Tag: #NHS

The state is policing social security claimants in hospital and via their medical records to find reasons to cut their support

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The Department for Work and Pensions (DWP) officers have been visiting patients in hospital to check if they are actually unwell, a damning new review into the roll-out of universal credit has revealed. This news comes after it emerged that the DWP are in the process of designing an automated system to trawl claimants NHS health records. 

Doctors have already raised serious concerns that social security claimants could be deterred from accessing healthcare after it emerged that the government is to start accessing medical records as an intrusive part of the welfare assessment process. A job advert posted by the DWP shows that a team in Leeds is building a system to “capture information from citizens and present this to DWP agents”. The work is proceeding on the controversial assumption that the consent of patients would make the system lawful. 

However the DWP have told doctors that when people make a claim for disability benefits, they have already consented for medical information to be shared.

GPs and charities said the plans resemble the controversial data-sharing scheme  between the Home Office and the NHS, which prompted outrage after it emerged some immigrants were subsequently afraid to access healthcare, ultimately forcing the government to end the policy.

In response, Professor Helen Stokes-Lampard, chair of the Royal College of GPs, expressed concern that the process would damage the doctor-patient relationship, and “deter vulnerable people from seeking medical assistance when they need it”.

“If the reports are true, the DWP, like the Home Office before them, must not consider GP patient data as an open resource to support them to carry out their duties. We are doctors, whose first interest is the care of our patient: we are not border guards, and we are not benefits assessors.

“We do not hold our patients’ confidential data to help other organisations check their eligibility for welfare, their immigration status, or any other function not related to their health and wellbeing,” she said.

Head of policy and profile at Law Centres Network, Nimrod Ben-Cnaan, said the sharing of people’s medical records would breach patient confidentiality and put GPs and other medical staff in the “invidious” position of benefits assessors.

However it seems the DWP are determined to co-opt doctors into policing people who are ill and claiming social security. I raised my own concerns about this back in 2015-16 and have continued to campaign on this issue, raising awareness of the implications and consequences of state intrusion in the health care of vulnerable citizens.

The DWP continually look for reasons to end people’s disability awards, even following assessments that have deemed them eligible. Trawling through people’s medical records presents another opportunity to look for tenuous reasons to cut people’s support claim. 

As does intruding on people who are ill in hospital.

The all-pervasiveness of welfare conditionality and the state panopticon

In 1965, American historian Gertrude Himmelfarb published an essay, The Haunted House of Jeremy Bentham, in which she portrayed Bentham’s mechanism of surveillance as a tool of oppression and social control. Bentham’s famous mechanistic and inhumane approach to human lives – the Panopticon – is a type of institutional building and a system of control designed by the English philosopher  in the late 18th century. The scheme of the design is to allow all (pan-) inmates of an institution to be observed (-opticon) by a single watchman without the inmates being able to tell whether or not they are being watched.

Bentham conceived the basic plan as being equally applicable to hospitals, schools, sanatoriums, and asylums. The idea is that people are in constant fear of being scrutinised, and so are coerced or compelled to regulate or change their own behaviour to comply. Bentham described the Panopticon as “a new mode of obtaining power of mind over mind, in a quantity hitherto without example”. Elsewhere, in a letter, he described the Panopticon prison as “a mill for grinding rogues honest.”

The Panopticon is the tool of a deeply suspicious state with a very pessimistic view of human nature. 

Last year, Dr Jay Watts wrote:  “The level of scrutiny all benefits claimants feel under is so brutal that it is no surprise that supermarket giant Sainsbury’s has a policy to share CCTV “where we are asked to do so by a public or regulatory authority such as the police or the Department for Work and Pensions”. Gym memberships, airport footage and surveillance video from public buildings are now used to build cases against claimants, with posts from social media used to suggest people are lying about their disabilities. More and more private companies are being asked to send in footage. The atmosphere is one of pervasive suspicion, fuelled by TV programmes such as Benefits Street and successive governments’ mentality of “strivers v skivers”. 

People claiming disability benefits have often raised concerns that the right to privacy is no longer their own – and this is a deliberate function of an extremely punitive regime.

Mass surveillance has become a norm in developed countries, through both the proliferation of overt measures like security cameras, the use of facial recognition software, but also more subtle and invasive means like data trawling, analysis, segmentation, psychograpic profiling and targeted , tailored ‘interventions’.

Governments, corporations and other powerful entities are able to comb through large volumes of data on specific people or larger demographics in order to gather information on them and exert control over their decision-making and behaviours. Nudge reflects the further development of covert state strategies to scrutinise and  manage citizens’ perceptions and behaviours.

Foucault, in Discipline and Punish, developed the Panopticon as a metaphor for the modern disciplinary society, in which the state constantly oversees the behaviour of the citizens, and he saw it as a mechanistic tool and oppressive system of permanent visibility as a tool of power. Foucault’s idea of panoptic architecture turned it into an omnipresent and insidious institution. It’s true to say that now, the disciplinary “eye of the state Inspector” is upon all of us. But some are scrutinised more than others.

More recently, DWP employees have also found to be interviewing people awaiting NHS treatment to ensure they were on the “right money” and not “abusing the system.” This is a particularly intrusive, oppressive practice, designed to police claims and scrutinise the ever-shrinking criteria of validity for someone’s need or social security support.

The visits were condemned as ‘grotesque’ by a council scrutiny panel in London, where it has emerged that hospitalised universal credit claimants have received shock visits from the welfare officials policing patient’s claims.

Islington’s Policy and Performance Scrutiny Committee, which has been tracking the full roll out of universal credit in Islington since last June, published a review earlier this month, where the information emerged that DWP officers have been pursuing ill claimants while in hospital.

In the meeting on 14 February, concern was expressed that DWP staff visiting claimants in hospital and this added to the stress that patients were already under while in hospital.

The DWP responded that “the visiting team may occasionally visit claimants in hospital but this would be done in a supportive manner and it happened on only a very small number of cases”.

On one occasion, DWP officers visited a person in hospital awaiting an operation because they had missed an appointment,
 reports the Islington Gazette.

The committee’s vice chair, Councillor Troy Gallagher, told the Gazette: “The fact that the DWP send people out to the hospital to interview and pursue people sends the wrong message.

“When people are in hospital they are not there to be chased and it’s not for the DWP to guess or validate if they are well or unwell. I think it’s callous.

“It’s an issue they need to amend quickly because it’s highly stressful and deeply upsetting.”

Cllr Gallagher added: “It’s grotesque and unbelievable.

“If someone says they’re unwell, whatever the reason is, you should always accept that.”

A DWP spokesperson said: “Jobcentre staff occasionally conduct hospital visits to confirm people’s bank account or rent details. This ensures we can pay their full benefits on time.”

They added that visits to claimants homes will be made “if necessary”.

The DWP told me “Claimants must inform the relevant benefit office when they go into hospital and when they come out. If they don’t report changes and they’re overpaid as a result, they have to pay back any money they owe. They may also have to pay a civil penalty.

“State Pension will not be affected.

“A stay in hospital affects people’s disability benefit support in the following ways:

“If someone has been in hospital for 28 days, they should stop receiving these benefits:

  • Attendance Allowance
  • Disability Living Allowance (DLA)
  • Personal Independence Payment (PIP)

“If someone is discharged but goes back into hospital within 28 days, the days spent in hospital on both occasions will be added together and if the total is more than 28 days they will lose eligibility until they go back home. They will still be paid for the days they spend at home between hospital stays.”

I was also informed: “Employment and support allowance is paid for an indefinite period as long as the other qualifying conditions are met. If someone is getting income-related employment and support allowance (ESA), certain premiums and housing costs are affected:

  • Severe disability premium will stop after four weeks if someone is in hospital and they lose their attendance allowance, disability living allowance care component or personal independence payment daily living component. If the person has a partner who is not in hospital and who also qualifies for the severe disability premium, they will continue to receive it.
  • Carer premium will stop 8 weeks after the person’s carer’s allowance stops.
  • After 52 weeks, they will lose the enhanced disability premium unless they have a partner who meets the conditions for the premium themselves. They will also lose their work-related activity or support component.”

It seems that documented evidence from doctors isn’t considered sufficient for the DWP to verify that someone is ill and in need of support. People who are ill in hospital are being treated as though they have done something wrong because of the effect their ill health has on their ability to work.

The government claims that disability support such as PIP is “targeted at those most in need”. Yet we see that those who are clearly most in need are being policed constantly and in an inexcusably intrusive, disrespectful way that strips disabled people of security and dignity.

What use is a social security system that is being designed to constantly work against those very people it was initially set up to help? 


 

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The NHS business services authority is creating a hostile environment for vulnerable patients

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Patients claiming universal credit who are exempted from prescription charges are receiving penalty notices because prescription forms have not been amended to include the benefit – six years after it was introduced. Some people have reported receiving multiple charge notices. Many people are being penalised for a pharmacy error or because of a misunderstanding. A third of the 2017 penalties imposed were overturned on appeal so far.

Patients who are suspected of wrongly claiming free prescriptions face a penalty of five times the prescription charge plus the charge itself. The maximum is £100; £50 is added if the bill is not settled within 28 days. 

