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� Incapacity Benefit Changes
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Elsewhere on the website you will see SDEF’s Comments on the Green Paper on Welfare Reform. This was posted on 24th January 2006.�
While we welcome enhanced prospects for social inclusion and equality, SDEF is clear that changes must be introduced with the support of those affected. Naturally, there will be concern amongst people receiving Incapacity Benefit if they believe that reform is being introduced for reasons other than improving their life opportunities. �
In late November 2005, SDEF was invited to a conference on the subject. The report below was written shortly afterwards. It gives an indication of the approach which has been taken in pilot areas and the thinking behind the proposed reforms. SDEF suggests that the sensitivity with which any changes go ahead will be key, but notes here the discussions which took place at the event.
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������ Reforming Incapacity Benefit
������������� Conference�
Monday 28th November 2005
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This is a report and commentary on the above event. The conference was chaired by Lord Archie Kirkwood, former Chairman of the Department for Work and Pensions (DWP) Select Committee and addressed by Margaret Hodge MP, Minister of State for Employment and Welfare Reform at the DWP. There were additional contributions from Terry Rooney MP, the current Chairman of the DWP Select Committee and from representatives of the Department of Health (DoH), Disability Rights Commission (DRC), the Shaw Trust, the Health and Safety Executive (HSE), JobCentre Plus, Disability Matters Ltd, the Chief Medical Officer of an insurance company and the Professor of Psychosocial and Disability Research at Cardiff University.
Incapacity Benefit (IB) was introduced in April 1995 to replace Sickness Benefit and Invalidity Benefit and is paid to people unable to work who have made qualifying contributions. There are three rates, two of which are short-term. The lower short-term rate (�57.65) is paid for the first 28 weeks of sickness and the higher (�68.20) for the remaining weeks of year one. The long-term rate (�76.45) is paid to people incapacitated for more than a year. There are supplements related to age and responsibility for dependent adults and children.
Despite government measures to assist people with disabilities to re-enter the jobs market, notably the “New Deal for Disabled People”, only around 50% of people with disabilities are employed. The aim is to increase this to 80%, as in Scandinavia. There are currently 2,700,000 people in receipt of IB in the UK (just under 7% of those of working age), in contrast to around 900,000 who claim Job Seekers Allowance (JSA).
In the coming years, a number of demographic changes will begin to influence patterns of employment, this partly driving the imperative for change, along with new duties to promote disability equality and life opportunities.
At present four workers support each pensioner: by 2055 it will be two workers. Raising the retirement age for women will reduce the increase in people of pensionable age, but would, in the absence of change, also swell the numbers of those eligible to claim IB by up to 300,000. Any future policy to increase the state retirement age beyond 65 would have a similar effect.
It was suggested that, at the time of applying for the benefit, 90% of claimants anticipate resuming work. However, once people had been on IB for a year, their chances of returning diminished markedly. The average period of claiming the benefit is currently nine years and half of those who remain on IB for more than two years never go back to work.
It was proposed that these circumstances do not simply reduce access to full social and financial equality for claimants, but that they are also a positive health risk. A number of papers were cited which suggested that people who leave work prematurely have diminished life expectancy. Worklessness can increase personal isolation and exacerbate health problems such as smoking and obesity.� Moreover, IB was viewed as endorsing the medical model of disability, ascribing the incapacity to individuals, while failing to make the necessary social adjustments to accommodate their needs.
From all perspectives, the drive for change seems irresistible. There is to be a much delayed Green Paper on the subject in January 2006. As may be known, seven “Pathways to Work” schemes have been piloted in recent years to assist IB claimants get back to work. Since October 2003 these have been established in Derbyshire; Renfrewshire, Inverclyde, Argyll & Bute; and Bridgend, Rhondda, Cynon & Taff. These were augmented in April 2004 by projects in East Lancashire; Somerset; Essex; and Gateshead & South Tyneside. The programme and its planned extension will be discussed below. However, the principle upon which it is based involves the use of a Personal Advisor to identify what people can do, rather than focus on their limitations.� The Advisor then works closely with the individual to address barriers to work, using a variety of provision.
The three most prevalent health problems affecting IB claimants are: mental health (44%); musculoskeletal (25%); and cardio-respiratory (10%). It has been estimated that less than 25% of those on IB have a severe medical condition. Common difficulties such as stress, depression, neck and lower back pain in their less severe forms were also present, their incidence, moreover, being mirrored in studies of general populations and samples of hospital outpatients.
