Category: Social Security

DWP accused of altering disability assessment reports to cut or end successful claims

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Pictured: Gail Ward, who was told that she did not qualify for Personal Independence Payment, despite living with a rare and potentially life-threatening heart condition – Prinzmetal’s angina – attacks can occur even when she is resting. She also had other health problems. Remarkably, Gail was told by the DWP that she doesn’t qualify for PIP. She won her appeal after waiting 15 months for her case to be heard at a social security tribunal.

It has been claimed that officials within the Department for Work and Pensions (DWP) have edited or removed thousands of work capability assessment reports submitted by privately contracted healthcare professionals.

It’s alleged that officials reduced qualifying points awarded during face-to-face assessments, delivered by ‘independent’ private firms, and in some cases disposed of the reports entirely.  

The Daily Record reports that during the last year paperwork was altered or amended in around 1,840 cases, while a further 460 applications were branded ‘unacceptable’ and simply binned.

In 2018, I raised concerns that the DWP were quietly editing people’s assessment reports for Personal Independence Payment (PIP) and Employment and Support Allowance (ESA), to reduce or end claims for disability support. I reported that a man with multiple sclerosis and mental ill health lost his PIP award after his original assessment report was dishonestly edited during a DWP ‘audit.’

Officials had clearly tampered with the assessor’s original report. The man only discovered the ‘audited’ version of his health assessment report when he asked for copies to make an appeal. He had been in receipt of the basic level of support for two years when he was summoned to be re-assessed for PIP, which is non-means tested and designed to help with the extra cost of living with debilitating conditions.

The original assessment document said the man, has “regular specialist input”. The ‘audited’ version says he does not. The report outlines the patient’s MS, depression and anxiety and tells of his difficulties with tasks including cooking, dressing and washing. The nurse noted his clothes were dirty and his top inside-out. The ‘auditor’ had removed the second point.

The ‘auditor’ changed a part which said the man needed supervision or prompting to wash or bathe, and a section on preparing food. The original said he “needs prompting” but the ‘audited’ version said he could prepare and cook a simple meal himself. In every section of the report where the man scored points towards his PIP award, the ‘auditor’ had reduced his score to zero, without contacting him to ask for information. This tampering with the original report was done without informing the claimant, and therefore without giving him an opportunity to clarify the original report or challenge the altered version of his account. 

He was accidentally sent ‘before and after’ audit copies of his assessment, highlighting the DWP editing designed to trivialise the impact of his medical conditions on his day to day living circumstances, and to remove points for his award eligibility. 

The Daily Record reports than an estimated 11,760 assessment reports were secretly graded by DWP officials as acceptable, unacceptable, or amended.

DWP officials graded around 980 health assessments per month, with up to 200 of these being amended every month, while 20 to 50 were deemed “unacceptable” and rejected outright.

However, the number of amended reports is likely to be much higher because the DWP only publishes data from Independent Assessment Service forms (formerly known as Atos).

The Daily Record also says that 33,670 assessments in total were audited from two private companies contracted by the DWP to carry of disability assessments for PIP. 

SNP MP Marion Fellows commented: “It is concerning that thousands of health reports are being tampered with each year by people who weren’t even present for the assessment.

“There must be a complete halt to audits and an inquiry into the UK Government’s rigged health assessments.

“DWP auditors, who aren’t present during assessments, should not be able to mandate changes which could bear heavily on peoples’ lives.

“Changes should not be made by so-called health professionals who didn’t even carry out the original assessment. This is a clear injustice that must be corrected.

“People have spoken to me about how they feel they are degraded in their assessments.

“For the whole process to be a sham and for the assessment to be undermined by auditors is infuriating.”

The DWP said: “We are absolutely committed to ensuring people receive the support they are entitled to.

“That is why assessments are carried out by qualified health professionals and we continue to work with them to ensure quality is continuously improving.

“Sometimes assessment reports are returned to providers to ensure we have as much information as possible to reach an accurate decision.”

That’s clearly untrue. Information is most often actually removed at ‘audit’ by the DWP.  And inaccurate decisions are unacceptably high. The high success rate of claimant appeals indicates that clearly, something is seriously wrong with the system.

Last year, around two thirds of cases heard at tribunal in Great Britain found in favour of the claimant. In Northern Ireland, the figure was around 54% in 2018-19. The rise in the percentage of successful appeals came despite a drop in the overall number of cases being heard at court.

This raises concerns about the overall quality of decision-making in the DWP – both on PIP and ESA, in the apparent push to remove support unlawfully from as many disabled people as possible in the name of austerity.

