(2019). Alternative spaces of failure. Disabled ‘bad boys’ in alternative further education provision. Disability & Society. Ahead of Print.
Sarah Newton, former minister of state for disabled people. However, it’s very evident that neither she nor her party actually support disabled people. They prefer oppressing them.
Last month and previously, I reported about the controversial issues raised by the Department for Work and Pensions’ standard ESA65B GP’s letter template, which was only relatively recently placed on the government site, following a series of probing Parliamentary Written Questions instigated by Emma Dent Coad, addressed to the minister of state for disabled people. Her responses to the questions were repetitive, vague, unevidenced and did not address the questions raised.
Campaigners and MPs have called for the Department for Work and Pensions’ (DWP) amended letter to GPs to be scrapped after it emerged that ill and disabled people appealing against unfair work capability assessment (WCA) decisions were left in near destitution after their GPs refused to provide further ‘fit notes’, because they were instructed that they did not need to by DWP officials.
It emerged that ministers ordered changes to the standard-issue letter to remove references that made it clear to GPs they may have to issue a medical statement if their patient wished to appeal against a WCA decision. The DWP claims this was not intended to dissuade GPs from issuing fit notes.
However, it’s highly unlikely that government ministers ordered the amendment to the letter for another purpose, as there are none. This was a calculated strategy to deter people from appealing DWP decisions, by leaving them in severe financial hardship.
The mandatory review was also introduced for similar reasons, since people are left without any income while the DWP reviews its decision, a process which can take longer than six weeks.
Those people who challenge WCA decisions are entitled to continue to receive employment and support allowance (ESA) at basic rate, worth £73.10 a week while they await their appeal hearing, but to do so they must obtain fit notes from their GPs to provide evidence that they are too ill to work.
They must also first await the outcome of a mandatory review before submitting their appeal. Before a claimant may lodge an appeal, they must first ask the DWP to ‘reconsider’ their original decision. There is no limit on how long the DWP may take to reconsider the original decision about their award.
The DWP has a stated target of upholding 80% of their original decisions, so the majority of people then have to appeal following the review outcome, since the . The law says that the claimant may claim basic rate ESA following mandatory review if they wish to proceed with an appeal.
So the misleading change to the template letter routinely sent from the DWP to GPs has led to people who have lodged an appeal against an unfair decision being stopped from claiming basic rate ESA while awaiting the appeal hearing. This prevents many low-income disabled people from accessing any financial support while they wait for months on end to go to tribunal. Furthermore, we know that catastrophically inaccurate decisions following the assessments within the DWP are pretty much the norm. Nationally, 72% of people who appeal against their work capability assessment decision are successful.
Entitlement to ESA pending appeal is enshrined in the ESA Regulations to cover the whole of the period leading up the hearing. It is also possible to have the payment backdated to cover the Mandatory Review waiting period too – it can take over six weeks for the DWP to review their original decision, over which time people are left without welfare support.
ESA pending appeal is not paid automatically – people usually have to ask for it, and must provide fit notes from their GP, presenting these along with their appeal acknowledgment letter from the Tribunal Courts to their local Job Centre. The Job Centre should report back to the DWP who will arrange for ESA pending appeal to be paid.
From last year, then minister for disabled people, Sarah Newton, responded to one of several Written Questions from Emma Dent Coad, saying: “The ESA65B letter is issued to GPs in every case where an Employment and Support Allowance (ESA) claimant has been found ‘fit for work’. This process was built into the IT system as part of the introduction of ESA in October 2008.
That is partly untrue, since the original wording has been amended.
Newton went on to say: “Following a Ministerial requirement by the Cabinet Secretary, which was endorsed by the Secretary of State for Work and Pensions, the content of the ESA65B letter has been improved in order to explain to GPs the type of support customers can expect to receive from their local Jobcentre, and to ask GPs to encourage customers in their efforts to return to work.” [My emphasis].
The decision to change the letter template was made without any scrutiny from or consultation with parliament or the public.
The standard template letter, titled Help us support your patient to return to or start work says: “We assessed [Title] [First name] [Surname] on and decided that [select] is capable of doing some work, but this might not be the same type of work [select] may have done before.
“We know most people are better off in work, so we are encouraging [Title] [First name] [Surname] to find out what type of work [select] may be able to do with [select] health condition or disability through focused support at [select] local Jobcentre Plus.
“In the course of any further consultations with [Title] [First name] [Surname] we hope you will also encourage [select] in [select] efforts to return to, or start, work
“Please do not give [Title] [First name] [Surname] any more fit notes relating to [select] disability/health condition for ESA purposes.
Newton responded to one of several Written Questions from Emma Dent Coad, saying: “The ESA65B letter is issued to GPs in every case where an ESA claimant has been found ‘fit for work’. This process was built into the IT system as part of the introduction of ESA in October 2008.
“Following a Ministerial requirement by the Cabinet Secretary, which was endorsed by the Secretary of State for Work and Pensions, the content of the ESA65B letter has been improved in order to explain to GPs the type of support customers can expect to receive from their local Jobcentre, and to ask GPs to encourage customers in their efforts to return to work.” [My emphasis].
Professor Helen Stokes-Lampard, the chair of the Royal College of GPs (RCGP), said the lack of clarity over when GPs should issue fit notes could put patients’ finances and health at risk. “No GP wants that, and it only serves to threaten the long-standing trust that patients have in their family doctor.”
Until 2017 the standard letter advised GPs that if their patient appealed against the WCA decision they must continue to provide fit notes.
However, on (undisclosed) ministerial orders, the letter now states that GPs “do not need to provide any more fit notes for ESA purposes”. It does not mention the possibility that the patient may appeal, or that a fit note is needed for the patient to obtain ESA payments until the appeal is heard.
Frank Field, the chair of the work and pensions select committee, also raised the issue with Newton back in January. Newton replied that the wording was amended “to make the letter simpler and clearer”, adding that DWP communications were intended to be “clear, understandable and fit for purpose”.
The purpose appears to be to deter people from appealing unfair DWP decisions concerning the loss of their social security disability award.
Field replied that the wording was “not having the desired effect”, and urged her to revise it to make clear ESA claimants on appeal were entitled to fit notes. “This simple step could greatly ease the stress and worry that people who are awaiting an appeal experience.”
Newton told Field: “We are committed to ensuring our communication is clear, which is why the wording of this letter was cleared by both the British Medical Association and the Royal College of General Practitioners (RCGP). However, we will of course consider feedback when revising the letter.” Newton tends to stick to a script in her responses, though. She told Emma Coad Dent exactly the same thing, almost word for word last year, in her response to a Written Question.
As I commented in a previous article, it was extremely unclear on what basis the RCGP agreed to the new wording as the change was agreed at a DWP stakeholder meeting for which, according to Newton, there are no formal minutes.
