Does ‘welfare-to-work’ work? A systematic review of the effectiveness of the UK's welfare-to-work programmes for people with a disability or chronic illness

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Abstract

Welfare-to-work programmes promoting employment of people with a disability or chronic illness are an expanding aspect of welfare reform in the UK. What evidence is there of impact on employment outcomes? This paper presents a systematic review of the evidence on UK policy initiatives. Both quantitative and qualitative studies were identified: 5399 abstracts were located, from which 16 studies were critically appraised. Overall, each of the five main welfare-to-work strategies operating in the 1990s helped people with disabilities into work, who were previously on benefits. The proportion of participants gaining employment after involvement ranged from 11% to 50%, dependent on characteristics of participants, such as ‘job-readiness’, as well as wider labour market context. As most studies were uncontrolled, it was difficult to determine if the improved employment chances were due to the effectiveness of the welfare-to-work interventions themselves or to external factors. Wider impact, such as uptake of schemes as a proportion of the total target population, was weak. The qualitative components identified barriers and facilitators concerned with effective implementation, to aid design of future initiatives.

Introduction

In the UK, disability and chronic illness are associated with poverty and social exclusion (Acheson, 1998; Bartley & Lewis, 2002; Burström, Whitehead, Lindholm, & Diderichsen, 2000; Oliver & Barnes, 1998). This is largely because work is one of the main sources of income in the UK and people with disabilities and chronic illnesses have disproportionately low employment rates—currently running at 49%, compared with 81% for those without disability (ONS, 2003a). There are 2.7 million people with a disability or a chronic illness who are on state benefits (DWP, 2003a): the largest group of benefit claimants, accounting for around 25% of all benefit expenditure (ONS, 2003a). Many people with a disability or chronic illness are out of work for long periods of time (around one-third of incapacity-related benefit claims last over 5 years). They face a number of potential barriers to entering employment, not least the lack of experience or skills, discrimination from employers, problems with physical access to work, loss of benefit entitlement, or concerns over pay, hours and conditions (Gardiner, 1997).

Traditionally, public policy in the UK towards increasing the employment chances of people with a disability or a chronic illness has been fairly ambivalent (Floyd & Curtis, 2000). The Disabled Persons Employment Act of 1944 set up specialist employment facilities (such as Remploy), rehabilitation services and the post-war employment quota. The measures incorporated in this act were supplemented in the 1970s with a number of specialised out-of-work cash benefits such as invalidity benefit (1971) and mobility allowance (1975). Over the last few years (see Fig. 2) there has been a significant policy shift as the 1995 Disability Discrimination Act abolished the post-war quota system and introduced a more ‘rights-based’ approach to disability (Oliver & Barnes, 1998). Furthermore, employment measures such as the 1997 New Deal for Disabled People have put people with disabilities at the centre of the current UK government's ‘welfare-to-work’ strategy. This policy change has been in response to both Treasury concerns with the rising costs of incapacity-related benefits—around £16 billion per annum—and calls from the disability movement for measures to tackle poverty and exclusion (Barnes (1991), Barnes (2002); Disability-Alliance, 1991; Treasury, 1998; DWP, 2003a).

The phrase ‘welfare-to-work’ refers to policy interventions designed to promote the transition from out-of-work benefit receipt to paid employment: a central plank of the present government's ongoing employment strategy (Treasury, 2003). Conceptually, there have been five main types of welfare-to-work strategies aimed specifically at increasing the labour market participation rates of people with a chronic illness or a disability (see Fig. 1): education, training and work placements; vocational advice and support services; in-work benefits; incentives for employers; and improving physical accessibility.

Welfare-to-work is therefore an important and salient public policy area, yet the evidence base relating to the effectiveness of the various programmes in terms of increasing employment chances of participants is both diffuse and incomplete. We conducted a systematic review of the relevant UK literature to shed light on the available knowledge and inform future initiatives.

