1. © Dr Nick Niven-Jenkins CMG 2004 1 Pathways to Work Condition Management Programmes York Cardiac Care & Rehabilitation Conference Dr Nick Niven-Jenkins Corporate Medical Group Department for Work and Pensions March 2005

2. © Dr Nick Niven-Jenkins CMG 2004 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 n Sick and claiming benefit n 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. © Dr Nick Niven-Jenkins CMG 2004 3 Incapacity Benefit Caseload But general ‘health’ of population is improving! 50% recipients are over 50 years of age

4. © Dr Nick Niven-Jenkins CMG 2004 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. © Dr Nick Niven-Jenkins CMG 2004 5 Importance of work Work is a major part of most peoples lives Work provides: n Financial status and security n An occupation and activity n Sense of identity and purpose n Social interaction

6. © Dr Nick Niven-Jenkins CMG 2004 6 Impact of worklessness Negative health & social consequences include: n Changing health related behaviour Increased morbidity [especially mental health] & mortality [suicide] n Isolation and social exclusion Social deprivation n Disruption to future work career and assumptions of unemployability n Loss of motivation & confidence Acheson D [1998] Inequalities in health HMSO

7. © Dr Nick Niven-Jenkins CMG 2004 7 Work and health strategy Move people from: welfare dependency to work opportunities Three reasons: n Health – work improves health & reduces health inequalities n Social – rights of people with health condition and/or disability n Economic – loss of expertise impacts on economic growth

8. © Dr Nick Niven-Jenkins CMG 2004 8 Rehabilitation n Traditional process inappropriate for common health problems n Obstacles predominantly psychosocial rather than severe pathology or impairment Therefore: n Use a process that identifies and helps overcome the health, personal,psychological and social/occupational obstacles to recovery

9. © Dr Nick Niven-Jenkins CMG 2004 9 A New Approach n best medical evidence suggests that a return to normal activity - including work - improves well being and enhances recovery for most people n complex clinical interventions or expensive programmes of treatment are often not necessary rather n individuals need to be ‘empowered’ to manage their symptoms and engage in normal activities

10. © Dr Nick Niven-Jenkins CMG 2004 10 Choices n Structured and comprehensive package of help and support n 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. © Dr Nick Niven-Jenkins CMG 2004 11 Condition management programmes Short term interventions lasting 4-13 weeks Main elements of this approach: n Initial assessment n provide patient with information about their condition n address patient concerns and beliefs n provide physical/psychological interventions and support where needed [Health Action Plan] n provide vocational advice and support

12. © Dr Nick Niven-Jenkins CMG 2004 12 Condition management programmes - common elements - n Education n cognitive therapy/behavioural groups n goal setting n work [including supported job seeking] n physical exercise n relaxation/’stress’ management

13. © Dr Nick Niven-Jenkins CMG 2004 13 Results n 10,700 people have returned to work - over 2,000 had been on benefits for more than 2 years n 20-25% of people attending work- focussed interviews take up some form of back-to-work help [choices] n About a third of these started a CMP

14. © Dr Nick Niven-Jenkins CMG 2004 14

15. © Dr Nick Niven-Jenkins CMG 2004 15 Benefit ‘off-flow’ rates

16. © Dr Nick Niven-Jenkins CMG 2004 16 And finally....... for more information