IPS for alcohol and drug dependence: data linkage outcomes report
Published 11 December 2024
Applies to England
© Crown copyright 2024
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Summary
This is the first report on the outcomes of the expansion of Individual Placement and Support (IPS) for adults in treatment for alcohol and drug dependence in England. IPS is an intensive employment support intervention to help people find and stay in work. The IPS for people with alcohol and drug dependence programme is managed by the Office for Health Improvement and Disparities (OHID) in the Department of Health and Social Care (DHSC).
This report presents the results of data linkage between OHID’s National Drug Treatment Monitoring System (NDTMS) and employment records held by HM Revenue and Customs (HMRC). The aim of this data linkage was to evaluate the outcomes for clients in the IPS programme.
It found that over half of IPS clients successfully obtained employment during a follow-up period of up to 18 months and IPS achieved positive results regardless of their primary drug use.
Four out of 5 clients who achieved employment sustained their employment for 13 weeks or more and there was a clear association between positive alcohol and drug treatment outcomes and successful employment.
The expansion of IPS across England will be completed during 2024 to 2025 and these promising findings provide continued evidence of the effectiveness of the programme.
Introduction
Background to IPS
Employment makes an important contribution to supporting people to improve their financial and economic status. Job loss and unemployment are linked to poverty and ill health. Unemployed people with alcohol and drug dependence often say that employment is a recovery goal, but they are regularly excluded from the workplace, or struggle to get or keep a job.
IPS was originally developed in the USA and is an intensive employment support intervention to help people find and stay in work.
IPS follows principles of:
- aiming to get people into competitive employment
- being open to all people who want to work
- trying to find jobs that people prefer
- working quickly with a rapid job search
- bringing employment specialists into the clinical team
- employment specialists developing relationships with employers based on a person’s work preferences
- providing ongoing, individualised support for the person and their employer
- expert benefit advice
Between 2018 and 2021, we ran the first study of IPS for adults in treatment for alcohol and drug dependence, IPS - Alcohol and Drugs (IPS-AD), in 7 community treatment centres in England. It found that IPS helped more study participants achieve employment in the open job market than standard employment support. This study informed the policy decision to make IPS available to more people in treatment for alcohol and drug dependence. You can find a summary of the first study in the report Helping people in alcohol and drug treatment services into work. We include a comparison later in this report between study participants who took part in the IPS-AD study and clients who engaged in the IPS programme since the IPS-AD study ended.
The expansion across England began in October 2019 and is almost complete. It began with 6 of the IPS-AD trial study sites. During 2021 to 2022, more areas joined the IPS programme. These were areas that were:
- included in the Home Office programme Project ADDER (addiction, diversion, disruption, enforcement and recovery)
- successful through an expression of interest process
Since then, IPS has been rolling out to the remaining areas in yearly groups from 2022 to 2023. You can find more information about the number of local authorities that joined the IPS expansion in table 1.
Table 1: IPS expansion in England
| Group | IPS services | Cumulative services | Local authorities | Cumulative local authorities |
|---|---|---|---|---|
| IPS-AD trial sites | 6 | 6 | 6 | 6 |
| 2021 to 2022 | 25 | 31 | 40 | 46 |
| 2022 to 2023 | 23 | 54 | 26 | 72 |
| 2023 to 2024 | 9 | 63 | 18 | 90 |
| 2024 to 2025 (planned) | 40 | 103 | 57 | 147 |
This report presents the results of data linkage between NDTMS, and employment records held by HMRC. This was to verify and evaluate the outcomes of IPS support delivered during the expansion of IPS across England.
NDTMS treatment data
Information on people who engage in alcohol and drug treatment in England is recorded in the NDTMS and provided to OHID each month.
In NDTMS reporting, people in treatment are divided into 4 substance groups:
- Opiate: people who are dependent on or have problems with opiates, mainly heroin.
- Non-opiate: people who have problems with non-opiate drugs only, such as cannabis, crack and ecstasy.
- Non-opiate and alcohol: people who have problems with both non-opiate drugs and alcohol.
- Alcohol only: people who have problems with alcohol but do not have problems with any other substances.
The NDTMS records information on people who access IPS. This includes, with additional consent procedures, their National Insurance number and their postcode of residence which are used for data linkage with HMRC.
