Understanding the drivers of changes in demand for disability benefits in Scotland since 2010: A quick scoping review

5. Findings

This section describes findings related to the primary research question: ‘What are the drivers of changes in the overall number and profile of people applying for and receiving disability benefits over the last 15 years?’

The review shows that a large proportion of the identified evidence is focused on changes in population health as a driver, followed by changes in the design and operation of the benefit system(s). The number of sources found for each driver were as follows:

• Changes in population health - 18 sources
• Changes in the design and operation of the benefit system(s) - 17 sources
• Changes in the economy and labour market - 11 sources
• Changes in attitudes and behaviour - 7 sources
• Demographic changes - 4 sources

The results are presented for each of the five drivers. However, they often intersect, and many sources discuss multiple drivers. Signposting is used throughout to highlight the connections across the different drivers.

Within each section, specific research questions are posed which flow from the conceptual model (Annex 1). These were developed by the Research Advisory Group and updated as the evidence review developed.

The aim of a quick scoping review is to identify relevant studies and gaps in research, and typically they do not assess the methodological quality of included studies. However, for policy purposes it was important to understand whether findings were robustly evidenced, or more speculative. This review presented primary evidence first in each section, followed by discussions that drew on evidence from other sources and/or included more speculative conclusions. Most of the sources are secondary and in these cases the findings for Scotland are set out first, followed by findings for the UK as a whole or constituent countries.

5.1 Demand driven by changing population health

Eighteen sources examined the role of health as a driver of demand for 'health-related’^[7] benefits. Seventeen focused on changes in population health, and one examined the role of NHS waiting lists. Sources included grey literature by the IFS, the Resolution Foundation, the Learning and Work Institute, Scottish Health Equity Research Unit (SHERU), the Office for Budget Responsibility (OBR), the Scottish Parliament and the Scottish Fiscal Commission (SFC). All sources used existing administrative and survey data. One primary source used secondary data, but primary statistical analysis was conducted.

5.1.1 What evidence is there that declining population health is a driver of disability and health-related benefits?

Summary: Nine sources examined population health within the context of increasing health-related benefit caseloads. The majority of sources suggested that population health has declined across Scotland and the UK. Most of the sources showed that rates of disability and ill health amongst children and working-age adults have increased since the early 2010s, and particularly since the onset of the Covid-19 pandemic. This is demonstrated in both objective measures of population health and more subjective, survey based self-report measures of health (although not all analyses of surveys of self-reported health show that this is declining). The evidence suggests that the rise in the share of the population who report being disabled or in ill-health mirrors, and may at least partially explain, the rise in disability benefit caseloads.

Nine sources^{[38], [39], [40], [41], [42], [43], [44], [45], [46]} examined whether there had been an increase in reports of disability and ill health. None of these focused exclusively on Scotland, however a report by the IFS^[47] included a small comparison between Scotland and England and Wales. This stated that Census data for Scotland showed that from 2011 to 2021, the share of people self-reporting that they were in ‘bad’ or ‘very bad’ health increased slightly, whereas for England and Wales it stayed roughly the same (with a slight decline). The report suggested that this could be due to a genuine difference between Scotland and England and Wales, or because the Scotland Census was carried out a year later in 2022 and so might possibly reflect the longer-term effects of Covid-19.

The rest of the sources and findings focused on the UK, England, or England and Wales. Six of these sources reported that across the UK there has been an increase in the share of people reporting that they are disabled or experiencing a health condition which limits their daily activity. For England and Wales, one report by the Resolution Foundation^[48] stated that if the receipt rate for disability benefits had remained the same between 2013 and 2023, then population change^[8] and increased self-reported disability alone would have accounted for 87% of the increase seen in disability benefit caseload over this period.

However, not all sources reviewed showed a clear increase in reported disability / ill health: two reports, one by the IFS^[49] and one by the Learning and Work Institute^[50] outlined that findings may depend on the data being used, as “different surveys measure different things in different ways”. This is the case for self-reported measures in particular but more objective measures (such as life expectancy) do make clear that population health has declined in recent years and that inequalities in health have widened by most measures.^[51]

Only one of the nine sources, a letter from the House of Lords Economic Affairs Committee to the Secretary of State for Work and Pensions,^[52] claimed that the “health of the nation has been fairly stable over the past decade.” This letter used data (self-reported long-term health problems over time) from the UK Household Longitudinal Survey and the Health Survey for England. However, these self report measures are limited, which may explain why they do not show a clear increase in reports of disability and ill-health like other surveys and administrative data do.^[9]

Five of the nine sources used alternative ways to investigate changes in population health other than survey based self-reported measures of health, including mortality and sickness absence from work. A Resolution Foundation report (2024)^[53] showed that in the UK, between 2020 and 2022, life expectancy rates were the lowest they have been since between 1980 and 1982, and while this most recent fall may be a result of the pandemic, life expectancy rates began declining in 2011. Two of the sources showed that mortality rates for working-age adults have remained higher since the pandemic.^{[54], [55]} Of these two, one^[56] was based on UK data and the other used data for England and Wales.^[57] The IFS report^[58] also showed that sickness absences are higher now than pre-pandemic levels (using a mix of UK and England data) and a slide pack by the Resolution Foundation^[59] showed that the proportion of working-age families in the UK with at least one disabled adult increased from 2012-13 to 2022-23 in every household income decile.

Three reports by the IFS^{[60], [61], [62]} outlined that (in 2022) the success rate for new PIP applications had remained roughly the same since around 2016. They stated that this indicated that the rise in new awards for disability benefits is a result of more people being in ill health rather than due to changes in disability benefit assessments. One of the reports discussed this in relation to mental health specifically.^[63] This is discussed more in section 5.2.

5.1.2 What evidence is there that increases in mental and behavioural disorders have driven disability benefit caseloads?

Summary: Thirteen of the sources reviewed discussed the rising prevalence of ‘mental and behavioural disorders’ within the context of increasing disability benefit caseloads. Together, they showed that there has been a large increase in the number of people receiving disability and health-related benefits as a result of the impact of these. One source^[64] stated that 55% of the post-pandemic rise in disability benefits are due to claims primarily for mental health problems/conditions. Several sources presented evidence to suggest that this reflects wider shifts in population mental health. There has been an increase in the number of people reporting a mental health problem/condition over time, and this increase has been particularly pronounced since the pandemic. There have also been increases in the number of people dying from ‘deaths of despair,’ the number of people in contact with mental health services, and the number of people receiving antidepressants. Several of the sources highlighted that some of these increases may in part be due to increased awareness of mental health problems/conditions and a greater willingness to report these and seek help.

Five of the thirteen sources stated that the proportion of people receiving disability benefits for mental health problems/conditions and behavioural disorders has increased since the early 2010s or since the onset of the Covid-19 pandemic in 2020. Three sources focused specifically on Scotland. A report by the Scottish Parliament’s Information Centre^[65] showed that around a third of ADP/PIP recipients reported a ‘mental or behavioural disorder’ as their main condition in 2025.^[10] This was also the case in 2022; however, the increase in disability benefit caseload for ‘mental and behavioural disorders’ was larger than the increase for any other condition.

Source: SPICe Spotlight (2025). Disability Benefit Reform – implications for Scotland (colours adapted for accessibility)

Another report by the IFS^[66] showed that the percentage of new disability benefit recipients (PIP and ADP) receiving disability benefits for mental and behavioural disorders in Scotland increased between March 2017 and July 2019 and March 2022 and July 2024, and that there are a larger percentage of people receiving disability benefits for ‘mental and behavioural disorders’ in Scotland than in England and Wales (both before and after the introduction of ADP). The third source^[67] had similar findings showing there was a large rise in the number of new awards for ‘mental and behavioural disorders’ in Scotland over the pandemic period, and the percentage change was larger in Scotland than England and Wales.

The other two reports did not include data for Scotland. A report by the IFS^[68] compared the (in their terms) ‘primary medical conditions’ associated with PIP awards in England and Wales before and after the pandemic. It stated that the biggest change was for ‘mental and behavioural disorders’ which increased by 9%. Similarly, the 2024 Welfare Trends report^[69] by the OBR showed that in England and Wales, the share of PIP onflows for ‘mental health conditions’ increased over the pandemic period by around 10%.

Eight sources discussed the rise in applications for disability and health-related benefits for mental health problems/conditions and ‘behavioural disorders’ and how this reflects wider shifts in population mental health. None of the sources focused on Scotland. Collectively, they illustrate that across the UK, England, and England and Wales, the increase in applications for disability and health-related benefits for ‘mental and behavioural disorders’ is mirrored by an increase in rates of self-reported mental health problems/conditions in the general population.

A report by the IFS^[70] showed that in 2023 there was an increase in ‘deaths of despair’ (caused by alcohol, drugs or suicide) compared to the 2015-19 average. Moreover, between 2019 and 2023, the number of people in contact with mental health services increased by 36%, and the share of people in England receiving antidepressants increased by 12%. This source stated that this will be at least partly due to the NHS’s aims to increase provision of mental health services, however the findings are in line with the rise in reports of mental health problems/conditions within the population. Changing attitudes and behaviours around mental health were discussed in several reports and is explored in section 5.9.

5.1.3 What evidence is there on child disability driving increases in child disability benefit caseloads?

Summary: Five of the sources discussed child disability and/or changes in child disability benefit caseloads. There has been a large increase in the number of disabled children in the UK since before 2010, and the proportional rise in reports of children being disabled has outpaced that for working-age adults. Across the UK, the most common reasons for being disabled are related to social/ behavioural issues, learning disabilities, and mental health problems/conditions.^[11] Whilst the proportion of children with social/ behavioural issues and mental health problems/conditions has risen, the proportion of children with learning disabilities has remained broadly unchanged.