Newton confirmed this in the correspondence between herself and Field, as well as in her responses to Emma Coad Dent’s long series of Written Questions on this issue.
Firstly, on 16 May, last year, Newton says: “The Cabinet Secretary first issued the requirement to revise the ESA65B letter in November 2014.
“The wording of the ESA65B was changed to emphasise the benefits of work and to ask GPs to encourage their patients in their efforts to return to some form of work.”
Then, according to Newton: “The British Medical Association and the Royal College of General Practitioners agreed to the revised wording of the ESA65B on 4 August 2016.”
However, in June last year, she also said, in response to a Written Question from Emma Dent Coad: “DWP’s Legal Service cleared the revised wording on 29 July 2016 and the then Secretary of State for Work and Pensions subsequently authorised the changes.”
Yet when asked in November last year what written evidence her Department holds on the British Medical Association and Royal College of General Practitioners agreement to the revised wording of the ESA65B letters sent to claimants’ GPs when they fail the work capability assessment, she replied: “There is no written evidence relating to the agreement obtained from the British Medical Association and the Royal College of General Practitioners on the revised wording of the ESA65B letter.
“In accordance with the Answer of 30 May 2018 to Question 146987, agreement on the final wording of the ESA65B was obtained via the regular meetings DWP holds with both organisations.”
She was being conservative with the truth. In other words, she was telling lies.
Following a series of distressing reports about people dying as they await the result of the Personal Independent Payment (PIP) and ESA assessments, the Work and Pensions select Committee has published the Royal College of GPs’ (RCGP) and the British Medical Association’s (BMA) views on DWPs controversial advice to doctors on “Fit Notes” for people awaiting the outcome of an ESA appeal.
The Committee asked both organisations ( PDF 163 KB) ( PDF 163 KB) for their input, following DWP’s repeated claims that they had approved the advice, given in a letter (form, ESA65B) to the GPs of people who have been denied ESA after assessment: PIP and ESA Assessments.
The Committee has described the assessment processes for disability/incapacity benefits as “gruelling” and “error-ridden”, potentially forcing claimants into DWP’s “arduous, protracted” reconsideration and appeals process. People who have been denied ESA at the assessment stage, but who are awaiting the results of their appeal are entitled to an “assessment rate” of ESA, in recognition of the hardship they may endure during the potentially lengthy wait for their appeal.
However, in recent months the Committee has been investigating concerns ( PDF 1.41 MB) that the advice DWP is giving to doctors about the system and process is causing confusion, leading directly to people being left without the lifeline income they are entitled to.
I have reported previously that people have died soon after being declared ‘fit for work’ by the DWP, after the Department have contacted a patients’ doctor without notifying them, telling the GP not to issue any more ‘fit’ notes.
Comments from RCGP and BMA
The Department has claimed in response to the Committee ( PDF 219 KB)that Agreement on the final wording of the revised ESA65B was obtained via the regular meetings DWP holds” with both the British Medical Association and Royal College of GPs”, ( PDF 84 KB) and that the wording is the outcome of “close and extensive working between DWP, BMA and RCGP.” ( PDF 165 KB)
Both medical professionals’ associations’ have now written to the Committee – and in the case of the RCGP, directly to the Secretary of State ( PDF 199 KB) – expressing their concerns about both DWP’s advice to GPs and its characterisation of their approval or endorsement. The RCGPs said:
“Without a fit note from their GP, claimants who are awaiting the outcome of their appeal will not be able to receive ESA. They would therefore have to seek Universal Credit or Jobseekers Allowance, and subsequently try and meet the work-seeking requirements of those benefits, potentially endangering their health in the process. As such the College is deeply concerned about the potential impact of this on doctors and their relationships with potentially vulnerable patients.”
“By way of background the BMA attends meetings with the RCGP and the DWP where information is shared with the aim of improving working practices between the DWP and clinicians. While the BMA may act in an advisory capacity it does not have the authority to clear, approve or otherwise sign off any DWP correspondence or policies and would see this as being clearly outside of our remit…At a meeting with the DWP and RCGP a BMA representative was given sight of the ESA65B amended letter. The BMA considers that sight of this letter was for the purposes of information sharing and did not agree or otherwise sign off the content of the letter.”
“We are aware that the Department claims that ‘The British Medical Association and the Royal College of General Practitioners agreed to the revised wording of the ESA65B on 4 August 2016’. However, there is some ambiguity about what was said in the referenced meeting with the DWP. Since the DWP did not keep any written records of what was said at this meeting [as DWP admits in its latest letter to the Committee ( PDF 165 KB)], we are unable to provide further clarity.”
The RCGP statement continues:
“Since these changes were made, significant evidence has come to light about the negative impact that these changes have had in relation to patient care, leading to some patients being denied fit notes by their doctors. We are concerned that the current wording of ESA65B does not sufficiently clearly indicate that there are circumstances in which GPs may need to continue to issue fit notes for their patients. It is essential that communication with GPs is as clear as possible, to uphold the high levels of trust that exist between GPs and their patients. As a minimum we would want to see the wording of the ESA65B letter urgently changed to its previous wording.”
This means that ministers have once again mislead both parliament and the public in claiming that both medical professional organisations agreed to the wording of a controversial letter which told GPs not to provide benefits officials with proof that seriously ill patients were unfit for work.
I’ve reported on this particular issue more than once, and highlighted the parliamentary dialogue between Newton, who resigned in March, and the DWP, who have said in separate statements that the document wording “was cleared by both the British Medical Association and the Royal College of General Practitioners”.
Both organisations have now dismissed Newton and the DWPs’ claim. In the letter, the BMA, said that they did not “clear” the wording, they were simply been shown the letter template during a meeting at the DWP.
When the organisation wrote to Frank Field, Pensions select committee, the letter states categorically that: “The BMA considers that sight of this letter was for the purposes of information sharing and did not agree or otherwise sign off the content of the letter.”
The RCGP has told work and Pensions secretary Amber Rudd that the letter “does not clearly indicate that there are exceptions to this wording, including if a claimant is appealing against the decision”.
The Royal College raised fears that vulnerable patients awaiting the outcome of appeals may further harm their health by trying to meet the requirements of other benefits such as Universal Credit or Jobseeker’s Allowance.
However, a DWP spokesperson told me: “We have regular discussions with the BMA and RCGP to ensure we deliver effective support to disabled people and those with health conditions.
“The wording of this letter was discussed as part of these meetings, as both organisations confirm, as was the release of the final letter.
“Of course we recognise the concerns of GPs which is why we are discussing a revised letter with the BMA and RCGP and have issued clear guidance for GPs in the meantime.”
So, not only did the DWP and Conservative ministers lie and get caught out, they have continued to repeat the lie following its exposure.
