a framework for supported employment - jrf ·

A framework for supportedemployment

Anne O’Bryan, Ken Simons, Steve Beyer and Bob Grove forThe Policy Consortium for Supported Employment

The Joseph Rowntree Foundation has supported this project as part of its programme of researchand innovative development projects, which it hopes will be of value to policy makers andpractitioners. The facts presented and views expressed in this report are, however, those of theauthors and not necessarily those of the Foundation.

© Joseph Rowntree Foundation 2000

All rights reserved.

Published for the Joseph Rowntree Foundation by YPS

ISBN 1 84263 009 1

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Contents

PageExecutive summary iv

1 Introducing the framework for supported employment 11.1 The Policy Consortium for Supported Employment 11.2 How we worked 11.3 What is supported employment? 11.4 Why create a national framework? 61.5 Guide to the rest of the framework 7

2 The current system of supported employment 82.1 Access to supported employment 82.2 Funding supported employment 112.3 The quality of supported employment 142.4 The benefit system 152.5 Conclusion 17

3 Lessons from abroad 18

4 Proposals for a new system of supported employment 234.1 Outcomes 234.2 The key points 234.3 Quality 294.4 Benefits 334.5 Conclusions 35

Bibliography 36

Appendix: Contributors to this report 39

Introducing the framework for supported

employment

This framework was produced by the PolicyConsortium for Supported Employment, whichwas established following discussions withMargaret Hodge, Equal Opportunities Minister. Weset out to produce a coherent policy framework,building on the experience and concerns of thoseconnected with supported employment.

We define what we mean by supportedemployment, and supported employment agencies,and contrast this with other approaches to theemployment of disabled people. In essence, wedefine supported employment as a way of enablingpeople who need additional assistance to obtainand develop their careers in real jobs, so that theycan enjoy the social and economic benefits ofemployment. Support is provided on an individualbasis to both employer and employee for as long asit is required. The basic concept of supportedemployment is relevant, with appropriatemodifications, to a wide range of disabled peopleand also people facing other problems.

There is a need for a national frameworkbecause supported employment exists in thecontext of a complex range of policies andpractices. The government has recently announcedplans to modernise its Supported EmploymentProgramme, providing an unrivalled opportunityto develop the framework. Studies suggest thatthere is considerable scope for society to benefitfinancially, as well as in other ways, by enablingmore disabled people to work.

The framework pulls together key componentsof the existing system of supported employmentand identifies policies, structures and skills thatneed to be in place. It is based on wide consultationwith relevant organisations and individuals fromthe UK and abroad.

The current system of supported employment

We were told of some significant problems inaccessing and funding supported employment,difficulties in ensuring consistent quality, andmajor issues relating to the benefit system.However, we also heard of positive experiences todraw on.

It is particularly difficult for many people,especially those with substantial support needs, toaccess supported employment. There are markedgeographical variations in the level of provision.There are particular problems for disabled youngpeople leaving school being able to access this formof support.

Supported employment agencies receivefunding from diverse sources. However, accessingfunds can be complex and time consuming, withmuch funding of a short-term nature. Supportedemployment is an emerging sector with noconsistent approach to the quality of servicesprovided.

The UK benefit system is particularly complexand provides a number of serious disincentives todisabled people who wish to enter paid work. Wegive a brief commentary on the main issues relatingto benefits, and provide more detail in a separatedocument, ‘Economic security and supportedemployment’, by the same authors, available on theNational Development Team’s web site, http://www.ndt.org.uk/.

Executive summary

The document ‘Economic security andsupported employment’ can be accessed onthe NDT website at www.ndt.org.uk. Forthose without access to the web, a paper copycan be obtained (priced £5.00) from NDT atNational Development Team, Albion Wharf,Albion Street, Manchester M1 5LN, UK.

iv

Executive summary

Lessons from abroad

We drew on the experience of supportedemployment in Ireland, Norway, New Zealand andthe USA. This points to some general lessons forthe UK. Experience abroad suggests that thespecialist supported employment sector needs toengage with more generic ‘one stop’ centreapproaches, so that people with significantimpairments get access to the skilled and specialistsupport they require.

We can draw on experience in providing adviceand information, training strategies and indeveloping quality assurance systems. There are arange of approaches to funding, both forindividuals and for agencies. Although manycountries have benefit systems which are just ascomplex as ours, there are pointers to ways ofcombining wages with some income maintenancebenefits.

Proposals for a new system of supported

employment

We set out our ideas for a positive policyframework, so that a wide range of people are ableto benefit from supported employment across theUK. There is a need to ensure that supportedemployment is much more widely available, withservices of consistent quality.

Social services departments in England arerequired to develop Joint Investment Plans forWelfare to Work services. This provides anincentive for local authorities to work inpartnership with other agencies to develop andinvest in supported employment. Themodernisation of the Supported EmploymentProgramme provides significant opportunities to

move further towards individualised support forjob applicants and employers.

We suggest ways in which the various sourcesof funding for supported employment can becombined flexibly to provide the full supportindividuals require. We look at ways in which thecommissioning and contracting process can be usedto sustain and develop specialist supportedemployment. We also make suggestions for changein the funding of the Supported EmploymentProgramme.

We suggest steps which can be taken to ensurethat young disabled people are encouraged andsupported to move from school into employment.We outline ways to ensure that supportedemployment develops as a coherent, high qualityform of support. This requires leadership fromgovernment, but we also spell out implications foremployees, employers, providers andcommissioners.

We outline strategies for getting more out of theexisting benefit system, but also suggest ways thatit can be improved. These include options foreasing the transition from benefits into paidemployment and bridging the gap betweenincapacity benefits and the Disabled Person’s TaxCredit. We look at the implications for the wayHousing and Council Tax Benefits are applied topeople who start work, and ways of ensuring thatpeople are not penalised through charges forcommunity care.

We argue the need for a debate about moreradical reform of the benefit system and presentsome ideas for consideration. Finally we arguestrongly for demonstration projects which explorenew ways of linking benefits to the availability ofsupport.

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1.1 The Policy Consortium for Supported

Employment

The Policy Consortium for Supported Employmentis a group of professionals, researchers and peoplewho use supported employment services,1 who areworking to support more disabled people into jobsand decent careers. We believe in creatingopportunities for individualised supportedemployment. The Consortium was establishedfollowing discussions with Margaret Hodge, EqualOpportunities Minister, who is responsible forGovernment policy on employment and disabledpeople. Having listened to the concerns of peopleworking in supported employment, the Minsterchallenged members of the Consortium to developa more coherent policy framework, which bothrecognises government concerns, and whichsupports attempts to assist people with significantimpairments to find and keep paid employment.

This report is our answer to that challenge.Throughout, every attempt has been made to ensurethat the process of developing the framework was asinclusive as possible; it not only reflects the views ofthe Consortium members, but draws on the distilledexperience and knowledge of many individuals andorganisations involved in the field. Particular effortswere made to include at least some of the concerns ofactual and potential supported employees.

1.2 How we worked

The Policy Consortium carried out a rapid andbroadly-based consultation exercise. We sent 181questionnaires to a wide range of organisations andindividuals with an interest in or experience ofsupported employment. These were supplementedby telephone contacts or face-to-face visits. We alsomet with a number of self-advocacy groups, all ofwhom have an interest in the issue of employment,and people with learning disabilities.

We received 139 responses from across the UKfrom people representing supported employmentagencies, supported employees, EmploymentService personnel, careers advisers, employers,senior managers in social services/social workdepartments, and researchers.

We also received detailed responses fromexperts in the United States, New Zealand, Norwayand the Republic of Ireland.

A cross-departmental working group was set upto support the Consortium in developing a realisticframework. This included officials from theDepartment for Education and Employment, theEmployment Service, the Department of Healthand Social Security and the Benefits Agency.

Five hundred copies of an initial draft of thisdocument were circulated for comment andfollowed up with a further round of consultation.We have attempted to incorporate the responses tothe draft in this final version of the framework.

1.3 What is supported employment?

Throughout this report we use the term supported

employment in a very specific sense. We define it asa way of enabling people who need additionalassistance to succeed in work, with the followingresults.

• They are hired and paid by an employer.Supported employment is about ‘real jobs’,

1 Introducing the framework for supported

employment

This section:

• introduces the Policy Consortium forSupported Employment

• describes how we worked

• defines supported employment

• sets out the rationale and aims of theframework

• signposts the rest of the document.

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A framework for supported employment

not makeshift work designed simply to keepthe person occupied.

• They receive full employee entitlements.Supported employees are regarded as fullemployees. Wages should be the going ratefor the job. Safe working conditions arecritical.

• The job meets the employee’s aspirations for

employment. Supported employmentresponds to each individual’s interests,talents and skills (existing and potential). Ithelps people explore their careers. It alsotakes account of the wider social context ofwork, including all sorts of social interactionswith co-workers and customers.

• The work meets the employer’s requirements. Thekey to success is to enable disabled people tobecome good employees. This meansresponding to the needs of employers as wellas workers.

• The employer and employee receive just enough

help from a support organisation to ensure

success. Assistance is provided for just thoseaspects where employer or employee needssupport. There is a long-term commitment tosupport for as long as necessary, but for nolonger.

Our notion of supported employment is basedon the values of social and economic inclusion,promoting self-determination, choice andindependence. We believe that people should befull participants in their communities, welcomedand valued for the contributions they make, ratherthan excluded because of their labels.

This approach is based squarely on a socialmodel of disability. It attempts to address some ofthe systematic barriers that result in discriminationand exclusion. In particular, the difficulties thatindividuals face are dealt with in terms of support,not individual ‘pathology’. As a matter of principle

we start from the assumption that all disabledpeople may wish to access work, and that noindividual or group should be assumed to be‘unemployable’.

Supported employment transcends thetraditional divides between ‘vocational training’and employment-related supports; there is noassumption that potential workers have to be‘work-ready’ before they can access supportedemployment. Embedded in our approach is theassumption that the best place to learn about workis in the workplace.

We readily acknowledge that what is describedhere represents an ideal, and one which is rarelyfully realised. This is partly because we are onlybeginning to develop the range of skills needed tofully include people with the full range of supportneeds. For some people with complex needs,finding ways to achieve successful outcomes willbe hard.

Nevertheless, there is substantial evidence,drawn from both the UK and elsewhere, thatsupported employment is a ‘technology’ thatworks.2

Supported employment agencies

Supported employment agencies vary considerablyin size and in the way they are organised. They allwork with people on an individual basis, planninga career path with each person. The majority ofthose identifying themselves as supportedemployment agencies are likely to offer a series ofphased interventions which include most or all ofthe following:

• finding out about the person’s skills andpreferences through a vocational profile

• job development to find the person’s preferredjob through contact with employers

• job analysis to find out about the workplace,co-workers and supports the person mightneed

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Introducing the framework for supported employment

• help in applying for jobs and career

advancement

• job support to ensure the employer andemployee receive just enough assistance,information, back-up and creativity forsuccess.

Within this broad framework, practice amongstsupported employment agencies varies. Forexample, many people with mental healthproblems find the idea of having on-site jobsupport potentially stigmatising, and mainlyrequire help out of hours or at the end of a phone.While there are significant structural barriers toachieving the aims of supported employment,organisational competence and capacity are alsoimportant factors. As Beyer et al. (1996) point out,there is clear evidence that it takes time for mostagencies to acquire the skills and experienceneeded. Given that many supported employmentagencies are relatively new, it seems appropriate totalk in terms of an ‘emerging’ specialist supportedemployment sector.

Who benefits from supported employment?

