Arthritis and Employment

Secondary School Standards: East Cleveland – in Westminster Hall at 4:26 pm on 21st May 2019.

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Photo of Bill Grant Bill Grant Conservative, Ayr, Carrick and Cumnock 4:26 pm, 21st May 2019

I beg to move,

That this House
has considered arthritis and employment.

It is a pleasure to serve under your chairmanship, Sir Graham.

I am delighted that my application for a Westminster Hall debate has been successful, as it provides an opportunity to highlight arthritis, a condition with which we are all familiar. It is estimated that, in its various forms, it will affect approximately one in five individuals in the UK by 2050. Arthritis disrupts the body’s locomotor system, which is the bones, joints and muscles that facilitate a person’s movements. There are many types, and most people will have heard of osteoarthritis and rheumatoid arthritis, but there are other forms of inflammatory arthritis, and other inflammatory conditions such as lupus and polymyalgia rheumatica.

Arthritis is a frequently debilitating condition and does not, as some assume, affect only the older generations.

Photo of Kevin Brennan Kevin Brennan Shadow Minister (Digital, Culture, Media and Sport) (Arts and Heritage)

I congratulate the hon. Gentleman on securing this debate on a very important subject. Like many Members, I have constituents and family members who are affected by arthritis. Does the hon. Gentleman agree that when we consider people with arthritis and employment, and the benefit system as well, it is important to take into account the fact that some days people are able to work and on other occasions that is not the case? That needs to be reflected in how we treat people with arthritis.

Photo of Bill Grant Bill Grant Conservative, Ayr, Carrick and Cumnock

Those three elements are indeed linked. Flexibility is the key. Employers and managers have to understand that those suffering from arthritis have good days and, as I will come on to later, bad days. We need to adapt the workplace and be flexible.

The symptoms may be identified in very young children or occur at any time in a person’s life. More than half of the 17.8 million people in the UK with arthritis and related conditions experience daily pain. The condition severely impinges on their lifestyle, whether it be their ability to live independently, to care for family, to work, to travel or to take part in sports and hobbies, all of which, in some instances, may lead to social isolation. I recall at an event trying on a tight-fitting gauntlet with the purpose of experiencing the restrictions caused by arthritis of the wrist and hand. I was concerned to note how I lost my fine motor skills for even the simplest of tasks. It must be so frustrating to be faced with such difficulties on a daily basis.

Photo of Mary Robinson Mary Robinson Conservative, Cheadle

I congratulate my hon. Friend on securing this debate on such an important subject. He speaks about social isolation; many people who suffer from arthritis have not been able to work for years, such as my constituent Russell, who came to my surgery. One of the things he does is volunteer: he is an ambassador, who goes out and helps other people in his community in a really positive way. However, he and potentially others have found that when they get expenses for helping out, they are charged as if they were in employment. Does my hon. Friend feel it is important that we make sure that people who want to volunteer when they can are able to do so without that fear?

Photo of Bill Grant Bill Grant Conservative, Ayr, Carrick and Cumnock

I thank my hon. Friend for that intervention, and I wholeheartedly agree with her. The modest expenses of somebody who makes a special effort to go and volunteer should not affect any other income that individual may have.

In my constituency of Ayr, Carrick and Cumnock, the second most common reason for awards of personal independence payments was musculoskeletal disease, including osteoarthritis, inflammatory arthritis and chronic pain syndrome, which accounted for some 20% of awards in the constituency. That is similar to the UK average of around 21%. Those of us who attended Versus Arthritis’s recent event in Parliament heard about new research, illustrating that some 43% of people with arthritis struggled with tasks at home, and some struggled for in excess of two years before sourcing equipment that could assist them.

Photo of John Howell John Howell Conservative, Henley

It is not just about struggling at home. About a quarter of people with disabilities who are employed said that they did not get the right sort of support: their employers had not got advice from Access to Work to try to make their lives easier. Does my hon. Friend think that is something we can tackle?

Photo of Bill Grant Bill Grant Conservative, Ayr, Carrick and Cumnock

I thank my hon. Friend for that intervention. Access to Work is important, but as I will come to later in my speech, it is not widely known about. The Government and Departments have more to do to promote that scheme and make people aware of it, so that workplaces can be made that bit more acceptable to individuals with particular disabilities.

Versus Arthritis’s “Room to Manoeuvre” campaign has been set up to improve access to aids and adaptations in the home and—I would hope—in the workplace, as my hon. Friend John Howell has suggested. Apparently, a remarkable 94% of people with arthritis said that those aids and adaptations had immensely improved their life. That independence is valuable to a person’s overall wellbeing, and reduces the strain on our NHS and local authorities.

Photo of Hugh Gaffney Hugh Gaffney Labour, Coatbridge, Chryston and Bellshill

I congratulate the hon. Gentleman on securing this debate. What Versus Arthritis is doing is fantastic, but does he agree that workers are now having to work longer, which they cannot do because of arthritis? This is not only about adaptations; there is a financial burden on them. What will this Government do for the people who have been forced to work longer for their pension?

Photo of Bill Grant Bill Grant Conservative, Ayr, Carrick and Cumnock

I thank the hon. Gentleman for that intervention, and to a degree, I accept his criticism. Consecutive Governments have made pension adjustments in 1995 and 2011 to reflect the equalisation of the pension age and people living longer, although I think we have plateaued in that regard. However, those who have disabilities and conditions such as arthritis will be impacted that bit more. For those who plan to continue a career but are impacted in extreme cases by disabilities such as arthritis, I agree with the hon. Gentleman. Maybe we need to think about how we can assist those people’s allowances more when they have to retire early, before their planned retirement.

