Improving job quality including through providing robust health and well-being support are crucial to enhance employee retention, career mobility, and productivity. Workers benefit from jobs that offer fair pay, job security, and flexible working conditions, which not only improve job satisfaction but also facilitate career progression and contribute to healthier, longer work lives. These aspects are particularly important for mid-to-late career workers, who place a high value on flexibility to manage health issues and caregiving responsibilities. Effective enforcement of labour standards and the introduction of fair and balanced flexible work policies can further improve job quality, making employment more sustainable across various life stages.

The role of management practices is particularly significant in fostering good quality jobs for all workers. High-quality management practices, such as continuous improvement, tracking key performance indicators, and fostering skill development, not only boost firm productivity but also support better wages and working conditions, thereby benefiting workers of all ages. However, SMEs often lack formal management frameworks, and could greatly benefit from targeted support to adopt practices that improve workforce engagement. Firms with overall poor management practices are unlikely to be at the forefront of implementing age‑inclusive practices that enable firms to harness the experience of older workers while fostering a culture that supports intergenerational learning and collaboration. Nor are poorly managed firms likely to be proactive in implementing health and well-being programmes, offering flexible work arrangements, and making necessary accommodations. If employers act, they can significantly reduce absenteeism, improve workforce productivity, and support the long-term career advancement of all workers.

Poor health remains a significant barrier to workforce participation, as health issues, particularly chronic and age‑related conditions, are leading reasons for individuals exiting the workforce before retirement age. Prolonged absences due to illness or disability exacerbate health conditions, reducing the likelihood of re‑entry into work. Early intervention, personalised support, and proactive health management are essential to prevent long-term disengagement from the labour market and to help workers maintain sustainable employment.

Despite the importance of health support, the current provision of Statutory Sick Pay (SSP) and access to occupational health (OH) services in the United Kingdom remains inadequate. SSP, which is low compared to other OECD countries, offers insufficient income protection and has eligibility limitations that disproportionately affect low-paid workers. Comprehensive occupational health services are critical for supporting workers throughout their careers, particularly as the workforce ages, yet access is limited – especially among SMEs. To ensure sustainable work for all, there is a pressing need to expand OH coverage and improve proactive health management in the workplace.

Individuals with disabilities or chronic health conditions often face barriers to staying in or returning to work, including discrimination, lack of support, and insufficient workplace accommodations. These challenges contribute to long-term unemployment and prevent many from reaching their full potential. While several government programmes, such as the Work and Health Programme (WHP) and Intensive Personalised Employment Support (IPES), aim to assist these workers, they are often limited by their scope, geographic reach, and fragmented nature, reducing their effectiveness in supporting those with long-term health conditions.

Timely, personalised, and integrated interventions are necessary to support disabled workers and those with chronic health conditions. Initiatives like Individual Placement and Support (IPS) have shown positive outcomes, as they provide tailored assistance that addresses health-related employment barriers. These programmes emphasise early intervention and a holistic approach to health and employment support, highlighting the need for an integrated framework that allows for seamless transitions between health recovery and work re‑entry.

Current policies, however, are overly focused on benefits and their associated costs, often neglecting the importance of early interventions to retain workers in their existing roles. Many disabled individuals who are not working do not receive benefits, and efforts to reduce benefit dependency do not always translate into sustainable employment outcomes. Typically, a person’s path from employment to sickness absence and then to worklessness and benefit receipt involves 28 weeks of Statutory Sick Pay, followed by at least three months waiting for assessment for Employment and Support Allowance, before finally being directed to back-to-work services. This is problematic because it is well-known that the longer someone is away from work, the less likely they are to return to employment.

To address these challenges, a shift toward a more positive and proactive approach is required, one that emphasises early action in supporting workers to stay in their roles, facilitating accommodations for those with health conditions or disabilities, and promoting career progression. Supporting people while they are still at work, rather than intervening only after they leave, is not only beneficial for the individual but also for employers and society as a whole. This approach reduces the societal and governmental costs of disability benefits, supports inclusive workplaces, and fosters an environment where individuals can continue to contribute productively throughout their working lives.

Job quality plays a crucial role in the well-being of workers and is closely linked to various aspects of firm performance, such as employee turnover, productivity, and profitability, and the likelihood of people staying in work longer. Research suggests that low pay, job insecurity, and limited flexibility are key factors driving employees to seek new job opportunities. While pay, and pay inequality are key factors in determining job quality, the quality of the working environment is also key. As people work longer, their initial job fit may worsen due to changing preferences, health issues, or caregiving responsibilities. Evidence shows that late‑career workers increasingly value flexibility and less demanding work environments, and some are even willing to accept lower pay for such accommodations (Ameriks et al., 2020[1]).

There is no single definition or element of a “good job”, and this is something that will vary over time and over the lifecycle, and across workers and occupations. Most definitions include dimensions such as pay and other fringe benefits, job security, job design, health and well-being at work, work-life balance and voice and representation. Recent work by the ONS, as recommended by the Taylor review has sought be better measure job quality along several dimensions (satisfactory hours, overtime, desired contract, zero-hour contracts, low pay, career progression, employee involvement, union representation, workplace injury and illness).

The UK labour market is known for its flexibility, allowing individuals and businesses to set terms and conditions that suit them, provided they adhere to minimum legal standards. The government describes flexible working as including job sharing, remote work, part-time roles, compressed hours, flexitime, annualised hours, staggered shifts, and phased retirement. While this flexibility is beneficial, it also poses risks. Some employers exploit this flexibility to shift risk onto workers and exert control over them. However, effectively implementing flexible working depends on several factors. For example, shift work, often used in frontline jobs, can disrupt work-life balance, and hours are often changed with little notice. To improve conditions for vulnerable workers, it’s important to preserve flexibility to maintain high participation rates, ensure employers do not use flexible arrangements merely to cut costs while considering the impact on employee health and productivity, and find ways to incentivise employers to adopt fairer and more balanced models of flexibility.

Creating minimum standards beyond the minimum wage would contribute to improving job quality, reducing inequality, and potentially improving job mobility. Some statutory rights accrue with tenure, such as sick pay, as do some non-statutory benefits such as access to longer holidays, maternity pay (above statutory), or more flexible working arrangements. Workers in low-paid jobs might refrain from changing job even if an alternative job offers slightly better pay, as it means starting all over again in terms of earning these rights and building a relationship with the new employer. As discussed further below, the United Kingdom has one of the lowest levels of Statutory Sick Pay among OECD countries.

The United Kingdom has recently made improvements to minimum standards around workplace flexibility. The Employment Relations (Flexible Working) Act, effective from 6 April 2024, allows employees in England, Scotland, and Wales to request flexible working arrangements from the first day of employment (In Northern Ireland, employees have the right to request flexible working only after completing 26 weeks (six months) of continuous employment). The legislation also introduces a new entitlement for unpaid carers to take a week of unpaid leave to care for a dependent with long-term care needs. This provision aims to help carers balance their caregiving duties with their work responsibilities, allowing them to stay in employment.

Similarly, the replacement rate for statutory maternity pay (SMP) is lower than in other wealthy countries. For a woman on average private‑sector pay, statutory maternity pay covers only 27% of her earnings over a one‑year maternity leave (Figure 3.1). This is significantly below the OECD median replacement rate of 40%, and there are 14 OECD countries where the rate exceeds 50%. The replacement rate of statutory maternity pay can greatly influence when and if a mother returns to work. Lower replacement rates may force mothers to return to work sooner due to financial pressure, while insufficient maternity leave compensation can lead to earlier-than-desired returns, potentially reducing job satisfaction and productivity due to work-life balance challenges. SMP pay also varies significantly across the income distribution, in a survey conducted by Cominetti et al. (2023[2]), two‑thirds of female workers under the age of 45 earning below GBP 20 000 expect to either receive SMP, or not be paid at all, compared to 28% of female workers with an income over GBP 40 000.