Meanwhile citizens who are ill and disabled are left in dangerous situations with unacceptable levels of hardship, and some have died as a consequence, yet the government continues to present and mechanically repeat crib sheeted PR and strategic comms responses to limit the political damage of justified concern and criticism of their cruel, miserly, punitive, discriminatory, robotic neoliberalism and authoritarian policies that target those with the least in any way they can to prevent them from accessing the support that their taxes and National Insurance have contributed to creating.
When David Cameron said the Conservative party was going to address the ‘culture of entitlement’, and ‘change the relationship between citizens and the state’ this is precisely the kind of underhand, targeted discrimination he had in mind. The ‘low tax, low welfare society’ is one where the wealthiest pay very little tax and the poorest citizens – in work and out – simply go without the means of meeting their most fundamental needs.
The wider political aim is to systematically dismantle every single welfare and public service and to normalise the brutality of this process by almost inscrutable degrees, by telling lies that attempt to neutralise the serious concerns raised by campaigners, opposition MPs, academics, charities and medical professionals. This method of political gaslighting is much worse than lying, because it is a calculated, deliberate method of psychological manipulation and abuse.
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In 2017, the then minister for disabled people, Sarah Newton, said that the Department for Work and Pensions (DWP) was “recruiting, training and deploying” approximately 150 presenting officers (POs) to attend Personal Independence Payment (PIP) and Employment and Support Allowance (ESA) tribunals “in order to present the Secretary of State’s case and support the first tier tribunal in arriving at the right decision”.
The question is the ‘right decision’ for whom? It’s certainly not disabled people.
Given that, at the point of appeal, the Secretary of State’s case has already been presented twice – at the first DWP decision following assessment and again during the mandatory review – it seems that the government is using an incredibly oppressive and authoritarian approach to prevent successful appeal outcomes for ill and disabled people trying to access disability-related social security alone, without legal aid and support in the majority of cases.
Last week I spoke to someone who won her PIP appeal following a reassessment which had resulted in the loss of her PIP award. After waiting two weeks for some communication from the DWP, she rang to see when her award would be reinstated. She was informed that the DWP had requested the full written reasons for the tribunal’s decision, and that they were considering challenging the court’s decision. If the DWP decide to proceed with their challenge, they must apply for permission to appeal.
The application must be made within one month of the date of the tribunals’ written statement of reasons. So far, the claimant has been left without her award for 13 weeks, and she is very distressed. Having gone through mandatory review and appeal, she is utterly exhausted and the stress of the process has significantly exacerbated her illness – she has multiple sclerosis. Since her assessment, she has also needed treatment for anxiety and depression.
The claim for PIP was in relation to her physical disabilities, but she has become mentally unwell as a direct consequence of her extremely distressing experiences. The DWP will be permitted to appeal the tribunal’s decision only if it is considered that the decision resulted from an error of law. Once the tribunal have received the request the chair of the tribunal will provide a written statement to the claimant and the DWP explaining why they awarded PIP. It can take up to 12 weeks for the written statement to be sent out.
I co-run a support group online for people going through ESA and PIP claims, assessments, mandatory review and appeals. We are seeing a rise in the number of cases where the DWP are requesting written reasons for the decision of the tribunal, but quite often, it eventually emerges that they are not proceeding with an appeal.
This leaves people waiting many months with the fear they may lose their lifeline award, causing a lot of additional and unnecessary distress. Furthermore, the DWP are not keeping people informed of their intentions in a reasonable and timely manner, which adds significantly to the distress and uncertainty that the whole awful process has created.
There are two people who have waited over 12 months after they won their appeal, while being told by the DWP that they are still awaiting the judge’s decision as to whether the DWP can proceed with a challenge. Meanwhile, the DWP refuse to discuss the details of the matter any further when people ask for details and an idea of a timescale.
One person told me he felt that the DWP are “intentionally playing mind games to demoralise and scare people”, and that leaving people feeling precarious was “a deliberate strategy” to undermine people’s expectation of support, and
Someone else who won their PIP appeal has been left for four months without any payments, the DWP claim he owes them money for an overpayment, and refuse to release the money he is owed. However, he told me that he does not owe any money, and has never been overpaid, as prior to his relatively recent claim for PIP and ESA, he was in work and received no social security. He ahs also been forced to appeal the DWP’s decision not to award him ESA.
The DWP were allocated £22m of public money to hire the “presenting officers” to “support” the DWP at disability benefit tribunals. Disability campaigners warn that these 180 presenting officers, rather than helping judges to make fair decisions about whether to overturn the DWP’s rejection of someone’s claim for benefits, will inevitably argue as forcibly as possible in the government’s favour. The aim is to cut the number of successful appeal outcomes for claimants. The reality is that PO’s are sent by the DWP to try to discredit claimants’ accounts and to argue forcibly for the DWP’s interpretation of the law to be accepted.
A freedom of information request by Disability News Service resulted in them being sent forms that have to be completed by presenting officers after each tribunal they attend.
Included in the documents are the following questions for presenting officers attending ESA and PIP tribunals, respectively:
“PO impact – Was SG [support group] award averted”
“PO impact – was enhanced PIP award averted?”
DNS quotes a DWP insider, saying that presenting officers are being given the ‘target’ of stopping enhanced PIP payments and that this was placing ‘immoral pressure’ on presenting officers. (See the full article: ‘Truly appalling’ revelations ‘show DWP is subverting justice’ at appeal tribunals.)
The DWP outline says: “The PO must be confident that the decision is accurate and prepared to lapse appeals where this is not the case. They must highlight inconsistencies and take appropriate action when new evidence comes to light, including making a critical assessment of its validity.”
But surely that is the role of an independent court.
At the time, Marsha de Cordova, Labour’s shadow minister for disabled people, described the DWP’s admission as “truly appalling”.
She said: “The idea that the ‘impact’ of DWP staff is being assessed on whether they managed to get ESA support group or enhanced PIP awards ‘averted’ is truly appalling.
“Presenting officers are supposed to be there to provide fair and balanced evidence of a claimant’s needs.
“In May last year , freedom of information requests revealed that the DWP was setting targets to reject 80 per cent of social security appeals at mandatory reconsideration.
“They clearly haven’t changed their approach.”
She added: “The whole system is broken: from assessments where, for example, only eight per cent of claimants think assessors understood their mental health, through to appeals where judges are overturning over 67 per cent of initial ESA and PIP decisions.
“Labour will scrap the current PIP and ESA assessments, bringing an end to the Conservatives’ failed, privatised assessment system.
“Instead of enforcing a culture of distrust and cost-cutting, we will work with disabled people to ensure that they have personalised, holistic support to live full and independent lives.”
The assessment process, from beginning to end, is almost entirely about providing opportunities for assessors and DWP decision makers to manufacture as many far fetched ‘inconsistencies‘ as they can to prevent awards and deter as any higher rate awards as possible.
This means that PIP is not about meeting the needs of disabled people, it is about how little the state can get away with paying out from public funds, regardless of a person’s needs and entitlement.
