Musculoskeletal Conditions and Employment

Wednesday 10th January 2024 Westminster Hall

09:30

[Margaret Greenwood (Wirral West) (Lab)]

I beg to move,

That this House has considered musculoskeletal conditions and employment.

It is a pleasure to serve under you chairmanship, Dame Caroline. Musculoskeletal conditions can be devastating for those affected. They can cause pain, reduce mobility, diminish self-confidence and lead to isolation. They can also lead to extended periods of absence from work and, in some cases, people giving up work altogether. Instead of enjoying a productive working life, people can find themselves unemployed and impoverished. In addition to the terrible human cost, MSK conditions bring substantial costs to the state in the form of social security and NHS spending.

Conditions include osteoporosis, rheumatoid arthritis, traumatic fractures, osteoarthritis, rheumatic rheumatoid arthritis, traumatic fractures and a range of conditions that cause pain in the lower back, the neck and parts of the arms and legs. The workplace can be a source of such conditions through injuries sustained from one-off accidents or through poorly managed working practices that lead to conditions developing over time.

The Health and Safety Executive has noted that MSK conditions can be caused by a number of things, including, but not limited to: lifting heavy loads, working with handheld power tools, long-distance driving or driving over rough ground, working with display screen equipment, and repetitive work that sees an individual using the same hand or arm action over a period of time. HSE statistics show that the industries with the most reported incidents of musculoskeletal disorders are agriculture, construction, health and social care, and transport and logistics.

It is clearly important to ensure that healthy working practices are the norm and that mitigations are put in place where such movements are required. That might include ensuring that there are sufficient breaks from routine activities. The Health and Safety Executive has reported that 35.2 million days were lost due to work-related ill health in Great Britain in 2022-23. MSK disorders accounted for 6.6 million of those lost days and was the second highest cause after stress, depression or anxiety. Research from the charity Versus Arthritis suggests that over 20 million people—around a third of the UK population—live with an MSK condition. For current UK employees, the figure is one in 10.

Of course, we have to remember that a lot of people have to give up work precisely because they have an MSK condition. According to the Government's statistics, the employment rate for people who have an MSK condition and are classified as disabled was 57.5% in 2022-23. In contrast, the employment rate for the whole population was much higher at 75.7%. Versus Arthritis estimates that the cost of working days lost due to osteoarthritis and rheumatoid arthritis, which are just two of the many types of MSK conditions, was £2.5 billion in 2017, and that that figure will rise to £3.43 billion by 2030. In 2022, the Government’s Office for Health Improvement and Disparities stated that musculoskeletal conditions represent the third largest area of NHS spend, costing around £5 billion a year. The report cited a 2016 study based on 2012-13 costs, and so is not recent. It would be helpful if the Government could revisit this and provide a more up-to-date figure.

The scale of the problem demands a clear and focused response from the Government. In short, the Government should come forward with a cross-departmental MSK strategy. That strategy must set out how the Government will seek to promote good MSK health, reduce the risk of accidents and practices in the workplace that lead to or exacerbate MSK conditions and ensure that support is there for people who need it through positive workplace practices and, where appropriate, the use of equipment, devices and assistive technologies. They should also invest far more in the provision of leisure centres and swimming pools, particularly in deprived areas, so that people can manage and improve their health, and should increase investment in research into MSK conditions. Ministers should consult with stakeholders including clinicians, health and safety experts, trade union health and safety representatives, employers and employees when coming up with this strategy.

Those who are in work need the right support so that they can remain in work, and those who are looking for work need to know of the support that is available to help them get back into employment. Modern design and technology can improve working conditions for people with some MSK conditions, yet people can often feel awkward asking for such adjustments.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Member for Wirral West (Margaret Greenwood) for bringing this important issue forward for us to consider. I apologise to you, Dame Caroline, and to the hon. Lady because, unfortunately, I cannot be here for the debate because I have to attend a Northern Ireland Affairs Committee session. I will just make this point: in Northern Ireland, we have almost half a million sufferers of MSK. That equates to a quarter of the population. Does the hon. Lady agree that we need to enable working people to continue working by providing support and help? I think she does, and I believe that the Minister will as well. The Government must offer support to small businesses to ensure that they know how to make a reasonable adjustment to allow someone who wants to work to do so, rather than having to take sick leave, which they do not want to do.

[Margaret Greenwood]

The hon. Gentleman is absolutely right. Support is needed particularly for small businesses who may struggle to understand and source what is required to support people, and to have the confidence to do so and the understanding that it is a positive investment in their workforce. He makes a really important point. I am also very glad that he cited the scale of the issue in Northern Ireland. One in four is incredibly high, so we need a focused response as a matter of urgency, and I thank him for that point.

There should be absolutely no stigma around having an MSK condition, nor for asking for help in relation to it. For example, in an office environment, it should be common practice that employees are made to feel comfortable in speaking up if they face issues, and that adjustments and equipment such as sit-stand desks, voice recognition software, a vertical mouse, split keyboards and other ergonomic computer equipment are made available to people if that would support their MSK health.

The strategy to which I have referred should be launched alongside a large public awareness campaign so that everyone can be involved and benefit. The Access to Work scheme provides important support for people who are disabled or have a health condition that impacts on their ability to get work or stay in work, but it seems that not nearly enough people know about it.

There has been much evidence to suggest that many people who could benefit from the scheme do not know that it exists. Indeed, I have heard it referred to as the Government’s best-kept secret. In 2021-22, only around one in eight—just over 4500 people—who received support from Access to Work had an MSK condition. The Work and Pensions Committee has highlighted that the application process can be complex and difficult for people to navigate. We therefore need a much greater effort from the Government to raise awareness of the scheme and the benefits that it can bring.

For example, the Government could make it a legal requirement for all employers to inform new and existing employees about Access to Work and to provide a point of contact for any employee who thinks they might benefit from it. This would highlight and promote the scheme, and it would give the opportunity for expertise to be developed within workplaces to support MSK health.

