Work and Pensions Committee
Oral evidence: Get Britain Working: Pathways to Work, HC 837
Tuesday 22 April 2025
Ordered by the House of Commons to be published on 22 April 2025.
Watch the meeting
Members present: Debbie Abrahams (Chair); Johanna Baxter; Steve Darling; Danny Kruger; John Milne; David Pinto-Duschinsky.
Questions 1 - 42
Witnesses
I: Tom Pollard, Head of Social Policy, New Economics Foundation; Ben Baumberg Geiger, Professor in Social Science and Health, King’s College London; Ruth Curtice, Chief Executive, Resolution Foundation; and Jean-André Prager, Senior Fellow, Policy Exchange.
II: Iain Porter, Senior Policy Adviser, Joseph Rowntree Foundation; Ruth Patrick, Professor of Social Policy, University of York; and Angela Matthews, Director of Public Policy and Research, Business Disability Forum.
Witnesses: Tom Pollard, Ben Baumberg Geiger, Ruth Curtice and Jean-André Prager.
Chair: A very warm welcome to the first oral evidence session of our inquiry into pathways to work. It is a pleasure to welcome our panel of witnesses today. We will start with Tom Pollard and go down the panel line.
Tom Pollard: I am Tom Pollard. I am the head of social policy at the New Economics Foundation. I also work as a mental health social worker in the NHS and was formerly an adviser on mental health at DWP.
Ruth Curtice: I am Ruth Curtice. I am the chief executive of the Resolution Foundation.
Jean-André Prager: I am Jean-André Prager. I am a senior fellow at Policy Exchange. Previously I was a special adviser to the Prime Minister on welfare policy.
Ben Baumberg Geiger: I am Ben Baumberg Geiger. I am a professor of social science and health at King’s College London. For a while, about a decade ago, I worked on secondment in the DWP.
Q1 Chair: As I say, a very warm welcome to you. I will kick off and then we have some questions to ask you. My questions are specifically about the drivers behind the rise in caseloads we are seeing in incapacity and disability benefits and what you see those drivers as, and in particular about the discussion around the impact of health status and other factors affecting caseload levels. Who would like to kick off?
Ruth Curtice: I am happy to kick off, because I suspect that others have more detail than me. Two trends stand out in terms of the rising caseload for health and disability specifically. One is the rise in the numbers of PIP or disability benefit-related claims for mental health, with nearly a doubling since the pandemic.
The second relates to young people. I think it is helpful to be quite specific on young people. For disability benefit, the striking rise is among teenagers. For incapacity benefit, the rise has been among those in their early 20s—the under-25s. When we come to policy, that distinction is important.
You would expect some of that rise from an ageing population. You would expect some rise in health and incapacity-related benefits. The levels of the rises clearly go above what you would expect just for ageing, but there is wider evidence, that Ben and others are more expert in than me, that there are underlying health issues—an ailing population as well as an ageing one—which would also contribute to these numbers.
Jean-André Prager: I am sure that Ben and others will talk about the health issues and whether the population has got less healthy, but I would add a couple of other factors to what Ruth said.
Obviously, there is an issue around how one defines disability. I think that, over time, there has been a growing prevalence in the number of people who now state they are disabled; about one in four people now self-declare they are disabled. The really interesting discussion around that is that even though that has risen significantly, even more people are claiming disability benefits than the self-declared rate. There might be some issue around the structure of the benefit that people need to look at.
Also over time, we need to look at the nature of the benefit. Obviously, the gateway of the benefit has expanded since it was created, and that is predominantly because of legal cases. That has also impacted the caseload. Also, although there is definitely less material evidence you can point to, over time people get more aware of the benefit and how it works, and you see people being able to claim more efficiently and effectively.
Those are some other pointers that might mean that you get such an increase in the caseload, but I am sure that Ben and others will talk more about that.
Tom Pollard: There are a couple of things. There clearly is a big, significant rise around mental health for incapacity benefits and disability benefits. On incapacity benefits, we can see not just the primary condition people are claiming for but other conditions alongside that. What we see for incapacity benefit is that only about less than a fifth of people who are claiming because of mental health are only claiming because of mental health.
On PIP, for disability benefits, all we see is the primary condition. There has been a lot of talk about mental health driving that up, but we know it is a roughly similar cohort. There is about a 70% overlap in the cohort, so there is almost certainly a similar level of complexity of health conditions. Often we are talking about three, four or five different declared health conditions, physical and mental. We need to think about the complexity of health, rather than just mental health, partly because the mental health argument often leads us towards a discussion about whether it is mental health or not.
Secondly, for PIP in particular, the proportion of people going through the assessment and getting the benefit on the back of that has not increased. There has been an increase in demand, and the Government would say that that increase in demand is not commensurate with the increase in disability prevalence. My argument would be that this is not about just disability prevalence; it is about the intersection of disability and poor health with financial insecurity. There is a much bigger cohort of people who declare themselves disabled who do not get PIP. That cohort has grown over time, but the financial insecurity of that group has increased over time faster than for the non-disabled population. When people are struggling financially, they are more likely to look to things like PIP for support.
We need to understand that there are complex dynamics are going on here. I am sure the other thing Ben will touch on is the changing nature of the labour market. I think that there is a danger in jumping too quickly to thinking about whether people are just following financial incentives in the system. That may be part of the picture, but I think it is much more complex than that.
Ben Baumberg Geiger: I will continue with what Tom indicated. It is helpful to split the reasons for rising disability benefits—DLA and PIP—from rising incapacity benefits. For me, the main story on rising disability benefits is that there have always been a lot of people with ill health and disabilities, and a rising proportion of them are claiming disability cost benefits because they are struggling to get by without it, for a number of other reasons that we can go into. Rising distress and other things are a part of that, but you have to see non-pensioner welfare spending as a whole. Increasingly, we have seen cuts in most non-pensioner welfare spending, and rising PIP spending has been partly meeting that need. We end up not spending that much more or that much less, but doing it in a much more dysfunctional way.
I think that there are a lot of things going on around incapacity benefits. Some of them have to do with artefacts of ways of counting, which I am not going to go into, but the actual rise in incapacity claims is lower than the headline rates, as a recent DWP piece of research indicates. Even beyond that, more people who are out of work are being classified on the health and disability side of it, but that does not mean that there are more people out of work claiming benefits; it is just that the labelling of that has changed.
That artefact is part of it, but it is also about the wider things that are often ignored in talking about the system, which I would categorise under rising distress, rising medicalisation and rising exclusion. We have already talked a little bit about rising distress and trying to deal with the underlying drivers of distress, particularly among young people, but across the whole population.
On medicalisation, I am not really talking about the cultural aspects so much as systems, particularly welfare and work, that are dysfunctional and require people to get medical labels to negotiate them successfully. That is a failing in the systems that we have set up as a country.
Finally, on rising exclusion, it is striking that the skills and employment survey that came out last month, which is the gold standard study of working conditions in the UK, shows that control over work—control over the nature of work, not start and finish times—is now lower than when records began in 1992. Over 60% of people were classified as having a high discretion at work in 1992, and that has now fallen to 31%. We have talked about the decline of light work and so on.
There is a danger in just saying it is a matter of incentives, because the rise in incapacity claims predominantly happened in the 1980s. Since then, we have repeatedly said that this is a problem of incentives, and tried to tighten the assessment and reduce the generosity of benefits, and we have continually failed. If we just do the same thing again, we are going to fail once more. So I think it is about trying to tackle those deeper things.
Q2 Chair: That is really interesting. Following on from that, Ben, some people have said that it is because of structural issues within the system itself—that the difference in value of the UC standard allowance and the health element may be affecting the on-flows. Are you saying that that is not really a key driver?
Ben Baumberg Geiger: This is a difficult thing to describe in an accurate way. I am not saying that this makes no difference at all and that some of the things the Government have done will have no positive impacts whatsoever. I am saying that, in focusing solely on that, you are likely to do things that will make the situation worse.
If you look at the reasons that people have for doing things, rather than their narrow incentives, sometimes when you are trying to tighten the disability gateway—meaning that if people do not get the disability entitlement, they cannot survive—they go into a conditionality regime that still does not have a decent way of deciding what people with health conditions and disabilities can be required to do. They have an amount to live on that, by historical and comparative standards, is very low. What is it rational for people to do in this situation? It is to hunker down and try to cling on to what they can get.
Ideally, you would have a system where people who do not get a classification of ill health or disability have enough to live on, are not forced to do things they cannot do and are incentivised to work. If you get all of those incentives in the right direction—crucially, combined with incentives for employers to create spaces in the labour market for people to go into—you might get somewhere. Just saying that the problem is that we give people with health conditions and disabilities more and we need to cut it is what we have repeatedly tried to do, and it has only made the situation worse for everybody involved.
Q3 Chair: Does anybody have a slightly different view from Ben on the structural issues within the system itself and on the standard allowance and health element differences being a key driver?
Ruth Curtice: The only thing I would add to what Ben said is that one area where the Government’s proposals are quite different from what we have seen in recent years is the rebalancing of the UC standard rate and the UC health element. I do not disagree with what Ben said in terms of incentives being the whole answer to the problem, but I do think that making these changes, in a way that boosts the UC standard rate quite significantly, addresses some of his concern about whether, if you do not qualify for these benefits, you still have enough to live on, in that it reverses about half of the real-terms erosion in the value of UC since 2010.
Tom Pollard: I have just a couple of things. As these reforms progress, it is critical to think back to what happened with the employment and support allowance, because there are lots of echoes of what happened there. The Government has spoken a lot about it being a binary system and you are either fit for work or you are not, but that is not true. There is a middle group where you are judged to have some capability to look for work, and previously you received a middle rate of payment. People who were put in that group did not habitually appeal to try to get the higher rate of payment, so the idea that this is just a case of people always going for the most money available just does not stand up to scrutiny. People who were put on a middle rate of payment often stayed there, and they got a middle rate of conditionality as well—it was not as strict as what someone on jobseeker’s allowance would get, but they were not exempt from conditionality.
We can see that incentive plays some role but not all of the role, but when that rate of payment was cut to be the same as the basic rate of universal credit, you opened up a huge gulf. I am wary of an argument that says that to close that gap we cut the higher rate, because even with the increase to the basic rate of universal credit, it is still far from covering people’s essential costs.
It is about the balance between understanding that there are incentives in the system but there are also baselines people need to meet. If people are struggling day to day to meet their basic needs, all the evidence and all my experience suggest that that makes it very hard for people to engage with the process of getting back to work, especially if they face additional barriers because of health and disability.
Jean-André Prager: There has been a lot of discussion about the financial incentives. The thing I would say about the binary nature of the system—we have not focused on this as much, but it is a pretty obvious point—is that if you are on the UC health element of the benefit, we do not have an assertive system at all. You are parked on that benefit and you get the money, and there is no other support for you at all. That is a big issue, and it is part of what the Government is trying to correct here. I think that is a different kind of incentive, which is not focused on as much as the financial incentive. It is about trying to create, frankly, a more assertive system that is more helpful to people. That is why they are looking at trying to scrap the work capability assessment in the long term.
