Tag: Work Capability Assessment

The Choice Architecture Of Poverty

Special Rapporteur Philip Alston has presented a United Nations Report on Poverty in the UK. The UK Mainstream Media have not really excelled in analysis or presentation of the findings. After almost a decade of Nudge by Press Release, the Guardian has missed the vital message while the BBC has simply recycled old Government Press Releases. The Mainstream Media seem to be shy about embracing the most damning finding of the report.  

In December 2017, Professor Alston carried out a visit to the USA – California, Alabama, Georgia, Puerto Rico, West Virginia, and Washington DC – carrying out the same kind of investigation as has just finished in the UK. The most damning finding of the UN-US Report on Poverty was similar to the most damning finding of the UN-UK Report on Poverty. Had the Guardian excelled in Journalism they might have highlighted that the UN was not simply finding something isolated.

The Guardian and the BBC might not have concluded that the “Government is in denial” because following the implications of the most damning finding is that POVERTY IS A CHOICE 

Both in 2017, in the USA, and in 2018 in the UK, the UN has concluded that poverty is a choice and that Government has made the decision that the only choice on offer is compliance or poverty. The Mainstream Media is failing to follow any kind of analysis that follows the implications of the finding that poverty is a choice and there is no adequate explanation as to why? The notion that poverty is a choice is one that has been foisted onto everybody by the Government since 2010. Welfare Changes have been touted as Reforms which will enable people to choose to lift themselves out of poverty. That choice takes place within the Choice Architecture that has been created by policy.   

In the UN-US Report, Alston states that: 

“ …I heard how thousands of poor people get minor infraction notices which seem to be intentionally designed to quickly explode into unpayable debt, incarceration, and the replenishment of municipal coffers…”  

In the UN-UK Report, Alston similarly finds that:  

One of the key features of Universal Credit involves the imposition of draconian sanctions, even for infringements that seem minor. Endless anecdotal evidence was presented to the Special Rapporteur to illustrate the harsh and arbitrary nature of some of the sanctions, as well as the devastating effects that resulted from being completely shut out of the benefits system for weeks or months at a time. As the system grows older, some penalties will soon be measured in years.”  

The Mainstream Media make no connection between the American Experience and the British Experience. As if there was no connection between US Policy and UK Policy. As if all the shuttling back and forth between Republicans and Conservatives has never had any impact. As if the Minor Infraction Notices are, in no way, related to Benefit Sanctions. There is an almost willing blindness: never stray from the press release.  

The UN Rapporteur was never commissioned to analyse Nudge Theory. The outcome of eight years of Libertarian Paternalism has transformed British Society into something that, the UN recognises, punishes the Poverty it also chooses to deliver. The overwhelming Mainstream Media response has been the Punch and Judy caricature and Poverty Porn Prurience instead of analysis.

How did a Government get to the point where Human Rights are optional or contingent upon being an Employee: this is a question central to the current Welfare Policy which is transforming British Society. It also has an answer that the UN Rapporteur gives: POVERTY IS A CHOICE.  

In putting forward an endless series of press releases and promoting the production of daytime television portraying skivers and strivers the Department of Work and Pensions has been nudging the Mainstream Media into only presenting a narrative where strivers can choose to leave poverty and only skivers would want to avoid that choice. The constant nudging – the well written Press Releases that, frequently, substitute for actual Journalism – has worked. The Government has decided to provide the choice of poverty in a range of ways.  

The Government provision of choices of poverty underline that decisions are placed beyond Claimants in a calculated and cruel manner. The Choice Architecture prevents Claimants from making decisions. Decisions would empower Claimants and also permit innovation. Claimants could determine what is the best course of action. Instead the digital by default process has been used to provide a series of choices without any deviation permitted.

A Claimant who fails to fill in any choice – and fill it in correctly, and fill it in digitally – automatically chooses poverty. Similarly, those who fail to know that choices have been proffered are choosing poverty. The complexity of the choice architecture is overwhelming – even for those engaged in administering it. It is a system that has been designed to deliver poverty – and it has.  

The skills to interact with a State that is being made actively oppositional and digital as the UN-UK Report highlights:   

The reality is that digital assistance has been outsourced to public libraries and civil society organizations. Public libraries are on the frontline of helping the digitally excluded and digitally illiterate who wish to claim their right to Universal Credit.” 

Which is not too distant from the UN-US Report:

Much more attention needs to be given to the ways in which new technology impacts the human rights of the poorest Americans. This inquiry is of relevance to a much wider group since experience shows that the poor are often a testing ground for practices and policies that may then be applied to others. These are some relevant concerns.”  

The truth is, the US and the UK have parallel tracks in overarching Policy objectives: eliminate the State and have the Poor fend for themselves. The emphasis on digital systems as a means to distance Policy Makers from Policy Delivery and to “cut costs” is evident across the US and UK Reports. Pretrial detention has been an area calling for systematic reform in the US for decades. The UN-US Report observes:   

Automated risk assessment tools, take “data about the accused, feed it into a computerized algorithm, and generate a prediction of the statistical probability the person will commit some future misconduct, particularly a new crime or missed court appearance.”

The system will generally indicate whether the risk for the particular defendant, compared to observed outcomes among a population of individuals who share certain characteristics, is ‘high’, ‘moderate’, or ‘low’. Judges maintain discretion, in theory, to ignore the risk score.” 

Which reflects the “automated” nature of the Work Capability Assessment for the Disabled in the UK, previously reported by the UN as being either at risk or actually in the process of grave human rights abuse. In the UN-UK Report the Automated Risk Assessment tools are commented upon:   

But it is clear that more public knowledge about the development and operation of automated systems is necessary. The segmentation of claimants into low, medium and high risk in the benefit system is already happening in contexts such as ‘Risk-based verification.’ Those flagged as ‘higher risk’ are the subject of more intense scrutiny and investigation, often without even being aware of this fact. The presumption of innocence is turned on its head when everyone applying for a benefit is screened for potential wrongdoing in a system of total surveillance. And in the absence of transparency about the existence and workings of automated systems, the rights to contest an adverse decision, and to seek a meaningful remedy, are illusory.”   

Which underlines that the Government of the day – regardless of political inclination – are delivering Policy Objectives without transparency, clarity or even sufficient information to determine what the Policy Objectives are. When policy objectives only become clear through outcomes, there is a clear suspicion that Democracy has been subverted. Which is the general direction the UN-US and UN-UK Reports indicate. There are serious Human Rights failings but also a serious democratic deficit arising from the idea that POVERTY IS A CHOICE.   

The use of Computer Systems is not neutral or innocent. The Special Rapporteur notes that:   

it is worrying that the Data Protection Act 2018 creates a quite significant loophole to the GDPR for government data use and sharing in the context of the Framework for Data Processing by Government.”  

Which is not simplistically that UK Government Departments have “rights” to trawl through personal data but that it is increasingly criminalised for Claimants – more than eight million people – to object to that trawl or to object to the sharing of data with Commercial Contractors. Those same Contractors being Employers and the inevitable consequence of data sharing being to put Claimants at a distinct power and negotation disadvantage when contracts of Employment are considered. Because the UK Government Departments have zero obligation to ensure Claimants get the best possible job. Simply that Claimants flow off the Register.   

Which is how POVERTY IS A CHOICE is being delivered from Government to the People. Interaction with the Department of Work and Pensions has become the single most corrosive interaction with Government that People can have. The design of benefits has become an exercise in delivering the ideological convictions of the Government regardless of the practicality of those convictions. For the Conservative Government, that conviction is that people should be in poverty unless they are Employed. Which ensures the disabled, parents, students, pensioners, entrepreneurs in start-up and Carers are locked into a combative process in which the only exit is to choose poverty.  

The UK Mainstream Media is not really exploring this dimension of the UN Rapporteur’s commentary. It leads to uncomfortable terrain for any Journalist. Not least, the intimate connection between the Republicans in the US and the Conservatives in the UK. The ideological convergence of the Conservatives with the Republicans has delivered a wide range of public policy disasters. The Department of Work and Pensions has been allowed carte blanche to redesign the Welfare State based on the Workfare preferred by the Republicans.

The Nudge Unit has crossed, and recrossed, the Atlantic ensuring that the Conservative’s historic prejudice for “the right to manage” has become inflated. Including all aspects of social existence into contractual relationships between the Government and the People. Dating back to Ronald Reagan’s 1985 “Contract with America” speech where everything was reduced to legislation as contract and society became replaceable with a well ordered business.

The UK Mainstream Media is not really capable of exploring these ideas because, quite simply, to do so is to undermine the interests of their owners. Without any need for coercion, the Government is capable of nudging the Media into endlessly propagating the POVERTY IS A CHOICE agenda.  

Despite the comprehensive nature of the UN Rapporteurs investigations and reporting, there is little about the UN-UK Report that is actually surprising. The connection between the UN-UK and UN-US Reports might well be a surprise to the Media. Realistically, there should be no surprise at all. The Extremists of The Atlantic Bridge, The Heritage Foundation and all the myriad of Far Right Think Tanks since Reagan, have all been promoting the same ideas both sides of the Atlantic. They have all been ensuring that the tools exist for Government to make only once choice possible for the People and that choice is Poverty.  

UN-UK Report  

UN-US Report 

 Picture: Mika Rottenberg, Bowls Balls Souls Holes, Video Installation Rose Art Museum Waltham USA (2104). 

This article was written by Hubert Huzzah.


 

 

The revolving door of disability assessments and appeal is still killing people who are chronically ill

 

Sandra Burns

Sandra Burns

Social security was originally designed to ensure that everyone was protected from the worst ravages of unfettered capitalism. To say that we have regressed as a society since then is an understatement. 

‘Behavioural economics’ are currently embedded within our current welfare system. This is a technocratic solution to essentially politically created problems. It addresses social problems by simply shifting the blame and responsibility from state to individual. This has led to an increasingly punitive social security system, aimed at pushing people into employment, regardless of whether or not they are able to work. ‘Nudge’ is increasingly being used by an authoritarian Conservative government to ensure citizens behaviours are aligned with neoliberal ideology and policy outcomes.

