Evidence that Labour is ignoring: 18-24 month WRAG

This is the third blog in a series looking at various employment support programmes that have tried to support sick and disabled people into work. In the first, the Work and Health Programme worked with people who were expected to be able to find work within 12 months, but in 18-24 months only 19% of these people into work, compared to 16% for the control group. In the second, Health-Led Employment Trials failed to get people who had ‘mild/moderate’ mental or physical illness into work: one of two sites saw an improvement from 18% to 22% after a year, but the other saw a non-significant decline from 27% to 25%.

In this blog, I am looking at support provided to people who had been assessed by the Work Capability Assessment as being likely to recover enough to be well enough to work within 18-24 months. It is worth noting that the WCA has no actual mechanism for assessing the likelihood that a person is on, or likely to enter, an upward health trajectory. It merely designates some people as less severely ill than others, and assumes that less severely ill people must be going to get better. Nevertheless, the people in this study are plausibly the sickest or most disabled group of the three that I have looked at so far.

The study had three pilot programmes: the Jobcentre Plus model (JCP); the Work Programme model (WP); and the Healthcare Provider model (HCP). 63-70% of participants said that their health ruled out work, with 16-22% saying they could consider it and 5-7% saying they could return if a job was available. 47-61% did not know when they’d be able to work, and 15-19% did not expect to ever be able to work again, despite being treated as having an 18-24 month prognosis. 28-30% of participants had moved into the Support Group by the time of the Wave 2 survey.

Attitudes to work were ambivalent. 58-60% said they would be a happy person if they were in paid work, yet 57-61% said that the thought of work made them nervous. Staff said there was a ‘deep seated’ fear about being made to do work that was beyond their capabilities. Given that over a quarter of participants entered the Support Group, this seems like a reasonable attitude to take; staff, however, thought that participants’ perception of their health could sometimes be a bigger barrier than the illness or disability itself.

The JCP model provided 530 minutes of support to a claimant per year for two years, compared to 88 minutes per year for the control group. Participation was mandatory, unlike the Work and Health Programme and the Health-Led Employment Trials which focussed on voluntary (and therefore self-selecting) claimants. Reflecting this, a repeated theme from work coaches was the severity of claimants’ illnesses and disabilities, with work not being a realistic prospect for some. Some work coaches thought that caseloads should remain below 30; others were happy with caseloads up to 70, but they managed this by reducing support to those who were not making progression towards work.

There was concern that work coaches who didn’t have a background in supporting sick and disabled people did not have the necessary expertise to help this group. These work coaches expressed concern about causing harm to claimants when they didn’t have the knowledge to comment appropriately on a person’s situation. There was increasing use of non-specialists work coaches over the course of the pilot, and this was felt to be detrimental to its effectiveness.

The WP model varied according to the provider. Like the JCP work coaches, the WP staff reported needing to reduce support to people who were further from being able to work, in part because the Payments by Results model meant that it wasn’t economically viable to provide much support to people who were not going to move into work. Participants were seen as having a high level of need and distance from the labour market, and specialist rather than generalist support was important.

The HCP model was very different. This offered only five appointments over 18 months. Staff came from occupational therapy or occupational health backgrounds. Again, the staff reported that many of the participants would not enter work within the two-year programme.

The JCP model was the only one to achieve employment outcomes. The outcomes went from 4% to 8%. A further 4% had tried work but left, mainly because of health problems. In the WP model, 4% were in work and in the HCP model it was 2%; these were the same as the control groups. Although the report does not say what proportion of these jobs were part-time, it does say that when people applied for jobs, the majority of those jobs were part-time positions.

Interestingly, 64% of JCP participants were positive about getting work, with 79% saying it would take a year or less. In the WP, 56% thought they would work in the future. In the HCP, 55% thought they would work in the future, with 73% saying it would take a year or less. None of the programmes had any impact on this positivity compared to the control groups. Given how few had found work within the study, and the ongoing health problems, this positivity seems misplaced and should not be used as a reliable indicator of capacity for work. The JCPPs were no more positive than their control group, so the programme itself didn’t change people’s attitudes.

Of those in work from the JCP model, 56% said it was positive for their health whilst 18% said it was negative and 26% said there was no effect. Again, there were no differences with the control group.

Of those not working after the JCP programme, health and disability continued to be a barrier for 71%. 63% felt unable to work due to their illness or disability, compared to 71% in the control group. 61% said that the programme did not help with their health, 66% that it either didn’t help with work or wasn’t relevant because they couldn’t work, and 58% that it didn’t help with barriers to work. There were particular concerns that the JCP staff could not provide help with health-related barriers.

In the WP, 82% said that their illness or disability ruled out work as an option, and just 8% said they could work now if the right job was available. 11% thought they might be able to work on some days, but realistically this makes a person unviable as an employee, because of the unreliability of their capacity for work. 75% said that the programme did not help with their health, 82% that it either didn’t help with work or wasn’t relevant because they couldn’t work, and 69% that it didn’t help with barriers to work. As with the JCP programme, the main concern was that the staff could not provide medical help.

In the HCP programme, 80% said that their illness or disability ruled out work as an option, whilst 6% said they could work now if the right job was available. 14% felt that ‘on some days’ they could consider a return to work. In contrast to the JCP and WP, where the majority reported no benefit to their health, 54% of those in the HCP programme said that it helped a little or a lot with their health. 79% said that it either didn’t help with work or wasn’t relevant because they couldn’t work, and 59% that it didn’t help with barriers to work. These are better figures than the WP but not as good as the JCP on help to work, though similar on reducing barriers to work.

More than half of participants had experienced no change in their motivation to leave ESA (58% JCP, 61% WP, 62% HCP) or to find work (54% JCP, 63% WP, 63% HCP). Where there was increased motivation to find work, it did not lead to increases in work-search behaviours, again raising queries over the usefulness or validity of soft outcomes. The JCP programme led to slightly more positive attitudes towards work, but this was not consistent across all measures.

The report authors conclude that, “Across the three pilots, pilot support did not significantly affect the likelihood of participants applying for jobs, compared with standard Jobcentre Plus support. Similarly, pilot support did not affect participants’ views on whether they would find paid work in future and the timeframes for this, compared with business as usual support… Among those in work on the JCP pilot (base sizes were too small on the WP and HCP pilots for analysis), there was no evidence that pilot support led to more positive perceptions of the effect of work on their health compared with standard support.”

Whilst the JCP did see more people enter and sustain work – 8% versus 4% in the control group – this was a very small outcome given that these people had been assessed as likely to be able to enter work within 18-24 months. The paucity of job outcomes, especially compared to 28-30% moving into the Limited Capability for Work-Related Activity group, should be taken as evidence of the lack of capacity for work of people assessed as able to enter within 18-24 months. This evidence indicates that the criteria used in the Work Capability Assessment are overly optimistic about sick and disabled people’s prognoses and capacity for work. More people should be assessed as LCWRA and given additional financial support without work-related requirements – yet the government is moving in the opposite direction.