Pathways to work - Helping people into employment
Response from Lasa

– London Advice Services Alliance

Lasa is a development and resource agency for advice and information workers. We want to see good advice available for all who need it.

The following comments are based on our expertise of the law; experience of advising and training advisers; and experience of advising and representing individual claimants at tribunals and Social Security Commissioners. Our concerns relate to both the principals involved and practical issues emerging. General points are covered first, then our response to the specific queries.

A. General

1. Selective statistics

The consultation identifies the primary problem as the apparent persistence of incapacity claims in contrast to a decrease in others, such as unemployed claimants. But it fails to acknowledge the context and statistical manipulation that underlies this.

The decrease in unemployment per se is largely attributable to a healthier economy – rather than assistance to claimants in finding work. However many ex claimants enter employment at the lowest levels of the labour market – typically the least secure, lowest remunerated and most marginal work. Another recession will therefore likely show a reverse of that movement.

The claimant count used only includes those receiving Jobseekers Allowance (JSA). Successive restrictions to the eligibility rules over the last two decades mean that many unemployment people cannot access JSA and so do not appear in these statistics. Young people and others participating in the New Deal, even temporarily, are also excluded. The long-term JSA claimant count - given as 5% - is also unreliable. It excludes people participating in New Deal initiatives – regardless of their previous or overall length of unemployment. Hence the acclaimed 75% reduction in youth and long-term unemployment (p5) seems largely accountable by those on New Deal. It proves nothing about sustained employment. Hence, comparing the incapacity count to the well massaged unemployed figures is not a valid comparison.

The incapacity statistics themselves seem presented in a particular slant and without adequate contextual information or analysis. The majority, 60%, of those claiming a benefit for incapacity do so for a temporary period, of less than a year. Within this group many only claim for a period of weeks or months. Indeed many people, including those with back problems and mental health problems, never claim a benefit at all. Many are able to combine their condition with work for various reasons. So is the problem being exaggerated? It seems pointless to hound those 60%, who sort out their re-employment and health for themselves in any case. This would also be a complete waste of public funds for the sake of being able to claim (false) success in reducing the numbers of claimants.

In turn the Department imply that most of the remaining 40% have ‘manageable conditions’, but provide no sound basis for this presumption.

The DWP place excessive trust on a small selection of limited studies and imply that these prove that all people with back problems, heart conditions and mental health problems are universally the same and that with “appropriate treatment” could work. They fail to define or contextualise such claims –such as which people? what extent of illness? what treatment? what work? As stated, many people would find or return to work themselves in any case. But overall these global presumptions, projections and lack of definitions undermine the reliability of this paper.

In terms of public finance, incapacity benefit accounted for 6% of total social security expenditure over 2001/2 (IFS, 2002). Even including income support expenditure on the basis of incapacity does not boost that figure significantly ( income support. Aug 2002)

The consultation fails to acknowledge that access to social security support for incapacity has already been steadily reduced over the past 10 years: most recently by abolishing one benefit – severe disablement allowance, plus narrowing the national insurance rules and introducing means-testing for incapacity benefit; and in 1995 by the complete restructuring of the benefit and the restriction of eligibility criteria, especially for long term incapacity benefit. These changes have reduced claimant numbers, not including thousands in the limbo between JSA and incapacity. But obviously more people have remained incapable than desired by the Department, despite all these restructurings.

The failure of the consultation to examine or present the total context, alongside over-simplifications and lack of definitions mean that the residual minority of claimants who have serious, or long-term health problems which are incompatible with work seem threatened with losing entitlement to their safety net, for the sake of spurious statistics. This emphasis on reducing claimant numbers seems irreconcilable with the purported aim to provide support for people.

2. Generalisations and over-simplifications

The document presumes a simplistic one-size-fits all approach to diagnosed conditions, resultant incapacity and employment potential.

On p13 the DWP seem to acknowledge that the problems, creating obstacles to work are many, complex and in need of exploration. But elsewhere in the document this intelligence is jettisoned and replaced by a gross simplification that if not ‘severe’ enough to be exempted from the Personal Capacity Assessment (PCA), the condition is mild and compatible with employment. For instance on p12 it alleges that approximately three-quarters of those on benefit for less than two years do not have severe conditions – defined as not being exempted from the PCA - and thus have ‘good prospects’ of returning to work. Such a spurious use of statistics and leaps of the imagination should not form the basis of new government policy.