People who are chronically ill are suffering terribly because of the government’s anti-welfare ideolology. Yet most of us have paid tax and National Insurance to ensure that we have access to social security if or when we need it, only to find that the hostile environment created by by the government has made claiming support an ordeal. 

Back in 2013, I wrote about the terrible impact of  stressful, continuous work capability assessments on disabled people, particularly those with chronic illness. It’s long been understood that stress exacerbates the symptoms of illness. 

Many people have described a “revolving door” process of endless assessment, ceased ESA claim, (based on an outcome of almost invariably being wrongly “assessed” as fit for work), appeal, successful appeal outcome, benefit reinstated, only to find just three or four months later that another assessment is required.

The uncertainty and loss of even the most basic financial security to meet the bare necessities to survive that this process creates, leading to constant fear and anxiety, is having a damaging, negative impact on the health and wellbeing of so many. It’s appalling that in a first world so-called liberal democracy, sick and disabled people are being punished for being ill and disabled by a system that was originally intended to support them in meeting their most basic living costs.

Five years on, nothing has changed. People are still dying because of a system that is fundamentally flawed and not fit for purpose. The government are not listening to us. 

I write all too regularly about disabled citizens who have been treated brutally because of Conservative policies, many who have died as a consequence of a system that is intentionally designed to punish people for their need. 

I’m saddened to report that disabled woman has died from a heart attack after she was repeatedly refused vital financial support following disability assessments carried out by a private benefits firm, Atos, over a five year period. 

Sandra Burns, who lived in Luton, was found dead at the bottom of the stairs at her home on 16 April. She was surrounded by letters from the Department of Work and Pensions (DWP) and overdue utility bills, having suffered what is believed to be a massive heart attack. 

Sandra’s brother, Ian, told Luton Today: “She was found dead at the foot of her stairs, apparently of a massive heart attack. 

“She was surrounded by letters informing her that the gas, electricity, water, telephone and television were all in danger of being cut off.” 

“This debt and anxiety lay all around her on the floor”.  

Ian also said that the stress of the process had a degenerative impact on Sandra. He says that the work assessments were “punitive” and that they “ignored the comments of her GP”.

“These appeals would take six to eight months. Every single time, she won the appeal and got a backdated payment. But in that period, she would get into debt and lose her credit rating. 

“And then she’d get back on an even keel until the next year, when the same thing would happen,” he added.

Sandra, who was 57, had worked in retail for 30 years before severe back pain caused by five fused vertebrae in her spine forced her to give up working. She had failed a number of work capability assessments over a five year period but had successfully challenged each decision at appeal. 

The disability assessments were carried out at the time by Atos, on behalf of the DWP, who withdrew from a contract to carry out assessments for Employment and Support Allowance (ESA) following widespread failures and mounting criticism. 

Each time she failed an assessment, Sandra found herself looking at a growing mountain of debts while she fought to have the harsh decisions overturned at appeal.

In a letter sent to the DWP before her death, Sandra wrote: “I am old school and would still be working if I could do it. Do you think I would be silly enough to do this? I have always worked.”

Why do they think it’s ok to treat me like this? It’s not acceptable”.

Her Brother Ian said the difficulties of living with a chronic health condition, coupled with having to repeatedly fight for the benefits she desperately needed, caused her health to deteriorate. 

He says that Atos “based their assessment on the fact she could walk the five or six steps of the stairwell to the interview room”.

“She could walk small distances and couldn’t stand for long”, he said.

Every time ATOS assessed her, they judged her fit for work.”

“She described how one man said, ‘I’ve been watching you walk from the waiting room and as far as I’m concerned, you’re fit for work’.”  

Ian Burns, who lives in Denmark, said his sister had become reclusive during the last year of her life, adding that he had last spoke to her on 3 April.

Having not heard from his sister for some time, Ian asked a friend and neighbour to check up on her. 

He said: “They knocked on the door and went around the back. Through the kitchen window, they could see piles of dishes.

“The police came quarter of an hour later. They got through the back door and found her at the bottom of the stairs.”

Ian came to his sister’s home the following day. “I came the next day … all around the sofa was a pile of letters and debts.

“It was terrible heartbreak and I just feel it could have all been avoided… everyone is treated as cheats or maybe the DWP have an agenda.

“Whatever it is, it’s putting people like Sandra under incredible amounts of stress.”

A DWP spokesman, offering the usual discordant platitudes, said: “Our thoughts are with Ms Burns’ family. We are absolutely committed to ensuring that people get the support they’re entitled to. 

“Assessments are carried out by qualified healthcare professionals who look at how someone’s disability or health condition impacts them on a day-to-day basis.”

Disabled people protesting about the punitive disability assessments in Parliament

 

If you have been affected by the issues raised in this article and need support, please contact the Samaritans free on 116 123 (UK).

Related

What you need to know about Atos assessments

Thousands of disability benefit assessments deemed ‘unacceptable’ by the Government’s own quality audits

Atos’s PR company director wants me to phone him about one of my articles

The connection between Universal Credit, ordeals and experiments in electrocuting laboratory rats

The ESA ‘Revolving Door’ Process, and its Correlation with a Significant Increase in Deaths among Sick and Disabled People

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

Disability Income Guarantee abolished under Universal Credit rules – a sly and cruel cut

 


 

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. The smallest amount is much appreciated – thank you.

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Man who had two heart attacks was forced to work resulting in another heart attack

Emily and Michael Bispham (Photo: cascadenews.co.uk)

A 44 year old man suffered his third heart attack after being refused disability benefits and being forced to work. Michael Bispham, who had already suffered two heart attacks, collapsed with a third on the day he started work as a delivery driver, just three hours into his shift.

He had been awarded zero points at his Work Capability Assessment (WCA), and was told he was not eligible to claim sickness benefit and must look for work.  

Michael was told he was found “fit for work” by the Department for Work and Pensions (DWP), despite 11 letters from consultants and other doctors that clearly stated he wasn’t.

Yet he received confirmation that he had won his Employment and Support Allowance tribunal – reversing the DWP decision – as he lay in hospital following his heart attack in work. 

Michael had been fitted with a cardiac defibrillator – a device that delivers electric shocks as a treatment for life-threatening cardiac dysrhythmias – before he started work on February 13.

As a delivery driver, Michael was forced into an unacceptable situation of risk, both to himself and to others, potentially, through no fault of his own. 

Anyone who has seen the film I, Daniel Blake will probably recognise parallels. It’s a work of art that really does imitate real life.

In February, the employer relationship manager at Jobcentre Plus in Tyne & Wear and Northumberland, who is based at the branch featured in the film I, Daniel Blake, said: “I, Daniel Blake is a representation … I hope people don’t think the film is a documentary, because it’s a story that doesn’t represent the reality we work in.”

“My team and I try to treat people as individuals, and we care about the work we do,” he told the Guardian. “There will be times when we get it wrong, but I don’t believe we are ever as wrong as how we are portrayed in this film.

“I remember talking about the film in the canteen. We were concerned about how it might affect our relationship with the people we were trying to help find work. How would they react to it?”

Ken Loach, however, defended the authenticity and realism of the film’s content. “I challenge anyone to find a single word in that film that isn’t true,” he said.

I, Daniel Blake tells the story of a joiner who has had a heart attack, and is no longer able to work. However, he becomes caught up in the nightmare bureacracy of the welfare state, is passed as “fit for work” at his Work Capability Assessment, and is told he has to look for work. He suffers a second attack just before his tribunal, as a consequence of the sustained psychological distress and strain he experiences because of the punitive Conservative welfare “reforms”. 

Damian Green, the work and pensions secretary, said the film was “monstrously unfair” – though he added he had not seen it. 

Michael’s wife, Emily, would disagree.

Emily has spoken out about the distress of helping Michael to recover, while having to fight the “horrendous and unfair” benefits system she says is designed to make “honest people feel worthless”.

She says: “My husband scored zero points when he was assessed for employment support allowance.

“He’d already had two heart attacks. That should have been it.

“We knew he was too poorly, we submitted 11 letters about his condition from consultants and the hospital, but they declared him fit to work.

“It nearly killed him. I’m so angry about it.

“Just when we needed help and support, we had to navigate the system with pages of forms.

“They stopped any money because he was no longer able to job seek and we were told to start from the beginning and apply again for the ESA he’d been turned down for in the first place.

“We had nothing for three weeks at what was the worst time of our lives. It was so difficult.”

Emily was forced to stop work herself last year after being diagnosed with Crohn’s disease. She is hoping to return to work as soon as she is well enough, though Crohn’s disease is a chronic illness.

She said: “We were just normal people with jobs. We’ve got a mortgage. This could happen to anyone. But the way you are treated by the government is appalling.

“Basically, it’s a case of guilty until proven innocent at these assessments. You are there to prove you’re not making it up.

A DWP spokesperson, giving what has become a standardised and somewhat meaningless response, said: The decision on whether someone is well enough to work is taken following a thorough assessment, including all available evidence from the claimant’s GP or medical specialist.

 “Anyone who disagrees with the outcome of their assessment can appeal.” 

However, recently a Freedom of Information (FoI) request showed that controversial targets exist within the DWP that prompt decision makers carrying out mandatory reconsiderations of DWP decisions to favour their original decision, regardless of the evidence submitted and the quality and appropriateness of the original decision. Appeals cannot go ahead until the mandatory reconsideration has been carried out.

The FoI response says:

The key measures which are used by the Department for Work and Pensions to monitor Mandatory Reconsideration (MR) Performance are: 
 
a) 90% to be cleared within target. 
         
b) 80% of the original decisions are to be upheld. 
 
