Tag: PIP

Mental Wealth Alliance response to the psy professional bodies’ statement on benefit sanctions and mental health

February 28, 2017March 1, 2017 · 1 Comment ·

aaeaaqaaaaaaaad4aaaajdk1ytqwzdyxltjinwytngjhmc05njdlltmyzmu4mty4owi5za

The British Psychological Society (BPS) has responded jointly with other psychological bodies to call on the UK Government to suspend its cruel and degrading benefit sanctions regime.

The BPS say that the government should suspend its benefit sanctions system as it fails to get people back to work and damages their mental health. s

The professional bodies highlight evidence that sanctions, or the threat of sanctions (benefit cuts following a claimant’s failure to comply with jobcentre conditions, e.g. missing an appointment with their work coach) can result in destitution, hardship, widespread anxiety and feelings of disempowerment.

The call came in a joint response to the Government’s consultation, ‘Improving Lives’, from the British Psychological Society, the British Association of Counselling and Psychotherapy, the British Psychoanalytic Council, the British Association for Behavioural and Cognitive Psychotherapies and the UK Council for Psychotherapy.

Findings from the National Audit Office show that there is limited evidence the sanctions system actually works, or is cost effective. The bodies argue that the Government needs to change focus from trying to make unemployment less attractive, to trying to make employment more attractive.

BPS President Professor Peter Kinderman said:

“We call for the benefits sanctions regime to be suspended until the completion of an independent review of their impact on people’s mental health and wellbeing

While there is evidence that the sanctions process is undermining mental health and wellbeing, there is no clear evidence that it leads to increased employment. Vulnerable people with specific multiple and complex needs are being disproportionately affected by the increased use of sanctions.”

In order to improve mental health, the bodies have also called for:

Jobcentres to care about the quality of work they provide – citing evidence that bad jobs can be more damaging to mental health than unemployment.
The development of statutory support for creating psychologically healthy workplaces.
Increased mental health awareness training for jobcentre staff.
Review and reform of the work capability assessment (WCA), which may be psychologically damaging, and lacks clear evidence of reliability or effectiveness.

The Mental Wealth Alliance have written a response to the collective statement on benefit sanctions and mental health:

Source: the free psychotherapy network

From:

Mental Wealth Alliance [1]

Mental Health Resistance Network; Disabled People Against Cuts; Recovery in the Bin; Boycott Workfare; The Survivors Trust; Alliance for Counselling and Psychotherapy; College of Psychoanalysts; Psychotherapists and Counsellors for Social Responsibility; Psychologists Against Austerity; Free Psychotherapy Network; Psychotherapists and Counsellors Union; Social Work Action Network (Mental Health Charter); National Unemployed Workers Combine; Merseyside County Association of Trades Union Councils; Scottish Unemployed Workers’ Network; Critical Mental Health Nurses’ Network; National Health Action Party.

To:

British Association for Behavioural and Cognitive Psychotherapies

British Association for Counselling and Psychotherapy

British Psychoanalytic Council

British Psychological Society

United Kingdom Council for Psychotherapy

30^th January 2017

MWA response to the psy professional bodies’ statement on benefit sanctions and mental health 30^th November 2016

We welcome the call from the psychological therapy bodies for the government to suspend the use of sanctions by the DWP subject to the outcomes of an independent review of its welfare policies and their potential damage to the mental health of benefit claimants. Given the accumulation of evidence over many years of the material and psychological suffering inflicted on benefit claimants by workfare-based conditionality[2], it has been frankly shocking that the professional bodies directly concerned with the mental health of the nation have preferred to welcome and participate in workfare policies rather than publicly and vociferously dissociate themselves.

The timing of the statement is given to be the recent report on sanctions by the National Audit Office. Welcome as its report is, the NAO’s perspective on government policy is primarily monetary, not one of health, ethics and social justice. Its “vision is to help the nation spend wisely”. The choice of this timing represents realpolitik on the part of the professional bodies no doubt, as perhaps is the intention of the conditional statement: “The sanctions process may be detrimental to people’s mental health and wellbeing”. But surely as psychotherapists and counsellors we can do better to represent the overwhelming evidence of personal suffering on such a scale than point to poor returns on expenditure and an ambivalent proposal that sanctions may be detrimental to people’s mental health.

Sanctions are only one dimension, albeit at the sharp end, of a welfare regime based on the political assertion that people need to be coerced off benefits and “nudged” into work. The psychological pressure of WCA and PIP assessments, job search rules, work programmes on “good employee” behaviours and the regular cuts to welfare benefits generally are part and parcel of the psycho-compulsion of the DWP benefits regime.[3]

We dispute the government’s premise that work is a therapeutic priority for people suffering from mental health difficulties. The marshalling of evidence for this modern-day workhouse mentality lacks both substance and integrity. Work has become the ideological mantra for neoliberal welfare policies.

Obviously where people want to work and where employment possibilities exist that will support and nourish people’s mental health, then encouragement, training and professional support should be available. But why is there no acknowledgement of the hundreds of thousands of claimants with mental health difficulties who cannot work, whether they want to or not?[4] Where is the evidence that people with mental health difficulties are actually benefiting from what is now two decades of workfare conditionality in the UK? Where is the evidence that in our current labour market decent jobs exist that will nourish people’s mental health? And where is the evidence that psychological therapy for benefit claimants with long-term mental health disabilities succeeds in supporting them into decent jobs they want, can survive and maintain?

When the professional bodies say, “an estimated 86-90% of people with mental health conditions that are not in employment want to work”, they are supporting the proposition that getting into work is an overwhelmingly important and efficacious goal for this group of benefit claimants. It is not clear where this figure comes from and what it means.

A similar figure is quoted by The Royal College of Psychiatrists’ report on Mental Health and Work (2013)[5], making use of a Sheffield study by J. Secker and others (2001)[6]. In fact, Secker finds that of their sample of 149 unemployed service users, when asked if they were interested in work of any kind – including voluntary and supported work – “around half (47%) responded positively, and almost the same proportion (43%) had a tentative interest. Only 15 people (10%) had no interest in work”. At the same time, only 25% of respondents saw full-time employment as a long-term goal. 71% said that their preferred vocational assistance would be “help for mental health/keep current service”.[7]

This study does not translate into “86-90% of people with mental health conditions that are not in employment want to work”.[8] What it points to is the complex texture of attitudes, desires and fears around waged work that are the common experience of service users, alongside the harsh realities of the current labour market, the socio-economic environment generally, and the dire state of mental health services of all kinds more particularly.[9]

From our point of view, the professional bodies’ statement is a step in the right direction. It is a step that must now be followed through with active political pressure on the DWP and the Dept of Health to suspend sanctions and set up an independent review of their use, including the damage they inflict on people’s mental health. Parliament has already called for such a review.[10]

But more than this, the remit of such a review should include all aspects of conditionality in a benefits system that deploy psycho-compulsion through mandatory rules or through the more subtle imposition of behavioural norms which aim to override the claimant’s voice.

We again suggest that the psy professional bodies would benefit by widening their own conversations to include service users and the rank and file of their membership. They would also win more credibility as organisations with ethical and social values independent of the government’s policies of dismantlement of social security and the welfare state if they were willing to make transparent their currently private conversations with DWP.

[1] Mental Wealth Alliance (MWA), formerly the Mental Wealth Foundation, is a broad, inclusive coalition of professional, grassroots, academic and survivor campaigns and movements. We bear collective witness and support collective action in response to the destructive impact of the new paradigm in health, social care, welfare and employment. We oppose the individualisation and medicalisation of the social, political and material causes of hardship and distress, which are increasing as a result of austerity cuts to services and welfare and the unjust shift of responsibility onto people on low incomes and welfare benefits. Our recent conference focused on Welfare Reforms and Mental Health, Resisting the Impact of Sanctions, Assessments and Psychological Coercion.

[2] Parliamentary committees, the national press, endless reports from charities, service user organisations, people with disabilities, claimants unions and workfare campaigners have been reporting the physical and psychological damage of ‘welfare reform’ and its tragic outcomes for a decade.

[3] On psycho-compulsion and the benefits system see Friedli and Stearn http://mh.bmj.com/content/41/1/40.full and https://vimeo.com/157125824

[4] In February 2015 over a million people claiming ESA under a MH diagnosis were in either the Support Group or WRAG. Over 70% of new applicants for ESA are found unfit for work

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/470545/3307-2015.pdf

[5]https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/212266/hwwb-mental-health-and-work.pdf p.17

[6] Secker, J., Grove, B. & Seebohm, P. (2001) Challenging barriers to employment, training and education for mental health service users. The service users’ perspective. London: Institute for Applied Health & Social Policy, King’s College London.

