Oral evidence: Employment support for disabled people: Access to Work, HC 481Wednesday 3 September 2014

Oral evidence, 3 September 2014.

Witnesses

Ms Nicola Oliver, Individual Placement with Support Project Coordinator, Centre for Mental Health, Ms Ciara Lawrence, Campaigns Assistant, and Ms Ailis Hardy, Staff Development Coordinator (Ciara’s Access to Work funded Support Worker), Mencap, and Ms Rachel Brown, Administrative Assistant, Notting Hill Housing, and Ms Susan Askew, Workplace Support Consultant (Rachel’s Access to Work funded Support Worker), National Autistic Society, gave evidence.

Chair

Can I welcome the second group of witnesses and thank you very much for coming along this morning? The first thing I have to ask is, if I can start with you, Nicola, to introduce yourselves for the record.

Nicola Oliver

My name is Nicola Oliver. I have bipolar disorder and use Access to Work after four years of unemployment. I also work with the Centre for Mental Health, where I support organisations to set up services to support people with severe mental illness in getting into work.

Chair

Ciara, I know you have a statement but just introduce yourself at the moment and we will get your statement next.

Ciara Lawrence

Yes. Thank you. Good morning. My name is Ciara Lawrence. I have a learning disability. I work as a campaigns assistant in the Campaigns and Activism Team at the learning disability charity Mencap.

Ailis Hardy

My name is Ailis. I work for Mencap as a Support Worker. I am funded through Access to Work and I am Ciara’s supporter.

Susan Askew

Hello. My name is Susan Askew. I work as a Workplace Support Mentor for the National Autistic Society, and I am Rachel’s Workplace Support Mentor.

Rachel Brown

Good morning. My name is Rachel Brown. I have Asperger’s syndrome, which is on the autistic spectrum. I am an Office Services Officer at Notting Hill Housing Trust, which is a housing association, and I receive support of one hour per two weeks from Susan Askew.

Chair

Thank you all for coming along. We look forward to your evidence. Ciara, I know that you have a statement to make.

Ciara Lawrence

Yes. Thank you. Thank you for giving us the opportunity to speak to you today. My name is Ciara Lawrence and I have a learning disability. I am a full-time Campaigns Assistant in the Campaigns and Activism team at Mencap. Access to Work pays for Mencap to employ my colleague Ailis Hardy, who supports me and three of my colleagues with a learning disability in our jobs. She is there to help me develop new skills in my job so I can do new things. Ailis supports me to plan my workload, manage my work diary better, and my timekeeping. She helps me to prioritise my tasks and meet all of my work deadlines. I am also a media spokesperson for Mencap. Ailis supports me to get ready for my interviews by doing a pretend interview, so that I can practise how I answer questions. Going to meetings is a very important part of my job, but I could not go by myself. This is because sometimes I find following meetings hard. At meetings, Ailis takes notes for me while I listen to what is being said and explains complicated parts of the meeting. A really good example of this is the Learning Disability Programme Board, which is chaired by Norman Lamb, who is the Minister for Care and Support. Ailis and I prepare by going through the agenda and the papers. We talk about the subjects that will be spoken about at the meeting and prepare questions to ask. We also talk to our colleagues to get their views. I often have to travel to lots of events, like the party conferences, which I will be going to soon. As a spokesperson for Inclusion Europe and International, I also have to travel abroad. Ailis supports me with travelling. Without the support, I would not have been able to go to the meetings on my own. I know Ailis is there to help if anything goes wrong. If I did not have a support worker like Ailis and I did not work for an organisation that understands the support that I need, like Mencap, I am not sure whether I could do my job to the best of my ability. Before Ailis came to work with us, I had good support from my manager and my colleagues, but I feel that my work has got much better and I have improved in my job, like being able to do pieces of work to a really good standard and on time. I have also developed new skills and become much more confident. There are ways I think Access to Work can get better. I know I need support to do things, but when you phone up Access to Work they use jargon and long words, and it makes it very difficult to speak to the person on the other end of the telephone. I had a bad experience, when one of the advisers on the phone was patronising. The advisers need training in communicating with people with a learning disability. I always say at the beginning of the call, “I have a learning disability”, but I find it very frustrating and it makes me feel really stupid. Ailis is third-party contact, which means we can call on speakerphone, and she acts as an advocate, but it should not have to be like that. Access to Work should make sure the same advisers have the same cases, so I always talk to the same person. It used to be like this, but now we always have to speak to a different person and explain things over and over again. I find it upsetting to have to explain again and again what I find difficult. All of the paperwork should be in Easy Read. This means information in easy-to-read words and with pictures. They know I and my colleagues have a learning disability but they send out really inaccessible letters that we do not always understand. Other parts of the Department for Work and Pensions have information like Easy Read leaflets, and Access to Work use accessible formats like audio and Braille, so it seems really strange that they do not produce Easy Read materials. Not a lot of people know that Access to Work can be used to support people with a learning disability. The Government needs to promote Access to Work. The Government should also lead by really good example and have advisers with a learning disability working in their teams. Applying for Access to Work is frustrating, but I have the support that I need. I can get out there and speak out for Mencap a lot more now. The support I have had has helped me to go out to groups of people with a learning disability and talk to them about our big current campaign, which is called Hear My Voice. The campaign is about empowering people with a learning disability to tell their MPs and candidates what issues are important to them in the lead-up to the General Election. Thank you for listening.

