Tag: John Pring

Research finds damaging mental health discrimination ‘built into’ Work Capability Assessment. Again.

Research conducted by academics at Edinburgh’s Heriot-Watt and Napier universities confirms what many of us already knew: that the government’s “fit for work” assessment is causing permanent damage to some people’s mental health, from which they are not recovering. 

The researchers say in their report that the Work Capability Assessment (WCA) experience “for many, caused a deterioration in people’s mental health which individuals did not recover from”.

The study comes at the same time as John Pring, journalist from the Disability News Service (DNS) has exposed private provider Maximus in their use of “brutal and dangerous” questions about suicide intention directed at people with mental health problems during their assessments. 

Dr Jay Watts, a clinical psychologist and academic, told DNS that people should only be asked about suicidal ideation by a trained mental health professional who can offer help, or someone in an “existing trusting relationship with the individual”.

Watts said that WCAs were “degrading and humiliating experiences for most if not all claimants” and were carried out in a space which was “not a trustworthy one”.

She said: “Individuals are required to parade their distress and feel compelled to answer intrusive questions (for the means to live relies on this).”

She went on to say: “To ask about suicide or self-harm in this context brings huge risks.”

She added that such questioning “can be suggestive if the environment is unsafe.”

She said that claimants were “battered with multiple questions about that which is most personal” in disability assessments and questioned about suicide while the assessors are “typing away” on their keyboards.

Watts concluded: “I have no doubt that questions on suicidal ideation, and the degrading manner in which they are asked, are one reason behind the suicide spike associated with the WCA process.”

The tragic case of Michael O’Sullivan, who killed himself after being found fit for work by the government’s disability assessors, has also cast a spotlight on the harmful consequences of the work capability assessment, particularly in relation to people with mental health problems. 

Though O’Sullivan’s suicide is the first to have been judged a direct consequence of being found fit for work, the DWP has conducted 49 internal reviews into benefit-related deaths since 2012, according to data released following freedom of information requests by the Disability News Service.

Of these, no fewer than 40 were conducted following the suicide, or apparent suicide, of a person claiming benefit. This is both profoundly shocking and entirely unsurprising. It is the wholly predictable result of a system designed and operated by people who appear to lack even the most basic understanding of the realities of living with mental illness.

Despite providing reports from three doctors, including his GP, stating that he had long-term depression and agoraphobia, and was unable to work, O’Sullivan was taken off employment support allowance (ESA) and placed on jobseeker’s allowance. The decision to find him fit for work was made after an assessment by a Department for Work and Pensions (DWP) doctor, a former orthopaedic surgeon, who did not factor in the views of any of the three doctors treating O’Sullivan.

Work capability assessments discriminate against people with mental health problems and should be “redesigned entirely”, according to Professor Abigail Marks from Heriot-Watt University’s Centre for Research on Work and Wellbeing. This recent study also established, through dozens of in-depth interviews of people who had been through the tests, that “in the worst cases, the WCA experience led to thoughts of suicide”. Mental health charities said the contents of the interviews “reflect what we hear from people every day”.

The researchers interviewed 30 people with existing mental health conditions who had taken the tests throughout 2016. The majority of subjects suffered from depression or anxiety, whilst a smaller number had more complex issues like bipolar disorder or borderline personality disorder. In addition, the team interviewed individuals from advocacy organisations, Citizens Advice Bureau and a former employee of Ingeus, one of the private Work Programme providers.

Marks said: “It is unacceptable that healthcare professionals who act as assessors for the WCA, for example, physiotherapists, nurses, occupational therapists are not fully qualified or trained to assess mental health conditions, yet they seem to be able to override participants’ own GPs, community psychiatric nurses, and therapists.

The WCA must be entirely redesigned, and focus on the potential barriers to work for both physical and mental health problems.”    

The report also highlighted that WCAs make non-Work Programme work experience, or other voluntary work, almost ‘impossible’ for people with mental health conditions. 

Dr Gavin Maclean, research assistant at Edinburgh Napier University, said: “Many of the participants in the study found the experience of the WCA so damaging that they stopped engaging in work-based activity and did not return to it.

This could further reduce their long-term employability and potentially increase their dependency on benefits.”

Dr Sue Cowan, assistant professor of psychology in the School of Social Sciences, said: “For people with severe and enduring mental health conditions, voluntary work may be as ‘good as it gets’, as one of our participants stated.

This does not mean a failure to obtain more. Rather, it is a recognition that an individual is making a choice, and the current system does not recognise or support that in any way.

