Written evidence from Centre for Social Investigation, Nuffield College, University of Oxford

The inquiry notes the interest in establishing the value for money of DWP’s administration of benefit sanctions. An important aspect of value of money are the costs of the unintended consequences of sanctions. There exists clear evidence linking the experience of sanctioning with extreme material hardship, as evidenced by the number of people being referred to foodbanks due to benefit sanctions. The potential health consequences of the dietary restrictions and consequent risks to health faced by these people should be included when estimating the value for money of the sanctions regime. This submission focuses specially on the side effects of benefit sanctions on food insecurity – as measured by foodbank use – although other consequences are also well established. The potential influence of benefit sanctions on foodbank use has previously been raised in the House of Commons (House of Commons 2015).

This submission draws on data on foodbank use to derive the following estimates:

1. The number of emergency food parcels distributed to households who have been sanctioned
2. The proportion of the British population who have sought emergency food from Trussell Trust foodbanks as a result of sanctions

Evidence Summary

The results of quantitative analyses included in this evidence submission can be summarised as follows:

• Research suggests that between 8 and 30 per cent of foodbank referrals are due to sanctions
• Encouragingly, the proportion of foodbank referrals due to sanctions is declining over time
• Data on foodbank use will underestimate the proportion of people experiencing food insecurity as a result of sanctioning, because many people in need do not seek assistance from foodbanks
• There is a robust link between the number of sanctions applied in a local area and the rate of foodbank use in that area
• The number of unique foodbank users who have sought assistance due to benefit sanctions is in the region of 50,000 people in Great Britain
• The number of people experiencing severe food insecurity (distinct from foodbank use) as a result of benefit sanctions is estimated to be in the region of 150,000 people in Great Britain
• Evidence from Canada on the high healthcare costs associated with food insecurity suggest that benefit sanctions have costly implications for healthcare. Assessments of the value for money of benefit sanctions should therefore include the unintended costs to the NHS

1. How many food parcels are distributed to households who have been sanctioned?

The Trussell Trust – the largest supplier of emergency food in Britain, and the only such organisation to record the number of people receiving emergency food – collects routine information about the demographic characteristics of people receiving emergency food, alongside basic information on their reason for referral to a foodbank. This reason for referral data includes reasons of benefit delays and benefit changes, but there is no separate category relating to benefit sanctions. Consequently, the precise number of people referred to foodbanks due to sanctioning in Britain is not definitively known.

However, detailed information on foodbank referrals due to sanctioning is available from West Cheshire Foodbank. Since May 2014 the foodbank has collected additional detailed data on all referrals, providing information on the number of referrals due to sanctions, and the benefit claimed. Using 24 months’ data from West Cheshire Foodbank, Table 1 below summarises the number and proportion of referrals due to sanctions. In 2014-15, 9.22 per cent of referrals to West Cheshire Foodbank were due to sanctions; encouragingly, this figure fell to 4.81 per cent in 2015-16. In both years, just over two-thirds of sanctions were applied to households claiming Jobseeker’s Allowance (JSA). The fourth column displays DWP figures on the number of sanctions applied in Great Britain over the two time periods being examined. In both years, approximately ten times as many sanctions were applied to JSA than Employment Support Allowance (ESA) claimants. The higher proportion of foodbank referrals due to JSA than ESA sanctions probably reflects the more stringent conditions of JSA than ESA, making it more likely that JSA than ESA claimants fail to comply with their claimant commitment, thereby increasing the likelihood of sanctions. The final column aggregates estimates of the number of foodbank visits due to sanctions, based on the proportion of visits to West Cheshire foodbank, and the national number of sanctions, assuming that the proportion of referrals due to benefit sanctions in West Cheshire is typical of Great Britain. These final estimates are that 62,646 foodbank referrals in Great Britain in 2014-15 were due to sanctions, falling considerably to 14,766 in 2015-16.

Table 1: Summary of sanctions data, May 2014 to April 2016

Note: Universal Credit sanctions are not reported here due to small numbers

The figures reported in Table 1 are of course only estimates because the proportion of foodbank referrals due to sanctions is likely to vary between foodbanks, depending on the characteristics of the local populations they serve. However, the figures below are unlikely to over-state the scale of the benefit sanctions leading to foodbank use for two main reasons. First, figures on the proportion of foodbank visits due to sanctions and the national number of sanctions track each other very closely. In both years, the proportion of foodbank referrals due to sanctions was slightly over twice as high for sanctions applied to JSA than ESA claimants. The national number of sanctions showed a similar pattern, although the order of magnitude for JSA than ESA sanctions is approximately ten times higher. When comparing 2014-15 and 2015-16, both the proportion of foodbank referrals due to sanctions and the number of sanctions reduced by approximately fifty per cent. The similarity of these patterns suggests that the proportion of foodbank referrals due to sanctions and the national sanctioning rates do reflect broader trends.

