Social security, disability and health-related inactivity: What is the Conservative case for reform?

IfG Events

This Institute for Government panel discussion at the Conservative Party Conference 2026 examines the urgent need to reform the UK's social security system for health-related disability and inactivity

Key takeaways

• Health and disability benefits spending has surged from £70bn to ~£100bn, projected to reach £120bn by decade's end, with only 1% of incapacity benefit claimants moving into work monthly.
• The PIP assessment process is widely criticized as error-prone and uncompassionate, relying heavily on flawed remote interviews rather than expert face-to-face evaluations, leading to high tribunal appeal rates.

Main topics

• Social security and disability benefit reform
• PIP assessment process flaws and appeals

Notable quotes

"The whole welfare system is subject of the most atrocious political neglect."

Conclusion

The episode delivers a nuanced, evidence-based critique of the UK's disability

Transcript preview

Speaker 5 (0:00) So hello and welcome to this Institute for Government event supported by Trussell on Social Security, Disability and Health-Related Inactivity, the Conservative Case for Reform. I'm Tom Pope, the Chief Economist at the Institute for Government. Now we know that health-related disability incapacity benefits provide a vital safety net for that group of people and also provide support for daily living expenses. But we also know that health-related benefits are the fastest growing part of the Social Security bill and have increased especially quickly since the pandemic. And that includes an especially large proportional increase for people towards the beginning of their working lives, but a big increase across the working age population. The Labour government U-turned on some of its reforms to the system last year and may come forward with more proposals soon. The Conservatives, on the other hand, have already promised at last year's conference, I believe, to find £23 billion from the Social Security bill in total, which included a big chunk from disability and inactivity benefits. However, while cutting welfare in general is popular, and when you poll people, they like that idea in the abstract, the recent British Attitude survey shows that people don't, when you ask them, want to see disabled people lose out. So at this event, we're asking what a better reform system might look like and what the conservative case for reform should be. Now, we have a great panel to discuss these questions. We have Ben Paxton, my colleague, who's a senior researcher at the Institute for Government and the author of a very recent report we've written on this topic and on incapacity benefits specifically, and one not quite so recent report that we wrote earlier in the year on employment support. We have Helen Barnard, who's the Director of Policy and Research at Trussell. We have Fraser Nelson, who's now a columnist at The Times and has written widely on this issue. And we will soon have Helen Waitley MP, who's the Shadow Secretary of State for Work and Pensions. Just to do a little bit of housekeeping before we get going. The event is being recorded for audio. So if you miss a bit of it and want to listen back, I want to... Send it on to other people afterwards. Please do. It will be on the usual Institute for Government channels. There may be some photos being taken, but it will only be of the back of your heads. So please don't worry about that. After we've had some opening remarks and some questions from me, we'll go to questions from the floor. Please wait for the roving mic to come round, which my colleague will come round with. We will be taking questions in two or three. It would be really great if you say who you are, where you're from, and please do keep it to... questions rather than comments if possible. I think we'll have a lot of questions and we want to get as many in as possible. Welcome Helen, thank you for joining us. Speaker 6 (2:50) No Speaker 5 (2:50) problem at all. Perfect timing. So with that I will go to opening remarks and Ben I'll start with you. As I mentioned we've been doing lots of work on this topic and so based on that work what would you say are the biggest problems with how the government currently supports people out of work due to ill health and what can we learn about how to start to Speaker 7 (3:10) tackle these problems from previous attempts at reform? Thanks Tom. So Welfare and social security policy more broadly can be seen to be achieving a range of things, but three kind of key things. One is supporting the living standards of those who are receiving them. And we know that in the health and disability benefits system, people who are disabled are much more likely to be living in poverty and requiring additional support to meet their daily living needs. So supporting living standards isn't doing a great job on. aim of the system is to support people into work. We know that one of people who are on incapacity benefits, the means-tested benefit for people whose health limits their ability to work, only 1 % of those people per month or fewer are moving into work each month. And the final kind of aim of the system and policy, health and disability benefits policy, is to control costs for the taxpayer to make the system fiscally sustainable. And we know that although social security spending overall is not particularly high by historical standards, health and disability benefits spending has risen significantly since the pandemic under both Conservative and Labour governments. I think there is consensus amongst people that the system isn't working. And it's kind of fundamentally... not clear exactly what the system is actually achieving for different groups of people and what it's actually aiming to achieve for the range of people who claim health and disability benefits and a few particular problems with how the system works. The assessment process, the way people are determined as eligible or not for particular benefits and the level of benefit they receive, really favours simplification over personalisation, putting people into