Breaking down barriers: helping disabled people enter and sustain employment

“We have a moral duty to remove the barriers to participation for people with disabilities, and to invest sufficient funding and expertise to unlock their vast potential.Professor Stephen Hawking (2011)

In the UK, the disability employment gap – the difference in the employment rate of disabled and non-disabled people – has remained largely static for over a decade.

Just 48% of disabled people are in employment, compared to 80% of non-disabled people.  Employment rates are even lower for people with certain disabilities, such as learning disabilities (6%), and for people with autism (32%).

There are a number of reasons for this.  These include the personal barriers that people with disabilities face when working, a lack of appropriate support to help them into and remain in work, negative attitudes from employers and recruitment agencies, inaccessible workplaces and inflexible working practices.

Perceived barriers and prejudice

Employers are often wary of hiring people with disabilities.  A recent poll found that as many as 22% of employers openly admitted that they would be less likely to hire a person with disabilities.  Many more may have felt similarly but were less willing to admit to it.

According to research by the Centre for Social Justice, 63% of employers feel that there are significant barriers to employing someone with a disability.  These include:

  • concerns about their ability to do the job
  • the costs of making reasonable adjustments
  • the inconvenience of making reasonable adjustments
  • fear of increased possibility of litigation
  • concerns about their ability to integrate into the team
  • concerns about a potentially negative customer reaction

Given these negative attitudes and perceptions, it is no wonder that as many as 1 in 5 (21%) disabled people hide their disability from employers, and over half (58%) feel that they are at risk of losing their jobs because of their impairments.

Benefits for employers

In truth, research has found that there is a “compelling case” for hiring disabled people – although few (9%) employers recognise this.

Becoming more disability-friendly can significantly increase an employer’s potential talent pool – around 1 in 5 working age adults in the UK have some kind of disability.

The majority (around 80%) of disabled people acquire their disability during the course of their working life.  There are clear benefits to retaining an experienced, skilled employee who has acquired an impairment – not least avoiding the costs and inconvenience involved in recruiting and training new staff.

Research has also found other benefits. These include:

  • higher rates of retention, lower absenteeism and good punctuality
  • improved employer loyalty and commitment
  • improving access to disabled customers
  • improving staff relations and personnel practices
  • improving the public image of the company as a fair and inclusive employer
  • bringing additional skills to the business, such as the ability to use British Sign Language (BSL)

Adjustments often low cost

Research has also found that employers frequently overestimate the costs of reasonable adjustments. Indeed, according to ACAS, only 4% of reasonable adjustments do cost, and even then the average is only £184 per disabled employee.

In any case, the government’s Access to Work scheme is specifically designed to cover the majority of the costs associated with making reasonable adjustments, including the provision of special aids and equipment, adaptations to equipment, travel to and from work, and support workers.

However, not enough employers know about the Access to Work scheme; only 25% are aware of it.

Free support and advice

According to Acas, there are many things that employers can do to become more ‘disability-friendly’.

These include helping people to gain employment, by tackling unconscious bias, adapting recruitment processes, creating an inclusive workplace culture, providing appropriate training and support for line managers, as well as addressing basic issues such as access to buildings (particularly older buildings where adaptations are more difficult/costly).

Once in work, it is important to maintain an open dialogue between managers and employees in order to develop an awareness of individual needs and potential adaptations.

Wellbeing initiatives, and clear and consistent attendance management/return to work policies, including ‘keep in touch’ days during any period of absence, can also help disabled people to avoid ‘falling out of work’.

Employers can obtain support on attracting, recruiting and retaining disabled people in the workplace through the government’s Disability Confident scheme. They can also make use of Fit for Work – a national occupational health service that is free at the point of delivery.

A better workplace for all

While not all disabled people should be expected to work, a significant majority would like to work more.

Closing the disability employment gap is important – not just for the individuals involved, but for businesses themselves and the wider economy.  Social Market Foundation research has found that halving the gap and supporting one million more disabled people into work would boost the economy by £13 billion.

There are some promising signs of progress.  Organisations as diverse as Barclays, Channel 4 and the Civil Service have all established innovative approaches to employee disability support and management.  Such initiatives not only help disabled employees directly, but also serve as a benchmark of what other employers can do to encourage and support disabled people within their organisation, and raise awareness of the benefits of employing disabled people for the organisation itself.

In many cases too, the improved working practices associated with becoming disability-friendly are of benefit not only to disabled employees, but to all employees, customers and service users too.


You may also be interested in our previous blog posts on supporting neurodiversity and mental health in the workplace.  

To see what other topics our researchers are interested in, follow us on Twitter.

A different perspective: supporting neurodiversity in the workplace

“We need to admit that there is no standard brain” Dr Thomas Armstrong

It is estimated that over 1 in 100 people in the UK are on the autistic spectrum and awareness of the concept of ‘neurodiversity’ is rising. It recognises that autism, and other conditions that affect how people learn and process information – such as attention deficit disorders, dyslexia, dyspraxia, or dyscalculia – are a form of neurological difference, rather than being assumed to be a disability.

However, there remains a significant employment gap – where people on the autistic spectrum are often willing and able to work, but struggle to find and maintain employment.

Employment rates for adults with autism are considerably lower than for other groups. For example, only 32% of adults with autism in the UK are in some kind of paid employment. This compares with about 80% for non-disabled people and 47% for disabled people as a whole.

