When work isn’t working: tackling the UK’s sickness problem – with Jon Ashworth and Sacha Romanovitch

Jennifer Dixon:

Why are so many working-age people in the UK reporting ill health? The benefits bill is ballooning. What should be done to tackle all this? Well, with me to discuss this, I'm delighted to welcome back to the pod Sacha Romanovitch. Sacha has a long-distinguished background in business and she's just chaired the Health Foundation's Commission for Healthier Working Lives, which published earlier this year. And Jon Ashworth, who is chief executive of Labour Together, a think tank. He was Labour MP for Leicester South until the last election. And before that, he held a number of shadow cabinet roles, including Shadow Secretary of State for Health and Social Care, and for Work and Pensions. Welcome both.

A lot of ill health around in the country, a lot of increase in reported ill health among the working-age population. There's about 8 million people who are reporting a long-term condition that is either keeping them economically inactive or they're working with a work-limiting condition, that's 8 million people. And it looks as though health in this population hasn't really bounced back to where it was pre-pandemic compared to other countries. Sacha, you've just chaired a commission for us, could you just chart out some of the big trends?

Sacha Romanovitch:

I think it's an interesting one. There has been a lot of narrative, ‘Oh, did the pandemic cause it?’ But actually when you look at the underlying trends, a lot of those were there way before COVID and they continued through that period. And we've got 1.7 million people reporting that it's actually work itself that has caused their health condition or it's creating the challenges. When you look at the type of conditions, where are you getting significant increases in mental health conditions increasing significantly. But you have to look at that in the context of the environment we've been in over the last 15, 20 years really. Where you've had the massive increase in terms of social media, being online all the time, all of those dynamics, which still aren't fully researched, the impact of that on people, plus also significant impact of people in financial worries and the impact that has on their mental and physical health, which of course plays out in the workplace as well. So you've got these broader dynamics, which is why it's so important we look at these issues in the round.

Jon Ashworth:

My big preoccupation and passion when I led for the Labour party on health policy was what can we do as a society and potentially a government to tackle the unequal distribution of sickness in our society? And related to that, the unequal access to health services in some cases. And I think we know that the material circumstances in which you find yourself, the quality of the housing in which you live, the access to nutritious food, the broader environment, and indeed the place that you go to work and spend hours and hours and hours every week, has a direct impact on your health outcomes. And what became pretty obvious to me straight away when I moved from the health brief to the work and pensions brief was that really we needed to get our health services working much more closely with our whole galaxy of welfare services. I put it in those terms because the welfare system is very complicated, far too confusing for many people. But it was pretty clear that health and welfare, if you like, or health and social security, should work more closely together.

We've always known really, if we think about it, that the nature of work directly impacts your health. It's entirely intuitive. We know that if you worked down a coal mine for many, many years, that not only had huge implications for your knees and your back, it also had huge implications for your lung health. It was almost something we'd forgotten. But then we remembered it in the pandemic that the nature of work impacts your health. Because throughout the pandemic, when I was the shadow health spokesperson, every day I was on the TV demanding proper sick pay, proper recompense for people who cannot work. But we knew that there were people who had to work, particularly in social care because they didn't have access to sick pay. So we've always known this.

We have come out of the pandemic and we've been left with this curious phenomenon where we have not recovered our employment rate compared to our competitor nations. And it's certainly true when you look at the data, which is what the DWP is trying to grapple with now, increasing numbers of particularly younger people have flowed onto the different versions of incapacity benefits, sickness benefits. Some older people didn't go back to work, particularly if they could draw down on some private income, who would blame them? But we also know obesity has probably driven a lot of older people out of the workplace. We also know there's older people being driven out of the workplace because they're often caring for a mother, a father, an uncle as well.

So there's a whole complicated picture out there and it is a failure of social policy and my message to my colleagues who are now in government that this has to be one of their big priorities. They have to fix this because if they do not fix it, they will not get the economic growth that they want. They will not be able to raise living standards sustainably. They'll not be able to deliver the quality of life that people should rightly expect. So for me, this should be the number one mission of the government.

