Fit for Purpose - Supported employment · 2016-09-19 · Fit for Purpose: Transforming employment...
Transcript of Fit for Purpose - Supported employment · 2016-09-19 · Fit for Purpose: Transforming employment...
Fit for Purpose Transforming employment support for
disabled people and those with health
conditions
Ann Purvis
Sarah Foster
Lorraine Lanceley
Tony Wilson
July 2014
This report has been quality assured by:
Name: Tony Wilson
Position: Policy Director
Date: 2 July 2014
Tony Wilson
Centre for Economic and Social Inclusion
Third Floor
89 Albert Embankment
London
SE1 7TP
Tel: 020 7840 8346
Email: [email protected]
Contents
Acknowledgements ........................................................................................... 4
Executive Summary .......................................................................................... 5
1 Introduction ............................................................................................. 14
Context .......................................................................................................... 14
The ‘Fit for Purpose’ project ............................................................................ 19
2 The landscape of support ......................................................................... 21
The current framework ................................................................................... 21
Local provision ............................................................................................... 29
Conclusion ..................................................................................................... 30
3 What works (and for whom)? .................................................................. 31
Introduction ................................................................................................... 31
The effectiveness of different types of support ................................................. 32
What works for specific groups? ...................................................................... 43
Cross-cutting themes ...................................................................................... 52
Conclusion ..................................................................................................... 58
4 Commissioning support ............................................................................ 59
Payment by Results ........................................................................................ 59
Individual budgets .......................................................................................... 62
Local and joint commissioning ......................................................................... 64
Evidence based commissioning ........................................................................ 69
Conclusion ..................................................................................................... 70
5 Recommendations .................................................................................... 71
The framework for future employment support ................................................ 71
The management of future programmes .......................................................... 80
Workforce development .................................................................................. 85
Conclusions .................................................................................................... 87
Fit for Purpose: Transforming employment support
4
Acknowledgements
This project would not have been possible without the financial support of a
number of organisations. We would like to extend our thanks, both for this
support and for their time in attending workshops, shaping the direction of the
work and discussing and commenting on findings and recommendations. Many
also gave their time to be interviewed for case studies, for which we are grateful.
A4e Avanta ESG i2i Ingeus Interserve intraining Kennedy Scott learndirect Maximus Prospects Randstad Reed RNIB Seetec Serco Shaw Trust CDG St Loye's Foundation The Salvation Army Wheatsheaf Trust Work Solutions Working Links
We would also like to thank BASE, Remploy and PublicCo for the time and expert
input that they have contributed throughout this project.
Particular thanks go to the participants of our focus groups for their time and
views on the emerging recommendations – as well as to Shaw Trust CDG, St
Loye’s Foundation, The Salvation Army, and the Central and the North West
London NHS Foundation Trust for arranging and hosting these groups.
Finally, many thanks to Inclusion colleagues – past and present – for their
contributions to this work and report, including Paul Bivand, Tim Riley, Malen
Davies, Callum Miller and Lauren Bennett.
Fit for Purpose: Transforming employment support
5
Executive Summary
Disabled people and those with health conditions are far less likely to be in work,
less likely to find work and spend longer out of work than the population as a
whole. Despite more than a decade of near-constant reforms to disability benefits
and to employment support, these gaps did not narrow by much during the boom
years, and progress may have stalled more recently.
Fewer than half of all disabled people are in work and we estimate that just one
in ten of those not in work are being supported through either the Work
Programme or Work Choice. Almost all of these are in the Work Programme, with
only limited funding available to provide intensive or specialist support.
This project sets out how the employment support system can be transformed to
create a system that offers employment opportunity for all – with the right
support to prepare for and take up work. It sets out twenty case studies of
current good practice, and has been ‘crowd funded’ by twenty-two organisations
that work with and support disabled people and those with health conditions.
The landscape of support
The current system of support for disabled people and those with health
conditions is complicated and complex.
Jobcentre Plus provides limited specialist support and more extensive
support to jobseekers (many of whom may be disabled). However, concerns
have been raised around resource levels and specialism.
The Work Programme supports disadvantaged jobseekers and many
claimants of ESA – however disabled people are less likely to find work than
participants without an impairment and may also be less likely to receive
appropriate support (driven in part by very low funding).
Work Choice provides more specialist support to those with complex needs
– supporting around 20,000 people a year, many of them on JSA and with
pre-work support limited to six to twelve months1.
1 There is an option to extend the pre-work support module of Work Choice from six
months to one year, although the evaluation of Work Choice (Purvis et al (2013) Op. cit.) found little evidence of this being used in practice.
Fit for Purpose: Transforming employment support
6
Access to Work provides employers and individuals with funding to meet
the extra costs of employing a disabled person – but awareness and uptake
is often low.
Finally, a range of local and national provision supports disabled people
with specific (and often severe) needs – in particular through local
‘Supported Employment’ and national residential training. However budgets
for the former are devolved and not ring-fenced, and for the latter have
been reduced and remain under threat.
What works (and for whom)?
This complex landscape only partly reflects the evidence on what works. This
evidence is far from complete, but points to a number of effective service models
and common themes.
Different types of support
There is unequivocal evidence that Supported Employment, when
implemented effectively, can lead to significant positive impacts on employment.
This ‘place, train, sustain’ model is built around holistic engagement of the
participant and those around them, effective profiling, job matching and then
extensive support in work. However, Supported Employment when implemented
fully is relatively expensive and needs to be effectively targeted.
Personalisation of service delivery appears to be key, and in particular having
adequate time to spend with participants and the opportunity to tailor services.
Effective employer engagement includes both in-work support to employers
and employees, alongside wider engagement to source and secure job
opportunities – the so-called ‘individual’ and ‘employment agency’ approaches.
There is no clear evidence that financial incentives – to individuals or
employers – have had positive impacts in UK programmes, although there is a
wide literature on the use of incentives for other groups and they remain a key
pillar or support in many countries.
Well-designed ‘intermediate labour market’ models (ILMs) – which create
temporary employment with structured support to move into unsubsidised work –
can have lasting positive impacts. However these are relatively expensive, and
‘supported business’ models have been criticised for increasing segregation in the
labour market. We believe that there are clear opportunities to develop models
that build on the strengths of ILMs and supported businesses.
Fit for Purpose: Transforming employment support
7
What works for specific groups?
There is some evidence on models that appear to be particularly effective for
those with specific impairments or barriers to work.
There has been extensive work on mental health and employment in recent
years. This points to the importance of early engagement, co-operation with
health and employment services, integration of psychological therapies and
tailored support (including small adviser caseloads). Individual Placement and
Support (IPS), a form of Supported Employment, combines these elements and
has delivered impressive results. There is also robust evidence that peer-led
group work can be effective in improving wellbeing and employment.
Recent work on sensory impairment points to the importance of specialist
adviser support; supporting computer skills including use of assistive technology;
independent travel; and effective employer engagement.
Musculoskeletal conditions are among the most common reasons for absence
from work. There is some evidence that a multidisciplinary approach (involving,
for example, workplace-focused interventions, cognitive behavioural therapy and
social support) is effective.
Moving from education into work is harder for disabled people. Specialist job
coaches and Supported Employment services appear to be successful for young
people with learning difficulties and/or disabilities; other key aspects of support
include effective working relationships, mentoring and links with employers.
Across all of this, there are common themes that appear key to delivering
effective support: the timing of interventions, assessment and segmentation,
partnership working, workforce development and quality management.
Commissioning support
The use of ‘Payment By Results’ (PBR) models has delivered real benefits in
ensuring that commissioners and providers are focused on outcomes. However,
PBR can present particular challenges for supporting those facing the most
significant barriers to work – so-called ‘creaming and parking’ – while the interim
report of this project demonstrates that very high gearing towards outcome
payments has led in the Work Programme to systemic under-funding by
Government.
Fit for Purpose: Transforming employment support
8
Individual Budgets have been tested in recent years, although with mixed
results. Service users often report difficulties (and stress) in managing them and
there have been difficulties around implementation and take-up.
Joining up commissioning is critically important, given the diversity of support
across welfare to work, health, education and social care. There is limited
evidence of jointly commissioned services, but a growing commitment at strategic
levels and good examples of effective provision of employment support within
health settings (including co-location and joint working).
Recommendations
The design of future employment support
1. Future employment support for disabled people and those with
health conditions should be built around three levels:
‘Into work’ support – for those closest to returning to work, with
some specialist support
Health and disability employment support – for those needing
more intensive and joined up support to secure employment
Supported Employment and rehabilitation – for those with the
most significant support needs
‘Into work’ support would support those who have health- or disability-related
needs but are closer to work and could (re)enter employment with the right
support. This would include many of those on Employment and Support
Allowance (ESA) following Statutory Sick Pay, as well as those found ‘fit for work’.
Support would be adviser-led, with small caseloads, and focused on job-
placement and condition management – with signposting or referral to more
specialist services.
Health and disability employment support would support those whose
health conditions and impairments have a more significant impact on their ability
to find work, who may have been out of work for some time or never worked,
and who would often need additional support in work. This would integrate
employment, health, disability and wider support, would be led by specialist
advisers, and would be built on Supported Employment principles: small
caseloads, a holistic approach, and an emphasis on effective employer
engagement and job brokerage.
Fit for Purpose: Transforming employment support
9
Supported Employment and rehabilitation would support those with more
significant impairments – including learning disabilities, severe autism and severe
mental illness – who are unlikely to have their needs met through the two levels
of support described above. We propose additional and separate support for
these groups – in particular Supported Employment and residential training.
2. Review the operation of Access to Work to improve utilisation
and ensure that it fully integrates into a coherent and simplified
system of DWP employment support
This review should aim to ensure Access to Work fully aligns with other aspects of
the DWP disability employment support offer – resulting in a more coherent,
comprehensive and simplified system of support.
3. Access to, and funding for, employment support for disabled
people and those with health conditions should be significantly
increased
Recent work by the IPPR sets out that well-designed future disability employment
support could reasonably expect to draw on £400-800 million of funding from
central government, local government and health services. This could support
between 200 and 400 thousand people each year. We support this ambition.
4. Access to each of the three levels of support should be
underpinned by a common, robust assessment process – joined
up with other assessments, and with decisions reviewed after
three months
This process should be based on needs rather than benefit type and should be
common across all levels of support. In line with the Government’s proposed
Gateway, the process should be applied at the right time and be capable of being
applied by local partners and organisations working with disabled people.
5. Individuals should be able to access employment support on a
voluntary basis, but the assessment process should include the
scope to require individuals to participate where that is
appropriate and in line with their conditionality rules
Those that volunteer for employment support should in principle be able to
receive it. At the same time, we would expect that many of those referred,
particularly for ‘Into work’ support, will be Jobseeker’s Allowance (JSA) claimants
or ESA claimants in the Work Related Activity Group. Well designed, specialist
Fit for Purpose: Transforming employment support
10
employment support should take the place of their requirements to look or
prepare for work.
6. Participants should normally be able to receive pre-employment
support in any one level for up to two years
Individuals should be able to stay in support for up to two years, with in-built
reviews so that participation can be ended earlier than this where appropriate.
7. Government and service providers should review their approach
to employer engagement, with a focus on: simplifying employer
access; co-ordinating work to improve awareness and education;
and building sector-led approaches
Employers encounter a fragmented system with often overlapping programmes
but also clear gaps in support that meets their needs. There are good examples
from Government and the employability sector in developing more co-ordinated
approaches. These should be built upon to ensure that employers have a clear
and simple route in, that there are co-ordinated efforts to raise awareness, and
that sector bodies including trade associations are engaged effectively.
The proposed new framework of support is illustrated below.
Fit for Purpose: Transforming employment support
11
The commissioning and delivery of support
8. Local and national commissioners should work together to
ensure that the three levels of support are in place – within a
clear national framework but with approaches to devolution,
joint commissioning, pooling or alignment that are appropriate
to local areas
We propose a clear national framework for employment support, with provision
then commissioned in the most appropriate ways within that. This national
framework should include:
That support will be available to meet the three levels set out above
That access will be underpinned by the common assessment approach
That there will be national (GB) coverage – perhaps aligning with LEP
boundaries or groups of local authorities, but that support may be
commissioned within smaller geographies where appropriate
That clear local governance will support service providers to join up – in
particular health, skills and other employment support
Within this, we recommend that central and local government, and their partners,
work together to agree the most appropriate ways to commission support locally.
9. Jobcentre Plus and local Health and Wellbeing Boards (HWBs)
should work together to develop protocols on joint working,
including information sharing
Senior level buy-in is critical in driving effective local partnerships. Developing
strong links between HWBs and Jobcentre Plus should underpin efforts to improve
partnership working more generally, and in particular how information is shared
on local priorities, needs, funding and provision.
10. Funding models for all three levels of support should include
‘payment by results’, but with clear safeguards to minimise risks
of vicious circles, creaming and parking
Payment By Results should continue to play a role, but future provision should
retain ‘service fees’ that ensure that providers can meet the upfront and delivery
costs of programme provision – and so that unintended risks around vicious
circles, creaming and parking can be reduced.
Fit for Purpose: Transforming employment support
12
11. There should be a common quality framework across all
provision, based on self-assessment, external inspection, service
user input and continuous improvement
This framework would cover all three levels of support. It need not reintroduce
fully independent inspection, but should be based on rigorous self-assessment
alongside periodic external inspection and assessment.
12. A ‘What Works Unit’ should be established with a remit to
collect, review and disseminate best practices; facilitate
knowledge exchange between providers; and encourage
innovation in service design and delivery
The unit would support commissioners and delivery organisations to build capacity
and capability, measure impact, learn what is working, share practices and drive
up performance and quality.
Workforce development
13. Jobcentre Plus and the wider employment services industry
(through ERSA and Institute of Employability Professionals)
should work together to ensure that all advisers have training in
identifying health and disability needs and providing initial
support and signposting
This will ensure that advisers have the right training to identify needs, and
confidence in how to support and direct those who need more specialist support.
14. The Institute of Employability Professionals (IEP) should work
with organisations including the British Association of Supported
Employment (BASE) to develop industry-wide, best practice
training for specialist disability employment advisers
The IEP exists to professionalise the industry and drive up standards, and would
be the obvious organisation to lead on developing or distributing a range of
materials to the sector.
15. Jobcentre Plus and employment services providers should
commit to ensuring that all advisers leading on employment
support for disabled people and those with health conditions will
have been trained in line with industry benchmarks, or be on the
journey to receiving that training
Fit for Purpose: Transforming employment support
13
Conclusions
This report draws on input from service users, service providers, those that work
with disabled people and a range of national and international evidence. They
show that there is a long way to go in tackling the entrenched gaps in opportunity
for disabled people and those with health conditions – but that there are good
practices, here and abroad, that can be built upon. The proposals presented here
would have the scope to radically reform support for these groups and to strike a
new balance between health and employment services and between national and
local government.
Fit for Purpose: Transforming employment support
14
1 Introduction
Context
1.1 Nearly eight million adults of working age are disabled or have a work-
limiting health condition.2 Nearly five million people report that this limits
their daily activities to some extent, while 1.6 million classify their health
as ‘bad’ or ‘very bad’.3
1.2 Those whose activities are affected by a health problem or disability are
far more likely to be over 50 than under, to be in lower socio-economic
groups, to live in deprived areas, and to be out of work or to have never
worked.
1.3 Overall, half of all disabled people are out of work, compared with one
quarter of those who are not disabled. This wide difference in the
likelihood of being in work narrowed markedly throughout the 2000s, and
continued to narrow slowly through the recession. However most recent
data suggests that progress may have stalled, as Figure 1.1 shows.
Figure 1.1: Employment rate ‘gap’ between disabled people and
the overall employment rate, 1998-2013
Source: Labour Force Survey and Inclusion calculations
2 Source: Labour Force Survey 3 Source: Census 2011
Fit for Purpose: Transforming employment support
15
1.4 Four million people who are out of work are disabled or have a long-term
health condition. Disabled people are twice as likely as non-disabled
people to be out of work, and the likelihood of being out of work
increases with the extent to which disability or ill health limits an
individual’s day-to-day activities. This is shown in Figure 1.2 below.
Figure 1.2: Economic status of disabled people and those with
long-term health conditions
Source: Census 2011 and Inclusion analysis
1.5 This also illustrates the extent to which those who are out of work are
‘economically inactive’ – meaning they are not looking for work or
available for work – rather than unemployed. 44 per cent of disabled
people are economically inactive, compared with 17 per cent of those who
are not disabled. And of those who are unemployed, disabled people are
more likely to have been so for long periods, and in particular much more
likely to have been unemployed for five years or more – as Figure 1.3
below shows.
