Tag: James Purnell

Demos say the DWP should be axed, I disagree. Here’s why

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A leading cross-party thinktank has proposed that ministers should consider abolishing the Department for Work and Pensions.

In a provocative paper that marked the start of Demos’ research examining the Department of Work and Pensions, Tom Pollard, formerly of the mental health charity Mind, who has also completed an 18 months secondment to the Department for Work and Pensions (DWP), illustrates a bureaucracy blighted by “historic dynamics and averse to radical thinking.”

Pollard’s paper identifies three problems with the DWP. First, the department is afflicted by a “benefits lens”, where case handlers perceive employment support as a condition for receiving benefits, rather than a means of enabling claimants to pursue fulfilling work. Where benefits are the carrot, sanctions are the stick. Sanctioning claimants for misdemeanours such as arriving late to meetings creates a “confrontational dynamic of power asymmetries.” In other words, it strips citizens of their autonomy.

Many neoliberals have also claimed that welfare strips citizens of responsibility, though there has been no convincing evidence of this to date. 

Second, Pollard argues the department is impoverished in ambition. DWP staff are often promoted from frontline roles working in job centres. While such expertise is valuable, he argues that staff often seem “incapable of thinking about radical solutions”, and repeat the mistakes of the past, gravitating towards punitive systems of conditionality and sanctions.

These factors contribute to the DWP’s “injured reputation” among frontline users. Productive engagement between case handlers and claimants is dependent on trust. “There’s such a rift between the DWP and hard to help groups that I don’t know how you could get back to engaging on meaningful terms – there’s too much baggage”, Pollard says.

In the thought-provoking paper, entitled Pathways from Poverty: a case for Institutional reform, Pollard explains why he believes that the DWP is institutionally and culturally incapable of making the reforms needed to deliver better outcomes for society’s most vulnerable and sets out a radical new vision for the future of welfare provision.

Most of the work of Amber Rudd’s department could be carried out more effectively by other Whitehall ministries, according to Pollard. He calls for the DWP to be stripped of responsibility for these “hard-to-help groups”, with the health department and NHS helping the ill find work, local government taking over Jobcentre Plus, and benefits and pensions delivered by HMRC. The charitable sector could also be given a bigger role. 

Some criticisms

Pollard critically discusses the culture within the DWP, implying that the key problems and devastating social consequences arising from the government’s welfare reform programme are simply a result of staff attitudes and inept administrative procedure within the department. 

The crisis in our social security system is the result of government’s policies, which have embedded traditional prejudices about people experiencing poverty, and that have led to the institutionalisation of discriminatory practices within the DWP. There is no guarantee that moving the functions of the DWP somewhere else will bring about any change in attitudes and practices, or improved outcomes for people relying on social security as a lifeline. 

The DWP has come under constant fire from many campaigners, academics and charities for serious problems with universal credit, and for the catastrophic work capability assessments of those who are unfit to work. Rudd is attempting to repair The department’s reputation by tinkering with the roll-out of universal credit and fighting with the Treasury to end the freeze on working-age benefits. However, these gestures are nowhere near enough to put the major shortcomings of the system right and to mitigate the cuts to support that univesal credit and other benefits entail. 

The report concludes that while the DWP has been able to “help” people with minor difficulties into employment, the outcomes are “much poorer when it comes to supporting people with more complex needs”, such as the ill, disabled, older people, those with drug and alcohol problems, ex-prisoners and those who are homeless.

Pollard proposes that if the removal of these functions from the DWP proves to be a success, a more comprehensive approach could see the department abolished altogether”.

He says: “If the department as it stands remains at the heart of employment support for ‘harder-to-help’ groups, we will face further years of well-intentioned reforms and programmes yielding disappointing outcomes, because of how they will be formulated and how they will be received.”

The problem is that the reforms are not “well-intentioned”, and the outcomes are not “disappointing”, they are catastrophic. The policies were intentionally punitive, leading to the consequences we see: people experiencing hardship have been punished by as system that was designed originally to support them and mitigate the circumstances of  hardship.

Pollard accuses the DWP of seeing claimants through a “benefits lens”, in which conditions were placed on their payments as a way of forcing them into work. He warns that the department’s reputation among many groups is now so bad that it may prove impossible and expensive to improve. “A bad reputation is far harder to lose than a good one,” he says.

However, the problem is rather much larger than the poor reputation of the DWP. It is the policy framework that determines the set of administrative practices which in turn, shapes the “culture” within the DWP.  It is the distress and harms that are being experienced by people claiming support, most of whom have also paid into the Treasury – that is the most pressing issues here, not reputation ‘damage limitation’ strategies, or an exercise in PR trust building for the government.

Abolishing the DWP, merging it with the Department of Health and involving charities in service delivery, as proposed by Pollard, will send out the clear message that social security is no longer a discrete function or key priority of the state. It also permits the state to withdraw from providing social security.

Responsibility for budgeting for and administering welfare will become diffuse. Placing social security side by side with healthcare is also risky, as it may further stigmatise jobseekers. We have already seen the government consistently stigmatise those who are out of work, implying that unemployment is some kind of psychological disorder. Others, such as Adam Perkins, have even proposed that there is a “genetic welfare trait.” , that runs counter to Conservative notions of “good citizenship”. 

The NHS is also suffering from chronic under-funding. How will it prioritise welfare provision, when it is already struggling to deliver health care, in the face of the increasing rationing of treatments and procedures?

Historically, charities administered welfare. But the provision was patchy and varied from area to area. There were no consistent standards of support for people in hardship. During times of economic recession, charities were often unable to provide people with any support at all, at a time when they needed it most.

Local authorities are now struggling to deliver statutory services because of government cuts. Essential provisions are being rationed as a consequence. There is no guarantee that any additional funding would be ringfenced. We have already seen social services sending vulnerable young people to other areas – sometimes back to their hometown, for example – to shift the burden of cost to another local authority.  The old Poor Law saw parishes moving poor people out of their area, they were pushed from parish to parish, refused ‘relief’ in order, often, to keep local rates bills low.

A recent paper entitled “Dependency, Shame and Belonging” examines the practice of making the poor wear badges from the 16th century through to the compulsory identification of all parish paupers under a 1679 statute, differentiating between those deemed ‘deserving’ and ‘undeserving’. By the late 17th century, magistrates and legislators decided to deter potential badge applicants by making life on the parish as unattractive as possible. Badging became a means of preventing begging and shaming holders, made compulsory in 1697.

The proposal from Demos simply exchanges one form of expensive, intrusive and ineffective bureaucracy with another. How would the Department of health and charities be allocated funds to carry out this publicly funded state function? How would they be held accountable? 

As I touched on earlier, unless the policy framework is also radically changed to one that is supportive, rather than punitive, and to one that isn’t about administering cuts to people’s lifeline support, then the perverse incentives to apply conditionality and sanctions will remain embedded in administration practices. 

A government that does not support a social security programmme – and the anti-welfarism of the Conservatives has been apparent for a long time – is likely to see the shift in responsibillity for delivering social security as a further step in abolishing welfare provision entirely, which has always been their long term aim. 

Finally, it’s worth noting that Demos produced a paper in 2011 advocating reducing the costs of disability benefit by “engaging with the private insurance industry” and proposing that: “reform to encourage individual responsibility and income protection is genuinely of mutual benefit.” The approach laid out in this report builds on the theory and practice of the profoundly antidemocratic ‘libertarian paternalism’ or ‘nudge’ theory. 

Other papers from the thinktank peddle the views of antiwelfarist James Purnell, who, for example, proposed charging interest on crisis loans to unemployed people and pensioners made by the Department for Work and Pensions, which were interest-free, at a rate of up to 26.8% per annum. This was met with great hostility and was blocked by the intervention of the Prime Minister, Gordon Brown. It was Purnell who announced the Work Capability Assessment, triangulating the Conservatives. Purnell advocated Unum’s approach to “claims management”, in a bid to cut costs of disability support. (See Rogue company Unum’s profiteering hand in the government’s work, health and disability green paper for more detailed discussion). 

The Conservative’s ideological position has been used politically as a justification to reduce social security provision so that it is no longer an adequate amount to meet citizens’ basic living needs. The aim is to discredit the welfare system itself, along with those needing its support. The government have long wished to replace the publicly funded social security provision ultimately with mandatory private insurance schemesas have some ‘blue Labour’ neoliberals, including Purnell. 

The th empirically unevidenced idea that welfare creates ‘dependency’ and ‘disincentivises’ work has been used as a justification for the introduction of cuts and an extremely punitive regime entailing ‘conditionality’ and sanctions. The government have selectively used punitive behavioural modification elements of behavioural economics theory and its discredited behaviourist language of ‘incentives’ to steadily withdraw publicly funded social security provision, which is the ultimate ideological goal. That is the root of the problem. 

In light of this, the timing of Pollard’s set of proposals is also rather suspect – see The Centre for Social Justice say Brexit is ‘an opportunity’ to introduce private insurance schemes to replace contribution-based social security.

A DWP spokesperson has responded from the government’s crib sheet of crafted statements: “This report is completely misguided and we have no plans to reduce functionality at a time when unemployment is at its lowest, welfare reforms are rolling out across the country and millions are saving for a private pension for the first time. Jobcentres are a local presence yet benefit from a national framework. DWP supports around 20 million people to get into work and save for their retirement, as well as giving stability to those who cannot work, and will continue to do so as one responsible organisation.”

 


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

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I wrote an extensive critique of the recent government green paper on work, health and disability. I mentioned that a government advisor, who is a specialist in labour economics and econometrics, has proposed scrapping all Employment and Support Allowance (ESA) sickness and disability benefits.

Matthew Oakley, a senior researcher at the Social Market Foundation, recently published a report entitled Closing the gap: creating a framework for tackling the disability employment gap in the UK, in which he proposes abolishing the ESA Support Group.

I also said: “Oakely also suggests considering a “role that a form of privately run social insurance could play in both increasing benefit generosity and improving the support that individuals get to manage their conditions and move back to work.” 

And: “I’m sure the private company Unum (formerly UnumProvident) would jump at the opportunity. Steeped in controversy, with a wake of scandals that entailed the notorious company systematically denying people their disabilty insurance, in 2004, Unum entered into a regulatory settlement agreement (RSA) with insurance regulators in over 40 US states.

The settlement related to Unum’s “mishandling” of disability claims and required the company “to make significant changes in corporate governance, implement revisions to claim procedures and provide for a full re-examination of both reassessed claims and disability insurance claim decisions.”

The company is the top disability insurer in both the United States and United Kingdom. In the US, it has been regarded as one of the two most unscrupulous insurance companies. The rogue company was also accused of cheating thousands of people out of welfare payments in the US. By coincidence, the company has been involved in the design of the UK government’s controversial 2012 Welfare Reform Bill, advising the government on how to cut spending, particularly on disability support. What could possibly go right?

Of course the vulture capitalist company Unum continues to “mishandle” claims both in the US, in violation of the US Employee Retirement Income Security Act (ERISA) and here in the UK, denying people incapacity benefit, under employer’s group income protection policy (GIP).

The Reform think tank has also recently proposed scrapping what is left of the disability social security system, in their report Working welfare: a radically new approach to sickness and disability benefits, and has called for the government to set a single rate for all out-of-work benefits and to reform the way sick and disabled people are assessed.  

The members of the neoliberal think tank propose that the government should cut the weekly support paid to 1.3 million sick and disabled people in the ESA Support Group from £131 to £73. This is the same amount that people claiming Jobseeker’s Allowance receive. However, those people placed in the Support Group after assessment have been deemed by the state as unlikely to be able to work again in the foreseeable future. It would therefore be very difficult to justify this proposed cut, given the additional needs that disabled people have, which is historically recognised, and empirically verified by research.