It was acknowledged in my own PIP assessment report that I had cognitive difficulties because of my illness. The HCP said that I had difficulty focusing when asked questions and needed prompting. She acknowledged that I rely on a 7 day pill organiser to ensure I take my medication safely and correctly.
However, the report said that I had a degree (I graduated back in 1996), I had worked in a profession – as a social worker (until 2010, when I became too ill to work) and I had a driving licence in 2005 (I haven’t been able to drive since 2005 because of flicker-induced partial seizures). The assessment took place in 2017. I was not awarded a point for cognitive problems, and was just one point short of an enhanced PIP award. The reasoning behind not awarding the one point was unreasonable, irrational pretty thinly stretched, given that I cannot drive, I was forced to give up work in 2010, and I graduated in 1996. The decision at mandatory review was exactly the same, with the same woefully incoherent reasoning presented again.
In November 2017, POs attended 23% of all first tier PIP tribunals, but the aim back then is to increase this to 50%.
It would seem likely that presenting officers are being used primarily to target claimants who are likely to be seeking enhanced rates of PIP or the support group of ESA. In which case their presence has nothing to do with improving decision making by feeding back to colleagues and everything to do with taking awards from disabled people, regardless of the high price disabled people have to pay in terms of loss of independence, loss of income to meet their basic and additional needs, placing them in unacceptable situations of severe hardship.
A claimant who secretly recorded his personal independence payment (PIP) assessment and provided a transcript to a tribunal has won his appeal against a disability living allowance (DLA) to PIP transfer decision, the BBC has reported.
Nev Cartwright, 45, received DLA because of breathing difficulties caused by a lung tumour which led to his left lung being removed.
Last year he was told to attend a ‘medical’ to assess him for PIP instead of DLA. Because he had seen a programme the night before questioning the fairness of PIP assessments, Nev decided to secretly record the interview on his mobile phone.
As a result of the assessment Nev lost his higher rate mobility and had to return his Motability car.
When he read the PIP assessors report he realised that there was information missing and other details such as his peak flow reading, had been altered. The effect was to make Nev seem much more mobile than he actually was.
Nev had a professional company write a transcript of his assessment recording and asked to be allowed to submit it as evidence for his appeal.
The DWP tried to prevent the transcript being admitted by the tribunal, but they failed and the transcript was taken into account. As a result Nev won his case and now has his Motability vehicle again.
Given the very costly restrictions attempt to place on openly recording your PIP assessment, it is not surprising that some claimants turn to doing so covertly. Although we have had members who have used relatively inexpensive cassette recorders at their assessment.
It is not illegal to secretly record your assessment.
But if you are caught doing so and refuse to stop, the interview is likely to be ended and you will be held by the DWP to have failed to take part in the assessment with the result that you will not be awarded PIP.
This imbalance of power is most certainly subverting justice for disabled people. We often hear about the outright unfair methods the DWP uses to cut disabled people’s income when they have been held to account. But for every case we hear about where justice prevails in the end, there are many more that slip under the radar, because perhaps some of us are simply too ill, exhausted and disheartened to appeal alone, without any legal support, while the government spends hundreds of thousands of pounds of public funds to prevent us from having a fair and balanced assessment and hearing, and accessing the social security support that most of us have paid towards.
Meanwhile, Atos and Capita have come under fire for the reported mishandling of as many as a third of the PIP assessments they carried out. The firms received a raise for their efforts last year, raking in more than £250 million each for the controversial disability welfare checks, despite Parliament’s Work and Pensions Committee recently suggesting vulnerable people had been “pushed to the brink of destitution” by the contractors’ handling of the scheme.
That’s because the private companies are contracted to do precisely that by the government.
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The Institute for Statecraft and its offshoot, the Integrity Initiative, constitute a secret propaganda network tied to the UK security services and the broader establishment. They bring together high-ranking military and intelligence personnel, journalists and academics to manufacture and disseminate propaganda serving the geopolitical and economic aims of the UK and those of its allies.
Created by the NATO-affiliated, UK-funded Institute for Statecraft in 2015, the Integrity Initiative was unmasked last November after Anonymous hackers released a volume of documents detailing a web of politicians, journalists, military personnel, scientists and academics involved in purportedly fighting ‘Russian disinformation.’
The Integrity Initiative is run by military intelligence and communication specialists.
The highly secretive, government-bankrolled “network of networks” has found itself under scrutiny for smearing Her Majesty’s opposition leader Jeremy Corbyn as a ‘Kremlin stooge’ – ostensibly as part of its crusade against ‘Russian disinformation.’ It was also revealed that the infowars unit developed secretive “clusters” of friendly journalists and “key influencers” throughout Europe who use social media to ‘hit back against disinformation.’ The Initiative has received more than £2.2million from the Foreign Office in two years to – in one minister’s words – “defend democracy against disinformation.”
It would be closer to the truth to say that the Initiative defends disinformation against democracy.
The leaks indicated that the organisation played a central role in shaping media narratives after Sergei Skripal and his daughter Yulia were mysteriously poisoned in Salisbury last March. It’s notable that many of the draconian anti-Russia measures that the group advocated as far back as 2015 were swiftly implemented following the Skripal affair – even as Whitehall refused to back up its blame frame with evidence. That the Initiative serves a highly political ‘strategic comms’ role is beyond doubt.
The Integrity Initiative is a self declared ‘charity’, funded by the UK Foreign Office, British Army and Ministry of Defence, which has been described by the Sunday Mail as a right wing infowars unit. But let’s call it what it is: a right wing establishment’s black ops propaganda unit.
The Labour party has made renewed calls for an investigation into the government-funded Integrity Initiative (II) after it emerged that the group had now apologised to Jeremy Corbyn – and apparently admitted violating charity law.
Leaders of the highly controversial Integrity Initiative, which a registered Scottish charity, said they had written to the Labour leader after personal attacks on Corbyn were retweeted on the unit’s Twitter feed. The publicly funded subsidiary of the Institute for Statecraft (IFS), apparently accused him of aiding Russia, possibly ‘unwittingly.’
In the wake of the tweets, which were exposed by the Sunday Mail, among others, four months ago, the II and its supporters denied Corbyn had been unfairly targeted.
However, it emerged yesterday that an apology had been given, with the IFS’s founder Chris Donnelly apparently admitting that the activities breached both Foreign Office rules and Scottish charity law. The group are registered at a Fife address.
(Image: Sunday Mail)
Labour MSP Neil Findlay said: “It is right and proper that this organisation has apologised but there are still further serious questions to be answered here.
“This is a charity registered in Scotland and overseen by the Office of the Scottish Charity Regulator, funded by UK Government contributions. It should never have been spewing out political attacks on the Labour Party and the Labour movement.
“Such clear political attacks shouldn’t be coming from any charity. We need to know why the Foreign Office has been funding it.