The NHS Business Services Authority (NHSBSA), an arm’s length body of the Department of Health and Social Care (DHSC), says a universal credit tick box should be added “later this year”. Until then, claimants entitled to free prescriptions must tick the “income-based jobseeker’s allowance” box. However, some who did so report they have still been penalised. Furthermore, no one is informing people which box to tick.

Many of the patients who receive penalty notices simply failed to realise that they no longer qualified for free prescriptions and dental treatment. Exemption certificates are automatically issued to those who earn less than £15,276 a year and receive working tax credit, child tax credit, or income support, as well as income related Employment and Support Allowance.

However, apparently, the certificates are only valid for up to seven months and recipients are not notified if they do not qualify for a renewal. The new fraud prevention system seems to be set up to penalise people because of the fact they are not kept informed of changes to their entitlement to free prescriptions, which is categorically unfair.

Moreover, it is creating severe distress and harm.

The devastating impact on vulnerable patients

Last year, Labour called for an overhaul of the system when a woman killed herself after receiving nearly £200 in penalty charges. Penny Oliver, a part-time chef, had not realised her exemption had lapsed after an ESA assessment deemed her fit for full-time work. Because her benefits had been cut she could not afford the penalties. In June 2018, she took an overdose of antidepressants – the medication that had created the debt.

Oliver owed sums of just £8.60 and £20.60. But with penalty fees and surcharges these rocketed – the second one alone soaring to £120.60. That’s ten times the amount for that prescription. After having lost hundreds of pounds a month when her benefits were cut, she simply couldn’t pay. Her housing benefit and council tax reduction were also cut, leaving her facing recovery action for an overpayment. 

She had just a few pounds in her account and was surrounded by payment demands when her family tragically found her dead last in June. Letters from the council, the NHS and Department for Work and Pensions included threats to take her to court and inform her employer if she did not pay.

At the time, shadow Health and Social Care Secretary Jonathan Ashworth said: “This is shocking. Questions have to be asked about the humanity of a system that does this to vulnerable people.

Penalty charges should be scrapped – it’s a disgrace to exploit vulnerable, ill people in this way. Ministers urgently need to step in and review this system.

“Our NHS is there to help patients get better not make their condition worse by putting ­unacceptable burdens on people like this.”

Single mother Sue Carpenter was ordered to pay £100 after mistakenly claiming a free dental check-up. “I have had an NHS exemption since my daughter was three, but I received no reminder that it would run out when she was 18,” she explains.

“I knew my child tax credit would change, but I’m still eligible for working tax credit and I assumed the exemption was linked to the entire tax credit award, not just to the child component. The dentist didn’t ask to see my certificate, which I now realise expired two weeks before.”

Carpenter says that the expiry date should be made clear. “The NHS exemption seems a unique instance of a status that runs out with no clear warning, allows you to continue using it when it has expired and then incurs a steep penalty without prior notice of the consequences.”

The NHSBSA says it is a patient’s responsibility to check the expiry date on their exemption certificate.

However, recovering costs someone incurred in error is one thing, but fining people because they didn’t read the very small print, especially given that the citizens affected are likely to be ill and also on a low income, is a step too far. While it raises revenue for a cash-starved NHS, it is at the expense of those with the least, as usual. Fining people for a genuine mistake because they are not provided with sufficient information in the first place is outrageously mercenary.

The high cost of countering pre-estimated fraud

It is unsurprising to learn that the NHS counter fraud authority was created by legislation, launched in 2017-18, and is subject to direction by the Secretary of State. It’s also worth noting that the majority of health funding goes to the Department’s
arm’s-length bodies. 

In 2016-17 the Health Department had an overall revenue and capital budget of £122.2 billion. Less than 4% (£4.7 billion) of its funding was allocated to the core Department, according to the National Audit Office (NAO). The remainder  (£117.5 billion) was allocated to its arm’s-length bodies. That’s a huge sum of public money that is spent on managing the NHS and not on delivering frontline services. 

Furthermore, amendment was made via statutory instrument to the Regulation of Investigatory Powers (Directed Surveillance and Covert Human Intelligence Sources) to ensure that the senior officers of the NHSCFA will have the power to authorise the conduct of covert directed surveillance. The health authority is directed to carry out the Secretary of State’s functions in relation to counter fraud against or affecting the health service in England.

Usually when Conservatives claim to “counter fraud”, it entails the creation of a hostile environment. Social security, for example, has been transformed from a redistributive system for the public protection from the ravages of poverty to one that administers the discipline, coercion and sanctions, using absolute poverty as a punishment for “non compliance”.

Professional and patients’ bodies have also expressed their concern that the system designed to detect fraud is undermining the whole ethos of the NHS.

Rachel Power, chief executive of the Patients Association said: “Serving penalty notices on patients cannot be a caring way to manage this system.” 

“Some of the people who received these notices will be in vulnerable situations, and the impact of letters threatening court action, particularly for those who are receiving treatment for mental illnesses, should not be underestimated.

“While it’s important that fraudulent and incorrect claims are identified, nearly one in three penalty notices had to be withdrawn because they were issued in error. This shows a system that is highly dysfunctional.”

It also indicates the introduction of an increasingly hostile environment within health services, especially for those ill people on low incomes. 

The health secretary, Matt Hancock, has previously said: “The message is clear. The NHS is no longer an easy target, and if you try to steal from it you will face the consequences.”  

I’m wondering how it is possible to steal healthcare, bearing in mind that the same minister insists that the healthcare in the UK is still “free at the point of access”. I think this systematic restriction of access to public services more generally is precisely what David Cameron meant when he said that he wanted to tackle the “culture of entitlement”.

The public pay taxes and national insurance – “social insurance” – for increasingly little return while millionaires get tax cuts and carrots while everyone else gets the austerity stick, and told to live within our increasingly diminishing means. We are being dispossessed, so the very wealthy can accumulate even more wealth.

This year the NHS is piloting a digitised system that it claims will enable pharmacists to check eligibility instantly. However, surely the same system could be used to inform patients of their eligibility status also. That would reduce error considerably, too. 

The NHSBSA say they are digital by default, and: “We use complex algorithms and data mining tools as a means to identify both normal behaviour and outliers in NHS data, within which fraudulent behaviour may be found.

The resulting “analyses” are used to support ongoing investigations as well as inform the intelligence picture and guide fraud prevention steps.”

The “complex algorithms” are very clearly being used as a blunt instrument, resulting in least one death, to date. Yet one of the highest costs of “highly probable” fraud, according to the NHS BSA is from procurement and commissioning fraud, at an estimated cost of £266m £266m between 2016-17. (See page 8 here). 

The key stakeholders of the counter fraud authority include NHS England, NHS Improvement and the Cabinet Office.

The Royal Pharmaceutical Society and the British Medical Association fear the new system will withhold vital treatment from people on low incomes who remain eligible for free prescriptions but have failed to renew their paperwork.

“Pharmacists don’t want to be the prescription police, spending their time checking exemptions rather than advising on patient care,” says Sandra Gidley, chair of the Royal Pharmaceutical Society’s English pharmacy board.

“It’s very easy for mistakes to happen. Sometimes it’s that the computer says ‘no’, on other occasions people have simply forgotten to renew. Some don’t know if they’re exempt or not, or wrongly assume they are.”

She says that the prescription system should be overhauled to prevent confusion and reflect medical advances. “Medical exemption criteria have not changed since 1968. This means they are completely unjust. For example, those with long-term asthma have to pay for prescriptions, whereas people with diabetes don’t. Many new long-term conditions have been discovered in the past 50 years and they aren’t covered at all.

“It would be much simpler to have free prescriptions for everyone, as is the case in Scotland and Wales, because then no one would have to worry about remembering to fill out the right form.”

Data released under the Freedom of Information Act last year shows that 1,052,430 penalty notices were issued to patients in England in 2017 – about double the level in the previous year. But the data confirms that 342,882 penalty notices were subsequently withdrawn because the patient was entitled to free prescriptions after all, upon further investigation. 

The NHSBSA, the agency in charge of issuing the fines, said it was “continually reviewing its data-matching process and making improvements to ensure eligible patients were not wrongly pursued.”

The agency said it was also trying to educate patients on the importance of keeping the details on both their GP records and their exemption or prescription prepayment certificates up to date. 

It’s yet another public service system that’s been designed to assume people are guilty of fraud, with the onus on patients to provide proof that they are innocent.

“The NHS loses millions each year through fraudulent and incorrect claims for free prescriptions,” said Alison O’Brien, head of loss recovery services at the authority. “On behalf of NHS England, and in discussion with the Department of Health and Social Care, the NHS Business Services Authority checks claims randomly and retrospectively to appropriately recover funds and return them to NHS services.”

However, as the data strongly suggests, in far too many cases, it isn’t appropriate to recover funds and impose fines. Errors are happening all too frequently, creating anxiety, distress and hardship. When accusations of fraud are made which are not true, it causes humiliation and creates scapegoats.

Given that the neoliberal state treats citizens as if they have done something wrong as a starting point – which is the key message embedded in hostile environments; creating stigma and criminalising already marginalised groups –  it’s become a standardised form of political abuse which is entrenched within our public services. It’s designed as a punitive form of resource gatekeeping, resulting in withholding service and support from the very people who those services were designed to support.

