Comment: ‘Capacity’ to work is not an abstract concept

Incapacity benefit reform is not addressing the underlying question: Are disabled people avoiding work or are companies unwilling to employ them?
By Prof Alan Roulstone
This month witnessed the launch of the coalition government’s reform of incapacity benefits (IB). These major reforms are seen as vital in reducing the waste of disabled people’s workless lives and of the growing benefit spend on IB. Following a ‘work capability assessment’ those deemed fit to work will enter job seekers allowance (JSA), the remainder will be migrated to employment support allowance (ESA), a mixture of benefits and condition management support.
What then do we know about the facts of the problem that warrant such a major reform? Firstly, we know that the rate of entry and ‘stock’ of IB claimants has grown much more quickly in the last 15 years than expected; whilst for working age people in work health is generally improving. It is important to note however that IB has provided vital additional support for people of working age who have previously been judged eligible for the benefit due to sickness or disability. IB fraud is also seen a problem by HM government. Despite a lack of firm evidence on IB fraud, reasonable criticisms have been made of the incapacity benefits system by the coalition government as too focused on what people cannot do, and to unilaterally shift from incapacity to capacity-based approaches to disability sounds attractive on first hearing. Clearly we all want to accentuate the positive and go beyond stereotypes of disability as a synonym for inability.
However, such facile analogies end there – at the level of popular perceptions. In practice, any attempt to define capacity or capability can only be meaningful where we are clear as a state what capacity is. Capacity for sick and disabled people may fluctuate, may be the result of complex physical and mental health interactions and in the workplace may require sustained and additional support. Capacity relates to the specificities of a given economy, opportunities and time. Most significantly, for capacity or capability to be meaningful, employers have to want to employ ex-claimants who are increasingly demonised in the daily newspapers as products of a culture of dependency. Have the government thought this through? It is also worth noting that the incapacity approach, what people cannot do, characterises the wider disability benefits in the UK, however inappropriate that sounds.
Much of the disquiet that attaches to the IB reforms relates to the process of reassessment itself. The use of a major multinational ATOS to undertake much of the work capability assessment, the test at the core of employment support allowance reassessments is noteworthy. Whilst the medical and scientific credibility seem to have been questioned by the recent Harrington report which roundly condemned the previous assessment system as ‘impersonal, mechanistic and lacking empathy’; the new assessment is to be completed by the same organisation.
The ability of such organisations to understand capacity or capability beyond a very abstract level of bodily functioning is a moot point. Whilst GPs and consultants opinions may be sought it will be a ‘appointed health care practitioner’ that scores an individual-their work capability. Let’s be clear, these health practitioners are not expert in occupational medicine. One story to emerge in the wake of the reforms was a person with leukaemia who was told they were work-able simply because they had not yet started their treatment. Indeed, the rather selective governmental use of evidence from the recent pilots in Aberdeen and Burnley means that the figure of 29.6% being assessed as immediately capable of work ignores the fact that a similar number of pilot subjects had not had their status decided at the time the press release announced this figure.
What would motivate the Department for Work and Pensions to release ‘definitive’ figures ahead of final decisions being made? If we factor in the 350 IB claimants for whom no decision had been made on the launch date the real figure of immediately work-able could at worst be as little as 23%. The appeal rate against shifts from IB are running at 40% success rates. With an estimated cost of reassessment being £500 million, levels of reduced fraud and new tax take from those entering work have to be substantial if this review is to pay for itself.
A detail often overlooked by Treasury and DWP ministers is the concentration of claimant growth in ex-industrial areas of the UK. This points to differential health patterns (especially poor mental health) and also to the complex interplay of work, health and social dislocation in prompting claimants to seek the additional shelter of incapacity benefits. Additionally, the equation of ‘severity of disability’ with needing to enter a ‘support’ category perpetuates assumptions that severely disabled people do not want to work, this is not reflected in much of the evidence. Would Stephen Hawking for example agree with this assertion? Conversely the shifting of large numbers from IB/ESA to job seekers allowance where they are deemed capable of work seems not to include guaranteed or quantified support, especially where the figures involved run to potentially 500,000 migrated claimants and during a major retraction in public services where most disabled people have traditionally found employment. A cynic might say that with the increased numbers needing support, those being moved to JSA will simply be ‘free’ to avail themselves of support.
Whether the need to review incapacity benefit was driven by an imperative for a more humane and fair ‘out of work’ benefit system for sick or disabled people, or whether the result of an identification of these benefits as an easy target for reducing the benefits spend, is likely to exercise politicians and policy analysts for some time to come. Clearly, if large numbers of former IB claimants are moved onto JSA then it will be hard to track the overall level of unemployment of disabled people. What would happen though in the absence of greater work opportunities would be a growth in the number on JSA, and although they would receive less, the welfare bill and lack of tax take on new employees would still present a major fiscal challenge. The moral challenge however is that of needing to provide a seamless pathway for those having to leave IB to enter employment or high quality tailored support en route to paid work. As the work capability test is an abstract formulation of work capability or capacity, the government is storing up major problems for the future. As the myriad disability welfare blogs attest, disabled people are not going to stand by passively and not voice their concern over their movement from IB or their shift to the review group who face constant reassessment in a kind of welfare purgatory.
Disability policy is an area where politicians can manipulate the rules, the malleability of the very idea of disability provides a testing ground for very radical ideas. It must be remembered however that behind every claimant is a person, a very worried person. The highest rates of IB claimancy are in areas of post-industrial blight. We could continue to widen the notion of welfare dependency to further stigmatise IB and its claimants, but that may taint further public perceptions of the very people we are telling have a brighter future. Capability and capacity only make sense in a given economic and social context and where real support is available. The lack of Treasury impact assessment on these complex costs and benefits of support versus benefits savings adds further to policy analysts concerns. At heart, the question remains – is the failure to reduce IB/ESA the result of a refractory claimant population or rational decisions by disabled people about the local job opportunities and the result of entering often low paid unsupported work? We are left asking whose incapacity is at the root of the problem here.
Alan Roulstone is professor of applied social sciences (disability policy) at Northumbria University.
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