Tag: Matthew Oakley

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

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Context

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

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

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

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

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

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

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

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

The architects

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

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

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

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

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

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

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

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

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

State diagnosis and treatment – a blunt instrument

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

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

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

The belief. Not evidenced fact.

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

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

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

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

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

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

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

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

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

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

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

The shrinking category of illness and disability 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

That has always been the ultimate aim of the Conservatives.

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

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

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 Related

What you need to know about Atos assessments

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

The power of positive thinking is really political gaslighting

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

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

Research finds strong correlation between Work Capability Assessment and suicide

 

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A few thoughts on the implications of the United Nations report

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There is an important link between human needs and human rights that the Conservatives have dismally and persistently failed to recognise

The United Nations (UN) inquiry into the allegations many of us made regarding the systematic abuse of the human rights of disabled people in the UK has exposed the multiple injustices of targeted cuts and the disproportionate burden of austerity heaped on sick and disabled people, their carers and their families, evidencing and detailing the effects of a range of policy measures affecting them that have been introduced since 2010. These include the bedroom tax and cuts to disability benefits, funds to support independence and social care.

The report concludes that the overall effect of what is now an essentially punitive welfare regime, which has been based almost entirely on unevidenced political claims and assumptions, has had an extremely detrimental and regressive effect on the rights of disabled people, to live independently, to meet their basic needs, to seek and stay in work,  and to be able to live an ordinary life as citizens.

The UN report documented multiple violations of disabled people’s rights, including the way that they are politically portrayed as being lazy and a “burden on taxpayers”, the harm to health caused by unfair assessments, the cuts to legal aid and curtailed access to justice, the imposition of the bedroom tax and the ending of the Independent Living Fund.

I wrote a lengthy article about the unsurprising but nonetheless disquieting report findings and recommendations as I read it, here.

Predictably, the government responded to the damning contents of the report by denying a “causal link” between their policies and the evidenced accounts of the consequences being presented to them. Yet the government have never monitored the cumulative impact of their policies and successive cuts on disabled people, and they told the UN rapporteurs that it was “not possible or practical” to carry out an impact assessment on how reforms would affect disabled people. The UN disagreed, and stated that with the evidence and data already available, the government could have done this. 

The UN have called on the government to carry out a cumulative impact assessment. The government have refused to comply with any of the recommendations the UN has made. However, that means they cannot legitimately claim that there is “no causal link demonstrated” regarding the austerity measures and psychological distress, severe hardship, deteriorating health and death, as they have persistently refused to investigate the associations that academics, charities, disabled people’s organisations, individual campaigners and opposition MPs have consistently demonstrated. Denial isn’t empirical evidence or any kind of proof that your claims are valid. Nor does withholding evidence of correlation disprove causality.

It was also noted that the government failed to listen to the concerns of disabled people it had claimed to involve in policy making processes. Disabled people and their representative organisations “were not meaningfully taken into account in the decision-making and had little or no influence on policy decisions.”

The implication is that disabled people have not been democratically included. The government have persisted in treating us as objects of policies, rather than seeing us as democratic subjects and citizens. 

Also of note: “The [individual] impact assessments conducted by the State party prior to the implementation of several measures of its welfare reform expressly foresaw an adverse impact on persons with disabilities.”

“The State party has not conducted a comprehensive human rights-based cumulative impact assessment even though reliable sources have indicated it is feasible.”

The UN stated that the Department for Work and Pensions (DWP) failed to properly investigate people’s deaths after their social security payments were stopped. t was noted that the government had made no “attempts at objective, thorough, open and impartial investigation(s)” to look at the alleged 90 deaths a month, despite being aware that there was widespread public concern about this.

Among other concerns, the committee said the UK government had used rhetoric to stigmatise disabled people, negatively influencing public perceptions. The report says that disabled people “have been… negatively portrayed as being dependent or making a living out of benefits; committing fraud as benefit claimants; being lazy and putting a burden on taxpayers, who are paying ‘money for nothing’. Persons with disabilities continue to experience increasing hostility, aggressive behaviour and sometimes attacks to their personal integrity.”

The committee said it found no evidence to support any of these ideas, especially the idea that disabled claimants were committing benefit fraud.

The committee were very critical of the legal aid cuts, which have created a significant barrier for people challenging benefits decisions and holding the government accountable:

“Evidence indicates that legal aid to challenge administrative decisions ending or curtailing their benefits before first-tier tribunals has been restricted. Legal aid for cases before those tribunals has also been curtailed. Similarly, access to review by an independent and impartial tribunal has been restricted by the introduction of mandatory reconsideration procedures before the same administrative entity that has ruled on benefits.”

I was pleased to see the United Nations report highlight a fundamental prejudice that informed the very basis of the “functional capacity approach” of the Work Capability Assessment (WCA), as well as commenting on the major flaws of the assessment process itself. The WCA is based on the assumption that a health condition or disability should not automatically be regarded as a “barrier” to work and that work itself can have health benefits. However these assumptions have been controversial from the outset.

The WCA places focus entirely on how we as individuals experience our illness and impairments. As such, this approach does not permit us to place our experiences of disadvantage in the context of how organisations, institutions, policy-makers and wider society interact with us. Despite the government claiming that they take a social model approach, eligibility for benefits and services is still being determined by assessment of how much our own bodies are affected by illness and impairment rather than the disabling social, cultural and political barriers that we experience.

The report said: Work Capability Assessments do not take into account the “support persons with disabilities need to perform a job or the complex nature of some impairments and conditions.” 

The inquiry also found that welfare assessors displayed a “lack of awareness and limited knowledge of disability rights and specific needs”, and disabled people experienced distress, “anxiety and psychological strain” as a result of this flawed process, and the financial insecurity that it generates.

“The committee observes that measures have caused financial hardship to persons with disabilities resulting in arrears, debts, evictions and cuts to essentials such as housing and food,” the report said.

The Government’s own research, published in June this year, revealed that one of the cornerstones of their austerity campaign – that cutting social security means recipients will be more likely to find work – is fundamentally flawed. 

Researchers found that cutting unemployed peoples’ benefits had the opposite effect to what is being claimed – something that many of us have also previously argued. The study, carried out by Oxford city council and the Department for Work and Pensions, found unemployed people become less likely to get a job when benefits are cut. Instead of looking for work, they are forced to devote their energies to surviving day-to-day. For every £1 in benefits cut per week, a person’s chance of getting a job drops by 2 per cent.

The government can no longer justify its narrative about benefit cuts, claiming that they are  “incentives” to “support” people into work.

Beyond the rhetoric – the hidden agenda

There is a wider agenda driving the welfare “reforms” and it is important to consider the hidden ideological dimension and the language references and signposts to that, as well as the superficial narratives and semantic shifts being deployed as a PR exercise, techniques of neutralisation and gaslighting to obscure political intentions and the consequences of policies.

The UN report effectively exposed the justification narratives presented by the government for their welfare “reforms” as unfounded and unsupported by empirical evidence. This report is just the beginning, it arms us with an invaluable weapon with which to continue our campaigning, and shape future challenges and debate to government policies and social injustice.  

The Conservatives have an ideological commitment to a “small state” and this is fueled by privatisation and an ever-expanding neoliberal competitive “market place.” The market place, private profit opportunities and neoliberal outcomes have been conflated with citizen’s interests and needs.

The welfare “reforms” have presented the opportunity to promote and deliver private income protection provision via profit making companies operating in free markets. Insurance companies and right-wing think tanks have been attempting to steer governments in this direction for many years. 