The MPs who attended the “Room to Manoeuvre” event heard from Maureen, who suffers from rheumatoid arthritis. She said:

“I use aids at home, they help to keep me independent. However, I didn’t realise I could get them through the local authority and it’s not clear what to do when you need support. It’s important that MPs learn about the problems people with arthritis have accessing aids and adaptations, so they can make sure the right help is available.”

Arthritic conditions can be a drain on medical resources, requiring regular medication, blood checks, bone scans, and occasional time off work to attend appointments. They are often lifelong conditions, and remissions or flare-ups may occur. As was said earlier, we need to be flexible in our places of work to host and accommodate the issues that affect these individuals.

Being able to work is often seen as beating the challenge that such a condition presents: a person taking control of their condition, rather than the condition being in control of them. It allows that person to have dignity and pride in their personal achievements, which I think we would all agree they are entitled to. Versus Arthritis includes in one of its publications a quote from Dr Carol Black, the expert adviser to the Government on health and work:

“The evidence is clear that most people with these disabling conditions want to work. Indeed, with the right support and working arrangements, usually with modest adjustments, they can do so and be valued employees” or continue to be valued employees in a company.

Let us endeavour to ensure that we do not unnecessarily lose talented and hard-working people from the workforce. The Equality Act 2010 requires an employer to make reasonable adjustments to support job applicants and enable an employee with a disability, or physical or mental health condition, to in effect wholly fulfil the duties of their post. I am aware that the Department for Work and Pensions has published guidance on employing disabled people with health conditions, and the Equality and Human Rights Commission has provided, or cited, examples.

Additionally, the Government’s Access to Work scheme affords an opportunity for funding extra assistance, bespoke to an individual’s specific needs, to help that person start work, stay in work, or move into self-employment. I will refer later in my speech to the work, health and disability Green Paper that resulted in the announcement of the personal support package, through which people with health conditions including arthritis will be able to receive employment support that is more tailored to their specific or individual needs. Such funding is available to both employees and the self-employed, and may be provided for specialist equipment, support workers, transport needs, or training for colleagues to ensure that they fully understand the needs of their fellow employee and how best to assist them with their day-to-day workplace activities. There is a maximum amount, which is uprated annually. The Government’s “Improving Lives” White Paper stated that the Access to Work scheme would be “significantly enhanced”; hopefully, the Minister will provide an update on that point.

It is certainly of concern that employees may not be aware that assessments under that scheme are free, and some people may not even be aware of the qualifying criteria. Although I am not overly well informed, I am aware of some of the available support and of the employer’s responsibility, as I have signed up to the DWP’s disability confident scheme. That scheme improves how employers attract, recruit and, importantly, retain disabled workers. I am pleased to note that some 5,000 businesses in the United Kingdom are already on board.

I employ a person with osteoarthritis, osteopenia and polymyalgia rheumatica. Reasonable adjustments feature in my constituency offices. New chairs were purchased to ensure appropriate lumbar support, and a document stand for copy typing was subsequently purchased at a low cost, for occasions on which stiffness restricts movement—a stiffness that, when untreated, my staff member describes eloquently as

“at times, a living rigor”.

Other staff are observant, supportive, and undertake heavy weight-bearing tasks; in other words, they are collaborative and work as a team. That involves permission, sharing information about the condition, and—as I said—teamwork. My staff member also has fantastic support from her general practitioner and practice nurses.

People with arthritis and related conditions can often experience a greater than normal degree of tiredness, stiffness, or the side effects of medication for the condition. Indeed, certain necessary medication such as steroids may deplete the calcium levels in the body, putting people at further risk, in that they may potentially develop osteoporosis in addition to their existing condition. It is also important to note that symptoms will often fluctuate, with the sufferer having good days and bad days. I understand that even the weather may have an adverse effect on an individual, particularly temperature changes.

Arthritis and related conditions are the biggest cause of pain and disability in the United Kingdom, and result in over 30 million working days lost per annum. The British Society for Rheumatology highlights the need for multidisciplinary teams, and the considerable cost of rheumatoid arthritis to the UK economy. I am pleased that as part of the work, health and disability Green Paper, Ministers have explored ways to improve support for people with conditions such as arthritis, so that they can find and remain in work.

The ministerial foreword stated:

“This government is determined to build a country that works for everyone. A disability or health condition should not dictate the path a person is able to take in life—or in the workplace. What should count is a person’s talents and their determination and aspiration to succeed…We are bold in our ambition and we must also be bold in action. We must highlight, confront and challenge the attitudes, prejudices and misunderstanding”.

That message is still relevant today, and I hope this debate will reinvigorate discussion and capture the wider public’s attention.

The work, health and disability Green Paper proposed a 10-year plan to remove employment barriers for disabled people, and the Fit for Work scheme is being reformed to focus on what people can do, not what they cannot. I welcome the fact that the Access to Work scheme is being expanded to help more disabled people into work. However, at present there appears to be a lack of knowledge about the scheme and it is crucial that the Government proactively promote that valuable opportunity. When Versus Arthritis conducted a survey between May 2018 and June 2018, it found that of those who responded, 59% had never even heard of the Access to Work scheme. A proactive promotion of the scheme would, I am certain, assist the Government in meeting their ambitious and commendable aim of having 1 million more disabled people in employment by 2027.

There is a degree of comfort in knowing that since 2013, some 600,000 disabled people have moved into employment. We must build on that with a sense of urgency. In addition, according to Versus Arthritis, it has been discovered that many of the people who qualify for assistance from the Government’s Access to Work scheme face problems with how it is operated. Administration processes can on occasion be cumbersome, and it may be that the Government could carry out a review to ensure that things are more user-friendly. I am sure the Minister will take note of that. That is a concern with a number of issues with the DWP.

