Detached from reality

What’s wrong with the way we design the welfare system

How welfare policy got stuck

This might sound strange, but I’m optimistic about the future of social security. There is a shared feeling across my profession that the country is stuck when it comes to welfare policy; with that, there’s a growing consensus that, as a nation, we need to change the way things are done. This is where the glimmer of hope lies for me.

The benefits system is a part of British life that feels broken. The trends over the last 15 years have barely changed: spending keeps going up, while significant change to longstanding issues fails to materialise.

When it comes to benefits policy, the conversation about change is either focused on specific policy reforms, or levels of support the system provides. Both are important in their own right, and need action. But I’m concerned that unless we look at the way we make welfare policy, we will be limiting the chances of ever achieving genuine change in terms of outcomes and value for money.

I believe there are two problems to address:

First: governments have become more and more fixated on short term cost savings as a measure of success. This has meant they are, at best, treating symptoms rather than causes. At worst, they have simply been bearing down on people’s living standards.

Second: welfare policy is still rooted in the outdated notion that the way people make decisions is mainly driven by narrow financial incentives, and nothing else. Years of reform have focused too much on financial incentives, carrots and sticks — at the expense of developing our understanding of the variety of wider factors that contribute to people’s rational choices and actions. Who gets to decide what “rational” even means? One person’s priority is another person’s irrelevance.

If you start with two assumptions: that short-term savings mean success, and that narrow financial incentives are the main thing driving peoples’ decisions — then you end up with a system that can get 60% of unemployed people back into work within 9 months. But over decades, that same system barely moves the dial on the numbers of people on benefits moving from “unable to work” to “working”.

These two assumptions are both entrenched in the way we make welfare policy. They have become unchallenged, received wisdom.

Focusing on these assumptions when we make policy means we miss other, potentially more important, factors that could contribute towards progress on the areas where the system doesn’t work well.

Factors like: the additional barriers caused by disability, skills or adequate childcare; or the role of risk aversion; or overloaded cognitive bandwidth in people’s decision-making.

I’ve given benefits advice to more people than I can count over the years. This experience has led me to conclude that these other factors play a huge and largely overlooked part in the way many people make decisions about their lives. Those decisions are not based on narrow calculations of marginal financial gains — as policy often implicitly assumes — but on complex weighing-up of the pros, cons and barriers that need to be overcome.

This narrow focus is not only hindering progress, it is handcuffing it. It means policy development relating to these more complex longstanding challenges has to first mitigate for a system that wasn’t designed for people in those circumstances, before it can start actively looking at progress.

I believe the solution lies in helping frontline welfare service staff to make the most of their deep understanding of the complexity of claimants’ lives. This rich knowledge and insight needs to inform the design of the whole system, and not just when people walk into a Jobcentre.

I want to share my insight on how policies based on short-term cost savings and narrow financial incentives play out on the ground, and how they’re experienced by hundreds of thousands of people every day. The assumptions behind these policies are found across the benefit system, but for now I’m going to focus on how they affect one group: people who have a health problem or disability that stops them from working.

I’m also going to set out some suggestions for change — two of them structural, and one very practical, to unlock the potential of occupational therapy.

Radical change is necessary, I’m convinced of that. Without significant change in the way we form benefit policy, we are likely to spend more and more money on worse and worse outcomes.

Benefit enquiries have been the number 1 topic at Citizens Advice for 15 years. Over that time we’ve helped 9.5 million people with enquiries relating to benefits. In the last year alone, we have helped over 600,000 people with over 3 million benefits issues. Even before the pandemic and now the cost of living crisis, we were regularly helping over half a million people a year who were struggling with the benefit system. That’s 5 people per minute needing support and advice.

If you don’t already work at the frontline of public services, it’s hard to grasp how structural assumptions create new practical problems for ordinary people like the hundreds of thousands who come to Citizens Advice. So throughout this paper, I’m going to tell you real stories about real people I and my colleagues have met and helped. Their names and some minor details have been changed for anonymity; but the stories are true, and the people are real.

Let’s start with Dave.

Dave’s story

Dave came to Citizens Advice a few years ago. He spent 30 years driving lorries, but developed cancer and couldn’t currently work.

He often said that he felt things went from bad to worse in his life as his mental health deteriorated and his marriage broke down from the stress of it all. His recounting of his situation was much more colourful, littered with swear words and dry laughter.

He was full of colourful stories about life on the road — the friends he’d made, the places he’d seen, his favourite service stations. But getting information out of him about his current condition was difficult. He found it hard to open up.

The disability benefits he received included payments because he couldn’t work — but these were stopped after a review. By this point his cancer was in remission, but the toll it had taken on his health and life was clear. He needed help with the basics of self care — washing, eating, dressing and getting around in the house. He separated from his wife, but neither of them could afford to move out. She ended up helping him with sponge baths. Over a few years, his life had become unrecognisable.

The services around him weren’t geared up to help. The numerous assessments he went through were in effect ways of prioritising access to limited support — healthcare, social services, disability benefits — rather than interventions to help him figure out how to adapt and cope. Support was limited because the funding to provide it kept being cut, and was prioritised for those with the most severe need. His benefits were paid at a lower rate, to ensure he would be better off if he returned to work. He was definitely keen to go back to work, but it was lower down on his long list of things to deal with.

Dave got to the point where he had stopped telling services about health changes and the worsening of his situation, because the whole thing seemed so pointless to him. None of the assessments seemed to reflect his reality, or the severity of change in his life and none of them seemed to help him without a battle. He felt trapped by systems that didn’t understand his priorities, and couldn’t account for the things he had to think about, in order to make decisions or change things.

Dave reached the point where sticking with the status quo, no matter how miserable and difficult, was less risky and less challenging than trying to get the right level of support.

I helped Dave to appeal the benefit decision, get a new social care assessment, and access funding for a builder to install a wet room with special adaptations, so he didn’t have to rely on his ex-wife for incredibly personal care.

We helped his ex-wife get advice so she could go through her housing options and get support with adapting to the change in her life.

It took a year to get his disability benefits back in place. A year where Dave had to go without the critical income he needed to help him deal with the challenges he faced every day. A year where all of Dave’s energy was focused on fighting the benefit system, rather than adapting to his new reality — including considering what type of work, if any, he could now do.

