Author
BAMBRA Clare; WHITEHEAD Margaret; HAMILTON Val;
Title
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.
Journal citation/publication details
Social Science & Medicine, 60(9), May 2005, pp.1905-1918.Summary
Sixteen studies of the impact of ‘welfare-to-work' strategies, designed to help those who are disabled or chronically ill move off benefits and into work, are examined. The proportion of participants gaining employment after involvement ranged from 11% to 50%, but it was difficult to determine if improved employment chances were due to the effectiveness of the intervention or external factors. Some interventions were found to be more soundly based than others, most notably education, training and work placement, and vocational advice and support services, but the evidence does not point to any one intervention as significantly better than any other.
Context
In the UK people with disability and chronic illness are associated with poverty and social exclusion because they have disproportionately low employment rates. This group accounts for 25% of all benefit expenditure in the UK . The ‘welfare-to-work' strategy aims to promote the move away from benefits and towards employment. This systematic review examines the evidence for the effectiveness of the five main ‘welfare-to-work' strategies; education training and work placements; vocational advice and support services; in-work benefits for employees; employer incentives and improving accessibility of the work environment.
Methods
What sources were used?
Seventeen databases were searched: ASSIA, Caredata, Cochrane Library, Dissertation Abstracts, Business Course Premier, Embase, HMIC, IBSS, Index to Theses, Infotrac, Medline, PolicyFile, PsycINFO, SIGLE, Social Services Abstracts, Sociological Abstracts and Web of Science. In addition, organisational websites were searched, including UK government departments, Employment and Disability Network, ESRC, Joseph Rowntree Foundation, Social Policy Research Unit and Centre for Research in Social Policy.
What search terms/strategies were used?
The search strategies are not given. The date limitation was 2002 onwards.
What criteria were used to decide on which studies to include?
The review sought to identify experimental and observational quantitative and qualitative studies that examined the effectiveness of welfare-to-work interventions specifically designed to help individuals with a disability or chronic illness in the UK to move into work from welfare benefits. The focus was on individuals of working age (16-59/64 years). Studies that did not include employment as an outcome were excluded, as were studies examining the impact of discrimination under the Disability Discrimination Act 1995 .
Who decided on their relevance and quality?
The search identified 5,399 studies in total, of which 105 were examined in detail. The data were extracted by one reviewer and checked by a second, both unnamed. Both reviewers critically assessed each study against the appraisal criteria.
How many studies were included and where were they from?
Sixteen studies met the inclusion and critical appraisal criteria. Of these, seven were identified by electronic database searching, six from website searches, two from personal communications and one from citation follow-up. Three other potentially relevant studies were unobtainable. All studies were conducted between 1993 and 2002.
How were the study findings combined?
Studies were combined using study details, evaluation methods and employment outcomes. Quantitative methods were control, response rate/follow-up and sample size. Qualitative methods were sample and interpretation of findings.
Findings of the review
Education, training and work placement programmes : four studies assessed the effectiveness of education, training and work placement programmes, including two government Work Preparation schemes, New Deal initiatives and a residential training scheme run by specialist colleges. All studies found a positive impact on employment, with employment after the intervention ranging from 15% to 50%, but they differed over which aspects of the programmes were most successful and for whom. None of the studies was controlled.
Vocational advice and support services : four studies evaluated vocational advice and support services. All showed improved employment chances among people with disability or chronic illness. Only one study included controls and it found no statistical difference in outcomes for participants and non-participants.
In-work benefits : in the four studies evaluating the strategy of providing in-work benefits, awareness and uptake of the benefits among the target population was found to be low, but the benefits had a positive influence on employment among those receiving them. Disability Working Allowance, a wage top-up incentive, was not found to be effective. Only 2% of disabled people moved into work in 1993, a majority without the support of the allowance, and only 200 of those claiming the allowance (3,500) were encouraged into work by the scheme. The study challenges assumptions made about awareness of the allowance and the quality of work wanted/possible by disabled people. The Travel to Work scheme, which provided financial assistance towards transportation, was seen to be important in allowing disabled people to take up and keep their employment. A study of other in-work benefits, including the Disabled Persons Tax Credit, showed mixed results.
Employer incentive initiatives : the two qualitative studies of evaluations of employer incentive initiatives both indicated that a majority of participants obtained employment after the intervention period. However, the importance of the incentive was questionable because of the low skill/low paid nature of the work and the low level of the subsidy offered.
Four studies examining the Access to Work scheme which was introduced in 1994 (comprising travel support, on-the-job support, aids and equipment and alterations to premises) were reviewed. None of these studies was controlled. The results were generally positive for participants, who reported that they would not have commenced employment without the scheme. However, this view was not shared by the employers. There was no specific evidence of Access to Work helping disabled people from benefits into work.
Authors' conclusions
The review concludes that ‘there is evidence that the various welfare-to-work programmes helped people with disabilities into work who were previously on benefits'. The proportion of participants gaining employment after involvement in one of the programmes ranged from 11% to 50% and participants generally reported positive perceptions and experiences of the schemes. However, the lack of controlled studies means that it is not possible to determine how much employment could be attributed to the programme and how much to external factors. The larger studies were ‘unable to unpick the barriers and facilitators concerned with the effective implementation of the schemes', in order to ‘aid design of initiatives in the future'.
The quality of the evaluation outcomes was found to be variable, both in quantitative and qualitative studies, and ‘experimental evidence was particularly lacking' with subjective assessments and little evidence about the characteristics of successful participants in terms of gender, age, type of disability or socio-economic status.
The incentive appeal of existing in-work benefits, both to employee and employer, was found to be low because the financial value of these incentives does not match the expectations or desires of disabled people who want ‘proper jobs paying a fair wage rather than low-paid, part-time employment with earnings topped up with state benefits.'
Implications for policy or practice
The evidence tentatively suggests that some types of welfare-to-work interventions are more soundly based than others, but ‘no single UK welfare-to-work approach stands out as by far the best way of solving the twin policy problems of low employment rates amongst people with a disability or chronic illness, and rising numbers of incapacity benefit claimants'. Strategies to prevent individuals with a disability or chronic illness leaving employment in the first place, such as those in place in other European countries, should be considered.
Related references
None