Tag: Disability Confident

Government criticised for lack of diversity, lack of transparency and poor fiscal management

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The Institute For Government (IFG) published their annual Whitehall Monitor Report on Thursday, presenting an insight and analysis of the size, shape and performance of government and the civil service.

In the opening paragraph, the IFG say: “The Prime Minister Theresa May lost her parliamentary majority in a snap general election. Revelations about ministers’ inappropriate conduct resulted in three Cabinet resignations. Preparations for Brexit have been disrupted by the snap election, by turnover in personnel and by difficulties in parliamentary management. The Government faces challenges in key public services, notably hospitals, prisons and adult social care.

It was noted in the report that preparations for Brexit have been disrupted by “difficulties in parliamentary management”. The Government has introduced only five of the nine new bills it says are needed for Brexit, and a third of the Government’s major projects worth over £1bn are at risk of not being delivered on time and on budget.

This Whitehall Monitor annual report – which is the fifth – summarises:

  • The political situation following the early election constrained the Prime Minister’s political authority and created challenges for the Government’s legislative programme and management of public services, major projects and Brexit.
  • The civil service is growing, in terms of size, but should be more diverse.
  • Government is less open than it was after 2010, and is not using data as effectively as it should.

I’ve used the summary to shape my analysis.

Fiscal management

The forecasts for tax revenues have been downgraded, the Government also forgoes billions of pounds through tax expenditures that are not subject to rigorous value-for-money assessments.

Since 2010, the value of liabilities on the government’s balance sheet has grown more quickly than the value of assets, increasing net liabilities. Furthermore, “revenue is not likely to overtake spending, in the foreseeable future”. 

Despite the promises from George Osborne of a budget surplus by 2020, and his fiscal straitjacket – the imposed, rigid programme of spending cuts and austerity for the majority of citizens, and tax cuts to the wealthiest ones. 

In real terms, revenues from taxes have grown 7% since 2010/11. This is largely the result of:

  • VAT receipts increasing by 22% (partly due to the standard VAT rate increasing from 17.5% to 20% in 2011)
  • National Insurance contributions increasing by 11%
  • Some increases in income tax collected following a stabilisation following the global crash

Council tax is also included in Treasury revenue, and that will have risen, since many low paid or out of work people now pay a contribution, whereas previously, they were exempt. Despite the increases in VAT, revenue from the sale of goods and services has fallen 34% since 2010/11. 

For the 2017 Autumn Budget, the Office for Budget Responsibility (OBR) downgraded its forecasts for productivity growth. This, in turn, has resulted in the outlook for Government revenue being revised downwards.

Tax expenditures cost £135bn per year. Tax expenditures are tax discounts or exemptions that “further the policy aims of government”. The total sum of all forgone revenue from tax expenditures across income tax, National Insurance contributions, VAT, corporation tax, excise duties, capital gains tax and inheritance tax was £135bn in 2015/16. This is equal to a quarter of the total central government tax revenue in that year, and is larger than the total budgets of all but two departments (Department for Work and Pensions and Department of Health).

For capital gains tax, the cost of tax expenditures was more than four times the amount of revenue collected

This certainly provides a strong indication of the government’s policy and budget priorities, making a mockery of trite sloganised claims of “a country that works for everyone”. Some social groups clearly raise rather more hidden political costs than others, but it is only disadvantaged and marginalised groups that tend to be negatively ideologically portrayed as a “burden” on the state by Conservatives and the media. 

In the 2017 Autumn Budget, the Chancellor announced new stamp duty reliefs for first time buyers purchasing properties worth under £500,000. Due to the policy being specifically targeted at first time buyers, this policy resembles a tax expenditure, and in 2018/19 (its first full year) is expected to cost £560m.

Furthermore, the National Audit Office has reported that the Treasury does not monitor tax expenditures and assess the value for money they offer with the same rigour as it does general expenditure. The Institute for Government, along with the Chartered Institute of Taxation and the Institute for Fiscal Studies, has called for the tax reliefs that most closely resemble spending measures to be treated as spending for accountability and scrutiny purposes.

Net government liabilities are now over £2 trillion. The Whitehall Monitor report says: “The Government’s net liability has implications for future generations of taxpayers, who will bear the costs of meeting these obligations, but the long-term nature of such obligations can make discussions around the government balance sheet seem more remote than the immediate choices about how much departments should spend each year.

“Nonetheless, policy choices have important implications for the Government’s liabilities – for example, the decisions taken by the Coalition Government to increase the state pension age, and to set a triple lock that guarantees annual increases of at least 2.5% in the state pension, are likely to have contrasting effects on the size of the state pension liability.”

The report goes on to say: “But the Government has made commitments to voters on public services, productivity, social mobility and major projects. If it fails to meet their expectations, it risks further undermining confidence in government.”

