Pathways to Work: Progress in Government initiatives

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Pathways to WorkProgress in Government
initiatives

• Dr Philip Sawney
• AOHNP(UK) Symposium
• 13 May 2004

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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

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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

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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

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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

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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

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Why do we need this strategy ?

• 2.7 million people of working age on a state
  incapacity benefit lt 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)

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IB Growth 1979 - 2001
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IB claim trends
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IB some diagnoses predominate
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Pathways to Work Nov 02/June 03
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The case for reform

• Health
• Social
• Economic

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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

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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

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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

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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

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Helping people realise aspirations - creating
better pathways to work

• Key principles
• Early skilled intervention -gt 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

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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

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Bio-psychosocial model and Pathways pilots
AXIS 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
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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

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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

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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

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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

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More information

• www.dwp.gov.uk/medical