The Keep Britain Working review highlights the crisis of people leaving the labour market because of poor health (Fixing Britain’s worklessness crisis will cost employers £6bn a year, report says, 5 November). Its call for employers to improve occupational health support and early intervention is welcome, but it risks missing the bigger issue: work itself.

For too long, the UK has subsidised poor work. Public authorities have awarded contracts to employers that pay low wages, offer insecure hours and provide little support when people fall ill. The state then picks up the cost in welfare, lost tax and pressure on the NHS. That’s not a sustainable economy, it’s a subsidy for failure.

The deeper problem is institutional disadvantage. The labour market is designed to reward people who can work full-time. It locks out millions who could contribute: disabled people, older workers, parents needing flexibility and those with criminal records. These barriers aren’t accidental – they’re structural. The review puts prevention and early intervention at the heart of reform, but it should also challenge the conditions that make work inaccessible or unsustainable in the first place.

The government has the tools to lead. Every public contract could be tied to the real living wage and meet the Good Work Standard or Good Employment Charter, as London and Greater Manchester have shown. Section 32 of the Procurement Act even allows public bodies to reserve contracts for social enterprises and inclusive employers that create jobs for those facing disadvantage.

These measures could build a network of employers who pay fairly, train locally and design jobs around real lives. That’s how we start to make work work.
Dr Katharine Sutton
Director, Aspire Community Works

Sir Charlie Mayfield is right that the worklessness crisis won’t be solved by money alone, and without culture change, the £6bn a year that employers are set to spend will get swallowed by paperwork instead of staff support.

Away from Whitehall, it is managers who make the difference. They decide if someone with long Covid can work from home, if a bad back means new duties rather than no job, if flexible hours mean a new start or a lost worker. But too many are scared to act and are not trained to. A third of managers fear getting it wrong or causing offence, and just as many say that they haven’t had the line management training to support returning staff.

Employers must give managers the skills and confidence to act early. Without that, many people will end up as names on a Department for Work and Pensions spreadsheet.
Petra Wilton
Director of policy, Chartered Management Institute, London

A lack of eyesight has never limited my ambition, nor that of scores of blind and partially sighted people like me. I know thousands of blind and partially sighted people are looking for work each year, and last year the Royal National Institute of Blind People supported more than 2,000 people to gain or keep employment. To truly open up the world of work, three system changes are essential.

First, resource the Access to Work scheme that helps disabled people get and keep jobs. Second, research shows employers are reluctant to employ blind and partially sighted people, so they need to be equipped to change this. Third, skill up work coaches to offer meaningful support.
Anna Tylor
Chair, Royal National Institute of Blind People

I read with interest the report in which Charlie Mayfield “warned that businesses needed to play a more central role in tackling a rising tide of ill-health that is pushing millions of people out of work”.

If the experience of a close friend of mine is anything to go by, this seems extremely unlikely to ever happen.

My friend had worked for a university for almost 25 years when she developed a chronic but serious health condition during the pandemic. Despite continuing to work successfully from home, she was constructively dismissed from her role simply because she was unable to go into the office. The university in question was utterly unwilling to make any “reasonable adjustments” and was, presumably, confident that she was far too unwell to take them to a tribunal (which she was).

My point is that if employers such as universities, which we may reasonably expect to be on the more progressive side, are behaving like this, what chance is there of getting other employers to play ball?

This was a couple of years ago; my friend is still waiting for treatment on the NHS and so remains unable to work.
Libby Johnes
Llanrhystud, Ceredigion