The hostile environment

The introduction of mandatory reconsiderations in 2013 and cuts to legal aid have deterred many people from appealing. Mandatory Reconsideration don’t seem to function as a genuine check to ensure the original decision is fair and accurate, instead it is an administrative hurdle for claimants to clear, leaving them without any support while the DWP review the original decision. Furthermore, there were targets in place for DWP decision-makers to uphold around 80% of the original DWP decisions.

The DWP have claimed that the largest single reason for the high success rate of those claimants appealing DWP disability benefit adverse decisions. However, the Department has failed to explain why it takes until the appeal stage for evidence to come to light. In almost half of cases the “new evidence” presented was oral (not medical) evidence from claimants, which arose most often during the appeal process. It is difficult to understand why this information was not, or could not have been elicited and reported by the assessor.

The DWP’s attempt at explanation does not absolve the Department of responsibility. It certainly fails to address or explain how a target for upholding original decisions is compatible with ensuring that questionable reports are thoroughly investigated, and clearly flawed, inaccurate decisions identified and corrected.

Government guidelines for assessments are aimed at invalidating disabled peoples’  accounts of their experiences of illness and disability

The government produced guidelines that says assessors must look for ‘inconsistencies’ in disabled people’s accounts. Assessors are told: “All evidence must be interpreted and evaluated using medical reasoning, considering the circumstances of the case and the expected impact on the claimant’s daily living and/or mobility. When weighing up the evidence, it is important to highlight any contradictions and any evidence that does not sufficiently reflect the claimant’s health condition or impairment or the effect on their daily life.”.

This means that rather than focusing on written medical evidence and verbal evidence provided by the claimant, the assessor is looking for any evidence that may be used to discredit the claimant’s account of their disability from the start. 

Disabled peoples’ benefits assessments are carried out on behalf of the Department for Work and Pensions by the private contractors Capita, the Independent Assessment Services (formerly called Atos) and Maximus. However, it is the DWP that makes the decisions regarding a person’s eligibility for social security support.

The government guidance document for PIP assessments (section 3.4 onwards) says that “audit processes are in place for auditing the quality of assessments through:

• DWP Lot-wide audit (random sample); and
The provider – Approval-related audit (for trainees).

And: “Audit has a central role in ensuring that decisions on benefit entitlement, taken by DWP, are correct. It supports this by confirming that independent Health Professional advice complies with the required standards and that it is clear and medically reasonable. It also provides assurance that any approach to assessment and opinion given is consistent so that, irrespective of where or by whom the assessment is carried out, claimants with conditions that have the same functional effect will ultimately receive the same benefit outcome.”

It goes on to say: “The DWP Independent Audit Team carries out lot-wide audit, which is an audit of a controlled random sample from across each contract Lot, feeding in to routine performance reporting for DWP.”

Where a report is deemed ‘unacceptable’: “Any changes made to forms should be justified, signed and dated. It should be made clear that any changes are made as a result of audit activity. Where necessary a new report form should be completed.”

The government guidelines also say that: “Any challenge to the reason DWP has returned a case to the Provider for rework must be made via the nominated rework Single Point of Contact (SPOC).”

In the event of a dispute regarding a request for an assessment report to be changed, “the final decision on whether the case requires rework rests with DWP and not the assessor.” 

So ultimately, an official at the DWP who was not present when a person was assessed, may decide that the assessment report is ‘reworked’, and use non-transparent criteria to change the facts established and recorded during the assessment.

This means that the person making the claim has no opportunity to challenge the changes made to ‘reworked’ reports before the decision is made regarding the claim. 

Over the last few years, evidence has mounted that disability benefits are being reduced or removed from people on fabricated grounds. Disability News Service (DNS) has  carried out an investigation into claims of widespread dishonesty in the disability benefit system. The research found more than 250 PIP claimants who have alleged assessors repeatedly lied, ignored written evidence and dishonestly reported the results of physical examinations. It’s a regular occurrence for disabled readers to read the reports of their benefit assessment, and find a statement of their circumstances, an event or comment that never happened.

For example, one person with a serious spinal injury who is wheelchair-bound was baffled by the comment on her assessment report which said she could bend to feed her dog and could take it out for a walk. She said she doesn’t have a dog, and has never had one. 

The government produced guidelines that says assessors must look for ‘inconsistencies’ in disabled people’s accounts. For example, if a person says they lack dexterity in their hands, but they are wearing jewellery, it will simply be assumed that they can open and close the clasp. They won’t be offered an opportunity to clarify that this is the case. 

In my own PIP assessment report in 2017, it said that the HP had to prompt me several times because of my lack of concentration. She also acknowledged that I needed aids to remember to take my medication. Yet the report is riddled with inconsistencies and inaccuracies. It was concluded that there is no evidence that I have any ‘cognitive difficulties’ because I have a degree (from 1996), and worked as a professional – social work (before I became too ill to work in 2010.) 

