The current Labour government is very keen for people with chronic illness to somehow move into work. Despite all the evidence which shows that people assessed as unfit for work are, indeed, unfit for work, Labour think that if they just take away half of the living-costs element of our social security and tell us that we must engage with work preparation, then suddenly we’ll find that we’re able to work after all. The fact that people who are deemed less sick (i.e., those who already don’t get the extra living-costs money and already have to prepare for work, but are still unfit for work) are very unlikely to move into paid work doesn’t seem to matter. Apparently the same treatment for an even sicker, more disabled group of people will have different results.
In light of this, I thought it would be helpful to review some of the DWP’s own research on getting sick and disabled people into work. For a long time I’ve wanted to do a proper literature/systematic review of DWP research reports, but I lack the health. So I thought I’d try a simpler version, where I just give a summary of the some of the DWP’s most relevant research. This is all from work done under Tory governments, but that’s not a reason for Labour to ignore it, any more than the Tories should have ignored research done under previous Labour governments.
This blog is looking at the Work and Health Programme Evaluation Report 2023. In particular, I’m looking at the ‘disability group’, which was comprised of “Disabled people as defined by the Equality Act 2010 and who have been identified as being capable of finding work within a year of starting the programme.” That latter phrase is important, because it indicates the relative level of sickness and disability present in this group. These are people deemed (by some unspecified process[1]) to be on an upward trajectory with their health, such that they’ll be capable not just of working but of actually having had time to find work within twelve months. The Disability Group (DG) was also voluntary, which means that it was likely comprised of a self-selecting group of people who were themselves optimistic about their health trajectory. Additionally, it was not restricted to people who were assessed as unfit for work, and could therefore be predominantly made up of people who had been assessed as fit for work despite their disabled status. Unfortunately, the report does not comment on people’s status as regards the Work Capability Assessment.
Interestingly, only 68% of those referred to the W&HP actually started (this includes people from non-DG referrals). Most of the data reported does not separate out the DG from the ‘early access group’, which reduces the usefulness of the data for the purposes of sick and disabled people.
Sometimes, people were referred to the programme who were not suitable for it. This was most often because a person was not deemed likely to be able to find work within a year. Programme providers reported that they had been over-optimistic in their bids regarding how many people they could get into work. Staff also found that participants had more complex needs than they had anticipated, with 80% saying that participants’ needs were a little (26%) or a lot (54%) more complex than they had anticipated, and just 1% saying needs were less complex.
11% of voluntary participants had disengaged by three months into the programme, despite these being both voluntary and expected to be able to find work within a year. Sometimes this was because a person had moved location or found a job, but for other people it was because of poor health or life crises. The report did not investigate the percentages belonging to each reason.
Prolonged illness was common even amongst the non-disabled referral groups, with 55% of mandatory participants and 47% of early-access (EAG) participants reporting a health condition, disability, or illness expected to last at least six months at the time of the Wave 2 survey (around 18-24 months after referral[2]). Interestingly, 26% of DG participants did not report a prolonged health condition at the time of the Wave 2 survey. It is possible that these people had recovered over the 18-24 months since referral, or that they had a different understanding of long-term health condition compared to that used in the recruitment. Given that this group was expected to be well enough to work within 12 months, one might have expected the level of illness amongst the DG group to be closer to that of the EAG and mandatory groups by this point. Unfortunately, this issue was not explored.
Of those who had a health condition likely to last at least six months at Wave 2 (18-24 months after referral), over half reported being worried that they wouldn’t be able to stay in a job. This means that around 40% of those expected to be well enough to work within 12 months were still worried that they couldn’t sustain work after 18-24 months on the programme. People were more likely to express concern about work if they had worse health.
