Category: Illness and disablility

Sarah Newton lied to parliament and the public about the DWP’s standardised letter to GPs following ‘fit for work’ assessment

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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 PDF 163 KB)Opens in a new window  (PDF PDF 163 KB)Opens in a new window 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 PDF 1.41 MB)Opens in a new window 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 PDF 219 KB)Opens in a new windowthat 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 PDF 84 KB)Opens in a new window and that the wording is the outcome of “close and extensive working between DWP, BMA and RCGP.” (PDF PDF 165 KB)Opens in a new window

Both medical professionals’ associations’ have now written to the Committee – and in the case of the RCGP, directly to the Secretary of State (PDF PDF 199 KB)Opens in a new window – 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.”

As the BMA describes in its response to the Committee (PDF PDF 164 KB)Opens in a new window:  

“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.”

The Royal College of GPs put the same point to the Committee (PDF PDF 197 KB)Opens in a new window:

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 PDF 165 KB)Opens in a new window], 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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The government are challenging independent disability assessment appeal decisions

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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 [2017], 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 ‘inconsistenciesas 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.

pip-esa inhumane

 


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Misleading DWP letter to GPs is depriving disabled people of lifeline support

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Credit: PA Images

Last month I reported about the issues raised by the Department for Work and Pensions’ ESA65B GP’s letter template, which was only recently placed on the government site, following a series of Parliamentary Written Questions.

Campaigners and MPs have called for the Department for Work and Pensions (DWP) standard letter to GPs to be scrapped after it emerged that ill and disabled 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 advised 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. 

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 prove they are too ill to work.

They must also await the outcome of a mandatory review.  Before a claimant may lodge an appeal, the must first ask the DWP to ‘reconsider’ their original decision. However, 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. 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 blocked from claiming ESA while awaiting the appeal hearing. This prevents many low-income disabled people from accessing financial support while they wait for months on end to go to tribunal. Furthermore, we know that catastrophically inaccurate 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. 

“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 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.

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 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, has also raised the issue with the then disability minister Sarah 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”.

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.”

A DWP spokesperson said: “These letters simply inform GPs when a claimant has been found fit for work and are not intended to dissuade them from issuing fit notes for ESA appeal purposes, to claim otherwise is inaccurate.”

However, there is a hint the letter may be changed. 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.

It remains very 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.” 

Newton had previously also said: “In accordance with the Answer of 3 July 2018 to Question 155402, the information is not available as there is no written minute of the meeting between officials from this Department and representatives from the British Medical Association and the Royal College of General Practitioners on the revised wording of the ESA65B letter.” 

In June last year, Dent Coad asked Newton who attended the meetings between officials in her Department and the (a) British Medical Association and (b) Royal College of General Practitioners on the revised wording of the ESA65B; and if she would place in the Library a copy of the minutes of those meetings. Newton responded on 03 July 2018:  

“The names of the participants representing the British Medical Association and the Royal College of General Practitioners who attended the meetings referred to constitute their personal data and in accordance with data protection principles, they will not be disclosed without informed consent. DWP officials did not take minutes of these meetings.”

And: “No other external stakeholders were consulted on the development of the revised ESA65B letter.”

Newton has also said in response to Written Questions: “The Department is committed to ensuring all of its communications are clear, accurate and understandable and we continuously improve our letters. We engage regularly with the welfare benefits advice sector and disability charities and take into account all of the feedback we receive.”

“We have received comments from a number of sources including MPs, stakeholder organisations and GPs on the current version of the ESA65B letter and will take all of their feedback into account when revising it.”

I should hope so. The idea of the state persuading doctors and other professionals to “sing from the same [political] hymn sheet”, by promoting work outcomes in social and health care settings is more than a little Orwellian. Co-opting professionals to police the welfare system is very dangerous. 

In linking receipt of welfare with health services and “state therapy,” with the single intended outcome explicitly expressed as employment, the government is purposefully conflating citizen’s widely varied needs with economic outcomes and diktats, isolating people from traditionally non-partisan networks of relatively unconditional support, such as the health service, social services, community services and mental health services.

Public services “speaking with one voice” as the government are urging, will invariably make accessing support conditional, and further isolate already marginalised social groups. Citizens’ safe spaces for genuine and objective support is shrinking as the state encroaches with strategies to micromanage those using public services. This encroachment will damage trust between people needing support and professionals who are meant to deliver essential public services, rather than simply extending government dogma, prejudices and discrimination.

 

Related

Jobcentre tells GP to stop issuing sick notes to patient assessed as ‘fit for work’ and he died.

GPs told to consider making fit notes conditional on patients having appointment with work coach

Let’s keep the job centre out of GP surgeries and the DWP out of our confidential medical records

 


 

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Court victory for disabled EU benefit claimants at appeal

lady.justice.small

Two disabled people who moved to the UK from other EU countries have won an important Appeal Court case which entitles them to disability-related benefits in the UK from shortly after they arrived rather than having to wait two years.

The case, brought by Child Poverty Action Group and Harrow Law Centre, will ensure that disabled EU citizens and their carers who have a “genuine and sufficient” connection to the UK will receive social security support at an earlier point if they relocate to the UK.

