Tag: WCA

Misleading DWP letter to GPs is depriving disabled people of lifeline support

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Credit: PA Images

Last month I reported about the issues raised by the Department for Work and Pensions’ ESA65B GP’s letter template, which was only recently placed on the government site, following a series of Parliamentary Written Questions.

Campaigners and MPs have called for the Department for Work and Pensions (DWP) standard letter to GPs to be scrapped after it emerged that ill and disabled appealing against unfair work capability assessment (WCA) decisions were left in near destitution after their GPs refused to provide further ‘fit notes’, because they were advised they did not need to by DWP officials.

It emerged that ministers ordered changes to the standard-issue letter to remove references that made it clear to GPs they may have to issue a medical statement if their patient wished to appeal against a WCA decision. The DWP claims this was not intended to dissuade GPs from issuing fit notes. 

Those people who challenge WCA decisions are entitled to continue to receive employment and support allowance (ESA) at basic rate, worth £73.10 a week while they await their appeal hearing, but to do so they must obtain fit notes from their GPs to prove they are too ill to work.

They must also await the outcome of a mandatory review.  Before a claimant may lodge an appeal, the must first ask the DWP to ‘reconsider’ their original decision. However, the DWP has a stated target of upholding 80% of their original decisions, so the majority of people then have to appeal following the review outcome. The law says that the claimant may claim basic rate ESA following mandatory review if they wish to proceed with an appeal.

So the misleading change to the template letter routinely sent from the DWP to GPs has led to people who have lodged an appeal against an unfair decision being blocked from claiming ESA while awaiting the appeal hearing. This prevents many low-income disabled people from accessing financial support while they wait for months on end to go to tribunal. Furthermore, we know that catastrophically inaccurate assessments within the DWP are pretty much the norm. Nationally, 72% of people who appeal against their work capability assessment decision are successful.

Entitlement to ESA pending appeal is enshrined in the ESA Regulations to cover the whole of the period leading up the hearing. It is also possible to have the payment backdated to cover the Mandatory Review waiting period too – it can take over six weeks for the DWP to review their original decision, over which time people are left without welfare support.

ESA pending appeal is not paid automatically – people usually have to ask for it, and must provide fit notes from their GP, presenting these along with their appeal acknowledgment letter from the Tribunal Courts to their local Job Centre. The Job Centre should report back to the DWP who will arrange for ESA pending appeal to be paid.

From last year, then minister for disabled people, Sarah Newton, responded to one of several Written Questions from Emma Dent Coad, saying: “The ESA65B letter is issued to GPs in every case where an Employment and Support Allowance (ESA) claimant has been found ‘fit for work’. This process was built into the IT system as part of the introduction of ESA in October 2008. 

“Following a Ministerial requirement by the Cabinet Secretary, which was endorsed by the Secretary of State for Work and Pensions, the content of the ESA65B letter has been improved in order to explain to GPs the type of support customers can expect to receive from their local Jobcentre, and to ask GPs to encourage customers in their efforts to return to work.” [My emphasis]. 

The decision to change the letter template was made without any scrutiny from or consultation with parliament or the public.

The standard letter, titled “Help us support your patient to return to or start work.” says: “We assessed [Title] [First name] [Surname] on and decided that [select] is capable of doing some work, but this might not be the same type of work [select] may have done before.

“We know most people are better off in work, so we are encouraging [Title] [First name] [Surname] to find out what type of work [select] may be able to do with [select] health condition or disability through focused support at [select] local Jobcentre Plus.

“In the course of any further consultations with [Title] [First name] [Surname] we hope you will also encourage [select] in [select] efforts to return to, or start, work

“Please do not give [Title] [First name] [Surname] any more fit notes relating to [select] disability/health condition for ESA purposes.

Minister for disabled people, Sarah Newton, responded to one of several Written Questions from Emma Dent Coad, saying: “The ESA65B letter is issued to GPs in every case where an ESA claimant has been found ‘fit for work’. This process was built into the IT system as part of the introduction of ESA in October 2008. 

“Following a Ministerial requirement by the Cabinet Secretary, which was endorsed by the Secretary of State for Work and Pensions, the content of the ESA65B letter has been improved in order to explain to GPs the type of support customers can expect to receive from their local Jobcentre, and to ask GPs to encourage customers in their efforts to return to work.” [My emphasis]. 

Professor Helen Stokes-Lampard, the chair of the Royal College of GPs (RCGP), said the lack of clarity over when GPs should issue fit notes could put patients’ finances and health at risk. “No GP wants that, and it only serves to threaten the long-standing trust that patients have in their family doctor.”

Until 2017 the standard letter advised GPs that if their patient appealed against the WCA decision they must continue to provide fit notes.

However, on (undisclosed) ministerial orders, the letter now states that GPs “do not need to provide any more fit notes for ESA purposes”. It does not mention the possibility that the patient may appeal, or that a fit note is needed for the patient to obtain ESA payments until the appeal is heard.

Frank Field, the chair of the work and pensions select committee, has also raised the issue with the then disability minister Sarah Newton back in January. Newton replied that the wording was amended “to make the letter simpler and clearer”, adding that DWP communications were intended to be “clear, understandable and fit for purpose”.

Field replied that the wording was “not having the desired effect”, and urged her to revise it to make clear ESA claimants on appeal were entitled to fit notes. “This simple step could greatly ease the stress and worry that people who are awaiting an appeal experience.”

A DWP spokesperson said: “These letters simply inform GPs when a claimant has been found fit for work and are not intended to dissuade them from issuing fit notes for ESA appeal purposes, to claim otherwise is inaccurate.”

However, there is a hint the letter may be changed. Newton told Field: “We are committed to ensuring our communication is clear, which is why the wording of this letter was cleared by both the British Medical Association and the Royal College of General Practitioners (RCGP). However, we will of course consider feedback when revising the letter.”  Newton tends to stick to a script in her responses, though. She told Emma Coad Dent exactly the same thing, almost word for word last year, in her response to a Written Question.

