Research and analysis

Access to Work: Qualitative research with applicants, employers and delivery staff

Published 13 November 2018

Executive summary

Background and aims

Access to Work (AtW) is a government initiative seeking to support the ambition to substantially improve employment outcomes for disabled people. It aims to reduce inequalities in employment outcomes by providing advice and practical support for individuals with health conditions that make it hard to do their job or to get to or from work. AtW funds (in part or full) the provision needed to help these individuals fulfil their role, where needs go beyond the reasonable adjustments that employers are required to make under the Equalities Act 2010. In some cases, AtW provides a workplace assessment to explore in-situ the barriers to employment and inform decisions on whether funding for further provision will be granted.

Robust evidence already exists on who is accessing AtW and what for, but there is no current evidence around how it is working for the full range of individuals and employers that may benefit from the support, and the staff involved in its delivery. This evaluation sought to provide this insight, and answer two overarching research questions: how well are access and delivery processes working? And where is AtW adding value? The research ultimately seeks to inform the future direction of AtW, by supporting decisions on where efforts to improve and develop the programme should be focused.

Methodology

The evaluation used a qualitative approach, conducting:

• 60 in-depth interviews with applicants that had been approved an AtW grant
• 25 in-depth interviews with employers with experience of AtW
• 2 focus groups with specialist contracted providers of workplace assessments
• 2 telephone in-depth interviews with AtW staff responsible for writing final reports and making decisions on recommendations and grants

In-depth interviews with applicants and employers were predominantly face-to-face.

Applicants that had been approved an AtW grant were evenly split between one of three groups: those who took up an AtW grant in the past 6 months; those who took up an AtW grant more than 12 months ago; and those who did not take up their AtW grant. There was also an even split between those with a primary physical health condition and other, non-physical primary health conditions.

All fieldwork took place between April and June 2018.

Key findings

Views and experiences of AtW across all audiences were mostly positive. Nearly everyone felt it offered invaluable support for individuals with health conditions and/or disabilities, and their employers – often transforming difficult situations (for example, in which employees were struggling to continue in work, or employee-employer relationships were deteriorating). Where potential improvements were suggested, these related to specific elements of the process; there was very little criticism of AtW in terms of its broad purpose or impacts.

Value of Access to Work

In keeping with previous research on AtW^{[footnote 1]}, the programme was deemed invaluable and essential in allowing many individuals to stay in work. Often, applicants had been struggling in their role for some time due to their health. Many applicants stated that they were on extended sick leave or felt as though they had reached ‘crisis point’ at the point they applied; and that without AtW providing support when it did, they would not have been able to continue as they were. In other cases, AtW enabled applicants to get a role they felt they would not have been able to otherwise.

Applicants felt empowered by AtW support; for most it enabled them to work to the best of their ability and more confidently, and it ‘levelled the playing field’ between them and their peers. Some reported that, owing to this, they had received promotions, access to broader roles and/or greater responsibility within their roles. Improved mental wellbeing was also evident, including among those with physical health conditions. For example, where provision enabled an applicant to go into the office to work, this reduced feelings of isolation and the associated negative impacts.

Employers noted that AtW had enabled them to hire new staff with essential skills who had health conditions or disabilities that otherwise might have made them challenging to employ.

As well as supporting individuals to start or stay in work, applicants and employers alike reported the positive impact of AtW in terms of productivity, employee-employer relationships and confidence that the most appropriate and effective support was being provided for employees with health conditions. Increased confidence from the employer perspective was particularly prominent in smaller organisations that had less experience of supporting these employees.

What’s working well

In general, the overall process of accessing AtW was seen as user-friendly and straightforward by applicants and employers.

The relatively new online application process was viewed as simple, although having alternative methods (telephone, postal) was still seen as important. Different options for applying ensured that the needs of applicants with a range of health conditions and disabilities were catered for.

Workplace assessment experiences tended to be very positive. Employers and applicants felt that assessments were comprehensive and appropriate, and conducted sensitively. Many applicants talked about how the recommendations and advice given during the assessment alone had enlightened them about the support available for their condition and small changes they could make in the workplace which went a long way in improving their workplace experience. Applicants that were previously too nervous to ask their employer for (even ‘light touch’) adjustments felt the expert ‘stamp of approval’ via the assessment helped them to approach their employer and empowered them to ask for changes.

Assessors felt the movement to a more holistic approach to workplace assessments in recent years had improved recommendations and enabled more cost-effective solutions to be reached. They also felt better equipped to advise on a wide range of health conditions. This meant they were able to assist with conditions and barriers raised for the first time during the assessment, without this causing problems.

Applicants and employers were generally happy with the recommendations made by assessors and with the provision funded. There were only a handful of examples where the applicant and their employer did not feel the recommendations made were appropriate. In these cases, the AtW grant was not taken up.

What’s working less well

Many applicants said they had limited understanding of AtW at the point they applied. They were unsure about what AtW offered and how it could help them in their situation, meaning they were uncertain about their eligibility and the relevant provision available. Lack of awareness of their eligibility for support impacted on how confident applicants felt about disclosing their disability to employers and potentially prevented them from seeking help at an earlier stage (i.e. before they reached ‘crisis point’).

Employers also tended to have limited understanding of AtW and the overall process. Poor comprehension of the overall process meant employers were unable to support applicants, and in some cases, it resulted in key deadlines for procurement of aids and equipment being missed. Many attributed their lack of understanding to the limited involvement that they were given in the process prior to procurement.

Relatedly, applicants tended to associate the application process with a sense of burden, due to the responsibility falling solely at their door until the point of procurement. In some cases, particularly where the applicant had a mental health condition, this responsibility caused a lot of stress and anxiety.

Applicants and employers thus called for more information and clarity on what to expect from the process from application to reimbursement and expected timelines. Both felt waiting times were not set out clearly and sometimes this exacerbated conditions (for example, for applicants with anxiety), as well as making things difficult for employers.

Financial support with travel to work was viewed as crucial for applicants with a variety of conditions, ranging from mobility issues to severe anxiety and panic attacks. That said, procedures relating to this were described as confusing and onerous, particularly selecting suppliers and having receipts signed. Many applicants felt clearer guidance would be helpful here.

Some applicants experienced a lot of repetition when dealing with AtW staff as there was little continuity in who they spoke to, and a seeming lack of ‘organisational memory’ of them as individuals. As a result, applicants were often frustrated by having to repeat information already provided.

Workplace assessors felt that there was a need to improve the standard of applicant information passed on to them as this would help them to be better prepared. Sometimes assessors felt that they did not have the expertise needed, or were not the appropriate assessor for an individual, as they did not have enough prior information.

Assessors also felt they were left ‘in the dark’ about the final decisions on a case, the reasons for these, and the consequences of these for the applicant and their employer – thus removing opportunities to learn and refine their practice.

Conclusions

Views on AtW and its processes were mostly positive; where potential improvements were suggested, these related to specific elements of the process as opposed to AtW in terms of its broad purpose or impacts.

Areas identified as working less well largely echo findings from previous research into AtW. That said, findings from this evaluation point to some improvements. For example, previous experiences of the application process and workplace assessments were felt to be more geared towards those with less complex, physical health conditions. Although some issues were still raised with the application process, these tended to relate to the information provided at this stage rather than difficulties relating to a health condition - workplace assessment experiences were generally very positive across all health condition types. Key benefits of the assessment identified included increased confidence and a sense of empowerment, both of which applicants and employers felt had contributed to improving mental wellbeing.

The evidence from this research suggests that areas to focus on for future development of AtW could include:

• work to provide greater clarity upfront regarding how AtW can support individuals (for example, through case study examples online)
• providing a step-by-step guide outlining the different stages of the process, expected timescales and who is responsible for what at different stages
• raising awareness in a targeted way, for example, by equipping employers with knowledge to successfully identify and inform potential recipients
• developing processes that allow and encourage a collaborative application between applicant and employer
• AtW advisors to work on a caseload basis, with named contacts for AtW applicants, to improve retention of individuals’ case histories and needs
• follow-up contact from AtW advisors to provide support during procurement and when situations change, if necessary
• improving the level and standard of applicant information collected during the application process and passed onto workplace assessors
• keeping assessors informed of final recommendations and outcomes, to support learning and refinement of their practice

About these findings

These findings are based on qualitative research. Qualitative research is used to capture a range of views and experiences and why people hold a particular view, not to estimate or quantify how many people hold those views. This research purposely recruited a variety of research participants (applicants and employers) with a broad range of characteristics. But findings, or any verbatim quotes included, cannot be taken to represent all AtW applicants.

Acknowledgements

We are very grateful to all the individuals that contributed to this research.

We wish to acknowledge the helpful advice, support and guidance of Department for Work and Pensions (DWP) staff involved with the study, notably Jo O’Shea, Lucy Glazebrook and Evgeniya Gorbatsevich from the Disability Analysis Division.

We would also like to express our thanks to everyone who participated in the research – Access to Work applicants, employers, individuals delivering workplace assessments, and Access to Work staff.

Authors

IFF is a research organisation with 50 years of experience in conducting research into issues of work and welfare. Lorna Adams and Angus Tindle, Directors, headed up the IFF team responsible for the study. Both have considerable experience in researching employment support and welfare issues, particularly in relation to vulnerable client groups. Christabel Downing, Research Manager, was responsible for day-to-day management of the study. Leo Holker, Research Manager, Naomi Morrice, Senior Research Executive, and Manuel Domingos, Research Executive, contributed to the fieldwork and analysis.

