Assessing the impact of benefit sanctions on health

Lead Research Organisation: University of Glasgow
Department Name: School of Social & Political Sciences

Abstract

The aim of this research is to examine whether benefit sanctions lead to claimants having worse physical or mental health, or making greater use of health services. It also seeks to add to our knowledge on whether sanctions encourage claimants to return to employment more quickly. The proposal is innovative in using a database of individuals' benefits, employment and health histories constructed from administrative records which have not previously been linked.

Background
People who claim some benefits, especially Jobseeker's Allowance (JSA) and Employment & Support Allowance claimants in the Work-Related Activity Group (ESA WRAG), have conditions placed on them. With JSA, for example, claimants must sign on at the Jobcentre Plus office regularly and take certain steps to find work. If they fail to meet these conditions, they can be sanctioned, i.e. their benefits are stopped for a period. There have always been conditions on unemployment benefits but they have increased in recent years, with the number of sanctions and maximum length rising. The introduction of Universal Credit has seen conditions extended to those in work as well as higher sanction rates for early cases.
Sanctions are meant to ensure that people return to work as soon as they can. This is good for public finances as it keeps claims down, good for the economy as it keeps labour supply up and, arguably at least, good for claimants since unemployment tends to be bad for our health. However, critics argue that sanctions may have unintended side-effects: harming claimant health, increasing homelessness, or putting stress on families which affects child welfare. Health effects may arise from restricted spending on food or heating but also from the psychological stresses of trying to cope without income. These unintended impacts could lead to greater expenditure on public services, off-setting savings from reduced benefit claims. There has been very little research on these unintended impacts associated with sanctions, and almost none which can provide convincing evidence that sanctions cause harm.

Proposed research
We will construct a database of individuals' benefit, work and health histories by combining information held in the administrative records of the Department for Work and Pensions (DWP) and NHS Scotland. The data are sensitive, personal information so we need special permissions to access them which we are in the final stages of securing. The database will cover people who claimed JSA or ESA WRAG in Scotland for 2010-17. We focus on Scotland because the health data are currently only available here. From DWP, we get records of claim spells and whether people were sanctioned. From NHS Scotland, we get information on: the prescribing of medicines which can indicate various physical and mental health conditions; use of Accident & Emergency or unplanned hospital admissions which can indicate incidents arising from risky behaviours such as alcohol abuse or the worsening of chronic conditions due to poor diet, stress, etc.; and mortality data, including suicides. We will also examine missed appointments since these are a significant concern for the health services.
From Oct 2013 on, DWP can provide data on employment spells so we can look at the labour market impact of sanctions in this period, and hence whether any health effects depend on whether people find paid work or not.
The main challenge for our analysis is to show whether sanctions cause a change in health. To do this, we have to rule out the possibility that there are other factors which mean that the people who are more likely to get sanctioned also tend to have worse health; examples might include a drug or alcohol problem, or a domestic crisis such as a bereavement. There are various techniques which let us do this.

The results of the research will feed into academic debates about the recent changes to welfare but are also intended to have an influence policy in this area.

Planned Impact

This research has clear potential for economic and societal impacts, through its influence on welfare policy and debates, but also by demonstrating the value of linked administrative data for research.

The most direct beneficiaries of our research are current and future welfare benefit claimants. Evidence that the current sanctions regime has harmful impacts on physical and mental health would provide a powerful impetus for reforms to reduce those harms. The research will also provide new knowledge on the effectiveness of sanctions in relation to employment outcomes which could improve the ability of the system to support returns to work. A range of third sector organisations have campaigned on what they argue are the negative impacts of current sanctions policies for social welfare, including health. To date, they have drawn largely on qualitative research and case studies of their service users. Valuable as this is in identifying areas of concern, such research cannot provide convincing evidence of the causal impacts of sanctions. This work would provide important new information which could be used by these groups to inform public debates.

It should be stressed that the research may support or challenge the claims made by campaigning groups. There is valuable impact in either case: in providing evidence for change or a justification for current policies.

Evidence of impacts on health and health service use from sanctions would be of wider value to the general public as funders and users of these services. The research will examine whether sanctions put additional pressure on A&E services as well as hospital admissions, and whether they lead to more missed out-patient appointments. Indirectly, it looks at pressure on GP services, as increased prescribing rates indicate increased attendance at GP surgeries. All have been seen as being under great pressure in recent years. The health bodies responsible for providing these services will be interested in evidence of the impacts of welfare reforms on their activities, and likely to use these in future discussions with DWP.

Improving employment outcomes could produce fiscal gains as well as economic benefits from increased labour supply. There will be particular interest here from the devolved administrations such as the Scottish Government and from English local authorities whose funding is increasingly linked to the economic performance of their regions.