The ruling overturns an Upper Tribunal finding that had denied both households benefits. And it confirms that the “genuine and sufficient” link which must be demonstrated by claimants in these circumstances is to the UK as a whole, rather than to its social security system.

One of the claimants, Ms Mohamed, is a Somalian-born woman who after 14 years’ residence in Germany as a German citizen came to the UK to settle here, aged 65.

When her health deteriorated to the point where she could no longer live alone and required the care of her daughter, a British citizen living in the UK, she claimed Attendance Allowance (AA). Her claim was refused.

The other claimant is 18-year-old Brandon Kavanagh, an Irish citizen who was diagnosed with Asperger’s Syndrome as a child.

His mother, a British citizen, moved to Ireland when she was a teenager but returned to the UK in 2013 with her children to escape domestic violence and to be closer to her family, from whom she receives support. Her son was then aged 12.

She claimed Disability Allowance (DLA) for her son when she arrived in the UK, but her claim was refused.

Between 2011 and 2013 she had received care allowances for her son and for herself from the Irish social security system.

Both were refused disability-related benefits on the grounds that they hadn’t been in the UK long enough to pass the so-called ‘past presence test’.

The test requires people claiming disability benefits to have been in Britain for 104 weeks of the 156 weeks before they claim. EU citizens may be able to meet this test by combining, in certain circumstances, the time they have lived in another EU state with the time they lived in the UK.

Alternatively, the test doesn’t apply to EU citizens if they can establish a genuine and sufficient link to the UK.

Both claimants appealed the refusal of their benefit claims. In Brandon Kavanagh’s case he lost the appeal while Ms Mohamed was successful in hers. Brandon appealed to the Upper Tribunal in his case and the Secretary of State for Work and Pensions appealed in Ms Mohamed’s case.

The cases then went jointly to an Upper Tribunal which found that although the “genuine and sufficient link” needed to be to the UK as a whole rather than limited to its social security system and that such a link may be established on the basis of presence alone, neither of the claimants could demonstrate a sufficiently strong link to the UK.

In a judgement handed down yesterday, the Court of Appeal ruled that both claimants had a genuine and sufficient connection to the UK when they claimed disability benefits shortly after their arrival and that the approach taken by the Upper Tribunal was flawed and unduly inflexible because it failed to take account of all the particular, personal circumstances and motives of the claimants which, in the round, proved the required sufficient link.

The Judges say: “… objective evidence of the [genuine and sufficient] link is plainly critical but evidence of the motives, intentions and expectations of the applicant are not to be ignored if they are relevant to proof of the link and are convincing.”

In Kavanagh’s case, the judges found the fact that his mother was fleeing domestic violence explained and confirmed her settled intention to remain in the UK, her country of nationality.

She needed the support of her wider family in England, enrolled her children in English schools, closed her only bank account in Ireland, severed all ties with the Republic and had no intention of returning.

In the case of Ms Mohamed, she suffered a number of physical ailments including osteoporosis, rheumatoid arthritis and high blood pressure.

She used a wheelchair, required support with mobility and daily activities such as washing, cooking meals, dressing and administering medication and had moved to the UK to join her daughter, a British citizen who provides daily care for her.

Commenting on the judgement, Child Poverty Action Group’s Head of Litigation Carla Clarke said: “This is a strong judgement which recognises that justice requires decision makers to take a wide view of all the relevant facts and motives where a genuine and sufficient link to the UK must be proved for benefit purposes.

“Both of our clients already had strong family ties to the UK and a clear intention to settle here when they first claimed disability benefits yet they were denied help with the extra costs of disability because, as today’s judgement finds, the criteria for proving a sufficient link to the UK has been too narrowly applied.

“Today’s ruling means that disabled EU citizens, including UK citizens, who relocate or return to the UK from another EU country because their carer is fundamentally connected to the UK will receive the financial help they need because of their disability at a much earlier point.”

 


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The state is policing social security claimants in hospital and via their medical records to find reasons to cut their support

Related image

The Department for Work and Pensions (DWP) officers have been visiting patients in hospital to check if they are actually unwell, a damning new review into the roll-out of universal credit has revealed. This news comes after it emerged that the DWP are in the process of designing an automated system to trawl claimants NHS health records. 

Doctors have already raised serious concerns that social security claimants could be deterred from accessing healthcare after it emerged that the government is to start accessing medical records as an intrusive part of the welfare assessment process. A job advert posted by the DWP shows that a team in Leeds is building a system to “capture information from citizens and present this to DWP agents”. The work is proceeding on the controversial assumption that the consent of patients would make the system lawful. 

However the DWP have told doctors that when people make a claim for disability benefits, they have already consented for medical information to be shared.

GPs and charities said the plans resemble the controversial data-sharing scheme  between the Home Office and the NHS, which prompted outrage after it emerged some immigrants were subsequently afraid to access healthcare, ultimately forcing the government to end the policy.

In response, Professor Helen Stokes-Lampard, chair of the Royal College of GPs, expressed concern that the process would damage the doctor-patient relationship, and “deter vulnerable people from seeking medical assistance when they need it”.