crude categories that don't reflect the range and diversity of need that they have. When people have been assessed as eligible or not, the system of support they provide is not joined up and holistic. Employment support to help people move into work, where that's a realistic goal for them, is very centralised and not built around the individual. And recent years, policymaking in the run-up to fiscal events, budgets and the like, has been kind of very rushed. And it's meant that some of the biggest reforms we've seen announced over the last decade or so under both Labour and Conservative governments haven't always stuck. The rubber has hit the road in terms of who's going to be affected. The policy hasn't been sustained and there's been reversals on policy. And this kind of speaks to political challenge here. The British Social Attitudes Survey, which Tom mentioned at the start there, shows that people do want to limit and control spending on welfare in general, but they're not keen on cutting spending for disabled people who are out of work at a high level. And I think the lessons from this is not that... kind of reducing spending on the social security system is impossible if that's what you want to do. The lesson here is you need to be really specific about what you think the system is for, what you're trying to achieve for different people who are engaging and dependent on that system. And then from that, say, what policies you're going to introduce and why they will help you achieve those aims, rather than focusing kind of broad cuts, which are kind of crudely targeted, things that you have to have interventions, which are actually aiming to achieve particular outcomes. particular groups. Some people that might be moving into work and some people that might be more around participation in a broader range of activities and for some people that might be really focused around living independently and we need a kind of more nuanced debate about what the system is actually trying to achieve for particular groups. Speaker 5 (6:22) Great, thank you very much Ben. A great starter. I'll go to Helen Barnard next. I need to be very specific about that throughout. So Helen Barnard, what would you say are the key principles for how government should go about reforming the benefits system specifically for those with health and disabilities and the wider systems of support for those people as well. Speaker 4 (6:41) Okay, so for those who don't know, Trussell is an anti-poverty charity. We support about 1,400 food bank centres across the country, which is relevant for this because what we see, so at food banks, you have to be referred to our food banks, so it's not a kind of walk-in. So people have been referred because they need that support. And on average, people who come are trying to get by on about £100 a week to cover all of their costs. Just for context, on average, people have £600 a week just for the average income. And what we find is about three quarters of the people who are referred to our food banks are disabled in some way. Now, they aren't necessarily on disability benefits because obviously the two don't always go together. but they are people who are facing often severe hardship. So by the time people get to the food bank, they've normally been going without food and other essentials for quite a while. They have drawn on family and friends, they are in debt, and that's when they've reached a kind of point of crisis that they will overcome what is often a feeling of shame of having to turn to a charity in that situation. And what we see is that when people come to food banks... in that position, they are in what food banks call survival mode. So their entire bandwidth is taken up with how am I going to put food on the table for myself or my family? I'm behind with the rent, am I going to get evicted? How am I going to keep up with these bills? That's what takes up people's bandwidth. Now most of our food banks, they have all sorts of other support in the food bank. So it's not just food, there's financial advice, there's connection to housing or help with lots of other issues. But what they tell us is that you have to give people a base level of security for them to have the bandwidth to engage with those other things. So that would be my first principle, is people need to be able to at least afford the essentials if they are going to be in a position to take up what we absolutely agree needs to be a much better system. So you need that really base level of protection for people. If you haven't eaten... If you've washed in cold water for the last month, if you can't afford the bus fare to your hospital appointment, it's highly unlikely you're going to be able to get your life back on track. The second principle is about reducing fear, because we've been doing a lot of work talking to both food banks who are working on disability and employment support on the ground and people who have been through those systems. And one of the overriding things is how scared people are to be in this system, and in particular the fear of a kind of constant cycle of reassessments. which again kind of sucks people's energy, gets sucked away from actually improving their lives because they are so scared of the next assessment. And that's because they could lose literally everything. They could lose the ability to eat, to run medical equipment, to do anything at all in their lives. And it takes a long time, it's pretty dehumanising, and it's often wrong. So as a system, this does not work well. The decisions are often wrong. And you know you've then got like a nine-month battle to get back to where you started. And by the way, it costs massively more to be doing this system this badly. And you get what people call the recovery trap. So people's fear is if they take steps to, whether it's getting into work, whether it's getting out into their community, that that will be used to take away the support, which is their only means of survival. And that is a well-founded fear because even though something like PIP is not supposed to be linked to something like employment status, there are lots of examples where people