Section snippets

The main welfare-to-work strategies

The main welfare-to-work strategies are directed at either the individual or the work environment. Three of the strategies focus on individuals with a disability or chronic illness—by aiming to raise their education and vocational skills levels; providing support and advice in locating and obtaining work; or overcoming financial concerns about the benefits-to-work transition. The other two strategies concentrate on the work environment: by providing incentives to employers to employ people with

Methods

Seventeen electronic databases were searched from the start date to 2002: ASSIA, Caredata, Cochrane Library (Cochrane Database of Systematic Reviews, CCTR, DARE), Dissertation Abstracts, Business Source Premier, Embase, HMIC (DH-Data, HELMIS, King's Fund), IBSS, Index to Theses, Infotrac, Medline, PolicyFile, PsycINFO, SIGLE, Social Services Abstracts, Sociological Abstracts, Web of Science.

Relevant organisational websites were also searched: Centre for Research in Social Policy, Department for

Results

The search strategy identified 5399 studies in total (see Fig. 3), 16 of which were included in the final analysis (listed in Table 1, Table 2, Table 3, Table 4, Table 5). Seven of the included studies were identified from electronic databases, six from website searches, two from personal communications, and one from citation follow-up. The studies were all recent, the earliest dated from 1996. References to a further three potentially relevant studies were located, but these were either

Effectiveness of welfare-to-work

Overall, there is evidence that the various welfare-to-work programmes operating in the UK in the 1990s helped people with disabilities into work who were previously on benefits. The proportion of participants gaining employment after involvement in one or the other of the schemes ranged from 11% to 50%, depending on a number of factors, including how selective the services were in accepting applicants onto the schemes: the age, type of disability and ‘job-readiness’ of participants, as well as

Acknowledgements

This study was funded as part of the ESRC Centre for Evidence Based Public Health Policy, ‘EvidenceNetwork’ project Grant number H141251011. We thank Mark Petticrew, Matt Egan and the three anonymous referees for helpful comments on earlier drafts.

References (45)

  • D. Acheson

    Independent inquiry into inequalities in health

    (1998)
  • H. Arksey

    People into employmentfinal report

    (2002)
  • H. Arksey

    People into employmentsupporting people with disabilities and carers into work

    Health and Social Care in the Community

    (2003)
  • Arthur, S., & Zarb, G. (1997). Evaluation of the 1995 change to disability working allowance (No. 25). London:...
  • S. Arthur et al.

    New deal for disabled peopleearly implementation

    (1999)
  • J. Atkinson et al.

    Evaluation of the job introduction scheme

    (1998)
  • Banks, P., Riddell, S., & Thornton, P. (2002). Good practice in work preparation: lessons from research (No. WAE 135)....
  • C. Barnes

    Disabled people in Britain and discriminationa case for anti-discrimination legislation

    (1991)
  • C. Barnes

    Disability, policy and politics

    Policy and Politics

    (2002)
  • M. Bartley et al.

    Accumulated labour market disadvantage and limiting long-term illness

    International Journal of Epidemiology

    (2002)
  • Beinart, S. (1997). A survey of PACT clients and services. Social and Community Planning...
  • S. Beinart et al.

    The access to work programme—a survey of recipients, employers, employment service managers and staff

    (1996)
  • V. Blackburn et al.

    New deal for disabled peopleearly findings from the innovative schemes

    (1999)
  • B. Burström et al.

    Inequality in the social consequences of illnesshow well do people with long-term illness fare in the British and Swedish labour markets?

    International Journal of Health Service

    (2000)
  • A. Corden et al.

    Incapacity benefits and work incentives

    (2001)
  • A. Corden et al.

    Disabled persons’ tax creditsa qualitative evaluation

    (2003)
  • K. Croucher et al.

    Paying the mortgage? A systematic literature review of safety nets for homeowners

    (2003)
  • Disability-Alliance. (1991). A way out of poverty and disability: moving towards a comprehensive disability income....
  • DWP. (2003a). Incapacity benefit and severe disablement allowance: quarterly summary statistics....
  • DWP. (2003b). New Deal....
  • A. Edwards et al.

    Judging the ‘weight of the evidence’ in systematic reviewsintroducing rigour into the qualitative overview stage by assessing signal and noise

    Journal of Evaluation in Clinical Practice

    (2000)
  • M. Egan et al.

    New roads and human healtha systematic review

    American Journal of Public Health

    (2003)
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