Much of the experience within supportedemployment in the UK to date has been around theemployment of people with learning disabilities.However, many agencies are beginning to work ona more generic basis, supporting people with amuch wider range of impairments and conditions,including people with more severe impairments,mental health problems and/or complex supportneeds. The basic concept of supported employmentis relevant, with appropriate modifications, topeople with a wide range of impairments and otherproblems. For example, the National ServiceFramework for Mental Health includes therequirement that people with complex needsreceiving the Care Programme Approach shouldhave ‘action for employment, education and otheroccupation’ included in their care plans.

Indeed, we would argue that these principles

and practices are generally applicable to anyperson who needs support to get and hold down ajob and progress in their career.

Supported employment is not …

Judging from the responses to our initialconsultation, it is equally important to be clearwhat we are not saying, which is as follows.

• Everyone wants to work … There will be manypeople who decide sensibly that paid work isnot for them. Our main concern is to tacklethe barriers that exclude people. As far as weare concerned, finding ways to respond topeople who want to work will more thanabsorb our energies for the foreseeablefuture. We see no role for policies that coercepeople into working. However, manydisabled people are telling us that work isimportant to them and policies must removethe barriers to employment for them.

• Work is the only way of achieving inclusion and

equality ... Life is about a lot more than work,and strategies for promoting inclusion mustreflect the full range of opportunities thatexist. Indeed, as advocates of paid work wewould not wish to imply that other lifechoices are not equally valid.

• Success is only defined in terms of people who no

longer need any support, or no longer use benefits

... Some people have used supportedemployment to get a full-time job, which hasenabled them to be financially independentand require no further assistance. Whilethose will be perfectly feasible ambitions forsome, others will want or need to work part-time, will still need to rely at least in part onbenefits, and will need assistance to maintaintheir job on a more or less permanent basis.All may be equally valid outcomes.

This last point is critical to the way we are usingthe term supported employment. Many readers will

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be as, if not more, familiar with its use in relation tothe Supported Employment Programme (see boxbelow). Here, supported employment is oftendistinguished from ‘open’ employment. From ourperspective the critical outcome is that theindividual is successfully holding down a decentjob. However, there is a very ingrained assumptionthat equates ‘success’ to individuals managingwithout any form of support. Our concern with thisassumption is that it risks excluding the verypeople who need the most assistance; it potentiallydevalues the contributions that many people couldmake, simply because they do not match up tooverly rigid notions of independence.

In the context of this document it is worthclarifying that, by supported employment, we donot mean the following.

• Sheltered workshops. Historically, the mainemployment-related option for manydisabled people who want to work has beenthe sheltered workshop. They have certainlyprovided occupation and some earnings forsignificant numbers of people. However,their ‘sheltered’ nature excludes them frombeing inclusive or progressive.

• Employers’ subsidies. A core component of thegovernment’s Supported EmploymentProgramme (which is a key strategy forachieving successful job outcomes fordisabled people) has been subsidies foremployers, used as an incentive to employdisabled people.

• Unpaid ‘work experience’. As surveys (seeBeyer et al., 1996; Schneider et al., in press) ofpeople using supported employment show,there is often a significant number of‘workers’ who are employed, but not paid.

Many supported employment agencies usesome of these options as part of their strategies.Indeed there is a case for using work experience inthe form of very time limited ‘tasters’ for people

who have few vocational experiences to build on.Similarly, as we suggest later in this document, thetargeted use of employers’ subsidies may beappropriate for people who find it difficultperforming at a sufficient level in jobs whereproductivity is critical. However, such options areonly means to ends; they are not a core part of ourvision of real jobs and careers.

Other approaches to employment

Supported employment agencies are not the onlyways in which people are assisted to get work.Disability Employment Advisers and New DealPersonal Advisers help people to find jobs. Thegovernment’s Supported Employment Programmewas initially set up to help disabled servicemenback to work, but now has a much broader focus.

The Supported Employment Programme

The Supported Employment Programmeprovides job support to over 22,000 disabledpeople who face complex barriers to gettingor keeping a job, but who can work effectivelywith the right support. It providesopportunities for disabled people to work in asupportive environment and where possibleto progress in mainstream employment.

The programme is managed by theEmployment Service, which contracts with200 local authorities and voluntaryorganisations and Remploy Ltd. Supportedemployees work in mainstream employmentwith a range of organisations. Some areemployed in supported factories andbusinesses run as part of the programme.

Currently potential supported employeesmust be assessed as disabled, but capable ofbetween 30 and 80 per cent of theproductivity of a non-disabled person doing

continued

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Other Employment Service supports

In addition the Employment Service providessupport to disabled people through Jobcentres,employment programmes and the specialist serviceoffered by its Disability Service Teams. DisabilityEmployment Advisers offer support to bothemployers and employees.

There is a further important funding streamknown as Access to Work. This provides practicalassistance to help disabled people enter or stay inemployment by contributing to their costs,including (in some instances) funding for in-worksupport.

Over the last couple of years these existingstructures have been supplemented in some partsof the UK with the New Deal for Disabled People(NDDP), and the ONE pilots. The NDDP offeredshort-term funding for a series of ‘innovativeprojects’ along with piloting a system of PersonalAdvisers. The ONE pilots took this idea a stepfurther by combining the idea of Personal Adviserswith a ‘one stop shop’ approach to employmentissues, combining the resources of the EmploymentServices with input from the Benefits Agency.

We explore the relationship between thespecialist supported employment sector and therange of supports offered by the EmploymentService in much more detail in the next section.Here it is sufficient to recognise that, while there issome overlap between the specialist supportedemployment sector and the SupportedEmployment Programme, the latter has generallyoperated on rather different principles. Forexample, leaving aside the sheltered employment

element, most effort and resources have focused onthose who were either ‘work ready’, and who inparticular were likely to work for more than 16hours a week.

Social firms and social enterprises

The social firm is an ordinary business structured toprovide goods or services under normal terms andconditions. It has a fundamental differencehowever from other firms in that a significantnumber of its employees are disabled people whoneed a carefully planned working environment.Social firms pay their workers the rate for the joband adopt employment policies which givedisabled employees the same rights and promotionopportunities as other workers. Some social firms –particularly those in Italy (but also some in the UK)– are registered as co-operatives (businesses whichare owned and democratically controlled by theirmembers). There are currently 40–50 social firmsoperating in the UK employing around 500 people.A further 150–200 businesses describe themselvesas ‘emerging’ social firms (information from SocialFirms UK).

The social enterprise concept is more general. Itembraces both paid and voluntary work and itcovers a range of rehabilitation or trainingorganisations. The objectives of a social enterpriseare primarily training, work experience or shelteredwork; but there may also be production of goodsand services which is not necessarily market lednor intended to generate the levels of incomenecessary to sustain a business which pays itsworkforce.

Finally, there are other equally valid approachesto promoting employment opportunities, includingvocational training, some college courses and self-employment.

We do not want to suggest that supportedemployment is the only way to achieve our ends.People will find many ways to fulfil theirindividual job potential. However, supportedemployment is distinctive because it focuses on

the same or similar work. However thisproductivity element will no longer form apart of future eligibility criteria.

As we note later, the Supported EmploymentProgramme has been the subject of a recentmajor review.

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progression to full employment and careerdevelopment. We see supported employmentagencies and other approaches as complementary,rather than competing strategies. Many of the skillsand experiences required in supportedemployment will be equally useful in these othercontexts.

1.4 Why create a national framework?

There are a number of reasons why we felt itparticularly timely to attempt to develop a moreappropriate policy framework for supportedemployment.

There is currently little infrastructure support for

the emerging specialist supported employment

sector

The sector has developed significantly over the lastdecade, yet despite the best efforts of nationalorganisations championing supportedemployment, many developments remain fragile. Ifthe sector is to continue expanding and developing,then some kind of appropriate infrastructure needsto be put in place.

The best efforts of many agencies are constrained

by the complex range of policies and practices,

often designed with quite different values in

mind

A substantial proportion of this report is focused onthe barriers that constrain the development ofsupported employment, in particular on problemswith funding and access, along with the impact of abenefit system that at times can appear perverse.As a result we are not getting nearly as much out ofsupported employment as might otherwise be thecase. One measure of the extent to which thespecialist sector has not yet realised its fullpotential is the relatively low cost–benefit ratios inthe UK, compared to the USA (see box opposite).

The Review of the Supported Employment

Programme

Following public consultation, the governmentannounced plans to modernise the programmefrom 1 April 2001. Key changes will include neweligibility criteria and priority for people onincapacity benefits, targets for progression tomainstream employment, funding arrangementsthat support progression and quality standards forthe programme’s delivery. An individual’spotential productivity will no longer form part ofeligibility criteria. The aim is to move to a moreflexible model of delivery that moves away fromthe typical wage subsidy model of previous years,with a greater focus on individual development,use of job coaches/job trainers, individual advice,mentoring and support to employers. Thesechanges will bring the Supported EmploymentProgramme much closer to the approach of thespecialist supported employment sector,representing an unrivalled opportunity for positivechange and development.

Cost–benefit comparisons

Based on a sample of over 200 UK supportedemployment agencies, the Welsh Centre forLearning Disabilities Applied Research Unit(Beyer et al., 1996) carried out a major reviewof the costs and benefits of supportedemployment in the UK. Their data (collectedduring 1995) took into account not just thecosts of the support provided, but alsoincluded estimates for a whole range of otherfactors, from the increased tax and nationalinsurance contributions flowing from peopleworking, through to the rates of jobdisplacement (people who might otherwisehave got the jobs occupied by supportedworkers). On the basis of their data theresearchers estimate that for every £1 invested

continued

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The aims of the framework

We set out to develop a framework, based onevidence and experience that:

• pulls together the key components of theexisting system of supported employment inthe UK and elsewhere

• identifies the policies and structures whichneed to be in place locally and nationally forsupported employment to be more real formore people.

The long-term goal is that anyone who wants ajob and needs support anywhere in the country willbe able to get it; and that any employer wanting asupported employee will be able to find the rightperson.

1.5 Guide to the rest of the framework

Section 2 reviews the current system of supportedemployment in the UK. It outlines currentapproaches and comments on their effectiveness.We discuss the ways that supported employment isaccessed and funded and look at the implications ofthe UK benefit system. Section 3 summarises keylessons from abroad which will be of value indeveloping the framework. Section 4 presents ourproposals for a new system of supportedemployment in the UK.

Notes

1 Members of the consortium, including theauthors of this report together with othercontributors, are listed in the Appendix.

2 See, for example, Crowther et al. (2000), Pozneret al. (1993), Beyer et al. (1996), Bass andDrewett (1997), Kiernen and Schalock (1997),Revell et al. (1999), and Neufeld et al. (1999).

in supported employment, the taxpayerreceives back around 43p from savingselsewhere in the system. As agencies becomemore experienced, so the cost–benefit ratioimproves. Beyer and his colleagues estimatethat for agencies operating over five years thetaxpayer recoups 54p in the £1.

To provide a point of comparison, theresearchers also reviewed a range ofAmerican studies which had explored cost–benefit outcomes for supported employment.Returns to the taxpayer tended to start higher(for example, $0.66 for every $ invested) andrise steadily, to the point that some studieswere showing a net gain for the taxpayer fromsome well established programmes. In oneinstance this was as high as $2.95 for every $1invested.

Given that many of the developments in theUK were modelled on their US counterparts,how is it that essentially the same approach isdelivering such different results? Theimmediate reasons for the differences areclear. In the USA people were working longerhours and getting more pay than their UKcounterparts. To some extent we can onlyspeculate why this might be the case. It maybe that, in the USA, supported employmentagencies are more experienced, and use theapproach more effectively. It might evenreflect differences in wider economicperformance. However, Beyer and hiscolleagues argued that, as far as the UK wasconcerned, the uncertain funding structures,coupled with the impact of the UK benefitsystem, were likely to be major contributingfactors in this country’s relative under-performance.

