The Black Review

Last week (5 December 2016) Professor Dame Carol Black published her Independent review into the impact on employment outcomes of drug or alcohol addiction, and obesity. In the foreword, she describes the purpose of the review:

At the heart of this Review is a concern to ameliorate the human, social and economic cost of drug or alcohol addiction or obesity, by addressing the challenges in finding work facing people who are affected. The aim is not to offer utopian solutions to deeply complex problems, but rather to offer, as far as possible, an evidence-based analysis of the factors that stand in the way of employment. We recommend practical interventions, including changes in services, practices, behaviour and attitudes. Whilst drug and alcohol addiction have common features, obesity is different and is treated separately.

Findings and Recommendations

A key element of the review was an assessment of treatment services which produced a strong, critical finding:

Fractured commissioning responsibilities and lines of accountability can make co-ordinated action challenging. Yet it is only by working together across these boundaries that improved recovery outcomes, including jobs, can be achieved for people with a drug and/or alcohol dependence.

The review repeatedly talks of the importance of integrating employment, housing and skills support within a treatment package, stating that “few who enter treatment without work find it during or after treatment”.

A number of key recommendations flow from this view:

• We therefore recommend the introduction of an expanded recovery measure that includes work and meaningful activity (including volunteering) alongside successful treatment completion. Measuring meaningful activity steps can represent important steps back towards a job, but should be subordinate to an overall job outcomes ambition. We recommend that this be reflected in revised UK guidelines on the clinical management of drug misuse and dependence. We also recommend improving treatment and Jobcentre Plus data to help local Jobcentres and treatment services target, deliver and benchmark their efforts to find work for these groups.
• Improved performance metrics for providers that include work must be backed by a high-quality offer of employment support within treatment services. That is why we recommend trialling several Individual Placement and Support (IPS) approaches and the co-location of Jobcentre staff in treatment centres. This would provide unemployed people in treatment with individual advice and support to find a job, and ongoing support once in work.

The review is brave enough to highlight “many failings” in the benefit system and again makes some key recommendations:

• Improving the identification of addiction in benefit claimants by developing information sharing between treatment and health providers and the DWP.
• Considering a requirement for all claimants to attend an assessment with a health professional early in their benefit claim.
• JobCentre Plus to trail peer mentors for claimants with addiction problems.
• An enhanced JobCentre Plus offer to claimants with drug and alcohol problems with: “a greater number of work-based options for staff to refer claimants to. This offer must be underpinned by upskilling delivery staff, improving accountability, and maintaining links to drug and alcohol treatment services.”

The review also focuses on the role of employers, in particularly making it less risky for them to employ people with drug and alcohol misuse problems by including work support within the proposed Individual Placement and Support service described above.

Conclusions

The review highlighted three areas where action is needed on addiction and employment:

1. Addiction treatment does not, in itself, ensure employment, though it brings other social gains. Work has not hitherto been an integral part of treatment, and it needs to be if progress is to be made.
2. The benefits system, which has a central role in helping people enter or return to work, requires significant change. The system is hampered by a severe lack of information on health conditions, poor incentives for staff to tackle difficult or long-term cases, and a patchy offer of support for those who are reached.
3. Employers are the gatekeepers to employment and, without their co-operation employment for our cohorts is impossible. Employers are understandably reluctant to hire people with addiction and/or criminal records. They have told us that they need Government, quite simply, to de-risk these recruitment decisions for them.

This report enhances Professor Black’s reputation with its relentless focus on identifying key barriers and looking for practical ways to overcome them. She clearly sees an important role for government in providing dedicated support for drug and alcohol users engaged in recovery journeys.