Musculoskeletal Conditions and Employment

Jim Shannon Excerpts

Wednesday 10th January 2024 Westminster Hall

[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.