Written evidence from Versus Arthritis (DEG0179)

1. Versus Arthritis welcomes the opportunity to provide input into the Work and Pensions Commons Select Committee inquiry into the ‘Disability Employment Gap’.[1] We would be happy to expand on the points below or to provide oral evidence to the Committee.

2. Versus Arthritis is the charity formed by Arthritis Research UK and Arthritis Care joining together. We work alongside volunteers, healthcare professionals, researchers and friends to do everything we can to push back against arthritis. Together, we develop breakthrough treatments, campaign for arthritis to be a priority and provide support. Our remit covers all musculoskeletal conditions which affect the joints, bones and muscles including osteoarthritis, rheumatoid arthritis, back pain and osteoporosis.[2]

3. Following the Committee’s call for evidence[3], this response includes:

• Background to musculoskeletal conditions, disability and employment
• Progress so far and impact
• Providing support
• Enforcement and next steps
• Annex A: Summary of Versus Arthritis evidence sources.

4. Summary points:

• Arthritis and related musculoskeletal conditions affect 18.8 million people in the UK and are the single biggest cause of pain and disability.[4] These conditions often limit people’s mobility and dexterity and cause pain, affecting people’s ability to work.
• People with musculoskeletal conditions face challenges with employment – they are less likely to be employed, they are more likely to experience sickness absence and they face a disability ‘pay-gap’.
• It is also important to recognise that people with musculoskeletal conditions may not consider themselves to be disabled.
• In our July 2020 survey data 1 in 5 respondents with arthritis were temporarily or permanently out of a job (furloughed or no longer working).
• In our Back Pain Britain survey in late August 2020, 81% of desk workers who switched to home working had developed musculoskeletal pain, and 23% reported that pain affected them either often or all the time. If unaddressed, this rise in musculoskeletal problems is likely to affect people’s long-term musculoskeletal health, and in turn their ability to work.
• The Department for Work and Pensions should undertake immediate and ongoing promotion of Access to Work to reach more people with musculoskeletal conditions and their employers. They should confirm the planned level of spend for promoting the Access to Work scheme and how outcomes will be assessed.
• The Department for Work and Pensions should ensure that the needs of disabled people and people with health conditions are taken into account as any new employment support schemes are introduced, and also that those providing employment support schemes have the expertise to support people with disabilities and long-term health conditions.
• The Department for Work and Pensions and the Government Equalities Office should commission or undertake work to clarify the meaning of reasonable adjustments, ensuring that people with arthritis and related conditions are consulted, so that it is clear what employers should provide.
• The National Disability Strategy should explicitly recognise musculoskeletal conditions as the leading cause of disability in the UK and include measures to enable people with these conditions to be supported across many aspects of life.

Background to musculoskeletal conditions, disability and employment

5. Arthritis and related musculoskeletal conditions affect 18.8 million people in the UK and are the single biggest cause of pain and disability.[5] These conditions often limit people’s mobility and dexterity and cause pain, affecting people’s ability to work.

6. People with musculoskeletal conditions are less likely to be in work than people without health conditions. Around 63% of working age adults with an musculoskeletal condition condition are in work compared to 82% of people with no health condition.[6] Musculoskeletal conditions are also the most common conditions in the UK’s working age population, and among people who are in work, they are a leading cause of sickness absence. They result in the loss of around 28.2 million working days to the UK economy each year and account for a fifth of all sickness absence.[7][8]

7. Analysis conducted by the Office for National Statistics found that in 2018 people with a musculoskeletal condition were, on average, earning 9.5% less than their non-disabled counterparts.[9]

8. In all, people with musculoskeletal conditions face challenges with employment – they are less likely to be employed, they are more likely to experience sickness absence and they face a disability ‘pay-gap’. (Further detail about the challenges faced by people with musculoskeletal conditions in the workplace are included in Annex A).Yet despite these difficulties, many people with musculoskeletal conditions want to work and value the economic, health and social benefits of working. They can thrive within work, with the right support.

9. It is also important to recognise that people with musculoskeletal conditions may not consider themselves to be disabled. In a recent study conducted to support Versus Arthritis’ input into the forthcoming National Disability Strategy, only 32% of respondents with musculoskeletal conditions reported that they considered themselves (at least in part) to be disabled due to their musculoskeletal condition.[10] This can have consequences in the workplace, as several legal duties around employment are based on the definition of disability in the Employment Act (2010).[11] People who don’t view themselves to be disabled may be more likely to miss out on relevant workplace protection and support.