Five reports^{[71], [72], [73], [74], [75]} showed that there has been a rise in the proportion of children in receipt of disability benefits (for Scotland, England or the whole of the UK). Two reports by the SFC from 2023^[76] and 2024^[77] showed they had increased their forecasts for spending on CDP, mainly due to the higher number of successful applications for CDP than they had previously anticipated. The SFC suggested that this mirrored a trend across the UK for more successful applications for child disability payments since 2020 but also speculated that it was due to the introduction of CDP in 2021 'leading to larger increases in Scotland than in England and Wales.' (see section 5.3.2)

A Resolution Foundation report^[78] showed that for England and Wales, this increase is almost entirely due to a higher disability benefit (child DLA) receipt rate as opposed to older working-age people for which the increase is partly due to population change. The other two reports^{[79], [80]} stated that the increase in child disability benefit receipt is mirrored by an increase in reported disability in children, as stated by a further Resolution Foundation report:^[81] ‘the upward trend in child DLA fundamentally reflects the sharp rise in the prevalence of poor health and disability among British children.’ This report also stated that the proportional rise in disability in children outpaces that for working-age adults. Figure 5.2 shows how the prevalence of disability among children has increased over the last ten years, particularly for children aged 11-15.

Source: Murphy, L. (2024) Growing Pressures: Exploring trends in children's disability benefits, Resolution Foundation (colours adapted for accessibility)

It is also evident from these reports that the types of health conditions experienced by children are reflected in the impact of the types of conditions that children receive disability benefits for. The ‘Growing Pressures’ report^[82] showed that the most common main conditions for children in receipt of disability benefits in England and Wales were learning difficulties, behavioural disorders and ADHD, and the receipt rate has increased for all three. This mirrors health conditions in disabled children more widely: the OBR 2019 Welfare trends report^[83] showed that across the UK, social/behavioural and learning disabilities were the most reported disability for children in 2016-17, with the largest proportional increase between 2012-13 and 2016-17 being for mental health conditions. By 2022-23, the most common disorders experienced by children were social/behavioural, learning, and mental health disorders.^[84] More on changes in child disability benefit caseloads can be found in section 3.2.

5.1.4 What evidence is there about age and gender differences in relation to rising disability and health-related benefit caseloads?

Summary: Nine sources highlighted age/gender differences in relation to health and rising disability and health-related benefit caseloads. There has been an increase in the number of young adults, particularly young women, receiving health-related benefits and reporting that they are disabled or experiencing ill-health. Young people are also more likely to receive disability benefits for conditions relating to mental health, which appear to be particularly common among young women.

Three of the sources that highlighted age differences focused on Scotland.^{[85], [86], [87]} They showed that older adults are more likely to receive disability benefits,^{[88], [89], [90]} and in absolute terms, the largest increase in new awards has been for older adults 55 and over.^{[91], [92]} However, there has been a larger proportional increase in the number of young people receiving disability benefits, and it is this group that make up a larger proportion of awards since the pandemic, according to the SHERU report.^[93] Two of the reports compared Scotland with England and Wales.^{[94], [95]} An IFS report^[96] stated that the rise in young people applying for disability benefits in Scotland “mirrors the change seen in England and Wales.” The SHERU report^[97] also stated that there are no major differences in the age profile of ADP awards compared to PIP. However, it did report that since April 2024, rates of new awards for disability benefits are lower in Scotland than England and Wales for every age group except under 25’s.

The rest of the reports focused on the UK, England, or England and Wales. These findings largely mirrored findings for Scotland showing that while most people who receive health-related benefits - disability and incapacity benefits together - are older, there has been a large increase in the number of young people in receipt of disability benefits.^[98] In terms of gender, it was also evident that there has been a larger increase in awards for health-related benefits for women compared to men^{[99], [100]} and there has been a rise in the number of older women receiving incapacity benefits due to the rising state pension age^[101] (see section 5.10.2). The 2024 Welfare Trends report by the OBR^[102] compared the increase in incapacity benefit caseload across different ages for men and women over the pandemic period. It reported that all age and gender groups showed similar rises.

Two sources showed that this reflects health trends in the general population: young people - young women in particular^[103] - are more likely to report that they are disabled or in ill health than previously, both across the whole of the UK and for England/England and Wales.^[104] This Resolution Foundation report showed that between 2013 and 2023, there has been a rise in overall disability benefit caseload for 16-24-year-olds of 151,000 and 25-34 year-olds of 183,000, driven by a rise in self-reported disability in these groups. This report also showed that across England and Wales, for younger age groups, had all other factors been held constant, the increase in self-reported disability would have pushed the disability benefit caseload higher than it actually was.

With regards to mental health, young people were more likely to receive disability benefits for a mental health problem/condition. An IFS report^[105] stated that in England and Wales, 70% of PIP recipients under 25 receive disability benefits for a ‘mental or behavioural condition’. For those age 55 or above it was only 20%. Another source^[106] reported that across the UK, in 2023-24, 82% of awards to 16-year-old women were primarily due to mental health problems/conditions compared with 12% for 64-year-old women, claiming that this indicates that some of the increase in awards for mental health problems/conditions is a result of a rise in claims by young people. The sources also showed that women were more likely to report a mental health problem/condition, though these findings were based on data for England.^{[107], [108]} The report by the Learning and Work Institute showed that this was the case for women of all ages, and the OBR 2019 welfare trends report summarised findings from two NHS surveys, stating that the increase in prevalence of mental health problems/conditions from 1999 to 2017 was particularly large for young girls, young working-age women, and older working-age women.

5.1.5 What evidence is there that the Covid-19 pandemic was a driver of disability or health-related benefits?

Summary: Seven sources discussed the effect of the Covid-19 pandemic on rising health-related benefit caseloads. They stated that population health (including mental health) was declining before the pandemic and that evidence suggests that this decline has accelerated and has continued since the beginning of the pandemic.

The effect of the Covid-19 pandemic is highlighted several times throughout this report, but the findings on health are summarised here. Two of the sources that discussed the pandemic period focused on Scotland. Together, they showed that since the onset of the pandemic in 2020 there has been a large increase in the number of new awards overall, the number of new awards for ‘mental and behavioural disorders’,^[109] and the number of new awards for young people specifically. These findings are in line with what is seen across the rest of the UK. The IFS report^[110] largely discussed the increase in awards over the pandemic period within the context of the rollout of ADP in Scotland (see section 5.2) rather than within the context of changing population health.

Other sources focused on the UK, England, or England and Wales. While it is evident that the disability benefit caseloads have increased since the early 2010s, these sources provided evidence to suggest that there has been a larger rise over the pandemic period,^[111] particularly for conditions relating to mental health problems/conditions.^{[112], [113]} They suggested that this reflects a change in population health, and mental health, over the course of the pandemic.^{[114], [115]}

One report by the IFS^[116] which drew comparison with other OECD countries, stated that the interaction of a combination of drivers is the most convincing explanation for the rise [in health-related benefits], in particular, the interaction of recent health and income shocks, the state of the UK’s economy, welfare system and public services. It stated: ‘the UK’s health system has struggled to cope since the pandemic, and this may mean COVID has (directly or indirectly) had a greater impact on health and health-related benefit claims in the UK than elsewhere.’

5.1.6 What evidence is there that NHS waiting lists have driven up disability and health-related benefit caseloads?

Summary: The review did not identify evidence to suggest that NHS waiting lists are a driving factor in explaining the recent rise in health-related benefit claims. However, only one source was identified and thus it is not possible to rule out NHS waiting lists as a factor in increased health-related benefit caseloads.

Only one study was found that investigated the role of NHS waiting lists and it focused on data from England. The report by the IFS^[117] was a primary source which used secondary data but conducted primary statistical analysis. It did not find strong evidence to suggest that longer waiting lists or waiting times are a driving factor in explaining the recent rise in claims for health-related benefits. There was some evidence of a slight relationship between elective waiting lists and claims for ‘mental health conditions’, and trauma and orthopaedic care waiting lists and musculoskeletal conditions. However, the effects are very small and disappear when alternative measures of waiting lists and times are used (i.e., when they only include working-age adults). Any effect found does not necessarily mean there is a causal relationship. Given only one source was identified, it is not possible to rule out NHS waiting lists as a factor in increased disability and health-related benefit caseloads.

5.2 Demand driven by changes in the policy design and operation of the benefits system(s)

This section of the report reviews the evidence on the ways in which changes to the design and operation of the Scottish and UK benefit systems may have driven demand for disability benefits since 2010. It begins by discussing the effects of disability benefit reforms, then examines the evidence on whether changes to UK disability benefit (PIP) application, assessment and reassessment approaches may have driven up PIP caseloads. Finally, wider changes to the UK benefits system are considered, including whether unintended consequences and the conditionality of means-tested benefits may have driven take up of disability benefits.

Seventeen sources examined factors related to changes in the design of the benefit system(s) as drivers of demand for disability benefits since 2010, several of which also considered incapacity benefits. The majority focused on more recent changes to the benefit system(s) (shortly before and after the pandemic), rather than longer term changes since 2010. Five specifically examined the role of Scotland’s devolved disability benefit system as a driver of demand for disability benefits and higher caseloads. Sources included reports by the IFS, the Resolution Foundation, the SHERU, the OBR, SFC and the Learning and Work Institute. These included a mix of secondary analysis of published data, reviews of existing research, findings from a stakeholder consultation and opinion pieces. None involved primary research.

