The Green Paper on Disability Reform: a flawed effort to reform payments for people with disabilities

Dr Mel Cousins, School of Social Work and Social Policy, Trinity College Dublin

Key words: Disability, social protection

The paper is available to download here.

Introduction

The Minister for Social Protection, Heather Humphreys TD, has recently published a Green Paper on the reform of disability payments in Ireland (DSP, 2023). This has proved somewhat controversial leading to protests outside the Dail in December 2023.[i] The proposals have been seen by some as designed to import the UK system of ‘work capability assessment’ (WCA) to Ireland,[ii] although it seems very unlikely that this was the Minister’s intention. Nonetheless, the proposals set out in the Green Paper attempt to address two separate (though related) issues – the costs of disability and the low level of employment amongst people with disabilities – with one policy measure (a reformed payment system) which is very unlikely to achieve either objective. However, given the abject failure of current policy (with low levels of employment and high poverty amongst people with disabilities), there is a need for a constructive debate on how to improve the proposals, rather than fighting for the retention of the current failed system.

The policy context

Income support

The current system of income support for people with long-term disabilities (PWD) consists of two main payments: a means-tested disability allowance (DA), and a contributory invalidity pension (IP) administered by the Department of Social Protection (DSP). There is also a small (in numerical terms) means-tested blind pension (BP) and a partial capacity benefit (PCA) which allows a person with reduced capacity to return to work or self-employment and continue to receive a payment (see Table 1). These payments can be seen as being in implementation of Ireland’s obligations under Article 28 of the Convention on the Rights of Persons with Disabilities (CRPD). 

PaymentNumbersExpenditure (€M)
Invalidity pension56,450766
Disability Allowance157,8072,016
Blind pension99713
Partial Capacity Benefit3,09226
Table 1: Disability income support payments, 2022

In the last two decades there have been a number of reviews of disability schemes, including an overall review of sickness and disability benefits (DSFA, 2003); a subsequent review of disability allowance (DSP, 2010); and a study of issues concerning the barriers faced by people with disabilities in returning to work (in particular incentive issues) (Interdepartmental Group, 2017). Despite these reviews, there have been relatively limited policy changes in relation to disability payments over this period. In general, and in contrast to the position in the UK, conditionality measures in relation to people with disabilities have been non-existent[iii] and (despite the recommendations of several reports) activation measures[iv] to support integration of people with disabilities into the labour market have been very limited.[v] This would appear to be due to the recognition that integration of people with disabilities into accessible work is a complex issue; a related lack of skills on the part of many public agencies[vi] in this area; and a concern about negative publicity in relation to anything which might be interpreted as conditionality for people with disabilities.

Costs of disability

There is no overall payment to cover the cost-of-disability (unlike some EU countries and the UK) but there are a number of payments and schemes which, to some extent, cover disability-related expenses. These include the domiciliary care allowance (for children who require additional care), free travel (access to public transport), household benefits, etc. There are also some other supports for persons with disabilities such as the disabled drivers and passengers scheme, operated by the Revenue Commissioners. The motorised transport grant and mobility allowance which provided assistance with transport costs were terminated in 2013 (for new claims) and proposals for replacement schemes seem to have lost any traction.[vii] 

PaymentNumbers in receiptExpenditure (€M)
Domiciliary care allowance50,125224.5
Free travel[viii]197,683n/a
Disabled Drivers scheme5,73762
Table 2:  Costs of disability related payments, 2022

A range of studies have shown that people with disabilities in Ireland do incur additional costs (Indecon, 2004; Cullinan, et al., 2008; 2011; Cullinan and Lyons, 2014). These include equipment and disability aids; transport and communications; medical care; and personal care. As outlined in the Green Paper, a recent Indecon (2021) study commissioned by the DSP produced an estimated range of costs which are related to the degree of a person’s disability. The range of costs ranged from €11,579 to €16,284, or between €9,282 and €14,513 using an econometric/equivalent standard of living approach. This was based on a survey of direct costs reported by people with disabilities. The study also showed that the costs incurred by a person with a severe disability are estimated to be about €5,000 a year more than faced by an unemployed person without a disability.

