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Disability and Employment in Scotland: A Review of the Evidence Base

CHAPTER 6: EXPERIENCES OF SPECIFIC GROUPS: POLICIES, PROGRAMMES AND OUTCOMES

INTRODUCTION

6.1 This chapter examines the experiences of specific groups of disabled people in employment and training programmes because rates of participation and barriers vary greatly by impairment. Whilst some programmes are generic, others are geared towards the needs of particular groups. Providers also tend to work extensively, but not exclusively, with impairment-specific groups. People with learning disabilities, people with mental health problems, people with chronic illnesses, people with sensory impairments, disabled young people, disabled students and graduates, older disabled workers and disabled parents are all considered. The chapter also considers employment and multiple disadvantage and looks at disabled people's and employers' perspectives.

People with learning disabilities

6.2 People with learning disabilities tend to be socially and economically marginalized, with very low rates of participation in employment. The Summer 2002 Labour Force Survey showed that people with learning disabilities had the second lowest employment rate of any impairment group (24%). People with mental health problems had the lowest employment rates, and the DRC has prioritised these two groups in its campaigns to ensure the implementation of the DDA. Learning disability strategies were produced by the Department of Health (DoH, 2001) and the Scottish Executive (2000a), and implementation strategies were developed to ensure that ongoing monitoring took place.

6.3 The Scottish Learning Disabilities Strategy The Same as You? (Scottish Executive, 2000b) drew attention to the considerable costs to local authorities of maintaining people in day centres ( about 53 million a year). The number of people going to such centres grew from 4,400 in 1980 to 8,300 in 1998, at a cost of about 7,000 a place. In addition, in March 1998, hospitals had 270 day places for 489 people at a cost of 2 million. People in day centres tended to spend their time on leisure and development activities within the centre; 20% of activities in day centres involved education and employment, whereas 25% involved work-focused activities. Only 7% of people in day centres had paid work. Overall, day centres were criticised for not extending and developing individuals sufficiently, but it was also noted that carers were concerned about the withdrawal of day centre services, since they were necessary to enable other members of the household to engage in education or employment.

6.4 A key recommendation of The Same as You? was that local authorities should put much more energy into developing employment opportunities for people with learning disabilities. The report noted that this could be cost effective; the cost of a day centre place (7,000 per annum) was compared with the cost of training and employment support. For example, a Training for Work place, funded by Scottish Enterprise, cost 3,200 and a place on the WORKSTEP programme, funded by the Department for Work and Pensions, cost up to 4,760. The Same As You? noted that the benefits system often acted as a deterrent for people attempting to progress into employment, and suggested a more flexible approach to enable people to try out work without jeopardising their future benefits status.

6.5 It was recommended that a number of structures and mechanisms should be put in place to oversee the implementation of the strategy. Local authorities and health boards were advised to establish partnership in practice agreements by 1st June 2001 and to appoint local area co-ordinators to integrate health and social care services for people with learning disabilities. It was also recommended that everyone with a learning disability should be able to have a personal life plan and that a national change fund should be established to underpin the shifting focus of services, and a national centre for learning disabilities should be established (the Scottish Consortium for Learning Disabilities).

6.6 A national short-life working group on employment was set up, and in 2003 its report Working for a Change? (Scottish Executive, 2003d) was published. The report focused on the changes needed to lower the barriers for people with learning disabilities entering employment, which included a fairer and simpler tax and benefits system, the promotion of non-discrimination and equality, inclusive employment practices and individualised person-centred support. The fragility of supported employment services was highlighted and the difficulties encountered by people with learning disabilities in accessing Jobcentre Plus support were noted. It was recommended that Jobcentre Plus should make much greater efforts to engage with people with learning disabilities, and that supported employment services should forge stronger links with JCP. However, as noted in Chapter 5, the thrust of many JCP programmes for disabled people is to target those who are closest to the labour market and who can therefore be moved into employment with the shortest and least costly intervention. It was also recommended that Careers Scotland should be much more pro-active in including people with learning disabilities in its mainstream provision.

6.7 The question of which government department should take lead responsibility for people with learning disabilities was considered. It was recognised that the Scottish Health and Education Departments have responsibilities in this area, but ultimately the Scottish Department of Enterprise, Transport and Lifelong Learning should be the lead agency, since employment rather than health and welfare was the major issue. The need for much better liaison with the Department for Work and Pensions was also indicated.

