Who are the people assessed as unfit for work by the WCA?

The current Labour government is seeking to make substantial cuts to social security for sick and disabled people. A major plank of Labour’s argument in favour of this seems to be that sick and disabled people will mitigate the loss of social security income by moving into paid work. Sick and disabled people will be able to do this because of the employment support that Labour is going to provide.

This is premised on a misunderstanding (or misrepresentation) of who it is actually received these benefits, and the availability of the jobs they are able to move into. This short paper outlines why -even with the best most comprehensive support – the vast majority of sick and disabled people hit by Labour’s cuts will not be able to move into employment and this already poor cohort will simply be made poorer

Case Study

Annie has widespread pain, fatigue, illness symptoms and post-exertional malaise. She gets the mobility element of PIP, but is deemed able to cook a simple meal and wash her torso with assistance and therefore does not qualify for PIP Daily Living. At her last WCA, she was assessed as LCWRA due to substantial risk to health if required to work or prepare for work. Annie uses mobility scooters and taxis to get around, and pays for five hours of help in the home each week for things such as laundry, washing up, cooking, and cleaning.

Annie has recently attempted a course of study, but has had to take leave due to 5/hours per week, completely under her own discretion, proving detrimental to her health.

Under the new system, people like Annie would not qualify for the UC Health Element at all. They would lose £97/week compared to the current system, and would also lose the work allowance. Taking into account both the UC taper and the withdrawal of Council Tax Support, such a person would have to work around 21 hours at NMW to make up for the loss of the UC Health Element. Given that people like this struggle to walk and cannot keep their own home clean and safe, their illness is such that they cannot come close to working 21 hours.

Annie is typical of current LCWRA recipients, and of many LCW recipients, who often experience widespread illness symptoms including pain and fatigue, which greatly reduce the capacity for activity.

What needs to happen for employment support to overcome disability benefit cuts?

For employment support to be an adequate mitigation for cuts to social security, almost all sick and disabled people impacted by the cuts(2) would have to instead move into or retain at least some part-time work, and they would have to do so at a level that compensates for the cut to social security. The remainder, who are unable to move into work, would have to be identified as completely unable to work, and their incomes protected. The government has set out no plans for how it intends to do this, but the implication of the Green Paper is that it expects this to be a small minority of those who are unfit for work under the WCA. However, the government has presented no evidence to support this belief, and research on employment support for people who are unfit for work indicates that the large majority are not able to move into work even with two years’ of employment support.

It is important to note that if the government truly believed employment support were able to achieve such high and rapid entry to work, they would not see any need to cut social security, because social security receipt would fall rapidly as people move into work.

However, it is utterly implausible that employment support would be so effective as to compensate for a cut to sick and disabled people’s incomes. Firstly, it is very unlikely that someone assessed by the WCA as unfit for work – a notoriously tough assessment – would have the health to move into a significant number of hours of paid work. Secondly, it is implausible that large numbers of sick and disabled people have chosen to remain on sickness benefit despite having the capacity to earn money at a rate that would substantially improve their income and therefore their life.

Who are the people who could be helped by employment support?

If employment support is to get sick and disabled people into work, then they need to fall into one of these categories:

The person has the health to work full-time, or close to full-time hours, but the nature of their disability means that:

They can only work a very restricted range of jobs, which means that it takes a longer time than typical to find a job;
Employers are reluctant to employ such a person despite them being a viable worker, and so it takes longer to obtain work;
They can work, but struggle with work-search, which means it takes longer to obtain work; and/or
They need support to work, such as help with travel, a support worker, or aids/adaptations.

The person has the health to work full-time or close to full-time in a wide range of jobs and without substantial support, but falsely thinks that they can’t do so;
The person currently lacks the capacity to work, but this is only indirectly linked to their health, such that it is employment support rather than healthcare or a natural improvement in health that enables this person to move into work.

Category 1: Healthy people with static disabilities

Person 1 is most likely a person who has a relatively static disability, such as sensory impairment or learning disability, rather than being ‘ill’ as such. Relatively few people on sickness benefits are in this category. Some of these people also struggle with illness, or find that navigating the world with their impairment is itself fatiguing and may trigger illness symptoms such as migraines.

