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

How well is the City performing/what have

we learned?

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

Current Costs

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.

A Possible Longer Term System

• 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?