Dan Heap University of Edinburgh Social Policy Group School of Social and Political Sciences

1. Integrating and mainstreamingsick and disabled benefit claimantsinto the ‘active’UK and Danish welfare states Dan HeapUniversity of EdinburghSocial Policy GroupSchool of Social and Political Sciences

2. Aims and Focus Emphasise the importance of looking more closely at disabled people's access to appropriate employment support services to an assessment of the emerging welfare-to-work regime that they face.Make a case for the value of 'mainstreaming' as a way of understanding recent changes to the organisation of employment services in the UK. Identify what factors influence how easily disabled benefit claimants can access appropriate support, in particular the impact of mainstreaming.Demonstrate the value of cross-nationally comparative analysis through a comparison of the UK with Denmark.

3. Welfare-to-Work and ‘The organisation of opportunity’ • Evans 2001: A claimant’s benefit status has a strong influence of the type, extent and adequacy of the employment support they can access. • Governments need to do more to enable claimants with multiple disadvantages to access a wider array of employment services more easily. • But this is likely to be a slow process and one vulnerable to fluctuating policy priorities, political will and economic cycles. • Problem Evans poses even more pressing now that more and more disadvantaged claimants are required to seek work.

4. Evans on the New Deal • “These divisions [between claimant groups] have been both undermined and continued by the New Deals. They have opened up access to active labour market policy for many that were previously excluded or ignored. However, resources have been allocated in a pattern that continues to exclude or ignore some of the most pressing needs of those who were previously excluded” (2001, p.2).

5. Mainstreaming, access to employment services and the Freud Report • Premised on the assumption that unemployment had fallen to a frictional level, Freud recommended focus of UK W2W policy shift from unemployment to non-employment; specifically incapacity benefits claimants, lone parents and older people. These groups should get more and better support than previously, and on the basis of an individual assessment and not according to a benefit label, what Freud called the 'client group' approach to providing employment services.Reason given by Freud as justification for the application of benefit conditionality: “with the least advantaged in receipt of more individualised support, the rights and responsibilities of all benefit recipients should be brought more closely into line.” (2007, p.1).

6. Mainstreaming • Three main aspects1. Movement away from specialist support schemes and towards most claimants accessing support through the same gateway, regardless of their reason for being out of work. 2. Expectation that almost all claimants should eventually enter paid work (narrowly defined).3. Large transfer of claimants from IB to conditional benefits as a result of the Work Capability Assessment (WCA). Beatty and Fothergill (2011) estimate that by 2014,910,000 former IB claimants will have some form of conditionality newly applied to them. 580,00 will be removed from benefits entirely.

7. It is hard to understand why government sees the type of benefit received as the common despite denominator when designing advice and support for return to work. People who have not worked recently, across all claimant groups, experience erosion of confidence and social skills encounter discriminatory barriers.[Harris & Thornton 2005, p.161] It is clear to us that the overwhelming assumption and expectation of most of the players involved, including disabled people, is that disabled people must go through specialist programmes. There is a major culture change needed to shift this thinking and we realise it is a long-term undertaking. A clear mainstream pathway, with satellite support networks through the Disability Service, social services, specialist programmes and the not-for-profit sector will provide clarity for all.[ACDET 2001, p.3]

8. Risks of mainstreaming • 1. The erosion of specialist services • 2. Frontline staff lack experience to help claimants with multiple disadvantages.3. Imposition of on a diverse group a single set of expectations in terms of what claimants should be moving towards and how.4. Government and external providers unable to provide sufficient services given the rapidly rising numbers on conditional benefits.5. Difficulties in establishing provider incentives – risk of creaming and parking 6. Competition between different groups for services.

9. Mainstreaming and the Work Programme

10. Outcome based funding and lack of recognition of gradual nature of the return-to-work journey or the value of intermediate steps:“We focus, for example, on disabled young people, lone parents or young people in or leaving care, and I think there is a real risk with the Work Programme that those groups might be ignored. When you are solely looking at the customer journey from not being in work to being in work, you can omit those that need more complex support.”. [Provider, House of Commons 2011, emphasis added]

11. Providers are working to very tight budgets, particularly so because of the heavy discounting providers engaged in to win contracts (Bivand 2011), meaning that there is limited scope for interventions that won’t lead directly to a job: “Prime contractors went into [The Work Programme] with the intention that they would have their key subcontractors, who would deliver across the board, but that where more specialist help was needed they would have a pool, if you like, of money to refer people to. I think the further we have gone down the process, the more prime contractors found that there just simply is not the money in it for that...there is very, very little money for any interventions that do not have a clear job outcome.”[Work Programme Provider, House of Commons 2011]

