Can health services really solve the government’s growing benefits bill?

In March, the government announced its proposals for reforming the welfare system. Plans to reform benefits pre-date this government, but a spiralling benefits bill along with concerns about the long-term impact on the future workforce and economic productivity has hastened action.

Analysis by the Institute for Fiscal Studies highlights a significant rise in claims for benefits among working-age adults in the past decade, with more than half of the rise due to claims relating to mental health or behavioural conditions. The government’s response is to make it harder to claim benefits for health-related reasons, while addressing those needs through health services and providing access to training and employment support.

Among the government proposals for addressing the health needs of claimants are access to NHS Talking Therapies and Individual Placement and Support.

NHS Talking Therapies provide support for people experiencing anxiety disorders and depression. For those who complete treatment, approximately 50% achieve a meaningful level of recovery. Furthermore, recent analysis has demonstrated that receipt of effective treatment increases the likelihood that someone is able to work, making the NHS Talking Therapies service pay for itself within two years when taking into account taxes and disability benefits. In addition, NHS Talking Therapies services already have employment advisers as part of the service. Evaluation found that people who were out of work when they entered NHS Talking Therapies who received employment support were more likely to enter the labour market.

A common concern raised about NHS Talking Therapies is long waits for treatment. NHS Talking Therapies have a maximum waiting-time standard that 75% of referrals are seen within six weeks, and 95% within 18 weeks, of referral. These targets have been consistently delivered at a national level. However, people can face additional waits within services, with 25% of people waiting over 90 days between their first and second appointment for treatment. Those who require a greater intensity of treatment are more likely to experience long waits. Such waits not only delay treatment but can contribute to further deterioration, making recovery less likely.

Importantly, NHS talking therapies are not suitable for everyone. They are less effective for people with more complex needs, and are unlikely to meet the needs of the large number of people seeking support for symptoms associated with attention deficit and hyperactivity disorder and autism.

A key challenge to the proposed benefit changes is the risk of increasing rates of poverty. Indeed, the government’s own modelling indicates that as a result of the changes there will be an additional 250,000 people (including 50,000 children) in relative poverty after housing costs in the financial year ending 2030. People with mental illness are more likely to have higher rates of poverty, and this is particularly the case for people with severe mental illness. NHS Talking Therapies services have been careful to create boundaries between treatment and employment support, so that the aims of treatment are not adversely impacted by perceived requirements to work. Similarly, access to Individual Placement and Support, a service which supports people with severe mental illness to gain and maintain meaningful employment, is largely provided alongside secondary mental health services. The majority of people with mental health problems want to work but tying treatment and work together risks compromising outcomes, with a knock-on effect on demand for support.

That demand also translates to social care. Many people who currently receive disability benefits also receive social care support from local authorities. Currently, many people use Personal Independence Payments to pay for their social care charges. Loss of that income has raised concerns that local authorities will end up having to fund a greater proportion of costs. The timescale for social care reform is several years away, so any additional costs in the short term risk exacerbating current pressures, with fewer people receiving social care support.

It is not surprising that these proposals have been met with almost universal condemnation by organisations supporting people with disabilities and health conditions. The proposed changes make for a somewhat blunt instrument, leaving many in financial uncertainty, and neither the initial announcement or the Spring Statement provide much detail about the support people will receive that accounts for the breadth of people’s health needs. The commitment to meeting those health needs is also difficult to reconcile with a fall in NHS funding for mental health services.

The increase in the number of people unable to work due to health reasons should rightly raise concerns, and the role of government in addressing those needs and supporting people to capitalise on the benefits of work is an important one. Yet an approach that reduces access to income as a means of increasing economic activity risks increasing poor mental health and compounding the substantial impact of poverty on health and care services.