Mind the disability gap: why small business must not be a no-go area for occupational health


Small businesses are often thought of as something of a no-go area for occupational health provision and support – not enough cash, not enough capacity, not enough interest or engagement from owners, too ‘difficult’ to reach all round. But a recent conference suggested this may not in fact be the case. Nic Paton listened in.

It has long been recognised that small businesses are an especially tough nut for occupational health to crack. The capacity constraints the profession is working under and the fact small businesses, too, may often not have the capacity (or budget) to engage with professional workplace health interventions means it can be all too easy for OH, whether it means to or not, to “write off” small businesses when it comes offering access to workplace health interventions, advice and support.

But, as Sonali Parekh, head of policy at the Federation of Small Businesses (FSB) argued at a conference earlier this year, there is often in fact not only demand for greater workplace health support among small and medium-sized enterprises (SMEs) but potentially also an appetite for accessing OH expertise.

Parekh was speaking at a Westminster Business Forum ‘Disability in the Workplace’ conference on removing barriers in the workplace for people with disabilities. The conference took place pre-lockdown but, nevertheless, some of its messages and reflections remain relevant even as we move into what is likely to be a challenging, post-pandemic “new normal” in the context of the workplace.

Parekh highlighted research carried out by the FSB among its membership that showed more than three-quarters (78%) of smaller businesses now employ at least one person aged above 50, and 30% employ at least one person above the age of 65. Some 30% employed at least one individual with a disability or a mental health condition.

More than two-thirds (69%) offered flexible working in some shape or form to all their employees, with 89% offering it to all or some staff. “Very interestingly, this percentage rises for those smaller businesses that employ someone with a disability, with 80% of those smaller businesses offering flexible working to all staff, rising to 95% offering flexible working to all or some staff,” she pointed out.

SMEs struggling with absence

Small and medium-sized firms, like most employers, did however struggle with persistent, intermittent short-term absence, with more than a quarter (27%) reporting this to be an issue, and 30% having experienced four-day-or-more absences, rising to 38% for those employing at least one worker aged over 65.

This was why, Parekh argued, the FSB was among those organisations calling for reform of statutory sick pay (SSP), in particular for an SSP rebate for smaller businesses, something that is likely to be a focus of the government’s workplace health Green Paper, whenever it finally emerges. “Whilst we would welcome this rebate being provided in all sets of circumstances, we also support the rebate being conditional on smaller firms adopting measures to reduce ill health-related job loss,” Parekh said.

When it came to access to or use of occupational health, the FSB’s numbers suggested one in 10 smaller business employers currently offered OH services. “But 41% of smaller business employers say they don’t know enough about occupational health,” added Parekh.

The FSB therefore wanted the government within its Green Paper “to explore the potential for tax breaks or vouchers to incentivise occupational health within smaller firms”, she said.

“This would encourage smaller businesses to pay for occupational health and may in turn ease the burden on an under-pressure NHS. Such an incentive can lead to increased output efficiency, employment, and productivity.

“We also want the government to think about how to provide specific support for smaller businesses to access the occupational health market,” Parekh said.

‘Fragmented’ OH difficult for SMEs to understand

Parekh conceded our current “fragmented” OH market could be difficult for SMEs to navigate and understand. “So we want the government to consider how to improve awareness and knowledge of occupational health and occupational health products by improving advice, perhaps through an advice line or accessibility, perhaps through a portal. And garnering that support at a national and at a local level.

“We also want to see the implementation of better occupational health provision through supply chain pilots. Larger businesses have a really important role to play here for smaller businesses and their supply chains.

“These pilots should focus on scalable interventions that really incentivise larger companies to provide occupational health provision for smaller businesses within their supply chains. Smaller businesses could benefit hugely from access to these resources, and the support and training, that large companies are more likely to have.

“Smaller businesses could also partner with other organisations that are able to provide this bespoke help, advice and support, and this could work well in sectors such as construction where there are a greater degree of smaller businesses subcontracting to larger businesses through a supply chain,” Parekh added.

Finally, Parekh emphasised that it was important not to forget self-employed people within this debate. “We’re keen to see dedicated funding for self-employed occupational health pilots that focus on scalable interventions to support the self-employed to access occupational health and to provide cashflow during a period of ill health,” she said.

Case for mandatory disability employment reporting

Earlier in the day, Professor Kim Hoque, director of the Industrial Relations Research Unit at Warwick University, had urged the government to consider the case for mandatory disability employment reporting within its workplace health reforms.

“We would argue that Disability Confident should be given greater teeth. If it is not given greater teeth – mandatory reporting and benchmarking and so on – is it actually going to be meaningful in any sense or way?” he highlighted.

While the Disability Confident scheme was positive enough in itself, the level of take-up and engagement among employers remained limited, he argued. “It is not widespread; it is not going to be transformative; it is not going to bring about the level of change we would like to see in the workplace.

“There are pockets of good practice all over the UK at the moment. By making this [reporting] mandatory, what we’re saying is that those pockets of good practice are simply being brought to a much wider number of organisations.

“As well as employment reporting, we also need to see pay gap reporting; an extension of gender pay gap reporting to disabled people. You can then identify where disabled people cluster towards the bottom of an organisation and, if they do, this is something organisations will be able to identify and hopefully do something about it,” argued Professor Hoque.

Slow progress on disability employment gap

Neil Heslop, chief executive of the charity Leonard Cheshire, echoed Professor Hoque in arguing that, while well-meaning, neither Disability Confident nor the Access to Work scheme were currently fulfilling their potential in terms of improving access to the workplace, and support once in work, for people with disabilities.

“Unless and until the scheme [Disability Confident] carries with it the confidence of the people that it exists to serve, the community of people with disability, I guess we have quite a long way to go,” he said.

“While one has to welcome that 16,000 organisations see fit to take this agenda seriously, it is very difficult if you are a person with a disability to take that seriously when you cannot actually put your finger on ‘well OK, how many disabled people do you employ?’. That is a fundamental requirement for what I genuinely believe we all want – government, third sector organisations, large-scale employers.”

It was “tremendous” that Access to Work in 2019 had supported 36,240 people, Heslop conceded. “But what we also need is the honesty to recognise that in 2009/19 that was 31,080 people. So, the fact an extra 5,160 benefiting from Access to Work over 10 years, of course that’s good. But against the magnitude of the task before us, it is really a huge opportunity.”

The disability employment gap had also “barely moved” in 20-25 years, he highlighted. “So, if we are genuinely serious about unlocking the untapped talent that is out there, and genuinely serious about contributing the UK economy’s productivity challenges – which are deep and serious – I think it is incumbent on all of us to be clear about where we are and the magnitude of the task before of us,” said Heslop.


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