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2.1 Access to supported employment

There are two key starting points to bear in mindwhen considering the issue of access to supportedemployment. These are as follows.

• There is a considerable shortfall in provision.Various studies show that significantproportions of disabled people, people withmental health problems, and people withlearning disabilities would like to work butare unable to do so. For example, evenamongst people with learning disabilities (todate the main users of the specialist sector),only a small minority actually get any accessto this form of support. In a recent survey of24 local authorities carried out by theDepartment of Health (DoH, 1999), just 7 percent of social services or NHS day servicestook the form of supported employment.Amongst people in any form of residentialservices, the proportion in any form ofemployment is even lower; as little as 4 percent according to a recent study (Emerson et

al., 1999). Surveys of people with mentalhealth problems1 show that, while over halfwould like to work, less than 10 per cent areactually in employment. The lack of access to

supported employment is particularly acutefor people with greater support needs.

• There are also marked local, regional and national

variations in the levels of provision. Evenallowing for the general shortfall inprovision, there is wide geographicalvariation in the availability of supportedemployment. This was clearly apparent fromthe Department of Health study whichcompared English local authorities. SomeEnglish regions (the North West, and Londonand the South East are two obviousexamples) seem to do better than others(possibly reflecting some kind of strategicsupport), while in Wales, the additionalresources which followed the All WalesLearning Disability Strategy seem to havehad the effect of encouraging developments.However, conversely, some parts of the UKappear to have little or no specialistsupported employment. For some people itsimply is not yet an option.

Problems with access

Given this context it is perhaps not surprising thatour respondents highlighted a whole range ofdifficulties in relation to accessing the specialistsupported employment sector. These included thefollowing.

• Many people do not know about supportedemployment and all the possibilities it offers.These include disabled people, families, caremanagers, Disability Employment Advisers,schools.

• Supported employment is often not seen as apossibility for people with high supportneeds (for example, people with multipleimpairments or severe learning disabilities).

2 The current system of supported

employment

In this section we outline current policies andapproaches to supported employment andcomment on their effectiveness.

In particular we look at the ways in whichpeople access supported employment, howschemes are funded, the quality of supportedemployment and the impact of the benefitsystem. We conclude that significant changesare required if there is to be a coherent andeffective system of supported employment inthe UK.

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• For the past 30 years mental health serviceshave implicitly assumed that people usingsecondary mental health services are likely tobe unemployed and unemployable. Henceemployment aspirations have rarely featuredin care plans and it is often assumed that,once people get work, they no longer needthe support of mental health services.

• Supported employment is not equallyavailable to people in different regions of thecountry. In only a few places is it available topeople with high support needs.

• Different agencies focus on different clientgroups, offering different staffing ratios andapproaches, and achieve different outcomes.

• Little is being done to assist disabled schoolleavers to access supported employment (seebelow).

• Social services care managers do notgenerally consider employment as an optionfor adults receiving social care.

• Where social services fund supportedemployment schemes, access is oftenrestricted to those with assessed needsreceiving other social services support. Inother words, a group of people who mightotherwise gain much from supportedemployment may find they are deemed ‘notdisabled enough’ to access this form ofsupport.

• Families are sometimes reticent in referringtheir relatives for employment support, oftenbecause of concerns about the impact oflosing welfare benefits.

• Disability Employment Advisers were seenas having too wide a range of responsibilitiesto deal adequately with employers whoprovide supported employment.

• Traditions of assessing people as ‘capable’ or‘incapable’ of work may result in a focus byDisability Employment Advisers onidentifying those who are not ‘work ready’and therefore ineligible for support throughtheir schemes.

• There were even reports that in some areasthe implementation of New Deal/PersonalAdviser pilot schemes may have reducedreferrals to supported employment agencies.There is concern that the increasing need toaccess specialist supported employmentthrough generic or mainstream programmescould be counter-productive for those whoneed the most assistance.

Transition from school to adult life

Support for young disabled people’s transitionfrom school into adult life is vitally important butoften complex and inadequate. The situation isoften compounded by the (often unmet) need foreffective inter-agency working, the fact that not allyoung disabled people access reviews for transitionplanning, and the often low expectations ofprofessionals, families and young people aboutoptions for independent living and employment.

Legislation requires local education authoritiesto arrange reviews of people who have Statementsof Special Educational Needs from 14 years of ageuntil they leave school. These reviews provide abasis for transition planning. The reviews involvethe young person and their family and may includesocial services, the careers service and local healthservices. It might reasonably be expected thattransition planning would include an attempt toexplore the possibility of employment (the nationalguidance on the subject is relatively explicit on thematter). Strategically, this would give anopportunity to divert a new generation of usersaway from traditional options (i.e. day care andsheltered work) into employment before additionalbarriers for those individuals develop. However,

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relatively few people have progressed to supportedemployment from any form of education. Forexample, Beyer et al. (1996) found that less than 3per cent of people using the specialist employmentsector had come from special schools, and only justover 8 per cent from further education colleges.This situation does not appear to have changedmuch. There was genuine bafflement amongst ourmany respondents that more was not beingachieved in progressing young disabled peoplefrom school into some form of employment.

Problems with transition planning

A number of problems have been identified withthe current system of transition planning.

• Few participants in the transition processappeared to have any expectation that youngdisabled people could work (in some casethis includes the Careers Service).

• Low expectations on the part of teachers,families and careers advisers mightparticularly impact on specific groups, e.g.young black disabled people (Bignall andButt, 2000).

• There is very little involvement of supportedemployment agencies with schools, and littleknowledge in schools about what might bepossible.

• Information on crucial issues such as welfarebenefits and housing is rarely available informs that young people and their familiescan use.

• Most planning does not extend beyond theimmediate move out of school. At this stagefurther education is typically seen as thepreferred ‘default’ option by bothprofessionals and families (the latter tend tosee this as more ‘secure’).

• Where people are perceived to be ‘toodisabled’ for college, then traditional ‘dayservices’ are the automatic choice.

• While many colleges are increasinglyproviding vocational courses for disabledpeople, and may well work hard to supporttheir disabled students into workplacements, the funding systems do notpromote long-term support; nor are therewell established links between colleges andsupported employment agencies in manyareas.

• The planning process may focus on theallocation of resources, rather than looking atthe support the person needs to access anordinary life.

• The education system does not generally linkwith supported employment models.

• The National Curriculum can be a barrier topeople with moderate or severe learningdisabilities. This group in particular willneed access to work based experience fromearly on, yet at school this does not appear tobe on the agenda.

• An already complex situation can becomplicated by the sheer range of agenciesinvolved in transition planning, many ofwhom do not see employment as withintheir remit.

The government is introducing a new initiative,the Connexions Strategy and the ConnexionsService, which will provide a comprehensiveapproach to transition to adulthood for all youngpeople on the basis of an individual, ‘whole person’approach. Pilot projects are already under way. Thestrategy will extend the options for 14–16 year oldsto opt out of Key Stage 4 study to spend time inwork-related learning. Connexions heralds a newKey Skills Qualification, based on communications,information technology and the use of numbers,

11


linked to NVQ. It introduces new forms of grant forthose wishing to stay in school beyond the age of16. It also introduces a comprehensive PersonalAdviser scheme that can help young people tacklepractical and social issues to ensure they can accesstraining and gain employment after leaving school.The new service will be available to young disabledpeople, and people who face multiple problems areto be regarded as a priority group (DfEE, 2000a).

Connexions has the potential to make a majorimpact on these problems facing young disabledpeople in transition. However, it has a very wideremit, covering all young people. Because of itsgeneric remit, the Connexions Service still has afocus on helping people access education andtraining, and in keeping people in this system longenough to increase their chances of success. Thetest of the Connexions Service in this area will be ifit can use its brokerage role with other services, andits large-scale and flexible resources, to deliver theparticular forms of practical and learning supportthat young disabled people – including youngblack disabled people, and young disabled peoplewith high support needs – require over and abovenormal education and careers advice.

Positive examples of access

In contrast to these difficulties, there were somepositive examples where access to supportedemployment had improved. These typicallyinvolved situations where supported employmentagencies had managed to develop positiverelationships with other agencies, in particular theEmployment Service. So, for example, we werecited situations where:

• good strategic planning exists between somesupported employment agencies andPersonal Adviser pilot schemes

• some Personal Advisers have been able tohelp individuals to obtain funding forsupported employment

• some Supported Employment Programmesponsors offer job coach support toindividuals.

Similarly, there were areas where progress hadbeen made in embedding supported employmentas part of the transition planning process. Indeed,in some places a sea-change is taking place, withemployment being seen as the first option foryoung disabled people. For example:

• Some Disability Employment Advisers areinvolved in school transition and refer youngpeople to supported employment agencies.

• Some supported employment agencies aretaking an active part in the transitionprocess. Some work with colleges to assistfurther education graduates to get jobs.

• In Northern Ireland, MENCAP has producedlearning and awareness materials to promoteemployment as an option for young people.

• There are examples of supportedemployment being an option for youngpeople labelled as disaffected or in need ofsecure accommodation. One careers servicecreatively involves disaffected young peoplein creating a vision for their future and apractical plan for getting there.

• The Child and Youth PartnershipProgramme has helped fund supportedemployment for some school leavers.

These examples are sources of optimism andprovide a basis for building better access tosupported employment on a wider basis.

2.2 Funding supported employment

At first glance the sheer range of funding sourcessuggests there should be little problem funding thespecialist supported employment sector. Ourrespondents reported positive responses from all of

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the following.

• The government’s Supported EmploymentProgramme.

• Social services or (in Scotland) social workdepartments.

• Access to Work.

• Work Preparation funds through DisabilityService Teams.

• Training and Enterprise Councils and LocalEnterprise Councils.

• Work Based Learning for Adults.

• Social Inclusion Partnership Area funding inScotland.

• Single Regeneration Budget funding inEngland.

• Mental Illness Grant.

• Health Improvement Programme.

• Northern Ireland Special SupportProgramme for Peace and Reconciliation.

• Pilot project funding under New Deal forDisabled People.

• European Social Fund Objective 3.

• Horizon and other special funding throughthe European Union.

• Charitable funding sources.

• Direct funding from employers.

However, as far as funding is concerned,diversity is not always helpful and is no guaranteeof the long-term commitment needed to developeffective provision. Indeed, many of the accessproblems described earlier may well have theirroots in the inadequate levels of resources goinginto supported employment.

Social services/social work department funding

In the past, social services/social work departmentshave been the key funders of the specialist supportedemployment sector. In their 1995 survey, Beyer et al.(1996) found well over half (58 per cent) of the totalfunding for the sector came from this source. Anumber of agencies responding to our survey receiveeither core funding from, or are managed directly by,social services/social work departments. Many havesocial services/social work staff on secondment, orreceive contracts from social services/social workdepartments amounting to a substantial element oftheir running costs. For many, this is their main formof funding, whilst others supplement this from arange of other funding sources. However, not allsocial services/social work departments fundsupported employment.

In contrast, at the time, the funding originatingfrom the Department for Education andEmployment made up just under 3 per cent of thetotal, with Training and Enterprise Councils doinglittle better at 4 per cent.

Issues with the current funding mechanisms

Respondents to our survey highlighted a numberof problems.

• Funding is complex, with many of thedifferent funding sources only willing or ableto fund certain components withinsupported employment. For example, WorkBased Learning for Adults will help with aninitial placement, but not long-term support.Access to Work monies can be used for in-work support, but not the initial planning orjob-finding. Typically only core funding forstaff from social services/social workdepartments will pay for supportedemployment in its entirety.

• Identifying and applying for funding fromall the different sources is time consumingand presents a very considerableadministrative burden. The multiple sources

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of funding use different measures ofoutcome, have different approaches toaccountability, and work to different cycles.There are also often long chains between thefunder and the recipient agency, addingfurther time and complexity for applicants.

