Work should adapt as people’s lives and health change

Dr Louise Bell Tomkins, Disability Employment, Inclusion & Policy Consultant and Doctoral Researcher at the University of Lancashire, says that employers and employment support professionals have key roles to ensure that Disabled people and people with long-term health conditions can continue to thrive in work. 

Many people do not think of themselves as Disabled. They may describe themselves as having arthritis, chronic pain, fatigue, a heart condition, anxiety, menopause-related symptoms or simply not being able to do the things they used to. But whatever language people use, the workplace question is often the same: “Can their job adapt enough for them to stay, contribute and progress?”

My doctoral research focused on Disabled people’s experiences of employment, but many of the findings have wider relevance for people ageing in work or managing long-term health conditions.The research showed that the challenge is not only getting into work. It is whether recruitment processes, managers, reasonable adjustments, employment services, and workplace culture make work sustainable over time.

Employment is about more than income

One Disabled participant in my research explained that work was not only about money: 

That quote stayed with me because it captures why employment matters. Work can provide income, but it can also provide routine, confidence, identity, social connection, and a sense of feeling valued. When people are pushed out of work because their health changes, because support is inconsistent, or because workplaces are inflexible, the impact is not only financial. It can affect confidence, wellbeing and how people see their place in society.

This becomes increasingly important as people work for longer and as more workers have to try to manage health conditions alongside employment. If support only arrives once someone is already struggling, or after they have left work, opportunities for early and practical support are missed, and it becomes harder to help people stay at work.

Getting into work is only one part of the problem

Employment policy often focuses on helping people get into work. That is important, but my research found that employment should be understood as a journey.

Disabled people described barriers at different stages: finding suitable opportunities, completing inaccessible application forms, navigating interviews, deciding whether to disclose a condition, requesting reasonable adjustments, managing sickness absence, and trying to stay in work when their needs changed.

Some people could access employment support but still encountered resistance from employers. Others secured work but struggled to obtain reasonable adjustments. Some remained in work but had limited opportunities to progress.

This shows why employment support must look beyond securing employment. A job outcome is not enough if the role is not accessible, if reasonable adjustments are delayed, or if the person is made to feel like a problem for needing support.

Workplaces often rely too much on individual managers

One of the clearest findings from my research is that workplace inclusion is often dependent on individual managers rather than consistent systems.
Some participants described supportive managers who listened, adapted job roles, offered flexibility, and treated reasonable adjustments as part of good employment practice. These examples show that inclusive practice is possible.

However, others described managers who lacked understanding, questioned the legitimacy of support needs, or treated reasonable adjustments as inconvenient. In these cases, disabled people were often expected to repeatedly explain themselves, prove their needs, or negotiate support informally.

For people ageing in work or managing long-term health conditions, this is a serious issue. Support should not depend on whether someone happens to have an understanding manager. Workplaces need clear, consistent, and accountable processes so that people know what support is available and how to access it.

Disclosure should not feel like a risk

Many Disabled people and people with long-term health conditions face a difficult decision about whether to disclose their condition at work.

Disclosure can be necessary to access reasonable adjustments or flexible working. But it can also feel risky if people worry they will be judged, overlooked for promotion, treated as unreliable, or seen as less capable.

My research found that disclosure was often influenced by fear of stigma and uncertainty about what would happen next. This put additional pressure on Disabled people to manage not only their work and health, but also the emotional labour of deciding when, how and whether to explain their needs.

This is particularly relevant for people who may not identify as Disabled but are experiencing changes in health or capacity. They may not know what support they are entitled to, they may not feel comfortable asking for reasonable adjustments, or they may delay seeking help until work becomes unsustainable.

Employers can reduce this risk by creating a culture where conversations about health, access and reasonable adjustments are normal, practical, and non-punitive.

Employment services can be a bridge, but they need the right conditions

My research also examined the role of employment service professionals. These are the people who often support jobseekers with applications, interviews, placements, confidence-building, and employer engagement.

One of the original contributions of my thesis was the idea of employment services as “inclusion intermediaries.” By this, I mean that employment service professionals can act as a bridge between Disabled people, employers and wider policy and funding systems.

Effective employment support professionals not only support individuals to become “job ready” but also engage employers, challenge assumptions, negotiate opportunities and help translate inclusion into practice.

However, my research also found that this role is constrained. Employment services often operate within target-driven systems where success is measured by job outcomes rather than sustainable, accessible employment. This can make it harder to provide person-centred support, especially for people whose needs are complex, fluctuating day-to-day or set to increase over the longer term.

If employment services are expected to support people into meaningful and lasting work, they need funding models and performance measures that value retention, progression, accessibility, and employer change — not just job starts.

What needs to change?

My research recommends several practical changes.

1. Recruitment needs to become more accessible. Application forms, online systems, and interviews are often designed around narrow assumptions about communication, literacy, confidence, and digital access. Employers should offer flexible application routes, clear job descriptions, alternative interview formats, and work trials where appropriate.

2. Reasonable adjustments need to be implemented consistently. Reasonable adjustments should not rely on informal negotiation or manager goodwill. Employers need clear processes, timely decision-making, and better understanding of how reasonable adjustments support retention and productivity.

These findings also informed my written evidence to the parliamentary committee inquiry into Access to Work, where I highlighted how employment support can be valued in principle but delayed, inconsistent or difficult to navigate in practice.

3. Disability-related support should be treated as part of workplace equality, not as poor attendance or reduced commitment. One of my recommendations is Disability Support Leave: a formal entitlement that could support people who need time for disability-related appointments, treatment, recovery, fluctuating conditions, or support needs. This would reduce reliance on annual leave, sickness absence, or informal manager discretion.

4. Lived experience must shape policy and workplace practice. Disabled people and people with long-term health conditions should be involved in designing, reviewing, and evaluating employment support, workplace standards, and inclusion policies.

5. Employers need stronger accountability. Voluntary commitments to inclusion are not enough if they do not change what happens in recruitment, management, and workplace support. Inclusion should be measurable, reviewed and linked to real consequences when practice falls short.

Supporting people to stay in work benefits everyone

As people’s lives and health change, work needs to be able to change too. This is not only a disability issue or an ageing issue. It is a workplace design issue, a policy issue, and a social justice issue.

People should not have to wait until they are at crisis point before support is offered. They should not have to leave work because reasonable adjustments are delayed, because managers do not understand, or because systems are too rigid to respond to changing needs.

If we want more people to stay in work as they age, we need to stop treating support as an exception. Accessible, flexible, and accountable employment practice should be part of how good work is designed.

Getting people into work matters. But helping people stay, adapt, and thrive in work matters just as much.

Author note: Dr Louise Bell Tomkins recently completed her Professional Doctorate researcher at the University of Lancashire. Her doctoral thesis, Disability Employment from Policy to Practice: Accountability, Accessibility, and the Lived Experience, is awaiting institutional repository publication. Findings from the research have contributed to published written evidence for the UK Parliament Access to Work inquiry: AWS0083.