Glossary of terms

Term	Definition
Access to Work (AtW)	AtW is a publicly funded employment support programme that aims to help more disabled people start or stay in work. It can provide practical and financial support for people who have a disability or long term physical or mental health condition. Support can be provided where someone needs help or adaptations beyond the reasonable adjustments that employers are required to make under the Equalities Act 2010. To get an AtW grant, you must have a disability or health condition that affects your ability to work, be 16 or over, and live in England, Scotland or Wales.
Access to Work Advisor	An applicant’s point of contact when applying for AtW is an AtW Advisor. These advisors are Department of Work and Pensions staff and manage a case and liaise with the applicant, employer and any third-party assessor. They arrange holistic workplace assessments where needed and will work with applicants and their employer to determine the best way to help. These advisors work from contact centres.
Advisory, Conciliation and Arbitration Service (Acas)	A Crown non-departmental public body of the Government of the United Kingdom. Its purpose is to improve organisations and working life through the promotion and facilitation of strong industrial relations practice. The service is best known for resolving disputes between groups of employees or workers, often represented by a trade union, and their employers.
Elements	Elements are intended to supplement the reasonable adjustments that employers are required to make under the Equality Act 2010. In some, but not all, cases an assessment may be required to find out whether an applicant is eligible to receive an element. Elements can include: communication support for interviews, special aids and equipment, adaptations to premises, adaptations to vehicles, help with the costs of travelling to and in work, support workers, and access to Mental Health Support Service.
Mental Health Support Service (MHSS)	This service gives advice to employers to help them understand mental ill health and how they can support employees, as well as giving eligible people an assessment / development support plan. It is currently delivered by Remploy.
PeoplePlus Group (PPG)	In the context of Access to Work, PPG is one of two specialist contracted providers for workplace assessments.
RBLI	In the context of Access to Work, RBLI is one of two specialist contracted providers for workplace assessments.
Reasonable adjustments	Changes to the workplace / ways of working employers are required to make under the Equalities Act 2010, to make sure workers with disabilities, or physical or mental health conditions, are not substantially disadvantaged when doing their jobs.
Support worker	An individual available to support applicants with health conditions / disabilities depending on their needs. Support workers include readers, communicators at work, personal assistants, and drivers to work and in work. They often perform more than one function, although levels of support needed vary between applicants.
Travel to work	Provision wherein taxi fares to/from work are subsidised for those whose health condition / disability makes it difficult for them to use public transport.
Workplace Assessment	Assessments involve exploring workplace-related barriers to employment and making recommendations on how these can be overcome. In some, but not all, cases the outcome of an assessment can be to recommend the provision of one or more elements. The assessments are undertaken by specialist contracted providers.
Workplace Assessor / Assessors	Individuals from the specialist contracted assessment providers that conduct the workplace assessments.

1. Introduction and Background

1.1. Introduction to Access to Work

The 2016 Green Paper ‘Improving Lives: Work Health and Disability’ highlighted the government’s ambition to reduce the disability employment gap^{[footnote 2]}. This is one of the most significant and longstanding inequalities in the UK today with 48% of disabled people in employment, compared to 80% of non-disabled people. Tackling the disability employment gap will require sustained and specialist practical support as well as a change in some employer attitudes^{[footnote 3]}.

Access to Work (AtW), introduced in 1994, is one government initiative seeking to reduce inequalities in employment outcomes between disabled and non-disabled people. The initiative provides advice and practical support for individuals with disabilities or physical or mental health conditions that make it hard to do their job or get to or from work. AtW funds (in part or full) the provision needed to help such individuals fulfil their role, where the support needed goes beyond the reasonable adjustments that employers are required to make under the Equality Act 2010.^{[footnote 4]} The grants for provision are given on a discretionary basis; AtW is not an entitlement.

There are two main types of AtW provision:

• workplace assessments – conducted by a specialist contractor at an applicant’s place of work, this assessment explores workplace-related barriers to employment (including performing an existing role) in order to make recommendations on how these barriers could be overcome. In some, but not all, cases the outcome of an assessment can be to recommend the funding of one or more elements, if needs identified are not covered by reasonable adjustments
• elements – these are intended to supplement the reasonable adjustments that employers are required to make under the Equality Act 2010. Examples include providing special aids and equipment, access to a support worker or Mental Health Support Service, and help with travel to work

In 2016 to 2017, AtW provision was approved for 25,020 people^{[footnote 5]}. Of all AtW awards:

• 6% were assessment only (c.1,390 people)
• 46% were assessment and at least one element (c.11,550 people)
• 43% were elements only (c.10,690 people)^{[footnote 6]}

As shown in Figure 1.1, special aids and equipment were the most commonly approved element in this period, accounting for two-fifths of all elements. Access to a support worker (or job coach) to help applicants in the workplace, and taxi fares to or from work if an individual can’t use public transport were also commonly used (accounting for 29% and 20% of all elements, respectively). The number of applicants who had a Mental Health Support Service element approved has been gradually increasing since the introduction of this aspect of the service in December 2011, but still only accounts for 6% of all approved elements despite 14% of applicants with approved AtW provision citing a mental health condition as their primary medical condition. ‘Other’ elements, including travel in work, communication support for interviews, and adaptations to vehicles and premises, only accounted for 3% of all approved elements.

Figure 1.1 Types of elements approved in 2016 to 2017^{[footnote 7]}

Element	Percentage approved
Special aids and equipment	42%
Support worker	29%
Travel to work	20%
Mental Health Support Service	6%
Other	3%

Additional funding means that AtW aims to help over 60,000 people per year by the end of 2020 (which represents a rough doubling of the number of people that received payments in 2016 to 2017).

AtW has recently increased its focus on responding to those with hidden impairments like mental health conditions and learning disabilities; and the 2016 ‘Improving Lives’ Green Paper announced increased funding for the Mental Health Support Service element of AtW. Remploy currently deliver the Mental Health Support Service.

1.2. Application process

The application process – including the initial application, approval or rejection, and processes for receiving grant payments and reviewing provision and eligibility – is outlined below:

Claimant application process

1. Application: online, telephone or postal – the individual will provide contact information, answer general questions about their health condition and employment status for initial eligibility review. If DWP:

• approves provision (element and/or workplace assessment) after considering customer’s eligibility and employer’s duty to make reasonable adjustments, go to Step 2
• rejects provision after considering customer’s eligibility and employer’s duty to make reasonable adjustments, customer notified that their application has not been approved

2. At this stage the element can either:

• be approved. Go to Step 4
• be assessed to explore workplace-related barriers to employment and make recommendations on how these can be overcome. Go to Step 3

3. The outcome of an Assessment can:

• recommend the provision of one or more Elements. Go to Step 4
• recommend no further provision be approved. In this case, the customer will be notified.

4. Notification: Customer notified and grant approved to cover all / some of the costs of the approved provision.

5. Commissioning: The customer or their employer commissions the approved provision and submits invoices relating to approved grants to the DWP.

6. Receipt: Customer receives the approved and commissioned provision.

7. Payment: DWP pays the invoices relating to approved grants. In some cases a DWP payment is not required, for example because provision can be provided at no cost, or the employer covers the relevant costs.

8. Review: DWP schedules reviews to ensure the provision is still adequate and to check that the customer is still eligible.

Further details on the process, eligibility, and funding can be found in Annex 1 of this report.

1.3. Research background and focus

The Department for Work and Pensions (DWP) collects and publishes data on who is accessing AtW and what for on an ongoing basis, but up to date evidence on how AtW is working in practice is sparse as the last comprehensive look at the programme dates back to 2009.^{[footnote 8]} This research was commissioned to assess how AtW is currently working and seeks to understand two overarching questions: how well are access and delivery processes working for individuals and employers? And where is AtW adding value?

More specifically it focusses on:

• to what extent does AtW add value to applicants and employers by achieving outcomes that may not have been attained otherwise, how does it do so, for whom, and in what circumstances?
• how is the purpose of AtW understood and communicated?
• what aspects of AtW access and delivery are working well; conversely, what process improvements might be considered and why?
• why do some applicants not take up AtW support, and what happens in the absence of AtW?
• what does all of this mean for the future direction of AtW?

1.4. Approach for this research

A short review of the existing literature on AtW was conducted at the outset of this project^{[footnote 9]} and the content of subsequent depth interviews and focus groups with applicants, employers and delivery staff was, in part, informed by these prior findings.

Key findings of the prior research which informed this piece of research are as follows:

• according to Sayce (2011), there is a lack of awareness of AtW, particularly amongst smaller employers and amongst applicants with mental health conditions
• Adams et al (2012) found that awareness of rights to reasonable adjustments was also low, with many believing that the reasonable adjustments were up to the discretion of the employer
• Sayce (2011) reported that support is best when it is flexible, personalised and long-lasting, as well as able to meet the needs of those with fluctuating health conditions. AtW was criticised by a small number of employers and employees for a lack of flexibility
• difficulties in AtW applications often occurred when an applicant had a disability which was more difficult to categorise, a health condition that made application forms difficult to navigate, or were self-employed but found it difficult to provide the paperwork to evidence this. Dewson (2009) found that those with fluctuating conditions, complex or non-physical disabilities felt that the application process was geared to those with less complex conditions
• Sayce (2011) found that the number of individuals with non-physical disabilities such as mental health conditions and learning disabilities using AtW was disproportionately low; partly because it started as a service for those with physical disabilities, and the belief that it is only for those with physical disabilities still persists
• Dewson (2009) found that the length of time the application process takes was problematic for some; during delays in getting support into place their health condition worsened or they were unable to start work

For this research, a total of 60 applicants that had been approved for AtW were interviewed. Applicants fell into one of three groups, with an equal number of interviews conducted across each:

• applicants who took up AtW, and applied in the previous six months (‘newer claims’)
• applicants who took up AtW, and applied more than 12 months ago (‘older claims’)
• applicants who did not take up their AtW grant

Within these groups there was a mix of applicants looking for help to stay in work and those looking for help to change role or move to a new employer. There was also an even split of interviews between applicants with a primary physical health condition and applicants whose primary condition was a learning disability, a mental health condition, or other (non-physical) health condition.