Paid maternity leave can support female employment by promoting maternal employment continuity and easing labour market re‑entry after childbirth (Canaan et al., 2022[3]; Farré and González, 2019[4]), though extended leave does not appear to help women attain higher positions in companies or close gender gaps in pay and hours (Corekcioglu, Francesconi and Kunze, 2020[5]). Some studies indicate that excessively long maternity leave can negatively affect women’s physical health and hinder their career advancement (Canaan et al., 2022[3]; Healy and Heissel, 2020[6]).

Evidence suggests that better sharing of parental leave can be beneficial not only for family well-being but also female employment. Although fathers’ uptake of leave remains low on average across the OECD, it brings significant benefits. Paternity leave supports maternal employment without diminishing fathers’ labour market attachment (Farré and González, 2019[4]; Rønsen and Kitterød, 2014[7]). Fathers who take leave also tend to engage more in childcare and housework, strengthening bonds with their children and enhancing family dynamics. Policies encouraging paternal leave uptake can help shift entrenched gender norms, improve family well-being, and boost both parents’ life satisfaction, especially for mothers (Korsgren and van Lent, 2022[8]). Policies promoting paternity and parental leave for fathers could help break longstanding gender norms around paid and unpaid work, fostering stronger father-child relationships and facilitating mothers return to work.

Recent policy reforms in some OECD countries have increased opportunities for fathers to take parental leave through designated months or bonus systems. In 1995, only seven OECD countries offered parental leave specifically reserved for fathers, but by 2020, this number had grown to 34 (OECD, 2022[9]). In the United Kingdom the total leave earmarked for fathers is two weeks compared to an OECD average of 12.7 weeks (OECD, 2024[10]).

Many countries now also have systems in place to allow the sharing of parental leave between partners or leave that is reserved specifically for fathers. In 2023, on average across OECD countries 26.2 weeks of leave are shareable (OECD, 2024[10]). The United Kingdom has a shared parental leave scheme (SPL) designed to promote shared childcare responsibilities and support for work-life balance for families (Department for Business & Trade, 2023[11]). This allows eligible parents to share up to 50 weeks of leave (SPL) and 37 weeks of Statutory Shared Parental Pay following the birth or adoption of a child. This scheme enables parents to take leave simultaneously or at different times, tailoring arrangements to their family’s needs. Shared Parental Leave is created when the birth parent curtails her maternity leave or Maternity Allowance, allowing her partner to take SPL and Shared Parental Pay.

Evaluation of Shared Parental Leave in Great Britain shows that 1% of eligible working mothers and 5% of eligible working fathers took SPL following the birth or adoption of a child (Department for Business & Trade, 2023[11]). Take‑up varies by age, income, education, and job type, with higher rates among fathers in central government, predominantly female workplaces, and unionised organisations. Since its introduction, the number receiving Shared Parental Pay has risen from 6 200 in 2015‑16 to 13 000 in 2021‑22, aligning with initial forecasts. Most SPL participants are fathers. On average, parents taking SPL used just over 16 weeks, with mothers taking more leave (19 weeks) than fathers (14 weeks). There are currently no known causal estimates of the effect of SPL on female labour market participation.

Several OECD countries have introduced a non-transferable parental leave right for fathers to encourage their participation (OECD, 2023[12]). For instance, Estonia offers fathers 30 days of paid leave, while Greece provides each parent with four months of leave, two of which are paid. Canada offers additional benefits when parental leave is shared more equally. Norway and Iceland have extended individual leave entitlements, promoting equal leave‑sharing between mothers and fathers.

The high cost of childcare and long-term care in many countries often prevents women from returning to the workforce or forces them to leave their jobs in search of more flexible work options. Offering greater support for childcare, such as through public programmes or subsidies, is vital for boosting female workforce participation (Albanesi, Olivetti and Petrongolo, 2022[13]).

Enforcement of current labour market standards, for example minimum wages, health and safety legislation, holiday and sick pay entitlements is often lacking. There is a wide range of evidence on the scale of labour market non-compliance which most often affects the low paid, the youngest and oldest workers, ethnic minorities and those on insecure contracts (Cominetti et al., 2023[2]; Low Pay Commission, 2023[14]). Evidence suggests that around 32% of workers paid at or around the minimum wage are underpaid the minimum wage; around 900 000 workers report no holiday pay despite this being a day one entitlement; 600 000 people who have not been automatically enrolled in a pension scheme by their employer; Around 1.8 million workers say they do not get a payslip – important for being able to check if you have been paid correctly (Cominetti et al., 2023[2]). There are also very real threats to health and safety, estimates from HSE show that from 2019/20 to 2022/23, an average of 606 000 workers were injured in workplace accidents each year and a further 677 000 workers each year suffered a new case of ill health which they believe to be caused or made worse by their work (Health and Safety Executive, 2022[15]). The total cost of self-reported workplace injuries and ill health in 2021/22 amounted to GBP 20.7 billion, with most of these costs (GBP 12.2 billion) falling on employees. Ill health accounted for the largest share of these costs, about 63% (GBP 13.1 billion), while injuries made up around 37% (GBP 7.7 billion). The higher costs associated with ill health are primarily due to the greater amount of time taken off work on average in these cases.

The previous government consulted on creating a single enforcement body (SEB) for employment rights in 2021. There is a need to significantly increase the number of inspectors and proactively conduct more workplace inspections, particularly in high-risk sectors (CIPD, 2021[16]). To raise awareness, the government, in collaboration with organisations like Acas, Citizens Advice, trade unions, and professional bodies, should launch a high-profile “know your rights” campaign to provide essential information about core employment rights.

Self-employed workers have only minimal employment rights compared to employees and has the share of self-employed workers has risen the share of workers outside of most employment regulations has risen. This is particularly pertinent for mid-to-late career workers who are more likely to be self-employed. Boundaries are often blurred in the United Kingdom between whether someone is an employee, self-employed or a “worker” – a separate legal category that does not exist in most OECD countries. In some cases, it’s evident that businesses categorise their workforce as self-employed to sidestep responsibilities like paying the minimum wage, providing holiday pay, and covering sick pay (Low Incomes Tax Reform Group, 2022[17]).

AI is reshaping work environments, influencing job content, task design, and interactions between workers and machines. For older workers, these changes bring both opportunities and challenges. AI-driven tools can alleviate some physically demanding tasks, enhancing job safety and reducing risk factors like musculoskeletal injuries, particularly in manufacturing and service sectors. Many people are still exposed to risk factors for physical health at work, even though many tasks have been automated that formerly required hard physical labour (Saint-Martin, Inanc and Prinz, 2018[18]). However, collaborative robots, or cobots, have the capacity to assist with physically strenuous tasks, reducing the strain on workers (Lane and Saint-Martin, 2021[19]). Although older workers might face new physical and psychosocial risks if these tools require them to keep pace with automated processes or if they experience heightened monitoring due to AI’s data capabilities. In a survey conducted by Generation, over 60% of respondents said that they strongly or somewhat agree that AI helps automate repetitive tasks (Figure 3.2).