It was also mentioned that I had a driving licence as further justification for removing a point, but the report failed to mention I have not been able to drive since 2005 because of flicker-induced seizures, even though I made that clear. I therefore lost one point – which meant I was not awarded the enhanced rate. The reasons provided were not justified, since the assessor referred to events and periods of my life when I was not ill and disabled.

As well as widespread allegations of fabricated reports, secret filming has produced claims of a culture of targets, in which assessors are allegedly monitored to ensure they don’t find excessive numbers of disabled people eligible for benefits, and mounting evidence of toxic punitive measures. As one former jobcentre adviser put it when describing her role with benefit claimants, there were “brownie points for cruelty”.

Consequences of the DWP’s hostile environment

The Conservative’s welfare reforms have led to “grave and systematic violations” of disabled people’s rights, a United Nations (UN) inquiry has concludedChanges to social security “disproportionately affected” disabled people, the United Nations Committee on the Rights of Disabled Persons (CRPD) found.

The UK was the first country to be investigated under a UN convention it has been signed up to since 2007.

However, the government said it “strongly refuted” the committee’s findings and its “offensive” view of disability. Many disabled people, charities and campaigners submitted evidence to the United Nations for the inquiry. The government’s response was offensive.

The committee launched an investigation in 2012 after receiving evidence from individuals (I submitted evidence) and disability organisations about an the adverse impact and harm of government reforms on disabled people. The government have refused to act upon the findings and recommendations of the UN report.

Last year, the DWP disclosed that over 21,000 ill and disabled people died waiting for their PIP assessment to be completed, between April 2013 and 30 April 2018.

Sarah Newton, then Minister of State for Disabled People, published the figures on 11 January following a question raised in parliament by Labour MP Madeleine Moon in December: “How many people have died while waiting for their personal independence payment assessment to be completed; and what were the conditions those people died from?”

Newton responded: “All benefit claims can be made under the special rules for people who are terminally ill which will mean that they are fast tracked. These are currently being cleared within 6 working days for new claimants to PIP. The Department would encourage all claimants with a terminal illness to let the department know and to apply using the special rules.

The cause of death of PIP claimants is not collated centrally by the Department.”

Over 3.6 million applications to PIP were made between April 2013 and 30th April 2018. Of these:

  • 4,760 claimants died between their case being referred to, and returned from, an assessment provider;
  • 73,800 claimants died within 6 months of their claim being registered; and
  • 17,070 claimants died after registering but prior to the DWP making a decision on their claim. Details of the claimant’s primary medical condition, where recorded, are in the accompanying spreadsheet.”

The total number of PIP claimants who died was 95,000. But Newton’s response does not indicate at what stage of their claim the 73,800 people, who died within six months of it being registered, were at. Nor does it indicate what those people who did not have terminal or degenerative illnesses died of – including those with mental illness. For example, 270 of those mortalities are listed as having had anxiety and/or depressive disorders as their primary disorder.

Of those who did have terminal illnesses, we need to ask why these people were  cruelly left waiting so long for their assessment, if, as Newton claims, they are ‘fast tracked’ through the claim and assessment process.

Prior to the introduction of PIP, Esther McVey stated that of the initial 560,000 claimants to be reassessed by October 2015, 330,000 of these are targeted to either lose their benefit altogether or see their payments reduced. Of course the ever-shrinking category of “those with the greatest need” simply reflects a government that has made a partisan political decision to cut disabled people’s essential income to fund a financial gift to the wealthiest citizens. There is no justification for this decision, nor is it remotely “fair”, as the government claims. 

We also need to ask how and why McVey had those figures in advance of the assessments taking place.

It’s become very evident since that ‘those in the greatest need’ are not being served by social security.  Disabled people are suffering distress, harm and some are dying as a consequence of government policy. The DWP end disabled people’s support any way they can, it seems. And when they can’t find a reason, they edit the evidence to attempt to justify their brutal and incoherent decision making.

In August 2013, Mark Wood starved to death at his home in Oxfordshire after his ESA was stopped.

David Barr, from Glenrothes, Fife, also died that month, having taken his own life following an assessment that deemed him “fit for work”, resulting in the withdrawal of his ESA. He had a long history of serious mental health problems. 

On 23 September 2013, a father-of-two, Michael O’Sullivan, took his own life at his flat in north London. He had a long history of significant mental ill-health.

In November 2015, Paul Donnachie killed himself at his home in Glasgow. His ESA was stopped in error, but the letter informing him of the DWP’s mistake arrived too late. His body was found when the council came to evict him.

All of these people had significant mental health problems, and there are countless others, many whose names are never likely to be known, other than by grieving family and friends. These deaths are inextricably linked to decisions and actions taken by Conservative ministers and senior civil servants from the early days of the 2010 coalition government.