The identification of unintended impacts on health would bolster the case for using a similar approach to look at other potential side effects discussed in the academic literature and in public debates, notably on criminal justice and homelessness systems, and on family and child welfare. More fundamentally, it would add powerfully to arguments that welfare policy needs to consider potential unintended consequences and review evidence on likely effectiveness from the outset.

Lastly, by demonstrating what can be achieved through the analysis of linked administrative data, the research could bolster support for this kind of work and hence widen opportunities for similar work in the future, offering diverse potential benefits for policy making and public debate. At root, the ability to exploit linked administrative data relies on public support for data sharing. A clear case study of the benefits which can be achieved from data linkage research has the potential to boost such support and to reinforce to political leaders and public bodies the value to be gained from supporting this work. This project will be particularly valuable in this respect because of the novelty of the data linkages proposed and the high profile of the issues being examined.
 
Description The main output from this work has been the first full scoping review of the international quantitative evidence on the impact of benefit sanctions. The scoping review was conducted using a transparent protocol to systematically search, identify and analyse relevant studies of the impact of sanctions, based on the PRISMA guidelines (the Preferred Reporting Items for Systematic Review and Meta-Analysis). A total of 7573 studies were initially identified. These were then screened to reduce them to a set of 94 studies meeting our inclusion criteria. Between them, these studies reported outcomes on a total of 253 measures. The paper was published as open access in the Journal of Social Policy in February 2022. It has already attracted widespread attention (Altmetric 96 and more than 800 views in the first month). The pre-print on SocArXiv from 2021 had already also attracted a lot of interest (Altmetric 56).
The article makes a major contribution to our understanding of the current state of the quantitative evidence on the impact of sanctions. First, we provide an overview of the quality of the evidence base for policy, paying close attention to the quality of the study design in each article using the concept of a hierarchy of evidence. We show that more studies focus on labour market effects than on the wider impacts of benefit sanctions, and that the latter were very unlikely to employ methods which could provide strong evidence on the impact of sanctions.
Second, in relation to labour market impacts, we find that studies show that sanctions increase rates of return to work but that this is at the expense of lower quality employment (and hence lower earnings and tax payments) and lower security or higher risks of returning to unemployment. They also increase other flows off benefits into non-employment or economic inactivity.
Third, in relation to wider impacts, we find that studies range widely in the domains examined. As well as impacts on claimants, they examine impacts on family relationships and on children's well-being albeit that the research designs rarely support strong conclusions on the causal impacts of sanctions. In the evidence reviewed, sanctions were associated with an increase in material hardship, as might be expected, but also increasing health problems for claimants. They were also associated in increases in child maltreatment.
Given there are more articles on labour market outcomes and they are more likely to employ more robust research designs, there is scope to conduct a meta-analysis of results in this area. This would involve systematically combining results in order to strengthen conclusions. Work on this meta-analysis is on-going.
Exploitation Route The results of the scoping review have widespread value for those researching or developing welfare conditionality policies in the UK and elsewhere, as well as those interested in this policy area from the public and third sectors. First, they motivate efforts to extend and raise the quality of the evidence base in relation to sanctions policies. By showing the current state of the evidence base, they make it easier for researchers to make the case for additional work in specific areas. By placing a particular emphasis on the quality of research design, our findings encourage researchers in this field to take the identification of causal impacts more seriously, especially in relation to the wider impacts of sanctions, beyond labour market outcomes.
Second, findings may be drawn on by a wide range of groups working or interested in closely-related areas where the impacts of welfare conditionality may be felt. That includes those in health, education, housing, social services and criminal justice, among others. We are seeking to disseminate results widely to reach these groups, including using social media and blogs aimed at a broad audience. Media coverage has also helped raise the profile of our main output.
Sectors Communities and Social Services/Policy,Healthcare,Other

URL https://www.scadr.ac.uk/our-research/work-and-social-security/assessing-impact-benefit-sanctions-health
 