Second, the estimated proportion of referrals to West Cheshire Foodbank due to sanctions is likely to under-state the scale of the issue. Further research has reported higher levels of foodbank referrals reflecting benefit sanctions than suggested by the figures above. Data collected by the Citizens Advice Bureaux (CAB) on reasons for referral in spring 2013 revealed that 16 per cent of referrals were due to benefit sanctions (Citizens Advice Bureaux 2013). A survey of three foodbanks likewise found that 20-30 per cent of foodbank referrals were due to sanctions, and this proportion varied slightly between foodbanks (Perry et al. 2014). Evidence submitted to the All-Party Parliamentary Inquiry into Hunger in the United Kingdom indicated that 79 per cent of YMCAs in England who referred young people to foodbanks did so as a direct result of benefit sanctions and delays (All-Party Parliamentary Inquiry into Hunger in the United Kingdom 2014). Taken together, these figures provide broad estimates of the proportion of foodbank referrals due to sanctions, which are far more likely to under-state that over-state the scale of this phenomenon.

Aggregate analyses of sanctioning rates and foodbank use

Taking a different approach, research linking aggregate numbers of referrals to foodbanks with local-level information on the number of sanctions applied in the local area also demonstrates clear links between benefit sanctions and foodbank use. Using this technique, Loopstra et al. (2015) reported that between 2006-07 and 2013-14, local authorities with higher rates of benefit sanctions also distributed a larger quantity of emergency food parcels. A one percentage point increase in the rate of benefit sanctions was associated with a significant 0.09 percentage point increase in emergency food parcel distribution. This association was independent of the capacity to receive assistance from foodbanks, measured as the number of foodbanks operating in the local authority and the number of years each foodbank had been operating. The authors cited the example of Derby, where in 2013 sanctions affected 13 per cent of benefit claimants, and was associated with a rise of one food parcel per 100 people.

Using longitudinal analyses, Loopstra et al. (2016) also reported that local authorities with higher levels of sanctioning also recorded greater foodbank use. It was estimated that an increase of 10 sanctions resulted in 3.36 more foodbank users per 100,000 people. This association was independent of the availability of food aid and how long foodbanks had been established in the local area. Using figures on the number of sanctions applied, the authors estimated that the increase in JSA sanctions between 2012/13 and 2013/14 accounted for 5-10 per cent of the rise in foodbank use over this period. These results were robust after accounting for local rates of unemployment, urban-rural status and local area multiple deprivation, demonstrating that the association between sanctioning and foodbank use was not confined to areas with particular characteristics.

2. What proportion of the Great British population have sought emergency food from Trussell Trust foodbanks as a result of sanctions?

To complement the examination of the number of food parcels distributed in relation to benefit sanctions, it is also possible to derive an estimate the proportion of the population who have sought assistance from Trussell Trust foodbanks as a result of sanctions. Headline Trussell Trust figures report the number of emergency food parcels issued, which is not the same as the number of people using foodbanks because recipients are ordinarily allowed to claim three vouchers for emergency food. This means that Trussell Trust figures do not identify the number of individuals receiving emergency food, leaving unknown the proportion of people using foodbanks in Britain.

Unpublished analyses of repeat visits to West Cheshire Foodbank suggest that between one and 1.3 per cent of people living within West Cheshire received emergency food from West Cheshire Foodbank between 2013 and 2015. Applying this proportion to population estimates for Great Britain over the same period, Table 2 shows that the number of people receiving assistance across Great Britain was estimated to rise between 2013 and 2014 before falling slightly in 2015. These figures relate to all visits to West Cheshire foodbank, not those specifically relating to sanctions. Due to data availability, the time period of these analyses differs slightly to those in Table 1. Nonetheless, using the published figure of 8 per cent of referrals over this period (Garratt et al. 2016) makes it possible to estimate the total number of foodbank recipients in Great Britain who referred to foodbanks due to benefit sanctions. The figure of 64,860 recipients due to sanctions in 2014 is extremely similar to the 62,646 foodbank visits in 2014-15 estimated in Table 1 above. In contrast, the estimated 55,659 recipients of emergency food due to sanctioning in 2015 is far higher than the estimated 14,766 foodbank visits due to sanctioning in 2015-16. This discrepancy is likely to reflect the mismatch between time periods being explored, where the declining number of sanctions over time means that it is not surprising that the number of unique recipients in Great Britain in 2015 would exceed the number of foodbank visits due to sanctions between May 2015 and April 2016.

Table 2: Number and proportion of people using foodbanks between 2013 and 2015

The figures so far relate to emergency assistance received from foodbanks. Yet we know that for a range of reasons – including awareness, accessibility and willingness to seek help – only a minority of people experiencing food insecurity receive help from foodbanks. This means that the scale of food insecurity – and its health consequences – will be understated by a reliance on figures related on the narrow experience of foodbank use. In Britain, the proportion of people experiencing food insecurity who receive help from foodbanks is not known. Evidence from Canada suggests that 40 per cent of households experiencing severe food insecurity receive help from foodbanks (Kirkpatrick & Tarasuk 2009). Severe food insecurity is defined as missing meals, reducing food intake and at its most extreme, going days without food. Assuming that the same proportion of severely food insecure households use foodbanks in Britain, Table 3 provides estimates of the number of people in Great Britain experiencing severe food insecurity, both overall and in relation to benefit sanctions. Looking first at the total numbers, the figure of 2.023 million people in Britain experiencing severe food insecurity in 2014 is lower than estimates from the Food Foundation that 3.7 million UK adults experienced severe food insecurity in 2014 (Taylor & Loopstra 2016). This discrepancy potentially indicates that the assumption that 40 per cent of severely food insecure households in Britain use foodbanks might overstate the availability and willingness to use foodbanks in Britain. Canada has a far longer history of emergency food supply so a larger proportion of severely food insecure Canadian households may be expected to use foodbanks compared with equivalent households in Britain. It should also be emphasised that the figures reported here relate to emergency food supplied by the Trussell Trust, who are the largest but by no means the only foodbank operating in Britain, so will by necessity under-estimate the number of people receiving emergency food from foodbanks.