Fit for Purpose: Transforming employment support
16
Figure 1.3: Duration of unemployment for the disabled and non-
disabled population (proportion of total unemployed population)
0% 20% 40% 60% 80% 100%
Non-disabled people
DDA and/or work-
limited disabled
people
Less than 3 months 3 months but less than 6 months
6 months but less than 12 months 1 year but less than 2 years
2 years but less than 3 years 3 years but less than 4 years
4 years but less than 5 years 5 years or more
Source: Labour Force Survey and Inclusion analysis
1.6 Perhaps most concerning of all, recent research by Inclusion for the TUC4
has found that disabled people are far less likely to move into work than
the non-disabled, and are even less likely to do so if they are
‘economically inactive’. Figure 1.4 illustrates this, showing the
probability of an individual who is unemployed or inactive moving into
work from one quarter to the next.
4 Wilson, T. and Bivand, P. (2014) Equitable Full Employment: Delivering a jobs recovery for all, TUC Touchstone Extras
Fit for Purpose: Transforming employment support
17
Figure 1.4: Hiring rates by economic inactivity and disability
status of the workless population
Source: Labour Force Survey and Inclusion analysis
1.7 The differences here are stark. The hiring rate for unemployed disabled
people is 8 percentage points below that for their non-disabled peers.
And while around one in six unemployed disabled people move into work
each quarter, just one in fifty disabled people who are ‘economically
inactive’ do so. Chances of finding work have fallen since the recession
and not regained the ground lost.
The benefits system
1.8 Many disabled people and those with health conditions who are out of
work also receive benefits due to their disability or ill-health. In total
there are 2.4 million claimants of Employment and Support Allowance
(ESA) or incapacity benefits – more than half of all working age claimants.
Many of these have been claiming for a very long time – with ESA
claimants accounting for only 3 per cent of short-term benefit claims
(when you exclude Incapacity Benefit (IB) claimants who have recently
been reassessed) and more than half of claimants out of work for five
years or more5.
1.9 Numbers claiming ESA and IB grew strongly through the 1980s and 1990s
and have remained high ever since – even at a time of falling claimant
unemployment and a growing economy, as Figure 1.5 shows.
5 Source: DWP statistics
Fit for Purpose: Transforming employment support
18
Figure 1.5: Claimants of key ‘out-of-work’ benefits
Source: Labour Force Survey and Inclusion analysis
1.10 A growing proportion of JSA claimants are also likely to be disabled or
have health conditions, as a result of the tighter Work Capability
Assessment (WCA) for claiming ESA. Since ESA was introduced in 2008,
3.2 million claimants have completed the WCA (including those claimants
of predecessor benefits reassessed under the new regime), with 1.2
million of these being found ‘fit for work’6. Many of these will instead
have gone on to claim JSA.
1.11 Alongside this, there are two million working age claimants of Disability
Living Allowance7, which provides financial support to help meet the
additional costs of living (mobility and caring) for disabled people. It is
estimated that nine out of ten of these claimants are out of work8, while
half also claim ESA or incapacity benefits.
1.12 Government research has found that most disabled benefit claimants
want to work (56 per cent) and believe that having a job would make
them better off financially. However, a far smaller proportion thinks that
6 Source: ‘ESA: outcomes of Work Capability Assessments June 2014’, Department for Work and Pensions 7 Source: DWP statistics 8 Berthoud, R. (2006) The employment rates of disabled people; DWP Research Report No 298
Fit for Purpose: Transforming employment support
19
they are currently able to work (15 per cent), and just one in four believe
that having a job would be good for their health.9
Employment support
1.13 Given the position set out above – of wide employment inequality, poorer
outcomes for many disabled people, and a growing share of those on
benefits claiming due to ill health or disability (and many claiming for long
periods), successive governments have prioritised employment support
for disabled people. However, this support has often not lived up to
expectations and has tended only to support a small fraction of those who
are out of work and disadvantaged.
1.14 Just 20,000 disabled people per year access Work Choice – the
Government’s specialist disability employment programme – with about
ten times as many disabled people or those with health conditions joining
the Government’s Work Programme (between 170,000 and 200,000 per
year). In total, of the 3.6 million people who are out of work and have a
work-limiting disability, we estimate that just one in ten are receiving
support through either of these programmes.10 And within the Work
Programme, disabled people are far less likely to secure employment, and
overall funding per participant has fallen to just £550 for ESA claimants
against an original expectation of £1,170.11
1.15 Tackling the gap in employment opportunity, and supporting more
households to move off benefits and into work, requires radical action to
reform our employment services for these groups.
The ‘Fit for Purpose’ project
1.16 This project has been ‘crowd funded’ by twenty-two organisations that
work with and support disabled people and those with health conditions,
with a further five organisations providing ‘in kind’ support. The project
sets out how employment services can be reformed, based on our
assessment of provision in the UK and internationally. It has included:
9 DWP (2013) A survey of disabled working-age benefit claimants, In House Research
Report No.16. 10 Source: DWP Work Choice and Work Programme Statistics. 373,000 claimants
starting the Work Programme in the two years to March 2014 were either claimants of IB/ ESA or were JSA claimants identified as being disabled. 10,000 claimants started
Work Choice in the six months to March 2014. 11 Riley, T., Bivand, P. and Wilson, T. (2014) Making the Work Programme work for ESA claimants; Centre for Economic and Social Inclusion
Fit for Purpose: Transforming employment support
20
An extensive data and literature review, looking at the landscape of
support for disabled people and those with health conditions, what has
been tried before, and what works for whom;
Interviews with organisations delivering services, to identify examples
of current and/ or innovative service delivery – with twenty case
studies presented in this report;
Four focus groups with participants in employment support, to discuss
their experiences and to review the emerging findings from this
project; and
Detailed analysis of Work Programme performance and financial
information, which informed our interim report on Work Programme
funding models, published in April 2014.12
Report structure
1.17 Chapter 2 describes the current and recent landscape of employment
support for disabled people and those with health conditions, exploring
both mainstream and specialist support with a primary focus on provision
funded by DWP.
1.18 In Chapter 3 we then describe ‘what works’ in supporting disabled
people and those with health conditions both to find and maintain
employment. We also set out the evidence on what works for particular
groups, such as those with mental health conditions, alongside case
studies of more recent practices and innovations.
1.19 Chapter 4 reflects on lessons on how support is designed and
commissioned – including the use of ‘payment by results’, personal
budgets, and how organisations work together in partnership.
1.20 Finally, in Chapter 5 we set out practical recommendations to ensure
that the future of employment support for disabled people and those with
health conditions is fit for purpose.
12 Riley, T., Bivand, P. and Wilson, T. (2014) Op. cit.
Fit for Purpose: Transforming employment support
21
2 The landscape of support
2.1 Until recently, labour market policy in most countries offered very little
support for disabled people and those with health conditions, particularly
those on disability benefits. And while this had started to change by the
end of the last decade, work by the OECD13 concluded that in the UK and
many other developed economies, these shifts had not yet fed through
into better outcomes and higher employment for disabled people.
2.2 Here in the UK, the Government has likewise acknowledged14 the need to
do more to develop effective employment support for disabled people and
those with health conditions. This chapter sets out the current system of
support.
The current framework
2.3 As set out in Chapter 1, most disabled people who are not in employment
do not receive structured support to prepare for work. Eligibility for
employment programmes is generally based on benefit rules and then
individual or adviser discretion. Most of those who have a work-limiting
disability or health condition, and claim an ‘out of work’ benefit
(Employment and Support Allowance (ESA), Jobseeker’s Allowance (JSA)
and Income Support (IS)), are eligible to access support. However very
few choose to take it up.
2.4 There are three broad strands of support nationally, through the
Department for Work and Pensions: Jobcentre Plus support, the Work
Programme and Work Choice. These are set out in more detail below.
Jobcentre Plus support
2.5 Jobcentre Plus delivers back-to-work support to benefit claimants across
all working-age benefits, which includes three key elements:
A core regime of mandatory interventions which vary depending on
benefit and circumstances;
13 OECD (2010) Sickness, disability and work: breaking the barriers. A synthesis of findings across OECD countries, OECD 14 DWP (2013) The disability and health employment strategy: the discussion so far
Fit for Purpose: Transforming employment support
22
Flexible adviser support; and
A flexible menu of support options.
2.6 If an adviser, or other frontline staff member, feels that a claimant needs
more specialist support due to a health condition or disability, they can
refer them to a specialist Disability Employment Adviser (DEA). However
a recent Work and Pensions Select Committee report15 indicates access to
this specialist support is limited – with an estimated ratio of one specialist
DEA to more than 600 ESA WRAG claimants (compared to Jobseeker’s
Allowance caseloads of around 140 claimants per adviser).
2.7 The most recent evaluation of the Jobcentre Plus Offer16 also found that
some JSA claimants with health conditions (particularly a mental health
condition) and ESA claimants do not always discuss or receive the level of
support they require. It recommended strengthening adviser support to
help meet the needs of ESA claimants to ensure they are referred to
appropriate support to help them into employment.
The Work Programme
2.8 The Work Programme aims to offer tailored support to claimants who are
long-term unemployed or have other significant disadvantages in the
labour market. Claimants are referred to the Work Programme at
different points depending on the benefit they are claiming and their
individual circumstances. Once on the programme, participants are
required to remain for two years, and providers are paid according to the
results that they achieve (with discretion in how they design and deliver
support).
2.9 Four-fifths of those who have joined the Work Programme since it began
in June 2011 are on Jobseeker’s Allowance (1.26 million claimants in
total). These are typically claimants who have been unemployed for more
than nine months and are required to participate, but also includes
claimants who have volunteered for early support (including due to a
health condition or disability). A quarter of JSA claimants who have
joined the Work Programme are disabled.
15 Work and Pensions Select Committee (2014) The role of Jobcentre Plus in the reformed welfare system 16 Coulter, A., et al (2013) The Jobcentre Plus Offer: Final evaluation , DWP research report 852
Fit for Purpose: Transforming employment support
23
2.10 One fifth of those who have joined (260,000) are claimants of
Employment and Support Allowance or incapacity benefits, who by
definition will have work-limiting health condition. Most of these are
claimants who are required to attend after their Work Capability
Assessment (WCA) as they are assessed as being likely to be capable of
returning to work within twelve months. In addition, any ESA or
incapacity benefit claimant can volunteer for the Work Programme but
just 110,000 claimants have done so – around one in twenty of all of
those that are not required to participate.
2.11 Looking across the programme as a whole, then, those who have joined
the Work Programme who are disabled or have a work-limiting health
condition are more likely to be JSA claimants, and much more likely to be
those that have been required to take part in the programme. This is
shown in Figure 2.1 below.
Figure 2.1 – Cumulative Work Programme participants who are
disabled and/ or claim ESA/ IB by referral type (thousands)
Source: DWP statistics and Inclusion analysis
2.12 The latest analysis of the Work Programme shows that disabled people
and those with health conditions are less likely to leave benefits and enter
employment than participants without an impairment, and less likely than
any other identified disadvantaged group. Figure 2.2 below sets this
out. Meanwhile, programme evaluations suggest that these groups may
also be less likely to receive appropriate support17 - with more ‘job-ready’
17 Newton, B., et al (2012) Work Programme evaluation: Findings from the first phase of qualitative research on programme delivery, DWP research report 821
Fit for Purpose: Transforming employment support
24
participants being prioritised for support ahead of those with more
complex or substantial barriers.
Figure 2.2 Proportion of Work Programme referrals that achieve
a job outcome
Source: DWP statistics and Inclusion analysis
2.13 The interim report of this project18 demonstrates that performance
against job outcomes for those on ESA is far below the levels expected by
the Department when the programme was commissioned. The interim
report concludes that a range of factors may explain this – including
targets being set too high, a weaker than expected economy, referrals of
claimants further from work, and provider performance.
2.14 In some respects, this is nothing new: previous programmes for
jobseekers, such as the Flexible New Deal (FND), have also typically
delivered lower employment outcomes for disabled than for non-disabled
participants19. Similarly the specialist programme for those with health
conditions that the Work Programme replaced (Pathways to Work) also
under-performed. Its evaluation concluded that it had had no significant
employment impact20, with the programme being judged poor value for
money by the National Audit Office21. More positive impacts22 were found
18 Riley, T., Bivand, P. and Wilson, T. (2014) Op. cit. 19 Hill, D., et al (2007) What works at work? Review of evidence assessing the effectiveness of workplace interventions to prevent and manage common health problems. HMSO. 20 Bewley H, et al (2009) The impact of Pathways to Work on work, earnings and self-reported health in the April 2006 expansion areas. DWP research report 601 21 National Audit Office (2010) Support to Incapacity Benefit claimants through Pathways to Work.
Fit for Purpose: Transforming employment support
25
in the New Deal for Disabled People (NDDP) although overall the
programme was only taken up by a very small number of people.
2.15 In November 2013 DWP announced a series of pilots within the Work
Programme aiming to test approaches to developing work with the ESA
claimant group23. The pilots will compare three approaches:
Regular appointments with healthcare professionals
Enhanced support from Jobcentre Plus
Enhanced support from Work Programme providers
2.16 Participants will be selected on a random basis and the pilots are due to
run until August 2016. An overview of one pilot is set out below.
Case study: Work Programme PG7 pilot, Intraining
Intraining have secured funding to deliver a pilot for Work Programme
participants in ‘Payment Group 7’ (ESA volunteers who had previously
claimed incapacity benefits).
Advisers use a self-assessment tool that helps participants to address
what health issues they have and how they can live with them. It is based
around the social model of disability, rather than the medical model. This
means that the main emphasis is on what impact their health condition
has on their lives and what they can do about this in the long-term, rather
than how they can recover from their health condition. It is completed on
paper over a period of time and focuses on factors including claimants’
daily activity and their sense of well-being.
It attempts to get participants to stop defining themselves by their
disability, which they see as the biggest barrier, and to instead start to
think about how their life can be different and what can be changed to
successfully deliver this.
Work Choice
2.17 The final strand of support for those out of work is Work Choice – the
Government’s specialist disability employment programme. This was
22 Orr, L., et al Long-term impacts of the New Deal for Disabled People DWP
Research Report 432 23 https://www.gov.uk/government/news/pilot-schemes-to-help-people-on-sickness-benefits-back-to-work
Fit for Purpose: Transforming employment support
26
introduced in October 2010, replacing two previous specialist programmes
(WORKSTEP and Work Preparation). It is aimed at people who:
Have complex work-related support needs that cannot be met by
Jobcentre Plus and the Work Programme;
Have requirements in work which cannot be immediately overcome
through reasonable adjustments or Access to Work support (see
below); and
Can aspire to work for a minimum of 16 hours per week.
2.18 Work Choice is a voluntary programme. It was designed using a ‘modular’
approach to move participants along a clear path from supported to
unsupported employment. Specialist advisers work with individuals to
assess their needs and to develop an action plan based on a range of
support tailored to the needs of the individual. Once participants move
into work they are offered short to medium in-work support for up to two
years or, for those with more complex needs, longer term in-work
support.
2.19 Whilst there were initial concerns related to the performance of the Work
Choice programme, there have been recent improvements. Looking at
those who joined the programme in the first half of 2013 (9,390
participants), nearly half had obtained a ‘job outcome’ by the end of that
year (4,310)24.
2.20 In the DWP Work Choice evaluation25, carried out by Inclusion,
participants reported positive impacts of the programme on their ability to
gain employment and remain in work. Many elements of delivery that
providers identified as contributing to good performance align with the
‘Supported Employment’ model, which is discussed further in Chapter 3.
2.21 Just over one third of those who have participated in Work Choice
(32,950 individuals) were claimants of ESA/ incapacity benefits or
Disability Living Allowance, or both. However this means that nearly two
thirds of those who have taken part were not claiming a benefit due to
disability or ill health. Of these, around three quarters were claimants of
JSA (26,250) while one quarter was not benefit claimants (9,870). These
low numbers of ESA participants are in turn in part due to the fact that
24 Source: DWP Work Choice official statistics, February 2014 25 Purvis, A et al (2013) Evaluation of the Work Choice Specialist Disability Employment Programme, DWP Research Report 846
Fit for Purpose: Transforming employment support
27
many ESA claimants are mandated to the Work Programme – whether it
is appropriate for their needs or not.