Few would disagree with the conclusion of one study (Cullinan, et al. 2011) that

‘policies do not go far enough in addressing the extra costs faced by the disabled community in Ireland’.

This raises issues as to Ireland’s compliance with Article 28(2) of the CRPD.[ix]

The issue of how to address the cost of disability has been ongoing in Irish policy over a number of decades. The Commission on the Status of People with Disabilities (1996) recommended that there should be

‘a graduated payment to meet the additional everyday costs associated with disability. This payment, which would be made irrespective of whether the person is at work or not, would be called the ‘Costs of Disability Payment”.

An interdepartmental committee was later established to consider the issue under the then-social partnership agreement (Towards 2016). This concluded that the introduction of a costs of disability payment was dependent on both the availability of comprehensive data and a structured process of the assessment of need.[x] The scope and availability of disability-related services are also of critical importance in this area. In parallel, with the DSP/Indecon consideration of the costs of disability, the Department of Health published the report of a Task Force on Personalised Budgets for People with a Disability in Ireland (2018). This set out how personalised budgets could work as a funding mechanism for people with a disability to meet specified support needs. The HSE subsequently established a number of pilot demonstration projects to test models of personalised budgets and evaluate service user experiences and costs differences. These were extended until 2023 with an evaluation due in 2024.[xi]

The challenges facing social protection policy

The Green Paper highlights a number of challenges in relation to disability policy. The key issue is the high level of poverty facing people with disabilities. The Paper (p. 2) notes that the ‘consistent poverty’ rate of people unable to work due to long-standing health problems is just under 20% which is about nine times that of people who can work. One key driver of this high level of poverty is the fact that employment rates are very low for PWD. This is important both in terms of financial poverty but also, given the importance of work in Irish society, in terms of broader social exclusion. A further contributing factor is the fact that many people with disabilities have additional disability-related costs (as discussed above). So, in short, the current system of social protection (and related policies concerning employment and social services) is doing a very poor job even in protecting PWD from poverty and social exclusion let alone in the more positive sense of ensuring social inclusion.

An issue which is presumably of concern to the DSP – though not mentioned in the Green Paper – is the rise in the number of people on disability payments, specifically DA.  The total numbers in receipt of long-term disability payments have increased from 150,000 in 2000 to 218,400 in 2022. The growth in the total numbers on these payments means that persons on sickness and disability payments now make up the largest group of people of working age on welfare compared to unemployed persons (187,100 in 2022)[xii] or lone parents (only 43.200 in 2022).

The number of DA recipients grew by 55% in the decade to 2022 and only about half of this increase can be attributed to demographic and disability prevalence changes (Doyle, 2023). The majority of DA recipients (54%) are over 45 (with 78% over 30). However, the number of young claimants (under 20) has increased from 5% in 2016 to 8% in 2022. Over a third (37%) remain on the scheme for 10 years. Only 16% are in employment and DA claimants are more likely than the overall population to be working in lower paid sectors and occupations.

One third of inflows to DA in 2022 (13,800) came directly from Domiciliary Care Allowance (DCA), i.e. claimants turned 16 and transferred onto DA (Doyle, 2023).[xiii] A further third came from unemployment (34%) with a quarter (25%) coming from short-term illness benefit. Meanwhile, over half (54%) of all outflows from DA are not moving into work but onto other social welfare payments, mainly the State (old age) pension. Almost all inflows to IP (5,200 in 2022) come from short-term illness benefit, meaning that over 40% of all inflows to the two main long-term payments come from short-term IB.

The proposals

The Green Paper states that the reforms which it sets out are intended to address two specific aims. These are:

  1. to encourage a higher level of employment for people with disabilities, which will enhance their participation in society and reduce the risk of poverty and deprivation; and
  2. to better insulate (protect) disabled people who cannot work from poverty and deprivation.