It remains very unclear on what basis the RCGP agreed to the new wording as the change was agreed at a DWP stakeholder meeting for which, according to Newton, there are no formal minutes. Newton confirmed this in the correspondence between herself and Field, as well as in her responses to Emma Coad Dent’s long series of Written Questions on this issue.

Firstly, on 16 May, last year, Newton says: “The Cabinet Secretary first issued the requirement to revise the ESA65B letter in November 2014.

“The wording of the ESA65B was changed to emphasise the benefits of work and to ask GPs to encourage their patients in their efforts to return to some form of work.”

Then, according to Newton: “The British Medical Association and the Royal College of General Practitioners agreed to the revised wording of the ESA65B on 4 August 2016.” 

However, in June last year, she also said, in response to a Written Question from Emma Dent Coad: “DWP’s Legal Service cleared the revised wording on 29 July 2016 and the then Secretary of State for Work and Pensions subsequently authorised the changes.”

Yet when asked in November last year what written evidence her Department holds on the British Medical Association and Royal College of General Practitioners agreement to the revised wording of the ESA65B letters sent to claimants’ GPs when they fail the work capability assessment, she replied: “There is no written evidence relating to the agreement obtained from the British Medical Association and the Royal College of General Practitioners on the revised wording of the ESA65B letter.

“In accordance with the Answer of 30 May 2018 to Question 146987, agreement on the final wording of the ESA65B was obtained via the regular meetings DWP holds with both organisations.” 

Newton had previously also said: “In accordance with the Answer of 3 July 2018 to Question 155402, the information is not available as there is no written minute of the meeting between officials from this Department and representatives from the British Medical Association and the Royal College of General Practitioners on the revised wording of the ESA65B letter.” 

In June last year, Dent Coad asked Newton who attended the meetings between officials in her Department and the (a) British Medical Association and (b) Royal College of General Practitioners on the revised wording of the ESA65B; and if she would place in the Library a copy of the minutes of those meetings. Newton responded on 03 July 2018:  

“The names of the participants representing the British Medical Association and the Royal College of General Practitioners who attended the meetings referred to constitute their personal data and in accordance with data protection principles, they will not be disclosed without informed consent. DWP officials did not take minutes of these meetings.”

And: “No other external stakeholders were consulted on the development of the revised ESA65B letter.”

Newton has also said in response to Written Questions: “The Department is committed to ensuring all of its communications are clear, accurate and understandable and we continuously improve our letters. We engage regularly with the welfare benefits advice sector and disability charities and take into account all of the feedback we receive.”

“We have received comments from a number of sources including MPs, stakeholder organisations and GPs on the current version of the ESA65B letter and will take all of their feedback into account when revising it.”

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

In linking receipt of welfare with health services and “state therapy,” with the single intended outcome explicitly expressed as employment, the government is purposefully conflating citizen’s widely varied needs with economic outcomes and diktats, isolating people from traditionally non-partisan networks of relatively unconditional support, such as the health service, social services, community services and mental health services.

Public services “speaking with one voice” as the government are urging, will invariably make accessing support conditional, and further isolate already marginalised social groups. Citizens’ safe spaces for genuine and objective support is shrinking as the state encroaches with strategies to micromanage those using public services. This encroachment will damage trust between people needing support and professionals who are meant to deliver essential public services, rather than simply extending government dogma, prejudices and discrimination.

 

Related

Jobcentre tells GP to stop issuing sick notes to patient assessed as ‘fit for work’ and he died.

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

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

 


 

I don’t make any money from my work. I’m disabled through illness and on a very low income. But you can make a donation to help me continue to research and write free, informative, insightful and independent articles, and to provide support to others going through Universal Credit, PIP and ESA assessment, mandatory review and appeal. The smallest amount is much appreciated – thank you.

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Campaigners organise ‘First Do No Harm lobby’, aimed at preventing further social security related deaths

this ESA round

Disabled campaigners, researchers and organisations who have played a key role in exposing the discrimination and harm caused by the government’s social security reforms have been travelling to Westminster to attend round table discussions with five Labour shadow ministers. The meetings are chaired by Shadow Chancellor John McDonnell. I was invited to attend by John McDonnell’s office in September, because of my own ongoing campaign work.

The meetings are also the launch of a series of campaigning efforts and consultation between the Labour party, disabled activists, researchers and allied organisations. Labour MPs also hope to secure support from members of other political parties in the longer term.

We will be continuing to challenge the government’s persistent denial of a ‘causal link’ between their draconian social security policies and the distress, systematic human rights violations, serious harm and deaths of disabled people that have arisen in correlation with those policies.

Unless the government undertakes a cumulative impact assessment of the harm and  injustices that have followed in the wake of their welfare reform acts, they cannot provide evidence to support their own claims and flat denials that their policies are causing hardship, harm and distress. 

Public health experts from the Universities of Liverpool and Oxford have also produced a research report titled First, do no harm’: are disability assessments associated with adverse trends in mental health? A longitudinal ecological study. It highlights that the process of reassessing people on incapacity benefit for the new employment and support allowance (ESA) from 2010 to 2013 was “associated with” an extra 590 suicides, 279,000 additional cases of self-reported mental health problems, and the prescribing of a further 725,000 anti-depressants.

Speaking to the Huffington Post last year, the shadow chancellor said that he became furious during a Parliamentary debate when he demanded a comprehensive assessment of the cumulative impact of welfare reforms on disabled people and the government refused. He praised the website Calum’s List, which details the cases of at least 60 deaths linked to welfare cuts.

He added:  “We said to the Government we know now from Calum’s List, listing people from reports in the press and elsewhere of people committing suicide as a result of Government cuts.

We knew the Government were monitoring some coroners’ reports and we wanted them published, but [then DWP minister Esther] McVey wouldn’t and I got really angry.”