“If the reports are true, the DWP, like the Home Office before them, must not consider GP patient data as an open resource to support them to carry out their duties. We are doctors, whose first interest is the care of our patient: we are not border guards, and we are not benefits assessors.

“We do not hold our patients’ confidential data to help other organisations check their eligibility for welfare, their immigration status, or any other function not related to their health and wellbeing,” she said.

Head of policy and profile at Law Centres Network, Nimrod Ben-Cnaan, said the sharing of people’s medical records would breach patient confidentiality and put GPs and other medical staff in the “invidious” position of benefits assessors.

However it seems the DWP are determined to co-opt doctors into policing people who are ill and claiming social security. I raised my own concerns about this back in 2015-16 and have continued to campaign on this issue, raising awareness of the implications and consequences of state intrusion in the health care of vulnerable citizens.

The DWP continually look for reasons to end people’s disability awards, even following assessments that have deemed them eligible. Trawling through people’s medical records presents another opportunity to look for tenuous reasons to cut people’s support claim. 

As does intruding on people who are ill in hospital.

The all-pervasiveness of welfare conditionality and the state panopticon

In 1965, American historian Gertrude Himmelfarb published an essay, The Haunted House of Jeremy Bentham, in which she portrayed Bentham’s mechanism of surveillance as a tool of oppression and social control. Bentham’s famous mechanistic and inhumane approach to human lives – the Panopticon – is a type of institutional building and a system of control designed by the English philosopher  in the late 18th century. The scheme of the design is to allow all (pan-) inmates of an institution to be observed (-opticon) by a single watchman without the inmates being able to tell whether or not they are being watched.

Bentham conceived the basic plan as being equally applicable to hospitals, schools, sanatoriums, and asylums. The idea is that people are in constant fear of being scrutinised, and so are coerced or compelled to regulate or change their own behaviour to comply. Bentham described the Panopticon as “a new mode of obtaining power of mind over mind, in a quantity hitherto without example”. Elsewhere, in a letter, he described the Panopticon prison as “a mill for grinding rogues honest.”

The Panopticon is the tool of a deeply suspicious state with a very pessimistic view of human nature. 

Last year, Dr Jay Watts wrote:  “The level of scrutiny all benefits claimants feel under is so brutal that it is no surprise that supermarket giant Sainsbury’s has a policy to share CCTV “where we are asked to do so by a public or regulatory authority such as the police or the Department for Work and Pensions”. Gym memberships, airport footage and surveillance video from public buildings are now used to build cases against claimants, with posts from social media used to suggest people are lying about their disabilities. More and more private companies are being asked to send in footage. The atmosphere is one of pervasive suspicion, fuelled by TV programmes such as Benefits Street and successive governments’ mentality of “strivers v skivers”. 

People claiming disability benefits have often raised concerns that the right to privacy is no longer their own – and this is a deliberate function of an extremely punitive regime.

Mass surveillance has become a norm in developed countries, through both the proliferation of overt measures like security cameras, the use of facial recognition software, but also more subtle and invasive means like data trawling, analysis, segmentation, psychograpic profiling and targeted , tailored ‘interventions’.

Governments, corporations and other powerful entities are able to comb through large volumes of data on specific people or larger demographics in order to gather information on them and exert control over their decision-making and behaviours. Nudge reflects the further development of covert state strategies to scrutinise and  manage citizens’ perceptions and behaviours.

Foucault, in Discipline and Punish, developed the Panopticon as a metaphor for the modern disciplinary society, in which the state constantly oversees the behaviour of the citizens, and he saw it as a mechanistic tool and oppressive system of permanent visibility as a tool of power. Foucault’s idea of panoptic architecture turned it into an omnipresent and insidious institution. It’s true to say that now, the disciplinary “eye of the state Inspector” is upon all of us. But some are scrutinised more than others.

More recently, DWP employees have also found to be interviewing people awaiting NHS treatment to ensure they were on the “right money” and not “abusing the system.” This is a particularly intrusive, oppressive practice, designed to police claims and scrutinise the ever-shrinking criteria of validity for someone’s need or social security support.

The visits were condemned as ‘grotesque’ by a council scrutiny panel in London, where it has emerged that hospitalised universal credit claimants have received shock visits from the welfare officials policing patient’s claims.

Islington’s Policy and Performance Scrutiny Committee, which has been tracking the full roll out of universal credit in Islington since last June, published a review earlier this month, where the information emerged that DWP officers have been pursuing ill claimants while in hospital.

In the meeting on 14 February, concern was expressed that DWP staff visiting claimants in hospital and this added to the stress that patients were already under while in hospital.

The DWP responded that “the visiting team may occasionally visit claimants in hospital but this would be done in a supportive manner and it happened on only a very small number of cases”.

On one occasion, DWP officers visited a person in hospital awaiting an operation because they had missed an appointment,
 reports the Islington Gazette.

The committee’s vice chair, Councillor Troy Gallagher, told the Gazette: “The fact that the DWP send people out to the hospital to interview and pursue people sends the wrong message.

“When people are in hospital they are not there to be chased and it’s not for the DWP to guess or validate if they are well or unwell. I think it’s callous.

“It’s an issue they need to amend quickly because it’s highly stressful and deeply upsetting.”