A total of 25 employers with experience of AtW participated in the research^{[footnote 10]}. Table 1.1 shows the breakdown of interviews achieved by employer size.

Table 1.1 Employer interviews achieved by size

Number of interviews	Number of employees
4	10 or fewer
8	Between 11 and 100
13	More than 100

There were five paired sets of employees and employers, i.e. for five employees we also spoke to their employer. Interviews for both samples took place face-to-face, unless otherwise requested by the participant.

Two focus groups with specialist contracted workplace assessors were also conducted – one from each provider (PeoplePlus Group and RBLI).

In addition to this, there were two depth interviews with decision-maker AtW staff (those who write the reports and have the final decision on recommendations). One decision-maker specialised in cases involving employers, the other specialised in self-employment cases. All fieldwork took place between April and June 2018.

A more detailed breakdown of the AtW applicants that participated in the research can be found in Annex 2.

1.5. About these findings

These findings are based on qualitative research. Qualitative research is used to capture a range of views and experiences and explore why people hold a particular view, not to estimate or quantify how many people hold those views. We ensured that we recruited a variety of research participants (applicants and employers) with a broad range of characteristics. But findings, or any verbatim quotes included, cannot be taken to represent all AtW applicants.

2. To what extent does Access to Work add value to individuals and employers?

This chapter explores the ways in which Access to Work (AtW) has made a difference to individuals’ working lives, from the perspective of applicants and their employers. The impacts explored include harder outcomes, such as job retention or progression, and softer outcomes, including confidence and mental wellbeing.

2.1. Ways in which value is added

AtW adds value to applicants and employers in a number of ways, which have significant positive impacts in both the short and long term. The different ways in which AtW adds value vary according to the type of condition, the applicant’s needs and condition type, and the type of employer. However, these were often transformational impacts – completely turning around difficult situations (for example, in which employees were struggling to continue in work, or employee-employer relationships were deteriorating).

2.1.1. Job retention

Applicants in this research often applied for AtW as a last resort, when they felt that they had reached ‘crisis point’. Many of these individuals had been struggling to cope in their job for some time and would have had to leave it without further support, which they were provided through AtW.

I couldn’t have carried on working without substantial help.

I was at the stage where I had to seriously consider whether I could continue in my role or not.

(Employed, AtW recipients)

In a few cases, AtW enabled applicants to get a role in the first place, something they felt they would not have been able to do, or would have found much more difficult without AtW. For example, one recipient, who was granted access to the Mental Health Support Service (MHSS) through Remploy, had moved from sick leave into unemployment due to this support. They described the AtW advice and support as critical in getting them through the “traumatic” time of redundancy, into training and ultimately back into employment. The advice and support provided was both practical (for example, signposting to job vacancies, advice on relevant career paths) and emotional. The applicant believed that they would not have been made redundant in the first place if they had accessed MHSS sooner.

Employers often echoed these sentiments; without the support of AtW many felt that those employees who received it would not have been able to stay in work.

In many cases I don’t think they would be able to find employment without the support AtW gives them.

(Employer, 10 to 49 staff)

For example, one employer was particularly positive about how AtW-funded software had helped an employee with a degenerative visual impairment to stay in work. Another employer was particularly positive about the impact of AtW-funded support for employed wheelchair users. Through AtW, they had been able to ensure that the building was wheelchair friendly, the staff that needed them were able to obtain a wheelchair and to fund travel to and from work for some of these individuals. This employer felt that, without this provision available, many employees would have given up.

I think it’s highly likely that some [employees] would have resigned, retired or dismissed through ill health- one person with a wheelchair because of the illness she had [motor neurone disease] wouldn’t have been able to come to work, therefore probably medically retired. Staff can keep doing the job they always wanted to do and not have to give it up just because of a disability… because they’ve got the wheelchairs they’re still able to get out and about to do their social worker role, rather than being office-based if they didn’t have the wheelchair supplied.

(Employer, 250+ staff)

Negative impacts on employers were apparent in situations when employees were struggling to cope at work as a result of their disability; employers said that prior to AtW being granted, they had experienced reduced productivity, strained employee/employer relationships and a sense of being unable to support the employee any longer. Once AtW provision was granted, the issues employers and their employees were struggling to cope with tended to be alleviated.

The impact is a positive one, in that they can keep doing the job they always wanted to do and not have to give it up just because of a disability.

(Employer, 250+ staff)

Case Study: AtW helping an employee stay in work

An applicant with a hearing impairment that came on in recent years (and gradually worsened) worked as a customer service manager. Due to their difficulty in hearing, their job had become increasingly stressful due to noise around the office and difficulty hearing customers over the phone. They were keen to stay in their job but found it overwhelming, and they felt pressured by their employer to take on less work. Eventually, the applicant went on sick leave as they couldn’t cope anymore. During this time, they applied for AtW.

As well as hearing loop equipment being funded by AtW, the applicant requested that the reasonable adjustments suggested in the workplace assessment report were also sent onto their employer. The employer actioned some of these, allowing the employee to move to one of the smaller, quieter offices. In this office, they sat in a corner seat against a wall (as opposed to in the middle of the room). The employee was very positive about the impact these changes had had on her ability to cope in the workplace. She was able to return to work and continue in her previous role, something she did not think would have been possible without AtW; the changes they suggested and the equipment provided. The employee believes that without AtW they would have found the workplace too stressful and left as a result.

2.1.2. Retaining and acquiring staff with key skills

Some employers noted that AtW enabled them to continue to employ essential staff who had developed disabilities whilst working for them, or to hire new staff with essential skills who had disabilities. One employer in the Finance sector described how, because of AtW funding travel to work, they were able to employ a Senior Developer with issues with his knees and back that made standing and walking difficult:

He might not have been able to work here [without AtW], which would have, given his level of skill and ability, had impacts on us.

(Employer, 10 to 49 staff)

This employer said the employee could not have worked from home every day as they have a collaborative environment and need to share ideas to create a better product; as such, the employee would have been unable to take the role without the AtW grant.

Employers stated that they would have been reluctant to have to let these employees leave, but that without AtW they would have struggled to continue to employ them – thus AtW had had significant positive impacts for both the applicant and the employer. In most cases, the employer felt they would not have be able to afford the equipment/support needed for the employee to fulfil their job role properly.

One employer described how an existing member of staff in their organisation started losing their eyesight a few years into their employment. They were keen not to lose the employee, and provided the relevant reasonable adjustments (for example, funding taxis to and from external meetings and Speech Talk software on her computer), but her eyesight progressed to a point where she was not able to travel to and from work on her own. The employer was unable to support the employee in getting to and from work from a financial perspective. The employee applied for AtW, was granted a travel element and was able to remain in their job.

Another employer reported that AtW puts disabled job applicants on a level playing field when recruiting, as possible practical barriers and associated costs of hiring these individuals are removed:

With transport in particular, it allows us the flexibility to employ people with disabilities on the same basis that we would someone who was able bodied…if some applied and they were completely functionally blind…without AtW I’d have to consider whether that job could be done outside of the office/ from home.

(Employer, 250+ staff)

2.1.3. Career progression

The support received through AtW was sometimes credited (by applicants and employers) with leading to promotions, broader roles and the ability to take on more responsibilities.

For example, one employer noted that since receiving AtW-funded support, the performance of one employee with dyspraxia had improved significantly and as a direct result they were going to promote the employee to a role that their disability would previously have prevented them from working in.

Another employer from a Higher Education institution described how one employee with vocal impairments and a physical disability was able to advance her career through use of AtW provision:

One employee has multiple impairments; [they require] a significant amount of support including taxi travel and specialist equipment. They have progressed within the IT service, from a front line service [role] to be a change analyst, working on a strategic level, over the last 10 years. She has limited manual dexterity but now has a tablet device that allows her to write using a specialist pen and translate that into typed text - so she can record her thoughts and notes, and then action in real time without attempting to type up, using speech text software…with the number of meetings that she attends, particularly working on a strategic level, it takes a lot of the workload off of her.

(Employer, 250+ staff)

Case Study: AtW support enabling applicants to work to their full ability (applicant and employer interviewed)

One applicant that was born with no right hand described the difference AtW-funded equipment and Dragon software had made to their performance in the workplace. This applicant had received AtW-funded support in all of their workplaces, but had gone for a period of time without it when changing employer.

The applicant felt that, without the support, they would have struggled to continue in their role:

You can’t do your work to your best ability…some of the emails maybe won’t be as long as you want them to be because you’re just reliant on one-handed typing. Some [emails] you can’t actually complete. If I had a long spreadsheet of accounts figures that I would have had to reinput, I just couldn’t do that. I’d have to ask a colleague to do it and wait for them to come back to me maybe half a day later or longer, when if I’d had the Dragon I could have done it in five minutes.

