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Greater Manchester's early help to avoid long term unemployment

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Joint working should successfully address the health impact of unemployment at an early stage, writes Jenny Osborne, strategic lead for health and employment, Greater Manchester Health & Social Care Partnership.

  • Project name: Working Well Early Help
  • Objectives: Assisting 11,000 people with health conditions who are at risk of falling out of employment, or who are newly unemployed, to remain in or return to employment.
  • Timescale: March 2019 to April 2022
  • Cost: £8m
  • Number of staff working on project: Dedicated team of three, plus widespread partner support
  • Officer contact: Jenny Osborne, jenny.osborne4@nhs.net

The health of the working-age population of Greater Manchester is vital to the city-region’s long-term prosperity. Unemployment through sickness is a waste of people’s potential and a cause of long-term ill health. It is both a significant drain on the public purse and a brake on economic growth.

Greater Manchester’s Working Well Early Help programme, launched in March, builds on our Working Well programme, which has supported people with health conditions who were long-term unemployed since 2014.

Working Well Early Help is the latest in a developing suite of programmes to support all residents to find, get and keep good quality employment. They are built on the strong foundations of integrated working across our 10 local authorities. Since 2014 more than 4,000 long-term unemployed people have been helped back to work by providing support to those with health conditions or disability to find and sustain work.

However, there was an appetite to test earlier intervention before people had become out of work long-term (with an associated impact on their mental and physical health). This followed evidence from the National Institute for Health & Care Excellence that only one in five people get back to work after being off for six months, and after two years someone is more likely to die or retire than ever return to work.

Devolution of Greater Manchester’s £6bn health and social care budget provided the opportunity to think differently in relation to population health for our 2.8 million residents. Employment plays a significant role as a determinant of health and therefore became a key strand of the Greater Manchester Population Health Plan. For the first time, this enabled a significant level of local NHS transformation resources to be committed to prioritising “work as a health outcome”.

With leadership provided by Andy Burnham (Lab) as mayor, the Greater Manchester CA’s employment and skills team and Greater Manchester Health & Social Care Partnership, we established a joint programme team – our own ‘joint work and health unit’.

This coincided with the launch of Improving Lives, the government’s work, health and disability strategy, and accompanying resources to fund innovative programmes to build evidence on what works to close the work, health and disability gap.

Programme objectives, resourcing and method

The programme’s objectives are to assist 11,000 people with health conditions who are at risk of falling out of employment, or who are newly unemployed, to remain in or return to employment. It will run over three years from March 2019 to April 2022.

We know that in Greater Manchester 98% of businesses are small and medium enterprises with little or no access to occupational health or employee support. We also have more than 150,000 residents out of work with a health condition. Half a million “fit notes” are issued annually but GPs report that they have neither the time, nor the occupational health knowledge to advise patients fully.

The service, which offers both telephone support and face to face where needed, is comprised of a mixture of vocational rehabilitation caseworkers, physiotherapy and mental health professionals, and engagement partners to work with GPs and SMEs.

It will support 8,800 individuals who are in work but at risk of losing their employment as a result of a health condition. It will also support 2,200 individuals who have lost their employment in the previous six months due to a health condition, to prepare and get back into employment.

The service will do this by providing a holistic individual return to work plan for participants who can either self-refer or be referred by their GP. Those unemployed will be signposted from Jobcentre Plus. Where appropriate the programme can spot purchase brief clinical interventions to bridge the gap for participants to access mainstream services, alongside help and advice addressing any issues or barriers impacting on their employability.

The £8m cost is met from NHS transformation funds, the government’s Work & Health Unit, Greater Manchester CA and European Social Fund. A dedicated programme team of three staff is in place, supported by a wide range of commissioning, finance, legal, information governance and procurement partners.

The programme approach has been to “test and learn” to establish whether delivery can:

  • result in a higher proportion of people who return to work and are sustained in work than would otherwise have done so without the service;
  • improve health and wellbeing of participants;
  • contribute to a reduction in the number of days lost to sickness absence for those in employment;
  • reduce time spent by clinicians on non-clinical work in primary care for this cohort;
  • reduce health inequality within this cohort.

Innovation

So what is different about the Greater Manchester approach?

We are aligning investment across the local government and health system against a shared objective – prioritising employment as a key driver for health gain. This is the largest ever local NHS investment in early intervention employment support in England.

The close working and joint systems of the 10 boroughs has enabled development, integration and ownership of the programme. We worked from the premise that if this wasn’t owned and shaped by each borough, and tailored to local neighbourhood need, it wouldn’t work.

We worked across local authorities and clinical commissioning groups to establish a health and employment local lead and a GP lead in each locality who would support and champion the programme. Boroughs decided which neighbourhoods and GP practices would be involved, and consulted with their local businesses, voluntary organisations and politicians.

Significant time was spent in developing local system infrastructure and securing political and strategic buy-in from governance structures (such as health and wellbeing boards and joint commissioning committees), before the process was repeated at a Greater Manchester level. Our job is to add value through bringing economies of scale at a city region level in terms of co-ordination, commissioning and programme management.

The co-design process was extensive and inclusive. We involved GPs/health professionals, employers/SMEs, voluntary sector groups, experts by experience, Jobcentre Plus, occupational health specialists, work and health unit partners and national experts such as Dame Carol Black and Dr Steve Boorman. We underpinned this with an extensive evidence review. Doing things this way took time, but the specification we arrived at was co-produced and far better than anything we would have created ourselves.

Despite the work that has gone into design, this is very much a ‘test and learn’ programme supported by impact and process evaluation and cost benefit analysis. We have invested significantly in this area, with the Sheffield Hallam University as the lead evaluation partner. Building the evidence base on what works, and for who, is crucial to our sustainability strategy and to inform our future dialogue with employers, commissioners, and government.

The evolution of a joint city region team working across local authorities and the health and care system to develop a suite of programmes and initiatives which take a whole population approach to health, skills and work is bearing fruit. We are commissioning a third Working Well Programme focusing on specialist employment support for those with learning disabilities, autism and severe mental health issues later in the year, again with joint investment from health and council partners.

The recent Greater Manchester Independent Prosperity Review, which is directing our local industrial strategy, clearly stated the need for health to feature far more prominently in discussions of human capital, labour market participation and productivity. This is well understood by Mr Burnham, who believes that solutions designed in an integrated way by local partners from the ‘bottom up’, rather than imposed from Whitehall, have a much better chance of addressing both our health and productivity challenges.

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