corporate medical group website: pathways to work: progress in government initiatives dr philip...
TRANSCRIPT
CORPORATEMEDICALGROUP
Website: www.dwp.gov.uk/medical
Pathways to Work:Progress in Government initiatives
Dr Philip Sawney
AOHNP(UK) Symposium
13 May 2004
CORPORATEMEDICALGROUP
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
CORPORATEMEDICALGROUP
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
CORPORATEMEDICALGROUP
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’
CORPORATEMEDICALGROUP
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
CORPORATEMEDICALGROUP
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’
CORPORATEMEDICALGROUP
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)
CORPORATEMEDICALGROUP
Website: www.dwp.gov.uk/medical
IB Growth 1979 - 2001
Working age recipients of Invalidity and Incapacity Benefits,including NI Credits Only, 1979-2001
0
500
1,000
1,500
2,000
2,500
Year
Tho
usan
ds
CORPORATEMEDICALGROUP
Website: www.dwp.gov.uk/medical
IB claim trends
Incapacity Benefit ClaimsSource: 1% sample of all IB claimants
-
50,000
100,000
150,000
200,000
250,000
1987/ 88 1989/ 90 1991 / 92 1993/ 94 1995/ 96 1997/ 98 1999/ 00
Years
MH problems
M-skeletal
CORPORATEMEDICALGROUP
Website: www.dwp.gov.uk/medical
IB – some diagnoses predominate
Incapacity-related benefit recipients by diagnosis group, February 2001
Diseases of thecirculatory system
8%
Diseases of thenervous system
6%
Injury, poisoningetc6%
Diseases of therespiratory system
3%
Other conditions orcondition not
specified23%
Mental andbehaviouraldisorders
33%
Diseases of themusculoskeletal &connective tissue
21%
CORPORATEMEDICALGROUP
Website: www.dwp.gov.uk/medical
Pathways to Work: Nov 02/June 03
CORPORATEMEDICALGROUP
Website: www.dwp.gov.uk/medical
The case for reform
• Health
• Social
• Economic
CORPORATEMEDICALGROUP
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
CORPORATEMEDICALGROUP
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
CORPORATEMEDICALGROUP
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
CORPORATEMEDICALGROUP
Website: www.dwp.gov.uk/medical
Obstacles to rehabilitation
Not just Government saying this…..
Vocational Rehabilitation: The Way Forward - BSRM, 2nd 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
CORPORATEMEDICALGROUP
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
CORPORATEMEDICALGROUP
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
CORPORATEMEDICALGROUP
Website: www.dwp.gov.uk/medical
Bio-psychosocial model and Pathways pilotsAXIS ELEMENT PATHWAYS FEATURE
Bio Impairment
Function
Legal framework
Residual functional capacity
Psycho- Attitudes & beliefs
Psychological distress
Coping strategies
Illness behaviour
Earlier intervention
Integrated support
Condition management progs
Clearer messages
Social Occupational demands/adjustments
Economic incentives
Cultural attitudes
Employer strategy
Return to work credit
Involving other stakeholders
CORPORATEMEDICALGROUP
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
CORPORATEMEDICALGROUP
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
CORPORATEMEDICALGROUP
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’
CORPORATEMEDICALGROUP
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
CORPORATEMEDICALGROUP
Website: www.dwp.gov.uk/medical
More information
www.dwp.gov.uk/medical