Tag: DPAC

Disabled woman and survivor of abuse to be subjected to grossly intrusive council surveillance to justify care costs

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 Cuts Kill, No More Benefit Deaths protest, Westminster Road block, 7 September 2016: part of Disabled People Against the Cuts’ Rights Not Games week of action.

Photo courtesy of Paula Peters, DPAC.


John Pring from Disability News Service
reports:

“A disabled woman has told how her local council is threatening to spend several days watching her every move as she eats, showers and uses the toilet, in order to check if planned cuts to her care package will meet her needs.

The woman, Jane*, a survivor of serious sexual, physical and emotional abuse, and a former Independent Living Fund (ILF) recipient, spoke about the council’s “violation” at a parliamentary campaign meeting this week.

The meeting was held to launch Inclusion London’s report on the impact of last year’s ILF closure, as part of the Rights Not Games week of action organised by Disabled People Against Cuts (DPAC)**.

The report, One Year On: Evaluating The Impact Of The Closure Of The Independent Living Fund, includes information from all 33 London local authorities, and concludes that there has been a “dramatic postcode lottery” in the support provided to former ILF recipients since the fund closed.”

*Not her real name

**DPAC has set up a legal fund to help former ILF recipients like Jane challenge cuts to their support packages.

I recommend that you read the full article: Council wants to watch abuse survivor shower and toilet to check post-ILF needs.

The council have suggested that Jane may survive on microwave meals – which she has said would damage her health and be unaffordable – and that she can use incontinence pads for up to 12 hours a day, instead of being helped to use the toilet.

Over the summer, council officials told Jane that once the cuts to her care package were in place (from 12 hours of support a day to 38 hours a week), they wanted to send a “team of people” to observe (for up to two weeks) the impact of the reduction in care on how she manages to use the toilet, take a shower, gets in and out of her wheelchair and her bed, and feeds herself.

This will require an intrusion on a very intimate level, into aspects of her life where privacy is something that most people would take for granted. For disabled people, the public/private divide no longer exists. The details of our most intimate circumstances have become public property. Jane is not only horrified at this dehumanising move to cut costs, and about the fact that her physical needs, citizen rights and dignity are being so casually disregarded; she also has concerns regarding the potentially very damaging psychological effects of such an intrusion from the state, who have the sole aim of callously cutting her essential support.

The Independent Living Fund (ILF) was set up in 1988 to fund support for disabled people with high support needs in the United Kingdom, enabling them to live in the community independently, rather than move into residential care.

The ILF was designed to combat social exclusion on the grounds of disability. The money is generally used to enable disabled people to live in their own homes and to pay for care, and in particular, to employ personal care assistants. Many of the beneficiaries would have otherwise had to move to residential care homes.

In December 2010 the Government announced the closure of the Fund to new applicants, and in December 2012, following a consultation on the future of the Fund, it was announced that the Fund would be closed permanently from April 2015. The Government claimed that Local Authorities could meet the same outcomes as the ILF and proposed transfer for existing ILF recipients to their Local Authorities.

The Government initially decided to close the fund by March 2015 but this was delayed until June 2015 after five disabled people challenged the Government’s decision in the High Court.

In a very significant decision on 6 November 2013 following the Judicial Review, which highlighted the effects of the Equality Act 2010 on public authorities and their decision-making, the Court of Appeal found that the Department of Work and Pensions’ (DWP) decision to close the ILF was not lawful, overturning the High Courts’ decision of April 2013. The Government had indicated that it would not be appealing this judgement and the ILF would remain intact for the time being. 

The Court of Appeal unanimously quashed the decision to close the fund and devolve the money, on the basis that the minister had not specifically considered duties under the Equality Act, such as the need to promote equality of opportunity for disabled people and, in particular, the need to encourage their participation in public life. The court emphasised that these considerations were not optional in times of austerity.

On March 6, 2014, the Government made the authoritarian announcement that it would go ahead with the closure of the ILF fund on 30th June 2015, saying that a new equalities analysis had been carried out by the DWP. The government has shown a complete disregard for disabled people and the Court of Appeal decision. 

Highlighting that government had failed to comply with the equality duty had been a rare victory, entirely due to disabled people fighting back. The government responded to this by simply ignoring the court ruling.

