Sick need support to stay in work, says former John Lewis chair

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A fear of talking about ill health in Britain is driving people out of the workforce at a growing cost to society and business, according to the former John Lewis boss.

Charlie Mayfield, who has been tasked by the UK government with findings ways to keep sick and disabled people in work, said people often ended up jobless and on benefits because of a lack of health support in the workplace.

“There is a lot of fear. People who are fearful of disclosing their condition . . . and also fear on the side of the line manager, of saying the wrong thing,” he said.

Mayfield said HR managers were often told not to call someone who was off sick, in case they were accused of bullying and ended up at a tribunal. “They would do anything to avoid that.” 

The result, he said, was that people who might be better off staying in work, including many with mild anxiety or depression, are left to fester at home while managers “run down the clock” until they can terminate the contract.

Mayfield’s challenge, when he sets out policy recommendations for ministers in the autumn, will be to work out what should fill the current vacuum in the UK’s system — and how to pay for it.

The stakes are high, he told the Financial Times in an interview, when a “rising wave” of sickness and disability is “landing on a system which has never been particularly well suited or designed” to deal with it.

Among employers, “there is an understanding that everybody loses if we don’t fix this problem”, said Mayfield, who was chair of the John Lewis Partnership from 2007 to 2020. The retailer is owned by its employees.

Mayfield, who was appointed to lead the review last November, was speaking as pressure builds on ministers to abandon planned cuts to sickness and disability benefits that would save the government £4.8bn a year, but push hundreds of thousands of people into poverty. 

Ministers have argued that welfare reform is a “moral mission” to help people work rather than spending a life on benefits, but think tanks estimate that at best between 50,000 and 100,000 will find jobs as a result of the reforms.

“Prevention is better than cure,” said Mayfield, who argues it is in businesses’ interests to have more support in place to prevent people falling out of work when they first develop a health condition.

At present, Mayfield said, the UK system “starts with employment law . . . and then it’s GPs at the other end. There’s very little in between,” he said.

The pressures on family doctors mean that most do not have the time or expertise to assess people’s capacity to work when they ask for a so-called “fit note” to justify extended time off. 

These notes are supposed to help people stay in work, setting out any adjustments needed for them to do so. But in practice, doctors sign off more than 9 in 10 patients as unfit to work.

Many then end up on extended sick leave until their eligibility for statutory sick pay runs out. Unless employers offer extra support with occupational health or sick pay — which smaller businesses often feel unable to do — people often slip into claiming health-related benefits. 

Mayfield points to the Netherlands as an example of the opposite extreme. There, employers must offer occupational health support and continue paying wages for up to two years when an employee falls sick, provided employees engage with help to return to work.

“There is a stronger safety net with higher expectations,” Mayfield said, describing a structured process where company doctors weight the patients’ interests with those of the business and of society as a whole.

He did not advocate going as far as the Netherlands, where one consequence of the duties on employers is a high rate of gig work. 

But even as ministers sought to cut spending on health-related benefits, he argued, they would need to find ways to channel more money into workplace health, whether from taxpayers, employers or individuals.

“Some other countries are spending more than us as a share of GDP, but they spend more in areas where they get a return, on prevention and rehabilitation,” he said. “When you think about that economically . . . it’s a very different picture.”