In view of the range and histories of health conditions and impairments of panel recruits we would expect changes in various directions during contact with the researchers. We can report generally on whether people felt any ‘better’, or thought they were ‘getting worse’. We have no objective evidence of their medical condition, but how people feel about themselves and their condition is likely to be a strong influence on decisions they make about their everyday lives. In this section we look at developments in the period from the reported first contact with the incapacity benefit Pilot up to the last research interview, among those who completed the panel. For most people this was a period of nine to 12 months.
4.1.1 ‘Feeling better’
Men and women who perceived an overall improvement in their condition during this period included people who were awarded incapacity benefit on the basis of the effects of cardio-vascular disease, musculo-skeletal conditions, mental health problems and cancer. People attributed their improvement to:
• NHS surgery and treatment;
• changes in medication (including some people’s own decisions to stop taking medicines they believed had adverse side effects);
• psychological relief when consultants were satisfied with progress made, or people got the ‘all-clear’ from tests or scans;
• the lifting of depression or reduction in stress related to changes in family circumstances; starting a job or finding a new interest, or improved financial situation;
• additional services received, including physiotherapy and behavioural therapy within the Pilot Condition Management Programme.
The experience of people who found the Condition Management Programme helpful was described in Chapter 3.
4.1.2 ‘Feeling about the same’
We now look at the group of people who said there had been no change in their condition during the comparable period, or saw some initial improvement that was not maintained. Again, there were both men and women in this group, and representatives of all the health condition sampling criteria. For some people it was a relief that there had been no change, for example, people recovering from a heart attack who were aiming at stabilisation of their condition and prevention of relapse, and people waiting for surgery who hoped their condition did not deteriorate in the meantime. For people like this, important inputs were GP and consultant surveillance, and medication to control their condition. One person remembered being told about a new service for ‘heart patients’ by the Personal Adviser during one of the work-focused interviews, but she decided she did not need this kind of service.
Perceiving ‘no change’ in their underlying condition, rather than being a relief, was a disappointment to people who had expected some improvement or relief from symptoms. However, some said they were managing their physical symptoms better, by the time of their last research interview. Mentioned as helpful here was attending an NHS pain management clinic, accessed via a hospital consultant, and having a TENS machine5 at home. However, another person who perceived no
improvement in severe back pain did not remember being offered any support with pain management, either from his consultant or the work-focused interview adviser.
Among people with mental health problems, medication and counselling services from the GP and mental health services had sometimes been declined, to avoid the stigma perceived to attach to people who received treatment or counselling for mental illness.
4.1.3 ‘Getting worse’
Finally, we look at those people who felt their condition had got worse since their first contact with the Pilot. Included here were people still undergoing hospital investigation for physical conditions that were becoming increasingly debilitating; and people who said congenital conditions or conditions that developed in childhood were deteriorating. Some people in the latter group had experience of various Jobcentre Plus services over many years. None of these people remembered any discussion about the Condition Management Programme.
The panel also included people whose original physical condition had remained stable since their first contact with the incapacity benefit Pilot but who had developed another serious condition – depression or another physical illness. One such person had herself enquired about receiving help through the Condition Management Programme, and by the time of the last panel interview, had started physiotherapy.
Summing up, health trajectories since the first contact with the Pilot were highly variable. Some people whose health condition improved said that physiotherapy or behavioural therapy received through the Condition Management Programme had helped them, and some of these had returned to work. There was little experience of the Condition Management Programme among people who felt no change in their condition, or among people who felt worse by the end of the panel interviews. Nobody attributed deterioration in health to participation in the Pilot.
Going back to work did not depend on experiencing some improvement in health condition. Some of the people who went back to work perceived no change in their health condition, or thought that their condition had worsened. The next section helps to explain such decisions by showing how people’s views about work changed after contact with the Pilot.
5 Small TENS units made available for people to use at home transmit
transcutaneous electrical nerve stimulation to treat pain and aches in the back or neck.