Sickness while unemployed

The provisions in the new regulations for people who fall sick while they are unemployed are very restrictive. People are exempt from the requirement to be available for work for “a maximum of 14 consecutive days from the date (of sickness)” or “on no more than 2 such periods in any period of 12 months.” (UC Regulations s.90 (5a))

This is not equivalent to saying that a person could be sick for 28 days in any one year – though that would still be more restrictive than the conditions applying to people in employment who claim Statutory Sick Pay. It states that a person will cease to be available for work if that person is sick for any period of more than 14 days, or has three periods of sickness in a year, regardless of their length. Someone who is sick for longer is not entitled to benefit; the same is true if their partner is sick, because these rules apply to both members of a couple. So, a person sick for three bouts of three days in a year – less than the national average for British workers – could be denied benefit. A person who is unfortunate enough to contract a long-term illness which does not lead to long-term incapacity for work, such as diabetes or heart disease, could be subject to sanctions on that account.

It does seem to me that any restrictions of this sort should be set with reference to evidence – which I don’t have – and sanctions should only be applied at the upper end.

The case for exempting some people from reassessment

On 8th February I suggested that some groups might reasonably be exempted from the process of reassessment for ESA, and mentioned in particular “young people with severe disabilities from early ages or people with defined conditions like cancer”. The recent statistical release tells us that these groups have a quite different profile from most other claimants. As things currently stand 12% of all claimants are being placed in the “support group”, those who are not expected to work. In the case of “neoplasms”, or cancer, that rises to 67.7% of assessed claims; in the case of “congenital” or “chromosomal” conditions, it is 66.7%.

Reassessing claims for ESA

The reports of delays in access to Employment and Support Allowance are unsurprising. The finger of blame has been pointed at Atos Healthcare. Atos has been the subject of a barrage of criticism during the last couple of years; their processes were described by the Harrington report as “mechanistic” and “impersonal”; many of the decisions made about fitness to work are wrong and 40% of appeals have been successful. Atos has issued a statement attributing the delays to the longer, more sensitive assessments introduced since Harrington.

There is however a more general issue about the capacity of the administration to deal with mass reassessment. Governments have not just undertaken in recent years to reassess all the former claimants of incapacity benefit; they also propose to introduce equivalent tests for the Personal Independence Payment, the reformed Disability Living Allowance. As people with disabilities are displaced from the labour market, and as the government requires further categories to be ready for work, including lone parents and those who are bereaved, the demands on the system of reassessment will increase. Current calculations on throughput rely heavily on people not turning up for the assessment.

There are some practical ways of relieving the burden of administration. One is to exempt more groups – such young people with severe disabilities from early ages or people with defined conditions like cancer. Another might be to offer compensation to some people to transfer to JSA voluntarily. A third might be to license a range of independent practitioners to certify the assessment. The procedure needs to be faster as well as fairer.

Assessing cancer patients for ESA

Most people in receipt of Employment and Support Allowance are treated as needing preparation to return to work. It has taken a little time for government to realise the implications of that process, but an informal consulation on the circumstances of cancer patients suggests that the penny has started to drop. When I was interviewed on Radio Wales on 28th April last year, I took the treatment of cancer patients as an illustration of the problems. What I said was this:

“Of the people who are down here as having neoplasms, which are various tumours, we have 33% who don’t get signed off. Some are being found fit for work and some don’t complete the assessment. Now of course, it’s not that people basically say, ‘I’ve got cancer, I’m stopping work.’ What happens is that people are uncertain. They don’t know. They want medical assessment. They want clarification. They are unsure about the situation. Theyhope that things will be different. It takes time to sort this out. And what we’ve increasingly got is a system that is treating people mechanistically, ticking boxes, and saying ‘sorry – wrong boxes – go away.’ “

Are claims for incapacity out of control?

There’s been a lot of confusion about the stats issued for Incapacity Benefit, which was recently replaced by Employment and Support Allowance. The IB stats seem to show an increase of over a million people since the revision of the system in the mid -1990s. The Daily Mail reports that the figures trebled after 1979. That seems initially plausible, because we might expect incapacity to rise in line with unemployment, but it’s not actually true. In 1979, the principal benefits covering people now covered by ESA were Invalidity Benefit (contributory), Supplementary Benefit for people who were sick or disabled (means-tested) , Non-Contributory Invalidity Pension and Sickness Benefit. There were 1,463,000 claimants for those four benefits in 1979. There was a reduction in the early 80s when Statutory Sick Pay came in, and then a lesser increase when Severe Disablement Allowance replaced NCIP. The big increase for people with incapacities happened in the 1990s, and it mainly occurred in Income Support – the means-tested benefit – rather than in Incapacity Benefit. Incapacity Benefit figures may also have seemed to increase, but that was mainly because Sickness Benefit was taken into it in 1995, and Severe Disablement Allowance was rolled into IB for new claimants in 2001 – those inclusions probably account for 250,000 extra claimants.

