Today sees the publication of the government's plan to 'Get Britain Working' and tackle economic inactivity among the working age population. The plan relies on the NHS and employment services working hand-in-hand. John Copps looks at where we are now and what needs to happen to realise that goal.
Today the government has published its plan for reform to employment support to ‘Get Britain Working’. A big part of this is to address the ill-health that blights a chunk of the working age population – a group that has swelled to more than 2.8 million since the pandemic.
The government's plan makes good on the Chancellor's pledge of £240m funding for employment, skills and health support to disabled people and those that are long-term sick. Included in it is a promise to ‘tackle the root causes of ill‑health related inactivity’, with ‘eight trailblazer areas across England and Wales that bring together health, employment, and skills services to improve the support available to those who are inactive’. Part of this is the establishment of ‘Health and Growth Accelerators’ to target the top health conditions driving inactivity as well as ‘Connect to Work’, a programme matching people with jobs and supporting them in their new roles.
The government recognised the challenge this poses in practice and its emphasis on testing new approaches. It knows the road to achieving success won’t be an easy one.
Where are we now?
Healthcare and employment support are delivered separately.
Existing employment support – such as that delivered within job centres – explores health as a ‘barrier to work’ and can help direct individuals to health services. But people’s experience of this varies hugely, relying on luck or a single professional that is ‘in the know’. The enablers and relationships that make the link between services work consistently are almost always missing.
In the NHS, the way clinicians think and behave is not geared up towards an appreciation of the importance of patients’ employment status. The medical world tends to treat ‘work’ like it does everything else: it boxes it off into a specialism – occupational therapy – and affords it scant recognition elsewhere. (This is perhaps a bit unfair. There are many professionals that buck this trend, most notably in General Practice, but they aren’t actively supported by the clinical environment around them.)
Despite all this, we know that reducing economic inactivity won’t happen by treating patients’ presenting health needs and then expecting them to magically find a job. The solution lies in knitting together both types of support, and understanding the relationship between health, work and personal ambitions.
What can we do in practice?
So where should we start? Here are three things that I think could help bridge the gap between employment and health services:
1. Experiment and learn from what works
There are no ready-made solutions to integration in this area. The Joint Directorate on Work and Health – a collaboration between DWP and DHSC – is already trialing a range of new approaches, most notably its investment in fifteen ICBs to deliver the WorkWell Programme. This initiative brings together local NHS, councils, JobCentre Plus and employers to find ways of collaborating. That work must continue.
A big mistake would be for the new programmes announced in the Budget to reinforce existing siloes. The Health and Growth Accelerators that are described as targeting ‘top health conditions’, for example, must not become medically-driven projects that just treat obesity, bad backs, and depression and anxiety. If they are, they won’t shift the dial on economic inactivity.
2. Focus services on the person with a coaching approach
All support must be person-centred and holistic, not narrowly focused on individuals’ presenting medical condition. We have the tools to work in this way. Employment services already use ‘work coaches’, ‘health coaching’ is gaining currency in the NHS, and the WorkWell Programme is pioneering the use of ‘Work and Health Coaches’. Building a relationship with the person, a coach can provide access to a range of professionals including counsellors, physiotherapists or social prescribers. As these new roles becomes established the government must ensure they are supported, including through a network of peer support and access to professional development opportunities.
3. Enforce the ‘fourth aim’ of Integrated Care Systems
The NHS already has a standing commitment beyond simply providing health care. The fourth aim of Integrated Care Systems is to ‘support broader social and economic development’, which includes the impact on local employment. The problem is that the fourth aim is very much the fourth out of four.
As my colleague at PA Consulting Tim Pope argues, NHS England could and should do more to enforce the fourth aim. That means measuring it, reporting on it and requiring that someone in each ICB is accountable for it. As is the way with the NHS, the system would respond.
All the evidence shows having a job and undertaking fulfilling work is one of the most important things for our well-being, life satisfaction and longevity. The government has set out a bold agenda on work and health – and relies on its success to achieve its target for economic growth. Services and professionals must now work together to achieve it.
To learn more about MV’s work on health, employment and economic inactivity contact John Copps john@mutualventures.co.uk.
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