An adviser’s view on the benefits system

My name is Kayley Hignell. Dave was one of the hundreds of people I helped as an adviser in several local Citizens Advice offices — now I work in our central policy team. I’ve been part of Citizens Advice for 15 years. I’ve worked in 15 children’s centres, 5 mental health clinics, doctor’s surgeries, community centres, and in people’s homes. My experience includes a year spent on secondment at the Department for Work and Pensions, and membership of the Social Security Advisory Committee. I’ve built up a huge amount of knowledge when it comes to benefits, and the policy that shapes them.

I’ve seen countless reforms and tweaks to the system play out in practice. I like to think my knowledge as well as practical experience gives me the privileged position of seeing how benefits work for individuals, what that looks like across the country and over time, and why benefits work in the way they do.

Every day as an adviser is different, and every person’s circumstances are different. Every day I meet people whose lives have been turned upside down by relationship breakdowns, health problems, bereavement, and loss of income. The problems they face are complex, but not unusual.

While every family’s story is new, they all face similar wrong turns, steep hills and dead ends while trying to get help from the benefits system. Too many of them are just surviving, rather than actually getting the sort of help that will allow them to move forward and change their circumstances for the better.

At Citizens Advice, we get privileged insight into the minutia of people’s daily lives, because they come to our offices and open up. We hear about the disagreements people are having with their bosses or their partners. We hear about their income, their bills, and the cost of their food shopping to the penny.

We hear about their health ups and downs, their hospital and GP appointments, and see the lists of phone calls they’ve made in an attempt to fix problems.

I’ve talked to colleagues about our work. Many of us feel like we’ve had the same conversations time and time again.

The people we help are usually under extraordinary stress. The anxiety shows on their faces before they’ve even sat down. They’ve often had to pick themselves up off the floor multiple times — perhaps even just that morning — before coming to us.

Most of the people we support are just about getting by, from day to day, and from month to month. They are usually one bill or mishap away from financial disaster, and find it hard to think about anything other than constant financial survival decisions. No one wants to live like this. But millions do. Dave did.

Along with many of my colleagues, I believe that welfare policy has become detached from the reality of real people’s lives. So much effort has gone into cutting short-term costs, and policy interventions so often focus on narrow financial incentives, that the goal of supporting people in need has been pushed to the side.

The deeper problem isn’t with levels of spending or with specific reforms. It lies in the way welfare policy is created and changed over time. The process of understanding how policy is working, then iterating it to respond — that’s what needs to change.

This is not a formal report

Everything you’re about to read is from me; these are my views, backed by my experience and expertise. I’m sharing what I know and what I believe, but this is not a formal policy proposal. It’s not written like a formal paper, or like academic research backed by data. Rather, it’s a reflection of how I see the world of welfare and benefits, backed by my years of experience at the frontline. This has given me a deep understanding of how people live and make choices.

It includes suggestions for new ways of thinking about the system, and one suggestion for practical change (bring on the occupational therapists).

The sort of change I have in mind won’t be easy, it won’t be quick, and it will require changed mindsets and new ideas. It requires unpicking entrenched assumptions that success can be found by pursuing short term savings and that people primarily care about narrow financial incentives. These assumptions are found across the benefit system, through reforms made by different governments and over many years. It’s a huge challenge.

But meeting that challenge is essential. Not just because the system is broken, and not just because of the recent shocks caused by the Covid-19 pandemic, the financial crisis, the energy crisis, and rising inflation. But also because of simple demographic pressures: as our population ages, more people will experience more years of ill health. This problem, left unaddressed, will only get bigger.

Without reforms, I’ve come to think that the UK is likely to spend more and more money on worse outcomes, and will still fail at tackling some important societal challenges.

How did we get here? What got us to this point?

How benefits were broken

The benefit system is reaching the limits of its potential within its current structures and institutions. Progress won’t come from simply reforming or scrapping particular benefits — it will only come from creating the right conditions for success. The sort of change that goes much deeper, and is more far-reaching, than most governments have considered for many years.

To be clear, there are many thousands of individuals working extremely hard in government departments, Jobcentres, employability programmes and charities — people who do everything they can to help. The problems with the welfare system are not of their making.

What’s more, there are some parts of the existing system that do work well.

For example: the system we have is pretty good for helping people when they are temporarily unemployed. It is also fairly good at dealing with large scale emergencies — as demonstrated by the government’s social security response to things like Covid-19.

Beyond that, the system has got stuck in a rut of policy development where the same levers are pulled repeatedly. Some progress is made, but mostly on just one or two short term aims, rather than the much larger list of possible good outcomes. Over many years, the parameters for policy formation — the way governments decide how welfare works — have got too tight.

For example: our welfare system does not work well for people who can only work part-time. It doesn’t help those facing a lack of career progression at work. It’s not well designed to help people live independently, or for preventing worse outcomes when families break down. It doesn’t work well for people dealing with health problems or disabled people.

These are harder problems, requiring a change of approach and of entrenched assumptions. This is about changing the way we think about the whole system.

If we don’t think of this as a whole system that needs to work well for people in different circumstances, we spend as much effort trying to mitigate for a system not designed for the problems people face, as we do trying to help them move forward.

The result is more layers of complexity and administration, for people who already have an overwhelming amount of complexity and administration in their lives.

What if we prioritised the harder problems? What if we started by designing a system to help people overcome challenges that stem from those other factors in their decision-making, rebalancing the role of financial incentives? What if we thought about people not just through the lens of benefits, but across their lives and public policy? How might the system look different? Would we make the same trade-offs? What could it achieve?

We’re not talking about people on the margins here — we’re talking about millions of claimants who could be affected by this. Right now, 5.9 million people currently claim Universal Credit. Half of them have children and “a large proportion of households have the limited capability for work entitlement, including the majority of couples without children”.

Focusing on cost, not outcomes

It costs money to deliver a welfare system that works well and achieves its aims. Debates about how much money have existed since the modern benefit system was created, and this isn’t a bad thing. It’s a healthy tension which, in theory, should lead to continuing progress on delivering aims.

The difference now is that reducing the short term cost of the system has become an embedded aim in itself, rather than something to balance against ambition or policy intent.

You can argue that always looking at cost savings can produce good outcomes — I think of it as trying to reduce the need for a system in the first place. Much like the Trussell Trust trying to get rid of foodbanks, rather than trying to expand their provision.

But for benefits policy, this argument is what has brought us to where we are today: the pursuit of short term cost savings has stifled the purpose of change. Successive governments have treated benefits as a burden, instead of seeing them as critical infrastructure. And infrastructure requires investment.

