Concerns expressed about support for people who need more help in Provider-led Pathways to Work
People with health conditions that make them ‘harder to help’ may not get the support expected under outcome-based contracts between the government and service providers. This is one of the findings from a recent study of Provider-led Pathways to Work based on qualitative research interviews in four Jobcentre Plus districts. The research was commissioned by the Department for Work and Pensions (DWP) and undertaken by the Policy Studies Institute in 2009, involving a research team led by Maria Hudson.
The researchers explored the influence of outcome-based contracting upon the delivery of Provider-led Pathways to Work from the perspective of key stakeholders in Jobcentre Plus, the DWP and provider organisations. The research also sought to investigate how targets might bear an influence upon the practice of Provider Advisers, how contracting arrangements function at present, and also how these might be improved.
The research found that the influence of the outcome-based contract was highly evident in the operations and delivery of Provider-led Pathways. All stakeholders felt that the contract was shaping the nature and extent of the Pathways support. A division of services emerged: prime providers served those clients who were considered more likely to enter work, while partner agencies attended to the less work-related needs of clients who were not immediately ready for employment.
The current economic downturn and resultant decline in job vacancies was felt to have made the task of placing clients in jobs more difficult, exacerbating the financial risks associated with achieving employment targets. There was little evidence that prime providers were developing in-house provision to enhance the quality of client services. Instead, partner agencies (the supply chain) were increasingly used to address specialist service needs. Service innovation on the part of prime providers was largely focused on reducing operational costs and achieving performance efficiencies.
Another issue was the way in which provider organizations were classifying clients. Traffic-light and numerical systems were being used, which some advisers felt were rather crude and subjective, but these systems were a way of prioritising how much time advisers spent with clients as well as shaping action points.
Asked about the skilled necessary for their work, frontline advisers suggested that the key skills were empathy, the ability to motivate, good organisational skills and the ability to work under pressure. Many advisers valued the training they received, but they felt that it should be more on-going and that there were gaps. All prime providers set internal job outcome targets for advisers which had been lowered due to the impacts of the recession on their achievability. However, targets were still felt to be unrealistic, for example due to the impact of the recession, the complexity of client needs and clients’ own lack of motivation. While advisers tended to feel that it was important to have job-outcome targets, they were also concerned that targets did not reflect the varied nature of their roles in working with clients.
In all areas there was adviser frustration that management pressure to focus on job-ready clients was leading to less time being spent with clients who are further away from work.
There is a need for policy to look at a number of areas:
- The division of labour across prime providers and the supply chain . Supply-chain experiences raise a number of concerns, indicative of an imbalance of power in prime provider and supply-chain relationships.
- Stronger client feedback mechanisms must surely be a priority given the concerns about outcome-based contracts and lack of support for those further away from work.
- The adequacy of Provider-led Pathways resources in a difficult economic climate. This raises the broader issue of whether the contracting framework should be more tightly linked to wider conditions in the overall economy. Adequate resources need to be made available for organisations working with clients with more complex needs.
- The need to improve administrative processes, including pre-referral health assessments, job-outcome evidence and monitoring of referral flows.
- Whether providers should be paid on the basis of a wider range of outcomes, recognising both the nature of client journeys and the nature of the frontline adviser role in supporting those journeys.
- The potential for differentiated outcomes for groups of customers requires some creative thinking, recognising the complexity of work orientations and job readiness.
Further queries about this research can be directed to Dr Maria Hudson.
The research report, including an executive summary, can be found here.
Hudson, M. Phillips, J. Ray, K. Vegeris, S. and Davidson, R. (2010) The Influence of Outcome Based Contracting in Provider-led Pathways to Work. Department for Work and Pensions Research Report No 638.