Yes we can – How the NHS can lead the Disability Confident movement, Steve Hawkins, Pluss

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If you haven’t seen it yet, you will soon. And when you do, it’ll blow you away.

It’s the ‘Superhumans’ trailer for Channel 4’s coverage of the 2016 Paralympics that comes hard on the heels of this summer’s Rio Olympic Games. Set to the Sammy Davis Jr. track Yes I Can being stunningly performed by a band of disabled musicians, the three-minute film features world-class athletes as well as a rock climber with one arm and a rally driver who steers cars with his feet. It also shows people carrying out everyday tasks – a woman without arms efficiently changes her child’s nappy; another writes notes during a phone call while gripping her pen with her toes. Cut to a gloomy room where a careers officer is telling a young man with a disability, ‘No you can’t’. His message is swamped by a kaleidoscope of people who’ve been featured in the trailer who take it in turn to chorus ‘Yes I can’.

The message is a simple one – see the person; recognise ability; help it flourish because that way everyone benefits.

Within the NHS, it’s easy to think of disability in terms of us and them. In fact, one in three people have some form of disability or limiting condition. The reality is that disability is a part of everyone’s life whether this means friends, family or colleagues, and any of us can become disabled at any time. Disability is everyone’s business.

The Government recognised this recently when, as part of its Disability Confident campaign, it made a commitment to halve the UK’s disability employment gap. That’s the difference between the percentage of people with disabilities who are in work and that of the working age population as a whole. That difference is currently around 33%. To achieve this ambition – in other words to close the gap – will mean one million additional people with a disability or a health condition in work.

Pretty much everyone agrees that this would be a good thing – for the individuals themselves, for employers, for all of us. For NHS Trusts in particular, it makes sound business sense, not least because the NHS Confederation reports a huge problem in recruiting – especially to the 60% of its lower tier jobs. Trusts need talented and resourceful staff, but how best to bring them on board?

There’s a mountain of evidence that workers with a disability are at least, if not more, productive and reliable than their non-disabled colleagues. From Pluss’ experience, disabled employees also bring to work those can-do attributes that they’ve needed to develop in their everyday lives. And having a workforce that is representative of the people being supported by NHS Trusts can only help inspire recovering patients, and help Trusts better understand and respond to their patient base.

For this to happen, Trusts need to think creatively about recruitment if they are to tap into this pool of talent. Employment rates amongst people with a disability or health condition (that’s one in three of us, remember) are low because stubborn preconceptions stop us seeing beyond the disability; and because inflexible recruitment procedures can prevent that pool of people from showing Trusts how they could shine if they were given the chance.
There are some simple steps that Trusts can take to develop a more inclusive approach to recruitment, one that is flexible enough to include some innovative routes into employment for people with a range of disabilities and health conditions. Traditional recruitment procedures such as panel interviews and group sessions are one of the biggest barriers for people with complex disabilities. Working interviews or time limited work trials offer a far better opportunity to judge whether a person has the skills and capabilities to do a job really well. Job carving, with the help of an organisation like Pluss, can ensure a job fits a person’s unique set of skills. Longer term recruitment techniques including traineeships and internships such as Project SEARCH help people grow steadily into outstanding employees.

A yes we can willingness to make small adjustments in work pays dividends too. The changes a Trust might need to make to support dedicated disabled employees are frequently tiny and, almost always, those changes are worth the investment. 

The NHS is the most iconic health brand in the world. As an institution, it is uniquely placed to see the whole remarkable person, to recognise not what people can’t do but what they can. Showing innovation in how it recruits its workforce can put an NHS Trust where it should be – at the forefront of the Disability Confident movement, and be good for business too.

If your Trust isn’t sure about the best place to start, or how to build on the steps you’ve already taken, the Disability Confident campaign offers some really good ideas to raise awareness and challenge perceptions. And you can always talk to Pluss. We love hearing from employers and we’re always happy to help.

Steve Hawkins, Pluss blogs on halving the disability employment gap

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Mind the gap: the step change needed to halve the disability employment gap

First the good news, then the maths.

The good news is the government’s unequivocal commitment to halving the disability employment gap.

Now the maths.

The disability employment gap currently stands at around 43 percentage points. To halve the gap means moving around 1.2 million more disabled people in work. In the last five years, the number of disabled people in work has risen by just 23,000.

Halving the gap also means keeping people in work. According to the ONS, over 400,000 disabled people each year lose their job and fall into unemployment or inactivity. One in six of those who become disabled while in work lose their employment during the first year after becoming disabled.

What’s more, the challenge is increasing. The ONS predicts that by 2020, over a third of the workforce will be over fifty, and more than half of the over-50s workforce will have a disability or impairment.

Like all really effective aspirational statements, the government’s pledge sets an almost unachievable goal. Almost, but not quite. It raises the bar. It demands that we think differently, that we make some brave choices.

Like President Kennedy’s pledge in 1961 that Americans would land on the Moon by the end of the decade, the idea of halving the disability employment gap is do-able because, perhaps naively, we can imagine a world in which it is possible.

Many people believed that a Moon landing was possible, but not all of them understood the level of commitment, resilience and willingness to innovate that was needed to realise the goal in 1969. I believe we can, if we choose, get a million more people with disabilities into work and, importantly, keep most of them there – but not without an almost unimaginable level of commitment, resilience and willingness to innovate on the part of government and the partners it chooses to work with.

As the flagship initiative to deliver the government’s pledge, the challenge for the Work and Health Programme is that, for a majority of its customers, `any job` won’t be good enough, and for many a job start will, at most, represent only half of the journey. We’ll need to have primes in place who understand the critical nature of specialists in delivering outcomes on the programme, who can build and contract manage a team of specialists with local credentials and partnerships that are integrated with local health systems, in particular mental health, to support the journey back to work.

