Joint strategic needs assessment

Health and Work (2024)

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Topic title	Health and Work (2024)
Topic owner	Health and Work JSNA Owning Group
Topic author(s)	Alexandra McNeice, Rosie Cunningham, Dawn Jenkin, Carol Ford, David Gilding, Olivia Azouaghe, Ian Bates, Kirsten Lochhead
Topic quality reviewed	May 2024
Topic endorsed by	Health & Work JSNA Owning Group, June 2024
Topic approved by	Health and Wellbeing Board, December 2024
Linked JSNA topics	Covid-19 Impact Assessment (2021) Adult Mental Health (2024)

Executive summary

Introduction

Health and work are interconnected, influencing each other significantly. This profile pack examines how these dynamics manifest in Nottinghamshire, impacting the workforce and public health.

Impact of Work on Health:

Higher employment rates correlate with better health outcomes.
Unemployed individuals face higher health risks and poorer health status.
Good quality, appropriate employment improves physical and mental health and reduces social exclusion.

Impact of Health on Work:

Health conditions significantly affect employment status.
Nationally, 24% of the working-age population report disabilities, with only 54.2% of disabled people employed.
Locally, Nottinghamshire's disability employment rate is lower than the national average, with 46% of disabled people employed.

Evidence of What Works

Effective interventions in employment and health support are ongoing and have strong presence within Nottinghamshire. Key local initiatives and schemes include the Individual placement and support scheme and Brooke Farm. Highlighting successful local and national initiatives can guide ongoing and future strategies.

Key Findings about Health and Work in Nottinghamshire

The employment rate in Nottinghamshire is 75.8%, with disparities in health outcomes affecting employability. Long-term health conditions and disabilities are significant barriers, particularly post-COVID-19. The following spotlight areas have provided a snapshot insight into key themes:

COVID-19: Impact on different workforce groups and the rise of long COVID.
Musculoskeletal Conditions: Prevalence, impact on work, and associated health factors.
Mental Health: Fastest rising cause of work-limiting conditions, relationship with employment, and the importance of 'good work'.
Sex Disparities: Analysis of economic inactivity and long-term sickness by sex.
Disability: Review of the current picture and what is in place to support.

Highlights from the report are:

There are 27,990 businesses in Nottinghamshire ranging in size, the significant majority (24,960) are micro businesses (0-9 employees).
COVID-19 is more likely to lead to long COVID amongst people of working age [1]. Between January -March 2020 and January to March 2022, long-term sickness was the most common reason for becoming economically inactive, closely followed by return to education [2]. It is unclear to what extent the development of long COVID was responsible for these changes.
The Institute for Fiscal Studies (IFS) estimated that one in ten people who developed long COVID have had to stop working [3].
The pandemic has highlighted the importance of digital skills in the modern workforce. “Future”, a group of industry leaders in digital skills now estimates that there are 11.8 million people of working age without essential digital skills for life and work, this represents 36% of the UK workforce [4]. Digital skills are now required for around two-thirds of jobs in the UK [5].
In Nottinghamshire, the prevalence of an MSK condition was reported as 20.9% in 2023, higher than prevalence for England (18.4%) [6].
Around 70% of adults with a long-term MSK condition have a Body Mass Index (BMI) which would categorise them as overweight or obese [7].
Poor mental health is the fastest rising cause of work-limiting conditions across the workforce and mental health remains one of the leading causes of absence in the UK.
There has been a significant rise in the number of young people reporting work-limiting mental health conditions nationally, from 1% in 2013 to 4% 2023[8].
The number of young people who are economically inactive rose by 245,000 from June 2023 to June 2024 to 2.99 million, making it close to the highest rate since records began in 1992 (this figure includes numbers in fulltime education)[9].
A 2023 report by the All–Party Parliamentary Group for Youth Employment found that approximately 67% of young people who are economically inactive also have a common mental health disorder [10], a particular concern given that youth unemployment is known to be attributable to a significant wage penalty later in life.
After the year to December 2022, there were noticeable trend changes in levels of male and female economic inactivity in Nottinghamshire. With male economic inactivity reducing and female economic inactivity increasing, a pattern not seen in the England data during the same period.
There is a significant disparity between employment rates for disabled and non-disabled working age people in Nottinghamshire, in January – December 2023, the Nottinghamshire employment rate for disabled people was 55.5% versus 75.8% for non-disabled.
Locally in Nottinghamshire although the average disability employment gap for both males and females are largely in alignment with national averages, there is notable variation in the size of the disability employment gap between the local districts and boroughs.
Evidence shows that employment support services integrated within health teams and utilising the Individual Placement Support model can be more effective than traditional approaches. [11][12].
There is currently a wide range of both national and local support schemes in Nottinghamshire available. Most of the current offers focus on either improving individual’s employment skills through personalised support, or, working with local businesses to improve their knowledge of recruiting those with disabilities and/or health conditions, making them more accessible.