• Much funding is short-term, so agencieshave to continually apply for new grants.

• Eligibility for some funding streams isinterpreted differently in differentgeographical areas.

• The Supported Employment Programme wascriticised by some respondents for failing torespond to individual employees’ needs forpersonal development and careerprogression.

• The potential for disabled people to useDirect Payments to purchase support withinthe workplace has not yet been realised.

• Ways of getting funding for specialequipment change as people move betweenprogrammes and life stages. It is difficult totransfer the cost of existing equipmentbetween agencies. Sometimes there is anunhelpful distinction between the use ofequipment for community care and foremployment.

• The NHS does not widely fund supportedemployment, even though this can be acrucial aspect of rehabilitation.

• Training and Enterprise Councils see theirmain funding priority as training and are oftenunwilling to use their own development fundsfor supported employment. Where they haveput money into the sector, this has often beenon a short-term basis.

• Funding from the European Union variesbetween geographical areas and usuallyrequires matched funding. There are often

significant delays in payment which causecash flow problems. There is a requirementin the UK for schemes to be innovative, sothat long-term funding can be a problem.

• Many of the agencies commissioningsupported employment do not appear toeither understand it, or have clear measuresof quality or value for money.

• There is some concern that pressure onbudgets is leading some hitherto committedsocial services/social work departments tofreeze or even cut their funding forsupported employment.

Examples of successful funding and helpful

policy initiatives

Nevertheless, some of our respondents did identifyareas of success, where supported employmentagencies had been able to establish a securefunding base. The factors that were said to havebeen helpful included the following.

• A strong continuing commitment from social

services/social work departments. There areexamples where supported employment ispart of a systematic approach of movingaway from local authority day centreprovision for people with learningdisabilities. Modernising Social Servicesrequires social services/social workdepartments to take responsibility for theemployment needs of their clients.

• Partnership arrangements. There are examplesof social services/social work departments,the Employment Service, Health andTraining and Enterprise Councils planningstrategically to develop employmentopportunities for disabled people in theirarea. This may involve combining fundingfrom a number of sources to provide ageneric service for a wide range of disabledpeople.

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• Flexible funding schemes in the Employment

Service. Work Preparation funding has beenused to provide vocational profiling, jobfinding and job coaching within a supportedemployment model. The SupportedEmployment Programme has been usedflexibly by some sponsors to provide a rangeof support in addition to a wage subsidy.There have been examples of successfulcollaboration between Personal Advisers andsupported employment agencies, withpayments by the Personal Adviser Servicefrom flexible budgets.

• Core funding from the NHS. The Mental IllnessSpecific Grant was reported as a relativelyunbureaucratic form of funding forsupported employment for people withmental health difficulties. Core funding fromHealth has been used to provide longer-terminput, such as help with retaining a job afterthe onset of ill health or disability.

• Joint funding. Some NHS Trusts and socialservices/social work departments doprovide core funding for supportedemployment for people with mental healthneeds through joint funding.

• Flexible mainstream funding by Training and

Enterprise Councils. There were examples ofWork Based Learning for Adults funding forsupported employment. This type of fundinghas been used successfully to supplementcore resources by a number of agencies,funding initial on-the-job training within asupported employment framework.

• Good relationships with employers. Manysupported employment agencies reportedthat employers were able to take a lead rolein supporting their disabled employees.

• The National Minimum Wage, which makes itillegal for employers to underpay disabledpeople.

2.3 The quality of supported employment

Supported employment has developed throughcommitted individuals starting local initiatives.This has led to great creativity and diversity in thedelivery of supported employment services, but ithas also meant that it has remained an emergingsector with minimal infrastructure. Confusionremains between funders and providers. Currently,providers look to funders to define quality, yetfunders are confused and contradictory in whatthey require. Neither is there a coherent approachto measuring and assuring quality. Currently thereare no clear quality guidelines which areuniversally applied. Yet response to ourquestionnaire suggested that everyone has anopinion about, and should have a role in, ensuringquality.

There is no consistent approach to qualityassurance by supported employment agencies. Twospecific approaches are in use by some agencies,Supported Employment Quality Assurance (SEQA)and Continuous Quality Improvement (CQI), butneither is widely used. Some agencies use othergeneric approaches.

Present funding and review mechanisms createbarriers to improving the quality of supportedemployment, including:

• limited short-term funding which providesno resources for quality review

• lack of expertise in defining good qualitysupported employment and best practice

• inappropriate or narrowly defined measuresof quality, for example number of jobs foundor hours spent with an individual.

A primary area of need identified bypractitioners is their own development ofstandards and codes of good practice. Nationalassociations such as the Scottish Union ofSupported Employment and the Northern IrishUnion of Supported Employment suggested thattheir membership should develop minimum

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standards for the delivery of good support.Individual members of national supportedemployment associations also have specific trainingand mentoring expertise in areas such as disabilityawareness and the elements of good supportedemployment practice. Indeed, some practitioners,consultants and researchers have already providedtraining to Personal Advisers in pilot areas such asDundee and Bristol. Many have been involved indeveloping useful courses such as the Master’sdegree course offered at the Welsh Centre forLearning Disabilities. This use of knowledgeablepeople to teach, evaluate and support others buildsa growing body of experienced people willing toshare, support and continue to develop goodpractice.

In Section 4 we present our ideas for developinga consistent approach to quality within supportedemployment services.

2.4 The benefit system

The sheer complexity of the UK benefit systemposed us a considerable problem in developing thisdocument. Keeping the text brief and to the pointinevitably meant assuming considerablebackground knowledge on the part of the reader.However, presenting the benefit system in its full,convoluted glory, risks overwhelming the readerwith detail. In the end we compromised. In thismain part of the document we have kept ourcommentary on the benefit system to a brief outlineof the issues. However, in the separate document,‘Economic security and supported employment’,mentioned on page iv, we have included a muchmore detailed account, which not only providessome important background, but serves to helpclarify what we say here. This arrangement has alsoallowed us to use the document to explore in moredepth some areas where we feel there isconsiderable confusion or misunderstanding. As anexample of this we would point to the widespread(and potentially dangerous) belief amongst many

people working in social care organisations thatpeople can earn up to £15 (the level of the IncomeSupport ‘disregard’) without undergoing anyformalities.

Despite the fundamental problems with thebenefit system, it was possible for some of theindividuals and organisations we consulted toidentify positive features in the current system.These included the following.

• The Disabled Person’s Tax Credit. There wassupport for the structure of this particularbenefit, although the numbers of people in aposition to take advantage of it appearrelatively small. However, the lack of a linkto help with housing costs (and in particularthe lack of any equivalent to Income Supportpayments to cover the interest on mortgages)is a significant limiting factor.

• Improved capacity to mobilise good welfare rights

advice. The adoption of new technology,along with the development of goodworking relationships with other agencies(including in some instances the BenefitsAgency) has enabled some supportedemployment agencies to deliver reliableinformation about the impact of differentoptions, ensuring potential workers are ableto make informed decisions.

Indeed, there was evidence that someorganisations were much better than others atsupporting workers to get more out of the benefitsystem. While some organisations appear to haveadjusted their strategies around the specifics ofparticular benefits (rather than the aspirations of thesupported employees), others appeared to view thebenefit system as a considerable irritant, but one thatcould be managed or worked around. However,even amongst experienced professionals, there is stilla lot of confusion about what is, and what is not,possible. There are important issues about which itremains hard to get a definitive answer.

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As a result, even allowing for the more positiveamongst our correspondents, there were few (ifany) who did not have major concerns about theway the system works. Many of ourcorrespondents had very strong feelings about thesubject, particularly some of the disabled peoplewith whom we had contact. Particular problemsincluded the following.

• Concerns that any form of work may threaten

benefit status. The inherent tension betweenbeing seen as ‘incapable’ of work and anysubsequent steps towards employment(which inevitably demonstrate somecapacities) is at the heart of many of theproblems faced by potential disabledworkers. As a result there is a risk of losingcritical benefit status because of even quitelimited forays into paid employment,training, study or even unpaid voluntarywork. We were cited examples where simplyapplying for the Therapeutic EarningsConcession triggered an automatic review ofan individual’s eligibility for incapacitybenefits.

• Concerns about the bureaucratic and stigmatising

requirements for access to the Therapeutic

Earnings Concession. In theory, people onincapacity benefits are permitted toundertake some limited work if a doctorindicates that the work is of ‘therapeutic’value to the individual,2 and if the BenefitsAgency adds its approval. The process ofapplying is slow, cumbersome and uncertain(some people are excluded), and is resentedby many of those who been forced to use it.The process adds to an already marked ‘pro-institutional bias’ in decision making, whichrisks undermining the wider policy aims ofpromoting employment in more inclusivesettings.

• The unreformed Income Support regulations. The

combination of a devalued disregard, and a100 per cent taper, make Income Support aparticularly problematic benefit. And yet thisis a benefit that most people who have neverpreviously worked will have to rely on to atleast some degree.

• The rigidities that follow the distinction between

‘therapeutic’ and ‘remunerative’ work. Thedivide (at 16 hours) between the Tax Creditsystem acts to limit choice, and effectivelydevalues the contribution made by peoplefor whom part-time work is the mostappropriate arrangement.

• The uncertain links back onto incapacity benefits.Although there are links back onto incapacitybenefits when paid employment does notwork out, these are limited in scope,uncertain and poorly advertised. The lack ofprotection is of particular concern for peoplewith more variable conditions (like mental illhealth), where individuals may need to movein and out of work on a cycle that does not fitthe existing linking rules.

• Administrative confusion and inconsistency. Thelimitations of the current system arefrequently compounded by inconsistent andarbitrary decision making by the BenefitsAgency and other critical players. This isfurther aggravated by the lack of accessibleinformation about key areas of the benefitsystem. Further, decision making in thebenefit system lacks a clear link to widerwelfare to work policies.

• Consequential uncertainty. Although thesystem is in some measure designed toprotect vulnerable people, its impact is eitherlimited, or blunted by other aspects of thesystem. The lack of security acts to ensurethat many potential workers, their families,and the professionals who guide them, areunderstandably reluctant to take any risks

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(even if there are positive reasons foraccepting some change in benefit status).These generalised fears about the system areprobably more important in shapingbehaviour than any single aspect. They arecorrespondingly more difficult to dispel.

The problems are not limited to incomemaintenance benefits. Once income goes above aminimal level, workers are likely to find themselvesfacing reductions in other forms of financialassistance, often overlapping with, andcompounding, the problems within the benefitsystem. These include the following.

• Housing and Council Tax Benefit. The steeptaper on Housing Benefit is a particularproblem. Coupled with Council Tax Benefit,it can leave some individuals with a marginaltax rate of well over 90 per cent.

• Charging for community care services. Policieson charging for community care servicesvary from area to area, but in some instancescan create a very acute ‘personal assistance’trap.

These overlapping ‘withdrawal’ rates can leavesome individuals little better off, no matter howmuch they earn. This is particularly the case formost people in residential care where the chargingsystem effectively ensures any gains throughearnings are limited to £15, no matter how manyhours they work. Local authorities have thediscretion to give individuals under 65 who work ahigher ‘personal allowance’, yet few exercise it.

The problems are compounded by innovationsthat might otherwise be very helpful. For example,although the National Minimum Wage has led to apay rise for some supported employees, the lack ofaccommodation for people with low levels ofproductivity,3 plus its interaction with Income

Support, have minimised its impact. Indeed there issome evidence that it is not being fullyimplemented.

2.5 Conclusion

This section has highlighted some of the features ofthe current system of supported employment, andin particular a range of problems faced bysupported employment agencies and peopleseeking this form of support. There are alsopositive aspects to build on. There is a need for asubstantial development of the supportedemployment sector, which will require changes inaccess, funding and quality safeguards. Thebenefits and other related systems will have to bereformed in ways that provide both greatersecurity, and better incentives for people movinginto work.