The government is still not transparent about its spending plans. The report says that “Better data is needed to understand the benefits – and risks – of outsourced public services”. 

“Wider government contracting includes back-office outsourcing by departments and the purchase of goods they use in the delivery of public services (e.g. paper, energy), as well as privately run public services. In 2015/16, £192bn was spent by government on goods and services, of which £70bn was spent by local government, £65bn by the NHS and £9bn by public corporations, with central government departments and other public bodies accounting for the remaining £49bn. 

“While some contract data is published, the Institute for Government and Spend Network have previously highlighted gaps in transparency – including on contractual terms, performance and the supply chains of third-party service providers.

“The Information Commissioner has said that the public should have the same right to know about public services whether the service is provided directly by government or by an outsourced provider”. [My emphasis]

The IFG also say in their report: “In 2016, the Public Accounts Committee concluded that the outsourcing of health disability assessments at DWP had resulted in claimants ‘not receiving an acceptable level of service from contractors’, while costs per assessment had increased significantly. [My emphasis. Some 10% of the budget for the Department for Work and Pensions goes to private contractors.]

“Similarly, in 2013 MoJ [Ministry of Justice] found that it had been overbilled in relation to contracts worth £722m.”

There have been numerous high-profile failings in government outsourcing. The recent collapse of Carillion highlights many of the longstanding and existing issues, and should encourage a political focus on solving them.

The report continues: “There is no centrally collected data outlining the scope, cost and quality of contracted public services across government. Nonetheless, we know that Whitehall departments account for only a portion of outsourced service delivery, which can also happen further downstream after departments have provided funds to public bodies (for example, the purchasing of services from GPs by the NHS) or local authorities.”

The next section of the report outlines the 2016–17 parliamentary session, in which 24 government bills were passed – fewer than in any session under the 2010–15 Coalition Government. In part, this reflects the curtailed session, which ended with the dissolution of Parliament on 3 May ahead of the election in early June. The report goes on to say that 1,097 pages of legislation – 38% of all pages passed in the session – were dealt with at speed, raising questions about the adequacy of the scrutiny these bills received.

There were also concerns raised about the scope of the powers the government has sought regarding the EU Withdrawal Bill, which has proven controversial. In particular, the inclusion of so-called ‘Henry VIII’ powers, allowing the Government to amend or repeal existing primary legislation without the scrutiny normally afforded to bills. This has quite properly provoked concern among parliamentarians.

Curiously, the report says that the use of statutory instruments (SIs) – previously used only to pass non-controversial policies and amendments – has dropped. However, this flies in the face of existing evidence, which is sourced from the government’s own site. If there has been a drop since 2014, it certainly contradicts the trend set since 2010. Furthermore, the Government has been criticised for using SIs to pass controversial policies, such as welfare cuts.

It seems that IFG counted the number of SIs by parliamentary session (the parliamentary year which tends to run from Spring to Spring) rather than by calendar year.

Scrutiny of SIs is rather less intensive than scrutiny of primary legislation. They are subject to two main procedures, neither of which allows Parliament to make any amendments:

  • negative procedure, in which an SI is laid before Parliament and incorporated into law unless either House objects within 40 days
  • affirmative procedure, in which both Houses must approve a draft SI when it is laid before them.

It’s also worth reading: Conservative Government accused of ‘waging war’ on Parliament by forcing through key law changes without debate.

The lack of progress on inclusion and diversity

The IFG says there has been “little recent progress” in numbers of senior civil servants with disabilities or ethnic minority backgrounds, while the percentage of women  also decreases proportionally with ascending Whitehall pay scales. .

They report: “The civil service needs to fulfil the promise of its diversity and inclusion strategy, especially in improving the representation of ethnic minority and disabled staff at senior levels.”  

Of those appointed to the highest departmental rank of permanent secretary in 2017, “as many were men with the surname Rycroft as were women – two in each case”. The report notes also “there has never been a female cabinet secretary for the UK”.

Despite the much-trumpeted launch of the Disability Confident employment scheme, aimed at “helping to positively change attitudes, behaviours and cultures,” and “making the most of the talents that disabled people can bring to the workplace”, sadly there is no evidence that the Government intends role-modeling positive behaviours or putting into practice what it preaches.

The representation of disabled civil servants at senior level has improved only very slightly: 5.3%, up from 4.7% in 2016. Across the UK population as a whole, according to the Office for National Statistics (ONS), 21% of people are estimated to have a disability (some 18% of the working-age population). 

Lack of openness, transparency and accountability

In the UK, the idea that government should be open to public scrutiny and policies congruent with public opinion is central to our notion of democracy. Government openness and transparency also tends to be linked with citizen inclusion, democratic participation and a higher degree of collaboration between citizens and government on public policy decisions. It also ensures that corruption and the misuse of political  t power for other purposes, such as forms repression of political opponents is less likely.

