Title: What is 'incapacity'? The role of working conditions & job availability in incapacity claims, & whether these should be part of incapacity assessment
Funder: Economic and Social Research Council

Abstract: 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.


Research activity codes: 8.4 RESEARCH DESIGN AND METHODOLOGIES (HEALTH SERVICES);8.3 POLICY, ETHICS AND RESEARCH GOVERNANCE
Health categories: GENERIC HEALTH RELEVANCE