Tag: WCA

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

aaeaaqaaaaaaaad4aaaajdk1ytqwzdyxltjinwytngjhmc05njdlltmyzmu4mty4owi5za

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

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

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

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

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

BPS President Professor Peter Kinderman said:

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

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

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

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

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

Source: the free psychotherapy network

From:

Mental Wealth Alliance [1]

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

To:

British Association for Behavioural and Cognitive Psychotherapies

British Association for Counselling and Psychotherapy

British Psychoanalytic Council

British Psychological Society

United Kingdom Council for Psychotherapy

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. 

DonatenowButton cards

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.

DonatenowButton cards

‘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.

14264869_10155156840200130_1352094000808474819_n

 

 Related

What you need to know about Atos assessments

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

The power of positive thinking is really political gaslighting

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

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

Research finds strong correlation between Work Capability Assessment and suicide


 

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

DonatenowButton

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

519670

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

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

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

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

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

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

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

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

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

Far too little far too late

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

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

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

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

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

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

Labour have already pledged to abolish the Work Capability Assessment

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

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

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

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

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

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

That isn’t true.

Some historical context

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

Related

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

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

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

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

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

Research finds strong correlation between Work Capability Assessment and suicide

What you need to know about the Work Capability Assessment

 


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

DonatenowButton cards

Secret ‘internal reviews’ show clear link between Tory welfare ‘reforms’ and suicides

tory cuts


I’ve written more than one lengthy critique of Tory notions of what passes for “research” methods, and often criticised Conservative refusals to accept the research findings of academics regarding, for example, established links between the Work Capability Assessment, increased suicide and mortality, the link between sanctions and increased mortality. The Tory plea for the universal and unqualified dismissal of whatever they deem to be criticism of their policies is often based on the claim that “no causal link has been established.”

As I have pointed out previously, whilst correlation certainly isn’t quite the same thing as cause and effect, it quite often strongly hints at a causal link, and as such, warrants further investigation.

It is inaccurate to say that correlation doesn’t imply causation. It quite often does. Correlation means that an association has been established. The tobacco industry, for example, has historically relied on exactly the same dismissal of correlational evidence to reject the established link between tobacco and lung cancer.

The standard process of research doesn’t entail, at any point, a flat political denial that there is any relationship of significance to concern ourselves with, nor does it involve a systematic and deliberate withholding of relevant data, attempts at censoring democratic dialogue, and a point blank refusal to investigate further. Furthermore, the government claims that there is “no evidence of a causal link ” is unverified. There is no evidence to support government claims that there isn’t such a link, either. In fact empirical evidence strongly refutes the Conservative’s persistent claims of no association between the welfare cuts and an increase in suicide and mortality.

I’ve observed more than once that when it comes to government claims, the same methodological rigour that they advocate for others isn’t applied. Indeed, many policies have clearly been directed by ideology and traditional Tory prejudices, rather than being founded on valid research and empirical evidence. The fact that no cumulative impact assessment has been carried out with regard to the welfare “reforms” indicates a government that is not interested in accountability, and examining the potential negative outcomes of policy-making. Policies are supposed to be about meeting public needs and not about inflicting Conservative dogma and old prejudices in the form of financial punishment on previously protected social groups.

We need to ask why the government has so persistently refused to undertake cumulative impact assessments and conduct open, publicly accessible research into their austerity policies, the impact they are having and the associated deaths and suicides.

Without such research, it isn’t appropriate or legitimate to deny a causal link between what are, after all, extremely punitive, targeted, class-contingent policies and an increase in premature mortality rates.

Government policies are expressed political intentions regarding how our society is organised and governed. They have calculated social and economic aims and consequences. Political denial of responsibility is repressive, it sidesteps democratic accountability and stifles essential debate and obscures evidence. Denial of causality does not reduce the probability of it, especially in cases where a correlation has been well-established and evidenced. Nor does attempting to hide the evidence.

Being civilised, holding values of decency and having legitimate concerns about the welfare and wellbeing of sick and disabled citizens have all been depreciated as mere matters of “subjective interpretation” and not as worthy subjects of political, rational or objective discussion. This isn’t a government prepared to engage in a democratic dialogue with citizens, it is one intent on imposing authoritarianism.

 —

The following article titled “Suicides of benefit claimants reveal DWP flaws, says inquiry” was written by Patrick Butler and John Pring, for The Guardian on Friday 13th May 2016 22.59 UTC

A series of secret internal inquiries into the deaths of people claiming social security reveal that ministers were repeatedly warned of shortcomings in the treatment of vulnerable claimants facing potentially traumatic cuts to their benefits entitlements.

The conclusions are contained in 49 Department for Work and Pensions (DWP) inquiry reports finally released to campaigners on Friday after a two-year Freedom of Information (FOI) battle. Some 40 of the reports followed a suicide. In 10 cases, the claimant had had their benefits sanctioned.

Although the heavily redacted reports do not draw a direct link between the death of a claimant and problems caused by their dealings with the benefits system, they highlight widespread flaws in the handling by DWP officials of claims by people with mental illness or learning difficulty.

