Category: Sickness and Disability

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

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Source: the Independent, written by James Moor.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Related

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

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

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

What you need to know about Atos

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

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


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

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

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Heartless PIP Cuts Latest, ESA WRAG Cut Regulations Published – Benefits and Work

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I got the following email from Benefits and Work:

Dear Sue,

Even by this government’s standards it’s a shockingly cruel move.

Last month a tribunal of judges ruled that claimants with mental health conditions such as severe anxiety have a right to claim even the higher rate of PIP for help with going outdoors.

It was a decision that put an end to years of the DWP deliberately misinterpreting the law. It meant that many thousands of people with serious mental health conditions finally had a chance to gain a little bit more independence.

So the government acted with remarkable speed.

Bypassing the social security advisory committee, who are supposed to get the chance to comment on all changes to social security law, they published a statutory instrument that will reverse the judges’ decision.

In an effort to justify overturning the judges’ ruling, Tory policy supremo George Freeman mocked as “bizarre” the idea that claimants with mental health conditions should be eligible for PIP. Instead, he said, PIP should only be for “the really disabled people who need it.”

The changes will apply to all claims made from 16 March, 2017.

Just a few days ago we had the following feedback by email.

“Just wanted to say thank you so much for your amazing site! I have used your advice over the years for my son’s DLA applications with great success, have now had his PIP awarded for enhanced care, and after mandatory reconsideration, got the award for mobility as well (thanks to your advice about the tribunal rulings on this for people with a mental health issue).”

Unless attempts by the Lib Dems and Labour to overturn the statutory instrument are successful, and that seems a very long shot, we won’t be seeing many more emails like that.

ESA CUTS REGULATIONS FINALLY PUBLISHED
The DWP have finally published regulations removing the work-related activity component of employment and support allowance (ESA) for new claims.

New ESA claimants in the work-related activity group who are aged 25 or over will receive only £73.10 a week. They will not receive the additional £29.05 component that current claimants receive.

Similar regulations apply to universal credit claimants who have limited capability for work.

Claimants who made a claim for ESA before 3 April, or who are deemed to have made a claim before that date, as well as claimants who are still waiting to be transferred from incapacity benefits to ESA, will not be affected.

Claimants who qualify for the support group are not affected by the changes.

TRIBUNAL CHANGES
Sir Ernest Ryder, the Senior President of Tribunals, has confirmed that benefits claimants will be the Guinea pigs for changes to appeal tribunals due to begin in September 2017. From that date social security tribunals will move more and more online.

You can look forward to attempting to upload your personal data to the cloud, getting emails from tribunal clerks or judges which hopefully won’t disappear into your spam folder and to having a hearing – if you get one at all – via Skype or telephone.

We’ll keep you informed, and our appeals guides updated, as we learn more.

HAVE YOU BEEN ASKED TO JOIN THE DWP’S CLAIMANT PANEL?
DWP minister Penny Mordaunt told the Commons last week, in relation to PIP and ESA, that:

“One thing I have done to ensure that we get more timely information about where things are going wrong and where standards are not being maintained is to establish a claimant user rep panel, which will go live in the next few weeks. It will be rolled out on a very large scale across the country.”

We’re very keen to hear from anyone who has been invited to join this, until now, completely unknown body. Please contact us if you have.

HOME MEDICALS SURVEY
Many thanks to everyone who took part in our survey on PIP and ESA home medicals. We had almost 2,000 responses. There were a lot more additional comments than we had expected, so we’re making sure we go through them all before we publish our findings, which we plan to do in a fortnight.

Good luck,

Steve Donnison

Related

Two EDMs have been tabled to stop Tory cuts to disability support, with cross-party endorsement

Tory MP says PIP should only go to ‘really disabled’ people, not those with anxiety ‘taking pills at home’

Government subverts judicial process and abandons promise on mental health ‘parity of esteem’ to strip people of PIP entitlement

Lords table motion to kill new Tory restrictions on PIP

 


 

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

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Two EDMs have been tabled to stop Tory cuts to disability support, with cross-party endorsement

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I reported last week that the Liberal Democrats were planning an Early Day Motion (EDM) to halt the government’s authoritarian Personal Independence Payment (PIP) regulations. The new regulations are designed by the government to disregard the rulings of two upper tribunals regarding the scope of eligibility criteria for disabled people claiming PIP. However, upper tribunals are part of a body of administrative law that governs the activities of the administrative agencies of government. It is designed to independently review the decisions of governments, and as such, it provides protection and promotion of fundamental rights and freedoms for citizens.

