Supporting people back to work: the intersection of health and economic policy

We’ve recently seen a flurry of ministerial suggestions for how the NHS could help ‘get sick Brits back to health and back to work’. This includes Wes Streeting suggesting unemployed people could get weight loss jabs to help them back into work, Liz Kendall suggesting mental health patients could have job coaches on wards, and follows an announcement at the Labour Party Conference that teams looking at how to improve elective wait times through increasing surgeries would be targeted at areas of economic inactivity.

As the saying goes, health is wealth. You can’t build a thriving economy if people are too sick to work.

It makes sense to think about the impact of ill health on economic inactivity. Not least to highlight that – particularly with the upcoming Budget – funding the NHS is not just a cost to the taxpayer. As the saying goes, health is wealth. You can’t build a thriving economy if people are too sick to work.

But these recent suggestions have sparked significant debate. In large part, that might be due to a lack of detail behind these ideas: they seem to be signalling ‘new thinking’ rather than specific policies. So, what do we know about these new proposals?

Let’s start with the waiting list ‘crack teams’. The plan is to embed surgical high-intensity theatre (HIT) teams – an approach pioneered by Guy's and St Thomas’ to maximise surgical capacity – in targeted areas in order to bring down waiting lists. Now, there is clearly a connection between waiting lists and employment: a recent ONS survey found that 15% of those on waiting lists report their employment is being negatively impacted by long waits for care. But surgery might not be the solution: the top reason for ill-health related economic inactivity is mental illness, followed by musculoskeletal disorders. The majority of these cases will not be solved in an operating theatre. If you were serious about reducing ill health related economic inactivity, it is not clear this would be your starting point.

Even if this was the silver bullet to get sick people on the waiting list back into work, a look at a map of economic inactivity versus where these teams have been announced shows a curious mismatch: there are lots of areas of high economic inactivity that have not been targeted, and some of the teams have been sent to areas that do not have high levels of economic inactivity. The rhetoric here does not seem to match the reality.

Meanwhile, the ‘jabs for jobs’ announcement caused an outbreak of concern about whether the NHS has the capacity to offer weight-loss drugs to everyone who could benefit from or wants them, whether it is fair to target certain groups of people for a drug that is in high demand, what the side effects and long-term implications of taking these drugs could be, and whether it is appropriate to focus on medication as the main solution to a much wider public health issue. On a closer look, the starting point for this announcement is a five-year trial covering 3,000 people in Greater Manchester, to gather evidence around whether weight-loss drugs can influence labour market outcomes. Once again, this seems a more like ‘kite flying’ than anything else: Streeting did not initially emphasise that there would be a trial – instead he focussed on the wider idea.

The reported comments from Kendall are a bit more concerning – having job coaches on wards for those with serious mental illness sounds on the face of it extremely jarring. She cites evidence from two local sites that this has been beneficial – but the results from these trials have not yet been made public. And it is important to consider the impact of an idea such as this on patient’s health as well as their employment outcomes: we know that some people with serious mental illness find their stays in hospital difficult and traumatising, and job coaching may not be what they need at a time of crisis.

Just as a good job can be beneficial to your health, some jobs and bad employment practices can make you sick through mental or physical stress. 

A good job can in fact be beneficial to your health: it can provide financial stability and a sense of purpose. So thinking about how health policy can support the economy has a potential to be win-win. But these ideas raise serious questions around efficacy and equity.

And the relationship between health and the economy goes both ways. Just as a good job can be beneficial to your health, some jobs and bad employment practices can make you sick through mental or physical stress. 

Focusing on policies that help the health system to encourage people into work is only one side of the story. There is no point getting people back into work if that work just makes them sick again. 

The Employment Rights Bill has potential in making work better able to support health – improving flexibilities and strengthening workers’ rights – as long as it isn't watered down over the next year as it travels through the parliamentary process. The previous government consulted on occupational health policies and regulations such as developing a national workplace health and disability standard as a minimum framework for quality occupational health provision – this should not get lost with the change of government.

And the impact of economic policy on health goes beyond employment policy. The benefits system can also have a huge impact on health, for example there is evidence that punitive benefits sanctions can lead to an increase in anxiety and depression. There is real potential for thinking differently about economic policy as a way to support people to be healthy and prevent people getting sick. As we move forward, I would like to see some reciprocity - ask not just what our health policy can do for the economy but what our economic policy can do for our health?