Question for Short Debate
To ask Her Majesty’s Government what steps they will take to promote the Access to Work mental health support service.
My Lords, in this Shakespeare celebratory year, I have been reflecting on the mental health of some of his most colourful characters, and in particular the mental state of perhaps his most villainous king—Richard Ill. Here is part of what he says about his own appearance:
“I, that am curtail’d of this fair proportion,
Cheated of feature by dissembling nature,
Deformed, unfinish’d, sent before my time
Into this breathing world, scarce half made up,
And that so lamely and unfashionable
That dogs bark at me as I halt by them”.
Richard clearly could have done with the help of Access to Work mental health services in view of his very singular and ruthless method of accessing his particular vocation.
The House will be glad to know that that brings me to the purpose of this short debate on how the Government can promote this most laudable service, which seeks to help those with mental health conditions to remain in work, including self-employment, take up a job offer or start a work trial. But before leaving Richard Ill entirely, there is one more point which is relevant. The passage is, of course, from Richard’s opening soliloquy. Richard does not voice his self-loathing when others are present so no one knows about his deep distress. In keeping those destructive thoughts to himself, he has much in common with the vast majority of people with mental health problems today.
The Mental Health Foundation points out that Access to Work will really only succeed when the culture within organisations—whether office, factory, hospital, shop, school et cetera—is more open about, and less stigmatising of, people with mental health problems. This is backed up by a survey of 2,000 people across the UK by the Chartered Institute of Personnel and Development. About half of respondents said that they would not feel confident disclosing unmanageable stress or mental health problems to their employer or manager, and less than half were satisfied at the way in which their employer supported employees with mental health problems.
The Access to Work scheme in general is not well enough known, although things have certainly improved in the past few years. It is run by the DWP through Jobcentre Plus, and provides practical advice and support—mainly at present to disabled people and their employers to help them overcome work-related obstacles. Although help for employees with mental health problems has been available for a few years now, it was only in January of this year that the Government awarded seven contracts to run this particular intervention throughout the country to Remploy Employment Services.
We know that mental health problems account for more non-manual workers being absent from work than any other cause, and the figure is even higher when those with a secondary mental health diagnosis are included. This is well covered in the booklet Models of Sickness and Disability, written by Waddell and Aylward, which looks at the whole picture of common health problems experienced by the working-age population. They say that if current trends continue, within a few years mental health problems will be the main cause of all long-term sickness absence, incapacity for work and ill-health retirement, and will cost the UK even more than the estimated £40 billion to £48 billion per annum that it already costs. We are not talking here about severe conditions such as schizophrenia, but mild to moderate conditions such as anxiety-related or depressive disorders and stress. The authors’ conclusions are stark. They say:
“There is therefore an urgent need to improve vocational rehabilitation interventions for mental health problems. Promising approaches include healthcare that incorporates a focus on return to work, workplaces that are accommodating and non-discriminating, and early intervention to support workers to stay in work and so prevent long-term sickness”.
That is exactly what Remploy’s vocational rehabilitation consultants—VRCs—are trained to do. The key question is: who knows about this service and how do they find out about it? It is entirely a self-referral service for employees, although employers can seek advice. The sort of interventions VRCs might suggest are time management, organisation, planning or communication. Perhaps an employee needs help in making an employer aware of an existing mental health condition and would welcome the intervention of a VRC to help with the disclosure conversation. If the employee consents, then the VRC might talk to the employer about how the condition could be managed without the employee having to take time off. We all know that the longer a person is off work, the harder it is for them ever to return. The sort of changes and workplace adjustments that might be suggested include a change to working hours, flexible working, changes to the work environment, the introduction of a workplace mentor or buddy, or even additional training.
So, are there any downsides to the whole programme? The Mental Health Foundation does not think that the scheme is nearly ambitious enough. The three-year contract will cost £4.8 million and is estimated to help up to 1,600 individuals per year. Mind also believes that the service has the potential to be so valuable that funding should increase and the scheme be much more widely promoted. It also takes the view, and is not alone in this, that assessments and agreement of funding should take place before someone secures a job, so that people can go to an interview with the Access to Work offer in place, and for packages of support to be portable.