Jennifer Dixon:

800,000 more people are out of work because of the economic inactivity due to ill health since pre-pandemic. That's the Manchester and Bristol populations combined. And I think in our report, Sacha, you were saying that only 3% of people go back to work after a year when they've been economically inactive.

Sacha Romanovitch:

Yeah, that's right. When we were doing the report and deciding where to focus, we very quickly zoned in on where are the areas where people aren't looking. And for us it was this 300,000 people a year who were falling out of the workplace and then how much harder it seems to be for them to get back in. And thinking, well, if you could actually intervene earlier, can you do something different? That's where looking at what other countries do differently, there are some clues for us. I mean you can't take another country and put that straight onto the UK. But I do think it gives productive ground for policymakers to look in.

So if you look at both Denmark and the Netherlands, they've got quite a lot of structure. They've got wraparound support that actually says it's not leaving it until six months after someone's been off sick to actually say, ‘Oh, hang on, what's going on here?’ It's really early stage to actually say, ‘Right, what is going on with your situation?’ And not just look at your health, to look at your housing, to look at other dynamics around that can actually be creating the conditions for poor health and seeing how they can actually put in place a package of support right at that early stage to help people stay and work. And I think there were some signs of that in the Green Paper, the intent to do that, which I think is so important.

The other thing I just want to pick up on from what Jon was saying, we know the sectors that are most impacted in terms of health challenges: it's education, it's health and social care, and transport and logistics. What's in common in those three sectors? Those are three sectors where people were continuing to be in the workplace through the pandemic, bearing the stress and strain and, frankly, trauma of some of the things that they were experiencing working through that period. And have emerged into a world that's sort of forgotten that ever happened. But they're still carrying that and not only carrying that but carrying the legacy of working in systems with ever more constrained budgets, with workloads that are ever more increasing.

And particularly for those in vocational things, the thing I've heard a lot of people in vocations who are really struggling with the fact that they cannot give the care, they cannot do the job that they went into that vocation to do because of the constraints sitting around them. So it does have to be this much more holistic look at job design and how do you set people up to thrive. Because we've got some amazing people in our country. And time and time again when we were doing this work, it's people who wanted to work, wanted to do different stuff and it felt like doors were being slammed in their faces.

Jennifer Dixon:

So let's just think about our pathway for a minute. So there's the nature of the work itself and what could and should happen vis-a-vis flexibility. Then there's the occupational health or health related support that you get as a business as usual working environment. And then we'll go on to think about what happens when you get sick and what should happen there perhaps. So let's just talk about this first bit, the nature of the world of work and the rigidities that I think you described in the report. And I know, Jon, you've talked about as well, what should be happening here given the fact that you see how businesses are being hammered at the moment, and not least because of the economy, energy costs, national insurance contribution hikes and other things, what is realistic for businesses to be doing?

Sacha Romanovitch:

I've been involved in business my whole working life. Any good business person wants to have a workforce where people are thriving and able to do their best work and actually for them to be able to operate with their head up, looking to what's coming down the line for that business as well as their head down, just cracking on with stuff. So it's in businesses' best interests to have people set up and work like that. We're now in a world where actually when you look at how shifts are structured, anyone who watches Ambulance or something like that, they'll see people on 12 hour shifts going from traumatic situation to traumatic situation for 12 hours and then, bam, they're home for a bit of sleep and then back on it again. Why 12 hours?

We saw some pilots in our work where people were experimenting using AI schedulers to give a lot more flexibility to schedule shifts that were kinder for people, that gave more certainty, that actually created better work. And this is where we were calling in the report for some cross-industry collaboration, not just to be a talk shop, but rethinking knowing what we know now, how then would you design work rather than carrying on with structures that probably don't look that different really to 100 years ago, bar from some different buildings and computers around the place.

Jennifer Dixon:

And Jon, I know that we've got the Employment Rights Bill, haven't we? And I don't know what the government is thinking with respect to this type of flexibility to help people stay well.

