Why aren't we working? – with Sacha Romanovitch and Oliver Coppard

Jennifer Dixon:

Welcome back to the pod and a very happy new year to all of our listeners. There's no let up here. We're diving straight back into the big issues. And today we'll be discussing why so many people are not working. 

About a fifth of us of working age that's just under 9 million people are so-called ‘economically inactive’. That is, they are not looking for or able to work. Now some will be students or people who want to care for their families full time, but while the number of people who were economically inactive had been steadily falling over the last couple of decades, it jumped by half a million during the pandemic. And in the UK it still hasn't returned to the pre-pandemic level, in contrast to our European neighbours. The biggest growth by far has been in people who report long-term illness. That's now about 2.7 million people, a record high, and understandably this is alarming politicians, as well as businesses. Rishi Sunak said recently on BBC One's, Laura Kuenssberg show that he was worried about the significant rise of the number of people deemed unfit for work.

[Quote from Rishi Sunak, appearing on BBC One’s Sunday with Laura Kuenssberg]

‘What we've seen over the past couple of years is a very significant rise in the number of people who are being deemed unfit to work. And that's something that is concerning to me. I believe very strongly in the importance of hard work and rewarding hard work, which is why we're cutting taxes on work as of this weekend very significantly. Now, in the last decade, that system hasn't been reformed at all and you've seen the number of people who are signed off has tripled. Now do I think our country is three times sicker than it was a decade ago? The answer is no, and the system is not working as it was designed to work and now we are bringing forward reforms that will mean that we look at the eligibility for who is signed off sick.’

Jennifer Dixon:

So what's going on? Well, to help us understand more, I'm delighted to welcome two guests, Sacha Romanovitch, who is the Chief Executive of Fair4All Finance, an organisation which helps affordable credit for families and small businesses. Sacha is a member of the government's Levelling Up Advisory Council and she was also the first female chief executive of the major accountancy firm, Grant Thornton. Sacha is also chair of the Health Foundation's Commission for Healthier Working Lives. And Oliver Coppard, who is a Labour co-op politician and has been serving as a Mayor of South Yorkshire since May 2022. South Yorkshire has had to adapt to the rapid decline of some heavy industries like coal mining and it's particularly affected by economic inactivity. Oliver sits on a commission led by Alan Milburn, former Secretary of State for Health under Labour, investigating economic inactivity in Barnsley, a commission which I'm also a member of. So welcome both. 

We've got record levels of people who are economically inactive. How much of an issue is this really for the economy, and how much of an issue is it for the wider population?

Sacha Romanovitch:

I think there are some really wide consequences of this as an issue. So from an economic perspective, there is the obvious one in terms of people aren't economically active then they still need to be supported and funded to be able to live lives in a meaningful way, which obviously has an economic cost to it. However, you stretch into two other aspects I think are really important, which is, one is in terms of business and business growth and ability to actually seek people to be able to deliver key work. Anyone operating a business I think has seen over the last few years this real challenge of finding people with the right skills to be able to fill their open positions and to actually really grow their businesses. And that has been a challenge, but also the social consequences in terms of if people are economically active, then that has consequences in terms of how they feel about themselves and can tip into making their mental health worse, etc., etc. But also then in terms of their families and beyond, and we're seeing some of those consequences actually coming through in schools.

Oliver Coppard:

I think it's huge, although I think it's not always identified as the root cause of the issues that we then confront. So absolutely it is a huge challenge for us that in South Yorkshire we lose on average about 14 million working days a year to ill health. So there is a huge healthy life expectancy challenge in South Yorkshire, about a 20-year healthy life expectancy gap from essentially richest to poorest places. We are unhealthy in South Yorkshire and other parts of the country. So healthy life expectancy for men in South Yorkshire is about 59.5, which is about 3 plus years below the rate for England. And that is a problem obviously because of the lost income that comes with 14 million working days lost. And so economic challenge is number one. Economic challenge number two, though, is then the cost of those people and the support that we need to put in order to provide them with the care, the support, the help that they need either to remain off work because they're too ill to work or to get back into work or the other challenges around not having the income from work. So those two dual economic challenges. 

