Examination of Witnesses (Questions 85-99)
WEDNESDAY 12 FEBRUARY 2003
MR IAN
CHARLESWORTH, MS
JOANNE HINDLE,
MR DAVID
NICHOLL AND
MR AUSTIN
HARDIE
Chairman
85. Good afternoon, ladies and gentlemen. The
Committee is taking oral evidence in its Employment for All inquiry,
looking at the problems of trying to assist people with health
problems and disabilities into work. We are grateful that we have
a group of witnesses to help us with the inquiry and they include
this afternoon Ms Joanne Hindle, who is the Corporate Services
Director of UnumProvident, Mr Ian Charlesworth, who is the Managing
Director of the Shaw Trust, and Mr David Nicholl and Mr Austin
Hardie, who are respectively the Chief Executive and Director
of Employment Resources at The Wise Group. You are very welcome,
and thank you for your written submissions which have been very
helpful. What I would like to start with is a broadish question
addressed to all three of your organisations, which is one that
is central to the Committee's work on this inquiry: why the increase?
There are some pointers to that in some of the written evidence
we have seen but the extent of the increase is quite dramatic
and you might have some insights about that which you might like
to share with us before we go into some of the more detailed,
technical sides of some of these questions. Ms Hindle, perhaps
I could ask you to start. You might help us as well with a couple
of sentences about the background to your own organisation. We
are familiar with the Shaw Trust and The Wise Group but it might
be helpful for others who do not have the advantage of the written
evidence if you would say a word about what UnumProvident does
and your hopes and aspirations for what you are trying to do.
(Ms Hindle) Thank you very much for asking us along
to have the chance to have a chat to you this afternoon. UnumProvident
is a private company. We are an insurance company insuring people
against the risk of disability. That is really all we do; we are
a specialist in that field. I hope today we might be able to help
in two areas: first, our experience as an insurer, because what
we try and do is work with our insured (either individuals or
companies) to get people back into work after a disability or
incapacity, or to help people stay in work, and, second, as an
employer ourselves (and we employ about 900 people across the
UK) we try to practise what we preach and we currently have a
workforce about 8% of whom are people with disabilities. From
two perspectives therefore we can comment. To pick up the initial
question, I perhaps would not be so bold, certainly at this stage
in the afternoon, to comment on the UK's national disability book,
but I will comment on our own insurance book which, from the work
we have done, we understand very closely mirrors the state book
in its shape and make-up. The biggest areas of increase we see
are subjective claims—and I will define those a little in
a moment—and mental health related claims. Over the last
four or five years those have both grown enormously. Subjective
claims are what we describe as claims where there is no provable
physical illness. In no way are we saying the person is not ill.
ME fell into that category for quite a while until medical science
caught up with it and was able to prove that ME is a virus-related
illness. I am talking about things where the person generally
says, "I have got a bad back", but nothing we do can
find out whether they have or not; there is nothing provable.
Those two areas have increased hugely and, as I say, I understand
in the state they have as well. The mental health related is very
much to do with stress and with the pressures of modern-day life,
and I do not think that is any different whether you are a private
insurer or a state insurer. It is the pace at which we expect
people to work, the stresses of living in busy cities, etc. It
results in many more mental illnesses than has been the case in
the past. On the subjective illness perhaps the jury is still
out. It is either that we are all much more aware of how well
we should feel and so are more inclined to worry about when we
do not feel 100% and we are sure there must be some medical reason
for it, or it is that there are many more things, of which ME
is a prime example, where medical science has just not yet caught
up with what is going on in our bodies.
86. That is very helpful. Mr Charlesworth?
(Mr Charlesworth) My answer would be that people who
are sick, who suffer from ill health or disability, have largely
been divorced from any employment initiatives and strategy. They
have been the forgotten army, as I refer to them, and so they
have grown in number, largely because there has been a medical
model of disability that has dominated the employment strategy
and has largely meant that people with disabilities or suffering
from ill health that is ongoing are told that they cannot work.