Jon Ashworth:

The Employment Rights Bill is about restoring, introducing protections for workers in their workplace and that's good and proper. Our economy has been too dependent on insecure, low-paid precarious work in recent years. So giving low paid workers those protections in the workplace is good for their material circumstances and I would argue therefore in turn for their health prospects as well. But I do think government's got to think carefully about this. And one of my frustrations with the DWP under successive governments, the DWP was created by the last Labour government bringing together other bits of different government departments, is that even though in theory there is supposed to be a joint unit working across DWP in the Department of Health, a Health and Work unit, I don't think it's got the impetus and the weight behind it that it needs.

So I'll give you an example. The DWP is the sponsor department for the Health and Safety Executive. Health and Safety Executive will quite rightly send out reminders around how to deal with dangerous substances, toxic waste, heavy in the workplace, quite rightly so, as you would expect. When was the last time the Health and Safety Executive actually put together a package of proposals to encourage employers to create a healthy workplace? So I think there's an issue about the Health and Safety Executive. People don't realise it's sponsored by the DWP. They sort of thing is a Department of Business thing. It's actually a DWP arm's-length body.

The second issue is occupational health. We've had different proposals over the years. I think towards the end of the last Labour government, Dame Carol Black did a review and the whole health sector got quite excited, finally, we're going to have an occupational health system put in place. I think the incoming Conservative government did a couple of pilots, then pulled the plug on it. I think some of these combined authority mayors have got some to try different things, which is better than nothing. But if we know the longer you're out of work for sickness, the harder it ever is to return to work. So we do need, I believe, some sort of occupational health system, government backed government funded, in partnership with business obviously, but we've got to put something in place.

Sacha Romanovitch:

It was good you mentioning Carol because Carol was on our commission as well and is a passionate advocate for rethinking how you do that early support. And I think it's great having people like that because she's not going to give up on this one. Sometimes change takes a long time, but ultimately, we were saying that right now with occupational health, oftentimes that is just way down the line and also it often, in my view wrongly, ends up almost managing the cost for the employer to manage the person out of the workplace. And I think this is where there's the opportunity for actually the combination between employers, government working with insurers to actually say, ‘Right, early stage, how could we work together to make sure someone gets the right spot?’

I'll give you an example, let's call her Jo, who'd been diagnosed with an arthritic condition, which meant she couldn't do her previous job. But she didn't really know at the stage of early diagnosis of what it meant she could do, and the employer didn't know either. So at that stage, both of them, what they really needed was someone expert who could give them both advice as to, ‘Right, at this stage in your condition, this is what you can do, this is what the employer might need to do to adapt. Jo, this is what it means for you. This is what you might need.’ So that then they could work together to actually support her to stay and work in a role.

What actually happened was, ‘No, there aren't any jobs you can do. Oh well, there might be a job that's up three flights of stairs. No, there isn't a lift. Sorry about that. Oh Jo, you're not being very productive now, are you?’ Now Jo is out of work, her mental health is shot, her physical health is shot and she's been told once Occupational finally got involved, ‘Oh yeah, you're not fit for work.’ Well, that's just a debilitating situation for somebody who wants to work. It's a bit like triage, having a caseworker who can support that work with the employer and the individual, but also to identify what else they might need around them to give them support.

Jennifer Dixon:

I think I read in the Commission report that was it 49% of employers don't have anything like this, and particularly the SMEs. And turning to Jon, given the costs employers are increasingly facing, how is this going to be paid for?

Jon Ashworth:

We have a bill for sickness and incapacity benefits, disability benefits, which is escalating even with the government's cuts, I mean they're introducing about £5, £6bn of cuts, which are going to be very difficult. Even with that, this bill is on a trajectory to be absolutely monumental, far more than we pay a fund on all kinds of different public services. Just listening to the example there, Jo, at the moment, she's lost her job, she will go to the Jobcentre, where presumably she'll be signed off work for reasons of sickness and therefore will flow onto the higher level Universal Credit and will probably be beyond that higher level Universal Credit for some considerable time, which is not in the taxpayer's interest. Yet. So the Jobcentre's role though, which is run by the DWP, is to find Jo a job or sign her off onto Universal Credit.

