Select Committee on Work and Pensions Written Evidence

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 consistent messages;

    —  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 examples—particularly Government departments and the devolved administrations.

  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 disorders (MSDs).

    —  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 accidents.

  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 spring 2008.

  The review will seek to answer the following specific questions:

    —  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 Group—incentives and dis-incentives project

  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 the following:

    —  National Insurance and the benefit-in-kind rules—Could 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?

    —  VAT—where does VAT fall, and how does it affect business decisions?

    —  Corporation Taxes—could these have an impact on rehabilitation?

    —  Tax credits—Are 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.

Stakeholder Engagement

  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 with:

    —  The UK Rehabilitation Council and other rehabilitation service provider bodies.

    —  Association of Personal Injury Lawyers.

    —  Chartered Institute of Personnel and Development.

    —  NHS Employers.

    —  National Institute for Health and Clinical Excellence in their programme on management of long-term sickness and incapacity guidance 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 and well-being.

    —  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 health problems.

    —  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 age groups.

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.

General findings

    —  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).


Pathways to Work—background

    —  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,[85] 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 all durations.

    —  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 more effectively.

    —  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 year.

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.

Facts—Performance & 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 achieved—the 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.


  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 through:

    —  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.

    —  Stress.

    —  Role of line managers and early return to work.

    —  The Cabinet Office has been leading on a project to improve sickness absence reporting mechanisms.


January 2008

85   Essex; Somerset; Derbyshire; Lancashire East; Gateshead and South Tyneside; Bridgend, Rhondda, Cynon and Taff; and Renfrewshire, Inverclyde, Argyll and Bute. Back

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