The Government must also give thought to the fact that over 7 million adults in England have very poor literacy skills. It is vital that information about the scheme is presented in a way that is easy for them to understand. Last year, the Government published their “Transforming Support” White Paper, which, among other things, pledged to pilot a new Access to Work enhanced package for people who need more support than the existing scheme can provide. How does the Minister envisage that that will benefit those with MSK conditions specifically? The White Paper also spoke of Access to Work developing an innovative digital service. Will the Minister guarantee that changes will be mindful of the fact that so many adults struggle with literacy and digital skills?

It is disappointing that the Government are failing to administer the Access to Work scheme promptly. In a response to a written question from my hon. Friend the Member for Lewisham, Deptford (Vicky Foxcroft), who will respond on behalf of the Opposition this morning, the responding Minister said that 21,780 applications were outstanding on 5 September last year. That is 21,780 people waiting to receive support for their health condition. It is completely unacceptable. I ask the Minister to update the House on the current state of affairs.

The last Labour party manifesto committed to help disabled people who want to work by bringing back specialist employment advisers and introducing a Government-backed reasonable adjustments passport scheme to help people move between jobs more easily. In their White Paper, the Government said:

“Access to Work is supporting a series of Adjustment Passport trials. The Adjustment Passport will provide a living document of the disabled person’s workplace adjustments, general working requirements and signposts adjustment support at every stage of the journey into work.”

Will the Minister give more information on these trials and how they are going? Can she say what actions her Department has taken to ensure that the passports are user-friendly for people who have problems with literacy?

The Government can promote MSK health and prevent issues from arising through specific campaigns developed with the expertise of health professionals and occupational therapists. They can also legislate for good working practices. It is important that the Government lead on creating positive workplace cultures around promoting MSK health, but for this to be most effective, they need to look at the issue from the employee’s perspective. Under the Equality Act 2010, employers must make “reasonable adjustments” to workplaces, working practices and policies or procedures, to remove or reduce any disadvantages faced by workers that are related to their disabilities. However, it can be difficult for people to raise concerns in the workplace, especially if their job is insecure. People on zero-hours contracts are a particular risk in this regard.

One of the key sectors in which MSK has an impact is transport and logistics, and we know that many delivery drivers are on zero-hour contracts. Health and care is another key sector affected; again, many in the care sector are on zero-hour contracts. Clearly, then, banning zero-hour contracts, as Labour would do, is important not just to ensure that people know that they have stable work and a reliable income, but to prevent a race to the bottom in health and safety at work. The Health and Safety Executive is responsible for inspecting organisations and enforcing statutory duties in relation to health and safety law. The HSE can investigate businesses and has the power to bring enforcement proceedings, including prosecutions, in cases of serious failures. Its work is incredibly important, yet the HSE’s funding has been savagely cut since 2010.

Analysis last year from the Prospect trade union found that Government funding for the HSE decreased by 45% in cash terms between 2010 and 2019, from £228 million to £126 million. Funding increased to £185 million in 2022, but this still represents a huge decrease from 2010 levels. Prospect’s research also highlighted staff cuts of 35% across the HSE since 2010, while the number of inspectors has fallen by 18%. These cuts are an attack on the health and safety of all of us, and I call on the Government to review the needs of the HSE and restore funding to at least 2010 levels. We cannot allow the Government’s obsession with austerity to damage our health and safety.

The Government could also promote MSK health and prevent issues from arising by supporting the “Better Bones” campaign, which is led by the Royal Osteoporosis Society and the Sunday Express and backed by many organisations, including the Federation of Small Businesses, Parkinson’s UK, Coeliac UK and a number of unions and royal colleges. Some 50% of women and 20% of men over the age of 50 will have a fracture caused by osteoporosis—staggering rates. A third of those who have a fracture and have osteoporosis will have to leave their jobs.

Fracture liaison services can do invaluable work in identifying whether people have osteoporosis. However, only 51% of NHS trusts in England have them. As a result, many people will break bones and go to A&E, and will be seen without their underlying osteoporosis being diagnosed and treated. That leaves a massive risk that they will suffer further, more serious fractures in the future. As a result of this postcode lottery, around 90,000 people a year are missing out on important diagnosis for a condition for which they could otherwise receive medication that would reduce their risk of further fractures.

The “Better Bones” campaign is calling for access for all over-50s to fracture liaison services with dedicated bone specialists, £30 million a year of extra investment to make fracture liaison services universal in England, Wales and Scotland, and the appointment of a fractures tsar for each British nation. It was therefore extremely disappointing that there was no extra funding in the autumn statement for fracture liaison clinics, despite the Minister in the Lords saying in September:

“We are proposing to announce, in the forthcoming Autumn Statement, a package of prioritised measures to expand the provision of fracture liaison services and improve their current quality. NHS England is also setting up a fracture liaison service expert steering group”.—[Official Report, House of Lords, 14 September 2023; Vol. 832, c. GC241.]

That is especially disappointing from a Government who claim that they want to try to help people over 50 to get back into work. It is disappointing too that, in July, the then Secretary of State for Health and Social Care said that the Government planned to spend more than £8 billion from 2022-23 to 2024-25 to support elective recovery, with NHS England prioritising fracture liaison services in its elective recovery plan. However, in the end, fracture liaison services were not even mentioned in the elective recovery plan.

The Government must address the shortcomings in fracture liaison services, which would contribute to helping over-50s back into work, and I ask the Minister to press this point with ministerial colleagues. As the Federation of Small Businesses said of the “Better Bones” campaign, it

“is more than a health initiative—it’s a matter of economic vitality. We need to address the increased numbers of those who have left the workplace as employees, self-employed or small business owners themselves due to sickness. This campaign is one of those steps.”

The Government can support workers with MSK conditions, too, by ensuring flexible working from day one, as a Labour Government would do. We also need to see action from Government on people’s general health and MSK conditions through investment in the health and wellbeing of all communities.