Chair

Thank you very much. I think that answers all the questions I had, so I am going to ask you a slightly different question, which is: did you have a job before you got your present job?

Ciara Lawrence

Yes, I did.

Chair

Did you have a support worker in that job?

Ciara Lawrence

No, I did not, but I had really good support from my manager and my colleagues.

Chair

Although you had some support but you did not have a support worker, what difference did you notice between that job and this job, now that you have Ailis working for you?

Ciara Lawrence

I have been able to prioritise my work time better. That means I have been able to go to more meetings. I have been able to take part more in those meetings. I have taken on many more tasks in my job, so I have been able to do lots of new things within my work time, which I really enjoyed. I have been able to meet work deadlines. A really good thing is that, now, the work that I am doing, people have said that I have been able to do my work to a high standard, and that gives me confidence to know that I am doing a good job. Ailis is there to make sure that I do my good job and that I do it to a good, high standard. She is there if anything goes wrong. I have been able to do lots more in my job. I know that there is someone there who I can rely on for questions, and it has been really fantastic. It has boosted my confidence and I really want to show that, as someone with a learning disability, I can do a good job, just like anyone else.

Chair

It sounds as though you get to travel the world.

Ciara Lawrence

I do—I am very lucky. With my role with Inclusion International and Inclusion Europe, I have been to places like Nepal and Washington. I go out as a Mencap representative and spokesperson and I get to talk about learning disability and what it is like for people in the UK all over the world. That is because I have had the right support to go and do it. I am very proud to do that.

Glenda Jackson

Does Ailis go with you?

Ciara Lawrence

Yes.

Glenda Jackson

That is okay then.

Chair

Do you know if Access to Work pays for Ailis to go with you, or is that paid by the organisation that would be paying your expenses?

Ailis Hardy

Because Inclusion Europe and Inclusion International are learning disability organisations, they understand that people need a support worker, so they pay. I think Access to Work would pay if they did not. For example, if we are going to party conferences, they are paying for me to accompany Ciara and another colleague.

Chair

There is an understanding, however, amongst organisations that you go to speak to that disabled people very often need support workers with them. I do as well—I need someone with me too.

Debbie Abrahams

You mentioned that you used to have an adviser who you used to contact, and now there are different people who you contact and it is very frustrating for you. When did those changes happen?

Ailis Hardy

When I was first in post, we had one adviser who worked across all four people who I support. I could call her up at any time and ask questions, and she gave advice to me and to Ciara and the other colleagues. In the last year and a half, it has changed, but there was no notice of it changing. It was all very sudden and we were having to ring the contact centre and talk to a different person every time, which has been frustrating.

Debbie Abrahams

That situation, then, has not resolved itself.

Ailis Hardy

Yes.

Chair

Can I just ask the rest of the panel if that is your own experience, that things have changed quite recently and, like the experience of the first panel, without anybody really being told?

Rachel Brown

The first time I ever heard of the Access to Work administrative processes changing from one single person to a call centre was earlier this year, when Susan asked me to get Fhold of my original offer letter. I contacted the number expecting to be put through to the adviser who I had always had, should I need to contact Access to Work, to find it was a central call centre. I asked them a simple question and they sent me an email saying that I needed to call them back to confirm the address where I needed the copy of the offer letter posted to. Why the conversation could not have just happened by email or I could not have confirmed that by email, I do not know. Why the single-person-contact method has gone, I do not know. Why we were not told, I do not know. The fact is, because I am on the autistic spectrum, I like knowing what is happening, who I need to contact and how I need to sort it out. To be told one thing and then I need to do another thing and then I need to jump through another hoop is just frustrating, really.

Debbie Abrahams

The next question is to Ailis, if that is alright. I understand that you support a number of other workers as well. How does that work?

Ailis Hardy

When the package was put together, there were 52 hours that I could draw from every week. It depends on what person needs what sort of support during that week. A week when Ciara is going to the LDPB, we would be doing a lot of work together. She needs a lot of support in that meeting. The next week, however, she might not have as many, and another person who I support would be getting more hours. It is a system that works really well because I am embedded in the team and I know their support. I am consistent. I know them and what they need, and I can offer that as soon as anything arises that they need support with. It would be much harder, I think, if I was working across different teams but, because we all sit together, we all work very well. I know what is going on in the team. I know the work of the Campaigns Team and, therefore, I understand the work that Ciara and our colleagues need to do.

