CORPORATE MEDICAL GROUP Website: Pathways to Work: Progress in Government initiatives Dr Philip Sawney AOHNP(UK) Symposium 13 May

CORPORATEMEDICALGROUP

Website: www.dwp.gov.uk/medical

Pathways to Work:Progress in Government initiatives

Dr Philip Sawney

AOHNP(UK) Symposium

13 May 2004



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



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



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’



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



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’



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)



IB Growth 1979 - 2001

Working age recipients of Invalidity and Incapacity Benefits,including NI Credits Only, 1979-2001

0

500

1,000

1,500

2,000

2,500

Year

Tho

usan

ds



IB claim trends

Incapacity Benefit ClaimsSource: 1% sample of all IB claimants

-

50,000

100,000

150,000

200,000

250,000

1987/ 88 1989/ 90 1991 / 92 1993/ 94 1995/ 96 1997/ 98 1999/ 00

Years

MH problems

M-skeletal



IB – some diagnoses predominate

Incapacity-related benefit recipients by diagnosis group, February 2001

Diseases of thecirculatory system

8%

Diseases of thenervous system

6%

Injury, poisoningetc6%

Diseases of therespiratory system

3%

Other conditions orcondition not

specified23%

Mental andbehaviouraldisorders

33%

Diseases of themusculoskeletal &connective tissue

21%



Pathways to Work: Nov 02/June 03



The case for reform

• Health

• Social

• Economic



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



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



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



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



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



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



Bio-psychosocial model and Pathways pilotsAXIS ELEMENT PATHWAYS FEATURE

Bio Impairment

Function

Legal framework

Residual functional capacity

Psycho- Attitudes & beliefs

Psychological distress

Coping strategies

Illness behaviour

Earlier intervention

Integrated support

Condition management progs

Clearer messages

Social Occupational demands/adjustments

Economic incentives

Cultural attitudes

Employer strategy

Return to work credit

Involving other stakeholders



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



‘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



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’



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



More information

www.dwp.gov.uk/medical

Documents

CORPORATE MEDICAL GROUP Website: Pathways to Work: Progress in Government initiatives Dr Philip Sawney AOHNP(UK) Symposium 13 May