Thanks to the Industry and Parliament Trust and the Wellcome Trust, I was given the opportunity to talk at a breakfast meeting at the House of Lords yesterday. The topic was disabled people and employment. As my PhD is on the history of disability policy, and I had recently written a POSTnote on the subject, I spoke a little about the role of disability social security in this area.
Here is my basic five-minute speech.
Incapacity versus Disability
Historically, we’ve seen disability benefits about two things: covering the “extra costs” of being disabled; and compensating for loss of earnings.
The problem with this is that we have seen “incapacity” and “disability” as the same thing. They are not. This is why we have such controversy over disability benefits.
We can outline two very basic and crude approaches to this.
For “the right”, the welfare bill needs to be cut. But making eligibility criteria more restrictive will mean that many disabled people who need help will be denied it.
For “the left”, more people require help. But by simply expanding eligibility criteria, help will go to people who clearly do not need it.
I am not here to take sides. Rather I want to explain this issue using some historical examples.
Extra-costs benefits – such as Disability Living Allowance and the up-coming Personal Independence Payment – assume some sort of “incapacity” to do “normal” activities.
And we currently pay Employment and Support Allowance – ESA – to those who cannot work, or require extra support to work because of their medical conditions.
The new PIP is to borrow the approach of the “Work Capability Assessment” from ESA and measure people’s functional limitations to decide what level of support they require. This is a departure from the twentieth century approach of using GP’s assessments to decide whether someone was sick enough to need help.
There are good reasons for this, as I outlined in my POSTnote. But to be brief, each medical diagnosis will affect different people in different ways. And GPs are not occupational health specialists. They cannot comment fully on the effects of a medical condition on someone’s ability to do their job. Or indeed, any hypothetical job.
The negative media coverage about Atos and the Work Capability Assessment comes from a problem we have never adequately tackled – how do you assess whether an individual is disabled? Our current systems, despite the rhetoric from successive governments of “focusing on what people can do” assess whether an individual is incapacitated when measured up against a set of DWP guidelines.
This isn’t new. In 1972 we had the case of Jimmy Martin. He was a child born with no legs and only one arm. Although “common sense” says that he was morally entitled to Attendance Allowance (the care component of DLA), he did not need attention to his needs during the night. Therefore, by the rules of the time, he was not “incapacitated”, and did not qualify for the higher-rate benefit.
There is a difference, therefore, between what “common sense” – a subjective judgement – might call disability and what the law says is incapacity. What the people of Britain think of as “disabled”, is not the same as the law’s definition of incapacity. And this works both ways. We’ve seen people with health conditions that are misunderstood or are not “obvious” be victimised as “scroungers”.
Each time we’ve tried to cut the welfare bill – as we did in 1988 with Income Support; 1995 with Incapacity Benefit; 2008 with ESA – we create new ways of defining incapacity. But we never assess disability.
And similarly, whenever we’ve expanded the system – as we did in 1971 with Attendance Allowance and Invalidity Benefit; 1975 with Mobility Allowance; 1993 with Disability Living Allowance – we’ve created new forms of incapacity which we think ought to be recognised by our benefits system.
I’m sure Catherine [Grinyer – the other speaker] will touch on this – but currently we assess incapacity for ESA on the basis of whether someone can work. To do this, we envision the idea of a “work place” and whether a person might be able to function in that work place. But of course – the ideal-type work place doesn’t exist. Each job requires different skills and different capabilities. Each workplace may be more or less accessible, both physically (can someone get into the building) and practically (can someone work the hours required).
And factors such as qualifications, work experience, availability of jobs in the labour market and so many other issues are just as important as a person’s health condition. The impact of a health condition on employability will therefore fluctuate. But we focus on the capabilities and incapacities of the individual; not on the social circumstances which affect the individual.
History is not predictive – and I’m certainly not the most qualified person to tell you how to do things now. You are the experts on the real issues faced by disabled people and by government departments.
However – proponents of reform, whether to cut benefit costs or expand to cover those who genuinely need help must recognise that the “incapacity” system has been shown to be fundamentally flawed.
Administratively, it is perhaps the most logical system to use. But this does not tally with the way that we as a society decide who is and is not disabled. Disability is a constantly changing issue, and is social, not medical. As the world of work changes and as society changes, so too will disability. Any systems we design have to take into account the discrepancy between disability and incapacity.
How to do that is the biggest question facing welfare reformers right now, and has been for over 40 years.