Tom Pollard: If I may say one more thing on that, my counter to that is that there was this middle group and it did have a middle level of conditionality. If you were in the work-related activity group, you were required to come to jobcentre appointments, which is what the Government is proposing for this group. That was a group who had been assessed as having a less significant barrier to working, and yet that group over time achieved about a one percentage point better return to work rate than the more severe group.
I am very sceptical of the idea that the critical difference will be a lower rate of payment and a higher rate of conditionality. I think that what really makes the difference is building trust and engagement. That is a difficult thing to do and it requires proactive outreach. The narrative that this group is trapped out of work and cannot receive support is disingenuous. They could receive support, but the Department has done very little to proactively reach out to them and engage them with support. They have done a bit more recently, and they have shown that when they do do that proactive outreach, you do start to get people engaging and you do start to get employment outcomes.
Again, I think we have been given a slightly false narrative about it being very binary, very clearcut, and that is not true—there are shades of grey here.
Q4 Chair: I will add another bit into the mix now. Some commentators have said that it is the number of work capability assessment reassessments that has fallen since the pandemic. Also, according to the Resolution Foundation, the same is true of PIP. Is that having an impact on the case levels?
Ruth Curtice: You are right that we have focused mainly in the discussion on on-flows. There has also been a slowing in off-flows from these benefits, and some of that slowing seems to be due to fewer assessments and fewer reassessments. It may also be due to stretched jobcentres being less able to provide support. The rate of off-flow for incapacity benefit has halved over the last decade. If you could get that back up, it would save hundreds of millions—not billions—but it would be worth doing. The waiting time for a PIP assessment, for example, is 50 weeks. From the day your assessment was meant to happen, you wait almost a year until it actually happens. There are clearly elements of the system that are not working, either for the Government, in terms of keeping the right people in the system, or for claimants, who are suffering delays.
Ben Baumberg Geiger: It is sensible to think about what a good process for reassessments is, ideally before introducing them on a particularly large scale. If you look over recent decades across OECD countries, there are times when countries have gone for large-scale reassessments that have been an absolute political disaster and a disaster for the people concerned.
It would be good to think about what a reassessment process is that works as well as possible for people, that commands their trust and where there is some sort of process for people. If there is a decision that someone is no longer entitled to a benefit, what should the off-ramp off benefits be? Suddenly taking large sums of money away from people who have at some point been assessed as having considerable extra costs of living and who unquestionably have a health condition is about one of the worst things that the system can do.
It is not that there is no place for reassessments, obviously, but—along with other things we will come to—it is about really thinking about how we get trust between claimants and the system and how we get a system that people can live with and that supports them in various ways.
Chair: Anybody else? Steve, you have been trying to get in—I do apologise. Do you want to ask a question?
Q5 Steve Darling: I would be grateful if Professor Ben would unpack a little further where there has been root-and-branch reform of a system on a large scale. What should we be looking at as a Select Committee to understand what that can look like in a good or a bad form?
Ben Baumberg Geiger: I will try to be quick, because I think there is another question about it later. There is not one model of success, looking at different countries. There are different ways you can set up the different parts of a system to help support people with independent lives and into the labour market.
Two things are critical in that. One is that Chris Prinz, who has been the head of the desk that works in this area at the OECD for a long time, always said that it is about aligning incentives so that all the different parts of the system are incentivised to do things that support each other. What you see too often in countries is dysfunctional systems where things do not line up. Each country will have a different set of actors where those incentives need to line up in a different context, but making sure they line up is crucial.
It is about taking the issue seriously. The countries that do reform are characterised by thinking radically about the benefits system, thinking radically about occupational health and vocational rehabilitation and really thinking radically about the role of employers, and trying to do all these things at the same time in a mutually supportive way.
Q6 Chair: Thank you, Steve. My last question is about the fact that we have heard in the press and so on that we have a bloated welfare system and that our health-related benefits are financially unsustainable. What is your view?
Jean-André Prager: I think one needs to make a distinction between what is sustainable for the individual and for the nation. There is no question that, for the nation, the bill has radically increased and will continue to increase over the course of this Parliament. It goes to other questions about what you think is the kind of support you should provide to people and whether you think we are providing people with the right type of support. There is a different question, on an individual basis, for people with specific needs. That is how I would answer the question. Ultimately, it is difficult without talking about individual cases.
The obvious answer is that we are going to spend £70 billion by the end of the Parliament on this. The Government have made it very clear that they think it is unsustainable, given the other challenges the country faces at this moment. You are dealing with the steps. They have already decided that they think it is unsustainable. The question is whether we support people appropriately at an individual level.
Q7 Chair: We are not part of the Government. Our job is to explore the Green Paper to get to the bottom of this issue. As a percentage of GDP, how has what we are spending on children and working-age adults changed?
Ruth Curtice: The debate has not always been clear about the distinction between welfare overall and then health and disability. Within health and disability, there is working-age and total population. Welfare as a share of GDP was already forecast to be pretty flat. It now falls very slightly as a proportion of GDP after these changes. We do not consider a defence budget, for example, constantly as a share of GDP and out of control.
There is a decision about whether the level of GDP is the right one or not. Health and disability has been rising, including as a share of GDP. I think it now rises over the forecast by something like 0.2% of GDP. Having seen quite sharp rises, the rises are now much less marked. Ben may want to add to that.
Ben Baumberg Geiger: It is very easy to write headlines around health and disability benefit spending going up, particularly when things are presented in real terms, which not everyone will agree about. I think it makes no sense at all to present anything about the welfare budget in real terms. It is intrinsically relative to standards of living in the population, wherever you draw that line. Even our conceptions of absolute poverty move with the times, and what would have been a minimum in 1900 is considered far below the minimum now. So it only makes sense to look at it as a percentage of GDP.
Beyond that is the fact that the headlines often focus only on health and disability benefits without focusing on the wider context. The cuts that were made after 2010 are still developing. For example, the impact of the two-child limit gets more and more every year because more and more people get caught up in it, given how it works as a policy. There are various policies like that, and if we are just focusing on rising health and disability benefit spending without seeing, as Ruth said, that overall non-pensioner spending is pretty flat, we are not seeing the real picture.
Tom Pollard: If the case that some of us have made is that what we see here is a manifestation of problems elsewhere around financial security and health and disability, my challenge would be that just squeezing spending on disability benefits does not necessarily achieve that much if those costs pop up elsewhere and that means more people turning up at mental health services or more people turning to their local authority and struggling with housing or whatever else. There is a real risk of looking at it in isolation and thinking, “We could just crack down on costs here and we will make savings.”
The other challenge relates to the question earlier about how you make a comprehensive set of reforms. In terms of the announcements for the Green Paper, a set of reforms were put forward. They were then scored by the OBR, which said, “We don’t think these will achieve the savings that you think they will achieve.” Then we had to have a new, additional set of cuts on top of that to hit a target. The risk is that we end up in a world where we design cuts to achieve savings that will be scored on those terms, whereas, in reality, more comprehensive reform of the system is inherently uncertain. If I say I am going to create a different sort of assessment, the outcome of that in terms of who gets money and whether people move into work is inherently uncertain. If the system says we have to be able to say we will achieve this saving by this point, you get more and more blunt cuts, because that is all the system understands. I think we are in quite a dangerous position right now.
Q8 David Pinto-Duschinsky: Thank you for this—it is very interesting. I want to come back to mental health in a moment, but first I want to touch on a couple of things to do with off-flows in other jurisdictions. First, we have heard conversation that the UK is a relative outlier in terms of rising levels of caseload and cost. Can you provide some insight into what you think is driving that?
Ben Baumberg Geiger: I will have the first go, but others will probably want to join in. Again, it is worth contextualising it. What you said is accurate. The IFS did some useful work. They did not look at a large number of countries, it has to be said, but of the countries they looked at, it was unusual to see rising health-related benefits expenditure since covid.
But that does not take us to the top of the league table. It is not like, suddenly, we are spending more than other countries. Depending on exactly what you put in the box for spending—which is more technical than I want to go into here, but I can follow up on it—we are either in the middle of OECD countries’ spending or still a bit below average, even forecast to the end of the decade. The trend is unusual, but the situation is not.
Q9 David Pinto-Duschinsky: What is driving this? Why is there this differential trend? There is a separate discussion about levels of spending in the UK versus other places, but why are we going up when others are not?
Ben Baumberg Geiger: It is not just due to covid, obviously, because other countries have seen covid as well. It seems likely to be some interaction of what happened in covid and other things that were going on in the UK at the time—covid is not irrelevant. One of them is waiting lists. It is interesting that the new survey that the DWP have released shows that a lot of people on health-related benefits are on NHS waiting lists. The OBR did some work suggesting that waiting lists are not really the cause of the problem, but I think we need to go over that now that we have a bit more evidence and re-evaluate how far we think that is true or not. The UK was just in a different position in terms of healthcare spare capacity and waiting lists than a number of other countries in the comparator.
I think these dysfunctional systems are also probably in a worse place in the UK. In terms of the cost of living crisis, our safety net was at a lower ebb and a lot of things were pushing people to medicalise what they were going through to get by, in ways that do not necessarily apply in other countries. That is partly to do with the welfare system, and partly to do with the world of work. We could get into a big conversation about SEND, which is similar things but with a younger age group, but obviously with knock-on impacts.
So the things that were just different in the UK, most strikingly, are those dysfunctional systems and also things to do with waiting lists. Those are the first things I would go for.
Ruth Curtice: The wider labour market data, as you know, is hard to interpret at the moment but does suggest that something seems to have happened to young people in the UK that has not happened as markedly in other countries. I cannot tell you why that is, but that is an important part of the story.
Tom Pollard: I broadly agree with what Ben said. I do not have the broader European data to think about why, necessarily, we are the outliers—to the extent that we are or not—but the factors Ben identified feel, to me, like the ones that are driving this. It is a combination of access to other services, the low ebb of the basic rate of social security and, broadly, the aftermath of austerity, as well as access to services. That will not be unique, so it is hard to pinpoint exactly why Britain is different from other places. But, my experience, those seem to be the factors that are driving some of this.
You might land on a place where you say that something about our benefits system is unique. I am not sure if that is the case, and Ben may know more about that in terms of comparison to other countries. I do not really think we can land on a place that says we are just a country that is inherently more prone to people dishonestly seeking support. I do not have a lot of time for the narrative around people claiming but not really to, because in my experience assuming bad faith on behalf of people does not get us very far in explaining these trends.
It seems incredibly complicated, and I cannot pin down exactly why we are different from other countries, to the extent that we are, but I think the things Ben said were right.
Q10 David Pinto-Duschinsky: Picking up on that point about medicalisation, and turning to mental health now, you have mentioned medicalisation. Ben, you in particular talked about the need for a more nuanced conversation about it, but you have several times referenced the fact that you think there has been an increase in medicalisation. Can you talk a bit about that and place it in the context of what might be driving rising levels of mental health claims, particularly among younger people?
Ben Baumberg Geiger: I would start by saying that it would be really helpful for the Committee and for a wide range of other people to do more on this area.
The second thing I would say is that it is very easy to be misinterpreted when talking about these issues, which is possibly why we have not talked about them more. It helps to talk about tackling distress, medicalisation and exclusion at the same time. The reason for that is that talking about medicalisation does not mean denying the realities of people’s experiences—denying that the distress is real for people. It does not get into culture war discussions, or what Lucy Foulkes, who is a leading researcher in these debates, calls a “one big eye roll” approach to young people’s mental health.