Yet the authors of the report doggedly insist that having a higher rate of weekly benefit for extremely sick and disabled people encourages them “to stay on sickness benefits rather than move into work.” However, people on sickness benefits don’t move into work because they are too sick to work. Their own doctors and the state (via the work capability assessment) have already established that. Forcing them to work is outrageously tyrannical.

The report recommended savings which result from removing the disability-related additions to the standard allowance should be reinvested in support services and extra costs benefits – Personal Independence Payment (PIP). However the government have ensured that eligibility for that support is rapidly contracting, with the ever-shrinking political and economic re-interpretation of medically defined sickness and disability categories and a significant reduction in what the government deem to be a legitimate exemption from being “incentivised” into work.

Policy change can often be explained by reference to changes in background ideas about the state, society and the individual, held and promoted by influential individuals, groups, political parties and … multinational companies.  

It turns out that you can predict such a lot by simply watching the way the wind blows.

The crib sheet  

Theresa May’s new director of policy, John Godfrey, is a keen advocate of what, in his last job, at financial services giant Legal and General, he called “Beveridge 2.0”: using technology to introduce new forms of “social insurance”.

Godfrey told a campaigning group, the Financial Inclusion Commission last year that the systems used to deliver “auto-enrolment”, the scheme that ensures all low-income workers have a pension, could also be used to help the public insure themselves against “unexpected events”.

“There is a clear lesson from auto-enrolment that if you have a plumbing network or an infrastructure that works, that auto-enrolment infrastructure could be used for other things which would encourage financial inclusion: things like, for example, life cover, income protection and effective and very genuine personal contributory benefits for things like unemployment and sickness,” he said. 

“They can be delivered at good value if there is mass participation through either soft compulsion or good behavioural economics.”

Note the context shift in the use of the term “inclusion”, which was originally deemed a democratic right, now it’s being discussed narrowly in terms of soft compulsion and individual responsibility. And an exchange of money. Subtext: inclusion is only for those who can pay for it. 

report published by the Adam Smith Institute as far back as 1995 – The Fortune Account also sets out proposals to replace “state welfare” with an insurance system “operated by financial institutions within the private sector”. 

Mo Stewart has spent eight years researching the toxic and all-pervasive influence of the US insurance giant Unum over successive UK governments, and how it led to the introduction of the “totally bogus” and non-medical work capability assessment (WCA), which she says was designed to make it very much more difficult for sick and disabled people to claim out-of-work disability and sickness benefits.

Stewart’s excellent bookCash Not Care: The Planned Demolition Of The UK Welfare State, was published in September. She states that the assessment was modeled on methods used by the controversial company Unum to deny protection to sick and disabled people in the US who had taken out income protection policies.

She goes on to say that the WCA was “designed to remove as many as possible from access to [employment and support allowance] on route to the demolition of the welfare state”, with out-of-work disability benefits to be replaced by insurance policies provided by private companies like Unum.

Stewart warns us that the UK is now close to adopting a US-style model.

She’s absolutely right.

Our public services are being privately auctionedThe multinational corporations are queuing up for the sale of the century in the UK.

The public are picking up the tab.

 Rogue and antisocial corporations are writing public policies

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Corporate lobbyists are primarily interested in a tactical investment. Whether facing down a threat to profits from a corporate tax raise, or pushing for market opportunities – such as government privatisations – lobbying has become simply another way of making a lot of money for a few people. Lobbyist messages are very carefully crafted and spun, especially in the media. The ultimate corporate goal is sheer self-interested profit-making, but this will always be dressed up to appear synonymous with the wider, national interest. At the moment, that means a collective chanting of the “economic growth”, supply side “productivity”, implied trickle down, “jobs” and “personal responsibility” neoliberal mantra.

Corporations buy their credibility and utilise seemingly independent people such as academics with a mutual interest to carry their message for them. Some think tanks – especially free-market advocates like Reform or leading neoliberal think  tank, the Institute of Economic Affairs – will also provide companies with a lobbying package: a media-friendly report, a Westminster event, meetings with politicians. The extensive Public Relations (PR) industry are paid to brand, market, engineer a following, build trust and credibility and generally sell the practice of managing the spread of information between an individual or an organisation (such as a business, government agency, the media) and the public.

PR is concerned with selling products, persons, governments and policies, corporations, and other institutions. In addition to marketing products, PR has been variously used to attract investments, influence legislation, raise companies’ public profiles, put a positive spin on policies, disasters, undermine citizens’ campaigns, gain public support for conducting warfare, and to change the public perception of repressive regimes.

You can see how the revolving door of mutually exclusive political and corporate favour operates: it just keeps on spinning.

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Edelman Intelligence and Westbourne, for example, are engaged in rebuttal campaigns and multimedia astroturfing projects to protect corporate interests:

“Monitoring of opposition groups is common: one lobbyist from agency Edelman talks of the need for “360-degree monitoring” of the internet, complete with online “listening posts … so they can pick up the first warning signals” of activist activity. “The person making a lot of noise is probably not the influential one, you’ve got to find the influential one,” he says. Rebuttal campaigns are frequently employed: “exhausting, but crucial,” says Westbourne.” From The truth about lobbying: 10 ways big business controls government

Edelman Intelligence is the world’s largest PR company and have been quietly visiting my own WordPress site over this last year, the link shows they were referred to my site from their own social media monitoring command centre. I’ve contacted the company to ask why, but have yet to receive a response. I’m not a paying client so it’s highly unlikely that the visits are in connection with promoting my best interests. Paying clients include the likes of Rupert Murdoch. (See footnote).

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Unum’s long standing toxic influence on policy-making

In a recent press release, the delighted vulture capitalists at Unum say that they welcome the government’s recent Green Paper’s focus on Group Income Protection. The press release also says:

“Unum has welcomed the government’s recognition in a new Green Paper that “Group Income Protection policies have a much greater role to play in supporting employers” help people with health problems to stay in or return to work.

The proposals were set out in Improving Lives: the Work, Health and Disability Green Paper, launched by the Department for Work and Pensions and Department of Health, yesterday, 31 October 2016. As part of its efforts to enable “more people with long term conditions to reap the benefits of work and improve their health”, the Paper includes a number of proposals to prevent people falling out of work for health reasons and to make employers feel more confident about supporting disabled employees. In particular, it includes a number of specific policy ideas to increase the number of British workers with Group Income Protection (GIP).

Through GIP, Unum has enabled thousands of people to return to work after long term sickness absences caused by mental health and musculoskeletal problems and other serious health conditions, including cancer and multiple sclerosis. Unum also provides training, support and advice to employers and line managers on how to look after employees with health problems and help them stay in or return to work.

To increase the number of workers who benefit from GIP coverage, Unum is calling on the government to consider a temporary tax break for employers that buy GIP for their staff. This would reduce the number of people who fall out of work for health reasons, protect the finances of those who are unable to work and boost the productivity of UK businesses.”

In my critical analysis of the work, health and disability green paper, I said: 

“And apparently qualified doctors, the public and our entire health and welfare systems have ingrained “wrong” ideas about sickness and disability, especially doctors, who the government feels should not be responsible for issuing the Conservatives recent Orwellian “fit notes” any more, since they haven’t “worked” as intended and made every single citizen economically productive from their sick beds.

So, a new “independent” assessment and some multinational private company will most likely very soon have a lucrative role to ensure the government get the “right” results.”

The medical specialists are to be replaced by another profiteering corporate giant who will enforce a political agenda in return for big bucks from the public purse. Health care specialists are seeing their roles being incrementally and systematically de-professionalised. That means more atrocious and highly irrational attempts from an increasingly authoritarian government at imposing an ideological “cure” – entailing the withdrawal of any support and imposing punitive “behavioural incentives” – on people with medical conditions and disabilities.

Doctors, who are clever enough to recognise, diagnose and treat illness, are suddenly deemed by this government to be not clever enough to judge if patients are fit for work. It seems that the Conservatives don’t like competent witnesses who may challenge their droning ideologically driven neoliberal psychobabbling.

The political de-professionalisation of medicine, medical science and specialisms (consider, for example, the implications of permitting job coaches to update patient medical files), the merging of health and employment services and the recent absurd declaration that work is a clinical “health” outcome, are all carefully calculated strategies that serve as an ideological prop and add to the justification rhetoric regarding the intentional political process of dismantling publicly funded state provision, and the subsequent stealthy privatisation of Social Security and the National Health Service. 

De-medicalising illness is also a part of that process:

“Behavioural approaches try to extinguish observed illness behaviour by withdrawal of negative reinforcements such as medication, sympathetic attention, rest, and release from duties, and to encourage healthy behaviour by positive reinforcement: ‘operant-conditioning’ using strong feedback on progress.” Gordon Waddell and Kim Burton in Concepts of rehabilitation for the management of common health problems. The Corporate Medical Group, Department for Work and Pensions, UK. 

Medication, rest, release from duties, sympathetic understanding – remedies to illness – are being redefined as “perverse incentives” for “sickness behaviours”, yet the symptoms of an illness necessarily precede the prescription of medication, the Orwellian (and political rather than medical) “fit note” and exemption from work duties. Notions of “rehabilitation” and medicine are being redefined as behaviour modification: here it is proposed that operant conditioning in the form of negative reinforcement, which the authors seem to have confused with punishment, will “cure” ill health.

This is the same kind of thinking that lies behind welfare sanctions, which are state punishments entailing the cruel removal of lifeline income for “non-compliance” in narrowly and rigidly defined “job seeking behaviours.” Sanctions are also described as a “behavioural incentive” to “help” and “encourage”people into work. People who are ill, it is proposed, should be sanctioned, too, which would entail having their lifeline basic health care removed.

Many qualitative accounts from first hand witnesses, extensive research and empirical evidence has repeatedly demonstrated that welfare sanctions make it less likely that people will find employment: taking essential support from people with very limited resources profoundly demotivates, distresses and harms people, rather than “incentivising” them to find work. (See also: Benefits sanctions: a policy based on zeal, not evidence and The Nudge Unit’s u-turn on benefit sanctions indicates the need for even more lucrative nudge interventions, say nudge theorists.)

The darker meaning of David Cameron’s comment about “ending a culture of entitlement” back in 2010 has become clearer. He wasn’t only talking about perceived attitudes and referencing erroneous, unverified and unfounded notions of “welfare dependency”: his party’s aim was and still is about reducing public expectations of a supportive and rights-based relationship with the publicly-funded state – one that has evolved from the post-war settlement to ensure that everyone in the UK can meet their basic human needs.

Poor and ill people cannot be simply punished (or “nudged”) out of being poor or ill. 

Sanctions are a callous, profoundly antidemocratic, dysfunctional and extremely regressive form of economic terrorism, founded entirely on traditional Conservative prejudices about poor people and rigid ideological assumptions. It is absolutely unacceptable that a government treats some people, including some of the UK’s most vulnerable citizens, in such horrifically cruel and dispensable way, in a very wealthy, so-called civilised, first-world liberal democracy.

Unum also have a longstanding reputation for trying to reduce physical illness to “subjective states” and “faulty behaviours”, too. (See also: evidence submitted to the the select health committee by Professor Malcolm Hooper and Subjective symptom disability claims: Chronic Fatigue, Fibromyalgia and Multiple chemical sensitivity syndrome for example).

Even public policies that are supposed to address fundamental human needs arising from sickness and disability are tainted by a neoliberal idée fixe. The leitmotif is a total corporacratic commodification of human needs and relationships; building hierarchies of human worth within the closed and entropic context of a competitive market place, where resources are “scarce” and people are being herded; where the only holding principle that operates is profit over human need.

