Health and Employment Bulletin August 2013
1 in 4 women
&
1 in 5 men Number of working age people who are disabled or have a health condition that seriously affects their day-to-day lives.
What does this mean for Greater Manchester?
Health and Employment Bulletin: Health and economic activity
Introduction Welcome to the first in a series of Health and Employment Bulletins. These bulletins aim to provide information on health and employment statistics and policy in Greater Manchester, analysing what they mean for health professionals, employers and employment support services. This bulletin also provides explanations and definitions for a variety of programmes, benefits and groups of individuals. This is in order to support better integration and understanding between services, and to provide information that might better support consistent employment and health messages.
Health and Employment News Work Programme performance not meeting targets for claimants with health conditions July saw the long-awaited release of Work Programme performance figures to March 2013. The Work Programme is an employment support programme for jobseekers (JSA claimants) and those with health conditions who require some help and support to return to work (ESA claimants), and providers are paid on results. Of the 30,970 referrals to the Programme between April 2012 and March 2013, 24.1% resulted in a job outcome. However, there was significant variance between the different groups on the Programme – whilst JSA claimants, especially those aged 18-24, achieved high job outcome rates, ESA claimants experienced the lowest rates of returning to work. Providers are assessed on minimum performance levels for three groups – JSA claimants aged 18-24, JSA claimants aged 25+ and new ESA claimants. The performance level is calculated as total job outcomes over the year as a proportion of total referrals to the Programme in the year. In the young JSA group, the performance level target was set at 33%. The performance nationally was below target (31.9%), but in Greater Manchester performance was above target (35.5%). Conversely, for the ESA group, performance was much lower than expected – the target was set at 16.5%, but nationally the rate was just 5.3% (in Greater Manchester, the figures provided by DWP are subject to a large rounding error). This has led to speculation that Work Programme providers, who are paid more when an ESA claimant gets into work than when a JSA claimant does, are ‘creaming and parking’ claimants. This refers to the process of supporting the easiest to help into work (‘creaming’) and not investing in support for the hardest to help (‘parking’). The reality is more complex. The Work Programme gives providers just two years to support someone back to work, and those with health conditions are harder to support, and have more complex problems – including a mixture of mental health, physical health, drugs, alcohol and family life issues. New Economy will be looking at how employment support services can be complemented by existing healthcare provision, and how Work Programme providers can better access existing drugs, alcohol and mental health services that support their clients’ journey to work. One element of this may involve better information sharing between services that support individuals, whilst Work Programme providers will need to increase awareness and understanding of certain health conditions and what can be done to support these people. The way the Work Programme pays providers is also crucial. The first payment is an attachment fee, when an individual is referred to the Programme. The second payment is made when an individual gains employment (as noted in HMRC records). And finally, the providers receive further payments if an individual remains in work. As work can aid recovery and support good health, both Work Programme providers and healthcare providers have a shared goal of supporting an individual to remain in employment. Greater Manchester aims to increase integrated support for Work Programme clients to support both good health and good work.
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Health and Employment Bulletin: Health and economic activity
Good Work: Good Health Charter award applications open Applications are now open for employers wishing to apply for a Good Work: Good Health Charter award. The Good Work: Good Health Charter (the Workplace Wellbeing Charter for Greater Manchester) is a toolkit that identifies a series of actions that employers can take around health and wellbeing at work. It is split into 8 core standards – from leadership through to smoking and tobacco-related ill health. Employers who feel they have met the actions from the Charter can apply for an award, recognition that they have met the standards. The next set of assessments will take place in central Manchester in the two weeks of the th th 16 to the 27 September. Applications for the award need to be submitted online via New th Economy’s website by Monday 19 August, and evidence needs to be submitted by a week later, th Monday 26 August. New Economy also runs some assessment panel introductory sessions for the Good Work: Good Health Charter award throughout the year. The most recent introductory session, which provides attendees with the knowledge and understanding behind Charter award assessments, took place at the end of July and trained up 12 new assessors. Assessment panel training is available from New Economy across all Greater Manchester local authorities for free, and several more training sessions are planned before the end of the year. To find out more information, check out the introductory session webpage on the New Economy website.