I have been conducting my own extremely unscientific survey for a few months now and have discovered that some large firms with HR departments know about and appreciate the scheme, but many smaller employers, even if they have vaguely heard about the original Access to Work scheme, do not know about its application to mental health problems. This comment from a retailer in the north of England with 30 staff bears this view out. He says:
“We are aware of the scheme generally, but would never have considered using it to help someone with mental health problems”.
Another comment, from a firm of accountants with seven employees, was that:
“I would have thought we were too small to use the scheme”.
Here is another comment, from a builder with fewer than 10 employees:
“Wouldn’t a person’s doctor recommend it? Surely an employee would have to be diagnosed with a mental health problem to qualify for help”.
The answer, of course, is no. Here is another comment on a similar theme from a fleet hire company:
“If we did have someone diagnosed medically, I would expect the GP to advise the correct solution”.
That shows a touching faith in the medical profession, which is interesting in view of the report out only today from the LSE, fronted by the noble Lord, Lord Layard, which found that three-quarters of those with depression or anxiety conditions get no treatment. Another employer, with about 40 staff, said that he had never heard of Access to Work at all, and usually got his information about employment matters from ACAS. He wondered whether the scheme would have helped with an employee with an alcohol problem. Yes, it could have helped there.
Finally, I accept that there is a much wider debate to be had about the whole question of health at work, and another about services for those with mental health problems. I hope that the Access to Work scheme will become much better known and prove so successful that it will be able to expand with a much bigger budget in the years ahead. I look forward to the rest of the debate and to my noble friend’s reply.
My Lords, I congratulate the noble Baroness on securing time to raise such an extraordinarily important and practical topic. During almost 30 years in this and another place, I have never ceased to take up opportunities to identify the critical importance of mental health. How excellent it is that so many in this House take this topic seriously.
In their strategy document entitled No Health without Mental Health, the Government made a strong statement on the importance of mainstreaming mental health. We all know the traditional stigma whereby if you had schizophrenia you would say that you had depression and that if you had depression you would say that you had flu, but you would do anything to avoid declaring openly that you were suffering from any form of mental health difficulty. How warmly I congratulate those many Members of Parliament who, in a recent debate in another place on the Mental Health (Discrimination) Bill, were able to discuss the mental health problems that they had faced. Such a debate would have been quite inconceivable when I first became a Member of Parliament. I congratulate them, as I do the many celebrities who use their celebrity status to talk about their own mental health problems, because the first challenge is to get people to talk about this issue which will face perhaps one in four people in their lifetime.
That brings me to the topic of today. I have a very high regard for our Minister. The merits or otherwise of bringing people out of the real world—I am not sure whether banking is the real world—into government are often discussed. What I have noticed about the Minister for Welfare Reform is that he has a forensic, tenacious approach to topics and brings his form of thinking not only to analysing the problem but to finding practical solutions. Ever since his independent report of 2007, Reducing Dependency, Increasing Opportunity, on the welfare-to-work system, he has seized the issues where a practical step can be made. People facing mental health problems lack confidence, lose their skills and feel isolated and stigmatised. Only today, in a reception given in another place for the campaign to fight hate crime, Mencap spoke of people with learning disabilities who are ridiculed, humiliated and made ever more isolated.
I have campaigned over many years on issues such as discrimination against women in the workplace, racism—we still do not have enough of our top managers from ethnic-minority backgrounds—and disabilities of all sorts. In some of the early meetings that I had with many people with mental health problems, I tried to suggest that one of the dilemmas for mental health is that employers do not understand it, particularly when there is a condition that may fluctuate. If you have a broken leg, a cancer or many other conditions, the employee’s behaviour can be predicted and the employer knows how to respond. The dilemma for mental health so often is that, with the best will in the world, the employer simply does not know how they should respond—“Is this going to get better? Is it going to get worse? Should I be sympathetic? Should I be more bracing and challenging? Should I be encouraging? Should I be empathetic?”. What is this all about for somebody who, because of the nature of society, does not understand how to assist for the best?
Here is a practical scheme. I join the noble Baroness in saying how delighted I am that Remploy is responsible for it, because it, of all organisations, has an excellent track record. Again I say that I so admire the way in which the Government set up an initiative and outsource it to an appropriate provider who can take forward practical schemes.
