The cost effectiveness of employment support for people with disabilities

Supporting more people who have mental health problems and/or a learning disability gain and retain paid work has been a policy priority for successive governments.

As a result, most social care and NHS commissioners commit funds to various forms of employment supports.

In order to help understand whether this money is being used effectively, the School for Social Care Research commissioned the National Development Team for Inclusion (NDTi) to research whether and how commissioners ensure they commission cost effective employment supports. 

The research is a follow up to an earlier scoping study which summarised the current evidence on economic effectiveness of employment supports.

This showed that whilst there are a number of gaps in the evidence base, there is also clear evidence that supported employment (within the learning disability field) and Individual Placement and Support (IPS) (within mental health) are the most effective solutions to supporting people into paid work. 

We are now just over half-way through the main research and NDTi have produced an interim report that summarises findings from the first stage of the research – data collection from across England about current commissioning practice.

All local authority and PCT commissioners in England were asked about the employment supports they commission and the outcomes they achieved. 99 responses were received, covering 83 local authority areas. 

Whilst further analysis of this data is being undertaken, and a second stage of the research will add more qualitative understanding of how commissioning is happening, there are three initial findings that can be shared now. 

Changes in council spending levels

We asked whether levels of spend on employment supports had changed in recent years – clearly an issue of interest at a time of general financial pressures. 

There was a predictable a variety of trends – including authorities significantly increasing spend on employment support (e.g. by moving investment from more traditional day services into employment supports) to authorities where spend on employment support was decreasing or even stopping totally.

However, taken across England, three provisional observations can be drawn:

* The three-year period where we sought detailed figures showed a general pattern of increases from 2010 to 2012, but then a decrease in 2012/13 to a level just below that of the first year. In other words, following increased spend, those increases appear to be being reduced to previous levels or below.
* Despite this recent reversal, spend now appears to be higher than it was five years ago. This is possibly because of the impact of policy initiatives from 2001-2010 such as the PSA indicator on employment.
* Despite this year’s apparent reductions, more commissioners expect to consolidate or increase the commissioning of employment supports over the next few years rather than reduce them.

Data available to inform commissioning decisions

It appears that many commissioners do not have access to the information they need to commission cost effective, evidence based employment supports.

Most have basic  information about how much they spend and most (66%) say they collect data on things such as the number of people supported into work. Most commissioners, however, do not have information on the types of employment support commissioned i.e. they are just commissioning ‘employment related support’.

This begs the question of how commissioners have decided to commit resources to those particular types and styles of services and how they decide whether they are being effective.

Personal budgets

Finally, the research sought information on the use of personal budgets to help people gain and retain paid work.

Whilst most authorities (76%) said personal budgets could be used for employment support (though 12% strangely said it was not permitted), very few authorities (28%) knew that this was happening and only 12% had information about the extent to which this was the case.

Provisional conclusions

We must emphasise again that these are interim conclusions and further work is being undertaken to understand the data received to date. However, this initial analysis suggests three potentially important findings:

1. In these difficult financial times there is an apparent reduction in spend on employment supports, even though (in theory at least), people gaining access to paid work should reduce the demands they place on social care services and thus the cost to local authorities.

2. Many commissioners would benefit from strengthening the data they collect about the type of employment supports they are commissioning, as at present they do not have the information they need to know whether they are commissioning effective evidence based supports that will support people into paid work.

3. The apparent lack of focus on employment support within personal budget delivery poses questions about whether the way in which personal budgets are being implemented across much of the country is ‘fit for purpose’ in terms of delivering the policy priority of supporting more disabled people into paid work.

A more detailed report on this first stage of the research is available on the NDTi website. The next report, including more information on outcomes achieved from money spent, will be available in the early summer.

Rob Greig is chief executive of NDTi