You can find more information on the NDTMS methodology and data quality in the Quality and methodology document in the ‘Annual publications for NDTMS’ section on the NDTMS website.
HMRC data
HMRC analysts used 2 of its systems to provide the requested data. They matched IPS clients in the HMRC Connect system. They then enriched matched clients’ data using its Pay As You Earn (PAYE) Real Time Information (RTI) system. RTI contains PAYE data from the National Insurance and PAYE System, which is updated daily.
Methodology
Overview of data linkage
NDTMS collects data on all people accessing publicly funded structured alcohol and drug treatment in England. The data collected includes:
- sociodemographic information
- clinical reviews
- physical health status
- mental health status
- the substances people have problems with
- the interventions people receive
- people’s treatment outcomes
For the purposes of this data linkage, we extracted limited data from NDTMS for people who engage in the IPS programme and consent for their information to be linked to HMRC. Specifically, this includes the client’s:
- initials
- date of birth
- sex
- postcode of residence
- National Insurance number
- IPS enrolment date
- IPS area where they received their intervention
The data also includes a coded NDTMS information field that identifies the client’s age band, NDTMS substance group and alcohol and drug treatment outcomes. The coding of this field is not shared with HMRC.
HMRC collects data on PAYE and self-employment earnings, along with tax and both employer and employee National Insurance contributions.
How the data linkage works
The data extracted from NDTMS is securely transferred to HMRC by OHID. HMRC uses the client’s National Insurance number, date of birth and postcode for deterministic data matching. This means that the match is only confirmed if the details match on all variables. The client’s postcode is matched if it matches to one of the last 3 postcodes recorded by HMRC. Client initials are used by HMRC to check data match quality. To anonymise the data returned to OHID, HMRC does not return the fields used for matching.
The data returned by HMRC to OHID includes:
- a non-identifiable person ID
- client sex
- IPS enrolment date
- IPS area
- coded NDTMS information (age band, NDTMS substance group and alcohol and drug treatment outcomes at the point of data linkage)
- a non-identifiable employer ID
- the client’s self-employment or PAYE records for 18 months before and 18 months after their IPS enrolment date
Clients who were sent to HMRC for data linkage:
- consented to the data linkage
- had complete data as described above
- had entered the IPS programme at least 9 months before the data linkage date
We undertook the data linkage in March 2024 using NDTMS data to the end of January 2024. We included clients with an IPS start date between the start of October 2019 and the end of April 2023. The results presented here include all returned data, so it includes people with an IPS start date between the start of August 2022 and end of April 2023 who had not yet completed the full 18 month follow-up.
Consent and confidentiality
People accessing alcohol and drug treatment are asked for consent to share their information in line with the NDTMS consent and privacy notice. Part of this consent allows their information to be linked with other administrative data sets. For IPS clients, there is an additional level of consent to collect and share their National Insurance number and full postcode with HMRC through the IPS consent form. You can find the IPS privacy notice on the NDTMS documentation webpage.
After matching, HMRC anonymise the data to ensure that identifiable information is removed from the processed data returned to OHID. The non-identifiable person ID and employer ID are both randomly created by HMRC to allow OHID to differentiate between individuals and their different employments for analysis purposes only. These references are non-identifiable and do not represent any actual information on the clients.
Managing the data
The data sent to HMRC by OHID, and the final linked anonymised data set returned by HMRC, are transferred through the HMRC Secure Data Exchange Service. The final linked data set is stored securely on OHID servers and access is strictly limited to a small number of OHID staff. The original OHID data set is deleted after HMRC confirms receipt of the data, to ensure that the returned data cannot be matched back to the original data set. HMRC manually deletes the files it holds 3 months after it delivers the data to OHID.
Outcomes
We included a range of employment outcomes, some of which reflect the IPS-AD study outcomes.
The main outcome was whether the client found work during the 18 month period following the start of accessing IPS. We defined this as working in the open job market for at least one day.
