United Kingdom Vocational Rehabilitation Policy and Outcomes Statements and Comments

United Kingdom Vocational Rehabilitation Policy and Outcomes Statements and Comments 1. Current and developing policy Patricia Thornton University of York Policy for vocational rehabilitation 63 of disabled people in the United Kingdom (UK) is transformed since 1997, under the Labour government. Long-standing specialist programmes remain but new welfare to work programmes target the seven per cent of the working age population claiming incapacity benefits 64, with the extension of active labour market policy to economically inactive groups. Welfare to work is part of a wider strategy against poverty and social exclusion. It is also driven by economic concerns about the ageing population and low birth rate, with the need to increase employment levels. Government aspires to an employment rate equivalent to 80 per cent of the working-age population 65. Personalised help to find work, backed by economic growth and stability, is thought central to achieving it. Also addressed are the skills gap, discrimination in employment, disincentives in benefit rules, and low earnings through tax credits (top-ups). Labour market and benefit reforms have gone hand-in-hand. Employment and social security responsibilities rest with the Department for Work and Pensions (DWP). Employment service and benefits agency merger created Jobcentre Plus in 2002. Government publications (Department of Social Security, 1998; DWP 2005, 2006, 2007a, 2008a, 2008b) show the increasingly heavy emphasis on conditionality and benefit sanctions, with a philosophy that all those deemed able to work have an obligation to do so. Within this rights and responsibilities framework, active support from Jobcentre Plus is stepping up. Historically, incapacity benefit rules discouraged working (there is no partial capacity benefit) and the aim is to overturn the assumptions they created and promote belief that work improves health and well-being. The name of the benefit to replace incapacity benefits, Employment and Support Allowance, shows how far policy has travelled. 1.1 The changing structure of the benefits system Social insurance sickness benefit was withdrawn from 1983. Employers must pay Statutory Sick Pay (SSP) for up to 28 weeks to employees fulfilling national insurance contribution and earnings requirements. Those excluded, and the self-employed, may claim a state incapacity benefit. SSP is set at a low flat-rate but some employers top up. 66 Employers may opt out of the scheme and employees claim from them the more generous Occupational Sick Pay (OSP). Employers must hold data on SSP but there is no requirement to submit it. With no large-scale surveys on use of 63 The term vocational rehabilitation is not widely used in the UK. 64 The contributory Incapacity Benefit; Severe Disablement Allowance, abolished for new claims in 2001; and Income Support on grounds of incapacity. Income Support, a means-tested benefit to boost income to a minimum level for working-age people not required to search for work, may be awarded on top of Incapacity Benefit or Severe Disablement Allowance. Half of all Income Support recipients get a disability premium, after 12 months of incapacity. 65 Working age is 16 to 59 for women and 16 to 64 for men. 66 SSP Lower Earnings Limit is currently 90.00 average weekly earnings. The current flat rate is 75.40 per week. 1