“Next week, what we are doing is getting a group of campaigning organisations and a group of experts together to talk about the way in which Work Capability Assessments are still having an impact, to try to get to the bottom in terms of mental health and suicide.”

McDonnell added that Labour’s first Queen’s Speech include legislation “making sure we have a welfare and benefit system that lifts people out of poverty”.

He said that his Hayes and Harlington constituency casework now operates an open-door system four days a week due to demand from people hit by government cuts. 

He added: “Helen who runs my office said the casework now is on a scale and a depth of suffering that we’ve never seen before. And this in a constituency with the [Heathrow] airport, high levels of employment but wages not matching the housing costs and the pressure on people working all hours just to keep a roof over their heads.

“If anything goes wrong they fall out of the system. Last month we were dealing with two families living in cars. We also have the ‘beds in sheds’ phenomenon, families living in a shed or garage rented out to them, it’s staggering really.

“Before this last eight years, those sort of horrendous situations would be infrequent but you wouldn’t have someone so heavily sanctioned. The sanctions often impact on people with mental health conditions hardest.”

The Labour party’s track record of inclusion and democratic consultation with disabled citizens and their communities contrasts starkly with the Conservative’s exclusionary ‘we know better than you’ approach to disability policies. The government have imposed cuts on disabled people, acting upon them as if they are objects of policy rather than being citizens within a democracy.  

Government policies are expressed political intentions regarding how our society is organised and governed. They have calculated social and economic aims and consequences. In democratic societies, citizens’ accounts of the impacts of policies ought to matter.

However, in the UK, the way that welfare policies are justified is being increasingly detached from their aims and consequences, partly because democratic processes and basic human rights are being disassembled or side-stepped, and partly because the government employs the widespread use of linguistic strategies and techniques of persuasion to intentionally divert us from their aims and the consequences of their ideologically (rather than rationally) driven policies. Furthermore, policies have more generally become increasingly detached from public interests and needs.

The Labour party listen to citizens’ accounts, and have always acknowledged our concerns. John McDonnell was involved in the setting up of Disabled People Against the Cuts (DPAC). After a nationwide round of consultations with disabled people about policies which enshrine the Equality and Human Rights acts, led by Debbie Abrahams, the Labour party wrote an additional manifesto, outlining policies for disabled people, called Nothing about you without you, which many of us have contributed to.

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Alex Cunningham, me, Debbie Abrahams and Gail Ward after the Disability Equality Roadshow and consultation in December, 2016.

The First Do No Harm lobby on 13 February aims to expose the continued harm caused to disabled people by government social security reforms, and to seek safeguarding changes to the social security system. It follows many years of growing concerns about the controversial Work Capability Assessment (WCA) and the failure of Department for Work and Pensions (DWP) ministers to make the necessary changes to make the assessment process safe.

Disability rights campaigners and MPs will focus on the repeated failure of the DWP to ensure that the “further medical evidence” needed to demonstrate a disabled person’s eligibility for out-of-work disability benefits is always collected, particularly for claimants with mental health conditions.

The three key asks of the lobby are:

1. To incorporate the principle of “First Do No Harm” into the assessment process for disabled people in the welfare system.
2. To call for the publication of a cumulative impact assessment of social security changes to disabled people.
3. To implement an assessment framework that treats disabled people with dignity and respect.

The lobby has been facilitated by Labour’s Treasury and work and pensions teams, through shadow chancellor John McDonnell and shadow work and pensions secretary Margaret Greenwood. Both Labour MPs and activists hope that MPs from all parties will attend. 

Shadow chancellor, John McDonnell has previously said that he believed the ongoing meetings with disability rights campaigners and allied organisations could herald the start of “a significant movement to expose the brutality of the system” and secure “permanent change”.

He told Disability News Service: “Disabled people have had enough of the continuing austerity, attacks and discrimination.

“The lobby will brief on the plight of disabled people and lobby for reform to protect against this harm.” The aim is to push for the principle of “First Do No Harm” to be included in the benefits assessment process, through a framework that “treats disabled people with dignity and respect”.

The lobby also aims to push the government to acknowledge years of raised concerns by our community to carry out a cumulative assessment of the impact of its social security cuts and reforms on disabled people. 

Campaigners will also call for an end to the government’s punitive sanctions and conditionality regime.

The First Do No Harm lobby is the first organised action arising from the ongoing meetings between disabled activists and allies and Labour shadow ministers, including John McDonnell, Margaret Greenwood and shadow minister for disabled people Marsha de Cordova.

Both Margaret Greenwood and Marsha de Cordova are to speak at the briefing as part of the lobby on 13 February.

A mass lobby is one way of using your right to turn up to the House of Commons and request a meeting with your MP as one of his or her constituents. An MP’s role is to represent a constituent’s interests – even if he or she does not entirely agree with them. As each MP may have up to 90,000 constituents to look after, it is best to be as brief, clear and courteous as possible when you meet your MP.   

Disabled people or allies who want their MP to attend the lobby should write to their MP – you can find MP’s email addresses here: WriteToThem – to inform them you wish to seek an appointment on the day of the lobby. 

The lobby is due to take place on Wednesday 13 February between 1pm and 6pm, with the briefing from 2-3.30pm, in the Palace of Westminster’s committee room 15. The committee room can be used for one-to-one meetings with MPs or further discussions on the issue from 1pm-2pm and then from 3.30pm-6pm 

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The most recent meeting at Portcullis House, Westminster.

 

Related

John McDonnell attacks Tory disability cuts and vows to address suicides linked to welfare reforms

Lobby aims to persuade MPs that DWP must First Do No Harm on assessments

Labour’s Disability Equality Roadshow comes to Newcastle

Nothing about you without you – the Labour party manifesto for disabled people

I very much wanted to attend this very important mass lobby and contacted my MP in respect of this. However, unfortunately I am currently not well enough to travel down to Westminster. I will, however, be working hard promoting the event on social media. 


