Fair Start Scotland - individual placement and support review: findings

A full report including findings and recommendations of an independent review of Individual Placement and Support (IPS) in Scotland commissioned by Scottish Government and produced by Social Finance.

Annex C. Calculation of IPS Worker Need

This calculation follows IPS Grow Guidance to estimate the number of IPS specialists required[84].

Step 1: Calculate the number of adults on the caseload of secondary mental health teams

The number of Clients in Contact with Mental Health Services in Scotland was approximated per health board, using publicly available data on the number of outpatients by Health Board[85]. The number of new appointments with General Psychiatry services over the course of the year was used as a proxy for the number of people in contact with mental health services - around 60,000 in total.

The population of Scotland is estimated to be 5.5m people[86]. This represents just over 1.1% of the population in contact with Mental Health services.

NHS England data shows that just under 1.1m adults are in contact with adult secondary mental health services[87]. This represents approximately 2% of the population[88]. This suggests that the figures we have used in our analysis for the number of clients in contact with Secondary Mental Health in Scotland are either an underestimation, or less people are in treatment. Either way, it is likely to result in a prudent estimate of the number of ES required to support this population.

These access figures have been "sense checked" with Scottish Government Fair Start Scotland colleagues as a reasonable estimate. Scottish Government could replicate this analysis using internal data as part of the process to set targets for IPS access for SMI clients.

Step 2: Identify the number of Clients who want Employment Support

We deducted the number of people who are already in paid employment. This is estimated to be approximately 10% based on comparable data points[89].

We then estimated the percentage of people with severe mental illness who may be interested in seeking paid work in any one year. Note that this is the only exclusion criteria for IPS and is not the same as the percentage that clinicians or other professionals believe may be suitable for paid work. While there is no definitive view on the proportion who fall into this category, studies suggest it may be 30-50% of the cohort[90]. We used the 30% criterion to be prudent.

We have then suggested that Scottish Government initially targets making support available to 25% of this population by the end of the next 5 years. This is designed to be a realistic ramp up target that will support implementation of high fidelity services as support scales. NHS England have a target to support 50% of the eligible population each year by the end of 28/29.

Step 3: Identify the number of Employment Specialists Required

IPS Grow data for a high performing service suggests a fully-trained employment specialist can work with 40-50 clients per year.

Step 4: Identify the Associated Costs

IPS Grow have developed a tool to calculate the expected costs of a service based on its access targets[91]. This uses benchmark data around the cost of staff, management and running a high-fidelity IPS service.

Step 5: Estimate the number of job outcomes

IPS Grow estimate that each Employment Specialist should be able to support around 16 clients into work each year. This is based on benchmarking existing high fidelity service performance.

NHS Scotland Region Estimated # of People in Contact with SMI Services[1] Estimated Clients Eligible for IPS[2] Estimated ES needed to work with 25% of the eligible population each year[3] Estimate Annual Service Cost (£000s) [4] Estimated Annual Number of Job Outcomes [5]
Ayrshire and Arran 3,654 987 6 325 95
Borders 6,000 1,620 10 564 160
Dumfries and Galloway 1,342 362 2 141 40
Western Isles 224 60 1 55 8
Fife 3,706 1,001 6 380 105
Forth Valley 2,820 761 5 282 80
Grampian 5,098 1,376 9 466 136
Glasgow and Clyde 9,966 2,691 17 932 272
Highland 5,588 1,509 9 543 152
Lanarkshire 6,586 1,778 11 607 176
Lothian 9,312 2,514 16 868 248
Orkney 268 72 1 55 8
Shetland 194 52 1 55 8
Tayside 5,666 1,530 10 543 152
TOTALS 60,424 16,313 104 5,815 1,640



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