Executive Summary

Beyond the Barriers

Executive Summary

1. This report is a comprehensive analysis of the most relevant evidence available on
Employment and Support Allowance (ESA), the Work Programme and the barriers to
work faced by people with long term health conditions and impairments.

2. The report draws on a wide range of international data, UK evidence and case
studies as the basis for any conclusions, giving weight to both academic research and
individual experience. Case studies were taken from 5 consultations which received
over 1,200 responses.

3. We look at multiple factors that indicate ESA is not working and find that tests are
inaccurate, unreliable and invalid. Reliable means a test can be repeated and is
consistent. Valid means a test accurately describes the real world. ESA is not reliable
as it does not produce consistent results. ESA is not valid as reports are inaccurate
and few claimants found fit for work do enter work, in comparison to claimants of
Jobseeker’s Allowance. There is urgent need to address the inaccuracy of
assessments and decision making to produce an assessment that is reliable, and to
address the descriptors and decision making to produce an assessment that is valid.

4. We asked people what they felt were the worst aspects of ESA and work capability
assessments (WCAs). The responses indicated that:
• 50% considered one of the worst parts of ESA to be that it is a highly stressful
process, frequently inducing fear in claimants;
• 40% identified specific flaws in the assessment process as among the worst parts;
• 30% expressed views that the process does not work;
• 29% were concerned by negative attitudes towards those on sickness benefits;
• 9% explicitly said that time-limiting is one of the worst things about ESA; and
• 5% explicitly said that they consider ESA to have been designed to deny claims.
We found that:
• The points system, descriptors and computer system are incapable of gathering the
reality and complexity of people’s conditions;
• The descriptors do not capture a person’s state of health in a way that reflects their
ability to work;
• Medical evidence from those who have detailed, accurate and relevant knowledge is
ignored;
• Assessors lack the time, ability and medical knowledge to assess and understand an
individual’s condition and how it relates to work;
• Decision makers lack the medical knowledge to make accurate and informed
decisions; and
• The assessment is irrelevant to work, as no attempt is made to discover what work
an individual is supposed to be capable of doing.

6. The report considers a wide range of international data from Australia, The Netherlands, Germany, Iceland, Norway, Denmark and Sweden, drawing on the most successful elements of each to make recommendations on how our own out of work sickness provision and work support could be improved.
7. The report suggests an alternative to the current ESA system, recommending:
• Early Intervention: Where a person becomes ill or disabled whilst in work, holistic assistance should start once Statutory Sick Pay is claimed, i.e. even before a claim for Employment and Support Allowance is made. If the person is not in work, then assistance should start within a few weeks of entering a claim for ESA.
• That an ESA113 form or equivalent is sent out to a chosen healthcare professional at the start of every claim and that regulations 29 and 35 for current and ongoing ESA claims and Contribution-based ESA are considered in all cases where:
a) The claimant suffers from an uncontrolled or uncontrollable illness, or
b) The claimant suffers from some specific disease or physical or mental impairment and, by reason of such disease or impairment, there would be a substantial risk to the mental or physical health of any person if the claimant were found not to have limited capability for work/work related activity.
• A supplementary payment for those not expected to work or move towards work, also available to those who engage with future support.
• That the criteria for access to sickness benefits should take into account the holistic, non-medical factors that interact with medical factors.
• That assessment should explicitly focus on what work or job role the claimant is supposed to be capable of doing, what physical, attitudinal and policy barriers exist and how these can be overcome.
• That assessments should occur over several meetings with a consistent caseworker to reduce the snapshot effect and to increase the amount of accurate evidence collected.
• That the assessor have experience in the relevant impairment or health condition.
• Once the process of assessment is complete, evidence should still be submitted to an independent Decision Maker.
• Multi-disciplinary interventions. An integrated system where the caseworker can advise on benefit entitlement, health services, social care, Access to Work, and has access to local and national information on work support provision, education and training.
• Early access to health interventions and control of a Personal Health Budget where appropriate.
• Including the claimant’s workplace in interventions where possible/applicable.
• Disability specific support and evidence-based practice.
8. Many of the suggestions for a new model of out of work sickness support will take time to implement. Therefore the ‘Interim Recommendations’ section suggests a series of recommendations that would quickly make the system that already exists safer and fairer whilst a new model can be developed and piloted. These include:

• Continuing to pay ESA whilst mandatory reconsideration is carried out, and setting a time limit for mandatory reconsideration to be completed.
• For all assessment centres to be made accessible and home visits to be offered where appropriate when this is not immediately possible.
• Setting minimum time limits on reassessments.
• A Mental Health Champion in every assessment centre.
• Removing the current division between cognitive and physical assessment.
• All WCAs to be recorded.
• Detailed consideration of the consequences of having a relevant specialist carry out the assessment and decision making (in particular for mental health and fluctuating conditions), in light of the findings from the Evidence Based Review.
• Requesting evidence from healthcare professionals in all cases (ESA113) and for sections 29 & 35 to be used in all cases where the healthcare professional believes there may be risk to the claimant.
• Ending the 1 year limit to contributory ESA for those in the work-related activity group (WRAG).
9. We look at the most up-to-date information available on the Work Programme and find that it fails to meet the needs of those with long term illnesses or disabilities. Just 5% achieved a Job Outcome, while for those transferring from the previous Incapacity Benefit the figure is just 1.8%. The Work Programme is less likely to result in a positive work outcome than the old Incapacity Benefit system. We found that:
• The conditionality regime does not address barriers to participation.
• The support service does not refer to the claimant’s assessment of needs.
• There is an unhelpful conflation of disability with long-term worklessness.
• Disabled people’s skills and motivation are often lost through the programme.
• Conditionality can move claimants further away from work.
• The Work Programme offers a poor level of customer service to often vulnerable claimants.
We recommend that mandation of ESA claimants to the Work Programme in its current structure is ended immediately. We recommend that clients should control their own back to work support budgets as they are best placed to assess what help they need, what barriers they face and what interventions might be necessary to return to work.
10. The final section of the report looks at how the labour market is currently structured and how it can act as a barrier to sick or disabled people entering or keeping work.
We recommend several ways in which those barriers might be addressed:
• New structures for flexible working and working from home.
• Re-structuring out of work sickness benefits and tapers to make sure that “Every Hour Counts.”
• More support for those living with long term conditions or disabilities to set up micro-businesses through co-operatives and pairing, and practical ways that the state might support innovation and enterprise.

• Making it easier to move between benefits and work fluidly
• Improved information on and access to further education and training.
• More employer engagement and more done to encourage, incentivise or mandate the employment of sick and disabled people.
• Improved childcare for children with disabilities and more support for parents with disabilities to fulfil their parenting role.
• Introduce a Volunteer’s Credit and a Carer’s Credit to the National Insurance system to recognise the contributions made by these groups.
11. We provide more in-depth analysis in the Appendices, which cover the policy assumptions underpinning ESA, an analysis of how successfully the recommendations made in the first year Review of the WCA have been implemented, and a critique of the concept of the ‘employment gap’ in UK policymaking.
12. We conclude that both ESA and the Work Programme are failing people living with long term health conditions and disabilities, and outline a blueprint for change based on existing evidence and the experiences of sick and disabled people themselves. Our proposals are workable, proven in other countries, and wherever possible we suggest existing schemes and structures that could be modified to accommodate a new way of working. A system which works for sick and disabled people, while also creating value for taxpayers, need not be a contradiction in terms.