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Chamber and committees

Meeting date: Thursday, November 22, 2018

Meeting of the Parliament 22 November 2018

Agenda: General Question Time, First Minister’s Question Time, Arthritis (Access to Work Scheme Survey), Scottish Parliamentary Corporate Body Question Time, Energy Efficient Scotland, Scotland’s Economic Future and Economic Data, Decision Time, Correction


Arthritis (Access to Work Scheme Survey)

The next item is a members’ business debate on motion S5M-13271, in the name of Rachael Hamilton, on the Arthritis Research UK survey on access to work. The debate will be concluded without any question being put.

Motion debated,

That the Parliament welcomes the survey by Arthritis Research UK and Arthritis Care Scotland, which has gathered information for, and raised awareness of, the Access to Work Scheme for people who live with arthritis and related musculoskeletal conditions, such as back pain; recognises that the scheme was created in 1994 as a specialist disability service giving practical advice and support to disabled people who are working, self-employed or looking for work; welcomes the news that around 36,470 people were helped by the scheme in 2015-16 across the UK; notes that, in Scotland, it is estimated that almost 1.5 million people live with a musculoskeletal condition, including in the Scottish Borders; understands that these conditions, such as arthritis and back pain, are a leading cause of sickness absence, including among the NHS workforce, which has an impact on the individual, the health service and the wider economy, if those individuals are not supported, and supports the work by Arthritis Research UK and Arthritis Care Scotland to raise awareness of the Access to Work Scheme to help all those in Scotland and the UK who could benefit from it, and looks forward to the results and findings of the survey that are due in 2018.

I thank members for supporting my motion, which highlights the results and findings of the survey that Versus Arthritis conducted from May to June 2018. I will discuss the findings that are in the report “Working It Out: Awareness of Access to Work & Employer Support”. I thank my colleagues for attending the debate, as I know that they are hungry and want to get to lunch.

Many members might be surprised to learn that arthritis and other musculoskeletal conditions affect 1.5 million people across Scotland. That is a significant figure that represents almost a third of people in Scotland. The stiffness, pain and fatigue that come from such conditions affect many aspects of daily life that are taken for granted and can make even the smallest tasks difficult. I know that because I have rheumatoid arthritis. Since my diagnosis in 2007, following the birth of my third child, I have endured the unpredictability of that chronic disease.

As I said, nearly a third of all Scottish citizens have a similar story. My home area in the Borders is a perfect example of the scale of the problem—almost 1,000 people there live with rheumatoid arthritis and, of residents who are aged 45 and over, an estimated 6,300 have osteoarthritis of the hip and 10,400 have osteoarthritis of the knee. Those numbers are staggering for a rural area with a small population but, sadly, they are not all that different from the proportions for Scotland as a whole.

No aspect of life is perhaps more affected by a musculoskeletal condition than the ability to work. Staying in work is vital to supporting all aspects of a person’s health, but it is much more difficult for those with musculoskeletal conditions. I completely understand the challenges that people with the same condition as me face. Before my rheumatoid arthritis was under control, every joint of my body was so swollen that I could not work, drive or even write with a pen.

Research that Versus Arthritis conducted found that more than 80 per cent of those with arthritis had experienced pain, fatigue and stiffness while at work. In many cases, those symptoms resulted in people needing to work fewer hours, retire early or even give up work entirely, which is exactly what I had to do—I had to give up my work, and I will explain a little about that later.

The number who need to stop working has reached such a level that the employment gap between those with arthritis and those who have no health condition is 20 per cent. The economic impact of that, for rheumatoid arthritis alone, is estimated to be more than £655 million.

I know at first hand how important it is to be in work—to have that sense of wellbeing, to be financially independent and to be able to be proud of contributing to the economy. In my situation, I was not able to speak about my condition; by speaking up today, I hope to raise awareness for others.

In our 2017 manifesto, the Conservative Party pledged to have 1 million more disabled people in work by the end of the decade. We planned to achieve that with help from the access to work scheme.

