Tag: Jeremy Hunt

Director of medical research says rise in cases of sepsis is because of NHS funding cuts and overcrowding in hospitals

Deaths from sepsis recorded in England’s hospitals have risen by more than a third in two years, according to data collected by a leading safety expert. 

According to Sir Brian Jarman, the director of the Dr Foster research unit at Imperial College London, the number of recorded deaths where the primary cause was sepsis was 11,328 in 2014-15. By 2016-17 there were 15,722 deaths in hospital or within 30 days of discharge where sepsis was the leading cause, an increase of 38.8%.

Jarman, whose unit sends real-time alerts to hospitals that fall behind the expected mortality rate, blamed the increase partially on the consequences of real-terms funding cuts.

“The biggest thing that’s important seems to be the number of staff – doctors per bed,” he told BBC Radio 4’s Today programme in August. “One of the secondary important things is the overcrowding of hospitals. The level of overcrowding shouldn’t be more than 85% [bed occupancy], and it’s been going over 90% in recent years.”

Jarman, a former president of the British Medical Association, said the number of beds available had halved and the number of admissions had roughly doubled over the past 30 years – an “amazing change of provision of healthcare”.

In 2015, an inquiry found that 40% of patients with sepsis who arrived in A&E had not been reviewed by senior doctors quickly enough. There were also avoidable delays in giving patients intravenous antibiotics in nearly a third of cases (29%).

Every death from sepsis is a tragedy, yet too often the warning signs are missed – there is a need to get far better at spotting sepsis across the NHS and this advice shows how vital it is for clinicians to treat life-threatening symptoms as soon as possible.

Last year, Jeremy Hunt, then the health secretary, told a private memorial service for a one-year-old boy who died from sepsis that the child was let down by the NHS and the government.

Speaking at the service in Cornwall, Hunt said he had “come here to say sorry” to the family of William Mead, who died after the emergency services failed to diagnose a fatal case of sepsis. Hunt told those gathered at Truro Cathedral: “I as health secretary, the government, and the NHS, let down William.

“I’ve come here to say sorry. This weekend William should have been enjoying beautiful Cornish sunshine with his parents.

“We didn’t spot his sepsis before it was too late.”

William’s motherMelissa Mead, has become a prominent campaigner for better diagnostics of sepsis, saying that the NHS system was “broken”.

She has also described her son’s final hours, his symptoms and her repeated pleas to health services in painstaking detail on her blog site.

In February 2017, I developed sepsis, which is caused by an overly aggressive immune response to an infection. In my case, it happened because I had developed pneumonia while I had ‘flu. In sepsis (sometimes called septicaemia) the immune response causes widespread and severe inflammation and a drop in blood pressure (‘shock’), which leads to organ damage and other life threatening complications. The problem is that people often feel unwell when they have an infection, and sepsis is insidious. It can advance  very rapidly. I developed pneumonia and sepsis within four days of starting with influenza symptoms, by the fourth evening, my symptoms had become life threatening. 

I thought my symptoms were simply because I had a severe strain of influenza, and hadn’t realised I had developed pneumonia. My sons had both been very poorly the week before, while they had the ‘flu, too. By the time I knew something was very wrong, I was already in septic shock, and despite having an almost overwhelming urge to crawl back to my warm bed and just sleep, a sudden weird sense of impending doom kept me from doing so. Had I gone back to bed, I would never have woken again. 

Although Jarman believes that staff shortages and overcrowding on wards are partly to blame for the rise in sepsis, NHS England have said more conditions were being classed as sepsis than before, and a spokesperson added that efforts had also been made to improve diagnosis. However, it’s not quite true that more deaths from sepsis are being recorded as being caused by sepsis.

Dr Ron Daniels, chief executive of the UK Sepsis Trust and an intensive care consultant, said sepsis was one of the most common causes of death in the UK, it’s responsible for killing up to 44,000 people a year – in hospital and in the community.

He said that hospital records made it almost impossible to keep track of the true number of deaths through sepsis, because, he added: “It’s very common that if someone dies of sepsis that it’s coded or reported as simply being the underlying infection.

“So they might die of sepsis in an intensive care unit with multiple organ failure – but they’re recorded as a death from pneumonia. We need to fix that problem before we can truly understand the scale of sepsis.

The best way for us to do that is to develop a prospective data system like a registry that exists for other conditions, so that we can really get a national picture of what’s going on.”

He added: “The treatment for sepsis, if it’s caught early enough, involves very basic interventions – looking for the source of the infection, giving antibiotics.

“For every hour we delay in giving antibiotics, the patient’s risk of dying increases by a few per cent, so it’s essential that we spot it early and deliver the basics of care quickly.”

Jarman hopes his research data can be used to improve the survival chances of hospital patients who developed sepsis, via alerts that he sends to hospitals that are falling behind.

He said “Some of those hospitals with a lower death rate have got particular ways of reducing mortality from septicaemia, which the others we hope might learn from, and also we hope that by giving them this alert, within a month or two of the actual happening, they can actually get in there and do something quickly.”

There has been more of a focus on screening for sepsis in the NHS in recent years, led by the UK Sepsis Trust, which was formed by a group of clinicians at the Good Hope Hospital near Birmingham.

However, the fact that deaths from sepsis are commonly recorded as being caused by an underlying infection, rather than abnormal immune response to it – sepsis – means that gathering mortality data about hospital practices in diagnosis and management of sepsis is likely to lead to inaccurate results and cannot be relied on to improve recognition and diagnostic practices, or treatment.

Some reasons why sepsis is increasing

Vulnerability to sepsis is becoming more widespread. This is thought to be for a number of reasons:

  • More opportunities for infections to become complicated – more people are having invasive procedures and organ transplants, and more of us are taking immunosuppressive drugs and chemotherapies
  • Rising antibiotic resistance – microbes are becoming immune to drugs that would otherwise control infections

People more likely to get sepsis include:

  • Those with underlying lung disease, such as COPD and asthma
  • Those with illnesses that affect their immune response, such as HIV, leukaemia, chronic illness such as diabetes, lupus, and some other connective tissue /autoimmune diseases
  • Those taking immunosuppressant therapies, such as people who have had organ transplants, those with autoimmune illnesses, those with cancer having chemotherapy, or those on long-term steroid treatment 
  • Those who have had their spleen removed

Other predictors of higher severe sepsis incidence rates include socioeconomic status (those in poverty and destitution are at greater risk), and urbanicity.

In a context of austerity and cuts to basic social security and the NHS, it seems almost inevitable that cases of sepsis will increase.  

Any infection can trigger sepsis, including minor accidental cuts and insect bites that have become infected, but the following types of infections are more likely to cause sepsis:

  • Pneumonia
  • Meningitis
  • Abdominal infection 
  • Kidney/ urinary tract infection
  • Appendicitis
  • Infection of the gallbladder
  • Some cases of ‘flu

Symptoms of sepsis include:

  • Fever above 101ºF or a temperature below 96.8ºF (above 38.3º Celsius or below 36º C)
  • Heart rate higher than 90 beats per minute (tachycardia)
  • Fast, shallow breathing – rate higher than 20 breaths per minute (tachypnea)
  • Infection.

