Late last month, the government published its latest plans for welfare reform. Many of the proposals in the green paper, No One Written Off, are likely to be very significant for sick and disabled people.
Some of them threaten to undo the good work that has been achieved to date in helping people get into employment through the pathways to work scheme.
The green paper sets out more about how the new employment and support allowance, which replaces incapacity benefit on 27 October, will work. All current claimants will be "migrated" to the new allowance by 2013, while the new work capability assessment will replace the existing test of incapacity and a new regime of sanctions for those who do not participate in return to work schemes will be introduced.
Following former City banker David Freud's 2007 proposals, all back to work support will be provided outside the statutory sector. This presents serious difficulties. It is proposed that private or voluntary providers will be paid according to their results. If results are defined narrowly as numbers of people placed into jobs, the risk is that providers will be incentivised to cherry pick, or cream off clients whose needs are simplest, leaving those who need more intensive support with inadequate help.
There is also a risk that people will be found jobs but not offered ongoing support, which we know to be fundamental to successful job placement for people with mental health problems.
Finding what works
The evidence about what works in terms of getting people with mental health problems into employment is clear. Rapid job search followed by ongoing training and support in work are key characteristics of the individual placement and support approach and they can be effective for people with severe and enduring as well as common mental health problems.
Yet we are in danger of building a system that will not support individual placement and support in practice, that will be a shadow of the successful pathways to work pilots, and that will offer little to those whose life chances are most restricted.
Small-scale community and voluntary groups can be more effective forms of support for the most disadvantaged people than larger providers. Yet a system that pays by results and fails to invest in small providers' infrastructures risks pushing them out of the market.
Finally, however return to work services are run and paid for, what matters most is that a sufficiently sized, capable workforce is available to offer evidence-based support to those who need it. At present, this workforce only exists in the NHS and in Jobcentre Plus. It is as yet unclear where the new workforce for private sector back to work services will come from and the risk is that we will simply rob Peter to pay Paul.
The government should be taking the opportunity to give disabled people a chance to make better lives for themselves. Yet with inflated rhetoric about fraud predominating in public debate, policy appears to be focused only on cutting back on benefit bills. Without a radical shift in policy, the government will fail to break the link between ill-health, disability and poverty that for too long has reduced the life chances of millions of disabled people and their families.