Work, health and growth: A guide for local councils

Foreword

There is strong evidence that work is good for people’s health and, that when people are in good health, they are more likely to find, remain in and be productive at work.

Conversely, unemployment and economic inactivity through long-term sickness are associated with worsening health outcomes with a negative impact on individuals, communities, and wider society. Once economically inactive through ill health, the data shows us that few people move back into employment. Therefore, reinventing – or managing – ill health at work and supporting people who experience ill health to get back into work is critical for improving population health outcomes, tackling health disparities and realising the wider economic benefits that come from increasing participation in the labour market.

Improving work and health outcomes for everyone across the country requires effective action by local and national government. Action must be tailored to local needs and involve partners across the health and welfare systems and wider industry.

Local councils play a key role in this as major employers, leaders of local economic development and, as commissioners and providers of services.

It is for this reason that the LGA and the Office for Health Improvement and Disparities (OHID) have produced this updated guide on 'Work, Health and Growth'. By setting out the evidence base on the relationship between work and health, and providing case studies on existing good practice, we hope that this guide will enable a better understanding of how local authorities and their partners can support work and health outcomes in their communities.

By working in collaboration, we can help people to find, remain in and be productive at work, improving their health and benefiting society as a whole.

David Fothergill and Dr Jeanelle de Gruchy

Dr Jeanelle de Gruchy
Deputy Chief Medical Officer for England
Co-Lead of the Office for Health Improvement and Disparities

Councillor David Fothergill
Chair
LGA Community Wellbeing Board

1. Introduction

Creating healthy workplaces entails supporting disabled people and people with long-term health conditions in their work settings. It is also important to ensure the health and wellbeing of healthy employees who do not have existing health conditions is maintained - work and the workplace can play a pivotal role in prevention.

As adults in employment spend a large proportion of their time in work, our jobs and our workplaces can have a big impact on our health and wellbeing. In fact, employment can impact both directly and indirectly on the individual, their family and community. Therefore, there is a significant opportunity to promote positive healthy behaviours in the workplace, reducing the numbers of people who develop health conditions and improving productivity.

Work and health is central to the story of people and place. We need to increase participation in the labour market and improve productivity. Helping people with health issues to gain, retain and progress in work supports economic growth and is a crucial part of the wellbeing of every community.

What is the cost of ill-health?

There is strong evidence that, in general, work is good for health and long-term unemployment is consistently associated with poor health outcomes. Ill health among working-age people costs the economy around £100 billion a year. It can also affect people’s participation in the labour market, with over 300,000 people annually, falling out of work and onto health-related welfare. Once people fall out of work due to long-term sickness, they are very unlikely to move back into employment.

Following a historic low prior to the pandemic, the economic inactivity rate increased from 20.2 per cent (8.37m) in Dec 19 – Feb 20 to 21.6 per cent (8.73m) in Jan 23 – Mar 23. This is an increase of 360,000, of which, 330,000 were aged 50 to 64 (by far the biggest increase of any age group) and 440,000 stated that their main reason for being inactive was long-term sickness - this has been offset by a fall in the number of people who are looking after family/home and retired. This is now the most common reason for being economically inactive, but this trend started in 2019 - prior to the pandemic. The economic inactivity rate increased by 0.1 percentage points on the quarter, to 21.1 per cent in May to July 2023. The increase in economic inactivity during the latest quarter was driven by people aged 16 to 24 years. Those inactive because of long-term sickness increased to another record high. Meanwhile, those inactive because they were looking after family or home decreased to a record low.

This has a huge cost to the individual, families, communities, employers and public services. There is a strong economic argument to address health-related worklessness, across public expenditure, the wider economy and personal and household income. It is estimated that having one extra disabled person in full-time work, rather than being out of work longer term, would mean Government could save and re-invest £15,000 a year. Alongside this, the value of coordinating provision across ‘place’ is critical. A cost benefit analysis of the LGA’s Work Local reveals that by using existing national investment more effectively, the number of people improving their skills or finding work could increase by 15 per cent.

What local benefits can ‘good work’ bring?

There is a clear relationship between health, work and growth, which is illustrated in Figure 1: good health contributes to high productivity and successful enterprises which supports economic prosperity, and the social wellbeing and wealth of communities.

Figure 1: Health and Work Cycle

Health and work cycle; a healthy and happy workforce has synergistic benefits for: workplaces, productivity and the economy. Good worker health pointing arrow to productivity at work pointing to business competitiveness pointing to economic development and prosperity pointing to social wellbeing and weath.

Good quality work is supportive of an individual’s health and wellbeing and protects against social exclusion through the provision of income, social interaction, a core role, identity and purpose.

Jobs need to be sustainable and offer a minimum level of quality, which should include:

a decent living wage
opportunities for in-work development
flexibility to enable people to balance work and family life
protection from adverse working conditions that can damage health.