The next section looks at some of the lessonsfrom experience abroad. In Section 4 we set out ourproposals for a new system of supportedemployment.

Notes

1 Unpublished surveys conducted in Sheffieldand Sutton among people on the top tiers ofCare Programme Approach. Research by theEmployment Research Unit, Institute forApplied Health and Social Policy, King’sCollege, London.

2 See the separate document ‘Economic securityand supported employment’, mentioned onpage iv, for a more formal definition of whatcounts as ‘therapeutic’.

3 By definition this is a group not currently ableto access the employers’ subsidies availablethrough the Supported EmploymentProgramme.

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International comparisons on any issue are fraughtwith danger. Rarely, if ever, do models easilytransfer from one country (each with its own veryspecific social policy context) to another. However,we still felt it worth drawing on the experiencesfrom other countries where supported employmentis well established, not least because there is a lot ofinterest in how things work elsewhere amongstboth practitioners, and decision makers.

Inevitably, despite the unstinting helpfulness ofour colleagues from (amongst others) Ireland,Norway, New Zealand, and (in particular) the USA,we are only able to touch briefly on what are oftencomplex issues. However, there were a number ofpoints that struck us, and these we describe brieflybelow.

The importance of engaging with ‘generic’

employment structures

Most of the overseas experts with whom we hadcontact indicated that, as in the UK, there was someform of specialist supported employment sector.Indeed, again echoing the UK, a critical issue ishow the specialist sector relates to the genericemployment structures and policies used in eachcountry. In some countries (for example, Norway)there is now a national system of supportedemployment, delivered through their EmploymentService. Effectively supported employment is aclearly defined option that has attracted bothrecognition and support at a national level.However, in other countries, the issues are not soclear cut.

So for example, in both the USA and Ireland,governments have opted to develop universal ‘one-stop’ centre approaches for access to all forms ofemployment-related supports (there are clearparallels to the ONE pilots in the UK). In the USA

in particular, this situation has led to a debate aboutwhether the interests of people with significantsupport needs will be best served by agenciesretaining their current specialist focus, or byreflecting the wider trend to greater genericism.While ‘universal access’ sounds appealing, thereare particular concerns that in the past the genericservices have not served the constituencies thatcurrently use supported employment at all well.Staff in these systems have traditionally lacked theknowledge, experience or interest to respond inways that met the needs of people with significantimpairments.

However, it is clear that the bulk of governmentfunding will be delivered through the ‘one-stop’centres. Therefore a clear consensus appears tohave developed about the need for those connectedwith supported employment to engage with thegeneric systems and try and shape theirdevelopment (see box below).

3 Lessons from abroad

In this section we summarise key lessons onsupported employment from experience inother countries.1

A strategy for shaping generic employment

access structures

Given the obvious parallels with ONEdevelopments in the UK, it is worth brieflyconsidering the strategies that Callahan(1999a) proposed for influencing thedevelopment of these generic structures. Heargued that the best approach is to look for,and build on positive examples. This wasmade easier by findings from an earlydemonstration project designed to test thefeasibility of supporting people withsignificant physical impairments to make useof an early form of the ‘one-stop’ centres. Thepilot explored the idea of using a combinationof a person-centred planning approach, thedevelopment of personal budgets drawn froma range of funding sources, and individualcontrol over the choice of support provider.

continued

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Lessons from abroad

Providing resources for the development of a

supportive infrastructure

As supported employment has gained acceptancein the various countries, so there has beenincreasing commitment from the respectivegovernments (at various levels) to develop a moresupportive infrastructure. The various alternativeapproaches to this have included the following.

• Access to technical advice and information. InIreland, as part of a programme fordeveloping the sector as a whole, a specificbudget has been set aside for technicaladvice. In the USA, university researchcentres2 have provided technical advice onthe development of specialist services (withseveral focusing specifically on supportedemployment) using Federal Governmentresources.

• The funding of training courses for new staff.Norway provides a year-long trainingprogramme for people working in supportedemployment.

• The development of quality assurance systems.Several countries have seen the developmentof quality assurance or accreditation systemsdesigned either to support the developmentof better practice, or to providecommissioners of supported employmentwith some measures of quality.

We were given an example of the way quality ismonitored in Washington State in the USA. Thisdemonstrates a richness of approach whichprovides valuable feedback and learning.

The initial findings were sufficiently positivefor Callahan to argue that those connectedwith supported employment (interestingly,his briefing was targeted as much at familiesand other supporters as well as professionals)should seek to influence local developmentsto move in the same direction. Hissuggestions for doing this included thefollowing.

• Ensuring that people are fully briefed aboutthe developments through accessingtechnical advice web sites.

• Lobbying State officials responsible for thedevelopment of ‘one-stop’ centres.

• Seeking representation on local ‘one-stop’centre management boards.

• Lobbying specialist services to ensure theytoo engage with these new structures, toensure the ‘one-stop’ centres are respondingto all disabled people. (This is equivalent togetting social services/social work in the UKto try and influence the local implementationof the ONE programme.)

• Encouraging local supported employmentagencies to offer skills, training and servicesto the ‘one-stop’ centres.

• Promoting positive ‘precedent-setting’ byencouraging applications to the ‘one-stop’centres from well-supported individualswith significant impairments who are clearabout their aims.

• Arguing for local demonstration projectsbuilding on the earlier experiences.

This ‘bottom-up’ approach to influencing theimplementation of major policy initiatives –effectively trying to equip individuals andorganisations with the tools they need to getinvolved at debates at the local level –

appears common in the USA. It is in markedcontrast to the more traditional attempts toshape such structures through debates about‘top-down’ policies.

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While some issues were common to allcountries we approached, other lessons werespecific to the USA. Given some of the parallelsbetween developments in the UK and the USA, itseemed worth pointing these out (although theywould not necessarily apply elsewhere). Theseincluded the following.

The use of ‘individualised’ funding to promote

choice

A key development in the USA has been thedevelopment of ideas about ‘self-determination’and providing people who use specialist serviceswith control over decisions about who providessuch services. It is also argued that such approachesforce service providers to become much more‘customer focused’.

There have been a number of pilots to explorehow these ideas might work out in the context ofemployment,3 with some success (see for example,the earlier references to the ‘one-stop’ centres).Given the aspirations of many disabled people for apaid job that is not in a segregated setting, theexpectation is that disabled people will take theirbusiness to the more effective supportedemployment agencies (rather than some traditionalproviders) to get the type of service that mostclosely reflects these aspirations.

Although not directly equivalent, these systemshave some parallels with the use of DirectPayments for community care services in the UK.Direct Payments have yet to be used for supportedemployment on anything other than the mostminimal scale.

Quality assurance mechanisms are built intocontracts with supported employmentorganisations. The required reportingincludes:

• number of persons who are currentlyworking

• average monthly wage

• retention

• number of replacements

• job type

• return on public dollars invested.

This information is made public at least once ayear on a statewide basis, and more frequentlyon a countywide basis. Also, supportedemployment programmes are evaluated bytheir respective counties on an annual basis.Counties typically look at quality indicatorssuch as:

• how well an agency is achieving itsoutcomes

• consumer handbooks that outline both theservice’s and an individual’s rights, shouldthe person choose that specific organisation

• how the supported employment agencydetermines whom they will serve

• job promotions over time

• variety of job opportunities that asupported employment agency offers

• methods by which the consumer’s jobpreferences are taken into consideration inthe job development process

• number of persons served from ethnicminority communities

• number of persons with severe impairmentsor conditions who are employed as a resultof the agency’s efforts

• make-up of Board of Directors.

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Lessons from abroad

The use of different funding approaches to promote

positive outcomes

Traditionally most supported employment agencieswere resourced either through ‘input funding’(effectively core funding for staff and overheads) oron some ‘output funding’ basis (for examplenumbers of hours of staff time, or numbers ofindividuals using the service). However, neither ofthese funding approaches bear any relation to theoutcomes for the people using the service. As aconsequence there has been increasing interest inpromoting funding approaches which reflect whatactually happens to people. This might be both interms of rewarding agencies for achievingintermediate outcomes (vocational profilescompleted, action plans agreed, finding a job whichmatches jointly determined preferences), rightthrough to the so called ‘terminal’ outcomes (wagesachieved, the length of time the job is retained,employer and employee satisfaction). For example,some outcome funding methods have taken theform of a negotiated unit cost for each individual,with a percentage of the total paid on achievementof the specified outcomes (including the keyintermediate stages). Others have tried to relate thelevels of payment to some kind of outcome-relatedformula; for example, agencies get a higher level ofpayment the more closely the jobs they find matchthe wages rates and hours worked for thatparticular industry.

Two issues seem to be particularly crucial inoutput related funding systems. Firstly, it is vitalthat an allowance is built in for a realistic ‘failurerate’ in achieving the various key outcomes;inevitably not everyone goes right the way throughthe whole process. Secondly, there need to bepremiums built into the system for assisting peoplewho have greater support needs. They are bothmore costly to provide a service for, and it is likelyto be harder to achieve positive outcomes fromthem. It is crucial that there are no ‘perverseincentives’ in the funding system that causeproviders to avoid taking on people who need

the most support.In practice, many of the more innovative

approaches appear to involve some kind of‘blended’ funding system which retains acombination of outcome related funding, alongwith either core funding or output funding. Thecombination helps promote good quality outcomes,whilst also providing a degree of organisationalstability and predictability.

The value of ‘natural’ supports

While in-work support remains key to the conceptof supported employment, there is increasingrecognition that delivering all of such supportthrough some kind of ‘outsider’ is not alwayseffective in promoting inclusion in the workplace.There has therefore been increasing interest infinding ways to draw on the full range of existingor potential supports that already exist within manyworkplaces. For example, Rogan et al. (1993)suggest a number of strategies for promoting thedevelopment of natural supports, including:

• ensure there is a match between the jobapplicant’s preferences and the work siteculture

• work with other employees whendeveloping adaptations or modification to ajob

• help to establish personal connectionsbetween the supported employee and theirco-workers

• facilitate the ongoing involvement of, andsupport from, co-workers.

However, for some people, a network ofsupport can be particularly helpful, for exampleduring evenings and weekends, which many findmore stressful and depressing than work.

There is increasing evidence4 that the carefuluse of natural supports, linked to job matching,results in a range of improved outcomes forindividuals.

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Welfare systems and supported employment

None of the countries whose benefit systems wereexplored were ideal. Indeed, in many there weresimilar problems to the UK, with either inherenttensions between claiming some kind of‘incapacity’ benefit and working, or weakincentives for people to move off benefits in towork.

However, the US system provided a partialexception to this rule. In the first place the access tothe income maintenance system is determined by atest of disability, not incapacity. Secondly, up to apoint there are reasonably consistent incentives forpeople to work (and it is generally accepted as adesirable aim). As a result the system is generallymore flexible and supportive of disabled peoplewho need to combine wages and some incomemaintenance benefits. This is probably one of thereasons supported employees tend to work longerhours than their UK equivalents, and have higherrates of take-home pay.

Despite this, we would not be keen to see ideasabout welfare imported uncritically from the USA.In the first place, the disability benefit system isacutely means tested above a certain level, when

significant disincentives emerge (like the loss ofMedicaid funding for health insurance andpersonal assistance services). Some efforts are beingmade to address these issues, but they are unlikelyto remove all concerns. Secondly, for people whoare not considered to be disabled, the provision ofwelfare benefits is very uncertain, and in somestates may be time-limited.

Nevertheless, the US system points to thepotential advantages of a disability-related incomemaintenance system that does not hinge around‘incapacity’, and which supports disabled people inexploring paid employment.

