There’s a big health and disability employment gap. What can we do about it?

Afzal Rahman, Policy Researcher - Families, Welfare and Work team

People who are disabled or have a health condition are much less likely to be in work than non-disabled people who don’t have a health condition. Across England and Wales, just 49% of those who are disabled or have a health condition are in work. For everyone else this figure is 80% – this is a 31 percentage point gap. This is a problem that has persisted over the last decade despite recent increases in the overall employment rate.

Recently, the government has outlined an aim to halve this gap by 2020. This ambition is welcome and timely; as the population ages and people work for longer, many more people will need to balance the demands of work and managing a health condition.

Citizens Advice has launched a new programme of research seeking to understand what needs to change to narrow the gap. Today, we publish some initial figures that start to explore why too many people with health conditions who want to work aren’t sufficiently supported to keep their jobs or find new ones.

The health and disability gap is not the same for everybody.

A complicated set of issues

Although health conditions or impairments make work impossible for some, others can work with the right support. Across England and Wales, there are 6.8 million working age people who are disabled or have a health condition such as depression or arthritis. Of the 3.5 million people in this group who are out of work, 1.4 million are hoping to move into work. To halve the health and disability gap, over a million people will need support to move into or stay in work. This is an enormous and complicated challenge.

People with certain conditions are less likely to get the support they need. For example, conditions that are fluctuating or hidden can be difficult for employers to understand, and the benefit system may not be structured to cater for them. We found that just a third of people (36%) whose main condition is a mental health problem are in work.

Alongside this, some people who are disabled or have a health condition will face numerous additional disadvantages – they may have low qualifications, live in a region where the gap is wide, or work in an industry which has a low employment rate for people with impairments or health conditions. A targeted approach is needed to address these separate, often overlapping issues.

While more needs to be done to get people into work, helping people stay in work is another important part of the puzzle. Our new research also reveals that disabled people or those with a health condition are more than twice as likely to fall out of work in any given year compared with people who are not disabled and do not have a health condition. Helping this group to access the support they need to keep their jobs if they develop a health condition is a pressing challenge.

What we’ll be doing next

Income security is declining and Citizens Advice is currently exploring the impact this has on people’s lives. We are looking at the various factors in the labour market and welfare systems that are contributing to this. As part of this we will be looking in depth at health and work, in recognition that health conditions or impairments can seriously reduce people’s income security.

We want to understand in detail the varied barriers disabled people and those with health conditions face. We will use this to develop ideas for how government and employers can better support disabled people and those with health conditions to move into work or retain the jobs they already have.

Appropriate and timely financial or other support is vital in helping people stay in work or move into it. We’re exploring the different types of support people can currently get through the benefit system, from the government, from their employer and other sources. We’re also speaking to people about their experiences of navigating this support, and mapping their journeys to identify where people are struggling to get the help they need.

Employers and managers have a crucial role to play if we’re to get this right. We’re speaking to employers about their experiences of recruiting and retaining staff who have health conditions or are disabled. We want to know how they support employees who need to balance the demands of their job and their health. Government support for employers is important too, and we’ll be asking how informed they feel they are about what’s available. Another key challenge is the variety of impairments and health conditions that people need to manage in addition to work or their job search. We’ll be doing research to understand how employers perceive different types of health conditions and how that might be impacting their approach to recruitment and supporting employees to stay in work.

Getting over a million people into work is a big task. New approaches need to be taken by government and employers that recognise the importance of this issue, the diversity of challenges people face, and the importance of timely support and well designed jobs.

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24 comments

  1. Jon Raab

    Not everyone can be relied on to show up for work at a particular time or place. THis does not mean that they cannot serve a useful role in society. I only have around 4 hours a day where is can be doing something as I have a condition that causes chronic fatigue, the treatment for it also causes fatigue and dealing with untreatable pain is tiring which is a different thing from fatigue.

    This prevents me from getting a job but it does not prevent me from making an impact in the world and I am very proud of some of the things I have achieved. I have made changes to the disability office of a local council when I realised that there was a bullying culture from managers to staff and also corruption where the manager was charging £60 for blue badges to be issued. I had the place closed down and moved to a position where there were other departments so they can all monitor each other. I also got the advertising standards agency to make a decision about furniture made of “Bonded leather” being advertised as real leather. This had been going on for years and the furniture industry had pulled together to Rip people off. I proved that this material did not have the qualities required from natural leather and that it was misleading to sell it as such. If lawyers and testing facilities had been used to pass a ruling on this issue it could have cost millions but I was able to put a good case forward in my own time, no deadlines and no pressure.

