Improving Lives: The Future of Work, Health and Disability

  • By Jenny Gulliford

The Improving Lives: The Future of Work, Health and Disability paper published on 30 November 2017 is a response to the Improving Lives: the Work, Health and Disability Green Paper that sets out the actions that the government will to take in achieve its manifesto commitment of a million more disabled people in work over the next 10 years. A range of pilots are announced, with a commitment to scale up successful activity in the future. Nation-wide implementation is not expected until the early 2020s.

Background

Halving the disability employment gap was a key government manifesto commitment in the 2015 election. In 2017 the government’s manifesto commitment changed to supporting a million more disabled people into work over the next 10 years. This led to the creation of the Improving Lives: Work and Health Disability Green Paper, which was published in October 2016. London Councils responded to the associated call for evidence, arguing for a radical change in way in which disabled people and people with long term health conditions are supported to enter and stay in work. We argued that many disabled people will need a range of services working together to do this, and that local government is well placed to deliver the integrated support people furthest from the labour market need. This policy stream has been led by the Work and Health Unit (WHU), which sits across the Department for Work and Pensions and the Department for Health.

Analysis

The paper splits the government’s strategy to support a million more disabled people in to work into three areas:

  1. The welfare system
  2. The workplace
  3. The health system

This paper is envisioned as the beginning of a two to three year period in which a strategy for transformative change will be taken to parliament.

The Welfare System
The government is committed to finding out ‘what works’ in supporting disabled people to enter and say in work, particularly people who have the most complex barriers to work and who are furthest from the labour market.

People in the ESA Support Group are not required to look for employment, but may volunteer to receive support to do so. The government seeks to look at new ways of encouraging more people in the Support Group to undertake work-related activity, and have developed a ‘proof of concept’ to test different engagement methods in 2018.

There are relatively few system-wide announcements made in the White Paper, which instead focuses on piloting new ways of working and gathering evidence. An exception to this is the government’s commitment to ensure all young people with Education, Health and Care Plan have the opportunity to undertake a supported internship.

The paper sets out a range of employment pilots that will be undertaken over the next years, many of which were previously announced in the earlier green paper. Notable examples include trialling:

  • Group work trials – combining interventions to improve motivation with job search skills training.
  • Personal budgets for employment support
  • JOBS II – a voluntary programme of facilitated peer support for disabled jobseekers.
  • Two new IPS trials in the West Midlands and Sheffield City Region combined authorities, testing an adapted programme for people with physical health condition and mild to moderate mental health conditions and in new settings such as primary and community care.
  • Voluntary interventions for the ESA support Group.

The paper also considers the long-term plan to replace the Work Capability Assessment (WCA). It announces the government’s plan to begin with small scale tests before moving to larger scale reform, designed to:

  • Improve customer support and experience
  • Provide greater data links between the different benefit assessments
  • Bring the WCA in-line with recommendations made in the Gray Review of the Personal Independence Payment (PIP).

The Workplace
The paper identifies a lack of easily accessible and understandable information aimed at employers as a key barrier to enabling more disabled people entering and staying in work. The paper commits that the Work and Health Unit will begin to explore how best to tackle the ‘advice issue’ later this year – seeking to understand what employers need and how can disparate information sources can be brought together.

The paper announces welcome reforms to the Access to Work scheme – allowing people to take equipment purchased through the scheme with them to new jobs rather than having to re-apply, trialling the use of personal budgets, and significantly expanding the Mental Health Support Service to meet rising demand.

The government is committed to leading by example, and the paper sets out the ambition that the Civil Service will become a beacon of good practice and a leading employer of disabled people and people with long term health conditions, undertaking a range of new initiatives. It seeks to work with the wider public sector to work collaboratively on this issue. A ‘Work, Health and Disability’ summit will be held in spring 2018 bringing together leaders from across the public sector, including local government. The Summit will be chaired by a Minister.

