Plotting a course towards the labour market: Navigating the results of the Health-led Employment Trials
22 May 2023
Becci Newton, Director, Public Policy Research
The Health-led Employment Trials (HLTs) tested new support for individuals struggling to get into, or get on, in the labour market: Individual Placement and Support (IPS). IPS is a well evidenced intervention with numerous high-quality studies finding it to be effective in achieving employment outcomes for groups with high needs - and some evidence points to employment resulting from IPS leading to improved health. As their USP, the HLTs took this intervention into primary and community care settings to test the effect for people with mild-to-moderate mental health and/or physical health conditions and impairments.
The evidence that ‘good’ work is beneficial for physical and mental health (and unemployment and long-term sickness absence often have a harmful impact), is longstanding (Marmot and Bell, 2012). The Black Review (2008) – Working for a Healthier Tomorrow recognised that work, health and wellbeing, are closely linked and need to be addressed together. The costs to society, individuals, government and the economy from absence from the labour force due to ill health were - and remain - sizeable. The trials aimed to test whether IPS could close this gap and achieve better outcomes through guiding participants into ‘appropriate’ work well-matched to their capabilities.
In the end-stage quantitative impact evaluation, 12-months following randomisation, employment, health and wellbeing outcomes were reviewed.
Evidence of impact
Table 1 shows the impacts of the trials which varied between the sites – West Midlands Combined Authority (WMCA) and Sheffield City Region (SCR). There was a strong statistically significant positive effect on sustained employment in WMCA, and a weaker and slightly smaller positive effect on the in-work group in SCR. However, the OOW group in SCR experienced poorer employment outcomes than seen by the control group. This was not statistically significant which means it may have occurred by chance.
In contrast, health and wellbeing outcomes were stronger in SCR than in WMCA, with a strongly significant positive effect on wellbeing for the SCR IW group and a less strong but still positive effect for SCR OOW. This presents a challenging picture with the two trials achieving different types of outcomes with limited overlap and our report considers the reasons why this might be the case.
However, what these figures do not reveal is whether the treatment group secured better quality work than the control group and whether in turn that was good for their health. For this, we turn to the analysis of the final survey.
Table 1: Summary of final impacts at 12 months
|
|
Employment |
Health |
Wellbeing |
|
WMCA |
4ppt *** |
0.05 sd |
0.9 sd |
|
SCR IW |
3ppt * |
0.10 sd |
0.18 sd *** |
|
SCR OOW |
-2ppt |
0.10 sd |
0.12 sd * |
Note: Bold indicates impact; asterisks indicate level of confidence/significance associated with impacts: * 90%; ** 95%; *** 99%; ppt = percentage points; sd – standard deviations (The extent to which an outcome varies. An impact of one sd would move the average person from the 50th percentile of the distribution for that outcome to the 84th percentile. An impact of 0.1 or 0.2 sds would move the median individual from the 50th percentile to the 54th or 58th percentile). Employment and earnings outcomes derived from national administrative datasets; health and wellbeing outcomes derived from the final survey, at 12 months following randomisation.
Evidence of the effect of good work on health
The final survey captured whether people were in employment 12-months following randomisation and where they were, asked about the quality of work, whether it was well matched and overall job satisfaction.
For job quality, a question from Workplace Employment Relations Study (WERS) explored influence over the tasks; pace of work; approach to work; the order of tasks; and the start or finish of the working day. The evidence was not hugely compelling. The results on most factors did not indicate any significant difference between the trial groups. Respondents in WMCA indicated greater influence over the hours they worked than those in SCR but further analysis showed there was no statistically significant difference between the WMCA treatment and control groups, which suggested the trial did not create this effect.
The picture on job match was also not statistically significant. In most cases, the treatment group was more likely to report their job matched their skills and interests ‘a lot’ or ‘somewhat’ compared to the control group, but the difference was only statistically significant for the SCR IW group.
The question on job satisfaction yielded greater differentiation with SCR IW respondents having the lowest job satisfaction with their jobs, nonetheless a statistically significant effect where the SCR IW treatment group was more satisfied than the control group. Hence the trial had an effect either through helping to ‘develop’ their existing jobs to better suit their capabilities or helping them to secure alternative work.
Separate to job quality, the survey explored whether working had a positive effect on health condition management. Across all trial groups, the treatment group was more likely than the control group to report that work made managing health conditions easier, with a statistically significant effect found for the SCR IW group.
The trial data is a rich source of information, and it will be possible for researchers in the future to use it to generate further insights into the relationship between work and health, and with job quality. The positive impacts on health and wellbeing in SCR generally appear to stem from the relationship with the employment specialist, where management information showed a pattern of meetings potentially more conducive to health discussions. It is a complex set of results that will benefit from further examination.
Source: Final evaluation data set
With thanks to Professor Richard Dorsett (University of Westminster) and Dan Muir (IES) for the impact findings; and Joe Crowley and colleagues at NatCen Social Research for the final survey research.
Any views expressed are those of the author and not necessarily those of the Institute as a whole.
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 Becci Newton
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