[7] Ibid, pp. 397-399

[8] Compare a DWP survey of disabled working age benefit claimants in 2013. 56% of 1,349 respondents agreed that they wanted to work. Only 15% agreed that they were currently able to work. Only 23% agreed that having a job would be beneficial for their health. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/224543/ihr_16_v2.pdf

[9] For example, some of this complexity is flagged by Blank, Harries and Reynolds (2012) The meaning and experience of work in the context of severe and enduring mental health problems: An interpretative phenomenological analysis Work: 47 45(3) “Stigma, the disclosure of a mental health problem and the symptoms of the mental health problem are frequently described, as well as feelings of hopelessness, seeing recovery as uncertain, and feeling a lack of encouragement from services. Difficulties in accessing occupational health services, having a disjointed work history, lack of work experience, age, lack of motivation and fears about competency, as well as the social benefits system and caring commitments, are also experienced as barriers to accessing employment for people with mental health problems.”

[10] https://www.parliament.uk/business/committees/committees-a-z/commons-select/work-and-pensions-committee/news/benefit-sanctions-report

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

Government subverts judicial process and abandons promise on mental health ‘parity of esteem’ to strip people of PIP entitlement

February 24, 2017March 14, 2017 · 24 Comments ·

Personal Independence Payment is a non means tested benefit for people with a long-term health condition or impairment, whether physical, sensory, mental, cognitive, intellectual, or any combination of these. It is an essential financial support towards the extra costs that ill and disabled people face, to help them lead as full, active and independent lives as possible.

Before 2010, policies that entailed cutting lifeline support for disabled people and those with serious illnesses were unthinkable. Now, systematically dismantling social security for those citizens who need support the most has become the political norm.

Any social security policy that is implemented with the expressed aim of “targeting those most in need” and is implemented to replace a policy that is deemed “unsustainable” is invariably about cost cutting, aimed at reducing the eligibility criteria for entitlement. The government were explicit in their statement about the original policy intent behind Personal Independence Payment. However, what it is that defines those “most in need” involves ever-shrinking, constantly redefined categories, pitched at an ever-shifting political goalpost.

Disability benefits were originally designed to help sick and disabled people meet their needs, additional living costs and support people sufficiently to allow a degree of dignity and independent living. You would be mistaken in thinking, however, that Personal Independent Payment was designed for that. It seems to have been designed to provide the Treasury with ever-increasing pocket money. Or as the source of profit for private providers who constantly assess, monitor, coerce and attempt to “incentivise” those people being systematically punished and impoverished by the state to make “behaviour changes,” which entail them not being disabled or ill and taking any available employment, regardless of its suitability.

The government have already considered ways of reducing the eligibility criteria for the daily living component of Personal Independence Payment (PIP) by narrowing definitions of aids and appliances, and were kite flying further limits to eligibility for PIP last year.

Two independent tribunals have ruled that the Department for Work and Pensions (DWP) should expand the scope and eligibility criteria of Personal Independence Payment (PIP), which helps both in-work and out-of work disabled people fund their additional living costs.

Following a court ruling in favour of disabled people last month, the government is rushing in an “urgent change” to the law to prevent many people with mental health conditions being awarded the mobility component of PIP. The court held that people with conditions such as severe anxiety can qualify for the enhanced rate of the mobility component, on the basis of problems with “planning and following a journey”, or “going out”.

The government’s new regulations will reverse the recent ruling and means that people with mental health conditions such as severe anxiety who can go outdoors, even if they need to have someone with them, are much less likely to get an award of even the standard rate of the PIP mobility component. The new regulations also make changes to the way that the descriptors relating to taking medication are interpreted, again in response to a ruling by a tribunal in favour of disabled people.

The first tribunal said more points should be available in the “mobility” element for people who suffer “overwhelming psychological distress” when travelling alone. The second tribunal recommended more points in the “daily living” element for people who need help to take medication and monitor a health condition.

The Department for Work and Pensions (DWP) warned that it would cost £3.7bn extra by 2022 to implement the court rulings. The government have responded by formulating “emergency legislation” to stop the legal changes that the upper tribunals had ruled on from happening. From 16 March the law will be changed, without any democratic conversation with disabled people and related organisations, or debate in parliament, so that the phrase “For reasons other than psychological distress” will be added to the start of descriptors c, d and f in relation to “Planning and following journeys” on the PIP form.

It’s worth noting that the Coalition Government enshrined in law a commitment to parity of esteem for mental and physical health in the Health and Social Care Act 2012. In January 2014 it published the policy paper Closing the Gap: priorities for essential change in mental health (Department of Health, 2014), which sets out 25 priorities for change in how children and adults with mental health problems are supported and cared for. The limiting changes to PIP legislation does not reflect that commitment.

The new regulations are being rushed in without any dialogue with the Social Security Advisory Committee, too.

The government have designed regulations which would, according to Penny Mordaunt, be about “restoring the policy originally intended when the Government developed the PIP assessment”.

The original policy intent was to create an opportunity to limit eligibility for those people previously claiming Disability Living Allowance (DLA) whilst they were being reassessed for PIP, which replaced DLA. And to limit successful new claims.

Mordaunt also said in a written statement to MPs: “If not urgently addressed, the operational complexities could undermine the consistency of assessments, leading to confusion for all those using the legislation, including claimants, assessors, and the courts.

“It is because of the urgency caused by these challenges, and the implications on public expenditure, that proposals for these amendments have not been referred to the Social Security Advisory Committee before making the regulations.”

An ever-shifting, ever-shrinking goalpost

The government has already considered ways of reducing eligibility criteria for the daily living component of Personal Independence Payment by narrowing definitions of aids and appliances, last year.

We ought to challenge a government that displays such contempt for the judicial system, and ask where the ever-reductive quest for the ever-shrinking category of “those with the greatest need” will end.

Labour’s Shadow Work and Pensions Secretary, Debbie Abrahams MP, criticised the government’s decision to overturn the tribunal rulings, she said: “Instead of listening to the court’s criticisms of PIP assessments and correcting these injustices, this government have instead decided to undermine the legal basis of the rulings”.

Abrahams added: “This is an unprecedented attempt to subvert an independent tribunal judgement by a right-wing government with contempt for judicial process.

By shifting the goal posts, the Tory Government will strip entitlements from over 160,000 disabled people, money which the courts believe is rightfully theirs. This is a step too far, even for this Tory government.”

The government seem to think that PIP is a policy that ought to benefit only the needs of a government on an ideological crusade to reduce social security away to nothing – “to target those in greatest need” – an ever-shrinking, constantly redefined and shifting category of disability.

It is not a democratic government: they are unwilling to engage in a dialogue with the public or to recognise and reflect public needs: that’s an authoritarian elite taking public money and handing it out to a very wealthy minority group in the form of “incentivising” tax cuts, who then say to the public that providing lifeline support for disabled people and those with mental health/medical conditions is “unsustainable”.

Implications for the UK’s obligations regarding the UN convention on the human rights of disabled persons and the Equality Act

The new PIP changes, pushed through without any public conversation or democratic exchange with disabled people, are in breach of both the UN convention on the rights of disabled persons, and the UK Equality Act.

In the Equality Analysis PIP assessment criteria document, the government concede that: “Since PIP is a benefit for people with a disability, impairment or long-term health condition, any changes will have a direct effect on disabled people. The vast majority of people receiving PIP are likely to be covered by the definition of “disability” in the Equality Act 2010.

By definition, therefore, the UT [upper tribunal] judgment results in higher payments to disabled people, and reversing its effect will prevent that and keep payments at the level originally intended. The difference in income will clearly make a real practical difference to most affected claimants, and (depending on factors such as their other resources) is capable of affecting their ability to be independently mobile, access services etc – all matters covered by the UN Convention on the Rights of Persons with Disabilities as set out at the start of this Analysis.”

It goes on to say in the document: “However, this does not necessarily mean that the increased payments that would result from the judgment are a fair reflection of the costs faced by those affected, or represent a fair approach as between different groups of PIP claimants.”

People with the following conditions are likely to be affected by the reversal of the upper tribunal’s ruling on those needing support to manage medication, monitor a health condition, or both:

Diabetes mellitus (category unknown), Diabetes mellitus Type 1 (insulin dependent), Diabetes mellitus Type 2 (non-insulin dependent), Diabetic neuropathy, Diabetic retinopathy, Disturbances of consciousness – Nonepileptic – Other / type not known, Drop attacks, Generalised seizures (with status epilepticus in last 12 months), Generalised seizures, (without status epilepticus in last 12 months), Narcolepsy, Non epileptic Attack disorder (pseudoseizures), Partial seizures (with status epilepticus in last 12 months), Partial seizures (without status epilepticus in last 12 months), Seizures – unclassified Dizziness – cause not specified, Stokes Adams attacks (cardiovascular syncope), Syncope – Other / type not known.