The ILF provided additional income to nearly 19,000 disabled people who have high level support needs. The government devolved the responsibility to already cash-strapped local authorities in England, which meant that it would cease to be ring-fenced and would be subject to constraints and cuts within a local authority budget in June 2015. The funding was not ring-fenced. Because of budget cuts, local authorities have had limited capacity to support individuals unless their needs are very severe and so the ILF had previously served to supplement this provision. Local Authorities are already struggling to fund statutory provision and services, as it is. 

Local Authorities had already said that they will not be able to offer the current level of financial support provided by ILF, potentially forcing many disabled people to move out of their homes and into residential care homes.

The Inclusion report aims at gathering evidence of the impact of the closure of the ILF with a focus on the situation in London. It brings together statistical analysis from Freedom Of Information (FOI) requests sent to all 33 London boroughs with findings from a survey sent out to London Deaf and Disabled People’s Organisations (DDPOs) as well as qualitative evidence provided by former ILF recipients concerning their experiences of transfer to Local Authority (LA) support.

Comparison of evidence gathered through comparison of the Freedom Of Information (FOI) responses, Deaf and Disabled People’s Organisations (DDPO) survey, and examples of lived experience submitted by former ILF recipients has led to a number of themes emerging:

  • Post-code lottery for former ILF recipients across Local Authorities.
  • The detrimental impacts of the ILF closure on former ILF recipients, ranging from distress and anxiety to removal of essential daily support. 9 One Year On: evaluating the impact of the closure of the Independent Living Fund
  • The lack of consistent practice across different Local Authorities regarding referrals for CHC funding.
  • Limitations of the mainstream care and support system and failings in the implementation of the Care Act.
  • The value of the model of support provided by the Independent Living Fund.
  • The importance of Deaf and Disabled People’s Organisations for making Deaf and Disabled people aware of and supported to exercise their rights.

There is an urgent need for a radical rethink of how Disabled people are supported to live independently. Disabled people who use independent living support must be at the forefront of developing ideas and with adequate resources for meaningful engagement.

This also needs to happen quickly, before the memories of what effective independent living support looks like and how much Disabled people can contribute when our support needs are met fade into the distance.

You can read the full report here: One year on: Evaluating the impact of the closure of the Independent Living Fund

Related  

ILF closure cuts report produces instant results from Labour and Greens

Two-way mirrors, hidden observers: welcome to the Department for Work and Pensions laboratory

 

 

Workfare coercion in the UK: an assault on persons with disabilities and their human rights – Anne-Laure Donskoy

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Anne-Laure Donskoy
is an independent survivor researcher, this paper was published by the National Survivor User Network (NSUN) for mental health, which is an independent, service-user-led charity that connects people with experience of mental health issues to give us a stronger voice in shaping policy and services.

In a report, titled Workfare coercion in the UK: an assault on persons with disabilities and their human rights, she provides an in-depth consideration of psychocompulsion as a series of state-sponsored human rights violations. I recommend that you read this discussion in full.

She writes: While there is a lot of focus on coercion organised and implemented in psychiatry, less attention is being paid to state engineered welfare measures based on libertarian paternalism, which have coercive practices at their core. Among them are policies that strongly support behavioural change using positive psychology and cognitive behavioural therapy. Freidli and Stearn (2015) call this ‘psychocompulsion.'”

“The narrative of welfare is changing drastically. As Friedli says, we are moving from a “what people have to do [to find work] to what they have to be [demonstrating the right attitude to be employable]”. This is exemplified through the new ‘Work and Health Programme’ planned to be rolled out in England and Wales. This programme has many strands, including:−

  • Embedding psychological services within Job Centres
  • Placing ‘job coaches’ within GP surgeries for people with certain conditions (specifically people with mental health issues): the ‘Working Better’ pilot scheme is funded by the Department for Work and Pensions and the coaches will be provided by welfare to work agency, Remploy (a welfare-to-work subsidiary of the Maximus).”

She goes on to say: “It has come to light that these new programmes are also the subject of ‘research’.The new Work and Health Programme is currently at a research and trialing stage. As Kitty Jones writes, “Part of the experimental nudge element of this research entails enlisting GPs to “prescribe” job coaches, and to participate in constructing “a health and work passport to collate employment and health information.”

