Pathways to Work and Pathways to Work and The Condition Management The Condition Management ProgrammeProgramme

Catherine Ryan, Jobcentre Plus

February 2006

Incapacity Benefit reforms pilot

Pathways to Work and Pathways to Work and The Condition Management The Condition Management ProgrammeProgramme

Eric Sharp

February 2006

Incapacity Benefit reforms pilot

Economic backgroundEconomic 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)

Health issues – an Health issues – an international perspectiveinternational 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

Health profile of IB claimantsHealth profile of IB claimants

• 35% Mental disorder

• 22% Muscular-skeletal

• 11% Circulatory/respiratory

• 10% Nervous System

• 6% Injury/poisoning

• 16% Other

Referrals received by Referrals received by Condition ManagementCondition Management

• 57% Mental Health

• 30% Muscular-skeletal

• 3% Cardio-respiratory

• 10% Other(Source CMP Management Information 05-06)

Implications of the prevalent Implications of the prevalent conditionsconditions• 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

Health profile of IB claimantsHealth 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.

Exit rates from IBExit 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)

Factors influencing return to Factors influencing return to workworkExit 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)

Health ConditionHealth 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

Effects of Unemployment 1Effects 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

Effects of Unemployment 2Effects 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 servicesRe-employment reverses the effects

Emerging views in Emerging views in RehabilitationRehabilitation• “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)

Principles of Condition Principles of Condition ManagementManagement• 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

Condition Management Condition Management essential featuresessential 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

Condition Management Condition Management ProcessProcess

• 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

Suddenly, Professor Liebowitz realizes he has come to the seminar without his duck.

Condition Management 1Condition 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

Condition Management 2Condition 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

Criteria for successCriteria 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

ChallengesChallenges

• 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

eric.sharp@centralderby-pct.nhs.uk