It is quite amusing, when we look at the figures produced so far for the number of people helped by the Access to Work scheme, to note that 580 people had mental health conditions, but that some 4,500 had difficulties in hearing or seeing and that 3,000 people had back or neck problems. The noble Baroness is of course absolutely right that we should do all that we can to ensure that as many people as possible understand this excellent scheme.
How much I commend the other organisations which are beginning to take a part. The noble Baroness mentioned the Chartered Institute of Personnel and Development, but the CBI—another great leader in the employment field—in its Healthy Returns? Absence and Workplace Health Survey 2011, stated:
“Mental health conditions emerge as the single most widespread cause of long-term absence amongst both manual and non-manual workers. When respondents were asked for the five main causes of long-term absence in their organisations … non-work related stress, anxiety or depression emerged as the most widespread health problem”.
Interestingly, that was the case among very many more of the non-manual employees than the manual employees.
There is no excuse for us now not to give priority to this issue. The biggest single reason for claims for incapacity benefit, now employment and support allowance, is mental and behavioural disorders. There are nearly 1 million recipients in that category, accounting for some 40% of total incapacity benefits.
Like the noble Baroness, I hope that more can be done to promote the scheme, particularly among small employers. It is easy for large businesses with global brands, stakeholder relationships and great concern for corporate social responsibility to set up excellent initiatives, but smaller employers often simply do not have the resource and the ability to deliver in practice.
I look forward to hearing the comments of the noble Baroness, Lady Meacher, on her husband’s excellent report for the mental health policy group at the LSE’s Centre for Economic Performance.
My Lords, I, too, congratulate my noble friend on giving us an opportunity to air this topic in such an interesting but also practical and informative debate in your Lordships’ House today. I shall take a practical approach to my questioning of the Minister and to some of the issues which have been raised.
The gateway to the mental health support service, now run by Remploy, is the Access to Work scheme, so it is essential that that gateway is not only open but welcoming. The focus must be on achieving a greater number of people passing through that gateway and a much greater understanding of what that portal means.
Looking at the literature around this whole area, I have found that some people will conflate—though they may treat them separately—learning disability and mental health issues. Will the Minister make it absolutely clear whether this mental health support service is for mental health issues or includes people with certain forms of learning disability?
The ONS figures with which we have been provided show us that only some 500 people were helped by the scheme in the first nine months of the past financial year. We are told, again by ONS, that the number of people who have mental health conditions could be in the region of one in six of our people. You would expect the number of people helped to approach that one-in-six figure, but 580 is just 0.2% of the total, so there has not been a huge impetus in the programme as it stood at the beginning of the year to get more people with mental health conditions into the programme.
The 2009 evaluation of the Access to Work programme states:
“AtW does not appear to be widely marketed and awareness of the programme seems to be fairly low”.
Liz Sayce, in her report entitled Disability Employment Support Fit for the Future, puts it more succinctly, saying:
“Access to Work should be transformed from being the best kept secret in Government to being a recognised passport to successful employment, doubling the number of people helped”.
My final question to the Minister, which I shall put to him again at the end but say it early enough to give him time to think about an answer is: if I were to ask this question in 12 months’ time, what would my noble friend view as being a measure of success? Would it be doubling the number of people who are helped? Would that be sufficient or would my noble friend wish to go beyond that aspiration? To achieve that, we need to raise awareness of the programme.
I need to say just a word or two about the other part of Remploy’s work, which is of course the Remploy factories, which have also been the subject of discussion and debate. It was interesting that only 6% of the employees of the Remploy factories have mental health conditions, compared to a quarter of the people to whom Remploy employment services are giving assistance, so we are looking at a different range of people here. Can my noble friend tell us—assuming that some of the 6% will not need to be in the programme because co-operatives, mutuals or employee buyouts may mean that some of those factories will continue—what special measures have been put in place for them? Are they being transferred automatically and directly to the Access to Work programme, and are they being given additional support beyond that which we now see within the programme?
The second issue relates not to the factories but to the broader workforce, and has already been mentioned: promotion and development of the Access to Work programme with employers and the broader workforce. It is all about perception, is it not? The National Health Service produced a figure that about one-half of people with mental health conditions would feel uncomfortable about discussing them with their employers. That is a slight improvement over the past decade, but the improvement has been very slow.
