Tag: Lawrence Mead

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The crib sheet  

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

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

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

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

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

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

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

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

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

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

She’s absolutely right.

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

The public are picking up the tab.

 Rogue and antisocial corporations are writing public policies

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

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

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

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

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

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

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

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Unum’s long standing toxic influence on policy-making

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

It’s mind over matter and quids in

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Here is further evidence that government policy is not founded on empirical evidence, but rather, it is often founded on deceitful contrivance. A Department for Work and Pensions research document published back in 2011 – Routes onto Employment and Support Allowance – said that if people believed that work was good for them, they were less likely to claim or stay on disability benefits.

It was decided that people should be “encouraged” to believe that work was “good” for health. There is no empirical basis for the belief, and the purpose of encouraging it is simply to cut the numbers of disabled people claiming ESA by “encouraging” them into work. Some people’s work is undoubtedly a source of wellbeing and provides a sense of purpose. That is not the same thing as being “good for health”. For a government to use data regarding opinion rather than empirical evidence to claim that work is “good” for health indicates a ruthless mercenary approach to fulfill their broader aim of dismantling social security and to uphold their ideological commitment to supply-side policy.

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

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

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

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

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

Rather than make a link between manual work, lack of reasonable adjustments in the work place and the impact this may have on longer term ill health, the government chose instead to promote the cost-cutting and unverified, irrational belief that work is a “health” outcome. Furthermore, the research does conclude that health status itself is the greatest determinant in whether or not people return to work. That means that those not in work are not recovered and have longer term health problems that tend not to get better.

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

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

Nudging, Unum and the behaviourist turn in medicine. 

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

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

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

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

Othering and outgrouping have become common political practices. 

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

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

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

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

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

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

He sounds rather like an authoritarian Victorian headmaster.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

All hail the corporatocracy.

 

imgres

 

Footnote

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

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

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

Related

Unum welcomes Green Paper focus on Group Income Protection  Unum

MUTUAL BENEFITS  Private Eye

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

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

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

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

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

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

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

Major breakthrough on PACE trial – George Faulkner

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

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

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

Nudging conformity and benefit sanctions

 


 

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The Minnesota Starvation Experiment provided empirical evidence that demonstrates clearly why welfare sanctions can’t possibly work as an “incentive” to “make work pay”

behavchange

“Behavioural theory is a powerful tool for the government communicator, but you don’t need to be an experienced social scientist to apply it successfully to your work.”

Alex Aiken
Executive Director of
Government Communications (Source).

 

Introduction

The Conservatives have always used emotive and morally-laden narratives that revolve around notions of “national decline” and a “broken society” to demarcate “us and them”, using overly simplistic binary schema. Conservative rhetoric reflexively defines what the nation is and who it excludes, always creating categories of others.

David Cameron’s government have purposefully manufactured a minimal group paradigm which is founded on a false dichotomy. People who “work hard” are deemed “responsible” citizens and the rest are stigmatized, labelled as “scroungers” and outgrouped (inaccurately) as irresponsible economic free riders. This prejudiced distinction requires a single snapshot of just one frozen point in time, and an assumption that people who claim welfare support are the same people year after year, but longitudinal studies indicate that over the course of their lives, most people move in and out of employment. Most people claiming welfare support have worked and made responsible contributions to society.

The Conservatives also claim that welfare provision itself is problematic, because it creates “a culture of dependency.” Yet there has never been evidence to support this claim. In fact, a recent international study of social safety nets from the Massachusetts Institute of Technology (MIT) and Harvard economists refutes the Conservative “scrounger” stereotype and dependency rhetoric. Abhijit Banerjee, Rema Hanna, Gabriel Kreindler, and Benjamin Olken re-analyzed data from seven randomized experiments evaluating cash programmes in poor countries and found “no systematic evidence that cash transfer programmes discourage work.”

The phrase “welfare dependencywas designed to intentionally divert attention from political prejudice, discrimation via policies and to disperse public sympathies towards the poorest citizens.

The Conservatives have always constructed discourses and shaped institutions which isolate some social groups from health, social and political resources, with justification narratives based on a process of class-contingent personalisations of social problems, such as poverty, using quack psychology and pseudoscience. However, it is social conditions which lead to deprivation of opportunities, and that outcome is a direct consequence of inadequate and biased political decision-making and policy.

Conditionality

One of the uniquely important features of Britain’s welfare state is the National Insurance system, based on the principle that people establish a right to benefits by making regular contributions into a fund throughout their working lives. The contribution principle has been a part of the welfare state since its inception. A system of social security where claims are, in principle, based on entitlements established by past contributions expresses an important moral rule about how a benefits system should operate, based on reciprocity and collective responsibility, and it is a rule which attracts widespread public commitment. National Insurance is felt intuitively by most people to be a fair way of organising welfare.

The Conservative-led welfare “reforms” had the stated aim of ensuring that benefit claimants – redefined as an outgroup of free-riders – are entitled to a minimum income provided that they uphold responsibilities, which entail being pushed into any available work. The  Government claim that sanctions “incentivise” people to look for employment.

Conditionality for social security has been around as long as the welfare state. Eligibility criteria have always been an intrinsic part of the social security system. For example, to qualify for jobseekers allowance, a person has to be out of work, able to work, and seeking employment.