Debbie Abrahams

Ciara, I see you nodding. Does it work well for you?

Ciara Lawrence

It does, yes. We all get the right support that we need to do our jobs. We have really seen that. I have seen my other colleagues blossom in their jobs in the last few months, and it has really made a positive impact in our team, so it has definitely been really worth it. We all have more tasks in our jobs now that we do than we used to do, which is really good, because we can be really good role models for other people and say, “We are doing really well. If you had a job, you could have that support and do really well too.” For us, it is really important that, if we do a really good job, we can show other people what we can do.

Debbie Abrahams

Thanks, Ciara. Ailis, in terms of the administrative arrangements, you are paid directly by Mencap—is that right?

Ailis Hardy

I am, yes.

Debbie Abrahams

Does that work well? Have there been any administrative hiccups?

Ailis Hardy

There have been hiccups, just because Access to Work do not always tell you when something has gone wrong. Because I am paid through Mencap, I do not see the problem occurring in my bank account. It is only when the Finance team at Mencap tell me someone’s funding has not come through that I realise there is a problem.

Debbie Abrahams

Has that happened?

Ailis Hardy

It has, yes. We then have to go back and chase Access to Work by going through the call centre, which takes ages because they have to ring you back and you have to wait for the adviser to get in contact, so it can take a really long time. With transport for work, several of my colleagues get taxis to and from work. The taxi firm are invoicing them and they might not be getting paid. That has happened before: Access to Work have just stopped or reduced the payments, and not told us or the taxi firm why. It is not until we have chased them. Once I have chased them, they also do not let you know when the problem has been resolved, so you could be worrying about it for a while and then find out that the payments have started going through again. The system now is inconsistent and ineffective. It just does not work.

Debbie Abrahams

Are the administrative issues recent?

Ailis Hardy

I have been working with that system for the last two years so, in the whole time that I have been working with them, it has just been like this.

Chair

It sounds as though the solution that you have come up with—that you service, if you like, four different people—is eminently sensible and absolute common sense, and is probably cheaper, in the long term, for Access to Work. I think it is the sort of arrangement that was alluded to by the first panel as being a good thing for Access to Work, Yet, from what you are saying, Access to Work makes it quite difficult to come up with that kind of sensible arrangement that, ultimately, would save them money.

Ailis Hardy

I think it would be very hard to get that package together now, just because four different people ringing the contact centre would be given four different advisers, who might not talk to each other. It worked well when our package was being put together, because we had an adviser who understood learning disability. There was an independent assessor who came out and also understood learning disability and could see what the support needs of the people I now support were.

Chair

Are you saying that it has got worse?

Ailis Hardy

I think it would be much harder.

Chair

These sensible arrangements that people have come up with, which make sense in their situation and have been accepted in the past, are less likely to be accepted now.

Ailis Hardy

Yes.

Chair

I wonder whether the difficulty created by the administration of Access of Work is putting people off applying for it, because it is just too difficult. Nicola, from your perspective, do you have any views on that?

Nicola Oliver

Could you repeat the question, please?

Chair

Because the administration of Access to Work has been made very difficult and seems to be getting worse, I wonder whether that means that some people are put off applying for Access to Work, because it is just too much effort and, therefore, they would rather not be in work because, to get into work, they need Access to Work, which is just too much effort.

Nicola Oliver

I think the application to Access to Work is not a problem because, when you make that first call, you do not know what you are going to expect. Some people with a lot of anxiety will not be able to deal with the conversation themselves, so they are asked if they want an advocate to negotiate with Access to Work.

Chair

Are there are any other views about whether the difficulties are putting people off from applying?

Susan Askew

Yes, I would say that the difficulties are definitely putting people off. Particularly people on the spectrum feel quite wary about approaching officials of a Government organisation. They are very hesitant to make that first move and quite often find it very difficult to be proactive. They very often do not know about the existence of Access to Work, and nor do their employers. At the National Autistic Society, we are often the first people to tell people that it is a possibility and that it is something that they can do—to apply for Access to Work. I have, however, met people who are very reluctant to do that, particularly because it is by phone, which is very off-putting for people on the spectrum. Another issue that has arisen from the call-centre situation is that someone makes that first call, and sometimes we are with them when they make that first call to help them through that. Then they are told that they will be called back, but not exactly when, so they will receive a call out of the blue from Access to Work, which takes someone on the spectrum by surprise and they are not ready for it. Very often, at that point, they say, “I am fine. I do not need help” and that is the end of it.

Chair

We have more questions on that now from Mike.

Mike Thornton

This is for Rachel. How did you hear about Access to Work and how does it help make it easier for you to work and carry out your duties at work?