Other symptoms may be:

  • Dizziness or feelings of faintness
  • Confusion or a drop in alertness, or any other unusual change in mental state, including a feeling of doom or a real fear of death
  • Slurred speech
  • Diarrhoea, nausea, or vomiting
  • Severe muscle pain and extreme general discomfort
  • Difficulty breathing – shortness of breath
  • Low urine output (not needing to urinate for a whole day, for example)
  • Skin that is cold, clammy, and pale, blue, discolored or mottled
  • Skin that is cool and pale at the extremities, signaling poor blood supply (poor perfusion)
  • Loss of consciousness

It’s crucial to seek immediate medical attention if someone has more than one or two those symptoms, though loss of consciousness and severe breathing difficulty always need urgent medical attention.

The earlier you seek treatment, the greater are the chances of survival.

Sepsis medical criteria

There are two tools or sets of criteria that doctors use to determine the severity of your condition. One is the systemic inflammatory response syndrome (SIRS). SIRS is defined when you meet two or more of the following criteria:

  • Fever of more than 38°C (100.4°F) or less than 36°C (96.8°F), often with chills and shivering
  • Heart rate of more than 90 beats per minute (tachycardia)
  • Respiratory rate of more than 20 breaths per minute or arterial carbon dioxide tension (PaCO 2) of less than 32 mm Hg
  • Abnormal white blood cell count

Another tool is the “quick sequential organ failure assessment” (qSOFA). It uses the results of three criteria:

  • Low blood pressure
  • High respiratory rate (greater than 22 breaths per minute)
  • Glasgow coma scale score of less than 15. (This scale is used to determine your level of consciousness.)

A positive qSOFA is determined if two or more of the above measurements are abnormal. Some doctors prefer using qSOFA because unlike the SIRS criteria, qSOFA does not require laboratory tests and so may be used to make a prompt assessment. This means it can also be used by paramedics – as it was in my case. The results of either or both of these assessments will help doctors determine care promptly.

Tests, diagnosis and treatment of sepsis

The first step that doctors and paramedics take in diagnosing sepsis is to observe the symptoms. Sepsis is a major challenge to diagnose, and in Intensive Care Units it’s one of the leading causes of death. It is also a leading cause of people being readmitted to hospital. Sepsis arises unpredictably and can progress very rapidly.

When doctors observe the typical signs and symptoms of sepsis, they will also consider the patient’s medical history and be alerted to possible sepsis if there has been a recent infection, a surgical or catheter procedure, or if the patient is particularly vulnerable to infection – because of compromised immunity, for example.

The main treatment for sepsis and septic shock is antibiotics, as most cases are caused by a bacterial infection, though viral and fungal agents less commonly may also cause sepsis. If someone has severe sepsis and septic shock, antibiotics will be given directly into a vein (intravenously). Often other support is provided, such as oxygen, ventilation, or dialysis, is also given to support organ function, depending on how well a person’s organs are coping. Methods to stabilise blood pressure are often used, along with administered anticoagulants to prevent blood clots.

Ideally, antibiotic treatment should start within an hour of diagnosis to reduce the risk of serious complications or death. Intravenous antibiotics are usually replaced by tablets after two to four days (though sometimes longer). Antibiotics may have to take them for 7 to 10 days or longer, and often for a while after someone leaves hospital, depending on the severity of their condition.

Doctors may have to make a quick “best guess” at the type of infection and, therefore, the type of antibiotics needed, because speed in treating the infection is of the greatest importance; waiting for laboratory sample tests would hold up a potentially lifesaving intervention. Treatment may be adjusted once the causative microbe has been identified.

Antibiotics alone may be sufficient at a very early stage of sepsis, but treatment needs to be given very promptly.

For later stages of sepsis and septic shock, emergency hospital treatment will be needed (often in the intensive care unit); additional to the IV antibiotics, it may include:

  • Intravenous fluids (especially during the first 24 to 48 hours after admission, if you have severe sepsis or septic shock.
  • Vasopressors (to raise blood pressure)
  • Central lines
  • Anticoagulants (to prevent blood clots)
  • Other means of organ support as necessary, such as oxygen therapy, mechanical ventilation or dialysis

Severe sepsis is associated with a drop in blood pressure. Low blood pressure reduces the amount of oxygen and nutrients going to the body’s organs. This drop causes damage to the body’s major organs.

Septic shock advances when adequate blood pressure cannot be restored despite treatment with IV fluids. Septic shock may progress very quickly to multiple organ failure and death.

Complications from septic shock may cause symptoms of:

  • Kidney failure
  • Lung failure
  • Heart failure
  • Blood clots
  • Death

Prompt medical attention, diagnosis and treatment are key to surviving sepsis.

Often, paramedics may test for a rise in blood sugar as hyperglycemia is very common in people who are critically ill with sepsis, regardless of whether they have diabetes. Mine had risen despite the fact I had been unable to keep food down for four days. Mine is usually on the low side generally, but it had risen while I was ill. No one really knows why this happens. 

Laboratory tests at the hospital include a blood test to measure C-reactive protein (CRP), which is a substance in the blood that is produced by the liver, and it is used to measure levels of inflammation in the body. It’s used often to test for some types of autoimmune illness flares, too.

A CRP level of more than 10 milligrams per litre (10mg/L) indicates clinically significant inflammation. However, when someone has a severe infection such as pneumonia, it is usually very high – often between 100-200, and sometimes higher. A high CRP is generally linked with infection severity, and a CRP of 200 + is fairly common in sepsis. A CRP above 300 is associated with a poorer prognosis. Mine was 396 by the time I got to hospital. 

CRP tests are very clever science and extremely useful. It’s not possible to make a diagnosis from the test result alone, but used in conjunction with other tests, CRP results can support a diagnosis. And the CRP level may also be used to judge how effective treatments are. The CRP “resolves” – comes down quite quickly, often before a patient starts to feel better – when their treatment, such as antibiotics, is successful. Two or three days into the IV antibiotic treatment, my CRP was down to 193.

Other biochemical tests include blood clotting assessments, a white cell count, measurements of serum lactate, procalcitonin and something called alkaline phosphatase, all of which collectively may helpt to diagnose a severe infection and a severe systemic inflammatory response syndrome (SIRS), which is the key feature of sepsis

Testing is usually done to determine which family of bacteria has caused the infection so that antibiotic treatment may be tailored to treat it. 

It’s important that doctors maintain a high suspicion of sepsis  when someone hasan infection and symptoms, which is necessary to help prevent deaths.

In my case, the paramedics were highly suspicious of sepsis because I was tachycardic, my breathing was rapid, and I had an impeding sense of doom. My temperature was very raised and my blood glucose was raised. My blood pressure had plummeted to 70/40. There were no oxygen exchange noises in my lower lungs, so pneumonia was quickly diagnosed. An x ray later confirmed the pneumonia. I was given IV fluids to help raise my blood pressure and an antibiotic in the ambulance. I have no doubt these measures helped save my life.