“This cannot be allowed to pass. We need a full inquiry into the actions of this organisation and its links to the Conservative Government.”
Findlay has previously said: “The tale of the Integrity Initiative gets murkier and murkier – now we see it exposed that they have been tutored by someone who was behind some of the worst fake news circulating during the disaster in Iraq.
“The UK Parliament and Scotland’s charity regulator OSCR must now take a serious look at the activities and funding of this so-called charity, who appear to be nothing more than a propaganda front.”
The II, which has received £2million in public funding, had already been the subject of an Office of the Scottish Charity Regulator (OSCR) investigation. The OSCR was unavailable for comment yesterday and has yet to complete its inquiry.
However, quotes published by The Times, show Donnelly appearing to admit that the OSCR’s rules had been broken.
He said: “We put out something like 26,000 tweets.
“About 400 made reference to some political party or politician, and they were roughly equal between the main political parties, but we should not have sent [them] because the Foreign Office does not allow us to make any party political comment, nor does Scottish charity law.
“That was a mistake and we wrote letters of apology to Jeremy Corbyn. I have been special adviser to two Tory defence secretaries, and for Labour’s John Reid and George Robertson, so we are as apolitical as we could be.”
It emerged that the charity had connections to strategic comms guru John Rendon, whose Rendon Group was hired by the CIA in the 90s to run a PR campaign against Saddam Hussein and is said to have been behind stories of ‘Iraqi weapons of mass destruction’.
Hacked documents revealed that Rendon, who calls himself an “information warrior” and “perception manager”, was a speaker at a £45,000 seminar to “educate core team and clusters” for the Integrity Initiative.
Donnelly is an honorary colonel in military intelligence. Another member of the board, Dan Lafayeedney, was an SAS soldier in 1978 and director Stephen Dalziel worked in military intelligence.
The Labour Party has already called for an independent investigation. Foreign Office minister Alan Duncan at first promised a full investigation but later attempted to dismiss the scandal as “Russian disinformation”. Integrity Initiative officials argued that other tweets had been critical of politicians of other parties. However, the weight of criticism was aimed at HM’s opposition leader.
Labour’s Chris Williamson has previously said: “One of the most worrying aspects of the Integrity Initiative’s activities is this seemingly covert effort to move the country on to a war footing.
“The involvement of someone like John Rendon is extremely concerning as this seems to be exactly the sort of thing that he specialises in.
“A lot of the focus has been on Brexit over the last few weeks but this isn’t an issue that the Labour Party are willing to let go of.
“We will be asking for more debate in Parliament and more answers from the Foreign Office in order to find out exactly what has been going on here.”
At the time the hacked documents emerged in the media, Professor David Miller of University of Bristol’s School for Policy Studies, said: “It’s extraordinary that the Foreign Office would be funding a Scottish charity to counter Russian propaganda which ends up attacking Her Majesty’s opposition.”
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Justin Tomlinson MP (pictured above) has been appointed as the new disabilities minister following the resignation of Sarah Newton MP last month over Brexit.
Tomlinson is the Conservative MP for North Swindon and is a former member of the Commons Work and Pensions Select Committee, a cross-party group of MPs charged with scrutinising government welfare policy.
He was appointed Parliamentary Under Secretary of State for Disabled People following the 2015 general election victory of the Conservative Party, serving until Theresa May reshuffled the government in 2016.
In May 2015, it was reported by The Huffington Post that his appointment as Minister for Disabled People was controversial as he had previously voted against protecting the benefits of disabled children and those undergoing cancer treatment.
He was a minister that defended George Osborne’s budget cuts to disabled people’s support, which was aimed at saving £1.3bn and contributing to an economic surplus.
However, there was no political, economic or moral justification for the Conservative’s decision to cut support for disabled citizens while controversially increasing tax benefits for the wealthiest. This simply indicates just how unfair Conservative policies are, and how such policies cannot fail to engineer socioeconomic inequality.
At the time, lifelong Conservative voter, Graeme Ellis, said he had quit the party over the cuts – and made his views known on the official website of the Conservative Disability Group, on whose executive he has served.
“This website is temporarily closed owing to Disability Cuts,” a message on the site read after Osborne confirmed the cuts to Personal Independent Payments (PIP).
“The owner of the hosting package, Graeme Ellis, has resigned over disability cuts from the group and will no longer develop or host this site.”
The message was later amended to emphasise that no other member of the group was involved in the action and they had not known about it in advance.
Ellis, a former NHS worker who has diabetes and uses a wheelchair, said Osborne was “destroying lives”.
“I’ve been a Conservative voter since I could vote. But as a lifelong Conservative I could no longer agree with what the Government’s doing,” he said.
A Conservative Party spokesman said at the time: “The Conservative Disability Group has not deactivated its website.
“The owner of the domain, who is no longer a member of the group, has deactivated it without any instruction to do so.”
Tomlinson caused a furious backlash after he suggested taking in a lodger may help families cope with the benefit cap. He was branded “ignorant” and “out of touch” after raising the idea as one way people have dealt with the £20,000-a-year limit per household on welfare payments. David Smith, policy director at the Residential Landlords Association, suggested Tomlinson did not understand basic rules in tenancy agreements. At the time, Tomlinson was the Parliamentary Under-Secretary (junior government minister) for Family Support, Housing and Child Maintenance within the Department for Work and Pensions.
He said most private landlords ban tenants from taking in lodgers – either because of restrictions in mortgages or extra legal burdens for the landlord.
Frank Field, chairman of the Commons Work and Pensions Committee, told the Mirror after the hearing: “What it shows is ministers find defending the benefit cap difficult.
“Many people would be breaking they tenancy agreement to follow the minister’s advice.”
People who live in council housing or housing association property would be breaking the rules of their tenancy by taking in a lodger and subsequently may be evicted.
Such an out of touch, ignorant and uncaring statement shows a woeful lack of understanding and empathy for people who are often in financial dire straits directly because of government policy.
Tomlinson was suspended from the House of Commons in 2016 for leaking a draft committee report. He shared the findings of an inquiry into regulating consumer credit with a Wonga employee in 2013. MPs backed the finding by the Commons Committee of Privileges that he had “committed a contempt” in disclosing the report. The incident happened when Tomlinson was a member of the Public Accounts Committee (PAC) in May 2013.
He gave a confidential draft report on regulating consumer credit to an employee of payday lender Wonga, who replied with comments and suggested amendments to the report. Apparently, Tomlinson presented the amendments, word for word to the Committee as if they were his own.
Parliamentary Commissioner for Standards Kathryn Hudson noted that Tomlinson’s actions “provided Wonga with an additional opportunity, not available to or known to anyone else, to influence the recommendations of the committee”.
Justin Tomlinson’s dismal voting record
- Generally voted against laws to promote equality and human rights.
- Almost always voted for reducing housing benefit for social tenants deemed to have excess bedrooms.