Rachel Brown

I heard about Access to Work from Susan’s predecessor Emma Jones, who was then my support worker from the National Autistic Society, about three or so years ago, when I first started my job at Notting Hill. Before then, I had never heard of Access to Work. I had never even heard of its existence. Also, my employers knew about it but they did not know about it to a great extent, until Emma, Susan’s predecessor, had explained it to them. The prospect of having to apply on the telephone did not fill me with too much glee, being, as Susan says, on the spectrum. The idea of ringing people up, especially people who would have some kind of authority over whether or not I would get the funding for the support I needed, was something that filled me with quite a great deal of anxiety. Also, I did have the experience of needing to be called back and not being told when I would be called back. I work full-time and, as I said, Susan is not with me all the time. She comes in an hour every two weeks; at that point, it was an hour every week. The chances of them ringing me back when Susan was not there, then, were much higher than when she was there. Also, there is the fact that I have my phone off while I am at work, because I am at work. They may try to call me back and may or may not leave a voicemail message for me, and I will think, “Goodness, I am going to have to call them back. Are they going to be available?”—phone tag. Once it is all sorted out, the support that Access to Work funding has enabled me to have through Susan has really helped me with my anxiety issues and to do my job and to gain more responsibility in my job, so much so that, if you were to look at me on a normal day, you would not even know I had autism.

Nicola Oliver

My experience of Access to Work contacting me back has been very different. I think when I put in the application form, they asked me whether I wanted to be contacted by email or by phone. They would send me an email asking me when I would like them to call me or when I could call them, which made the whole process a lot easier. The variation, however, means it is not a consistent process.

Chair

It can be done.

Mike Thornton

Basically, we want them to do the best and learn from other people who do it properly—best practice.

Rachel Brown

I never had a face-to-face assessment when I first went for Access to Work. My original Access to Work assessment was done entirely over the phone. Looking back on it, I think it might have been better to have had maybe even just a short face-to-face chat with an adviser, so that they could read my body language. It is more difficult—especially at that time, when I was worse off than I am now—for me to make myself heard over the telephone than face-to-face. Also, they do, in my experience, prefer you to contact them on the telephone rather than via email, because, when I asked for them to contact me via email, they did say, “That is not ideal because we cannot discuss your full case via email, because of confidentiality rules.” I understand where they are coming from, but I want time to be able to answer any questions that they are asking me and time to formulate my response, which I cannot do as easily when I am on the telephone.

Mike Thornton

It would be helpful to be able to have an initial discussion by email, followed up by a verbal discussion, preferably face-to-face. At least if you had had time to do everything on the email when you had a follow-up conversation on the telephone, would that have been a lot easier?

Rachel Brown

Yes. If they told me when they were going to call me or when I could call them, so I could tell my manager, “I need to take an important phone call. Can I step into a meeting room or are you okay if they ring me on my work phone?” or just make arrangements.

Mike Thornton

You could also arrange for Susan to join you as well if necessary.

Rachel Brown

If necessary, depending on her availability, but if I knew and I was prepared for it, in the worst-case scenario I could do it on my own. I have rung up Access to Work on my own, for example, when I was in Legal and Susan was on holiday and was not going to be there until after the time that I had to phone them had passed.

Nicola Oliver

I agree with the lady’s comment about face-to-face and discussions, because people with a mental health condition do not necessarily know exactly what they need to support them into work. The belief is that the support is mainly about physical support. What would be really helpful is if somebody with a mental health condition could describe their symptoms and what difficulty they think they might have, and have somebody help advise what kind of support could be provided to counteract those symptoms.

Mike Thornton

Would it be helpful if you could send that information over in an email so you could think about it, write it, discuss it with somebody else, and then have a follow-up conversation on the phone? Would that be probably a more efficient way of dealing with it as well?

Ailis Hardy

It would cut out a lot of the processes. At the moment, you have to wait and it just drags it all out so much, because you are just waiting for these phone calls. If they miss you or you miss them, then it takes so much longer. If you can get everything that you want to say to them down first, and then them ring you back and go over it with you again, that shortens the process a lot and it would make everything so much faster.

Mike Thornton

And save money.

Ailis Hardy

And save money. It would be easier, yes.

Susan Askew

You need the adviser or the assessor at the other end of the process to be someone with an understanding of autism, because autism is a hidden disability. It is often hidden not only to other people but, to a certain extent, sometimes to the person themselves. Other people with various different kinds of disability might be very sure of what they need; people with autism are often not sure at all, so you need a very understanding assessor at the other end, who can ask the correct questions and knows how to address those questions to someone with autism, not wide-open questions like “What difficulties do you have?” It has to be much more specific than that.

Mike Thornton

If there is an initial email from Rachel or whoever, then they could make sure it goes to the right person, not say “That person is not in the office. Someone else can deal with it.” Just simple organisational things.