 

Early suspicion of sepsis helps save lives.

 

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I wrote about my own experience of sepsis here, which includes more detailed information. The most shocking part ofthis experience was the fact I had not realised I was so gravely ill. So I wanted to raise awareness of this insidious and often fatal condition: Surviving sepsis: awareness raising and a case study

 


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

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Rationing and resource gatekeeping in the NHS is the consequence of privatisation

People march through London to mark 70 years of the NHS

People march through London yesterday to mark 70 years of the NHS.

Gatekeeping has become a watchword within our public services over the past seven years. It’s being driven by the government’s deep affection for neoliberal dogma, the drive for never-ending ‘efficiency savings’ and the Conservatives’ lean, mean austerity machine. Perish the thought that the public may actually need to use the public services that they have funded through their contributions to the Treasury, in good faith. 

In the NHS, even the resource gatekeepers have gatekeepers, those receptionists standing sentry at the end of the telephone, and in general practices, who ration access to the GPs so assiduously we patients often get better before we’ve managed to arrange an appointment. Or ended up at an Accident and Emergency Department.

Only a service dedicated to keeping the public and service providers apart could have devised a system so utterly demeaning. It turns patients into supplicants and receptionists into bouncers who make decisions they are unlikely to be qualified to make, neither being roles to which any of us aspired.

Now, it has been decided that the NHS needs to scrap more medical procedures, including injections for back pain, surgery to help snorers and knee arthroscopies for arthritis, which form part of an initial list of 17 operations that will be discontinued completely or highly restricted by NHS England as many of these problems “get better without treatment.”

I can assure you that arthritis of the knee, or anywhere else for that matter, doesn’t tend to get better. Medical interventions can help patients with ‘managing’ the condition, however. 

Varicose vein surgery and tonsil removal also feature on the list of routine operations to be axed as part of NHS England’s drive to cease “outdated” and “ineffective” treatments.

The latest round of rationing is hoped to save £200m a year by reducing “risky” or “unnecessary” procedures. Patients are to be told they have a responsibility to the NHS not to request “useless treatment.”

However, complications from varicose veins, for example, include leg ulcers which require more costly specialist treatment to help them heal. 

Steve Powis, the medical director of NHS England, said: I’m confident there is more to be done”, adding that the list of 17 operations formed “the first stage” of rooting out futile treatments that are believed to cost taxpayers £2bn a year.

“We are also going to ask ‘Are there other procedures and treatments we should add to the list?’. Additions could include general anaesthetics for hip and shoulder dislocations and brain scans for patients with migraines.

Hip and shoulder dislocations are notoriously excruciating, as is the process of having the joint relocated, though the latter is short-lived. It’s particularly brutal to leave patients without pain relief, and especially children.

The reason why brain scans are often very important when people develop migraine symptoms is that they can determine whether the severe headaches are caused by something more serious, such as a subarachnoid haemorrhage (which happened to me) or a tumour (which happened to my mother). Sometimes ‘migraines’ are something else.
Powis added: “We have to spend taxpayers’ money wisely. Therefore, if we are spending money on procedures that are not effective, that is money we could spend on new treatments that are clinically effective and would provide benefits to patients. It’s absolutely correct that, in getting more efficient, one component of that is to make sure we are not undertaking unnecessary procedures.”

The rationing comes as the government prepares to raise taxes and ditch an increase to the personal income tax allowance to pay for NHS funding plans. According to proposals, £20.5bn of extra funding would be set aside for the health service by 2023. In a speech at the Royal Free hospital in London a fortnight ago, Theresa May said tax rises were inevitable.

However, there doesn’t seem to be any indication that this additional measure will ensure the public has value and adequate health care for their money. 

The prime minister said: “As a country, taxpayers will need to contribute a bit more.But we will do that in a fair and balanced way. And we want to listen to people about how we do that, and the chancellor will bring forward the full set of proposals before the spending review.”

Here are the 17 treatments NHS England may axe

Four procedures will only be offered at the request of a patient:

  • Snoring surgery
  • Dilation and curettage for heavy menstrual bleeding
  • Knee arthroscopies for osteoarthritis
  • Injections for non-specific back pain

A further 13 treatments will only be offered when certain conditions are met:

  • Breast reduction
  • Removal of benign skin lesions
  • Grommets for glue ear
  • Tonsillectomy
  • Haemorrhoid surgery
  • Hysterectomy for heavy menstrual bleeding
  • Removal of lesions on eyelids
  • Removal of bone spurs for shoulder pain
  • Carpal tunnel syndrome release
  • Dupuytren’s contracture release
  • Excision of small, non cancerous lumps on the wrist called ganglia
  • Trigger finger release
  • Varicose vein surgery

Some of these procedures do improve the quality of people’s lives. I’m wondering how this sits with the government’s drive to push people with disabilities and medical conditions into work.

Although it was announced recently that the NHS is to hire 300 employment coaches to find patients jobs to “keep them out of hospital.” It’s what the government probably calls the ‘two birds and one bullet’ approach.

A man with a birthday placard as thousands of people march to mark 70 years of the NHS

Yesterday, tens of thousands of people marched through London to mark the NHS’s 70th anniversary and demand an end to government cuts and further privatisation of the health service. Bearing placards reading “Cuts leave scars”, “For people not profit” and “Democracy or corporate power” demonstrators moved down Whitehall on Saturday afternoon to the chant of “Whose NHS? Our NHS”.

The protesters stopped outside Downing Street to demand Theresa May’s resignation en route to the stage where they were greeted by a choir singing “the NHS needs saving, don’t let them break it”. Shortly after, Jeremy Corbyn addressed the crowd – organisers said there were about 40,000 people present – demanding an end to privatisation, the closure of the internal market, for staff to no longer be subcontracted to private companies and for social care to be properly funded.

Corbyn said: “There have been huge attacks on our NHS over many years,” he said. “The Tories voted against the original legislation and have always sought to privatise it and continue an internal market.

“Paying money out to private health contractors, the profits of which could and sometimes do, end up in tax havens around the world.

“Think it through, you and I pay our taxes because we want a health service for everybody, I don’t pay my taxes for someone to rip off the public and squirrel the profits away.”

I absolutely agree. 

A brief history of the travailing NHS under Conservative governments

The government has failed to adequately fund the NHS since taking office as part of the coalition in 2010, and has overseen a decline in the once widely admired public health service, as a way to privatise it by stealth. 

The Tories have utilised a spin technique that carry Thatcher’s fingerprints – it’s called ‘don’t show your hand.’

Image result for nhs safe in our hands

Jeremy Hunt and the Conservatives insist the NHS is ‘safe in our hands’

Chris Riddell 16.08.09

The direction of travel was set 25 years ago by the NHS review announced by Margaret Thatcher on the BBC Panorama programme in January 1988. The Conservatives have a poor track record with the NHS. Thatcher ushered in the NHS internal market, the mechanism that introduced what many in the health service still revile: competition.

