By Dr Lara Shemtob
The Health Foundation’s Final Report of the Commission for Healthier Working Lives was published on Monday offering a compelling examination of the challenges faced by individuals with long-term health conditions in the workplace. The report, alongside videos shared at the launch event, highlighted personal stories that bring to life the difficult choices people must navigate when balancing their health with employment.
During the launch event, one individual shared how the current welfare system failed to provide a financially viable transition from benefits to part-time work. Faced with an all-or-nothing decision - full-time employment or continued reliance on benefits - she found herself with no real choice. Unable to work full-time but lacking sufficient support to work less than full time, she was effectively locked out of employment.
Another individual described how his health needs became a barrier to securing traditional employment. The need for flexibility led him to become self-employed, granting him greater autonomy and allowing him to manage his health while staying in work.
A further account highlighted the burden of having to repeatedly justify one’s health condition to employers, proving ill health and at the same time, proving capability in the workplace.
The Role of Occupational Health
The report endorses a tiered approach to work and health support. This should provide a structured framework for deploying occupational health (OH) expertise. Complex cases require clinical input, but OH professionals can also play a crucial role in supervising and training multidisciplinary teams, ensuring that both clinical and non-clinical staff have the necessary skills to support service users effectively. With diplomates in occupational medicine practicing across the country - many with extensive experience in primary care - there is a strong foundation to build upon. A tiered model has been piloted nationally, led by Dr Shriti Pattani, OBE, National Clinical Expert in Occupational Health and Wellbeing at NHS England. Evidence and infrastructure from this work must inform policy makers.
Addressing the Limitations of the Fit Note
The well-documented limitations of the fit note were also highlighted in the report. SOM supports a more explicit connection between fit notes as an early intervention tool and deeper, more tailored work and health support. Specifically, complex cases or those beyond the scope of a treating clinician should have access to occupational health expertise. This would ensure that individuals are not delayed in receiving expert support early on in their sickness absence, while helping to bridge the gap between primary care and workplace adjustments.
Moving Towards an Agile System
One of the report’s key themes is the concept of ‘jeopardy’ - the risk that entering the welfare system leaves individuals in a precarious financial state, with a knock on impact on their mental state. Limited flexibility in benefits discourages people from attempting a return to work, as they fear losing financial support without a guarantee of job security. Additionally, statutory sick pay - where available - offers little financial security, often pushing people into long-term benefits instead.
The report recommended a stronger safety net for people receiving work-related health benefits moving back into work, to prevent long-term detachment from the workforce.
Accepting that health and function can be variable is a significant step forward. Implementing agile approaches is key to managing this. However, agility in welfare must be considered a late stage safety net. Ideally, individuals will be empowered to manage their work alongside their health and maintain productivity, without needing to take long term absences from work. Some of this comes down to employer empowerment on the other side of these work and health conversations within workplaces. Employers must be supported in understanding how to support a diverse workforce function at its best. Clinical occupational health expertise is essential to achieving this - for both the employee and the employer. Its impact is greatest when integrated within an organisation.