Access to Work
2.22 In addition to the three broad strands of support set out above, Access to
Work provides funding and support to disabled people and their
employers on meeting the extra costs that may arise because of an
individual’s impairment. This can include the cost of specially adapted
equipment, support workers, interpreters and travel to work. Access to
Work is administered by advisers and staff based in Jobcentre Plus
offices. Since December 2011, Access to Work has also offered a mental
health support service, delivered by Remploy Employment Services.
2.23 The 2009 evaluation of Access to Work26 reported that clients and
employers were happy with the amount and quality of support overall.
They also reported a number of positive impacts including reduced levels
of sickness and absenteeism, increased well-being and productivity, and
improved staff retention.
2.24 Access to Work supports over 30,000 disabled people and people with
health conditions every year27. However the evaluation reported that
there was no systematic way of informing clients of its availability, and
that there was low awareness amongst employers and Jobcentre Plus
staff. The Sayce Review28 described Access to Work as the Government’s
‘best kept secret’ and DWP have acknowledged that many employers are
still unaware of the programme, particularly in small and medium
enterprises.
2.25 In addition to poor levels of awareness, some agencies have reported a
number of concerns following the introduction of the new application
process via centralised call centres. Whilst there are currently a number
of proposals to improve awareness, accessibility and uptake of the
programme currently under consideration by DWP29, the Work and
26 Dewson, S., et al (2009) Evaluation of Access to Work , DWP Research Report 619 27 DWP (2013) Access to Work: Official Statistics. 28 Sayce L. (2011) Getting in, staying in and getting on: disability employment support fit for the future. DWP 29 DWP (2013) The disability and health employment strategy: the discussion so far
Fit for Purpose: Transforming employment support
28
Pensions Committee have also launched an inquiry to consider the
effectiveness of the programme.30
Residential Training
2.26 The Department for Work and Pensions also currently offers Residential
Training through nine contracted providers who offer specialist disability
employment training provision to disabled people and people with health
conditions who have the most significant barriers to work. A 2007 DWP
evaluation of Residential Training provision31 reported that that quality of
training was high, although this did not appear to be geared towards
securing employment outcomes. There was also an indication that there
was a limited focus on job placements or jobsearch activities.
2.27 In recent years, funding for Residential Training has been around £12-14
million per year. 1,224 people were supported through Residential
Training between April 2012 and December 2014, with over one third
(464) achieving job outcomes.32 Overall, costs per participant are around
£17,000 – driven in part by the requirement to offer full board for up to a
year to all participants, and by the intensive nature of the support (31-37
hours per week of structured support, and specialist sensory impairment
training where appropriate).
2.28 The 2011 Sayce review33 recommended that DWP should discontinue
direct funding for Residential Training, although a subsequent
Independent Advisory Panel review reported in 201334 evidence of direct
benefits of the holistic and intense nature of this provision. This report
strongly suggested that there is a case for Residential Training and made
a number of recommendations to DWP including that they work with
Residential Training providers to integrate this provision with other
specialist disability employment support.
Health and Work
2.29 Although the main focus of this report is support for individuals to prepare
for and take up work, it is important to note that around 300,000 people
30 http://www.parliament.uk/business/committees/committees-a-z/commons-select/work-and-pensions-committee/news/access-to-work-launch/ 31 Griffiths, R., et al (2007) Evaluation of Residential Training Provision, DWP research report 448 32 Source: DWP performance management statistics 33 Sayce L. (2011) Op cit 34 Residential Training Provision - Independent Advisory Panel report (2013) DWP
Fit for Purpose: Transforming employment support
29
per year fall out of work and into the welfare system because of health-
related issues.35 The 2011 Health at Work review examined the impact of
sickness absence and the effectiveness of the current system.36 In
January 2013, the Government published its response37, which included
plans to establish a health and work assessment and advisory service to
help individuals with a health condition to stay in or return to work.
2.30 This Health and Work Service will provide an occupational health
assessment and general health and work advice to employees, employers
and General Practitioners (GPs). The service, which is due to start in late
2014 has two elements:
Assessment: Once the employee has reached, or is expected to reach,
four weeks of sickness absence they will normally be referred by their
GP for an assessment by an occupational health professional, who will
look at all the issues preventing the employee from returning to work.
Advice: Employers, employees and GPs will be able to access advice via
a phone line and website.
2.31 In addition to this, the current Work Choice programme also includes
support for individuals in employment who becomes disabled, or whose
existing disability worsens, to retain their job.
Local provision
2.32 In addition to central government (DWP) provision, there is a range of
support commissioned and delivered locally through health, education and
social care. This support is funded by local and central government and
the charitable sector. However, the full nature and extent of this support
cannot be quantified (despite the efforts of researchers38), so it is far from
clear what provision is available in different areas, and for whom.
35 DWP (2013), Fitness for work: the Government response to ‘Health at work – an independent review of sickness absence 36 Black, C. and Frost, D. (2011), Health at Work: An Independent Review of Sickness Absence 37 DWP (2013), Fitness for work: the Government response to ‘Health at work – an independent review of sickness absence 38 Wilkins, A., Love, B., Greig, R. and Bowers, H. (2012) Economic Evidence Around Employment Support, National Development Team for Inclusion / School for Social Care Research, National Institute for Health Research
Fit for Purpose: Transforming employment support
30
2.33 Local Authorities in particular have historically been closely involved in the
provision of employment support for disabled people39. There is evidence
of a reduction in direct service provision in this area40 with some
indications that the overall spend on support has declined41. However the
performance frameworks for adult social care and public health include
targets aiming to support a reduction in the gap in the employment rate
between those with a long-term health conditions, mental health
conditions or a Learning Disability and the overall employment rate, so
the commissioning of relevant services remains a focus.
2.34 One of the most common areas of NHS commissioned and/ or delivered
employment support is for people with mental health conditions. For
example the ‘Individual Placement and Support’ approach, which helps
people with severe and enduring mental health conditions to move into
and maintain employment, is discussed further in Chapter 3.
Conclusion
2.35 There is a complicated landscape of employment support for disabled
people and those with health conditions. While there have been
extensive efforts to extend coverage and support since the late 2000s, we
estimate that just one in ten disabled people who are out of work are in
structured support and often have poor outcomes than non-disabled
peers. Spending on Access to Work is flat, despite efforts to increase
coverage, while funding for more specialist Residential Training is falling.
Additional local provision can play a key role, but there is no systematic
evidence on what support is available where – with some evidence that
the availability of provision may be declining.
2.36 However, the increased focus in public health and social care, and piloting
of new support through mainstream programmes, suggests that there
may be opportunities to extend access and support.
39 Purvis, A et al (2013) Op cit 40 Purvis, A et al (2013) Op cit 41 Greig, R., and Eley, A., (2012) The Cost Effectiveness of Employment Support for People with Disabilities Early Findings , National Development Team for Inclusion
Fit for Purpose: Transforming employment support
31
3 What works (and for whom)?
Introduction
3.1 This chapter sets out the evidence on ‘what works’ in supporting disabled
people and those with health conditions to find and maintain employment.
In particular it draws on recent reviews of both UK42 and international43
evidence along with reports produced subsequent to these two key
reviews. The evidence is divided into three sections:
Evidence on the effectiveness of different types of support –
looking in particular at ‘Supported Employment’ models, personalised
services, employer engagement, financial incentives, ‘Intermediate
Labour Markets’ and emerging evidence on telephone and online
services
What works for whom – focusing on mental health, young people’s
transitions to employment, sensory impairment and musculoskeletal
conditions
Cross-cutting themes that are important in delivering effective
support – covering the timing of interventions, the assessment of
support needs, partnership working, workforce development and
quality management
3.2 Throughout, we also include case studies of current and/ or innovative
service delivery, drawn from interviews with those delivering services and
from partners involved in the project.
3.3 As a number of previous reviews44 have noted, there are constraints in
terms of clearly identifying what works. These constraints include a lack
of consistency in the definitions used to categorise participants, support
models or methods of service delivery and programme outcomes45. There
is also a lack of robust assessments of the additional impact of
42 Shaw Trust, (2013) Making Work a Real Choice: Where next for specialist disability employment support? 43 Coleman, N. et al (2013) What works for whom in helping disabled people into work? DWP Working Paper 120 44 For example: Shaw Trust (2013) Op. cit.; and Dibden, P et al, (2012) Quantifying effectiveness of interventions for People with common health conditions in enabling them to stay in or return to work: A rapid evidence assessment DWP research report 812 45 Wilkins, A., Love, B., Greig, R. and Bowers, H. (2012) Op. cit.
Fit for Purpose: Transforming employment support
32
programmes, and on the costs and benefits of interventions46. This has,
in part, been linked to the fragmentation of support across multiple
agencies and programmes and which makes it difficult to plan, design and
evaluate interventions47. The most recent (2013) DWP working paper on
‘what works’48 reiterated that ‘good evaluation evidence is scarce’.
The effectiveness of different types of support
Supported employment
3.4 Notwithstanding these overarching limitations to the evidence on effective
employment support for disabled people and those with health conditions,
there is a strong body of international evidence related to Supported
Employment49. In 2010 the OECD50 concluded that the evidence on the
effectiveness of this approach was ‘unequivocal’, and a number of
subsequent studies have reached similar conclusions51.
3.5 Supported Employment was originally developed with the United States
(US) to support people with learning disabilities enter and maintain
employment. Within the European context the European Union for
Supported Employment (EUSE) has developed a best practice model of
Supported Employment which is supported by quality standards and a
number of ‘how to’ guides and toolkits52. This model, which is also
endorsed by the British Association for Supported Employment (BASE),
offers a framework which has previously been used by Government to
define and agree standards for Supported Employment in England. The
Valuing Employment Now (VEN) policy paper on Supported Employment53
described the key stages of Supported Employment which are outlined
below:
Participant engagement - The Supported Employment model
recognises the importance of raising the employment related
46 Dibden, P et al, (2012) Op cit 47 Wittenburg, D et al, (2013) The disability system and programs to promote employment for people with disabilities, IZA Journal of Labor Policy 48 Coleman, N et al (2013) Op. cit. 49 Also known as the ‘place, train and maintain’ model or job coaching 50 OECD (2010) Op cit 51 See for example Coleman et al (2013) Op. Cit; and Wittenburg, D et al (2013) Op. cit. 52 EUSE http://www.euse.org/process 53 HM Government (2010) Valuing Employment Now: Job Coaching or Supported Employment- Approach and Progress in Developing Standards. HM Government.
Fit for Purpose: Transforming employment support
33
expectations of disabled people, their families, and relevant education,
health and social care professionals.
Vocational profiling - Supported Employment should include a
mechanism for the identification of the aspirations, learning needs,
skills, and job preferences of the participant. This vocational profile
then informs job searching to ensure a high quality job match is
obtained.
Job matching - The accuracy of job matching should ensure the long-
term suitability of employment. Once an employer’s commitment to
offering work is secured, a job analysis is usually undertaken. This may
suggest ways of carving together parts of job descriptions that suit a
participant’s talents and are cost effective for the employer.
Employer engagement - is seen as a key element, where employers
are partners with whom the provider has an ongoing relationship. It
can help to overcome traditional recruitment barriers through the use
of working interviews and recognises that most people learn skills
better in situ adopting a ‘place and train’ approach.
In-work support - vocational profiling and job analysis should ensure
that in-work support is individually tailored. Where appropriate this
support may include specialist elements such as systematic
instruction54, alongside the development of natural supports within the
workplace. Providers should also ensure that goals are agreed and
progress recorded, that ongoing training takes place and offer out-of-
work support if needed.
3.6 The diagram below, produced by BASE55, illustrates how these elements
come together to support both employees and employers.
54 Systematic instruction is a particular method of job coaching that supports disabled
people in the workplace, and is felt to be a particularly useful approach for those with a learning disability. 55 http://base-uk.org/information-commissioners/what-supported-employment
Fit for Purpose: Transforming employment support
34
Figure 3.1 – the Supported Employment model
Source: BASE
3.7 Core elements of Supported Employment are also found in related models
of employment support developed to focus on supporting particular
groups of disabled people. For example the Individual Placement and
Support (IPS) model, which has been found to be successful for
supporting people with mental health conditions into work56 and some
56 Sainsbury Centre for Mental Health (2009) Doing what works, Individual placement and support into employment. Briefing 37.
Fit for Purpose: Transforming employment support
35
supported internships57, which support young people with a learning
disability in their transition from education into employment. Further
discussion of IPS and supported internships is offered below.
Personalised support
3.8 The DWP review of evidence from the evaluations of their programmes58
noted the heterogeneous nature of disability and the wide range of issues
that people face in entering and retaining work. Thus the personalisation
of service delivery, so that it meets the specific needs of individuals, is
crucial. In particular, ensuring that staff have adequate time to spend
with participants and the opportunity to tailor services to meet individual
need are seen as key factors in moving disabled people towards work.
3.9 Another DWP review of lessons from the US59 also reported that initiatives
that had the largest positive impacts on employment for this group
generally offered more intensive and personalised services. More recent
evidence on employment focused interventions within the US disability
system60 has also noted that interventions with a broad focus do not work
as well as those where support is individually customised.
3.10 The importance of personalised support, and of advisers that understand
an individuals’ barriers and their needs, also came across strongly in our
focus groups with service users. As one participant put it, describing the
characteristics of effective support:
“Somebody recognised what the problem was, and how to get you from
where you were, with depression, slow steps to get you where you
wanted to be, back to work. And it was ok to have that condition, and you
could work with it to get where you wanted to go. Most of the places it’s
not even recognised. So you weren’t having to pretend... I felt that I had
some hope.” (Participant with mental health condition)
3.11 Likewise, the focus groups reinforced the importance of staff having the
time and space to listen and get to know each individual. It was felt that,
where advisers spent longer time discussing barriers including health
57 Purvis, A., Small, L., Lowrey, J., Whitehurst, D. and Davies, M. (2012) Project SEARCH Evaluation: Final Report. Office for Disability Issues. 58 Hasluck, C. and Green, A. (2007) What works for whom? A review of evidence and meta-analysis for the Department for Work and Pensions. Department for Work and Pensions Research Report No. 407. 59 Rangarajan, A, et al, (2008) Programmes to Promote employment for disabled people: Lessons from the United States, Department for Work and Pensions Research Report 548 60 Wittenburg, D et al (2013) Op. cit.
Fit for Purpose: Transforming employment support
36
conditions, they gained a better understanding of needs and were able to
better personalise support.
“They didn’t say a lot, they allowed me to speak and that communicated
to them about my situation... I felt that was quite supportive, it wasn’t
rushed. They listened.” (Participant recovering from major surgery)
Case study: Want to Work, ESF/ Jobcentre Plus
Want to Work offers employment support to inactive people in Wales. It is
a voluntary programme financed by the European Social Fund and run by
Jobcentre Plus, and has some overlaps with the ‘voluntary’ access groups
in the Work Programme.
Despite the programme being targeted at those with significant
challenges in the most disadvantaged wards in Wales, Inclusion’s
evaluation found that the programme got 49 per cent of participants into
work, with 80 per cent staying in work for more than 10 months.
A central factor in the programme’s success, according to both
participants and staff, was the customer-focused advice and guidance
that delivered holistic support to tackle all of the barriers that kept
participants out of work. Focus was placed on building trust and
confidence instead of on the job search.
When possible, it embedded its services within communities and made
efforts to link up with health services, to support those that did not
normally interact with employment services and who were furthest away
from work. This enabled advisers to develop knowledge of, and
relationships with, other services on offer so that they could refer
individuals accordingly: likewise the other services found this partnership
beneficial for their service users.
Employer engagement
3.12 Working with employers should include both ‘in-work’ support to
individual employers to build their capacity to support disabled
employees, and wider engagement with employers and local labour
markets to source and secure job opportunities.
Fit for Purpose: Transforming employment support
37
3.13 The WORKSTEP Evaluation61 described two approaches to employer
engagement:
The individual approach, which placed more of a focus on the
individual requirements, capabilities and aspirations of the programme
participants to ensure a good job match (in line with the Supported
Employment model); and
The employment agency approach – with more of a focus on
developing relationships with larger employers (in some cases via
service level agreements) and adopting an agency approach to filling
their employment needs.
3.14 There are benefits and limitations to both of these models. The individual
approach is likely to be more resource intensive for the provider, but also
more likely to yield sustained outcomes. The agency approach is
dependent on the engagement of larger employers and may not deliver
as close a job match, but it does increase the number of vacancies that
can be offered to participants. The Work Choice evaluation62 therefore
recommended that providers should consider the use of both approaches
to employer engagement, as appropriate for participant needs and local
labour markets.
