Research and analysis

Summary: ESA: evaluation of pilots to support work-related activity group customers with an 18 to 24 month re‑referral period

Published 10 January 2019

By Ann Purvis, Kathryn Ray, Jane Aston, Lauren Bennett and Connor Stevens (Learning and Work Institute) and Rakhee Patel, Nilufer Rahim, Margaret Anderson, Loraine Busard, Thomas Chadwick, Malen Davies, Stephen Hinchcliffe and Hannah Jones (NatCen Social Research).

This report presents findings from the evaluation of pilots to support Employment and Support Allowance (ESA) customers in the work‑related activity group who are due to be re-referred within 18 to 24 months to assess if there has been a change in their health condition.

ESA is a type of unemployment benefit offering financial support to people who are out of work due to long-term illness or disability. ESA customers are placed into one of 2 groups depending on the extent to which their illness or disability affects their ability to work:

• the work-related activity group is required to have regular interviews with an adviser and undertake work-related activities
• the support group is not required to have interviews

Customers are allocated a re-referral date or ‘prognosis’ period during which they will be re-assessed for any changes to their health condition.

These pilots aimed to test the effectiveness of enhanced support, delivered over the course of 2 years, to ESA work-related activity group customers with an 18 to 24 month prognosis period. Three distinct models were piloted:

• Jobcentre Plus model – additional time and support from a work coach combined with additional support for work coaches, for example from work psychologists
• Work Programme model – an employment support programme to help long-term unemployed ESA claimants
• healthcare provider model – additional support from healthcare professionals to help manage participants’ health conditions or disabilities

This research is accompanied by an impact assessment that estimates the impacts of the pilots on employment and benefit outcomes, while this report explores the delivery of support, participants’ experiences of this, softer outcomes from the pilots and participants’ perceptions of pilot impacts.

Key findings

Overall, the Jobcentre Plus pilot appeared to have a small impact on employment outcomes, and also to have an impact on soft outcomes such as feelings about leaving ESA and starting work. The healthcare provider pilot also appeared to have a positive effect on these soft outcomes, while the Work Programme pilot did not have an impact on any of the outcomes observed in the survey.

Across all of the pilots, staff reported that the participant group had complex support needs, and the severity of their health conditions and/or their perceived distance from the labour market meant that work and work-related outcomes were difficult to achieve within the 2 year duration of the pilot.

The survey found that only a minority of pilot participants had made job applications and very few (between 2% and 8%) entered paid employment during the lifetime of the pilot. Fewer than one in 5 on the Jobcentre Plus pilot and one in 10 on the Work Programme and healthcare provider pilots felt that their health was such that they could return to work ‘right now’. The majority were, however, positive about the pilot support overall, with over 80% reporting a ‘good’ or ‘very good’ experience and substantial minorities reporting that the support had helped them to overcome barriers or helped with their health condition.

The main features of effective delivery of support to this group of claimants were:

• a focus on participants’ health-related needs and utilisation of specialist services as appropriate, whilst maintaining an employment-related focus
• delivery of flexible and personalised support to take account of diverse needs
• the development and maintenance of positive and consistent one-to-one adviser-participant relationships
• use of advisers with appropriate levels of skills, experience and support for this participant group
• access to specialist health support for adviser staff, with external partnerships playing a key role in this

Methodology

The evaluation of the pilots was carried out using a 2-wave survey of participants, supplemented by 2 waves of in-depth interviews, to explore the views and experiences of pilot participants and staff involved in pilot delivery.

The evaluation aims were:

1. To explore what the pilots delivered and claimants’ experiences of this.
2. To support the Department for Work and Pensions impact assessment (focused on employment and benefit receipt), with an exploration of softer impacts, including attitudes and work-related activity, and participants’ perceptions of pilot impacts.
3. To provide understanding about why the pilots did or did not have an impact on employment and benefit receipt.
4. To deliver lessons on the design and delivery of support for this claimant group to inform future provision.

It should be borne in mind that each of the 3 pilots was delivered in a different geographic area, and each had its own control group. As a consequence, differences in results across the pilots could be due to:

• differences in business as usual support (i.e. the Jobcentre offer) received by the control group
• differences in the characteristics of the local population in each area
• features of the local labour markets

This limits the extent to which robust conclusions can be drawn about the comparative effectiveness of the 3 pilots.

