1 July 2004

Malcolm Wicks MP, Minister of State for Pensions

Opening of the UnumProvident Centre for Psychosocial and Disability Research

Cardiff University 1 July 2004

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It is a real pleasure to join in launching the UnumProvident Centre for Psychosocial and Disability Research. It brings together a rigorous approach to research and evidence in a leading academic school in Europe; a refreshing linkage between classic medical studies, medical sciences and wider health related research; and a partnership between industry and the university.

They are all important because the centre will be the first in the UK to develop specific lines of research into the psychosocial factors related to disability, vocational rehabilitation, and the ill-health behaviours which impact on work capacity.

It will develop tools to identify people at risk of long-term incapacity for work, by understanding the psychological, social and cultural influences which can lead to ill health. It will evaluate more effective interventions and support for sick and disabled people. These are all highly complex, emotionally charged and contentious topics, and so political ones too, as anyone reading the daily newspapers this week will have seen.

Mansel brings, amongst his other skills, experience from the civil service and working with Ministers, helping us to understand how and why people move onto benefits and a life of dependency. The academic policy analyst is less concerned with the immediate public spending implications of his or her concluding recommendations even when occasionally these, in fact, cost a billion pounds a paragraph. The civil servant, Minister or shadow Minister does not have the luxury of ignoring such reality.

Another critical difference concerns timescales. We need more researchers willing to help in our imperfect political environment. The country's leading experts may have real results in 18 months' time, but the question may be confronting policy-makers now and is due for a debate in Parliament next month. When everyone else has an opinion on the matter, from the woman on the Clapham onmibus, the know-it-all in the saloon bar and the tabloid editor, the scholar may of course choose to keep the scholarly head down in the senior common room, but many show willingness to get stuck in. Government is expected very often to have answers to immediate questions. The public, our constituents and voters, have problems and needs which call for solutions: they elect governments to govern!

So what should Mansel create in the Centre? First, some mutual understanding. From the policy-makers, an understanding of the academic endeavour – its values, role, concerns, methodologies and timescales. And, conversely, from the academics an understanding of the political world – when exactly to make an impact, a recognition that while work needs to be put in hand for the long haul, today's agenda has to be addressed.

Having spent much of my career, before becoming an MP in 1992, in policy-related social science, I am fully signed up to the notion that social science has much to contribute to the business of government – to our understanding of societal change, to the analysis of social ills (and strengths too) and, simply, to how we might do things better. The government has recognised the importance of this research by appointing the first Government Chief Social Researcher, and her background is in research around social security. Unfortunately, she could not be with us today.

So, I am particularly pleased that the new centre will be looking at ‘social and cultural influences’ as part of its work, and so using the techniques and expertise of social research. I am not saying that all social science is, or should be, policy-oriented: as with the natural sciences, we need pure and theoretical work which is of value in its own right, but which might – just might –- raise practical questions for tomorrow's practitioners. I hope that Mansel will be able to guide the new Centre to balance the agendas of the policy -maker and the researcher, the former requiring solutions and the latter raising complex questions.

We now enjoy an unparalleled period of continuing prosperity. Unemployment is falling to levels that would have seemed impossible ten years ago, and which have not been seen for 30 years. More people are in work than ever before. You may have seen such statements in press releases from the Department for Work and Pensions, and they are true.

But, there are still complex problems that we need to address, and which do not fit easily into the short timescale of the media. The Research Assessment Exercise might concentrate academic minds, but there is also the Radio 4 ‘Today’ and ‘Newsnight’ tests :

So, we have a geographical problem which has to be addressed within the context of a social security system which deliberately takes no account of local circumstances but uses abstract concepts of ‘incapacity and ‘disability’ rather than the real barriers to work facing an unemployed man of 50 with indifferent health, few skills, and living in a Welsh valley. And a categorisation problem of those of working age who are not working; are we simply forcing them from the category ‘unemployed’ to the category ‘sick and incapacitated’. Are our expensive administrative efforts simply squeezing around the toothpaste in the tube?

The numbers on Invalidity Benefit tripled between 1974 and 1995. 60% of recipients had musculo-skeletal problems, and 40% back pain. Many of those with back pain had no discernible functional disability. The Incapacity Test (now the Personal Capability Assessment) which Mansel designed meant that many of them would no longer be considered entitled to benefit. With the test, the almost exponential rise in benefit recipients slowed, and showed little increase between 1996 and 1998. The rate of increase then speeded up again, to rates last seen in the early 1980s. There are now 2.7 million people of working age on an incapacity benefit. 2.4 million are claiming Incapacity Benefit itself, and 51% of those on Income Support are also classed as disabled. The levels vary between regions, and Wales has one of the highest. The overall cost to the taxpayer is a staggering £16 billion a year.

As before, this increase does not reflect an increased inflow onto benefit, indeed the inflow has fallen progressively since the test was introduced and must therefore be rated as a success. But, the outflow has slowed so that, for the first time, more than 50% of those on the benefit have received it for five years or more. How can we explain this increase from 46% in November 2000 to 51% in November 2003? Particularly when we know that 90% of those coming onto benefit wish and expect to return to work. And how do we explain that the greatest single cause of recipients being on benefit is now mental health problems, accounting for 33%, and well above the 21% for diseases of the musculoskeletal and related systems? Half the inflow now comes from unemployment, and we know that unemployment affects mental health after as little as six weeks. But, a biological explanation for these observed changes in chronic disability is hard to adduce. For example, as far as back pain is concerned, changes in the physical condition or pathology of the human back cannot be advanced as a reason. Health and Safety Executive statistics have not revealed any major change in work-related back injuries, and physical demands of work are generally reducing. All of this is set against a background of improvement in most objective measures of health.

It was, therefore, inevitable that we would reach the stage where democratic governments would have to cast a critical eye over the validity of claims whilst always seeking to ensure proper, and better, provision for those with a disability. How we achieve objective standards by which disability can be judged and 'malingering' defined, offering security to the vulnerable while protecting public funds on behalf of the taxpayer, provides us with a significant social policy dilemma in the 21st century.

It is important to make a clear distinction between symptoms and disability in clinical practice and as the basis for sick certification and social security benefits. Disability is more complex than biological symptoms, depending also on the individual, their health status and their social situation – and the complex interactions between them.

We therefore need to understand the motivations and mental reactions of those who move onto benefits, and then stay there. The focus must not be only on Illness Deception, but use insights into, and discussions of, such diverse subjects as behaviour among non-human primates, current models of disabilities and imaging of areas of the brain which may reflect conscious and unconscious processes of the mind. This work must feed into the needs of the policy-maker; to explain how to help people on benefits to recover, and move to seeking work. He also needs to be able to identify those at risk of moving onto an incapacity benefit, and understand how to help them too.

These are new areas for the social security system, but we now have appropriate helpers within Jobcentre Plus. Personal advisers supplement the work of the Disability Employment Advisers, bringing new skills to helping clients of the integrated Jobcentres which themselves bring together the old skills of the Benefits Agency and the Employment Service. The Pathways to Work pilots reflect a new partnership between the NHS and the social security system; providing health interventions through Jobcentre Plus personal advisers and bridging an administrative gap which Beveridge recognised but left to others to fill. The new centre we are inaugurating today will examine areas into which we need to extend the role of our personal advisers.

It is therefore both entirely appropriate that it should be based in Wales where the problems exist so starkly, and that the First Minister and I should eagerly hope for the results of its work.

So, let us thank the Cardiff University and UnumProvident for giving Mansel the chance to set up this innovative new Centre. It will examine issues of vital importance. Let us hope for great things of it. And a conference to hear what it produces.

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