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Durham University

Department of Geography

Departmental Research Projects

Evaluating the County Durham Worklessness and Health Support Programme, County Durham Primary Care Trust, £550,000 (2009-2014)

A research project of the Department of Geography.


In line with NICE guidance, an NHS commissioned case management intervention was provided for individuals receiving Incapacity Benefit payments for three years or more in the North East of England. The intervention aimed to improve the health of participants.


The project is funded by the following grant.

  • Evaluating The County Durham Worklessness And Health Support Programme (£524560.31 from County Durham & Darlington PCT)


To provide a prospective pilot evaluation of the effectiveness and cost-utility of a 'health first' case management service for long-term Incapacity Benefit recipients.


131 participants receiving the intervention were compared over nine months with a (non-equivalent) comparison group of 229 receiving Incapacity Benefit payments and usual care. Health was measured using EQ-5D, EQ-VAS, SF-8 HADS and the Nordic Musculoskeletal questionnaire. Socio-demographic and health behaviour data were also collected. Fixed effects linear models with correlated errors were used to compare health changes between groups over time. A preliminary cost-utility analysis was also conducted.


Comparison group measures of health were stable over time. Starting from comparatively poor initial levels, case management group generic (EQ5D, EQ-VAS) and mental health (HADS-A, HADS-D and SF8-MCS) measures improved within six months to similar levels found in the comparison group. Musculoskeletal (Nordic 2) and health behaviours did not improve. Tentative estimates of cost-utility suggest the intervention cost in the region of £16,700 to £23,500 per QALY.

Case management interventions may improve the health of incapacity benefit recipients. Further research is required to help confirm these pilot findings. 

Published Results

Journal Article

  • Copeland, A., Kasim, A. & Bambra, C. Grim up North or Northern Grit? Recessions and the English spatial health divide (1991-2010). Journal of Public Health. 2015;37:34-39.
  • Garthwaite, K. Becoming incapacitated? Long-term sickness benefit recipients and the construction of stigma and identity narratives. Sociology of Health & Illness. 2015;37:1-13.
  • Warren, J., Bambra, C., Kasim, A., Garthwaite, K., Mason, J. & Booth, M. Prospective pilot evaluation of the effectiveness and cost-utility of a "health first" case management service for long-term Incapacity Benefit recipients. Journal of Public Health. 2014;36:117-125.
  • Warren, J., Wistow, J. & Bambra, C. Applying Qualitative Comparative Analysis (QCA) in the evaluation of complex public health interventions: A case study of a health improvement service for long-term Incapacity Benefit recipients. Journal of Public Health. 2014;36:126-133.
  • Garthwaite, K., Bambra, C., Warren, J., Kasim, A. & Greig, G. Shifting the Goalposts: A Longitudinal Mixed-Methods Study of the Health of Long-Term Incapacity Benefit Recipients during a Period of Substantial Change to the UK Social Security System. Journal of Social Policy. 2014;43:311-330.
  • Garthwaite, K. Studying the Study: Reflections on Exploring the Health and Disability Narratives of Long-Term Sickness Benefits Recipients in the UK. Qualitative Report. 2014;19:8.
  • Garthwaite, K. Fear of the Brown Envelope: Exploring Welfare Reform with Long-Term Sickness Benefits Recipients. Social Policy & Administration. 2014;48:782-798.
  • Garthwaite, K., Bambra, C. & Warren, J. 'The unwilling and the unwell’? Exploring stakeholders’ perceptions of working with long term sickness benefits recipients. Disability & Society. 2013;28:1104-1117.
  • Warren, J., Wistow, J. & Bambra, C. Applying Qualitative Comparative Analysis (QCA) to evaluate a public health policy initiative in the North East of England. Policy and Society. 2013;32:289–301.
  • Warren, J., Garthwaite, K. & Bambra, C. ‘It was just nice to be able to talk to somebody’ long-term incapacity benefit recipients' experiences of a case management intervention. Journal of Public Health. 2013;35:518-524.
  • Garthwaite, K. ‘The language of shirkers and scroungers?’ Talking about illness, disability and coalition welfare reform. Disability and Society. 2011;26:369-372.

Chapter in book

  • Warren, J., Garthwaite, K. & Bambra, C. A health problem? Health and employability in the UK labour market. In: Lindsay, C. & Houston, D. Disability Benefits and Employment Policy: Fit for Work? Fit for Purpose?. Basingstoke: Palgrave Macmillan; 2013.


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