Information and data deficits are more likely to lead to political corruption and a reduction in democratic accountability.

The IFG report says that in 2016–17, more ministerial correspondence was answered in time, which were thanks to more generous targets, while fewer parliamentary questions were answered on time and information was withheld in response to more Freedom of Information requests.

Parliament has other mechanisms to hold government to account, including urgent questions (which have most tellingly increased significantly in recent years) or select committee inquiries (which have also increased in number, with the election delaying government responses). The Government has established a track record of withholding details of planned legislation from the opposition. (See for example: PIP and the Tory Monologue).

According to Democracy Audit UK  an independent research organisation, established as a not-for-profit company, and based at the Public Policy Group in the LSE’s Government Department – the lack of transparency has been fuelled by the coalition period, and now, the Conservative’s’ narrow majority,  as the amount of secondary legislation is growing, and primary legislation is drafted in ways that increasingly leave its consequences obscure, to be filled in later via statutory instruments or regulation. Commons scrutiny of such “delegated legislation” is subsequently reduced, and likely to be very weak and ineffective.

Meanwhile, departments’ publication of mandated data releases, including spending over £25,000, organograms and ministerial hospitality, is patchy. Departments also proactively publish on GOV.UK, though supply and demand differs by department

The IFG says that many departments are not publishing their data as frequently as they should and this, coupled with the difficulty of measuring government performance, suggests that the government is becoming less transparent and accountable.

A rise in the numbers of Freedom of Information requests that are being refused

Since 2010, government departments have become rather less open in response to Freedom of Information (FoI) requests. In 2010, 39% of requests were fully or partially withheld; this had increased to 52% by 2017. 

Departments are able to refuse requests on a number of grounds: if the request falls under one of the 23 exemptions in the Freedom of Information Act 2000 (such as national security or personal information) or those in the Environmental Information Regulations; if it breaches the limit for the cost involved in responding (£600 for central departments and Parliament); if the request is repeated; or if the request is ‘vexatious’ (meaning it is likely ‘to cause a disproportionate or unjustifiable level of distress, disruption or irritation’). 

Of the 2,342 requests withheld in full in 2017, 50% were held to be due to FoI Act exemptions, 47% to cost, 2% to repetition and 1% to vexatiousness.

Of course exemptions may also be used as “good reasons” – excuses – to withhold inconveniently controversial information that is likely to bring valid criticism and cause scandal.

Mike Sivier‘s request for information about how many people have died after going through the Work Capability Assessment, which had resulted in a decision that they were fit for work, was originally refused. The figures were only released after the Information Commission overruled a Government decision to block the statistics being made public, through Mike’s Freedom of Information request.

After the request, the Information Commissioner’s Office (ICO), an independent authority set up to uphold public information rights, agreed that there was no reason not to publish the figures, despite the Department for Work and Pensions variously claiming the request was “vexatious”, and that it “could impose a burden in terms of time and resources, distracting the DWP from its main functions”.

However, clearly the real reason for the original refusal of this request is that the information was highly controversial and contradicted political claims regarding the completely unacceptable level of harm that has been caused to citizens by the damaging impact of the Conservative’s draconian welfare policies. 

The ICO said: “Given the passage of time and level of interest in the information, it is difficult to understand how the DWP could reasonably withhold the requested information.”

More recently, the Department for Work and Pensions (DWP) has continued to try to block John Slater’s FoI request which is likely to expose the widespread failings of two of its Personal Independent Payment (PIP) disability assessment contractors, initially claiming that it did not hold the information he had requested, before arguing that releasing the monthly reports would prejudice the “commercial interests” of Atos and Capita.

The DWP later told the Information Commissioner’s Office (ICO) that releasing the information “will give rise to items being taken out of context… [and] will be misinterpreted in ways that could lead to reputational damage to both the Department and the PIP Providers”, and would “prejudice the efficient conduct of public affairs” by DWP.

It also warned the ICO that the information could be “maliciously misinterpreted to feed the narrative that the Department imposes ‘targets’ for the outcomes of assessments”.

However, that comment alone indicates the highly controversial nature of the information being withheld, and thus also betrays the real motive. Information is being restricted to stifle legitimate criticism of Government policy and to hide from public view the empirical evidence of its consequences.

The ICO has nonetheless ordered the release of the information requested. A DWP spokeswoman said: “We have received the ICO judgement and we are currently considering our position.” 

If the DWP disagree with the decision and wish to appeal, it must lodge an appeal with the First Tier Tribunal (Information Rights) within 28 calendar days. The requester also has a right of appeal.

The ICO say: Failure to comply with a decision notice is contempt of court, punishable by a fine.

It’s also worth noting that the DWP are obliged to inform any contractors of how the Freedom of Information Act may affect them, making it clear that no guarantee of complete confidentiality of information may be made and that, as a public body, it must consider for release any information it holds if it is requested. 