The assumption that engaging in voluntary work means an individual is fit for employment should be scrapped; there has to be much greater flexibility about undertaking training while on ESA and much greater value must be placed on voluntary work and work-preparation activity.”

The qualitative study highlights in particular a lack of expertise in mental health problems among WCA assessors and advice from the WCA that was not consistent with what people going through the assessment had been told by their own GPs. In one case recorded in the study, a participant recounted a doctor “actually physically gasping” during an appeal because of the poor quality of evidence recorded by a WCA assessor. 

Some participants reported being in tears or having panic attacks during the tests, and others told the researchers that the assessments were “making me feel worse”.

The researchers said that the extreme stress having to deal with multiple stigmas of being unemployed and having a mental health condition became “self-reinforcing and self-perpetuating”, leading to the deterioration of peoples’ condition.

It says in the report: “Our research has reinforced the fact that people with mental health problems face more stigma and discrimination than those with physical health conditions and that this discrimination is built into the WCA.” 

Professor Marks, the lead author of the study, who is based at Heriot-Watt University, told the Independent that people who worked closely with such cases reported that deterioration in mental health conditions was an “almost universal” response to the tests.

Key causes of extreme stress were said to be a claimant’s fear of losing their lifeline income, the prolonged nature of tests, a lack of specialist mental health training amongst assessors, and the fact the test was “clearly geared towards people with physical disabilities.”

This said, many people with physical disabilities have also stated that the WCA experience has had an adverse effect on their mental health. 

Marks says: “A lot of the people we spoke to were in a position where they are preparing to go back to work before their assessment – they were doing training courses, community initiatives, or volunteering.” 

“They said that after the assessment, because the assessment had caused them so much stress, they were unable to go back and take part in those activities because their mental health had had such a deterioration.

“Talking to the advocacy workers, as well, they said it was almost universal that after people had gone through an assessment there was a significant decrease in their mental health.” 

In October last year the Government announced that it would stop repeat Work Capability Assessments for people with chronic conditions, characterising the repeat assessments it was scrapping as “unnecessary stress and bureaucracy”.

Mental health charity Mind said the WCA was clearly “not fit for purpose” and that its lengthy and costly appeals processes could well make matters worse.

“The findings of this report are concerning but sadly not surprising, as they reflect what we hear from people every day,” Ayaz Manji, the charity’s policy and campaigns officer, said.

“People with mental health problems tell us that the current fit-for-work test causes a great deal of additional anxiety. We know the assessors rarely have sufficient knowledge or expertise in mental health, meaning many people don’t get the right outcome and then have to go through a lengthy and costly appeals process. 

“The current approach is not fit for purpose and needs to be replaced by an open and honest conversation based on each person’s individual needs.”

Debbie Abrahams, the shadow work and pensions minister, said the study was more proof that the WCA “is not only unfit for purpose, but is causing harm to some disabled people”.

She added: “That’s why I have committed Labour to scrapping these assessments completely and replacing them with a holistic, person-centred approach.”

As usual, a Department for Work and Pensions spokesperson dismissed the interviewees’ experiences as not “statistically significant”.

Apparently, qualitative data doesn’t count as “empirical evidence”, or contribute to it. Or put another way, if the government don’t want to count it, it doesn’t count.

The spokesperson said: “Only thirty people were interviewed for this report, which fails to acknowledge any of the significant improvements we have made to our assessments – particularly for people with mental health conditions.” 

“Last year alone at least 35,000 work capability assessments took place in Scotland to help ensure people get the right level of support that they need.”

In fact, 37 interviews were conducted for the study. Furthermore, there is much evidence outside of this study that supports the findings. Qualitative evidence often provides richer, more in-depth, detailed evidence than quantitative studies tend to permit. Yet the government insist that citizens’ own accounts are not important, regularly dismissing them as “anecdotal”.

The government have also failed to conduct a quantitative investigation into the established correlation between WCAs and a deterioration in mental health conditions.

In 2015, the “fit for work” tests, introduced to assess eligibility for disability benefit ESA, were again found to have caused relapses in patients with serious mental health conditions, Dr Jed Boarman, consultant with the Royal College of Psychiatrists, called for an  overhaul of the process.

Boardman, a consultant psychiatrist at the South London and Maudsley NHS trust, also said the WCA discriminates against those with mental health issues. 

Boardman, who treats patients with serious and long-term mental health problems, said: “People with severe long-term problems get very distressed about being assessed, probably because mistakes are made, because the process isn’t perfect, because they don’t feel they are being listened to in their interviews.

“You do see people relapsing as a consequence of getting distressed.”