This was echoed by the applicant’s employer:

It’s excellent. It has enabled him to proficiently do his job as well as anybody else could, it’s been excellent. The employer felt that the applicant would otherwise not have been able to fulfil his role in a timely manner, which in turn would have impacted on his workload, his levels of stress, as well as on his colleagues. The applicant worked in a school setting, and the employer also commented on how the individual acted as a positive role model to children.

2.1.4. Confidence and empowerment

Often applicants described AtW as enabling them to do their job to the best of their ability, rather than just surviving or struggling in the role. This also meant that employers were more satisfied with the employees’ work.

Many applicants felt that AtW provision improved their confidence and empowered them to request adjustments from their employers. It made applicants feel that they were on a par with their peers and that they could work to their full potential.

I can carry on working and carry on like a sighted person – I am very proud of that.

(Employed, AtW recipient)

In some cases, employers noticed that it improved their employees’ confidence and that it also gave the employee the reassurance they needed to request adjustments.

He’s going from strength to strength. I think he’s more confident now because he can hear people much better.

(Employer, 2 to 4 staff)

Employers said that AtW gave them the confidence that they were helping their staff appropriately, thereby ‘validating’ their approach to supporting staff with disabilities. Some employers felt that prior to involvement with AtW they had felt that they needed guidance on what support was appropriate for employees with disabilities. This was particularly the case in smaller organisations that had less experience of supporting these employees.

I think it helps guide us as to what we need to do to support these people. It’s a benefit to us to keep them in work.

(Employer, 250+ staff)

2.1.5. Transferable guidance

Some applicants who received AtW recommendations at one workplace then applied them when starting new roles; i.e. they took recommendations they had received in previous workplace assessments to their new employer, and these were acted upon.

Additionally, in some cases applicants had used assessment recommendations when setting up their own businesses. The applicant had gone on to set up their own consultancy, something they did not think would have happened without the knowledge they took from the AtW assessment from their previous job and the recommendations made:

The Access to Work advice and recommendations have helped me set up on my own as a consultant with the knowledge about equipment I gained.

(Self-employed, AtW recipient)

2.1.6. Reduced Stress

Before receiving support through AtW, some individuals were working longer hours as tasks took them longer and they were keen not to be seen to be underperforming.

AtW support had equipped some individuals with the necessary coping strategies for managing stress in the workplace. For others, the AtW-funded support enabled them to complete their work more easily. The adjustments that were made enabled them to work more efficiently, which meant they did not have to work overtime and felt less stressed.

Case Study: AtW support reducing stress caused by the working environment (applicant, support worker and employer interviewed)

An applicant with Asperger’s and attention deficit hyperactivity disorder (ADHD) was working in a community kitchen as an apprentice chef. His conditions meant that he found any changes in the work environment (for example, changes to staff) unsettling, and this made it hard for him to concentrate. The applicant also struggled with his motor skills and organisation, and his confidence was low. He had been late for work because of having to sometimes take different routes to work, as the individual needed to avoid crowds on the tube.

The café he worked at was run by a charity used to employing people with health conditions or disabilities and they suggested that he should apply for AtW. The employer supported the applicant throughout the application process, and the process went smoothly; within 6 weeks a support worker was in place.

The support worker suggested different ways of working, helped plan travel to and from work, helped change his working hours to start and finish an hour later so that he missed rush hour. The applicant felt he had a better schedule for his working day, it was more structured, and his role has since expanded to include service. The support worker had also taught the applicant coping mechanisms for when they got angry, which have gone a long way in making him feel calmer and more controlled at work.

Hours with the support worker were gradually reduced to increase the applicant’s independence, but with their help the applicant had also received equipment to enable him to cook and work more effectively.

From the applicant’s perspective, they felt AtW had helped him greatly, and he had much more positive experiences of the workplace because of the changes put in place.

I’d still be in [the job] but I would be very stressed; it would have affected my mental health and I would have more time off work. Before the support worker I was having a lot of time off with headaches and anxiety; my attendance has improved because I have been supported - I want to finish my apprenticeship…this is just a stepping stone.

The employer felt that without the support, they would have struggled to continue to keep the employee in their role. The employer was concerned that prior to receiving support from AtW the applicant was potentially a danger to himself and other staff. Their experience of AtW meant that they knew it might be possible to access a job coach / support worker and they were confident that this had potential to combat some of the issues that their employee was experiencing.

The employer felt that the job coach had been able to provide the correct level of support so that the employee was still performing the job role himself but receiving enough assistance to help him cope with some of the inevitable unpredictability of the job role safely and effectively. As noted above, at the time of interview, the job coach had reduced the hours spent with the employee and the employer was hopeful that over time the employee would be able to fulfil his duties without any support at all.

2.1.7. Mental wellbeing

The research found that in a few cases provision for applicants with physical conditions also had considerable benefits for their mental wellbeing, for example travel to work grants enabling them to come into their office for work instead of working from home, which had been isolating for them.

[A] large part of people’s social life is through their work… AtW would have a major impact on their physical, mental and emotional wellbeing.

(Employer, 10 to 49 staff)

To not receive [travel to work grants] would have created a lot of conflict and stress and I would have had to work from home all the time which would not have been good for my mental health.

(Employed, AtW recipient)

Some employees also felt that AtW improved their mental wellbeing by making them feel listened to and giving them individual support, particularly those receiving support through MHSS.

[I] felt that there was somebody there behind me, when you feel really down it’s hard to recognise what you can do.

(Employed, AtW recipient)

Additionally, through knock-on wellbeing effects such as their reduced levels of stress, AtW also improved some applicants’ relationships with family and friends. For example, one applicant with Myalgic Encephalomyelitis (ME) returned to employment in a call centre role after 10 years off due to ill-health. Through AtW, they received a suitable chair and keyboard, which greatly reduced the joint pain they had been experiencing and enabled them to stay in the new role. This applicant went on to describe the wider benefits of this, including improved mental wellbeing:

It has allowed me to go back to work, this reduces me having to claim benefits and also helps my employer as I am now back at work. It also helps my wellbeing and home life - I have more structure and purpose….it has all been positive…I’m in a better mood for my family.

(Employed, AtW recipient)

2.1.8. Bridging the gap after education

Some applicants interviewed were new to the workplace, having recently graduated from university. They had received support throughout their time as students which was essential to their academic success. These applicants had a good understanding of what equipment and support they needed in the workplace.

However, they noted that upon leaving university, the support they had received as students suddenly stopped, even though they still needed it. AtW enabled them to get back the same level of support that they had been able to secure previously.

I have always had support right through school, university, everything, so I roughly knew what I needed in equipment and that I couldn’t start a job without it.

(Employed, AtW recipient)

2.1.9. Multiple benefits

Many applicants experienced more than one positive impact from receiving AtW funded support; the ways in which AtW added value were often interlinked for these applicants. Many felt that AtW had removed the stresses they were previously experiencing which, if continued, would have pushed them out of employment. Related to this, individuals who described AtW as ‘putting them on a level playing field’ with their colleagues or enabling them to complete tasks faster and more efficiently often felt that this had, in turn, reduced their stress levels. Increased confidence and empowerment in the workplace tended to be associated with supporting career progression, as individuals were better able to demonstrate their abilities once support from AtW provision was in place.

Most of the positive impacts were seen across the full range of health conditions and disabilities. Individuals with learning disabilities (for example, ADHD, Asperger’s) were the most likely to experience multiple positive impacts, although increased confidence and empowerment was most prevalent (in some cases this subsequently reduced stress and job retention). Applicants whose health condition meant they were often in physical pain, such as those with neck or back problems or arthritis, were most likely to state that AtW had helped them stay in work – for many, it was travel to work that had ensured this. As touched on earlier in this chapter, these individuals also experienced improved mental wellbeing through staying in work and being able to leave their home to do so.

3. How is the purpose of Access to Work understood and communicated?

This chapter examines how applicants and employers become aware of Access to Work (AtW) and explores how well understood AtW is. In addition, it reviews the consequences of this level of understanding amongst both applicants and employers.

3.1. Awareness and understanding of AtW – applicants

Awareness and understanding of AtW was generally low amongst applicants and only a few had previous knowledge of it at the point of applying. Those who had prior knowledge of AtW were typically individuals who had heard about it from previous employers (but not used it), or, in a handful of cases, were graduates who had heard about it at university.

3.1.1. Finding out about AtW

Many applicants first become aware of AtW via word of mouth from colleagues, friends or family. These applicants were often at a ‘crisis point’ i.e. unable to manage a health condition that was having a detrimental impact on their ability to work.

I was having severe difficultly hearing. I couldn’t hear a landline, I couldn’t hear a mobile. I was at the stage where I had to seriously consider whether I would continue in my role or not.

(Employed, AtW recipient)

One example was an applicant who was working as an HR mediator and had a hearing impairment that was steadily getting worse. A colleague, with prior experience of AtW, recognised the severity of the situation and signposted them to AtW.

Other applicants first heard about AtW through their employers. Typically, employers recommended AtW to employees after observing they were struggling.

He (the manager) knew I was struggling with getting in to work and thought this might help. I had never heard of it.

(Employed, Non AtW recipient)

In a few cases, applicants had contacted their employer themselves when they became more conscious of their health condition posing difficulties regarding their ability to work, and had subsequently been pointed in the direction of AtW.

Only a few applicants discovered AtW on their own, typically after actively searching online or through the Advisory, Conciliation and Arbitration Service (Acas). These applicants also tended to be at a crisis point and were searching for anything that could help.