For example, Matthew Oakley, a senior researcher at the Social Market Foundation, and government advisor, recently published a report entitled Closing the gap: creating a framework for tackling the disability employment gap in the UK, in which he 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.

Oakley also proposes abolishing the ESA Support Group. To meet extra living costs because of disability, Oakley says that existing spending on PIP and the Support Group element of ESA should be brought together to finance a new extra costs benefit. Eligibility for this benefit should be determined on the basis of need, with an assessment replacing the WCA and PIP assessment. The Conservative definition of “the basis of need” seems to be an ever-shrinking category.

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 use of the term “inclusion”, which was originally deemed a democratic right, now it’s being discussed narrowly in terms of individual responsibility.

A 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 influence of the US insurance giant Unum over successive UK governments, and how it led to the introduction of the “totally bogus” work capability assessment (WCA), which she says was designed to make it harder for sick and disabled people to claim out-of-work disability benefits.Stewart’s book, Cash 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.  

The implications of the inquiry findings for Conservative welfare policies 

The government has announced further welfare measures which will affect disabled people including a four year freeze for most working-age benefits, reductions in the Benefit Cap, changes to tax credits and to Universal Credit, and abolishing the “Work-Related Activity Component” for new ESA claims from 2017.

As noted in the UN report: “The State party continues its policy of reducing social benefits of persons with disabilities as reflected in the Welfare Reform and Work Act 2016.” 

Article 28 of the Convention on the rights of persons with disabilities (CRPD) says: Adequate standard of living and social protection – This article affirms the rights of persons with disabilities to an adequate standard of living for themselves and their family, and to social protection without discrimination on the basis of disability. This right includes access to assistance from the state with disability-related expenses for persons with disabilities and their families.

The report reiterated something that many of us have noted and discussed in detail previously: that there is no evidence of a causal relationship between a reduction in social security and an increase in employment amongst disabled and sick people. Nor does welfare “dependency” “disincentivise” people seeking employment more generally. It was pointed out in UN report that these views are not evidenced. The two assumptions are embedded in justifications of Conservative welfare policies, and are prejudices that have been around since the Thatcher administration.

Bearing in mind these are key assumptions underpinning current policies and the proposals set out in the recent work, health and disability green paper –  for example, the recent decision to reduce the money paid to people who have been assessed as being unfit to work but able to undertake work related activity (those people in the Employment and Support Allowance work related activity group (WRAG)) is based on the same assumption- the Department for Work and Pensions have claimed  – that it will “remove the financial incentives that would otherwise discourage claimants from taking steps back to work”.

Particularly important in the current context and given the government’s recent work, health and disability green paper, the UN report says that: “Given the barriers that still prevent the full participation of persons with disabilities in the labour market and mean higher unemployment rates for them, income-maintenance social security schemes are particularly important for persons with disabilities. Such schemes allow them to maintain their autonomy and freedom of control and choice of their living arrangements and day-to-day activities. Without an adequate level of social protection, persons with disabilities run the risk of being isolated, segregated from the community and/or institutionalized. 

States parties should find an adequate balance between providing an adequate level of income security for persons with disabilities through social security schemes and supporting their labour inclusion. The two sets of measures should be seen as complementary rather than contradictory.

Measures aimed at facilitating the inclusion in the labour market of beneficiaries of social security should include transitional arrangements to ensure income protection while they reach a certain threshold and sustainability in their wages. They should become eligible again without delay if they lose their jobs.” 

Although many of us have been discussing these issues for a few years, the inquiry has consolidated a lot of valuable evidence and provided a concise rebuttal of government justification narratives for cuts in support for disabled people, which we really needed to be presented to the government formally, from an independent, official and international witness.

Though the government have tended to dismiss much evidence to date of the harm that their policies are causing, such as that which has been presented through case studies by shadow ministers, as “anecdotal”, it is rather more difficult to dismiss and ignore the substantial evidence presented as a result of rigorous international scrutiny.

The government response was founded on denials, more misdirectional rhetoric and techniques of neutralisation, defensive arrogance, authoritarian scorn and contrived outrage, rather than being about stepping up to democratic accountability, reasoned discussion and rationality. No sign of civilised conscience and decent concern regarding the impact of the prejudice and discrimination that is being intentionally and systematically embedded in Conservative policies, aimed at disabled people, at all. 

The government’s response to the UN report bears little resemblance to the lived experiences of disabled people, despite claims to the contrary. The government has justified systematic cuts to disabled people’s social security by claiming such cuts “incentivise” people to find work. The cuts are a form of punishment (apparently for our own “good”) designed to bring about “behaviour change” and this approach is founded on the wrongly perceived attitudes of disabled people, who this government consistently describes as being “parked on benefits” with the “misperception that they can’t work”. 

This does nothing at all to address the barriers disabled people face in finding and staying in work, nor does it address the acknowledged prejudiced attitudes of employers and Conservative ministers. It’s not long ago that Conservative welfare minister David Freud expressed the view that disabled people should work for less than the minimum wage. He wasn’t the only one, either. Philip Davies expressed the same view, claiming that disabled people “are the most disadvantaged by the national minimum wage,” so they should be “permitted” to work for less in order to “compete” in the labor market. Davies described criticism of his remarks that disabled people could work for less than minimum wage as “leftwing hysteria”.

It seems that Conservatives believe that the only way of “helping” disabled people in any way is by simply taking money from them. 

In their response to the UN report, the government say: “The United Kingdom is proud of its record in supporting disabled people to lead more independent lives and participate more fully in society. More than 20 years ago the UK legislated to protect disabled people’s rights. It now spends around £50 bn a year on benefits to support disabled people and people with health conditions, which is over £6 bn more than in 2010. That is around 5% of GDP, or over 6% of government spending. The UK spends more on disabled people and people with health conditions than the OECD average, and countries such as Germany, France and the USA.”

That’s definitely Conservatives being… conservative with the truth again.

The Institute of Fiscal Studies (IFS) report on spending on benefits for disabled people says the actual spend is £36,063 bn but this is partly in benefits that are not counted as working age disability benefits: War Pensions, Attendance Allowance for over 65s, Statutory Sick pay, Carer’s Allowance, Industrial Injuries Benefits and the ILF which the government has closed)

The total of those benefits not paid to working age disabled people is £7,908bn

That makes the actual spend on all working age benefits for disabled people £28,155 billion

The IFS report says: “The spending on DLA/PIP is only half what it was in 1995-96. Spending across Great Britain on disability benefits in 2014–15 was £13.5 billion. At 0.8% of national income this is half the level of disability benefit spending when it was at its peak in 1995–96.

The overall number of individuals receiving disability benefits has fallen slightly since the mid-1990s. But this is in the presence of underlying demographic change that would have tended to push UP the numbers receiving considerably – both overall population growth and the baby boomer generation reaching older working ages.”

It’s not clear if the spending figures include the massive costs of private companies that are contracted by the state, ironically, to cut welfare spending. 

The National Audit Office (NAO) report earlier this year scrutinised public spending for parliament, and is independent of government. The report indicates how public services are being appropriated for purely private benefit.

The audit report in January concluded that the Department for Work and Pension’s spending on contracts for disability benefit assessments is expected to double in 2016/17 compared with 2014/15. The government’s flagship welfare-cut scheme will be actually spending more money on the assessments conducted by private companies than it is saving in reductions to the benefits bill.

From the report:

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

£0.4 billion
Latest expected reduction in annual disability benefit spending.