The performance measures for April 2016 – March 2017 are: 
 
% MR Cleared within target = 70.2% 
 
% MR Original Decision Upheld = 87.5% 

This means that DWP “reconsiderations” are not objective, as they are likely to be favourable towards the original DWP decision.

 


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.

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Vote Labour to uphold the rights of disabled people – our letter to the Guardian

Image result for Human rights are universal

The following letter was published in the Guardian today, written and signed by a group of academics, professionals, campaigners and grassroots activists who work together cooperatively.

We collaborate to fulfil our mutual aims of achieving a progressive, civilised, just and safe society for all. We hope to do this by ensuring that the society we are a part of is democratic and fully inclusive: we want a civilised society that observes and meets its human rights obligations on behalf of all social groups. This isn’t happening currently. (See: UN’s highly critical report confirms UK government has systematically violated the human rights of disabled people).

As an independent researcher, writer, campaigner, and as a disabled person, I am very proud to be included among them. 

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Many disabled people see Labour’s policies as a lifeline, say the 30 signatories to this letter. 

For chronically ill and disabled people, recent years have been a disaster. The UN recently found “reliable evidence that the threshold of grave or systematic violations of the rights of persons with disabilities has been met” (Report, 8 November 2016).

We have been forced through a work capability assessment that the government’s own expert adviser described as “inhumane”, and which in 2015 was found to be associated with an additional 599 suicides.

Many needing help are now forced through another persecutory assessment – the personal independence payment – designed to reduce the numbers qualifying for help by half a million.

Social care has been so savagely cut that some young disabled must wear incontinence pads for lack of toileting assistance. People can’t take any more of this.

Many disabled people are not party-political, but see Labour’s policies for disabled people as a lifeline – envisioning a society where people are treated as human beings deserving of respect, equality and a decent life. Please, don’t endorse recent human-rights abuses; endorse the human rights of disabled people by registering, and by voting Labour on 8 June.

Paul Atkinson Jungian psychotherapist
Stef Benstead Spartacus Network
Peter Beresford Co-chair, Shaping Our Lives
Gary Bourlet Founder, People First Movement in England
Dr Emma Bridger Research fellow in psychology
Professor Woody Caan Journal of Public Mental Health
Dr Kelly Camilleri Registered clinical psychologist
Merry Cross
Dr David Drew Labour Parliamentary candidate for Stroud
Nick Duffell Psychohistorian
Dr Simon Duffy Centre for Welfare Reform
Dr Dina Glouberman Skyros Holistic Holidays
Catherine Hale Chronic Illness Inclusion Project
AC Howard DWPexamination.org – For The UK’s Disabled Community
Chris Johnstone General practitioner
Sue Jones Psychologists Against Austerity, researcher and writer, campaigner
Jayne Linney Disability activist
Alec McFadden TUC Salford
Helen McGauley Trainee clinical psychologist, Lancaster University
Beatrice Millar Person-centred counsellor/psychotherapist
Rev Paul Nicolson Taxpayers Against Poverty
Gavin Robinson Alliance for Counselling and Psychotherapy
Professor Andrew Samuels University of Essex
Nicola Saunders Psychotherapist
Martyn Sibley Disability blogger
Mike Sivier Vox Political
Professor Ernesto Spinelli
Mo Stewart Independent researcher, disability studies
Gail Ward
Dr Jay Watts Queen Mary, University of London
Dr Claudia GillbergSenior Research Associate in Education; Fellow at Centre for Welfare Reform and Disability Rights Activist

Dr Richard House Alliance for Counselling and Psychotherapy

 

Join the debate – email guardian.letters@theguardian.com

Read more Guardian letters – click here to visit gu.com/letters


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Terminally ill woman lost her ESA, home and all her belongings after being told she was fit for work

 


fireshot-capture-6-crowdfunding-to-hel_-https___www-justgiving-com_crowdfunding_tiffany-williams

Claire Hardwicke

Claire Hardwicke has stage four thyroid cancer. This means that it has spread to other parts of her body, and sadly, Claire was told that her cancer is terminal. She also has chronic osteoarthritis. Despite taking 80mg of morphine a day to cope, she still experiences considerable pain.

Additionally, Claire already had a life-threatening, acute allergy to latex. This means that she has to carry an EpiPen at all times, which is an epinephrine (adrenaline) injection to treat life-threatening anaphylaxis. Developing a severe allergy to latex unfortunately meant that Claire could no longer continue working as a mental health nurse. 

Claire first became ill 9 years ago with uterine/ovarian cancer, but it was the allergy that made her unemployable and ended her career as a mental-health nurse, her partner, Alan King, told me

Claire’s first bout of cancer was treated and she made a recovery, which lasted only 7 years. Sadly, the diagnosis of her more recent thyroid cancer and metastases wasn’t diagnosed until it was incurable. The tumours had spread throughout her thyroid gland, neck, lymph system and adrenal glands.   

All Claire can hope for now is palliative care, which is alleviatory only, as a cure isn’t possible. 

Unbelievably, Claire was assessed as “fit for work” by the Department for Work and Pensions (DWP) last year. Her Employment and Support Allowance was stopped. All of her financial support ended. This was despite being told by the Capita assessor (for Personal Independence Payments) that the report to the DWP would state that Claire was in need of more support, not less. 

Overnight the couple lost every bit of financial support they had previously been entitled to, so Alan decided to use what little financial resources he had left to help Claire to fulfill some of  her”Bucket List.”

The couple were forced to say goodbye to their rented bungalow and 99% of their possessions because their housing benefit was stopped. They had no income, as Claire’s Disability Living Allowance (DLA) and Employment Support Allowance (ESA) was stopped, and the Carer’s Allowance also ended.

Claire explained to me that when she lost her lifeline support, the wait for appeal hearings was over 18 months. The couple couldn’t afford to wait that long, as they had no income. They also didn’t know if Claire would survive the wait.

Claire and Alan went to visit family members around the UK before setting off, in October 2016, on a Mediterranean cruise for a month, which Alan paid for, using his credit cards. They already owed a lot of money on their credit cards, but with no income at all, the couple were facing destitution.  The incredible distress the couple suffered took its toll on Claire’s already poor health, too.   

On the return journey, both of them realised that coming all the way back to the UK – where they were homeless, with no income, and they no longer even qualified for free prescriptions – would be pointless. So the couple left the cruise when they got to Portugal, where it’s significantly warmer than the UK (and therefore less painful for Claire) – and they’ve been there ever since, living in a very basic, rented room.

Alan told me: “Claire’s cancer hasn’t claimed her life as quickly as we both had imagined, (which is good), but with medications, food and board, we’re now out of funds and out of options unless we can somehow fundraise for some subsistence.”

The couple have paid money in advance for their single room in Portugal, which covers rent until 14th March, after which time they will have absolutely nowhere to go.

Claire says: “There are new trial therapies for extreme cases of thyroid cancer like mine.

 I wish I had a pot of gold to pay for the experimental cancer therapy.
I don’t want to die, but choices and chances aren’t given to the poor people. We need a miracle, a winning lotto ticket. There should be equal opportunities for all patients.”

The treatment would possibly extend Claire’s life and improve the quality of the time she has left. She says: “I could have a chance of a longer, fuller life…. but I don’t have that option open to me….”

Tiffany Williams, a friend of Claire’s in the UK, has set up a crowdfunding page on JustGiving to raise £800 to help pay for her treatment. So far, 53% of the sum has been raised. 

It’s such a modest amount for a treatment that will make a huge difference to Claire and Alan, who have lost their home and everything else they had in the UK. Now they are at risk of losing their room in Portugal, too. 

You can make a donation at:  https://www.justgiving.com/crowdfunding/tiffany-williams

Update

Claire informs me that the gofundme collection has now closed. But for those wishing to help in some way, there is a beautiful painting of Claire by Jason Pearce, which is up for auction with funds going to her medical fees.  

She says many thanks. 

Jason Pearce is an administrator for a very popular political group, and like me, he was originally contacted and asked if a member (Alan) could post a gofundme page to raise money for treatment costs to the group, as his wife, Claire, is seriously ill. Jason agreed, and offered to help. As Jason is an artist, it was suggested that he could paint a portrait of Claire and it could then be auctioned online to help raise some more money towards Claire’s ongoing treatment.

This is Jason’s lovely painting of Claire.

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“Claire”

20″ x 16″ Mixed media on canvas.

 


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Rogue company Unum’s profiteering hand in the government’s work, health and disability green paper

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I wrote an extensive critique of the recent government green paper on work, health and disability. I mentioned that a government advisor, who is a specialist in labour economics and econometrics, has proposed scrapping all Employment and Support Allowance (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.

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

And: “I’m sure the private company Unum (formerly UnumProvident) would jump at the opportunity. Steeped in controversy, with a wake of scandals that entailed the notorious company systematically denying people their disabilty insurance, in 2004, Unum entered into a regulatory settlement agreement (RSA) with insurance regulators in over 40 US states.

The settlement related to Unum’s “mishandling” of disability claims and required the company “to make significant changes in corporate governance, implement revisions to claim procedures and provide for a full re-examination of both reassessed claims and disability insurance claim decisions.”

The company is the top disability insurer in both the United States and United Kingdom. In the US, it has been regarded as one of the two most unscrupulous insurance companies. The rogue company was also accused of cheating thousands of people out of welfare payments in the US. By coincidence, the company has been involved in the design of the UK government’s controversial 2012 Welfare Reform Bill, advising the government on how to cut spending, particularly on disability support. What could possibly go right?

Of course the vulture capitalist company Unum continues to “mishandle” claims both in the US, in violation of the US Employee Retirement Income Security Act (ERISA) and here in the UK, denying people incapacity benefit, under employer’s group income protection policy (GIP).

The Reform think tank has also recently proposed scrapping what is left of the disability social security 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 to reform the way sick and disabled people are assessed.  