Recommendations for consideration

	Recommendation	Lead(s)
	Recommendation	Nottinghamshire County Council	Community and Voluntary Sector Organisations	NHS partners	ICB	ICS	Other Partners
1.	Building Blocks of health communications approach: Public Health have been leading a systems approach to embedding the building blocks of health learning and recommendations to increase understanding of and drive action on the wider determinants of health and health inequalities in Nottinghamshire. It is recommended that the team continue to lead this programme of work to drive action on this agenda.	X
2.	Joint working and collaboration to maximise support and impact of existing initiatives in place to those facing physical and mental health related barriers to employment: It is recognised that this field has multiple partners and services involved making it a complex agenda. It is therefore vital that communications and collaboration between stakeholders is maintained as an ongoing priority. Specifically supporting local initiatives such as the Working Well East Midlands Programme and Future’s Positive (IPS Mental Health) to maximise referrals and impact. It is recommended colleagues support by leveraging their existing networks to encourage engagement and referrals such as Primary Care, and Community Pharmacy Networks. Collaborative support should also be given to the development of Health and Care Notts’ Health and Work Strategy, and further input provided to NCC’s Employment and Skills Framework when required.				X
3.	Understanding to what extent digital access is a barrier to work (digital skills/connectivity): Improving equity of digital access to reduce barriers to work (digital skills/connectivity): Use of digital technology could be a more significant and prevalent barrier following the pandemic, with a rise in jobs requiring digital skills, making it more difficult for those who do not have the digital skills and/or access required to secure employment. The draft digital connectivity framework highlights the importance of digital access and inclusion and NCC will work with partners and key stakeholders to develop and implement strategies that ensure equitable access to digital resources across all communities.	X
4.	Exploring the root cause of rising levels of economic inactivity for women due to ill health in Nottinghamshire: Data analysis undertaken as part of this report has highlighted a trend of rising economic inactivity for women due to ill health, that appears to not be in line with national trends. This trend varies across districts and is most notable in Mid Nottinghamshire. It is therefore recommended that work to understand why there is this local trend in certain areas of the county would be useful and form a foundation to begin to try to address this. This will be considered as part of the developing Nottinghamshire Women’s Health JSNA.	X
5.	Understand how COVID-19 has impacted the Nottinghamshire labour market? Whilst the national/local impact of COVID-19 on the workforce is difficult to understand, it is important to be mindful that there has been an impact to the Nottinghamshire labour market. It is recommended that this is considered when undertaking any work, or commissioning projects, interventions or services directly or indirectly relating to work and health, such as supporting people into employment. Additionally, Public Health should continue to identify and review evidence as it emerges to identify impact and ways to support whole population recovery in relation to employment.	X
6.	Anchor Institutions: It is recommended that key partners within the ICS Anchor Champions Network work together to identify priorities for ICS health and care related anchor organisations for joint agreement through ICS governance. It is recommended that for each agreed priority an ICS lead is identified to work to across the ICS and with individual anchor organisations to agree ambitions, action plans and measurable outcomes and lead delivery. All anchor organisations within Nottinghamshire (including those outside of the health and care sector) should also note the recommendations of this profile pack and develop actions they can take to understand and address physical and mental health barriers to employment.			X	X		X
7.	Explore opportunities to improve collection and sharing of data and intelligence across system partners to enable use of a broader system view of intelligence. Given the complexities and number of partners actively working in this space, it can be hard to gain a full system view of data and evidence available. To improve partnership working across this agenda and maximise use of available resources, having a single collection point of data and embedded framework to make data sharing easier and more accessible between system partners would improve outcomes.						X
8.	Consider and address the link between obesity and musculoskeletal (MSK) conditions in future strategic planning across the local system: This report shows that musculoskeletal conditions are a reason for a significant number of people to be out of work. Further exploration highlights that obesity is one of the leading contributors to musculoskeletal conditions and local strategic MSK partners have acknowledged the link between obesity, musculoskeletal conditions, and subsequent impacts on employment. It is recommended that relevant local strategic partners raise the profile of this link, recognising the impact of obesity and MSK conditions as a contributor to poor MSK outcomes and productivity loss locally. MSK strategic leads should use the findings of this report to ensure that obesity and productivity within MSK is consistently considered and addressed in future strategic planning relating to MSK across the system, including delivery of weight management services.			X		X	X
9.	Aligning and utilising opportunities arising from the formation of East Midlands Combined County Authority (EMCCA): Recently EMCCA has been formed and a mayor elected. One of the EMCCA’s defined objectives is: “to deliver more jobs and better skills”. This clearly sets out an ambition for EMCCA to prioritise work and health and serves as a good opportunity for Nottinghamshire County Council and wider system partners to work alongside them to achieve this. EMCCA’s governance and strategy formation is in the early stages, so it is recommended that Nottinghamshire County Council colleagues monitor ongoing developments and take opportunities to collaborate where possible. It is important to ensure the issue of physical and mental health conditions and disabilities as a barrier to employment is highlighted and considered in all related work in this space. NCC should consider EMCCA’s emerging developments within work undertaken relating to work and health priorities, ensuring these are strategically aligned where relevant and appropriate to do so.	X					X