health, disability and employment update for the health and wellbeing board (march 2015)
TRANSCRIPT
Joint Health and Wellbeing StrategyHealth, Disability and Employment
Work Programme Update
Health and Wellbeing Board Public Meeting
27th March 2015
Health, Disability and Employment
Lead officers: Chris Shaw and
Eve Waite
HWB Leads: Councillor Julie Dore and Dr Tim
Moorhead
• Maintain health for those in work and at work.
• Reduce incidence of those in work but struggling with poor health or a disability becoming off work
• Reduce the amount of time spent in work but off work and prevent that becoming ‘unemployed
• Reduce the amount of time spent between work for health or disability reason
• Prevent long periods of unemployment for health or disability reason
• Increase recognition and use of employment as a valuable health and disability intervention
• Links to other work programmes
• Baseline report: https://www.sheffield.gov.uk/caresupport/health/health-wellbeing-board/what-the-board-does/priorities/work-programmes/health-dis-employ.html
A quick recap:
Our Ambitions
(March 2014)
• Complete delivery of GP Referral Pathway ESA employment Pilot with JCP: Underway. Aim to move 300 people on ESA into employment
• Deliver Fit Note development between Primary Care and Employers: Changed – new Fit for Work Service now implemented in Sheffield by Health Management Ltd. (Maximus) on behalf of DWP - liaison underway
• Deliver Workplace Wellbeing Award: Underway South Yorkshire wide
• Review existing ‘Employment Support: Initial review completed, now incorporating employment support element of LD review and integrating into PSTN programme
• Deliver Core Cities agreement: Not completed – due to churn in Core Cities Director’s of Public Health and devolution effort by Core Cities. Joint meet with Core Cities Skills and Employment forum 28th April 2015 to agree joint working within the devolution context
• Hold first Employment Disability and Health Summit: Not done - as joint plans with CCG and within LD review are not sufficiently clear at this stage. Planned for Summer 2015
Progress(as described in March 2014 in red, March 2015 update in black)
• Vocational Rehab Pilot with Macmillan completed to enable/sustain employment for those with or recovering from Cancer
• Supported 300 people to remain in work though periods of poor health via SOHAS commission
• Provided pathway to employment for people with health conditions via Pathways to Work commission
• Developed draft ‘local pathway’ into employment as part of Public Sector Transformation project
Other activity since March 2014
Public Health Outcome FrameworkUK Yorkshire and
Humber
Sheffield
108 (i) gap in employment rate for those
with long term health condition
7.1 8.1 8.9
108 (ii) gap in employment rate for those
with LD
63.2 60.8 59
108(iii) gap in employment rate for those
in contact with secondary mental health
Services
62.3 59.7 62.9
109i
Sickness absence-% employees at least
one day off in prev week
2.2 2.3 2.5
109ii % lost working days due to
sickness absence
1.5 1.7 1.8
Source: PHOF, PHE
UK Yorkshire and
Humber
Sheffield
108 (i) gap in employment rate for those
with long term health condition
7.1 8.1 8.9
108 (ii) gap in employment rate for those
with LD
63.2 60.8 59
108(iii) gap in employment rate for those
in contact with secondary mental health
Services
62.3 59.7 62.9
109i
Sickness absence-% employees at least
one day off in prev week
2.2 2.3 2.5
109ii % lost working days due to
sickness absence
1.5 1.7 1.8
What would good look like for PHOF measure 108(ii)
(employment rate gap for those with a learning disability)?
55
1535
Current
Employed
Notemployed
65
1525
Upper quartile
353
1237
Best
55
+10
+298
What would good look like for 108(iii) (employment rate gap for those in contact with secondary mental
health services)?
115
1740
Current
Employed
Not employed
189
1666
Upper quartile
299
1556
Best
115
+74
+184
Problems with Nationally Commissioned Provision (broad generalisations, neither categoric nor universal
• Connection/understanding between health and employment systems are not strong (DH/DWP silos)
• The economics of current Work Programme Contracts (payment rates, periods of support permitted etc.)
• Access to work and work choice lack visibility or local context
• Evidence of ‘what works’ is still being developed
• It doesn’t integrate well with local assets (health trainers, community infrastructure, existing treatment services etc.
• Investment and payback doesn’t work in Silos
• Net result …. The ESA cohort is not reducing
Evidence from the Work Programme exemplifies the problem
• Work Programme
– The funding model does not appear to incentivise support for the hardest to help
– Underperformance results in less spending per capita on those who need the most help
– Specialist providers are underutilised
• Consequences
– Little improvement in life chances for the individual
– A significant proportion (14.9%) of Sheffield’s working age population claiming ESA/DLA remains economically unproductive
– Increasing pressure on health and care services at a time of severe budget reductions
– Failure to impact on rising welfare costs
Proportions of Work Programmeparticipants and job outcomes by payment group
Problems with Locally Commissioned Provision (broad
generalisations, neither categoricnor universal)
• Focus on work preparation not acquisition
• Lack of in-work support (including self-employment)
• Waiting lists
• Reliance on relationships/registration with GPs
• Provision has evolved so in some areas competes, whilst in others leaves gaps
• No follow up for signposting
• Gaps: Autism spectrum disorders, dyslexia, severe MH/LD, LD <18yrs, transition
• Brokerage with employers is piecemeal and they have little support
• Investment and payback doesn’t work in Silos
• The picture of local and national provision in Sheffield looks like this ….
In work and well
In work and managing condition
In work but struggling
Employed but off sick short-term
Employed but off sick long-term
Recently become unemployed
Long-term unemployed( over 12 months)
Economically inactive ( long term sick or disabled)
228,000( State of Sheffield) 130,000 days p.a( Black report).
