APPENDIX 41
Memorandum submitted by the Ingeus Group
(EDP 52)
INTRODUCTION
Over 2.7 million people currently claim an incapacity
benefit in the UK. Whilst claimant count unemployment has fallen
to a record low the number of people on incapacity benefits is
set to continue rising.
This increase brings with it an enormous cost
to society—both human and financial.
The Ingeus Group (which includes Work Directions
UK Ltd) welcomes the opportunity to contribute to the vital debate
on how we can help individuals to move from incapacity benefits
into work and social inclusion. It is also important to examine
how we can help stem the flow of people onto incapacity benefits
in the first place.
Within the Ingeus Group we believe that we have
a unique perspective on the challenges that we face. As a Group
of companies operating throughout Australia and the UK we deliver
a range of human services solutions including:
— rehabilitation and employment services
to those who become incapacitated due to injury;
— rehabilitation and employment services
to those with ill health;
— training and employment services
to long-term individuals.
Founded in 1989 we specialise in helping people
with disabilities, illness or injuries to return to sustainable
employment. To date we have helped over 30,000 of the "hardest-to-help"
to access suitable, sustainable employment.
Annex A gives a brief overview of the companies
within the Ingeus Group.
Do the High Numbers Claiming Incapacity Benefit
Represent Hidden Unemployment?
What is unemployment?
Unemployment is defined in various ways for
various purposes.
Claimant count unemployment is calculated counting
only individuals claiming benefit who are required to look for
work as a condition of receiving that benefit. This (very narrow)
definition of unemployment tautologically implies that the high
numbers claiming an Incapacity Benefit are not unemployed.
A wider definition might take into account individuals
who would like to work but who do not have jobs. Using this criterion
as a sufficient condition for an individual being unemployed leads
to the conclusion that the high numbers claiming Incapacity Benefit
do indeed represent significant hidden unemployment.
50% OF INCAPACITY
BENEFIT CLAIMANTS
WANT TO
WORK. THIS
REPRESENTS A
MILLION HIDDEN
UNEMPLOYED INDIVIDUALS
CLAIMING INCAPACITY
BENEFITS.
A more complete definition of unemployment might
go further to take into account those individuals who could quite
conceivably work but who choose not to do so. To qualify for an
Incapacity Benefit an individual does not have to be incapable
of work. Rather an individual's disability has to be significant
enough to exempt them from a requirement to work.
MOVING BEYOND
A HOMOGENOUS
VIEW OF
INCAPACITY AND
OF WORK.
Every Incapacity Benefit Claimant is an individual
with individual needs requiring an individually tailored approach.
To lose sight of this variation will blunt our response and hinder
our ability to provide any one of those special pathways back
to employment.
In Australia, Ingeus is one provider of Occupational
Rehabilitation services—a managed process of rehabilitation
which starts with an "holistic assessment", including:
— Functional capacity assessment—to
determine physical capability and tolerances.
— Psychosocial assessment—to
identify the psychological impact of the injury or disability.
— Workplace assessment—if still
employed, to determine the real job demands.
— Vocational capacity assessment—if
not employed, to identify current work skills, specific industry
knowledge, transferable skills, job related interests.
— Self-reports on home activity—to
identify congruence and consistency with other assessments.
— Liaison with treating medical practitioners—to
confirm diagnosis, current treatment requirements and medical
considerations for return to work.
— Conditions in the Labour Market.
It is possible on the basis of such holistic
assessment to determine a suitable rehabilitation goal from a
"hierarchy of goals":—
— Return to pre-injury job, same employer,
full pre-injury hours.
— Return to pre-injury job, same employer,
reduced hours.
— Return to alternate job, same employer,
full pre-injury hours.
— Return to alternate job, same employer,
reduced hours.
— Return to alternative job, with a
new employer.
— An avocational outcome.
What is, or Should be, the Role of Jobcentre Plus?
Are They Doing Enough Actively to Engage People with Disabilities
in Finding Suitable Work?
Jobcentre Plus have been remarkably successful
in helping to bring Claimant Unemployment levels down.
However, we would question whether Jobcentre
Plus has sufficient health expertise which is necessary to run
a really effective welfare-to-work programme for individuals on
Incapacity Benefits.
Our experience in Australia has demonstrated
to us the necessity of integrating job-broking expertise with
medical expertise for individuals in this client group. This is
called Occupational Rehabilitation.
The Australian model takes people into rehabilitation
almost immediately an injury or illness is identified. The individual
has a statutory obligation to participate. The earlier the intervention,
the stronger the likelihood of a return to full employment. It
is in this way that organisations, like Inergise, are able to
demonstrate such impressive results.
Occupational Rehabilitation is the restoration
of injured workers to the fullest physical, psychological, social,
vocational and economic functioning of which they are capable,
consistent with pre-injury status. It is a managed process aimed
at maintaining injured or ill workers in, or returning them to,
suitable employment. The "hierarchy of goals" has already
been described. The person is usually still employed when referred
for Occupational Rehabilitation and has either:—
— sustained an injury or illness because
of conditions in the workplace; or
— has become ill or injured themselves
outside of the workplace.
