Tag: Unum

Demos say the DWP should be axed, I disagree. Here’s why

Image result for DWP

A leading cross-party thinktank has proposed that ministers should consider abolishing the Department for Work and Pensions.

In a provocative paper that marked the start of Demos’ research examining the Department of Work and Pensions, Tom Pollard, formerly of the mental health charity Mind, who has also completed an 18 months secondment to the Department for Work and Pensions (DWP), illustrates a bureaucracy blighted by “historic dynamics and averse to radical thinking.”

Pollard’s paper identifies three problems with the DWP. First, the department is afflicted by a “benefits lens”, where case handlers perceive employment support as a condition for receiving benefits, rather than a means of enabling claimants to pursue fulfilling work. Where benefits are the carrot, sanctions are the stick. Sanctioning claimants for misdemeanours such as arriving late to meetings creates a “confrontational dynamic of power asymmetries.” In other words, it strips citizens of their autonomy.

Many neoliberals have also claimed that welfare strips citizens of responsibility, though there has been no convincing evidence of this to date. 

Second, Pollard argues the department is impoverished in ambition. DWP staff are often promoted from frontline roles working in job centres. While such expertise is valuable, he argues that staff often seem “incapable of thinking about radical solutions”, and repeat the mistakes of the past, gravitating towards punitive systems of conditionality and sanctions.

These factors contribute to the DWP’s “injured reputation” among frontline users. Productive engagement between case handlers and claimants is dependent on trust. “There’s such a rift between the DWP and hard to help groups that I don’t know how you could get back to engaging on meaningful terms – there’s too much baggage”, Pollard says.

In the thought-provoking paper, entitled Pathways from Poverty: a case for Institutional reform, Pollard explains why he believes that the DWP is institutionally and culturally incapable of making the reforms needed to deliver better outcomes for society’s most vulnerable and sets out a radical new vision for the future of welfare provision.

Most of the work of Amber Rudd’s department could be carried out more effectively by other Whitehall ministries, according to Pollard. He calls for the DWP to be stripped of responsibility for these “hard-to-help groups”, with the health department and NHS helping the ill find work, local government taking over Jobcentre Plus, and benefits and pensions delivered by HMRC. The charitable sector could also be given a bigger role. 

Some criticisms

Pollard critically discusses the culture within the DWP, implying that the key problems and devastating social consequences arising from the government’s welfare reform programme are simply a result of staff attitudes and inept administrative procedure within the department. 

The crisis in our social security system is the result of government’s policies, which have embedded traditional prejudices about people experiencing poverty, and that have led to the institutionalisation of discriminatory practices within the DWP. There is no guarantee that moving the functions of the DWP somewhere else will bring about any change in attitudes and practices, or improved outcomes for people relying on social security as a lifeline. 

The DWP has come under constant fire from many campaigners, academics and charities for serious problems with universal credit, and for the catastrophic work capability assessments of those who are unfit to work. Rudd is attempting to repair The department’s reputation by tinkering with the roll-out of universal credit and fighting with the Treasury to end the freeze on working-age benefits. However, these gestures are nowhere near enough to put the major shortcomings of the system right and to mitigate the cuts to support that univesal credit and other benefits entail. 

The report concludes that while the DWP has been able to “help” people with minor difficulties into employment, the outcomes are “much poorer when it comes to supporting people with more complex needs”, such as the ill, disabled, older people, those with drug and alcohol problems, ex-prisoners and those who are homeless.

Pollard proposes that if the removal of these functions from the DWP proves to be a success, a more comprehensive approach could see the department abolished altogether”.

He says: “If the department as it stands remains at the heart of employment support for ‘harder-to-help’ groups, we will face further years of well-intentioned reforms and programmes yielding disappointing outcomes, because of how they will be formulated and how they will be received.”

The problem is that the reforms are not “well-intentioned”, and the outcomes are not “disappointing”, they are catastrophic. The policies were intentionally punitive, leading to the consequences we see: people experiencing hardship have been punished by as system that was designed originally to support them and mitigate the circumstances of  hardship.

Pollard accuses the DWP of seeing claimants through a “benefits lens”, in which conditions were placed on their payments as a way of forcing them into work. He warns that the department’s reputation among many groups is now so bad that it may prove impossible and expensive to improve. “A bad reputation is far harder to lose than a good one,” he says.

However, the problem is rather much larger than the poor reputation of the DWP. It is the policy framework that determines the set of administrative practices which in turn, shapes the “culture” within the DWP.  It is the distress and harms that are being experienced by people claiming support, most of whom have also paid into the Treasury – that is the most pressing issues here, not reputation ‘damage limitation’ strategies, or an exercise in PR trust building for the government.

Abolishing the DWP, merging it with the Department of Health and involving charities in service delivery, as proposed by Pollard, will send out the clear message that social security is no longer a discrete function or key priority of the state. It also permits the state to withdraw from providing social security.

Responsibility for budgeting for and administering welfare will become diffuse. Placing social security side by side with healthcare is also risky, as it may further stigmatise jobseekers. We have already seen the government consistently stigmatise those who are out of work, implying that unemployment is some kind of psychological disorder. Others, such as Adam Perkins, have even proposed that there is a “genetic welfare trait.” , that runs counter to Conservative notions of “good citizenship”. 

The NHS is also suffering from chronic under-funding. How will it prioritise welfare provision, when it is already struggling to deliver health care, in the face of the increasing rationing of treatments and procedures?

Historically, charities administered welfare. But the provision was patchy and varied from area to area. There were no consistent standards of support for people in hardship. During times of economic recession, charities were often unable to provide people with any support at all, at a time when they needed it most.

Local authorities are now struggling to deliver statutory services because of government cuts. Essential provisions are being rationed as a consequence. There is no guarantee that any additional funding would be ringfenced. We have already seen social services sending vulnerable young people to other areas – sometimes back to their hometown, for example – to shift the burden of cost to another local authority.  The old Poor Law saw parishes moving poor people out of their area, they were pushed from parish to parish, refused ‘relief’ in order, often, to keep local rates bills low.

A recent paper entitled “Dependency, Shame and Belonging” examines the practice of making the poor wear badges from the 16th century through to the compulsory identification of all parish paupers under a 1679 statute, differentiating between those deemed ‘deserving’ and ‘undeserving’. By the late 17th century, magistrates and legislators decided to deter potential badge applicants by making life on the parish as unattractive as possible. Badging became a means of preventing begging and shaming holders, made compulsory in 1697.

The proposal from Demos simply exchanges one form of expensive, intrusive and ineffective bureaucracy with another. How would the Department of health and charities be allocated funds to carry out this publicly funded state function? How would they be held accountable? 

As I touched on earlier, unless the policy framework is also radically changed to one that is supportive, rather than punitive, and to one that isn’t about administering cuts to people’s lifeline support, then the perverse incentives to apply conditionality and sanctions will remain embedded in administration practices. 

A government that does not support a social security programmme – and the anti-welfarism of the Conservatives has been apparent for a long time – is likely to see the shift in responsibillity for delivering social security as a further step in abolishing welfare provision entirely, which has always been their long term aim. 

Finally, it’s worth noting that Demos produced a paper in 2011 advocating reducing the costs of disability benefit by “engaging with the private insurance industry” and proposing that: “reform to encourage individual responsibility and income protection is genuinely of mutual benefit.” The approach laid out in this report builds on the theory and practice of the profoundly antidemocratic ‘libertarian paternalism’ or ‘nudge’ theory. 

Other papers from the thinktank peddle the views of antiwelfarist James Purnell, who, for example, proposed charging interest on crisis loans to unemployed people and pensioners made by the Department for Work and Pensions, which were interest-free, at a rate of up to 26.8% per annum. This was met with great hostility and was blocked by the intervention of the Prime Minister, Gordon Brown. It was Purnell who announced the Work Capability Assessment, triangulating the Conservatives. Purnell advocated Unum’s approach to “claims management”, in a bid to cut costs of disability support. (See Rogue company Unum’s profiteering hand in the government’s work, health and disability green paper for more detailed discussion). 

The Conservative’s ideological position has been used politically as a justification to reduce social security provision so that it is no longer an adequate amount to meet citizens’ basic living needs. The aim is to discredit the welfare system itself, along with those needing its support. The government have long wished to replace the publicly funded social security provision ultimately with mandatory private insurance schemesas have some ‘blue Labour’ neoliberals, including Purnell. 

The th empirically unevidenced idea that welfare creates ‘dependency’ and ‘disincentivises’ work has been used as a justification for the introduction of cuts and an extremely punitive regime entailing ‘conditionality’ and sanctions. The government have selectively used punitive behavioural modification elements of behavioural economics theory and its discredited behaviourist language of ‘incentives’ to steadily withdraw publicly funded social security provision, which is the ultimate ideological goal. That is the root of the problem. 

In light of this, the timing of Pollard’s set of proposals is also rather suspect – see The Centre for Social Justice say Brexit is ‘an opportunity’ to introduce private insurance schemes to replace contribution-based social security.

A DWP spokesperson has responded from the government’s crib sheet of crafted statements: “This report is completely misguided and we have no plans to reduce functionality at a time when unemployment is at its lowest, welfare reforms are rolling out across the country and millions are saving for a private pension for the first time. Jobcentres are a local presence yet benefit from a national framework. DWP supports around 20 million people to get into work and save for their retirement, as well as giving stability to those who cannot work, and will continue to do so as one responsible organisation.”

 


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The NHS is to hire 300 employment coaches to find patients jobs to “keep them out of hospital.”

Image result for cognitive therapy for unemployed protests

The government has a problem with the public actually using public services

The government announced the creation of the Joint Health and Work Unit and the Health and Work Service in 2015/16, both with a clear remit to cut benefits and “get people into work.” Given that mental health is a main cause for long-term sickness absence in the UK, a key aspect of this policy is to provide mental health services that get people back into work.

There has already been an attempt to provide mental health services for people who claim social security support, which includes a heavily resisted pilot to put therapists into job centresAnother heavily opposed government proposal was announced as part of the  health and work pilot programme to put job coaches in GP surgeries
The proposals have been widely held to be profoundly anti-therapeutic, potentially very damaging and professionally unethical. 

With such a narrow objective, the delivery will invariably be driven by an ideological agenda, politically motivated outcomes and meeting limited targets, rather than being focused on the wellbeing of individuals who need support and who may be vulnerable. I also discovered almost by chance back in 2015 that the Nudge Unit team have been working with the Department for Work and Pensions and the Department of Health to trial social experiments aimed at finding ways of: “preventing people from falling out of the jobs market and going onto Employment and Support Allowance (ESA).” 

“These include GPs prescribing a work coach, and a health and work passport to collate employment and health information. These emerged from research with people on ESA, and are now being tested with local teams of Jobcentres, GPs and employers.”  Source: Matthew Hancock’s conference speech: The Future of Public Services

GPs have raised their own concerns about sharing patient data with the Department for Work and Pensions – and quite properly so. Pulse reported that the Department for Work and Pensions (DWP) planned to extract information from GP records, including the number of Med3s or so-called “fit notes” issued by each practice and the number of patients recorded as “unfit” or “maybe fit” for work, in an intrusive move described by GP leaders as amounting to “state snooping.”