Conversely, poor quality work and jobs with low job security are associated with increased risk of common mental health problems and physical health conditions, such as musculoskeletal health conditions.

Supporting Good Work: Good Work Project

The LGA has produced an online resource to help councils and combined authorities to support good work in their local area, including outlining what local benefits good work can bring and advice on how local government can support good work and top tips for supporting this. Councils could support good work by promoting good work charter schemes, creating social value through procurement and grants, giving and offering local business support.

What role can local government play in improving health and work outcomes?

As strategic leaders of people and place, councils have wide-ranging functions and expertise that are vital to facilitating system change and to enabling more people to get into good work. These include:

Civic and political leadership - as trusted convenors of partners, LAs work across the system and span all public services, private and charitable sectors to deliver whole-system change, efficiency and unlock economic growth to meet local need. Increasing numbers of councils have devolved responsibility through city, growth and devolution deals.
Direct deliverers of services - councils are responsible for public health, links with health provision and many other services including Family Information Services, Universal Support for Universal Credit Delivered Locally (USDL) and local advice services. LAs provide support for people, including those with complex barriers, so they can be training or work ready.
Large employers and commissioners – LAs are direct and indirect employers of members of their own community, and work with the public and private sector to deliver added-value employment and skills opportunities through social value.
Knowledge of the local economy – through their economic development functions, working with employers and businesses of all sizes, connections with further education providers and data analysis to ensure national and local provision is targeted and used to develop growth.
Ability to integrate – through their services, strategies and wider civic engagement, LAs provide added value by integrating locally commissioned employment provision and encouraging collaboration between agencies and skills providers. They also connect and promote multiple national employment, training, skills and economic growth initiatives; developing their own offer to address gaps or integration in the system.

Top tips for local government to support good work

Lead by example - get internal stakeholders on board and ensure that your own organisation is actively supporting good work in the same way that you are asking others to.
Keep it simple - depending on what works for your local business community, focus on a specific issue. Whether it be developing a public procurement framework to promote social value, introducing a Living Wage or developing a local 'good work' charter. Embed it in everything you do from recruitment to procurement strategies to work programmes.
Spread the word - segment your employer market and work out ways of reaching and engaging them with the support of clear message and high-profile ambassadors.
Plan long term - this won't happen overnight. Work out what you need to make your approach sustainable in the long-term and ringfence sufficient resources to deliver your vision.

Further information on these top tips can be accessed here.

Health and Work: The local picture

There is considerable variation in health and health-related employment outcomes across the UK. The latest information can be accessed from the Fingertips Tool: Wider Determinants of Health - Work and the labour market resource page

Regional unemployment rates aged 16 years and over (seasonally adjusted, May 2023 to July 2023):

West Midlands 5.0 per cent
London 4.8 per cent
North East 5.2 per cent
East 4.3 per cent
North West 5.3 per cent
East Midlands 4.1 per cent
South East 3.9 per cent
South West 3.6 per cent
UK average 4.3 per cent.

Difference between the employment rate (percentage points) for people with a physical or mental health long term condition and the employment rate for the general population by region [2021/2022].

England	2021/22	9.9
North East region	2021/22	13.8
North West region	2021/22	12.2
London region	2021/22	11.4
Yorkshire and the Humber region	2021/22	10.1
South West region	2021/22	10.1
East of England region	2021/22	9.0
East Midlands region	2021/22	10.2
West Midlands region	2021/22	8.9
South East region	2021/22	8.1

Sickness absence rate, by region of residence, UK, 2022

Great Britain	2.6%
England	2.5%
North East	3.1%
North West	2.6%
Yorkshire and The Humber	2.6%
East Midlands	2.7%
West Midlands	2.7%
East of England	2.2%
London	2.1%
South East	2.3%
South West	2.7%

2. Work and health agenda: key terms

What is the working age population?

The working-age population is individuals aged 16 to State Pension age (SPA). SPA for women equalised with SPA for men at 65 in November 2018. Both men’s and women’s SPA then increased from 65 to 66 between December 2018 and October 2020. The Pensions Act 2014 brings forward the increase in the SPA for men and women to 67, provided for in the Pensions Act 2007, to between 2026 and 2028.

What is health-related worklessness?

People not in employment for a health reason. Technically it can be defined as people claiming out-of-work welfare for a health reason or, being otherwise unemployed or economically inactive due to ill health.

Who is classified as unemployed?

The unemployed population is “people who are without a job, want a job, have actively sought work in the last four weeks and are available to start work in the next two weeks or, are out of work, have found a job and are waiting to start it in the next two weeks.”

What is economic inactivity?

People not in employment who have not been seeking work within the last four weeks and/or are unable to start work within the next two weeks

What is disability employment rate?

Difference in employment rate between disabled people and those who are not disabled. For example, the disability employment rate was 52.6 per cent in July to September 2022, compared to 82.5 per cent for non-disabled people.