Description The main output from our research, the scoping review, has already achieved very high visibility, with a mention and link in the Guardian newspaper article noted previously as well as wide discussion on social media, so contributing to public debate on sanctions policy. The Altmetric score puts it in the top 5% of all publications, and the top 3% given its age. The work is having an impact on political debates as well. Based on the findings from our review, a Member of the Scottish Parliament (Kaukab Stewart, MSP) has lodged a motion on sanctions policies. This has attracted sufficient cross-party support to be eligible for debate, scheduled for 31 March of this year. We are providing a briefing note on they key points from our work to those planning to contribute to this debate. We plan further engagement with Westminster Select Committees and politicians with the aim of raising awareness of our work and informing policy debate there. The Guardian article will help open doors here since the Chair of the Work and Pensions Select Committee (Stephen Timms) was quoted in it, commenting on the failure of DWP to share data, and relating this to more general concerns about the lack of evidence in relation to sanctions. We have further plans to promote the scoping review more broadly with a follow-up blog aimed at the wide range of groups concerned about the impacts of sanctions. We will continue to monitor the use of the scoping review in public and policy debates in the UK and overseas, and to seek other opportunities to feed into these. This award supported capacity-building activities undertaken by the early career researcher (ECR) within the team. The ECR attended a summer school to enhance her analytical skills in the area of causal inference. She has also gained experience in providing training herself, contributing to a course organised by the Scottish Centre for Administrative Data Research and aimed at social and health researchers from both academic and non-academic institutions who are working with or interested in using linked administrative data for their own research. As a result of the work on this award and related areas, the ECR has been promoted. She is now also a CoI on the award for the extension of the ADR Scotland infrastructure.
First Year Of Impact 2019
Sector Communities and Social Services/Policy,Healthcare,Other
Impact Types Societal,Policy & public services

 
Title Accreditation of Scottish national safe haven under DEA 2017 
Description One consequence of the processes undertaken for this research was that the Scottish national safe haven was required to gain accreditation under the Digital Economy Act 2017. This arose because of the decision by DWP to use powers for data sharing introduced by that Act. It required the three components of the safe haven (computing infrastructure, data linkage service, and data/systems management) each to secure accrediation from the Research Accreditation Panel of the UK Statistical Authority. The last stage was completed in autumn of 2021. 
Type Of Material Improvements to research infrastructure 
Year Produced 2021 
Provided To Others? Yes  
Impact This accreditation will greatly speed up the process for other projects reliant on DEA 2017 powers for data sharing. 
 
Description 'Devolved benefits in Scotland: policy, evaluation and rollout', Scottish Government Edinburgh, organised by Policy Scotland, University of Glasgow and Carnegie UK Trust 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact The event included presentations from researchers from Scottish Government and academia, as well as advisors working in the area of evaluation of devolved benefits. The presentation were followed by reflection and discussion among attendees and raised increased interest in our research project and related research activities.
Year(s) Of Engagement Activity 2019
 
Description 'Welfare reform in Scotland: research, policy and the third sector', organised by Policy Scotland, University of Glasgow 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact This seminar included presentations from Nick Bailey, academic colleagues and researchers from Scottish Government. The event aimed to interrogate ways in which academic and partners can impact the developing of the social security agenda in Scotland and how new research collaboration can improve the evidence base for the social security system. The event led to increased interest in our research project and related research activities.
Year(s) Of Engagement Activity 2019
URL https://policyscotland.gla.ac.uk/welfare-reform-in-scotland-research-policy-and-the-third-sector/
 
Description An introduction to data science for administrative data research (ISD-ADR) 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact The training event was addressed to social and health researcher from both academia and public sector organisations who are interested in applying data science techniques and methods to administrative data. The presentations concerning the project and related research activities sparked questions, discussion and request for further information.
Year(s) Of Engagement Activity 2021
URL https://www.scadr.ac.uk/administrative-data/training/introduction-data-science-administrative-data-r...
 
Description Blog - Can we use linked administrative data to identify social disadvantage? 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact This blog was written to share reflections about the research conducted for the following publication: Pattaro, S., Bailey, N., and Dibben, C. (2020) Using linked longitudinal administratrive data to identify social disadvantage, Social Indicators Research, 147(3): 865-895 (https://link.springer.com/article/10.1007/s11205-019-02173-1). The blog also offered some reflections on working with limitations of linked administrative data.
Year(s) Of Engagement Activity 2020
URL https://www.scadr.ac.uk/news-and-events/blog-can-we-use-linked-administrative-data-identify-social-d...
 
Description DWP's Areas of Research Interest, University of Glasgow 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact The workshop aimed at discussing findings from the research project and other research conducted by colleagues at the University of Glasgow. It also aimed at exploring potential avenues of research collaboration and engagement with colleagues from DWP Labour Market Analysis Unit and related units.
Year(s) Of Engagement Activity 2019
 
Description Guardian newspaper article focussed on project's efforts to secure access to DWP data 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact Guardian journalist (Patrick Butler) approached team to enquire about progress with this study, as DWP had (incorrectly) told House of Commons Work & Pensions Select Committee in 2018 that they had provided data to us to conduct analyses of the health impacts of sanctions. Article focussed on our struggles to access data and the failure of DWP to deliver. Included direct quotes from PI Bailey and response from Steven Timms, MP, the current Chair of the Select Committee, as well as a response from DWP. The article also referenced the recently-published Scoping Review of sanctions impacts (Pattaro et al 2022, Journal of Social Policy).
Year(s) Of Engagement Activity 2022
URL https://www.theguardian.com/society/2022/mar/02/dwp-blocks-data-for-study-of-whether-benefit-sanctio...
 
