Remploy project helps people in pain to gain work experience placements

A project involving Remploy and a general hospital is finding work placements for people whose lives are blighted by pain every day, reports Vern Pitt

Remploy adviser Karen Parkinson with client (pic: Hugh Nuit)


Project details

Project name: Remploy individual placement and support scheme, Southampton

Aims and objectives: To help pain sufferers find or retain work

Numbers of service users: About 60 at any one time

Number of staff: Two employment advisers

Annual cost: £95,000

Why not try reading this article while someone in football boots stands on your hands? That’s precisely how disabled people at Southampton General Hospital’s pain clinic have to go about their daily lives.

It’s hardly surprising that many struggle to hold down a job – some have been without one for years. But now a Remploy team of employment advisers is trying to address the needs of this group by embedding themselves within the clinical team.

“Before Remploy started working here we were seeing people on the cusp of losing their job because they were just not up to working due to the condition they were in,” says Dr Kathy Price, a consultant at the clinic.

Although the pain, which is usually caused by illness or injury, can be managed, it will never go away entirely and usually fluctuates from day to day.

Price was frustrated with the employment support provision on offer because providers would say the patients sent to them were not fit to work yet.

“The employers didn’t understand the patient’s issues and we didn’t understand the employers’ issues.”

Staff at the local Remploy centre, who shared a handful of clients with the clinic, also identified a gap in the market and the organisation approached Southampton University Hospitals NHS Trust about embedding staff to provide specialist employment support. The plan was to adapt a model called individual placement and support (IPS) for pain sufferers, with whom it had never been tried.

IPS has already been rolled out to some mental health teams across the country. It involves placing employment support specialists in clinical teams, making employment a core part of clients’ care plans and providing ongoing support for as long as necessary.

Many patients with pain also have mental health issues. Depression is a common side-effect of the pain and its associated isolation, something that unemployment can exacerbate. “It’s a loss of the person they once were, coupled with a loss of the person they wanted to be,” says Karen Parkinson, one of two employment advisers within the team.

Since they started taking referrals in May 2010, Parkinson and her colleague have helped at least 18 people remain in work where otherwise they would have fallen out of employment. They have also moved many more out of work closer to the job market.

She says that her clients wouldn’t access employment support if she wasn’t based within the hospital. “Sometimes they are frightened that if they disclose to their employer that there’s a problem they will lose their job,” she says. “They often don’t know that they have any rights – people don’t really class themselves as disabled.”

Parkinson provides support finding employment placements, liaising with employers, preparing for interviews or writing CVs.

Alongside this, she is often used by clients to offload problems they are having both with employment and other relationships. Although she is clear about the boundaries of her role she says that being based in a clinical team and subsequently receiving supervision from clinical staff is crucial to allowing this to work.

“A lot of the time you are coming across quite deep psychological issues and to hold that on your own is a lot,” she says. “But to have someone to go and discuss it with is valuable – not only for your own mental health but to make sure you are dealing with that patient in the right way.”

Parkinson and her colleague also run a job support group once a week, which is key to building users’ confidence. “The group for some people is a chance to come and join the human race for a day,” Parkinson says.

Remploy staff say that the NHS badge gives them greater weight with employers. A lot of stigma is attached to pain conditions and some employers are reluctant to accept it as a genuine problem, says Parkinson.

There are advantages for the NHS too. “We are having people who were highly distressed become less distressed,” says Price. “Before, people wanted us to fix their pain but now they have a more realistic outlook, which has decreased our workload.”

Jo Cohen, regional service operations manager at Remploy, wants more early intervention projects to be set up, but there is one problem. “Because it’s new it’s not something that people are putting out tenders for,” she says. “Also, there isn’t a natural pot of money for it to come from. It’s not something social services would usually fund. We’ve been asking the health trust we are working with if they could fund it if we walked away, and they’ve said no.”

Currently, the project is funded through Remploy’s contract for the government’s Work Choice programme but, because pain patients are often far from the labour market, it is expensive – £95,000 a year, according to Cohen’s estimates.

Whether it is viable to fund the project through the Work Choice programme is unclear but Cohen already has her eyes on another possibility – for the proposed NHS regional trauma centres to step in.

Case study: ‘I was like a wounded animal until I went to the pain clinic’

In 1994, Julian James* was working in a timber mill when his left hand was sucked into his machine. It damaged the tops of two fingers and his palm so badly that doctors contemplated amputating his hand.

“They did save my hand but as the years went by the pain became unbearable,” he says.

He describes the worst pain as like his arm splitting open and his finger joints burning. Unable to do manual labour, he found himself in and out of work for more than 10 years as the pain fluctuated. The lack of income strained his relationship with his partner, which contributed to his depression.

Two years ago he was referred to Southampton’s pain clinic, and then the Remploy team. “It was the first time that anyone had acknowledged I had a problem,” he says.

Remploy supported James to claim benefits and organised voluntary work to add to his CV. Before he went to the pain clinic James says he was aggressive and antisocial, “like a wounded animal”. He says Remploy’s support has been instrumental in building his confidence and gaining a “more hopeful” outlook.

That positivity led him to find a job delivering papers so he could gain a reference. He has ambitions to become a computer engineer and will soon start a course.

James describes the service Remploy and the pain clinic provide as his lifeline. But he worries about its future: “If national cuts mean they pull the plug on everything, then I’d be devastated.”

* Name has been changed

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