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Working for better health – how Greater Manchester invested £80million to keep people at work

Having a job is one of the most effective ways to stay healthy – if we can keep people in work they can be productive as a workforce and live more fulfilled and happy lives.

That’s why in Greater Manchester we’ve put a huge emphasis on helping people stay in work or get back to work as soon as they can.

GMs Working Well programme tested the model for 5,000 incapacity benefit and employment and support allowance claimants and we rapidly expanded it over three phases to more than 40,000 people by 2021.

By December 2018 we had engaged 20,000 people and had already helped over 4,000 back into work, achieving our target for phase two of the programme 18 months early. More than £80million has now been invested in our suite of programmes and we’re proud to share its learning.

Each person has their own key worker who works with them on a complex work and skills plan and wider determinants of their lives such as health, family and housing, are also taken into account so we can deliver a completely holistic view before working with a range of organisations to get them back into work. They then have 12 months support at their job to help make sure they remain stable.

Back in 2014, we recognised that the main Welfare to Work programmes were successful with younger people, but were underperforming for people with more complex health needs.

For example, the programmes often took class-room based approaches, a problematic format for this population, so we had to do things differently and that’s when Working Well was formed.

We’re particularly proud that the model has been totally integrated across health, social care and local authority services, and that we have local integration boards in each authority.

It’s created a feeling of shared ownership across the 10 Greater Manchester boroughs but we’ve been careful not to duplicate what is already out there.

So what did we do differently? Firstly, we wanted to get the structure right so we established a health and employment board setting out our ambition to turn the programme into a whole population system: work, health and wellbeing.  We also worked with two key partners: one with experience at delivering welfare to work and a social enterprise experienced in public health and wellbeing.

Secondly, we targeted those with the highest need and were realistic about the distance from the labour market facing many of these people. We offered many other future benefits too – both for the participants and for the Greater Manchester economy – for example, reducing debt or future dependency on social care.

We looked at what drives access to services and any blockages: it’s amazing how long people struggled before getting help – the average length of time before accessing Talking Therapies was 13 years.

One of the insights of our pilot scheme was that people on the programme had been out of work and claiming benefits for an average of six years before joining. The Chief Executive of Turning Point back in 2008 said ‘if you have been claiming incapacity benefit for more than two years, you are more likely to die or retire than get a job’.

We asked ourselves: why wait for 6 years before doing anything?

Half a million ‘fit notes’ are issued annually but GPs report that they have neither the time, nor the occupational health knowledge, to advise patients fully.

So, in March we launched our Working Well: Early Help Programme – the first programme of its kind in the country – to identify ‘at-risk’ people – for example people currently absent from work at risk of long-term sickness and offered support using the same personalised and integrated programme approach, but at a much earlier point in time.

It brings doctors, employers, individuals and support services together to take early action to help residents with ill health at a crucial point when they are starting to be at risk of falling out of employment or newly out of work.

We can offer telephone support and face to face advice and the service includes vocational rehab caseworkers, physiotherapy and mental health professionals, and engagement partners to work with GPs and small and medium-sized enterprise (SMEs).

This is a much more preventative approach – population health management we might call it – and can lead to much better outcomes for people and is also particularly valuable to business like SMEs, who don’t have the occupational health infrastructure of bigger organisations.

Many senior stakeholders have been championing our programmes, all the way up to the mayor Andy Burnham, helping us keep our high levels of ambition.

Stakeholders have been very supportive and pooled health and social care budget streams around transformation funds helping us support a broader range of people, from those struggling to maintain work due to poor health to people with learning disabilities, autism or severe mental illness.

This level of health and social care partnership is what devolution is all about. It is our ability to think big, and we’re now doing things no single part of the system could hope to achieve on their own.

Don’t under estimate how much work goes into building relationships and building trust – it all starts from that personalised approach to care.

Read more about the GMCA Working Well programme.

To register as part of our on line Population Health Management network and stay up to date with the latest information please email: england.stgphm@nhs.net.

Mat Ainsworth is the Assistant Director for Employment (Strategy, Policy & Delivery) at the Greater Manchester Combined Authority. Mat is responsible for the delivery of the employment elements of GM’s groundbreaking devolution agreement and the Greater Manchester Strategy priority around good jobs for people to progress & develop. The key elements of this include the development of a whole population Working Well system to ensure people have the support and opportunities to secure and progress in work; developing a world-class jobs and progression service, working with Jobcentre Plus; and developing a GM approach to managing welfare reform that delivers job progression and addresses low pay.

The role includes significant joint working with partners across GM, especially those working in health, skills and economic development, as well as with central government departments, academics and Think Tanks.

Mat has previously worked for Salford City Council, Nottingham City Council, Jobcentre Plus and as a teacher and freelance translator in Slovenia.

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