Cllr Gallagher added: “It’s grotesque and unbelievable.

“If someone says they’re unwell, whatever the reason is, you should always accept that.”

A DWP spokesperson said: “Jobcentre staff occasionally conduct hospital visits to confirm people’s bank account or rent details. This ensures we can pay their full benefits on time.”

They added that visits to claimants homes will be made “if necessary”.

The DWP told me “Claimants must inform the relevant benefit office when they go into hospital and when they come out. If they don’t report changes and they’re overpaid as a result, they have to pay back any money they owe. They may also have to pay a civil penalty.

“State Pension will not be affected.

“A stay in hospital affects people’s disability benefit support in the following ways:

“If someone has been in hospital for 28 days, they should stop receiving these benefits:

  • Attendance Allowance
  • Disability Living Allowance (DLA)
  • Personal Independence Payment (PIP)

“If someone is discharged but goes back into hospital within 28 days, the days spent in hospital on both occasions will be added together and if the total is more than 28 days they will lose eligibility until they go back home. They will still be paid for the days they spend at home between hospital stays.”

I was also informed: “Employment and support allowance is paid for an indefinite period as long as the other qualifying conditions are met. If someone is getting income-related employment and support allowance (ESA), certain premiums and housing costs are affected:

  • Severe disability premium will stop after four weeks if someone is in hospital and they lose their attendance allowance, disability living allowance care component or personal independence payment daily living component. If the person has a partner who is not in hospital and who also qualifies for the severe disability premium, they will continue to receive it.
  • Carer premium will stop 8 weeks after the person’s carer’s allowance stops.
  • After 52 weeks, they will lose the enhanced disability premium unless they have a partner who meets the conditions for the premium themselves. They will also lose their work-related activity or support component.”

It seems that documented evidence from doctors isn’t considered sufficient for the DWP to verify that someone is ill and in need of support. People who are ill in hospital are being treated as though they have done something wrong because of the effect their ill health has on their ability to work.

The government claims that disability support such as PIP is “targeted at those most in need”. Yet we see that those who are clearly most in need are being policed constantly and in an inexcusably intrusive, disrespectful way that strips disabled people of security and dignity.

What use is a social security system that is being designed to constantly work against those very people it was initially set up to help? 


 

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Disabled people face a hostile environment of calculated, strategic ordeals to deny support

PIP court

Disabled people face a hostile environment comprised of strategically placed and thoroughly demoralising ordeals, which are being passed off as arising because of bad administrative practices and simple errors. However, such ordeals are happening far too frequently to have arisen through random error. Furthermore, there is an identifiable pattern of government sponsored behaviours that has emerged within privately contracted companies hired to deliver disability assessments, and within the Department for Work and Pensions, which is aimed at simply denying people support.

Many people who have challenged a Department for Work and Pensions’ (DWP) decision not to award them Personal Independent Payment (PIP) in court successfully are finding that soon after they have won their appeal, they face a reassessment, and their award is taken from them again.

Even when people appeal, the system is rigged against them applying for legal support, and cuts to charities mean any support at all is shrinking away. Official figures last year showed that legal aid cuts mean ill and disabled people appealing their lifeline support through what have been consistently shown to be fatally flawed assessments and irrational, poorly evidenced DWP decision-making, are denied legal support in a staggering 99% of cases.

This means that someone with severe depression, or battling serious illnesses such as multiple sclerosis, cystic fibrosis or connective tissue illnesses for example, are left to take on a long, exhausting and complex legal case against the government, alone. 

The assessment process is set up to remove people’s disability benefits entirely because the evidence provided in medical notes by GPs and consultants, and the account of ill and disabled people, are not deemed by the state to be as credible as a snapshot report by a private company assessor, based on a half hour interview.

Private companies are motivated purely by making profit. This perverse incentive leaves no room for improving the dire situation that people, often at their most vulnerable, are facing. Improving performance as a service provider, or of prioritising human needs in a system that was originally designed to do so offers no reward for companies such as Maximus and Atos, because the government has been willing to pay them – from public funds – for atrocious failings that have harmed people and caused much distress. 

Since PIP was launched in 2013 to reduce the costs of disability support, the increasingly reduced access to financial assistance to help with the additional costs of being disabled has forced more than 75,000 people to give up their specially-adapted Motability vehicles. 

The UN have found that government policies have brought about “grave and systematic violations of disabled people’s rights” in the UK.

As someone who has gone through both PIP and Employment and Support Allowance (ESA) assessments and subsequent appeal, and as someone who co-runs a support group online for others going through this system, I know that both the assessment processes are beset by profound administrative failures and ordeals which seem to be wholly designed to work to the disadvantage of  ill and disabled people.

A report last year called Access Denied: Barriers to Justice in the Disability Benefits System, shows some of the immense suffering that the adversarial social security system causes disabled people and the long, exhausting and difficult process people who are ill have to go through to finally get the support they deserve and have paid into.

After being wrongly turned down at assessment, people must first go through mandatory review which can take anything from a few weeks to several months. The DWP argues that claims are fully reviewed at this stage, but the fact that 69 per cent of claimants win their appeal after having gone through MR proves that the MR itself is failing to correct the assessment’s flaws.

