Sheffield's Joint Health and Wellbeing Strategy (see https://www.sheffield.gov.uk/caresupport/health/health-wellbeing-board/what-the-board-does/joint-health-and-wellbeing-strategy.html) has five work programmes, of which Health, Disability and Employment is one. This presentation updates the Board on some work in this area. You can read the accompanying paper at: http://sheffielddemocracy.moderngov.co.uk/ieListDocuments.aspx?CId=366&MId=5651&Ver=4.=

1. Joint Health and Wellbeing Strategy
Health, Disability and Employment
Work Programme Update
Health and Wellbeing Board Public Meeting
27th March 2015

2. Health, Disability and
Employment
Lead officers:
Chris Shaw and
Eve Waite
HWB Leads: Councillor
Julie Dore and Dr Tim
Moorhead
• Maintain health for those in work and at work.
• Reduce incidence of those in work but
struggling with poor health or a disability
becoming off work
• Reduce the amount of time spent in work but off
work and prevent that becoming ‘unemployed
• Reduce the amount of time spent between work
for health or disability reason
• Prevent long periods of unemployment for
health or disability reason
• Increase recognition and use of employment as
a valuable health and disability intervention
• Links to other work programmes
• Baseline report:
https://www.sheffield.gov.uk/caresupport/healt
h/health-wellbeing-board/what-the-board-
does/priorities/work-programmes/health-dis-
employ.html
A quick recap:
Our Ambitions
(March 2014)

3. • Complete delivery of GP Referral Pathway ESA employment Pilot with JCP:
Underway. Aim to move 300 people on ESA into employment
• Deliver Fit Note development between Primary Care and Employers: Changed
– new Fit for Work Service now implemented in Sheffield by Health
Management Ltd. (Maximus) on behalf of DWP - liaison underway
• Deliver Workplace Wellbeing Award: Underway South Yorkshire wide
• Review existing ‘Employment Support: Initial review completed, now
incorporating employment support element of LD review and integrating into
PSTN programme
• Deliver Core Cities agreement: Not completed – due to churn in Core Cities
Director’s of Public Health and devolution effort by Core Cities. Joint meet with
Core Cities Skills and Employment forum 28th April 2015 to agree joint working
within the devolution context
• Hold first Employment Disability and Health Summit: Not done - as joint plans
with CCG and within LD review are not sufficiently clear at this stage. Planned
for Summer 2015
Progress
(as described in March 2014 in red, March 2015 update in black)

4. • Vocational Rehab Pilot with Macmillan completed to enable/sustain
employment for those with or recovering from Cancer
• Supported 300 people to remain in work though periods of poor health via
SOHAS commission
• Provided pathway to employment for people with health conditions via
Pathways to Work commission
• Developed draft ‘local pathway’ into employment as part of Public Sector
Transformation project
Other activity since March 2014

5. How well is the City
performing/what have
we learned?

6. Public Health Outcome Framework
UK Yorkshire and
Humber
Sheffield
108 (i) gap in employment rate for those
with long term health condition
7.1 8.1 8.9
108 (ii) gap in employment rate for those
with LD
63.2 60.8 59
108(iii) gap in employment rate for those
in contact with secondary mental health
Services
62.3 59.7 62.9
109i
Sickness absence-% employees at least
one day off in prev week
2.2 2.3 2.5
109ii % lost working days due to
sickness absence
1.5 1.7 1.8
Source: PHOF, PHE
UK Yorkshire and
Humber
Sheffield
108 (i) gap in employment rate for those
with long term health condition
7.1 8.1 8.9
108 (ii) gap in employment rate for those
with LD
63.2 60.8 59
108(iii) gap in employment rate for those
in contact with secondary mental health
Services
62.3 59.7 62.9
109i
Sickness absence-% employees at least
one day off in prev week
2.2 2.3 2.5
109ii % lost working days due to
sickness absence
1.5 1.7 1.8

7. What would good look like for PHOF measure
108(ii)
(employmentrategapforthosewithalearningdisability)?
55
1535
Current
Employed
Not
employed
65
1525
Upper quartile
353
1237
Best
55
+10
+298