SSP and OSP (Woolf et al 2007) or a system to record issue of sick notes by general medical practitioners, information on trends and characteristics of recipients is lacking. There are no medical or vocational rehabilitation benefit stages before eligibility for incapacity benefits. A significant proportion of new claimants come directly from employment but a quarter come from unemployment benefit (Jobseeker s Allowance 67 ) and around one tenth from Income Support; one in three have not worked in the previous two years (DWP 2006). Payments are flatrate 68 at around 25 per cent of average earnings (OECD 2007). The working age caseload grew rapidly in the 1980s up to 1995, then the rate of growth slowed and stabilised, but while the inflow rate is falling outflow is declining (Kemp and Thornton 2006). Working age claimants 69 numbered 2.62 million at February 2008, a fall of 44,000 over the previous year (DWP 2008c). Government aspires to reduce the total by one million over the course of a decade (DWP 2006). Claimants include those receiving National Insurance credits and no money; total working age beneficiaries, who receive money, is much lower at 1.61 million (DWP 2008c). Key caseload composition points (Kemp and Thornton, 2006) are the growing share of females; almost one in four men aged 60 to 64 in receipt of incapacity benefits; half of claims lasting five or more years; and substantial increase in mental disorders, overtaking musculo-skeletal as the most common main condition. In 2005 nearly 40 per cent of claimants main condition was mental disorder (DWP 2006). Employment and Support Allowance replaces Incapacity Benefit from October 2008, initially for new applicants. A new medical assessment will direct more claimants than before to Jobseeker s Allowance; Income Support will be abolished. The new benefit has three elements: a holding benefit equal to Jobseeker s Allowance 70, for applicants in the initial 12-week assessment period; an enhanced rate for the Work Related Activity Group, conditional on drawing up an action plan focused on rehabilitation and attending six compulsory work-focused interviews (see Pathways to Work) and eventually on work-related activity; and a higher rate 71 for the Support Group whose conditions cause very severe limitation of their ability, who are exempt from activity requirements. 1.2 Vocational rehabilitation programmes and employment outcomes 1.2.1 Introduction to Jobcentre Plus specialist and mainstream programmes As with incapacity benefits previously, new claimants of Employment and Support Allowance will be seen by a disability specialist personal advisor in the Pathways to Work Programme. They may then be referred on a voluntary basis to one of the condition management programmes recently established under Pathways to Work; to a recently established programme catering primarily for incapacity benefits recipients (New Deal for Disabled People); or to one of the small, long-established specialist disability programmes which are also open via other routes to longerterm recipients of incapacity benefits and to people defined as disabled by the Disability Discrimination Act (Work Preparation, Job Introduction Scheme, WORKSTEP, Access to Work). 67 Jobseeker s Allowance is for those of working age who are required to look for work as a condition of benefit and have entered into a Jobseeker s Agreement. The contribution-based form is limited to six months; income-based Job Seeker s Allowance is means-tested and indefinite. 68 A long-term rate applies from 52 weeks onwards. There are additions in specific circumstances. 69 Incapacity Benefit and Severe Disablement Allowance, excluding Income Support on grounds of incapacity alone. 70 The Incapacity Benefit rate currently is higher than the Jobseeker s Allowance rate. 71 102.10 a week compared with 86.35. 2

Claimants may access a mainstream training programme for unemployed people (Work-Based Learning for Adults) through Pathways to Work and disabled people may enter this programme through the unemployment route. Long-term beneficiaries of Jobseeker s Allowance are required to participate in either the New Deal for Young People or the New Deal 25 Plus. Other claimants of Jobseekers Allowance or Income Support will be directed to other mainstream New Deal programmes according to their circumstances (older age, lone parent, dependent partner of a claimant); 1.2.2 Pathways to Work Pathways to Work, piloted from 2003 and now nationwide, is aimed at new incapacity benefits claimants mainly. They must attend a work-focused interview with a Jobcentre Plus personal adviser; existing claimants can take part voluntarily. If not judged at that interview as likely to leave benefit without additional support, or exempt because of their condition, new claimants must attend a further five monthly interviews with their adviser or, in some areas, with a voluntary or private sector provider. A variant applies to longer-term claimants in pilot areas. Action plans are compulsory. Where Jobcentre Plus delivers, participants may access specialist disability employment programmes, new condition management programmes aiming to tackle deepseated issues such as anxiety and lack of confidence and targeted at those with cardiorespiratory, musculo-skeletal and moderate mental health problems; and mainstream work-based training programmes. Overall take-up of these programme options is around 22 per cent after twelve months (DWP 2008d). An allowance is available to existing claimants undertaking some activity that contributes to eventual return to work. On return to work, participants may be eligible for a financial payment for 12 months. Pathways to Work starts to May 2008 totalled 935,660 for 712,000 people and job entries to November 2007 totalled 125,730 for 94,230 individuals (DWP 2008d). The programme has been evaluated extensively. 72 Research comparing Pathways with non-pathways areas (Bewley et al 2007) found a 7.4 percent increase in Pathways new claimants employed 18 months after claiming Incapacity Benefit. Impact was lower for long-term customers. It had little effect on employment where the main health condition was mental illness, however. 1.2.3 New Deal for Disabled People The New Deal for Disabled People is a voluntary programme to help recipients of incapacityrelated benefits 73 move into sustained employment, piloted and then extended nationally in 2001. It is delivered by voluntary, public and private job broker organisations. Service components vary but can include support and confidence building, general careers guidance, vocational or work skills development or training, access to voluntary work or work placements, job search support, help with applying for jobs, financial help and in-work support. Take up is low, in the year ending May 2006 equal to 3.1 per cent of the population flowing on to the qualifying benefits. Of 260,330 registrations from July 2001 to end November 2006 43 per cent found jobs, most within the first few months, but only 57 per cent of those entering work by August 2006 had employment lasting 72 Eighteen commissioned external reports to July 2008. 73 That is, a wider range than just incapacity benefits. 3