3.1.2. Understanding of AtW

Pre-application understanding of AtW tended to vary considerably amongst applicants. Some were aware of the workplace assessment and that it was a discretionary grant. Many were aware that AtW could provide specialist equipment but had very little awareness of anything to do with the application process. Others didn’t have any understanding at all.

I went down the OH [Occupational Health] route and my line manager told me about it…I think, at that time, all I knew was there was equipment I could get for the desk.

(Employed, AtW recipient)

As a result, at the point of application, many applicants didn’t know what to expect from the service. Sometimes applicants stated that they had very little idea of what AtW could offer but were at a point where anything was ‘worth a try’.

I didn’t know if it would help me but I was willing to try anything…

(Employed, Non AtW recipient)

Of the applicants who used the online AtW pages before applying, many felt the pages lacked detail around eligibility criteria and types of support provided. Specifically, there was felt to be a lack of tangible examples or case studies on the support that AtW offered.

I felt they were quite limited…there is a lack of information online…it is very brief, there should be case studies on how AtW has helped people.

(Employed, Non AtW recipient)

3.2. Awareness and understanding of AtW – employers

Levels of understanding and awareness of AtW varied widely amongst employers. Often employers had only been made aware of AtW through an employee, though some had built up knowledge through multiple previous experiences of employees applying for, or using, AtW-funded support. Some employers could also draw on internal specialisms i.e. HR and Occupational Health staff for information on AtW.

3.2.1. Employee-driven awareness and understanding

Most commonly, employers did not have any knowledge about AtW until an employee approached them about it. An example of this was an applicant with a hearing impairment who recognised that certain equipment could improve their working conditions. Though keen to support the employee, the employer had no awareness of AtW. After carrying out research, the employer presented information on AtW to senior management.

[The employee] considered what was possible and put together a case study for us… afterwards we had an interview and identified the needs…

(Employer, 2 to 4 staff)

Often employers had only been made aware of AtW once an employee had applied and their administrative input was required. Some employers had built up understanding through multiple dealings with AtW, and these employers could then use previous experience of AtW to support current employees.

However, despite previous organisational experience, some employers only retained a limited understanding of AtW i.e. they had little/no knowledge of the purpose, context or application process. Typically, these were in cases where in recent times, employees had only required basic administration tasks, for example, signing off taxi receipts. Sometimes more holistic understanding had been lost as the staff who inputted into the original application had moved on. Sometimes these employers felt unable to help other employees who might benefit from AtW.

I’ve had no information on what the services are to be honest, it was just that she claimed for the taxis and I signed it off.

(Employer, 50 to 99 staff)

3.2.2. Searching for help

Some employers only found out about AtW once they had noticed an employee having difficulties and felt compelled to try to find a way to help. In these circumstances, employers often came across AtW through online searches or after contacting third parties such Local Authorities or charities, for example, Disability Rights UK. One example of this was a comprehensive school who, keen to help a member of staff but unable to finance support, contacted their Local Authority. After the Local Authority highlighted what outside help was available, the employer suggested to their employee that they access AtW. There was a feeling amongst school management they should have been aware of AtW to provide the necessary support sooner.

3.2.3. Accessing formal and informal networks

Some employers could access AtW through HR and Occupational Health departments. Others sounded out personal and professional networks for ways in which they could support their employee or became aware of AtW through training sessions.

I found out about it through my networks, my job. One of my minor criticisms is they don’t communicate with individuals properly.

(Employer, 5 to 9 staff)

As a manager I did a ‘supporting employees and recruitment’ course, and (became aware of) …AtW…reasonable adjustments are part of that training.

(Employer, 10 to 49 staff)

3.3. Consequences of current awareness and understanding for applicants and employers

The research found that low levels of awareness and knowledge of AtW had a negative impact on the work life of individuals, many of whom felt they had been unsupported for longer than necessary simply because they/their employer had not known that such support was available. Some assessors pointed out that low levels of knowledge also affected the AtW workplace assessment negatively, with too much time and resource spent on managing expectations and explaining processes during the actual assessment.

3.3.1. Applicant views

Due to low levels of knowledge amongst applicants at the point of application, many were unsure about what AtW could offer, whether they might be eligible, and how it could help them in their situation. Applicants stated that if they had known about their ability to obtain support from AtW earlier then this would have given them confidence to disclose their disability to employers and seek help at an earlier stage.

There are lots of people who could benefit from [AtW] but haven’t heard of [it]…it’s ridiculous that somebody I think would really benefit from [AtW] is very unsure about even applying because she thinks they won’t help her.

(Employed, AtW recipient)

As a result, individuals felt they had gone unsupported for longer than needed which impacted negatively on their work situation. Some had had significant periods off sick and were struggling to perform or had left their job. This inability to manage their health condition had also had a negative effect on their relationships with their employers.

I was going off sick from work a lot because I couldn’t sit properly…it was affecting work as I was having too much time off …

(Employed, AtW recipient)

Poor understanding of AtW among applicants also drove misconceptions of what AtW offered. This led to the belief amongst some that AtW was more relevant for physical rather than mental conditions.

For example, one applicant who suffered from anxiety and depression had been off sick for two weeks. They searched online for support and came across the AtW pages which they felt lacked sufficient detail – specifically an applicant journey for those suffering from a mental health condition. The lack of clarity left the applicant unsure of whether AtW catered for people with mental health conditions.

Linked to this, some applicants were unaware that support delivered by Remploy was linked to AtW (and instead felt that they had simply been signposted from AtW to Remploy). In one case, an applicant spoke about how Remploy had been able to guide them through redundancy whilst also signposting them to support with their mental health. However, they were unsure whether or not Remploy was part of the AtW provision leading them to underestimate AtW’s value and impact.

3.3.2. Consequences of low employer understanding

With no clear outline of the overall process for how employees receive AtW-funded provision available, many employers were unaware of what to expect, for example, the timeline involved, number of stages etc. This poor comprehension caused waiting and uncertainty for applicants which impacted negatively on their mental health. It also meant employers were less able to support these applicants through the application process.

3.3.3. Assessor views

Assessors felt that more accurate information on what to expect from AtW should be provided to applicants before the assessment took place.

They felt that they had to devote too much time to managing expectations and explaining AtW processes in the assessments. This impacted on their ability to devote as much time to the assessment itself.

They also felt that workplace assessments ran more smoothly where there was greater awareness and understanding amongst employers. They reported some occasions where employers were suspicious about the assessment (and perhaps fearful that it was checking up on them) and tended to ‘hover’ around making the assessment less comfortable for the employee and the assessor.

The level of contact an applicant had with an AtW advisor and how experienced the advisor was impacted on how informed the applicant was. Assessors tended to witness much lower levels of understanding among those who applied online. In a few cases, assessors had negative experiences due to misinformation that had seemingly come from AtW advisors ahead of their assessment.

I think sometimes there is confusion with some of the [applicants] with what they’re expecting from the assessment itself… It appears that some of the advisors are a bit confused, or maybe the client has been pushy and they’ve just given into them and said, ‘Yes, they’ll [do a full accessibility audit for you]’. So that can lead to a bit of negativity sometimes.

(AtW Assessor)

4. What aspects of Access to Work access and delivery are working well or less well?

This chapter outlines areas identified as working well in the Access to Work (AtW) process – from application through to recommendations - and where experiences have been less positive. It also explores some more overarching feedback for how AtW could be working better.

4.1. Application

Overall the research found that the process of applying for AtW was user-friendly and straightforward. Applicants felt that the online application process was simple and did not report any specific difficulties with it; the online form was straightforward.

However, there were some aspects of the broader application process that applicants and employers found difficult.

For instance, one applicant who had dyslexia noted that alternative methods of completion were important. This applicant had made a number of applications for AtW as they moved job roles; they felt that more recently they had to push to be able to complete the form over the telephone.

Both applicants and employers felt that waiting times were not set out clearly and they did not know how long each part of the application process would take. This uncertainty sometimes exacerbated conditions, for example for individuals with anxiety.

Related to uncertainty about timescales, most applicants and employers were also unsure about what the sequence of steps for the application were. This meant both employees and employers did not know when key deadlines might be approaching and what employer involvement would be needed. Both felt that a timeline of key milestones would be helpful. In some cases, this uncertainty resulted in missed deadlines, which meant that the application process had to be started again.

You’re sitting and waiting and you have no idea what you’re waiting for. Especially with mental health and anxiety, you don’t need more unknowns.

(Employed, AtW recipient)

Employers varied in their level of involvement in the initial stages. Some employers who had less involvement in the application process were frustrated by this. Some employers and assessors felt that the process excludes the employer from what would ideally be a collaborative process between the employer, employee and AtW. Several employers felt that it would be helpful for them to have more involvement, both in terms of ensuring the smooth running of the process and in terms of their relationship with employees applying for AtW.

There are times when I would like to get a little more involved, particularly if there are problems. Rather than not feel that I am able to unless I take on a much more formal relationship… unless I actually get them to appoint me as [a] third party, I don’t think I can intervene.

(Employer, 250+ staff)

A triangulated approach would have helped though – when you are at work, you are not well and having difficulty managing your job - to pass on information to the employer who was double checking everything just raises the anxiety levels…you could do without this stress.

(Self-employed, AtW recipient)

4.2. Assessment

The assessment process was viewed positively by applicant and employers. Both felt that it was comprehensive and appropriate. Applicants felt that the assessments were thorough; assessors looked at applicants’ situations in detail, examining things like accessibility, desk setups, lighting and use of technology.