People with the following conditions are likely to be affected by the reversal of the independent tribunal’s ruling regarding PIP mobility awards, with conditions in the general category of “severe psychological distress”:

Mood disorders – Other / type not known, Psychotic disorders – Other / type not known, Schizophrenia, Schizoaffective disorder, Phobia – Social Panic disorder, Learning disability – Other / type not known, Generalized anxiety disorder, Agoraphobia, Alcohol misuse, Anxiety and depressive disorders – mixed Anxiety disorders – Other / type not known, Autism, Bipolar affective disorder (Hypomania / Mania), Cognitive disorder due to stroke, Cognitive disorders – Other / type not known, Dementia, Depressive disorder, Drug misuse, Stress reaction disorders – Other / type not known, Post-traumatic stress disorder (PTSD), Phobia – Specific Personality disorder, Obsessive compulsive disorder (OCD).

The government’s so-called commitment to a “parity of esteem for mental health and physical health” was clearly nothing more than an empty promise – an opportunistic platitude. This is a government that says one thing and then does exactly the opposite.

It’s all part of a broader gaslighting and linguistic techniques of neutralisation strategy that passes as Conservative “justification” for their draconian deeds and bullying, discriminatory and uncivilised austerity regime, aimed disproportionately at disabled people.

Commenting on the Ministerial announcement (made yesterday, 23rd February), Rob Holland, Public Affairs Manager at Mencap and Disability Benefits Consortium Parliamentary Co-Chair said:

“We are concerned by these changes to the criteria for Personal Independence Payment (PIP). These risk further restricting access to vital support for thousands of disabled people. Last year, MPs strongly opposed restrictions to PIP and the Government promised no further cuts to disability benefits. Other changes have already had a devastating impact on thousands and in far too many cases people have had to rely on tribunals to access the support they need.

We are deeply disappointed as a coalition of over 80 organisations representing disabled people that we were not consulted about these proposals and their potential impact. The Government must ensure the views of disabled people are properly considered before they proceed with these changes.”

tough-choices

The full ministerial statement can be read here.

Download a copy of the new regulations here.

PIP and the Tory monologue

Government guidelines for PIP assessment: a political redefinition of the word ‘objective’

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

November 15, 2016May 27, 2017 · 24 Comments ·

Context

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

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

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

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

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

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

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

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

The architects

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

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

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

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

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

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

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

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

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

State diagnosis and treatment – a blunt instrument

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

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

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

The belief. Not evidenced fact.

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

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

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

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

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

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

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

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

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

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

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

The shrinking category of illness and disability

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

That has always been the ultimate aim of the Conservatives.

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

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

14264869_10155156840200130_1352094000808474819_n

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

The power of positive thinking is really political gaslighting

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

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

GP practices to provide advice on job seeking in new pilot scheme

New return to work service goes live to help GPs, employees and employers across England

A critique of benefit sanctions: the Minnesota Starvation Experiment and Maslow’s Hierarchy of Needs

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

The Psychological Impact of Austerity – Psychologists Against Austerity

A critique of Conservative notions of social research

Research finds strong correlation between Work Capability Assessment and suicide

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

A few thoughts on the implications of the United Nations report

November 11, 2016November 27, 2016 · 21 Comments ·

maslow-5
There is an important link between human needs and human rights that the Conservatives have dismally and persistently failed to recognise

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Beyond the rhetoric – the hidden agenda

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

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

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

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

For example, Matthew Oakley, a senior researcher at the Social Market Foundation, and government advisor, recently published a report entitled Closing the gap: creating a framework for tackling the disability employment gap in the UK, in which he suggests considering a “role that a form of privately run social insurance could play in both increasing benefit generosity and improving the support that individuals get to manage their conditions and move back to work.

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

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

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

“There is a clear lesson from auto-enrolment that if you have a plumbing network or an infrastructure that works, that auto-enrolment infrastructure could be used for other things which would encourage financial inclusion: things like, for example, life cover, income protection and effective and very genuine personal contributory benefits for things like unemployment and sickness,” he said. “They can be delivered at good value if there is mass participation through either soft compulsion or good behavioural economics.”

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

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

Mo Stewart has spent eight years researching the influence of the US insurance giant Unum over successive UK governments, and how it led to the introduction of the “totally bogus” work capability assessment (WCA), which she says was designed to make it harder for sick and disabled people to claim out-of-work disability benefits.Stewart’s book, Cash Not Care: The Planned Demolition Of The UK Welfare State, was published in September. She states that the assessment was modeled on methods used by the controversial company Unum to deny protection to sick and disabled people in the US who had taken out income protection policies.

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

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

The implications of the inquiry findings for Conservative welfare policies

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

From the report:

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

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

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

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

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

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

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

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

Inquiry reports

1. Report of the Inquiry Concerning the United Kingdom of Great Britain and Northern Ireland carried out by the Committee under article 6 of the Optional Protocol to the Convention

2. Observations of the Government of the United Kingdom of Great Britain and Northern Ireland on the report of the Inquiry carried out by the Committee under article 6 of the Optional Protocol to the Convention

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

Initial thoughts on the work, health and disability green paper

November 6, 2016November 15, 2017 · 68 Comments ·

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

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

The context indicates the general intent

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

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

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

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

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

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

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

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

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

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

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

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

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

Watching the way the wind blows

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Semantic thrifts: being Conservative with the truth

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The nitty gritty

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Well, at least until you die.

Pictures courtesy of Robert Livingstone

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

Government guidelines for PIP assessment: a political redefinition of the word ‘objective’

October 14, 2016February 21, 2019 · 40 Comments ·

Thousands of disabled people have already lost their specialist Motability vehicles because of Conservative PIP cuts and many more are likely to be affected.

The Department for Work and Pensions (DWP) have issued a guidance document for providers carrying out assessments for Personal Independence Payment (PIP), which was updated last month. It can be found here: PIP Assessment Guide.

The DWP Chief Medical Officer states that this is a supplementary guidance, in addition to “the contract documents agreed with providers as part of the commercial process, providing guidance for health professionals [HPs] carrying out assessment activity and for those responsible for putting in place and delivering processes to ensure the quality of assessments.”

Words like “fair”, “quality”, “support”, “reform” and even “objective” have been given a very subjective, highly specific Conservative semantic make-over, to signpost and reference a distinctive underpinning ideology, and to align them with neoliberal and New Right anti-welfare discourse and outcomes, over the last five years.

There is some preemptive dodging of criticism and patronising get-out clauses in the document, for example: “It must be remembered that some of the information may not be readily understood by those who are not trained and experienced HPs.”

This comment is indicative of the lack of transparency in the terms, conditions and process of assessments, and how they are generally carried out. It also emphasises the professional gap between the “health professional” employed by the state to carry out the “functional capacity” assessments in the context of a neoliberal welfare state, and medical health professionals, whose wider work is generally not directly linked to the politically defined conditionality of welfare support.

If you fundamentally disagree with any of the approach outlined in the content of the document, or the policy, it’s because you “fail to comprehend it”, simply because you haven’t trained as a HP.

I had no idea that HPs are the only people who can work out policy outcomes and who recognise government cuts, small state ideology and general cost-cutting measures for what they are, despite the thumping Orwellian semantic shifts and language use that is all about techniques of neutralisation (where the rhetoric used obscures or “neutralises” the negative aims and harmful consequences of the policy.)

Firstly, the HPs are not so much “health professionals”, but rather, “re-trained disability analysts.” Their role entails assessing the impact of illness and disability on the “functional capacity” of individuals in direct relation to justification or refusal of a PIP award only. Furthermore, it is the decision of the HP to “determine whether any additional evidence needs to be gathered from health or other professionals supporting the claimant.”

Often at the appeal stage, it turns out HPs frequently decide not to ask for further evidence. The DWP must take all medical evidence into account when making a decision about PIP claims. Yet the DWP say: “In many cases, appeals are granted because further medical evidence is provided.”

However, neither HPs nor the DWP decision-makers contact people’s GP or other professionals for more information about their health condition very often. This indicates that people are having to go to court, often waiting months for their appeal to be heard, because of deliberately under-informed, poorly evidenced DWP decisions.

Furthermore, it says in the government guidance to GPs: “Your patient should complete the forms to support their [PIP] claim using information that they have to hand, and should not ask you for information to help them do this, or to complete the forms yourself.”

It seems that the DWP are determined to continue making ill-informed, medically unevidenced decisions as long as they can get away with it.

The ‘functional’ assessment

From the document: “The assessment for PIP looks at an individual’s ability to carry out a series of key everyday activities. The assessment considers the impact of a claimant’s health condition or impairment on their functional ability rather than focusing on a particular diagnosis. Benefit will not be paid on the basis of having a particular health condition or impairment but on the impact of the health condition or impairment on the claimant’s everyday life.”