Progress so far and impact

Qu: What progress has been made, especially since 2015, on closing the disability employment gap? How has this progress been made?

10. Briefing based on data from the Office of National Statistics indicates that between April-June 2013 and April-June 2020, the disability employment gap (i.e. the difference in the employment rate of disabled people and people who are not disabled) reduced by 5 percentage points, from 33.1 to 28.1.[12]

11. Although this trend is positive, the rate of change is gradual. To meet the Government’s 2017 pledge to get ‘1 million more people with disabilities into employment over the next ten years’ and a 2015 pledge to ‘halve the disability employment gap’ (no date was set for this pledge) it would require an increase of 350,000 more disabled people in employment by 2027, and a further reduction in disability employment gap of 12%.[13]

Qu: What is the economic impact of low employment and high economic inactivity rates for disabled people? Are some disabled people (for example, young disabled people or people with different health conditions) more at risk of unemployment or economic inactivity than others?

12. (Please also see section 6 above). The impact of musculoskeletal conditions on the UK economy is clear, and results from both lower employment rates for people with these conditions and high levels of sickness absence. This is a loss of opportunity both for individuals and to the economy.

13. The overall costs of working-age ill health fall on individuals, employers, the health service and the wider economy, and approaches to calculating costs vary. In 2007, the total annual costs to the UK economy of working-age ill health (including lost productivity, sickness absence, informal care and NHS healthcare costs) were estimated to be £103–129 billion.[14] The cost of musculoskeletal ill health is a significant part of this overall figure. Rheumatoid arthritis has been estimated to cost the UK economy between £3.8–4.8 billion per year, the combined costs of rheumatoid arthritis and osteoarthritis £14.8 billion.[15],[16]

Qu: What has been the impact of the coronavirus pandemic on disabled peoples’ employment rates?

14. Briefing based on data from the Office of National Statistics indicates that between January-March 2020 and April-June 2020, for disabled people, there was a slight fall in the employment rate and a small increase in the inactivity rate. (It is noted that these data are for the initial stage of the pandemic and also that ‘these figures not seasonally adjusted so when comparing consecutive quarters there may be seasonal impacts.’).[17]

15. Impact on employment status: Our survey data, collected at different stages throughout the pandemic, reveal concerning changes (For further details see Annex A). Data collected in July our COVID-19 & Shielding Survey, found that among approximately half of 1003 respondents with arthritis who would normally have been in work, 1 in 5 were temporarily or permanently out of a job (furloughed or no longer working).[18] The report ‘An unequal crisis’ by Citizen’s Advice in August 2020, suggested that 51% of people facing redundancy were either disabled or had a long-term health condition.[19]

16. Impact on musculoskeletal health: Before the pandemic almost three-quarters of working age adults in the UK were in work and spent on average a third of their waking hours in the workplace.[20] Workplaces were one of the most important settings for actively promoting well-being and health, including musculoskeletal health. The pandemic has affected the working lives to different extents: for front-line workers, people working from home, and those unable to work or furloughed. The opportunities to promote musculoskeletal health within workplaces have changed in the short-term, and there are new threats and opportunities for musculoskeletal health among people with different working patterns and locations.

17. Our survey Back Pain Britain was conducted between 25 August – 1 September 2020, among 1,040 UK workers who worked from home over lockdown. 81% of desk workers who switched to home working had developed musculoskeletal pain, and 23% reported that pain affected them either often or all the time.[21] The Institute for Employment Studies also found a significant increase in musculoskeletal pain among home workers in the early stage of the pandemic, with more than half of their survey respondents reporting new aches and pains compared to their normal physical condition.[22] These findings also align with the impact assessment carried out by the Scientific Advisory Group for Emergencies, which estimates that the burden of musculoskeletal conditions is likely to increase in response to COVID-19, principally due to the guidance to work from home wherever possible often without suitable ergonomic office equipment.[23]  If unaddressed, this rise in musculoskeletal problems is likely to affect people’s long-term musculoskeletal health, and in turn their ability to work.