The reports, called “peer reviews,” appear to challenge blanket claims by ministers that there is no connection between government welfare reform policies and the deaths of vulnerable claimants.

Several suggest that claimants who died may not have received adequate support from DWP staff handling their benefit claims. At least five of the reports call for major reviews or substantial changes to procedures on identifying and supporting vulnerable claimants.

Many of them centre on the much-criticised Work Capability Assessment (WCA), the test used to assess whether claimants are fit for work. Campaigners argue the tests are flawed and linked to health relapses, depression, self-harm, and suicides.

Activists have linked the WCA to a string of tragic deaths – including poet Paul Reekie, former sheep farmer Nick Barker and ex-security guard Brian McArdle – all of whom died after being found “fit for work” and told by the DWP that they would lose their out-of-work disability benefits.

Peer reviews are triggered when a claimant death is “associated with a DWP activity”. The reports released on Friday were drawn up between February 2012 and August 2014, when an FOI request was originally submitted.

One report warns that vulnerable claimants risked being overlooked by DWP officials, with potentially harmful consequences, because staff resources were stretched by a ministerial decision to push ahead with the speedy re-assessment of hundreds of thousands of incapacity benefit claimants.

It says: “The risk associated with disregarding the possibility that some of these claimants need more support or a different form of engagement is that we fail to recognise more cases like [name redacted] with consequent potential impact on the claimant.”

The report adds: “We need to ask whether or not in the context of a fast-moving environment of high [claimant re-assessment] volumes and anticipated levels of performance, the current process requires, encourages and supports … colleagues to independently and systematically consider claimant vulnerability.”

Another report suggests that while official written policy demanded vulnerable claimants to be treated appropriately this was not implemented in practice. It says: “This case may highlight a dislocation between policy intent and what actually happens to claimants who are vulnerable.”

Ministers initially denied back in 2014 that they held any records on people whose deaths may have been linked to benefits system. Although they subsequently admitted that so-called “peer-review” investigations had been carried out since 2012, they argued social security laws prevented them from publishing them.

A DWP spokesman said it would be wrong to link benefit claims with deaths. “Any suicide is a tragedy and the reasons for them are complex, however it would be inaccurate and misleading to link it solely to a person’s benefit claim.”

They added that guidance was provided to staff on how best to support vulnerable claimants. Ministers were not routinely shown the reviews, which were undertaken internally help staff to deal with complex and challenging benefit cases.

However, they were unable to say whether ministers or senior officials had acted on any of the recommendations contained in the 49 reviews.

Disability News Service, a specialist press agency which submitted the original FOI request to obtain the reports, asked the Office of the Information Commissioner to review the DWP decision. The ICO ruled in favour of the DWP in July 2014, but a subsequent appeal was upheld in March and ministers ordered to publish the reports.

Officials have removed from the reports any references to the specific events that triggered an investigation, as well as dates, names of claimants or staff and locations. Several of the inquiry reports have been stripped of almost all data.

But a number retain entries under the heading “Lessons learned”. Collectively these show that investigators examining the links between a claimant’s death and their treatment by local DWP officials uncovered persistent problems.

They found frontline officials were often unable to identify potentially vulnerable claimants, failed to deal sensitively or appropriately with them, or anticipated problems they may have negotiating their way around the welfare bureaucracy.

Investigators found, variously, that communication between officials and vulnerable claimants was often poor, that practice guidelines were not followed, and that benefits staff often rigidly adhered to the rulebook rather than using “common sense” in their dealings with claimants.

In two instances, investigators reported that it was difficult to carry out a proper inquiry because DWP records had been purged, or not kept properly. In another instance the investigator concluded that officals precedural actions were followed correctly and could not have prevented the death of the claimant.

Other peer review findings include:

• Local DWP branch officials should be given awareness training to deal with “customers who made suicide/self harm declarations”, one report urges. It concludes: “In learning from this experience it is clear there is work to do”.

• In one local office staff failed to provide adequate support for vulnerable claimants, according to a report. It says: “It is clear that we had several opportunities to identify and address the errors made over the duration of this claim, but we neglected to do so”.

• DWP staff who decide on whether to award or disallow disability benefit claims should always consider the claimants’ full historical case files and medical history, a report concludes, to “minimise the risk of withdrawing benefit inappropriately and placing a vulnerable claimant at risk”.

It is understood nine similar DWP peer reviews have since been undertaken since August 2014 and are subject to further FOI requests.

guardian.co.uk © Guardian News & Media Limited 2010


Sign the petition asking the government to examine the DWP, ATOS & Maximus’s culpability for deaths of benefit claimants

“There’s been a marked increase in the number of deaths & suicides of claimants recently found “fit for work” by work capability assessments, possibly implying those benefits entitlements were removed hastily and that the DWP, ATOS & Maximus failed in its duty of care to vulnerable benefit claimants.”

I don’t make any money from my work. But you can support Politics and Insights and contribute by making a donation which will help me continue to research and write informative, insightful and independent articles, and to provide support to others. The smallest amount is much appreciated, and helps to keep my articles free and accessible to all – thank you.
DonatenowButtoncards

Maximus ‘has falsified results of fitness for work tests’, says MP – John Pring

By John Pring

The discredited US outsourcing giant contracted to carry out “fitness for work” tests on behalf of the government has been accused by an MP of “falsifying” the results of assessments.