8. What wouldgood look like for 108(iii)
(employmentrategapforthoseincontactwithsecondarymental
healthservices)?
115
1740
Current
Employed
Not employed
189
1666
Upper quartile
299
1556
Best
115
+74
+184

10. Problems with Nationally Commissioned Provision
(broadgeneralisations,neithercategoricnoruniversal
• Connection/understanding between health and employment
systems are not strong (DH/DWP silos)
• The economics of current Work Programme Contracts
(payment rates, periods of support permitted etc.)
• Access to work and work choice lack visibility or local context
• Evidence of ‘what works’ is still being developed
• It doesn’t integrate well with local assets (health trainers,
community infrastructure, existing treatment services etc.
• Investment and payback doesn’t work in Silos
• Net result …. The ESA cohort is not reducing

11. Evidence from the Work Programme
exemplifies the problem
• Work Programme
– The funding model does not appear
to incentivise support for the
hardest to help
– Underperformance results in less
spending per capita on those who
need the most help
– Specialist providers are
underutilised
• Consequences
– Little improvement in life chances
for the individual
– A significant proportion (14.9%) of
Sheffield’s working age population
claiming ESA/DLA remains
economically unproductive
– Increasing pressure on health and
care services at a time of severe
budget reductions
– Failure to impact on rising welfare
costs
Proportions of Work Programme
participants and job outcomes by
payment group

13. Problems with Locally Commissioned Provision(broad
generalisations,neithercategoricnoruniversal)
• Focus on work preparation not acquisition
• Lack of in-work support (including self-employment)
• Waiting lists
• Reliance on relationships/registration with GPs
• Provision has evolved so in some areas competes, whilst in others
leaves gaps
• No follow up for signposting
• Gaps: Autism spectrum disorders, dyslexia, severe MH/LD, LD <18yrs,
transition
• Brokerage with employers is piecemeal and they have little support
• Investment and payback doesn’t work in Silos
• The picture of local and national provision in Sheffield looks like
this ….

14. In work and
well
In work and
managing
condition
In work but
struggling
Employed but off sick
short-term
Employed
but off sick
long-term
Recently become
unemployed
Long-term
unemployed(
over 12
months)
Economically
inactive (
long term
sick or
disabled)
228,000( State of Sheffield) 130,000 days p.a(
Black report).
9,600Fit for
Work press
release)
12,000(SoS 7,000(SoS) 18,0009SoS)
National Fit for Work Service(
potentially 3-4,000 referrals
p.a£500k p.a..
Job Centre
DEA’s
Work Programme( only around
x % of this cohort will find work
Access to work /( adaptive cost beyond reasonable DDA Adjustment) around 300 p.a.
£1mill
Work Choice –to enable a person to find and stay in work ) (approx. 2-300 p.a around 30% will find
work )numbers capped
Residential
Colleges
*SOHAS (300-400 p.a.)£ *Bridge Employment 200 p.a. £k)
*First Step Trust ( café- London Road) 9 into
work £ p.a.
*SCC Internal LD employment support.
*Burton Street Project
Mental Health First Aid *Autism Centre (LS funded )
*Workplace wellbeing Charter 200
businesses target
*JCP/PH ESA Pilot 300+
clients, 1-200 into
employment £250k p.a.
Mindful Employer *SCC non disability ( some specific, some non
specific) Employment initiatives
Pathways to Work, Job Clubs, xxx
*SHSCT Employment initiatives
Increase Access to psychological Therapies (IAPT)(not employment specific ( recovery based) approx. 3-4,000 p.a.£1.5m p.a. )
Primary Care + Mental Health Services
Total local spend of these wrap around commissions = £2-3 M

