The DWP uses all sorts of different names for its programmes, which makes it hard to compare what they’re proposing now to the evidence from what they’ve done in the past. For example, they tried a time-limited version of Individual Placement and Support called Health-Led Employment Trials. This was for people who self-defined as having a mild or moderate mental or physical illness. Given that the government defines ‘severe mental illness’ as any MI that isn’t depression or anxiety, it is possible that people whom the government defined as severe MI were able to participate in this programme as their non-depression, non-anxiety MI was in their own view mild or moderate.
Despite consisting of people with mild or moderate illness, the 9 months of support provided by this programme saw at most 25% of people enter work. This was at one of two sites. The control group at this site saw the same proportion enter work (actually it was 27%, but the difference wasn’t statistically significant). The other site got 22% into work compared to 18% of the control group there. So 9 months of employment support only made a difference of 4 percentage points; and both control and treatment group did worse than at the first site. The researchers suggested that what really made the difference was the availability of jobs in the local area, which was why the first site saw more people enter work regardless of whether they received IPS or not.
Furthermore, employment support providers in this project reported that many of the people whom they sought to help were not ready for work, had serious health conditions, and were impacted by other factors such as a lack of suitable jobs and difficult family circumstances.[1] Some of the employers who offered taster sessions “found the treatment group to be too far from the workplace to be considered for recruitment”.[2] Remember that this is for people who are not so ill as to be unable to work.
Similarly, the government is offering a ‘Universal Support Programme’ for ‘economically inactive long-term sick or disabled people who are experiencing additional barriers to employment’. This is a ‘place and train’ model, which sounds basically like what Individual Placement and Support aims to do. Is this also based on the Health-Led Employment Trials, which proved of very little value to people who were seeking work? Given that this is for ‘economically inactive’ people, i.e. people who are not well enough to be already seeking work, does the government really expect many people to get employment when less-ill people are still ill enough to severely struggle?
When the government did try to help people who are unfit for work yet required to prepare for work, employment support workers reported that this group “had complex support needs and that it was inappropriate for some of them to be on the programme due to the severity of their conditions.”[3] Despite support, there was “minimal employment impacts”; where a return to work was achieved, it was an improvement in health that was pivotal, not the employment support. There was a reduction in the number of days spent receiving benefits, but without a commensurate increase in days spent in employment, this represents a harm not a good.
The government has not offered much detail on its ‘WorkWell’ Service, in particular whether this is for people who are treated as unfit for work or includes jobseekers who experience illness. It aims to help 60,000 people, although it is not clear whether that refers to the number of people expected to participate or the number the DWP expects will “start, stay and succeed in work”. The aim is to integrate health and work support, so perhaps this is an extension of placing Employment Advisers in IAPT, which had the same aim. Or it might be based on the Personal Support Package, of which the Health and Work Conversation is a part, for anyone on a ‘health journey’, which seems to be DWP-language for people who are waiting for a Work Capability Assessment or who have had an assessment and been found unfit for work.
The pilot project for Employment Advisers in IAPT was aimed at people who were not so ill as to be unable to work. They were variously in work but struggling; off sick from a job; or unwell and looking for work. Nevertheless, even for these people, work was “not always the best outcome for an individual and their health; in some cases, work may be exacerbating health issues and for others remaining in work does not give an individual the space to recover their health”.[4]
When the PSP and HWC surveys were carried out, 9% of participants were in paid work. A further 8% (9% of 91%) of participants thought that they could work immediately if the right job and support were available. This means that despite soft outcomes around improved confidence, motivation, or health management after engaging in PSP, 83% still considered themselves to be unable to work. Of those who were in work, the majority were in part-time work, and the majority of those were doing less than 16 hrs/week (permitted work; still in receipt of sickness benefit). However, only 42% reported taking up any of the offered PSP support.
Some of what the PSP offered was health-related services such as CBT or drug recovery support. Healthcare of this sort should not be provided faster just because someone is participating in a DWP programme. Healthcare should be provided as of right and on an equal basis to all people, regardless of their future capacity for work and their current ability or willingness to engage in a government work-related programme.
The PSP achieved some soft outcomes, although less than half of the claimants who responded to the telephone survey on PSP could recall having taken up any of the offers of support (and the survey response rate itself was only 9%). Of those who did respond and who could recall taking up PSP support, the support was generally reported as helpful (75%) and suitable to needs (59%). 46% of these people reported an increase in motivation to find work and 42% said that their confidence had increased. However, other research found that when sick or disabled people did get work, they did not necessarily consider any increases in confidence to have had a causal impact; or they may have felt that improvements in health were more important than any gain in confidence.[5]
The PSP also achieved work-related outcomes for 44% of those who took up support, or less than 22% of all participants. This included 13% (<6.5%) who found work. However, at the time of the PSP survey, only 9% were in work, suggesting that 4% had left work again. For most of these people, the work was part-time, with 8% doing ‘permitted work’ (less than 16 hours/week), 3% in part-time work, and 3% in full-time work. 26% were volunteering and 15% in training or education. There was no control group to see how many would have found work or work-related activity in the absence of PSP (i.e., the report does not comment on work-related outcomes for people who did not take up PSP), but participants did indicate a belief that the PSP had helped them move into work-related activity. In the absence of a control group, and given other pilots that reported little to no employment effect, it would be misleading to attribute more than a small proportion of the 13% to the effects of PSP.