5.3 What evidence is there that demand for disability benefits has increased because of disability benefit reforms?

This section considers the evidence on disability benefit reforms, and whether changes in the policy design and delivery of new systems have acted as drivers of increased disability benefit caseloads over the last 15 years. The key reforms over this period are the transition from DLA to PIP (at the UK level) which began in 2013 (migration is ongoing), and the more recent introduction of ADP and CDP in Scotland.

The purpose of this report is not to draw comparisons between the UK and devolved social security systems. However, several of the studies included examined the differences between ADP and PIP as a means of understanding the extent to which devolved disability benefits in Scotland were a driver of increased caseloads.

Summary: The policy design of PIP (including its changed focus on assessment of functionalities rather than conditions) and early delivery challenges associated with the transition from DLA to PIP were factors which contributed to the increased PIP caseload.

Several sources discussed features of ADP which they anticipated would increase caseloads by removing barriers for disabled people, increasing support available to people applying for ADP and reforming the approach to reviews. None of these sources provided causal evidence to show that these changes had led to the increases in caseload in Scotland.

It can take many years for awards to stabilise after the introduction of a new disability benefit^[118] and it may be too soon to assess whether the devolution of disability benefits to Scotland has driven up caseloads in the post-pandemic period. Longer term data are required.

5.3.1 Did the replacement of DLA with PIP increase demand and PIP caseloads?

Five sources^{[119], [120], [121], [122], [123]} discussed how the introduction of PIP to replace DLA had increased caseloads, although three of these mainly focused on increased spending.^[12] Several reports^{[124], [125], [126], [127], [128]} discussed how PIP was intended to reduce disability benefit caseloads and spending, whereas in fact the reverse occurred. The 2019 OBR report^[129] showed how the proportion of working-age adults in receipt of DLA or PIP rose from 3.5% in 1997-98 to 4.3% in 2007-08 and 5.4% in 2017-18 and highlighted the notable rise in 2015-16 when the transition from DLA to PIP took effect.

Source: DWP, ONS, OBR in Office for Budget Responsibility (2019) Welfare trends report – January 2019 (colours adapted for accessibility)

The 2019 OBR report^[130] showed that the introduction of PIP saw higher than expected: volumes of new claims to PIP (and compared to DLA); success rates for new claims; higher than expected award rates at reassessment and; average awards, and lower than expected: reassessment volumes; and numbers of people coming off PIP – ‘outflows’ initially, which led them to revise up their spending forecasts. It also reported that legal challenges contributed to higher than forecasted award rates and spending on PIP. The Resolution Foundation^[131] noted that early operational challenges led to delays and backlogs which partly explain the increasing share of PIP recipients on longer awards: ‘PIP was bedevilled by delivery challenges from the outset, with new claimants sometime encountering delays of six months or more before they reached first assessment’.

All five of the reports examined or discussed whether changes in policy introduced by PIP (especially the decision not to include the lowest level of support available in DLA) increased the share of awards to disabled people with mental health conditions and learning disabilities. The 2019 OBR report^[132] stated that PIP shifted the assessment approach away from a focus on conditions and towards assessment of functionalities, which made it more likely than DLA to recognise the needs of people with mental health conditions and learning difficulties. This was reiterated in a 2025 Resolution Foundation report.^[133] A separate report by the Resolution Foundation (2024)^[134] stated that an explicit policy aim of PIP was to provide better support for people with mental health conditions and learning disabilities than its predecessor (DLA) and suggested that this may have contributed to increased caseloads for people with mental health conditions.

However, the 2024 OBR report analysed DWP data on the primary conditions of PIP ‘onflows’ (successful applications) which showed that the share of onflows / successful applications for mental health conditions was relatively stable up until 2019-20 and did not start to increase until the Covid-19 pandemic (Figure 5.4). This share has risen by a third, up from 28% in 2019-20 to 38% of onflows in 2023-24.

Source: DWP, OBR in Office for Budget Responsibility (2024) Welfare trends report – October 2024 (colours adapted for accessibility)

A report by the IFS (2022)^[135] noted that one of the UK government’s policy aims of PIP was to better target support to those with the greatest ‘medical need’. The report found evidence that ‘disability benefits receipt has become more concentrated among those with a substantial number of conditions, suggesting that disability benefits in 2018–19 were more targeted at those in the worst health than in 2012–13.’ It also found that the overall increase in claims had become concentrated among those with psychiatric conditions (as mirrored across the population as a whole). However, their analysis wrote that ‘the screening of applicants with mental health and social/behavioural problems has not become any more or less lenient over time, suggesting that the disability benefits system continues to restrict support to those with the most severe mental health and social/behavioural problems.’

5.3.2 Did the replacement of PIP with ADP in Scotland increase demand and ADP caseloads?

Five sources^{[136], [137], [138], [139], [140]} were included that examined how changes in the design and delivery of ADP may have acted as a driver for increased disability benefit caseloads in Scotland, particularly after the initial rollout of ADP. Three of these reports were by the IFS, one by the SFC and one by SHERU.

Awards for disability benefits in Scotland started to rise before the rollout of ADP and a steady upward trend in awards began in 2021. This reflects similar trends in England and Wales.^[141] However, several reports^{[142], [143], [144], [145]} showed a notable escalation in new applications and successful awards after the rollout of ADP and CDP in 2023 in Scotland, compared to the rate of new applications in England and Wales over the same period. Regarding applications, an IFS report^[146] wrote: ‘New applications to ADP in Scotland – as a share of the working-age population – were 41% higher in the three months to May 2023 than in the three months to May 2022 (Scottish Fiscal Commission, 2023). In comparison, new applications grew by only 16% in England and Wales in the same period.’

A separate IFS report^[147] speculated that this might be partly explained by applicants choosing not to apply for PIP in anticipation of the introduction of ADP, alongside delays before ‘significant numbers of applications were processed’. It is also worth noting that the introduction of CDP and ADP received significant media attention which may have raised people’s awareness of the new devolved benefits.^[148]

The number of applicants for ADP fell after the initial spike but remains high compared to pre-pandemic levels of applications to PIP (118% higher in July 2024).^[149] Several sources discussed features of ADP which they anticipated would increase applications for the benefit by removing barriers to and increasing support for applying for ADP.^{[150], [151], [152]} None, however, provided causal evidence to show that these changes inherent in ADP had led to the increases in caseload in Scotland. These reports also drew comparisons with the PIP application process, and some noted that although ADP award values are the same as PIP and eligibility criteria largely replicated, features of the ADP application and review processes were expected to make both more straightforward and accessible than PIP. These features included support with the application process, application routes, introducing person-centred assessments, changes around the decision making and the approach to reviews (see section 2.4 for more detail on these).

The 2024 SFC report^[153] highlighted data from Social Security Scotland which was published in 2023, which showed that the percentage of ADP award reviews resulting in awards being stopped or decreased was 2% compared with 16% of awards ended for PIP in England and Wales. The SFC noted that ADP clients undergoing planned review can confirm no change in circumstances by ticking a box and only need to provide additional information if they believe their circumstances have changed. The report stated: ‘After ADP rollout, applications increased in Scotland, and there has also been less people leaving after the review (attributed to the light-touch review).’ The same report speculated that the increase in disability benefits in Scotland (since the roll out of ADP and CDP) related to both the UK-wide increase^[13] as well as the operational and delivery changes inherent in the newly introduced ADP and CDP in Scotland.^[14] The SFC report speculated that the effects of the delivery and operational changes introduced with ADP are now ‘evident’ in benefit statistics and argued:

‘…Since the launch of ADP in August 2022 there has been a higher number of applications, reflecting the Scottish Government policy to maximise take-up, and a decrease in the number of people exiting the caseload at award review because of the light-touch review process.’^[154]

Three reports published in 2024^{[155], [156], [157]} showed that while ADP application rates remain high, the higher rate of ADP awards relative to PIP changed in March 2024^[158] and during 2024 the ADP application success rate^[15] in Scotland became lower than the comparable rate for PIP in England and Wales.^[16] The IFS^[159] showed that there had been lower approval rates for ADP applications in Scotland compared to England and Wales in the most recent period May - July 2024 (42% in Scotland compared to 48% in England & Wales). The 2024 SFC report^[160] stated that while it still expected that the number of successful new applications to be higher than before the introduction of ADP, they revised down their December 2023 forecast for successful applications because of the lower than projected increase in the application success rate. The SFC report speculated that this might partly be because applications for more severe conditions - accompanied by more comprehensive supporting information - were processed more quickly when ADP was rolled out and suggested that this could have had the effect of ‘skewing the initial success rate’.

Given the recent lower than anticipated award rates for ADP, several reports^{[161], [162], [163]} stated that whereas the initial expectation was that features of ADP design and delivery (discussed above) would increase caseloads compared to equivalent PIP caseloads in England in Wales, there is now uncertainty around whether this would transpire over the longer term. The SFC 2024 report^[164] stressed the particular uncertainty in forecasting, given the implications of fewer ADP awards being reduced or stopped following review. This was partly because it is unclear whether this will remain the case over the longer term but also due to uncertainty around whether the reduction in the number of awards ended at review could have knock-on effects on application rates in the future (e.g. fewer people reapplying for ADP once their awards end, as happened with PIP).