 

I don’t make any money from my work. But you can make a donation if you wish and help me continue to research and write informative, insightful and independent articles, and to provide support to others going through disability claims, assessments, mandatory reviews and appeals. The smallest amount is much appreciated – thank you.

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My response to Brandon Lewis when he invited me to support the Conservatives

Image result for brandon lewis and theresa May

I was surprised to get the following email from Brandon Lewis, the Conservative party chairman, yesterday. 

I’ve published my response below the email.

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Brandon Lewis 2

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My response:

I want to share some news with you, Brandon,

I won’t ever be supporting the Conservatives. 

The government claims that austerity will ensure our children don’t inherit debt. That’s utter rubbish. I have seen my 2 youngest sons struggle making ends meet to get through university. Their tuition fees cost a lot more than our young people are permitted to borrow through the student loans company to meet their living costs each year. Despite the poorest students struggling to get by, they will still come away from university with a debt that is the same size as my mortgage was in 2003. My sons also lost their Education Maintenance Allowance because of your government.  To be frank, your party have caused my family and loved ones nothing but increasing hardship.

That’s how much this government values young people. Not very much. Certainly not enough to invest in their future, or in in opportunities that are meaningful and secure. My generation had access to free higher education. This generation is the first in a long time to be worse of than their parents were, in multiple ways, and not just because of the heavy costs of an education.

Jobs have become increasingly precarious. Worker’s rights and conditions are deteriorating and exploitation is flourishing because you have viciously attacked trade unionism and undermined the principle of collective bargaining. You have also deregulated the labour market because you are, after all, the ‘business friendly’ party.

Conservative corporatocratic principles have tilted the balance of power away from workers, leading to blatantly exploitative employment practices and grim, insecure working conditions. Your ‘business friendly’ agenda is the reason for bank bailouts, excessive pay for CEOs, increasing socioeconomic inequality, as well as the exploitation of national treasuries, people, and natural resources. Such an approach constitutes proto-fascism. 

Historically, fascists have operated from a social Darwinist perspective of human relations. Like the Conservatives, they create and value inequality. In terms of economic practices, this has generally meant promoting the interests of successful and monopolistic big business while destroying trade unions and other organisations of the working class. Fascists also promoted nationalism. I’m sure you don’t need me to point out the numerous uncomfortable parallels here, including your party’s stranglehold on the media. 

“Fascism should more appropriately be called Corporatism because it is a merger of state and corporate power” – attributed to Benito Mussolini, but probably came from Giovanni Gentile, the philosopher of fascism, in the first edition of the Italian Encyclopedia (Enciclopedia Treccani).

In 2013, JP Morgan wrote a document, which I read at the time – The Euro Area Adjustment—About Half-Way There. Firstly,  they say that financial measures are necessary to ensure that major investment houses such as JP Morgan can continue to reap huge profits from their speculative activities in Europe. Secondly, the authors maintain, it is necessary to impose ‘political reforms’ aimed at suppressing opposition to the massively unpopular austerity measures being imposed at the behest of the banks. 

The authors write: “The political systems in the periphery were established in the aftermath of dictatorship, and were defined by that experience. Constitutions tend to show a strong socialist influence, reflecting the political strength that left-wing parties gained after the defeat of fascism.

“Political systems around the periphery typically display several of the following features: weak executives; weak central states relative to regions; constitutional protection of labour rights; consensus-building systems which foster political clientalism; and the right to protest if unwelcome changes are made to the political status quo. The shortcomings of this political legacy have been revealed by the crisis.

Whatever the historical inaccuracies in their analysis, there can not be the slightest doubt that the authors of the JP Morgan report are arguing for governments to adopt authoritarianism to complete the process of social counterrevolution that is already well underway across Europe.

What JP Morgan is making clear is that anything resembling ‘socialism’ or left inclinations must be removed from political structures; localism must be replaced with strong, central authority; labour rights must be removed, consensus (democracy) and the right to protest must be curtailed. In short, JP Morgan called for authoritarian measures to suppress the working class and wipe out its social gains since the post-war settlement. This is the unadulterated anti-philanthropic voice of neoliberalism, which your party has embraced. 

Last year 16,333 people in the London borough of Kensington and Chelsea voted in the general election for Jeremy Corbyn’s Labour party, a constituency that has always been Conservative. Curiously, as the Financial Times pointed out, Kensington is where the senior European bankers live.  Andrea Orcel, chief executive of UBS’s investment bank, is among its denizens. BNP Paribas employs 7,500 people in London, and above VP level, most of them live in the vicinity of South Kensington station. – 25% of inhabitants of the South Kensington neighbourhood in particular work in finance. It is inferred that the swing happened in part because of the complete hash that your party is making of Brexit.

Your ‘high employment’ narrative does not benefit citizens, who face zero hour contracts, little employment security and more than half of those people needing to claim welfare support are in work. Your definition of ‘employment’ includes people who work as little as one hour a week. It includes carers. It also includes people who have been sanctioned.

Now there is a perverse incentive to furnish a hostile environment of DWP administrative practices in action.

When your party took office in 2010, on average citizens earned £467 a week. The latest figures from the Office for National Statistics (ONS) show that we now take home £460 a week. In other words, average wages have gone down in real terms during the eight years of Conservative-Lib Dem and Conservative governments, while the cost of living has risen substantially. It’s a misleading to make these claims at all when weekly earnings are actually 1.3 per cent lower now in real terms than they were when the Conservatives took office in 2010.

Furthermore, the ONS also produced household data suggesting that the true rate of unemployment is 4 times greater than the government’s preferred statistic.

The Conservative’s official definition of unemployment disguises the true rate, of course. In reality, about 21.5% of all working-age people (defined as ages 16 to 64) are without jobs, or 8.83 million peopleaccording to the Office for National Statistics. I know whose statistics I believe, given your party’s track record of abusing figures and telling lies.