Versus Arthritis argues that being overweight or obese increases the risk of developing arthritis conditions such as osteoarthritis and gout. It also points out that swimming is a good exercise for people with musculoskeletal conditions, such as arthritis or back pain. The water helps to support the weight of the body, which reduces strain on painful joints. The Government should also promote MSK health by ensuring people can access facilities such as swimming pools and leisure centres.

Sadly, central Government cuts to local government since 2010 have resulted in many pools and leisure centres closing across the country, including in my own constituency of Wirral West. During the campaign to save the Woodchurch Leisure Centre and swimming pool, I remember people telling me how they used the pool to cope with arthritis. The loss of this facility has been devastating for many people trying to manage MSK conditions in my constituency and it is doubtless the same for people across the country.

Government strategy must look at the impact of austerity policies on sport and leisure facilities and at the impact that this has on the health of the population. Musculoskeletal issues cause serious problems for millions of people and can have a devastating impact on an individual’s working life. The high prevalence of such conditions warrants a high-profile, cross-departmental policy intervention. I to pay tribute to all those who work so hard to promote safe and healthy working environments, including the HSE professionals, occupational therapists and of course hard-working trade union health and safety reps who do such invaluable work in identifying workplace issues and campaigning for greater safety for working people.

The Government must bring forward a cross-departmental MSK strategy with clear goals to improve prevention and to support those with MSK conditions. Failure to do so will only lead to continuing costs to people’s health and happiness and continuing costs to the Exchequer for NHS and social security spending. The benefits of taking action on MSK are clear to all, and I call on the Government to do just that.

09:47

[Tom Randall (Gedling) (Con)]

It is a pleasure to serve under your chairmanship, Dame Caroline. I congratulate the hon. Member for Wirral West (Margaret Greenwood) for bringing this very important subject to the House. This is a timely debate and, as she outlined in her speech, getting various parts of the population into work and getting people back into work are popular with the Government at the moment, but they are important on their own terms as well. She properly outlined the human cost that these conditions cause in her speech. Via the charity Versus Arthritis, which does so much good work in this field, one of my Gedling constituents commented on her condition:

“Living with arthritis changes you and turns your world upside down.”

I know that that will be the experience of many people.

Although the human cost is very important—and perhaps the most important factor—it is worth focusing on the economic cost, given that the focus of this debate is employment. It is also worth looking at some of the steps that the Government are taking to try to mitigate this. Conditions such as arthritis in the popular imagination are perhaps still thought of as being something that affects pensioners. That is the popular image, but we know, and we should know, that it is far more widespread than that. More than 10 million people in the UK—one in six of our constituents—have arthritis; that is one in six of our constituents with pain or fatigue and with restricted mobility. People with arthritis are 20% less likely to be in work than people without arthritis and 12% of sickness absence in the NHS between September 2021 and August 2022 was due to back problems and other MSK conditions, which illustrates how widespread this is.

I declare an interest as the co-chair of the all-party parliamentary group for axial spondyloarthritis, but the charity that supports people in that space, the National Axial Spondyloarthritis Society, estimates that a patient aged 26, who has waited eight and a half years for an axial spondyloarthritis diagnosis is likely to lose around £187,000 in their life, the majority of which derives from a loss of productivity due to reduced employment. The average patient incurs costs of around £61,000 in out-of-pocket expenses while waiting for a diagnosis, including the cost of medication, travelling to appointments and private healthcare appointments such as visits to chiropractors. The scale of this issue is quite staggering. According to the Office for National Statistics, 23.3 million working days were lost in 2021 due to musculoskeletal conditions. The cost of working days lost due to osteoarthritis and rheumatoid arthritis was estimated at £2.58 billion in 2017, rising to £3.43 billion by 2030. There is a definite need to address this with some urgency.

In that light, I welcome the announcement in the last Budget of over £400 million in funding for employment support and resources within MSK and mental health services, with £100 million specifically to support people with MSK conditions. That funding includes tailored employment support within MSK and mental health services in England, including expanding the well-established and successful individual placement and support scheme and scaling up MSK hubs in the community. The experiences of people with arthritis and MSK conditions must be at the heart of that extension and the development of new services, to ensure that the Government create efficient resources that meet the needs of people with MSK conditions. I understand that the IPS scheme is already well established for people with mental health problems and they are usually referred to it from within the healthcare system. Having that support on offer and available to people with arthritis and MSK conditions could mean that they find suitable work that does not have a negative impact on their MSK health.

The Government have said that they will ensure digital resources such as apps for the management of mental health and MSK conditions are readily available so that more people can easily access the right support for them. I hope that that will include employment support. While the Budget leans towards a digital first approach, as everything does these days, I hope that the combination of apps and tailored employment support within a community will allow people to access support in a variety of ways and choose the method that suits them.

I also welcome the recent announcement that employment advisers will be introduced into MSK pathways to support people with MSK conditions back into work. People with arthritis and MSK conditions need equitable access to employment support programmes.

[Mr Gregory Campbell (East Londonderry) (DUP)]

On the issue of employment support, does the hon. Gentleman agree that it is important that advisers and people in that position understand some of the lesser-known conditions? For example, I have had some experience of syringomyelia of the spinal cord. Knowledge and experience of such conditions at an early stage can help considerably to keep people in work or get them back into work if they have been off.

[Tom Randall]

The hon. Gentleman is absolutely right. We need to be smart. We can talk about MSK as an umbrella term, but within that there are lots of different conditions with different symptoms that affect people differently. That is where we need to be smart. Some people will have conditions that enable them to work on some days, while flare-ups on another day might prevent them from doing so. A one-size-fits-all approach is probably less likely to work. If we are serious about getting people back into work, which we should be, we need to be creative about that and try to recognise, as the hon. Gentleman said, the broad range and spectrum of conditions and how they affect different people. That is a difficult task, but it is something we should certainly aim for.