In practice, efforts to generate short-term cost savings result in benefit policies that restrict access to support to ever-narrower groups of people who are considered most in need. Consequently, we miss opportunities to prevent need becoming more severe, and for improving the lives of huge numbers of people who have non-severe but still chronic needs.

We’re stuck in a mode of policy formation that prioritises reducing the short term costs of the system, not tackling structural challenges and improving the lives of the people for whom the system exists.

Reforms that don’t change much

For about 20 years, welfare reform has been dominated by two primary assumptions:

1. Cutting short-term costs is a good result
2. Recipients of welfare make decisions primarily on the basis of narrow financial incentives

This is a methodology for welfare design found in politics, civil service and wider civil society.

Those assumptions — we will examine their shortcomings later — have been supported by a series of events, afflicting successive governments:

• Permanent crisis mode, resulting in more short-termism, and a tendency for policy to be more reactive
• A glut of reforms, one after the other, with a pronounced focus on getting the new reforms “delivered” instead of on their consequences in the real world
• Austerity or tight fiscal contexts, further driving short-term thinking and competitive behaviour among government departments, which in turn suppresses collaboration

Reforms over this time have therefore focused on:

• Financial incentive policies, where people are expected to make decisions about their lives based on narrow positive or negative financial incentives
• Targeting policies where the rules are changed to limit or change who is eligible for certain benefit payments often focusing on those most in need
• Simplification policies, where benefits and schemes are bundled together to create one simple and clear system for everyone

Experimenting with policy in this way is not a bad thing. It’s good to try out new approaches and new processes, and adapt accordingly. But only if you actually can do the adapting part.

Having a culture of “test and learn” implies that the system has the capability to do the testing and do the learning, and iterate the policy as a result. This is rare in today’s welfare system.

In the context of multiple reforms and the scale of the delivery challenge, it’s become accepted that we should judge these experiments on whether or not the policies have successfully been rolled out, and whether they are showing narrow financial incentives. The logic being that if they have, they’ve been successful. Not because the outcomes have been assessed, but because they should therefore be generating the short-term cost savings that were predicted.

This institutional behaviour is now widespread across government. It seems to be built into the structures of the Treasury, the Department for Work and Pensions, HM Revenue and Customs, and the National Audit Office. It has become embedded in the processes and incentives that govern their measures of success.

As the cost of living crisis continues to grip the economy and the nation’s finances, we risk seeing the same pattern being repeated all over again.

The results are stark. As a nation, we are:

• missing what could have been learned in recent years, because the focus has always been on the costs, not on what was learned
• drifting further away from the realities people face in their lives, making it more likely that we treat symptoms, not causes
• missing opportunities to catch up with progress — particularly in behavioural science, psychology and technology; it’s time to accept that most people are not, and never will behave like, “rational economic actors” in the way that some economists and policy makers presumed

Some efforts at reform have been more successful than others. Disability benefits have undergone a lot of change from both Conservative and Labour governments, for little tangible return, so I want to look at one benefit in more detail: Employment and Support Allowance.

How ESA failed

The Welfare State has always provided some support for people who are too ill to work. From the mid-1990s to the mid-2000s, the government provided Incapacity Benefit, but in 2008 that was replaced by Employment and Support Allowance (ESA).

One of the problems with Incapacity Benefit was that once people could claim it, they had little reason to interact with the government again, and rarely returned to work.

With the introduction of ESA, the goal was to encourage more people with health conditions to go back to work when they were able. Claimants would be expected to undergo more frequent assessments, in order to prove that they were still unable to work. Another goal was to remove the binary working-vs-not-working status of Incapacity Benefit.

After being assessed for ESA, claimants are assigned to one of two groups; one that is deemed “closer” to being able to work, and one for people with more serious medical conditions who are never likely to work.

This simplistic approach had unexpected consequences. It created an entirely new, and entirely artificial, binary condition within the benefit system.

People in the first group are paid the same amount as people without health conditions who claim unemployment benefits, with no additional support. This follows reforms in 2013, aimed at showing clearer financial incentives for work for this group. Their illness, in effect, is cancelled out; many people feel like their illness is “ignored” if they find themselves in this group. The people in the second group are paid more.

ESA fails to take account of the variety of health conditions and how they affect a person’s ability to work. In making sure that people either qualify for ESA or don’t, the government sidelines lots of people who are capable of work under certain conditions.

In my time at Citizens Advice, I have met countless people who could work — and would like to work — if they could do so part-time. Or if they could do so sitting down. Or if there was some form of reliable, accessible public transport between their home and their place of work.

ESA simply doesn’t account for cases like that. You are either “a little bit” ill, in which case you get the same benefit that someone claiming unemployment gets. Or you are “seriously” ill, in which case you qualify for additional payments. There are no options in between.

This in turn creates a bizarre incentive for people to try and get themselves allocated to the second group of people who are more seriously ill. These can be people who could work, and would be happy to work, with just a small amount of practical support. But with that support lacking, people stay on ESA, and aim for allocation in the “seriously” ill category.

They act this way not out of greed or laziness, but out of fear that they might lose some or all of their benefits when the time comes for their next assessment. Being in this category gives people reassurance that the barriers they face due to their illness or disability are recognised, and that their income is more secure.

Since it was set up, ESA has seen growing numbers of people assigned to the second group. Only a tiny percentage of claimants ever make the move away from benefits. Even cuts to the value of the basic payout — made under the assumption that people would “act rationally” and seek out work instead — have failed to make an impact. People with disabilities and those with health conditions don’t necessarily act in ways that economists used to predict. The “rational actors” of economic policy, making decisions solely on the basis of narrow financial incentives, are a myth. People just don’t behave that way. The field of behavioural economics has shown this to be true many times, but successive governments have ignored the conclusion.

ESA is failing both as a policy and as a support mechanism. Rather than encouraging people back to work, cuts in its value have simply reduced claimants’ living standards. Again, we see short-term thinking focused on “reducing the bill for taxpayers”, and narrow financial incentives triumphing over a genuine re-think of policy to make it better meet the needs of claimants.

Worse still, almost all aspects of the policy — such as assessments, claimant groups and payment levels — have been copied over to the newer Universal Credit benefit, which comes with its own renewed focus on the role of financial incentives to work. We’re not learning from past mistakes.

A health benefit with no health input

What we see here is the effect of government organisational silos reflected in the services they provide to citizens.