But in recent years conditionality has become conflated with severe financial penalities (sanctions), and has mutated into an ever more stringent, complex, demanding set of often arbitrary requirements, involving frequent and rigidly imposed jobcentre appointments, meeting job application targets, providing evidence of job searches and mandatory participation in workfare schemes. The emphasis of welfare provision has shifted from providing support for people seeking employment to increasing conditionality of conduct, enforcing particular patterns of behaviour and monitoring claimant compliance.

Sanctions are “penalties that reduce or terminate welfare benefits in cases where claimants are deemed to be out of compliance with  requirements.” They are, in many respects, the neoliberal-paternalist tool of discipline par excellence – the threat that puts a big stick behind coercive welfare programme rules and “incentivises” citizen compliance with a heavily monitoring and supervisory administration. The Conservatives have broadened the scope of behaviours that are subject to sanction, and have widened the application of sanctions to include previously protected social groups, such as sick and disabled people, pregnant women and lone parents.

The new paternalists often present their position as striking a moderate, reasonable middle ground between rigid anti-paternalism on the one hand and an overly intrusive “hard” paternalism on the other. But the claim to moderation is difficult to sustain, especially when we consider the behavioural modification technique utilised here – punishment – and the consequences of sanctioning welfare recipients, many of whom are already struggling to meet their basic needs.

Nudge permits policy-makers to indulge their ideological impulses whilst presenting them as “objective science.” From the perspective of libertarian paternalists, the problems of neoliberalism don’t lie in the market, or in growing inequality and social stratification: neoliberalism isn’t flawed, nor are governments – we are. Governments don’t make mistakes – only citizens do.

Work programme providers are sanctioning twice as many people as they are signposting into employment (David Etherington, Anne Daguerre, 2015), emphasising the distorted priorities of “welfare to work” services, and indicating a significant gap between claimant obligations and employment outcomes.

Ethical considerations of injustice and the adverse consequences of welfare sanctions have been raised by politicians, charities, campaigners and academics. Professor David Stuckler of Oxford University’s Department of Sociology, amongst others, has found clear evidence of a link between people seeking food aid and unemployment, welfare sanctions and budget cuts, although the government has, on the whole, tried to deny a direct “causal link” between the harsh welfare “reforms” and food deprivation. However, a clear correlation has been established.

The current government demand an empirical rigour from those presenting legitimate criticism of their policy, yet they curiously fail in meeting the same exacting standards that they demand of others. Often, the claim that “no causal link has been established” is used as a way of ensuring that established, defined correlative relationships, (which often do imply causality,) are not investigated further. Qualitative evidence – case studies, for example – is very often rather undemocratically dismissed as “anecdotal,” which of course stifles further opportunities for important research and inquiry regarding the consequences and impacts of government policy. This also undermines the process of a genuine evidence-based policy-making, leaving a space for a rather less democratic ideology-based political decision-making.

Further concerns have arisen that food banks have become an institutional part of our steadily diminishing welfare state, normalising food insecurity and deprivation amongst people both in and out of work.

There is no evidence that keeping benefits at below subsistence level “incentivises” people to work. In fact research indicates it is likely to have the opposite effect. In 2010/2011 there 61,468 people were given 3 days emergency food and support by the Trussell Trust and this rose to 913,138 people in 2013-2014.

At least four million people in the UK do not have access to a healthy diet; nearly 13 million people live below the poverty line, and it is becoming increasingly difficult for them to afford food. More than half a million children in the UK are now living in families who are unable to provide a minimally acceptable, nutritious diet. (Source: Welfare Reform, Work First Policies And Benefit Conditionality: Reinforcing Poverty And Social Exclusion? Centre for Enterprise and Economic Development Research, 2015.)

There is plenty of evidence that sanctions don’t help people to find work, and that the punitive application of severe financial penalities is having an extremely detrimental, sometimes catastrophic impact on people’s lives. We can see from a growing body of research how sanctions are not working in the way the government claim they intended.

Sanctions, under which people lose benefit payments for between four weeks and three years for “non-compliance”, have come under fire for being unfair, punitive, failing to increase job prospects, and causing hunger, debt and ill-health among jobseekers. And sometimes they result in death.

I want to discuss two further considerations to add to growing criticism of the extended use of sanctioning which are related to why sanctions don’t work. One is that imposing such severe financial penalities on people who need social security support to meet their basic needs cannot possibly bring about positive “behaviour change” or “incentivise” people to find employment, as claimed. This is because of the evidenced and documented broad-ranging negative impacts of financial insecurity and deprivation – particularly food poverty – on human physical health, motivation, behaviour and mental health.

The second related consideration is that “behavioural theories” on which the government rests the case for extending and increasing benefit sanctions, are simply inadequate and flawed, having been imported from a limited behavioural economics model (otherwise known as libertarian paternalism) which is itself ideologically premised.

At best, the new “behavioural science” is merely a set of theoretical propositions, at a broadly experimental stage, and therefore profoundly limited in terms of scope and academic rigour, as a mechanism of explanation, and in terms of capacity for generating comprehensive, coherent accounts and understanding about human motivation and behaviour.