His comments followed a study, published the previous month, that linked the WCA tests with an additional 590 suicides, increased mental health problems and hundreds of thousands of antidepressant prescriptions.

The study, published by the Journal of Epidemiology and Community Health, showed a correlation between worsening mental health and assessments under the WCA.

The Department for Work and Pensions described the study as “misleading.”

The study’s main author, Benjamin Barr, said it was crucial the DWP takes seriously concerns that WCAs are “severely damaging” mental health. He called on the department to release data it holds to researchers to allow further analysis of the health impact of the controversial test.

Boardman added: “Their primary criticism of our study is that we don’t have data specifically on people going through the WCA and consequent mental health problems,” said Barr, from the University of Liverpool. “They have data on who has died following the WCA and they could facilitate linkage of that data with health causes.”

Thousands of claimants have died after being found fit for work, according to statistics released in August 2015 by the DWP, following a freedom of information request and a determined and successful court appeal by Mike Sivier of Vox Political. Ministers insisted that the figures they have released could not be used to link claimant deaths to welfare reforms, but the government has refused to release figures that would make it possible to assess whether the death rate for people found fit for work is higher than normal.

Boardman and Mark’s concerns are echoed by psychologists and benefit advisers working with claimants, who say they have gathered a lot of qualitative evidence that WCAs cause much additional psychological distress for those with mental health issues.

Related

Maximus ‘admits’ using brutal and dangerous suicide questions – John Pring

Man leaves coroner letter as he fears Work Capability Assessment will kill him

Doctors bribed with 70-90k salaries to join Maximus and “endorse a political agenda regardless of how it affects patients.”

What you need to know about Atos

The importance of citizen’s qualitative accounts in democratic inclusion and political participation

Dying from inequality: socioeconomic disadvantage and suicidal behaviour – report from Samaritans


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Secret DWP documents prove they silenced the media from running stories they didn’t approve of – Evolve Politics

Following a 13 month battle, the Department for Work and Pensions (DWP) have finally been forced to release secret documents illustrating the tactics they use to control and manipulate the media.

The documents reveal that the DWP monitors and analyses both mainstream and social media to reduce and manage negative coverage.

And even more worryingly, the documents show the DWP have managed to kill hundreds of stories by making sure that they are not reported on.

Almost every month since March 2014 the DWP communications team has produced “Media Evaluation Reports” detailing the ways and methods that the DWP controls negative stories about them in the media.

The DWP refused to release the reports since the Disability News Service (DNS) originally requested them in September 2015 stating they were “commercially sensitive”. 

Finally after a struggle that took over a year, and a complaint by the DNS to the Information Commissioner’s Office (ICO) the documents have finally been released.

The reports show that on a nearly monthly basis from March 2014 to September 2015 the DWP “spiked” (persuaded journalists not to run) a total of 385 stories.

The highest month for spiked stories was June 2015 when the department managed to successfully kill a massive 46 negative stories.

spiked-june-2014

The second highest was March 2014 when the DWP terminated 44 stories.

spiked-march

In August 2015 the DWP “proactively briefed” the media about long-awaited statistics which showed the amount of ESA claimants who had died after being found fit for work, and successfully spiked coverage in a range of news outlets.

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The reports confirm that the DWP considers the right-wing press to be supportive of them, and highlights cases where they have used them to “set the record straight” and further government policy.

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The reports show that the DWP closely monitors media output, and compiles a “sentiment of articles” chart every month to make sure that they receive positive coverage.

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The reports give valuable insight into a department that is unhealthily focused on the press coverage they receive.

The fact that they have managed to kill so many stories that they don’t approve of raises serious questions as to how the department is exercising its influence over the free press.

The role of journalism is to bring people the truth behind the DWP’s rhetoric, not to act as the chief mouthpiece for it.

Link : Evolve Politics.

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.



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


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

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

Photo courtesy of Paula Peters, DPAC.


John Pring from Disability News Service
reports:

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

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

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

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

*Not her real name

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Related  

ILF closure cuts report produces instant results from Labour and Greens

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

 

 

Secret ‘internal reviews’ show clear link between Tory welfare ‘reforms’ and suicides

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I’ve written more than one lengthy critique of Tory notions of what passes for “research” methods, and often criticised Conservative refusals to accept the research findings of academics regarding, for example, established links between the Work Capability Assessment, increased suicide and mortality, the link between sanctions and increased mortality. The Tory plea for the universal and unqualified dismissal of whatever they deem to be criticism of their policies is often based on the claim that “no causal link has been established.”

As I have pointed out previously, whilst correlation certainly isn’t quite the same thing as cause and effect, it quite often strongly hints at a causal link, and as such, warrants further investigation.

