Mental Health: Absence from Work

Paula Sherriff Excerpts

Wednesday 17th October 2018 Westminster Hall

[Paula Sherriff (Dewsbury) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Betts. I thank the hon. Member for North Warwickshire (Craig Tracey) for securing such an important and timely debate. Further, I thank him for his thoughtful speech. My friend the hon. Member for Motherwell and Wishaw (Marion Fellows), who represents two places that she knows I am familiar with from my childhood, spoke incredibly bravely, which is no surprise, about her own battle with mental health in the workplace. Everyone in the Chamber will agree with her that prevention and early intervention must be the key when we are looking at all aspects of mental health.

As other cases that we have heard about have shown, for the one in four people who experience mental health issues there are serious consequences in all areas of their lives. Of course that includes work, which the hon. Member for Strangford (Jim Shannon) said is where we spend most of our time—I am sure hon. Members agree. Right now, it is estimated that up to 5 million workers are experiencing a mental health condition, although we all acknowledge that it is difficult to quantify such numbers when we are talking about millions of people. Many are frightened to come forward, for a variety of reasons.

The human cost of the mental health epidemic we face is incalculable, and every individual deserves the treatment they need. When it comes to mental health in the workplace, research from Mind and others has shown that we can put a number to the cost of failure to fund our mental health services adequately. Poor mental health at work is estimated to cost taxpayers between £24 billion and £27 billion a year in NHS costs, benefit costs and lost tax revenue.

The costs for British businesses are also significant. Research from the insurance sector shows that it costs small and medium-sized enterprises £30,000 to replace a staff member in recruitment costs, training time and lost productivity. When 300,000 people with long-term mental health problems are losing their jobs each year, that is no small problem. The hon. Member for North Warwickshire also alluded to that figure. The total annual cost to the UK economy from our mental health crisis is an eye-watering £99 billion.

There is also a flip side. As the TUC points out, UK workers with mental health problems, despite often suffering illness, contributed £226 billion to UK GDP in 2016. Their work supports our economy and our society must support them. However, in so many cases of poor mental health at work there is a direct, negative link to Government policies. Many of the worst-affected professions are in our public services, which have suffered under austerity. For example, the Office for National Statistics has found that health and social careworkers—including those who treat others for mental health conditions—are at an especially high risk of experiencing poor mental health. It also found that low-income workers who do not earn enough to make ends meet, sometimes receiving a top-up via universal credit, are more than twice as likely to experience poor mental health as other workers. Not being able to put food on the table and being forced to rely on the shambolic universal credit system is enough to affect anybody’s mental health.

What about people in precarious work? Under this Government we have seen an explosion in the number of insecure workers: staff on zero-hours, temporary or agency contracts and workers forced to be self-employed so that employers do not have to take responsibility for their rights. Research from the GMB union—I declare an interest as a proud member of it—showed that more than 60% of precarious workers had suffered stress or anxiety as a result of their work or had been to work while unwell for fear of losing their pay or their job. Over a third would also struggle to cope with an unexpected bill for £500, with all the anxieties and stresses that creates.

Those with barely any employment rights have three options when it comes to their mental health. They can take days off unpaid, lose their insecure work due to their condition or suffer in silence, continuing to work as things get worse and worse. Seventy-eight per cent of the workers the GMB spoke to had previously been in permanent employment. That is not flexible working; it is the new normal. The Prime Minister has declared that austerity is over and promised to tackle insecure work. The Budget will be the test of whether she means it.

Health Ministers have given us warm words but little action on mental health. The Farmer-Stevenson report made a number of recommendations on mental health and employers, which the Government claimed to support wholeheartedly. However, almost a year since its publication, how much action has there been? Several recommendations were addressed to the Government, including changes in the public sector and ensuring the NHS prioritises mental health. However, the NHS is crippled by cuts, and its own staff are suffering. For example, the GMB found that 39% of ambulance workers have suffered from post-traumatic stress disorder, and 12% took sick leave due to stress, anxiety, depression and related conditions in 2016-17, which totalled 80,000 sick days. Given that the chronic lack of funding for frontline mental health services has led to excessive waiting lists for even basic talking therapies, is it likely that those workers got timely and effective treatment as the Farmer-Stevenson report advocates?

