The costs and financial benefits accruing from two employment agencies were analysed over the two years of their operation. The analysis determined the net costs for society as a whole, the taxpayer and the supported employees, when reductions in welfare benefit payments and costs to previous day services, and increases in tax were taken into account. The results indicated that supported workers generally benefited financially as a result of their uptake of paid work but that costs outstripped financial benefits for the taxpayer and society as a whole. There were significant differences in net costs between the two agencies. The results also indicated that the cost-benefit performance of the two agencies was improving over time, suggesting that the financial benefits of providing the service could ultimately outweigh the costs involved. This is in line with the general trends found in research in the USA, but progress towards a break-even point was much slower.

T his paper describes supported employment, its growth as an alternative to traditional day services and research which indicates potentially beneficial outcomes in the areas of increased employee income, social integration, satisfaction, engagement in activity, employer satisfaction, and in the relationship between financial costs and savings. Outcomes may be reduced due to welfare benefit restrictions that hamper transition into employment, and more part-time jobs are found as a result in the UK compared to the USA. Providers face problems with low expectations among carers, lack of knowledge of disability among employers, and their funding is precarious. If people with severe disabilities are not to be excluded from supported employment, commissioners need to consider the outcomes they require and the priority needs of clients when setting day service contracts.

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Nominated representatives from the various stakeholder interests, i.e. social services, health, education, voluntary organizations, parent groups and self-advocacy groups, involved in the implementation of the All Wales Strategy for the development of services for people with intellectual disability were interviewed 2 years after the end of the initial 10-year phase. Interviewees were asked to reflect on the strengths and weaknesses of policy implementation, including: changing priorities, planning arrangements, agency roles, central guidance and financial mechanisms, consumer participation, and the impact of more recent policy or structural developments. Despite recognition of the leadership of the Welsh Office, the shift in thinking achieved, the developments made in joint agency collaboration and in consumer participation in planning, and an increasing competence to plan effectively over time, the overriding perception was that more could have been made of the opportunity afforded by the clearest and best resourced central government policy within the UK in this area. At the heart of this judgement lay concerns about pragmatic rather than strategic planning, a failure to link annual service developments to a final comprehensive end point and a related failure to integrate planning to meet community needs with hospital resettlement Factors which may have contributed to these weaknesses are discussed, as are lessons for subsequent community care policy.