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The challenge

At around 30% points the UK has amongst the largest disability employment gap of any advanced economy. Around 75% of Universal Credit benefit recipients in the UK have health-related barriers to work and most wish to be in employment. However, for over two decades unemployed people with health conditions or disabilities have suffered from markedly weaker employment outcomes and support experiences within the UK’s employment support interventions. This is despite such groups being a policy priority for governments of all stripes within labour market activation programmes throughout that period.

What we did

Whitworth’s impacts rest on a body of critical and empirical research over many years that form the foundation of his policy activities and impacts. His research is applied in nature in terms of its orientation around priority policy challenges as well as its collaboration with policy partners through advisory work, codesign, consultancy and embedded secondments.

What impact we made

Supporting effective design of Department for Work and Pension’s (DWP’s) national Work and Health Programme

Since 2019 the c£600 million voluntary Work and Health Programme (WHP) has been one of Great Britain’s main contracted-out national employment support programmes. Within WHP payment-by-results was again DWP’s key performance lever through which to seek to drive employment outcomes, taxpayer value-for-money and positive service user experiences. Seconded to DWP in 2015-16, Whitworth was embedded into DWP’s key teams responsible for WHP’s participant identification and payment model.

Regards participant identification, a critical need in any public policy is to identify and refer the right individuals for the programme designed. In WHP this is essential since key programme features including funding per participant, delivery model, support services and provider performance targets were all designed with a specific cohort in mind – unemployed individuals with health conditions or disabilities who have a reasonable prospect of moving into paid work with additional intensive supports. Whitworth’s research expertise in statistical profiling and segmentation helped shape DWP’s approach to participant identification in WHP.

In terms of the payment model, Whitworth’s research was influential to DWP’s decision not to attempt to incorporate different payment groups and payment levels into WHP because of their problematic roles in the predecessor Work Programme that appeared perverse to DWP’s programme objectives around performance, user experiences and value-for-money. Whitworth’s research here was cited in DWP’s official impact evaluation of Work Programme and as a central piece of evidence in WHP’s design recommendations. Whitworth’s research was also influential as part of the case for the inclusion of secure service fees within the WHP funding model.

 

Leading evidence-based codesign of the world’s largest ever trial of Individual Placement and Support (IPS)

From 2016-2018, Whitworth led the codesign of Sheffield City Region’s (SCR) modified IPS health-led employment trial (HLT) during his extended secondment to SCR. The HLT is a randomised control trial and flagship national policy of the DWP-DHSC joint Work and Health Unit (WHU) to transform employment support for individuals with health conditions across the UK. IPS is a well-evidenced model of employment support for individuals with severe mental health conditions. The HLT is the world’s largest IPS trial (c£20 million, c15,000 service users) and innovatively modifies the traditional IPS model for new cohorts, settings, functions and volumes. Specifically, unique IPS features designed into in SCR’s HLT are its expansion to a low to moderate mental health and/or physical health cohort, its expansion to an in-work cohort at risk of sickness absence, and its co-location with wider primary care teams (e.g. GPs, physios, IAPT mental health teams) and community services.

Informed by his research around IPS specifically and employment programme design more broadly, Whitworth led protocol development, codesign, fidelity modification, costings and profiling. The HLT has successfully transformed experiences and outcomes for this key cohort. At October 2020 the HLT had supported 3010 service users in total across SCR: 1800 unemployed individuals of whom 33% had successfully been supported into paid employment and 1210 employed individuals at risk of sickness absence of whom 76% had successfully sustained their employment. For the unemployed cohort the HLT’s 33% success rate compares to a 10% ‘business-as-usual’ rate seen across Jobcentre Plus (note not in the HLT control group). This equates to an expected Treasury gain in reduced benefit spend and increased tax take of around £6.3 million over 5 years. If HLT were rolled out nationally across Great Britain’s 2 million Employment and Support Allowance (ESA) claimants then equivalent performance would result in a net increase of around 466,666 unemployed individuals supported into employment and a net Treasury benefit of around £7 billion over 5 years compared to ‘business-as-usual’.

Publications

1. James Rees, Adam Whitworth, Elle Carter (2014) Support for All in the UK Work Programme? Differential Payments, Same Old Problem. Social Policy & Administration, 48(2)
2. Carter, E & Whitworth, A (2015) Creaming and parking in quasi-marketized welfare-to-work schemes: designed out or designed into the UK Work Programme? Journal of Social Policy, 44(2)
3. Whitworth, A (2018) Mainstreaming Effective Employment Support for Individuals with Health Conditions: An Analytical Framework for the Effective Design of Modified Individual Placement and Support (IPS) Models. Social Policy and Society, 18(4)
4. Whitworth, A (2018) The economic case for well-considered investment in health-related employment support: Costs and savings of alternative modified Individual and Placement Support (IPS) models. Disability and Health Journal, 11(4)
5. Whitworth, A. and Carter, E. (2017) Rescaling employment support accountability: From negative national neoliberalism to positively integrated city-region ecosystems. Environment and Planning C: Politics and Space, 36(2)
6. Whitworth, A and Murphy, R (2018) Local integration: harnessing the potential for public policy. A report by the University of Sheffield in collaboration with the Mayoral Combined Authorities and Core Cities. Sheffield: University of Sheffield.