5.4 Have changes to the PIP application process increased award rates ?

Summary: Six reports^{[165], [166], [167], [168], [169], [170]} examined the evidence around award rates for PIP over the last 15 years, and whether changes to the application process have increased award rates. All sources concluded that there was little evidence to suggest that it is ‘easier’ to be awarded PIP today than to be awarded PIP in the past (after the roll out of PIP), which is demonstrated by steady award rates over time. The evidence suggested that the increases in awards are more likely to have been driven by increased numbers of eligible applicants.

A Resolution Foundation report (2024)^[171] examined evidence on whether it has become ‘easier’ to be awarded PIP by looking at award rates and DLA reassessments over time for England and Wales. The report found that PIP award rates for new PIP claims have been broadly steady at around 45% since 2015-16 and are no higher than when PIP was introduced in 2013-14. The report also examined DLA to PIP reassessment data and found that the award rate for those who were transferred from DLA to PIP has decreased over time. The report concluded that this analysis offers little evidence to suggest that it is ‘easier’ to qualify for PIP today than it was in the past (see Figure 5.5 below).

Source: Resolution Foundation (2024) Under strain: Investigating trends in working-age disability and incapacity benefits

An article by the New Economics Foundation^[172] analysed DWP data on the number of PIP applications and the success rate for a later period - between 2018 and 2024 - and found that the success rate for claiming PIP has been ‘fairly static’ since the pandemic.

A 2022 report by the IFS^[173] investigated the sharp increase in PIP claims in England and Wales from 2021 to 2022.^[17] The report examined the rate of PIP applications, decisions, and awards (Figure 5.6) and found that the increase in monthly PIP awards matched the rise in decisions, indicating that the success rate has remained roughly stable since 2016 at around 40%.

Source: Institute for Fiscal Studies (2022) The number of new disability benefit claimants has doubled in a year (colours adapted for accessibility)

The report stressed that these findings are consistent with the assessment system remaining roughly the same in terms of its “strictness” and concluded that the increase in awards ‘does not seem to be driven by a change in the operation of the PIP system’.

A 2023 IFS report^[174] reiterated this conclusion. It stated that the number of PIP applications saw a similarly ‘meteoric rise’ and so the share of successful applicants remains largely unchanged. A 2024 IFS report^[175] also demonstrated this and noted that the share of claimants being awarded PIP after initial assessment was 52% in 2019–20 and 54% in 2023–24. A separate 2024 IFS report^[176] also briefly considered the success rates of applications for both disability and incapacity benefits, drawing on the aforementioned IFS report.^[177] Despite there being different trends for incapacity benefits, the report concluded ‘taken together, this suggests that increased numbers of applications have been a more important factor than greater leniency.’

5.5 Have changes to the assessment approaches for PIP driven up caseloads?

Another key change which may have affected caseloads is the change from face to face to telephone as the main means of assessment for PIP due to the Covid-19 pandemic.^[178] The Resolution Foundation^[179] showed that in 2023-24, two-thirds (64%) of all PIP assessments in England and Wales were conducted by telephone or video, 17% were paper-based assessments, 6% were face-to-face (no assessment method was recorded for the remaining 13%).

Summary: Two sources^{[180], [181]} were included that examined whether changes to the assessment approaches for PIP have driven up caseloads, and a further two^{[182], [183]} examined this for incapacity and disability benefits together. Only one^[184] carried out secondary analysis of published data on PIP assessment types and found that for PIP the assessment type had little affect on award rates. There was a lack of evidence on the impact of changes in assessment approaches and no robust evidence to show that changes to PIP assessment approaches due to the Covid-19 pandemic had contributed to increased caseloads.

A Resolution Foundation report^[185] analysed data from the DWP’s Health Assessment Channels trial for England and Wales from 2023-24, to examine the proportion of PIP assessments resulting in an award by different assessment channels. They found no evidence to show that the decision to carry out more remote assessments during and after the pandemic has led to a significant increase in the PIP caseload, as PIP award rates were very similar for both face-to-face and telephone/ video assessments (43% and 48% respectively).^[18]

This research included a policy roundtable with ten welfare rights advisers which highlighted views that the shift towards telephone interviews had affected clients, and was both a barrier as well as a facilitator for PIP applicants in England and Wales. Some advisers suggested that important information could be missed when the assessment was conducted by telephone and that telephone assessments have made it harder for some clients to explain the impact of their condition.

A comment piece by the IFS (2024)^[186] used existing published data to examine trends, to report on how the number of disability benefit applications and awards has changed in Scotland, relative to England and Wales over recent years. The article outlined how the introduction of ADP was expected to have driven the increase in awards compared with England and Wales, but speculated that changes to PIP assessment processes (and reassessments, see below) - alongside other changes to PIP - may have had an impact on the caseload, and reduced the anticipated divergence in caseloads between Scotland, and England and Wales.

An IFS report^[187] (2024) discussed whether changes to the way that assessments are made due to the pandemic, might in part explain the rise in health-related benefits. The report acknowledged the lack of evidence on the impact of this shift in assessment approaches. It speculated that the change from face to face to telephone or video could have increased the number of applicants who might otherwise not have applied due to a ‘potentially stressful face-to-face assessment’.

A report by the Learning and Work Institute^[188] (2025) discussed whether PIP and Work Capability Assessments (WCA) have become easier to claim following the shift to online or phone assessments, which, alongside other factors, has increased caseloads. The report stated that there is insufficient ‘hard’ evidence to attribute this to operational changes in systems during and after the pandemic, including the switch to more online and phone assessments, but that this (and other factors) may have played a role. However, this report was principally focused on incapacity benefits and did not offer any supporting evidence to back up this argument.

5.6 Have changes to the frequency and outcomes of PIP reassessments increased caseloads?

Summary: This section examines the evidence around the frequency and outcomes of PIP reassessments and is included because changes to these may have increased disability benefit caseloads. Four sources^{[189], [190], [191], [192]} examined the evidence on the frequency and/or outcomes of PIP reassessments and impacts of this on awards. A further report^[193] examined the impact of low PIP ‘outflow rates’ on rising disability benefit caseloads. These found that part of the reason that PIP caseloads are increasing (in England and Wales) is because of longer award durations / fewer ‘outflows’^[19] for PIP over time, in part due to less frequent reassessments and a falling share of awards which were stopped or reduced at review in the post pandemic period. Several reports highlighted the longer term consequences of longer awards and low outflow rates. However, reports did not compare these to past levels of award refusals successfully appealed and re-instated. Thus, it is plausible that longer awards could have reduced outflows which may have become inflows again following appeal.

Resolution Foundation analysis of DWP data^[194] showed that part of the reason that PIP caseload numbers in England and Wales have increased is because recipients are remaining on the benefit for longer and being reassessed less frequently. This is despite the original policy intentions of PIP to introduce more regular reassessments and reduce the proportion of people in receipt of PIP for long periods of time. The report attributed this to numerous operational, legal and circumstantial challenges, many of which pre-dated, but were exacerbated by, the Covid-pandemic, and which have created backlogs in the system (for initial awards and reviews), meaning PIP recipients are staying on the benefit longer than in the past. The report stated that ‘although the proportion of PIP awards being made for two or more years has fallen in recent years… the impact of long award durations during the mid-2010s will continue to have an impact in the 2020s as many of these claimants remain in the PIP caseload.’

The IFS^[195] (2022) concluded that while the number of successful PIP applications in England and Wales had risen considerably over several years, the number of outflows had remained around the same, and if this trend were to continue then the result would be a rise in the total PIP caseload. Analysis in a later IFS report (2024)^[196] showed that since the pandemic, the share of PIP recipients in England and Wales seeing their awards ended or reduced at a periodic award review had fallen by a third, while the share seeing their award maintained had grown.

Source: Institute for Fiscal Studies (2024) What has happened to disability benefits in Scotland? An update (colours adapted for accessibility)

Another IFS report (2024)^[197] discussed the impact of low outflow rates from PIP on rising disability benefit caseloads. The report argued that the increase in UK disability benefit caseloads is both due to increasing numbers of applicants and fewer people ‘ending claims’. Their analysis of DWP data showed that the share of claimants ending their claim fell from 9.0% in 2019 to 7.4% in 2023, and outflow rates declined across all claimant lengths over time and were particularly low in 2023. The authors indicated that it is not clear why outflow rates have fallen so steeply but stated that if these remain low, ‘the caseload could continue to grow even if inflow rates fell back to pre-pandemic norms’.

A Resolution Foundation slide pack^[198] (2025) includes some of the analysis from the report above, which showed that the durations that people are remaining on PIP are longer than in the past. The Resolution Foundation stated that this is to be expected given that ‘PIP reassessments have not kept pace with rising caseload, and average clearance time for PIP reviews is 50 weeks’.

Changes to the frequency of reassessments for incapacity benefits are not within scope. However, it is worth noting the 2024 OBR Welfare trends report,^[199] the focus of which was incapacity benefits, identified similar trends to PIP, including the temporary suspension of reassessments during the pandemic and that reassessments have remained at a low level since.

5.7 Demand driven by policy design of the reserved benefits system

This section considers the evidence for how the design of reserved disability and incapacity benefits (PIP and UC Health) and their relationship to other forms of entitlements may have created what is sometimes referred to as ‘perverse incentives’. Section 5.8 considers how falling incomes and rising inflation may have driven take up of health-related benefits, while this section examines potential impacts due to the design of the reserved benefit system, which includes the effects of falling incomes from social security benefits. These areas are closely interrelated, and so there are overlaps in the evidence.

It is important to note when reading this section - particularly comparisons on the relative value of social security benefits - that disability, incapacity and unemployment benefits are intended for different purposes (see Introduction).