This process of assessment, however, is a very speculative one, with inferences drawn from seemingly unrelated questions and assumed circumstances, such as “do you have a pet?” This translates into “can bend from the waist to feed a cat/dog” on the HP’s report to the DWP.

During examination, people are asked to perform a series of movements, and inferences are drawn from these regarding the performance of day to day tasks. The movements bear no resemblance to ordinary day to day tasks, nor do they take into account the use of aids and adaptations that people may use to carry out daily tasks.

Furthermore, the person being assessed isn’t presented with the assumptions drawn from the examination and questions, which means they are not provided with an opportunity to verify any claim made by the HP, or to say if they can manage to feed their pet “reliably, safely and consistently”, or if their family have to feed the animal for much of the time.

From the document: “The HP should check the consistency of what is being said by using different approaches, asking questions in different ways or coming back to a previous point. When considering inconsistencies, HPs should bear in mind that some claimants may have no insight into their condition, for example claimants with cognitive or developmental impairments.”

I know of a lady who wore a gold locket. It was simply assumed at her assessment that despite her extremely arthritic fingers, and information about her pain and the lack of movement in her hands from her GP, that she had sufficient dexterity to fasten and unfasten the clasp. Had she been asked, she would have informed the HP that she never took the locket off, even in the shower.

This approach – “checking for inconsistencies” by using indirect questioning and assumption is NOT “objective”. It is a calculated strategy to justify a starting point of disbelief and skepticism regarding the accounts provided by ill and disabled people about the impact of their conditions and disabilities on their day-to-day living. As such, it frames the entire assessment process, weighting it towards evidence gathering to justify refusing awards, rather than being “objective”.

It’s simply a method based on side-stepping and discounting people’s own accounts and experiences of their disability, and any medical evidence submitted to verify that.

This approach is also mirrored in the Work Capability Assessment, reflecting Conservative cynicism and prejudice towards sick and disabled people. (See: What you need to know about Atos Assessments – it provides a good overview from a whistle-blower of how responses to seemingly casual observations and apparently conversational questions are re-translated into “inconsistencies” which are then used to justify refusing a claim.)

The introduction of PIP was framed by New Right anti-welfarism

Secondly, “PIP is replacing Disability Living Allowance (DLA), which has become outdated and unsustainable. The introduction of PIP will ensure the benefit is more fairly targeted at those who face the greatest barriers, by introducing a simpler, fairer, more transparent and more objective assessment, carried out by health professionals” [All boldings mine].

In other words, PIP is aimed at cutting welfare costs and support for people who would previously have been eligible for Disability Living Allowance (DLA). We are told that it’s no longer possible as a society to support all disabled people who need help with the additional costs that they face simply because they are ill and disabled, so the government propose to establish those “with the greatest need” by using a more stringent assessment process, which is claimed to be fair and more “objective”.

A recent review led the government to conclude that PIP “doesn’t currently fulfil the original policy intent”, which was to cut costs and “target” the benefit to “those with the greatest need.” That originally meant a narrowing of eligibility criteria for people formerly claiming Disability Living Allowance, increasing the number of reassessments required, and limiting the number of successful claims.

Controversially, the cuts to disability benefits (including the £30 per week cut from those claiming ESA in work related activity group) will fund tax cuts for the most affluent – the top 7% of earners. The chancellor raised the threshold at which people start paying 40p tax, in a move that will probably see many wealthier people pulled out of the higher rate of income tax. Osborne said he wanted to “accelerate progress” towards the Conservative’s manifesto pledge of raising the threshold for the 40p rate to £50,000 in 2020.

Prior to the introduction of PIP, Esther McVey stated that of the initial 560,000 claimants to be reassessed by October 2015, 330,000 of these are targeted to either lose their benefit altogether or see their payments reduced. Of course the ever-shrinking category of “those with the greatest need” simply reflects a government that has made a partisan political decision to cut disabled people’s essential income to fund a financial gift to the wealthiest citizens. There is no justification for this decision, nor is it “fair.”

Fiona Colegrave, who is chief medical adviser, clinical governance and in charge of training for PIP at Capita, says: “As a disability assessor (DA), you are required to assess objectively how someone’s health conditions affect them and submit a report that is fair, reliable and can be justified with evidence because, if necessary, it may need to be scrutinised through an appeals process.

For these reasons, it is essential we equip DAs with the skills required to manage the assessment process, including: time management; questioning techniques; non-advocacy; collating all available evidence and identifying contradictions; and using an analytical but empathetic approach.

It is important for DAs to establish a rapport with the claimant, so that claimants feel like they have been able to express, in their own words, how their disability affects them and so they know that a DA will produce a report that accurately reflects their functional ability.”

Only “feel like”? Feedback from “claimants” says that DAs do NOT accurately reflect their “functional ability” in reports. And note the reductive use of the word “claimant” – language use that places the other at a psychological distance from the author and administrators, objectifying them, as if people claiming PIP and other benefits are a homogenous group of people, bound by characteristics rather than circumstances, in a context of political decision-making.

It becomes easier to disassociate from someone you view “objectively” and to distance yourself from the impact of your calculated and target-led decision-making, constrained within a highly political framework. Such an objectification of a person or group of people serves to de-empathise us, which is a key characteristic requirement of neoliberal ideology, embedded in inhumane “small state” policy and extended via administrative (and outsourced, privatised) practices. It leaves us much less likely to relate to the circumstances, emotions or accept the needs and choices of others.

Surely a considerable part of our experience of being objectively diagnosed as ill and/or disabled, in any case, is a person’s subjective experience of it, rather than categories and counts; quantifiable, reductive and speculative statements about how we may perform highly specific tasks.

Quantitative medical evidence is important, because it does often give a general indication of conditions that would entail loss of function. But considering medical evidence isn’t a central part of the assessment process. Whether or not we can perform certain tasks, and inferences drawn from that are the central considerations for PIP eligibility.

Many conditions “fluctuate” – they vary so much that it’s difficult to assess performance of specific tasks consistently. Many conditions become progressively worse at a varied pace, often leaving little scope for a person developing coping strategies and adapting their everyday lives to the changes as they happen, such as a progressive loss of mobility, cognitive impairment, mood changes, anxiety, depression, sleep disruption and other psychological impacts, and the increasing pain and fatigue that they may experience.

If the process were genuinely “fair, accurate and objective” then there would be no need for mandatory reviews and scrutiny through the appeals process. The introduction of the mandatory review – another layer of bureaucracy and a barrier to justice, where the DWP decide whether their first decision should be changed – has deterred many from appealing wrong decisions.

Those making the decisions about PIP awards are: “trained DWP staff who are familiar with the legislation governing PIP, but who do not have a healthcare background. The HP enables CMs to make fair and accurate decisions by providing impartial, objective and justified advice.“

The PIP assessment is geared towards looking for “inconsistencies” in “functional limitations”. For example, if you say you can’t sit unaided for half an hour, but then say that you watch soaps on TV, it will be assumed you sit unaided for at least half an hour to watch TV, and that will be classed as a “discrepancy between the reported need and the actual needs of the claimant.”

The whole assessment is set up and designed to look for “inconsistencies.” In other words, the assessor is looking for any excuse to justify a decision that you are not among those in “greatest need” for a PIP award. The entire process happens within a framework of reducing welfare costs, after all. This makes a mockery of the government’s fondness for using the word “objective.”

What can we do to try to counter the state bias towards political cost-cutting, which is embedded in the assessment process?

Well, we can use the guidelines and existing legislation to ensure that we are heard clearly. We can also raise awareness that, whilst most ill and disabled people tend to emphasise how well we cope, and remain positive about what we can do independently, and we often tend to understate our needs for support, in assessment situations, that tendency is likely to be used to trivialise the impact of our condition and disabilities on day-to-day “functioning.”

Reliability

The government says in the PIP handbook: “For a descriptor to apply to a claimant, they must be able to reliably complete the activity as described in the descriptor. Reliably means whether they can do so:

 safely – in a manner unlikely to cause harm to themselves or to another person, either during or after completion of the activity

 to an acceptable standard

 repeatedly – as often as is reasonably required, and

 in a reasonable time period – no more than twice as long as the maximum period that a non-disabled person would normally take to complete that activity.”

If you cannot complete an activity reliably, safely and repeatedly, as outlined, then you must be regarded as unable to complete that task at all. The reliability criteria are an important key protection for disabled people claiming both PIP and Employment and Support Allowance (ESA).

From the document: “Symptoms such as pain, fatigue and breathlessness should be considered when determining whether an activity can be carried out repeatedly. While these symptoms may not necessarily stop the claimant carrying out the activity in the first instance, they may be an indication that it cannot be done as often as is required.”

