Healthy pathways to employability?

Lessons for welfare-to work

Colin Lindsay SCER, University of Strathclyde Matthew Dutton ERI, Edinburgh Napier University

Introduction and structure

Coalition approach to activation of IB claimants:
Benefits simplification and incentives; sanctions Work Programme replacing Pathways to Work; black box funding incentives and freedom to develop content Reduced role for health condition management (CMPs)

Our research: review of evidence on a) impacts; b) limitations of Pathways CMPs, 2003-11 Our research: in-depth interviews with NHS professionals delivering CMP services What lessons can be drawn for future policy?

Background and policy context

IB problem and policy responses

IB claiming explained by: labour market factors; gaps in employability; and ill-health Lindsay and Houston eds 2013 Strong evidence of health/disability-related barriers
IB claimants left work due to ill-health Beatty et al 2010 BHPS = long-term links between health/IB Jones et al 2010 Number/severity of conditions = re-entry Kemp and Davidson 2010 NHS professionals verify ill-health Lindsay and Dutton 2010

Pathways to Work: CMP developed by NHS, but under-used, like other Choices interventions Work Programme free to develop CMPs, or not

Our research on CMPs

Lessons from Pathways to Work:
13 week CMP based on CBT principles/other content Designed and led by NHS professionals in 18 JCP-led districts; kind-of extended to other contracted districts

Structured evidence review focusing on 12 key evaluations of Pathways CMP (and other studies) 52 interviews with NHS managers and staff
Benefits and added value of CMP Problems and limitations of CMP Lessons for future welfare-to-work for IB/ESA claimants

Findings

Benefits and added value of CMP

Evidence review: improvements in HADS anxiety measures; and (less so) depression Ford and Plowright 2009 Reduced distress and perceived disability Kellett et al 2011 Qualitative evidence of healthier behaviours/diet Increased social activity and reduced feelings of isolation; improvements in self-esteem Better understanding/management of conditions Interviews: similar benefits and gradual progress towards considering a return to work Interviews/review: NHS expertise trusted/valued

Problems and limitations of CMP

No job impact; more disadvantaged less likely to achieve job outcomes, but never a target NAO 2010 DWP (2012): CMP was discontinued as there was not sufficient evidence to show that it offered value for money in terms of measurable job outcomes Poorer outcomes for those with chronic, physical and more severe conditions MCR 2010; Warrener et al 2009; Kellett et al 2011 Resistance to CBT-oriented content Warrener et al 2009 Interviews: need for range of CMP provision; inwork support; and things outside work and health Socio-economic inequalities untouched Patrick 2011

Lessons for future welfare-to-work strategies for IB/ESA claimants

Conclusions and lessons for policy

Overwhelming evidence that health/disability is a key element of the IB/ESA problem Conditionality and compulsion may reduce the numbers on benefits, but will not improve their health or employability Health services need to be part of the solution, but evidence of neglect (and therefore parking of IB/ESA clients) under Work Programme Pathways CMP was under-used but offers some lessons for policy that might work

Conclusions and lessons for policy

Flexible, short-term condition management therapies can have positive outcomes
Need for flexible (beyond CBT-oriented) approaches

Need for further research on what works for whom Need to consider interventions to assist those with more severe disabilities/chronic conditions NHS professionals added value, but need not deliver all CMP provision but evidence that black box funding will lead to parking/neglect Lindsay and Dutton 2010 Social and labour market barriers remain crucial

Edited by Colin Lindsay and Donald Houston

Disability Benefits, Welfare Reform and Employment Policy

9780230349940 Palgrave Macmillan, 2013