Notes

1 Notes about the benefit systems in othercountries are available free of charge from theNorah Fry Research Centre web site at http://www.bristol.ac.uk/Depts/NorahFry/

2 For more details see the web site http://www.aauap.org/, which provides details ofparticipating centres.

3 See, for example, Callahan (1999a).4 See Mank et al. (1998, 1999).

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When we started this exercise, we were clear that itwould not be enough to simply say what is wrongwith the current system; we would have to comeforward with some positive suggestions foralternatives. In this section we set out our ideas fora much more positive policy framework forsupported employment. In many instances thesewere prompted by ideas from respondents, orcollective concern about areas of policy that had tochange (the benefit system is an example).

4.1 Outcomes

It is worth beginning by being explicit about thekind of positive outcomes that we were aiming forwhen developing this framework. These included:

• more people successfully using supportedemployment to access decent paid work inall parts of the UK

• more people with high support needs gettingwork

• increases in the disposable income of peoplein supported employment

• more people getting better jobs, moving upthe career ladder

• more people enjoying the social benefits ofpaid employment.

4.2 The key points

In order to achieve these outcomes, supportedemployment will clearly have to be much morewidely available than it is now. In a nutshell, if thisis to happen:

• The potential of the supported employment model

must be recognised for many disabled peoplecurrently served by social services, healthservices, Disability Services Teams, PersonalAdviser Schemes and in the SupportedEmployment Programme. The modelprovides a means for such people to progressto less sheltered arrangements.

• The links between the specialist supported

employment sector and the modernised Supported

Employment Programme and Disability Services

Team provision has to be consolidated and

expanded, with the government playing amuch greater role in funding the former.

• Sufficient additional funding must be deployed tosecure the involvement of the existingspecialist supported employment sector andexpand its availability.

• The links between supported employment

agencies and the emerging Personal Adviser

schemes need to be enhanced, ensuring that thesupported employment model of service isreadily accessed through whichever formemerges as the main ‘gateway’ toemployment-related supports.

• The benefits and other related systems (for

managing housing and personal assistance costs)

will have to be reformed in ways that provideboth greater security, and better incentivesfor people moving into work (and certainlyfewer disincentives).

At the same time:

• The integrity of the model will have to be

maintained and developed (services will have tobecome more skilled and reliable).

• The capacity of the specialist sector will have to

increase dramatically over a relatively shortspace of time.

4 Proposals for a new system of supported

employment

This section sets out our proposals for thedevelopment of supported employment in theUK.

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• Existing investment will have to be further

developed and expanded (or certainlymaintained). There is a risk that localauthority social services/social workdepartments will disinvest in supportedemployment if greater financial supportcomes from central government.

Below we explore some of the ways in whichthese key points could be addressed.

Develop joint investment plans for welfare to

work services

By April 2001 all social services departments inEngland will have been required to develop JointInvestment Plans (JIPs) on their ‘welfare to workservices’. These will help to implement policiesincluded in relevant guidance, such as the WhitePaper, Modernising Social Services (DoH, 1998), andemployment policy aspirations in other areas suchas Health Action Zones. These JIPs provide a vitalshort-term focus for addressing at least some of theaims outlined earlier. They give social servicesdepartments an important lead role, but they alsorequire them to:

• work in partnership with all the keyagencies, including health, the EmploymentService and the Benefits Agency, as well asthe emerging Learning and Skills Councilsand Connexions Service

• indicate how agencies plan to use their jointresources to develop and invest in servicesover the next three years.

The government recognises that the creation ofJIPs will be a developmental and evolutionaryprocess. As such JIPs represent an excellentopportunity to kick-start the process of change anddevelopment at a local level. It would seemsensible for the Department of Health to work withthe Department for Education and Employmentand the Department of Social Security in givingexplicit guidance and technical support. Some of

our suggestions for this process would include thefollowing.

• Require JIPs to indicate how social services will

create (or expand) the specialist supported

employment sector (on the basis of evidencewhich shows that it is likely to be the mosteffective model of supporting people with arange of needs).

• Require JIPs to indicate how Employment

Services will begin to play a more significant role

in funding the specialist supportedemployment sector.

• Require JIPs to indicate how access to

supported employment will be developed as a keycomponent of school transition planning.

• Require JIPs to indicate how social servicesdevelopments will ensure that futurecommunity care assessments will take greater

account of work-related needs, underlining therequirements within Modernising Social

Services.

• Ensure that artificial barriers between

employment and social care services are removed.Personal assistance should be provided atwork as well as at home and support that isavailable at home should be available atwork (and vice versa).

• Promote the role of joint referral mechanisms.

• Ensure that specialist training on disability

equality is available for all potentialgatekeepers for the new system, includingPersonal Advisers, Learning and SkillsCouncils and Connexions Personal Advisers.

• Ensure there is joint training for staff in all the

partnership agencies about the aims of the JIPs,and the way that plans will be implemented.

• Explore the use of Direct Payments as a way ofextending control and choice over support in

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Proposals for a new system of supported employment

the workplace. This will probably requiresome dissemination about good practice.

• Require JIPs to identify existing providers oftraining in supported employment anddevelop a joint strategy for an expansion in

training capacity.

It will be important to keep the development ofJIPs under review, and to use other measures, suchas Social Services Inspectorate monitoring criteriafor welfare to work implementation, to ensure theeffective promotion and use of supportedemployment services.

Ensure that funding relates to key principles

There are a variety of stakeholders whose viewswill need to be taken into consideration whenchoosing an approach to funding. These includepeople who want to work and their supporters,employers, the Employment Service, socialservices/social work departments, NHS Trusts andsupported employment provider agencies.

Funding may come from a variety of sources:the modernised Supported EmploymentProgramme, Disability Services Teams, PersonalAdvisers, or joint funding with social services orother commissioners. Whatever the source, fundingshould ensure that the following are achieved:

• valued outcomes that make a positivedifference in people’s lives

• creativity in job finding and matching

• variations in cost catered for, both in terms ofnatural variation in the costs of services andin the level of support needed by individuals

• follow-on support available for careerdevelopment

• successful inclusion for people with high support

needs or severe impairments

• appropriate support for employers.

The funding model should pay for all criticalelements of supported employment (specific aims:profiling, matching, support, follow-on). It shouldinvest in new provision which starts with anassumption that no one is unemployable orineligible. Funding should be based on anexpectation that people will develop their workskills and advance in their careers.

Build on existing Supported Employment

Programme work

There are already examples where SupportedEmployment Programme providers are offering arange of individualised support to job applicantsand providers. This positive experience needs to bebuilt on, and the good practice which already existsshared with others.

An important cultural change involves movingaway from an assessment process which focuses oneligibility for fixed programmes, and replacing itwith individualised action planning, designed toestablish what support each individual needs. Thuspeople should be regarded as ‘employable’ whenthey want to work and require support. We weretold that the notion that people on incapacitybenefits will never hold down a job is beingchallenged. New Deal for Disabled People pilotshave demonstrated that, with appropriate support,some people on incapacity benefits who want towork can be helped back to work. The newSupported Employment Programme will focus onpeople who are on incapacity benefits, therebygiving this group of people the opportunity tomove back to work.

There are some specific ways in which the workof some Supported Employment Programmeproviders can be built on to encourage a range ofindividualised support to job applicants andemployers.

• Redefine the concept of ‘employability’ toinclude people who want to work and needsupport.

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• Remove the productivity assessment (this is tohappen, following the recent review of theSupported Employment Programme) andinclude people with greater support needs.

• Encourage full employment status by the hostorganisation becoming an employer, givingthe employee full entitlements andopportunities for advancement.Organisations may need help to developtheir competence in supporting individualsappropriately.

• Combine with other funding sources (such ashealth and social services) to provide long-term support to those people who need it.

• Redefine ‘progression’ to include increases inresponsibility, job status, hours and wages, aswell as independence. This will encourageproviders to support individuals’ careerdevelopment.

• Increase available funding and look for new

providers who deliver the model of supportedemployment described here.

Re-examine the funding of the Supported

Employment Programme

We were told that at present all money for theSupported Employment Programme is tied up insupported businesses and individual employersubsidies. Freeing up some of this funding willenable the service to expand to new providers.There are a number of ways in which the fundingof the Supported Employment Programme couldbe changed to encourage a move towardssupported employment.

• Supported Employment Programmecontractors should be able to retain surpluses

and recycle these to pay for additional forms ofsupport other than Wage Subsidy.

• Bridging funds should be provided, if required,for additional support (including job

coaches) to encourage progress towards openemployment. Recycling of monies within theSupported Employment Programme willonly occur if investment in new forms ofsupport is provided at the beginning of themodernisation process.

• Such developments should be based on

individual action plans and support contracts,which encourage career development andsocial inclusion, not just reductions in WageSubsidy.

• Wage Subsidy should be retained as part of thesupport tool kit, but linked to people’s actual job

performance. Wage Subsidy mayprogressively be used with people who havehigher levels of disability, if needed.

• New entrants to the Supported EmploymentProgramme should be contracted on the basis

of individual action plans and support contracts,linked to clear quality outcomes in terms ofwage rates, hours worked and socialinclusion, including progression to openemployment, and not on the basis ofperceived productivity.

If expansion of the valuable SupportedEmployment Programme resource becomesavailable, some of this could be directed towards ahigher subsidy to cover coaching, mentoring,support and Wage Subsidies for people with highsupport needs.

Build on existing Disability Services Team and

Personal Adviser partnerships

There are examples where Disability EmploymentAdvisers and Personal Advisers are working withspecialist supported employment agencies to provideindividualised support to job applicants who aremore difficult to place and not eligible for theSupported Employment Programme. Here, they areusing Work Experience and Access to Work fundingto pay for some parts of the supported employment

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model, building on agency core funding from socialservices and other funders.

However, these Advisers are not able to fund allaspects of supported employment. So, if theirclients are not also clients of the social services/social work department, they are ineligible for thecore funded supported employment service. Toensure a full and effective service is available to alltheir clients, Disability Services Teams should:

• have resources to contract with specialistsupported employment providers for theirclients

• contract in relation to an individual action plan

linked to clear quality outcomes

• be able to commission all aspects of thesupported employment process, includingvocational profiling, workplace training andsupport, ongoing support, job retention andcareer advancement

• be available to all disabled people regardless ofimpairment or condition, or severity ofimpairment.

As the Personal Adviser system develops, itseems likely that increasing this role ofindividualised action planning will fall to them.However, person-centred planning for people whohave greater support needs can be time intensive,and it is unlikely that Personal Advisers with largecase loads will be able to undertake this kind ofactivity on any scale. This suggests that it will beimportant for Personal Advisers also to:

• be able to contract out the task of ‘vocational

profiling’ and other individualised support tospecialist agencies who have the appropriateskills

• have resources to pay for this service

• be able to commission services flexibly in waysthat realise the outcomes of this planningprocess.

Find ways to change the culture of the

Employment Service

The recently announced changes to the SupportedEmployment Programme (briefly outlined inSection 1) are clearly to be welcomed. However, itwill take time for these changes to work throughthe system.

Personal Advisers, those implementing ONEand Disability Services Teams need to be positive inidentifying what work tasks people could do, whatwork environments would best suit them, what itwould take to support them in the short and longerterm, and what approaches will help in transitionfrom school and college. They will then need towork creatively to achieve these. Increasedflexibility in funding will help, but a shift will alsobe needed from assessing what people cannot do, towhat they could do with help.