Restart is a 12-month programme for jobseekers who have been looking for work for nine months. The government has announced shortening the wait period to six months. Restart is expected to be more intensive and more tailored than jobcentre support, although this raises the question of why the Jobcentre can’t provide this from the start of a person’s claim. The DWP expects benefits of £2.44 for every £1 spent if just 6 more participants in every 100 obtain work.
The DWP over-estimated how many people would be suitable for Restart, partly due to failing to take into account the complexity of many people’s circumstances, and partly due to post-Covid employment rebounding faster than the DWP expected.[6] From initially paying for 1.4mn spaces and expecting this to be an underestimate, the DWP had to expand the range of people eligible for Restart to get less than half that number on the scheme. Jobcentre staff find only half as many people to be suitable for Restart as the DWP thought.
The DWP does not have a system for recording information about people’s circumstances, such as English as second language, mental or physical illness, homelessness, and childcare needs. This is despite a report in 2019 saying that it was important to be able to identify vulnerable people in this way.[7] The Public Accounts Committee reported concerns that failure in public services, such as mental health care, are being passed onto the DWP which lacks both funding and expertise in these matters.[8] This failure to know very much about jobseekers may explain why the DWP takes such a harsh and punitive approach: it is simply unaware of how difficult many jobseekers’ lives are, and the multiple barriers that people face both to work and to seeking work.
Restart applies sanctions less often than does the Jobcentre. The Public Accounts Committee reports that, “on Restart, work coaches have been told to apply sanctions with care and to encourage voluntary participation and engagement in the first instance” and “DWP has rarely applied sanctions for Restart”.[9] This suggests that the DWP is able to consider, at least sometimes, that sanctions might be counter-productive to the aim of getting people into decent, sustainable work (as opposed to just getting people off benefits, even without them entering work). On the other hand, some Restart providers reported that “DWP’s decision to rarely use sanctions made achieving the standards harder.”[10]
Participants on Restart have to have fortnightly meetings with Restart as well as fortnightly meetings with the jobcentre. As of March 2023, there was no system for keeping Restart and the Jobcentre informed of what the other was doing, apart from the jobseeker telling each side. The fact that both provisions occurred at the same time makes it difficult to attribute any given job outcome to Restart. A job outcome is any work of 16 hours or more at the minimum wage that has been sustained for six months, within 18 months of starting on Restart.
The NAO and Committee of Public Accounts both reported observing good quality advice from Jobcentre and Restart advisers. However, the claimant experience has repeatedly been reported as the opposite of this, with many claimants being inappropriately sanctioned. In future, when NAO and Committee review government projects, it would be appropriate to speak to the people affected by the project, and to make efforts to check for adverse consequences.
Conservative governments have previously tried forcing jobseekers into unpaid work placements for private companies. This received a lot of condemnation at the time, for a number of reasons including 1) the low-skilled nature of the work meant that such placements added nothing to an individual’s skills compared to other activity in which they could engage; and 2) it is inappropriate for private companies to profit from such schemes. If a private company has space for an additional worker, it should pay for that worker at the appropriate wage (I.e. at least the minimum wage, if not the real living wage). The government should not be subsidising private companies.
There are a range of superior options available to the government. One is to enable and support people to engage in voluntary work in their local community. A person could be supported to do 15-20 hours of voluntary community work, which is an appropriate amount of activity given the amount of benefits paid by the government, and leaves people with time to continue to search for a paid job. The government currently limits volunteering to 17.5hours, or half of the mandated 35 hours of job search and work-related activity, because it fears letting people engage in activity without also insisting on job applications. It is inconsistent to then not worry about this factor when requiring people to take up full-time work for a private company.
Voluntary activity has a number of benefits over mandatory work placements. It is much easier to tailor to the individual, suiting them in terms of location, hours, and nature of the work done in accordance with their skills and interests. It is often more flexible, allowing people to work out what is suitable for them and fit activity in around the other demands on their time, such as health needs and caring duties. It benefits the local community by allowing useful activity to occur that would otherwise go undone, and bringing value to the person engaging in it because they can see the worth of what they are doing. It is meaningful to employers, precisely because it was chosen and not imposed. It can occur long-term, until a person finds a job, rather than being a short placement whose value shrinks even further the longer a person continues without a paid job after finishing a work placement.
The government is introducing a ‘claimant review point’ for people who have completed Restart without finding a job. These people will have been unemployed for 18 months at this point. The CRP seems to be based on the assumption that the primary reason for someone not finding a job is lack of effort. Consequently, the appropriate government response is to force someone to make more effort.