Any benefit tied to health is likely to work better if some aspect of health expertise was involved beyond just making assessments of eligibility. Once someone is assessed for ESA, there’s no health advice available to help them overcome barriers to work. There is some piecemeal practical support for people who could do some work, in some circumstances — things like helping people write a CV. But it’s not much.

This is a benefit that is all about health, run by a bureaucratic machine that is entirely separated from the health system. It’s designed in a way that presumes financial incentives will play a bigger role in people’s work choices than the real barriers they face in adapting to work with an illness.

A few simple changes could make a big difference. We need to get the right professionals involved.

Assessments for ESA should involve evidence from an occupational therapist (OT), who has the relevant expertise to properly understand a person’s capacity for work. The OT would be in a much better position to assess barriers to work, and to give practical advice and support. This OT support would provide more than adequate evidence and information for making benefit eligibility decisions.

Doing this would require a large investment in occupational therapy, in primary and community based NHS services. The benefits system needs access to the skill of occupational therapy, without necessarily being caught up in the processes and bureaucracy of the secondary and hospital-based NHS services that currently provide most OT services. To put it more simply: fund more OTs, in more contexts, and make them easier to access for more people.

My experiences over the last 15 years have convinced me that occupational therapy could play a big role, and make a big difference, to the way we deliver welfare. That kind of difference is possible, but only if we move away from trying to achieve short term cost savings and focus on tackling long standing challenges. I’ll explain more about this below. But first, let me introduce Claire.

Claire’s story

I was helping Claire with a fairly standard review of her benefits. She received ESA payments as her severe anxiety and depression meant she could not work. It took 3 hours over a couple of appointments to steadily work through the 30-page form with over 100 questions — this was something she had to do every year or two.

Claire’s anxiety was through the roof during this whole process. We met at a mental health clinic that she was familiar with, which made her feel a little more comfortable. Even so, she frequently broke down in tears, and we needed lots of breaks to give her time to catch her breath.

At this point, Claire didn’t have much contact with healthcare providers. She saw her GP every now and then for small things like repeat prescriptions, medication reviews and occasional infections. She lived alone and received no help from social care as her need wasn’t deemed severe enough. She constantly worried that without any supporting evidence for her benefit claim, no-one would believe that her mental health difficulties were serious enough to affect her ability to work.

Whilst working through one question about social situations, Claire mentioned that she had been able to leave the house a few times (something she usually really struggled with) to do some shopping, because her friend had started working in the local supermarket.

Knowing that she would see her friend gave her enough reassurance to leave the house. It hadn’t gone well on a few occasions, but her friend was still texting her to let her know when she was at work, in case Claire wanted to try coming in.

Claire used to work at the same supermarket, so she was also familiar with the layout and knew some of the longstanding staff and customers. I asked if she ever thought about trying to do a small amount of work there, and the question immediately put her on the verge of a panic attack. I took extra care to reassure her that I understood and believed her mental health challenges, and quickly moved to a different question about her medication.

I was annoyed at myself for forgetting how big a question I was asking, and for not picking the right moment to have that conversation.

The right time didn’t come until Claire had finally received the decision letter that stated in black and white that her benefits would continue to be paid at the rate she was already receiving.

The fact that the letter accurately reflected her condition; that it showed she’d been listened to and believed; and that it meant we wouldn’t have to spend more months challenging the bad decision we’d been fearing — all of this was a source of huge relief for Claire. She said she felt like she’d won the lottery.

Now that she had some certainty about her income, we talked again about part time work.

She had thought about it a little since the last time, but it was clear she was completely overwhelmed by the things that she would have to sort out both with the employer and in her benefits. To Claire, trying to find work felt like a huge risk. She was particularly worried about having to travel to or from work in the dark. She hadn’t managed to leave the house in the dark for several years.

On the other hand, it was also clear that she wanted the chance to have a social connection with people at work. She mentioned people she remembered who still worked there, and good memories of having a laugh with them. She clearly missed this.

I explained that if she did go for a job that her employer would have to consider making reasonable adjustments, which could include a shift pattern that avoided travelling in the dark. She was worried this wouldn’t be taken seriously.

We talked through the 3 or 4 different ways her benefits might change. There was no certainty on what would happen in terms of her eligibility for extra help because of her mental health, and therefore whether it was financially viable for her to work a short amount of hours.

Claire wasn’t figuring out whether she would be better off from work — she was worried about whether she would lose the ability to reliably pay the rent, and how much she might have to fight to get back to financial stability if things did go wrong.

Ultimately I couldn’t give her the level of reassurance she needed that an employer would agree to the adjustments that she needed, or that part time work would mean she could still cover all her essential bills. She didn’t want to take steps to find out more from the Jobcentre as she worried about risking her benefits. We agreed that she would have a think about it and we would pick it up at another appointment — but Claire never came back.

I sometimes wonder how her story might have ended if she had been able to talk to an occupational therapist, who could have provided the evidence she needed for a quick and accurate benefit decision. Crucially, she would also have received support earlier on to help her deal with the barriers she faced in life, like using public transport or going out in the dark. She would have had a practical and personalised plan to help her to leave the house confidently. All geared up towards helping her to take steps to live her best life, not just survive between benefit assessments.

If we look beyond metering out access to support to make short term savings, we can then target policy attention at addressing the additional barriers that people like Claire face. We can move beyond simply checking eligibility for benefits, towards policy that cuts across government departments with the shared goal of helping Claire move forward.

New questions to ask

To make progress, we need to make changes to the way we form policy. This is a huge task which will take a long time, but I believe the results would be worth it.

Better outcomes are possible — but they require two things:

First, a huge shift in the way we think about the costs of the benefit system.

Second, the unpicking of entrenched assumptions about the role financial incentives play in people’s decision-making.

It’s normal to have a complex life, with lots of competing and overlapping things to think about. It’s almost impossible to separate out income, health, housing, employment, bills, and everything else. The real world is always more tangled than policy expects it to be. It’s time that policy recognised that, and adapted accordingly.

Government tends to think more about “value for money” as a method of delivering short term cost savings, than about getting good outcomes. More attention is paid to pulling the same old policy levers, than to truly understanding the impact of old policy and the likely impact of new changes. Most government departments are so busy trying to keep up and maintain the status quo, that there’s no time to stop and consider something new.

We’ve looked in some detail at health and ESA; there are many similar problems in other parts of the system, and with other specific benefits.

All this leads me to think about what causes this dysfunction; and what we could change.