What is the definition of disability under the Equality Act 2010?

You’re disabled under the Equality Act 2010 if you have a physical or mental impairment that has a ‘substantial’ and ‘long-term’ negative effect on your ability to do normal daily activities.

What is workplace health and what are workplace health interventions?

Workplace health is promoting and managing the health and wellbeing of staff and includes managing sickness absence and ‘presenteeism’ (a person physically at work but not fully productive). Workplace health interventions are activities undertaken within the workplace by an employer or others to address these issues; it also includes action to address health and safety risks.

How do you create a healthy workplace?

Creating healthy workplaces entails supporting disabled people and people with long-term health conditions in their work setting. It is also important to ensure the health and wellbeing of healthy employees who do not have existing health conditions is maintained - work and the workplace can play a pivotal role in prevention.

Being in good employment reduces the risk of mental health conditions such as depression and psychological distress but, for some people, can also be a cause of stress and common mental health problems. Line managers play a vital role in determining the health, wellbeing and engagement of their teams. By improving their management capabilities, managers can achieve better results, improving their own wellbeing as well as that of their teams, achieving better results and benefiting the organisation as a whole.

The 2017 independent Stevenson/Farmer review of mental health and employers makes a number of recommendations for the public sector, government and employers on managing mental health at work. The Business in the Community Employer Toolkit suite provides employers of all sizes with a roadmap to improve workplace health.

What is the evidence that health and work are linked?

employment is a primary determinant of health, impacting both directly and indirectly on individuals, their families and communities
long-term unemployment is associated with an increased risk of mortality and morbidity, including limiting illness, cardiovascular disease, poor mental health, suicide and health-damaging behaviours
individuals unemployed for more than six months have lower wellbeing than those unemployed for less time.

What is the cost of ill health?

The total economic cost of lost output and extra health costs among working age people is estimated to be around £100bn a year
£53-56 billion annual cost of poor mental health to UK employers
£18.8 billion annual cost to society in workplace injuries and ill health.

In 2022, 185.6 million working days were lost because of sickness or injury in the UK equivalent to 5.7 days per worker.

What are the benefits of being in work for people with long-term conditions?

Good quality employment
promotes recovery and rehabilitation
leads to better health outcomes
minimises the harmful physical, mental and social effects of long-term sickness absence and worklessness
reduces the chances of chronic disability, long-term incapacity for work and social exclusion
promotes full participation in society, independence and human rights
reduces poverty.

What is the scale of health-related worklessness?

In November 2020, 3.5 million working-age people were claiming a benefit with a health condition.
In Q1 2023, the disability employment rate was 53.7 per cent, compared to 82.7 per cent for non-disabled people
The disability employment gap was 29.0 percentage points in Q1 2023.

What is the health of the working age population?

One in five people aged 16 to 64 in the UK are classed as disabled
One in three people aged 16 to 64 in the UK report having a long-term health condition.

1 in 3 working age people in the uk have a health condition, 1 in 6 adults will have experienced a common mental health disorder in the past week and 1 in 10 employees in the uk reported having a musculoskeletal condition.

Ill health in employment

One in four UK employees reported having a physical health condition, and one in five of employees with physical health conditions also reported having a mental health condition.
In 2022, minor illnesses were the most common reasons for sickness absence, accounting for 29.3 per cent of occurrences of sickness absence. This was followed by "other" conditions at 23.8 per cent, musculoskeletal problems at 10.5 per cent, respiratory conditions at 8.3 per cent and mental health conditions at 7.9 per cent.

What are the benefits of businesses investing in workplace health?

reduction in absence and increased productivity
return on investment mental health at work – return of £5 every £1 spent
reduced staff turnover and associated reduction in recruitment costs.

Employment and treatment outcomes

Employment is associated with improved treatment outcomes as well as less severe and less frequent relapse for people with a history of substance misuse. For people in employment at the start of treatment and at their six-month review, the average number of days they were in employment in the last 28 days increased. This rose from 17.6 days at the start of treatment to 17.7 days at their review.

3. What services are available to help people with health conditions or disabilities back into work?

The Government operates various schemes that practically and financially help support employment among people experiencing ill health:

Disability Confident – The Disability Confident scheme supports employers to make the most of the talents disabled people can bring to the workplace. It provides employers with the knowledge, skills, and confidence they need to attract, recruit, retain and develop disabled people in the workplace. The scheme provides support for employers who might lack the confidence to recruit disabled people or might need guidance to support an employee who has acquired a disability during their working life.

Access to Work – can help an individual get or stay in work if they have a physical or mental health condition or disability.

Adjustment Passport – to support transitions into employment. Access to Work is supporting a series of Adjustment Passport pilots. The passport will provide a living document of workplace adjustments, reduce the need for assessments, support the holder to have confident conversations about their disability and adjustments. The pilot should actively raise awareness of Access to Work.