The other outcomes during the 18 month period were:
- number of days of employment
- number of days to first job from enrolment in IPS
- length of longest held job
- working in a single job for at least 13 weeks
- tax and National Insurance contributions
Follow-up period
We sent the information about clients who had entered the IPS programme at least 9 months before the data linkage date to HMRC. This ensured that all clients who were included in the data linkage had an opportunity to achieve a positive employment outcome. However, we expect that some clients who are still within the 18 month follow-up period will achieve a positive outcome after this reporting period. We will include clients who have not completed the full 18 month follow-up period in future rounds of data linkage.
The data returned by HMRC is for the period of up to 18 months after the client’s enrolment in IPS. This means that the analytical end date is 18 months after IPS enrolment or the date of data linkage for clients who have not completed the full 18 month follow-up. For this reason we can only report findings up to 18 months after IPS enrolment for:
- the time-based outcomes that are calculated from start of employment (number of days employed, length of longest held job and working in a single job for at least 13 weeks)
- tax and National Insurance contributions
We expect that most clients will continue their employment beyond the analytical end date, but we do not capture employment data beyond 18 months after enrolment in IPS. The reported averages for the outcomes above are limited by the 18 month cutoff and this does not mean clients stopped working after this period.
On average, clients included in this analysis had completed 440 days (14.6 months) of follow-up. Of the clients who had not completed the full 18 month follow-up, on average they had completed 376 days (12.5 months).
IPS clients
OHID sent the details of 3,391 clients to HMRC. Of these, HMRC matched and verified the records of 2,535 (75%) clients.
Of the client data returned by HMRC:
- 70% were men
- 16% were aged 16 to 29 years, 63% were aged 30 to 49 years and 21% were aged 50 years and over
- 38% were alcohol only users, 33% were opiate users, 15% were non-opiate and alcohol users and 14% were non-opiate only users
- 43% had successfully completed alcohol and drug treatment
- 62% had shown substantial progress in alcohol and drug treatment
- 37% had completed their 18 month follow-up
Results
Successful employment
Over half (52%) of IPS clients successfully obtained employment during the up to 18 month follow-up. Rates of employment ranged from 42% among opiate users to 58% among alcohol users. The opiate group were statistically less likely to be successfully employed than all other groups.
Figure 1: successful employment by substance group
| Substance group | Successful employment |
|---|---|
| Opiate | 42% |
| Non-opiate only | 53% |
| Non-opiate and alcohol | 54% |
| Alcohol only | 58% |
Figure 2: successful employment by sex
| Sex | Successful employment |
|---|---|
| Men | 51% |
| Women | 53% |
Figure 3: successful employment by alcohol and drug treatment status
| Treatment status | Successful employment |
|---|---|
| In treatment | 44% |
| Successfully completed treatment | 61% |
| Unplanned exit | 45% |
Figure 4: successful employment by alcohol and drug treatment progress
| Treatment progress | Successful employment |
|---|---|
| Substantial progress | 56% |
| Not currently showing substantial progress | 46% |
Number of days of employment
On average clients were employed for 286 days (9.5 months) during follow-up.
The alcohol group were statistically more likely to have higher days employed than all other groups. Women also had statistically higher days employed than men (301 compared with 279 days). Clients who did not successfully complete alcohol and drug treatment had statistically lower days employed (242 days) compared with those who were still in treatment (280 days) and those who had successfully completed treatment (303 days). Clients who had not yet shown substantial progress in alcohol and drug treatment had statistically lower days employed compared to those who were showing substantial progress (252 compared with 302 days).
Figure 5: average days employed by substance group up to 18 months
| Substance group | Average days employed |
|---|---|
| Opiate | 279 days |
| Non-opiate only | 260 days |
| Non-opiate and alcohol | 268 days |
| Alcohol only | 306 days |
Number of days to first job from IPS enrolment
The time from IPS enrolment to first job was on average 137 days (4.5 months). There were no statistical differences by substance group, sex, alcohol and drug treatment status or treatment progress.