Universal Credit rolls out across Oldham and Warrington The Universal Credit programme has been expanded to cover Oldham and Warrington, as of late July. Universal Credit is one of the flagship programmes of the Department for Work and Pensions and is designed to provide an incentive to get people into employment by making work pay. It does this by tapering off as income from employment increases, and is designed so that individuals will always be better off financially through working than being on benefits. It applies to individuals on some out-of-work benefits and some low-income benefits. One of the major differences between Universal Credit and other benefits is that it brings together six existing benefits into one single monthly benefit: Income-related Employment and Support Allowance; Income-based Jobseeker’s Allowance; Income Support; Working Tax Credit; Child Tax Credit; and Housing Benefit. Rather than one payment for housing benefit and one for Employment and Support Allowance, for example, Universal Credit claimants will receive just one benefit payment a month, covering all the benefits for which the customer is eligible. For customers, this has been a fairly contentious issue. Currently, claimants are usually paid every two weeks. Under the new system, claimants will be paid only once a month, and customers will receive the full amount for their family, rather than just for themselves. Whilst customers have broadly agreed with the principles behind Universal Credit – that of putting all payments into one, and simplifying the process, claimants have indicated that they disagree with how this has been done. For example, claimants with drug or alcohol misuse issues, or those lacking basic financial skills, are worried that they will not be able to budget a full monthly payment. The rollout means that any new claimants in Oldham or Warrington who are applying for any of the above benefits will be asked to apply for Universal Credit instead. This adds to Tameside residents, who have been able to apply for Universal Credit since April 2013. The changes may mean that GPs and health professionals are asked to provide support for this transition – especially as all claims are expected to be made online, and many claimants with health conditions may need additional support. Jobcentre Plus offices can provide some guidance and support, whilst online claims and guidance is also available on gov.uk.
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Health and Employment Bulletin: Health and economic activity
Health and economic activity Individuals with a health condition are significantly less likely to be in employment, and more likely to be economically inactive. Just over one in five individuals (rising to one in four women) are likely to have a health condition that affects their ability to hold down a job. For health professionals, this is a serious issue. Work can be both an aid to recovery and a support to maintain good health. Work provides an income for individuals, improving access to better nutrition and more opportunities for physical activity. As was noted in the Marmot Review and reiterated in the Sickness Absence Review, the link between employment and health is both multi-dimensional and bi-directional. Whilst work can improve health, an improvement in health can also support an individual’s return to work. Improving the link between health services and employment support services can help to improve an individual’s potential outcomes. For example, if an individual is in residential rehabilitation, they will not be able to meet with their claimant commitment to engage with employment support. Sharing information between health and employment support services would mean than individuals in this situation would not receive benefit sanctions for not engaging with employment support, and as such this can help both their rehabilitation and their likelihood of returning to work. When individuals are in work, the focus for health professionals should shift towards employment sustainability. The Independent Review of Sickness Absence by Dame Carol Black and David Frost highlighted that the costs of sickness absence are disproportionately borne by the state and the individual. When a sickness absence occurs, a quick return to work is beneficial for all. A more prolonged absence can lead to greater healthcare needs, and potentially increased costs if the individual falls out of work. However, employers benefit the most from individuals remaining healthy and in work. As such, employers are a key partner to support good health in the workplace – preventing ill health; and in helping to reduce the likelihood of an individual falling out of work and onto benefits because of a health condition. Sustainability of employment amongst individuals with long-term health conditions is a key issue for Greater Manchester. At 43.9% the employment rate of disabled people in Greater Manchester is well below both the national figure (49.0%) and the total employment rate (67.6%). Therefore, supporting disabled people’s health in work
can help to reduce the likelihood that they will fall into worklessness, and experience poorer health. Yet many employers find supporting individuals with health conditions difficult, especially if they don’t understand a health condition or understand what workplace adjustments they can make to support employees’ health and their remaining in work. GPs, who have an understanding of their patients’ needs, can support an individual to remain in work through providing workplace improvement suggestions in a fit note. The GP and practice nurse website developed by the University of Liverpool can help GPs and practice nurses with fit note suggestions and support. New Economy supports a range of initiatives across Greater Manchester that engages employers in health and wellbeing, and supports a return to work. One of the most common issues that employers find it hard to deal with is mental health, an area where individuals, employers and GPs working together could provide better outcomes: individuals with mental health problems have the lowest employment rates (27.6% in Greater Manchester). Therefore, Greater Manchester Public Health Network, working with New Economy and partners from across Europe developed a series of mental health toolkits for each group to improve employment sustainability for individual with mild to moderate mental health conditions. New Economy also delivers assessments for the Good Work: Good Health Charter Award, which recognises employers that implement good work and good health actions in the workplace. The award is open to all employers, and actively engages them in health and wellbeing activities.
