Homes and Jobs

Social Inclusion for the disadvantaged

Homes and Jobs

Ian Bainbridge – Deputy Regional Director –Department of Health South East

Why do we need your help?

Homes and Jobs

Some groups find it very difficult to get jobs and houses without support. The Department of Health are keen to increase the number of vulnerable people

with their own home and a jobs, as work and settled accommodation are shown to increase the health, wealth and wellbeing of these groups, including;

• People with learning disabilities• People in contact with secondary mental health services• Care leavers• Offenders

Health, Work and Wellbeing

Dame Carol Black

Dame Carol Black National Director for Health and Work

Work and health

Increasing opportunities in the public sector

Guildford 25 June 2010

As far as possible all working age people

should have the opportunity to flourish at work

FLOURISHING IN WORK

CHILDREN AND YOUNG PEOPLE

PEOPLE WHO ARE EMPLOYED

PEOPLE WHO ARE NOT

EMPLOYED

In School, Training, Further

Education, or University

Flourishing in work

In Work

On Sick Leave

On Job Seekers

Allowance

On health related benefits

Not on work related benefits

Flourishing at work

Work and Health

Waddell and Burton (2006) Work is generally good for physical and

mental health and well-being

Galen (129-200)Employment is nature’s physician

and is essential to human happiness.

Theodore Roosevelt (1858-1919)The best prize that life offers is the chance to work hard at work worth doing.

William Osler (1849-1919)To the young it brings hope, to the middle-

aged confidence, to the aged repose: work.

Voltaire (1694-1778)Work banishes those three great evils:

boredom, vice and poverty.

And yet for too long, people with disabilities have been kept from work by discrimination, lack of reasonable adjustments and other peoples’ low expectations.

Long-term Worklessness – a Great Risk to Health

• Greater risk than many “killer

diseases”

• Greater risk than most

dangerous jobs (e.g.

construction, fishing, etc)

• 2 to 3 times risk of mental

illness

• Poor health in children of

workless families

• Social exclusion and poverty

Health of unemployed andre-employed men

Nottingham health profile

Emotional reaction Social isolation Physical mobility

A. Newman Taylor, after McKenna and Payne, 1989

Mean scores

Unemployed 18-24 months

Re-employed (unemployed

more than 6 months before)

Weighted random

population sample

0

5

10

15

20

25

30

35

Association between lower parental

income and poor health in children.

• Children in workless households

suffer higher rates of psychiatric disorders

• Behavioural/conduct disorders are

more likely where no parent in the

household is working

• Children living in workless

households are more likely to

experience worklessness

themselves during adult life

• 30% of children who have a parent

with a disability or health condition

live in poverty

Impact on the next generation

The Fundamentals

“People’s social and economic circumstances affect health throughout life, so health policy must be linked to the social and economic determinants of health.” Michael Marmot

Work & unemployment are social determinants of health.

“At the heart of this Review is a recognition of,

and a concern to remedy, the human, social

and economic costs of impaired health and

well-being in relation to working life in Britain.

The aim is not to offer a utopian solution for

improved health in working life, but rather to

identify the factors that stand in the way of

good health and to elicit interventions,

including changes in attitudes, behaviours and

practices – as well as services – that can help

overcome them.”

Working for a healthier tomorrow, 2008

Working for

a Healthier

Tomorrow

A new vision for health and work

Prevent illness, promote health, intervene early, improve the health of the workless.

Costs of working-age ill-health

Financial

• Overall costs of working-age ill-health in UK exceed £100 billion per year

• Around 172 million working days were lost to sickness absence in 2007, at a cost to the economy of over £13 billion (CBI)

Social

“If people are not healthy enough to work – or are inadequately supported through ill health to make a return to work possible – it is not just the individual or the business which is affected. The bottom line is often the impact on his or her family and children.”

Lane Lecture, University of Manchester, November 2007

Worklessness is a greater risk to health than many ‘killer’ diseases.

Problems with the UK system in 2007-2008

Workplace culture

• Misconceptions about health and work – “need to be 100% fit”.

• Poor retention in work of those with disabilities or chronic disease.

• Workplace and employers often needing a different culture and approach.

Inadequate systems

• Inflexible system of sickness certification that labelled you as sick even when it was inappropriate.

• No pathways of rapid intervention to keep you in work or return you to it.

• Health, work and well-being not part of training curricula or clinical practice,

leading to poorly-informed healthcare professionals with little

understanding of work as a determinant of health.