Unfortunately, there is a pathological political narrative that tends justify cost cutting measures and punitive policies which portray the state and the mythically discrete class, “the taxpayer”,  as victims, when the state is actually perpetrator, and we all pay taxes for the services that are being dismantled by stealth.

Many of us have raised concerns related to the impact of the government’s various “hostile environment” policies in the health, housing, welfare, finances and banking, education, social services and other sectors, on vulnerable groups and those who share protected characteristics. The Equality Act was originally designed to address this kind of discrimination. But as we have learned over the last eight years, the government regards human rights and equality frameworks as a mere inconvenience. 

Peter Burt, a patient who was wrongly issued with one of the NHS penalty notices, said he worried about how certain patients would react to receiving one. “Some of the people who received these notices will certainly be in vulnerable situations and some will be receiving prescription medication for anxiety and mental health issues,” Burt said.

“They should not be receiving letters threatening court action just because the NHS can’t be bothered to check the records to see whether they have a prepayment card – especially if there is no intention of carrying out the threat. It’s hugely disappointing that, at a time when clinical services are clearly facing financial strains, the NHS bureaucracy is wasting money by sending out hundreds of thousands of inaccurate demands every year.”

Watson said more problems lay ahead if further planned changes to the way medicines were prescribed were introduced.

“The bureaucracy around prescriptions is unfit for purpose, and will only get worse if NHS England introduces its planned restrictions on prescribing over the counter medicines,” she said. “Serving notice of penalties for free prescriptions on patients who may be vulnerable and unwell and are then required to demonstrate their right to a free prescription cannot be a compassionate and caring way to manage this system.”

It certainly seems to be the government’s modus operandi to withdraw compassion and care when it comes to public policy design, which have been templated to implement austerity rather than ensure delivery of public services that are fit for purpose.

You can check your eligibility for free prescriptions and other health services here: National campaign launches urging patients to ‘Check Before You Tick’ for free prescriptions.

 


 

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GPs told to consider making fit notes conditional on patients having appointment with work coach

Thanks to  for the copy of a patient work coach letter to GPs.

One of the most worrying comments on the above letter is that despite claiming the work coach service is voluntary, and that if a patient refuses to engage “it won’t affect any benefit they get”, the letter then goes on to suggest that doctors may consider the issuing of subsequent fit notes conditional (“with the proviso that”) on their patient attending a meeting with the work coach. That one sentence simply makes a mockery of the claim that patient engagement with work coaches is voluntary. 

Illnesses don’t respond to provisos or caveats. People don’t suddenly recover when the Department for Work and Pensions decides that they are fit for work. When job centre staff tell GPs to stop issuing sick notes to patients it can have catastrophic consequences, from which the government never seem to learn. In fact they don’t even acknowledge the terrible costs that their deeply flawed policies are inflicting on citizens. 

Julia Savage is a manager at Birkenhead Benefit Centre in Liverpool. In 2016, she wrote a letter (an ESA65B notification form) addressed to a GP regarding a seriously ill patient. It said:

We have decided your patient is capable of work from and including January 10, 2016.

“This means you do not have to give your patient more medical certificates for employment and support allowance purposes unless they appeal against this decision.

“You may need to again if their condition worsens significantly, or they have a new medical condition.” 

The GP subsequently repeatedly refused to provide him with new fit notes, even as his health deteriorated, and he died months later.

James Harrison – the patient – had been declared “fit for work” and the letter stated that he should not get further medical certificates. The Department for Work and Pensions contacted his doctor without telling him, and ordered him to cease providing sick certification, James died, aged 55.

He was very clearly not fit for work.

It is very worrying that the ESA65B form is a standardised response to GPs from the Department for Work and Pensions following an assessment where someone has been found fit for work.  

The government as boardroom doctors: political jobsworths

The Department for Work and Pensions issued a new guidance to GPs in 2013, regarding when they should issue a Fit Note. This was updated in December 2016. 

In the dogma document, doctors are warned of the dangers of “worklessness” and told they must consider “the vital role that work can play in your patient’s health”. According to the department, “the evidence is clear that patients benefit from being in some kind of regular work”

As a matter of fact, it isn’t clear at all.

The idea that people remain ill deliberately to avoid returning to work  – what Iain Duncan Smith and David Cameron termed “the sickness benefit culture” – is not only absurd, it’s very offensive. This is a government that not only disregards the professional judgements of doctors, it also disregards the judgements of sick and disabled people. However, we have learned over the last decade that political “management” of people’s medical conditions does not make people healthier or suddenly able to work.

Government policies, designed to ‘change behaviours’ of sick and disabled people have resulted in harmdistress and sometimes, in premature deaths.

Call me contrary, but whenever I am ill with my medical and not political illness, I generally trust my qualified GP or consultant to support me. I would never think of making an appointment to see the irrational likes of Esther McVey or Iain Duncan Smith for advice on lupus, or to address my health needs and treatment. 

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

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

Waddell and Burton are cited frequently by the Department for Work and Pensions (DWP) as providing ‘scientific evidence’ that their policies are “verified” and “evidence based.” Yet the DWP have selectively funded their research, which unfortunately frames and constrains the theoretical starting point, research processes and the outcomes with a heavy ideological bias. 

This behaviourist framing simply shifts the focus from the medical conditions that cause illness and disability to the ‘incentives’, behaviours and perceptions of patients and ultimately, to neoliberal notions of personal responsibility and self-sufficient citizenship in the dehumanising context of a night watchman, non-welfare state, absent of any notion of human rights. 

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

It’s a completely slapstick rationale, hammered into shape by a blunt instrument – political ideology. People cannot simply be ‘incentivised’ (coercion is a more appropriate term) into not being ill. Punishing people for being poor by removing their support does not ‘help’ them to stop being poor, either, despite the  doublespeak and mental gymnastic pseudoscientific rubbish the government spouts.

Turning health care into a government work programme 

The government dogmatically assert “The idea behind the fit note is that individuals do not always need to be fully recovered to go back to work, and in fact it can often help recovery to return to work.” 

It was 2015 when I wrote a breaking article about the government’s Work and Health programme, raising concerns that the Nudge Unit team were working with the Department for Work and Pensions and the Department of Health to trial social experiments aimed at finding ways of: “preventing people from falling out of the jobs market and going onto Employment and Support Allowance (ESA).” 

“These include GPs prescribing a work coach, and a health and work passport to collate employment and health information. These emerged from research with people on ESA, and are now being tested with local teams of Jobcentres, GPs and employers.”

Of course the government hadn’t announced these ‘interventions’ in the lives of ill and disabled people. I found out about it quite by chance because I happened to read Matthew Hancock’s  conference speech: The Future of Public Services.

I researched a little further and found an article in Pulse – a publication for for medical professionals – which confirmed Hancock’s comment: GP practices to provide advice on job seeking in new pilot schemeI posted my own article on the Pulse site in October 2015, raising some of my concerns.

Many of us have warned that the programme jeopardises doctor-patient confidentiality, risks alienating patients from their doctors and perverts the primary role and ethical mission of the healthcare system, which is to help people to recover from illnesses. Placing job coaches in GP surgeries makes them much less inaccessible, because it turns tappointments potentially into areas of pressure and coercion. That is the very last thing someone needs when they become ill.

One worry was that the government may use the ‘intervention’ as a further opportunity for sanctioning ill and disabled people for ‘non-compliance’. People who are ill often can’t undertake work related tasks precisely because they are ill. Until recent years, this was accepted as common sense, and any expectation of sick people having to conform with such rigid welfare conditionality was quite properly regarded as both unfair and unrealistic.

I expressed concern that the introduction of  job coaches in health care settings, peddling the myth that ‘work is a health outcome’ would potentially conflict with the ethics and role of a doctor. I also stated my concern about the potential that this (then) pilot had for damaging the trust between doctors and their patients. 

In another article in 2016, titled Let’s keep the job centre out of GP surgeries and the DWP out of our confidential medical records, I outlined how GPs had raised their own concerns about sharing patient data with the Department for Work and Pensions – and quite properly so. 

Pulse reported that the Department for Work and Pensions (DWP) plans to extract information from GP records, including the number of Med3s or so-called ‘fit notes’  issued by each practice and the number of patients recorded as ‘unfit’ or ‘maybe fit’ for work, in an intrusive move described by GP leaders as amounting to “state snooping.”

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

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

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

When a GP says a person is ‘unfit for work’, they generally ARE unfit for work, regardless of whether the ‘business friendly’ government likes that or not. And regardless of the politically prescribed Orwellian renaming of sick notes, which show ‘paternalist’ linguistic behaviourism in action.

In 2017, the General Medical Council (GMC) – independent regulator for doctors in the UK – wrote a response to the government’s green paper: Improving Lives: The Work, Health and Disability Green Paper consultation. The authors of the document begin by saying ” Our purpose is to protect, promote and maintain the health and safety of the public by ensuring proper standards in the practice of medicine.”

The response continues: “Where doctors are expected to play a role in initiatives such as those set out in the Green paper, our concern is to ensure that any responsibilities that might be placed on doctors would be consistent with their professional obligations and would not risk damaging patients’ trust in their doctors. While we believe that many of the Green paper proposals are promising, we are concerned that key elements appear to present a conflict with the ethical responsibilities we place on doctors. The comments below are seeking clarification in these areas.”