Here is more data here on the effect of chronic underemployment of the unemployment rate, and the depressing new reality of the gig economy.

Conservatives being conservative with the truth as ever.

As ever we are witnessing the same old cheap labour Conservatism, where profits grow and wages are a stagnated pittance. Private companies gatekeep resources and services that were originally intended to meet the most basic needs of citizens, costing the tax payer billions while offering nothing in return but misery and cruel ideologically driven behaviourist practices. 

The clue is in the name: the word “Tory” I guess. It derives from the Middle Irish word tóraidhe, which means outlaw, robber or brigand, from the Irish word tóir, meaning “pursuit”, since outlaws were “pursued men”. It was originally used to refer to an Irish outlaw and later applied to Confederates or Royalists in arms. The term was originally one of abuse. As far as I am concerned, it remains so.

The Tories live by plundering. They steal people’s wages, public services, human rights and liberties, public provision and labour, in order to raise more money for the rich.

People know that wages are low, because of their daily experiences. The cost of living has risen, while wages have remained depressed throughout the last 8 years. People in work have had to queue at food banks, and in-work poverty is growing. Meanwhile you have pared publicly funded welfare support down to the bone. We pay for public services that your government seems to think we shouldn’t need. Your government is a sanctimonious, arrogant Victorian relic, with scant regard for citizens rights and democracy.

A personal account of why I won’t ever support the Conservatives

I’m a disabled person and from where I am trying to stand, I can see very clearly and first hand how your government have taken money from the poorest citizens and handed it out to your very wealthy and powerful friends. At the same time that you were imposing austerity on the poorest citizens and savage cuts on welfare and public services – placing a disproportionate burden on disabled people in particular – you were handing out tax cuts to millionaires to the tune of £107,000 each per year. Your austerity programme was very class contingent. Your generosity is pure elitism in action. Your ‘accumulation by wealthy through dispossession of the poorest’ approach to economics creates a hole in our economy which you attempt to plug every time by squeezing the poorest citizens. It’s a vicious cycle of vicious class discrimination and despotic behaviour, Brandon. 

And you richly reward private companies to gatekeep publicly funded services, causing those who have funded and continue to fund those safety net provisions distress and harm when they need to access the support they have paid for.

I have experienced this first hand. After working for many years, I became too ill to work in 2010, just as the Conservative-led coalition took office. I was forced to give up a social work job I loved because I was very ill. The last 8 years have been the bleakest I have ever known. Not just because I am seriously ill, but because your government have treated my human rights and those of other disabled people as somehow optional and increasingly conditional. Yet the whole point of human rights is that they are universal.

Disabled people like me have been forced to carry the heaviest burden of austerity because of traditional Conservative prejudices. In the last 8 years I have undergone 4 assessments, mandatory review, appeal and years of unwarranted distress and hardship, exacerbating my illness. I lost my home.

At my last ESA assessment, I was so ill that I collapsed. It was just 3 months after I had won my appeal. The nurse who conducted my first assessment said I was fit for work and I scored zero points. Her report must have been about someone else, because it bore no resemblance to my disability, my illness, my life or the assessment. At my last ESA assessment, I ensured that the interview was recorded. The doctor I saw could not understand why the Department for Work and Pensions had sent me for a reassessment when I was so clearly very unwell and having to take chemotherapy. Remarkably, following my collapse, he kindly sent me home in a taxi and Atos paid for it. It was either that or an ambulance.

Because my experiences claiming ESA were so distressing, I couldn’t face claiming PIP for SEVEN years. My local council had helped me, despite the miserly cuts you have imposed on them, (especially in view of the current surplus) because I needed aids and appliances in my home to maintain my mobility, and they offered support with my PIP claim. The assessment experience was once again appalling, leaving me in a lot more pain than when I arrived for the examination. Furthermore, I was told I could not have a point awarded for cognitive difficulties, despite the fact it was noted in the report that I needed prompting during the interview several times, and that my short-term memory is poor – I need aids to remember to take my medication, for example.

The assessor, having acknowledged my cognitive difficulties, went on to conclude somewhat incoherently that it wasn’t a problem. The point was the difference between a basic award and an enhanced award.  The reasoning for deducting that point went as follows: I used to have a driving licence in 2003. I worked as a social worker until 2010 – when I became too ill to work. She also said that I have a degree (gained in 1996, long before I became ill). Therefore there is ‘no evidence’ that [in 2017] my illness has caused cognitive problems, despite it being known to do so. I haven’t been able to drive since 2005 because I developed a sensitivity to flicker, which causes partial seizures. Just driving past lamp posts, telegraph posts and trees triggers vertigo, blindness, severe coordination difficulties, speech difficulties, altered states of consciousness, and muscle rigidity and twitching. I haven’t worked for 8 years, since becoming seriously ill. 

The DWP didn’t even bother to respond to my request for a mandatory review.

My experiences are not isolated events. They have become commonplace. Your government continues to refuse to listen to people like me. You have dismissed us, deplorably, as ‘scaremongers’. Such political gaslighting is shameful.

You have refused to listen to the concerns raised by the United Nations regarding the systematic and grave violations of disabled people’s human rights because of your excruciatingly punitive policies that create hostile environments for those social groups your government clearly despises.

So I’m sure you will understand why I cannot ever support an authoritarian government that refuses to listen to so many citizens’ accounts of their experiences of extremely punitive government policies, or one that refuses to democratically include them in policy design and support them in participating in the economy and society.

What is the point of a government of a wealthy country that not only fails to ensure that all citizens can meet their basic survival needs, but also remains completely indifferent to those needs?

So my answer is no, Brandon.

Ask yourself: what has your party ever done for people like me, my loved ones and my friends? 