Rachel Brown

Going to the right person but also to somebody who can at least take a message if that person is not in the office, You do not want it to go into the kind of black hole where they are not in the office, and therefore it is not going to be dealt with for three weeks.

Mr Thornton

I take your point there, definitely.

Susan Askew

Another factor is that Access to Work then speak to the relevant line manager. Really you have to hope and have the goodwill that that line manager is someone with an understanding of their employees’ needs. Generally when we have worked with people, that is the case, but I sometimes worry about how the process would work if someone was on the autism spectrum in a smaller company and decided to approach Access to Work completely as a standalone thing and maybe did not have the support of their manager. Their manager is then going to get a call asking, “What are the person’s needs?”, and they might say, “Well, he is fine,” or, “I’m not sure what his needs are.”

Nicola Oliver

I agree with the need for the advisers to be fully trained in the diagnosis they are dealing with, because in the issue of mental health, the default is the Remploy mental health service, and if you look at their documentation, it might be okay for people with mild to moderate symptoms, but it certainly would not be applicable to people with more severe mental health conditions.

Chair

We have some questions on that coming later.

Mr Thornton

That is what I would like to ask you about, Rachel. You are on the Asperger’s end of the spectrum, which means, as I understand it, your language skills have not been inhibited.

Rachel Brown

Not really. My problem is with anxiety. When I am feeling anxious, I would say that my language is impaired. My communication is impaired in that I have a block that comes down and that is what Susan helps me with: tips and tricks on how to cope with things that make me anxious, and training for my colleagues and my manager to deal with that.

Mr Thornton

Obviously, there is a huge range across the autistic disability spectrum, right the way from somebody obviously functioning well with help, to somebody who would find it difficult to leave the house in the morning, and even more extreme than that. So it is a very wide-ranging question that I am going to ask you, which you probably cannot answer, but any ideas from you would be helpful.

Rachel Brown

I will have a shot at it.

Mr Thornton

We talked about the email, but with your knowledge of where you stand and people in different areas on the spectrum, what other kinds of support do you think that people on the spectrum typically need in employment? Can you think of anything? I know to throw that at you like that is a bit unfair.

Rachel Brown

Having a support worker is a big thing that I think definitely people at my end, and probably people more towards the severe end of the autistic spectrum, would need in order to keep in employment. The more severe the person’s autism is, the more hours of support they would require from a support worker in order to function effectively in employment. There is also the possibility that they might need to work in a more sheltered environment than that which a mainstream employer could provide. There should definitely be training for the employee’s colleagues and manager on the specific type of autism that the person has. So my colleagues and manager received training on Asperger’s syndrome because that is what I have got. Somebody with more severe autism would need their colleagues to receive training on more severe autism as appropriate. In addition, why is it us that need to contact Access to Work? Why can’t Susan do it? That was my question, especially for more severely autistic people who cannot communicate, for whom picking up the phone and talking to somebody would instil in them so much dread that they would not do it—that they would put it off. Also, when Access to Work communicate with you, the support worker needs to be in the loop, so that if you perhaps do not feel you can deal with it—because your autism is such that you cannot deal with these things on your own—the support worker needs to step in and help sort it out. With regard to the phone, perhaps an online application process would help, but this would need to have the functionality, like most online applications do these days, to save your work so that you can come back to it later, instead of a time‑out that means you lose everything. It needs to be functional and easily accessible, in language that we understand. People with autism, in my experience, need routine; they generally need a certain thing to happen at a certain time. With support, I have been able to counteract that to some degree and become more flexible, but the more you get towards the severe end of the spectrum, the more routine, typically, I think, people need. And employers, Access to Work, support workers, colleagues and managers need to be able to deal with and accommodate that.

Mr Thornton

Obviously, there is such a huge range, and I was wondering if you think people in the Access to Work system, and in the system as a whole, understand the difference between somebody like you, who is on one end of the spectrum, and somebody who could be completely thrown out by moving a time from eight o’clock to 8.15. I just wondered whether you and Susan feel there is that knowledge in the system.

Rachel Brown

Not really. If you ask the man on the Clapham omnibus about autism, he would think Rain Man. He would not think necessarily of the extreme end of the spectrum. There are people like me at one end and there are people right at the other end who cannot leave their houses. When I tell somebody I have Asperger’s, sometimes, if they have not been told what it is, they ask, “What is Asperger’s?” and I have to explain it to them. Also, people do not know that autism—and Asperger’s within that—has so much of a range that I am different from Person B with autism, who is different again from Person C with autism, and we all have individual, unique needs. The Access to Work assessor that we speak to needs to have knowledge of the autistic spectrum when they are dealing with somebody with autism, so they can help put in place the support we need but that we might not know that we need.

