Comment: Self-employment and return to work just got personal

Hands in hospital bed

A looming hospital operation has brought home to Nic Paton the need for the government’s review of workplace health to address how the UK’s growing army of self-employed workers and contractors can be better supported when health issues strike.

Confessional, open-your-heart-to-the-public journalism has never been my thing. In 28 years as a full-time professional journalist, I’ve always tried to keep an element of distance – to make it all about the story I’m reporting on rather than me.

I’m going to make something of an exception with this article, not least because it is literally about opening my heart. But bear with me on the personal stuff because there is a wider point here about workplace health that I hope to be illustrating.

By the time you’ll be reading this in January I should, hopefully, be home and recovering from open-heart surgery. I have a congenital bicuspid aortic valve and ascending aortic aneurysm that need to be replaced and repaired respectively. It is, of course, a big and scary operation but these days a relatively standard, straightforward one with good recovery rates (at least that’s what I keep saying to myself).

Being a congenital condition (and thanks to our wonderful NHS) I’ve been regularly monitored for many years now and so I’ve always known that, one day, this reckoning would come. It will mean, I’ve been told, that I will need to be off work for approximately six to eight weeks – largely to allow for my breast bone to heal – and, naturally, will not be allowed to drive during this period. I’m also assuming that it will be a number of further months before I feel full recovered, fit and back to normal.

However, this is the issue. Since 2001, I have been a self-employed freelance journalist. In my circumstances I am lucky. I am freelance very much from choice rather than circumstance and I earn good money from it, above the average for the industry. All my clients, including DVV Media, publisher of Occupational Health and Wellbeing, have been extremely accommodating about the fact there is going to be a hiatus in the work I do for them. I am looking forward to being back battling for occupational and workplace health from (probably) February and, in the meantime, I have the reassurance that my colleague here at DVV, HR and wellbeing editor Ashleigh Webber, will be ably holding the fort.

Moreover, given the fact I’ve known for some time that this was likely to happen at some point, a few years ago I put aside some money to cover for just this eventuality. So I, personally, have nothing to complain about.

Self-employment and workplace health

But what my situation has brought home to me is the great big hole that currently exists around workplace health provision for the self-employed. The number of self-employed workers in the UK has been rising sharply in recent years. Earlier this year, the Office for National Statistics estimated that, from 12% of the workforce and 3.3 million in 2001, last year there were 4.8 million self-employed workers, or 15.1% of the labour force.

Whole industries – construction, hairdressing, hospitality, the “gig” economy – increasingly rely on self-employed “contractors” (even if sometimes the definition is somewhat loose) to make ends meet. And, while it is recognised that micro, small and even medium-sized employers are hard enough to reach from an occupational health perspective (and this is an ongoing issue in its own right), addressing how to support the workplace health of this growing army of self-employed workers is potentially even more of a challenge.

The government’s 2017 Taylor review and subsequent response last year did begin to open a conversation around these areas. Matthew Taylor’s recommendations around creating a new form of worker, a so-called “dependent contractor”, access to sick pay from day one of employment, and the right to return to the same job after a period of prolonged ill health were all positive. But, as yet, these only remain recommendations because, while the government broadly accepted all Taylor’s recommendations, the meat of his proposals was put out to further consultation. So, we are no further forward.

Return to work as a health outcome

There is, too, the issue of return to work as a health outcome. The government, to its credit, in last year’s Improving Lives green paper did recognise the need to “reinforce” work as a health outcome in commissioning decisions and clinical practice.

From my perspective as a self-employed person who predominantly works from a home office tapping away at a keyboard, while I would not expect any of “my” doctors or nurses to have specific expertise in how I work, the blanket six-to-eight weeks stipulation is frustratingly opaque. Given that, for me, time is quite literally money, will I really need to be off for that long?

I appreciate everyone is different and will cope with pain, recovery and rehabilitation in different ways, not to mention the fact things may go smoothly or there may be complications. But, given my working situation, it would have been useful to have someone to be able to speak to about all this and what to expect. What should I be doing to facilitate my return-to-work process, even just part time? Is there specific equipment or adjustments I may need to be looking at or anticipating?

I simply do not know, and this is not a conversation the NHS has been willing to have with me. I have had a hugely generous offer from Diane Romano-Woodward of post-operative occupational health advice and support (which I shall certainly be taking up), but that is pure luck because of the role I do. For most self-employed workers, this is simply not an option or something accessible to them.

How can occupational health provision therefore be extended to, or put more within reach of, both self-employed workers and those working for micro or small employers? What new models of provision or access are we going to need to think about or test? Is there a need for some sort of Roosevelt-style “New Deal” for self-employed, casual and precarious workers? And, if so, what sort of structural, financial or sick pay reforms might help and, crucially, be affordable in this context? What does the NHS, too, need to be thinking about in terms of making return to work more of a health outcome?

Some firms are beginning to recognise they need to put in some protections (even basic ones) for their self-employed contractors. Uber, for example, back in May last year introduced a range of protections for its self-employed drivers through a new insurance scheme, including sick pay and maternity and paternity payments. Gig economy delivery firm Deliveroo also now offers its cycle couriers free insurance to protect them and their earnings if they are involved in an accident.

Similarly, last year parcel delivery company DPD said it was going to give its self-employed drivers access to benefits such as paid annual leave, sick pay and pension entitlement through a new self-employed worker contract. Admittedly, this was a move prompted by the damaging fall-out from the case of self-employed courier Don Lane, who died after missing medical appointments to treat kidney damage caused by his diabetes because he feared he would be subject to DPD’s then £150 daily penalty if he did not find cover for his deliveries (a penalty now also scrapped). All of this is a start and perhaps illustrates the sort of solutions that could be arrived at more widely.

I am simply a hack with an interest in this area; I don’t pretend to have answers to any of this. My point here is simply this: that, with self-employment growing exponentially as a way of working (whether by choice or necessity), this is a conversation that needs to be had. These are questions that need to be discussed at the very least. If they aren’t already on the radar, I very much hope such questions can be considered within the government’s ongoing review of workplace health. I, for one, will certainly be making this argument to anyone prepared to listen in any small way that I can.

The government said within its response to Improving Lives that it was “committed to exploring a key question with potential to deliver transformational change: how to shape, fund and deliver effective occupational health services that can support all in work.” The italics here, I emphasise, are mine. Let’s work to make that lofty aspiration a reality rather than simply warm words.

Trends in self-employment in the UK, Office for National Statistics, 07 February, 2018,

Good work: the Taylor review of modern working practices, Department for Business, Energy and Industrial Strategy, July 2017,

Good work: a response to the Taylor Review of modern working practices, February 2018, Department for Business, Energy and Industrial Strategy,

“Government’s Taylor Review response comes up short for OH”, Occupational Health and Wellbeing, April 2018,

Work, health and disability green paper: improving lives, November 2017, Department for Work and Pensions, Department of Health and Social Care,

Uber to give drivers medical cover, sick pay and other benefits, Personnel Today, 24 May 2018,

DPD to offer self-employed drivers sick pay and annual leave, Personnel Today, 26 March 2018,

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