Part of the reason for this renewed government attack on sick and disabled people is that the government’s flagship fit note scheme, which replaced sick notes five years ago in the hope it would see GPs sending thousands more employees back to workto reduce sickness-related absence, despite GPs having expressed doubts since before its launch, has predicably failed.

The key reason for the failure is that employers did not take responsibility for working with employees and GPs seriously, and more than half (59%) of employers said they felt unable to support employees by making all of the legally required workplace adjustments for those who had fit notes signed as “may be fit for work.” Rather than address this issue with employers, the government has decided instead to simply coerce patients back into work without essential support.

Another reason for the failure of this scheme is that most people who need time off from work are ill and genuinely cannot return to work until they have recovered. Regardless of the government’s concern for the business and state costs of sick leave, people cannot be simply ushered out of illness and into work by the state to “contribute to the economy.” When a GP says a person is “unfit for work”, they generally ARE unfit for work, regardless of whether the government likes that or not.

The government have planned to merge health and employment services, and are now attempting to redefine work as a clinical outcome. Unemployment has been stigmatised and politically redefined as a psychological disorder, the government claims somewhat incoherently that the “cure” for unemployment due to illness and disability, and sickness absence from work, is work.

The latest strand of this ideological anti-welfare crusade was recently announced: the NHS is to hire 300 employment coaches who will find patients jobs to “keep them out of hospital.” The Individual Placement and Support services (IPS) is aimed at ‘supporting’ people with severe mental illness to seek work and ‘hold down a job’. Job coaches will offer assistance on CVs, interview techniques and are expected to work with 20,000 people by 2021. Pilot schemes running in Sussex, Bradford, Northampton and some London boroughs suggest that the coaches manage to find work for at least a quarter of users. The scheme is to be extended nationwide. 

The roll out of mental health employment specialists across the country is based on  analysis of the pilots, which is claimed to show that 2,300 patients have been helped into work in the last year. However, the longer term consequences of the programme are not known, and it is uncertain if there will be any meaningful monitoring regarding efficacy, safeguarding and the uncovering of unintended consequences and risks to participants.

It is held that those in work tend to be in better health, visit their GP less and are less likely to need hospital treatment. The government has assumed that there is a causal relationship expressed in this common sense finding, and make an inferential leap with the claim that “work is a health outcome”.

However, support for this premise is not universal. Some concerns which have been reasonably raised are commonly about the extent to which people will be ‘pushed’ into work they are not able or ready to do, or into bad quality work that is harmful to them, under the misguided notion that any work will be good for them in the long run. 

Of course it may equally be the case that people in better health work because they can, and have less need for healthcare services simply because they are relatively well, rather than because they work. 

Undoubtedly there are some people who may be able to work and who want to, but struggle to find suitable employment without adequate support. This section of the population may also face the lack of knowledge, attitudes and prejudices of potential employers regarding their conditions as a further barrier to gaining appropriate employment. The scheme will be ideal for supporting this group. That is, however, only provided that engagement with the service is voluntary, and does not become mandatory. 

It must also be acknowledged that there are some people who are simply too ill to work. Again, it’s a serious concern that this group may be pressured and coerced to find employment, which may prove to be detrimental to their wellbeing. Furthermore, placing them in work may present unacceptable risk to both themselves and others. How can we possibly know in advance about the longer term risks presented by the impact of an illness, and the potential effects of some medications in the workplace? If something goes catastrophically wrong as a consequence of someone taking up work when they are too unwell to work, who will hold the responsibility for the consequences?

In the current political context where the public are told “work is the route out of poverty” and “work is a health outcome”, people feel obliged to try to work, when they believe they can. But what happens when they are wrong in that belief? Who is responsible, for example, when someone has a loss of consciousness or an episode of altered awareness, caused by a condition or medication, while operating machinery, at the wheel of a taxi, bus or refuse waggon? 

Harry Clarke, who believed that he was fit for work, suffered a loss of consciousness on 22 December 2014 while at the wheel of a moving refuse lorry in Glasgow city centre, resulting in six deaths and leaving 15 people injured. Following numerous warnings from the court about his right to remain silent, Clarke refused to answer key questions about numerous doctors visits and medical tests for dizziness, fainting, vertigo, heart problems, tension headaches, operations on hands and knee pain dating back to 1976. However, one of the biggest revelations of the inquiry was Clarke’s lengthy medical history, which showed he had suffered episodes of dizziness and fainting for decades prior to the tragic crash.

Yet during an inquiry about the case, a health care professional who assessed the Glasgow bin lorry crash driver for the renewal of his HGV licence in 2011 would have deemed him only “temporarily unfit to drive” if she had known he had fainted the year before the accident. Furthermore, Clarke’s conditions would probably not have made him eligible for Employment and Support Allowance (ESA). Dr Joanne Willox told the inquiry panel at Glasgow Sheriff Court that she saw Mr Clarke on 6 December 2011 at the request of his employer Glasgow City Council to complete a HGV renewal application form with him which was to be submitted to the DVLA. 

Dr Willox, an occupational medical adviser for the private company Bupa, on behalf of Glasgow City Council, did not have access to his medical records. She could have requested the records with the patient’s consent if she considered it necessary, though this was not the normal practice and it may have taken time to get the records.

She said it would have been “helpful” to have the records. The inquiry revealed that Clarke had a history of fainting and dizziness, and had in fact previously suffered a similar episode while at the wheel of a stationary bus, in 2010.

The horrific case highlights several issues, not least that employment of people with unpredictable or undiagnosed medical conditions does not only pose a threat to the person, but it may potentially be contrary to public safety, too. It also highlights that a privately contracted occupational health professional who had no knowledge of Clarke’s medical history, was unsuitably tasked to make a judgement about his potential ability to work as a refuse waggon driver. Employing people who are ill and later found to be unfit for the role is potentially in contravention of the Health and Safety at Work Act. 

Another horrific example of the dangers presented by placing trust in unqualified bureaucrats and the state – who have ideological interests that often lie in conflict with those of patients – to make decisions about citizens’ health and welfare arose when a manager at Birkenhead Benefit Centre in Liverpool 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.” (My emphasis)

The job centre manager was wrong. The health care professional, assessing the patient on behalf of the private company contracted to carry out the ESA assessment, on behalf of the government, was wrong. 

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.

He was clearly not fit for work.

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

It has become very evident over recent years that the labour market is not delivering an adequate income for many citizens and despite “record levels of employment”, the problem seems to be getting bigger. The government’s answer to the problem has been to extend punishment those on low pay, rather than tackle employers who pay exploitative, low wages.

The neoliberal narrative and Conservative antiwelfarism

Some of the underpinning language used to justify this approach also troubles me, as it is clearly couched in economic terms. It’s about cutting costs, propping up the economy as a whole and “rewarding” tax payers. Here, it is implied that people who are ill are somehow a burden on tax payers. However, most people who become ill have also worked and contributed to the Treasury. Furthermore, people who aren’t in employment also pay taxes, too, be it VAT, council tax, or a range of other stealth taxes from which even the poorest citizens are no longer exempted. 

Claire Murdoch, NHS England national mental health director, said: “Helping people with mental ill health to find and keep a job is good for individual wellbeing and good for the health of our economy. Tackling severe mental illness is not just about getting medication and treatment right, but ensuring people can recover to live independently with their condition, including the reward and satisfaction of getting and keeping a job.

In our 70th year, mental health is one of the NHS’ top priorities, and ensuring services are integrated, so people get whole-person care, means our patients get better outcomes and taxpayers are rewarded as treatment is more efficient. One in seven of us will go through mental ill health whilst at work, so delivering a safety net, to help people back in to work when they fall ill, will minimise harm and make our country’s workforce more productive.”

NHS England say: “As part of patients’ care and support package, work coaches in NHS Individual Placement and Support (IPS) services, offer advice about finding a job, help them to prepare for an interview and can speak with potential employers about how someone’s condition can be managed so that they can work effectively while staying in good health.

“The trained specialists also improve the health of people with severe mental illness, reducing the need for urgent hospital admissions and GP appointments. Research shows that type of support can free up as much as £6,000 per patient, which can be invested in other frontline care.”

Again, the language is loaded, it’s a narrative with a scattering of casual cost-cutting phrases and prioritises a ‘productive workforce.’ There isn’t any discussion regarding the claim to ‘minimise harm’, it seems to be assumed that work in itself will take care of that. It’s also a little worrying that employers and work coaches are to be included in the ‘management’ of employees’ illnesses. When I am ill, I don’t want the advice or ‘management’ of a boss or a work coach, I want impartial medical diagnosis, treatment and advice from my doctor, not a ‘nudge’ or trite armchair psychology and pseudoscientific platitudes from the state.

It’s difficult to see how someone with a serious, chronic or progressive illness, can actually ‘manage’ their illness and ‘move back into work.’ The use of the extremely misinformed, patronising and very misleading term manage implies that very ill people actually have some kind of choice in the matter.

Implicit in this narrative is the idea that illness is caused by deviant behaviours. The ‘cure’ therefore, is to simply address and remedy the faulty behaviours. 

The sick role and the resurrection of Talcott Parsons: disciplining disabled people

There is a lack of coherence within the narratives of contemporary Conservative governance, which is simultaneously neoliberal – grounded in free market principles and the ideal of a small, ‘non-intrusive’ state – and paternalism – which is founded on an authoritarian, large, extremely intrusive state, which is designed to tell people what is best for them and nudging citizens’ behaviours towards government defined policy outcomes.

The tension between neoliberalism and paternalism which outlines current policy approaches to disability and employment policy is filled with ambiguity, inconsistency and contradiction in its definition and understanding of the subject, the nature of the ‘problem’ and the policy ‘solutions’. On the one hand, neoliberalism is a doctrine that demands the withdrawal of social support mechanisms such as welfare, health care and public services, on the other, paternalism is based on state interventions designed to extend politically defined ‘optimal outcomes’.

These apparently contradictory narratives have been embodied in discipline of behavioural economics, which is largely aimed at enforcing the alignment of public expectations, attitudes and behaviours with neoliberal outcomes. It’s a prop for dogma and the status quo. Behavioural economics is concerned with reducing citizens’ expectations of social provision, while enforcing self reliance, and with providing justification narratives for neoliberal policies. 

I have written critical accounts of this somewhat draconian Conservative neoliberal paternalism on more than one occasion. The Conservatives place emphasis on highlighting the obligations of citizens, rather than on their rights, and this is why the work of Talcott Parsons in the early 1950s is especially appealing to them. 