“In defiance of the substantial biomedical evidence submitted to its Guideline Development Group (GDG), NICE is recommending an inappropriate and potentially dangerous behavioural modification regime as the only management strategy for those with ME/CFS. NICE’s recommended management regime is promoted by a group (mainly psychiatrists) who have undeclared but undeniable competing financial interests.” Malcolm Hooper

It’s mind over matter and quids in

Behavioural medicine was partly influenced by Talcott Parsons’ The Social System, 1951, and his work regarding the sick role, which he analysed in a framework of citizen’s roles, social obligations, reciprocities and behaviours within a wider capitalist society, with an analysis of rights and obligations during sick leave. From this perspective, the sick role is considered to be sanctioned deviancewhich disturbs the function of society. (It’s worth comparing that the government are currently focused on economic function and enhancing the supply side of the labour market.)

Behavioural medicine more generally arose from a view of illness and sick role behaviours as characteristics of individuals, and these concepts were imported from sociological and sociopsychological theories.

However, it should be pointed out that there is a distinction between the academic social science disciplines, which include critical perspectives of conflict and power, for example, and the recent technocratic “behavioural insights” approach to public policy, which is a monologue that doesn’t include critical analysis, and serves as prop for neoliberalism, conflating citizen’s needs and interests with narrow, politically defined economic outcomes.

We have a government that has regularly misused concepts from psychology and sociology, distorting them to fit a distinct framework of ideology, and justification narratives for draconian policies. Parsons’ work has generally been defined as sociological functionalism, and functionalism tends to embody very conservative ideas. From this perspective, sick people are not productive members of society; therefore this deviation from the norm must be policed. This, according to Parsons, is the role of the medical profession. More recently we have witnessed the rapid extension of this role to include extensive State policing of sick and disabled people.

It seems many of the psychosocial advocates have ignored the rise of chronic illnesses and the increasing pathologisation of everyday behaviours in health promotion. Parson’s sick role came to be seen as a negative referent (Shilling, 2002: 625) rather than as a useful interpretative tool. Parsons’ starting point is his understanding of illness as deviance. Illness is the breakdown of the general “capacity for the effective performance of valued tasks” (Parsons, 1964: 262). Losing this capacity disrupts “loyalty” to particular commitments in specific contexts such as the workplace.

Theories of the social construction of disability also provide an example of the cultural meaning of certain health conditions. The roots of this anti-essentialist approach are found in Stigma by Erving Goffman (1963), in which he highlights the social meaning physical impairment comes to acquire via social interactions. The social model of disability tends to conceptually distinguish impairment (the attribute) from disability (the social experience and meaning of impairment). Disability cannot be reduced to a mere biological problem located in an individual’s body  (Barnes, Mercer, and Shakespeare, 1999). Rather than a “personal tragedy” that should be fixed to conform to medically determined standards of “normality” (Zola, 1982), disability becomes politicised. The issues we then need to confront are about the obstacles that may limit the opportunities for individuals with impairments, and about how those social barriers may be removed.

From a social constructionist perspective, emphasis is placed on how certain illnesses come to have cultural meanings that are not reducible to or determined by biology, and these cultural meanings further burden the afflicted (as opposed to burdening “the tax payer” , the health services, those with profit seeking motives, or the state.)

So to clarify, it is wider society and governments that need a shift in disabling attitudes, perceptions and behaviours, not disabled people.

The insights that arose from the social construction of disability approach are embodied in policies, which include the Disability Discrimination Act 1995, which included an employers’ duty to ensure reasonable adjustments/adaptations; the more recent Equality Act 2010 and the Human Rights Act 1998, which provides an important tool for disabled people to use to challenge discrimination, violations to their human rights and unacceptable treatment.

In contrast, Parsons invokes a social contract in which society’s “gift of life” is repaid by continued contributions and conformity to (apparently unchanging, non-progressive) social expectations. For Parsons, this is more than just a matter of symbolic interaction, it has far more concrete, material implications: “honour” (deserving) and “shame” (undeserving) which accompany conformity and deviance, have consequences for the allocation of resources, for notions of citizenship, civil rights and social status.

Parsons never managed to accommodate and reflect social change, suffering and distress, poverty, deprivation and conflict in his functionalist perspective. His view of citizens as oversocialised and subjugated in normative conformity was an essentially Conservative one. Furthermore, his systems theory was heavily positivistic, anti-voluntaristic and profoundly dehumanising. His mechanistic and unilinear evolutionary theory reads like an instruction manual for the capitalist state.

Parsons thought that social practices should be seen in terms of their function in maintaining order and social structure. You can see why his core ideas would appeal to Conservative neoliberals and rogue multinational companies. Conservatives have always been very attached to tautological explanations (insofar that they tend to present circular arguments. One question raised in this functional approach is how do we determine what is functional and what is not, and for whom each of these activities and institutions are functional. If there is no method to sort functional from non-functional aspects of society, the functional model is tautological – without any explanatory power to why any activity is regarded as “functional.” The causes are simply explained in terms of perceived effects, and conversely, the effects are explained in terms of perceived causes). 

Because of the highly gendered division of labour in the 1950s, the body in Parsons’ sick role is a male one, defined as controlled by a rational, purposive mind and oriented by it towards an income-generating performance. For Parsons, most illness could be considered to be psychosomatic.

The “mind over matter” dogma is not benign; there are billions of pounds and dollars at stake for the global insurance industry, which is set to profit massively to the detriment of sick and disabled people. The eulogised psychosocial approach is evident throughout the highly publicised UK PACE Trial on treatment regimes that entail Cognitive Behaviour Therapy (CBT) and graded exercise. By curious coincidence, that trial was also significantly about de-medicalising illnesses. Another curious coincidence is that Mansel Aylward sat on the PACE Trial steering group. 

Here is further evidence that government policy is not founded on empirical evidence, but rather, it is often founded on deceitful contrivance. 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”

Rather than make a link between manual work, lack of reasonable adjustments in the work place and the impact this may have on longer term ill health, the government chose instead 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 downright dangerous.

As neoliberals, the Conservatives see the state as a means to reshape social institutions and social relationships based on the model of a competitive market place. This requires a highly invasive power and mechanisms of persuasion, manifested in an authoritarian turn. Public interests are conflated with narrow economic outcomes. Public behaviours are politically micromanaged. Social groups that don’t conform to ideologically defined economic outcomes are politically stigmatised and outgrouped.

Nudging, Unum and the behaviourist turn in medicine. 

The history of medicine and definitions of illness and disability are being re-written for the insurance industry, by neoliberal “small state” ideologues and anti-welfarist governments.

Formally instituted by Cameron in September 2010, the Behavioural Insights Team, (otherwise known as the Nudge Unit), which is a part of the Cabinet Office, is made up of people such as David Halpern, who co-authored the Cabinet Office report: Mindspace: Influencing Behaviour Through Public Policy, which comes complete with a cover illustration of the human brain, with an accompanying psychobabble of decontextualised words such as “incentives”, “habit’, “priming” and “ego.” It’s all just a stock of  inane managementspeak. Neoliberal psychobabbling and strategies of psycho-complulsion.

The report addresses the needs of policy-makers.  Not the public. The behaviourist educational function made explicit through the Nudge Unit is now operating on many levels, including through policy programmes, forms of “expertise”, and through the State’s influence on citizens, the mass media, other cultural systems and at a subliminal level: it’s embedded in the very language that is being used in political narratives.

The increasing focus on social control and conformity in public policy design and governing has been dubbed “neuroliberalism”, reflecting something of a behaviourist turn. It draws on social marketing as a policy tool, in which principles from private marketing and advertising are applied to the definition and promotion of “good” behaviours. Deviance (“bad” behaviour) is defined politically through the intentional and systematic stigmatisation of already marginalised social groups, leading to the creation of folk devils and moral panic which is amplified and perpetuated by the media. 

Othering and outgrouping have become common political practices. 

This serves to desensitise the public to the circumstances of marginalised social groups and legitimises neoliberal “small state” policies, such as the systematic withdrawal of state support for those adversely affected by neoliberalism, and it also justifies inequality. By stigmatising the poorest citizens, a “default setting” is established regarding how the public ought to perceive and behave towards defined outgroups. 

Policies directed at the poorest and some of the most vulnerable citizens are being used to extend behaviour modification techniques, based on methodological behaviourism. This is a psychocratic approach to administration: the government are delivering public policies that have an expressed design and aim to act upon individuals, with an implicit set of instructions that inform citizens how they should be.  

Aversives and punishment protocols are being used on the public. Coercive and harshly conditional welfare policies are one example of this.

The origin of active welfare (the idea that the social security system should reflect that the habitually “idle poor” need coercing into work), founded on the idea that poor people are the cause of their own poverty because of their cognitive and behavioural flaws – they fail to take advantage of the opportunities “available” to them – lies with the US neoliberal right.

Charles Murray and Lawrence Mead clearly made an impact on the international policy debate in the 1980s, partly due to the legitimisation that they received from the support of the Reagan and Thatcher administrations for their central claims. They were particularly influential in the growth of work fare and a welfare system based on punishment and psycho-compulsion. Murray claimed the underclass of poor people avoid work because of the “overgenerous” nature of welfare benefits. Mead argued that a “culture of poverty” meant that workfare policies are required to “reintegrate” and “incentivise” the unemployed poor. 

In the UK, James Purnell, one of the work and pensions secretaries for New Labour, said: “For those who play by the rules, there is a world of opportunity. But for those who don’t, there will be clear consequences from their behaviour”.

He sounds rather like an authoritarian Victorian headmaster.

So what exactly are “the rules”, and who has made them?

Government policies are expressed political intentions regarding how our society is organised and governed. They have calculated social and economic aims and consequences. In democratic societies, citizens’ accounts of the impacts of policies ought to matter. 
 
However, in the UK, the way that policies are justified is being increasingly detached from their aims and consequences, partly because democratic processes and basic human rights are being disassembled or side-stepped, and partly because the government employs the widespread use of linguistic strategies: euphemisms, superficial glittering generalities and techniques of persuasion to intentionally divert us from aims and consequences of ideologically (rather than rationally) driven policies. Furthermore, policies have become increasingly detached from public interests and needs. 

Neoliberal anti-welfarism, amplified by a corporate media, has aimed at reconstruction of society’s “common sense” assumptions, values and beliefs. Class, disability and race narratives in particular, associated with traditional prejudices and categories from the right wing, have been used to nudge the UK to re-imagine citizenship, human rights and democratic inclusion as highly conditional.  

Illness is all in the mind: conforming to roles and academically constructed stereotypes

“Diagnosis elicits the belief the patient has a serious disease, leading to symptom focusing that becomes self-validating and self-reinforcing and that renders worse outcomes, a self-fulfilling prophecy, especially if the label is a biomedical one like ME. Diagnosis leads to transgression into the sick role, the act of becoming a patient even if complaints do not call for it, the development of an illness identity and the experience of victimization”. Simon Wessely and Marcus S.J. Huibers: The act of diagnosis: pros and cons of labelling chronic fatigue syndrome. Psychological Medicine 2006: 36

In 1993, Mansel Aylward invited psychiatrist Simon Wessely to give a presentation on his biopsychosocial approach to Chronic Fatigue Syndrome before the then Minister for Social Security. Wessely claimed: “As regards benefits:- it is important to avoid anything that suggests that disability is permanent, progressive or unchanging. Benefits can often make patients worse.” 

Benefits can often make patients worse.” I think he meant the patient’s illness is made worse. Despite there being little empirical evidence for these claims, the Minister for Social Security was looking to cut spending, so self-styled “experts” were more useful to an expedient government than rigorous research. I think it would be true to say that without social security, many people who are disabled because of Chronic Fatigue Syndrome (CFS) would experience MUCH worse symptoms, as indeed people with other chronic illnesses would, and some would undoubtedly die without lifeline support to enable them to meet their basic survival needs. 

ME action UK say that on  May 17, 1995, Wessely was one of  the main speakers at a Unum-supported symposium held in London entitled “Occupational Health Issue for Employers” (where ME was described as “the malingerers’ charter”) at which they advised employers how to deal with employees who were on long-term sickness absence with “CFS”.  Moreover, in UNUM’s “Chronic Fatigue Syndrome Management Plan”, ME/CFS is described as “Neurosis with a new banner” and the same document states  “UNUM stands to lose millions if we do not move quickly to address this increasing problem”. 