5.7.1 Have changes to reserved unemployment benefits incentivised the take up of disability and health-related benefits?

Summary: Four sources^{[200], [201], [202], [203]} examined how changes to wider reserved social security benefits over the last 15 years have created a sizeable gap in the financial value of health-related (disability and incapacity) benefits relative to unemployment benefits, which may have incentivised people to apply for disability and incapacity benefits. Despite clear evidence of a divergence in the relative value of these benefits, there was no robust evidence to demonstrate that this has been a driver of more people applying for disability benefits.

Several reports^{[204], [205]} speculated that the gradual yet significant fall in the real value of out of work benefits since 2010-11, compounded by the removal of the £20 uplift to UC (introduced at the onset of the Covid-19 pandemic) and the cost of living crisis may have enhanced the importance of health-related benefits for incomes, compared to a decade ago. These Resolution Foundation reports showed how the basic value of unemployment benefits has fallen by 8% in real-terms between 2010-11 and December 2024, driven by below-inflation uprating and freezes.

A 2025 Resolution Foundation report^[206] on shifting income sources for poorer households over the last 30 years showed that increases in ill health and disability alongside changes to the benefit system have ‘triggered a rise in the number of claimants receiving health- and disability-related benefits’. It found that the proportion of income from benefits overall has fallen for all households, but especially for low-income households between 1994-95 and 2022-23, particularly over the 2010s and 2020s. The report stated that over this period the proportion of benefit income for low-to-middle income households from disability benefits (DLA, PIP, ADP and CDP) has more than quadrupled in real-terms and become a more important source of income for these households. It stated that 14% of total low-to-middle income benefit income now comes from disability benefits, and for low-to-middle income households that receive disability benefits, this now constitutes 31% of benefit income. The total proportion of gross income from disability benefits for low-to-middle income households also increased from 1% in 1994-95 to 3.2% in 2022-23.

Separate Resolution Foundation analysis^[207] showed how being in receipt of incapacity and disability benefits delivers a ‘huge boost to incomes’. Figure 5.8 illustrates the differences in support between people in receipt of the basic rate of Universal Credit (UC), those in receipt of the health element of UC (Limited Capability for Work-Related Activity (LCWRA)), and those in receipt of both the LCWRA health element of UC and PIP. The increase is especially significant for single adults – an income increase of 186% if awarded the UC health element and PIP, compared to an award of the basic single adult rate of UC alone.

Source: Adapted from Resolution Foundation (2024) Under strain: Investigating trends in working-age disability and incapacity benefits (colours adapted for accessibility)

The Resolution Foundation report did not provide direct evidence that the relative value of health-related benefits had translated into more people applying for disability benefits, but stakeholder perspectives were included which stated that it would be rational for people to apply for these:

“There are more holes in the safety net than there were 20 years ago. It’s full of holes now. Lots of people fall through and are living well below even the meagre subsistence level of benefits … so getting [UC health] or PIP has become more important, more critical.”

An IFS comparative analysis (with other OECD countries)^[208] from 2024 stated that the design of the UK’s benefit system (including employment support), plays a role in explaining the rise in health-related benefits. The amount of basic unemployment support is lower relative to earnings in the UK than most comparable countries. The report speculated that alongside the demanding job-search requirements, the recent cost of living crisis, and other factors, this may have incentivised more people with health conditions in the UK to apply for health-related benefits than in other countries.

The Learning and Work Institute^[209] emphasised the ‘push’ factors (lower generosity of the unemployment system and greater stringency) and ‘pull’ factors (higher financial support and lower conditionality) at play in incentivising disabled people and those with health conditions who had not previously applied for health-related benefits to do so. Their report stated ‘…a rising proportion of people with health problems or disabilities isn’t necessary for a rise in claims for disability and incapacity benefits. People can have greater incentives to claim for conditions they already had if they believed they would otherwise receive insufficient financial or other support.’ These findings were discursive and not underpinned by quantitative analysis.

5.7.2 Have job search conditionality regimes been a driver of disability benefit take up and caseloads?

Summary: Six reports^{[210], [211], [212], [213], [214], [215]} were identified that examined or discussed job search conditionality regimes as a driver of disability and health-related benefit caseloads. There is some qualitative evidence as well as speculation in the reports that the exemption from the conditionality regime afforded by the LCWRA element of UC, and lack of means-testing of PIP, have been a driver of applications for these both. However, there was no robust evidence to support this.

Conditionality refers to the work-related activities a person in receipt of UC usually must do in order to receive their full payment of UC. If agreed work-related activities are not carried out without a ‘good reason’, a person’s UC payments can be reduced or stopped, which is known as a sanction.^[216] If a person is considered to have LCWRA they are not required to carry out work-related activities to keep their UC, whereas if they are in the LCW group, they usually have to do some work-related activities, but not a full job search.

A Resolution Foundation report (2024)^[217] examined the impact of work-related conditionality and the ‘non-monetary’ advantages of health-related benefits, as well as disability benefits specifically in the context of England and Wales. The evidence cited in relation to work-related conditionality came mainly from the stakeholder ‘roundtable’, rather than from secondary analysis of published data in other parts of this report. The report stated that work-related conditionality is most likely to act as a driver for incapacity benefits, as recipients of the LCWRA element of UC are exempt from the ‘conditionality regimes’ that those in receipt of UC are required to carry out (also emphasised by the Learning and Work Institute^[218]) but is also a driver of PIP in England and Wales.

The report distinguished between ‘explicit’ conditionality (specific requirements and the threat of sanctions) and ‘implicit’ conditionality (e.g. the perception/ sense of stress/ insecurity that benefits are conditional even when they are not, which can influence people’s decisions as to whether to apply, and can impact their mental health etc.) in the current social security system, in line with earlier work by Geiger et. al.^[219] The report stated that the scale of those subject to conditionality (3 million people in receipt of benefits in GB were subject to conditionality in 2023) and the level of political discussion around sanctions and work-related conditionality has meant that regardless of a person’s conditionality status, ‘many feel that being a benefit claimant without a health-related element would be an insecure way of life.’ Quotes from welfare rights advisers from the stakeholder ‘roundtable’ demonstrated views that people’s experience of work-related conditionality drives claims for disability benefits as well as incapacity benefits:

“With means-tested benefit income being (or feeling) insecure, it may be more important for claimants to apply for non-means-tested disability benefits, which are stable and entirely separate from the UC conditionality system.”

“People absolutely refuse to claim UC [rather than ESA]… That’s partly the nature of the claim process - the monthly payment, the online assessment – but it’s also because they are just terrified [of conditionality].”

A recent report by the IFS (2024)^[220] examined the evidence around whether a stricter and more demanding conditionality regime, and the exemption of (some or all) conditionality requirements for individuals receiving incapacity benefits is a driver behind the recent rise in health-related benefits in the UK. The report surmised that ‘as things stand, this seems like a plausible but far from confirmed hypothesis.’ The report drew on the findings from a previous IFS report (2023)^[221] which found that when conditionality was widened to include lone parents between 2008 and 2012, for every four individuals who moved into work in response to the policy, another three started claiming incapacity benefits. The report noted that UC sanction rates have more than doubled since before the pandemic but the reasons for this are not clear (e.g. whether this is because the conditionality regime has become stricter, or down to a change in the composition of the UC towards groups that may be more likely to be sanctioned).

A letter from the House of Lords Economic Affairs Committee^[222] to the Secretary of State for Work and Pensions also discussed conditionality in the context of the increase in spending on incapacity and disability benefits. Findings on conditionality were based on expert witnesses, many of whom were authors of other sources cited in this scoping review. The report stated that the conditions attached to various benefits were imbalanced, and ‘the lower level of conditionality attached to health-related benefits creates an incentive to apply for these benefits’.

Lastly, recent (2025) Resolution Foundation analysis^[223] highlighted that the increase in conditionality in UC compared to the legacy benefit system also incentivises claimants to apply for disability benefits, ‘as these are seen as a stable source of income that cannot be revoked if a claimant doesn’t meet their conditionality requirements’. However, it did not provide supporting evidence for this claim, and this was discussed alongside several other contributing factors.

5.7.3 Have qualifying benefits acted as an incentive and driver of disability benefit take up and caseloads?

Summary: Two Resolution Foundation reports^{[224], [225]} discussed how being in receipt of PIP, which qualifies people for other sources of support and is not subject to the benefit cap, may act as a positive incentive for, and driver of disability benefits. Testimonies from welfare rights advisers were provided but there was no causal evidence to demonstrate this has been a driver of disability benefits.

One report^[226] was found that examined the role of qualifying benefits (also known as passported benefits) as a positive incentive or influence on people’s decisions to apply for health-related benefits in England and Wales. The report described how being in receipt of PIP qualifies a person for other sources of support and so acts as a positive incentive for, and driver of disability benefits, independent of other incentives set out above. The evidence cited in this report in relation to qualifying benefits comes mainly from the stakeholder consultation, rather than from secondary analysis of published data.

The report listed the range of benefits that disability benefit recipients may also be entitled to, acting as a ‘gateway’ to further support. These include: Blue Badge parking or concessionary travel; reduced council tax bills; Carers’ Allowance and significantly, exemption from the benefit cap (for adults and children), which ‘puts very serious downward pressure on their household income’.^[227] The report also noted the additional support that those in receipt of incapacity benefits (the LCWRA element of UC) are entitled to, such as free prescriptions and dental treatment.

