biopsychosocial model has no empirical foundation in relation to ME/CFS

Attention is drawn to a letter recently sent to two high-profile members of The House of Lords by Douglas Fraser, a former professional violinist but now severely affected by ME/CFS (http://www.meactionuk.org.uk/FraserToTGTandMM.htm ).

In it, Fraser sets out his concerns about a paper circulated by Lord (David) Freud, Parliamentary Under Secretary of State (Minister for Welfare Reform) to certain members of the House of Lords (this being “Models of Sickness and Disability” by Waddell G and Aylward M, whose track record on the alleged deviance of sick people -- those with ME/CFS being specifically targeted -- is documented in “Magical Medicine: how to make a disease disappear” by Professor Malcolm Hooper available at www.meactionuk.org.uk/magical-medicine.htm ).

David Freud’s history is interesting: he previously worked as a journalist for the Financial Times and then joined a leading UK investment bank (UBS investment banking), where he was on record as saying to his deputy: “If the rest of the country knew what we were being paid, there would be tumbrels on the streets and heads carried round on pikes”. In his city career he frequently got things seriously wrong.  As one reviewer of his book put it, Freud “will be remembered in the City as one of the key players in several of the most embarrassing and badly managed deals in investment banking”.  His revenue forecasts were, in his own words: “completely potty”; according to the Daily Telegraph, his financial plans for Euro Disney “went so goofy they almost wrecked his career” and on the Channel Tunnel Rail Link he got his sums wrong by £1.2 billion and had to be bailed out by the Government (www.variant.org.uk/events/Doc7Poverty/BankerBankies.pdf ).

Nonetheless, as the “To Banker from Bankies” 2009 report (which was supported and funded by Oxfam) states, in 2007 Freud was appointed as the key Government advisor on welfare reform by Labour’s John Hutton, having been commissioned to produce a report “Reducing Dependency, Increasing Opportunity” on the “Welfare to Work” programme.  This was despite the fact that, in his own words, Freud “didn’t know anything about welfare at all” (Daily Telegraph, 4th February 2008). Despite the great complexity of the welfare system, Freud researched and wrote his welfare “shake-up” plan in just three weeks. It recommended that the existing role of private firms (such as the French company Atos) in the Government’s “Welfare to Work” programme be dramatically increased; he acknowledged that there was no evidence to suggest that private contractors were any better than the Department for Work and Pensions, but he still concluded that it would be “economically rational” to pay them tens of thousands of pounds for every person they removed from benefits.

The Daily Telegraph subsequently reported that Freud himself had severed all ties with Labour Ministers and was joining the Conservatives’ Work and Pensions team “after being put forward for a peerage”.

In May 2010 the Coalition Prime Minister (David Cameron) appointed him to his current post as Minister for Welfare Reform.

On 17th January 2012 Hansard recorded that Lord Freud referred to the “Models of Sickness and Disability” document that he had handed round to some members of the House of Lords (http://www.publications.parliament.uk/pa/ld201212/ldhansrd/text/120117-0001.htm), this being the document which will apparently underpin the transition from Disabled Living Allowance (DLA) to the Personal Independence Payment (PIP) and from which document it is clear that the biopsychosocial construct now permeates medical assessments for state benefits (so it may come as no surprise that Professor Peter White is acknowledged as an advisor).

Lord Freud explained: “I am hopeful that PIP will do a better job than DLA….I shall now turn to the more technical aspects of this issue – that is, looking at what we are doing with the PIP and its assessment.  Is it a medical assessment…? It absolutely is not.

“…Our approach is – and this is rather a mouthful – akin to the biopsychosocial model…

“I sent round a rather interesting piece of analysis to many noble Lords in the Committee, called Models of Sickness and Disability, which showed the differences between the models, explaining the medical model, the reaction of the social model against the pure medical model and the synthesis of the biopsychosocial model. The summary of the biopsychosocial model in the analysis is that: ‘Sickness and disability are best overcome by an appropriate combination of healthcare, rehabilitation, personal effort and social/work adjustments’.  There is a coherent theory behind this assessment”.