12. Comprehensive support over the full two-year period that claimants are enrolled on the Work Programme looks to be unlikely given that there is little incentive to do so after the first few months. Most job outcomes tend to come within the first months of the claimant starting with the provider and the attachment fee the DWP pays is small – between £400 and £600 depending on the payment group – relative to payments that come later for job entry and sustainment and so for those with perceived lower levels of employability, “the prospect of continued support is bleak especially in the second year” (Simmonds 2011, p.5).

13. These issues are compounded by the fact that there is relatively little the DWP can do other than enforce providers’ own minimum standards, most of which do not mention health or disability issues “I think a critical point is that there are no centralised minimum standards attached to the Work Programme so it entirely depends on what the providers offer, they have to set their own minimum standards and those vary quite widely. It’s entirely conceivable that somebody could go through two years of the Work Programme and not really receive the meaningful intervention that addresses their barriers to work. Providers will say with justification that they can’t afford to do that, they have to get results or they’ll go bust. In employment programmes there are no rights: just responsibilities.”[Interview, DWP official involved in the design of WP]

14. There now seems to be an open admission by both the DWP and providers that the Work Programme as currently constituted is likely to fail those claimants whose needs cannot be met given the strictures of the payment groupings and incentives: “So the differential pricing in the Work Programme contains a break against creaming a parking but the reality is there will still be creaming and parking within payment groups and often the differences between payment groups arguably are not large enough to drive provider behaviour, something the providers themselves say. ... I think that they understand that they haven’t got this right and there will be creaming and parking. I think you’re looking at 10-20% of participants that will effectively be written off. Providers are looking to get about 40% of their caseload into work and to my mind they can’t afford to provide a bells and whistles service to everybody...What worries us is that they will appear two years later with two years more of not being in the labour market, even more disadvantaged and you end up spending even more money.”[Interview, DWP official involved in the design of WP]

15. In addition to the programme apparently weakly guaranteeing an IB/ESA claimant’s right to support, accessing it in the first place may be difficult. Referrals of ESA/IB claimants is running way below what was originally forecast by the DWP (ERSA 2012) whilst the proportion of JSA places has been increased hugely: “So [ESA/IB claimants] are still not coming through in the volumes that they should be and it has resulted in DWP revising down their forecasts at the same time as massively revising up their forecasts for JSA. Overall programme forecasts have been revised up 32% between when the programme was tendered and last year. So in the space of a year referral forecast volumes were increased by a third and within that the IB/ESA volumes have fallen and the JSA have increased so the relative share we’re looking is much smaller: it’s largely a JSA programme.” [Interview, DWP official involved in the design of WP] ...Begs question of what support they can expect if not referred to the Work Programme.

16. Work Programme sets the bar relatively high in terms of a claimant's work readiness: They must be ready for work within six (previously three months, changed because too few people were accessing the programme). Limited evidence that there is a clear strategy to bring claimants to this level of readiness.Typifies the 'wait and see' approach that has long characterised British welfare-to-work policy, whereby sick and disabled claimants are only prioritised for support when they are relatively close to the labour market, and even then often behind ordinarily unemployed claimants.

17. The impact of economic downturn Recession...raise[s] an important question about how those with health limitations...can now compete for jobs with newly unemployed groups. It is probable that the employment needs of the claimant unemployed...who represent a more politically sensitive measure of labour market disadvantage, will be prioritised over those on inactive benefits. [Sissons 2009, p.180, emphasis added] • Freud’s recommendations were predicated explicitly on the fact that unemployment had fallen to a frictional level. • It is therefore pressing to ask whether the challenges presented by the economic downturn have led to a slow-down in attempts to improve employment support for sick and disabled claimants.