However, this ‘research’ (if one can call it so), has been heavily criticised because it is not sanctioned according to the usual robust ethical guidelines. Research that adheres to robust ethical guidelines would absolutely seek not to cause harm to its participants,and would seek their informed consent beforehand. This is not the case here where claimants are the participants, involuntary and ‘unconsented’, of an experiment they know nothing about, “There are a wide range of legal and Human Rights implications connected with experimentation and research trials conducted on social groups and human subjects.”

A spokesperson for Disabled People Against the Cuts (DPAC), talked of the UN CRPD Committee’s visit to the UK and described the situation thus: It means the UN will examine the vicious and punitive attacks on disabled people’s independent living as well as the cuts which have seen so many placed in inhuman circumstances and has led to unnecessary deaths.”

There is a more, and also, a very detailed and important consideration of the implications of current UK policies within the context of the Convention on the Rights of Persons with Disabilities (CRPD) throughout this excellent article.

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Related 

Cited on the article:

https://kittysjones.wordpress.com/2015/11/28/the-goverments-reductive-positivistic-approach-to-social-research-is-a-nudge-back-to-the-nineteenth-century/– The idea that it is both possible and legitimate for governments, public and private institutions to affect and change the behaviours of citizens whilst also [controversially] “respecting freedom of choice.”

https://kittysjones.wordpress.com/2015/12/14/the-department-for-work-and-pensions-dont-know-what-their-ethical-and-safeguarding-guidelines-are-but-still-claim-they-have-some/

Friedli L, et al.MedHumanit2015;41:40–47. doi:10.1136/medhum-2014-010622

http://www.disabilitynewsservice.com/coroners-ground-breaking-verdict-suicide-was-triggered-by-fit-for-work-test/

(amongst other work)

Watch – And This time its Personal Psychocompulsion & Workfare from wellredfilms on Vimeo.

Other related:

Cameron’s Nudge that knocked democracy down: mind the Mindspace

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

Nudging conformity and benefit sanctions

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Conservative welfare “reforms” – the sound of one hand clapping

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“Labour MPs sat perplexed … By cutting housing benefit for the poor, the Government was helping the poor. By causing people to leave their homes, the Government was helping people put a roof over their heads. By appealing the ruling that it discriminated against the vulnerable, the Government was supporting the vulnerable.

Yes, this was a tricky one.” – From an unusually insightful article in the Telegraph about the incoherence of Conservative welfare rhetoric:  How bedroom tax protects the vulnerable.

“Ministers keep using the mantra that their proposals are to protect the most vulnerable when, quite obviously, they are the exact opposite. If implemented their measures would, far from protecting the most vulnerable, directly harm them. Whatever they do in the end, Her Majesty’s Government should stop this 1984 Orwellian-type misuse of language.”  – Lord Bach, discussing the Legal Aid Bill. Source: Hansard, Column 1557, 19 May, 2011.

Conservative policies are incoherent: they don’t fulfil their stated aims and certainly don’t address public needs. Furthermore, Conservative rhetoric has become completely detached from the experiences of most citizens and their everyday realities.

Under the Equality Act, provision was made by the Labour government to ensure that legislations didn’t discriminate against protected social groups, which included disabled people. However, the need for public bodies in England to undertake or publish an equality impact assessment of government policies, practices and decisions was quietly removed by David Cameron in April 2011. The legal requirement in the Equality Act that ensured public bodies attempt to reduce inequalities caused by socio-economic factors was also scrapped by Theresa May in November 2010, who said she favoured a greater focus on “fairness” rather than “equality.”

The Conservatives have since claimed to make welfare provision “fair” by introducing substantial cuts to benefits and introducing severe conditionality requirements regarding eligibility to social security, including the frequent use of extremely punitive benefit sanctions as a means of “changing behaviours,” highlighting plainly that the Conservatives regard unemployment and disability as some kind of personal deficit on the part of those who are, in reality, simply casualties of unfortunate circumstances, bad political decision-making and subsequent politically-constructed socio-economic circumstances.

