Supporting benefit recipients' health and wellbeing: A role for the Personal Adviser?

1. Supporting benefit recipients' health and wellbeing: A role forthe Personal Adviser? Jenny Ceolta-Smith PhD student 20th September 2012 NIHR CLAHRC for South Yorkshire

2. What I will cover • Rationale • Developments-Personal Adviser (PA) role • The multidimensional PA role • The Work Programme PA role • Illustrations from Work Programme observations and interviews • Overarching issues • Implications to policy and practice

3. Rationale • Personal Adviser plays a central role in supporting people into work (Dickens, Mowlem and Woodfield 2004, NAO 2006, Hasluck and Green 2007). • "The role of personal advisers in provider organisations will be crucial in the effective delivery of the Work Programme." (House of Commons Work and Pensions Committee Work Programme 2011 p 45). • Differential treatment: ‘creaming’ and ‘parking’ (NAO 2005, Hudson et al. 2010).

4. Developments: PA role • 'The PA role is still very new. We need to define the ideal PA or job description of competencies. We need a common understanding of the role, because different people will consider PAs as doing different things.’ (Parry and Crawford 2010, p51) • The Professionalisation of Welfare Expert Reference (PoWER) group • New Institute of Employability Professionals

5. Realist review • To increase our understanding of the PA's role in relation to supporting claimants with long- term illness • Does a PA need to adopt different roles in order to provide health related support interventions?

7. PA role Legitimacy and preparedness of PAs to engage in activities that are more typically associated with health professionals

8. Work Programme PA roles Work Programme bid analysis: • Continuity versus split • Generic role • Specialist roles, e.g. providing specific health support • Integrated with in house health care professional •  Sector specific

9. Illustrations from Work Programme observations and interviews

10. Assessor • …generally I’ll find out all about them so I know, I know John inside out, (…) if he doesn’t manage his diet then he can get hypoglycaemic, and does, so his friends will end up picking him off the floor and rescuing him and he’ll end up in Accident and Emergency …

11. continued • …so I know that John has got type one diabetes, so what I’m doing at the moment, I’m trying to understand what that means and how that affects his life, right down to when I offer him a drink and he has a tea with one sugar, then if he’s had a drink before he arrives here he’ll say no, right, and that’s, I think that’s because, I don’t know whether it’s sugar or what it is, so I’m trying to understand that… • Work Programme PA

12. Enforcer …they’ve had customers who’ve been so ill that they’ve mandated them to go and see their GP, and they’ve had serious illnesses as well, like cancer and stuff, and they’ve mandated them, saying if you don’t go and see your GP I’m going to sanction your benefits… Work Programme CMP practitioner

13. Monitoring health and wellbeing • During interactions- phone, face to face and in groups e.g. mood, behaviour, appearance, diet • Self diagnosed and undiagnosed health conditions • Impact of: WCA, sanctions, appeals • "Suicide watch"

14. Advocate Supporting: • Appeals: WCA and sanctions • Not fit for work message • Protecting from sanctions

15. Overarching issues • Work Programme participants do have real health related barriers and needs • Welfare reform may impact on individuals' health and wellbeing • PAs are involved in supporting individuals' health and wellbeing needs • Who is responsible for Work Programme participants' health related needs?

16. Policy implications • Black box approach-are health needs adequately addressed? • Conditionality and ESA? • WCA - impact on individuals' health and wellbeing

17. Practice implications • Legitimacy of role-boundaries, level of responsibility, power and discretion • Impact on benefit recipients' health and wellbeing • Mixed messages fit versus not fit for work • Preparedness- training, levels of support and access to health professionals

18. References • Dickens, S., Mowlam., A. and Woodfield, K. (2004). Incapacity Benefit Reforms –the Personal Adviser Role & Practices. Department of Work and Pensions Research Report No. 212, Leeds, Corporate Document Services. •  Hasluck, C. and Green A, E. (2007). What works for whom? DWP Research Report No 407, Leeds, Corporate Document Services. • GREAT BRITAIN, House of Commons Work and Pensions Committee (2011). Work Programme :providers and Contracting arrangements. London, The Stationery Office. HC 718 (2010-12). •  Hudson, M., Philips., Ray, K., Vegeris, S., Davidson, R. (2010). The influence of outcome-based contracting on provider led pathways to work. DWP Research Report No 638, Leeds, Corporate Document Services. • National Audit Office (2005). Gaining and retaining a job DWP’s support for disabled people. Report by the Comptroller and Auditor General; HC 455 Session 2005-2006. • National Audit Office (2006).Jobcentre Plus: Delivering effective services through personal advisers. Report by the Comptroller and Auditor General; HC 24 Session 2006-2007. • Parry, F. and Crawford, E. (2010). Professionalising the welfare to work industry: developing a framework for action [online] Last accessed on 26th October 2010 at: http://www.cesi.org.uk/Resources/CESI/Documents/Professionalising_the_welfare_to_work_industry.pdf

19. Contact Email: J.A.Ceolta-Smith@shu.ac.uk

20. This research was supported in part by NIHR CLAHRC for South Yorkshire.  The views expressed in this presentation are those of the author and not necessarily those of the NHS, the NIHR or the Department of Health. Further details, including partner details, can be found at http://www.clahrc-sy.nihr.ac.uk NIHR CLAHRC for South Yorkshire

21. Acknowledgements • To supervisory team: Sarah Salway and Angela Tod