And: “The following situations highlight examples where an individual may be considered unable to repeatedly complete a descriptor in the way described due to the impact this would have:

A person who is able to stand and move 20 metres unaided, but is unable to repeat it again that day cannot do it repeatedly as you would reasonably expect people to move 20 metres more than once a day • A person who is able to prepare a meal, but the exhaustion from doing so means they cannot then repeat the activity at subsequent meal times on the same day. This means they cannot complete the activity repeatedly as it is reasonable to expect people to prepare a meal more than once a day.”

This also applies to people with mental health conditions, which may also impact on a person being able to carry out tasks reliably, repeatedly and safely.

Time periods, fluctuations and descriptor choices

The document says: “The impact of most health conditions and disabilities can fluctuate. Taking a view of ability over a longer period of time helps to iron out fluctuations and presents a more coherent picture of disabling effects. The descriptor choice should be based on consideration of a 12-month period.

This should correlate with the Qualifying Period and Prospective Test for the benefit – so in the 3 months before the assessment and in the 9 months after. A scoring descriptor can apply to claimants in an activity where their impairment(s) affect(s) their ability to complete an activity, at some stage of the PIP regulations.

The following rules apply: If one descriptor in an activity is likely to apply on more than 50% of the days in the 12-month period – the activity can be completed in the way described on more than 50% of days – then that descriptor should be chosen.

If more than one descriptor in an activity is likely to apply on more than 50% of the days in the period, then the descriptor chosen should be the one that is the highest scoring. For example, if D applies on 100% of days and E on 70% of days, E is selected. Where one single descriptor in an activity is likely to not be satisfied on more than 50% of days, but a number of different scoring descriptors in that activity together are likely to be satisfied on more than 50% of days, the descriptor likely to be satisfied for the highest proportion of the time should be selected.

For example if B applies on 20% of days, D on 30% of days and E on 5% of days, D is selected. If someone is awaiting treatment or further intervention, it can be difficult to accurately predict its level of success or whether it will even occur. Descriptor choices should therefore be based on the likely continuing impact of the health condition or disability as if any treatment or further intervention has not occurred.

The timing of the activity should be considered, and whether the claimant can carry out the activity when they need to do it. For example, if taking medication in the morning (such as painkillers) allows the individual to carry out activities reliably when they need to throughout the day, although they would be unable to carry out the activity for part of the day (before they take the painkillers), the individual can still complete the activity reliably when required and therefore should receive the appropriate descriptor.”

Again, “fluctuating conditions” include many mental health conditions.

Risk and safety

“When considering whether an activity can be carried out safely it is important to consider the risk of a serious adverse event occurring. However, the risk that a serious adverse event may occur due to impairments is insufficient – the adverse event has to be likely to occur.”

Even if complex probability calculations were used – and I am certain HPs are unlikely to have been trained to use such formulae – there is no “objective” way of calculating risk of serious “adverse” events over time.

However, it is not such a big inferential leap to recognise that continually cutting essential lifeline support for sick and disabled people will ultimately lead to harm, distress, hardship and other negative consequences for individuals and will have wider social, cultural and economic “adverse” consequences, too.

“Making work pay” for whom?

Personal Independence Payment handbook

Government Toolkit of information for support organisations

Relevant:

PIP and the Tory monologue

Government plans further brutal cuts to disability support

Consultation as government seek to limit disabled people’s eligibility for Personal Independence Payment

Second Independent Review of Personal Independence Payment assessment

Department for Work and Pensions Recruits Staff to Reduce ESA and PIP Appeal Success Rates

Request For Evidence – PIP: Mobility Criterion – Politics and Insights

I don’t make any money from my work. I’m a disabled person with lupus, and I’m stuggling to get by. But you can help by making a donation and enable me to continue to research and write informative, insightful and independent articles, and to provide support to others going through disability benefit assessment processes and appeals. The smallest amount is much appreciated – thank you.

Second Independent Review of Personal Independence Payment assessment

August 27, 2016February 24, 2017 · 8 Comments ·

Any social security policy that is implemented with the expressed aim of “targeting those most in need” is invariably about cost cutting and reducing eligibility criteria for entitlement. The government were explicit in their statement about the original policy intent of Personal Independence Payment. The government has already considered ways of reducing eligibility criteria for the daily living component of Personal Independence Payment by narrowing definitions of aids and appliances, earlier this year.

In July, the Department for Work and Pensions appointed Paul Gray CB to undertake the second “independent review” of the Personal Independence Payment (PIP) assessment. This is the second independent review as required by Section 89 of the Welfare Reform Act 2012.

This review includes a call for evidence of the PIP assessment. It seeks information about how the PIP assessment is “working.” The consultation includes all stages of the PIP process, with a particular focus on the use of further evidence in the claim process, data sharing and the claimant experience.

However, I’m just wondering where the ever-reductive targeting quest for the ever-shrinking category of “those with the greatest need” will end. The evidence that a policy “working” is usually related to the stated original aim. In this case, PIP isn’t a policy aimed at meeting the needs of disabled people. It’s a policy that is ultimately aimed at cutting support for ill and disabled people.

We have already witnessed a shrinking of eligibility criteria for people formerly claiming Disability Living Allowance, a marked increase in the number of reassessments required, and a limiting of the number of successful claims. Prior to the introduction of PIP, Esther McVey stated that of the initial 560,000 claimants to be reassessed by October 2015, 330,000 of these are targeted to either lose their benefit altogether or see their payments reduced.

Any “review” will therefore be framed by the original intent of the policy. However, that does not mean we should not respond to reviews and submit evidence, as a review provides us with an opportunity to flag up concerns regarding inadequacies experienced by those the policy is meant to support, too. The policy is not meant to serve the government, who are on an ideological crusade to dismantle all social security support, ultimately.

Disability benefits were originally designed to help sick and disabled people meet their needs, additional living costs and support people sufficiently to allow a degree of dignity and independent living. You would be mistaken in thinking, however, that Personal Independent Payment was designed for that. It seems to have been designed to be the Treasury’s ever-increasing pocket money. Or as profits for private providers who constantly assess, monitor, coerce and attempt to “incentivise” those people being systematically impoverished by the state to make “behaviour changes” by taking any low paid, insecure and poor quality work, regardless of how suitable or appropriate that is.

Apparently, that is the Conservative psychobabble “cure” for “worklessness,” which, regardless of market conditions, health, socioeconomic circumstances and poor political decision-making, is always down to an individual’s “bad behavioural choices.” The government regard work as a “health outcome.” I expect that soon, work coaches will replace doctors, and the Department for Work, health and Pensions will subsume the NHS.

For what it’s worth, Paul Gray will use evidence from the second review to inform his report to the Secretary of State for Work and Pensions. The second review will be laid before Parliament by April 2017.

Individuals and organisations are invited to submit evidence to help inform the review by answering the following questions. Where the Department for Work and Pensions use the word “condition” in these questions they mean disabilities, health conditions and impairments. They use “condition” for short.

Your responses can only be taken into account if you press submit at the end of the survey form, if you send a submission using that method.

The deadline for submissions is 5pm on 16 September 2016.

Your privacy
The note on privacy: “By providing personal information for the purposes of this call for evidence, it is understood that you consent to its disclosure and publication. If you want the information in your response to be confidential, please explain why and we will endeavour to do so. However we cannot guarantee to do this.”

Terms of reference for the second independent review of the PIP assessment
First independent review of the PIP assessment
www.gov.uk/pip – who is entitled to PIP and how to claim it

Ways to respond

Respond online

Email: pip.independentreview@dwp.gsi.gov.uk

Write to:
PIP Independent Review Team
Department for Work and Pensions
Floor 4
Caxton House
Tothill Street
London
SW1H 9NA

—

Related

“Consideration of the ability of a claimant to carry out an activity safely, to an acceptable standard, repeatedly and in a reasonable time period is key to the PIP assessment. We recognise that these ‘reliability criteria’ and the rules setting out how fluctuating conditions should be considered are an important protection for claimants, and these are enshrined in legislation” – Government’s second response to the first Independent Review of the Personal Independence Payment Assessment

Consultation as government seek to limit disabled people’s eligibility for Personal Independence Payment

Request For Evidence – PIP: mobility Criterion

PIP and the Tory monolgue

Request For Evidence – PIP: Mobility Criterion

May 10, 2016May 11, 2016 · 49 Comments ·

On May 4, there was a debate in the House of Lords about discussions with Disability Rights UK and the Disability Benefits Consortium on identifying a mobility criterion in the Personal Independence Payment (PIP) assessment framework, which was led by Liberal Democrat Baroness Thomas.

Baroness Thomas of Winchester tabled a Motion to resolve in the House of Lords:

“That this House calls on Her Majesty’s Government to hold urgent talks with Disability Rights UK and the Disability Benefits Consortium to identify a mobility criterion in the Personal Independence Payment (PIP) “moving around” assessment which is fairer than the current 20 metre distance, in the light of the impact on reassessed disabled claimants and the resulting large number of successful appeals.”