    I have always taken on issues that effect other people but since 2013 the DWP has removed any opportunity to do more by taking up my time in battle to save or regain benefits they have taken from me, usually by misinforming me and then punishing me for taking their advice. They have also violated my human rights which caused me to have mental health problems that I have never experienced before . I had a lifetime award for both components of DLA but scored 0 points for PIP after a hostile assessor lied on every question and the DM who worked on the reconsideration actively avoided evidence and decided that I could walk 200 meters when there are no nerves in my legs to activate the muscles. I have been unable to get help from my CAB in Lewisham who’s office is only open for 6 hours a week. and the queue can be violent . I cannot get there in any case as my car was taken and I cannot afford taxis. I cannot even get to my front gate so there is no chance of using busses.

    My benefits were cancelled on Xmas eve 2013 and nine different explanations were given but none made any sense. (I have since learned that it was a hostile act that was covered up until I got my file on a subject access request.) They refused a community loan or hardship payment and so In desperation and diminished responsibility due to hunger I cashed in my pension but had 5 weeks to pay my lump sum back with no consequences and I asked the DWP to complete their investigation within this time.. After seven weeks I received an apology for the maladministration and my money was backdated but then i received a letter telling me that deductions were being made as I now had an income and excess capital..

    they have effectively stolen my pension from me but that was just the start of a war of paperwork that they continue by lighting a new fire under me almost every week and ignoring my complaints, or requests to escalate my complaints. I have managed to get them to admit four counts of maladministration and harassment but the consolatory payments received do not even cover my printing costs. I have also learned to expect a bombshell to arrive on Xmas eve and bank holiday weekends. I think I can predict this years present as I have been informed that I am being investigated for fraud for years of incapacity benefit that they have decided I was not entitled to even if my medical records show otherwise. There is no case to answer but it is an opportunity to cause me more inconvenience and stress. Knowing that the worse outcome for them will be another fifty quid consolatory payment for harassment and a meeting where they will mostly eat hobnobs and drink tea. They have stolen over £25000 from me and almost made me homeless. This may still happen .

    If the DWP staff can come up with these clever traps and dirty tricks to get people off the benefits they are entitled to, they should realise that people can motivate themselves to work even if there is no income or reward . Any work done adds to our value as a population but wasting time and paper carrying out punitive tasks for the DWP and the huge benefit fraud carried out by ATOS had cost the country its chance of financial recovery and its respect now that the UN has given us such a scathing report . DWP must realise that there are very few people who do not want to feel useful in some way. Those who don’t care are very few and probably have mental health problems which will not be cured by imposing sanctions on them. It’s also time for the deaths caused by abuse of office to be investigated and charges brought on those who have allowed themselves to become killers by dehumanising their victims by treating them as “stock” to be cleared, and imposing sanctions where the outcome is inevitably going to cause harm.

  2. Statistic

    My disability directly impacts upon how well I come across at interview. On paper I have all the right things to talk about, I apply and am good at getting interviews whether I apply under guaranteed interview schemes or not. The problem is I have Aspergers and frankly don’t come across very well in interviews.

    Aspergers means I am a bit too academic for my own good. I achieved a First in my undergraduate degree “with ease” according to a uni reference. It is useful at Citizens Advice in the sense that I am a bit more interested than most in the difference between a hardship payment and a budgeting loan and how the rules for hardship payments are different under UC compared to ‘legacy’ benefits.

    Aspergers means interviews are really really difficult. I particularly struggle with the questions designed to illicit some kind of negative response. ‘Tell me about a time you disagreed with your boss’, ‘Tell me about when you failed at something’ ‘What is your greatest weakness’. I try to compensate by preparing thoroughly. I was recently rejected from a job with Citizens Advice where I prepared 8 pages of interview notes.

    Basically my disability means I can’t make it in an organisation that takes diversity stuff rather more seriously than most. Ironic isn’t it. The only reasonable adjustment that would help me is no interview. What would be good is a short term contract to prove myself. I’m sure we can all think of examples of people who have given all the right interview answers and been rubbish in the actual job.

  3. Anon

    I’m not sure what use these guaranteed interview schemes are if it means being rejected at interview stage rather than at application stage.