One of my constituents felt that the DWP did not fully comprehend the consequences of her osteoporosis when asking her to attend a course, particularly as she relied on others for transport. I for one appreciate that the DWP has been increasing its advisers, including its community partners, small employer advisers, disability employment advisers and work coaches, as well as providing training for them. It may be that that needs to be further enhanced to provide greater awareness among some of the DWP’s frontline staff of the various arthritic and associated conditions and to adequately address the needs of service users. I do not say that with any intention to be unkind to those staff, because they do a wonderful job on our behalf on a daily basis.

Photo of Hugh Gaffney Hugh Gaffney Labour, Coatbridge, Chryston and Bellshill

The hon. Gentleman is doing a great job. We are talking about helping people, but can we not also help health and safety in the workplace by working with young workers to prevent arthritis later in life?

Photo of Bill Grant Bill Grant Conservative, Ayr, Carrick and Cumnock

I am not a medical expert—arthritis may or may not be related to the workplace—but where issues can be identified, such as repetitive work that might affect the musculoskeletal system of an individual, we can change it. We can automate it without losing the job, but we need to be conscious of what staff are subject to through 10, 20 or maybe 30 years of work. I agree with the hon. Gentleman: if those issues can be identified, they should be removed and we should mitigate the risks as best we can. Where possible, we should assist employers in doing so.

Spending on the Access to Work scheme has increased by 8% in recent times, supporting more than 25,000 people. Around £54 billion per annum is spent on benefits to support people with disabilities, equating to some 6% of all Government spending. Nevertheless, I make a plea to the Treasury to consider further increasing the allocation of funding for the scheme and introducing incentives to encourage employers to consider health and wellbeing initiatives to assist those with arthritic conditions. The benefits of physiotherapy have been recognised. In Scotland, the public may self-refer, but that may not be the case throughout the whole United Kingdom.

Finally, there is a problem that action does not always follow post-assessment recommendations. Will the Government consider what they can do to address any negative attitudes on the part of employers or managers, whether that be by further legislative provision or some other means? By sharing and encouraging best practice and putting the right support in place, we can make it easier for people with arthritis who want to work, helping to achieve the Government’s laudable ambition of getting 1 million disabled people into work.

Several hon. Members:

rose—

Photo of Graham Brady Graham Brady Chair, Conservative Party 1922 Committee

I have six Members wanting to catch my eye, so I propose a four-minute time limit on Back-Bench speeches.

Photo of Mary Glindon Mary Glindon Shadow Minister (Environment, Food and Rural Affairs) (Farming and Rural Communities) 4:45 pm, 21st May 2019

It is a pleasure to serve under your chairmanship, Sir Graham. I congratulate Bill Grant on securing this debate and on his excellent and informative speech. Several constituents requested that I attend this debate, but I was particularly encouraged to be here by Danielle Swinney. Danielle suffers badly with ankylosing spondylitis, an inflammatory form of arthritis that causes the vertebrae in the spine to fuse. Despite being in constant crippling pain, Danielle works full-time in a pressurised job as an accountant.

Danielle told me how her condition affects her. It differs from day to day, but every day she sets her alarm for 4 am, two hours before she needs to get up, because her joints and back are so stiff that she has trouble moving first thing in the morning. It takes her an hour to get to work. Once she is there, she works from 8 am until 4.30 pm, and some days even longer. None of that helps with the symptomatic chronic fatigue she experiences, like so many others with arthritis. Danielle wants to work, however, and like everyone she needs to work, but she says that some days are so hard that even just to put on her own socks and shoes is a problem.

Danielle is just 25 years old. I salute her for her determination, her professionalism in her work and her frankness in talking about her condition. On her behalf, I ask the Minister to ensure that the Government do more to make employers aware of the effects of arthritis and to ensure that courageous people such as Danielle, who puts many of us to shame, can get into and be supported to remain in work. People with arthritis do not want their condition to keep them out of employment, and we owe it to them to make sure it does not.

Photo of Douglas Ross Douglas Ross Conservative, Moray 4:47 pm, 21st May 2019

It is a pleasure to serve under your chairmanship, Sir Graham. I congratulate my hon. Friend Bill Grant on securing this debate and on his outstanding speech, which showed his passion and enthusiasm for this topic. I listened carefully, and I do not think he declared an interest at the start, so the spring in his step that we see from him every day around Westminster is perfectly natural and his interest in this debate comes not from any self-interest, but is for his constituents, who have rightly raised the issue. It was good to hear what he has done in his office to accommodate a member of staff.

I want to briefly give some figures from my constituency of Moray. Nationally, 63% of people of working age who have arthritis are in work. When we look at the figures more closely, in Moray, people over 45 with osteo- arthritis of the hip number 4,757. There are 7,848 people over 45 with osteoarthritis of the knee. There are 653 people with rheumatoid arthritis. There are 15,526 people in Moray with back pain. Had it not been for my hon. Friend’s debate today, I would not have known that such a large number of people within my community suffer day in, day out with this condition.

We heard from Mary Glindon about a young person who lives with arthritis. It is testament to them that much of the time when we see them in our communities, they put on a very brave face. They work hard to live with their condition while in excruciating pain. This debate has shown that there is support for them, and we have to do all we can to encourage them to take up that offer of support, but we should also realise how many of those we work with day in, day out in our communities suffer from arthritis.

Arthritis and related conditions are the biggest cause of pain and disability in the United Kingdom, and account for 28.2 million working days lost each year. Nearly half of all work-related illnesses in Scotland are related to arthritis and joint pain, so it is a considerable issue, both in Scotland and across the United Kingdom, and something that we really need to tackle.

