Worklessness and NHS Reform

Warren Heppolette: Acting Director of Policy & External Relations

Gemma Marsh: Health & Worklessness Manager

Overview

•Offer an overview of the progress made and learning identified so far in Greater Manchester

•Provide an insider’s view of how the NHS reforms will change the way health services are managed, commissioned & delivered

•Identify how welfare to work providers can best engage with the NHS to ensure a good quality health offer for programmes.

Greater Manchester: Size of the problem

• 1 in 10 Greater Manchester residents of working age is out of work and claiming IB or ESA.

•DWP’s indicative volumes suggested that at least 170,000 residents of GM, Cheshire and Warrington will enter the Work Programme over the lifetime of the contract.

•Benefit trends suggest that about 140,000 of this number will be GM residents.

•DWP expect that a third of the Work Programme customer group will be either recent

or current claimants of health-related benefits, such as ESA or IB

•Based on New Economy analysis it is predicted that there is significant disparity between ex IB on flows and likely outcome of IB reassessment enter the Work Programme via the Work Capability Assessment

Health and Employment in Greater Manchester

Importance of work to health, and vice versa – a strong evidence base

• Black Report, 2008

• Marmot Report, 2010

• Manchester Independent Economic Review

• Greater Manchester Strategy

•Worklessness is a barrier to improving health

•But poor health is a barrier to tackling worklessness

•The Work Programme can help to address health priorities•Health can help to meet the priorities of the Work Programme

Worklessness in Greater Manchester

Life Expectancy in Greater Manchester

Each 1% increase in unemployment sustained for five years produces in the 5th year: a 1.9% increase in total mortality

a 4.3% increase in male mental hospital admissions,

a 2.3% increase in female mental hospital admissions, a 4% increase in prison admissions,

a 4.1% increase in suicide and

a 5.7% increase in homicide

Employment is key to reducing health inequalities

Greater Manchester: What has happened so far?Work Programme

Partners including health commissioners and providers have been active inhelping prospective prime contractors to shape their Work Programme bids tobetter fit the needs of GM residents.

This has included sharing information with the prospective prime contractorson:• What has/has not worked in relation to the Work Programme client group in

the past• Specific local priorities and intelligence that can shape the development of

provision under the Work ProgrammeDetails of successful local services that:• can be stopped, as the Work Programme will provide that service• can be aligned for free • can be co-located, or co-case managed• can be co-commissioned

– or potentially ‘sold’ to preferred providers within the framework

Greater Manchester

Joint projects to date.

Greater Manchester Health & Work Group

• Action Plan of activity

• Fit for Work

• Workplace Charter

• GP Fit Note Toolkit

• Mental Health Training for Managers

• Events linking Prime Contractors to Local Partners

Real issues in Greater Manchester

• Local health data has shown a marked increase in alcohol-misuse hospital admissions – Greater Manchester now has the highest rates in the country

• 58% of customers accessing the phase 1 Fit For Work Service have presented with alcohol and/or substance misuse issues that need addressing if the individual is to remain in employment.

• It is estimated that 45% of IB claimants have a Mental Health issue of varying scales

• At present we are unclear as to the detail of the results of the Work Capability Assessment

• Welfare to work providers need to be aware of the scale of this issue and ensure they have services who can help.

Challenges

• Significant numbers of people coming through the Work Programme with health needs: are the services in place to support them?

• Sustaining people in work: How?

• Accessing mainstream Department of Health services: Improving Access to Psychological Therapies, GP, Alcohol & Drugs, Musculoskeletal services

• Impacts of waiting lists

• Highlighting the importance of employment as an outcome to the NHS.

Example

Manchester City Council Economic Development Service Framework

• Health & Employment Project & Intensive Support Project

• Engaging & supporting long term incapacity benefit clients to move into employment or training.

• Many had health issues: May not present at initial meetings

• Average 8 months to support clients into sustained employment

• In work support

• Joint working: Clients are getting support with a range of barriers i.e. Housing & health.

NHS Reform

• Overview: Before & After

• Links to welfare to work

• Navigate your way through

NHS Reform

Parliament

Department ofHealth

Strategic HealthAuthorities

Primary CareTrusts

Local Authorities

Links Patients and the Public

Providers

MonitorCare QualityCommission

FundingAccountability

Local Partnership

Contract

Licence

As Is….

Parliament

Department ofHealth

NHS CommissioningBoard

Clinical Commissioning Groups

Local Authorities

HealthWatch Patients and the Public

Providers

MonitorCare QualityCommission

Health & well Being Board

Licence

FundingAccountability To Be….

HealthWatchEngland

Public Health England

Clinical Senates

Recent Developments

– Reinstating the legal responsibility of the health secretary for the overall performance of the NHS

– Scrapping the primary role of the regulator, Monitor, to promote competition - and focusing on improving patient choice instead

– Relaxing the 2013 deadline for the new GP commissioning arrangements to be introduced

– Strengthening the power of health and well-being boards, which are being set up by councils, to oversee commissioning and giving patients a greater role on them

– Retaining a lead role for GPs in decision-making, but boosting the role of other professionals such as hospital doctors and nurses alongside them

Step-by-step guide to NHS changes

• Competition – A strong retention of the concept of a co-operative system

• Control of budget – Clinical Commissioning & The National Commissioning Board

• Pace of Change – What is fluid and what is fixed?

• Public Accountability – Opportunities for a new discussion spanning the whole public sector

Looking forward: Opportunities & Risks• Engagement with NHS: How? Who? Key priorities & questions. Directors of Public Health (DPH) Influential GP’s Providers

• Speak their language – finding the issues which resonate across the institutional boundaries e.g.

Health Inequalities: DPH’s Reduction in demand for services: GP’s

• Opportunities: JSNA Evidencing the positive link between health & employment, Public Health Indicators. A moral case for concerted action An economic case for new ways of working

• Benefits- the mandatory application of regular and routine contact with our target population

• Risks- misalignment, mistrust, mistranslation

Thank you

Any Questions?

Warren Heppolette: Acting Director of Policy & ExternalRelations, NHS Greater Manchester.Email: warrenheppolette@nhs.net

Gemma Marsh: Health & Worklessness Manager, NewEconomy.Email: Gemma.marsh@neweconomymanchester.com