This summary reflects staggering economic incompetence, a flagrant, politically motivated waste of tax payer’s money and even worse, the higher spending has not created a competent or ethical assessment framework, nor is it improving the lives of sick and disabled people. Private companies like Maximus are paid millions from our welfare budget, yet they are certainly not “helping the government” to serve even the most basic needs of sick and disabled people.

I will be challenging the government’s response to the UN report fully in due course. It would be good to see some collaborative effort from disabled campaigners and activists in addressing the government as comprehensively as possible. If anyone is interest in working together on this, just contact me here via the comment section.

The UN committee will meet to discuss the government’s comments and determine a response in Geneva, in March 2017. 

Meanwhile it’s crucial that we use the body of evidence collated by the UN and the conclusions drawn in the report effectively. For example, our responses to the consultation on the work, health and disability green paper must address the underpinning propositions and delve beneath the superficial rhetoric and glittering generalities, rather than permitting the DWP’s weighted and somewhat leading questions to shape the outcome of the consultation.

We must use the UN findings constructively to continue to challenge existing policies, and any which arise in the future to violate the human rights of disabled persons. 

We need to continue to coherently and collectively challenge the government’s assumptions on which their proposals for work, health and disability policy are based, none of which are not supported by a shred of solid empirical evidence.

 

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Initial thoughts on the work, health and disability green paper

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proper Blond

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

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

The context indicates the general intent

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

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

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

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

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

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

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

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

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

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

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

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

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

Watching the way the wind blows

Earlier this year I wrote that a government advisor, who is a specialist in labor economics and econometrics, has proposed scrapping all ESA sickness and disability benefits. Matthew Oakley, a senior researcher at the Social Market Foundation, recently published a report entitled Closing the gap: creating a framework for tackling the disability employment gap in the UK, in which he proposes abolishing the ESA Support Group.

To meet extra living costs because of disability, Oakley says that existing spending on PIP and the Support Group element of ESA should be brought together to finance a new extra costs benefit. Eligibility for this benefit should be determined on the basis of need, with an assessment replacing the WCA and PIP assessment. 

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

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

I’m sure the rogue company Unum would jump at the opportunity. Steeped in controversy, with a wake of scandals that entailed the company denying people their disabilty insurance, in 2004, Unum entered into a regulatory settlement agreement (RSA) with insurance regulators in over 40 US states. The settlement related to Unum’s handling of disability claims and required the company “to make significant changes in corporate governance, implement revisions to claim procedures and provide for a full re-examination of both reassessed claims and disability insurance claim decisions. 

The company is the top disability insurer in both the United States and United Kingdom. By coincidence, the company has been involved with the UK’s controversial Welfare Reform Bill, advising the government on how to cut spending, particularly on disability support. What could possibly go right? 

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

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

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

The Reform think tank proposes that the government should cut the weekly support paid to 1.3 million sick and disabled people in the ESA Support Group from £131 to £73. This is the same amount that Jobseeker’s Allowance claimants receive. It is claimed that the cut will  somehow “incentivise” those people to find work, as if they simply lack motivation, rather than being ill and disabled. However, those people placed in the Support Group after assessment have been deemed by the state as unlikely to be able to work again in the near future, many won’t be able to work again. It would therefore be very difficult to justify this proposed cut, given the additional needs that disabled people have, which is historically recognised, and empirically verified by research. 

Yet the authors of the report doggedly insist that having a higher rate of weekly benefit for extremely sick and disabled people encourages them “to stay on sickness benefits rather than move into work.” People on sickness benefits don’t move into work because they are sick. Forcing them to work is outrageous. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A Department for Work and Pensions research document published back in 2011 – Routes onto Employment and Support Allowance – said that if people believed that work was good for them, they were less likely to claim or stay on disability benefits.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Semantic thrifts: being Conservative with the truth

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Another major assumption throughout the paper is that disabled people claiming ESA are somehow mistaken in assuming they cannot work: “how can we improve a welfare system that leaves 1.5 million people – over 60% of people claiming Employment and Support Allowance – with the impression they cannot work and without any regular access to employment support, even when many others with the same conditions are flourishing in the labour market? How can we build a system where the financial support received does not negatively impact access to support to find a job? How can we offer a better user experience, improve system efficiency in sharing data, and achieve closer alignment of assessments?”

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

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

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

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

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

The nitty gritty

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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Thanks Mr Green, but we want more than token gestures and political opportunism

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The work and pensions secretary, Damian Green, is expected to announce at the Conservative conference that those people with severe, lifelong conditions will no longer face six-monthly reassessments.

Employment and support allowance (a misleading title for sickness and disability support for those people whose doctors say are too unwell to work) will now continue automatically for people who have lifelong, severe health conditions, with no prospect of improvement, according to Green.

However, the retesting of chronically ill or disabled people for another key disability benefit – personal independence payments – is to remain, and thousands with unchanging or degenerative conditions are preparing to be put through that pointless assessment again.

I can’t help wondering how “chronic” and “degenerative” will be defined and how exemption from reassessment will be decided. It’s unclear which medical conditions will be considered grounds for a reprieve from further WCAs, but apparently the criteria will be drawn up by “health professionals“. There were no details provided about who these “health professionals” will be. Many people have no faith whatsoever in the medical judgments of the assessors themselves – especially when they have previously been known to ask woefully ignorant questions like “how long are you likely to have Parkinson’s disease?”

It may be the case that those claiming Employment and Support Allowance, placed in the support group will be exempt from the reassessments. However, as Samuel Miller, a human rights specialist and campaigner for disabled people, points out: 

“The Department for Work and Pensions says that it is scraping retesting for people with severe, lifelong conditions at the same time that there has been a sharp drop in Support Group awards and a sharp increase in people placed in the Work Related Activity Group (WRAG). Charities report that 45% of people who put in a claim for Employment Support Allowance (ESA), and had Parkinson’s, Cystic Fibrosis, Multiple Sclerosis, or Rheumatoid Arthritis, were placed in the WRAG.“

Disability rights campaigners are concerned that the figures show the government is cutting spending on disability benefits “below the radar”, after being forced to abandon its attempts to reduce expenditure on personal independence payment (PIP) in April.

The Department for Work and Pensions (DWP) statistics, released last month, show the proportion of disabled people applying for ESA who were placed in the support group – for those assessed with “the highest barriers to work” – plunged by 42 per cent in just three months. There are concerns that the Work Capability Assessment has been made even more harsh by stealth.

For assessments completed during November 2015, 57 per cent of claimants were placed in the support group; but by February 2016 that had dropped by 24 percentage points to just 33 per cent. 

Far too little far too late

This small change will not undo the suffering of sick and disabled people who have already been caught in the revolving door of the assessment and reassessment process. It’s not uncommon for people fighting a wrong “fit for work” decision to wait for many months before they win at tribunal, only to find that within three months of their successful appeal, they have another appointment for reassessment.

You would think that if someone has just won an appeal, common sense would prevail – that someone at the DWP would acknowledge that it’s highly unlikely these people have suddenly got better in such a short space of time. The strain of being put through this callous revolving door process has an adverse impact on people with chronic conditions, exacerbating their symptoms. It is profoundly stressful and anxiety-provoking. 

This political token gesture will not undo the profound physical and psychological damage that the WCA has caused some of our most vulnerable citizens. And for many who did not feel vulnerable – those who felt they coped pretty well with their illness ordinarily – the constant strain of having to prove themselves ill and the loss of lifeline income whilst they await mandatory review and appeal, has led to increased vulnerability.