Furthermore, in relying upon a pseudo-positivistic experimental approach to human cognition, behavioural economists have made some highly questionable ontological and epistemologial assumptions: in the pursuit of methodological individualism, citizens are consequently isolated from the broader structural political, economic, sociocultural and established reciprocal contexts that invariably influence and shape an individuals’s experiences, meanings, motivations, behaviours and attitudes, causing a problematic duality between context and cognition. The libertarian paternalist approach also places unfair and unreasonable responsibility on citizens for circumstances which lie outside of their control, such as the socioeconomic consequences of political decision-making.

Yet many libertarian paternalists reapply the context they evade in explanations of human behaviours to justify the application of their theory, claiming that their collective “behavioural theories” can be used to serve social, and not necessarily individual ends, by simply acting upon the individual to make them more “responsible.” (See, for example: Personal Responsibility and Changing Behaviour: the state of knowledge and its implications for public policy, David Halpern, Clive Bates, Geoff Mulgan and Stephen Aldridge, 2004.)

In other words, there is a relationship between the world that a person inhabits and that person’s actions. Any theory of behaviour and cognition that ignores context can at best be regarded as very limited and partial. Yet the libertarian paternalists overstep their narrow conceptual bounds, with the difficulty of reconciling individual and social interests glossed over somewhat.

The ideological premise on which the government’s “behavioural theories” and assumptions about unemployed and sick and disabled people rests is also fundamentally flawed. Neoliberalism and social Conservatism are not working to extend wealth and opportunity to a majority of citizens. The shift away from a collective rights-based democratic society to a state-imposed moral paternalism, comprised almost entirely of unfunded, unsupported, decontextualised “responsible” individuals is simply an ideological edit of reality, hidden in plain sight within the tyranny of decision-makers shaping our “best interests”, to justify authoritarian socioeconomic policies that generate and perpetuate inequality and poverty. Libertarian paternalists don’t have much of a vocabulary for discussing any sort of collective, democratic, or autonomous and deliberative decision-making.

The Conservatives and a largely complicit media convey the message that poor people suffer from some sort of character flaw – a poverty of aspiration, a deviance from the decent, hard-working norm. That’s untrue, of course: poor people simply suffer from material poverty which may steal motivation and aspiration from any and every person that is reduced to struggling for basic survival.

It’s not a coincidence that those countries with institutions designed to alleviate poverty and inequality – such as a robust welfare state, a strong role for collective bargaining, a stronger tax and transfer system, have lower levels of income inequality and poverty.

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The Minnesota Starvation Experiment volunteers

1. “Starved people can’t be taught democracy.” Ancel Keys

Imposing punishment in the form of financial sanctions on people who already have only very limited resources for meeting their basic survival needs is not only irrational, it is absurdly and spectacularly cruel. There is a body of evidence from a landmark study that describes in detail the negative impacts of food deprivation on physical and psychological health, including an account of the detrimental effects of hunger on motivation and behaviour.

During World War Two, many conscientious objectors wanted to contribute to the war effort meaningfully, and according to their beliefs. In the US, 36 conscientious objectors volunteered for medical research as an alternative to military service. The research was designed to explore the effects of hunger, to provide postwar rehabilitation for the many Europeans who had suffered near starvation and malnutrition during the war.

A high proportion of the volunteers were members of the historic peace churches (Brethren, Quakers, and Mennonites). The subjects, all healthy males, participated in a study of human semistarvation conducted by Ancel Keys and his colleagues at the University of Minnesota. The Minnesota Starvation Experiment, as it was later known, was a grueling six month study designed to gain insight into the physical and psychological effects of food deprivation. Those selected to participate in the experiment were a highly motivated and well-educated group; all had completed some college coursework, 18 had graduated, and a few had already begun graduate-level coursework.

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The Minnesota laboratory

During the experiment, the participants were subjected to semistarvation, most lost 25% of their body weight in total. Extensive tests were given to the participants throughout the experiment. Body weight, size, and strength were recorded, and basic functions were tracked using X-rays, electrocardiograms, blood samples, and metabolic studies. Psychomotor and endurance tests were given, as the men walked on the laboratory treadmills, and participants received intelligence and personality tests from a team of psychologists.

The men ate meals twice a day. Typical meals consisted of cabbage, turnips and half a glass of milk. On another day, it might be rye bread and some beans. Keys designed the meals to be carbohydrate rich and protein poor, simulating what people in Europe might be eating, with an emphasis on potatoes, cabbage, macaroni and whole wheat bread (all in meagre proportions). Despite the reduction in food, Keys insisted that the men try to maintain their active lifestyle, including the 22 miles of walking each week.

The negative effects of the reduced food intake quickly became apparent. The men rapidly showed a remarkable decline in strength and energy. Keys charted a 21 per cent reduction in their physical strength, as measured by their performance, using a variety of methods, including a back lift dynamometer. The men complained that they felt old and constantly tired.

There were marked psychological effects, too. They developed a profound mental apathy. The men had strong political opinions, but as the grip of hunger tightened, political affairs and world events faded into irrelevance for them. Even sex and romance lost their appeal. Food became their overwhelming priority. The men obsessively read cookbooks, staring at pictures of food with almost pornographic obsession. One participant managed to collect over a 100 cookbooks with pictures over the course of the experiment.

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Some subjects diluted their food with water to make the meagre proportions seem like more. Others would savour each little bite and hold it in their mouth as long as possible. Eating became ritualised and took a long time.

