Labour’s Disability Equality Roadshow comes to Newcastle

Jeremy Corbyn, Paul Rutherford and Debbie Abrahams, Shadow Work and Pensions Secretary, at the launch of Labour’s Disability Equality Roadshow. She is talking to people across the country about what disabled people want to see in Labour’s next manifesto. If you’re a Labour Party member keep an eye on updates from the National Policy Forum for more opportunity to get involved.

The Labour Party’s Disability Equality Roadshow was launched in Manchester in November and is set to go nationwide over the coming months. This democratic engagement process is the vitally important first step in developing policies which will address the structural  (social, cultural, political and economic) issues affecting disabled people and their carers across the UK, as well as the challenges we all face in building a fairer, more equal society.

At the launch, Paul Rutherford said: “This initiative will enable Labour to develop real policies which will properly support disabled people, not punish and harm them, making their often difficult lives harder, which is what this government’s policies are doing.”

Debbie Abrahams added: “The roadshow will draw on the experiences and expertise of disabled people themselves who have been particularly affected by this Tory Government’s changes to social security.”

After six years of Conservative policies that have not involved any genuine consultation and engagement with disabled people in political decision-making processes, we have witnessed a raft of increasingly punitive measures and cuts that have been imposed on us, supposedly to “incentivise” the poorest citizens – presumably to be less poor – by imposing financial punishments and stigma on them. Invisible bootstraps were included in the government’s basic incentives package.

The phrase “behavioural change” has become a euphemism for traditional Conservative prejudice, blaming individuals for structural barriers and politically constructed problems. “Incentivising” is another euphemism for discrimination and punitive state behaviour modification policies, such as benefit sanctions, for the poorest people. It’s also a fundamental part of a justification narrative to advance the dismantling of the welfare state in stages, a cut at a time.

The wealthiest people, however, have been presented with the deluxe package of Conservative “incentives”, which entail generous handouts in the form of tax cuts and endorsed exemptions. Such policies, which take lifeline income from the poorest citizens, including those in low paid or part-time work, and award it to the very wealthiest cannot fail to extend and accentuate growing inequalities and increase social and economic exclusion.

This topical comment was very welcomed on Saturday: 

“Tax justice means that supporting disabled people IS sustainable. This is our flag in the sand”. Grahame Morris, Labour MP, on Labour Party priorities at the Disability Equality Roadshow, Newcastle.

Debbie said: Firstly, an inclusive labour market is one that finds the right job for those who can work. The Tory government has focused solely on getting people ‘off-flow’, forcing them into any job to bring down claimant numbers, or none, for example, as a result of sanctions.

I believe there is a fairer way; a more holistic, person-centred approach that looks at people’s strengths and barriers to work whether this relates to skills or housing issues. We need to provide them with the best possible employment support but also opportunities to work.”

And on support for disabled people in work: “Ensuring that proper workplace adjustments are made to retain disabled people who are in work is a vital part of an inclusive labour market. These adjustments could be in the form of more flexible leave arrangements as well as extending Access to Work which currently only supports a tiny minority of disabled people, approximately 36,500 out of 3.7 million in work.”

The Roadshow is part of Labour’s commitment to transform our social security system, ensuring that, like our NHS, it is fit for purpose; there for us all in our time of need.

The Disability Equality Roadshow is using the UN Convention on the Rights of Disabled Persons as a framework to help develop a wide array of policies, not just those concerning social security, but also embedding the convention articles in education, health and social care, justice policies and many others.

The Labour Party has already pledged to scrap the discriminatory and unfair Bedroom Tax. Debbie Abrahams announced at Labour Party Conference that a Labour government will also scrap the discredited Work Capability Assessment. Debbie said she wants to 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.”

Debbie has asked for our help in exploring how this might be achieved.

Many of us welcomed the announcement from Debbie that a Labour government will get rid of this Government’s punitive sanctions too. As Debbie pointed out: “This will mean Job Centre Plus and employment support providers’ performance will not just be assessed on how many people they get off their books.”

She also discussed the need for a culture change regarding the prejudiced attitudes of many regarding people with disabilities and those out of work.

The event on Saturday was hosted at Unite the Union.

Saturday 3 December was also the International Day for Disabled People.

dis-eq-roadshow Democracy and inclusion in action: discussing social security

Some of the issues that we discussed:

  • We raised individual cases that demonstrated the terrible distress caused by the work capability assessment (WCA) and the serious impact that being told wrongly they are fit for work has on people who are very ill. Labour will scrap the WCA. We said that the evidence that should be considered in claims for disability related benefit should always be medical – presented by qualified doctors and specialists, not from “functional assessment” carried out by non-specialised occupational therapists and nurses employed by private companies hired to cut benefits and make a massive profit at our expense.
  • We must also move away from any process of assessment that is intimidating and distressing. People generally felt that the DLA system was much fairer, with provision for life long awards for chronic and progressive conditions.
  • Increasingly, private companies are taking up money from the social security budget, whilst those that the budget is meant to assist are seeing their support cut and their standard of living plummet. Many are now unable to meet their most basic needs – such as having sufficient income to meet the costs for food and fuel.  It was suggested that benefit levels are set by a specialised  committee, ensuring that the costs of basic needs can be met.
  • As benefits were originally calculated to meet only basic needs, the additional costs of housing and council tax were not included in the benefit level when it was originally calculated. It was assumed that people would remain exempt from paying any additional rent and council tax. That needs to be addressed, since benefits do not cover these or the bedroom tax (though Labour intend to scrap the bedroom tax).
  • The new in-work conditionality is likely to impact on disabled people, many of who may need to work part-time. Shorter and flexible working hours are a reasonable adjustment. Some of us have to also manage hospital appointments with more than one specialist and hospital based treatment regimes. The threat and use of sanctions aimed at part-time and low paid workers is incompatible with the aim of “halving the disability employment gap.”
  • We suggested that employers should fined for not employing a quota of disabled people, rather than being rewarded, as suggested in the government Green Paper, for employing disabled people, given that disabled people have a right to socioeconomic inclusion, including the right to work, without discrimination.
  • The Equality Act was not implemented in full by the Coalition. This limits redress for disabled people regarding:  
    • Dual discrimination: the government decided not to bring this into force as a way of reducing the cost of regulation to business. 
    • Socioeconomic inequalities under the Public Sector Equality Duty 
    • Provisions relating to auxiliary aids in schools
    • Diversity reporting by political parties
    • Provisions about taxi accessibility among other things. These omissions need to be remedied. 
  • Accessibility issues were also raised, ranging from the lack of provision and accessibility for disabled users of public transport and taxis to the lack of large print ESA forms available for people with visual impairments and barriers regarding the availability of home visits for assessments.
  • Run-on benefits for people starting work need to be reinstated, since people usually work a month at least before being paid a wage. Previously, housing benefit, council tax and other benefits were payable for the first month of employment.
  • We discussed the need for culture change to address prejudice, and the now commonly held negative perceptions and attitudes towards disabled people and those out of work.

