Employment and Disability Policy Initiatives in the U.K.: Results and Lessons for the U.S.

1. www.edi.cornell.edu Employment and Disability Institute Employment and Disability Policy Initiatives in the U.K.: Results and Lessons for the U.S. A Public Policy ForumNovember 8, 2007Cornell University Government Affairs Office Hall of States, Room 333 444 North Capitol Street, N.W. Washington, DC 20001

2. Rehabilitation Research and Training Center on Employment Policy for Persons with Disabilities Funded by the U.S. Department of Education National Institute on Disability and Rehabilitation Research (Grant Number H133B040013)

3. Collaborating Partners • Employment and Disability Institute ILR School, Ithaca, NY • Dept. of Policy Analysis and Management College of Human Ecology, Ithaca, New York • Mathematica Policy Research, Inc.Princeton, NJ, Washington, DC, and Cambridge, MA • American Association of People with DisabilitiesWashington, DC • Rutgers University, School of Management and Labor Relations, Program for Disability ResearchNew Brunswick, NJ

4. Upcoming Policy Forums • Date & Location TBD - Winter 2008 Review of the Final Report from the Ticket to Work Panel Speakers & Moderators to be determined • Date & Location TBD - Winter/Spring 2008 Older Workers Who Experience Disability Onset Speakers & Moderators to be determined • Date & Location TBD - Spring 2008 Youth Focused Panel Speakers & Moderators to be determined • Date & Location TBD - Summer 2008 Employment Policy Options for Improving Services and Employment Outcomes for Returning Veterans with Disabilities from Iraq and Afghanistan Speakers & Moderators to be determined

5. Welcome & Introductions • Susanne Bruyerè, Director, Cornell University – Employment and Disability Institute Moderator • Stephen Bell, Abt Associates Panel • Michael Daly, Department of Work and Pensions, U.K. • Richard Dorsett, Policy Studies Institute, U.K. • Susan Purdon, National Center for Social Research, U.K. • Bruce Stafford, University of Nottingham, U.K. Discussant • David Stapleton, Ph.D., Mathematica Policy Research Inc.

6. Disability Employment Programmes UK evaluations Mathematica Policy Forum Washington, D.C. November 8th 2007 Mike Daly, UK Department of Work and Pensions

7. Why did we fund these studies? • Government commitment to evidence-based policy making • Reinforced by challenging high level targets: • Eliminate child poverty • Increase employment rate to 80% • Narrow the employment rate gaps • Places the focus on outcomes, not inputs

8. Why disability particularly?(not necessarily in this order) • Social reasons as reflected by: • Disability Discrimination Act 1995 • ‘Improving life chances of disabled people’ report by Prime Minister’s Strategy Unit 2005 –goal of equality for disabled people by 2025 • Financial – 2.7m on incapacity benefits at cost of >£12bn • Broader economic reasons – aim to increase employment rate to 80% to keep dependency ratio under control

9. Why these particular studies? • Job Retention and Rehabilitation: belief that early intervention is important, but no evidence of what works • New Deal: first attempt at a large scale intervention designed specifically to help disabled people • Pathways: first serious attempt to introduce an element of compulsion, backed by high quality services, with aim of making a substantive impact on benefit/employment rates

10. Re-engineering incapacity benefits: the effects of the Pathways to Work reforms Richard Dorsett Policy Studies Institute, London Policy Forum 8 November 2007 Washington D.C.

11. Incapacity benefits in the UK • Incapacity Benefit (IB) • for those with sufficient earnings history • Income Support (IS) • for those with insufficient earnings history • Personal Capability Assessment (PCA) • Medical test of eligibility • Points system assessing physical & mental health • 20-25% exempted due to nature of condition • Takes from 2 weeks to 5 months to complete • Appeals often succeed (about 50% in quarter ending March 06)

12. Comparisons with the US • Similarities • Some parallels between IB/IS and SSDI/SSI • With USA and Canada, PCA is among the most stringent tests of disability • Differences • Benefits paid while awaiting PCA outcome • NHS provides universal health care • PCA does not require individual be incapable of work

13. The growth in incapacity benefits

14. What Pathways to Work offers • Early focused intervention • Series of work focused interviews for most claimants • Accelerated PCA and focus on capability • Specialist support • NDDP: help into work, support in work (for 6 mths) • CMP: help managing disability/illness • Clearer incentives • RTWC: £40 per week for a year 16+ hr job <£15k

15. Evaluation approach • Piloted in number of areas - focus on April 2004 areas • Evaluation data: • Surveys of individuals at start of claim process and 1½ years later • Full population of claimants from administrative records • Data available pre/post Pathways and in pilot/comparison areas • Effect evaluated by difference-in-differences

16. Six-month IB off-flow rates - administrative data October 2003 April 2004 Source: House of Commons Work and Pensions Select Committee Report (2006).