Job quality may also be influenced by AI’s role in supporting or undermining workplace relationships and individual autonomy. AI applications in human resources management, for instance, promise to streamline career development and training opportunities (Broecke, 2023[20]; Lane and Saint-Martin, 2021[19]). Some AI tools can improve the job-matching process, help in career guidance, and facilitate skills alignment, which could benefit older workers looking to adapt to changing roles. Nevertheless, the reliance on data‑intensive AI systems may contribute to stress, particularly if transparency and explainability are lacking. Concerns over data privacy and intensive monitoring could negatively impact mental well-being and trust, especially for workers unaccustomed to such pervasive surveillance.

However, the success of these AI integrations depends significantly on the management practices and organisational culture surrounding AI deployment. Poorly implemented AI applications focused solely on productivity gains can deteriorate job quality, especially for older employees who may feel alienated by a lack of agency in their tasks. Ethical considerations, such as data transparency and respect for worker autonomy, are critical to ensuring that AI enhances rather than detracts from job quality for all workers, particularly those less comfortable with constant technological change.

The overall impact of AI on older workers’ job quality and work environment will largely hinge on thoughtful integration policies that support worker adaptation while minimising health and stress risks. By prioritising transparent, human-centred AI implementations and encouraging collaborative use, organisations can leverage AI to create a safer, more inclusive work environment that benefits older workers without compromising their job satisfaction and well-being.

Investment in good people management is critical because without it, implementing improvements in any area, whether it be hiring practices, training or workplace health polices, is likely to suffer.1 Productivity performance in the United Kingdom has been poor, particularly since the financial crisis and is low relative to many comparable OECD countries (OECD, 2024[22]). A critical contributor to a firm’s productivity is its management, and productivity plays an important role in the ability of a firm to pay higher wages and provide other workforce benefits.2 Evidence over the last 50 years has shown that SMEs face particular limitations on management capacity and skills (Wapshott and Mallett, 2022[23]).

Businesses in the United Kingdom underinvest in physical capital, ideas and human capital compared to international peers, particularly France, Germany, and the United States (Oliveira-Cunha et al., 2021[24]). This investment gap includes a shortfall in capital assets like machinery and technology, which limits productivity, as UK workers have about 40% less capital compared to French workers (Oliveira-Cunha et al., 2021[24]). Human capital is critical for improving the productivity of workers and firms, yet skills gaps hinder productivity. While tertiary education rates have improved, gaps remain in basic and technical skills essential for a productive workforce. These deficits, coupled with issues in management practices, have resulted in a lower adoption rate of productivity-enhancing technologies. Management practices lag behind those in the United States and Germany, with a significant portion of UK firms falling behind in management effectiveness, which impacts overall firm productivity​.

An ageing workforce raises many challenges and opportunities for firm management and HRM practices. Firms must address potential productivity declines and increased health-related absences, necessitating adaptive strategies to maintain efficiency and morale. Firms need to focus on implementing flexible work arrangements, continuous training programmes to update skills, and initiatives to promote health and well-being. Additionally, succession planning becomes critical, as does fostering an inclusive culture that values the experience of mid-to-late career employees while integrating younger talent. Inclusivity of all ages can foster a more dynamic, innovative, and resilient workforce, enabling businesses to leverage the full potential of their talent pool while addressing the challenges and opportunities presented by an ageing demographic.

Recent research focused on large companies (primarily in manufacturing) has identified the importance of certain operational management practices on firm productivity including: (1) ongoing improvement efforts, involving the adoption of modern manufacturing techniques and process enhancements; (2) the integration of key performance indicators (KPIs) into decision-making processes; (3) setting, tracking, and reviewing ambitious targets; and (4) employment practices that prioritise the management, reward, attraction, and retention of talented employees (Bloom and Van Reenen, 2007[25]). However, the use of formal management practices suggests a certain level of organisational sophistication, which is more common in larger businesses and less likely in smaller businesses. A key issue is whether smaller businesses, where leaders often focus more on daily operations than strategy, will truly benefit from leadership training focused on these practices. In some cases, adopting formal management practices might even be counterproductive (Henley, 2022[26]). In dynamic entrepreneurial settings, leadership qualities like vision and influence might play a more critical role in business success than formal management systems (Henley, 2022[26]).

Results from the quantitative analysis of performance benefits from management and leadership amongst SMEs suggests that: (1) SMEs are less likely to adopt management practices, and (2) the link between adopting these practices and improved performance is weaker (Forth and Bryson, 2018[27]; Broszeit et al., 2016[28]; Feng and Valero, 2020[29]). Additionally, small businesses with stronger networks are more inclined to adopt management practices, highlighting the potential benefits of support programmes that facilitate the sharing of best practices and access to tacit knowledge (Forth and Bryson, 2018[27]).

The United Kingdom trails behind both the United States and Germany in terms of organisational capital that boosts productivity within companies. The World Management Survey has consistently evaluated management practices in firms and public sector organisations across 35 countries over the last 20 years. On average, UK firms score lower in management compared to their counterparts in the United States and Germany, but they are on par with firms in France. Furthermore, the distribution of these scores reveals that the United Kingdom has a larger proportion of poorly managed firms and fewer firms with excellent management practices (Oliveira-Cunha et al., 2021[24]).

However, recent data from the ONS Management and Expectations Survey (MES) indicates that management practices in UK firms are improving (Figure 3.3, Panel A). Specifically, there is evidence that the proportion of poorly managed firms is decreasing, while the number of well-managed firms is increasing. The management practice scores developed in the MES capture four dimensions of management: continuous improvement, or how businesses respond to problems; the use of key performance indicators (KPIs); the use of targets; and employment practices relating to promotion, training and employee underperformance. Analysis of firms that participated in multiple survey rounds suggests that these improvements are mainly due to enhancements within individual firms rather than changes in the survey sample. Generally, smaller firms have been found to have poorer management (Figure 3.3, Panel B). However, distributional analysis by firm size shows that small firms have notably improved their management performance, contributing significantly to the reduction in the number of poorly managed firms.

Management training in the United Kingdom has come to be primarily funded through “management” apprenticeships, as the introduction of the Levy in 2017 gave firms that paid it an incentive to convert existing management training into apprenticeships.3 However, apprenticeships might not be the most effective method for preparing individuals for the demands of line management. The significant disparity between the number of people starting these apprenticeships and those completing them indicates a high dropout rate. In 2021/22, the completion rates for management apprenticeships were 49% for operations or department managers, 50% for team leaders/supervisors, 57.5% for degree‑level chartered manager apprenticeships, and 58% for senior leader (MBA-level) apprenticeships (CIPD, 2023[30]). Evidence also suggests that using apprenticeships to improve the management skills of existing staff represents poor value for money (Richmond and Regan, 2022[31]). One of the most popular apprenticeships is the Team Leader/Supervisor standard which can receive up to GBP 4 500 in funding. However, the Chartered Management Institute (CMI), which developed the standard and conducts the end-point assessment, also offers a Level 3 Diploma in Principles of Management and Leadership. This diploma, costs only GBP 1 300 and is a 12‑month part-time course, with classes one evening per week for three hours, making it a much more affordable option (Richmond and Regan, 2022[31]).

A multitude of programmes have been introduced in recent decades by government and other institutions such as universities to support management and leadership of SMEs, the most recent being the “Help to Grow: Management” programme launched in June 2021. designed to enhance the leadership and management skills of SME leaders. This 12‑week training initiative is delivered through a network of business schools across the United Kingdom, consisting of 50 hours of structured learning along with one‑on-one business mentoring, peer-learning opportunities, and access to an alumni network. The programme is 90% funded by the government and costs participants GBP 750 and is limited to companies with 5‑249 employees. While there is no formal quantitative of the causal effects of the programme, qualitative evaluation finds that satisfaction is high among SME participants and in particular the mentoring element is highly valued (Department for Business, 2023[32]). Participants also reported significant improvements in management and leadership skills, often exceeding their initial expectations (Department for Business, 2023[32]). Early evidence suggests these personal gains are starting to benefit their businesses, with many participants implementing changes within six months of completion. Most completers shared their new knowledge with colleagues, especially when supported by senior staff. While the results are self-reported and may have some bias, they indicate that the programme is positively impacting business performance for some participants.

