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Back to Work or Back against the Wall: responding to the 2023 Autumn Statement

Dr Gabriel Lawson

Research Associate

23 November 2023

The 2023 Autumn Statement has proposed several changes to policy that aim to help people return to work after ill-health but will its approach actually encourage and support people to do this? Dr Gabriel Lawson from the ESRC Centre for Society and Mental Health and the Policy Institute at King's considers the proposals in the light of responses from stakeholders and insights from the Centre’s researchers.

With 2.5m people out of work due to ill-health, there is a clear need for reform to support people experiencing ill-health, both in and out of work. Mental health and mental ill-health are key contributors to this figure. Data from the Office for National Statistics data indicates that more than 50 per cent of those inactive because of long-term sickness reported depression, bad nerves, or anxiety in the first three months of 2023. As such, action is needed not only to support those with mental ill-health but also to help prevent mental ill-health from emerging.

The Autumn Statement and the government’s recent ‘Back to Work Plan’, has made a number of changes to expand access to employment support. However, the evidence suggests further reform is needed, including a move away from welfare conditionality, which requires people to meet certain conditions to receive benefits, while under the threat of sanctions.

The need for more holistic approaches

The expansion of additional employment support for those experiencing mental health difficulties is a welcome change, in the form of wider access to Individual Placement & Support and the doubling of capacity on Universal Support. It is also a policy supported by research from Centre members which indicates that those experiencing mental health difficulties need holistic keyworker support, in combination with access to a range of interventions focused on health, wellbeing, finances, skills and employability. Individuals need personalised, tailored and flexible support, based on a long-term and consistent relationship of trust and support with a skilled and empathic keyworker, which can help them overcome physical, psychological, financial and skills-related barriers and enter the workforce.

Two things are important here. Firstly, people need to be seen as more than a mental health issue to be treated. People need support to boost their confidence and self-belief, to reach a baseline of financial and personal security, and to identify jobs that fit with their wider life circumstances and aspirations. Secondly, effective employment support takes time and trust. Mandatory work programmes tied to conditionality and sanctions fuel fear, anxiety and mistrust, which are major obstacles to engagement and positive progress.– Dr Annie Irvine, Research Fellow, ESRC Centre for Society and Mental Health

Conditionality is not the way forward

It is therefore concerning that these new measures have been accompanied by an increased focus on conditionality and sanctions within the welfare system. The Chancellor has claimed that individuals are wilfully leaving the workforce but this is not the case and neither is the proposal that the simplistic approach of conditionality will result in more people entering the workforce. The least well-off in our society need support, not sanctions. Indeed, evidence from around the world suggests that conditionality is counterproductive for people with health conditions, pushing them further away from work – as well as risking hardship and deteriorating mental health.

For many people with health problems claiming benefits, they simply don’t know how they would cope in the workplace – it's simply not clear whether it would work out, or be a disaster. Ideally claimants could experiment with things, safe in the knowledge that they will still have enough money to live if it doesn’t work out. Sanctioning, however, drives people to hunker down rather than to experiment. This explains why the evidence – and the overwhelming majority of frontline experts – suggests sanctioning would be counterproductive.– Professor Ben Geiger, Professor in Social Science and Health at King’s College London

In the short term, the recent policy suggestions from the Money & Mental Health Policy Institute make for a more effective and considerate approach. These include more accurate assessment for claimants, better training for DWP staff, and a mandatory mental health impact assessment, which must be completed before sanctions are applied. In the longer term, many organisations working with the people who are affected by these policies agree that a move away from conditionality would improve outcomes for everyone involved with the welfare system.

What is ultimately needed is a more ambitious strategy to tackle the wider determinants of mental health. The root cause of mental ill-health is often located in larger structural factors such as poverty, poor housing, relationship breakdown, violence, or childhood trauma. It is only by addressing these factors through measures at a societal level and in partnership with communities that we will improve mental health inside and outside of the workplace.