The word “fair” originally meant “treating people equally without favouritism or discrimination, without cheating or trying to achieve unjust advantage.” Under the Conservatives, we have witnessed a manipulated semantic shift, “fair” has become a Glittering Generality – part of a lexicon of propaganda that simply props up Tory ideology in an endlessly erroneous and self-referential way. Conservative ideology is permeating language, prompting semantic shifts towards bland descriptors which mask power and class relations, coercive state actions and political intentions. One only need to look at the context in which the government use words like “fair”, “support”, “help”, “justice” , “equality” and “reform” to recognise linguistic behaviourism in action. Or if you prefer, Orwellian doublespeak.

The altered semantics clearly signpost an intentionally misleading Conservative narrative, constructed on the basic, offensive idea that people claiming welfare do so because of “faulty” personal characteristics, and that welfare creates problems, rather than it being an essential mechanism aimed at alleviating poverty, extending social and economic support and opportunities – social insurance and security when people need it.

The government claims to be “committed to supporting the most vulnerable” and ensuring “everyone contributes to reducing the deficit, and where those with the most contribute the most.” That is blatantly untrue, as we can see from just a glance at Conservative policies.

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Conservative rhetoric is a masterpiece of stapled together soundbites and meaningless glittering generalities. And intentional mystification. Glittering Generalities are being used to mask political acts of discrimination.

Cameron claims that he is going to address “inequality” and “social problems”, for example, but wouldn’t you think that he would have done so over the past five years, rather than busying himself creating those problems via policies? Under Cameron’s government, we have become the most unequal country in the European Union, even the USA, home of the founding fathers of neoliberalism, is less divided by wealth and income, than the UK.

I’m also wondering how tripling university tuition fees, removing bursaries and maintainance grants for students from poorer backgrounds and reintroducing banding in classrooms can possibly indicate a party genuinely interested in extending “equal opportunities.”

It’s perplexing that a government claiming itself to be “economically competent” can possibly attempt to justify spending more tax payers money on appealing a Supreme Court decision that the bedroom tax policy is discriminatory, when it would actually cost less implementing the legal recommendations of the court. As Owen Smith, Shadow Work and Pensions Secretary, said: “Just the Supreme Court session itself will cost the Government more in legal fees than the £200,000 needed to exempt domestic abuse victims affected.

“If the Tories had an ounce of decency they could have stood by the decision and exempted the two groups.

“Instead they are instructing expensive lawyers to fight in the Supreme Court for the right to drive people further into poverty.”

As a consequence of the highly discriminatory and blatantly class-contingent Tory policies, rampant socio-economic inequality apparently is the new Tory “fair”. There is a clear incongruence between Conservative rhetoric and the impact of their policies. This is further highlighted by the fact that the UK is currently being investigated by the United Nations regarding serious contraventions of the human rights of sick and disabled people, and other marginalised groups, because of the dire impact of Conservative welfare “reforms.”

It’s clear that the austerity cuts which target the poorest are intentional, ideologically-driven decisions, taken within a context of other available choices and humane options.

The rise in the need for food banks in the UK, amongst both the working and non-working poor, over the past five years and the return of absolute poverty, not seen since before the advent of the welfare state in this country, makes a mockery of government claims that it supports the most vulnerable.

Income tax receipts to the Treasury have fallen because those able to pay the most are being steadily exempted from social responsibility, and wages for many of the poorer citizens have fallen, whilst the cost of living has risen significantly over this past five years.

The ideologically motivated transfer of funds from the poorest half of the country to the more affluent has not contributed to deficit reduction. It doesn’t take a genius to work out that the cumulative impact of Tory tax and welfare changes, from out-of-work and in-work benefits to council tax support, to the cut in the top rate of income tax and an increase in tax-free personal allowances, has been extremely regressive and detrimental to the poorest.

The revenue gains from the tax changes and benefit cuts were offset by the cost of tax reductions, particularly the increase in the income tax personal allowance, benefitting the wealthiest.

The Treasury response to this is to single out the poorest yet again for more cuts to “balance the books” – which basically translates as the Conservative “small state” fetish, and deep dislike of the gains we made from the post-war settlement. Yet for a government that claims a non-interventionist stance, it sure does make a lot of interventions. Always on behalf of the privileged class, with policies benefitting only the wealthy minority.