Description HMRC RTI and Self-Assessment Data Research Hack Day, organised by Office for National Statistics (ONS), Newport 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact The event aimed to identify products, concepts and research questions to enable public benefit research and improved statistical products. The event raised questions and a discussion with colleagues from academia, ONS and HMRC.
Year(s) Of Engagement Activity 2019
 
Description Health and inequalities in an era of crisis organised by the Centre for Research on Environment, Society and Health, Global Health Policy Unit at the University of Edinburgh and the Scottish Graduate School of Social Science - Doctoral Training Partnership 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact This event explored the implications of the recent economic recession and austerity, rising tension over immigration and right-wing populism for health and health inequalities. The event was opened to researchers, policy-makers and advocates. It sparked questions and increased interest from both academic researchers and Scottish Government analysts.
Year(s) Of Engagement Activity 2019
URL https://lgiu.org/event/one-day-symposium-health-and-inequalities-in-an-era-of-crises/
 
Description Introduction to using administrative data for social and health research, Edinburgh, co-organised by Scottish Centre for Administrative Data Research (SCADR) and Scottish Longitudinal Study Development and Support Unit (SLS-DSU) 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact The training event was addressed to social and health researchers from both academia and public sector organisations working with linked administrative data. The presentations concerning the project and related research activities sparked questions, discussion and request for further information.
Year(s) Of Engagement Activity 2019
URL https://www.ncrm.ac.uk/training/show.php?article=10284
 
Description Making data research ready, pre-conference workshop, organised by 4th International Conference on Administrative Data Research, Cardiff 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact The workshop was co-organised by Administrative Data Research-UK (ADR-UK) and Office for National Statistics (ONS); the audience included academic researchers working with administrative data, policy and data analysts from public sector organisations involved as partners in ADR-UK. The workshop sparked questions and discussion which led to increased interest from colleagues from academia and the various public sector organisations.
Year(s) Of Engagement Activity 2019
URL https://ijpds.org/adr2019
 
Description Meeting, organised by Head of Family Resources Survey, Surveys Branch, Department for Work and Pensions, Caxton House, London 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact The meeting involved colleagues from our research team, research collaborators from MRC/CSO Social and Public Health Sciences Unit, and leading officials from DWP (e.g. Family Resources Survey, Central Analysis and Science Strategy Unit, Labour Market, Families and Disadvantage Directorate). It involved discussion of initial research findings and exploration of avenues for research collaboration.
Year(s) Of Engagement Activity 2019
 
Description Scotland's DWP Areas of Research Interest Workshop, co-organised by Policy Scotland, University of Glasgow, Research Support Office, University of Edinburgh and DWP Central Analysis and Science Strategy Unit 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact The workshop brought together DWP analyst, Scottish Government officials and analysts, and leading Scottish academics working in the broad areas of research interest. The workshop created the opportunity for discussion of potential avenues for research collaboration and advancements in the area of employment and progression.
Year(s) Of Engagement Activity 2019
URL https://policyscotland.gla.ac.uk/scotlands-dwp-areas-of-research-interest-workshop-outcomes/
 
Description TalkingData: ADR Scotland mini-summit, Edinburgh 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact This event included brief presentations and discussion on activity from across the ADR-Scotland partnership; it was addressed to colleagues from Scottish Government, Scottish Centre for Administrative Data Research (SCADR), electronic Data Research and Innovation Service (eDRIS), National Records of Scotland (NRS) and Edinburgh Parallelel Computing Centre (EPCC). The networking event sparked questions and interests from both academic colleagues and colleagues from Scottish Government, eDRIS and NRS.
Year(s) Of Engagement Activity 2019
URL https://www.scadr.ac.uk/news-and-events/talkingdata-adr-scotland-mini-summit
 
Description What's the next game changer for solving poverty in Scotland, organised by Joseph Rowntree Foundation, Edinburgh 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact This event aimed to identify a plan of action to address the drivers of child poverty across work, housing and social security in Scotland. It included talks by executives of JRF and other third sector organisations, academic researchers and policy makers. The event included parallel workshop and participants raised questions and interests concerning our research project and related research activities.
Year(s) Of Engagement Activity 2019
URL https://www.jrf.org.uk/event/what%E2%80%99s-next-game-changer-solving-poverty-scotland