Slide pack to accompany Dame Carol Black's presentation of the findings from her 2016 review into drug and alcohol misuse, obesity, and employment.

1. Capital Gains ….
… maximising work opportunities
for disadvantaged Londoners
London, Guildhall EC2V, 24 July 2017
Dame Carol Black
Expert Adviser on Health and Work
NHS and Public Health England
Principal, Newnham College Cambridge

2. Review 2016 : Terms of Reference
To consider how to support those suffering from long-term
treatable conditions back into, or to remain in, work...
… especially those with alcohol or drug addiction or obesity,
their holistic needs, and barriers to work.
To understand:
• causes of worklessness and the associated costs
• pathways taken through the healthcare and benefits
systems, and the roles of providers and employers
• availability and cost-effectiveness of treatments and
interventions.

3. Preventing people from working
Social determinants of health
Common Mental Common MSK Chronic medical Major
functional
Health problems problems conditions (multiple?) incapacity
Stress, anxiety Back pain, Diabetes, lung Major trauma,
depression Neck pain disease, heart multiple sclerosis,
Soft tissue disease, cancer, cancer,
rheumatism Rheumatoid addictions
Arthritis
Poor workplaces, poor work, poor managers

4. Review 2016 : Objectives
• To ameliorate the human, social and economic cost
of drug or alcohol addiction or obesity….
• …. by addressing the challenges in finding work faced by
those affected.
• To present not utopian solutions, but evidence-based
analysis of the factors discouraging employment.
• To recommend practical cost-effective interventions,
including changes in services, practices,
behaviour and attitudes.

5. Prevalence of drug and alcohol problems
Drugs :
•294,000 opiate and/or crack
users in England ( 0.8%
of 15-64 population)
•No reliable estimates of
other drug misuse.
•205,000 in treatment in
2015
Alcohol :
•UK 11th
highest of 40 OECD
countries on consumption
•Most alcohol consumed by
heaviest-drinking 20%
•6% adults ‘mildly’ dependent
(250k to 650k severely so)
•90,000 in treatment in 2015
No evidence on employment of problem users not in treatment.

6. Review 2016 : Research Findings
On drugs and alcohol addiction, three main areas for
action :
• Treatment in itself does not ensure employment. Work
needs to be an integral part of treatment.
• The benefits system is hampered by severe lack of
information on health conditions, poor incentives
for staff to tackle difficult or long-term cases.
• Employers, without whose co-operation employment of our
cohorts is impossible, are reluctant to hire people
with addiction and/or criminal records – decisions to
recruit need to be de-risked

7. Review 2016 : Stories
• We sought to understand the perspective of people who
have experienced these conditions, and their
journeys through the health and benefits
systems.
• Their stories are powerful, and send a clear message …
• … within and after treatment for addiction there must be
meaningful activity, preferably work ….
• … otherwise the void and boredom will soon be filled by a
return to old habits.

8. Review 2016 : Addiction
Treatment
A mutually-reinforcing relation, employment and
recovery.
• Being employed at treatment start improves chances of
completing the treatment successfully, …
• … and completing treatment improves the chances of
finding employment.
• Also employment can moderate relapse.
• Only 1 in 5 starting treatment are employed – these tend
to stay in work throughout treatment.
• But few who enter treatment without work find it

9. Review recommendations : IPS
• Government should conduct a trial of the Individual and
Placement Support (IPS) approach, including
comparison with a time-limited version (IPS-lite), and with
Jobcentre Plus work coaches co-located in treatment
services providing employer support.
• Government should ensure that the employment advisors
forming part of the IPS trial have access to a small
discretionary fund to cover legitimate additional costs that
smaller employers incur when recruiting people with a
history of alcohol or drug dependency.
• Advisors should also be able to offer Work Trials to employers.

10. The Car Crash
Addicts
•no trust
•enter with one disabling
diagnosis
•no granularity
•Medical Certificate often
does not mention
addiction
Civil servants in job centres
•doing their best
•have poor information
•no ‘specialist’ training
•often sanction the client

11. Review recommendations : Information
• Government, working with the clinical community, should
review ways for better health information to be provided
to Jobcentre Plus in support of a benefit claim.
• Government should conduct a trial of a requirement for each
claimant, early in their claim to benefit, to attend a
structured discussion with a health professional on
the impact of their health condition(s) on ability to work,
to test the value of this approach and identify delivery issues.
• Government should enhance the core Jobcentre Plus
drugs and alcohol offer.

12. Review recommendations : Information
• Government should enhance Jobcentre and treatment
data sets, to support and illustrate joined-up work between
Jobcentres and treatment services ….
• … and record steps towards both the labour market and
job outcomes.
• This is intended to ensure that Jobcentre Plus, local authority
commissioners, and others, understand the level of need
and the progress being made in their areas.

13. Review recommendations : employers
• Government, working with employers, should develop
guidance on best practice in recruiting drug- and alcohol-
dependent people.
• See Potential and other campaigns should be used to
promote this guidance and to address the problem
of stigma more generally.
• Government should extend the assessment and support
services within Access to Work to cover all drug- and
alcohol-dependent people on a treatment programme,
whether or not they have an additional declared
physical or mental health issue.

14. Estimating ‘benefit’ of work
The Review analysts estimated the return, to the Exchequer
and to society, for every extra day worked as a result of
a proposed intervention (net of intervention costs).
•Benefits to the Exchequer: estimated increases in tax
receipts (net of tax credits), reduction in benefit
spending, healthcare costs etc.
•Benefits to society : increased output, reduced healthcare,
changed distribution of household income, etc.
•Daily benefit of moving an ESA Support Group claimant
into employment averaged £35 Exchequer, £53 society.

15. Work days required to break even
This estimate of daily ‘benefit’ of work allows calculation, from
estimated cost of a proposed policy and predicted success rate,
of required number of days in work for a policy to ‘break even’.
Results: IPS trial : “.. require those who successfully complete
the programme and find employment to sustain work for
between 145 and 180 days, on average, for the
Exchequer to break even.
Co-location work coaches in treatment centres: “.. require ..
sustain work for between 240 and 305 days ….”
For other estimates, of costs and required success, see Review.