Pathways to Work Condition Management Programmes York Cardiac Care & Rehabilitation Conference

1. Pathways to WorkCondition Management ProgrammesYork Cardiac Care & Rehabilitation Conference Dr Nick Niven-Jenkins Corporate Medical Group Department for Work and Pensions March 2005

2. Background • Sick and away from work • 1 million people report sick each week • 3000 remain off work at 6 months and • 2,400 of these will not work again in the next 5 years • Sick and claiming benefit • 2.7 million people of working age currently claim a state incapacity benefit 1 [less than 1 million unemployed] • demographics not good - ageing population 1. DWP Analytical Services Division 2002

3. Incapacity Benefit Caseload • But general ‘health’ of population is improving! • 50% recipients are over 50 years of age

4. Reported common health problems The ‘others’ category consists of the remaining 13 ICD diagnostic groups The majority of people have mild-moderate medical conditions

5. Importance of work Work is a major part of most peoples lives Work provides: • Financial status and security • An occupation and activity • Sense of identity and purpose • Social interaction

6. Impact of worklessness Negative health & social consequences include: • Changing health related behaviour Increased morbidity [especially mental health] & mortality [suicide] • Isolation and social exclusion Social deprivation • Disruption to future work career andassumptions of unemployability • Loss of motivation & confidence Acheson D [1998] Inequalities in health HMSO

7. Work and health strategy Move people from: welfare dependency to work opportunities Three reasons: • Health – work improves health & reduces health inequalities • Social – rights of people with health condition and/or disability • Economic – loss of expertise impacts on economic growth

8. Rehabilitation • Traditional process inappropriate for common health problems • Obstacles predominantly psychosocial rather than severe pathology or impairment Therefore: • Use a process that identifies and helps overcome the health, personal,psychological and social/occupational obstacles to recovery

9. A New Approach • best medical evidence suggests that a return to normal activity - including work - improves well being and enhances recovery for most people • complex clinical interventions or expensive programmes of treatment are often not necessary rather • individuals need to be ‘empowered’ to manage their symptoms and engage in normal activities

10. Choices • Structured and comprehensive package of help and support • consists of work focussed programme provision and financial incentives • these reforms build on existing range of provisions and introduce new health condition management programmes delivered by the NHS [but funded by DWP]

11. Condition management programmes Short term interventions lasting 4-13 weeks Main elements of this approach: • Initial assessment • provide patient with information about their condition • address patient concerns and beliefs • provide physical/psychological interventions and support where needed [Health Action Plan] • provide vocational advice and support

12. Condition management programmes- common elements - • Education • cognitive therapy/behavioural groups • goal setting • work [including supported job seeking] • physical exercise • relaxation/’stress’ management

13. Results • 10,700 people have returned to work -over 2,000 had been on benefits for more than 2 years • 20-25% of people attending work-focussed interviews take up some form of back-to-work help [choices] • About a third of these started a CMP

15. Benefit ‘off-flow’ rates

16. And finally....... www.dwp.gov.uk/medical for more information