That said, for me at least, the economic challenge is one thing. The real problem is the moral case actually, for making sure that everybody has the opportunity to access our society and work is a hugely important part of people's lives, people's livelihoods, it's how they get to a certain extent, their place in the world, their own personal wellbeing comes for a lot of people through work. And if you can't work actually, it's a problem for that individual person. It's a tragedy for that person, for their family, for their friends, and for them individually. That is the root cause. The reason why we need to address that problem, albeit the economic challenge is the one that we then have to try and figure out how to fix materially and what shows up on the statistics, which is a smaller economy and a bigger draw on the public purse.

Jennifer Dixon:

And are you seeing locally when you go round, do you see local people raising this as an issue directly with you?

Oliver Coppard:

I have said very clearly that I want to make South Yorkshire the healthiest region in the country and for people who are listening to this podcast, people who know this world well, I've got no doubt some people who've just heard that scoffed at that idea. And I say that knowingly, that wasn't a political promise that I made when I got elected in the hope that people would forget I'd said it. I genuinely am committed to that and it's the reason that I've become the Chair of the Integrated Care Partnership in South Yorkshire, the only metro mayor to have taken on that role and we're doing a huge amount of work in this space and that is because it is a huge challenge for South Yorkshire. It holds us back in all sorts of ways, but I think the tragedy of that is that we've actually normalised it.

So until I said that, until I made that a point of principle, until I said that, that was a clear focus for me and it's one of the things that I spend most of my time on. I wouldn't say it was a conversation that we were having across South Yorkshire, certainly not as politicians because I think to a certain extent we've normalised the idea that you get born in South Yorkshire, you die early.

Jennifer Dixon:

So you mentioned ill health and obviously that's where the biggest jump in numbers have happened. Why do you think this is so prevalent now? What's happened? Is it the pandemic, is it something else?

Sacha Romanovitch:

Data coming through is really showing, well first of all, the prevalence of six core conditions with cancer at top of the list, then cardiovascular disease, then muscular skeletal disorders, then mental ill health, then dementia, then chronic respiratory disease. And often people are finding they've got more than one of those that are impacting on them. And I think there's a big study going on at the moment nationally as part of the major condition strategy, which has been really starting to get under the skin of what is some of the causal factors? The extent to which some of those are because during COVID there weren't early diagnoses happening, which mean that people's conditions have got more challenging, the nature of COVID situation in itself and the extent to which those have exacerbated particularly mental health and people then finding that isolation, making it much harder for them to make an entry back into the workplace.

So I think that you've got this combination of factors. There's a really interesting one that I find in terms just the musculoskeletal disorders that as sort of a link on a causal factor that I draw across from my work at Fair4All Finance is that we've seen a real divide in terms of the pandemic of people who ended up with in an even worse financial position that one of the things that we see among that population is bed poverty is a real thing. Well it doesn't take a lot to make the connection that if you can't afford a decent bed it might not be a surprise that you aren't making progress in the recovery from your back condition. So I think unpicking some of these causal factors is really critical to understanding what we can actually do about it.

Jennifer Dixon:

Ollie, obviously your area is no stranger to stress. When you think of really what happened way back in the 80s, you yourself have talked about scarring. Do you think there's a long-term issue in your area? But if there is, what's caused the more recent blip?

Oliver Coppard:

Clearly South Yorkshire faced significant and very quick industrial declines. So the closure of the steelworks and mines in the 1980s and 90s were rapid and that caused a huge number of challenges that we've had to face. But the scarring of that, as you say, the inheritance of that, we're still living through. And so South Yorkshire is no stranger to those challenges around health inequalities, all the other problems that come with low income communities and challenges in those specific households where peoples in some instances have not been in work for a couple of generations. That is a real problem and a very difficult one to fix. Those problems that we see today all coming at once is what I think is causing the uptick. So we see the NHS being increasingly hard to navigate an access, so people being on waiting lists for longer than they have ever been, so not getting treatment for those conditions and those things worsening. The cost-of-living crisis happening at that same time.