However, assuming that such a person is impaired but not ill, then there is a plausible conception in which some of these people are not so impaired as to be unable to work at all, but do struggle to obtain work. Such a person may conceivably be helped by employment support, and in particular such services as job brokership, work trials, and Access to Work funding. However, because these people are a small minority of sickness benefit recipients, the success of employment support in mitigating cuts to social security cannot be predicated on its relative success for this group. Furthermore, the severity of disability needed to qualify for sickness benefit on these grounds is such that the majority of these ‘healthy but disabled’ people are likely to be unable to work, regardless of employment support.

In terms of such people who are ‘healthy but disabled’ and qualify for sickness benefit, we are talking about people who, for example:

have lost both arms;
are quadriplegic;
have such substantial visual impairment as to be unable to see a simple visual sign well enough to understand what it conveys;
have such substantial hearing impairment as to be unable to hear a simple verbal message well enough to understand what it conveys;
have such severe learning disability as to be unable to learn a simple task, such as setting an alarm clock.

It is illustrative to also consider which people with static disabilities do not qualify for sickness benefit. These include:

Someone who has only one functioning arm and hand;
Someone who is paralysed who can wheel their own manual wheelchair;
Someone who has epileptic fits on average once every eight days;
Someone who is registered blind but can just about comprehend a simple sign, such as the location of a fire escape, even though they cannot see well enough to read or understand slightly more complex signs;
Someone who is registered deaf but can just about comprehend a simple verbal message, such as the location of a fire escape, even though they cannot hear well enough to participate in spoken conversation;
Someone who is learning disabled and can learn a simple task, such as setting an alarm clock, but nothing more complex than this.

The people listed in the second group are likely to experience substantial difficulties in getting and maintaining work. Yet, they are treated by our social security system as fit for work. This confirms that our social security system is already very strict and potentially treats too many disabled people as fit for work, who ought to be given a higher level of benefit than standard jobseekers (because of the length of time likely to be needed to find work), reduced conditionality (because there are fewer jobs to apply for, and greater barriers to work), and specialised employment support. Yet instead of expanding the scope of sickness benefit, to include people who are currently excluded, Labour want to exclude many people who are currently – rightly – included.

Categories 2 and 3: People with illness who may benefit from employment support

Persons 2 and 3 largely do not exist, and this may be where the problem lies in terms of why it is thought that employment support will have a large impact for people assessed as unfit for work. Successive governments, including the current Labour government, seem to insist on believing that the bulk of sick people fall into one of these two categories: flawed attitudes and beliefs, which can be rectified by social security cuts and employment support; or some sort of illness which somehow benefits from employment support. And yet there is no plausible evidence that many, let alone most, sick people fall into either of these two categories.

In terms of the first category, it must be remembered that the Work Capability Assessment is not a self-assessment tool. It is largely a series of relatively simple questions such as whether a person can walk 50 metres, or sign their name, or understand a simple message. A person has to fill out a large form based around these questions, and then be interviewed for around an hour. There may also be reports from doctors, and also a list of diagnoses, medications, and other therapies. The assessor is looking for ways to discount what a person says (e.g. ‘this person says they can’t walk but they can drive for two miles; therefore they can in fact walk’); the sick person is trying to explain why they can’t work whilst also being required to stick only to the questions that the assessor raises, none of which may reflect their specific issues.

Given the nature of the WCA and the type of difficulties that a person has to have in order to be assessed as unfit for work, it is implausible that a substantial number of people in receipt of sickness benefit actually have enough capacity to work at least 16 hours per week. Therefore, it is implausible that there are large numbers of people who both have been assessed as unfit for work and yet falsely believe that they can’t work. Actions taken to address this theoretical problem, such as cutting social security so that such people are financially encouraged (forced) to try work and so discover that they can in fact work, will not have much impact when so few people exist in this category. Instead, it will simply cause severe harm to people who lose income whilst not having the health to do anything to increase their income in response.

In terms of the second category, again we come back to the severity of the WCA threshold. It is implausible that there are many people who have been assessed as unfit for work for whom some employment support will result in a dramatic increase in their capacity for work. When considering such a hypothetical group, it seems that MPs think these are people with depression or anxiety – perhaps caused initially by physical illness, but subsequently by a lack of purpose and activity in life due to being unemployed – and that employment support will give these people hope, purpose, and social activity which will lift their depression/anxiety and result in a return to work.