Findings

Pilot participants

The participant group had complex support needs. The severity of their health conditions and disabilities, and the extent to which their lives were affected, varied widely. Some could manage daily life independently and work a small number of hours, while others had more limited mobility, were on strong medication or had regular hospital stays, and some had unstable conditions with fluctuating effects.

At the outset of the pilot, around two-thirds of respondents felt that their health condition or disability currently ruled out the possibility of work. Around half reported that they did not know when they would be able to work and around one in 6 felt that they would never be able to do so. The majority were not currently undertaking any work-related activities. Around a third of pilot participants moved from the ESA work-related activity group to the support group during the pilot.

Jobcentre Plus pilot findings

The Jobcentre Plus pilot operated in 4 Jobcentre Plus districts in Southern England, offering a maximum 530 minutes of contact time per year for pilot participants. Support was delivered by existing Jobcentre Plus work coaches, the majority of whom had prior experience of working with ESA customers and pilot staff felt well-supported in their delivery, through case conferencing (discussion about individual customer cases by work coaches, managers and work psychologists), line management and by work psychologists. Jobcentre Plus staff delivering the pilot had flexibility to offer support that met individual needs and priorities including a combination of employment-related, health-related and soft skills support. Support to look for and to apply for jobs was the most common type of support received by pilot participants, and in significantly higher numbers than in the control group. Larger numbers also received training and voluntary work.

There was a small but significant difference between the proportion of Jobcentre Plus pilot participants in paid work at the time of the survey compared to the control group, suggesting that Jobcentre Plus pilot support had a small impact on participants’ employment status. The Jobcentre Plus pilot also appeared to have a positive impact on participant motivation to leave ESA and to find work and to have positively influenced participants’ feelings about how ready they were for work.

Work Programme pilot findings

The Work Programme pilot operated in 2 contract areas in the North East of England, delivered by 4 single provider organisations and a host of subcontractors. Services were delivered by the providers’ existing employment advisers, some of whom had experience of the ESA customer group. A mixture of soft skill, employment-related and health-related support was deployed. Support with job applications and CV writing was by far the most common form of work-related support received, by considerably more people than in the control group. Work Programme pilot participants were also more likely than the control group to receive support with soft skills development, for example confidence building and attending group sessions. Analysis of outcomes measured in the survey suggests that the Work Programme pilot did not have an impact either on employment and job search activity or on soft outcomes.

Healthcare provider pilot findings

The healthcare provider pilot operated across 5 Jobcentre Plus districts in Central England, delivered by a single provider using healthcare professionals to deliver support. A few of these staff had prior experience of working with ESA claimants. Support comprised 5 face to face appointments over 24 months, with additional support at the provider’s discretion. Support delivered was primarily focused on health and soft skills. Over a third of participants received support to help them manage their health or disability, much higher levels than in the control group, and larger numbers in the pilot group received support focused on exercise, pain management, physiotherapy and confidence building. In contrast, work-focused support was limited. The healthcare provider pilot appeared to have no effect on employment outcomes, but did have an impact on soft outcomes, such as increased motivation to leave ESA and to enter work.

Overall findings

There were 5 main ingredients which, combined, led to effective provision for this claimant group:

• personally tailored approach – with staff who could work flexibly with participants, tailor support individually and work according to each participant’s support needs
• flexibility in the mode of delivery – delivery of support in flexible formats that took account of participants’ needs, such as physical mobility barriers, low confidence and social anxiety
• intensity and duration of support – engaging with participants frequently to provide participants with a regular routine that emulated aspects of the work environment
• staff capabilities – including a range of features, such as well-trained and knowledgeable staff; adequate staffing levels to ensure caseloads were manageable; access to more specialist staff and services; and peer support which facilitated the sharing of good practice
• partnership working – in order to provide, or broker access to, a broad and holistic package of support that participants would not have had the motivation to seek out for themselves or would have struggled to find

The relative priority that organisations placed upon the delivery of the pilot appeared to be an important factor in determining successful implementation. Within the Work Programme and healthcare provider pilots, this was at least partly driven by contractual requirements, such as the achievement of funded outputs, outcomes or other performance targets.

Read the full report Employment and Support Allowance: evaluation of pilots to support work-related activity group customers with an 18 to 24 month re‑referral period.