Behavioural medicine was partly influenced by Talcott Parsons’ The Social System, 1951, and his work regarding the sick role, in 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 deviance, which 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 noted 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, usually entailing the diversion of public funds from public services and the provision of social security to wards rewards for the wealthiest citizens, usually in the form of tax cuts. 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, however, we have witnessed the rapid extension of this role to include extensive State policing of sick and disabled people, and the introduction of increasingly coercive measures to push citizens into self managing their health conditions, while the medical profession have been increasingly politically sidelined in their provision of advice, care and support, regarding sickness and employment.

Last year, the government proposed extending ‘fit note’ certification beyond GPs to a wider group of non-specialist healthcare professionals, including physiotherapists, psychiatrists and senior nurses, to better ‘identify health conditions and treatments’ to help workers go back into their jobs faster. This is very worrying, since it entails the diagnosis and treatment of conditions by people who are not qualified to undertake this role.

‘Fit notes’ are specifically designed to ‘help’ patients develop a return to work plan, and are meant to be tailored to their individual needs. However, the introduction of fit notes –  a somewhat Orwellian title that refuses to acknowledge people get ill, or permit citizens time to recover, which replaced sick notes –  failed to produce an increase in a more rapid return to work for patients generally, mainly due to the fact that employers failed to support patients with adequate workplace adjustments to accommodate their return.  

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 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 bErving Goffman (1963), in which he highlights the social meaning physical impairment comes to acquire via social interactions. The social model of disability tends to conceptually distinguish impairment (the attribute) from disability (the social experience and meaning of impairment). Disability cannot be reduced to a mere biological problem located in an individual’s body  (Barnes, Mercer, and Shakespeare, 1999). Rather than a “personal tragedy” that should be fixed to conform to medically determined standards of “normality” (Zola, 1982), disability becomes politicised.

The issues we then need to confront are about the obstacles that may limit the opportunities for individuals with impairments, and about how those social barriers may be removed.

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

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

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

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

Parsons never managed to accommodate and reflect social change, suffering and distress, poverty, deprivation and conflict in his functionalist perspective. His view of citizens as oversocialised and subjugated in normative conformity was an essentially Conservative one. In fact, the instituted Nudge Unit at the heart of the Cabinet Office and a proliferation of nudge-laden behaviourist policies over recent years indicates this view is a Conservative ideal. 

Furthermore, Parsons’ systems theory was heavily positivistic, anti-voluntaristic and profoundly dehumanising. His mechanistic and unilinear evolutionary theory reads like an instruction manual for the capitalist state.

Parsons thought that social practices should be seen in terms of their function in maintaining order and social structure. You can see why his core ideas would appeal to Conservative neoliberals and rogue multinational companies (such as Unumwho had a hand in the government’s Work, Health and Employment green paper). Conservatives have always been very attached to tautological explanations (insofar that they tend to present circular arguments.)

One question raised in this functional approach is how do we determine what is functional and what is not, and for whom each of these activities and institutions are functional. If there is no method to sort functional from non-functional aspects of society, the functional model is tautological – without any explanatory power to why any activity is regarded as “functional.” The causes are simply explained in terms of perceived effects, and conversely, the effects are explained in terms of perceived causes). 

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

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

Work will set you free


Arbeit macht frei
(‘work makes you free’) is a German expression which comes from the title of a novel by German philologist Lorenz Diefenbach, Arbeit macht frei: Erzählung von Lorenz Diefenbach (1873), in which gamblers and fraudsters find the path to virtue through work. The Weimar Republic in the 1920s, and later, the Nazis, found the leading character of Diefenbach’s book, whose achievements are defined by ‘concentrating on doing his work’, compelling.

The phrase was used to promote German employment policies. The slogan was placed at the entrances to a number of Nazi concentration camps. It strikes as an almost mystical declaration that self-sacrifice in the form of endless labour does in itself bring a kind of spiritual freedom. However, given the true role of concentration camps such as Auschwitz during the Holocaust as well as the individual prisoner’s knowledge that once they entered the camp, freedom was not likely to be gained by any means other than their death, the terrible and cruel irony of the slogan becomes clear. And the lie. 

Though the context and wording has changed –  “work is a health outcome” – and full employment at any cost is the neoliberal goal, the idea that work has some mystical benefit, such as curing illness, or even simply alleviating poverty and inequality, remains a lie. 

The British Psychological Society (BPS) has expressed concerns about the idea  that employment (of whatever type) should be recognised as a “health outcome”. The Society recognise that suitable work can be good for wellbeing – but this very much depends on the type and quality of work and its social context. 

Furthermore, my own view is that the IPS programme will make it more difficult to ensure and maintain the political independence of health professionals. The private and confidential patient-doctor relationship ought to be a safe space, where citizens may address medical health problems, and doctors can provide support for people who are ill. The government is creating yet another space for an intrusive, overextension of the coercive arm of the state to “help people into work”, regardless of whether or not they are actually well enough to cope with working.

Placing employment advisors in the NHS will not address inequality, and the social conditions that are the consequence of political decision-making and imposed economic frameworks, so it permits the government and society to look the other way, while the government continue to present mental illness as an individual weakness or vulnerability, and a consequence of “worklessness” rather than a fairly predictable result of living in a highly unequal, competitive society, and arising because of experiences of living stigmatised, marginalised lives because of politically expedient policy-directed material deprivation. 

Feeding a myth 

I found a document almost by accident, while researching the Health, Work and Disability green paper a couple of years back. It presents further evidence that government policy is not founded on empirical evidence, but rather, it is often founded on deceitful contrivance. The 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 work being miraculously “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 relentless determination to uphold their ideological commitment to supply-side policy, regardless of the harmful social costs.

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 economically outgrouped.

Nicola Oliver, from Northamptonshire Healthcare NHS Foundation Trust, said: “Employment support linked to mental health means people can live the life they want to lead.

“If you help someone into a job they really like – which means they are inspired to get up in the morning and want to manage their symptoms – they’re likely to say to their clinician ‘This is what I want to do, help me to overcome these barriers.’ In this way, you’re motivating the person to manage their own condition” (My emphasis).

Mental health employment specialists in the IPS service are part of community mental health teams. They currently operate in parts of the country including Sussex, Bradford, Northampton and some London boroughs, which have seen 9,000 people in the past twelve months. NHS England will be providing £10 million funding to expand access over the next two years, with further investment to follow. By 2021, NHS England anticipates that 20,000 people with severe mental illness will receive tailored care and employment advice via the NHS, suggesting that around 5,000 people with mental ill health avoid unemployment thanks to ‘better health care’.

IPS is one of a number of integrated mental health services which are being introduced or expanded across England, as part of NHS England’s Five Year Forward View for Mental Health, described as a “transformation and investment programme to improve care between 2016 and 2021.”

People can only work when their basic needs are met

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Despite the government’s rhetoric on welfare “dependency”, and the alleged need for removing so-called “perverse incentives” from the social security system by imposing a harsh conditionality framework and a compliance regime – using punitive sanctions – and work capability assessments designed to preclude eligibility to disability benefits, research shows that generous social security regimes make people more likely to want to work, not less. I have written at length over the last few years about why a punitive welfare system can never work, as the government claim, to “incentivise people to find employment. See, for example, The Minnesota Starvation Experiment provided empirical evidence that demonstrates clearly why welfare sanctions can’t possibly work as an “incentive” to “make work pay”).

The government’s welfare “reforms” have already invited scathing international criticism because they have disproportionately targeted cuts at those with the least income. Furthermore, the government have systematically violated the human rights of those with mental and physical disabilities. In a highly critical UN report which followed a lengthy inquiry, it says: “States parties should find an adequate balance between providing an adequate level of income security for persons with disabilities through social security schemes and supporting their labour inclusion. The two sets of measures should be seen as complementary rather than contradictory.”

However, the UK government have continued to conflate social justice and inclusion with punitive policies and cuts – dressed up in the language of “incentives” and “nudge” – aimed at coercing disabled people towards narrow employment outcomes that preferably bypass any form of genuine support and the social security system completely.  (See –UN’s highly critical report confirms UK government has systematically violated the human rights of disabled people).

It’s hardly the case that the state has an even remotely credible track record of assessing people’s medical conditions, nor is it the case that this government bothers itself with empirical evidence, or deigns to listen to concerns raised by citizens, academics, professionals and charities regarding the harm that their policies are causing. This is a government that can’t even manage to observe basic human rights, let alone care about citizen’s best interests, health and wellbeing. In a political context of savage cuts to essential support and services for disabled people, and such blatant disregard of the legislative frameworks that outline their fundamental rights, it is very difficult to trust that this government have the best interests of disabled people in mind with the formulation of Work, Health and Employment related programmes. 

The government’s aim to prompt public services to “speak with one voice” to promote work as a health outcome is founded on highly questionable ethics. This proposed multi-agency approach is reductive, rather than being about formulating expansive, coherent, comprehensive and importantly, responsive provision.

Employment is not therapy. Ultimately, the IPS programme is all about (re)defining the behaviours, experience and reality of a social group to ensure they conform to government ideological incentives and to justify dismantling public services (especially welfare, and increasingly, the NHS – see, for example, Rogue company Unum’s profiteering hand in the government’s work, health and disability green paper).

This is form of gaslighting intended to extend oppressive political control and behavioural 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.

Conservatives really seem to believe that the only indication of a person’s functional capacity, value and potential is their economic productivity, and the only indication of their moral worth is their capability and degree of willingness to work. But unsatisfactory employment – low-paid, insecure and unfulfilling work – can result in a decline in health and wellbeing, indicating that it is poverty and growing inequality, rather than unemployment, that increases the risk of experiencing poor mental and physical health.

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

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

Matthew Oakley, a senior researcher at the Social Market Foundation, recently published a report entitled Closing the gap: creating a framework for tackling the disability employment gap in the UK, in which he proposes abolishing the ESA Support Group.

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

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

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

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

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

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

The members of the neoliberal think tank propose that the government should cut the weekly support paid to 1.3 million sick and disabled people in the ESA Support Group from £131 to £73. This is the same amount that people claiming Jobseeker’s Allowance receive. However, those people placed in the Support Group after assessment have been deemed by the state as unlikely to be able to work again in the foreseeable future. It would therefore be very difficult to justify this proposed cut, given the additional needs that disabled people have, which is historically recognised, and empirically verified by research.

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

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

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

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

The crib sheet  

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

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

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

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

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

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

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

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

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

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

She’s absolutely right.

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

The public are picking up the tab.

 Rogue and antisocial corporations are writing public policies

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

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

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

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

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

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

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

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Unum’s long standing toxic influence on policy-making

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

It’s mind over matter and quids in

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Nudging, Unum and the behaviourist turn in medicine. 

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

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

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

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

Othering and outgrouping have become common political practices. 

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

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

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

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

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

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

He sounds rather like an authoritarian Victorian headmaster.

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

Government policies are expressed political intentions regarding how our society is organised and governed. They have calculated social and economic aims and consequences. In democratic societies, citizens’ accounts of the impacts of policies ought to matter. 
 