Unum have been advising UK governments since at least 1994, when the  Conservative government hired John LoCascio, second vice-president of giant and scandalous US disability insurance company, Unum, to advise on reducing the numbers successfully claiming Incapacity Benefit (IB). He joined the “medical evaluation group”.

Another key figure in the group was Mansel Aylward. The group devised a stringent “all work test”. Approved doctors were trained in Unum’s approach to “claims management”. That’s basically  managing not to pay people what they are entitled to. The rise in IB claimants came to a halt. However, it did not reduce the rising numbers of claimants with mental health problems.

Supporters of the behaviourist “non-medical” model of disability and illness include Mansel Aylward, Dame Carol Black, Lord Freud and Lord Kirkwood of Kirkhope (the chairman of the Unum customer advisory panel, whilst he was also Chair of the UK parliament’s work and pensions select committee).

Of course there is the lowest common denominator for highest possible private profits in operation in the US and UK. Some names keep recurring, like the proverbial bad penny for bad thoughts. The controversial PACE trial is just another small variation of the leitmotif. Recently an information tribunal rejected a university’s £200,000 attempt to prevent release of data from the controversial medical trial, that was the first to receive Department for Work and Pensions (DWP) funding.

The PACE trial mirrors Unum’s previous systematic and wholly non scientific de-medicalisation and subsequent trivialisation of serious illnesses such as Myalgic Encephalomyelitis (ME), Chronic Fatigue Syndrome (CFS) and Fibromyalgia in the US, and has led to the growth and standardisation of “behavioural” medical treatment regimes, such as cognitive behaviour therapy (CBT), which is often used to reduce the use of pharmacological pain relief in a wide range of chronic illnesses, including connective tissue diseases such as rheumatoid arthritis and lupus.

The World Health Organisation classified these illnesses as physical diseases, now they are being reconstructed as “psychosocial” phenonena, with recovery supposedly being dependent on the sick person’s attitude and mindset, by greedy crony capitalists and ideologically expedient neoliberal “small state” anti-welfarist governments.

This current psychosocial approach to medical conditions is about addressing a perceived need for cognitive and behavioural change: it allegedly addresses patient’s “attitudes and perceptions” of their condition, their “coping mechanisms” or lack of them, and perceptions of pain and its “management”. None of this affects the underlying disease activity or the damage that disease processes cause to the body.  It’s speculative nonsense.

The trial assessed the value of “biopsychosocial” interventions at the same time as the DWP was using the biopsychosocial model of disability to help justify cuts to disability spending. 

The absurd consequences of permitting a vulture capitalist insurance multinational to write sickness and disability public policies

It’s an interesting observation that Mansel Aylward, who was a key architect of the last decade’s welfare “reforms”, had helped to secure funding for the PACE Trial and sat as an “observer” on the trial’s steering committee. The DWP co-funded the trial. The failure to release the results for the pre-specified analyses laid out in the PACE trial’s protocol is of concern as it had already been noted that there was a likely ideological bias of the trial’s three principal investigators.

All three investgators have invested in developing careers founded on the development of biopsychosocial interventions for CFS, and the two who had been part of the Chief Medical Officer’s CFS working group both resigned because the active biopsychosocial approaches of Cognitive Behaviour Therapy (CBT) and Graded Exercise Therapy (GET) were not endorsed over “pacing” in the way that they had wanted. (See Chronic fatigue report delayed as row breaks out over content. The British Medical Journal, 2002, and Power-sharing, not a take-over, 2002.)

All three principal investigators also reported conflicts of interest involving the insurance industry. There has long been concern about private insurance companies influencing changes to undermine the UK welfare state, a system of social insurance that they currently compete against. (See Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial, 2011 and “In the Expectation of Recovery” MISLEADING MEDICAL RESEARCH AND WELFARE REFORM, George Faulkner, 2016).

“Back in 1995 a Unum report on CFS stated that they could “lose millions if we do not move quickly to address this increasing problem”. It was argued that CFS claims should be managed “more aggressively and in a proactive rather than a reactive fashion” while attempting to present CFS as “neurosis with a new banner”. Emphasising the importance of psychosocial factors and classing CFS as a mental health problem could bring immediate financial benefits to insurance companies when policies limit payouts for mental health problems.

“One of the PACE trial’s principal investigators gave a presentation on the results of the PACE trial to Swiss Re insurance. Swiss Re’s report of his talk detailed the potential use of mental health exclusions to cut payments, while a 2013 Swiss Re presentation on their approaches to mental health problems describes their use of specific exclusions for CFS and ME.

“During the Swiss Re presentation on PACE no mention seems to have been made of the fact that PACE found neither CBT nor GET were associated with improved employment outcomes, and instead Swiss Re’s claims managers continued to be encouraged to believe that promoting these active rehabilitative approaches would assist return to work. There has been concern about insurance companies pushing some patients with CFS to take part in CBT and GET against their wishes.

“A response to the paper which published the PACE trial’s data on employment outcomes was titled Coercive practices by insurance companies and others should stop following the publication of these results, but has yet to receive a response from the PACE team.” George Faulkner, 2016

From 1996 to April 2005 Mansel Aylward was chief medical adviser, medical director and chief scientist of the UK Department for Work and Pensions and chief medical adviser and head of profession at the veteran’s agency, Ministry of Defence. He was involved in the establishment of the new Work Capability Assessment. When he left the department, he headed the UnumProvident Centre for Psychosocial and Disability Research, at Cardiff University. (The centre has since been renamed and Unum claim they no longer provides any funding – no doubt because of the claims that academic integrity could be called into question by its influence.)

The Scientific and Conceptual Basis of Incapacity Benefits by Gordon Waddell and Mansel Aylward, followed by the 2006 report: Is work good for your health and well-being by Gordon Waddell and Kim Burton, were both very influential reports that were commissioned by the DWP and so inclined towards ideologically biased outcomes from the start. Both reports were produced when Aylward and Waddell were sponsored by UnumProvident – Centre for Psychosocial and Disability Research ( at Cardiff  University) – with funding of course from Unum Provident, from 2004-2009.

In January 2003, an influential book, Malingering and illness deception was published as a very large hymn crib sheet that was to inform political rhetoric, media justification narratives and the subsequent welfare “reforms.” It was also funded by the DWP, with telltale dogma and schematic contributions from Gordon Waddell, John LoCascio of UNUM Provident Insurance Company, and of course there is this telling acknowledgment:

The meeting which formed the basis for this book would not have been possible had it not been for the enthusiastic support of Professor Mansel Aylward and funding from the Department for Work and Pensions.” 

The book has political agenda-setting chapter sub-headings such as: Investigating benefit fraud and illness deception in the United Kingdom, Malingering, insurance medicine, and the medicalization of fraud and Wilful deception as illness behaviour. 

Unum insidiously built up credibility and influence in Britain. The company appointed Mansel Aylward as director of their Centre for Psychosocial and Disability Research, following his retirement from the DWP. The launch event was attended by Archie Kirkwood, who was appointed chair of the House of Commons select committee on work and pensions. Malcolm Wicks, minister of state in the DWP, gave a speech praising the “partnership between industry and the university.”

The whole aim of the centre was to transform the ideological paradigm of welfare from one based on a rights-based post- war collectivism to one increasingly enclosed by a responsibility-based individualism and so help develop the market for Unum’s products. In 2005, the centre produced The Scientific and Conceptual Basis of Incapacity Benefits (TSO, 2005) written by Aylward and colleague Gordon Waddell. It provided the conceptual framework for the 2006 welfare reform bill.

Of course the more recent widespread criticism of “Atos” assessments in the UK has been beneficial to Unum as it undermines confidence in state provision of disability benefits. Such a profound loss of confidence makes it much easier to sell alternatives: private insurance. 

Its methodology is the same one that informs Unum’s approach. Is work good for your health and well-being by Gordon Waddell and Kim Burton was also a very influential report, both were also commissioned by the DWP and so inclined towards ideologically biased outcomes from the start. Just to be clear, both reports were produced when Aylward and Waddell were sponsored by UnumProvident – Centre for Psychosocial and Disability Research (the Centre) at Cardiff  University, with funding by Unum Provident, from 2004-2009.

Among the spurious ideas used to justify cutting lifeline social security support is that disabled and ill people are not working because of an “internalisation of the sick or “patient” role as the dominant feature of their lives,” and that “work is good for health.” 

In a memorandum submitted to the House of Commons select committee on work and pensions, Unum define their method of working: “Our extended experience […] has shown us that the correct model to apply when helping people to return to work is a biopsychosocial one.”

The emphasis, however, is on the “psychosocial”. This shifts the focus from the medical conditions that cause disability and illness to the behaviours and perceptions of patients and ultimately, to neoliberal notions of personal responsibility and self-sufficient citizenship in a context of a night watchman, non-welfare state. 

Waddell and Aylward adopted the same arguments in their monograph. Disease is the only form of objective, medically diagnosable pathology. Sickness is a temporary phenomenon. Illness is a behaviour. Incapacity Benefit trends are a social phenomenon rather than a health problem. The solution is not to cure the sick, but a “fundamental transformation in the way society deals with sickness and disabilities” (p123). The goal and outcome of treatment is work, because work is therapeutic.

Worklessness is a serious risk to life. It is “one of the greatest known risks to public health: the risk is equivalent to smoking 10 packets of cigarettes per day” (p17). And: “No-one who is ill should have a straightforward right to incapacity benefit.”

David Freud adopts the same spurious psychosocial approach in a report that formed a review of the government’s Welfare to Work strategy. He cites Waddell and Burton: “Work is good for health.” (From “Is Work Good for your Health and Well-Being”, 2006)

Aylward has been widely criticised for giving “academic” credibility to the biopsychosocial model which was said to be the basis of the Cameron government’s disability benefits “reforms”. Aylward prepared reports that were quoting “illness belief” as being a supposedly more likely cause for many “common mental health conditions” or “musculoskeletal conditions”. There were repeated references made in some of his and Gordon Waddell’s research to alleged “malingering” by patients.

“Obstacles to recovery and return to work are primarily personal, psychological and social rather than health-related “medical” problems.”

“Beliefs, perceptions and personal responses lie at the heart of the problem [of worklessness through ill health].”  Worklessness and Health: A Symposium – Mansel Aylward.

It’s worth noting that the “musculoskeletal conditions” include backache, pulled ligaments and muscles, injured tendons, prolapsed spinal discs, sciatica – all of which a person may fully recover from. This category of conditions also includes osteoarthritis, osteoporosis and more serious and chronic illnesses caused by connective tissue disease – most people do not recover from these, and the biological damage that this family of diseases cause is not just confined to the musculoskeletal system. By using such a broad category of wide-ranging conditions, this effectively trivialises the most serious and often progressive diseases in the category.

This is why I visit my doctor, and not the government or a “researcher” with a vested interest, when I am unwell. I don’t believe anyone was ever cured by ideology. Nor do I believe work is a “health” outcome. If the protestant work ethic is such an effective cure for disease, the Victorian era “trial” certainly didn’t provide any empirical evidence of that in the premature mortality rates. In fact both men and women were debilitated by the age of forty. Poor nutrition, long hours and premature full-time employment all contributed to a short life expectancy. (Daily Life in Victorian Britain, Sally Mitchell, 1996.)

Although life span slowly increased within the Victorian age, notably as treatment became more advanced, surgery more effective, and medical knowledge more extensive, the average life span in 1840, in the Whitechapel district of London, was 45 years for the upper class and 27 years for tradesman. Laborers and servants lived only 22 years on average. (Victorian Britain Encyclopedia, Sally Mitchell, 1988.)  

