Context and methodology

UK policy makers have recently piloted a range of new approaches to employability in an attempt to address weaknesses in the performance of standard labour market programmes. New initiatives have sought to address issues ranging from the need to promote retention and advancement for those entering low-paid work to ‘activating’ the unemployed partners of New Deal clients (DWP, 2005, 2006). However, a review of recent strategy documents suggests that two particularly important themes for reform focus on: the development of ‘tailored policies to meet individual needs’ among people of working age claiming incapacity benefits (HM Treasury, 2006: 39); and ‘ensuring that efforts are more effectively targeted at areas of greatest deprivation’ (HM Treasury, 2005: 46).

The introduction of a new Employment and Support Allowance in 2008 will impose more rigorous work tests, restricting access to incapacity benefits to those with severe health problems: an approach that builds upon recently introduced Personal Capability Assessments and work-focused interviews (DWP, 2006). The government claims that this will be balanced by a ‘holistic approach’ (HM Treasury, 2005) providing intensive support for those with mild–moderate health problems. Emerging evidence from the piloting of such intensive services is therefore of considerable interest. Since 2003, Pathways to Work (PtW) has established partnerships between Jobcentre Plus, the National Health Service (NHS) and other health providers in order to take forward this agenda: the initiative's operation in one pilot area provided a focus for one of our case studies.

Successive government strategies have highlighted the importance of measures to combat area-based disadvantage. An emerging Cities Strategy will result in the allocation of additional resources to local authority ward-level areas, with Jobcentre Plus leading the establishment of multi-agency ‘City Consortia’ with a remit to ‘pool resources and expertise in order to tackle unemployment’ in these disadvantaged micro-areas (HM Treasury, 2006: 46). The government has explicitly acknowledged that these neighbourhood-level initiatives will build on lessons from predecessors such as the Working Neighbourhoods (WN) pilot (HM Treasury, 2005). During 2004–06, WN tested new neighbourhood-level approaches in areas characterised by concentrations of long-term worklessness: the initiative's operation in one pilot area provides a focus for the second of our case studies.

By presenting case studies across these pilot programmes and areas, we are able to report on innovative initiatives (involving new forms of inter-agency cooperation) that target different, complex client groups; operate in inner-city and peri-urban environments; and involve leadership from public and private sector bodies. In the case of PtW, the research focused on the piloting of the programme in a mainly peri-urban/urban Jobcentre Plus district in central Scotland. The research involved a review of policy and evaluation documents and six in-depth interviews with: senior regional innovation managers leading Jobcentre Plus's involvement in the development of PtW in the pilot area (two interviews); a regional Jobcentre Plus operations manager involved in planning its delivery; a regional project director who led NHS involvement in PtW; a mental health project manager involved in delivering (and managing other NHS staff involved in the delivery of) PtW; and a senior NHS rehabilitation coordinator involved in the delivery of services. Interviews were undertaken during two case-study visits, first to the relevant Jobcentre Plus office, and then to a health centre providing the base for NHS services delivered under PtW.

In the case of WN, a review of policy and evaluation documents was supplemented by case-study research in one of the pilot areas, located in a major English city, where the delivery of the programme was led by a subsidiary of a large private sector employment and training agency. In addition to a review of local strategy and management documents and outcome data, the case-study research involved four in-depth interviews with: the CEO and a senior company manager within the WN Lead Partner; the Lead Partner's national director for welfare-to-work services (who was previously closely involved in the development of services in the case-study area); and the local project manager leading the delivery of the WN pilot. Interviews were undertaken during two case-study visits, first to the Lead Partner's main regional service centre, and then to the ‘Local Advancement Centre’ facility that provided the base for WN services in the pilot area.

