Health-Related Worklessness in Wirral: Barriers, Opportunities and Service Transformation

This research looked at how to make people in Wirral healthier and happier by tackling problems in service delivery around work and wellbeing. Using ethnography, the research focused on people who receive Employment Support Allowance, the challenges they face, and what helps them feel ready for change. The research also explored how where people live affects their choices. The insights helped to inform service redesign and investment strategies to reduce health inequalities and improve outcomes for residents.

Insights gathered: January 2015 - December 2015

• Mental health and wellbeing
• Physical health and wellbeing
• Work and employment
• Benefit conditions/changes
• Experience of service provision
• People living with physical disabilities

Insights gathered by

Revealing Reality

Aim

This research was jointly commissioned by Wirral Council’s Public Health and Regeneration teams. The research aimed to understand why health-related worklessness persists in Wirral and identify practical ways to improve health, wellbeing, and employment outcomes. The aim was to engage with people who receive Employment Support Allowance (ESA) to understand their challenges and how the place where they live impacts on their motivation to change.

People engaged with

The research engaged over 150 residents, including ESA claimants, unemployed individuals, and non-claimants. Participants represented diverse ages, backgrounds, and communities across Wirral. The research also engaged with local group leaders, service providers and frontline staff.

Methods

An ethnographic approach was used, combining semi-structured interviews and place-based observation.

The methods included:

• Over 20 ethnographic interviews with residents.

• Over 25 place-based ethnographies, including attending groups and services.

• Stakeholder interviews.

Key insights

The research identified the following key themes around barriers to health and work-related services:

• Overly basic support: Setting activities and programmes at the lowest common denominator means that some individuals are not challenged, with their ability and/or health only maintained rather than improved. Content may even patronise and deskill individuals. It could also deter people from accessing further support.

• Unrealistic Goals: Regarding health and wellbeing, many individuals could not see themselves engaging in fitness or sport or could not see how they could fit in it to their life. With little idea of how and/or motivation to take first steps, goals felt unachievable.

• Confusing service provision and messaging Service users found it difficult to understand what is available to them. Navigating the landscape of different brands and offers, and understanding what they may be eligible for can feel impossible. This can lead to individuals missing out on services and support that could be helpful.

• Perverse Incentives Claimants were so worried about being judged ‘work-ready’ in the Work Capability Assessment that they had stopped enjoying any aspect of their life (or hid enjoyment) in order to fully embody what they understood as expected of an ‘ESA claimant’. This had negative implications for individuals’ sense of self-worth and confidence, and interaction with others.

• Social Isolation The absence of connection and increased isolation can have a significant impact on mental health, reducing confidence and self-belief. ESA claimants suffered from focussing on how they might be perceived by others - as a ‘benefits scrounger’, without interesting experiences to talk about - and this led them to retreat from social situations further. Some health conditions left individuals housebound. • Mental Health Problems were often going ‘untreated’ or treated only with medication. Few people had contact with mental health services. Some individuals had experienced their mental health problems worsen before reaching a point of crisis, and only then received treatment.

• Demotivation The research found that some individuals were very quick to blame outside factors for their lack of success and had a lack of awareness of more internal barriers. By focussing on external barriers, individuals can reason their self-limiting behaviour and divert their attention away from their low self-confidence.

 

The research identified the following opportunities for progression:

Service factors – provision aimed at different abilities, steady progression, navigable services, and incentivising health and healthy behaviours.

Personal factors – connection with others, positive outlook and wellbeing, and sense of responsibility and motivation.

 

The research identified nine ideas to investigate further:

1. Supporting non-mental health experts to deliver mental health support.

2. Finding ways to promote social mixing and enable the development of social capital.

3. Professional nourishment – helping the frontline to stay hopeful.

4. Ensuring support is tailored & future focussed, ambitious & integrated.

5. Lobbying central government and politicians, where central government is in the way.

6. Professional friendship makers & passion fuellers (for example community organisers).

7. Ensuring health and fitness is built into other service provision.

8. Making use of ‘children’ as effective agents of change.

9. Creating a mechanism within the commissioning process to help acknowledge the scale & extent of problems (as opposed to professional defensiveness).

Quotes

“Being out of work slows your brain. It messes your body up - you’re out of whack because your routine ends. It becomes hard to focus on things.”

“Trying to articulate to someone that moving forwards is positive and not scary is one of the hardest things.”

How have the insights been used/shared?

The immersive approach enables Wirral Council to understand the individuals behind the statistics of health-related worklessness – seeing first hand hoe individuals were stuck in a cycle of demotivation, isolation and low-level mental health problems – while services inadvertently exacerbated these problems. The stories of real people catalysed a Wirral-wide innovation process, resulting in the commissioning of two new services aimed at addressing the problems raised by the research. 1. Move On-Up Programme: providing non-therapeutic interventions to improve low mood and anxiety for people out of work due to health-related issues. 2. Connect Us: launched to support people to overcome social isolation and become active in the communities.

Online links

https://www.wirralhealthwellbeingknowledgehub.co.uk/media/ujddcy2b/final-wirral-toolkit-1d.pdf