This starts within the education system in that for many it is
from school or from special education through into college and
then on to benefit and that is the message that goes through.
For those who are on IB (Incapacity Benefit) they have been divorced
through having a benefit book because they have never had to sign
on and no-one tells them about work. They are not involved with
the Employment Service, Jobcentre Plus, who have always seen their
role as very much dealing with job seekers and not with people
who are out of the labour market. Finally, we have had employers
who have been using medical retirement as an alternative to redundancy
and a reduction in employment. I would cite those three reasons
for the growth.
(Mr Nicholl) I certainly would not disagree with anything
that Mr Charlesworth or Ms Hindle have said so far. I think there
are a whole number of reasons why the numbers have increased.
It is a very complex subject. I think though that one of the other
major effects in recent years has been a flight from unemployment
into Incapacity Benefit. There is a more generous benefits regime
under Incapacity Benefit, for instance, than under jobseekers'
allowance. One of the things we have touched on in our paper is
the benevolent GP syndrome where general practitioners often feel
sorry for people's economic circumstances and the bad back or
the stress becomes long term incapacity and it results in a group
of people who have enormously diverse characteristics. We do think
there is a flight from the entry level labour market into Incapacity
Benefit.
87. I understand perfectly well what you are
saying, and this is a leading question but I am going to put it
to you anyway. There is no real fraud that is a significant factor
in any of this? There are not people who are calculatingly getting
on to this benefit? I understand what you are saying about early
retirement schemes and so on, but from a dispassionate view you
do not think the Committee should spend a lot of time drilling
into trying to investigate and illuminate a serious degree of
fraud in any of this question, do you?
(Mr Nicholl) It is a leading question but I think
it would be remarkable if, out of 1.2 million people on Incapacity
Benefit, some of them were not in there in fairly dubious circumstances.
The number is so large that even if a relatively small percentage
were there on a fraudulent basis you would still be talking about
a very large number. There is certainly plenty of anecdotal evidence
that many of the people engaged in the black economy, for instance,
in some of the industrial or post-industrial areas where we work,
are also on Incapacity Benefit. It would be difficult to arrive
at the conclusion that there was not any element of fraud involved
here.
88. Let me put the question another way. If
we made the system better people would not have to go through
some of these systems. If we had a better system that was more
sensitive and responsive to individual needs, there would not
be, in the view of any of you, a substantial residual question
about deliberate fraud?
(Mr Nicholl) Absolutely.
Andrew Selous
89. Can I clarify one thing you said? We have
a briefing here which mentions that there are 2.7 million incapacity
claimants. You just mentioned 1.2 million and, given that this
is public evidence, can I ask you to clarify that?
(Mr Nicholl) I was simply referring to people on Incapacity
Benefit only, but if you add everybody involved, it is 2.7 million.
90. Thank you for that. Carrying on with the
theme that the Chairman introduced, we know from the evidence
that you have given us that, for example, UnumProvident have said
that there are more than a million disabled adults who do not
have a job but who want one. The Shaw Trust evidence also tells
us that you believe that many of those who are judged incapable
of work are willing and able to work, so my question to you is
this. If you had a magic wand and a blank sheet of paper and you
could redesign the system, how can we better establish individuals'
capacity for work? You have clearly got criticisms of the medical
model that is being used at the moment. Should we perhaps look
at the terminology as well? Would you like to come up with another
name for Incapacity Benefit to perhaps stress the potential that
these claimants have? I presume also that you feel that the medical
test is somewhat backward-looking and that it is taking a judgement
on an individual's capacity to do or not to do the last employment
they have had rather than looking at the possibilities of other
types of work that they could get into. If you had the power to
redesign the system how would you approach that?