The paper has a focus on encouraging change in the work place through voluntary actions, and continues to promote the Disability Confident scheme as its flagship programme to inspire companies to change. The government will also ask organisations with over 500 employees to voluntarily publish the actions that they are taking to address poor mental health in the workplace.

Improving the way in which sickness absence policy works in this country is also identified as a key challenge and the paper announces a commitment to reform the current ‘Fit Note’ system, and make the way in which sickness absence is managed through the health service much more flexible. The government is considering a range of options, including extending the ability to sign individuals off work sick from GPs to other elements of the health care system, such as occupational health; giving people a ‘right to return’ to a job after a period of sickness absence, and financial incentives for employers.

Not announced in the paper, but stated in the accompanying press release, the Government has now confirmed that they will be closing down the Fit for Work service on 31st March 2018 due to low referral numbers. Employers, employees and GPs will continue to be able to use the same Fit for Work helpline, website and web chat, which offers general health and work advice as well as support on sickness absence.

The Health Service
The paper announces a number of ‘light touch’ schemes designed to raise awareness and practical understanding of the relationship between work and health, such as the creation of ‘Work Champions’ among GPs in CCGs and among Public Health professionals. More training will be provided for GPs at both an undergraduate and post graduate level, and a programme of encouraging employment data to be collected as part of health data collection will be undertaken. A new national knowledge hub will be established to understand ‘what works’ in supporting people with MSK related conditions to find and stay in work.

The paper provides an update on the schemes announced in the green paper, including the commitment to put more employment advisors in IAPT services. Implementation support will also be made available to Individual Placement and Support (IPS) schemes as part of the ‘IPS Grow’ project, helping them to achieve value for money and sustainability.

The lack of access to occupational health services for those most likely to fall out of work was identified as key issue in the green paper. While larger employers are more likely to provide their staff with paid-for OH provision, employees working in SMEs are left without support. This is hampered by a lack of join up between GPs, employers, other health care professionals and Jobcentre Plus. The paper commits the government to setting out a clear strategy for reform by 2019/20. This will be informed by the work of a new Expert Working Group to build the evidence base and who will explore new modes of funding and provision.

There is some focus on the role that local areas can play in tackling problems within the Public Health system. Pilots will be undertaken by the Greater Manchester Combined Authority and in Scotland exploring how best to integrate health and work support at a local level. In Manchester this will be called the Working Well Early Health Programme. The importance of ‘local partners’ is recognised, but no specific mention of local authorities.

Commentary

There is some recognition of the work that local authorities are already doing in this area, but little consideration of the way in which this could be expanded and built upon. The focus remains on in-house activity – primarily small pilots delivered through DWP, although there are some pilots taking place in partnerships with combined authorities in Sheffield and Greater Manchester. The roll of ‘local partners’ is recognised but not fully articulated, so London Councils will continue to work to persuade government of the benefits of working closely with local government.

The focus on piloting and understanding ‘what works’ is welcome, but must be acted on. The paper does not demonstrate the ambition London Councils believes is needed to address the long term and entrenched factors that drive chronic unemployment among disabled people, with the current welfare system relatively untouched.

The follow-up activity of the work that the paper commits the DWP and the Work and Heath Unit to over the next years will be a crucial measure of the government’s commitment to tackling this issue. Will these pilots translate into real systems change, bringing in local partners and the services that disabled people need to enter and stay in work? Further detail on this, and the contents of the proposals that will be set out to Parliament, will be vital to judging whether this programme of work is enough. The government should also consider looking at successful local programmes as well as national DWP-funded schemes.

The decision to close the Fit for Work service as a result of low referrals numbers means that there is now a clear gap in provision in this area, and we believe that a local alternative should be considered. London Councils will take this opportunity to push government on this issue.

The focus on prevention and in-work support is a positive step towards creating more open and inclusive workplaces, and recognises the role of employers in tackling the disability employment gap. London Councils looks forward to working with government in their ambition to make the Civil Service and the wider public sector beacons of good practice.

Jenny Gulliford, Principal Policy Officer

E: [email protected]
T: 020 7934 9756