17. Impacts 1½ years after benefit enquiry– survey data, April 2004 areas

18. Employment impacts, survey data

19. Benefit impacts, administrative data

20. Concluding comments • First mandatory active labour market programme for sick and disabled people in Britain • Embraces the idea of health benefits of work • Broadly welcomed by disability interest groups • Sustained rise in employment but not reduction in benefit – 2016 target (1m off IB) unlikely by Pathways alone • Positive health effects Reminders when generalising to the USA… • Benefit population includes those who will not pass PCA • Medicaid and Medicare alter the incentive structure relative to the UK

21. Stopping Job Loss Following Onset: the JRRP trialSusan Purdon

22. The design of JRRP • Randomised controlled trial with four randomisation groups • Aimed at those off work sick for 6-26 weeks • Main objective: successful return to work for 13+ weeks • Participation: voluntary; self-nominating • Four randomisation groups: health intervention; workplace intervention; combined intervention; control • Ran from April 03 to April 05

23. The three interventions • Health: Physiotherapy; referral to specialists; complementary therapy • Workplace: Ergonomic assessment; employer liaison/mediation. • Combined: CBT; any of above. (Best practice).

24. Numbers taking part • 2845 (711 per group) • Not all those randomised to an intervention received an intervention (health 78%; workplace 55%; combined 77%) • Not all those randomised were interviewed (health 587; workplace 545; combined 571; control 458)

25. Costs

26. Findings

27. Findings: those off work because of injury (n=96/group)

28. Findings: those off work with mental health problem (n=211/group)

29. Findings: depression (HAD scores)

30. Possible explanations • Interventions offered not always seem as appropriate by clients • Service providers did not always encourage clients to be proactive and to initiate contact • For mental health group, some evidence that control group found new jobs

32. Supporting Moves into Work Once on Benefit: Implementation Challenges and Impact Results from the National Extension of NDDP Bruce Stafford International Centre for Public and Social Policy

33. Key findings • NDDP ‘worked’: • Reduced benefit receipt and increased employment • A positive net social benefit • Notwithstanding implementation issues: • Funding and contractual regime • Institutional arrangements

34. New Deal for Disabled People (NDDP) • Piloted in 1998, nationally extended July 2001 • Designed to help people claiming incapacity-related benefits secure sustainable employment • Voluntary program • Delivered by around 60 Job Brokers – private, public and voluntary organisations under contract to Department for Work and Pensions (DWP) • Outcome related funding

35. The evaluation

36. Implementation issues • Area differences in take-up rates • Funding / contract regime & resources: • Increased focus on those closer to work • Responses to funding ‘gap’ • Role of communication & information giving: • Job Brokers and Jobcentre Plus • Participants’ having an informed choice

37. Outcomes and Impacts Impacts on benefit receipt and employment over 24 months

38. Impacts

39. CBA

40. Conclusions and lessons • Jobcentre Plus had key role in success of NDDP • Signposting people • Mandatory work-focused interviews • Outcome related funding: • Economics of scale – small/local providers • Equity – those further from the labour market • Is a role for NDDP-type services for client group

41. Bruce Stafford • International Centre for Public and Social Policy • School of Sociology and Social Policy • The University of Nottingham • University Park • Nottingham • NG7 2RD • Tel: 0115 846 7439 • Email: Bruce.Stafford@Nottingham.ac.uk • http://www.nottingham.ac.uk/sociology/research/Int_Ctre_for_Public_and_Social_Policy.php

42. Upcoming Policy Forums • Date & Location TBD - Winter 2008 Review of the Final Report from the Ticket to Work Panel Speakers & Moderators to be determined • Date & Location TBD - Winter/Spring 2008 Older Workers Who Experience Disability Onset Speakers & Moderators to be determined • Date & Location TBD - Spring 2008 Youth Focused Panel Speakers & Moderators to be determined • Date & Location TBD - Summer 2008 Employment Policy Options for Improving Services and Employment Outcomes for Returning Veterans with Disabilities from Iraq and Afghanistan Speakers & Moderators to be determined