  4. Volunteer

    Interesting report , what I would like to know how were statistics collected.I think we need more examples of successful support for employing disabled and health conditions with more specifics on how it works in the workplace.Is employment in referred to here only referring to paid Employment The research covers many areas of importance and I would be interested in knowing the next steps and the campaign progress in future

    1. Afzal Rahman

      The statistics come from our analysis of the Labour Force Survey. This is a large survey that provides the official measures of employment and unemployment for the UK. More details about the statistics can be found here: https://www.citizensadvice.org.uk/Global/CitizensAdvice/Work%20Publications/Working%20with%20a%20health%20condition%20or%20disability%20FINAL.pdf

  5. Lawrence Taylor

    I called into the Harlow CAB and enquired about options re employment with health restrictions.

    The adviser I saw shut me up on two occasions and then said he “did not know how to advise me”.

    My complaints have been ignored by Harlow CAB.

    So I have had no option but to publicise this.

    1. Afzal Rahman

      Hi Lawrence,

      Sorry to hear this happened. To help us deal with this, we encourage you to make a formal complaint about the service you received here: https://www.citizensadvice.org.uk/about-us/contact-us/Contact-us-form/

      Afzal

  6. Andy

    I have a mental health condition, and although I have a university level qualification I am finding it extremely hard finding work even though until early last year my employment history was fairly sound.
    When employers learn that I have the condition which I suffer usually their impression of me changes especially with my appearance, mixed race and 6ft tall.
    There has been absolutely no support for me from DWP, in fact the truth is that the powers that be have honestly endangered my life by leaving me not only with no support but also ly on my physical and emotional health and almost ruined my

  7. Graham Jowett

    Some of the best research on disability and employment has come from Richard Berthoud at Essex University.* This has shown that it is wrong to think of ‘disability’ or ‘health conditions’ as single categories – which past research tends to have done. He prefers to talk of distinct impairments which can be cumulative, so someone with several functional impairments will statistically be further from the employment market. Mental health and behavioural issues and limitations to mobility are the key issues most strongly linked to unemployment.

    It has always been the case that government-funded schemes ‘cream off’ people with recent employment histories and/or less significant disabilities. They can thus show success in terms of job placement outcomes and claim the funding, whereas they tend to ‘park’ those with more complex disabilities or less recent employment experience where the funding premium has never covered the intensive support necessary.

    The job market has changed, and many employers will claim they cannot take workers who may not be as experienced or productive as others. Financial incentives, or practical support such as job coaching is rarely at a realistic.

    With trends in employment such as people needing to work into their sixties or seventies and job insecurity, we need to change the relationship between work, self-esteem and active citizenship and access to social goods and services. Many people who will remain excluded from the job market do have skills and could make a positive and valuable contribution to their community IF they were not subjected to the indignity of DWP conditionality rules. There is sound evidence that volunteering significantly enhances self-esteem in young people with disabilities, for example.

    As a start, why not relax the permitted work rules further, massively increase support for social enterprises and other schemes for encouraging volunteering and community involvement, and make the funding levels for supporting people with more complex impairments into employment more realistic?

    *(https://www.iser.essex.ac.uk/research/publications/working-papers/iser/2014-17.pdf).

    1. rebecca

      Really appreciate your perspective on this. As a (fairly) young person struggling with what value I have in my community/society whilst coming to terms with a chronic health condition that has left me unable to work for a few years now, I often feel terrified of the very benefit system that is supporting me. I certainly long to contribute and build up some self-esteem, and couldn’t agree more that we need a broader way of valuing people beyond simply ‘work’. There is a lot of stigma and shame associated with being on benefits, especially being young and with a health condition that is not visible, people make many assumptions which creates a culture of fear around experimenting and participating. Hardly anyone chooses to be cast out of the social web of working, giving, having a role, positive feedback etc… but finding yourself outside that web for whatever reason it can seem like ‘work’ is the only way back, and if your health makes this seem impossible then self-esteem can be very hard to find! Hoping that we can move as a society to a more compassionate view of each other when health disrupts our lives, and a benefit system based on genuine support and encouragement rather than fear.

  8. Malik

    Thanks for sharing these statistics. The number will eventually grow by 2020 to see more people with health condition in employment.

  9. CAB volunteer

    I believe the overlooked aspect of this debate is the discrimination candidates face simply being unemployed in the first place.