The Green Paper proposes to replace the existing long-term disability payments (DA, IP, BP and PCA) with a new scheme, the Personal Support Payment (PSP) (with both contributory and means-tested components). For people who work, a new Working Age Payment (WAP – details to be announced) would replace the current fragmented system of employment supports. Thus, it is proposed to replace the current two main schemes (with two minor schemes) with three main schemes (PSP (con), PSP (non-con) and WAP).

The PSP would have three tiers:

  • Level 1: High support – Very low capacity to work (very unlikely to be able to take up any kind of paid employment for at least 2 years)
  • Level 2: Medium support – Low to moderate capacity to work (a disability that is expected to limit capacity to work for at least 24 months but may allow some limited types and durations of work).
  • Level 3: Low support – Moderate to high capacity to work (incapable of the type of type of work they were doing before acquiring their disability but capable of taking up other forms of employment and to do many types of work activity).

Persons on tier 1 would receive an increased payment equivalent to the current State pension rate (€277.30 per week), those on tier 3 would receive the current DA rate (€232.00) while those on tier 2 would receive an intermediary rate.

All people in receipt of PSP would have access to employment supports but this would be entirely voluntary for tier 1. Tier 2 would be required to make reasonable efforts both to engage with public employment service (PES) and to take part in training and other programmes appropriate to their circumstances. Tier 3 would have to engage with the PES and take up reasonable offers of places in training and employment programmes, and employment opportunities appropriate to their capacity and circumstances.

This has proven to be the most controversial aspect of the proposals because of some resemblance to the UK work capability assessment approach. However, the intention seems to be to provide a higher rate of payment to those incapable of work in recognition of the loss of income and (one assumes) on the assumption that they face higher disability costs.

The age at which Personal Support Payments can be accessed will be standardised to 18, i.e. people on DCA would have to wait to the age of 18 to claim PSP rather than the current 16.[xiv]

Discussion

There are a number of issues with the proposals. First, they do not address the costs of disability issue in any coherent manner. If the higher rates of benefit to people with higher levels of incapacity are intended to do this, there is a lack of evidence as to what disability costs people of tier 1 might have or the extent to which they may vary depending on personal and other circumstances. And, of course, this proposal is of no benefit at all to people with disability-related costs who do not receive a disability payment, e.g. people on State (old age) pension.

In terms of employment, the Green Paper proposes that PWD should have to engage with the employment services. It does not explain how the employment services will be made to engage with people with disabilities. It seems highly unlikely that the current employment services would be able to engage in a meaningful manner with significant numbers of people with disabilities. As critics of the proposals have pointed out, the Green Paper does not include proposals to remove barriers to employment, such as improving workplace accessibility or disability equality training for employers.

A review of international experience would suggest that, indeed, it is difficult to get people who are on long-term disability payments (back) into the labour market (OECD, 2010). Therefore, rather than an emphasis on welfare-to-work, there needs to be an emphasis on work-to-welfare, i.e. on limiting the movement of people from employment to welfare by facilitating their retention in employment. This would address the main source of inflows to long-term disability payments.[xv]

To do this, there are two key lessons from a policy perspective. First, as highlighted by the OECD (2010), there is a need for cultural change supported by financial and other incentives for all actors (employers, individuals, medical professionals and social protection authorities) to promote work-retention and return to work. As part of this, reforms need to take into account the overall labour market and social protection systems to ensure that particular approaches will have a positive impact and not simply lead to a transfer of costs from one sector to another or a transfer of claimants from one welfare scheme to another.

Second, early intervention to reduce sickness absence and promote return to work is most effective. The countries which have been most successful in achieving return to work (such as the Netherlands) have put the focus on assessing work capacity and developing return to work plans at an early stage. In contrast, by the time people are approaching long-term incapacity they have (almost by definition) reduced work capacity and they are further from the labour force. Rates of return to work from long-term disability are low in most countries.