How can Conservatives believe that poor people are motivated to work harder by taking money from them, yet also apparently believe that wealthy people are motivated by giving them more money? This is not “behavioural science,” it’s policy-making founded entirely on traditional Tory prejudices.

The government claim that “Every individual policy change is carefully considered, including looking at the effect on disabled people in line with legal obligations,” but without carrying out a cumulative impact assessment, the effects and impacts of policies can’t possibly be accurately measured. And that is intentional, too.

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 signifant 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 the House of Lords have been paying attention to the game.

The use of secondary legislation has risen at an unprecedented rate, reaching an extraordinary level since 2010, and it’s increased use is to ensure that the Government meet with little scrutiny and challenge in the House of Commons when they attempt to push through controversial and unpopular, ideologically-driven legislation.

Conservative cuts are most often applied by stealth, using statutory instruments. This indicates a government that is well aware that its policies are not fit for purpose.

We can’t afford Conservative ideological indulgence.

The National Audit Office (NAO) scrutinises public spending for Parliament and is independent of government. An audit report earlier this month concluded that the Department for Work and Pension’s spending on contracts for disability benefit assessments is expected to double in 2016/17 compared with 2014/15. The government’s flagship welfare-cut scheme will be actually spending more money on the assessments themselves than it is saving in reductions to the benefits bill – as Frances Ryan pointed out in the Guardian, it’s the political equivalent of burning bundles of £50 notes.

The report also states that only half of all the doctors and nurses hired by Maximus – the US outsourcing company brought in by the Department for Work and Pensions to carry out the assessments – had even completed their training.

The NAO report summarises:

5.5
Million assessments completed in five years up to March 2015

65%
Estimated increase in cost per ESA assessment based on published information after transfer of the service in 2015 (from £115 to £190)


84%
Estimated increase in healthcare professionals across contracts from 2,200 in May 2015 to 4,050 November 2016

£1.6bn
Estimated cost of contracted-out health and disability assessments over three years, 2015 to 2018

£0.4 billion
Latest expected reduction in annual disability benefit spending

13%
Proportion of ESA and PIP targets met for assessment report quality meeting contractual standard (September 2014 to August 2015).

This summary reflects staggering and deliberate economic incompetence, a flagrant, politically-motivated waste of tax payers money and even worse, the higher spending has not created a competent or ethical assessment framework, nor is it improving the lives of sick and disabled people.

The government claim they want to “help” sick and disabled people into work, but nearly 14,000 disabled people have lost their mobility vehicle after the changes to Personal Independence Payments (PIP) assessment, which are carried out by private companies. Many more, yet to be reassessed, are also likely to lose their specialised vehicles.

In 2012, Esther McVey revealed that the new PIP  was about cutting costs and that there were targets to reduce the number of successful claims when she told the House of Commons:330,000 of claimants are expected to either lose their benefit altogether or see their payments reduced.How else could she have known that before those people were actually assessed? A recent review led the government to conclude that PIP doesn’t currently fulfil the original policy intent, which was to cut costs and “target” the benefit to “those with the greatest need.”

That basically meant a narrowing of eligibility criteria for people formerly claiming Disability Living Allowance, increasing the number of reassessments required, and limiting the number of successful claims. The government have used the review to attempt to justify further restrictions to PIP eligibility, aimed at cutting support for people who require aids to meet fundamental needs such as preparing food, dressing, basic and essential personal care and managing incontinence. “Greatest need” has become an ever-shrinking category under Conservative austerity measures. 

DPAC

The use of political pseudo-psychological “diagnoses” to both stigmatise and “treat” what are generally regarded by the Conservatives as deviant behaviours from cognitively incompetent citizens, infering that the problem lies within the individual rather than in their circumstances, or arise as a consequence of political decision-making and socio-economic models, has become the new normal. We are discussing people here who have been deemed too ill to work by their own doctor AND the state. Not for the first time, the words Arbeit macht frei spring to mind.

Welfare has been redefined: it is preoccupied with assumptions about and modification of the behaviour and character of recipients rather than with the alleviation of poverty and ensuring economic and social wellbeing.

The stigmatisation of people needing benefits is designed purposefully to displace public sympathy for the poor, and to generate moral outrage, which is then used to further justify the steady dismantling of the welfare state.