She said: “Tabling a Motion is an unusual course to take, but I assure the House that there is nothing fatal about it. However, if it were to be agreed, it would send a powerful message that this House is very concerned about this particular government policy and is taking a constructive approach to seeing what can be done to help the situation.

Why am I so concerned about the “Moving around” section? Because the relevant walking distance test for PIP has been made much harder than the Disability Living Allowance (DLA) test, meaning that by the Government’s own estimate the number of people on enhanced or higher-rate mobility will go down from around 1 million people to 600,000 by 2018.

Some 400 to 500 Motability cars a week are now being handed back by disabled claimants whose condition may not have improved but who are losing not just their car but, in many cases, their independence. Under DLA, the walking distance was 50 metres, which was in the Department for Transport guidance on inclusive mobility. The new distance of 20 metres is just under two London bus lengths, and is unrecognised in any other setting. There is no evidence that it is a sensible distance for the test, and it is not used anywhere else by the Government.

So someone with a walking frame, say, who can just about manage 20 to 30 metres, will not usually qualify for PIP. I see the Minister even now sharpening her pencil to make a note reminding her to tell me that this is a travesty of the truth. No, I have not forgotten the reliability criteria, which were made statutory in the last Parliament—thanks, in fact, to the intervention of the Liberal Democrats. The full reliability criteria in the PIP guidance are that 20 metres must be able to be walked,

“safely … to an acceptable standard …repeatedly … and … in a reasonable time period”.

Baroness Thomas added: “To sum up, to be told that the bill for PIP is too high and must be cut by more than halving the walking distance test is a real slap in the face for thousands of disabled people, particularly those of working age with lifetime awards under DLA. Of course the bill is going up—because the disabled population is going up. The Government must have factored that into their calculations years ago. The last thing that anyone wants is for more and more disabled people to become socially isolated and totally reliant on other services for everything they need. A great deal of money could actually be saved by other government departments, such as health, social services, employment and transport, by making the PIP walking distance fairer. I beg to move.”

There were also some outstanding contributions made in this debate by Baroness Sherlock (Labour), Baroness Grey-Thompson (Cross Bench), Baroness Masham of Ilton (Cross Bench), Lord Low of Dalston (Cross Bench), Baroness Brinton (Liberal Democrat), Baroness Doocey (Lib Dem), Lord McKenzie of Luton (Labour), amongst others.

I recommend that you read the debate in full here: Personal Independence Payment: Mobility Criterion.

One very important issue raised in this debate was clarified in a statement made by The Minister of State, Department for Work and Pensions, Baroness Altmann (Conservative). She said:

“I would like to clarify what appears to be a widespread misconception regarding the differences between the mobility assessment in PIP and the mobility assessment in DLA. Many noble Lords have spoken of a “20-metre rule”, but there is no such rule. Some people believe that we have changed the assessment of a distance a claimant is able to walk from 50 metres to 20 metres. This is not the case. The higher rate of DLA was always intended to be for claimants who were unable, or virtually unable, to walk. This is still the case in PIP, but we have gone further.

Under PIP, if a claimant cannot walk up to 20 metres safely, reliably, repeatedly and in a timely manner, they are guaranteed to receive the enhanced rate of the mobility component. If a claimant cannot walk up to 50 metres safely, reliably, repeatedly and in a timely manner, then they are guaranteed to receive the enhanced rate of the mobility component. [My bolding]

I can assure the noble Baroness, Lady Brinton, that if a claimant is in extreme pain, they will be assessed as not reliably able to walk that distance. The reliability criteria are a key protection for claimants.

It was after my department’s work with the noble Baroness and noble Lords in 2013 that we set out these terms, not just in guidance but in regulations, confirming our commitment to getting this right. If a claimant cannot walk up to 50 metres without such problems, they will still be entitled to the mobility component at the standard rate. If they cannot walk that distance reliably and in the other ways in which we have protected it, they will be entitled to the enhanced rate. Therefore, the enhanced mobility component of PIP goes to those people who are most severely impacted and who struggle to walk without difficulty.”

I co-run advice and support groups for disabled people, and have to say that the majority of accounts of experiences I witness from those going through the PIP assessment process do not tally with Baroness Altmann’s claims.

So, in light of these claims, which were made despite evidence presented during the debate to the contrary, Baroness Tanni Grey-Thompson is gathering further evidence, and she requests that anyone who can walk less then 50 metres and who has lost their PIP, please get in touch with her: Baroness Tanni Grey-Thompson DBE – Email: greythompsont@parliament.uk

Picture courtesy of Robert Livingstone

Shut The Door On Your Way Out Campaign

April 24, 2016August 27, 2016 · 12 Comments ·

: We call for his resignation.

This cross-border Campaign aims at naming and shaming those colluding in the cuts to disabled people instead of addressing disabled people’s rights. We will be writing a series of letters asking for the resignations of those not defending our rights as appointed to do so.

This letter is to the Chair of EHRC.

Dear Lord Holmes of Richmond,

I wish to draw your attention to the functions that were delegated to the Disability Committee and the Commissions duties as they relate to “disability matters” in:

Promoting understanding of the importance of equality and diversity
Encourage good practice
Promoting equality of opportunity
Promoting awareness and understanding of rights
Enforcing equality law
working towards the elimination of unlawful discrimination and harassment
Promoting understanding of good relations

Let me draw your attention to an article printed in the Guardian by the EHRC on 01.03.2016 http://www.theguardian.com/politics/2016/mar/01/equalities-watchdog-criticises-planned-cuts-to-work-support-allowance

The very body you are a Commissioner for, the EHRC, say that the proposed cuts to ESA will disproportionately affect disabled people, widen inequalities and undermine the UK’s Human Rights obligations.

How can you be seen to be promoting the above when you went on to vote for these cuts to both ESA and PIP as a Conservative Peer, your actions will have a detrimental effect on disabled people’s lives, to both Independent living and will undermine the UK’s Human Rights obligations.

As a disability rights campaigner I am calling for your immediate resignation of the position you hold as Disability Commissioner and Chair of the Disability Committee for EHRC as alongside my peers and other user led organization’s we think you are no longer worthy of this position.

Look forward to your reply

Susan Archibald
Disability Rights Campaigner.

Please sign the petition and support this campaign – Campaigners Demand For Lord Chris Holmes Resignation.

Supported by:

Dr Stephen Carty -Black Triangle Campaign

Professor Peter Beresford, Co-Chair, Shaping Our Lives

Mo Stewart –Disabled Veteran/Researcher

Dr Simon John Duffy – Centre of Welfare Reform

Gail Ward – Cross Border Alliance

John McArdle-Black Triangle Campaign

Pat Onions – Pats Petition

Rosemary ONeill – Carerwatch

Frances Kelly – Carerwatch/Dead Parrot Campaign

Linda Burnip – DPAC

Debbie Jolly – DPAC

Anita Bellows – DPAC

Merry Cross – DPAC

Rick Burgess – DPAC Manchester

Paula Peters – DPAC

Annie Bishop – Involve North East & Cumbria for deaf, blind and people with disabilities

Carole Robinson – Bolshy Divas

Tracey Flynn – Bolshy Divas

Catherine Hale – Disability Researcher

C Richardson – Disability Researcher

Stef Benstead – Disability Researcher

Jayne Linney DEAP

Sue Livett-Campaign for a Fair Society England

Michelle Mayer

Rosemary Trustam-Publisher Community Living Magazine

Jo Walker

Sue Jones – Psychologists against Austerity/Human Rights/Policy Researcher/Writer

Again, if you want to sign our petition please click the link here.

The biggest barrier that disabled people face is a prejudiced government

March 29, 2016October 4, 2016 · 19 Comments ·

The very act of renaming incapacity benefit support for sick and disabled people “employment and support allowance” signaled the political intent to make that support precarious, with an aim of pushing people previously exempted from work on medical grounds from lifeline social security protection into work on political grounds, regardless of the consequences. The word “allowance” means the amount of something that is permitted, especially within a set of regulations or for a specified purpose. This language shift signaled the increasing contingency of support for disabled people.

It also reduced and transformed the sick role, making it increasingly transitory, redefining chronic, incurable conditions as somehow transient, and marking a shift from medical definitions of sickness and disability to psychopolitical redefinitions, which are ultimately aimed at pushing forward a small state neoliberalist agenda. Welfare provision is being steadily dismantled.

However, changing the name and making the eligibility criteria for support much more stringent has not helped sick and disabled people into work. It has simply created circumstances of further disadvantage, hardship and distress for many people.

It hasn’t worked because many of those people affected by the nudge-styled rebranding of their lifeline support and draconian cuts to “incentivise” people to take up and cherish the Puritan work ethic, as the paternalistic Conservatives think we ought to, are simply too ill to work.