The members of the neoliberal think tank propose 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 people claiming Jobseeker’s Allowance 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 in the foreseeable future. It would therefore be very difficult to justify this proposed cut, given the additional needs that disabled people have, which is historically recognised, and empirically verified by research.

Yet the authors of the report doggedly insist that having a higher rate of weekly benefit for extremely sick and disabled people encourages them “to stay on sickness benefits rather than move into work.” However, people on sickness benefits don’t move into work because they are too sick to work. Their own doctors and the state (via the work capability assessment) have already established that. Forcing them to work is outrageously tyrannical.

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

Policy change can often be explained by reference to changes in background ideas about the state, society and the individual, held and promoted by influential individuals, groups, political parties and … multinational companies.  

It turns out that you can predict such a lot by simply watching the way the wind blows.

The crib sheet  

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

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

“There is a clear lesson from auto-enrolment that if you have a plumbing network or an infrastructure that works, that auto-enrolment infrastructure could be used for other things which would encourage financial inclusion: things like, for example, life cover, income protection and effective and very genuine personal contributory benefits for things like unemployment and sickness,” he said. 

“They can be delivered at good value if there is mass participation through either soft compulsion or good behavioural economics.”

Note the context shift in the use of the term “inclusion”, which was originally deemed a democratic right, now it’s being discussed narrowly in terms of soft compulsion and individual responsibility. And an exchange of money. Subtext: inclusion is only for those who can pay for it. 

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

Mo Stewart has spent eight years researching the toxic and all-pervasive influence of the US insurance giant Unum over successive UK governments, and how it led to the introduction of the “totally bogus” and non-medical work capability assessment (WCA), which she says was designed to make it very much more difficult for sick and disabled people to claim out-of-work disability and sickness benefits.

Stewart’s excellent bookCash Not Care: The Planned Demolition Of The UK Welfare State, was published in September. She states that the assessment was modeled on methods used by the controversial company Unum to deny protection to sick and disabled people in the US who had taken out income protection policies.

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

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

She’s absolutely right.

Our public services are being privately auctionedThe multinational corporations are queuing up for the sale of the century in the UK.

The public are picking up the tab.

 Rogue and antisocial corporations are writing public policies

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Corporate lobbyists are primarily interested in a tactical investment. Whether facing down a threat to profits from a corporate tax raise, or pushing for market opportunities – such as government privatisations – lobbying has become simply another way of making a lot of money for a few people. Lobbyist messages are very carefully crafted and spun, especially in the media. The ultimate corporate goal is sheer self-interested profit-making, but this will always be dressed up to appear synonymous with the wider, national interest. At the moment, that means a collective chanting of the “economic growth”, supply side “productivity”, implied trickle down, “jobs” and “personal responsibility” neoliberal mantra.

Corporations buy their credibility and utilise seemingly independent people such as academics with a mutual interest to carry their message for them. Some think tanks – especially free-market advocates like Reform or leading neoliberal think  tank, the Institute of Economic Affairs – will also provide companies with a lobbying package: a media-friendly report, a Westminster event, meetings with politicians. The extensive Public Relations (PR) industry are paid to brand, market, engineer a following, build trust and credibility and generally sell the practice of managing the spread of information between an individual or an organisation (such as a business, government agency, the media) and the public.

PR is concerned with selling products, persons, governments and policies, corporations, and other institutions. In addition to marketing products, PR has been variously used to attract investments, influence legislation, raise companies’ public profiles, put a positive spin on policies, disasters, undermine citizens’ campaigns, gain public support for conducting warfare, and to change the public perception of repressive regimes.

You can see how the revolving door of mutually exclusive political and corporate favour operates: it just keeps on spinning.

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Edelman Intelligence and Westbourne, for example, are engaged in rebuttal campaigns and multimedia astroturfing projects to protect corporate interests:

“Monitoring of opposition groups is common: one lobbyist from agency Edelman talks of the need for “360-degree monitoring” of the internet, complete with online “listening posts … so they can pick up the first warning signals” of activist activity. “The person making a lot of noise is probably not the influential one, you’ve got to find the influential one,” he says. Rebuttal campaigns are frequently employed: “exhausting, but crucial,” says Westbourne.” From The truth about lobbying: 10 ways big business controls government

Edelman Intelligence is the world’s largest PR company and have been quietly visiting my own WordPress site over this last year, the link shows they were referred to my site from their own social media monitoring command centre. I’ve contacted the company to ask why, but have yet to receive a response. I’m not a paying client so it’s highly unlikely that the visits are in connection with promoting my best interests. Paying clients include the likes of Rupert Murdoch. (See footnote).

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Unum’s long standing toxic influence on policy-making

In a recent press release, the delighted vulture capitalists at Unum say that they welcome the government’s recent Green Paper’s focus on Group Income Protection. The press release also says:

“Unum has welcomed the government’s recognition in a new Green Paper that “Group Income Protection policies have a much greater role to play in supporting employers” help people with health problems to stay in or return to work.

The proposals were set out in Improving Lives: the Work, Health and Disability Green Paper, launched by the Department for Work and Pensions and Department of Health, yesterday, 31 October 2016. As part of its efforts to enable “more people with long term conditions to reap the benefits of work and improve their health”, the Paper includes a number of proposals to prevent people falling out of work for health reasons and to make employers feel more confident about supporting disabled employees. In particular, it includes a number of specific policy ideas to increase the number of British workers with Group Income Protection (GIP).

Through GIP, Unum has enabled thousands of people to return to work after long term sickness absences caused by mental health and musculoskeletal problems and other serious health conditions, including cancer and multiple sclerosis. Unum also provides training, support and advice to employers and line managers on how to look after employees with health problems and help them stay in or return to work.

To increase the number of workers who benefit from GIP coverage, Unum is calling on the government to consider a temporary tax break for employers that buy GIP for their staff. This would reduce the number of people who fall out of work for health reasons, protect the finances of those who are unable to work and boost the productivity of UK businesses.”

In my critical analysis of the work, health and disability green paper, I said: 

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

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

The medical specialists are to be replaced by another profiteering corporate giant who will enforce a political agenda in return for big bucks from the public purse. Health care specialists are seeing their roles being incrementally and systematically de-professionalised. That means more atrocious and highly irrational attempts from an increasingly authoritarian government at imposing an ideological “cure” – entailing the withdrawal of any support and imposing punitive “behavioural incentives” – on people with medical conditions and disabilities.

Doctors, who are clever enough to recognise, diagnose and treat illness, are suddenly deemed by this government to be not clever enough to judge if patients are fit for work. It seems that the Conservatives don’t like competent witnesses who may challenge their droning ideologically driven neoliberal psychobabbling.

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

De-medicalising illness is also a part of that process:

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

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

This is the same kind of thinking that lies behind welfare sanctions, which are state punishments entailing the cruel removal of lifeline income for “non-compliance” in narrowly and rigidly defined “job seeking behaviours.” Sanctions are also described as a “behavioural incentive” to “help” and “encourage”people into work. People who are ill, it is proposed, should be sanctioned, too, which would entail having their lifeline basic health care removed.

Many qualitative accounts from first hand witnesses, extensive research and empirical evidence has repeatedly demonstrated that welfare sanctions make it less likely that people will find employment: taking essential support from people with very limited resources profoundly demotivates, distresses and harms people, rather than “incentivising” them to find work. (See also: Benefits sanctions: a policy based on zeal, not evidence and The Nudge Unit’s u-turn on benefit sanctions indicates the need for even more lucrative nudge interventions, say nudge theorists.)

The darker meaning of David Cameron’s comment about “ending a culture of entitlement” back in 2010 has become clearer. He wasn’t only talking about perceived attitudes and referencing erroneous, unverified and unfounded notions of “welfare dependency”: his party’s aim was and still is about reducing public expectations of a supportive and rights-based relationship with the publicly-funded state – one that has evolved from the post-war settlement to ensure that everyone in the UK can meet their basic human needs.

Poor and ill people cannot be simply punished (or “nudged”) out of being poor or ill. 

Sanctions are a callous, profoundly antidemocratic, dysfunctional and extremely regressive form of economic terrorism, founded entirely on traditional Conservative prejudices about poor people and rigid ideological assumptions. It is absolutely unacceptable that a government treats some people, including some of the UK’s most vulnerable citizens, in such horrifically cruel and dispensable way, in a very wealthy, so-called civilised, first-world liberal democracy.

Unum also have a longstanding reputation for trying to reduce physical illness to “subjective states” and “faulty behaviours”, too. (See also: evidence submitted to the the select health committee by Professor Malcolm Hooper and Subjective symptom disability claims: Chronic Fatigue, Fibromyalgia and Multiple chemical sensitivity syndrome for example).

Even public policies that are supposed to address fundamental human needs arising from sickness and disability are tainted by a neoliberal idée fixe. The leitmotif is a total corporacratic commodification of human needs and relationships; building hierarchies of human worth within the closed and entropic context of a competitive market place, where resources are “scarce” and people are being herded; where the only holding principle that operates is profit over human need.

“In defiance of the substantial biomedical evidence submitted to its Guideline Development Group (GDG), NICE is recommending an inappropriate and potentially dangerous behavioural modification regime as the only management strategy for those with ME/CFS. NICE’s recommended management regime is promoted by a group (mainly psychiatrists) who have undeclared but undeniable competing financial interests.” Malcolm Hooper

It’s mind over matter and quids in

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

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

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

We have a government that has regularly misused concepts from psychology and sociology, distorting them to fit a distinct framework of ideology, and justification narratives for draconian policies. Parsons’ work has generally been defined as sociological functionalism, and functionalism tends to embody very conservative ideas. From this perspective, sick people are not productive members of society; therefore this deviation from the norm must be policed. This, according to Parsons, is the role of the medical profession. More recently we have witnessed the rapid extension of this role to include extensive State policing of sick and disabled people.