"Same employer" return to work rates
of 89% are being achieved in an average of 21.5 weeks.
Similar support is offered to workers and employers
in New Zealand, Canada and the United States, where there are
active rehabilitation industries with early intervention and case
management approaches.
Best practice from Australia suggests a much
more pro-active response to individuals taking up "incapacity
benefits". Managed rehabilitation services are provided by
organisations such as Inergise who combine an expertise in health
rehabilitation with an expertise in job-broking. It is only through
tackling health barriers to employment in tandem with other barriers
to work that individuals can be fully supported in returning to
employment. Early intervention is an essential part of this process.
In Australia, an Inergise rehabilitation team includes occupational
therapists, psychologists, and physiotherapists working closely
in conjunction with the treating Doctor. A rehabilitation co-ordinator
orchestrates the process according to a negotiated Rehabilitation
Plan.
THE ROLE
OF THE
PRIVATE SECTOR
IN DELIVERING
EMPLOYMENT SERVICES
FOR PEOPLE
WITH DISABILITIES
AND HEALTH
PROBLEMS.
The private sector has proved itself to be adept
at helping individuals to access employment where other programmes
have failed. In Australia, all employment services provision is
delivered by the private sector. This has been shown to be both
highly effective and very economical in comparison to the previous
public sector provision that it replaced. Rehabilitation services
for individuals on incapacity-type benefits are provided by professional
rehabilitation service providers from the private sector. The
goal of this rehabilitation provision is always suitable employment.
In the UK the private sector has also shown
itself to be highly effective in delivering welfare-to-work provision
though it still tends to be on the basis of delivering pilots.
Figures vary and it is difficult to measure like with like but
there is strong evidence that private and voluntary sector providers
are achieving very high return to work rates in Employment Zones
and the various New Deal programmes.
FUNDING OUTSOURCED
EMPLOYMENT PROGRAMMES
There are three significant programmes outsourced
directly by the Department for Work and Pensions or through Jobcentre
Plus with fixed payment structures: Employment Zones, Private
Sector Led New Deal and Action Teams for Jobs. In addition to
these, Jobcentre Plus operates a detailed funding framework according
to the target group, nature of intervention, location and outcomes.
Funding for New Deal for Disabled People varies between contracts
but is heavily output-related.
Performance on existing programmes suggests
that innovation is encouraged, and controlled, when:
— Funding is common between like contracts
and contractors.
— The client group is carefully defined
to ensure services are targeted on those most in need and providers
do not "cream".
— Payments are linked to clearly defined
employment outcomes.
The greatest flexibility is afforded to the
delivery agent through the Employment Zone contracts, in which
benefit payments are redirected to assist the move to work rather
than maintain someone in poverty out of work. There are three
key features to the Employment Zones:
— Benefits are included in the "pot"
and become the responsibility of the delivery agent.
— Payments are heavily outcome-related,
with the largest coming at three months of full-time employment.
— The provider is financially incentivised
to move the client as quickly as possible into sustainable employment.
The Employment Zone contracts effectively pass
on a large degree of the "risk" of such delivery to
the private contractor. It is not clear whether there is sufficient
evidence to accurately predict the potential cost of a similarly
intensive programme for people on an Incapacity Benefit.
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 Need Rather
Than be Aimed at People with Specific Disabilities?
Every individual is unique with a unique set
of needs. This is especially true of unemployed individuals with
a disability or health problem.
An individual who finds themselves out of work
may have a number of barriers to employment. Some of these might
be health or disability-related. Many will not.
A good job programme needs to be able to identify
an individual's barriers to employment and help that individual
to overcome them. In the case of someone with a disability or
health problem some of those barriers may well be medical. Only
a fully integrated approach to rehabilitation and employment can
help the majority of individuals to find suitable, sustainable
employment.
Employment projects work best when they are
fully targeted at individual need. This is one of the key reasons
for the success of the "Personal Advisor" approach in
Employment Zones and the New Deal. The same can be said of the
"Advisor Discretionary Fund". Giving individual Advisors
the freedom and resources to plan and deliver an individual's
path back to work has been shown to be the most effective way
of helping people into employment.
A truly flexible employment programme can cater
for the additional needs of individuals with specific health problems
or disabilities provided that the programme has a significant
rehabilitative element to the delivery.
As already noted, in Australia, an Inergise
rehabilitation team is multi-disciplinary including job-brokers,
occupational therapists, psychologists, rehabilitation counsellors
and physiotherapists working closely in conjunction with the treating
Doctor. A rehabilitation co-ordinator orchestrates the process
according to a negotiated Rehabilitation Plan.