And: “We understand from this Green paper, and from the Department of Work and Pensions’ published FOI response, dated 22 December 2016, that the work coaches who will conduct the mandatory health and work conversation with claimants will not be health professionals. There is a risk that claimants will not get the right support in setting health and work-related goals during this mandatory conversation if the work coach does not have clinical expertise.

“It would be helpful to know whether work coaches will be expected to have access to the claimant’s healthcare team and/or health records to inform these conversations. If so, we would appreciate reassurance that there will be a process for obtaining consent from the claimant, and providing assurance to the relevant health professionals that the individual has provided consent. Given that work coaches do not require medical expertise, we have some concerns about these conversations leading claimants to agree to health-related actions in a Health and Work ‘claimant commitment’. It seems possible that agreed actions might not be clinically appropriate for that individual or not the best course of action given their health condition. 

If a claimant commitment were reviewed by the claimant’s doctor (or other healthcare professional), and the doctor concluded that there was a health risk; then would the claimant be free to withdraw from the commitment without facing a benefits penalty? If not, then this would put the doctor and patient in a very difficult position, if it appeared that the patient had been poorly advised by the work coach and was not making an informed, voluntary decision in requesting a particular treatment or care regime from their doctor. 

We note the intention is for any agreement made in the Health and Work Conversation to be seen as voluntary. However, it seems to us that since the Conversation itself is mandatory and a Claimant commitment may influence subsequent handling of an individual’s Work Capability assessment, then in practice claimants may see these agreements as mandatory.

“As a result they may feel pressured to accept advice and make commitments which may not be appropriate in their case. This would place theirdoctors in a difficult ethical position, and we are concerned to ensure that this is not the case.

The authors add: “… we make it clear in our guidance that doctors must consider the validity of a patient’s consent to treatment if it is linked with access to benefits. Doctors should be aware that patients may be put under pressure by employers, insurers, or others to accept a particular investigation or treatment (paragraph 41, Consent: patients and doctors making decisions together).

“Difficulty could arise if a doctor does not believe that a patient is freely consenting to treatment and is instead only giving consent due to financial pressure. Doctors must be satisfied that they have valid consent before providing  treatment, which means they could be left with a difficult decision as to whether to refuse treatment in the knowledge that this could affect the patients benefit entitlements.” 

The GMC also raise concerns about how sensitive health data is collected and shared for purposes other for patients’ direct care, without patients being informed or giving consent. The government have simply proposed to access health care data to support “any assessment for financial support” and told GPs to assume consent has been given.

Promoting the myth that work is a ‘clinical outcome’ 

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. 

Of course it may be the case that people in better health work because they can, and have less need for healthcare services simply because they are relatively well, rather than because they work. 

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.” 

A political decision was made that people should be “encouraged” to believe that work was “good” for their 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 Employment and Support Allowance (ESA) by “helping” them into work.

Another government document from 2014 – Psychological Wellbeing and Work – says: We know that being in work is good for wellbeing and that mental health problems are an increasing issue for the nation and so the Minister for Welfare Reform and the Minister for Care and Support jointly sought to expand the evidence base on common mental health problems.  

“A number of Government programmes assess and support those with mental health difficulties to work, but it is internationally recognised that the evidence base for successful interventions is limited. 

“The Contestable Policy Fund gives ministers alternative avenues to explore new thinking and strategies that offer cross-Government benefits. This report was commissioned through this route.” 

And: “Within the time and resources available for this study the research team did not undertake extensive assessment of the quality of the evidence base (eg assessing the research design and methodology of previous studies)”

The government have gone on to declare with authoritarian flourish that they now want to reinforce their proposal that “work is a health outcome.” Last year, a report by the Mental Health Task Force and chaired by Mind’s Paul Farmer, recommended that employment should be recognised as a ‘health outcome’.  I’m just wondering how people with, say, personality disorders, or psychosis are suddenly going to overcome the nature of their condition and all of a sudden successfully hold down a job for a minimum of six months.

Mind those large logical gaps… 

This has raised immediate concerns regarding the extent to which people will be pushed into work they are not able or ready to do, or into bad quality, low paid and inappropriate work that is harmful to them, under the misguided notion that any work will be good for them in the long run.

It has become very evident over recent years that the labour market is not delivering an adequate income for many citizens and despite “record levels of employment”, the problem seems to be getting bigger. The government’s answer to the problem has been to extend punishment those on low pay, rather than tackle employers who pay exploitative, low wages.

The idea of the state persuading doctors and other professionals to “sing from the same [political] hymn sheet”, by promoting work outcomes in social and health care settings is more than a little Orwellian. Co-opting professionals to police the welfare system is very dangerous. 

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” as the government are urging, will invariably make accessing support conditional, and further isolate already marginalised social groups. Citizens’ safe spaces for genuine and objective support is shrinking as the state encroaches with strategies to micromanage those using public services. This encroachment 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.

State micromanagement of tenants

The GMC say in their response to the government’s proposals: “We are unclear about the evidence that might support a move to the position that ‘being in employment’ should be regarded as a ‘clinical outcome’ that healthcare professionals are expected to work towards with people of employment age seeking health-related advice and treatment. This is a highly contentious issue and indeed Dame Carol Black’s report certainly makes clear that there is limited support for this within the profession.” 

I’m not unclear. There is no evidence. In an era of small state neoliberalism and ideologically driven austerity, it is an act of sheer political expediency to claim that ‘worklessness’ is the reason for the poor health outcomes that are in fact correlated with increasing inequality, poverty and lower standards of living – higher mortality;  poorer general health, long-standing illness, limiting longstanding illness; poorer mental health, psychological distress, psychological/psychiatric morbidity; higher medical consultation, medication consumption and hospital admission rates.

Both social security and the National Health Service have been intentionally underfunded and run down by the Conservatives, who have planned and partially implemented a piecemeal privatisation process by stealth, to avoid a public backlash.

Unemployment (not ‘worklessness’ –  that’s part of the privileged discourse of neoliberalism, which serves to marginalise the structural aspects of persistent unemployment and poverty, by transforming these into individual pathologies of benefit ‘dependency ‘and ‘worklessness’) is undoubtedly associated with poverty, because welfare provision no longer meets the most basic living costs.

However to make an inferential leap and claim that work is therefore ‘good’ for health’ is incoherent, irrational and part of an elaborate political gaslighting campaign of an authoritarian government, who simply don’t want to address growing poverty and inequality caused by their own neoliberal policies.

The direction that government policy continues to be pushed in represents a serious threat to the health, welfare, wellbeing, basic human rights, democratic inclusionand lives of patients and the political independence of health professionals.


Related

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

Illustration by Jack Hudson

 


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Brexit is a zero sum neoliberal strategy

Image result for pictures of Trump and May

The capricious Donald Trump apparently told the Sun that he doesn’t like Theresa May’s Brexit plan and so it’s likely that the deal for trade between the US and UK is going to be very difficult indeed. I didn’t particularly relish the thought of unregulated US food, such as genetically modified grains, vegetables and fruit, the famous Kentucky chlorinated chicken and hormone-pumped beef filling our supermarket shelves and refrigerated sections, personally, for what it’s worth.

Apparently Trump said May ignored his advice by opting for a ‘soft Brexit strategy’.

Image result for pictures of Trump and May

British Prime Minister Theresa May and her husband, Philip May, greeting President Donald Trump and the first lady, Melania Trump, at Blenheim Palace on Thursday in Woodstock.

He warned her that any attempts to maintain close ties with the EU would make a lucrative US trade deal ‘very unlikely.’

May’s proposals were finalised last Friday and quickly sparked a slew of high-profile political resignations from her Cabinet, including Foreign Secretary Boris Johnson and Brexit Secretary David Davis, over concerns that the plans would leave the UK ‘too closely’ linked to the EU. May is already dangerously close to a vote of no confidence by her party.

“If they do a deal like that, we would be dealing with the European Union instead of dealing with the UK, so it will probably kill the deal,” Trump said, according to the Sun.

View image on Twitter

Trump telling May that he doesn’t like the Brexit plan is completely outrageous. I’m wondering how Leave notions of ‘sovereignty” and “taking back our country” can be reconciled with Trump telling the UK government what they should and should not do.

And earlier today, the fickle US president accused the media of “fake news” following the interview in which he criticised the prime minister’s Brexit plans. 

I didn’t criticise the PM,” Trump said at a press conference at the prime minister’s official retreat in Chequers.

“Unfortunately a story was done which was generally fine but didn’t put in what I said about the PM. I said tremendous things.” (Evasion tactics)

He added: “We record when we deal with reporters… It’s called fake news.”

The Sun interview was published as Trump dined with the prime minister at formal dinner at Blenheim Palace. As images of the front page story were released on Twitter, fury spread among UK diplomats.

Backtracking on his previous comments, Trump said: “If they go in a slightly different route, I hope you’re going to be able to trade with the US.” 

“I read reports that won’t be possible but after speaking to May’s people it will absolutely be possible. The trade is a little bit tricky.”

It all sounds rather like frantic flip-flop to me.

It does bother me that the UK may be set to be totally isolated thanks to the Tories. Or even worse, Theresa May could decide to do Trump’s bidding, because she’s placed us in a desperate situation, which will leave us in an even more desperate situation.

