Supplementary memorandum from DWP
DWP published the Framework for Vocational Rehabilitation
in October 2004 following the commitment given in the Second Stage
Report of the Review of Employers' Liability Compulsory Insurance.
This Framework for Vocational Rehabilitation
was a first step towards building a new approach. It demonstrated
the Government's commitment to provide direction and leadership
on vocational rehabilitation by:
producing a working description of
vocational rehabilitation which we can all use;
taking appropriate action to ensure
that Government initiatives complement each other and contain
setting up a Vocational Rehabilitation
Steering Group so stakeholders can contribute to the development
of the new approach to vocational rehabilitation;
establishing a Research Working Group
and a Standards and Accreditation Working Group to take forward
these important issue;
developing new guidance and additional
tools for stakeholders;
giving a commitment to consider the
range of issues that stakeholders have raised; and
highlighting that the public sector
has a significant contribution to make by setting appropriate
examplesparticularly Government departments and the devolved
DWP, Department for Health and HSE jointly launched
the Health Work and Well-being strategy in October 2005 and appointed
Dame Carol Black, the National Director for Health and Work. The
strategy is a groundbreaking partnership between Government (Department
for Work and Pensions, Department of Health, Welsh Assembly Government,
Scottish Executive and the Health and Safety Executive), employers
and healthcare professionals. Its main themes are engaging stakeholders,
improving working lives and healthcare for working age people.
The strategy subsumed current and future work on vocational rehabilitation.
The Vocational Rehabilitation Task Group (VR
task group) was set up by Lord McKenzie on 18 June 2007.
The purpose of the group is:
To develop evidence of what works/identify
effective interventions for the rehabilitation and return to work
of employees suffering from work related stress and musculoskeletal
To produce advice, information and
guidance for employers and others involved in procuring rehabilitation
services on the what, why, where, when and how of rehabilitation.
To investigate and where appropriate
make the case for provision of incentives/removal of disincentives
to encourage a wider take up of rehabilitation services.
To support and encourage contributions
of others in developing competence and delivery standards of providers
of rehabilitation services.
The group is chaired by Bill Gunnyeon, DWP Director
for Health, Work and Well-being. The group also has representation
from the Association of British Insurers (ABI), Federation of
Small Businesses (FSB), TUC, CBI and the Department of Health.
The VR Task Group has commissioned an evidence
review with the Industrial Injuries Advisory Council (IIAC) of
the evidence of the effectiveness and cost effectiveness of measures
designed to ensure the rehabilitation and return to work of adults
of working age suffering from common health problems and from
The work was commissioned on 16 November 2007
by the ABI on behalf of the VR Task Group and IIAC. The work will
be overseen by a steering group comprising representatives nominated
by the Group and IIAC.
The review has been commissioned with Professor
Waddell and Burton, who produced the well-respected 2006 publication:
Is work good for your health and well-being? The review will follow
similar lines to the earlier publication with evidence linking
and rigorous methods used to assess the strength of evidence.
We expect a final report to be published in
The review will seek to answer the following
What rehabilitation and return to
work measures are effective?
When should these measures be implemented?
What is the impact on effectiveness
if these measures are delayed longer than six months?
How cost-effective are these measures?
VR Task Groupincentives and dis-incentives
The VR Task Group has commissioned work to assess
all the possible ways to correct those market failures which impair
the development and provision of vocational rehabilitation services,
including through the provision of better information and through
assessing incentives, and the current disincentives, including
National Insurance and the benefit-in-kind
rulesCould this be hampering the development of a stronger
market, and could we kick-start a greater interest in rehabilitation
by making changes in this area?
VATwhere does VAT fall, and
how does it affect business decisions?
Corporation Taxescould these
have an impact on rehabilitation?
Tax creditsAre there any arguments
for providing these?
The group member leading the work will deliver
a comprehensive report to the task group, featuring the strongest
available evidence as well as their own research findings and
looking at the impacts of the proposals.
The report will describe the current
market for rehabilitation, where it doesn't work, and look at
how tax rules impact upon it.
It will assess various options for
change according to their costs and benefits and make the business
case for the chosen option/s.