There are also many people on the autistic spectrum who work, but are struggling to maintain employment or to progress their careers due to discrimination, lack of understanding and lack of effective support.

Barriers to employment

Many autistic people are simply brilliant people – highly educated, highly capable, detail-oriented, yet unemployed” James Mahoney, Executive Director and Head of Autism at Work for JPMorgan Chase.

A lack of awareness and understanding means that some employers are fearful of the behaviour traits of people with autism, and the effect of these on their business, resources and other employees. Hiring processes, management practices and workspaces also tend to unconsciously favour ‘neurotypical’ employees.

Research has shown that standard recruitment processes are a key barrier to employment for people on the autistic spectrum.  Processes such as writing a CV, completing an application form, attending an interview, or doing a work-place assessment all rely heavily on social and communication skills. It may be difficult for people on the autistic spectrum to respond to open questions, or to abstract, hypothetical situations. They may be prone to conversational tangents, be overly honest about their weaknesses, or have difficulties in understanding body language and maintaining appropriate eye contact.

‘Good communication skills’ and ‘ability to work as part of a team’ are commonly listed as essential criteria in job descriptions – even though in practice, these skills may not be essential to the role. Thus, those on the autistic spectrum may find themselves ‘screened out’ of selection processes.

The workplace itself can also be challenging for people on the autistic spectrum. Office etiquette, social interaction and the sensory environment (such as sounds, lights, smells, interruptions) may present difficulties. People on the autistic spectrum may also suffer from anxiety or low self-esteem, which can impact upon their working lives.

Thinking differently

“Asperger’s syndrome provides a plus – it makes people more creative. People with it are generally hyper-focused, very persistent workaholics who tend to see things from detail to global rather than looking at the bigger picture first and then working backwards, as most people do.”  Professor Michael Fitzgerald, Trinity College Dublin

Despite the challenges that they may face, research has shown that neurodivergent individuals also demonstrate a number of strengths of particular relevance to employment.

People on the autistic spectrum are often good problem solvers and innovative thinkers, with particular strengths in analytical thinking, memory, pattern recognition, and attention to detail. Some often have an exceptional ability to assimilate and retain detailed information, which can result in highly specific interests and technical abilities in specific areas of work.

Likewise, individuals with ADHD can have strong visual spatial reasoning and creative thinking abilities, and can be hyper-focused, passionate and courageous. Indeed, many of the world’s top entrepreneurs – including Sir Richard Branson – have ADHD.

As such, forward-thinking employers are beginning to recognise that they are missing out on a large pool of potential talent. Large-scale corporations like Microsoft, JPMorgan, EY, SAP and Ford have all recently instigated neurodiversity initiatives. There has also been an increase in the number of small companies that employ almost exclusively autistic people – such as IT and compliance consulting business Auticon – and specialist employment agencies – such as Specialisterne – that help match autistic candidates with employers looking for specialist technical skills.

What can employers do?

Traditional workplaces are built to suit “neurotypical” people. However, employees who fall slightly outside the range of what is considered typical often have valuable skills that employers need, such as lateral thinking or innovative problem-solving. It’s necessary to make adjustments for people on an individual basis to ensure they can perform their best in their role.” Ray Coyle, UK CEO of Auticon

There are a number of things that employers can do to help support employees with autism in the workplace. Many of these are low-cost and easy to implement, and have the potential to benefit all employees. The Chartered Institute of Personnel and Development (CIPD) recently published guidance for employers on becoming ‘neurodiversity smart’ – covering areas such as recruitment, induction, management and provision of on-the-job support for neurodivergent employees.

They recommend considering alternatives to recruitment interviews that focus on the ability to perform the job role to ensure that organisations are not unintentionally screening out neurodivergent individuals. These may include work trials, work samples, practical assessments, and mini apprenticeships. They also suggest providing candidates with detailed information about what to expect, being clear about the purpose of assessments and being aware of the bias of ‘first impressions’ and the limits of interviews to judge on-the-job performance.

In the workplace, suitable adaptations may include enabling employees who are disturbed by open-plan offices to wear earphones or face a wall, or to work from home where possible. Other adaptations may include the provision of formal or informal coaching or mentoring, regular breaks and access to flexitime, training and support for managers and colleagues, access to quiet spaces, flexibility regarding communication preferences, and clarification of any ‘unwritten’ organisational rules or office etiquette.

There is no ‘one-size-fits-all’ response. What is key is that the support provided is both personalised to suit the needs of the individual employee, and sustained over time. It is also important that a culture is fostered where it is easy for employees to disclose their condition, to be open to suggestions for adaptations that suit each individual’s needs, and to raise wider awareness and understanding of neurodiversity among employees.

Neurodiversity smart

Making reasonable adjustments is a cost-effective benefit to society; we also have a moral and ethical duty to act inclusively. We could view the pool of potential employees with neurodiverse conditions as untapped talent, rather than an employment burdenBritish Psychological Society, 2017

The UK government has also committed to halving the disability employment gap by 2020. In order to achieve this, the number of autistic people in employment will have to double. Employers also have a legal duty to make reasonable adjustments under the Equality Act.

However, becoming ‘neurodiversity smart’ is not just a legal or moral obligation – it is also essential if organisations are to harness the skills of this significant pool of untapped talent.


Follow us on Twitter to see what developments in public and social policy are interesting our research team. If you found this article interesting, you may also like to read our article on ‘Girls with autism‘.

