Wrong question, right answer – the Dame Carol Black review of drug and alcohol addiction, and obesity: effects on employment outcomes
The Conservative manifesto for the 2015 election contained a commitment to:
Review how best to support those suffering from long-term yet treatable conditions, such as drug or alcohol addiction, or obesity, back into work. People who might benefit from treatment should get the medical help they need so they can return to work. If they refuse a recommended treatment, we will review whether their benefits should be reduced.
The two-part nature of this commitment caused concern to some, including us at Revolving Doors. How best to support people affected by substance misuse into employment is a question worth asking, and worth trying to answer, but the prospect of using the social security system to enable the effective mandation of treatment for substance misuse raised a number of questions. These ranged from medical ethics to the practical – is it necessary? Is it legal? Will it achieve the goal set out for? Will there be unintended or undesirable consequences?
Having reviewed the evidence and spoken to stakeholders and experts by experience around the country, Dame Carol in her report decided that mandated treatment was not the right route to go down. Instead, she focussed on a range of practical and achievable recommendations around improving services to the individual, helping local stakeholders to develop a better understanding of need, and employer-facing measures – previous research with employers has shown a reluctance to recruit people with histories of substance misuse, even when they are otherwise suitable for the role.
Importantly, she also calls for a trial of Individual Placement and Support, a manualised model of employment support that originated in the field of mental health, that is already showing promising results in the few services where it is being used to support people with needs primarily relating to substance misuse. Doing ‘what works’ has a mixed history in the UK; evidence-based policy sometimes gets trumped by expediency or political will. As there is limited ‘what works’ evidence for employment support for people with needs relating to substance misuse, it is to be hoped that the government, in its response to the review, will seize the opportunity to add to the sum of knowledge.
Dame Carol’s report hints at the complexity of needs often found among those with substance misuse problems; this is something we highlighted in our submission. We know that integrated and coordinated support can often be more effective, and we expect more progress to be made more rapidly when this is the case. Dame Carol is right to focus on the role that Jobcentre Plus could play in this, and what they can do to lower the conditionality-related barriers that have sprung up between claimant and work coach.
We also welcome the collective move towards a ‘work first’ approach where employment becomes part of the journey rather than the destination. However, as we argued in our submission, work is not a panacea. While work is still the best route out of poverty, it is a less sure route than it used to be. Similarly, job quality matters. There is some evidence that poor quality jobs are not good for mental health and wellbeing, and may in fact be worse than being unemployed. Many people, when entering or re-entering the labour market, start out in jobs that may not be of high quality, so ensuring the availability of in-work support and help to progress is important.
To conclude, we welcome Dame Carol’s recommendations. The report, backed by high quality analysis by staff at the Department for Work and Pensions and Public Health England, has helped to move the debate on. The challenge now lies with the Government, who will need to respond to the recommendations, with commissioners, staff and managers of local services, who will need to consider how they can be implemented, and finally, with employers. If they are unresponsive and unpersuaded of the business benefits of recruting a diverse workforce, there is the risk that all this will have been for little; we have to aim higher and keep making the case.
