Health and work support pilot: final evaluation

Introduction and Scope

Background information^[2]

The Health and Work Support (HWS) pilot was a two-year pilot project in Dundee and Fife^[3] from June 2018 - March 2020. 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, as part of its Work and Health Innovation Fund, with additional funding from Scottish Government.

The purpose of the HWS pilot was to test the value and impact of creating a clear and obvious access point for specialist health and work services, aimed at helping those at risk of losing their employment because of ill health or those who are recently unemployed due to ill health and/or disability. The pilot also included a pathway for employers to access support or advice for their employees who may need additional support.

The pilot was structured around a 'Single Gateway' access channel for health and work support services and aimed to achieve the following three objectives:

• Integration and alignment of affiliated services for health and work support;
• Improved experience for the clients receiving support;
• Better understanding of the outcomes of early intervention approaches.

The pilot was originally meant to run until June 2020, but challenges resulting from the COVID-19 pandemic meant that closure was brought forward with the last clients enrolling with the service in March 2020 and with all clients being discharged by August 2020. The decision was made to close the service as the local delivery teams were required to be redeployed to respond to the pandemic.

Context for the pilot

The pilot was developed in response to individuals leaving work in Scotland as a result of problems around health or disability.

The introduction of the 'Single Gateway' pilot was proposed as a response and was articulated through two specific actions set out in the Scottish Government's published No One Left Behind policy document under the heading 'Employability and Health'^[4]:

• Action 4 – "From Summer 2018 to Summer 2020, the Scottish Government will work together with partners including Health and Social Care Partnerships, DWP, wider third sector bodies, and employers to pilot a Single Health and Work Gateway in the Fife and Dundee areas to help more disabled people, and people with health conditions access early support to help them sustain or return quickly to work."
• Action 5 – "From Summer 2018, the Scottish Government will work with partners within the Single Gateway pilot areas of Fife and Dundee to agree a plan to trial additional mental health support."

The action points in the strategy described how the Single Health Gateway / HWS pilot could act as a primary entrance or referral point for NHS-led and in-work support. This introduced an innovative alternative to the complex and confusing landscape of health and work support services which offered similar types of support with different criteria for access.

Through the pilot, eligible clients in Dundee and Fife were offered up to 20 weeks of case management, holistic health and work assessment, fast tracked access to therapeutic and non-therapeutic work-and-health focused support. A brief summary of the pilot service design is presented below:

Source: Adapted from Rocket Science

The main features of the pilot were:

• the use of a new brand to promote the service to those clients who faced health barriers to work or risked the loss of their job because of health issues;
• using current national services (Healthy Working Lives & Salus) as a single gateway access point to the service in Dundee and Fife;
• the use of a wide range of referrers – including JCP work coaches, GPs and employers – to ensure that the service reached those who could benefit;
• the appointment of clinically trained case managers to carry out assessment and onward referral of clients to appropriate services;
• the availability of a range of specialist support, including physiotherapy and talking therapies;
• an intervention period of 20 weeks; and
• the use of workstreams matching eligibility criteria:
  • Working Health Services Scotland (present or absent from work) – employed individuals from small and medium enterprises struggling to stay in work due to a health condition or disability;
  • Large Employee Employer Service (present or absent from work) -– employed individuals from larger businesses struggling to stay in work due to a health condition or disability;
  • Employability and Health (unemployed) – recently unemployed (less than 6 months) individuals as a result of a health condition or disability;
  • Healthy Working Lives (employers) – for employers in the Fife and Dundee pilot area who require advice and support around health and work issues.

This report

This evaluation offers an opportunity for reflection on the lessons learned from the HWS pilot (i.e., service design and delivery), and gathers insights into whether and how the approach could inform the design and delivery of future place based services, for example via the No One Left Behind (NOLB) approach to employability services^[5].

Specifically, there is a focus on whether the pilot made a difference to the clarity, coordination and efficiency of the landscape of support.

The report presents:

• A summary of quantitative findings
  • Analysis of management and performance data
  • Telephone interviews with clients
• A summary of qualitative findings
  • Longitudinal interviews with clients
  • Staff and employer findings
  • Stakeholder engagement
• A synthesis of research and findings