Lack of Primary Care involvement

• Rehabilitation to work not a performance measure for Primary Care Trusts,

which therefore show little interest.

• No Occupational Health services in Primary Care. Patchy OH elsewhere.

• Two-thirds of sickness absence and long-term incapacity is due to mild and treatable conditions:

• Depression, anxiety, stress-related mental health problems (est. cost £28.3 bn in 2008)

• Musculoskeletal conditions – mild and often soft tissue (est.cost £7 bnin 2007)

• Cardio-respiratory conditions

• Inappropriate “medicalisation”

• Poor retention in the workplace of those with disabilities or chronic disease

Why people are off work in the UK and many other countries

‘Causes of the causes’?

Economic Costs of Mental Ill-Health

£100 billion is lost to the economy because of working-age ill health and

associated sickness absence and worklessness. Estimated that between

£30-40 billion can be attributed to mental ill-health. This includes:

• Lost production of people who are on sickness absence or out-of-work

benefits

• Lost production of people of working age who provide informal care, and

• A proportion of NHS healthcare costs used to treat people of working age

with a mental health condition

“Some of these costs fall directly to individuals with mental health conditions and are mitigated through the tax and benefit system.Estimated that the government pays around £8 billion every year in benefit payments to people with a diagnosed mental health condition.”Working for a Healthier Tomorrow

Mental health as a reason for claiming incapacity benefit : Scotland

Percentages of all IB claimants who were claiming for a mental health problem in February 2000 and 2007:

56.237.844.2February 2007

46.528.833.6February 2000

Of credits-only claimants (%)

Of payment claimants (%)

Of total claimants (%)

Quarter ending

Note: “Credits-only claimants” have a poor employment history.

• The ‘mental health’ proportions are all increasing.

• More of those with poor employment history claim because of a mental health problem.

Early intervention – ‘turning the tap off’

Old system - paper ‘Sick Note’ New system ‘Fit Note’

Uninterrupted flow of the untreated unwell.

Cultural and behavioural change requiredEarly intervention reducing the

flow on to incapacity benefits

Working for a healthier tomorrow, 2008

“Tackling stigma around ill-health and disability will be key to enabling

more people with health conditions find work and stay in work. This is

particularly true for those with mental ill-health, as many organisations

often fail to recognise the full value of the contribution they can make”

“The sheer scale of the numbers of people on incapacity benefits

represents an historical failure of healthcare and employment support to

address the needs of the working age population in Britain. Over 200,000

people with mental health conditions flow on to incapacity benefits each

year, and this figure has not changed over the last decade.”

“Government must fully integrate the option of specialist mental health

provision into its employment programmes – not just for those on

incapacity benefits – but for all those who are workless, whether lone

parent, jobseeker or Income Support recipient.”

‘Working for a healthier tomorrow’. Dame Carol Black 2008

The System and the Barriers

The system may help or hinder people:

• GPs, specialists, counsellors etc. need to support the role of work.

• a joined-up approach with agreed goals and coordinated themes for all those involved is needed.

Potential barriers:

• how to get started in work if you have had a mental health problem whilst in the education system

• occupational health questionnaires which filter out people with mental health problems or force them to disguise the truth

• sick leave and benefits systems which, for some, become traps preventing return to work rather than supporting it

• lack of flexible and supported entry or return to work

Achieving well-being at work

• Reward small business workplace innovation with

Challenge Fund

• Develop a UK-wide network of Health, Work and

Well-being Co-ordinators

• Work with EU partners - on new criteria for

organisations to assess the quality of their mental-

health-related workplace health

• Encourage managers to use HSE’s competency

framework for line managers and commit to training for managers

• Encourage the public sector to review their

recruitment retention and prevention procedures for

people who use secondary mental health services

• Promote good practice – there are some fine

examples

Employment Advisors

• Part of Improving Access to Psychological Therapies (IAPT)

• Pilot study started mid 2009

• So far, around 1000 people have accessed their services

• 70-80% of those seen retain employment

• Early intervention is key

Case study

My client was employed in I.T.

His depression and shift

rotatations were causing him

problems with sleep, resulting in

tiredness at work. I set up a

meeting with his employer, at

which we agreed changes to his

shift patterns. He returned to

work in October and is coping

well.

Common Mental Health problems at work: surveying progress

• Common Mental Health Problems are widespread, and are the health problem of working

age; but most employers are not aware of the high levels of associated morbidity

• Employees do not have to be entirely symptom-free to remain in or return to work

successfully.

