Renfrewshire Community Health Partnership Committee
Date: 19 September 2008 Paper No. 08/34
Author: Fiona MacKay, Head of Planning and Health Improvement
Agenda Item Description – Employability and Health
1. Purpose
1.1 The purpose of this paper is to present a report to the CHP Committee on
Employability and Health.
1.2 The report includes a scoping exercise carried out in Renfrewshire (CHP).
2. Introduction and Background
2.1 In Renfrewshire 21% of the working age population are economically inactive and are in receipt of various benefits.
2.2 Incapacity Benefit (IB) accounts for the largest proportion of the benefits. The vast majority (58%) of Incapacity Benefit recipients suffer from two main health issues: Mental Health & Behavioural Disorders (43.4%) and Diseases of the Musculoskeletal System & Connective Tissue (14.6%). For the CHP as a service provider, this translates to increasing demand on Physiotherapy and Psychological services.
2.3 As a Community Planning partner, Renfrewshire CHP is supporting Renfrewshire Workforce Plus the employability focussed programme. The programme has received funding of £11million through European Structural Fund (ESF), European Regional Development Fund (ERDF), Fairer Scotland Fund and contributions from the Community Planning partners.
3. Scoping Exercise
3.1 Recognising the impact of health on employment, a component of the programme proposes the creation of a small health team to support frontline health staff. This will help them take the opportunity to raise employment with their clients and to support the development of the employability agenda within the CHP.
3.2 Prior to confirmation of ESF and ERDF funding a scoping exercise was carried out by the CHP from January until March 2008, supported by Community Planning Partners through the Renfrewshire Employability Framework.
3.3 The scoping exercise focused on what potential the CHP could have on employability through the current health services provided to patients and what support health practitioners would require to enable them to engage with people who wish to progress towards and into work.
4. Brief Summary of the Findings
4.1 One Hundred staff from a range of departments and from community health projects took part.
4.2 The CHP does not ask practitioners to capture employment status as part of their patient data. Nor is it routinely discussed as part of the assessment process. However, Community Mental Health services includes employment and aspirations to work as part of a holistic assessment.
4.3 Seventy nine percent of the staff claimed to know their patients employment status, this was mainly by default rather than intent with only 28% of those asking this as part of their assessment. Twenty three per cent did not see employment as their business and a further quarter were ‘unsure’.
4.4 In general, frontline staff were not familiar with the different employability support agencies available within Renfrewshire. A number of factors appear to heighten awareness, one being proximity to an employability agency. Staff suggested it would be useful to have basic awareness raising training on employability and benefits. Main reasons for not discussing employability with clients were cited as lack of support and constraints.
5. Next Steps
5.1 Establish a small team of health staff as an integral part of Renfrewshire Workforce Plus programme. The delivery structure is detailed in Appendix E of the report.
5.2 Deliver a multiple intervention service to people experiencing multiple health barriers concurrently by people knowledgeable both in the field of health and health barriers to work.
5.3 Strengthen links between employability and health via a network of supports for NHS staff within the CHP.
5.4 Provide training, workshops and participatory events to increase awareness and understanding of employability issues and to enable discussion of employment with clients as well as to equip staff to signpost people facing barriers to employment due to health problems to an appropriate service.
5.5 Expand access of service to include people receiving Statutory Sick Pay (SSP), people who are already in work but whose health and related barriers put continued employment at risk, those undertaking prolonged treatment and those awaiting planned surgery. This would be complementary to the CMP already in existence within Renfrewshire.
5.6 Undertake awareness raising and capacity-building events for employment agencies in Renfrewshire regarding the main health-related issues and their impact on employability.