There are rumours in the media that the government is planning on stockpiling processed food and medicines in the event of a no deal. If that’s part of our Brexit plan, then it’s a clear indication that we are truly and royally set up to be stuffed. Ministers have denied this is true. But then, don’t they always?

The food plan is one of 300 contingency measures that will be revealed in the next few weeks as part of a Brexit plan to show Brussels that “plan B” is a serious option, the Sun reported.

Downing Street told the paper that “no deal preparation work is to be stepped up”. Dominic Raab, who replaced David Davis as Brexit Secretary after his resignation, will take charge of the plans. It was revealed last week that a unit had been set up in the Cabinet Office to deal with the complex issues that could arise. It is reportedly focused on plans for the border in the case of a swift change. 

The prime minister’s Brexit blueprint – finally revealed and supposedly agreed upon at Chequers – veers towards a softer Brexit than many Eurosceptics would like and this wing of her party have been quick to express their outrage.

However, the fears of a no deal Brexit, coupled with the rumours of the government stockpiling food, have inspired a surreal sense of impending doom that would wouldn’t be out of place in the event of a threat of nuclear war. As a contingency plan, it certainly doesn’t inspire confidence in a post-Brexit UK future. 

Concerns about the impact of Brexit on the NHS

Other departments have also been handed budgets to put plans in place quickly. NHS England boss Simon Stevens revealed earlier this month that “extensive” plans are in place to make sure the health service keeps running in a no deal scenario, while Justice Minister Lucy Frazer said in Parliament that preparations were ‘underway.’

“Like all competent government departments, we are also working to ensure that if there is no deal we are ready for it,” she said.

“We have £17.3m extra from the Treasury to look into and ensure that we have the right Brexit scenario.”

The NHS has always remained vulnerable to the vicissitudes of governments, and has been subject to constant re-organisation: currently, as the dust is just settling on the controversial Health and Social Care Bill, enacted in 2012 by the Coalition, the present government and NHS England are pressing forward with even further restructuring.

Since 2010, we have witnessed the NHS undergoing fiscal deprivation – the cuts are radical compared to any in its history. The promised ‘dividend’ to the NHS depends entirely upon the overall health of the economy following Brexit. The EU and the UK are currently negotiating and much remains very uncertain.

There are practical issues concerning access to supplies for hospitals. This isnot just a question of trade, hence, with the prospect of some impact on healthcare provision, the head of NHS England has indicated this week that the NHS was making contingency plans for a hard Brexit with consequent risks to medicines supply.

A further arising variable which exacerbates the potential vulnerability of the NHS is that of staff shortages. The lack of trained doctors in the UK has meant the NHS has needed the support of clinicians drawn from abroad – including those jurisdictions of other EU member states. The recent controversy over the lack of access to visas for highly skilled non-EU staff to work in the NHS, if replicated for EU citizens, would further impact adversely on staffing levels.

Earlier this year, the prime minister stoked fears that the NHS will be “for sale” in a trade deal with the US after Brexit, after refusing to say it will be excluded from the talks.

May was warned that a “key objective” for Washington would be gaining access to the health service, which is being opened up to more private firms.

Vince Cable, Liberal Democrat leader, asked “Can she give an absolute guarantee that, in those negotiations, the NHS will be excluded from their scope?

“Can she confirm that, in her conversations with President Trump, she has made it absolutely clear to him the NHS is not for sale?”

But, in her reply, during Prime Minister’s Questions in the Commons, May said it was too early to judge what “requirements” the US would have in those post-Brexit trade talks.

Her answer failed to mention the NHS at all, instead saying negotiations were already “starting” to try to boost trans-Atlantic trade, even before Britain leaves the EU. Her refusal to rule out opening up the NHS to US health giants is extremely worrying 

The vote for Brexit has created significant uncertainty in the UK food and agriculture sector

Many of us are hoping that there will be a free trade deal made between the UK and the EU before the March 2019 deadline, otherwise the UK will be forced to trade under the ruling of the World Trade Organisation, and as a result, food prices are likely to increase further.

The British Retail Consortium has stated that the absence of a trade deal between the UK and the European Union will see the price of imported food rise by 22%. Also worrying is the fact that there has currently been no promise that current EU food quality regulations will be maintained once we have withdrawn from the European Union.

Trade talks with America have faced a backlash of criticism and concern, as its widely known that US farming practices entails cattle fed with growth hormones, chickens washed with chlorine, beef washed with lactic acid, genetically modified crops and the practice of feeding waste meat back to animals. We all know the potential catastrophe to bovine and human health that the latter can create, as we learned when Thatcher deregulated farming practices. The current import of these food items are banned under the current EU law.

There has also been rumours that British farmers, producers and suppliers would be forced to lower their standards in order to compete with the American imports. The government in the UK, however, value deregulation. But history has shown us that health and welfare problems in the food industry start when governments deregulate and encourage companies to police themselves. Salmonella in eggs, BSE in cattle, foot and mouth and swine flu all followed cuts in animal welfare standards or inspection services.

They became national scandals under successive Tory governments in the 1980s and 1990s, and a generation of children were put off eating meat, disgusted at at the treatment of animals and the potential health dangers because of a deregulated industry, that watered down hygiene practices, food and farming standards.

This is what happens when private business is permitted by neoliberal governments to seek unrestricted profit. It comes at a cost because the profit incentive sidesteps even the most basic of human needs. 

British distaste for animal cruelty, and the serious public health scares led the Labour government to progressively raise welfare standards that are higher in the UK than in much of the rest of the EU.  But the few giant poultry groups, for example, that dominate an industry that provides nearly 50% of all the meat we eat, have always complained that the high standards puts them at a ‘competitive disadvantage’. 

Currently, it’s variously estimated that around 70% of Britain’s food supply comes from the EU, and Brexit has highlighted the fact that the age of variety and plenty that we live in is fragile and could collapse if we fail to strike up adequate trade deals. 40 % of our fresh produce – fruit and vegatables – are also imported from the EU. The potential impact of a Brexit for the food and beverage sector is huge, be it on trade, inward investment, labour and employment or policy and regulation.  

The farming sector has also benefited from direct EU payments of £2.4bn in 2015 via the Common Agriculture Policy (CAP). This is all likely to change and the direction of travel is currently unknown.

Some sources say the vast majority of processed food and drinks in Britain are imported, with as much as 97 per cent arriving from the European Union.

A free flow of goods means minimal delays in transit, which is crucial for anything fresh. As the head of the British Retail Consortium warned Theresa May and Michel Barnier last week, a no-deal Brexit could mean “food rotting at ports”.

Of course, if the flipside of a no-deal Brexit is a UK-US trade deal like Nafta, as I’ve pointed out, things aren’t looking any cheerier. 

Failing to secure a free trade deal after Brexit will be “disastrous” for Britain’s £28bn processed food and drinks industry and must be avoided at all costs, a committee of MPs has warned earlier this year.

In a report, they outlined that without access to European Union markets after the end of the transition period, in December 2020, exports of processed foods such as chocolate, cheese, beef, pork and soft drinks would suffer while UK consumers would face higher prices and less choice on the supermarket shelves.

The stark warning came from the Business, Energy and Industrial Strategy Committee, with MPs also saying that reversion to World Trade Organisation rules after withdrawal from the bloc would have a “seismic impact” on the country’s largest manufacturing sector.

Brexit will see food prices rise and potentially lower standards, but as food sectors rely heavily on foreign labour forces, we won’t have the work force to support an intense home-grown model of food supply. We don’t have the space. And for some foods, (like avocados, pineapples, banannas, grapes, olives and olive oil, capers, rice, lentils, pasta, many spices and so on), we don’t have the climate. 

The phase of platitudes about ‘sovereignty’ and ‘the will of the people’ and other gnomic banalities is over. There has been an erosion of public confidence that May’s government knows what it is doing, since she took office. Nonetheless we will now face the consequences of our collective political decision making, regardless of how dire those consequences may well be.

Brexit has divided our nation. We have stood witness to toxic social divisions and growing racism – people who look or sound different have been told by triumphant leavers to ‘pack your bags and go back where you came from. Such events don’t bode well, and they become more ominous still when serious incidents such as the horrific murder of an MP as a perceived ‘traitor’ to the nation are also considered. 

I’m sure that the successive Conservative governments since 2010 could not have damaged and alienated the UK any more than they already have. It’s not just the country that they have trashed, this die hard bunch of charmless relics of imperialism have extended their arrogance, intractability incompetence, lack of diplomatic skill and destructively regressive mindset on a global scale, making enemies of countries that were once our allies.

Brexit means more neoliberalism: deregulation, low taxes for the wealthy, and more cuts to public services. State provision, paid for by citizens, to serve the needs of citizens, is a thing of the past. Alone, or in trade cahoots with Trump, Brexit will simply heighten the austerity, competitive individualism, building a bigger shrine to the market place, where human needs are sacrificed, dog eat dog rules, simply amplifying the worst elements of a failing neoliberal regime. 

Furthermore the Conservative government since 2010 have displayed an aggressive authoritarian turn. Without membership of an international community, founded on cooperation, with a negotiated system of safeguarding regulation, which encourages transparency and accountability by virtue of the level of sociopolitical normative sharing, scrutiny and evolving protective legal frameworks, the future of the UK may be a good deal less democratic than our present.