The Department for Exiting the European Union (DExEU) overtakes the DWP to become the most opaque department. This is one example of a wider lack of transparency around Brexit and reflects the wider reluctance of the Government to share assessments of the anticipated impact of Brexit on different parts of the UK economy. Publication of spending and organisational data remains patchy, suggesting departments are not using the data themselves. 

The Scotland Office, Wales Office and Department for Transport tend to grant more requests in full, and in a timely manner. Among the more opaque are several departments regularly granting fewer than 30% of requests, particularly since 2015, including the Cabinet Office, Foreign and Commonwealth Office (FCO), the Treasury, HM Revenue and Customs (HMRC) and Minstry of Justice (MoJ).

None of the departments created in July 2016 – DExEU, DIT and BEIS – has ever granted even half of its total requests in full. In the three-quarters leading up to Q3 2017, DExEU was the least likely of all departments to comply with FoI requests, respectively answering 18%, 10% and 15% in full. It also refused a higher percentage because they were considered “vexatious” than any other department in 2017; 14% of requests.

The IFG report says “DExEU’s lack of transparency here, and its tardy responses to other requests for information (though not on FoI, where it is the sixth most responsive department), are consistent with its wider reluctance to release information, including the Government’s assessments of the anticipated impact of Brexit on different parts of the UK economy.”

Chart percentage of Freedom of Information requests withheld by government departments

You can read the full IFG Whitehall Monitor Report here


 

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The government’s in-work sanctions are incompatible with ‘halving the disability employment gap’ (and other ideological problems)

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The government have introduced in-work sanctioning for low paid and part-time workers to “incentivise” them to “progress” in work. Historically, wages and employment conditions were raised, and hours were often negotiated by Trade Unions. Now those decisions are entirely down to the executive decisions of employers not employees. Sanctioning employees is grossly unfair, because they have very little negotiating and bargaining power (especially since the raft of Conservative anti-collectivist and anti-Trade Union legislation) to improve their lot.

There is also a significant growing body of empirical evidence that informs us sanctions do not work as the government claim.

It’s not as if employees’ behaviour is at fault or that they would ever actually want poor pay, fewer rights and adverse working conditions – that’s down to exploitative employers who are primarily profit driven. It’s hardly fair to punish workers for the motivations and behaviour of their employers.

There are profoundly conflicting differences in the interests of employers and employees. The former are generally strongly motivated to purposely keep wages as low as possible so they can generate profit and pay dividends to shareholders and the latter need their pay and working conditions to be such that they have a reasonable standard of living. 

Clearly, the weight of favour in policy-making is heavily towards big business profiteering. Implying that the behaviours of workers are a problem in this context is simply another way justification is presented for the further erosion of state responsibility and support and ultimately, the long term plan is to remove such support completely.

Workplace disagreements about wages and conditions are now typically resolved neither by collective bargaining nor litigation but are left to management prerogative. This is because Conservative aspirations are clear. Much of the government’s discussion of legislation is preceded primarily with consideration of the value and benefit for big business and the labour market. They want a cheap labour  force and low cost workers, unable to withdraw their labour, unprotected by either Trade Unions or employment rights and threatened with destitution via benefit sanction cuts if they refuse to accept low paid, low standard work. Similarly, desperation and the “deterrent” effect of the 1834 Poor Law Amendment Act – the principle of less eligibility – also served to drive down wages.

In the Conservative’s view, trade unions distort the free labour market which runs counter to New Right and neoliberal dogma. Since 2010, the decline in UK wage levels has been amongst the very worst in Europe. The fall in earnings under the Coalition is the biggest in any parliament since 1880, according to analysis by the House of Commons Library, and at a time when the cost of living has spiraled upwards.

In-work conditionality enforces a lie and locates blame within individuals for structural problems – political, economic and social – created by those who hold power. Despite being a party that claims to support “hard-working families,” the Conservatives have nonetheless made several attempts to undermine the income security of a significant proportion of that group of citizens recently. Their proposed tax credit cuts, designed to creep through parliament in the form of secondary legislation, which tends to exempt it from meaningful debate and amendment in the Commons, was halted only because peers in the House of Lords have been paying attention to the game.

Sanctioning people in work flies in the face of the government’s previous “hard working families” mantra. But it also flies in the face of their aim to “help” disabled people into work. Many of disabled people would have to work part-time: reduced and flexible hours are also a reasonable adaptation, especially for people who are ill. Many of us also have to accommodate hospital appointments, often with a variety of specialists, as well as hospital based treatment regimes. All of which probably makes us much more likely to face in-work sanctioning in the future.

How does this address the “disability employment gap”? 

