Supplementary memorandum submitted by
Leonard Cheshire after the publication of the Welfare Reform Green
Leonard Cheshire (www.leonard-cheshire.org)
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 is grateful for this opportunity
to submit further evidence to the Committee following the publication
of the green paper "A new deal for welfare". Broadly
speaking the thrust of our previous submission to the Committee
remains fully appropriate, however, there are a number of further
points that we would wish to make in the light of the proposals
in the green paper.
1. What lessons can be learned from the Pathways
to Work pilots in shaping the direction of the reform of incapacity
Many aspects of the Pathways to Work (PtW) programme
have been incorporated in the proposed Employment and Support
Allowance (ESA), but the principles that have made PtW broadly
successful have not been transferred wholesale. Notably the green
paper is equivocal about the role of the "return to work
credit" that is such a vital part of the support mechanisms
within the PtW scheme. The green paper states that:
"We would therefore envisage the roll-out
of the `Return to Work Credit' in new Pathways to Work areas."
(Chapter 2, paragraph 107)
Further clarity is required as to what this
actually means. The presumption must be that this is stating that
it is likely, although not certain, that the rolled-out PtW would
continue to operate a "return to work" credit system.
This would also seem to suggest that the credit would not be part
of the wider ESA, marking a significant shift in the balance of
rights and responsibilities within this system. Where both the
new ESA and the PtW programme are in operation the potential would
arise for a two-tier system.
2. What are the implications of DWP's proposals
for the new structure of incapacity benefits? Do they address
the complications inherent in the existing incapacity benefits
system? Is a dual benefit the right approach? Could it be improved?
The approach signalled in the green paper is,
in principle, broadly sensible. Such a system will not work, however,
without sufficient flexibility, and investment in both training
for personal advisers and in developing effective return to work
programmes. This must include:
(i) Flexibility to challenge decisions quickly,
without lengthy tribunal processes, whilst leaving a formal tribunal
appeals process available where necessary.
(ii) Flexibility to move from one strand
of the benefit to the other as circumstances dictate.
(iii) Flexibility for DWP decision makers
to reach conclusions on individual cases rather than simply assigning
claimants through a tick box process.
(iv) Flexibility for personal advisers to
develop appropriate workplans with each individual claimant.
The green paper makes reference to adjusting
the "gateway" onto Incapacity Benefit. Changing the
nature of the assessment procedure to focus on capability for
work as well as medical incapacity is a welcome development. It
is absolutely critical, however, that this process is not used
as a means to tighten the gateway onto the benefit.
The then Secretary of State for Work and Pensions
Alan Johnson stated on 6 December 2004 that the UK already has
the "the most stringent gateway into incapacity benefit
in the world, as measured by the Organisation for Economic Co-operation
and Development" (Official Report, 6 December 2004, Column
913). Tightening that even further and leaving people who are
forced out of employment by disability without appropriate support
would be unacceptable.
3. Will the reforms help to improve work incentives
for sick and disabled people?
There is little detail in the green paper about
how permitted work rules and test-trading rules can be improved.
At present the rules concerning permitted work are complex and
often restrictive. A particular problem has been the earnings
limitwhich has not risen in line with inflation. This is
a real problem for a large number of the disabled people that
Leonard Cheshire works with and is illustrated by the case below:
An IB recipient contacted us to say that she
volunteered as a representative on her local Primary Care Trust
board, which as it entailed only a few hours work a month, she
felt she was be able to manage. The payment for attending each
meeting was, however, too high for permitted work rules and as
a result she cannot be paid for her work, unlike every other member
of the PCT board.
This level must be raised and opportunities
to engage in work without risking the loss of benefits should
4. What are the implications of the reforms
on levels of fraud and error?
Fraud on Incapacity Benefit remains extremely
lowcurrent Government figures suggest that fraud is less
than half a percent. The fact that more than half of those who
appeal against initial Personal Capability Assessments are successful
demonstrates that there is scope for addressing error within decision-making.
A more complex assessment will increase the potential for errors
to be made, but this could be counteracted by an improved appeals
Leonard Cheshire would suggest enhancing the
appeals system to allow initial formal appeals against a decision
be made within Jobcentresthis could provide for reassessment
of a decision without a full tribunal. Such a system could be
particularly important for decisions about which benefit rate
claimants should receive, or challenges against sanction decisions.
A full tribunal should, however, remain an option for challenging
decisions, particularly given continuing concerns about the standard
of decision-making throughout benefits system.
4. Will the reforms address the main areas
of concern with the current system?
Leonard Cheshire believes that:
(i) Disability benefits are often insufficient
to afford recipients a decent standard of living.
ii) The present system often does not provide
enough support and encouragement for disabled people who want
To this end, we would support reforms that would
help lift disabled people who rely on benefits out of poverty
and provide genuine assistance for those who wish to get back
to work. The details presented in the green paper are not sufficient
to make a judgment as to whether these key demands would be met.
We welcome the proposal to increase the basic rate of the benefit,
in particular for those who are unlikely to be able to return
to work. Likewise we welcome the principle of Jobcentres providing
more programs and support mechanisms to help people return to
The green paper is not explicit about the rates
of the benefit, and proposes scrapping the age additions and adult
dependent addition. Leonard Cheshire would be deeply concerned
if this meant that new claimants might actually end up receiving
less from their welfare entitlement package than is the case now.
