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

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Abbie and her late father, James Harrison.

Julia Savage is a manager at Birkenhead Benefit Centre in Liverpool. She wrote a letter addressed to a GP regarding a seriously ill patient. It said:

“We have decided your patient is capable of work from and including January 10, 2016.

“This means you do not have to give your patient more medical certificates for employment and support allowance purposes unless they appeal against this decision.

“You may need to again if their condition worsens significantly, or they have a new medical condition.” 

The patient, James Harrison, had been declared “fit for work” and the letter stated that he should not get further medical certificates. 

However, 10 months after the Department for Work and Pensions (DWP) contacted his doctor without telling him, James died, aged 55, the Daily Record has reported.

He was clearly not fit for work.

His grieving daughter, Abbie, said: “It’s a disgrace that managers at the Jobcentre, who know nothing about medicine, should interfere in any way in the relationship between a doctor and a patient.

“They have no place at all telling a doctor what they should or shouldn’t give a patient. It has nothing to do with them.

“When the Jobcentre starts to get involved in telling doctors about the health of their patients, that’s a really slippery slope.”

Abbie said James had worked since leaving school at a community centre near his home. But his already poor health went downhill after the centre was shut down because of austerity cuts.

James had a serious lung condition and a hernia before the centre closed, and also developed depression and anxiety afterwards.

Abbie said: “He’d worked all his life. He wasn’t the kind of guy who knew anything about benefits.

“But as his health deteriorated, there wasn’t any chance he could do a job. He applied for employment and support allowance.”

James received Employment and Support Allowance (ESA), but only at the low rate of £70 a week, the same amount as jobseekers’ allowance. He was then sent to attend one of the DWP’s controversial Work Capability Assessments – and declared fit for work.

Despite that decision, Abbie said James remained in constant need of medical help and had to visit his doctor regularly.

However, the GP concerned repeatedly refused to give him a sick note, and James began to suspect the Jobcentre were to blame for this.

Abbie said: “He really needed a note. He was too ill to go to the constant appointments at the Jobcentre and he didn’t want to be sanctioned.

“He became convinced the DWP had been talking to his doctor behind his back.”

Although Abbie felt her father was confused, and didn’t think his explanation was right at the time, she later asked to see her father’s medical records. She found the letter in his file from Julia Savage, the manager at Birkenhead Benefit Centre, in James’s home city of Liverpool.

The letter was addressed to James’s GP.

Context: Government claims that work is a “health outcome”

James Harrison was very worried that his ill health interfered with his obligation to comply with the inflexible and constant conditions attached to his eligibility for welfare support, and that this would lead to sanctions – the withdrawal of his lifeline support, which was calculated to meet basic survival needs only.

The GP should have provided evidence that this was the case. The doctor was advised not to provide further fit notes by the DWP, however, unless James appealed. Yet the circumstances warranted that the GP provide a fit note. 

fit-note-guidance

Last year, the Department for Work and Pensions issued an ideologically directed new guidance to GPs regarding when they should issue a Fit Note. This was updated in December 2016.

In the document, doctors are warned of the dangers of “worklessness” and told they must consider “the vital role that work can play in your patient’s health”.  According to the department, “the evidence is clear that patients benefit from being in some kind of regular work”.

The biopsychosocial model, with a current political emphasis on the psychological element, has become a disingenuous euphemism for psychosomatic illness, which has been exploited by successive governments (and rogue insurance companies) to limit or deny access to social security, medical and social care.

Nobody would deny that illness has biological, psychological and social dimensions, however, the model has been adapted to fit a neoliberal “small state” ideology – one that rests almost entirely on Conservative individualist notions of citizen responsibility, as opposed to a rights-based approach and provision of publicly funded state support.

This approach to disability and ill health has been used by the government 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 was originally designed to provide 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 to support the Conservative notion of welfare “dependency”. 

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

The idea that people remain ill deliberately to avoid returning to work  – what Iain Duncan Smith and David Cameron have termed “the sickness benefit culture” – is not only absurd, it’s very offensive. This is a government that not only disregards the professional judgements of doctors, it also disregards the judgements of sick and disabled people. However, we have learned over the last decade that political “management” of people’s medical conditions does not make people healthier or suddenly able to work. Government policies, designed to “change behaviours” of sick and disabled people have resulted in harm, distress and sometimes, in premature deaths

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 also 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.