- Consistently voted against raising welfare benefits at least in line with prices.
- Consistently voted against paying higher benefits over longer periods for those unable to work due to illness or disability.
- Consistently voted for making local councils responsible for helping those in financial need afford their council tax and reducing the amount spent on such support.
- Consistently voted for a reduction in spending on welfare benefits.
- Consistently voted against spending public money to create guaranteed jobs for young people who have spent a long time unemployed.
I don’t make any money from my work. If you like, you can help me by making a donation to help me continue to research and write informative, insightful and independent articles, and to provide support to others going through disability assessment, mandatory review and appeal.
Homeless man, Jay Blue, who had his personal property seized by the council and police. Image: Jonathan Myers/WalesOnline)
Council officers cleared an ‘encampment of tents’ in Cardiff city centre on Wednesday after giving homeless people living there just 24 hours to leave.
I wonder where they imagined homeless people would go?
Police officers supervised the evictions and at one point held a homeless man back as he remonstrated with officials and demanded the return of his possessions. He was stunned when his worldly possessions disappeared onto the back of a truck.
As the camp was cleared and property seized, the homeless man told council staff: “You have no right to throw my stuff away, this is what keeps me alive.”
He added: “You’re pushing me in a doorway and I’m not going in a doorway” before desperately grabbing onto the truck as it tried to drive away. He was subsequently ‘spoken to’ by police officers.
“I will die before I give up this cause – people shouldn’t be living in tents,” he said.
He had desperately to recover his belongings. Tents and personal items from the site were loaded onto the back of a truck before being driven away from the encampment in parkland off Museum Place, Cardiff.
When the police and council left only one tent had remained in the area.
The 38-year-old man who had tried to reclaim his belongings, calls himself Jay Blue. He said he was making a stand to give homeless people the right help that will take him to City Hall or the Senedd if necessary.
He said: “They took my world – everything I owned apart from a couple of sleeping bags.
“I was happily sleeping last night but where am I going to sleep tonight? Probably sleeping in a doorway or pushed into a situation I don’t want to be in.
“It’s not getting easier, my situation. It’s just getting worse.
“I was in the city centre for three months hiding behind a big shop. There wasn’t a problem when I was there. When they moved me on there was nowhere I could really go.”
Jay said it was the seventh time he’d had his tent taken off him since he became homeless last November after leaving prison.
Cardiff council said it could not return the tent because it contained “needles, broken glass, and human waste”.
Jay, who said he had been kept alive on the goodwill of strangers or charitable groups to get by, said that he’s had difficulty accessing benefits, and that he was willing to work for money and had even been litter-picking in the city when he can’t sleep.
He is calling for homeless people to be given their own safe accommodation rather than having to go into hostels, as he claims they are unsafe due to the prevalence of drugs.
The council said last week that they removed the ‘tent village’ from Museum Avenue because it had concerns about ‘antisocial behaviour and health and safety’ and ‘some people in the tents had refused to engage with their help.’
But some of the tent occupiers returned shortly afterwards which meant the council and police visited the area again on Wednesday after giving them just 24 hours to leave.
“I’m making a stand,” Jay said. “But every time I got somewhere or got some recognition they just crushed me back down.
“You’re pushing people in doorways so people can buy more coffees for the homeless in town. I want to sit in the park out of the way of everyone. But because I’m behind such a public building that gets sightseers driving past it all day I’m causing a problem.”
“Well I’ll be a problem for the rest of your life because I will be outside this police station saying this until you help people like me.”
Cardiff council claim there is no need for homeless people to sleep in tents as there is ‘more than enough emergency accommodation available.’
The council and homeless charities such as Huggard have previously insisted their services are ‘safe’ and people ‘could be at serious risk if they sleep out in tents.’
However, nothing has been done to address the longstanding systemic exclusion of single homeless people with complex needs. Policymakers and wider society are preoccupied with using social security policy as a means to punish those pushed into poverty, because of what they deem ‘irresponsible’ behaviour, rather than focussing on providing services to adequately meet the basic needs of marginalised people. Furthermore, marginalised groups have become more vulnerable precisely because of government policies that have led to growing inequality and people being plunged into absolute poverty.
When the council began removing tents in the city in February it insisted it was not removing occupied tents and only getting rid of those that had been abandoned.
One Tory councillor who called on Cardiff council to ‘tear down’ homeless tents has attacked Twitter critics as ‘virtue signallers’ who ‘don’t represent public opinion.’
Councillor Kathryn Kelloway is standing by her Tweet which called on council leader Huw Thomas to “tear down these tents” in Queen Street. She’s said there is “no good reason for there to be tents” when Cardiff has enough emergency overnight accommodation for rough sleepers, and said allowing tents to be erected in the city centre “sends out the wrong message”.
Kelloway, who represents the Cyncoed area of Cardiff, has also said Twitter is “disproportionately used by political activists who are happy to misrepresent the views of others in order to signal their virtue and justify their hatred of opponents.”
Welsh Conservatives have distanced themselves from councillor Kelloway’s comments, saying they “in no way reflect the views of the Welsh Conservatives”.
The Tweet, which sparked a justifiable backlash with over 1,900 replies, says: “Cllr Thomas, if you seek safety in our city centre, if you seek prosperity for local businesses, if you seek a better image for Cardiff. Cllr Thomas come to Queen Street.
“Cllr Thomas, tear down these tents.” (See Homeless tents row Tory attacks Twitter critics as ‘virtue signallers’)
Kelloway was suspended from Cardiff’s Conservative Group just hours after disgracefully urging council leader Huw Thomas to take action over tents on Queen Street. Responding to Kelloway, Cardiff council’s Labour leader Huw Thomas described her comments as “awfully judged”.
He said: “Of course no one wants tents in our city centre, but we have to act sensitively, and support people into accommodation with help for their underlying needs. Small wonder homelessness is soaring under this Tory Government, if ‘tearing down tents’ is their mindset.”
The ‘Parish pauper’ mentality
The council say that outreach workers were able to ‘engage’ with another man on the site that was disbanded, and are helping him ‘reconnect with his home town’.
This euphemism means that the workers are sending the person back to his home town, rather like the Parish paupers who were pushed on from one place to the next to cut costs, under the Elizabethan Poor Act of 1697. The Act is probably best remembered for its expansion of the requirement that welfare recipients be marked to indicate their status, in this case by wearing a prominent badge on their right shoulder. These badges would contain the first letter of the parish name, followed by the letter “P” (pauper). The penalty to paupers who did not wear badges was whipping and imprisonment, and overseers providing relief to unbadged paupers were fined 20 shillings.
Part of the system involved the determination of what parish to which a recipient belonged, and was thereby responsible to provide relief to that recipient. Under the earlier Poor Relief Act 1662, also known as the Settlement Act, a parish could banish those poor unable to rent lodgings of at least £10 per year within forty days of their arrival in the parish. Those banished this way would be sent back to their parish of birth, or where they had resided in the prior three years.