These findings do not minimise the difficulties faced by people receiving IB; they simply highlight the opportunities for people to resume normal patterns of activity, social inclusion and financial stability, with appropriate assistance. Nor do they suggest a lesser role for clinical intervention; they make the case for earlier treatment to avoid a condition becoming chronic and for clinical management to be matched by psychological and social support.
It may be fair to ask whether the medical resources required for early intervention would be available in such areas as cognitive behavioural therapy and physiotherapy, how quickly they could be marshalled and what the impact would be on clinical services for those not on IB. However, the intention is clearly to provide a service to prevent the development of chronic incapacity.
The aim is to extend the current pilots on a gradual basis, with a view to covering 1/3 of the country by October 2008. The Programme will continue to be focussed on partnership working, involving the individual, employers, NHS Primary Care and Jobcentre Plus. An underlying principle is that work can promote health and offer opportunities for fulfilment and social involvement. A second is that rehabilitation in its widest sense may involve more than removal of acute symptoms: it can also entail providing support to rebuild confidence or develop skills to assist a return to work.
In the “Pathways to Work” areas, new claimants are required to attend a work focussed interview with a Personal Advisor after eight weeks. They also undergo a “Personal Capability Assessment” and an action plan is agreed. Up to five further interviews may be carried out, where individuals most likely to benefit from the programme are identified and the most appropriate courses of action agreed.
All participants have access to the range of Jobcentre Plus resources, these including: “New Deal for Disabled People”; “Work Preparation”; “Workstep” (supported employment); “Job Introduction Scheme”; “Work Trials”; “Work Based Learning for Adults” (England & Wales) and “Training for Work” (Scotland). They may also volunteer to take part in the “Condition Management Programme” described below and can receive �40 per week “Return to Work Credit” for one year, should they work for at least 16 hours per and earn less than �15,000 pa.
In the pilot areas the numbers of those on IB returning to work, or taking some of the nationally available preparatory steps described, exceed those recorded elsewhere. At the time of writing, around 150,000 people have taken part in “Pathways to Work”, of whom approximately 20,000 have re-entered employment; 7,500 have taken part in the “Condition Management Programme”; and 11,500 have accepted the “Return to Work Credit”. It has also been noted that, the majority of those receiving it for the full year remained in work once the Credit had expired. One general caveat to enter, however, is that the resources available in the pilot areas may not be matched as the programme is implemented more widely and these figures may not be replicated nationally.
The “Condition Management Programme” is delivered jointly by Jobcentre Plus and local NHS providers and is fully funded by the former. Participation is wholly voluntary. The process begins with an assessment of the individual’s condition and how it affects daily functioning. Other barriers such as lack of childcare or transport and cultural issues may also be identified. Participants have access to a range of modular interventions lasting between four and thirteen weeks, both on a one to one basis or in group sessions. The modules vary but may include: stress and anxiety management; pain management; confidence building; pacing and goal setting; healthy lifestyle advice; relaxation techniques; and exercise programmes. There is a recognition that health issues are complex, that other factors may be present and that the traditional path of, diagnosis, treatment and early return to work can often fail.
Delivery of the “Condition Management Programme” varies, but most areas have recruited a range of professionals to implement the programme, these including: physiotherapists; occupational therapists; mental health counsellors; and administrative staff.
The service is delivered in locations, where possible outwith the NHS, including: local community venues; leisure centres; cafes; local business offices; and Jobcentre Plus.
The Government has clearly decided that there is to be a concerted effort to assist people to return to work. This initiative is mirrored by a desire to encourage up to 300,000 lone parents and 1,000,000 older people to re-enter the jobs market. While this may create suspicion amongst many, there are also clearly issues of social inclusion for affected individuals.
One million people on IB have expressed a desire to work and access to employment provides opportunities for physical, mental and financial wellbeing. It is also clearly undesirable that people with short-term acute difficulties, or chronic problems present within the general population, should find themselves without work for periods of years. The average period of worklessness for those on IB or preceding benefits has trebled in the last twenty years from three to nine years.
Whatever the motivation, the Government is clearly mobilising considerable resources to tackle the difficulty. For many, the additional opportunities will prove welcome. Much will depend on the sensitivity with which the programme is developed and the element of compulsion. However, measures should be encouraged which lift people from circumstances in which benefit averages less than a quarter of the average wage and opportunities are absent for using skills and talents.
Wyn Merrells
December 2005
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