The closure of most of the condition management programmes in the NHS this year is truly a great loss at a time when support into employment is more important than ever.
As HSJ reported last month, the end of Pathways to Work means that the condition management programmes that accompanied it – assisting people to manage their health condition in the context of their employment – have also disappeared in most places, to be replaced later this year by privately provided services for the new Work Programme.
Condition management programmes may have produced mixed evaluation results but for many people with mental and physical health problems they have provided a crucial link between health and employment support to give them the confidence to take up a job and manage their own health.
The Work Programme itself begins soon. Prime contractors for each region have now been chosen, each with its own supply chain of specialist providers for groups of people with particular needs. It is vital that the NHS is not shut out of this process, nor that health care providers shun the opportunity to help more of the people they work with into paid employment.
Over a million people in the UK are out of work with a mental health problem – most commonly depression and anxiety. Only about one person in eight using specialist mental health services is in paid employment.
Yet we know that helping someone to get a job can have a dramatic, positive effect on their health. Getting back to work can speed up recovery from many mental health conditions, from depression to schizophrenia, as well as benefiting our physical health. It also, over time, much reduces health care costs.
The NHS therefore needs to regard employment support as a health intervention and reach out to Work Programme providers to ensure that their efforts combine effectively. Unless health care – whether in the GP surgery or in specialist services – is integrated with employment support neither will be as effective as they should be.
For large numbers of people with mental health problems, welfare reforms are the biggest source of anxiety they face. The Work Programme arrives alongside radical changes to incapacity benefits and changes to housing benefit and disability living allowance. The impact of a Work Capability Assessment on a person’s mental health can be considerable, especially given the shortcomings of the WCA as it is currently constituted.
Despite the loss of many good condition management programmes, health services have lots to offer to the Work Programme. From offering Individual Placement and Support in mental health services to providing Fit for Work support to people in primary care, the NHS should be focused on employment as a key outcome.
The NHS and social care outcome frameworks both measure employment rates for people with mental health problems. NHS organisations that take this imperative seriously will bring huge benefits to their communities and the most marginalised people within them.