Recommendations:
The Committee is asked to:
· Note the contents of the report
Scoping Exercise
EMPLOYABILITY AND HEALTH
January – March 2008
Contents
1. / Purpose / 4
2. / Introduction / 4
3. / Background / 4
4. / Objectives / 5
5. / Methods / 5
6. / Key Findings
6.1 Views of Practitioners
6.2 Employment Agencies
/ 5
7. / Conclusions
7.1 Views of Practitioners
7.2 Employment Agencies / 8
8. / Recommendations / 9
9. / Appendices
A. Employability/Vocational Rehab Agencies, Renfrewshire
B. Questionnaire
C. Agencies linking Health and Employability
D. Employability Pathway / 11
Acknowledgement
I would like to thank the frontline CHP staff and managers for their commitment to this process. Their involvement and opinions were invaluable. I am also thankful of the people both internal and external to the NHS who gave freely of their time and openly shared their knowledge, experiences, expertise, and in particular, existing models of health and employability.
1. Purpose
The purpose of this paper is to describe current Renfrewshire Community Health Partnership (CHP) links to the employability agenda and make recommendations as to how they can be improved.
Recently, RCHP successfully secured funding through the Renfrewshire Employability Framework. This was to map current health activities supported by the RCHP, which impact on employment opportunities either directly or indirectly and to identify what assistance practitioners would require supporting clients* who wish to return to work. In addition, explore activities relating to health and employment, which could be adapted and implemented in Renfrewshire.
2. Introduction
As a partner in the Community Planning Partnership (CPP), RCHP is signed up to European Structural Fund (ESF) and European Regional Development Fund (ERDF) bids, to focus support for employability in Renfrewshire. A component of the bid proposes workers to support health staff make the most of their potential to raise employment with their clients in this area and to support the development of the employability agenda within the Community Health Partnership (CHP).
The CHP has the potential to have an impact on employment either by providing entry-level jobs or through health services provided to patients. The latter is the focus of this report, referred to throughout as ‘employability and health’. This work has been undertaken with the support of Workforce Plus through the Renfrewshire Employability Framework.
3. Background
RCHP Development Plan for 2007-10 shows that 72% of working age population is employed compared to 74% in Scotland. Data from May 2006 described 21% of the working age population in Renfrewshire as economically inactive. Of these 21,500 people, 5,900 declared themselves as ‘wanting a job’.
Renfrewshire ranks 7th position for the numbers of employment deprived individuals by Local Authority (Renfrewshire Employability Action Plan [2007]). Ferguslie and St.James were ranked the 6th most deprived data zone in Scotland in 2006 for the employment domain. Worklessness within Renfrewshire is consistently higher in the 15% Data Zone areas where, in some, the workless population is twice as high compared to Renfrewshire as a whole. Worklessness is also falling at a slower rate in these areas. Of those entering the labour market from the most disadvantaged areas, 70% are most likely to find jobs in their own area.
Incapacity Benefit (IB) gives people of working age a replacement income when they cannot work or look for work because of ill health or a disability. The vast majority (58%) of IB recipients suffer from two main health issues: Mental Health & Behavioural Disorders (43.4%) and Diseases of the Musculoskeletal System & Connective Tissue (14.6%). For the CHP as a service provider, this translates to demands, particularly on Physiotherapy and Psychological services.
Almost 70% of those claiming IB or Severe Disablement Allowance (SDA) have been in receipt of these benefits for 3 years and over.
* Also referred to as patients or service users throughout
The health sector is quoted among the fastest growing sectors and this is indicative of job growth. Currently, on an annual basis, NHS Greater Glasgow and Clyde (NHSGGC) need to recruit approx 6500 staff to fill existing posts.
RCHP directly manages health visitors (HV), school nurses, district nurses (DN), allied health professionals (AHP), health improvement staff and has a contractual relationship with primary care contractors. It also jointly manages teams for learning disabilities and older adults within Renfrewshire Council and hosts specialist children’s services. It works closely with GP’s in the area via the clinical directorate and has direct links with mental health, addictions, community pharmacy. Also, the services of the national Condition Management Programme (CMP), a key part of the UK-wide Pathways to Work initiative, which offers work-focused support and advice to people who have been unable to work because of illness, are being delivered in the Renfrewshire area.
4. Objectives
The main purpose of the scoping exercise was to:
· map current health activities in Renfrewshire, supported by the CHP, the extent to which they currently impact on employment opportunities either directly or indirectly and ascertain, what support practitioners would require to enable them to engage with people who wish to progress towards and into work.