Many campaigners have raised concerns about the DWP interfering with people’s medical care and accessing their medical files. I wrote an article last year about how the government plans to merge health and employment services and are now attempting to redefine work as a clinical outcome. I raised concerns about the fact that unemployment has been stigmatised and politically redefined as a psychological disorder, and that the government claims, somewhat incoherently, that the “cure” for unemployment due to illness and disability, and sickness absence from work, is work.

In a critical analysis of the recent 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.

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

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

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. 

Waddell and Burton are cited frequently by the DWP as providing “evidence” that their policies are “evidence based.” Yet the DWP have selectively funded their research, which unfortunately frames and constrains the theoretical starting point, research processes and the outcomes with a heavy ideological bias. 

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

Medication, rest, release from duties, sympathetic understanding – the remedies to illness – are being appallingly redefined as “perverse incentives” for ill health, yet the symptoms necessarily precede the prescription of medication, the Orwellian renamed (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. 

People cannot simply be “incentivised” into not being ill. 

The political use of the biopsychosocial model to cut costs at the expense of people who are ill will undoubtedly have further extremely serious implications. Such an approach, which draws on behaviourism and punishment (such as the threat and implementation of sanctions) is 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.

This is clearly the direction that government policy is moving in and this represents a serious threat to the health, welfare, wellbeing and human rights of patients and the political independence of health professionals.

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

  1. The doctors should not give any information about his patients , an to take advice from a person by letter under mind in there professionals they should not be allowed to practice an should be held responsible as well as the people who told his gp they should be done for murder at the least man slaughter distace, sorry Abbie for your loss Mark ormy

    Liked by 1 person

    1. my thoughts too Mark. GPs are well trained medical proffessionals. no one at the DWP have such medical knowledge at all. they should not be involved in the patients care in any way shape or form . this government (all those who have had anything to do with these measures /austerity etc,) need to be brought to task. they’ve already been told they have broken several human rights by the UN courts of human rights but are refusing to take that on board because they dont care. well all i can say is, one day they will get THEIR rights and they wont like it. but i hope i live long enough to see the day. i may be christian but i will be jumping for joy when they get their just desserts.

      Liked by 1 person

      1. words carnt say how I feel all I can say is how can we beat thease people are children don’t go to private schools , some don’t have a breakfast some see there mother there father on drugs they have to live with that go to school worried about there parents watching ballifes at the door that’s there life tit for tat but if you
        Are lucky to
        Have a good family an does good in school they don’t get taught about politics an the value of money ( we’re in private schools ) it’s manortary Mark

        Like

  2. Surely a GP does not have to listen to a medically unqualified civil servant, after all they are the ones who are aware of the patient’s illness, not a desk-bound civil servant who is being manipulated by some very evil politicians.

    Liked by 2 people

  3. Another astute and as ever astringent assessment of the state of our welfare system. Having seen this tragedy commented on a number of times this week, I noticed that the role of the GP in this is strangely muted, despite the pivotal role in refusing to sign those Orwellian “fit notes”. The get out clause for the DWP is their letter stating that fit notes should no longer be signed for the “purpose of ESA”. WELL, WELL. The smoking gun. It didn’t say never sign one ever for this patient, or that they can be issued during claims for JSA. The GP failed in his/ her duty and did much harm, and I hope they are hauled in front of the BMA and at least made to do some training, if not struck off. But if course, there are many in the health profession who are in fact supporters of the neocon-trick. They will unfortunately be in the vanguard of leading the medical profession into dark places reserved for the ” caring professions” under eugenics or social darwinism or whatever they pretend they are not. They are the one who do actually have the power of life and death, along with the DWP who can perform their perverted “Liverpool pathway” for the useless eaters, by withdrawing shelter and food and warmth from the dehumanised masses we disabled and sick are now. The medical profession must now either step up to their duties, or step away. Of course their perception of their duties – the rationing of underfunded healthcare to workers in cahoots with the DWP – is perhaps too great a responsibility for some of them who are morally compromised.