One of the volunteers recalled memorising the location of all of the lifts in the university buildings because he struggled climbing stairs, and even experienced difficulty opening doors, he felt so weak. The researchers recognised that “energy is a commodity to be hoarded – living and eating quarters should be arranged conveniently” in a subsequent leaflet designed to help in accommodating the increasing weakness and lethargy in people needing aid and support to recover from semistarvation.

Within just a few weeks of the study, the psychological stress that affected all of the subjects became too much for one of the men,  Franklin Watkins. He had a breakdown after having vivid, disturbing dreams of cannibalism in which he was eating the flesh of an old man. He had to leave the experiment. Two more subjects also suffered severe psychological distress and episodes of psychosis during the semistarvation period, resulting in brief stays in the psychiatric ward of the Minnesota university hospital. One of the men had also reported stealing scraps of food from bins.

Amongst the conclusions from the study was the confirmation that prolonged semistarvation produces significant increases in depression, hysteria and hypochondriasis, which was measured using the Minnesota Multiphasic Personality Inventory. Most volunteers experienced periods of severe emotional distress and depression. There were extreme reactions to the psychological effects during the experiment including self-mutilation (one subject amputated three fingers of his hand with an axe, though the subject was unsure if he had done so intentionally or accidentally.)

The men also became uncharacteristically irritable, introverted and argumentative towards each other, they became less sociable, experiencing an increasing need for privacy and quiet – noise of all kinds seemed to be very distracting and bothersome and especially so during mealtimes. The men became increasingly apathetic and frequently depressed.

The volunteers reported decreased tolerance for cold temperatures, and requested additional blankets, even in the middle of summer. They experienced dizziness, extreme tiredness, muscle soreness, hair loss, reduced coordination, and ringing in their ears. They were forced to withdraw from their university classes because they simply didn’t have the energy or motivation to attend and to concentrate. Other recorded problems were anemia, profound fatigue, apathy, extreme weakness, irritability, neurological deficits, and lower extremity fluid retention, slowed heart rate amongst other symptoms.

The Minnesota Experiment also focused study on attitudes, cognitive and social functioning and the behaviour patterns of those who have experienced semistarvation. The experiment illuminated a loss of ambition, self-discipline, motivation and willpower amongst the men once food deprivation commenced. There was a flattening of affect, and in the absence of all other emotions, Doctor Keys observed the resignation and submission that hunger very often manifests.

The understanding that food deprivation dramatically alters emotions, motivation, personality, and that nutrition directly and predictably affects the mind as well as the body is one of the legacies of the experiment.

In the last months of the experiment, the volunteers were fed back to health. Different groups were presented with different foods and calorie allowances. But it was months, even years – long after the men had returned home – before they had all fully recovered. Keys published his full report about the experiment in 1950. It was a substantial two-volume work titled The Biology of Human Starvation. To this day, it remains the most comprehensive scientific examination of the physical and psychological effects of hunger.

Keys emphasised the dramatic effect that semistarvation had on motivation, mental attitude and personality, and he concluded that democracy and nation building would not be possible in a population that did not have access to sufficient food.

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Further study of the impact of food deprivation and starvation on
psychological and cognitive deterioration – The Psychological Effects of Starvation in the Holocaust

Cognitive function deficits and demotivation associated with food deprivation: Blood glucose influences memory and attention in young adults

Nutritional deficiencies and detrimental consequences for mental health: Nutrition and mental health

A comprehensive study of the detrimental impacts of food insecurity on the development, behaviour, mental health and wellbeing, learning, educational attainment, citizenship and physical health of children in America: Child Food Insecurity: The Economic Impact on our Nation

The effects of breakfast on cognitive performance, academic performance and in-class behaviour in adolescents

Comprehensive computerized assessment of cognitive sequelae of a complete 12-16 hour fast

The Minnesota food deprivation experiment also established a link between food insecurity and deprivation and later unhealthful eating practice, eating disorders and obesity – Journal of the American Dietetic Association

2. Abraham Maslow and the hierarchy of human needs

“It is quite true that man lives by bread alone – when there is no bread.”

Maslow was humanist psychologist. He proposed his classical theory of motivation and the hierarchical nature of human needs in 1943. His critical insights have been translated into an iconic pyramid diagram, which depicts the full spectrum of needs, ranging from physical to psychosocial. Maslow believed that people possess a set of simple motivation systems that are unrelated to the punishments and rewards that behaviourists proposed, or the complexities of unconscious desires proposed by the psychoanalysts.

Maslow said basically that the imperative to fulfil basic needs will become stronger the longer the duration that they are denied. For example, the longer a person goes without food, the more hungry and preoccupied with food they will become.

So, a person must satisfy lower level basic biological needs before progressing on to meet higher level personal growth needs. A pressing need would have to be satisfied before someone would give their attention to the next highest need. If a person has not managed to meet their basic physical needs, it’s highly unlikely that they will be motivated to fulfil higher level psychosocial ones.

Maslow recognised that although every human is capable and has the desire to move up the hierarchy of needs to fulfil their potential, progress is often disrupted by a failure to meet lower level needs. Life experiences, including the loss of a job, loss of a home, poverty, illness, for example, may cause an individual to become trapped at the lower needs levels of the hierarchy.