Case study: ‘Rose’

I spoke to someone this week who has faced two tribunals regarding her PIP award.  After successfully appealing the first, Rose (not her real name) had a face to face assessment when her review was due in July 2017.  The DWP decided to end her award, so she requested a mandatory review.  The DWP ‘lost’ Rose’s request twice after she had sent it, and then failed to log it and upload it onto their system.

Many other people have reported that they are not being notified of mandatory review outcomes, too, finding out after months of phone calls that the original decision was upheld. People cannot appeal until they have gone through a mandatory review, and several people told me they think the delaying tactics are deliberate, to discourage them from appealing DWP decisions. 

The mandatory review request in Rose’s case was sent in September 2017. The DWP acknowledged it had been received but had not been ‘logged’. As she was kept in the dark, Rose rang to find out what was happening over a month later in November, and was told once again hat the DWP had  ‘forgot’ to put it on the system.

She told me “They just said that there were always delays and to be patient and didn’t tell me why it had been delayed in the first place, then didn’t log it yet again”.

She added: “The DWP finally did the MR in a rush (and did not change anything from the original decision obviously) when I phoned again a month after that in Dec 2017 (as I still hadn’t heard anything) and they finally admitted what had happened both times. They sort of apologised on the phone but that was it. The MR document didn’t even change one letter of their original decision.”

Rose then waited almost a year for a tribunal date, which was arranged for 19 December 2018.

She told me: “The tribunal was very hard. It was not my first or even my second, as I fought and won before a couple of years ago after having two hearings adjourned because I was too upset to continue. But I won.

“It was an interrogation in a proper court room, with very quick fire questions and a very bizarre one, to presumably try to catch me out right at the end as I was standing up.

“The judge asked where I went to get my nails done!? I have never had my nails done in my life. I actually laughed and showed them my very short, bitten, discoloured nails. When I told my parents about that bit, they were furious and quite rightly said ‘would he have asked a man something like that?'”

The court didn’t reach a decision that day.

Rose said: “They did not decide on the day as it was 3.45pm (the hearing started at 3) and they were finished for the day – it was almost Christmas. The staff there definitely seemed to be winding down to say the least.

“Whilst I was crying in the waiting area, the receptionists were all screeching and laughing about their party plans, which I felt was pretty jarring and unprofessional. 

“I finally got my letter on Christmas eve telling me that they had awarded me standard rates on both daily living and mobility components, which I was relatively happy with.

“Although relieved, I do think it should have been enhanced rate on daily living but they never consider finances / therapy in most cases I’ve heard. I wasn’t so happy with the amount of time awarded (see below) but I was relieved to have an award.”

Rose waited for around five weeks to hear from the DWP, anxious that they may be considering appealing the tribunal’s decision. After being prompted to ring them by  someone online offering her advice, she was told it was usual for the DWP to contact people to check details before they can sort out an award and backpay.

Rose told me: “I don’t have my own phone so used my parents’. The DWP said that their self imposed deadline to ‘sort it out’ was within six weeks and it would be paid then.

“I  phoned up again to check something and they said the same… then phoned yet again when the six weeks was up, a few days later, and I still hadn’t heard anything.

“The guy on the phone said he didn’t know why I hadn’t heard anything (he was lying as they did know by then) but said that there was nothing he could do and to just to be patient.

“I was distressed, pretty hysterical and in tears at this point on the phone to him and felt a bit sorry for him, as I don’t think he could understand much of what I was saying.”

Rose became more and more anxious and worried, so emailed her MP  in the hope that she could find out what was going on. She told me she was petrified that the tribunal outcome was being appealed.

Her MP phoned a special DWP ‘hotline’ and immediately found out that there was a problem, as the tribunal decision letter that Rose and the DWP had received on Christmas eve had one tiny date error on it: the court had written that Rose’s  PIP award should be backdated from the 07/07/2017 rather than 02/07/2017 .

Rose said: “The error apparently meant that they couldn’t pay me until it had gone back to the courts service to be changed (and then back to the DWP and right back to the back of the queue) which could take months, depending on how busy they were. 

“I would NOT have known this if the MP’s office had not have got involved ….the DWP outright lied to me on the phone more than once when they knew what was happening and further to that should really have picked up on this earlier i.e. when it was received by them before Christmas, according to the MP’s assistant.

“The MP’s assistant emailed the courts email address (apparently the only way he could contact them as they don’t have a hotline to HMCTS like they do to other government departments) and told me that they had two weeks to respond to him with further details.

“The day before that deadline this week (now 9 weeks since the tribunal) they contacted him and said that apparently the courts are STILL waiting for my file to be sent from an ‘offsite storage facility’ and it has not even got to the judge yet to sign. They have known about this since the 25th January (which is when the DWP finally contacted them, they took over a month to realise the mistake)! You’d think sending a simple file would not take that long…..

“They refuse to give timescales (the MP’s assistant has emailed them back to ask for some but obviously they then have 2 weeks to respond to that request again!) ….and obviously after the judge deigns to have time to change it, it then has to go back to the DWP to sort out (and go to the back of their queue again).