    Liked by 2 people

  4. If Basic Income Guarantee (BIG) was introduced, then the whole nasty DWP machine can be dismantled and this scenario confined to history.

    Never forget that the money the DWP pays you is YOURS – it comes from the taxes you have paid over the years from VAT, Car tax, NI contributions, income tax etc. it is not THEIRS.

    I am an advocate for BIG and I urge you to sign up the petition to force the change. BIG is needed because millions of jobs are vanishing, Mark Carney BOE Chief says 15 million will go.

    Government cannot sit ‘Canute like’ trying to command the tide to stop. It is too late for that, the tide has to be managed and BIG is the only alternative, because the jobs will no longer be there.

    Doctors should make choices based on their expert knowledge not from the direction of amateurs in the DWP who have little grasp about the realities of work in the real world.

    Liked by 2 people

    1. Matt, I for one agree with what you say (and there are others in my age group (the elderly…contrary to what conservatives would have you believe,, we do NOT support them..thats all BS.) ,also a good number of others from all walks of life and all ahe groups. only thing i cant get my head around is, where would the money cone from? under normal situations, someone works, manufacturing goods or selling them.. money exchanges hands, fresh stock is bought after paying out tax and wages etc… but if no work, no manufacturing/growing of goods therefore nothing to sell either here or abroad, therefore no income for anyone. so i can only assume it’ll come from the Bank of England and taxes already paid in (no jobs = no further taxes paid except VAT which we all pay unless exempt.(diabetics are exempt when buying essential extra test strips/finger prick needs etc.)…some people must have jobs though for essential services, GPs, hospital staff wether private or otherwise…..various others.(fire service, refuse collectors…. unless we are going to end up with none of these things as in pre late victyorian times

      Like

      1. The money for BIG will be largely self generating, give people money and they usually spend it. But also to consider is we have 14 billion from EU contributions to draw on and if we cut the foreign aid budget of the 9 billion the EU forces us to spend we would be ok.

        The DWP is 80,000 staff strong, why? the model it is trying to service of people having jobs is vanishing, they are out of step. BIG would cut the bureaucracy that costs millions.

        BIG is the only viable alternative to work, I have watched jobs vanish since 2009, it is getting worse! 15 retail shops on the high streets of the UK close every day.

        Like

  5. Recognition of the role the GP played has been overlooked. He is guilty of dereliction of duty and should be held to account for shirking responsibility for his/her patient’s health and well being. The DWP needs the GP’s cooperation in order to pursue it’s eugenics by stealth tactics, which means, in essence, that GP’s tacit collusion is tantamount to negligence. This is an issue the BMA needs to address properly instead of brushing it under the carpet. I wonder how many extremely well paid GP’s would be willing to work for the pittance earned by so many patients. Crap doctors are ten a penny but that doesn’t mean we should tolerate them without complaint.

    Like

    1. Doctors ten a penny with respect we don’t have choice who we can take are health in any ones hands but we have no choice , so to be honest you have good morals but to me it sounds like your try into be a cut above the rest 2 a penny ? We’re talk in about some one who as lost her dad who has worked all his life gave his spare time to the youth centres what a fella he was 👍🏼 mate your in or out

      Like

  6. Samuel butler. ” Erewhon ” published 1872. A satire. A fictional country where crime is treated as a sickness, and sickness is treated as a crime.
    Where are these lunatic neolib fanatics taking us ?
    ” I have seen the future. It is a boot stamping on a human face for ever ” !
    George Orwell said that. The Samuel butler of his day.

    Liked by 1 person

  7. Hi Kitty, have just seen this article, and wonder if it is too late to complete the opt- out form (care.data),and deliver it to our doctor’s surgery? I had read that the programme had been put on hold,but am unsure if it has been started again under the radar. Thank you for your helpful articles, and a Happy New Year!

    Liked by 1 person

  8. are we sure that this opt out thing when signed wont be buried in our notes as time goes on? i opted out ages ago.(cant remember when but around the time that news broke) but i have evidence that a lot of stuff gets buried way back on computers just as it does on our own PCs. from things my drs have said that proves they dont read notes properly.because something is from way back even though it could affect how you may be treated in future but they dont have time tyo wade through it all.

    Like

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