What can the Access to Work programme do to help employers and the workforce in general to understand mental health conditions and how they should be treated as an illness like any other? How can increased promotion to both employers and the workforce in general take place? In the notion of having the portal—the gate—open and accessible, it is crucial that awareness is raised.
Finally, I ask my noble friend: apart from numbers as a measure of success, is there anything that he would like to see in 12 months time about the manner in which the whole Access to Work mental health support service has been carried out?
My Lords, I, too, applaud my noble friend Lady Thomas for tabling this important debate and for her rather pertinent quote from Shakespeare.
The Department for Work and Pensions indeed has an enormous challenge if it is to condense the vast numbers of claimants of employment support allowance. The objective at one stage was to reduce those numbers by 1 million over 10 years; I do not know whether that remains true today. Perhaps the Minister will correct me if that is not right these days. We know that nearly one half of all claimants have some form of mental health problem. If the department is to achieve any sort of target, it clearly has to make a major impact on the number of people who are not in work because of mental health difficulties.
The noble Baroness, Lady Bottomley, referred to my excellent husband. Perhaps I am allowed to refer to the excellent LSE report issued today, entitled, How Mental Illness Loses out in the NHS. It underlines the challenge for Access to Work as regards mental health. For example, the report points out that among under 65s, nearly as much ill-health is mental illness as all physical illness put together. That is a striking fact. We think of one single physical illness, but mental illness equals pretty much the whole of physical illness, and mental illnesses are, in general, more debilitating than long-term, chronic physical disabilities. I do not think that people fully appreciate that.
As others have mentioned, only one quarter of people with mental illness are in treatment, while pretty much everyone with any kind of serious physical problem is in treatment. It is a completely different landscape. To prepare those sick and untreated benefit claimants requires the DWP to work closely with the providers of improved access to psychological therapy services, because those services are evidence-based. At last, we have evidence-based mental health services; we have never before had effective evaluations. The commission has been given £400 million to roll out increased access to psychological therapy and, by next year, 900,000 people should be receiving those services.
In my view, DWP clients should be at the front of the queue for those services if the Government are to achieve what they hope to. May I be so bold as to challenge the Minister to contact his colleagues in the Department of Health to persuade them of the importance of ensuring that that £400 million is in fact devoted to increase access to psychological therapies and is not diverted to other parts of the system, because the money is not ring-fenced? If the DWP is to succeed, it must have that money spent where it is supposed to be. Otherwise Access to Work as regards mental health will have to pick up the pieces.
Of course, effective treatment is only the beginning for many such clients. The people we deal with need volunteering opportunities, help to improve skills, skilled employment support and all sorts of things which, in the secondary sector, we provide, but there are people not in the secondary sector mental health services who will need some of those services—probably not all of them. Many with mental health problems, unlike physical health problems, will need help once they have gone into a job. That is crucial, and employers and bosses will need some help as well as they do not understand these things. The need for special Access to Work as regards mental health is clear. That certainly came out of the Institute for Employment Studies’ evaluation of the main Access to Work programme. I have to say that its results are dismal. Others have mentioned the figure of 580 people receiving help through the Access to Work programme, compared to 27,000 altogether. One of our colleagues referred to 0.2%, I calculated it as 2%; but anyway it is a very small percentage compared with nearly 50% of all people who suffer from mental health problems.
Access to Work as regards mental health is therefore, as I said, so important, but we have only three offices for the entire country—one office for the whole of south-east London, I read in a document circulated by the Library. The only way to get these services is by a postal system so you have to write. Oh dear. As another colleague mentioned, it is the best kept secret. I talked to some employment specialists in east London who work with these issues all the time. They had never heard of Access to Work mental health. They had just about heard of the main programme, but, as they said, it does not deal with our people; they do not understand our clients at all.
So we have a long way to go. Clearly, the three offices will not touch the problem, if that is still the case today and that was the only briefing that we were given. I put one plea to the Minister. If the DWP really wants to achieve something, it needs one really good mental health specialist in each DWP office and a budget that they can allocate specifically to the personal needs of each individual with mental health problems. Many years ago when I went to Stockholm, Sweden had the lowest unemployment levels of any western European country and they had that budget. That was the key, alongside the skills of the individual.