Programmes such as Access to Work may not, on the surface, appear relevant to many people with arthritis who might not consider themselves to have a disability, but they need to have access to such programmes. Following the hon. Gentleman’s comments, the potential impact of arthritis and MSK conditions on people’s ability to work and their experiences of work can be misunderstood, particularly when the severity of conditions fluctuates unpredictably over time. I hope that, as he said, employment advisers are skilled and confident in supporting people with arthritis and MSK conditions, and that they receive the training they need to know how they affect people’s experiences of employment.

Perhaps the most important thing we need is a change of mindset. Over recent decades, we have revolutionised the way in which we approach wheelchair users and talk about mental health in the workplace: we are more positive about and accommodating of various things. We have been open, embraced that and made the necessary adaptations to bring people into the workplace, but we have not quite got there with musculoskeletal conditions, arthritis and other things. The Government and employers should create flexible workplaces so that people can participate in society. That change of mind—that forward thinking—will be good not only for society and the Exchequer but, most importantly, for the people involved. Instead of being at home in pain, they will be out in employment, which will be fulfilling and good for them. That is what we should be aiming for. It will perhaps be a long process, as it is about changing minds, but we should commit ourselves to it today.

09:56

[John McDonnell (Hayes and Harlington) (Lab)]

I want to continue in the same spirit as the hon. Member for Gedling (Tom Randall). It is entertaining and sometimes enjoyable to have debates in which we just kick the Government and other political parties, but Westminster Hall debates are often a way to share information about our own experience of policy development and our constituents with the hope that the noise we make is listened to by the Minister and their advisers. We often find that there are shared issues that we can all learn from.

As the hon. Gentleman said, in the past there was almost a stigma around MSK conditions. Back pain was seen as an easy excuse to pull a sickie, when actually it is incredibly significant for individuals’ lives and, as the hon. Gentleman and my hon. Friend the Member for Wirral West (Margaret Greenwood) said, for the economy overall. I congratulate my hon. Friend on putting this issue on the agenda.

I want to go through the experience of my constituency and set out what has led me to the debate. At Heathrow airport, which is in my constituency, there was almost an epidemic of back injuries among baggage handlers. Some Members may recall, when they went through the airport over the years, that there were different campaigns about the weight of the baggage. Although mechanisation was introduced, the work nevertheless involves physical exercise, so we had an epidemic of people who were going sick as a result of back pain. We went through all those allegations of people fraudulently going sick, but when we did the investigations, working with the employer and the trade unions, we discovered the scale of the back injuries over almost a generation, along with the consequences.

The lesson we learned is that, through joint campaigning with the employer, the trade unions and local health bodies, we were able to introduce practices that minimised the damage that was being done to these individual workers, even though the problem continues. For large employers, it is easier. The epidemic of back injuries in my constituency at the moment is among smaller employers, whose actions are often on the margins of legality and they fail to take reasonable care of their employees.

Through airport campaigns, which involved Unite, GMB, the Public and Commercial Services Union and other unions coming together, we found that we needed engagement with the HSE at the earliest stage. We need guidance in place that can be applied so that the employers recognise their responsibilities and the trade unions representing their members can enforce the guidance through negotiation and, if necessary, through various forms of industrial action if individual employers are not adhering to those guidelines.

This is not in any way an attack on the Government or anything like that, but I want to flag up the resourcing of HSE, which my hon. Friend raised. There is an issue here that has to be addressed. I know that individual Ministers have to fight their corner with the Treasury for resources in their patch. Whenever the Minister goes into budget negotiations for her field again, she will have cross-party support for securing additional resources for the HSE. The current denial of those resources means that inspection and intervention processes are not working as effectively as they should to prevent actions that put people’s livelihoods in danger as a result of back injuries. One problem is that small companies are infrequently inspected these days, which means that incidents are arising where companies are ignoring basic guidelines set out by the HSE.

With regard to incidence, my hon. Friend the Member for Wirral West has set out the scale of the problems. I want to congratulate Versus Arthritis, which works so hard. We are all drawing on the briefing we received from the organisation.

[Dr Rupa Huq (Ealing Central and Acton) (Lab)]

My right hon. Friend, who is a near neighbour of mine as a Heathrow MP, is making a powerful case. He mentioned Versus Arthritis, of which my constituent, Julian Worricker —as a media person, you will know him, Dame Caroline —is a champion, as am I. My right hon. Friend talked about big or large employers. Some of their advice is well intentioned, such as the information on diet for people with arthritis, saying they should have oily fish, omega 5, extra virgin olive oil and all this healthy stuff. In a cost of living crisis, that may be difficult for people to buy when it is so much cheaper to get Iceland stuff for 99p or whatever it is, with loads of fat in it. Does my right hon. Friend agree with me?

[John McDonnell]

I am glad my hon. Friend has raised that matter in advance of my raising it. Poverty almost certainly relates to that, as it does to work practices, particularly with regard to hours of work. Fatigue then leaves people open to making mistakes at work, particularly around handling goods, heavy lifting and not following practices because they are just so tired. In addition, my hon. Friend’s point about diet is fundamental. A number of constituents have seen me and said, “This is the advice from my local doctor or whoever about what I should be eating, but I literally can’t afford it,” or they do not have the support they need to enable them to go on a path of healthier living and a healthier diet.

Versus Arthritis also made the point that for many of our constituents with these injuries, in the winter conditions, the cold affects them. There is nothing in the financial support that we give people that reflects or effectively deals with the incidence of cold. From the briefing we have all received, for my constituency the figure is 15,000 people. In other words, one in six people in my constituency have some form of condition. They are in pain, they experience fatigue and at times have restricted mobility. That is an epidemic by any calculation, and it has an impact on the economy overall. However, for many of the constituents I have met, it is also savaging their quality of life and, as a result, some of us have a sense of urgency about the need for action.