13 weeks or more (Stafford with others 2007). 74 A matched comparison group analysis estimated that for people registering in the six months from July 2001 the employment rate 24 months later had increased by 11 percentage points for longer-term participants and by seven percentage points for more recent participants (Orr et al 2007). Research has identified sub-groups with an increased likelihood of entering work but it is hard to determine elements of practical support that are effective or not. Maintained, effective relations and communications between job broker staff and participants, with support matched to needs, were found crucial (Lewis et al 2005). 1.2.3 Specialist disability employment programmes Work Preparation is a six to eight week programme open to Disability Discrimination Act defined disabled people. 75 Voluntary and private sector providers (around 270 in 2002) mainly support unpaid work placements and personal development; some offer modules in confidence building, self-presentation, job search techniques, work adjustment training or college courses. Modulebased provision seemed more effective (Banks et al 2002). The financial year 2003/04 saw 7,400 participants and 1,300 job outcomes (National Audit Office 2005), compared with 11,500 entrants in 2000/01 when an estimated fifth of leavers were in jobs within 13 weeks (Banks et al 2002). The Job Introduction Scheme is for situations where an employer has doubts about a potential recruit s ability to cope for reasons related to their impairment. It provides a weekly payment to the employer for a trial six-week period, relating to around 2,000 people in the financial year 2003/04 (National Audit Office 2005). A qualitative study found the scheme attractive to small employers finding it hard to recruit to low waged or part-time jobs (Atkinson and Kodz 1998). WORKSTEP, a development of the previous Supported Employment Programme, is focused on disabled people meeting the Disability Discrimination Act definition claiming an incapacity benefit or long-term unemployed, who face complex employment barriers to finding and keeping work and require support greater than other programmes offer. In the financial year 2004/05 around 200 provider organisations from public, private and voluntary sectors supported around 27,000 disabled people (Purvis et al 2006). Supported placements in ordinary employment increasingly outnumber jobs in supported businesses established to employ disabled people. The intended high rate of progression to open employment is far from met (National Audit Office 2005), in part because the funding structure does not offer sufficient incentive to contractors (Purvis et al 2006). Following a public consultation (DWP 2007b) government proposes to combine these three schemes (but losing the job subsidy) into a single programme with three elements: work entry; transitional supported employment; and longer-term supported employment. 1.2.4 Access to Work The Access to Work programme, for Disability Discrimination Act defined disabled people, helps employers with specification and costs of special aids and equipment, adaptations to workplace premises and equipment, support workers and communicators. It also helps meet costs of private transport to work. In the financial year 2003/04 it supported 34,800 disabled people (National 74 This report synthesises findings from 18 published evaluation reports and DWP administrative data. 75 With a disability that has a substantial and long-term effect on ability to carry out normal day-to-day activities. 4

Audit Office 2005). Funding increased from 15 million in 1997 to 69 million in 2008/09 (DWP 2008a). Over 90 per cent of users are established in work when they apply (Thornton et al 2001). The main impact is continued employment of disabled people already in a job, where help with travel to work costs is particularly effective; help with substantial costs of adaptations to premises and of support workers promotes both recruitment and retention (Thornton and Corden 2002). 1.2.5 Mainstream active labour market programmes Most mainstream measures belong to the New Deal family, introduced from 1998, through which 2.01 million people found jobs up to February 2008 (DWP 2008c) with increasing conditionality. Jobcentre Plus is now implementing a new Flexible New Deal. New Deal for Young People and New Deal 25 Plus are compulsory for longer-term claimants of Jobseeker s Allowance (six and 18 months respectively) and have contributed to the marked fall in long-term unemployment. Disabled people 76 and other disadvantaged groups may enter early. New Deal for Young People aged 18-24 begins with a short, intensive period of advice and training in job search methods. Four options follow: subsidised job; public job creation environmental programme; placement with a non-profit employer; or full-time education or training. In some areas private or voluntary sector organisations deliver, elsewhere Jobcentre Plus. Jobcentre Plus New Deal personal advisers deliver New Deal 25 Plus, offering training, guidance, subsidised work experience and access to supported self-employment. In the New Deal for Lone Parents, single parents claiming Income Support must meet and agree action with a personal advisor who helps to identify skills and develop confidence, understand the financial consequences of taking up work, access training and education, access childcare information and also supports job search and employer liaison. New Deal for Partners, mandatory for most partners of Jobseeker s Allowance and economically inactive benefits claimants, gives job search help, in-work benefits information, training access and an allowance, a childcare subsidy and access to debt counselling. New Deal 50 Plus is for older people claiming Jobseeker s Allowance or economically inactive benefits for at least six months; personal advisers provide advice, job search help, a training grant and financial support on entering work. Administrative data show immediate employment outcome rates for disabled participants close to overall rates (Table 1).Yet, multivariate analysis found disabled leavers from the New Deal for Lone Parents less likely than non-disabled counterparts to move into employment (reported in Evans et al 2003). New Deal for Young People evaluations (reviewed in Thornton 2003) show that where the health condition or disability was work-limiting, outcomes were poorer than where it was not 77 ; and people with mental health problems were less likely to enter employment. Otherwise, what works for all seems to work for disabled participants. A review of evaluations (Hasluck and Green 2007) found the quality, enthusiasm, motivation and commitment of staff providing the service to be important and personal advisers critical to success of interventions. 76 Self-assessed, using a definition based on the Disability Discrimination Act. In New Deal 25 Plus, if the personal advisor judges them as disadvantaged. 77 The Disability Discrimination Act does not include work amongst normal day-to-day activities. 5