It seems many of the psychosocial advocates have ignored the rise of chronic illnesses and the increasing pathologisation of everyday behaviours in health promotion. Parson’s sick role came to be seen as a negative referent (Shilling, 2002: 625) rather than as a useful interpretative tool. Parsons’ starting point is his understanding of illness as deviance. Illness is the breakdown of the general “capacity for the effective performance of valued tasks” (Parsons, 1964: 262). Losing this capacity disrupts “loyalty” to particular commitments in specific contexts such as the workplace.

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

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

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

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

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

Parsons never managed to accommodate and reflect social change, suffering and distress, poverty, deprivation and conflict in his functionalist perspective. His view of citizens as oversocialised and subjugated in normative conformity was an essentially Conservative one. Furthermore, his systems theory was heavily positivistic, anti-voluntaristic and profoundly dehumanising. His mechanistic and unilinear evolutionary theory reads like an instruction manual for the capitalist state.

Parsons thought that social practices should be seen in terms of their function in maintaining order and social structure. You can see why his core ideas would appeal to Conservative neoliberals and rogue multinational companies. Conservatives have always been very attached to tautological explanations (insofar that they tend to present circular arguments. One question raised in this functional approach is how do we determine what is functional and what is not, and for whom each of these activities and institutions are functional. If there is no method to sort functional from non-functional aspects of society, the functional model is tautological – without any explanatory power to why any activity is regarded as “functional.” The causes are simply explained in terms of perceived effects, and conversely, the effects are explained in terms of perceived causes). 

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

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

Here is further evidence that government policy is not founded on empirical evidence, but rather, it is often founded on deceitful contrivance. A Department for Work and Pensions research document published back in 2011 – Routes onto Employment and Support Allowance – said that if people believed that work was good for them, they were less likely to claim or stay on disability benefits.

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

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

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

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

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

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

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

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

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

Nudging, Unum and the behaviourist turn in medicine. 

The history of medicine and definitions of illness and disability are being re-written for the insurance industry, by neoliberal “small state” ideologues and anti-welfarist governments.

Formally instituted by Cameron in September 2010, the Behavioural Insights Team, (otherwise known as the Nudge Unit), which is a part of the Cabinet Office, is made up of people such as David Halpern, who co-authored the Cabinet Office report: Mindspace: Influencing Behaviour Through Public Policy, which comes complete with a cover illustration of the human brain, with an accompanying psychobabble of decontextualised words such as “incentives”, “habit’, “priming” and “ego.” It’s all just a stock of  inane managementspeak. Neoliberal psychobabbling and strategies of psycho-complulsion.

The report addresses the needs of policy-makers.  Not the public. The behaviourist educational function made explicit through the Nudge Unit is now operating on many levels, including through policy programmes, forms of “expertise”, and through the State’s influence on citizens, the mass media, other cultural systems and at a subliminal level: it’s embedded in the very language that is being used in political narratives.

The increasing focus on social control and conformity in public policy design and governing has been dubbed “neuroliberalism”, reflecting something of a behaviourist turn. It draws on social marketing as a policy tool, in which principles from private marketing and advertising are applied to the definition and promotion of “good” behaviours. Deviance (“bad” behaviour) is defined politically through the intentional and systematic stigmatisation of already marginalised social groups, leading to the creation of folk devils and moral panic which is amplified and perpetuated by the media. 

Othering and outgrouping have become common political practices. 

This serves to desensitise the public to the circumstances of marginalised social groups and legitimises neoliberal “small state” policies, such as the systematic withdrawal of state support for those adversely affected by neoliberalism, and it also justifies inequality. By stigmatising the poorest citizens, a “default setting” is established regarding how the public ought to perceive and behave towards defined outgroups. 

Policies directed at the poorest and some of the most vulnerable citizens are being used to extend behaviour modification techniques, based on methodological behaviourism. This is a psychocratic approach to administration: the government are delivering public policies that have an expressed design and aim to act upon individuals, with an implicit set of instructions that inform citizens how they should be.  

Aversives and punishment protocols are being used on the public. Coercive and harshly conditional welfare policies are one example of this.

The origin of active welfare (the idea that the social security system should reflect that the habitually “idle poor” need coercing into work), founded on the idea that poor people are the cause of their own poverty because of their cognitive and behavioural flaws – they fail to take advantage of the opportunities “available” to them – lies with the US neoliberal right.

Charles Murray and Lawrence Mead clearly made an impact on the international policy debate in the 1980s, partly due to the legitimisation that they received from the support of the Reagan and Thatcher administrations for their central claims. They were particularly influential in the growth of work fare and a welfare system based on punishment and psycho-compulsion. Murray claimed the underclass of poor people avoid work because of the “overgenerous” nature of welfare benefits. Mead argued that a “culture of poverty” meant that workfare policies are required to “reintegrate” and “incentivise” the unemployed poor. 

In the UK, James Purnell, one of the work and pensions secretaries for New Labour, said: “For those who play by the rules, there is a world of opportunity. But for those who don’t, there will be clear consequences from their behaviour”.

He sounds rather like an authoritarian Victorian headmaster.

So what exactly are “the rules”, and who has made them?

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 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: euphemisms, superficial glittering generalities and techniques of persuasion to intentionally divert us from aims and consequences of ideologically (rather than rationally) driven policies. Furthermore, policies have become increasingly detached from public interests and needs. 

Neoliberal anti-welfarism, amplified by a corporate media, has aimed at reconstruction of society’s “common sense” assumptions, values and beliefs. Class, disability and race narratives in particular, associated with traditional prejudices and categories from the right wing, have been used to nudge the UK to re-imagine citizenship, human rights and democratic inclusion as highly conditional.  

Illness is all in the mind: conforming to roles and academically constructed stereotypes

“Diagnosis elicits the belief the patient has a serious disease, leading to symptom focusing that becomes self-validating and self-reinforcing and that renders worse outcomes, a self-fulfilling prophecy, especially if the label is a biomedical one like ME. Diagnosis leads to transgression into the sick role, the act of becoming a patient even if complaints do not call for it, the development of an illness identity and the experience of victimization”. Simon Wessely and Marcus S.J. Huibers: The act of diagnosis: pros and cons of labelling chronic fatigue syndrome. Psychological Medicine 2006: 36

In 1993, Mansel Aylward invited psychiatrist Simon Wessely to give a presentation on his biopsychosocial approach to Chronic Fatigue Syndrome before the then Minister for Social Security. Wessely claimed: “As regards benefits:- it is important to avoid anything that suggests that disability is permanent, progressive or unchanging. Benefits can often make patients worse.” 

Benefits can often make patients worse.” I think he meant the patient’s illness is made worse. Despite there being little empirical evidence for these claims, the Minister for Social Security was looking to cut spending, so self-styled “experts” were more useful to an expedient government than rigorous research. I think it would be true to say that without social security, many people who are disabled because of Chronic Fatigue Syndrome (CFS) would experience MUCH worse symptoms, as indeed people with other chronic illnesses would, and some would undoubtedly die without lifeline support to enable them to meet their basic survival needs. 

ME action UK say that on  May 17, 1995, Wessely was one of  the main speakers at a Unum-supported symposium held in London entitled “Occupational Health Issue for Employers” (where ME was described as “the malingerers’ charter”) at which they advised employers how to deal with employees who were on long-term sickness absence with “CFS”.  Moreover, in UNUM’s “Chronic Fatigue Syndrome Management Plan”, ME/CFS is described as “Neurosis with a new banner” and the same document states  “UNUM stands to lose millions if we do not move quickly to address this increasing problem”. 

Unum have been advising UK governments since at least 1994, when the  Conservative government hired John LoCascio, second vice-president of giant and scandalous US disability insurance company, Unum, to advise on reducing the numbers successfully claiming Incapacity Benefit (IB). He joined the “medical evaluation group”.

Another key figure in the group was Mansel Aylward. The group devised a stringent “all work test”. Approved doctors were trained in Unum’s approach to “claims management”. That’s basically  managing not to pay people what they are entitled to. The rise in IB claimants came to a halt. However, it did not reduce the rising numbers of claimants with mental health problems.

Supporters of the behaviourist “non-medical” model of disability and illness include Mansel Aylward, Dame Carol Black, Lord Freud and Lord Kirkwood of Kirkhope (the chairman of the Unum customer advisory panel, whilst he was also Chair of the UK parliament’s work and pensions select committee).

Of course there is the lowest common denominator for highest possible private profits in operation in the US and UK. Some names keep recurring, like the proverbial bad penny for bad thoughts. The controversial PACE trial is just another small variation of the leitmotif. Recently an information tribunal rejected a university’s £200,000 attempt to prevent release of data from the controversial medical trial, that was the first to receive Department for Work and Pensions (DWP) funding.

The PACE trial mirrors Unum’s previous systematic and wholly non scientific de-medicalisation and subsequent trivialisation of serious illnesses such as Myalgic Encephalomyelitis (ME), Chronic Fatigue Syndrome (CFS) and Fibromyalgia in the US, and has led to the growth and standardisation of “behavioural” medical treatment regimes, such as cognitive behaviour therapy (CBT), which is often used to reduce the use of pharmacological pain relief in a wide range of chronic illnesses, including connective tissue diseases such as rheumatoid arthritis and lupus.

The World Health Organisation classified these illnesses as physical diseases, now they are being reconstructed as “psychosocial” phenonena, with recovery supposedly being dependent on the sick person’s attitude and mindset, by greedy crony capitalists and ideologically expedient neoliberal “small state” anti-welfarist governments.

This current psychosocial approach to medical conditions is about addressing a perceived need for cognitive and behavioural change: it allegedly addresses patient’s “attitudes and perceptions” of their condition, their “coping mechanisms” or lack of them, and perceptions of pain and its “management”. None of this affects the underlying disease activity or the damage that disease processes cause to the body.  It’s speculative nonsense.

The trial assessed the value of “biopsychosocial” interventions at the same time as the DWP was using the biopsychosocial model of disability to help justify cuts to disability spending. 

