Strategies for resolving the unemployment of disabled people – ethically and long-term.

What do you think:

DWP doomed to fail on disability unemployment unless other Departments play their part?

Back-to-work help for disabled people is pointless without improving poor health (especially mental) and skills?

Are disabled people “forced to fail” by low success rates of employment support and tough benefit rules?

(Apologies for this being long- would welcome your ideas on what’s missing/wrong)

In the UK, we are squandering the contribution of nearly 20% of the workforce to our national economy: around half of these working age disabled people are not in employment and, for those who are, work tends to be low level, part-time and short-term.  It’s easy to blame employer prejudice and discrimination for costs we all bear from lower economic inactivity and higher disability benefits.  It’s easy to make the Department for Work and Pensions (DWP) responsible for putting everything right.  But reality is more complicated and far-reaching.

There is little point in forcing people in poor health to take part in costly return-to-work programmes: their chances of success are very limited and any work they do achieve is likely to be low paid and difficult to sustain – the starting point is to improve their overall health as far as possible (and especially mental health).  The same applies to people with lower education who are about four times as likely as others to be claiming disability benefits – the starting point is to build on their existing work skills and add new ones.  And the same principles apply to every unemployed disabled person regardless of what benefits they are getting – or not.

A key issue is whether the policies are driven by the narrow goal of reducing the numbers/cost of benefit claimants or creating real social and economic change by increasing their employment rates.  All of The latter does more for taxpayers and lifts disability unemployment beyond the reach of just DWP: different Departments across Government (spurred on by the Treasury) have to leap out of their work silos and take strategic collective responsibility across their policies and delivery –it’s what Cabinets are good for!  But in times of financial strain, none of this is likely without an across–the-board cost-benefit analysis and funding regime – it’s the starting point that seems missing for this part of Welfare reform.

And, while all of this is based on UK structures and data, the strategic principles could be relevant to other countries and their economies.

Realising the benefits of more disabled people in good work depends on life-long, society-wide changes:

  • Increase Public Health, education and social initiatives that encourage health and fitness and reduce the occurrence and consequences of the most common impairments.
  • Target health care according to demand (especially mental health), incentivise health professionals with clinical work outcomes and ensure they understand the life consequences of impairments, of delayed treatment, on future poor general and mental health, on worse health outcomes for those with visual and hearing conditions, and on employment prospects.
  • Target life-long learning on people with lower education and low-level jobs as better education reduces the likelihood of disabled people becoming unemployed or claiming benefits and improves their return-to-work prospects.
  • Ensure that the transport infrastructure, staffing and travel concessions are geared to working disabled people.
  • Stop using the criminal justice system to manage disproportionately high levels of disabled people.
  • Ensure that self-employment tax and National Insurance processes plus business start-up support is fully inclusive and accessible as working disabled people are more likely to be self-employed than their non-disabled peers.
  • Target employment in all sectors with the highest risk of causing long-term health conditions and use Health and Safety requirements, the health insurance industry and legislation to improve their performance, retention and re-employment support.
  • Abolish the stigma surrounding impairments (especially around mental ill-health) with more, successful disabled workers – disability prejudice is the largest by far cause of contacts with the UK Government’s Equality Advice and Support Service (EASS).  Imposing costs may have reduced the number of disability discrimination cases going to employment tribunals but they are still the main cause of calls to the EASS.
  • Use the might of public sector employment and its massive procurement spending power to lead by example and exercise financial muscle with contractors to increase employment of disabled people at every level, in every sector – compliance with equality legislation is an added bonus.

Specific action for young people will bring long-term benefits:

  • Ensure all young people stay in education as long as possible, gaining their maximum qualifications, vocational and employability skills.  Disability and unemployment are linked to low skills whereas higher skills are linked to lower levels of disability and better return-to-work/less benefit claimants.
  • Enable schools, colleges etc to make changes so that disabled students reach their full potential: provide adequate funding and effective management of student adjustments/support plus tailored specialist careers advice.
  • Provide mental health care, treatments and therapies as levels of such conditions can be high in youth.