The government propose tax cuts and other rewards for employers who employ disabled people in their recent consultation on work, health and disability. However, it is against the law to treat someone less favourably than someone else because of a personal characteristic, such as being disabled.

Furthermore, disabled people have a legal RIGHT to work and to be included in the economy, and I think in light of this, employers should be fined for not employing a quota of disabled people instead. “Disability Confident” is supposed to be about supporting disabled people, not providing publicly funded handouts to employers, whilst at the same time, financially punishing the very people that the policy is supposedly designed to “support.”

There was some very worrying discussion in the recent work health and disability green paper about new mandatory “health and work conversations” in which work coaches will use “specially designed techniques” to “help” disabled Employment and Support Allowance (ESA) claimants “identify their health and work goals, draw out their strengths, make realistic plans, and build resilience and motivation.” Apparently these conversations were “co-designed with disabled people’s organisations and occupational health professionals and practitioners and the Behavioural Insights Teamthe controversial Nudge Unit, which is part-owned by the Cabinet Office and Nesta. 

It’s very evident that “disabled people’s organisations” were not major contributors to the design. It’s especially telling that those people to be targeted by this “intervention” were completely excluded from the conversation. Sick and disabled people are reduced to objects of public policy, rather than being seen as citizens and democratic subjects capable of rational dialogue.

Systematically reducing social security, and increasing conditionality, particularly in the form of punitive benefit sanctions, doesn’t “incentivise” people to look for work. It simply means that people can no longer meet their basic physiological needs, as benefits are calculated to cover only the costs of food, fuel and shelter. In fact sanctioning people make it less likely that they will find work.

Food deprivation is closely correlated with both physical and mental health deterioration. Maslow explained very well that if we cannot meet basic physical needs, we are highly unlikely to be able to meet higher level psychosocial needs. The government proposal that welfare sanctions will somehow “incentivise” people to look for work is pseudopsychology at its very worst and most dangerous. State imposed sanctions on sick and disabled people are known to have very harmful consequences. In fact sanctions create significant difficulties and distress for everyone subjected to them. (See also An example of in-work conditionality: when work doesn’t pay).

In the UK, the government’s welfare “reforms” have further reduced social security support, originally calculated to meet only basic physiological needs, which has had an adverse impact on people who rely on what was once a social safety net. Poverty is linked with negative health outcomes, but it doesn’t follow that employment will alleviate poverty sufficiently to improve health outcomes.

In fact record numbers of working families are now in poverty, with two-thirds of people who found work in 2014 taking jobs for less than the living wage, according to the annual report from the Joseph Rowntree Foundation a year ago.

Essential supportive provision is being systematically reduced by increasing conditionally; by linking support to such a narrow outcome – getting a job – and this will ultimately reduce every service to nothing more than a state behaviour modification programme based on punishment, with a range of professionals being politically co-opted as state enforcers of an ideology  which is perpetuating and accentuating socioeconomic problems in the first place.

Work is not a “health” outcome

The Government is intending to “signpost the importance of employment as a health outcome in mandates, outcomes frameworks, and interactions with Clinical Commissioning Groups.”

A Department for Work and Pensions research document published back in 2011 – Routes onto Employment and Support Allowance – said that if people believed that work was good for them, they were less likely to claim or stay on disability benefits.

It was decided that people should be “encouraged” to believe that work was “good” for health. There is no empirical basis for the belief, and the purpose of encouraging it is simply to cut the numbers of disabled people claiming ESA by “encouraging” them into work. Some people’s work is undoubtedly a source of wellbeing and provides a sense of purpose. That is not the same thing as being “good for health”.

For a government to use data regarding opinion rather than empirical evidence to claim that work is “good” for health indicates a ruthless mercenary approach to fulfill their broader aim of dismantling social security and to uphold their ideological commitment to supply-side policy.

From the document: “The belief that work improves health also positively influenced work entry rates; as such, encouraging people in this belief may also play a role in promoting return to work.”

The aim of the research was to “examine the characteristics of ESA claimants and to explore their employment trajectories over a period of approximately 18 months in order to provide information about the flow of claimants onto and off ESA.”

The document also says: “Work entry rates were highest among claimants whose claim was closed or withdrawn suggesting that recovery from short-term health conditions is a key trigger to moving into employment among this group.”

“The highest employment entry rates were among people flowing onto ESA from non-manual occupations. In comparison, only nine per cent of people from non-work backgrounds who were allowed ESA had returned to work by the time of the follow-up survey. People least likely to have moved into employment were from non-work backgrounds with a fragmented longer-term work history. Avoiding long-term unemployment and inactivity, especially among younger age groups, should, therefore, be a policy priority. ” 

“Given the importance of health status in influencing a return to work, measures to facilitate access to treatment, and prevent deterioration in health and the development of secondary conditions are likely to improve return to work rates”

The government made a political and a particularly partisan decision, rather than one that has any an evidence base, to promote the cost-cutting and unverified, irrational belief that work is a “health” outcome.