International experience shows a number of measures which could be relevant to Ireland (Cousins et al., 2016). These include reforming the role of sickness certifiers to place an increased emphasis on return to work; strengthening early reassessment of people at risk of moving onto longer-term receipt of sickness and disability payments; and engaging employers centrally in the process in the context of the new statutory sick pay scheme. Despite the difficulties involved, a more structured approach to supporting people with disabilities into employment should also be developed. In this context, there is a case for looking at whether the approaches adopted in Norway (e.g. dialogue meetings between worker, employer and doctor)[xvi] and the UK (e.g. Work and Health Programme) could be relevant in an Irish context. The Work and Health Programme (WHP) is an employment support programme which provides support to people to find and keep a job and is available to persons with health conditions or disabilities, and others. Evaluations have found a range of positive outcomes for WHP participants (DWP, 2023).

A similar approach to assessing need and providing support on a voluntary basis to young people capable of work (with appropriate supports) would appear to be a much more appropriate option than placing people aged 16 (or even 18) on a long-term disability payment with little possibility of progression (currently one-third of inflows to DA). Finally, the rationale for moving people on a conditional payment (JSA) to an unconditional payment (DA) and then reforming this to make it conditional (PSP) is unclear.

For the costs of disability, disability-related needs could be addressed either by the provision of services or through cash which would allow people to purchase services or address needs in another way (Indecon, 2021, chapter 10). However, to date, the issues of disability services and costs of disability have been addressed in parallel and in a largely institutionally-bounded manner in Ireland. It would appear desirable to have a more joined-up approach to this issue involving both Departments of Health and Social Protection.

Conclusion

The current system of disability support is not working and the Green Paper provides an opportunity to improve it. But the main focus needs to be (insofar as possible) on stopping people drifting into long-term reliance on disability payments which requires a broader scope than that adopted by the Green Paper. It is important to engage with people moving onto disability payments but, so far, this has barely been tried in an Irish context. So, there is no evidence that compulsory activation is necessary or that the PES could support it. And while the idea of categorising people by level of disability sounds appealing, assessing disability is an inherently difficult task (Cousins et al., 2016). There is nothing to suggest that the approach proposed (using current assessment methods) can do this in a reliable manner.

References

Cousins, M., Roberts, S. and Stafford, B. (2016). Comparative systems of assessment of illness or disability for the purposes of adult social welfare payments, National Disability Authority. Available: https://nottingham-repository.worktribe.com/index.php/output/771631/comparative-systems-of-assessment-of-illness-or-disability-for-the-purposes-of-adult-social-welfare-payments-first-report-final-incapacity-for-work

Cullinan, J., Gannon, B., Lyons S. (2008) New Estimates of the Cost of Disability in Ireland Using the Standard of Living Approach (Working Paper No. 0134) Department of Economics, National University of Ireland, Galway

Cullinan, J., Gannon, B., & Lyons, S. (2011) ‘Estimating the extra cost of living for people with disabilities’. Health Economics, 20(5):582-99.

Cullinan J. and Lyons, S. (2014) ‘The private economic costs of adult disability’ in J. Cullinan, S. Lyons, and B. Nolan (Ed.), The Economics of Disability: Insights from Irish Research, Manchester University Press.

Department of Employment Affairs and Social Protection. (2015). Disability Allowance Survey.  Available: https://assets.gov.ie/212417/b991a163-0b79-4f0f-8d2c-07e9c893b328.pdf

Department of Health, (2012). Value for Money and Policy Review of Disability Services in Ireland, Department of Health

Department of Social and Family Affairs, (2003). Report of the Working Group on the Review of the Illness and Disability Payment Schemes, Department of Social and Family Affairs.

Department of Social Protection (DSP) (2010).  Value for Money Review of the Disability Allowance Scheme, Department of Social Protection.

Department of Social Protection (2012). Domiciliary Care Allowance Review. Department of Social Protection

Department of Work and Pension (DWP) (2023). Work and Health Programme Evaluation Research Report. Department of Work and Pensions. Available: https://www.gov.uk/government/publications/work-and-health-programme-evaluation-synthesis-report

Doyle, A. (2023). An Assessment of the Disability Allowance Scheme Trends and Characteristics. Government of Ireland. Available: https://assets.gov.ie/271075/fbfe982e-a189-434f-a130-e4c97e51df6f.pdf

Indecon (2004). Cost of Disability Research Report. National Disability Authority.