The Work and Health Programme (WHP) – provides voluntary employment support, for disabled people and disadvantaged groups who are motivated to work and expect to find work within 12 months. Participants receive personalised and tailored support for up to 15 months followed by six months’ light- touch, in work support.

Better Health

Better Health is one of the Government’s flagship public health campaigns, aimed at contributing to improved health outcomes and reducing health inequalities. It exists to motivate and enable the nation to enjoy better health, encouraging and supporting people to take steps to improve their physical and mental wellbeing.

Activity is focused on a number of health behaviours including weight loss, physical activity, mental health and quitting smoking. Campaigns promote evidence-based tools and advice to show adults and families the simple steps they can take to make and sustain changes to improve their health. This includes the NHS 12-week Weight Loss app, Couch to 5K, Mind Plan and Active 10.

Local government can support Better Health in the workplace by ordering resources.

Activity is focused on a number of health behaviours including weight loss, physical activity, mental health and quitting smoking. Campaigns promote evidence-based tools and advice to show adults and families the simple steps they can take to make and sustain changes to improve their health. This includes the NHS 12-week Weight Loss app, Couch to 5K, Mind Plan and Active 10.

Local government can support Better Health in the workplace by ordering resources.

The LGA has conducted its own analysis of national employment and skills-related provision for its member authorities to help them navigate the provisions available. This includes employment support for people with health conditions such as Access to Work and Intensive Personalised Employment Support.

4. How local councils can improve work and health outcomes

Local councils, as employers, can take actions to ensure that the health and wellbeing of their workforces is looked after, regardless of the size of their organisation or the sector in which it lies. These actions range from ensuring workplace health is prioritised by senior members of staff, to encouraging healthy behaviours in the workplace such as taking regular breaks and eating well.

Local councils already have existing governance mechanisms in place such as their Employment and Skills Boards (ESBs) which aim to bring partners together to encourage collaboration and provide intelligence to national agencies and delivery partners. These could also be used to further improve health and work outcomes in their communities. Alongside ESBs, it would be useful to engage with:

Health and Wellbeing Boards (HWBs)
Integrated Care Boards and Integrated Care Partnerships
Devolution partners where relevant
Employers of all sizes, their regional representatives and new Employer Representative Bodies (ERBs) established to develop Local Skills Improvement Plans
Employees
Voluntary and Community Sector Enterprises
Jobcentre Plus (JCP)/Department Work and Pensions.

Work and health: Integrated Care Systems (ICSs)

The Health and Care Act 2022 builds on the work of non-statutory Integrated Care Systems (ICSs) by establishing Integrated Care Boards (ICBs) and requiring the creation of Integrated Care Partnerships (ICPs). This will empower local health and care leaders in the NHS, and with local authorities to join up planning and provision of services and help improve health outcomes.

ICPs are a joint committee of the ICB and their partner Local Authorities. ICPs are responsible for producing integrated care strategies, and both LAs and ICBs must, so far as relevant, have regard to the strategy when exercising their functions. In July 2022, DHSC published guidance on the preparation of integrated care strategies - GOV.UK (www.gov.uk). This encourages ICPs to consider the importance of employment as a wider determinant of health, and consider engaging with employers and employment support services on this agenda.

ICSs have four key aims: improve outcomes in health and healthcare; tackle inequalities in outcomes, experience and access; enhance productivity and value for money; and help the NHS support broader social economic development.

Unlocking the NHS’s social and economic potential produced by the NHS Confederation sets out in detail what social and economic development is, why it matters to the NHS and vice versa, how ICSs might deliver against this purpose for the benefit of its populations and where next this form of broad, strategic partnership working might lead system thinking.

Leadership:

promote this agenda to partnerships within which they operate and, in management of their own staff
use their unique position to bridge the gap between the health and economic agendas, linking HWBs and economic agencies to help them develop joint approaches and programmes, and contributing to Integrated Care Partnerships
help shape the social norms and expectations of the public and professionals regarding health and work so that everyone expects, and wants, to work in a ‘good job’
use devolution powers and any changes in business rates to drive action to improve health outcomes.

Engagement:

promote and encourage take up of services and initiatives led by national Government (Access to Work, Adjustment Passport, Intensive Personalised Employment Support, New Enterprise Allowance and the Work and Health programme)
promote close working with JCP and local health services
promote efforts by supplier companies within the local government supply chain to employ and retain people with disabilities or health conditions
foster a vibrant charity and social enterprise sector to develop creative and innovative projects to help people with disabilities or health conditions back into work.

Management:

undertake a needs analysis to profile health issues within the local workless population and develop services and support to address these needs.