The Scottish Government must join the United Kingdom Government in doing more to assist everyone who lives with a musculoskeletal condition. The access to work scheme provides vital funding and support for people with a range of disabilities to enable them to be in work. It is a fabulous scheme for providing help.

However, there is a problem. Not many people know that the access to work scheme exists. The Versus Arthritis survey found that 60 per cent of respondents had never heard of the scheme. Of the remaining 40 per cent, 10 per cent had heard of the scheme but did not know what it does.

The UK Government is sponsoring many promotional events throughout the UK for access to work, but we can do more to ensure that awareness of the scheme is greatly increased. That is one of the calls in the Versus Arthritis report. It is imperative that more be done to promote the scheme not just to people with arthritis but to employers, to ensure that the proper support that is required to enable people to join or remain in the workforce is given in the first place.

To help in that regard, I am pleased that the UK Government Department for Work and Pensions and its colleagues from access to work are developing closer ties with Jobcentre Plus work coaches. That will ensure that employers and prospective employees with arthritis are fully aware of the scope of the programme.

The expectations on employers should be clearer, too. Under the Equality Act 2010, employers are required to make reasonable adjustments to assist people with disabilities in the workplace. However, what qualifies as a “reasonable adjustment” is not clear. Adding to the definition is a very simple solution that the Government can put in place to create a more streamlined support system for employers and employees and to pave the way to improving many people’s experience at work. I will continue to campaign for the Minister for Women and Equalities, Penny Mordaunt, to clarify the definition.

Furthermore, the Scottish Government must do all that it can to assist employers to hire people with musculoskeletal conditions. The Scottish Government and public agencies need to be leaders in promoting the employment of people with arthritis.

It is astounding that arthritis and back pain are a leading cause of sickness absence, including among the national health service workforce. The forthcoming strategy on increasing disability employment in Scotland’s public sector needs to acknowledge musculoskeletal conditions, including arthritis, and the support that people with such conditions require if they are to join, remain in and contribute to the workforce.

The minister met Versus Arthritis recently, and I hope that he will commit to taking up the points that I have made and the points in the report. Both Scotland’s Governments can and must do better for people with musculoskeletal conditions. Better promotion of access to work, a definition of “reasonable adjustments”, training for Jobcentre Plus staff and further reviews from the Scottish Government are not unreasonable asks, and the changes could make an extraordinary impact on someone’s life.


I thank Rachael Hamilton for securing this important debate and for her moving and personal speech.

I am happy to take part in the debate, which is helping to raise awareness of the access to work scheme. The scheme has the potential to benefit a huge number of the estimated 1.5 million people who live with a musculoskeletal condition.

Arthritis and related conditions are the most common conditions to affect the UK workforce, with around 10 million sufferers losing some 30.8 million working days each year. Having arthritis or a related condition can make everyday tasks that we take for granted near impossible. Even the commute to work—never mind the work itself—can make employment impossible for some people with such conditions.

The access to work scheme can be hugely beneficial for people who suffer from such conditions but are able to work. It can help them to start work, stay in work or move into self-employment by providing support workers, meeting additional travel-to-work costs and arranging communication support at interviews.

It is critical to note that the access to work scheme will usually cover all the costs of any support that is required by the employees of companies with fewer than 50 employees, meaning that there is no detriment to those companies when they hire an employee who is part of the scheme.

The charity Versus Arthritis is doing an amazing job of raising awareness of the condition and putting it front and centre of the public health agenda. Its teams in Scotland, England and Wales ensure that people with arthritis have access to the support that they need. However, a huge hurdle faced by the scheme is that too many individuals are unaware of the support that they could be entitled to.

People with arthritis throughout Scotland should be supported to work for as long as they can and want to be in employment. However, for that to become a reality there has to be a far bigger push of information to the people who need it most. As Rachael Hamilton stated, employers must get on board, too.

National statistics show that although the number of individuals who are diagnosed with arthritis each year has risen, the number of people with arthritis who are assessed for support has fallen every year since 2013-14.

Although it is great that support is available for people living with arthritis and related conditions, much more could be done to promote the scheme so that those who require the support are able to access it. That is why the work that Versus Arthritis is doing is so important. It is also doing valuable work in studying the link between adverse childhood experiences and the development of arthritis.