Table 3: Estimated number and proportion of people experiencing severe food insecurity between 2013 and 2015

Health consequences and costs food insecurity due to benefit sanctions

Food insecurity is associated with poor quality (Pilgrim et al. 2012) and nutritionally inadequate diets (Kirkpatrick & Tarasuk 2008). It also confers increased risks of general health impairments in adults and children (McIntyre et al. 2000; Cook et al. 2004; Olson et al. 2004), alongside a range of chronic conditions including diabetes (Gucciardi et al. 2009; Seligman et al. 2009), asthma, migraines, and heart disease (Tarasuk et al. 2013). Experiences of food insecurity also have serious consequences for mental health in adults (Power et al. 2016; Tarasuk et al. 2013; Olson et al. 2004) and children (Whitaker et al. 2006; Belsky et al. 2010), and are associated with elevated suicide rates (McIntyre et al. 2013). Although emergency food is designed to be nutritionally balanced (Trussell Trust n.d.), a review of studies concluded that foodbank users are likely to have poor-quality diets, putting them at risk from nutritional deficiencies (Bazerghi et al. 2016).

People with physical or mental health problems also face an elevated risk of sanctioning (Work and Pensions Committee 2015). There may be insufficient jobs suitable for people with such problems, and health conditions – especially those relating to mental health – may make it difficult for people to comply with the conditions of their benefit (Garthwaite et al. 2015). For example, Garthwaite (2016) reported the case of a partially sighted man whose health needs meant he was able to apply for only a limited number of jobs. He was sanctioned and later referred to a foodbank. Evidence submitted to the All-Party Parliamentary Inquiry into Hunger in the United Kingdom further noted that vulnerable groups – including those who find it difficult to read letters, to leave their homes or answer the telephone – were particularly susceptible to sanctioning (All-Party Parliamentary Inquiry into Hunger in the United Kingdom 2014). Sanctions therefore appear most likely to affect vulnerable people who genuinely face difficulties in meeting the conditions of their benefits, not those who are reluctant to do so and instead want to ‘play the system’. The independent review into JSA sanctions also recognised that vulnerable claimants were less likely to understand and fulfil the conditions of their benefits, and letters from DWP were frequently not understood. Qualitative research reveals that sanctioning is only likely to worsen people’s health: “I’ve never been on anti-depressants before but I am now because of the stress from being sanctioned and having no money. I need them now to cope.” (Cooper et al. 2014).

Having derived estimates of the number of proportion of people in Britain who experience food insecurity due to benefit sanctions, a consideration of the health consequences is warranted. No analyses of the health costs of food insecurity have been undertaken in Britain, although the doubling of malnutrition-related hospital admissions between 2008 and 2012 led clinicians to warn of an impending public health emergency (Taylor-Robinson et al. 2013). Again, we can use evidence from Canada – which has a similar system of social health care to Britain – to help derive estimates for Britain. Tarasuk et al. (2015) estimated that compared with food secure households and after adjusting for background characteristics including income, education, and household composition, households experiencing severe food insecurity were 71 per cent more likely to incur healthcare costs. The healthcare costs of this group were higher, with an average spend of 1,438 Canadian dollars for people living in food secure households, rising to 2,529 Canadian dollars for people experiencing severe food insecurity. Although these figures may not be immediately comparable with the costs of healthcare in Britain, the costs of treating the consequences of food insecurity facing the NHS are nonetheless likely to be considerable.

Conclusions

The evidence presented in this submission demonstrates that a significant minority – between 8 and 30 per cent – of foodbank referrals are due to benefit sanctions. Although this proportion appears to be reducing over time, data on foodbank use understates the scale of food insecurity as a result of sanctioning, because many people in need do not seek assistance from foodbanks. Benefit sanctions are thought to result in approximately 50,000 people using foodbanks in Great Britain. The number of people experiencing severe food insecurity – meaning that they do not always have enough to eat and may go for days without eating – as a result of benefit sanctions is estimated to be 150,000 people. The high healthcare costs associated with food insecurity demonstrates that cost savings incurred by benefit sanctions will almost certainly have unintended fiscal consequences. Assessments of the value for money of benefit sanctions should therefore include the unintended costs to the NHS.

Acknowledgement

This submission draws on data supplied by West Cheshire Foodbank, whose assistance is gratefully acknowledged. Responsibility for all analyses and their interpretation lies with the author.

6 November 2016

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