We asked Rob Greig, from the National Development Team for Inclusion, to review our indicators on the employment gap for people with long-term mental health conditions and learning disabilities. He writes that the quality and volume of collected data is inadequate, while policy-making is increasingly failing to press for application of the evidence base.
The Government has made statements about their intent to close the disability employment gap - the difference between employment levels of disabled people and the population as a whole. However, data highlighted recently on the QualityWatch website show that, for at least some sections of the disabled population, the trend is in the opposite direction. The tendency to use ‘disabled people’ as a generic term denies the additional barriers to the world of paid work faced by specific groups of disabled people - for example people with long-term mental health conditions and people with learning disabilities.
QualityWatch’s data analysis describes how the employment rate of people in receipt of secondary mental health services has fallen from 9.5% in 2010/11 to 6.8% in 2014/15. For adults with learning disabilities, a slow growth that saw a ‘peak’ of 7.1% in 2011/12 has now reversed to 6.0% and is declining further.
The reasons for these low employment levels, and the ways to resolve them, are well researched and understood – yet policy delivery seems unable to implement evidence-based practice. In summary, the main causes and solutions are:
- Low aspirations for people being able to work. This is fostered by (for people with learning disabilities) the negative messages communicated from early school years onwards, and (for people with mental health conditions) the attitudes of many care professionals - aided and abetted by media images that influence employers. These need to change.
- For people with significant mental health conditions and learning disabilities, additional and specific employment support is needed above and beyond that provided through Job Centre Plus. This has traditionally been provided by the health and care sector – but boundaries and responsibilities are unclear.
- Specifically, approaches known as Individual Placement and Support (IPS) in the mental health sector, and Supported Employment in the learning disability sector, are the evidence based ways to support more people into paid work – but are often not followed.
Crucially, these successful approaches are based on a ‘place and train’ concept – whereby people who want to work are helped to get an appropriate job and then supported in the workplace to learn the skills required to perform to a high standard. Services that pursue the opposite approach of ‘train and place’, like work preparation schemes, volunteering and sheltered work experience, do not lead to people entering and remaining in the world of real, paid work.
Policy and evidence
Yet, despite this, research shows that around two thirds of spend by local authorities and the NHS on mental health and learning disability specific employment supports is on these non-evidence based approaches. Even more baffling, despite the evidence that people being in work saves money, both for local services and the taxpayer, compared to the alternative health and social care supports, local authorities and the NHS are currently cutting employment supports as a short-term financial saving.
Some of the reasons for this were found in undertaking the research cited above. Gathering robust evidence on the cost and impact of employment supports was challenging because most local authorities and Clinical Commissioning Groups simply do not ask for, retain and analyse data on service performance. So, for example, whilst most knew how much they spent per se on employment supports, they did not know whether they were spending it on evidence based or non-evidence based services. The data they collected were on things like ‘people worked with’ – not ‘people supported to gain a job’. Only small amounts of data were collected on whether people then stayed in work over time and almost no authorities asked whether someone being in work reduced the demand that person placed on other health and social care services. Put another way, commissioners generally have no way of measuring success and thus commissioning on that basis.
History lessons
Thus, in the absence of local evidence, and apparent ignorance of the nationally available evidence, services are being cut and the employment levels, as shown by QualityWatch, are falling. Ten years ago this trend was moving in the opposite direction as a result of explicit policy requirements, performance monitoring of local authorities and investment in advice and support to local commissioners. We would do well to learn the lessons from history and follow a simple, five point action plan, consisting of:
- Clarity from the Department for Work and Pensions and Department of Health as to where responsibility rests (in both funding and policy terms) for ensuring people with significant mental health conditions and learning disabilities are supported into work
- Greater directiveness from the Department of Health that the statements in the Care Act about employment being a social care outcome are a requirement on local authorities - not an optional extra
- The re-introduction of performance management of employment outcomes in the mental health and learning disability sectors of the health and social care system
- National funding of advice and support services to facilitate and mentor local commissioners and providers to adopt evidence based practice
- A national awareness campaign to promote more positive aspirations about the employment potential of people with mental health conditions and learning disabilities.
Without this, even if Government policy starts to show a reducing employment gap for disabled people as a whole, statistics for those whose conditions mean they are least likely to be in work will continue to move in the opposite direction.