The charity also challenges the stereotype that arthritis is an old person’s condition. Sadly, an estimated 15,000 children throughout the UK battle with the disease, which creates huge challenges for children who are trying to lead a normal life. Thankfully, a growing network of support, including peer mentoring, is available for young people to help them cope with such a difficult journey.

We have moved into new territory when it comes to arthritis. It is no longer acceptable to dismiss it as an inevitable part of ageing. Arthritis affects people of all ages. Lifestyle changes, early diagnosis and new treatments all herald a brighter future for people living with the condition and give them hope.


I congratulate my colleague Rachael Hamilton on having secured time in the chamber to debate and raise awareness of arthritis and to recognise the work that Versus Arthritis continues to do.

I convene the cross-party group on arthritis and musculoskeletal conditions, so this is a welcome debate for me. In the time for which I have been in that position, my thoughts on the issues have been shaped and developed by a very passionate group of people. It is always a very well-attended CPG and speakers are cross-examined in a fashion that I have not seen in any of the other CPGs that I attend.

I took on the convenership of the CPG with the thought of promoting self-help, the impact of nutrition and physical activity on many conditions, and the steps that can be taken as part of the preventative agenda. However, at the very first CPG that I convened, I was properly educated. Although prevention is very much part of the thrust of the work of the CPG, it is obvious that availability of medical facilities and treatments for people who suffer from the conditions is very patchy across Scotland. Availability, in itself, forms a major part of the preventative agenda, which I will come to later.

On access to work, I have been asked a couple of times to present at small conferences in Ayrshire, which have brought together a load of employers and helped them to understand the help that is available to them to support employees who have such conditions. I brought Jeremy Balfour to join me. It has been alluded to that there is an obvious gap in the knowledge of many employers about the help that is available to them, as well as about the help that is available to people who suffer. Work to raise awareness of that must continue.

As I raised at First Minister’s question time a couple of weeks ago, being unable to work and having chronic pain—the cross-party group on chronic pain works with our CPG—can lead to isolation and can impact on mental health, which is perhaps missed, now and again.

Almost half of absences from work are related to musculoskeletal conditions and arthritis, so it is a very serious issue. As Rachael Hamilton suggested, 1.5 million people in Scotland are affected.

I recently hosted an osteoporosis reception at which the cost of fragility fractures was really brought home to me. There are available, through fracture liaison services, treatment and procedures that have proven positive impacts not only on the NHS budget, but in terms of improved quality of life, which is an important factor.

The statistics show that one in two women and one in five men over the age of 50 will have a fracture. Almost half of people who have hip fractures have had a fracture before that. There are, each year in Scotland, 45,000 fragility fractures—more than three times the number of strokes. That figure is expected to increase by 50 per cent over the next 17 years because we have an ageing population. That is something that we must be cognisant of.

The cost of fragility fractures to the NHS in Scotland is estimated at about £36 million each year, and there is an estimated £33 million more spent on social care. If we had universal fracture liaison services across Scotland, we could prevent in the region of 4,500 fragility fractures, with overall combined economies in health and social care that would allow the NHS to save some £7.4 million a year. All aspects are incredibly important.

The National Osteoporosis Society is working in partnership with the NHS to establish fracture liaison services across Scotland, in line with the published clinical standards, which have yet to be formally adopted. The minister was at the osteoporosis reception and he took cognisance of that, so I hope that the Scottish Government will take the issue forward.


I, too, thank Rachael Hamilton for securing the debate to raise awareness of arthritis and the access to work scheme. I also thank her for speaking about her personal circumstances, which is often not easy to do.

It is important to note the extent of the funding and research that Versus Arthritis provides in Scotland. A recent report stated that it has invested almost £17 million. Its research focuses on, among other things, health interventions that provide people who have the condition with better knowledge of how to manage the pain that it causes.