I welcome the presence of the Minister, who I am sure will speak about the access to work scheme. It is an excellent scheme that we should promote, but as my hon. Friend the Member for Ayr, Carrick and Cumnock said, we need to promote it because there is not enough awareness of its benefits. As he said, between May and June 2018 Versus Arthritis surveyed 15,082 people with arthritis and related conditions. Those people live with it, day in, day out, and are acutely aware of the need for assistance and support. Yet almost 60%—59%—had never heard of the scheme, so the people we are trying to target are unaware of a scheme that is designed to help them.

Worryingly—I would appreciate the Minister’s response to this, if he is aware of why it has happened—the number of people with arthritis who benefit from the scheme has fallen each year.

Photo of Douglas Ross Douglas Ross Conservative, Moray

That was from a briefing that I received ahead of the debate. If the Minister does not believe that to be the case, it would be useful to clarify that on the record. Certainly the campaign group supporting the debate and briefing MPs says that it has fallen, year on year, over the last five years. I welcome any update from the Minister on that.

I welcome the debate, which is an opportunity for us all to raise awareness of this crippling condition, to support those in our communities who live with arthritis, and to try to get them better services to allow them to work. They all want to be part of the community, and part of the working community. We can support them as a Government and as MPs. Today, because of my hon. Friend the Member for Ayr, Carrick and Cumnock, we have done that.

Photo of Justin Madders Justin Madders Shadow Minister (Health and Social Care), Shadow Minister (Business, Energy and Industrial Strategy) (Labour) 4:51 pm, 21st May 2019

It is a pleasure to serve under your chairmanship, Sir Graham. I congratulate Bill Grant on securing the debate, which is of great interest to me, both in a professional capacity as a former employment lawyer, and in a personal capacity as the husband of a fibromyalgia sufferer. I have seen at first hand the impact that invisible conditions such as arthritis and related conditions can have on an individual’s daily life. We do not talk about it enough, because the hardest symptoms for any of us to understand are those that we cannot see. Symptoms such as fatigue and pain, which are common in arthritis and related conditions, can be invisible to the outside world but no less debilitating for that.

Photo of Ruth Jones Ruth Jones Labour, Newport West

As a former physiotherapist, I share my hon. Friend’s interest in this important subject. Anna Lockey, a young woman in my constituency, has psoriatic arthritis. She is planning on going back to work following her maternity leave in September. She is one of many who want to work and contribute to the wider economy. Does my hon. Friend agree that utilising the access to work scheme and the aids and adaptations, which are often inexpensive, can be really helpful?

Photo of Justin Madders Justin Madders Shadow Minister (Health and Social Care), Shadow Minister (Business, Energy and Industrial Strategy) (Labour)

I thank my hon. Friend for her intervention, and welcome her to this place. She will clearly have a great deal of professional expertise to bring to bear. I will talk a little about some of the barriers that people with such conditions face in getting back to work. It is an important point, and central to the debate.

In my constituency, it is estimated that more than 16,000 people live with back pain, and that more than 4,000 and 8,000 people live with osteoarthritis of the hip and knee respectively. Versus Arthritis tells us that 17.8 million people live with arthritis or a related condition across the country, about half of whom live with pain every day. That is a staggering number of people coping with that in their everyday lives. Just because we cannot see their pain, it should not be ignored or written off as part of the ageing process. That can negatively affect the support that they receive.

The problem is exacerbated by the fact that many arthritic conditions can fluctuate in severity, leaving people unsure how well they will be able to cope from day to day. That can make it difficult to hold down a regular job, but equally it should not be used as cover for discrimination. Many people with arthritis want to work if the right support is in place. As has been touched on, that help is available through the access to work scheme. However, there are concerns that the scheme is not working as well as it should.

Not enough people who would benefit from the scheme are aware of it. We know that 60% of people surveyed by Versus Arthritis had never heard of the access to work scheme or were unaware of what kind of help it could provide, and nearly 70% had never accessed support through the scheme. Clearly, there is a lot more to be done to promote it. In a debate on disabled people and economic growth last year, my hon. Friend Marsha De Cordova made the point that the scheme is probably one of our best kept secrets. When we hear the figures about the lack of awareness, it is hard to disagree.

With the Government’s own figures showing that access to work was approved for only 25,000 people in 2016-17, it is clear just how much room we have to make up. The scheme can provide invaluable practical and financial support to meet the needs of disabled people, but only if it is actually accessed. If the Government are serious about meeting their aim of getting 1 million more disabled people into work by 2027, the scheme must be better publicised and actually work for its users.

A quarter of those who have applied for support from the scheme did not receive all the support that was asked for or that was recommended by their assessor. A tenth of respondents reported that they did not receive any support at all after applying to the scheme. Has the Minister looked at those alarming figures, and has there been any kind of research on why that is the case?

As we know, the major arthritis charities are calling for the Government to commission research on the meaning of “reasonable adjustments”, and for support to be put in place to help people who challenge employers who do not act on access to work recommendations. Employers are obliged to make reasonable adjustments, but if someone is in work and not in a trade union, who will help to argue for them? If someone is applying for a job, just how easy is it to introduce that issue at a job interview? If an employer still refuses to make adjustments, just how realistic is it to expect people to take their employer to tribunal, especially without support, and what comfort do they have that putting their head above the parapet will not rebound on them?

Do not forget that the coalition Government introduced employment tribunal fees, putting another hurdle in the way of those who seek justice. I make that point because having rights is one thing, but being able to enforce them is another, whether through support in the workplace or through access to the tribunal system. Too little protection is given to workplace rights in this country. If we are to change the hire and fire culture, those with disabilities need extra support, and we need to understand the real barriers that they face not only to accessing support but to enforcing their rights. Without doing that, we will not do them the service that they deserve.