It was a thorough assessment and in principle I was aware of what was going to happen, [this] met with my expectations.

(Employed, AtW recipient)

Assessors sometimes asked applicants to enact their everyday work tasks whilst they observed, which employees found helpful. Additionally, applicants felt that during the assessment, assessors were good at explaining the different types of support available.

It was a very good process. Quite user friendly. I liked the way they come in and spot the problems that are there and they make suggestions that are helpful.

(Employed, AtW recipient)

Some applicants found that the assessment process made them aware of types of support they didn’t know about. Most applicants noted that assessors were good at discussing with them how the support they recommended would be helpful.

You don’t know what you don’t know until someone comes along and assesses you. You don’t realise how much you have been struggling.

(Employed, AtW recipient)

Assessments were also seen as positive as they empowered applicants to approach their employer regarding adjustments they needed; whereas previously applicants had sometimes been apprehensive about asking for (even ‘light touch’) adjustments. The assessment gave them the expert ‘stamp of approval’ by confirming that adjustments were necessary.

I felt more confident because it had the full grant. So, any lingering concerns I might have had about putting the organisation out of pocket were dispelled, but then in the end [my employer] just paid for it anyway.

(Employed, did not take up AtW)

Finally, most assessors felt that the move to a more holistic approach to assessments had improved recommendations and enabled them to suggest more cost-effective solutions. Assessors mentioned that previously multiple assessments could take place by different assessors in cases where there was more than one health condition or disability. They felt that equipping assessors to address all health conditions or disabilities in one visit meant there were no longer conflicting recommendations, and solutions were the best fit for the variety of issues faced by each individual (rather than one solution being good for one health condition but potentially exacerbating another). It also ensured that conditions not mentioned at the point of application can be addressed.

Although experiences of the assessment stage were positive overall, there were some areas in which it was felt it could be improved.

Many assessors felt that contextual case information supplied to them was sometimes poor. As a result, the assessor sometimes lacked expertise in the applicants’ condition, or was not appropriate to the case, for example in one case an employer reported that the assessor who came to assess an employee with visual impairment did not know much about it and therefore the recommendations were not appropriate, after which the employee had to request another assessment with someone with the appropriate expertise. In other cases, assessors were unaware of practical issues such as site access rules before attending an assessment, which made the assessment more difficult/time consuming. A common example given by assessors was prisons, where many items would be confiscated on entry. If they had known beforehand, they would have made the appropriate adjustments/preparations:

I’ve been into places like prisons or mental health institutions where I’m not allowed to take any equipment in – I can’t even take a pen in, like, that kind of knowledge would be useful so I can make a couple of notes before I go in on paper as opposed to relying on technology while in the assessment, which we do as a rule.

(AtW assessor)

Some applicants were frustrated with the lack of flexibility with assessment appointment times, which did not fit with their working hours, for example when they worked part-time. One applicant, who worked evenings, described the frustration of trying to organise an AtW assessment with limited flexibility from AtW about when this could take place:

[The AtW advisor was] saying that work might have to make reasonable adjustments but AtW were not going to make reasonable adjustments! The latest appointment they would give me was 1pm.

(Employed, AtW recipient)

4.3. Actioning workplace assessment recommendation reports

Applicants and employers were broadly happy with the recommendations outlined in reports. Both found it helpful to have specific types of equipment recommended, so that they had confidence that the equipment being procured was appropriate for the employee’s needs.

It’s provision of an expert coming in to advise on what support an individual might need.

(Employer, 250+ staff)

Some employers who used AtW alongside other reasonable adjustments made in the workplace mentioned that they used the report to ensure that the adjustments made were comprehensive.

However, there were some aspects of actioning reports that applicants and employers did not find straightforward. Specific suppliers are recommended in reports for each type of equipment or support required; while this was often reassuring, it was felt by some to be limiting as sometimes recommended suppliers were unable to supply equipment within the six-month timeframe required to claim back costs. Both applicants and employers felt that a mechanism to access alternative suppliers was needed for these types of scenarios.

Some applicants said that they were unsure of the ‘next steps’ after AtW was granted, or what they should do if they were to change employer, or if the state of their condition changed. They felt that clearer written follow-up communication outlining their rights and responsibilities would be helpful, particularly in terms of ownership of equipment and re-applications.

Another aspect of actioning reports that some employers felt could be improved was the transparency of the reporting process. These employers noted that they would find it helpful to have a full copy of the report, as opposed to simply receiving a report outlining only the recommendations that needed their financial investment. Both applicants and employers felt that giving the full report to both parties would reinforce a collaborative approach between them. It would enable employers to understand and implement ‘softer’ adjustments that had been recommended but which did not qualify for/necessitate AtW funding, rather than leaving the onus on the employee to ask for these.

4.4. Employer involvement and responsibilities

How involved employers were in their employees’ AtW application process varied, although they tended to take a ‘hands off’ approach. This meant they only got involved in the process where necessary; normally this was not until the procurement of provision. When employers were more involved, they had often been the one to recommend AtW to their employee in the first place.

In a similar vein, when workplace assessments had taken place, applicants often said their employer had little to no involvement in the visit. This finding was corroborated by employer accounts.

As managers we don’t really get involved, we get a date for the assessment, they come in, follow this up with a report and we order necessary equipment.

(Employer, 100 to 249 staff)

Some applicants felt that they did not receive adequate support from their employer throughout the application process. These applicants felt frustrated that the responsibility for the application process sat entirely with them until the point of procurement. In some cases, particularly where the applicants had a mental health condition, this level of responsibility caused additional stress and anxiety.

As mentioned, employers also felt some frustration with the overall process as their involvement was only required – and therefore usually called on – at a late stage. Some of them felt that this excludes the employer from what would ideally be a collaborative application process between the employer, employee and AtW. They felt that, if they had been involved prior to procurement, they would have had a greater understanding of AtW and their responsibilities in securing the provision; in some cases this increased understanding could have avoided procurement deadlines being missed.

The first I realised was receiving a message from the member of staff asking why I hadn’t responded to what AtW had recommended – I hadn’t received anything from AtW! There was no connection with the employer…again frustrating from my point of view…I even had to go and measure the size of the lift to see if the scooter would fit.

(Employer, 50 to 99 staff)

Applicants holding responsibility for the process until the point of procurement also felt that it caused confusion about what their rights to the equipment purchased would be, if they moved employer. Many were also unsure about their responsibilities and what their options would be if they left their role, in terms of notifying AtW and re-applying with a new employer.

By definition, self-employed applicants did not have these issues.

The process of applying for, and obtaining AtW provision tended to go well for employees and employers where the process had been more collaborative; accounts in these instances from both employee and employer were positive.

[My employer] was very hands on – which is what you need when you have special needs. It is quite hard talking about yourself and your difficulty…I find it hard to word things so it was very good to have them helping me.

(Employed, AtW recipient)

Some assessors also commented that workplace visits where the employer was more present and involved tended to be most effective in achieving positive outcomes for the employee. For example, where employers were there for (some of) the conversations around how the applicant’s health condition affected them in the workplace, and what reasonable adjustments could help them.

Many felt the issues they had experienced with the employee-employer balance of responsibility could be addressed if the process required a more collaborative approach, i.e. a ‘joint application’.

4.5. Case management

There was a call from both applicants and assessors for improvements in ‘institutional memory’ for individual cases.

Many applicants had experiences of speaking to different AtW staff throughout the process – for example, when first applying or when trying to resolve an issue or query – and feeling like they were often repeating information they had already provided. They felt there was little evidence of AtW storing their case information or, if they do, accessing it to make the process more efficient.

Applicants who had re-applied for AtW due to a change in circumstance provided similar accounts; they had to ‘start from scratch’ rather than build on their previous applications. One applicant – born without a right hand and with no other health conditions or disabilities – had gone through multiple AtW applications over the course of 28 years, when changing employer. They were clear that their health condition was constant and their needs unchanged, yet every application had resulted in a workplace assessment. They felt this was neither necessary nor cost-effective.

They come from quite far afield and, when you’ve got a constant disability and you’ve had several claims, over 28 years, and none of them being any different […] I think you could obviously save a lot of money by just looking at the previous [applications] and making sure, maybe, just the software is updated. Nothing’s changed in terms of my needs.

(Employed, AtW recipient)

This applicant, along with others, thought that a movement towards handling applicants as ‘individuals’ rather than each contact as a separate ‘event’ would improve AtW, both from an applicant experience point of view and in terms of the overall quality of the process.

In addition, many applicants felt their experience with AtW would have been improved by having a single AtW staff member or team looking after their case(s). These applicants felt this could contribute to improving ‘institutional memory’, continuity in support and streamlining of processes. For example, applicants cited instances of their employer impeding the implementation of recommendations, with no-one to intervene to positively influence this. They would have liked a named AtW staff member to approach about this to discuss how they could help the application to progress.

Some assessors also said they would benefit from being able to see the outcomes of the case. They felt left ‘in the dark’ about the final decisions on a case, the reasons for these, and the consequences of these for the applicant and their employer – thus removing opportunities to learn and refine their practice.

5. Specific types of Access to Work support

This chapter explores some specific types of Access to Work (AtW) provision. The types of AtW explored were common and distinct in their impacts and challenges, compared to other provision. For each, it examines the value added, as well as possible refinements.

5.1. Mental Health

AtW support for applicants with mental health conditions was provided by Remploy. The support received was felt to be vital for these individuals.