I have to raise the issue of waiting times for diagnosis and treatment, which has become a real problem. In my area, the numbers waiting more than a year for operations and interventions are better than some: the national average is 6%, whereas in my area it is 3%. We are performing better than the national average, but even 3%, which is a couple of hundred people waiting more than a year in my area, is a significant number. Hon. Members will know that when we meet those people, they are waiting in real pain and I am finding that the mental health consequences are significant too. People are desperate to support their families and they feel guilty that they are not doing so. At the same time, they are frustrated because they literally do not know what to do in that waiting period. I come to the points the hon. Member for Gedling made with regard to support and access to work. I cannot agree with him more about the significance of this. While I welcome the additional funding that has come from Government, we have found in the past—this relates to the work capability assessment, which I will come on to—a lack of expertise in assessment and advice. Exactly as the hon. Gentleman said, there is a range of conditions and, in many instances, very specific advice is needed—even at first assessment. We have to bring relevant expertise into the pathways at every stage and be capable of drawing on that, otherwise we just get things wrong. If the wrong advice is given, that adds to the pressure and stress on the individual.

The issue with the work capability assessment, which we have been dealing with since its inception, is—to be frank—the brutality of it. The regime has now become even harsher. We have been in debates here on a number of occasions, and we have even heard of suicides taking place as a result of the work capability assessment implementation. That relates to the lack of expertise in the assessment. Harsh conditions are placed on people who cannot meet those conditions, and as a result they lose their benefits. In addition to losing their benefits, there is a feeling of guilt and ostracisation in the community itself, and a stigma attached.

It is important that the Minister sits down with the Public and Commercial Services Union, which represents the civil servants administering these benefits. They are saying to us that their caseloads have increased dramatically, and that as a result they do not feel they have sufficient staff to deal with individual cases effectively. The pressure that many of their members are under is unacceptable, and the problem of being able to deal with their caseload properly has become insurmountable.

My final point is about the strategy for the future. The key thing that comes out of discussion with virtually every organisation we meet, whether it is Versus Arthritis or the Royal Osteoporosis Society, is the importance of engagement with the sufferers themselves and their representatives. It is similar to the disability principle, “Nothing about us without us.” Engagement with MSK sufferers is absolutely key to developing the future strategy. I also put in a plea for engagement with the trade unions representing many of the workers who have been involved in back injury cases and in prevention work. The hon. Member for Strangford (Jim Shannon) made a point about small businesses. The Federation of Small Businesses has really been helpful on a whole range of these issues, not only about how it can advise its members on best practice, but also reporting back on what it feels are impediments to getting people back into work, and the support needed for small businesses to make reasonable adjustments for people suffering from these conditions.

There is a desperate need to move forward. I welcome what additional money there is, but it will not be used effectively unless there is proper engagement with all concerned with the experience that we have had over the last generation. In my constituency, I am hoping that we can overcome the issues of access to proper advice and to health treatment, and do much more on the preventive side, because many of my constituents are disabled for life as a result of past practices.

10:09

[Marion Fellows (Motherwell and Wishaw) (SNP)]

It is a pleasure to serve under your chairmanship, Dame Caroline. I warmly congratulate the hon. Member for Wirral West (Margaret Greenwood) on securing this really important debate. I am grateful to Versus Arthritis and to the British Society for Rheumatology for their very helpful briefings. I listened with great interest to the right hon. Member for Hayes and Harlington (John McDonnell), and I absolutely agree with him that Westminster Hall is more conducive to sharing ideas, rather than just having a go at the Government. However, as the SNP spokesperson, I always have to give the Scottish perspective on things in this place, so I will do a fair bit of that this morning—not for too long, I hasten to add.

We have heard of the number of working days lost because of musculoskeletal conditions, which I will now refer to as MSK conditions, for everyone’s sake—especially those from Hansard who are here. It is really important that the Government change attitudes to people with disabilities such as MSK conditions. We have to support those people, improve their access to work and help them stay in work.

Let us look at what we tried to do in Scotland, and some of the issues that we are really concerned about. We in the SNP are deeply concerned about the changes to work capability assessments, which will lead to disabled people and those with long-term health conditions being put at risk of sanctions. We know that sanctions do not work—we have the evidence—and we really feel that they are not the way forward. More support for people who have been unemployed for a long time is welcome, but sanctions should not form part of that. We do not support mandatory work placements, either.

People with MSK, arthritis and similar conditions often have to give up work because they cannot continue, and they cannot live on statutory sick pay if they have to take short-term absences from work. If the Government are serious about closing the disability employment gap, they have to start providing statutory sick pay that treats workers with dignity. It is ridiculous that recipients get only £109.40 a week; that is wholly inadequate, and is among the lowest amounts in Europe. The Government should look at increasing SSP in line with a real living wage. We also want the Government to provide guidance to employers on reasonable adjustments, and to create statutory timescales for their implementation. We are all agreed that we want people to be able to work, but we need to give them the right support.

The right hon. Member for Hayes and Harlington and others have talked about how difficult things are for people with long-term conditions, especially MSK conditions. They need to dig deep into their household budget to be able to eat properly and keep warm—that is currently a huge problem. The SNP has asked many times for a social energy tariff, and I requested a debate on that in this very place. We need measures to help people return to work properly, when they can and want to.

It is absolutely ridiculous that there has still been no mention of work practices, nor any movement since the Taylor review was first published. We keep hearing promises from the Government, but action is not happening. The SNP’s vision is for Scotland to be a fair work nation by 2025, where fair work drives success, wellbeing and prosperity for individuals, business organisations and the whole of society. That means that we have to look at the drivers of workplace inequality and ensure that everyone is supported to enter into work and progress. That is making a difference: in Scotland people are happy, and want to sign up to the fair work scheme. I know that everyone here wants things to become better. We really need to improve things, but in Scotland we cannot do that on our own, because workers’ rights remain firmly in the hands of Westminster.

We need to look at this issue. The Smith commission tried to look at it, but we were outvoted by Labour and the Tory Government at the time. In Scotland, we want—indeed, we need—the right to set our own agenda for fair work practices. It is really important that people with MSK conditions are able to participate in work fully and do not spend months and months waiting for access to work. Also, when they have to take time off work, they should receive proper statutory sick pay. Then they can go back into the workplace and can continue to contribute to society.

I thank everyone here. We have covered a wide range of issues, and I will listen carefully to the Opposition spokesperson, and especially to the Minister who responds to this very important debate.

