Evidence that Labour is ignoring: Additional Work Coach Support

This is the fifth in my series of blog posts looking at the impact of employment support for sick and disabled people. So far, a handful of key trends have emerged:

·      Employment support still fails the majority of people who are sick/disabled but well enough to be deemed fit for work. The majority do not get work despite employment support, and the majority of those who do get work would have done so anyway;

·      Sick and disabled people who have been assessed as unfit for work are very unlikely to move into work with or without employment support;

·      When sick people do move into work, it is usually enabled by an improvement in health. I.e., their health status has changed from too-sick-to-work to well-enough-to-work. It is the level of health that matters, not the amount of employment support.

Additional Work Coach Support.

In the standard jobcentre offer, people waiting for a Work Capability Assessment (pre-WCA) and people who have been assessed as Limited Capability for Work (LCW) but capable of work-related activity are expected to receive 22 minutes of Work Coach support every three months. In AWCS, they were expected to receive 30 minutes of support per fortnight.  In practice, pre-WCA participants had on average a total of 4 appointments, and some had just ten minutes of appointment time per month. LCW participants averaged 6 appointments each, and tended to drop down to 20 minutes once a month, after an initial phase of 30 minutes every fortnight. The reason for the lower level of Work Coach support was that most people were too sick or disabled to benefit from more. This is also why support tended to focus on access to benefits and wider wellbeing rather than employment.

It was intended that people with Limited Capability for Work-Related Activity (LCWRA) would have 30 minutes of appointment time every month. In practice, appointments could be as short as 10 minutes, and typically occurred once every 6 weeks. As with the other groups, the reason for this was the distance from work caused by illness or disability, which meant that employment-related support simply wasn’t appropriate or helpful. People typically received just 4 appointments.

In the qualitative research, 40 interviews were conducted with LCWRA recipients, 30 with LCW, and 20 with pre-WCA. Most interviewees had received five or more appointments and were therefore deemed to be in the ‘late’ stages of support. 27 interviewees had been claiming for over 3 years; 57 interviewees had been claiming for between 100 days and 3 years; and 6 had been claiming for fewer than 100 days (just over 3 months).

AWCS did not seek to improve people’s capacity for work by improving health or health management. Instead, it focused on “helping individuals to develop work search skills and improve their confidence, motivation and attitudes towards work.”

Interviewees saw their health as the key barrier to entering work. For most people, their illness had been ongoing for a number of years, often whilst still in work, and had deteriorated in recent years. Mental illness was more likely to be the primary condition for those still pre-WCA, whilst for LCW/WRAG and LCWRA/SG it was physical illness that was the primary condition. This undermines suggestions from Labour that mental illness is a primary driver of sickness benefit receipt.

Employment outcomes

The available quantitative research on AWCS was not able to analyse the work-related impact of AWCS on pre-WCA or LCW groups. This was because work coaches did not offer AWCS to people with a short-term illness and/or likely to return to work without support. It therefore wasn’t possible to compare ACWS recipients to non-recipients, because the non-recipients were, on average, healthier. This is unfortunate, because the majority of AWCS was directed at pre-WCA people.

For people assessed as having Limited Capability for Work-Related Activity, AWCS had a small positive impact on employment. 12 months after starting AWCS, 11% of LCWRA recipients were in work compared to 8% of those who didn’t receive AWCS. 1/3 of these were working less than 16 hours a week; it is not reported how many of the remaining 2/3 were also not working full-time.

It is noteworthy both that the majority (89%) of LCWRA recipients did not move into work despite AWCS, and that the majority (72%) of those who did get work after AWCS would have done so even without AWCS. There is therefore no evidence here that employment support has a substantial impact on the employment of sick and disabled people. Instead, the evidence is that most people assessed as unfit for work cannot work even after employment support. Yet according to the Green Paper, these figures show that “employment support makes a significant difference to the work prospects of disabled people and people with health conditions”.

The Green Paper also references the Work-Related Activity Group pilots, but neglects to point out that the Work Programme pilots had no impact on work outcomes; the Jobcentre Pilots only increased employment by two months over seven years; the impact of the Jobcentre Pilots had been lost by year seven; and the Jobcentre Pilots made no impact on benefit receipt.

The AWCS qualitative report cites a report on the Personal Support Package as evidence that “with regular support, health journey customers can move towards and into work”. However, the PSP didn’t have a control group. Only 12% of participants moved into work, with 8% or participants working less than 16 hours/week, 3% part-time, and 3% full-time. Some participants found that the work or volunteering opportunities to which they were referred were too demanding for their health; that the support offered was too generic; or that the support offered was too short.

Whilst some employment support programmes return results that are significant in the sense of statistical significance, they are not significant in the sense of having a substantial social impact. They are certainly not adequate to justify a substantial cut to social security for sick and disabled people, when clearly the large majority of these people will not be able to mitigate the financial loss by moving into paid work at all, and those who do move into paid work may not earn enough to overcome the lost social security as well as the costs associated with work, such as commuting and childcare.

The Green Paper says that, “By not designing our benefit pathways around the work ambitions of disabled people and people with health conditions, and by not ensuring people get the support they need, we are at risk of writing off their employment prospects.” But if 8 in 100 people from the LCWRA get work without AWCS, and only 3 in 100 get work because of AWCS, it doesn’t seem like the current system is all that much of a failure. Indeed, the OBR report that 1% of LCWRA and 1.5-2% of LCW move into work each month anyway. People are managing to move into work even without employment support, so employment support has little scope for making a difference.