    I am someone volunteering with CAB while looking for paid work. I recently phoned up a bureau and enquired about paid vacancies. It was a very painful conversation as the hiring person just could not see beyond the fact I was unemployed.

    I wanted to talk about all the knowledge and skills I’d gained at CAB. Knowledge of housing law/employment law. They were more interested in knowing the length of time I’d been out of work (!) and my age (!!). Ok it wasn’t a formal interview but Equality Act anyone?!

    The issue isn’t that I have a health condition. The issue is how do you earn the respect of hiring managers if – because of a health condition – you have been out of the labour market for a while.

    Say Afzal was hiring for some policy wonk role up at Aldersgate looking at labour market insecurity. Do you go for (a) someone in a similar policy wonk role who would require little training or (b) me who has been volunteering with CAB for several months not working due to a mental health condition?

    1. Eben Foster, Digital Communications Officer

      Eben Foster, Digital Communications Officer

      Thanks for your comment – we take discrimination very seriously. To better consider the issues you’ve raised we encourage you to give us feedback on what you experienced: https://www.citizensadvice.org.uk/about-us/contact-us/Contact-us-form/

      1. CAB volunteer

        No I don’t want to progress this. It is just an illustration of why there is a disability employment gap. Obviously the person shouldn’t have asked my age but the main point was they could not see beyond the fact I was unemployed. What I am doing for my local citizens advice very much feels like a 9-5 job at times even if there is no wage. I have a lot to give Citizens Advice but I need a paid role and every time I apply I seem to come up short.

  10. Shaz

    I am currently employed by the Leicester constabulary. Since I started menopause 2years ago my depression has got ten times worse. I have suffered with depression all my life but have managed with medication for 16 years. My sick record is diabolical I do admit that but now I am on stage 3 and being threatened with dismissal. I don’t know what to do I have worked there for nearly 11 years and can’t cope with it all. I am feeling suicidal all the time and can not cope with fighting to keep my job.I can’t afford a solicitor I never joined unison because I didn’t think I would ever need them. Is threre anyone who can help or information, website I can visit. Most days I cannot leave the house. All this work stuff is making me feel worse.

    1. Julie

      Hi Shaz – it sounds like your having a really difficult time!

      The contact details for Leicestershire Citizens Advice can be found here http://www.leicscab.org.uk/

      If you are feeling suicidal you can contact the Samaritans on 116 123. It’s free to call any time.

      Hope you get it sorted!

  11. Sue

    The reality for many with disabilities or long term health conditions is that the job market is highly competitive. Whilst there are many wonderful people in the world of work, prejudice and discrimination in education and employment is widespread, largely due to ignorance, lack of training, and lack of meaningful and timely remedies to support employees. The tribunal system is cumbersome and jargon laden, and not easily navigated without representation, and certainly not when the employee has disabilities or health conditions. Currently it is taking 5-8 months for an employment tribunal hearing in the south. It is not compulsory for employers to engage with ACAS in early conciliation and that has been a big mistake. The worst employers simply ignore ACAS altogether, knowing that it will be months before tribunal. Meanwhile, the employee risks losing their job for complaining about discrimination, especially if they have less than two years service. The two year rule in these cases needs urgent review. The tribunals need to respond more quickly to these cases, and the remedies need to be reviewed – they are not severe enough to make these employers think again and overhaul their practices.

  12. m imran

    HI my english is not very good i got very bad back problem since 2014 and treatment is still going on in been refused to get any kind of benifet i got 3 kids im very upset cant work whats my rights or what i can do about it please let me know if u can thanks

    1. Anon

      Is it possible for you to contact your local citizens advice office.
      There is a search (by postcode) facility on the front page of the website that will tell you the nearest one’s to you and their contact details.
      They should be able to advise you on what options you have to deal with your issue.

  13. Gwendoline Maher

    I have been trying to chase ESA payment since April, I had a breakdown last year July 2016, so decided under my GPs recommendation to leave my very stressful Senior Account Manager role.
    I am 49years old & have never claimed in my life as I have always worked.
    I got into debt so decided to find if I was able to receive benefits, after many calls and frustrating meetings, I started to receive ESA in November 2015, I began a rehabilitation admin role at my Drs Surgery.
    I had to attend a assessment interview and advised I was now working under a non contract position where I will be required at the most 2 days per week.
    The following week I received a letter advising I was entitled extra money under Universal credits.
    Two days later I received a letter informing me my payments were being stopped as well as a Bailiff visit if I did not repay £109.00.
    This made me feel sick to my stomach and my health condition worsened.
    I sent a letter advising this as well as the Practice Manager writing to advise I am entitled to payments from ESA.
    I have never heard back, I have had no money since April as I am unable to work as my anxiety & depression & under active thyroid has become severe. Could you please advise I am desperate and am getting into debt & unable to pay my mortgage.
    Many Thanks

    1. Anon

      Is it possible for you to contact your local citizens advice office.
      There is a search (by postcode) facility on the front page of the website that will tell you the nearest one’s to you and their contact details.
      They should be able to advise you on what options you have to deal with your issue.