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Maslow’s hierarchy of human needs

Some theorists have claimed that whilst Maslow’s hierarchy makes sense – it’s founded on an intuitive truth – it lacks scientific support. However, Maslow’s theory has certainly been verified by the findings of the Minnesota Experiment and other studies of the effects of food deprivation. Abraham Maslow’s humanist account of motivation also highlights the same connection between fundamental motives and immediate situational threats.

The experiment highlighted a striking sense of immediacy and fixation that arises when there are barriers to fulfiling basic physical needs – human motivation is frozen to meet survival needs, which take precedence over all other needs. This is observed and reflected in both the researcher’s and the subject’s accounts throughout the study. If a person is starving, the desire to obtain food will trump all other goals and dominate the person’s thought processes. This idea of cognitive priority is also clearly expressed in Maslow’s needs hierarchy. 

In a nutshell, this means that if people can’t meet their basic survival needs, it is extremely unlikely that they will have either the capability or motivation to meet higher level psychosocial needs, including social obligations and responsibilities to seek employment.


Conclusions: the poverty of reponsibility and the politics of blame

American Conservative academic, Lawrence Mead, argued in 2010 that the government needed to “enforce values that have broken down” such as the “work ethic”, with an expensive, intrusive bureaucracy that “helped and hassled” people back to work. Mead was a Conservative political “scientist” who said that poverty was largely due to a breakdown of public authority. Poverty reflected disorder more than denials of opportunity. He felt that the poor were “too free,” rather than not free enough.

He believed that benefits should be “mean and conditional,” forcing recipients to take any available jobs. Calling himself a “new paternalist”, his proposal is that people must be taught to blame themselves for their hardships and accept that they deserve them. He believed that workfare should be an onerous threat, so that people opt out of the social security system altogether. (See: Guardian, June 16, 2010). Mead provided the theoretical basis for the American welfare reforms of the 1990s, which required adult recipients of welfare to work as a condition of aid.

The consequences of the US reforms have been dire for many families, both in and out of work, many are now facing destitution as a consequence of the US welfare safety net being cut away. Mead also considerably influenced the UK Conservative-led welfare reforms.

The extremely conditional welfare approach that Mead advocated rests on the assumption that the problems it seeks to address are fundamentally behavioural in nature (rather than structural) and are therefore amenable to remedy through paternalist punishment, or, to borrow from the libertarian paternalist bland lexicon, through manipulation of  “cognitive biases“, in this case, one specifically known as loss aversion.

A paper, written in 2010 – Applying behavioural economics to welfare to work contained outlines of the pseudopsychological justification  for increasing the use of sanctions. The “research” was sponsored by Steve Moore, Business Development Director of esg , a key welfare to work consortium, which was  established by two Tory donors with close ties to ministers. The Government’s Behavioural Insights Team (the “Nudge” Unit) provided a tenuous theoretical framework and a psychobabbled rationale for increasing and extending the use of benefit sanctions, transforming welfare provision into a system of directed political prejudice, discrimination and punishment.

The following year, in June, the government announced that it would toughen the sanctions regime, making it much more difficult for claimants to temporarily sign off benefits to avoid being forced into unpaid work. Perhaps the woefully under-recognised and under-acknowledged cognitive bias called “vested interests escaped the attention of libertarian paternalists, when esg were awarded two extremely lucrative government contracts with Iain Duncan Smith’s Department for Work and Pensions in 2011, totalling £73million.

So, the paper provides a justification narrative for welfare sanctions and mandatory work fare, and it also preempts an opportunity for work fare providers to make lots of profit and to subsidise private businesses with free labor at the expense of the UK’s poorest citizens and taxpayers. Yet the government’s own research also showed that the scheme does not help unemployed people to find paid employment once they have finished the four weeks of mandatory work “experience”. It also has no positive effect in helping people “off benefits” and into employment in the long term.

The libertarian paternalist justification narrative is basically a pseudoscientific attempt to pathologise and homogenise the psychology of unemployed people, justifying the need for a very lucrative “remedy,” which is costing the poorest citizens their autonomy, health and wellbeing. It’s also costing the public purse far more than it would to simply provide social security for people needing support in meeting their basic needs.

Furthermore, as I have previously pointed out, it flies in the face of established empirical evidence.

From the document in 2010, on page 18: The most obvious policy implication arising from loss aversion is that if policy-makers can clearly convey the losses that certain behaviour will incur, it may encourage people not to do it.” This of course assumes that being without a job is because of nothing more complex than opting for a “lifestyle choice.” 

And page 46: “Given that, for most people, losses are more important than comparable gains, it is important that potential losses are defined and made explicit to jobseekers (e.g.the sanctions regime).”

The recommendation on page 46: We believe the regime is currently too complex and, despite people’s tendency towards loss aversion, the lack of clarity around the sanctions regime can make it ineffective. Complexity prevents claimants from fully appreciating the financial losses they face if they do not comply with the conditions of their benefit.”

The Conservatives subsequently “simplified” sanctions by extending their use to previously protected groups, such as sick and disabled people and lone parents, increasing their severity and increasing the frequency of their use from 2012.

Of course there is a problem in assuming that punishing people will make them behave more “rationally,” and that is aside from the ethical dilemmas presented with neoliberal paternalists and businesses deciding what is “rational” and in other people’s “best interests.”

