King's College London

One of the most significant announcements within the March 2023 Spring Budget was that the Work Capability Assessment – the test of health-related “functional impairment” used to establish limited capability for work or work-related activity within the UK benefits system – is to be abolished. The Work Capability Assessment (WCA) has long been criticised for its poor ability to accurately or meaningfully assess a person’s capacity for work. Moreover, it is a highly distressing experience for those going through the process, exacerbating mental health problems and in some cases being linked to suicides.

In a general sense, then, the scrapping of the WCA might be seen as good news. However, there are concerns about what it will be replaced by, and the fact that – for all its flaws – it is still essential that disabled people and people with long-term health conditions have some process though which their work-related health limitations can be recognised and supported by the welfare system.

In the same week as the budget, we published an article which sets out some ideas for what a different type of approach to assessing work capability could look like. We focused particularly on mental health, an area where the WCA has been signalled as especially problematic. In the article, we put forward the suggestion that a more holistic approach to exploring work capability could be more productive. Whilst health would still be an important part of this, we consider whether a broader lens on mental health and work – to some extent shifting health out of its dominant and decontextualised place in the current WCA – might lead to a more complete and, therefore, productive understanding of what it might take for someone with a health condition to be supported into work.

Mental health problems rarely occur in the absence of a complex range of other personal, social, economic and structural adversities. We argue that by treating a mental health condition as a discrete and independent medical entity, the assessment process fails to acknowledge and understand the ways in which mental distress arises from and is inextricably linked with this wider range of circumstances in a person’s life. This may be why people often find it difficult to explain or articulate, within the narrow framework of the WCA interview, how their ‘mental health condition’ – viewed as a discrete medical entity – affects their ability to work.

We also highlight that the WCA is conducted in the abstract, not linked to the specific environment or requirements of any particular job. So much about ability to work is intimately connected to the particular role and workplace – the nature of the job requirements, the quality of management and support, other social relationships in the workplace, fit with aspirations and skills. Where people are experiencing mental health problems, capacity for work really needs to be considered with a particular work context in frame.

Finally, we emphasise the importance of looking at a wider set of socioeconomic and structural barriers and challenges, beyond – but often connected to – people’s mental distress. The feasibility of moving (back) into work depends on practicalities such as accessibility by public transport, availability of suitable and affordable childcare, relevant skills and qualifications, and stability and security in essential needs including housing, finances and personal safety. Our current research, looking at transitions between work and welfare, is also highlighting the fine balance that needs to be maintained with other household members’ work arrangements – the feasibility of one family member’s work is often contingent on that of another.

We suggest that a more holistic assessment of work capacity – a different kind of conversation, that considers not only the (fluctuating) effects of health issues but also the range of personal, social and economic circumstances impacting an individual – might offer a less distressing and ultimately more productive approach to understanding work capability. Such a shift would reduce the need to focus on a state of medicalised incapacity and open up space in encounters for a more empowering focus on capacity, capabilities, aspirations, and what types of work are (or might be) possible, given the right kinds of contextualised and personalised support.

Our propositions are not straightforward – but nothing about mental health is! It may be naïve to think that years of punitive approaches, which have sought to limit access to welfare support, will be turned around by the scrapping of the WCA. However, a glimmer of hope lies in the government’s commitment to test, evaluate and potentially expand the holistic Employment and Health Discussion for welfare claimants. These “people-focused” conversations, which consider all “health, personal, occupational and societal factors affecting the person”, represent a step in the right direction. Whilst we are yet to see how this plays out in practice, this moment opens a doorway to considering what a different approach could look like. Our article hopes to contribute to this conversation, with a focus on mental health.

Dr Annie Irvine is a Postdoctoral Research Associate at the Centre for Society and Mental Health at King's College London.

Tianne Haggar is a Research Assistant at the Policy Institute, King's College London.