How can local government improve workplace health in their local area?

identify champions for this work amongst elected members and key local businesses
ensure a workplace wellbeing scheme for employers is in place
ensure your local health risk reduction and promotion programmes (e.g., NHS Health Checks, NHS Stop Smoking Services) are maximising opportunities to partner with employers for delivery within, or linked to, workplaces
use levers including provision of advice, partnership working, incentivisation and accreditation, enforcement of employer legal obligations, and contractual levers of procurement using the Social Value Act 2012, focusing especially on those within the supply chain to the local authority
promote efforts by supplier companies within the local government supply chain to employ and retain people with disabilities or health conditions
promote and increase awareness of the NICE Quality standard [QS147] Healthy workplaces: improving employee mental and physical health and wellbeing and guideline [NG212] Mental Wellbeing at Work .
prioritise employment through the HWB, including consideration in the JSNA and Joint Health and Wellbeing Strategy (JHWS), with links to the Employment and Skills Boards (ESBs) which aim to bring partners together to encourage collaboration and provide intelligence to national agencies and delivery partners
co-commission health and employment services between the local authority and NHS ICBs
share and access good practice among local authorities through the LGA and the Office for Health Improvement and Disparities
promote and increase awareness of national programmes, guidance and legislation on employment of those with long-term or fluctuating health conditions.
encourage employers to offer expert work and health support, such as occupational health services, to staff. Evidence shows that occupational health (OH) can support people to return to and thrive in work but access and awareness levels vary, particularly for small and medium sized enterprises (SMEs) and self-employed.

5. Improving workplace health case studies

Public health workplace health team for Milton Keynes, Bedford Borough and Central Bedfordshire: The Healthy Workplace Standards Yorkshire and Humber Association of Directors of Public Health: Workplace Health and Wellbeing Network (WHWBN)

Background

Yorkshire and Humber Association of Directors of Public Health (YHADPH) sector led improvement workstream includes opportunities for local systems to come together to share learning and collaborate on projects with common interest. The WHWBN was established in June 2018 to share experiences and practices in Workplace Health programmes across the region, and beyond, in pursuit of the Workplace Health ambitions set out in Improving Lives: The Work, Health and Disability.

Membership was initially comprised of the workplace Health and Wellbeing leads from the 15 local authorities in the yorkshire and humber region. The WHWBN meets quarterly and is supported by Office for Health Improvement and Disparities (OHID) Yorkshire and Humber to develop a systems approach to supporting the promotion of positive health and wellbeing in a workplace setting. It is chaired by a public health consultant working in the region and has the sponsorship of a Director of Public Health (DsPH) to champion this work with fellow directors of public health at the YHADPH Network.

The Network is currently expanding its membership to include Integrated Care Systems, Local Enterprise Partnership, Active Partnerships and some larger-scale, cross regional employers. This enables the network to have the maximum impact on the sharing of resources and guidance and for network members to form networks outside of the regional presence to strength the impact of this work at Place.

Activity

The Network produces a forward plan which brings together common issues which require at scale solutions. Areas of priority include:

1. Promote, engage and influence employers across all sectors
2.Understand the wellbeing needs of local businesses and how we can support them
3. Develop a Peer Support network for Public Health leads across the region
4. Using data, intelligence & outcomes to ensure that workplace health is based on need and good practice.

Examples of this work have included:

Mental Health and Money and Mental Health and Work webinars Employment and Health Dashboard which brings together data and evidence on employment and health.
It is structured around the economic section of the Inclusive and Sustainable Economies Framework.
Work and Workplace Health and Wellbeing resources.

Learning
Strong relationships across all sectors support developing networks to collaborate on common issues
Governance and buy-in from senior leadership networks support the development of these relationships and validates the outcomes from these networks
Developing plans to collaborate on common issues takes time and needs to acknowledge the difference at Place and across organisations/sectors
Reviewing plans in light of changes to policy levers and drivers, organisational change and resource limitations is essential.

Midlands Engine: The Mental Health and Productivity Pilot

Background

Government awarded funding to the Midlands Engine for a three-year programme to explore the link between mental health and productivity. In 2019, this funding was awarded to the Mental Health and Productivity Pilot (MHPP) collaboration led by Coventry University to test and evaluate mental health interventions.

The MHPP offers a package of initiatives which work towards supporting employees’ wellbeing and ensuring they are happy, satisfied and able to thrive at work. The support includes academic-led interventions, such as REST, an employee-focused intervention testing Cognitive Behavioural Therapy and Emotional Regulation techniques to reduce depression and anxiety, and MENTOR, an intervention to support employees with existing mental health conditions to overcome workplace barriers and promoting effective communication between the employee and their manager. As well as the academic-led initiatives, the MHPP offers organisation-level workplace commitments, such as Thrive at Work and Mind’s Mental Health at Work Commitment, which offer support to help employers create healthier working environments.

Learnings

Following impacts from the Covid-19 pandemic, in 2022 Government awarded an 18-month extension to the MHPP to allow delivery to continue until December 2023, to be followed by an evaluation by April 2024.