In terms of "return to work activity"
we need reassurances that personal advisers will receive sufficient
training to ensure that they can deal effectively with a diverse
caseload. "Return to work activity" must be well funded
if it is to be effective. Engagement with full-time education
and voluntary work should both be recognised as important work
We also retain grave doubts about the rationale
behind imposing sanctions on claimants. Incapacity Benefits recipients
are often among the poorest people in society and reducing their
benefit is not a sensible way to proceed as it potentially compromises
the partnership approach inherent between personal advisers and
We do recognise that sanctions are part of the
PtW scheme. Sanctions have, however, been very infrequently used
within PtWcasting doubt on their potential value. This,
against the potential damage the continuing presence of sanctions
may cause to any new, expanded national reform programme is the
basis of our doubts.
5. How will the reforms help those who are
not able, or not yet ready, to work?
Leonard Cheshire welcomes the assertion in the
green paper that those who will receive the "support component"
of the new ESA will receive a higher rate of benefit. There is
a real risk, however, particularly for those who are not yet ready
to return to work, but who are placed in the lower rate category
of the new benefit, that any form of coercion could have a serious
detrimental impact on their health.
In launching the green paper the Secretary of
State for Work and Pensions stated that "work is good
for people" (Official Report, 24 January 2006, Column
1305). This is plainly a gross simplification. For many people
a return to work could have great potential benefits, and could
help to improve their health condition. Some people, however,
could find that returning to work, particularly if they do not
yet feel ready to do so, could worsen their impairment and further
distance them from the labour market.
6. Can the reformed systems support those
with variable and manageable medical conditions, or those who
are able to work part-time? Are those with mental health difficulties
Successfully accommodating fluctuating conditions
can only be achieved by ensuring that flexibility and genuine
understanding of those conditions is enshrined within the new
system. This means:
(i) appropriate training and resources for
(ii) discretion and flexibility within the
system to allow personal advisers and other decision makers to
react to each individual circumstance rather than simply having
to meet targets; and
(iii) roles for mental health, and other
health professionals within the assessment and decision making
procedure.There also needs to be a significant shift of culture
within NHS services to recognise that many patients with manageable
conditions need easier and swifter access to regular professional
healthcare appointments and support if they are to enter and retain
7. Has Pathways successfully worked with healthcare
professionals, including GPs, particularly in rehabilitation initiatives
such as the Condition Management Programme? How can healthcare
professionals be further engaged in the reform of the incapacity
Using the expertise of health professionals
other than GPs in the assessment procedure is a positive step
towards ensuring that the process is better informed. Where possible
it would also be beneficial to ensure that expert advice is available
throughout the benefits processthe impact on individual
claimants of benefit sanctions, for example, should be carefully
considered with people with an expert knowledge of an individual
Involving health professionals in the condition
management programme is certainly important, but it is also important
to understand the role of social care within the management of
Whilst encouraging a return to work through
measures such as placing job advisors in GP's surgeries is broadly
an acceptable step, it is clear that at no stage should the primacy
of GPs and other health professionals in recognising the needs
of their patients be undermined by any wider drive to get people
back into employment.
8. Have the private and voluntary sectors
been successfully involved in the Pathways pilots? How can they
be further involved in the reform of incapacity benefits?
Involvement in condition management and training
programmes is certainly possible, but if involvement extends to
the administering of sanctions to claimants then great care must
be taken in outsourcing such work. Many charities, for example,
could find their core purpose compromised by close involvement
in a system that could penalise their client group.
One useful area of work could be in the recognition
of external schemes by Jobcentres. Leonard Cheshire, for example,
runs a number of programmes that help disabled people enter employment
(such as our Workability scheme, our Discover IT programme or
our Ready To Start initiative to help disabled people to start
their own business). Whilst not linked directly to the benefits
system, these and similar programmes can be useful in helping
to improve job-readiness and could be recognised and recommended
to people wishing to return to work, forming part of a wider portfolio
of "solutions" available to those disabled people who
wish to work.
9. What type of jobs are participants of Pathways
moving into? Are they receiving appropriate in-work support to
enhance job retention? Are local labour markets able to provide
the jobs needed? What is the experience of employers?
The role that Access to Work (AtW) can play
in helping disabled people into employment should not be underestimated.
AtW should be recognised and promoted actively through Jobcentres.
Where possible, extending the scope of AtW to include volunteering
should also be considered, particularly given that the green paper
suggests voluntary work can be a stepping stone to returning to
AtW can play a key part in ensuring the long-term
sustainability of employment. This can also be helped by addressing
wider issues in the labour market including:
(i) challenging continuing discrimination
in recruitment and the workplace;
(ii) ensuring improvements to the accessibility
of public transporta Leonard Cheshire report into this
issue found that nearly a quarter of disabled people seeking work
had had to turn down a job offer because of inaccessible transport;
(iii) ensuring that the Disability Discrimination
Act provisions relating to employment are properly understood,
widely promoted and fully enforced; and
(iv) working in conjunction with local authorities
and the Department of Health to ensure that the role of social
care in sustaining and enabling employment is fully recognised.
Measuring the success of PtW and subsequently
the ESA requires an understanding of the type and sustainability
of employment generated through the programmes. Assessments of
the programmes should therefore attempt to examine not only the
number of people that enter employment but also the number of
people that remain in that job after six, 12 and 24 months.
Local jobs markets, social care provision and
accessible transport availability must also be taken into account
in assessment procedures. A genuine assessment of employability
cannot be made without taking account of these factors.
The role of employers is also crucial. Beyond
a welcome consideration of occupational health policies the green
paper makes scant reference to the responsibilities of employers
to ensure fair recruitment practices and to support disabled employees.
This must be a central plank of any reform programme.