At £130 million a year, the Work and Health Programme will have around 20% of the combined resources of Work Programme and Work Choice, and will help upwards of perhaps 10,000 people a year to enter the workplace. It will set an important tone. But to reduce the disability employment gap by any significant measure will require a step change across half a dozen complementary areas of work.

First, government should explore ways of developing a robust retention service that meets the needs of both employers and disabled employees in a much more proactive way than the Fit for Work Service and Access to Work provision is currently able to do.

Second, we should ensure that the strategic and commissioning weight of LEPs, City Deals and Growth Plans are used in a co-ordinated way to maximise the opportunities of disabled people to enter local labour markets.

Third, I endorse the calls of a number of organisations for Government to explore the potential for ‘disability leave’ as a way of more constructively managing the fluctuating conditions of some employees. 40% of all employed disabled people say that modified hours have enabled them to stay in work; 36% of those out of work say that modified hours could have helped them retain their job.

Fourth, we need to find ways to support people who cannot access DWP provision to re-enter the labour market. Providing employment support is not a statutory requirement for local authorities or CCGs The four DWP mental health and employment pilots about to commence are welcome, but they take place against a background of dwindling funding for locally commissioned supported employment programmes, making it vital that government finds ways of incentivising local authorities to retain employment services for people in receipt of adult social care who are unlikely to gain access in large numbers to a capped Work and Health Programme.

Fifth, a significant percentage of disabled people falling out of the workforce are from professional, technical and managerial positions with acquired disabilities and health conditions who have long careers behind them and who will choose not to access JCP. Government and other stakeholders should urgently explore the potential for an intervention designed to support this cohort of people to rapidly re-enter the workforce.

Sixth, we need to get to grips with the transitions agenda, finding ways to help talented young people with learning disabilities and hidden impairments onto apprenticeship routes and supported internship programmes as part of a national unified drive to ensure that every young person with a disability who wants to transition into work can do so.

Finally, we need a step change in the way employers are engaged and supported to be part of the solution. We need to build on the Disability Confident initiative – from a promising PR campaign driven by committed providers and seventy active employers into a national movement which is identifiably driving the agenda, holding to account and championing innovation across each part of the plan.

Achieving remarkable things isn’t easy. We shouldn’t pretend this is a quick fix, or that more and more can magically be achieved with fewer and fewer resources. But a challenge has been set. Now we need some brave decisions that will move us from a visionary slogan to a detailed roadmap.

Read Pluss’ full submission to the Work and Pensions Committee inquiry into halving the disability employment gap.

Steve Hawkins is Chief Executive Officer at Pluss. 

Claudia Wood, Chief Executive, DEMOS, on an ‘asset based’ assessment for disability benefits


Any opinions represented within this blog are the authors and do not represent the views of ERSA.

In August, Iain Duncan Smith gave a speech regarding disability benefits and fitness for work. It was noticeable in its new emphasis on focusing on what people can do when it comes to work, not what they can’t. This means, he pointed out, a shift from a binary fit/unfit approach to disability benefits, to one which more readily allows some work, based on one’s capacity, and working with employers, and a “can do” approach to fitness to work.

All this isn’t new. Policy wonks familiar with social care know this as the “asset based” rather than “deficit based” approach to care and support. It means focusing on what a disabled person can do, what they want to achieve, and then identifying ways of overcoming the barriers to this. It is recognised as the best approach to providing a form of support that develops independence, rather than encouraging being “done to” and passivity.

Applying this pro-active approach to benefits assessment can only be welcomed – a thorough rethink of ESA is a long time coming.

What if IDS went further? What if he took the asset based, social care approach to ESA reform beyond the WCA phase, to its natural conclusion?

In social care, many disabled and older people help develop their own care plan, setting out the outcomes they hope to achieve and how they can achieve them. Their local authority then assesses how much money, in the form of a personal budget, it will take to fulfil the care plan and the individual in question can spend that budget accordingly.

The potential parallels between this process and the welfare to work regime are obvious. Both involve a support plan and an allocation of cash, but when it comes to welfare to work, the two are currently disjointed. The eligibility assessment for ESA and the assessment to develop a work plan are entirely separate, carried out at different times by different people and, most importantly, are not mutually reinforcing – a disabled person who is unemployed will not necessarily spend their ESA on fulfilling their work plan, but rather use it to support themselves during their unemployment.

But what if, upon a single assessment, an individual was helped to develop a “welfare to work plan”, and given a personal budget – composing of money to live (the current ESA) at a fixed amount, and a variable amount of money based on the range of barriers they face in implementing their work plan? Disabled people could take this to Work Programme and other relevant support providers to help them get back to the workplace, bringing new choice and competition into a system.

It’s an idea that has been raised before, but no one yet has joined the dots between the assessment and the allocation of this cash. It would require an assessment of incapacity and employability in a single assessment, a ‘real world’ test which remains a point of contention for the DWP, as well as the addition of support planning tacked on after the eligibility phase.
Recent research published by Demos has found, in fact, that no other country combine these “eligibility” and “diagnostic” tests. But then again, none use personal budgets. A personal budget could act as a tool to marry the two by bringing together the “how” and “how much” – so that an assessment of incapacity and employability coexists, creating both an employment plan and a corresponding budget to carry it out. It would move from a binary question of eligibility to a sliding scale based directly to the amount of support needed. 

The main difference between this and the current approach is not that it is more generous, but rather more efficient – by combining and rationalising two disparate stages of assessment. It could also empower disabled people in the process of assessing their employability and enabling them to take charge of their journey back to the workplace – an asset based approach if ever there was one.

By Claudia Wood, Chief Executive, DEMOS