It is the human costs that are particularly distressing, and in a wealthy, first world liberal democracy, such draconian policies ought to be untenable. Some people are dying after being wrongly assessed as “fit for work” and having their lifeline benefits brutally withdrawn. Maximus is certainly not helping the government to serve even the most basic needs of sick and disabled people.

However, Maximus is serving the needs of a “small state” doctrinaire neoliberal government. The Conservatives are systematically dismantling the UK’s social security system, not because there is an empirically justifiable reason or economic need to do so, but because the government has purely ideological, anticollectivist prescriptions. Those prescriptions are costing the UK in terms of the economy, but MUCH worse, it is costing us in terms of our decent, collective, civilised response to people experiencing difficult circumstances through no fault of their own; it’s costing the most vulnerable citizens their wellbeing and unforgivably, it is also costing precious human lives.

It’s not just that Conservative rhetoric is incoherent and incongruent with the realities created by their policies. Policy-making has become increasingly detached from public needs and instead, it is being directed at “incentivising” and “changing behaviours” of citizens to meet a rigidly ideological state agenda. That turns democracy completely on its head. There is no longer a genuine dialogue between government and citizens, only a diversionary and oppressive state monologue.

And it’s the sound of one hand clapping.

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There are many ways of destroying people’s lives, not all of them are obvious. Taking away people’s means of meeting basic survival needs, such as money for food, fuel and shelter – which are the bare essentials that benefits were originally calculated to cover – invariably increases the likelihood that they will die. The people most adversely and immediately affected are those who have additional needs for support.

The moment that sick and disabled people were defined as a “burden on the state” by the government, we began climbing Allport’s Ladder of Prejudice.

Whilst I am very aware that we need take care not to trivialise the terrible events of  world war 2 and Nazi Germany by making casual comparisons, there are some clear and important parallels on a socio-political level and a psycho-social one, that I feel are crucially important to recognise.

Gordon Allport studied the psychological and social processes that create a society’s progression from prejudice and discrimination to genocide. In his research of how the Holocaust happened, he describes socio-political processes that foster increasing social prejudice and discrimination and he demonstrates how the unthinkable becomes acceptable: it happens incrementally, because of a steady erosion of our moral and rational boundaries, and propaganda-driven changes in our attitudes towards “others” that advances culturally, by almost inscrutable degrees.

The process always begins with the political scapegoating and systematic dehumanisation of a social group and with ideologies that identify that group as an “enemy” or a social “burden” in some way. A history of devaluation of the group that becomes the target, authoritarian culture, and the passivity of internal and external witnesses (bystanders) all contribute to the probability that violence against that group will develop, and ultimately, if the process is allowed to continue evolving, genocide.

If you think this observation is “extreme” then you really haven’t been paying attention. By 2012, hate crime incidents against disabled people had risen to be the highest ever recorded. By 2015, there was a further 41 per cent rise in disability hate crime. This is the so-called “civilised” first world, very wealthy liberal democracy that is the UK.

Most disabled people have worked, contributed to society, paid taxes and national insurance. Those that haven’t genuinely cannot work, and as a decent, civilised society, we should support them. Being ill and disabled is not a “lifestyle choice.” Unfortunately it can happen to anyone. A life-changing accident or illness doesn’t only happen to others: no-one is exempted from such a possibility. That this government thinks it can get away with peddling utter nonsense about the characters, lives and motivations of a marginalised social group, dehumanising them, directing hatred, resentment, prejudice and public derision towards them, demonstrates only too well just how far we have moved away from being a decent, civilised society. 

It seems to be almost weekly that there’s a report in the media about a sick and disabled person dying after being told by the state that they are “fit for work” and their lifeline benefits have been halted, or because the state has sanctioned someone and withdrawn their only support. There are many thousands more suffering in silence, fearful and just about living.

 

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

 

Image result for work coaches : you can still work if you are ill UK
Source: Work, health and disability green paper: improving lives. Consultation outcome


Last year I wrote a critical article about the government’s new
Work and Health Programme, I flagged up concerns regarding government plans to enlist GPs in prescribing work coaches for people who are sick and disabled, and in providing advice on job-seeking. The private and confidential patient-doctor relationship ought to be about addressing medical health problems, and supporting people who are ill, not about creating yet another space for an over extension of the coercive arm of the state to “help people into work”, regardless of whether or not they are actually well enough to cope with working.