I know the Minister well understands these issues and I respect his ability to come up with practical solutions, so I hope that he will respond positively to the practical proposal that I have just offered.
My Lords, I too would like to thank my noble friend Lady Thomas for bringing this debate to the Chamber tonight. I know that she feels passionately about this subject. She is ever diligent in making sure that we all keep up to speed with what is happening and she knows when to prod the Government if she feels that more needs to be done.
I have been quite encouraged lately by some of the television advertising that has taken place. It has depicted a situation where people have been away from an employment environment because of mental illness and has shown the way in which they and their colleagues deal with the subject. To have that kind of public information being broadcast on the subject of mental health is a breakthrough and I hope that my noble friend will agree that we need to keep up the momentum with that type of information as it goes to the heart of what we are debating tonight. There is still a stigma attached to mental health, not least in the workplace, and it is important that we ensure that employers and those who work with people who are known, or perhaps just suspected, to have had absences due to mental health problems, learn to understand the condition.
I was rather concerned, as others have been, about the statistics that have been provided for this debate. People have mentioned the Access to Work statistics of only 580 people with a mental health condition. I want to draw the Minister’s attention to the very bottom of that column on page 9 of the statistics, where it says “Other: 3,380”. Perhaps I am being imaginative, but I wonder whether among that 3,380 are people who have mental health problems but perhaps also have another diagnosis as well. Often these very complex, dual or sometimes triple-diagnosed conditions make it more difficult for people to obtain help.
My noble friend will not be surprised to hear me mention, along with mental health conditions, the condition of autism. Although autism is not a mental health condition or a learning disability, it is quite common for people with autism, particularly for the more able people on the autistic spectrum, to have mental health problems and to be under the care of the mental health services. In reply, could my noble friend say whether such people with multiple diagnoses are eligible not only for the Access to Work programme, but also for the very important service that Remploy offers? Remploy’s contract has not been in place long enough for us to evaluate properly just how much of a difference it has made. Could my noble friend share with us tonight what discussions were held around the issuing of that contract regarding expected outcomes, not just numerically but in terms of those people who have not only a mental health diagnosis but other diagnoses as well?
I am sure my noble friend is familiar with the work of companies such as BT. I remember going to a presentation by BT at least three to four years ago, when the work that they had done to create a proactive policy of deliberately recruiting people with a mental health diagnosis was outlined to Members of Parliament. They wanted to make it mainstream throughout the company. It is a big company, but one where the HR department and other employees were trained in how to work with and support people with mental health problems in the workplace.
It seemed to me that it was an exemplar that would warrant some encouragement from the top to take it more widely around other companies and, as we have also heard tonight, the public sector. The public sector is a huge employer of people and if you can do it in BT, I should think you can do it in every government department and agency around the country. If you did that you would cover quite a wide percentage of the population.
We are talking about two areas here: one is getting people into work and the other is maintaining people in work who perhaps have had an absence. A range of conditions come under the umbrella of mental health, but the biggest thing that goes when someone has had a mental illness is confidence. That often happens with due cause because such illnesses can recur. Having had one incident, there is a fear that it will happen again, and that causes people to lose confidence as individuals. The service that Remploy can offer to that group is particularly important.
My Lords, I am very pleased to follow my noble friend Lady Browning. She is an expert in these things, and I agree with what the noble Baroness, Lady Bottomley, said earlier about the expertise available to us in this House.
I do not consider myself to be a great expert in this subject, but I want to say in passing to my noble friend Lady Thomas that I do not know how many sessions of cognitive behavioural therapy Richard III would have needed, but it would certainly have spoilt the plot. She should stop going to literary book festivals, because this is all above my literary pay grade.
Reading up for this debate, the subject really took me back. Some of these statistics are quite startling. I did not realise that the trends had been so dramatic. I think, therefore, that it is something that we as a House and as legislators need to keep a careful eye on, which is why I am so pleased to take part in the debate this evening, brief as it is.
I agree very strongly with Liz Sayce’s report. Liz Sayce is an excellent person. She did an excellent piece of work for the Government, and we are all in her debt, but the bit of the report that captured my imagination and which picks up on what my noble friend Lady Browning has just said is the bit that says that what we really need is confident, well-informed disabled people with confident well-informed employers and an enabling state. That was the essence of where Liz Sayce started from, and I agree with that. Confidence is a very important element in all this.