Health authorities ceased to run hospitals but instead “purchased” care from hospitals who had to compete with others to provide it and became independent, self-governing trusts. The stated aim was to ‘increase efficiency’ and ‘eliminate waste’ through competition. Yet by the time John Major was prime minister, we saw the crisis deepen, with the postcode lottery and patients parked on hospital trolleys in hospital corridors for hours on end, waiting to see a worn out, overworked doctor.  

In order to assess the impact of Thatcher’s legacy on healthcare, it’s essential to appreciate that NHS market reforms began on her watch. Even the apparently relatively minor step of outsourcing hospital cleaning services was to cast a dark shadow over hospital care decades later. Putting cleaning services out to competitive tender meant that the job of cleaning wards went to the lowest bidder – often to companies that used casual, untrained staff, supplied by job centres. The contrast between the high quality of surgical treatment and the dirtiness of wards became notorious. The level of hospital-acquired infections grew steadily, including those caused by  ‘superbugs’  including MRSA. 

A study published by the Health Service Journal laid the blame for the rise of antibiotic resistant infections on poor hygiene standards; finding hospitals full of rubbish, uncollected left-over food in canteens and dirty linen strewn over bedroom floors. The impact outsourcing has had on cleaning services has been a constant source of tension since those early reforms. While trade unions and medical professionals have consistently argued against it, business leaders have always rejected any connection between outsourcing, infection rates, and declining standards.

Public sector outsourcing is central to the present government’s ideological strategy, despite the evidence that is now stacked against it being genuinely ‘competitive’. Since 2010, the number of large contracts awarded has increased by over 47% with tens of thousands of workers in various sectors – health, defence and IT – being transferred to corporate employers like Serco, Capita and G4S. The UK’s public sector has become the largest outsourcing market in the world, accounting for around 80% of all public sector contracting in Europe. These multinationals are not particularly interested in competition; they’re interested in profit and being in a monopoly position where they can dominate the market. Despite the wake of scandals that follows these companies, growth in the public sector outsourcing market shows no signs of slowing and the government shows no signs of learning from these events. 

Thatcher wanted to introduce even more radical changes – such as a shift to an insurance based healthcare model, with ‘health stamps’ for the poor – but in a busy decade, it seems that her battles with trade unions and left-wing Labour councils took priority.

It was under Thatcher’s administration that the climate of austerity began within the NHS. 

Then there was the Black Report into health inequalities, published in 1980 after a failed attempt by the  Conservatives to block its publication, noted that health inequalities in the UK were linked to socio-economic factors such as income, housing and conditions of work. The government rejected the report’s findings and recommendations.

Conservatives published a policy book called Direct Democracy in 2005. It claimed that the NHS was “no longer relevant”, and a system was proposed whereby patients were funded “either through the tax system or by way of universal insurance, to purchase health care from the provider of their choice” – with the poor having their contributions “supplemented or paid for by the state”. The authors included the current health secretary Jeremy Hunt. 

Against a backdrop of austerity and public cuts, healthcare facilities are continuing to contract out their facilities management and clinical services. But, the practice remains deeply controversial and the consequences are becoming more visible. 

Thatcher’s competitive tendering was introduced for cleaning, catering and other ancillary non-medical services, and were extended by the Tories in the ’90s under the NHS and Community Care Act – the first piece of legislation to introduce an internal market into the provision of healthcare. This was followed by the Private Finance Initiative (PFIs) in 1992 under the Major government.  Lansley’s reforms – premised on ‘increasing the diversity of providers in the management of the NHS’ – represent only the culmination of this legacy.

A centrally funded health service has demonstrated its a major contribution to reducing health inequality, by permitting healthcare practitioners and policy makers to design services and deliver care based on need, not the profit incentive. An increasingly privatised NHS has simply led to rationing and inadequate healthcare.

The biggest single contribution to health inequality is social inequality, a problem that has deteriorated significantly in the wake of the Conservative agenda of combined economic austerity and welfare reform.

Image result for hands up NHS
Image courtesy of Robert Livingstone 

 

Related

The Coalition has deliberately financially trashed the NHS to justify its privatisation

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

Private bill to introduce further charges to patients for healthcare services is due for second reading today

Labour challenge government about ‘shocking’ rise in coroner warnings over NHS patient deaths

 


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

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Initial thoughts on the work, health and disability green paper

proper Blond

I’ve read the government’s Work, health and disability green paper: improving lives and consultation from end to end. It took me a while, because I am ill and not always able to work consistently, reliably and safely. It’s also a very long and waffling document. I am one of those people that the proposals outlined in this green paper is likely to affect. I read the document very carefully.

Here are a few of my initial thoughts on what I read. It’s organised as best I can manage, especially given the fact that despite being dismally unsurprised, I am scathing.

The context indicates the general intent

“The fact is that Ministers are looking for large savings at the expense of the poorest and most vulnerable. That was not made clear in the general election campaign; then, the Prime Minister said that disabled people would be protected.”Helen Goodman, MP for Bishop Auckland, Official Report, Commons, 2/3/16; cols. 1052-58.

I always flinch when the government claim they are going to “help” sick and disabled people into work. That usually signals further cuts to lifeline support and essential services are on the way, and that the social security system is going to be ground down a little further, to become the dust of history and a distant memory of a once civilised society. 

If the government genuinely wanted to “help” sick and disabled people into work, I’m certain they would not have cut the Independent Living Fund, which has had a hugely negative impact on those trying their best to lead independent and dignified lives, and the Access To Work funding has been severely cut, this is also a fund that helps people and employers to cover the extra living costs arising due to disabilities that might present barriers to work.

The government also made the eligibility criteria for Personal Independence Payment (PIP) – a non-means tested out-of- work and an in-work benefit – much more difficult to meet, in order to simply reduce successful claims and cut costs. This has also meant that thousands of people have lost their motability vehicles and support.

Earlier this year, it was estimated at least 14,000 disabled people have had their mobility vehicle confiscated after the changes to benefit assessment, which are carried out by private companies. 

Under the PIP rules, thousands more people who rely on this support to keep their independence are set to lose their vehicles – specially adapted cars or powered wheelchairs. Many had been adapted to meet their owners’ needs and many campaigners warn that it will lead to a devastating loss of independence for disabled people.

A total of 45% or 13,900 people, were deemed as not needing the higher rate of PIP, and therefore lost their vehicles after reassessment. And out of the 31,200 people who were once on the highest rate of Disability Living Allowance (DLA) who have been reassessed, just 55%, or 17,300 – have kept their car.

dpac
In 2012, Esther McVey, then the Minister for people with disabilities, as good as admitted there are targets to reduce or remove eligibility for the new disability benefit PIP, which was to replace DLA. How else could she know in advance of people’s reassessment that 330,000 of claimants are expected to either lose their benefit altogether or see their payments reduced as she had informed the House of Commons. 

This was a clear indication that the new assessment framework was designed to cut support for disabled people. A recent review led the government to conclude that PIP doesn’t currently fulfil the original policy intent, which was to cut costs and “target” the benefit to an ever-shrinking category of “those with the greatest need.” 

The Government was twice defeated in the Lords over their proposals to cut Employment and Support Allowance (ESA) for sick and disabled people in the work related activity group (WRAG) from £103 to £73. However the £30 a week cut is to go ahead after bitterly disappointed and angry peers were left powerless to continue to oppose the Commons, which has overturned both defeats.

The government hammered through the cuts of £120 a month to the lifeline income of ill and disabled people by citing the “financial privilege” of the Commons, and after Priti Patel informing the Lords, with despotic relish, that they had “overstepped their mark” in opposing the cuts twice. 

A coalition of 60 national disability charities condemned the government’s cuts to benefits as a “step backwards” for sick and disabled people and their families. The Disability Benefits Consortium said that the cuts, which will see people lose up to £1,500 a year, will leave disabled people feeling betrayed by the government and will have a damaging effect on their health, finances and ability to find work. 

Research by the Consortium suggests the low level of benefit is already failing to meet disabled people’s needs. A survey of 500 people in the affected group found that 28 per cent of people had been unable to afford to eat while in receipt of the benefit. Around 38 per cent of respondents said they had been unable to heat their homes and 52 per cent struggled to stay healthy.

Watching the way the wind blows

Earlier this year I wrote that a government advisor, who is a specialist in labor 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. 

I think the word “need” is being redefined to meet politically defined neoliberal economic outcomes. 

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.” 

I’m sure the rogue company Unum would jump at the opportunity. Steeped in controversy, with a wake of scandals that entailed the company 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 handling 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. By coincidence, the company has been involved with the UK’s controversial Welfare Reform Bill, advising the government on how to cut spending, particularly on disability support. What could possibly go right? 

It’s difficult to see how someone with a serious, chronic and progressive illness, (which most people in the ESA Support Group have) can actually “manage” their illness and “move back into work.” The use of the extremely misinformed, patronising and very misleading term manage implies that very ill people actually have some kind of choice in the matter.

For people with Parkinson’s disease, rheumatoid arthritis, lupus and multiple sclerosis, cancer and kidney failure, for example, mind over matter doesn’t fix those problems, positive thinking and sheer will power cannot cure these illnesses, sadly. Nor does refusing to acknowledge or permit people to take up a sick role, or imposing benefit conditionality and coercive policies to push chronically ill people into work by callous, insensitive and inept and often medically unqualified assessors, job advisors and ministers.  

The Reform think tank has also recently proposed 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.  

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. It is claimed that the cut will  somehow “incentivise” those people to find work, as if they simply lack motivation, rather than being ill and disabled. 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 near future, many won’t 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. 

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. 

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 – PIP. However, as outlined, 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 hard work.

The current United Nations investigation into the systematic and gross violations of the rights of disabled people in the UK because of the Conservative welfare “reforms” is a clear indication that there is no longer any political commitment to supporting disabled people in this country, with the Independent Living Fund being scrapped by this government, ESA for the work related activity group (WRAG) cut back, PIP is becoming increasingly very difficult to access, and now there are threats to the ESA Support Group. The Conservative’s actions have led to breaches in the CONVENTION on the RIGHTS of PERSONS with DISABILITIES – CRPD articles 4, 8, 9, 12, 13, 14, 15, 17, and especially 19, 20, 27 and 29 (at the very least.)

There are also probable violations of articles 22, 23, 25, 30, 31.

The investigation began before the latest round of cuts to ESA were announced. That tells us that the government is unconcerned their draconian policies violate the human rights of sick and disabled people.

And that, surely, tells us all we need to know about this government’s intentions.

Coercing those deemed to ill to work into work. It’s not “nudge”: it’s psycho-compulsion

The casual discussion in the green paper about new mandatory “health and work conversations” in which work coaches will use “specially designed techniques” to “help” some ESA claimants “identify their health and work goals, draw out their strengths, make realistic plans, and build resilience and motivation” is also cause for some concern. 

Apparently these conversations were “co-designed with disabled people’s organisations and occupational health professionals and practitioners and the Behavioural Insights Teamthe controversial Nudge Unit, which is part-owned by the Cabinet Office and Nesta.

Most people who read my work regularly will know by now that I am one of the staunchest critics of nudge, which is being used as an antidemocratic, technocratic, pseudoscientific political tool to provide a prop and disguise for controversial neoliberal policies. It’s very evident that “disabled people’s organisations” were not major contributors to the design. It’s especially telling that those people to be targeted by this “intervention” were completely excluded from the conversation. Sick and disabled people are reduced to objects of public policy, rather than being seen as citizens and democratic subjects capable of rational dialogue.  

John Pring at Disability News Service (DNS) adds: “Grassroots disabled people’s organisations (DPOs) have criticised the government’s decision to exclude them from an event held to launch its new work, health and disability green paper. 

The event for “stakeholders” was hosted by the disability charity Scope at its London headquarters, and attended by Penny Mordaunt, the minister for disabled people.

The Department for Work and Pensions (DWP) said in its invitation – it turned down a request from Disability News Service to attend – that the event would “start the consultation period” on its green paper, Improving Lives. 

It said that it was “launching a new conversation with disabled people and people with health conditions, their representatives, healthcare professionals and employers”.  

But DWP has refused to say how many disabled people’s user-led organisations were invited to the event, and instead suggested that DNS submit a freedom of information request to find out.
But DNS has confirmed that some of the most prominent user-led organisations with the strongest links to disabled people were not invited to the launch, including Shaping Our Lives, Inclusion London, Equal Lives, People First (Self Advocacy) and Disabled People Against Cuts.” 

For further discussion of the policy context leading up to the green paper, see The new Work and Health Programme: government plan social experiments to “nudge” sick and disabled people into work from October 2015. 

Also see G4S are employing Cognitive Behavioural Therapists to deliver “get to work therapy” and Stephen Crabb’s obscurantist approach to cuts in disabled people’s support and also Let’s keep the job centre out of GP surgeries and the DWP out of our confidential medical records from earlier this year.

The dismal and incoherent contents of the green paper were entirely predictable.

The Conservatives claim work is a “health” outcome: crude behaviourism

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 then 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 a broader aim of dismantling social security.

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 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 stigmatised and outgrouped.

Othering and outgrouping have become common political practices, it seems.

Stigma is a political and cultural attack on people’s identities. It’s used to discredit, and as justification for excluding some groups from economic and political consideration, refusing them full democratic citizenship.

Stigma is being used politically to justify the systematic withdrawal of support and public services for the poorest – the casualties of a system founded on competition for allegedly scarce wealth and resources. Competition inevitably means there are winners and losers. Stigma is profoundly oppressive.

It is used as a propaganda mechanism to draw the public into collaboration with the state, to justify punitive and discriminatory policies and to align citizen “interests” with rigid neoliberal outcomes. Inclusion, human rights, equality and democracy are not compatible with neoliberalism.

Earlier this year, I said: The Conservatives have come dangerously close to redefining unemployment as a psychological disorder, and employment is being redefined as a “health outcome.” The government’s Work and Health programme involves a plan to integrate health and employment services, aligning the outcome frameworks of health services, Improving Access To Psychological Therapies (IAPT), Jobcentre Plus and the Work Programme.

