Employability through health? Partnership-based governance and the delivery of Pathways to Work condition management services

The Pathways to Work (PtW) initiative has been rolled out in 49 Jobcentre Plus districts across Great Britain as the government seeks to provide services to activate claimants of incapacity benefits and help them overcome health-related barriers to work. The recent expansion of PtW has seen a heavy reliance on the contracting-out of services to the private and third sectors, with ‘Lead Providers’ paid according to job outcomes achieved for clients. However, during the initial development of PtW, the initiative was defined by a flexible, partnership-based form of governance, with a key role for the public National Health Service (NHS) in the delivery of health ‘condition management’ services. This approach has been retained in a minority of Jobcentre Plus Districts. Based upon a review of previous evaluation evidence and more than 50 in-depth interviews with NHS staff and managers, this article critically assesses this partnership-based governance model and the potential added value flowing from the involvement of the NHS and its professional clinicians in the delivery of condition management services. The article concludes by identifying lessons for the continuing development of governance and delivery mechanisms for condition management under the PtW regime and future employability/health interventions.