Introduction
Despite recent attempts by UK policymakers to restrict access to incapacity and disability benefits (DBs),1 claimant numbers remain high by historical comparison, with approximately 2.4 million people receiving these forms of income support in 2014. The need for policy action to assist people on DBs is not disputed. Spending long periods on these benefits has been associated with further deteriorations in health (Bambra 2011); the meagreness of payment rates in countries such as the UK means that claimants experience increased poverty risks (Kemp and Davidson 2010); and exclusion from work may undermine individuals' employability (Green and Shuttleworth 2013). However, there remain concerns that current policy agendas are not equal to the task of moving large numbers of people from DBs into sustainable employment. Indeed, the main focus of UK Government policy appears to be on restricting access to DBs by tightening eligibility criteria and means-testing. There appears little sign of a coherent strategy to enhance the employability and health of those already on benefits (other than directing claimants to a generic, compulsory activation programme â The Work Programme â or other forms of âwork-related activityâ) (Lindsay and Houston 2013).
This article aims to offer direction on more productive foci for welfare reform and activation policies. We do this by reviewing the latest evidence on the ânature of the problemâ (i.e. the factors contributing to high levels of DBs among some groups and communities); analyzing the appropriateness of current and recent policies in responding to these factors; and (briefly) contrasting the UK's approach with that of Denmark, which has deployed a different set of policy instruments in its efforts to reduce DB numbers. In order to conduct this analysis of the nature of the problem and evaluation of policy solutions, we carried out a structured literature and evidence review identifying the most robust evidence from both academic sources and policy stakeholders. We used online search engines to identify key research and policy publications with keywords including âactivationâ, âactive labour market programmeâ, âincapacity benefitsâ, âdisability benefitsâ, âwelfare-to-workâ, and variants on these themes. Following a preliminary thematic review of outputs, we selected out key research reports and academic publications to provide the focus for our analysis because of their specific interest in the challenges, outcomes, benefits, limitations and lessons from employability programmes targeting those on DBs. The reliability of this approach was strengthened by its coverage of research from a range of disciplines (reflecting the multi-disciplinary expertise of the authors) including economic geography, social policy, clinical psychology and public health policy analysis. Our findings are presented below. The analysis also draws on the latest research published in this Special Issue of Social Policy & Administration. The article then concludes with a discussion of implications for future policy development.
Assessing the Evidence Base: Factors behind Concentrations of Disability Claiming
Over the past decade, successive UK Governments have deployed relatively consistent policies to address high levels of DB claiming. The focus of policy has been on restricting access to, and increasing the conditionality associated with, welfare benefits, along with a greater emphasis on activation, first under the Pathways to Work (PtW) initiative (2003â10) and now the Work Programme, the main activation programme for people of working age. However, it has been suggested that the general thrust of policy fails to address the complex combination of factors that explain concentrations of dB claiming (Beatty et al. 2009). Following Lindsay's and Houston's (2013) line of argument, we now assess the latest evidence on the extent to which three key issues can be identified as underlying the high level of DBs claiming in the UK, namely: concentrations of health and disability-related barriers among the claimant group; gaps in their employability and skills; and labour market inequalities and the impact of low quality work on opportunities for people with health and disability-related limitations. We then go on to discuss the failure of policymakers to develop joined-up, spatially-focused solutions to these problems.
Health and disability-related barriers
One of the distinctive features of the discourse around DBs in the UK is policymakers' reluctance to fully acknowledge that those claiming these benefits are, indeed, sick or disabled. Policymakers partly justified this position with reference to a well-established evidence base suggesting that industrial restructuring and job destruction in regions dependent on traditional employment sectors preceded increases in DB claiming. Seminal works during the mid-1990s by Beatty and Fothergill (1994) and Green (1994) identified concentrations of DB growth in post-industrial labour markets, suggesting that Incapacity Benefit (IB, then the main DB) was absorbing displaced workers and hiding the real level of unemployment. These authors wished to expose the âhidden unemploymentâ problem in order to demonstrate the need for regional demand-side policies to generate more job opportunities for those trapped on benefits (Beatty et al. 2000), but their argument has been appropriated by the political right as evidence of malingering (CSJ 2009).
Yet this is a misrepresentation of both the evidence and the argument. Indeed, Beatty et al.'s (2000, 2009) seminal âtheory of employment, unemployment and sicknessâ hypothesized that âhidden sicknessâ was as important as âhidden unemploymentâ in explaining high disability claiming in some regions. They argued that there is substantial ill-health and work-limiting disability throughout the labour force â among those in work, jobseekers who are available for work, and those receiving DBs. Labour market conditions decide whether those with health or disability-related barriers are able to find their way into work (due to employers' willingness to adjust their demands in tight labour markets) and manage their conditions in the workplace. But this need not lead us to conclude those on DBs are feigning illness.