But the government’s aim to prompt public services to “speak with one voice” is founded on questionable ethics. This proposed multi-agency approach is reductive, rather than being about formulating expansive, coherent, comprehensive and importantly, responsive provision.

This is psychopolitics, not therapy. It’s all about (re)defining the experience and reality of a social group to justify dismantling public services (especially welfare), and that is form of gaslighting intended to extend oppressive political control and micromanagement. In linking receipt of welfare with health services and “state therapy,” with the single intended outcome explicitly expressed as employment, the government is purposefully conflating citizen’s widely varied needs with economic outcomes and diktats, isolating people from traditionally non-partisan networks of relatively unconditional support, such as the health service, social services, community services and mental health services.

Public services “speaking with one voice” will invariably make accessing support conditional, and further isolate already marginalised social groups. It will damage trust between people needing support and professionals who are meant to deliver essential public services, rather than simply extending government dogma, prejudices and discrimination.

Conservatives really seem to believe that the only indication of a person’s functional capacity, value and potential is their economic productivity, and the only indication of their moral worth is their capability and degree of willingness to work. But unsatisfactory employment – low-paid, insecure and unfulfiling work – can result in a decline in health and wellbeing, indicating that poverty and growing inequality, rather than unemployment, increases the risk of experiencing poor mental and physical health. People are experiencing poverty both in work and out of work.

Moreover, in countries with an adequate social safety net, poor employment (low pay, short-term contracts), rather than unemployment, has the biggest detrimental impact on mental health. 

There is ample medical evidence (rather than the current raft of political dogma) to support this account. (See the Minnesota semistarvation experiment, for example. The understanding that food deprivation in particular dramatically alters cognitive capacity, emotions, motivation, personality, and that malnutrition directly and predictably affects the mind as well as the body is one of the legacies of the experiment.)

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

Food deprivation is closely correlated with both physical and mental health deterioration. Maslow explained very well that if we cannot meet basic physical needs, we are highly unlikely to be able to meet higher level psychosocial needs. The government proposal that welfare sanctions will somehow “incentivise” people to look for work is pseudopsychology at its very worst and most dangerous.

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

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

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

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

I have pointed out previously that there has never been any research that demonstrates unemployment is a direct cause of ill health or that employment directly improves health, and the existing studies support the the idea that the assumed causality between unemployment and health may actually run in the opposite direction. It’s much more likely that inadequate social security support means that people cannot meet all of  their basic survival needs (food, fuel and shelter), and that contributes significantly to poor health outcomes.

It’s not that unemployment is causing higher ill health, but that ill health and discrimination are causing higher unemployment. If it were unemployment causing ill health, at a time when the government assures us that employment rates are currently “the highest on record,” why are more people becoming sick?

The answer is that inequality and poverty have increased, and these social conditions, created by government policies, have long been established by research as having a correlational relationship with increasing mental and physical health inequalities. 

For an excellent, clearly written and focused development of these points, the problem of “hidden” variables and political misinterpretation, see Jonathan Hulme’s Work won’t set us free.

Semantic thrifts: being Conservative with the truth

Prior to 2010, cutting support for sick and disabled people was unthinkable, but the “re-framing” strategy and media stigmatising campaigns have been used by the Conservatives to systematically cut welfare, push the public’s normative boundaries and to formulate moralistic justification narratives for their draconian policies. Those narratives betray the Conservative’s intentions.

Not enough people have questioned what it is that Conservatives actually mean when they use words like “help”, “support”, and “reform” in the context of government policies aimed at disabled people. Nor have they wondered where the evidence of “help” and “support” is hiding. If you sit on the surface of Conservative rhetoric and the repetitive buzzwords, it all sounds quite reasonable, though a little glib.

If you scrutinise a little, however, you soon begin to realise with horror that Orwellian-styled techniques of neutralisation are being deployed to lull you into a false sense of security: the ideologically directed intentions behind the policies and the outcomes and consequences are being hidden or “neutralised” by purposefully deceptive, misdirectional political rhetoric. It’s a kind of glittering generalities tokenism ; a superficial PR ritual of duplicitous linguistic detoxification, to obscure deeply held traditional Conservative prejudices and ill intent.

Rhetoric requires the existence of an audience and an intent or goal in the communication. Once you stand back a little, you may recognise the big glaring discrepancies between Conservative chatter, policies, socioeconomic reality and people’s lived experiences. At the very least, you begin to wonder when the conventional ideological interests of the Conservatives suddenly became so apparently rhetorically progressive, whilst their policies have actually become increasingly authoritarian, especially those directed at the most disadvantaged social groups.

The ministerial foreword from Damian Green, Secretary of State for Work and Pensions and Jeremy Hunt, Secretary of State for Health, is full of concern that despite the claim that “we have seen hundreds of thousands more disabled people in work in recent years”, there are simply too many sick and disabled people claiming ESA.

They say: We must highlight, confront and challenge the attitudes, prejudices and misunderstandings that, after many years, have become engrained in many of the policies and minds of employers, within the welfare state, across the health service and in wider society. Change will come, not by tinkering at the margins, but through real, innovative action. This Green Paper marks the start of that action and a far-reaching national debate, asking: ‘What will it take to transform the employment prospects of disabled people and people with long-term health conditions?’

I think mention of the “engrained attitudes, prejudices and misunderstandings within the welfare state and across the health service” is the real clue here about intent. What would have been a far more authentic and reassuring comment is “we have met with disabled people who have long-term health conditions and asked them if they feel they can work, and what they need to support them if they can.”

Instead, what we are being told via subtext is that we are wrong as a society to support people who are seriously ill and disabled by providing civilised health and social care, social security and exempting them from work because they are ill or injured.

Ministers say:Making progress on the government’s manifesto ambition to halve the disability employment gap is central to our social reform agenda by building a country and economy that works for everyone, whether or not they have a long-term health condition or disability. It is fundamental to creating a society based on fairness [..] It will also support our health and economic policy objectives by contributing to the government’s full employment ambitions, enabling employers to access a wider pool of talent and skills, and improving health.”

I think that should read: “By building a country where everyone works for the [politically defined] economy.”

There’s patronising discussion of how disabled people should be “allowed to fulfil their potential”, and that those mythic meritocratic principles of talent determination and aspiration should be “what counts”, rather than sickness and disability. There are some pretty gaping holes in the logic being presented here. It is assumed that prejudice is the reason why sick and disabled people don’t work.

But it’s true that many of us cannot work because we are too ill, and the green paper fails to acknowledge this fundamental issue.

Instead “inequality” has been redefined strictly in terms of someone’s employment status, rather than as an unequal social distribution of wealth, resources, power and opportunities. All of the responsibility and burden of social exclusion and unemployment is placed on sick and disabled people, whilst it is proposed that businesses are financially rewarded for employing us.