Furthermore, the research does conclude that health status itself is the greatest determinant in whether or not people return to work. That means that those not in work are not recovered and have longer term health problems that tend not to get better.

Work does not “cure” ill health. To mislead people in such a way is not only atrocious political expediency, it’s actually potentially downright harmful and dangerous.

The government’s Work and Health programme involves a plan to integrate health and employment services, aligning the outcome frameworks of health services, Improving Access To Psychological Therapies (IAPT), Jobcentre Plus and the Work programme.

2020health – Working Together is a report from 2012 that promotes the absurd notion of work as a health outcome. This is a central theme amongst the ideas that are driving the fit for work and the work and health and programme. Developing this idea further, Dame Carol Black and David Frost’s Health at Work – an independent review of sickness absence was aimed at reviewing ways of “reducing the cost of sickness to employers, ‘taxpayers’ and the economy.”

Seems that the central aim of the review wasn’t a genuine focus on sick and disabled people’s wellbeing and “health outcomes,” then. Black and Frost advocated changing sickness certification to further reduce the influence of GPs in “deciding entitlement to out-of-work sickness benefits.”

The subsequent “fit notes” that replaced GP sick notes (a semantic shift of Orwellian proportions) were designed to substantially limit the sick role and reduce recovery periods, and to “encourage” GPs to disclose what work-related tasks patients may still be able to perform. The idea that employers could provide reasonable adjustments that allowed people who are on sick leave to return to work earlier, however, hasn’t happened in reality.

The British Medical Association (BMA) has been highly critical of the language used by the government when describing the fit for work service. The association said it was “misleading” to claim that fit for work was offering “occupational health advice and support” when the emphasis was on sickness absence management and providing a focused return to work.

The idea that work is a “health” outcome is founded on an absurd and circular Conservative logic: it’s an incorrect inference based on the fact that people in work are healthier than those out of work. It’s true that they are, however, the government have yet again confused causes with effects. Work does not make people healthier: it’s simply that healthy people can work and do. People who have long term or chronic illnesses most often can’t work. It has been historically  and empirically established that poverty is closely correlated with disproportionate levels of ill health, and it’s most probable that targeted austerity, leading to increasingly inadequate welfare provision, has made a significant contribution to poorer health outcomes, too.

The government’s main objection to sick leave and illness more generally, is that it costs businesses money. The government remain committed to a supply-side labour market model. However, as inconvenient as it may be, politically and economically, it isn’t ever going to be possible to cure people of serious illnesses by cruelly coercing them into work.The government’s aim to prompt public services to “speak with one voice” is founded on questionable ethics. This proposed multi-agency approach is reductive, rather than being about formulating expansive, coherent, comprehensive and importantly, responsive provision.

This is psychopolitics. It’s all about (re)defining the experience and reality of a social group to justify dismantling public services (especially welfare), and that is form of gaslighting intended to extend oppressive political control and micromanagement. 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” will invariably make accessing support conditional, and further isolate already marginalised social groups. It 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.

However, unsatisfactory employment – low-paid, insecure and unfulfiling work – can result in a decline in health and wellbeing, indicating that poverty and growing inequality, rather than unemployment, increases the risk of experiencing poor mental and physical health.

People are experiencing poverty both in work and out of work. Moreover, in countries with an adequate social safety net, poor employment (low pay, short-term contracts), rather than unemployment, has the biggest detrimental impact on mental health. There is ample medical evidence to challenge the current political dogma, and to support this account. (See the Minnesota semistarvation experiment, for example. The understanding that food deprivation in particular dramatically alters cognitive capacity, emotions, motivation, personality, and that malnutrition directly and predictably affects the mind as well as the body is one of the legacies of the experiment.)

Systematically reducing social security, and increasing conditionality, particularly in the form of punitive benefit sanctions, doesn’t “incentivise” people to look for work. It simply means that people can no longer meet their basic physiological needs, as benefits are calculated to cover only the costs of food, fuel and shelter.Food deprivation is closely correlated with both physical and mental health deterioration. Maslow explained very well that if we cannot meet basic physical needs, we are highly unlikely to be able to meet higher level psychosocial needs.

The government proposal that welfare sanctions will somehow “incentivise” people to look for work is pseudopsychology at its very worst and most dangerous.In the UK, the government’s welfare “reforms” have further reduced social security support, originally calculated to meet only basic physiological needs, which has had an adverse impact on people who rely on what was once a social safety net.

Poverty is linked with negative health outcomes, but it doesn’t follow that employment will alleviate poverty sufficiently to improve health outcomes.In fact record numbers of working families are now in poverty, with two-thirds of people who found work in 2014 taking jobs for less than the living wage, according to the annual report from the Joseph Rowntree Foundation a year ago.