In taking it seriously, it is about saying that there is reasonably strong evidence that there have been real rises in the distress that people have experienced. Part of this is rising distress; we need to take that seriously and look at why it is the case. If you were trying to save money in a preventative approach, you would want to invest in trying to reduce the distress that particularly young people, but all people in the country, are facing.
Secondly, around reducing medicalisation, it is about trying to tackle systems that seem to push people to get a medical diagnosis, often for no readily good reason, to get the things that they need. This is a real problem in the workplace at the moment. To take one example that I think many of us can relate to is that, say you are a parent of a child with a disability going through a period of crisis. What conventionally happens in those situations is that you need to go to your GP and get signed off sick with stress. Even though the disability is not yours, the systems are often set up such that there is no way of dealing with the issues in their own right. The distress is there, it is part of it, but why can we not have things in the workplace that help people deal with the things that they face?
We can talk similarly about the education system and the fact that children are not getting what they need in education systems without going through the whole SEND process, and others have written extensively about this. It is clear that that then pushes people into getting a diagnosis.
So we have genuinely rising distress and dysfunctional systems that push people to medicalise to get what they need. The final part is what I would call exclusion. For people experiencing distress and other health conditions and disabilities, there are some ways in which the labour market is better than it used to be, but also lots of ways in which it is worse. We do not have light work any more—since the 1980s pretty much—in the way that we used to. It was often badly paid and low status, but there were bits of the labour market that people could continue in when other bits were not available. Control at work is lower. Where are the spaces in the labour market that we are expecting all these people with health conditions and disabilities to go into? What can we do with the Mayfield review and beyond to tackle them?
In talking about medicalisation, and to avoid going into an unhelpful back and fro in a culture wars frame, it is helpful to say, “We want to tackle distress, medicalisation and exclusion all together and take them all seriously.”
Tom Pollard: I can add from my perspective of doing frontline work in mental health. I broadly agree with what Ben said, but I come at it from a slightly different angle. Mental health, in particular, is fundamentally mediated by people’s social and economic circumstances. Social and economic factors are often a key driver of what leads to people having mental health problems in the first place. The social and economic circumstances in which you exist fundamentally mediate your experience of a mental health problem.
My experience as someone with a history of depression and anxiety is very different in jobs where I am well supported and have a good line manager, compared with the experience of someone who is struggling with similar symptoms but is in a job where they do not have any sort of line manager; they have a shift manager, and there is very little receptiveness to hearing what they are saying.
Some of it, as Ben said, is about people being forced to frame these things only as medical conditions because that is the only thing that is seen as legitimate in the system. But some of it is due to a bit of a mis-step in the public debate and the political debate around mental health, where we start to think, “Is this a real mental health problem or is it about someone’s circumstances?” In many cases, those things are inseparable, and for a lot of people experiencing mental health who are in low-income households it is intrinsically tied up in their poor living conditions, housing and social isolation.
I do not really see the value of the idea that what we need to do is somehow objectively score that mental health problem on some sort of scale to prove it is a medical condition. A lot of the debate around whether these are or are not real mental health problems has missed the mark and takes us down a path that does not lead us anywhere particularly productive or constructive in addressing these issues.
Q11 David Pinto-Duschinsky: I have one quick final question before I hand over. We have talked a lot about on-flows due to mental health and some of the comparisons, and about the off-flows for assessment. In terms of off-flows into work, if you look at the LCWRA, one of the striking things is that only 0.9% of the caseload flows into employment every month. That rate has halved since 2012. Why? It was already low, and it has gone even lower. What is driving that? Why have off-flows almost stopped?
Jean-André Prager: I think there is a major issue—I have tried to make this point in some of the things I have written—with how we do the assessments and how binary the whole system is in terms of how people can access other levers of support. The most obvious example is that if you do a WCA assessment or a PIP assessment, it is a purely fiscal transfer assessment: you get more money or you do not. There is no other discussion in that process about what other types of levers DWP might be able to offer.
One of the arguments I have had is whether you could at least mention Access to Work, for example, in one of the assessments and say that it does exist. There is a real challenge there in how binary the system is around support. People talk about Access to Work, for example, being the best-kept secret. I know it is a very small programme, in general, so I do not think it will fix all the problems. It goes to a conversation we have had more broadly about the adversarial nature of the system. If you are going to change the way you do conditionality and other things, you need to have the conversation point that everyone has made, where people feel like they can have a discussion about what they might need and what kind of labour market support might be available.
Fundamentally, part of the problem is the very structure of the system. It goes to a macro point around really saying to the Government and MPs when they look at these proposals that we need to look not only at some of the financial things that people have discussed but at how you can join everything up much better within the whole benefits system.
Ruth Curtice: If I might add one thing about the changes the Government are making, there is a clear risk that they affect those off-flow rates in the wrong way. We will now have a system where the existing stock of claimants for UC health have a much higher rate than new claimants. That vastly increases the jeopardy for them of trying work if they might have to reclaim in the future. I think that keeping an eye on those off-flow rates, given the tiered system that has been introduced, will be quite important.
Q12 Steve Darling: Thank you all for coming; it really is appreciated. Clearly, the Green Paper highlights restrictions around PIP, the scrapping of work capability assessments and reductions in universal credit health payments, as well as a few other changes to the system. How do you see this affecting claimants and particularly their ability to get into work?
Jean-André Prager: I will start, but everyone else in the room is probably better on this than I am, or at least has more experience of it than I do.
Fundamentally, you will know that it is extremely difficult to know what kind of labour market impact these reforms will have. The OBR has been very clear that they have not assessed it yet and will come back in the autumn. As other people have mentioned, the forecasts for all these measures have been extremely poor over many years, and to believe in a forecast is somewhat foolhardy, given how off they have been.
The answer to your question is probably unsatisfactory, which is that it is very difficult to tell. Obviously, PIP is not to do with work, so it is a difficult one to answer. Fundamentally it goes back to what Tom, Ben and Ruth have already mentioned, which is that at this point it is very difficult to tell how this will impact labour market outcomes at all. I do not know if other people have things to add.
Ruth Curtice: I agree, but I was going to have a bit more of a punt. Two elements are uncertain. One is the impact of the cuts themselves and the changes, and one is the impact on employment. The response I have heard in the debate, when the cuts for individuals are discussed—they are very concentrated, particularly on those families who will lose access to PIP; in some cases, families losing PIP and carer’s allowance can lose over £10,000—is that those numbers do not include the employment effects.
It is important to think about orders of magnitude here. We know that the number of losers, as estimated by the Government, is 3.2 million. The losers may be more than that if, in fact, the OBR are wrong about the extent of behavioural adjustment. They have effectively halved the number of losers from the PIP changes by assuming a behavioural response from claimants and assessors. That is an uncertain number, but 3.2 million is the Government’s number. The employment effects are very uncertain but will be in the region of tens of thousands, not millions and not even hundreds of thousands.
The reductions to PIP have effects in two ways. They lower people’s income. At the margin, we know that, for healthy individuals, that will tend to increase your propensity to work. We do not really know what it means for unhealthy individuals. In particular, we have heard very strong evidence that, for certain PIP claimants, that support is enabling them to work. So I would call PIP zero.
The changes to UC are a rebalancing within the system, where you will see some winners and losers. They are more similar to things the OBR have modelled in the past. I think you might get low tens of thousands of employment effects there.
Where you might see some positive effects is on employment support. Again, when you look at what the OBR previously scored, in autumn 2023, the Government spent about £1 billion cumulatively on employment support, and the OBR scored 25,000. If this Government get the same rate, they are spending about £2 billion, so they will get 50,000. You can add up all these numbers, and I really struggle to get above 100,000 of an employment effect. That is the number of people who will move into employment.
They will not all earn enough to replace the number of losers, but let us assume that we get to 100,000 and that they all earn enough to recompense all of the benefits they have lost, that is still 3% less losers. That is 3.2 million losers rather than 3.2 million losers—when we talk about things like poverty effects, they become rounding errors in the numbers. The employment effects are important, but they are not going to change the fundamental story of the impact of these changes.
Q13 Steve Darling: Any further reflections from the panel?
Tom Pollard: What was disappointing for me was that prior to Christmas we had a White Paper from DWP, which I think set out quite a transformative agenda around improving employment support, trying to de-risk the process for people and trying to push conditionality further into the background so that it does not become such an adversarial system. I think that part of what then drove the pressure from Treasury to introduce this Green Paper and the tranche of cuts we have seen was that Treasury and the OBR were quite sceptical that that would achieve a significant employment outcome.
The evidence they have to rely on for that is that the last 10 to 15 years of employment support has not achieved good outcomes for this cohort. But I would argue that part of the reason it has not achieved good outcomes is that it was all taking place in quite a hostile environment for this cohort. Speaking to David’s question earlier about why we saw this drop-off, I imagine that some of that was due to less spending on employment support for this group but also, from 2012 onwards, a very hostile environment where people were constantly worried about losing their benefits. In that situation, my experience of supporting people is that, as Ben mentioned earlier, they hunker down. It is not that they just want to hold on to having lots of money; it is that they gain some sense of security after going through assessment processes and they are very worried about losing that security. At that point, people will hunker down and not engage with the support.
I think we are stuck in a bit of a doom loop where OBR and Treasury say, “We don’t really believe that you can transform this system and get more people back into work,” but I think you could. You see services like individual placement and support within NHS mental health services that support people with quite profound and severe mental health problems back into work, but they do it because they can build a relationship of trust. But the headline evidence from the DWP over the last 15 years says, “These schemes don’t really achieve much in terms of outcomes. If we want to achieve savings, we have to cut, with harsher, more short-term cuts”. Those harsh, more short-term cuts drive an environment where people feel afraid and feel cautious about engaging with DWP, so we get another round of employment support that does not achieve good outcomes. I think we are stuck in this loop, and we have to find, as Ben was saying earlier, some way of breaking out of this cycle.
Q14 Steve Darling: Thank you. Any further reflections?
Ben Baumberg Geiger: Extremely quickly—and I totally agree with what has been said already—I do believe there is a world in which we could support, probably not millions, but hundreds of thousands of people with health conditions and disabilities back into the labour market. That is probably a world in which they do not feel so fearful. A lot of what you face as a person with a health condition or a disability is just not knowing how it is going to go. It is not like you have a work capacity that you are hiding from the state; you just do not know. I think that de-risking, plus support, plus spaces in the labour market, done on a really serious level, could get us somewhere.
The trouble is that part of this is stuff that the OBR will find hard to score, like trust. Incidentally, the cuts really damage that trust in this context, much as there are some good parts of the Green Paper. If you look at the countries that do better in their overall employment rates, with high rates of employment, probably, for people with disabilities, although it is hard to tell, there is a lot of stuff that the OBR will not be able to put a number to and that the Government will find it hard to make the case for. It is not the OBR’s fault; they are doing what they have been tasked with doing, but the framework they are operating in does not make it easy to focus on prevention and those more intangible but important things.
Q15 Steve Darling: Can you unpack the stuff you referred to that other countries do?
