By Dr Lara Shemtob, SOM Honorary Policy Adviser
Welfare reforms for people unable to work due to long-term ill health were announced last week by the UK government, and featured in the Spring Statement. Spending cuts of of £4.8 billion are predicted in 2029/2030 (£3.4 billion overall once £1.4 billion investment pledges have been accounted for). But, the focus must not rest solely on welfare spend - reforming the thresholds is unlikely to be the lever that gets people back to work. The real opportunity lies in the quality and design of support provided.
For most people, being in good work is good for their health. It is a social and economic win on both an individual and societal level if government’s plans to support people with long term ill health to return to work are successful. But many working age adults who are not in work are likely to feel unsure about their ability to work.
For policy changes around welfare to be successful they must be matched with effective support. WorkWell trailblazer sites have potential. They aim to move beyond cycles of 'assessment' and 'reassessment' and instead build comprehensive, responsive, and innovative support systems that work in tandem with the welfare financial support offering.
Occupational health expertise should be part of it – ideally early on. OH support is most valuable when there is scope for continuity of care and follow up so people feel there is holistic, long-term support - so:
1. Early access to occupational health expertise
- Decisions about health and work require timely, specialist input. Clinicians who can currently authorise fit notes should be able to recommend that their patients ‘may be fit for work, subject to an occupational health review.’
- Having easy access to OH is likely to help employers feel confident to support people who are returning from long-term sickness absence as well as advising organisations about preventative approaches to ensure that employees with health conditions remain at work. Forward thinking employers leverage OH in a preventative capacity, helping avoid long term sickness absence in the first place.
- The way that OH expertise is deployed in supporting welfare claims must be deepened. Data gathering alone, to inform one-off eligibility checks and gatekeep benefits is not enough.
- Expert support provided to welfare claimants should be used beyond assessment, to provide proactive, personalised management plans that address individuals’ health needs while actively building their work potential.
2. Continuity and follow-up
- Continuity and follow-up are powerful tools when OH is used, both within an organisation and within the welfare system. It strengthens trust, improves outcomes, and maximises the impact of interventions over time.
- Work and health are dynamic. One-time assessment only offers a snapshot and fail to account for changing circumstances. It is rarely helpful to be rigid in approach to assessment of fitness to work. Instead, thinking broadly about the strengths and skills someone can offer considering their health and functioning can lead to opportunities to remain in work with changes and adjustments to their role.
- Regular follow-up, at intervals tailored to the individual, is the only way to ensure adjustments are made as health conditions and life situations evolve.
- There is also a need for more healthcare professionals outside of OH settings to ask about patient’s views on work and to help patients to work in an effective way.
- Coaching delivered by non-clinicians also has a role in helping people who are not in work to both gain confidence that they can work and to help them navigate inevitable challenges that will arise as they embark on their return-to-work journey.
3. Working with employers and the workplace
- Effective systems engage both the individual and their current or prospective employer. OH professionals working within an organisation are independent and ethical in terms of the advice they offer, seeking to find the right balance between the needs of the employee and employer.
- Focusing solely on the individual and not on the work landscape around them risks leaving a disconnect between guidance and workplace realities.
- Support must bridge this divide—facilitating communication, building relationships, fostering reasonable adjustments, and adapting to changing labour market conditions, including technological advancements, and evolving working practices.
So, for welfare reforms to translate into genuine progress, work, and health support needs to be increased, with access to occupational health expertise and continuity of care.