It will define a range of services
and benefits which could be part of a policy that attracts incentives.
The report is expected in spring 2008.
Strong support from and engagement with a variety
of stakeholders has been a high point of the Department's work
on rehabilitation. The VR Task Group is building on this by work
The UK Rehabilitation Council and
other rehabilitation service provider bodies.
Association of Personal Injury Lawyers.
Chartered Institute of Personnel
National Institute for Health and
Clinical Excellence in their programme on management of long-term
sickness and incapacity guidance work.
3. HEALTH WORK
Is Work Good for your Health and Well-being
DWP published in September 2006 the comprehensive
review of more than 400 pieces of scientific evidence: Is Work
Good for your Health and Well-being? This review by Professors
Waddell and Burton showed that:
Being in the right type of work is
good for your health. It improves self esteem, quality of life
Being out of work is bad for both
mind and body. Unemployment progressively damages health and results
in more sickness, disability, mental illness, obesity, use of
medication and medical services and decreased life expectancy.
When people return to work from unemployment
their health improves. Returning to work from unemployment improves
health by as much as unemployment damages it.
If you have a health condition, being
in work can help you get better. Remaining in or returning quickly
to work is beneficial for people with both physical and mental
The positive effects of work do not
just benefit the individual. Work also reduces poverty and health
inequalities for the family and the community.
Although aspects of work can pose
a risk to health, far more people gain health benefits from work
than are negatively affected by it. The benefits of work are also
greater than the harmful effects of prolonged sickness absence.
The positive effects apply to all
What Works at Work?
Published on 16 November 2007, this review investigated
the evidence regarding workplace interventions (such as sickness
absence management policies or individually focussed help to employees)
and the effect that they had on work outcomes (such as sickness
absence and staff turnover).
The review concentrated on the three most common
health problems affecting those of working age: back pain and
MSDs; common mental health problems; and cardiorespiratory diseases.
Interventions which feature some
form of employee-employer partnership and/or consultation yield
the best results.
Improved communication, co-operation
and common agreed.
Goals between employers, employees,
occupational health providers and primary care professionals can
result in faster recovery, less re-occurrence of ill-health, and
less time out of work overall.
It is not only the employee's health
condition that is important to consider, but also their attitudes
and beliefs. Cognitive behavioural approaches are one way of effectively
addressing this aspect of health and recovery.
Interventions should be comprehensive,
addressing both individual-level factors (eg the beliefs and skills
of individual employees) and organisational-level factors (policies
and practices of a company).
4. PATHWAYS TO
Pathways to Workbackground
Pathways to Work is a fundamental
plank of the Welfare Reform agenda and will contribute to the
aspiration of an 80% employment rate by helping to reduce the
number of people in receipt of incapacity benefits by one million
within the next decade.
Through mandatory work focused interviews
it extends the principle of rights and responsibilities to most
customers in receipt of an incapacity benefit.
This is a theme that will be taken
forward with the introduction of the Employment and Support Allowance
(ESA) in October 2008; Pathways to Work is essential in providing
the underpinning support and conditionality that ESA will offer.
Pathways to Work currently provides
a single gateway to financial, employment and health support for
people claiming incapacity benefits. This includes both mandatory
and voluntary elements.
Mandatory elements of Pathways to
Work apply only to new claimants, although it can be accessed
on a voluntary basis by existing customers.
History of Pathways to Work (2003-06)
Pathways to Work was first piloted
in seven Jobcentre Plus Districts,
which rolled out in two phases in October 2003 and April 2004.
Coverage was gradually expanded and Pathways now covers around
40% of the national incapacity benefits caseload. Pathways to
Work is delivered through Jobcentre Plus in these areas.
In an additional pilot, Pathways
has been extended, on a mandatory basis, to some existing incapacity
benefits customers. In the seven original pilot districts, Pathways
was extended to customers whose incapacity benefits claims started
in the two years immediately prior to the roll-out of Pathways
and this commenced in February 2005. A further extension to customers
whose incapacity benefits claims started between two and six years
prior to the roll-out of Pathways commenced in April 2006. In
one district, Somerset, this has been extended to customers of
Pathways already covers some of the
most deprived parts of the country. Pathways will be rolled out
across Great Britain by April 2008 in two phases using provider-led
contacts. The first phase began in December 2007; the second phase
will begin in April this year.