It is also important to note the difference between ‘move towards’ and ‘move into’ work. Whilst moving towards work may generally be considered a positive outcome for the individual, as it may represent soft outcomes such as improved health management or an increase in social participation, this is not going to mitigate the impact of a cut to social security. When it comes to cutting social security for sick and disabled people, the only outcome that matters is how much paid work a person takes up. Improvements in non-financial wellbeing are good, but compensating for a cut to social security requires a move into paid work that outweighs the lost social security income.

AWCS support

Most interviewees did not feel that AWCS helped them into work or materially closer to work.  Where interviewees did move into work, it was typically at very low levels such as three mornings a week. A couple of interviewees got work following volunteering.

Interviewees did report an improvement in motivation and confidence, but this did not necessarily mean that they felt work ready. Instead, it meant that they felt that they would be ready for work if their health improved. However, it may make more sense to wait until health does improve before offering such support. Otherwise, the gap between ACWS and any improvement in health may be so long as to have eroded any gains in motivation and confidence, whilst any certificates gained may also be so old as to be of limited interest to potential employers.

Support was helpful insofar as it provided a consistent, supportive person outside of a person’s family, with whom they could discuss their issues. Support was also helpful when it enabled people to claim more benefits, such as PIP, Carer’s Allowance, or LCWRA; and when it focused on wider wellbeing rather than employment. Participants also benefited from not being threatened with sanctions. However, some interviewees reported that AWCS made their mental health worse.

One Work Coach is reported as telling a pre-WCA interviewee that “I don't think telling you to get a job right now is going to be of any help to you. You need to get help to get better”. Other work coaches spent time reassuring people that they were worthy of financial support. Advice from Work Coaches is one of the reasons that PIP claims have increased in recent years.

Interviewees who were closer to work were more likely to say that the support was inadequate. They wanted “more intensive support to find appropriate upskilling opportunities and job openings”. Interviewees with severe mental illness or specific conditions such as autism or substance misuse were also more likely to say that their work coach lacked skills to help them. Despite overall positive views of Work Coaches, “effective, personalised referrals to help them develop the right skills, and to find work that aligned with their aspirations” “rarely happened.”

Early intervention

The Green Paper talks about wanting to “entrench early intervention, so there is help for people to recover from, adapt to, or manage their condition so they can return to work – offered at the point it is most likely to make a positive impact.”[1] The idea is that “instead of queuing for a benefit assessment, disabled people and people with a work-limiting health condition will have a support conversation. This will focus on their goals and act as a gateway to a range of personalised support to help achieve them, for anyone who wants it. This support conversation will centre on employment, but in the context of someone’s wider health and independent living aspirations.”[2]

For people pre-WCA, handling their new diagnosis or deterioration in health was their primary focus. They were keen to return to work once they had addressed their health, but addressing their health issues came first. It was important to learn their new limits and how to manage their health well before trying work. Consequently, pre-WCA interviewees typically did not benefit from discussions around work. Instead, they benefited from help focused on health and wider issues, including financial, support.

This undermines the government’s case for ‘early intervention’. By the time someone is waiting for a WCA, they have often already been ill for years. Typically, they have spent several years managing their illness whilst in work, but a recent deterioration forced them out of work. ‘Early intervention’ would mean intervening whilst a person was still in work with an illness or disability, not waiting several years for a person to become so ill as to be unable to work, and then expect that ‘employment support’ will somehow be the answer to a severe chronic illness.

Case studies

The AWCS qualitiative report gives some case studies of how Work Coaches helped participants. Interestingly, they almost all show that people coultn’s work despite ACWS:

·      Alisha had to leave work after her long-standing depression and anxiety became very severe. Although she wants support with a change of career and building her confidence, what her Work Coach actually gave her was help with finances and with accessing support for her mental health. She obtained counselling and therapy separately from Jobcentre support.

·      Peter’s longstanding degenerative back condition forced him to leave work when he could no longer carry out the tasks safely. He got support to make sure he was on the right benefits, but no other support.

·      Jon appreciates chatting with a work coach but he’s currently housebound after complications following a second stroke, and is unlikely to return to work.

·      Amy was helped by her work coach to move into the LCWRA group, and felt validated in her receipt of sickness benefits. By moving into LCWRA and having support from her work coach, Amy is beginning to feel ready to look for work.

·      Elijah isn’t ready for work, but feels that if his health improves in the future then he may be able to make use of the support he’s received at that point.

·      Rebecca got some certificates in transferable work-related skills, but would have liked longer sessions to discuss her health, and emotional support for dealing with long-term unemployment.

·      Clara took up self-employment, but not at a level high enough to make it a viable source of income.

·      Katie got a flexible job, but it doesn’t bring in enough money to affect her benefits.

Conclusion

Additional Work Coach Support has limited impact on employment outcomes for people who are too sick or disabled to work. It is inappropriate for people waiting for a Work Capability Assessment, because these people are typically experiencing a recent deterioration in health and need time to stabilise and learn how to manage their new, lower state of health. Where AWCS was helpful was in providing a consistent, supportive presence; supporting people to claim more disability-related benefits; and offering wider wellbeing support.

[1] Paragraph 46, page 15

[2] Para 49, pg16