It is inaccurate to say that correlation doesn’t imply causation. It quite often does. Correlation means that an association has been established. The tobacco industry, for example, has historically relied on exactly the same dismissal of correlational evidence to reject the established link between tobacco and lung cancer.

The standard process of research doesn’t entail, at any point, a flat political denial that there is any relationship of significance to concern ourselves with, nor does it involve a systematic and deliberate withholding of relevant data, attempts at censoring democratic dialogue, and a point blank refusal to investigate further. Furthermore, the government claims that there is “no evidence of a causal link ” is unverified. There is no evidence to support government claims that there isn’t such a link, either. In fact empirical evidence strongly refutes the Conservative’s persistent claims of no association between the welfare cuts and an increase in suicide and mortality.

I’ve observed more than once that when it comes to government claims, the same methodological rigour that they advocate for others isn’t applied. Indeed, many policies have clearly been directed by ideology and traditional Tory prejudices, rather than being founded on valid research and empirical evidence. The fact that no cumulative impact assessment has been carried out with regard to the welfare “reforms” indicates a government that is not interested in accountability, and examining the potential negative outcomes of policy-making. Policies are supposed to be about meeting public needs and not about inflicting Conservative dogma and old prejudices in the form of financial punishment on previously protected social groups.

We need to ask why the government has so persistently refused to undertake cumulative impact assessments and conduct open, publicly accessible research into their austerity policies, the impact they are having and the associated deaths and suicides.

Without such research, it isn’t appropriate or legitimate to deny a causal link between what are, after all, extremely punitive, targeted, class-contingent policies and an increase in premature mortality rates.

Government policies are expressed political intentions regarding how our society is organised and governed. They have calculated social and economic aims and consequences. Political denial of responsibility is repressive, it sidesteps democratic accountability and stifles essential debate and obscures evidence. Denial of causality does not reduce the probability of it, especially in cases where a correlation has been well-established and evidenced. Nor does attempting to hide the evidence.

Being civilised, holding values of decency and having legitimate concerns about the welfare and wellbeing of sick and disabled citizens have all been depreciated as mere matters of “subjective interpretation” and not as worthy subjects of political, rational or objective discussion. This isn’t a government prepared to engage in a democratic dialogue with citizens, it is one intent on imposing authoritarianism.

 —

The following article titled “Suicides of benefit claimants reveal DWP flaws, says inquiry” was written by Patrick Butler and John Pring, for The Guardian on Friday 13th May 2016 22.59 UTC

A series of secret internal inquiries into the deaths of people claiming social security reveal that ministers were repeatedly warned of shortcomings in the treatment of vulnerable claimants facing potentially traumatic cuts to their benefits entitlements.

The conclusions are contained in 49 Department for Work and Pensions (DWP) inquiry reports finally released to campaigners on Friday after a two-year Freedom of Information (FOI) battle. Some 40 of the reports followed a suicide. In 10 cases, the claimant had had their benefits sanctioned.

Although the heavily redacted reports do not draw a direct link between the death of a claimant and problems caused by their dealings with the benefits system, they highlight widespread flaws in the handling by DWP officials of claims by people with mental illness or learning difficulty.

The reports, called “peer reviews,” appear to challenge blanket claims by ministers that there is no connection between government welfare reform policies and the deaths of vulnerable claimants.

Several suggest that claimants who died may not have received adequate support from DWP staff handling their benefit claims. At least five of the reports call for major reviews or substantial changes to procedures on identifying and supporting vulnerable claimants.

Many of them centre on the much-criticised Work Capability Assessment (WCA), the test used to assess whether claimants are fit for work. Campaigners argue the tests are flawed and linked to health relapses, depression, self-harm, and suicides.

Activists have linked the WCA to a string of tragic deaths – including poet Paul Reekie, former sheep farmer Nick Barker and ex-security guard Brian McArdle – all of whom died after being found “fit for work” and told by the DWP that they would lose their out-of-work disability benefits.

Peer reviews are triggered when a claimant death is “associated with a DWP activity”. The reports released on Friday were drawn up between February 2012 and August 2014, when an FOI request was originally submitted.

One report warns that vulnerable claimants risked being overlooked by DWP officials, with potentially harmful consequences, because staff resources were stretched by a ministerial decision to push ahead with the speedy re-assessment of hundreds of thousands of incapacity benefit claimants.

It says: “The risk associated with disregarding the possibility that some of these claimants need more support or a different form of engagement is that we fail to recognise more cases like [name redacted] with consequent potential impact on the claimant.”