10:15

[Vicky Foxcroft (Lewisham, Deptford) (Lab)]

It is a pleasure, Dame Caroline, to serve under your chairship, and I am grateful for the opportunity to respond to this debate on behalf of the shadow work and pensions team.

I congratulate my hon. Friend the Member for Wirral West (Margaret Greenwood) on securing this debate. She is absolutely right to say that the Government must have a cross-departmental strategy to address this issue, and must ensure that the Health and Safety Executive is properly funded to ensure that all of us are safe in the workplace. They do that alongside trade unions. Many important points have been made in the debate and I hope that the Minister will respond to them in detail.

I apologise to my right hon. Friend the Member for Hayes and Harlington (John McDonnell), because I must make a little criticism of the Government and nudge them at this point. The Minister will already be aware of my thoughts about the Prime Minister’s decision to downgrade her role as the Minister for Disabled People, Health and Work. I assure her that I will do all I can to get her and her role repromoted to where they should be. It is so important that we do that.

The number of people who are economically inactive because of long-term sickness has risen to over 2.5 million, which is an increase of more than 400,000 since the start of the pandemic, and the figure is now higher than ever. That has a huge impact on our economy, as well as on individuals’ health, wellbeing and ability to support themselves and their families.

The increase in the number of people off work because of long-term sickness since the pandemic is costing the country an extra £15.7 billion a year. Along with mental health conditions, musculoskeletal conditions—or MSK conditions, as I will refer to them, to make sure that I do not pronounce “musculoskeletal” incorrectly—are one of the main reasons for long-term sickness. They affect one in five of the people defined as being economically inactive.

As my right hon. Friend the Member for Hayes and Harlington said so eloquently and respectfully, we need proper resourcing of the HSE. That is really important in terms of cross-departmental working. Also, the HSE is a very powerful example of employers, trade unions and others working together. He cited the example of baggage handling workers. I was personally involved with such work myself before I was an MP, when I was working for Unite the union. There was a really strong campaign for those workers, and it really made a difference for them.

Over 20 million people in the UK, or almost a third of the population, have an MSK condition. However, with NHS waiting lists at a near-record high, people are waiting months for trauma treatment or orthopaedic treatment. As many people have already said, according to Versus Arthritis, over 1 million people are waiting for such treatment, many of them having to put their life on hold while they wait. In 2021 alone, arthritis and other MSK conditions resulted in the loss of 23.3 million working days.

Last month, I asked the Minister several written questions on what steps her Department is taking to help people with MSK conditions to re-enter the workforce. First, I would like to place on record my concern about the fact that the Department has made no estimate of the number of people awaiting treatment. That prompts the question of whether it really has a grip on the extent of the problem. In her response, the Minister outlined the package of measures set out in the spring Budget and the autumn statement to tackle the leading health-related causes of economic inactivity, including MSK conditions. Those measures include introducing employment advisers into MSK services, developing and scaling up MSK community hubs, and making the best use of digital health technologies, alongside various pilots and commitments to exploring new ways of providing timely support and improving occupational health problems. That is not ambitious. It is simply more pilots, and more exploring what to do, from a Government who have been in power for over 13 years. Furthermore, will the Government be open and transparent, and publish the details of those pilots? I have asked for this information in many written parliamentary questions, and sadly they are not forthcoming.

I would like to touch on two initiatives, the first of which is Access to Work. The Minister already knows some of my thoughts on this, but I will reiterate them. Her predecessor, the hon. Member for Corby (Tom Pursglove), when asked numerous times, continued to assure me that the Department for Work and Pensions has increased the number of staff working to clear the Access to Work backlog, but it does not appear to be going down. In November 2022, the backlog was 25,281, but a year later, it was 24,339. I think we will all agree that there is not much sign of progress.

Secondly, the much-criticised Disability Confident scheme is also in need of urgent reform. Recent analysis by Disability@Work shows that even employers who have achieved level 3—the highest level—are no more likely to employ disabled people than those who have not signed up to the scheme. It also shows that disabled people working for Disability Confident employers do not report better experiences than those working for employers who are not members of the scheme. The Minister’s predecessor admitted to the Work and Pensions Committee in the summer that it was time for a root-and-branch review of Disability Confident, so I am interested to know what progress has been made. I also want to add my voice to calls for an update on when the major conditions strategy will be published.

I end as others have, by paying tribute to the organisations that support people with MSK conditions—many are here today and without them many people would be struggling even more than they already are. I reiterate what my right hon. Friend the Member for Hayes and Harlington said. Government must engage with those affected by these conditions. After all, these people are the experts by experience.

10:23

[The Minister for Disabled People, Health and Work (Mims Davies)]

It is a pleasure to serve under your chairship, Dame Caroline, and I thank the hon. Member for Wirral West (Margaret Greenwood) for introducing today’s debate in a constructive, positive and very interesting way. As the Minister for Disabled People, Health and Work, it is an honour early on in my tenure to talk about the Government’s commitment to enabling people with musculoskeletal conditions to start work, stay in work, and importantly succeed in work, which is what today’s debate is about, and it was an honour to hear from Members on all those matters. As the hon. Member for Motherwell and Wishaw (Marion Fellows) said, the spirit and context of the debate is extremely important. I thank the hon. Member for Lewisham, Deptford (Vicky Foxcroft). We have always had a very constructive and positive relationship. I look forward to working with her on her challenges to us, and all her asks across Government; I note all of these. As hon. Members might note, I have a lot of material here. Whether I can get to all of it we will see, but I hope to share the Government’s ambition for this society as one where disabled people and those with health conditions can fulfil their potential when it comes to employment, and one where they have the fair rights and access that we all want for them.

My mum lived with osteoporosis and rheumatoid arthritis, and she worked with disabled adults; my dad lived with a head injury for more than 25 years under the Court of Protection, and I am a coeliac, so despite the height of my role, I want to reassure those in the Gallery and those listening to the debate that my convening power is no less and my commitment is no less, but I understand the asks from the hon. Member for Lewisham, Deptford—and on her advocacy for my promotion, one could ask for nothing else.