There were three other task groups, some worked on addressing barriers to access to justice, others worked on disability and barriers at work, among other topics, all of who raised many other issues, which were also fed back. 

It was a very productive and positive event: an excellent opportunity for democratic inclusion in the decision-making process and to contribute positively towards progressive Labour policies.

Of course that process doesn’t stop with the Roadshow events, but in the coming months, if you can get to the Roadshow when it comes to your area, it’s recommended you do. If you’re a Labour Party member you can follow updates from the National Policy Forum, which also provides further opportunity to get involved.

“Nothing about us without us,” as Gail Ward summarised on the day. 

Debbie has asked if I would contribute in a collaborative response to the government’s recent consultation and green paper on work, health and disability, which I’ve agreed to do. 

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, citizen’s accounts of the impacts of policies ought to matter. It’s very reassuring to know that the Labour party recognise this, especially in a context of an increasingly authoritarian government that isn’t interested in first-hand witness accounts concerning the terrible consequences of their draconian policies. 

Any consideration of future policy and its impacts must surely engage citizens in dialogue, on a democratic, equal basis and ensure participation in decision-making, to ensure an appropriate balance of power between citizens and government.

The Labour Party recognise that democracy is not something we have: it’s something we  must DO, and that process includes all of us. 

One final point that needs raising is that the progressive left – particularly Labour – do not find any favour with the mainstream corporate media, generally speaking. It is therefore down to all of us to bypass the constraints of media neoliberal framing, to ensure that news of Labour policies and events like this are shared widely. Otherwise genuine alternative narratives to the current socioeconomic paradigm and order will continue to be systematically stifled, at a time when there has never been a greater need for alternatives.

Upwards and onwards. 

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With Alex Cunningham, Debbie Abrahams and Gail Ward on Saturday at the Disability Equality Roadshow 

I’d like to thank Debbie Abrahams, Grahame Morris, Alex Cunningham, Ian Lavery, Ian Mearns, Emma Lewell-Buck, Richard Williams, Dave Allen, Labour North, Unite the Union, and every one who came on Saturday for an excellent and very productive, hope-inspiring event.

The government’s in-work sanctions are incompatible with ‘halving the disability employment gap’ (and other ideological problems)

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The government have introduced in-work sanctioning for low paid and part-time workers to “incentivise” them to “progress” in work. Historically, wages and employment conditions were raised, and hours were often negotiated by Trade Unions. Now those decisions are entirely down to the executive decisions of employers not employees. Sanctioning employees is grossly unfair, because they have very little negotiating and bargaining power (especially since the raft of Conservative anti-collectivist and anti-Trade Union legislation) to improve their lot.

There is also a significant growing body of empirical evidence that informs us sanctions do not work as the government claim.

It’s not as if employees’ behaviour is at fault or that they would ever actually want poor pay, fewer rights and adverse working conditions – that’s down to exploitative employers who are primarily profit driven. It’s hardly fair to punish workers for the motivations and behaviour of their employers.

There are profoundly conflicting differences in the interests of employers and employees. The former are generally strongly motivated to purposely keep wages as low as possible so they can generate profit and pay dividends to shareholders and the latter need their pay and working conditions to be such that they have a reasonable standard of living. 

Clearly, the weight of favour in policy-making is heavily towards big business profiteering. Implying that the behaviours of workers are a problem in this context is simply another way justification is presented for the further erosion of state responsibility and support and ultimately, the long term plan is to remove such support completely.

Workplace disagreements about wages and conditions are now typically resolved neither by collective bargaining nor litigation but are left to management prerogative. This is because Conservative aspirations are clear. Much of the government’s discussion of legislation is preceded primarily with consideration of the value and benefit for big business and the labour market. They want a cheap labour  force and low cost workers, unable to withdraw their labour, unprotected by either Trade Unions or employment rights and threatened with destitution via benefit sanction cuts if they refuse to accept low paid, low standard work. Similarly, desperation and the “deterrent” effect of the 1834 Poor Law Amendment Act – the principle of less eligibility – also served to drive down wages.

In the Conservative’s view, trade unions distort the free labour market which runs counter to New Right and neoliberal dogma. Since 2010, the decline in UK wage levels has been amongst the very worst in Europe. The fall in earnings under the Coalition is the biggest in any parliament since 1880, according to analysis by the House of Commons Library, and at a time when the cost of living has spiraled upwards.

In-work conditionality enforces a lie and locates blame within individuals for structural problems – political, economic and social – created by those who hold power. Despite being a party that claims to support “hard-working families,” the Conservatives have nonetheless made several attempts to undermine the income security of a significant proportion of that group of citizens recently. Their proposed tax credit cuts, designed to creep through parliament in the form of secondary legislation, which tends to exempt it from meaningful debate and amendment in the Commons, was halted only because peers in the House of Lords have been paying attention to the game.

Sanctioning people in work flies in the face of the government’s previous “hard working families” mantra. But it also flies in the face of their aim to “help” disabled people into work. Many of disabled people would have to work part-time: reduced and flexible hours are also a reasonable adaptation, especially for people who are ill. Many of us also have to accommodate hospital appointments, often with a variety of specialists, as well as hospital based treatment regimes. All of which probably makes us much more likely to face in-work sanctioning in the future.

How does this address the “disability employment gap”? 

The government propose tax cuts and other rewards for employers who employ disabled people in their recent consultation on work, health and disability. However, it is against the law to treat someone less favourably than someone else because of a personal characteristic, such as being disabled.

Furthermore, disabled people have a legal RIGHT to work and to be included in the economy, and I think in light of this, employers should be fined for not employing a quota of disabled people instead. “Disability Confident” is supposed to be about supporting disabled people, not providing publicly funded handouts to employers, whilst at the same time, financially punishing the very people that the policy is supposedly designed to “support.”

There was some very worrying discussion in the recent work health and disability green paper about new mandatory “health and work conversations” in which work coaches will use “specially designed techniques” to “help” disabled Employment and Support Allowance (ESA) claimants “identify their health and work goals, draw out their strengths, make realistic plans, and build resilience and motivation.” Apparently these conversations were “co-designed with disabled people’s organisations and occupational health professionals and practitioners and the Behavioural Insights Teamthe controversial Nudge Unit, which is part-owned by the Cabinet Office and Nesta. 

It’s very evident that “disabled people’s organisations” were not major contributors to the design. It’s especially telling that those people to be targeted by this “intervention” were completely excluded from the conversation. Sick and disabled people are reduced to objects of public policy, rather than being seen as citizens and democratic subjects capable of rational dialogue.

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

Food deprivation is closely correlated with both physical and mental health deterioration. Maslow explained very well that if we cannot meet basic physical needs, we are highly unlikely to be able to meet higher level psychosocial needs. The government proposal that welfare sanctions will somehow “incentivise” people to look for work is pseudopsychology at its very worst and most dangerous. State imposed sanctions on sick and disabled people are known to have very harmful consequences. In fact sanctions create significant difficulties and distress for everyone subjected to them. (See also An example of in-work conditionality: when work doesn’t pay).

