In six large London NHS hospitals a quiet but remarkable revolution is taking place in the perceptions and expectations of people with learning disabilities as employees. This revolution has arisen from the work of Project SEARCH, an organisation that has a very simple mission – to secure competitive employment for people with learning disabilities. Simon Jarrett visits supported employment providers Debbie Robinson and Steve Parr, who are partners in a Project SEARCH programme at the Royal London Hospital, to find out more.

Twenty years ago, at the Cincinnati Children’s Hospital Medical Centre in Ohio, Erin Riehle had a revolutionary thought. She was the director of the renowned Cincinnati Children’s Emergency Department, and wondered if it would be possible to train people with developmental disabilities to fill some of the high-turnover, entry-level positions in her department, many of which involved complex and systematic tasks such as stocking supply cabinets. She discussed her ideas with Susie Rutkowski, a special education expert, and so was born the partnership that became Project SEARCH.

Project SEARCH now operates in 45 states of the US and nine other countries across the world, including the UK, where it currently has 41 sites. In the NHS in London, Project Search programmes are in operation at six large hospitals – Charing Cross, The Royal London, Great Ormond Street, Whipps Cross, Northwick Park and Newham – supporting people with learning disabilities and those on the autistic spectrum into full-time employment.

Job rotation

At each of these sites, eight to twelve interns each year, aged between 16 and 24, go through a job rotation of three internships combined with a programme of tutoring, coaching and mentoring. The expectation is that by the end of the year, each student will have entered into long-term paid employment, at the prevailing wage, of 16 hours a week or more. There is no job segmentation (carving up jobs so that people just do part of them, as they are deemed incapable of doing the full job) – and all jobs are on the open labour market. The rate for successful transitions into employment in UK Project Search sites is 67%, and internationally is 75%. Currently in the London Hospital programmess it ranges between 73% and 83%. Most of the jobs are full time, and people stay in them long term. These success rates are all the more remarkable given the context within which they occur – a national employment rate for people with learning disabilities just below 6%.

The model is straightforward. Project SEARCH programmes work in partnership with large employers in both the public and private sectors. Employers must have a workforce of at least 250, so that job rotation across a range of departments is possible during the internship. The programmes must be business-led and are a partnership between the host business, the education provider, supported employment provider and Project SEARCH. The partners work together to deliver a series of core critical success factors defined by Project SEARCH (and known in America as Model Fidelity). They purchase a Project SEARCH license, which gives them access to programme infrastructure, resources and specialists. There is no hard sell, says supported employment provider Debbie Robinson, because the model will only work if it is a good fit and right for all partners, but especially the host business.

Once a programme gets off the ground, it is owned by the host business, and the tutor, and job coaches see themselves as its guests. On this basis, interns are treated exactly like any other employee – they have smart cards, computer access, access to all areas necessary for their work, and are expected to abide by all the employer’s codes and practices. While coaching, support, development and training are provided by the job coaches and education partner, management and mentoring come from within the host organization, as they would for any other employee.

The jobs that people secure are often not what stereotypical assumptions might suggest. They work across all areas of the hospital, including contracted out services. One person is processing blood and fluid samples in a microbiology lab, highly critical work, at a level of accuracy and productivity that has astonished co-workers. Another was put forward to apply for a position as a ward host, only for the ward sister to intervene and appoint them to the higher position of health care support worker. People are working as receptionists in busy outpatient departments, or carrying out complex sterilization and maintenance work on high-level equipment. They are working in areas as diverse as oral surgery, endoscopy, catering, restaurants, maternity, estates, medical records, portering and medical engineering. Each of them has gained their job on merit, because they have the skills, ability and personality to do it.

What are the secrets of this success? There seem to be a number of factors. Underpinning it all appear to be the high expectations that Project SEARCH holds of its participants. They go through a process of total immersion in the work they do, and interact with the workforce and its management as employees, not as ‘special’ people. This can be tough, but Debbie Robinson and colleague Steve Parr describe the transformations which people undergo when they are placed in this sort of environment. Project SEARCH also works with the families of participants, to ensure that they understand that the expectation is full-time employment in a real job and escape from the benefits system. Families sometimes have to undergo a similar journey of transformation to change their own expectations. There is, of course, a need for adaptation, adjustment and learning, on both sides, as people integrate into the workforce. Here Project Search’s team of job coaches come in, liaising with employee, employer and co-workers to ensure that a person has the skills and self-confidence and benefit from the understanding of those around them. This ensures they can fit successfully into their team and do their job well. The approach is an unusual mix of high idealism and deep pragmatism. The idealism is that there is no compromise on the central premise – people must go into real jobs, with proper pay, on the open labour market. The pragmatism is in building a coalition of interests around the person to make this happen.

Franchise basis

It is not of course just about working in the NHS. Project Search operates on a franchise basis, overseen in the UK and Europe by employment specialists Anne O’Bryan and Carmel McKeogh. There are partnerships with hotel groups, universities, retail distribution, drug companies, local authorities and, in America, even a casino. It is not so much what employers do that matters, as their willingness to integrate people with learning disabilities into their workforce and build their skills and experience.

Project SEARCH overturns many of the assumptions that bedevil people with learning disabilities who wish to enter the labour market. For many years we have been told that people need endless training, literacy and maths skills, social skills instruction and guarantees of a ‘safe’ environment before they can even walk through the doors of an employer. We have heard that there must be job segmentation (such as doing the photocopying) rather than a full job role, as people only have limited skills. Their families won’t let them work because of the loss of benefits, they will find open work environments too stressful, they will be bullied, their behaviours will annoy and alarm their coworkers. Project SEARCH have politely consigned all of these assumptions to the rubbish bin, looked at the people with learning disabilities they support, and seen them as people who can work. So have the employers who have taken them on, much to the astonishment of some learning disability professionals.

On the day that I visited the Royal London Hospital, the lead BBC news story was that the NHS had over 30,000 full time job vacancies, and had advertised more than 86,000 vacancies in the first three months of 2017. This was described as an ‘unprecedented workforce crisis in the NHS’. In circumstances like this, it is an act of almost criminal negligence to consign a significant segment of the population to a lifetime on benefits because they are considered incapable of working. Project SEARCH are showing, very elegantly, one way out of this morass.



For queries about Project SEARCH in the UK: anne.o’

Thanks to Project SEARCH job coaches Lee Bones and Lorraine Hall for their help with this article.