It’s also tragic and painful that it’s far too late to help the people who have died as a consequence of  being told they are fit for work when they are not, and being forced to fight for lifeline social security to meet their basic needs.

I am happy to see the announced decision to stop reassessing chronically sick people every six months, because it’s unlikely they will get better. (The clue was always in the word “chronic,” curiously enough). If that brings about a reduction in the widespread suffering caused by the callous cost-cutting WCA , it’s a small step towards much needed positive change. This move would have been more credible as a signal of good intentions had Green also intended to announce the reversal of the cuts planned for those in the work related activity group, claiming ESA.

That a UK government feels it’s acceptable to financially penalise and punish a previously protected social group – comprised of people judged as too ill to work by doctors – shows how far our society has regressed in terms of equality and human rights. And democracy. 

Labour have already pledged to abolish the Work Capability Assessment

Call me a cynic, but didn’t the Labour party pledge to completely scrap the Work Capability Assessment at their conference? Debbie Abrahams, shadow work and pensions secretary, spoke of strong ethical and empirically evidenced reasons for doing so.

She says: “As ever with this government though, the devil is in the detail. While the end to repeated assessments will be a relief to those that have been affected, this announcement falls far short of the fundamental shift to a more holistic, person-centred approach we so desperately need.

“Too many sick and disabled people will remain subject to this harmful, ineffective assessment. We will continue to push the Tories for a better deal for disabled people.”

After years of people suffering and evidenced feedback from victims of their policies, campaigners and academic researchers, the government decide NOW that chronic actually means “chronic”?

Duncan Smith, whose resignation from the role of work and pensions secretary was seen as an attack on the then leadership of David Cameron and George Osborne, told the Today programme he “completely agreed with the changes.”

“We worked to change this process, it was one we inherited and it just functioned badly on this area,” he said.

That isn’t true.

Some historical context

The Work Capability Assessment was piloted under the last Labour government, but Duncan Smith passed it into law after disregarding the concerns that the Labour party had raised following their review, regarding the assessment process being insensitive to fluctuating conditions and mental health status. In fact Duncan Smith modified the assessment process, making it even less sensitive. In early 2011, the Conservative-Liberal Democrat coalition government initiated the planned expansion of the programme to reassess 1.5 million people whom previous governments had judged to be entitled to Incapacity Benefit.

At the same time the DWP introduced long-planned revisions to the test’s eligibility criteria, which became more stringent overall: most notably, the 03/11 version awarded no points when a claimant who had difficulty walking could overcome the disability by using a wheelchair, if reasonably practicable. When Atos were recontracted in 2010, targets to remove the higher rate benefits from seven out of eight claimants were built into the new contract. Dr Steven Bick reported that “experts” testing Incapacity Benefit claimants were told they should rate only about one in eight as so disabled they will never work. The “quota” was enforced by French firm Atos, paid £100 million a year for the testing, and was revealed by undercover GP Bick on Channel 4’s Dispatches.

In February 2011, Professor Paul Gregg, an economist and one of the original architects of ESA, warned that the WCA was “badly malfunctioning” and urged further pilot studies before the more stringent 03/11 version was used as the default assessment. Nevertheless, the mammoth Incapacity Benefit reassessment programme got under way in the spring of 2011, using the new version of the test.

In January 2016, the National Audit Office (NAO) published its evaluation of the DWP’s health and disability assessment contracts. It said the cost of each WCA had risen from £115 under Atos to £190 under Maximus.

The report went on to say that Maximus was facing “significant challenges with staff failing to complete training requirements” and revealed that in July 2015 – less than six months into the new contract – the DWP had been obliged to draw up a “performance improvement plan” with Maximus because “volume targets were not being met”.

Perhaps the real reasons for stopping the six-monthly assessments are entirely financial – merely cost-cutting measures. As well as the heavy cost of each assessment to the public purse, there is also the considerable cost of many tribunals, because of the many “wrong decisions”. 

Green told the Press Association: “We are building a country that works for everyone – not just the privileged few. A key part of that is making sure that all those who are able to work are given the support and the opportunity to do so. But it also means ensuring that we give full and proper support to those who can’t.”

(You can laugh now. I’m just wondering when an assessment for tax-dodging millionaires who were awarded at least £107,000 each per year in the form of a “tax break” will happen. This was at the same time the first round of welfare cuts were announced. It would be refreshing to see the minority of privileged citizens shouldering some of the burden of austerity and “paying down the the deficit” for a change. It would be fair to expect those who have gained the most from society to put something back, after all.)

He went on to say: “That includes sweeping away any unnecessary stress and bureaucracy – particularly for the most vulnerable in society.

“If someone has a disease which can only get worse then it doesn’t make sense to ask them to turn up for repeated appointments. If their condition is not going to improve, it is not right to ask them to be tested time after time. So we will stop it.”

I find it incredible that it’s taken six years for this “revelation” to hit home. Overwhelming empirical evidence that the assessment process is harming sick and disabled people has been presented to the government on many occasions, only to prompt what is, after all, a very small and inadequate policy change.

Green has almost always voted for a reduction in spending on welfare benefits, generally voted against raising welfare benefits at least in line with prices, almost always voted against paying higher benefits over longer periods for those unable to work due to illness or disability, and almost always voted for reducing housing benefit for social tenants deemed to have excess bedrooms (the “Bedroom Tax”), which has disproportionately affected sick and disabled people and their carers.

Earlier this year, a report for the Social Market Foundation thinktank recommended that the government entirely scrap the work capability assessment. The report also said the government should introduce a properly funded system – making use of trial projects and extensive consultation with benefit claimants – which would identify those disabled people closest to being able to get a job, while those too ill or disabled to work should have a “level of benefit provided … sufficient to allow them to live comfortably and engage fully in society.”

It also recommended that the government abandon the failing benefit sanction system for people with chronic illness or a disability – instead putting an emphasis on support meetings and financial incentives through a “steps to work wage” on top of their unemployment benefit. 

Remarkably, the report was written by Matthew Oakley – a former Treasury adviser who until 2013 was head of economics at the right-of-centre Policy Exchange thinktank. He was also on Iain Duncan Smith’s own social security advisory committee.

What Green has offered falls far short of Oakley’s recommendations.

Let’s not accept politically opportunistic sops and scraps of small comfort.

Sick and disabled people deserve so much better than this. The Work Capability Assessment is not only consistently empirically demonstrated as being unfit for purpose, arbitrary and cruel, but it is also one of the most shocking political betrayals of those most in need that has ever been allowed to go unchecked.

 

Related

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

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

Labour pledge to scrap punitive Tory sanctions and the Work Capability Assessment

The Government’s brutal cuts to disability support isn’t ‘increasing spending’, Chancellor, but handing out tax cuts to the rich is

Government Finally Reveals That More Than 4,000 Died Within Six Weeks Of Being Deemed ‘Fit For Work’

Research finds strong correlation between Work Capability Assessment and suicide

What you need to know about the Work Capability Assessment

 

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

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The government have persistently denied any “causal relationship” between their welfare reforms and an increase in premature deaths and suicides, despite an existing correlation. Ministers have also denied a link between disability assessments and an increase in mental distress and ill health.

Figures released last year show that between December 2011 to February 2014, 4,010 people died after being told they were fit for work, following a Work Capability Assessment (WCA). 40,680 died within a year of undergoing the WCA, making a bleak mockery of any claim that the WCA is a real and valid “health assessment” of any kind. Or that our welfare system is “supportive” to those in most need, in any real or meaningful sense. Those people were clearly not at all “fit for work.” The figures were only released after the Information Commission overruled a Government decision to block the statistics from the public.