With utmost sincerity,

Sue Jones

 

Related

Conservatism in a nutshell

JP Morgan wants Europe to be rid of social rights, democracy, employee rights and the right to protest (2013)



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DWP is facing investigation following the suicide of 42-year-old mum of nine

Jodey Whiting’s mother, Joy Dove, with Jodey’s daughter Emma Bell (Image: Ian McIntyre)

The Department for Work and Pensions (DWP) is facing a legal investigation after a mother of nine took her own life “because the DWP stopped her benefits”. 

Jodey Whiting, who suffered severely disabling medical conditions, ended her own life in February 2017, shortly after the DWP stopped her disability support payments. The payments stopped because was claimed by the DWP that Jodey failed to attend a work capability assessment (WCA).

However, her family claims that she never received the appointment letter and is blaming the Government for her suicide.

The 42-year-old grandmother was diagnosed with a brain cyst and curvature of the spine and could barely walk to her own front door, but an inquest has heard that despite her  disabilities, Jodey Whiting faced a distressing battle with the DWP for lifeline benefits.

Supported by volunteers from the Citizens Advice Bureau, Jodey appealed the DWP decision to end her claim, but was told that due to a backlog in appeals it could take up to sixteen months before her case was reviewed.

Her mother, Joy Dove, who assisted her daughter in claiming the lifeline support she was entitled to, has taken up the battle with the DWP following her daughter’s death. She told Gazette Live“To have to wait another 16 months is devastating, but we can’t do anything about the fact there are so many cases that need investigating.

“I’m glad they’ve taken the case on. We will always fight for justice for my daughter.

“She has kids and grandchildren left without a mum, and I’ve been left without a daughter. I want to make sure this doesn’t happen to anyone else.”

The case will now be investigated by an Independent Case Examiner (ICE), who will look at the circumstances surrounding Jodey’s death and whether the DWP’s decision to stop her benefits affected her metal state at the time of Jodey’s suicide.

The ICE will looks at five key parts of the case against the DWP:

  • The Citizen’s Advice Bureau sent a letter to the DWP regarding Jodey’s health issues on February 15, six days before her death, but it failed to act on it until March 23.
  • Despite being made aware of her death on February 23 using the ‘tell us once’ system, the DWP issued a claim to Jodey about her Employment Support Allowance claim on February 25.
  • The DWP failed to take appropriate action to upgrade their computer systems until March 1.
  • The DWP continued to call Jodey’s phone and leave her voicemail messages until May, despite knowing of her death.
  • The department failed to respond to Mrs Dove’s letter of April 13, 2017 until June 14, 2017.

Jodey had been sent a letter that instructed her to attend a work capability assessment on January 16 last year, but missed the mandatory meeting while being in hospital because of a brain cyst. She knew nothing about the appointment.

On February 6, the DWP ruled that Jodey had not ‘provided sufficient evidence’ for missing the appointment and stopped her disability benefits. Jodey raised concerns about the decision on February 10 and made a formal appeal on the 13th. She killed herself on February 21, before a different DWP decision maker had reviewed her case and decided on February 25 – just four days after her death – that she should have continued to receive disability benefits.

A message about the ruling was sent to Jodey’s mobile phone inbox after her death, despite the DWP being informed of her death.

Joy has also started a ‘Justice for Jodey’ petition, with the aim of persuading the DWP to look again at how it handles social security claims. You can sign it here: you.38degrees.org.uk/petitions/justice-for-jodey

She said that messages of support there have helped her as she struggles to overcome her grief: “We’ll never stop battling. The messages I get on the petition, and from people who have been in similar situations, are incredible.”

The DWP did not respond for requests for comment.


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Nothing about you without you – the Labour party manifesto for disabled people

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FOREWORD

Over the last seven years disabled people have borne the brunt of the cuts inflicted on them by the Conservative Government and the Coalition before them.

The cuts have had a detrimental effect on the lives of disabled people, cutting living standards and undermining their access to education, social care and to justice.

Two years ago the United Nations (UN) convened a committee to investigate state violations of the UN Convention of the Rights of Persons with Disabilities (UN CRPD). Last year the UN published their report and concluded that the Conservative Government had committed ‘grave, systematic violations of the rights of persons with disabilities.’

This is a damning indictment of the treatment of disabled people by the Conservatives, one which shames us as a country.

We believe in a social model of disability, a society which removes the barriers restricting opportunities and choices for disabled people. As such we will build on the previous Labour government’s commitment to disabled people in 2009 as signatories to the UN CRPD. A Labour government will incorporate the UN CRPD into UK law.

We are proud of the manifesto we have developed with, and for, disabled people, and would like to take the opportunity of thanking everyone who has taken part in Labour’s Disability Equality Roadshow over the last year. We have crossed the length and breadth of the country to engage with disabled people and their carers, capturing their views on what needs to change for disabled people to live full and independent lives.

We will continue to work with disabled people in government, fulfilling our promise of ‘nothing about you, without you’.

Jeremy Corbyn, Leader of the Labour Party

Debbie Abrahams, Shadow Work & Pensions Secretary

Marie Rimmer Shadow, Minister for Disabled People.

To access full CONTENT click here (PDF)

After seven years of punitive policies and systematic abuse of the human human rights of disabled people by the coalition and Conservative governments, it is such a profound relief to see Labour have developed this manifesto, using consultations as a democratic opportunity to HEAR and include us in political decision making, and will strongly support disabled people and their families. I am proud to have contributed to this via the consultation held in Newcastle.

Here is a brief summary of some of Labour’s policies:

  • Labour will make it a priority to repeal the numerous cuts in social security support for people with disabilities. They will do this through a new Social Security Bill that will be passed within the first year of the new parliament.

  • Labour will reverse the £30 per week cut that the Tories recently imposed on disabled people who receive Employment and Support Allowance (ESA).

  • Labour will scrap the Bedroom Tax that has cruelly and disproportionately hit over 400,000 families with disabled members with punitive charges for “spare” rooms that are often used to store medical equipment, or for carers to sleep in.
  • Labour will end the pointless and needlessly expensive continuous reassessments of disabled people with permanent disabilities, chronic illness and degenerative illness.

