing;
  • impairments with fluctuating or recurring effects such as rheumatoid arthritis, myalgic encephalitis (ME)/chronic fatigue syndrome (CFS), fibromyalgia, depression and epilepsy;
  • progressive conditions, such as motor neurone disease, muscular dystrophy, forms of dementia and lupus (SLE);
  • organ specific, including respiratory conditions, such as asthma, and cardiovascular diseases, including thrombosis, stroke and heart disease;
  • developmental conditions, such as autistic spectrum disorders (ASD), dyslexia and dyspraxia;
  • learning difficulties;
  • mental health conditions and mental illnesses, such as depression, schizophrenia, eating disorders, bipolar affective disorders, obsessive compulsive disorders, as well as personality disorders and some self-harming behaviour.

Certain conditions are not to be regarded as impairments for the purposes of the Act. For example:

  • addiction to, or dependency on, alcohol, nicotine, or any other substance (other than in consequence of the substance being medically prescribed);
  • the condition known as seasonal allergic rhinitis (e.g. hayfever), except where it aggravates the effect of another condition.

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

  • Are there national statistical sources (censuses, administrative registers, ad-hoc surveys on chronic diseases, working conditions surveys, other surveys, etc.) that analyse the issue of chronic diseases and their relation to employment and working condition? If so, identify them and provide information on the following issues (per identified information source if it is the case):

There are no national sources of data that analyse ‘chronic diseases’ and their relation to working conditions.  However, the LFS survey does include questions on the type of impairment suffered as well as providing data based upon the definition of ‘disability’ contained in the EA 2010 (and the disability discrimination legislation which preceded it) and its relation to work and employment. Another survey, the Life Opportunities Survey (LOS) compares how disabled and non-disabled people participate in a number of areas of society including work.  Since its focus is on disability, not on chronic illness, this survey has not been included here.

  • What is the official name of this statistical source (in national language and translation into English) and its responsible body?

The Labour Force Survey (LFS) is managed by the Social Surveys division of the Office for National Statistics (ONS) in Great Britain.  The Office for National Statistics (ONS) is the executive office of the UK Statistics Authority, a non-ministerial department which reports directly to Parliament. ONS is the UK government’s single largest statistical producer. It compiles information about the UK’s society and economy, and provides the evidence-base for policy and decision-making, the allocation of resources, and public accountability.  

  • What definition of chronic disease is used?

The LFS provides data on the number of people who report a disability. Respondents are either defined as having a current long-term disability covered by the disability discrimination legislation (the Equality Act 2010 or the Disability Discrimination Act that preceded it) or a work-limiting disability, or both. A work-limiting disability is a long-term problem that affects the kind of work and the amount of work that a person can do.

  • What are the categories of chronic diseases surveyed/registered?

Problems with arms or hands

Problems with legs or feet

Problems with back or neck

Difficulty in seeing

Difficulty in hearing

Severe disfigurement, skin conditions, allergies

Chest or breathing problems, asthma, bronchitis

Heart, blood pressure, circulation

Stomach, liver, kidney, digestive problems

Diabetes

Depression, bad nerves or anxiety

Epilepsy

Severe or specific learning difficulties

Mental illness, phobia, panics, nervous disorders

Progressive illness not included elsewhere

Other health problems or disabilities

  • What are the questions in relation to employment and working conditions?

Economic activity

Individuals in high-level employment (which is considered to include those who report to be managers or senior officials, in professional occupations, are associate professionals or technical professionals, or work in skilled trade occupations). 
 

Individuals who have never worked

Individuals who would like to work more hours

Hourly wage rates

Highest educational qualification

Individuals not in work who would like to work

  • What is the methodology used to collect the data?

The Labour Force Survey (LFS) is the largest survey of households living at private addresses in the UK. The sample covers 60,000 households every quarter. LFS fieldwork is carried out by the Labour Force survey interviewing force which is comprised of both face-to-face interviewers and by telephone interviewers. All first interviews (wave 1) at an address are carried out face-to-face. If the respondent agrees to it, recall interviews are carried out by telephone. Overall, including wave 1, around 62% of interviews are by telephone, and 38% are face-to-face.

  • What information is provided?

As well as providing the answers to the questions set out above, since 2003/04 the Health and Safety Executive has routinely commissioned questions to be included annually in the LFS that relate to self-reported work related illness (SWI).

  • Other info (time frequency, origin of the info, etc.)