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Health and Employment Bulletin: Economic Activity
ECONOMIC ACTIVITY AS OF MARCH 2013:
ECONOMICALLY ACTIVE: 1,299,700 74.7% OF WORKING AGE POPULATION +2.0% ANNUAL INCREASE
ECONOMICALLY INACTIVE: 440,100 25.3% OF WORKING AGE POPULATION -4.2% ANNUAL DECREASE
OF WHICH EMPLOYED: 1,176,200 67.6% OF WORKING AGE POPULATION +2.8% ANNUAL INCREASE
UNEMPLOYED: 123,500 9.5% OF ECONOMICALLY ACTIVE POPULATION -5.6% ANNUAL DECREASE
OF WHICH EMPLOYEES: 1,033,400 59.4% OF WORKING AGE POPULATION +2.5% ANNUAL INCREASE
SELF-EMPLOYED: 132,100 7.6% OF WORKING AGE POPULATION 2.0% ANNUAL INCREASE
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Health and Employment Bulletin: Work and Worklessness
Economically active The number of individuals who are both willing and able to work. This includes those in work (employed) and those who are looking for work (unemployed). The employment rate is calculated as those in employment as a proportion of all the working age population. The unemployment rate is the number of unemployed people as a proportion of all economically active people.
Employment rate
67.6%
Annual change
+2.8%
Over 32,500 more people are in employment now than one year ago. The largest increase has come in the employees group, increasing by 25,500 (2.5%) over the year.
Unemployment rate
9.5%
Annual change
-5.6%
Significantly fewer people are unemployed than one year ago, with the number falling by 7,300. However, this may largely be due to the way employment and unemployment is calculated – individuals claiming benefits who are on the Work Programme are considered employed, even if they haven’t got a job. Greater Manchester’s unemployment rate (9.5%) continues to remain higher than the national average (8.0%).
Economic activity over time United Kingdom North West Greater Manchester Over time, the gap between Greater Manchester and the UK has fallen, whilst both have risen. However, Greater Manchester remains below both the national and regional economic activity rates.
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Health and Employment Bulletin: Work and Worklessness
Economically inactive The number of individuals who are either unwilling or unable to work. The majority of individuals in this group are unable to work, mainly due to a health condition, but students, stay-at-home carers and the retired are also inactive. However, some do want to work.
Economically inactive and want a job
25.9%
Annual change
-1.3%
Around 114,000 people in Greater Manchester are economically inactive but want a job – 25.9% of the economically inactive population. This is higher than the national average of 24.5%, and represents a slight increase (as a proportion) on the past year. However, as the number of economically inactive people has fallen, the number of people who are inactive and want a job has fallen.
Economically inactive due to illness
2.1% Inactive with a temporary illness Annual change: +1.1% UK average: 2.0%
26.0% Inactive with a long-term illness Annual change: -8.2% UK average: 22.2%
The proportion of individuals who are inactive due to a temporary illness (2.1%) is a much smaller proportion than those who are inactive due to a long-term health condition (26.0%). Whilst around 1 in 4 individuals are inactive due to a long-term condition, nationally the figure is closer to 1 in 5, suggesting Greater Manchester has a more significant issue around long-term conditions.