The absurd consequences of permitting a vulture capitalist insurance multinational to write sickness and disability public policies

It’s an interesting observation that Mansel Aylward, who was a key architect of the last decade’s welfare “reforms”, had helped to secure funding for the PACE Trial and sat as an “observer” on the trial’s steering committee. The DWP co-funded the trial. The failure to release the results for the pre-specified analyses laid out in the PACE trial’s protocol is of concern as it had already been noted that there was a likely ideological bias of the trial’s three principal investigators.

All three investgators have invested in developing careers founded on the development of biopsychosocial interventions for CFS, and the two who had been part of the Chief Medical Officer’s CFS working group both resigned because the active biopsychosocial approaches of Cognitive Behaviour Therapy (CBT) and Graded Exercise Therapy (GET) were not endorsed over “pacing” in the way that they had wanted. (See Chronic fatigue report delayed as row breaks out over content. The British Medical Journal, 2002, and Power-sharing, not a take-over, 2002.)

All three principal investigators also reported conflicts of interest involving the insurance industry. There has long been concern about private insurance companies influencing changes to undermine the UK welfare state, a system of social insurance that they currently compete against. (See Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial, 2011 and “In the Expectation of Recovery” MISLEADING MEDICAL RESEARCH AND WELFARE REFORM, George Faulkner, 2016).

“Back in 1995 a Unum report on CFS stated that they could “lose millions if we do not move quickly to address this increasing problem”. It was argued that CFS claims should be managed “more aggressively and in a proactive rather than a reactive fashion” while attempting to present CFS as “neurosis with a new banner”. Emphasising the importance of psychosocial factors and classing CFS as a mental health problem could bring immediate financial benefits to insurance companies when policies limit payouts for mental health problems.

“One of the PACE trial’s principal investigators gave a presentation on the results of the PACE trial to Swiss Re insurance. Swiss Re’s report of his talk detailed the potential use of mental health exclusions to cut payments, while a 2013 Swiss Re presentation on their approaches to mental health problems describes their use of specific exclusions for CFS and ME.

“During the Swiss Re presentation on PACE no mention seems to have been made of the fact that PACE found neither CBT nor GET were associated with improved employment outcomes, and instead Swiss Re’s claims managers continued to be encouraged to believe that promoting these active rehabilitative approaches would assist return to work. There has been concern about insurance companies pushing some patients with CFS to take part in CBT and GET against their wishes.

“A response to the paper which published the PACE trial’s data on employment outcomes was titled Coercive practices by insurance companies and others should stop following the publication of these results, but has yet to receive a response from the PACE team.” George Faulkner, 2016

From 1996 to April 2005 Mansel Aylward was chief medical adviser, medical director and chief scientist of the UK Department for Work and Pensions and chief medical adviser and head of profession at the veteran’s agency, Ministry of Defence. He was involved in the establishment of the new Work Capability Assessment. When he left the department, he headed the UnumProvident Centre for Psychosocial and Disability Research, at Cardiff University. (The centre has since been renamed and Unum claim they no longer provides any funding – no doubt because of the claims that academic integrity could be called into question by its influence.)

The Scientific and Conceptual Basis of Incapacity Benefits by Gordon Waddell and Mansel Aylward, followed by the 2006 report: Is work good for your health and well-being by Gordon Waddell and Kim Burton, were both very influential reports that were commissioned by the DWP and so inclined towards ideologically biased outcomes from the start. Both reports were produced when Aylward and Waddell were sponsored by UnumProvident – Centre for Psychosocial and Disability Research ( at Cardiff  University) – with funding of course from Unum Provident, from 2004-2009.

In January 2003, an influential book, Malingering and illness deception was published as a very large hymn crib sheet that was to inform political rhetoric, media justification narratives and the subsequent welfare “reforms.” It was also funded by the DWP, with telltale dogma and schematic contributions from Gordon Waddell, John LoCascio of UNUM Provident Insurance Company, and of course there is this telling acknowledgment:

The meeting which formed the basis for this book would not have been possible had it not been for the enthusiastic support of Professor Mansel Aylward and funding from the Department for Work and Pensions.” 

The book has political agenda-setting chapter sub-headings such as: Investigating benefit fraud and illness deception in the United Kingdom, Malingering, insurance medicine, and the medicalization of fraud and Wilful deception as illness behaviour. 

Unum insidiously built up credibility and influence in Britain. The company appointed Mansel Aylward as director of their Centre for Psychosocial and Disability Research, following his retirement from the DWP. The launch event was attended by Archie Kirkwood, who was appointed chair of the House of Commons select committee on work and pensions. Malcolm Wicks, minister of state in the DWP, gave a speech praising the “partnership between industry and the university.”

The whole aim of the centre was to transform the ideological paradigm of welfare from one based on a rights-based post- war collectivism to one increasingly enclosed by a responsibility-based individualism and so help develop the market for Unum’s products. In 2005, the centre produced The Scientific and Conceptual Basis of Incapacity Benefits (TSO, 2005) written by Aylward and colleague Gordon Waddell. It provided the conceptual framework for the 2006 welfare reform bill.

Of course the more recent widespread criticism of “Atos” assessments in the UK has been beneficial to Unum as it undermines confidence in state provision of disability benefits. Such a profound loss of confidence makes it much easier to sell alternatives: private insurance. 

Its methodology is the same one that informs Unum’s approach. Is work good for your health and well-being by Gordon Waddell and Kim Burton was also a very influential report, both were also commissioned by the DWP and so inclined towards ideologically biased outcomes from the start. Just to be clear, both reports were produced when Aylward and Waddell were sponsored by UnumProvident – Centre for Psychosocial and Disability Research (the Centre) at Cardiff  University, with funding by Unum Provident, from 2004-2009.

Among the spurious ideas used to justify cutting lifeline social security support is that disabled and ill people are not working because of an “internalisation of the sick or “patient” role as the dominant feature of their lives,” and that “work is good for health.” 

In a memorandum submitted to the House of Commons select committee on work and pensions, Unum define their method of working: “Our extended experience […] has shown us that the correct model to apply when helping people to return to work is a biopsychosocial one.”

The emphasis, however, is on the “psychosocial”. This shifts the focus from the medical conditions that cause disability and illness to the behaviours and perceptions of patients and ultimately, to neoliberal notions of personal responsibility and self-sufficient citizenship in a context of a night watchman, non-welfare state. 

Waddell and Aylward adopted the same arguments in their monograph. Disease is the only form of objective, medically diagnosable pathology. Sickness is a temporary phenomenon. Illness is a behaviour. Incapacity Benefit trends are a social phenomenon rather than a health problem. The solution is not to cure the sick, but a “fundamental transformation in the way society deals with sickness and disabilities” (p123). The goal and outcome of treatment is work, because work is therapeutic.

Worklessness is a serious risk to life. It is “one of the greatest known risks to public health: the risk is equivalent to smoking 10 packets of cigarettes per day” (p17). And: “No-one who is ill should have a straightforward right to incapacity benefit.”

David Freud adopts the same spurious psychosocial approach in a report that formed a review of the government’s Welfare to Work strategy. He cites Waddell and Burton: “Work is good for health.” (From “Is Work Good for your Health and Well-Being”, 2006)

Aylward has been widely criticised for giving “academic” credibility to the biopsychosocial model which was said to be the basis of the Cameron government’s disability benefits “reforms”. Aylward prepared reports that were quoting “illness belief” as being a supposedly more likely cause for many “common mental health conditions” or “musculoskeletal conditions”. There were repeated references made in some of his and Gordon Waddell’s research to alleged “malingering” by patients.

“Obstacles to recovery and return to work are primarily personal, psychological and social rather than health-related “medical” problems.”

“Beliefs, perceptions and personal responses lie at the heart of the problem [of worklessness through ill health].”  Worklessness and Health: A Symposium – Mansel Aylward.

It’s worth noting that the “musculoskeletal conditions” include backache, pulled ligaments and muscles, injured tendons, prolapsed spinal discs, sciatica – all of which a person may fully recover from. This category of conditions also includes osteoarthritis, osteoporosis and more serious and chronic illnesses caused by connective tissue disease – most people do not recover from these, and the biological damage that this family of diseases cause is not just confined to the musculoskeletal system. By using such a broad category of wide-ranging conditions, this effectively trivialises the most serious and often progressive diseases in the category.

This is why I visit my doctor, and not the government or a “researcher” with a vested interest, when I am unwell. I don’t believe anyone was ever cured by ideology. Nor do I believe work is a “health” outcome. If the protestant work ethic is such an effective cure for disease, the Victorian era “trial” certainly didn’t provide any empirical evidence of that in the premature mortality rates. In fact both men and women were debilitated by the age of forty. Poor nutrition, long hours and premature full-time employment all contributed to a short life expectancy. (Daily Life in Victorian Britain, Sally Mitchell, 1996.)

Although life span slowly increased within the Victorian age, notably as treatment became more advanced, surgery more effective, and medical knowledge more extensive, the average life span in 1840, in the Whitechapel district of London, was 45 years for the upper class and 27 years for tradesman. Laborers and servants lived only 22 years on average. (Victorian Britain Encyclopedia, Sally Mitchell, 1988.)  

Aylward claims that the principal negative influences on return to work are: Personal / psychological: Catastrophising pain (even minor degrees). Low Self-Efficacy. Social: Lone parenthood / unstable relationships – being a “Victim” of modern society in rented or social housing. General Affect: Being sad or low most of the time: Pervasive thoughts about personal illness. Cognitive: Minimal health literacy. Self-monitoring (symptoms). False beliefs. Economic: Availability of alternative sources of income / support (such as the availability of health care and welfare. (Pages 15-16).

“Catastrophising pain” is a phrase that crops up in a lot of biopsychosocial texts. It’s another of those made up words and phrases, like “worklessness”, “making work pay” and “culture of dependency” which are just ideological signposts to neoliberal notions of competitive individualism, anti-welfarism and personal responsibility, without any reference to reality. And if you make a claim that sickness and pain are “subjective”, surely attempts to describe how other people subjectively experience sickness and pain is even more subjective.