Ben Baumberg Geiger: A lot of it has to do with employers. That works in very different forms. I and other people have talked a lot about the Dutch reforms. The Dutch did a lot to the benefits system but also had very heavy incentives on employers. Employers had to pay two—and sometimes more—years of sick pay unless they could show that they had done everything not just to reintegrate someone into their old job, and not even just to find them a different job in their workplace, but to look at their entire supply chain to see whether there was a way that that person could use their skills going forward. If employers did not discharge their responsibilities, there was a big financial penalty. There were lots of other things going on there as well, and other countries have had different ways of making employers sit up and take notice, providing the support to employers that is necessary, incentivising them to take part and having similar incentives for disability.
In most countries—in no other country I can think of at the moment—you just do not get the levels of distrust between the claimants and the disability benefits system that you have here, and that makes it very difficult for people to move forward. So it is about lots of things, but trust is crucial, and trust is hard for OBR to score.
Q16 Steve Darling: The panel have rightly identified that we will not hear back from the OBR until the autumn about what the impact is, potentially, or about their perception of the Green Paper. In the light of that, and the fact that primary legislation will probably go through Parliament before the summer recess, what amendments would you put forward to that primary legislation to make these reforms more effective?
Ruth Curtice: One thing the Government could do, which could be facilitated by an amendment, is publish evidence of who they think will be affected. They know exactly who scores more than four points at the moment. They would then need to explain to us where they think the behavioural effects would kick in. It is very surprising that that has not been published, and that is something they could do.
The Government could also publish their own assessment of the employment impact of their measures. I have previously worked in the Treasury and closely with the OBR, and I do not think that it would be a threat to the OBR’s independence for the Government to have a view on the benefits of their reforms and to choose to publish that before legislation.
More specifically on the policy, Ben mentioned earlier this issue of what happens when someone is reassessed. In a world where the system is changing, having a lengthy gap between that reassessment happening and when the benefits are taken away will be important, so that if people are going to lose £4,000 or more, there is, say, six months’ notice so that they have some ability to deal with that.
The Government have told us that there will be employment support, but that kicks in very late. This is less amendment territory, but the Government have an opportunity in the spending review to provide that employment support before the cuts come in. There is only £200 million of employment support in the years the cuts come in; the £1 billion only comes in the final year, beyond even this spending review.
The Government could also complete the review of PIP before they make these changes. They want to make these changes in 2026. They have said PIP needs reviewing to be fit for purpose. Perhaps they should complete that review before the changes are made. I am sorry—that was a bit of a long list.
Steve Darling: It was really helpful. Thank you.
Jean-André Prager: I agree with Ruth about the PIP review. They should try to make sure everything is holistic in the way they think about this, and that includes the Access to Work review and the PIP review. If they are going to make these kinds of changes, we need to have a more holistic way of looking at this. That would be my main point to the Government.
Q17 Johanna Baxter: The Government have said that it will introduce an additional premium for those with more severe lifelong conditions who would never have to face reassessment. What is your understanding of how that will happen or how it will work?
Jean-André Prager: How they think this will work is very vague in the Green Paper. In documents the previous Government published there was something called a severe disability group, which looked at trying to ensure that some people would never have to go through a reassessment again. So this is a similar idea that other people have had over many years. That was looking at whether you could get a group of practitioners to come up with a group, and I think the DWP published some draft criteria on that. I imagine that that is how they would go about that kind of process: they would come up with a group of expert practitioners who might formulate who they deem to be the people most severely in need who would get the additional benefit.
There is a level of subjectivity because “severe” is a subjective point and there will always be the challenge of where you place that line. I think that that will be a point of big contention and debate forever, and it will constantly come up.
Tom Pollard: Coming back to when the employment and support allowance was introduced in 2008—which first led us to the situation where we have a group who are judged to be much more severely unwell or disabled and further from work, a middle group and then a fit for work group—the original intent then was that the most severely disabled group would be about 10%. Obviously, now it is much more than that, for some of the reasons we have discussed today. My instinct is that a lot of this feels like we are trying to move back to the original intent of employment and support allowance.
I envisage it probably being about 10% who are judged to be most severe and who will then get protected from conditionality, protected from the lower rate of the benefit, and then the Government envisaging a much larger group being in what used to be called the work-related activity group, where you get a lower rate of payment and you are expected to turn up for jobcentre appointments. That is what it feels like to me but, as others have said, it is hard to know exactly.
Q18 Johanna Baxter: Do others have a view? No. I am just trying to understand if this is the territory most Governments get into in trying to define that level of severity. Do you think there is a danger that, over time, that group just expands again?
Jean-André Prager: Yes.
Q19 Johanna Baxter: What do we do about that? Do you have any recommendations?
Jean-André Prager: This is the issue collectively around these benefits and creating a more dynamic system. I think we should constantly re-evaluate the assessment criteria for PIP. It should be a constant process of re-evaluation. Instead, the debate around these things is so fraught, complicated and difficult, and affects people’s lives in such a material way, that we rarely look at these things. It only happens once in a blue moon. We need to constantly look at these criteria to make sure we are supporting the people we deem to need the support. I think it goes back to a more macro point around the dynamism of the system. How you do these things is probably more complicated than me talking about them in a macro sense, but that would be my general point.
Ben Baumberg Geiger: Something that Jean-André has written about recently is the need to constantly be coming back to things. This also goes back to Steve Darling’s question. In terms of what it would make sense to push for as various bits of legislation go through at different points over the next few years, we could look back at the independent reviewers of the WCA, the independent reviewers of PIP and what was helpful in that process as a way of trying to say that, in signing off this legislation, we do not just want to give the Government carte blanche to then not revisit this for a long period. We want to have some way of trying to hold people to account, of coming back to see what learning is taking place, and of listening to various people and improving the system, which is what everyone should do. I think that having that learning in is part of it.
The other side of it is that no system is perfectly stable. In terms of pressure on disability assessments, if the system does not work unless the disability assessment is perfect, the disability assessment is not going to last in the long term. You have to accept that there is some cushion around it, so that if something does not go right, people do not end up in an impossible situation.
On the PIP rises, for example, we have seen DLA PIP rising ever since it was reintroduced, but this has happened much faster since 2010, in the context of wider cuts to welfare and other services, than before. Keep coming back to it and keep holding the Government accountable, but trying to reduce the pressure on it more widely will also give it the best chance of success.
Ruth Curtice: The additional premium you mentioned is one among a number of examples of where the Government have said in the Green Paper that there may be additional support for specific groups, but those are not scored in the current money by the OBR. That has risks both ways. It has risks to the Government that this will end up costing more than is currently expected, and it has risks to individuals that, in the end, the Government will decide it cannot afford elements of this support.
As well as the one you mentioned, we have not talked much about the proposal to scrap the work capability assessment and to use the PIP assessment as the assessment for incapacity benefit. That means there are some quite specific groups that the Government have said it thinks need protecting in that case—particularly people who have conditions that would currently qualify because they do not last longer than nine months, which includes high-risk pregnancy and some forms of cancer treatment—but we do not know what form that protection would take. That means that there are also families facing a kind of double whammy. If they lose their PIP entitlement under the new system, they are also in the future losing their UC health entitlement. It looks like it could be quite a significant cohort of people losing both benefits, which is not in the current impact assessment.
Q20 Johanna Baxter: I think you answered one of my other questions, which was about your understanding of how the proposal would impact those with high-risk pregnancies and also those at substantial risk.
Ruth Curtice: Sorry, I did anticipate your question, yes. At the moment, the Government have said that it is definitely scrapping the work capability assessment, but it has not scored that with the OBR. This proposal has a slightly funny status: it is not in the Green Paper, as I understand it; it is a decision that has been made, but it is not in the numbers that the OBR have scored, I think, because the effects and the details are not yet certain enough for them to score it.
That means that, in the DWP impact assessment, those numbers do not include the effects on the people who will lose entitlement to UC health because they do not qualify for PIP, either at the moment or under the new PIP system because those systems have two separate reviews. As you say, in particular, the difference is that one is about your capacity to work and the other is about whether you have a long-term condition. People with acute short-term conditions that prevent them from working will particularly lose.
Q21 Danny Kruger: Brilliant. Thank you so much. It has been fascinating. I think mine are the last questions. I have a couple of practical questions, but I want, if you do not mind, to invite you to react. I am searching for soundbites; I would like some useful headlines that I can use to navigate these problems.
I have an observation and a question. The observation—tell me if you agree with it—is that, inspired by what you have all been saying, the welfare system is not the place necessarily to cope with welfare demand and that the challenges we have, whether we decide that the welfare bill is ballooning or not, will not be affected significantly by changes that we make to the welfare system, unless we are prepared to be radical in a way that I do not think anybody is. Is it a fair observation that welfare demand is not primarily influenced by the welfare system itself and that there a whole lot of broader factors at play there? That is my observation. Any reactions are welcome.
That said, looking at the welfare system itself—again, this is a huge topic, and you do not all have to answer everything, by the way; I just want any reactions to my question—is it fair to say that the effect of the 2010 reforms and of the introduction of universal credit after 2010 was to reduce the unemployment benefit bill and the numbers of people receiving unemployment benefit, but that, rather than pushing a lot of people into employment, which we Tories claim happened, there was a countervailing effect, which was to push people into sickness benefit of one sort or another? Would you weigh up those two effects: whether people would be pushed into employment or pushed deeper, as it were, into benefit dependency? Any reactions to those points?
Tom Pollard: Specifically on the point around people getting pushed around the system, there is a lot of truth in the fact that often, when we see a headline about how many people move off a benefit, the assumption is that they are moving into work and that, if you get reassessed as fit for work, you will move into work. Often, what happens is that someone gets reassessed, moves into a different part of the system, stays there for a while and is moved somewhere else. So there has been a lot of shunting around the system.
The OBR have said that, from their perspective, much of the driver of that has been as much about conditionality as it has been about the rates of benefits. Yes, some parts of the system have certain financial incentives, if you want to frame it that way, but there are also big incentives around conditionality. If you feel that you would struggle to go to the jobcentre under threat of potentially losing your benefit if you do not turn up, there is an incentive to seek protection from that. We have ended up with a system that is quite adversarial, and a lot of people, in my experience, have been seeking protection from that.
The issue is that DWP’s muscle memory around this stuff is to engage with someone and support them back to work by saying, “You have to come in for this appointment. If you do not come in, you lose your benefit.” That is what will happen now. We will have an expansion of conditionality to this group that is currently exempt from it.
The risk is that what gets underpriced in that thinking is the benefit of genuine engagement with support. For this group, in particular, if you face additional barriers to work, the critical ingredient—and DWP recognise this—is relationships, trust and genuine engagement. That is how you get someone to take quite transformational steps and go from being long-term unemployed back into work.
Q22 Danny Kruger: Do you accept that, sometimes, being compelled to take the first step to that relationship might lead to a positive outcome?
Tom Pollard: Sometimes it may. In many more cases, the threat of it will lead people to hunker down and not engage.