• Line managers need effective skills development and training

• Independent case management by third-party specialists is critical to achieving successful

outcomes for individuals and organisations where employees are not recovering as

expected.

• The workplace is an important but not the only setting for delivery of effective interventions

• There is a sufficient body of evidence to inform the development of important services and

interventions that can keep people with CMHPs in work or facilitate their return.

• Research in the UK has not advanced far in the five years covered by this update review,

and there is a need to replicate critical findings within a British context.

(Courtesy of Bob Grove, Sainsbury Centre for Mental Health)

Sainsbury Centre

Workplace Programme

• Training programme aimed at giving managers confidence to respond to staff experiencing mental distress.

• Based on the proven beyondblue National Workplace Programme (Australia)

• Excellent results in UK pilot:• Builds awareness of

depression and

anxiety, and trains

managers to spot symptoms.

• Allows time for

discussion, and helps

Health for Work Adviceline

• Free GB-wide Occupational Health telephone advice line pilot aimed at reducing sickness absence and avoidable job loss

• Professional occupational health advice on individual problems, and information about local services, by nurses with extra Mental Health training

• Focus on helping manager resolve individual employee health at work problems (especially mental health issues)

• Target audience: employers/managers in businesses with fewer than 50 employees

• Also in scope: businesses with 50-249 employees, GPs

08000 77 88 44

Early life: building resiliencefor our future workforce

To increase the life chances of young people :

• Improve support in education

• Encourage supportive parenting and relationships

• Provide early and co-ordinated intervention

Four recent Reports address this:

• Foresight, Mental Capital and Wellbeing;

• The Black Review Working for a Healthier Tomorrow;

• Working our way to better mental health: a framework for action;

• The Marmot Review.

“…to give every child and young person the best possible chance tothrive, families carers and health and education systems must act together to promote wellbeing and foster skills for resilience.”

So how much of the journey is left to go?

• We’re not there yet!

• All individuals and

organisations concerned

with working-age

healthcare need to

cooperate if we are to

improve the health of the

working-age population

Homes and Jobs

Social Inclusion for the disadvantaged

Care Leavers experience of

working with their service- Jessica Inwood, a young persons perspective

My Story

Dawn North and Robert King

Workshops

Please choose one

Workshops

Janine Hobbs – Jobcentre Plus

WORKSHOP A

How Job Centre plus can support your organisation

Kathy Melling – National Lead for VPN (Learning Disabilities)

WORKSHOP B)

Making Recruitment accessible for hard to reach groups

Clare Cherry – HMPS –Partnerships Team

WORKSHOP C

Managing and Minimising Risks

David Raison – Richmond Fellowship (Mental Health employment specialists)

WORKSHOP D

Improving Retention

Workshop Feedback

Feedback from workshop facilitators and questions

Harnessing the power of

the wider organisation

Influencing jobs and training for disadvantaged groups through

the procurement process

Lunch

Lunch is Served - Please be back promptly

36

respect trust listen responsible

June 2010

Carmel Millar

Head of HR&OD

Making a Difference

DVD

• Valuing People Now

• What we have done

• Our success in realising potential

• Working with Employability

Realising Everyone’s Potential

Jenni Brown

Surrey County Council’s Supported Employment

service

Currently only Learning Disability and Autism

Open Referral

Work with colleges and schools

Supporting around 630 people across the county

Support

Train

Place

Minimal monitoring

Employer Support

Resolution

Advocacy

Induction

Workplace training

Travel Training

Meet client

Vocational profile

Job search

Work experience

Job Carving

Recruitment

Risk Assessment

Supported Employment

• 43 year old, never worked

• Attending day centre for 15 years

• Communication difficulties

• Wanted to work in an office

• Liked cooking

• Job Carving

• Works 2 days a week

• Travel Training – catches bus

“I enjoy everything about

my job. It is important to me

that I get paid. My job

makes me feel good, and

the staff I work with are

friendly. Every Friday I look

forward to having fish and

chips in the staff canteen”

Sarah

Case Study

Working together HR&OD and EmployAbility

Established

Job carving

Work trials

Working Interviews

Easy-Read documentation

30 People found paid work

• Benefits for individuals

• Benefits for the council

• Benefits for the community

Commitment

• Recruitment strategy and methods

• Objective in E&D action plans

• Job carving at source

• Job design

• Support & Training

• Website meets accessibility standards

Homes & Jobs – Social Inclusion

INCREASING EMPLOYMENT OPPORTUNITIES IN THE PUBLIC SECTOR

25th June 2010.

