Downing Street has ruled out adopting David Cameron’s proposal for obese people or those with drug or alcohol problems to be forced to undergo treatment as a condition of receiving benefits.
Theresa May’s deputy official spokesman confirmed that the idea of sanctions for people who are obese or have addiction problems and refuse help is “not under consideration”, after a government-commissioned review found that there was no evidence it would work.
The review by Dame Carol Black, a doctor and academic who is the principal of Newnham College, Cambridge, was set up by Cameron 18 months ago to examine the wider effects of obesity and addiction on employment levels.
Black was specifically tasked by the then prime minister with looking into whether very overweight people, or those with addiction problems, could be deprived of benefits if they declined treatment.
At the time, Cameron said: “Whether it is drug or alcohol problems, or preventable conditions in terms of obesity, support and treatment will be there for you. And we must look at what we do when people simply say ‘no thanks’ and refuse that help, but expect taxpayers to carry on funding their benefits.”
But in her report published on Monday, Black said such a proposal was impractical, in part because of ethical concerns and the fear that such sanctions could lead people to try to hide their problems.
She also found that it would be hard to accurately identify benefits claimants with addictions, and noted that treatments and other help were too sporadically available for such a plan to be effective.
Instead, her report recommended a series of measures to improve the way the benefits system deals with people with addictions, and make access to work or volunteering a part of treatment regimes.
“After a searching inquiry, we are clear that a fresh approach is needed, one that brings together health, social and employment agencies in new collaborative ways, personalised to the circumstances of each individual,” Black said.
Following the report’s publication, May’s spokesman said: “Withdrawing benefits from obese people is not under consideration.”
In the 140-page report, Black noted that with the benefits system, “there is no reliable way of identifying claimants with addictions and there is a distinct lack of specialised support”.
“We doubt whether mandation of treatment – one of the possibilities mentioned in our terms of reference – should be the first response to the evident problems for the cohorts under discussion,” she said.
“Further, there is a strong consensus that mandating treatment would lead to more people hiding their addiction than revealing it.
“We also heard from health professionals [with] serious concerns about the legal and ethical implications of mandating treatment, and whether this would be a cost-effective approach.”
On obesity, she said the relationship between being overweight and out of work was complex. “We cannot infer a direct causal relationship between obesity and unemployment,” the report noted, recommending more research on the subject.
In her introduction to the report, Black said she thought the benefits system required “significant change” to better help people with addictions into work, and any connection with obesity seemed indirect.
While treatments for drug and alcohol dependence were easily available, with waiting times for both about three or four days, only about 20% of people entering such schemes have a job and relatively few people find work during or after the treatment, she said.
“It is clear that providing treatment alone, without additional support such as employment, housing and skills, has limited and inconsistent effects on employment,” the report found.
Black recommended that claimants with drug or alcohol problems should see a health professional about what could be preventing them from obtaining work.
She said employers should be encouraged to give jobs to those who have faced addiction, for example by providing grants to small companies that employ people with a history of alcohol or drug dependence.
While the report found relatively little difference in employment rates between obese adults and those of normal weight – 68% and 70% respectively – the gap increased by more than 10 percentage points for severely obese people.
But establishing a causal relationship was difficult, with unemployed obese adults more likely to live in the most deprived areas, and have poor qualifications and health issues such as diabetes. The report found there was a significant overlap between obesity and poor mental health.
In a statement, the minister for disabled people, Penny Mordaunt, said Black’s findings “support our plans to join up employment and health systems”.
“Your success in life shouldn’t be determined by the circumstances of your birth. We are committed to helping people break down the barriers they face and secure a good job where they can fulfil their potential,” she said.
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