Rose told me “I can’t believe this, I need this money to live on. I SHOULD have had it every month since July 2017 (20 months back dated almost)! I’m at the end of my tether and don’t think I can cope with much more.

“It has almost been 20 months that I have been living on the breadline, just on my ESA as I don’t claim anything else. This whole process has made me so very ill. I mean I’m ill anyway, very ill but the added of all of this and the constant mistakes and errors and not knowing what’s going on and waiting has out me on the verge of sending me into crisis again. I have started self harming more regularly, my psychiatrist has put my medication up yet again and I don’t think I can cope with this anymore.”

Rose added “There will be no respite either, even when /if this gets sorted out, as I have just had my ESA renewal forms (ESA50) through last week …which is what sent me into a [mental health] crisis a couple of years ago.

“I will also have to apply for PIP again at the end of this year presumably as most of the backdated PIP will then be gone, as they only gave me 3 years. They felt I ‘could get better’, which is utterly laughable.”

Rose has Ehlers Danlos Syndrome (EDS), which is a degenerative genetic connective tissue disorder which causes constant chronic pain, chronic fatigue and frequent joint dislocations, with it’s concurrent POTS [postural orthostatic tachycardia syndrome], MCAS [a mast cell autoimmune disorder]and IBS. Rose also has spinal scoliosis, kyphosis, three ruptured spinal discs and trigeminal neuralgia. She is undergoing investigations for dyspraxia as well. 

She also has bipolar with severe depression and chronic anxiety.

She told me: “I’m a relatively intelligent person who used to have a very good job before I became too ill to cope (something the DWP have repeatedly used against me, that and my degrees). 

“Obviously mental health can improve in some cases, which is probably what they were getting at (very unlikely though with this strain constantly happening. I can’t see anyone going through this terrible system having time to gather their thoughts and improve in any way, shape or form when they constantly make you fight and justify why you are ill).

“But EDS is a degenerative genetic illness and the symptoms severely impact on my mental health as it is. Trigeminal neuralgia also only gets worse with age. The latter is also known as the ‘suicide disease’ because of the amount of people who have killed themselves rather than live with the pain. It’s said to be one of the most painful things you can get.

“It’s ridiculous, these are things that aren’t just going to go away. I have already been ‘not well’ for 20 years now, but was forced to finally give up work in 2009 after years of struggling and disciplinary meetings for being off sick so much. Yet the judge only gave me an award for three years, as it is, because they thought I could ‘improve’, which is impossible. 

“I’m so scared, this can’t be right, living in constant fear like this. Why do they hate us so much? I still can’t get hold of my welfare advisor at the local council to help me with my ESA50 either. I emailed him on the 12th and have left phone messages on his mobile and with his colleagues.

“I’m just so petrified that they will find some excuse not to give this [PIP award] to me now altogether. At the same time I am terrified that my ESA will be taken away and I’ll be left with nothing. The timing of the ESA reassessment is atrocious (but not surprising). I’ve been on ESA, in the support group since 2013 and have never had an assessment for that. Not until now, anyway.”

The tribunal granted Rose’s appeal. Because of the date error on the court letter, it may be justifiable that the error needs to be rectified by the court before the DWP issue the money she is owed in PIP backpay – from the date of her claim. However, Rose is entitled to ongoing PIP payments too. The DWP know this, yet haven’t given her a single payment. There is no credible reason for not paying her ongoing award in the meantime.

Recently, I have seen a large number of cases where people are being re-assessed earlier than the DWP had stated and they are losing their awards. For those on PIP and ESA, it’s become commonplace for people to be going through appeals for both awards at the same time, or successively, which means there is no respite from the extreme strain that they are being put through. The thing that strikes me is that in every case, the decision to end someone’s award is irrational and cruel, most often with absolutely no reasonable justification provided in the assessment reports, which are invariably completely inaccurate.   

The endless ordeal of re-assessments and withdrawals of support for disabled people; the introduction of heavily bureaucratic mandatory reviews, designed to deter appeals; the withdrawal of support and the long periods people are being left without any means of meeting even basic needs; the fact that mandatory review very rarely changes the decision to end an award and then the awful experience of having to appeal again is certainly convincing evidence of an intentionally created hostile environment for ill and disabled people – those very people the government claims it protects. 

There are also the unofficial, undeclared and non-legislative means that the Department for Work and Pensions frequently use to try at every opportunity to end claims. For example, it’s fairly common for the DWP to try to end ESA claims because a disabled person has been awarded PIP – a non means-tested income to support day-to-day independence and meet the costs of the additional needs arising because of disabilities. The DWP often try to claim that this is “standard” process when someone has “another award.” But PIP does not affect people’s  eligibility for ESA at all.

The endless tactics deployed by the DWP are designed to force disabled people to go through the thoroughly demoralisng, anxiety-provoking and punitive claim process all over again – which means a huge reduction in income because during the mandatory review, people cannot claim any ESA, and following MR, they will then only be eligible for the basic rate ESA. This also means there will be another long wait for another harrowing assessment, which presents a further opportunity for the withdrawal of lifeline disability support, and so on.

This kind of ruthless tactic was probably also designed to ensure that people never feel secure while needing lifeline support – a kind of informal Poor Law-styled “deterrence”.

