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Our working-age health challenge: how a new Commission can help us reach consensus on action Q&A with Sacha Romanovitch

14 December 2023

Less than a minute to read

New Health Foundation analysis shows that the number of working-age people with work-limiting health conditions has grown by 2 million over the last 10 years, an increase from 15% to 19% of the working-age population.  

The Health Foundation has announced a new Commission for Healthier Working Lives that will explore the impact of the decline in working-age health.  

We spoke to Sacha Romanovitch OBE, Chair of the new Commission, about why she’s passionate about this agenda. 

Why does it matter that our working-age health has worsened?  

It matters on a number of levels, but the one I often come back to is equality. Here in the UK, in 2023, there are over 17.5 million people in financially vulnerable circumstances. There is only so much people can do to reduce their costs and many do not have the option of increasing their income because of health issues.  

When you look at the data around who is excluded financially, you find that people living with disabilities or challenging health conditions are the ones struggling the most. From that human perspective, figuring out what can enable people to access work is really important.

Work is also important in supporting a sense of purpose, connection with other people, and self-worth. How you feel about yourself has a wider effect on your ability to participate in society. The people who are most fulfilled in their working lives are often also extraordinarily active in their communities, because they're doing something that gives them verve and energy.  

There’s a growth perspective, because our businesses need workers in order to grow. Then there’s the macroeconomic aspect. Our system requires people of working age to be working, in order to fund provision for older people who have reached the end of their working lives. With an ageing population and fewer people of working age working to their full potential, the economic model starts to fail.

The Commission is partly about the longer term, but what challenges do you see around health and work now, and in the year ahead? 

Because of the cost-of-living crisis and the pressure that is putting on households, we've seen that savings levels are decreasing. As savings go down, people end up in more financially precarious situations and that is especially true for those living with health problems.  

This is happening at a time when the growth of UK businesses is being restricted by the lack of access to people with the right skills.

We need to ask, what can we do to support people into work? If we could shift the dynamic in the next year, it could make a big difference.  

It feels like a jigsaw puzzle without the picture on the box. I’m an optimist. We have all the pieces and it's up to us to construct that picture and start to solve these problems.

What interests you most about the new analysis published recently by the Foundation? 

What interests me is that the analysis shows an increase in people, across the board, living with physical and mental health problems.  

The data also confirms that musculoskeletal health remains one of the most important issues. At Fair4All Finance, we're piloting a no-interest loan scheme and one of the things people borrow money for is a bed. People tell us that having a decent bed improves their sleep or their back problems get better, and then they are able to take on work. These relatively small things have an impact.  

Of course, not every health condition will have a solution like that, but there are root causes we can probe. I’m interested in looking behind the data to find out what people struggle with, what the root causes are, and how we might look at things in different ways to support people to wellness.

Why do employers need to take this agenda seriously? 

From an employer's perspective, there is something people refer to as ‘discretionary effort’. When your employees are doing things they don’t have to do, but they do them because they really enjoy their work and have energy to put into it, that's when you have more innovation and better customer service.  

You still sometimes hear the narrative that employees are slackers who don’t want to do a decent day’s work. If employers understand that people actually do want to work, but sometimes their health is a challenge, what difference would that make?  

From an employer’s perspective, it's like thinking about your workforce as if you were the leader of a high-performing sports team. How can you support people to have their best energy?

What initiatives have you introduced in your own organisations and what have you learned?

When we're looking at how to work together in a workplace, there are three different aspects we consider: what works for us as an organisation delivering our goals; what works for our people in terms of collaboration and support; and what works for individuals.  

If you focus too much on the individual aspect, you can fail on the other two aspects. It's important that anything is considered in those three dimensions, and continually reviewed.  

In my time at organisations both large (over 5,000 employees in the UK at Grant Thornton) and small (less than 40 at Fair4All Finance), I’ve recognised that employers have an important role to play. We need to understand what drives good physical and mental well-being and ensure the work environment supports that.  

At Grant Thornton, we invested a lot in supporting employees’ mental health, with a great initiative led by one of our partners which enabled people to talk about their mental health. It started with a blog they wrote sharing some of their mental health challenges. Creating a safe environment where people can talk about challenges they are facing is the first step to being able to provide the right support for people so they can thrive.

In my current role, we have paid particular attention to the importance of financial well-being on people’s health and intentionally considered all our policies to be financially inclusive and to support good health.

We were a young organisation during the COVID-19 lockdowns and we were trying to do a lot. We found we had to really pay attention to how to make sure that people weren't just online all the time. We worked with the team around how to set a better balance. We set core hours for meetings and agreed to try not to have meetings before 10am and after 4pm so that people weren’t just on screen all day.

We currently have what we call reset days, where people have time to read, catch up and create space to think and sit back from their screens. We also bring the whole team together quarterly to build connections. Connecting with each other is really important, so we pay a lot of attention to that.

What excites you most about the Commission and what do you think you can bring to the role of Chair? 

What excites me most is being able to build from the data to create recommendations for action. What’s been missing in the landscape are the practical steps that enable people to be in productive, well-paid work and enable employers to nurture their workforce in ways that make a difference.  

I want this work to bring attention to the realities of people’s lives, so we can work on solving the real issues, and that’s exciting.

The majority of people are employed by businesses with fewer than ten employees, so it’s important to think about practical things that any business can do. Many of the organisations I work with are very small, so I bring that experience to the role, as well as experience of what makes people thrive.  

We haven’t all had the experience of being unable to afford a bed. If we can get more people to understand the reality for some people and understand the small things that can make a difference, lots of things become possible.  

This content originally featured in our email newsletter, which explores perspectives and expert opinion on a different health or health care topic each month.

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