Aylward claims that the principal negative influences on return to work are: Personal / psychological: Catastrophising pain (even minor degrees). Low Self-Efficacy. Social: Lone parenthood / unstable relationships – being a “Victim” of modern society in rented or social housing. General Affect: Being sad or low most of the time: Pervasive thoughts about personal illness. Cognitive: Minimal health literacy. Self-monitoring (symptoms). False beliefs. Economic: Availability of alternative sources of income / support (such as the availability of health care and welfare. (Pages 15-16).

“Catastrophising pain” is a phrase that crops up in a lot of biopsychosocial texts. It’s another of those made up words and phrases, like “worklessness”, “making work pay” and “culture of dependency” which are just ideological signposts to neoliberal notions of competitive individualism, anti-welfarism and personal responsibility, without any reference to reality. And if you make a claim that sickness and pain are “subjective”, surely attempts to describe how other people subjectively experience sickness and pain is even more subjective.

And accusing someone else of holding false beliefs regarding their own state?  Really? You can’t get further away from empirically verifiable statements than that.

The UK government and the Reform think tank claim that the availability of social security serves as a “disincentive” for ill and disabled people to return to work. The cuts to essential lifeline support for people who are ill and disabled that have been embedded in the systemic welfare “reforms” are all about “promoting economic self-sufficiency.”  

However, that is precisely what public national insurance contributions are about. The idea originally was that social provision should be designed to protect people from the ravages of absolute poverty and capitalism – it was intended to support poor citizens  – and to speculate that such support actually makes people poor is simply incoherent pseudoscientific nonsense and derisory political posturing from the “private” state neoliberals.

Aylward highlights more than once on his writing a perceived tension between “disability rights” and state notions of “benefit dependency.” (for example, on Page 8 of  Worklessness and Health: A Symposium). 

Yet Unum say:  “And contrary to popular belief, if your employees are aware of benefits – such as private health insurance or Income Protection – they are not likely to take more time off sick. Cass’ research shows that communicating about a wide range of employee benefits actually builds employee engagement and a more loyal workforce that takes less time off sick.”  Unum: How to communicate your employee benefits package.

However, there are conflicting messages to employers on this issue: “Sick-pay provisions may also encourage or discourage absence, and it is important that an organisation monitors and analyses its absence recording systems in order to pick up any perverse behaviours being driven by the sick-pay schemes. For example, it is not uncommon to see spikes of return to work when an absent employee moves to half pay or no pay.”

The cure for sick leave is work and other gems of wishdom

The biopsychosocial model has become a disingenuous euphemism for psychosomatic illness, which has been exploited by medical insurance companies and by governments keen to limit or deny access to social security, medical and social care.

This approach to disability and ill health has been used to purposefully question the extent to which people claiming social security bear personal responsibility for their own health status, rehabilitation and prompt return to work. It also leads to the alleged concern that a welfare system which provides a livable income to those with disabling health problems may provide “perverse incentives” for perverse behaviours, entrenching “worklessness” and a “culture of dependency”. It’s worth pointing out at this point that there has never been any empirical evidence of welfare “dependency”.

Instead of being viewed as a way of diversifying risk and supporting those who have suffered misfortune, social and private insurance systems are to be understood as perverse incentives that pay people to remain ill and keep them from being economically productive.

The government have made it clear that there are plans to merge health and employment services. In a move that is both unethical and likely to present significant risk of harm to many patients, health professionals are being tasked to deliver benefit cuts for the DWP. This involves measures to support the imposition of work cures, including setting employment as a clinical outcome and allowing medically unqualified job coaches to directly update a patient’s medical record.

The Conservatives (and the Reform think tank) have proposed mandatory treatment for people with long term conditions (which was first flagged up in the Conservative Party Manifesto) and this is currently under review, including whether benefit entitlements should be linked to “accepting appropriate treatments or support/taking reasonable steps towards “rehabilitation”.  The work, health and disability green paper and consultation suggests that people with the most severe illnesses in the support group may be subjected to welfare conditionality and sanctions.

Such a move would have extremely serious implications. It would be extremely unethical and makes the issue of consent to medical treatment very problematic if it is linked to the loss of lifeline support or the fear of loss of benefits. However this is clearly the direction that government policy is moving in and represents a serious threat to the human rights of patients and the independence of health professionals.

Behavioural medicine is prevalent in the United States, where many health problems are primarily viewed as behavioural in nature, as opposed to medical. The biopsychosocial model of illness has encouraged unsubstantiated claims that “positive attitude” or “fighting spirit” can help slow cancer and other progressive diseases, which may be very harmful to the patients themselves. Patients may come to believe that a poor prognosis or their poor progress results from “not having the right attitude”, when in fact it is most likely through no fault of their own.

Increasingly, insurers, policy makers and employers are pressing for policies that would redistribute expenses resulting from what they regard to be “voluntary” health risks to those who “choose” to take such risks.

Of course the long term aim of the Conservatives is to dismantle social security and the National Health Service (NHS) – free health care provision – entirely. Access to health care in the UK is currently being rationed because of the government’s systematic cuts to the NHS budget, and payments for some treatments have been introduced by stealth.  

Unum say:The Green Paper also calls for proposals to overhaul sickness certification and GPs’ approach to Fit Note. Unum has been calling for reform of Fit Notes so more people are able to access the right support to return to work as soon as possible.”

By that phrase “the right support” the predatory private company are simply singing from the same crib sheet as the government. Lots of mutual back patting and private handshakes have sealed the deal of doom for the welfare state long ago. The “right support” simply entails removing any support at all for ill and disabled people so that they are forced to work or starve and become destitute.

Unum’s modus operandi in the US was based on the unscrupulous practice of putting profit over human health. A 2004 investigation determined the practice began as early as 1994, and a CBS 60 Minutes report revealed the company established a quota for denied claims and actually offered incentives to employees who denied valid claims from policyholders. The company also delayed claims to make profit.

Unum was forced by state regulators to re-open 290,000 disability insurance claims that had been rejected, including a case where “Unum insisted that a man who had quintuple bypass surgery was fit to go back to his job at a stock brokerage firm, even though his doctors said the stress might kill him” and also, where Unum “refused benefits to a man who had had multiple heart attacks”

An investigation in California found that Unum systematically violated state insurance regulations and fraudulently denied claims using phony medical reports, policy misrepresentations, and biased investigations. The rogue company admitted to only reviewing 10 percent of the eligible cases for reopening under the terms of their legal settlement reached three years earlier.

Unum’s callous profiteering and illegal behaviour led California Insurance Commissioner John Garamendi to state that “UnumProvident is an outlaw company. It is a company that for years has operated in an illegal fashion.” A Yale University research paper commented that, with regards to Employee Retirement Income Security Act (ERISA) and other cases, Unum was “engaged in a program of deliberate bad faith denial of meritorious claims.” 

Yet this is the company admired and unscrupulously hired by UK governments as a “leader” in dealing unscrupulously with disability claims, and violating the human rights of disabled people.

The cooperation between the UK government and Unum stems entirely from a community of mutually vested interests between them, with both the corporate vultures and their allies in government wishing to reduce the amount of people who are able to claim disability through sickness; the government so it can pay less and less of our money in social security to people who need to draw on their national insurance for support and the insurance company so it can profitably contest or refuse more insurance claims. 

So, after the systematic cuts to social security have been persistently justified by an alleged need to “change the behaviours” of poor people and to “incentivise” them into work, we now have behavioural change treatments becoming more prominent in health care and medicine. In the same way that poor people are held responsible for poverty, ill people are held responsible for illness. Just as ministers claim that poor people are a “burden” on public services and tax payers, now they are saying ill people are a burden on the NHS and tax payers… just take a moment think that through.

The Conservatives came up with an idea that will kill two birds with one stone, as it were. They decided to demand that poor people think work is good for health. They plan to combine the goals of job centres and GP surgeries. Job coaches are the new health care professionals, apparently. Of course that anti-welfare and anti-health care strategy won’t change a thing, except to make people who are ill and out of work even more miserable, poor and ill.

Political authoritarianism, neoliberalism and façade democracy present a tragicomedy that creates the ultimate experimental théâtre de l’absurde, transforming lucrative big business propositions of crony capitalism into Schadenfreude; groaning clichés and stereotypes, political scapegoats and outgroups. Irrational, anecdotal populist “common sense” soundbites become incoherent, cognitive dissonance-inducing justification narratives. For ordinary citizens this fanfares increasingly irrational and draconian policies – the “science” of imaginary solutions to fictitious citizen “behavioural” problems in a Théâtre de la Cruauté (cruelty) – because of a strong motivation to control, rule and empty the public purse into private bank accounts (usually offshore), rather than recognise public needs and interests, and include the masses in democratic decision-making and the economy.

The government think that social justice is actually about “incentivising” those at the wrong end of politically constructed socioeconomic problems with punishments. I’m surprised we haven’t seen the reintroduction of public thrashings, flogging and the ducking stool. Meanwhile the people responsible for hoarding all the wealth and causing poverty for others – and to a considerable degree, contributing to health inequalities too – well they get the deluxe package of privileged incentives – tax cuts, high esteem, status and a pat on the head just for being sanctimonious, greedy, grasping, antisocial money hoarders, enforcing the equivalent of an economic enclosure act. They also have a lot of power and freedom, and so get to write a lot of policies that help them make profits and thus hoard even more of what was once our public wealth.

It’s curious how ministers claim that throwing money at a problem doesn’t change it. They’re right: the very worst of the hoarding and wealthy elite remain the biggest socioeconomic problem with faulty behaviours that we face as a society.

But poor people are poor because of a lack of money. Taking more money from them that they don’t have won’t cure poverty. You can’t thrash wealth into someone. You can’t thrash poverty out of someone. I really should not have to explain that like a patient parent explains the way things work to a toddler. But the Conservatives have a form of arrested development, and cling to their reductionist rituals of ontological security. They refuse to learn. The government are too busy telling us how they think society ought to be, they never have time or an inclination to listen to mere citizens. Big businesses take up every shred of their attention.

We know from recent history that once the Conservatives start to hold people responsible for problems that are not their fault, the public institutions that support people facing social difficulties are in peril – usually through the increasing privatisation of services, and ultimately, through the dismantling and transformation of publicly funded social support mechanisms to purely private profit generating mechanisms for the crony vulture capitalists. The only people set to gain in the long term from all of this political destruction and mis-spending from the public purse are the big vulture capitalist insurance companies, who have also had a hand in the construction of narratives of “personal responsibility” economic self sufficiency, thrift and self help. Perhaps Neoliberal governments should develop a policy of providing invisible bootstraps for citizens to pull themselves up from the damage being inflicted on them from a great height. 

When you hear the same incoherent crib sheet responses over and over, and see the intentional political stigmatisation of social groups, you come to recognise the pattern of preemptive justificationism and the malicious and greedy intent behind the draconian policies.

It’s goodbye to the welfare state, the NHS and democracy, and hello to the new wealth care. 

The ministry of plenty say that private interest is public interest.

All hail the corporatocracy.

 

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Footnote

(Update: I shared this article in a few Facebook groups last night with no problem. Some 12 hours later, I just tried to share this article in one group on Facebook and received a ban from posting in groups immediately, with no reason provided for the restriction on my account. I can’t share posts for a week and suspect the content of the article is what has triggered the ban. I certainly haven’t violated any of Facebook’s community rules or posted this in a way that could have been construed as “spamming”.

I appealed Facebook’s seemingly random decision and have had no response at all. I posted this article and asked my friends to share it. After posting that request, my account restrictions have been extended by a further two hours, with no reason provided by Facebook.

Facebook are a client of Edelman Intelligence. Someone should tell both companies that if you insist on censoring information, such repressive action tends to ensure items are shared much more widely than they would have been ordinarily.)