Related

How might Brexit Affect Food Prices – The Institute for Fiscal Studies (IFS)

 


 

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The NHS is to hire 300 employment coaches to find patients jobs to “keep them out of hospital.”

Image result for cognitive therapy for unemployed protests

The government has a problem with the public actually using public services

The government announced the creation of the Joint Health and Work Unit and the Health and Work Service in 2015/16, both with a clear remit to cut benefits and “get people into work.” Given that mental health is a main cause for long-term sickness absence in the UK, a key aspect of this policy is to provide mental health services that get people back into work.

There has already been an attempt to provide mental health services for people who claim social security support, which includes a heavily resisted pilot to put therapists into job centresAnother heavily opposed government proposal was announced as part of the  health and work pilot programme to put job coaches in GP surgeries
The proposals have been widely held to be profoundly anti-therapeutic, potentially very damaging and professionally unethical. 

With such a narrow objective, the delivery will invariably be driven by an ideological agenda, politically motivated outcomes and meeting limited targets, rather than being focused on the wellbeing of individuals who need support and who may be vulnerable. I also discovered almost by chance back in 2015 that the Nudge Unit team have been working with the Department for Work and Pensions and the Department of Health to trial social experiments aimed at finding ways of: “preventing people from falling out of the jobs market and going onto Employment and Support Allowance (ESA).” 

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

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

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

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

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

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

The latest strand of this ideological anti-welfare crusade was recently announced: the NHS is to hire 300 employment coaches who will find patients jobs to “keep them out of hospital.” The Individual Placement and Support services (IPS) is aimed at ‘supporting’ people with severe mental illness to seek work and ‘hold down a job’. Job coaches will offer assistance on CVs, interview techniques and are expected to work with 20,000 people by 2021. Pilot schemes running in Sussex, Bradford, Northampton and some London boroughs suggest that the coaches manage to find work for at least a quarter of users. The scheme is to be extended nationwide. 

The roll out of mental health employment specialists across the country is based on  analysis of the pilots, which is claimed to show that 2,300 patients have been helped into work in the last year. However, the longer term consequences of the programme are not known, and it is uncertain if there will be any meaningful monitoring regarding efficacy, safeguarding and the uncovering of unintended consequences and risks to participants.

It is held that those in work tend to be in better health, visit their GP less and are less likely to need hospital treatment. The government has assumed that there is a causal relationship expressed in this common sense finding, and make an inferential leap with the claim that “work is a health outcome”.

However, support for this premise is not universal. Some concerns which have been reasonably raised are commonly about the extent to which people will be ‘pushed’ into work they are not able or ready to do, or into bad quality work that is harmful to them, under the misguided notion that any work will be good for them in the long run. 

Of course it may equally be the case that people in better health work because they can, and have less need for healthcare services simply because they are relatively well, rather than because they work. 

Undoubtedly there are some people who may be able to work and who want to, but struggle to find suitable employment without adequate support. This section of the population may also face the lack of knowledge, attitudes and prejudices of potential employers regarding their conditions as a further barrier to gaining appropriate employment. The scheme will be ideal for supporting this group. That is, however, only provided that engagement with the service is voluntary, and does not become mandatory. 

It must also be acknowledged that there are some people who are simply too ill to work. Again, it’s a serious concern that this group may be pressured and coerced to find employment, which may prove to be detrimental to their wellbeing. Furthermore, placing them in work may present unacceptable risk to both themselves and others. How can we possibly know in advance about the longer term risks presented by the impact of an illness, and the potential effects of some medications in the workplace? If something goes catastrophically wrong as a consequence of someone taking up work when they are too unwell to work, who will hold the responsibility for the consequences?

In the current political context where the public are told “work is the route out of poverty” and “work is a health outcome”, people feel obliged to try to work, when they believe they can. But what happens when they are wrong in that belief? Who is responsible, for example, when someone has a loss of consciousness or an episode of altered awareness, caused by a condition or medication, while operating machinery, at the wheel of a taxi, bus or refuse waggon? 

Harry Clarke, who believed that he was fit for work, suffered a loss of consciousness on 22 December 2014 while at the wheel of a moving refuse lorry in Glasgow city centre, resulting in six deaths and leaving 15 people injured. Following numerous warnings from the court about his right to remain silent, Clarke refused to answer key questions about numerous doctors visits and medical tests for dizziness, fainting, vertigo, heart problems, tension headaches, operations on hands and knee pain dating back to 1976. However, one of the biggest revelations of the inquiry was Clarke’s lengthy medical history, which showed he had suffered episodes of dizziness and fainting for decades prior to the tragic crash.

Yet during an inquiry about the case, a health care professional who assessed the Glasgow bin lorry crash driver for the renewal of his HGV licence in 2011 would have deemed him only “temporarily unfit to drive” if she had known he had fainted the year before the accident. Furthermore, Clarke’s conditions would probably not have made him eligible for Employment and Support Allowance (ESA). Dr Joanne Willox told the inquiry panel at Glasgow Sheriff Court that she saw Mr Clarke on 6 December 2011 at the request of his employer Glasgow City Council to complete a HGV renewal application form with him which was to be submitted to the DVLA. 

Dr Willox, an occupational medical adviser for the private company Bupa, on behalf of Glasgow City Council, did not have access to his medical records. She could have requested the records with the patient’s consent if she considered it necessary, though this was not the normal practice and it may have taken time to get the records.

She said it would have been “helpful” to have the records. The inquiry revealed that Clarke had a history of fainting and dizziness, and had in fact previously suffered a similar episode while at the wheel of a stationary bus, in 2010.

The horrific case highlights several issues, not least that employment of people with unpredictable or undiagnosed medical conditions does not only pose a threat to the person, but it may potentially be contrary to public safety, too. It also highlights that a privately contracted occupational health professional who had no knowledge of Clarke’s medical history, was unsuitably tasked to make a judgement about his potential ability to work as a refuse waggon driver. Employing people who are ill and later found to be unfit for the role is potentially in contravention of the Health and Safety at Work Act. 

Another horrific example of the dangers presented by placing trust in unqualified bureaucrats and the state – who have ideological interests that often lie in conflict with those of patients – to make decisions about citizens’ health and welfare arose when a manager at Birkenhead Benefit Centre in Liverpool wrote a letter, addressed to a GP, regarding a seriously ill patient. It said:

We have decided your patient is capable of work from and including January 10, 2016.

“This means you do not have to give your patient more medical certificates for employment and support allowance purposes unless they appeal against this decision.

“You may need to again if their condition worsens significantly, or they have a new medical condition.” (My emphasis)

The job centre manager was wrong. The health care professional, assessing the patient on behalf of the private company contracted to carry out the ESA assessment, on behalf of the government, was wrong. 

The patient, James Harrison, had been declared “fit for work” and the letter stated that he should not get further medical certificates. However, 10 months after the Department for Work and Pensions (DWP) contacted his doctor without telling him, James died, aged 55.

He was clearly not fit for work.

James’ grieving daughter, Abbie, said: “It’s a disgrace that managers at the Jobcentre, who know nothing about medicine, should interfere in any way in the relationship between a doctor and a patient.

“They have no place at all telling a doctor what they should or shouldn’t give a patient. It has nothing to do with them.

“When the Jobcentre starts to get involved in telling doctors about the health of their patients, that’s a really slippery slope.” (See Jobcentre tells GP to stop issuing sick notes to patient assessed as ‘fit for work’ and he died.)

It has become very evident over recent years that the labour market is not delivering an adequate income for many citizens and despite “record levels of employment”, the problem seems to be getting bigger. The government’s answer to the problem has been to extend punishment those on low pay, rather than tackle employers who pay exploitative, low wages.

The neoliberal narrative and Conservative antiwelfarism

Some of the underpinning language used to justify this approach also troubles me, as it is clearly couched in economic terms. It’s about cutting costs, propping up the economy as a whole and “rewarding” tax payers. Here, it is implied that people who are ill are somehow a burden on tax payers. However, most people who become ill have also worked and contributed to the Treasury. Furthermore, people who aren’t in employment also pay taxes, too, be it VAT, council tax, or a range of other stealth taxes from which even the poorest citizens are no longer exempted. 

Claire Murdoch, NHS England national mental health director, said: “Helping people with mental ill health to find and keep a job is good for individual wellbeing and good for the health of our economy. Tackling severe mental illness is not just about getting medication and treatment right, but ensuring people can recover to live independently with their condition, including the reward and satisfaction of getting and keeping a job.

In our 70th year, mental health is one of the NHS’ top priorities, and ensuring services are integrated, so people get whole-person care, means our patients get better outcomes and taxpayers are rewarded as treatment is more efficient. One in seven of us will go through mental ill health whilst at work, so delivering a safety net, to help people back in to work when they fall ill, will minimise harm and make our country’s workforce more productive.”

NHS England say: “As part of patients’ care and support package, work coaches in NHS Individual Placement and Support (IPS) services, offer advice about finding a job, help them to prepare for an interview and can speak with potential employers about how someone’s condition can be managed so that they can work effectively while staying in good health.