Deprivation substantially increases the risk of mental illnesses, including schizophrenia, depression, anxiety and substance addiction. Poverty can act as both a causal factor (e.g. stress resulting from poverty triggering depression) and a consequence of mental illness (e.g. schizophrenic symptoms leading to decreased socioeconomic status and prospects).

Poverty is a significant risk factor in a wide range of psychological illnesses. Researchers recently reviewed evidence for the effects of socioeconomic status on three categories: schizophrenia, mood and anxiety disorders and substance abuse. Whilst not a comprehensive list of conditions associated with poverty, the issues raised in these three areas can be generalised, and have clear relevance for policy-makers.

The researchers concluded: “Fundamentally, poverty is an economic issue, not a psychological one. Understanding the psychological processes associated with poverty can improve the efficacy of economically focused reform, but is not a panacea. The proposals suggested here would supplement a focused economic strategy aimed at reducing poverty.” (Source: A review of psychological research into the causes and consequences of poverty, Ben Fell, Miles Hewstone, 2015.)

The Conservative shift in emphasis from structural to psychological explanations of poverty has far-reaching consequences. The recent partisan reconceptualision of poverty makes it much more difficult to define and measure. Such a conceptual change disconnects poverty from more than a century of detailed empirical and theoretical research, and we are witnessing an increasingly experimental approach to policy-making, as opposed to an evidence-based one, aimed solely at changing the behaviour of individuals, (to meet the demands of policy-makers) without their consent.

At least the Treasury is benefiting from the new conditionality and sanctions regime. Earlier this year, the Work and Pensions select committee heard independent estimates (committee member Debbie Abrahams MP said the DWP will not give or does not have figures) that since late 2012 sanctions had resulted in at least £275m being withheld from benefit claimants (the comparable figure for 2010 was £50m).

Many people in work are still living in poverty and reliant on in-work benefits, which undermines the libertarian paternalist case for increasing benefit conditionality somewhat, although those in low-paid work are still likely to be less poor than those reliant on out-of-work benefits. The Conservative “making work pay” slogan is a cryptographic reference to the punitive paternalist 1834 Poor Law principle of less eligibility.

But part of the government’s Universal Credit legislation is founded on the idea that working people in receipt of in-work benefits may face punitive benefits sanctions if they are deemed not to be trying hard enough to find higher paid work. It’s not as if the Conservatives have ever valued legitimate collective wage bargaining. In fact their legislative track record consistently demonstrates that they hate it, prioritising the authority of the state above all else.

Workplace disagreements about wages and conditions are now typically resolved neither by collective bargaining nor litigation but are left to management prerogative. Conservative aspirations are clear. They want cheap labor and low cost workers, unable to withdraw their labor, unprotected by either trade unions or employment rights and threatened with destitution via benefit sanction cuts if they refuse to accept low paid, low standard work. This is thought to “increase economic competiveness.” Similarly, desperation and the “deterrent” effect of the 1834 Poor Law amendment served to drive down wages. In the Conservative’s view, trade unions distort the free labor market, which runs counter to New Right and neoliberal dogma.

Since 2010, the decline in UK wage levels has been amongst the very worst in Europe. The fall in earnings under the Coalition is the biggest in any parliament since 1880, according to analysis by the House of Commons Library, and at a time when the cost of living has spiralled upwards.

 

web-earnings-graphic

There has been a powerful shift back from progressive notions of collective social justice and equality to increasingly absurd, unfair and enforced individual responsibilities without concomitant rights, the underpinning Conservative view is that that socioeconomic inequality resulting from the free market is necessary and not something that the state need or should do anything about. Inequality in the UK is now greater than in any other European Union country, including the US. Yet the subsequent growing poverty and uncertainties of the labor market are irrationally held to be the responsibility of the individual.

In fact the state is forcefully redistributing the risks and burdens of job-market instability from the state to unemployed individuals. The “problem” of an entirely politically-defined  “welfare dependency” is presented with a “solution” in terms of a one-way transition into low-waged, poor quality work, which does not alleviate poverty.

Any analysis of the British economy over the past 40 years shows how the decline of union power since the early 1980s has coincided with the fall in the proportion of GDP that goes to wages, and the rise of private business profits. Boardroom pay has sky-rocketed whilst wages have been held down, as chief executives and directors no longer fear the effect of their pay rises on their staff. It’s a neoliberal myth that if firms are profitable, they are more likely to employ more workers, or that falling profitability is likely to reduce the demand for labor. One problem is that the government and employers have come to see the workforce as a disposable cost rather than an asset.

Wage repression has nothing whatsoever to do with workers, and threatening to punish low paid workers for their employer’s profit motive and the vagaries of an unregulated (liberalised) labor market by removing the in-work benefits that ensure exploited workers don’t face destitution is not only absurd, it is extremely cruel. The steady erosion of the post-war welfare state, and the increasing use of punitive approaches has served to further facilitate private sector wage repression. Ninetheenth century notions of punitive deterrence have replaced civilised notions of citizen rights and entitlement, once again penalising people for the manifested symptoms but sidestepping the root causes of poverty.