Occupational Rehabilitation programmes in Australia
are achieving "new employer" average return to work
rates of 59% in 46 weeks. However, where it is not possible to
return to the same occupation and where the individual has been
out of the labour market for a considerable period, some pilots
have been showing return to work rates of over 30%. The clients
participating in these pilots will be fairly similar to those
envisaged for the UK pilots.
The Tax Credit and Benefit System: is it too Complex
for the Circumstances Faced by People with Disabilities? Should
it be Reformed to Remove Financial Disincentives to find Work?
Unless it is possible to move easily backwards
and forwards between different benefits, reflecting the dynamic
nature of illness and disability, then the application of the
benefits system encourages the fossilisation of incapacity. A
claimant will hold onto their disability in order to hold onto
the safety net of the benefit which it was so hard to win.
Incapacity Benefits are viewed as a single benefit,
in much the same way as claimants can be perceived inaccurately
as a homogenous group. A more responsive and, therefore, effective
system would be sensitive to variation within this population.
It would encourage movement between different degrees of support.
It would enable different provision to be targeted to the needs
of particular claimants of particular Benefits. It would demand
a different level of expertise to deliver, or a different degree
of engagement with external allied health professionals.
The complexity of the benefits system can be
circumvented on an individual basis by getting a benefits expert
to conduct a "better-off" calculation for every individual
based on their circumstances. A better-off calculation takes ten
minutes to do and is invaluable in showing an individual how much
better off they would be in work. There are benefits experts in
every Jobcentre Plus office in the country. WorkDirections UK
will shortly be making a simple better-off calculator freely available
on their website in the very near future.
Although the vast majority of individuals are
better off in work the difference in pay between working and not
working can be small—especially when working costs such
as travel and lunch are taken into account.
Ireland has a system of benefits whereby a disabled
individual can continue to claim a significant percentage of their
"incapacity benefit" for their first few years in work.
The percentage of their old benefit that can be claimed decreases
over the years but serves as a very significant incentive to work.
Quite simply, individuals are massively better off if they take
a job. Developing a work ethic and developing skills, individuals
find that they stay and progress in employment. In the UK once
an individual has been on an incapacity benefit for a year they
only have a 20% chance of returning to work in the next five years.
What Experience do Other Countries Have in Tackling
the Growth in the Numbers Claiming Incapacity-Related Benefits?
There are a number of innovative and effective
solutions from around the world for tackling the growth in the
numbers claiming incapacity-related benefits. Some of these are
summarised below:—
— The Walle Villages in Germany integrate
work and rehabilitation and a housing solution, with participants
learning new skills and receiving psychological care as they build
their own future homes.
— 13 Travels in France takes participants
through six months of professional travel agency training, then
six months of work, followed by a second year in which they are
the teachers for the next group. Each group of participants includes
50 per cent long-term unemployed and 50% with mental health problems.
— 80% of the participants attending
the Workers Educational Association in Iceland found employment
following a 3 month-programme integrating counselling with education
(maths, grammar, word processing and basic English), writing resumes
and courses in self-esteem. The delivery model is "self organized
learning" and the educational elements were given real-life
contexts, such as budgeting to maintain a household.
— Use for Everyone in Sweden ran a
10-week course with participants becoming "process leaders",
forming work groups around different activities based on leaders'
interests. The New Deals run by WorkDirections in London are giving
the same principle of empowerment a vocational twist with "Community
Activism" enabling participants to develop their own solutions
to their group's unemployment.
— "On sick leave—and active",
run by the Danish Ministry of Social Affairs, increases the likelihood
of recovery and reintegration in autonomous working life through
involving recipients of sickness benefit in a range of activities.
— The programmes of job "alternation"
in Finland or job "rotation" in Denmark have the dual
impact of reducing stress and its impacts through enabling extended
leave or rehabilitation, whilst creating an opportunity for an
unemployed person to gain experience and develop a work ethic.
William Smith
Chief Executive
Work Directions UK Ltd.
12 February 2003
Annex A
A brief guide to the Ingeus Group
The Ingeus group is one of the world's leading
providers of welfare-to-work services. Established in Australia
14 years ago as a company specialising in occupational rehabilitation
and injury management Ingeus now specialises in a range of integrated
human solutions. The Ingeus Group delivers services through special-purpose
subsidiaries:—
Inergise
Provides pro-active, outcome-focused Corporate
Health services, in particular, injury management, injury prevention,
occupational health and safety and related training.
WorkDirections Australia
Provides employment services and provides resources
and support to assist individuals move from unemployment into
work through specific programs, such as the Personal Support Program
and Transition to Work.
WorkDirections UK
Provides innovative welfare-to-work services
for people who are long-term unemployed including running the
Private Sector Led New Deal programmes in Central and West London.
Invisage
Provides exceptional management training, accredited
vocational training and traineeships.
Clements
Provides recruitment services in: labour hire,
office and administration (permanent and temporary), technology
and IT, corporate and executive.
| 