Related

Unum welcomes Green Paper focus on Group Income Protection  Unum

MUTUAL BENEFITS  Private Eye

A Tale of two Models: Disabled People vs Unum, Atos, Government and Disability Charities – Debbie Jolly

Two Apparent Irregularities Involving UNUM, ATOS, And DWP – George K Berger

FROM THE BRITISH WELFARE STATE TO ANOTHER AMERICAN STATE – Mo Stewart

MAGICAL MEDICINE: HOW TO MAKE A DISEASE DISAPPEAR  ME Action UK

Health at work – an independent review of sickness absence  Carol Black and David Frost

Trust Law as Regulatory Law: The Unum/Provident Scandal and Judicial Review of Benefit Denials under ERISA  John H. Langbein 

TRIAL BY ERROR: The Troubling Case of the PACE Chronic Fatigue Syndrome Study – David Tuller

Major breakthrough on PACE trial – George Faulkner

Fit for Work: a quick guide for General Practitioners – The government: our armchair doctors and shrinks

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

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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‘Reforming’ ESA: the final frontier and the last moral boundary

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Context

Employment and Support Allowance (ESA) is a benefit for people who are assessed as being unable to work because of a health condition and/or disability. Despite this, ESA has also been politically defined as financial support for people having difficulty finding a job because of a long-term illness or disability, to “help them back to work” despite their illness or disability. This presents a problematic tension because in order to qualify for ESA at all, people must be found to be unable to work, by their own doctor, and by the “independent” Work Capability Assessment.

There’s a significant difference between being unable to work, and facing significant additional barriers to work. People who are assessed are most commonly described as having “limited capability for work” – a phrase which is not precise in its meaning, and which does not include or prompt any consideration of social, cultural, political and economic contexts that also present disabled people with significant barriers to employment. 

The name of the allowance (“employment and support”) is also purposefully misleading, and betrays the original controversial political cost-cutting aims that prompted its inception. This re-branding of what was previously called “incapacity benefit” has been problematic. It implies that even those people placed in the Employment and Support Allowance Support Group, who are considered “unlikely” to be able to work in the foreseeable future, are nonetheless being “supported” into employment.

This blurring of definitions, categories and purposes has provided scope and political opportunity for discussion of introducing the mandatory requirement for pre-employment preparation, conditionality and sanctions to be applied to claimants with the most severe health conditions, in the Support Group. This has been casually suggested in the recent work, health and disability government consultation and green paper. Currently, anyone in the Support Group can voluntarily ask for pre-employment support, it isn’t compulsory.

A major assumption throughout the green paper is that disabled people claiming ESA are somehow mistaken in assuming they cannot work: “how can we improve a welfare system that leaves 1.5 million people – over 60% of people claiming Employment and Support Allowance – with the impression they cannot work and without any regular access to employment support, even when many others with the same conditions are flourishing in the labour market?   

This group were assessed by doctors and the state (via the Work Capability Assessment) as being unable to work. 

The aim behind the introduction of ESA was to actively reduce those previously eligible for Incapacity Benefit to a small group of people with severe disabilities (Support Group) and another moderately sized group who were to undergo fixed term pre-employment preparation and training (Work-Related Activity Group.)  The latter group are deemed unable to work, but expected to recover sufficiently to work within two years of the assessment. 

However, the controversial Work Capability Assessment (WCA) has been widely criticised, not least for its insensitivity and lack of capacity in differentiating between those people who “may” work, and those who cannot. Furthermore, the  WCA does not identify the social, cultural, political and economic barriers that disabled people face in finding suitable employment, and so the focus is on individuals without a context and their perceived personal “deficits” caused through illness and disability. This means that any pre-employment “support” for those who may or who wish to work is by its design unlikely to address the structural barriers to suitable employment that disabled people face.

The architects

Much of the politics of welfare in the 1980s revolved around “cuts” and restrictions in public spending designed to allow tax cuts, particularly reductions in the rates of income tax. Blair’s new programme, the New Deal, was all about moving people from social security benefits into work, as were many of the measures in the 1998 Budget.

David Freud, a former vice-chairman of bulge bracket investment banking at UBS, was an advisor on out-of-work benefit reform in December 2006. Freud’s 2007 report – dubbed “the Freud report” but officially titled Reducing dependency, increasing opportunity: options for the future of welfare to work – called for the greater use of private sector companies who would be paid by results, for substantial “resources” to be made available to help people on Incapacity Benefit back into work, and for a single working-age benefit payment to replace individual benefits such as Housing Benefit and Jobseeker’s Allowance (the forerunner of Universal Credit). His central idea was that spending on “delivery” – such as schemes to get people back to work, like the work programme – would save money in the long run because there would be fewer people being paid money in the form of benefits. 

Other contributions to the body of ideas behind ESA came from Frank Field, who was made Minister for Welfare Reform following the 1997 election, with Labour in power. Field felt that the state should have only a small role to play in the provision of welfare, and he viewed his task as “thinking the unthinkable” in terms of social security reform, but others report that Prime Minister Blair wanted some simpler vote-winning policy ideas. Blair writes that: “the problem was not so much that his thoughts were unthinkable as unfathomable”.

In January 2006, John Hutton published a White Paper outlining the government’s latest plans for welfare reform: the benefit that would replace Incapacity Benefit would be called Employment and Support Allowance and its “gateway” assessment would be transformed. Over the course of a decade, Hutton expected the number of people on Incapacity Benefit to fall by one million, saving £7billion a year.

In July 2008 a Green Paper was published, which James Purnell said was “inspired by the reforms proposed by David Freud”. The author announced that “between 2009 and 2013, all Incapacity Benefit claimants will be reassessed using a medical assessment called the Work Capability Assessment” that would divide them into three groups: fit for work; unfit for work but fit for work-related activity; or fit for neither. At the same time, Professor Paul Gregg was asked by the Department for work and Pensions (DWP) to conduct a feasibility study of conditionality and how it might be applied to people claiming sickness benefits. When responding to the Gregg Review, the DWP said that the study had recommended that conditionality be applied to “the vast majority of people in receipt of Employment and Support Allowance.”

In early 2011, under the Coalition government, the Incapacity Benefit reassessment programme was underway using a much more stringent version of the WCA. Atos were recontracted to carry out the work. Targets were written into Atos’s new contracts to reduce successful claims. Dr Steven Bick, a GP with 20 years’ experience, applied for a job as an assessor with Atos to carry out the WCA, and secretly filmed his training for Channel 4’s Dispatches programme, which was broadcasted on Monday 30 July. Undercover filming shows Bick being told by his trainer that he will be watched carefully over the number of applicants he “found eligible for the highest rate of disability payments.”

The documentary also highlighted the unease about the radically heightened eligibility criteria felt by some trainers employed by Atos to teach new recruits how to carry out the tests. It had become much more difficult for very severely disabled claimants to qualify for support. No matter how serious claimants problems are with their arms, for example, “as long as you’ve got one finger, and you can press a button,” they would be found fit for work, one trainer said. Bick said that assessors testing Incapacity Benefit claimants were told they should rate only about one in eight as needing to be placed in the Support Group. That’s regardless of the level of illness and disability they would be presented with, case by case.

In January 2016, the Conservative Welfare Secretary, Iain Duncan Smith, announced that ESA was “fundamentally flawed” and declared that a brand new policy, which would get nearly all ESA recipients back to work, would be unveiled within weeks. A hint of what that policy might be was given in a detailed report on ESA published the following month by Reform, the right-of-centre neoliberal think tank:

  • Effectively, ESA would be abolished: the amount of money paid each week to the claimant would be reduced to the level of Jobseekers Allowance
  • The WCA may be replaced by another assessment that set out to identify any barriers to work faced by the claimant, but which would play no role in determining eligibility to benefits
  • As a way to nudge claimants towards overcoming those barriers, extra money might be made available to fund a tailored programme of rehabilitation – although participation in this could be made a requirement of continued receipt of the benefit.

State diagnosis and treatment – a blunt instrument

The government say that according to previous research undertaken by the DWP, musculoskeletal conditions were the most common main condition of people claiming ESA. Mental health conditions have more recently overtaken this category of illnesses as the main condition that “triggers” an ESA claim.

In the recent work, health and disability green paper, the government also say: ““[..] how can we improve a welfare system that leaves 1.5 million people – over 60% of people claiming Employment and Support Allowance – with the impression they cannot work and without any regular access to employment support, even when many others with the same conditions are flourishing in the labour market?”

The research paper also says: “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 belief. Not evidenced fact.

That is a very dangerous idea. Many conditions are complex, unpredictable and difficult to diagnose. Some conditions have multiple symptoms affecting many different parts of the body. Musculoskeletal conditions, for example, are a category that includes conditions ranging from injuries to systemic and serious diseases. So “musculoskeletal conditions” include low back pain, injuries such as broken bones, torn or pulled ligaments and tendons, and slipped discs, wear and tear on joints, osteoarthritis, osteoporosis, and connective tissue diseases such as rheumatoid arthritis, lupus and scleroderma.

Connective tissue diseases are systemic illnesses that usually affect other parts of the body, such as major organs, as well as the widespread pain and damage in the musculoskeletal system. Most people with these illnesses don’t just contend with pain in their joints, tendons, ligaments and nerves; they usually feel very unwell, suffering from weight loss, profound fatigue, susceptibility to infections and general malaise. They may have serious lung, heart, kidney or blood disorders, neurological disorders, eye and ear problems, vascular problems and a wide range of other serious symptoms that can be caused through widespread inflammation throughout the body. Physiotherapy, splinting damaged joints, and other traditional measures for helping injury doesn’t help in the long term with connective tissue disease, because the damage is caused by a disease process: through autoimmune mediated widespread inflammation.

This is precisely why I see my doctor and not the government when I am ill. I want an objective and precise medical opinion, diagnosis and specialist treatment when needed, not an ideological diagnosis, dogma in soundbites and a prescription for hard labour, to “set me free.” 

“[…]with the impression they cannot work and without any regular access to employment support, even when many others with the same conditions are flourishing in the labour market?”  

Not all of the “same category” of conditions are the same. To assume they are is very dangerous. Furthermore, as previously stated, rehabilitation is unlikely to be helpful, since damage to the joints, tendons and ligaments isn’t caused through injury and it won’t heal. Medication is the only way to slow the damage that is caused by autoimmune complexes and inflammation. Connective tissue diseases are incurable. 

However, many of the treatments for connective tissue disease are also very risky and experimental. They include methotrexate, which is a chemotherapy, and immune suppressants such as enbrel and rituximab, which leave people at risk of dying from overwhelming infection, as well as other serious side effects, which may also kill.  

Having people believe that work is good for their health in order to reduce the numbers of people claiming ESA is authoritarian, disgracefully irresponsible and very dangerous.

On 22 December 2014 a bin lorry collided with pedestrians in the city centre of Glasgow, Scotland, killing six and injuring fifteen others. The driver of the council-owned vehicle, Harry Clarke, said he had passed out at the wheel. A similar blackout had happened to him in the driving seat of a bus, although he had not disclosed the incident on his heavy goods vehicle licence renewal application, despite such self-reporting being mandatory. 

Having been admitted to the Western Infirmary after the crash, Clarke was discharged on 7 January 2015 He was eventually diagnosed as having suffered neurocardiogenic syncope, a fainting episode caused by drop in blood pressure. The inquiry also revealed that Clarke’s medical history contained episodes of dizziness and fainting dating from the 1970s and that he had previously suffered a blackout while at the wheel of a First Glasgow bus, which was in service but stationary at a bus stop. 

It was stated that Clarke had been passed fit to return to work as a bus driver owing to failures by both the bus company’s doctor and Clarke’s own GP to spot that Clarke had changed his account of events, telling his GP that the episode had occurred in the canteen, which the GP then attributed to the hot conditions and deemed to be unlikely to be repeated. Clarke had a four-year history of episode-free driving after the 2010 incident, and First Glasgow’s occupational-health specialist had cleared him to drive after the 2010 incident and told him he need not notify the DVLA. 

