Supported living and supported employment: opening up opportunities to people with learning difficulties

July 1998 - Ref 728
Supported living and supported employment: opening up opportunities to people with learning difficulties

The Government has stated that it seeks to create a society based on inclusion, independence and empowerment. In particular, it has emphasised the importance of taking up paid employment, but it is not yet certain to what extent people with learning difficulties will be part of this in practice. This review of JRF research identifies the barriers facing people with learning difficulties and suggests possible solutions which would make inclusion of this highly marginalised group more likely.

Adults with learning difficulties still often find themselves among the most marginalised people in the community. Despite hospital resettlement programmes and the development of community care, they remain at risk of either being trapped in the family home or ending up in residential care. Similarly, although many would like to work, for the majority, a segregated day centre remains the only option. As a result, people with learning difficulties are too often socially and financially impoverished, vulnerable and living in, but rarely part of, their communities.

The Government is placing an unprecedented emphasis on creating a society which promotes inclusion, independence and empowerment, rather than exclusion, marginalisation and dependence. Current developments represent both risks and opportunities: risks of the 'unintended' effects of wider changes; opportunities to explore how policies on housing, employment and benefits might be adapted or adjusted to ensure that they work for people with learning difficulties.

A strategy that creates a more supportive policy framework could be developed, building on current innovations in supported living and employment, as identified in a number of JRF research projects. These include supported employment schemes which do one or more of the following:

Similarly, innovative supported living schemes have been developed with the following elements:

Such schemes demonstrate what can be achieved and offer considerable potential as a basis for constructing a system of support is that both more comprehensive and more inclusive.

Even assuming a more supportive policy framework, strategic commitment at a local level will be needed to ensure that supported living and employment options become more widely available. The components of such a commitment are shown in the box below.

Only a small minority of people with learning difficulties have been able to access supported living and/or employment. New initiatives have been seriously impeded, both by constraints within the 'social care' world and by the wider social framework.

A wide range of barriers and structural problems exists within and beyond specialist services, which limit opportunities for people with learning difficulties to live in their own home, take up paid work and, even more significantly, do both at the same time. Addressing these barriers is central to any strategy designed to create a more positive policy framework. They are listed in the box opposite and taken together show that the current system effectively:

Barriers to be overcome

Specialist residential services which are neither flexible nor comprehensive

Despite all that has been written about people with learning difficulties leading 'an ordinary life' in their own homes, in practice this rarely happens. Because of their assumed potential vulnerability and the lack of statutory regulation of alternatives, people with learning difficulties tend to end up in residential care. Yet registration and inspection offer relatively little protection. The unhelpful link between benefits and registration leaves residents with minimal disposable income and often more dependent and socially isolated, arguably increasing their vulnerability.

This has been compounded by a system unable to deliver the requisite volume of services. Reliance on residential care and 'special needs' funding has led to a shortfall of around 5,000 places a year. At the same time, pressure on local authority expenditure has led to tighter eligibility criteria, increasingly excluding those not priorities for community care packages (even though they may have some support needs). Similarly, lack of ring-fencing for resources formerly invested in long-stay hospitals has created financial instability in NHS specialist services.

Continuing 'perverse incentives' favouring residential care, and fragmentation of local services, together with lack of central guidance, means that few localities have genuinely comprehensive services and levels of provision across the country are extremely uneven.

Failure to recognise the role of housing benefit in community care

Housing benefit can play a critical role in enabling people to live in their own homes, yet the recently introduced caps on housing benefit are limiting opportunities to develop innovative alternatives to residential care. This is compounded by uncertainty about the outcome of the inter-departmental housing benefit review, people who might formerly have used 'low support' options funded through housing benefit being particularly vulnerable.

Social security benefits

The current system is anomalous, complex, unreliable and lacking coherence. It hinges around the notion of 'incapacity', which fails to take account of the wider social context (including job availability or in-work support). People with learning difficulties are vulnerable to either being classed as 'incapable of work' (and treated as a low priority for employment services assistance) or being judged as 'fit for work' (and facing what may be inappropriate sanctions).