This implies a considerable programme oftraining, geared to equipping the key personnelwith not only the appropriate skills, but also somekind of vision of what is possible, not simply what isavailable. There is scope for collaboration betweenthe Employment Service, the specialist supportedemployment sector, other key governmentdepartments (the Department of Health and theDepartment of Social Security), and Connexions, aswell as with other critical players (for example, thesocial firms movement), in the large-scaledevelopment of training materials designed toachieve this end. The development of a PersonalAdviser training and qualification structureproposed in relation to Connexions provides a realopportunity to develop awareness of supportedemployment and the potential of the model forassisting a wide range of disabled workers.

Ensure that the full range of funding streams can

be combined flexibly to support individuals

A wide range of funding streams are currently usedto pay for supported employment. However, thesystem is confused and fragmented. There werestrong demands for some kind of rationalisation,

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which would allow funding from different sourcesto be combined flexibly in ways which arespecifically designed to deliver supportedemployment.

There may well be a case in the longer term forconsolidating some currently distinct fundingstreams into a single flexible strand, so that there isone coherent source of contract funding for disabledpeople to access supported employment. Theobvious candidates here would be a merger of theAccess to Work and other Disability Services Teamfunding programmes with a modernised SupportedEmployment Programme, to provide one expandedfund, based on individual contracting. This couldprovide individualised support including job tryouts,job coach support, employer based mentoring, aidsand adaptations, transport, training, post-placementsupport and short- or long-term wage subsidy, ifrequired. There is also a real need to learn about theuse, and potential for wider use, of Direct Paymentsin this area.

Develop commissioning and contracting

processes that will sustain and develop the

specialist supported employment sector

A variety of contract models will be required topromote better quality employment-relatedsupports, and also allow some security for newlyemerging providers in areas that currently havelittle provision. These contract models should beavailable whether people are within the SupportedEmployment Programme, or placed throughDisability Services Teams or the relevant PersonalAdviser schemes. They would include thefollowing.

• Core funding to fund job coaches,management, administration, training anddevelopment, to secure fragile existingservices and to enable the setting up of newservices in areas that are poorly served.Without the ability to core fund, the currentlevel under-provision will not be addressed.

• Outcome-related funding for the achievementof key stages (completion of vocationalprofile, job found, etc.) and ultimateoutcomes (job retention etc.). These shouldbuild on the experience developed in theUSA and should include some componentdesigned to accommodate a level of failure ata rate that reflects local experience under‘best practice’ conditions. These will provideincentives for efficient and effective workingamong stable supported employmentagencies.

• Time-limited contracts to enable funding ofshorter-term job tryouts and exploration ofchoice.

• Fee-for-service funding, providing tranches ofhours, could be used to enable long-termmonitoring and career development to takeplace. The ability to intervene after a personhas been stable in a job for some time isespecially important for people with mentalhealth problems who may suffer recurrentcrises that threaten their job, but for whomtimely, intensive intervention can be criticalin sustaining their career.

• Supplements should also be available toreimburse providers of supportedemployment for additional work with clientswho are harder to place.

• Quality specification, monitoring and quality

improvement methods which focus onoutcomes for employees and the impact onthe local community (see 4.3 below).

Improve transition from school to adult life

There is a need to ensure that young disabledpeople are encouraged and supported to move intoemployment when they move from school orcollege into adult life. The following steps will helpensure that supported employment is available as areal option to those who may require it.

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• Local authority social services/social workdepartments should ensure that theirCommunity Care Plans include supported

employment as a serious alternative to daycentre provision.

• While, for many young disabled people,effective education and qualification is theroute to successful transition from school,others require direct help into well matchedemployment, possibly without the benefit ofmany qualifications. Connexions will need to be

flexible enough to provide personal support forwork-based learning, job tryouts, andtransport, often while people are still atschool or college, and to provide a Key SkillsQualification framework that reflects thepositive entry level skills that can beachieved by some people with moresignificant learning disabilities.

• The new Connexions Service should be aware of

the role supported employment can play andwork with Learning and Skills Councils andexisting commissioners of supportedemployment to fund opportunities for pupils to

explore employment while they are still atschool.

• Supported employment agencies should beencouraged to work in schools, encouraging

pupils to explore employment as an option andgenerating the support they will require whenthey leave school.

• Personal Advisers within Connexions have acrucial role in assessment, case work andbrokering the involvement of other services.A new training and qualification structure isbeing introduced to support their work. Itwill be crucial that this training adequately

prepares Connexions Personal Advisers for

supporting transition of young disabledpeople, including young disabled peoplefrom black and minority ethnic communities.

• Changes are to be introduced to the NationalCurriculum shortly. The Department forEducation and Employment should ensurethat there is no conflict between the National

Curriculum and encouraging disabled young

people to explore employment opportunities

whilst at school.

4.3 Quality

The government recognises the need for improvingthe quality of the existing Supported EmploymentProgramme to ensure that individuals aresupported in the best way to achieve real jobs. Weneed clear, strong government leadership now forall forms of supported employment.

This section presents our proposals for ensuringthat supported employment develops in a waywhich promotes quality support for the people whoaccess it.

Promoting quality is everyone’s job. Supportedemployees, employers, supported employmentagencies, central and local government all have arole to play and need to work together. Leadershipfrom employers and their organisations needs to beencouraged. Supported employees and employerscan provide valuable feedback on what is workingand what needs to change. Central and localgovernment should state clearly what they wantfrom supported employment and give feedbackaccordingly. Supported employment agenciesshould be continuously learning how to be moreeffective from their own experience and that of thepeople they support.

Ideas for change

A recent ministerial statement about the SupportedEmployment Programme set out some ambitionswhich could usefully apply to all supportedemployment endeavours.

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The basis of quality in supported employmentis that there should be a co-ordinated approach inwhich everyone has responsibility for qualityimprovement. This means:

• adopting a customer-led perspective, where theviews, experiences and satisfaction ofemployees and employers are the maindeterminants of quality

• taking employee and employer satisfaction

seriously, reflecting their key roles assupported employment customers

• the government taking a lead throughestablishing standards, procedures forapproving programmes and agreeingcontracts

• providers of supported employment taking a

responsibility for setting their own standardsand codes of good practice, organisationaldevelopment, self and peer review andcontinuous quality improvement methods.

Implications for supported employees

People who are supported in employment can bevery clear about the personal outcomes they wishto achieve. This paints a helpful picture of what weare trying to achieve and the direction in which weshould be heading. Feedback from employees alsoprovides a clear focus to check progress indeveloping supported employment as anincreasingly successful means of support. Disabledpeople need to be supported to take leadership inmaking clear what help they require to developtheir working careers.

Implications for employers

Employers are essential partners in supportedemployment. Not only do they provide the jobs, itis vital that they benefit from their involvement inthe sector. Their feedback is essential so they play akey role in the definition and review of successfulsupported employment.

Implications for providers of supported

employment

Providers can take a number of steps to promotehigh quality supported employment:

• develop standards and codes of practice

• share training, effective support, ideas,knowledge and development

• use outcome-based review tools such asSupported Employment Quality Assurance(SEQA), as well as reviews which focus onprocesses, such as Investors in People or ISO9000.

Implications for commissioners of supported

employment

We recognise that there are a variety ofcommissioners of supported employment and thatthey are in a good position to ‘manage’ the localsupported employment ‘market’ and build localcapacity by contracting for schemes with clear

Ministerial statement on modernising the

supported employment programme

Supported employment has always been abouthelping disabled people to take their place in workinglife. We need to modernise the programme to reflectthe ambitions of disabled people; to increase thenumber of disabled people in work and to respond tothe changes in today’s labour market. In particular wewant employers to play a greater role in offering newopportunities for people with disabilities, so that theycan develop the skills and personal qualities valued inmainstream employment. In doing this we intend tosafeguard the position of people currently employedin the Supported Employment Programme, althoughthey will be able to take advantage of the newopportunities the Programme will offer.

(Margaret Hodge, Equal OpportunitiesMinister, May 2000)

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quality specifications, based on the principles wehave outlined. In particular, social services CareManagers need to become aware of the potentialadvantages of supported employment andencourage their clients to pursue this option.

Developing of standards

The government’s modernisation of the SupportedEmployment Programme indicates that standardsfor their programme will be developed, so ourinterest here is more about their content than theneed for them. When used with a customerperspective and provider-led improvementstrategies, minimum standards can be very helpfulto focus provider effort to best gain and delivertheir basic expertise. Callahan (2000) suggests thecharacteristics of quality services and qualityproviders listed in Table 1, which could be used as

a basis for developing standards.Contracts can be used to specify outcomes, both

for individual employees and in terms of theimpact of supported employment on the localcommunity. This can be used to inform localstrategies, for example for Welfare to Work JointInvestment Plans. Contract monitoring candemonstrate annual increases in the number andvariety of jobs, hours worked, wages and careeradvancement. It can also show how services areincreasingly successful in including people whohave historically been considered ‘unemployable’.Other useful aspects to be monitored are job lossand support costs per pound earned, and projectedwelfare benefit savings as a quality measure(although not as a prime target).

The service outcome is consistent with what theindividual wants

Services are delivered to the individual with respectand concern for the impact on the person’s life

A fair price is charged for the service

Agreed work is performed in a reasonable time orwithin the time specified

The service is delivered in a safe and responsiblemanner and results in a safe outcome

The individual gets a copy of the plan that showsthe delivery of the outcome as well as anyinformation gathered about the person

The individual is treated as a partner in the servicedelivery relationship

Services and outcomes are accessible to theindividual and their family

The provider has experience, skills and/oreducational credentials in the area of servicedelivery

The service provider does not have any legalrestrictions or history which might compromise theservices offered

The provider is able to provide the services in atimely manner

The provider has enough financial resources andstability to perform the agreed service outcomesbefore being paid

The provider treats the service user with respect, asan individual rather than as a service recipient

The provider offers a reasonable guarantee to theindividual to redo services or products that are notacceptable or successful

The provider offers individualised outcomes ratherthan stock options

Table 1 Characteristics of quality services and quality providers

Characteristics of quality services Characteristics of quality providers

Source: Callahan (2000)

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Implications for government

We have already pointed out the need forgovernment leadership in developing access andfunding mechanisms, in ensuring continuingcommitment from other current commissioningbodies, and in reviewing the benefit system. Thegovernment also has a role in promoting thequality of supported employment, through policystatements which stress the belief that real jobs andcareers are possible for all people, and thatemployment offers major benefits in terms of socialand economic inclusion.

In addition, the sector will require help withworkforce planning and training: How many supportpersonnel will be needed? Who will train them?Training is not only required for staff in supportedemployment agencies; staff in other relevantdepartments (health, social services/social work,Employment Service, etc.) need to be familiar withthe principles and practice of supportedemployment. Training should be carefully specifiedin terms of the information and skills required.There needs to be investment in skilled staff withexcellent communications skills. There should beco-ordination with new training lead bodies andthose concerned with professional qualificationsand standards in social services to ensure adequateattention is given to providing for this new skillbase.

Government must also promote and supportthe development of quality assurance practices insupported employment agencies. There must be aclear understanding of what is required to ensurehigh quality service delivery. Such a qualityassurance approach might look for:

• the components of a good supportedemployment service (vocational profiling,individual job development, etc.)

• flexibility in applying these methods tomatch individuals’ requirements

• key staff skills and competencies

• staff training and support

• regularly consulting employees andemployers and acting on their feedback

• organisational development in the light ofexperience.

Development initiatives should ensure thatsupported employment practice can always reflectnew thinking and learning. Government leadershipin research and development will be necessary toensure the sector keeps advancing. Research shouldinclude supported employees’ and employers’views and experiences, best practice examples ofoutcome improvement and trends showing theimpact on local communities over time.

There is already a wealth of learning from pilotstudies and other innovative work, includingsupport of people with complex and significantimpairments. There is a need to ensure thateffective dissemination takes place so that lessons arewidely known and acted upon.

