Looking back to see what’s ahead…

1. Looking back to see what’s ahead… Andy MacFarlane, RMN Director, Condition Management Partners

2. Introduction • Variation in Mental Health presentations • Variation in ESA/IB Claimant presentation • Aims of Condition Management Programmes (CMP) • Description of a CMP service • Evaluation & typical outcomes gradients • Designing transition – Pathways to Work into Work Programme framework • Marketing • Operations • Reflections

3. Bipolar disorder Psychosis/Schizophrenia Unipolar depressive disorders Anxiety related disorder Post-traumatic stress disorder General Prison Pop (1/4). Pop (3/4). 10% 10% 62% 15% 3% Sources: WHO + Justice dep’t Variation in MH presentations – drivers of service development 6% 36% 45% 10% 3% Severe & enduring Common

4. ESA and IBVariation in health presentation 43.3% 15.9% 6.4 % 5.7% 4.3% 2% 22.4% DWP (November 2011) • Mental and behavioural disorder • Musculoskeletal system • Diseases of nervous system • Injury or poisoning • Diseases of circulatory system • Diseases of nervous system • Other

5. Aims of Condition Management • Assist people to understand and manage their health condition via learning CBT self help tools and increasing work-related functional activity (education/training/volunteering/part-time work/full time work). • Reduce psychological distress, improve mood, reduce anxiety, overcome pain and fatigue, adapt to changes in level of functioning (mental and/or physical). • Improve self efficacy, shift locus-of-control from external to internal. • It can be delivered as voluntary or mandatory activity under employment programmes, but is limited to those with common health conditions

6. CMP • Is not a quick-fix/cure all (3 month – 2 year improvements gradient) • Is aimed at common MH problems (and physical problems) • Sees high volumes of throughput • Offers clinical expertise at greatly reduced cost by co-locating clinical specialists within existing employment services • Is strictly time-limited, yet highly individualised for the person • Requires clinical expertise and rigorous following of methodology (beware those selling snake oil…)

7. CMP • Initial contact & one-to-one engagement interview • CMP programme – 5 sessions – group based • Biopsychosocial approach + Therapeutic Interventions - CBT, SFBT, MI – all evidence-based interventions (RCT evidence & nice guidelines) • Differs from NHS/GP/IAPT – work-related focus (and outcomes) • Employment adviser training in dealing with people who have health problems. Individual support with signposting and/or liaison with appropriate local health services on behalf of customer

8. Evaluation Methods - quantitative • Measures completed pre and post CMP group - also at 3 month & 2year follow-up:- • CORE-OM (Barkham et al, 2005) • Work and Social Adjustment Scale (Mundt et al, 2002) • Intrinsic Motivation Scale (Hackman & Lawler, 1971) • General Self-Efficacy Scale (Schwarzer & Jerusalem, 1995) • Employment status at 3 months and at 2 years

9. Psychological Distress 3 months to 2 year Greater psychological distress Lower psychological distress

10. Perceived Disability and Occupational Response 3 months to 2 year Greater perceived disability Lower perceived disability

11. Designing a service to transition from NHS to WP Framework provision • We put together an offer based on very stringent budgetary constraints (unit costs are roughly a quarter of same service commissioned by DWP/NHS under PtW) • Total co-location model reduced costs • Flexible staffing model reduced costs (both based on Australasian model of services)

12. Marketing… First meeting • Very large prime with Very deep pockets… • “We need exactly what you are offering. It's a perfect fit with our delivery model, and we’d be only too happy to have you aboard…” • “All you need to do is find a way deliver it at no cost to us whatsoever.”

13. Marketing… Second Meeting • Smaller prime, much shallower pockets. • We need exactly what you are offering it's a perfect fit with our delivery model, and we’d be happy to have you aboard… • Here is an annual budget for the service… Now please tell us how you can use it to deliver whatever you think will work…

14. Operations… First Meeting • CMP costs double what we pay front line staff!! • Tell you what… You train our staff, then they can just do whatever it is you do for half the price… (took at least a year to train many advisors just to be able to differentiate common MH condition customers. High attrition of staff meant we had to start again almost from scratch) • Cost of experienced well trained health professional staff who are qualified and experienced enough able to actually deliver this stuff is what it is. Just the going rate we have to pay to get staff.

15. Operations… Delivery • Initial belief... For those with health conditions, we can just continue to do what we have always done with other customer groups and it will work just as well for them… • CMP knows that’s not how it works… Barriers related to health are complex and multi-faceted - and CMP says so. • 3 years later, everyone is beginning to realise that’s not how it works (Separate health provision framework for employment related services, anyone?) • Framework doesn’t actually matter - outcomes can be achieved - what matters is provision of right service for particular grouping of needs, and getting the right mix of people in to do it.

16. Reflections on Framework/Services • There are genuine opportunities to put together innovative packages of outcome-based assistance and support using partnership models of delivery. • We need to access and pull together the pockets of existing expertise (these models are not generally available in mainstream health). • We need to stick to replicating the evidence-based methodologies – utility already tested, and proven. • It can be done cost effectively, results can be achieved, but it’s not that easy, and it cannot be done for nothing.

17. Thank You andy@conditionmanagement.co.uk