Case study: Access Ability
Access Ability is a web portal that represents collaboration between the
leading providers of Work Choice and Access to Work. The initiative is
concerned with reaching the maximum number of employer organisations
– the majority of whom have not yet considered employing disabled
people – with a ‘Responsible Employment’ message.
It was developed in response to consistent complaints from UK employers
about the complexity faced when hiring those with a disability. It is
designed to provide a practical and accessible ‘single point of contact’ –
allowing any employer organisation anywhere in Britain to find expert,
local assistance to recruit a disabled person with one click: “the right
support, from the right people, right on your doorstep”.
61 Purvis A, Lowrey J and Dobbs L. (2006) WORKSTEP evaluation case studies: Exploring the design, delivery and performance of the WORKSTEP Programme, Department for
Work and Pensions Research Report No 348. 62 Purvis A., et al (2013) Op. cit.
Fit for Purpose: Transforming employment support
38
The primary site functionality – its address/ postcode search and mapping
of local Work Choice and Access to Work providers – is complemented by
an extensive information repository. The site has therefore been able to
play an important role in the delivery of the Government’s ‘Disability
Confident’ employer campaign as well as in other areas of Government
employment service delivery.
It also manages much of its communications output in line with sector
‘verticals’, and specifically through employer organisations and
associations within these sectors (which already have communications
channels in place and have the authority to command attention). This
makes for an innovative, low-cost, high impact communications model
that is scalable across all sectors of industry.
This web portal can be found at http://accessability.info/
3.15 The role of employers is a key theme in the DWP development of a new
disability and health employment strategy63. This paper identifies
employers as key partners in terms of the improving the recruitment,
retention and progression of disabled people and those with health
conditions. Whilst it reports some examples of good practice in these
areas it acknowledges that there is more that Government can do to help
employers build their knowledge and confidence recruit, retain and
support this group. The Government’s ‘Disability Confident’ campaign
aims to achieve this, by increasing understanding among employers and
widening opportunities for disabled people.
Financial incentives
3.16 Many countries, including Britain, have a history of giving financial
support to employers to encourage the employment of disabled people.
The terms ‘incentive’ or ‘subsidy’ have been used interchangeably,
although here incentive is used to describe a short-term encouragement
to employ someone and address any initial needs. Subsidy here describes
the (older) model of compensating an employer on an ongoing basis for
employing a disabled person who is potentially regarded as less
productive than other employees. In Britain there has been a move away
from the use of long-term financial subsidies, as they can become a
barrier to progression to open employment64. In many European
63 DWP (2013) The disability and health employment strategy: the discussion so far 64 Purvis A., et al (2006) Op. cit.
Fit for Purpose: Transforming employment support
39
countries, however, these still form a proportion of spending on active
labour market programmes for disabled people65. For example Poland and
Denmark have both provided permanent subsidies, although progression
to unsubsidised employment is low.
3.17 An exploration of financial support to employers within Work Choice did
not appear to offer any clear evidence on the effectiveness of this
approach. Many providers reported a move away from their use, in
particular the longer-term subsidies. Some providers did report some
benefit from using short-term incentives, although this was not universal.
Findings from the related review of the Work Choice wage incentive for
young people were also mixed.
3.18 More generally, there is extensive evidence66 that financial support to
employers can enhance employment prospects, but tends to have
relatively high deadweight costs (paying for employment that would have
happened anyway) and substitution and displacement effects (improving
prospects for some workers at the expense of others).
3.19 There are a number of examples of financial incentives being used to
support individuals, to support the transition to work and to create a
stronger incentive to seek or prepare for work. The recent DWP review of
evidence67 examined in particular Tax Credits in the UK; In Work
Payments in Denmark and the Netherlands (which top up wages to the
level they would be without reduced earnings capacity); and the Resting
Disability Pension (RDP) in Sweden. However, the available evidence was
considered ‘patchy’, making it difficult to establish a clear view on the
impact of financial incentives to individuals and what works best.
Intermediate Labour Market models
3.20 In an independent report for DWP68 Professor Paul Gregg noted that the
Intermediate Labour Market (ILM) model can be particularly useful as a
means of tackling barriers to employment faced by those furthest from
the labour market. His report went on to recommend that providers
65 European Commission (2011) Supported Employment for people with disabilities in the EU and EFTA-EEA: good practices and recommendations in support of a flexicurity approach. European Commission Study Report 66 See for example Martin J and Grubb D. (2001) What works for whom: a review of OECD countries’ experiences with active labour market policies. Institute for Evaluation
of Labour Market and Education Policy Working Paper 2001:14 67 Coleman, N. et al (2013) Op. cit. 68 Gregg P. (2008) Realising Potential: A Vision for Personalised Conditionality and Support. Department for Work and Pensions.
Fit for Purpose: Transforming employment support
40
should be encouraged to provide this model as an option for support. A
subsequent impact assessment of the Future Jobs Fund69 demonstrated
that a carefully-designed ILM programme can have significant and lasting
impacts on the employment prospects of young people. This found that
the FJF had a significant and long-lasting positive impact on participants’
chances of being both off benefits and in unsubsidised employment.
3.21 The development of ILM models has also been noted within some
workplaces that have been set up specifically to offer employment to
disabled people (known as supported businesses). Whilst in some EU and
OECD countries there have been moves away from supported business
provision towards jobs in the open labour market70, some European
countries, such as Germany, Finland and Italy, there have been moves to
expand this approach71, suggesting that some support for this approach
remains at an international level.
3.22 In Britain the supported business model has been criticised on the
grounds of creating a segregated environment for the employment of
disabled people and low levels of progression to open employment72.
Research on the WORKSTEP programme73, however, noted a number of
positive attributes related to the supported business model, such as high
levels of satisfaction reported by their supported employees. This
research, along with evidence from the Work Choice Evaluation74 also
reported an increasing use of short-term contracts within supported
businesses as part of developing an ILM model. This model offered the
experience of real work coupled with additional support to help
participants move into external employment (usually a supported job with
the longer-term goal of open employment).
3.23 The Work Choice Evaluation also found positive evidence of the benefits
of integrating existing supported businesses with wider programme
delivery via an ILM approach. This included developments of ILMs with
host employers.
69DWP (2012) Impacts and Costs and Benefits of the Future Jobs Fund 70 OECD (2010) Op cit 71 Greve B. (2009) The Labour Market Situation of Disabled People in European Countries and Implementation of Employment Policies: A summary of evidence from country reports and research studies. Report prepared for the Academic Network of European Disability experts (ANED) Report 72 Sayce (2011) Op. cit. 73 Purvis et al (2006) Op. cit. 74 Purvis et al (2013) Op. cit.
Fit for Purpose: Transforming employment support
41
Case study: Work Programme PG7 Pilot ILM model, Work
Solutions
Work Solutions are a Work Programme sub-contractor in the North West.
They are piloting a Payment Group 7 (PG7) ILM Model, in which employer
engagement officers work with claimants to find them 16 hours of work
per week for 13 weeks. In agreement with the employer, they pay the
participant’s wages in this period, and once the ILM funding has finished
they work with the employer and participant to try and get the contract
extended.
The success of the ILM model with other groups prior to the Work
Programme led to it being established as a pilot for Work Programme
participants (with 65 to 70 per cent of lone parents and disabled people
maintaining work once funding ended). Thus it was decided that the
large up-front costs were justified, as there was evidence that it was likely
to be profitable and lead to successful outcomes in the long-term.
Telephone and online services
3.24 Recent DWP research75 found robust evidence that assessment of needs
by telephone can compare favourably to face-to-face methods, and that
even case management by telephone can be an effective way to support
people with common health problems through care pathways, monitor
progress and facilitate return to work.
3.25 Effective approaches to the provision of telephonic support were found to
include the identification of obstacles to work participation, the
development of return-to-work plans, the provision of work-focused
information and the coordination of ‘key players’. An important caveat to
these findings was the need for services to be well designed and
implemented, and staffed by professionals who have appropriate training
and support.
3.26 Following this, a recent study on Psychological Wellbeing and Work76
commissioned by the Department of Health and DWP has proposed
piloting four potentially complementary employment support options
including telephonic and on line support. It recommends that Jobcentre
Plus Districts procure third party telephone-based psychological and
75 Burton et al (2013) Telephonic support to facilitate return to work: what works, how, and when? DWP Research Report 853 76 van Stolk et al (2014) Psychological Wellbeing and Work Improving Service Provision and Outcomes, Department for Work and Pensions/ Department of Health
Fit for Purpose: Transforming employment support
42
employment-related support, to be offered to JSA or ESA claimants before
they enter the Work Programme. For online support, the report proposes
building on tested eHealth models of online mental health assessment
and Cognitive Behavioural Therapy (CBT), with an additional vocational
element.
Case Study: SHINE, Greater Manchester Public Health Network
SHINE is an intervention that ran in Bolton in 2011 and demonstrated an
innovative use of technology to engage with a client group with alcohol
dependency.
It involved using an everyday text messaging service to monitor client’s
progress. Each individual who had opted in to the service would get a
message at a time that suited them asking how they were. Their replies
were then tracked by software, and they would get another message
based on their response. If it was extremely negative, their key worker
would be notified and could then call them to intervene at a critical point.
If not they would be congratulated or encouraged to keep going with a
personalised message.
This easy and not intimidating contact worked well, especially as clients
were nervous about speaking on the phone and reluctant about engaging
with health services. It was also found to be cost-effective as it freed up
key workers time and allowed performance managers to better balance
caseloads.
It has since been adopted for people on Working Well in Greater
Manchester and has been piloted with primary drug using clients in
Darlington and Bradford.
Use of behavioural insights and techniques
3.27 Finally, there is evidence of growing use of ‘motivational interviewing’ and
other techniques that draw on behavioural economics, including the
‘Stages of Change’ model. All of these approaches have been applied in a
wide range of settings, not just in relation to welfare to work. As they are
fairly new there is limited evidence on their effectiveness in supporting
disabled people and those with health conditions.
Case study: Motivational workshops, Randstad
Randstad provide pre-employment motivational workshops for disabled
people and those with a health conditions on the Work Programme.
Fit for Purpose: Transforming employment support
43
Participants are ESA claimants, many of whom also suffer from depression
or anxiety, who have been moved onto JSA and are now having to look
for work. Providing this specific support, alongside the work of the Work
Programme adviser, they are able to achieve a higher than average
success rate for these people.
The workshops are two hour sessions, with three follow-up telephone
calls. Workshops may have up to 15 participants. The purpose of the
workshop is to engage with people and help them set realistic goals to get
closer to, and into, work. The workshops provide helpful ideas and tips on
how they can look for work. The follow-up coaching calls are to see how
they are doing, assess if they have reached the three goals they set
during the workshop and to offer support and sign posting.
Randstad believe a key factor in the success of the workshops is the
specialist trainers. The trainers have had personal experience of disability
which resulted in them being out of work for a period of time and this has
a very positive impact on participants too. Furthermore it means the
trainers are empathetic to the course participants. They understand that
just attending the course can be a huge step for people who feel that
their barriers are preventing them from a successful return to work.
What works for specific groups?
3.28 There is some evidence that different forms of interventions can be
particularly effective for some groups, or more effective for these than for
others. These differences illustrate the fact that disabled people are a
diverse group with diverse needs. We have presented below the evidence
on what works across four key groups: those with mental health
conditions; sensory impairment; musculoskeletal conditions; and finally
for young people making the transition into employment. In all cases,
this evidence reinforces many of the key points on what works more
generally – and in particular the need for personalised and tailored
services, effective employer engagement, and a holistic approach.
Fit for Purpose: Transforming employment support
44
Mental health
3.29 Recent research by the OECD, on mental health and work in the UK77,
identifies a number of key ingredients in supporting people with mental
health conditions who are out of work:
Addressing issues in the early stages of unemployment
Systematic, timely and accurate identification of mental health
problems for jobseekers on all benefits – through robust profiling
tools and ensuring that advisers have the right skills
Strong co-operation between employment and health services,
either through referrals or service integration
Reduced caseloads for staff doing targeted work with those with
mental health conditions.
Tailored services for clients with mild and moderate mental health
problems including more use of specialist mental health subcontractors
Case study: Psychologically trained caseworkers
In Denmark, the use of psychologically trained caseworkers has resulted
in improvements in job placement outcomes for people with common
mental health conditions. Jobseekers have weekly 1:1 meetings with the
specialist caseworkers focused on training and employment. These
meetings involve discussion about returning to work, psychological
counselling and the provision of help to access mental health treatment.78
Psychological therapies such as cognitive behavioural therapy (CBT)
Greater in-work follow up and support, including greater use of
Access to Work
A strong relationship with employers to address the stigma
related to mental health problems
Following the principles of Individual Placement and Support
(IPS).
77 OECD (2014) Mental Health and Work: United Kingdom 78 OECD (2013) Mental Health and Work: Denmark
Fit for Purpose: Transforming employment support
45
Case study: Individual Placement and Support (IPS)
The IPS model is an approach which helps people with severe and
enduring mental health conditions to move into and maintain
employment. The IPS model was developed in the US in the 1990s, and,
in the UK, IPS is primarily offered via mental health rather than
employment, provision. IPS is a variant of the Supported Employment
model and the key principles of IPS are:
A goal of competitive employment
Everyone with severe mental health problems is eligible
Individualised and rapid job search
Co-location and joint working between employment and clinical
specialists
Support is time unlimited
Employers are approached based on the client’s preferences
3.30 There is a substantial evidence base supporting the efficacy of the IPS
model79. However, the model needs to be implemented well in order to
be effective. A randomised controlled trial of IPS in the UK80 found no
evidence at a one-year follow up that IPS was of significant benefit for
achieving competitive employment as compared to standard vocational
services. A possible explanation was that the IPS programme in this trial
was not integrated with community mental health services.
3.31 There is also robust evidence that well designed, peer led group
work can be effective both in improving wellbeing and employment
prospects – from the ‘JOBSII’ model in the US.
Case study: JOBSII
JOBSII is a peer-led group intervention programme with the dual goals of
facilitating jobseekers to return to work and preventing negative mental
health consequences of unemployment. JOBSII is based on theories of
active learning process, social modelling, gradual exposure to acquiring
79 Bond GR, Drake RE, Becker DR, et al. (2008) ‘An update on randomised controlled
trails of evidence-based supported employment.’ Psychiatric Rehabilitation Journal, 31 80 Howard et al. (2010) ‘Supported Employment: Randomised Controlled Trial.’ The British Journal of Psychiatry, Vol. 196, 404–411.
Fit for Purpose: Transforming employment support
46
skills and practice through role playing. It aims to increase jobseekers’
sense of job search self-efficacy and improve their ability to deal with
setbacks during the job search process. The group sessions are
intensive: lasting around four hours a day, four days a week, over six
weeks. There is evidence to suggest that JOBSII has a significant effect
on re-employment and decreasing psychological distress81.
3.32 Both JOBSII and IPS were recommended in the recent study on mental
health and employment commissioned jointly by the Department for Work
and Pensions and the Department of Health82 (alongside the online and
telephonic support services described in paragraphs 3.24 to 3.26).
Case study: Workwell – Business in the Community
Business in the Community (BITC) is a business led organisation. One of
their programmes is Workwell, a coalition of businesses committed to
improving levels of understanding of the role of workplace wellness.
Recently, Workwell has focused on mental health in the workplace and
has released a paper, Mental Health - we're ready to talk.83 This is an
employer-led initiative that aims to break taboos about discussing mental
health in the workplace, based on the idea that there is a clear business
case for employers to help maintain the mental health of their workforce.
The BITC approach aims to encourage employers to discuss this issue and
to put in place processes to support staff. The campaign is led by the
BITC Workwell Mental Health Champions group, a group of large
employers such as BT and Santander. Employers are encouraged through
the campaign to make the Time for Change Pledge: a public statement
that their organisation wants to tackle mental health stigma and
discrimination.
Sensory impairment
3.33 As part of a recent three year action-based research project, RNIB and
the University of Birmingham looked at what works for blind and partially
81 Audhoe, S. S., Hoving, J. L., Sluiter, J. K. and Frings-Dresen, M. H. (2009) ‘Vocational
interventions for unemployed: Effects on work participation and mental distress. A systematic review.’ Journal of Occupational Rehabilitation, 20(1), 1–13; Vinokur, A. D.,
Price, R. H. and Schul, Y. (1995) ‘Impact of the JOBS intervention on unemployed workers varying in risk for depression.’ American Journal of Community Psychology, Vol.
