Title: Evaluation of the health impacts of Universal Credit: a mixed methods study
Funder: Chief Scientist Office, Scotland

Abstract: The social security system in the UK is being transformed by the introduction of Universal Credit (UC). By the time rollout is complete in 2024, over 8 million households are expected to be receiving UC payments – a number that may now rise significantly as a result of the effect of COVID-19 on the economy. UC is designed to improve work incentives for people on low incomes but has been criticised for causing hardship. Research to date on the health impacts has been small-scale and has not been able to provide a full picture of the effect of UC on population health or health inequalities. Our study will be the first to comprehensively evaluate the impacts and costs of UC on mental health and health inequalities. There are some differences between Scotland and England, for example in the way UC is paid. As well as evaluating the overall impact of rolling out UC across Great Britain, we shall investigate whether the different rules lead to differences in health outcomes._x000D_ _x000D_ We will use a combination of approaches (known as ‘mixed methods’) to assess the short-, medium- and long-term effects of UC on mental health and wellbeing; examine any impact on health inequalities; explore the factors underpinning these impacts (such as income or employment); evaluate the costs and benefits of the policy; and to model the future health effects of different ways of carrying out the policy._x000D_ _x000D_ In work package one, we will use large scale survey data to compare the mental health and wellbeing of adults and children in households receiving UC – compared to those in households receiving the so-called ‘legacy benefits’ such as Job Seekers Allowance and Employment Support Allowance). In work package two, we will use data from surveys carried out by Citizen’s Advice to identify features of the UC claim and payments process that cause difficulties for claimants. In work package three, we will interview claimants and JobCentre staff in the North East of England and the West of Scotland to explore the ways in which the experience of claiming UC affects the mental health and wellbeing of claimants, recipients and staff. In work package four we will use the findings of the first three work packages to develop a new simulation model that can predict impacts on income, employment and health of different ways of providing UC. Work package five will examine the costs and consequences of introducing UC and whether they represent value for money._x000D_ _x000D_ The findings of the research will provide evidence that decision-makers can use to reduce harms or increase the positive mental health and wellbeing effects of UC in the future._x000D_ _x000D_ Throughout the study, we will work with UC recipients and organisations that help people with their claims to find out the best ways of involving people with the study, sharing information with them, and explaining what our findings mean. We will have an independent advisory group made up of policy and practice stakeholders to make sure that what we do has practical relevance. A study website and social media will be used to publicise the research as widely as possible. We will target our results at a wide range of audiences including key influencers, policymakers and organisations that support UC claimants. Results will also be published in research articles and presented at national and international conferences.

Lay abstract: Universal Credit (UC) combines six existing benefits and tax credits (known as legacy benefits) for working age people and their children into a single monthly payment. UC is designed to improve work incentives for people on low incomes but has been criticised for causing hardship due to conditions related to eligibility and the way that claims are managed and payments made. UC is being introduced gradually, with rollout currently expected to be complete in 2024. Research to date has not provided a comprehensive picture of UC’s impact on population health or health inequalities._x000D_ _x000D_ We propose a mixed methods study comprising five closely related work packages (WPs) to answer the question: what is the impact of the introduction of UC on mental health and wellbeing, what are the implications for health inequalities, and how these effects are moderated by variation in implementation across Great Britain?_x000D_ _x000D_ In WP1, we will compare health outcomes for new recipients of UC with outcomes for legacy benefit recipients in the Understanding Society and the Annual Population Surveys, using the phased rollout of UC as a natural experiment. We will use a Small Area Mental Health Index (SAMHI) that we have developed to analyse the relationship between the proportion of UC claimants in each Lower Super Output Area and a composite measure of population mental health._x000D_ _x000D_ In WP2 we will use anonymous data routinely collected by Citizen’s Advice from UC claimants to explore the socio-demographic and health characteristics of people who have difficulty claiming, and features of the claim and payment process that prompt advice-seeking. We will also analyse a unique dataset linking requests for advice with heath service use._x000D_ _x000D_ In WP3 we will conduct in-depth interviews with a purposive sample of UC claimants in England and Scotland to explore reasons for claiming and experiences of the claim and payment process. In Scotland we will explore use of the alternative payment arrangements known as ‘Scottish Choices’ and what these mean for claimants. Follow-up interviews will investigate the way claimants’ experiences change over time. We will interview frontline staff from JobCentre Plus, the NHS, local government, voluntary and community sectors._x000D_ _x000D_ In WP4 we will create a new dynamic microsimulation model of the health impacts of UC. We shall use our model to simulate the impacts of different implementation scenarios, and to explore how these differ between subgroups of the working age population, and between local authorities._x000D_ _x000D_ In WP5 we will use cost-consequence analysis to identify and quantify the whole range of potential costs and outcomes of introducing UC. We shall also undertake analyses of UC’s distributional consequences (e.g. by geography, deprivation or employment status) and the cost-benefit of mitigating actions, such as those taken by Scottish Government or individual local authorities._x000D_ _x000D_ The project will last 52 months. The research team will work with a Study Advisory Group comprising representatives working in central and local government, the NHS and organisations that support UC claimants, so that we can keep abreast of policy changes and feed research findings directly into policy and practice development at both national and local authority level.

Research activity codes: 2.3 PSYCHOLOGICAL, SOCIAL AND ECONOMIC FACTORS
Health categories: MENTAL HEALTH