The report adds: “We need to ask whether or not in the context of a fast-moving environment of high [claimant re-assessment] volumes and anticipated levels of performance, the current process requires, encourages and supports … colleagues to independently and systematically consider claimant vulnerability.”

Another report suggests that while official written policy demanded vulnerable claimants to be treated appropriately this was not implemented in practice. It says: “This case may highlight a dislocation between policy intent and what actually happens to claimants who are vulnerable.”

Ministers initially denied back in 2014 that they held any records on people whose deaths may have been linked to benefits system. Although they subsequently admitted that so-called “peer-review” investigations had been carried out since 2012, they argued social security laws prevented them from publishing them.

A DWP spokesman said it would be wrong to link benefit claims with deaths. “Any suicide is a tragedy and the reasons for them are complex, however it would be inaccurate and misleading to link it solely to a person’s benefit claim.”

They added that guidance was provided to staff on how best to support vulnerable claimants. Ministers were not routinely shown the reviews, which were undertaken internally help staff to deal with complex and challenging benefit cases.

However, they were unable to say whether ministers or senior officials had acted on any of the recommendations contained in the 49 reviews.

Disability News Service, a specialist press agency which submitted the original FOI request to obtain the reports, asked the Office of the Information Commissioner to review the DWP decision. The ICO ruled in favour of the DWP in July 2014, but a subsequent appeal was upheld in March and ministers ordered to publish the reports.

Officials have removed from the reports any references to the specific events that triggered an investigation, as well as dates, names of claimants or staff and locations. Several of the inquiry reports have been stripped of almost all data.

But a number retain entries under the heading “Lessons learned”. Collectively these show that investigators examining the links between a claimant’s death and their treatment by local DWP officials uncovered persistent problems.

They found frontline officials were often unable to identify potentially vulnerable claimants, failed to deal sensitively or appropriately with them, or anticipated problems they may have negotiating their way around the welfare bureaucracy.

Investigators found, variously, that communication between officials and vulnerable claimants was often poor, that practice guidelines were not followed, and that benefits staff often rigidly adhered to the rulebook rather than using “common sense” in their dealings with claimants.

In two instances, investigators reported that it was difficult to carry out a proper inquiry because DWP records had been purged, or not kept properly. In another instance the investigator concluded that officals precedural actions were followed correctly and could not have prevented the death of the claimant.

Other peer review findings include:

• Local DWP branch officials should be given awareness training to deal with “customers who made suicide/self harm declarations”, one report urges. It concludes: “In learning from this experience it is clear there is work to do”.

• In one local office staff failed to provide adequate support for vulnerable claimants, according to a report. It says: “It is clear that we had several opportunities to identify and address the errors made over the duration of this claim, but we neglected to do so”.

• DWP staff who decide on whether to award or disallow disability benefit claims should always consider the claimants’ full historical case files and medical history, a report concludes, to “minimise the risk of withdrawing benefit inappropriately and placing a vulnerable claimant at risk”.

It is understood nine similar DWP peer reviews have since been undertaken since August 2014 and are subject to further FOI requests.

guardian.co.uk © Guardian News & Media Limited 2010


Sign the petition asking the government to examine the DWP, ATOS & Maximus’s culpability for deaths of benefit claimants

“There’s been a marked increase in the number of deaths & suicides of claimants recently found “fit for work” by work capability assessments, possibly implying those benefits entitlements were removed hastily and that the DWP, ATOS & Maximus failed in its duty of care to vulnerable benefit claimants.”

I don’t make any money from my work. But you can support Politics and Insights and contribute by making a donation which will help me continue to research and write informative, insightful and independent articles, and to provide support to others. The smallest amount is much appreciated, and helps to keep my articles free and accessible to all – thank you.
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Maximus ‘has falsified results of fitness for work tests’, says MP – John Pring

By John Pring

The discredited US outsourcing giant contracted to carry out “fitness for work” tests on behalf of the government has been accused by an MP of “falsifying” the results of assessments.

Labour MP Louise Haigh attacked the track record, ethics and even criminal behaviour of Maximus in delivering public contracts in the US, during a debate on the work capability assessment (WCA).

But she also highlighted what she described as a “disconcerting pattern of behaviour” by Maximus in the UK since taking over the WCA contract from Atos last year.

She said: “There seems to be an alarming trend of cases being rejected based on factual errors or even – I hesitate to say this – falsification.”

Haigh (pictured speaking in the debate), a shadow Cabinet Office minister, also raised concerns that there was no way for the public to check whether targets set for Maximus by the government – such as the number of serious complaints and the payment of travel expenses within nine working days – were being met.

