Mental Health: Access to Work Support Service

Lord McKenzie of Luton Excerpts

Monday 18th June 2012 Lords Chamber

[Lord McKenzie of Luton]

My Lords, I add my thanks to the noble Baroness, Lady Thomas, for securing this debate, which is especially timely given the report released today by the Centre for Economic Performance’s mental health policy group, to which I think every noble Lord has referred. It very much sets the context for our debate by pointing out the massive inequality in the NHS in the way in which mental illness, as compared with physical illness, is treated. It also stresses, as the noble Baroness, Lady Meacher, said, the importance of completing the national roll-out of the Improving Access to Psychological Therapies programme.

We know that the costs of poor mental health are huge: costs to individual businesses in absenteeism and presenteeism and costs nationally in lost output and tax revenues and increased benefits, but costs to individuals in the aspirations blunted, the careers interrupted, the income lost and the social interactions diminished. We know that around 10 million people in the UK are affected by a mental health condition at any time. The Centre for Mental Health suggests that only about a quarter receive any treatment and that only about 19% of people with a mental health condition are in employment. In response to Dame Carol Black’s review of the health of Britain’s working-age population, the previous Government acknowledged the need to create a new perspective on health and work, that being in work is in general good for health, and that worklessness leads to poorer health. This is as much the case for mental health as for physical health and is, I believe, an agenda that is shared with the coalition Government.

We know that poor mental health is the main cause of absence from work and that with the right support individuals can be productive and fulfilled employees. This strand of thinking led to the piloting of the placing of employment advisers as a core component of the IAPT programme. Perhaps the Minister could give us an update on this. Before this evening, someone—I cannot recall who—referred to Access to Work as one of the previous Government’s best kept secrets, and we did not have many. The opportunity to shine some light on it, especially the newly commissioned service, is therefore to be welcomed. I think the noble Lord, Lord German, referred to the 2009 DWP evaluation of the programme as it was then organised, before the business model for delivery was changed. As he said, the evaluation concluded that awareness of the programme was patchy among Jobcentre Plus staff and that there was no evidence to suggest that customers found out about the programme in any systematic way, so the question posed by this debate is very relevant.

We know that this is currently a very difficult labour market and that this will continue for some time to come. Addressing the challenge that this presents for those with a mental health condition has been and will continue to be a recurring theme of our deliberations around welfare reform: the descriptors for the WCA; the fit for work, WRAG and support group determinations; the Harrington changes; the application of universal credit; and the Work Programme. In all this, the application of Access to Work for people with mental health conditions is of course to be welcomed. By definition, it applies to those who are in or close to the labour market. To get support, an individual must be in paid employment or have a confirmed start date, and the support must be needed when starting a new employment to reduce absence from work or to stay in work. The support is further available for the self-employed and for those about to start a work trial. As we have heard, the service has been contracted to be delivered by the vocational rehabilitation arm of Remploy.

If I may, I have a few questions for the Minister’s forensic approach. According to the specification, the indicative numbers for the service over the three-year contract period are between 0 and 1,615. Contrast this with the data for Access to Work as a whole, which identify 35,000 people having been helped in 2010-11 alone, of whom over 13,000 were new customers. Contrast it also with plans to make 1,500 people compulsorily redundant from the closure of the first wave of Remploy factories. If the numbers for the mental health service are realistic, that suggests just a scratching of the surface. Where will the funding come from if the take-up is to be higher?

What will the funding be for Access to Work for the current spending review? What additional resources are being made available for the new mental health service? There is seemingly a switch of funding amounting to some £15 million from the Remploy closures, but it is not clear how this is to be allocated. Under the specification, the support to be provided is limited to a maximum period of six months for any individual referral. Clearly we recognise the need to deploy limited resources in a targeted way, but given what we know, particularly about fluctuating conditions, will the Minister explain why this precise cut-off is used? How does this sit alongside the Work Programme? Is there a route for those on the Work Programme to be referred for support under this programme or indeed the existing Access to Work arrangements? If so, who bears the cost?

The contract with Remploy has been running for just six months, so these are therefore early days, but if there are any data on take-up and outcomes so far it would be helpful to know them, including the extent to which, under the right to control, customers have availed themselves of providers other than Remploy.

We welcome and support the new service, which will help some to access and some to retain mainstream employment. It is a small but important step.