Libertarian paternalist nudges may only work by stigmatising particular behaviours. The new “behavioural science” reflects an ideological and cultural rejuvenation of the Conservative’s ancient moral and prejudiced critique of the poor, polished by nothing more than pseudoscientific attempts at erecting a stage of credibility, using a kind of linguistic alchemy, based on purposefully manufactured semantic shifts and bland, meaningless acronyms.

What was once summarily dismissed from Victorian moralists such as Samuel Smiles, and Herbert Spencer, who is best known for the expression, and sociopolitical application of the social Darwinist phrase survival of the fittest, is now being recodified into the bland terminology and inane managementspeak acronyms emanating from the behavioural economics “insights” team – the Nudge Unit at the heart of the Cabinet Office.

This was the race to the bottom situation for many people in Victorian England, where conditions in the workhouses became appalling because conditions for unskilled workers were also appalling. It established a kind of market competition situation of the conditions of poverty, where “making work pay” invariably means never-ending reductions in the standard of living for unemployed people and those in low paid work. Benefit sanctions amount to cutting unemployment benefits, reducing choices by forcing people into any available low paid employment and have exactly the same effect: they drive down wages and devalue labour.

Narratives are representations of connected events and characters that have an identifiable structure, and contain implicit or explicit messages about social norms, and the topic being addressed as such may impact attitudes and behaviour. One way to shift perceptons and “change behaviours”, according to the new economolgists, is through intensive social norms media campaigns. Media narratives are being nudged, too.

From MINDSPACE: Influencing behaviour through public policy,  David Halpern et al (2010):

“Framing is crucial when attempting to engage the public with behaviour change.”

“There are ways in which governments can boost their authority, and minimise psychological reactance in the public.”

Sometimes campaigns can increase perceptions of undesirable behaviour.”

Research shows that public ideas about poverty and unemployment depend heavily on how the issues are framed. When news media presentations frame poverty, for example, in terms of general outcome, people tend to believe that society collectively shares the responsibility for poverty. When poverty is framed as particular instances of individual poor people, responsibility is assigned to those individuals. In 1986, The General Social Survey documented how various descriptions of poor families influence the amount of assistance that people think they ought to have. Political framing is a powerful tool of social control. It agendarises issues (according to a dominant and Conservative economic, moral and social system that values thrift and moderation in all things, but mostly for the poorest people) and establishes the operational parameters of public debate.

The most controversial government policies are, to a large extent, reliant on dominant media narratives and images for garnering public endorsement. Prevailing patterns have emerged that systematically and intentionally stigmatise and scapegoat unemployed citizens, framing inequality and poverty as “causally linked” with degrees of personal responsibility, which is then used as a means of securing public acceptance for “rolling back the state.” News media define political issues for much of the public, and set simplistic access levels, often reducing  complex issues to basic dichotomies – and establishing default settings, to borrow from the lexicon of libertarian paternalists. Default settings allow policy-makers to shift the goalposts, and align public attitudes and behaviours with new policy objectives and outcomes. And ideology.

For example, one established default setting, is that hard work, regardless of how appropriate or rewarding, is the only means of escaping poverty. A variety of methods have been used to establish this, although the new paternalists tend to rely heavily on notions of political authority to manipulate social norms, the mainstream media has played a significant role in extending and propping up definitions of an ingroup of “hardworking families,” whilst othering, pathologising and outgrouping categories of persons previously considered exempt from employment, such as sick and disabled people and lone parents.

The perpetual circulation of media images and discourse relating to characters pre-figured as welfare dependents, and accounts of the notion of a spiralling culture of dependency this past five years closely correspond with New Right narratives.

The marked shift from the principle of welfare provision on the basis of need to one that revisits ninteenth century notions of “deservingness” as a key moral criterion for the allocation of societal goods, with deservingness defined primarily in relation to preparedness to make societal contribution via paid work is likely to widen inequality. In fact behaviour theory approaches to policy simply prop up old Conservative prejudices about the nature of poverty, and provide pseudoscientific justification narratives for austerity, neoliberal and Conservative ideology. As such, nudge is revealed for what it is: an insidious form of behaviourism, social engineering, and the targeted and class-contingent restriction of citizen autonomy.

There are many examples on record of sanctions being applied unfairly, and of the devastating impact that sanctions are having on people who need to claim social security. Dr David Webster of Glasgow University has argued that benefit claimants are being subjected to an “amateurish, secret penal system which is more severe than the mainstream judicial system,” and that “the number of financial penalties (sanctions) imposed on benefit claimants by the Department of Work and Pensions now exceeds the number of fines imposed by the courts.

Furthermore, decisions on the “guilt” of noncompliance” are made in secret by officials who have no independent responsibility to act lawfully. Professor Michael Adler has raised concern that benefit sanctions are incompatable with the rule of law.

There is no doubt that sanctions are regressive, taking income that is designed to meet basic needs from families and individuals who are already very resource-constrained, is particularly draconian. But even by the proclaimed standards of the Department of Work and Pensions sanctions are being applied unfairly, it’s a policy that has been based on discretionary arbitrary judgments, and the injustice and adverse consequences of welfare sanctions make their continued use untenable. As well as having clearly detrimental material and biological impacts, sanctions have unsurprisingly been associated with negative physical and mental health outcomes, increased stress and reduced emotional wellbeing recently, once again. (Dorsett, 2008; Goodwin, 2008; Griggs and Evans, 2010).