Every one of their deaths could and should have been avoided.

The Disability News Service (DNS) reported more recently that Errol Graham weighed just four-and-a-half stone when his body was found by bailiffs who had knocked down his front door to evict him. He had just a couple of out-of-date tins of fish left in his flat, because the DWP had wrongly stopped his ESA. He starved to death, and his rent support had been stopped as a consequence of his ESA claim being ended. The DWP failed to follow safeguarding rules in their haste to end his claim. He was also denied PIP, which left him without any income whatsoever. 

DWP civil servants had failed to seek further medical evidence from his GP, just as in many other tragic cases that have sparked repeated calls for an independent inquiry into links between the deaths of claimants and the actions and failings of the DWP. The government have consistently refused to acknowledge a correlation between their actions and the death of disabled people, so have no intention of investigating the evidence. 

Assistant coroner Dr Elizabeth Didcock, who heard the inquest, was told that the DWP stopped Graham’s ESA entitlement – and backdated that decision to the previous month – after making two unsuccessful visits to his home to ask why he had not attended a face-to-face work capability assessment (WCA) on 31 August 2017. The inquest heard that it was standard DWP procedure to go ahead with stopping the benefits of a claimant marked on the system as vulnerable after two failed safeguarding visits.

However, the DWP (somehow) managed to stop an ESA payment that had been due to be credited to his bank account on 17 October, the same day officials made the second unsuccessful safeguarding visit.

DWP’s own rules state that it should make both safeguarding visits before stopping the benefits of a vulnerable claimant.

Because Errol lost his ESA entitlement, his housing benefit was also stopped. His family says he had also been found ineligible for PIP. Deprived of all financial support, experiencing significant mental distress and unable or unwilling to seek help, he slowly starved to death. He was 57. His body was discovered on 20 June 2018 when bailiffs arrived at his Nottingham council flat to evict him for non-payment of rent. 

His benefits had been stopped even though he had been receiving incapacity benefit, and then ESA, for many years as a result of enduring mental illness and distress that had led to him being sectioned. Errol was clearly extremely vulnerable.

He had also told the DWP on an ESA form three years earlier that he could not cope with “unexpected changes”, adding: “Upsets my life completely. Feel under threat and upset…”

He added: “Cannot deal with social situations. Keep myself to myself. Do not engage with strangers. Have no social life. Feel anxiety and panic in new situations.”

The assistant coroner said: “There simply is not sufficient evidence as to how he was functioning, however, it is likely that his mental health was poor at this time – he does not appear to be having contact with other people, and he did not seek help from his GP or support agencies as he had done previously.”

She concluded in the narrative verdict, delivered last June, that the “safety net that should surround vulnerable people like Errol in our society had holes within it”.

Those ‘holes’ are a consequence of deliberate, ideologically driven anti-welfare policies. They have intended consequences. The government assumes that people treated unfairly will appeal wrong decisions. Firstly, many people are far too ill to cope with the stress of that process. Secondly, it should never be primarily the role of courts to allocate social security fairly. That is the official role and purpose of the DWP.  However, the government department is clearly failing to fulfil its role. This is because the neoliberal ideology that drives austerity policies is incompatible with the central principles of social security. 

She continued: “He needed the DWP to obtain more evidence [from his GP] at the time his ESA was stopped, to make a more informed decision about him, particularly following the failed safeguarding visits.”

She said that a consultant psychiatrist had told the inquest “that Errol was vulnerable to life stressors” and that it was “likely that this loss of income, and housing, were the final and devastating stressors, that had a significant effect on his mental health”.

But she decided not to write a regulation 28 report demanding changes to DWP’s safeguarding procedures to “prevent future deaths” because the department insisted that it was already completing a review of its safeguarding, which was supposed to finish last autumn.

The DWP had promised her it would “listen to clients and to those representing them, and… ensure that the DWP was focused on support and safety for vulnerable people”.

Dr Didcock insisted that this commitment “must be converted into robust policy and guidance for DWP staff” and that the DWP must ensure that “all evidence that can reasonably be gathered is put together about a client, before a benefit is ceased”.

Disability News Service also highlights that the death of Errol Graham closely mirrors other tragedies caused by the DWP’s repeated refusal to make significant improvements to its safeguarding policies and practices.

Denise McKenna, co-founder of the Mental Health Resistance Network (MHRN), said the network was “absolutely devastated and saddened beyond words to hear of the circumstances surrounding the death of Mr Graham”.

She said: “We are enraged that the DWP continues to treat the lives of people who live with mental distress as disposable.

“This level of cruelty is outside of anything that would happen in a civilised society.

