Title page
Contents
Foreword by Professor Dame Carol Black 5
Executive summary 7
Part 1 - Drugs and alcohol: employment outcomes, the benefits system and the role of employers 17
1. Improving the employment outcomes of drug and alcohol dependent people: the role of treatment 18
Introduction 18
Substance misuse treatment services 20
The role of employment in recovery and current employment outcomes 23
The employment ambition 26
Delivering the ambition 30
The Individual and Placement Support approach 31
Housing and the criminal justice system: two other critical elements in recovery 35
2. Improving employment outcomes for drug and alcohol dependent people: the role of the benefits system 37
Introduction 37
Numbers and characteristics of alcohol and drug dependent claimants in the benefits system 37
Identification and disclosure of dependence within the benefits system 38
Self-disclosure 40
Enhancing the support offer for drug and alcohol dependent people 43
The Work Programme and other support 45
Universal Support 46
Conclusion 46
3. The role of employers: in recruitment, support and prevention 47
Introduction 47
Prevention 47
The importance of preventative action 48
Recruitment of drug and alcohol claimants 49
The challenge for employers 51
Recruitment practices 51
De-risking recruitment decisions 53
Conclusion 55
Part 2 - Obesity, employment outcomes and the benefits system 58
4. Obesity, employment outcomes and the benefits system 59
Introduction 59
Obesity prevalence 59
Obesity as a risk factor for physical and mental health conditions 61
Future increasing prevalence 62
The impact of obesity on unemployment and the benefits system 62
Obesity in the benefits system 63
Obesity treatment 63
The impact of obesity in work 64
Sickness absence and productivity 64
Stigma and wage penalty 65
The role of healthy workplaces 67
Conclusion 68
5. Review conclusions 69
Linking benefit entitlement to treatment 69
Other recommendations 70
Annex A. Glossary of key terms 72
Annex B. Review terms of reference 78
Annex C. Summary of recommendations 80
Annex D. Analysis of employment status and outcomes of individuals in contact with the substance-misuse treatment system 83
Annex E. Analysis of benefit data 106
Annex F. Analysis of obesity data 112
Annex G. High level costs and benefits for key recommendations 126
Annex H. Summary of the submitted evidence 136
Annex D. Analysis of employment status and outcomes of individuals in contact with the substance-misuse treatment system 94
Table 1. Employment outcomes at six and twelve months, and discharge 94
Table 2. Associations between employment at treatment start and successfully completing treatment 96
Table 3. Associations between baseline covariates and full-time employment at treatment discharge 97
Table 4. Associations between an increased likelihood of opiate clients gaining employment during treatment 100
Table 5. Associations between an increased likelihood of non-opiate clients gaining employment during treatment 101
Table 6. Associations between an increased likelihood of alcohol only clients gaining employment during treatment 101
Table 7. Associations between time on benefits and likelihood of gaining employment 102
Table 8. Main disabling condition of individuals in drug or alcohol treatment and the overall ESA/IB/SDA population in England, February 2012 104
Table 9. A breakdown of the 'Mental and behavioural disorders' for individuals claiming ESA/SDA/IB in drug or alcohol treatment in England, February 2012 104
Table 1. Published population statistics of ESA and IB/SDA claimants: February 2015 106
Table 2. Subset of population in Table 1: number of ESA, IB/SDA claimants with live claims aged 23-59 in February 2015 107
Table 3. Duration of individual claims to DWP main working-age benefits between 2010 and 2015, by those with an MDC of alcoholism and drug abuse 108
Table 4. Cumulative duration on DWP main working-age benefits between 2010 and 2015, by those with an MDC of alcoholism or drug abuse 108
Table 5. Duration of claims to ESA/IB/SDA, JSA and IS between 2010 and 2015, by those with an MDC of obesity 111
Annex G. High level costs and benefits for key recommendations 128
Table 1. Support Group claimants: benefit and costs (net of programme costs) of moving an ESA Support Group claimant into employment 128
Table 2. WRAG claimants: benefit and costs (net of programme costs) of moving an ESA WRAG claimant into employment 129
Table 3. Number of participants for the IPS proposal 130
Table 4. Estimated benefits in the first year of each trial 134
Table 5. Cost estimates for a named responsible office per district 135
Table 6. Total cost of the Jobcentre Plus support offer proposal 135
Annex D. Analysis of employment status and outcomes of individuals in contact with the substance-misuse treatment system 86
Figure 1. Clients in contact with the treatment system in 2014/15, and those included in analyses 86
Figure 2. Year of treatment commencement, for those in contact during 2014/15 87
Figure 3. Referral sources into treatment 87
Figure 4. Proportion of individuals reporting paid work at the start of treatment 88
Figure 5. Proportion of clients in any employment by financial year of treatment start 89
Figure 6. Proportion of CJS clients in any employment by financial year of treatment start 89
Figure 7. Regional variations in employment at the start of treatment 90
Figure 8. Associations between covariates measured at the start of treatment and full-time employment in opiate clients 91
Figure 9. Associations between covariates measured at the start of treatment and full-time employment in non-opiate clients 92
Figure 10. Associations between covariates measured at the start of treatment and full-time employment in alcohol clients 93
Figure 11. Proportion of individuals employed by discharge status 95
Figure 12. Associations between employment at treatment start and successfully completing treatment 96
Figure 13. Five-year latent class growth analysis of employment in opiate users that had been in treatment for five years plus or who were in treatment on the 31st March 2015 99
Figure 14. Number of individuals in England claiming ESA/IB/SDA with a main disabling condition of drug abuse and alcoholism and their treatment status, 29 February 2012 103
Annex E. Analysis of benefit data 109
Figure 1. Duration profiles in Table 4 by working-age benefit for those with an MDC of alcoholism or drug abuse 109
Figure 2. Number of JSA claims made by the cohort (Table 2) over the five year period 110
Figure 3. Cumulative period not claiming any one of DWP's working-age benefits, for those with an MDC of alcoholism or drug abuseImage 110
Annex F. Analysis of obesity data 113
Figure 1. Obesity and overweight in OECD and non-OECD countriesImage 113
Figure 2. Obesity prevalence by gender 114
Figure 3. Obesity prevalence by age 114
Figure 4. Obesity prevalence by region 115
Figure 5. Obesity prevalence by deprivation quintile 115
Figure 6. Economic activity status by BMI group 116
Figure 7. Breakdown by deprivation quintile 117
Figure 8. Breakdown by highest qualification 118
Figure 9. Gender split within each of the six named groups 119
Figure 10. Breakdown by age group 120
Figure 11. Proportion reporting top most common long-standing health conditions by BMI group 121
Figure 12. Number of health condition reported by BMI groups 122
Figure 13. Breakdown of other prevalent health conditions among the obese group subject to QA, February 2015 123
Figure 14. Predicted trend: prevalence of overweight and obese adults in the UK 124
Figure 15. Direct NHS costs avoided if prevalence of overweight and obesity was reduced by 1 per cent below predicted trend 125