Where next for back-to-work support?

Into work support from the work programme and job centre is not delivering for single parents, or for the tax payer.

If there’s one mantra that underpins much of the government’s social policy reforms, it’s that work is the answer. Whether it’s benefit cuts, radical welfare reform, troubled families, or child poverty–the end game is principally based on getting people into (or back to) work.

Indeed, getting into stable work that pays a decent wage is single parents’ best route out of poverty for their families. Yet there are still 1.16 million children growing up in single parent families where no-one works.

It’s an issue that successive governments have failed to resolve–and, despite the promises of a new approach to employment support, our research published today shows that this government is no closer to making this a reality.

Turning rhetoric into reality

The coalition government has made clear commitments to delivering a more personalised approach to employment support. This includes the promise to give “more responsibility to Jobcentre Plus advisers to assess claimants’ individual needs and to offer the support they think most appropriate”, as well as the Work Programme’s aim of “creating a structure that treats people as individuals and allows providers greater freedom to tailor the right support to the individual needs of each claimant”.

But in practice, our research shows that this rhetoric is firmly at odds with many single parents’ experiences, despite all the evidence showing that the best way to get single parents into work is to offered tailored, personalised support.

Where does this leave single parents? Their starting point is already behind that of other groups—while 59 per cent of single parents are in work, that’s still significantly behind the proportion of mothers from couple families: 71 per cent. More worryingly, despite the billions being invested in the new Work Programme by the government, its first year results—at 3.5 per cent of claimants achieving job outcomes—were already well below government minimum performance targets. And single parents were doing worse still—in fact around a third worse than other claimants. Just 2.5 per cent of single parents achieved job outcomes on the Work Programme. Drill down to young single parents and the figure gets even worse: just 2 per cent achieved job outcomes.

Where there’s a will—there must be a way

Single parents are highly motivated to work. They are the sole breadwinners for their family. They want to be role models, and they want and need to provide for their children.

But they face very specific and significant barriers to work: the cost and availability of childcare, a shortage of family friendly jobs and being able, once childcare and travel are factored in, to make work pay for their family.

Many of the single parents we speak to say that they will take almost any job, as long as they can balance it with caring for their child. Others have clear aspirations to train and skill up in a particular sector, or start on a path that takes them to a career rather than just a job.

We know it’s not lack of motivation that’s holding single parents back. They are a group with huge potential but they are still being failed by government back to work schemes that offer them a one-size-fits-all approach which barely meets the lowest common denominator of need.

Duplication

Even if the Jobcentre can only achieve delivery of a more of a basic and generic approach, the Work Programme should be the start of more intensive, targeted support that helps those a bit further away from work—those who have been long-term unemployed, or those who have requested a bit of extra help. As one of the single parents we spoke to said:

It lifts your spirits a little bit thinking maybe this is different, maybe this is something that is more about me, because that’s how they sell it to you—it’s more personalised. But actually your experience isn’t that different.

Instead single parents found it was groundhog-day. They again were offered basic courses ill-matched with their experience and met with advisers who weren’t trained to understand or meet their needs.

Some of our interviewees even felt sorry for their Work Programme advisers:

The atmosphere was awful. While the advisers weren’t unpleasant, there was such a high turnover of staff that they really struggled.

Again, single parents were recognised for their strong motivation to work. But this didn’t always work in their favour: in fact we found evidence that those closest to work were being ‘parked’—seemingly because their advisers thought they would find work on their own.

Of the single parents on the Work Programme who did find work, only one of our interviewees attributed it to the support they had received. However, all of those who stay in work for six months will result in a pay-out for providers. Is this really value for money for the tax payer?

What next?

There must be an urgent, renewed focus on single parents from Jobcentre Plus and Work Programme providers. We want the government to set a clear and ambitious target for single parent employment and an action plan to achieve it.

The government must undertake a rapid review to draw out the key differences between Jobcentre Plus and Work Programme provision, map out a seamless referral process between the two, and remove duplication in the services provided.

Advisers need greater training and direction to ensure that across both the Jobcentre Plus and Work Programme advisers are informing single parents about their rights to balance job seeking with their childcare responsibilities. Advisers should also be helping single parents to access consistent and reliable support for childcare costs when preparing for work.

And we want to see Jobcentre Plus and Work Programme providers carrying out assessments of single parents’ need for skills training, and investing in vocational skills—not just basic skills and employability.

In short, there has to be an overhaul of both programmes to ensure that they are making an impact, are helping single parents into sustained work and are delivering on the government’s promises. Supporting single parents into work can be—and should be—the answer.

Find out more about Gingerbread’s three-year campaign to Make it work for single parents.

A young single mother and her child living on a housing estate in Middlesbrough, circa 1984. Photograph: Getty Images

Caroline Davey is the Director of Policy, Advice and Communications at Gingerbread.

Flickr/Michael Coghlan
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Why does the medical establishment fail to take women in pain seriously?

Women with mesh implants have been suffering for years. And it's not the only time they have been ignored. 

Claire Cooper’s voice wavered as she told the BBC interviewer that she had thought of suicide, after her mesh implant left her in life-long debilitating pain. “I lost my womb for no reason”, she said, describing the hysterectomy to which she resorted in a desperate attempt to end her pain. She is not alone, but for years she was denied the knowledge that she was just one in a large group of patients whose mesh implants had terribly malfunctioned.