“The fact that Mr Graham had not responded to attempts to contact him following his failure to attend the work capability assessment (WCA) should have raised alarm bells over his safety, but instead the DWP took the opportunity to stop his social security entitlements.”

And there’s the truth: the government have created a hostile environment for disabled people that is heavily weighted towards preventing successful claims, taking its lessons from rogue multinational insurance companies such as Unum, who have systematically employed strategies to pay out insurance only as the last resort, rather than on the basis of need. 

And if the evidence doesn’t suit the politically desired outcome – as outlined by the likes of Esther McVey –  it can always be edited or disposed of by the DWP.

Hostile environment McDonnell

 


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Research shows ‘unprecedented’ rise in infant mortality linked to poverty in England

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Slide from my presentation on neoliberalism, the still face paradigm and poverty at Beyond the Therapy Room psychology conference, 2019.

According to new research, an unprecedented rise in infant mortality in England is linked to poverty, according to new research. An additional 570 infant deaths, compared to what would have been expected based on historical trends, were recorded in the country from 2014-2017. Around one-third of those deaths, which related to children under the age of one, were linked to rising poverty.

The results of the new study by researchers from the University of Liverpool, University of Leeds and Newcastle University, which analysed data from 2000-2017, have now been released. In their report, published in BMJ Open, the researchers note that infant mortality rates often act as an indicator of the changing overall health of societies, as well as an early warning system for future adverse trends.

Rising infant mortality is unusual in wealthy, high income countries, and international statistics show that infant mortality has continued to decline in most wealthy countries in recent years. 

But in England, social security cuts in the last decade have taken their toll on the poorest communities.

In the study, the researchers grouped 324 local authorities into five categories (quintiles) based on their level of income deprivation, with Quintile 1 being the most affluent and Quintile 5 the most deprived.

Inferential testing – using a statistical model –  was used to quantify the association between regional changes in child poverty  and infant mortality during the same period. 

The researchers found that “a sustained and unprecedented rise” in infant mortality in England from 2014-2017 was not experienced evenly across the population.

In the most deprived local authorities, the previously declining trend in infant mortality had reversed and mortality increased. This led to an additional 24 infant deaths per 100,000 live births per year, relative to the previous trend.

There was no significant change from the pre-existing trend in the most affluent local authorities. As a result, inequalities in infant mortality increased, with the gap between the most and the least deprived local authority areas widening by 52 deaths per 100,000 births.

Overall from 2014-2017, there were a total of 572 “excess infant deaths” compared to what would have been expected based on historical trends, the report says.

The researchers estimate that each 1% increase in child poverty was significantly associated with an extra 5.8 infant deaths per 100,000 live births.

The findings suggest that about one-third of the increases in infant mortality between 2014 and 2017 may be attributed to rising child poverty, equivalent to an extra 172 infant deaths.

Professor David Taylor-Robinson of the University of Liverpool, the lead author on the research, said the study “provides evidence that the unprecedented rise in infant mortality disproportionately affected the poorest areas of the country, leaving the more affluent areas unaffected”.

“Our analysis also linked the recent increase in infant mortality in England with rising child poverty, suggesting that about a third of the increase in infant mortality from 2014-17 may be attributed to rising child poverty. 

“These findings are really concerning given that child poverty is rising. It is time for the government to reverse this trend establishing a welfare system that protects children from poverty.” 

Taylor-Robinson said child poverty has “a myriad of adverse impacts on other aspects of child health that will have repercussions for decades to come”.

“In the context of increasing health inequalities in England, policies that reduce poverty and social inequalities are likely to reduce the occurrence of infant mortality and that of many other adverse child health outcomes,” he added. 

Cuts to social security 

The report notes the impact of “sustained reductions” in social security benefits in England in the last decade. It states: 

“Since 2010, there have been sustained reductions in the welfare benefits available to families with children, including the abolition of child benefit and child tax credit for the third child or more; reductions in the value of tax credits and below-inflation up-rating of most working-age benefits; housing benefit reforms including the under occupancy charge (most commonly referred to as ‘bedroom tax’) and introduction of universal credit; and household caps on total benefit receipt (regardless of how many children are in the household).

“These welfare changes have disproportionately affected the most deprived local authorities and regions and have led to a rise in child poverty.”

Dr Paul Norman of the University of Leeds, who also worked on the research, noted that the findings show “an unprecedented rise in the deaths of children under one year of age”.

He said the researchers’ next step is “to examine the gestational age and the number of weeks at which infants die, to learn more about when key interventions may be needed or when they are being missed”.

“This will inform the urgent action needed by national and local governments, and help drive the health and social care policies needed to reduce infant mortality rates,” Norman said. 