Earlier this year, through a parliamentary question from Labour MP Madeleine Moon, it was revealed that more than 17,000 people died waiting for a DWP decision on their PIP claim between April 2013 and April 2018.

Disclosed official DWP data also reveals that 7,990 people died within six months of having a claim for PIP rejected by callous DWP ‘decision makers’. This indicates that contrary to Conservative minister’s claims, those most in need of support are being catastrophically failed by the assessment and decision making regime. 

Of these, 3,680 died within just three months of having their PIP applications rejected by the DWP.

I’m wondering what it will take for the government to admit that the system is unacceptably cruel and to acknowledge the mounting empirical evidence that, rather than supporting those most in need, the system is intentionally set up to deny support to as many people as possible, regardless of their needs and regardless of the ethical red line that has been shamefully crossed by the Conservatives under the guise of ‘welfare reform’.

 


I don’t make any money from my work. I am struggling to get by, like many other ill and disabled people. But if you like, you can contribute by making a donation and help me continue to research and write informative, insightful and independent articles, and to provide support to others going through the disability assessment process, mandatory review and appeals. The smallest amount is much appreciated – thank you.

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DWP is trying to co-opt GPs in forcing ill people into work

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Yesterday on Twitter, I posted one of my previous posts – Jobcentre tells GP to stop issuing sick notes to patient assessed as ‘fit for work’ and he died in which I discuss a letter addressed to a GP regarding a seriously ill patient. It said:

We have decided your patient is capable of work from and including January 10, 2016.

“This means you do not have to give your patient more medical certificates for employment and support allowance purposes unless they appeal against this decision.”

The patient, James Harrison, had been declared “fit for work” and the letter stated that he should not get further medical certificates. 

However, 10 months after the Department for Work and Pensions (DWP) contacted his doctor without telling him, he died, aged 55. James clearly wasn’t fit for work. 

The GP had stopped issuing medical certificates when the DWP told him to. It is completely unacceptable that James Harrison was left struggling without support, when he was clearly very ill. It is also unacceptable that James’ GP was given instructions from the state – that caused harm – without James’ knowledge. 

The certificates – so-called fit notes – demonstrate that the government seems to have some difficulty in recognising that sometimes people get ‘sick’ and require support via the provision they have paid into.

Austerity: When the state takes money from the public and hands it out to millionaires

David Cameron, however, had other plans for the UK. He said: “We simply have to get to grips with the sicknote culture that means a short spell of sickness absence can far too easily become a gradual slide to a life of long-term benefit dependency.

“The new welfare bill – described as the biggest shake-up of the system since it was set up 60 years ago – is designed to say end the culture of the fit and healthy being able to refuse work being rewarded for staying at home.”

However, the statement isn’t coherent. He infers that people are recovering from a brief period of illness and then refusing to return to work. As we have learned at great human cost over the last few years, this legislation has destroyed the lives of thousands of people who are ill. It was always intended to take away support from those who need it most. That is evident in the Conservatives’ incoherent attempt at a justification narrative, propped up by the right wing media. 

It never seemed to have crossed Cameron’s mind that 1) people’s medical conditions may worsen, they may have a chronic or degenerative illness. Being chronically ill does not make a person ‘benefit dependent’, it simply makes them ill. 2) The public contributes to the treasury, which is in part a funding mechanism towards social security and other state provisions, via tax and national insurance. This is done on the understanding that the state ensures that citizens can meet their basic survival needs. The Conservatives have clearly stated they have ‘other’ ideas on how our public funds should be spent, which does not include meeting the needs of the public.

The state is responsible for handling public funds. It is unacceptable that such contentious neoliberal ideology is being used by the Conservatives to dismantle state provision for those who need it most, while deliberately targeting the poorest citizens with austerity cuts. Meanwhile, millionaires are rewarded with generous tax cuts from the public purse. At the time when the welfare reform act was passed, millonaires were handed a tax cut of £107,000 each per year. This callous and unjustified approach to social administration is destroying people’s lives and has profoundly damaged our democracy and society, while seriously and systematically violating the human rights of the UK’s most marginalised groups.

It is very worrying that the clearly dangerous ESA65B form is a standardised response to GPs from the DWP following an assessment where someone has been found fit for work.  I discussed some of the raised issues further in another article from last year that I posted on Twitter yesterday – GPs told to consider making fit notes conditional on patients having appointment with work coach 

It’s even more worrying that the part clarifying ‘fit notes’ should continue if a person is appealing a ‘fit for work’ has been removed from the standard letter, and a line added that says: “In the course of any further consultations with […] we hope you will also encourage [the patient]in [their]efforts to return to, or start, work.” 

I always worry when the government uses the words “encourage”, “help” and “support” in the context of policies and political practices that affect disabled people. They are usually techniques of neutralisation – euphemisms for the actions embedded in punitive and harmful policies.

This growing practice of the state intruding in the confidential relationship between a GP and patient undermines trust, it damages the professionalism and clinical expertise of doctors and threatens the safety and wellbeing of patients. It shrinks the safe spaces for citizens to escape the increasingly oppressive practices of the government. It turns GPs into non-neutral agents of the state.