The Upper Tribunal is a superior court of record, giving it equivalent status to the High Court and it can both set precedents and can enforce its decisions (and those of the First-tier Tribunal) without the need to ask the High Court or the Court of Session to intervene. It is also the first (and only) tribunal to have the power of judicial review. (The Conservatives have a historical dislike of judicial review. See for example: The real “constitutional crisis” is Chris Grayling’s despotic tendencies and his undermining of the Rule of Law.)

The first EDM has already gained excellent cross-party support. It’s primary sponsor is Tim Farron. Signatories include Jeremy Corbyn, Debbie Abrahams and a number of other Labour Party MPs, Caroline Lucas (Green Party), Jonathan Edwards (Plaid Cymru) and Scottish National Party MPs.  

It says: “That an humble Address be presented to Her Majesty, praying that the Social Security (Personal Independence Payment) (Amendment) Regulations 2017 (S.I., 2017, No. 194), dated 22 February 2017, a copy of which was laid before this House on 23 February, be annulled.”

From 1 April 2017, further cuts to Employment and Support Allowance (ESA) are to be introduced, again via statutory instrument (which are usually reserved for non-controversial policy amendments only). The new regulations mean that claimants who are placed in the Work-Related Activity Group (WRAG) will lose around £30 a week, receiving the same rate of payment as those claiming Jobseeker’s Allowance and the equivalent in Universal Credit.

Another EDM was tabled by the Labour Party, with the primary sponsor being Jeremy Corbyn, which says: “That an humble Address be presented to Her Majesty, praying that the Employment and Support Allowance and Universal Credit (Miscellaneous Amendments and Transitional and Savings Provisions) Regulations (S.I., 2017, No. 204), dated 23 February 2017, a copy of which was laid before this House on 27 February, be annulled.”

Disabled people have already carried a disproportionately large burden of austerity cuts.

 

 

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The cuts to disability support have been widely opposed, yet the government apparently pays little heed to the need for democratic accountability. 

You can support disabled people who are being targeted by ever-increasingly punitive Conservative policies that are having an extremely damaging impacon us by emailing your MP and asking them to sign both EDMs. (Contact details here).

 

Related

A black day for disabled people – disability benefit cuts enforced by government despite widespread opposition

House of Lords debate: ESA – Monday 07 March 2016 (From 3.06pm)

MP attacks cuts hitting disabled people – Debbie Abrahams

Leading the debate against the Welfare Reform and Work Bill – 3rd reading – Debbie Abrahams

My speech at the Changes to Funding of Support for Disabled People Westminster Hall Debate – Debbie Abrahams

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

The government need to learn about the link between correlation and causality. Denial of culpability is not good enough.

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

Stephen Crabb’s obscurantist approach to cuts in disabled people’s support

A Critique of Conservative notions of “Social Research”

The DWP mortality statistics: facts, values and Conservative concept control


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

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

With many thanks to Open Democracy.

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Related

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

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


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

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Government subverts judicial process and abandons promise on mental health ‘parity of esteem’ to strip people of PIP entitlement

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Personal Independence Payment is a non means tested benefit for people with a long-term health condition or impairment, whether physical, sensory, mental, cognitive, intellectual, or any combination of these. It is an essential financial support towards the extra costs that ill and disabled people face, to help them lead as full, active and independent lives as possible.

Before 2010, policies that entailed cutting lifeline support for disabled people and those with serious illnesses were unthinkable. Now, systematically dismantling social security for those citizens who need support the most has become the political norm.

Any social security policy that is implemented with the expressed aim of “targeting those most in need” and is implemented to replace a policy that is deemed “unsustainable” is invariably about cost cutting, aimed at reducing the eligibility criteria for entitlement. The government were explicit in their statement about the original policy intent behind Personal Independence Payment. However, what it is that defines those “most in need” involves ever-shrinking, constantly redefined categories, pitched at an ever-shifting political goalpost.

Disability benefits were originally designed to help sick and disabled people meet their needs, additional living costs and support people sufficiently to allow  a degree of dignity and independent living. You would be mistaken in thinking, however, that Personal Independent Payment was designed for that. It seems to have been designed to provide the Treasury with ever-increasing pocket money. Or as the source of profit for private providers who constantly assess, monitor, coerce and attempt to “incentivise” those people being systematically punished and impoverished by the state to make “behaviour changes,” which entail them not being disabled or ill and taking any available employment, regardless of its suitability. 