Management apprenticeships have also become a key way of supporting management training for older employees within larger firms. As discussed in Chapter 2 this is not a cost-effective strategy for upskilling managers, completion rates for apprenticeships remain low, and they will generally not reach the SMEs that struggle most with management and productivity.

Workplaces now have more age diversity than ever before, with as many as four different generations working together. In light of this, it’s essential for organisations to focus on creating an inclusive environment for all age groups, to prevent any potential harms at the individual, interpersonal, or organisational levels. This includes adopting age‑inclusive HR and management practices. An age‑inclusive approach not only recognises the unique strengths and experiences of mid-to-late career employees but also ensures that workers of all ages are supported in their professional development. A lot hinges on the quality of line managers, therefore it is essential to ensure that they are equipped to manage mid-to-late career workers. They are typically the gatekeepers to promotion or skill development through internal mobility and therefore affect how efficiently human resources are used in a company.

Discrimination and negative employer attitudes towards particular age groups present an obstacle to productive working lives. Age discrimination remains widespread across OECD countries (Neumark, Burn and Button, 2019[33]; Neumark, 2024[34]; Carlsson and Eriksson, 2019[35]; Oesch, 2020[36]). A recent survey in the United Kingdom found that among respondents aged 45 and over, 33% had experienced some form of age discrimination, with 51% believing that older workers face discrimination (Figure 3.6). While ageism can be positive or negative for an individual, ageism generally has negative connotations. It’s often not just age that matters; the intersection with gender, ethnicity, or other characteristics can also play a crucial role. Further, in addition to institutional and interpersonal ageism, ageism can also be self-directed.

The rise of AI tools in hiring brings both potential benefits and risks, especially for mid-to-late career workers. While AI can reduce biases inherent in human decision-making, it can also perpetuate age discrimination if trained on biased data. Algorithms on job platforms, for instance, may exclude older workers from seeing certain ads. AI-powered tools used for screening CVs or conducting gamified assessments may also embed past biases, although gamified tools focus more on skills. Video interview AI, which became popular during COVID‑19, may seem efficient but can feel impersonal for older candidates (Broecke, 2023[20]). Policies like the European Union AI Act aim to regulate these tools for fairer, more transparent implementation, ensuring AI doesn’t reinforce systemic discrimination.

Previous OECD research recommends using age‑friendly job ads, age‑blind hiring practices, semi-structured panel interviews, and bias-reducing tools like blind-hiring software to minimise discrimination against older workers (OECD, 2020[38]). Practical tools exist that can help employers reduced age bias in the workplace and in the recruitment process, for example the Centre for Ageing Better’s Good Recruitment for Older Workers toolkit (Centre for Ageing Better, 2023[39]). Continuous monitoring and evaluation are essential to ensure these measures effectively promote inclusivity.

Employers can also take systematic approaches to ensure that their workplace is inclusive of all ages, for example the Acknowledge‑Grow-Embrace (AGE) framework suggested by Cortijo, McGinnis and Şişli-Ciamarra (2019[40]). This approach, rooted in self-determination theory, encourages organisations to shift their age‑related practices from being externally driven (something they do out of obligation) to being internally motivated (something they genuinely want to do). The first step, “Acknowledge,” involves the organisation recognising that ageism might exist, even if anti-discrimination policies are in place, especially if those policies were adopted just to meet regulations. A company can start by auditing its age‑related practices, including the age distribution of employees, how different ages are treated in appraisals, performance issues, training opportunities, and hiring practices. With this understanding, the company can proceed to the “Grow” stage, where it implements systems to address any identified age biases. This could involve regular monitoring, improving hiring practices, ensuring training for all ages, challenging stereotypes, and offering flexible work options or retirement planning for older workers. Finally, in the “Embrace” stage, employees of all ages are valued and encouraged to reach their full potential.

Strategic workforce planning tools can be used to assess the current skill set of a business and proactively identify emerging skill needs. The CIPD provides a guide and tools for undertaking strategic workforce planning (CIPD, 2023[41]).

The use of high-performance work practices (HPWP) is widely recognised as important to improving skill use and raising productivity, and evidence suggests that they can play a role in improving the retention of mid-to-late career workers (Boehm, Schröder and Bal, 2021[42]).4 However there are several areas where there is ongoing debate. For example, over the relative effectiveness of age‑neutral versus age‑related HRM policies. In contrast to just adapting individual HR policies, a holistic approach can be more effective (Walker, 1999[43]). However, such practices can inadvertently reinforce age‑related stereotypes, as traditional HR methods often rely on ageist assumptions (Boehm, Schröder and Bal, 2021[42]). Therefore, organisations should carefully design and communicate age‑specific HR practices to avoid reinforcing these stereotypes.

Research also distinguishes between maintenance (e.g. providing job security) and development HRM practices and finds that the latter have the most desirable effects on work ability and preferred retirement age, while maintenance policies are negatively associated with outcomes such as work engagement, regardless of age (Boehm, Schröder and Bal, 2021[42]). This suggests that employees of all ages appreciate when their organisation recognises their talents and invests in their growth by offering development opportunities, rather than gradually phasing them out.

Beyond workforce management and HR practices, investing in training and development for workers of all ages, supporting employee health and well-being, ensuring options for flexible working, and phased retirement are all essential elements of managing an age diverse workforce.

Poor health is the most common reason people stop working before they want to or before they reach State Pension age (OECD, 2023[44]). Major health conditions such as cancer, cardiovascular diseases (including stroke and diabetes), chronic respiratory diseases, dementia, mental health issues, and musculoskeletal disorders impact millions in the United Kingdom, and these conditions increasingly affect the quality of life and work prospects for people of working age. As individuals age, the likelihood of early and permanent exit from the workforce rises, especially when jobs are physically or mentally demanding. At the same time, prolonged absences from work can result in a worsening of health conditions and more complicated challenges to returning to work, so once people become inactive due to long-term sickness, they tend to remain inactive for extended periods.

On the other hand, although age‑related changes impact work in various ways, age alone does not determine health or job performance (Crawford et al., 2016[45]). While some physical and cognitive abilities may decline with age, many older workers maintain high levels of strength, skill, and motivation, often outperforming younger colleagues in specific tasks due to their experience and job-specific knowledge. Chronic health issues are more common among older workers but are often manageable and do not necessarily hinder work performance. Additionally, long-term exposure to workplace hazards can affect older workers’ health, with effects becoming evident only after many years. Overall, individual differences, lifestyle, and external factors play a significant role in the work capabilities of older adults.

Sickness benefits and employer-provided sick pay support workers during temporary illnesses by preventing the difficult choice between working while sick or losing income and possibly their job. These benefits protect workers’ jobs by maintaining employment relationships, safeguard their income through continued wage payments or public benefits, and enhance health by allowing recovery at home. Additionally, these protections help reduce the spread of contagious diseases, lowering the incidence of presenteeism and thereby protecting workplaces, societies, and economies from the broader impacts of illness.