“The trained specialists also improve the health of people with severe mental illness, reducing the need for urgent hospital admissions and GP appointments. Research shows that type of support can free up as much as £6,000 per patient, which can be invested in other frontline care.”

Again, the language is loaded, it’s a narrative with a scattering of casual cost-cutting phrases and prioritises a ‘productive workforce.’ There isn’t any discussion regarding the claim to ‘minimise harm’, it seems to be assumed that work in itself will take care of that. It’s also a little worrying that employers and work coaches are to be included in the ‘management’ of employees’ illnesses. When I am ill, I don’t want the advice or ‘management’ of a boss or a work coach, I want impartial medical diagnosis, treatment and advice from my doctor, not a ‘nudge’ or trite armchair psychology and pseudoscientific platitudes from the state.

It’s difficult to see how someone with a serious, chronic or progressive illness, 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.

Implicit in this narrative is the idea that illness is caused by deviant behaviours. The ‘cure’ therefore, is to simply address and remedy the faulty behaviours. 

The sick role and the resurrection of Talcott Parsons: disciplining disabled people

There is a lack of coherence within the narratives of contemporary Conservative governance, which is simultaneously neoliberal – grounded in free market principles and the ideal of a small, ‘non-intrusive’ state – and paternalism – which is founded on an authoritarian, large, extremely intrusive state, which is designed to tell people what is best for them and nudging citizens’ behaviours towards government defined policy outcomes.

The tension between neoliberalism and paternalism which outlines current policy approaches to disability and employment policy is filled with ambiguity, inconsistency and contradiction in its definition and understanding of the subject, the nature of the ‘problem’ and the policy ‘solutions’. On the one hand, neoliberalism is a doctrine that demands the withdrawal of social support mechanisms such as welfare, health care and public services, on the other, paternalism is based on state interventions designed to extend politically defined ‘optimal outcomes’.

These apparently contradictory narratives have been embodied in discipline of behavioural economics, which is largely aimed at enforcing the alignment of public expectations, attitudes and behaviours with neoliberal outcomes. It’s a prop for dogma and the status quo. Behavioural economics is concerned with reducing citizens’ expectations of social provision, while enforcing self reliance, and with providing justification narratives for neoliberal policies. 

I have written critical accounts of this somewhat draconian Conservative neoliberal paternalism on more than one occasion. The Conservatives place emphasis on highlighting the obligations of citizens, rather than on their rights, and this is why the work of Talcott Parsons in the early 1950s is especially appealing to them. 

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

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

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

We have a government that has regularly misused concepts from psychology and sociology, distorting them to fit a distinct framework of ideology, and justification narratives for draconian policies, usually entailing the diversion of public funds from public services and the provision of social security to wards rewards for the wealthiest citizens, usually in the form of tax cuts. Parsons’ work has generally been defined as sociological functionalism, and functionalism tends to embody very conservative ideas. 

From this perspective, sick people are not productive members of society; therefore this deviation from the norm must be policed. This, according to Parsons, is the role of the medical profession. More recently, however, we have witnessed the rapid extension of this role to include extensive State policing of sick and disabled people, and the introduction of increasingly coercive measures to push citizens into self managing their health conditions, while the medical profession have been increasingly politically sidelined in their provision of advice, care and support, regarding sickness and employment.

Last year, the government proposed extending ‘fit note’ certification beyond GPs to a wider group of non-specialist healthcare professionals, including physiotherapists, psychiatrists and senior nurses, to better ‘identify health conditions and treatments’ to help workers go back into their jobs faster. This is very worrying, since it entails the diagnosis and treatment of conditions by people who are not qualified to undertake this role.

‘Fit notes’ are specifically designed to ‘help’ patients develop a return to work plan, and are meant to be tailored to their individual needs. However, the introduction of fit notes –  a somewhat Orwellian title that refuses to acknowledge people get ill, or permit citizens time to recover, which replaced sick notes –  failed to produce an increase in a more rapid return to work for patients generally, mainly due to the fact that employers failed to support patients with adequate workplace adjustments to accommodate their return.  

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

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

The issues we then need to confront are about the obstacles that may limit the opportunities for individuals with impairments, and about how those social barriers may be removed.

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

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

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

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

Parsons never managed to accommodate and reflect social change, suffering and distress, poverty, deprivation and conflict in his functionalist perspective. His view of citizens as oversocialised and subjugated in normative conformity was an essentially Conservative one. In fact, the instituted Nudge Unit at the heart of the Cabinet Office and a proliferation of nudge-laden behaviourist policies over recent years indicates this view is a Conservative ideal. 

Furthermore, Parsons’ systems theory was heavily positivistic, anti-voluntaristic and profoundly dehumanising. His mechanistic and unilinear evolutionary theory reads like an instruction manual for the capitalist state.

Parsons thought that social practices should be seen in terms of their function in maintaining order and social structure. You can see why his core ideas would appeal to Conservative neoliberals and rogue multinational companies (such as Unumwho had a hand in the government’s Work, Health and Employment green paper). Conservatives have always been very attached to tautological explanations (insofar that they tend to present circular arguments.)

One question raised in this functional approach is how do we determine what is functional and what is not, and for whom each of these activities and institutions are functional. If there is no method to sort functional from non-functional aspects of society, the functional model is tautological – without any explanatory power to why any activity is regarded as “functional.” The causes are simply explained in terms of perceived effects, and conversely, the effects are explained in terms of perceived causes). 

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

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

Work will set you free


Arbeit macht frei
(‘work makes you free’) is a German expression which comes from the title of a novel by German philologist Lorenz Diefenbach, Arbeit macht frei: Erzählung von Lorenz Diefenbach (1873), in which gamblers and fraudsters find the path to virtue through work. The Weimar Republic in the 1920s, and later, the Nazis, found the leading character of Diefenbach’s book, whose achievements are defined by ‘concentrating on doing his work’, compelling.

The phrase was used to promote German employment policies. The slogan was placed at the entrances to a number of Nazi concentration camps. It strikes as an almost mystical declaration that self-sacrifice in the form of endless labour does in itself bring a kind of spiritual freedom. However, given the true role of concentration camps such as Auschwitz during the Holocaust as well as the individual prisoner’s knowledge that once they entered the camp, freedom was not likely to be gained by any means other than their death, the terrible and cruel irony of the slogan becomes clear. And the lie. 

Though the context and wording has changed –  “work is a health outcome” – and full employment at any cost is the neoliberal goal, the idea that work has some mystical benefit, such as curing illness, or even simply alleviating poverty and inequality, remains a lie. 

The British Psychological Society (BPS) has expressed concerns about the idea  that employment (of whatever type) should be recognised as a “health outcome”. The Society recognise that suitable work can be good for wellbeing – but this very much depends on the type and quality of work and its social context. 

Furthermore, my own view is that the IPS programme will make it more difficult to ensure and maintain the political independence of health professionals. The private and confidential patient-doctor relationship ought to be a safe space, where citizens may address medical health problems, and doctors can provide support for people who are ill. The government is creating yet another space for an intrusive, overextension of the coercive arm of the state to “help people into work”, regardless of whether or not they are actually well enough to cope with working.

Placing employment advisors in the NHS will not address inequality, and the social conditions that are the consequence of political decision-making and imposed economic frameworks, so it permits the government and society to look the other way, while the government continue to present mental illness as an individual weakness or vulnerability, and a consequence of “worklessness” rather than a fairly predictable result of living in a highly unequal, competitive society, and arising because of experiences of living stigmatised, marginalised lives because of politically expedient policy-directed material deprivation. 

Feeding a myth 

I found a document almost by accident, while researching the Health, Work and Disability green paper a couple of years back. It presents further evidence that government policy is not founded on empirical evidence, but rather, it is often founded on deceitful contrivance. The Department for Work and Pensions research document published back in 2011 –Routes onto Employment and Support Allowance– said that if people believed that work was good for them, they were less likely to claim or stay on disability benefits. 

It was decided that people should be “encouraged” to believe that work was “good” for health. There is no empirical basis for the belief, and the purpose of encouraging it is simply to cut the numbers of disabled people claiming ESA by “encouraging” them into work. Some people’s work is undoubtedly a source of wellbeing and provides a sense of purpose.

That is not the same thing as being work being miraculously “good for health”. For a government to use data regarding opinion rather than empirical evidence to claim that work is “good” for health indicates a ruthless mercenary approach to fulfill their broader aim of dismantling social security and relentless determination to uphold their ideological commitment to supply-side policy, regardless of the harmful social costs.

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

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

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

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

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

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

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

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

Nicola Oliver, from Northamptonshire Healthcare NHS Foundation Trust, said: “Employment support linked to mental health means people can live the life they want to lead.

“If you help someone into a job they really like – which means they are inspired to get up in the morning and want to manage their symptoms – they’re likely to say to their clinician ‘This is what I want to do, help me to overcome these barriers.’ In this way, you’re motivating the person to manage their own condition” (My emphasis).

Mental health employment specialists in the IPS service are part of community mental health teams. They currently operate in parts of the country including Sussex, Bradford, Northampton and some London boroughs, which have seen 9,000 people in the past twelve months. NHS England will be providing £10 million funding to expand access over the next two years, with further investment to follow. By 2021, NHS England anticipates that 20,000 people with severe mental illness will receive tailored care and employment advice via the NHS, suggesting that around 5,000 people with mental ill health avoid unemployment thanks to ‘better health care’.