Up until the end of 2005, the LFS was run on seasonal quarters, i.e. March to May, June to August, September to November, and December to February. From 2006, the LFS has been run on calendar quarters, i.e. January to March, April to June, July to September, and October to December. 

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

Around a quarter of those people with a long standing problem have 3 or more problems. The number of people with three or more long-term conditions is predicted to rise from 1.9 million in 2008 to 2.9 million in 2018. http://www.kingsfund.org.uk/time-to-think-differently/trends/disease-and-disability/long-term-conditions-multi-morbidity

  • What is the employment situation of people with chronic diseases in your country (% of people in employment/unemployment/inactivity that are affected by chronic diseases)?

Most of the available data in the UK does not apply to people with chronic diseases.  Data is only available for disability. In March 2012, 21% of the working age population in the UK (over 8 million people), had a disability as defined under the EA 2010.  The UK employment rate among working age disabled people was 47.8% (3.97 million), compared to 75.9% of non-disabled people. Disabled people remain far less likely to be in employment. The trend shows that there has consistently been an employment rate gap between disabled and non-disabled people, though it has narrowed from 33.5 per cent in 2005 to 28 per cent in 2012.

In 2012, 48.9 per cent of disabled people were in employment compared to 78.0 per cent of non disabled people. Although it seems as if the employment rates for disabled people have improved over the last few years, due to the improved disability reporting in the UK since 2010, it is not possible to conclude whether this is a real increase.

The economically inactive rate for working age disabled people is 45.9%. This figure is 2.5 times higher than that of non-disabled people (17.8%).  Disabled people are nearly 4 times as likely to be unemployed or involuntarily out of work as non-disabled people. 57% of adults with impairments experience barriers to employment (in the type or amount of paid work they do) compared with 26% of adults without impairments.

When the employment rates are broken down by full-time and part-time, data shows that disabled people are more than twice as likely to report working full time as working part time. This pattern remained broadly stable since 2005. Both full and part time employment rates have significantly decreased for non-disabled people between 2005 and 2009 which resonates with a significant reduction in overall employment rate for this group during this period.

There is a concentration of disabled people and those with work-limiting conditions in low-paid and low-skilled work.

  • Are certain chronic diseases associated to or more prevalent in certain economic sectors/occupations?
     

We know that disabled people are less likely than non-disabled people to work in high level (managerial, professional and technical) occupations, and more likely to work in lower level and manual occupations. However, the sectoral profiles of disabled and non-disabled workers jobs are similar (disabled people are slightly under-represented in banking, finance and business services, and slightly over-represented in the public sector).   

In relation to chronic disease, however, according to the Health and Safety Executive (2013) and based upon data from the LFS, occupation is the most important risk factor for work-related ill health, particularly for musculoskeletal disorders (MSDs). There has generally been a downward trend in the total number of work-related MSDs since 2001/02. The total number of MSD cases in 2011/12 was 439,000 out of a total 1,073,000 for all work-related illnesses. The number of new cases of MSDs in Great Britain in 2011/12 was 141, 000, down from 158 000 in 2010/11. The industries with the highest rates of total cases of MSDs were post and courier activities, agriculture and specialized construction activities. Building trades and skilled agriculture trades had higher rates of MSDs compared to the average across all occupations. The main work activities attributed by respondents as causing their musculoskeletal disorder, or making it worse, was manual handling, awkward or tiring positions and keyboard work.

For stress, depression and anxiety, occupation and hours of work are jointly the most important risk factors, with longer hours being associated with higher rates of mental ill health. Job tenure also has a significant influence on rates of work-related ill health, with those who have been in their jobs longer having a higher risk of work-related illness.

The construction industry has the largest number of occupational cancer cases, with 3,500 cancer deaths and 5,500 cancer registrations each year.

  • What are the typical employment trajectories of workers affected by chronic diseases? (entry/exit patterns)

Again there is no data available in the UK for chronic disease. One of the key reasons for the low employment rate of disabled people is the fact that 1 in 6 of those who become disabled while in work loses their employment during the first year after becoming disabled. Eighty per cent of all those who become disabled are in employment at the time they acquire a disability, only 60% are employed the following year, and 36% the year after that.

Disabled people are more likely to be long term unemployed and economically inactive. Over half of disabled people claiming incapacity benefits have been out of work for more than 5 years.