Research last year from Leonard Cheshire, a charity that works with disabled people, also showed that the assessments are making people who are ill more sick. Almost three quarters (72 per cent) said they found the assessment had a negative impact on their mental or physical health, or both. The same number described the face to face appointment as very stressful.

David Sugg would agree with those research findings. David suffered a life threatening subarachnoid haemorrhage (bleeding in the brain) because of an aneurysm (a swollen and very weakened point in a blood vessel) in 2013, and faces more life saving surgery because he has developed two more aneurysms that threatens to rupture, putting him at risk of another catastrophic brain haemorrhage. Whilst he waits for his operation, he has been told that if his blood pressure goes up, he is likely to die.

He had a Work Capability Assessment with Maximus this week. He was so afraid of the adverse health impacts that the strain of the WCA may have on him that he left a letter for the local coroner, to be opened in the event of his sudden death.

The letter said: “You may be looking into the reason for my death. I am hoping I can save you some time. This uncaring and spiteful Tory government killed me.”  

He told me: “My neuro-surgeon says I mustn’t get stressed, but I have been called by the Department for Work and Pensions for an assessment even though I’ve told them about my situation. 

If I don’t go for an assessment my benefits will be stopped. But I fear it may cost me my life.”

Although David survived his appointment, he has been suffering with a violent headache since, and hasn’t been able to eat for a week.

 “That appointment might still kill me. If my blood pressure goes up I could be dead before I hit the floor. I asked the assessor why she was putting my life at risk, but she said it wasn’t her decision,” he said.

Aneurisms are quite often caused by an increase in blood pressure. The majority of people don’t survive a subarachnoid haemorrhage, and those who do are remarkably lucky if they escape without serious disability. Most people don’t survive if they have a second one.

David added that he felt the situation he is in has “Orwellian” parallels. It’s a terrible choice to have to make: he either risks his life and complies with the assessment or loses his lifeline support – his benefit is the only income he has.

David explained to me that like many people needing to claim Employment Support Allowance – which is a very misleading name for a sickness benefit –  he had worked all of his life before becoming ill. He worked in IT and security until a couple of years ago. He became unemployed at that time, and was struggling to find work.

 “I’d paid tax and national insurance all my life – since I was 15,” he said.

“The battle to get Job Seekers Allowance was so stressful I actually think that led me to having the aneurysm in the first place. Then I had to battle to get support. The first work capability assessment I had was just six months after I’d had seven-hour brain surgery.”

He told me that his assessor recognised how inappropriate the appointment was, telling him “you shouldn’t actually be here.”

Despite the fact that David was awaiting life saving surgery, the Department for Work and Pensions (DWP) demanded that he was assessed again. He returned the form, explaining that he was awaiting life saving surgery and must avoid stress, but to his horror, was forced to attend nonetheless.

He said “It’s brutal bullying by the DWP. No wonder people are committing suicide, pushed over the edge. You either die because of your condition or from suicide. All I would have to do is stop taking my pills for a couple of days and I would die.”

Debbie Abrahams, the shadow Work and Pensions Secretary, said that David’s case is far from unique.

She said: “This WCA process, revised by this Government, is not only not fit for purpose, there is growing evidence of the harm it is doing. These assessments need to be completely overhauled. Labour want to see a holistic, person-centred approach, not the dehumanising, harmful, inefficient process we have now.”

David wrote to his own MP, Stephen Metcalfe, outlining his extremely distressing circumstances, and was told that Stephen would contact the Department for Work and Pensions, but did not yet receive a response.

The system is designed to deter successful claims

I co-run a support group on Facebook for sick and disabled people claiming disability benefits. I know from the accounts and everyday experience of many others just how stressful the assessment process is. It’s a terrible state of affairs when people who are already struggling with severe health problems are made even more vulnerable because of callous cost-cutting government policies.

The assessment is not always an end to the stress, either. Quite often, people are forced to challenge wrong decisions, because the WCA is designed to find ways of passing people off as “fit for work” regardless of whether they actually are, cutting their benefit. It’s worth remembering that people needing sickness benefits have already been assessed as unfit for work by their own doctors.

If people need to appeal a wrong decision, they first have to go through a mandatory review  – where the DWP “reconsider” the decision. Sickness benefit is stopped at this stage, leaving people who are often very ill without any lifeline income. Most can’t claim jobseekers allowance because they are too ill to work and so cannot meet the harsh and rigid conditionality requirements of that benefit. There is no set time limit for how long the DWP have to undertake the mandatory review. No-one may appeal until after their review is completed. The appeal process is also very stressful and intimidating, it usually entails another wait of months. 

The revolving door of assessments and psychological distress

David is not the only person to contact me this week.

George Vranjkovic has been extremely anxious and distressed about his Work Capability Assessment, too. He is very afraid at the thought that he may lose his lifeline support.

He told me: “I took 5 days filling out the assessment form by hand and I sent it in 12 days before my deadline. But 5 days before the deadline I got a letter saying it had still not been received, so I rang them, and I got some bloke who chuckled. He said it probably got lost and was there anything else he could do.

I blew my top I’m afraid and said he could effing apologise for losing my form!!! He said he deserved to be treated with respect. I was so upset I shouted not if you sit there laughing at desperate people you don’t . Anyway, I ended up filling in the form on line, printing it off and sending one version by fax, and one version by special delivery, which is what I was instructed to do by them… £22.00 that cost me.”

The form showed up, according to another advisor that George spoke to the next day, but by then he had already paid out for the fax and special delivery and was told the likelihood of getting the £22.00 back was pretty remote. This is someone relying on just a lifeline benefit, calculated to meet only basic living costs – essentials: food, fuel and shelter.

Previously, George has been left without any money to live on by the DWP, without them providing any reason. That’s absolutely unacceptable.

“For 6 months when they cut my money off completely,  I was made to feel like a criminal. I was spoken to so badly on the phone. I wasn’t being sanctioned. They just weren’t paying me.

 This is all just another example of the abject cruelty we, as honest people, are put through,” he said.

Like many other disabled people, George has also worked previously, co-running a photographic service.

George talked to me over a period of 24 hours before his assessment yesterday. He hasn’t slept for weeks. He really needed someone to support him emotionally. He was extremely anxious, agitated and afraid. He knows that the WCA is designed to try and cut costs and take lifeline support from sick and disabled people.

He told me that he is someone who usually copes, and doesn’t like to make a fuss. He said “I try not to fall to pieces in public.” He was in a state of sheer panic, however, when he contacted me.

When he arrived for his appointment, George said that the assessor tried to reschedule the assessment. His distress was so great by this time that he absolutely refused to leave until the assessment was carried out. He simply couldn’t face going through the strain of waiting again.

“He asked me how the rescheduling of the test made me feel.  He told me that it wasn’t the first time today he’d heard that forms had got lost or went missing, he asked me if I’d ever thought about committing suicide. Which I have, the last time being a year and a half ago when the DWP cut off my money for 6 months,” he said.

Like many others, George has had several assessments. It’s fairly common experience to have to go through an appeal, only to get another appointment within three months of a successful outcome.