The report also recommended an increased role for the Health and Safety Executive. However, instead of providing resources for its work, the Government have continued to cut its funding. In a particularly bitter irony, the HSE now has one of the highest levels of anxiety among its staff of any public service employer. Perhaps the Minister can tell us who will inspect the inspectors. What resources will go to the HSE and what progress has been made in implementing that specific recommendation?

One of the report’s key findings was that the stigma around mental health is still a barrier for employees seeking support. Other Members have alluded to that. The Conservative manifesto committed to

“extend Equalities Act protections against discrimination to mental health conditions that are episodic and fluctuating.”

That would protect people who have long-term mental conditions from discrimination, and people who have short-term episodes of poor mental health, such as those caused by bipolar disorder.

People with such life-changing conditions might be deemed by an employer not to meet the current Equality Act 2010 definition. In one case, a worker with bipolar disorder was stable on medication, but asked to start work a little later because of the effect of the medication. Their boss refused. Mental health charity Rethink advised the worker that they could take legal action, but they felt that would just cause more stress. With the stigma around complex conditions such as bipolar disorder, when will the Equality Act 2010 be extended so that people get the support they so desperately need?

Similarly, employers sometimes see making reasonable adjustments as doing someone a favour rather than meeting their legal obligations. I have heard this in my constituency surgeries—I suspect others have heard the same. Will the Minister tell us how the Department has been monitoring progress from employers on achieving their legal obligations and what it has done to ensure proper HR training and processes?

Given that people spend on average 90,000 hours at work over a lifetime, the Government must ensure that employers prioritise health and wellbeing in their workplaces. The Government must also put their own house in order. Mental health services are still reeling from years of underfunding and we are all paying a price. It is high time this Government put their money where their mouth is.

[The Parliamentary Under-Secretary of State for Housing, Communities and Local Government (Nigel Adams)]

It is a pleasure, as always, to serve under your chairmanship, Mr Betts. I congratulate my hon. Friend the Member for North Warwickshire (Craig Tracey) on securing this important debate and on putting his point across with such characteristic eloquence.

I was particularly struck by the recognition in the debate that employers and Government both have a stake in the nation’s mental health. The Government provide the necessary health support, offer a safety net when people are out of work and promote the right action in the workplace. However, employers are increasingly recognising that they have a crucial role to play in creating healthy workplaces to enable their employees to remain in work and thrive, providing a supportive environment in which their employees can discuss health issues, and helping people return to work promptly when they fall ill.

Mental health is a matter of national importance. It is particularly relevant this month, following World Mental Health Day on 10 October, during which the Prime Minister announced that the Government are providing £1.8 million over the next four years to cover the cost of calls to the Samaritans helpline. This will enable more people to receive support when they reach out for help.

The Prime Minister is personally committed to improving mental health services and addressing one of the most burning injustices in our society. As we have heard, the Government are backing that up by investing record levels in mental health, with annual spending reaching just under £12 billion last year. In addition, the Prime Minister announced a five-year funding settlement, which will see the NHS budget grow by more than £20 billion a year in real terms in the next five years. In return, she has asked the NHS to develop a long-term plan for the next 10 years. She has been clear that mental health needs to be a key element of that.

Financial difficulties can have a serious detrimental impact on mental health, but mental health problems can devastate our finances, too. As we heard from the hon. Member for Dewsbury (Paula Sherriff), one in four people who suffer from mental health problems may have debt problems as well. Supporting people with their financial resilience is vital. We are committed to addressing issues faced by people who fall into problem debt. This year, the Government commissioned the Money Advice Service and spent just over £56 million to provide help to more than 530,000 people.

The NHS provides some services to people who may be experiencing the symptoms of debt problems or financial difficulties. Mental health services, including improving access to psychological therapies, may also signpost patients to debt advice services as part of their care. In our 2017 manifesto, we committed to developing a breathing space scheme for people in problem debt. We will publish a consultation shortly and lay before the House regulations on breathing space by the end of 2019. The Prime Minister has also announced a review of the practice of GPs charging patients to complete debt and mental health evidence forms. We are considering options to end the need for GPs to charge their patients to provide this information to their creditors, and I know that that will be welcomed.

