Pathways to Work and The Condition Management Programme

Incapacity Benefit reforms pilot Pathways to Work and The Condition Management Programme Catherine Ryan, Jobcentre Plus February 2006

Incapacity Benefit reforms pilot Pathways to Work and The Condition Management Programme Eric Sharp February 2006

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) Economic background

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 issues – an international perspective

35% Mental disorder 22% Muscular-skeletal 11% Circulatory/respiratory 10% Nervous System 6% Injury/poisoning 16% Other Health profile of IB claimants

57% Mental Health 30% Muscular-skeletal 3% Cardio-respiratory 10% Other (Source CMP Management Information 05-06) Referrals received by Condition Management

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 Implications of the prevalent conditions

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. Health profile of IB claimants

Exit rates from IB (Berthoud 2004)

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) Factors influencing return to work

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 Health Condition

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 1

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 Effects of Unemployment 2

“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) Emerging views in Rehabilitation

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 Principles of Condition Management

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 essential features

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 Condition Management Process

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

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 1

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 Condition Management 2

‘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 Criteria for success

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 Challenges

eric.sharp@centralderby-pct.nhs.uk

Pathways to Work and The Condition Management Programme