Memorandum submitted by Ingeus
WorkDirections UK is part of the Australian-owned
Ingeus group of companies. We provide effective, accountable welfare-to-work
services. We launched in the UK in 2002, and started delivering
services to people on Incapacity Benefit through the New Deal
for Disabled People (NDDP) in April 2004. Our Birmingham operation
is the largest single NDDP programme in the UK, and is co-located
with our new Employment Zone operation in the city centre. We
also deliver Incapacity Benefit outreach programmes in South and
North West London. Our experience of complementing effective employment
services with vocational rehabilitation techniques put us in a
unique position to enable this client group to access meaningful
The current structure of Incapacity Benefit
has fuelled the perception that people need to follow a sequential
process in order to be well enough to work, rather than positioning
work as part of a concurrentand therapeuticprocess.
There is a clear danger that the proposed changes will recreate
this tension with those on DSA receiving minimal interventions,
until they consider themselves "fit" to work.
This can be challenged in a number of ways.
The transitions between DSA and RSA will be of fundamental importance,
as this will reflect how well the fluctuating nature of many illnesses
and disabilities are understood. This will entail consideration
of how people will move into work from DSA, and whether this is
a staged process that means people are encouraged to move to RSA
first. Clients moving between the two will need to be convinced
that an easy transition can occur in both directions. Without
this there will be an understandable hesitance to accept increased
conditionality without the safety net to return to DSA if this
There will need to be absolute clarity about
the impact on benefits should a client move from DSA into work.
Will linking rules apply to DSA or will they return to RSA, as
a result of recent work experience? Will there be different conditions
should a client choose to undertake permitted work?
In addressing the wider question of the level
and type of intervention provided for people on DSA it is important
that these are an improvement on the current system. We advocate
regular and well signposted intervention with prescribed minimum
contact levels set as appropriate for the individual. Condition
management interventions would also be of value to those not ready
to return to work immediately in order that they can increase
the control they have over their situation. This should sit alongside
information about, and access to, other programmes delivered by
Jobcentre Plus and its partners, enabling clients to remain engaged
in meaningful activity, preventing isolation. This should include,
although in no way be limited to, learning opportunities which
may support future transitions to work. This could be delivered
through the Learning Option detailed in the 2004 Pre Budget Report.
We would like to frame our answer by underlining
the fundamental importance to any reform of the support available
of both a clear work focus and flexibility in delivery. The current
NDDP programme provides an excellent example of how a flexible
approach works in practice; enabling providers to deliver services
they perceive to be most appropriate for the individuals on their
caseload. The risk-reward structure of both funding and contracts
ensures a clear focus on outcomes.
In the context of the suggested reforms to IB,
we advocate identifying the best approaches to work-focused interventions,
rather than attempting to prescribe content. We contend that the
ability to tailor effective interventions is heavily dependent
on the approach to service provision, both by procurer and purveyor
of services, and that, therefore, this requires due focus. Best
practice requires interventions to be respectful, empowering and
The superiority of a case-management approach,
driven by the needs of the individual, has been identified as
key by a number of organisations including the British Society
of Rehabilitation Medicine. Our experience of delivering services
in both the UK and Australia has underlined the central importance
of the client/advisor relationship. Integral to success with all
clients, including those most disadvantaged within the labour
market, is the need for this relationship to be professionally
informed. It is essential that advisors understand the nature
of both incapacity and unemployment. The combined impact on claimants'
lives can be seen in their levels of motivation, activation and
socialisation. The response needs to meet intertwined causes with
It is apparent that risks associated with moving
from benefits into work can be minimised, and associated incentives
increased, by introducing systemic changessome of which
are already planned. Additionally, the value of improving people's
experience of work in both the short and the longer term should
not be underestimated.
The extension and simplification of the linking
periods identified in the 2005 Budget are certainly welcome. This
should remove some considerable concerns for some people as the
current system is unnecessarily complicated and bureaucratic.