Of those that may be able to work, over time, their would-be employers have not engaged with legal requirements and provided adjustments in the workplace to support those disabled people seeking employment. The government have removed the Independent Living Fund, and reduced Access to Work support, Personal Independence Payment (PIP) is very difficult to access because of the stringent eligibility criteria, whilst the disability benefit Employment and Support Allowance was also redesigned to be increasingly difficult to qualify for.

But political word games, and intentions to attempt to shrink the categories of what is deemed “illness and disability” along with the ever-shrinking state, don’t cure illness and disability, and it’s offensive to witness a very wealthy first world so-called democratic government viciously hounding and shamefully coercing a group of people, negatively labeling them as a “burden on the taxpayer”, and forcing them to take any low paid, insecure work, without any support whatsoever, despite the fact their doctor and the state, via the work capability assessment, have deemed them already to be unfit for work, whilst at the same time leaving this group on an isolated, ever-shrinking island with ever-decreasing lifeline support.

Perhaps PIP ought to include invisible bootstraps in the aids and appliances categories.

This is juxtaposed with the recent gifted tax cuts for the wealthiest, indicating clearly that Conservatives perceive and construct social hierarchies with policies that extend inequality and discrimination. The axiom of our international human rights is that we each have equal worth. Conservative ideology is fundamentally incompatable with the UK government’s Human Rights obligations and with Equality law. The chancellor clearly regards public funds for providing essential lifeline support for disabled people as expendable and better appropriated for adding to the disposable income for the wealthy.

Most people (over three-quarters ) who are disabled became so during their working life. There is an implicit political prejudice regarding disability, evident in policy-making, which is that it is an undesirable state and somehow preventable. There is another more explicitly stated prejudice, which relates to the oversimplistic false dichotomy of society. Citizens have been redefined as taxpayers or economic free-riders. However, not only have most disabled people worked and contributed tax and national insurance, people claiming social security also contribute significantly to the Treasury, because we pay VAT, council tax, bedroom tax and a variety of other stealth taxes.

The state confines its focus and responsibility mainly at re-connecting disabled people with the labor market, without any consideration of potential health and safety risks in the workplace, as a strategy of “support,” and justifies the draconian cuts to support as providing “incentives” for people to work, by constructing a narrative that rests on the bogus and socially divisive taxpayer/free-rider dichotomy:

“You answer if a disabled person can’t work there is NO cut but if they can but won’t, why should taxpayers subsidise them & trolls go mad!”

— Michael Fabricant (@Mike_Fabricant) March 26, 2016

By “trolls” Michael Fabricant actually means disabled people and campaigners responding to his tweet.

What happens to those people that can’t work or cannot find an understanding employer, prepared to make reasonable adjustments in the workplace?

On becoming ill – it can happen to anyone

I am medically ill and my illness (lupus) affects my mobility, focus and general wellbeing. I am restricted in what I can do, and the symptoms and exacerbations are very unpredicable. However, it is economic, political and cultural forces which have created and continue to create my ongoing disability and social marginalisation, not my illness. Many of my problems are compounded because of an unadapted physical environment, a lack of resources and the attitudes of others, particularly the current government’s.

I don’t accept that health problems ought to be seen as the cause of the socioeconomic deprivation and exclusion that many of us are experiencing, because the real cause is entirely political. Policies, which exclude disabled people from their design and rationale, have extended and perpetuated institutional and cultural discrimination against disabled people.

My own illness arose partly because of a genetic predisposition, partly because of my gender and hormonal events which often trigger the illness, and probably a variety of other complex reasons, none of which specialists fully understand yet. Prior to becoming very ill, I led a very active and healthy life. I worked hard in a job I loved. My diet is and always has been balanced and healthy, I enjoyed outdoor activities such as climbing, abseiling, archery and walking. I was never inactive or overweight, and I am not stupid when it comes to health issues. Lupus isn’t a “lifestyle choice” and it didn’t arise because of something I did wrong.

All the same, I frequently get well-meaning but bad advice to try different diets, “natural” herbal remedies (people forget that they contain chemicals) – usually the immune- enhancing ones like echinacea, which my rheumatologist has already advised could be very dangerous – and the best one of all: “You should stop taking the heavy duty medication and ‘cleanse your system’.” That would be medication that I take to keep me alive because I tried and ran out of all the other options. I usually recommend a simple course of water melons for such “experts”, to be taken at four hourly intervals, rectally.

Like many other ill and disabled people, I have worked for most of my life. My work was rewarding, and the professional roles I took up have entailed developing inspirational ways to support and enable others, from voluntary work with Women’s Aid and Victim Support, to salaried youth and community work, social work, mental health work and delivering training. I worked whilst being ill for a number of years.

By 2010, I simply couldn’t work any more. My previous and mostly background joint, nerve and muscle pain suddenly became all consuming. My ankles, knees, wrists and fingers swelled. I caught a cold at work which turned to pneumonia on two occasions in 2009. I had apparently random finger abcesses, inexplicable kidney infections, and bruised every time I was touched. I had severe nerve pain in my face and optic nerves, which affects my vision. My hips and lower spine became stiff and painful, my shoulders became frozen. I had a painful rash across my face that looked like eczema, only it wasn’t. I was profoundly tired all of the time, and weighed less than eight stones. My GP ran some tests and everything came back lupus, with complications such as a severe autoimmune bleeding disorder, very low immunity to infection and neurological involvement.

Working put my safety, health and wellbeing at substantial risk. It also potentially exposed other people to risk, too, because of the impact of my illness on my judgments, reliability and consistency, eyesight, ability to supervise, mobility and so on. A tribunal agreed with this assessment in 2012.

It was a very painful recognition that I could no longer work, my decision to leave was very difficult, compounded by a sense of loss of self worth and meaning. I felt that my experience, developed skills, not to mention time and effort invested in studying for a highly vocational Master’s degree, were meaningless and unavailing. However, I was completely unprepared for the damaging impact of the political othering and socioeconomic outgrouping that followed from 2010.

And the poverty. I came to feel that I had been politically redefined as somehow “deviant” by 2012. A much needed transformation to add to the grieving process for the person I was before my body became a traitor. Cheers, Mr Cameron, for the milk of human blindness. The Sex Pistols got it a bit wrong back in the last days of counter-culture and agitprop: it’s not just anarchy that we need for the UK, it’s a modicum of empathy, too.

Doctors and rehabilitation professionals continually recommend medical treatments and practices even though they know that these will not necessarily improve my quality of life. Most of the treatments for autoimmune illnesses such as lupus are largely experimental: comprised of chemotherapies and immune suppressants that carry their own life-threatening risks, and being ill with lupus and other autoimmune illnesses presents a constant and difficult process of weighing up of such risks – life threats from the illness versus life threats and serious life-changing risks from the treatments.

The dangers that arise when everyone thinks they are an expert on illness and disability

That didn’t stop a job advisor, during my time in the employment support allowance work-related activity, group telling me I should take the chemotherapy methotrexate because her friend with rheumatoid arthritis had some benefit from it. Methotrextate helps around 25% of people taking it, to various degrees, but it cannot cure the illness. Side-effects include sudden death, blindness, liver, kidney and heart failure, lung fibrosis, thrombocytopenia – a serious bleeding disorder which I already have – and death from an overwhelming infection, which I am already susceptible to, since my immune system is easily compromised and broken, amongst many other problems.

As it happens, I had already tried methotrexate for many months, administered by injection into my stomach. It didn’t work and the side-effects were truly diabolical, adding to my existing misery and multiplying symptoms. Another treatment, considered far less risky, called hydroxychloroquine, damaged my retina because I was prescribed too high a dosage, I’m now partially sighted.

However, the unqualified advice from a job coach overlooked that I have a different illness than her friend, and that methotrexate is a black box drug with life-threatening side-effects. Everyone seems to think they are a medical expert nowadays, and that’s the government’s doing, since they have been redefining illness and disability, making it a moral and public matter rather than a private, medical issue. Such political negative role-modelling has permitted a rise in expressions of social prejudice towards disabled people, which is why hate crime has risen significantly since 2010 and is now at the highest level since records began.

We are either deserving or non-deserving, abled or disabled, never just ill or physically disadvantaged. Our lives have somehow become public property, with all manner of unqualified people feeling entitled to intrude at an intimate level to tell us how to “manage” our illness better. Or to transform media tropes and political folk devils into forms of justification for abuse.

Job centre staff it seems will recommend anything, including unqualified advice about medical treatments, regardless of the risks that may be involved, to coerce people from what was once a social safety net and into any job, regardless of its appropriateness, quality, pay, security, and importantly, it’s potential impact on people’s health and safety.

Last October, I flagged up the extremely worrying government plans to place job coaches in GP practices, with provision made for job centre staff to “update” people’s medical files. The government hadn’t announced this “intervention” in the lives of disabled people, nor had we been consulted or involved in its design. I found out about it quite by chance because I read Matthew Hancock’s recent conference speech: The Future of Public Services.