Throughout working lives, interventions can reduce the employment consequences of disability:

  • Target people in low-level, poor quality jobs:
    • Improve their skills and employability so they have better prospects should they acquire an impairment.
    • Provide careers advice and encourage to full-time, permanent, better quality jobs to reduce the risk of unemployment linked to disability and other characteristics (women, age, mental health) – with added bonus of reducing need for Government low-income subsidy.
    • Encourage better health and fitness at work and leisure.
    • Improve Health & Safety protection as low level jobs can have higher risk and so higher general health consequences.
    • Provide easy access to health care (including for mental health) to mitigate occurrence/consequences of most common impairments (moderate pain, muscular skeletal and mental health conditions) noting that poor mental health is linked to low quality jobs.
  • Support employers with:
    • Information and practical help to make the changes needed to retain employees with/acquiring disabilities enabling them to change role/tasks, work locations and hours, equipment and support, information, policies, practices and procedures and so fulfil their legal responsibilities.  In the UK, the Fit for Work occupational health service should assist employers with some of these responsibilities. Target tailored support at small and medium-sized employers that employ the majority of the workforce but have limited organisational resources (rather than larger corporates).
    • Promote and effectively manage legally-compliant, adequate Government funding for workplace changes/support that would be unreasonable for employers of/self-employed disabled people (especially those with mental health conditions)

Notwithstanding the interventions above, some people with long-term health conditions will still have periods of unemployment and need return-to-work help.  Characteristics likely to make that support more successful include:

  • Demand.  Capitalise on existing demand from those already keen to work to achieve early success benefits: persuasive motivational role model examples for positive promotion and publicity to increase further demand and employer buy-in, counter any negative perceptions caused by past employment support and road-test delivery models.
  • Mandatory?  Enforce participation with caution.  Early return-to-work activity can be justified by reducing the mental ill-health, loss of employability and fossilisation of work skills linked to long-term unemployment.  But the enforcement methods must be equitable and productive rather than simply forcing claimants off benefits.  The UK’s Work Capability Assessment (WCA) and sanctions regime move claimants on to Job Seekers Allowance (JSA) or the Employment and Support Allowance (ESA) Work Related Activity Group and penalise non-participation.  But justification and effectiveness is less convincing when the WCA itself has been flawed (especially in relation to mental health), when providers of mandatory or voluntary support (Work Programme and Work Choice) “cream” the easiest to progress, while “parking” the more challenging/reluctant, when benefit sanctions are disproportionately applied to ESA claimants and those with mental health conditions and when support lacks the breadth described here.  In these circumstances, mandatory participation and sanctions become counter-productive “enforcement to fail”: unemployment rates show limited reduction, attitudes are further polarised, mental ill–health and psychological barriers increase while those abandoning benefits for economic inactivity are further removed from the prospect of work.  Suggestions of enforcing mental health treatment by threat to benefits flies in the face of “informed consent”.
  • Scope.  Support needs wider capacity than just creating good CVs and job-matching.  It needs to be holistic: encompassing health, housing, finances, personal relationships, work travel, confidence building, training, volunteering and work experience, employment skills, self-employment.
  • Health.  There is little point in funding employment support without interventions to maintain good health/improve poor health (especially mental health). People in poor health have far less chance of returning to work or staying there while those unemployed long-term are more likely to have mental health conditions.
  • Skills.  Likewise, funding employment support that doesn’t improve employability beyond basic skills has little prospect of cost-effective long-term success.  People moving in to low level jobs face all the risks to health and job security outlined above.   Although some will bring psychological barriers and experience of education shortfalls, many will have previous work experience to build upon if training is sufficiently flexible and accommodating of their current circumstances.  Combining practical learning with vocational experience in apprenticeships might merit further development/promotion to break down the disability/low education/unemployment relationship.
  • Attitudes.  Alongside mental health consequences, individuals have many psychological reactions to (the onset of) disability and unemployment ranging from anger to apathy.  Interventions need to re-build self-confidence and esteem, motivation and aspiration while countering status quo bias, isolation and despair. Poor success rates as measured by “forced to fail” policies simply risk reinforcing these barriers.
  • Delivery.  Group delivery and batch processing might seem cheaper but is a form of “creaming” that fails those with more complex barriers requiring help tailored to their individual needs and circumstances.  Instead, personalised support can be more productive: one-to-one, local delivery, non-judgemental, not time bound, recognising a range of individual goals.
  • Specialism.  No single provider is likely to have either sufficient skill or capacity to provide every element of a comprehensive return-to-work model – nor would it probably be cost-effective.  Primary case-workers need to be highly experienced in supporting unemployed disabled people with funded access to other specialists for specific contributions (e.g. health, training, disability-specific interventions/equipment, self-employment etc).  For some conditions, such as severe mental health and learning disabilities, a case worker with appropriate additional skills/experience may be more productive.  The key is that funding agreements (and subsequent contract management) is specific as to access to specialist support and ensures that it happens.  Notwithstanding which, Specialist Employment Support has now been introduced in the UK.
  • Local.  The geographical reach of support can be important for disabled people who lack the capability or means to travel – they may need more local support (often in their own homes initially).  Providers also need knowledge of local cultures, social structures, labour markets plus partnerships with other local support and specialist organisations.  Coordinated funding of local delivery can realise best value and eradicate silo-working, mismatched eligibility and success criteria, incoherent management information plus gaps and duplications.
  • Funding.  Any employment support provider is going to cream the quick wins but must be disincentivised from doing so to the cost of individuals placed in poor, unsustainable jobs and those parked as more difficult to assist. The significance of “failure” goes beyond the psychological and mental health consequences for the individual to undermine employer confidence, policy competence and taxpayer credibility. More subtle funding and sanctions structures are required: equitable and geared to the degree of need/complexity; rewarding a range of positive outcomes other than work; balancing costs in some Departments (health, education) with savings elsewhere (benefits, criminal justice) and acknowledging increased tax and National Insurance takings, broader economic improvements etc.