Economic inactivity over time United Kingdom North West Greater Manchester Over the past 2 years, the economic inactivity rate has fallen, and at a greater rate across Greater Manchester than nationally. Yet the figure still remains higher than the national average.
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Health and Employment Bulletin: Disability and Ability to Work
Disability The number of individuals who have identified that they have a health condition or disability that substantially limits their ability to carry out normal day-to-day activities. This includes those who have disabilities or health conditions compliant with the Equalities Act 2010 and the Disability Discrimination Act of 2005 (DDA), and those who have a work-limiting disability. This group is not confined to the economically active or inactive groups.
Disability rate
22.4%
Annual change
0.0%
Around 389,200 people of working age in Greater Manchester are disabled. Whilst the figure is relatively steady over time, the variation between the two groups (those with a health condition or disability, and those with a health condition or disability that affects their ability to work) differs. The number of work-limiting disabled people in Greater Manchester has risen by 1.3%, whilst those who are both DDA and work-limiting disabilities have fallen by 2.4%. In contrast, the UK has a lower disability rate of 20.8%. However, GM and the UK have the same rate of individuals with work-limiting disabilities (3.5%), suggesting that Greater Manchester should be performing at a similar level regarding the employment of economically active disabled people.
DDA DISABLED: 328,800
DDA AND WORK LIMITING DISABLED: 236,500
WORK LIMITING DISABLED: 296,900
1 IN 4 Number of working age women who are disabled or have a health condition that seriously affects their day-to-day lives.
1 IN 5 Number of working age men who are disabled or have a health condition that seriously affects their day-to-day lives.
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Health and Employment Bulletin: Disability and Economic Activity
Economic activity of those with health conditions or disabilities The number of individuals who are economically active (i.e. employed or unemployed), or economically inactive and have a health condition or disability. Some of these individuals have temporary illness, whilst others have a condition expected to last more than one year.
Economic activity rates of individuals with health conditions or disabilities
■ GM POPULATION
■ GM DISABLED
■ GM DISABLED
■ UK DISABLED
The disabled population of Greater Manchester – totalling around 389,200 – is more likely to be unemployed or economically inactive than the total population on average. Whilst this is not surprising, it does indicate that disabled individuals might find it more difficult to find work – the number of disabled unemployed individuals has risen 17.2% over the year, despite a 5.6% drop in overall unemployed individuals. Nearly half (48.4%) are economically inactive, compared to just one in four in the total population. However, the number of economically inactive individuals has fallen in Greater Manchester by 4.6% (9,000) over the last year. Both the economically inactive and unemployment figures may largely be explained by the Work Programme, and the reassessment of individuals claiming health benefits as being ‘fit for work’, or in a ‘work-related activity group’. More strikingly, Greater Manchester falls behind UK figures in terms of disabled employment. Whilst UK disabled employment (49.0%) and economic activity (55.7%) rates are lower than total UK rates (77.0% and 70.8% respectively), Greater Manchester rates are even lower. This suggests that Greater Manchester’s disabled residents are worse off than disabled residents of other areas of the country.
Long-term disability (health condition for over 12 months)
58.2%
7.9%
33.8%
IN EMPLOYMENT
UNEMPLOYED
UK average: 62.9%
UK average: 6.6%
ECONOMICALLY INACTIVE UK average: 30.5%
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Health and Employment Bulletin: Health Conditions and Worklessness
Health conditions A variety of health conditions are monitored on the Annual Population Survey. These are broad groups, not directly linked to the ICD codes. However, they do give an indication of functional disability – e.g. musculoskeletal issues, hearing or sight problems etc.
Health conditions and worklessness IN EMPLOYMENT
UNEMPLOYED
ECONOMICALLY INACTIVE
The data above highlight the difficulties of many individuals with health conditions in gaining employment. Of particular interest is the first group – individuals with mental health conditions, learning problems and nervous disorders. Nearly two thirds of the group in GM (62.6%) is economically inactive, compared to individuals with musculoskeletal issues. Comparatively, across the UK, fewer individuals with mental health conditions and learning problems are economically inactive. Whilst the figure remains over half, at 58.4% this is significantly lower than in Greater Manchester. In addition to there being smaller proportions of inactive individuals across all health conditions nationally, there are also fewer unemployed across all health conditions. Linked to the recognition that just over 1 in 4 economically inactive individuals want a job, this suggests that many of the economically inactive individuals with health conditions could be better supported into employment.