The government have already considered ways of reducing the eligibility criteria for the daily living component of Personal Independence Payment (PIP) by narrowing definitions of aids and appliances, and were kite flying further limits to eligibility for PIP last  year

Two independent tribunals have ruled that the Department for Work and Pensions (DWP) should expand the scope and eligibility criteria of Personal Independence Payment (PIP), which helps both in-work and out-of work disabled people fund their additional living costs. 

Following a court ruling in favour of disabled people last month, the government is rushing in an “urgent change” to the law to prevent many people with mental health conditions being awarded the mobility component of PIP. The court held that people  with conditions such as severe anxiety can qualify for the enhanced rate of the mobility component, on the basis of problems with “planning and following a journey”, or “going out”. 

The government’s new regulations will reverse the recent ruling and means that people with mental health conditions such as severe anxiety who can go outdoors, even if they need to have someone with them, are much less likely to get an award of even the standard rate of the PIP mobility component. The new regulations also make changes to the way that the descriptors relating to taking medication are interpreted, again in response to a ruling by a tribunal in favour of disabled people.

The first tribunal said more points should be available in the “mobility” element for people who suffer “overwhelming psychological distress” when travelling alone. The second tribunal recommended more points in the “daily living” element for people who need help to take medication and monitor a health condition. 

The Department for Work and Pensions (DWP) warned that it would cost £3.7bn extra by 2022 to  implement the court rulings. The government have responded by formulating “emergency legislation” to stop the legal changes that the upper tribunals had ruled on from happening. From 16 March the law will be changed, without any democratic conversation with disabled people and related organisations, or debate in parliament, so that the phrase “For reasons other than psychological distress” will be added to the start of descriptors c, d and f in relation to “Planning and following journeys” on the PIP form.

It’s worth noting that the Coalition Government enshrined in law a commitment to parity of esteem for mental and physical health in the Health and Social Care Act 2012. In January 2014 it published the policy paper Closing the Gap: priorities for essential change in mental health (Department of Health, 2014), which sets out 25 priorities for change in how children and adults with mental health problems are supported and cared for. The limiting changes to PIP legislation does not reflect that commitment.  

The new regulations are being rushed in without any dialogue with the Social Security Advisory Committee, too. 

The government have designed regulations which would, according to Penny Mordaunt, be about “restoring the policy originally intended when the Government developed the PIP assessment”.

The original policy intent was to create an opportunity to limit eligibility for those people previously claiming Disability Living Allowance (DLA) whilst they were being reassessed for PIP, which replaced DLA. And to limit successful new claims. 

Mordaunt also said in a written statement to MPs: “If not urgently addressed, the operational complexities could undermine the consistency of assessments, leading to confusion for all those using the legislation, including claimants, assessors, and the courts.

“It is because of the urgency caused by these challenges, and the implications on public expenditure, that proposals for these amendments have not been referred to the Social Security Advisory Committee before making the regulations.”

An ever-shifting, ever-shrinking goalpost

Any social security policy that is implemented with the expressed aim of “targeting those most in need” is invariably about cost cutting and reducing eligibility criteria for entitlement. The government were explicit in their statement about the original policy intent of Personal Independence Payment. 

The government has already considered ways of reducing eligibility criteria for the daily living component of Personal Independence Payment by narrowing definitions of aids and appliances, last  year

Prior to the introduction of PIP, Esther McVey stated that of the initial 560,000 claimants to be reassessed by October 2015, 330,000 of these are targeted to either lose their benefit altogether or see their payments reduced.

We ought to challenge a government that displays such contempt for the judicial system, and ask where the ever-reductive quest for the ever-shrinking category of “those with the greatest need” will end. 

Labour’s Shadow Work and Pensions Secretary, Debbie Abrahams MP, criticised the government’s decision to overturn the tribunal rulings, she said“Instead of listening to the court’s criticisms of PIP assessments and correcting these injustices, this government have instead decided to undermine the legal basis of the rulings”.

Abrahams added: “This is an unprecedented attempt to subvert an independent tribunal judgement by a right-wing government with contempt for judicial process.

By shifting the goal posts, the Tory Government will strip entitlements from over 160,000 disabled people, money which the courts believe is rightfully theirs. This is a step too far, even for this Tory government.”

The government seem to think that PIP is a policy that ought to benefit only the needs of a government on an ideological crusade to reduce social security away to nothing – “to target those in greatest need” – an ever-shrinking, constantly redefined and shifting category of disability.