23 No. 1, 39–74. 82 van Stolk C, Hofman J, Hafner M and Janta B (2014) Psychological Wellbeing and Work: Improving Service Provision and Outcomes. Department for Work & Pensions and
Department of Health Policy Paper 83 http://www.bitc.org.uk/programmes/workwell/mental-health-were-ready-talk
Fit for Purpose: Transforming employment support
47
sighted jobseekers in terms of assessment and employment support
interventions84.
Case study: A specialist assessment toolkit, RNIB
Most employment services for blind and partially sighted people are
delivered by non-specialist organisations. These organisations often lack
sufficient knowledge about the particular needs of blind and partially
sighted jobseekers, and are therefore unable to deliver the specialist
support required.
RNIB group of charities worked closely with blind and partially sighted
people, the University of Birmingham and employment professionals to
develop a comprehensive employment assessment toolkit, which takes
account of the specific needs of blind and partially sighted job seekers.
The toolkit was developed because there was nothing in place to assess
distance from the labour market and to segment blind and partially
sighted people into groups and level of support needs. While it includes
the assessment of proximity to the labour market and job aspirations, it
places sight loss at the heart of this tool.
Over 100 people were consulted over three years of development
including service users and delivery staff making this a robust toolkit. The
tool was developed through a mix of practical knowledge and gap in the
market alongside academic research which validated the model.
The toolkit enables employment advisers who work with blind and
partially sighted people to gain a clear understanding of their clients’
employment aspirations and to design appropriate interventions to help
them on their path to employment.
The toolkit can be found here www.rnib.org.uk/assessmenttoolkit and can
be used by any employment provider working in the welfare to work
industry that supports blind and partially sighted people.
3.34 The research85 found that blind and partially sighted people who are
furthest from the labour market benefit from intensive support and
specialist interventions in relation to:
84 Saunders A, Douglas G and Lynch P. (2013) Tackling unemployment for blind and partially sighted people. RNIB Research report 85 Saunders A, Douglas G and Lynch P. (2013) Op. cit.
Fit for Purpose: Transforming employment support
48
Developing computer skills, including use of assistive technology
Developing the confidence and ability to travel independently on public
transport
Disability disclosure and communicating their needs and workplace
adjustment requirements
Making the most of any residual vision
3.35 These specialist interventions can be delivered either as targeted
interventions or as part of a standard pre-employment programme
specially designed for blind and partially sighted people.
Case study: Specialist pre-employment programme
One of the innovative support strategies RNIB have been trialling is a pre-
employment programme designed for small groups of blind or partially
sighted jobseekers. RNIB has just completed a major revision to the pre-
employment programme trainer’s toolkit, which can be found here:
www.rnib.org.uk/preemployment
3.36 In addition to the specialist interventions highlighted above, the research
found that blind and partially sighted people also benefit from
interventions which are not disability specific such as:
Developing job search skills
Attending training/college programmes
Gaining work experience, especially where this is linked to meaningful
practice and the development of other skills such as mobility, IT and
confidently discussing their sight loss with work colleagues
Access to wider support services such as independent living training,
self-care support and benefit advice
3.37 Finally, evidence suggests that the majority of employers have a negative
attitude to employing a blind or partially sighted person. Therefore it is
also critical to develop links with employers to generate opportunities and
appropriate support; and to increase awareness amongst employers and
Fit for Purpose: Transforming employment support
49
jobseekers of positive role models (i.e. blind and partially sighted workers
achieving successful outcomes)86.
3.38 In relation to hearing loss, some specific recommendations for improving
the effectiveness of employment services for this group from the RNID87
include:
Specialist deaf awareness training for all employment advisers
Providing the opportunity for every deaf client to see an employment
adviser with appropriate communication skills/support
Ensuring appropriate alternatives to telephone contact are readily
available
More awareness and promotion of the Access to Work scheme to both
employers and potential employees
3.39 Research also suggests that there are specific lessons on supporting
those with hearing or sight loss to stay in work88, specifically by:
Providing people with sensory impairment with appropriate vocational
rehabilitation support
Increasing awareness within occupational health and human resource
teams of possible adjustments that can be made and specialist
retention services, including Access to Work
Encouraging employers to provide training to staff on disability
awareness, including understanding the impact of sight and hearing
loss on an individual, the importance of adjustments, and the legal
rights of disabled people
Helping employers to understand the business case for job retention
Musculoskeletal conditions
3.40 A 2012 rapid evidence assessment conducted for DWP89 examined
evidence on the effectiveness of interventions for people with common
86 Saunders A, Douglas G and Lynch P. (2013) Op. cit. 87 RNID (2007) Opportunity Blocked. RNID Research Report 88 RNIB (2013) Evidence-based review: People of Working Age. RNIB Evidence Review;
and Matthews, L. (2011) Unlimited Potential? A research report into hearing loss in the workplace. Action on Hearing Loss Research Report
Fit for Purpose: Transforming employment support
50
health conditions, including musculoskeletal conditions, in enabling them
to stay in or return to work.
3.41 Non-specific low back pain is one of the most common, and most costly,
causes of absence from work. The evidence review found that the
majority of studies conducted in the area of musculoskeletal conditions
that included measurement of employment outcomes were focused on
low back pain. There is some evidence that a multidisciplinary approach
(involving, for example, workplace-focused interventions, cognitive
behavioural therapy and social support) is effective.
3.42 Coordination also appears to be important, with studies finding that
interventions that involve employees, health practitioners and employers
working together to implement work modifications were more consistently
effective than other interventions. Lessons on joining up commissioning
are set out in Chapter 4.
Young people’s transitions to employment
3.43 Finally, there is clear evidence that young disabled people are particularly
disadvantaged and suffer from poorer transitions from education to
work90. In our view it is therefore a priority to support young disabled
people to find and keep work. We set out below the evidence on what
works.
3.44 A 2010 Ofsted91 review identified that initiatives involving job coaches and
Supported Employment services were successful in helping young people
with learning difficulties and/or disabilities to access work, and also had a
significant positive impact on their aspirations.
3.45 A 2012 research study which analysed 44 case studies of good practice
across 11 EU countries92 identified a number of further elements of good
practice, which included:
89 Dibben P, Wood G, Nicolson R and O’Hara R. (2012) Quantifying effectiveness of interventions for People with common health conditions in enabling them to stay in or return to work: A rapid evidence assessment. Department for Work and Pensions
Research Report 812 90 DWP (2013), Fulfilling Potential: Building a deeper understanding of disability in the UK today 91 Ofsted (2010) The special educational needs and disability review: A statement is not enough. 92 McAnaney D, Wynne R, DeVos E, Reijenga F, Delfosse C and Spooren J. (2012) Active inclusion of young people with disabilities or health problems. Eurofound Report
Fit for Purpose: Transforming employment support
51
Good working relationships between all those involved in
supporting young people into work
The use of mentoring
Close links with employers, including to identify local labour demand
and then providing targeted training and support
Case Study: Supported internships
Supported internships were one of a number of initiatives proposed in the
2011 Special Educational Needs Green Paper93.
Following the Project SEARCH supported internship demonstration
projects94, in autumn 2012 a supported internship trial began at fifteen
Further Education (FE) colleges in England. These supported internships
provided a structured study programme for 16 to 24 year olds with a
learning difficulty assessment.
The evaluation of the trial95 identified a number of key success factors for
supported internships:
The need to be distinctive from other forms of college provision, with a
clear focus on achieving sustainable employment
Job coaches with broad skill sets
Interns that want to work and that have families supportive of this
Personalised, tapered support, with further support available post-
programme as needed
On-going partnerships between employers, interns, college staff, and
where appropriate, parents and carers
Achieving an appropriate realistic job match for an intern
College-based learning that is personalised, clearly linked to the
workplace and a source of peer group support
93 DWP (2011) Support and Aspiration: a new approach to special educational needs and disability. Green Paper 94 Purvis, A., et al (2012) Op. cit. 95 CooperGibson Research and Disability Rights UK (2013) Supported internship trial for 16 to 24 year old learners with learning difficulties and/or disabilities: An evaluation. Department for Education Research Report
Fit for Purpose: Transforming employment support
52
A focus from the outset on how to secure employment by the end of
the internship, especially for those who are not offered paid work by
their internship employer
Case study: Group Supported Internships, Remploy
Remploy have developed a supported internship approach for individuals
with severe disabilities, which aims to pool funding from a range of
sources and reduce unit costs by providing group internships with large
employers.
These internships are targeted at young people under 24 who typically
have a learning disability, autism or behavioural problems. They are
usually at FE colleges, and the supported internship forms their final year.
Remploy have targeted large employers and placed 10 to 12 young
people with them, staggering starting dates. This drives down costs and
means that one support worker can be available to support more
participants and is present if there is an urgent need.
There is an estimated unit cost of £6,500 per participant (met by the SFA,
the participant’s FE college and LEA’s), and around 60 to 70 per cent of
participants get into work at the end of the programme; a considerable
success considering that the employment rate for this group is around 10
per cent.
Cross-cutting themes
3.46 We have also identified five cross-cutting themes that are key to the
successful delivery of employment support for disabled people and those
with health conditions: the timing of interventions; assessment and
segmentation; partnership working; workforce development and
quality management. These are explored below.
The timing of interventions
3.47 The Government identifies96 that getting the right support at the right
time is particularly important for disabled people and those with health
conditions. It reiterates that the longer an individual is out of work, the
96 DWP (2013) The disability and health employment strategy: the discussion so far
Fit for Purpose: Transforming employment support
53
more likely they are to remain out of work for long or even indefinite
periods. Early or timely intervention is also important where individuals
develop an impairment in work, to prevent loss of employment97.
3.48 Timely intervention can also mean providing employment support at the
point where any health condition has been stabilised. For example for
those with fluctuating mental health problems, delivering employment
support at the point where the condition is being effectively managed is
likely to have more impact than delivering the same support alongside
condition management.
Assessment and segmentation
3.49 Delivering early intervention also critically depends on effective
assessment of need and then referral to support. As the Government
acknowledges98, assessment based on benefit or health condition alone
does not give an adequate indication of support needs.
3.50 The Work Choice Evaluation99 and evaluation of the ‘Jobcentre Plus
offer’100 noted difficulties with the identification of claimant support needs
within Jobcentre Plus. This can result in support not being appropriate,
and effectively block access to specialist support – for example for some
claimants referred directly to the Work Programme following the outcome
of a Work Capability Assessment (WCA).
3.51 The DWP strategy paper acknowledges that, as reported within the Work
Choice Evaluation, the Statutory Referral Organisation (SRO) referral
route onto the Work Choice programme is also not working well. It
therefore goes on to outline proposals for a new ‘Gateway’ to employment
services for disabled people and people with health conditions.
3.52 The approach for this new Gateway is described as ‘a timely and light
touch way of identifying the right type of support for each individual,
focusing on each person’s strengths and employment support needs,
rather than their health condition, impairment or the type of benefit they
receive.’ The assessment process is described as potentially involving two
stages, based on a first step filtering, followed by a more in-depth
engagement with an adviser where appropriate.
97 Coleman, N et al (2013) Op. cit. 98 DWP (2013) The disability and health employment strategy: the discussion so far 99 Purvis, A., et al (2013) Op. cit. 100 Coulter, A., et al (2013) Op. cit.
Fit for Purpose: Transforming employment support
54
3.53 The Work and Pensions Select Committee has recommended101 a more
thorough and systematic assessment of claimants' needs, similar to the
Jobseeker Classification Instrument (JSCI) used in the Australian welfare
system. DWP have already carried out some research exploring the
development of such a ‘segmentation’ tool102, although even the best-
performing model could only predict 59 per cent of data variation.
3.54 In our view, there are two key issues in the development and
implementation of any new assessment processes:
First, to ensure that they are appropriately aligned with each other and
the WCA, to ensure consistency of outcome; and
Secondly, that relevant information is shared between the assessor and
the service provider that an individual is then referred on to. A number
of programme evaluations have reported difficulties related to the
inadequacies of referral information103.
Case study: Systematic assessment
In Belgium, the public employment service addresses health problems
routinely and jobseekers are systematically assessed for mental health
problems. Those found to have more severe barriers are sent for a
diagnosis to an in-house psychologist or to an external specialist in in-
depth multidisciplinary screening.104
Partnership working
3.55 Partnership working, and joining up services between employment,
health, social care and other services, underpins many of the examples of
‘what works’ set out in this chapter. The importance of joining up
services came across particularly strongly in focus groups conducted with
service users. In general, the more linked up different forms of support
could be, the better.
“I think it’d give both sides a better understanding of our needs, and
might help these people at [the employment provider] get a better handle
101 Work and Pensions Select Committee (2014) The role of Jobcentre Plus in the reformed welfare system 102 DWP (2013) Predicting likelihood of long-term unemployment: the development of a UK jobseekers' classification instrument, Working Paper No. 116 103 For example Newton, B., et al (2012) Op. cit. 104 OECD (2013) Mental Health and Work: Belgium
Fit for Purpose: Transforming employment support
55
of what my mental health conditions are.” (Participant with a mental
health condition)
“I think the more they co-operate the better – I can’t see a downside to it
to be honest.” (Participant with a mental health condition)
3.56 One focus group was conducted with users of NHS services, whose
experiences demonstrated that linked working was already being
delivered to some extent – with employment-related support delivered
within mental health services. There was general support for this way of
working services, with the service user at the centre of all of the support
being delivered.
“I like the way that the employment specialists are included in the medical
team, the care co-ordinators, the psychiatrists, so no matter what
information you give it all gets fed back and then there’s a plan made. I
know for a fact that if I don’t feel very well, if I mention it to my
employment specialist, I know for a fact that I’m going to get a phone call
from my care co-ordinator to ask I need to go and see them.” (Participant
with a mental health condition)
Workforce development
3.57 The importance of adviser attributes, in terms of their skills, commitment
and enthusiasm, has been identified in a range of studies105. A 2010
report by Inclusion106 highlighted that, even though high levels of
satisfaction were associated with job roles, there was evidence of churn
within the workforce, with salary and progression outlined as areas of
weakness but with staff showing a strong interest in training and
professional development. The report recommended clear development
pathways, transferable skills and an overarching professional membership
body for the sector.
Case study: The Institute of Employability Professionals (IEP)
The Institute of Employability Professionals (IEP) was launched in 2012.
It is a membership body for those working across the employment related
services (ERS) sector. The IEP is setting professional standards for the
employability sector and overseeing the implementation and adaptation of
105 See for example Hasluck C and Green A. (2007) Op. cit. 106 Crawford, E. and Parry, F. (2010) Professionalising the welfare to work industry: developing a framework for action. Centre for Economic and Social Inclusion
Fit for Purpose: Transforming employment support
56
the ERS framework of qualifications. This is expected to lead to the
creation of National Occupational Standards and possibly practitioner
licensing and a National Skills Academy. By September 2013, the IEP had
nearly 4,000 members, engaged 18 prime contractors and approved 60
new qualification units.
3.58 In their submission to the Government Review of Disability Employment
Strategy, BASE advocate107 more support for provider development,
including the need for ongoing workforce development. The BASE
submission notes the highly skilled nature of the adviser role within this
area of service provision and the evidence on what works highlights the
key role adviser staff play in successful service delivery. The BASE paper
reports on current developments such as National Occupational Standards
for Supported Employment and the Level 3 certificate in Supported
Employment. It recommends that all providers (including Jobcentre Plus)
must ensure their staff are appropriately trained to support those with
complex needs.
3.59 The importance of skilled advisers was also emphasised by participants in
our focus groups. They did not expect advisers to be medically trained,
but emphasised the need for a good understanding and appreciation of
health conditions. Mental health conditions in particular were singled out.
Many described the importance of advisers with experience in working
with a range of health conditions, and perhaps who had themselves
experienced mental health issues. As one participant put it:
“She’s got a lot of experience and training, she’s got a lot of
understanding, she’s got a lot of contacts and numbers, and she has that
professionalism. That was very helpful, because you could talk about
mental health conditions and physical health and she’s got experience of
it and she understands it.” (Participant with mental health condition)
3.60 Hasluck and Green108 also cited the importance of continuity in adviser
relationships with participants, particularly at times of transition. This was
also emphasised in the Work Choice Evaluation109 and the evaluation of
107 BASE (2013) Submission to the Government Review of Disability Employment. British
Association for Supported Employment Response Paper 108 Hasluck, C. and Green, A. (2007) Op. cit. 109 Purvis et al (2013) Op. cit.