At no point in that story did anybody think, let's go to the government's Jobcentre, the government's public service, which is about getting people in work, and asking them for advice on help and how to keep somebody in work. And that bit of public service is only stepping in when it's too late for that individual. And their only answer is therefore to put that individual on a higher level of sickness benefit, which meanwhile the politicians in Westminster are going, ‘My word, why are we spending so much on these sickness benefits?’ There's got to be a better way of delivering this system.

Jennifer Dixon:

So are you saying, if I've understood correctly, that the job centres would stretch further into businesses?

Jon Ashworth:

That is a proposal that I'm floating, may well not necessarily be the right thing. But I've always thought it was curious that we have a Jobcentre service directly funded by the state, which only seems to operate really when someone's lost their job, isn't helping somebody stay in a job or helping somebody negotiate a flexible job. I think there are more radical things we can do with that employment service.

Jennifer Dixon:

I was helping Alan Milburn with his Pathways to Work Barnsley Commission and one of the breakfasts we had was with all these local SMEs, 30 employees, 40 employees, and they didn't know what hit them, particularly mental health issues, they just didn't know what to do and they were thinking of trying to pull their resource. So that's another way of doing it, isn't it, with through the Chambers of Commerce or through the CBR, whatever it is. I don't know whether that was something that we considered in our commission.

Sacha Romanovitch:

How can organisations and industries come together to create solutions? I think it's just a really sensible thing to do. Often when people talk about the cost of this, at the moment, as Jon said, the cost is ever escalating, but nobody is winning in this system. Individuals aren't sitting there living the life of Riley on the benefits that they're getting. It's actually really challenging to manage on the benefits that they get. Businesses are losing talent. And in any environment, losing people that you've hired, who are experienced, who want to work is never a good business idea. This is where the clue is in terms of who pays. I think at the moment we are spending an awful lot of money and not getting great outcomes from it. So how do you think differently about how we're using the resources that we're already spending to give better outcomes has got to be the way to go.

Jon Ashworth:

Well, there's two things there. First of all, the Treasury will always be sceptical about the Department of Work and Pensions, getting people back to work schemes. It never, ever thinks that the savings that the DWP is promising will ever materialise at that level. I can say that as a former Treasury special advisor from back in the day. So there's always that tension between the Treasury and the DWP. But I think there are examples in public services where you are giving people that broader support and getting them into work. So one of the projects out there, something called Individual Placement and Support, and this is where DWP employment advisors are co-located in mental health services and they will help people find work and they will continue to support them through their work journey.

I've visited ones which focused on addiction services in Nottingham, but it doesn't have necessarily have to be addiction services. It's usually a mental health provider. There is evidence that those projects do work and works with employers who are prepared and want to take people on if they've got an addiction problem who also understand, perhaps if you've got an addiction problem, you might not necessarily be able to get yourself to work every day. You've got employers working with them who want to help and that's very important here. It is an expensive model compared to other DWP back to work schemes. But if you're getting people into work, my word, that is transformative for those individuals. And it's exactly the sort of thing we should be doing.

Jennifer Dixon:

You mentioned some examples from the Netherlands I think and Denmark. But I wondered whether you'd come across really good examples in the UK of maybe small businesses, or even larger ones, that have been more proactive than others.

Sacha Romanovitch:

Some of our examples are with larger businesses. So Centrica had done a really sort of big study in terms of how they could give that early support and how that actually helped people. And I think they demonstrated it delivered annual cost savings around 2.5 million pounds by doing that. But I think it's really easy for people to say, oh, well that's all right for the likes of Centrica, for small businesses it's not possible. But this is where, we've got some fantastic trade bodies in this country, we've got some fantastic business organisations. They exist to actually help businesses to be better.

I had my experience from working in the accountancy profession when we were working on social mobility. The large firms got together, what we found was that when we worked together to share best practice, we could actually come to an industry contract as to what we wanted to be like as an industry, to make commitments around social mobility and giving people opportunities. And the larger firms with more resources were able to share their expertise with those with less resources so we could all be better. And that, to my mind, is what trade bodies exist for, right?