  • Labour will end the privatisation of disability assessments so that disabled people never again have to face the indignity degradation of having to prove their disability to some corporate bureaucrat with targets to throw as many disabled people off their benefits as possible.
  • Labour will scrap the discriminatory and degrading Work Capacity Assessment (WCA) regime that costs billions more to administer than it actually saves in reduced payments in social security support for disabled people.
  • Labour will end the privatisation of disability assessments so that disabled people never again have to face the indignity degradation of having to prove their disability 
  • Labour will scrap the Personal Independence Payment (PIP) assessment regime too.
  • Labour will replace the WCA and PIP assessment regimes with a system where personal advisers help to provide every disabled person who feels capable of work to develop a tailored personal plan, adopting a genuinely holistic approach. Those who feel they can’t work will be supported without punishment or threat of uncertainty.
  • Labour will incorporate the UN Convention on the Rights of Persons with Disabilities into UK law. And observe the law.
  • Labour will scrap  the draconian sanctions regime that has consigned hundreds of thousands of disabled people to absolute destitution. 
  • Labour will increase the Carer’s Allowance by £11 per week to bring it into line with the rate of unemployment benefit. 
  • Labour will reverse the Tories’ assault on the Bereavement Allowance.

The Labour Party manifesto is a fantastic demonstration that they have been listening to the concerns of disabled people and their families.

The manifesto presents a set of policies that will make people’s lives better.

I’ve summarised a handful of policies here, so be sure to read the full document.

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 Alex Cunnigham, me, Debbie Abrahams and Gail Ward at the Disability Equality Roadshow in Newcastle

Successful Appeals Against Disability Assessments – It’s As If There’s Something Wrong With The System

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Source: the Independent, written by James Moor.

It’s rapidly becoming clear that Prime Minister Theresa May’s bold pledge to create a Britain that works for everyone should have an asterisk attached to facilitate the addition of “except for those pesky people with disabilities, can’t we pack them off somewhere else?”

In recent days the Government’s plan to cut people with serious mental health conditions out of eligibility for personal independent payments has justifiably come under sustained fire. 

However, the attitude problem displayed by both May’s administration, and that of her predecessor David Cameron, goes beyond that, as a delve into the latest statistics demonstrates.

What they show is that the number of appeals against decisions made by the DWP on the basis of assessments made by the private, profit driven contractors working on its behalf is increasing at a similar speed to that at which Lewis Hamilton exits Silverstone corners. 

They show that there were 60,600 Social Security & Child Support appeals between October and December 2016, an increase of 47 per cent. Even Lewis might think twice about acceleration like that. 

Some 85 per cent of those appeals were accounted for by the Personal Independence Payment (PIP) and the Employment & Support Allowance (ESA).

The rate at which the decisions made by the DWP on the basis of information supplied by the Government’s contractors – Capita and Atos – are overturned is also increasing. 

People started taking notice when it was running at 50 per cent. Now close to two thirds of appeals in the case of the PIP (65 per cent) are successful. The figure is higher still when it comes to ESA (68 per cent). 

I’m given to understand that the people who sit on tribunals have been asked to keep June clear, in an attempt to reduce a growing backlog. So forget about an early summer holiday. 

Needless to say, these people have to be paid, which puts extra cost into the system at a time when the Government says it’s trying to save money. 

Simply applying for either benefit causes a great deal of stress to people with disabilities. Having to go to appeal only exacerbates that. Applicants find themselves in the middle of a process that is humiliating and dehumanising.

That process also seems to throw up scandals with alarming regularity. Channel Four, for example, infamously filmed a Capita assessor saying a claimant had a “disability known as being fat”. Another claimed to have filled out forms before even seeing clients amid pressure to get as many done as quickly as possible. 

Other scandals have involved people with weeks or months to live being told they’re fit for work in the case of ESA, which is paid to people whose fitness to do so is impacted by medical conditions and disabilities. 

Set against that backdrop, is it any wonder that there has been so much criticism of the process, and so many successful appeals? 

If the assessment process worked effectively, and as it should, the number should be limited, and you wouldn’t expect such a large majority to be successful.

Ken Butler, welfare rights advisor at Disability Rights UK, says he is “very worried for all those disabled people who get turned down for benefits and don’t have the time or energy to challenge poor decisions made by the Department for Work and Pensions (DWP)”. 

He adds: “We’d advise all claimants to get benefits advice and, if they are turned down, to use the independent appeals process.”

Butler says that the high success rate of appeals clearly demonstrates that there is something wrong with the system. 

Unless, of course, the system, also savagely criticised by the United Nations, was deliberately set up to be this way. 

Before you suggest that is me indulging in a conspiracy theory, take a moment to think about this. If you make something difficult, stressful and painful, if you litter it with traps, and take the view that everyone getting involved in it is a dirty scrounger until proven otherwise, a lot of people will get put off and won’t apply. Still more won’t appeal when turned down, saving the Government money it can use for things like millionaires tax cuts. 

Dealing with a disability presents enough of a challenge as it is, without having to get to grips with a state that operates in a manner that would have impressed some of George Orwell’s darker characters. Would anyone be terribly surprised to find O’Brien working as a civil servant in the DWP?

The cynicism on display is breathtaking, if my assessment is correct. Alternatively, the situation I’ve discussed could simply have been created by a toxic mix of bureaucratic callousness and incompetence. 

The net effect is the same regardless, which is why there will be peals of bitter laughter emanating from Britain’s disabled community every time those words of Theresa May’s are trotted out. 

You’d be able to hear them if it weren’t for the fact that so many people with disabilities are now trapped in their own homes.  

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Related

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

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

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

What you need to know about Atos

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

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


I don’t make any money from my work. I am disabled because of illness and have a very limited income. The budget didn’t do me any favours at all.

But you can help by making a donation to help me continue to research and write informative, insightful and independent articles, and to provide support to others. The smallest amount is much appreciated – thank you.