(Mr Charlesworth) From our point of view we would
say get away from doctors controlling the process and get people
in who can take a more holistic view of the person before them
that would include a medical assessment only as part of the overall
assessment, and concentrate on the individual's housing problems,
their financial problems, and look at their abilities for the
future in the way that you describe rather than looking back at
what they cannot do, particularly as, for many of them, they may
have come out of heavy manual work or whatever, and look at what
future skills they can develop. It would be a team that was more
employment focused than medical focused. That would be in our
opinion a major improvement. It also depends on who we are talking
about. I have already indicated that for young people that process
should go back into the education system. For many people social
services have to be involved. I would like to leave you our evidence
on the Green Paper, and I have already given a copy to your Clerk[38]One
of the criticisms we have of that is that it is just a benefits
model, a Benefits Agency solution, to a very complex problem.
There is not even a mention of social services throughout the
whole document and there is no mention of education. In our view
that is absolutely way out of line with thinking much more strategically
about what is needed in order to get away from that medical model.
Indeed, recent developments seem to show Jobcentre Plus going
more and more down the medical model route and the combination
of benefits and employment is not a good thing. You must in our
view separate them out. People who see the payment of benefits,
particularly Incapacity Benefit, linked to employment will come
to defend the benefit, not to talk positively about employment.
Incapacity Benefit, often tied up with housing benefit, is not
like JSA. Again, we have got a simple solution from Jobcentre
Plus that is impractical and will not work, and there is plenty
of evidence about that, not least of which is the recent evaluation
of the ONE pilots which showed that the ONE pilots have had no
impact whatsoever on the target we were talking about and yet
we have built a Jobcentre Plus model on that and we are now going
to build a model on dealing with people with disabilities.
(Ms Hindle) I would start by distinguishing
two different audiences. The first is people coming onto Incapacity
Benefit or becoming incapacitated who might ultimately end up
on Incapacity Benefit. For them we do have to start with the doctor
and my magic wand would be as literal as saying to every GP in
the country, "You must not sign somebody off sick until you
have answered a question somewhere on a medical form that you
have satisfied yourself that this sickness or incapacity prevents
this person from doing their job". Whether or not you are
sick or have whatever it is is irrelevant. If you are signing
someone off sick you are saying they cannot do their job, which
is different from giving them a prescription or sending them to
see a specialist. Signing them off work implies that you know
what their job is and that they are now incapable of doing it.
The second point is, yes, I would change the description of the
benefit once they get on to it. Why not call it capacity benefit
so that we are looking at what they can do, what is the capacity
of a person, not their incapacity? Keep the entire focus all the
way through on "What is it you are able to do?" I have
a very quick anecdote. Our parent company in the States runs a
very large book which is almost totally computerised. When somebody
phones in to say they are off sick and they wish to claim, and
literally it is all done by phone, the first person they speak
to is a nurse who has a computer in front of them and they look
up whatever the person has been told by their doctor they have
got, and they say, "Right; you have got X, Y, Z. We would
expect you to be back at work in"—three days, three
weeks, three months. From that very first phone call the expectation
of a set return to work date is in everyone's minds, and a nurse,
having registered the claim, will then get in touch with the employer
and say, "So-and-so is off sick. We have authorised the claim
for the normal three weeks/three days/three months", whichever.
Absolutely from day one everyone has the expectation of a return
to work within a set time frame. Of course that can be varied
if things then change medically or whatever. If that is the flow,
that is, people coming on, if you like, my second is people who
now have some incapacity, who have been on the benefit for a while,
or people born with an incapacity where it has not suddenly happened
to them, and there I can say nothing more than that I agree completely
with everything that has been said and I will not repeat it.
Mrs Humble
91. How does this system work with the nurses?
People's responses to the same illness can be different, and of
course the medical treatment available in different areas can
be different and waiting lists to access medical care can be different.
(Ms Hindle) This is an American system used by our
parent company in America. We do not use it here; we are not big
enough. It is based on a very large database of average illnesses.