A study published by the Journal of Epidemiology and Community Health last year, showed a correlation between worsening mental health and assessments under the WCA. The study linked the WCA tests with an additional 590 suicides, increased mental health problems and hundreds of thousands of antidepressant prescriptions

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

Calls to scrap the WCA

Earlier this year, a report for the Social Market Foundation thinktank recommended that the government entirely scrap the work capability assessment. The report also said the government should introduce a properly funded system – making use of trial projects and extensive consultation with benefit claimants – which would identify those disabled people closest to being able to get a job, while those too ill or disabled to work should have a “level of benefit provided … sufficient to allow them to live comfortably and engage fully in society.”

It also recommended that the government abandon the failing benefit sanction system for people with chronic illness or a disability – instead putting an emphasis on support meetings and financial incentives through a “steps to work wage” on top of their unemployment benefit.

Remarkably, the report was written by Matthew Oakley – a former Treasury adviser who until 2013 was head of economics at the right-of-centre Policy Exchange thinktank. He was also on Iain Duncan Smith’s own social security advisory committee.

The WCA is not only unfit for purpose, arbitrary and cruel, but it is also one of the most shocking political betrayals of those most in need that has ever been allowed to go unchecked.

 

Related

What you need to know about Atos assessments

Benefits Assessor: How Long Are You Likely To Have Parkinson’s?

Clause 99, Catch 22 – The ESA Mandatory Second Revision and Appeals

Essential Information about ESA claims, assessments and appeals

 

 

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Stephen Crabb’s obscurantist approach to cuts in disabled people’s support

· 17 Comments ·

proper Blond

It’s less than two months ago that the new Work and Pensions secretary, Stephen Crabb, assured us that the Government had “no further plans” for specific welfare cuts. Now, he has admitted that welfare is to be the source of further austerity cuts to “bring down the deficit,” bearing in mind that the last budget saw alternative  and far more fair, humane measures taken off the table when the Conservatives controversially announced cuts to disability benefits to fund tax cuts for the most affluent – the top 7% of earners. The Chancellor raised the threshold at which people start paying the 40p tax. This leaves the poorest and some of our most vulnerable citizens carrying the entire burden of austerity and the whole responsibility for cutting the deficit.

Of course Crabb assumes we believe that austerity is an economic necessity and not an ideological choice. However, austerity is being used as a euphemism for the systematic dismantling of the gains of our post-war settlement: welfare, social housing, the NHS, legal aid and democracy. There is no such thing as conditional democracy. It can’t be rationed out or applied with prejudice and discrimination. That would make it something else, more akin to totalitarianism and not a necessarily inclusive democracy.

The Government has already made substantial cuts to the Employment and Support Allowance disability benefit, cutting the rate for new claimants in the Work Related Activity Group by £30 a week from 2017. Now the Work and Pensions Secretary has said he wants to go further than the £12 billion welfare cuts declared in the Conservative manifesto and to “re-frame discussion” around disability welfare support, signalling his intention to cut expenditure on disability benefits through further reform to the welfare system. The Conservatives are clearly using the word “reform” as a euphemism for dismantling the welfare state in its entirety.

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

Crabb said that he will set out a “discursive” Green Paper on the additional proposed cuts to disability benefits later this year. Iain Duncan Smith had previously promised a more formal White Paper which was considered key to persuading Tory rebels to vote through the cuts despite opposition in February.

The shadow Work and Pensions secretary, Owen Smith, said that the Government should reverse the ESA cuts which had already been passed, adding that the Conservatives needed to offer clarity on how the “reforms” would support disabled people into work.

He said: “Yet again the Tories have let down disabled people, by breaking their promise to quickly publish firm plans on supporting disabled people in to work.

“When the Tories forced through cuts to Employment Support Allowance in the face of widespread opposition they bought off their own rebels with a promise to have a firm plan in place by the summer.

“Now the new Secretary of State has confirmed that he is going to downgrade the plan to a Green Paper, effectively kicking the issue in to the long grass for months, if not years.

The flimsy case for the cuts to Employment Support Allowance is now totally blown apart by this broken promise and the Tories must listen to Labour’s calls for them to be reversed.”

Remarkably, Crabb has claimed that disability benefit cuts are among policies “changing things for the better.” However, if cutting people’s income is such a positive move, we do need to ask why the Conservatives won’t consider taxing wealthy people proportionately, distributing the burden of austerity more fairly amongst UK citizens, instead of handing out money for tax cuts to those who need the very least support, at the expense of those who need the most.

The secretary for Work and Pensions has said: “The measures  that have either already been legislated for or announced get us to the £12 billion [welfare cuts planned in the Conservative manifesto].

Does that mean welfare reform comes to an end? I would say no. I’ve already pointed to what I see as one of the big challenges of welfare reform – and that’s around work and health.”

Crabb told MPs on Work and Pensions Select Committee that he would deploy “smart strategies” for cutting expenditure on disability and sickness benefits and would hopefully be able to secure the support of disability charities.

“In terms of how you make progress of welfare reform there when you are talking about people who are very vulnerable, people with multiple barriers, challenges, sicknesses, disabilities – I am pretty clear in my mind that you can’t just set targets for cutting welfare expenditure,” he said.

“When you’re talking about those cohorts of people you’ve actually got to come up with some pretty smart strategies for doing it which carry the support and permission of those people and organisations who represent those people who we are talking about.”

Both Crabb and his predecessor, Duncan Smith, have claimed that there are “millions of sick and disabled people parked on benefits,” yet rather than providing support for those who may be able to work, the Conservatives have abolished the Independent Living Fund and made substantial reductions to payments for the Access To Work scheme, creating more barriers instead of providing support for those who feel they are well enough to work.

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

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

I’m sure the private company Unum would jump at the opportunity. Steeped in controversy, with a wake of scandals that entailed the company denying people their disabilty insurance, in 2004, Unum entered into a regulatory settlement agreement (RSA) with insurance regulators in over 40 US states. The settlement related to Unum’s handling of disability claims and required the company “to make significant changes in corporate governance, implement revisions to claim procedures and provide for a full re-examination of both reassessed claims and disability insurance claim decisions.

The company is the top disability insurer in both the United States and United Kingdom. By coincidence, the  company has been involved with the UK’s controversial Welfare Reform Bill, advising the government on how to cut spending, particularly on disability support. What could possibly go right?

It’s difficult to see how someone with a serious, chronic and progressive illness, (which most people in the ESA Support Group have) can actually “manage” their illness and “move back into work.” The use of the extremely misinformed, patronising and very misleading term manage implies that very ill people actually have some kind of choice in the matter. For people with Parkinson’s disease, rheumatoid arthritis, lupus and multiple sclerosis, cancer and kidney failure, for example, mind over matter doesn’t fix those problems, positive thinking and sheer will power cannot cure these illnesses, sadly. Nor does refusing to acknowledge or permit people to take up a sick role, or imposing benefit conditionality and coercive policies to push chronically ill people into work by callous and insensitive and medically ignorant assessors, advisors and ministers.  

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

Reform says the government should cut the weekly support paid to 1.3 million sick and disabled people in the ESA Support Group from £131 to £73. This is the same amount that Jobseeker’s Allowance claimants receive. However, those people placed in the Support Group after assessement have been deemed by the state as unlikely to be able to work again. It would therefore be very difficult to justify this proposed cut.

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.”