How to tackle unconscious bias: Step 1 – read this!

What is unconscious bias?

Although levels of explicit prejudice are falling, discrimination continues to be a problem for many sections of society.  One reason for this may be ‘unconscious bias’.

Unconscious bias is “a bias that we are unaware of, and which happens outside of our control. It is a bias that happens automatically and is triggered by our brain making quick judgments and assessments of people and situations, influenced by our background, cultural environment and personal experiences.”

Everyone has some degree of unconscious bias.  Unconscious thoughts are often based on stereotypes and prejudices that we do not realise that we have.

From a survival point of view, these brain ‘shortcuts’ are a positive and necessary function – they help us to make snap decisions in dangerous situations, for example.  However, in everyday life, they can negatively effect rational decision-making.

Types of unconscious bias

Unconscious bias has different forms.  One common form is Affinity bias – the subconscious preference for people with similar characteristics to ourselves (sex, age, ethnicity, socioeconomic class, educational background etc.).  In 2015, the CIPD reported that recruiters were often affected by affinity bias, resulting in the tendency to hire ‘mini-mes’.

The Halo effect involves the tendency for an impression created in one area to influence opinion in another area.  For example, a disproportionate number of corporate CEOs are over six foot tall, suggesting that there is a perception that taller people make better leaders, or are more successful. Similar patterns have been observed in the military and even for Presidents of the United States.

The Horns effect is the opposite of the ‘Halo effect’ – where one characteristic clouds our opinions of other attributes.  For example, the perception that women are ‘less capable’ in certain occupations.  A review found that female psychologists and women in STEMM (science, technology, engineering, mathematics and medicine) departments were just as likely to discriminate against female candidates as their male counterparts.

The same qualities can also be perceived very differently in different people – for example, assertiveness in a man may be perceived more positively (‘strong leader’) than in a woman (‘bossy’).

Impact of unconscious bias

Unconscious bias not only influences our body language and the way we interact with people, it can also negatively influence a number of important decisions in the workplace, including:

  • Recruitment
  • Promotion
  • Staff appraisals
  • Workload allocations

As well as being unfair, decisions based on unconscious biases are unlikely to be optimal and can result in missed opportunities.  Where unconscious bias also effects a protected characteristic, it can also be discriminatory.

How to mitigate unconscious bias

So, now you know what unconscious bias is, what can you do about it?

The good news is that it is possible to mitigate the effects of unconscious bias. The first step is to become more aware of the potential of unconscious bias to influence your own decision-making. Large organisations such as Google and the NHS are already providing unconscious bias training to their staff.

You can take this awareness further by taking an Implicit Association Test, such as that provided by Harvard University.  This will help to identify and understand your own personal biases.

Other ways to help reduce the influence of unconscious bias include:

  • Taking time to make decisions
  • Ensuring decisions are justified by evidence and the reasons for decisions are recorded
  • Working with a wider range of people and get to know them as individuals, such as different teams or colleagues based in a different location
  • Focusing on positive behaviours and not negative stereotypes

At the corporate level, ways that organisations can help to tackle unconscious bias include:

  • Implement policies and procedures which limit the influence of individual characteristics and preferences, including objective indicators, assessment and evaluation criteria and the use of structured interviews
  • Ensure that selection panels are diverse, containing both male and female selectors and a range other characteristics where possible (ethnicity, age, background etc.)
  • Promote counter-stereotypical images of underrepresented groups
  • Provide unconscious bias training workshops

Tackling unconscious bias is not just a moral obligation; it is essential if organisations are to be truly inclusive.  By making best use of the available talent, it can also help to make organisations be more efficient and competitive.


If you enjoyed this blog, you may also be interested in our other articles on management and organisational development.

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More, better, faster: the potential of service design to transform public services

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For government at all levels – national, regional and local – the year ahead promises even greater challenges.  The need to provide more, better and faster services, using fewer resources, while responding to unprecedented levels of technological, demographic, and social change is greater than ever.

Increasingly, public sector organisations are taking an interest in the concept of service design as a means of responding to these challenges and developing better public services.

In this blog post, we provide an overview of service design and consider how it can contribute to public service innovation.

What is ‘service design’? 

Initially a private sector concept, ‘service design’ is an innovative approach that has successfully been applied to the public sector in order to ‘do more with less’.

The Service Design Network defines it as:

“the activity of planning and organising people, infrastructure, communication and material components of a service in order to improve its quality and the interaction between service provider and customers”

Some of service design’s key principles include:

  • the creation of services that are useful, useable, desirable, efficient, and effective;
  • the use of a human-centred approach that focuses on customer experience and the quality of the service encounter;
  •  the use of a holistic approach that considers in an integrated way strategic, system, process, and ‘touch-point’ (customer interaction) design decisions;
  • an implicit assumption of co-crafting services with users (e.g. co-production).

Approaching service design in this manner has a number of advantages, including improved knowledge of user requirements, lower development costs, improved service experience, and improved user satisfaction.

Indeed, in 2012, the UK Design Council has estimated that for every £1 invested in the design of innovative services, their public sector clients have achieved more than £26 of social return.

Service design in the public sector

How should service design be applied within the public sector?

A report by the Service Design Network, drawing on research by public service designers around the world, identified five areas of the public sector that are particularly relevant for service design:

  • policy making
  • cultural and organisational change
  • training and capacity building
  • citizen engagement
  • digitisation

The report presents a number of examples of the successful application of service design in the public sector.  Two such examples are highlighted below.