Susan Askew

Yes. I think we say, “If you’ve met one person with autism, you’ve met one person with autism.” Everyone is very individual and has their own needs, and I do not think that is fully understood by Access to Work. When I have supported clients in their contact with Access to Work, we have come across some advisers who clearly do not have an understanding of what autism is. So we talk about needing a support worker, and someone once said to me, “Well, that would be lovely; we would all love to have one of those.” That kind of comment is not helpful.

Ailis Hardy

I think that is also why there needs to be consistent and ongoing support. People with a learning disability are often offered job coaching, but that does not allow for any leeway of change. For people with a learning disability, something might happen and they might not be able to deal with it and have to go through the whole process of applying to Access to Work again. That is why the model of me being embedded in the team with four people with a learning disability works so well, because I am able to deal with an issue or a problem before it becomes so much bigger and that person might lose their job because of it.

Nigel Mills

Can we just switch back to how Access to Work supports people with mental health conditions? Nicola, I think you mentioned a little while ago that perhaps people see it as being for people with physical difficulties, not mental illnesses. What could be done to change that perception? Have you got any ideas for that?

Nicola Oliver

There is an issue with the marketing for Access to Work, because the examples that tend to be given are physical examples, or the Remploy system. When people with mental health conditions contact Access to Work, they are not necessarily sure about what support would be available, or how to verbalise the difficulties they face.

Nigel Mills

Do you think that some published examples of how people with mental health conditions have been helped would be a useful way of stimulating interest?

Nicola Oliver

Yes, it would. Also, the location of the marketing needs to be addressed. Most of the marketing I have seen is actually focussed on the employer, and many people with mental health conditions will not actually disclose their condition to employers. The support needs to be available without the employer’s knowledge.

Nigel Mills

How would you do that? Would that be through health providers?

Nicola Oliver

I think that should be the primary marketing area. So, community mental health teams who are dealing with people with severe mental illness, IAPT teams and possibly GPs as well need to talk to them about whether they want to go back to work, to make sure they know that Access to Work is an option for them, and also when they go on sick-leave, to help keep them in work rather than exiting employment.

Rachel Brown

I would like to add something to that. I am under the West London mental health service for my anxiety issues, and when I went to my GP, and more so the specialist mental health assessment centre, there was no mention whatsoever of Access to Work or wanting to go back into work on the posters—not that I can recall from when I was sitting in the waiting room waiting for this specialist to see me. That would definitely be one place to put it. As I said, there is no real marketing of Access to Work whatsoever. I had not heard of it before I started at Notting Hill and Susan’s predecessor told me about it. I had had three jobs before then, and I had not had any real support in any of those three jobs because I did not know support existed within the workplace, especially for someone on the autistic spectrum, or with a learning difficulty, or with mental health issues. When you think of support in the workplace, you think of a wheelchair ramp, or a bigger screen, or something like that that people with physical disabilities need.

Nicola Oliver

I help organisations to set up employment services for people with mental illnesses. I set up a working group between the different mental health charities and Remploy, and other people interested in this kind of work. That was not managed by Access to Work; that was me wanting to help people with mental illness. We have a network of services that provide people with support to get them into work and stay in work. None of these services knew about Access to Work and these are people working with severe mental illness on a daily basis. The promotion to them was through me, and then bringing in an external relations adviser from Access to Work. That external relations adviser no longer exists. I do not think that department exists any longer. I have got nobody to draw on to send to other services to provide more information about Access to Work.

Nigel Mills

Is this fixable, or should we have a separate scheme for people with mental health conditions and people with physical conditions?

Nicola Oliver

There clearly are services that promote support for people with mental health conditions. They should be contacted and supported to make them aware of what Access to Work could provide for their clients. Beyond that, getting the knowledge about Access to Work into health services and the understanding of what support could be provided would help increase the usage of Access to Work by people with mental health conditions. It is very low for that group at the moment.

Graham Evans

So Remploy is now the sole provider of mental health services. In your experience how effective are the Remploy services, Nicola?

Nicola Oliver

The people that I have spoken to from the services that I work with have not condoned the Remploy service because it is not adequate for people with severe mental illness. Also, we have to think about the journey into work of somebody with mental illness. They have probably been off work for a long period at a time, or they might have had a bad experience at work previously because of their condition. They are supported into work by one adviser organisation, developing a relationship with that adviser. Then they are asked to have contact with a completely different adviser. It is also very restricted contact; I think it is three face-to-face and six telephone conversations. So the anxiety of going back into work and having a different support worker, and that support being very restricted, means that it is not adequate for the people with mental health conditions.

Graham Evans

What would you say would be adequate? What would your solution be to that?

Nicola Oliver

I think that where somebody has been supporting an individual for a while, they should be allowed to be the support worker for that client. If they have not been working with them, then the person with the mental health condition should be asked if there is somebody they know who would be suitable to provide that support. The mental health voluntary services—so Mind, Rethink, Bipolar UK—who are experts in that diagnosis should be allowed to provide the support to the people that have those specific conditions, because they understand their symptoms. They may not necessarily understand that particular workplace but they will be able to negotiate with the employer if the client wants to disclose.

