Introduction

The main focus of recent debates around disability, chronic illness and work has centred on access to paid work. Over the past two decades this has also been at the heart of the social policy agenda in Britain, with concerted efforts to maximise labour market participation, embodied in initiatives such as the New Deal programmes, which were aimed at various groups (for example, young people, single parents and disabled people) who were seen as being marginalised by the labour market. Additionally, schemes, such as Work Trials and Pathways to Work, were available to disabled people and those with long-term health issues. Initiatives such as these have been underpinned by a political commitment to the idea that work in any form is always preferable to welfare (Warren, 2005) and also by a large body of medical evidence that supports the idea that work is good for individuals and has positive health benefits (see, for example, Black, 2008; NICE, 2009). However, such claims are problematic because, as we shall see, the type of work and the context within which it takes place are important. In brief, ‘good work’ is good for health, while ‘bad work’ is not (see Chapter One, this volume).

Nevertheless, work has been seen as ‘the answer’ for disabled people and those with chronic health problems, in terms of offering both a higher degree of economic autonomy and potential health benefits, and, despite challenges from commentators such as Roulstone and Barnes (2005), this has remained a dominant and persistent theme. As a result, numerous activation policies and interventions to increase the employment of people in receipt of benefits due to ill-health or disability have been initiated in recent decades. These policy strategies have been directed at the supply side – enhancing the ability of individuals with a disability or chronic illness to be employed – and the demand side, notably increasing the desirability to employers of recruiting and retaining this particular group of workers (Bambra, 2006; see also Chapter 10, this volume).

Supply-side strategies are concerned with increasing the availability and work-readiness of individuals with a disability or chronic illness. They are designed to overcome some of the employment barriers that people with a disability or chronic illness face, particularly in terms of a lack of skills or work experience, and financial uncertainty about the transition into paid employment (Gardiner, 1997).