A good question to ask is this. In the event of injury or death to either the person coerced by the state into work, assured that work is good for health, or to their work colleagues, as a consequence of that person not being fit for work, who is ultimately responsible? Bearing in mind that to qualify for ESA, a person has already been assessed as unfit for work. 

The shrinking category of illness and disability 

ESA was originally calculated to include the acknowledged additional every day costs that disabled people face in their day to day living. There was also a recognition that disabled people who can’t work face the cumulative effects of poverty because of a low income over time, too. The ESA Support Group have the higher rate because they are anticipated to be highly unlikely to work in the longer term. That outcome is assessed via the state WCA. So the state has already acknowledged that those in the Support Group are unlikely to be able to work. Those in the Work-Related Activity Group (WRAG) are deemed unable to work, but “may” be capable of work in the future, more specifically, “within two years”.

Although PIP covers some additional costs that disabled people face, it’s designed to cover highly specific needs, with “components” for mobility, and a daily living component which is paid if you need personal care. Both the mobility and daily living allowance are narrowly task related, not cost related. There is no component, for example, that would cover extra heating, special diet and additional laundry requirements. Many special adaptations that people may need are not included, too. 

Many people who were previously eligible for mobility support through the Disability Living Allowance (DLA) assessment are no longer eligible because of the much harsher eligibility criteria for PIP. This has meant many thousands of people have lost their specially adapted motability vehicles or motorised wheelchairs. This includes people who relied on their vehicles to get to and from work, since PIP and DLA are not means tested, it can be claimed by people in or out of work.

Earlier this year I wrote that a government advisor, who is a specialist in labour economics and econometrics, has proposed scrapping all ESA sickness and disability benefits. Matthew Oakley, a senior researcher at the Social Market Foundation, recently published a report entitled Closing the gap: creating a framework for tackling the disability employment gap in the UK, in which he proposes abolishing the ESA Support Group. To meet extra living costs because of disability, Oakley says that existing spending on PIP and the Support Group element of ESA should be brought together to finance a new extra costs benefit. Eligibility for this benefit should be determined on the basis of need, with an assessment replacing the WCA and PIP assessment.

Both ESA and PIP were introduced with the same claim: that eligibility should be determined on the basis of need. The category of disabled people that the government regard as “most in need” is shrinking as the political goalposts constantly shift. I think the word “need” is being conflated with politically defined neoliberal outcomes.

Oakley also suggests considering a “role that a form of privately run social insurance could play in both increasing benefit generosity and improving the support that individuals get to manage their conditions and move back to work.”

A toxic article from the Conservative and neoliberal Reform think tank suggests that “treatments” for some ESA claimants are made mandatory, subject to sanctions and so on.

And I can see that coming down the pipeline to the tune of an insane political mantra: “work is a health outcome.” 

In Working welfare: a radically new approach to sickness and disability benefits, Reform have this to say:

“Those with mild or moderate health conditions that, with support, could be managed should be expected to take reasonable rehabilitative steps – some level of conditionality should therefore be applied. Employment advisers must be appropriately trained to support those claimants, and given a high degree of discretion in how they apply that conditionality.”

“Could be managed” by work coaches and state sponsored occupational therapists? That comment implies that sick and disabled people and our health service are somehow “failing” to “manage” sickness and disability. Seriously? The inference we are supposed to make is that people are sick and disabled because they can’t be bothered helping themselves. I think that tells you all you need to know about the attitude that informs what kind of “rehabilitation” will be on offer. It won’t be tailored to your medical condition, it will be tailored to you simply getting a job. 

Another Reform articleReforming ESA: the final frontier? says: “There is a risk, though, with making health support mandatory and asking health professionals to police this.”

Compulsory medical treatment is against the law. There are also human rights implications. That’s regardless of the government’s narrow aim of coercing people into work by using “health” interventions as a prop. A medical intervention without valid informed consent is a criminal offence and the offending health care professional can be charged with assault or battery. Examples of such situations include treatment against the patient’s will, different treatment than the one consented for and treatment after consenting when a person has been deliberately provided with wrong information.

There are very few exceptions, which include: patients with acute or permanent incapacity (i.e loss of consciousness after an accident or patients on mechanical ventilation) or chronic illness (i.e dementia), patients suffering from severe mental illness, (but if a patient has clearly given an advance directive while still competent, the treating physician is legally bound to respect this) and patients suffering from communicable diseases, such as tuberculosis (TB).

The four main principles of medical ethics are justice, non-malificence, autonomy and beneficence. Autonomy is the main ethical consideration underlying informed consent. The patients’ right to determine what investigations and treatment to undergo must be respected by all doctors.

For consent to be valid it must be informed consent. For this to be the case it must be:

  • Given voluntarily with no coercion or deceit. Sanctioning and the threat of sanctioning would constitute coercion.
  • Given by an individual who has capacity
  • Given by an individual who has been fully informed about the issue.

There are further implications regarding job coaches accessing medical records for patient confidentiality:

  • Breaching confidentiality fails to respect patient autonomy.
  • Violation of patient confidentiality is a form of betrayal.
  • Patients have a right to confidentiality that has frequently been demonstrated in common law and in some specific areas outlined in statute law.

The Reform think tank has also recently proposed entirely scrapping what is left of the disability benefit support system, in their report Working welfare: a radically new approach to sickness and disability benefits and has called for the government to set a single rate for all out of work benefits and reform the way sick and disabled people are assessed.

You see dangerous, circular and irrational justifications such as: “Nonetheless, international evidence does show that the rate at which sickness benefits are set can have behavioural effects – particularly on claim duration. ”  

Well no. Those on the higher rates are assessed as unlikely to be able to work in the long term and thus the “behavioural effects” are simply that this group are too ill to work. That means they will be claiming for long periods. Yet this blunt, dangerous and backwards logic is being used to claim that higher disability rates serve as a “disincentive”for work. 

The Reform think tank proposes that the government should cut the weekly support paid to 1.3 million sick and disabled people in the ESA Support Group from £131 to £73. This is the same amount that Jobseeker’s Allowance claimants receive. However, those people placed in the Support Group after assessment have been deemed by the state as unlikely to be able to work again. It would therefore be very difficult to justify this proposed cut, given the additional needs that disabled people have, which is historically recognised, and empirically verified by research.

Reform had also promoted the idea that the ESA WRAG should be paid the same as those claiming job seeker’s allowance. That happened of course. Now they are arguing that there should be NO disability premium at all for the Support Group, on the grounds that it serves as a “disincentive” to work. The government’s recent green paper clearly shows the idea has been taken on board in principle, given the discussion for introducing conditionality, work related activity and sanctions for the previously exempt group of very ill and disabled people, placed in that group originally because doctors and government contracted “independent” assessors deemed them too ill to work.

Yet the authors of the report doggedly insist that having a higher rate of weekly benefit for extremely sick and disabled people encourages them“to stay on sickness benefits rather than move into work.” People on sickness benefits don’t move into work because they are sick. Forcing them to work is outrageous. “Too ill to work” is simply that. It has nothing to do with “incentives”, and that patronising and dangerous claim is simply a politically expedient reinterpretation.

The government’s aim is to manage sickness and disability in the short term sufficiently enough to meet narrow neoliberal outcomes including fueling the supply side of the “labour market”.

But it’s a well known historical fact that a large reserve army of labour drives wages down. The other trend, over this last decade, has been the unprecedented growth of “flexible” or insecure contracts, which are considerably attractive to employers, who dispute many of the downsides that unions, workers and analysts have highlighted. (See: More than 7m Britons now in precarious employment). In this highly competitive context, it is highly unlikely that employers who have increasingly come to regard their employees as a disposable means of making profit are going to be “disability confident.” The fact that the government are proposing offering temporary financial “incentives” to employers that recruit disabled people tells us there is a major barrier there. 

Further comment from Reform: “Reform call for a single rate of ‘income replacement’ for out of work claimants, whether disabled or not. This would mean a reduction for many ESA claimants. However, Reform ask why ESA is paid at a higher rate. If it is because there are extra costs associated with disability, then isn’t this what Personal Independence Payment (PIP) is for? If it is because ESA claimants are expected to take longer to find work, then doesn’t this also apply to some Jobseeker’s Allowance claimants and other groups?” From Reforming ESA: the final frontier?

PIP covers very only highly specific additional costs: those related to mobility and personal assistance, as I outlined earlier, and it is very difficult to fulfil the eligibility criteria, since this was another re-branded benefit designed to cut cost. Being sick and disabled does mean that at the very least, people may need recovery time, and meanwhile cannot meet even basic signing on conditionality, such as being available for work seven days a week. However, many in both ESA groups cannot work because they are chronically ill, or have degenerative conditions. Some people in the Support Group are terminally ill. This is very worryingly something that Reform have chosen to ignore. 

The title of Reform’s paper – Reforming ESA: the final frontier? provides a glimpse of a wider political intention – ESA is the “last unexplored area” for welfare “reform.”  “Thinking the unthinkable” is one of those trite things that ministers say when they expect something of a public backlash, but have nonetheless already made up their minds about cutting some public service or essential social support provision. Beforehand, think tanks and ministers periodically “kite fly” their proposals to test out public responses, using justification narratives: techniques of persuasion, usually reserved for the dodgy end of the advertising industry, and techniques of neutralisation to soothe and to sell their ideas about how things ought to be. And where our money should not be spent. The “public purse” is being “protected” from more and more of the public – ordinary citizens – and is now regarded as disposable income for the very wealthy and powerful. Austerity for us, tax gifts for the 1%

Six years ago it would have been unthinkable for a government to take away financial support from sick and disabled people, and to coerce them into work. It would have been unthinkable for a government to propose making any kind of medical treatment mandatory for a protected social group – sick and disabled people who need support to meet their basic needs. It would have been unthinkable that a UK government would systematically violate the human rights of disabled people. Yet they have. 

That we have progressed to become a society that permits a so-called democratic government to do this indicates that the public’s moral and rational boundaries have been pushed, this has been an incremental process, permeated by a wide variety of deliberative practices which have added to the problem of recognising it for what it is.

There has been a process of gradual habituation of the public, to being governed by shock and surprise; to receiving decisions and policies deliberated and passed in secret; to being persuaded that the justification for such deeds and controversial policy was based on real evidence that the government parades as slogans propped up by glittering generalities and techniques of persuasion. It happens in stages. Many don’t notice the calculated step-by-step changes, but those that do  – usually those affected – are often overwhelmed with the sheer volume of them.

 “The final frontier” is the political garnering of sufficient levels of public indifference and complicity with state cruelty, coercion and the uncivilised systematic sanctioning and removal of support for those sick and disabled citizens that doctors and state assessors have already said are not able to work. This is a government that likes to get its own way. 

Once the public’s rational and moral boundaries have been pushed sufficiently to accommodate this atrocity, it won’t be very difficult at all to argue a case for the complete dismantling of the welfare state.

That has always been the ultimate aim of the Conservatives.

If you think that’s okay, then perhaps it’s worth contemplating that illness can happen to anyone, and so can an accident. We have all paid into our social security system, as have our parents. It is ours; it’s there for if or when we need support. It reflects the collective best of us as a society, yet somehow this government have managed to attach shame and stigma to it. And as a society, we’ve allowed them to do that.

Disability can happen to any of us at any time. And when it does, you soon realise that it isn’t a “lifestyle choice” that you would ever have chosen to make.

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 Related

What you need to know about Atos assessments

G4S are employing Cognitive Behavioural Therapists to deliver “get to work therapy”

The power of positive thinking is really political gaslighting

Nudging conformity and benefit sanctions: a state experiment in behaviour modification

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

Research finds strong correlation between Work Capability Assessment and suicide


 

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It’s absolute poverty, not “market competition” that has led to a drop in food sales.

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Public spending in food stores fell for the first time on record in July this year, putting the UK recovery in doubt. Such a worrying, unprecedented record fall in food sales indicates that many consumers evidently have yet to feel the benefit of the so-called recovery.

