Derbyshire Jobcentre Plus Managers Workshop 12th/13th November 2002

1
Incapacity Benefit
reforms pilot
Pathways to Work and The Condition Management
Programme
Catherine Ryan, Jobcentre Plus February 2006
2
Incapacity Benefit
reforms pilot
Pathways to Work and The Condition Management
Programme
Eric Sharp February 2006
3
Economic background

• Since 1994, Job Seekers Allowance numbers have
  been falling
• However, Incapacity Benefit numbers rose from
  1979 to 2003
• Current IB levels nationally are about 2.6
  million people
• JSA is now under 1 million
• (Source ONS/DWP, in Green Paper)

4
Health issues an international perspective

• All cultures have long-term health problems,
  including chronic pain and depression
• However, the impact of these conditions on
  individuals and society is dependent on cultural,
  social, political and economic factors
• The prevalence of long-term illness has not
  increased, but the effects have

5
Health profile of IB claimants

• 35 Mental disorder
• 22 Muscular-skeletal
• 11 Circulatory/respiratory
• 10 Nervous System
• 6 Injury/poisoning
• 16 Other

6
Referrals received by Condition Management

• 57 Mental Health
• 30 Muscular-skeletal
• 3 Cardio-respiratory
• 10 Other
• (Source CMP Management Information 05-06)

7
Implications of the prevalent conditions

• Mental Health has become the most significant
  cause of long-term absence from work
• For those people with chronic pain, or other
  health conditions, secondary mental health
  difficulties set in
• Any programme working with vocational
  rehabilitation needs skills in managing both
  physical and psychological aspects

8
Health profile of IB claimants

• The majority of health conditions relating to IB
  claims are manageable
• That is, the type and severity should not prevent
  someone from working
• However, there are several factors influencing
  whether someone does return to work.

9
Exit rates from IB
Exit rate/ month Exit rate/ quarter
Month 1 12 32
Month 12 2.1 6.2
Month 24 1.2 3.6
Quarter 12 -- 2
(Berthoud 2004)
10
Factors influencing return to work

• Exit from IB is influenced by
• Health Condition
• Locality - Labour market issues
• Age
• Benefits received
• Length of time on benefit is this a causal
  effect or a selection effect?
• (Berthoud 2004)

11
Health Condition

• Whether someone is able to work is as much
  affected by their perception of their health
  condition as by the condition itself
• Emerging evidence shows that a bio-psycho-social
  approach is the most helpful in achieving
  rehabilitation
• That means that taking into account the
  psychological and social factors is more likely
  to get a result

12
Effects of Unemployment 1

• Isolation, social exclusion and stigma
• Changing health-related behaviour
• Disruption to future work career
• Trapping people on lower incomes than available
  through work

13
Effects of Unemployment 2

• Changed health behaviours include
• Increased smoking, alcohol consumption, obesity,
  drug use, suicide and some cancers
• Reduced physical activity and mental health
• Increased use of health services
• Re-employment reverses the effects

14
Emerging views in Rehabilitation

• Evidence based clinical practice . . .
  increasingly rejects both inactivity and
  prolonged rest as acceptable forms of treatment
  for the most common conditions reported on
  incapacity benefits
• (Grove/Harrison DH, 2006)

15
Principles of Condition Management

• Aims to reduce the impact of the health condition
  as a factor in remaining out of work
• Helps the participant to understand and manage
  their condition
• Works with mainstream NHS processes does not
  replace treatment
• Works as part of the Pathways process

16
Condition Management essential features

• Partnership between JCP and the NHS
• Clinical knowledge, skill and credibility
• Voluntary nature of participation
• Outcome focused approach symptom reduction is
  not a primary aim
• Active participation is needed

17
Condition Management Process

• Referral by JCP Personal Advisor
• Assessment by clinician
• Individual plan
• Group and/or individual sessions/modules
• Work alongside New Deal where appropriate
• Feedback to PA

18

Suddenly, Professor Liebowitz realizes he has
come to the seminar without his duck.
19
Condition Management 1

• Main principles
• Education knowledge about the health condition
• Cognitive replacing negative beliefs and
  behaviours
• Confidence building
• Increasing levels of activity
• Management rather than treatment

20
Condition Management 2

• Use of Cognitive Behaviour Therapy principles,
  even when not using formal CBT
• Employment oriented, but taking a whole person
  approach
• Encouraging greater activity, both physically and
  socially
• Learning to accept limitations, and work within
  them
• Using targets, facing challenges

21
Criteria for success

• Soft criteria
• Improved confidence
• Better understanding of health condition
• Hard criteria hardest first
• Entry to work, off Incapacity Benefit
• Starting substantial training or education
• Regular voluntary work

22
Challenges

• Engaging and retaining participants
• Keeping the participant moving through the
  pathway
• Managing attendance and numbers for group
  interventions
• Keeping elements of the programme in touch with
  each other and with other partners

23

• eric.sharp_at_centralderby-pct.nhs.uk