Don’t forget about us

Disability disproportionately affects the poorer half of Britain. Working-age adults in low-to-middle income families are twice as likely to report that they are disabled as those on higher incomes: 30 per cent compared to 15 per cent. This means that the proportion of adults in low-to-middle income families who report being disabled has risen by just over a half over the past three decades, when the rate was 19 per cent. Although population ageing plays a part, most of the rise (83 per cent) is due to rising disability rates across all ages, but especially among younger age groups: the proportion of 16-24-year-olds in low-to-middle income families who are disabled has doubled over the past ten years, from 10 per cent to 21 per cent, with almost all of the rise (96 per cent) driven by mental health conditions.

But to fully understand the impact of these rises, we need to consider not only those directly affected, but also the friends and family members who may care for them. One-in-ten (10 per cent) working-age adults in low-to-middle income families provides at least five hours a week of unpaid care for sick, disabled or elderly people (either in or outside their own household), slightly up from around 8 per cent throughout the 2000s and 2010s, compared to 6 per cent among those in higher-income families. Among those in low-to-middle income families, the likelihood that someone is providing unpaid care is highest among women (12 per cent) and older working-age adults (13 per cent of those aged 45 and above). And 1.1 million working-age adults in low-to-middle income families – more than one-in-twenty (6 per cent) of this group, or three-fifths (58 per cent) of all carers in low-to-middle income families – provide care for at least 35 hours a week, equivalent to a full-time job.

Together, more than two-fifths (43 per cent, or 5.6 million) of low-to-middle income families include a carer or someone with a disability, and a third (35 per cent) of working-age adults in low-to-middle income families – a total of 6.3 million people – are disabled or a carer. This includes around 800,000 working-age adults, or 4 per cent of those on low-to-middle incomes, who are both a carer and are disabled themselves; almost one-in-ten (9 per cent, or 1.1 million) families in Unsung Britain include both a carer and a disabled person.

This over-representation of carers and disabled people among low-to-middle income Britain reflects that people with a disability or who are caring have, on average, considerably lower incomes and living standards than others. For example, 32 per cent of families with a disabled member and 44 per cent of those with both a disabled person and a carer experience material deprivation, compared to 14 per cent in families with neither. These gaps cannot be explained by other characteristics that we can adjust for. Relative to comparable families without a disabled member or a carer, those with a disabled person in the family are more than 10 per cent worse off (£3,300 for those who also have a carer in the family, and £4,000 a year for those who do not, although the difference between these two figures is not statistically significant). When we exclude disability benefits that are designed to cover additional costs from household incomes, these gaps widen further, to £5,600 and £7,600 respectively.

One reason for lower incomes is that disabilities and caring responsibilities can constrain people’s ability to do paid work. But although recent policy debates have focused on those who are not working at all due to long-term sickness or disability, this binary distinction does not reflect the reality that the impact of disability on low-to-middle income adults extends beyond the one-third (31 per cent) who are out of work due to long-term sickness or disability. Even among those in work, more than half say that their health limits the amount or type of work they can do (for example, 58 per cent say their physical health limits the kind of work they can do). Similarly, 34 per cent of low-to-middle income adults providing care for someone they live with report being unable to work due to their caring responsibilities, but 41 per cent of carers who are in paid work have needed to reduce their hours to meet their caring responsibilities. For those in work, not being able to work full-time or needing additional flexibility can also push people with disabilities or who are caring into non-standard forms of work, such as zero-hours contracts or self-employment. One-in-three (33 per cent) disabled working adults in low-to-middle income families are in these forms of work, and 37 per cent of those disabled people who also care, compared to 26 per cent without either constraint. In some cases, the flexible nature of this work might be what allows disabled people or carers to undertake paid work, but it also means that they are doing work that is insecure and lacks guaranteed levels of earnings or important protections such as Statutory Sick Pay (SSP).