Case study: Transforming mental health services in Lambeth

The London borough of Lambeth was under pressure to cut mental health budgets by more than 20%, at the same time as experiencing double the average rate of prevalence of mental health issues in England. In response, it employed a service design approach to transform its model of care for people suffering mental health problems.

The transformation was achieved over several years. Lambeth incorporated the use of service design by introducing a social networking site called Connect&Do, employing in-house service designers and prototyping new services through a multi-agency hub for community-based wellbeing.

These have all contributed to making Lambeth an award-winning pioneer in participation and innovative, collaborative commissioning.

Case study: Transforming services for vulnerable people in Brent

Brent Council worked with a design partner to support the review of three areas: employment support and welfare reform; housing for vulnerable people; and regeneration.

The council also wanted to strengthen its internal capacity by developing an innovation hub and training a cohort of managers and officers in service design methods.

Three reviews were conducted in parallel by a multidisciplinary team of designers, researchers and managers. They conducted extensive research, including ethnographic interviews, observations, focus groups, pop-up community events, expert interviews, data analysis and visualisation. At key points, the teams came together to share insights and critique each other’s work as they progressed from research into idea-generation and prototyping.

The new innovation hub aimed to build staff capability, hold idea-generation events and provide an accepting environment for rule-breaking experimentation. It also included leadership development for innovation through specialist guidance of the senior management team.

Thinking outside the box

Service design encourages people to get alternative perspectives and develop creative solutions that go beyond their usual comfort zones. By doing so, it has the potential to positively transform public sector service delivery and improve efficiency. In effect, service design is all about viewing things from a different angle, which – as Albert Einstein observed – can often open up new possibilities:

“The significant problems we have cannot be solved at the same level of thinking with which we created them”


If you found this article interesting, you may also like to read our previous blog on service design.

Follow us on Twitter to see what developments in public and social policy are interesting our research team. 

Innovation – just another meaningless buzzword?

Innovation Road Sign with dramatic clouds and sky.

By Heather Cameron

As one of the trendiest terms of recent times, innovation has become familiar across the business world. But has its excessive use to refer to anything new effectively made the term a meaningless buzzword?

Lack of meaning

Certainly, critics argue that innovation is overvalued by its promoters and that it is what follows innovation that is really important.

An article published in Aeon magazine last year discusses this view. It highlights that over the last decade questions have been raised over the intrinsic value of innovation, citing a number of statements, including:

‘Innovation is in grave danger of becoming the latest overused buzzword’

‘Innovation died in 2008, killed off by overuse, misuse, narrowness, incrementalism and failure to evolve… In the end, “Innovation” proved to be weak as both a tactic and strategy in the face of economic and social turmoil.’

Even a professional innovation consultant interviewed for the Wall Street Journal said he had advised his clients to ban the word at their companies, describing it as just a ‘word to hide the lack of substance’.

The article suggests that maintenance and repair, the building of infrastructures, the labour that sustains functioning and efficient infrastructures, has more impact on people’s daily lives than the vast majority of technological innovations.

Indeed, an idea can be argued to be of little value on its own.

Meaningless or misinterpreted?

An array of definitions can be found for innovation, perhaps the most widely referred to being that of the OECD:

‘the implementation of a new or significantly improved product (good or service) or process, a new marketing method, or a new organisational method in business practices, workplace organisation or external relations’

The important term here is implementation. Other definitions similarly refer to innovation as the implementation of such things that add value. Therefore innovation isn’t just about the new idea/technology/process, it is about the application of it and the outcomes it achieves.

As a recent blog in the Huffington Post noted, while being ‘new’ matters to the definition of innovation, ‘it is far less important than the description of what’s achieved through innovation’.

With so many definitions, it is hardly surprising that innovation has not only been overused but has often been misused. In particular, it has often been used instead of invention. The difference between these two terms is that an invention is the creation of an idea whereas innovation is an activity or process that adds value.

As the Aeon article suggests, innovation isn’t technology and that highlighting maintenance ‘involves moving from buzzwords to values, and from means to ends‘.

Final thoughts

Perhaps the Aeon article’s conclusion sums things up pretty well:

Innovation-speak worships at the altar of change, but it rarely asks who benefits, to what end? A focus on maintenance provides opportunities to ask questions about what we really want out of technologies. What do we really care about? What kind of society do we want to live in? Will this help get us there? We must shift from means, including the technologies that underpin our everyday actions, to ends, including the many kinds of social beneficence and improvement that technology can offer.

Rather than labelling innovation as meaningless, perhaps it is more accurate to say that innovation means little on its own.


Follow us on Twitter to see what developments in public and social policy are interesting our research team. 

Focusing on the end result: outcomes based commissioning in health and social care

In March 2016, the government announced that it was pairing up with the Blavatnik School of Government at the University of Oxford to create the Government Outcomes Lab (GOL). The aim of this partnership was to create a centre for excellence in commissioning research and practice – to find new and innovative ways for the public sector to commission projects, provide on the ground support to local commissioning teams and become a world class research centre on effective models of commissioning.

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Payment by service vs payment by results

Traditionally, governments contract third-party service providers on a ‘fee for service’ basis – so commissioners prescribe and pay for a particular service that they believe will lead to a desired outcome. More recently however, commissioning teams have started to introduce elements of ‘payment by results’ or ‘pay for success’ when commissioning services – so providers only get paid in full if they deliver the desired outcomes.