The price of food was 0.2% higher than a year ago. The Office for National Statistics (ONS) started collecting the data for food sales in 1989The volume of food sales was also down last month, by 1.5% on an annualised basis.

There was also a marked fall in petrol consumption, and the only prominent area of growth was in spending that entailed use of mail order catalogues, and at market stalls, as people use credit to buy essential items and shop around for cheap alternatives and bargains.

Food manufacturing is the UK’s single largest manufacturing sector. The food and drink supply chain is a major part of the UK economy, accounting for 7% of GDP, employing over 3.7 million people, and generating at least £80 billion per year,  according to data from the Cabinet Office. There was an increase in the food sector (excluding agriculture) from 2000-2009 in Britain; the whole UK economy increased by 47% during the same period.

The Office for National Statistics has put the recent decline down to “prolonged discounting and price wars”.

However, crucially, the quantity of food bought in food stores also decreased by 1.5 per cent year-on-year in July.

It doesn’t take a genius to work out that repressed, stagnant wages and RISING living costs are going to result in reduced sale volumes. Survation’s research in March this year indicates that only four out of every ten of UK workers believe that the country’s economy is recovering. But we know that the bulk of the Tory austerity cuts were aimed at those least able to afford any cut to their income.

What we need to ask is why none of the mainstream media articles, or the ONS account, duly reporting the drop in food sales, have bothered to link this with the substantial increase in reported cases of malnutrition and related illnesses across the UK. It’s not as if this correlation is a particularly large inferential leap, after all.

It stands to reason that if people cannot afford food, they won’t be able to buy it. Furthermore, that consumers were not actually considered as a part of the ONS and media assessment is frankly strange, to say the least, with emphasis being placed solely on deterministic market competition criteria, and hardly a skim over any analysis of the social-political conditions that have undoubtedly contributed to the significant drop in food sales.

Food banks provide food aid to people in acute need, usually following referral by health or social care professionals, such as social workers, doctors, health visitors, and organisations such as the Citizens Advice Bureau and Jobcentre Plus. The Department for Work and Pensions has acknowledged that there is internal guidance to staff on signposting to food banks and a recent Freedom of Information request reported in The Guardian, revealed a “high level process” to be observed by jobcentre staff for referring claimants who say that they are suffering hardship and need food.

The role of Jobcentre Plus in referring people to food banks was described by Mark Hoban, Minister of State for Employment at the Department for Work and Pensions (DWP) as follows in December 2012: “The DWP, through Jobcentre Plus, operates a foodbank referral service. This is a simple signposting process which builds on the Jobcentre Plus standard practice of holding, locally, the details of organisations to which we signpost claimants who tell us they are in financial difficulty. Jobcentre Plus will only signpost claimants when they can offer no more help.”

Jobcentre Plus have been “signposting” people to food banks nationally since September 2011. Circumstances where a Jobcentre might make a referral to a food bank include:

  •  where a Crisis Loan or Short Term Benefit Advance had been refused;
  •  where a change in circumstances had affected a person’s entitlement to benefit, or reduced the amount they receive;
  •  where payment of benefit had been delayed (e.g. because a claim was still being
    assessed, or DWP was awaiting information to enable a decision on a claim).

The original version of the Jobcentre Plus referral form included boxes to tick to indicate the reason for the referral. However, the report in the Guardian on 6 September 2013 highlighted that the DWP had suddenly “unilaterally redesigned the food bank vouchers it issues to clients” – the three boxes on the previous form which had enabled JobCentre Plus “to indicate why they referred the person: because of benefit delay, benefit change, or refusal of crisis loan … have been removed from the new version of the form. The vouchers no longer tell the [Trussell] trust why the person has been referred”.

As Patrick Butler astutely observed, this has the effect of removing data that helps highlight why impoverishment caused by welfare “reform” has become one of the biggest single drivers of people turning to food banks. The Government needs political cover for lying ministers such as Freud and McVey, who like to pretend food banks have nothing to do with austerity and welfare reform; but the DWP sends its impoverished customers in droves to them anyway.

Research by the Joseph Rowntree Foundation and others indicates quite clearly that:

  • Some of the increase in the number of people using food banks is
    caused by unemployment, increasing levels of underemployment,
    low and falling income, and rising food and fuel prices. The
    National Minimum Wage and benefits levels need to rise in line
    with inflation, in order to ensure that families retain the ability to
    live with dignity and can afford to feed and clothe themselves and
    stay warm.
  • More alarmingly, up to half of all people turning to food banks
    are doing so as a direct result of having benefit payments delayed,
    reduced, or withdrawn altogether. Figures gathered by the Trussell
    Trust show that changes to the benefit system are the most common reasons for people using food banks;these include changes to crisis loan eligibility rules, delays in payments, Jobseeker’s Allowance ,sanctions and sickness benefit
    reassessments.
  • There is very clear evidence that the benefit sanctions regime is leading to destitution, hardship and hunger on a large scale.

Furthermore, in November last year, in a letter to the British Medical Journal, a group of doctors and senior academics from the Medical Research Council and two leading universities said that the effect of Government austerity policies on vulnerable people’s ability to afford food needed to be “urgently” monitored.

There was a significant surge in the number of people requiring emergency food aid, a decrease in the amount of calories consumed by British families, and a doubling of the number of malnutrition cases seen at English hospitals, which represents “all the signs of a public health emergency that could go unrecognised until it is too late to take preventative action,” they wrote.

Despite mounting evidence for a growing food poverty crisis in the UK, Tory ministers continue to maintain the lie that there is “no robust evidence” of a link between their sweeping welfare “reforms” and a rise in the use of food banks. However, publication of research into the phenomenon, commissioned by the Government itself, was delayed, amid speculation that the findings may prove embarrassing for the Government.

“Because the Government delayed the publication of research it commissioned into the rise of emergency food aid in the UK, we can only speculate that the cause is related to the rising cost of living and increasingly austere welfare reforms,” the public health experts wrote. It is very evident that the welfare state is “failing to provide a robust last line of defence against hunger.”

The authors of the letter, who include Dr David Taylor-Robinson and Professor Margaret Whitehead of Liverpool University’s Department of Public Health, say that malnutrition can have a devastating, long-lasting impact on health, particularly amongst children.

Chris Mould, chief executive of the Trussell Trust, the largest national food bank provider, said that one in three of the 350,000 people who required food bank  support at the Trussell Trust centres alone this year were children. It is estimated that by 2013, at least 500,000 people were reliant on food aid.

Access to adequate food is the most basic of human needs and rights. The right to food is protected under international human rights and humanitarian law and the correlative state obligations are equally well-established under international law. This right is recognised in the 1948 Universal Declaration of Human Rights (Article 25) as part of the right to an adequate standard of living, and is enshrined in the 1966 International Covenant on Economic, Social and Cultural Rights (Article 11).

Olivier De Schutter (a United Nations Special Rapporteur on the Right to Food) recently pointed to increases in the number of food banks in developed countries  such as the UK as an indicator that Governments are “in danger of failing in their duty to protect citizens under the International Covenant on Economic, Social and Cultural Rights” (IESCR), which states that all citizens should have access to adequate diet without having to compromise other basic needs.

Whilst the Department for Work and Pensions (DWP) claims that the benefits system provides a “safety net for essentials such as food”, the evidence increasingly does not support this claim. In fact, there is substantial and ever-mounting evidence that the inadequacies of the welfare safety net are now directly driving the growth of hunger and reliance on charitable food handouts.

The BBC reported the “‘Shocking increase’ in Employment Support Allowance (ESA) sickness benefit sanctions” on August 13th, within the first three months of 2014, there were 15,955 sanctions on ESA claimants, compared with 3,574 in the same period last year. I reported about the impact of sanctions in February, 2014, and I reported the substantial increase in ESA sanctions May 2014, along with the Benefits and Work site, amongst other “non-mainstream” writers. It’s incredible that the BBC, with relatively vast resources to hand hasn’t bothered researching and reporting this issue until now.

Perhaps this explains the BBC’s endorsement of the Government welfare “reforms” and their complicity with the persecution of sick and disabled people: James Purnell – one  of the chief architects of the current government’s “reforms”  (Gordon Brown had previously rebuffed Purnell’s proposals, and Purnell resigned as a consequence), is the BBC’s Director of Strategy & Digital which “brings together Communications, Future Media, Marketing, Policy, Research and Development and Strategy”. So, Mr Purnell is on the Executive Board, which, I am sure, contributes to the BBC’s current degree of “impartiality”, especially evident in attempts to defer delivery of politically damning news, or in their other quest to purposefully deliver politically motivated factual detours.

There is currently no established government measure of food poverty. A recent report by the Centre for Economics and Business Research defined households who have to spend more than 10% of their annual income on food as being in food poverty.

The Food Ethics Council states that food poverty means that an individual or household isn’t able to obtain healthy, nutritious food – they have to eat what they can afford or find, not what they choose to.

If people can’t meet basic survival needs, then that is defined as absolute poverty. We haven’t seen absolute poverty in the UK since before the inception of the welfare state. Until  now.

“Food banks open across the country, teachers report children coming to school hungry; advice services and local authorities prepare for the risks attached to welfare reform. There is evidence of a rising number of people sleeping rough, and destitution is reported with increasing frequency.” Julia Unwin, Joseph Rowntree Foundation, 2013.

“In households which cannot afford an adequate diet for their children, 93% have at least one adult who “skimps” on their own food to try to protect the children. Half a million children are not adequately fed in the UK today, not as a result of negligence but due to a lack of money.” Poverty and Social Exclusion UK. 2013.

We know that the imposed limitations on welfare processes and procedures have been found to be impacting on the growing demand for food banks. Decision-making around sanctions has been found to be particularly problematic from the perspective of food banks, where decisions were seen as unfair and/or arbitrary. Similarly, errors made in declaring people on Employment Support Allowance fit for work were also highlighted, by research undertaken by the Sheffield University Political Economy Research Institute.

More generally, “ineffective administration” of lifeline welfare payments is also seen to be an important driver of need, where people’s payments are delayed or stopped and they are left with no or heavily reduced income. Tory policy changes to the length of time sanctions run for (from 2 weeks to 3 years) is “significantly problematic”, given the  enormous implications for financial insecurity. And resultant absolute poverty.

Basic incomes are being reduced, making it much more difficult for people to make ends meet. In addition, “reforms” – which is the Orwellian Tory word for severe cuts – impacting on food poverty include the cap to benefit payments, the Bedroom Tax, and the loss of full Council Tax exemption for many benefit claimants.

No-one should be hungry, without food in this Country. That there are people living in a politically imposed state of absolute poverty is unacceptable in the UK, the world’s sixth largest economy (and the third largest in Europe). This was once a civilised first-world country that cared for and supported vulnerable citizens. After all, we have paid for our own welfare provision, and we did so in the recognition that absolutely anyone can lose their job, become ill or have an accident that results in disability. This is a Government that very clearly does not reflect the needs of the majority of citizens.

It is also unacceptable in a so-called liberal democracy that we have a Government that has persistently denied the terrible consequences of their own policies, despite  overwhelming evidence that the welfare “reforms” are causing people, harm, distress and sometimes, death. Furthermore, this is a Government that has systematically employed methods to effectively hide the evidence of the harm caused to others as a consequence of their devastating, draconian “reforms” from the public. This clearly demonstrates an intention to deceive, and an intention to continue causing people harm.

In English criminal law, intention is one of the types of mens rea (Latin for “guilty mind”) that, when accompanied by an actus reus (“guilty act”), constitutes a crime. It’s difficult to envisage that anyone in the UK would fail to understand that any act that prevents people from accessing food, and the means of meeting other basic survival needs, such as shelter, will cause them harm.

This is a Government that knows exactly what it is doing.

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Many thanks to Robert Livingstone for his excellent artwork