Figure 6: average time from IPS enrolment to first job by substance group
| Substance group | Average time from IPS enrolment to first job |
|---|---|
| Opiate | 143 days |
| Non-opiate only | 125 days |
| Non-opiate and alcohol | 135 days |
| Alcohol only | 137 days |
Of the clients who successfully achieved employment:
- 46% began employment in the first 3 months of follow-up
- 86% began employment by the end of month 9 when IPS support would typically end
Figure 7: time to first job by follow-up month
| Month post-enrolment | Number of clients achieving employment during month |
|---|---|
| 1 | 179 |
| 2 | 183 |
| 3 | 149 |
| 4 | 126 |
| 5 | 81 |
| 6 | 83 |
| 7 | 65 |
| 8 | 52 |
| 9 | 47 |
| 10 | 38 |
| 11 | 25 |
| 12 | 23 |
| 13 | 19 |
| 14 | 15 |
| 15 | 14 |
| 16 | 7 |
| 17 | 10 |
| 18 | 5 |
Length of longest held job
Clients had on average 2 jobs during the follow-up. The average length of longest held job (job tenure) was 243 days (8.1 months) during follow-up.
The alcohol group were statistically more likely to stay in a job longer than all other groups. Women were statistically more likely to stay in a job than men (261 compared with 234 days).
Clients who did not successfully complete alcohol and drug treatment had a statistically shorter longest held job (195 days) compared with clients who:
- were still in treatment (242 days)
- had successfully completed treatment (258 days)
Clients who had not yet shown substantial progress in alcohol and drug treatment had a statistically shorter longest held job compared to those who were showing substantial progress (211 compared with 257 days).
Figure 8: average length of longest held job by substance group up to 18 months
| Substance group | Average length of longest held job |
|---|---|
| Opiate | 239 days |
| Non-opiate only | 210 days |
| Non-opiate and alcohol | 222 days |
| Alcohol only | 263 days |
Working in a single job for at least 13 weeks
Four-fifths of clients (79%) worked in a single job for at least 13 weeks. The alcohol group were statistically more likely to work in a single job for at least 13 weeks than all other groups.
Clients who successfully completed alcohol and drug treatment were statistically more likely to work in a single job for at least 13 weeks (84%) compared with clients who:
- were still in treatment (77%)
- had not successfully completed treatment (67%)
Clients who had not yet shown substantial progress in alcohol and drug treatment were statistically less likely to work in a single job for at least 13 weeks compared to those who were showing substantial progress (70% compared with 82%).
Figure 9: proportion working in a single job for at least 13 weeks by substance group up to 18 months
| Substance group | Proportion working in a single job for at least 13 weeks |
|---|---|
| Opiate | 78% |
| Non-opiate only | 71% |
| Non-opiate and alcohol | 73% |
| Alcohol only | 84% |
Tax and National Insurance contributions
On average, clients paid £658 in tax contributions and £1,233 in National Insurance contributions (combination of employee and employer) during follow-up. Contributions were made in the tax years 2019 to 2020 to 2024 to 2025 depending on when the client entered IPS.
Women were statistically more likely to make lower tax and National Insurance contributions than men (£514 compared with £726 in tax and £884 compared with £1,396 in National Insurance).
Clients who made substantial progress in alcohol and drug treatment were statistically more likely to make higher tax and National Insurance contributions (£689 in tax and £1,312 in National Insurance) compared to those who had not yet shown substantial progress treatment (£612 in tax and £1,082 in National Insurance). There were no statistical differences by substance group or alcohol and drug treatment status.
Figure 10: average tax and National Insurance contributions by substance group up to 18 months
| Substance group | Average National Insurance contributions | Average tax contributions | Total |
|---|---|---|---|
| Opiate | £1,336 | £648 | £1,984 |
| Non-opiate only | £1,077 | £565 | £1,642 |
| Non-opiate and alcohol | £1,157 | £652 | £1,809 |
| Alcohol only | £1,247 | £699 | £1,946 |
Outcomes for follow-up complete group
For the 944 clients who had completed 18 months of follow-up from IPS enrolment date (37% of the full group returned by HMRC), the findings for the follow-up complete group were similar to the full group. The rate of successful employment for the follow-up complete group was slightly higher at 53% and the proportion working in a single job for at least 13 weeks was steady at 79%. Broadly, the findings were similar across outcomes by sex, substance group, and alcohol and drug treatment status and treatment progress.
Comparison with IPS-AD study
Compared with the IPS-AD study, IPS clients who had engaged in the programme since the study ended obtained substantially higher rates of successful employment (52%) compared with the IPS-AD:
- ‘intervention arm’ study participants receiving IPS (30%)
- ‘control arm’ study participants receiving standard employment support (25%)
For clients in the opiate group who had engaged in the programme since the IPS-AD study ended, there was a marked improvement in successful employment, with 42% obtaining employment compared with 23% of the IPS-AD intervention arm study participants.