I think CBI and Chambers, I think there is some good work going on. I just think that as with all of this work to stop it being just a sort of a nice talking shop to something that really gives deliberate action, you need to actually be quite specific and say, this is a situation that we want to change. This is what great would look like and this is how we will work together to deliver that. And I think there is absolutely that opportunity for them to do that now, and working with government in partnership. Because anyone who's sitting out there in the country thinking that, government can do this on their own, employers can do it on their own, individuals can do it, that's why it's all got messed up in the first place. It's going to take that triumvirate working together to actually create a significant change that benefits everybody.

Jennifer Dixon:

Now let's talk a little bit about the statutory sick pay and the benefits because what you don't want to do is disincentivise work and you don't want to incentivise staying on health related benefits or disability related benefits for a long, long time. So maybe I'd go to Jonathan first. What was the DWB Green Paper, Get Britain Working, saying and trying to do?

Jon Ashworth:

Sure. Just quickly on statutory sick pay, there's been an acceptance since the pandemic, certainly in Labour circles that statutory sick pay was inadequate and if you are out of work for reasons of ill health, you should receive proper recompense. Because being forced to go to work when you are ill and it's not good for you and it's certainly not good for your colleagues, that is something the government wants to fix. And I think the pandemic put that in bright lights that it desperately needed fixing.

There's something else going on in benefits more generally. For different policy reasons, the difference between sickness benefit and unemployment benefit, there's, what, £300 a month or so? Mainly because Chancellors of the Exchequer, frankly, have not wanted to stand up and say, ‘We're increasing unemployment benefit,’ because they assumed they would get a political backlash over that. The consequence of that is that this huge gap has opened up between unemployment benefit and sickness related benefit.

Now in social security theory, if you like, unemployment benefit is also always supposed to be lower because unemployment benefit is supposed to offer you a bridge while you find another job. It's not supposed to give you long-term security. Because the system, the taxpayer, wants you to find a job and go to work. But there is a feeling, a theory, an assumption that this discrepancy has incentivised people to get themselves onto that benefit rather than going on the job seeking benefit. Look, totally appreciate there'll be people shouting at this podcast when I say this, I'm just trying to explain the rationale as to what is going on there. So the government are trying to even that up a bit.

There's a second issue is something called the Personal Independence Payment, which is a disability benefit to support you both with the costs, the extra costs of your disability and to help you feel included in society. And the government are tightening up the criteria for that because, again, there is a feeling that increasing numbers of people have been accessing that benefit, often for mental health issues, depression, anxiety, ADHD, and the government feels that that benefit bill has been increasing hugely. So the criteria for getting that benefit needs to be tightened up. That's the government's rationale. They want to find about £5 to £6bn. This is a lot of money, but still the disability benefit bill is still going to increase substantially even with about £5 to £6bn chopped off it anyway.

Jennifer Dixon:

The system for assessing whether you qualify for the Personal Independence Payment, has anyone really looked at that to see if somehow it's changed over time?

Jon Ashworth:

No, these debates are very contested as we all know. But there is certainly in today's social media world accounts encouraging people how to game the system, which the government is very exercised about.

Jennifer Dixon:

And Sacha, could you then say a little bit more about what we were saying, you were saying, in the Commission's report about statutory sick pay?

Sacha Romanovitch:

If you're on statutory sick pay, the fear that people have is that they're on this cliff edge of will something happen where even that support, which isn't that much, will disappear? Because actually then they're really looking into the abyss. And I think it's that dynamic that you've got to shift and remove. Because there's a very clear link. If people are really worried about their financial position, then their mental health, that financial cliff edge precarity is really challenging for people. The system tends to look at health as binary, you're capable of doing this or you're not. And yet a lot of conditions don't work like that. It's like, well, some days I can, but some days I really can't. And so being able to look at how you can have a much more adaptable system in terms of a sick pay that actually gives people safeguards if they do go into work and it doesn't work out, that they're not suddenly at the back of a eight-week queue and end up with this massive financial gap that then can really put them into a very, very precarious position.