6.8 In 2004, the Scottish Executive published a Statistics Release summarising progress in relation to the recommendations of The Same as You?. A breakdown was provided of the number of adults experiencing different types of employment opportunities (see table 6.1):

Source: Scottish Executive 2004c

6.9 Overall, 2,493 adults with learning disabilities known to local authorities are participating in some type of employment, representing 7% of the total. This is exactly the same proportion as that reported in The Same as You? In addition, only 4% are involved in some form of open employment (which of course may be one or two hours a week). The statistical release concludes that all local authorities are making progress towards implementing the strategy's recommendations, although on the face of it progress appears to have been quite slow, particularly in relation to the appointment of local area co-ordinators and the expansion of open employment participation.

6.10 There is a growing body of research on the experiences of people with learning disabilities in Scotland. Findings from the study The Meaning of the Learning Society for People with Learning Difficulties (Riddell et al, 2001; Wilson, 2003) illustrated the way in which services for people with learning disabilities often had the effect of constraining them in 'special' rather than mainstream services. Only a small number of people attained mainstream employment and their position was tenuous, as employers sought the most effective and efficient workers. The ethos of supported employment agencies tended to reflect the principles of normalisation, maintaining that people with learning disabilities are able to do 'the same' work as others. The need for reasonable adjustments to regular jobs was under-played because of fears that employers would be reluctant to take people with learning disabilities if they were going to be required to adjust established working practices.

6.11 Gooding (2005 forthcoming) noted that the number of people with severe learning disabilities (as opposed to dyslexia) bringing employment cases to tribunal under the DDA was low (only 16 cases in total). Cases involved bullying, name-calling, sexual harassment and physical assault. Three cases related to discrimination in recruitment, and a number were brought with regard to failure to make reasonable adjustment. One woman working as an egg packer, for example, was dismissed on the grounds that she required 'too much training'. Overall, the analysis by Gooding (2005 forthcoming) and Riddell et al (2001) suggested that many of those involved in supporting people with learning disabilities into employment did not consider the application of the DDA. In addition, as noted in Chapter 2, the DDA has proved less successful in relation to recruitment cases. This is likely to pose particular problems for people with learning disabilities, who might require adjustments to recruitment procedures such as a trial period in a job rather than an interview.

6.12 Finally, supported employment, which developed in the US to meet the needs of people with learning disabilities, is now being used to support many other groups, including young people with additional support needs. However, policy shifts towards the use of supported employment are not based on strong empirical data gathered in the Scottish context. Extremely optimistic assessments of supported employment based on US studies are assumed to be transferable to Scotland, although the group of people in the US identified as having learning disabilities (12 % of the population according to some estimates) is much broader than the Scottish estimate (0.4 % of the population are known to have learning disabilities by local authorities). Some research conducted in the UK has raised questions about the costs and benefits of supported employment. For example, Shearn et al (2000) investigated the costs and benefits of supporting seven people with severe learning disabilities in the Special Needs Unit (SNU) of a day centre with the costs of supporting a comparator group in employment. The financial costs of staff time were considerably higher for those in the employment group. People in the SNU had greater opportunities for social contact, whereas people in the work setting received more contact from people other than paid staff (although the quality of this contact is not described). Such findings suggest that better quality information is needed on the experiences and outcomes of people with learning disabilities undertaking open employment, non-open-employment and voluntary work.

People with mental health problems

6.13 People with mental health problems have the lowest employment rate of any impairment group (only 21 per cent are in employment). Relative to their participation in employment, they are more likely to bring cases to tribunal under the DDA and are less likely to be successful than other groups. People with mental health problems represent about a third of all new incapacity benefit claimants (see Chapter 2), and one in five days of certified work incapacity are due to mental health problems. For all these reasons, supporting people with mental health problems to obtain and retain employment, and making workplaces less stressful for all, is seen as a priority for the UK and Scottish Governments and the DRC.