I also posted my article on the Pulse site for medical professionals last October, raising some of my concerns. I proposed that the government may use the “intervention” as a further opportunity for sanctioning sick and disabled people for “non-compliance”, and I expressed concern that this would conflict with the ethics and role of a doctor. I also stated my concern about the potential this pilot has for damaging the trust between doctors and their patients. I do support the idea of social prescribing in theory, but this scheme is certainly not that. This is plain state harassment and coercion.

It’s interesting to see that among all those listed present at the various pilot-related meetings behind closed doors regarding the government’s new Work and Health programme, there isn’t a single sick and disabled person or relevant representative charity to be found. That’s telling, because it means that the provision is not founded on consultation, is not designed to be inclusive from the start, nor does it have a democratic or representative foundation. It’s another case of government policy that acts upon groups people, prescriptively, as if they were objects, rather than human subjects with identifiable needs and the capacity for democratic dialogue.

I discovered last October, almost by chance, that the Nudge Unit team have been working with the Department for Work and Pensions and the Department of Health to trial social experiments aimed at finding ways of: “preventing people from falling out of the jobs market and going onto Employment and Support Allowance (ESA).”

“These include GPs prescribing a work coach, and a health and work passport to collate employment and health information. These emerged from research with people on ESA, and are now being tested with local teams of Jobcentres, GPs and employers.”  Source: Matthew Hancock’s conference speech: The Future of Public Services.

Now GPs have raised their own concerns about sharing patient data with the Department for Work and Pensions – and quite properly so. Pulse reports that the Department for Work and Pensions (DWP) plans to extract information from GP records, including the number of Med3s or so-called “fit notes” issued by each practice and the number of patients recorded as “unfit” or “maybe fit” for work, in an intrusive move described by GP leaders as amounting to “state snooping.”

Part of the reason for this renewed government attack on sick and disabled people is that the Government’s flagship fit note scheme, which replaced sick notes five years ago in the hope it would see GPs sending thousands more employees back to work to reduce sickness-related absence, despite GPs having expressed doubts since before its launch, has predictably failed.

The key reason for the failure is that employers did not take responsibility for working with employees and GPs seriously, and more than half (59%) of employers said they felt unable to support employees by making all of the legally required workplace adjustments for those who had fit notes signed as “may be fit for work.” Rather than address this issue with employers, the government has decided instead to simply coerce patients back into work without essential support.

Another reason for the failure of this scheme is that most people who need time off from work are ill and genuinely cannot return to work until they have recovered. Regardless of the government’s concern for the business and state costs of sick leave, people cannot be simply ushered out of illness and into work by the state to “contribute to the economy.” When a GP says a person is “unfit for work”, they generally ARE unfit for work, regardless of whether the government likes that or not.

The government plans to merge health and employment services, and are now attempting to redefine work as a clinical outcome. Unemployment has been stigmatised and politically redefined as a psychological disorder, the government claims somewhat incoherently that the “cure” for unemployment due to illness and disability, and sickness absence from work, is work.

This is the kind of mentality that the new Work and Health programme is founded on: Dr Josephine Sauvage, the joint vice chair of NHS Islington CCG and a GP at City Road Medical Practice, where the programme is being trialed currently, said the programme can help patients.

She said: “When we become ill we often stop doing those things that get us out and about and bring fulfilment to our lives.”

Yes, that’s what being chronically ill means: we often become incapacitated and sometimes we can’t do all of the things we did before. But since when is working the only source of fulfilment? And how does forcing people who are ILL to look for ANY job, regardless of pay, security, terms and conditions and appropriateness lead to “fulfilment”? A patient is defined as:

  • A person who requires medical care.
  • A person receiving medical care or medical treatment.
  • A person under a physician’s care for a particular disease or condition.

There is no mention of a person’s employment status or the pressing need for a job prescription in that definition.

As part of the Work and Health programme, beginning next month, the DWP plans to access people’s medical information. Employment coaches will be able to directly “update” a patient’s medical record.

GPs will have to inform patients of the access to information and any extraction of confidential information from their medical files, but cannot withhold information unless their patient explicitly objects.