Anyone rational, if you're looking at, ‘Well, if I do this, this could happen, it could be good. But if it doesn't work out, something really terrible is going to happen,’ it's a really hard thing to ask someone to take that leap if they're also managing a challenging health condition. You need to have a sick pay that actually gives people a bit more financial security. You look in the pandemic, why did we have the whole furlough scheme, why did that come in 80% of salary? It's because people quickly realised that people couldn't actually sustain going from their normal salary to 116 pounds a week. So looking at getting sick pay at a sensible level, giving a phased return to work option for people, actually giving employers some incentives. And we didn't go this far in the report, but with all the stuff about NI, you could envisage a way in which if employers were actively helping employees to stay in work, that there could be some kind of recompense, an NI rebate or something for smaller employers who were doing the right thing, frankly.

So it's not beyond the wit of man to actually start to think about it quite differently. And I think the other bit that we really started thinking about was this idea of this vocational rehabilitation benefit, which would be continued financial support, caseworker-led support, ongoing assessment of what you can do, but tied in with employers being able to work flexibly with people. There are so many conditions from if you're living with cancer and you're on chemo through to arthritis and muscular skeletal through to living with depression where your health is variable. I know from personal experience it is perfectly possible to do really great work when you're living with conditions like that. But you do need to have some flexibility to be able to do it.

Jennifer Dixon:

And did the Commission cost this out, because mindful of what you've just both been saying about the rising costs?

Jon Ashworth:

This is where I would've fallen out potentially with colleagues of the Treasury had I been in government working on some of this because in the end, helping people stay in work and return to work is in the interest of the economy. It's in the interest of economic growth and it is in the long-term interest of the country. But of course the Treasury will come along and they'll say... Because they're thinking about annual budgets or they may be thinking about 2 to 3 year spending settlement, and they'll be looking at it in those terms and they get very snooty about ministers and departments and officials pointing to the long-term savings. But short-termism in British policymaking has been a detriment across all kinds of areas of government. So I would really urge the Treasury to look at this in terms of the long-term getting people into good, well-paid sustainable work is in their interest in the end. Even if it is a cost over the next spending round.

Sacha Romanovitch:

We'd done some beautiful sort of modelling and costings as you would expect, and saying that by year five of doing the sorts of changes that we propose, that even if you just got 100,000 more people staying in work, the annual savings would be about 670 million pounds and the total savings to government over that period could be 1.1 billion. Now, we estimated the cost of delivering the support and those types of things could be around £620m. It's really easy to think, oh gosh, we've got to go big bang, and then everything becomes too difficult and no one does anything and then 10 years from now we'll look back and go, oh, we didn't do anything. It's got terribly worse. What we said is, look, let's continue to actually do some of these pilots to test and learn what works.

Because one of the things that I've seen time and time again is if employers see stuff that's working, hey, they copy it. If insurers see stuff that's working, they copy it. If government sees stuff that's working, even they copy it. Let's test, learn, repeat, spreading that approach. And I think offering the opportunity to some job centres, because we were both speaking to people in job centres who are like, if only we could. Wouldn't it be amazing if we could liberate all of those people who know day in day out, what people actually need, but feel their hands are tied behind their backs in terms of delivering it. Wouldn't it be amazing if we could liberate some of those people to actually do just that and see if that could actually make a tremendous difference to people's lives?

Jennifer Dixon:

This sounds like a 10-year mission, right, is one of the missions and therefore the Treasury's calculation for the payback is a 10-year payback, not a yearly payback.

Jon Ashworth:

But as we know from when we're focusing on the NHS side of our discussions, again, it's a very similar argument. It's a very similar debate when we're talking about public health and prevention budgets. The short-termism bedevils so much in our policymaking in the UK.

Sacha Romanovitch:

It is crazy how much of our public finances is actually accounted for on an in-year cash basis, which gives all sorts of perverse kind of behaviours. And actually, really practically, any business would actually be properly planning a longer-term investment fund. You would never be sort of pinning yourself to long-term system change in a year budget.

Jon Ashworth:

When I was in opposition, I was toying with could you get a health and all policies standard across government decisions or could have sort of future generation's wellbeing... I sort of played around with these different suggestions. There's been ideas about health indexes as well. Public health prevention, I mean that has an impact if it works well on people's ability to go to work. But government departments would never think of it in those terms, but they should. So there has to be something government-wide, which prioritises health, because, look, I'm not going to be boorishly partisan, but a Labour government is supposed to be about equality, the quality of life for individuals and therefore long-term decisions. And health is the foundation of all of that.

