APPENDIX 18
Memoranda submitted by the Institute for
Applied Health and
Social Policy, Kings College, London (EDP
27)
This response recognises that there are people
with mental health problems and physical impairments who are unwillingly
at risk of losing their employment or who are unwillingly unemployed.
There are others who do not feel confident of
their ability to sustain employment. They fear the lack of financial
security offered by the benefits system and the coercive approach
taken by employment and social security services, and are therefore
unlikely to try out paid or unpaid work.
There is thus a failure to act before the individual
with a health problem or impairment has become affected by the
disabling process of unemployment and assessment. There is a corresponding
failure to support people out of the "disabled" status
thrust upon them, making it difficult for them to become an active
part of the workforce.
The response highlights the factors which propel
people into a status where they are deemed to be disabled and
incapable of work. These factors are:
— The lack of effective employment
support and job retention services.
It is acknowledged the benefits system is too
complex and not achieving it's aims. The key areas of concern
are:
— Part-time work is not financially
viable.
— Financial security available to those
trying out work is insufficient.
— The fear of triggering a Personal
Capability Assessment is a major deterrent to trying out any voluntary
or paid work.
— Coercive approaches do not lead to
sustained employment.
The lack of effective employment support
and job retention services:
— The NDDP scheme is not able to cater
for people with significant health problems or disabilities. Instead,
a case management approach with the DEA could provide a single
gateway for all whilst meeting specialist needs.
— Timely prevention of job loss involving
the Access to Work scheme, the GP, private sector, Employee Assistance
Programmes, legal advice etc in job retention programmes are essential
to avoid people with health problems becoming disabled.
— Coercive approaches do not lead to
sustained employment.
The response notes that there are lessons to
be learnt from the New Deal pilots and from the Avon and Wiltshire
Mental Health Trust Job Retention Pilot which can contribute to
the design of more effective services.
FULL RESPONSE
1. Do the high numbers claiming Incapacity
Benefit represent hidden unemployment?
There are people claiming Incapacity Benefit
who would like to work. They may have a physical impairment or
mental health problem, but they do not feel totally "incapacitated"
or incapable. However, the processes within the benefits system
and employment service confine them to a role of "disabled
person" and incapable of contributing in the job market.
The main reasons why many cannot access employment is because:
— the support systems required to find,
get and maintain the right job are not available;
— people know if the job does not match
their abilities and support needs then it cannot be sustained;
— part-time jobs are not financially
viable due to the benefits system: an estimated 80% of those claiming
sickness benefits because of their mental health problems are
prevented from working for more than four hours a week. As they
claim means-tested benefits, any earnings above £20 a week
will result in a similar reduction in their housing and income
benefits, and, more seriously, their benefits are likely to be
delayed or reviewed. Many of these claimants could be economically
active if the option of part-time work for eight to 15 hours was
available. For many, part-time work could lead in time to full
time employment;
— intermittent employment for those
with fluctuating health problems would be possible if the benefit
system was improved to ensure that the financial penalties above
were removed and if financial security were improved; and
— financial security (offered by the
Linking Rules) is required if a person is to risk leaving the
benefit system. At the moment this is not sufficient—it
is time limited and conditional on registering successfully before
taking up employment. There is no adequate guide to the 52 Week
Linking Rule. The 104 week Linking Rule does not protect Income
Support or Housing Benefit.
We suggest:
— In order to reduce the high numbers
of people on Incapacity Benefit who would like to work, the Government
address their support needs and the barriers within the benefits
system outlined above.
— A coercive scheme to remove people
from Incapacity Benefit is not likely to result in sustained employment.
2. What is or should be the role of Jobcentre
Plus? Are they doing enough actively to engage people with disabilities
in finding suitable work? Are initiatives such as WorkStep successful?
Jobcentre Plus is focused on persuading disabled
people to have a go at work, but comes short on providing the
level of support needed. Access to Work is a key service because
it is the most flexible means of addressing the barriers in a
practical way, but it is extremely difficult for people—especially
people with mental health problems—to claim it. Workstep
is promising but it remains to be seen how much it offers opportunities
for people to get and sustain ordinary employment. Like other
options, it may be scuppered by inflexibilities in the benefits
system. It still does not address the needs of people with mental
health problems.