I researched a little further and found an article in Pulse which confirmed Hancock’s comments: GP practices to provide advice on job seeking in new pilot scheme.

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

This is why I visit my doctor and not David Cameron or George Osborne when I need advice, support and treatment related to my medical (and not political) condition.

It’s a prejudiced government that has edited the script regarding sick roles – we no longer have medical sick notes, they have been replaced by political fit notes. The subtext is that we must participate in the world of mainstream work without any choices, without reasonable adaptations and without support. Without any acknowledgement of illness and disability, in fact. Or, we have to accept being redefined, our identity rewritten as “dependent”, “impaired” “unfit for work” as a trade-off for a degree of meagre support.

All of our previous achievements and contributions are forgotten. We once celebrated the achievements of disabled people, but now, we cannot, because disabled people are systematically repressed. We are politically defined as either fit for work (and thus not seen as “disabled”) or not. There are no other options for us, unless we happen to be very wealthy as well as ill.

Singing the body politic in our own voices

We don’t fit with neoliberal dogma and the Tory ideals of “individual responsibility”, competition, a “small state” and compulsory (low) paid employment to enhance profits for the elite’s old boys network. Any positive association with impairment, such as reasonable allowances made or degrees of freedom from the Tory notion of “social obligations” and “responsibilities,” is prohibited. We are faced with an overly simplistic, terribly reductive and dehumanising either/or choice.

We are deemed either fit for work, or too disabled to work, with no accommodation made for what we may be able to contribute in myriad ways to society, nor is our past accumulative experience and skill regarded as a valuable. The moment there is a hint we may have some kind of tenuous work-related capability, all support is withdrawn. However, once we are deemed unfit for work, we are denied full citizen’s status and economic inclusion.

This narrow political approach does nothing to enable and support people, nor does it reflect human diversity. It simply disables us further and denies us autonomy and the right to define ourselves. It’s an approach that actually punishes people for the abilities, experience and skills that they have, stifling human potential. The moment those abilities and skills are revealed at a work capability assessment, all support is withdrawn and those qualities remain unfulfilled. Instead of investing in personal development and extending opportunities, the government is simply cutting social security and public service costs at our expense. It’s not actually their money to cut.

We are expected to participate in an unaccommodating and increasingly competitive job market or suffer the dehumanising consequences and impoverishment of claiming social security long-term. And the people profiting from this are the competing, vulture capitalist private “service” providers.

There is no support for creating circumstances where our skills may be transfered. There is no support to help anyone adapt their skills and experience to fit future employment. Access to higher education has been restricted because of the steep rise in cost, especially for mature and disabled students. There is nothing in place to ensure that employers recognise disabled people’s skills and experiences and make adaptations to accommodate people wanting to work, and no safety net at all to encourage personal development for disabled people, since all support is tied to rigid definitions of disability. You can either work or not.

Under the guise of lifting burdens on business, this government has imposed burdens on those with disabilities by removing the “reasonable adjustments” that make living our lives possible and allow us some dignity. The labor market is hostile and unaccommodating, providing business opportunities for making profit, but increasingly, the needs and rights of the workforce are being politically sidelined. This will invariably reduce opportunities for people to participate in the labor market because of its increasingly limiting terms and conditions.

This highlights the paramount importance of shifting the political focus to the pressing need to change a disabling culture and to actually listen to our lived experiences, including us in policy design from that of merely coercing us into fitting reductive Conservative definitions to accommodate and fit in with a neoliberal model of society.

We have smug, wealthy and healthy Conservatives redefining disablity, our identity is ascribed by others who have handed us a socially devalued status: we are being told who we are and how we must be.

Citizen’s “needs” are being aligned with politically defined neoliberal outcomes. Those most acutely aware of this are those politically assigned a lower status in the increasingly steep socioeconomic hierarchy. Stigma and othering is used politically to justify the hierarchy and the consequent crass inequalities, which are designed and mediated through policies, not citizens.

Stigma arises because of the perceptions of the oppressor, not those being oppressed. But perhaps it’s time that people who are “working hard” to contribute to the increasingly enclosed economy paused and observed what is going down, because disabled people are not the only ones being stigmatised and radically reduced by a particularly toxic combination of social conservatism and neoliberalism. Punitive and coercive welfare conditionality, including sanctioning, has recently been extended to those in low paid employment and part-time work, as tax credits and additional support vanish under the guise of “universal credit”. The bedroom tax is likely to be extended to the elderly. How does this in any way ensure that “work pays”? All this will do is increase the precariousness of people’s situations and substantially increase their vulnerability.

The recognition and celebration of human potential, diversity and equal worth has been superceded by an all-pervasive Puritan “hard work” ethic. Our worth is being defined purely in terms of our economic contribution. We are measured out in pounds and pennies whilst making billions for a handful of other people. That is a value that comes exclusively from the dominant paradigm-shaping elite – the ones who actually profit from your hard work.

You don’t.

The government’s new “health and work” programme is actually workfare for sick and disabled people. Apparently, slave labor for big business is good for our “health” and has the added bonus of adding substantially to profits for friends of the Conservatives. It’s amazing how quickly the public have accepted the political semantic shifts, such as “work programme” – compulsory labor for no wage, which was originally about “exploitation” and has now been redefined as “work experience”. Apparently that is also “fair”, “inclusive”, “good” for our health and “makes work pay”.

Makes work pay for whom?

Disability can no longer be considered solely as a medical problem, affecting only a minority of the population. It must be seen for what it is: as a civil rights issue as central to mainstream political discourse. This government uses draconian policies to act UPON disabled people, it does not value our lived experiences nor does it listen and RESPOND to us. It’s a government that simply tells us how we must BE. That is profoundly undemocratic, it discriminates against us and excludes a social group on the basis of a protected characteristic.

There are and have been a lot of ways to define disability, it has variously has been defined through the eugenic model, a medical model, charity model, rights-based model, social model and a radical model. Now it’s time for a disabled people’s model, founded on our lived experiences and varied needs.

Understanding that oppressive situations have not arisen through any fault of our own, and that the oppression is real and has a basis in sociopolitical prejudice and discrimination provides us with the courage needed, and a more solid ground on which to fight for liberation. It always seems to be the case that fighting social injustice is left to the very people who have been excluded and systematically deprived of a political voice and power, it’s always down to us to make others listen. Yet it is invariably the case that when one social group is targeted for political prejudice and discriminatory policies, it affects everyone. Historically we have learned it quickly follows that other groups are singled out, too.

The universal character of human rights is founded on the inherent dignity of all human beings. It is therefore axiomatic that people with medical conditions that lead to disabilities, both mental and physical, have the same human rights as the rest of the human race.

The United Nations is currently investigating this government’s gross and systematic violations of the Convention on the Rights of Persons with Disabilities (CRPD), and a recent report from the House of Lords Select Committee on the Equality Act 2010 and Disability, investigating the Act’s impact on disabled people, has concluded that the Government is failing in its duty of care to disabled people, because it does not enforce the act.

Furthermore, the Select Committee concludes that the government’s red tape challenge is being used as a pretext for removing protections for disabled people. It’s a government that regards the rights and protections of disabled people as a mere bureaucratic inconvenience.

There’s a certain irony regarding the Conservative preoccupation with preserving social order: their rigid ideologically-driven policies create the very things they fear – dissent, insecurity, disorder and the raising of public awareness and recognition of a pressing need for social change and reform. It’s seems to be the case that Conservative governments prompt a growth of social challenges that encourage the flourishing of the very radicalism and revolutionary ideas that they fear and loathe.

That is what happens when people are oppressed.

Picture courtesy of Robert Livingstone

—

I don’t make any money from my work and I’m not funded. You can support Politics and Insights by making a donation to help me continue researching and writing independently, and to continue to help others.

Share this:

An ever-shifting, ever-shrinking goalpost

Implications for the UK’s obligations regarding the UN convention on the human rights of disabled persons and the Equality Act

Share this:

Context

The architects

State diagnosis and treatment – a blunt instrument

The shrinking category of illness and disability

Share this:

Beyond the rhetoric – the hidden agenda

The implications of the inquiry findings for Conservative welfare policies

Share this:

The context indicates the general intent

Watching the way the wind blows

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

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

Semantic thrifts: being Conservative with the truth

The nitty gritty

Share this:

The ‘functional’ assessment

The introduction of PIP was framed by New Right anti-welfarism

Reliability

Time periods, fluctuations and descriptor choices

Risk and safety

Share this:

Related information

Ways to respond

Share this:

Share this:

Share this:

On becoming ill – it can happen to anyone

The dangers that arise when everyone thinks they are an expert on illness and disability

Singing the body politic in our own voices

Share this: