Select Committee on Work and Pensions Written Evidence

Memorandum submitted by Papworth Trust


  The Papworth Trust ("Papworth") is pleased to respond to the House of Commons Work and Pensions Committee's inquiry on the reform of incapacity benefits. We have focused our comments on the reform of the main incapacity benefit rules, the support needed by disabled people to move back into work, our experience with the delivery of the Condition Management Programme in Essex and the role of the private and voluntary sectors in the reform.

  Papworth is a Registered Charity and Company Limited by Guarantee, which has been providing a number of services to disabled people for over 80 years. The Trust helps over 4,500 people each year to achieve more independence in their lives and employs 240 staff directly, who are supported by around 40 volunteers to deliver its services. The organisation operates from seven centres across the Eastern region and also delivers a number of its services on an outreach basis in local communities. As an organisation, Papworth is fairly unique in both the services it delivers and the clients it supports. Services Papworth provides cover the full range of social, care and work related activities and include specialist housing, residential care and employment related services such as vocational assessment, work preparation, vocational rehabilitation, and support in to and during employment. Papworth works with people with physical disabilities, learning disabilities, mental health conditions and/or acquired disabilities. Wherever possible, Papworth cooperates with partner organisations from the private, public and voluntary sectors in order to offer appropriate expertise and services to its clients. These organisations include Jobcentre Plus, Social Services, Health Services, Legal Services Commission, educational establishments, private employers and other voluntary sector service providers. They can act as funding providers as well as referral or signposting bodies.


Reform to Incapacity Benefits

    —    Accessible and quality advice and guidance on available support and benefit rules.

    —    Review of the Personal Capability Assessment.

    —    More incentives to return to work.

    —    Increase of incapacity benefits entitlements to take into account extra costs of disability.

Support for Sick and Disabled People to Move Back Into Work

    —    Personalised, flexible and progressive return-to-work programmes.

    —    Promotion and development of funded rehabilitation programmes.

    —    Promotion of equality for disabled people.

Condition Management Programme (Pathways to Work)

    —    Mixed reactions of clients to service delivery.

    —    Positive impact of programme on clients' health condition.

    —    Implications: to improve range and quality of services; need for integrated support and good communication.

The Role of the Private and Voluntary Sectors

    —    Participation of disabled people in policy design and delivery.

    —     Involvement of private and voluntary sector in development and delivery of services.


  1.  The majority of incapacity benefit claimants perceive the transition into employment to be risky and complicated because they are:

    —    Afraid of benefit reviews,

    —    Wary of the financial implications of leaving benefits,

    —    Not fully aware of the existing "return to work" linking rules and financial incentives provided by tax credits, and

    —    Restricted by the existing permitted work rules.

  2.  Therefore, whilst Papworth welcomes the reform of the benefit linking rules proposed by the Government, it would support the introduction of a guarantee that Disability Living Allowance would not be reviewed for at least the first six months of employment. It also asks for changes to the permitted work rules system to promote voluntary work and to allow disabled people to easily progress to 16 hours work after they pass the four-hour disregard mark (£20 a week). It also recommends that earnings disregards be set at a realistic level—equivalent to ten hours at national minimum wage—and that Jobcentre Plus provide better information and guidance to benefits claimants on the linking rules and existing financial incentives to return to work.

  3.  Moreover, the entitlements to Rehabilitation and Sickness Allowance (RSA) and Disability and Sickness Allowance (DSA) should be set at a higher level than the current one to help break the link between disability and poverty. Indeed, the extra costs of disability are substantial, especially for disabled people living alone, and rise with severity of disability. Research has shown that the weekly income of disabled people who are solely dependent on benefits is approximately £200 below the amount required for them to ensure an acceptable, equitable quality of life.[30]

  4.  Papworth would also like to stress that, in order to be guided through the new system and its stages of support, claimants would need the help of skilled personal advisors who can give specialist advice and are trained on all disability issues. If claimants need extra-support, they should be allowed to nominate an advocate to liaise with Jobcentre Plus and their personal advisor.


  5.  To provide support more effectively a personalised approach should be followed, offering tailored support around individual needs. This would include getting coordinated support from employers, health and social services, Jobcentre Plus and all other relevant agencies.

  6.  Papworth believes that the reform of incapacity benefits should promote more flexible and progressive return-to-work programmes that would take into account the individual's:

    —    Immediate and long-term needs (including fluctuating or progressive conditions and multiple disabilities),

    —    Personal circumstances, and

    —    Abilities and aspirations.

  7.  These programmes should encompass:

    —    Traditional work-related activities like CV writing and interview preparation,

    —    Communication skills,

    —    Life skills,

    —    Condition and medication management,

    —    Independent living skills,

    —    Personal development,

    —    Work-based training,

    —    Advice on anti-discrimination legislation, and

    —    Financial management.

  8.  All claimants should be offered opportunities for employment or rehabilitation from a menu of options depending on their circumstances and irrespective of the type of benefit they receive. Long-term incapacity benefit claimants who would move onto DSA should also be included in the new system and offered appropriate support.

  9.  To help determine which return-to-work activities might be most beneficial to the claimants, Jobcentre Plus would have to take into account the state of the local labour market. To increase the range of job opportunities for disabled people, Jobcentre Plus should develop local partnerships with employers, regional development agencies and any other relevant local organisations.

  10.  Effective rehabilitation is an important component of the overall system for supporting disabled people into sustained employment. The new system should:

    —    Provide early support and information to people who become disabled to help them access whatever help they need to manage their condition, look for work, retain work and/or return to work,

    —    Offer relevant training to GPs and employers, and

    —    Involve primary and secondary care services, as well as vocational private and public providers.

  11.  In testing for disability and sickness to define eligibility for RSA and DSA, the Personal Capability Assessment should not mainly focus on incapacity but provide an assessment of the claimant's residual capabilities and identify which steps should be needed to enable the individual to return to work (ie rehabilitation, training, workplace adjustments, etc). Claimants on DSA should have an automatic review of their status after a six-month period of rehabilitation, during which they should not be compelled to attend work interviews and should not be sanctioned when not fully engaging in return-to-work activities.

  12.  In addition to these measures that would help tackle functional impairments, the government has a duty to promote equality for disabled people. There are wider societal barriers that prevent disabled people from getting or keeping employment, which need to be addressed:

    —    Age and gender discrimination,

    —    Inaccessibility of public transport,

    —    Lack of free or available personal care and/or assistance,

    —    Prejudices against incapacity benefit claimants,

    —    Lack of childcare provisions, and

    —    Care for elderly or disabled relatives.

  13.  To help remove some of the societal stigmas that surround benefit claimants, Papworth believes that the name "Disability and Sickness Allowance" should be changed. The new system should also target employers as they sometimes have a negative attitude towards disabled people. Papworth supports training for employers to break down misconceptions, make a positive business case for employing disabled people and help them understand their obligations under the law and the guidance that is available to them when recruiting and retaining disabled employees.


  14.  Papworth is involved in the Condition Management Programme (CMP) in the pilot area of Essex. The programme, which is part of the Choices package of Pathways to Work (PtoW), aims at advising Incapacity Benefit claimants on how to manage their health condition and is intended for claimants with the following conditions:

    —    Moderate mental health conditions,

    —    Cardio-respiratory conditions, and

    —    Musculoskeletal conditions.

  The programme is compulsory for new claimants and voluntary for all other claimants; it is offered by Local Primary Care Trusts in collaboration with Jobcentre Plus. Two distinct programme formats are usually offered to claimants:

    —    One-to-one sessions with health professionals for people with specific conditions, like musculoskeletal problems, and

    —    Group sessions for people with any conditions on, for example, confidence building.

  15.  We have noticed that:

    —    Claimants are not well aware of the programme. They mostly hear about it from their Incapacity Benefit Personal Adviser and, on very few and rare occasions, from their GP;

    —    People attend the programme in the hope that it will help them manage their health condition and not necessarily because they wish to return to work. We believe that 50% to 60% of them are motivated to get back to work;

    —    Claimants have vague expectations of what services the programme could offer; and

    —    People's changing health status has an important impact on their feelings about work.

  16.  When clients are well aware of the programme's objectives eg health management and understanding of one's own capabilities and limitations, they usually think that the programme has had a positive impact on their physical or psychological condition. For instance, some say to have gained knowledge about managing their condition and felt that they had undertaken some preparation for work.

  17.  The recent DWP research report on "Incapacity Benefit Reforms Pilot: findings from a longitudinal panel of clients" points out that the programmes that do not focus on specific conditions do not appear to have such an impact on people's conditions or movements towards work. Some claimants said that group sessions were tailored to neither their health condition nor their personal circumstances.

  18.  The claimants who have responded positively to the programme are those who are strongly motivated to get into work in the short-term or who aspire to work in the future. Claimants who do not see work as either possible or desirable tend to be more negative in their accounts of their experience of CMP. This emphasises that claimants' work trajectories are influenced by a variety of factors, including not only health but also employment, finances, household and involvement with organisations other than Jobcentre Plus.

  19.  To improve the efficiency of CMP services and of PtoW as a whole, PtoW needs to tackle two related problems:

    —    How to improve the range/quality of services and other types of help; and

    —    Whether and how to engage with claimants who are not ready or willing to consider receiving help and support to overcome initial key barriers to work.

  Therefore, the points below should be addressed:

    —    Advertising: PtoW should be better advertised to claimants and GPs;

    —    Information provision: claimants who take part in PtoW should be constantly kept informed about the procedures to follow and the services and information available to them;

    —    Gaps in the programme besides the Choices package: we have identified gaps, especially for claimants with mental health problems, drug and alcohol dependency or going through bereavement: courses to deal with particular social issues (debt management, drug and alcohol problems, English language courses etc), voluntary work, short training courses, support for transition to work and in-work support, referral to self-help groups, etc need to be made more readily available within a condition management model. Some of these activities do exist with mainstream Jobcentre Plus programmes. However, the integration of services within a person centred approach needs to be thought through;

    —    Relationship with client: it is important for PtoW providers to endeavour to maintain regular contact with claimants and not leave clients isolated through the process of returning to work. It is important that an agreement is reached between providers and clients on the clients' needs, which also outlines a clear understanding of responsibilities of both parties; and

    —    Service co-ordination: the extent to which Incapacity Benefit Personal Advisers should take on a co-ordinating role for the services received by their clients should be further discussed.


  20.  In order for the reform to be successful, the Government should involve:

    —    Disabled people in its design and delivery at all levels; and

    —    Private and voluntary sector organisations in the development and delivery of services.

  This will ensure a range of expertise and views are considered, and established service delivery skills are utilised to generate the best possible outcomes for both disabled people and the taxpayer, which would not be available if service delivery is left to public bodies.

  In conclusion, it is vital that Government remains engaged with both claimants and providers of services to ensure the development of future services remains a truly inclusive process.

Elisabeth Serres

3 October 2005

Smith N, Middleton S, Ashton-Brooks K, Cox L, Dobson B and Reith L (2004), Disabled people's costs of living: more than you would think. York: Joseph Rowntree Foundation.

30   Zaidi A and Burchardt T (2003), Comparing incomes when needs differ: Equivalisation for the extra costs of disability in the UK, CASEpaper64. London: Centre for Analysis of Social Exclusion, London School of Economics. Back

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