 

You can read the rest of this excellent article here

Related

Doctors bribed with 70-90k salaries to join Maximus and “endorse a political agenda regardless of how it affects patients.”

The government need to learn about the link between correlation and causality. Denial of culpability is not good enough.

 

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Correlation isn’t quite the same as causality. When researchers talk about correlation, what they are saying is that they have found a relationship between two, or more, variables. “Correlation does not mean causation” is a quip that researchers chuck at us to explain that events or statistics that happen to coincide with each other are not necessarily causally related.

Correlation means that an association has been established, however, and the possibility of causation isn’t refuted or somehow invalidated by the establishment of a correlation. Quite the contrary. Indeed an established association implies there may also be a causal link. To prove causation, further research into the association must be pursued. So, care should be taken not to assume that correlation never implies causation, because it quite often does indicate a causal link.

Whilst the government deny there is a causal link between their welfare policies, austerity measures and an increase in premature deaths and suicides, they cannot deny there is a clear correlation, which warrants further research – an independent inquiry at the VERY least. But the government are hiding behind this distinction to deny any association at all between policy and policy impacts. That’s just plain wrong.

Correlations between two things may be caused by a third factor that affects both of them. This sneaky, hidden third factor is called a confounding variable, or simply a confounder.

However, most of the social research you read tends to indicate and discuss a correlation between variables, not a direct cause and effect relationship. Researchers tend to talk about associations, not causation. Causation is difficult but far from impossible to establish, especially in complex sociopolitical environments. It’s worth bearing in mind that establishing correlations is crucial for research and show that something needs to be examined and investigated further. That’s precisely how we found out that smoking causes cancer, for example – through repeated findings showing an association (those good solid, old fashioned science standards of replicability and verification). It is only by eliminating other potential associations – variables – that we can establish causalities.

The objective of a lot of research or scientific analysis is to identify the extent to which one variable relates to another variable. If there is a correlation then this guides further research into investigating whether one action causes the other. Statistics measure occurrences in time and can be used to calculate probabilities. Probability is important in studies and research because measurements, observations and findings are often influenced by variation. In addition, probability theory provides the theoretical groundwork for statistical inference.

Statistics are fundamental to good government, to the delivery of public services and to decision-making at all levels of society. Statistics provide parliament and the public with a window on the work and performance of a government. Such data allows for the design of policies and programs that aim to bring about a desired outcome, and permits better targeting of resources. Once a policy has been implemented it is necessary to monitor and evaluate the effectiveness of the policy to determine whether it has been successful in achieving the intended outcomes. It is also important to evaluate whether services (outputs) are effectively reaching those people for whom they are intended. Statistics play a crucial role in this process.  So statistics, therefore, represent a significant role in good policy making and monitoring. The impact of policy can be measured with statistics.

So firstly, we need to ask why the government are not doing this.

If policy impacts cannot be measured then it is not good policy.

Ensuring accuracy and integrity in the reporting of statistics is a serious responsibility. In cases where there may not be an in-depth understanding of statistics in general, or of a particular topic, the use of glossaries, explanatory notes and classifications ought to be used to assist in their interpretation.

Statistics can be presented and used in ways that may lead readers and politicians to draw misleading conclusions. It is possible to take numbers out of context, as Iain Duncan Smith, amongst others, is prone to do. However, official statistics are supposed to be produced impartially and free from political influence, according to a strict code of practice. This is a government that systematically breaches the code of conduct. See: List of official rebukes for Tory lies and statistical misrepresentations, for example

We need to ask why the government refuses to conduct any research into their austerity policies, the impact they are having and the associated deaths and suicides.

Without such research, it isn’t appropriate or legitimate to deny a causal link between what are, after all, extremely punitive, targeted, class contingent policies and an increase in premature mortality rates.

The merits of qualitative research

However, I believe that social phenomena cannot always be studied in the same way as natural phenomena. There are, for example, distinctions to be made between facts and meanings. Qualitative researchers are concerned with generating explanations and extending understanding rather than simply describing and measuring social phenomena and establishing basic cause and effect relationships. Qualitative research tends to be exploratory, potentially illuminating underlying intentions, reasons, opinions, and motivations to human behaviours. It often provides insight into problems, helps to develop ideas, and may also be provide potential for the formulation hypotheses for further quantitative research.

The dichotomy between quantitative and qualitative methodological approaches, theoretical structuralism (macro-level perspectives) and interpretivism (micro-level perspectives) in sociology, for example, is not nearly so clear as it once was, however, with many social researchers recognising the value of both means of data collection and employing methodological triangulation, reflecting a commitment to methodological and epistemological pluralism. Qualitative methods tend to be much more inclusive, lending participants a dialogic, democratic voice regarding their experiences.

