What needs to change to get more people working?

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A report has outlined major changes needed to get the hundreds of thousands of "economically inactive" people in Britain into work and prevent more from leaving employment.

One in five working age people are out of work and not seeking work, according to the review by former John Lewis boss Sir Charlie Mayfield.

Tackling this problem should be a "shared responsibility" between employers, employees and health services, it concluded.

But what changes are being suggested? The BBC has spoken to bosses, workers and GPs about some of the challenges posed by the Keep Britain Working review.

"Employers will need to do more," the report states.

It says they are "uniquely placed" to prevent people from leaving the workplace in the first place, support people back into work, and remove barriers for disabled people.

The report suggests the answer is not extra spending, as many employers "already invest billions in health and wellbeing but need greater clarity on what works".

But many businesses have been hit with extra costs in recent times. In April, employer National Insurance Contributions (NICs) and minimum wages increased.

When it comes to helping managing employees with health issues, some small businesses may not have HR departments and staff trained. One small business owner told the BBC the report findings were "spot on", but what action follows needs to be "practical and realistic".

Tina McKenzie, policy chair at the Federation of Small Businesses, said firms it represents already make a "huge effort" towards workplace health.

"It is only by backing small firms to grow that we can recover and expand employment levels," she said.

It's a view echoed by Kate Nicholls, chair of UKHospitality, who said the report's recommendations need to be "taken in tandem with a concerted effort at the Budget to reduce the sector's tax burden".

She says the lack of money to invest "is one of the primary barriers to hospitality fulfilling its potential to employ more people and support people back into work".

Dunsters Farm

A healthy workforce is also good for employers, who lose on average £120 per day in profit from sickness absences, which are at a 15-year high.

Hannah Barlow runs food business Dunsters Farm employing 200 people in Bury, North Manchester - where Sir Charlie visited while compiling the report.

Ms Barlow told the BBC the business has been impacted by young people being off sick with mental health issues.

The report proposes "a fundamental shift" from health at work being "largely left to the individual and the NHS" to a shared responsibility between employers, employees and health services - which Ms Barlow welcomes.

But she said small businesses did not have "an endless pot of money" to invest in occupational health needed from a rise in adults being diagnosed with conditions such as autism and ADHD.

"How can we help them and where do you draw the line?" she asked.

"It currently relies on the employee to do something but they aren't in a good place, they can't physically and mentally engage in those conversations. If there was employer-led signposting to the help they need that would be a massive relief."

She said in some cases it was not always practical to keep staff with health problems in work.

"You might have people waiting for over a year for a hand or knee operation," she said. "The majority of our roles are in a warehouse lifting goods or driving trucks, there's not really an alternative role for them to be doing."

She said the company has gone to great lengths to engage with agencies, job centres and prisons to employ people currently out of work.

"We've found it quite hard to engage and it's frustrating that there's not more support for businesses as well as the people looking for work. If they're not tech savvy how are they supposed to apply for these jobs?"

The rise in sickness is being driven by a "surge" in mental health issues among young people and muscular skeletal issues, aches and joint pain in older people that is leading them to leave work.

But the report put an emphasis on employees' "personal responsibility", warning: "Disengaging from work and potential support, or relying on welfare as an alternative to work, can set people on a path towards detachment and dependency, rather than recovery and participation".

Katie Livings has chronic fatigue syndrome which causes exhaustion, headaches and sensitivity to light. She also has an inflammatory condition which affects her joints.

"The pain can be so severe I can be left completely bedbound and if that happens I can't work and have taken long periods of sick leave," she told the BBC.

When she graduated from university she worked in a call centre but "ended up taking sick leave and then having to resign in a very short space of time".

When she was able to return to the workplace she said she felt "a little bit lost" and turned to disability charity Scope for help in finding a new role.

"I asked for part-time and the roles were reduced on that basis for me that was the big reason I was able to go back into work," she said.

She began work as a legal assistant and asked for adjustments to help her.

"Having access to an ergonomic chair, keyboard and mouse means I can stay in work longer," she said. Ms Livings is also able to take regular rest breaks and attend medical appointments often at short notice during the day.

She said being able to ask for changes was "empowering" and "allowed my health condition to improve". She has since progressed into a paralegal role.

The Equality Act 2010 already requires employers to make "reasonable adjustments" for disabled people to prevent them from being at a substantial disadvantage.

Some business groups have pointed out a "clash" with the Keep Britain Working report and a shake-up of rules under the Employment Rights Bill due to take effect in two years.

The proposed new law includes a right to guaranteed hours and cracks down on zero-hour contracts without the offer of work.

Helen Dickinson, chief executive of the British Retail Consortium said the government's goals and its policies were "at odds with one another".

"In its current form, the Employment Rights Bill would make it harder for retailers to continue offering as many crucial flexible roles."

Ms Nicholls at UKHospitality which has been working closely with Sir Charlie said "unless its carefully managed there is a clash".

She said in its current form the Employment Rights Bill proposed workers were offered guaranteed hours based on an average they had done over a 12-week period.

"If we are providing supported pathways back into work or employing people with ill health and mental health issues the key is flexibility."

"Some weeks they can do eight hours, some weeks 40 hours, some weeks none," she said, adding retaining flexible, temporary, part-time, zero hours work is a "key part of this".

Some 93% of fit notes in England deem the patient "not fit for work," and "are often extended without further consultation", the report said.

But GPs say they find it difficult to judge whether or not a person is suitable to work while they are ill, but are asked to issue sick notes by patients themselves.

The report has called for a fit note reform and recommends the widespread adoption of a Workplace Health Provision (WHP).

It would be a non-clinical case management service funded by employers to support employees and line managers

"The WHP will offer support and advice, early intervention, good case management, and targeted early-stage treatment pathways," the report said.

Over time it envisaged reducing – or even replacing – the need for the current fit note, the report said.

Professor Kamila Hawthorne, chair of the Royal Colleg of GPs, said one part of the reform could be transferring the responsibility for longer-term fit notes from GPs to more specialised professionals.

"However, it is the College's view that GPs and our teams should still have the option to continue to issue short-term (up to 3 weeks) fit notes and retain some involvement in longer-term care and oversight of patients' overall health, where appropriate."

She said any reform "must be in the best interests of patients" adding "this process should never be punitive in nature."