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A new deal for welfare

Lynn Young
Primary Healthcare Adviser for the RCN

Many of us within the world of healthcare anticipate that 2007 will be just as challenging as 2006, and while ministers in England have announced that there will be no more reorganisation, the pressure is well and truly on primary care trusts to divest themselves of community services. Energy, experience and expertise is to be focused on PCT personnel commissioning services, in line with bringing health services closer to home, further financial control - the books must balance - and improved public health and better prevention of disease.
For the last six months the top NHS priority has been that of diminishing financial deficits, so any implementation of the white paper Our Health, Our Care, Our Say has been insignificant.(1) The hope is that as the books begin to become painfully balanced there will be more capacity enabling the white paper policy to translate into new community services. So, although ministers preach the message of more stability in the system, achieving just some of the white paper recommendations will take a level of reconfiguration, ambition, talent and courage.

Incapacity benefits
But, let's move away from the English DH and towards the UK Department of Work and Pensions (DWP). Did you know that we currently have 2.6 million people on incapacity benefits, meaning that they are considered by the state and themselves to be too sick to work? This time last year the DWP issued a green paper titled A New Deal for Welfare: Empowering People to Work.(2) The RCN responded to this document and, as this NIP edition goes to print the white paper is expected to land on our RCN desks.
The government is determined to reduce the number of people claiming incapacity benefits by putting new services in place aimed at helping people who have been considered too sick to work, reclaim their health and confidence and be gently - but successfully - returned to the world of work and the payment of income tax!
New Deal and Jobcentre Plus are to receive record investment and will fund trained people to dedicate themselves to working with individuals with the aim of building enough confidence so they feel able to once more become a member of the labour market.
It is often the case that people cannot return to their previous line of employment, but with imagination and flexibility they are well able to find a suitable job that holds the potential of vastly improving their quality of life and personal health.
Discussion will take place in the near future on how the job centres can engage better with general practice on this initiative. Many practices already record their patients receiving incapacity benefits so we can expect these to be ahead of the game in terms of working in a thoroughly integrated way with job centre personnel and clients.

Long-term unemployment
We know only too well about the negative impact that long-term unemployment has on the health of individuals and their families. It is not uncommon for some families to have now been through three generations where the only experience of work is being tied into the benefit system.
A minor revolution needs to take place so that our prosperous nation is well placed to support people who truly need state help and rehabilitate those who have been sick but who are able to become well with the right support. Employment can be health enhancing in many ways. Most of us need an income in order to live well and positive aspects of work bring social interaction, good friends, a sense of purpose, wellbeing and raised self-esteem. In many ways good working environments induce health rather then cause ill health.
The worlds of occupational health, job centres and general practice need to blend during 2007. If this ambition succeeds, we may well see a full-blown cultural shift from the world of welfare and dependency to one of health, self-reliance and
gainful employment.


  1. Department of Health. Our health, our care, our say. London: DH; 2006.
  2. Department of Work and Pensions. A new deal for welfare: empowering people to work. London: DWP; 2006.