Further, once people are established on 'incapacity' benefits, the transition into work can be very difficult. Going beyond the arbitrary 16 hours per week cut-off point is simply too risky for most people with learning difficulties (and the Disability Working Allowance has had little impact), while working less than 16 hours inevitably means that any increase in income is limited to £15 per week (the earnings disregard level). Similarly, the system effectively discriminates against people who have never accumulated National Insurance contributions.

The marginalisation of supported employment

Supported employment has opened up work for increasing numbers of people with learning difficulties (and, more recently, for other groups) but it is widely confused with other forms of employment-related assistance and frequently not recognised as a priority by employment services, remaining marginalised in the debate about employment and disabled people.

Supported employment has primarily been funded from hard-pressed social care budgets and provision across the country is extremely uneven. This marginalisation, coupled with a social security system which makes it hard to take up paid work while receiving incapacity benefits, means that supported employment is nowhere near as cost-effective in the UK as in the US.

Some expansion is possible with the £195 million allocated to disabled people through the New Deal, but most of the resources committed to Welfare to Work are targeted at the unemployed, not those who have been 'economically inactive'.

The unhelpful link between housing costs and social security benefits

Where someone with learning difficulties lives can determine whether they can afford to work: those still living in the family home tend to be most likely to take up supported employment. For those living in their own homes, the steep taper on housing benefit adds to the difficulties of moving into paid work. But the greatest unemployment trap is faced by people in residential care.

The failure to mobilise continuing education

Although the 1992 Further and Higher Education Act has generally benefited people with learning difficulties, requiring funders to have 'regard' to their particular needs and leading to increased provision for some groups, there have also been less positive outcomes, with evidence that provision is not always geared to the needs of individuals or relevant to people's lives outside college.

Some change is inevitable. The new Government is committed to making radical changes including: expansion of Welfare to Work and the New Deal; reform of the welfare state; introduction of a minimum wage; establishment of the Social Exclusion Unit; extension of registration to all community care services; and the lifelong learning initiative. These developments could provide a basis for a thorough-going reform of the system which would open up many opportunities for people with learning difficulties and other marginalised groups. The risk is that such changes will be introduced in a piecemeal way, reflecting different policy aims with widespread unintended side-effects. Like many marginal groups, people with learning difficulties will be particularly vulnerable to such effects. Reforms will need to be evaluated in terms of whether they:

Creating a social policy framework which promotes inclusion, independence and empowerment, yet also addresses the potential vulnerability of people with learning difficulties will clearly involve a complex set of inter-related problems which need to be addressed across the board at both national and local level.

People with learning difficulties would benefit from codification and clarification of rights and entitlements. Clear leadership from central government on the aims and delivery of services would also be beneficial. But a co-ordinated programme of change would also include action in all of the following areas.

Social security benefits
National minimum wage This could be inclusive but also be flexible enough to support those who are less productive, by allowing the combination of wages and benefits to the minimum wage level. The system could be linked to support, subject to regular monitoring to avoid exploitation, and reflect the social aims of employment.

The concept of incapacity This could be replaced by a system which recognises disadvantage (rather than functional incapacity) in the job market, does not discourage people from starting work, or penalise people for limited earning capacity, and offers security if a job does not work out.

A single income maintenance benefit All three incapacity benefits and all in-work benefits could be merged into a single income maintenance benefit set at or above the current levels of Incapacity Benefit. This would simplify the system and ease the transition into work.

Disability-related costs separated from income maintenance benefits Disabled people are more likely to gain from work if benefits designed to compensate them for additional costs are kept separate (and non-means-tested) from income maintenance benefits. Currently there is some overlap between Disability Living Allowance and Income Support which could be dealt with by consolidating the Severe Disability Premium of Income Support into Disability Living Allowance. Similarly, anyone living in supported housing but without a community care package will need some means of paying for support. There is a case for extending Disability Living Allowance to this group or providing a separate non-means-tested 'supported living allowance'.

All Work Test This could be replaced with a multidisciplinary process which recognises disability and disadvantage in the labour market and enables people to access benefits and support.

Pension reviews The current review of state retirement pensions and any subsequent reviews need to take account of people who have never been economically active.

Employment
Supported employment Central government could actively ensure that supported employment becomes a recognised priority for Employment Services and is readily accessible through the New Deal 'gateway'.