Furthermore, it’s a little difficult to take all the loose talk seriously about the “injustice” of ill people not being in work, or about meritocratic principles and equal opportunities, when it’s not so long ago that more than one Conservative minister expressed the view that disabled people should work for less than the minimum wage. This government have made a virtue out of claiming they are giving something by taking something away. For example, the welfare cuts have been casually re-named reforms in Orwellian style. We have yet to see how cutting the lifeline benefits of the poorest people, and imposing harsh sanctioning can possibly be an improvement for them, or how it is helping them.

The Conservatives are neoliberal fundamentalists, and they have supplanted collective, public values with individualistic, private values of market rationality. They have successfully displaced established models of welfare provision and state regulation through policies of privatisation and de-regulation and have shifted public focus, instigating various changes in subjectivity, by normalising individualistic self-interest, entrepreneurial values, and crass consumerism. And increasing the social and material exclusion of growing numbers living in absolute poverty.

Basically, the Tories tell lies to change perceptions, divert attention from the growing wealth inequality manufactured by their own policies, by creating scapegoats.

Another major assumption throughout the 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? How can we build a system where the financial support received does not negatively impact access to support to find a job? How can we offer a better user experience, improve system efficiency in sharing data, and achieve closer alignment of assessments?”

The government’s brand of armchair pseudo-psychology, propped up by the Nudge Unit, is used to justify increasingly irrational requirements being embedded in policy. The government intend to merge health and employment services, redefining work as aclinical health outcome. According to the government, the “cure” for unemployment due to illness and disability and sickness absence from work, is… work.

The new work and health programme, “support” for disabled people, is actually just another workfare programme. We know that workfare tends to decrease the likelihood of people finding work.

Work is the only politically prescribed “route out of poverty” for disabled people, including those with mental distress and illness, regardless of whether or not they are actually well enough to work. In fact the government implicitly equates mental health with economic productivity. Work will set us free. Yet paradoxically, disabled people haven’t been and won’t be included in the same economic system which is responsible for their exclusion in the first place.

Competitive market economies exclude marginalised groups, that’s something we ought to have learned from the industrial capitalism of the last couple of centuries. GPs inform us that employers are not prepared to make the necessary inclusive workplace adjustments sick and disabled people often need to work.

But in a dystopic Orwellian world where medical sick notes have been  politically redefined as ”fit notes”, sick and disabled people are no longer exempt from work, which is now held to be a magic “cure”. People are already being punished and coerced into taking any available job, regardless of its appropriateness, in an increasingly competitive and exclusive labor market.

The nitty gritty

You know the government are riding the fabled rubber bicycle when they calmly propose coercing the most disabled and ill citizens who are deemed unlikely to work by their doctors and the state (via the Work Capability Assessment) into performing mandatory work-related activities and finding jobs. Previously, only those assessed as possibly capable of some work in the future and placed in the Work Related Activity Group (WRAG) were expected to meet behavioural conditionality in return for their lifeline support.

However, the government have cut the WRAG component of Employment and Support Allowance (ESA) – another somewhat Orwellian name for a sickness and disability benefit – so that this group of people, previously considered to have additional needs because of their illness and disability, are no longer supported to meet the extra costs they face. The ESA WRAG rate of pay is now to be the same as Job Seeker’s Allowance.

If the government make work related activity mandatory for those people in the ESA Support Group, it will mean that very sick and disabled people will be sanctioned for being unable to comply and meet conditionality. This entails the loss of their lifeline support. The government have the cheek to claim that they will “protect and support” the most vulnerable citizens.

Hello, these ARE among our most vulnerable citizens. That’s why they were placed in the ESA support group in the first place.

Apparently, sick citizens are costing too much money. Our NHS is “overburdened” with ill people needing healthcare, our public services are “burdened” with people needing… public services. It is claimed that people are costing employers by taking time off work when they are ill. How very dare they.

Neoliberals argue that public services present moral hazards and perverse incentives. Providing lifeline support to meet basic survival requirements is seen as a barrier to the effort people put into searching for jobs. From this perspective, the social security system, which supports the inevitable casualties of neoliberal free markets, has somehow created those casualties. But we know that external, market competition-driven policies create a few “haves” and many “have-nots.” This is why the  welfare state came into being, after all – because when we allow such competitive economic dogmas to manifest without restraint, we must also concede that there are always ”winners and losers.”

Neoliberal economies organise societies into hierarchies.The UK currently ranks highly among the most unequal countries in the world.

Inequality and poverty are central features of neoliberalism and the causes of these sociopolitical problems therefore cannot be located within individuals.

The ESA Support Group includes people who are terminally ill, and those with degenerative illnesses, as well as serious mental health problems. It’s suggested that treating this group of people with computer based Cognitive Behaviour Therapy (cCBT), and addressing obesity, alcohol and drug dependence will “help” them into work.

Ministers claim that this group merely have a “perception” that they can’t work, and that they have been “parked” on benefits. It is also implied that illness arises mostly because of lifestyle choices.

Proposals include a punitive approach to sick and disabled people needing support, whilst advocating financial rewards for employers and businesses who employ sick and disabled people.

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 private company will most likely soon have a lucrative role to get the government “the right results”.

Meanwhile health and social care is going to be linked with one main outcome: work. People too ill to work will be healthier if they… work. Our public services will cease to provide public services: health and social care professionals will simply become co-opted authoritarian ideologues.

Apparently, the new inequality and social injustice have nothing to do with an unequal distribution of wealth, resources, power and opportunities. Apparently our society is unequal only because some people “won’t” work. I’m just wondering about all those working poor people currently queuing up at the food bank, maybe their poorly paid, insecure employment and zero hour contracts don’t count as working.

I’ve written as I read this Orwellian masterpiece of thinly disguised contempt and prejudice. I don’t think I have ever read anything as utterly dangerous and irrational in all my time analysing Conservative public policy and the potential and actual consequences of them. These utterly deluded and sneering authors are governing our country, shaping our life experiences, and those of our children.

The sick role and any recovery time from illness or accident that you may need has been abolished. Work will cure you.

Well, at least until you die.
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Pictures courtesy of Robert Livingstone

The closing date for the consultation is 17 February 2017.
You can download the full consultation document from this link.
You can take part in the consultation from this link.



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

 

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

You can:

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

Opt out letter (PDF)

Opt out letter (MS Word)

Opt out letter (Rich Text)

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

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

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

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

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

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

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

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

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

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

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GPs bribed to send FEWER cancer patients for vital hospital tests – Mike Sivier

An important article from Vox Political (and the Mirror.) It needs to be shared.

Visit Vox Political for the full article

GPs are being offered cash to send fewer patients with suspected cancer to hospital for vital tests.Surgeries can claim thousands of pounds worth of “incentives” for not sending patients to hospitals for tests, scans and operations, according to an investigation by doctors’ magazine Pulse.

First appointments for cancer – which should happen within two weeks of a GP suspecting the disease – are included in some of the targets to cut referrals, the probe found.

The rewards are being offered by Clinical Commissioning Groups (CCGs), local NHS bodies responsible for commissioning of healthcare across the country.