Photo of Stephen Kerr Stephen Kerr Conservative, Stirling 4:57 pm, 21st May 2019

It is a pleasure to serve under your chairmanship, Sir Graham. I commend my hon. Friend Bill Grant on introducing the debate, and on his excellent speech.

I am grateful to have a few minutes to reflect on this topic, because I witnessed at first hand, through the life of my late mother-in-law, Joyce Ferguson, what such conditions can do, in terms of daily pain, and what an encumbrance the condition is to people trying to lead what we would consider a normal life. I saw the benefit of the aids and adapters available to people with such conditions, and I hope that more people will have the opportunity to take advantage of what is available, such as grab rails, electric tin openers and lever taps.

We should take some satisfaction from the fact that, since 2013, 930,000 disabled people have been able to return to work. It is a noble goal that another 1 million people who suffer from disability should return to work by 2027. As has been mentioned, only 63% of working-age adults with any kind of condition affecting muscles, tendons, ligaments, bones and joints work, compared with 81% of the overall population with no health condition, so the Government must do everything that they can to continue helping those with such conditions back to work. Given that 17.8 million people suffer from such conditions, half of whom live with pain every day, this subject should concentrate our minds.

The motivation for helping people back to work is not just about statistics. In fact, it should be a long way from them. Work is ennobling. It can bring independence and financial security to someone’s life. It can also lead to social interaction and a more fulfilling life, creating opportunities to develop skills and so on. Allowing people, regardless of their background, the opportunity to work and reap the benefits that work brings should motivate us to give even more support to those with conditions such as arthritis and help them into work.

We must recognise that there are many different types of arthritis, which affect individuals differently, and some are more severe than others. The pain experienced is constant with some forms and less so with others. It is important that the Government continue to recognise that those differences exist and that we should not try to apply a one-size-fits-all approach. We should take that variance into account when we design policies to encourage those who suffer from arthritis to come back into work.

Rheumatoid arthritis is one of the forms in which the pain can vary. One day, an individual may be considered fit to work, but the next day they will struggle to get out of bed. Some will argue that those who suffer from rheumatoid arthritis should work on the days when their pain is relatively lower, but that is unrealistic; flare-ups are unexpected and can occur at any moment. The Government must ask themselves why any employer would hire a worker who cannot guarantee that they are fit enough to go to work the next day. The Government need to intervene.

I ask the Minister to answer some questions. Will the fit for work forms be adjusted to make it easier for people to express the fact that they suffer from flare-ups? What role can GPs and rheumatologists play in giving a correct and detailed medical update about the health of a person? Does the Minister agree that both of those things would not only give taxpayers greater value for money but make those who suffer from medical conditions that affect their ability to work feel that they are being encouraged, treated on a more human basis and welcomed by a Government who are intent on serving their needs?

Photo of Patricia Gibson Patricia Gibson Shadow SNP Spokesperson (Consumer Affairs) 5:01 pm, 21st May 2019

I am delighted to participate in this debate; I thank Bill Grant for securing it. I applaud the work of Versus Arthritis on behalf of those who live with the condition.

Approximately 10 million people in the UK live with arthritis and other musculoskeletal conditions. Only 60% of working-age people with persistent musculoskeletal conditions are in work, and those people account for a fifth of all working days lost through ill health in the UK. According to the latest figures that I have seen, approximately 30.6 million working days were lost to absence in 2013 because of those and similar conditions. There are 44,000 people who live with rheumatoid arthritis in Scotland, and they often suffer considerable pain.

If we are to halve the disability employment gap, it is important to stem the flow of disabled people leaving employment because of discrimination or lack of support. People with arthritis want to work, and the majority can, so I echo the calls for greater promotion of the Access to Work scheme among employers and employees who could benefit. The task before us is to support those who live with these conditions into work or support sustained employment for them. I urge the Minister to ensure that the Department for Work and Pensions system is fully cognisant of the fact that some people with these conditions simply are not able to work. That is our task, and I hope that the Minister will fully echo and endorse those goals today.

We know that the challenges posed by these conditions are significant, since those who live with them are less likely to be employed than those in good health and are more likely to retire early. That also has implications for the wider economy. The combined direct and indirect cost to the UK economy of osteoarthritis and rheumatoid arthritis is estimated to be about £21.6 billion. In addition, there is a loss to those who are affected by those conditions when they find that they have to give up their work.

I echo the comments of other hon. Members that those who live with these conditions do not just lose out financially; they lose a sense of wellbeing, personal fulfilment and social contact. As well as promoting the Access to Work scheme more widely and robustly to those who can benefit from it and to employers, I urge the Minister to consider the DWP’s response, the expertise that people who present with these conditions require and the level of support that they need. I look forward to his reassurances on those issues.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health) 5:04 pm, 21st May 2019

It is a pleasure to speak in this debate. I thank Bill Grant for setting the scene so well and for his obvious expertise.

From January to March 2019, 7.6 million people between the ages of 16 and 64—18% of the working-age population—reported that they had a disability. Some 3.9 million of those people were in employment, which represents an increase of 150,000 on the previous year. The Government have set a target for 4.5 million people with disabilities to be in employment by 2027. Where does that leave those people with disabilities who live with pain every single day, such as the 17.8 million people in the UK with arthritis and related conditions?

Arthritis can have a huge impact on mental health. It is all very well to look at the physical aspects, but we also have to look at the anxiety and depression that they can lead to, as well as the limits on the ability to stay connected and keep active. There are real physical, emotional and mental pressures. I know many people who work in local shops who are literally crippled with arthritis. Notably, they include women from the generation whom we have let down by changing their retirement plans with a sharp rise in pension age—the WASPI women.

