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A busy day for multiple and complex needs

A busy day for multiple and complex needs

The last 12 months have been exceptional by any standards. Since the referendum in June 2016 on the UK’s membership of the European Union, much has changed in central government. There have been wholesale changes at every ministerial level, and while the civil service has been diligently working away across the piece, the programme of government has inevitably been affected. Places on the famous Downing Street grid (the timetable through which major policy announcements are coordinated) has become more scarce and more insecure than in recent memory.

It might be related to this that a slew of documents and resources relevant to the Revolving Doors group were published today: one from Public Health England (PHE) and three from the Department for Work and Pensions (DWP). I thought it might be useful to provide a quick overview of them here.

Public Health England: Estimates of alcohol dependence in England, including estimates of children living in a household with an adult with alcohol dependence

The National Treatment Agency (the special health authority that was folded in to PHE in 2013) used to produce regular estimates of the prevalence of opiate and/or crack cocaine use down to local authority level. These estimates were useful not only for planning, commissioning and providing local services, but also for researchers, analysts and others with an interest in the topic. Producing the same kind of estimates for alcohol misuse has always been seen as more complex and, potentially, more contentious – for a number of reasons, data on alcohol consumption and dependence may require more careful, or at least different interpretation to those on opiate and crack cocaine misuse.

Now, academics from the University of Sheffield and University College London have done just that, producing the first robust local authority level estimates of dependence for PHE. It is available here, and is accompanied by data tables here. After a break of several years, new prevalence estimates for opiate and crack cocaine misuse are expected later this year.

Department for Work and Pensions: Improving lives: helping workless families

This policy is intended to shape and inform phase two of the Troubled Families initiative. The evaluators of phase one of Troubled Families famously struggled to find any evidence of progress against the programme’s key outcomes, although some positive process and other qualitative outcomes were identified.

Helping workless families recasts Troubled Families more in the direction of a labour market programme, although one which will pay particular heed to the types of needs and disadvantages that are associated with worklessness and worse outcomes for children. Beyond that, there are proposals around the involvement of Jobcentre Plus in local strategic boards such as Health and Wellbeing Boards, and around taking some of the proposals contained in Dame Carol Black’s recent review of substance misuse and employment forward. The policy document is available here, and is supported by a substantial evidence and analysis pack here.

Department for Work and Pensions: evaluation of the Work Programme drug and alcohol pilots

These pilots, delivered within the existing Work Programme, were announced by the former Secretary of State for Work and Pensions in early 2013. The two pilots tested different approaches to supporting people affected by substance misuse into employment, one varying the Work Programme payment model, the other on supporting the close cooperation between employment support provider and treatment provider which should, at least in theory, have been a feature of the programme from the start. The pilots remained low profile while they ran (including to the people who were tasked with delivering them, from my experience) and met with limited success. The evaluation is strongly focussed on aspects such as implementation, barriers and distance travelled, hard outcomes are largely absent, which seems surprising in a payment by results model. However, while learning what does work is the holy grail, learning what doesn’t can also be illuminating, and DWP should be commended for commissioning and supporting the pilots and the evaluation. The pilots enabled a number of different components to be tested, including the idea that providers respond to financial incentives in the way one would expect. The evaluation is available here.

Department for Work and Pensions: Drug and alcohol addiction, and obesity: effects on employment outcomes: claimants' views

While the main report of Dame Carol Black’s review into substance misuse, obesity and employment surprised many by not being published until December 2016, the companion volume of claimants’ views had to wait until April to be published. This report is based on the findings of interviews with a relatively small number of people affected by substance misuse, and smaller numbers again of people affected by obesity, and treatment staff. The findings certainly ring true – that dealing with Jobcentre Plus can be difficult, that people recognise the importance of employment, but that the obstacles in the way, whether personal or structural, should not be underestimated. Participants valued long term support and the involvement of peer support and/or mentors. The report is available here