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

The current United Nations investigation into the systematic and gross violations of the rights of disabled people in the UK because of the Conservative welfare “reforms” is a clear indication that there is no longer any political commitment to supporting disabled people in this country, with the Independent Living Fund being scrapped by this government, ESA for the work related activiy group (WRAG) cut back, PIP is becoming increasingly very difficult to access, and now there are threats to the ESA Support Group. The Conservative’s actions have led to breaches in the CONVENTION on the RIGHTS of PERSONS with DISABILITIES – CRPD articles 4, 8, 9, 12, 13, 14, 15, 17, and especially 19, 20, 27 and 29 (at the very least.) There are also probable violations of articles 22, 23, 25, 30, 31.

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

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

 —

This post was written for Welfare Weekly, which is a socially responsible and ethical news provider, specialising in social welfare related news and opinion.

 

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The Government’s brutal cuts to disability support isn’t ‘increasing spending’, Chancellor, but handing out tax cuts to the rich is

· 26 Comments ·

Chancellor George Osborne

 

2 wrag

Source: Hansard

Context

Many of us recognised in 2012, when the welfare “reforms” and other cuts to public services that support the poorest citizens were forced through parliament despite considerable opposition, using only the “financial privilege” of the Commons as a justification, that the Conservatives are on an ideological crusade, which flies in the face of public needs, democracy and sound economics, to shrink the welfare state and privatise our essential services.

In a wealth transfer from the poorest to the very rich, we have witnessed the profits of public services being privatised, but the losses have been socialised – entailing a process of economic enclosure for the wealthiest, whilst the burden of losses have been placed on the poorest social groups and our most vulnerable citizens – largely those who are ill, disabled and elderly. The Conservative’s justification narratives regarding their draconian policies, targeting the poorest social groups, have led to media scapegoating, social outgrouping, persistent political denial of the aims and consequences of policies and reflect a wider process of political disenfranchisement of the poorest citizens, especially sick and disabled people.

That the cuts are ideologically driven, and have nothing whatsoever to do with economic necessity, was demonstrated only too well by the National Audit Office (NAO) report earlier this year. The NAO scrutinises public spending for Parliament and is independent of government. The report indicates how public services are being appropriated for purely private benefit.

The audit report in January concluded that the Department for Work and Pension’s spending on contracts for disability benefit assessments is expected to double in 2016/17 compared with 2014/15. The government’s flagship welfare-cut scheme will be actually spending more money on the assessments conducted by private companies than it is saving in reductions to the benefits bill.

From the report:

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

£0.4 billion
Latest expected reduction in annual disability benefit spending.

This summary reflects staggering economic incompetence, a flagrant, politically motivated waste of tax payers money and even worse, the higher spending has not created a competent or ethical assessment framework, nor is it improving the lives of sick and disabled people. Some people are dying after being wrongly assessed as “fit for work” and having their lifeline benefits brutally withdrawn. Maximus is certainly not helping the government to serve even the most basic needs of sick and disabled people.

However, Maximus is serving the private needs of a “small state” doctrinaire neoliberal government, and making lots of private profit whilst it does so. The Conservatives are systematically dismantling the UK’s social security system, not because there is an empirically justifiable reason or economic need to do so, but because the government has purely ideological, anticollectivist, antidemocratic, profoundly uncivilising prescriptions and longstanding prejudices.

Last week I wrote about the £30 a week Employmen Support Allowance (ESA) work related activity group (WRAG) cuts, which the Government have forced through the legislative process, despite meeting with widespread opposition, the government claim that it is their financial privilege to do so. Yesterday I wrote about the brutal cuts that are planned for Personal Independence Payments (PIP) for sick and disabled people, which are aimed at saving money by reducing eligibility for the support. The cut, it is estimated, will affect at least 640,000 disabled people by 2020, who may lose up to £150 a week. This is money that provides essential support for people who need help to prepare food, use the toilet or dress themselves, amongst other things, and to maintain a degree of dignity and independence.

The cuts to ESA and Personal Independent Payments (PIP) take place in the context of a Tory manifesto that included a pledge not to cut disability benefits. In fact in March last year, the Prime Minister signalled that the Conservatives will protect disabled claimants from welfare cuts in the next parliament (this one). Cameron said the Conservatives would not “undermine” PIP, which was introduced under the Coalition to save money by “targeting those most in need.” Now it seems those most in need are not the ones originally defined as such.

At the time he told BBC Breakfast: “We’ve replaced one benefit – Disability Living Allowance – with a new benefit – Personal Independence Payment – it’s working well, it is also going to lead to some savings over time and we haven’t created that benefit in order to undermine it. We want to enhance it and safeguard it.”

Semantic thrifts: being Conservative with the truth

Only a Conservative minister would claim that taking money from sick and disabled people is somehow “fair,” or about “helping”, “supporting” or insultingly, “incentivising” sick and disabled people who have already been deemed unfit for work by their doctors and the state via the work capability assessment to work.

The Tories all too frequently employ such semantic shifts and euphemism – linguistic strategies – as an integral part of a wider range of techniques of neutralisation that are used, for example, to provide linguistic relief from conscience and to suspend moral constraint – to silence both “inner protest” and public objections – to the political violation of social and moral norms; to justify acts that cause harm to others whilst also denying there is any subsequent harm being inflicted; to deny the target’s and casualties’ accounts and experiences of political acts of harm, and to neutralise remorse felt by themselves or other witnesses.

Media discourse has often preempted the Conservative austerity cuts, resulting in the identification, stereotyping and scapegoating of the groups in advance of the targeted, discriminatory policies. Media discourse is being used as a vehicle for the government to push their ideological agenda forward without meeting legitimate criticism, public scrutiny and without due regard for essential democratic processes and safeguards.

The five neutralisation techniques identified by Gresham Sykes and David Matza are: denial of responsibility, denial of injury, denial of victims, appeal to higher loyalties, and condemnation of condemners.

The really critical part of Sykes and Matza’s argument is that rationalisations precede immoral, cruel or controversial acts and are a key factor in making deviant behaviour possible (amongst delinquents, the mafia or Conservative ministers). As such, the rationalisations betray intent.

The cuts of £120 a month to the disability benefit Employment Support Allowance  are also claimed to be “fair.” and “supportive.” Though I have yet to hear a coherent and rational  explanation of how this can possibly be the case. Ministers claimed that people subjected to the ESA Work Related Activity Group cuts could claim PIP if they required support with extra living costs, but now we are told that PIP is to be cut, too.

Osborne’s techniques of neutralisation: calling a cut “increased spending”

The chancellor has defended his decision to use the cuts in disability benefits to fund tax breaks for the wealthy. On the Andrew Marr show yesterday, he was questioned about his decision to cut PIP, currently made to over 640,000 disabled people in a bid to save at least £1.2 billion. Many severely disabled people are facing a cut of up to £150 a week under the new reduced eligibility assessment criteria.

Controversially, the cuts to disability benefits will fund tax cuts for the most affluent – the top 7% of earners. The Chancellor is set to raise the threshold at which people start paying 40p tax, in a move that will probably see  many wealthier people pulled out of the higher rate of income tax, in the coming budget. Mr Osborne says he wants to “accelerate progress” towards the Conservative’s manifesto pledge of raising the threshold for the 40p rate to £50,000 in 2020, it is understood. The average annual income in the UK is around £27,000. 

Andrew Marr said: “You’re taking money out of the pockets of some of the most vulnerable people in this country, disabled people. These are the people who can least afford the sacrifice, the people with the weakest shoulders.

And you’re changing the rules to hit them. Is that really your priority?”

Osborne ludicrously claimed that the Conservative government was “increasing spending on disabled people”, he said: “Controlling welfare bills is part of what you need to do if you’re a secure country confronting the problems in the world.”

