In England and Wales, between October 2015 and December 2016, 59 per cent of individuals who were referred and discharged received an assessment according to management information. Forty-one per cent did not receive an assessment and therefore disengaged with the service pre-assessment. In Scotland, 55 per cent of referred employees received an assessment, with 46 per cent not, indicating a slightly higher pre-assessment drop-out rate in Scotland than in England and Wales (Table 4.1). Discharge reasons, including pre-assessment drop-out, are explored in detail in Chapter 5.
Table 4.1 Did referred employees receive an assessment?
Categories England and Wales Scotland
N Col
% N Col
%
Received an assessment 4,984 59 554 55
Did not receive an assessment 3,502 41 463 46
Total 8,486 100 1,017 100
Source: English and Welsh management information, Scottish management
information, clients referred and discharged October 2015 – December 2016.
There was a statistically significant difference by referral route into the service and the likelihood of receiving an assessment, with employees referred by an employer more likely than those referred by GPs to receive an assessment. The majority of employees referred by employers, both in England and Wales, and Scotland received an assessment (65 per cent, and 60 per cent respectively). In contrast, the majority of employees referred by their GP did not receive an assessment (55 per cent in England and Wales and 53 per cent in Scotland) as shown in Table 4.2 and Table 4.3 below.
Table 4.2 Did referred employees receive an assessment? (By referral route, England and Wales)
Categories Employer GP All
N Col
% N Col
% N Col
%
Received an assessment 3,701 65 1,283 45 4,984 59
Did not receive an assessment 1,965 35 1,537 55 3,502 41
Total 5,666 100 2,820 100 8,486 100
Source: English and Welsh management information, clients referred and discharged October 2015 – December 2016.
Table 4.3 Did referred employees receive an assessment? (By referral route, Scotland)
Categories Employer GP All
N Col
% N Col
% N Col
%
Received an assessment 341 60 213 47 554 55
Did not receive an assessment 213 40 237 53 463 46
Total 567 100 450 100 1,017 100
Source: Scottish management information, clients referred and discharged October 2015 – December 2016.
Among those employees who received an assessment in England and Wales, GPs referred a higher proportion of cases experiencing mental health conditions than were referred by employers, (34 per cent compared with 21 per cent) whereas employers referred a higher proportion of cases with ‘other’ health conditions (28 per cent compared with 16 per cent) (Table 4.4). A similar pattern was found in Scotland, where among those who received an assessment, GPs also referred a higher proportion of individuals experiencing mental health conditions than employers.
Approximately 40 per cent of those referred by their GPs were experiencing mental health conditions, compared to 27 per cent of those referred by their employer, although in both instances, mental health was the most common health condition (Table 4.5).
Table 4.4 Types of health conditions, diagnosed at assessment (By referral route, England and Wales)
Categories Employer GP
N Col
% N Col
%
Mental Health 767 21 418 34
Musculoskeletal conditions 987 27 276 23
Other 1,026 28 196 16
Mental Health & MSK 263 7 109 9
Mental Health & Other 362 10 150 12
MSK & Other 158 4 44 4
MH, MSK & Other 63 2 34 3
Total 3,626 100 1,227 100
Base: All assessed and identified with one or more health condition (N=4,853).
Source: English and Welsh management information, clients referred, assessed and discharged October 2015 – December 2016.
Table 4.5 Types of health conditions, diagnosed at assessment (By referral
Mental Health 86 27 79 40
MSK 57 18 28 14
Other 78 25 34 17
Mental Health & MSK 28 9 16 8
Mental Health & Other 34 11 26 13
MSK & Other 35 11 16 8
Total 318 100 199 100
Base: All assessed and identified with one or more health condition (N=517).
Source: Scottish management information, clients referred, assessed and discharged October 2015 – December 2016.