Social impact bonds

Social impact bonds (SIBs) are a tool to help outcomes-driven providers deliver on their projects, by giving them access to financing and management support from “socially-minded investors”. The idea being that this will broaden the pool of skilled providers, encourage smaller more locally based providers to tender for projects (who may have been reluctant to previously because of cost and lack of support) and, potentially, increase the chances of the service being successful.

One of the primary aims of the Government Outcomes Lab is to consolidate and promote as far as possible the use of social impact bonds to align social value based commissioning with commissioning for measurable outcomes – to promote a social value as well as an economic value in the way providers deliver on contracts. There are now 32 Social Impact Bonds across the UK, supporting beneficiaries in areas like youth unemployment, mental health and homelessness.

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Benefits and challenges to outcome based commissioning

While to many people it may seem almost impossible to question the principle of outcomes based commissioning (to move from a system focused on process measures and targets to a system that is focused on improving the outcomes that matters to citizens and patients) the reality for commissioning teams, providers and service users is, in some cases, very far removed from this ideal.

In April 2012, the Audit Commission published its guidance on Payment by Results (PbR). This generated fairly positive messages around PbR but also advised commissioners to be aware of the risks:

“At its best, PbR can deliver savings and bring in new resources at a time when budgets are under great pressure. It also defers costs to commissioners to allow time to realise the benefits of change and preventative work….. However, PbR carries extra risks to securing value for money and requires higher level commissioning skills than more traditional approaches”- Audit Commission (2012)

Much of the literature on outcomes based commissioning models emphasises the importance of:

  • transparency;
  • agreed objectives;
  • agreed measurable outcomes;
  • communication and clear definitions of accountability between commissioners;
  • any social investors or third sector bodies with input;
  • providers;
  • and any secondary providers who may be awarded subsequent sub contracts

A more comprehensive list of pros and cons to outcomes based commissioning can be found here.

One high-profile intitiative which has faced more challenges than it has produced benefits is the “troubled families” programme. which aimed to support families with long-standing problems. The programme was heavily criticised for its payment by number (number of clients processed) rather than payment by specific outcome. The issue here appeared to be the lack of definition of outcomes and what was going to be expected of the provider in terms of service before they could be paid.

In this instance the organisations delivering the “troubled families” programme in some areas were being paid for the number of people who went through the service, rather than the number of people who completed the programme successfully, or saw notable improvement as a direct result of the input of the programme, and without taking note of the professional view of the quality of the service being provided (which was considered in some areas to be poor). This resulted in providers being paid for a service which, while many people used, did not actually achieve the expected outcomes. This is something which future commissioning bodies must take note of and act upon to ensure that any future agreements do not contain such massive loopholes with regards to payment.

Outcome Flow Chart

Outcome Flow Chart via Roma Learning Leaders

Outcomes based commissioning in health and social care

A number of different policy areas have begun to use outcomes based commissioning models with varied success (although as we have seen this can be as much to do with the quality of the provider and the transparency of the contract as it is about the implementation of an outcomes based model). Rather than focusing on inputs (e.g. number of doctors) or outputs (e.g. number of operations conducted, or amount of drugs administered), these commissioning models are based on achieving specific, predefined and measurable ‘outcomes’ (e.g. improved health).

In a specific health and social care context, outcomes based commissioning can, if done well, form a key part of a wider prevention agenda, as well as helping to improve personalisation of services. In Wiltshire for example, the council has employed outcomes based commissioning techniques in relation to its domiciliary social care teams. This example shows that when the right providers are selected and clear outcome measures are defined, the impact for service users can be significant, in a positive way: there is a strong focus on getting the best possible result for the customer in the way that suits them; with every visit having a clear purpose and a focus on achieving greater independence for the older person wherever that is possible (which is the overall wider outcome the commissioning teams were hoping to achieve – greater independence of service users and less reliance on the social care teams in the long term).

Some specific challenges in a health and social care context include coordinating payment for outcomes with direct (or personal) payment schemes and agreeing on realistic and well defined outcomes and time frames with service users (which if done well can have a very positive impact on the personalisation agenda of services) Attributing outcomes specifically to one set of interventions in health and social care can also be difficult, particularly if a service user is in receipt of a number of different strands of care, for example, primary care and domiciliary social care as well as having access to some remote telehealth facilities.

Commissioning for long term outcomes

If the issue of defining or attributing outcomes is a challenge for outcomes based commissioners, then the issue of planning for long term outcomes is even more difficult. This approach requires commissioners to have a long term view of the strategic aims of a programme, as well as requiring them to consider any factors which may influence or change these aims, and additionally to consider the scope of need in the future if other preventative measures are successful.

Advice for councils

The LGiU and academics at Oxford Brookes University, as well as many others, have published guidance for local authority commissioning teams, giving them some direction in relation to best practice in outcomes based commissioning. Some of the key “pointers” for councillors include:

  • Take time to get the right set of providers in place to deliver the new model and collaborate with them to get the best possible system in place – be thorough in research and consideration of tenders.
  • Be very clear what the likely outcomes are that any specific service is being asked to deliver.
  • Make the payment mechanism as simple as possible. Consider whether any rewards will be paid for good performance in delivering outcomes. Consider if payments should be made on each individual outcome achieved or for outcomes for sub-sets of the population e.g. hospital discharges.
  • Make use of the public, their opinions and data collected about them to assess the needs of the population and reflect this in the agreed outcomes.
  • Try to implement outcomes based commissioning as part of wider transformation within the organisation – in order to improve quality, reduce costs and improve efficiency (particularly in health and social care) other infrastructure and practices (such as IT systems and skills development in staff) need to be addressed in addition to commissioning models in order to bring about change.