The two conditions most obviously targeted in these proposals are back and mental health problems - the ‘usual suspects’ in all incapacity benefit changes over recent years. Alarmingly the document glosses over the array of situations found within these conditions. Most insidiously all mental health problems, which are not ‘schizophrenia’ or ‘severe learning disabilities’, seem branded as ‘mild’ and “manageable “ conditions, including all depressive, anxiety and neurotic disorders.

The simplifications may be based on a presumption that much is determinable on the basis of a diagnosis alone. Whilst many symptoms are common across a particular illness, each individual’s condition varies, in terms of extent of impairment, stability, interaction with other factors and day-to-day exacerbation, including pain, energy levels and concentration. At one end of the scale, many people with back pain already manage to continue working, or return to work after a brief spell off. For some incapacity is intermittent. Some people’s work is more compatible with back problems. Others might enjoy more flexible employers. But the consultation document fails to acknowledge this variability, or indeed that for some the condition may be very serious or /and permanent. At the other end of the scale, back problems sometimes mean severe disablement for example through continuous, intractable pain and /or impaired mobility, general movement, concentration, sleep and dexterity.

Are the DWP being intentionally misleading or forgetful by stating that the Personal Capacity Assessment does not assess incapacity for all work? Indeed up to recently it was called the “All Work Test”. In the original consultation the DSS described it as “A test [which] would focus on the claimant’s ability to perform a range of activities related to work (DSS, 1993, Chap 4.6 (i)). Passing the PCA on physical grounds requires near total disablement, incompatible with either work or with the suggestion of easily ‘manageable’ conditions. Someone with back pain would only pass the PCA if they convince the examining doctor and decision maker, or perhaps a tribunal, that they normally cannot walk for more than 50 metres, or sit for more than 10 minutes, or stand for 10 minutes, of lift or carry, or reach, or kneel.

Mental health problems are extremely prevalent in the general population, and according to diagnosis, the largest proportion of incapacity claims is under mental health problems and learning disabilities. Obviously this ‘mental health’ label encompasses a hugely diverse spectrum of conditions as well as further variations in form, extent and impairment. The consultation fails to acknowledge this complexity, or that this diversity is as wide as covered by the term ‘physical illness’. Hence it goes on to provide one crude distinction: those so severely mentally impaired that they can be exempted from the PCA; and others with ‘manageable’ conditions, including neurosis and depression, who are apparently thus ‘capable’ of work.

Even the simplistic terms used, such as ‘depression’, incorporate many different potential diagnoses. Additionally, any one diagnosis is further distinguished and complicated by day to day symptoms of the condition such as lack of energy, poor concentration, impaired sleep, difficulty in dealing with stress or pressure or people or impaired communication.

The exemption to the PCA allowed for mental health only applies to those with ‘severe mental illness’, which in practice is reserved mainly for people with psychotic conditions or personality disorders. The fact that a person does not fit this tight exemption criterion does not mean that they do not have a serious mental health problem with makes them incapable of work.

The insinuation that all not exempted people are capable of work is gross and misleading. It is impossible to pass the PCA on mental health grounds if all that is wrong is a ‘manageable’ depression. If anything the mental health assessment is even more demanding than that applied to physical and sensory conditions. To succeed a person needs to show a wide range of un -’manageable’ impairments to their daily functioning, social interaction and communication. These include not being able to take a phone message, deal with people, cope with pressure, cope with changes, interact with people, concentrate without prompting, pursue leisure activities, communicate, maintain self care, or being a danger to self or others. Given the continuing stigma to mental illness, how many employers would employ someone who declared all of those?

Mental health in terms of social security and especially employment is a complex area, deserving of deeper analysis and detailed proposals. Without these it seems that the proposals are not actually sincere about helping people with disabling mental health issues. Many seriously ill or disabled people may be effectively forced off their benefit, despite their profound incapacity.

2. The relationship between incapacity and unemployment

Many people who are ill or disabled often find, or keep, work. It is clear from the figures that most people move off incapacity benefit very quickly. Not surprisingly most people, ill or not, might want to work, for multiple social, cultural and financial reasons. But presuming that all ill or disabled people will find work with some undefined intervention of an adviser is a huge and unfounded, leap of the imagination, denying many realities.

