The release of each month’s employment and unemployment data has taken on a new slant over the last couple of years. The mainstream coverage now picks up on the growth in the number of people who are economically inactive, with this figure having grown since the Covid-19 pandemic. This issue of inactivity was recognised by all parties in the general election and several thinktanks have identified the fiscal impact and burden. People not working, either by choice or through poor health, disability and/or caring responsibilities, has limited the labour market supply, and in turn limited the UK’s economic growth.
With the new Government under pressure to provide a solution, now seems an opportune moment to ask: what does the existing evidence suggest for programmes in this policy space? As researchers and consultants who spend much of our time gathering and analysing evidence, we would hope that the existence of previous evaluations should provide insights to ensure evidence based policy. However, in practice the policy developments appear more complex and confusing.
The Conservative Government had announced previously its intention to roll out Universal Support from later in 2024. The development of Universal Support (US) was an important strand in supporting people back to work, especially as other key programmes funded by the Department for Work and Pensions (DWP) were due to finish around the same time. The previous government funded a range of programmes, with the main ones through DWP being:
- The Work and Health Programme (WHP), including latterly the Pioneer programme. WHP was introduced in 2018 and a randomised controlled trial (RCT) was run on the programme between 2018 and 2020 with DWP now processing the results. Targeted at those with health or disability issues, and those out of work over two years, it initially included both mandatory and voluntary participants, but now is focussed on the latter.
- Restart began in summer 2021 as part of the COVID-19 response. It was a mandatory programme, targeted initially at those out of work 12-18 months and in receipt of Universal Credit in the Intensive Work Search group.
- Individual Placement and Support in Primary Care (IPSPC): this builds on a tried and tested IPS model that was developed for people with severe mental health illness who were out of work. However, IPSPC instead focuses on people with mild to moderate mental and physical health conditions and disabilities and included in work (prevention) and out of work strands. It is a voluntary programme. The Conservative Government intended IPSPC as an interim roll out of Universal Support.
Critical to the evidence behind IPSPC and Universal Support was the Health Led Trials which included an RCT carried out in Sheffield City Region and Birmingham (West Midland Combined Authority). However, it produced very mixed results[1]:
- In the West Midlands, where all recruits were out of work, there was a substantial and strongly significant impact on the probability of being employed for 13+ weeks over the year following randomisation
- The Sheffield the in work group saw less substantial and weaker impact on employment using the same measure
- No impact on employment was observed for the Sheffield Out of Work group
- Across Sheffield groups, strongly significant impacts were seen for health and wellbeing outcomes. These did not emerge in the West Midlands
- When the data was combined across the two areas,
- no impact was detected on employment for the two out of work trial groups
- small impacts on health and wellbeing were statistically significant
- economic benefits to society greater than costs were achieved through health-related outcomes alongside employment outcomes from the IPS services.
Behind these results are three striking issues around the delivery and achievements of the trial:
- despite the initial focus on primary care, GPs accounted for 18% and 16% of all referrals, and, while more came through secondary care, ‘Others’ including JCP accounted for overall half of all referrals. We have seen similar patterns in other areas from more recent SQW work
- referrals and support from health services were higher in Sheffield, while JCP was more prominent in the West Midlands. The authors of the evaluation suggest this might have influenced the differences in outcomes between the two areas
- the 12 month survey found 18% in the West Midlands and 23% of the Sheffield out of work cohorts were in employment (by contrast the figure for in work was 72%). A further 19% of the out of work group in both areas were listed as having an ‘Other’ status, including being in education and training. This indicates higher overall positive outcomes if this were viewed as a more traditional employment programme, but less so in one that is based on a premise of ‘place and train’ with an emphasis on moving people in to work.[2]
Given these somewhat mixed findings it is interesting that DWP decided to continue and expand IPSPC to other areas, and to announce it as a forerunner of Universal Support. No similar announcement has been made about the long term future of Restart or WHP, despite 46% of WHP starts achieving first earnings from employment within 24 months[3] and 42% of people on Restart doing likewise in 12 months[4], which is the most comparable figure to the job entry rate from IPSPC. Unit costs for WHP and IPSPC are broadly similar.
It also appears from SQW work in one part of the country that the out of work people participating in IPSPC are more employable in many ways, e.g. have higher qualifications and less time out of work, but do have greater health issues. They are also more likely to be female.
With the new Government announcing the intention to have new work, health and skills plans for the economically inactive developed, led by Mayors and local areas, it is worth asking: what has been learned from the evidence of the last few years and how this might shape a future delivery? In doing so we suggest DWP and Mayors consider a series of key questions in deciding the appropriate policy mix to ensure best value for money:
- Is the scale of job entry outcomes delivered through IPSPC sufficient to view it as the mainstream way to tackle economic inactivity, or should it be targeted instead at those in-work with an enhanced and larger scale offer for the out of work. This is an issue to watch as the current programme reaches maturity.
- While primary care might appear a good alternative to Jobcentre Plus to identify people who are inactive and would benefit from support, the level of buy-in from primary care is mixed. Therefore, what additional measures are required to either increase engagement from primary care to ensure their input against competing pressures or to find other routes to ensure the support is made available to those who most need it? And if other routes are used what does this imply for the Fidelity model, which underpins IPS, and workload of Employment Specialists who deliver the programme?
- What can be learned from WHP and Restart about integration and meeting the needs of individuals, including health needs? Our experiences of WHP have seen good examples of integrating health support within the programme, rather than the IPSPC approach of trying to create a strong link from and with the primary care system. Would bespoke health support within an employment programme be more available to those seeking to return to work and so avoid issues about wider access to and integration with the NHS and local variations in wating times etc?
How these issues are addressed may well vary for place to place and we would be very interested to discuss them with areas as they work through and consider their options.
[1] Health-led Trials: Evaluation Synthesis Report
[2] Survey findings: Health-led Employment Trial Evaluation