We know that too many people with a mental health condition do not participate fully in key activities of society, including work. The figures are stark: people who are unemployed for more than 12 weeks are between four and 10 times more likely to suffer from depression and anxiety. That is why this Government are committed to supporting people with mental health conditions who are out of work, including through our Jobcentre Plus network. All work coaches across the network receive training on supporting people with health conditions and disabilities. In addition, the roll-out of the health and work conversation across the UK supports work coaches to continue to build engagement with claimants who have disabilities and health issues.

The Government also continue to invest in mental health-related trials and studies. These include doubling the number of employment advisers in IAPT services and launching a £4.2 million challenge fund to build the evidence base of what works to support people with mental health conditions, as well as musculoskeletal conditions.

The good news is that staying in or returning to work after a period of mental ill health can help mental health recovery. Good work supports our good health. It keeps us healthy, mentally and physically. It enables us to be economically independent and gives us more choices and opportunities to fulfil our other ambitions in life. Our Command Paper, “Improving lives: the future of work, health and disability”, which was published jointly by the Department of Health and Social Care and the Department for Work and Pensions last November, sets out a comprehensive strategy for achieving the Government’s challenging target of ensuring that 1 million more disabled people are in work by 2027.

Given the scale of this ambition, a key part of our programme is to achieve transformational change by focusing action on three key areas: welfare, workplace and health. We have made good progress. Employment rates are at historic highs and the number of disabled people in work reached 3.5 million in 2017, having increased by nearly 600,000 since 2013. The Government recognise the crucial role of employers in creating mentally healthy workplaces. Too many people fall out of work because of their mental health. We are asking employers to do more to prevent that.

That is why, as we heard from my hon. Friend the Member for North Warwickshire, in January 2017 the Prime Minister commissioned Lord Dennis Stevenson and Paul Farmer, the chief executive of Mind, to conduct an independent review into how employers can better support all employees, including those with mental ill health or wellbeing issues. The review set out a compelling business case for action, with the central recommendation that all employers should adopt a set of six core mental health standards to encourage an open and transparent organisational culture that supports employees’ mental health. Those standards included developing mental health awareness among employees, encouraging open conversations about mental health and routinely monitoring employee mental health and wellbeing.

The review went further by recommending that all public sector employers, and private sector companies with more than 500 employees, deliver mental health enhanced standards, including increasing transparency and accountability through internal and external reporting. We have made progress with implementation and are developing with partners, including employers, a framework for voluntary reporting on mental health and disability. We will publish supporting guidance, including on the important issue of how to encourage employees to disclose health issues.

It will take time before we can call all of our workplaces truly healthy and inclusive, but we have been encouraged by the level of engagement and commitment to this agenda. Momentum is building around the challenge to all employers to adopt the core standards that lay the basic foundations for good workplace mental health, and to larger businesses to adopt the enhanced standards. Following the Prime Minister’s acceptance of the Stevenson-Farmer recommendations as they apply to the NHS and the civil service as major employers, both organisations are making progress.

Working in partnership is vital. The Government recognise the collaborative approach that has created the new mental health at work gateway, which is aimed at employers, senior management and line managers, to help them to support a colleague, challenge the stigma or learn more about mental health in the workplace. Looking at the wider system in which employers make decisions, the Government are committed to reforming the current system of statutory sick pay so that it supports more flexible working, which can help people to return to work after a period of sickness.

I will use this opportunity to take a moment to address some of the points raised by hon. Members in the debate. I will come on to my hon. Friend the Member for North Warwickshire shortly. The hon. Member for Strangford (Jim Shannon), who gave a characteristically eloquent exposition of the issues, talked about employees sharing responsibility. I could not agree more, and nor could the Government. Employers have a key role to play in creating good working conditions and providing supportive line management so that people have the opportunity to speak out about issues and keep in contact with employees. I was encouraged by what he said about ensuring that his own staff took breaks and had some downtime during the working day.