To get started I think we (government, opposition, civil society and academia) need answers to 3 questions:

1. Is it a good strategy to save money by focusing on the simplest cases, and those with the most severe need?
2. How do different groups of people make decisions and act?
3. How do we prevent welfare policy formation from becoming too fixed on one mode?

Let’s look at each of those 3 questions in turn.

Question 1: Is it a good strategy to save money by focusing on the simplest cases, and those with the most severe need?

We hear repeatedly that when finances are tough, government must prioritise the needs of the most vulnerable people.

At first glance, this makes perfect sense. If there is less to go round, of course we should make sure that those who most need help, receive it.

But this thinking is flawed when it becomes the default way of working, rather than a response to crisis.

Focusing only on severity of need stops us from investing in policy that prevents need from arising in the first place. Or policy that deals with non-severe, but still chronic need. People whose challenges fall into these categories can only access support when their need becomes bad enough to count as “severe”. This approach is riddled with huge opportunity cost.

In a crisis, you temporarily accept these opportunity costs but you can’t ignore them forever. Not least because they can end up costing you more, as more people develop severe needs.

But as day-to-day policy, it becomes a blocker to adaptation, and consequently a blocker to improvement.

If we permanently put severity of need at the top of our priority list, we fail to take a hard look at the underlying problems that create severe need in the first place. At best, we’re treating the symptoms, but not the cause.

Currently this is coupled with an approach that also focuses attention on showing narrow financial incentives that arguably only serve the simplest circumstances . So we are left with a mode of policy formation that only deals with simple or severe need missing swathes of people in the middle where policy could make a huge difference.

Question 2: How do different groups of people make decisions and act?

Our understanding of “rational economic behaviour” has vastly improved since reforms like Universal Credit were introduced.We need to update our policies to reflect both the wider factors that we know come into people’s rational decision making, and the new and growing field of behavioural economics.

Benefits policy has been anchored in narrow assumptions about financial incentives for years now. Policies that put effective downward pressure on rent support started out on the assumption that people could be incentivised to move to more affordable accommodation. One of Universal Credit’s main aims is to show clear financial work incentives. Reductions in sickness benefits started out on the assumption that lowered benefit income would incentivise people to work.

When I think about the people who have come to Citizens Advice for help, making sure that whatever action they take doesn’t make things worse or actually improves their situation, is always far more complicated than simply thinking about the “financial incentives” they’re expected to respond to.

In reality, people think about a much wider set of considerations:

• Can I find suitable childcare nearby, while I’m working?
• If I move house, will my brother still be able to help me with the shopping?
• How will I cope if things go wrong, and I don’t have any savings?
• The last time I took on an extra shift, my benefits stopped.

All of these are perfectly “rational” things to think about. People don’t simply live in a bubble that’s primarily defined by financial incentives. Their lives shape their thinking. Their past experiences and future plans come into play. They think about loved ones, about social connections, about caring for others.

It takes a long time to work through all of these considerations and concerns, and that uses up cognitive bandwidth that most people don’t have to spare.

Given that years of recent reform have worked on the assumption that people will respond primarily to financial incentives, we need to fully understand if and how this has worked in practice. Critically, we need to understand the different roles that financial incentives play for different groups of claimants. Currently, there is little distinction by group of the accuracy of this assumption.

To properly understand the role of financial incentives, we have to improve our understanding of other factors that can contribute to people’s rational decision-making.

From what I’ve seen at my time in Citizens Advice, I would start with 3 areas:

1. Cognitive bandwidth
2. Risk
3. Additional barriers

Cognitive bandwidth

If you want people to focus on improving their income from work, it’s arguably more helpful to take actions that reduce the demands on their cognitive bandwidth, and free up more space in their minds to think about other things. Make it easier for them to keep a roof over their heads. Make it easier for them to find reliable, reasonably-priced childcare. Make it easier for people to avoid debt.

Some things that use up a person’s cognitive bandwidth are actually caused by other parts of the benefit journey. For example, the challenges of figuring out levels of childcare support and payment cycles that are out of sync with wages and bills. Things like this cause repeated budgeting nightmares for people.

There are hundreds of policy trade-offs like this, hidden in the detailed design and processes of claiming and maintaining benefits. Currently, we don’t factor in the downside of overloading people’s cognitive bandwidth against trying to make a system easy to deliver.

The US government is currently taking active steps towards reducing the administrative burden, and therefore the cognitive load, in applying for benefits. This includes using government administrative data to proactively identify eligibility. In contrast, the next stage of the Universal Credit rollout requires claimants to complete a full new benefit application, risking their benefit income stopping if they do not take the necessary steps before the deadline.

With several studies now showing the negative impact of this on people’s decision-making, now is a good time for us to look again at where and why we are adding to this.

Risk

Any number of charts can show that people will be better off in work, but if the claim process itself means people are unsure of their incomings and outgoings, or forces them to take on debt to manage until they start getting payments, then the charts become irrelevant. They don’t reflect how being on benefits actually plays out in people’s real lives.

We are missing multiple opportunities to deal with the rational risk assessments that people use when they are making decisions.

For example: Universal Credit has at least a 5-week wait, and a built-in loan used as mitigation to help people get by while they wait. It was designed this way to mirror wage payments and keep the system simple (the same process is used throughout the life of a claim, and all claims are built on the same monthly assessment). It’s also designed to ensure that people are getting the right amount of benefit support (minimising fraud and error in the system).

This 5-week delay wasn’t intentional. It wasn’t seen as a central part of the original idea for Universal Credit. But it emerged as a trade-off — to mirror monthly wages and keep the simple monthly assessments, you had to accept a gap in income at the beginning of a claim.

Assessments for UC are made in arrears, so in most cases, people have to wait for a month to prove how much they earn. Then they are assessed, then they get payments. It wasn’t planned this way, it just ended up being accepted that this trade-off was worth it. Its existence means that many people start off their UC claims having to weigh up the risk of taking on debt that takes months to repay, against going without essentials.

Additional barriers

Some decision-making factors lie beyond the benefit system, but can still have a huge impact on how benefit recipients make decisions. Things like waiting for health investigations and treatment, the closure of local nurseries that can’t make the books balance, poor transport options, or employers who are yet to realise the benefits of flexible working arrangements.

These either need cross-government action to tackle, pulling all available levers of the state in a coordinated effort; or for the benefit system to factor them into its understanding of people’s decision-making, and therefore into the design of the system.

A clear example is the approach taken to helping people find work in Universal Credit.