  14. Bee Bryce

    This is spot on.

    In past employment, I struggled to get the support I needed in order to carry on with my job effectively. It took me almost a year to get my last employers to undertake an assessment, and provide suitable adaptations that would help me. If I was off, no understanding was given, and on one occasion, having been signed off for a week due to being unable to walk, my then manager asked me “Yes, but you will be in tomorrow won’t you?”

    Needless to say, I am no longer with that employer.

    My present employers are fantastic – and it makes all the difference. Most people with disabilities would rather struggle on than take time off, admitting we have difficulties is almost like giving in. I count myself very lucky, and the support from everyone I work with makes the difference on bad days from my being totally incapacitated, to being able to manage. My physical conditions do not affect my ability to use my brain! (well, some people might not agree!)

    Providing support benefits employers – there is a wealth of knowledge and talent out there that cannot be written off.

    I love working. And I love working for CAB 🙂

  15. Bill Wells

    A key part of narrowing the gap needs to be to work with workless people with health problems to get them to look for work. And as most of the people with health problems have been without work for a long time ‘activation’ or getting the long-term workless people to look for work needs to the priority.

    According to the latest LFS figures around 90% of all workless people with health problems are ‘inactive’ not looking for work. The other ~10% are ILO unemployed and so are looking for work.

    Around 3 3/4 million people of working age with health problems are workless of whom around 400 thousand are ILO unemployed (LFS). The majority of these people will be amongst the 2 1/2 million who are on ESA (and other disability benefits). And, of these 2 1/2 million, over 2 million have been on ESA for a year or more with 1.4 million on ESA for fully 5 years or more.

    Therefore, an essential prerequisite to closing the gap is to get long term ESA claimants to look for work – move from inactivity to unemployment. Because if you do not look for work you cannot find one – whether you want a job or not.

    UK’s welfare to work policy of maintaining activation throughout the duration of a claimant’s claim (with greater help the longer the duration) has proved successful for both JSA – down from 3 /12 million in the mid 1980s to around 3/4 of a million now – and the numbers on lone parent benefit more than halved. Unfortunately, despite the success with the other benefits this approach has never been tried for ESA and other benefits where the focus has tended to be on people newly workless (and even still in employment). In addition, the focus has been on the health issue rather than getting people to look for work and helping them find jobs where their skills are needed and the health problems are irrelevant.

  16. Bill Wells

    A key part of narrowing the gap needs to be to work with workless people with health problems to get them to look for work. And as most of the people with health problems have been without work for a long time ‘activation’ or getting the long-term workless people to look for work needs to the priority.

    According to the latest LFS figures around 90% of all workless people with health problems are ‘inactive’ not looking for work. The other ~10% are ILO unemployed and so are looking for work.

    Around 3 3/4 million people of working age with health problems are workless of whom around 400 thousand are ILO unemployed (LFS). The majority of these people will be amongst the 2 1/2 million who are on ESA (and other disability benefits). And, of these 2 1/2 million, over 2 million have been on ESA for a year or more with 1.4 million on ESA for fully 5 years or more.

    Therefore, an essential prerequisite to closing the gap is to get long term ESA claimants to look for work – move from inactivity to unemployment. Because if you do not look for work you cannot find one – whether you want a job or not.

    UK’s welfare to work policy of maintaining activation throughout the duration of a claimant’s claim (with greater help the longer the duration) has proved successful for both JSA – down from 3 /12 million in the mid 1980s to around 3/4 of a million now – and the numbers on lone parent benefit more than halved. Unfortunately, despite the success with the other benefits this approach has never been tried for ESA and other benefits where the focus has tended to be on people newly workless (and even still in employment). In addition, the focus has been on the health issue rather than getting people to look for work and helping them find jobs where their skills are needed and the health problems are irrelevant.

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