However, as we move towards the new benefit system the concerns
of those on IB currently will heighten, particularly if they perceive
that they will be more exposed under the new system. The implications
for people on IB starting work after the reforms have occurred
need to be explicit and, importantly, simple. One of the endemic
problems with the current system is its structure, which takes
no account of the fluctuating nature of many conditions. Changing
the linking rules should have a considerable impact on risk managementit
is essential that this is not lost when more fundamental changes
to the benefit take place.
"Incapacity" is a nebulous concept.
Not only do levels of capacity fluctuate, but also the nature
of disabilities and health issues can and do change. There is
a clear need for this to be reflected within the structure of
the reformed benefits.
Permitted work should be an ideal way for clients
to try out work. However, inflexibilities within the current system
mean its advantages are not maximised. An example of this is the
treatment of ad hoc overtime which would take clients' hours above
16 in that week. Should irregular overtime be possible, clients
would be better able to meet their employer's needs and prove
their value. It would also enable clients to test their own ability
to work more than 16 hours a week. Additional earnings could be
offset against benefit income.
There are additional issues of "security
equity" for those on Income Support with a Disability Premium
which need to be addressed as part of any proposed reforms. Under
the current system the latter group encounter greater restrictions
in taking up permitted workthey are only able to earn £20
per week before their benefits are affected. Without the same
level of protection as clients on IB they are less likely to take
the "risk" of starting employment.
Considerable effort has been made to "make
work pay" through the use of tax credits, the minimum wage
and the return to work credit. These could, however, be considerably
enhanced. The tax credit system is notoriously complexindeed
clients can receive different responses depending on whether they
apply for credits over the phone, or on-line.
We also have a concern about the equivocal evidence
of the success of return to work credits in terms of increasing
both retention and earning capacity beyond 52 weeks. This could
be improved through a flagged intervention for working recipients
at 45 weeks. This would ensure that clients were aware that the
credits were coming to an end, and had fully explored all options
available to them to continue earning at that rate.
Other aspects of service delivery pre-employment
are important to ensure risks are minimised. A quality match between
client, vacancy and employer will do much to allay fears and provide
motivation. This requires an understanding of client needs in
terms of the required working environmentthis is true for
anyone looking to work, but can be more important for people with
certain health conditions or disabilities. Increasing emphasis
is being placed on educating employers both about their responsibilities
and their potential gains from implementing better retention and
sickness policies, and this is certainly a move we welcome.
The successes of Pathways to Work have been
well documented. However, closer examination of the available
evidence highlights two findings which are important for future
The first concerns the success of NDDP programmes
in Pathways areas in assisting clients into work. NDDP programmes
in Pathways areas are achieving a job outcome rate of 63% with
Pathways clients, equivalent to the national success rate, despite
the considerable increase in referrals. NDDP is currently only
available to 3.6% of the IB populationit appears from the
Pathways experience that it would continue to be as successful
if it were a larger programme. However, this would necessitate
more effective referral mechanisms - we suggest this could be
achieved through the roll-out of more regular WFIs to all non-Pathways
areas, and by providing NDDP Job Brokers with access to details
of eligible benefits claimants.
The second finding is that 63% of all those
finding work through Pathways have accessed the Return to Work
credit. This means they have accessed jobs paying £15,000
pa or less. This raises the question of what will happen to these
clients when the credit ends.
Pathways to Work has to date been delivered
by Jobcentre Plus in partnership with local organisations. WorkDirections
welcome both the success to date of Pathways to Work and the decision
to extend them to a further 14 areas. We believe this extension
provides the Government with a clear opportunity to enhance the
learning available from these pilots, in particular by testing
different delivery models within the same overall framework. Contracting
out the delivery of one or more of the new areas to the private
or voluntary sector would provide such a comparison along with
increasing the scope for innovation.