Over recent years there’s been an assumption in the design of benefits that within a system with clear financial incentives to work, the government should encourage people to take any job that’s available, rather than taking a longer view of matching people’s skills to jobs; or improving adult education and increasing people’s skills to compete for different types of jobs. Or even working with employers to improve the flexibility of jobs, so that a wider pool of people could do them.

Does this approach work better for some groups than others? In particular, do groups who face additional barriers to work (such as needing reasonable adjustments due to an illness, or caring responsibility) get good outcomes with this approach?

As the demands of the economy change and jobs change with them, does this approach deal with barriers that people face due to lacking key skills?

From my time as an adviser, it’s clear that the additional barriers people face limit their ability to make progress. Putting pressure on individuals to change their actions without addressing these barriers — which are often caused by their wider environment and broader public policy — leaves people with an incredibly steep, if not impossible, hill to climb.

Question 3: How do we prevent welfare policy formation from becoming fixed in one mode?

I firmly believe that good policy comes from deep-seated curiosity. It’s good for policymakers to form a depth of understanding about the problem being tackled, and to be open to all potential avenues for achieving change.

So much works against forming policy in this way. The pace of political change, the silos that government departments are built on, the increasing occurrence of crises, the scale and therefore slow pace of reform, and the ever-present need to balance the books in the short term.

It’s hard work to counteract these forces. I think we should start in two ways:

1. Put in place a structure for evaluating and learning
2. Look again at the purpose of the benefit system

A structure for evaluating and learning

Many people have tried to improve how our benefit system works over the last decade. A huge amount of effort, funding and political capital has been spent trying to make changes that make a difference.

No policy survives contact with the real world unscathed — there is only so much we can know before giving things a go. This isn’t a weakness of how we form policy, but a necessary part of the process that we should acknowledge and build on. We’ve ended up with processes and institutions that aren’t sufficiently focused on learning and evaluation — some of it happens, sometimes, but it’s usually on the margins. It’s not an integral part of how the system works.

This is a deep-rooted cultural issue, and changing it won’t be easy or quick. Learning and evaluation have to be a key component of reform. It needs to be easier and quicker for us to change things — not just small details, but big load-bearing components of the welfare system.

There’s a balance to strike here. It’s hard to learn anything of value from an experiment that’s too small or too localised. It’s also hard to turn a policy into operational reality at scale, and still be able to test assumptions within it, without going so far that making significant changes becomes almost impossible.

Looking at reforms over the last 10 or 15 years, I’m not sure we are getting that balance right. This is not a problem of will or effort; to me, it feels structural. It seems that the more certainty we need to secure funding for reform, the less able we are to learn as we test assumptions in the real world.

Scale itself is also a blocker to change. Rolling out reforms at national level can be such a huge task that simply achieving the roll-out becomes the focus of the reform. We have often heard promises about the big savings to be made, once a big change is complete. But the changes come and go, and the savings rarely seem to materialise.

It’s worth noting here that Universal Credit did start its life as a tiny experiment, in just a few streets in south London. It grew towards national roll-out via a series of experiments and iterations. Even with an approach that starts small and grows, there’s still a tendency to focus on assessing the progress of delivering a reform rather than whether or not it is achieving its anticipated outcomes.

For example, even now, years on from the small-scale roll-out and 5 years after planned publication, we still don’t have any analysis of whether UC is helping more people to move from being inactive into part-time and then full-time work.

Re-thinking the purpose of social security

I think the time is right for reviewing the aims and purpose of the social security system. Not just because of the recent 80th anniversary of the Beveridge report, but because it’s clear that welfare policy is drifting, and has been drifting for some time. The only tangible thing you can really see is an aim towards maximising employment — which is less helpful if it pushes everyone towards working full time, all the time.

Benefits work well when they support people to navigate change and challenge in their lives.

This should be embedded as a core purpose, defining the shape and the nature of our entire welfare system. It should be, but right now, it’s not.

So many people find themselves in need of support when the challenge is something unexpected, sudden and often not their fault: a partner dies, a relationship breaks down, a job is lost, a health condition rears its head, a baby is born.

These are rarely small bumps. More often, they are step-changes in people’s lives, things that take months and years to adjust to. The benefit system often fails to acknowledge the severity and life-altering nature of events like these, where most people find their cognitive bandwidth almost completely used up. It’s hard to act on autopilot when something’s happened that turns your life upside down. It’s hard to make decisions when your head is full of new questions with no easy answers:

• How will I wash if I can’t get into the shower on my own?
• How many nappies should I buy for the month ahead, when I’ve just been paid and I’ve got the money to buy them?
• Have I done the right thing leaving my partner?
• How do I tell the kids why it’s so cold in our flat?

Right now, the state isn’t seen by all benefits claimants as a provider of support when they face change and challenge. Far from it.

Rather, many claimants think the state is saying: “We know you’ve got a lot on your plate at the moment, but we need you to think about more things, and do more things.” Or worse, the state doesn’t acknowledge people’s existing circumstances at all. It just says: “We need you to do more.”

So the result of change and challenge in people’s lives is more change, and more challenge. More work. More stress.

We frontload processes and systems to triple-check eligibility. We apply means testing to help us file people and families into convenient boxes. In most situations, we push people into increasing their income by accepting work under any circumstances — any work, no matter how poorly paid, or how ill-fitting the conditions are to childcare and family life.

Even with the introduction of Universal Credit, an attempt to simplify the system, people still have to navigate multiple different systems across welfare benefits. They have to wait weeks for payments, or take out state-backed loans to deal with the gap. They miss out on payments they’re entitled to, because they didn’t know they existed.

On top of this, many people are dealing with similar problems and complexity in related systems beyond benefits. Getting medication and healthcare, dealing with changes in their housing situation, getting social care, arranging childcare. All of that, on top of more routine things like paying the bills, managing tenancy agreements, negotiating changes to mortgages or phone contracts, and making sure direct debits are updated.

Everyone’s cognitive bandwidth is particularly limited during a period of change or challenge. But the complexity of the systems designed to support people in our society do little to ease the burden. They just add more burdens.

Either the benefits system can work in a way that acknowledges this and helps with it, or it can ignore reality and plough on, denying the impact its own flaws have on people and families.

And to be very clear: this criticism is of the system as a whole. I know there are thousands of staff in Jobcentres, for example, who completely understand what people are up against, and go out of their way to help. They find workarounds, they drop hints, they point people towards other sources of help.

