Commissioning IPS: the role of local partnerships

Jonathan Allan

Disability Services Manager Shropshire Council

Shropshire IPS partnership

• Enable supported employment service, Shropshire Council

• Shropshire PCT

• South Staffordshire and Shropshire Foundation Trust

• In various forms since 1995

Full Partner in Centre of Excellence

• Shropshire has had 2 Fidelity Reviews: moved from “Fair” to “Good”

• Regional role in developing IPS in the West Midlands

Current funding partners

• Shropshire Council ,Shropshire PCT, Shropshire SSS FT, Workstep

• Elsewhere: Mental Health Trusts

• Mix of in – house and voluntary providers

“No health without mental health”

• Early intervention• Joint work between health and employment

providers• Welfare to Work reform• Work Choice, Access to Work• Fit for Work pilots and “fit notes”• IAPT commitment: employment coordinator,

employment advice

Healthy Lives, Healthy people consultation on outcomes

• Costs of working age ill health in UK= £100 billion p.a.

• Local Health and Wellbeing Boards driving improvements in public health

• “Proportion of people with mental illness and or disability in employment”

• Is there a better formulation?

The business case: Quality

• The evidence: Employment is good for health, unemployment is bad for health

• Increased employment improves quality of life, self esteem, relationships

• Unemployed have more GP consultations and hospital admissions

• 16 international randomised controlled trials demonstrates IPS is best vocational approach

• IPS Fidelity scale provides only audit tool

The business case: innovation & productivity

• People accessing IPS based services twice as likely to achieve employment

• Cost benefit analysis Perkins suggests a save to spend ration of £1 for every £1.51 spent

• Centre for MH estimate in – patient savings of £6000 per person.

• Further evidence Bush, 2009) that long term savings can be realised for high support service users.

• IAPT / primary care: employment specialists accelerate by 7 months

Commissioning 1: Is the service effective?

• IPS is twice as effective as other vocational approaches

• Best validated both internationally and in this country

Commissioning 2: Is it good value for money?

• No thorough cost benefit analysis: difficult as some savings locally, some to government

• IPS “relatively inexpensive…and is cost effective” (Drake & Bond 2008) against other vocational services

• Info from elsewhere indicates cost savings

Commissioning 3: Is it affordable?

• about £2000 per place – argument for investment as opposed to other services

• current economic climate

• does it save money elsewhere? Is it a good investment? Do employment outcomes lower health care costs?

What’s the link?

“If recovery is to become a reality,

employment must become one of its key

priorities.”

Centre for Mental Health (2008)

Making Recovery a Reality - Policy

Paper

Hope

• Recovery is about the hope that things can change for the better

• Hope is the catalyst of the recovery process

• Employment is key means of obtaining hope in all our lives

• Integrated strategies and closely aligned services

questions…….

• How does employment survive the next 2 years before GP commissioning?

• How do we engage with GP commissioning?• Can we link health commissioning (GP

primary / secondary, LA led Public Health) with DWP and other programmes and approaches?

• What do we want measuring in terms of mental health employment outcomes?

Jonathan Allan

Shropshire Council

Jonathan.allan@shropshire.gov.uk

01743 276900