Providing support

Qu: Where should lead responsibility for improving disabled peoples’ employment rates sit (for example, DWP; Business, Energy and Industrial Strategy; Health and Social Care)?

18. The Department for Work and Pensions (DWP), Department of Health and Social Care (DHSC), the Disability Unit within Cabinet Office and the Department for Business, Energy & Industrial Strategy (BEIS) must all contribute to improving disabled peoples’ employment rates, as they are responsible for relevant schemes, legislation or policy.

19. In addition, there needs to be cross-Government co-ordination of activity across a wider range of Government teams including workplace health activity that was based within Public Health England; and also within the Joint Work and Health Unit; the Government Equalities Office, the Equality and Advisory Support service (EASS) and the Ministry of Housing, Communities & Local Government. Consortia of large employers should be regularly consulted as key stakeholders.

20. There is a risk of the agenda being held back by the spread of responsibility across Government. Clear Ministerial accountability may help to ensure this is avoided.

Qu: The coronavirus pandemic continues to make it difficult to offer in-person support. What evidence is there of “best practice” in supporting disabled people remotely—either in or out of work? How can DWP put this into practice in services such as Access to Work and the Work and Health Programme?

21. Access to work: Versus Arthritis’ policy work on employment has had a strong focus on the Access to Work scheme.[24] We are members of the Access to Work FORUM in both England and Scotland, and have engaged in work in this area throughout the pandemic. There have been some helpful changes to the scheme during this time, including help for people for equipment to use at home as well as from their normal workplace; funds for some of those unable to use public transport to travel safely; some personal protective equipment costs for support workers; and increased mental health support.[25] The DWP should report on the levels of uptake of these new provisions.

22. In addition, there are further improvements that could be made to the scheme to support people during the pandemic and beyond. These include the creation of an on-line portal to enable people to claim costs virtually (this is proposed but has been delayed), a default of relaxation of the requirements for ‘wet signatures’ and the creation of a FREEPOST scheme so that people claiming costs using hard copy receipts do not have to shop for postage.

23. A further essential measure is greater promotion of Access to Work. Our 2018 study found that 59% (932/1581) of respondents with arthritis or related conditions had never heard of Access to Work.[26] More widely it has been described the Government’s ‘best kept secret’.[27] We appreciate the Minister for Disabled People, Health and Work’s response to a recent Parliamentary Question which indicated that ‘to ensure that Access to Work information reaches as many people as possible, the Department is planning to supplement [this] already extensive promotion with paid advertising from January 2021. Final proposals are currently being worked on for the paid advertising campaign and detailed media planning will determine final spend.’[28]

24. The Department for Work and Pensions should undertake immediate and ongoing promotion of Access to Work to reach more people with musculoskeletal conditions and their employers. They should confirm the planned level of spend and how outcomes (i.e. any increase in the number of claimants in response to this promotion) will be assessed.

25. Return to work support: In July 2020, the Government introduced new measures to help to support people to return to work, including for example the Kickstart scheme which was intended to create high quality jobs for young people at the highest risk of unemployment.[29] Some of the new schemes would be available to disabled people. It was stated that the expansion of scope of the Work and Health Programme, a scheme which supports unemployed people to find work and for which disabled people are eligible, would have ‘no impact on the existing provision for those with illnesses or disabilities in England and Wales’.[30],[31]

26. There are several schemes which provide support for disabled people or people with long-term health conditions to remain in, or return to, work including Access to Work, the Work and Health Programme and Intensive Personalised Employment Support.[32],[33] It is important that changes to these schemes, and new schemes, are integrated so that people can access the most appropriate support.

27. The Department for Work and Pensions should ensure that the needs of disabled people and people with health conditions are taken into account as any new employment support schemes are introduced, and also that those providing employment support schemes have the expertise to support people with disabilities and long-term health conditions.

28. Clinically extremely vulnerable people and those shielding: The group of people considered ‘clinically extremely vulnerable’ (CEV) to the COVID-19 virus includes people with musculoskeletal conditions (this may not be the reason they are considered CEV). In addition, people with musculoskeletal conditions, in particular inflammatory forms of arthritis, have chosen to shield during the pandemic even if they have not been formally advised to do so.