So we hear about bed poverty, there are all sorts of other effects that come through as a result of the cost-of-living crisis and that cost-of-living crisis, while it may be acute now, has been a long-term problem for all too many people in South Yorkshire over the last 10 years plus. And so actually, what we see is those problems mounting in some households individually and specifically for individuals and therefore those people being out of work for longer and harder to get back into work because they're just not getting the support, the help, and don't have the money to be able to get out of that themselves. And that is a real and very challenging complex picture for all too many families, households, and individuals across South Yorkshire and further afield.

Jennifer Dixon:

I don’t know if either of you heard the interview with Rishi Sunna on Laura Kuenssberg. He was clearly among other things focusing on the tripling of some of the incapacity benefits or ill health-related benefits over the last couple of years and sort of sceptical that, that could be possibly due to the extent of ill health. It's difficult to believe, isn't it? Because the benefits in this country are lower than most other comparable countries in terms of the amount that we give.

Oliver Coppard:

I think this is a man who's driven the car into the ditch and then he's sitting there behind the driver's wheel kind of wondering why he's in a ditch. He absolutely has over the past 14 years been intimately involved in one way, shape or form with a Tory party that have done this to our country. And the idea that this person, the Prime Minister and former Chancellor doesn't seem to be able to understand the reasons why we now see so many people who are too ill to work baffles me. Of course there are challenges within welfare system. Of course there are things that you could change or fix, but I don't think reducing benefits is necessarily the way in which you're going to induce people to get back into work. And that I think has been proven time and time again. We've got something in South Yorkshire called Working Win, which is a pilot scheme, government funded to be fair to them, it is about getting people who are furthest away from the labour market back into work, through coaching, through support, through intense periods of help. And that is showing real progress at helping people to get back into the workplace when they've been quite far away from the workplace as a result of their health.

Now that is the way that you help people. You don't take away their crutches and then ask them to walk. You give them the support and the help that they need in order to be able to get them back into the workplace by helping them to address those challenges that they face. And as a result, we all win. Everybody wins from that. I think this idea that you take a punitive approach to those people who want to be back in work is just for the birds.

Jennifer Dixon:

We'll return to this in a second. I just want to ask Sacha about whether you and your national work, Sacha and with levelling up, focusing on benefits whether you think there's an issue with the incentives of the benefits system here?

Sacha Romanovitch:

When we look at where we are seeing deeper areas of chronic ill health, it correlates with areas where people are living in much more poverty and we already know that there is this massive interaction between people's financial health and their physical and their mental wellbeing, causal both ways actually, them creating a spiral for people that is really unhelpful. I think as Ollie said, I think the focus in terms of the levelling up, side of things has been very much looking at cross-government initiatives. What are the things that you can do that actually start to get into some of those root causes? So the Work Well partnerships really looking at how you support people into work. Looking at what are different ways in which you can actually increase prevention of heart attacks and strokes in terms of the digital health checks. And also starting to look at how they can expand funding to tackle the root causes of mental health problems.

I think it's those sorts of things that are actually going to get to the root causes of what can we do that we need to pay a lot of attention to when we are looking at it politically, because I think that it's going to be really hard for any incoming government to say, ‘Oh, we're going to increase benefits radically,’ just given the state of the public finances. So looking at how they are used in a way to ensure they're providing people with helping hands out of that situation alongside other things that are going to support them on their journey into work. 

I don't know about Ollie, but I've had periods of ill health where I haven't been able to work. I think the data shows that if you're out the workplace for 6 weeks, you can feel isolated, you can feel disconnected, you can lose your sense of self-worth. So anything that we can do to support people, whatever they're conditioned to be in a place where they are connected into society in that way has to be a really good thing for us to do.

Jennifer Dixon:

Looking at the figures, there seem to be two broad groups. One is the 50 plus age group where people have got chronic long-term somatic disease as we would say in medicine, hypertension, diabetes, musculoskeletal, the things you mentioned there. But then there's also this worrying group of 18 to 25 where people aren't really necessarily getting into the world of work, they're not students and mental ill health seems to be the bigger issue. Is that familiar to you Ollie, in your work locally?