What is Jobcentre Plus Pathways to Work?
The detailed elements of the Jobcentre Plus
Pathways model are:
A Personal Capability Assessment,
which determines the level of incapacity and therefore entitlement
to the benefits. Due to the nature of their illness some individuals
will be exempt from this assessment and any further mandatory
involvement in the pilots.
Six mandatory Work-Focused Interviews,
beginning eight weeks after making a claim to incapacity benefits
and continuing at one monthly intervals.
A Screening Tool at the initial Work-Focused
Interview whereby those deemed to be closest to the labour market
and in least need of intensive support are screened out and have
no further mandatory involvement with the Pathways process.
Access to Choices, a range of programme
provision aimed at improving labour market readiness and opportunities.
Key aspects of Choices are the New Deal for Disabled People (NDDP)
and the Condition Management Programme (CMP). The CMP is run in
cooperation with local NHS Primary Care Trusts with the aim of
helping the customer manage his or her health condition or disability
A Return to Work Credit, where customers
who enter employment can qualify for a weekly payment of £40
per week for 12 months if their salary is below £15,000 per
Provider led Pathways to Work
From April 2008, the remaining 60%
of the country will have Pathways to Work delivered by external
contractors. In these areas providers have the flexibility to
tailor the range of programmes that are available to customers
in order to tailor provision to their needs. Therefore the support
available in Provider-led Pathways areas may differ slightly from
that delivered in Jobcentre Plus led Pathways to Work areas.
The first 15 contracts for provider
led Pathways districts have now been awarded and went live on
3 December 2007. The final phase of Pathways to Work contracts
was announced on 20 December 2007 to deliver the programme in
the remaining 16 Jobcentre Plus districts from April 2008, completing
the national rollout across Great Britain.
FactsPerformance & Evaluation
Pathways significantly increased
the probability of being employed about a year and a half after
the initial incapacity benefits enquiry by 7.4 percentage points.
The effect of Pathways was to raise the probability of employment
in month 18 from roughly 28-35%.
Since October 2003, Pathways to Work
pilots have helped more than 53,000 people into work [over 69,000
job entries have been achievedthe same person can be helped
by Pathways into work more than once].
The number of recorded job entries
for people with a health condition or disability has significantly
increased since before Pathways to Work started.
Over 20% of all those attending mandatory
work-focused interviews take up one of the voluntary forms of
back-to-work help available in Pathways pilot areas. Over 40,500
people have registered with the NDDP and almost 29,500 people
have been referred to NHS Condition Management Programme.
5. ROLE OF
The Framework for Vocational Rehabilitation
as set out in Government's commitment to provide direction and
leadership on vocational rehabilitation.
Part of that leadership commitment means setting
an appropriate example, the Government has delivered that commitment
The Ministerial Task Force on Health,
Safety and Productivity was set up in 2004 to focus on reducing
public sector sickness absence.
By October 2007, the Task Force had
largely met its remit and was subsumed into the Health Work and
Well-being (HWWB) Strategy. As such, the task Force and the HWWB
Strategy's Joint Ministerial Group will be combined into one group,
which will be re-launched shortly.
Discussions about the composition
and remit of the new Joint Ministerial Group are currently ongoing.
It is hoped that the new Group will meet for the first time in
February/March this year, to ensure their support for Dame Carol
Black's Review of the Health of the Working Age Population.
Also under the HWWB Strategy Leigh
Lewis (Permanent Secretary DWP) and Peter Housden (Permanent Secretary
DCLG) are leading on a series of projects aimed at providing a
healthy and productive civil service. A series of events for Permanent
Secretaries and Departmental Human Resource Directors has been
held dealing with:
Health and productivity.
Illness and injury prevention.
Role of line managers and early return
The Cabinet Office has been leading
on a project to improve sickness absence reporting mechanisms.
85 Essex; Somerset; Derbyshire; Lancashire East; Gateshead
and South Tyneside; Bridgend, Rhondda, Cynon and Taff; and Renfrewshire,
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