Labour MP Louise Haigh attacked the track record, ethics and even criminal behaviour of Maximus in delivering public contracts in the US, during a debate on the work capability assessment (WCA).

But she also highlighted what she described as a “disconcerting pattern of behaviour” by Maximus in the UK since taking over the WCA contract from Atos last year.

She said: “There seems to be an alarming trend of cases being rejected based on factual errors or even – I hesitate to say this – falsification.”

Haigh (pictured speaking in the debate), a shadow Cabinet Office minister, also raised concerns that there was no way for the public to check whether targets set for Maximus by the government – such as the number of serious complaints and the payment of travel expenses within nine working days – were being met.

 

You can read the rest of this excellent article here

Related

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

Iain Duncan Smith is complaining about valid criticisms of his draconian policies by journalists and social media commentators

36626_217452248405831_532419169_n

The Work and Pensions Select Committee has just published some letters between Frank Field, the chair, and Iain Duncan Smith, who responded to questions about the correlation between benefit assessments and suicide.

Mr Field had asked what data the Department for Work and Pensions collects on the deaths of benefit claimants.

The issue had been raised in a research report by Oxford University and Liverpool University entitled First Do No Harm, which I also reported on last year.

The letter addressed to Frank Field MP, features a barely legible hand-written footnote warning against listening to those “in the media and on social media” who “accuse the Government of outrageous actions.”

Duncan Smith writes in the footnote:

“There are some out there in the media and social media who have used [raw?] [ons ?- Office for National Statistics?] figures to accuse the govt of outrageous actions.

I would hope that the committee would not seek to follow suit. I [illegible] [note?] that having introduced ESA and the WLA, the Labour Party now seeks to attack it as though they had nothing to do with it.

Surely the committee should seek to recognise the good intent of those engaged in this difficult area.”

2014-02-17-BurdenoftheCuts-thumb
I would say that this blatant political discrimination constitutes an “outrageous action.” It’s difficult to recognise any “good intent” here, Mr Duncan Smith.

The correlation between the work capability assessment and suicide was established by academic researchers, not by journalists or social media commentators. We simply reported the findings.

Iain Duncan Smith will be accusing the United Nations (UN) of failing to see the government’s “good intent” when the inquiry into “grave and systematic violations” of the rights of disabled people in the UK concludes, next. Despite the fact that we are the first country to face such an inquiry, and given that the UN investigate only when there is evidence of grave and systematic violations of human rights, the prime minister has already dismissed the significance of the inquiry, ludicrously claiming “it may not be all it’s cracked up to be.”

It’s particularly noteworthy that when it comes to government claims, the same methodological rigour that they advocate for others isn’t applied. Indeed, many policies have clearly been directed by ideology and traditional Tory prejudices, rather than valid research and empirical evidence. The fact that no cumulative impact assessment has been carried out with regard to the welfare “reforms” indicates a government that is not interested in accountability, and examining the potential negative outcomes of policy-making. Policies are supposed to be about meeting public needs and not about inflicting Conservative dogma and old prejudices in the form of financial punishment on protected social groups.

As someone with a background in the social sciences, I have written extensive criticism of Iain Duncan Smith’s peculiar brand of epistemological and methodological fascism. He’s not exactly well known for his skill in statistical analysis, having been rebuked more than once for being notoriously conservative with the truth and numbers. Yet he feels compelled to dismiss the accounts of academics, campaigners, empirical evidence and the many qualitative accounts of those adversely impacted by his policies, in his vain attempt to exercise a stranglehold on his own peculiar brand of “truth.”

The goverment often claim that any research revealing negative social consequences arising from their draconian policies, which they don’t like to be made public “doesn’t establish a causal link.”  Recently there has been a persistent, aggressive and flat denial that there is any “causal link” between the increased use of food banks and increasing poverty, between benefit sanctions and extreme hardship and harm, between the work capability assessment and an increase in numbers of deaths and suicides, for example.

The government are referring to a scientific maxim: “Correlation doesn’t imply causality.” 

The tobacco industry made exactly the same claim about the established link between lung cancer and smoking.

It’s true that correlation is not the same as causation.

It’s certainly true that no conclusion may be drawn regarding the existence or the direction of a cause and effect relationship only from the fact that event A and event B are correlated.

Determining whether there is an actual cause and effect relationship requires further investigation.

This is something the government has persistently refused to do. (Here’s a full critique of Conservative methods of “social research”. I sent Mr Duncan Smith a copy, along with some information about proper definitions and measurement of poverty, but he clearly hasn’t read either. Unless he has included those in his arrogant and dismissive horror of “accusations”  criticisms on social media of course)

It is completely inaccurate to say that correlation doesn’t imply causation. It quite often does.

Here’s a final comment from a social media-based campaigner, analytical writer and a qualified social scientist who knows about statistical inference, causality and correlation and suchlike:

Iain Duncan Smith, you’re a blatant numpty.

160211IDSnote-outrageousaction

You can read the full letter here.

%d bloggers like this: