Health and work support pilot: interim evaluation report

2. Introduction

2.1 Purpose of the Report

This interim evaluation report provides an overview of the implementation and early delivery phase of the Health & Work Support (HWS) pilot, during the period June 2018 to March 2019.

This review offers an opportunity for reflection on lessons learned to date and for the identification of enhancements and changes that could be made to further improve performance and impact.

The report has been developed using a number of sources of information, including:

• Externally commissioned fieldwork, delivered by Rocket Science, which included:
  • Interviews with stakeholders.
  • A survey with local delivery staff.
  • Focus groups with local delivery staff.
• Focus groups and interviews with local participants delivered in-house by Scottish Government.
• In-house analysis of data collected from the HWS management information system.

2.2 Purpose of the Pilot

The Health & Work Support (HWS) service is a two year pilot running in Dundee City and Fife from June 2018 to June 2020. This pilot is funded by the Department for Work and Pension’s (DWP) and the Department for Health and Social Care’s (DHSC) Employers, Health and Inclusive Employment Directorate, as part of its Work and Health Innovation Fund, with additional funding from the Scottish Government.

The pilot is intended to contribute to a number of strategic commitments across the Scottish Government, details of which are outlined in a variety of key documents. Centrally, the Health & Work Support service forms part of the 2018 ‘No One Left Behind’ Scottish Government Strategy for employability support^[6]. The strategy aims to facilitate the development of more effective integration and alignment between employability and other support services, including health services, in order to help groups with multiple challenges (e.g. disability, illness, homelessness, substance misuse) stay, return, or transition into employment. The action points within the strategy describe how the pilot will act as a primary entrance point for NHS-led support, introducing a streamlined alternative to the complex and confusing landscape of existing health and work support services.

In addition to the above the pilot features within the Disability Employment Action Plan^[7], with specific reference to increasing accessibility of the service and exploring additional use of mental health training and interventions. Commitments are also described in the Mental Health Strategy^[8], including working with employers around mental health support for employees and also exploring ways to connect mental health, disability and employment support.

More broadly through its focus on improving health, supporting people to stay in or get back into work and also supporting employers, the pilot intends to contribute towards the following outcomes within the National Performance Framework^[9]:

• We are healthy and active.
• We have thriving and innovative businesses with quality jobs and fair work for everyone.
• We have a globally competitive, entrepreneurial, inclusive and sustainable economy.
• We tackle poverty by sharing opportunities, wealth and power more equally.

2.3 Pre-Existing Health Related Employment Support in Scotland

The landscape for health and employability support services nationally is considered to be confusing and difficult to navigate for those in need of health and work services. The pilot focuses on streamlining the following national services:

• Working Health Services Scotland (WHSS) – a Scottish Government funded service, delivered by the NHS, for self-employed individuals and employees of Small to Medium Enterprises (SMEs) who are at risk of unemployment due to ill health.
• Fit for Work Scotland – a DWP-funded service for employees of companies of any size and sector, who are on sick leave or at risk of sick leave for four weeks or more.
• Healthy Working Lives (HWL) – a Scottish Government funded service offering employer-focused advice and guidance on health and work (e.g. risk and safety, employment law, health policy).

These services have been reconfigured and brought together under the banner of the HWS pilot within Dundee City and Fife^[10]. This constitutes the ‘core services’ that are offered to clients.

In addition to the above the HWS pilot has added a pathway for those who have become recently unemployed and who are experiencing ill health or a disability as a barrier to re-employment.

2.4 Who Does the Pilot Aim to Help?

The pilot is focussed on targeting; those at risk of losing employment due to a health condition and/or disability, individuals who are recently unemployed due to ill health and/or disability and employers who require support, in the form of advice or training, for health and work issues.

Pre-existing services (detailed above) largely focussed on individuals with musculoskeletal (MSK) problems whereas the pilot has widened its remit to include a focus on those with mental health concerns related to work. The overall eligibility criteria for the pilot is as follows:

• An adult aged 16 plus;
• In paid employment or self-employment experiencing a mental / physical health condition or disability that is affecting their employment;
• Or unemployed for up to 6 months, experiencing a mental / physical health condition or disability that is affecting their prospects of employment;
• Living or working in Fife or Dundee City;
• An employer in Fife or Dundee City who requires advice on mental / physical health, disability and work issues.

Dundee became one of the two pilot areas for a number of reasons including pre-existing high levels of demand for health and work services. Fife was felt to be an appropriate complementary pilot area with a more dispersed population and a tighter labour market (less unemployment).

It should also be noted that these two areas are different in terms of population size and make-up, geography (including rural and urban differences) and wider service provision.

2.5 How is the Pilot Set Up?^[11]

There are two main referral routes into the service: self-referral (via website, or the national phone line), or referrals from GPs and other health professionals. Access to the pilot follows three steps, each delivered by a different delivery partner:

1. National Pilot Phone Number (delivered via Healthy Working Lives) – provides telephone access to the pilot for clients who self-refer. If clients are seeking clinical support and live or work in the pilot area, then they are considered eligible for triage and are transferred to the next stage.

2. Pilot Triage and Enrolment Service (delivered by Salus) – the main call handling service within the pilot, providing triage and enrolment. Clients access Salus either via the HWL advice-line or directly via a web-form provided on the Salus website. Salus establishes whether clients are eligible for the pilot by taking them through a triage system. Eligible clients are then enrolled into different ‘workstreams’ (explained below) before being transferred to case management staff in the local pilot areas. Those who are not eligible are signposted to other relevant services.

3. Case Management (delivered by local NHS Boards) - the case management service represents the core of the pilot and incorporates bio-psychological assessments, action planning, onward referral for clinical interventions and access to self-management materials. Case Managers normally contact clients by telephone to conduct the initial assessment before referring clients to clinical support where required (i.e. the intervention^[13]). This part of the pilot is intended to last up to 20 weeks. Case Managers can also signpost to a variety of other services within the local area that offer support.

There are three workstreams within which individuals can be enrolled, dependent on their employment status and background. Services offered by the workstreams are largely similar, involving both case management as well as the potential for onward referral for clinical interventions, although the focus of support will vary dependent on an individual’s needs.

Working Health Services Scotland - individuals employed by an SME (less than 250 staff), whether absent or present at work and struggling to stay in employment due to a health condition or disability;

Large Employer/Employee Service (LEES)^[14] - individuals employed by larger organisations (more than 250 staff), whether absent or present at work and struggling to stay in employment due to a health condition or disability;

Employability and Health – individuals recently unemployed (less than 6 months) as a result of a health condition or disability;

A fourth workstream is available for employers:

Healthy Working Lives – for employers in the Fife and Dundee pilot area who require advice and support around health and work issues.

In addition to the above there is a ‘light touch’ element to the pilot (referred to as the Local Support workstream) which provides support and signposting for clients not meeting the eligibility criteria. It is important to note that individuals in receipt of this light touch service do not count towards the services target numbers.

The operational work of the pilot is also supported via the work of a dedicated Improvement Advisor within the Scottish Government’s national pilot team. The Improvement Advisor works with both pilot staff and wider stakeholders using techniques based on the Scottish Government’s Three Step Improvement Framework for Scotland’s Public Services^[15].

Source: Adapted from Rocket Science