Pathways to Work

Pathways to Work was piloted in seven delivery areas from 2003, and rolled out to a further fifteen areas across the UK in 2005–06. Target areas were selected on the basis of their relatively high numbers of claimants on long-term incapacity benefits (Incapacity Benefit and its means-tested social assistance equivalent, Income Support). The government has described PtW as offering ‘a new intervention regime to activate people's aspirations to return to work’ (DWP, 2004a: 16): the first step in a process of activating the incapacity benefits regime in order to ‘focus on what people are capable of doing’. All new claimants of incapacity benefits (and in some areas those who started claiming during the two years preceding the introduction of the programme) are eligible. The programme rolls out to more than 30 districts across the UK from 2007–08. The content of PtW includes:

• • a compulsory assessment interview, followed by five compulsory work-focused interviews with Jobcentre Plus PAs;¹

• • voluntary access to short ‘Choices’ training options (for example, ‘work preparation programmes’ that provide basic employability skills and preparation for the workplace, delivered in partnership with training providers and employers);

• • a one-year ‘Return to Work Credit’ paid at £40 per week tax free for full-time work;

• • access to a PA Discretionary Fund;

• • a Condition Management Programme (CMP): a six to thirteen week voluntary intervention designed to enable clients to cope with the main ‘moderate medical conditions’ experienced by Incapacity Benefit claimants (mental health, cardio-respiratory, and musculo-skeletal conditions). The CMP is not designed to replace standard health care interventions; rather it uses ‘cognitive behaviour therapy’ and related techniques to challenge negative attitudes and help clients to learn to cope with conditions in such a way that they may return to some form of employment. In the study area – and in many other pilot areas – CMP services are entirely delivered by NHS Allied Health Professionals (AHPs), such as occupational therapists and physiotherapists, or by mental health nurses, who are highly trained in CMP.

The rationale informing PtW can, to some extent, be seen as reflecting Work First thinking. Throughout, NHS and other delivery partners have been reminded that progressing clients towards work, rather than treating their medical problems per se, is the objective of the programme. NHS professionals acknowledged that the ‘classic, medical model’ of diagnosis and treatment has been replaced (for the purposes of this programme) by a more proactive approach that concentrates on what the individual is capable of achieving. A senior health practitioner emphasised how AHPs have been challenged to modify standard practice, to ‘de-medicalise’ their interactions with clients.

While clearly quantified job entries are not part of the programme targets regime for the CMP, Jobcentre Plus staff managing the overall PtW initiative are required to promote sustained employment as the ultimate objective for all participants. It was acknowledged that some health professionals have been concerned by the different objectives associated with a programme that focuses on helping people cope with ill health in a work setting, rather than eradicating the health problem first. While occupational therapists – who make up the majority of CMP staff in the study area – have been understandably more comfortable with this work-focused model, some other AHP professional groups initially voiced concerns about the potential danger of pushing clients towards work ‘too soon’. NHS professionals interviewed for the research suggested that these concerns have been allayed, to some extent, by the absence of compulsion in the CMP, and by the quality of provision that CMP teams have been able to develop. Research with CMP practitioners involved in other PtW pilots has produced similar findings (Barnes and Hudson, Reference Barnes and Hudson2006).

There are also some Work First elements in the PtW intervention model. The work preparation programmes that form an important element of the PtW Choices training provision offer a familiar combination of short-term employability-raising measures, which, in many cases, will have a limited impact on clients’ longer-term skills development. As with many other UK labour market programmes, the focus is on inserting the jobseeker into available (often entry-level) opportunities, and there was some acknowledgement among Jobcentre Plus stakeholders that closer partnership working with employers may be required if harder-to-reach clients are to be supported while in work (not currently a major focus for the programme). In this sense, the relationship to the labour market articulated through the programme is, so far, demand-responsive; PtW seeks to insert clients into existing positions rather than supporting the individual in the workplace, challenging employers’ perceptions of such clients or delivering opportunities for career progression.

PtW also maintains a link to the ethos of Work First through a relationship with individuals characterised by a combination of compulsion and financial incentives. Mandatory work-focused interviews remain a central element of PtW. Furthermore, a compulsory Personal Capability Assessment (a medical examination) must be completed with PtW clients within twelve weeks of a benefit claim. By deploying a series of quantitatively assessed health checks, the Personal Capability Assessment provides a ‘score’ reflecting clients’ work fitness: those assessed as capable of work will see their benefit claim terminated. National evaluations of PtW have noted that improvements in clients’ health have in some cases been identified during delayed Personal Capability Assessments, and used as a basis to terminate benefit claims: ‘a particular concern amongst some Incapacity Benefit Personal Advisers was that where medicals were taking place later than when they were supposed to, customers were failing because they had been significantly helped by services such as the CMP’ (Knight et al., Reference Knight, Dickens, Mitchell and Woodfield2005: 95). Barnes and Hudson's (2006) evaluation research also notes the difficulties in regaining the confidence and commitment of returning clients who have had their benefits terminated following a Personal Capability Assessment. PtW has been presented to both clients and service delivery partners as not being about ‘forcing people off benefits’. The use of Personal Capability Assessments to ‘fail’ clients’ benefit claims therefore has the potential to undermine trust in the programme. Finally, the programme's main approach to supporting people in work is financial: a Return to Work Credit enabling clients to consider lower-paid jobs.