Graham Evans

So do you think there should be other providers such as the ones you have mentioned?

Nicola Oliver

Yes. If you think about it, Remploy is providing that kind of service, but they are not experts in those conditions, and the support they provide is very superficial, like time-management and condition-management. Support for these individuals should be much more bespoke. The other issue with the Remploy service concerns situations where a client’s behaviour and symptoms have started to cause difficulties at work and are perceived to be—for want of a better word—bad behaviour or anti‑social behaviour. What the client needs then is somebody to advocate between the employer and the client to help them understand what the difference is between their symptoms and other issues, rather than going down a grievance process.

Chair

The mental health sector has recommended that assessments and agreements of funding for support are put in place for individuals with mental health problems before they have secured a job. In that context, why is the current Access to Work eligibility letter not enough? They have got a letter that they can take to their employer that says they would be eligible for Access to Work, but it does not say what that support is. That is not enough, because you and your organisation are advocating that the person should know, “This is the help I will get,” so when they go to their employer they know all of that and it is all spelt out for them.

Nicola Oliver

The client needs to know what support they are going to get before they get into work, rather than be told they are eligible and then the support they ask for not being covered by Access to Work. That not knowing could be the difference between accepting a job and not accepting a job.

Chair

A lot of mental health conditions fluctuate. Does this not make it quite difficult to use something like Access to Work, which is continuing support, when in fact for six months of the year the person might not need it, but for six months of the year they might, or indeed it might be a week‑to‑week fluctuation? Is that the root of some of the difficulty of identifying the kind of support someone with a mental health problem might need?

Nicola Oliver

It should not be, if it is made clear. Access to Work can adjust the hours depending on who needs the support. One of my symptoms at certain times of the year is chronic fatigue, so I have got Access to Work to pay for car parking when I need it, rather than having to walk from the nearest free parking. They allocate 50 car parking tickets per year. If I run out of that, then they will negotiate more, so they are allowing me to self-manage the support that I need over the time.

Chair

Is it not more effective to concentrate on job retention? That was a question I put to the earlier panel: particularly for people with mental health problems who have been in work at some time in their life, but have fallen out of work and find it very difficult to get back in, when they start to present with some problems, it is not picked up, it is too far down the line before it is, and by that time they have lost their job.

Nicola Oliver

I would not say do not provide the support before the client gets a job; that is also needed, but as soon as the GP knows that they are asking for a fit note and they know that they have got a mental health condition, then they should make them aware of this Access to Work support and have job retention experts that will support them to stay in employment.

Chair

Do you think GPs know about that? Has anybody experienced whether GPs or clinicians of any type know very much about Access to Work?

Rachel Brown

I have not heard anything from my GP about Access to Work. I think they have it on my record somewhere that I have a support worker, because I told them, but when I went to my GP before Christmas last year and said, “I have got anxiety problems that are affecting my work because I have got Asperger’s. I need help; here is a letter from my employer,” the GP said, “We had better refer you to the specialist.” I had a couple of months’ wait, and then I saw the specialist.

Chair

By that time the anxiety was passed, was it?

Rachel Brown

No, my anxiety is an ongoing issue as part of my Asperger’s syndrome. It is being managed by medication, which has made it better, but I still have issues with anxiety, even now. I had an hour and a half with the specialist, and there was still, as far as I can remember, no mention of Access to Work from him.

Mr Thornton

I think most doctors see a medical solution, not practical solutions. It is quite common I think.

Susan Askew

There used to be within Access to Work a Fluctuating Conditions team, which was the team that we used to deal with, because they understood that people with autism might need more support at certain times. But now the support that people receive is very much put down on a monthly basis. For example, if someone did need more support in one month and our claim form stated that, they would probably return it back to that person, as their client, to say, “You’ve gone over your allocated time for this month,” which is a problem. I think if there was some flexibility as to when we could use our support, that would really help us.

Rachel Brown

Yes, because between one month and another, the working environment and things that are happening affect my anxiety levels. For example, when work went through a restructure and I had to apply for my job again, I needed more support from Susan. At a normal time, when everything is going hunky dory, she can come in once every two weeks and it is fine. Also, when I am on annual leave, I obviously do not need her to come in, because I am away.

Chair

The flexibility for Access to Work to be able to cope with those particular pinch points, when the anxiety is particularly acute, is important.