Fit for Purpose: Transforming employment support
57
WORKSTEP110, which also attributed the positive outcomes for many
participants to the commitment of advisers.
Case study: Training of advisers, Remploy
Over the last 18 months, Remploy has overhauled staff training in order
to improve the service it offers those with health conditions and
disabilities, and to help more into work.
They have invested in specialist disability training to improve performance
by: changing the beliefs and attitudes of advisers; persuading them that
they can support those with disabilities into work; providing advisers with
the specialist knowledge and ensuring that they have access to tools to
help them deal with different situations.
All staff receives basic level training to get a baseline knowledge about
disabilities. All staff that work with disabled people receive intermediate
training, to get more detailed knowledge so they can support them back
into work. The IEP Level 3 ERS qualifications will be provided over the
next few years, and Remploy have worked with EDI to refine each unit
with additional criteria about disabilities. Furthermore, a small number
within the organisation receive specialist training, such as how to support
those with dyslexia, while 29 ‘how-to’ guides have been developed with
practical advice for employers and staff.
Quality management
3.61 The DWP evaluation of Work Choice found that, in general, the
mechanisms used to manage performance appeared to focus primarily on
monitoring and managing outcomes rather than developing service
quality. A lack of external quality inspection was felt to have
compounded this issue.
3.62 Evidence from the evaluation of the predecessor to Work Choice,
WORKSTEP111, noted the positive influence that an external inspection
process had in developing the quality of provision. Such inspection
processes linked to a quality framework also forms a core element of
contracted employment services in some other countries such as
110 Purvis et al (2006) Op. cit. 111 Purvis et al (2006) Op. cit.
Fit for Purpose: Transforming employment support
58
Australia112 and in Northern Ireland113. The Work Choice Evaluation
therefore recommended development of a quality framework for specialist
disability employment services, along with the reintroduction of external
inspection. This was supported by BASE in their submission to the
Government Review of Disability Employment Strategy114.
3.63 The importance of developing service quality was also acknowledged by
Shaw Trust, in their report on the development of a future disability
employment programme115. They note that in order to ensure support
delivered is consistently of the highest standard, an independent quality
evaluation, using feedback from participants and employers should be
undertaken at regular intervals.
Conclusion
3.64 While there are limitations in the evidence around what works, this
chapter sets out that there is nonetheless extensive research – and
numerous case studies – that can point us in the right direction. There
are a relatively small number of well-evidenced models, but a broad range
of evidence that emphasises the importance of personalised support,
small adviser caseloads, holistic services (that go beyond just condition
management and employment advice), and a different approach to
employer engagement. Ensuring that needs are fully understood, and
support is well-timed, are also key.
3.65 These principles, and many of the specific models and approaches
covered in this Chapter, should underpin future employment support.
112 In Australia all disability employment services must meet the requirements of the
independently assessed quality assurance system to receive funding. 113 Through the Northern Ireland Education and Training Inspectorate 114 BASE (2013) Submission to the Government Review of Disability Employment. British
Association for Supported Employment Response Paper 115 Shaw Trust (2013) Op. cit.
Fit for Purpose: Transforming employment support
59
4 Commissioning support
4.1 There is growing evidence that how programmes are commissioned
can have a bearing on the effectiveness of support for disabled people
and those with health conditions. In particular, the use of ‘Payment by
Results’ models, personal budgets, and locally-based and joint
commissioning models all have important lessons for the future of
employment support. These areas are explored below.
Payment by Results
4.2 Outcome based payment structures, or Payment by Results (PBR) models
in employment support were first developed in the USA and subsequently
adopted in a number of countries including the UK. Such systems
incentivise providers to achieve entry into sustained employment, rather
than payments being simply based on the number of participants starting
a programme. There have been real benefits from these contracting
systems – in terms of ensuring that commissioners and providers are
focused on outcomes, that spending is geared towards achieving results,
and finances are closely managed. However the PBR model can present a
particular challenge for the delivery of support to those facing the most
significant barriers to the labour market116. This is related to concerns
about ‘creaming’ and ‘parking’ behaviour on the part of providers,
whereby effort and resources are focused on those participants for whom
employment outcomes can be achieved most quickly and/ or cheaply.
4.3 The Work Choice programme has retained significant levels of service fees
(70 per cent of a provider’s contract price, paid monthly) alongside
outcome payments for short and sustained job outcomes. The
evaluation117 reported that this balance between service fees and
outcome-based funding was welcomed by providers. The service fee
element was felt to allow for investment (which was felt to be particularly
important given the support needs of participants) and to facilitate the
participation of some smaller specialist providers in the programme. It
also appeared to reduce any perverse incentive to ‘park’ participants
unlikely to achieve an employment outcome. The research therefore
116 Finn, D (2011)Job Services Australia: design and implementation lessons for the British context, DWP Research Report 752 117 Purvis et al (2013) Op. cit.
Fit for Purpose: Transforming employment support
60
recommended that future funding models for specialist support should
recognise the role of service fees within the funding model.
4.4 However, it is important to note that concerns were nonetheless raised in
the Work Choice evaluation that the ‘prime provider’ model used to
commission the programme had led to some specialist providers (and
local authorities) exiting the market, and others only being utilised on a
very limited basis. This was likely to have a negative impact on specialist
service delivery and on the diversity of provision in the future (particularly
for those with specialist needs).
4.5 Within mainstream employment programmes, differential payment
models have been developed in an attempt to address concerns
regarding ‘creaming’ and ‘parking’. Under these models, providers are
paid at different rates for outcomes achieved by different target groups
(with outcomes for the harder-to-help groups being paid at higher rates
than those for groups closer to the labour market)118. For example in the
Work Programme, there are nine ‘payment groups’ primarily based on an
individual’s benefit type. Providers are paid at different rates for outcomes
achieved by these nine groups, with outcomes for ‘harder-to-help’ groups
being paid at higher rates than those for groups deemed to be closer to
the labour market.
4.6 There is, however, concern that this differential payment model is not
working effectively, with the first report of the DWP Work Programme
evaluation119 noting that those furthest from work have infrequent access
to specialist provision and see support reduce over time.
“Providers routinely classify participants according to their assessed
distance from work, and provide more intensive support (at least as
measured by the frequency of contact with advisers, for example) to
those who are the most ‘job-ready’. Those assessed as hardest-to-help
are in many cases left with infrequent routine contact with advisers, and
often with little or no likelihood of referral to specialist (and possibly
costly) support, which might help address their specific barriers to work.”
4.7 The interim report of this project120 sets out starkly the limitations of the
PBR model in the Work Programme. As a consequence of outcomes
118 Finn, D (2009) Differential Pricing in Contracted Out Employment Programmes: Review of International Evidence, DWP Research Report 564 119 Newton, B et al (2012) Op. cit. 120 Wilson, T. and Riley, T (2014) Op. cit.
Fit for Purpose: Transforming employment support
61
being below expectations, DWP funding per ESA participant is significantly
lower than DWP intended, and will fall to just £550 per person for those
now joining the programme. That report proposes a revised payment
model in order to ensure that payment levels for ESA claimants are in line
with original plans. This model would maintain some level of attachment
payments, introduce job entry payments as well as job outcome
payments, and compress the time period in which sustainment payments
are made. Our proposals are set out in Table 4.1 below.
Table 4.1 – Proposed Work Programme payment model for ESA claimants
PG5 - ESA Volunteer
PG6 - ESA Flow
PG7 - ESA ex-IB
Attachment payment £350 £350 £350
Job entry payment £600 £900 £1,250
Job outcome payment (three months in work)
£1,150 £1,400 £4,000
Maximum job sustainment payment*
£2,300 £4,700 £9,620
Cost per attachment £1,018 £1,181 £1,413
* Same overall levels as current model, but paid over 9 months after job outcome payment.
4.8 Other approaches proposed to adjust the Work Programme funding model
include the introduction of payments for outcomes other than
employment such as ‘progression measures’121, an approach that is
currently used within the DWP ESF Families programme.
4.9 International research into the use of differential pricing122 has explored
other proposals such as a ‘target accelerator’, with a sequence of
differential fees for each segment of a specific claimant population,
although this model is currently untested. In the Australian system the
use of the Jobseeker Classification Instrument (JSCI) and a differential
pricing system have been relatively effective at targeting support towards
highly disadvantaged job seekers. However there has also been some
strengthening of financial incentives, with specific funds for employment
barrier reduction, greater scrutiny of ‘parking’ and frequent adjustments
to the JSCI and the performance management Star Rating system. The
121 Inspire to Independence (2013) How to improve on The Work Programme 122 Finn D. (2011) Op. cit.
Fit for Purpose: Transforming employment support
62
key source of additional funding in Australia is the Employment Pathways
Fund, which is described below.
Case study: Employment Pathways Fund, Australia
The Employment Pathways Fund (EPF) is a flexible pool of funding that
can be drawn down by employment services providers to support
jobseekers or groups of jobseekers. The fund allocates a notional ‘credit’
for each jobseeker, with the level of the credit linked to the level of labour
market disadvantage. Providers can then claim reimbursement against
these credits for eligible expenditure. They cannot draw down funding to
cover administrative costs or overheads.
Credits range from A$11 for those closest to work to A$1,100 for the most
disadvantaged.
The evaluation of the EPF123 found that three quarters of the most
disadvantaged jobseekers receive support through the fund – typically,
training support, wage subsidies, adviser support or other professional
services (including health services) – and concluded that the fund was
generally well targeted towards those with greater disadvantages.
However the evaluation also found significant underspends for ‘Stream 4’
jobseekers, which covers those with the most significant barriers –
including many disabled people and those with mental health conditions.
4.10 In practical terms, any future changes to the current differential payment
model will need to be easy to administer, both in terms of the capacity to
apply and assess eligibility and to manage performance and financial
accounting. Increasing the targeting capacity of the assessment and
pricing model while retaining simplicity remains a significant challenge.
Individual budgets
4.11 An alternative to the current PBR models is the use of individual
(personal) budgets. This approach was proposed within the Sayce
Review124 of DWP specialist disability employment support and more
recently within a Disability Rights UK (DRUK) report125. The DRUK report
offers findings from an on-line survey of disabled people that indicated
123 DEEWR (2012) Employment Pathways Fund evaluation, Australian Government 124 Sayce, L (2011) Op. cit. 125 DRUK (2013) Taking Control of Employment Support
Fit for Purpose: Transforming employment support
63
that many respondents would like to decide how the money for their
employment support is spent. It goes on propose that disabled people
should be given the opportunity to choose how to spend the budget for
their employment support via individual budgets.
4.12 Research commissioned by Shaw Trust126, which included focus groups
with their customers, offered a different view, with most participants
hesitant about the concept of individual budgets. Concerns were
expressed that individual budgets would be ‘complicated’ and ‘stressful’
and would result in employment support becoming more difficult to
access. The DWP Fulfilling Potential report127 also noted that many
disabled people experience difficulties managing an individual budget.
4.13 Similar concerns were raised by focus groups conducted for this project.
Most participants felt that even if information was provided, having a
personal budget would just be another thing to have to think about.
Many did not want to have to make any more decisions, and were happy
to trust the professionals to refer them to the right provision for them.
“In my state of health I’d find that too challenging.” (Participant with a
mental health condition)
4.14 Some also questioned what would happen if they chose a provider and
they turned out not to be suitable; whether there would be a way to
change provider or get the money back? Others highlighted that some
people may not need as much funding as other people and so questioned
how the level of funding would be appropriately decided if it was allocated
at individual level.
4.15 The use of individual budgets to commission employment support has
been subject to some evaluation and, to date, there is little evidence to
support their use. A pilot on provision of employment support and Access
to Work alongside Individual Budgets128 reported implementation
difficulties and very low uptake. The early evaluation of the Right to
Control Trailblazers129, which include Work Choice and Access to Work
budgets, described similar difficulties. Despite subsequent progress in
126 Shaw Trust (2013) Op. cit. 127 DWP (2013) Fulfilling Potential: Building a deeper understanding of disability in the UK today 128 Aston, J. (2009) Evaluation of Access to Work: Individual Budget Pilot Strand,
Department for Work and Pensions Research Report No. 620 129 Tu, T et al (2012) Right to Control Trailblazers Process Evaluation Wave One, Office for Disability Issues.
Fit for Purpose: Transforming employment support
64
delivering Right to Control, the final evaluation report130 found no
evidence of the Right to Control having a measurable impact on
experiences of accessing services or on day-to-day lives.
4.16 The evaluation of Job First131, a Department of Health project which
aimed to test out the use of Personal Budgets combined with non-social
care funding streams for people with learning disabilities, also found little
evidence that this approach was effective. It did, however, recommend
joint funding of Supported Employment for this group, along with a need
for central and local government responsibility for providing and funding
these services to be clarified.
4.17 Overall, therefore, whilst there is considerable evidence to support the
need for the delivery of personalised services, there is currently a lack of
evidence to support the use of individual budgets as an effective route for
the commissioning of employment support.132
Local and joint commissioning
4.18 As noted in Chapter 2, employment support for disabled people and those
with health conditions is currently being provided across welfare to work,
health, education and social care133. However, there is little evidence of
jointly commissioned services – despite at a strategic level an increasing
commitment to develop this approach. For example there is improved
alignment between the relevant aspects of Adult Social Care Outcomes
Frameworks (ASCOF) and the Public Health Outcomes Frameworks
(PHOF), reflecting the joint contribution of health and social care to
improving outcomes. The 2013/14 ASCOF, NHS Outcomes Framework
and the PHOF include shared measures aiming to support a reduction in
the gap in the employment rate between those with long-term health
conditions, mental health conditions or a Learning Disability and the
overall employment rate.
130 Tu, T et al (2013) Evaluation of the Right to Control Trailblazers Synthesis Report. Office for Disability Issues 131 Stevens, M. and Harris, J. (2013) Jobs First Evaluation: Final Report, Social Care Workforce Research Unit Kings College London 132 Looking ahead, the Greater Manchester (GM) Youth Contract Extension is piloting the use of personal budgets for young unemployed people. This should provide further and
more current evidence on the effectiveness of personal budgets, albeit for a different
client group. 133 Wilkins, A., Love, B., Greig, R. and Bowers, H. (2012) Op. cit.
Fit for Purpose: Transforming employment support
65
4.19 There are a number of benefits reported by initiatives adopting a locally
based partnership approach to providing this type of support, such as the
European Commission funded Help to Work Plus project in Bolsover and
Chesterfield134.
Help to Work Plus offered employment related support to disabled
people and those with health conditions. It was funded by Partnerships
between Employment Services (PARES), a European Commission initiative
which aims to bring together all types of employment services with the
aim of stimulating and improving the co-operation between them.
The need for a local focus was a consensus observation of the PARES
Strategic Dialogue135, which offered recommendations on local and
regional partnerships to employment services. Help to Work Plus partners
articulated a wide range of strengths of their partnership approach,
including the importance of this locality focus. They reported that a local
partnership facilitated an understanding of local needs and could
potentially support the development of services to meet those needs.
The PARES Strategic Dialogue also noted that the primary justification for
establishing partnerships was the recognition that no one organisation has
the competences to deliver the entire package of support needed by some
client groups. Help to Work Plus partners reported that many of their
clients have a wide range of complex needs that one organisation was
unlikely to be able to address. The partnership approach facilitated client
access to a wide range of services that more traditional delivery models
may not be able to provide.
The Help to Work Plus partnership approach was also reported to have
improved service delivery within and between individual organisations. For
example, there were reports that partnership working had facilitated the
sharing of knowledge and techniques for supporting clients into work. In
addition to this type of service development, it was reported that the work
of the project had facilitated the identification of potential gaps in service
provision. The identification of such gaps is potentially the first step in the
process to address unmet need, and one of the local authority partners
reported that analysis undertaken by the partnership had offered some
clarity around where they should focus employment support.
134 Inclusion (2013) Evaluation of Help to Work Plus 135 European Commission (2012) PARES Strategic Dialogue 2012 Local and Regional partnerships: Recommendations to employment services
Fit for Purpose: Transforming employment support
66
4.20 There are also examples of where the provision of employment related
support within NHS settings has been found to be effective. For example,
the placement of employment support workers within mental health
teams as part of IPS service delivery, and within GP surgeries as part of
the ‘Getting London Working’ programme. The evaluation of a project
which saw advisers from Tomorrow’s People located in GP surgeries was
presented as part of their recent report on how to help people overcome
health issues and enter employment136. This identified the cost per job
achieved by the project as significantly better than comparable models,
and also reported substantive reductions in appointments with GPs,
counselling sessions and prescriptions costs.