Further reading about health and social care on our blog

Co-production in social care … a need for systems change

Why a holistic approach to public health and social care needs a wider evidence base … and how Social Policy and Practice can help

What’s happening to make big data use a reality in health and social care?

How to become a more effective coach

Teacher talking with student

Coaching can be described as the use of positive support, feedback and advice to help improve personal effectiveness.

Its use within the work environment is not a new concept.  Indeed, according to the CIPD, 9 out of 10 organisations already use coaching by line managers, and 2 out of 3 use external coaches.

However, despite its prevalence, there is very little research evidence about what makes a ‘good’ coach and whether coaching actually works.

The Institute for Employment Studies (IES) are among those working to address this.  In August, they published a report which explored the factors leading to coaching success, from both the coach and the coachee perspective.  They also examined the nature of an effective coaching relationship and set out practical advice for organisations on how to improve coaching elements of everyday work.

The key to success

They found that, according to coachees, the most important characteristics of a coach were:

  1. Communicates clearly (including the ‘ability to listen’, ‘ask good questions’ and being ‘non-directive’)
  2. Displays emotional intelligence (e.g. ‘presence’, ‘emotionally involved’, ‘awareness’, ‘connection’, ‘sensitive’, ‘empowering’, and ‘authentic’)
  3. Has experience within the coachee’s industry
  4. Is challenging but supportive
  5. Displays acceptance of the coachee

In the context of achieving successful outcomes from coaching specifically, coachees felt that successful coaches:

  1. Displayed acceptance of the coachee
  2. Were calm
  3. Displayed self-confidence
  4. Were organised
  5. Had experience within their industry

The characteristic ‘has experience within my industry’ was of particular interest.  Whether or not coaches need experience of the industry in which their coachee works is a point of contention between different coaching researchers and practitioners.  Based on this research, the IES suggest that industry experience may help to improve coach credibility, but also note that who coaches are has importance to coachees, not just what they do”.

They conclude that “the key to effective coaching lies within the coachee having respect for the coach’s ability. A coachee can also derive comfort from the coach’s experience in dealing with situations, and in the coach’s confidence and manner”.

While the characteristics perceived as important by coach and coachee were broadly similar, it was noted that coaches being organised, calm and self-confident was considered very important to coachees – much more so than to the coaches themselves.

In terms of the coaching relationship, the coach having ‘similar values’ was considered the key to success.   It is thought that such shared values may promote the sense of connection between the coach and coachee.  The coach being the same gender, age or having a similar personality was less important to the development of a successful coaching relationship.

Addressing the barriers

The majority of coachees felt that their coaching was effective.  However, there is clearly room for improvement – around 1 in 10 people felt that their coaching was of limited or no effect at allPrevious research by the IES has also shown that as many as 84% of coachees have faced barriers to their coaching experience.  These include:

  1. Unclear goals
  2. Emotions getting in the way
  3. Lack of commitment
  4. Unsupportive boss
  5. Defensiveness

Coachees also faced difficulties with:

  • Their own readiness and engagement
  • The coaching model used
  • Organisational culture/boss
  • Coaches skills or manner
  • External events
  • The coaching relationship

Awareness of the barriers commonly experienced by coachees and the factors coachees perceive as contributing towards their success is a useful first step towards developing and adopting effective coaching practices.

Improving coaching practice

According to the IES, their research on coaching is a conscious attempt to “shift away from ‘guru’- led coaching practices to research-informed and evidence-based practices”.  Based on their research to date, they offer the following advice for coaches and line managers:

  • Not to worry about having less experience than coachees – that the coachee having respect for your ability is more important
  • Weave reflection into everyday coaching practice after each session/encounter – consider how to best help your coachee, how your coaching made a difference, and how your coaching compares to that of others
  • Obtain feedback from your coachee about what you did that made the coaching successful (or unsuccessful) for them, and ask them to contribute to collective feedback mechanisms such as evaluation surveys

Follow us on Twitter to see what developments in public and social policy are interesting our research team. If you found this article interesting, you may also like to read our briefing on coaching and mentoring.

From failure to improvement: how public services can turn themselves around

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A new report on the instructive role of failure has been published this summer by the Institute for Government.

Failing Well describes the experiences of four previously failing public services organisations which managed to turn their services around.

Introducing the report, the authors highlight what failure means for public services.

“Failure matters because failure happens. The constellation of organisations that constitute public services in the UK is inherently complex and therefore at permanent risk of failure. This risk, while longstanding, is particularly acute at present. Service providers remain under pressure to cut costs and reconfigure the way services are delivered.”

In addition, structural changes to the ways services are being delivered – a push towards more decentralised and autonomous models of public services – can heighten the risk of failure.

And the authors note that the impacts of failure in the context of public services can be serious:

  • unacceptable standards of service provision
  • harm to service users
  • disruption to service provision
  • discontinuation of the service entirely

Doncaster Council

Four case studies in the report illustrate the different ways in which identified failings in a public sector organisation can lead to changes for the better.

