Select Committee on Work and Pensions Written Evidence

Memorandum submitted by Leonard Cheshire


  Disabled people currently have an employment rate of just over 50% and there are 2.8 million people of working age claiming incapacity benefits. DWP has a PSA target to increase the employment rate of people with disabilities and the Government has a long-term aspiration to increase the overall employment rate from 75% to 80% of the working-age population.

  Consequently helping more disabled people move into employment, while also supporting those who are unable to work, has a central role in the Government's welfare to work strategy.

  The Committee seeks written contributions on this issue from interested organisations and individuals. Oral hearings will take place in the autumn. The deadline for written evidence is 3 October 2005, although the Committee will accept supplementary memoranda once the Government's Green Paper on the reform of incapacity benefits is published. Written submissions should be submitted in accordance with the guidelines.


  Leonard Cheshire ( is the UK's largest voluntary sector provider of support to disabled people. It supports over 21,000 disabled people in the UK (90% in their own homes, 10% in care homes) offering a range of flexible social care services to meet their needs. The charity campaigns for the rights of disabled people in the UK and raises awareness of the issues affecting them. The charity also works with disabled people in 57 countries worldwide working in partnership with more than 255 autonomous and locally managed services and organisations.

  Leonard Cheshire's breadth of experience, knowledge and constituency of disabled people gives it a unique platform from which to engage in public debate and to campaign on the social policy and civil rights issues that impact upon disabled people.


  Leonard Cheshire believe that the reform of Incapacity Benefit (IB) should be viewed as a golden opportunity to address disabled people's poverty by offering genuine support and assistance for those looking to return to employment and providing genuine financial security and dignity for those for whom full-time employment is not a realistic option.

  If security and dignity is to be achieved then the basic rate of IB must be raised. At present the average IB payment is around £84 pounds a week. If this was considered as a "nine to five" job then it would work out at well under half the minimum wage. For this reason a recent study by Leonard Cheshire into disability and debt found that many disabled people who rely on benefits for their income can end up living in poverty.

  The reform of IB must work from the principle of addressing and alleviating disabled people's poverty.

  We would also urge caution with regard to the use of compulsion in the IB system. As a point of principle Leonard Cheshire does not believe that return to work activities should be forced on claimants. We believe that, whilst such activities may be very helpful for some claimants, a "one size fits all" approach to disability can never be effective and as such there must be flexibility within the system to ensure that no-one is being forced down a certain path when that path may end up being detrimental to their health and general well-being.

  The current Personal Capability Assessment (PCA) is already extremely stringent and can be a difficult and traumatic experience for many claimants. To use any reform of the benefit to try to further tighten this procedure and narrow the gateway on to the benefit would be socially unjust and would be fervently opposed by many disabled people and their organisations.

  The Employment Capability Assessment proposed in the DWP's Five Year Strategy could be a very welcome development if it can begin to assess wider reasons for disabled people's absence from the job market including employer discrimination, the local job market, the availability of accessible transport and social care services and so on. Care must be taken, however, to ensure that the process becomes no more stressful for claimants than it already is.

  It is also important to note at the outset that if someone is unemployed it should not mean that they have been written off and cannot be a valued citizen. Citizenship is a broad term and contributions to society are not limited only to paid employment. For example, volunteering, civic participation and the self-management of chronic conditions should also be regarded as "work". Leonard Cheshire would also point out that being in paid employment is not necessarily appropriate or beneficial for all people. There are people for whom being forced to seek paid employment would be detrimental and it would be a profound dereliction of duty not to offer this group the appropriate support.

  In this document Leonard Cheshire has responded to the particular questions and areas raised as part of this consultation.


  1.1  The early results of the Pathways to Work (PtW) pilots have been extremely encouraging. The emphasis of the benefits system needs to change from what people could not do to what they could—from disability to capability. Schemes such as PtW will help to do just that.

  1.2  The DWP's five year strategy proposed that there will be sanctions in place for recipients of the provisionally titled Rehabilitation and Support Allowance (RSA), the entitlement proposed for those the Government expect to return to work, who do not fully engage in return to work activity. The strategy does not however indicate what those sanctions might be, and whether they could include cutting a claimant's benefit. Leonard Cheshire is instinctively opposed to the idea of such sanctions and would therefore urge great caution in setting them. Those claiming IB, or its replacement entitlements, will require support and encouragement in returning to work; sanction and condemnation have the potential to be deeply damaging and to exacerbate social exclusion and poverty. Leonard Cheshire will wait to see firm proposals from the Government in this area before commenting definitively on this proposal.

  1.3  The strategy also says that some return to work activity will be compulsory for those claiming the provisionally titled Disability and Sickness Allowance (DSA)—the benefit proposed for claimants for whom work is not considered realistic. It is not clear from the paper, however, whether there will be any sanctions in place for those on DSA who are considered not to be engaging at all in this activity. It would surely be inappropriate to impose sanctions on those for whom a return to work is not a viable option. Leonard Cheshire awaits the Government's proposals in this area but would oppose any moves to impose compulsory work focussed activities on this group of claimants.