It is not a democratic government: they are unwilling to engage in a dialogue with the public or to recognise and reflect public needs: that’s an authoritarian elite taking public money and handing it out to a very wealthy minority group in the form of “incentivising” tax cuts, who then say to the public that providing lifeline support for disabled people and those with mental health/medical conditions is “unsustainable”.

Implications for the UK’s obligations regarding the UN convention on the human rights of disabled persons and the Equality Act

The new PIP changes, pushed through without any public conversation or democratic exchange with disabled people, are in breach of both the UN convention on the rights of disabled persons, and the UK Equality Act.

In the Equality Analysis PIP assessment criteria document, the government concede that: “Since PIP is a benefit for people with a disability, impairment or long-term health condition, any changes will have a direct effect on disabled people. The vast majority of people receiving PIP are likely to be covered by the definition of “disability” in the Equality Act 2010.

By definition, therefore, the UT [upper tribunal] judgment results in higher payments to disabled people, and reversing its effect will prevent that and keep payments at the level originally intended. The difference in income will clearly make a real practical difference to most affected claimants, and (depending on factors such as their other resources) is capable of affecting their ability to be independently mobile, access services etc – all matters covered by the UN Convention on the Rights of Persons with Disabilities as set out at the start of this Analysis.”

It goes on to say in the document: “However, this does not necessarily mean that the increased payments that would result from the judgment are a fair reflection of the costs faced by those affected, or represent a fair approach as between different groups of PIP claimants.” 

People with the following conditions are likely to be affected by the reversal of the upper tribunal’s ruling on those needing support to manage medication, monitor a health condition, or both:

Diabetes mellitus (category unknown), Diabetes mellitus Type 1 (insulin dependent), Diabetes mellitus Type 2 (non-insulin dependent), Diabetic neuropathy, Diabetic retinopathy, Disturbances of consciousness – Nonepileptic – Other / type not known, Drop attacks, Generalised seizures (with status epilepticus in last 12 months), Generalised seizures, (without status epilepticus in last 12 months), Narcolepsy, Non epileptic Attack disorder (pseudoseizures), Partial seizures (with status epilepticus in last 12 months), Partial seizures (without status epilepticus in last 12 months), Seizures – unclassified Dizziness – cause not specified, Stokes Adams attacks (cardiovascular syncope), Syncope – Other / type not known.

People with the following conditions are likely to be affected by the reversal of the independent tribunal’s ruling regarding PIP mobility awards, with conditions in the general category of “severe psychological distress”:

Mood disorders – Other / type not known, Psychotic disorders – Other / type not known, Schizophrenia, Schizoaffective disorder, Phobia – Social Panic disorder, Learning disability – Other / type not known, Generalized anxiety disorder, Agoraphobia, Alcohol misuse, Anxiety and depressive disorders – mixed Anxiety disorders – Other / type not known, Autism, Bipolar affective disorder (Hypomania / Mania), Cognitive disorder due to stroke, Cognitive disorders – Other / type not known, Dementia, Depressive disorder, Drug misuse, Stress reaction disorders – Other / type not known, Post-traumatic stress disorder (PTSD), Phobia – Specific Personality disorder, Obsessive compulsive disorder (OCD).

The government’s so-called commitment to a “parity of esteem for mental health and physical health” was clearly nothing more than an empty promise – an opportunistic platitude. This is a government that says  one thing and then does exactly the opposite.

 It’s all part of a broader gaslighting and linguistic techniques of neutralisation strategy that passes as Conservative “justification” for their draconian deeds and bullying, discriminatory and uncivilised austerity regime, aimed disproportionately at disabled people.

Commenting on the Ministerial announcement (made yesterday, 23rd February), Rob Holland, Public Affairs Manager at Mencap and Disability Benefits Consortium Parliamentary Co-Chair said:

“We are concerned by these changes to the criteria for Personal Independence Payment (PIP). These risk further restricting access to vital support for thousands of disabled people. Last year, MPs strongly opposed restrictions to PIP and the Government promised no further cuts to disability benefits. Other changes have already had a devastating impact on thousands and in far too many cases people have had to rely on tribunals to access the support they need.

We are deeply disappointed as a coalition of over 80 organisations representing disabled people that we were not consulted about these proposals and their potential impact. The Government must ensure the views of disabled people are properly considered before they proceed with these changes.”

tough-choices

 

The full ministerial statement can be read here.

Download a copy of the new regulations here.

Related

PIP disability benefit test ‘traumatic and intrusive’

PIP and the Tory monologue

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


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

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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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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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