We do not do the diagnosis, I stress. The person will ring up
and say, "My doctor has told me I have got X, Y, Z",
so their medical practitioner will have told them what is wrong
with them. Clearly the person is entirely free to comment on what
we say. If we say that the normal return to work is three weeks
and they say, "My practitioner told me it was four",
then we will pick that up with the practitioner and we will talk
them through it and it may well be that it is four weeks. The
person may say, "My leg is fractured"; "Oh well,
you will be back to work in eight weeks"; "Well, no,
actually it is a complicated fracture"; "Okay",
and then they will vary it. In the States we cover even very short
term illnesses, so if you are off sick for two days you will be
covered by our insurance. An awful lot, 80 to 90%, are simply,
"I have got a cold", "I have got the flu",
"It will be two days", "It will be three days",
and it does work very well.
Andrew Selous
92. Mr Nicholl and Mr Hardie, would you like
to respond to the question?
(Mr Nicholl) If we had a magic wand in this, frankly
we would want to find out much more about the group. I do not
think it is possible to advance a single solution for a group
as diverse as this. I think we have to get much more research
on how the group is made up and look at different solutions for
different parts of the group. Going back to changing the name,
I think there is an argument for changing the name, but I think
part of that is differentiating between the different groups and
I do not think it is helpful to have one description covering
a group of 2.7 million people.
Mrs Humble
93. First of all can I return to Mr Charlesworth's
reply to Andrew Selous about Jobcentre Plus? First of all, I have
to say, Chair, that I had a very interesting meeting with representatives
of the Shaw Trust locally, discussing the local delivery of service
and it was a very positive meeting about how they are working
across a whole range of organisations. You are quite right in
saying in your submission that Jobcentre Plus does not have links
with health and social services. What sort of links would you
want them to have? Would you prefer the personal adviser, the
individual in the Jobcentre Plus, to be fully trained to meet
every eventuality of every disabled person, or would you want
them to be trained to the extent of recognising those people's
needs and being able to flag up, "I need to talk to social
services or housing about this", or whomsoever else?
(Mr Charlesworth) The latter. If you went to see our
job broking in Preston, what I would say is that if you took personal
adviser pilots one of the big successes of that, certainly from
our point of view, was that we had higher placings, higher numbers
going into employment on those than on job broking. There are
two main reasons for that. First of all, they have changed the
contact system with the individual, and instead of us being able
to send letters via the Benefits Agency personalised from us,
which brought us a 6% success rate, they decided to do a very
standard letter telling them that there were three job brokers.
That brings less than 0.1% in terms of response. The second thing
the Personal Advisor pilots did was set up partnerships between
health, social services, education, training and all the voluntary
organisations that might be dealing with those disabilities so
that they get could get a message out, because no one group, whether
it is health workers, social workers, education, those in training
or involved in employment, is in touch with this group. A lot
of this group are divorced from this, but many of those different
organisations do have contact points with people with disabilities
who are out of work and they can get the positive message across
that if you want to work there is help there to get you into work.
It is all about getting people to that stage. Once we get them
through the doors we are very successful at getting them into
employment.
94. But how do you build a structure into the
system to enable that to happen, because all too often it relies
upon the personal knowledge and expertise of an individual who
builds up those links themselves, but we are talking about having
a structure that can be replicated across the whole country? I
know how it works in my area but it does not work the same in
another area.
(Mr Charlesworth) I would say it can work in any area.
You should make employment the focus and then build up a partnership
that has that focus. What has happened with the joint investment
planning with health and social services is that you have had
welfare organisations essentially and the health service and social
services being asked to produce an employment plan for their clients,
and of course they do not know how to do it. If you want to switch
the focus from welfare to work you need people who are employment
focused who then create those partnerships and put that infrastructure
in place, to bring that in and to bring a positive message across
that it is about employment. Then you have got to properly resource
the employment provision. In our evidence you will see the disparity
between the money that has gone into New Deal for Disabled People
and other New Deals. We are really just playing, are we not? The
reality is, why have we got so many numbers? It is because nobody
is doing anything with this group. In general there is no resource
going in towards getting them into employment. If you had the
properly resourced provision to offer, led by a provider with
an employment focus who has formed local partnerships, whether
it be public, private or voluntary sector leading that, it is
our contention that you could get 300,000 people a year back into
work.