Inclusive economic regeneration strategies People with learning difficulties could be more explicitly included in the generation of new job opportunities.

Supported employment at transition from school or college The option of supported employment could be the norm for people leaving school or college (rather than the exception, as at present).

Housing and support funding mechanisms
Housing benefit as a key component of community care arrangements This could be achieved by:
reinstating housing benefit eligibility for support clearly defined as related to 'accommodation';
removing current caps on housing benefit so that people at risk of social exclusion can live in the most appropriate locations and accommodate any necessary support workers;
keeping social rents low through increased capital subsidies for social housing;
developing a stepped housing benefit taper tied to the proposed minimum wage to provide clearer incentives to work for people currently on housing benefit;
encouraging the development of 'low support' alternatives to residential care by Social Services Departments.

The Independent Living Fund This could be reviewed as part of a wider strategy to promote independent living and widen the Fund's scope.

A 'preserved rights' conversion fund If this were introduced it would remove the current disincentives for people to move from residential care into more independent living.

A 'mortgage benefit' As part of a wider measure to assist low-income homeowners, this would provide security for the small number of home-owning people with learning difficulties and enable others to pursue the home-ownership option.

Charging for residential care A new charging regime would interact with wages and benefits and enable people to access paid employment.

Education
The following would improve access to lifelong learning for people with learning difficulties in ways which enhance and complement other aspects of their lives:
implementation of the key recommendations of the Tomlinson and Kennedy Committees, designed to broaden participation in integrated adult and continuing education;
development of a much more comprehensive 'independent living skills' curriculum;
use of supported employment to improve the transition from college to work.

Regulation and protection
A comprehensive framework would cover specialist services but also acknowledge the rights of people with learning difficulties as citizens. Measures which could contribute to that framework include:
ensuring that people with learning difficulties have effective access to the criminal justice system;
implementing the clauses of the Law Commission's Mental Incapacity Bill enabling local authorities to act where someone is considered at risk of harm (a measure which the Government recognises as having "some merit");
revising legislation and guidance on registered homes so as to clarify the difference between residential and domiciliary services in a way which promotes the rights of people to live in their own home without introducing loopholes for registered home providers.

Specialist services
Specific changes within health and social services are also needed, to complement wider changes:
complete the hospital closure programme;
develop comprehensive community-based services, particularly for people with complex disabilities or low support needs;
encourage a more co-ordinated approach to service planning and delivery;
develop a national training strategy for professionals working in supported living and employment.

Such is the pace of reform that new initiatives (and rumours of initiatives) are emerging almost daily. Means-testing of benefits and switching Disabled Living Allowance funds to local authorities have been floated and then apparently dropped. Yet despite all this activity, many fundamental questions remain unanswered.

In the 1998 Budget, the Government did announce the replacement of Disability Working Allowance with the Disabled Person's Tax Credit. While this may be helpful, it will not deal with all the rigidities of the current system. Similarly, the Green Paper on welfare reform has proposed reforming Incapacity Benefit and the All Work Test, replacing the latter with a measure of 'employability'. While the removal of 'incapacity' as an organising principle is to be welcomed, 'employability' still assumes that for some more severely disabled individuals their involvement in work will only be 'therapeutic'. Indeed, the Green Paper largely side-steps the issues of the future shape of benefits for people who have never been in work.

There is scope for a much more comprehensive review of the system. Many of the proposals outlined above could be incorporated into the Government's new initiatives. However, what is absolutely critical is that:

This study represented an opportunity to pull together the wider policy implications of two earlier JRF-supported research studies; one on housing and support (A Foot in the Door by Linda Ward and Ken Simons, published by the National Development Team) and one on employment issues (Baguettes and bicycles: the impact of work opportunities on the lives of people with learning difficulties in France and the UK by Jenny Pannell, Ken Simons, and Margaret Macadam, forthcoming). It also drew on a range of other studies which were also supported by the JRF.

The full report, Home, work and inclusion: the social policy implications of supported living and employment for people with learning disabilities, by Ken Simons is published for the Foundation by YPS (ISBN 1 899987 81 9, price £9.95).