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

6. Discussion

6.1 Summary of the findings

This quick scoping review assessed the extent of available evidence on the primary 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?’. To do this, it examined whether changes in demand for disability benefits have been driven by five potential drivers: changes in population health, the design and operation of the benefit system(s), the economy and labour market, changing attitudes and behaviours and demographic changes.

Of the 350 sources screened, only 23 met the inclusion criteria. The review highlighted a lack of primary research evidence across the five drivers examined. Most of the sources included secondary research and were reports by think tanks, policy and research organisations and independent fiscal institutions. Around two-thirds of the sources were produced by think tanks and just over a third were by the IFS.

The number of working-age adults and children receiving disability benefits in Scotland has increased substantially since the early 2010s. The rise in caseloads has been particularly pronounced since the Covid-19 pandemic in both Scotland and the UK, with a spike in disability benefit applications in Scotland following the introduction of ADP and CDP.

The age profile of new recipients of working-age disability benefits in Scotland has changed and now includes a larger proportion of younger people. There has also been an increase in the proportion of people receiving working-age disability benefits due to the impact of ‘mental and behavioural disorders’ and circulatory diseases.

This review examined and presented the drivers of disability benefit demand separately but highlighted the interrelationships between drivers. A large proportion of the evidence found is focused on changes in population health as a driver (18 sources) followed by changes in the design and operation of the benefit system(s) (17 sources), the economy and labour market (11 sources), changing attitudes and behaviour (7 sources), and changing demographics (4 sources).

Evidence assessed on the role of changes in population health as a driver showed that the rise in the share of the population who report being disabled or in ill-health mirrors, and at least in part, explains the rise in disability benefit caseloads.

Population health was declining before the pandemic, but this decline has accelerated and continued since. There has been a large increase in the number of people receiving health-related benefits due to the impact of ‘mental and behavioural disorders’, and the number of disabled children in the UK since before 2010 (proportionate to working-age adults). This is mirrored by the increase in the number of children in receipt of child disability benefits.

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, but evidence on this was scarce and so it is not possible to rule out NHS waiting lists as a driver of increased caseloads.

There was no conclusive evidence, in the sources reviewed to show that the introduction of ADP in Scotland had led to the increases in caseload seen in Scotland. It is likely too soon to assess whether the devolution of disability benefits in Scotland has driven up caseloads in the post-pandemic period and longer follow-up data is needed to understand whether this will persist or not.

There was little evidence to suggest that it has become ‘easier’ to be awarded PIP since its roll out, and there was a lack of evidence on the effect of changes in PIP assessment approaches on disability benefit caseloads. Some reports found that PIP caseloads are increasing (in England and Wales) in part, because of longer award durations and fewer people coming off PIP over time. There was no robust evidence to demonstrate that the financial value of disability and health-related benefits relative to unemployment benefits has increased applications for disability benefits.

There was no robust causal evidence to show that demand for disability benefits has been driven by the economy and/or the labour market changes since 2010. Most commentary was found on the role of the cost of living crisis as a driver of increased disability benefit caseloads, but findings were discursive and speculative. Some evidence was found to show that while worsening labour market conditions have played a minor role in explaining the increase in disability benefits post pandemic,^[31] recent labour market changes were not a key driver of the rise in caseload.

There was a lack of primary research evidence 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 problems/conditions which they speculated may have increased willingness to apply for disability benefits.

Demographic changes, in particular population ageing and the consequences of an increased SPA were found to be drivers of increased disability benefit caseloads.

Few studies quantified the contribution of different drivers, but the Resolution Foundation provided estimates of the extent to which demographic changes have contributed to the rise in disability benefit caseloads. It 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, and one-fifth of the rise in working-age health-related benefit caseloads.

This report also estimated that the combined effect of population change and the rising incidence of disability explains 87 per cent of the increase in the disability benefit caseload between 2013 and 2023.

While this quick scoping review examined the evidence for drivers separately, most sources discussed drivers of demand for disability benefits in relation to several or multiple intersecting drivers and made clear that the rise cannot be attributed to a single driver.

6.2 Strengths and limitations of the quick scoping review

Quick scoping reviews have a number of strengths but also limitations.

In terms of strengths, by systematically mapping existing evidence on the drivers of changes in demand for disability benefits, this quick scoping review has identified key themes that may help answer the primary research question. In addition, it has highlighted a dearth of primary research evidence on this question, particularly relating to Scotland as well as identifying existing gaps in knowledge.

In terms of limitations, a quick scoping review does not provide an exhaustive review of evidence to address the primary research question or wider relevant studies. Sources were included that directly discussed and investigated the topic of interest (drivers of disability benefits) to gain a clearer picture of the available evidence. Other sources that may be relevant but did not meet the inclusion criteria for the review were not included. For example, explanations for changes in population health were beyond the scope of the review as was the contested question of whether stigma around mental health is decreasing which may contribute to disability benefit awareness or take up. Similarly, given these criteria for inclusion, there were few sources which reflected the actual experiences of disabled people, which would likely have been helpful in highlighting some of the complexity and nuance behind the drivers of demand for disability benefits.