Are we really doing enough to help those most at risk of falling out of the labour market to stay in work

‘Developing a fluctuating condition in work was devastating for me. I struggled with my manager who failed to understand my condition and constantly questioned my need for support. The stress …led me to resign from my job. …I no longer had the job I had loved doing and my employer lost someone who they had previously seen as a valuable member of staff.’

Jacqueline Winstanley, CEO Universal Inclusion, Chair UK Forum for Hidden & Fluctuating Conditions, International Advisory Board Member C4GEI

Despite a number of advances in the way we are helping those with chronic and fluctuating conditions to stay in work, such as reforms to access to work, the introduction of the right to request flexible working and DWP’s latest initiative, Fit for Work – with stories such as Jacqueline’s commonplace, we have to ask ourselves – are we really doing enough to help those most at risk of falling out of the labour market to stay in work?

In the latest paper from The Work Foundation’s Health at Work Policy Unit, we focus on what policymakers could do to better support, enable, and encourage employers to make the changes necessary to manage a workforce in which fluctuating chronic health conditions are set to rise. This would enable them to better adjust working practices to support those with a fluctuating condition and to make provisions for times when a flare up could otherwise result in a business loss- aiding business sustainability into the future.

We have reviewed provision currently offered through government policy. Significant policy gaps have been found in several areas, summarised into four categories:

  • Implementation of legislation
  • Provision of occupational health support and advice
  • Help for employers to fulfil their obligation to individual employees
  • Support for employers to take a strategic ‘whole of business’ view


We believe that a number of different measures could serve to fill these gaps. At the forefront of these, we call on government to support measures to increase the flexibility of sickness absence policies, to allow employees with fluctuating health conditions to pre-emptively arrange part-time sick leave. Modelled on the ‘Part-time sick pay’ system already operating in the Nordic countries, employees could arrange to reduce hours in agreement with their line managers for a set amount of time, in the early stages of their condition flaring. In addition we recommend that the scope of income protection insurance be further developed so that businesses can better support those with fluctuating conditions to remain in work. This would mean that in the event of sustained absence the employer could continue to pay the employee and receive compensation for this, along with offering them rehabilitation support to facilitate an earlier return to work.

In addition we suggest:

  • Improving and expanding Access to Work’s provision for fluctuating conditions
  • Developing an employee-owned ‘health at work’ report
  • Improving access to specialist occupational health support for small business through partnership with NHS providers
  • Increasing local commissioning of occupational health and vocational rehabilitation support

It is suggested that ‘clusters’ of coordinated recommendations are developed from these to provide a comprehensive strategy to ensuring employers are equipped and able to support employees with fluctuating conditions to remain in, or return to, work. Fluctuating health conditions are a real threat to the sustainability of the UK workforce, and the resilience of UK businesses. It is our hope that government heeds this warning, and takes action to support employers in developing businesses that reflect the needs of the workforce, ensuring their productivity into the future.