I perfectly understand that we have come a very long way since the mid-1990s on the role of work, the support that is necessary and the active labour markets. Provision and support for people with disabilities going into work is much more accommodating than it used to be. Of course, there is still a huge amount to do. I just want to point out in passing that we have to be doubly careful about mental illness because we are putting greater pressure on people to go into work. I say that neutrally. We have to be careful because we get into conditionality and there are some real problems with that, because if we do not acknowledge and deal with mental illness we can suddenly find we are penalising people in ways that are contrary to natural justice. There is a real necessity to get this right.
One other point that I would like to put on the table is that I am still not confident we have enough capacity—broadly defined as occupational health experts, the medical profession, specialist services and employment support services—to deal with the explosion of need that we may face if some of these assessments are right. We must think very carefully about that.
I also agree with the point about co-ordinating commissioning services. The noble Baroness, Lady Meacher, rightly said that £400 million is being spent in the health service. The health service people need to talk to the skills people, to employers and to Jobcentre Plus—to all of them. If we do not do that, people will fall through the gaps.
I was interested in what my noble friend Lady Browning said about the public service. The Minister will put me right about this but I do not think that Access to Work is capable of being deployed in the public service. I may be completely wrong about that. If I am right, however, I do not begin to understand why that is not the case if it is true. People in the Civil Service may, the argument runs, have enough employment support and capacity in their own departments to be able to provide an equivalent service anyway, but the Minister would help me enormously if he could clear that up. I may have misunderstood, but if I have not I join my noble friend Lady Browning in saying that public service absence rates are far higher than they should be. We really need to address them as soon as we can.
I will make two final points in the two minutes left available to me. Everyone has said this, but I hope that the Minister takes this message back to the department: raising awareness is key and has to happen. If we are short of budgets, as we always are on these things—no one finds it easy to find money in these straitened financial times—I do not understand why the professionals in Jobcentre Plus and indeed in Remploy, or any others who are actively engaged in this important area of public policy, do not engage employers and deploy the business case for supporting mental illness and reducing absence rates. I have talked to employers in my time who think that absence rates are nothing to do with them. They said that it is for doctors to sort out, which is so old-fashioned as to be positively dangerous. There is a business case, which again the Sayce report clearly makes, that if we get this properly done, well-being can be increased and the public purse can be better off.
My test for the improvement suggested by my noble friend Lord German was whether more Jobcentre Plus people were engaged with more business people—particularly managers, if I can mention them. If you really capture the imagination of managers in their workplace, not only do you deal with the individual case in front of them but the whole workplace can become transformed and it is much better value for money.
Finally, in the weeks and months as we go on, I would like to continue to explore how regional variations pan out, because I deduce from the fact that there are quite big variations in some of these policy roll-outs that best practice is not being shared. That is another thing that Jobcentre Plus could do. This is a very important subject. I confess that I had not realised just how important it was until I started looking at some of these stats. I am sure that the Minister is on the case and very much look forward, as other noble Lords are, to hearing his response to this important debate.
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.
My Lords, I thank my noble friend Lady Thomas, as has everyone else, for raising this important issue. I am grateful for the important and thoughtful contributions from other noble Lords today. I have listened very closely, and I shall take the opportunity to outline how the Government are supporting disabled people into work, especially those with mental health conditions, and in particular how we are promoting the Access to Work service.
I assure noble Lords that I feel very strongly about this issue. Over the years there has been a huge change in how we think about mental health and work. Evidence shows that being in good work generally leads to improved outcomes for people with both mental and physical conditions. Returning to work often has a therapeutic effect. The workplace offers an important opportunity for people to build resilience and to develop social networks and their own mental capital. The Government aim to improve employment outcomes for people with poor mental health by supporting them to gain and sustain employment and to remain in suitable employment, and to ensure that they are treated equably in the operation of the reformed welfare benefits system.