95. Can I concentrate again on the role of Jobcentre
Plus itself and ask each of the other witnesses, do you think
that the restructuring of Jobcentre Plus has helped people with
disability?
(Ms Hindle) So far, not yet. In principle, yes, it
should. A colleague of mine says, "If it does what it says
on the tin it will be perfect". So far the delivery is at
best patchy. For employers, certainly we are finding that it is
very difficult to form any meaningful links because no sooner
have we found somebody than staff keep changing. It is a constant
state of flux. When you talk to DWP they will say, "Yes,
this is a five-year change programme. It will be five years before
that state of flux finishes". That is great, but in the meantime
certain groups in particular do not seem to be being helped any
more; if anything they are probably being helped less because
the Disability Employment Advisor's are changing, they are no
longer so specialist, etc. The concept, for us at least, of a
one-stop-shop, if you wish to call it that, is positive, but so
far the delivery does not seem to be coming through.
(Mr Hardie) I would echo Ms Hindle's comments. I think
it is early days for Jobcentre Plus in terms of how it drills
down to meet this client group and there are a number of challenges
that face us. A lot of it, I think, will come in time, but there
is also a plethora of programmes managed by Jobcentre Plus at
the moment, all aimed at aiding people with disabilities and long
term health problems. Those again will take time to filter through
properly in starting to take as many of the clients as possible.
There are a number of things that Jobcentre Plus could do better
and quicker, things like engaging in the specialist sub-contracting
that Mr Charlesworth is talking about. That is very important.
There are specialists on the ground in many areas that have umpteen
years' experience in dealing with people on Incapacity Benefits,
and those need to be engaged with properly. To some extent that
does not happen all the time and as well as it should happen.
Jobcentre Plus, looking at how it builds national, regional and
local relationships with these providers, needs to be looked at
in a lot more depth in order to get the best value from what is
on the ground. Jobcentre Plus has a chance at an early stage to
be quite innovative and be quite a catalyst for change. It is
a rather large agency tackling this issue but it really needs
to work much more dramatically and in a much deeper way with partners
in order to be that catalyst. Otherwise what we will end up with
is again a range of New Deal-type programmes that are not really
digging in deep enough to the problem to make the substantial
changes that are required.
96. The Green Paper talks about the pilot rehabilitation
project. What sort of role do you each think Jobcentre Plus should
have in rehabilitation and job retention, because you have all
identified that as being a key area to be addressed?
(Mr Charlesworth) I think that they can be one of
a number of providers. If I could go back to your last question
before I move on, because I do not want to lose this point, Jobcentre
Plus themselves, where they are delivering New Deal, for instance,
actually operate outside the Jobcentres. They take the service
to the community with mobile vans and using community premises
and so on. Why? If it is such a good idea to link the benefits
and the employment through the Jobcentres themselves, why do they
do that? You ask them. Because that is the way they know they
are going to be successful as a deliverer. Yet when it comes to
developing the contracting strategy they revert back to the principle
that we must have Jobcentre Plus as the hub of the network that
is going to be involved in providing those rehabilitation and
retention pilots. We do not believe that that is a sensible way
to go forward and they are unlikely to work on that principle.
But if you must run them, then have at least a private sector
and a voluntary sector model that runs alongside them that is
outside that joining up and using the Jobcentres as the hub, because
we believe you will get a better result.
97. Mr Charlesworth, we could spend all afternoon
talking about this. We are going to have a vote in 10 minutes
and I would like to cover the retention and rehabilitation before
then.
(Mr Charlesworth) It seems to us that it is based
on a belief that somehow you can cure the disability or ill health
and, as such, we think it is the wrong angle completely; you need
that much more holistic model. We are not in favour of the pilots,
as you will see in our submission. We think that it is yet another
pilot trying to do something for people with disabilities. I will
leave with you the analysis I have here. It is an analysis of
the most successful districts of Jobcentre Plus in relation to
placing of people with disabilities[39]You
might be interested to know that all the top performing areas
are also the top performing job brokers. When they get a programme
that works they say, "We will ignore that and go for another
research project". There is an exact correlation where you
have got a good job broker—and actually we are top on all
three—you get a good result. If you are a poor job broker
there is nothing happening.