29. Employment policy changes that the government should consider to better support CEV people with musculoskeletal conditions and others during the pandemic, include:

• Extending the duty on employers to provide reasonable adjustments in the workplace to people who are considered CEV for the duration of the COVID-19 pandemic.
• Developing guidance to help employers have conversations with CEV employees about their options if they are unable to work from home.
• Establishing a process for CEV people to anonymously report concerns to the Health and Safety Executive (HSE) and local authorities about their employer’s ability to provide a COVID-secure and safe workplace.
• Increased promotion of the Access to Work scheme and the modifications made during the pandemic to employers and employees through new guidance to people who are CEV.

Enforcement and next steps

Qu: Are “reasonable adjustments” for disabled people consistently applied? How might enforcement be improved?

30. The Equality Act (2010) sets out a duty for employers to make reasonable adjustments for disabled employees so that they are not put at disadvantage.[34] These rights are poorly understood and implemented. As discussed in section 9 above, people with musculoskeletal conditions may not consider themselves to be disabled (or they may not understand if they meet the definition of disability set out by the Equality Act) and so be unclear if the right to reasonable adjustments applies to them and so in turn less likely to request these from their employer.[35]

31. In our 2018 survey of people with arthritis and related conditions, 29% (415/1444) of respondents said their employer had made all possible adjustments to support them in their role; 25% (367/1444) said employer had made some adjustments, but that there were additional things that they I would have found helpful and 25% (355/1444) said their employer had not made reasonable adjustments but they would have appreciated some.[36]

32. Alongside problems in understanding eligibility, a second issue is a lack of clarity about what is considered a reasonable adjustment. This can result in people with musculoskeletal conditions being unclear about what support they can request, and whether they should request it from their employer or from the Access to Work scheme.

33. We have called for the Department for Work and Pensions and the Government Equalities Office to commission or undertake work to clarify the meaning of reasonable adjustments, ensuring that people with arthritis and related conditions are consulted, so that it is clear what employers should provide.[37]

Qu: What would you hope to see in the Government’s National Strategy for Disabled People?

34. The Government’s intention to publish a National Strategy for Disabled people in 2020 was set out in the Queen’s Speech in December 2019.[38] The aim was to develop - with disabled people, disability organisations and charities - a strategy that would be ‘ambitious, supporting disabled people in all aspects and phases of their life’. It was stated that the strategy would include housing, education and transport. The overview of the strategy also included a commitment to reducing the disability employment gap, alongside content on the benefits system, hospital parking charges and hospital discharge processes.

35. Versus Arthritis has engaged with the Disability Unit throughout 2020 to provide input into the developing strategy. This has included attending an initial roundtable, and subsequent cross-cutting meetings focusing on ‘Economic recovery’ and on ‘Being Part of a Community’. We would welcome further opportunities to engage as the strategy development continues.

36. To ensure that Versus Arthritis input into the strategy is based on the views of people with musculoskeletal conditions we commissioned a survey between 19-20 October 2020 which received 426 responses from people with musculoskeletal conditions. The survey explored whether people considered themselves to be disabled due to their musculoskeletal condition or for other reasons (see section 9 above) and the areas of daily living where people with musculoskeletal conditions experience the greatest challenges. We will build on the survey findings with additional qualitative research and develop a series of policy recommendations for inclusion in the strategy.

37. Our initial recommendation is that the National Disability Strategy should explicitly recognise musculoskeletal conditions as the leading cause of disability in the UK[39] and include measures to enable people with these conditions to be supported across many aspects of life.

Qu: How should DWP look to engage disabled people and the organisations that represent them in formulating the Strategy?

38. The DWP and Disability Unit should use a combination of methods to engage disabled people, and people with disabling health conditions, in formulating the strategy. Consultation and engagement must be accessible and inclusive and should take place over appropriate timeframes to enable people to contribute.

Annex A: Summary of Versus Arthritis evidence sources.

39. Versus Arthritis is committed to ensuring the views of people with musculoskeletal conditions inform our policy work. This section provides a brief overview of surveys and research we have conducted in relation to people with musculoskeletal conditions and employment. We can provide further detail as needed.