The research also notes that arthritis is a major component of multimorbidity. As we know, multimorbidity disproportionately affects people from poorer backgrounds; people in the most-deprived areas of Scotland develop multimorbidity 10 to 15 years earlier than those in the least-deprived areas. That worrying statistic proves that arthritis is a major contributor to the health difficulties that some people in poverty face. When arthritis is combined with another chronic illness—as it frequently is—such as thyroid disorder, that further reduces a person’s chances of getting into work and out of poverty.

I am sure that members will join me in welcoming the new research that has been commissioned by Versus Arthritis that has started at the University of Glasgow. It will examine in detail the life impact of living with arthritis along with other chronic conditions. More than 700,000 people in Scotland suffer from a form of arthritis, and the figure is expected to double by 2030.

In the past, arthritis charities have made various recommendations to help to reduce the expected increase in numbers of people who suffer from arthritis, including sharing the information that there are local services across the country to assist people. One such helpful service in my region is the club 365 project in North Lanarkshire, at which young people who are living in poverty are supported, and are encouraged to have a free healthy meal during school holidays and to participate in activities.

That kind of initiative helps young people who live in deprived areas in the first place to access food, but also to make improvements to poor diet and to take part in leisure programmes, free of charge. As well as tackling the increasing poverty that is blighting our communities and which is resulting in hunger, poor diet and lack of physical exercise, such programmes also help to reduce the chances of people going on to suffer from a chronic illness, such as arthritis or other musculoskeletal condition, and to reduce multimorbidity in the future.

I attended in the Parliament last night a performance of the harrowing play “Food Bank As It Is”, which tells true stories from food banks around the country, and which I wish was compulsory viewing for every MSP. It is simply shocking that, in a rich country like Scotland, parents go hungry in order to feed their children, and that men, women and children are contemplating suicide because of poverty that is often caused by insecure, low-paid employment or by people having no job at all. What chance has the one in four children who lives in poverty got of having a healthy diet and lifestyle that would reduce arthritis and multimorbidity, when they are going hungry right now?

At last night’s event, the Menu for Change organisation highlighted the number of people who should not even have been at the food bank: people who had not received the benefits and support to which they were entitled or people who are losing jobs due to disability. The latest Versus Arthritis report on take-up of the access to work programme shows that there is low awareness of it among people who are living with arthritis, so that has to be tackled as a matter of urgency. Not only are we losing talented people from our workforce, but many of them are ending up at food banks, which should only ever be a last resort. Sadly, however, food banks are used increasingly by people who should not be living in such extreme poverty, including people who are entitled to appropriate support—such as the access to work programme—in order to access and remain in employment.

The work that Versus Arthritis does is commendable and is rightly recognised—I am glad that we are doing so in this debate—but its recommendations also need to be listened to and acted on. In addition, particularly given the role that is played by poverty in multimorbidity, we should all be ashamed that we live in a country that last week received such a damning report from the United Nations rapporteur on poverty.


Like others, I thank Rachael Hamilton for introducing the debate. I thank all members for their contributions and I hope that they will not mind my highlighting in particular Rachael Hamilton’s contribution, because she spoke so openly about her experience. As Elaine Smith said, that is not always an easy thing to do. I sincerely thank Rachael Hamilton for having done that. I also thank Versus Arthritis for the activity and research that it engages in; it is a valuable organisation and it is also a valuable partner to our Administration.

The context of the debate is, of course, the access to work programme and how it can be of great assistance to people, enabling them to enter and stay in work. The access to work programme is a great initiative—members will be aware that I do not often get to say that about DWP initiatives—but the sad thing is that too many people still do not know that that support is available. It is often described as the DWP’s best-kept secret, which is something that we need to change, and I will come to that in a moment.

Rona Mackay referred to the fact that people still tend to think of arthritis as a condition that affects older people. However, we know, and as we have seen powerfully demonstrated in the television advertisement campaign that is under way, that that painful and life-changing condition is indiscriminate in terms of those that it can impact on, because it can strike anyone at any age and at any time. Arthritis is a significant challenge for us as a nation, because nearly 28 per cent of disabled people cite musculoskeletal problems as their main disability and many others will have a diagnosis of the condition but will not class it as their main disability. In addition, many of those people will have arthritis. Across the UK, there are 10 million people with arthritis, which is one in six of the population. The condition affects all aspects of life: personal independence, family life, relationships and employment, which is the context for the debate.

