Work Capability Assessments Re-assessed
Authors: Stephen Bevan
24 November 2010
In some quarters it has become acceptable to caricature claimants of long-term sickness benefits as workshy malingerers. This has contributed to a prevailing mood of intolerance and indignation in parts of the press, reflecting that felt – it has to be said - by many ordinary folk. Yet we know that benefit fraud, while still costing a significant £1.6 billion a year, still represents only 1 per cent of the total welfare budget compared with the £3.1 billion of overpayments paid out in error. We also know that at least 9 in 10 claimants want to work and what many workless people with health problems lack is not the work ethic but the support to find pathways back into sustainable jobs.
Yesterday’s ( 23 November) review of Work Capability Assessments (WCAs) by eminent occupational health expert Professor Malcolm Harrington confirmed what many campaigning organisations have long claimed – that the medical tests for people on benefits are 'impersonal, mechanistic and lack empathy'. The review proposes a series of reforms to WCAs which will be more humanising and supportive. Having spent the last three years conducting research on the impact of chronic health conditions such as back pain and rheumatoid arthritis on labour market participation, I also welcome Professor Harrington’s acknowledgement of the effects of fluctuating conditions on work incapacity. Our own research has highlighted that people of working age with inflammatory conditions such as rheumatoid arthritis or people with multiple sclerosis (MS) experience variability in the severity of their conditions which means that their fitness for work fluctuates considerably and is often accompanied by extreme fatigue. The support needed by these people is often complex and needs special consideration by both GPs and employers.
However, there are two areas where I am concerned that Professor Harrington’s review places too little emphasis. First is the role of employers in facilitating return to work among those who, having been assessed as ‘fit for work’, are seeking re-integration. It’s really important that we avoid the so-called ‘revolving door’ effect where people with long-term health conditions – or even able-bodied people who have had long periods of unemployment – spend a short time in work and then find themselves languishing on benefits. Part of the answer here is to provide more guidance and support for employers in managing phased return to work, implementing workplace adjustments and re-designing work for those employees who can work, but for whom often minor changes to either their working time or physical working environment can help them maximise their contribution. These adjustments are important both for those re-entering work and for those trying to stay in work after developing a health condition. Many employers want to help, but many struggle to implement the changes which can make most difference.
Second, Professor Harrington places renewed emphasis on understanding the impact of mental health on work incapacity. This is very welcome because depression and anxiety can be a major cause of worklessness and yet both are poorly understood, often stigmatised and – even worse – ignored. My concern, however, is that there is no mention of co-morbidity in the review: the increased risk that people with long-term or chronic physical health conditions also develop mental health problems which complicate both the degree of work incapacity they suffer and the interventions needed to support successful and sustained return to work. Recent research by The Work Foundation highlights these issues very starkly and suggests that assessments of work capacity need to identify co-morbid conditions early on and that supported return to work and vocational rehabilitation for people with both physical and mental health conditions needs to be managed with care.
One of the problems facing the Coalition Government as they seek to reform the welfare system and make work pay is that labour demand is low and there is strong competition for every vacancy. If more people with work-limiting health conditions are assessed as job-ready, it will be important that more is done to support them in finding sustainable, high quality employment. In this sense the Work Capability Assessment must be seen as the beginning of a journey back into work and not just as the end of a period on benefits.
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