  1.4  Media reports at the time of the publication of the Five Year Strategy suggested that there might be a split of approximately 80% to 20% between the RSA and DSA respectively. It is assumed that these proportions are probably drawn roughly from the list of those impairments within the current system that do not require claimants to re-sit PCAs. This distinction is clearly unlikely to be the best method for discerning how to separate claimants at the PCA stage. Some conditions may be long-term, and hence not require constant re-evaluation through the PCA process, but may not provide a considerable barrier to work, whereas some might fluctuate considerably and greatly curtail an individual's opportunities for employment.

  1.5  Leonard Cheshire understands that it will be necessary to draw a line at some point to separate the two proposed benefits. We would, however, urge that definitions set for the PCA process are not too rigidly applied. Given the variability of disability, to operate a simple list of conditions that qualify for each benefit would be a clumsy method for separation. Any point of separation should be based on an individuals abilities rather than their disabilities—but recognising that these may change over time. Conditions like multiple sclerosis can fluctuate considerably and what may be appropriate for one person may not be appropriate for another. Setting any sort of percentage target for the level of inflow on to each benefit would not be an appropriate way to separate the two benefit strands

  1.6  The PCA process should not simply be a question of box ticking—but should be a flexible needs-based assessment. The level of successful appeals against PCA verdicts at present would indicate that refinements are certainly needed to the system. There would, however, most likely be extra costs involved in making the PCA process more effective in recognising clients' needs and abilities. Leonard Cheshire would seek more information from Government about potential costs, and potential future funding for the reform programme.

  1.7  The proposed "Employability and Support Assessment" will also play an essential part in this process. It is vital that this assessment takes a holistic view of an individual claimant's circumstances alongside external drivers such as local labour market conditions, employer discrimination and the availability of any necessary public support services, such as social services and accessible transport. Leonard Cheshire again awaits further details before commenting substantively on this proposal.

  1.8  The cornerstone of the decision-making process at PCA stage should be an assessment of an individual's immediate and long-term support needs. Any decision taken purely on the immediate potential to return to work will be difficult and potentially prejudicial, particularly to those with fluctuating conditions.

  1.9  There must be sufficient scope for individuals to switch between the benefits should circumstances change, but this should not predicate a requirement for constant reassessment through the PCA procedure—which can be difficult and burdensome for many disabled people. There will need to be careful linking rules established between the two strands of the benefit to ensure that shifting from one to another will not incur unnecessary sanction


  2.1  Leonard Cheshire welcomes the early findings on the effectiveness of the PtW programme. It would seem sensible to build much of this successful formula into any new system. Evaluation of the way in which PtW has been successful and ways in which it could be improved will be important in charting the course of a new IB system. Leonard Cheshire therefore awaits further results from the extended PtW pilots.


  3.1  The PtW programme has successfully encouraged many people receiving incapacity benefit back into the workplace. The pilots saw people who had not initially been on the scheme, request to be added. If awareness of the scheme were to increase, we believe that more people still would want to join PtW.

  3.2  There is some concern over the capacity within Jobcentre Plus to deliver the appropriate level of support on a nationwide level. This is discussed in further detail in 6.1. It is important that the scheme does not become excessively target driven; avoiding a situation where only those people who are "closest" to the labour market receive proper support.


  4.1  The principle behind any return to work activity must be to assist a claimant in looking for work, and to offer preparation and support for returning to the workplace. Activity need not only focus on the application process, but also on practical support in the workplace including information about what statutory support is available, and what protection is offered by anti-discrimination legislation. The benefit system must work in tandem with programmes like Access to Work, that provide real and tangible assistance in the workplace, if the Government is to meet its ambitious employment targets.

  4.2  Action plans for those that are keen to return to work should be agreed with each individual claimant. This means that there must be a wide range of possible activities on offer to suit each individual's needs. There should not be a set list of activities in which all claimants must engage if those activities will plainly not be of benefit to the individual.

  4.3  The role of Personal Advisors (PAs) in engaging claimants in return to work activity will be crucial. Much of the success of the Pathways to Work pilots has stemmed from highly trained PAs with the freedom to engage on an individual basis with claimants. Any new system must utilise highly trained PAs in a way that offers them the freedom to seek the best results for clients—this means that their work should not be excessively target-driven. Requiring PAs to hit targets regarding what return to work activities clients are engaged in will curtail PAs freedom to work personally with clients. Comprehensive Disability Awareness Training must be part of the PAs training programme to ensure that they are able to make reasoned and considered judgements regarding their clients. Where Pathways to Work is effective we believe that it has and will help to address a large concern with the current system—the difficulty people with disabilities have in returning to and remaining in work.

  4.4  Return to work activity could also include broader societal components that are nonetheless crucial to finding employment. For example, a survey conducted by Leonard Cheshire found that 23% of disabled people had been forced to turn down a job because of inaccessible transport. Nearly half (48%) said that inaccessible transport had restricted their choice of jobs. Support in dealing with the public transport system may be crucial in empowering some disabled people to enter paid employment—this could be included as an option in return to work activity programmes.

