Vocational Rehabilitation – Economic Growth through Innovation Sarah Evans – Specialist VR and CHC OT Community Neurological Conditions Management Team

The QIPP Challenge LTNC affect some 10 million people in the UK (DOH 2005) with a large majority working age Lack of specialist vocational rehabilitation identified in the UK including London (Playford 2011) Low rates of post injury employment in: TBI (41% at 1-2 years post injury) Van Velzen et al 2009) MS – only 20-30% of people are still in paid employment by 5-15 years after diagnosis (BSRM 2010) The current financial impact of ill-health benefits on DWP is approximately £30bn pa. Emerging evidence base for VR but there is a lack of shared terminology, descriptive interventions, outcome data and economic evaluation (Phillips, J & Radford, K 2014) Economic benefits are realised across multiple government departments – not the NHS.

Innovation Vocational Rehabilitation service commissioned in 2011 in partnership with Barnet CCG Based within a Community Neurological Team – a new innovative approach to service delivery A local approach to enable innovative multiagency pathways to work. Other existing models were via a tertiary service or in a geographically remote location from the patients community/work base. Tiered service model designed to describe and measure intervention Work Outcomes measured on admission and discharge Standard assessment outcome battery

INNOVATION: Tiered Service Model Tier 3 (20+ sessions) Individual work preparation & work hardening programmes: Specialist VR and Functional Assessment Job skills/demands analysis Develop/relearn work skills after illness or injury. Identify work placement and education opportunities Education about work skills to client, families and employers Tier 2 (6-8 sessions) Aimed at supporting work retention including: Assessment of work skills and on the job support. Work Site and ergonomic assessment Liaison with employers, occupational health, supervisors and work colleges. Tier 1 (4 sessions) Support and liaison with local and national employment support organisations. Advice re benefits and finances. Specialist advice about neurological conditions and impact on work. Access to symptom management groups

Quality Evidence Based - NSF - BSRM Guidelines Tiered System Comprehensive Outcomes Menu Local -sustainability - employment opportunities Responsive Service - Fast track Person Centred - Goal Directed - Self referral system Integrated care - within CNCMT - with voluntary sector “ Returning to work is important to people and helps maintain QOL and independence” NSF2005

Productivity: Referrals and response Number of Referrals April 13/March 14: 106 April14/March 15: 115 Assessment Waits (mean): April 2013 – March 2014: 125 days April 2014 – March 2015: 69 days

Productivity: 2014/15 Vocational Outcomes

Productivity: Provisional Economic Impact VRS total Service Costs: £91,670 13/14 cost per patient seen = £ Cost of VRS Per patient£ Weekly Support group benefit£ Annual DWP cost£5,683 Number of patients unemployed on entry (2013/14) 46 Total Annual DWP benefits cost£261,418 Number of patient employed on completion of VRS (2013/14) 28 Total Annual DWP benefits cost saving £159,124 Time to offset VR cost (per patient)8 weeks

Prevention Triage/Inpatient clinic (preventing long waits for initial contact) Positive Feedback from patients and employers regarding the service Increased participation in meaningful roles and occupations is associated with emotions and physical well being Prevention of ill health associated with unemployment Impact on patient experience, quality of life, health outcomes. Converts benefit recipients into tax payers. “ I thought I could go straight back to work when I went home from rehab but the psychologist and VROT helped me to understand why this couldn’t happen ” “It was helpful to meet the VROT before I left the rehab unit” “It was good to see my boss away from my home and in a place that was comfortable (the NRC) with my VROT to explain to my boss what had happened to me” “I appreciated the follow up calls”

Future Potential for further economic evaluation of service District expansion Outreach clinics to increase access to early VR advice e.g. to acute services and develop professional skills and knowledge Use of remote technology to increase efficiency and expand reach