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Inequality in incapacity for work - a response to Ben Baumberg

Why is it that some people with a health condition can hold down a job while others can’t?

Ben Baumberg’s latest paper is an excellent discussion of the real-world factors in the labour market that create disadvantage and lower the employment rates among disabled people.  As you could imagine, the nature of work, the degree of autonomy and flexibility, and choice in work all explain why some people are incapacitated for work by an impairment while others aren’t. 

This analysis might seem to speak directly to Iain Duncan Smith’s recent speech about the false binary of fit/unfit for work. But this would be a mistaken conclusion to draw. 

As part of wider Rethinking Incapacity project Baumberg discusses the inequalities in education, choice and job prospects that mediate illness or impairment and capacity for work. The people he interviewed had more or less flexibility in pacing their workload or requesting adjustments from employers, and they had differing degrees of choice to seek different, more suitable work. Very often these depended upon their level of qualifications. Essentially, the better their qualifications the less likely they were to face incapacity for work. “Maryah”, for example, quit her highly pressurised marketing job in a multinational company and was able to find a less stressful role within the same company and ultimately choose not to work and be supported by her partner. “Khaled”, a bus driver with chronic back pain did not have the flexibility to alter his activities to manage pain, nor of changing jobs and so had to endure significant pain and distress to retain employment.

But crucially, the 30 subjects of  this qualitative study appear to be significantly less impaired than the average person qualifying for ESA. This is a very important caveat for policy makers seeking to understand and address the very low rates of people on ESA moving into work. The assessment for ESA does not assign people into binary categories of Fit for Work (in which case they must claim JSA) or Unfit for work (eligibile for ESA) as IDS claimed. It contains an intermediary category, the Work Related Activity Group or WRAG. The WRAG is a subgroup of ESA, for people who are not Fit for Work but not categorically incapacited either: those people are put in the "Support Group" of ESA. No one seems quite sure what the status of those in the WRAG are. The DWP’s opaque definition is that they have "limited capability for work" but are not limited capability for work related activity".

It is often assumed the WRAG embodies the shades of grey between impairment and incapacity for work that Baumberg's study describes. Except that it doesn’t. From the brief mentions of their health problems, none of the subjects in Baumberg’s study would appear impaired enough to qualify for the WRAG of ESA. None of them appears to have been assessed as unfit for work under the Work Capability Assessment. You could come away wrongly thinking that severity of impairment is less predictive of incapacity for work for people in the WRAG than educational levels or job flexibility.

Policy makers never appear to examine the detail of how the WCA measures incapacity for work, what degree of illness or impairment places people in the Support Group, the WRAG or deems them fit for work. It is assumed that the WCA is grounded in impartial medical science, when in fact it was modelled on the claims management practices of the large US insurance company Unum. 

Look at these illustrative examples of people who would qualify for the WRAG: “Mike” with brain injury and epilepsy, “Alan” with autism and “Sheila” with MS. Would flexible hours or a change in role give them the same latitude to compete for a job as “Maryah” in Baumberg’s example,who suffers from stress? 

Whilst there is almost no absolute incapacity for work, there is much more incapacity for holding down a job in a competitive labour market than most policy commentators are willing to admit. Severity of impairment matters, and yet it is always left in a black box by social policy analysts discussing the disability employment gap.

Having said this, Baumberg’s thesis of inequalities in incapacity is very significant. As he outlines, the policy research on disability and incapacity benefits to date has been simplistic. All have assumed that health alone could not be the reason for the increase in the sickness benefit caseload and have sought explanations in malingering, welfare dependency or “hidden unemployment”. Baumberg insists that impairment is a factor in incapacity benefit claims but for some people it is more of a factor than others. 

Unfortunately this idea cannot be applied to people currently in placed in the WRAG because the WCA is too blunt and inaccurate to correctly assess people’s distance from the labour market and how much “latitude” they have in employability. But it must be applied to any reform of the WCA. A fair assessment process should judge distance from the labour market not just on health or impairment grounds alone but in terms of education, qualifications, previous experience and the choices in employment that they bring.


  1. I agree that the policy research on incapacity benefits and employability has been far too simplistic. However, I have reservations about applying Baumberg’s findings to the WCA; in particular, I think it is important not to overstate the employment opportunities available to better-educated sick and disabled people.

    First of all, more than half of graduates are working in non-graduate jobs, so there is a huge shortage of professional jobs offering the kind of autonomy that those with health conditions need. Having a degree (or two) is not enough: in today’s highly competitive labour market, you have to be exceptionally talented or be able to offer skills in high demand. Why would an employer take on someone with special employment requirements when there are plenty of equally qualified applicants who don’t need any adjustments or aids?

    Secondly, there are many different factors influencing someone’s employability, including age and work history. My experience is that in the real world a good employment record counts more than qualifications. So incapacity benefits claimants, especially long-term claimants, tend to be at the back of the queue for jobs, regardless of their level of education.

    I’m wondering: is it possible to devise a fair assessment system that takes all these different factors into account? The current test is based on the unrealistic assumption that anyone with very basic functional ability can work, thanks to all the aids and adjustments available in the modern workplace. I wouldn’t want it to be replaced by a test based on another set of unrealistic assumptions about an individual’s employability.

  2. Very important to include the unpredictability and impact of fluctuating illnesses - one of the most difficult areas to cope with for both the person and the employer. Most won't be able to cater for it IMO.

  3. Sorry for the very slow reply, and thanks for the really interesting response. You're right that the two examples I went through in detail (Maryah and Khaled) would probably not have been eligible for ESA (though Khaled had been told he would have been) - but other people I spoke to did have more severe disabilities, and were claiming ESA.

    More generally, though, you're clearly right that wider advantages (including education, the area you live) are only useful for some people, while there are others that will be unable to work whatever wider situation they're in. This is one of the things I'm trying to look at in the project - exactly how much of a difference does this make?

    I don't have any answers yet, but hopefully will do in the next 12 months or so... Looking forward to discussing the results with you when I finally have them!


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