Since its launch in 2019, the Midlands’ Mental Health and Productivity Pilot (MHPP) has supported more than 850 Midlands’ organisations to improve workplace mental health and boost productivity. This potentially impacts over 650,000 employees, approximately 17 per cent of the workforce in the Midlands Engine region.

The MHPP website provides more information about the support available for employers in the Midlands.

Supporting employers and employees through the Mental Health and Productivity Pilot

After their organisation joined the Mental Health and Productivity Pilot (MHPP) journey in September 2021, a quality, health, safety and environment manager said:

“As a forward-thinking and people-focused organisation, we put people at the core of everything we do – this is not just something we say, we mean it. We do appreciate that both physical and mental health and wellbeing hold equal importance.

Having a predominately male workforce brings its own challenges when addressing mental health men can be less open with their feelings so, we wanted to put programs and policies in place where people felt they had the space to talk.

When COVID hit, we stepped up our support for mental health as we knew it was a challenging time for everyone.  This was when we started to look for support from external bodies that could give us further guidance and support.

Kate from MHPP has been a huge support in furthering the development of our health and mental wellbeing strategy, she has assisted us in signing the Mental Health at Work Commitment and working towards the standards. She’s helped us in the delivery of mental health and resilience-awareness sessions to directors, line managers and other colleagues, which has been well received.

In addition, a key part of our wellbeing offering has been our Wellbeing Hub, which was launched on our company intranet last year, and Kate has been helpful in feeding us with further resources to upload and use.

As a result of this increased visibility and openness regarding mental health and wellbeing, there appear to be more conversations going on among our people. The Wellbeing Hub is regularly visited by our people and reinforces our message and commitment. Our colleagues are keen to share information as well as their stories and details of their hobbies and interests to show how they relax and have fun outside of work.”

6. Local case studies of partnership working and approaches to support workless people

Haringey Council, London: Haringey Works Greater Manchester: Working Well

Greater Manchester (GM) historically has a number of labour market inequalities, which have recently been exacerbated by COVID-19. The GM employment rate (75.5 per cent) is consistently below that of Great Britain (78.4 per cent) as a whole. Nearly a quarter of GM working age residents are economically inactive, compared to 21 per cent for England. GM has a working age population of 1.8M people, 221,000 of whom are claiming out of work benefits. As is well documented, there is a strong link between work and health, and 64 per cent of GM residents claiming out of work benefits have a health condition.

To combat this, Working Well, a system of integrated work, health and skills provision was created. Each of the Working Well programmes delivers to a different cohort of residents, from closest to furthest from the job market.

All programmes adhere to the same three delivery principles:

1.Personalised support
2. Local integration
3. An eco-system of work, health, and skills.

These principles were derived from a Test and Learn pilot from 2014 and are embedded into each Working Well contract.

Personalised Support

All Working Well programmes use a Key Worker model, meaning there is a single point of contact for each participant which allows relationships and trust to develop. The support of the programme is then tailored to the individual needs of the participant by making use of personalised action plans. The support is sequenced to ensure that the right support is delivered at the right time

Local Integration

Each programme integrates into each Greater Manchester borough and adapts to the local needs of the residents. Each Local Authority area has a designated Local Lead to liaise, support, and challenge delivery of these commissioned programmes. The programmes will also have designated members of staff who will build links with key stakeholders. Each locality will also develop an integration plan and will meet regularly at integration boards to ensure the programmes are embedded effectively.

Eco-System of Work, Health, and Skills

The broader system of support has been brought together to work towards a shared set of goals. The recently refreshed Greater Manchester Strategy outlines the goals and what needs to be done to impact them. Co-design and co-commissioning with key partners are also at the heart of this strategy and have been used on a number of Working Well programmes.

How to engage local partners to support the design of provision to meet local needs?

Locality-based Ask and Offer Documents

Each of the 10 Local Authorities of GM were consulted and an Ask and Offer document was created for each borough with respect to the local delivery of a specific programme. The document outlines what support the local authority can offer the provider by way of links to local organisations and businesses, additional resources etc. and makes requests of the provider such as sharing local data and taking part in regular local meetings.

These documents are developed during procurement to allow the information to shape local practices, governance and areas of focus. The documents can be referred to during live delivery to ensure that the local delivery intent is achieved. The documents are ‘live’ and adapt to continuous local need and management through local integration boards.

Co-commissioning

Programmes such as Working Well Early Help (WWEH), and Specialist Employment Service have been co-commissioned with partner organisations. In the case of WWEH, the programme was co-commissioned and co-funded by Greater Manchester Combined Authority, GM Health & Social Care Partnership and the Work and Health Unit. This process shaped the design and outcomes of the programme to help impact the well-established link between work and health, and the importance of early intervention.