The average annual rate of disabled people making a transition from economic inactivity into employment is 4%, while the equivalent figure for non-disabled people is 6 times higher. (The Papworth Trust (2012).

  • What are the main difficulties/problems for people with chronic diseases to access or stay in the labour market?

There is no information about difficulties for those with chronic disease, although the Life Opportunities Survey does provide some data about difficulties faced by those who are defined as disabled. This reveals that the main barriers faced by those with a disability were lack of job opportunities (43%); difficulty with transport (29%); lack of qualifications/experience/skills (28%); attitudes of employers (20%); and anxiety/lack of confidence (16%).  According to a report by the Papworth Trust (2012) disabled adults are twice as likely to have no formal qualifications as non-disabled adults, 26% and 12% respectively and at age 16, young disabled people are twice as likely not to be in any form of education, employment or training (NEET) as their non-disabled peers (15% compared to 7%).

  • What are the main difficulties/problems for enterprises with workers affected by chronic diseases? What solutions do enterprises adopt to deal with these workers affected by chronic diseases?

Many employers do not understand the definition of disability contained in the EA 2010 and continue to rely on informal and intuitive notions of disability.  They are, therefore, more likely to regard as disabled those with visible physical impairments rather than those with mental or progressive and chronic illnesses.

Research from the Department for Work and Pensions and the Equality and Human Rights Commission suggests that employers favour the employment of non-disabled people compared to disabled people (Needels and Schmitz, 2006), believing that disabled people will be less productive and that they will impose additional costs on the employer even though research suggests that the actual cost of adjustments for disabled workers are quite small—in many cases zero.

However, the CIPD’s annual survey report on Absence Management (2013) does suggest that reasonable adjustments are being made by some employers to help employees to return to work after a period of absence, and that relatively small changes to working hours, like working 10-6 instead of 9-5 are effective. More than 70% of employers reported a positive impact on employee motivation and employee engagement after making such changes. A further 46% said they were using flexible working options to support employees with mental health problems.

  • Are there differences in the previously mentioned patterns by types of chronic diseases or groups of pathologies? are there differences according to age or gender

Employment rates differ across impairments. Depression, anxiety and severe learning difficulties are the worst impairments for finding and keeping a job.  Employment rates are particularly poor for those with learning disabilities (less than 1 in 5), and mental health problems (just over 1 in 10).   The highest employment rates (6 in 10) exist for those with diabetes, skin conditions or chest / breathing problems.  See the Life Opportunities Survey for more details.

  • Is it possible to identify some changes in the previously mentioned patterns in recent years?, reasons for this and possible specific effects of the economic crisis

The relative disadvantage of disabled people appears to be rather insensitive to cyclical economic fluctuations, but highly sensitive to local variations in demand (the ‘disability penalty’) is higher in poorer-performing local economies.

2.2. Working conditions of employed people affected by chronic diseases

According to statistics available from the Health and Safety Executive (2012) and based upon data from the Labour Force Survey occupation is the most important risk factor for work-related ill health, particularly for musculoskeletal disorders. For stress, depression and anxiety, occupation and hours of work are jointly the most important risk factors, with longer hours being associated with higher rates of mental ill health. Job tenure also has a significant influence on rates of work-related ill health with those who have been in their jobs longer having a higher risk of work-related illness.

Musculoskeletal Disorders

There has generally been a downward trend in the total number of work-related MSDs since 2001/02. The total number of MSD cases in 2011/12 was 439 000 out of a total 1 073 000 for all work-related illnesses. The industries with the highest rates of total cases of MSDs were post and courier activities, agriculture and specialised construction activities. Building trades and skilled agriculture trades had higher rates of MSDs compared to the average across all occupations. The main work activities attributed by respondents as causing their musculoskeletal disorder, or making it worse, was manual handling, awkward or tiring positions and keyboard work.

COPD

The most important cause of COPD is smoking, but past exposures to fumes, chemicals and dusts at work will have also contributed to causing many currently occurring cases.  Research shows that about 15% of COPD is likely to be work-related. Research is underway to provide details of the main causes in GB. There are currently approximately 12 000 deaths each year due to occupational respiratory diseases, about two-thirds of which were due to asbestos-related diseases or COPD. About 35 000 people who worked in the last year, and 130 000 who had ever worked currently have breathing or lung problems that they thought were caused or made worse by work.  There are currently an estimated 13 000 new cases of breathing or lung problems caused or made worse by work each year among those in, or recently in, work.