Despite these familiar Work First elements, there is again evidence of investment and innovation towards a more HCD approach. For example, PA advice services are central to Jobcentre Plus's delivery of the programme, and pilot area managers suggested that the re-engineering of these services (and retraining of PAs through a two-month intensive development programme) had produced more flexible and individualised adviser services.

It is important that such claims are critically assessed, and extensive evaluation data are not available at the time of writing. However, early qualitative research with clients has been positive, suggesting that PA services – if focused on individuals’ needs and provided by skilled staff – can deliver high-quality support (Corden et al., Reference Corden, Nice and Sainsbury2005). Any renewal of Jobcentre Plus's commitment to delivering high-level PA services is to be welcomed.

Crucially, the CMP element of this PtW pilot marks a step change in Jobcentre Plus's approach to programme development and delivery, and a shift towards a more holistic, HCD-focused intervention model. Jobcentre Plus has formed a partnership with the NHS, which has the expertise to implement effective occupational health services, building credibility and trust with clients. At the outset of the partnership, Jobcentre Plus agreed to replace its rigid contractual model with more flexible financial structures, allowing NHS managers considerable freedom in the recruitment of staff and resourcing of programme development. The emerging programme is flexible, but takes the principles of cognitive behaviour therapy (CBT) as its starting point. A combination of cognitive and behavioural therapies are used: the former help the client to understand their behaviour in terms of their beliefs, and to dispute and expose irrational beliefs; the latter seek to address problem behaviours, for example by teaching stimulus control techniques, or gradually helping the individual to challenge perceived risks, in order to build confidence in their ability to cope with employment.Footnote ²

NHS professionals involved in the delivery of PtW pointed to the increasing credibility of CBT approaches among clinicians, which has helped to build trust in the quality and coherence of the CMP model among those AHPs charged with its delivery. A senior rehabilitation specialist involved in the delivery of PtW noted that ‘there is a strong evidence base on CBT’, that has helped to gain the ‘buy-in’ of NHS managers by demonstrating the value of the CMP in terms of delivering health benefits.

The CMP seeks to assist clients to make gradual progress towards managing their own condition: clients’ personal development was clearly seen by NHS professionals as a key target and outcome alongside progress towards work. Research conducted in other pilot areas has noted the range of benefits delivered by the CMP:

Evaluations of PtW have acknowledged the inherent limitations of the CMP approach: CBT and related therapies will be inappropriate for some clients (a point fully acknowledged by NHS professionals participating in our case study) and particularly those with severe or chronic problems (Corden et al., Reference Corden, Nice and Sainsbury2005); and the vulnerability of even those willing to participate means that attendance and completion rates can be variable (Corden and Nice, Reference Corden and Nice2006). Nevertheless, for those able to participate and willing to ‘buy in’ to CBT-type approaches, there appear to have been benefits (Barnes and Hudson, Reference Barnes and Hudson2006).

Finally, in the case-study area, one senior health professional pointed to the particular value in basing the CMP within the NHS, due to the wealth of professional expertise both within and beyond the core team of CMP staff.

As noted above, there have been cases where some of the most progressive, HCD-oriented aspects of piloted labour market initiatives have been replaced by cheaper, Work First content once programmes have been rolled out nationally. There remain concerns that, without the expert (but admittedly resource-intensive) contribution of NHS professionals, the high-quality provision established by some PtW pilots will not survive the programme's continued expansion (Barnes and Hudson, Reference Barnes and Hudson2006). Recent government announcements that ‘future PtW provision will be delivered primarily by the private and voluntary sectors, with payment by results’ (HM Treasury, 2006: 43) mean that two key factors in the success of this PtW pilot – the capacity, expertise and credibility brought to the programme by the NHS; and relative freedom from the rigid contractualism that characterises most government labour market programmes – are now under threat. Furthermore, programmes that reward providers for achieving quick job entries may assist those with mild incapacities who are near job-ready, but are unlikely to deliver the intensive support required by the more disadvantaged. It suggests a ‘peeling the onion’ approach, where those easiest to support into employment are assisted immediately, before progressively targeting those requiring more assistance, but potentially leaving behind the hardest to help.