Trans-vaginal mesh is a kind of permanent “tape” inserted into the body to treat stress urinary incontinence and to prevent pelvic organ prolapse, both of which can occur following childbirth. But for some patients, this is a solution in name only. For years now, these patients – predominantly women – have been experiencing intense pain due to the implant shifting, and scraping their insides. But they struggled to be taken seriously.

The mesh implants has become this month's surgical scandal, after affected women decided to sue. But it should really have been the focus of so much attention three years ago, when former Scottish Health Secretary Alex Neil called for a suspension of mesh procedures by NHS Scotland and an inquiry into their risks and benefits. Or six years ago, in 2011, when the US Food and Drug Administration revealed that the mesh was unsafe. Or at any point when it became public knowledge that people were becoming disabled and dying as a result of their surgery.

When Cooper complained about the pain, a GP told her she was imagining it. Likewise, the interim report requested by the Scottish government found the medical establishment had not believed some of the recipients who experienced adverse effects. 

This is not a rare phenomenon when it comes to women's health. Their health problems are repeatedly deprioritised, until they are labelled “hysterical” for calling for them to be addressed. As Joe Fassler documented for The Atlantic, when his wife's medical problem was undiagnosed for hours, he began to detect a certain sexism in the way she was treated:

“Why”, I kept asking myself, when reading his piece, “are they assuming that she doesn’t know how much pain she’s feeling? Why is the expectation that she’s frenzied for no real reason? Does this happen to a lot of women?”

This is not just a journalist's account. The legal study The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain found that women report more severe levels of pain, more frequent incidences of pain, and pain of longer duration than men, but are nonetheless treated for pain less aggressively. 

An extreme example is “Yentl Syndrome”. This is the fact that half of US women are likely to experience cardiovascular disease and exhibit different symptoms to men, because male symptoms are taught as ungendered, many women die following misdiagnosis. More often than should be acceptable, female pain is treated as irrelevant or counterfeit.

In another significant case, when the news broke that the most common hormonal birth control pill is heavily linked to a lower quality of life, many uterus-owning users were unsurprised. After all, they had been observing these symptoms for years. Social media movements, such as #MyPillStory, had long been born of the frustration that medical experts weren’t doing enough to examine or counter the negative side effects. Even after randomised trials were conducted and statements were released, nothing was officially changed.

Men could of course shoulder the burden of birth control pills - there has been research over the years into one. But too many men are unwilling to swallow the side effects. A Cosmopolitan survey found that 63 per cent of men would not consider using a form of birth control that could result in acne or weight gain. That’s 2 per cent more than the number who said that they would reject the option of having an annual testicular injection. So if we’re taking men who are afraid of much lesser symptoms than those experienced by women seriously, why is it that women are continually overlooked by health professionals? 

These double standards mean that while men are treated with kid gloves, women’s reactions to drugs are used to alter recommended dosages post-hoc. Medical trials are intended to unearth any potential issues prior to prescription, before the dangers arise. But the disproportionate lack of focus on women’s health issues has historically extended to medical testing.

In the US, from 1977 to 1993, there was a ban on “premenopausal female[s] capable of becoming pregnant” participating in medical trials. This was only overturned when Congress passed the National Institutes of Health (NIH) Revitalisation Act, which required all government funded gender-neutral clinical trials to feature female test subjects. However, it was not until 2014 that the National Institutes of Health decreed that both male and female animals must be used in preclinical studies.

Women’s exclusion from clinical studies has traditionally occurred for a number of reasons. A major problem has been the wrongful assumption that biologically women aren’t all that different from men, except for menstruation. Yet this does not take into account different hormone cycles, and recent studies have revealed that this is demonstrably untrue. In reality, sex is a factor in one’s biological response to both illness and treatment, but this is not as dependent on the menstrual cycle as previously imagined.

Even with evidence of their suffering, women are often ignored. The UK Medicines and Healthcare Regulatory Agency (MHRA) released data for 2012-2017 that shows that 1,049 incidents had occurred as a result of mesh surgery, but said that this did not necessarily provide evidence that any device should be discontinued.

Yes, this may be true. Utilitarian thinking dictates that we look at the overall picture to decide whether the implants do more harm than good. However, when so many people are negatively impacted by the mesh, it prompts the question: Why are alternatives not being looked into more urgently?

The inquiry into the mesh scandal is two years past its deadline, and its chairperson recently stepped down. If this isn’t evidence that the massive medical negligence case is being neglected then what is?

Once again, the biggest maker of the problematic implants is Johnson&Johnson, who have previously been in trouble for their faulty artificial hips and – along with the NHS – are currently being sued by over 800 mesh implant recipients. A leaked email from the company suggested that the company was already aware of the damage that the implants were causing (Johnson&Johnson said the email was taken out of context).

In the case of the mesh implants slicing through vaginas “like a cheese-wire”, whether or not the manufacturers were aware of the dangers posed by their product seems almost irrelevant. Individual doctors have been dealing with complaints of chronic or debilitating pain following mesh insertions for some time. Many of them just have not reported the issues that they have seen to the MHRA’s Yellow Card scheme for identifying flawed medical devices.

Shona Robison, the Scottish Cabinet Secretary for Health and Sport, asked why the mesh recipients had been forced to campaign for their distress to be acknowledged and investigated. I would like to second her question. The mesh problem seems to be symptomatic of a larger issue in medical care – the assumption that women should be able to handle unnecessary amounts of pain without kicking up a fuss. It's time that the medical establishment started listening instead. 

 

Anjuli R. K. Shere is a 2016/17 Wellcome Scholar and science intern at the New Statesman

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