In 2010, a corporate governance inspection by the Audit Commission reported that Doncaster Metropolitan Borough Council:

“does not do enough to meet the needs of its most vulnerable people, does not safeguard children, and has not been good at helping vulnerable people find a home.”

In short, the commission described Doncaster Council as “a well-known failure”.

In the light of this damning assessment, the Communities Secretary appointed a new chief executive and a team of commissioners to oversee a turnaround at the council. As Failing Well’s authors note, the move by central government to impose its will on local government in direct opposition to democratically elected councillors was an extraordinary step. One of the lessons from Doncaster’s case is that earlier forms of support may prevent such interventions before a public service reaches the point of serious failure.

The report goes on to describe the improvement plan for Doncaster Council agreed by the new commissioners, covering areas such as corporate issues, health and caring. At the same time, the commissioners sought to repair breakdowns in personal relationships at the council that were partly responsible for the problems in running the organisation. By 2014, confidence in the governance of Doncaster Council was restored, and the commissioners were withdrawn ahead of schedule.

West Sussex Children’s Services

Another case study in Failing Well describes the traumatic impact a poor Ofsted assessment had on West Sussex County Council’s Children’s Services, particularly concerning recruitment and retention. But the labelling of failure also proved to be pivotal in bringing problems into the open and stimulating action.  Children’s Services presented its own improvement plan, with progress measured by the council’s Improvement Board. Subsequent Ofsted assessments demonstrated that the journey from failure to improvement was under way.

Lessons from failure

The case studies from Doncaster and West Sussex, along with those from a school and an NHS foundation trust, highlight the different pressures faced by a range of public service organisations. But the authors found some common lessons emerging from these different stories:

  • Peer-to-peer support provides opportunities for earlier intervention – but it needs a trigger.
  • Interventions may not need to remain in place until the turnaround is complete.
  • Insularity is often a characteristic of failing organisations.
  • Responses to failure can be over-reliant on structural reforms.
  • Creating an open, no-blame culture helps to protect against future risk of failure.
  • There is scope for more sector-wide learning from failure.
  • Failure can appear to get worse before it gets better.
  • Turnarounds should set the foundation for long-term improvement, as well as dealing with immediate problems.

The authors warn against an over-reliance on blame, suggesting that this can forestall attempts to understand why failure arose. And they conclude that cultural reform is key to responding to failure:

“In all of the case studies, turnarounds were to some extent predicated on the adoption of new cultures and ways of working…Open, blame-free cultures, where staff are actively encouraged to flag risks or concerns about standards of provision, allow organisations to prevent further failure and encourage reflection when failure does occur.”


Previous blog posts on the the subject of public sector services include:

Implementation science: why using evidence doesn’t guarantee success

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Using evidence in policy making is not a new concept. In recent years it has become commonplace across all areas of policy in the UK, with the introduction of the What Works centres being just one example of this. Policy makers also use evidence to defend the rationale of their initiatives and programmes. But a large evidence base does not necessarily guarantee a successful outcome for a programme or initiative. Without an effective implementation strategy, evidence might as well not exist.

Linking evidence use to implementation within policy is one of the key challenges for policy-makers and those on the frontline of service delivery. Implementation science is an emerging discipline which looks at the nature of implementation, and how it can affect the success of a programme or policy.

Introducing the Hexagon Tool

This tool was developed by the National Implementation Research Network. It outlines six broad factors that should be considered to promote effective implementation of programmes. Designed in a US context for application at state and district levels, many of the ideas about what makes for good implementation are relevant more broadly.

  1. Needs (of service user) – consider how well the programme or practice being implemented might meet identified needs.
  2. Fit – with current and pre-existing initiatives, priorities, structures, support, and local community values and context.
  3. Resource availability – for training, staffing, technology supports, data systems, and administration
  4. Evidence – indicating the outcomes that might be expected if the programme practices are implemented well (assessment criteria)
  5. Readiness for replication – including any expert assistance available, the number of existing replications, examples of best practice for observation, and how well the programme is operationalised.
  6. Capacity to implement – as intended, and to sustain and improve implementation over time
The Hexagon Tool How to cite: Blase, K., Kiser, L. and Van Dyke, M (2013) The Hexagon Tool: Exploring context. Chapel Hill, NC: National Implementation Research Network, FPG Child Development Institute, University of North Carolina.

The Hexagon Tool
Blase, K., Kiser, L. and Van Dyke, M (2013) The Hexagon Tool: Exploring context. Chapel Hill, NC: National Implementation Research Network, FPG Child Development Institute, University of North Carolina.

In addition to the hexagon, other useful frameworks for implementation exist. Some are more practical and others are more conceptual. These may link to theories underpinning the practice of implementation of programme strategies, or discuss the idea of values within systems.

However, frameworks only provide some of the knowledge and infrastructure for implementation. They do not take account of the skills, abilities, values and existing experience of “implementers”. All of these can have a significant impact on how a programme or strategy is implemented.Solution and business words jigsaw

Systems change and innovation

Implementation science has previously focused on changing the behaviour of individual practitioners. However, unless you change the understanding of the wider structures and systems, and implement whole system change, you won’t achieve practitioner change.