9,600Fit for Work press release)
12,000(SoS 7,000(SoS) 18,0009SoS)
National Fit for Work Service( potentially 3-4,000 referrals p.a£500k p.a..
Job Centre DEA’s
Work Programme( only around x % of this cohort will find work
Access to work /( adaptive cost beyond reasonable DDA Adjustment) around 300 p.a. £1mill
Work Choice –to enable a person to find and stay in work ) (approx. 2-300 p.a around 30% will find work )numbers capped
Residential Colleges
*SOHAS (300-400 p.a.)£ *Bridge Employment 200 p.a. £k)
*First Step Trust ( café- London Road) 9 into work £ p.a.
*SCC Internal LD employment support.
*Burton Street Project
Mental Health First Aid *Autism Centre (LS funded )
*Workplace wellbeing Charter 200 businesses target
*JCP/PH ESA Pilot 300+ clients, 1-200 into employment £250k p.a.
Mindful Employer *SCC non disability ( some specific, some non specific) Employment initiatives
Pathways to Work, Job Clubs, xxx *SHSCT Employment initiatives
Increase Access to psychological Therapies (IAPT)(not employment specific ( recovery based) approx. 3-4,000 p.a.£1.5m p.a. )
Primary Care + Mental Health Services
Total local spend of these wrap around commissions = £2-3 M
Local Employment
System proposal
• Dedicated local approach to supporting people into work beyond mainstream JCP services
• Wrap around public services to support particular needs
• Integrated referral routes for all parts of public sector (including GPs, integrated social care system, keyworker support models etc).
Employment Support Allowance
(ESA)
Employment support for people with
disabilities & long-term conditions
Cross over with people with disabilities/LTCs on ESA
Work Prog 2 discussions
Member-led MH/LD project
ESA pilot with DWP
Work Programme
co-commissioned
(2016+)
Near work
Not near work
Cohorts with specific issues
(eg. ex-offenders)
Mainstream JCP support
Short term / current
CYP review of SEN/LD
LD Review (commissioning)
SY Housing work on disabilities
• Alignment of SCC/PH spend
• Brokerage with employers
• New pathways
Medium term Longer term
Comprehensive Sheffield approach
• Wider buy-in to new pathway• Greater alignment of budgets
(CCG, STH, DWP)• Influencing cultural change in
commissioning of employment as a solution of long-term conditions
• Opportunity for a risk and reward deal to incentivise delivery and ensure proceeds of local investment in a more effective employment system are reinvested locally.
JHWS: Health, disability & employment
HWB
SCR Social Inclusion
Board
From what we have learned, what are the
ambitions / success factors now? Need to maintain balance between ‘quick wins’ and longer term ambitions around devolution + welfare reform
Short- Medium Term-12 months
• combined efforts to improve employment opportunity performance or people with disabilities within existing ‘system’ HWB to propose a target ?
• Ensure different current pieces of work add value to the overall driver e.g. –Member group, Activity around SEND changes, Review of LD services, the recent discussions/ agreements in CCG
• Improve brokerage and commitment within employers ( Lead by example?)
• Develop the Sheffield ‘ask’ within the PSTN project for future Employment/ welfare/ health
• Ensure future commissioning arrangements do not continue the ‘un co-ordination’
Medium- Long term 12- 24 months
• Deliver longer term ‘cultural and organisational shift ’ making work a desirable, realisable option for people with disabilities and health conditions
• Use the momentum to develop a new city wide system for employment/ health and disability where pathways are clear, commissioning is coherent ( shared?) - this is the driver within the devolution proposals to be facilitated by the Public Sector Transformation Network.
Observations
• Don’t recreate a local version of national programme
• Recognise issues of scale – (an extra 100 people with LD would put us top quartile, whilst there are 20,000 people on ESA)
• Ensure we maximise strategic linkage and opportunity with PHE (Due North report) Lottery funding , LEP funding, Skills funding + VCF expertise, work together, across organisations
Jan Feb March April May June
Commissioning Proposal
Co-design new pathway for MH/LD referral with ASC and Sheffield CCG Exec
Segmentation of the our MH/LD clients to focus initial activity
Develop costed commissioning proposal using employability funds and wider SCC/PH investment
Engage Health and Wellbeing Board via health/work discussion at 26th March meeting
Build activity into longer term CCG commissioning plans alongside learning from CCG/DWP ESA pilot
Business Engagement
Identify potentially ‘friendly’ businesses to target initially to deliver some initial wins
Member-led engagement activity with target businesses to establish initial ‘champions’ and momentum behind the work
DWP / Devolution Deal ESA activity
Discussions to establish on DWP pilot (Sheffield / SCR)
Work Programme 2 negotiations (building on local learning and pilot activity) ahead of 2015 Election
Engage Government (and next Government) in plans for local employment system model.
• GPs to refer into the Well To Do Pilot (ESA referral)
• Put ‘weight’ behind ‘Good Employer’ award- joint endorsement with Chamber of Commerce? – or LEP?
• Actively participate in LEP Social Inclusion and Equalities Advisory Board and seek to influence investment regarding support funding (ESIF ) for employment of those with health conditions or disabilities
• Set target for the partners in terms of increasing employment outcomes (upper quartile by 2016?)
• Actively participate in PSTN group to develop the devolution ask back to Government in terms of health and disability related employment provision
• Arrange further discussion by Health and Wellbeing Board reps to develop the Cities Approach – possibly develop a SCC/ CCG shared commissioning Strategy for Supported Employment to steer related commissioning intentions over next 3-4 years
What can the Board do to help or accelerate this work?