Sickness absence and health issues in the United Kingdom have been on the rise in recent years, especially since the COVID‑19 pandemic. The ONS reported that the sickness absence rate increased by 0.4 percentage points to 2.6% in 2022 (aged 16 and over), marking the highest rate since 2004 (Office for National Statistics, 2022[46]). In 2022, the rate was 2.3% for individuals aged 35‑49, while for those aged 50 to 64, it was 3.5%. Additionally, a record 185.6 million working days were lost due to sickness or injury. The Chartered Institute of Personnel and Development (CIPD) noted that the average number of sick days per employee increased from 5.8 days in 2009 to 7.8 days in 2023, the highest in a decade, although smaller organisations generally had lower rates. Recent studies have highlighted a notable rise in mental health issues among young people, affecting their ability to secure and maintain employment (McCurdy and Murphy, 2024[47]).

The fact that SSP is in urgent need of reform is widely recognised. Key issues with SSP are the rate of SSP, the waiting period, flexibility, and the lack of incentives to encourage employers to be proactive in managing sickness absence (Box 3.1). The COVID‑19 pandemic exposed just how precarious work and life is for those on low incomes. The new government is removing the requirement of the Lower Earnings Limit to make SSP available to all employees and is removing the waiting period so that it is paid from the first day of sickness absence. Sick pay is only one part of an overall system that can allow recovery from illness and promote return to work. Equally vital are reforms to the “fit note” and strategies to promote return to work which are covered in more detail in the subsequent section.

As the government said in its 2019 consultation, the “fall in earnings when receiving SSP may pose a significant risk to an individual’s financial security and ability to recover from serious illness”. In October 2024 the government launched a consultation inviting feedback on the appropriate percentage rate for SSP. It is essential that this rate achieves a balance between offering employees the financial security they need, maintaining incentives to return to work when suitable, and managing costs for businesses. The waiting period has caused financial hardship for those who take time off, and it can prolong absences and increase the transmission rates of infectious diseases among those who continue to work, therefore it’s removal is to be welcomed. Moving to an hourly rather than weekly calculation for SSP and allowing an employee to receive a combination of some SSP and their usual wages would encourage phased returns to work. This allows quicker returns to work reducing the likelihood of falling back out of work, and can help maintain a connection to the workplace, reducing the risk of becoming detached from work and not returning (OECD, 2022[48]).

Raising the level of SSP will increase the burden on employers, although this can help provide incentives for employers to play an active role in supporting employees back to work. Nevertheless, some smaller employers may struggle to bear an increase in the cost of SSP. The government should consult on options to support the smallest companies. Currently, SMEs can reclaim 103% of their costs for some forms of statutory pay (Statutory Maternity, Statutory Paternity, Statutory Adoption, Statutory Parental Bereavement and Statutory Shared Parental Pay) via the Small Employers’ Relief.5 One possibility is to allow SMEs to claim a percentage of their costs through this scheme. However a rebate is implemented, it should be based on some conditionality, requiring companies to put in place back to work plans and the provision of occupational health services for example. Recognition also needs to be made of the administrative burden on employers a rebate scheme. A Percentage Threshold Scheme used to operate for SSP, but this was abolished in 2014 due to administrative complexity and low take‑up.

The self-employed make up a significant and growing proportion of the labour market, particularly among late‑career workers. Self-employed workers are not eligible for SSP, but they might qualify to apply for Universal Credit or a type of Employment and Support Allowance. The OECD has previously recommended that countries expand the coverage of their social security systems to include self-employed workers (OECD, 2023[49]). Options include the creation of a contributory scheme for self-employed as recommended by the House of Commons Work and Pensions Committee (House of Commons Work and Pensions Committee, 2024[50]), or the creation of portable benefits platforms tied to individuals as recommended by the Taylor Review of Modern Working Practices (Taylor, 2017[51]).

A critical issue in the United Kingdom is a general lack of early intervention, which makes return-to-work policy during sick leave important. Reforming fit notes has been under recent discussion in the United Kingdom.6 The United Kingdom should encourage return-to-work strategies by emphasising the remaining work capacity during the period of illness, promoting workplace accommodations and a gradual reintegration, and actively involving all stakeholders within a framework of shared responsibilities (Box 3.2). The fit note was introduced in 2010 to replace the “sick note” and was intended to ensure patients received advice about the benefits of returning to work, and that employers had the information they needed to make changes to facilitate an earlier return to work. However, evidence shows that over 90% of fit notes are issued as “not fit for work” without any assessment of what people could do (Department for Work and Pensions and Department of Health and Social Care, 2024[55]).

There is a case for reviewing the role of family GPs in issuing fit notes. Evidence shows that family doctors chosen by workers often do not serve as effective gatekeepers for benefit entitlements. Extensive research indicates significant variation in sickness certification decisions among family doctors, which greatly impacts the absence behaviour of sick workers (OECD, 2022[48]). However, this evidence is often from competitive physician markets where GPs may have incentives to attract and retain patients, and this is not typically the case in the United Kingdom. Nevertheless, many OECD countries involve independent social insurance doctors in the assessment of work capacity and sickness certificates.

Certifying doctors should address sickness with a strong early intervention and employment focus. Clear guidelines are needed on the typical duration for sick leave related to specific diseases and associated (re)assessment of remaining work capacity and return-to-work strategies. This would go beyond the current advice for patients and employers available online (Department for Work and Pensions, 2023[57]). Guidelines need continuous updating and doctors require specialist training on how to use them to effectively reduce sickness absence and promote return to work.

Workers also need to be encouraged to aid their return to work, whether in their current job or a different one. Workers often underestimate the career impact of absenteeism; in Norway, a 1% increase in sick leave decreases the employment probability two years later by 0.5% and earnings by 1.2% (OECD, 2022[48]). They must promote their recovery and participate in return-to-work activities if they have remaining work capacity. Some countries such as Belgium engage sick leave employees in training.7

Local authorities can also play a role in promoting return to work. In Denmark, municipalities – which implement all social and labour market policies – have strong economic incentives to promote return to work. The state reimburses municipalities for sickness benefit expenditures based on whether return-to-work activities are implemented. Municipalities are incentivised to reduce sickness benefit costs, as reimbursement is only available for cases lasting less than 52 weeks. They can initiate various active labour market programmes, requiring individuals with certified remaining work capacity to participate. Evaluations indicate that subsidised job training positively impacts the transition into employment, and education programmes improve employment duration for sick-listed workers (OECD, 2023[53]).

Graded work, also known as part-time sick leave, allows employees recovering from illness to resume their duties on a reduced schedule, supplemented by partial sickness benefits or sick pay (Box 3.3). This approach gradually increases working hours as the employee’s health improves, facilitating a full return to work. Implementing graded work offers notable economic and health advantages. Economically, it reduces sickness-related expenses and enhances productivity by enabling employees to contribute during their recovery period. Health-wise, maintaining a work routine during recovery helps preserve skills and experience, fosters employer-employee interaction, and can accelerate recovery for certain conditions.

Research consistently indicates that graded work effectively promotes return-to-work across various countries and health conditions (OECD, 2023[53]). Systems with mutual obligations and strong incentives for all parties involved, such as those in Denmark, the Netherlands, and Norway, yield positive and lasting labour market outcomes. Even in countries without mutual obligations, like Germany and Finland, graded work has been associated with increased long-term work resumption and a reduced risk of transitioning to disability benefits. Initiating graded work early, as soon as a physician identifies the cause of illness and assesses remaining work capacity, leads to better labour market outcomes.

