Posted on: 5 May 2023
Hello, my name is Robin.
The economy is flatlining, and the health and care system is in crisis. These two issues are, rightly, featuring prominently in political discourse and media coverage. However, while they are often thought of and presented separately, they are in fact part of the same story. Health is wealth, and wealth is health. Without urgent and sustained action by Government, public services, and civic institutions, we face a descent into a state no longer able to respond to the needs of its population, with an economy slowly withering on the vine.
According to ONS data, the number of working age adults absent from the labour market due to long-term illness reached two and a half million in the summer of last year, up from around two million in 2019. This is a thirty year high, with suggested causes for the increase including lengthy waiting lists for NHS treatment and the impact of long COVID. However, this is a long-term trend, with the numbers out of work for health-related reasons already rising – though less rapidly – before the pandemic began. Simply put, our population is getting more ill and frailer, and any effort to tackle both wellbeing and productivity of the UK has to tackle this head on.
The development of Integrated Care Systems (ICSs) has a potential to broker new collaboration and alignment between the NHS, councils, combined authorities, and the voluntary sector. The recently published Hewitt Review highlights scope for greater alignment of resource across public services, and the potential impact of greater collaboration. Here in West Yorkshire, we have created joint posts focusing on work and health, building on the joint working already in place. I am delighted that Jennifer Connolly has now joined us to lead the integrated work on health and the economy, which is agreed as a key priority for our Improving Population Health Programme.
In my joint role in the Council and ICB, I am clear that work on elective recovery is as much about the economy and worklessness as it is health, with the system shifting its focus and understanding of impact in this context. Calderdale and Huddersfield NHS Foundation Trust have done excellent work in this space, focusing on health inequalities and those most at risk from delay in access to care. The Institute for Public Policy Research has just reported the clear links in cutting waiting lists boosting the economy by £73million over five years, whilst we know the operational challenges remain significant, particularly in view of the recent industrial action.
Policy and political responses have been traditionally focused on getting people back to work when experiencing long term ill health, but the evidence is clear that once people have left the workforce for a substantial period of time, they are unlikely to return. Health Foundation research has shown 1.6 million of the 3.5 million economically inactive 50 to 69-year-olds reported ill health as their primary reason for not working, and the Resolution Foundation have highlighted that less than 2% of people over 50 and out of work for two years or more return to work.
Long-term ill health is bad for the people experiencing it, who are often prevented from working despite the desire and financial need to do so. However, it is also bad for businesses – particularly in areas experiencing significant skills shortages – and the wider economy, with fewer workers meaning lower tax income and therefore less to spend on the public services that prevent people getting ill in the first place, or support those who are already unwell back to health. This is a vicious cycle, and we need to fundamentally change the way we think about, fund, and deliver services in both employment and health.
Truly effective action to address economic inactivity must start to focus on those at risk of poor health and just leaving work at an early stage. It can only take place with significant resources, funding and powers being devolved and distributed right across the country to enable a seismic shift in spending with a greater focus on prevention and early intervention activity linked to both health and the economy. Even devolving a small proportion of the £20bn currently spent by Government on national employment schemes to local leaders could see a 15% increase in people finding work or improving their skills, as research conducted for the LGA by the Learning and Work Institute shows.
What is clear is that we must move beyond the fragmented and piecemeal nature of national programmes towards strong place-based schemes. For if we are to turn the tide on growing worklessness and create the conditions that keep working age people healthy and in employment, then we have got to invest not only in people but places too – and who better to do that than those who know their people and places best? Taking a top-down approach to both addressing health and worklessness has not worked. It is time to give local areas the funding and powers to get our people and places fighting fit, working, and driving the growth the country so sorely needs.
Have a good weekend,
Robin