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

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

Essential supportive provision is being systematically reduced by increasing conditionally; by linking support to such a narrow outcome – getting a job – and this will ultimately reduce every service to nothing more than a state behaviour modification programme based on punishment, with a range of professionals being politically co-opted as state enforcers of an ideology  which is perpetuating and accentuating socioeconomic problems in the first place.

Work is not a “health” outcome

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

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”

The government made a political and a particularly partisan decision, rather than one that has any an evidence base, 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 potentially downright harmful and dangerous.

The government’s Work and Health programme involves a plan to integrate health and employment services, aligning the outcome frameworks of health services, Improving Access To Psychological Therapies (IAPT), Jobcentre Plus and the Work programme.

2020health – Working Together is a report from 2012 that promotes the absurd notion of work as a health outcome. This is a central theme amongst the ideas that are driving the fit for work and the work and health and programme. Developing this idea further, Dame Carol Black and David Frost’s Health at Work – an independent review of sickness absence was aimed at reviewing ways of “reducing the cost of sickness to employers, ‘taxpayers’ and the economy.”

Seems that the central aim of the review wasn’t a genuine focus on sick and disabled people’s wellbeing and “health outcomes,” then. Black and Frost advocated changing sickness certification to further reduce the influence of GPs in “deciding entitlement to out-of-work sickness benefits.”

The subsequent “fit notes” that replaced GP sick notes (a semantic shift of Orwellian proportions) were designed to substantially limit the sick role and reduce recovery periods, and to “encourage” GPs to disclose what work-related tasks patients may still be able to perform. The idea that employers could provide reasonable adjustments that allowed people who are on sick leave to return to work earlier, however, hasn’t happened in reality.

The British Medical Association (BMA) has been highly critical of the language used by the government when describing the fit for work service. The association said it was “misleading” to claim that fit for work was offering “occupational health advice and support” when the emphasis was on sickness absence management and providing a focused return to work.

The idea that work is a “health” outcome is founded on an absurd and circular Conservative logic: it’s an incorrect inference based on the fact that people in work are healthier than those out of work. It’s true that they are, however, the government have yet again confused causes with effects. Work does not make people healthier: it’s simply that healthy people can work and do. People who have long term or chronic illnesses most often can’t work. It has been historically  and empirically established that poverty is closely correlated with disproportionate levels of ill health, and it’s most probable that targeted austerity, leading to increasingly inadequate welfare provision, has made a significant contribution to poorer health outcomes, too.

The government’s main objection to sick leave and illness more generally, is that it costs businesses money. The government remain committed to a supply-side labour market model. However, as inconvenient as it may be, politically and economically, it isn’t ever going to be possible to cure people of serious illnesses by cruelly coercing them into work.The government’s aim to prompt public services to “speak with one voice” is founded on questionable ethics. This proposed multi-agency approach is reductive, rather than being about formulating expansive, coherent, comprehensive and importantly, responsive provision.

This is psychopolitics. It’s all about (re)defining the experience and reality of a social group to justify dismantling public services (especially welfare), and that is form of gaslighting intended to extend oppressive political control and micromanagement. In linking receipt of welfare with health services and “state therapy,” with the single intended outcome explicitly expressed as employment, the government is purposefully conflating citizen’s widely varied needs with economic outcomes and diktats, isolating people from traditionally non-partisan networks of relatively unconditional support, such as the health service, social services, community services and mental health services.

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

However, unsatisfactory employment – low-paid, insecure and unfulfiling work – can result in a decline in health and wellbeing, indicating that poverty and growing inequality, rather than unemployment, increases the risk of experiencing poor mental and physical health.

People are experiencing poverty both in work and out of work. Moreover, in countries with an adequate social safety net, poor employment (low pay, short-term contracts), rather than unemployment, has the biggest detrimental impact on mental health. There is ample medical evidence to challenge the current political dogma, and to support this account. (See the Minnesota semistarvation experiment, for example. The understanding that food deprivation in particular dramatically alters cognitive capacity, emotions, motivation, personality, and that malnutrition directly and predictably affects the mind as well as the body is one of the legacies of the experiment.)

Systematically reducing social security, and increasing conditionality, particularly in the form of punitive benefit sanctions, doesn’t “incentivise” people to look for work. It simply means that people can no longer meet their basic physiological needs, as benefits are calculated to cover only the costs of food, fuel and shelter.Food deprivation is closely correlated with both physical and mental health deterioration. Maslow explained very well that if we cannot meet basic physical needs, we are highly unlikely to be able to meet higher level psychosocial needs.

The government proposal that welfare sanctions will somehow “incentivise” people to look for work is pseudopsychology at its very worst and most dangerous.In the UK, the government’s welfare “reforms” have further reduced social security support, originally calculated to meet only basic physiological needs, which has had an adverse impact on people who rely on what was once a social safety net.

Poverty is linked with negative health outcomes, but it doesn’t follow that employment will alleviate poverty sufficiently to improve health outcomes.In fact record numbers of working families are now in poverty, with two-thirds of people who found work in 2014 taking jobs for less than the living wage, according to the annual report from the Joseph Rowntree Foundation a year ago.

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

I have pointed out previously that there has never been any research that demonstrates unemployment is a direct cause of ill health or that employment directly improves health, and the existing studies support the the idea that the assumed causality between unemployment and health may actually run in the opposite direction.It’s not that unemployment is causing higher ill health, but that ill health and discrimination are causing higher unemployment. If it were unemployment causing ill health, at a time when the government assures us that employment rates are currently “the highest on record,” why are more people becoming sick?

The answer is that inequality and poverty have increased, and these social conditions, created by government policies, have long been established by research as having a correlational relationship with increasing mental and physical health inequalities. For an excellent, clearly written and focused development of these points, the problem of “hidden” variables and political misinterpretation, see Jonathan Hulme’s Work won’t set us

– childhood immunisation
– antibiotics
– access to education, and particularly, improving female literacy
– increasing social equality

Given that, as statistics sadly show, the health of the poorest in the UK is again declining despite the first four factors mainly still being accessible to even the UK’s very poorest, one can only point at the worsening inequalities and social injustices as a significant cause. The Marmot review pretty much concludes the same. “

Addressing these issues is not consistent with the ideological thrust of Conservative policies, unfortunately, since the government insist that social problems such as poverty and ill health (the biopsychosocial model, with an emphasis on the “psychosocial” elements) are due to individual “behaviours.” Their approach to date has been to level punitive policies with an embedded core of behaviour modification techniques which usually entails the punitive removal of lifeline income at the poorest citizens – casually called “incentivising” and “supporting” – whilst addressing the behaviours of the wealthy with a system of publicly funded financial reward. This simply recreates, deepens, perpetuates and accentuates existing inequalities.

Empirical research published two years ago demonstrated the high a cost the country paid in terms of health and wellbeing for the Thatcher administration’s neoliberal economic and social policies. The study, which examined at material from existing research and data from the Office for National Statistics, illustrates that Thatcherism resulted in the unnecessary and unjust premature deaths of British citizens, together with a substantial and continuing burden of suffering and a widespread degradation of wellbeing.

