The undercover geographer transforming employment health support
The knotted and complex systems that thread and connect central government, local authorities and members of the public are a daunting territory that’s claimed many a policymaker. And Adam Whitworth, who’s helping government, councils and local authorities design better social policy interventions,
Adam Whitworth’s appraisal of the UK’s social health and employment policy is practised and clear, despite the problems he works on being chiefly defined by their complexity.
“Of the people who are in receipt of out of work benefits about 70 per cent of them would present with some form of health condition. That’s primarily mental health conditions and musculoskeletal conditions – things like bad backs, bad shoulders.” He explains when we meet in his office at the University of Sheffield’s Department of Geography. “And that’s about complexity of support needs if they’ve got multiple issues. If they’ve got health issues, they’ve got housing needs, they’ve got skills, needs, family needs – and more, quite possibly.”
These are people in need, struggling with a system – Whitworth references Ken Loach’s film ‘I, Daniel Blake’ several times in our conversation – and expensive for the treasury. All factors not lost on those in power. “Central government readily admit we need to do better – their phrase – around work health,” he says.
Whitworth’s work is focused on people with moderate to severe barriers to work. There’s plenty of press about how much social welfare costs us in taxes in the UK, but Adam highlights that our spend on supporting people around moving into work and staying in work is about a quarter of countries like Denmark. We like to think of ourselves as comparable to countries like France and Germany. “But actually we’re more comparable with Slovakia or Italy in terms of our spend,” Adam highlights.
Central government readily admit we need to do better around work health.
Dr Adam Whitworth
“On the frontline what that means if you’re out of work and you go to a Job Centre Plus, that work coach has got a caseload of at least a hundred people. Each person gets ten minutes a fortnight and most of that is having to check you’ve done what you need to do to stay in work. I think there’s a widespread view that we need to radically change the way we configure policies and the way people experience policies.”
That radical change has been a new set of principles and systems, or ‘Governance mechanisms’, which aim to assess the best type of support for those who are out of work or struggling in employment due to health problems.
Individual Placement and Support (IPS) is a well-evidenced model for people with severe mental health issues such as schizophrenia or bipolar disorder. “If you’re that kind of person in the UK, you don’t go to a GP. You maybe go through a GP, but you end up in something called a secondary mental health service.” IPS is small volume, specialist provision and it’s internationally effective for people with severe mental health problems. Adam’s research is exploring if it’s possible to take the kernel of that successful model, transplant it out of this niche secondary mental health and put it all the way through to primary care for a far larger and wider range of individuals with low to moderate mental health and/or physical health conditions, who might be in work and struggling or out of work.
Sheffield City Region’s ‘Working Win’ employment trial is the world’s largest randomised controlled trial of IPS, involving the largest pilot of local integration boards worldwide. It’s a massive national flagship programme testing an innovative modified IPS model and Whitworth anticipates it will provide big answers for central government, Treasury and DWP about what the future of health-related support should look like.
So how does being a geographer inform this work? “My background [as a geographer] is in social policy,” Adam says. “I’ve been working here in the Department of Geography for a decade and that’s been enormously advantageous over time because social policy and public policy isn’t a terribly geographic discipline or policy practice.” But partners from Mayoral Combined Authorities to frontline work coaches in Job Centres are benefiting from that insight.
Adam’s integration into a notoriously labyrinthine system sounds comprehensive. “I was intensively embedded into Sheffield City Region for about two years. I went from being an academic here to the centre of a massive health-led employment trial that was a national flagship of the DWP-DH joint Work and Health Unit. And then you’re at the centre of a really big, complicated, high profile, high pressure, potentially nationally transformative project with lots of critical stakeholder engagement.”
What’s it like being a geographer in these kinds of rooms? “It’s great.” Do people look at you sideways? “Yeah, a bit.” How do you deal with that? “You go native, essentially. I think there are two really interesting things there. One is the project management. You have to be able to operate in a very different policy environment, and all that world requires, and that’s not something that academics do or are trained in. But also the academic value added is really critical. The specific and deep knowledge that you take into those policy meetings is, you know, I’ve got – as all academics do – years worth of expertise on an extremely specialist topic. You just don’t have the luxury of that as a policy maker at any tier. You’re so overwhelmed.”
“Academics can be terribly parochial. But if you can find the right academic for the right problem at the right time it’s an absolute godsend, I think policy colleagues would say. And that work-health connection has been a longstanding policy problem. How we better connect the two worlds to help people in the right ways at the right moment, that’s what it’s all about. So that people have better experiences, work and health outcomes from our interventions are better, and Treasury and local budgets see savings. To be in the mix of that as an academic expert and passionate in that terrain was a rare privilege.”
That connection is the focus of Whitworth’s pilot, which is about coordinating support across an ingrained fragmented system – locally and centrally.
“The context in the UK is we’ve got a highly centralised central government,” Adam says. “Department for Work and Pensions is highly centralised. It finds it difficult to collaborate with central government partners and also with local partners, regionally or locally. So my work has been with mayoral command authorities, with local authorities, trying to create a conversation and create interventions.” It’s a complicated, high stakes investigation but Adam’s academic expertise is providing a route through. The map is in his head.
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Whitworth, A and Carter, E (2017) 'Rescaling employment support accountability: From negative national neoliberalism to positively integrated city-region ecosystems', Environment and Planning C: Politics and Space
Whitworth, A (2018) 'Transforming employment support for individuals with health conditions?: 3Cs to the aid of the Work, Health and Disability Green Paper', Journal of Poverty and Social Justice
Whitworth, A (2018) 'Mainstreaming Effective Employment Support for Individuals with Health Conditions: An Analytical Framework for the Effective Design of Modified Individual Placement and Support (IPS) Models', Social Policy and Society, doi: 10.1017/S147474641800043X
Whitworth, A and Murphy, R (2018) Local integration: Harnessing the potential for public policy – A report by the University of Sheffield in collaboration with the Mayoral Combined Authorities and Core Cities.
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