Putting employment support at the heart of the health system
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Much has been made about the dramatic reduction in anticipated spend on the government’s flagship welfare-to-work programmes. This will likely result in a loss of employment support infrastructure, with greater reliance on the Jobcentre Plus (JCP) network to provide advice and support to most jobseekers.

But there’s another infrastructure, much larger than JCP, that already has deep and trusted links with a great many people with employment needs. That infrastructure exists in every community and is under a great deal of pressure to manage its own costs and demand.

It is, of course, the National Health Service. Earlier this year, the NHS’s five-year strategy on mental health declared employment to be a clinical health outcome – an important factor in helping people to recover from their mental illness. That’s significant because evidence shows that the health service can often have more success than traditional routes in helping people with mental illness into work.

Raising job success rates will be key if the government is going to meet its commitment to halve the gap in the employment rates of those with disabilities and those without.

Achieving that goal would mean a million more people with health conditions and disabilities in work. Yet five years of Work Programme helped fewer than 40,000 ESA claimants into jobs. That’s why the Learning and Work Institute believes that, on current trends, it would take 200 years for the government to hit their target.

In June, the team at Social Finance offered its response to this challenge with the launch of Health and Employment Partnerships. 

Health and Employment Partnerships starts from the premise that everyone has the capacity, with the right support, to engage productively in the open, competitive, labour market.

And that we know what works to help people achieve their employment goals: personalised support; support that continues in work; and, critically, a close and physical link between employment support and health treatment.

There are examples of this working in practice, notably with the deployment of the Individual Placement and Support (IPS) model within community mental health teams. The seventeen IPS Centres of Excellence in the UK are achieving astounding outcomes.

But the UK has struggled to make such programmes work across the system as a whole.

The problem is that proven interventions like Individual Placement and Support don't quite fit the current system. On the one hand, we have a health service with huge levels of trust but with a strong focus on clinical treatment. That doesn’t always leave room for wider goals, such as employment. On the other hand, we have an employment system that is tasked with policing benefits even as it tries to build up trusted relationships with clients.

Health and Employment Partnerships has already taken an important step to bring the two systems together through the development of the first mental health and work Social Impact Bond. The aim of this model is to show how local, health and central government resources and capabilities can be brought together to scale up services in a rigorous, but flexible way.

Under our model, national funders, in this instance Cabinet Office and the Big Lottery Fund, co-pay for Individual Placement and Support (IPS) services alongside councils and NHS funders on a payment-by-outcomes basis. Once employment outcomes are achieved, payments are released.

This has allowed us to partner with three areas in London and the West Midlands to develop IPS services that will work with 2,500 people with severe mental illness over three years. To help providers manage the financial risk involved in outcomes-based contracts, we raised socially-motivated capital from Big Issue Invest to pay for part of the service up-front.

The programme launched earlier this year and early results are promising, both in terms of the numbers entering work and the speed with which they find jobs. This is particularly encouraging as the service is for people with severe and enduring mental illness who may have been out of work for years.

Our goal is to test a model for sustainable, scalable funding of IPS that will allow it to be rapidly replicated across the country. We are already working with one devolved region to explore how IPS can be rolled out across an entire region. With a £50m commitment from the NHS for further investment in IPS, we believe there is opportunity to go much, much further.

And that’s not all. We think that the principles of health-based employment support can be applied to many different groups of people.

That’s why we’re now working with Tower Hamlets council to explore if a Social Impact Bond could finance supported employment services for adults with learning disabilities. It’s also why we’re working on a route forward to support older workers at risk of involuntary early retirement.

Until now, employment support has largely been the domain of DWP and its network of internal and external providers. Now employment is becoming the business of the health service too.

Not only does that open up a major new infrastructure to aid the delivery of employment services. It could also dramatically improve our success rates in helping those with health conditions and disabilities into work.

Better outcomes for individuals. More savings for the state. That is a goal both DWP and the NHS can firmly agree on.

Adam is the programme lead for Health and Employment Partnerships. If you are interested in learning more about Health and Employment Partnerships, please contact us on healthandemployment@socialfinance.org.uk.

Adam Swersky

Associate Director, Social Finance