Halving the Gap – Willing the ends but not the means?

14th June 2016

On 25 May we hosted our latest event overlooking the idyllic Vincent Square in Westminster. Representatives from prime contractors, think tanks, local authorities and third sectors organisations discussed the challenges and possible solutions facing the new Work and Health Programme and how it can make the biggest contribution possible to the government’s ambitions to ‘halve the gap’ in employment rates between disabled people and the wider population.

The day opened with an address from Norman Lamb MP, the Liberal Democrat spokesperson on health and the Chair of the West Midlands Health Commission. He stressed the importance of work; noting that outcomes for individuals with mental health problems were linked with improved self-esteem, resulting from meaningful work. He also strongly expressed his desire to see clinicians offering more support on work related matters.

“Work is a legitimate goal for clinicians” Norman Lamb MP

The challenge ahead – the political will required to succeed

The scale of the challenge was set out clearly by Tony Wilson from Learning and Work Institute. Successive governments have failed to significantly close the employment gap for those with a long term health conditions and impairments; while the introduction of Employment and Support Allowance (ESA) in 2008 had done little to change the absolute numbers of claimants. At the current rate of progress, it could take 200 years to halve the gap. Alongside this, the Work and Health Programme will significantly cut funding for support for these groups – with spending likely to be less than half the levels seen under the Coalition. So while the government’s ambitions are welcome, we risk willing the ends but not the means to achieve them.

Phil Martin, Deputy Director at the Department for Work and Pensions, set out the broad approach that DWP will be taking both within Jobcentre Plus and through the new programme, while recognising the scale of the challenge in halving the gap. He emphasised in particular the contrasts with the Work Programme – which he argued was designed and implemented in very different labour market conditions. The new programme would instead look to overcome new challenges and in a new economic climate – in particular with a much greater emphasis on partnership working, voluntary access, and delivering specialist and personalised health-related support. But what was also clear was that with funding so limited, provision would need to be carefully targeted – leading to a potentially difficult trade-off between outreach and engagement work on the one hand, and rationing of support by DWP on the other. Disabled people will not be automatically entitled to support.

What does local look like?

A glimpse of what the Work and Health Programme could look like was set out by Matthew Ainsworth from Greater Manchester. There, the ‘Working Well’ programme is targeting ESA clients who have exited the Work Programme without a job. In this model, the whole approach to local partnership and delivery has been reformed, so that the employment programme is one part of a wider effort to raise employment of those with health conditions and impairments, with clear accountability across the public sector.

For Amy Galea of NHS England, successful local delivery was about a demand driven approach to support where services were available when required. Indeed, a demand – client driven – programme appeared appealing to many in the room. Some felt that client controlled budgets could be an option worth exploring.

A lot was made of flexibility in the approach to contracting throughout the day; how best to draw on local resource and capabilities; as well as who would best engage wider partners and manage links with employers. Balancing the need to have a framework to guide and support local delivery without producing a programme that was seen as ‘Command and Control’ was deemed to be important. How these are reconciled with the expected contract sizes, however, was less clear.

Where can gains be made from innovation?

With ‘limited’ resource, generating innovative and successful new models of delivery was seen a necessary part of the picture going forward. Most delegates agreed that innovation is currently happening – budgetary pressures make this a fact of life – but learning, developing and sharing new ideas may not have been done well enough.

Good practice in the world of ‘innovation’ is at times hard to find. But we can support innovators better, and the new Work and Health Innovation Fund will be key in this.

Investment needs to happen so new ideas can be tried-out. And good ideas need to be incubated and scaled up when they’re really good. In the manufacturing world Technology Readiness Scales and Manufacturing Readiness Scales are used to understand what progress has been made in developing new ideas, and what support is needed for each stage. Could similar scales and guidance be applied in this space?

Likewise, allowing disabled people to be at the centre of services, having real input into the Work and Health Programme, could be a huge benefit to new and existing delivery systems. The input from people with lived experiences can and should be of real value to the programme going forward.

And how is this going to happen?

There was a huge amount of positivity on the day but the elephant in the room was not ignored. Despite some new ideas and investment, the Work and Health Programme would still overlook large numbers of ESA claimants. Realistically, the programme will support at most 300,000 disabled people, and of these maybe 50,000 will find work. 

In particular, Stephen Martin of PublicCo pointed out that there was a great deal that could be done if the political will was there to accept responsibility for; and attempt to address, the challenges faced by those disabled and out of work.

So what’s next?

Quite a lot it seems. Organisations such as Learning and Work Institute will continue to highlight good practice and suggest approaches based on evidence. Practitioners will also need to get adept at seeking out funding, making partnerships, joining things up and being flexible and responsive in how they deliver – huge challenges when overall budgets continue to shrink.

For government, though, the immediate task will be finalising the design of the Work and Health Programme and alongside this publishing its (now) Green Paper on disability employment. At the moment, the tools are not there to halve the gap. We need both to press for more, and to make the very best of the opportunities that we’ve got. 

Alex McCallum is a Labour Market Researcher at Learning and Work Institute..