Sacha Romanovitch:

Ultimately, in terms of someone's health and employer has a role to play. But then the planning in a local system, has someone got safe and healthy housing? Have they got clean air to breathe? Have they got access to shops that sell healthy foods? Have they got the right financial support around them? Have they got access to healthcare? All of those bits need to be working together to actually create that impact. And I was on the Levelling Up Advisory Council, as you know, and I discussed it a lot with Andy Haldane. I think my real challenge with that was that in some ways it had got things upside down, that it was talking about people and all of these different things in service of the economy versus the economy should be in service to people and the planet.

And if we were able to bring a philosophy of thinking around, what is the future we're trying to create? What's the future we're trying to lean into? What are the outcomes we want to get? And different parties will have different ideas of how they'll get there, but at least if we could have an environment of, well actually this is the world we're trying to lock onto the targets, then you'd have much more likelihood of actually making some sustained progress through successive governments.

Jennifer Dixon:

Government's got a lot on its plate at the moment, that's an understatement, and it's got a lot on its plate with respect to DWP and economic inactivity and health. It's already set out a Green Paper and some other work beforehand. What do you really want it to do as next steps to tackle this agenda? Is it simply to carry out what's in the Green Paper or is there something more that should be thinking about? And Sacha, I'll ask you the same with respect to the business community.

Jon Ashworth:

I would do a lot more than what is being proposed in the Green Paper at the moment. I mean, the Green Paper is mainly about trying to incentivise work, it's making some pretty tough decisions around benefit levels, which already is a controversial debate. But I actually think the government needs to think more broadly. And you mentioned young people, and I think this has to be a big priority for the government. First of all, it's utterly unacceptable in my view that we've got a million young people not in education, employment, or training. A big chunk of this is young people citing mental health problems. I know lots of people who write op-eds for newspapers question that, but I would say highly surprising when so many of these young people missed a big chunk of school only 5 years ago, and have had so many of their opportunities curtailed. We shouldn't be surprised that that's had a long mental health tale for some of our young people.

We also know from all the evidence throughout social policy, if you are out of work as a young person, you're at risk of a life on the margins. The second thing is young people and children are not given the priority in public policy that they deserve. I would have big goals on tackling child poverty. I would do a big extension and support of mental health services for young people. I think it's absolutely unbelievable, frankly, that so many of our children missed out on so much education and schooling and so much of the stuff that children should be able to enjoy in life and we've never really had a catch-up programme. But I don't mean a sort of academic catch-up programme, I mean... I'm not being party political, but why didn't the previous government do a big programme of access to sports activities, theatre, drama, creative activities for a bunch of young people who've missed 2.5 years of really important times in their lives? So put children's health and children's wellbeing as one of your big goals. That's what I would do.

Jennifer Dixon:

Sacha, and business, what should they do next?

Sacha Romanovitch:

I think probably the top thing that I do, and I think Beth Kume-Holland, if she was sitting here would say is really reframing how businesses think about health and wellness and to as much as possible to come to things with an open state of inquiry for people around what barriers are in place? What can we do to remove things? I can't remember now the precise figure. It was astonishingly low the cost of the average workplace adjustment that flipped it from someone not being able to manage in that workplace to being able to manage.

And this whole narrative around people not wanting to work, the number of people living with disabilities who'd founded their own businesses because they wanted to work, but that was the only way they could actually get the flexibility to work, was just astonishing. And that was talent that businesses are missing out on, which is what's the crying shame. So I think that that business at a systemic level collaborating with insurers who hold loads of data around people, conditions, what it takes for people to be able to stay in work, with medical professionals, with individuals to then share among them, this is how we address this barrier, to actually help people to stay and work. It would make a phenomenal difference to an awful lot of people.

Jennifer Dixon:

So we must leave it there. A very complex topic, but thank you to Sacha and Jon. Thanks as ever to my Health Foundation colleagues, Sean and Leo, to Paddy and team at Malt Productions, and it's goodbye from me, Jennifer Dixon.