98. I have to say that is what your local colleagues
were telling me as well, so I am hearing the same story.
(Ms Hindle) A rehabilitation and retention role for
Jobcentre Plus—if you ignore the current pilots essentially
it is something that Mr Charlesworth has been saying. The word
we would use is "case management", that the disability
employment advisor, the personal adviser, should be the holistic
case manager for the person who has or has acquired the disability
or incapacity. Hence they may well be expert in helping them get
into work; they may well be expert in the benefit system, but
they should be responsible for making the links on behalf of that
person with whatever else they need, whether that is training,
whether it is education, whether it is help with transport, because
if they do not nobody else does and you end up that the person
is ready to go back to work and they cannot get the transport,
or they have got everything else lined up and they have not got
the training. Somebody needs to say, "Yes, it is my job to
look after every angle of what it is that is stopping them getting
back to work". Our experience is in very many cases that
it is not the incapacity that stops the person working; it is
one of the other issues. It is because they need retraining or
they need some health care or they need the transport sorting.
It is not the incapacity itself, the illness, that is stopping
them working. As regards the specific pilots, the rehab and retention
pilots, I have to say that we were very anti them on the ground
of the random assessment assignment.
(Mr Charlesworth) As we were.
(Ms Hindle) And we looked at bidding for them and
refused to bid because we felt it was totally unethical basically
to go for the random assessment assignment.
(Mr Hardie) I tend to think of it being incredibly
difficult to get this super person to cover all angles of everybody's
incapacity, be it housing, be it economic, be it health or whatever.
There is an enormous amount of responsibility put on to disability
employment advisors or personal advisers as things are, so personally
I think it will be very difficult to evolve this type of thing.
What I do believe is that there is a definite link on a very practical
and a day-to-day level between GPs and health practitioners at
local levels who in the first instance sign people off and on
to sickness and the Jobcentre Plus. As a practical thing I would
put a personal adviser, a specialist, in every local health centre.
I would not necessarily take the health centre to the Jobcentre
Plus; I would put a PA into every health centre who could be there
to advise GPs and health practitioners about back to work programmes
and about different incentives for folks to get back to work and
help educate and inform our GPs and health practitioners about
the value of work better as an aid to job retention and that type
of thing.
99. It is difficult in a town like Blackpool
that does not have health centres but has individual GP practices.
Finally, can I ask you about how you see the Green Paper emphasis
on more frequent, job focused interviews, speeding that process
up? How do you think that is going to help people with disability?
It is supposed to be reminding them that there is work there.
Picking up the points that you have made, reminding them that
work is there and that they should be thinking about work, is
that going to be to the benefit of people with disability and
do you think that Jobcentre Plus will be able to cope with having
more frequent interviews?
(Mr Charlesworth) The question has a two-fold answer.
For some people it will be helpful. For others it will be a cause
of severe anxiety and stress and add to their illness. Overall
we would favour non-compulsion and a much more client centred
process which is based on voluntary presentation about work.
(Ms Hindle) If anything I would go further. If all
you do is say, "Come in more often for a job-focused interview",
I do not think it achieves anything for anyone much except giving
Jobcentre Plus a lot more work. What you need to do in between
the interviews is help the person get the retraining or the health
care or the housing sorted out so that the next time they come
in for an interview one of the barriers or hurdles that you had
previously identified has been resolved. If all you do is say,
"Come in for an interview. Now go away for three months and
then come back in for another one", not surprisingly, nothing
much is going to happen in that three months.
(Mr Nicholl) The principle of regular work focused
interviews is a good one and I would only question whether there
is sufficient resource to do it effectively, and I think that
is a question that Jobcentre Plus would have to work on.
38 A copy of the Shaw Trust's response to the Government's
Green Paper has been circulated to Members of the Committee. Back
39
A copy of the paper provided by the Shaw Trust was circulated
to Members of the Committee. Back
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