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Health and Employment Bulletin: Benefit claimants
Benefit claimants Benefit claimants represent almost one in five of the Greater Manchester working age population. Many claim income-related benefits as they do not work enough hours or earn enough income to survive. Many also claim health-related benefits as their health conditions impose a high cost on their lives, which can include not being able to get a job. More than four in every five claimants claim an out-of-work benefit, with the majority of these claimants on Employment and Support Allowance (ESA) or Incapacity Benefit (IB). Simultaneously, there is also a large group of claimants in receipt of disability benefits. In total, around 165,000 claimants in Greater Manchester – over half of all claimants – claim a healthrelated benefit. Worklessness and the impact on health services Evidence shows that good work is good for health, and can promote recovery. Conversely, worklessness – where an individual is either unemployed or economically inactive – can lead to poorer health. Yet improving health can give individuals the opportunity to access work. Therefore, health services can support health by helping to return people to work. This all has an impact on the demand for health services. With individuals on benefits and out of work, they are more likely to develop health conditions or experience worsening health that creates added demand on the health system (e.g. long-term unemployment can lead to an increased likelihood of mental health conditions). Changes to the current benefit system The current benefit system and programme of welfare reform has also increased the importance of supporting individuals back to work. Research conducted between 2010 and 2012 showed that GPs are more aware of the need to be actively involved in supporting an individual to return to work. Yet awareness of the benefit system amongst GPs remains poor, and the provision of good local support and advice remained low. At the same time, New Economy has received anecdotal information that benefit changes have resulted in increased use of GP time and resources. These changes have included the introduction of ESA; the associated Work Capability Assessments; and the introduction of the Work Programme. The introduction of ESA ESA took over from IB in 2008 as the main benefit for individuals with a health condition. No new claims for IB were accepted after
October 2008. When applying for ESA, benefit claimants are assessed on their ability to work – a Work Capability Assessment (WCA). At the same time, IB claimants are being transferred to the new benefit by going through the WCA – a reassessment of their needs. The WCA categorises claimants into three groups – fit for work, and therefore placed onto Jobseeker’s Allowance, a non-health related benefit; requiring some work related activity to support them back to work; and requiring support because they cannot work. GPs and claimants have identified that WCAs are a significant reason for visiting a GP. There have been over 330,000 appeals against WCA decisions since the benefit was put in place, with 37% of these successful on appeal. Hence there is a big benefit to individuals to seek the support of their GP for an appeal. The Work Programme The Work Programme is an employment support programme brining together a range of previous programmes into one. Companies (known as ‘primes’) are contracted to help individuals back into work and to help them stay in work. The primes and their subcontractors are paid on results. ESA and JSA claimants are supported by this programme. However, recent figures show that those with health conditions –those on ESA – are significantly less likely to achieve a job outcome. For health services this is important. Locally, primes have found it difficult to engage with health services that can help their clients, lacking the information on how to refer clients and how to access drug, alcohol, physiotherapy and IAPT services. At the same time, information sharing could help to support claimants who access health services already.