Work-related stress

This is defined as a harmful reaction people have to undue pressures and demands place on them at work.  The total number of cases of work-related stress in 2011/12 was 428 000 (40%) out of a total of 1 073 000 for all work-related illnesses. The estimated cases of work-related stress, both total and new cases, have remained broadly flat over the past decade. The industries that reported the highest rates of total cases of work-related stress (three-year average) were human health and social work, education and public administration and defence. The occupations that reported the highest rates of total cases of work-related stress (three-year average) were health professionals (in particular nurses), teaching and educational professionals, and caring personal services (in particular welfare and housing associate professionals). The main work activities attributed by respondents as causing their work-related stress, or making it worse, was work pressure, lack of managerial support and work-related violence and bullying.

Cancer

The construction industry has the largest number of occupational cancer cases, with 3 500 cancer deaths and 5 500 cancer registrations each year from this industry.  Exposure to silica, Diesel Engine Exhaust, solar radiation, shift work and working as painters and welders might become the main causes of occupational cancer in the future.

Noise Induced Hearing Loss

150 new claims for Noise-Induced Hearing Loss disablement benefit were assessed in 2011. The industries with the largest number of new cases are: manufacturing, construction and extraction, energy and water supply.  The LFS survey suggests that the average total case number of NIHL caused or made worse by work from 2009/10 - 2011/12 is 19 000 cases.

Skin Diseases

Reporting by doctors during 2010-2012 suggested there could be over 35 000 new cases of work-related skin disease per year, although the estimated annual number of new cases based on self-reporting of skin disease in the Labour Force Survey is substantially lower at around 7 000 (LFS). Most occupational skin disease cases are contact dermatitis and similar numbers of these are caused by exposures to allergens and irritants.  Working with wet hands, and contact with soaps and cleaning materials continue to be the most common causes of occupational contact dermatitis. Occupations with the highest rates are florists, hairdressers, cooks, beauticians, and certain manufacturing and health care related occupations.

  • Reconciliation of working and non-working life: are people with chronic diseases allowed special conditions in terms of work-life balance, flexibility at work to cope with the diseases/attend treatment, ability to set their own working time arrangements, etc.?
  • Career and employment security: to which extent and how is the employment status of people with chronic diseases affected by their health situation?; is there an impact in their remuneration levels/conditions?; in what measure is there a repercussion on their employment security and working career?; are they allowed/forced to changes in their jobs?
  • Skills development: in what measure have chronic diseases an impact in the access of workers to training activities promoted by the employer? Has the training anything to do with the disease situation?
  • Are there any significant differences in these working conditions according to different groups of affected workers (type of disease, gender, age, sector, etc.)?
  • Are there any significant changes in recent years? Possible effects of the economic crisis on these situations, if any.

There is little information available in the UK on the working conditions of employed people affected by chronic disease.  Generally one can conclude from the data that disability and long term health conditions are likely to have a negative impact on employment status and quality: the onset of disability is strongly linked with declining income and increasing unemployment.  People with disabilities or long term health conditions are more likely to be in low paid, poor quality jobs.  A higher proportion of non-disabled individuals is in better paid and higher level employment than disabled individuals. Those with disabilities or long term health conditions are at an increased risk of redundancy.

Research by the Work Foundation (2013) found that a major factor contributing to success of employees with impairment in managing work outcomes and careers was the extent to which their employers and colleagues were supportive in accommodating the effect of the chronic disease or disability on workplace attendance and productivity. Just over 76% of the survey respondents said their manager was supportive of their condition when they disclosed it, and in 88% of these cases respondents received some form of adjustment to their work which improved the management of their condition. For 23% of respondents this meant an adaptation to their working patterns, and for 24% it meant a change to their working hours. However, slightly less than half (49%) of respondents reported that they had not discussed or been offered any workplace adjustments by their employer, despite the fact that under the Equality Act 2010 an employer is under a legal duty to make a reasonable adjustment where a disabled person would otherwise be put at a substantial disadvantage compared with people who are not disabled.

