Health and work support pilot: final evaluation

Conclusions and Recommendations

Conclusions

There has been an increased focus on health and work, driven by growing evidence of the issues faced by those with health conditions in seeking work, and the impact on those who develop or manage an existing health condition at work.

The evidence suggests the HWS pilot worked to fill an essential gap by providing support targeted at those experiencing health and work challenges. Satisfaction with the pilot services was high, and there were better health and employment outcomes for those people who received full support available under the pilot. Employers and referrers were also positive about the pilot.

Referrers felt the process for clients was improved compared to the health and work support that existed locally prior to the pilot but some stakeholders and participants still felt there were too many steps to go through from first point of contact through to the first clinical intervention. About a third of participants disengaged with the service before they had finished their support and there was a mix of positive and negative reasons for disengaging.

The benefits from the pilot services differed across client groups. People with more complex needs and conditions and people with mental health conditions did not seem to benefit as much as people with physical health conditions. There were also differences in which element of supports was felt to be most useful. People who accessed physiotherapy services said the clinical support was most useful, while those who accessed mental health support (counselling) felt regular support from their case manager was most useful.

While it is not clear from the evidence gathered for this evaluation as to whether the pilot's service delivery model is the optimal one for addressing health and work related issues, the pilot has successfully identified lessons for future initiatives in terms of system reform and service design, including the referral process. These are set out in the Recommendations section.

Recommendations

The findings from this evaluation of the Health and Work Support Pilot complement those from the DWP/DHSC Challenge Fund and have identified a number of service design features which can be drawn on by LEP partners in developing locally appropriate Health and Work support:

• To ensure the service operates effectively from launch, it is important to fully utilise the set-up period. It took about 6 months to set up the pilot to a stage where clients could be referred and supported. While the ultimate service was appreciated and beneficial, the main lesson was about the way in which this set up period was used.
  • It would be valuable to consult both employers and potential referrers in this local design phase to increase buy in and this engagement is also likely to help with awareness and subsequent promotion of the service.
  • It is important to build effective partnerships between stakeholders involved in development of health and work services (in this instance SALUS, Healthy Working Lives and local NHS Teams) particularly with regards to the service design phase.
  • It would also be helpful to set up data sharing agreements during the set-up period – if these are not in place - so that clients do not have to repeat their story at each stage.
• To ensure there is clarity over who the service is designed to support, consideration needs to be given to branding and promotion. There were two issues with the way that the HWS service was promoted:
  • Many of the initial clients had conditions, which were too severe for the service to respond to effectively, so it will be important to ensure that the promotion of the service focuses on earlier stages of conditions when a relatively short intervention can make a difference. Alongside this, it is important to ensure follow up arrangements for those with more severe conditions who are referred into mainstream NHS services.
  • The way that the brand and associated marketing material is worded is important. It needs to be clear and easy to understand in terms of the target group and the purpose of the service(i.e., rapid access to appropriate early interventions). For example, the use of the word disability in some promotion of HWS appears to have led to some clients who could benefit feeling that the service was not for them – as they do not consider themselves as experiencing a disability.
• To maximise the value of the Case Manager, which was central to the design and success of the pilot, their role and responsibilities must clearly reflect the expertise and value that they bring:
  • Case Managers need to be clinically trained (e.g., nursing qualification), able to understand the situation of client, offer some rapid advice and refer accurately. In the HWS model there was a temptation for them to do some interventions themselves, but this was not part of role, and it took up too much of their time. Having a clinical training was clearly valuable, but there is a need to have clear case management roles and responsibilities.
  • An associated finding, is that the clinically trained Case Managers did not have the skills and experience to carry out effective engagements with employers and carry out wider advertising and marketing responsibilities.
• To ensure that the system is as easy as possible for users to navigate, there should be a single point of contact in a local area. This would avoid the risk of some clients feeling that they were sent from pillar to post in the most complex arrangement in the pilot, which involved two national services working alongside local delivery.
• In order to maximise accessibility, services should not be limited to 9-5. As a high proportion of potential clients were in work, this limits the accessibility of the service for those who could have been supported to remain in work.
• Delivery in a health context appears to work well, rather than in an employability context. Clients can feel uncomfortable opening up to employability staff (particularly in terms of Job Centre Plus where they may be anxious about the risk of sanctions to benefit payments).