We are pushing people to work with crippling pain every day, yet we have nothing in place to make life easier for them except stronger and stronger drugs. I am ever mindful that many of the people I know who work with arthritis have said that they cannot take the drugs because they make them fuzzy and unable to concentrate, among other side effects. Of course, being in pain also makes concentration incredibly difficult.

Many arthritic conditions fluctuate in severity, as Stephen Kerr pointed out. People may feel good one day, but bad the next day—or even later the same day. People are left unsure how well they will be able to cope every day. In 2015-16, half a million people had a musculoskeletal disorder that was caused or made worse by work. Sometimes being in work does not make their condition any easier.

The estimated cost of rheumatoid arthritis to the UK economy is between £3.8 billion and £4.8 billion. Some 33% of people with rheumatoid arthritis stop work within two years from onset of symptoms, and almost 45% stop within five years. It is very clear that working sometimes significantly worsens the pain and the symptoms.

It is also clear that arthritis is a large-scale issue that needs a large-scale solution. I agree with the arthritis charities that more needs to be done. If we expect people to make their way to work regardless of the pain, we need to make it easier for them, but that can be done only with a co-ordinated approach and response.

The British Society for Rheumatology has been very clear about the steps that need to be taken. The joint work and health unit, collaborating with professional bodies, provides a guide for health professionals that outlines their responsibilities to their patient’s employer, what the employer is required to provide for their employee, and other outcomes to allow those who wish to continue working to do so. The Minister always responds well to questions that we put to him; if at all possible, I would like him to set out how the joint work and health unit will look after employees and address the responsibilities of employers.

A diagnosis must not be the death of working life for those who want to work through it and find a different way of working. This House and the Minister must play their part by helping businesses to understand that small changes can allow staff to continue working in a way that will not adversely affect the business. There are ways and means in each case, and we must connect them to help people.

I support the ideas that the hon. Member for Ayr, Carrick and Cumnock and other hon. Members have put forward. I look forward to the Minister’s response, because I believe that he will give us the answers that we want—no pressure at all.

Photo of Angela Crawley Angela Crawley Shadow SNP Spokesperson (Disabilities), Shadow SNP Spokesperson (Pensions), Shadow SNP Spokesperson (Youth affairs), Shadow SNP Spokesperson (Children and Families), Shadow SNP Spokesperson (Equalities) 5:07 pm, 21st May 2019

It is a pleasure to serve under your chairmanship, Sir Graham. I congratulate Bill Grant on securing this debate, on speaking from personal experience and on advocating for his constituents. He rightly highlighted that in many ways, the simple solution for those who want to remain in work is to broaden awareness of the Access to Work scheme. I reiterate that point, which has been highlighted by all hon. Members today, including the hon. Members for North Tyneside (Mary Glindon), for Moray (Douglas Ross), for Ellesmere Port and Neston (Justin Madders), for Stirling (Stephen Kerr) and for Strangford (Jim Shannon) and my hon. Friend Patricia Gibson.

Many hon. Members have highlighted the fact that arthritis is an invisible illness with a profound effect on many people’s lives. When people think of arthritis, the stereotype is often of someone in their later years, but many people are now being diagnosed in their 20s and 30s; the hon. Member for North Tyneside mentioned her constituent Danielle, who is 25.

As well as highlighting the Access to Work scheme, it is essential to address the fact that there is too often a stigma around declaring an illness, especially at a younger age. Too many people, especially those who are in insecure or part-time work, do not declare their health issues or seek workplace adaptations. It is crucial for support to be distributed not just to large employers, but to small and medium-sized enterprises. Too many people in insecure work are afraid to highlight their health condition, but it is essential that they get the support that they need.

My hon. Friend the Member for North Ayrshire and Arran highlighted the statistics for Scotland. The majority of people can and do want to work. As the hon. Member for Ayr, Carrick and Cumnock highlighted, we want to support people into work. We want to make it possible, particularly for young people who suffer from arthritis, to remain in work. Many who are diagnosed will continue to work, and we rely on employers to offer the flexibility, understanding and the adaptations that people require.

Employers who do not support their staff are breaking the law. According to the Equality Act 2010, employers must make reasonable adjustments. Many people, however, may not tell their employer. Ensuring that disabled people can overcome this significant disadvantage relies on a workplace culture change, and attitudes to disability in the workplace changing.

The UK Government can play a role, including through the Access to Work programme. I urge the Minister to promote the scheme more and to enhance the benefits, both for the employer and for employees, specifically for people with arthritis, fibromyalgia and other long-term conditions. The Government could also undertake work to clarify the meaning of “reasonable adjustments”, so that it is clear what employers should provide for those who may suffer from such a condition, and consider what steps they can take to ensure that employers comply with the 2010 Act and carry out the recommendations of the Access to Work scheme.

In closing, I thank my senior caseworker, Rhona. She is probably one of the hardest working people that I know. Despite having arthritis, she has turned her experience and her disability into a positive. She is one of the most empathetic, uplifting and passionate staff members that I could ask for and has provided an invaluable service to so many of my constituents—I am indebted to her. I am so grateful. She is one of many people who have a massive contribution to make, who want to manage their condition and who want to remain in the workplace. I call on the Minister to improve the focus to ensure that today’s figures are drastically improved, and to help support people with arthritis to work for as long as they can and as long as they want to.

Photo of Mike Amesbury Mike Amesbury Shadow Minister (Work and Pensions) (Employment) 5:12 pm, 21st May 2019

It is a pleasure to serve under your chairmanship, Sir Graham. I thank Bill Grant for securing such a vital debate, which has been informed by a number of charities, which work so hard for the benefit of people with disabilities and those who suffer with arthritis and related conditions.