15. Local
Employment
System proposal
• Dedicated local
approach to supporting
people into work
beyond mainstream
JCP services
• Wrap around public
services to support
particular needs
• Integrated referral
routes for all parts of
public sector (including
GPs, integrated social
care system, keyworker
support models etc).
Employment
Support Allowance
(ESA)
Employment support
for people with
disabilities & long-
term conditions
Cross over with people
with disabilities/LTCs
on ESA
Work Prog 2
discussions
Member-led
MH/LD
project
ESA pilot with
DWP
Work
Programme
co-
commissioned
(2016+)
Near work
Not near
work
Cohorts with
specific issues
(eg. ex-
offenders)
Mainstream JCP support
Short term / current
CYP review of SEN/LD
LD Review
(commissioning)
SY Housing work on
disabilities
• Alignment of
SCC/PH spend
• Brokerage with
employers
• New pathways
Medium term Longer term
Comprehensive Sheffield
approach
• Wider buy-in to new pathway
• Greater alignment of budgets
(CCG, STH, DWP)
• Influencing cultural change in
commissioning of employment
as a solution of long-term
conditions
• Opportunity for a risk and
reward deal to incentivise
delivery and ensure proceeds
of local investment in a more
effective employment system
are reinvested locally.
JHWS: Health, disability
& employment
HWB
SCR Social
Inclusion
Board

16. From what we have learned, what are the
ambitions / success factors now?Need to maintain balance between ‘quick wins’ and longer term ambitions around devolution + welfare
reform
Short- Medium Term-12 months
• combined efforts to improve employment opportunity performance or people with disabilities within
existing ‘system’ HWB to propose a target ?
• Ensure different current pieces of work add value to the overall driver e.g. –Member group, Activity
around SEND changes, Review of LD services, the recent discussions/ agreements in CCG
• Improve brokerage and commitment within employers ( Lead by example?)
• Develop the Sheffield ‘ask’ within the PSTN project for future Employment/ welfare/ health
• Ensure future commissioning arrangements do not continue the ‘un co-ordination’
Medium- Long term 12- 24 months
• Deliver longer term ‘cultural and organisational shift ’ making work a desirable, realisable option for people
with disabilities and health conditions
• Use the momentum to develop a new city wide system for employment/ health and disability where
pathways are clear, commissioning is coherent ( shared?) - this is the driver within the devolution proposals
to be facilitated by the Public Sector Transformation Network.
Observations
• Don’t recreate a local version of national programme
• Recognise issues of scale – (an extra 100 people with LD would put us top quartile, whilst there are 20,000
people on ESA)
• Ensure we maximise strategic linkage and opportunity with PHE (Due North report) Lottery funding , LEP
funding, Skills funding + VCF expertise, work together, across organisations

17. Current Costs

18. Jan Feb March April May June
Commissioning Proposal
Co-design new pathway for MH/LD referral with ASC and
Sheffield CCG Exec
Segmentation of the our MH/LD clients to focus initial activity
Develop costed commissioning proposal using employability
funds and wider SCC/PH investment
Engage Health and Wellbeing Board via health/work discussion
at 26th March meeting
Build activity into longer term CCG commissioning plans
alongside learning from CCG/DWP ESA pilot
Business Engagement
Identify potentially ‘friendly’ businesses to target initially to
deliver some initial wins
Member-led engagement activity with target businesses to
establish initial ‘champions’ and momentum behind the work
DWP/DevolutionDealESAactivity
Discussions to establish on DWP pilot (Sheffield / SCR)
Work Programme 2 negotiations (building on local learning and
pilot activity) ahead of 2015 Election
Engage Government (and next Government) in plans for local
employment system model.

19. A Possible Longer Term System

20. • GPs to refer into the Well To Do Pilot (ESA referral)
• Put ‘weight’ behind ‘Good Employer’ award- joint endorsement with
Chamber of Commerce? – or LEP?
• Actively participate in LEP Social Inclusion and Equalities Advisory
Board and seek to influence investment regarding support funding
(ESIF ) for employment of those with health conditions or disabilities
• Set target for the partners in terms of increasing employment
outcomes (upper quartile by 2016?)
• Actively participate in PSTN group to develop the devolution ask back
to Government in terms of health and disability related employment
provision
• Arrange further discussion by Health and Wellbeing Board reps to
develop the Cities Approach – possibly develop a SCC/ CCG shared
commissioning Strategy for Supported Employment to steer related
commissioning intentions over next 3-4 years
What can the Board do to help or accelerate this
work?