Co-author and researcher Professor Clare Bambra from the Wolfson Research Institute of Health and Wellbeing said that deaths from violence and suicide all increased substantially during the Thatcher era in comparison with other countries. Regional inequalities in life expectancy between north and south were also exacerbated, as were health inequalities between the richest and poorest in British society.

Professor Bambra also says that the welfare cuts implemented by Thatcher’s governments led to a rise in poverty rates from 6.7% in 1975 to 12% by 1985; poverty is well known to be one of the major causes of ill health and mortality. Income inequality also increased in the Thatcher period, as the richest 0.01% of society had 28 times the mean national average income in 1978 but 70 times the average by 1990. Other research (The Spirit Level) indicates that income inequality is internationally associated with higher mortality and morbidity.

Yet earlier this year, the welfare reform minister, Lord Freud, refused to monitor the number of people who take their own lives as a result of the £120-a-month cut planned for those people in the work related activity group (WRAG), claiming employment and support allowance from April 2017. Concerns were raised in the House of Lords, when Baroness Meacher, amongst others, warned that for the most vulnerable citizens, the cut was “terrifying” and bound to lead to increased debt.

Condemning the truly callous and terrible actions of the Treasury, she urged ministers to monitor the number of suicides in the year after the change comes in, adding: “I am certain there will be people who cannot face the debt and the loss of their home, who will take their lives.”

Many people have died as a consequence of the welfare “reforms.”

Not only have the government failed to carry out an impact assessment regarding the cuts, Lord Freud said that the impact, potential increase in deaths and suicides won’t be monitored, apart from “privately” because individual details can’t be shared and because that isn’t a “useful approach”.

He went on to say “We have recently produced a large analysis on this, which I will send to the noble Baroness. That analysis makes it absolutely clear that you cannot make these causal links between the likelihood of dying – however you die – and the fact that someone is claiming benefit.”

However, a political refusal to investigate an established correlation between the welfare “reforms” and an increase in the mortality statistics of those hit the hardest by the cuts – sick and disabled people – is not the same thing as there being no causal link. Often, correlation implies causality and therefore such established links require further investigation. It is not possible to disprove a causal link without further investigation.

Whilst the government continue to deny there is a “causal link” between their punitive welfare policies, austerity measures and an increase in premature deaths and suicides, they cannot deny there is a clear correlation , which warrants further research and political accountability.

We have a government that provides disproportionate and growing returns to the already wealthy, whilst imposing austerity cuts on the very poorest. How the government possibly claim that inequality is falling, when inequality is so fundamental a prop to their ideology and when social inequalities are extended and perpetuated by all of their policies? It seems an Orwellian re-writing of language about inequality is being used to mislead us into thinking that the economy is far more “inclusive’ than it is. The number of vulture private businesses payrolled by the government to deliver increasingly ideologically biased and punitive welfare, health and social care “services” has risen dramatically this past six years, all of which has cost the UK taxpayer billions.

Meanwhile, those people who need essential supportive public services are facing severe cuts to their lifeline provision. Many of the multinationals contracted by the government are paid to cut the costs of public services, but are costing the public far more than they save.far more than they save. This brand of neoliberal crony capitalist is an entrenched mindset that needs to radically change, because the only beneficiaries are big businesses, and at the expense of those people with the highest level of need. The government’s policies are harming our most vulnerable citizens.

It seems that for wealthy people, “incentives” are always financial rewards, and for poor people, “incentives” simply involve grossly unfair financial punishments, which have too often challenged people’s  capacity to meet basic survival needs.

It’s time to challenge the class-based prejudice and blatant discrimination that is embedded in Conservative policies, which ultimately may only serve to deepen existing wealth and health inequality and increase social and economic division.

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Government welfare policies are ‘historically obsolete’ say researchers

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Historical research shows that the National Health Service (NHS) and welfare state are fundamental to a healthy, productive economy.

The government has been accused of following a “historically obsolete” welfare strategy by a team of Cambridge University researchers.  

Research by Simon Szreter, Ann Louise Kinmonth, Natasha M Kriznik, and Michael P Kelly also supports the work of campaigners, charities and other academics raising their concerns about the harmful social and economic impacts of the Conservatives’ austerity measures. These include the draconian welfare “reforms” and the consequences of the increasing privatisation of and political under-investment in the NHS from 2012 onwards. 

In an article published on Friday in The Lancet, titled  Health and welfare as a burden on the state? The dangers of forgetting history, the group of academics criticised Conservative austerity policies, which were instituted by David Cameron and George Osborne’s and continued by Theresa May and her chancellor Philip Hammond. The researchers point out that investment in welfare has always been crucial for Britain’s economic success.

The Conservatives have frequently claimed that welfare provision isn’t “sustainable”. Welfare support has been reduced so much that many people have been unable to meet even their most basic needs. Food and fuel poverty have significantly increased over the past four years, for example. We have witnessed the return of absolute poverty in the UK, something we haven’t seen since before the inception of the welfare state, until now. Social security is also harshly conditional, with punishment regimes and psycho-compulsion embedded in the diminishing “support” being offered. The emphasis has shifted from “support” to managing and enforcing poor citizen’s compliance and conformity.

Crucially, the researchers, who are based at St John’s College are opposing the idea that welfare and health spending is a “burden” on the country’s economy, arguing instead that economic prosperity is intrinsically tied to an adequate level of welfare provision.

Simon Szreter is a Professor of History and Public Policy at Cambridge’s Faculty of History. He writes: “The interests of the poor and the wealthy are not mutually opposed in a zero-sum game. Investment in policies that develop human and social capital will underpin economic opportunities and security for the whole population.”

The report also states: “The narrow view that spending on the National Health Service and social care is largely a burden on the economy is blind to the large national return to prosperity that comes from all citizens benefiting from a true sense of social security.”

The authors continue: “There are signs that Theresa May subscribes to the same historically obsolete view.

Despite her inaugural statement as Prime Minister, her Chancellor’s autumn statement signals continuing austerity with further cuts inflicted on the poor and their children, the vulnerable, and infirm older people.””

To support their position, the researchers point to the period of economic growth the UK experienced following the post-war settlement – including the development of the welfare state and the NHS, something which they argue also brought about greater equality, with the rich-poor divide falling to an all-time low during the 1970s.

Drawing on recent historical research, they also trace the origins of the British welfare state to reforms to the Poor Laws introduced under Elizabeth I in 1598 and 1601, and claim that investment in supporting the poorest citizens has always gone hand in hand with economic growth.

The report establishes an interesting and useful historical context, following the effect of welfare provision on the nation’s economic prosperity prior to the creation of the modern health and welfare apparatus and institutions that we are familiar with today, arguing that the concept of a British welfare state can be traced back to the reign of Elizabeth I. There are also parallels drawn in the report between the perceived problem of the “idle poor” during the Victorian era and the contemporary political narratives that intentionally label benefit claimants as “scroungers” who allegedly benefit unduly at the expense of “hard-working families”.

