Health-led employment support in South Yorkshire and Bassetlaw

Working Win was a trial programme of health-led employment support run by South Yorkshire Mayoral Combined Authority in partnership with Department of Work and Pensions, Department of Health and Social Care and NHS England.

The South Yorkshire Mayoral Combined Authority (SYMCA), previously named Sheffield City Region Mayoral Combined Authority, had constituent authorities and non-constituent authorities at the time of the Working Win pilot programme. The constituent authorities were the four South Yorkshire metropolitan boroughs (Sheffield, Barnsley, Doncaster and Rotherham), and the non-constituent authorities were four Derbyshire districts (Derbyshire Dales, North East Derbyshire, Chesterfield and Bolsover) and the Nottinghamshire district of Bassetlaw. The LEP formerly covered both Bassetlaw and the South Yorkshire authorities’ areas, but now just covers South Yorkshire.

Working Win was a trial programme of health-led employment support run by SYMCA in partnership with Department of Work and Pensions (DWP), Department of Health and Social Care (DHSC) and NHS England, across South Yorkshire and Bassetlaw. This geography was chosen to be co-terminous with that of the Integrated Care System (ICS). It aimed to test whether the Individual Placement and Support (IPS) model can be adapted for people with mild to moderate mental and/or physical health issues, leading to an increase in employment and productivity and a reduction in sickness absence. In 2015, the government’s Work and Health Unit (WHU), a partnership between NHS England, DWP and DHSC, invited combined authorities to co-design a new trial programme. In existing IPS programmes, local authorities and other organisations work with residents with severe mental health issues on an individual basis, place them into employment and provide support to them to remain in employment. 

Through co-design with partners, a design was proposed to WHU which deviated from traditional IPS.  Firstly, it would work with those with both mental and physical health barriers. Secondly, these need not necessarily be severe issues – people with milder health issues would also be supported. Thirdly, it would not just support those out of work at the start of the trial, but also support those in work who were struggling with health issues.

WHU accepted the SYMCA proposal, alongside a proposal from West Midlands Combined Authority. To ensure that the added value of the programme was correctly identified, it was structured as a randomised controlled trial. This meant that participants were randomly assigned to one of two groups. One of these received the full package of support, provided through an ongoing relationship with an assigned employment specialist. The other group – the control group – was provided with information about local job services and could access ‘business as usual’ support. Statistical techniques were used to make comparisons between the two trial groups in terms of employment, health and wellbeing outcomes, to ascertain what impact, if any, the programme had.

For designing the programme, the SYMCA worked with a researcher from Sheffield University, whose research had covered other programmes elsewhere with similar features. This allowed the SYMCA to set some targets for the programme, but these were fairly limited, given its experimental nature (especially for the in-work cohort). A small proportion of the contract value for the providers of the programme was based on payment by results.

The programme opened for participants in May 2018. The programme did take referrals from health and care providers and from community organisations, but the majority of participants were self-referrals. More than 6,000 people had chosen to take part in the trial by the time it closed to new participants, in October 2019. Half of these were allocated to the control group and half to an employment specialist. Participants could leave the trial at any time. The full programme lasted a maximum of 12 months for each out of work participant and up to twelve months for each in-work participant, starting at the time they signed up. All of the trial participants have now completed the programme. Participants could choose to leave before the end of their five or 12 months, if they felt they had gained the full benefit from it and had no further need of it.

On signing up to the trial, participants were asked about their age, ethnicity, employment situation and general health and wellbeing. The evaluation of the trial will use government administrative data on participants, which will provide information about participants’ employment, benefits and taxes (participants were asked to consent to this data sharing at the start). This information was passed to a research team that is evaluating the trial, drawn from academia and research institutes and organisations.

Those who were assigned an employment specialist worked with them to create an action plan setting out an agreed employment journey, and they met roughly every two weeks to review progress. All participants were supported to complete a strengths-based assessment to identify the qualities and strengths in all parts of their life. Support onwards was then based on building on these strengths and taking them into employment. Participants may have had additional support needs around mental health, debt and benefits, for example, which were addressed by specialist workers. For those in work, employment specialists could also work with the employer to put in place measures that supported the participant to do their work.

Support workers had higher caseloads than previous IPS schemes – up to 30 clients – reflecting the fact that some clients had milder health issues.

The evaluation team carried out a survey of participants after four months and at the point at which they reached the end of the trial. They also carried out in-depth interviews with some participants (some in person and some by telephone).

The programme was overseen by a steering group, whose members included representatives of the local authorities and the ICS. The group initially met monthly, but then reduced to one meeting every two months.

As the programme closed to new participants in October 2019, it is now possible to make observations about the characteristics of participants. At the outset, the SYMCA expected that around 30 per cent of participants would be in work. However, with little support for this group available from other sources, the actual proportion was around 42 per cent.

A lot of the referrals to the programme did not identify with just one condition, but with multiple conditions, both physical and mental. There were also a higher proportion of participants from BME groups than in the general population. This may, at least in part, have been due to targeting of working with community groups supporting residents of different ethnic backgrounds.

Anecdotally, and from initial analysis through the evaluation, the programme showed positive signs of delivering. By September 2019, there were already anecdotal reports from participants that they had found genuinely ­fulfilling work which was manageable alongside their health conditions. And where targets were set for the programme, those were met earlier than expected. Furthermore, it provided a context for the health practitioners to have work-related conversations with patients, and further work around work as a health outcome between the SYMCA and health partners was planned, but unfortunately this did not take place due to approval delays within the local NHS Trust.

The full evaluation of the trials in both SYMCA and WMCA, commissioned by WHU, is currently underway. The final report will be delivered in 2022. This will include a full exploration of the impact of the programme on employment, health and wellbeing for trial participants, based on robust evidence gathered through the surveys, in-depth interviews, and analysis of government administrative data.

Should other authorities wish to put together an IPS-based programme for residents with mild to moderate physical and mental health conditions, there are features of this scheme which SYMCA believes are worth drawing attention to. At the outset, it is helpful to consider the needs of those in work as well as those currently unemployed. Working with partners on the scheme design is critical to support good programme design and increase referral numbers. This has helped SYMCA design a low-complexity scheme which has a low threshold for participation and allows for self-referrals, and draws on the existing strengths and skills of participants.