Alignment within systems, both within organisations in a hierarchical sense, but also across systems in order to create coherence across services, is important. Many service users have experience of receiving support simultaneously from a number of different organisations. Implementation scientists stress that it is important to align funding, outcomes, compliance and overall goals of parallel organisations in order to effectively implement programmes. This can be a major challenge.

One reason why this can be so challenging is the difference in values and experiences of the individual front line workers implementing a new programme on the ground. Teachers have a very different understanding, training and set of experiences relating to children than those of social workers, or those who work in youth criminal justice. The inherent and fundamental philosophical beliefs which drive the practice of different professionals will have an impact on how they implement a programme, regardless of how thorough guidelines are.

This, implementation scientists suggest, needs to be taken account of, and steps taken to try and more closely align the thinking of different professionals and agencies (interagency working) in order to effectively, and coherently implement new programmes.

Evidence is contextual

Implementation science raises some interesting points about how to facilitate change and implement new initiatives. It reminds us that no intervention – no matter how much evidence is produced in support of its effectiveness elsewhere – is guaranteed to be a success. It highlights the often overlooked elements to intervention strategies, such as the need to be context aware, and aware of the values of the people who are implementing the changes, and those affected by the changes.

Finally, it highlights the need to encourage wider structural and systems change, rather than just changing the behaviour of individual practitioners. This is the way to ensure lasting, sustainable and successful implementation of evidence-informed policy interventions and programmes.


Read some of our other blogs on evidence use in policy:

Performance appraisals – does the public sector need to be more innovative?

Innovation Road Sign with dramatic clouds and sky.By Heather Cameron

In a time of austerity, there is increasing pressure to get the best out of staff in order to improve organisational performance, particularly in the public sector.

Staff performance appraisals are a well-established practice in most organisations but there has been much debate over their effectiveness. Many say they are time-consuming and involve too much paperwork. Others say they are a key part of an organisation’s human resources strategy and align the strategy and objectives of an organisation with those of individuals, which is necessary for effective service delivery.

Why performance management?

A number of reasons have been highlighted for implementing performance management in any organisation, including:

  • to provide information on organisational and/or employee effectiveness and efficiency
  • to improve organisational and/or employee effectiveness and efficiency
  • to improve employees’ levels of motivation
  • to link employees’ pay with perceptions of their performance
  • to raise levels of employee accountability
  • to align employees’ objectives with those of the organisation

In the public sector, the aim of performance management is to motivate staff and managers to improve organisational performance and therefore effectively deliver services.

But while this may seem simple enough, is this what is happening in practice? Some would argue that performance appraisals have the opposite effect of motivating staff and lead to increased pressure and stress, resulting in poorer performance.

Concerns

A recent survey of over 25,000 civil servants highlighted widespread concern over how performance management is working in practice.  A huge majority (94%) said it was unfair that 10% of staff should be ranked as ‘must improve’, a recommendation that has been suggested to lead to discrimination against black and minority ethnic (BAME) staff, those who are disabled and part-time workers.

Performance appraisals have also been described as a “waste of time” or “tick-box exercise”.

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The CIPD Employee outlook surveys have consistently revealed a general dissatisfaction with performance management practices among employees, with the most concern shown in the public sector. The most recent survey highlights a slump in job satisfaction and a lack of motivation among employees, and an increase in the number believing their performance management processes are unfair.

And this is not new. There have been concerns over the effectiveness of such systems in the public sector for some time. Research by the World Bank in 2003, which considered factors influencing better performance in public administration, concluded that performance management systems demonstrated remarkably little influence on anything and in some cases produced negative effects.

Lack of understanding

The literature suggests that the reasons for such criticism of performance appraisals more recently include: people generally don’t like to evaluate or be evaluated; the nature of public affairs being hard to quantify makes it difficult to develop performance objectives and measureable performance indicators; these systems tend to create more paperwork and increase both performance pressure and stress; and a lack of understanding of such systems among managers.

As a former chief executive of the Institute for Leadership and Management (ILM) emphasised:

“One of the skills that is often not developed is understanding what an appraisal is and why it is relevant to the whole organisation’s success… Being able to appraise is a fundamental management skill.”

So rather than scrapping them all together, perhaps a culture change within organisations is what is needed.

Good practice

Indeed, there have been signs of innovation within the public sector when it comes to performance appraisals.

An innovative approach to the employee appraisal form was taken by South Lakeland district council which has shown promising results. A personal qualities framework was created which was used to redesign the appraisal form. It was tested, staff were informed about it and line managers received training in how to use it.

After two years of the framework being introduced, peer reviews were good, their Investors in People award was the best yet, the staff survey highlighted many positive messages, and customer and member satisfaction had improved significantly.

Similarly, Wiltshire Council developed a successful transformation and ongoing culture change programme which resulted in significant efficiencies being delivered.

The council’s behaviours framework was developed to clarify social expectations of staff by defining ‘how’ staff are expected to approach work alongside ‘what’ they deliver. The behaviours have since been embedded into: a new on-line appraisals solution, job description templates, recruitment procedures, human resource policies and employee well-being initiatives, and corporate awards categories and selection criteria.

A training programme for all people managers also inspired new thinking and provided approaches and skills for performance managing for the behaviours, skills and objective setting.

Research by Nesta suggests that performance appraisal can also help to harness motivation to innovate in the public sector by valuing appropriate behaviours.

So perhaps staff appraisals have a future after all.


Read our previous blog post on performance-related pay in the public sector.

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