However, in the UK, the way that policies are justified is being increasingly detached from their aims and consequences, partly because democratic processes and basic human rights are being disassembled or side-stepped, and partly because the government employs the widespread use of linguistic strategies: euphemisms, superficial glittering generalities and techniques of persuasion to intentionally divert us from aims and consequences of ideologically (rather than rationally) driven policies. Furthermore, policies have become increasingly detached from public interests and needs. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

All hail the corporatocracy.

 

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Footnote

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

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

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

Related

Unum welcomes Green Paper focus on Group Income Protection – Unum

MUTUAL BENEFITS  Private Eye

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

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

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

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

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

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

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

Major breakthrough on PACE 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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A few thoughts on the implications of the United Nations report

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There is an important link between human needs and human rights that the Conservatives have dismally and persistently failed to recognise

The United Nations (UN) inquiry into the allegations many of us made regarding the systematic abuse of the human rights of disabled people in the UK has exposed the multiple injustices of targeted cuts and the disproportionate burden of austerity heaped on sick and disabled people, their carers and their families, evidencing and detailing the effects of a range of policy measures affecting them that have been introduced since 2010. These include the bedroom tax and cuts to disability benefits, funds to support independence and social care.

The report concludes that the overall effect of what is now an essentially punitive welfare regime, which has been based almost entirely on unevidenced political claims and assumptions, has had an extremely detrimental and regressive effect on the rights of disabled people, to live independently, to meet their basic needs, to seek and stay in work,  and to be able to live an ordinary life as citizens.

The UN report documented multiple violations of disabled people’s rights, including the way that they are politically portrayed as being lazy and a “burden on taxpayers”, the harm to health caused by unfair assessments, the cuts to legal aid and curtailed access to justice, the imposition of the bedroom tax and the ending of the Independent Living Fund.

I wrote a lengthy article about the unsurprising but nonetheless disquieting report findings and recommendations as I read it, here.

Predictably, the government responded to the damning contents of the report by denying a “causal link” between their policies and the evidenced accounts of the consequences being presented to them. Yet the government have never monitored the cumulative impact of their policies and successive cuts on disabled people, and they told the UN rapporteurs that it was “not possible or practical” to carry out an impact assessment on how reforms would affect disabled people. The UN disagreed, and stated that with the evidence and data already available, the government could have done this. 

The UN have called on the government to carry out a cumulative impact assessment. The government have refused to comply with any of the recommendations the UN has made. However, that means they cannot legitimately claim that there is “no causal link demonstrated” regarding the austerity measures and psychological distress, severe hardship, deteriorating health and death, as they have persistently refused to investigate the associations that academics, charities, disabled people’s organisations, individual campaigners and opposition MPs have consistently demonstrated. Denial isn’t empirical evidence or any kind of proof that your claims are valid. Nor does withholding evidence of correlation disprove causality.

It was also noted that the government failed to listen to the concerns of disabled people it had claimed to involve in policy making processes. Disabled people and their representative organisations “were not meaningfully taken into account in the decision-making and had little or no influence on policy decisions.”

The implication is that disabled people have not been democratically included. The government have persisted in treating us as objects of policies, rather than seeing us as democratic subjects and citizens. 

Also of note: “The [individual] impact assessments conducted by the State party prior to the implementation of several measures of its welfare reform expressly foresaw an adverse impact on persons with disabilities.”

The State party has not conducted a comprehensive human rights-based cumulative impact assessment even though reliable sources have indicated it is feasible.”

The UN stated that the Department for Work and Pensions (DWP) failed to properly investigate people’s deaths after their social security payments were stopped. t was noted that the government had made no “attempts at objective, thorough, open and impartial investigation(s)” to look at the alleged 90 deaths a month, despite being aware that there was widespread public concern about this.

Among other concerns, the committee said the UK government had used rhetoric to stigmatise disabled people, negatively influencing public perceptions. The report says that disabled people “have been… negatively portrayed as being dependent or making a living out of benefits; committing fraud as benefit claimants; being lazy and putting a burden on taxpayers, who are paying ‘money for nothing’. Persons with disabilities continue to experience increasing hostility, aggressive behaviour and sometimes attacks to their personal integrity.”

The committee said it found no evidence to support any of these ideas, especially the idea that disabled claimants were committing benefit fraud.

The committee were very critical of the legal aid cuts, which have created a significant barrier for people challenging benefits decisions and holding the government accountable:

“Evidence indicates that legal aid to challenge administrative decisions ending or curtailing their benefits before first-tier tribunals has been restricted. Legal aid for cases before those tribunals has also been curtailed. Similarly, access to review by an independent and impartial tribunal has been restricted by the introduction of mandatory reconsideration procedures before the same administrative entity that has ruled on benefits.”

I was pleased to see the United Nations report highlight a fundamental prejudice that informed the very basis of the “functional capacity approach” of the Work Capability Assessment (WCA), as well as commenting on the major flaws of the assessment process itself. The WCA is based on the assumption that a health condition or disability should not automatically be regarded as a “barrier” to work and that work itself can have health benefits. However these assumptions have been controversial from the outset.

The WCA places focus entirely on how we as individuals experience our illness and impairments. As such, this approach does not permit us to place our experiences of disadvantage in the context of how organisations, institutions, policy-makers and wider society interact with us. Despite the government claiming that they take a social model approach, eligibility for benefits and services is still being determined by assessment of how much our own bodies are affected by illness and impairment rather than the disabling social, cultural and political barriers that we experience.

The report said: Work Capability Assessments do not take into account the “support persons with disabilities need to perform a job or the complex nature of some impairments and conditions.” 

The inquiry also found that welfare assessors displayed a “lack of awareness and limited knowledge of disability rights and specific needs”, and disabled people experienced distress, “anxiety and psychological strain” as a result of this flawed process, and the financial insecurity that it generates.

“The committee observes that measures have caused financial hardship to persons with disabilities resulting in arrears, debts, evictions and cuts to essentials such as housing and food,” the report said.

The Government’s own research, published in June this year, revealed that one of the cornerstones of their austerity campaign – that cutting social security means recipients will be more likely to find work – is fundamentally flawed. 

Researchers found that cutting unemployed peoples’ benefits had the opposite effect to what is being claimed – something that many of us have also previously argued. The study, carried out by Oxford city council and the Department for Work and Pensions, found unemployed people become less likely to get a job when benefits are cut. Instead of looking for work, they are forced to devote their energies to surviving day-to-day. For every £1 in benefits cut per week, a person’s chance of getting a job drops by 2 per cent.

The government can no longer justify its narrative about benefit cuts, claiming that they are  “incentives” to “support” people into work.

Beyond the rhetoric – the hidden agenda

There is a wider agenda driving the welfare “reforms” and it is important to consider the hidden ideological dimension and the language references and signposts to that, as well as the superficial narratives and semantic shifts being deployed as a PR exercise, techniques of neutralisation and gaslighting to obscure political intentions and the consequences of policies.

The UN report effectively exposed the justification narratives presented by the government for their welfare “reforms” as unfounded and unsupported by empirical evidence. This report is just the beginning, it arms us with an invaluable weapon with which to continue our campaigning, and shape future challenges and debate to government policies and social injustice.  

The Conservatives have an ideological commitment to a “small state” and this is fueled by privatisation and an ever-expanding neoliberal competitive “market place.” The market place, private profit opportunities and neoliberal outcomes have been conflated with citizen’s interests and needs.

The welfare “reforms” have presented the opportunity to promote and deliver private income protection provision via profit making companies operating in free markets. Insurance companies and right-wing think tanks have been attempting to steer governments in this direction for many years. 

For example, Matthew Oakley, a senior researcher at the Social Market Foundation, and government advisor, recently published a report entitled Closing the gap: creating a framework for tackling the disability employment gap in the UK, in which he 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.

Oakley also proposes abolishing the ESA Support Group. To meet extra living costs because of disability, Oakley says that existing spending on PIP and the Support Group element of ESA should be brought together to finance a new extra costs benefit. Eligibility for this benefit should be determined on the basis of need, with an assessment replacing the WCA and PIP assessment. The Conservative definition of “the basis of need” seems to be an ever-shrinking category.

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 individual responsibility.

A 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 influence of the US insurance giant Unum over successive UK governments, and how it led to the introduction of the “totally bogus” work capability assessment (WCA), which she says was designed to make it harder for sick and disabled people to claim out-of-work disability benefits.Stewart’s book, Cash 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.  

The implications of the inquiry findings for Conservative welfare policies 

The government has announced further welfare measures which will affect disabled people including a four year freeze for most working-age benefits, reductions in the Benefit Cap, changes to tax credits and to Universal Credit, and abolishing the “Work-Related Activity Component” for new ESA claims from 2017.

As noted in the UN report: “The State party continues its policy of reducing social benefits of persons with disabilities as reflected in the Welfare Reform and Work Act 2016.” 

Article 28 of the Convention on the rights of persons with disabilities (CRPD) says: Adequate standard of living and social protection – This article affirms the rights of persons with disabilities to an adequate standard of living for themselves and their family, and to social protection without discrimination on the basis of disability. This right includes access to assistance from the state with disability-related expenses for persons with disabilities and their families.

The report reiterated something that many of us have noted and discussed in detail previously: that there is no evidence of a causal relationship between a reduction in social security and an increase in employment amongst disabled and sick people. Nor does welfare “dependency” “disincentivise” people seeking employment more generally. It was pointed out in UN report that these views are not evidenced. The two assumptions are embedded in justifications of Conservative welfare policies, and are prejudices that have been around since the Thatcher administration.

Bearing in mind these are key assumptions underpinning current policies and the proposals set out in the recent work, health and disability green paper –  for example, the recent decision to reduce the money paid to people who have been assessed as being unfit to work but able to undertake work related activity (those people in the Employment and Support Allowance work related activity group (WRAG)) is based on the same assumption- the Department for Work and Pensions have claimed  – that it will “remove the financial incentives that would otherwise discourage claimants from taking steps back to work”.

Particularly important in the current context and given the government’s recent work, health and disability green paper, the UN report says that: “Given the barriers that still prevent the full participation of persons with disabilities in the labour market and mean higher unemployment rates for them, income-maintenance social security schemes are particularly important for persons with disabilities. Such schemes allow them to maintain their autonomy and freedom of control and choice of their living arrangements and day-to-day activities. Without an adequate level of social protection, persons with disabilities run the risk of being isolated, segregated from the community and/or institutionalized. 

States parties should find an adequate balance between providing an adequate level of income security for persons with disabilities through social security schemes and supporting their labour inclusion. The two sets of measures should be seen as complementary rather than contradictory.

Measures aimed at facilitating the inclusion in the labour market of beneficiaries of social security should include transitional arrangements to ensure income protection while they reach a certain threshold and sustainability in their wages. They should become eligible again without delay if they lose their jobs.” 

Although many of us have been discussing these issues for a few years, the inquiry has consolidated a lot of valuable evidence and provided a concise rebuttal of government justification narratives for cuts in support for disabled people, which we really needed to be presented to the government formally, from an independent, official and international witness.