There are about 170 references to “models” scattered throughout the 40 page document and Fraser points out that readers may get the impression when it comes to the “biopsychosocial model” that a rigorous and scientific approach has been taken, yet it may be argued that there is no coherent theory whatsoever behind that “model”.

Fraser draws attention to the authors’ footnotes, which are rife with selective referencing and contain misquotations from and misrepresentations of the (not easily available) cited source.

In one instance the authors seem to infer (from their cited source) that it has been shown to be perfectly legitimate to proceed directly from biopsychosocial theory (or the “conceptual model”) to biopsychosocial practice and policy, when the cited author in fact concluded that the biopsychosocial model is “hardly a theory” and “certainly not a model”.

The central arguments surrounding issues of bias and confounding in relation to the biopsychosocial model that are exposed within the cited source are not -- as they should have been -- made known by Waddell and Aylward.

Notably, the impression from the footnotes is that it was Professor Peter White who provided “classic” examples on “how the biopsychosocial model is not an aetiological model of disease, and (how) arguments about whether the cause of a particular disease is biological or psychosocial obscure the main issue”, when in reality it was George Davey-Smith, Professor of Clinical Epidemiology at the University of Bristol who urged caution and who carried the torch for intellectual integrity: it was he who showed that bias can generate spurious findings and that when interventional studies to examine the efficacy of a psychosocial approach have been used, the results have been disappointing, and he who pointed out that cholera was attributed to “moral” factors and that peptic ulcer was attributed to stress before the appliance of science (Proof Positive?  Eileen Marshall & Margaret Williams, 30th August 2005 http://www.meactionuk.org.uk/PROOF_POSITIVE.htm ).

According to Waddell and Aylward (and White), both these examples are of “specific diseases of doubtful relevance to common health problems” and they are dismissed because they appear to threaten the biopsychosocial philosophy, which Waddell and Aylward claim applies to “any illness”.

However, when one examines Waddell and Aylward’s claim of supporting evidence for the biopsychosocial model in the management of low back pain (“extensive scientific evidence that the biopsychosocial model provides the best framework for the modern management of low back pain”), one finds from the latest Cochrane meta-analysis examining the results of behavioural interventions for low back pain that: “the risk of bias of the trials included in this review was generally high” and, in relation to the addition of behavioural therapy to in-patient rehabilitation over the longer term, that: “there was only low or very low quality evidence, which was based on the results of only two or three small trials” (Behavioural treatment for chronic low-back pain; 7 JUL 2010.  The Cochrane Collaboration.  http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD002014.pub3/full ).

Such seeming sleight of hand by Waddell and Aylward in seriously misleading a Government Minister and members of the House of Lords is to be deplored.

When it comes to ME/CFS, over 20 renowned international experts on ME/CFS have provided written statements of concern effectively stating that cognitive behavioural therapy and graded exercise therapy used to support the alleged existence of the “biopsychosocial model” do not work for people with ME/CFS (Magical Medicine pp 88-92).

Furthermore, numerous trials have shown that not only is the “biopsychosocial model” unsuccessful in the management of ME/CFS but that the model itself is not evidence-based and it may be actively harmful:

(i)              the evidence that behavioural modification techniques have no role in the management of ME/CFS is already significant and has been confirmed by a study in Spain, which found that in ME/CFS patients, the two interventions used to justify the biopsychosocial model (CBT and GET) did not improve HRQL (health-related quality of life) scores at 12 months post-intervention and in fact resulted in worse physical function and bodily pain scores in the intervention group (Nunez M et al; Health-related quality of life in patients with chronic fatigue syndrome: group cognitive behavioural therapy and graded exercise versus usual treatment. A randomised controlled trial with 1 year follow-up. Clin Rheumatol 2011, Jan 15: Epub ahead of print)

