3 Integration with related local services
25.Unemployed people with complex needs are likely to be, or ought to be, in contact with a range of locally-run health, housing, education and other services. All of the welfare-to-work practitioners we heard from during our inquiry recognised that employment support is unlikely to be effective for people with complex needs unless JCP and contracted providers have strong links with local providers of related services. The Department also recognised this and, as a first step towards achieving greater integration, has recently established a joint Health and Work unit with the Department of Health. However, despite the widespread recognition of its importance, the evidence was that in practice effective integration is patchy. Below we set out some examples of good practice, and emphasise the opportunities for more effective integration of services afforded by the introduction of Universal Credit and the related DWP programme, Universal Support Delivered Locally.
Local pre-Work Programme approaches: Pathways to Employment programme
26.Pathways to Employment is a pilot programme in which Lewisham, Lambeth and Southwark borough councils are working together with a voluntary sector provider (Tomorrow’s People) and the JCP District to provide more integrated services. The pilot engages with Universal Credit claimants with complex employment support needs. It is administered by co-located JCP, Tomorrow’s People and local authority teams based in three of the boroughs’ Jobcentres. The teams are able to able to address a range of issues, including housing, health, education and skills, and debt and financial advice. Robyn Fairman, Head of Strategy at Lewisham Council, told us that effective triage was essential to the approach, further emphasising the importance of a characteristic-based assessment, as discussed in the previous chapter.29
27.The Pathways to Employment approach seeks to pool the resources of the various local agencies involved in supporting people with complex needs, while ensuring that helping people back into work remains the central focus. Robyn Fairman told us that without service integration:
Different agencies spend loads of money on the same individuals, and they still come out six years later unemployed, because no one has spent the right amount of money at the right point.30
28.Pathways to Employment commenced in late 2014. Given that it is working only with claimants with complex needs, its early results appear comparatively very good: by September 2015 around 20% of participants had entered paid employment. This figure is expected to rise to 30% by the end of the year-long pilot in November 2015 (as previously noted, only 3.9% of ex-IB ESA claimants achieve three months of work after a year on the Work Programme).31
Potential impact of Universal Credit: Universal Support Delivered Locally
29.A number of witnesses emphasised the opportunities for greater integration afforded by Universal Credit, and in particular the related pilot programme, Universal Support Delivered Locally. USDL pilots have been established in 11 local authority areas to support Universal Credit claimants who require help adapting to the new benefit, which is a single monthly benefit payment including housing costs, designed to be claimed and managed predominately online. USDL was set up to identify and help claimants who require support with IT and management of their household finances. The programme is run jointly by DWP, local authorities and local providers of relevant support services.32
30.Robyn Fairman explained that the Pathways to Employment teams had used the opportunity presented by USDL, in which claimants are triaged for IT and budgeting support needs, to work with JCP to also identify claimants with a range of complex employment-related support needs. They had therefore been provided with appropriate help at an early point in benefit claims.33
Integration within the Work Programme
31.ERSA acknowledged concerns about a lack of integration with local services within the Work Programme; however, we heard some good examples to the contrary.34 In Ramsgate, a local NHS employee attended the Work Programme site one day per week, to offer support and arrange referrals for jobseekers with health conditions. The provider in Ramsgate regularly referred Work Programme participants to help provided by a local drug and alcohol misuse charity.
32.Shaw Trust, a prime contractor in east London, told us that it had taken steps to adapt its services to take account of the growing proportion of people with complex needs referred to its Work Programme provision. Its recently established “Community Hubs” in Lewisham and Hackney co-locate Work Programme advisers with a range of local organisations providing services including occupational therapy, counselling and housing advice. The Shaw Trust hubs also accommodate gyms and offer leisure and well-being activities such as yoga and pilates. Shaw Trust reported that Community Hubs had transformed its Work Programme provision into “a place where customers want to participate, rather than merely a place they are mandated to attend.” Early indications were that the new approach was helping more participants, including people with disabilities, make progress towards a return to employment.35
33.One of the clearest conclusions we draw from the evidence to our inquiry is that employment support for long-term unemployed people with complex needs relies on effective integration with other locally-run services, including health, housing, education and skills, and support for alcohol and drug addiction and other indicators of a generally chaotic lifestyle. There are excellent examples of JCP, contracted providers, local authorities, and other local organisations working together in co-located teams, pooling resources to address these types of issues at an early stage in benefit claims, while maintaining a central focus on employment. DWP should more actively seek to establish integrated and co-located teams more widely across Great Britain. We recommend that the Universal Support Delivered Locally pilots be expanded beyond IT and budgeting support, to include more effective integration of housing, health, education and skills, and drug and alcohol teams in single locations, each contributing part of their budget, with a clear focus on employment as the ultimate goal.
The relationship between health budgets and employment
34.We heard a particularly striking example of NHS spending contributing to employment. Theresa Grant, the Chief Executive Lead for Employment and Skills in Greater Manchester, told us that one 28 year old participant in Greater Manchester’s Working Well pilot programme had never worked, despite being highly motivated to do so and well-qualified. He had never been beyond the interview stage for a job because he had no teeth, and prospective employers had assumed that this was due to drug misuse. In fact, he had lost his teeth as a result of treatment for a medical condition. This had led to loss of confidence and low self-esteem, which was compounded by his inability to find work. Ms Grant told us that the underlying problem had never been addressed despite several years of contact with JCP and a two-year attachment to the Work Programme. Working Well’s integrated service had ensured that he accessed NHS dentistry. He had then received a new set of teeth and found a job “within a month.”36 We consider how the broader welfare-to-work sector can learn lessons from the Greater Manchester Working Well pilot, and other locally-commissioned approaches, in chapter 6.
35.Mental health organisations argued that there was a particularly urgent need for integration of services in relation to unemployed people with mental health problems. They recommended that the NHS Improving Access to Psychological Therapies (IAPT) programme, which promotes the implementation of National Institute for Health and Care Excellence (NICE) guidance on supporting people with depression and anxiety disorders, be integrated with employment support, housing and social care services at a local level.37
36.We welcome the establishment of the joint DWP/Department of Health Work and Health Unit as a first step towards integration of health and employment support. For integration to be effective, we believe that some pooling of budgets will be necessary. We recommend that the Health and Work Unit test the efficacy of allocating a small part of local NHS commissioning budgets to employment support in Universal Support Delivered Locally pilot areas. We further recommend that the Work and Health Unit prioritise integration of the NHS Improving Access to Psychological Therapies (IAPT) programme with employment support, to ensure that unemployed people with depression and anxiety disorders more consistently receive appropriate and prompt support.
30 Ibid.
32 GOV.UK, ‘Universal Support – delivered locally: information for local authorities’, accessed 1 October 2015