But moving people on doesn’t address the serious and often life-threatening problems faced by the growing number of people who are homeless.
Call me a ‘virtue signaller’ if you like, but it’s hard to avoid the conclusion that the current system of homelessness support routinely fails to meet the most basic needs of many highly vulnerable homeless individuals, with many councils and the public preferring instead to simply move the evidence of a catastrophically failing system elsewhere, in the hope that it will somehow become invisible.
I don’t make any money from my work. If you like, you can help me by making a donation to help me continue to research and write informative, insightful and independent articles, and to provide support to others going through disability assessment, mandatory review and appeal.
NHS England has published an updated list of medical conditions for which you can no longer receive prescriptions for, as part of a wider cost-cutting exercise due to insufficient funding from central government.
Last year I wrote an article about the stealthy creep of rationing of treatments in the NHS, and how gatekeeping has become a watchword within our public services over the past seven years. It’s being driven by the government’s deep affection for neoliberal dogma, the drive for never-ending ‘efficiency savings’ and the Conservatives’ lean, mean austerity machine. Perish the thought that the public may actually need to use the public services that they have funded through their contributions to the Treasury, in good faith.
One important point I didn’t raise in the article was about how the marketisation of the NHS has given rise to ‘perverse incentives’, which violate the very principles on which the national health service was founded. Neoliberal policies have shifted priorities to developing profitable ‘care markets’ making ‘efficiency’ savings and containing costs, rather than delivering universal health care.
In 2017, doctors raised concerns that vital medical treatments and operations are being increasingly rationed. The treatments affected include hip and knee replacements and cataract surgery to help restore sight as well as drugs for conditions such as severe forms of autoimmune related arthritis.
Such health care is normally given routinely under the NHS, but the British Medical Journal has found evidence it is being cut back, the data showed doctors are having to resort to special appeals to get their patients treated, and that the increasing restrictions were due to a lack of funding.
The journal gathered evidence from clinical commissioning groups (CCGs) which showed the special requests are increasingly being used for vital non-emergency services, many of which prevent conditions from deteriorating and preserve mobility and vision, for example.
Responses from 169 of the 209 clinical commissioning groups, which control local budgets, showed:
- In 2013-14 there were just 49 requests made for hip and knee surgery, but by last year the figure had reached 899
- Over the same period, the number of cataract appeals trebled to more than 1,000.
- Overall the number of requests being made through the special cases route rose by 47% to 73,900
- Just over half of all requests were approved.
Doctors now use a standardised scoring system to assess how much discomfort and lack of mobility a patient has for hip and knee replacements, for example. By increasing the bar at which a referral for an operation is made, the NHS is restricting the numbers of people getting treatment. This will invariably have an impact on the quality of people’s lives, and their degree of independence.
These restrictions also apply to essential mental health care.
Doctors said the trend was a clear indicator that care was being rationed. For every case where an ‘exceptional argument’ has been made for treatment, there will be plenty more where patients will have gone without care and their doctor did not appealed.
Restricting access to mental health care, arthritis and cataract treatment is a false economy. Patients with these conditions are at risk of social isolation, depression, and the latter two conditions may lead to fall-related injuries and other complications. This cost-cutting approach means the NHS is reduced to little more than a crisis management service, rather than one that treats citizens to ensure they don’t reach a point of crisis in the first place, which is the best possible outcome.
The administration of health service support impacts on people’s ability to work
The impacts of a profoundly punitive and inadequate social security system on the health of disabled people, and how the cuts have become a barrier to work has been well documented, and the enduring poverty and hardship disabled people are forced to live under. There has been rather less discussion about the impact of cuts to health care, treatment rationing and how this affects peoples’ working lives, however. With the NHS in crisis and waiting times for non-urgent treatments escalating, it’s difficult to see how timely interventions to help people back to work can possibly be delivered.
One patient who has been caught up in the health care squeeze is Helen Cole, from west London. She was diagnosed with rheumatoid arthritis 11 years ago. This is an autoimmune condition that leads to very severe and disabling inflammatory arthritis and progressive joint damage. It doesn’t only affect the joints, however, as the illness can also affect major organs, such as the heart and lungs. It can cause osteoporosis and affect blood vessels, nerves, tendons and may even affect the hearing. Furthermore, during flare ups of inflammation, rheumatoid arthritis generally makes people feel very unwell.
Most rheumatologists agree that early treatment is essential to try and prevent the disease progressing rapidly. Helen relies on an immune suppressing drug called rituximab, but it is not being routinely funded by her local health managers, so her doctor has to make a special request for it every six months. This has led to delays in her getting the drug and gaps in her treatment. Last time, she had to wait 10 weeks to get her next treatment.
“I had a lot of pain in my joints and really big problems with fatigue. It can be really challenging day to day.”
She said she finds the whole process “stressful” and believes it “makes no sense”.
“The whole point of treating a disease like rheumatoid arthritis is to try to keep it under control at all times,” she added.
Having timely and effective treatment which manages symptoms as effectively as possible can make a lot of difference to a person’s quality of life and independence, including being able to remain in work.
Autoimmune conditions such as rheumatoid arthritis leave a progressive wake of damage that cannot be undone, which is why early treatment is essential. Patients are not always given treatments that are the most effective. The new generation of biologics – such as rituximab – are very effective, but cost much more than older ‘disease modifying’ medications such as methotrexate, which is a chemotherapy that suppresses the immune system. Between 15 – 25% of people with rheumatoid arthritis respond positively to methotrexate.
The new and expensive biologics, on the other hand, tend to be prescribed to those people whose disease is deemed ‘severe’, and who have not responded to methotrexate. But classification of ‘severe’ disease is an imprecise art and definitions are now invariably tied in with available funding. It means that people are waiting until their disease becomes aggressive, and damage to their joints has progressed before even being considered for a treatment that could have helped prevent the damage in the first place. In other words, NHS cuts are leading to disability, when it may have been prevented with effective treatments.
Stephen Cannon, of the Royal College of Surgeons, said local health managers were “unfairly and unnecessarily prolonging the time patients will spend in pain, possibly immobile and unable to carry out daily tasks or to work”.
The latest list of restrictions on prescriptions includes those for:
- Acute Sore Throat
- Cold Sores
- Coughs and colds and nasal congestion
- Cradle Cap (Seborrhoeic dermatitis – infants)
- Infant Colic
- Mild Cystitis
- Contact Dermatitis
- Diarrhoea (Adults)
- Dry Eyes/Sore tired Eyes
- Excessive sweating (Hyperhidrosis)
- Head lice
- Indigestion and Heartburn
- Infrequent constipation
- Infrequent Migraine
- Insect bites and stings
- Mild Acne
- Mild Dry Skin/Sunburn
- Mild to Moderate Hay fever/Allergic Rhinitis
- Minor burns and scalds
- Minor conditions associated with pain, discomfort and/fever. (e.g. aches and sprains, headache, period pain, back pain)
- Mouth ulcers
- Nappy Rash
- Oral Thrush
- Prevention of dental caries
- Ringworm/Athletes foot
- Teething/Mild toothache
- Travel Sickness
- Warts and Verrucae
- Probiotics, vitamins and minerals are no longer available on prescription.