Though the government have tended to dismiss much evidence to date of the harm that their policies are causing, such as that which has been presented through case studies by shadow ministers, as “anecdotal”, it is rather more difficult to dismiss and ignore the substantial evidence presented as a result of rigorous international scrutiny.

The government response was founded on denials, more misdirectional rhetoric and techniques of neutralisation, defensive arrogance, authoritarian scorn and contrived outrage, rather than being about stepping up to democratic accountability, reasoned discussion and rationality. No sign of civilised conscience and decent concern regarding the impact of the prejudice and discrimination that is being intentionally and systematically embedded in Conservative policies, aimed at disabled people, at all. 

The government’s response to the UN report bears little resemblance to the lived experiences of disabled people, despite claims to the contrary. The government has justified systematic cuts to disabled people’s social security by claiming such cuts “incentivise” people to find work. The cuts are a form of punishment (apparently for our own “good”) designed to bring about “behaviour change” and this approach is founded on the wrongly perceived attitudes of disabled people, who this government consistently describes as being “parked on benefits” with the “misperception that they can’t work”. 

This does nothing at all to address the barriers disabled people face in finding and staying in work, nor does it address the acknowledged prejudiced attitudes of employers and Conservative ministers. It’s not long ago that Conservative welfare minister David Freud expressed the view that disabled people should work for less than the minimum wage. He wasn’t the only one, either. Philip Davies expressed the same view, claiming that disabled people “are the most disadvantaged by the national minimum wage,” so they should be “permitted” to work for less in order to “compete” in the labor market. Davies described criticism of his remarks that disabled people could work for less than minimum wage as “leftwing hysteria”.

It seems that Conservatives believe that the only way of “helping” disabled people in any way is by simply taking money from them. 

In their response to the UN report, the government say: “The United Kingdom is proud of its record in supporting disabled people to lead more independent lives and participate more fully in society. More than 20 years ago the UK legislated to protect disabled people’s rights. It now spends around £50 bn a year on benefits to support disabled people and people with health conditions, which is over £6 bn more than in 2010. That is around 5% of GDP, or over 6% of government spending. The UK spends more on disabled people and people with health conditions than the OECD average, and countries such as Germany, France and the USA.”

That’s definitely Conservatives being… conservative with the truth again.

The Institute of Fiscal Studies (IFS) report on spending on benefits for disabled people says the actual spend is £36,063 bn but this is partly in benefits that are not counted as working age disability benefits: War Pensions, Attendance Allowance for over 65s, Statutory Sick pay, Carer’s Allowance, Industrial Injuries Benefits and the ILF which the government has closed)

The total of those benefits not paid to working age disabled people is £7,908bn

That makes the actual spend on all working age benefits for disabled people £28,155 billion

The IFS report says: “The spending on DLA/PIP is only half what it was in 1995-96. Spending across Great Britain on disability benefits in 2014–15 was £13.5 billion. At 0.8% of national income this is half the level of disability benefit spending when it was at its peak in 1995–96.

The overall number of individuals receiving disability benefits has fallen slightly since the mid-1990s. But this is in the presence of underlying demographic change that would have tended to push UP the numbers receiving considerably – both overall population growth and the baby boomer generation reaching older working ages.”

It’s not clear if the spending figures include the massive costs of private companies that are contracted by the state, ironically, to cut welfare spending. 

The National Audit Office (NAO) report earlier this year scrutinised public spending for parliament, and is independent of government. The report indicates how public services are being appropriated for purely private benefit.

The audit report in January concluded that the Department for Work and Pension’s spending on contracts for disability benefit assessments is expected to double in 2016/17 compared with 2014/15. The government’s flagship welfare-cut scheme will be actually spending more money on the assessments conducted by private companies than it is saving in reductions to the benefits bill.

From the report:

£1.6 billion
Estimated cost of contracted-out health and disability assessments over three years, 2015 to 2018

£0.4 billion
Latest expected reduction in annual disability benefit spending.

This summary reflects staggering economic incompetence, a flagrant, politically motivated waste of tax payer’s money and even worse, the higher spending has not created a competent or ethical assessment framework, nor is it improving the lives of sick and disabled people. Private companies like Maximus are paid millions from our welfare budget, yet they are certainly not “helping the government” to serve even the most basic needs of sick and disabled people.

I will be challenging the government’s response to the UN report fully in due course. It would be good to see some collaborative effort from disabled campaigners and activists in addressing the government as comprehensively as possible. If anyone is interest in working together on this, just contact me here via the comment section.

The UN committee will meet to discuss the government’s comments and determine a response in Geneva, in March 2017. 

Meanwhile it’s crucial that we use the body of evidence collated by the UN and the conclusions drawn in the report effectively. For example, our responses to the consultation on the work, health and disability green paper must address the underpinning propositions and delve beneath the superficial rhetoric and glittering generalities, rather than permitting the DWP’s weighted and somewhat leading questions to shape the outcome of the consultation.

We must use the UN findings constructively to continue to challenge existing policies, and any which arise in the future to violate the human rights of disabled persons. 

We need to continue to coherently and collectively challenge the government’s assumptions on which their proposals for work, health and disability policy are based, none of which are not supported by a shred of solid empirical evidence.

 


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Initial thoughts on the work, health and disability green paper

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I’ve read the government’s Work, health and disability green paper: improving lives and consultation from end to end. It took me a while, because I am ill and not always able to work consistently, reliably and safely. It’s also a very long and waffling document. I am one of those people that the proposals outlined in this green paper is likely to affect. I read the document very carefully.

Here are a few of my initial thoughts on what I read. It’s organised as best I can manage, especially given the fact that despite being dismally unsurprised, I am scathing.

The context indicates the general intent

“The fact is that Ministers are looking for large savings at the expense of the poorest and most vulnerable. That was not made clear in the general election campaign; then, the Prime Minister said that disabled people would be protected.”Helen Goodman, MP for Bishop Auckland, Official Report, Commons, 2/3/16; cols. 1052-58.

I always flinch when the government claim they are going to “help” sick and disabled people into work. That usually signals further cuts to lifeline support and essential services are on the way, and that the social security system is going to be ground down a little further, to become the dust of history and a distant memory of a once civilised society. 

If the government genuinely wanted to “help” sick and disabled people into work, I’m certain they would not have cut the Independent Living Fund, which has had a hugely negative impact on those trying their best to lead independent and dignified lives, and the Access To Work funding has been severely cut, this is also a fund that helps people and employers to cover the extra living costs arising due to disabilities that might present barriers to work.

The government also made the eligibility criteria for Personal Independence Payment (PIP) – a non-means tested out-of- work and an in-work benefit – much more difficult to meet, in order to simply reduce successful claims and cut costs. This has also meant that thousands of people have lost their motability vehicles and support.

Earlier this year, it was estimated at least 14,000 disabled people have had their mobility vehicle confiscated after the changes to benefit assessment, which are carried out by private companies. 

Under the PIP rules, thousands more people who rely on this support to keep their independence are set to lose their vehicles – specially adapted cars or powered wheelchairs. Many had been adapted to meet their owners’ needs and many campaigners warn that it will lead to a devastating loss of independence for disabled people.

A total of 45% or 13,900 people, were deemed as not needing the higher rate of PIP, and therefore lost their vehicles after reassessment. And out of the 31,200 people who were once on the highest rate of Disability Living Allowance (DLA) who have been reassessed, just 55%, or 17,300 – have kept their car.

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In 2012, Esther McVey, then the Minister for people with disabilities, as good as admitted there are targets to reduce or remove eligibility for the new disability benefit PIP, which was to replace DLA. How else could she know in advance of people’s reassessment that 330,000 of claimants are expected to either lose their benefit altogether or see their payments reduced as she had informed the House of Commons. 

This was a clear indication that the new assessment framework was designed to cut support for disabled people. A recent review led the government to conclude that PIP doesn’t currently fulfil the original policy intent, which was to cut costs and “target” the benefit to an ever-shrinking category of “those with the greatest need.” 

The Government was twice defeated in the Lords over their proposals to cut Employment and Support Allowance (ESA) for sick and disabled people in the work related activity group (WRAG) from £103 to £73. However the £30 a week cut is to go ahead after bitterly disappointed and angry peers were left powerless to continue to oppose the Commons, which has overturned both defeats.

The government hammered through the cuts of £120 a month to the lifeline income of ill and disabled people by citing the “financial privilege” of the Commons, and after Priti Patel informing the Lords, with despotic relish, that they had “overstepped their mark” in opposing the cuts twice. 

A coalition of 60 national disability charities condemned the government’s cuts to benefits as a “step backwards” for sick and disabled people and their families. The Disability Benefits Consortium said that the cuts, which will see people lose up to £1,500 a year, will leave disabled people feeling betrayed by the government and will have a damaging effect on their health, finances and ability to find work. 

Research by the Consortium suggests the low level of benefit is already failing to meet disabled people’s needs. A survey of 500 people in the affected group found that 28 per cent of people had been unable to afford to eat while in receipt of the benefit. Around 38 per cent of respondents said they had been unable to heat their homes and 52 per cent struggled to stay healthy.

Watching the way the wind blows

Earlier this year I wrote that a government advisor, who is a specialist in labor economics and econometrics, has proposed scrapping all ESA sickness and disability benefits. Matthew Oakley, a senior researcher at the Social Market Foundation, recently published a report entitled Closing the gap: creating a framework for tackling the disability employment gap in the UK, in which he proposes abolishing the ESA Support Group.

To meet extra living costs because of disability, Oakley says that existing spending on PIP and the Support Group element of ESA should be brought together to finance a new extra costs benefit. Eligibility for this benefit should be determined on the basis of need, with an assessment replacing the WCA and PIP assessment. 

I think the word “need” is being redefined to meet politically defined neoliberal economic outcomes. 

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.” 

I’m sure the rogue company Unum would jump at the opportunity. Steeped in controversy, with a wake of scandals that entailed the company 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 handling 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. By coincidence, the company has been involved with the UK’s controversial Welfare Reform Bill, advising the government on how to cut spending, particularly on disability support. What could possibly go right? 

It’s difficult to see how someone with a serious, chronic and progressive illness, (which most people in the ESA Support Group have) can actually “manage” their illness and “move back into work.” The use of the extremely misinformed, patronising and very misleading term manage implies that very ill people actually have some kind of choice in the matter.

For people with Parkinson’s disease, rheumatoid arthritis, lupus and multiple sclerosis, cancer and kidney failure, for example, mind over matter doesn’t fix those problems, positive thinking and sheer will power cannot cure these illnesses, sadly. Nor does refusing to acknowledge or permit people to take up a sick role, or imposing benefit conditionality and coercive policies to push chronically ill people into work by callous, insensitive and inept and often medically unqualified assessors, job advisors and ministers.  