We know that we need to do more. The employment rate for disabled people is just over 46%, compared with an employment rate for non-disabled people of around 76%. For people with mental health conditions, the employment rate is much worse at around 15%. This is a great loss, not least for employers. For example, people with autism—I accept that people with mental health conditions have something else, but this is related—can have exceptional talents and prove a tremendous asset to business. That is why we asked Liz Sayce to carry out a review of specialist employment support, and why we consulted on her recommendations that were published in June 2011. The responses to the consultation strongly supported the idea that money to support disabled people into employment should follow individuals, not institutions, and that government-funded segregated employment is not the way forward for disabled people.
Liz Sayce’s report recommended that Access to Work be expanded so that it can support more people. She suggested measures such as opening it up to internships and making it easier through, for example, an internet portal. On 7 March we published our response, in which we repeated our commitment to protecting the £320 million budget for specialist employment support but to spending it more effectively so that it could support thousands more disabled people into work. In answer to the question from the noble Lord, Lord McKenzie, there is a £15 million increase in Access to Work to help an additional 8,000 people, along with other efficiencies.
We announced in our response that we would accept all the recommendations on Access to Work and that we would work with disabled people to get these right. In particular, we announced the extra £15 million, and we will also recycle money freed from Remploy into Access to Work and other programmes to enable more disabled people to meet their aspirations and remain in work.
My noble friend Lord German asked what I would consider an additional measure of success in 12 months. It basically comes down to an increase in the number of people with mental health issues using the service. As we have sorted out, slightly under the carpet, 2%, even if that is more than 0.2%, is simply not enough.
Over the next 12 months, we will deliver a rolling campaign to build up a strong profile internally and externally with the aim of increasing the take-up from underrepresented groups. In particular we will build operational awareness of the Mental Health Support service. This service was established to allow Access to Work to meet the longer-term objectives of increasing the numbers of customers with mental health issues who gain assistance from the programme. The contract began in December 2011 and is due to run for three years. It offers additional support for individuals with a mental health condition.
In answer to the question from my noble friend Lord German on how it supports individuals, work-focused mental health support will be tailored to the individual. The other types of support that it offers include assessment of an individual’s needs to identify coping strategies; a personalised support plan detailing the steps needed to enter, remain in or return to work; suggestions for reasonable adjustments in the workplace or in working practices; advice and guidance to enable employers to understand mental ill health fully and how to support employees with mental health conditions; and signposting to other external support services and networks.
My noble friend Lady Browning asked about multiple diagnoses. Yes, that is part of this service as long as mental health is a factor in the need for support.
My noble friend Lord German asked whether the focus is on mental health or people with learning difficulties. It is on mental health.
Alongside this we will look at how we can inject more expertise in mental health into the employment support offered by the department. On the Work Programme, which is our biggest welfare-to-work programme, all providers have pledged to develop their expertise to support people with mental-health conditions to find, enter and remain in employment.
In response to the question from the noble Baroness, Lady Meacher, each Jobcentre Plus district has a mental health and well-being partnership manager. We are also looking carefully at how best to bolster the knowledge and confidence that Jobcentre Plus staff have about mental health, including close working with primary care trust mental health counsellors to enable the fast-tracking of customers for counselling.
The Government are considering their response to the health at work review—an independent review of sickness absence—which makes recommendations to help people who can work stay attached to the labour market through periods of ill health, while ensuring those too sick to work receive support quickly.
The review recognises that mental health in the workplace is poorly understood by employers and the public and that much needs to be done to eliminate the stigma. It makes a number of recommendations, including the establishment of a state-funded independent assessment service. The Government are considering their response to the report and will make an announcement in November. My own ambition for this response is that we take advantage of it as a key vehicle to expand medical capacity, particularly in the area of mental health, where capacity is scarce, and to provide support for people who work for smaller companies. I do not think that they will ever get the kind of support that a company such as BT offers, because BT is an extraordinary exemplar in this area. However, we can pull them a long way from the complete lack of support that happens to too many people in that area.
To close, I shall answer one of the questions asked by the noble Lord, Lord McKenzie of Luton, but I shall have to write about the others as there were too many for me to deal with in such a short time. The IAPT programme is being rolled out across England by March 2015.
I again thank the noble Baroness for raising this issue. It is critical because roughly 40% of people who end up in that state or who are on sickness absence have a mental health issue. To get our strategies right for people, we need to get our mental health strategies right.