The way around this is to say, “Yes, we have conditionality as a backstop that we use if and when we see an absolute case that it is needed.” DWP’s MO generally has been to say, “We mandate someone to come because once they are through the door, we can offer them support.” They forget the collateral damage that that causes. Once someone is engaging on those terms—the New Economics Foundation did a lot of research into this last year—it is very much a transactional relationship; it is not a genuine relational engagement. You should be doing everything you can to try to get genuine engagement before you think about resorting to conditionality.
My argument would be that DWP has done little to proactively try to achieve that engagement with this group. More recently when it has, the evidence it is leaning on now as a case for more conditionality has been about offering voluntary engagement. They have been achieving quite good outcomes and getting more people into work, but I would argue that that is partly because people do not feel under threat; they feel like they are there of their own volition. It is a real risk that we face now.
Ben Baumberg Geiger: Can I continue on that? Tom has that exactly right. If you have a look at the highest quality international evidence on the effect of conditionality on people with health problems, particularly mental health problems, whenever you have a comparison, it looks like the employment effect that you find for people without health problems does not exist for people with mental health problems. In fact, sometimes you succeed in pushing people away from work rather than towards work. Also, you are much more likely to get negative mental health consequences. that includes some randomised control trials.
Why is that the case? It is because people do not know what their work capacity is. You are trying to force people into something that you do not know they can do. You are trying to give them the confidence to experiment with something that is uncertain. Challenge has a role in good frontline employment support, but challenge is not the same as threat. It is not that there is no challenge in that, but you are trying to develop a trusting relationship where you can challenge people to experiment with something that they are not sure that they can do. The evidence shows you do not get that with threat.
This is a problem with what happened with UC. As I said to the Committee last time I was here, no one at any stage when UC was being introduced thought about the practicalities of how to do conditionality for people with health conditions and disabilities. It was always thought to be an implementation issue that we would come back to, which is understandable given how much was going on, but it is a massive issue. If the Government try doing that in the wrong way, leading with conditionality for everyone rather than being there as a backstop, it will be both counterproductive and an implementation nightmare.
Q23 Danny Kruger: My memory of that time is that there was a great rhetorical emphasis on the importance of the support that people needed and, because of certain decisions that were made, that was not adequate. Jean-André, does that chime with you?
Jean-André Prager: That is possibly right, especially when people talk about universal support and universal credit and things like that. That is not a false assertion, no. It is correct.
I slightly differ from other panellists—I know they are experts in this specific subject—and I have tried to make a point a number of times during this session around the fact that some of this is so alien to people: “I have to come in whether I have conditionality or not.” There is a certain argument that we need to make engagement much more normalised, with it being just a conversation with somebody, rather than a conditionality.
It goes back to the trust point. We can talk about it, but it is a vague phrase. How do you build that trust? My point is that if people could see more people more often and have conversations that are possibly more about what types of support are available, we would be more successful.
Q24 Danny Kruger: That is great. I have one more minute, so I will try to combine the other questions I had. Ruth has already mentioned the scrapping of the WCA. Could I get quick responses from you? In principle, if the assessment were done well, does it make sense to combine the incapacity and the disability assessments into one, if it were maybe iterative and if a lot of appropriate conversations were going on? Is the principle of essentially stopping UC health from being an incapacity assessment benefit altogether and making it a disability benefit the right one, if we can get the assessment and the conversations right?
Tom Pollard: In principle, it is about having a more rationalised assessment system. In practice, taking one assessment and saying, “This now serves broadly both purposes” massively ups the stakes for that one assessment. Also, both those assessments have struggled to assess the thing they are supposed to be assessing, and so I am sceptical of the idea that one assessment will be able to assess both those things effectively.
Ruth Curtice: To add some detail, there are also quite big devolution issues with combining them, because there are not PIP assessments Scotland. If you end up having one test in England and two in Scotland, that seems quite challenging to me.
Just to mention the young people proposals in the Green Paper, there is a suggestion that UC health is removed from under-22s, which is not linked to the evidence on the trends for young people. It is related because, if we can move to a world where conditionality and entitlement are separate, it creates the opportunity for young people to have greater conditionality without a reduction in their entitlement.
Danny Kruger: It is time for a soundbite from each of you two.
Jean-André Prager: If your perfect world of assessment worked, rationalising it would be sensible. It would help the Department with some of the flows issues. If you could get it right, it would be the right thing to do. Tom’s points were all accurate.
Ben Baumberg Geiger: In a single sentence, we need to do a lot of stuff better. Whether or not you combine the assessments or merge them, you need to do those things better. To focus on that as the main issue is not actually what matters.
Chair: Thank you, Danny. Thank you so much to all the members of the first panel, Tom, Ruth, Jean-André and Ben. Many thanks. It has been very helpful indeed.
Witnesses: Iain Porter, Ruth Patrick and Angela Matthews.
Chair: Welcome to the second panel for this Pathways to Work inquiry. I am pleased to welcome our witnesses. Iain, would you like to introduce yourself, and then we will go down the panel?
Iain Porter: Thank you. I am Iain Porter. I am a senior policy adviser at the Joseph Rowntree Foundation.
Angela Matthews: Hello, I am Angela Matthews. I am director of public policy and research at the Business Disability Forum.
Ruth Patrick: Hi, I am Ruth Patrick, and I am professor of social policy at the University of York.
Q25 Chair: Again, a warm welcome to all of you. I will kick off, if that is all right. I will be a lot more succinct than I was for the first panel. What impact have similar welfare reforms to what we have had with Pathways to Work and incapacity benefits had on labour market participation and poverty?
Ruth Patrick: Thanks so much for inviting me here today. I was going to say I feel like I am not an expert, but that is a gendered thing, so I should not start by saying that—just scrap that; edit it out of the cut. That was a bad start.
I led a big piece of research with colleagues at the University of Oxford and the London School of Economics that looked at the impact of the two-child limit and the benefit cap on larger families with three or more children. Importantly, that research looked both at the impact against stated goals like employment and, in the case of the two-child limit, the impact on fertility, but also at the impact on poverty. We looked at it in a mixed-method way as well. I am primarily a qualitative researcher, so I speak directly to people and I talk about the impact that changes are having on their lives. We did that, but we also looked at statistical evidence and we did some quasi-experimental analysis.
To take those policies in turn, if we look at the benefit cap, a sharp work incentive is built into the benefit cap. The idea is that, quite literally, your benefits are capped if you do not work at least 16 hours, and also if you are not claiming disability-related benefits, but then that cap is lifted if you work those hours. That is a sharp and clear work incentive, and we might imagine—we might predict—that we would see very strong responses through the labour market.
When we did analysis that looked at when the cap was lowered in 2016—this analysis was led by Aaron Reeves, who was then at Oxford and is now at LSE—employment increased by a small amount. But interestingly—this is very relevant for what we are talking about here today—economic inactivity rose by more. That is really important.
Also—I could talk for the next hour, but do not worry, because I am not going to—we looked at the mental health impacts of the benefit cap. What we saw was that the benefit cap was worsening people’s mental health. People were at greater risk of mental ill health because of the impact of being capped. It is important when we look at these policy changes and reforms to think about how the social security system is designing in mental ill health, which will then inevitably push people further away from the labour market.
To take the other policy, the two-child limit, which continues to get lots of attention in the media and also from the Government, the employment effects were negligible. We did not see any employment effects. Again, we saw in the qualitative evidence how it was harming people’s mental health and then, of course, pushing people much further into poverty.
On the broader evidence base—we have not heard this so far, certainly not in the first panel—we have to think about the harms being done right now, before the policies even take effect. The climate of uncertainty creates a constant environment of fear and insecurity. Again, that makes movements into work probably less rather than more likely. We see that again and again.
I have done research that tracks the impact of welfare reform on a small group of people, going right back to 2010. People talk about how, again and again and again, we have these cuts and we have these reforms. People are scared even when, in fact or possibly, they are not affected in the end. It creates anxiety: “What will I do? What will I do if my PIP is taken away?” That is what people are telling us now. That harm and that distress, which is real distress, is being caused right now, before even a penny is saved. I will stop there.
Iain Porter: I am glad Professor Patrick brought up the benefit cap study that her team did. To add to that, it was a really good study that built on the DWP’s own impact assessment of the reduction in the benefit cap in 2016. It is interesting, because it is a straightforward cut in out-of-work benefit levels. Yes, that did find a statistically significant increase in employment—about 5 percentage points among some people. But, more importantly, it also found that 90% of people impacted by that reduction did not respond by moving into work or by moving house, which was one of the other intentions of that policy. That just serves to illustrate the sledgehammer-to-nut size of impact here. Yes, there might have been a few percentage point increases in employment, but nine times more people were impacted hugely by this cut, where it did not have that effect.
The DWP’s research at the same time also found that many people subject to the reduced cap had to respond by cutting back on essential spending, increases in arrears on bills, and borrowing from friends and family, and there were also negative impacts on wellbeing and mental health.
It is interesting that we see a parallel in the proposals that are being discussed today. Over 3 million disabled people will be impacted with a cut in their benefits, and we know that disabled people are disproportionately at risk of poverty and hardship. All our evidence shows they are disproportionately going without essentials already. Yet the best estimates we have at the moment of even the employment support provision that is being provided as part of this package—the £1 billion extra by the end of the decade—will at most see 1%, 2% or 3% of those millions of disabled people impacted by cuts getting into work.
The Joseph Rowntree Foundation has funded some work by the Learning and Work Institute, which has just been published. It estimates a range of maybe 45,000 to 90,000 extra people in employment from that extra employment support. That is set against at least 3 million disabled people who will see very large cuts to their incomes and will be pushed into poverty and hardship. The balance here is off the scale.
Q26 Chair: Has there been any modelling of the impact on poverty?
Iain Porter: Of course, the Government did publish its own impact assessment, and the headline figure was that the whole package would pull about 250,000 more people into poverty. The Joseph Rowntree Foundation was looking at the detail of the Government’s impact assessment, and we think that the impact of the main cuts—the cut to PIP eligibility and the cut to the health element of UC—in themselves is likely to mean close to 400,000 in poverty, and certainly well over 300,000.
This is a problem more broadly with the impact assessment that the Government published. The Government’s headline figures in that impact assessment are a net across a range of measures that they have lumped together into the package, one of which should not be in there at all. One is reversing, essentially, a bookkeeping entry that the OBR have had to make in their forecasts. The previous Government had announced plans to cut eligibility for the health element of UC by restricting the work capability assessment, but that was never going to happen.
When the new Government came in, they said that they were not going to do that. They proposed their own changes to achieve savings that would replace that entirely. In their impact assessment, the Government has had to net off the reversal of that, which was already scored in the OBR. The impact assessment shows that that would have increased poverty by 150,000. So, essentially, the Government’s headline net impact figure is after reducing the overall figure by 150,000.
This applies not just to the poverty figures, but also the impact figures. The 3.2 million total number of people that the impact assessment states will be affected will also be underestimated, because that, again, is reversing out the previous changes of the Government.
What people want to know, and what MPs need to know when they are voting on it, is how many more people will be put into poverty by the Government’s new package, which entirely replaces the old package. That is certainly 300,000 to 400,000, not the 250,000 that is the headline of the impact assessment. [Interruption.]
Chair: Can we bring Angela in before we come back to you, Ruth?
Angela Matthews: Actually, BDF is more focused on disabled people in work and on in-work support, so I am happy, if that is okay, to defer to Ruth.