Sofia Lind, a senior journalist at Pulse, says: GPs, as data controllers, will be required to tell patients in person, via notices in the practice and on the practice website of the impending extraction.”

Patients have the right to object to the use and disclosure of confidential information that isn’t used for their medical care.

Patients can explicitly refuse their consent to data sharing. The Data Protection Act 1998 covers personal information including health records. Further provision under Article 8 of the Human Rights Act 1998 establishes a right to respect for private and family life. This underscores the duty to protect the privacy of individuals and preserve the confidentiality of their health records.

There is also additional guidance from the British Medical Association (BMA) here – GPs as Data controllers guidance. (PDF)

You can:

Write your own letter to the GP health centre. Here is a basic letter template in 3 formats that you can download and use:

Opt out letter (PDF)

Opt out letter (MS Word)

Opt out letter (Rich Text)

Make sure you state clearly that don’t wish for any of your data and medical information, including details of your fit notes, to be shared with the DWP and any other third party. You can also:

In addition to sharing information with the DWP, due to changes in legislation, your GP can now be required to upload personal and identifiable information from the medical record of every patient in England to central servers at the Health and Social Care Information Centre (HSCIC).

Once this information leaves your GP practice, your doctor will no longer be in control of what data is passed on or to whom. This information will include diagnoses, investigations, treatments and referrals as well as other things you may have shared with your doctor including your weight, alcohol consumption, smoking and family history. Each piece of information will be identifiable as it will be uploaded with your NHS number, date of birth, post code, gender and ethnicity. NHS England – the body now in charge of commissioning primary care services across England – will manage and use the information extracted by HSCIC for a range of purposes, none of which are to do with your direct medical care.

Whenever I am ill, I don’t ever consider consulting Iain Duncan Smith or the government more generally for advice. There are very good reasons for this. I don’t want to be confronted with pseudoscientific Conservative anti-welfare dogma, I prefer instead to seek the expert, trusted medical opinion of a qualified doctor. I expect professional medical care, not brute state coercion and a punishment regime that is particularly reminiscent of the 1834 Poor Law amendment Act.

And despite assurances from those professionals currently trialing the Work and Health programme that all participation is (currently) voluntary, against the current backdrop of ever-increasing welfare conditionality, the political stigmatisation of people not in work, the frequent punitive deployment of benefit sanctions, the mandatory  welfare-to-work schemes, it’s difficult to imagine a Conservative scheme that will not entail exercising Conservative prejudice and pseudoscientific justifications of Tory economic Darwinist ideology.

It’s hardly the case that the state has an even remotely credible track record of assessing people’s medical conditions, nor is it the case that this government bothers itself with empirical evidence, or deigns to listen to concerns raised by citizens, academics, professionals and charities regarding the harm that their policies are causing. This is a government that can’t even manage to observe basic human rights, let alone care about citizen’s best interests, health and wellbeing.

It’s not possible to make people who are ill better by punishing them, in just the same way as state coercion and using prejudiced language doesn’t “cure” poverty.  I don’t need more quack medicine on top of the current heavy doses of Conservative big state psychopolitics, traditional prejudices and subsequent quacking, slapstick psychobabble. It’s bad enough that Jeremy Hunt thinks he’s the all singing homeopathic Minister for magic and that Iain Duncan Smith thinks he can miraculously cure sick and disabled people by simply forcing them to work. The side-effects of five years of the Conservative’s ontologically insecure rhetoric, that’s been largely ranting, repetitive, incoherent monologue, are nauseating enough. Nobody should need to say any of this in 2016, but tragically, we seem to have a government that hasn’t yet escaped the feudal era. Or playing with their alchemy sets.

I’m in full agreement with Boycott Workfare, the Mental Health Resistance Network, and Disabled People Against the Cuts. I shared my original article with two of those groups and I’m pleased that they have since organised a protest for March 4, 3pm at the City Road Surgery, 190-196 City Road, London EC1V 2QH to raise public awareness of the issues and implications outlined. I just wish I was currently well enough to get to the protest.

They say: GP surgeries are for medical treatment, the job centre is for “employment coaching” and job-hunting.

And governments in first-world liberal democracies are for creating policies that actually meet public needs, rather than imposing totalitarian control, manipulating and micromanaging citizens to meet government needs and political outcomes.

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