No One Left Behind: next steps for employability support

Employability And Health

Figure one below shows that the gap in the employment rate between disabled people (as defined by the 2010 Equality Act) and non-disabled people was around 37 percentage points (42.8% vs 80.2%) in 2016. This shows we need to do more to support people with disabilities and health conditions into sustainable work.

Figure One: Employment Rates in Scotland

Source: Annual Population Survey, ONS 2016

The Scottish Government's 2009 Health Works strategy ^[8] set out our ambition to minimise health conditions as a barrier to work. We remain committed to this strategy and to improving the coherence of the offer to those who require support to overcome health and disability barriers to work, developing better collaboration across service providers. These principles are embedded in our commitments to tackling inequality and supporting inclusive growth in Scotland's Economic Strategy ^[9] .

A Fairer Scotland for Disabled People ^[10] , published in December 2016, recognises the importance of fair employment for those who are able to work and who wish to do so; adopts a target to at least halve the disability employment gap; and sets out a range of actions to help achieve this.

While some people with a disability or poor health may be unable to work, for disabled people or people with health issues who are looking to stay in or enter the labour market, sustaining employment or finding new employment can be very difficult. A lack of employment can be a key factor in the health of a person, and long periods of unemployment can also have a detrimental impact on their mental and physical wellbeing.

Ensuring that healthcare services support people to remain in or enter work and that the workplace supports the health, safety and wellbeing of workers will be an essential part of delivering this plan. The Scottish Government will undertake a review of its current Health Works strategy to ensure that it reflects the nature of modern work and the workplace, and to build the necessary links to wider employment and Fair Work policies.

We have identified a number of key areas in respect of health and disability where we will integrate and align with existing employability services.

Action 4

From Summer 2018 to Summer 2020, the Scottish Government will work together with partners including Health and Social Care Partnerships, DWP, wider third sector bodies, and employers to pilot a Single Health and Work Gateway in the Fife and Dundee areas to help more disabled people, and people with health conditions access early support to help them sustain or return quickly to work.

On 30 November 2017, the Minister for Employability and Training announced funding of over £630,000 for a Single Health and Work Gateway ('the Single Gateway') to be piloted in the Fife and Dundee and Tayside areas over 2018/19 – 2019/20 that will provide early support to people with a health condition (including mental health conditions) or a disability and help them to either sustain or return to work. The Single Gateway is a £3.5 million total investment, being delivered by the Scottish Government as part of the UK Government's Work and Health Unit's Innovation Fund programme.

While there is early intervention support in place to help people with a health condition or a disability ( e.g. Working Health Services Scotland, Healthy Working Lives, Access to Work), much of the support landscape is complex and confusing, offering similar and/or slightly different types of support, with different criteria for access.

The Single Gateway will act as the primary entrance or referral point for a range of currently funded, NHS-led health and in-work support services and it will include a new defined and coordinated national system of early health support and intervention to provide more joined up support.

In the Fife and Dundee areas where the Single Gateway will operate, we will ensure that links are made to Fair Start Scotland so that disabled people or people with health conditions who face more severe barriers to work and who are eligible to participate in the service are referred to the right place to get the most appropriate support.

Action 5

From Summer 2018, the Scottish Government will work with partners within the Single Gateway pilot areas of Fife and Dundee to agree a plan to trial additional mental health support.

The Single Gateway will improve the ease with which people with a mental health condition can find their way to tailored support to help them to remain in, or return quickly to work. It will provide access to services that will offer up to 12 weeks of case management, holistic health and work assessments, fast tracked access to therapeutic and non-therapeutic work-and-health focused support, and coordination with local services for wider support such as debt advice.

Where people with mental health conditions face more severe barriers to a return to work – for example, because of the severity of their condition, or because they have been out of work for some time – the Single Gateway will play a role in guiding people to Fair Start Scotland where they meet relevant qualifying criteria.

There are likely to be some people with mental health conditions accessing the Single Gateway who benefit from the relatively light-touch, short-term support offered by the core services. While some people are unlikely to require the more intensive support available under Fair Start Scotland they may need additional ongoing support beyond that which is currently available from the Gateway's core services. For example, because of the nature of their condition, once the Single Gateway's core services have helped them return to work they may require more specialised ongoing, in-work support in order to successfully sustain employment. With our partners in the Single Gateway pilot areas of Fife and Dundee we will explore innovative ways including what links can be made to local authority employability pipeline provision to provide additional ongoing support to people beyond that which will be available from the Single Gateway's core services.

Action 6

From July 2018 onwards, the Scottish Government will work with Health and Work partners within the Single Gateway pilot areas of Fife and Dundee, academic partners, and the UK Government to develop and test new risk and decision assessment tools that will provide a more accurate assessment of risk and associated support requirements for people who are at a high risk of falling out of work and into long term unemployment.