Testimonies from the roundtable with welfare rights advisers highlighted how they consider the benefit cap to have acted as an incentive for people to claim health-related benefits (disability and incapacity benefits):

“Absolutely the benefit cap [has boosted incentives to claim disability benefits]. When the benefit cap came in there was a lot of work to see if they could find exemptions. Any good welfare rights adviser would do their level best to support someone to apply for disability benefits if they can.”

A later report from the Resolution Foundation^[228] also highlighted that disability benefit (and incapacity) recipients are exempt from the benefit cap, making this a more secure source of income.

5.8 Demand driven by changes in the economy and labour market

Eleven sources examined the role of changes in the economy and/or the labour market as a driver of demand for disability and health-related benefits. All sources were grey literature, including reports by the IFS, OBR and NEF. Two of the eleven sources examined whether demand for disability benefits has been driven by rising inflation and fall in the value (and comparative value), of wider working-age benefits over the longer term. These are discussed in section 5.7.

The sources reviewed contained no robust causal evidence to show that demand for disability benefits has been driven by the economy and/or the labour market since 2010. More commentary was found on the role of the cost of living crisis (than of the pandemic or the state of the labour market as a driver) but findings on the cost of living crisis were mainly discursive and there was a lack of empirical studies to support the arguments. Two IFS reports conducted analysis which they argued has provided some evidence to show that while worsening labour market conditions have played a minor role in explaining the increase in disability benefits post pandemic, recent changes in the labour market are not a key driver of the rise in caseloads.

5.8.1 What evidence is there that the Covid-19 pandemic caused economic and/or labour market disruption which increased demand for disability benefits?

Summary: Two reports^{[229], [230]} discussed economic and/or labour market disruption due to the pandemic in combination with other factors, one as a driver of health-related benefits and the other as a driver of incapacity benefits. Both reports were discursive and speculative. No sources were found that specifically examined whether economic / labour market disruption caused by Covid-19 had increased demand for disability benefits. The wider effects of Covid-19 in relation to disability benefit caseloads are discussed further in other sections of this report.

The effect of the Covid-19 pandemic on disability benefits was discussed in several sources but primarily in relation to the other drivers examined, particularly the health driver (section 5.1.5) and changes in the benefit system(s) (section 5.2). These sections of this review show that the pandemic brought about: changes to disability benefit assessment and reassessment processes; contributed to backlogs in the system (for awards and reviews); saw the suspension of conditionality (for incapacity benefits); the introduction of the £20 UC uplift at the start of the pandemic and its subsequent removal in October 2021; and may have increased awareness of benefit entitlements.^[231]

The findings of one of the reports found, by the IFS,^[232] are discussed in the health section and also below. The other report by the OBR^[233] argued that labour market disruption due to Covid was one of several factors behind the increase in initial claims for incapacity benefits. Other factors which were identified in the report (examined in this and other sections of this review) included the rising state pension age widening eligibility; evidence of deteriorating health; and cost of living pressures. The report speculated that - alongside the relatively lower financial value and higher conditionality elsewhere in the benefit system - this may have increased eligibility and take up of incapacity benefits, but the evidence to support this is limited.

5.8.2 What evidence is there that the cost of living crisis has acted as a driver of disability benefit applications and caseloads?

Summary: Eight sources examined whether the cost of living crisis and worsening economic conditions since the pandemic have been a driver of disability and health-related benefits caseloads. One source^[234] included secondary analysis of published data. However, despite speculation and circumstantial evidence on this as a possible explanation, there was no causal evidence in this or other sources to show that the cost of living crisis acted as a driver of disability benefit caseloads or led to increased take up of disability benefits. Three of the eight sources focused on Scotland.

Eight sources^{[235], [236], [237], [238], [239], [240], [241], [242]} examined or discussed how the cost of living crisis may have acted as a driver of increased disability and health-related benefits caseloads. Two of these sources did not refer to the cost of living crisis directly, but to worsening economic conditions since the pandemic. Four of the eight sources examined ‘health-related benefits’. A further source^[243] discussed the impact of the cost of living crisis on incapacity benefit caseloads.

Five sources^{[244], [245], [246], [247], [248]} examined or discussed whether falling real household incomes and worsening economic conditions due to the cost of living crisis may have led people eligible for disability benefits to take up their entitlement when previously they had not applied. One of these focused on health-related benefits.

An article by the NEF^[249] examined the ways in which PIP caseloads vary across parts of England and Wales, and how social and economic disadvantage may explain regional PIP caseloads at points in time. Their analysis found that a region’s disability prevalence is a strong predictor of PIP claims. They estimated that the number of disabled people in an area explains 71% of PIP caseload in a particular region. However, they also observed that the number of people claiming PIP was heavily influenced by the region’s level of deprivation with a lower proportion of people claiming PIP in more affluent areas and vice versa. Their analysis found that the amount of disabled people in an area, as well as a region’s relative deprivation explained 94% of the regional PIP caseload. This suggested that the rise in PIP claims is caused both by rising rates of disability and ‘worsening hardship’, including the cost of living crisis. The article highlighted evidence on how disabled people had been particularly negatively affected by high inflation during the cost of living crisis. It speculated that while rising rates of disability means more people are eligible for PIP, worsening hardship means that more people previously eligible for PIP who did not apply for it, would now need to apply for this additional financial support, and that the rise in caseloads could be explained by ‘greater legitimate take-up rate within the disabled population’. However, there was no analysis of change over time or causal evidence of increased take up due to the cost of living crisis.

A report by SHERU^[250] did not refer to the cost of living crisis directly but speculated that given that disability benefits are designed to cover additional living costs faced by disabled people and can be a ‘protective factor against economic disadvantage’, the rise in new awards in Scotland could reflect more people taking up their entitlements or be a response to declining ‘economic circumstances’ (or be due to increased prevalence of health conditions).

Two reports by the SFC^{[251], [252]} and one by the OBR (cited by the IFS)^[253] attributed the higher number of applications for ADP and PIP (respectively) to a combination of factors including the impact of the cost of living crisis. The 2023 SFC report^[254] revised its forecasts to attribute greater weight to the cost of living crisis as a driver of demand for ADP. It stated: ‘We agreed with the OBR that this increase in demand could be due to a range of possible explanations such as the long-term increase in mental health related cases, the NHS waiting lists, and the cost of living crisis, which together could exacerbate existing health conditions as well as increase the likelihood of people applying for disability payments.’

The IFS^[255] stated that the OBR revised down its forecast for the growth in disability and incapacity benefit caseloads in November 2023 on the assumption that caseload growth was partly driven by the cost of living crisis, and therefore improvements in economic conditions would adjust down the rate of increase in the numbers of applicants. The 2023^[256] and 2024^[257] SFC reports also set out an expectation that some of the demand for ADP would ease as the crisis abated and real household incomes return to pre-pandemic levels.

Several reports^{[258], [259]} highlighted the detrimental impact of the cost of living crisis on recipients of unemployment benefits during the cost of living crisis and speculated that the further erosion in the value of these benefits, alongside the removal of the £20 a week UC uplift, may have led recipients of out of work benefits to take up disability or health-related benefits. The Learning and Work Institute noted that there is no evidence to corroborate this. A Resolution Foundation report^[260] (2024) stated that welfare rights advisers in a policy roundtable they ran believed that the ‘shock nature of the cost of living crisis’ had led people to take up health-related benefits. One adviser said:

“The thing I hear the most is cost of living crisis. It’s quite common that we get people who have maybe tried to claim in the past, maybe had a bad experience and it put them off, but they are coming back to [claim again] now that they are struggling with their bills”.

An IFS report^[261] discussed the ‘onerous’ nature of the application and assessment processes for health-related benefits and proposed that people might only undergo this if it was worth it in terms of the additional income gained; ‘Falling real incomes caused by high inflation over recent years might mean higher value is placed on additional income, inducing more people to apply for health-related benefits.’ The report referenced previous studies of disability benefit take up during periods of recession in the United States and speculated that should similar responses occur in the UK, then the rate of applications for health-related benefits would likely slow down as economic conditions improve and the crisis eased.

The above and a further IFS report^[262] (both published in 2024) reiterated that the drivers of health-related benefit caseloads in the UK are complex and interrelated and have no single cause, but the cost of living crisis may be a contributing factor. Analysis by the IFS^[263] showed that most western countries had also experienced high rates of inflation but had not seen comparable increases to the UK in health-related benefit caseloads.^[20] This report suggested that ‘there are UK-specific factors driving the recent upsurge in claims’ and the rise in (health-related benefit) caseloads cannot be solely attributed to the cost of living crisis (and the effects of the Covid-19 pandemic). It stated that interactions between ‘recent health and income shocks and the condition of the UK’s economy, welfare system and public services’ were more plausible explanations of the increase, but that more research is required to disentangle the possible drivers and interactions.

While focussed on incapacity rather than disability benefits, the 2024 OBR welfare trends report^[264] stated that recent cost of living pressures (together with a range of other factors) have contributed to rising incapacity benefits caseloads by ‘widening means-tested eligibility and incentivising take-up’. It stated that ‘the greater generosity of incapacity benefits relative to unemployment benefits has not changed materially in this period [2018-19 to 2022-23] but the large gap may be a more important consideration for potential claimants when cost-of-living pressures are more acute.’

5.8.3 What evidence is there that changes in the labour market have been a driver of disability benefit applications and caseloads?

Summary: One IFS report^[265] was found that examined the role of the labour market as a driver of disability benefits and a further IFS report^[266] examined this for disability and incapacity benefits together. Both reports examined UK level data from the Labour Force Survey (LFS).

