© dr nick niven-jenkins cmg 2004 1 pathways to work condition management programmes york cardiac...

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© Dr Nick Niven-Jenkins CMG 2004

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

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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

Sick and claiming benefit 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

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Incapacity Benefit Caseload

• But general ‘health’ of population is improving!• 50% recipients are over 50 years of age

Chart 1: Incapacity benefits caseload (1979-2003, excluding IBSTL) and inflows (1988-2003)

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1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003

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caseload (excl IBSTL)

inflows

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Reported common health problems

Incapacity Benefit Caseload by Diagnosis Code - November 2001

Mental and Behaviourial Disorders - 33%

Diseases of Musculo-skeletal tissue - 23%

Not specified - 11%

Others - 9%

Disease of the Circulatory System - 8%

Diseases of the Nervous System - 5%

Injuries, Poisoning - 6%

Diseases of the Respiratory System - 3%

The ‘others’ category consists of the remaining 13 ICD diagnostic groupsThe majority of people have mild-moderate medical conditions

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Importance of work

Work is a major part of most peoples lives

Work provides:

Financial status and security An occupation and activity Sense of identity and purpose Social interaction

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Impact of worklessness

Negative health & social consequences include:

Changing health related behaviourIncreased morbidity [especially mental health] & mortality [suicide]

Isolation and social exclusionSocial deprivation

Disruption to future work careerand assumptions of unemployability

Loss of motivation & confidence

Acheson D [1998] Inequalities in health HMSO

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Work and health strategyMove people from:

welfare dependency to work opportunities

Three reasons: Health – work improves health & reduces health

inequalities Social – rights of people with health condition and/or

disability Economic – loss of expertise impacts on economic

growth

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Rehabilitation

Traditional process inappropriate for common health problems

Obstacles predominantly psychosocial rather than severe pathology or impairment

Therefore: Use a process that identifies and helps

overcome the health, personal,psychological and social/occupational obstacles to recovery

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A New Approach best medical evidence suggests that a return to

normal activity - including work - improves well being and enhances recovery for most people

complex clinical interventions or expensive programmes of treatment are often not necessary

rather individuals need to be ‘empowered’ to manage

their symptoms and engage in normal activities

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Choices

Structured and comprehensive package of help and support

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]

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Condition management programmes

Short term interventions lasting 4-13 weeksMain elements of this approach:

Initial assessment provide patient with information about their condition address patient concerns and beliefs provide physical/psychological interventions and

support where needed [Health Action Plan] provide vocational advice and support

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Condition management programmes

- common elements - Education cognitive therapy/behavioural groups goal setting work [including supported job seeking] physical exercise relaxation/’stress’ management

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Results

10,700 people have returned to work -over 2,000 had been on benefits for more than 2 years

20-25% of people attending work-focussed interviews take up some form of back-to-work help [choices]

About a third of these started a CMP

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Sick and Disabled PRA job entries in Pathways Pilot Districts: year-on-year comparison

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2003 2004

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Benefit ‘off-flow’ ratesIB Six Month Off-flow Rate

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Month of benefit start

Off

-flo

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National

Pathways Phase 1

Pathways Phase 2

The off-flow rates presented are produced from the Working Age Statistical Database (WASD). WASD does not include a proportion of short-term Incapacity Benefit claims, therefore the off-flows presented will be lower than actual rates. However, trends over time will be consistent.

Start of phase 1

pilots

Start of phase 2

pilots

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And finally.......

for more information

© dr nick niven-jenkins cmg 2004 1 pathways to work condition management programmes york cardiac...

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