Although there are over-the-counter medications that people can buy for most of these conditions, those living on low incomes may not be able to afford the treatments. Effective pharmacy treatment for cystitis, for example, is around £25. If left untreated, cystitis can lead to kidney infection, which will require urgent treatment. Conjunctivitis is an eye infection that can be caused by bacteria, and this type most frequently needs an antibiotic ointment to prevent it from becoming more serious, because the eyes are very vulnerable to infection. Left untreated it can damage the eye and may cause blindness.
There are exceptions to the restrictions, however. Circumstances where the product licence doesn’t allow the type of medication to be sold over the counter to certain groups of patients, for example. This may vary by medicine, but could include babies, children and/or women who are pregnant or breast-feeding. Community pharmacists will be aware of what these restrictions are and can advise patients accordingly.
Patients with a minor condition suitable for self-care that has not responded sufficiently to treatment with an OTC (over the counter) product may also be prescribed treatment.
Patients where the clinician considers that the presenting symptom is due to a condition that would not be considered a minor ailment may also be prescribed medication for some of the above conditions. For example, chronic dry eyes many be one symptom of an underlying autoimmune condition, without effective treatment, it may cause progressive damage to the cornea as well as recurring bouts of conjunctivitis. Recurring mouth ulcers may be a symptom of a chronic condition, such as an autoimmune disease – for example lupus.
In circumstances where the prescriber believes that in their clinical judgement exceptional circumstances exist that warrant deviation from the recommendation to self-care, they may prescribe medication for the above conditions.
Patients where the clinician considers that their ability to self-manage is compromised as a consequence of social, medical or mental health vulnerability to the extent that their health and/or wellbeing could be adversely affected if left to self-care may also warrant prescribed treatment for these conditions.
NHS England chief executive Simon Stevens, said: “To do the best for our patients and for taxpayers it’s vital the NHS uses its funding well.”
But that flies in the face of the ‘preventative approach’ that health secretary Matt Hancock has proposed recently. For example, contact dermatitis may become infected if left untreated, especially if the person affected can’t isolate the cause. If one member of a family has head lice (and children pick them up very easily from nursery or school) and this isn’t treated promptly, the whole family is likely to catch them. Effective head lice treatment is costly and needs to be repeated.
Threadworms are also highly contagious, and children pick them up very easily, as they are transmitted via microscopic eggs that can stick to clothing, towels, bedding, carpets and on unwashed hands. One study showed that up to 40% of children at primary school age will have threadworms. If access to prescribed treatment is restricted, children with embarrassing and very unpleasant, uncomfortable conditions like threadworms and head lice in poorer families may be left with the conditions longer, and may well pass on the parasites to others.
Deflection is when patients who are unable to get a GP appointment or adequate treatment seek treatment elsewhere – for example, an accident and emergency (A&E) department. The national GP patient survey asked patients who were unable to get a convenient appointment last time they called their GP what they did instead. It found that people end up going to an A&E department or a walk-in centre. Again, cost-cutting leads to further costs further down the line.
Restricting treatments for those with mental health conditions and chronic illness means that these citizens are less likely to be able to work. This is at odds with the government’s pledge to ‘half the employment disability gap’.
GP’s are being ‘incentivised’ to reduce referrals to specialists
It was announced in April last year that General Practitioners across England will be able to “better manage” hospital referrals with a “digital traffic light system” developed by the Downing Street policy nudge wonks. This nudge is designed to target the ‘referral behaviours’ of GPs.
GPs are being offered cash payments as an ‘incentive’ to not refer patients to hospitals – including cancer patients – according to an investigation by Pulse, a website for GPs.
Furthermore, a leaked letter sent by NHS to England to Clinical Commissioning Groups (CCGs) and seen by Pulse magazine last year, asks that all family doctors in England to seek approval from a medical panel for all non-urgent hospital referrals.
A “clinical peer review of all referrals from general practice by September 2017”, will be required, the letter said.
To ‘incentivise’ the scheme, the letter said that there will be “significant additional funding” for commissioners that establish peer-led policing schemes. It added that it could reduce hospital referral rates by up to by 30 per cent. NHS England said that they want to introduce the “peer review scheme” whereby GPs check the referrals of one another to ensure they are ‘appropriate’. However, experts warn this increasingly Kafkaesque layer of bureaucracy could lead to more problems and possible conflict with patients’ safety and standard of care.
“Cash incentives based on how many referrals GPs make have no place in the NHS, and frankly, it is insulting to suggest otherwise,” said Professor Helen Stokes-Lampard, chair of the Royal College of GPs.
“Of course, it’s important to take measures to ensure that GP referrals are appropriate and high-quality, but payments to reduce referrals would fly in the face of this, and erode the trust our patients have in us to do what is best for them and their health.”
The NHS has been squeezed for increasingly drastic ‘efficiency savings’ in the past eight years. It’s absurd, however, that a huge amount of money is being spent on restricting access to healthcare, rather than on simply adequately funding healthcare provision.
Potential impact on social security assessments for people with chronic illness
Something else to consider is the potential impact this may have on people needing to claim social security disability support. The private company assessors hired by the government to determine eligibility for Employment and Support Allowance (ESA) and Personal Independence Payment (PIP) tend to regard people who haven’t been referred to a specialist as being less ill than those who have.
They also tend to take prescribed treatments into account when assessing the severity of illness, the needs of claimants and their eligibility for an award. Being let down by the NHS potentially has a knock-on effect which may leave some people in a situation where they can’t get either the health care or the financial support they need to live independently, increasing their vulnerability.
There is no specific list of services to which individuals using the NHS are guaranteed access. Instead individuals have a number of legal rights that are set out in the NHS Constitution. These include the right to: receive most NHS services free of charge; receive certain treatments within a maximum waiting time; be treated in a safe and clean environment; have access to drugs and treatments recommended by the National Institute for Health and Care Excellence (NICE), if a doctor says it is appropriate.
Like our social security system, the NHS should be there for all of us in our time of need, based on principles of inclusion, support and security for all, assuring us of our safety and dignity. However, chronic under funding, rationing and the increasing marketisation and ‘efficiency savings’ demanded by the government are incompatible with supporting citizens – especially those with multiple disadvantages – to live full, healthy and independent lives.
I don’t make any money from my work. If you like, you can help me by making a donation to help me continue to research and write informative, insightful and independent articles, and to provide support to others going through disability assessment, mandatory review and appeal.