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The Rapid Review on employment support for Black people with long-term health conditions

McPin Foundation’s report into employment support for Black people with long-term health conditions (LTCs) is now available.

Commissioned for Black Thrive Lambeth’s Employment Project, it explores the evidence that systematic discrimination is a barrier to this group of people finding good employment opportunities.

This project, funded by Guy’s and St Thomas’s Charity, will operate in the London Borough of Lambeth. It has the highest percentage of Black residents of all London boroughs (37%) and is the 22nd most deprived area of England. Discrimination results in poverty, poorer health and unequal access to education and employment.

The report reviews current employment support models, focussing on Black people with LTCs. Its findings show that current models and practices are not providing them with the support and opportunities afforded to other groups of people. There is an ethical, social, and financial responsibility to ensure equal access for all.

Inequality arising from structural racism and ableism, and their intersections, affects employment and Black people with LTCs face a double discrimination, exacerbated by the COVID-19 pandemic. They’re less likely to access ‘good’ work, not helped by previous negative experiences with employers leading to expectations of low-paid, insecure and unsuitable work.

Education is also key for future employment, but evidence proves disadvantages occur throughout the educational pathway. Statistics show twice as many young Black graduates compared to their White counterparts were unemployed one year after graduation. They also show Black workers are twice as likely to have zero-hour contracts than White workers and people with long-term health conditions are more likely to be in part-time, low skilled work.

Black people with LTCs are less likely to get access to ‘good work’ and its psychological, cultural, and institutional benefits. This has a negative impact on their quality of life, self-confidence, social networks and sense of community. The lack of financial security can also impact their mental health and self-esteem.

The Equality Act (2010) dictates that organisations cannot lawfully discriminate against Black and disabled people. However, employers need improved employment support services to become fully inclusive. The report shows a need to move beyond existing diversity policies to develop support systems that allow a diverse workforce to thrive.

The report, based on scientific literature searches, reviewed the different models of employment support available and the evidence for their effectiveness. It includes the following categories, from interventions placing people into competitive employment to interventions seeking to improve ‘work readiness’ (the skills required to find and sustain employment).

The categories reviewed were:

  • Supported employment (IPS): a ‘place then train’ ethos into competitive employment.
  • Transitional employment: a ‘train then place’ ethos into non-competitive employment, with stepwise progression to competitive employment for some.
  • Pre-vocational support: focuses on preemployment outcomes like ‘work readiness’ and confidence, before progressing to employment outcomes.
  • Working with employers: focus on the employer and organisational level barriers to employment or developing networks for job seekers.

Supported employment (IPS)

IPS produces better outcomes than alternative vocational services and ‘train then place’ interventions, costing less to health and social care systems. IPS and ‘augmented’ supported employment trials were the most effective interventions for people with severe mental illness in gaining and maintaining employment. Clients valued the flexibility and consistency of support, which compared favourably against other experiences of employment support.

Another study in this area looked at equality of access of IPS services for people from Black, Asian and other ethnic minorities communities in the UK. It found a disproportionate number of Black people were accessing IPS, despite little to suggest that Black people were disadvantaged in these services. More work is needed to understand Black people’s experiences of supported employment.

Transitional employment

Transitional employment provides a path into non-competitive employment, preparing people for future competitive employment possibilities. One systematic review found that the traditional ‘sheltered work’ model could impede the transition to competitive employment but, peer-led models show more promise. Clubhouses also provide transitional support and there is some evidence for its effectiveness.

The Clubhouse develops relationships with employers, with members attending work placements on its behalf. The placement can be filled by substitute members if one member cannot attend. The decision on who will fill the vacancy rests with the Clubhouse, who provide on-site support. Some members may seek competitive employment where the Clubhouse has no formal relationship with the employer and provides no on-site support.

Pre-vocational training and support

Pre-vocational employment focuses on the prerequisites to employment, rather than training people for specific jobs. Systematic reviews suggested pre-vocational training was not as effective as supported employment in terms of getting people back into competitive employment. There are potential benefits of pre-vocational support and education when combined with supported employment for people with learning disabilities and ongoing support and work-related social skills training is helpful.

Face-to-face interventions, such as coaching, can also help employees with underlying cognitive difficulties. Peer support can be used in conjunction with employment support, particularly for people who have experienced work-related discrimination. Peer support, with its friendly, safe and egalitarian attitude, can allow people to ‘open up’ about sensitive topics that may not otherwise be possible in structured environments.

Working with employers

Employers must be ready to work with diverse workforces and put reasonable adjustments in place to support them. The benefits of representing hiring diverse workforces include, reduced levels of bullying and discrimination, improvements in profitability, competitive advantage and inclusive work culture and ability awareness.

Interventions such as coaching, mentoring, workplace design and flexible working are important for people with disabilities, while increasing managers’ understanding of disabilities may also be effective. Employers benefit from holistic leadership, for example, having managers that support diversity and inclusion, work collaboratively with ‘lived experience’ advocates, support mentorship schemes and have values aligning with social impact. Collaborating with local user-led organisations may also widen recruitment.

Clearly, systematic discrimination reduces opportunities for Black people with LTCs to build social, cultural, and financial capital. Employment support interventions must acknowledge how such ‘capitalism’ confers employment advantages to some at the expense of others. Black people with LTCs have less access to good work and are more likely to be exploited via precarious work arrangements.

Experiences of racism, ableism and discrimination affect preconceptions about employment, leading to ‘imposter syndrome’ and internalised stigma. Preliminary evidence suggests that Black people are accessing supported employment equally, but little is known about Black people’s experiences of employment support as a whole.

Comprehensive employment support for Black disabled people should include elements of supported employment, peer support, mentoring and coaching, while teaching about the Equality Act (2010). It must also work with employers to help them model inclusivity and diversity.

Introducing diversity without pro-inclusivity commitments is likely to exacerbate discrimination. Employment support services aiming to support Black people into employment need to be developed for and with Black people. Plus, an ageing of the population means that by 2030, most of the population will have a long-term health condition.

Intersectional employment support for Black people with LTCs is vital to a functioning and healthy society. The COVID-19 pandemic marks a turning point in history, coinciding with international anti-racist protest, leading to greater awareness of systemic racism in the UK.

However, it has also seen the development of worrying ableist attitudes about the relative worth of people with long-term health conditions and disabilities. Black Thrive’s employment project aims to improve employment outcomes for Black people in Lambeth with long-term physical and mental health conditions.

The Good Work Report shares the importance of developing employment support systems for, and with, Black people, as well as the vital role peer support is likely to play in improving outcomes. Employers, and job seekers, will find guidance and support to help build a more inclusive workforce.