Health and work strategy: review report

8 Access To Fair And Healthy Work

Recommendation 1.1

Increase access to Individual Placement and Support (IPS) and use learning from the approach to support people with less severe health conditions and disabilities who are seeking work.

Implementation

• Support Scotland wide access to IPS for individuals with severe and enduring mental health conditions to enable them to access work.
• Test the wider applicability of the IPS approach for people with a wider range of disabilities and long-term health conditions.

Evidence/Rationale

IPS is an internationally recognised, heavily evaluated and effective^[55], cost-effective though expensive model for people with severe and enduring mental health conditions, and involves intensive individualised support, placement in paid employment and long-term support for the employee and employer. It is not, however, currently available in all areas, with training for practitioners and effective cross-organisational working required to enable wider access.

It would also be useful to explore the evidence base for, and pilot the wider applicability of a lighter-touch model for less severe conditions, indeed the idea of 'IPS Light' was proposed as part of the Single Gateway Pilot bid though it was not supported at the time by the UK Health and Work Unit. Caution around describing the approach would be needed to avoid confusion with practice based in the IPS fidelity model^[57].

IPS within Fair Start Scotland has been highlighted for review within the Scottish Government's Fairer Scotland for Disabled People: Disability Action Plan^[11](2018) which is to be welcomed and its wider applicability is worth exploring.

Target Audience

Those seeking work, and potentially at risk of losing their existing work, as a consequence of a severe mental health issue or other disability or long term condition.

Stakeholders

Scottish Government (SG) Employability, Employability Providers, NHS, Local Authorities and 3^rd Sector organisations.

Cost

A pilot would not incur significant expense though it would require appropriately scaled evaluation. Wider roll-out based on the wider experience of IPS would be cost effective in terms of return on investment.

Complexity

IPS is already available in Scotland meaning there is the experience to support its integration, as well as learning from any 'IPS light' approach, into existing employability programmes.

Impact

Greater sustainability of disabled people in work would positively impact the disability employment gap.

Recommendation 1.2

Increase the number of people able to gain support through the Access to Work.

Implementation

• Scale up investment in Access to Work, through advocacy with UK Government.

Evidence/Rationale

The Access to Work grant scheme is an effective^[58] though relatively small-scale intervention to support people with disabilities or long-term conditions, including mental health issues, with special equipment, adaptations or a support worker. It supports people to remain in work and to access work and is a well-regarded and effective scheme. Increasing awareness amongst employers and employees would increase the number of people supported.

Access to Work features prominently in the Scottish Government's Fairer Scotland for Disabled People: Employment Action Plan^[11] with a commitment to invest up to £500,000 to pilot support similar to Access to Work to support disabled people undertaking work experience or work trials. With the average award being £3,000, this investment would potentially support an additional 170 people in Scotland.

Target Audience

People with a disability or health condition who are either in work and struggling with an aspect of their job because of their condition, or who are about to start or return to work.

Stakeholders

SG Employability, DWP.

Cost

Investment in Access to Work is cost effective at approximately £3,000 per person assisted according to UK figures quoted by the Scottish Government^[2].

Complexity

Access to Work is an existing programme, but is currently reserved to the UK Government. Greater awareness of the scheme should assist in greater awareness and take up of support.

Impact

The greater the number of individuals supported, the greater the impact on the disability employment gap.

Recommendation 1.3

Encourage recruitment practices that are fully supportive of, and not inadvertently creating barriers for, people with health conditions and disabilities.

Implementation

• Provide, as an extension of existing employer focused advice such as Healthy Working Lives, advisory support and good practice guidance to employers, especially SMEs, to ensure recruitment policies and processes are fully disability and mental health aware.
• Public sector bodies should be exemplars who can test, using the Health Inequalities Impact Assessment^[58], and model good practice.

Evidence/Rationale

The Equality Act has built upon previous legislation to protect employees and potential employees from discrimination, including on the grounds of disability and health conditions, however unintended barriers remain. Careful use of language, such as avoiding phrases such as 'the ability to work under pressure,' a potential barrier to someone with an anxiety related condition, proactively highlighting jobs that would be suitable, and using alternative recruitment methods to traditional interviews are examples of practices that can overcome such barriers.

The Scottish Government's Fairer Scotland for Disabled People: Disability Action Plan^[11] and the Fair Work Action Plan^[12] both include actions relating to this, and such actions should be implemented in a way that make sense for employers in terms of accessibility and joined-up messaging.

Health Inequalities Impact Assessment^[58] is a tool that can be used to test approaches and identify and eliminate practices that inadvertently discriminate.

Target Audience

Individuals with disabilities or health conditions seeking work or wishing to move on to new roles.

Stakeholders

All employers, especially those lacking internal HR functions such as smaller employers. Public Sector organisations have an important role to play as exemplars.

Cost

Minimal, on the basis that initiatives have already been announced. Integration with existing employer focused support will be more efficient than creating something new and stand-alone.

Complexity

The key is ensuring the solutions meet the needs of employers, which will require detailed employer engagement. The new advisory support will be most effective if it is delivered in a coherent way that connects to existing employer focused services such as Healthy Working Lives.

Impact

Removing barriers to jobs and career development will help close the disability employment gap and reduce health and disability related inequality.

Recommendation 1.4

Strengthen the integration of healthcare services into Fair Start Scotland to minimise the impact on individuals of health and disability as barriers to work.

Implementation

• Learn from existing best practice and integrate into delivery across Scotland.

• Evaluate the impact of national (Salus supported) and local (i.e. NHS Forth Valley supported) models.

Evidence/Rationale

Fair Start Scotland is a relatively new and ambitious large-scale employment programme delivered by a range of providers across Scotland. Though accessible to anyone requiring employment support, the scheme does include specific support people for whom health conditions or disabilities may be barriers to work. This support is delivered differently depending on the area and feedback suggests it is variable. It is also understood that the demands placed upon the health support component can be very high with many of the scheme's participants being quite distant from the labour market.

Fair Start Scotland is subject to evaluation as an action arising from The Scottish Government's Fairer Scotland for Disabled People: Disability Action Plan^[11] and this work would helpfully include consideration of the most effective model for providing the health focused component. Enhancing the role of NHS professionals in supporting employment outcomes and developing a national occupational health offer through the NHS (addressed by recommendations 4.3 and 4.4) should both feature in this thinking. This would also be consistent with the Public Health Reform Agenda and the priority placed on the role of work in preventing poor heath and developing a sustainable and inclusive economy.

Target Audience

Job seekers with health problems and disabilities that present a barrier to accessing work.

Stakeholders

SG Employability, SG Health at Work, Fair Start Providers, Local Authorities, NHS.

Cost

The health and social care services required to support scheme participants already technically exist though they are not currently organised or their staff mandated to do so. Tackling problems further upstream should result in long term cost savings

Complexity

Complexity is likely to be high given the multi-provider nature of the delivery model and learning should be taken from the experience of health and social care integration. Implementation would also fit within the ambition of recommendation 4.4, which considers the role of NHS health professionals for which a Managed Clinical Network based approach has been proposed.

Impact

Fair Start Scotland is currently subject to evaluation, within which there should be reflection on the optimal design for the health support required to remove health and disability related barriers to work for Fair Start Scotland participants.