There was a statistically significant relationship between the ages of referred employees and whether or not they participated in an assessment in England and Wales. Employees in older age groups were more likely than those in younger age groups to receive an assessment. In England and Wales those aged 16-24 were fairly evenly split with 49 per cent receiving an assessment, and 51 per cent not receiving an assessment. This compared to 63 per cent of employees aged 55-64 and 59 per cent of employees aged over 65 receiving an assessment (Table 4.6). The age differences in Scotland were not statistically significant, but are included in Table 4.7 for comparative purposes.
Table 4.6 Did referred employees receive an assessment? (By age range, England and Wales)
Categories Received
an assessment Did not receive
an assessment All
25-34 930 56 740 44 1,660 100
35-44 1,010 57 760 43 1,770 100
45-54 1,450 61 930 39 2,380 100
55-64 1,210 63 700 37 1,910 100
65+ 140 59 100 41 230 100
Total 4,980 59 3,500 41 8,490 100
Notes: Disclosure control has been applied to this table.
Source: English and Welsh management information, clients referred and discharged October 2015 – December 2016.
Table 4.7 Did referred employees receive an assessment? (By age range, Scotland)
Categories Received
an assessment Did not receive
an assessment All
Total 552 54 462 46 1,014 100
Source: Scottish management information, clients referred and discharged October 2015 – December 2016.
In England and Wales, employees that received an assessment were fairly evenly split in terms of main health condition, with 31 per cent identifying mental health as their main condition, 32 per cent identifying a musculoskeletal condition as their main condition, and 37 per cent identifying ‘other’ as their main health condition (Table 4.8).
However, employees with some main health conditions were more likely than others to receive an assessment. Employees with a musculoskeletal condition or other health condition (61 per cent and 60 per cent respectively) were more likely than those with a mental health condition (55 per cent) to receive an assessment (see TA Table 4.1 in the Technical Annex).
In Scotland, compared to England and Wales, a higher proportion of employees receiving an assessment presented with a mental health condition (39 per cent), although the slightly differing process and timing for collecting the data throughout the intervention affects comparability here (see Table 4.8 and Table 4.9). In England and Wales, data about the ‘main health condition’ is provided at referral/enrolment stage whereas in Scotland information about health conditions is asked for at the assessment stage.
Table 4.8 Referred employees receiving an assessment (By main health condition, England and Wales)
Source: English and Welsh management information, clients referred and discharged October 2015 – December 2016.
Table 4.9 Referred employees receiving an assessment (By main health
Source: Scottish management information, clients referred and discharged October 2015 – December 2016 and giving health condition.
In England there was a statistically significant association between Index of Multiple Deprivation (IMD) quintile and whether an employee received an assessment, with those in the most deprived areas less likely to receive an assessment than those in more affluent areas. In the most deprived areas in England (IMD quintile 1) 58 per cent of employees received an assessment and 42 per cent did not. In the most affluent areas (IMD quintile 5) 64 per cent of employees received an assessment, and 36 per cent did not (Table 4.10). A similar pattern was found in Scotland where those in the most deprived areas were less likely to receive an assessment than those in more affluent areas. In the most deprived areas in Scotland (Scottish Index of Multiple Deprivation (SIMD) quintile 1) 53 per cent of employees received an assessment and 47 per cent did not. In the most affluent areas (SIMD quintile 5) 63 per cent of employees received an assessment, and 37 per cent did not (Table 4.12). By contrast in Wales across the Welsh Index of Multiple Deprivation (WIMD) quintiles between 55 and 59 per cent of employees received an assessment in each quintile, but there was not a similar pattern to that found in England and Scotland in terms of degree of disadvantage, and the differences in the Welsh data are not statistically significant (Table 4.11).
Table 4.10 Did they receive an assessment? (By IMD quintiles for England) Categories Received
an assessment Did not receive
an assessment All
N Row
% N Row
% N Row
%
IMD quintile 1 1,129 58 828 42 1,957 100
IMD quintile 2 1,060 63 626 37 1,686 100
IMD quintile 3 912 62 560 38 1,472 100
IMD quintile 4 783 64 431 36 1,214 100
IMD quintile 5 617 64 343 36 960 100
Total 4,501 62 2,788 38 7,289 100
Source: English management information, clients referred and discharged October 2015 – December 2016.