Many of us have drawn the same parallels over the past four years. In my  some of my own work, three years ago, I also compared the 1834 Poor Law Amendment Act – particularly the principle of less eligibility with the Conservative’s recent punitive and regressive approach to “making work pay”, which is about reducing social security provision, rather than raising national wages. Basically the idea behind both ideas is that any support given to people out of work needs to be punitive, and much less than the poorest wages of those in the lowest paid employment. That tends to drive wages down, as people who are desperate to survive have little bargaining power, and are more likely to be forced to work for much less, because employers can exploit a desperate reserve army of labour.

The Poor Law Amendment Act of 1834 is largely remembered through its connection to the punitive workhouses that were infamously instituted across Victorian Britain.

The researchers argue that, though the 1834 Act was passed out of “concerns” that the welfare system was being abused and was an unduly heavy burden on taxpayers, there isn’t any evidence that it had much an economic benefit. They also point out that Britain’s growth actually fell behind that of rival nations after 1870, only recovering in the 1950s, following the post-war settlement

Simon Szreter said: “We are arguing from history that there needs to be an end to this idea of setting economic growth in opposition to the goal of welfare provision. A healthy society needs both, and the suggestion of history is that they seem to feed each other.”

 
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Rogue company Unum had a 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. 

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

The 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. It would therefore be very difficult to justify this proposed cut, given the additional needs that disabled people have, which is historically recognised, and empirically verified by research.

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

The report recommended savings which result from removing the disability-related additions to the standard allowance should be reinvested in support services and extra costs benefits – 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 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 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 auctioned. The 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.

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 deranged attempts from an increasingly despotic 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 ill health, yet the symptoms 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 callous, profoundly antidemocratic, dysfunctional and extremely regressive, 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 and for notions of citizenship.

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 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. 

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 about de-medicalising illnesses. Another curious coincidence is that Mansel Aylward sat on the PACE Trial steering group. 

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, 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.

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 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 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. 

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 “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 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. 

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 – 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 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 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 that social provision designed to protect people from the ravages of absolute poverty and capitalism – it was intended to support poor citizens  – actually makes them poor, is simply incoherent 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 can 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.

imgres

 

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, it tends to ensure it gets shared much more widely  than it would have done 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 trialMajor 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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Malnutrition, austerity and eugenics.

Minnes

Earlier this year, I reported that figures released by The Office of National Statistics (ONS) showed 391 people died from malnutrition in 2015. There were 746 hospital admissions for malnutrition in just 12 months. The statistics also showed two people in the UK are admitted to hospital with the condition every day in what campaigners have called a “national scandal.” 

Official figures more recently from the Department of Health reveal that people with malnutrition accounted for 184,528 of days in hospital beds taken up in England taken up last year, a huge rise on 65,048 in 2006-07. The sharp increase is adding to the pressures on hospitals, which are already struggling with record levels of overcrowding and limited resources because of underfunding.

161127-malnutrition-stats

Critics and campaigners have said the upward trend is a result of austerity and rising absolute poverty, deep cutbacks in recent years to meals on wheels services for the elderly and inadequate social care support, especially for older people. 

Theresa May has made it clear there will be no end to Tory austerity, she said:“What I’m clear about is we’re going to continue as we have done in Government over the last six years – ensuring that we’re a country that can live within our means.”

The figures once again directly contradict the glib claim from government ministers that the rise in the use of food banks is linked to the fact that there are now more of them. Ludicrously, millionaire David Freud has claimed that people use food banks just because they provide a  “free good”.  However, research shows that people turn to charity food as a last resort following a crisis such as the loss of a job, the delays and problems accessing social security benefits, and through benefit sanctions.

People may only be referred to a food bank by a professional such as a social worker or GP. If someone turns up without a voucher, food bank staff put them in touch with relevant local agencies who can assess whether they need a voucher and signpost them to the right services. The number of people receiving emergency food is disproportionate to the number of new food banks opening: following the welfare “reforms”, by 2013, numbers helped by food banks increased by 170% whilst there was only a 76% increase in new food banks opening. 

Over 50% of children living in poverty in the UK are from working households and many of the people helped by food banks are in work, with the rising cost of living combined with no rise in low wages causing many to hit a crisis where they can’t afford to met basic needs such as eating.

Jonathan Ashworth, the shadow health secretary, unearthed the latest figures in a response to a recent parliamentary question submitted to the health minister Nicola Blackwood. He said:

“These figures paint a grim picture of Britain under the Conservatives. Real poverty is causing vulnerable people, particularly the elderly, to go hungry and undernourished so much so that they end up in hospital.

Our research reveals a shocking picture of levels of malnutrition in 21st-century England and the impact it has on our NHS. This is unacceptable in modern Britain.”

In a very wealthy first-world  democracy, it is completely unacceptable that anyone is left hungry, malnourished and in absolute poverty.

The Department of Health figures showed that the number of “bed days” accounted for by someone with a primary or secondary diagnosis of malnutrition rose from 128,361 in 2010-11, the year the coalition came to power, to 184,528 last year – a 61% rise over five years.

The National Institute for Health and Care Excellence classes someone as malnourished if they have a body mass index of less than 18.5, have suffered the unintentional loss of more than 10% of their weight over the last three to six months, or if they have a BMI under 20 and have unintentionally seen their weight drop by more than 5% over the previous three to six months.

The worrying decision by the chancellor, Philip Hammond, not to fund the NHS or social care with any more money in his autumn statement last week will only worsen this already unacceptable situation.

Ashworth said: “The reality is the government have failed this week to both give the NHS and social care the extra investment it needs while also failing to invest in prevention initiatives to foster healthier lifestyles. The cuts to public health budgets along with an emaciated obesity strategy are both utterly misguided.” 

Figures are not available for exactly how many patients accounted for the 184,528 bed days last year, but information supplied to Ashworth by the House of Commons library shows that 57% of the patients were women and that 42% were over-65s.

Worryingly, four out of five people who needed inpatient hospital care because of malnutrition were admitted as an emergency, which suggests their health had deteriorated significantly in the days before they were taken in.

Not enough health and social care professionals have the time or knowledge to correctly identify malnutrition.

Stephen Dalton, the chief executive of the NHS Confederation, which represents hospitals, said: “Our members take malnutrition seriously. Good nutrition is a fundamental human right our citizens can expect, and vulnerable, particularly older, people are most at risk of serious consequences if denied basic compassionate care. At a time of unprecedented demand on health and social care we need to be alert and will take seriously any reliable evidence of basic care not being delivered.”

Time and time again, when challenged and confronted with overwhelming empirical evidence of the harm that their class-contingent austerity policies and welfare “reforms” are inflicting on citizens, the government simply deny any “causal link”. They say that the increase in absolute poverty, malnutrition and hunger, deaths and distress are unrelated to their policies, which they claim to be “working”.