As has been identified throughout this response,
key to effective provision of services is the flexibility to focus
on the needs of the individual. Working from this premise we have
concerns about the value of separating clients by condition, particularly
as all unemployment has an impact on mental health. Interventions
need to be goal orientateda barrier-led approach is counterproductive.
Health is only one of a number of issues that need to be addressed
as people move towards employment.
For WorkDirections the provision of access to
a condition management programme has entailed embedding a psychologist
and physiotherapist within the advisory team. They work with advisors
and clients on a one to one basis and in groups as an intrinsic
part of the transition process not a bolt-on service. The presence
of specialists has also improved the skills of the whole team.
It also enables us to offer clients a more informative service
where their work and health needs are explored. Evidence from
the back pain pilot delivered in Salford in 2003 also demonstrates
positive gains from people actively understanding their health
issues and how to manage them.
All clients accessing WorkDirections services
have, in addition to their advisor, access to a psychologist.
They work alongside the advisor in order to provide additional
professional support. This is valuable not only for those clients
with identified mental health conditions, but also for many others
who are better able to meet their goals as a result of this specialist
intervention. This may be in the form of three-way meetings between
advisor, specialist advisor and client, one to one support, or
through group activities. Examples of the latter include sessions
on confidence, managing pain and walking groups. These are available
to all clients who would benefit from themwith the emphasis
on the results clients want to achieve, rather than the condition
or disability they have.
Also important at the pre-placement stage is
the professionally informed advice and support given to clients
about managing their condition once in work. In addition to building
confidence, this empowers clients to take control over their lives
and make decisions that are right for them. This process is currently
significantly weakened by a fragmented and poorly coordinated
approach which often sees clients given conflicting messages by
health and employment specialists about the value and possibility
of returning to work.
Risk to the individual could be minimised by
reviewing the Housing Benefit process for those moving into work.
The system needs to be simpler, more transparent and easier to
navigateparticularly for people once they are in work.
The perception amongst clients is that the process is complicated
in order to discourage applications. Health professionals with
whom we are trying to engage have expressed reluctance about clients
starting work because of the likelihood of ensuing housing benefit
There is undoubtedly stigma attached to some
mental health conditions that does not exist with, for example,
some muscular-skeletal injuries or disabilities. This underlines
the need for professional, discerning and knowledgeable staff
who are able to tailor support appropriately. This might include,
for example, understanding the impacts of medication or discussing
disclosure of the condition to employers. These discussions should
occur as required, as an integral part of the job-search process,
not as an adjunct to it.
Addressing either employment barriers or meeting
clinical need in isolation is likely to be ineffective in producing
sustainable positive change. The importance of integrating health
and employment approaches has been made clear in recent government
publications, including the Choosing Health white paper and the
Framework for Vocational Rehabilitation. This holistic approach
has tended to be more difficult in practice.
We have, however, had some success with Birmingham
PCTs which demonstrates how links can be forged between health
and employment providers for the benefit of clients. The PCT Director
of Public Health is recommending that WorkDirections NDDP be classified
as a "locally enhanced service". These are additional
services of benefit to the health of the local population that
the PCT will pay doctors to provide (in this instance they would
be paid for signposting). Importantly, this gives employment interventions
legitimacy with healthcare professionals.
Within the IB reform process there is also the
opportunity to look at longer-term interventions to improve employment
life-chances of claimants. This should include skills enhancement
through the Learning Option, Employer Training Programme, and
support for those who have moved into work from IB to progress.
The 52-week life span of the Return to Work credit on Pathways
also provides a framework to re-engage with clients 45-48 weeks
after they have started in work in order to provide support to
look for a new, better-paying job.
A retention and progression focus to service
provision should ensure that clients are able to continue to access
services once in work should they want to increase or decrease
hours or change jobs. Whilst good providers offer these services,
they are not expected or funded to do so beyond 13 weeks. This
is a comparatively short timeframe considering the length of time
many clients will have been out of work. Elements of the recent
Skills Strategy should offer some opportunities through which
to deliver this.
3 October 2005