6.14 The Mental Health Framework for Scotland was published in 1997 and identified employment as of major importance for people with mental health problems. However, according to Durie (1999), it did not provide enough guidance to health and social services with regard to the restructuring of services to increase their focus on employment. The Scottish Development Centre (2001) argued, on the basis of the figures in Table 6.2 below, that there continued to be a major shortfall between the number of jobless people with mental health problems in Scotland who would be capable of working and the training and employment services available. It should be noted that the Pathways to Work pilot projects, which are testing the effectiveness of employment and health interventions to helping people on incapacity benefits return to the labour market, are particularly targeted at people with mental health problems.

Source: Pathways to Work Summary Report, Scottish Development Centre, February 2001

6.15 In Scotland, a probable link between lack of employment and increased risk of suicide has been demonstrated (Platt and Kreitmann, 1984) and UK studies have demonstrated the connection between lack of work and deteriorating mental health (Warr, 1987). At the same time, it is evident that many people develop mental health problems whilst in work and leave employment as a result. Few incapacity benefit claimants make the transition back into employment and Secker et al (2001) noted the difficulties experienced by people with mental health problems throughout the UK in accessing employment support services.

6.16 In the field of mental health and employment, there is a growing body of work seeking to identify which interventions work best for which groups. Comparisons have been made between the effectiveness of pre-vocational training and supported employment for this group. Crowther et al (2001) conducted a systematic review of evaluations of pre-vocational training and supported employment services in the US and concluded that supported employment was more effective than pre-vocational training in helping people to obtain and retain employment. However, the problem of different definitions of supported employment and pre-vocational training was highlighted. The incapacity benefit pilots are also attempting to identify the best approaches to job rehabilitation for people with mental health problems. Given the growing interest in social firms in Scotland, there is a need for an evaluation of this approach in comparison with other forms of employment support.

6.17 Secker et al (2002) explored the implicit models of recovery from mental illness exemplified in five supported employment projects. One project was based on a clinical model of recovery, so that at a certain point clients were passed from mental health professionals to employment support workers, with the roles of the two practitioner groups insulated from each other. Another project worked on the assumption that engaging in supported employment was part of the recovery process, so that people needed help with mental health problems in addition to employment support. Unfortunately, the mental health professionals had withdrawn before the client began to work, so that the employment workers had to provide support in relation to the new job and the client's mental health and psychological issues. Secker and colleagues argued that the clinical model of recovery, which attributes entirely different roles to mental health and employment professionals, is unhelpful. The social model of recovery, on the other hand, recognises that the reclaiming of social and employment identities is intrinsically linked to clinical recovery. Much closer working is needed between mental health and employment professionals to ensure ongoing support and better outcomes for those who experience mental health problems.

6.18 Secker and Membrey (2003) examined ways in which employers could facilitate the transition or return to work by people with mental health problems. Drawing on the accounts of 17 employment project clients, Secker and Membrey suggested that flexibility in working hours, work schedules and job tasks was critical. In addition, there were a number of 'natural supports' which would arguably benefit all employees. These included adequate training and support to learn the job and a focus on supportive interpersonal relationships at work, workplace culture and approaches to staff management. The Scottish Executive has also commissioned work to examine employees' perspectives and inform the development of the mental health agenda in Scottish workplaces (McCollam et al, 2003). Focus groups were used with employees with and without mental health problems in a range of workplaces. However, difficulties were encountered in running the groups as a result of lack of co-operation and interest by managers, HR staff and employees. The following findings emerged:

• According to employees, mental health and well-being in the workplace hinged on good work relationships, a manageable workload and a good work/life balance.

• There was some scepticism about stress policies or counselling services, because these were not helpful if the general culture did not support mental health in the first place.

• Many mental health problems at work went un-noticed until they reached crisis point. A positive work culture was likely to support workers in disclosing a mental health problem.

• A whole-organisation approach was required in order to improve mental health and well-being.

6.19 Finally, the Scottish Executive commissioned Social Firms Scotland to undertake research into the experiences of people with mental health problems moving into work. Key findings from the Mind the Gap project (Robbie and Presland, 2003) were published as a briefing paper. The following four key areas were identified:

• Stigma and discrimination

• Joined-up approaches

• Service provision

• The Benefits System.