Oliver Coppard:

There are a bunch of people out there, young people in particular, who've had a really tough time over the last few years. There is a generation who have gone through the pandemic, now face a world in which student fees are sky-high and repayments never go away. Who are trying to enter the labour market in a very difficult economic situation who are trying to get on the housing ladder when all too many houses are priced out of their reach. And then we're surprised when people have mental health challenges. Of course people have mental health challenges in those situations. I think the rational response in some ways, when you face that number of challenges, is for some people to really struggle. The challenges for us as politicians is to find solutions to the very real problems that those people face, be it housing, be it work, being it education; a path forward, a future in life in our country.

I have this phrase about wanting people to stay near and go far. That has to be the thing that we focus on as politicians, metro mayors, who are invested in the idea of levelling up our country, giving people the opportunity to grow up in a place that gives them all the opportunities they need to get on in life. And when that's taken away from people, I'm not surprised that results in poor mental health and huge challenges when it comes to getting those people into the workplace. So we've got to address the fundamental challenges those people face themselves and help them through those challenges by creating a world in which they can access opportunity. And that's the way I think we help people most of all, with some of those mental health challenges.

Jennifer Dixon:

I've just been reading a very interesting history of the miners’ strike, obviously affecting your area, Ollie the most. There you have these large industries, very heavily unionised, lots of social capital, community sticking together, understanding their identity and so on. All that gets kicked away. And what's left then is a kind of hodgepodge of smaller industries which are kind of precarious and was a very safe and secure for life kind of lifestyle has gone and it's all rather difficult to negotiate. And particularly, this history then goes on to the children of the miners who then find just this environment having to deal with it, having been totally unprepared for it. So if you look at unionisation halved in the last 30 years, the gig economy, health and safety, not really policed very well. Is there something there about the type of work that just is more difficult now?

Oliver Coppard:

So I think it goes to the question that you want to ask either as a politician or somebody interested in this sort of area, are we asking the question how do we stop people from falling out of the labour market because they're too ill to work? Or are we asking the question, how do you help people to thrive? And I'm much more interested in the second question: how do we help people to thrive? And the answer to that for me is we give people purpose and we give people security. And I to a certain extent, hate the idea of a safety net. And I say that and I realise it's a contentious point to make. I think we should be building platforms that people can stand on, not safety nets that are there to catch them if and when they fall. And you start right back at the bottom and you've got to get right back up the greasy pole to the top.

We've got to build a platform where you can take risks, where we're all invested, and where actually we're helping people to be part of something bigger, a community that gives you that security and that sense of purpose about what you're there for. What your community is there for, what your work is there for, what you are there to do. And if you look at the communities in South Yorkshire that suffered so much through the miners’ strike, through deindustrialisation, steel mills, everything else, what we had was a community that relied on each other, that had purpose, that had high wages, trade unions, had support to be skilled up through their workplace and outside it. Who had extracurricular, brass bands being a good example of what your workplace gave you, and that was all taken away. And as a result those communities fractured and as a result we're left with a bunch of individuals, all of whom are trying to do the best thing for them and their families but don't have that social network and platform on which to stand in order to be able to go forward. And I think that's the problem that we face in a place like South York, arguably the problem that we face as a country.

Jennifer Dixon:

Sacha In the work that Oliver and I've been involved in Barnsley looking at economic inactivity, we were interviewing a whole load of small businesses and they were talking about their experience in trying to hire school-leavers and they said that there was obviously a lot of challenges, unreadiness for work, not the right skills. I suppose that's not uncommon, but particularly, attitudes to work and levels of motivation and that a lot of younger people particularly, had ‘issues’, that was how it was described and by which these SMEs, small businesses meant particularly anxiety and confidence, and needed a whole lot more support than was the case even 10 years ago. Is this something that your work on inclusive growth has been looking at? And about what kind of pathways then, could a young person with issues perhaps take that could be more forgiving than just going straight to a large and personal warehouse where they might feel alone and alienated?

Sacha Romanovitch:

I think that there is something that exists around the social contract. What are people's expectations of the world of work and, frankly, what's in it for them? That there are a whole load of things that previous generations expected in terms of being able to afford their home, various things that people expected work would be able to give them that they're not seeing as a possibility for them in the workplace, which impacts how they feel about it and how they look at it. I think the impact of social media and all of that side of things. The levels of pressure that are on young people from that perspective in terms of how they interact with the world, I think that really has an impact. And also, if you think about the kids who are sort of 18 to 20 now, some of the really formative teenage years at school where you have an awful lot of that stuff where you are having to build that resilience to people not liking you and falling out with people, and feeling uncertain and feeling uncomfortable, all of that was taken away from them because they suddenly entered either this online world or not having that experience at all.