An ageing workforce and longer working years have significant implications for occupational safety and health (OSH) and sustainable work practices. To ensure mid-to-late career workers remain employed, it’s essential to provide good working conditions, including a proper work-life balance, job security, and opportunities for lifelong learning. Sustainable working conditions necessitate a comprehensive understanding of how ageing affects work capabilities and the cumulative impact of risk exposure over a worker’s lifetime.8 Otherwise changes to workers as they age, and changes to health over the life course have the potential to keep mid-to-late career workers out of the labour market or to prevent them from staying in work.

The business, legal and moral case for employers to invest in OH is clear, as are the benefits to government and society (HM Government, 2023[58]).9 Yet there is a clear need to create wider access to quality occupational health provision, particularly among SMEs. Only 45% of workers in Britain currently have access to some form of occupational health service. About 28% of employers in Britain offer some form of occupational health services, with large employers (89%) being nearly three times more likely to provide these services compared to small and medium-sized enterprises (SMEs) (28%). The availability of OH services also vary significantly by sector. There is also evidence that SMEs are sceptical about the business case for the quality and impact of OH (Department for Work and Pensions and Department of Health and Social Care, 2019[59]).

There are broadly two legislative approaches to OH access. In the first type, OH legislation is enshrined in a single act with focus on an integrated, multidisciplinary service, stipulating rights and roles of employers and employees. In the second type OH legislation is spread across social security, health and safety, and labour laws. The United Kingdom, along with Australia, Canada, Ireland and the United States fall into the second type. Most European countries fall into the first category where employers are legally mandated to provide OH services for their employees, however the requirements can differ depending on the size of the employer (for example the Netherlands). Coverage is typically estimated to be between 75‑100% in these countries (Box 3.4).

The need to increase OH take‑up and develop OH workforce capacity were recognised by the previous government which launched two public consultations on occupational health in 2023 and in 2024 launched a new Occupational Health Taskforce chaired by Dame Carol Black.10 The consultation led by DWP and DHSC focused on the role of the government, OH providers and employers, in increasing OH coverage across the United Kingdom, within the broader context of enabling better workplace support to improve productivity and prevent ill-health related job loss (HM Government, 2023[58]). The aim of the Taskforce was to develop clear, evidence‑based expectations and provide the necessary support to encourage greater OH adoption by employers. Businesses, in turn, are expected to take proactive steps to enhance employee health in the workplace. The consultations and Taskforce are valuable commitments to improving occupational health and can be built on by the current government. The focus is on encouraging greater voluntary employer action and there are opportunities to go beyond developing voluntary guidance. A separate consultation run by HMT and HMRC explored how the tax system can be used (HM Treasury and HM Revenue & Customs, 2023[60]).

A financial incentive scheme to tackle financial barriers in purchasing OH among SMEs was piloted from February to September 2024. Also, in January 2023, the government launched a GBP 1 million fund to boost innovation in the OH market, aiming to increase access and capacity. The fund supports developing new OH models, especially for the self-employed and SMEs, with an emphasis on using technology.

Decades of experiments in voluntary approaches in the United Kingdom have failed to yield much of an increase in OH coverage. This suggests it might be time for the United Kingdom to consider legal mandates for employers to provide OH services, something which the most recent government consultation backs away from (HM Government, 2023[58]). The government could build on previous consultations and retain the previous government’s Occupational Health Taskforce but expand its remit beyond developing voluntary guidance. There are a variety of ways such a mandate could operate, and there would have to be supports for the smallest companies. The government should consider subsidies or tax incentives particularly for SMEs. The smallest companies may not need to be subject to the same requirements as larger companies – some countries have a tired system where the requirements vary by firm size.

With respect to disability and ill-health there is a lack of sufficient emphasis on the employment relationship and the health-related reasons why people leave work. Improving employment outcomes for disabled people requires a multifaceted approach, rather than a one‑size‑fits-all solution. While it is crucial not to divert resources or attention away from providing intensive support to those who have been out of the workforce for an extended period, nevertheless, there needs to be equal focus on retaining people in employment. Key government schemes focused on improving employment include Disability Confident, Access to Work as well as WorkWell.

Early intervention is important, as recognised in the previous governments’ green paper on Shaping Future Support. The previous government announced WorkWell, a joint DWP and DHSC pilot in 2023 that is due to being operating in 15 areas of England in autumn 2024, with the intention of an eventual national rollout. The initial focus will be on mental health and musculoskeletal health conditions, which are the most common conditions leading to health-related labour market inactivity. The scheme recognises that a comprehensive, whole‑systems approach to tackling health-related barriers to employment is required at the local level, rather than programmes operating in silos which is commendable given the complex patchwork of schemes that exist. WorkWell will be open to both people in employment and out of work and people can be referred to the programme by a range of actors including GPs, local authorities (social workers), local health services, employer, JCP, or self-referral. An initial assessment will be conducted with work and health coaches of the barriers to employment that the person is facing (physical health, mental health and social situation), after which a Return-to-Work Plan/Thrive in Work Plan will be agreed. Services will be delivered by multidisciplinary teams, which may include occupational health clinicians, occupational therapists, vocational rehabilitation professionals, physiotherapists, and talking therapists. Rehabilitation might involve a variety of interventions, such as life coaching, running clubs, community activities, and NHS social prescribing, among other initiatives.

The Disability Confident scheme was introduced in July 2013. As of July 2024, there were 19 496 employers signed up to the scheme, of whom 632 were Disability Confident Leaders. The scheme is designed to increase employment opportunities for disabled people and reduce the employment gap between disabled and non-disabled individuals. An employer can become Disability Confident Committed (Level 1) by agreeing to certain commitments and offering opportunities to disabled individuals within 12 months, after which they receive a certificate and badge for one year. To advance to a Disability Confident Employer (Level 2), the employer must actively attract, recruit, and support disabled employees, make reasonable adjustments, and commit to actions that develop disabled staff, earning them a badge for two years. The highest level, Disability Confident Leader (Level 3), requires independent validation of their efforts and a demonstration of support and encouragement for other employers to become Disability Confident.

However, analysis by Hoque and Bacon (2023[61]) shows that the share of disabled employees is no higher in Disability Confident Level 1 or Level 3 organisations compared to non-Disability Confident organisations, and it is only slightly higher in Disability Confident Level 2 organisations. Further, they find that disabled employees in Disability Confident organisations do not have better work experiences (in terms of job discretion, fairness, mental health, and job satisfaction) than those in non-Disability Confident organisations.11 This leads Hoque and Bacon to conclude that the scheme is little more than “window dressing that masks ongoing disadvantage”.

As Bacon and Hoque (2024[62]) argue, a reason for the apparent failure of Disability Confident is that it does not reliably indicate that a business provides the type of policies that might attract and retain disabled workers. Few jobs listed by Disability Confident organisations on the UK Government’s Find a Job service mention benefits like enhanced sick pay (0.50%), critical illness cover (0.15%), income protection (0.35%), healthcare plans (0.04%), or employee assistance programmes (9.79%) (Bacon and Hoque, 2024[62]). While these organisations are more likely than non-Disability Confident ones to reference income protection and employee assistance programmes, they are less likely to mention critical illness cover and healthcare plans, and no more likely to offer enhanced sick pay.

As recommended by the Disability Employment Charter (The Disability Employment Charter, 2021[63])12 the government should require that all employers at Disability Confident Levels 2 and 3 meet minimum thresholds for the percentage of disabled individuals in their workforce. Additionally, employers that do not progress from Level 1 to Levels 2 or 3 within three years should have their accreditation removed.