6.20 With regard to tackling stigma and discrimination, the Scottish Executive advertising campaign See Me was seen as highly effective and follow-up work was recommended. In addition, it was argued that pump-priming of service provision linked to the Transitional/Intermediate/Alternative Labour Market was required. Transitional Labour Market approaches, which include social firms and jobclubs, are based on the assumption that some people need additional support to become job ready, or may require long-term support to sustain employment. Most Jobcentre Plus programmes (with the exception of WORKSTEP) are geared towards the attainment of mainstream employment in a relatively short period of time. Such approaches may exclude people with enduring mental health problems, whose conditions may fluctuate. Robbie and Pressland recommended that the UK and Scottish governments should take the following actions:

• Develop a New Deal (Mental Health) programme geared towards the needs of people with mental health problems, given their low employment rates.

• Fund specially targeted WORKSTEP programmes such as WORKSTEP (Social Firms) and WORKSTEP (ILMs).

• Increase substantially the Mental Illness Specific Grant and encourage local authorities to contract with social economy organisations which are developing new models of employment provision such as social firms, enterprise projects, transitional employment schemes and clubhouses.

• Extend the New Futures Fund Initiative by funding an NFFI (Mental Health) to give greater support to young people with mental health problems and prepare people to enter other New Deal programmes.

• Transform existing day care and sheltered work provision into new models of support provided by external organisations, often operating with the social economy.

People with chronic illnesses/progressive conditions

6.21 Studies conducted by researchers at the Strathclyde Centre for Disability Research, University of Glasgow, have explored the employment experiences of people with a range of chronic illnesses and progressive conditions, for example, Banks and Pearson (2002) investigated the experiences of young stroke survivors (i.e. people in the 18-49 age group). In the UK, stroke is the largest killer after cancer and heart disease, and the largest single cause of disability. Mortality from stroke in the younger age groups (but not amongst older people) is strongly correlated with level of deprivation. In Figure 6.1, area disadvantage was calculated using the Carstairs Index of Deprivation, with 1 being the least deprived and 7 the most deprived.

Source: Scottish Executive Information and Statistics Division

6.22 Fifty people participated in the study, and each was interviewed 3-6 months after discharge from hospital and 6-9 months later. Banks and Pearson reported that approximately one third of those who had been working prior to the stroke returned to work during the course of the study. Where young stroke survivors had returned to work, employers appeared to be supportive initially. However, there was little understanding of the difficulties stroke survivors were likely to experience (tiredness, problems with concentration and memory) and employers were reluctant to make adjustments to hours of work or to the content of the job. One participant was supported by the voluntary organisation Rehab Scotland (now Momentum) which helped him regain skills and confidence and liaised with the employer to identify required adjustments. This support had a positive impact on his return to work, but was not widely available.

6.23 Carers and relatives were also affected by the experience of the stroke. During the course of the study, two thirds of those who had been working prior to the stroke had returned to work. One had reduced her hours of work, two were still on sick leave and three had left work to become full-time carers. All those who did not return to work were women. As a result of their withdrawal from employment, some families experienced a sudden drop in income, including a period of time when some, particularly those who were self-employed, had no income at all.

6.24 Further studies were conducted with people with muscle disorders (Banks, Edson and Petty, 2003) and people with Parkinsons Disease (Banks and Lawrence, 2003). These studies also found that the onset of disease resulted in rapid withdrawal from the labour market for many people.

People with sensory impairments

6.25 Very little Scottish research has been conducted on the employment rates and experiences of Deaf people or people with visual impairment in Scotland. Research in relation to Deaf people in employment in the USA (Belknap et al, 1995), argued that vocational rehabilitation services tended to focus on preparing clients for work and finding them a placement. However, little in-work support was available, leading to low rates of job retention. In the light of the similar experiences of people with learning disabilities and mental health problems, this is also likely to be the case for Deaf people in employment.

6.26 A report by the RNIB (RNIB, 2002) noted that blind and partially sighted people have low rates of employment (only 25% are in work, the same proportion as that found in the US). In the Work Matters report, the RNIB argued that the needs of four discrete target groups should be considered:

• Young people entering the labour market

• People in work who are losing their sight

• Unemployed people, particularly those who are medium or long-term unemployed

• Blind and partially sighted people with additional disabilities.

6.27 The RNIB was in the process of restructuring its direct services to blind and partially sighted people to assist them in gaining or retaining employment with a view to creating:

• A retention service designed to bring together the support required by employers and employees to enable those losing their sight at work to remain in employment

• A supported employment agency designed to bring long-term unemployed people with sight difficulties into the labour market

• A work experience service, so that blind and partially sighted people are not excluded from employment due to a lack of work experience.