Some of these individuals needed assistance with practical issues related to their mental health condition, for example assistance with travel to work when they had problems with anxiety on public transport. In other cases, these individuals needed direct mental health support such as counselling, which they were able to access through Remploy.

The breadth of different support that AtW funding could provide for those with mental health conditions meant that these applicants were able to access the different support they needed through one system.

Support was provided in several different ways, for example through provision of:

• a contact at Remploy who provided advice and guidance through illness and redundancy. They guided the applicant to training and to suitable job roles. Additionally, they put the individual in contact with Mind who provided support with accessing further psychological therapy
• 6 weeks of counselling and support whilst an applicant was applying to train as a teaching assistant. This ultimately led to a new work role
• a job coach who helped an applicant to communicate with their employer during sick leave due to depression and anxiety. Although the employer was uncooperative, having someone “fight their corner” gave the applicant the mental strength and determination to return to work

Often these applicants felt that without AtW they would have been unable to remain in work. In some cases they had been on long term sick leave, with conditions that often made communication and making the steps towards a return to work particularly challenging. The tailored support they received through Remploy enabled them to progress towards a return to work or a new job.

Additionally, the support provided to those with mental health conditions through AtW was often focused on creating a longer-term plan that would enable the applicant to make a sustainable return to appropriate work, as opposed to simply a short-term solution. In one case the individual was supported by Remploy to tailor a work plan around studying for a new qualification in order to move into a job role that was more suited to them.

They helped me tailor a plan around studying for something that I would be qualified for and would give me a good salary whilst also having a job on the side. I had some ideas about it and they gave me the confidence to push for it.

(Employed, AtW recipient)

5.2. Travel to work

For some applicants with a variety of different conditions, ranging from mobility issues to severe panic attacks, AtW travel to work provision was felt to be crucial. These applicants felt that they would have been unable to work without the provision, as there was no other way for them to get to their workplace. Sometimes these applicants were required to travel as part of their job, for example to visit clients.

I know that I am safe and secure by getting a cab… I also know that we will be on time for a person’s appointments.

(Employed, AtW recipient)

This also had wellbeing benefits for other applicants who had been working from home due to mobility issues; being able to get into the workplace meant they could socialise with colleagues, and one employer noted that this was also much more effective as it enabled them to better work as a collaborative team.

However, some applicants who used AtW to fund travel to work found some aspects of the applications complicated.

The procurement process for travel caused some issues, as AtW would cover the cost of the cheapest taxi option, but this was not always suitable and was sometimes unreliable.

I want to go with a company I feel I can trust so I have to make a contribution to my journeys because I want to feel safe!

(Employed, AtW recipient)

Some taxi drivers were reluctant to sign the receipts which were required by the applicant to make claims. This was required daily and was felt to be quite an administrative burden. One applicant reported being unable to obtain a formal quote from the most cost-efficient taxi provider, which meant that they were unable to use them. Additionally, two applicants reported that AtW often raised queries about different journey lengths when they needed to go to multiple locations. These applicants felt that there was a lack of understanding of the need for this in the context of their job role, which caused them undue stress.

Finally, the lengthy reimbursement process for taxi journeys meant that applicants were left out of pocket. This was particularly frustrating as at times they were owed up to two weeks of taxi fares.

5.3. Support workers

Support workers were felt to be essential to those applicants receiving support from one. Support workers helped applicants in many ways, for example:

• a self-employed accountant with a visual impairment had a support worker to read small print on confidential documents, and prepare some documents
• an applicant with dyslexia was given assistance with reading and writing, data entry and keeping work organised
• an applicant who used a wheelchair was given mobility assistance; this was the same support they had received as a student
• an apprentice chef working with ADHD and Asperger’s was supported to develop effective ways of working, including planning a route to work and recommending a change in hours to avoid rush hour

Experiences of support workers were generally positive; issues mentioned were practical or administrative. Some applicants noted that they would have found it helpful to meet their support worker before they started the role, as not meeting them before had caused undue stress.

Applicants were frustrated by the need to re-apply for AtW when changing support workers. Some also felt that the hours of assistance they had been granted per week were fewer than needed.

6. What happens when awarded Access to Work is not taken up?

This chapter explores the reasons for individuals not taking up Access to Work (AtW) support and examines the outcomes achieved in its absence. This chapter also highlights what alternative support is offered by employers.

6.1. Reasons for individuals not taking up support

There were a number of different reasons why individuals applied for AtW but then did not take up the grant for support.

In some cases, input from employers, either positive or negative, resulted in applications being discontinued. In some instances, the employer acted positively by choosing to cover the costs of the recommended elements themselves and decided to treat them as reasonable adjustments.

However, in a few cases, employers were less cooperative. Some employers refused recommendations as they felt they were not appropriate within their workplace, or because they did not comply with the regulations of the particular workplace (for example, one individual with body temperature regulation problems was not allowed a desktop fan due to safety rules in their office). In other cases, employers were unwilling to provide the initial outlay for equipment, whilst one employer impeded the application process by not filling in the appropriate paperwork. Another employer reportedly rebuked the employee for getting AtW involved as they did not feel this was appropriate; this employee subsequently left the company.

In some cases, the reasons for applicants not taking up support were more circumstantial, for example, they had left their job since applying for AtW.

In a minority of cases, the AtW application process or recommendations received were cited as the reason for deciding not to take up the provision. There were a number of reasons for this. In some cases it related directly to the recommendations made, for example in one case the individual and their employer did not feel the AtW assessor was an expert; they did not feel the recommendations were appropriate and felt that they would have benefited from alternative options. They therefore decided not to take up the funding.

The process was fine it was just that the recommendations weren’t right for my needs…the equipment suggested was top end, very expensive…it wasn’t appropriate for the job role.

(Employed, Non AtW recipient)

In other cases, individuals were unable to complete the application process itself and therefore were unable to take up AtW. For example, one applicant did not feel that AtW had informed them about what was required to complete the application. After experiencing difficulties with providing a doctor’s note, they discontinued the process. As a result, their application was unsuccessful.

Another individual felt ‘stressed’ by being repeatedly asked questions during the application process and decided not to continue, a decision she now regrets. It is also notable that several of those who had discontinued their application for AtW support felt somewhat confused about the sequence of events that had led to their application not progressing any further. While they cited some of the reasons given above (for example, recommendations being unsuitable, or their employer covering the costs); they also said that they felt somewhat ‘in the dark’ as to what was going on at the time. This may be a consequence of the lack of clarity around the stages in the process and the relative roles of the individual and the employer, discussed earlier.

6.2. What happens when AtW is not taken up

6.2.1. Positive outcomes

In some instances, applicants were empowered by their encounter with AtW even though they did not take up support. Some applicants described feeling confident about looking for future employment knowing that support existed. Others had been able to transfer knowledge of AtW to a new employer or AtW recommendations had been used to shape employer funded provision, or their own provision when embarking on self-employment.

At least now I know about AtW; whenever I go for a job I can tell them about it and even though I know my eyesight is not good I know there is support there.

(Unemployed, Non AtW recipient)

Case study: not taking up AtW support

One applicant had made two applications to AtW, neither of which resulted in them taking up the support. The first of the applications was made a few years ago, when they were returning to work after a period of sick leave. The individual had developed partial blindness due to diabetes. They were having to commute into London each day and found the journey very daunting; their fellow passengers were not very accommodating. They had been offered the travel to work grant, but – due to their blindness – found the process of gathering quotes too difficult. Eventually, they abandoned the process and left the job role.

More recently, the applicant had moved into a new role for an employer they were already employed by. This role involved more paperwork and work on the computer than their previous one, which they found daunting and struggled with. The employee applied for AtW to try and get equipment to support them with this, but as they were not able to get this process started until they were in the role, quite some time passed before recommendations were made by AtW. In the meantime, the individual had purchased cheaper equipment and adopted ways of working that worked for them, to help them fulfil their role. When the recommendations report came through, the individual felt the equipment was too expensive to ask their employer to purchase, and somewhat redundant given how well they were able to do their job with what they had already put in place. They decided not to take up the recommendations.

Case Study: AtW support not taken up (applicant and employer interviewed)

An employed applicant with Dyspraxia and Scoliosis found out about AtW through the occupational health nurse at her workplace. Whilst at university, she had received support through voice recognition technology. Once in the workplace, she had not received similar support, as she had not declared her disabilities to her employers. Her employer became aware that she was applying for AtW when she came to let him know that she would be having a workplace assessment. He offered to ensure that other colleagues were out of the office whilst her assessment took place, and he was keen to ensure that she got the support she needed.

The assessor made recommendations that the applicant felt were suitable; they recommended Dragon software, a laptop for mobile working and making notes in meetings, mind mapping software and a chair with improved support.

I felt more confident because it had the full grant. So, any lingering concerns I might have had about putting the organisation out of pocket were dispelled, but then in the end they just paid for it anyway. […] Having had it in writing and having a good report to go with it was really, really useful.

Her employer received these recommendations and they purchased the equipment themselves, without using the AtW funding, as the organisation was able to absorb these costs without any issues.

Overall, the experience of AtW was positive for both the applicant and the employer, as the applicant was able to get all the equipment she needed, and the assessment gave her employer knowledge of what equipment was required.

6.2.2. Negative outcomes

In a few cases where employers had prevented the application from progressing by being uncooperative at the procurement stage, individuals were left feeling unsupported. Some applicants lost their jobs while going through the AtW application; often these were applicants who were on sick leave and looking for support to get back to work. Most in this position felt that they would not have lost their jobs if they had known about and applied for AtW sooner.