Ruth Patrick: I was just going to say that, on the impact and the poverty modelling, it may be worth flagging that the Child Poverty Action Group have done some modelling of the impacts on child poverty. If we look at that, and we compare what is in the impact assessment with what the Child Poverty Action Group is suggesting, they predict an extra 100,000 on top of the 50,000 that is in the impact assessment. That would be a tripling. I do not know if it would map on.
I would also like to use the opportunity to emphasise something that I think is really problematic with the whole approach, which is the pace of change that we are seeing. In the impact assessment, there is no accounting for, or examination of, for example, the impact of the ending of the WCA. They cannot model what the transitional protection will look like yet, because we do not know what it will look like. In the earlier session, one of the MPs asked about the additional payment for people with severe disability. We do not know what that looks like; we cannot model that.
This is a big, significant and, I would say, frightening change that we are seeing to the system of social security support. To press ahead at this pace, without more understanding and more insight, would be foolhardy.
Q27 Chair: I have a couple of quick questions, if I may. First, who is more likely to be affected by this, looking at our demographics? Then, you probably heard from the previous panel as well about the impact on conditionality and whether this will help. Who would like to have a go at that?
Angela Matthews: We see from disabled people who are in work that this is not just about disabled people who are out of work. For disabled people who are in work, their condition changes, or their condition may even get better because of the support they have had. Therefore, they are also looking to change where they are in the labour market, whether that is a sideways move or, “I am ready to earn more money now.”
To echo what has been said here, and in the previous panel as well, the term “distress” is really apt here. We see disabled people sometimes saying, “Okay, I am ready for my promotion now. I am ready to earn more. I am ready to do more. But I am losing my accessible house because the rent is up and it is not being renewed, so I need an accessible home before anything else.”
People have also said that if someone is revising their work situation and their PIP is up for renewal, they will wait for that PIP to happen first before they see what they could do with work. If they lose the higher rate, they will lose their car and their transport to work, and then they will not be going to work in the places that they can at the moment.
In terms of assessing this distress, is everything in place in someone’s social and personal life before they seek to change their work circumstances? That is my in-work contribution to that.
Ruth Patrick: Could I add as well? On conditionality, I would echo everything that Tom Pollard said in the previous session, especially about how conditionality governs encounters. It governs encounters in really negative ways. It makes those relationships of trust, and a willingness to try something new or to make a change, more difficult to achieve.
When we talk about conditionality, there is a danger that we talk in absolutes. It has been disappointing to see how the Government have depicted the discussion around the Green Paper, saying that we have this binary system. As Tom was rightly reminding us, we do not have a binary system; there are actually three categories people can fall into. And it seems like, in the future, there will also be three categories, once we have the severe disability premium as well. So what are we actually talking about here?
Also, when we look at conditionality, our social security regime has always had conditionality. It is right and proper that entitlement to benefits is conditional on something, but what we have seen, and what scholars, including at the University of York, have argued, is that over time we have seen both an intensification and an extension of conditionality. So what we have seen in parallel is the risks for non-compliance rising and rising and rising, and we have also seen conditionality rolled out so that it affects more people.
When I started life as an academic, you could claim income support without conditions as a single parent until your youngest child turned 16. Now we have conditionality built in from a young age. That has happened with disabled people, and their conditionality experience has increased. That has happened, unfortunately. That is bad in and of itself when the risks are so high. We know that, at the zenith of the last Government, we had a three-year sanction for people who were subject to the most severe—
Q28 Chair: How did that relate to employment?
Ruth Patrick: In terms of the employment effects of high rates of sanction, I would need to go back and look, but I do not think we saw good employment outcomes from that. What is really important—we see this again and again, especially in the qualitative space—is that we see people who are living with the consequence of a sanction, and that pushes them further away from the labour market. In my research, I would have people saying to me, “I am literally going to job interviews and”—it sounds melodramatic, perhaps—“I am literally starving. I have not had anything to eat. The employer is looking at me as if I am not fit to work. All I can think about is where I can get my next meal from.” The sanction system was definitely counterproductive.
All I would say, to really emphasise this, is that when we look at these new proposals, it is hard to understand what the changes to PIP are about in terms of an employment incentive model because, as we know, PIP applies both in and out of work. How does taking away support from disabled people help them? It just does not add up; it is not a cohesive narrative to me at all.
Q29 Chair: I have a final bit, if I may, on employment support. Again, in the previous panel, a lot was lauded about good employment support and the fact that it can increase trust and produce positive employment outcomes. From your experience, Ruth, in terms of your Changing Realities programme and so on, what does good employment support feel like to the people you have been working with?
Ruth Patrick: Again, I am echoing what Tom Pollard says, but I guess there are worse things to do. It is very much relational. Danny Kruger, you asked for soundbites earlier. For as long as I work in this field, I will remember a young jobseeker who had repeated spells of work. He had gone to a work coach, and they had said, “You have to apply for 10 security jobs or you will be sanctioned.” He said to me, “If they had said, ‘would you’, I would have, but because they said, ‘you must’, I did not do it.” It immediately got his back up, as those of us with teenage children will understand, and made him think he did not want to do it, because he was entering into an adversarial relationship.
Good employment support is very much about having those supportive conversations. It is about having those open-ended discussions about what might be possible, what you would like to do, what feels feasible, what we can do to help things happen. It happens away from, and separate to, a discussion that is completely bound up in, “If you do not do this, your benefits will be lost.”
The problem at the moment is that that threat and that fear of it, however or wherever it will be implemented, pervades and is there all the time. In every encounter people go into in the jobcentre, they have that fear. Again, if we think about the impact of extensive conditionality, it is not just about the impact on the people who are sanctioned; it is the people who are fearful of sanctions. They think, “What happens if I miss that appointment?” There is a culture of fear. We have all had times in our life when we are fearful, and we all know that that does not make us more willing to take risks and make changes.
I know I am talking too much, but the only other thing I would say is about employment support. We have to have a baseline of adequacy within our social security system. If we are living with endemic financial insecurity, it becomes hard to take risks. Also—and again, as shown a great deal by the work of Changing Realities and other research—the work of getting by is so intensive. People are working day in, day out just to make ends meet on inadequate social security benefits. That does not make it then possible for them to maybe take on some volunteering or to go to that CV course, because they are bound up in that everyday work.
Q30 Steve Darling: I would like you to take a trip down memory lane with me to when DLA was introduced and then transferred, or reformed, I should say, into PIP. I would welcome your reflections on how these benefits have impacted people with disabilities and also on the transition from DLA to PIP. Was that a bumpy ride or was it a positive one for claimants, in your perception?
Also, some parts of our community believe that mental health is overemphasised around PIP. Clearly, there was some really useful evidence around this from the first panel, but I would welcome your thoughts on mental health and PIP, and the impacts and opportunities there. Thank you.
Iain Porter: I can come in on the mental health point because, again, the Joseph Rowntree Foundation have recently supported some work from the Institute for Fiscal Studies that looked at this. The IFS found a range of consistent evidence from across lots of different sources, confirming that there has been a genuine deterioration in population mental health. It has likely contributed to the rising disability benefit caseloads that we have seen. There are indicators from across a range of social surveys since the mid-2010s. Previously, about 8% to 10% of the working-age population reported a long-term mental health condition or behavioural condition. In the latest data, that is up to 13% to 15%, and that is triangulating across a range of different surveys.
In terms of the harder data, so to speak, the IFS looked at what they called deaths of despair amongst the working-age population—these are deaths relating to alcohol, drugs or suicide. We know there is a strong link between those and mental health issues. There has been a massive increase. The numbers are up 24% since before the pandemic, which does indicate an increase in severe mental health problems.
There has also been a large increase in the number of people in contact with mental health services, or waiting for mental health services, with the NHS. Those numbers have risen over a third since pre-pandemic. Similarly, there has been an increase in the number of people in England with prescriptions for antidepressants. So that IFS report shows that there has been, from lots of different sources, a real increase in poor mental health amongst the population, which is very likely to be contributing to some of the rise in disability benefits.
I will finish by saying that, from the work that we do with people claiming benefits, going through a PIP assessment is extremely stressful. People find it extremely demeaning. Lots of people will not even go through a PIP assessment, because of the stress that it causes. To give a short quote from someone in the research we did recently with the disability charity Scope, she said, “I find it a really traumatic experience”—she was talking about assessments. She said, “The whole process broke me.”
So these are not easy assessments to go through. Lots of people do not even want to go through them, and back away from them, because of the experiences they have had. By the way, that applies to both the work capability assessment and the PIP assessment. They are both horrible assessments for people. These are not assessments that people try to go through lightly.
Ruth Patrick: On the invitation to go down memory lane, one of the things that is important to talk about as well is the social model of disability and the idea that disabled people are experts in their own lives and know what they need and what they need to spend money on. If we think right back to DLA, that was part of the drive behind DLA, and that was a very positive thing.
That is interesting, because in George Osborne’s emergency Budget in 2010 he announced the replacement of disability living allowance with personal independence payments, and as part of that, he said, “We will cut spend by 20% and we will cut caseload by 20%.” I wondered if that had transpired, in terms of a lesson for today, so I looked—I am pleased that I did—and the OBR’s analysis for 2019 found that the transition from DLA to PIP actually increased spending on disability benefits significantly, by between £1 billion and £2 billion a year, which contrasts with the savings of £1.5 billion per year when this was originally announced. In fact, spend on those benefits in 2018-19 was £4.2 billion higher than the estimate of spend for 2018 made in December 2012. I thought that was really interesting in terms of us thinking about where we are now and where we were previously.
The other thing I would say—it is probably obvious that I would say this as somebody who works directly with people on low incomes and people who are themselves disabled—is that if we are to make these reforms effective and to make them work, we have to draw directly on the expertise that comes from experience and the expertise that comes with lived experience of claiming disability benefits and of trying to seek work. Again, that would be a call to take more time and not to rush changes, but to stop and sit around the room with disabled people and to ask them what they would like from an assessment process that was more supportive and from employment support that could meet these aims. We are not seeing that today.
Q31 Steve Darling: There was an element where I was asking about how PIP is used to good effect. Is somebody able to unpack that a little bit? That would be helpful.
Ruth Patrick: I could have a go, and then others can join in. That relates very much to this point around disabled people being the experts. It can be used for a variety of different things. We take that learning directly from the social model of disability.
Iain read a short quote, but I will read a longer quote from a participant in Changing Realities who talked about how she uses her PIP. This is for mental health issues. This is Lili K writing last July: “My diagnosis is Bipolar—a serious, enduring, often completely debilitating mental illness that prevents me from working and often from living a ‘normal’ life. Because of this I am in receipt of PIP…PIP has afforded me not only physical independence but allows me some financial control through the choice of how to spend the money I receive. My choices will differ from others’ as much as our symptoms, circumstances and requirements. I spend the majority on keeping our old car on the road so I can be driven to my appointments…on providing better quality food for my family… PIP has paid to top up our electric meter as the extra few pounds makes the difference between me staying in bed all day to keep warm and being able to get up because we can put the heater on for an hour or two…I see my PIP as being the top up, that I am unable to earn through work, required to make a bare existence into a life worth living.”