6.28 US research has noted that a considerable amount of support may be necessary, particularly in the early stages, to help people get to work and negotiate round their workplace. Other required changes include altering public attitudes, ensuring access to information through IT and upgrading the skills of professionals.

6.29 The Access to Work programme may be particularly helpful to people with sensory impairments to obtain the in-work support required, such as sign language interpretation and an employment assistant. The difficulties in obtaining Access to Work were highlighted in Chapter 5. It should also be borne in mind that people with sensory impairments may also have other difficulties. The majority of children and young people with visual impairments, for example, also have learning difficulties, and are therefore likely to face multiple barriers to employment.

6.30 It is evident that lobbies are tending to cluster around different impairment groups and promote particular types of provision. Advocates of employment for people with learning disabilities and people with mental health problems advocate supported employment and Transitional Labour Market approaches, whilst the extension of Access to Work is seen as particularly helpful for people with visual impairments. There is clearly a danger that each impairment group may promote the interests of its own members and argue for distinctive provision, rather than seeking to transform mainstream provision so that it meets the needs of all.

Disabled young people

6.31 As noted by Stalker (2002) in a review commissioned by the Joseph Rowntree Fundation, about 12% of the adult population of Scotland is aged 16-24, and of these about 9% have a long-standing illness, health problem or disability (Scottish Executive 2001c). Data on the number of young disabled people entering FE was collected for the first time in 2002. About 5% of students in higher education in Scotland have reported a disability. Figures are not available on the destinations of disabled young people leaving mainstream schools in Scotland. Stalker (2002) reported that, in 2000-01, out of 700 pupils leaving special schools in Scotland, 45% entered full-time further education, 14% training, 8% employment, less than 1% university, 26% went to 'other' destinations and 7% were unknown. 'Other' destinations include day centres and, in some cases, no formal provision.

6.32 Over recent years, greater attention has been focused on the transitional experiences of disabled young people as they move from school into the early adult phase of life. As we noted earlier in the review, the Beattie Committee (Scottish Executive, 1999b) focused on the transitional experiences of young people with additional support needs, which includes disabled young people. The report argued strongly for an approach based on inclusiveness, with much more joined-up working across agencies. It was suggested that every young person with additional support needs should have access to a key worker to co-ordinate services and advise on future directions. As described earlier, seventeen multi-agency inclusiveness projects were set up, which were managed by Careers Scotland after 2002. Not all include young people with disabilities, since the definition of additional support needs embraces such a wide spectrum, including young care-leavers and people with addictions.

6.33 Research on the experiences of young people with learning disabilities in transition (Riddell et al, 2001; Baron et al, 1999) found that they were generally excluded from mainstream pathways. In further education, students on 'extension' courses had very little to do with the other students, often using different classrooms and taking breaks at different times. In this way, further education was much less inclusive than mainstream schools, where disabled students would be expected to spend at least part of each day with their peers. Very little provision in further education catered for young people with multiple or complex disabilities, and the ability to travel independently was used as one of the criteria governing admissions. Part 4 of the DDA, which came into force in September 2002, places a duty on responsible bodies to make reasonable adjustments, and further research is needed to explore whether disabled students' experiences of further and higher education have improved as a result. For example, for some young people, transport to college may be problematic and there is a need to know whether matters have improved as a result of the DDA .

6.34 As noted earlier, further possibilities for autonomy may be provided through the use of Direct Payments. Direct Payments were extended to 16 and 17 year olds through the Regulation of Care (Scotland) Act 2001. The Community Care and Health (Scotland) Act 2002, placed a duty on local authorities to make Direct Payments available to 16 and 17 year olds by 2003. These funds could be used to pay for transport to or support at college, place of work or training and research on the future use of Direct Payments is needed.

Disabled students & graduates

6.35 Whilst many disabled young people experience great difficulty in accessing the labour market, disabled students and graduates provide a counter-example of a group who have managed to access the most selective part of the education system. Riddell et al (2003) reported on a project which investigated rates of participation, institutional policies and students' experiences.