  4.5  PAs should be able to offer official programmes of work placement and work experience within the new benefit system. Such programmes could help claimants that wish to return to the workplace gain experience, perhaps in a new area of work, and could also help employers discover the potential benefits of employing disabled people. Offering work placement may be a useful way of improving the perception that employers have of disabled employees. Any such schemes should be operated on an opt-in basis to ensure that disabled people are not pushed into a work environment where there is not appropriate support available.

  4.6  In order to facilitate a return to work, there must be increased awareness of, and funding for, the Access to Work scheme. Employers in particular need to be made aware of the benefits of using the scheme and the relatively minor costs of making adaptations that can help to empower a disabled employee.

  4.7  Approximately 40% of those on IB have mental health difficulties.[29] It is crucial that PAs are appropriately trained to support those with mental health conditions in to work. Incapacity can be caused by conditions that fluctuate in the effect that they have on claimants, and inevitably cause different limitations on their ability to work. This is especially true for those with mental health difficulties and must be recognised by the system and PAs.


  5.1  Healthcare professionals and particularly GPs will of course always have some sort of role within the IB system. Leonard Cheshire would, however, warn against their role being excessively controlled by Government. We were concerned at suggestions in the DWP five-year strategy that GPs could be censured for signing too many sick-notes, and by subsequent comments from the DWP about work being beneficial to health. Whilst in many cases work may indeed be beneficial, clearly this will not always be the case and GPs must retain the discretion to advise their patients to the best of their ability without any external pressure. It is also important that GPs are not the only healthcare professionals involved in the development of initiatives such as the condition management programme. The reasons why people are out of work can be complex and it can often require specialist knowledge, particularly with regard to mental health conditions, when assessing the appropriate ways to return to the workplace. GPs, by definition, tend to offer a very broad medical knowledge base and may not be best placed to solely produce a rehabilitation programme. It is important that all healthcare professionals also respond to the individual needs and requests of claimants, and accept that their views are often the most accurate and valid.


  6.1  The reform of IB, even if not applied to existing claimants, will inevitably mean a large change for those who currently claim it, and who will claim in the future. It is essential that there is sufficient scope within Jobcentre Plus to introduce, implement and explain these changes. This can sit uneasily alongside the DWP's efficiency agenda. The expansion to the PtW scheme will require more people to be employed in the sector, and the reforms proposed in the DWP's five-year strategy will require highly trained personal advisors delivering highly personalised support. It is important that PAs are given the freedom to tailor their advice and support to individuals and are not driven by targets.

  6.2  The large number of PAs that will need to be recruited or upskilled from the current workforce to implement the expansion of PtW and the subsequent reforms of IB will require significant extra resources.


  7.1  The basic principle of any reforms must of course be to deliver proper support to those who cannot work, and genuine, effective assistance for those who are looking to return to the labour market. As such it is understandable that the DWP has already begun looking at the role that voluntary and private sector providers could play within the system. The voluntary sector can offer enormous expertise, innovation and knowledge of specific impairments. There are some concerns, however, that if charities were to be those who delivered frontline services then it could compromise and distance them from their own charitable purpose. In particular, if sanctions were to be introduced as part of the reform to Incapacity Benefit it could lead to a situation where a charity was introducing sanctions against some of its own beneficiaries. This would be unacceptable.


  8.1  Work must be undertaken with employers in the local area to make them aware of their legal obligations and to improve the provision of possible jobs for disabled people. The Government should consider what sort of incentives might be offered to employers who actively seek to employ disabled people. In areas of high unemployment particular efforts may need to be made to ensure that there are jobs available for claimants and those employers are fully aware of the benefits of employing disabled people. In particular ensuring that a wide breadth of jobs is available will help encourage those that wish to find work.

  8.2  Assessments of employability will need to take into account the dynamics of the local economy and the availability of jobs in the local area. This may help determine what return to work activity might be most beneficial. Given that there is often an understandable correlation between areas of high unemployment and numbers of Incapacity Benefit (IB) claimants it will always be important not to force claimants to undertake return to work activity that will not realistically provide any help in entering full employment. Such activity would simply be demoralising.

  8.3  The Government's proposal to appoint a national director for occupational health may help work to reduce the number of accidents at work and encourage best practice with regards to health and safety. Neither this nor the Workplace Health Direct help line proposed in the five year strategy will challenge employer discrimination.


  A central tenet of any reform of welfare benefit must be the elimination of "benefit poverty". Poverty levels amongst disabled people are significantly higher than people without disabilities. Paid work is a possible route out of poverty and Leonard Cheshire welcomes constructive moves, which enable unemployed disabled people to become employed. In parallel, we also ask that disabled people not able to work be properly supported through enhanced levels of benefit enabling them to live a life of dignity and not one of poverty.

Alison Goldworthy

3 October 2005

29   DWP official figures, see: Back

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