4.21 Many of the specific models of good practice discussed in Chapter 3 on
‘what works’ for specific groups also indicate the need for a co-ordinated
approach between health and employment services. For example, the IPS
model requires co-location and joint working between employment and
clinical specialists, while evidence on musculoskeletal conditions indicates
the effectiveness of multidisciplinary approaches.
4.22 A number of disability related organisations have therefore advocated the
need to consider local commissioning approaches via collaborative
partnerships including social care, health and education agencies137. Such
approaches would fit with the Government commitment to devolving and
localising control of public services. Whilst the evidence base on these
approaches to commissioning employment support is limited, lessons can
potentially be drawn from the development of Community Budgets –
where public services are given more freedom to work together to join up
services, reduce duplication and improve outcomes.
4.23 Some of the lessons from the development of Community Budgets on
joining up design, commissioning and delivery of services that have been
identified so far were presented in research by Inclusion last year138. This
outlined the following key success factors:
Being locally driven;
Having an end to end approach;
136 Tomorrow’s People (2013) Doing Well, Working Well 137 Trotter, R (2013) Work in progress: Rethinking employment support for disabled people Disability Charities Consortium
BASE (2013) Submission to Government Review of Disability Employment Support 138 Inclusion (2013) Community Works: Putting work, skills and enterprise at the heart of Community Budgets
Fit for Purpose: Transforming employment support
67
Taking a pragmatic approach to financial control and investment;
Sharing data and information effectively; and
Central government facilitation and support.
4.24 Another initiative that has sought to develop a better understanding of
what is needed for effective working relationships between Jobcentre Plus
and NHS services was work commissioned by the London Health
Inequalities Network139. The study explored current working relationships
between Jobcentre Plus and the NHS in two London Boroughs. It made a
number of recommendations on improvements to joint working between
the two services and these included:
The need for cultural change within the two organisations, including
an improved understanding of employment as a key
determinant of health
The development of a better understanding of how each other
works
The need for more joint case work and potentially shared services
4.25 It also made recommendations for Local Authorities and Public Health
professionals on the needs for clear client pathways and on their role in
the facilitation of joint working.
Case study: Working Well, Greater Manchester
Working Well is an employment programme in Greater Manchester for
Work Programme leavers claiming ESA. It is expected to support 5,000
claimants, with mandatory referrals coming from Jobcentre Plus over the
next two years.
Two providers (commissioned locally by Greater Manchester Combined
Authority) have been appointed to deliver a key worker service, rather
than a more traditional employment adviser service. They have two years
to work with each participant, and will also provide up to a year of in-
work support, to help sustain employment.
139http://stats.cesi.org.uk/events_presentations/SEMINARSERIES/Tacklinghealth/Andrew_Attfield.pdf
Fit for Purpose: Transforming employment support
68
As well as providing employment support, the key worker helps the
participant to tackle the wider barriers preventing them from working.
Interventions are sequenced to ensure these barriers are addressed in the
correct order, and local authorities across Greater Manchester have
developed a Local Integration Plan that helps key workers navigate the
different services on offer.
Getting senior level buy-in from different partners early on ensured that
stakeholders could influence the development of the programme and
enabled close partnership working.
While the budget for the programme itself is around £8.5m, it is expected
that the funds focused on supporting this cohort will reach around £20m,
as key workers access and refer service users to a wide range of
additional support delivered by local partners
4.26 Joining up funding is a key challenge to the development of a more
integrated approach to service provision. A number of initiatives that have
sought to use a ‘braided’ approach to funding support such as Project
SEARCH140, Jobs First141 and Right to Control142 have found the approach
to be very complex to implement and difficult to sustain. The provision of
employment support services to patients carried out in GP surgeries by
Tomorrow’s People143 has also significantly reduced due to the complexity
and constraints of funding arrangements. This suggests that further
development of such approaches is required to achieve a sustainable and
effective model of locally based joint commissioning.
Case study: Central and North West London NHS Foundation
Trust (CNWL)
CNWL is recognised as a Centre for Mental Health national ‘Centre of
Excellence’ for its vocational services. These comprise the User
Employment Programme (helping people access paid jobs and time
limited placements within CNWL) and the delivery of an Individual
Placement and Support (IPS) model across the organisation. This
involves integrating Employment Specialists (ES) into mental health and
addiction treatment teams to help those teams become more effective at
supporting people to access paid employment. ES posts are funded in a
140 Purvis, A., Small, L., Lowrey, J., Whitehurst, D. and Davies, M. (2012) Op. cit. 141 Stevens, M. and Harris, J. (2013) Op. cit. 142 Tu, T et al (2012) Op. cit. 143 Tomorrow’s People (2013) Op. cit.
Fit for Purpose: Transforming employment support
69
variety of ways including through the NHS, local authorities, ESF, the
Lottery and co-location of external employment agencies such as
Jobcentre Plus staff.
The IPS team have partnership agreements with a range of providers of
employment support which offers a number of benefits. For example, it
facilitates the maintenance of on-going contact with referred individuals
so the team can be alerted of any difficulties before someone fully
relapses. In some cases the agreements also provide access to vacancies
before other organisations. The team also work with individuals (and
their advisers) on the Work Programme through such agreements. Such
partnerships are reported to reduce individual anxiety about job
participation and to ensure the focus continues to be placed on them and
their needs.
Another important part of their work involves working with Jobcentre Plus
and Disability Employment Advisers to ensure that people with mental
health problems are not excluded. A key part of the model is building
relationships with local employers to access the hidden labour market,
given that some people accessing the service have been unemployed for
long periods and find it difficult to compete through traditional job seeking
approaches.
Evidence based commissioning
4.27 While the evidence on what we know about effective service delivery
noted gaps, it also highlighted approaches where there is a strong body
of evidence – such as Supported Employment. In order to ensure the
most effective models of support are implemented, providers should apply
this knowledge to their delivery and commissioners should use the
evidence to inform their commissioning decisions. Recent research carried
out by the National Development Team for inclusion (NDTi) into the
commissioning and delivery of employment support for disabled people144
suggests that this is often not happening in practice.
4.28 The NDTi reviewed the evidence on the cost-effectiveness of different
service models and commissioning approaches. It found that
commissioners and providers have little systematic data or knowledge
about how best to target funding to generate positive job outcomes (i.e.
144 NDTi (2014) The Cost Effectiveness of Employment Support for People with Disabilities Final Detailed Research Report
Fit for Purpose: Transforming employment support
70
jobs gained or jobs retained). For example it reported that only around
one third of current employment-related spend within the NHS and local
authorities is being committed to the evidence-based models of IPS (in
mental health services) and Supported Employment (in learning disability
services). It also reported that there is little or no evidence to support
other service models currently being used by these commissioners.
4.29 The NDTi study reported significant variability in the cost of employment
support services and found that costs per job outcome could not be
explained by factors such as complexity of people’s disability or size of
service delivering support. The study therefore concluded that variable
cost and outcomes was primarily explained by the service model being
used and a range of organisational/strategic actions, such as prioritising
employment outcomes. It concluded that existing investment in
employment support could be used to deliver much higher numbers of
new or retained jobs at significantly lower average costs than is presently
being achieved by adopting evidence-based models.
Conclusion
4.30 There has been a diversity of approaches to commissioning services for
disabled people. At a national level, recent years has seen a strong shift
towards larger and longer contracts with increasing use of outcome-based
payment models. Locally, there appears to have been a diversity of
approaches and often wide variations in the sorts of provision being
commissioned. Given the breadth of activity, it is perhaps surprising that
there has been so little joint commissioning of support, or even close co-
ordination of services.
4.31 Overcoming barriers that prevent co-ordination and joint commissioning –
and particularly barriers around aligning funding, objectives and
timescales – will be key in the future design of employment support. It
will also be imperative to build on the evidence of what has worked well,
and less well, in designing and delivering services.
Fit for Purpose: Transforming employment support
71
5 Recommendations
5.1 Chapters 1 to 4 have set out the scale of the challenge in tackling the gap
in opportunities for disabled people and those with health conditions; how
current provision measures up; and the evidence on what works in both
the design and commissioning of employment support. In our view, there
is a clear and pressing case for radical reform of the current system of
support – both to radically extend access for disabled people and those
with health conditions who are out of work, and to create a framework
that better reflects the needs and aspirations of those service users.
5.2 We set out below our recommendations for reforms to achieve these
objectives. We do so in three broad themes:
The framework of support – ensuring that support is available and
appropriately targeted
The management of future programmes – ensuring that support is
then effective in improving employment and wellbeing
Workforce development – ensuring that all advisers that work with
disabled people and those with health conditions have the skills and
capabilities that they need.
The framework for future employment support
1. Future employment support for disabled people and those with
health conditions should be built around three levels:
‘Into work’ support – for those closest to returning to work, with
some specialist support
Health and disability employment support – for those needing
more intensive and joined up support to secure employment
Supported Employment and rehabilitation – for those with the
most significant support needs
5.3 As set out in Chapter 2, the current system of employment support
comprises the Work Programme for some, the specialist Work Choice
programme for far fewer, and then a patchwork of locally commissioned
Fit for Purpose: Transforming employment support
72
programmes and nationally funded provision (like Residential Training) for
those with the most significant needs.
5.4 This system lacks coherence and creates risks of some people receiving
support that isn’t right for them, or more often no support at all: there is
evidence from the Work Choice evaluation, in particular, that many of
those who could benefit from more specialist support are not able to
because they have already been mandated to join the Work Programme;
while those on Work Choice with more extensive needs can see their
support end after six months on the programme.145
5.5 Our research – both the evidence on what works and research with
disabled people – emphasises the importance of ensuring that support is
personalised and recognises the diversity of needs amongst disabled
people and those with health conditions. The framework of employment
support must also reflect this. We propose three broad levels of support,
to ensure that provision is appropriately targeted and that needs can be
met.
‘Into work’ support: This level would support those who have health,
or disability, related needs but are relatively closer to work and could
(re)enter employment with the right support. This would include,
broadly, many of those on ESA following Statutory Sick Pay, as well as
those who have been found ‘fit for work’. Many of these people are
currently on the Work Programme but, as Chapter 2 sets out, achieve
poorer outcomes than non-disabled people. ‘Into work’ support would be
adviser-led, with small caseloads, and focused on job-placement and
condition management with signposting or referral to more specialist
services.
Health and disability employment support: This level would support
those with health conditions and impairments that have a more significant
impact on their ability to find work, who may have been out of work for
some time or never worked, and who would often need additional support
in work – but who could nonetheless enter work with the right
combination of support, and ultimately work independently. Many of
these people are currently on the Work Programme, Work Choice or
neither – indeed they likely account for a large part of the gap in
employment between disabled and non-disabled people. This level would
145 There is an option to extend the pre-work support module of Work Choice from six
months to one year, although the evaluation of Work Choice (Purvis et al (2013) Op. cit.) found little evidence of this being used in practice.
Fit for Purpose: Transforming employment support
73
integrate employment, health, disability and wider support, would be led
by specialist advisers, and would be built on Supported Employment
principles: small caseloads, a holistic approach, and an emphasis on
effective employer engagement and job brokerage to place and then
maintain participants in work.
Supported Employment and rehabilitation: Those with more
significant impairments – including those with learning disabilities, severe
autism and severe mental illness – are unlikely to have their needs met
through the two levels of support described above. We propose that, as
now, there is additional and separate support for these groups – in
particular Supported Employment, which has been evidenced to have a
sustained positive impact where it is properly implemented, variants of
this, like supported internships for young disabled people, and residential
training.
5.6 In addition to these three levels of support, our assumption is that there
will continue to be mainstream back-to-work support for those who are
long-term unemployed or otherwise disadvantaged jobseekers. As now,
we would also expect that some of those referred into mainstream
support would have mild to moderate health conditions or disabilities that
are not in themselves significant barriers to employment. The levels
described above, then, would be in addition to this mainstream support.
2. Review the operation of Access to Work to improve utilisation
and ensure that it fully integrates into a coherent and simplified
system of employment support
5.7 As discussed in Chapter 2, there are a number of proposals related to
improving the awareness, accessibility and uptake of Access to Work
currently under consideration within the development of the DWP
disability and health employment strategy. Development of these areas
should prove beneficial within the current system although we also
believe there is a need to review the strategic fit and operation of Access
to Work alongside other elements of DWP specialist support. This review
should aim to ensure Access to Work fully aligns with other aspects of the
DWP disability employment support offer, resulting in a more coherent,
comprehensive and simplified system of support.
3. Access to, and funding for, employment support for disabled
people and those with health conditions should be significantly
increased
Fit for Purpose: Transforming employment support
74
5.8 On average 120,000 people a year have been referred either to Work
Choice or as an ESA or ex-Incapacity Benefit claimant to the Work
Programme. Given the scale of the challenge set out in Chapter 2, we
argue that access to support should be significantly extended in future
employment programmes.
5.9 Recent work by the IPPR146 sets out that well-designed future disability
employment support could reasonably expect to draw on £400-800 million
of funding from central government, local government and health
services. This in part is based on the findings from the interim report of
this project, which demonstrated that central government is spending
£380 million less than intended through the Work Programme. The IPPR
argue that this funding could support between 200 and 400 thousand
people each year. We would support this ambition, and the view that this
funding could be realised through a combination of planned expenditure
by DWP on support for these groups, alignment of local health funding,
and allocations from the European Social Fund.
5.10 The three level model described above should lead to substantially more
people accessing support, at all levels. In particular, we would expect
that the ‘Health and disability employment support’ level would be
significantly larger than Work Choice, which supports fewer than 20,000
people per year.
4. Access to each of the three levels of support should be
underpinned by a common, robust assessment process – joined
up with other assessments, and with decisions reviewed after
three months
5.11 As Chapter 2 sets out, the rules that govern access to current
employment support are not fit for purpose – and, to address this, the
Government is proposing a light-touch Gateway to initially identify
individuals’ employment support needs. Those requiring ‘co-ordinated
support’ will be referred on for a more detailed assessment. We believe
that that more detailed assessment should in turn be used to identify
which of the three levels of support set out above is most appropriate for
that individual. This assessment process should be based on needs rather
than benefit type and should be a common process across all levels of
support. In line with the Government’s proposed Gateway, the
146 Lawton, K., Cooke, G. and Pierce, N. (2014) The condition of Britain: Strategies for social renewal; Institute of Public Policy research
Fit for Purpose: Transforming employment support
75
assessment process should also be applied at the right time (usually, as
soon as is possible – but it could also follow from a regular meeting with
an adviser or support worker where individuals are ready to engage with
employment support) and should also be capable of being applied by local
partners and organisations working with disabled people.
5.12 There are a number of assessment tools available that could provide a
basis for developing this model, including toolkits for those with specific
needs like the benchmarked RNIB Employment Assessment Toolkit. In
addition the Department is testing assessment tools that can be used to
target access to different forms of adviser and employment support. It
will be imperative that any proposed tool is thoroughly tested and kept
under continual review. In addition, as we set out in Chapter 3, the
assessment process must be aligned with other appropriate assessments
including the WCA and assessment for PIP; and relevant information
should be shared between the assessor and the subsequent service
provider – so that support needs are understood and burdens on
individuals reduced.
5.13 Assessment should not just be seen as a one off event. In-depth
assessment can only occur over a period of time, particularly where there
are multiple barriers, so any future assessment system should include an
in-built review – with the ability for individuals to move between levels of
employment support where circumstances change or new information
becomes available.
5. Individuals should be able to access employment support on a
voluntary basis, but the assessment process should include the
scope to require individuals to participate where that is
appropriate and in line with their conditionality rules
5.14 We believe that individuals that volunteer for employment support should
in principle be able to receive it. The act of volunteering is itself a strong
indicator that individuals are motivated to prepare for work and would
likely benefit from additional support. And by expanding the support
available, as we propose, more individuals should be able to access
provision that better meets their needs.
5.15 At the same time, we would expect that many of those that are referred
for support, particularly the ‘Into work’ support, will be JSA claimants or
ESA claimants in the Work Related Activity Group (WRAG(. Both JSA and
ESA WRAG claimants are currently required to participate in employment
support as part of the conditions of continuing to receive benefit. This
Fit for Purpose: Transforming employment support
76
can include, in particular, participation in regular interviews with advisers,
or participation in the Work Programme. Well designed, specialist
employment support should be able to take the place of these
requirements and it follows that in those cases it will often be appropriate
to require individuals to participate in that support rather than to be
supported through Jobcentre Plus directly.