Essential supportive provision is being reduced by conditionally; by linking it to such a narrow outcome – getting a job – and this will reduce every service to nothing more than a political semaphore and service provision to a behaviour modification programme based on punishment, with a range of professionals being politically co-opted as state enforcers. 

I have pointed out previously that there has never been any research that demonstrates unemployment is a direct cause of ill health or that employment directly improves health, and the existing studies support the the idea that the assumed causality between unemployment and health may actually run in the opposite direction.It’s not that unemployment is causing higher ill health, but that ill health and discrimination are causing higher unemployment. If it were unemployment causing ill health, at a time when the government assures us that employment rates are currently “the highest on record,” why are more people becoming sick?

The answer is that inequality and poverty have increased, and these social conditions, created by government policies, have long been established by research as having a correlational relationship with increasing mental and physical health inequalities. For an excellent, clearly written and focused development of these points, the problem of “hidden” variables and political misinterpretation, see Jonathan Hulme’s Work won’t set us

– childhood immunisation
– antibiotics
– access to education, and particularly, improving female literacy
– increasing social equality

Given that, as statistics sadly show, the health of the poorest in the UK is again declining despite the first four factors mainly still being accessible to even the UK’s very poorest, one can only point at the worsening inequalities and social injustices as a significant cause. The Marmot review pretty much concludes the same. “

Addressing these issues is not consistent with the ideological thrust of Conservative policies, unfortunately, since the government insist that social problems such as poverty and ill health (the biopsychosocial model, with an emphasis on the “psychosocial” elements) are due to individual “behaviours.” Their approach to date has been to level punitive policies with an embedded core of behaviour modification techniques which usually entails the punitive removal of lifeline income at the poorest citizens – casually called “incentivising” and “supporting” – whilst addressing the behaviours of the wealthy with a system of publicly funded financial reward. This simply recreates, deepens, perpetuates and accentuates existing inequalities.

Empirical research published two years ago demonstrated the high a cost the country paid in terms of health and wellbeing for the Thatcher administration’s neoliberal economic and social policies. The study, which examined at material from existing research and data from the Office for National Statistics, illustrates that Thatcherism resulted in the unnecessary and unjust premature deaths of British citizens, together with a substantial and continuing burden of suffering and a widespread degradation of wellbeing.

Co-author and researcher Professor Clare Bambra from the Wolfson Research Institute of Health and Wellbeing said that deaths from violence and suicide all increased substantially during the Thatcher era in comparison with other countries. Regional inequalities in life expectancy between north and south were also exacerbated, as were health inequalities between the richest and poorest in British society.

Professor Bambra also says that the welfare cuts implemented by Thatcher’s governments led to a rise in poverty rates from 6.7% in 1975 to 12% by 1985; poverty is well known to be one of the major causes of ill health and mortality. Income inequality also increased in the Thatcher period, as the richest 0.01% of society had 28 times the mean national average income in 1978 but 70 times the average by 1990. Other research (The Spirit Level) indicates that income inequality is internationally associated with higher mortality and morbidity.

Yet earlier this year, the welfare reform minister, Lord Freud, refused to monitor the number of people who take their own lives as a result of the £120-a-month cut planned for those people in the work related activity group (WRAG), claiming employment and support allowance from April 2017. Concerns were raised in the House of Lords, when Baroness Meacher, amongst others, warned that for the most vulnerable citizens, the cut was “terrifying” and bound to lead to increased debt.

Condemning the truly callous and terrible actions of the Treasury, she urged ministers to monitor the number of suicides in the year after the change comes in, adding: “I am certain there will be people who cannot face the debt and the loss of their home, who will take their lives.”

Many people have died as a consequence of the welfare “reforms.”

Not only have the government failed to carry out an impact assessment regarding the cuts, Lord Freud said that the impact, potential increase in deaths and suicides won’t be monitored, apart from “privately” because individual details can’t be shared and because that isn’t a “useful approach”.

He went on to say “We have recently produced a large analysis on this, which I will send to the noble Baroness. That analysis makes it absolutely clear that you cannot make these causal links between the likelihood of dying – however you die – and the fact that someone is claiming benefit.”

However, a political refusal to investigate an established correlation between the welfare “reforms” and an increase in the mortality statistics of those hit the hardest by the cuts – sick and disabled people – is not the same thing as there being no causal link. Often, correlation implies causality and therefore such established links require further investigation. It is not possible to disprove a causal link without further investigation.

Whilst the government continue to deny there is a “causal link” between their punitive welfare policies, austerity measures and an increase in premature deaths and suicides, they cannot deny there is a clear correlation , which warrants further research and political accountability.

