Case study summary
Gaining employment is vital to supporting individuals in their recovery. Over the past 12 years the Central and NW London NHS Foundation Trust has through its Individual Placement and Support model supported over 1,000 people recovering from mental health and addictions to gain and sustain paid employment.
Central and NW London NHS Foundation Trust (CNWL) has over 6,000 staff providing integrated healthcare to a third of London’s population, Milton Keynes and areas beyond.
What did you do?
CNWL made a commitment to increasing access to paid employment for people accessing its mental health and addiction services by creating an Employment Services Manager post in 2004. The service now includes:
- Delivery of the evidenced-based Individual Placement and Support (IPS) employment model, integrating employment specialists (ES) into clinical teams, supporting a recovery approach, and increasing access to paid employment. The model has been established in both secondary mental health and addiction teams across the organisation.
- An internal User Employment Programme – supporting people with lived experience of mental health or addictions to access existing paid posts within the Trust. This has been an important first step in ensuring that IPS was adopted by the Trust.
- Delivery of a range of employment courses at the Trust’s Recovery and Wellbeing College.
As there was no initial budget for the service, income has been generated from a variety of sources, including clinical commissioning groups (CCGs), local authorities, Lottery funding and European funding. The foundation trust has also worked in partnership with external agencies such as Job Centre Plus and voluntary sector partners to co-locate employment posts and convert existing NHS posts where possible.
The case for the IPS model was built by drawing on the evidence base, including success stories from other Trusts who had already implemented it. Once IPS services at CNWL were up and running managers were able to use performance data and feedback from service users to persuade commissioners and internal services to support the expansion of the service.
Impact – what changed?
Since 2010 the service has been recognised as an IPS Centre of Excellence, sponsored by the Centre for Mental Health. Over the past 12 years it has supported over 1,000 people recovering from mental health and addictions to gain and sustain paid employment in a range of industries. A number of teams have achieved ‘Good’ or ‘Exemplary’ IPS Fidelity. Many of the service’s employment outcomes were achieved during the economic recession, which is a credit to both the motivation of service users, and the relationships that Employment Specialists have built with employers to access the hidden labour market.
In the 12 months from April 2015, 512 people accessed Trust-wide Employment Services and 236 paid outcomes were achieved for 197 people, resulting in a 38.4% placement rate. As part of the journey back to work 100 education and training outcomes were achieved, and 68 Recovery and Wellbeing Courses – which complement the return to work journey – were completed. In a confidential phone survey 100% of service users reported they were either ‘very’ or ‘quite satisfied’ with the support they received from their Employment Specialist to achieve their employment goal.
I feel very proud of having our Employment Specialists embedded within our teams. I have seen service users who felt they could never work secure paid employment with their support. This is an invaluable service and something CNWL should be very proud of.
Care Co-ordinator, Mental Health Team.
Employment Specialists embedded in the community teams are a real asset. I have seen the impact of the service with various different patients in their recovery journey. The service is accessible and very positive about the real possibility of returning to the workplace, in a meaningful way, and I have seen the rewards in self-esteem and self-confidence for the patients I work with.
Care Co-ordinator, Mental Health Team.
Having an ES in the addictions team continues to make a difference by both supporting the employment needs of our clients, which in turn enhances recovery and abstinence.
Key Worker Addictions Team.
Anything you would do differently next time?
Relationships with CCGs and local authorities
More work on publicising the evidence base for IPS fidelity to all local CCGs and local authorities will be a key objective in the coming year.
Partnerships with external employment providers
CNWL will ensure managers will spend time identifying the right employment providers when working in partnership to develop new IPS services, and that both the Trust and employment providers share the same values and commitment to implementing high fidelity IPS services.
Top tips – action points for others in this situation?
Recruit staff with the right skills and qualities
Employment Specialists (ES) need to be self-starters, optimistic, tenacious, recovery-driven, good communicators; and able to build relationships with clinical teams, service users and employers. To ensure effective recruitment, a recruitment assessment centre has been co-produced, and there is a probation process.
Utilise case management standards and audits early
To help ensure the delivery of a high quality service, Quality Assurance Fidelity Reviews are used, and case management standards and an audit process have been developed. These should be implemented as early as possible in the programme.
Introduce employment leadership roles for organisational commitment
The Employment Services Manager’s role, additional Trust wide and local team leadership posts have been key in moving the agenda forward. All are employed by CNWL, making it possible to influence the organisation strategically, and ensure buy-in for evidence-based services and practice at a local level – and also to help drive commissioner support to expand the services. For further organisational synergy and commitment a link has been formed with the Trust-wide recovery agenda and with its Recovery and Wellbeing College to deliver training.
Use innovative resources
Service users are encouraged to co-facilitate training and presentation through the use of a range of communication tools including employment recovery story booklets, regular annual reports, journal articles, a DVD and online information.
Get the right people involved
All health professionals have an important role to play in both motivating service users to think about work, and in providing interventions which will support the return to work process. In particular Occupational Therapists have been important in working with ES to champion the employment agenda, and to provide specific interventions relevant to the return to work. Close working with the Trust board, occupational therapy senior management team, borough management teams, local services, commissioners and service users was also found to be vital in delivering services.
Feedback from service users who have accessed employment services
I sometimes cannot believe my luck; I cannot believe that I was so lucky to have met an amazing Employment Specialist. She helped me believe again, she helped me achieve things I thought I was unable to do. She made me realise that if I take my medicine and stay well, I will be able to climb my career ladder! I sometimes walk to work and feel like it’s a dream.
It has increased my happiness levels, going from not working to working has been an important step.
My health improved, and I have a reason to live, keeps you occupied and helps with negative thoughts.
Most importantly my Employment Specialist believed in me and she gave me back my confidence! I got the job and it changed my life.
The re-design of CNWL mental health services continues to ensure that employment is central to supporting individuals in their recovery, and in stepping down to primary care. There is a growing need to both expand existing IPS services in secondary care, as well as to develop new services within primary care. Plans are now in place to pilot the IPS approach in primary care settings, alongside a new Staying Well at Work service. This service will work with HR, occupational health and managers to support CNWL staff in managing their mental health at work.
For more information please refer to the CNWL Employment Services website.