We know from the high rate of success at appeal for Employment and Support Allowance claims that the DWP’s decision making regarding ill and disabled people’s ‘work capability’ is truly atrocious and negligent, and there is absolutely no convincing empirical evidence that “work is a health outcome”. (See: Work as a health outcome, making work pay and other Conservative myths and magical thinking.)

Last year, jobcentre staff were forced to withdraw guidance that urged GPs in Leeds to use deceitful tactics to attempt to get people who are ill off social security support and into work. The shocking guidance asked doctors to send patients for a 45-minute session with a “Patient Coach” – without mentioning that the coach actually worked for the the DWP.

It was even suggested that GPs withhold sick notes unless patients agreed to attend an appointment with the work coach. 

This is a tactic many of us have previously warned of – the government attempting to co-opt doctors to police ill and disabled people, pushing them into work, regardless of whether or not it is appropriate or safe to do so. But it also indicates the direction of travel for healthcare in the UK. The government intend to make that provision conditional also. (See Tories propose nudge, big business AI initiative and ‘personal responsibility’ in place of adequate health care funding.)

The government is forcing people who are ill into either work or into poverty, and both  outcomes are absolutely ethically unacceptable, a violation of rights, authoritarian and very dangerous. Increasingly, poverty is being used as a weapon to coerce people into work. However, many jobs are not paying enough for people to meet their living costs, so it is no guarantee that work will alleviate poverty.

The government seems to think that citizenship rights ought to be entirely conditional on people being economically useful to the government.

If we fail to be so, we are being treated as disposable political commodities. But citizens are not a means to state imposed ends and ideological aims in wealthy so-called first world democracies. And democratic governments don’t generally impose ‘behavioural change’ techniques on citizens, or professionals, for that matter, in order to make them complicit in the abuse and oppression of marginalised groups. The state is increasingly policing and punishing the poorest citizens, leaving them completely isolated and without any reliable support whatsoever.

The ESA65B is misleading GPs and deterring people from appealing wrongful  DWP decisions

On the DWP’s ESA65B GP’s letter template most recently placed on the government site, titled “Help us support your patient to return to or start work” it 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.

The problem is that people appealing wrongful DWP work capability decisions need to provide sickness certification in order to proceed.

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 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]. 

GPs are trained and tasked to objectively address health and wellbeing, they should not be co-opted as government ideologues.

The decision to change the letter template was made without any scrutiny from or consultation with parliament and the public. It’s worth reading the series of questions by Emma Dent Coad. Prompting accountable and transparent answers from Sarah Newton appears similar to an exercise in pulling teeth. The responses given display the arrogance, contempt and delusions of an authoritarian government.

When people become ill, they make an appointment with my GP, and not the secretary of state for work and pensions, and for very good reasons. People need support and treatment, not someone spouting ideologically orchestrated dangerous claptrap about how work is ‘good’ for them. It seems the notion of convalescence and recovery are incompatible with the government’s aim of “getting Britain working”.

Catastrophically inaccurate assessments within the DWP are the norm. The government are intentionally reducing access to essential support and services for ill and disabled people, and this ideological attack is causing material hardship, suffering, distress and sometimes, it is killing people. 

The contentious “fit for work” assessment is forcing severely ill people to look for work and sanctioning them if they’re exhausted, in too much pain to get out of bed, while delays in social security are forcing cancer patients to food banks, and the bedroom tax results in bed-bound ill and disabled people facing horrifying threats of eviction. 

These are the direct consequence of intentionally punitive government policies, which aim at enforcing ‘personal responsibility’ and ‘behavioural change’ on those citizens with the fewest choices.

Dan Carden’s letter to Amber Rudd

I was pleased to see Liverpool Walton MP Dan Carden’s letter to Amber Rudd (below) which addresses some of the concerns many of us have raised. He also notes that without a GP’s ‘fit note’, (the Conservative’s Orwellian rebrand of the sick note) it isn’t possible for people challenging Department for Work and Pensions (DWP) decisions to claim Employment and Support Allowance (ESA) in the interim period, until their appeal is heard at Tribunal. 

Indeed, people who have lodged an appeal against a wrongful decision have been blocked from claiming ESA while awaiting the hearing, due to the misleading letter routinely sent from the DWP to doctors. This prevents untold numbers of low-income claimants from accessing financial support while they wait for months on end to go to tribunal. 

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.

However, 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.

It simply isn’t appropriate for the DWP to interfere in a GP’s professional and qualified judgement, especially given the high rate of successful ESA appeals, indicating just how poor the decisions issued by the DWP actually are concerning people’s capacity to work. 

Dan’s letter:

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Related

Jobcentre tells GP to stop issuing sick notes to patient assessed as ‘fit for work’ and he died.

Rogue company Unum’s profiteering hand in the government’s work, health and disability green paper

The new Work and Health Programme: government plan social experiments to “nudge” sick and disabled people into work

Tories propose nudge, big business AI initiative and ‘personal responsibility’ in place of adequate health care funding

 


I don’t make any money from my work. But you can contribute by making a donation and help me continue to research and write informative, insightful and independent articles, and to provide support to others. The smallest amount is much appreciated – thank you.

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