1. Welfare to Work Convention 30 th June, 2011 Developing and Sustaining a Healthy Workforce & Delivering Employment Outcomes Through Health Related Group Work Lucy Goodwin & Nicky Thomas (Occupational Therapists)

2. Aims of Session  To cover the following themes:  Into work and staying there: what works?  Delivering fairness: Opportunities for all

3. History of the Condition Management Programme (CMP)  Green Paper (published November 2002) set out a strategy for enabling people with health conditions to move into and remain in work  Department for Work and Pensions (2003) Pathways to Work: Helping People into Employment, The Governments response and Action Plan D.W.P. London  2.7 million people receiving Incapacity Benefit (IB) in May 2002  The duration on IB was increasing – averaged 9 years compared to 3 years in 1985  Once people have been on IB for 1 year, their chances of returning to work diminish significantly

4. Aims of the CMP  To promote self care and use of self help techniques  Explore and overcome barriers to recovery  Assist customers to achieve a work life balance  Reinforce the health benefits of work (Waddell & Burton 2006) (Waddell & Burton 2006) N.B Medical treatment and diagnosis not offered

5. Long term health impacts Chronic Pain Depression Reduced Self Esteem Anxiety / Fear Low Motivation Social Exclusion Stigma Debt Low Confidence Fatigue

6. CMP Solutions focused Groups and 1:1 Community Delivery Motivational Interviewing Approaches Partnership with JCP Signposting Increased social inclusion Increased quality of life CBT based interventions Education and advice

7. Evaluation Evaluation An evaluation of CMP revealed successful outcomes in relation to An evaluation of CMP revealed successful outcomes in relation to Return to work/training and education Return to work/training and education Volunteering Volunteering Re-engagement with the community Re-engagement with the community Positive customer experience Positive customer experience

8. Research Question ‘To what extent do CMPs enable customers to manage their health conditions & move closer to work/education/training?’ ‘To what extent do CMPs enable customers to manage their health conditions & move closer to work/education/training?’ Dr Carly Reagon and Chris Vincent Dr Carly Reagon and Chris Vincent

9. Data Collection  N=244 (122 non-responses)  Qualitative interviews with customers (N=15) & staff (N=12)  Customers represent broad range of ages, but cluster in 36-55 yr bracket  Primary health conditions: Mental health & musculoskeletal  Quantitative data collection over 12 months: SF36v2, GSES, HADS plus demographic data

10. Short Form 36 Outcome Measure  Health-related quality of life measure  Produces two scores:  Physical Component Summary (PCS)  Mental Component Summary (MCS)  A score of between 45 and 55 is deemed the norm for the general population

11. Changes in SF36v2 Component Scores (%)

12. The Hospital Anxiety and Depression Scale  Provides scores of Generalised Anxiety & Depression  Interpreted as: Normal (0 - 7)Normal (0 - 7) Mild (8 - 10)Mild (8 - 10) Moderate (11 - 14)Moderate (11 - 14) Severe (15 - 21)Severe (15 - 21)

13. HADS Depression Scores Pre/Post CMP (%)

14. HADS Anxiety Scores Pre/Post CMP (%) normal mild moderate severe

15. General Self Efficacy Outcome Measure  Self belief to cope with life demands  Produces a score of between 10 & 40  A score of 29 is deemed the average score for the general healthy population

16. GSES Scores Mean 10 20 30 GSES Post ScoreGSES Pre Score 0

17. Work Outcomes

18.  During the 2009/10 operational year 250 clients completed the Pathways to Work CMP. Of those, 112 (45%) reported positive work related outcomes:  Paid employment 62 (25%)  Voluntary work 25 (10%)  Training/education courses 25 (10%)  A further 23 (9%) clients were referred or signposted to other services/organisations which is considered to be a positive outcome as a result of accessing the CMP

19. Qualitative Analysis  Main Themes – CMP staff  The bio-psycho-social approach meets the complex needs of CMP customers  Work and unemployment linked to personal identity and social inclusion  Link between being out of work and deteriorating mental health  Personal motivation related to successful outcomes  Therapeutic relationship dependant on collaborative working, openness and honesty, and professional behaviours