6.36 The final report of the study noted that higher education has been through a period of great change, with reductions in funding, increased workloads brought about through a huge expansion in the student population and greater accountability through the Research Assessment Exercise and the requirements of Quality Assurance Agency. In this changing context, institutions have been under pressure, through the publication of performance indicators, the introduction of premium funding (in HE) and the introduction of DDA Part IV, to widen access to under-represented groups and to develop policy and provision for disabled students.

6.37 In spite of this demanding context, there were definite signs of progress in provision for disabled students. Most institutions had a designated disability officer and a senior manager with responsibility for disability issues. Where they did not fully meet criteria for base-level provision, significant numbers reported 'partially meeting' them. Few could claim to be prepared in advance for disabled students, but there were signs of movement away from the reactive end of the continuum. Disabled students had been written into policies on admissions, assessments, estates and buildings and into some strategic plans. Most institutions had definite written plans for further development.

6.38 While all of these signs of progress were encouraging, there were many areas requiring further development such as teaching and learning, monitoring and evaluation and staff development. Teaching and learning in particular remained an area of concern, with respondents stating that the kind of culture change required to really make a difference would take a long time to achieve.

6.39 In general, disabled students were more likely to be white, male and to have come from the more advantaged end of the social class spectrum. The social class profile of disabled students in the elite pre-92 universities matched that of non-disabled students.

6.40 Analysis of student experience indicated that many disabled students were isolated and lacked the social networks in which much informal learning takes place. They struggled to persuade often reluctant staff to make reasonable adjustments. The culture of some institutions and subject areas was particularly hostile, with staff expressing fears over the erosion of standards as a result of the requirement to accommodate disabled students. The label 'disabled', which students must adopt to qualify for the Disabled Students Allowance and the protection of the DDA, did not sit easily with many students' self concept. This may prove a barrier to the effectiveness of equality legislation in this area in the future.

6.41 A HEFCE funded project (Evans and Farrar, 2003) has begun to explore the outcomes of disabled graduates in the labour market using HESA first destination survey data. The findings of the destination survey in 2002, which looks at outcomes six months after graduation, found that 48.4 % of disabled graduates with a first degree and 53.4% of non-disabled graduates were in full-time employment. Disabled graduates were more likely to be employed in clerical and secretarial, craft, personal services and sales jobs, as well as in part-time and unpaid work. They were less likely to be embarking on careers in health and education. Further work is needed to explore the fortunes of disabled graduates as their careers develop. Evidence suggests that significant differences between disabled and non-disabled graduates exist, but nonetheless this group is performing markedly better than disabled non-graduates.

Older disabled workers

6.42 In the past three decades, at a time when the general health of the population has improved, the employment rate of people over 50 has fallen, in particular that of older men. Recently, there has been a slight increase in the employment rate of the over-50s, but it has not returned to 1970s levels. There is concern about the employment rates of older workers, particularly in the context of the falling birth rate and the new European Directives which outlaw age discrimination. Research was commissioned by the DWP (Humphrey et al, 2003) to investigate factors affecting labour market participation of older workers. The research, which surveyed 2,800 people aged 50 to 69, revealed some interesting linkages between older workers' self-perceptions relating to disability and retirement status.

6.43 Among people of working age who were not in employment, there were three sub-groups:

• Those who were not seeking work due to ill-health (50%)

• Those not seeking work because they were retired

• Those not seeking work because they were looking after the home or family (12%).

6.44 The first group were predominantly male and living off benefits. They were more likely to be single, have no qualifications and be younger. Those who were retired
or financially secure had above average incomes derived from private pension plans and other assets. The final group was predominantly female, more than half were carers and the majority had a partner.

6.45 The researchers found that people redefined their status as they moved past the State Pension Age. A quarter of men aged 60-64 described themselves as retired, compared with 90% of men aged 65-69. Conversely, 27 % of men aged 60-64 described themselves as long-term sick or disabled, compared with 1% of men aged 65-69. The same pattern held true for women. In general, people's health gets worse as they get older, therefore, the researchers concluded, it would appear that administrative categories such as a fixed State Pension Age have a marked impact on personal definitions of status.