But we cannot continue with an approach that only takes account of people’s real lives when they happen to speak to an empathetic and experienced individual in a Jobcentre. We have to integrate the same level of empathy and understanding into the system as we redesign it.

As well as redefining purpose, we should follow through with reassessing our current metrics for success. For benefits, these relate to reducing poverty and full employment. What if we considered something more dynamic, something that shows progress? Not just a fixed state?

For example: what if we used a metric about reducing underemployment, or one that assesses whether people had made appropriate progress for their situation? This would require us to accept that for some people, part time work is the most appropriate choice. It shouldn’t be classed as “sub-optimal” or “a failure”. This metric would require us to separate these people from people who could work more hours, as this group would need different policy interventions.

Focusing on “levels of earning” rather than “hours worked” could lead away from an “any job will do” approach, and towards an approach that prioritises skills improvement, or matching people with roles that have good progression routes.

We would also need to look at the systems and structures that exist to agree policy change, fund it and assess its performance.

Lucy’s story

Lucy would always come to see me with her 2-year-old twins in tow. We’d have complete chaos in the room as we tried to keep the kids contented and occupied, while also having a grown-up conversation about Lucy’s difficulties.

Lucy’s husband, the father of the twins, had left her without any warning or explanation. With two demanding twins to care for, she was also in arrears on the rent, had maxed out her overdraft at the bank, and was scrabbling to survive from one paycheck to the next, topped up with her benefits.

What was once a dual-income household had become a single-income household. Lucy tried to do the honest thing, and tell the government that she was now a single parent.

Lucy’s tenancy agreement still had her husband’s name on it. Existing benefits payments were sent to them as a couple, jointly. Lucy had no way to change those details on the right documents.

The system responded not with help, but with an accusation. If she wasn’t in a relationship now, perhaps she had never been in one. Perhaps she had been claiming too much all along. Suddenly, her benefits were at risk. She made fresh claims as a single parent, but they were delayed while investigations were carried out on the old claims.

The system simply couldn’t easily accept that Lucy’s relationship had broken down. There wasn’t enough organisational agility for that.

Lucy and I made countless calls to government agencies, to her landlord, to the nursery that provided childcare while she went to work. Delays with benefit payments meant that she struggled to pay for the nursery care. If that had gone, she’d have lost her job too.

It took weeks to get Lucy out of danger of financial and personal disaster. She managed to keep her job, and pay the nursery bills, and stay in her rented accommodation.

It took 2 years to sort out the benefits.

To this day, I remember her stoic unflappable smile, how she stayed calm and cheerful even with the twins bouncing round the room and all over her, even with all the stress and anxiety.

None of Lucy’s problems were of her own making. Most of them resulted from a benefits system so rigid and inflexible that it simply couldn’t cope with something as common and as ordinary as the breakup of a relationship. The system did nothing to ease the burden on her shoulders — it only added to it, and made the chances of ruin even higher.

How many Lucys find themselves in these circumstances today? How many of them make it through, as Lucy did — just?

Suggestions for change

We now need significant course correction to break out from this broken mode of policy development.

Making genuine change will take years of effort, and more thought and planning than I have been able to put into this one document.

But I have some suggestions for starting points.

Take time to take stock

A good first step would be to allocate people, time and money for detailed evaluation of the last 15 years of policy reform and experiments. We need to be sure that we know what we need to know, in order to change outcomes and our trajectory towards them.

The team doing this work should focus on:

• What role financial incentives have played in people’s behaviours and actions — how important are they for people in different circumstances?
• Does “targeting spending based on severity of need” actually work? What are the downsides we need to mitigate against?
• Are welfare systems as a whole simpler for individuals now than before? Would we get better results if we made things simpler for individuals, at the risk of increasing complexity for the state?
• With regard to unemployment benefits, does the “take the first job you’re offered” approach actually work? Does it benefit all different types of claimants?
• How can policy, not delivery, iterate faster and react faster to changing needs and national or international circumstances? What structures and permissions need to be in place for that to happen?
• If we accept that “rational economic actors”driven primarily by narrow financial incentives are a myth, what other psychological and behavioural factors could be helpful? To what extent should the state consider people’s cognitive bandwidth, and design benefits that account for it?

Create space for widespread change

In addition, political leaders and senior civil servants should consider what they can do to create the right conditions for success in the longer term, such as:

• Providing clarity on the purpose of welfare, and what it exists to achieve
• Recognising that for many people, part-time work is a better option and a widespread reality in today’s world; then allowing policy teams to design around it, rather than excluding it
• Reassessing whether full employment is the right objective for the benefit system
• Rebalancing the structures and incentives that exist for everyone working on welfare policy — which means removing the constant push for short-term cost savings, allowing and creating space for a culture that continues the experiments but also makes it possible to evaluate them afterwards, learning from them and sharing that knowledge with others

So far, my suggestions are high-level, strategic, structural. The third is more down-to-earth, more practical, and perhaps more unexpected. I mentioned it briefly above, but I want to explain the thinking behind it in more detail.

I think we could achieve a great deal by making a large and sustained investment in occupational therapy.

Invest in occupational therapy

To help disabled people and those with health challenges that make it harder to work, I think it’s helpful to consider approaches that go beyond the benefit system. Occupational therapy (OT) would be an excellent source of practical help and advice for people with health conditions.

Don’t get me wrong — we need to make big changes to the way disability benefits work in the UK as well. I also don’t think we’ll find the changes we need simply by speeding up access to healthcare diagnosis and interventions. Even when we didn’t face big challenges due to an overwhelmed health system, we still hadn’t cracked this problem.

If we start by focusing on what help someone needs to navigate a change in their health, we should look at their situation in the round, not just how and when they are interacting with the benefit system or the labour market.

People in this position need adequate financial support to secure the basics of life, and they need timely and sufficient health interventions.

Yes, they need to figure out the implications of the change for work, but actually they most likely have to make huge adaptations to all aspects of their life. Factors that often get in the way of work, or at best make it difficult — you have to be able to get dressed and washed to work. You have to be able to physically get to your workplace.

Does their health condition affect someone’s energy levels and ability to concentrate? Do employers need to consider a different shift pattern, or different allowances for breaks?

Could they work better if there was a way to sit, instead of standing for hours? Do they need to change profession, and build new skills to do a job that fits better with their new reality? What support would that need?

Might simple changes at home make all the difference? Physical aids and adaptations, assistive technologies, or just paying for a cleaner?

