The art of work and wellbeing
There are few issues more important to the nation and crucial to unlocking new and better forms of policy and action than economic inactivity writes Matthew Taylor.
This article was first published in The MJ on 23 September 2024.
The problem we face is stark. Until the outset of the covid pandemic, economic inactivity rates in the UK were too high, but largely in line with similar countries. Since then, the number of people out of work for health-related reasons has risen by 900,000 to 2.8 million across the country.
In other countries, inactivity rates have returned to pre-covid levels, but in the UK they continue to rise with a projection of peaking at 3.5 million people on current trends.
The cost to the economy in lost taxes, additional welfare payments and labour shortages is massive. Conversely, if we could reverse the trend, the upside would be game-changing. The NHS Confederation calculated a potential £35 billion dividend to the public purse over five years from halving the post-covid increase.
For the health service there is potential for a double effect. On the one hand, if health interventions help people find or stay in work, it strengthens the case for NHS services as investable propositions. On the other hand, as people of working age generally get sicker when they are not in employment, helping people with health conditions to access jobs can reduce future demand.
But in our haste to help people and grasp the many benefits of reducing inactivity, it is vital that policy is properly thought through.
First, we need to be clear and realistic about the nature of the problem. For example, in focusing on the conditions that seem to be the main reason for inactivity – mental health among the young and muscular-skeletal conditions among older people – we need to appreciate the complex and dynamic nature of ill health and the way mental and physical issues reinforce each other. The longer people are out of work the more conditions they develop and the more complex their needs become.
Also, while it is important to offer routes into work for the people already economically inactive, the most cost effective interventions will be to slow the ‘flow’ into inactivity.
The opportunities presented by tackling economic inactivity are huge and the challenges of getting it right are too.
This was how older men’s employment rates in the post-2000 period were increased. So, engaging and supporting employers is vital.
Second, we need to grapple with the thin evidence base for what works.
I have seen and heard good examples of practice in the health service, including prioritising vulnerable wage earners for access to services, the NHS targeting recruitment at marginalised groups, mental health services supporting local employers to promote wellbeing, and integrated neighbourhood teams thinking about employment support as part of care packages for high intensity service users of working age.
Third, we need to get the policy and delivery framework right. There are already innumerable employment support programmes and funding pots – well intentioned but often small and non-recurrent.
Our new report with Boston Consulting Group combined the analysis of health and work with the case for mission-driven or whole-government approaches. Worryingly, I hear that views about mission-driven government are mixed in Labour’s high command. Unless No.10 determinedly drives new ways of working, politicians will soon fall back into old ways.
The most effective way of joining up is simply to devolve.
The NHS has an important role to play in tackling economic inactivity. This is the kind of problem integrated care systems were created to tackle. The system and place leaders the NHS Confederation represent are enthusiastic about this opportunity to deliver on the integrated case systems’ fourth purpose – that is to help the NHS support broader social and economic development. But it will be local government, largely, but not wholly, in the form of combined authorities, that need to take the lead.
The opportunities presented by tackling economic inactivity are huge and the challenges of getting it right are too. But given the situation the country and our public services are facing, the only thing more dangerous than trying to do things differently is carrying on doing the same.
Matthew Taylor is chief executive of the NHS Confederation. You can follow Matthew on X @FRSAMatthew