Surveys and research during the COVID-19 pandemic on musculoskeletal conditions and employment:

40. Back Pain Britain (August 2020). This work, conducted by Opinium, was a survey of 1,040 UK workers who worked from home over lockdown (excluding those who were self-employed or who normally worked from home). The poll was conducted between 25 August – 1 September 2020. It found that:

• 81% of desk workers who switched to home working had developed musculoskeletal pain, and 23% reported that pain affected them either often or all the time;
• 89% of those experiencing pain had not told their employers about this new pain;
• One in three (35%) office workers had received no kit, support, or advice from their employer on home working.[40]

41. COVID-19 & Shielding Survey (July 2020). The survey was conducted for Versus Arthritis by Revealing Reality.[41] Data was collected between 2 - 8 July 2020 from an online panel of survey respondents, including 1003 people with arthritis, and 250 people with other long-term health conditions (but not arthritis).

• Among the roughly half of people with arthritis who work normally, 1 in 5 were temporarily or permanently out of a job (furloughed or no longer working);
• Confidence about returning to workplaces was low – only half were confident their employer will be able to provide a COVID-safe workplace;
• Among the shielding population in the survey, a third of the working age population (31%) said financial pressures or pressure from their employer forced them to stop shielding and return to work.

42. COVID-19 Pain Impact survey (April - June 2020). This survey was circulated among Versus Arthritis campaigner network, through email and by social media between 9 April and the end of June 2020. It received 6,180 responses.[42]

• Of those people with a musculoskeletal conditions who had started working from home: 60% felt it benefitted their physical health; 53% enjoyed the flexibility working from home afforded them; 47% wanted working from home to be a long-term option for them post-restrictions; 37% said it benefitted their mental health.
• However, only 53% of respondents confirmed that they had their equipment needs met and 40% reported that they had not being able to make changes or access support to be in work during the pandemic. 46% said that practical adjustments and more support at work would help them manage their pain.

Previous surveys and research on musculoskeletal conditions and employment:

43. Social media snap-shot to inform ‘Health is everyone’s business’ (2019). Versus Arthritis conducted a brief poll which was circulated on our social media channels from 26 –29 Sep 2019. 324 responses were received. In brief, people with musculoskeletal conditions said that different factors would help them most to stay in, or get back to, work. These included being able to change their hours or duties; changes to sick pay rules; knowing their employment rights and time for appointments.[43]

44. Working with arthritis 2018 survey (2018). Arthritis Research UK, incorporating Arthritis Care developed and conducted the ‘Working with arthritis 2018’ survey, which was promoted through the charity’s social media channels and through partner organisations between 17 May and 21 June 2018. 1,582 people, who reported that they had arthritis or a musculoskeletal condition, responded.[44] The survey confirmed findings that arthritis and related conditions have a substantial impact on the working lives of the majority of people with them. People described a range of types of support – either provided by employers as reasonable adjustments, or support through the Access to Work scheme – that could improve their working lives. However, people’s experiences and ability to access such support was variable. Key findings:

• 96% (1510/1573) respondents said arthritis or a related condition had made it harder to do their job at some point.
• As a result of their arthritis/related condition 36% (542/1507) had reduced their hours; 26% (399/1507) had changed the type of work they did; 19% (294/1507) had stopped working or retired; 27% (407/1507) had carried on without change.

45. Survey to inform ‘Improving Lives: The Work, Health and Disability Green Paper’ (2017). In 2017, we invited people with arthritis and other musculoskeletal conditions to directly share their stories of living and working with arthritis on-line through our campaign website ‘Work matters to me’.[45] We focused on understanding how people with arthritis can be supported to remain in work, return to work and to have access to a fair and timely access to a benefits and assessment system.  We received 260 responses between 16 December 2016 and 7 February 2017. Three major themes were:

• Flexibility of support provided by employers: The importance of flexibility on the part of the employer to support people with arthritis was an important issue raised in many responses.
• Challenges with the benefit system: Many respondents indicated that they felt inadequately supported to stay in or return to work. Some respondents said that the challenges of accessing benefits and support worsened their health condition.
• Change of employment status: Many respondents who had become unemployed or who had retired indicated that they would have stayed in work had they been able to make adjustments to their working hours or way of working. Many people indicated that they had become self-employed as the only way to remain in work.

46. Our report ‘Working with arthritis (2016)’ included an overview of surveys and studies on the employment experiences of people with musculoskeletal conditions conducted by several organisations dating back to 2007.[46]

References