Table 4.11 Did they receive an assessment? (By IMD quintiles for Wales) Categories Received
an assessment Did not receive
an assessment All
N Row
% N Row
% N Row
%
WIMD quintile 1 123 58 89 42 212 100
WIMD quintile 2 92 55 75 45 167 100
WIMD quintile 3 90 55 74 45 164 100
WIMD quintile 4 86 59 61 41 147 100
WIMD quintile 5 50 56 40 44 90 100
Total 441 57 339 43 780 100
Source: Welsh management information, clients referred and discharged October 2015 – December 2016.
Table 4.12 Did they receive an assessment? (By IMD quintiles for Scotland) Categories Received
an assessment Did not receive
an assessment All
N Row
% N Row
% N Row
%
SIMD quintile 1 136 53 122 47 258 100
SIMD quintile 2 115 49 121 51 236 100
SIMD quintile 3 111 54 94 46 205 100
SIMD quintile 4 95 61 61 39 156 100
SIMD quintile 5 90 63 52 37 142 100
Total 547 55 450 45 997 100
Source: Scottish management information, clients referred and discharged October 2015 – December 2016.
Employer characteristics of employees receiving an assessment
In England and Wales, the management information suggests most employees receiving an assessment worked in the service sector in ‘other services’ (48 per cent) or ‘public administration, education and health’ (27 per cent). The same pattern was found in Scotland, where the majority of employees who received an assessment were working in ‘other services’ (62 per cent), followed by ‘public administration, education and health’ (18 per cent) as shown in Table 4.13. It should be noted that sector data was not collected using the Standard Industrial Classification (SIC) code system, and data collected from the employer and employee surveys using this measure indicates a greater diversity of sectors using the service.
Employees receiving an assessment were most likely to work for very large employers with more than 500 employees. In England and Wales, 50 per cent of employees receiving an assessment worked for very large employers and in Scotland it was 57 per cent (Table 4.14).
In England and Wales, three in four employees receiving an assessment worked in the private sector (75 per cent). This compared to 56 per cent in Scotland, although the extent of missing data in this variable in Scotland limits comparability here (Table 4.15).
Table 4.13 Employees receiving an assessment (By employer sector)
Categories England and Wales Scotland
N Col
% N Col
%
Agriculture, forestry and fishing 38 1 6 1
Banking and Finance 103 2 21 4
Construction 104 2 19 3
Distribution, hotels and restaurants 402 8 20 4
Energy and Water 46 1 18 3
Manufacturing 345 7 12 2
Other services 2,401 48 341 62
Public admin, education and health 1,354 27 97 18
Retail and Wholesale - - 4 1
Transport and communications 191 4 13 2
Total 4,984 100 551 100
Source: English and Welsh management information, Scottish management information, Clients receiving an assessment and referred and discharged October 2015 – December 2016.
Table 4.14 Employees receiving an assessment (By employer size and nation) Categories England and Wales Scotland
N Col
% N Col
%
Very Large (500+) 2,494 50 314 57
Large (250-499) 642 13 51 9
Medium (50-249) 1,070 21 96 18
Small (10-49) 648 13 60 11
Micro (1-9) 130 3 24 4
Total 4,984 100 545 100
Notes: Disclosure control has been applied to this table.
Source: English and Welsh management information, Scottish management information, Clients receiving an assessment and referred and discharged October 2015 – December 2016.
Table 4.15 Employees receiving an assessment (By employer type and nation) Categories England and Wales Scotland
N Col
% N Col
% Private sector business 3,757 75 306 56
Public sector business 895 18 128 23
A voluntary/not for profit 245 5 56 10
Not known 87 2 59 11
Total 4,984 100 549 100
Source: English and Welsh management information, Scottish management information, Clients receiving an assessment and referred and discharged October 2015 – December 2016.