We suggest:
— The DEA should provide a case manager
role.
— Providing an assessment of individual
aspirations, training and support needs and barriers to employment.
— Referring the individual to the service(s)
within the local community which can best meet the individual's
needs.
— Monitoring progress and ensuring
the individual moves towards work experience and paid employment
at the fastest rate possible for that individual.
— The DEA should develop contacts with
the full spectrum of employment and training services in the local
community, in order to identify what each project can offer.
— Jobcentre Plus should offer access
to expert benefits advice to all people thinking of moving into
work, and benefits advisors should be made aware of all additional
costs that might affect people with mental health problems and
other disabilities such as prescription costs, taxis etc.
— Access to Work should be publicised
to GPs as an option to offer patients before they are signed off
sick and should be advertised to the public for those at risk
of losing their employment due to ill-health or disability (who
do not start to use the Jobcentre until the job has ended) and
extend more effectively to people with mental health problems.
3. The New Deal for Disabled People: have
the lessons been learned from earlier pilots? How might it be
made more effective?
A number of features of the earlier pilots which
were welcomed by job-seekers and those supporting them have been
lost. These are:
— The case manager role of the Personal
Advisor.
— The flexibility of the service (eg
secondments to improve partnership working, drama and other innovative
ways of increasing confidence etc).
— Not outcome focused—a broader
view was taken so that steps towards employment were valued as
well as getting jobs. This approach is likely to ensure greater
job sustainability in the long term.
The NDDP job broker scheme is unable to help
people with more complex needs or high support needs, because
it lacks this flexibility.
The work-focused interviews appear threatening
in style, and are offered under threat—in that if not attended
people will lose their benefits. Although a government edict was
issued assuring that people with mental health problems should
not lose their benefits without a full investigation and support
provided, there is no evidence that this edict has been implemented.
There do not appear to be any systems in place for ensuring that
the Jobcentres are made aware of customers who are vulnerable
and therefore should not have their benefits stopped.
We suggest:
— The positive aspects of the New Deal
pilots outlined above are re-instated.
— A supportive, voluntary, rather than
coercive approach is taken to enabling people to access work.
4. The role of the private sector in delivering
employment services for people with disabilities and health problems.
The private sector already provides Occupational
Health and other early intervention/rehabilitation programmes
to prevent long term sickness absence. The public sector should
join forces with such schemes to prevent disability and choke
off the flow onto Incapacity Benefit.
One example of partnership working between public
and private sectors is the Avon and Wiltshire Mental Health Trust
Job Retention Pilot for people experiencing mental health problems.
This pilot is being jointly funded by the Department of Health
and Department of Work and Pensions. What is unique about this
pilot is that it has linked with a number of private sector organisations
that provide services which may benefit clients of the job retention
team. Some of the private services offered include: stress audits;
conflict and mediation management; and legal advice on employment
law.
Additionally, many private services such as
Employee Assistance Programmes (EAPs) are more socially inclusive
and promote early intervention as they are available to all employees
within an organisation for a set cost to the employer. EAPs provide
telephone counselling to all employees and effective support for
mild mental health problems and a range of issues that are factors
in the development of mental health problems.
We suggest:
— Use the learning, experience and
current service provision of the private sector, particularly
in prevention and early intervention, in partnership with public
sector mental health and employment services.
5. Are the needs of particular groups of
people with disabilities and health problems adequately catered
for? Should employment projects be more inclusive and adapt to
individual need rather than be aimed at people with specific disabilities?
People with mental health problems are inadequately
catered for because the mental health professionals do not regard
employment as important. Jobcentre Plus and DEAs in particular
need to work in partnership with mental health services, to ensure
all people with experience of mental health problems get appropriate
encouragement and support to access work.
Generic services do not address the fact that
some groups are more discriminated against than others. Indeed
they can make it worse by cherry picking and thinking that they
are doing a good job, whilst in fact those who are experiencing
long term unemployment because they have specific support needs
and barriers due to their history of mental ill-health continue
to be excluded from employment.