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 Reform think tank proposes that the government should cut the weekly support paid to 1.3 million sick and disabled people in the ESA Support Group from £131 to £73. This is the same amount that Jobseeker’s Allowance claimants receive. It is claimed that the cut will  somehow “incentivise” those people to find work, as if they simply lack motivation, rather than being ill and disabled. However, those people placed in the Support Group after assessment have been deemed by the state as unlikely to be able to work again in the near future, many won’t 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 sick. 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 – PIP. However, as outlined, 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 hard work.

The current United Nations investigation into the systematic and gross violations of the rights of disabled people in the UK because of the Conservative welfare “reforms” is a clear indication that there is no longer any political commitment to supporting disabled people in this country, with the Independent Living Fund being scrapped by this government, ESA for the work related activity group (WRAG) cut back, PIP is becoming increasingly very difficult to access, and now there are threats to the ESA Support Group. The Conservative’s actions have led to breaches in the CONVENTION on the RIGHTS of PERSONS with DISABILITIES – CRPD articles 4, 8, 9, 12, 13, 14, 15, 17, and especially 19, 20, 27 and 29 (at the very least.)

There are also probable violations of articles 22, 23, 25, 30, 31.

The investigation began before the latest round of cuts to ESA were announced. That tells us that the government is unconcerned their draconian policies violate the human rights of sick and disabled people.

And that, surely, tells us all we need to know about this government’s intentions.

Coercing those deemed to ill to work into work. It’s not “nudge”: it’s psycho-compulsion

The casual discussion in the green paper about new mandatory “health and work conversations” in which work coaches will use “specially designed techniques” to “help” some ESA claimants “identify their health and work goals, draw out their strengths, make realistic plans, and build resilience and motivation” is also cause for some concern. 

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.

Most people who read my work regularly will know by now that I am one of the staunchest critics of nudge, which is being used as an antidemocratic, technocratic, pseudoscientific political tool to provide a prop and disguise for controversial neoliberal policies. 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.  

John Pring at Disability News Service (DNS) adds: “Grassroots disabled people’s organisations (DPOs) have criticised the government’s decision to exclude them from an event held to launch its new work, health and disability green paper. 

The event for “stakeholders” was hosted by the disability charity Scope at its London headquarters, and attended by Penny Mordaunt, the minister for disabled people.

The Department for Work and Pensions (DWP) said in its invitation – it turned down a request from Disability News Service to attend – that the event would “start the consultation period” on its green paper, Improving Lives. 

It said that it was “launching a new conversation with disabled people and people with health conditions, their representatives, healthcare professionals and employers”.  

But DWP has refused to say how many disabled people’s user-led organisations were invited to the event, and instead suggested that DNS submit a freedom of information request to find out.
But DNS has confirmed that some of the most prominent user-led organisations with the strongest links to disabled people were not invited to the launch, including Shaping Our Lives, Inclusion London, Equal Lives, People First (Self Advocacy) and Disabled People Against Cuts.” 

For further discussion of the policy context leading up to the green paper, see The new Work and Health Programme: government plan social experiments to “nudge” sick and disabled people into work from October 2015. 

Also see G4S are employing Cognitive Behavioural Therapists to deliver “get to work therapy” and Stephen Crabb’s obscurantist approach to cuts in disabled people’s support and also Let’s keep the job centre out of GP surgeries and the DWP out of our confidential medical records from earlier this year.

The dismal and incoherent contents of the green paper were entirely predictable.

The Conservatives claim work is a “health” outcome: crude behaviourism

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 then 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 a broader aim of dismantling social security.

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 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 stigmatised and outgrouped.

Othering and outgrouping have become common political practices, it seems.

Stigma is a political and cultural attack on people’s identities. It’s used to discredit, and as justification for excluding some groups from economic and political consideration, refusing them full democratic citizenship.

Stigma is being used politically to justify the systematic withdrawal of support and public services for the poorest – the casualties of a system founded on competition for allegedly scarce wealth and resources. Competition inevitably means there are winners and losers. Stigma is profoundly oppressive.

It is used as a propaganda mechanism to draw the public into collaboration with the state, to justify punitive and discriminatory policies and to align citizen “interests” with rigid neoliberal outcomes. Inclusion, human rights, equality and democracy are not compatible with neoliberalism.

Earlier this year, I said: The Conservatives have come dangerously close to redefining unemployment as a psychological disorder, and employment is being redefined as a “health outcome.” 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.

But 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, not therapy. 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.

Conservatives really seem to believe that the only indication of a person’s functional capacity, value and potential is their economic productivity, and the only indication of their moral worth is their capability and degree of willingness to work. But 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 (rather than the current raft of political dogma) 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.

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

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 much more likely that inadequate social security support means that people cannot meet all of  their basic survival needs (food, fuel and shelter), and that contributes significantly to poor health outcomes.

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 free.

Semantic thrifts: being Conservative with the truth

Prior to 2010, cutting support for sick and disabled people was unthinkable, but the “re-framing” strategy and media stigmatising campaigns have been used by the Conservatives to systematically cut welfare, push the public’s normative boundaries and to formulate moralistic justification narratives for their draconian policies. Those narratives betray the Conservative’s intentions.

Not enough people have questioned what it is that Conservatives actually mean when they use words like “help”, “support”, and “reform” in the context of government policies aimed at disabled people. Nor have they wondered where the evidence of “help” and “support” is hiding. If you sit on the surface of Conservative rhetoric and the repetitive buzzwords, it all sounds quite reasonable, though a little glib.

If you scrutinise a little, however, you soon begin to realise with horror that Orwellian-styled techniques of neutralisation are being deployed to lull you into a false sense of security: the ideologically directed intentions behind the policies and the outcomes and consequences are being hidden or “neutralised” by purposefully deceptive, misdirectional political rhetoric. It’s a kind of glittering generalities tokenism ; a superficial PR ritual of duplicitous linguistic detoxification, to obscure deeply held traditional Conservative prejudices and ill intent.

Rhetoric requires the existence of an audience and an intent or goal in the communication. Once you stand back a little, you may recognise the big glaring discrepancies between Conservative chatter, policies, socioeconomic reality and people’s lived experiences. At the very least, you begin to wonder when the conventional ideological interests of the Conservatives suddenly became so apparently rhetorically progressive, whilst their policies have actually become increasingly authoritarian, especially those directed at the most disadvantaged social groups.

The ministerial foreword from Damian Green, Secretary of State for Work and Pensions and Jeremy Hunt, Secretary of State for Health, is full of concern that despite the claim that “we have seen hundreds of thousands more disabled people in work in recent years”, there are simply too many sick and disabled people claiming ESA.

They say: We must highlight, confront and challenge the attitudes, prejudices and misunderstandings that, after many years, have become engrained in many of the policies and minds of employers, within the welfare state, across the health service and in wider society. Change will come, not by tinkering at the margins, but through real, innovative action. This Green Paper marks the start of that action and a far-reaching national debate, asking: ‘What will it take to transform the employment prospects of disabled people and people with long-term health conditions?’

I think mention of the “engrained attitudes, prejudices and misunderstandings within the welfare state and across the health service” is the real clue here about intent. What would have been a far more authentic and reassuring comment is “we have met with disabled people who have long-term health conditions and asked them if they feel they can work, and what they need to support them if they can.”

Instead, what we are being told via subtext is that we are wrong as a society to support people who are seriously ill and disabled by providing civilised health and social care, social security and exempting them from work because they are ill or injured.

Ministers say:Making progress on the government’s manifesto ambition to halve the disability employment gap is central to our social reform agenda by building a country and economy that works for everyone, whether or not they have a long-term health condition or disability. It is fundamental to creating a society based on fairness [..] It will also support our health and economic policy objectives by contributing to the government’s full employment ambitions, enabling employers to access a wider pool of talent and skills, and improving health.”

I think that should read: “By building a country where everyone works for the [politically defined] economy.”

There’s patronising discussion of how disabled people should be “allowed to fulfil their potential”, and that those mythic meritocratic principles of talent determination and aspiration should be “what counts”, rather than sickness and disability. There are some pretty gaping holes in the logic being presented here. It is assumed that prejudice is the reason why sick and disabled people don’t work.

But it’s true that many of us cannot work because we are too ill, and the green paper fails to acknowledge this fundamental issue.

Instead “inequality” has been redefined strictly in terms of someone’s employment status, rather than as an unequal social distribution of wealth, resources, power and opportunities. All of the responsibility and burden of social exclusion and unemployment is placed on sick and disabled people, whilst it is proposed that businesses are financially rewarded for employing us.

Furthermore, it’s a little difficult to take all the loose talk seriously about the “injustice” of ill people not being in work, or about meritocratic principles and equal opportunities, when it’s not so long ago that more than one Conservative minister expressed the view that disabled people should work for less than the minimum wage. This government have made a virtue out of claiming they are giving something by taking something away. For example, the welfare cuts have been casually re-named reforms in Orwellian style. We have yet to see how cutting the lifeline benefits of the poorest people, and imposing harsh sanctioning can possibly be an improvement for them, or how it is helping them.

The Conservatives are neoliberal fundamentalists, and they have supplanted collective, public values with individualistic, private values of market rationality. They have successfully displaced established models of welfare provision and state regulation through policies of privatisation and de-regulation and have shifted public focus, instigating various changes in subjectivity, by normalising individualistic self-interest, entrepreneurial values, and crass consumerism. And increasing the social and material exclusion of growing numbers living in absolute poverty.

Basically, the Tories tell lies to change perceptions, divert attention from the growing wealth inequality manufactured by their own policies, by creating scapegoats.

Another major assumption throughout the paper is that disabled people claiming ESA are somehow mistaken in assuming they cannot work: “how can we improve a welfare system that leaves 1.5 million people – over 60% of people claiming Employment and Support Allowance – with the impression they cannot work and without any regular access to employment support, even when many others with the same conditions are flourishing in the labour market? How can we build a system where the financial support received does not negatively impact access to support to find a job? How can we offer a better user experience, improve system efficiency in sharing data, and achieve closer alignment of assessments?”

The government’s brand of armchair pseudo-psychology, propped up by the Nudge Unit, is used to justify increasingly irrational requirements being embedded in policy. The government intend to merge health and employment services, redefining work as aclinical health outcome. According to the government, the “cure” for unemployment due to illness and disability and sickness absence from work, is… work.

The new work and health programme, “support” for disabled people, is actually just another workfare programme. We know that workfare tends to decrease the likelihood of people finding work.

Work is the only politically prescribed “route out of poverty” for disabled people, including those with mental distress and illness, regardless of whether or not they are actually well enough to work. In fact the government implicitly equates mental health with economic productivity. Work will set us free. Yet paradoxically, disabled people haven’t been and won’t be included in the same economic system which is responsible for their exclusion in the first place.

Competitive market economies exclude marginalised groups, that’s something we ought to have learned from the industrial capitalism of the last couple of centuries. GPs inform us that employers are not prepared to make the necessary inclusive workplace adjustments sick and disabled people often need to work.