Thirty-eight per cent of those surveyed by Versus Arthritis said that they had given up work altogether, while the same proportion of people have had to reduce their hours. That clearly has a huge personal impact on those with arthritis, with many of the negative consequences that Elaine Smith was correct to identify. There is also a significant cost to our economy through the loss of talented and skilled people from the workforce. It is something that we need to discuss and respond to. In that regard, Brian Whittle talked about the cross-party group on musculoskeletal conditions and arthritis. I was going to offer to attend a meeting of the CPG, but Brian Whittle said that he had never seen speakers cross-examined in such a fashion as at the CPG.

You are very welcome to attend.

If Mr Whittle wants to invite me to discuss the matter of this debate, I would be very happy to attend.

Rachael Hamilton mentioned—word obviously got out—that I met people from Versus Arthritis last week and, as Minister for Public Health, Sport and Wellbeing, Joe FitzPatrick also met them to discuss different aspects of their work. I was pleased to meet Maureen McAllister, Angela Donaldson-Bruce and Anne Lowe, with a focus on employment, and we discussed the survey from both a professional and a personal point of view.

Anne Lowe, who is a volunteer, told me about her experience of being supported by Versus Arthritis and the issues that she has experienced both in managing her condition and trying to remain in employment. The fundamental challenges that she has faced were very clear from that conversation, and they will be symptomatic of those faced by many other people.

We discussed and agreed the need for greater promotion of the access to work scheme. That is an action that we can take. We do not have direct responsibility for access to work, and I will mention in passing that I think that we should have, but I will not focus on that. However, we can certainly run a campaign or initiative to help the DWP to promote better the availability of the access to work scheme.

The most recent statistics show that in 2017-18, 33,860 people received access to work payments totalling £110.8 million. That sounds very impressive. It is a UK-wide figure and we do not have details of the level of spend in Scotland, but we know that, historically, spend here is around 6 to 7 per cent of the overall budget. I do not need to labour the point, but that clearly shows that we are not getting a proportionate level of expenditure. It is not only not proportionate to our overall population, but we know that the prevalence of disability generally, and of this condition, is greater in Scotland than across the UK as a whole.

Versus Arthritis set out clearly how it believes the scheme could be improved and, in tandem with Versus Arthritis, we will continue to lobby the UK Government for changes that will improve the scheme. As I say, if we had direct control, we could tie it up with other messages and improve it further, but I will not press that point. Even without direct policy responsibility, we will act.

In “A Fairer Scotland for Disabled People”, which we published in December 2016, we committed to promoting the access to work scheme. Since that time, we have had awareness sessions with staff from across a range of Scottish Government areas of responsibility, as well as with members of the third sector employability network. In fair start Scotland, our employment programme, it is a requirement that our service providers ensure that disabled people participating in the service know about the access to work scheme, and at our disability congress in April, we asked the DWP to undertake two sessions on the scheme, which it agreed to do and which were very well attended. We have been promoting access to work and we will continue to do so.

Rachael Hamilton mentioned prevention. Will the minister also talk about the importance of initiatives such as the schemes that help to tackle poor diet and to increase physical exercise among young people, which can help to prevent such conditions?

Of course; I accept that that is of fundamental importance for the whole range of reasons that we have set out. Ultimately, it is a quality-of-life issue, but being in employment is also a quality-of-life issue. Yes, we need to support people to be as fit and healthy as possible, so that they have the best chance possible not to acquire the condition in the first instance, but it is incumbent on us to do all that we can to support those who do acquire it.

We will publish a disability employment plan in the coming weeks. That will set out our initial steps towards our ambition to at least halve the disability employment gap. I recognise that that will require different measures and forms of intervention for different types of disability, but I assure Rachael Hamilton and all members that we will and do take the matter seriously. We will continue to work with Versus Arthritis and everyone interested in the matter to make sure that we do everything that we can to support people with arthritis into the labour market and, if they are already in work, to remain in employment.

13:19 Meeting suspended.  

14:00 On resuming—