In real life being capable for work requires meeting a complicated matrix of factors. Some of these are internal to the individual, including education, training, skills, expertise and experience. Someone who is highly skilled, educated, experienced or trained will find it easier to transfer their skills, even when older, to different types of work, which can accommodate their incapacity. Other factors are part and parcel of the expectations of any employer – such as stability, energy, consistency, dedication, time-keeping, compliance with health and safety, being able to travel daily to and from work and cover all the aspects of the job on top of any domestic responsibilities. All of these can be undermined by poor health. For example how many employers will accept someone who cannot be reliable, or cannot carry out certain tasks, or needs to take repeated time off due to pain, fatigue or inability to cope with pressure or changes, or people?

It is hardly surprising that those longest on incapacity, and previously invalidity, benefit live in areas of highest structural unemployment. Commonly the fit, young, educated or skilled people in these areas only manage to find employment by moving out of the area altogether, or by travelling long distances. Is it surprising that older, ill or disabled people facing a structural dearth of employment opportunities, even at the lowest and marginal ends of the labour market, are least successful in competing against younger fitter recruits, especially given the added impact of discriminatory attitudes and inflexibility towards age, illness and disability?

It is unfair to blame the victim for being unsuccessful. Insinuating that people with long-term illness and disabilities, who fail to compete successfully in areas of structurally reduced labour market, are work shy, or are taking advantage of the benefit system is a huge insult. Implying that the mere intervention of an interview will overcome those barriers is another insidious over-simplification of a general problem requiring economic and social change.

3. Pre-mature: excessive reliance on anti discrimination law and rehabilitation, which are not fully functional

The proposals seem to hinge on policies and systems not yet in place. It seems folly to suggest that disability discrimination will have been eliminated so soon following recent legislation. Gender and race based discrimination are still rife in Britain, despite legislation passed nearly 30 years ago. Meanwhile age discrimination remains legal and widespread.

There is a huge discrepancy between the success of a minority of disabled people and the experiences of many in finding or keeping employment. The success of the former, despite the seriousness of their condition, mostly serves to prove that anti-discrimination policies are essential. But individuals’ success, often requiring enormous personal feats or more flexible, employers who take equal opportunities seriously, should not be used to punish the majority facing inflexibility and discrimination in the general labour market.

In equal measure the consultation over-romanticises the availability, scope and potential of rehabilitation services. Rehabilitation is a very scarce resource and certainly not as available as is implied. Moreover the consultation fails to analyse the potential scope and impact of rehabilitation for different claimants with different levels of different conditions and places excessive reliance on a limited number of small-scale studies. Once again this one-size-fits approach proves inadequate. Perhaps abdominal exercises or lifting and carrying training is envisaged for people with back problems. But this is not always successful. What happens then? What precise ‘cognitive training’ has the Department in mind for someone with manic-depression, or suicidal tendencies, or a dual diagnosis (none of whom would be exempt)? What time-scale do they envisage for such rehabilitation? Is there some over-ambitious projection here that people with serious long-term conditions will be fine and fit for work within a few weeks or months?

Moreover, it will take some time for joint initiatives with the health service to be operational nationwide. The continuing fragmentary nature of community care, especially mental health, systems and services, 10 years after the last major overhaul in 1993, should be seen as a warning that new systems and inter-agency cooperation take a long time (if ever) to function as originally desired in Whitehall. Even if, or when, operational the effectiveness of these heralded rehabilitative services then needs to be evaluated.

The Department should wait until the desired non-discriminatory labour market and easily accessible, plentiful and appropriate rehabilitation services exists and the latter have been evaluated to be effective, before hounding people off their social security entitlement.

4. Plethora of employment initiatives and other changes

An abundance of schemes already exists, such as the New Deal for Disabled People, connexions, Employment Zones, modernization of the Employment Service and the compulsory One – Jobcentre Plus Gateway interviews. The array of initiatives and names causes confusion and obscurity and arguably undermines access and acceptance. The Department should perhaps allow these schemes time to establish rather than launch into another restructuring.

From years of experience most claimants and advisers see name changes as a camouflage for reductions in eligibility. Indeed it seems possible to change the first Job-Centre Plus interview to a later date, and to encourage the NHS to provide more rehabilitation, without changing the benefit name.

Whilst it is still early days for the existing schemes, the evaluations have shown that to date small numbers are assisted into work (4000 from New Deal for the Disabled July 2001 /2); that targeting help effectively is difficult; that the already work-ready have participated and benefited most to date, skewing the results and making them unrepresentative; that many enter marginal employment; and that most support is offered to get people into work, with little long-term support given to sustain work, or to develop skills or careers (Corden & Thornton; 2002).