And accusing someone else of holding false beliefs regarding their own state?  Really? You can’t get further away from empirically verifiable statements than that.

The UK government and the Reform think tank claim that the availability of social security serves as a “disincentive” for ill and disabled people to return to work. The cuts to essential lifeline support for people who are ill and disabled that have been embedded in the systemic welfare “reforms” are all about “promoting economic self-sufficiency.”  

However, that is precisely what public national insurance contributions are about. The idea originally was that social provision should be designed to protect people from the ravages of absolute poverty and capitalism – it was intended to support poor citizens  – and to speculate that such support actually makes people poor is simply incoherent pseudoscientific nonsense and derisory political posturing from the “private” state neoliberals.

Aylward highlights more than once on his writing a perceived tension between “disability rights” and state notions of “benefit dependency.” (for example, on Page 8 of  Worklessness and Health: A Symposium). 

Yet Unum say:  “And contrary to popular belief, if your employees are aware of benefits – such as private health insurance or Income Protection – they are not likely to take more time off sick. Cass’ research shows that communicating about a wide range of employee benefits actually builds employee engagement and a more loyal workforce that takes less time off sick.”  Unum: How to communicate your employee benefits package.

However, there are conflicting messages to employers on this issue: “Sick-pay provisions may also encourage or discourage absence, and it is important that an organisation monitors and analyses its absence recording systems in order to pick up any perverse behaviours being driven by the sick-pay schemes. For example, it is not uncommon to see spikes of return to work when an absent employee moves to half pay or no pay.”

The cure for sick leave is work and other gems of wishdom

The biopsychosocial model has become a disingenuous euphemism for psychosomatic illness, which has been exploited by medical insurance companies and by governments keen to limit or deny access to social security, medical and social care.

This approach to disability and ill health has been used to purposefully question the extent to which people claiming social security bear personal responsibility for their own health status, rehabilitation and prompt return to work. It also leads to the alleged concern that a welfare system which provides a livable income to those with disabling health problems may provide “perverse incentives” for perverse behaviours, entrenching “worklessness” and a “culture of dependency”. It’s worth pointing out at this point that there has never been any empirical evidence of welfare “dependency”.

Instead of being viewed as a way of diversifying risk and supporting those who have suffered misfortune, social and private insurance systems are to be understood as perverse incentives that pay people to remain ill and keep them from being economically productive.

The government have made it clear that there are plans to merge health and employment services. In a move that is both unethical and likely to present significant risk of harm to many patients, health professionals are being tasked to deliver benefit cuts for the DWP. This involves measures to support the imposition of work cures, including setting employment as a clinical outcome and allowing medically unqualified job coaches to directly update a patient’s medical record.

The Conservatives (and the Reform think tank) have proposed mandatory treatment for people with long term conditions (which was first flagged up in the Conservative Party Manifesto) and this is currently under review, including whether benefit entitlements should be linked to “accepting appropriate treatments or support/taking reasonable steps towards “rehabilitation”.  The work, health and disability green paper and consultation suggests that people with the most severe illnesses in the support group may be subjected to welfare conditionality and sanctions.

Such a move would have extremely serious implications. It would be extremely unethical and makes the issue of consent to medical treatment very problematic if it is linked to the loss of lifeline support or the fear of loss of benefits. However this is clearly the direction that government policy is moving in and represents a serious threat to the human rights of patients and the independence of health professionals.

Behavioural medicine is prevalent in the United States, where many health problems are primarily viewed as behavioural in nature, as opposed to medical. The biopsychosocial model of illness has encouraged unsubstantiated claims that “positive attitude” or “fighting spirit” can help slow cancer and other progressive diseases, which may be very harmful to the patients themselves. Patients may come to believe that a poor prognosis or their poor progress results from “not having the right attitude”, when in fact it is most likely through no fault of their own.

Increasingly, insurers, policy makers and employers are pressing for policies that would redistribute expenses resulting from what they regard to be “voluntary” health risks to those who “choose” to take such risks.

Of course the long term aim of the Conservatives is to dismantle social security and the National Health Service (NHS) – free health care provision – entirely. Access to health care in the UK is currently being rationed because of the government’s systematic cuts to the NHS budget, and payments for some treatments have been introduced by stealth.  

Unum say:The Green Paper also calls for proposals to overhaul sickness certification and GPs’ approach to Fit Note. Unum has been calling for reform of Fit Notes so more people are able to access the right support to return to work as soon as possible.”

By that phrase “the right support” the predatory private company are simply singing from the same crib sheet as the government. Lots of mutual back patting and private handshakes have sealed the deal of doom for the welfare state long ago. The “right support” simply entails removing any support at all for ill and disabled people so that they are forced to work or starve and become destitute.

Unum’s modus operandi in the US was based on the unscrupulous practice of putting profit over human health. A 2004 investigation determined the practice began as early as 1994, and a CBS 60 Minutes report revealed the company established a quota for denied claims and actually offered incentives to employees who denied valid claims from policyholders. The company also delayed claims to make profit.

Unum was forced by state regulators to re-open 290,000 disability insurance claims that had been rejected, including a case where “Unum insisted that a man who had quintuple bypass surgery was fit to go back to his job at a stock brokerage firm, even though his doctors said the stress might kill him” and also, where Unum “refused benefits to a man who had had multiple heart attacks”

An investigation in California found that Unum systematically violated state insurance regulations and fraudulently denied claims using phony medical reports, policy misrepresentations, and biased investigations. The rogue company admitted to only reviewing 10 percent of the eligible cases for reopening under the terms of their legal settlement reached three years earlier.

Unum’s callous profiteering and illegal behaviour led California Insurance Commissioner John Garamendi to state that “UnumProvident is an outlaw company. It is a company that for years has operated in an illegal fashion.” A Yale University research paper commented that, with regards to Employee Retirement Income Security Act (ERISA) and other cases, Unum was “engaged in a program of deliberate bad faith denial of meritorious claims.” 

Yet this is the company admired and unscrupulously hired by UK governments as a “leader” in dealing unscrupulously with disability claims, and violating the human rights of disabled people.

The cooperation between the UK government and Unum stems entirely from a community of mutually vested interests between them, with both the corporate vultures and their allies in government wishing to reduce the amount of people who are able to claim disability through sickness; the government so it can pay less and less of our money in social security to people who need to draw on their national insurance for support and the insurance company so it can profitably contest or refuse more insurance claims. 

So, after the systematic cuts to social security have been persistently justified by an alleged need to “change the behaviours” of poor people and to “incentivise” them into work, we now have behavioural change treatments becoming more prominent in health care and medicine. In the same way that poor people are held responsible for poverty, ill people are held responsible for illness. Just as ministers claim that poor people are a “burden” on public services and tax payers, now they are saying ill people are a burden on the NHS and tax payers… just take a moment think that through.

The Conservatives came up with an idea that will kill two birds with one stone, as it were. They decided to demand that poor people think work is good for health. They plan to combine the goals of job centres and GP surgeries. Job coaches are the new health care professionals, apparently. Of course that anti-welfare and anti-health care strategy won’t change a thing, except to make people who are ill and out of work even more miserable, poor and ill.

Political authoritarianism, neoliberalism and façade democracy present a tragicomedy that creates the ultimate experimental théâtre de l’absurde, transforming lucrative big business propositions of crony capitalism into Schadenfreude; groaning clichés and stereotypes, political scapegoats and outgroups. Irrational, anecdotal populist “common sense” soundbites become incoherent, cognitive dissonance-inducing justification narratives. For ordinary citizens this fanfares increasingly irrational and draconian policies – the “science” of imaginary solutions to fictitious citizen “behavioural” problems in a Théâtre de la Cruauté (cruelty) – because of a strong motivation to control, rule and empty the public purse into private bank accounts (usually offshore), rather than recognise public needs and interests, and include the masses in democratic decision-making and the economy.

The government think that social justice is actually about “incentivising” those at the wrong end of politically constructed socioeconomic problems with punishments. I’m surprised we haven’t seen the reintroduction of public thrashings, flogging and the ducking stool. Meanwhile the people responsible for hoarding all the wealth and causing poverty for others – and to a considerable degree, contributing to health inequalities too – well they get the deluxe package of privileged incentives – tax cuts, high esteem, status and a pat on the head just for being sanctimonious, greedy, grasping, antisocial money hoarders, enforcing the equivalent of an economic enclosure act. They also have a lot of power and freedom, and so get to write a lot of policies that help them make profits and thus hoard even more of what was once our public wealth.

It’s curious how ministers claim that throwing money at a problem doesn’t change it. They’re right: the very worst of the hoarding and wealthy elite remain the biggest socioeconomic problem with faulty behaviours that we face as a society.

But poor people are poor because of a lack of money. Taking more money from them that they don’t have won’t cure poverty. You can’t thrash wealth into someone. You can’t thrash poverty out of someone. I really should not have to explain that like a patient parent explains the way things work to a toddler. But the Conservatives have a form of arrested development, and cling to their reductionist rituals of ontological security. They refuse to learn. The government are too busy telling us how they think society ought to be, they never have time or an inclination to listen to mere citizens. Big businesses take up every shred of their attention.

We know from recent history that once the Conservatives start to hold people responsible for problems that are not their fault, the public institutions that support people facing social difficulties are in peril – usually through the increasing privatisation of services, and ultimately, through the dismantling and transformation of publicly funded social support mechanisms to purely private profit generating mechanisms for the crony vulture capitalists. The only people set to gain in the long term from all of this political destruction and mis-spending from the public purse are the big vulture capitalist insurance companies, who have also had a hand in the construction of narratives of “personal responsibility” economic self sufficiency, thrift and self help. Perhaps Neoliberal governments should develop a policy of providing invisible bootstraps for citizens to pull themselves up from the damage being inflicted on them from a great height. 