Source material.  Some of the supporting data gathered from recent reading and blogs:

  • About 20% of the working age population are disabled people.
  • Most disabled people acquire their disability during their working lives rather than at birth/as children.
  • Propensity for disability (especially physical impairments) increases with age (under 4% for 16-24 year olds to about 23% for 50-65 year olds ONS.
  • In 2013, there were about 2.3 million disabled people who were unemployed.  They outnumber and cost more than those receiving Job Seekers Allowance.
  • In 2013, disabled people who reported that their primary impairment was a mental health condition made up 26.9% of all disabled unemployed people and 18.5% of all disabled working age people.
  • People with lower education are about four times more likely to claim disability benefits than those with higher education.
  • People with poor health are less likely to get back to work and, if they do, are less likely to sustain jobs.
  • Since 2008, the employment rate for disabled people has been about 31% lower than for non-disabled people; the economic inactivity rate for disabled people has been similarly around 31% higher than for non-disabled people.
  • Unemployed disabled people aren’t just those claiming Employment and Support Allowance or Incapacity Benefit.  It has been estimated that about 25% of Job Seeker Allowance claimants have disabilities, others are claiming Income Support and more are not claiming any benefits at all.
  • Regarding the Work Programme:For Employment Support Allowance (ESA) claimants the DWP’s original minimum standard was to ensure at least 22% of those who had completed the Work Programme achieved job outcomes (lasting at least three months). By the end of March 2014, only 11% had. The DWP now predicts this measure to rise only to 14% by the current end of the Work Programme—March 2016 … ESA sanctions for those within the Work Programme also far exceed job outcomes.”
  • Regarding Work Choice: less than a third of the volunteers joining the scheme achieved a work outcome
  • Disability discrimination concerns make up over 60% of all contacts to the Government’s Equality Advice and Support Service (the dramatic reduction in tribunal cases reflects the new costs to claimants).  Mental health conditions continue to be amongst those carrying most stigma.
  • 1 in 4 UK adults have mental health problems each year – ONS.
  • Ministry of Justice data shows that the level of disabled people in prison is nearly double that in the wider population.

Penny Melville-Brown

Disability Dynamics ltd www.disabilitydynamics.co.uk

Helping disabled people to work since 2000

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