With no sign that the government are going to emerge from behind their basic defence mechanism of collective denial – nor are the Conservatives remotely interested in investigating a clear correlation between their blatant attacks on the poorest citizens via their draconian policies and the terrible hardships people are suffering –  we do have to wonder what the real intention is underpinning such clearly targeted austerity.

Conservative ideology seems to be founded on the hypothesis of an inborn and “natural order” – a society that is based on a human hierarchy of worth. The Conservatives feel justified that they are part of a superior class in society and therefore they have an entitlement to hold power. Their policies don’t include the majority of us in their design or aims. The government are not democratic, they are authoritarians. Conservative policies act upon ordinary citizens and have become increasingly detached from citizen needs.

I was accused of the terrible crime of being an “interfering do-gooder” recently by someone with social Darwinist ideals. I couldn’t understand his ferocity. Then I made a connection, the proverbial penny dropped. Again. I suddenly felt very weary, disgusted and shocked – the recognition froze me. Again

Historically, eugenicists thought that misguided “do-gooders”, by giving poor people help and support, were allowing them to survive “unnaturally”, and were consequently interfering in human “natural selection”, a benign force which they thought was “deselecting” the people with the “weakest” genes and the “moral defectives”.  The Conservatives moralise about people who are poor and their punitive anti-welfare policies indicate plainly that they think that poor people have moral deficits.

The Conservative message that poverty is caused by character or behavioural “defects” and not socioeconomic and political circumstances should have been ringing alarm bells very loudly everywhere. The problem with authoritarian governments is they usually have sufficient power, one way or another, to mute the alarm. The first base of power over public perceptions that all authoritarians build is invariably facilitated by the corporate mass media. 

Austerity, “the national debt”, “a country living within its means”, “hardworking families”, the scrounger/striver rhetoric, “hard choices” and the “culture of entitlement” has all been a smokescreen for eugenic policies.

We cannot find any comfort in the belief that the government are simply neglectful policy makers. The persistent and loud denial regarding the increasingly precarious existence of the poorest citizens – especially disabled people – and the loud refusal to investigate the correlation between austerity policies and social outcomes that are damaging and harmful, and to consider the empirical evidence of humanitarian harm presented by citizens, academics, charities and campaigners, indicates a government that is not ignorant of the consequences, yet has no intention of changing their policies. The Conservatives are appallingly unconcerned about the terrible harm they are inflicting on invididuals and on our society.

 “Eugenic goals are most likely to be attained under another name than eugenics.” – Frederick Osborn

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The art of character divination

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National consultation on the rights of disabled people – the Labour party’s disability equality roadshow

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Jeremy Corbyn, Paul Rutherford and Debbie Abrahams at the Roadshow in Manchester

The Labour party would like to invite you to attend the Disability Equality Roadshow, an event asking disabled people, their carers and service providers, which policies Labour should develop to best defend and extend their rights.

The events are free and the next one is to be held in the North East in Newcastle on 3 December. You can register to attend here.

Regardless of your personal party affiliations, I think as many of us as possible need to attend these events and have a positive input into policy because we need political parties to recognise disabled people’s needs, especially given the past six years of harrowing and disproportionately targeted austerity cuts and systematic violation of disabled people’s human rights.

I don’t support the Liberal Democrats, but nonetheless have permitted the party to use some of my work on disabled people’s rights and the impact of austerity on their site, because our needs and views ought to matter to every political party. Something as fundamental as the recognition and observation of human rights should be a collaborative and collective cross-party endeavour – a cooperative effort in a democratic, inclusive society.

Human rights should not be a party political issue, but it’s a fact that they are. The Conservatives want to repeal our Human Rights Act, and that must not happen. The government have already demonstrated clearly that they will not observe the rights of disabled people. Without a robust legal framework in place, we would have absolutely no access to justice and redress, and no protection from the brutality and disregard of an increasingly authoritarian government .

Debbie Abrahams has organised and launched the Roadshow, which is an important opportunity for us to have a democratic say in political decision-making and shape future policies. 

The Labour party are using the United Nations Convention on the Rights of Disabled People as a framework to help develop policies not just on social security but on education, health and social care, justice and more. It was the last Labour government that signed the UK up to the Convention.

The Roadshow will be going across the country to every region and to every nation state. 

Debbie is the Member of Parliament for Oldham East and Saddleworth and Shadow Secretary of State for Work and Pensions. She has represented the constituency since her by-election victory in January 2011.

Debbie was a member of the Work and Pensions Select Committee from June 2011-March 2015, where she led the call for an independent inquiry into the Government’s punitive New Sanctions Regime. She was re-elected as a member of the Work and Pensions Committee in July 2015 until her appointment as Shadow Minister for Disabled People in September 2015.  In June 2016 she was appointed Shadow Secretary of State for Work and Pensions.

Debbie is passionate about tackling inequalities and has campaigned extensively for a fairer society, setting up the Oldham Fairness Commission to deliver this in her own constituency. 

The Labour party assure us that the next Labour government will ensure that the UK upholds its obligations under the UN convention on persons with disabilities. They say their “commitment to people-powered politics means that they believe that future social security policy should be co-produced with deaf and disabled people, carers and service providers”. That is our democratic right. The party want to transform our social security system, based on the principles of dignity, independence and support. 

 The Labour party say they will listen to our views on improving social security, removing the punitive elements such as sanctions, the work capability assessment and the bedroom tax, to ensure it is fit for purpose; ensuring fair and equal access to employment for people who can and want to work; suitable housing and education; improving the provision of care and best supporting carers. 

If you have any additional access needs please email Huma on huma_haq@labour.org.uk by Thursday 1st December. 

Hope to see you there.

 

DATE AND TIME: Sat 3 December 2016, 10:45 – 13:45 GMT

LOCATION: Unite the union

John Dobson Street

Newcastle upon Tyne

NE1 8TW

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Words and discrimination: ‘parked’ and ‘vulnerability’

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You can often tell such a lot about people’s views and sometimes, their intentions, by the words and phrases they use. The description of  disabled people as being “parked” on benefits (and told/under the impression they will never work again”) is a turn of phrase I loathe. It’s a mantra that’s gained a PR crib sheet resonance from George Osborne and Iain Duncan Smith to Stephen Crabb and Damian Green. To extend the metaphor, parking is subject to the availability of a parking space; permission; to regulations and laws; parking tickets and fines; parking attendants and traffic wardens to police and ensure compliance.

Disability and sickness are compared with the inconvenient abandonment of a vehicle in the middle of a very busy market place. Or the informal blatant plonking and installing of oneself on a sofa or bed, behind outrageously closed curtains in the middle of a busy viral epidemic of the protestant work ethic, prompting further symptoms of oppressive impacted resentments and frank, febrile tutting.

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Yet the Employment and Support Allowance (ESA) Support Group is made up of those individuals who “have a severe limitation which creates a significant disability in relation to the labour market, regardless of any adaptation they may make or support with which they may be provided” (Department for Work and Pensions, 2009: 8).

Disabled people are being excluded, and at the same time, represented in political and mainstream discourse in ways to evoke moral judgments and public emotions such as distrust, disgust and anger. Evidence of state culpability lies in the relationships between political rhetoric, media narrative and punitive, populist social policy.  

