1. CORPORATE MEDICAL GROUP Website: www.dwp.gov.uk/medical Pathways to Work: Progress in Government initiatives Dr Philip Sawney AOHNP(UK) Symposium 13 May 2004

2. CORPORATE MEDICAL GROUP Website: www.dwp.gov.uk/medical 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

3. CORPORATE MEDICAL GROUP Website: www.dwp.gov.uk/medical 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

4. CORPORATE MEDICAL GROUP Website: www.dwp.gov.uk/medical 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’

5. CORPORATE MEDICAL GROUP Website: www.dwp.gov.uk/medical 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

6. CORPORATE MEDICAL GROUP Website: www.dwp.gov.uk/medical 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’

7. CORPORATE MEDICAL GROUP Website: www.dwp.gov.uk/medical 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)

8. CORPORATE MEDICAL GROUP Website: www.dwp.gov.uk/medical IB Growth 1979 - 2001

9. CORPORATE MEDICAL GROUP Website: www.dwp.gov.uk/medical IB claim trends

10. CORPORATE MEDICAL GROUP Website: www.dwp.gov.uk/medical IB – some diagnoses predominate

11. CORPORATE MEDICAL GROUP Website: www.dwp.gov.uk/medical Pathways to Work: Nov 02/June 03

12. CORPORATE MEDICAL GROUP Website: www.dwp.gov.uk/medical The case for reform Health Social Economic

13. CORPORATE MEDICAL GROUP Website: www.dwp.gov.uk/medical 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

14. CORPORATE MEDICAL GROUP Website: www.dwp.gov.uk/medical 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

15. CORPORATE MEDICAL GROUP Website: www.dwp.gov.uk/medical 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

16. CORPORATE MEDICAL GROUP Website: www.dwp.gov.uk/medical Obstacles to rehabilitation Not just Government saying this….. Vocational Rehabilitation: The Way Forward - BSRM, 2 nd 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

17. CORPORATE MEDICAL GROUP Website: www.dwp.gov.uk/medical 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

18. CORPORATE MEDICAL GROUP Website: www.dwp.gov.uk/medical 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

19. CORPORATE MEDICAL GROUP Website: www.dwp.gov.uk/medical Bio-psychosocial model and Pathways pilots AXISELEMENTPATHWAYS FEATURE BioImpairment Function Legal framework Residual functional capacity Psycho-Attitudes & beliefs Psychological distress Coping strategies Illness behaviour Earlier intervention Integrated support Condition management progs Clearer messages SocialOccupational demands/adjustments Economic incentives Cultural attitudes Employer strategy Return to work credit Involving other stakeholders

20. CORPORATE MEDICAL GROUP Website: www.dwp.gov.uk/medical 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

21. CORPORATE MEDICAL GROUP Website: www.dwp.gov.uk/medical ‘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

22. CORPORATE MEDICAL GROUP Website: www.dwp.gov.uk/medical 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’

23. CORPORATE MEDICAL GROUP Website: www.dwp.gov.uk/medical 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

24. CORPORATE MEDICAL GROUP Website: www.dwp.gov.uk/medical More information www.dwp.gov.uk/medical