But as Marr pointed out, the cuts to ESA and PIP show an intended substantial reduction on government spending to essential support for disabled people.

From January 2017, the cut to PIP is likely to hit sick and disabled people who face fundamental barriers to health and essential basic care. The cut, it is estimated, will affect at least 640,000 disabled people by 2020.

Andrew Marr went on to say: “At the same time as you’re raising thresholds to help middle-class tax payers, it’s going to seem a very callous set of priorities.”

However, Mr Osborne maintained that the brutal and uncivilised cuts were “necessary to improve the economic conditions in the UK”. He said: “Yes, times are tough. The fiscal situation is a difficult one. All Western countries are not productive enough.”

You can see the interview here:


Austerity and premature mortality

Since 2011, a year after the government began their austerity programme, mortality rates have increased rapidly. Advisers to Public Health England (PHE) have warned that the 4-year trend may be the worst since World War II.

Data from the Office of National Statistics shows a 5.4% (27,000) increase in deaths in the past year alone, prompting calls for an urgent investigation. The year-on-year rise, to a total of 528,340 deaths, is the highest since 1968.

PHE said the elderly were bearing the worst of Tory austerity cuts, with women suffering disproportionately, though this is partly because they live longer, however, it is also due to a growing crisis in the NHS and cuts to social care. Professor Danny Dorling, from Oxford University, an advisor to PHE on older age life expectancy, said:

“When we look at 2015, we are not just looking at one bad year. We have seen excessive mortality – especially among women – since 2012.”

Figures show that the number of deaths had been falling steadily until 2011, a year after the government began their austerity programme, when deaths rates began to increase rapidly.

Professor Dorling cited Tory austerity as the biggest cause:

“I suspect the largest factor here is cuts to social services – to meals on wheels, to visits to the elderly.”

Empirical research published two years ago demonstrated the high a cost the country paid in terms of health and wellbeing for the Thatcher administration’s economic and social policies. The study, which looked at material from existing research and data from the Office for National Statistics, illustrates that Thatcherism resulted in the unnecessary and unjust premature deaths of British citizens, together with a substantial and continuing burden of suffering and a widespread degradation of wellbeing. Co-author and researcher Professor Clare Bambra from the Wolfson Research Institute of Health and Wellbeing said that deaths from violence and suicide all increased substantially during the Thatcher era in comparison with other countries. Regional inequalities in life expectancy between north and south were also exacerbated, as were health inequalities between the richest and poorest in British society.

Professor Bambra also says that the welfare cuts implemented by Thatcher’s governments led to a rise in poverty rates from 6.7% in 1975 to 12% by 1985; poverty is well known to be one of the major causes of ill health and mortality. Income inequality also increased in the Thatcher period, as the richest 0.01% of society had 28 times the mean national average income in 1978 but 70 times the average by 1990. Other research (The Spirit Level) indicates that income inequality is internationally associated with higher mortality and morbidity.

Welfare reform minister, Lord Freud, refused to monitor the number of people who take their own lives as a result of the £120-a-month cut planned for those people in the work related activity group (WRAG), claiming employment and support allowance from April 2017. Concerns were raised in the House of Lords last week, when Baroness Meacher, amongst others, warned that for the most vulnerable, the cut was “terrifying” and bound to lead to increased debt.

Condemning the truly callous and terrible actions of the Treasury, she urged ministers to monitor the number of suicides in the year after the change comes in, adding: “I am certain there will be people who cannot face the debt and the loss of their home, who will take their lives.”

Many people have died as a consequence of the welfare “reforms.”

Not only have the government failed to carry out an impact assessment regarding the cuts, Lord Freud said that the impact, potential increase in deaths and suicides won’t be monitored, apart from “privately” because individual details can’t be shared and because that isn’t a “useful approach”.

He went on to say “We have recently produced a large analysis on this, which I will send to the noble Baroness. That analysis makes it absolutely clear that you cannot make these causal links between the likelihood of dying – however you die – and the fact that someone is claiming benefit.”

Actually, a political refusal to investigate an established correlation between the welfare “reforms” and an increase in the mortality statistics of those hit the hardest by the cuts – sick and disabled people – is not the same thing as there being no causal link. Often, correlation implies causality and therefore such established links require further investigation. It is not possible to disprove a causal link without further investigation.

Whilst the government continue to deny there is a causal link between their welfare policies, austerity measures and an increase in premature deaths and suicides, they cannot deny there is a clear correlation establised, which warrants further research and political accountability.

Then they came for the ESA Support Group …

Despite the fact that this government face a UN inquiry into grave and systematic abuses of the human rights of disabled people, the blatant attacks on a social group with legally protected characteristics continues and the Conservatives continue to target disabled people for a disproportionately large and unfair burden of austerity cuts.

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

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

I’m sure the private company Unum would jump at the opportunity. Steeped in controversy, with a wake of scandals that entailed the company denying people their disabilty insurance, in 2004, Unum entered into a regulatory settlement agreement (RSA) with insurance regulators in over 40 US states. The settlement related to Unum’s handling of disability claims and required the company “to make significant changes in corporate governance, implement revisions to claim procedures and provide for a full re-examination of both reassessed claims and disability insurance claim decisions.

The company is the top disability insurer in both the United States and United Kingdom. By coincidence, the  company has been involved with the UK’s controversial Welfare Reform Bill, advising the government on how to cut spending, particularly on disability support. What could possibly go right?

It’s difficult to see how someone with a serious, chronic and often progressive illness, (which most people in the ESA Support Group have) can actually “manage” their illness and “move back into work.” The use of the extremely misinformed, patronising and very misleading term manage implies that very ill people actually have some kind of choice in the matter. For people with Parkinson’s disease, rheumatoid arthritis, lupus and multiple sclerosis, cancer and kidney failure, for example, mind over matter doesn’t fix those problems, positive thinking and sheer will power cannot cure these illnesses sadly. Nor does benefit conditionality and being coerced into work by callously insensitive and medically ignorant assessors, advisors and ministers.

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

Reform says the government should cut the weekly support paid to 1.3 million sick and disabled people in the ESA Support Group from £131 to £73. This is the same amount that Jobseeker’s Allowance claimants receive. However, those people placed in the Support Group after assessement have been deemed by the state as unlikely to be able to work again. It would therefore be very difficult to justify this proposed cut.

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.”

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

The current United Nations investigation into the systematic and gross violations of the rights of disabled people in the UK because of the Conservative welfare “reforms” is a clear indication that there is no longer any political commitment to supporting disabled people in this country, with the Independent Living Fund being scrapped by this government, ESA for the work related activiy group (WRAG) cut back, PIP is becoming increasingly very difficult to access, and now there are threats to the ESA Support Group. The Conservative’s actions have led to breaches in the CONVENTION on the RIGHTS of PERSONS with DISABILITIES – CRPD articles 4, 8, 9, 12, 13, 14, 15, 17, and especially 19, 20, 27 and 29 (at the very least.) There are also probable violations of articles 22, 23, 25, 30, 31.

The investigation began before the latest round of cuts to ESA and PIP were announced.

 

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Reverse the ESA disability benefit cut: sign the petition

Extend the PIP consultation & stop cuts to supporting terminally ill & disabled: sign the petition

 

Related

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

Paternalistic Libertarianism and Freud’s comments in context

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

Conservative governments are bad for your health

Research finds strong correlation between Work Capability Assessment and suicide

Benefits Assessor: How Long Are You Likely To Have Parkinson’s?

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