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Open Access Research article

Assembling the evidence jigsaw: insights from a systematic review of UK studies of individual-focused return to work initiatives for disabled and long-term ill people

Stephen Clayton1*, Clare Bambra2, Rachael Gosling3, Sue Povall1, Kate Misso4 and Margaret Whitehead1

Author Affiliations

1 Division of Public Health, University of Liverpool, UK

2 Wolfson Research Institute, Durham University, UK

3 Public Health Directorate, NHS Sefton, UK

4 Kleijnen Systematic Reviews Ltd., UK

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BMC Public Health 2011, 11:170  doi:10.1186/1471-2458-11-170

Published: 21 March 2011

Abstract

Background

Employment rates of long-term ill and disabled people in the UK are low and 2.63 million are on disability-related state benefits. Since the mid-1990 s, UK governments have experimented with a range of active labour market policies aimed to move disabled people off benefits and into work to reduce the risk of poverty and social exclusion. This systematic review asks what employment impact have these interventions had and how might they work better?

Methods

A systematic review of observational and qualitative empirical studies and systematic reviews published between 2002 and mid-2008 reporting employment effects and/or process evaluations of national UK government interventions focused on helping long-term sick or disabled people (aged 16-64) into the open labour market. This built on our previous systematic review which covered the years 1970 to 2001.

Results

Searches identified 42 studies, 31 of which evaluated initiatives with an individual focus (improving an individual's employability or providing financial support in returning to work) while 11 evaluated initiatives with an environmental focus (directed at the employment environment or changing the behaviour of employers). This paper synthesises evidence from the 31 studies with an individual focus. The use of personal advisors and individual case management in these schemes helped some participants back to work. Qualitative studies, however, revealed that time pressures and job outcome targets influenced advisors to select 'easier-to-place' claimants into programmes and also inhibited the development of mutual trust, which was needed for individual case management to work effectively. Financial incentives can help with lasting transitions into work, but the incentives were often set too low or were too short-term to have an effect. Many of the studies suffered from selection bias into these programmes of more work-ready claimants. Even though these were national programmes, they had very low awareness and take-up rates, making it unlikely that a population-level impact would be achieved even if effective for participants.

Conclusions

The evidence reveals barriers and facilitators for the effective implementation of these types of interventions that could inform the continuing welfare reforms. The evidence points towards the need for more long-term, sustained and staged support for those furthest from the labour market.