Indecon (2015). Evaluation of the Disability Activation Project, Department of Employment and Social Protection

Indecon (2021). The Cost of Disability in Ireland, Department of Social Protection. Available: https://www.gov.ie/en/publication/1d84e-the-cost-of-disability-in-ireland-research-report/

Interdepartmental Group (2017). Making Work Pay for People with Disabilities, Government of Ireland. Available: https://assets.gov.ie/10940/c4c20348897148eb9a50ac2755fd680f.pdf

Leonard, E. ‘Assessing the policies to assist Disabled People to access Employment in Ireland’ Available: https://publicpolicy.ie/labour-market/assessing-the-policies-to-assist-disabled-people-to-access-employment-in-ireland/

Markussen, S. and Røed, K. and Schreiner, R. C., (2018). ‘Can Compulsory Dialogues Nudge Sick‐Listed Workers Back to Work?’. The Economic Journal, Vol. 128, Issue 610, pp. 1276-1303, 2018.

OECD. (2010). Sickness, Disability and Work: Breaking the Barriers. OECD. Available: https://www.oecd.org/publications/sickness-disability-and-work-breaking-the-barriers-9789264088856-en.htm Task Force (2018). Task Force on Personalised Budgets for People with a Disability in Ireland. Department of Health. Available: https://www.gov.ie/en/publication/4ea89a-task-force-on-personalised-budgets/


[i] Irish Times, 7 December 2023. https://www.irishtimes.com/politics/2023/12/07/coalition-of-disability-groups-set-for-mass-protest-outside-dail-against-plans-to-reform-welfare-payments/

[ii] On WCA see https://commonslibrary.parliament.uk/research-briefings/cbp-9800/

[iii] That is policies requiring claimants to satisfy work-related condition to qualify for benefits (such as job search). For example, recipients of disability payments are not subject to any jobsearch requirements and were excluded from the reduced payments for persons aged 25 and under.

[iv] That is policies to support people with disabilities in taking up employment.

[v] See Indecon (2015, 61) for an evaluation of the pilot Disability Activation Project. This found that, despite being positively received by participants and employers, the project showed ‘weak outcomes as a labour market activation measure (where activation is defined as assisting people with disabilities to work in the open labour market and who have the capacity to work for at least eight hours per week)’.

[vi] Such as detailed labour market knowledge, detailed knowledge of issues facing people with disabilities and detailed knowledge of the policies which would support activation and how to implement them.

[vii] Dáil Eireann debate – 4 May 2023. Transport Support Schemes for People with Disabilities: Motion [Private Members] https://www.oireachtas.ie/en/debates/debate/dail/2023-05-04/18/?highlight%5B0%5D=ombudsman&highlight%5B1%5D=ombudsman&highlight%5B2%5D=ombudsman

[viii] Includes persons on DA, IP, IB.

[ix] The CRPD does not refer to general support for the costs of disability but only to targeted supports.

[x] Dáil Debates, Tuesday, 20 Apr 2010

[xi] Department of Health. 2022. Minister Rabbitte announces extension to Personalised Budget Pilot until 2023. Press Release, 1 July. https://www.gov.ie/en/press-release/4e443-minister-rabbitte-announces-extension-to-personalised-budget-pilot-until-2023/   

[xii] Including jobseekers’ allowance and benefit and Farm Assist.

[xiii] Doyle reports that almost half of those aged 15 on DCA transfer to DA once they reach the scheme’s maximum age.

[xiv] The Green Paper sets out limited transitional provisions for this group.

[xv] This, of course, is also dependent on people with disabilities being able to access the labour market in the first place. See Leonard (2023).

[xvi] Markussen et al. (2018) found that such meetings, organised by the local social security administration after around six months of absence, to discuss whether arrangements can be made to facilitate partial or full work resumption reduced absence duration considerably.