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
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.
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