20. “ Our programme is entirely tailored to individual needs, it is not standardised. it is clinician led which means that the clinician has the skills and professional competence to [act upon] what the individuals are telling them.” (M1:298-301) needs, it is not standardised. it is clinician led which means that the clinician has the skills and professional competence to [act upon] what the individuals are telling them.” (M1:298-301) “we don’t work from an expert model, the clients are the experts and we have the skills, so we work with them” (OT2 415-416) “we don’t work from an expert model, the clients are the experts and we have the skills, so we work with them” (OT2 415-416)

21. Qualitative Analysis  Main Themes – Customers  Association between CMP and Job Centre plus created anxiety for some:  “[The Job Centre] just want people off their books…I’d like to be off their books but you can’t magically say you haven’t got pain, get a job.” (C7:33-35)

22. Main Themes –Customers cont’d  Health practitioners seen as prime facilitators of change.  Benefits of seeing the same health practitioner throughout  Intervention plans tailored to suit their needs  “It’s helped me to deal with my physical problems and I emphasise that: my particular physical problems, because mine are not the same as anyone else’s.”  (C15: 407-409)

23. Common Themes  Benefits of CMP  Education about health condition/s  Learning to manage health condition  Learning to manage pain  Social interaction with other participants  Increased confidence & self esteem  Being listened to by healthcare practitioner  Referral/signposting to other services  Increasing activity & routine

24. Common Themes Referrals from employers/early intervention:Referrals from employers/early intervention: “If I had been picked up earlier by my employer and gone through [the CMP then] I would not have become ill. It would have been caught and sorted earlier.”(C2:250-5) Renewed sense of hope:Renewed sense of hope: Physiological & psychological problems often co-existPhysiological & psychological problems often co-exist “On the last session [at the CMP] I was a different person, a totally different person … I felt positive for the first time in years … I [was] more like the person I wanted to be, not the person I was when I became ill. I don’t want to be that person again.” (C2:159-165)

25. Benefits of Group work  Provided a structured day in the week  Interactive media –opportunity for group discussion  Building confidence through Social interaction  Solutions focused approach  Venue choice e.g. raising awareness of local services  Focus on exploring and overcoming barriers to returning to work  Previous customers talk about their experience of the course

26. Added Value and Unintended Consequences  Use of non clinical venues  Job Centre plus funding benefits 3 month gym pass 3 month gym pass Equipment to deliver courses Equipment to deliver courses Staff training i.e motivational interviewing, solution focus, transactional analysis, mindfulness Staff training i.e motivational interviewing, solution focus, transactional analysis, mindfulness

27. Sustainability  Raising Political Awareness/Support  Customer stories ( influenced ABMU Executive Team)  Argued the case for cost effectiveness  Demonstrable outcomes  NHS Award for ‘Working Seamlessly Across Organisations’  Publications in local media, professional magazines & research journal

28. The Future  NHS Staff Health & Well-being Agenda  Well-being through Work  Developing NHS Pain Management Programme  Developing Chronic Fatigue Programme  Providing services to local private & voluntary sector  Work Programme

29. Debate: Opportunities & Challenges  Further service development to ensure fit for purpose  Explore use of telephone support & e- resources to deliver health interventions  Involvement of participants in delivery  ‘ DOES HEALTH RELATED SUPPORT HAVE TO BE DELIVERED BY HEALTHCARE PROFESSIONALS’

30. Contact Details  Nicky Thomas and Lucy Goodwin - Occupational Therapists  Condition Management Programme,  ABMU Health Board,  Britannic House,  Llandarcy SA10 6JQ.  Telephone: 01792 326568  Email: nicky.thomas2@wales.nhs.uk nicky.thomas2@wales.nhs.uk nicky.thomas2@wales.nhs.uk lucy.goodwin@wales.nhs.uk lucy.goodwin@wales.nhs.uk

31. References  Department for Work and Pensions (2002) Pathways to Work: Helping People into Employment  Department for Work and Pensions (2003) Pathways to Work: Helping People into Employment, The Governments response and Action Plan D.W.P. London  Reagon, C & Vincent C (2010) An Evaluation of Three NHS-led Condition Management programmes in Wales Cardiff: Cardiff University  Waddell, G & Burton, A.K. (2006) Is Work Good for Your Health and Well-being? London: TSO