· identify employment activity, locally and elsewhere, that could be replicated or adapted to the needs of Renfrewshire.
5. Methods
A mapping of employability agencies in Renfrewshire and analysis of secondary data commenced in January 2008. Direct contact was not made with each employability agency within Renfrewshire (Appendix A). However, meetings with key individuals from some organisations already combining health and employment both within and out with Renfrewshire were undertaken (Appendix B).
Permission to speak with frontline staff was sought from Service Leads and Rehabilitation Enablement Service (RES) Managers and this gave access to CHP departments and projects. Meetings and participation with staff groupings was offered by way of workshops, semi-structured interviews or a survey. This was to explore their views regarding the link between health and employability and to offer ideas as to their potential contribution to this when engaging with their clients. Thematic analysis of the data collated was used to identify common experiences.
Ward and out-patient staff was not part of the survey.
Views of other interested parties e.g. voluntary organisations or the general public were out with the reach of this exercise.
6. Key Findings
6.1 Views of Practitioners
During the initial stage of the engagement process there was a general lack of understanding of the link between ‘employability and health’ among primary healthcare staff. Access to some professional groupings was not given for this reason and for some staff, time restraints was a factor due to clinical priority. Over 100 staff from a range of departments and from community projects took part. Questionnaires (Appendix C) from 82 members of CHP staff were returned. The data collated was then analysed as follows:
Survey group
Eighty-five per cent were Registered Nurses or qualified AHP, the remaining 13% being unqualified NHS and health-related project staff. Seventy-five per cent described themselves as ‘community based’ the majority working from Health Centres.
Work
A number of questions were asked regarding work. The majority of participants (98%) shared the view that ‘financial’ reasons were the main benefit to working and 70% quoted ‘social’ reasons as a further benefit.
Health benefits to working / Ill effects of unemployment
When asked about any health benefits to working, 92% described ‘mental well being’ and this was also cited as the main ill effect of unemployment, followed by ‘low self-esteem’ (48%) and ‘isolation’ (16%). A number of people felt being unemployed could alter lifestyle factors such as ‘an increase in smoking, eating, alcohol consumption and drug intake’ or ‘a decrease in physical exercise, healthy nutrition and self esteem.’
Supports if you were off work for a long period of time
From the suggestions offered, 74% would consider approaching their Occupational Health (OH) Department and 64% would go to their GP. Just under half would seek the advice of an Employment Adviser. Only 13% considered their Practice Nurse.
Your clients’ employment status
Although 79% claimed to know their patients employment status, this was mainly by default rather than intent with only 28% of those asking this as part of their assessment. Twenty three per cent did not see employment as their business and a further quarter were ‘unsure’. Reasons given by the 52% who did see employment as their business focussed mainly on the ’impact’ being off work could have on patients daily life, particularly ‘mental wellbeing’, ‘physical health’, ‘and changes in lifestyle’.
Clients who are off work long-term due to health
Seventy percent said that they currently either ‘signpost’ ‘offer encouragement or support’ and ‘explore barriers’. Suggestions offered as to what they could do included activities such as ‘review of their assessment’, ‘change in their care plan’ and ‘resetting of goals’.
Existing Employability Agencies
In general, frontline staff was not familiar with the different employability support agencies available within Renfrewshire with only 44% able to name any. A number of factors appear to heighten awareness, one being proximity to an employability agency. Within one project, all staff mentioned the same agency, (Community Renewal), as it was situated next door. Another factor was the referral process whereby informal arrangements were preferred. Similarly, an agency working with a specific target group to those in their own caseload raised knowledge significantly. Health visitors from one health centre knew of an agency targeting young mums, (Childcare Buddies). A further feature was the promotion of joint working and cross-referrals was between Projects who work to similar approaches e.g. community development and the use of staff as community animators.
Community-based health projects (Live Life Network, Health Inequalities Project and Renfrewshire Carers) were already involved in networking, partnership working and referral pathways for their service users, and accounted for a significant amount of referrals made in comparison to others. Employment status was clearly a substantial part of their existing remit and due to this they had the infrastructures already in place.