Impact case study database

Whitworth’s research has transformed policy understanding, and the design and effectiveness of health-related employment support policies in the UK at national and regional levels.

National policy impacts in the UK

Enhancing policymakers’ understandings of programme design

Since 2019 the £600 million voluntary Work and Health Programme (WHP) has replaced the Work Programme as Great Britain’s main contracted-out national employment support programme. DWP’s key performance lever in WHP was a payment-by-results model through which to drive employment outcomes, taxpayer value-for-money and positive service user experiences. From 2015-16, Whitworth was seconded to the DWP and embedded into DWP’s two key teams responsible: firstly, for the WHP participant identification and segmentation tool and, secondly, for WHP’s payment-by-results model. Whitworth guided the team through the key considerations, led team design workshops, and input to senior submissions. Whitworth’s impacts on WHP design were both general and specific. As the DWP Lead Analyst responsible for the WHP payment design summarised: “Adam’s expertise in segmentation and payment-by-results across similar international contracted employment programmes provided an invaluable evidence base and guidance to our thinking” [S1].

Beyond guiding DWP’s overall understanding and thinking in these design teams, Whitworth’s impacts were central to shaping three specific elements of the WHP design:

1. Identifying the right unemployed individuals for the programme

The WHP is designed with a specific cohort in mind - unemployed individuals with health conditions or disabilities and who have a reasonable prospect of moving into paid work with additional intensive support. Therefore, it is essential that the correct individuals are identified and referred to the programme. If they are not specific, key features of the WHP, including funding per participant, delivery model, support services, and outcome targets on providers cannot be realised. Whitworth’s research expertise in statistical profiling and segmentation [R2] was central to shaping WHP’s final design, including the development of WHP’s Identification Tool to select appropriate referrals from Jobcentre Plus into WHP. Whitworth provided expertise around profiling and segmentation and various profiling options. In addition, he recommended and advised on the incorporation of knockout questions to exclude referrals clearly outside of the target cohort as well as scoring questions to then prioritise the most appropriate referrals of those remaining. Both were incorporated into Identification Tool used by the DWP. As the Head of Health Provision, Change and Design at DWP summarises: “ His recommendations around priorities and a proposed design approach for the Identification Tool to achieve them was influential in shaping our thinking and impacted directly on its final design and operation in Work and Health Programme” [S2].

2. Payment-by-results design: avoiding the previous pitfalls from differential pricing

Whitworth’s research [R2] identified that incorporating different payment groups and levels into the Work Programme created perverse incentives and ‘parking’ risks and, as a result, undercut DWP’s outcomes, user experiences, and value-for-money objectives. His findings were key to DWP’s decision not to attempt to incorporate these different payment groups and levels into WHP. Whitworth’s research [R2] was cited to this effect in DWP’s official impact evaluation of Work Programme [S3] and as the central piece of research evidence in the design team’s key recommendation to DWP’s Senior Programme Board to avoid payment groups and differential pricing in WHP [S4]. This recommendation was accepted and WHP therefore avoids problematic differentiated payment groups. As the DWP Lead Analyst summarises: “Adam’s research into the weaknesses of the Work Programme payment model, and his knowledge of the limits of DWP’s administrative data for profiling, was key to our recommendation…and fed directly into shaping the eventual payment-by-results design” [S1].

3. Introduction of up-front secure fees whilst maintaining outcomes incentives.

Finally, Whitworth’s research [R1, R2, R5] was key to persuading DWP that secure up-front service fees of around £600 per customer needed to be included into WHP alongside its outcome-payments, unlike the predecessor Work Programme. This is to both to mitigate ‘parking’ risks and to help smaller specialist third sector providers to be able to engage with the programme – key weaknesses of Work Programme. Whitworth’s contribution directly shaped the eventual payment-by-results design and the decision to use upfront payments [S1].

Regional policy impacts in the UK

1. Evidence-based design of the world’s largest IPS trial

From 2016-2018 Whitworth led the design of Sheffield City Region’s (SCR) modified IPS health-led employment trial (HLET) during his extended secondment to SCR (£102,000 financed by SCR). With the aim of transforming employment support for individuals with health conditions across the UK, the HLET is a randomised control trial and flagship national policy of the DWP-DH joint Work and Health Unit (WHU). SCR contains around two million residents across nine local authorities spanning South Yorkshire, Derbyshire, and Nottinghamshire.

Individual Placement and Support (IPS) is a well-evidenced employment support model for individuals with severe mental health conditions. The HLET is the world’s largest IPS trial (£20m, 15,000 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 HLET by Whitworth 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.

Whitworth led protocol development, design, costings, profiling, and evaluation strategy for the HLET. As the HLET Programme Lead at the national WHU describes, Whitworth’s research expertise provided “considerable added value” in a number of areas. This includes model design, costings, profiling, and local evaluation strategy, but particularly in the central IPS task of “careful adaptation of the IPS fidelity scale to address the need of our trial cohorts, which differ from the [IPS] norm in terms of key patient characteristics, caseload sizes and delivery settings” [S5]. As the Director of Public Health in Rotherham, writes: “Adam’s knowledge of international employment schemes for people with health issues and of the IPS fidelity scale and evidence base, and how to flex it, has been essential to guide us through the project winning, design and launch so successfully” [S6]. Dan Jarvis MP, Mayor of SCR, writes: “Your excellent modelling and extensive knowledge of employment support programmes will transform the lives of those who are unemployed or in work and struggling within the City Region” [S7].

The HLET has successfully transformed experiences and outcomes for this key cohort. As of October 2020, the HLET had supported 3,010 service users in total: 1,800 unemployed individuals of whom 33% had successfully been supported into paid employment and 1,210 employed individuals at risk of sickness absence of whom 76% had successfully sustained their employment [S8]. HLET’s 33% success rate compares to a 10% ‘business-as-usual’ Jobcentre Plus counterfactual for the unemployed cohort where reliable benchmark data are known. For this HLET cohort alone this equates to an expected Treasury gain in reduced benefit spend and increased tax take of £6.3 million over 5 years. Although important, such financial calculations fail however to capture the HLET human impacts. One service user says of her success with the HLET: “It’s a very lonely place when you are out of work. But now that I have a job my whole outlook has changed, and things are on the way up. I’m over the moon with my new role and it’s a real pleasure to come to work!” [S8].

2. Building new regional governance to drive enhanced local integration.

Underpinned by Whitworth’s research into the potential for devolution to drive local integration [R5, R6], a second strand of regional impact relates to SCR’s development of innovative new cross-cutting governance mechanisms – Local Integration Boards (LIBs). Each of the SCR’s nine local authorities use these new governance arrangements to enable effective whole-person employment support. As the Director for Health Improvement in Sheffield, says: “Adam has presented and shared some of his academic work on these ideas to those of us closely involved, and those concepts and thinking have shaped the development of the local system and policy landscape… As a result SCR and political leaders have signed up to building a set of new governance mechanisms called Local Integration Boards (LIBs) across the nine local authorities in SCR” [S9]. Over 100,000 SCR residents are currently unemployed and with multiple support needs but failing to receive the coordinated whole-person support that they require. LIBs represent a key strategic change locally in overcoming this current fragmentation of services.

Taken together, the changes to the employment support system, and how that benefits service user experiences and outcomes, are significant. As the Chief Executive of SCR writes, “Adam’s expertise has had major impacts in the city-region’s employment landscape whether measured in terms of our substantive shift towards better locally integrated employment programmes that Adam consistently advocated, or in terms of the hard numbers” [S10].