However, the National Audit Office reported that the DWP does not attempt to collate information on claimants’ circumstances, such as homelessness, mental illness, or English as a second language. Consequently, the DWP is unaware of the characteristics of benefit recipients in general, or long-term unemployed people in particular. It is therefore not safe for the government to assume that these are healthy people with no challenging circumstances who simply haven’t bothered to look for work hard enough.
The risk is that these are instead some of our most vulnerable people: people who are experiencing any of a range of challenges, but those challenges aren’t recognised by the system because they either aren’t severe enough or because they don’t fit the criteria for receiving an easement on conditionality or being placed in a lower conditionality group. These people could be homeless, in temporary accommodation, moving location frequently, sick, disabled, caring for children or a disabled person but not treated as the main carer, struggling with drug or alcohol addiction, have limited English, or experience other problems that make seeking work challenging. They may even experience several of these problems at once. But because these problems aren’t recognised, these people are vulnerable to sanction and to inappropriate conditionality.
To impose even stricter conditions on these people – after increasing conditions at the 7-week mark, and again at the 6-month mark – under the threat of closing the claim completely if these conditions aren’t complied with is to risk completely misreading the nature of these people’s circumstances, and to cause extremely severe harm to struggling people.
The government intends to increase conditionality at 7-weeks, including through the use of mandatory work placements, have been covered in this and the above section.
The government intends to make sanctions tougher have all the same issues as described above. The government simply doesn’t know who the people are to whom it wishes to apply these harsh sanctions. It may be that the government assumes that people who only get the standard allowance of Universal Credit without any child, disability, caring, or housing element are predominantly young people living with their parents. But they could also be people living in temporary accommodation, domestic violence refuges, or sheltered accommodation. They could be people with chronic illness or disability that isn’t severe enough to be recognised by the Work Capability Assessment. They could have caring duties that they share with another person, so their caring isn’t recognised by UC. They could be people living insecure, chaotic lives on very little money. These people could easily struggle to comply with UC conditionality whilst desperately needing the money in order to live, and find themselves on an open-ended sanction because of inappropriate conditionality with which it was not possible for them to comply. The severe harm caused by kicking such people off benefits completely ought to be enough to stop the government from enacting such a policy at all, even if people at such risk represented only a small proportion of those on open-ended sanctions whilst receiving no additional UC elements.
The government has talked for many years about reforming the fit note process. Its primary problem seems to be that doctors see sick notes as a valuable therapeutic tool, rather than taking the government line that work is a way to improve someone’s health. It should be obvious that if someone is struggling to maintain work due to illness, then that work is not acting as a cure of illness.
The government has hinted at taking sick notes away from GPs and other healthcare professionals, and placing them in the hands of work coaches. This is not only professionally inappropriate, given that non-medics cannot assess a person’s health, but it is ethically flawed. It would be a major conflict of interest for the government to be involved in deciding who can receive a sick note and who cannot. The government is already involved in this process, at the point of a Work Capability Assessment, but this is a much more detailed assessment than the signing or not of a sick note, and it is still carried out by medical professionals.
During Covid, the government expressed surprise that people would attend work whilst sick. This is a well-known problem that may even cost society more than the cost of taking leave when sick. This is because quality and quantity of work falls when someone is sick, and because trying to work whilst sick can prolong and exacerbate illness. The government should be more concerned with ensuring that people are able to take appropriate leave when sick, and are able to get timely and quality healthcare to return them to maximum health.
It is good to see the government intend to increase access to NHS talking therapies. However, the government seems to be remarkably unambitious in this. 384,000 over 5 years is less than 77,000 people per year. NHS Taking Therapies served nearly 1.2 million people in 2021/22.[11] Adding 77,000 to this is an increase of only 6.4%. NHS Talking Therapies are largely self-help and CBT-based,[12] but there are a large range of other therapeutic approaches available, and a good counsellor or therapist is trained in a number of approaches in order to be able to select the appropriate one for the person in front of them. There is also a risk of losing out on much of the value of therapy, which often stems in large part from the quality of the relationship with the therapist, when that ‘therapy’ is self-help, computerised CBT, or group work.
[1] Newton, Gloster and Hofman (2023) Health-led Employment Trial Evaluation: Synthesis
[2] Elmore J, Gloster R, Clayton N and Newton B (2022) Health-led Employment Trial Evaluation 12-month outcomes report: Theory-based evaluation. DWP
[3] Dawson and Smithers (2019) Employment & Support Allowance: Evaluation of pilots to support Work-Related Activity Group customers with an 18 to 24 month re-referral period. A synthesis of evidence. DWP
[4] Adams L, Foster R et al (2022) Employment Advisers in Improving Access to Psychological Therapies Client Research. DWP
[5] Elmore et al (2022)
[6] National Audit Office (2023) The Restart scheme for long‑term unemployed people.
[7] Prime Minister’s Implementation Unit (2019) How effective is support for vulnerable Universal Credit claimants?
[8] Committee of Public Accounts (2023) The Restart Scheme for long-term unemployed people. Forty-Second Report of Session 2022–23 Pg34
[9] NAO (2023) Pg34
[10] NAO (2023) Pg 43
[12] Table 2 in the NHS Talking Therapies Manual