The move comes as the NHS is trying to slash £22billion in costs before 2020.

Source: GPs ‘bribed’ to send FEWER cancer patients for vital hospital tests – Mirror Online

The Mirror blasted the policy, run by CCGs that were created as part of the Health and Social Care Act of 2012 which began the mass-privatisation of the NHS, in its editorial:

Bribing family doctors not to send patients to hospitals for cancer tests is sacrificing lives by turning the NHS into a cut-price market place.

GPs should never be awarded bonuses at the cost of the public’s health. Those incentives are indefensible, because the likelihood is that cancers will go undetected.

Early detection is vital and when England’s cancer survival rates are already among the lowest in Europe, Health Secretary Jeremy Hunt should be demanding that more people are tested sooner.

Doctors must be free to make objective decisions on medical grounds rather than receiving dangerous instructions that reduce patients to financial statistics.

But don’t blame your doctor. Blame the Government. A Tory Government. The NHS wasn’t perfect under Labour but the Tories don’t appear to care at all.

This wasteful party is handing down a death sentence for unsuspecting patients. And that’s unforgiveable.

 

Related

The Coalition has deliberately financially trashed the NHS to justify its privatisation

Selling off NHS for profit: Tories’ and Liberal Democrats’ links with private healthcare firms revealed

The commercialisation and undemocratising of the NHS: the commodification of patients

252299_486936058042594_609527550_nPicture courtesy of Robert Livingstone

Selling off NHS for profit: Tories’ and Liberal Democrats’ links with private healthcare firms revealed

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Article from the Mirror 

PM David Cameron and Health Secretary Jeremy Hunt are among 64 Tory MPs named in a study by Unite – Lib Dems Nick Clegg and Vince Cable are also on the list.

One in five Coalition MPs have links with private firms who could profit from the Government’s NHS reforms, a damning dossier will reveal on Tuesday.

Prime Minister David Cameron, former Health Secretary Andrew Lansley and his successor Jeremy Hunt are among 64 Tory MPs named in a study by the Unite union.

Deputy PM Nick Clegg and Business Secretary Vince Cable are among seven Liberal Democrats on the list.

All 71 MPs named in the dossier voted in favour of the Government’s controversial Health and Social Care Act in 2012, which opened up the NHS to more private firms.

It comes ahead of Friday’s crunch vote on Labour frontbencher Clive Efford’s Private Members’ Bill, when MPs will decide whether to scrap key sections of the Act.

[However, the only way to see the Act scrapped in full is to make sure we have a Labour Government on May 7th 2015, as the Labour Party have pledged to repeal the entire Act since it came into being, in 2012.]

Unite general secretary Len McCluskey raged: “This dossier of disgrace exposes the corruption at the heart of our Government’s sinister health reforms.”

‘Dossier of shame’: Clegg, Cameron, Hague, Hunt, Duncan Smith and Lansley are named.

Len McCluskey at the Daily Mirror Real Britain Fringe

Unite leader Len McCluskey

He added: “The Government’s real plan is the complete and irreversible privatisation of our NHS.”

Many of the MPs named in the document have directly received donations from business leaders or firms with links to the private health industry.

There is no suggestion any of the politicians or donors acted illegally.

The Conservative Party stressed tonight that all donations are reported to the Electoral Commission in line with electoral law.

But critics said the dossier shines a bright light on the close ties between members of the ­Coalition and the private health industry.

Mr McCluskey said: “The sheer scale of the conflict of interest is staggering.

“But it is the subsequent betrayal and privatisation of our NHS, driven by the monstrous Health and Social Care Act, that has made this a genuine scandal for our democracy.”

The dossier shows Mr Lansley, the chief architect of the Coalition’s NHS reforms, accepted a £21,000 donation in November 2009 from John Nash, the former chairman of Care UK.

Andrew Lansley


Chief architect: Former Health Secretary Lansley received £21k from former chairman of Care UK.

 Two other Tory MPs received donations from Mr Nash’s wife Caroline.

Hunt, who took over as Health Secretary when Mr Lansley was sacked in September 2012, received more than £20,000 from hedge fund baron Andrew Law, a major investor in health care firms.

Other Cabinet Ministers to have received donations include Leader of the Commons William Hague, who accepted £20,000 from MMC Ventures, the part-owner of The Practice plc which runs 60 GP surgeries.

And Culture ­Secretary Sajid Javid received £11,000 from Moundsley Healthcare Ltd.

The Prime Minister is named in the dossier after handing a life peerage to nursing and care home tycoon Dolar Popat, who has given the Tories more than £200,000 in donations.

Tory Dolar: PM Cameron, pictured, gave peerage to nursing and care home tycoon who donated £200k+

Work and Pensions Secretary Iain Duncan Smith has share options in hygiene tech firm Byotrol, which sells products to the NHS.

Foreign Secretary Philip Hammond is named because his former firm Castlemead is a health care and nursing home developer.

Andy Burnham, Labour’s Shadow Health Secretary, said of the Tories: “They were bankrolled by private health in Opposition as they drew up secret plans to put market forces at the heart of the NHS.

“And once in Government, MPs and peers with links to private health voted it through without a mandate from the public.”

For the Lib Dems, the dossier says party leader Mr Clegg received a £5,000 donation to his constituency office from Alpha Medical Consultancy.

And Vince Cable was given £2,000 by Chartwell Care Services, which is owned by Chartwell Health & Care plc.

Liberal Democrat leader Nick Clegg accompanied by shadow chancellor Vince CableDonations: Clegg’s (left) office received £5k while Cable was given £2k

Tonight a Conservative spokesman hit back, and said: “Here in the ­Conservative Party, donations don’t buy our leader, our candidates or our ­policies. If only the same could be said of Unite and the Labour Party.

“The most important thing with NHS care is that it is high quality and free at the point of delivery.”

A Lib Dem spokesman said his party had “stopped Conservative privatisation plans and reversed Labour’s special favours to private health companies”.

He added: “We have already committed to spending at least £1billion extra on health and care in each year of the next Parliament.”

Some MPs’ health connections

  • George Osborne, Chancellor: Received donation through Conservative Campaign HQ from Julian Schild whose family made £184m in 2006 by selling hospital bed-makers Huntleigh Technology
  • Michael Fallon, Defence Secretary: Former director of Attendo AB, a Swedish private health company
  • Philip Hammond, Foreign Secretary: Beneficiary of a trust which owns controlling interest in nursing home developer Castlemead Ltd
  • David Davis, former Shadow Home Secretary: Received £4,250 for a speaking engagement for health insurance company Aviva
  • Liam Fox, former Defence Secretary: Received £5,000 from iIPGL Ltd, which purchased health care company Cyprotex
  • John Redwood, former Cabinet Minister: Advised the private equity company which runs Pharmacy2u
  • Vince Cable, Business Secretary: Received a donation of £2,000 from Chartwell Care Services, which is 100% owned by Chartwell Health & Care PLC.

    Click here for a full list of MPs with links to private healthcare firms

    See also: The Coalition has deliberately financially trashed the NHS to justify its privatisation

     

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