Work Based Learning for Adults (in England 78 ) is a voluntary training programme, administered by Jobcentre Plus and delivered by public, private and voluntary sector training providers and colleges. Aimed mainly at claimants of Jobseeker s Allowance for six months or more and aged 25 and over, it also includes inactive benefits claimants. Disabled people 79 may enter early. In all components - basic employability training, short job-focused training, longer occupational training and self employment employment outcomes for disabled trainees are similar to overall rates. Table 1: Mainstream programme participation and job outcomes Programme (start year) Spells / Participants Disabled Job entries Disabled job entries Young People (1998) 25 Plus (2001; pilots from 1998) 1,320,380 completed spells (at November 2005) 438,549 completed spells (at November 2005) 12.5% 41% 37% 29% 28% 27% Lone Parents (1998) 853,820 completed spells (at November 2005) 4% 80 42% 35% 50 Plus (2000; pilots 1999) 66,580 participants (January2004 - February2006) 34% No data 40% (April 2003 - February 2006) Partners (1999: expanded 2001) 5,350 participants (April 2004 - May 2006) 17% No data 22% (April 2004 - May 2006) Work Based Learning for Adults 294,500 participants (April 2001- February 2006) 35% 38% 39% (April 2001 - February 2006) Sources: DWP administrative data reported in Meager and Hill 2006; DWP WBLA Database www.dwp.gov.uk/asd/wbla.asp 2. Potential application of Norway s experience to current concerns Policy is struggling to make an impact on job retention when workers have a period of ill-health, and this is an area where the UK might learn from Norway. The UK has no equivalent to Norway s legislation under which the employer has a duty to take necessary actions to make it possible for the employee to maintain their employment within the company, via internal vocational rehabilitation to the extent this is possible. The UK Disability Discrimination Act 1995 makes it unlawful for an employer to discriminate against a disabled person. It imposes a duty to take reasonable steps to remove or reduce any substantial disadvantage caused to a disabled employee or job applicant by employment arrangements or physical features of the premises. The Disability Discrimination Act 2005 requires public bodies to promote equality of opportunity 78 There is similar provision in Scotland and Wales. 79 With a disability likely to last at least a year putting the person at a significant disadvantage in the labour market. 80 Surveys reported in Thornton 2003 found considerably higher proportions reporting a health condition or disability. 6

for disabled people, with a published disability equality scheme and action plan. But these laws apply only where the disability has a substantial effect on normal day-to-day activities lasting at least 12 months, and do not necessarily apply to health problems in work or sick leave. The UK approach is based on encouragement, including convincing employers of the business benefits of investing in the health and well-being of staff and encouraging use of light touch return to work action plans; there are plans to reform the sick note system, and pilots of Jobcentre Plus advisers located in general practitioner surgeries are underway (DWP 2008a). A randomised control trial of workplace, health and combined interventions, provided for volunteers by external organisations, found no impact on return to work (Purdon et al 2006). 3. Current debates The main area of debate surrounds the narrowed entry to the new benefit, Employment and Support Allowance, whereby existing incapacity benefits recipients found ineligible for the new benefit will be subject to increasingly tough activity requirements and sanctions if they claim Jobseeker s Allowance. If there is an economic downturn and jobs become scarce, ex-incapacity benefit recipients more distant from the labour market may stay unemployed longer than other jobseekers. As observed by Meager (2006), the long-standing and increasing emphasis on supply side measures has developed to the point where demand-side interventions for disabled people barely exist. A focus on employer-related barriers may well be necessary in less favourable economic circumstances. 7

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