Difficult decisions on worklessness

For physiotherapy, the announcement of £1 billion investment in supporting people with long-term health conditions or disabilities into work signals a positive step forward. The CSP has long argued that the welfare system should focus on the ability of people with impairments and on supporting them to maximise their potential. This is an area where physios and rehab support workers have a huge amount to offer.

The Secretary of State, Liz Kendall MP, assured Parliament that those who can’t work will be supported and that rules that work against disabled people working would be eased. This sets the tests against which her proposed changes should be judged.

Welfare to work

Liz Kendall proposed changes to the welfare system aimed at helping more people back into work. The green paper shows the direction the government wants to take but does not introduce any immediate changes.

The Government are planning to legislate for a ‘right to try’, guaranteeing that work alone does not lead to a benefit reassessment. With 2.8 million people in the UK currently unable to work due to illness or disability, many could benefit significantly from access to community rehabilitation and other forms of support. The CSP therefore welcomes better access to support for disabled people or long-term health conditions. However, plans to change the eligibility for some benefits are of concern to many people with disabilities.

The importance of personalised support for people

It is important to enable people with long-term conditions to return to the workforce if they can. There are negative health, social and economic impacts resulting from worklessness for individuals, businesses and society as a whole. The DWP’s commitment to personalised support is therefore very welcome, provided it is delivered in practice.

Physiotherapists can play a crucial role in helping many individuals with long-term health conditions or disabilities to return to work. Through rehabilitation and supported self-care physiotherapists can offer significant help in improving physical function and managing health conditions. Physiotherapists are especially well equipped to assess patients as potentially fit for work, with a higher success rate in this regard compared to GPs or other healthcare professionals.

First Contact Physiotherapists working in primary care are already reducing the impact of long-term conditions on workplace absence. Physios are actively using fit notes to help people return to work in a timely manner. So, access to physios and physio involvement is assessments should be a key element of personalised care for many people.

Addressing musculoskeletal conditions and worklessness

The DWP has already introduced a scheme to improve access to support for muscle and bone related issues (musculoskeletal, or MSK conditions), which are the second most common cause of worklessness, after mental health conditions. MSK problems account for a significant number of lost workdays, with over 20.8 million days lost to sickness absence in 2020 alone.

Many people are already working with long-term conditions. Supporting them to stay in work and providing better occupational health support are therefore also critical. This was recognised by Liz Kendall in her speech to Parliament.

Navigating concerns about benefit changes

Liz Kendall said she is moving to ensure that payments to help with the cost of living with health conditions or disability are not dependent on a notional ability to work. Yet, despite the focus on supporting people into work, the announcement did propose changes to a range of benefits, aimed at saving £5 billion by the end of 2030.

For some CSP members the benefits changes could directly affect them or family members. Many members will have patients who are affected and distressed about what they’ve heard. It is understandable that there is concern around changing health and disability related benefits. 

Whilst some of the changes debated in the media in advance of the announcement turned out to be speculation, it hasn’t been all positive news. Some people who will never work may benefit but early indications are that others may have less generous support in the future, which is concerning for many people.

On the plus side, the UK Government's proposals would replace some existing benefits with time limited Unemployment Insurance. This will be paid at a higher rate than current benefits.

Liz Kendall confirmed that personal independence payment (PIP) value will be maintained and that it will not be means tested, nor will the mobility element change.

There are however proposed changes to PIP eligibility assessment for the daily living element. The changes will result in lower payments for an unknown number of people in the future.

The planned changes to Universal Credit are complex. The plan is to increase the health top-up for people who will never work and abolish reassessment for those with the most severe conditions. That will be welcomed by many.

The standard allowance will also go up but the value of the health top-up for new claimants will be reduced. Some people will benefit from this but those who develop long-term health needs in the future are likely to be less well supported through this benefit than is the case now. This has been criticised by many disability groups.

How the changes will affect individuals will vary according to personal circumstances; whether you are in or out of work, their level of needs and which benefits you are eligible for.

Judging the outcomes

A great deal of reliance is being put on the success of supporting people back into work. If this isn’t realised, the Government can expect pressure to relax benefit entitlements and to find more money for more generous payments.

As has been pointed out in the Parliamentary debate on the green paper, access to timely, high-quality, personalised rehab is going to be critical to moving from welfare to work. That’s where physiotherapy can play a key role. The CSP will continue to advocate for the essential role of physiotherapists in the recovery and rehabilitation journey both within the NHS and through DWP funded support for individuals.