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Health and Employment Bulletin: Benefit claimants
BENEFIT CLAIMANTS AS OF NOVEMBER 2012: ESA / IB CLAIMANTS: 143,790
LONE PARENT CLAIMANTS: 27,980
8.2% CLAIMANT RATE -5.5% ANNUAL DECREASE
1.6% CLAIMANT RATE -11.7% ANNUAL DECREASE
INCLUDES ALL CLAIMING EMPLOYMENT AND SUPPORT ALLOWANCE, AS WELL AS INDIVIDUALS STILL CLAIMING THE OLD INCAPACITY BENEFITS
INCLUDES ALL CLAIMING INCOME SUPPORT WHO ARE LONE PARENTS
OTHER BENEFITS: 29,300
DISABLED CLAIMANTS: 21,220
INCLUDES ALL OTHER BENEFITS SUCH AS CARER’S ALLOWANCE AND BEREAVEMENT ALLOWANCE
1.2% CLAIMANT RATE 6.0% ANNUAL INCREASE
OTHERS ON INCOMERELATED BENEFITS: 7,960
JSA CLAIMANTS: 80,570 4.6% CLAIMANT RATE +0.3% ANNUAL INCREASE INCLUDES ALL CLAIMING JOBSEEKER’S ALLOWANCE
INCLUDES ALL CLAIMING DISABILITY LIVING ALLOWANCE, WHO NEED SUPPORT FOR A DISABILITY
0.5% CLAIMANT RATE -9.8% ANNUAL DECREASE INCLUDES PEOPLE RECEIVING OTHER INCOME SUPPORT, INCLUDING FOR A DISABILITY
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Health and Employment Bulletin: Out-of-work benefit claimants
Out of work benefits The number of people claiming Jobseeker’s Allowance (JSA); Employment and Support Allowance (ESA) or Incapacity Benefits (IB); Income Support (IS), especially for lone parents; and other out of work benefits. JSA claimants are economically active and mainly unemployed, though some do work part-time. ESA claimants have a health condition that limits their ability to work, and may be in work, unemployed or economically inactive. Lone parents may be in work, unemployed or economically inactive.
Out of work benefits rate OUT OF WORK BENEFIT CLAIMANTS:
260,300 (14.8%) Annual change: -4.6% Great Britain rate: 11.6%
LONE PARENT IS CLAIMANTS:
27,980 (1.6%)
JSA CLAIMANTS:
80,570 (4.6%)
ESA / IB CLAIMANTS:
143,790 (8.2%)
OTHERS ON INCOME RELATED BENEFITS:
7,960 (0.5%)
The greatest fall in claimant numbers came from the ESA and IB group, which saw a decrease of 8,360 over the past year. This may be due to the re-assessment of IB claimants, as 27% of all IB reassessments have been found ‘fit for work’ and moved off ESA onto JSA. JSA figures have shown an increase over the year of 0.3% (240), partly supporting this. Others may have made a claim for a different benefit, suc as disabled claimants (increase of 6.0% annually), which are not included in out-of-work benefits.
Out of work benefits activity over time United Kingdom North West Greater Manchester Though out of work claimant rates have fallen, against the national figure, the claimant rate remains high. Nationally, the claimant rate stood at 11.6%, compared to 14.8% in Greater Manchester and 14.1% in the North West. This difference has changed little in the past two years.
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Health and Employment Bulletin: Employment and Support Allowance
Employment and Support Allowance Individuals with a health condition can claim Employment and Support Allowance (ESA). Claimants are assessed through a Work Capabilities Assessment (WCA) as to how much their health condition affects their ability to work. There are two ESA groups – those who cannot work (economically inactive) and therefore receive a larger benefit payment (support group); and those who are able to work, but require some support and are expected to complete some work-related activity (work-related activity group, or WRAG).
Health conditions and ESA
As shown in the chart above, the three highest claimant health conditions in Greater Manchester continue to be mental and behavioural disorders, musculoskeletal disorders and non-classified health conditions. Constituting the largest proportion – and at a greater rate (47.6%) than nationally (45.3%) – mental and behavioural disorders continue to be the largest primary health condition experienced by ESA claimants. Over the past year, the change in ESA claimants alone has been dramatic, rising by 73.6% as IB claimants are reassessed. Yet this belies the fact that, overall, IB and ESA claimant numbers have fallen by 5.5%. However, mental and behavioural disorders now account for a greater proportion of ESA claimants than a year ago – rising from 43.7% in November 2011 to 47.6% in November 2012.
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Health and Employment Bulletin: More information
For more information, please contact: Christopher Pope Health and Worklessness Coordinator, New Economy T: 0161 237 4052 E: christopher.pope@neweconomymanchester.com
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