However, in official policy documents, welfare cuts have been dressed up as a discourse related to “support” , “social inclusion” and even “fairness” and “equal opportunity”. Though this is only narrowly discussed in terms of employment outcomes. “Inclusion” has been conflated with being economically productive. In contrast, the media rhetoric, and importantly, the consequences of Conservative policies aimed at disabled people, are increasingly isolating and exclusionary, as a result of intentional political outgrouping.

Yet such rhetoric is surely also counter‐productive to even such a limited view of inclusion, inevitably distorting employer responses to ill and disabled people as potential employees. However, Conservative neoliberal policies reflect a consideration of the supply rather than the demand side of the labour market.

“[…] rather than being concerned with the economic position of disabled people in Britain, the development of the Employment and Support Allowance and the Work Programme was concerned with relationships between the supply of labour and wage inflation, and with developing new welfare (quasi) markets in employment services. Attempting to address the economic disadvantages disabled people face through what are essentially market mechanisms will entrench, rather than address, those disadvantages.”  From: Commodification, disabled people, and wage work in Britain – Chris Grover.

Glib, deceptive and diversionary language use and ideological referencing does nothing to address the social exclusion of disabled people, who are already pushed to the fringes of society. Disabled people have become easy political scapegoats in the age of austerity. Scapegoating and outgrouping have become common political and cultural practices. Stigma is being used to justify the most regressive social policies since before the foundation of the welfare state in the 1940s.  

Patronising and authoritarian Conservatives like to speak very loudly over disabled people, and tell us about our own experiences because they really believe we can’t speak for ourselves. They simply refuse to listen to people who may criticise their policies, raising the often dire consequences being imposed on us because of the “reforms”  CUTS. I also think that we are witnessing the most powerful anti-intellectual and anti-rational ethos in government in living memory.

Whilst Conservative rhetoric lacks coherence, rationality, integrity and verisimilitude, it has an abundance of glittering generalities and crib sheet repetition designed from supremacist decisions made around elitist tables behind closed and heavy doors. The Conservatives seem to believe that disabled people aren’t like other citizens and that we don’t need a democratic voice of our own. Policies are designed to act upon us, to “change” our behaviours through the use of “incentives”, whilst we are completely excluded from their design and aims. Our behaviours are being aligned with neoliberal outcomes, conflating our needs and interests with the private financial profit of others. 

As one of the instigators and a witness for the United Nations investigation into the government’s systematic violations of the human rights of disabled people, as a person with disability, I don’t care for being described by a blatantly oppressive Damian Green as “patronising” or being told that disabled people – witnesses – presented an “outdated view” of disability in the UK. The only opportunity disabled people have been presented with to effectively express our fears, experiences, concerns about increasingly punitive and discriminatory policies and have our democratic opinion heard more generally has been through dialogue with an international human rights organisation, and still this government refuse to hear what we have to say.

Oppression always involves the objectification of those being dominated; all forms of oppression imply the devaluation of the subjectivity and experiences of the oppressed. 

Just as Herbert Spencer supported laissez-faire capitalism and social Darwinism (on the basis of his Lamarckian beliefs) – and claimed that struggle for survival spurred self-improvement which could be inherited – the Conservatives apply the same tired and misguided, private boarding school myths and disciplinarian moral principles in their endorsement of a totalising neoliberalism: the bizarre belief that competition, struggle and strife is “good” for character and even better for the market economy.

Under the Equality Act 2010 there are several types of discrimination that are prohibited. These are direct discrimination (s.13(1) Equality Act 2010), indirect discrimination (s.6 and s.19 Equality Act 2010, harassment (s.26 Equality Act 2010), victimisation (s.27(2) Equality Act 2010), discrimination arising from disability (s.15(1) Equality Act 2010) and failure to make reasonable adjustments (s.20 Equality Act 2010). 

Disabled people are being conveniently reclassified to fit Treasury cost-cutting imperatives. However, the government prefer to say that we are claiming lifeline support because we are “disincentivised” to find a job because we are claiming lifeline support… there’s a whole ludicrous circular government monologue going on there that we are being quite intentionally excluded from.

This is one common type of ableist behaviour: it is a form of discrimination which denies others’ autonomy by speaking for or about them rather than allowing them to speak for themselves. Ableism characterizes persons as defined by their disabilities and as inferior to non-disabled persons On this basis, people are assigned or denied certain perceived abilities, skills, and/or character traits. And often, denied rights and a democratic voice.

If you ask disabled people about work, most of us will say we would like to – after all, who of us would actually choose to be ill and disabled – but there are social, political, cultural and economic barriers to our doing so. None of us will tell you we don’t work because we feel secure and comfortably off on an ever-dwindling and paltry amount of ESA, which has been subjected to cuts, further threats of cuts from prominent think tanks, increased conditionality, the threat of sanctions, and constant, distressing assessments and reassessments which were designed to find ways of stopping your lifeline support.

Disabled people became amongst the first citizens of a new class: the precariat. In sociology and economics, the precariat is a social class formed by people suffering from precarity, which is a condition of existence without predictability or security, affecting material and psychological welfare. The emergence of this class has been ascribed to the entrenchment of neoliberalism.

Many disabled people, however, will tell you that they are simply too ill to work. It’s a ludicrous and frankly terrifying state of affairs that the administrating despots in office don’t accept that some people simply cannot work, and persist in hounding them, claiming that cutting social security, originally calculated to meet only basic needs and now reduced to the point where that is no longer possible, is somehow an “incentive” for very sick people to find work. It’s incredible that the government are telling us with a straight face that a poor person’s “incentive” is punishment and financial loss, whilst millionaires  are “incentivised” by reward and financial gifts, such as “tax breaks”.

The same approach is apparent in the recent green paper on work, health and disability, where the government casually discusses subjecting disabled people in the ESA support group to compulsory work related activity and “behavioural conditionality” (sanctions are suggested), though the support group were previously exempt from the punitive welfare conditionality regime, since their doctors and the state accepted that this group of people are simply too ill to work. Employers, it is suggested, are to be “incentivised” by financial rewards – tax cuts. When this government discuss “being fair” to the “tax payer”, they are referring to wealthy and privileged people, not the majority of ordinary citizens such as  you and I.

Discrimination is defined as “treating a person or particular group of people differently, especially in a worse way from the way in which you treat other people”, based on characteristics or perceived characteristics. Under Labour’s 2010 Equality Act, direct disability discrimination occurs when a disabled person is treated less favourably than a non-disabled person, and they are treated this way for a reason arising from their disability. Indirect discrimination happens when an organisation or government has a particular policy or way of working that has a worse impact on people who share your disability compared to people who don’t. Harassment is defined as someone treating you in a way that makes you feel humiliated, offended or degraded.