The state of the labour market is one of the key drivers of incapacity benefits.^[267] There is a large evidence base examining the relationship between the labour market and incapacity benefits, including the longer term impacts of industrial decline as well as the steep rise in health-related inactivity post pandemic and the associated rise in incapacity benefit caseloads over this period. These sources included academic journal papers and grey literature but were screened out as they did not include analysis of disability benefits. Disability benefits conversely are available to all disabled people regardless of work/employment status and for this reason, far fewer sources were found that examined the labour market as a driver of demand for disability benefits, compared with incapacity benefits.

A 2022 IFS report^[268] examined the labour market status of disability benefit recipients^[21] over time, using the LFS data. It discussed the possibility that recent instability in the labour market due to the pandemic might have been expected to have acted as a driver of disability benefit take up, in scenarios where people newly in receipt of PIP had taken up the benefit because they had lost their job and needed to replace lost income; or had to leave their jobs through worsening health, leading them to apply for PIP. However, their analysis found no evidence that the escalation in PIP applications was closely related to labour market factors, and found that by mid-2022, about two-thirds of PIP recipients had been out of work for over five years, which had remained the case before, during, and after the pandemic. This is reflected in other IFS analyses which showed that health-related inactivity is mainly driven by people already out-of-work becoming unwell, rather than those in work leaving the labour market because of deteriorating health.

A more recent report by the IFS^[269] (2024) examined the rise in health-related benefits following the pandemic through secondary analysis of LFS data from 2014 to 2023 which they stated provided some evidence to show that while deteriorating labour market conditions may have played a role, they are not the main driver of increases in health-related benefits. This report analysed disability and incapacity benefits separately. When examining disability benefits (PIP/DLA), it found that the labour market history of new disability benefit recipients is similar to those who started to receive disability benefits before the pandemic. While the share of new PIP/DLA claimants who had recently left their job increased slightly post pandemic compared to pre-pandemic^[22] (from 10.5% to 12.0%), around 70% of new disability benefit claimants were out of work both before and after the pandemic and most of these people (61%) had been out of work for more than two years before applying for them. It also found - for both disability and incapacity benefits - an increase in the share of new claimants who had never worked, and a decline in the share who last worked at least five years ago, which they speculated is driven partially by the increase in younger people in receipt of health-related benefits.

This report also analysed changes in the geography of health-related benefit claims to investigate whether this explained the rise in caseloads. There are notable geographic differences in the amount of health-related benefit claims according to differences in health outcomes and labour market strength. However, their analysis showed no association between the labour market and increase in health-related benefit claims. Areas with high and low employment rates, and areas where employment had risen or fallen showed similar changes in benefit claims and increases in health-related benefit caseloads were not faster in areas with weaker employment growth since the pandemic.

5.9 Demand driven by changes in attitudes and behaviour

This section of the review examines the evidence on whether increases in the number of people receiving disability benefits has been driven by changes in people’s attitudes and behaviours. The conceptual model set out in the protocol (Annex 1) hypothesised that attitudinal and behavioural changes could have acted as a driver of disability (and health-related) benefit caseloads in several ways, including:

• increased awareness of disability benefits (their existence, who qualifies and how to apply for them), and the role of those providing information and support in helping people to apply.
• increased awareness and knowledge of health conditions and different types of disability, which may have influenced people to seek support, including disability benefits.
• changing social attitudes and reduced public stigma around applying for and receiving disability benefits, which may have affected disabled people’s willingness to take up their disability benefit entitlement.

Summary: Seven sources were found that discussed changes in attitudes and behaviours as a driver for increased disability benefit caseloads since 2010. The evidence was limited and highlights a lack of primary research on how changing attitudes and behaviours may be a driver of changes in demand for disability benefits. Most of the findings related to increased awareness of disability benefits, through information and support, but some sources highlighted the increased awareness of health conditions, particularly mental health conditions. All the sources reviewed discussed disability benefits at the GB level or for England and Wales, and none considered Scotland separately.

Of the seven sources found that discussed changes in attitudes and behaviours as a potential driver for increases in disability benefits, one report^[270] is a primary qualitative study commissioned by the DWP. This report did not explicitly consider this as a driver of increased demand for disability benefits but has been included as this is implicit and there is mention of the increased role of some advisors following the pandemic. Five of the sources were reports by thinktanks^{[271], [272], [273], [274], [275]} and one was an OBR report (2019). ^[276] One of the Resolution Foundation reports^[277] presented secondary analysis of published data and qualitative research from a discussion with stakeholders. However, findings from the IFS, OBR, Resolution Foundation and Learning and Work Institute report^[278] were speculative or discursive.

While there is a large evidence base on changing social attitudes and a significant proportion of the sources screened at the early stage of this quick scoping review focused on stigma towards disability benefit recipients, these sources were excluded as they did not explicitly relate changing social attitudes to the increase in disability benefit recipients over time.

5.9.1 Has increased awareness of disability benefits driven demand for disability benefits?

The recent (2024) DWP report^[279] is a primary qualitative study (involving in-depth interviews with PIP applicants and advisors,^[23] and focus groups with non-claimants) which examined the importance of attitudes and behaviours in people’s ‘journey’s’ to applying for PIP and the role of different types of advisors on PIP applicants’ journeys. With the numbers of PIP registrations^[24] and clearances^[25] increasing, DWP commissioned Basis Social to conduct a study to inform approaches to support people who need to access PIP by improving understanding of why, how and when people with disabilities and long-term health conditions decide to apply for PIP. It found that the existence of, and access to encouragement from an outside source of advice can play a key role in ‘influencing applicants’ journeys to claiming PIP and were essential, as this was often how people first heard about PIP and how expectations about PIP entitlement and the application process were communicated.

The qualitative research found that the role of advisors could be brief or much more extensive but the extent to which applicants can access advisors significantly impacts their journey. This was particularly so for certain groups (e.g. applicants with low levels of literacy) and those without the support of advisors at key points throughout the application process are more likely to end before an application is made.

This study showed through interviews with Healthcare professions (HCP)^[26] that they have regular conversations about PIP and provide advice during interactions with patients, from once a week to multiple times per day. Some HCPs reported that the number of conversations they have about PIP had increased since the Covid-19 pandemic and are ‘increasingly associated with mental illness’.

In addition, a Resolution Foundation report^[280] highlighted increased awareness of health-related benefits as another of several explanatory drivers of the increases in take up of both incapacity and disability benefits. It stated that awareness of disability benefits has ‘plausibly’ increased in recent years – citing separate analysis by the Foundation which showed an increase in the mentions of ‘disability benefits’ in the UK press (from around 3,200 in 2017 to over 5,400 in 2023). The report highlighted how increased awareness of disability benefits and support to apply for these stems in part from the ‘concerted outreach to vulnerable individuals’ from all kinds of agencies in response to numerous crises over recent years. For example, advice provided about entitlement to various types of welfare benefits in response to austerity, followed by the Covid-19 pandemic, and subsequently the cost of living crisis. A welfare rights adviser in their policy roundtable said:

“There’s greater awareness of disability benefits than there was before - and I think that is coming from a few things. One thing is the pandemic meant that more people had to claim benefits and that just increased overnight people’s awareness of the benefit system and that just hasn’t gone away.”

Two sources^{[281], [282]} considered the role of online advice and support in driving demand for disability benefits. An accompanying study to the DWP report by Tenrec Analytics^[283] examined how the public source information about PIP online to develop their understanding of their potential eligibility for PIP and whether to apply. This involved an analysis of online search behaviour which found that people were seeking and being provided with online advice and support about: their eligibility to apply for PIP; the payment rates; queries about work status; and specific health conditions or disabilities.

The Tenrec Analytics research also found that social media - particularly content from individual creators with personal experience of applying for PIP - is significant in supporting people who are considering applying for PIP. A relatively small number of content creators dominate the ‘individual’ creator category, with the most watched five videos accounting for over half of all views. The report stated, ‘when approaching the application process and looking for tips to improve the likelihood of success, personal testimonies (such as those shared in videos by content creators on YouTube) have been found to be influential.’

The 2019 OBR Welfare trends report^[284] speculated on the role of social media and the internet in providing support and information around applying for disability benefits as potentially contributing to the rise in disability benefit caseload. The report stated that increased use of social media and the internet are likely to have had a ‘material impact’ on how accessible information is on the application process and assessment criteria, enabling applicants and their representatives to tailor their application accordingly. The report stated: ‘Changes in the caseload composition have typically pushed average awards higher than would be explained simply by uprating policy. This could reflect claimants and their advisors learning how to navigate the system to greater benefit – a factor that is likely to be more important now than in the past due to the internet and social media.’ However, these are statements of opinion and are not underpinned by evidence in the report.

5.9.2 Has increased awareness and knowledge of health conditions and different types of disability influenced people to seek support, including applying for disability benefits?

The evidence on increased awareness of health conditions principally related to greater awareness of mental, rather than physical health conditions. Changing attitudes and behaviours around mental health were discussed in five reports.^{[285], [286], [287], [288], [289]} While none of the sources provided any evidence to suggest that stigma around mental health conditions is declining, they speculated that this might be the case, and that the rise in reports of poor mental health may be due to changes in attitudes and behaviours around mental health that have resulted in people being more aware of mental health conditions and willing to report conditions and seek help. Three sources linked an increased awareness of health conditions to an increased willingness to apply for disability benefits, but this link was speculative rather than evidence based.