6.46 White and Loretto (2004) conducted a study for Scottish Enterprise on the employability of older workers. Focus groups were held with employers, employees, and benefits claimants in fours areas of Scotland. The study found that older workers were stereotyped as being more reliable or more rigid than younger workers. It was believed that employers were reluctant to invest in the training of the over-50s and assumed they would not be interested in career progression. People on benefits, including incapacity benefits, who had been out of work for some time, encountered enormous difficulties in persuading employers to take them on and were often bitter about the discrimination they encountered. Both the studies of older workers described above underlie the strong links between age and disability, however Priestley (2002) commented on older people's reluctance to see themselves as disabled, and the preference of the disability movement to represent itself through images of young and active disabled people.

Disabled parents and employment

6.47 In line with the goal of reducing and eventually eliminating child poverty, the DWP organised a seminar in November 2003 to consider disability and ill health among parents and its impact on families' employment prospects. Labour Force Survey data show that employment rates amongst couples with children and lone parents are significantly reduced if they report limiting health conditions. One third of non-employed lone parents and two thirds of non-employed couples with children reported a disability or long-term limiting illness. As a result, children growing up in families with a disabled parent are particularly likely to experience poverty (defined as less than 60% of the median wage).

6.48 Key points emerging from the report of the seminar (DWP, 2003) were the following:

• The overlap between disability and parenthood should be recognised at policy level, so that programmes are not geared simply at disabled people, parents or children living in poverty.

• Disability is strongly associated with other forms of social disadvantage, therefore mainstream programmes should always consider the needs of disabled people.

• The well-being of children should be considered explicitly. The Independent Living Fund and local authority social services often refuse to provide support for adults in connection with their parenting activities. Similarly, programmes such as Sure Start may fail to provide support to disabled parents.

• There was a proliferation of support schemes which were sometimes disconnected and which disabled parents found difficult to understand.

• Policies aimed at changing the attitudes and behaviour of disabled workers should be complemented by policies geared to changing employers' attitudes.

• Incentives and tax credits need to consider the needs of disabled parents, and should be geared towards enabling people to move easily between benefits and work.

• Services were particularly important at points of transition (e.g. transitions into and out of disability, transitions to parenthood and transitions into and out of work).

• GPs and hospital doctors may be too ready to acquiesce to patients' short-term expectations of being signed off work, at the expense of longer term rehabilitation prospects.

• More research is needed which looks at becoming disabled and moving into and out of work as longitudinal processes rather than steady state systems.

6.49 In addition to the new focus on the work and wider social experiences of disabled parents (Wates, 2002), research has also been conducted on the employment experiences of parents of disabled children (Kagan et al, 1998). Neither of these qualitative studies was conducted in Scotland, but clearly both have applicability to the Scottish context.

Employment and multiple disadvantage

6.50 Disability in relation to employment has sometimes been seen in uni-dimensional terms, but the evidence presented throughout this review makes clear that connections with a range of other variables, including social class, age, gender, ethnicity, parental status, need to be made. Burchardt (2003), on the basis of a major national survey, demonstrated that people on low income, who were often economically inactive, were more likely to become disabled, leading to further deterioration of their employment and financial status. Stanley and Regan (2003) noted that the New Deal programmes had been successful in lifting those closest to the labour market into employment, but had been much less successful in relation to people in poverty facing multiple disadvantages.

6.51 Throughout this report, we have noted the interconnections of gender, age and disability with employment status. Older men in socially disadvantaged areas are more likely than other groups to be economically inactive. Whilst these patterns have been clearly demonstrated by statistical data, qualitative work is needed to develop a better understanding of people's lived experiences and the types of intervention which are likely to be successful.

Absent voices: disabled people's and employers' perspectives

6.52 As noted above, whilst the evidence base needed to chart patterns of inequality has become more sophisticated over recent years, there continue to be large gaps in understanding of the daily practices which produce these inequalities. In particular, the voice of the disabled person is often absent. Sometimes, disabled people may hold a different world view from those of the social policy commentators who are well insulated from the difficulties experienced by those facing multiple disadvantages. For example, Heenan (2002) conducted a study of the Personal Adviser scheme operating in South Tyneside, which included a group interview with 14 disabled clients who had re-entered the labour market following participation in the New Deal for Disabled People. Participants were aged between 24 and 55 and had been out of work from 12 months to 18 years. Four personal advisers and a project manager were also interviewed. Heenan noted that social policy analysts tended to present an extremely negative view of the NDDP, seeing it as coercive, based on individual deficit thinking and inadequately resourced. Her study, however, suggested that the NDDP, despite its obvious shortcomings, had a predominantly positive effect on the lives of the study participants. As one individual commented, 'It won't change the world but it turned my life around'. The views of programme participants, Heenan concluded, should be given much greater weight in evaluating the impact of projects such as the Personal Adviser Scheme.