18. The impact of economic downturn Switch to handling with short-term unemployed; IB claimants get ‘lost’:“From the middle of 2008 the ministerial focus shifted a lot towards jobseekers and people who had been on benefit 6-12 months, so much focus went on to how to boost support for people who had been unemployed for a while but aren’t yet long term unemployed. The civil service are very responsive to what the ministers are focused on if ministers aren’t cracking the whip on an issue then it can drift and I think IB/ESA support for people with health conditions did get a bit lost there from mid ’08 onwards.”[Interview, DWP ministerial adviser]

19. The impact of economic downturn Downturn combined with failure of Pathways and a negative Treasury assessment of the value of spending to achieve job outcomes for IB claimants puts an end to a specific strategy for providing more support for sick and disabled claimants in particular."DWP were incredibly enthusiastic about [Pathways] for a very long time until they completed all their evaluations and found that unfortunately it didn't appear to have any impact. Which then I think to some extent with the onset of the recession was an important factor in them saying 'let's just package all this up in a single programme; let's actually worry less about people on IB and let the market sort it out' and assume that any job entry is a bonus rather than what had really happened in the last ten years or so, up until two years ago, which was a real effort to improve the support for people on IB." [Interview, DWP ministerial adviser]

20. Integrating and mainstreaming in Denmark 'More People in Employment' package of reforms (2002): Caseworkers must pursue quickest and most direct route into employment for all claimants. Shift towards more work-first strategies and a narrowing of activation offers across most claimant groups in the subsequent years. Changes to municipal refund system: Flat-rate system changed so that municipalities are compensated more fully for 'active' measures than 'passive' benefits and more for when claimants are 'activated' in the labour market. Integrated Jobcenters (2007-): As part a wider reform to government administration, separate Jobcenters for insured and non-insured claimants were abolished in favour of integrated offices run entirely by the municipalities. It was hoped that this would reduce the distinction between claimants in terms of what services they can access (cf. Evans 2001).New standardised tools: all claimants go through same contact system and services provided according to their membership of one of three groups depending on how well they are matched to the local labour market.

21. Integrating and mainstreaming in Denmark 'Parking' of claimants: With funding changes and an increased emphasis on activation in the labour market, some municipalities could no longer afford to continue to help claimants considered to be more distant from work. Led to a doubling of the number of claimants classified into the Match 3 category (claimant not considered ready for work and has no right to employment services). Jobcenter system: It was hoped that specialist knowledge and best practice would be generated by a national specialist centre and communicated through the Jobcenter network via a specialist in each office. This doesn't appear to have happened: knowledge of the needs of sick and disabled people is now less than it was before the reforms.

22. However, number of claimants onto permanent disability pension has continued to increase. Recent governments have been particularly concerned about the large increase in young people claiming the benefit and in those claiming for reasons of mental health. As a result, there is a growing consensus that recent mainstreaming reforms have not served some sick and disabled people well and that new approaches are needed:From 2013, people who would otherwise claim Førtidspension can access a new back-to-work scheme, Ressourceforløbb. Emphasises integration between employment, education, social and health services; with a Rehabilitation Team in each municipality formed of representatives from each sector which creates up a reintegration plan drawing on resources from each.

23. Acceptance that return-to-work process needs to be long and gradual: Participation can be for up to five years (with extensions) and claimants can take breaks from the programme if required. Dispenses with the tradition demand for the quickest and most direct route to work. Provision of support is not as conditional as in the UK on the exhibition of a certain, relatively high level of employability. Sign of increasing ambition on the part of the Danish authorities and a hardening of the commitment to provide employment support: Førtidspension claimants not previously seen as a target group for activation services.Funding will be generous, at DKK150bn per annum. Recognition that a collapsing together of support for different groups under the umbrella of the employment service may not work for all claimants: Ressourceforløbb appears to be attempt to return to a wider and more diverse, cross-sectoral portfolio of support and municipalities have the choice to deliver the scheme from local social service departments rather than the Jobcenter.

24. Conclusions Along with increasing conditionality and reductions in benefits rights, mainstreaming in terms of the kinds of back-to-work support made available to sick and disabled people and how they are accessed, with movements towards single programmes. This approach is replete with risks; the erosion of specialist services; parking of 'harder to help' claimants; inability of mainstream services to respond to need. The experience of the UK in particular bears out these fears. The failure of previous programmes in combination with the downturn has led to a large and rapid slowdown in government efforts to improve the quality and quantity of employment support for sick and disabled claimants, despite the huge increase in people on conditional benefits.

25. Conclusions Difficulties with mainstreaming are also evident in Denmark, though there has been more of a move from the government to respond to them, with efforts being made to provide a long-term, multi-disciplinary approach to increasing employability, a commitment that appears to have been more recession-resistant than in the UK.

26. edannheap@gmail.comw danheap.co.uktw @commentdan