And so it's almost like that really critical developmental stage has been missed for a lot of people. And so I think there is something around how you can bring through and normalise that that thing does for you at school, doesn't it? You go through it, it's painful, it starts to normalise and you actually start to develop the mental pathways to be able to deal with the fact that sometimes life is hard, sometimes people are vile, all of that sort of stuff. You develop the mental resilience and pathways to be able to deal with it. And I do think that an awful lot of young people have just missed that and instead actually been subject to an online environment which has exacerbated all of the bad things without giving them any of the tools to deal with it productively. From an employment perspective, I think that there needs to be that ability for employers to be able to support people appropriately. I think that there's been a lot of fear from a risk perspective of how you support people with mental health challenges. So if somebody comes in and says, ‘Oh, I'm finding this activity stressful, I'm really struggling with this, my mental health.’ Oftentimes the reaction will be, right, ‘Well we need to take you away from that work.’ Rather than ‘Right, let's handhold you through how we can support you to be comfortable with the level of work that is needed.’

Jennifer Dixon:

Interestingly in some of the work we've been doing in Barnsley, some of the smaller businesses were kind of, Ollie, you'll be able to say more, but they seemed almost surprised and baffled by what they're seeing from younger people coming forward to the level of support needed. It's not something that they recognised from when they were that age. And these are small businesses with tiny HR departments, probably one person finding it quite hard to manage this. Is that true at Ollie, is that fair representation?

Oliver Coppard:

I mean that's certainly what we've heard from the employers that we've spoken to through the inquiry. I think it's probably not unreasonable to suggest that the difference between somebody who is, and I'm 42 years old myself, somebody who is my age or older, 40, 50, sometimes 60 years old, trying to imagine the life of somebody who is 18, 20, 22, 25 years old. That generational divide is huge, in my view. That experience, that life experience that somebody who is 20 years old and trying to find their way in the world of work now faces is pretty alien to somebody that owns a business and grew up at a time when the world of work was a very different thing and the challenges were very different. So I don't think it's a huge surprise. I think there is a role for people like me, for the public sector potentially, and businesses themselves should take the challenge on, I would think, to understand what those challenges look like to understand how they can help young people to be onboarded into those organisations and give them the support they need to engage in the world of work in a way which is constructive.

I think our education system has a role to play in that as well. But I do think that it's not a huge surprise that those people who run businesses, who are entrepreneurs, business owners who are running businesses at 50, 60 years old, necessarily don't always understand what those challenges look like for those people who are now entering the world of work.

Jennifer Dixon:

And the other thing, Sacha, that I wondered whether you might be seeing in your work, is that obviously the pandemic did destroy quite a lot of small businesses, didn't it? Which will take time to grow back again. And we heard from someone, this is just one example, but a lady who did have some ‘mental fragility’, as she described it. And she was fine to cope with a job in a cafe, but she wasn't able to manage a large impersonal warehouse, which seemed to be the main thing on offer. If the pandemic has destroyed quite a lot of the small local business infrastructure say, then that could also be a reason for some of the patterns we're seeing?

Sacha Romanovitch:

I think that's one of the things in terms of doing the Commission for Healthier Working Lives we really want to get into, is just really being able to properly examine, and particularly in the age of AI and this whole ensuring that we are not creating a workplace where those who have got less skills are effectively expected to behave like human machines and then wonder why they struggle, because human beings aren't machines, right? So I do think that there is this real opportunity for us to think about. It goes back to Ollie's point around what work makes people thrive? What's the work that actually is never designed for human beings to do and should be done by machines? The opportunity in terms of AI and how do you make sure that that work is actually available in a geographical spread such that you don't have the accidents of birth or required to move to be able to get access to good work?

