What Pathways do IB claimants take from work to IB?

The literature has demonstrated the complexity of factors involved in increasing the number of IB claimants since the 1980s. The chapter will now outline the routes that people take today to enter IB which should be seen as part of the explanation for why people claim IB. It will be possible to identify points at which people with health conditions could be given increased support from their employers or other agencies in order to prevent labour market detachment.

The evidence available shows a diverse range of journeys onto IB (Nice and Thornton, 2004; Sainsbury and Davidson, 2006; Davidson, 2006; Kemp and Davidson, 2007). This does not seem to be linked to particular health conditions, although it is important to note that when a worker suddenly becomes unwell, there is less (and sometimes no) time in which employers could attempt to make adaptations to attempt to retain the worker.

Furthermore, differences relating to jobs can also determine whether sick workers are entitled to any sick pay or support from an occupational health department. Both sick pay and occupational support can be seen as buying a sick worker some time in order to attempt a return to their job in the future.

Sick workers who do not have such security become detached from the labour force much more quickly and often need to find an immediate alternative source of income. If they are unable to find alternative work, many sick workers will have little choice in satisfying their need for income but to claim some form of social security benefit. However, a complicated

124

and confusing benefits system does not mean that they will always end up claiming IB as soon as they would be eligible (Sainsbury and Davidson, 2006).

Amongst those who go on to claim IB, work, external factors or a combination of both factors can be seen as the causes of ill health (Sainsbury et al., 2008). The chart below attempts to summarise this complicated process, showing that the type of employment a sick worker has can have a large impact on their likelihood of claiming IB whilst sick. A factor that it has not been possible to show within the chart is that health conditions are also variable and can influence decisions about making accommodations within secure employment. In addition to the typology utilised by the DWP which looks exclusively at the aetiology of a condition (eg: musculo-skeletal and minor mental health), Hedges and Sykes (2001) propose that conditions can be:

• Complex, including multiple conditions

• Fluctuating or degenerative

• Acute, requiring long term treatment

• Short term, with an expectation for a quick return to good health

Furthermore, within secure employment, the type of work an employee undertakes, and has the potential to undertake, will influence how desirable it is for an employer to retain them. This is particularly relevant where employees have a physical health condition and there is not a ‘light’ job available for them to undertake, or they do not have the skills to undertake such a job.

An alternative journey to IB is from a previous IB claim via an unsuccessful return to work, and a return to IB under the linking rules. Within Sainsbury and Davidson’s (2006) research of the 36 new claimants coming from work, this situation applied to two claimants who had experienced deteriorating health since returning to work. Furthermore, Davidson (2006) notes that for

125

some people moves between insecure and low paid work and IB are common because of their labour market disadvantage. In such instances, it is sometimes the frugality of benefit levels, as opposed to feeling well enough to work, that prompts the end of a claim for IB and a return to the labour market. These moves are not always sustainable in the context of health conditions and labour market demands, prompting a cycle of unsuitable work and benefit receipt.

Whilst not all IB claimants were working prior to claiming IB in their study of 1,800 new claimants, the distinction between sudden onset and gradual worsening is also used by Kemp and Davidson (2007). The face-to-face survey found that 56% of new claimants experienced a gradual worsening of their condition and 44% of new claimants had a sudden acute episode.

126

Figure 4.4: Pathways from work to IB (neglecting severity of health conditions)

1. Health condition doesn’t affect work (K&D - 55% of cases)

Kemp and Davidson (2007) — K&D; Sainsbury et al. (2008); Irvine (2010)

Whilst the majority of the literature above has focused upon the journey, Sainsbury et al.'s (2008) research suggested that in cases where a mental health condition was the primary reason for claiming IB, work, external factors or a combination of both work and external factors could be the trigger for the mental health condition. This can be seen as a result of the more complex aetiology, and can lead to more complicated consequences.

What was of particular interest, however, was whether work was a trigger or not, many IB claimants felt ‘relief (p.95) when their jobs ended, particularly if they had been working with their condition for some time. This is of particular relevance if the labour market explanation of hidden unemployment for claiming IB is to be adopted as the primary discourse;

some people simply are not well enough to work and this should be acknowledged within policy.