Angela Matthews: I am happy to jump in on the experience of disabled people in work who also need PIP. I get PIP myself. I remember the days of disability living allowance as well.
For a lot of disabled people I speak to who are in sometimes senior, managerial, professional jobs, the issue is PIP is a gateway into other support that disabled people, whatever they earn, still need. I am concerned that that is getting lost in current narratives and debates. A lot of people, if they go into work and are then earning, lose entitlement to other types of grants—the disabled facilities grant, for example. Then, PIP becomes ever so important for that disabled person if they need any alterations, if their condition progresses or if they need a different vehicle or even an adapted vehicle.
Our concern at BDF is that this current narrative is conflating “Disabled people are not working and they are on benefits.” This is an homogenous view of being disabled. We really are concerned that PIP enables people to stay in work and have the lives and the means to keep going to their jobs. For a lot of people on PIP who have been claiming PIP for a long time are also in professional jobs, that PIP is also the means for them to continue and progress in their career as well. It is absolutely pivotal.
Q32 Danny Kruger: I want to ask Ruth a couple of questions, and then I have one for Angela, if that is okay. I am interested in what you said about the study you have done on the two-child cap. Forgive me if I missed it, but did you talk about the effect on fertility? I totally understand, and I intuitively agree with you, that it had little effect on employment, but in terms of a wider system effect or culture effect, do we think that people have had fewer children because of it?
Ruth Patrick: No. I did not talk about it because I felt like I was going on. On fertility, we did two bits of analysis. We did some work with Jonathan Portes and Mary Reader that had a triple difference design, so it was a very a technical examination of the fertility effects. We found a very, very small fertility effect.
Then we tried to unpack that with the qualitative evidence. We tried to understand why this did not lead to fertility effects. There were lots of reasons for that, but a lot of them were just because people did not even know about the two-child limit, or their circumstances changed so much. We found that a lot of people who were affected when they became pregnant did not know that they would not receive support for their third or fourth child.
We know that our social security system is incredibly complex, as we saw with the furore around the two-child limit. I will stop there, but there is a broader, important point, which is that we have a long history in the UK, probably stretching back to Thatcher and before, of welfare reforms that are brought in with clear intentions, but those intentions do not come to pass.
Q33 Danny Kruger: I agree. In that case, I can well imagine it is because the policy is not widely known. I wonder what effect it would have if it were more widely known.
To your broader point, Ruth, if I may, I want to push you a bit. I totally agree with the relational framework, by the way. A lot of my work outside politics is in prisons and with ex-offenders, and I totally recognise that it is not what you do but how you do it; it is who does it. On the point about nothing about us without us, these are essential principles to effective work. I completely agree.
Do you believe that compulsion can never be part of a functioning relationship? To me, it speaks of reality. If somebody needs to do something, they sometimes need to be told they should do it. You made the analogy of parenting teenagers. Sometimes teenagers need to be told, “This is the reality of the situation.” It respects the agency of the individual more if you are real with them, rather than pretending that things can be otherwise.
Ruth Patrick: Sorry, no, I am not saying that, and that is why I am saying that conditionality will always be there, is always there and has a rightful place. But is it front and centre or is it put towards the back? We have a history now; we have a history with conditionality where it was very much firmly front and centre. We have lots of evidence and accounts of people missing appointments because they are sick or their child could not get to school, and they go to the jobcentre and are told that they will be sanctioned. The harm that that does is massive because you are not entering into those conversations in a supportive way.
I would also say that if we think about conditionality, we sometimes talk about a contract. In the 1990s and 2000s, we talked about a welfare contract, but it also has to be two-sided. For ages, I used to say about the claimant commitment that you were asking people to sign up. What would they do? But what would they get in return? There was never an offer. There was never a reciprocal agreement, so—
Danny Kruger: They were getting money, but it goes to the point in the earlier session about the support that is available, which clearly has been lacking.
Ruth Patrick: They may get money, but the money is inadequate and, routinely, they are not getting treated with dignity and respect, and they are not having their individual needs and circumstances understood. Again, that brings us back to the relational. If that is your everyday experience, it makes it harder. I am not saying that there is no place, but I am saying that we can either put it front and centre or we can move it towards the back.
Q34 Danny Kruger: Thanks, Ruth; that was very helpful. Angela, your organisation works with employers, presumably. We heard a lot in the last session about the potential improvements we could get if employers took their responsibilities more seriously. Should that be something, again, that is compelled, or can culture affect the changes that are needed? What changes are needed? Can you unpack that a bit?
Angela Matthews: To respond to the Green Paper, I am speaking to a lot of our members who are employers. I have spoken to 52 of them so far. One thing that we are trying to unpack is how far employers know what it is reasonable for them to do. What is the role of employers and what is the role of Government in terms of providing support? That might be part of an organised employment support programme, or it might just be about someone getting a job in an organisation and the employer then knowing what are reasonable adjustments for them to be making and when it is reasonable or appropriate for them to refer into the Access to Work scheme.
Part of some of the current narrative, and particularly part of the Keep Britain Working review at the moment, is the question about whether employers should be doing more. This is a question that I am exploring with our members at the moment. The key term that comes out again and again across focus groups—they do not know each other and they have not conferred or anything—is clarity. They want to know what they should be doing, what the Government is offering to back them up and back up their workforce, and where they should leave off.
Some examples of that are employers saying to us, “We are making adjustments. We are adjusting someone’s job. But is it our role to provide taxis to work when there is an inaccessible transport system where this person lives?” One of the most common things that employers are saying is, “We do not know if we should be doing that or not. Is there any steer anywhere?” A lot of employers struggle with what is reasonable and the reasonableness. We are exploring that at the moment.
The fourth chapter of the Green Paper about Access to Work is concerning; a lot of our employers are concerned about that. I spoke to a cohort of employers the other day who only refer into Access to Work for high-cost adjustments; forgive the term “high-cost”—I know it can be emotive. Some of them have employed people who are deaf and who need BSL interpreters full time to be able to do their job, in a way that would not mean reducing hours because they do not have full-time BSL. Some of our employers told me they are paying between £71,000 and £75,000 a year for full-time BSL interpreters. Now they are asking me, “Is that reasonable? Is that what we should be doing? Is that beyond reasonable? Is that something Access to Work can help us with?” They have also employed a lot of people with mental health conditions, learning disabilities and autism over the last year, and they are paying for job coaching for all of them.
Now their bill for additional support, which is different to their central reasonable adjustments budget, is so much bigger than the reasonable adjustments budget that they have just for staff. They are asking, “What should we be doing? Where does the Government want us to stop? What is the potential for Access to Work to help us keep employing these people?”
I pushed some participants in those groups: “Okay, with your employee who has a BSL interpreter, where the cost is £74,000 a year for this person in their role with their interpreter, what would happen?” The employer said, “We would not be able to afford that adjustment, so we would be looking at redeploying, but it cannot be to a full-time role, or we would no longer be able to support that person.”
This is real, and we are seeing that with job coaching as well. If Access to Work is not there, without the hundreds and thousands of pounds per year that a lot of our members are paying for job coaching, they would no longer be able to support those people. So we are worried about that.
Q35 Johanna Baxter: I have a quick follow-up, if I may. How long does it take for Access to Work to process those claims, and is that an issue?
Angela Matthews: Yes, it really is an issue. At the moment, from the point of applying for Access to Work and getting an assessment, our members are quoting between six months and—I heard this the other day—13 months.
Q36 Johanna Baxter: Employers will not wait that long, is my guess.
Angela Matthews: Some employers I have spoken to so far have said, “We have been paying in the meantime, while our employee is the queue. When we get to Access to Work, they say, ‘You have been paying for it. You can afford it. You pay for it, then.” I have heard that on four occasions in in-depth interviews with four different employers who do not know each other, and that was just within the last two weeks.
Q37 John Milne: There is an apparent contradiction in a couple of Government statements, which I wonder whether you could give your views on. On the one hand, they say that in the future everyone receiving UC health will, as a minimum, have to attend regular support conversations. On the other hand, they also say that they do not envisage the requirement on this group extending to undertaking specific work-related activity, looking for work or taking jobs. Given those two contradictory statements, do you think you understand how conditionality will work?
Angela Matthews: From our perspective, we do not know that. We are not working on that at BDF, although we do know that even people who are in work, but in entry-level roles, are worried, and the anxiety is very high about this. We know that a lot of people are going to Scope, for example, saying, “How will this work? What will I need to do?” As I said earlier, people are assessing what work they can do and what work they should do, alongside managing their income. People are already thinking, “What is the situation where I could lose my benefits? I am going to starting to put a work situation in place now that could get me through that.” But without clarity, a lot of people are functioning on anxiety.
Ruth Patrick: I think it is best understood as part of that intensification and extension of conditionality that I spoke about before. It is almost like the natural next step is to say that we have this limited work-related activity group, or UC health, as we are calling them now, so all those with some yet-to-be-determined small exemptions, will be expected and mandated to take part in a support conversation or risk the consequences.
I would also say—perhaps this is deliberate, or it may be part of a rush to get the proposals out—that it is not clear what that looks like in practice yet. I read through the Green Paper quite closely with an eye on conditionality, and it is not clear.
I would also say—we have not had time to talk about this very much—that it links to what we were talking about with an earlier question. Conditionality can be applied in different ways, and individual work coaches have a lot of discretion. In terms of a devolved setting, for example, I know that Northern Ireland has a very strong approach, which is to avoid sanctions wherever possible. If you go to the Department for Communities in Northern Ireland, I do not know if it is literally this, but you almost get handed a leaflet saying how to avoid the sanction. It is supportive; it is saying, “This is what you can do to try to fulfil your conditionality requirements.” We know from history that in England that it has been employed in very different ways.
The shorter answer to your question is that we do not yet know, but it certainly looks like it is an extension of conditionality, which follows a well-trodden path that we have seen over time.
Q38 John Milne: Obviously, we do need to know in the very near future. Iain, you have written about this on Bluesky.
Iain Porter: Yes, adding to what has been said, the Government do not seem to know, looking at what is in the Green Paper. It is another area, and there are in big areas in the Green Paper, where the Government have basically said, “We are not sure how the details will work and we will have to consult on it.” Yet, MPs are being asked to vote on things before the Government have even given that detail or probably even thought about it themselves.
They are clear that they envisage conditionality extending to most people on the UC health element. Like some of the witnesses in the previous panel, I suspect, based on previous Government ideas, that they would like that to essentially cover the vast majority of people on the universal credit health element. The problem is that, to mitigate that, they have said, “There will be some people who we will not expect to be potentially at risk of sanctions, but we do not know how we will identify those people yet, and we do not know what the other people are supposed to do.”
They are almost recreating the same problem that they are trying to solve. They started by saying, “There is a problem here, in that the system tries to distinguish between two groups of people, some who cannot work and should not have any conditions, and some who can work and should have conditions. That is a problem, so we will get rid of that. Oh, but by the way, that is actually a real problem: some people should not have conditions. We will have to re-decide how to determine those people.” But they have not shown the detail of how that will work.