Jennifer Dixon:

Perhaps if I just turn to some shorter term solutions, I know both of you are really actively thinking about this, how to tackle economic inactivity. And Ollie, you began to say a few bits about what you're doing in South Yorkshire. I wondered if you could say a little bit more about some of the promising solutions and also whether you think that devolution is helping and what more needs to be done?

Oliver Coppard:

I do think devolution is helping. I think we could do more. I think that's absolutely true. One of the things I want to challenge the government to do more is devolve health responsibilities more to places like South Yorkshire. That's really important to me. We are doing a huge amount in South Yorkshire to try and meet that goal of becoming the healthiest region in the country. I don't imagine I will do that as Mayor, myself. I don't think we will hit that goal while I'm sitting in this chair, but I am determined to turn around the tanker of South Yorkshire because somebody's got to get a grip on that and make that change in direction happen. So the things that we are doing are investing in early years. We're about to announce a programme called Safe Place to Sleep, which is about giving young people a bed, literally a place to sleep that is safe.

So stopping the pipeline of those people, those ill health at the youngest age, 1 in 9 babies that go home from hospitals in Sheffield receive a Moses basket from a charity. So we've got to make sure that young people have that wraparound support from the earliest years. We're working with Professor Alan Walker, Healthy Lifespan Institute in Sheffield, Sheffield University to, he's writing a report for me. The Health Equity Advisory panel that he's chairing is writing a report for me about how we take a whole system approach to people's health and wellbeing across the whole of South Yorkshire and what we can do to address some of those health inequalities and challenges.

We're focusing on providing access to health care. So we've just invested, committed to investing £70 million in the Health on your High Street project in Barnsley where they're taking one of the shopping centres in Barnsley Town Centre. Huge redevelopment around Barnsley Town Centre has already happened. And the next phase of that is taking the Alhambra Shopping Centre and turning that into a health hub. So health access is more immediate and easier to get to take some of the pressure off some of those hospitals. We're investing in active travel so that people can make better and different travel choices working with our active travel commissioner, Ed Clancy, and a bunch of other things besides, but it's a whole system approach and it has to be in order to address the complexity of those challenges.

Jennifer Dixon:

And in terms of targeted activities for those who are maybe more recently economically inactive, specifically on the 50 pluses or the 18 to 25s?

Oliver Coppard:

So the Working Win programme is a significant part of what we're doing in order to intervene in those challenge work with regional local charities in order to be able to do some of that work. It's a really important piece of work for me. As I say, it's a pilot at this moment in time and West Midlands have a similar pilot going on over there through what Andy Street, the mayor down there is doing. And so we're hoping that we've spoken to the DWP about widening that out. So it's not just about health, but it's about people in the justice system or people in the education system as well. So getting people back into the world of work. As well as that clearly the work that we do with Barnsley Council through the Pathways to Work Commission that you and I are both involved in, that is a key piece of work for me because that's going to help us understand, what are those barriers? What does some of the solutions look like and how can we do that not just in Barnsley, actually, not just in South Yorkshire, but how can we pitch that to government as a solution that we can use to address these challenges wherever they might be across our country?

Jennifer Dixon:

And Sacha, I wondered if you might have a crack at this as well? Some of the solutions, particularly at national level maybe relating to your levelling up work?

Sacha Romanovitch:

One of the things that we know is there's this really close linkage between financial exclusion and physical and mental wellbeing. And people who are financially excluded are also disproportionately suffering from physical and mental health issues and challenges. And so one of the things that we are looking at from that front is to, well, what are the interventions that you could do? Tackling it maybe from a different end of the spectrum that could really make a difference. And so examples are, on the issue of bed poverty, finding that if people have got access to that, then what we are finding is that they do recover from health issues quicker and are able to really move forward in terms of getting back into the world of work. Similar challenges in terms of people suffering from food poverty. Oftentimes, what we've seen is that there are fixable barriers that you can actually work with.