At Wave 2 (18-24 months after starting; 6-12 months after being expected to be well enough to have found work), 52% of voluntary participants reported that their health was a barrier to work, and for 43% this was their main barrier. A further 11% (on top of the 43%) cited Covid-related barriers as their main barrier to work. For DG only, 54% gave health as their main barrier. There was little difference between the W&HP participants and control group on any of the barriers, indicating that the W&HP not only didn’t materially impact health (some of the Theory of Change for the DWP seems to be that employment support will improve people’s wellbeing and health), but also didn’t influence other barriers that might have been amenable to change, such as self-confidence, skills, and motivation. However, these were not commonly cited as barriers to work, and therefore there was little scope for the W&HP to have an impact by changing them. Interestingly, low self-confidence was more likely to be cited as a barrier by those in employment rather than by those not in employment, which raises questions about the relevance of low self-confidence as a ‘barrier’ to getting and maintaining work.
On the key measure of job outcomes, 19% of the voluntary group were in work 18-24 months after referral. A further 8% had been in but subsequently left work, but the reasons for leaving work were not investigated. A little over half of those who were still in work were working part-time, potentially indicating ongoing health restrictions; however, the reasons for working part-time were not investigated. In the control group, 16% were in paid work 18-24 months later. This was statistically significant, but nevertheless is only a small social difference: 100 people would have to go through the Work and Health Programme just to get 3 more people into work compared to the absence of the W&HP.
22% of voluntary participants were not looking for work due to their health or disability, despite having been assessed 18-24 months previously as likely to be able to find work within 12 months. 10% were unemployment and not looking for work, and 10% gave ‘don’t know’. Just 37% of the voluntary group were primarily looking for work after 18-24 months on the programme, meaning that overall 54% of this group were in or looking for work and 46% were not working or looking for work. Again, this is despite this being a group of people expected to be able to find work within 12 months, i.e. 6-12 months prior to these results. There was no difference between the W&HP group and the control group for the proportion in work at 18-24 months. The voluntary W&HP group was more likely to have been in work at some point compared to the voluntary control group (27% vs 22%), but the lack of sustained employment raises questions over the health capacity of these people to sustain work, and whether the short period in work was genuinely beneficial or perhaps caused a deterioration in health.
Employability characteristics such as confidence and interpersonal skills were moderately high amongst all participants, and did not change over the course of the W&HP. Given that the DWP thinks that helping sick and disabled people with CV writing and interview skills will materially impact their ability to work, it is noteworthy both that over 70% of voluntary participants were confident in job-search and job-application skills; and that the W&HP had no impact on these areas. Furthermore, participants with a long-term illness or disability were less likely to say that the W&HP helped with motivation or chances of finding suitable work.
Voluntary participants were aware that, in general, work is mostly good for health. The W&HP had no impact on this belief. The W&HP did have a small impact on concerns about employability, with 60% of voluntary participants being worried that employers wouldn’t employ them compared to 65% of the control group. Similar numbers, with no statistical difference between participant and control groups, remained concerned that their health would prevent them from remaining in work.
The voluntary nature of the W&HP was seen as important, as was the extended time available and the longevity of support.
Overall, the report shows that long-term sick and disabled people who have been both assessed and self-assessed as likely to be able to move into work within twelve months are not, in fact, able to move into work in twelve months. Key assumptions – around improvements in health or the ability of ‘employment support’ to change a sick or disabled person’s capacity for work without a change in health – were not met. Nearly half had stopped working or looking for work, and of the 18% who were in work over half of these only worked part-time.
[1] The Work Capability Assessment splits people into two groups: those deemed to have Limited Capability for Work but capable of work-related activity; and those deemed to have both Limited Capability for Work and Limited Capability for Work-Related Activity. In theory, the former group are on an upward trajectory in their health, such that once they’ve prepared for work they’ll also be healthy enough for it. In practice, the decision is based on current severity and has nothing to do with whether a person is getting better, staying the same, or getting worse.
[2] The Wave One survey aimed to carry out interviews around 3 months after referral, during February 2019 to March 2020. The Wave Two survey was carried out between September 2020 and June 2021, around 22 months after referral to the programme. Pg69 gives this as 18-24 months after referral.Can
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