The facts and figures from the Child Poverty Action Group (CPAG) show the reality of child poverty in the UK, and which groups are affected most:CPAG Infographics July 2019 v1-04

Related

Studies find higher premature mortality rates are correlated with Conservative governments

Austerity is “economic murder” says Cambridge researcher

Suicides reach a ten year high and are linked with welfare “reforms

Conservative governments are bad for your health

 


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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

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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? 


 

I don’t make any money from my work. 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 PIP and ESA assessments, mandatory review and appeals. The smallest amount is much appreciated – thank you.

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The DWP call handlers’ strike, structural violence and the Milgram experiment framework

DWP-Department-for-work-and-pensions-500x320 (1)

Universal Credit call handlers working at centres in Wolverhampton and Walsall have overwhelmingly voted in favour of strike action, accusing the Department for Work and Pensions (DWP) of treating them with “utter contempt”.

A ballot of PCS members working for the DWP on it’s highly controversial programme was announced earlier this month, warning of “severe under investment, staff shortages and ironically, criticism from claimants on how they are treated”. They also want full contracts for fixed-term workers, and an end to “management by statistics.”

Speaking ahead of the vote, PCS General Secretary Mark Serwotka challenged assumptions by government ministers that “Universal Credit is working well for workers and claimants”, instead arguing that “the opposite is in fact the case”.

He said that is was clear the DWP “want to run this service into the ground”, but the DWP insisted its “top priority remains assessing and making payments to customers”.

PCS and its members are calling on the DWP to hire 5,000 new staff, full contracts for fixed-term workers, and a reduction in the number of calls from Universal Credit claimants each case manager is required to handle.

Commenting on the result of the ballot, Serwotka said: “The message from our members is clear – changes need to be made otherwise they will walkout for two consecutive days.

This will mean that approximately 274 call handlers who work at the two offices will walk out for 48 hours starting on 11 March, after 90% of those balloted by the Public and Commercial Services (PCS) union backed industrial action.

Serwotka added: “The union has tried to negotiate for months but to no avail. Ministers have stuck their heads in the sand and our members are now sending them a very loud wakeup call.

“PCS members have not taken the decision to strike lightly but the fact is industrial relations have broken down because ministers seem intent on running this service into the ground while treating staff with utter contempt.”

Margaret Greenwood MP, Labour’s Shadow Work and Pensions Secretary, said: “It is shocking that staff working in DWP offices are feeling so stressed through overwork that they are going on strike and calling for the government to recruit more staff.

“Not only is the government’s flagship social security policy Universal Credit failing claimants, the government is also failing the DWP staff who work so hard.

“Labour will deliver a social security system that treats those in need and the people who are employed to support them with respect.”

A DWP spokesperson said: “This result is disappointing, we greatly value the work that our colleagues do and our top priority remains assessing and making payments to customers.

“We are comfortable with current staffing levels and will monitor and reallocate resource where necessary.

“Contingencies are underway to ensure the smooth running of our services to minimise any impact.

“We urge PCS to seek to resolve this through further dialogue.”

Serwotka said: “The union has tried to negotiate for months but to no avail.

“Ministers have stuck their heads in the sand and our members are now sending them a very loud wakeup call.

“PCS members have not taken the decision to strike lightly.

“But the fact is industrial relations have broken down because ministers seem intent on running this service into the ground while treating staff with utter contempt.”

Four years ago, 1,300 Universal Credit staff staged a 48-hour walkout in protest of the “oppressive” workplace culture.

DWP workers complained of staff shortages, poor training and at least £40m ‘squandered’ on IT that wasn’t used.

However, there was no complaint made about the intentionally cruel policies being implemented by the DWP, which troubles me a lot.

Some thoughts: government policy, structural violence and the Milgram experiment framework 

Milgram 1

 

One of the most famous and controversial studies of obedience in psychology was carried out by Stanley Milgram in 1963, he was a psychologist at Yale University. He conducted an experiment which explored the conflict between obedience to authority and personal conscience. Milgram examined justifications for acts of genocide offered by those accused at the World War II, Nuremberg War Criminal trials. Their defence was often based on “obedience” – that they were just following orders from their superiors.

The experimental procedure was that the participant was paired with another person and they drew lots to find out who would be the ‘learner’ and who would be the ‘teacher.’  However, the draw was fixed so that the participant was always the ‘teacher’, and the ‘learner’ was one of Milgram’s confederates (and actor pretending to be a real participant).

The ‘learner’ (a confederate called Mr. Wallace) was taken into a room and had electrodes attached to his arms, and the ‘teacher’ and researcher (there was also an “experimenter” dressed in a grey lab coat, played by an actor – not Milgram) went into a room next door that contained an electric shock generator and a row of switches marked from 15 volts (Slight Shock) to 375 volts (Danger: Severe Shock) to 450 volts (XXX). 

