What is 'incapacity'? The role of working conditions & job availability in incapacity claims, & whether these should be part of incapacity assessment

Over a million older people (aged 50-64) claim incapacity benefits in Britain, on the grounds that their health or disability stops them from working - four times as many as those claiming unemployment benefits, despite the downturn. Being classed as 'incapacitated' is important because incapacity claimants are widely seen as more deserving, and therefore receive more money and have to jump through fewer hoops. But what does it actually mean to say that someone is 'incapacitated'?

Policy treats 'genuine' incapacity as if it was strictly medical (either diseases or impairments); the current incapacity assessment has criteria like 'cannot pick up and move a one litre carton full of liquid'. But in reality it is not that simple. Take two people with identical impairments: a London-based graduate and an unskilled person in Merthyr Tydfil. The graduate may have better working conditions, an employer who is more willing to change the job to fit them, or be able to find another job that their health permits them to do. The unskilled worker may have none of these options, particularly if they are older and therefore more likely to have lower qualifications, to be biologically 'slowing down', and to face age-related discrimination.

There have been calls to take these 'non-medical factors' into account in assessing incapacity - including by the Shadow Minister just as this project was being finalised. Yet the Government's independent reviewer of the WCA dismissed this policy last year because we "lacked the necessary detail and evidence base" (Harrington 2011:37). In this project I will therefore do two things that have not been done before. Firstly, I will look at the role of non-medical factors in incapacity, for the first time looking simultaneously at working conditions, adjustments & the availability of work. I will do this with an advanced statistical analysis, using already-existing, high-quality surveys that follow thousands of older workers over time in England and Europe. I will also focus on whether these non-medical factors matter more in some countries than others, reflecting their different welfare systems and labour markets.

Secondly, I will look at whether the public and elites think that non-medical factors should be taken into account in assessing incapacity. We increasingly see stories that incapacity claimants are 'really' fit-for-work, alongside a reform process that suddenly tells people they are not incapacitated; yet from the other side, the British Medical Association and others have attacked the incapacity assessment as unfairly harsh and inaccurate. In this project I will look at what different groups think 'genuine incapacity' should mean, using:
(i) a survey to investigate attitudes among the public as a whole; and
(ii) workshops with elites (policymakers, frontline staff in the benefits system, disability advocates, and unemployment/disability claimants themselves) and the public to probe attitudes more deeply, in both cases getting people to respond to a series of pen portraits.

These workshops are unusual in answering a key research question at the same time as getting people to engage with my own results from the first part of the project. This means that the policy implications will be developed jointly with others - for example, seeing whether we should assess incapacity differently for those with lower skills (like GPs informally used to with the old 'Invalidity Benefit', and as other countries still do) and in regions with fewer jobs.

To do this work requires an unusual set of skills - advanced statistical skills that are rare in Social Policy, combined with skills in qualitative research and public attitude research. The Future Leaders Scheme will provide me the opportunity to gain these abilities, building on initial skills I am fortunate to have had the opportunity to develop in past work, and putting me in a position to deliver powerful research that can change policy.

Incapacity benefits themselves have multiple impacts on society: they are a major public expense, they help protect all of us from the income risk of losing our job through ill-health, and they are a central pillar of what is considered a fair and decent society. Yet currently in Britain (and elsewhere) they are heavily contested, particularly around the boundary of who is 'really' incapacitated. In this context, four groups will benefit from this research.

1. POLICYMAKERS
Policymakers will benefit from (i) understanding the role of non-medical factors in incapacity and how this contributes to inequalities in incapacity, and (ii) how far elites and the public consider these non-medical factors when assessing incapacity. This will help UK policymakers (i) design a better-functioning system of incapacity assessment (following on from official reviews in 2013 & 2014); and (ii) ensure that provision for disabled people in the new Universal Credit system (being rolled out 2013-2018) is efficient and fair - with analogous impacts in similar debates internationally(e.g. prompted by the OECD). It will also suggest broader policy areas and specific targeting of subgroups that could reduce the social and economic cost of incapacity claims (e.g. job matching for low-skilled disabled people in areas of low labour demand), and address issues about whether old workers will be 'fit for work' if state pension ages continue to be raised internationally.

2. PRACTITIONERS
Another impact will be on a diverse group of practitioners, including those involved in occupational health within employers, GPs, benefit incapacity assessors (Atos Healthcare), Jobcentre Plus staff, Prime Contractors, and other staff within the welfare-to-work arena. The project will lead to immediate lessons for practice in understanding how non-medical factors make it harder for their clients to return-to-work, and which factors may help overcome this. This will contribute to more accurate assessment, better support for clients, better employment-related outcomes, and (in the long-term) better contracts with Government with incentives that reflect the real barriers clients face.

3. LOCAL AUTHORITIES AND HEALTH PROVIDERS
Incapacity claims are highly concentrated in certain areas. This spatial analysis in this project will (i) given local authorities and GPs (taking over responsibility from Primary Care Trusts) a better understanding of incapacity in their specific area, helping them negotiate for appropriate settlements with central government and design appropriate local policy responses; and (ii) consider the acceptability among stakeholders of bringing regional factors into the assessment of incapacity, mirroring debates on regional variations in public sector pay.

4. DISABLED PEOPLE, OLDER PEOPLE and THE WIDER PUBLIC
Finally, the project will have an impact on the lives of disabled people and older people in three ways. Firstly, a better understanding of the nature of incapacity will contribute to a better system of incapacity assessment, not only providing support where it is intended but without the high levels of appeals and anxiety of the current system. Secondly, a clear idea of what incapacity is - linked to evidence on what the public think it SHOULD be - could remove some of the lack of legitimacy in the current system, thereby reducing some of the stigma of claiming (Baumberg et al, In Press). Finally, public debate about incapacity benefits is based on the misconception that incapacity is about whether people are 'completely incapable of work', and how many older people this applies to. The project's evidence on non-medical influences will contribute to a better quality of debate on a key welfare state issue - itself a positive impact on wider society.

Please see the Pathways to Impact statement for details of the innovative activities to achieve this.