Health and work support pilot: interim evaluation report

1. Executive Summary

The Health & Work Support pilot is a two year project funded by the UK Government’s Employers, Health and Inclusive Employment Directorate^[1] and the Scottish Government.

The pilot was launched as part of the Scottish Government’s No One Left Behind Strategy^[2] in June 2018 with the aim of making improvements to the way early intervention is provided to individuals who have health conditions or disabilities, in order to help them sustain or return to work. In addition to providing help to individuals the pilot also provides advice, training and support to employers on issues related to health and work.

The pilot was developed on the premise that although there is already early intervention support available, the existing support landscape is complex and confusing. As such the project was originally conceived of as a “single gateway” which would act as the primary entrance point for a range of pre-existing NHS-led health and work related services, with the expectation that this approach would increase the number of individuals and businesses accessing support.

The service is being piloted across Dundee City and Fife and will run between June 2018 and June 2020 with the aim of enrolling 6,000^[3] individuals across this time period. The primary service offer to individuals consists of up to 20 weeks of case management^[4], holistic biopsychosocial assessment^[5] and fast track access to health and work focussed clinical interventions (including physiotherapy and counselling services).

The Scottish Government and the Work and Health Unit have committed to a robust evaluation of the pilot and this report forms the first part of such an undertaking. This review focuses on the set up and early delivery stage of the pilot. It considers the extent to which the pilot is beginning to make a difference to the clarity, coordination and efficiency of the landscape of support.

The report summarises findings from commissioned research delivered by Rocket Science UK Ltd as well as additional research undertaken by Scottish Government analysts (further information about the methodology is set out in Appendix 2).

Key findings covered in this report include that:

• To date the pilot appears to be increasing the numbers of individuals accessing support in comparison to pre-existing services however this is largely due to widening of eligibility criteria.
• The pilot has struggled to meet its targets.
• Individuals who have recently become unemployed tend to present with mental health concerns as a primary issue whereas those in employment tend to present with musculoskeletal issues as their primary condition.
• Initial findings question the assumption that existing occupational health support provided by large employers (public and private) are adequately meeting the needs of their staff. This will require further exploration throughout the rest of the pilot.
• Call handling services within the pilot could be further streamlined to improve client experience by cutting down on the number of contacts required before reaching the point of receiving care.
• The employer facing component of the pilot requires further development. Levels of engagement with employers has varied significantly between pilot sites and requires further exploration.
• There is scope for further improvement of the pilots marketing materials and overall approach.
• The pilot’s primary mode of access for individual clients (i.e. self-referral) assumes a level of health literacy and capacity to engage. This may be problematic for more vulnerable members of the population.
• The pilot’s capacity to collect outcome data on clients requires further development and prioritisation.
• Case Managers reported an increase in the referral of clients with a range of intersecting and complex needs who may not have been seen by other mainstream services. The level and type of service required may therefore be more demanding than initially expected.
• In keeping with findings from the wider research literature, the Case Manager role within the pilot requires further clarification.