But in a dystopic Orwellian world where medical sick notes have been  politically redefined as ”fit notes”, sick and disabled people are no longer exempt from work, which is now held to be a magic “cure”. People are already being punished and coerced into taking any available job, regardless of its appropriateness, in an increasingly competitive and exclusive labor market.

The nitty gritty

You know the government are riding the fabled rubber bicycle when they calmly propose coercing the most disabled and ill citizens who are deemed unlikely to work by their doctors and the state (via the Work Capability Assessment) into performing mandatory work-related activities and finding jobs. Previously, only those assessed as possibly capable of some work in the future and placed in the Work Related Activity Group (WRAG) were expected to meet behavioural conditionality in return for their lifeline support.

However, the government have cut the WRAG component of Employment and Support Allowance (ESA) – another somewhat Orwellian name for a sickness and disability benefit – so that this group of people, previously considered to have additional needs because of their illness and disability, are no longer supported to meet the extra costs they face. The ESA WRAG rate of pay is now to be the same as Job Seeker’s Allowance.

If the government make work related activity mandatory for those people in the ESA Support Group, it will mean that very sick and disabled people will be sanctioned for being unable to comply and meet conditionality. This entails the loss of their lifeline support. The government have the cheek to claim that they will “protect and support” the most vulnerable citizens.

Hello, these ARE among our most vulnerable citizens. That’s why they were placed in the ESA support group in the first place.

Apparently, sick citizens are costing too much money. Our NHS is “overburdened” with ill people needing healthcare, our public services are “burdened” with people needing… public services. It is claimed that people are costing employers by taking time off work when they are ill. How very dare they.

Neoliberals argue that public services present moral hazards and perverse incentives. Providing lifeline support to meet basic survival requirements is seen as a barrier to the effort people put into searching for jobs. From this perspective, the social security system, which supports the inevitable casualties of neoliberal free markets, has somehow created those casualties. But we know that external, market competition-driven policies create a few “haves” and many “have-nots.” This is why the  welfare state came into being, after all – because when we allow such competitive economic dogmas to manifest without restraint, we must also concede that there are always ”winners and losers.”

Neoliberal economies organise societies into hierarchies.The UK currently ranks highly among the most unequal countries in the world.

Inequality and poverty are central features of neoliberalism and the causes of these sociopolitical problems therefore cannot be located within individuals.

The ESA Support Group includes people who are terminally ill, and those with degenerative illnesses, as well as serious mental health problems. It’s suggested that treating this group of people with computer based Cognitive Behaviour Therapy (cCBT), and addressing obesity, alcohol and drug dependence will “help” them into work.

Ministers claim that this group merely have a “perception” that they can’t work, and that they have been “parked” on benefits. It is also implied that illness arises mostly because of lifestyle choices.

Proposals include a punitive approach to sick and disabled people needing support, whilst advocating financial rewards for employers and businesses who employ sick and disabled people.

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 private company will most likely soon have a lucrative role to get the government “the right results”.

Meanwhile health and social care is going to be linked with one main outcome: work. People too ill to work will be healthier if they… work. Our public services will cease to provide public services: health and social care professionals will simply become co-opted authoritarian ideologues.

Apparently, the new inequality and social injustice have nothing to do with an unequal distribution of wealth, resources, power and opportunities. Apparently our society is unequal only because some people “won’t” work. I’m just wondering about all those working poor people currently queuing up at the food bank, maybe their poorly paid, insecure employment and zero hour contracts don’t count as working.

I’ve written as I read this Orwellian masterpiece of thinly disguised contempt and prejudice. I don’t think I have ever read anything as utterly dangerous and irrational in all my time analysing Conservative public policy and the potential and actual consequences of them. These utterly deluded and sneering authors are governing our country, shaping our life experiences, and those of our children.

The sick role and any recovery time from illness or accident that you may need has been abolished. Work will cure you.

Well, at least until you die.
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Pictures courtesy of Robert Livingstone

The closing date for the consultation is 17 February 2017.
You can download the full consultation document from this link.
You can take part in the consultation from this link.



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

proper Blond

It’s less than two months ago that the new Work and Pensions secretary, Stephen Crabb, assured us that the Government had “no further plans” for specific welfare cuts. Now, he has admitted that welfare is to be the source of further austerity cuts to “bring down the deficit,” bearing in mind that the last budget saw alternative  and far more fair, humane measures taken off the table when the Conservatives controversially announced cuts to disability benefits to fund tax cuts for the most affluent – the top 7% of earners. The Chancellor raised the threshold at which people start paying the 40p tax. This leaves the poorest and some of our most vulnerable citizens carrying the entire burden of austerity and the whole responsibility for cutting the deficit.

Of course Crabb assumes we believe that austerity is an economic necessity and not an ideological choice. However, austerity is being used as a euphemism for the systematic dismantling of the gains of our post-war settlement: welfare, social housing, the NHS, legal aid and democracy. There is no such thing as conditional democracy. It can’t be rationed out or applied with prejudice and discrimination. That would make it something else, more akin to totalitarianism and not a necessarily inclusive democracy.

The Government has already made substantial cuts to the Employment and Support Allowance disability benefit, cutting the rate for new claimants in the Work Related Activity Group by £30 a week from 2017. Now the Work and Pensions Secretary has said he wants to go further than the £12 billion welfare cuts declared in the Conservative manifesto and to “re-frame discussion” around disability welfare support, signalling his intention to cut expenditure on disability benefits through further reform to the welfare system. The Conservatives are clearly using the word “reform” as a euphemism for dismantling the welfare state in its entirety.

Prior to 2010, cutting support for sick and disabled people was unthinkable, but the “re-framing” strategy and media stigmatising campaigns have been used by the Conservatives to systematically cut welfare, push the public’s normative boundaries and to formulate moralistic justification narratives for their draconian policies. Those narratives betray the Conservative’s intentions.

Crabb said that he will set out a “discursive” Green Paper on the additional proposed cuts to disability benefits later this year. Iain Duncan Smith had previously promised a more formal White Paper which was considered key to persuading Tory rebels to vote through the cuts despite opposition in February.

The shadow Work and Pensions secretary, Owen Smith, said that the Government should reverse the ESA cuts which had already been passed, adding that the Conservatives needed to offer clarity on how the “reforms” would support disabled people into work.

He said: “Yet again the Tories have let down disabled people, by breaking their promise to quickly publish firm plans on supporting disabled people in to work.

“When the Tories forced through cuts to Employment Support Allowance in the face of widespread opposition they bought off their own rebels with a promise to have a firm plan in place by the summer.

“Now the new Secretary of State has confirmed that he is going to downgrade the plan to a Green Paper, effectively kicking the issue in to the long grass for months, if not years.

The flimsy case for the cuts to Employment Support Allowance is now totally blown apart by this broken promise and the Tories must listen to Labour’s calls for them to be reversed.”

Remarkably, Crabb has claimed that disability benefit cuts are among policies “changing things for the better.” However, if cutting people’s income is such a positive move, we do need to ask why the Conservatives won’t consider taxing wealthy people proportionately, distributing the burden of austerity more fairly amongst UK citizens, instead of handing out money for tax cuts to those who need the very least support, at the expense of those who need the most.

The secretary for Work and Pensions has said: “The measures  that have either already been legislated for or announced get us to the £12 billion [welfare cuts planned in the Conservative manifesto].

Does that mean welfare reform comes to an end? I would say no. I’ve already pointed to what I see as one of the big challenges of welfare reform – and that’s around work and health.”

Crabb told MPs on Work and Pensions Select Committee that he would deploy “smart strategies” for cutting expenditure on disability and sickness benefits and would hopefully be able to secure the support of disability charities.

“In terms of how you make progress of welfare reform there when you are talking about people who are very vulnerable, people with multiple barriers, challenges, sicknesses, disabilities – I am pretty clear in my mind that you can’t just set targets for cutting welfare expenditure,” he said.

“When you’re talking about those cohorts of people you’ve actually got to come up with some pretty smart strategies for doing it which carry the support and permission of those people and organisations who represent those people who we are talking about.”

Both Crabb and his predecessor, Duncan Smith, have claimed that there are “millions of sick and disabled people parked on benefits,” yet rather than providing support for those who may be able to work, the Conservatives have abolished the Independent Living Fund and made substantial reductions to payments for the Access To Work scheme, creating more barriers instead of providing support for those who feel they are well enough to work.

A government advisor, who is a specialist in labour economics and econometrics, has proposed scrapping all ESA sickness and disability benefits. Matthew Oakley, a senior researcher at the Social Market Foundation, recently published a report entitled Closing the gap: creating a framework for tackling the disability employment gap in the UK, in which he proposes abolishing the ESA Support Group. To meet extra living costs because of disability, Oakley says that existing spending on PIP and the Support Group element of ESA should be brought together to finance a new extra costs benefit. Eligibility for this benefit should be determined on the basis of need, with an assessment replacing the WCA and PIP assessment. The Conservative definition of “the basis of need” seems to be an ever-shrinking category.

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.”

I’m sure the private company Unum would jump at the opportunity. Steeped in controversy, with a wake of scandals that entailed the company 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 handling 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. By coincidence, the  company has been involved with the UK’s controversial Welfare Reform Bill, advising the government on how to cut spending, particularly on disability support. What could possibly go right?

It’s difficult to see how someone with a serious, chronic and progressive illness, (which most people in the ESA Support Group have) can actually “manage” their illness and “move back into work.” The use of the extremely misinformed, patronising and very misleading term manage implies that very ill people actually have some kind of choice in the matter. For people with Parkinson’s disease, rheumatoid arthritis, lupus and multiple sclerosis, cancer and kidney failure, for example, mind over matter doesn’t fix those problems, positive thinking and sheer will power cannot cure these illnesses, sadly. Nor does refusing to acknowledge or permit people to take up a sick role, or imposing benefit conditionality and coercive policies to push chronically ill people into work by callous and insensitive and medically ignorant assessors, advisors and ministers.  

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. 

Reform says the government should cut the weekly support paid to 1.3 million sick and disabled people in the ESA Support Group from £131 to £73. This is the same amount that Jobseeker’s Allowance claimants receive. However, those people placed in the Support Group after assessement 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.

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.”

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 – PIP. However, as outlined, 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 hard work.

The current United Nations investigation into the systematic and gross violations of the rights of disabled people in the UK because of the Conservative welfare “reforms” is a clear indication that there is no longer any political commitment to supporting disabled people in this country, with the Independent Living Fund being scrapped by this government, ESA for the work related activiy group (WRAG) cut back, PIP is becoming increasingly very difficult to access, and now there are threats to the ESA Support Group. The Conservative’s actions have led to breaches in the CONVENTION on the RIGHTS of PERSONS with DISABILITIES – CRPD articles 4, 8, 9, 12, 13, 14, 15, 17, and especially 19, 20, 27 and 29 (at the very least.) There are also probable violations of articles 22, 23, 25, 30, 31.

The investigation began before the latest round of cuts to ESA were announced. That tells us that the government is unconcerned their draconian policies violate the human rights of sick and disabled people.