We suggest:
— Whilst specific expertise is essential
for the different types of health and disability problems, a single
gateway is required.
— The role of the DEA as Case Manager,
familiar with the full spectrum of resources in the community,
referring clients out to specialist services as required, would
be an ideal way of providing this single gateway with access to
the expertise required.
6. The tax credit and benefits system: is
it too complex for the circumstances faced by people with disabilities?
Should it be reformed to reduce financial disincentives to find
work?
The benefit system for people who claim because
of "incapacity" directly deters claimants from trying
education, training, voluntary work and part-time permitted work.
This is particularly prevalent where people have a mental health
problem or other "hidden" disabilities. People who believe
that they are unable to compete for and keep a job are very afraid
of putting their incapacity benefit income at risk. Fear of triggering
a Personal Capability Assessment is widespread amongst people
with mental health problems. Many refuse to undertake any activity
which could make such an Assessment more likely. The resulting
inactivity is damaging to mental health and further corrodes self-belief
and motivation for employment. Radical reform is needed.
The system is also too complex and the financial
disincentives create further considerable barriers to employment
for people with mental health problems and disabilities.
The government should pay more attention to
the gap between four hours and 16 hours paid work. All tax credits
should provide the means to a decent standard of living, not poverty
level wages.
We suggest:
— The basis for entitlement to incapacity
benefits is reviewed and other criteria are found. Level of disadvantage
and costs of disability could be considered as an alternative.
— All financial penalties for claimants,
such as reduced benefit levels, which follow from periods in employment,
are removed.
— Means are found to allow those with
a partial capacity for work, whether part-time or in intermittent
employment to become economically active (see paragraph one above).
— Tax Credits are paid to provide a
decent standard of living. Housing Benefit and Council Tax Benefit
regulations are amended to exclude Tax Credit from tapers. At
present one administration gives only for another to take away.
7. How does discrimination hinder the employment
of people with disabilities?
Discrimination affects all people with disabilities
who apply for jobs, but research consistently shows that people
with mental health problems face the greatest discrimination.
Diksa & Rogers (1998) found that employer's
reluctance to hire and retain staff with a mental illness included
concerns about the symptoms of the illness, it's fluctuating nature,
work performance and work personality.
"Working Minds" policy paper (Blackwell,
Burns, & Hardy, 2001) reported that discrimination is likely
to be common amongst managers and other employees as well as employers.
Moreover, discrimination extended beyond personnel and employment
matters to hostile behaviour towards those with mental health
problems.
We suggest:
— Involving mental health service users
in both the training of Jobcentre staff and in working with employers,
by doing presentations on mental health, the impact that mental
ill-health can have on employment, and the ways of supporting
people with experience of mental ill-health to remain in or move
into employment.
— Government bodies provide a lead
to other employers, by employing people with experience of mental
health problems and disabilities and by providing the necessary
(low-cost or nil-cost) good management systems that ensure adequate
support is provided. The recent Department of Health document,
"Mental Health and Employment in the NHS" demonstrates
how this might be done.
8. What effect does the Disability Discrimination
Act have?
Although the DDA makes little impact on the
recruitment of people with disabilities or mental health problems,
it does reduce the tendency to dismiss staff with health problems.
Many employers are now more cautious and seek advice before dismissing
staff in these circumstances.
As mentioned above, the NHS and the public sector
as a whole should give a lead on recruitment.
We suggest:
— There is a wide publicity campaign
particularly when the DDA applies to smaller employers.
— The publicity emphasises the positive
contribution that can be made by disabled people and people with
mental health problems in the workplace and the low cost (if any)
of most "reasonable adjustments".
— Legal advice for employers and employees
on the DDA is freely and readily available.
9. What experience do other countries have
in tackling the growth in the numbers claiming incapacity-related
benefits?
Other countries face similar problems, but some
have been more active in rehabilitation, for instance Australia.
There is more recruitment of people with mental health problems
within mental health services in USA.
Dr.Bob Grove
Patience Seebohm
Judy Scott
Tina Thomas
Mo Hutchison
Helen Lockett
Adam Pozner
Brenda Williams
Sandhya Dass
2 January 2002
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