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

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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

30th January 2017

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

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Dangerous new changes planned to force sick people into work – or into poverty – Debbie Abrahams

With many thanks to Open Democracy.

The government promised to help disabled people back into work. They’re failing – and now it looks like they’re targeting those who need higher levels of support.


The punitive changes to social security for sick and disabled people were recently highlighted in the film I, Daniel Blake

The Government published its long-awaited ‘Improving Lives: Work, Health and Disability’ Green Paper at the end of October 2016 after originally promising a White Paper in 2015. The White Paper was supposed to define how disabled people would be supported into work and meet the Government’s manifesto pledge of halving the disability employment gap of 34% by 2020 (currently it stands at 32%).

The employment gap was used to justify further draconian cuts in social security support for disabled people in the Welfare Reform and Work (WRW) Bill published last summer. In particular, the Bill announced cuts of approximately £1,500 a year in Employment and Support Allowance to half a million people in the Work-Related Activity Group (ESA WRAG) – those people who had been found not fit for work, but who may be in the future – to be introduced in April 2017.

The 2016 Welfare Reform and Work Act followed the 2012 Welfare Reform Act which Scope estimated by 2018 will have cut nearly £28bn of social security support to 3.7m disabled people. Of course this doesn’t include £4.6bn cuts in social services support since 2010 or the NHS crisis, both of which affect disabled people.

The Green Paper, the consultation for which closed on 17th February just 6 weeks before the ESA WRAG cuts come into place, makes the bold claim that ‘…employment can… promote recovery.’

The issue I have with this statement, and the tone of the Green Paper as a whole, is that this implies that disabled people and people with chronic conditions would recover if only they tried a bit harder, or their doctors weren’t such soft touches. It doesn’t mention ‘shirkers’ directly but comments on how some people with the same condition languish in the ESA Support Group whilst others “flourish at work”, making it clear that’s what they’re thinking, ignoring their own rhetoric about “not treating everyone in a one-size-fits-all way”.

As a former Public Health consultant who researched into the health effects of work and worklessness, I agree that some work is good for health, but I don’t agree with the Government’s flawed thinking underpinning this: that it’s OK for people to return to work when they are still not fit, because it may help. This is not just unsound, it’s dangerous.

The scapegoating of disabled people, which includes people with physical or mental impairments and long-term health conditions as defined under the 2010 Equality Act, has been a hallmark of this Government and the previous Coalition. But even the conclusion of the United Nations inquiry that the UK Government has been responsible for ‘grave…systematic violations’ of the UN Convention on the Rights of Persons with Disabilities since 2010, has been met with Government stonewalling.

It is already well established that disabled people are twice as likely to live in poverty as non-disabled people as a result of the extra costs associated with their disability. Currently 4.2 million disabled people live in poverty and I have been informed from unpublished analysis by an Economic and Social Research Council research project that this is getting worse.

The Government has refused to stop the cuts to ESA WRAG and Universal Credit’s Limited Capacity to Work which come in this April, which will undoubtedly increase the numbers of disabled people living in poverty, threatening their health and well-being. Various discretionary funds may be available, for example the Flexible Support Fund, but there is no guarantee of support and they are quite specific in what they can be used for.

The timing of these cuts when there has been a negligible reduction in the disability employment gap is quite shocking. The Green Paper rings alarm bells that people in the ESA Support Group are the next to be targeted. Linked to this, the new Work Capability Assessment criteria which the Government announced last September (after I committed to scrap the Work Capability Assessment) will be published later this year. These will give a clear indication what the Government’s real agenda is.

The Green Paper also talks about employers and the need for them to invest more in workplace health and occupational health support. This is, of course, very important; 90% of disability and long-term health conditions are acquired, so it is absolutely right to examine what can be done to reduce the risk of employees falling ill and how employers can make reasoned adjustments to support an employee to stay in work if they become disabled. But Access to Work helped only 36,000 disabled people stay in or access work in 2015 out of the 1.4m disabled people who are fit and able to work.

To date, the Disability Confident Campaign launched in 2015 has been a dismal failure making a negligible impact on the disability employment gap. Changes in employer attitudes and behaviour needs practical support, including Access to Work. But what is the Government doing to support employers, especially small businesses given that nearly half the workforce is employed by them? How can a small business access affordable, timely occupational health support? With the NHS in crisis and waiting times for non-urgent treatments escalating, how will timely interventions to help people back to work be delivered?

As always with this Government and the previous Coalition, they are happy to point fingers at everyone else without taking any responsibility themselves. They talk about the impact of work on health and the need for ‘culture change’ and to ‘reinforce health as a work outcome’ but what about the impacts of the social security system on the health of claimants? Their policies have a direct impact on people’s health in the punitive, humiliating way they are too often implemented, but also through the real, enduring poverty and hardship people are forced to live under.

Labour will hold this Conservative Government to account on all these areas, developing meaningful, alternative, approaches with disabled people, employees, and employers as part of our Disability Equality Roadshow. If this Government is committed to a fairer society, they should stop trying to rebuild the economy off the backs of poor, sick and disabled people.

Labour believe, like the NHS, our social security system should be there for all of us in our time of need, based on principles of inclusion, support and security for all, assuring us of our dignity.   

Related

Labour’s Disability Equality Roadshow is a nationwide public consultation about policy with disabled people  Make sure you go and have your say – Labour’s Disability Equality Roadshow comes to Newcastle

The next Disability Equality Roadshow event will be held in London on 27th Feb. Sign up here, to see when the consultation will be held in your area: Eventbrite -Labour’s Disability Equality Roadshow-Brixton. Attending the consultations is free.


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

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

 IDS ESA Speakout share post.png

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

That has always been the ultimate aim of the Conservatives.

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

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

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 Related

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

The power of positive thinking is really political gaslighting

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

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

Research finds strong correlation between Work Capability Assessment and suicide


 

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