Employers are legally required to make “reasonable adjustments” to enable a disabled person to carry out a particular job, so that they are not disadvantaged.13 Most adjustments are straightforward and cost little or nothing – like raising or lowering furniture or providing a car parking space. Not all disabled individuals require specialised equipment or support, but when they do, the Access to Work (AtW) scheme can provide financial assistance. Access to Work was established nearly 30 years ago by DWP to help individuals with disabilities or health conditions overcome challenges related to employment.14 It provides grants for eligible individuals to receive financial assistance for various types of practical support at work.15 This support can include special equipment, modifications to existing equipment or buildings, additional travel expenses, a support worker, mental health support, and communication assistance during job interviews. The programme has been widely praised for the crucial support it offers to people with disabilities or health conditions, helping them remain in their jobs and perform effectively by funding a safe and accessible work environment (Department for Work and Pensions, 2018[64]).

However, significant issues with the programme have been identified by a range of sectoral organisations (House of Commons Work and Pensions Committee, 2023[65]). The government has made efforts to enhance the scheme, addressing key issues such as the previously cumbersome bureaucratic requirements for evidence and paperwork. This challenge has been largely resolved with the introduction of a digital service in June 2023, streamlining the process significantly (Department for Work and Pensions, 2023[66]). Users can now submit claims online by uploading invoices or receipts, have their claims digitally countersigned, view past claims, check their remaining grant balance, and update their contact details. However, demand for the scheme continues to rise (Department for Work and Pensions, 2023[67]), and despite an increase in staff working on Access to Work, a rising backlog of claims remains.16 Organisations such as the Disability Employment Charter continue to argue that too often disabled people face delays in receiving equipment, are assigned the wrong type of support or cannot transfer their award onto a new job. The average timescale for an Access to Work application decision in April 2024 was 43.9 days (UK Parliament, 2024[68]).

In December 2021, DWP introduced the Health Adjustment Passport to help disabled students transition from university to employment by reducing the need for repeated health assessments when starting new jobs. Pilot programmes at two universities tested the passport, which records details about an individual’s condition and workplace adjustments for employers. These are now accessible to everyone as advocated by the MS Society and the Federation of Small Businesses (House of Commons Work and Pensions Committee, 2023[65]). This should help aid transitions from education to employment but needs to be reviewed and currently Access to Work is on one webpage, while the Health Adjustment Passport application is on a separate webpage.

A remaining issue is that, despite it being around for over 30 years, the scheme is still not widely known among employers (House of Commons Work and Pensions Committee, 2023[65]). A survey by the Centre for Social Justice in 2017 found only 25% of employers were aware of it, and a Unison survey in 2020 revealed only 5% of disabled workers used it to work from home during the pandemic, with many unaware of its benefits. Better promotion of the scheme could help more disabled people benefit from workplace adjustments and support, significantly improving their work experience. This lack of knowledge is particularly common among small and medium-sized businesses, which often lack dedicated HR resources. Publicise the Health Adjustment Passports together with Access to Work on an integrated website and explore making the Health Adjustment Passports digital.

Providing line managers with the necessary training to equip them with the skills to manage employees inclusively and the knowledge to understand their legal responsibilities would help promote early intervention. They should be able to handle discussions about disability and health conditions with sensitivity and know how to arrange and implement necessary adjustments effectively. A practical guide for managers has been produced in collaboration with the CIPD (CIPD, 2024[69]).

The costs of ill-health for employers are significant due to absenteeism, presenteeism and premature labour market exit resulting in a lack of valuable skills. With a growing share of workers over the age of 50 in employment, employers need to be more proactive in supporting employee health. Properly designed and implemented occupational sick pay (OSP) schemes can motivate organisations to manage sickness absences proactively and support effective returns to work. But such schemes need to be situated within a broader culture that supports good health and well-being to prevent ill-health from arising and mitigate the consequences. This can range from comprehensive and integrated workplace health and well-being schemes, to making workplace adjustments which are often small and inexpensive (OECD, 2023[44]; OECD, 2022[70]). Early interventions, like counselling or physiotherapy, can play a key role in preventing or minimising sickness absence.

Flexible hours and the ability to telework are frequently cited by employees as changes that are the most beneficial in allowing improvements in how they work. As of April 2024, all employees have the legal right to request flexible working from day one in their job. Employees can request a change to the number of hours they work, when they start or finish work, the days they work, where they work. Employers have an obligation to deal with requests in a “reasonable manner”, such as assessing the advantages and disadvantages of the application, discussing possible alternatives to the request, offering an appeal process.

Employers can be proactive and consider implementing a comprehensive and integrated workplace health and well-being programme (WHWP). These are employer-led initiatives to improve worker health through activities like exercise, healthy eating, and stress management, as well as addressing conditions like diabetes, cardiovascular diseases, and depression. These programmes increasingly include financial support to alleviate financial stress. The evidence on the effectiveness of WHWP is mixed, with some studies showing reduced medical costs and improved productivity, but results depend on evaluation methods (Baicker, Cutler and Song, 2010[71]; Baxter et al., 2014[72]; Chapman, 2012[73]; Mattke et al., 2013[74]). Healthier individuals are more likely to participate, so robust evaluations are needed. Holistic approaches focusing on job quality, flexible working, and organisational climate are more successful than purely medical interventions (Bevan and Cooper, 2022[75]). A WHWP could also include an occupational sick pay scheme. Employers without an OSP scheme should evaluate the advantages of offering income protection beyond the statutory minimum for employees unable to work due to illness. The scheme should be designed with criteria and payment durations that facilitate employees’ effective return to work and support their rehabilitation.17

Employers should also aim to provide reasonable workplace adaptions to all employees including those experiencing temporary illness. In the United Kingdom, like most OECD countries, employers are obliged to make adjustments for workers with disabilities, but this legal obligation does not extend to workers experiencing sickness, illness or injury (OECD, 2022[70]). Expanding eligibility to workers with health conditions would be beneficial, particularly for mid-to-late career workers. Accommodation costs are often minimal, as it usually involves an increase in flexibility for employees rather than an increase in expenditure (OECD, 2021[76]).

Job redesign is the process of adjusting the tasks, responsibilities, and work environment of a role to better fit the needs and strengths of employees (Box 3.3). By making roles more adaptable, job redesign can help create a healthier and more satisfying work experience for all workers. This is especially valuable for older employees who may face physical limitations or changing priorities; redesigning their roles can help them continue contributing in ways that are meaningful and manageable. Instead of losing the expertise and knowledge these experienced workers bring, job redesign allows organisations to harness their strengths in ways that support their well-being.

Many individuals with disabilities or chronic health conditions often encounter discrimination or insufficient support that hinders their ability to achieve their full potential or even maintain their employment. A significant number of employees with disabilities choose not to disclose their condition to their employers due to concerns about potential negative impacts on their career or job stability. As the workforce continues to age, this issue is expected to become more prominent. Consequently, employers will need to enhance their strategies for managing and supporting the increasing number of employees with disabilities and long-term health conditions.

Most of the 2.8 million people who are out of the workforce due to ill health have already been unemployed for a considerable amount of time. Further, 38% of those inactive because of long-term sickness report that they have five or more health conditions. They will probably face a range of difficulties beyond just health issues when attempting to return to work, and therefore offering meaningful help to navigate these barriers will require time and the delivery of thorough, well-co‑ordinated support.

The employment rate for people with disabilities was 53.6% in Q2 2023, compared to 82.5% for those without disabilities (Department for Work and Pensions, 2023[79]). For disabled people, this was an increase of 10 percentage points since the same quarter in 2013. People with disabilities have lower employment rates than people without disabilities across all age groups (Figure 3.8). Employment rates for both groups increase with age until around 50, after which they decline. The gap between disabled and non-disabled employment widens with age, particularly among those aged 50‑64, who experience a 32.9 percentage point difference compared to a 21.6 percentage point difference for 18‑24 year‑olds. The age distribution of the disabled population leans towards older individuals. For instance, those aged 50‑64 represent over 40% of the working-age population with disabilities, while those aged 18‑24 account for just over 10%. In contrast, within the non-disabled working-age population, the 50‑64 age group comprises around 30%.