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

Under the Equality Act 2010 an employer has a duty to make reasonable adjustments for a disabled person include changing the way in which employment is structured, the removal of physical barriers and/or providing extra support for a disabled worker or job applicant in order to provide, as far as is reasonable, the same access to everything that is involved in getting and doing a job as a non-disabled person. The employer is under a positive and proactive duty to take steps to remove or reduce or prevent obstacles that may face a disabled worker or job applicant. If an employer fails to do this a claim can be made against them in the Employment Tribunal. An employer can be ordered to pay compensation as well as make the reasonable adjustments. A failure to make reasonable adjustments counts as unlawful discrimination.  Whilst many chronic illnesses will fall with the definition of disability within the EA 2010, there are no separate measures relating to chronic illness.

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

Health, Work and Wellbeing’ is a cross-Government initiative aimed at protecting and improving the health and well-being of working age people. The initiative promotes the positive links between health and work and aims to help more people with health conditions to stay in or return to employment.  As part of this initiative, Dame Carol Black, the National Director for Health and Work launched the Workplace Wellbeing Charter a voluntary self- assessment scheme that can be used by any public, private or voluntary sector organisation.  It requires employers to demonstrate that they adhere to a set of minimum standards to promote good, safe and healthy work.  According to the wellbeing charter’s website 1000 employers have signed up to the charter.   

The government has also developed ‘The Workplace Well-being Tool’, an excel template, which is designed to help employers to work out the costs of poor health and well-being to their business and to help them build a business case for action to reduce their costs and improve the health and well-being of their employees.

In February 2013 the TUC published ‘Work and Well-being a Trade Union resource’.  It points out that the lack of any real agreement over the term workplace well-being means that ‘well-being’ has become a convenient label for almost any health-related initiative, which makes it difficult for trade unions to respond. However, the guide gives advice on the wide range of attempts being made to promote well-being in an effort to help trade union representatives.Union Learn, the learning and skills organisation of the TUC, has also produced a ‘Health, Work and Well-Being Tool Kit’, designed particularly as a resource to help raise awareness among workers of what they can do to improve their health and well-being, to help union representatives to raise workplace issues around health and well-being with their employers and to help them find out where they can access further information and resources.

The government’s National Institute for Health and Clinical Excellence (NICE) has produced guidance on promoting mental well-being at work. There is also NICE guidance on the workplace promotion of physical activity and smoking cessation.

The TUC has issued guidance (Sickness Absence and Disability Discrimination 2013) on the subject of disability discrimination in the workplace. It argues that the legal obligation on employers to consider reasonable adjustments is a key concept that can be used to underpin negotiations for changes to absence procedures. In general, it recommends that unions should use the requirements of the EA 2010 to resolve issues by persuading employers to adopt progressive policies and procedures rather than going to tribunal. However, they note that a lack of understanding of the principles of disability discrimination law remains a serious problem for many employers, managers and union representatives and training in what the EA 2010 requires (as a minimum) is vital if genuine progress is to be made.

In the public sector, the Public Sector Equality Duty contained within the EA 2010 which came into force on 5 April 2011, requires public bodies to have due regard to the need to:

  • eliminate discrimination, harassment and victimisation and other conduct prohibited by the Equality Act 2010;
  • advance equality of opportunity between people from different groups; and
  • foster good relations between people from different groups.

This puts an even greater emphasis on improving awareness of disability, and changing policies accordingly. This should be of considerable assistance in changing practices in the public sector.

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

Lloyds TSB is part of the financial services group, Lloyds Banking Group plc, which has 104,000 employees. The bank has put in place a programme that ensures that employees with disabilities have the same opportunities for career progression as their non-disabled colleagues. Its Personal Development Programme for disabled staff is a four day residential course. Participants are asked to think about how disability affects their attitude to life, not just work and how they project themselves to family, friends and colleagues. The company has also produced guides for all staff, including a brochure ‘Positive About Disability’ and a Disability Resource Toolkit. Line managers receive training so that they can provide help, advice and support to disabled people within the workplace. As at the start of 2013 over 11,000 employees had used the process and 97% were very pleased with the process and the adjustments they have received. 

A collection of mini case studies are provided by the Health and Safety Executive and the Equality Commission giving examples of good practice and showing practical steps, including involving the disabled worker, to promote disability equality when managing health and safety issues. 

Commentary

Although progress is being made, much remains to be done to remove the barriers to employment that the majority of people with long term chronic disease and disability face.  There is little sign that the employment of people with chronic disease or disability is particularly sensitive to economic ups and downs. More important it seems are the attitudes of employers, especially in relation to the perceived lack of productivity of employees with impairments.  Another worrying problem is the combination of disability and lack of skills, which continues to be an important and serious barrier to employment, especially for the young.

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