As we have heard through the very powerful contributions from the 13 Members present from across the House, living with the condition can be debilitating and have a negative impact on quality of life. Arthritis and related conditions are the biggest cause of pain and disability in the UK. As a result, 28.2 m illion working days are lost annually. Every year, one in five people—20% of the UK population—consults a GP about musculo- skeletal problems. More than half of the 17.8 million people in the UK with arthritis and related conditions live with pain every single day. My hon. Friend Mary Glindon highlighted that with the stark case of Danielle. Her condition has a huge impact on her life, slowly intrudes on everyday life, and affects her ability to work, to sustain work and to live independently.

Arthritis can also have a huge impact on an individual’s mental health, as hon. Members have highlighted. Living with a painful condition can lead to depression and anxiety, as well as placing limits on a person’s ability to keep active and to stay connected within communities and society.

We should pay particular attention to the disturbing fact that people in the most deprived areas of the UK are much more likely to report arthritis or back pain than people in equivalent age groups who live in less deprived areas. Some 40% of men and 44% of women in the poorest households report chronic pain, compared with 24% of men and 30% of women in more affluent households. There is a real social class and inequality issue here.

Versus Arthritis, the charity whose excellent work is dedicated to changing the lives of people who live with arthritis and related conditions, estimates that 10% of the UK population aged over 45 suffer with osteoarthritis of the hip, 17% suffer with back pain and 18% suffer with osteoarthritis of the knee. Many Members have highlighted the higher prevalence in their constituencies, which is also the case in mine.

This Government’s apparent antipathy and lack of regard for those who suffer with arthritis and related illnesses has been demonstrated in their limited approach to the promotion of the Access to Work scheme, which has been highlighted by Members across the House. The charity Leonard Cheshire has argued that there has been no significant extension of the programme over the last nine years.

Photo of Mike Amesbury Mike Amesbury Shadow Minister (Work and Pensions) (Employment)

The Minister shakes his head, but that is from the Government’s own figures.

Will the Minister tell the House what plans are in place to help people with musculoskeletal conditions in the workplace? Arthritis sufferers, who have applied to the Government’s Access to Work scheme, said they have faced problems with how the scheme operates. In a survey of people with arthritis and related conditions carried out by Versus Arthritis in 2018, 59% had never heard of the Access to Work scheme, with many more unaware of what help was available. It is almost the best kept secret, as my hon. Friend Justin Madders said.

Some 25% of respondents said they did not receive all the support that was asked for, or that had been recommended by the Access to Work adviser, with a further 10% saying they did not receive any support whatsoever after applying. Will the Minister tell the House what the Government are doing to ensure that recommendations made by the Access to Work scheme are enacted?

The Equality Act 2010 placed a legal responsibility on employers to provide reasonable adjustments to support people with a disability in the workplace, so that they would not be disadvantaged. However, the Equality Act does not define what those reasonable adjustments are. As a result, it can be difficult for someone with arthritis to know exactly what their employer should be doing to help them, especially if they are not unionised, as was pointed out. Will the Minister tell the House whether the Government plan to undertake work to clarify the meaning of “reasonable adjustments”? Would he agree to work with Versus Arthritis on that?

One in eight of the working-age population has a musculoskeletal problem, but only 63% of that group are in work, compared with 81% of people with no health condition. What steps are the Government taking to close the disability employment gap for people with arthritis and related illnesses?

The Government have pledged to see 1 million more people with disabilities and long-term health conditions in work by 2027—just 100,000 people per year. Curiously, the Office for National Statistics reports that the increased number of disabled people in work has not been matched by a reduction in the number of disabled people who are out of work. We are now two years into the Government’s 10-year strategy for supporting disabled people into work. However, the National Audit Office reports that they have yet to develop a full implementation plan to achieve their goal.

Through whatever kaleidoscope of smoke and mirrors we look when measuring our employment figures, facts are facts: the disability employment gap remains stubbornly at 30% and this Government are failing to get a grip on that dismal statistic. I ask the Minister to listen to the concerns raised by all the Members here today and to commit to addressing and rectifying the unacceptable existing inequality of support for those who suffer with arthritis.

Photo of Justin Tomlinson Justin Tomlinson The Minister of State, Department for Work and Pensions 5:19 pm, 21st May 2019

It is a pleasure to serve under your chairmanship, Sir Graham. I pay tribute to all the speakers—perhaps with the exception of the last one—for their very proactive and constructive speeches on this incredibly important subject. It reflects well on the brilliant opening speech given by my hon. Friend Bill Grant, who demonstrated a real passion, knowledge and interest in this area, that it was picked up and reflected in each and every speech. People who have listened to the debate will be encouraged at the great level of interest—it is not as if nothing else is happening in Parliament today. It is brilliant that this issue has captured so much interest.

My hon. Friend was spot on when he quoted Dame Carol Black, who said:

“The evidence is clear that most people with these disabling conditions want to work. Indeed, with the right support and working arrangements, usually with modest adjustments, they can do so and be valued employees.”

He made the powerful point that there is a misconception that this impacts only on older people. In fact, it can affect people throughout their lives. One in six people will develop a disability or long-term health condition, and many of them will be of working age. This is a common challenge and barrier that people need to overcome. I welcome Ruth Jones—with her expertise in this area, I am sure that she will be a valuable addition to Parliament.

Despite the previous pre-written speech, the reality of the disability stats is that there are now 947,000 more disabled people in work in the past five years. We have taken disability employment from 44.2% to 51.7%, which is a record high. For the first time, more disabled people are in work than not. However, it is not enough. We are an ambitious Government, and we set out two years ago our ambition for a further 1 million disabled people to be in work. In those first two years, over 400,000 more disabled people are in work. We are ahead of schedule, but it is still not enough.