The context for all this—just to emphasise what some of the previous panel said—is that all the evidence on conditionality is fairly clear that when it comes to disabled people and people with health conditions, the effect of extending conditionality is essentially nil or potentially negative in terms of employment impacts, but with quite clear negative impacts on health, especially mental health. So, overall, there is no real, clear evidence base for extending conditions.
In the recent research I mentioned, which JRF did with the disability charity Scope, we spoke to claimants who are currently claiming the universal credit health element. Some 75% of those claimants in our survey said that one of the biggest barriers to being able to engage with work-related support or to try work is the fear of what will happen to them if work coaches take that as a sign that they can add more conditions, and of then being told to do things that they are not able to do or that would worsen their health conditions.
One of the biggest fears in the system is a proposal to extend conditionality to this group. Potentially, if it follows some of what the previous Government’s White Paper in 2023 proposed, meaning that work coaches have more discretion over what conditions are applied to this group, that will just amplify the fear that people will have in what should be an important relationship with a work coach, and will push people away from genuine engagement rather than towards it.
Q39 John Milne: Thank you; that is very interesting. This is to Angela, in particular. The Government has said that the success of its welfare reforms depends on there being an accessible and inclusive labour market. What do you think this will mean in practice, and how will it be achieved?
Angela Matthews: From a wider perspective—from the individual’s perspective in terms of non-employment—as I said earlier, and as we heard at the previous panel, everything needs to be in place in someone’s own life before they can manage their condition and look for a job and get a job and stay in work and progress there.
We have heard from employers who have had disabled people apply for a job. When the recruiter has said, “Do you need anything? Can we help with anything else?” the person has said, “What should I wear to the interview?” The recruiter said, “Do you have a smart jacket that you could wear to come into the office?” But this person did not have anything. They had never been to an interview before. Then they started to think, “How will I get to the office? I have never had to follow directions like that before.”
So we do see recruiters and employers helping as much as possible. From the individual’s perspective, when they have that first interview or they try work, they have an idea of what they should do, but then there is a lot more to think about. I spoke to someone else, who then said they were trying to explain the concept of annual leave to someone. These things we take for granted, because we work, are huge, big concepts and also entirely new to a disabled person.
A lot of the skills that you need in order to go to work—to get up on time, to plan a route and to get there on time, regardless of having the cognitive and physical energy to sustain those working hours as well—are overlooked. We have heard from people who said, “I did try an employment programme for disabled people, but I have chronic fatigue. There was a four-hour session in the morning, so I could not go back the next day.” From the individual’s perspective, I hear a lot that they are starting to feel like, “I need to be well, I need to be healthy, I need to be at my best to start looking for work. Otherwise, I will not be able to cope with it.
The right to try is interesting to us and a lot of disabled people, but there are some questions there over who measures the success of that trying and how the disabled person’s experience will be accounted for. We really do not want to push disabled people into thinking they have to take any job they can, when the pay-off is spending the weekend in bed or in pain or needing more medication. They have tried work, and the pay-off has been so expensive to them and their condition, but from the Government’s perspective, they can work. The individual is thinking about all this.
From the employer’s perspective, in terms of an inclusive labour market, a lot of employers are looking at what good recruitment is. What is inclusive recruitment these days? We are seeing more employers saying, “If you cannot fill out that application form, or if you do not have a CV, do not worry: email us at this address.” Some employers I spoke to said, “What we have found is that a lot of young people are great at creating online content for social media.” One of our employers said, “Do not worry about the CV. Create a video as if you were going to post it online, but I want the content to be: you are applying for this job.” Brilliant! That individual had no mental barriers to doing that at all. So we are trying to encourage more employers, within what they can do, to be creative about how people apply for jobs, find jobs and communicate with them.
Employers are battling a whole magnitude of legislation—for example, even section 60. Employers, apart from in limited circumstances, should not ask health and disability questions before offering a job. A lot of employers are still not practising this. That means that when a disabled person comes to an interview, and they have been prepped that they will not be asked anything about their disability and that the employer is not allowed to ask them about that, the first question is, “Why have you not been in work until now?” There is definitely a marrying-up and educating employers, but I have to say that a lot of employers are doing a lot of good stuff as well.
Then you have to tackle the probation and the induction, for example. We know that a lot of disabled people go into work and then do not talk about their disability. They do not talk about adjustments until they have passed that probation, meaning that they are struggling all through that three, six or nine-month probation period, which exacerbates their condition. They either leave work before the probation is up or they are exhausted by those previous months and then they say, “Okay, I need adjustments now.” That is then completely new to the manager who has employed this person for three to nine months already.
In terms of an inclusive labour market, when we ask disabled individuals about this, they go back to the social model approach. They say, “Remove the barriers.” When I ask disabled people, they do not talk about their specific condition; they do not talk in medical terms. They say, “I need to get to work, I need to be able to do the working day, whatever that is—whether it is a few hours or a whole day—and I want a life outside of work when I go home as well.”
Chair: I am conscious of time.
Angela Matthews: I apologise.
Chair: No, you have such in-depth knowledge there that we would love to know more about, Angela. If you could put any of that in writing to us, it would be really helpful. John, I will move on, if that is okay. David Pinto-Duschinsky.
David Pinto-Duschinsky: Thank you. Given that we have only two minutes left, I will be unbelievably brief.
Chair: We will let you run over, David. That is fine.
Q40 David Pinto-Duschinsky: I am grateful to you for mentioning the right to try. If we had more time, I would ask questions about how that would work, because it feels like an important part of the equation. Another part of the equation is around Access to Work. The Government is consulting on the future of Access to Work and has launched a Keep Britain Working review into the role of employers in tackling economic inactivity due to ill health and disability. What difference could that make?
Angela Matthews: We are involving our members in the Keep Britain Working review. We are responding to the engagement questions. I am speaking to employers about that a lot at the moment as well.
Again, they are keen to be involved in this because they want to say—sorry, this goes back to how I answered the previous question—“We want to know what the Government want us to do. They are asking us to do a lot.” We need some balance between what the Government needs to do to support workers, employees and potential workers, but we also need to see some support for employers from the Government.
A lot of our members welcome that review, and they want Charlie Mayfield to hear how much they are doing. Some of them have also said, “We want to tell Charlie what we have done, so that we can get the review’s take on whether this was too much or not.” It comes back to that clarity.
We love the Access to Work scheme at BDF because we have seen how much it has got disabled people into work, and it is the difference between them working and not working. We think it would be a horrific shame and a huge detriment to an inclusive labour market if it left. I can go on, but I suppose we do not have time.
Ruth Patrick: Can I say one quick thing about work and employers? We hear a lot, and we have heard a lot in the debate around this, about how work is inherently good for people. So there is a paternalist approach saying that getting people, and getting disabled people, back into work is a really good thing. But when we unpick the evidence base, it depends on the nature and type of the work. We find that good work helps our health, and bad work—as many of us know who have experienced it—can have the opposite effect.
When we try to unpick what makes a job good, it is not all about pay. It is not necessarily all about being paid more and more. It is a lot about the levels of flexibility and autonomy. That matters for all of us. For those of us who are parents, it matters a great deal. For those of us who are disabled, it matters a great deal. Looking at how we move towards a labour market that does offer autonomy and flexibility to its employees is really important.
Another thing I would say really quickly, because we have not touched on it, is that analysis and research has been done on what employers think about conditionality. I know an academic who was at Leeds—she has now gone to Australia—called Jo Ingold, who found that employers really do not like conditionality either. If we are thinking about the case for this push, push, push on conditionality, they find it counterproductive, because they have people applying for jobs who have no interest in them or who are not suited to them, because they are told to by a work coach. I would just add that other picture.
We have to fight back against the argument that any job is good for you, because that is just not true. It does have to be good work. Then we have to look at how we make sure that more of us have access to good work.
Iain Porter: Can I add something quickly on Keep Britain Working? First, in the research we have done with people claiming the health element of universal credit, it is clear that if policymakers want to shift the dial on the disability and health benefits caseload, the answer does not lie in trying to change the benefits system. You will shift the dial by changing the labour market. The interaction of people’s health conditions with the labour market and jobs is the really important factor in driving people to have to claim disability benefits. So the review of what can be done in the employment space is welcome.
But I would ask again, on the timing of the legislation that is apparently coming in June on the cuts to disability benefits, why is that happening before Sir Charlie Mayfield’s review concludes—it is due to conclude in the autumn—when that is such an important part of the picture? These proposals on the benefits cuts are simply cutting almost £7 billion of income from disabled people. As we have heard in the evidence here, that will not help people materially into work; it will just increase poverty and hardship. We need to make the changes in the labour market, for sure, but let Sir Charlie Mayfield’s review at least happen first before cutting benefits so significantly.
Q41 David Pinto-Duschinsky: Picking up on the labour market point, one of the things the Government is talking about in the review is looking at the legal duties in the Equality Act, particularly around the role of the EHRC, HSE, ACAS and so on. What changes would you like to see made in those areas? I am particularly looking at you, Angela.
Angela Matthews: We would like to see the EHRC have more resourcing to do more of that enforcement work. We would like to see a supportive enforcement model with employers. When I asked employers if they had ever been contacted by the EHRC because of one of its enforcement powers—for example, on pre-employment questions or adjustments—they said, “Maybe, but we don’t know.” Employers do not know where the issuing of enforcement, or the letter, goes in their organisation, so they cannot say if they have been contacted or not.
We think there is a role for, as I said, collaborative enforcement that educates employers and says, “You failed to do this. This is what you need to be doing. Get it right. Next time, there is a different kind of enforcement action that we will need to take.” The EHRC needs to be resourced and equipped to take on that load. We would like to see that. We think there is a strong role in that.
One thing that we have not mentioned much at all, which is so huge, is work-related stress. What we see is that when we talk about people saying they have a mental health condition, we are talking about work-related stress a lot of the time. The Health and Safety Executive has a role in educating and working with employers on those six key workplace stressors that push people into not coping with work. The HSE has a huge supportive, equipping and educating role in working with employers to diminish work-related stress.
We already point people, employees and employers, who are potentially in dispute—again, often about work-related stress, work-related harassment, bullying in the workplace and discrimination—towards ACAS, and they all say what a brilliant process it was. We can use more of that as well, but not many people know what the role of ACAS is.
So, yes to all that—we would like to see more.
Q42 Johanna Baxter: I will be quick because we are out of time already. Many people have criticised the Disability Confident scheme as a box-ticking exercise. What future do you see for it?
Angela Matthews: We see it as a huge engager for employers, particularly those starting out with disability, diversity and inclusion in the workplace. It does need to be more robust. It does need to take account of disabled employees in the organisation: “What do you think? What is your experience?” That has to happen.
Research has been done about how much better employers who are Disability Confident-accredited are or are not. That research is by Kim Hoque. It is important that the scheme is already a good engager. We see that that is worthy in itself. A lot of employers come to us and say, “What is this Disability Confidence scheme?” That is their opening; that is the first thing they have ever done to talk about disability. That is great in itself, but then there is a point where, beyond that commitment, at level 1, employers need to be doing more, so let’s move them on now. The success criteria and the accreditation need to be more robust but, again, you need to resource a Disability Confident team to do that. It is a great team, but it is small.
Chair: Thank you so much. I am very grateful to Iain, Angela and Ruth for coming and giving evidence today.