Milgram was interested in researching how far people would go in obeying an instruction if it involved harming another person, and how easily ordinary people could be influenced into committing atrocities. 

Two rooms in the Yale Interaction Laboratory were used – one for the ‘learner’ (with an electric chair) and another for the ‘teacher’ and experimenter with an electric shock generator. The ‘learner’ (Mr. Wallace) was strapped to a chair with electrodes. After he has learned a list of word pairs, the ‘teacher’ then tested him by naming a word and asking the ‘learner’ to recall its partner/pair from a list of four possible choices. For the purpose of the experiment, Mr Wallace gave the wrong answers deliberately.

The punitive shocks were administered at an increasing voltage each time the ‘learner’ made a mistake. There were 30 switches on the shock generator (pictured above) marked from 15 volts (slight shock) to 450 (danger – severe shock). 

Milgram wanted to know whether people would administer what they believed to be fatal shocks to another person under the pressure of an authority figure.

Some of the teachers protested as the authority figure gave the orders to continue — which began with “please continue” or “please go on” and increased in severity to “you have no other choice, you must go on.” 

Other subjects were detached and methodical, not protesting even as the learner screamed from the other room, ostensibly from the extremely painful shocks.

65% (two-thirds) of participants (‘teachers’) continued to the highest level of 450 volts. All the participants continued to 300 volts.

Mr Wallace was a convincing actor who shrieked in pain and begged for the shocks to stop. All of participants believed the shocks they administered were real. 

They weren’t.

Participants in the experiment were also told that researchers know a good deal about how positive reinforcement improves learning, but they know very little about how punishment improves learning. This was the ‘front’ for the purpose of the study.

Milgram’s pessimistic conclusion was that ordinary people are likely to follow orders given by an authority figure, even to the extent of killing an innocent human being.  Obedience to authority is ingrained in us all from the way we are brought up.

People tend to obey orders from other people if they believe their authority is morally right and/or legally based. This response to legitimate authority is learned in a variety of situations, for example in the family, school, and workplace.

The government’s welfare policies place emphasis on citizen ‘learning’, compliance and obedience to authority. The Conservatives’ distorted and prejudiced views about social security claimants have resulted in technocratic attitude and ‘behavioural change’ programmes – a pseudoscientific behaviourist approach – which is embedded in extremely punitive and oppressive policy and DWP practices.  The government’s coercive and behaviourist methods of achieving their aim has resulted in a class related and particularly vindictive form of structural violence. 

The politically orchestrated hierarchical organisation and institutionalisation of structural violence has recently reminded me of the Milgram experiment. 

Structural violence

structural violence

The government’s antiwelfarist ideology has resulted in structural violence being institutionalised, administrated and imposed on targeted groups of society, namely the poorest citizens. From the top down, this culture of inflicting harm on certain groups has become routinised and normalised. It’s hidden in plain view. 

However, the key difference between the experiment and current punitive practices within the DWP – such as sanctions – is that the harm inflicted in the former was not real. The punishments inflicted by the DWP are very real and are having catastrophic consequences on some groups of citizens, ranging from hunger and fuel poverty to destitution, rough sleeping and even death. 

In a few years it has become acceptable to threaten people who are already on the breadline with the removal of their lifeline support, leaving them without the means to meet their most basic survival needs – food fuel and shelter.  

According to Norwegian sociologist, Johan Galtung, structural violence is an “avoidable impairment of fundamental human needs”. As it is avoidable, structural violence is a high cause of premature death and unnecessary disability. Because structural violence affects people differently in various social structures or groups, it is very closely linked with inequality, social injustice and oppression.

A major contributing factor to the increase the ‘culture of workplace oppression’ is the collective behaviours of the current government, which has perpetuated, permitted and endorsed prejudices against marginalised social groups, such as disabled and unemployed citizens, with a complicit media amplifying these prejudices.

Because the Conservatives’ policies embed such a deeply punitive approach towards the poorest social groups, this in turn means that those administering the policies, such as staff at the DWP and job centres, for example, are also bound by punitive, authoritarian behaviours directed at the targeted group.

As authority figures and role models, their behaviours establish a normative framework of acceptability. Parliamentary debates are conducted by the Conservatives with a clear basis of one-upmanship, lies and aggression, rather than being founded on rational exchange. Indeed, ministers frequently sneer at rationality and do not engage in a democratic dialogue, instead they employ the tactics of a bully: denial, gaslighting, scapegoating, vilification, attempts at discrediting, smearing and character assassinations.

This in turn pushes moral and normative boundaries and gives wider society permission and approval to behave the same.