IPS is one of a number of integrated mental health services which are being introduced or expanded across England, as part of NHS England’s Five Year Forward View for Mental Health, described as a “transformation and investment programme to improve care between 2016 and 2021.”

People can only work when their basic needs are met

maslows_hierarchy_of_needs-4

Despite the government’s rhetoric on welfare “dependency”, and the alleged need for removing so-called “perverse incentives” from the social security system by imposing a harsh conditionality framework and a compliance regime – using punitive sanctions – and work capability assessments designed to preclude eligibility to disability benefits, research shows that generous social security regimes make people more likely to want to work, not less. I have written at length over the last few years about why a punitive welfare system can never work, as the government claim, to “incentivise people to find employment. See, for example, The Minnesota Starvation Experiment provided empirical evidence that demonstrates clearly why welfare sanctions can’t possibly work as an “incentive” to “make work pay”).

The government’s welfare “reforms” have already invited scathing international criticism because they have disproportionately targeted cuts at those with the least income. Furthermore, the government have systematically violated the human rights of those with mental and physical disabilities. In a highly critical UN report which followed a lengthy inquiry, it says: “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.”

However, the UK government have continued to conflate social justice and inclusion with punitive policies and cuts – dressed up in the language of “incentives” and “nudge” – aimed at coercing disabled people towards narrow employment outcomes that preferably bypass any form of genuine support and the social security system completely.  (See –UN’s highly critical report confirms UK government has systematically violated the human rights of disabled people).

It’s hardly the case that the state has an even remotely credible track record of assessing people’s medical conditions, nor is it the case that this government bothers itself with empirical evidence, or deigns to listen to concerns raised by citizens, academics, professionals and charities regarding the harm that their policies are causing. This is a government that can’t even manage to observe basic human rights, let alone care about citizen’s best interests, health and wellbeing. In a political context of savage cuts to essential support and services for disabled people, and such blatant disregard of the legislative frameworks that outline their fundamental rights, it is very difficult to trust that this government have the best interests of disabled people in mind with the formulation of Work, Health and Employment related programmes. 

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

Employment is not therapy. Ultimately, the IPS programme is all about (re)defining the behaviours, experience and reality of a social group to ensure they conform to government ideological incentives and to justify dismantling public services (especially welfare, and increasingly, the NHS – see, for example, Rogue company Unum’s profiteering hand in the government’s work, health and disability green paper).

This is form of gaslighting intended to extend oppressive political control and behavioural 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 unfulfilling work – can result in a decline in health and wellbeing, indicating that it is poverty and growing inequality, rather than unemployment, that increases the risk of experiencing poor mental and physical health.

facade welfare

 


 

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

NHS charges

Christopher Chope, a Barrister and the Conservative MP for Christchurch, has proposed a private bill that would make provision for co-funding, and to extend the use of ‘co-payment’ – charges – throughout the National Health Service (NHS); and for “connected purposes.”

Though there are already some charges for health services such dental treatments, eye tests and prescriptions already, experts have warned that if the bill gains assent, it would open the floodgates to charging for a range of other services including GPs appointments and minor operations.

The National Health Service (Co-Funding and CoPayment) Bill would “make provision for co-funding and for the extension of co-payment for NHS services in England” and this will be the second reading of the bill.

MPs are set to debate the proposed bill today.

Recent changes to NHS prescribing guidelines has shown that the co-payment system is far from perfect. Controversial limits to the kind of conditions for which GPs can prescribe medication. Instead, patients will be given advice on what medications to buy from the pharmacy. 

Simon Stevens, Chief Executive of NHS England, said: “Across the NHS our aim is to: ‘Think like a patient, act like a taxpayer’. The NHS is probably the most efficient health service in the world, but we’re determined to keep pushing further. Every pound we save from cutting waste is another pound we can then invest in better A&E care, new cancer treatments and much better mental health services.” 

John O’Connell, Chief Executive of the TaxPayers’ Alliance approved the changes, adding that “It’s great news that NHS England will save a vast amount of taxpayers’ money by curbing prescriptions for basic items that are much cheaper to buy in the supermarket than they are to prescribe. Taxpayers should not be footing the bill for items like anti dandruff shampoo or athlete’s foot powder, so cutting out wasteful spending like this will mean that precious resources can be focused on frontline services. Patients too must remember that these items are not “free” – the money comes out of taxpayers’ pockets, so NHS England should be applauded for this move.”

However, someone should remind Stevens and O’Connell that everyone pays tax and national insurance. This kind of rationing is a steep and slippery slope to a health service that is no longer free at the point of delivery. 

However, NHS has always been free at the point of delivery – that’s one of the founding principles on which it was created. Millions of ordinary people rely on this principle. Under no circumstances must we permit the government to take us back to the time when had to sell their household belongings to see their doctor. Citizens in a civilised  and democratic society should not be penalised financially for being ill and needing NHS services.

Justin Madders MP, Labour’s Shadow Health Minister, said: “Once again we see the Tories’ true colours.

“At a time when the NHS is going through the biggest funding squeeze in its history and more than four million people are waiting for treatment, Tory MPs are proposing a two-tier system where those who can afford it get treated first.

“Labour’s first priority will be to give the NHS the funding it needs to protect an NHS free at the point of use for everyone who needs it.”

Chope has previously tabled a range of other controversial bills.

He was appointed as the Parliamentary Private Secretary to Peter Brooke, the Minister of State at the Treasury in 1986, before being promoted by Margaret Thatcher to serve in her government as the Parliamentary Under Secretary of State at the Department for the Environment later in the same year, where he was responsible for steering through the immensely unpopular “Community Charge” (best known as the Poll tax) legislation.

In June 2013 Chope was one of four MPs who camped outside Parliament in a move to facilitate parliamentary debate on what they called an “Alternative Queen’s Speech” – an attempt to show what a future Conservative government might deliver. 42 policies were listed including reintroduction of the death penalty and conscription, privatising the BBC, banning the burka in public places and preparation to leave the European Union. 

Chope helped to lead backbench support for the motion calling for a European Referendum. He has also been heavily involved in the use of private member’s bills to achieve this aim. Chope came under fire in January 2013 for referring to some staff in the House of Commons as “servants”. Parallels were drawn between this opinion and his views on the minimum wage – which he has called to be abolished.

On 28 November 2014 Chope, a private landlord, filibustered a Liberal Democrat bill with cross party support intended to make revenge evictions an offence.

In 2014 Chope along with six other Conservative Party MPs voted against the Equal Pay (Transparency) Bill which would require all companies with more than 250 employees to declare the gap in pay between the average male and average female salaries.

He came under criticism in late 2014 for repeatedly blocking a bill that would ban the use of wild animals in circus performances, justifying his actions by saying “The EU Membership Costs and Benefits bill should have been called by the clerk before the circuses bill, so I raised a point of order”.

You can read Chope’s latest controversial and draconian bill: The National Health Service (Co-Funding and Co-Payment) Bill here.

GP and NHS campaigner, Bob Gill, says:

Ever wondered why Government wanted to spend a fortune on the charging infrastructure for collecting relatively insignificant sums from illegal immigrants using the NHS?

Well that was the cover story. Reality is that charging was always intended to apply to everyone.

Here is the Bill to extend charging to all.”

Please tell your MPs to attend the debate and to argue and vote against it, whatever party they are.

Here is how to contact your MP.

Template emails are downloadable from the 999 Call for the NHS website.

Let’s not let the Conservatives get away with privatising our NHS by stealth.

Image result for MPs with a vested interest in NHS

 

Update

The bill did not get through the second reading, as it ran out of time. However,  the Conservatives have rescheduled the bill for another attempt, on Friday 15 June.

Related 

Rogue company Unum’s profiteering hand in the government’s work, health and disability green paper: work as a “health outcome”.

 


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Leave Director admitted the Brexit referendum was won by lying to the public

Buried in a 19,800 word Spectator essay written by former online editor and Vote Leave director Dominic Cummings is an admission: The Brexit referendum was won by lying to the public.

The piece, found here, is well worth reading but also falls victim to classic “mansplaining” (explaining something in a condescending or patronizing way) of a complex issue with many words wasted on prose that most politicians would be proud of, working around the subject rather than delving in to the heart of it.

Of course, that’s for a very good reason, because at the heart of the vote to leave the European Union is an entanglement of lies and propagandist sensationalism that even the most brave souls wouldn’t dare admit to.

There is the admission that the NHS wouldn’t really take back our £350 million EU fee, and that immigration wouldn’t really be capped, and that standards of living wouldn’t really change if we left the EU. All of which are matters that the general public voted on, and all are incorrect.

And so to the damning paragraph that outs the Leave Campaign for what it was:

“Pundits and MPs kept saying ‘why isn’t Leave arguing about the economy and living standards’. They did not realise that for millions of people, £350m/NHS was about the economy and living standards – that’s why it was so effective. It was clearly the most effective argument not only with the crucial swing fifth but with almost every demographic. Even with UKIP voters it was level-pegging with immigration. Would we have won without immigration? No. Would we have won without £350m/NHS? All our research and the close result strongly suggests No. Would we have won by spending our time talking about trade and the Single Market? No way.”

Related image

 

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