This PtW pilot may represent a move towards a more holistic, HCD-oriented approach. The re-engineered PA services provided by Jobcentre Plus seek to acknowledge the complexity of the barriers faced by clients. Choice is a feature of the more structured employability options within PtW, and although these have tended to reflect the fairly standardised services available through other programmes, there are some examples of innovative practice (for example, in the piloting of intensive ‘work hardening’ programmes that offer clients experience within a supported work environment). The CMP also represents an important development. Jobcentre Plus has empowered NHS professionals to design and deliver this voluntary element of the programme, which offers expert therapeutic support for clients. Although the CMP targets work as a final objective, its emphasis on gradual progression and one-to-one support (delivered by health professionals) reflects a more sophisticated attempt to deliver personal development and coping and enabling skills, and a more HCD-oriented approach to reducing the numbers dependent on incapacity benefits. The proposed reduction of NHS inputs into PtW, and the imposition of rigid contracting out based on job entry targets, may undermine these important gains.

An emerging HCD approach?

The UK government has described its employability strategy as being based around Work First. Critics of Work First will argue that there is indeed much that is familiar in the PtW and WN pilots. The rationale for both programmes is that facilitating a quick return to work should be central to the aims of employability interventions. As with previous UK programmes, the target is to assist people to move into (often relatively low-paid) jobs that are easily accessible to them. Work-focused interviews and structured job search activities are central to both pilots’ intervention models, although it is notable that under PtW only work-focused interviews and related activities are compulsory (training and therapy options are voluntary), and there is a commitment to administering clients’ benefit claims before requiring activity from them. The extensive use of work-focused interviews under WN (combined with the fast-tracking of clients on to structured employability programmes) is more reminiscent of the kind of Work First seen in the US and now the Netherlands, where immediate compulsory activity is viewed as both an effective early intervention and a means of deterring benefit claims.

The longer-term skills development activities that characterise HCD approaches to employability were not prioritised in the case studies. In both cases, the work-focused services provided for jobseekers, excluding CMP services under PtW, followed a fairly familiar model of pre-vocational and job search assistance: measures to prepare jobseekers for (and support their progression towards) higher-skilled employment remained under-developed. An apparent reluctance to invest in training-based employability provision and to engage employers in the delivery of long-term training for the unemployed seems to have again found expression in both pilots. In their relationship to the labour market, both pilots adopted a demand-responsive approach, seeking to place clients into existing positions, rather than prioritising longer-term career progression or in-work support. In their dealings with individual clients, both pilots reflect the government's strategy of combining benefit sanctions to enforce cooperation with measures to ‘make work pay’ (that is, help people to cope with low-paid work).

However, other aspects of both pilots also suggest some progress towards an HCD-oriented approach. The development of high-quality PA services was a priority under both pilots, and evaluation data from elsewhere within the same programmes indicate that clients generally valued their engagement with PAs, which compared favourably with standard Jobcentre Plus services. The delivery of improved PA services – to offer one-to-one support and channel clients towards appropriate provision – therefore appears to be one HCD element shared by both pilots.

Furthermore, the CMP element of PtW, using established cognitive behaviour therapy and related techniques, represents an innovative approach that can deliver health, employability and quality of life benefits. By sharing the responsibility and resources for programme development with the NHS, Jobcentre Plus managers in the pilot area were able to produce a high-quality intervention based upon credible therapeutic principles, delivered by skilled health professionals. The CMP is not an HCD programme in the traditional sense – it does not deliver vocational skills – but it has the potential to impact positively on individuals’ employability by delivering the coping skills required to deal with mild-moderate health problems (in turn empowering individuals to develop and apply vocational skills more effectively). For many claimants of incapacity benefits, these coping skills can be the crucial element in a process of personal development towards a return to work. WN interventions were less intensive, but attempted to address a broad range of the barriers to work faced by many jobseekers, such as debt, health and childcare problems.