Studies of power, and obedience to authority provide an interesting paradigm in psychology, sociology, social psychology, political science, and obviously within organisational behaviours.

Scapegoating groups of citizens has a wide range of focus: from ‘approved’ enemies of very large groups of people (such as the mythologically discrete group known vaguely as the  ‘tax payer’) down to the scapegoating of individuals by other individuals.

The scapegoater’s target always experiences a terrible sense of their personal accounts of experiences being edited and re-written, with the inadequacies of the perpetrator often inserted into public accounts of their character (projection), resulting in isolation, ostracism, exclusion and sometimes, expulsion and elimination. The sense of isolation is often heightened by other people’s reluctance to become involved in challenging bullies, usually because of a bystander’s own discomfort and fear of reprisal.

Many of the participants in Milgram’s experiment said they acted as they did, not because they were committed to the experimenter or to science, but because they trusted the experimenter not to let them inflict serious harm.

The call handlers who voted to go on strike complain of “severe under investment, staff shortages and criticism from claimants on how they are treated”. They also mention a culture of oppression. Perhaps they believe they are administering harmless policies, and that their own stresses are simply down to severe under-staffing, “management by numbers”, mismanagement of IT projects and ‘complaints’ from claimants. But the call handlers are not those who are being targeted with political ‘contempt’. 

I was shocked that the DWP call handlers complained of “criticism from claimants on how they are treated”, rather than criticising how claimants are being actually being treated. 

Authority bias is the tendency to obey the orders of authority figures, even when you strongly believe that there is something wrong with those orders. During the Milgram experiment, participants could indicate at any point that they wished to stop. Most didn’t. 

At any point during the experiment, participants could indicate that they wish to stop. Any time this happened, the experimenter would tell the subject the following things, in order using an authoritative tone:

Please continue.

The experiment requires that you continue.

It is absolutely essential that you continue.

You have no other choice, you must go on.

If, after saying all four lines, the subject still refused to carry on with the experiment, then the experiment was stopped. 

I’m bitterly disappointed that both the workers themselves and the union fail to recognise the part those workers play within a hierarchy of power that is instrumental in inflicting structural violence on people claiming social security – those who have no negotiating power to change their circumstances whatsoever. 

It’s time to stop the experiment now.

 


 

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.

Woman who was refused PIP died, family successfully sue Capita for £10,000

victoria

The week after she died, a tribunal panel overturned the Department for Work and Pensions’ decision, deciding that Victoria was eligible for a PIP award that she had been refused.

Victoria Smith [pictured] passed away last July aged just 33, within weeks of being told she was not eligible for Personal Independence Payments (PIP). Her family have been awarded £10,000 in damages

Victoria’s mother, Sue Kemlo, sued Capita for making inaccurate statements on Victoria’s health assessment. However, Capita told the BBC it stood by the original decision.

Her mother, Sue Kemlo, told the BBC: “If they hadn’t cut her PIP, my daughter would still be here.” Victoria suffered from agoraphobia and fibromyalgia, which left her in constant and severe pain.

The Department for Work and Pensions (DWP) wrote to Victoria in early 2018 to tell her she needed to be re-assessed for the benefit, which is intended to help with the additional costs of having a disability, and to support disabled people in living as independently as possible.

In March, 2018, Victoria was re-assessed at home by a healthcare professional employed by Capita. The assessment led the DWP to decide she was no longer eligible for PIP, a conclusion her mother said “was a pack of lies”.

Victoria immediately asked for a mandatory review but was again refused her PIP award by the DWP. She received the decision in June, shortly after she was admitted to hospital. The decision “destroyed” her, her mother said.

“When they took away her ability to look after herself, to have a way of life, she gave up.”

Victoria died of a brain haemorrhage. However, her doctors told the family that her underlying conditions, particularly the fibromyalgia, had deteriorated as well.

The week after she died, a tribunal panel overturned the DWP’s decision, deciding that Victoria was eligible for PIP.

Furious with the conclusions the Capita employee had reached, Victoria’s mother took legal action against the company for maladministration; on the grounds that the Capita assessor made inaccurate statements in the report.

The family has now been awarded £10,000 in damages.

“I didn’t do it for the money,” said Mrs Kemlo.

“I did it for them to admit they were wrong, to get some justice for my daughter, because (it’s) only ever been about justice for Victoria.”

In a statement to the BBC, Capita said: “We offer our deepest condolences to the family in this very tragic case.

“We have reviewed this at a senior clinical level and we are confident that our report was correct based on the information presented to us at the time of the assessment.

“Our full response to the claim was not considered by the Court as a result of a procedural issue, and as a consequence judgment in default has been entered into against us.

“We have asked the Court to investigate the procedural issue and we are expecting a response from the Court shortly.”


 

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

facade welfare

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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