The figures in contemporary reports have been retrospectively revised between 1997 and the present, in the apparent belief that people will find the numbers easier to understand that way. Unfortunately it’s led people to believe that claims have rocketed, when they haven’t. I’ve had to piece these figures together from different sources, which always raises questions about consistency, but subject to that, here are the counts in 000s of claimants for 1998, 2003 and 2008.

1998 2003 2008
Incapacity Benefit 1618 1586 1413
Severe Disablement Allowance 376 331 281
Income Support for sick and disabled people of working age 881 1100 1191
Total 2875 3017 2885

Sick note Britain?

A report by Carol Black and David Frost makes proposals that are supposed radically to reduce the flow of people moving on to Employment and Support Allowance. The argument that this can be done is built on the belief that the initial response to illness makes it more likely that people will adjust to long term sickness by claiming benefits. However, the most substantial reduction that is foreseen in the report is in the numbers of people who move directly to long-term benefits without going to employment in between. This group includes people who would formerly have claimed Severe Disablement Allowance.

Despite the reports about “sick note” Britain, benefits are not in general issued with sick notes – or “fitness for work notes” as we must now learn to call them. GPs didn’t, in general, get to sign people onto Incapacity Benefit, and they don’t sign people onto Employment and Support Allowance. However, there are some exceptions. If a person is not entitled to Statutory Sick Pay, typically because their employment has been terminated, they will be put onto ESA directly. If they have certain illnesses, principally terminal illness and life-theatening conditions, there may be no requirement to undergo a Work Capability Assessment. Those exceptions will be maintained. The main proposal in the report is that such claimants should move directly to the WCA. It is not immediately clear how this procedure is going to deliver a substantial cut in the number of successful claims.

Reassessing people on Incapacity Benefit

One and a half million claimants of Incapacity Benefit are currently being reassessed prior to transfer to the Employment and Support Allowance. On 27th April, a DWP press release explained that most claimants who were being reassessed were either being found fit for work, or failing to complete the assessment process. Neither finding should be taken to imply that claimants are malingering. Incapacity Benefit is a provision for long-term sickness; it is not confined to people with permanent conditions, and many do get better over time. The statistics can be viewed at http://research.dwp.gov.uk/asd/workingage/esa_wca/esa_wca_25012011.pdf. There are high rates of non-completion of the process, for example, for people with infective diseases, injuries, or pregnancy. That is exactly what we should expect. More worrying is that many people are being found fit for work when they have serious medical problems, such as cancer, incontinence or degenerative diseases. Part of the problem here is the process of reassessment, which has been criticised for being impersonal, mechanistic and insufficiently informed by medical evidence; but part is the nature of the work test, which looks not at whether a person’s ability to work has been impaired, but at whether that person is deemed to be able to do any sort of work, anywhere. People who contract serious disorders need protection – time, space and support. All the emphasis in the new system falls on pressing people to return to work.

It is disturbing, too, that the release of this information should have been managed deliberately to paint benefit recipients in a negative light. A government statement on 21st April criticised the 80,000 claimants whose main reason for incapacity was alcoholism, drug use or obesity. It seems that people who do these things sometimes become ill as a result; the only noteworthy thing about that finding is that the government should want to draw particular attention to it. The information released on 28th April had been previously released in a press release in January, when it was announced in similar terms. This is beginning to look like a propaganda campaign.

Capacity for work

I have been in correspondence with Carer Watch, a network of carers which has raised concerns about the tests used for Employment and Support Allowance. ESA is available for people who cannot reasonably be expected to work – the issue of reasonableness is part of the statutory definition of the benefit. Nevertheless, the legislation has introduced a series of tests, including work-focused interviews and “action plans” related to work seeking, which make work-related demands on people who cannot be expected to work.

I think there is a discrepancy between the Welfare Reform Act 2007 and the regulations. People who have limited capacity for work are supposed to be given help in moving towards employment, for example by preparatory and supportive actions. However, the regulations focus on actions that are directly related to work, rather than on actions that will increase people’s capacity where that capacity is limited. They are specified in terms of either getting people to obtain work, or of keeping people in work. Either of those options, by definition, is not reasonable for ESA claimants.