Health and work support pilot: final evaluation

Executive Summary

Rocket Science, with Ipsos MORI and ekosgen, was commissioned by the Scottish Government to evaluate the Health and Work Support (HWS) pilot. The Health and Work Support (HWS) pilot was a two-year project which ran in Dundee and Fife from June 2018 to March 2020 to test the value and impact of creating a clear access point for specialist health and work services to support people experiencing health problems to get into work or stay in work. The pilot was funded by the Department for Work and Pension's (DWP) and the Department for Health and Social Care's (DHSC) Work and Health Unit, with additional funding from the Scottish Government.

The pilot was aimed at helping those at risk of losing their employment because of ill health or those recently unemployed due to ill health and/or disability. It aimed to explore the extent to which these people can easily find their way to appropriate early intervention support that integrates health and work support services to help them retain employment or gain new work, and to assess the difference that this support can make.

The aim of the evaluation is to provide an independent review of the delivery process and outcomes of the HWS pilot. A first stage implementation evaluation covering the set up and early delivery period of the pilot has already been published on the Scottish Government website^[1].

This evaluation report:

• provides further learning to help shape future policy and service design and delivery; and,
• provide insights and evidence for application of health and work interventions at the local level – particularly in terms of their use by Local Employability Partnerships as part of the roll out of the No One Left Behind approach.

This evaluation focuses on the outcomes of the HWS pilot, and considers the benefits in terms of employability outcomes, health and well-being outcomes.

The key research questions that the evaluation answers are:

• What difference did the HWS pilot make in terms of the referral process?
• What difference did the HWS pilot make for the client?
• What lessons can be learnt from the HWS pilot, and how might delivery of such a service be improved for clients, staff and referrers (Job Centre Plus work coaches, GPs and employers)?

In order to answer these questions a number of research methods have been deployed including gathering insights from referrers, staff, employers, stakeholders and clients of the HWS pilot. The report also provides quantitative analysis of management information from the pilot.

Following the COVID-19 outbreak, the pilot was closed earlier than anticipated to redeploy pilot staff to Covid facing roles. In addition to impacts on service delivery the pandemic affected the evaluation resulting in some elements of fieldwork that were originally planned having to be dropped or modified.

Key Findings

General views of the service

• Referrers felt that the support provided by the pilot was unique in the service landscape. The integrated approach filled an essential gap because of the inter-relatedness of issues around health and work.
• Overall levels of participant satisfaction with the support received through the Health and Work Support Pilot were found to be high. The services that made the most difference in helping participants to remain in or find work were: specialist support to address a physical health condition; and support received from a case manager.
• Most clients interviewed were positive about the service and felt that the process to access the HWS pilot was effective; the initial assessment of needs was straightforward and adequate; they had accessed the right level of support; and they felt that staff were friendly and treated them with respect.

The referral process

• Overall, referrers felt that the HWS pilot improved the referral process for clients who were eligible for the service in Fife and Dundee.
• Some stakeholders felt that there were too many steps for clients to go through from the first point of contact through to their first clinical intervention. Some clients also echoed this view.
• Just over a third of all participants (36%) were found to have dropped out of the service before they had finished receiving support. Those dropping out of the service said they felt they had got all the support they needed; the appointment times with a specialist were not suitable (i.e. only available 9 to 5) and/or their circumstances had changed.

Impact on service users accessing Health and Work Support

• The majority of service users felt that the pilot had made a positive difference to their health and employment outcomes, with 76% saying that the service made a difference in enabling them to remain in work and/or return to work from absence; change their working pattern; or find employment.
• Clients' concerns about losing their job due to their health condition reduced. Of those that stayed on the service to receive complete support, the proportion of participants concerned about losing their jobs because of their health condition was 12% (at the time of this survey). At the time of enrolment this was 34% (all participants).
• Absence from work fell. Of those that stayed on the service to receive complete support, the proportion of participants who were absent from work (due to sickness or other reasons) was 10% (at the time of the survey), at the time of enrolment this was 27% (all participants).
• Three quarters (78%) of survey respondents said that their health had improved since first contact with the service and a high proportion of them (91%) said that the service had contributed to this improvement.
• However, clients with more complex needs and conditions did not report the same level of benefits from the HWS pilot, and it did not help them re-enter or gain employment or better manage their daily life. Some interviewees who accessed mental health support felt their needs were perhaps too complex for the HWS pilot to respond to effectively, whereas those who accessed physiotherapy services were more likely to report tangible benefits.

Lessons learned for developing a work and health intervention

• Maximising ownership, awareness and reach are key elements in implementation.
• Data collection systems need to be in place from service launch, and data should be collected for clients' engagement with the different stages of support.
• Pathways are not linear so the service needs to be modelled on the client journey rather than the stages of service delivery.
• Relationships within and outwith the service need to be developed to maximise the value of the existing landscape of support, including across policy areas within government.
• Health and work should be addressed simultaneously but work coaches cannot provide health interventions so must be supported to ensure clients are able to access the support they need.
• Other barriers and challenges that clients face also need to be addressed alongside health and work, to ensure that they are able to sustain work.

Stakeholder reflections on the employability and health landscape

• Stakeholders reported growing awareness of the scale of health issues impacting on employment and recognition that there needs to be a holistic service offer for those facing health and work challenges. The pandemic may have accelerated the need for this.
• There was recognition amongst those contacted as part of the evaluation that the early intervention approach pioneered by the HWS pilot to support those in work should be sustained, especially with the emergence and impact of 'long Covid'.
• There is growing concern about the rising numbers of those who are withdrawing from the labour market and becoming economically inactive.

Conclusion

The evidence suggests the HWS pilot worked to fill an essential gap in simultaneously addressing health and work challenges for those in the workforce in pilot areas. Satisfaction with the service provided was high, and it had a positive impact on health and employment outcomes for those people who completed the service. Employers and referrers were also positive about the pilot. However, benefits were not uniform - people with more complex needs and people with mental health conditions did not report the same level of benefits as people with physical conditions. It is also not clear if the service delivery model used in the pilot is the best for addressing health and work issues. The pilot did however help identify learning for any future initiatives in terms of system reform and service design, including the referral process.