The government even have the cheek to call their discrimination “supporting” and “helping” us. I’ve never heard of such immorality, bullying, indecency, prejudice and punishment being called “help” and “support” before. Millionaires are helped; they get financial handouts in the form of tax cuts that they don’t need. Meanwhile we have lifeline income taken away to fund, leaving us without food, fuel and shelter increasingly often. Such mundane language use is an attempt to mask the intentions and consequences of draconian policies. It utterly nasty, manipulative, callous, calculated cold-blooded gaslighting.

Milton Friedman, in Capitalism and Freedom (1962) felt that “competitive capitalism” is especially important to minority groups, since “impersonal market forces”, he claimed, protect people from discrimination in their economic activities for reasons unrelated to their productivity. Through elimination of centralized control of economic activities, economic power is separated from political power, and the one can serve as counterbalance to the other. However, he couldn’t have been more wrong. What we have seen instead is an authoritarian turn. The UN conclusions to their recent inquiry into the government’s  systematic and grave violations of the rights of disabled people verify his lack of foresight and his conflation of public needs and interests with supply side economic outcomes.

A word about the use of the term “vulnerability”

The reason that some groups are socially and legally protected – and the reason why we have universal human rights – is because some groups of citizens have historically been vulnerable to political abuse and are structurally discriminated against. The aim of human rights instruments is the protection of those vulnerable to violations of their fundamental human rights. The recent United Nations inquiry into the UK government’s systematic violations of the convention on the rights of persons with disabilities concludes that disabled people in the UK are facing systematic political discrimination, social exclusion and oppression.

The Yogyakarta Principles, one of the international human rights instruments use the term “vulnerability” as such potential to abuse and/or social exclusion. Social vulnerability is created through the interaction of social forces and multiple “stressors”, and resolved through social (as opposed to individual) means. Social vulnerability is the product of social inequalities. It arises through social, political and economical processes.

Whilst some individuals within a socially vulnerable context may break free from the hierarchical order, social vulnerability itself persists because of structural – social, economical and political – influences that continue to reinforce vulnerability. 

The medical model is a perspective of disability as a problem of the person, directly caused by disease, trauma, or other health conditions which therefore requires sustained medical care in the form of individual treatment by professionals. The medical model sees management of the disability  as central and ideally, it is aimed at a “cure,” or the individual’s adjustment and behavioural change that would lead to better “management” of symptoms.

The social model of disability outlines “disability” as a socially created problem and a matter of the full inclusion and integration of individuals into society. In this model, disability is not an attribute of an individual, but rather a complex collection of conditions, created by the social environment. The management of the problem requires social  and political action and it is the collective responsibility of society to create an environment and context in which limitations for people with disabilities are minimal. Equal access and inclusion for someone with an impairment/disability is a human rights concern.

From the 70s, sociologists such Eliot Friedson observed that labeling theory and a social deviance perspective could be applied to disability studies. Social constructivist theorists discussed a non-essentialist perspective: the social construction of disability is the idea that disability is constructed as the social response to a deviance from the norm. “Disability” is constructed by social expectations and institutions rather than biological differences.

I think there is something positive to learn from the variety of models of disability, and should like to point out that despite the potential merits of any one in particular, each have also been heavily criticised, and most importantly, there is nothing to stop an unscrupulous government from intentionally exploiting a theoretical paradigm to suit an ideological design. 

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Eugenics

The French statistician, Alphonse Quetelet wrote in the 1830s of l’homme moyen – the “average man”. Quetelet proposed that one could take the sum of all people’s attributes in a given population (such as their height or weight) and find their average, and that this figure should serve as a norm toward which all should aspire. This idea of a statistical norm threads through the rapid growth in the popularity of gathering statistics in Britain, United States, and the Western European states during this period, and it is linked to the rise of eugenics. Disability, as well as other concepts including: “abnormal”, “non-normal”, and “normal” arose from this mindset.

With the rise of eugenics in the latter part of the nineteenth century, such deviations from the norm were viewed as somehow dangerous to the health of entire populations.

As a social and political movement, eugenics reached its greatest popularity in the early decades of the 20th century, when it was practiced around the world and promoted by governments, institutions, and influential individuals. Many countries enacted various eugenic policies, including: genetic screening, birth control, promoting differential birth rates, marriage restrictions, segregation (both racial segregation and sequestering the mentally ill), compulsory sterilization, forced abortions or forced pregnancies, culminating in genocide

The moral dimensions of the eugenics in the 19th and 20th centuries rejected the doctrine that all human beings are born equal, and redefined human worth purely in terms of genetic “fitness”. More recently in the UK we have seen a moral shift entailing human worth being politically redefined in terms of economic productivity. 

Common early 20th century eugenics methods involved identifying and classifying individuals and their families, including the poor, mentally ill, blind, deaf, developmentally disabled, promiscuous women, homosexuals, and racial groups (such as the Roma and Jews in Nazi Germany) as “degenerate” or “unfit”, leading to their segregation or institutionalization, sterilization, euthanasia, and ultimately, their mass murder. The Nazi practice of euthanasia was carried out on hospital patients in the Aktion T4 centres such as Hartheim Castle.

The “scientific” reputation of eugenics declined in the 1930s, a time when Ernst Rüdin used eugenics as a justification for the racial policies of Nazi Germany. Adolf Hitler had praised and incorporated eugenic ideas in Mein Kampf in 1925 and emulated eugenic legislation for the sterilization of “defectives” that had been pioneered in the United States once he took power

After World War II, the practice of “imposing measures intended to prevent births within [a population] group” fell within the definition of the new international crime of genocide, set out in the Convention on the Prevention and Punishment of the Crime of GenocideThe Charter of Fundamental Rights of the European Union also proclaims “the prohibition of eugenic practices, in particular those aiming at selection of persons.”

Recently the government in the UK introduced policies that curtail tax credits to the children of mothers claiming financial support for more than two children. Iain Duncan Smith announced that the policy was introduced to “change the behaviours” of people claiming welfare. Of course this assumes that people don’t plan and have their children in more prosperous periods of their lives, and then experience financial hardship for reasons that have nothing to do with their behaviours, such as recession and job losses, or being in low paid work and so on.  This has some profound implications for notions of equality and the idea that each human life has equal worth. Such a policy discriminates against children because of when they are born, as well as being discriminating against poor families. Such a policy is an example of negative eugenics by “incentives”

Some campaigners are very critical of the use of the word “vulnerability”, because they feel it leads to attitudes and perceptions of disabled people as passive victims.

Yet I am vulnerable, despite the fact that I am far from passive. Since 2010, no social group has organised, campaigned and protested more than disabled people. Many of us have lived through harrowing times under this government and the last, when our very existence has become so precarious because of targeted and cruel Conservative policies. Yet we have remained strong.in our resolve. Despite this, some dear friends and comrades among us have been tragically lost – they have not survived.

In one of the wealthiest democratic nations on earth, no group of people should have to fight for their survival.

I see vulnerability as being rather more about the potential for some social groups being subjected to political abuse. 

We are and have been. This is empirically verified by the report and conclusions drawn from the United Nations inquiry into the grave and systematic violations of disabled people’s human rights here in the UK, by a so-called democratic government.

 

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

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