Finally, government should take a lead onensuring technical advice and consultancy is availableto the sector. Support should centre on theimplications of policy initiatives such as Best Value,modernising the Supported EmploymentProgramme, Connexions, and Joint InvestmentPlans. Better advice is required on welfare benefits,funding, access and achievements for people whouse services, building on local learning fromdevelopments such as the formation of newpartnerships and the introduction of continuousquality improvement reviews.

Government should invest in information,training and support for all local customers,purchasers and providers of supportedemployment. Accessible advice on welfare benefits,funding and access to local services should bemade available. These initiatives could first be triedout in strategic locations, building on localexpertise and existing partnerships in combinationwith other proposals made in this paper.

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4.4 Benefits

There are a number of benefit reforms in thepipeline. These include restrictions on eligibility forIncapacity Benefit, the abolition of SevereDisablement Allowance, a new minimum incomeguarantee for severely disabled people, a Job Grantfor people moving from incapacity benefits to workand a simplification of the rules for HousingBenefit. However, it is not clear that these changeswill necessarily encourage more disabled people tofind and maintain paid employment. Strategies forchanging this situation are summarised in thesections below.

Get more out of the existing system

Although the case for reform is strong, so is thecase for making sure that the existing system isused more effectively, possibly through thefollowing.

• Require the Benefits Agency to provide more

accessible information, including material onissues like the 52 week linking rules.

• Use the framework of Joint Investment Plans

to engage with the Benefits Agency at a locallevel.

• Develop an independent source of technical

advice for people working in supportedemployment, using the internet to ensureready access to information about basicstrategies for getting the most out of thesystem.

Extend transitional protection

There are a range of options for easing thetransition. These could include the following.

• Either restore Income Disregard to somethingclose to its original value (say £30) or set it tobe equal to the Therapeutic EarningsConcession Limit (therefore providing equitybetween different groups).

• Allow the disregard to be ‘rolled-up’ for a longer

period. This could be used by people whohave irregular earnings, or it could providean Incapacity Benefit run-on.

• Ensure that qualification for the protection of

linking rules is automatic.

• Extend Housing Benefit run on, both in extent(perhaps to six months) and scope (not just toIncome Support claimants).

• Explore the possibility of guaranteed benefit

status for people using the Therapeutic Earnings

Concession (people would not have theirbenefits reviewed simply because of taking‘therapeutic work’).

• Abandon the requirement that applicants for the

Therapeutic Earnings Concession have todemonstrate that the work they undertakewould ‘improve or maintain their condition’.

Explore a more flexible approach to bridging the

gap between incapacity benefits and the

Disabled Person’s Tax Credit

There were considerable demands for somethingthat would address the 100 per cent taper inIncome Support. At the same time, the inflexibilityof the 16 hours per week boundary betweenIncapacity Benefit and the tax credit has also beenthe focus of much concern. Fundamental reformwould be required to deal with these directly (seelater). However, in the meantime, one possibilitywould be to extend the lower hours limit of theDisabled Person’s Tax Credit downwards, andallow individuals to opt into it at different stages. Itwould effectively become a hybrid benefit (an‘incapacity tax credit’) for people working less than16 hours, and an in-work credit for people workingmore than 16 hours.

There would need to be some thought to therestructuring required to ensure the new optionsprovide progressive incentives over the full rangeof hours. There would also be the need for

34


additional protection for people who are using it asan incapacity benefit (for example, permanentlinking rules back to previous incapacity benefitswhere people stop work altogether).

However, these problems do not seeminsuperable, and the new arrangements wouldhave the advantage of offering more choice, and ofeasing progression backwards and forwards overthe currently inflexible 16 hour divide.

Introduce mechanisms to accommodate low

productivity

Obvious first steps in dealing with the anomaliescreated by the National Minimum Wage would beto sort out the unhelpful Income Supportregulations, along with the provision of moreeffective support for people with low levels ofproductivity. However, to ensure that people withmore complex needs are not excluded from theworkplace, further steps may be needed. Optionsinclude:

• re-target the existing Wage Subsidies on peoplewith the lowest levels of productivity

• use individual certificates of exemption forpeople at risk of exclusion.

The latter has proved to be controversial, withconsiderable opposition to any form of exemptionon the basis that this undermines people’s status asequal citizens and could constitute an infringementof their human rights.

Address ‘overlapping withdrawal’ rates

Solutions will have to extend beyond socialsecurity benefits and include significant changes toboth Housing Benefit and community carecharging regimes. For example, we would suggestthat some of the following be explored.

• Increase disregards in Housing and Council Tax

Benefits in line with changes to the IncomeSupport Disregard suggested earlier.

• Reduce Housing Benefit tapers.

• Discount the Disabled Person’s Tax Credit inassessing income for Housing Benefit.

• Discount charges for community care services inHousing Benefit Assessments.

• Require local authority charging policies to

conform to minimum standards and to supportthe object of promoting independencethrough work.

• Require local authorities to provide anenhanced personal allowance for people inresidential care who work.

Begin a debate about more radical reform

Many of the options outlined above represent anattempt to identify pragmatic options forimproving the situation within the constraints ofthe current system. However, we argue that there isa need to begin a debate about more radical reform.Ideas to explore further include the following.

• Abandon ‘incapacity’ as an organisingprinciple and replace it with compensationfor disadvantage in the labour market. Therewould now no longer be an inherentcontradiction between any form of move towork, and receiving protection offered byspecial benefit status. Young people wishingto claim the new non-contributory form ofIncapacity Benefit are an obvious group tobegin exploring this approach, since theywill have to declare themselves ‘incapable ofwork’ before they have had a chance toexplore what work means.

• Integrate the tax credits and incapacity benefits

into a single structure which both values allwork, and provides a guaranteed minimumincome (should people not be in work) alongwith continuous and progressive incentivesfor individuals to work longer hours. Theproposed further reform of the tax credit

35


system provides an opportunity to explorethis approach. Combined with a shift awayfrom using incapacity as an organisingprinciple, the arrangement would do awaywith the need for the Therapeutic EarningsConcession.

• Provide greater financial security throughpermanent links back to previous levels of

financial assistance for people who continue tobe at a disadvantage in the labour market.There are already some emerging precedentsfor ‘permanent’ linking rules which shouldbe further developed.

Establish demonstration projects

Developing better access and more coherentfunding for supported employment without reformof the benefit system is likely to limit any returnsfrom the original investment. At the same time,developing new approaches to benefits withoutlinking them to the availability of appropriatesupport is also unlikely to have much impact. Whatis needed is a strategy which combines both.Inevitably, many of our proposals have to remaintentative; without further testing we have little wayof telling how they would work in practice. For thisreason we argue that there is a strong case fordeveloping a series of demonstration projects toexplore the impact of these ideas. Ideally, thesewould:

• be based in areas where there are some wellestablished and effective supportedemployment agencies

• focus on ways of linking supportedemployment to the emerging PersonalAdviser system and ONE (e.g. linking the

new Benefit Agency ‘Keeping in Touch’scheme to supported employees throughNew Deal Personal Advisers)

• involve the modernised SupportedEmployment Programme

• include efforts to explore the idea ofconsolidated individualised budgets andmore coherent approach to contracting

• influence the development and refinement ofquality assurance systems

• provide linked opportunities to pilot changesto the benefit system.

Other possibilities include exploring offeringpotential users of employment-related supportcontrol over choice of provider.

4.5 Conclusions

This section has set out our proposals for thedevelopment of supported employment in the UK.Ensuring that access to high quality support isconsistently available across the UK hasimplications for customers and providers ofsupported employment, commissioners and a widerange of health and social care agencies. We havealso identified important action which can be takenat government level to stimulate the extent towhich people are enabled to get jobs, advance theircareers and enjoy the financial and social benefitsof work. We hope that this framework will bewidely disseminated and used as a basis fordevelopment. We recognise that this document isonly a start; and look forward to taking part infurther efforts to develop supported employmentin the UK.

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Arthur, S., Corden, A., Green, A. et al. (1999) New

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39

This report is based on the efforts of many people.We express our thanks to all those who took thetime and trouble to send us their views andcomments. We are also grateful to the JosephRowntree Foundation who funded the work.

The Policy Consortium for Supported

Employment

Members of the Policy Consortium for SupportedEmployment are listed below. Authors of theframework document are marked with an asterisk.

Steve Beyer* Welsh Centre for LearningDisabilities

Mark Brookes Self Advocate – Values IntoAction

Anne Corden University of YorkBob Grove* Institute for Applied Health

and Social Policy, King’sCollege, London

Steve Leach ScopeGary Nield Direct Payments Consultant

NDTAnne O’Bryan* Consultant NDTSteve Parr Sabre EmploymentKen Simons* Norah Fry Research CentreSimon Whitehead Consultant NDT and employer

Contributors of information

A total of 181 questionnaires were sent tosupported employment agencies and others withan interest in the area asking for details of theirexperience. In addition we made extensive contactswith people by telephone and through visits. Atotal of 139 replies were received; those respondingincluded:

• individual supported employment agenciesfrom all over the UK

• people with learning and other disabilitiesusing supported employment

• employers

• Employment Service staff, includingDisability Employment Advisers

• Social services and social work managers

• Careers Advisers

• representatives of disabled people

• a range of agencies serving people withdisabilities.

We also received detailed responses fromexperts in the United States, New Zealand, Norwayand the Republic of Ireland.

Comments on a draft

Approximately 500 copies of a draft of this reportwere sent to interested individuals andorganisations, including those who completed thequestionnaire. We received detailed commentsfrom many individuals and organisations. Whilstwe have endeavoured to take on board the viewsexpressed, we alone must take responsibility for thecontents of this document, which will notnecessarily reflect the views of the individuals ororganisations listed. We express our particularthanks to the following:

Jonathan Allan Enable ShropshirePeter Bates National Development TeamMark Brookes Values into ActionMike Callahan Mark Gold & AssociatesAnne Corden University of YorkHuw Davies Bury ESTAlyson Dunn PraxisGerry Higgins Social Firms UKMarilyn Howard Independent ConsultantRichard Kramer MENCAPSteve Leach Scope Employment ServiceJanet Lewis Joseph Rowntree FoundationChristy Lynch KARE Central ServicesKathy Melling Kent Supported Employment

Appendix: Contributors to this report

40


Gill Rhodes Calderdale Social ServicesAlan Roulstone University of SunderlandJustine Schneider University of DurhamJudy Scott Service Development

Consultant, responding forSocial Firms UK

Tony Sheill Royal Association in Aid ofDeaf People

Emma Stone Joseph Rowntree FoundationSally Titchener Royal Association in Aid of

Deaf PeopleDave Willingham Employment Link ServiceMonica Wilson Disability Action

We received helpful interest and advice fromofficials in a number of government departments,including:

Benefits AgencyDepartment for Education and EmploymentDepartment of HealthDepartment of Social SecurityDepartment of Trade and IndustryEmployment Service

A number of groups organised workshops todiscuss the draft from a variety of perspectives. Atotal of 282 people attended workshops organised by:

Community Care Development Centre LearningDisability Annual Congress

Department for Education and EmploymentNorthern Ireland Union of Supported EmploymentPersonal Adviser Service ManagersSocial Firms UKStaffordshire Partners in PolicymakingScottish Union of Supported EmploymentWelsh Association of Supported Employment

AgenciesASEA Wales/SCOVO conference ‘Supported

Employment in your Best Interests’

The Joseph Rowntree Foundation organised aworkshop which included participants fromRemploy, RNIB, the Employment Service, theDepartment of Health and the Quality Network.

We are grateful to Karen Flear and Madi Blissfrom the National Development Team for theircontributions to this work. We are also grateful tothe Employers’ Forum on Disability for theirpositive interest in this work.

Last but not least, our sincere thanks to RogerBlunden for editing this report.

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