There has been a wealth of evidence that refutes the Conservative claim that benefit sanctions “incentivise” people and “help” them into employment. There is a distinction between compliance with welfare conditionality rules, off-flow  measurement and employment. Furthermore, there is no evidence that applying behaviourist principles to the treatment of people claiming social security, any subsequent behaviour change and positive employment outcomes are in any way correlated.

Sanctions don’t work, and the politics of punishment has no place in a so-called civilised society

The Conservative government have taken what can, at best, be described as an ambivalent attitude to evidence gathering and presentation to support their claims to date. There is no evidence that welfare sanctions improve employment outcomes. There is no evidence that sanctions “change behaviours.” 

There is, in any case, a substantial difference between people conforming with welfare conditionality and rules, and gaining appropriate employment. And a further distinction between compliance and conversion. One difficulty is that since 2011, Job Centre Plus’s (JCP) primary key performance indicator has been off-flow from benefit at the 13th, 26th, 39th and 52nd weeks of claims. Previously JCP’s performance had been measured against a range of performance indicators, including off-flows from benefit into employment.

Indeed, when asked for evidence by the Work and Pensions Committee, one minister, in her determination to defend the Conservative sanction regime, regrettably provided misleading information on the destinations of JSA, Income Support and Employment Support Allowance claimants from 2011, that pre-dated the new sanctions regime introduced in 2012, in an attempt to challenge the findings of the University of Oxford/LSHTM study on the effects of sanctions on getting JSA claimants off-flow. (Fewer than 20 per cent of this group of people who were no longer in receipt of JSA were recorded as finding employment.) Source: Benefit sanctions policy beyond the Oakley Review – Work and Pensions.

National Assistance Scales were originally based on specialist calculation of the cost of a “basket of essential goods” necessary to sustain life that were devised by Seebohm Rowntree for Sir William Beveridge when he founded the Welfare State in the 1940s. Rowntree fixed his primary poverty threshold, in his pioneering study of poverty in York (1901), as the income required to purchase only physical necessities. The scales were devised to determine levels of support for unemployed people, sick and disabled people, and those who had retired or were widowed.

Rowntree’s research helped to advance our understanding of poverty. For example, he discovered that it was caused by structural factors –  resulting from unemployment and low wages, in 1899 – and not behavioural factors. Rowntree and Laver cited full employment policies, rises in real wages and the expansion of social welfare programmes as the key factors behind the significant fall in poverty by the 1950s. They could also demonstrate that, while 60% of poverty in 1936 was caused by low wages or unemployment, the corresponding figure by 1950 was only 1 per cent. But we have witnessed a regression since Thatcher’s New Right era, and continue to do so because of an incoherent Conservative anti-welfare ideology, scapegoating narratives and neoliberal approaches to dismantling the post-war settlement.

Yet Rowntree’s basic approach to defining and addressing poverty remains unchallenged, both in terms of its empirical basis and in terms of positive social outcomes. There is categorically no doubt that human beings have to meet physical needs, having access to fundamental necessities such as food, fuel, clothing and shelter, for survival.

There is a weight of empirical evidence confirming that food deprivation is profoundly psychologically harmful as much as it is physiologically damaging. If people can’t meet their basic survival needs, it is extremely unlikely that they will either have the capability or motivation to meet higher level psychosocial needs, including social obligations and responsibilities to find work and meet conditionality requirements.

There is a clear relationship between human needs, human rights, and social justice. Needs are an important concept that guide empowerment based practices and the concept is intrinsic to social justice. Furthermore, the meeting of physiological and safety needs of citizens ought to be the very foundation of economic justice as well as the development of a democratic society.

An elitist, technocratic government that believes citizens are not reliably competent thinkers will treat those citizens differently to one that respects their reflective autonomy. Especially a government that has decided in the face of a history of contradictory evidence, that the “faulty behaviour” and decision-making of  individuals is the cause of social problems, such as inequality, poverty and unemployment.

Sanctioning  people who need financial support to meet their basic needs is cruel and can never work to “incentivise” people to “change their behaviours.” One reason is that poverty is not caused by the behaviour of poor people. Another is that sanctions work to demotivate and damage people, creating further perverse barriers to choices and opportunities, as well as stifling human potential.

Earlier this year, the Work and Pensions Select Committee heard evidence of a social security system that is built upon fear and intimidation. The Committee heard how sanctions can devastate claimant health and wellbeing. They impoverish already poor people and drive them to food banks. They can leave claimants even further away from work. Jobcentres routinely harrass vulnerable jobseekers, “tripping them up” so they can stop their benefits and hit management-imposed sanctions targets (or as the Department for Work and Pensions would have it, “expectations”).

Conservative claims about welfare sanctions are incommensurable with reality, evidence, academic frameworks and commonly accepted wisdom. It’s inconceivable that this government have failed to comprehend that imposing punishment in the form of financial sanctions on people who already have very limited resources for meeting their basic survival needs is not only irrational, it is absurdly and spectacularly cruel.

Sanctions are callous, dysfunctional and regressive, founded entirely on traditional Conservative prejudices about poor people and ideological assumptions. It is absolutely unacceptable that a government treats some people, including some of the UK’s most vulnerable citizens, in such horrifically cruel and dispensible way, in what was once a civilised first-world liberal democracy.

 
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