Upload
curtis-porter
View
217
Download
0
Embed Size (px)
Citation preview
1
© Dr Nick Niven-Jenkins CMG 2004
Pathways to Work
Condition Management Programmes
York Cardiac Care & Rehabilitation Conference
Dr Nick Niven-Jenkins
Corporate Medical Group
Department for Work and Pensions
March 2005
2
© Dr Nick Niven-Jenkins CMG 2004
Background Sick and away from work 1 million people report sick each week 3000 remain off work at 6 months and 2,400 of these will not work again in the next 5 years
Sick and claiming benefit 2.7 million people of working age currently claim a
state incapacity benefit 1 [less than 1 million unemployed]
demographics not good - ageing population
1. DWP Analytical Services Division 2002
3
© Dr Nick Niven-Jenkins CMG 2004
Incapacity Benefit Caseload
• But general ‘health’ of population is improving!• 50% recipients are over 50 years of age
Chart 1: Incapacity benefits caseload (1979-2003, excluding IBSTL) and inflows (1988-2003)
0
500
1,000
1,500
2,000
2,500
3,000
1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003
Cas
elo
ad -
exc
lud
ing
IBS
TL
(th
ou
san
ds)
0
200
400
600
800
1,000
1,200
Infl
ow
s (t
ho
usa
nd
s)
caseload (excl IBSTL)
inflows
4
© Dr Nick Niven-Jenkins CMG 2004
Reported common health problems
Incapacity Benefit Caseload by Diagnosis Code - November 2001
Mental and Behaviourial Disorders - 33%
Diseases of Musculo-skeletal tissue - 23%
Not specified - 11%
Others - 9%
Disease of the Circulatory System - 8%
Diseases of the Nervous System - 5%
Injuries, Poisoning - 6%
Diseases of the Respiratory System - 3%
The ‘others’ category consists of the remaining 13 ICD diagnostic groupsThe majority of people have mild-moderate medical conditions
5
© Dr Nick Niven-Jenkins CMG 2004
Importance of work
Work is a major part of most peoples lives
Work provides:
Financial status and security An occupation and activity Sense of identity and purpose Social interaction
6
© Dr Nick Niven-Jenkins CMG 2004
Impact of worklessness
Negative health & social consequences include:
Changing health related behaviourIncreased morbidity [especially mental health] & mortality [suicide]
Isolation and social exclusionSocial deprivation
Disruption to future work careerand assumptions of unemployability
Loss of motivation & confidence
Acheson D [1998] Inequalities in health HMSO
7
© Dr Nick Niven-Jenkins CMG 2004
Work and health strategyMove people from:
welfare dependency to work opportunities
Three reasons: Health – work improves health & reduces health
inequalities Social – rights of people with health condition and/or
disability Economic – loss of expertise impacts on economic
growth
8
© Dr Nick Niven-Jenkins CMG 2004
Rehabilitation
Traditional process inappropriate for common health problems
Obstacles predominantly psychosocial rather than severe pathology or impairment
Therefore: Use a process that identifies and helps
overcome the health, personal,psychological and social/occupational obstacles to recovery
9
© Dr Nick Niven-Jenkins CMG 2004
A New Approach best medical evidence suggests that a return to
normal activity - including work - improves well being and enhances recovery for most people
complex clinical interventions or expensive programmes of treatment are often not necessary
rather individuals need to be ‘empowered’ to manage
their symptoms and engage in normal activities
10
© Dr Nick Niven-Jenkins CMG 2004
Choices
Structured and comprehensive package of help and support
consists of work focussed programme provision and financial incentives
these reforms build on existing range of provisions and introduce new health condition management programmes delivered by the NHS [but funded by DWP]
11
© Dr Nick Niven-Jenkins CMG 2004
Condition management programmes
Short term interventions lasting 4-13 weeksMain elements of this approach:
Initial assessment provide patient with information about their condition address patient concerns and beliefs provide physical/psychological interventions and
support where needed [Health Action Plan] provide vocational advice and support
12
© Dr Nick Niven-Jenkins CMG 2004
Condition management programmes
- common elements - Education cognitive therapy/behavioural groups goal setting work [including supported job seeking] physical exercise relaxation/’stress’ management
13
© Dr Nick Niven-Jenkins CMG 2004
Results
10,700 people have returned to work -over 2,000 had been on benefits for more than 2 years
20-25% of people attending work-focussed interviews take up some form of back-to-work help [choices]
About a third of these started a CMP
14
© Dr Nick Niven-Jenkins CMG 2004
Sick and Disabled PRA job entries in Pathways Pilot Districts: year-on-year comparison
0
200
400
600
800
1000
1200
1400
1600
Jun Jul Aug Sep Oct Nov
2003 2004
15
© Dr Nick Niven-Jenkins CMG 2004
Benefit ‘off-flow’ ratesIB Six Month Off-flow Rate
20%
25%
30%
35%
40%
45%
50%A
pr-0
1
Jun-
01
Aug
-01
Oct
-01
Dec
-01
Feb
-02
Apr
-02
Jun-
02
Aug
-02
Oct
-02
Dec
-02
Feb
-03
Apr
-03
Jun-
03
Aug
-03
Oct
-03
Dec
-03
Feb
-04
Apr
-04
Jun-
04
Month of benefit start
Off
-flo
w r
ate
National
Pathways Phase 1
Pathways Phase 2
The off-flow rates presented are produced from the Working Age Statistical Database (WASD). WASD does not include a proportion of short-term Incapacity Benefit claims, therefore the off-flows presented will be lower than actual rates. However, trends over time will be consistent.
Start of phase 1
pilots
Start of phase 2
pilots
16
© Dr Nick Niven-Jenkins CMG 2004
And finally.......
for more information