Local integration

Local integration is a key principle across all Working Well programmes. Each Local Authority has a designated local lead who will engage with the commissioned programmes and work with them to ensure the needs of the borough are met. This integration generally involves local Integration Boards – led by the local authority and attended by providers, and local services (health, skills, housing, drug, and alcohol etc.). The meetings are used to discuss local needs, challenges, barriers and opportunities with a view to linking existing local provision together to meet need and achieve greater outcomes for local residents.

Providers of commissioned programmes employ staff (integration co-ordinators) to engage with local stakeholders and work with them to implement a local integration plan. This will focus on the needs of the participants and, within the borough.

Local Authority representatives also have an opportunity to be involved at the bid review stage of the commissioning cycle, allowing them to have input into the commissioning process.

How to join-up with other partners and local services to establish an effective signposting and referral process?

Social prescribing

The NHS long-term plan set ambitious targets for the scaling up and rolling out of social prescribing. GM is ahead of the trajectory on social prescribing, with all ten localities having commissioned, social-prescribing programmes in place – the largest city region to be able to offer social prescribing across all local authority/CCG areas – and over 25,000 people supported through social prescribing in 2019/20

As part of the bid process for the Working Well Work and Health Programme, GMCA built in a requirement for a social prescription platform to be used across GM to help facilitate signposting and referrals across the wider support system. Traditionally, referral pathways have been difficult to implement and difficult to track.

The platform allows services to advertise their offer and manage the referrals that they receive, while allowing the provider to effectively refer participants to external support. The platform also allows for effective reporting and tracking of these referrals.

As the provider for WHP, JETS and Restart is the same, the platform and the services signed up to it can be shared across contracts. The platform enables GMCA to understand where our services meet client needs and if they do not, whether it is it due to poor service or gaps in commissioned provisions.

Integration with GPs

On Early Help the GP referral pathway is key. The HSCP helped to facilitate the initial discussions with local GP practices and helped to establish referral pathways into the programme.

A local provider was subcontracted to engage with the GP practices what were involved in Early Help. The provider had years of experience in engaging with GPs in GM and were able to set up “Fit Note Clinics”, and on-site method to support practices in making use of the WWEH programme.

JCP

To ensure that referral levels match the programme expectations, each Working Well programme has close on-the-ground relationships with all local JCP offices. JCP co-ordinators will present webinars, liaise with work coaches, and spend time in JCP offices to ensure referrals who will benefit most from Working Well Provision are able to start on programme. Any local issues, challenges or barriers can be quickly addressed by utilising the strong relationships in each borough between provider and JCP.

Adult Education Budgets (AEB) and Skills Support

The Work and Health Programme has no embedded skills offer, however GMCA has devolved responsibility for the AEB and so strong referral links have been created between this provision and local skills and training providers. Both WHP and JETS can refer directly into local skills provision, from basic skills to improve employability, to industry recognised qualifications. To date WHP has made over 25,000 referrals to AEB provision.

Successes so far:

Working Well: Work and Health Programme

20,000 programme starts
Over 7,500 job starts
More than 500,000 keyworker appointments attended
Over 100,000 external referrals above and beyond
Direct Delivery (work, health, skills, life interventions). That is on average five external interventions per person
70,000 referrals to the WHP (internal) Health Support Team.

Social value added:
£100,000 charity fundraising
Delivered 23 disability confident events to employers
900 days staff volunteering.

Liverpool City Region: Wealth and Wellbeing Programme

Liverpool City Region (LCR) covers a population of approximately 1.5 million and functions as a city region with a Combined Authority. The six council areas that make up the city region are Liverpool, Halton, Sefton, Wirral, Knowsley and St Helens.

The Wealth and Wellbeing Programme in Liverpool City Region had its initial drive in the established link between work and health. Being in work is, generally, better for an individual’s health than not being in work and better still, if that work is shaped and structured in a way that enhances the health of employees.

From that starting point the programme developed the link between low productivity, a major concern of economic planners, and poor health and quantified the impact of poor health in terms of lower economic output. It was then a short step from knowing that the way the economy functions has a major impact on the health of the population to exploring just what it would mean if we started measuring economic success in terms of wellbeing outcomes.

The programme is now progressing to propose further investment in employee support programmes to help people suffering now from lack of employment owing to poor health and, to develop with people in communities what it would mean to plan the economy around wellbeing. Building on the National Health Science Alliance Wealth and Health report with further analysis by University of Liverpool, it was possible to quantify the impact of poor health on economic productivity in several ways.

When looking at the gap in productivity between the economy of the LCR and the rest of the country, this analysis found that 33 per cent of the gap can be attributed to ill health. This equates to £3.2 billion in lost gross value added and that is about 10 per cent of the total economic output of the LCR economy on an annual basis. Further analysis by Public Health England made it clear that the major impact of health on the economy is though mental ill health and some way after that, through musculoskeletal problems.

