Pathways to Work: Progress in Government initiatives

1. Pathways to Work:Progress in Government initiatives Dr Philip Sawney AOHNP(UK) Symposium 13 May 2004

2. Department for Work and Pensions • Created 2001 [from former DSS and part DfEE ] • Corporate centre and agencies • Jobcentre Plus • Pensions Service • Disability and Carers Service • Child Support Agency • The Appeals Service • Spends £115 billion /year [£3 bn running costs] • 120,000 staff • Sponsoring Dept for HSC/ HSE

3. DWP • “Promote opportunity and independence for all” • 10 Public Service Agreement targets • Working with others: • Health Depts [England,Scotland,Wales] • Inland Revenue • DfES • Local authorities • Employers • Voluntary sector • Commercial partners

4. People of working age • Objective: to promote work as the best form of welfare whilst protecting the position of those in greatest need • Delivery Targets (PSA): • Increase overall employment rate over economic cycle • Increase the employment rate of people with disabilities, taking account of the economic cycle, and significantly reduce the difference between their employment rate and the overall rate. • Work to improve the rights of disabled people and to remove barriers to their participation in society’

5. Jobcentre Plus • Helps people to find/access work and receive benefits • Helps employers fill their vacancies • Front office services for others eg DCS • Implements labour market policies • New initiatives: • Employment Zones • New Deals • Worklessness pilots • Pathways to Work

6. Disability Employment Strategy • Focus on what people can still do - with support to work • Systems support/encourage activity rather than inactivity • Interventions at earlier stage • Agencies working together • Healthcare systems treat work outcomes as a key element of clinical management • Employer engagement • Further develop the evidence base for ‘rehabilitation’

7. Why do we need this strategy ? • 2.7 million people of working age on a state incapacity benefit [< 1 million unemployed] • 1 million report sick each week; 3000 remain off work at 6 months and 80% of these will not work again in next 5 years • 20% of people of working age have a long term disability • 50% of the disabled population in the UK are economically inactive (versus 15% of the non-disabled)

8. IB Growth 1979 - 2001

9. IB claim trends

10. IB – some diagnoses predominate

11. Pathways to Work: Nov 02/June 03

12. The case for reform • Health • Social • Economic

13. Return to work should be a positive & realistic option • Satisfying Personal Capability Assessment (PCA) does not necessarily mean “incapable of any sort of work” • Almost everyone moving onto Incapacity Benefit says they want to work again • Most have more manageable conditions where outlook should be positive • For most people return to full activity (incl. work) will improve health and well-being

14. Effects of worklessness Acheson (1998) worklessness as a major risk to health For the majority being away from work has a significant adverse effect on health through: • isolation, social exclusion and stigma • changing health related behaviour • disruption to future career • lower income than available through work

15. Obstacles to rehabilitation • Lack of intervention and support • Skills and qualifications • Medical issues • Financial support • Employers role • Communication problems • Managing uncertainty • Stigma and discrimination ……steps to activation are undermined

16. Obstacles to rehabilitation Not just Government saying this….. Vocational Rehabilitation: The Way Forward - BSRM, 2nd Ed Dec 2003; Second UK Bodily Injury Awards Study - Oct 2000 CBI report ‘Business and healthcare for 21st century - Dec 2001 ABI/TUC paper ‘Getting back to work’ June 2002 Employment Opportunities and Psychiatric Disability – RCPsych 2003

17. Helping people realise aspirations - creating better pathways to work • Key principles: • Early skilled intervention -> best chance for help • Better specialist support, esp. health-work aspects • Making sure work clearly pays • Better support for people on JSA with health problems • Jobcentre Plus working in partnership- NHS and employers also key

18. Pathways to Work – the bio-psychosocial model of rehabilitation • Limitations of traditional health care • Models of disability • Modern concepts of vocational rehabilitation • Addressing the real obstacles • Developing the evidence base

19. Bio-psychosocial model and Pathways pilots

20. Other stakeholders • DWP/Jobcentre Plus cannot provide the whole solution • Other stakeholders to focus on agenda that encourages those with health problems/disabilities to remain in, or return to, work

21. ‘Pathways pilots’ – update • Public consultation; Govt response June 2003 • working with key stakeholders especially NHS (Condition Management Programmes) • 7 pilot areas: • Oct 03 - Bridgend; Renfrewshire; Derbyshire • April 04 -Somerset; Essex; E.Lancs; Gateshead • Full evaluation 2003 - 2006

22. Other DWP/Government initiatives • Jobcentre Plus • Anti-discrimination / focus on abilities • New Deal for Disabled People • Benefit rule changes – ‘permitted work’ • Job Retention and Rehabilitation Pilots (RCT) • Health Inequalities / Social Exclusion Unit • Securing Health Together • ELCI and ‘Framework for Vocational Rehabilitation’

23. Culture - a new understanding • Recognise diversity and individual need • Disability and work a mainstream issue • Dynamic nature of conditions • Need to consider functional capacity • Recognise influence of psychological and social factors

24. More information www.dwp.gov.uk/medical