Musculoskeletal Conditions and Employment

Margaret Greenwood 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.

--- Later in debate ---

[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.

--- Later in debate ---

[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.