So there's been a fantastic partnership between Iceland and an organisation called Fair For You to enable people to have small interest free loans to be able to bulk buy their food shopping, which gives them access to free delivery. And as a result of that, the social impact is that people are reporting that they are able to eat healthier and they're starting to address some of the health challenges. I think it would be grossly irresponsible of me to suggest that those things are all the sorts of things that will fix it. But I think it's just really interesting when you can actually break it down. Sometimes it can become this massive challenge of something to fix, but sometimes it's fixing the small things and only referred to some of them, have I got a good place to sleep? Have I got decent food to eat? Am I actually free from worry about my financial affairs? Those can all be things where actually, if you can start to address some of those causal factors, then you can provide people with that pathway into physical better health and then through access to no interest loans to be able to address some of the other barriers of getting into the workplace.

Jennifer Dixon:

Are there any really good examples that you see where people have made some progress internationally maybe or nationally in your work, outside of South Yorkshire and across the country?

Oliver Coppard:

I know for instance, that in the Netherlands they had a pit closure programme. As far as I understand it, they had a mining industry close their pits, not single miner was made redundant or it was out of work as a result of those changes. And I think that's the sort of approach that leads to a long-term progressive and healthy community where you've got people who are supported through those changes. And those changes in my view, are only going to become more significant, come further, come sooner, come quicker as we go through the fourth industrial revolution. The effect that things like AI are going to have on all of us and the world of work. We're going to have to work out how we can help people to navigate through those transitions and the changes to the world of work in our society. More broadly, that we're going to see in order to help them not to fall out of the world of work and be that through health challenges or skills challenges or anything else. And I think that's what government, that's what the public sector are going to have to get to grips with as our economy changes more rapidly over the coming years.

Jennifer Dixon:

So perhaps we can finish off, I'm going to put you both in the hot seat really. You are the primary advisor to a new government of whatever political stride. And it's the chance for you to say what you think maybe the top things are that you would advise them to do to reduce the, understanding it's multifactorial, to reduce economic inactivity due to ill health. So perhaps if I can start off with Ollie and then I'll hand to Sacha for the last word.

Oliver Coppard:

For me, devolution has to be a huge part of that solution. Mayors, communities more broadly, know their places best in terms of solving those problems, in terms of addressing those challenges that we face as a place. We know those challenges and what those opportunities and potential solutions look like best. So I think devolution has to be a huge part of that story. Clearly we've got some programmes in South Yorkshire that I would like to see fully funded and pushed further and to go faster, which are things like the Working Win programme that I've already talked about. Safe Place to Sleep, I hope, will be a similar thing.

More broadly, I think the thing that I would say to an incoming government and what I hope to see from any government quite honestly, is to treat those people who are out of work because of the health challenges that they face, because of problems that are not of their own making. Treat them with compassion, and care, and support, and love, and help them to get back into work in a way that you would treat a friend, a family member. These people are part of our community. They deserve our support, our help, our care and we should be treating them in the way that we would hope to see our family and friends treated. And look, I think any government that tries to do that and take that approach can't go far wrong.

Jennifer Dixon:

And Sacha?

Sacha Romanovitch:

Agree with everything that Ollie has said. I think devolution into local areas is really important. I think following through at a strategic level, there's been this big consultation on major condition strategy and a strategic framework outlined to really set out longer term that joins all the different bits of the system up together, I think it's going to be critically important so that you have got that real longer term focus around shifting and change. And I do think that there is something here in terms of the resetting the social contract. I think that treating people with compassion is absolutely important. And I often reflect in terms of, when you are really working well with someone, you've got that real clarity of this is what you will get and this is what I expect of you to work with us to be able to make things better for both of us.

And I do think that making sure that we are resetting that social contract, what should people expect from work in 2024? Will the world support them to adapt a world of AI? How can we really make the most of the opportunities that presents to give much more flexibility for people in terms of how they work? Which opens the workplace to so many more people, that if we can really reset that social contract of this is what you should expect, but this is what you expect in return, and to have that really clear for people, I think that's a really important and under-explored conversation in the UK.

Jennifer Dixon:

So we must leave it there. Thank you very much to our guest, Sasha Romanovitch and Oliver Coppard for their insights today.

Next month we'll be looking at the path for the NHS in future based on the deliberations of two forthcoming, high-profile independent commissions, the Times Commission and the BMJ Commission. And meantime, thanks very much go to Leo and Sean at the Health Foundation. To Paddy and colleagues at Malt Productions. And it's goodbye, until next time, from me, Jennifer Dixon.