Susan Askew

Yes, absolutely. As I say, they might return a claim form. If in a particular month, say, a client had three hours a month and we had put four down on the form, they will send it back and say, “You have gone over your allocated time for this month.” They send it back to the client—we have talked about this—and it causes huge anxiety for people to receive that paperwork back. Quite often the clients that I deal with think that they have done something wrong or their support is going to end; they do not understand. If Rachel received a letter, she would bring it to me and we would discuss it; some of our clients do not. They put that letter to one side and do not deal with it, so we do not know that there has been a problem with the system. I think we have discussed that the administrative side needs to be thought about a lot more carefully so that the people who are providing the service are somehow included and know particularly when people’s support comes to an end, because people do not have any notice of that, and therefore we do not either.

Chair

We have run out of questions and we have almost run out of time. I wanted to ask if there was anything else that any of you wanted to add. I think, Nicola, you might have wanted to add something.

Nicola Oliver

Yes, I had an incident where my payments should have ended in January, but I was not notified of it, so I was still trying to claim up until May or June, and it was only when I realised that there was a problem that I contacted Access to Work, and then eventually they dealt with it.

Chair

That is reflected in what we heard from the first panel as well. As I say, is there anything that you were hoping to say today that you have not managed to say and that you would like to say now?

Rachel Brown

Yes, please. I want to say something about the administrative hiccup that I had back in March. I had returned paperwork from Access to Work, saying that they could not pay Susan’s invoice because of the signature being wrong. It was sent to my home address. I had just got back from work; I was tired. I looked at it and I thought, “What is that?” and I looked at it a bit more, and thought, “If I did not deal with invoices on a daily basis at work, and if the Access to Work form were not so similar to the forms our finance department send me when I have got something wrong and they cannot pay the invoice, that would have made me a lot more anxious.” It did fill me with fear that the invoice would not be paid—that my support would stop. If I remember rightly, it was a few days before I saw Susan again, and I thought, “What on earth is going to happen? Will it be on time?”

Susan Askew

It is a paper‑based system and that is a real problem. I think if it was online and people had an account online that they could look into, and all the past correspondence was there to check through and the third party had an agreement to look at that as well, it would make life so much better for all of us. It seems a very antiquated way of dealing with things now. As a support worker we have to receive the client’s and the manager’s signature on the form. Sometimes, getting the manager’s signature is difficult, because the managers are often in meetings or they are away. I would say that it needs to be updated in its administration.

Rachel Brown

Yes, because the manager has to sign right there and then for the form to be accepted. They cannot accept scanned signatures; that is why I got the letter back.

Chair

Nicola?

Nicola Oliver

As well as my own experiences, I have asked employment advisers that refer to Access to Work what their experiences are and there are a couple of different things that they come up with. Somebody who had applied for taxis required the employer to be involved, and because the employment adviser could not get the employer to sign the forms, they would not pay for the taxis. Support is quite expensive; for example, you have to pay the taxi costs upfront, and then they will reimburse you at the end of the month, which is quite difficult for someone who is starting work for the very first time. In terms of success, once Access to Work has agreed everything, they are actually very good at sticking to what has been promised. The recommendations from the services include more marketing, the use of social networking, providing employers with training on the diagnosis for the individual concerned so that the peers and the manager know how to support that individual, face-to-face assessments—possibly with the DEA at the local Jobcentres rather than over the phone—and training of staff.

Chair

Can I suggest—because we have run out of time—that if there is anything you feel you have not said today you would like to say, then please write in? Any written evidence in that respect will be accepted as well. Can I thank you very much for coming along today? It is not something you are used to doing. Well, I do not know. Ciara, I think you are quite used to doing this kind of thing, but I know it is not a normal thing that people do in a day’s work, so we appreciate it all the more that you have come along and given us your time. I know that what you have said today will certainly help us a great deal in both writing our report but more importantly in making recommendations to the Government about how they can improve what I think you all agree is actually a really good system—if they can only get it right.

Ciara Lawrence

The only main thing I want to finish off by saying is that the information that is sent to us really needs to be more accessible.

Chair

You did mention this earlier.

Ciara Lawrence

That is the main point that I really want to stress. It has got to be fewer big words, less jargon. It just has to tell you what you need to do in a very clear way. When I get letters, I get so frustrated that I do not understand them, and I want to understand them. I have to take them to somebody and say, “I got this letter in the post last night at home; can you explain it to me?” and I have to do that, or else I will just put it in the drawer and I will not do anything about it. I have got to ask, and it makes me feel stupid that I have to ask, but I have to. If it were made a bit simpler, I could understand it. If things could be more accessible, I know that would really help people with a learning disability in their lives.

Mr Thornton

You are not the only one. There are loads of us that have difficulty reading those letters.

Chair

You are not the only one. It is all of them. I had one where a disabled constituent came to me and we could not understand the letter, and we had to write back to the local authority and say, “Please explain what this means, because none of us can understand it.” We have absolute sympathy with what you have just said. So, again, thank you very much for coming along this morning. Oral evidence: Employment support for disabled people: Access to Work, HC 481 22