6. Participants should normally be able to receive pre-employment
support in any one level for up to two years
5.16 The Evaluation of Work Choice identified that the short duration of the
pre-employment module of the programme (usually six months147) has
reduced the scope to support those with more complex needs. On the
other hand, the Work Programme has a fixed period of two years of
support (and potentially longer where participants find work). While this
allows substantially more time to work with those further from work, it
may also put off some of those groups from volunteering – as it is by
definition a long-term commitment.
5.17 The focus groups conducted with service users as part of this project
found that many disabled people and those with health conditions felt
that they needed pre-employment support to be available for at least two
years, if not longer.
5.18 In our view, individuals should be able to participate in a specific
programme of pre-employment support for up to two years. However
there should also be in-built reviews where participation can be ended
earlier than this – either where a participant is ending support entirely, or
is moving into more appropriate provision.
7. Government and service providers should review their approach
to employer engagement, with a focus on: simplifying employer
access; co-ordinating work to improve awareness and education;
and building sector-led approaches
5.19 As set out in Chapter 3, different strategies are often needed for
promoting employment of disabled people and those with health
conditions. The evidence suggests the need for a combination of the
traditional ‘recruitment agency’ model and more individual-focused
147 There is an option to extend the pre-work support module of Work Choice from six
months to one year, although the evaluation of Work Choice (Purvis et al (2013) Op. cit.) found little evidence of this being used in practice.
Fit for Purpose: Transforming employment support
77
support. Often this means addressing specific concerns around work-
place adjustments, managing absence, in-work support and potential
costs, as well as selling the often less immediate benefits of a diverse and
inclusive workforce. However, the delivery of services for employers is
fragmented across multiple programmes, and there are distinct challenges
in engaging large numbers of employers in supporting these groups.
5.20 The Government acknowledges this to some extent in the review of its
disability employment strategy. We consider that there are three
priorities for reviewing the system of employer engagement:
First, simplifying employer access. On the one hand the current
system leads to duplication and complexity – as employers seeking to
support disabled people and those with health conditions do not have a
clear single point of contact; while on the other it leads to risks of gaps
– as many organisations struggle to directly reach employers (due to
their scale or their position within supply chains). A far simpler system
would be based around clear points of contact, common approaches to
engagement, and as far as possible a single ‘front end’ for employers.
There may be lessons here from the Work Programme in London,
where the six prime providers have sought to manage key employer
relationships in this way. A simpler system for employers should also
include an improved online presence and online portal registration for
Access to Work.
Secondly, raising awareness and education must play a central role.
There are strong arguments for Government co-ordinating activity and
playing a stronger communications role; and equally strong arguments
for service providers – including, critically, Work Programme providers
– to then drive up awareness and education through the employers
that they work with. The Government’s Disability Confident campaign,
and the industry ‘Access Ability’ initiative (described in Chapter 3) both
provide models to build on. These efforts should be aligned and
extended to bring in more organisations and common guidance,
products and services to support employers.
Thirdly, we would propose focusing on building sector-led approaches
and partnerships to ensure that services have maximum reach and are
focused on employer needs. Again Access Ability provides some
pointers in this, with its focus on engaging industry ‘verticals’ like
employer bodies and trade associations. Focusing on sector bodies
should also help to ensure that there is a balance between reaching out
to small and medium employers, as Disability Confident intends to do,
Fit for Purpose: Transforming employment support
78
and not losing sight of the importance of large employers (which
employ as many people within 6,000 organisations as are employed
within 4 million small companies; and can themselves be enlisted as
visible and influential advocates).
5.21 Drawing these recommendations together, our proposed framework of
employment support comprises the four elements set out below –
identification; assessment and segmentation; three levels of support; and
review.
Fit for Purpose: Transforming employment support
79
Figure 6.1 Fit for Purpose: A new framework for employment support
Fit for Purpose: Transforming employment support
80
The management of future programmes
8. Local and national commissioners should work together to
ensure that the three levels of support are in place – within a
clear national framework but with approaches to devolution,
joint commissioning, pooling or alignment that are appropriate
to local areas
5.22 Chapter 4 sets out both the critical importance of joining up provision
locally, but also the real need for greater local capacity and capability to
commission effective employment programmes. There are a number of
areas of real expertise in commissioning often quite specialist support, but
many more areas where that capability does not exist.
5.23 We are agnostic on who commissions services – as long as those services
are evidence-based, well-designed, appropriately funded, well managed
and effectively joined-up. In principle local areas should be best placed to
do most or all of these things – but in practice, at least currently, much
expertise in design, commissioning and management sits centrally. We
do not therefore propose a single commissioning model (for example that
everything is commissioned by local government or central government).
Rather, we propose that there is a clear national framework and that
provision is then commissioned in the most appropriate ways within that.
5.24 This national framework should include:
That employment support will be available to meet the three levels set
out above
That access to support will be underpinned by the common assessment
approach set out above
That provision will be organised within geographical areas that give
national (GB) coverage – perhaps aligning with LEP boundaries or
groups of local authorities – but that provision may be commissioned
within smaller geographies where this is appropriate (for example, local
Supported Employment programmes)
That there will be local governance in place to support service
providers to join up with locally available provision – in particular
health, skills and other employment support
Fit for Purpose: Transforming employment support
81
5.25 This national framework is important in particular for service users and for
employers – to ensure that there is a clear and single system of support,
even if the design and commissioning approach will vary between areas.
5.26 Within this, we would recommend that central and local government, and
their partners, work together to agree the most appropriate ways to
commission support within geographical areas. In some cases, local
areas will take the lead in commissioning – with DWP pooling or
transferring its funding and local commissioners rolling in local funds. In
others, DWP will take the lead, with local partners commissioning
complementary services and working to align support locally. In still
others, there may be models of co-commissioning or pooled budgets.
5.27 We would also expect that local commissioning would have a stronger
role in the third level of provision (Supported Employment and
rehabilitation) where there is currently only limited national provision.
This should not, however, preclude national organisations from delivering
these support services where they can meet specialist needs or have local
presence.
5.28 It follows from this proposal that the three ‘levels’ of support set out
above need not necessarily be three different, separately-commissioned
programmes. Local commissioners may for example decide to combine
levels one and two within a single programme, or indeed to commission
level one support as an integral part of their mainstream programme for
the long-term unemployed. Critically, however, we propose that these
decisions are driven locally – within a clear framework that there will be
appropriate provision that maps against all three levels.
9. Jobcentre Plus and local Health and Wellbeing Boards should
work together to develop protocols on joint working, including
information sharing
5.29 Making a real impact on employment of disabled people and those with
health conditions depends critically on improving partnership working
between the health and employment sectors. This goes beyond just the
commissioning of employment programmes. For example as Chapter 4
set out, there have been a number of effective models of co-located
health and employment advisers, while models like Individual Placement
and Support and support for those with musculoskeletal conditions appear
to depend on effective multidisciplinary approaches. The importance of
joint working was also emphasised by service users themselves, in the
focus groups conducted for this research.
Fit for Purpose: Transforming employment support
82
5.30 Welfare reforms create a further pressure to work together – with health
professionals increasingly likely to be encountering patients in financial
hardship and with concerns about their benefit status, especially
concerning disability assessments and requirements to look for work.148
5.31 Senior level buy-in appears to be critical in driving effective local
partnerships: operational staff within sectors find it harder to engage
without the clear impetus from the top. We therefore propose a
systematic effort to agree protocols on joint working between local Health
and Wellbeing Boards and Jobcentre Plus (as the representative of the
Department for Work and Pensions). Health and Wellbeing Boards sit
within local authorities and bring together key health, local government
and other stakeholders (not usually including DWP/ Jobcentre Plus). They
do not directly commission, but work to co-ordinate public health
provision in local areas including by working with Clinical Commissioning
Groups.
5.32 Developing strong links between Health and Wellbeing Boards and
Jobcentre Plus should underpin efforts to improve partnership working
more generally and in particular to improve how information is shared on
local priorities, provision, funding decisions and so on.
10. Funding models for all three levels of support should include
‘payment by results’, but with clear safeguards to minimise risks
of vicious circles, creaming and parking
5.33 This report and our interim report set out clearly some of the challenges
and limitations of Payment by Results. In principle, PBR models should
sharpen incentives to achieve outcomes – specifically employment
outcomes – and reduce financial risks on the taxpayer from poor
performance. However in practice, if programme performance turns out
lower than anticipated then this can lead to permanently lower funding
available for support, in turn reducing performance; and an over-focus on
employment outcomes can lead to risks that those furthest from work
become further marginalised. Both of these appear to be playing out, to
a greater or lesser extent, in the Work Programme.
5.34 PBR models also increase the upfront investment costs for providers,
which can in turn squeeze out those who are less able to finance risk –
148 Finn and Goodship (2014) Take-up of benefits and poverty: an evidence and policy
review, publication forthcoming
Fit for Purpose: Transforming employment support
83
regardless of their effectiveness in delivering results. Other outcome-
based models like Social Impact Bonds seek to address this by clearly
separating financial risk from delivery risk (with delivery organisations
paid for services, but the funders only paid for results), but these are
relatively untested and often come with similarly high borrowing costs (far
higher than any government would face).
5.35 PBR should continue to play a role, through payments for employment
and sustained employment, but future provision should retain ‘service
fees’ that ensure that providers can meet the upfront and delivery costs
of programme provision, and so that unintended risks around vicious
circles, creaming and parking can be reduced. The precise balance
between service and outcome fees will depend on the nature or provision
and potentially local circumstances (where support is commissioned
locally) but we would envisage that service payments would normally
comprise the majority of a providers’ income, and a greater proportion
where support is relatively more expensive. One option would be to
allocate additional notional funding to meet the needs of the most
disadvantaged, that providers can draw down for specific expenditure –
along the lines of the Australian Employment Pathways Fund.
5.36 Linked to this, we would also recommend that contracts include ‘trigger
points’ to review performance and funding where there appears to be
systemic (programme wide) under-performance (as there has been with
ESA groups in the Work Programme, but with no adjustment of funding).
11. There should be a common quality framework across all
provision, based on self-assessment, external inspection, service
user input and continuous improvement
5.37 Ensuring that all participants receive high-quality support is important
because, in many cases, individuals will not achieve employment during
their time on provision. The benefits for most participants will be in
building their confidence and motivation, preparing for work, addressing
their barriers and ultimately moving closer to employment – in other
words, receiving a quality service.
5.38 Previously, quality was managed through Ofsted – with a regular process
of self-assessment and then independent inspection. This process was
not universally popular with providers, but did appear to improve over
time. The evaluation of WORKSTEP in particular noted the positive
influence that external inspection had in improving the quality of
Fit for Purpose: Transforming employment support
84
provision. This system was ended in 2011, but continues in Northern
Ireland through their Education and Training Inspectorate.
5.39 The benefits of reintroducing independent quality evaluation have been
endorsed by a number of disability-focused organisations including BASE
and Shaw Trust. We support the development of a clear quality
framework that can cover all three levels of support. This framework
need not reintroduce Ofsted or fully-independent inspection, and care
should be taken to ensure that this does not introduce new burdens and
is complementary to other activity like the Merlin Standard on supply
chain management. However it should nonetheless be based on rigorous
self-assessment alongside periodic external inspection and assessment.
In particular, quality management should be focused on understanding
the perspective of service users. The use of satisfaction surveys, as have
been used in Australian provision, could be one means of achieving this.
12. A ‘What Works Unit’ should be established with a remit to
collect, review and disseminate best practices; facilitate
knowledge exchange between providers; and encourage
innovation in service design and delivery
5.40 This research, and previous work by NDTi, has illustrated that there is
both a wealth of examples of innovative practices in supporting disabled
people and those with health conditions, but also a dearth of high quality
evidence on what is working, and often even of data on what is being
delivered where.
5.41 ‘What Works Centres’ have been established in a number of areas to try
to pull together robust evidence for policy makers and delivery
organisations working in different fields. We propose a lighter touch unit,
that would support the range of commissioners and delivery organisations
that would need to be working effectively together in order to deliver the
proposals set out here. In particular the Unit would have a key role in
supporting local partnerships to build their commissioning and oversight
capacity, and in supporting organisations in driving up quality
management. Its functions should include:
Systematically gathering and collating information on what is being
delivered and tested in different areas, so that organisations and
commissioners can learn from each other
Supporting organisations to improve how they assess the impact of
what they are doing
Fit for Purpose: Transforming employment support
85
Carrying out ‘thematic reviews’ of different models of support and what
works for different groups – in particular to extend our understanding
of ‘what works’ beyond the relatively small number of very well-
evaluated programmes like Individual Placement and Support
Facilitating discussion and sharing between organisations and
commissioners – including through events, action learning and virtual
networks
Encouraging innovation – for example by (part-)funding pilots of new
models of support, or running an ‘innovation fund’ that organisations
can bid to
Disseminating learning to wider practitioners – including those
delivering mainstream employment programmes, but who may
nonetheless be supporting people with mild or moderate illnesses or
disability
5.42 The Unit would likely be a relatively small team and would need to
prioritise between these areas of focus. Nonetheless we believe that it
could make a real impact with a team of 4-8 people, drawn from
operational policy, delivery and research backgrounds.
Workforce development
13. Jobcentre Plus and the wider employment services industry
(through ERSA and IEP) should work together to ensure that all
advisers have training in identifying health and disability needs
and providing initial support and signposting
5.43 As already noted, we would expect that many of those with mild or
moderate health conditions or disability will be receiving support through
‘mainstream’ employment programmes or through Jobcentre Plus. Others
still may have undisclosed health needs or hidden disability. Therefore all
frontline advisers will need to play a key role in identifying needs,
supporting those that do not enter specialist support, and referring
individuals on for assessment where that is appropriate.
5.44 We propose that training should be available to help advisers to identify
and understand the different barriers to entering work resulting from
different conditions. Ensuring that all advisers receive appropriate
training to have confidence that they know how to support these
individuals, and what adjustments they and employers might need to
Fit for Purpose: Transforming employment support
86
take, would help drive up service quality. This training could build on
initiatives such as the Working for Wellbeing mental health toolkits
currently being rolled out in Jobcentre Plus and amongst Work
Programme providers, which aim to help employment advisers spot when
mental health wellbeing support can help a jobseeker achieve their
employment goal.
14. The Institute of Employability Professionals should work with
organisations including the British Association of Supported
Employment to develop industry-wide, best practice training for
specialist disability employment advisers
5.45 As highlighted in Chapter 3, the key role of adviser staff, and the
importance of ensuring that staff have the right capabilities and
resources, came across strongly in both the literature on ‘what works’ and
the focus groups with service users.
5.46 It would not be efficient for providers individually to develop their own
tools for more specialist training, nor would it support wider moves
towards industry standards through the Institute of Employability
Professionals. The Institute exists to professionalise the industry and
drive up standards, and would be the obvious organisation to lead on
developing or distributing a range of materials to the sector. This would
need to draw on the existing good practice evidenced by the BASE adviser
professionalisation work. It may also encompass approaches exemplified
by Randstad’s package of health specific e–learning modules. Modules
include: General Disability Support, Mental Health awareness and Specific
Learning Difficulties.
15. Jobcentre Plus and employment services providers should
commit to ensuring that all advisers leading on employment
support for disabled people and those with health conditions will
have been trained in line with industry benchmarks, or be on the
journey to receiving that training
5.47 Building on Recommendation 13, we consider that both the industry and
Jobcentre Plus, including those delivering Access to Work, should commit
to ensuring that those advisers that lead on specialist support (either as
Disability Employment Advisers or as caseworkers within disability
employment programmes) have had training that is in line with industry
standards (including, for example, National Occupational Standards) for
supporting disabled people, or are receiving that training or due to start
receiving it.
Fit for Purpose: Transforming employment support
87
Conclusion
5.48 These proposals draw on input from service users, service providers,
those that work with disabled people, and a range of national and
international evidence. They show that there is a long way to go in
tackling the entrenched gaps in opportunity for disabled people and those
with health conditions – but that there are extensive good practices, here
and abroad, that can be built on.
5.49 The proposals presented here would have the scope to radically reform
support for these groups and to strike a new balance between health and
employment services and between national and local government.