When you hear the same incoherent crib sheet responses over and over, and see the intentional political stigmatisation of social groups, you come to recognise the pattern of preemptive justificationism and the malicious and greedy intent behind the draconian policies.

It’s goodbye to the welfare state, the NHS and democracy, and hello to the new wealth care. 

The ministry of plenty say that private interest is public interest.

All hail the corporatocracy.

 

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Footnote

(Update: I shared this article in a few Facebook groups last night with no problem. Some 12 hours later, I just tried to share this article in one group on Facebook and received a ban from posting in groups immediately, with no reason provided for the restriction on my account. I can’t share posts for a week and suspect the content of the article is what has triggered the ban. I certainly haven’t violated any of Facebook’s community rules or posted this in a way that could have been construed as “spamming”.

I appealed Facebook’s seemingly random decision and have had no response at all. I posted this article and asked my friends to share it. After posting that request, my account restrictions have been extended by a further two hours, with no reason provided by Facebook.

Facebook are a client of Edelman Intelligence. Someone should tell both companies that if you insist on censoring information, such repressive action tends to ensure items are shared much more widely than they would have been ordinarily.)

Related

Unum welcomes Green Paper focus on Group Income Protection  Unum

MUTUAL BENEFITS  Private Eye

A Tale of two Models: Disabled People vs Unum, Atos, Government and Disability Charities – Debbie Jolly

Two Apparent Irregularities Involving UNUM, ATOS, And DWP – George K Berger

FROM THE BRITISH WELFARE STATE TO ANOTHER AMERICAN STATE – Mo Stewart

MAGICAL MEDICINE: HOW TO MAKE A DISEASE DISAPPEAR  ME Action UK

Health at work – an independent review of sickness absence  Carol Black and David Frost

Trust Law as Regulatory Law: The Unum/Provident Scandal and Judicial Review of Benefit Denials under ERISA  John H. Langbein 

TRIAL BY ERROR: The Troubling Case of the PACE Chronic Fatigue Syndrome Study – David Tuller

Major breakthrough on PACE trial – George Faulkner

Fit for Work: a quick guide for General Practitioners – The government: our armchair doctors and shrinks

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

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

Nudging conformity and benefit sanctions

 


 

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

Debbie Abrahams MP, Shadow Secretary of State for Work and Pensions, said that she will scrap punitive benefit sanctions and the discredited Work Capability Assessment, at the Labour Party Conference in Liverpool. The pledge was echoed by newly re-elected party leader Jeremy Corbyn in his main speech to the conference. He said a Labour government would be “scrapping the punitive sanctions regime and the degrading work capability assessment.”

Here is a transcript of Debbie’s excellent speech:

“It is a real honour to stand here before you as the Party’s spokesperson for Work and Pensions, my first time on the Conference platform.

Conference, we live in troubling times. Our nation seems more adrift than ever. Our troubles often seem insurmountable.

But when I’m faced with complexity and difficulties, I recall some wise words: “The more complicated something is, the more important it is to define what your simple truths are.”

So, what are my ‘simple truths’? First, I am a socialist. I believe that society is stronger – can achieve more – when we stand together, and that every citizen has an equal stake in our future.

It is to me a simple truth that a nation aspiring to decency and fairness does not punish the disabled and disadvantaged.

It is to me a simple truth that the way a government prioritises finite finances reveals its authentic self.

So when this Tory Government imposes the bedroom tax on disabled people but gives tax breaks to millionaires, then their own simple truths are laid bare.

It is to me a simple truth that where the dignity of rewarding work is deprived to millions through a lack of quality jobs, the rise of zero-hours contracts, and indignities heaped on loyal work forces by the likes of Sports Direct and BHS, then social and economic progress is stunted.

And it is also a simple truth that targeting the most vulnerable in our society damages the least vulnerable, too. If you haven’t already, please read the Richard Wilkinson’s and Kate Pickett’s book, The Spirit Level.

This shows that societies with a wider gap between rich and poor experience higher levels of infant mortality, lower life expectancy, poorer mental health, and less social mobility.

To me, as a former academic, it is a simple truth that evidence-based policy must replace policy-based evidence. That’s why I’m a socialist. Because all the evidence points to another simple truth.

By building a society where the hope of progress is genuine and realistic and not forlorn, where every citizen feels themselves an equal participant in our nation, and where government is seen to be working for everyone, we create a virtuous circle of growth, stability and contentment.

For all the Prime Minister’s warm words, it is by her actions we will judge her. She has been a senior member of a government that has chosen to visit austerity on the most vulnerable in society. She has been a senior member of a government that continues to rain down on our education system ideological reforms with little or no evidentiary justification. And she has been a senior member of a government where the number of foodbanks increased ten-fold in 4 years.

Conference, inequality is not inevitable. We are all here precisely because we know that change is both possible and necessary.

Today there are 3.9 million children living in poverty, and children’s charities are estimating that will be 5 million. Conference, children being in poverty affects not just their childhood but their whole future life chances.

And the five million disabled people living in poverty because of the extra costs that they face associated with their disability, is set to increase as a result of even more cuts in social security support.

While I am proud of the last Labour Government’s success at reducing pensioner poverty, women and the lowest paid remain at high risk of falling into poverty in their retirement.

This injustice is being extended to 2.6 million women born in the 1950s, who have been short-changed by this Government bringing forward their state pension age.

The pensions system that I want to see ensures dignity in retirement, and a proper reflection of the contribution that older people have made, and continue to make, to our society.

This Government has fostered an insidious culture of fear and blame to justify their programme of cuts, deliberately attempting to vilify social security claimants as the new undeserving poor.

I wanted to show you the trailer from Ken Loach’s new film ‘I, Daniel Blake’ as I think it sets out so clearly much of that is wrong with the current social security system.

I believe there is a better way, a fairer way. One where Britain is the centre of a new industrial revolution with industries and technologies as diverse as our people.

To achieve this, we need to invest in our greatest asset – our citizens – nurturing a highly skilled workforce and rebuilding our country.

For too long the labour market has been dominated by poor quality, low paid, insecure jobs resulting in two thirds of children living in poverty coming from working families. Four in every five people working in low paid jobs are still stuck in them ten years later.

For those unable to work through illness or disability, we need to transform our social security system to one that is efficient, responsive, and provides basic support. Time and time again, I hear of how worthless the system makes people feel. For the vast majority of people who have paid into it all their working lives, this is like a slap in the face. People often feel desperate, have been left destitute and have even died.

I want to change the culture of our social security system and how the public see it. I believe that, like the NHS, it is based on principles of inclusion, support and security for all, assuring us of our dignity and the basics of life were we to fall on hard times or become incapacitated, giving us a hand up, not a hand out.

Work should always pay more than being on social security, but being in work shouldn’t mean living in poverty and neither should being on social security.

The Labour Party has already pledged to get rid of the discriminatory and unfair Bedroom Tax. But I want to go further.

I want to scrap the discredited Work Capability Assessment and replace it with a system based on personalised, holistic support, one that provides each individual with a tailored plan, building on their strengths and addressing barriers, whether skills, health, care, transport, or housing-related.

This Government’s punitive sanctions system must go too, so Job Centre Plus and employment support providers’ performance will not just be assessed on how many people they get off their books.

I want to see disabled people better supported into and at work. We will halve the Disability Employment Gap – and when we say it we mean it. And we will tackle other labour market inequalities too.

I believe in a fair and just Britain, where everyone can get on and no-one is left behind.

Labour’s policies will deliver prosperity for all and tackle the inequalities and poverty in Britain today.

I challenge the Government to deliver theirs.”

 


I just wanted to add a note of clarification, as some people are claiming that it isn’t the intention of the Labour party to scrap sanctions entirely. There has always been a degree of benefit conditionality, since the inception of the welfare state. This has not previously been particularly problematic, and a reasonable degree of government accountability and protecting the “public purse” has always been expected from the public.

However, the Conservatives introduced a very harsh and punitive regime in 2012, extending the use of sanctions to include previously protected social groups, such as lone parents and sick and disabled people. The severity and length of the sanctions was also radically increased, and as we know from evidence gathered since 2012, it is these changes that have caused so much hardship and distress for many people.

We also know that sanctions are very often applied unfairly, and that one of the main aims of them is to cut costs and reduce the welfare state. Instead of supporting citizens, our social security is now about coercing citizens into “job seeking” rule-following and conformity, regardless of the employment market conditions and other social and economic constraints.

The Conservatives introduced these changes because they think that coercive “behavioural change” techniques may align citizens’ behaviours with neoliberal outcomes. Their sanction regime is founded on a nudge theory – that we have a “cognitive bias” called loss aversion. The Conservatives expect that by manipulating this alleged bias – using the fear of financial loss – people will comply and get a job. That assumes, of course, that the cause of unemployment is something that happens within an individual, and not because of political decision-making and socioeconomic conditions. 

In this context, sanctions are a punishment for non-compliance with politically defined outcomes, directed entirely by economic dogma. It’s a form of operant conditioning. It does not take into consideration the real structural socioeconomic barriers that people face in finding appropriate work. Instead the individual is held responsible for the failings of a competitive, market-based system.

The stigmatisation of people needing social security – the political and cultural use of dehumanising metaphors and rhetoric – has been used to justify the ideologically-driven dismantling of the welfare state and the other gains of our post-war settlement. The punitive sanction regime is part of this process of political demolition. This is clearly a political misuse of “psychology”. Perhaps it’s more accurate to say it’s a technocratic application of techniques of persuasion: the marketing strategy and packaging for controversial “small state” and authoritarian neoliberal policies.

Debbie acknowledges much of this. She has promised to repeal the Conservative’s punitive sanction regime and the WCA. Her speech indicates clearly the direction of travel for the Labour party.

I welcome that. I’m certain that many others will. It’s long overdue.

Kitty

Related

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

 

 


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