One applicant, who had lost their job, felt this was directly attributable to not receiving AtW after they had found the application too burdensome to continue with.

I am no longer in that employment as I was ‘let go’. AtW would ultimately have helped because I would have managed to get to work with the funding.

(Currently Employed, Non AtW recipient)

7. Conclusions

This chapter reflects on how Access to Work (AtW) has progressed since previous reviews and, based on the research evidence, brings together suggestions for potential future developments in AtW; outlining what changes might be prioritised to optimise AtW’s impacts and the experience for people interacting with the service. Views and experiences of AtW across all research participants were mostly positive. Nearly everyone felt it was an invaluable support for individuals with health conditions and/or disabilities, and their employers – often transforming difficult situations (for example, in which applicants were struggling to continue in work, or employee-employer relationships were deteriorating). Where potential improvements were suggested, these related to specific elements of the process; there was very little criticism of AtW in terms of its broad purpose or impacts. Areas identified as working less well largely echo findings from previous research into the service. That said, findings from this evaluation point to improvements in some areas.

Previous experiences of the application process and workplace assessments were felt to be more geared towards those with less complex, physical health conditions. Although some issues were still raised with the application process, these tended to relate to the information provided at this stage rather than difficulties relating to a health condition. Indeed, this research found that workplace assessment experiences were generally very positive across all health condition types. Key benefits of the assessment and recommendations identified included increased applicant confidence and a sense of empowerment, both of which have contributed to improve mental wellbeing.

Most assessors felt that there had been positive progression with workplace assessments. Assessors felt the move to a more holistic approach in recent years has improved recommendations, enabled more cost-effective solutions to be reached, and ensured assessments were thorough and effective, even when unexpected health conditions and barriers came to light.

7.1. Increasing understanding and targeted awareness

The research suggests that more work could be done to increase the understanding of AtW among applicants applying and their employers, for example by:

• providing greater clarity on who AtW can support and what types of provision are available, for example, through case study examples online. This may help to ensure expectations of the service are realistic and that applicants have an improved understanding of how AtW could apply to their situation
• providing a step-by-step guide outlining the different stages of the process, expected timescales and who is responsible for what at different stages. This could reduce the likelihood of deadlines being missed, and of the process causing stress or anxiety for applicants because they feel unprepared or unaware of what to expect

Many applicants and assessors felt raising awareness was also important, and would be most effective if done in a targeted way, for example:

• through university career services, so students who receive support continue to do so, after graduating, in the workplace
• by equipping employers/HR departments with knowledge to successfully identify and inform potential recipients

Taken together, this could increase employer and employee confidence to engage in a dialogue about issues before ‘crisis point’ is reached.

7.2. Collaborative application between employee and employer

Many applicants, employers and workplace assessors alike called for the implementation of processes to allow and encourage a collaborative application between employer and employee. They identified the following aspects that could contribute to this:

• employer engagement with the process being required from the start, for example, by requiring they submit relevant organisational information for the application
• ensuring information provided clearly outlines the role of employees and employers, and the relevant timescales they need to work to
• AtW advisors could broker discussions between employer and employee about the provision and process, to encourage employer co-operation and ensure that more difficult relationships do not impact AtW
• with consent from employee:
  • encouraging the employer to be present at (some of) the workplace assessment.
  • ensuring full recommendations (i.e. including reasonable adjustments) are sent to the employer, as opposed to just the elements that they will need to contribute to financially

Taken together, this could encourage more constructive dialogue, encompassing more holistic adaptations.

7.3. AtW advisors to work on caseload basis

Some applicants felt that unnecessary repetition in processes, and general experiences of engaging with AtW could improve if:

• they had a named AtW contact(s) for each applicant
• AtW staff made use of case notes for re-applications and re-assessments
• there was potential scope for the advisor to have follow-up contact with applicants to check whether any help is needed with the application, for example, to check awareness of deadlines. Given the instances cited of missed deadlines, or, in a few cases, uncooperative employers leading to abandoned applications, it would be beneficial for advisors to follow up with applicants on a case by case basis and keep in touch with them throughout the application process

7.4. Ways to improve the quality of assessors’ work

Most workplace assessors felt that there was a need to improve the level and standard of applicant information passed onto workplace assessors, for example:

• ensuring basic information (name, address, phone number) is correct
• more detailed information on specific health conditions to ensure the appropriate assessor attends
• practical information for assessments (for example, venue specific, respondent preference / required characteristics of assessor)

They felt that this could be achieved through consistent training of AtW advisors collecting this information. This may decrease the likelihood of assessors ‘starting off on the back foot’ by starting a visit without the correct or contextually useful information.

Many assessors also expressed a wish to be kept informed of final recommendations and outcomes; they felt that if they had an increased understanding of how final decisions are reached and why, they could improve the quality of their work. Likewise, assessors felt access to information on the impact of provision for the individual would be similarly useful.

7.5. Increased flexibility in procurement

Specific suppliers are recommended in reports for each type of equipment. However, suppliers were sometimes unable to supply equipment within the six-month time frame required to claim back costs. Applicants and employers therefore felt it would be desirable to have a mechanism to enable applicants and employers to purchase equipment from alternate suppliers when the one recommended is unable to fulfil their procurement needs.

Annex 1

Further details on the process, eligibility, and funding structures for Access to Work

An applicant’s initial point of contact is with an Access to Work (AtW) advisor. These staff operate from a call centre. When an application is made, advisors are appointed to manage the case and liaise with the applicant, employer and any third-party assessors (if required) to determine the best way to help.

An application is discontinued if contact with the applicant is not made after three call attempts, a letter goes unanswered for 10 days, an applicant says they do not wish to go ahead with their application, or an employer decides that an AtW contribution is not needed (prior to any assessment costs being incurred).

The grants for provision are given on a discretionary basis; AtW is not an entitlement. The level of grant will depend on whether the person is employed or self-employed, how long they have been in their job and the type of help required. There is a current cap per person of £42,100 per annum.

If an employee has been working for six weeks or more when they apply, the employer will need to pay a share of costs if the support includes special aids and equipment or adaptations to premises/equipment. AtW will refund up to 80% of the approved costs between a (varying) threshold and £10,000 – employers pay 100% of costs up to the threshold. Thresholds differ by number of employees (0 to 49 = nil, 50 to 249 = £500, 250+ = £1,000).

However, AtW will consider paying grants of up to 100% of the cost of provision for certain groups:

• self-employed people
• people who have been working for less than six weeks when they first apply for AtW

It will also consider paying grants of up to 100% of the cost of certain types of provision, including:

• the Mental Health Support Service
• support workers
• additional travel to and in work
• communication support at interviews

If an applicant changes employer, commissioned equipment may be transferred, but awards for support workers and travel to work can only be transferred through the AtW team.

Applicants cannot appeal against a level of reward, but for each award an applicant is allowed one reconsideration by a different assessor. If an employee’s role changes, they can have their award reviewed as many times as their situation changes. These are intended to confirm that: the support is being provided, it continues to meet the needs of the individual, claims are being made promptly and are in line with the spend profiled for the applicant, changes in circumstance have been reported, and additional requirements for support are reported. Reviews take place, at a minimum, annually.

Annex 2

Further information on the sample of Access to Work applicants

This table shows the number of interviews conducted by recency of claim and whether or not Access to Work (AtW) was taken up; within this it also shows the outcome for the applicant (i.e. whether the applicant remains in their role, was moving into a new role or was job seeking). This in turn is subdivided by type of health condition.

Took up AtW – newer claim (within 6 months)	Physical health condition	Mental health condition	Total
Remaining in role	6	7	13
Moving into role or help with job seeking	3	4	7

Took up AtW – older claim (12+ months ago)	Physical health condition	Mental health condition	Total
Remaining in role	7	6	13
Moving into role or help with job seeking	4	3	7

Applied for AtW – did not take up	Physical health condition	Mental health condition	Total
Remaining in role	7	6	13
Moving into role or help with job seeking	3	4	7

	Physical	Mental	Total
Total	30	30	60

Bibliography

Adams et al., EHRC (2012) Opening up work: The views of disabled people and people with long-term health conditions

DWP (2017) Access to Work: statistics

Dewson et al. (2009) Evaluation of Access to Work - Core Evaluation

Sayce, L. (2011) Getting in, Staying In and Getting On: Disability employment support fit for the future

Thorton, P. and Corden, A. (2002) Evaluating the Impact of Access to Work: A Case Study Approach

1. Sayce, L. (2011) Getting in, Staying In and Getting On: Disability employment support fit for the future. ↩

2. DWP (2016a) Improving Lives: The Work, Health and Disability Green Paper. ↩

3. House of Commons Work and Pensions Committee (2017) Disability employment gap. ↩

4. Access to Work website. ↩

5. Please note, these figures are based on approval only, it does not consider the proportion of approved provision which is not then taken up. ↩

6. DWP (2017) Access to Work: statistics. ↩

7. DWP (2017) Access to Work: statistics. ↩

8. S. Dewson et al. (2009) Evaluation of Access to Work – Core Evaluation. ↩

9. See bibliography. ↩

10. The employer sample was collected via the AtW applicants. When recruiting employers to speak to, we ensured the individual was the best person to discuss their company’s experience of Access to Work. Job roles of participants included (but were not limited to) Human Resources / Personnel Managers, Team Leaders, and company Directors. ↩