The rates of working in a single job for at least 13 weeks were also higher for IPS clients (79%) compared with the IPS-AD intervention arm (42%) and control arm (42%) study participants. On average, IPS clients who achieved employment did so faster and were employed for longer than the IPS-AD study participants.
Main findings, strengths and limitations
Findings from the analysis
Over half of IPS clients successfully obtained employment during the 18 month follow-up. IPS had high rates of success regardless of the client’s main drug use.
The alcohol group had the highest rate of successful employment and were more likely to stay in a job and have longer job tenure than the other groups.
The opiate group were less likely to be successfully employed. However, at 42%, their rate of employment is markedly higher than the IPS-AD study. Opiate users typically have more complex needs and are likely to have been disengaged from the employment market for longer, and so this is a positive result for this group. Where clients in the opiate group obtain employment, the vast majority (78%) stay in a single job for at least 13 weeks and demonstrate a similar level of job sustainment to the other substance groups.
Women were more likely to have longer job tenure and higher total days employed. They also made lower tax and National Insurance contributions. The most probable explanation for this is higher levels of part-time working and caring responsibilities among women, and potentially lower average pay, but we do not have data to confirm this.
There was a clear association between positive alcohol and drug treatment outcomes and employment. Research evidence suggests that causality may go both ways, with recovery supporting employment and employment supporting recovery. Clients who successfully completed alcohol and drug treatment were more likely to:
- obtain employment
- achieve job sustainment
- have higher tax contributions
Clients who dropped out of alcohol and drug treatment were more likely to have shorter job tenure.
Clients who showed substantial alcohol and drug treatment progress were more likely to:
- obtain employment
- achieve job sustainment
- have longer job tenure and total days employed
- have higher National Insurance contributions
The similarity of findings for the follow-up complete group provides evidence for the reliability of the larger full group despite the high proportion of clients who had not completed their follow-up.
Compared with the findings of the IPS-AD study, the outcomes for clients engaged in IPS since have markedly improved across all outcomes. IPS clients achieve higher rates of employment and job sustainment, remain employed for longer and achieve employment faster than the IPS-AD study participants.
We attributed the improved performance of the IPS expansion to a number of factors, including:
- implementation and delivery improvements made as a result of lessons learned from the IPS-AD study
- a larger workforce with IPS experience from which to recruit staff for IPS services in alcohol and drug treatment
- improved support during the establishment of new IPS services from OHID and partner organisation IPS Grow
- peer-to-peer support provided by established IPS services to new services
- large nationwide alcohol and drug treatment services delivering IPS in multiple areas which benefit from national IPS co-ordination, established processes and learnings from establishment of earlier services
Strengths and limitations of the analysis
This analysis has both strengths and limitations.
Determination of employment outcomes through HMRC data linkage is the gold standard verification method. The relatively large sample size and high match rate increases confidence in the reliability of the findings. The expansion of the IPS programme is now well advanced, and this returned sample represents 50 IPS teams. Although IPS has not expanded enough for reporting at local authority level, it does cover a large proportion of England, providing representation across geographies, demographic patterns and labour market differences.
We included self-employment data in our analysis, but due to the submission of tax returns up to 9 months after the end of the tax year it is possible that we did not detect all self-employment during the follow-up. Also, HMRC cannot record working in the informal labour market or ‘cash in hand’ jobs, so these will also not be detected in our analysis.
The data sharing agreement between HMRC and OHID does not permit the inclusion of information on a client’s employer, employment type or working hours. This restricts the conclusions we can draw, such as the proportion of IPS clients who work part-time, common employment types or employers, and average earnings.
To date, the returned data shows that 944 clients have completed the 18 month follow-up. This sample size will increase during future rounds of data linkage and will help us to better analyse the time dependent outcomes. However, the similarity between the findings for the follow-up complete group and the full group provides evidence for the reliability of the larger full group. This is despite the high proportion of clients who had not completed their full follow-up, and our methodological approach of including clients who had enrolled in IPS at least 9 months before the data linkage.