(ii)            “Notwithstanding the medical pathogenesis of ME/CFS, the (bio)psychosocial model is adopted by many governmental organizations and medical professionals to legitimize the combination of Cognitive Behavioral Therapy (CBT) and Graded Exercise Therapy (GET) for ME/CFS…. Justified by this model CBT and GET aim at eliminating presumed psychogenic and socially induced maintaining factors and reversing deconditioning, respectively. In this review we invalidate the (bio)psychosocial model for ME/CFS and demonstrate that the success claim for CBT/GET to treat ME/CFS is unjust. CBT/ GET is not only hardly more effective than non-interventions or standard medical care, but many patients report that the therapy had affected them adversely, the majority of them even reporting substantial deterioration…. We conclude that it is unethical to treat patients with ME/CFS with ineffective, non-evidence-based and potentially harmful ‘rehabilitation therapies’ such as CBT/GET” (A Review on Cognitive Behavioural Therapy (CBT) and Graded Exercise Therapy (GET) in Myalgic Encephalomyelitis (ME) / Chronic Fatigue Syndrome (CFS). Neuroendocrinol Lett 2009:30(3):284-299)

(iii)          The Wessely School’s much-vaunted FINE (Fatigue Intervention by Nurses Evaluation) Trial could not by any standards be judged to have been successful: the results showed that “pragmatic rehabilitation” (PR, based on CBT/GET) was minimally effective in reducing fatigue and improving sleep only whilst participants were engaged in the programme and that there was no statistically significant effect at follow-up. Furthermore, pragmatic rehabilitation had no statistically significant effect on physical functioning; equally, its effect on depression had diminished at follow-up. Moreover the other intervention being tested (“supportive listening” or SL) had no effect in reducing fatigue, improving physical functioning, sleep or depression (AJ Wearden et al; BMC Medicine 2006, 4:9 doi:10.1186/1741-7015-4-9

(iv)          Equally, the widely acclaimed but statistically unsustainable PACE Trial cannot be said to have been successful since, uniquely, ratings that would qualify a potential participant as sufficiently impaired to enter the trial were considered  “within the normal range” when recorded on completion of the trial and no recovery statistics have been published by the Chief Principal Investigator, Professor Peter White (Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. PD White et al. Lancet 2011 Mar 5;377(9768):823-36).

It has not been possible to determine Lord Freud’s awareness of the need to distinguish biomedical science from biopsychosocial ideology before he formulates Government policies that will have a profoundly detrimental impact on sick and frightened people whose means of survival is threatened if their state support is withdrawn.

The term “biopsychosocial model” is used almost exclusively by Wessely School psychiatrists to refer to disorders that they continue to regard as psychosomatic (especially ME/CFS) and it is not used by other disciplines. For example, cardiologists do not refer to patients as having a “biopsychosocial” disorder and oncologists do not refer to cancer as a “biopsychosocial” disorder, nor do they claim that their patients must be coerced back to work by the withdrawal of their state benefits because it is patients’ aberrant belief that they are physically sick which maintains their disease.

The use of such a term can be seen as a linguistic misdirection by these psychiatrists, allowing them to conceal their belief that ME/CFS is not a physical disease but an aberrant state of mind maintained by psychological and behavioural factors (ie. the psychosocial components of “biopsychosocial”).  The only “bio” in their “biopsychosocial model” is their reluctant concession that ME/CFS is sometimes preceded by a self-limiting viral infection (and, despite the overwhelming international evidence to the contrary, they insist it is maintained by psychosocial elements that do not result from any organic pathology).

As Fraser states: “As the tortured arguments continue, one suspects that the authors (Waddell and Aylward) are keenly trying to ensure something is kept out of public view….Had Lord Freud said ‘We have not gone for the medical model; we have gone for the psychosomatic model’, I do not think that members of the House would have been impressed for a moment”.