We will continue to do everything we can to empower businesses to have the confidence to tackle the barriers and take advantage of the huge amount of talent that is all too often overlooked. I do not just preach as a Minister; I say that as an employer. Before I became an MP, my own business benefited from employing disabled people and having the confidence to make small changes. Actually, I benefited. I have been in a series of stakeholder meetings and events today, and everyone was united in saying we have to ensure it works for everyone.

The majority of today’s speeches focused on Access to Work, and I recognise that it is right to challenge the scheme. However, we must recognise that 33,800 people were helped last year—up 13%, and a record high. My hon. Friend Douglas Ross asked whether funding had been increased or decreased in this area. We do not record that specifically, but people who listed conditions that relate to the arms and hands, legs and feet or back and neck—we would expect those to be covered predominantly in this area—as their primary medical condition accounted for about 10% of our spend, which was up 2% on last year.

I recognise hon. Members’ broad point that more people need to benefit from the Access to Work scheme, especially in this area—particularly as technology plays an increasing part in removing barriers and creating opportunities, which I have seen on visits. Angela Crawley discussed her caseworker and explained how she is benefiting from small changes that can be replicated right across the board.

The key is improving the awareness of Access to Work. We are looking at improving awareness in jobcentres, so that in the initial conversation we take into account everybody’s unique opportunities and challenges, particularly on health, and that it is ingrained in all our frontline staff that this is an option to help unlock barriers. That goes right to the core of the principle of the Joint Work and Health Unit. I had a meeting about that earlier, and we recognise just how important it is. We need to work more closely with stakeholders to promote this to their members as something that can be utilised. We should work with GPs and health professionals to ensure that they are aware of the opportunity.

On fit notes, GPs can highlight the fact that there are fluctuating health conditions that can limit the amount of work someone can do. I understand the point that was made, and we are working with medical professionals to look at what more can be done in that area. We need to look at our health and work providers and ensure they include it—it should be embedded in their options. Through the Disability Confident scheme, we are now at 12,000 businesses—a record high. We have ambitions to increase that rapidly and are looking at putting additional requirements on the highest level of Disability Confident. We should perhaps look at signposting from general benefits. If we have identified people with health conditions through disability benefits, we could perhaps signpost people for additional local support. It is not something that they must have, but providing such information could be helpful for people.

There is one area where I think we can make a real difference. Justin Madders made a really good point: how can we be sure that businesses have an understanding? For many, particularly small and medium-sized businesses, this is not necessarily a common occurrence, and they like to have confidence. There is an opportunity through the Health and Safety Executive. It is a pretty good given. As part of the Health and Safety Executive, we lead internationally on safety. We have just recruited a new chief executive, and I made it very clear to her that the real priority going forward has to be looking at health. The HSE is brilliant at engaging with businesses of all sizes as part of those assessments, and they can identify areas of improvement within working environments. A one-stop shop can be a portal to signpost additional support, particularly on not letting people slip out of work. It is a darn sight harder to get people back into work than it is to keep them in work in the first place.

I was very interested to talk to my Access to Work team about ways in which we can help. Initially, I thought it was perhaps simply about technology. I was looking at some case studies—we cannot give names, for obvious reasons—and in some cases it is about technology. It is sometimes about making adjustments to the equipment that people use. Access to Work will talk to an employer and perhaps suggest changing the working hours or recognising that there might be times when they will have to limit them. Perhaps they could even look at changing people’s roles, which is incredibly important. If someone works for a big employer that has HR and personnel teams, we would expect them as a given to get this right. However, 40% of private sector jobs are in small and medium-sized businesses. They do not necessarily have bad intentions, but they do not have the confidence or expertise. Through organisations such as the HSE we can do a lot more.

I pay tribute to Versus Arthritis, with which I will definitely be working very closely. I will be speaking at its event in July. It is one of our key stakeholders in the Access to Work scheme, which goes through, line by line, how we are doing and what improvements we need to make. The Versus Arthritis report was very proactive and helpful.

I was genuinely impressed by how proactive and constructive the speeches we have heard. There is a real cross-party commitment to get this right—it is such an important issue. Not everybody is looking for a full-time job or career. I have met young disabled people for whom simply being able to do one hour is a life-changing opportunity. Wherever there is a barrier, we as a Government are absolutely committed to remove it. We want businesses to have the confidence to take advantage of the huge amount of talent that, I am afraid, is all too often overlooked. We are heading in the right direction, but we are ambitious to do more. I thank each and every hon. Member for what they are doing to highlight all the opportunities that people can take advantage of.

Photo of Bill Grant Bill Grant Conservative, Ayr, Carrick and Cumnock 5:28 pm, 21st May 2019

I thank the hon. Members for Strangford (Jim Shannon), for Ellesmere Port and Neston (Justin Madders), for North Ayrshire and Arran (Patricia Gibson) and for North Tyneside (Mary Glindon), and my hon. Friends the Members for Moray (Douglas Ross) and for Stirling (Stephen Kerr), for their valuable contributions to the debate. Clearly, hon. Members understand the challenges we face and the need for means to mitigate them.

I thank the Minister for listening intently and responding to the concerns that have been raised, and I thank the shadow Minister for his welcome contribution. I also thank the charities that campaign tirelessly for, and offer support to, my constituents and people throughout the United Kingdom who suffer arthritic conditions. I thank people in science, medicine and the care services who undertake research and treatment and provide care packages—in doing so, they greatly assist and support people to live their lives. Last but not least, I thank the Commons staff, who worked behind the scenes to enable the debate to take place. I give special thanks to the Library staff.

Question put and agreed to.

Resolved,

That this House
has considered arthritis and employment.

Sitting adjourned.