Lists of questions like this are unbelievably overwhelming for some people to navigate, and that is even before we think about what the benefit system requires of them.

Occupational therapy sets out to “help people live their best life at home, at work and everywhere else.” It helps people to overcome the challenges they face because of a health issue, and recommends “adjustments to the way you live by looking at the relationship between the activities you do every day, the challenge you’re facing, and your environment.”

Occupational therapy is an excellent way of helping people with the challenges they face following a change in their health.

But: OT is a tiny part of our health service. It’s often focused on the acute end of the spectrum: helping people in hospital, helping people to leave hospital, and as part of specialist healthcare pathways.

Local councils have some occupational therapy provision through their social care services, which are equally overwhelmed. There is some private and charitable provision, but not much. Some employers have their own in-house OTs. Generally speaking, it’s hard to access OT services in the UK, unless your health condition sends you down a particular path in health care. But there are so many people who could benefit from an OT’s help, who are not on any of those paths.

Every time I delivered benefits advice in health settings, I knew that if an OT was involved in someone’s life, we were much more likely to get a faster and better outcome for their benefits applications; and a better outcome for their health.

This was because, by default, OTs assess and assist people with the very things that the benefit system uses to assess eligibility.

So instead of getting medical evidence which gave a diagnosis and perhaps a list of medications and some brief notes about the impact on someone’s life, I could get a detailed breakdown of the barriers that an OT was helping someone to overcome, along with an assessment of what they can and can’t do; and even recommendations for work.

GPs and healthcare professionals are there to gather information about a person to make a diagnosis and a treatment plan. This is an important part of helping someone to deal with a health problem, but it is not the same as an assessment of the barriers they face in life or a plan for how to adapt to them.

It’s not their job to look at the barriers someone faces to wash, or cook. They aren’t breaking down all the steps someone would need to take to attend a social event, or even speak to a delivery driver when a parcel arrives. These are the things that OTs think about.

Eligibility and possibility

The current system assesses the barriers that people can face with work, but only to assess eligibility for benefits. With more resources for OTs, we could do so much more to assess possibility — what can be done to overcome the barriers?

There are many ways this could be done, but in my view the best option would be to drastically increase OT resources in primary or community healthcare.

Imagine a world where:

• someone needs a second or third fit note, so the local healthcare professional can make a referral to an OT if appropriate
• GPs are empowered to refer to an OT when a patient mentions in passing that they struggle to do their weekly grocery shopping, or can’t get on a bus
• the process of providing someone with help to adapt to a health problem automatically provides the data needed to assess their benefit eligibility
• professionals in Jobcentres and employability programmes can use the OT recommendations to help them recommend work options
• OT evidence can help them match people with suitable jobs, rather than pushing them into any job
• we need fewer repeat assessments for eligibility across services, because there’s easy access to up-to-date evidence from an OT

To get to a world like this, we need to get past the idea of constantly reducing short-term costs, and start thinking about the long-term value of investing in the right skills and capabilities to move the dial. This kind of investment is necessary to tackle the long standing challenge that too many disabled people are just about surviving in life and not managing to work when they want to. A challenge that is only set to get bigger and harder to address.

We need to target our attention on addressing the actual practical barriers that people face, and move beyond the spreadsheets that show incremental financial gains or losses. We need to stop seeing long standing challenges through the lens of separate government departments and short term budget envelopes. The people I help don’t get to separate out their challenges into convenient boxes labelled with department names. Their reality is having to slowly navigate the tangled web of services, assessments, and eligibility across public services, often on a repeat cycle.

We need to try something different, because what we’ve tried so far hasn’t worked.

I’m still optimistic

I started with a note of optimism, and I’ll finish with one too. I remain optimistic because of another consequence of my experience with Citizens Advice: the people.

I don’t just mean the people we help, like Dave, who maintained a brilliant sense of humour despite everything he was going through; or Lucy, who kept calm and stayed smiling even while her twin toddlers caused havoc around us.

And I don’t just mean the people I work with, all those colleagues and volunteers who make Citizens Advice an invaluable resource and a proud institution.

I also mean the people I alluded to above, who work in public service and do their utmost to help people find a way forward. The Jobcentre staff, the care workers, the NHS nurses, the social workers and occupational therapists who continue to put unbound effort into making life better for people. These deeds too often go unnoticed, they never get counted in any statistics or totted up in any formal report. But they make a difference, sometimes they make the difference, and they matter.

As I said at the start, the growing consensus around the idea that “welfare is broken” is leading to agreement that we have to change the way we do things and there are green shoots of this already starting to happen.

We are seeing steps towards policy breaking out of silos and the parameters of financial incentives in the approach to the green paper on disability benefits, which looks at the wider context of people’s lives including their health journeys and the role of employers. It also asks for broad ideas on what would help people live independently, as well as how people can be supported to move into work. There is more to do here, but it is a good start.

The longstanding and complex issue of a lack of progression for people in low-paid work is also being looked at, and new methods for forming policy are being used for this work. We’ve seen a Randomised Control Trial (considered a gold standard approach to evaluating impact) and a Commission that gathered evidence from a wide range of experts including many outside of welfare policy formation. In theory, this should mean there is a much more open approach to assessing current interventions and looking at next steps for this policy area.

Beyond government, we are seeing organisations looking at the effectiveness of policy over a longer time period, and focusing on wider outcomes — for example, a recent paper by the Institute for Fiscal Studies assessing the results of single parent benefit interventions.

The knowledge is there in the system — it’s not something we need to establish or seek out. It’s something we need to purposefully elevate and prioritise.

We just need to create the conditions for it to thrive.

Acknowledgements

My thanks to the following people for their input, challenge and advice while writing this paper:

• Colleagues from Citizens Advice including: Morgan Wild, Matt Upton, James Plunkett, Rebecca Rennison and Clare Moriarty
• Giles Turnbull- Editor — www.usethehumanvoice.com
• Karin Orman and Benjamin Powick — Royal College of Occupational Therapy
• Tom Waters — Institute for Fiscal Studies
• Helen Barnard — Joseph Rowntree Foundation
• Charlotte Pickles — Reform
• Gemma Tetlow and Olly Bartrum — Institute For Government
• Bruce Calderwood — Former policy Director in Department of Work and Pensions
• Hugh Stickland — Office for National Statistics
• Several Occupational Therapists, GPs + mental health professionals
• Countless Citizens Advice frontline staff and volunteers