1. Pathways to Work and The Condition Management Programme Catherine Ryan, Jobcentre Plus February 2006 Incapacity Benefit reforms pilot

2. Pathways to Work and The Condition Management Programme Eric Sharp February 2006 Incapacity Benefit reforms pilot

3. Economic background Since 1994, Job Seekers Allowance numbers have been falling However, Incapacity Benefit numbers rose from 1979 to 2003 Current IB levels nationally are about 2.6 million people JSA is now under 1 million (Source ONS/DWP, in Green Paper)

4. Health issues – an international perspective All cultures have long-term health problems, including chronic pain and depression However, the impact of these conditions on individuals and society is dependent on cultural, social, political and economic factors The prevalence of long-term illness has not increased, but the effects have

5. Health profile of IB claimants 35% Mental disorder 22% Muscular-skeletal 11% Circulatory/respiratory 10% Nervous System 6% Injury/poisoning 16% Other

6. Referrals received by Condition Management 57% Mental Health 30% Muscular-skeletal 3% Cardio-respiratory 10% Other ( Source CMP Management Information 05-06)

7. Implications of the prevalent conditions Mental Health has become the most significant cause of long-term absence from work For those people with chronic pain, or other health conditions, secondary mental health difficulties set in Any programme working with vocational rehabilitation needs skills in managing both physical and psychological aspects

8. Health profile of IB claimants The majority of health conditions relating to IB claims are manageable That is, the type and severity should not prevent someone from working However, there are several factors influencing whether someone does return to work.

9. Exit rates from IB Exit rate/ month Exit rate/ quarter Month 112%32% Month 122.1%6.2% Month 241.2%3.6% Quarter 12--2% (Berthoud 2004)

10. Factors influencing return to work Exit from IB is influenced by Health Condition Locality - Labour market issues Age Benefits received Length of time on benefit – is this a causal effect or a “selection effect”? (Berthoud 2004)

11. Health Condition Whether someone is able to work is as much affected by their perception of their health condition as by the condition itself Emerging evidence shows that a bio-psycho- social approach is the most helpful in achieving rehabilitation That means that taking into account the psychological and social factors is more likely to get a result

12. Effects of Unemployment 1 Isolation, social exclusion and stigma Changing health-related behaviour Disruption to future work career Trapping people on lower incomes than available through work

13. Effects of Unemployment 2 Changed health behaviours include: Increased smoking, alcohol consumption, obesity, drug use, suicide and some cancers Reduced physical activity and mental health Increased use of health services Re-employment reverses the effects

14. Emerging views in Rehabilitation “Evidence based clinical practice... increasingly rejects both inactivity and prolonged rest as acceptable forms of treatment for the most common conditions reported on incapacity benefits” (Grove/Harrison DH, 2006)

15. Principles of Condition Management Aims to reduce the impact of the health condition as a factor in remaining out of work Helps the participant to understand and manage their condition Works with mainstream NHS processes – does not replace treatment Works as part of the Pathways process

16. Condition Management essential features Partnership between JCP and the NHS Clinical knowledge, skill and credibility Voluntary nature of participation Outcome focused approach – symptom reduction is not a primary aim Active participation is needed

17. Condition Management Process Referral by JCP Personal Advisor Assessment by clinician Individual plan Group and/or individual sessions/modules Work alongside New Deal where appropriate Feedback to PA

18. Suddenly, Professor Liebowitz realizes he has come to the seminar without his duck.

19. Condition Management 1 Main principles Education – knowledge about the health condition Cognitive – replacing negative beliefs and behaviours Confidence building Increasing levels of activity Management rather than treatment

20. Condition Management 2 Use of ‘Cognitive Behaviour Therapy’ principles, even when not using formal CBT Employment oriented, but taking a ‘whole person’ approach Encouraging greater activity, both physically and socially Learning to accept limitations, and work within them Using targets, facing challenges

21. Criteria for success ‘Soft’ criteria –Improved confidence –Better understanding of health condition ‘Hard’ criteria – hardest first –Entry to work, off Incapacity Benefit –Starting substantial training or education –Regular voluntary work

22. Challenges Engaging and retaining participants Keeping the participant moving through the pathway Managing attendance and numbers for group interventions Keeping elements of the programme in touch with each other and with other partners

23. eric.sharp@centralderby-pct.nhs.uk