We have a government that provides disproportionate and growing returns to the already wealthy, whilst imposing austerity cuts on the very poorest. How the government possibly claim that inequality is falling, when inequality is so fundamental a prop to their ideology and when social inequalities are extended and perpetuated by all of their policies? It seems an Orwellian re-writing of language about inequality is being used to mislead us into thinking that the economy is far more “inclusive’ than it is. The number of vulture private businesses payrolled by the government to deliver increasingly ideologically biased and punitive welfare, health and social care “services” has risen dramatically this past six years, all of which has cost the UK taxpayer billions.

Meanwhile, those people who need essential supportive public services are facing severe cuts to their lifeline provision. Many of the multinationals contracted by the government are paid to cut the costs of public services, but are costing the public far more than they save.far more than they save. This brand of neoliberal crony capitalist is an entrenched mindset that needs to radically change, because the only beneficiaries are big businesses, and at the expense of those people with the highest level of need. The government’s policies are harming our most vulnerable citizens.

It seems that for wealthy people, “incentives” are always financial rewards, and for poor people, “incentives” simply involve grossly unfair financial punishments, which have too often challenged people’s  capacity to meet basic survival needs.

It’s time to challenge the class-based prejudice and blatant discrimination that is embedded in Conservative policies, which ultimately may only serve to deepen existing wealth and health inequality and increase social and economic division.

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If even the DWP isn’t Disability Confident, how will a million disabled people get jobs? – Bernadette Meaden

Nobody would expect a person who suffers blackouts to drive a bus or bin waggon once they had thought through the potentially devastating consequences. But political, cultural, psychological and financial coercion is being used to force sick and disabled people to work – the government continues to cut welfare, which was calculated originally to cover only the costs of meeting basic needs.

Cruel sanctions and strict, inflexible, often unreasonable behavioural conditions are being imposed on lifeline benefit receipt, adversely affecting some of our poorest and most vulnerable citizens; unemployed and disabled people are being stigmatised by the government and the media – all of this is done with an utterly callous disregard of a person’s capacity to work, and importantly, the availabilty of appropriate and suitable employment opportunities, and this can often have tragic consequences.

Modern employment practices, which have an increasingly strong focus on attendance micromanagement, present yet another barrier for disabled people who want to work.

The following is taken from an excellent article which was posted on Bernadette Meaden’s blog, on January 16, 2016.

The numbers of disabled people in ‘absolute poverty’ (unable to meet their basic needs) has risen steeply following welfare reforms. Yet in his most recent party conference speech Iain Duncan Smith said to disabled people, “We won’t lift you out of poverty by simply transferring taxpayers’ money to you. With our help, you’ll work your way out of poverty.”

The recent case  of a Department for Work and Pensions (DWP) employee sacked for taking time off for illness illustrates a truth that the government does not acknowledge. Modern employment practices often appear to be incompatible with its aim of getting sick and disabled people off disability benefits and into work.

In this particular case it was reported that after working at the DWP for thirty four years, Ms Powell, who has a disability, fell foul of its sickness absence procedure, whereby formal action is taken against employees after eight days absence, or four spells of absence within a 12-month period.

‘Health problems meant that Ms Powell was frequently off sick. As some of her absences were related to a disability, her trigger point was adjusted from the usual eight to 12 days. However, Ms Powell later went over her allotted 12 days’ absence by a few days, and she was dismissed.’

A year earlier, a DWP whistleblower had revealed :

“Attendance management continues to get more draconian and sackings have become a regular occurrence: a recent guideline instructed managers to consider dismissal for staff off work for longer than 28 days regardless of the reason.”

So despite its own Disability Confident campaign, which calls on employers to “help improve employment opportunities for disabled people and retain disabled people and those with long term health conditions in your business”, the DWP itself seems unable to provide employment for people who may have long or frequent spells of illness. This would suggest that if you have, say, a long term fluctuating health condition, or a disability that requires frequent hospital appointments, you will find it very difficult to keep a job at the DWP.

Of course the DWP is not alone in this. We know that in some workplaces the pressure to attend even when very ill is overwhelming. At the Sports Direct warehouse, for instance, it was reported that over a two year period, 76 calls for an ambulance had been made, with 36 cases classed as ‘life-threatening’ including strokes, convulsions and breathing problems. One woman gave birth in the toilets, and employees said they were too frightened to take time off when they were ill, in case they lost their job. The employment agency that supplied staff to the warehouse had a ‘six strikes and you’re out’ policy, where a strike could include being off sick, or taking ‘excessive or long toilet breaks’. Very few people with a long term health condition would find it possible to keep their job in these circumstances. 

The reality is that in a fiercely competitive economy and austerity-driven government departments, there is very little room for anyone who has a long term health problem. Perhaps somebody in the government should do a little experiment. Try applying for jobs and declaring a long-term illness or disability which may require regular absences. See how easy it is to get a job.

You can read the rest of Bernadette’s excellent article here.

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