Evaluation of the health impacts of Universal Credit: a mixed methods study

Universal Credit (UC) combines six existing benefits and tax credits (known as legacy benefits) for working age people and their children into a single monthly payment. UC is designed to improve work incentives for people on low incomes but has been criticised for causing hardship due to conditions related to eligibility and the way that claims are managed and payments made. UC is being introduced gradually, with rollout currently expected to be complete in 2024. Research to date has not provided a comprehensive picture of UC’s impact on population health or health inequalities.
We propose a mixed methods study comprising five closely related work packages (WPs) to answer the question: what is the impact of the introduction of UC on mental health and wellbeing, what are the implications for health inequalities, and how these effects are moderated by variation in implementation across Great Britain?
In WP1, we will compare health outcomes for new recipients of UC with outcomes for legacy benefit recipients in the Understanding Society and the Annual Population Surveys, using the phased rollout of UC as a natural experiment. We will use a Small Area Mental Health Index (SAMHI) that we have developed to analyse the relationship between the proportion of UC claimants in each Lower Super Output Area and a composite measure of population mental health. In WP2 we will use anonymous data routinely collected by Citizen’s Advice from UC claimants to explore the socio-demographic and health characteristics of people who have difficulty claiming, and features of the claim and payment process that prompt advice-seeking. We will also analyse a unique dataset linking requests for advice with heath service use. In WP3 we will conduct in-depth interviews with a purposive sample of UC claimants in England and Scotland to explore reasons for claiming and experiences of the claim and payment process. In Scotland we will explore use of the alternative payment arrangements known as ‘Scottish Choices’ and what these mean for claimants. Follow-up interviews will investigate the way claimants’ experiences change over time. We will interview frontline staff from JobCentre Plus, the NHS, local government, voluntary and community sectors. In WP4 we will create a new dynamic microsimulation model of the health impacts of UC. We shall use our model to simulate the impacts of different implementation scenarios, and to explore how these differ between subgroups of the working age population. In WP5 we will use cost-consequence analysis to identify and quantify the whole range of potential costs and outcomes of introducing UC. We shall also undertake analyses of UC’s distributional consequences (e.g. by geography, deprivation or employment status) and the cost-benefit of mitigating actions, such as those taken by Scottish Government or individual local authorities.
The project will last 52 months. The research team will work with a Study Advisory Group comprising representatives working in central and local government, the NHS and organisations that support UC claimants, so that we can keep abreast of policy changes and feed research findings directly into policy and practice development.