Condition Management Programme

Back ground: Green Paper -The Case for change (Nov 2002 ) 2.7 m people were claiming IB in 2002 (large increase from 1990 ’ s) 1 in 13 in receipt of IB (6.6%) 1.5 million claiming IB for at least 5 years 500,000 claimants are aged under 35 Duration on IB is, 9 years in 2002 compared to 3 years 1985

Background- Depression and Anxiety within 3 months of being of of work After 1 year on IB the chance of returning to work drops to 20% 2/3rds of new claims are due to conditions that are mild-moderate in nature 2/3 of Dorset referrals report a mental health condition

Stereotype for those on Incapacity benefit Older men Former industry workers Bad backs From Northern England, Scotland or Wales Neither want nor expect to work No jobs for them

Reality 40% are women 50% are under 50 years 40% have mild/moderate mental health conditions 90% of all claimants expect to return to work at the outset of their claim

IB by Diagnosis (2002)

Worklessness! “Long term unemployment /worklessness is harmful to physical and mental health” Isolation, social exclusion and stigma Changing health related behaviour (e.g. smoking, obesity, drug abuse) Higher use of healthcare services Disruption to future work career Trapping people on lower incomes than are available through work Suicide in young men - 6 months out of work is increased x 40 (Ref: Waddell & Burton 2006, Grove 2006)

Most people do not cite their health as the main barrier But: Loss of confidence Lack of skills Lack of financial incentive A feeling of inadequacy

Many people are treated as, and indeed come to believe, that their working lives have come to an end. “I’ll never work again” “There are no jobs that I could do anymore” “ Employers wouldn’t want to take me on ” “ They’ll take one look at me/my application/CV and say No ” “ Even if I got a job I’d never be able to keep it ”

Why Work? Economic, social and moral arguments that work is most effective way to improve well-being of individuals, families and communities. Research indicates work can be good for you. Many IB customers have a full employment history, are dependable and actually prefer to work.

Benefits of work Promotes recovery and rehabilitation Leads to better health outcomes Promotes social inclusion Improves well-being Reduces risk of long term incapacity Financial reward Social contact Learning/training opportunities Personal identity Routine Achievement Waddell & Burton 2006

Crazy but true: First time the NHS and DWP ever worked in partnership

JCP “Pathways to Work” programme “Pathways to Work” started in 2003 in some JCP areas – Dorset in Dec 2006 & nationally 2008 Incapacity Benefit Personal Advisers - Individual programme “Choices” - variety of voluntary options for customers Cash incentives for RTW, training opportunities, work focused help 1 “Choice” – Condition Management programme CMP started in Dorset April 2008

Dorset Condition Management programme Dorset PCT is providing CMP across Dorset, Bournemouth and Poole Team consists of a multidisciplinary qualified health staff and associated staff Based in Ferndown, Weymouth & Gillingham Contract for 425 new IB engagements each year

What is “Condition Management” ? Uses a bio-psychosocial approach to educate customers to understand and manage their health condition better Emphasis on self help and NOT treatment To support customers in making appropriate life “choices”.

Aims of CMP To help customers to better understand and manage their condition in the work environment To help customers feel more confident about returning to work To enable customers when in work to feel more confident and expert about negotiating with their employer about their health needs.

Introduction and first appointment

Second appointment

Named CMP Practitioner. Customer decides not to join CMP or fails to attend 2 appointments Customer completes program. This appointment may include IBPA Customer chooses to continue CMP Customer contacts CMP and agrees 2 nd appointment Initial CMP Appointment Customer decides not to join CMP or fails to attend 2 appointments Second Appointment One –to-one Support Support Modules Core Programme Rolling programme of 5 core modules. Condition specific Support modules as needed Final Appointment Programme Delivery

CMP Core Modules: Positively Healthy (healthy lifestyle) Positive Pressures (stress management) Communicate with Confidence (assertion skills) Working Well (managing health & work) SMART Steps ( pacing and goals) Either 1 or 2, 3 hour group sessions. Non NHS settings

CMP Dorset Support Modules: Anxiety Tool Kit - run with NHS (managing anxiety) Lift Your Mood - run with NHS (managing low mood) Move More! - run with Leisure centre (overcoming barriers to activity) Know Your Back – run with NHS ESP PT (managing back pain)

Employment Support Allowance (ESA) replaces IB from Oct 27 th 2008 Illness GP certificate Contact centre 0800 Benefits checks WFHRA 140 centres -> WCA 2 WF Interviews at 9-13/52 Personal Adviser WRA and Support group Work focused Interviews Pathways and ‘Choices’ as before

References: Original Pathways to Work Green Paper available at hways.pdf Waddell G & Burton AK (2006) Is work good for your health & well- being? TSO, London Eds: Grove B et al (2005) New thinking about mental Health and Employment. Radcliffe Publishing. Oxford. DWP (2006) A new deal for welfare: Empowering people to work. Warr PO (1987) Work, employment and mental health. Oxford University Press. Oxford

Further Reading: Ford J et al (2008) Rehabilitation for work matters. Radclliffe Publishing, Oxford Black C (2008) Working for a healthier Tomorrow: A review of the health of Britain’s working age population TSO, London Freud D (2007) Reducing dependency, increasing opportunity: options for the future of welfare to work DWP DWP report No 479 (2008) “Evaluation of the GP education pilot: Health and work in general practice”