We want to identify at an earlier stage people who are at the greatest risk of falling out of work and into long term unemployment due to ill health or disability. This will be key to our ability to offer early, effective support in Scotland. Evidence shows that the longer someone is out of work, the harder it is for them to return to work, so getting the right kind of support to the right people at the right time is crucial.

Innovative data analysis techniques such as predictive analytics have a part to play in driving positive change by helping identify those at highest risk and the interventions that will be most effective at helping them. It can help develop more sophisticated approaches to risk management, and to inform the re-engineering of services.

We will scope and develop the most appropriate risk and decision assessment tools in collaboration with Single Gateway case managers, Jobcentre Plus, integration authorities and other key actors such as Healthcare professionals. We will also seek to build on a range of innovative joint working currently underway in Scotland.

Action 7

From Spring 2018 onwards, the Scottish Government will work collaboratively with NHS Musculoskeletal ( MSK) Services to align a national MSK Advice and Triage Service ( MATS) with employability services to help people with MSK conditions find and sustain work.

MSK disorders are problems affecting the muscles, tendons, ligaments, nerves or other soft tissues and joints. The back, neck and upper limbs are particularly at risk.

It has been estimated that between 20-30% of all General Practitioner consultations are for MSK complaints, with 10 million work days lost annually to MSK problems.

The ability of a person with a MSK condition to remain at work or to return to work can often be of huge significance to a person and their family. With the right kind of support they can do so and be valued employees.

MATS is a phone service for people experiencing symptoms of MSK conditions. Between January 2013 and October 2017, MATS triaged over 293,000 patients.

At the access point of contacting MATS and at the clinical assessment/intervention point (when referral is from a GP or consultant), a person is asked about their work status, as well as the impact of the MSK condition on their ability to work. Further national work is currently underway, testing a MSK web-based access and triage model, and linking in all parts of the MSK pathway including developing first point of practitioners in GP practices in addition to the access methods described above.

We will work with NHS Scotland to develop new referral links to local and national employability services for people with MSK conditions at clinical assessment/intervention point where they have provided information on their work status.

Action 8

In 2018, we will publish a refresh of The Road to Recovery: A New Approach to Tackling Scotland's Drug Problem ^[11] that will include a focus for Health and Social Care Partnerships and Alcohol and Drug Partnerships to integrate with employability services to help improve employment outcomes for people experiencing substance misuse issues.

Problem drug or alcohol use affects individual physical health, emotional well being and employability prospects. Problem alcohol use alone costs Scotland £3.6 billion each year. That's £900 for every adult. Estimated annual costs to the NHS are £200-£400 million.

The Scottish Government's Road to Recovery Strategy published in 2008 has enabled key partners on a national and local level to improve access to treatment and offer person centred support for recovery to individuals, families, children and communities affected by substance misuse. Most critically, the introduction of a HEAT (Health Improvement, Access to Treatment) Efficiency (now Local Delivery Plan) standard (to ensure our services are constantly monitored and improved) now sees over 90% of people accessing treatment within 3 weeks, a key starting point into their recovery and employability journey.

Substance misuse remains a complex and challenging problem to solve but there are a large and growing number of people achieving sustained recovery and visible recovery communities across Scotland are changing attitudes towards people who experience problem drug and alcohol use. However, as improved access has been achieved and recovery becomes more visible, the nature and characteristics of substance misuse has changed since 2008, and the delivery landscape for services has also changed.

The Minister for Public Health has announced her intention to refresh the Road to Recovery to ensure that it brings fresh momentum and leadership to address the needs of people who continue to be at risk of death or harm from drugs or alcohol, and for whom, traditional services have not proved sufficient to address their complex set of needs. This approach will include a specific focus on employability to encourage Health and Social Care Partnerships and Alcohol and Drug Partnerships to develop stronger links with both local and national employability services. We will also seek to build the understanding and capacity of those in employability services through training in recovery orientated systems of care, and in reducing stigma, to help improve attitudes towards people engaging with services and finding work.

The Programme for Government 2017/18 set out our intention to back up the new strategy with an additional £20 million investment in alcohol and drug treatment. As we develop our thinking about how the new investment is best targeted, we will ensure that innovation in service connection with employability services is a feature of proposals that will be supported.

Alongside our work to refresh the Road to Recovery Strategy, we will oversee the introduction of a new drug and alcohol information system that will capture a range of information about a patient journey, including outcomes being achieved across many aspects of their life, including their place on the employability pipeline. We will support events between Alcohol and Drug Partnerships, Employability Partnerships and we will engage with Community Planning Partnerships to share good practice in needs assessment and commissioning, and we will encourage replication in other areas to help improve employment outcomes for people experiencing substance misuse issues.