And that, surely, tells us all we need to know about this government.

 —

This post was written for Welfare Weekly, which is a socially responsible and ethical news provider, specialising in social welfare related news and opinion.

 

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The new social prescribing: ask not what your government can do for you

socialprescribing


I have a background in community work and have always seen it as a progressive mechanism for social transformation; challenging oppression; extending inclusion and democracy; offering learning and personal growth opportunities; empowerment, social justice, equity, fairness, participation, self-determination, amongst many other things. Communities potentially provide essential support for individuals, groups and organisations, and opportunities for reciprocity. Good community work promotes human development, and fosters civic responsibility through solidarity, cooperation and mutual aid.

Social prescribing is basically a community-based referral: it’s a means of enabling primary care services to refer patients with psycho-social, emotional or practical needs to a range of local, non-clinical services, often provided by the voluntary and community sector, and it’s aim is to improve people’s mental health, physical health and wellbeing, using community interventions.

In practice this means that GPs, nurses and other healthcare practitioners work with patients to identify non-medical opportunities or interventions that will help, improving support and the wider social aspects of their lives. The services that patients can choose from include everything from debt counselling, support groups, allotments and walking clubs, to community cooking classes and one-to-one coaching. Both evidence and commons sense suggests that social prescribing may be particularly appropriate and beneficial for isolated, marginalised groups. And needs-led community provision that supports and enhances psychosocial health and wellbeing is an excellent idea.

Poor mental health is often correlated with poverty, (Melzer et al. 2004) poor community integration, and competitiveness amongst social groups (Arrindell et al., 2003). Key questions arise as to the efficacy, therefore, of working with individuals, when much research suggests community work would be more effective (Orford, 2008).

So far so good.

I had the following message yesterday from friend and fellow writer, Linda:

“I have received an email from my local Tory MP letting me (and other constituents) know that he is going to be setting up a ‘Mental Health Surgery’ Hub with a ‘Mental Health Expert’ who will be handing out ‘social Prescriptions’ as he says he is aware that many mental health problems are caused by ‘Social Problems’. Im wondering if there is perhaps a wider agenda from the Conservatives.”

This is the relevant paragraph taken from his email:

“Since my election in May I have been surprised at the number of my constituents with different mental health issues, so much so I am looking to run a surgery ‘hub’ with a mental health specialist so people can drop in and have their needs assessed and be issued with a form of ‘social prescription’. I recognise many mental health issues are caused or exacerbated by social factors so sometimes a social solution can be more effective than a medical one.

I did a little research.

The 2010 Marmot Review (Fair Society, Healthy Lives) of health inequalities identified social prescribing as an, “approach [that] facilitates greater participation of patients and citizens and support in developing health literacy and improving health and wellbeing”.

It identified additional NHS healthcare costs linked to inequality as being well in excess of £5.5 billion per year. It is claimed that social prescriptions can cut the NHS bill.

However, despite the growing popularity of social prescriptions amongst cash and resource-strapped professionals, the University of York has surprisingly produced research to show that there is little good quality evidence that social prescribing is cost-effective.

But the thing that bothers me the most is the link that the Conservative government have made between social prescriptions, cost-cutting and (as I deeply suspected) as a mechanism of extending behavioural modification (euphemistically called “nudging” by the government’s team of behavioural economists and decision-making “experts”).

I read several current reviews of social precribing, each mentioning both criteria in recommendations for “success.”:

“The work of social prescribing health trainers fits with the approach of the Coalition Government as described in its White Paper on Public Health which emphasises the need to ‘build people’s self esteem and confidence’ in order to bring about changes in behaviour.”

It also fits with the Marmot Review’s recommendation on tackling the social problems that undermine health and with the Coalition Government’s approach to behaviour change as outlined in recent publications such as MINDSPACE.” (Link added by me.)

and:

“In times when finances are under pressure and the NHS is charged with achieving ‘better for less’, primary care needs to be looking at how to do things differently.”

Nesta, who now partly own the Government’s Behavioural Insights Team (the Nudge Unit) are of course at the forefront of promoting social prescriptions amongst medical professionals, firmly linking what is very good idea with very anti-democratic Conservative notions of behaviour change, citizen responsibility and small-state ideology. So, it’s no longer just about helping people to access a wider range of community-based services and support, social prescribing has also places strong emphasis on “encouraging patients to think about how they can take better care of themselves.”

Of course, there is what may easily be construed as a whopping self-serving process of linking behavioural change with social prescribing, opening some potentially very lucrative opportunities for Nesta.  

However, taken at face value, the idea of promoting patient participation in their own care sounds very democratic and reasonable. Common sense, in fact.

In this context, social prescribing can be seen as a logical extention of the Biopsychosocial model (BPS) of ill health. The biological component of the model is based on a traditional allopathic (bio-medical) approach to health. The social part of the model investigates how different social factors such as socioeconomic status, culture and poverty impact on health. The psychological component of the biopsychosocial model looks for potential psychological causes for a health problem such as lack of self-control, difficulties with coping, emotional turmoil, and negative thinking.

Of course a major criticism is that the BPS model has been used to disingenuously trivialise and euphemise serious physical illnesses, implying either a psychosomatic basis or reducing symptoms to nothing more than a presentation of malingering tactics. This ploy has been exploited by medical insurance companies (infamously by Unum Provident in the USA) and government welfare departments keen to limit or deny access to medical, social care and social security payments, and to manufacture ideologically determined outcomes that are not at all in the best interests of patients, invalidating diagnoses, people’s experience and accounts, and the existence of serious medical conditions.

Unum was involved in advising the government on making the devastating cuts to disabled people’s support in the UK’s controversial Welfare Reform Bill. (See also: The influence of the private insurance industry on the UK welfare reforms.)

Secondly, this is a government that tends to emphasise citizen responsibilities over rights, moralising and psychologizing social problems, whilst quietly editing out government responsibilities and democratic obligations towards citizens.

For example, poverty, which is caused by political decisions affecting socioeconomic outcomes, is described by the Conservatives, using elaborate victim-blame narratives, and this is particularly objectionable at a time when inequality has never been greater in the UK. Poverty may only be properly seen in a structural context, including account of the exclusion and oppression experienced by those living in poverty, the global neoliberal order, the gender order, the disability, racial, sexual and other orders which frame social life and precipitate poverty in complex and diverse ways. It’s down to policy-makers to address the structural origins of poverty, not the poor, who are the casualities of politically imposed structural constraints.

In this context, social prescriptions are used to maintain the status quo, and are likely to be part of a broader process of responsibility ascription – based on the traditional Conservative maxim of self-help, which is used to prop up fiscal discipline and public funding cuts, the extensive privatisation of public services, defense of private property and privilege, and of course, the free market. The irony of the New Right, neoliberal, paternalistic libertarianism is that the associated policies are not remotely libertarian. They are strongly authoritarian. It’s a government that doesn’t respond to public needs, but rather, it’s one that pre-determines public interests to fit within an ideological framework

A government that regards individuals as the architects of their own misfortune tends to formulate policies that act upon individuals to change their behaviour, rather than to address the structural constraints (and meet public needs,) such as social injustice and unequal access to resources. This isn’t a government prepared to meet public needs at all. Instead it’s a government that expects citizens to change their behaviour to accommodate the government’s ideologically directed needs.

That approach flies in the face of established professional community work values and principles.

Poor people suffering mental ill health because we live in a society that is extremely unequal, are blamed by the government for the “symptoms” of their poverty – poor eating habits and “lifestyle choices”. But poverty is all about limited choices, which is itself not a “lifestyle choice.” No-one actually chooses to be poor. Government policies, social structures and systemic failures create poverty.

The Conservatives extend an economic Darwinism, coupled with an extremely intrusive disciplinary approach, mass surveillance and a stigmatising rhetoric, whilst moralising a free-market framework that constrains many and preserves the privilege of a few. The absurdity is this: if an economic framework isn’t meeting the needs of a population, it isn’t an adequate response for the government to act upon citizens who have become casualities of that framework, to persuade or coerce people into fitting within an increasingly harmful and useless socioecomomic ideology.

There is a clear correlation with low socioeconomic status and poor mental health. Poverty is a complex, multidimensional phenomenon, encompassing the lack of means to satisfy basic needs, lack of control over resources, often, a lack of access to education, exclusion from opportunities, and poor health. Poverty is intrinsically alienating and distressing, and of particular concern are the direct and indirect effects of poverty on the development of psychosocial stress. (See also: The Psychological Impact of Austerity – Psychologists Against Austerity.)

State “therapy” aimed at changing the behaviour of individuals diverts attention from growing inequality, and from policies that are creating circumstances of absolute poverty. It also diverts attention from the fact that if people cannot meet their basic physiological needs, they cannot possibly be “incentivised” to meet higher level psychosocial ones. 

I wrote a critical analysis of the government proposal to introduce Cognitive Behaviour Therapists to deliver state “therapy” in job centres earlier this year, with the sole aim of improving “employment outcomes.” There is also an extensive critique of Cognitive Behaviour Therapy (CBT) included in the article, along with some discussion about the merits of community work, which is very relevant to this discussion. (See: The power of positive thinking is really political gaslighting.)

I also wrote earlier this year about how the government has stigmatised and redefined unemployment, problematizing and re-categorising it as an individual psychological disorder. Both articles are very pertinent to this discusion. (See: Stigmatising unemployment: the government has redefined it as a psychological disorders.)

Welfare has been redefined: it is a now a reflecton of a government pre-occupied with assumptions about and modification of the behaviour and character of recipients rather than with the alleviation of poverty and ensuring economic and social wellbeing.

The stigmatisation of people needing benefits is designed purposefully to displace public sympathy for the poor, and to generate moral outrage, which is then used to further justify the steady dismantling of the welfare state.

Many psychosocial problems have arisen because of social conservatism and neoliberalism. The victims of this government’s policies and decision-making are being portrayed as miscreants – as perpetrators of the social problems caused by the government’s decisions.

It’s all too often the case that good ideas are placed in political ideological frameworks, distorted, and are then applied to simply justify and prop up dogma.

Meanwhile, mental health services are facing crisis because of budget cuts by this government, Local Authorities and community services have also been cut to the bone. (See: The cost of the cuts: the impact on local government and poorer communities.) Those with mental health problems are stranded on an ever-shrinking island.

Policy initiatives such as social prescriptions, which focus on how to remediate problems at an individual level, seeing both poverty and mental illness, for example, as simply states of being – rather than dealing with the generative political and economic practices and social relations framework which precipitated that state in the first place, effectively depoliticises political problems leaving people with an internalised state of oppression, disabling them from taking effective action.

The political refusal to permit people to voice their concerns and anxieties in political rather than personal terms further exacerbates sociopolitical marginalisation, low status, it breaks a sense of connectedness with others and wider communities, it reinforces a sense isolation and of personal responsibility for circumstances that are politically constructed and disowned.

 

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