An IFS report^[290] stated that the increase in the disability benefit caseload (GB) witnessed among working-age people is principally attributed to more people receiving disability benefits due to mental health conditions. It speculated that this trend could in part be ‘due to greater awareness of, or reduction in stigma around, mental health conditions leading to more people applying for these benefits than in the past, even if the underlying level of mental health has not worsened.’

The OBR 2019 Welfare trends report^[291] discussed changing social attitudes towards mental health issues, increased awareness of these and the willingness of individuals to report such conditions (in the context of trends in increased spending on disability benefits). This stated that surveys on attitudes to mental illness over the last 10 years show that more people now consider mental illness to be ‘an illness like any other’, fewer report negative attitudes towards mental illness and more people report that they would seek medical advice if they had a mental health ‘problem’.^[292] However, this discussion of the increased prevalence of reported mental health conditions did not explicitly link this to the increase in disability benefits.

One Resolution Foundation report^[293] stated that stigma related to some disabilities, especially mental health conditions ‘has clearly declined over time’, citing two studies^[294] evidencing this reduction in stigma in England (published in 2020 and 2014).^[27] It speculated that the increase in health-related benefits could partly be driven by ‘a rising awareness of benefits, and a decline in stigma for some, enabling more people to come forward and seek the help they need.’ This point was reflected by a welfare adviser in a roundtable discussion as part of this study:

“I think it is a mistake to see the level of disability in society as a problem necessarily – I think it is also to do with more people recognising disability and we can support that in various different ways, including in the world of work and how our society is structured – rather than come away and say, oh a quarter of our population is disabled, that’s terrible. Maybe it’s always been that way and it is a good thing [people] can come forward and get the help they need.”

Another Resolution Foundation report^[295] stated that there has been increased awareness and understanding of disabilities ‘and support available to help meet extra costs associated with them is undoubtedly positive and has likely led to more people claiming benefits.’ This point was not underpinned by supporting evidence.

None of the sources examined whether demand for disability benefits has been driven by changing social attitudes and/or reduced stigma around applying for and being in receipt of, disability benefits.

5.10 Demand driven by demographic changes

This section considers the evidence on whether demographic changes have contributed to changing demand for disability benefits since 2010. Demographic changes refer to a shift in the defined characteristics of a population over time but the focus here is on changes in Scotland’s and the UK’s age structure (as disability is closely connected to age) and the associated rising state pension age (SPA).

Summary: Four sources included in the review examined demographic changes - in particular an ageing population and the consequences of an increased SPA - as a driver for increases in disability benefits since (around) 2010. Two further sources were identified that considered the rising SPA as a driver for increases in incapacity benefits. The Resolution Foundation^[296] provided estimates of the extent to which demographic changes have contributed to the rise in disability benefit caseloads. This report found that an ageing population and rising SPA explained one-quarter of the increase in the working-age disability benefit caseload in England and Wales between 2013-2023. A Resolution Foundation slide pack^[297] extended this analysis to include incapacity benefits and found that the impact of an ageing working-age population and rising SPA accounted for one-fifth of the rise in working-age health-related benefit caseloads. Less evidence was found on how changes to the SPA alone has acted as a driver of disability benefit caseloads, although there was evidence to show that the rising SPA has been a driver of rising incapacity benefits caseloads. None of the sources examined the role of demographic changes as a driver in Scotland.

The four sources included were reports by the Resolution Foundation^{[298], [299]} and the IFS.^{[300], [301]} Findings from two further reports are included which examine incapacity rather than disability benefits.^{[302], [303]} All sources were based on secondary analysis of published data rather than primary research. Other sources^{[304], [305]} considered increases in spending on working-age disability benefits because of the rising SPA but were not included as spending is outside the scope of this review. Nevertheless, it is important to note the key role that changes in the size and age profile of the population play in how the OBR formulate their spending projections. The 2019 OBR report^[306] stated: ‘prevalence of disability benefit receipt varies considerably by age, so changes in the size and age profile of the population are key drivers of disability benefits spending.’

5.10.1 Has an ageing and expanding working-age population driven demand for disability benefits?

Three of the sources^{[307], [308], [309]} linked an ageing working-age population with the rise in the number of people claiming disability benefits over the last decade.^[28] A report by the Resolution Foundation^[310] explored changing demographics as one factor possibly explaining the increase in disability benefits and considered the ageing and growing working-age population as constituting structural drivers behind the increase in disability benefits (alongside other societal, economic and policy related drivers). Their analysis showed that Britain’s ageing population (and rising SPA, explored below), has played a key role in ‘boosting’ the disability benefit caseload over the last decade, as older people are more likely than younger age groups to report having a disability or a long-standing health condition. The Resolution Foundation used ‘shift-share decomposition’^[29] to examine the disability benefit caseload for people in different age groups (Figure 5.10). Their analysis showed that for England and Wales, an ageing population and rising SPA explained one-quarter of the increase in the working-age disability benefit caseload over the last ten years (2013-2023).

Source: Resolution Foundation (2024) Under Strain (adapted for accessibility)

The report attributed the increase amongst those aged 65 and over in receipt of working-age disability benefits to both the higher SPA (which has meant more older people have applied for working-age rather than pensioner benefits) as well as the fact that older recipients of PIP generally remain on it, even when they reach pensionable age. The report stated: ‘…if the likelihood that an adult of a certain age receives a working-age disability benefit had remained unchanged since 2013, then demographic changes alone [a growing, ageing population and a rising State Pension Age] would have pushed up the caseload by an additional 272,000, one-quarter (25 per cent) of the actual increase of 1.07 million.’

The second Resolution Foundation publication (a slide pack)^[311] used the same methodology as above and applied this to ‘health-related benefits’ – disability benefits and incapacity benefits together. It found that the impact of an ageing working-age population accounted for one-fifth of the rise in working-age health-related benefit caseloads. As set out in the section on population health, this report also estimated that the combined effect of population change and the rising incidence of disability explains 87% of the increase in the disability benefit caseload between 2013 and 2023.

The IFS report^[312] (2023) speculated that some of the rise in disability rates and disability benefit receipt might relate to population ageing. To explore this issue, it examined the share of individuals claiming disability benefits by age in 2002, 2012 and 2022. This analysis showed a particularly large increase in the proportion of children receiving disability benefits. However, it also showed that although the proportion of older working-age adults over 60 claiming disability benefits remained broadly the same as in 2002 a much larger proportion of this age group claim disability benefits.

5.10.2 Has a rising state pension age driven demand for disability benefits?

A rising SPA is also relevant to understanding increases in disability benefit caseloads.^[30] The SPA rose for women from 60 in April 2010 and reached 65 in December 2018, it then rose from 65 to 66 for both men and women between December 2018 and October 2020.^[313] The rising SPA for women in particular since 2010 has increased the population of people potentially eligible to receive working-age disability benefits at a stage of life when they are more likely to be disabled or have a health condition.^[314]

Three sources^{[315], [316], [317]} examined the link between a rising SPA and the increase in disability/ incapacity / health-related benefits over the last 10-15 years. The Resolution Foundation report^[318] discussed this alongside an ageing population and findings are presented for both factors together, above. The IFS report^[319] examined disability benefits and incapacity benefits together and the OBR report^[320] considered only incapacity benefits.

The 2024 IFS report^[321] showed that for ‘health-related’ benefits, the change in the SPA explained relatively little of the recent surge in claimant numbers in England and Wales. It found that between 2019 and 2023, the overall number of claimants for working-age health-related benefits in England and Wales grew by 38% and the number of claimants aged 16–64 grew by 36%. It stated that the latter figure adjusts for the change in female SPA from 65 to 66 and is only 2 percentage points lower than the unadjusted figure. However, this report did not explore changes associated with the larger increase in the rise of SPA for women from 60 to 65 between April 2010 and December 2018.

Two sources^{[322], [323]} were included that examined the role of the rising SPA on the increasing incapacity benefit caseload. While the focus of this review is on disability benefits, it is useful to note that both reports concluded that the rising SPA from 2010 led to the growth in claims among women aged 60-64. The 2024 OBR Welfare Trends report^[324] conducted secondary analysis of published data sources and found that incapacity benefits caseloads did not decline as much as they might have during the 2010s due to several ‘age-related factors’: ‘First, increases in the state pension age expanded the population eligible to receive incapacity benefits into age groups in which people are much more likely to claim. Second, a shift in the composition of the eligible population towards older working-age offset the particularly sharp falls in caseload prevalence at older ages.’

The report^[325] shows the distribution of incapacity benefits caseloads by age and sex in both 2008-09 and 2023-24. Figure 5.11 shows that 280,000 of the overall 330,000 caseload increase between these two points in time was made up of female recipients of incapacity benefits aged 60 and over, and 250,000 of this was women aged 60-64, so can be related to the rising female SPA between 2010 and 2018.

Source: Office for Budget Responsibility (2024) Welfare trends report – October 2024 (adapted for accessibility)

A report by the Learning and Work Institute^[326] (2025) stated that a third of the rise in incapacity benefits is explained by the rising SPA, an aging population, and the rollout of Universal Credit combined.

It is also worth highlighting recent analysis here by the DWP^[327] (2025) which did not meet the inclusion criteria and so is not included in this review but used a similar methodology to the Resolution Foundation^[328] but for incapacity benefits. Decomposition modelling quantified the contribution of changes in both demographics and in SPA behind the growth in the number of working-age people in receipt of incapacity benefits. It found that between May 2018 and May 2023 the caseload on the higher rates of UC health and ESA increased by just over 800,000, and of this: 89,000 (11%) is because of changes to SPA, and 57,000 (7%) is because of demographic change, with the population getting older, on average.