The government have tended to dismiss qualitative evidence of the negative impacts of their policies – presented cases studies, individual accounts and ethnographies – as “anecdotal.”

However, such an approach to research potentially provides insight, depth and rich detail because it explores beneath surface appearances, delving deeper than the simplistic analysis of ranks, categories and counts. It provides a reliable record of experiences, attitudes, feelings and behaviours and prompts an openness that quantitative methods tend to limit, as it encourages people to expand on their responses and may then open up new topic areas not initially considered by researchers. As such, qualitative methods bypass problems regarding potential power imbalances between the researcher and the subjects of research, by permitting participation and creating space for genuine dialogue and reasoned discussions to take place. Research regarding political issues and impacts must surely engage citizens on a democratic basis and allow participation in decision-making, to ensure an appropriate balance of power between citizens and government.

That assumes of course that governments want citizens to engage and participate. There is nothing to prevent a government deliberately exploiting a research framework as a way to test out highly unethical and ideologically-driven policies, and to avoid democratic accountability, transparency and safeguards. How appropriate is it to apply a biomedical model of prescribed policy “treatments” to people experiencing politically and structurally generated social problems, such as unemployment, inequality and poverty, for example?

Conservative governments are indifferent to fundamental public needs

The correlation between Conservative policies and an increase in suicides and premature deaths is a fairly well-established one.

For example, Australian social scientists found the suicide rate in the country increased significantly when a Conservative government was in power.

And an analysis of figures in the UK strongly suggests a similar trend.

The authors of the studies argue that Conservative admininistration traditionally implies a less supportive, interventionist and more market-orientated policy than a Labour one. This may make people feel more detached from society, they added. It also means support tends to be cut to those who need it the most.

Lead researcher Professor Richard Taylor, of the University of Sydney, told BBC News Online:

“We think that it may be because material conditions in lower socio-economic groups may be relatively better under labour because of government programmes, and there may be a perception of greater hope by these groups under labour.

There is a strong relationship between socio-economic status and suicide.”

The research is published in the Journal of Epidemiology and Community Health.

In one of a series of accompanying editorials, Dr Mary Shaw and colleagues from the University of Bristol say the same patterns were evident in England and Wales between 1901 and 2000.

Rates have been lower under Labour governments and soared under the last Conservative regime, which began in 1979 under Margaret Thatcher.

Interestingly, the authors of more recent research point out that although suicide rates tend to increase when unemployment is high, they were also above average during the 1950s when Britain “never had it so good,” but was ruled by the Conservative party.

Overall, they say, the figures suggest that 35,000 people would not have died had the Conservatives not been in power, equivalent to one suicide for every day of the 20th century or two for every day that the Conservatives ruled.

The UK Conservative Party typically refused to comment on the research.

Not a transparent, accountable and democratic government, then.

More recently, public health experts from Durham University have denounced the impact of Margaret Thatcher’s policies on the wellbeing of the British public in research which examines social and health inequality in the 1980s.

The study, which looked at over 70 existing research papers, concludes that as a result of unnecessary unemployment, welfare cuts and damaging housing policies, the former prime minister’s legacy includes the unnecessary and unjust premature death of many British citizens, together with a substantial and continuing burden of suffering and loss of well-being.

The research shows that there was a massive increase in income inequality under Baroness Thatcher – the richest 0.01 per cent of society had 28 times the mean national average income in 1978 but 70 times the average in 1990, and UK poverty rates went up from 6.7 per cent in 1975 to 12 per cent in 1985.

Thatcher’s governments wilfully engineered an economic catastrophe across large parts of Britain by dismantling traditional industries such as coal and steel in order to undermine the power of working class organisations, say the researchers. They suggest this ultimately fed through into growing regional disparities in health standards and life expectancy, as well as greatly increased inequalities between the richest and poorest in society.

Co-author Professor Clare Bambra from the Wolfson Research Institute for Health and Wellbeing at Durham University, commented:

“Our paper shows the importance of politics and of the decisions of governments and politicians in driving health inequalities and population health. Advancements in public health will be limited if governments continue to pursue neoliberal economic policies – such as the current welfare state cuts being carried out under the guise of austerity.”

Housing and welfare changes are also highlighted in the paper, with policies to sell off council housing such as Right to Buy  scheme and to reduce welfare payments resulting in further inequalities and causing “a mushrooming of homelessness due to a chronic shortage of affordable social housing.” Homeless households in England tripled during the 1980s from around 55,000 in 1980 to 165,000 in 1990.