UK employability policy has retained strong Work First elements, reflected in its reliance upon compulsory work-focused activity and the relative weakness of vocational training. However, with the introduction of New Deal and recent pilot programmes there have been some improvements in the quality of services for jobseekers: ‘[the government] has increased very substantially the resources available for training and advice, developed much more sophisticated and precise policies for specific groups of unemployed people and . . . pursued policies to increase incomes for the low-waged’ (Taylor-Gooby et al., Reference Taylor-Gooby, Larsen and Kananen2004: 579). Our case studies suggest that the extension of welfare to work to new client groups, and the intensification of compulsory activation in certain local areas, appears to have been tempered by the introduction of new approaches with a greater emphasis on some aspects of personal development and HCD.

Implications for policy

Improving the employability of people excluded from the labour market requires action to address a range of individual problems, adverse personal circumstances and external barriers to work (McQuaid and Lindsay, Reference McQuaid and Lindsay2005). If standardised Work First approaches are to succeed, they need buoyant labour market conditions, and jobseekers to be relatively near job-ready. Employability service providers are instead increasingly faced with multiply disadvantaged client groups, requiring more holistic, HCD-oriented services. Our case studies do not provide conclusive evidence of a shift towards a coherent, HCD-oriented approach in the UK, but they suggest continued progress towards a type of hybrid system: one where Work First compulsion is combined with ‘coping and enabling’ services that promote some forms of HCD.

However, the progress made under these pilots is threatened by proposed changes that will re-impose contracting mechanisms that reward ‘quick wins’ and favour certain types of provider; once again, the benefits reported by innovative pilots may be lost to the rigid contractualism and centralism that characterises too many UK labour market initiatives. Furthermore, during mainstreaming, many of the HCD components targeted at the disadvantaged may be lost in the shift towards a more Work First approach targeting those easier to place in employment. Similarly, those who would benefit from more intensive, and expensive, HCD-orientated support and training may be moved into work first with little support to access suitable training and development before or after they enter employment.

Meanwhile, current employability services continue to fail many among the most disadvantaged. With the rollout of PtW, some of those with mild-moderate health problems will be assisted to move towards work, but there is a need for more intensive and in-work support for people with limiting long-term illnesses and disabilities. Despite the proposed piloting of City Consortia, which share some features with WN, there has been little concerted effort to address the geographical disparities in the performance of programmes such as the New Deal, disparities that can often be traced to continuing weak demand and area-based social exclusion. And crucially, the approaches discussed above are limited to specific client groups and areas, while major employability programmes such as the New Deal are required to deal with often severely disadvantaged clients using an increasingly standardised, short-term intervention model. The result, as noted above, is declining job entry rates and the increasing ‘churning’ of repeat participants between periods of unemployment, New Deal activity and low-quality, short-term jobs. Despite these problems, there remains a reluctance to move beyond short-term piloting of ‘special programmes’ for the most disadvantaged towards an adequately resourced national model providing holistic support and HCD for all clients. Policy makers point to the UK's relatively low spending on activation as evidence of the New Deal's efficiency (DWP, 2004b), but it is an expected consequence of a failure to offer the long-term education and training that would benefit many disadvantaged adults.

Finally, there has been limited progress towards the kind of well-resourced, vocational training that is arguably the cornerstone of any genuinely HCD-oriented labour market strategy. There is a need for a comprehensive approach that builds upon the (to some extent) HCD-oriented provision introduced through recent pilots, in order to: address the needs of those economically inactive people with health and other problems who want to work; target a combination of supply- and demand-side strategies in disadvantaged areas; and provide HCD (and the time and space for personal and skills development) for those with multiple barriers to work. Policy makers can act to encourage the development of such a model: more flexible funding mechanisms and targets that reward both the sustainability of jobs gained and the ‘distance travelled’ by clients during the process would promote a wider range of better quality outcomes. In general, more flexible governance and funding structures appear to have helped to facilitate the relatively holistic approach developed by both pilots discussed above. Freed from the micro-managed contractualism that has come to characterise the governance of UK labour market policy, delivery agencies would be better able to create innovative, client-centred interventions based on partnerships with specialist providers.

At the most basic level, policy makers must accept that Work First works for some but not all jobseekers, and so promote the development of more intensive, longer-term, HCD-oriented provision. If UK policy makers are to reconcile Work First and HCD approaches to employability, compulsory work-focused activity must be balanced by both a strengthening of holistic ‘coping and enabling’ services, and a commitment to credible, high-quality training that can deliver sustainable transitions to work and career progression.