Presumably, whatever physical illness that led to their initial withdrawal from work is assumed either to have resolved or to have not been a real barrier to work in the first place. However, the type of low-level depression/anxiety envisaged here, which is amenable to improvement through employment support rather than requiring a prolonged course of intensive therapy and medication, would not qualify a person as unfit for work in the first place. Additionally, people who have recovered from illness enough to return to work tend to do so already under their own volition, and do not need to be forced off benefits in order to trigger a return to work.

Category 4 - the most common category: People who are too sick to work

Unsurprisingly, most people assessed as unfit for work by a notoriously harsh fitness to work test are unfit for work. The government, when advocating these changes, still say that only 5% of people claiming these benefits believe that even with support they could currently enter work.

It is not just that person 1 is not very common and persons 2 and 3 largely don’t exist, but that person 4 is the large majority of people on sickness benefit, yet has been completely overlooked. Person 4 is a person with sufficiently severe physical or mental chronic illness that they have reduced capacity not just for work but for activity in general. There are no aids or adaptations that overcome the raw impact of fatigue, illness, and a simple lack of capacity for activity. Employment support can, at best, get such people only into mini-jobs. But it is questionable whether a mini-job, and all the associated pressure and constraints, is the best use of such a person’s limited capacity. It is also questionable whether such mini-jobs really exist in such numbers as would be needed to mitigate cuts to social security for the millions of people who will eventually be affected.

When income is taken away from people in Category 4, they cannot respond by moving into paid work. It is not just that there are vanishingly few fully-remote, fully autonomous, mini-jobs, and so there simply aren’t enough jobs for everyone in group 4. It is also that work itself is often bad for these people. Paid work comes with quality, quantity, and timescale criteria that are not flexible to a person’s health needs. Paid work is also a zero-sum game. Every hour spent in paid work is an hour not spent on caring for health, or on family and friends, or on religious participation, or on hobbies and leisure activities, or even on voluntary work that is sufficiently relaxed that it does meet the flexibility requirements of a sick person. Paid work can be detrimental by taking away from core aspects of what it means to be human, as well as by the undue pressure it places on a sick person.

Conclusion

The government is basing its cuts to social security on an unfounded belief that employment support will see sick and disabled people, who are unfit for work based on the WCA, nevertheless move into work. Instead, the evidence is that the large majority of people assessed as unfit for work by the WCA are not fit for work, and therefore cannot move into work even with employment support. The majority of people who receive ESA or UC HE are people who are long-term sick and who have reduced capacity for activity. Excessive activity is often dangerous for these people as it makes their health worse.

With no attempt to understand the nature of illness and disability experienced by people who would be treated as LCW/LCWRA by the WCA, the government is creating a very dangerous situation. It is also an unprecedented reversal of decades of social security. Governments across the world have recognised that long-term illness and disability that reduces the capacity for work is a reality that needs to be properly assessed and catered for within a functioning welfare state. But this government is intending to remove the concept of long-term incapacity completely from the system, by instead using Daily Living needs as the route to the UC Health Element, so that extra financial support is not based on capacity to work.(3)

1. The work allowance means that people getting the Health Element of Universal Credit can keep the first £400 of earnings each month before their UC starts to be withdrawn. Losing the UC HE means also losing the work allowance, so that UC starts to be withdrawn as soon as any money is earned, and is withdrawn alongside any reduction in Council Tax Support.

2. Sick and disabled people are impacted differently by the cuts, depending on when they first became unable to work. For people who become ill prior to April 2026, their UC HE is frozen at £97/week until at least 2029/30. For people who become ill between April 2026 and April 2028, they are assessed under the Work Capability Assessment, and if they are assessed as unfit for work and unfit for work-related activity then their Health Element is cut by £47 compared to the April 2025 rate of £97/week. For people who become ill after April 2028, those who would have been assessed as LCWRA will lose £97/week compared to the current system if they do not get PIP Daily Living, and will lose £47/week compared to the current system if they do get PIP Daily Living.

3. Pathways to Work Green Paper (2025); page 13, paragraphs 37 and 38; page 28, paragraphs 110 and 114.