And while the NHS was relatively untouched, the authors point to policy changes in healthcare such as outsourcing hospital cleaners, which removed “a friendly, reassuring presence” from hospital wards, led to increases in hospital acquired infections, and laid the ground for further privatisation under the future Coalition government.

The figures analysed as part of the research also show high levels of alcohol and drug-related mortality and a rise in deaths from violence and suicide as evidence of health problems caused by rising inequality during the Thatcher era.

The study, carried out by the Universities of Liverpool, Durham, West of Scotland, Glasgow and Edinburgh, is published in the International Journal of Health Services. It was scientifically peer-reviewed and the data upon which it was based came from more than 70 other academic papers as well as publicly available data from the Office for National Statistics (ONS).

The Government has repeatedly denied any links between social security cuts and deaths, despite the fact that there is mounting and strong evidence to the contrary. Yet it emerged that the Department for Work and Pensions (DWP) has carried out 60 reviews into deaths linked to benefit cuts in the past three years.

The information, released by John Pring, a journalist who runs the Disability News Service (DNS), was obtained through Freedom of Information requests. The data showed there have been 60 investigations into the deaths of benefit claimants since February 2012.

The DWP says the investigations are “peer reviews following the death of a customer.”

Iain Duncan Smith has denied that this review happened:

“No, we have not carried out a review […] you cannot make allegations about individual cases, in tragic cases where obviously things go badly wrong, you can’t suddenly say this is directly as a result of government policy.”

Secretary of State for Work and Pensions, 5 May 2015.

Several disability rights groups and individual campaigners, including myself, have submitted evidence regularly to the United Nations over the past three years, including details of Conservative policies, decision-making narratives and the impact of those policies on sick and disabled people. This collective action has triggered a welcomed international level investigation, which I reported last August: UK becomes the first country to face a UN inquiry into disability rights violations.

The United Nations only launch an inquiry where there is evidence of “grave or systemic violations” of the rights of disabled people.

Government policies are expressed political intentions regarding how our society is organised and governed. They have calculated social and economic aims and consequences.

How policies are justified is increasingly being 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 propaganda to intentionally divert us from their aims and the consequences of their ideologically (rather than rationally) driven policies.  All bullies and despots scapegoat and stigmatise their victims. Furthermore, policies have become increasingly detached from public interests and needs.

It’s possible to identify which social groups this government are letting down and harming the most – it’s the ones that are being politically marginalised and socially excluded. It’s those groups that are scapegoated and deliberately stigmatised by the perpetrators of their misery.

Iain Duncan Smith and Priti Patel claim that we cannot make a link between government policies and the deaths of some sick and disabled people. There are no grounds whatsoever for that claim. There has been no cumulative impact assessment, no inquiry, no further research regarding an established correlation and a longstanding refusal from the Tories to undertake any of these. There is therefore no evidence for their claim.

Political denial is repressive, it sidesteps democratic accountability and stifles essential debate and obscures evidence. Denial of causality does not reduce the probability of it, especially in cases where a correlation has been well-established and evidenced.

arnstein-ladder-citizenship-participation.png

This is Sherry Arnstein’s Ladder of Citizen Participation and Power. Whereabouts are we?

For Arnstein, participation reflects “the redistribution of power that enables the have-not citizens, presently excluded from the political and economic processes, to be deliberately included in the future. It is the strategy by which the excluded join in determining how information is shared, goals and policies are set, tax resources are allocated, programmess are operated, and benefits like contracts and patronage are parceled out. In short, it is the means by which they can induce significant social reform which enables them to share in the benefits of the affluent society.”

A starting point may be the collective gathering of evidence and continual documentation of our individual experiences of austerity and the welfare “reforms”, which we must continue to present to relevant ministers, parliament, government departments, the mainstream media and any organisations that may be interested in promoting citizen inclusion, empowerment and democratic  participation.

We can give our own meaningful account of our own experiences and include our own voice, reflecting our own first-hand knowledge of policy impacts, describing how we make sense of and understand our own situations, including the causal links between our own circumstances, hardships, sense of isolation and distress, and Conservative policies, as active, intentional, consciencious citizens. Furthermore, we can collectively demand a democratic account and response (rather than accepting denial) from the government.


Related

A tale of two suicides and a very undemocratic, inconsistent government

The Tories are epistemological fascists: about the DWP’s Mortality Statistics release

The DWP mortality statistics: facts, values and Conservative concept control

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Pictures courtesy of Robert Livingstone


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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