Sociologists recognized years ago that one important consequence of being ill - of being in the so-called sick role - is that one is excused from certain responsibilities, including the responsibilities associated with work. The assumption here is that those who are healthy have a responsibility to work. Things are perhaps somewhat different now, because the levels of unemployment in society mean that for some people, it is impossible to fulfil this responsibility, however healthy they may be. This also creates another problem. Where there is (nearly) full employment, one can assume that with appropriate rehabilitation, those who have been ill can eventually return to work. However, as things stand, people who have been ill must compete for work with others who do not have the disadvantage of having been unwell.

A continuing problem for those who have been ill is that, in the eyes of others, one has to be either (completely) ill or (completely) well. There is little scope to be somewhere in between. However, particularly for people who are recovering from long episodes of illness, this is the reality they face. Often, the person contemplating returning to work is unsure how he or she will cope with the stress of work, whether previous skills and abilities will still be there and so on. However, the benefits system does not, unfortunately, accommodate such doubts. As it stands, the benefits system simply cannot cope with someone whose capacity to work might fluctuate and often lacks the flexibility to allow people to try to return to work unless they are very confident of succeeding. While it is possible in theory to switch between sickness and unemployment benefits, this is so cumbersome and takes so long that many people contemplating trying to return to work after illness are put off trying at all. The option to apply for the therapeutic work allowance is useful here, not only because it offers more flexibility, but also because it is often appropriate to see the return to work by someone who has been ill as a therapeutic experiment, which may or may not work in each instance. However, it would be far better if this allowance were more flexible.

An additional problem is that employers are not always aware of the therapeutic option and in any case, there a few jobs advertised which can accommodate this option. It is usually left to the person seeking work to try to negotiate work on an individual basis.

Some enlightened employers make special provision for those who have a history of illness, by ensuring that they are not unduly disadvantaged in applying for jobs, and by having appropriate support and supervision in place. However, one seldom hears of such employers and one suspects that they constitute a very small minority. It would be most interesting to learn of examples of good practice in this sphere.

These initiatives are usually taken by individual employers. While this is the case and while such initiatives are not encouraged more directly by governments, they are likely to remain few in number. Until this changes, a group of people in our society who might derive particular benefits from having work will remain among those most disadvantaged when it comes to finding work.