Although social security benefits such as the health and carer elements of Universal Credit (UC) and Carer’s Allowance offer some support, too often they fail to adequately protect family incomes. There are particular issues with carer’s benefits: as is well known, Carer’s Allowance claimants lose their entitlement entirely once they earn more than £196 a week, creating a sharp disincentive to work, and the potential for carers to unwittingly amass large debts to Department for Work and Pensions (DWP). And, for all the talk of disability benefits being easy to obtain, focus group participants spoke about how complex and difficult to navigate the benefits system can be, especially for those claiming in times of personal difficulty.

Given the significant income penalties and high levels of deprivation facing disabled people and carers, there is a strong case for policy reform. Although it will not be appropriate or possible for all disabled people or carers to work, it is important to remove as many barriers to paid work as possible. The Government’s ‘Keep Britain Working Review’ is exploring how employers can support disabled workers, and a forthcoming Resolution Foundation report will explore the role of employer flexibility, and transparency around flexible working opportunities, in more detail. The Employment Rights Bill’s provisions to give protections against short-notice shift changes and to extend SSP to low earners will particularly benefit disabled people and carers, given that they are particularly likely to be in insecure and low-paying roles. But the Government should go further and increase the level of SSP, which would ensure workers do not face a sharp hit to incomes when they are unwell and would allow SSP to better support workers with fluctuating health conditions. The Government should also address a relative lack of support for working carers by having the Department for Work and Pensions offer targeted employment support to carers who want it, and by extending statutory carer’s leave from one to four weeks per year – in line with parental leave – with the first two weeks employer-paid at the same rate as SSP to ensure the leave is accessible to lower-income workers.

There are also places where the social security system could be more effective at supporting disabled people and carers. The upcoming Timms review of Personal Independence Payment (PIP) provides an opportunity to make PIP quicker and simpler for claimants to access. The Government has commissioned a review of overpayments in Carer’s Allowance; the best way to prevent these is to introduce an earnings taper, instead of the current eligibility cliff-edge. But the Government should also review all the ways that the social security system supports carers, including how to balance support between the carer’s element of Universal Credit (which helps carers in families with a low income) and Carer’s Allowance (for all other carers). In particular, it should consider whether the overall level of support is adequate. A starting point would be to equalise the caring elements of UC with the health element (which, after the upcoming cuts to UC Health for new claimants, will mean increasing the monthly Carer’s Element by £15.60 to £217 a month, at a cost of around £200 million per year).

Lastly, although our focus has been on the living standards of those with disabilities or caring responsibilities, there is no doubt that public services play a crucial role in supporting people’s health and providing formal social care. It is clear that, in the case of social care, provision falls well short of need: according to NHS data, only two-fifths (41 per cent) of people who apply for publicly-funded social care end up receiving it, falling to less than a third (29 per cent) of working-age applicants, and recent Resolution Foundation polling has shown that low-to-middle income families would prioritise spending on social care above all other public services except the NHS and police. But a well-functioning health and social care system will not be a panacea. Recent rises in NHS waiting lists are one of the most obvious signs that the health system is struggling, but disability rates also rose when NHS waiting lists were shorter. And although formal social care can ease pressures on unpaid carers, many carers find their caring role deeply meaningful, and many care recipients prefer to be looked after by someone they know. The Government is aware of the need to reform the social care system (although the Casey review will not report until 2028), but they should also consider restoring wider support for unpaid carers, such as respite care. Local authority spending on support for unpaid carers in England has been cut by one-third in real terms since the mid-2010s, and restoring it would cost £84 million. Doing so would alleviate some of the pressures on carers – and back up government rhetoric on supporting unpaid carers and recognising the vital role they play.

In recent months, the policy debate about disability has become increasingly polarised, particularly around the subject of benefit cuts. But we must move beyond this narrow focus, and not forget the reality that disabilities and caring responsibilities are central to the lives of millions of low-to-middle income families.