More effort needs to be put into helping people with work-limiting health conditions stay in employment; disabled people are more likely to move out of work and less likely to move into work, compared to non-disabled people (Department for Work and Pensions, 2023[79]). Employers have a legal responsibility, under the 1995 Disability Discrimination Act and 2010 Equality Act, not to discriminate against disabled people and to make reasonable adjustments to work. However, employers might not always understand the best ways to support employees with disabilities or those with caregiving responsibilities, and individuals may be unaware of their rights or how to advocate for them.

Many white papers and action plans have been published by successive governments since 2017 on disability and employment but the direction of policy change is not always clear.18 DWPs Health Transformation Programme (2018‑29) aims to improve benefit services for disabled people and those with health conditions by creating a unified Health Assessment Service. This initiative includes procuring new contracts for functional assessments, modernising the service, and supporting the reform proposals outlined in the 2023 white paper on transforming support (Department for Work and Pensions, 2023[80]).

The Work and Health Programme is an employment support initiative aimed at helping people find and retain jobs. Participation is voluntary for individuals with health conditions, disabilities, and other vulnerable groups, while it is mandatory for individuals who have been unemployed for over two years (Box 3.6). As of May 2023, 410 000 people had been referred to the WHP with 280 000 having started on the programme (DWP, 2023[81]). Of the people referred, 316 000, were in the Disability group. Around 34 000 participants were Long-term Unemployed with 57 000 participants in the Early Access Group. Of those participants starting on the programme in May 2021 or earlier, 45% achieved the first earnings threshold within 24 months, and 30% achieved a job outcome within 24 months. An evaluation of the programme by DWP found the WHP had a statistically significant, but small, positive impact on voluntary participants’ entry into work (DWP, 2023[81]). Voluntary WHP participants were statistically significantly more likely than their control group to have done some work over the period (27% compared to 22%) and to be in work at the Wave Two survey (19% compared to 16%).19 There was no statistically significant difference in outcomes between mandatory participants and their control group.

In September 2023, the WHP was expanded to include a new component called WHP Pioneer, as part of the initial phase of Universal Support roll-out. Unlike the original WHP, WHP Pioneer targets economically inactive claimants within the disability and early access groups, helping them find and sustain employment through a “place and train” approach. The goal is to place participants into work as soon as possible after an initial work assessment. Meanwhile, active claimants will continue to receive support through the standard WHP. Economically inactive individuals are those eligible for WHP who are either claiming Jobseeker’s Allowance or are not in the Intensive Work Search regime on Universal Credit at the time of referral.

The Work and Health Programme stands out due to its voluntary nature, enabling open discussions about job readiness, personal challenges, and individual needs. Key workers have extended time to build rapport with participants, offering dedicated, long-term support. This approach contrasts with previous JCP programmes, where time constraints limited individual focus. WHP key workers are seen as more approachable and genuinely supportive, treating participants with respect and understanding, fostering a positive, judgment-free experience (DWP, 2023[81]). A further innovation in the WHP has been devolution and co-design in some areas. In Scotland devolution powers has allowed Scotland to use part of the WHP budget to develop their own programmes, while powers to develop, procure and deliver localised versions of the WHP have been devolved to London and Greater Manchester.

The Intensive Personalised Employment Support (IPES) provides a further level of intensive support to disabled people with complex barriers to work who are considered by DWP work coaches to be more than 12 months away from work. Complex barriers may be a combination of personal and work-related barriers such as disabilities, homelessness, or substance misuse. The goal is to provide participants with employability skills to help them find and keep a job. Participants do not need to be Jobcentre customers or receive specific benefits to join. Approved organisations can refer eligible individuals to Jobcentres, which are responsible for assessing their eligibility and suitability for the programme and getting their consent to participate. Support can be delivered for up to 21 months, including six months of intensive in-work support. Unfortunately, there are no publicly available quantitative or qualitative evaluations of this programme. Data released under a FOI shows that between December 2019 and January/February 2022 there were only 6 044 starts (across England and Wales). Of these, 1 071 lower threshold outcomes were achieved and 787 higher threshold outcomes.20 Considering there are almost 9 million people in inactivity and a further 1 million unemployed, and a significant percentage of these people will have multiple health conditions, these figures suggest that take up of the programme could potentially be much higher.

The support provided by both WHP and IPES is contracted out to different providers in different parts of England and Wales (In Scotland support was previously provided by Fair Start Scotland which has been replaced by No One Left Behind. This is a partnership approach where the Scottish and local government collaborates with public, third, and private sector partners to identify local needs and make informed, evidence‑based decisions), making it complicated for employers to find the support that they need (Phillips, 2022[82]). Providers are now collaborating to tackle this issue, specifically through cross-programme partnerships aimed at engaging and supporting employers. These partnerships were developed in the Work and Health Programme and are now being further expanded in the Restart initiative (Campbell et al., 2023[83]).

DWP has worked jointly with the Department of Health and Social Care (DHSC) in England to invest in employment support in health settings which join up local support for people who are in and out of work:

• NHS England’s Talking Therapies (previously Improving Access to Psychological Therapies, IAPT) programme offers evidence‑based psychological therapies for individuals with anxiety and depression. Employment advisers and therapists collaborate to help clients manage their mental health while staying employed, returning to work if on sick leave, or finding new employment if currently unemployed. Over half of the service users are employed.

• The Individual Placement and Support (IPS) programme is another evidence‑based initiative within the NHS aimed at individuals with severe mental health issues. It provides intensive support to help those with common mental and physical health conditions, including substance dependencies, secure and retain jobs. A collaboration with the Welsh Government and Betsi Cadwaladr University Health Board is testing the integration of IPS for those with common mental health conditions into the Welsh health system.

• For people with autism, learning disabilities, or severe mental health conditions, a Local Supported Employment (LSE) initiative has been piloted with nine local authorities. This programme provides intensive one‑on-one support to help individuals find and maintain employment. There are plans to expand LSE, aiming to assist individuals receiving local authority social care in accessing Jobcentre Plus support.

Individual Placement and Support (IPS) was created as a supported employment programme specifically for individuals with serious mental health conditions and has been part of the NHS strategy for mental health improvement. Grounded in eight core principles, IPS has proven effective in increasing employment rates through numerous trials conducted in Europe and North America (Brinchmann et al., 2020[84]). The Health-led Employment Trials are the largest international trial of IPS, involving over 9 700 participants with mild-to-moderate health conditions across the West Midlands Combined Authority and Sheffield City Region. A 12‑month evaluation by the Institute of Employment Studies and partners found significant positive impacts on achieving sustained employment in two of the three trial groups, as well as improvements in health and well-being (Department for Work and Pensions, 2023[85]). However, the evidence regarding the quality of work and its effect on health was less conclusive. Determining the effectiveness of interventions like IPS, and scaling them up if proven effective, can help people with health conditions or disabilities enter the labour market, offering broader benefits to society.

[13] Albanesi, S., C. Olivetti and B. Petrongolo (2022), “Families, Labor Markets, and Policy”, Working Paper, No. 30685, NBER, Washington, DC, http://www.nber.org/data-appendix/w30685 (accessed on 22 December 2022).

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[62] Bacon, N. and K. Hoque (2024), Retention practices in disability confident organisations.

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