A work and health profile was produced for the city region and for each of the six boroughs that make up the city region. Connecting across the system early in the programme the council leadership advised that the work should progress through engaging with communities and the bringing together of parts of the system that might not usually have much interaction. The emphasis was on a system leadership approach that invited views from as wide a range of perspectives as possible. This approach took its most tangible form in six workshops, one in each of the six boroughs, on a different aspect of the wealth and wellbeing programme. The intention was to place less emphasis on the presentation of good practice – although that is important at times – and to provoke discussion by posing questions. Workshop themes included links to the environmental agenda and asked whether it was more important to have a good job for everyone, or a good quality environment for everyone.

The workshops helped to engage people in discussion on work, health and the economy that would not otherwise have happened. A compelling narrative is important in any programme that is considering large scale change – to have a good understandable story at the core of the programme. It is crucial that, in this case, the story is built upon the views of people most affected by the current state of work and health.

A commission was undertaken to understand views on the social determinants of health and the role of local government. Views were secured from 21 people (out of 40) across the region who are experiencing the impact of ill health on employment. This has been written up in a report and presented in a video. It is the basis for development of a story about work, health and the economy in the LCR that will become a compelling narrative for change.

A review of the evidence-base on health and work showed good evidence for employee support programmes, particularly individual placement and support schemes for people with severe mental illness, but also others, as a sound investment to support people with health problems to engage with work again. Building on the good practice in the region in this area will be a feature of the programme as it moves into the next decade.

Much is being done through Fair Employment Charters, Healthy Workplace Charters and other activities to shape the workplace to be better for the health of employees. The Wealth and Wellbeing programme will bring a stronger health focus to this work in LCR and will take onboard the national reviews of the changing world of work to ensure that health for its own sake, and because we know that a healthy workforce is better for business, is prioritised.

Finally, the programme has tapped into the national and international interest in wellbeing economics. We engaged across the communities, health services, employers and councils of LCR and asked: what would it mean to have wellbeing at the core of economic planning for a city region; what would be different from the current focus of economic planning; what different priorities, actions and investment could follow if the main goal of economic planning was population wellbeing? By asking questions and inviting views from any quarter that is interested we believe that we stand a better chance of making a difference. We are establishing the belief that an economy that functions effectively for everyone is better for health and wellbeing and, a population with better health and wellbeing, is better for an effective and fair economy. Economic planning is therefore a legitimate interest of anyone interested in a healthier population.

Redbridge Institute of Adult Education: Targeting JobCentre Plus client with mental ill health and older people with poor literacy skills Kent Council: Live Well Kent Wakefield Council: evidence-based support to raise aspirations Gloucestershire: helping those furthest from the labour market Hackney, Lambeth and Islington: Central London Works Northumberland Council: ‘North East mental health trailblazer’

7. Resources for local government

NICE guidelines:

Mental wellbeing at Work (NG212)

Tobacco: preventing uptake, promoting quitting, and treating dependence

Promoting Physical Activity in the Workplace (PH13)

Workplace policy and management practices to improve the health and wellbeing of employees (NG13)

Evidence reviews and briefings

LGA guidance:

Work Local: Unlocking talent to level up

Good Work Project

Learning for Life: the role of adult community education in developing thriving local communities

Government resources:

What Good Health at Work Looks Like

Health inequalities: place-based approaches to reduce inequalities

Guidance on the preparation of integrated care strategies

Health matters: health and work

Using the Social Value Act to reduce health inequalities in England through action on the social determinants of health

Improving working conditions/job quality PHE evidence reviews and briefings

Local healthy workplace accreditation guidance

Inclusive and sustainable economies: leaving no-one behind

Data tools:

Health and Work: infographics

Work, worklessness and health: local infographic tool

Movement into employment: return on investment tool

Health and Safety Executive guidance:

Working together to prevent sickness absence becoming job loss. Practical advice for safety and other trade union representatives

How to tackle work related stress

Working together to reduce stress at work

Making the best use of lifting and handling aids

Managing upper limb disorders in the workplace

Don’t mix it: a guide for employers on alcohol at work

Drug misuse at work

Consulting employees on health and safety

HSE: Information about health and safety at work

Health and safety for disabled people at work

Managing sick leave and return to work - HSE

Health surveillance and occupational health - HSE

Managing drug and alcohol misuse at work - Overview - HSE

Home working - HSE

Employer resources

Developing and evaluating workplace health interventions: employer toolkit

BITC Health and Wellbeing Toolkits

Support with employee health and disability

Mental Health At Work

Disability Confident employer scheme

Access to Work

NHS Employers Health and Wellbeing

ACAS Health and Wellbeing

CIPD Health and Wellbeing at Work

References

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Finger Tips tool
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Deloitte: Poor mental health costs UK employers up to £56 billion a year
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Health is everyone’s business: Proposals to reduce ill health-related
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