What is the problem, exactly? The distribution of Incapacity Benefit claimants' conditions across British regions

Abstract

There is an entrenched regional hierarchy in the spatial distribution of Incapacity Benefit (IB) claimants in Great Britain: the ratio of claimants to population is two to three times higher in the ‘North’ than it is in the ‘South’, and whilst some convergence has occurred since numbers stopped growing towards the end of 2003, the gap has changed relatively little. Just as important though, from a practical policy point of view, there is also a marked regional differentiation in the relative importance of the medical conditions from which IB claimants suffer. For example, about one third of males in the ‘South’ are unable to work due to ‘mental and behavioural disorders’, whilst the proportion in the ‘North’ is under a quarter; whilst the converse is true of ‘diseases of the musculoskeletal system and connective tissue’. Clearly, as the ‘roll-out’ of Pathways to Work gathers pace with its offer of a ‘condition management programme’ to claimants, and the new regime for those unable to work due to sickness is introduced, those charged with planning and managing the ‘re-activation’ of benefit claimants need to have a more spatially informed understanding of the dimensions of the problem they are to address. This article seeks to help fill this information gap by investigating the cross-regional distribution of conditions and its connection with the cross-regional distribution of claimant numbers.

Keywords:

• Incapacity Benefit
• illness
• welfare reform

Notes

1. Raising employment rates of the sick and/or disabled, presently IB claimants is also implied by the government aspiration to reduce IB numbers by one million by 2010 (Anyadike-Danes and McVicar 2008).

2. Of course it would be unreasonable to infer that the ‘new wave’ welfare reform agenda is aspatial on the evidence of the Freud Report alone, but a careful trawl through the documents on the Department of Work and Pensions welfare reform website (www.dwp.gov.uk/welfarereform) on 28 May 2009 and the associated ‘Working for Health’ website (www.workingforhealth.gov.uk) found no substantial mention of geography. Of course, this complaint is not new (Gordon 1999) and has been noted elsewhere (Webster 2006).

3. See Beatty, Fothergill and Macmillan (1999) for a more complete statement covering much the same ground, and for a selection of the ‘facts’ see Anyadike-Danes (2004, 2007).

4. The data on ‘main conditions’ of IB claimants by sex and region is available quarterly from August 1999, but since our terminal quarter was February 2007 we chose February 2000 as the baseline to rule out seasonal effects.

5. The IB data used in this article were downloaded from the DWP website: www.dwp.gov.uk/asd/tabtool.asp

6. The working-age population is males aged 16–64, females aged 16–59. These data are from the Office of National Statistics website: www.statistics.gov.uk/statbase/tsdtables1.asp?vlnk=lms, Table 18A:Regional labour market summary-LFS data NSA.

7. The ‘North’ here refers to: East Midlands, North East, North West, Scotand, Wales, West Midlands, Yorkshire and Humberside; the ‘South’: East of England, Greater London, South East, South West.

8. Causes of incapacity are based on the International Classification of Diseases, 10th revision, published by the World Health Organisation.

9. The horizontal axis on Figure 4 is the same as Figure 1, so regional ordering is, necessarily, the same too.

10. Aside from one inversion in the middle – South West moved marginally above the West Midlands – the horizontal ranking and the vertical ranking are the same.

11. Unfortunately it is not possible from the published data to compare the beneficiary–credits-only categories across regions by gender.

12. Indeed, for the South East and the South West the rates rose very marginally – but less than one-tenth of a percentage point.

13. Of course, there is substantial intraregional variation in IB incidence and although IB claimant numbers are published at finer spatial scales (down to ‘ward’ level, of which there are about 10,000 in Britain), these data are not simultaneously cross-classified by gender and health condition and will not, therefore, allow us to show the extent to which the correlations between IB incidence and the importance of different health conditions vary by sex.

14. The argument which links the state of the labour market and claims for sickness and disability benefits was authoritatively stated by MacKay (1999), extended by Beatty et al. (1999) and updated by Beatty et al. (2007). For a more narrowly medical view, see Mclean et al. (2005).

15. See the discussion of this in Grover (2007, p. 537) and for an even more wide-ranging critique of the government policy in this area see Dorling (2007).

16. As far as Pathways to Work in particular is concerned their summary of the evaluation results is: ‘…although people with physical health problems more likely to be employed in the pilot areas, this was not the case for those with mental health problems…’ (Lelliot et al. 2008, p. 23).

17. Another prominent example is the evidence review by NICE on Public health interventions to promote positive mental health and prevent mental health disorders which found (on this somewhat wider question), for example: ‘Little evidence was found on the cost of mental health promotion interventions’ (Taylor et al. 2007, p. 7).

18. A description of the process which produced the guidance and all the key documents can be found at: www.nice.org.uk/guidance/PH19.

19. The NICE procedure requires that evidence reviews are followed by an ‘Evidence Consultation’, and this led to a somewhat more positive conclusion in respect of one element of the third review. But it is worth noting that the evidence of benefit from a single study (a cost/benefit study of Pathways to Work) was importantly qualified: ‘if the effectiveness evidence reported (in another study) on which this analysis is based is accepted’ (Hillage et al. 2008a, p. 16) and, of that ‘other’ study it had already been said that: ‘ it has several limitations leading to questions around its validity’ (Hillage et al. 2008a, p. 15). Moreover, in a further stage of the NICE process, an economic modelling exercise, designed to assess cost effectiveness, the ‘Pathways-type’ interventions were not modelled: ‘because (NICE) felt that the study did not sufficiently demonstrate adequate efficacy of the intervention’ (Pilgrim et al. 2008, p. 6).