The joint Department for Work and Pensions and Department of Health and Social Care work and health directorate was set up in 2015 to recognise the extremely strong links between work and health and the importance for health of good work, which has been highlighted today. I pay tribute to those doing the “Better Bones” campaign. As the Minister who was predominantly responsible for the HSE for a number of years, I assure the right hon. Member for Hayes and Harlington (John McDonnell) that I have paid close attention to the issue, and I hope that the HSE’s representatives will come to Parliament shortly to give us all an update on their work. The responsibility sits with my noble Friend Lord Younger now, but I will be working very strongly with him.

I absolutely agree with my hon. Friend the Member for Gedling (Tom Randall) and others on the subjects of prevention, tackling stigma and keenly engaging with those who understand this matter. Supporting and empowering those with MSK conditions is very important to me—I hope I have outlined why—both in this new role and in my capacity as a local MP. In fact, in that capacity, I invited my ministerial predecessor, who is now the Minister for Legal Migration and the Border, my hon. Friend the Member for Corby (Tom Pursglove)— I pay tribute to his work and his commitment on this subject—to visit VIM Health. This gives me an opportunity to mention Tom from VIM Health and all his team, all his patients and the work done in this specialist neurological rehabilitation centre and MSK therapy service, which I have seen. My hon. Friend and I agreed that it was incredibly inspiring to see how innovative technologies can make healthcare more accessible, enjoyable and transformative. This gym helps with rehab, and also makes accessible exercise, and other things that many of us take for granted. We talked about the pools, and I will come on to that later.

I am looking forward to meeting representatives of Versus Arthritis later this month; I met them at the party conference. Like others, I extend my thanks to third sector organisations for the important work that they do, and the knowledge that they impart to us in Westminster, to raise awareness and to support people living with MSK conditions, helping them to fulfil their potential in the workplace. As we heard from my hon. Friend the Member for Gedling, this is about a change of mindset. Work is so much more than a pay packet. It increases people’s wellbeing; it increases their network and their confidence. At times when their health is perhaps failing or fluctuating, nothing is more important than having confidence, a network and support, and that very much comes from work.

[Margaret Greenwood]

I appreciate the tone that the Minister is taking in the debate. On that point about mindset, would she look at perhaps requiring employers to inform new employees about Access to Work when they start, to make it quite a routine thing, and so that people know about it and can have an up-front conversation about all areas of their health, but particularly MSK health? I ask because from the point of view of the person who is suffering, it can be extremely difficult to raise an issue that they know will cause bother for their manager, perhaps cost them money and so on.

[Mims Davies]

I thank the hon. Lady for that point. In fact, in preparing for this debate and seeking to understand the issue further, this was something that we discussed and I was interested in. Gatwick is not far away from my constituency, and many constituents work there, and some of them work in passenger assist, getting people on and off planes. Being able to talk to employers confidently and comfortably is really important.

When someone’s health changes, it is often a bolt from the blue. How do they manage that with their employer? That is something that I am very focused on, and it covers the Access to Work programme and the Disability Confident scheme.

I will come on to Disability Confident, but we need to move this from being a nice thing on a website to a reality for people working in whatever sector and with all employers. We have taken that approach with menopause and the debilitating impact that it can have for women of all ages, including in the workplace. All of this, in the round, is very important when it comes to staying in work and thriving in work, which is what we ultimately want for everybody.

For context, around a third of the UK population—over 20 million people—live with an MSK condition. As we said, we do not want people to feel that leaving employment is the only option, and the Government absolutely recognise that good work is generally good for health, as we heard from my hon. Friend the Member for Gedling and the hon. Member for Lewisham, Deptford. MSK interventions to improve workforce participation were key when it comes to the £400 million health package in the 2023 spring Budget.

Let me go through some what the Government are doing. We are introducing employment advisers within MSK services to support people with conditions to thrive in work, help them to have those conversations and, above all, assist with engaging with employers. We are developing and scaling up MSK hubs in the community. Building on existing local practice, hubs will offer people with MSK conditions access to physical activity interventions in leisure centre or community settings—as we have heard—and we will explore how to embed vocational advice too. We will also be making the most of digital health technologies to support people with MSK conditions to better manage those symptoms and remain in work, and that will include digital therapeutics.

The reality is we are all living longer, and long-term sickness is a common reason for economic inactivity among the working-age population. Therefore, the Government rightly have an ambitious programme to support disabled people and those with health conditions, including MSK, to start, stay and succeed in work. That includes variety of interventions, which we have heard about today: Disability Confident, the Access to Work grants, the Work and Health Programme, and a digital information service for employers in relation this. Employers knowing how to manage and to have those conversations equally with employees will make a real difference, and of course there are also our own disability employment advisers in DWP. I will be engaging directly with all groups and stakeholders to make sure this works, and I will be putting myself, as I always do, in the place of our claimants and of those people that that need help.

[Margaret Greenwood]

I thank the Minister for giving way; she is being very generous.

On helping people to engage in activities that will improve their health, the closure of swimming pools is really serious. In my constituency, we have lost the swimming pool in the Woodchurch estate. I met users there—we were fighting against the closure—and they were clear that they were using the pool to deal with two things: mental health issues and arthritis. That particular estate has a higher-than-average level of deprivation, a higher-than-average level of disability, and more older people living there. For them, the closure has been catastrophic. I recognise that that is not the Minister’s Department, but will she talk with ministerial colleagues and look again at the provision of sport and leisure facilities, particularly in areas of deprivation, so that those people can improve their own health?

[Mims Davies]

I thank the hon. Lady for reiterating that point for her constituents. These hubs in the community will deliver both that physical activity and those interventions. I understand her point, and I know that support for pools has come to councils from the Department for Digital, Culture, Media and Sport. What the hon. Member has said is very specific, and I will take that away in the cross-Government work that I am doing. I think, as well, that it is a lesson for many of our local authorities to think very carefully about the decisions they make and how they affect the whole community. It is vital that people understand that the wider impact might involve losing more than just swimming lessons—and that is not easy in itself. The hon. Member has rightly put that on the record for her constituents.