Rather, there is substantial evidence as to the reality of the health and disability-related problems faced by people claiming DBs. Ill-health or limiting disability is consistently found as the primary reason why most DB claimants exit work in the first place, with extant health conditions then also a key barrier to return to work (Beatty et al. 2010; Kemp and Davidson 2010). Claimants with multiple and/or more serious conditions are significantly more likely to be âpermanently sickâ (i.e. remain on benefits), in contrast to those with fewer conditions who are more likely to find work (Barnes and Sissons 2013). For those re-entering employment following a period on DB, but then failing to sustain work, a decline in health is a common feature (Dixon and Warrener 2008). Large-scale national population surveys such as the British Household Panel Survey (BHPS) suggest robust and long-term relationships between health and exclusion from work (Jones et al. 2010), although as noted elsewhere in this Special Issue these data also highlight the importance of interactions between ill-health and spatial labour demand inequalities (Whittaker and Sutton 2015). Robroek et al.'s (2013) analysis of older workers' trajectories in 11 countries based on the âSurvey of Health, Ageing, and Retirement in Europeâ confirms that poor health and health behaviours as well as other work-related factors may all play a role in exits from paid employment, although their significance may vary according to exit routes. There is a significant relationship between DB claiming and physical (Bambra 2011) and psychiatric mortality (McKee-Ryan et al. 2005).
National Health Service (NHS) professionals working with DB claimants confirm evidence of a broad range of interacting and comorbid health problems and disabilities (Lindsay and Dutton 2013). Other researchers have similarly used accepted clinical tools (such as the âHospital Anxiety and Depression Scaleâ) to identify significantly poorer health among the DB claimant population that appears resistant to increasing exposure to conditionality and/or âincentivesâ as part of changes to the benefits system (Garthwaite et al. 2014). Purdie and Kellett (2015) evidence the pre-treatment severity of health problems and also register rates of associated clinically significant improvements following interventions to enable claimants to better manage their conditions. However, Rick et al. (2008) note that there are few well supported conclusions that can be made concerning the efficacy of health interventions to help DB recipients return to work, because the extant studies lacked credible outcome methodologies. Therefore, more methodologically robust outcome studies of health interventions with distressed claimants need to be conducted, in order to enable further meta-analytic perspectives to be taken. In summary, there is powerful evidence that health and disability-related limitations reported by those on DBs are real and an ongoing aspect of life without work. As we confirm below, other factors â and crucially the nature and extent of labour demand â tend to define whether such health and disability-related barriers can be managed in the workplace, or alternatively exclude people from the world of work.
Employability-related barriers
We see above that, contrary to some policymakers' claims, health and disability-related barriers are key to understanding the nature of the DB problem. Yet, successive UK Governments have been keener to portray the problem as rooted in the attitudes and behaviour of claimants. As we see below, increased conditionality and compulsion in the DB system appear to reflect a consensus among policymakers on the need to use financial incentives and punitive sanctions âto generate positive behavioural effectsâ (DWP 2010: 10). From a behavioural theory point of view, policymakers rely heavily (or exclusively) on punishment, as opposed to reward contingencies, as a means of changing the work behaviours of DB claimants.
The evidence for the existence of a âdependency cultureâ among DB claimants is, however, limited. Beatty et al.âs (2010) extensive survey research with DB claimants deployed a raft of attitudinal questions to assess work beliefs and found little evidence for negative or low levels of work commitment. Nor were DB claimants expert in âplaying the system (i.e. particularly knowledgeable about benefit regulations). Such findings enhance a long-established evidence base contradicting the rhetoric of individual claimants âchoosing to live on benefitsâ and popular myths of families defined and populated by multiple generations of the unemployed (Shildrick et al. 2012). Rather, evidence from in-depth research with DB claimants finds recurring themes of poverty and insecurity whilst struggling financially to survive on benefits, with experiences of the benefits system (and especially increasing conditionality) defined by stigma and distress (Garthwaite et al. 2014).
That said, people on DBs tend to hold a variety of views about work. Green and Shuttleworth (2013) found that a range of factors (most notably age and health) shape claimants' optimism and level of commitment to work. Kemp's and Davidson's (2010) longitudinal research similarly identified differences in levels of work commitment amongst the DB group, although other variables related to health and employability were much more powerful predictors of individuals' chances of returning to the labour market. Webster et al. (2013) argue that perceptions of the severity of limitations imposed by health conditions and the state of the local labour market can interact to produce pessimistic self-evaluations of both health and employability.
So attitudes to work vary considerably â but there is limited evidence that individual motivation or commitment are decisive in explaining the significant labour market exclusion experienced by those on DBs. Nevertheless, there is stronger evidence that long-term DB claimants face a complex range of other employability-related barriers to work. Extensive survey work with those on DBs demonstrates that they are significantly more likely to report basic skills problems, low levels of qualification, gaps in work experience, repeated periods of unemployment and limited social network ties to those in work (Beatty et al. 2010, 2013; Green and Shuttleworth 2013; Kemp and Davidson 2010; Barnes and Sissons 20...