6.53 The views of disabled people who are negotiating careers in particular occupations also deserve further analysis. Existing accounts include French's (2001) account of the working lives of visually impaired physiotherapists and Sapey's (2005 forthcoming) and McLean's (2003) studies of disabled people's access to and experiences of social work. Roulstone and Gradwell (2002) investigated the strategies and support used by working disabled people to 'survive and thrive' in jobs. In general, we know very little about the experiences of disabled people in a wide range of professions including those where they are relatively well or under represented. Focusing on the fields where disabled people are dong well would go some way to challenge the prevailing negative discourse.

6.54 Finally, the views of employers are not well represented in the literature, although some research has tried to triangulate the views of employers and workers (see Wilson's (2003) account of the experiences of people with learning difficulties in supported employment). Other research has begun to describe the nature of discrimination in job interviews (Duckett, 2000). In both the UK and Scotland, the hope is that employers will take on disabled people as a result of a sense of social obligation, and this appears to have worked reasonably well with some large employers such as Marks and Spencer who advertise themselves as an equal opportunities employer and work in partnership with Jobcentre Plus. There is some evidence to suggest that small to medium sized enterprises are more reluctant to take on disabled employees, and this is of particular concern in Scotland since most people are employed in SMEs. The recent changes to the DDA, which remove the exemptions on small employers, may go some way to improving the situation. However, for the legislation to work effectively we need to know more about why employers are reluctant to recruit and retain disabled employees and what actions by government are likely to be effective in ensuring more inclusive practices in the future. Some messages, based on principles of normalisation, may prove to be counter-productive. For example, it is often said that disabled employees have less time off than non-disabled workers. However, people with mental health problems make up the largest group of incapacity benefit claimants and have the lowest employment rate of any impairment group. As studies reported earlier show, some people with mental health problems may need long-term support and flexible working arrangements in order to be included in employment. The message, therefore, that disabled people are the same as, or indeed better than, non-disabled workers may be unhelpful if it leads to unrealistic expectations amongst employers. As has been argued by the social firms movement, recognising and respecting salient differences, whilst avoiding stereotypes, may be a more helpful approach.

Conclusions

6.55 This chapter explored the policies and provisions which have developed with particular impairment groups in mind. The main findings of the chapter are:

• Impairment specific provision raises a number of issues and dilemmas. The disability movement has emphasised that disabled people should be seen collectively as a group subject to particular forms of discrimination and economic oppression. Developing policy in relation to a range of impairment groups may therefore undermine the political development of the disability movement, since the claims of one group for priority action may be pitted against another, assumptions may be made about the homogeneity of people within groups and some people may have no lobby group to speak for them. An alternative approach to making policy and provision for different groups on an impairment-specific basis is to transform mainstream services to accommodate everyone seeking assistance. However, tensions arise here in relation to JCP policy, which prioritises people closest to the labour market, and those promoting more inclusive policies, who argue that access to employment is a basic right which should be accorded to all regardless of the cost of support.

• There is a tension between whether particular groups of disabled people should be characterised as 'the same as' or 'different from' other disabled people and the wider group of non-disabled people. The supported employment movement, for example, has tended to argue that 'learning disabilities' is a social construction and people labelled as such can undertake the same work as others given some initial support which can fade out as natural supports take over. Proponents of the Transitional Labour Market, on the other hand, have tended to argue that some people with mental health problems require long-term support and different working conditions, and therefore mainstream employment is unlikely to be a valid option for many.

• The perspectives of disabled people and employers have been under-researched and there is a need for future research to focus on their perspectives.

• More information is needed about the destinations of young people with disabilities leaving mainstream education and on disabled students' experiences of further and higher education since the DDA places a duty on colleges to make reasonable adjustments. There is a need for more research on disabled people who have successfully completed a college course and those who have gone on to have successful employment experiences as much research on people with disabilities tends to be fairly negative in its focus.

6.56 Chapter 7, the final chapter of the report brings together the main findings of this review of research on disability and employment.

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