Employment advice and NHS talking therapies will be included in our interventions, along with individual placement and support in primary care and increasing work coach time in jobcentres. The hon. Member for Motherwell and Wishaw spoke about making sure that we listen to and engage with people, and do it in the right way, and I wholeheartedly agree with that individual approach.

All these investments are part of a much wider agenda to tackle inactivity due to long-term sickness. We also announced our Back to Work plan in the autumn statement. It includes doubling the number of universal support employment programme places; increasing occupational health take-up in businesses, including SMEs, which is absolutely key; testing new ways of providing individuals receiving a fit note with timely access to their key support; and supporting people with health-related barriers to work through the 15 WorkWell pilot areas that we are working on. WorkWell is accepting applications for funding from local areas across England, with pilot areas due to be announced in April and more details in the autumn. I will be working with the Minister for Employment, my hon. Friend the Member for Bury St Edmunds (Jo Churchill) on this matter.

[Vicky Foxcroft]

I thank the Minister for giving way. She has pointed to a number of Government pilots and I know there are other pilots. In my contribution, I asked whether the Government would be transparent and publish data on those pilots. Does the Minister want to put on the record whether the Government would be willing to do that?

[Mims Davies]

I thank the hon. Lady for that ask. This is still being worked out. I am conscious that one of my predecessors in DWP warned about having “more pilots than easyJet” and about making sure that they work and are right. Once we have more details, I am sure we will be in a position to share them with her, so I will come back to her on that matter. It is early in my tenure, and I want to get to grips with this. When I am in a position to share, of course I will do so.

We have talked about the impact of poor MSK health on individuals and employers. We know that over 20% of employees and self-employed people have an MSK condition and that it is a leading cause of working days being lost through sickness and absence, accounting for over 23 million lost working days. My hon. Friend the Member for Gedling spelt that out strongly. Tackling these disparities and managing these conditions are absolutely key.

When it comes to women, the older population and certain ethnic groups, understanding the prevalence and the impact of the condition and doing more on prevention are key in terms of managing and supporting people. A predominant symptom is pain, which limits people’s mobility and dexterity. Living with pain is awful, managing it is incredibly stark, and it is very difficult for people to fully participate in society, so we need to make sure that people have a healthier home and working life.

We know that osteoporosis, which causes fragility and leads to fractures, disproportionately affects women. The Government’s women’s health strategy is key to understanding specific actions to improve women’s experiences and outcomes in relation to osteoporosis. I look forward to meeting Dame Lesley Regan, our women’s health ambassador, on this matter as soon as our diaries allow. I know she is very focused on this, and we will raise the profile of those issues. I have been very engaged with her in my work on menopause and employment action, and I will continue to do that.

I have talked about supporting employers and workplaces as key enablers for disabled people with health conditions to remain in work, so let me briefly cover prevention. Adults in employment spend a large proportion of their time in work. How we are engaged with in our jobs and workplaces has a massive impact on our health. Therefore, in 2022, the Government and the Society of Occupational Medicine published the MSK health toolkit for employers and further education institutions, which encourages employers to support adolescents and young adults with MSK conditions. We have also produced the MSK toolkit for employers, which has been developed in partnership with Business in the Community and provides practical information for employers of all sizes to address MSK conditions in the workplace for the working age population. We need to look at the adjustments and support there.

I thank Thriiver in my constituency, which is a brilliant group of people who deliver around £4 million to £5 million of support through the Access to Work scheme. They gave me a stark insight into what they feel should be done, which I fed back to my predecessor. We know that the grant scheme plays a key role in enabling people. The point about literacy and digital skills has been noted. I also note that the Chairman is looking at me, so I will conclude.

There are a few matters that I might write to Members about. I think we have all agreed that poor MSK health has a significant impact. The delays to Access to Work are improving—we have been forensic on that. People need support from employers, from Government, the wider economy and the NHS. We will continue to focus on good jobs to help everybody thrive and have fulfilling lives, with the benefit of health and wellbeing behind them. That is the best route out of poverty.

10:41

[Margaret Greenwood]

I thank everybody who has taken part in this important debate for their points. I also thank the many organisations, some of whom I have already referenced, that have been in touch with me in advance of today’s debate to offer briefings and expertise. I run the risk of missing someone out, so I will say that those organisations include but are not limited to the Society of Occupational Medicine, MSK Aware, On the Mend, the Royal Osteoporosis Society, the Chartered Institute of Ergonomics, Orthopaedic Research UK, Versus Arthritis, the British Society for Rheumatology, and ukactive.

I also want to thank the individuals who have been in touch with me to share their experiences, as well as staff at the House of Commons Library. I again pay tribute to the vital role played by trade unions in the workplace when it comes to matters of health and safety and improving working practices. Millions of people across the UK suffer with musculoskeletal problems, which profoundly impact not only their health and wellbeing, but their ability to acquire and stay in work. We need concerted Government action to improve prevention and support.

Given the scale of the problem, a comprehensive cross-departmental MSK strategy is desperately needed. There is a wealth of expertise in the public sector and the organisations that I have cited. I urge the Government to consult them and, crucially, the people with lived experience of MSK conditions. I reiterate that the Government need to address the issues with the administration of Access to Work. They need to oversee an increase in the numbers of people with MSK conditions getting support through Access to Work, significantly increase funding for the Health and Safety Executive and come forward with funding for fracture liaison clinics, as called for by the “Better Bones” campaign, to help the over-50s who suffer fractures due to osteoporosis.

I hope that the Minister will take on board everything that has been said. She said that she will write to respond to some of the questions, which I very much appreciate. We need to see vastly improved MSK health and improvements in how people are able to participate in the workplace.

Question put and agreed to.

Resolved,

That this House has considered musculoskeletal conditions and employment.

10:43

Sitting suspended.