My last blog post covered the Work and Health Programme (W&HP) for disabled people who had been “identified as being capable of finding work within a year of starting the programme”. In that study, only 19% were in work 18-24 months after starting the programme, and half of those were in part-time work. This was only three percentage points higher than the control group. Nearly half of the programme participants were no longer looking for work after 18-24 months, despite the expectation that they should have been able to find work 6-12 months previously.
In this post, I am looking at the Health-Led Employment Trials (HLETs). This trial was for people with mild/moderate mental and/or physical health conditions who were being treated in primary and community care (such as IAPT and pain clinics) settings. Trial participants had substantial health problems, with widespread fatigue, pain, anxiety, and depression amongst other health issues.
Compared to the W&HP participants (W&HPPs), HLET participants (HLETPs) were much more likely to report a lack of confidence in abilities or skills: 58% reported this as a factor that had made it difficult for them to find work, whilst 53% of those who were in-work but struggling also reported a lack of confidence in abilities or skills. In comparison, only 6% of voluntary participants in the W&HP cited lack of self-confidence as a barrier. The reports do not give the exact questions asked, so self-confidence may not be measuring the same thing as confidence in skills and abilities. On the other hand, the W&HPPs were healthier than the HLEPs. For example, in the W&HP 50% of voluntary participants reported mental health problems, compared to 66% reporting depression and 81% reporting anxiety in the HLETs. Similarly, 12% of W&HPPs reported a learning disability, compared to 20-21% of HLETPs. Unfortunately, the different reports did not use the same categories, so most direct comparisons are not possible, but it seems clear that the HLETPs were substantially more sick or disabled than the W&HPPs.
The HLETs were based on Individual Placement and Support, which is an intensive employment support programme for people with severe and enduring mental illness. IPS combines robust secondary mental health care with job brokerage and voluntary employment support. The HLETs were time-limited, and involved limited job brokerage compared to the full IPS model. Despite being aimed at people with ‘mild/moderate’ health problems, 29-33% of out-of-work participants and 39% of in-work participants said that they were limited ‘a great deal’ in everyday activities by their illness or disability. The report authors note that “it was common for recruits to have 6 or more interacting health conditions.” Interestingly, in-work participants reported higher rates of anxiety (86% vs 76% and 81% for the two out-of-work groups), depression (68% vs 68% and 64%), fatigue (72% vs 61% and 60%) and being limited ‘a great deal’ (39% vs 33% and 29%), though the report authors do not comment on whether these are statistically significant.
The employment outcomes for the HLETs are very low, and were not replicated within the study across different groups. Of the two out-of-work groups, WMCA saw a four percentage-point (4ppt) increase in employment compared to the control group (18% control vs 22% treatment), but SCR saw a non-significant 2ppt decline (27% control vs 25% treatment group). Participants at SCR experienced an increase in health and wellbeing by 0.1 and 0.12 standard deviations, but the improvement at WMCA was smaller and non-significant.
The report authors comment on factors thought to improve employment outcomes, yet the employment outcomes themselves were small and not repeatable within the study itself: only one of the two sites saw an increase in employment; and the employment rates at that site were still lower than at the site that saw a non-significant decline in employment. The authors cite healthcare and improved health management as contributors to people’s capability and self-belief; but as the majority of these people did not then get work, it is unclear whether a person’s self-belief, or subjective perception in capability separate from any objective improvement, are material factors in getting work. On the other hand, a stronger labour market could mean that employment support is less important (or even unnecessary) to moving into work – so perhaps Labour could focus on strengthening the labour market as a more positive and reliable approach to increasing employment rates for all people groups.
“Engagement with employers, and taking a holistic view to obstacles to the labour market… [and] identifying hidden vacancies and supporting job development” were also mentioned as contributing to employment outcomes. This is much more intensive than Labour’s recent discussion of CV writing and interview techniques.[1] Furthermore, Labour’s 1000 work coaches for 65,000 sick and disabled people is both well below the number of people who limited capacity for work, and a far higher caseload per work coach than the HLETs recommend. The IPS model recommends a caseload of no more than 20 clients per employment support worker; the HLETs aimed for 25-35. The HLETs report authors recommended that “future implementation might benefit from smaller, specialised caseloads.”
The report authors note that there were negligible financial returns from the employment programme (the cost of supporting people into work was pretty much equal to the financial savings made from moving slightly more people into work at one of the sites). It was possible that there were some wider economic benefits due to improved health at SCR (the site that didn’t have an increase in employment outcomes) but these results were not robust.
Overall, this group of people seems to have been more ill and disabled than the W&HPs. Nevertheless, employment rates after a year were higher, at 18-27% compared to 16-19% for the W&HPPs. This may reflect the labour market, as the higher employment rates within HLETs were seen at the site with a stronger labour market. It may also reflect the value of providing healthcare support. The report authors noted that “where [participants’] health was already improving as they entered the trials they could move towards employment, but those with degenerative or relapsing conditions were less able to benefit from support to find work”; and motivation to enter work “was often connected with a feeling that it was the right time as their health condition was no longer preventing them working”.
Looking at this report, there is little-to-no financial gain to the government from supporting sick and disabled people into work, because of the cost of the support needed to get a small increase in work. More reliable returns are likely to come from improved healthcare, as an improvement in health is often a key contributor to moving into work; and from a strengthened labour market, as the control group in WMCA out-performed the treatment group in SCR.
Comments