Who we are

West Sussex Works

Paritas Synchronise

Recruitment servicesfor people who have experienced mental health problems

Employer engagement forum in West Sussex

Leading by Example

Managing Wellbeing

Strategic

National Mental Health and Employment strategy

Perkins review ‘Realising ambitions’.

NICE guidance Mental Health in the Workplace.

NHS Health & Wellbeing (Boormanreview)

New Horizons

Public Service Agreements (PSA16)

Public Sector as exemplar employers.

Disability & Equality Duties.

Local Area Agreements.

Strategic & Policy Public Sector Duties

Managing WellbeingEmployer

Over 200,000 working days are likely to be lost across the public sector in West Sussex due to mental ill health every year.(average absence per employee 2.8 days due to stress & mental health- Sainsbury

Centre)

Mental Illness related absence is likely to cost public sector employers in West Sussex over £75 million pounds a year.(The cost per employee is over £1000 Sainsbury Centre)

3 in 10 employees will experience some kind of mental health problem in any given year

Stress is the second biggest reason for absence in the UK

Over 50 % of employees conceal mental ill health in the workplace.

Very real need to keep employees in work and performing during a time of recession.

Managing WellbeingCommunities

1 in 6 people will be experiencing a mental health problem at any given time. (over 100,000 people of working age in West Sussex)

Around 10,000 people are receiving Incapacity benefit or Employment

Support Allowance (ESA) on the basis of a mental health condition in

West Sussex .

Possibility of developing depression after 6 months unemployment is 1 in 6. Total people not in employment (including Jobseekers Allowance claimants) is over 12,000 people in West Sussex.

Low employment rate of under 25 % for people with a mental health

condition.

Over 50 % of people would not disclose to an employer.

What we do

Paritas Services

Paritas provides talented people to meet recruitment needs

Paritas helps to manage wellbeing in your workplace

Paritas provides ongoing access to mental healthinformation, training and resources.

Paritas acts as a champion in promoting wellbeing in the workplace and positive images of mental health.

The audit tool

Designed to enable public sector to,

Meet strategic objectives & policy requirements.

Support wellbeing of current workforce.

Recruit people who have experienced mental health problems

Create workplace accessible to disadvantaged people

Exemplar Employer

Employer Training

Delivered to over 300 managers across WSCC, NHS West Sussex,Library service & Fire and Rescue service

‘Mental Health and Employment’ training designed to provide in-depth and stimulating training to managers

Delivered through training seminars and supported byParitas Line managers guide

Recruitment services

Partnership with Recruitment Agency

Assessment and matching

Ongoing vocational support

Impact and success

Recommendations for introduction

Creating mentally healthy organisations

Enable

Develop

The Paritas services can

The Paritas services could

achievement of strategic objectivities and policy requirements.

support for wellbeing of current workforce

recruitment of people who have experienced mental health problems.

becoming an exemplar employer

partnership working of public sector in South East.

setting of cross organisation benchmarks

sharing of good practice

becoming an exemplar public sector network

Enabling People

David Cain

01903 204083 david.cain@westsussex.gov.uk07894 603813

diversity is a fact of being human

diversityis inclusive of all people

diversityis how we are different

Panel Discussion

How to make it work

Panel Discussion

How to make it work

Locality Support Groups

Diversity in practice

Case Study

“Out of the blue your job is gone, and with it any financial security you may have had. At a stroke, you have no

purpose in life, and no contact with other people. You find

yourself totally isolated from the rest of the world. No one telephones you. Much less writes. No-one seems to care

if you are alive or dead.”Realising ambition December 2009

Posed by model

Case Study“My first job, a few months after leaving

the psychiatric hospital, was as a

customer services assistant. Previous to this I had no experience in the retail

industry so the prospect of serving customers, during probably the busiest

time of the year, was incredibly

daunting. But what became apparent was that, whilst working in a busy store

and having so many customers to serve I wasn’t reflecting on my thoughts or

becoming paranoid about my problems. Remaining focused upon the jobs

required, coping with having lots of

people around, made it much easier.”Realising Ambitions (Dec 2009) Posed by model

Case Study

• Started part time work at school

• Foxes Academy

• Moved to supported Living

• Work experience in local pub

• Prepares sandwiches, vegetables etc

• Learnt to travel on bus

• Offered paid job

• Staff very supportive

• Parents support important

“All we wanted for Mikael was a normal life. Thanks all those who have helped, he

now has a job, a flat and friends and is part of his local community”

Mikael’s mum

Close

Thank you for coming and to all those who contributed to today’s event – please complete feedback