What is 'incapacity'? The role of working conditions & job availability in incapacity claims, & whether these should be part of incapacity assessment

在英国，有100多万老年人（年龄在50-64岁之间）申请丧失工作能力津贴，理由是他们的健康或残疾使他们无法工作——尽管经济低迷，这一数字是申请失业津贴人数的四倍。被归类为“无行为能力”是很重要的，因为无行为能力的索赔人被普遍认为更有资格，因此可以获得更多的钱，不必经过更少的手续。但是说某人“无行为能力”到底是什么意思呢？政策将“真正的”丧失行为能力视为严格的医疗原因（疾病或损伤）；目前的残疾评估标准包括“不能拿起并移动装满一升液体的纸箱”。但实际上并没有那么简单。以两个有相同缺陷的人为例：一个是伦敦的毕业生，另一个是梅瑟蒂德菲尔的非技术人员。毕业生可能有更好的工作条件，雇主更愿意改变工作以适应他们，或者能够找到另一份工作，他们的健康允许他们做。非技术工人可能没有这些选择，特别是如果他们年龄较大，因此更有可能资历较低，在生理上“减速”，并面临与年龄有关的歧视。有人呼吁在评估丧失工作能力时考虑这些“非医疗因素”——包括影子部长，就在这个项目最后确定的时候。然而，政府对WCA的独立审查员去年驳回了这一政策，因为我们“缺乏必要的细节和证据基础”（Harrington 2011:37）。因此，在这个项目中，我将做两件以前没有做过的事情。首先，我将研究非医疗因素在丧失工作能力中的作用，这是第一次同时研究工作条件、调整和工作的可用性。我将通过先进的统计分析来做到这一点，使用已经存在的、高质量的调查，这些调查在英国和欧洲追踪了数千名老年工人。我还将重点讨论这些非医疗因素在某些国家是否比其他国家更重要，这反映了它们不同的福利制度和劳动力市场。其次，我将看看公众和精英是否认为在评估丧失行为能力时应考虑非医疗因素。我们越来越多地看到，丧失工作能力的索赔人“真的”适合工作，同时改革过程突然告诉人们他们并没有丧失工作能力；然而，另一方面，英国医学协会和其他机构则抨击这种丧失工作能力的评估不公、苛刻和不准确。在这个项目中，我将探讨不同群体认为“真正的无能”应该是什么意思，方法是：(I)调查公众对整体的态度；（ii）与精英（政策制定者、福利制度的一线工作人员、残疾人倡导者和失业/残疾索赔人本身）和公众一起举办研讨会，更深入地探讨态度，在这两种情况下，都让人们对一系列笔画做出回应。这些研讨会在回答一个关键的研究问题的同时，也让人们参与到我自己从项目的第一部分得到的结果中，这是不寻常的。这意味着政策影响将与其他方面共同制定——例如，看看我们是否应该对那些技能较低的人（如非正式地使用旧的“伤残津贴”的全科医生，以及其他国家仍然这样做）和就业机会较少的地区的丧失能力进行不同的评估。做这项工作需要一套不同寻常的技能——在社会政策领域罕见的高级统计技能，以及定性研究和公众态度研究的技能。未来领袖计划将为我提供获得这些能力的机会，建立在我有幸在过去的工作中有机会发展的初步技能的基础上，并使我能够提供能够改变政策的强有力的研究。

Over a million older people (aged 50-64) claim incapacity benefits in Britain, on the grounds that their health or disability stops them from working - four times as many as those claiming unemployment benefits, despite the downturn. Being classed as 'incapacitated' is important because incapacity claimants are widely seen as more deserving, and therefore receive more money and have to jump through fewer hoops. But what does it actually mean to say that someone is 'incapacitated'?Policy treats 'genuine' incapacity as if it was strictly medical (either diseases or impairments); the current incapacity assessment has criteria like 'cannot pick up and move a one litre carton full of liquid'. But in reality it is not that simple. Take two people with identical impairments: a London-based graduate and an unskilled person in Merthyr Tydfil. The graduate may have better working conditions, an employer who is more willing to change the job to fit them, or be able to find another job that their health permits them to do. The unskilled worker may have none of these options, particularly if they are older and therefore more likely to have lower qualifications, to be biologically 'slowing down', and to face age-related discrimination.There have been calls to take these 'non-medical factors' into account in assessing incapacity - including by the Shadow Minister just as this project was being finalised. Yet the Government's independent reviewer of the WCA dismissed this policy last year because we "lacked the necessary detail and evidence base" (Harrington 2011:37). In this project I will therefore do two things that have not been done before. Firstly, I will look at the role of non-medical factors in incapacity, for the first time looking simultaneously at working conditions, adjustments & the availability of work. I will do this with an advanced statistical analysis, using already-existing, high-quality surveys that follow thousands of older workers over time in England and Europe. I will also focus on whether these non-medical factors matter more in some countries than others, reflecting their different welfare systems and labour markets.Secondly, I will look at whether the public and elites think that non-medical factors should be taken into account in assessing incapacity. We increasingly see stories that incapacity claimants are 'really' fit-for-work, alongside a reform process that suddenly tells people they are not incapacitated; yet from the other side, the British Medical Association and others have attacked the incapacity assessment as unfairly harsh and inaccurate. In this project I will look at what different groups think 'genuine incapacity' should mean, using:(i) a survey to investigate attitudes among the public as a whole; and(ii) workshops with elites (policymakers, frontline staff in the benefits system, disability advocates, and unemployment/disability claimants themselves) and the public to probe attitudes more deeply, in both cases getting people to respond to a series of pen portraits. These workshops are unusual in answering a key research question at the same time as getting people to engage with my own results from the first part of the project. This means that the policy implications will be developed jointly with others - for example, seeing whether we should assess incapacity differently for those with lower skills (like GPs informally used to with the old 'Invalidity Benefit', and as other countries still do) and in regions with fewer jobs.To do this work requires an unusual set of skills - advanced statistical skills that are rare in Social Policy, combined with skills in qualitative research and public attitude research. The Future Leaders Scheme will provide me the opportunity to gain these abilities, building on initial skills I am fortunate to have had the opportunity to develop in past work, and putting me in a position to deliver powerful research that can change policy.