It is also important that we keep in contact with employees who happen to go off sick. The Government have worked with Mind to produce a new website resource, and we are reviewing current obligations and incentives to see what we can do to encourage more good behaviour. The hon. Gentleman talked about suicide prevention; as hon. Members will be aware, on World Mental Health Day the Prime Minister announced not only the appointment of my hon. Friend the Member for Thurrock (Jackie Doyle-Price) as Minister for suicide prevention, but, as I mentioned earlier, almost £2 million to cover the costs of calls to the Samaritans helpline, where there will be help for people who reach out.

The hon. Gentleman also talked about parity of esteem for mental and physical health. It was this Government who legislated for parity of esteem by making mental and physical health an equal responsibility for the NHS in the Health and Social Care Act 2012. We are also backing our commitment with a significant increase in funding.

We are all extremely delighted to see the hon. Member for Motherwell and Wishaw (Marion Fellows) in her place, and it was a genuine pleasure to hear from her. It takes enormous courage to admit that one has suffered mental health problems, so to hear that from the hon. Lady was incredibly moving, and it was a privilege to be in the Chamber for that moment. It is important that employers create the right supportive environment. One thing we are doing is investing to make sure that there are 1 million mental health first aiders in the workplace, which is crucial.

The hon. Lady talked about the impact of low wages, and I agree with her. That is why we introduced the national living wage and are providing in-work financial support through tax credits and now through universal credit. That also makes it easier for people to move in and out of work, removing difficult transitions. She mentioned work capability assessments; it is true that they are designed to determine benefit eligibility, but they should not be viewed in isolation. We provide personalised and tailored support through work coaches in our jobcentres.

Moving on to the remarks of the hon. Member for Dewsbury, I politely and gently remind her that the funding picture in the NHS is not quite so gloomy as she painted it. We are backing our commitments with some significant funding increases in this space. We have record levels of investment in mental health, with annual spending reaching just under £12 billion just last year. The Prime Minister, as I have mentioned, has announced a five-year funding settlement. That is not the picture that the hon. Lady paints.

[Paula Sherriff]

How would the Minister respond to the professionals I speak to every single week, who tell me that mental health services—particularly child and adolescent services—are in crisis; that on some weekends there is not a single psychiatric bed available in the country; and that people are travelling up to 300 miles to get an inpatient psychiatric bed? Perhaps there are positives out there, but it is difficult to say that things are not so gloomy when that is what I hear every week.

[Nigel Adams]

The hon. Lady makes a fair point. The need to travel hundreds of miles out of area, in some cases, for inpatient treatment is something that we desperately need to tackle, and we are tackling it. That is why we are putting in the investment. I gently remind her again of the additional £20 billion a year in real terms for the NHS over the next five years. Nobody is saying that this is a perfect situation, but we are matching our words with real-terms cash and investing a further £1.4 billion for mental health services for children and young people, which I am sure she would support.

We briefly mentioned the Stevenson-Farmer report, and I remind the hon. Lady that we responded in full through the “Improving Lives: the Future of Work, Health and Disability” Command Paper and fully supported all 40 recommendations of the Stevenson-Farmer review. Progress is being made, and has been made, on implementing those recommendations.

My hon. Friend the Member for North Warwickshire raised the role that the insurance industry can play. We recognise the positive aspects of group income protection for helping to retain sick employees, in particular access to expert-led health services and the financial certainty it offers individuals. I am not entirely sure that the product is widely known out there in the business space; I have run businesses for the last 20-odd years and was not aware that such insurance products were available. I very much hope that my former colleagues are tuned in at this precise moment and will do some research on it.

GIP is clearly a product that works well for those employees who choose to buy it, and we encourage the industry to continue to promote its benefits. I am sure the Association of British Insurers is doing a good job of that. However, we believe that small and medium-sized enterprises, in particular, lack sufficient incentives to invest in GIP as it is currently structured, because they often choose not to offer sick pay for periods beyond statutory requirements. That is why we have been looking more broadly at incentives and obligations on employers. We will continue to engage with the industry, and I know that the ABI will play a big role in that as well. We are listening closely to employers’ views about the appropriate products that retain the positive aspects of GIP and that overcome the existing barriers to increasing take-up.

By working with our partners, including employers, the Government can continue to tackle poor mental health, ensuring that disabled people, and people with physical and mental health conditions, go as far as their talents can take them.