have lost PIP because they did what everyone is telling them to do, which is try and get into work. So reducing that fear is crucial to getting a system which actually gets the outcomes we want. The third thing, really quickly, is when we're connecting people with support, it needs to actually work. Speaker 4 (10:47) And what I think we see at the moment, and I don't think, I'm slowly coming, my policy team aren't necessarily here yet, but I'm slowly coming to the point of view that government is not the right organisation to be doing this. So the kind of monolith of the job centre, where you go in, you have a 10-minute appointment with a work coach, it's a different one every time, they're mainly just, have you met these conditions? Fine. They aren't coaching, they aren't... By and large, they don't have the capacity, they don't have the skills, they don't have the resources to actually sit down and say, trust me, tell me what your barriers are and I can help you with that. What we do have is enormous numbers of examples and evidence of people who do this well. And generally, it is organisations, both private sector and charities, who are out in the community. And the model is fairly well established now. An individual advisor who builds a relationship with you, you see the same person every time, they are always there when they say they will, you can trust them, you can tell them what you're struggling with, they have access to that ecosystem of local support. So we kind of know that works. Now the current government, I think they are slowly going in a positive direction on that, but it just feels incredibly slow. Most people's experience is still the job centre monolith that we know doesn't work. So I talked to a company the other day who do a lot of this stuff and what they were saying, which I thought was job centres should be basically just like the triage. So you go to the job centre, you get assessed for your benefits, they kind of do a triage, which track do you need to be on, what kind of support is what you need, then you go to your community provider of that support. That I think is going to get results. in a way that just forcing people to engage with the current model even more. We've kind of tested that to destruction for about 10 years and it really, really hasn't worked. So I think we should try something different. Speaker 5 (12:41) Great. Thanks very much. Loads that we can pick up in later discussion. Go to Helen Waitley now. What's your vision for how a Conservative government would want to be supporting people who are out of work due to ill health or disabilities? Speaker 6 (12:54) Thank you. I mean, the starting point is clearly that the system that we have, isn't working. It's not working for those who are seriously sick and disabled who are often really struggling. We're talking about some examples of that. It's also not working for those who are less sick and disabled but finding that having an income through a combination of universal credit, universal credit health and PIP even though of course as you just said Helen that PIP is a benefit that you can get whether you are in or out of work. The reality of it is that people really worry that they will lose their PIP if they do work, and there are examples of people, in fact, for whom that has happened. So it's also not working for those who really could be working alongside sickness and disabilities. And I say that almost every person I speak to... who has a disability, who is not working, usually wants to be working. Therefore, starting point, we need to change the system. I take the view that welfare reform is hard and needs to be done thoughtfully, particularly this area of how we best support people struggling with sickness and disability. That's why a few months ago we launched a conservative root and branch review of the sickness benefits system to really dig into what is wrong and how do we need to do it differently. Looking across PIP and also universal credit health, both sides of the system. Speaker 6 (14:36) That's looking at how do we assess people differently and better? What should the help and support then look like? Yes, talking about how much should we spend on this? Because that's an important question. Can't spend money that we don't have. And looking at kind of effective accountability for the overall system and the budget. On the assessments, I mean, already I've gone and spoken to... PIP assessment centres, for instance, and it's been quite clear about the flaws in the process. And it's well known that the quantity of assessments that are being done remotely rather than people being seen face to face is definitely a flawed part of the system. And PIP assessment centres themselves have told me they can't tell if somebody's... telling them the truth. They can't tell whether somebody really, really is struggling in all the ways that they're saying they're struggling. Or is it that that person has just gone and found a sick fluencer, one of these sort of how to gain the benefit system coaches online and read this is what you need to do to maximise your benefits. The assessment centres can't tell which of those things is the case. So the way the assessments are working are not... I absolutely know that for people who have, for instance, conditions that are, you know, sadly only ever going to get worse, and they're very disabled, being dragged in for lots of assessments isn't a good answer. So I think you also need to look at, clearly the frequency of assessment should be different according to your disabilities. But we need to be doing the assessments differently with more expert consideration of the evidence and people's health conditions and how it's affecting them and say a much more face to face. And that way you're in a much better position to know firstly who needs help. And some people just step away and not demand something for the system. And then there's more for everybody else. And then for those who do need help. what that help should look like. And I'm already certain that at the moment, too much of the help is just going out as cash without really looking at what support would be. And