Informed readers of “Models of Sickness and Disability” might wonder why something that has been repeatedly shown not to be a successful model is being promoted by a UK Government.

As Fraser points out, an explanation may be found from a 2005 issue of “Decision Makers’ Exchange” (DME), the monthly newsletter for DLA and Attendance Allowance decision makers: “Confirmation that Medical Services (ie. the DWP) have adopted the Biopsychosocial Model for assessing not just claims based on incapacity for work but also DLA and AA came in the July edition of Decision Makers’ Exchange…An item explained that Medical Services have recently introduced a change in the way that they assess a customer’s disabilities and the effect it has on their lives.  The Biopsychosocial Model aims to address how a person’s disability has an effect on that individual’s life”.  The newsletter features an article by Mansel Aylward, former Chief Scientist at the DWP, entitled “Professor Aylward endorses the Biopsychosocial Model of Disability….Conditions for which there is limited or no recognised pathological basis, such as chronic fatigue, fibromyalgia…feature regularly in disability assessments for state benefits….The Biopsychosocial Model is the answer to the disability analyst’s plight”.

Fraser then quotes from an Atos Origin Medical Services meeting in 2004 which sets out just how the dogma that underpins the “biopsychosocial model” is being authoritatively promulgated, and he notes “the convenient fictions and lack of logic those responsible would…refuse to tolerate if applied to their own family and friends”.

The Atos Origin 2004 Conference report is explicit: “Psychosocial factors…are at least as important as physical factors in the onset and maintenance of these conditions.  Patients can make a number of ‘secondary gains’ with these unexplained illnesses, such as…turning a socially unacceptable disability into a more acceptable ‘organic’ disability caused by injury or disease beyond their control. They can blame their failures on the illness; elicit care, sympathy and concern from family and friends; avoid work or even sex; and there are financial rewards associated with disability.

“…if a patient believes their illness was caused by a virus and there’s nothing they can do about it, their prognosis is not likely to be positive.  But if the patient believes…that the symptoms won’t last long and they have control over them, then the prognosis will be better….  We need patients to understand their situation, so they are more likely to go back to work”  (http://www.meactionuk.org.uk/AtosConference2004.pdf).

Fraser concludes in his letter: “Given the combined forces of what appears as an unseen (and) corporate-generated self-serving attitude (tacitly approved by “Models of Sickness and Disability” authors as perfectly moral) in the guise of the…psychosomatic model…promoting the prejudice of…pop-psychology directed at vulnerable and relatively powerless others…and a profit-driven foreign company…it is unsurprising that so many of the bad decisions they help facilitate are overturned on closer examination at costly appeals.  It would of course, be much cheaper in the long run to adopt some of the higher standards of appeal tribunals in the first place”.

This non-evidence-based but pervasive biopsychosocial ideology is now being foisted on the unsuspecting people of Australia and New Zealand, because in May 2010 Aylward wrote a report for the Australasian Faculty of Occupational and Environmental Health (Realising the Health Benefits of Work: A Position Paper. Professor Sir Mansel Aylward CB; Director: Centre for Psychosocial Research and Disability Research, Cardiff University (the Centre being funded by the health insurance company UNUM Provident).  In it, Aylward asserts:

“Fundamental Precepts:
Main determinants of health and illness depend more upon lifestyle, socio-cultural environment and psychological (personal) factors than they do on biological status and conventional healthcare
Work: most effective means to improve well-being of individuals, their families and their communities
Objective: rigorously tackling an individual’s obstacles to a life in work.

“Making the distinction: definitions and usage:
Disease: objective, medically diagnosed pathology
Illness: subjective feeling of being unwell
Sickness: social status accorded to the ill person by society

In that report Aylward claims that largely subjective complaints (such as ME/CFS) are often associated with psychosocial issues, not with pathology, and that “bio-psycho-social factors” may aggravate and perpetuate disability and that they may also act as obstacles to recovery and barriers to return to work. He refers to the UK Government’s “Pathways to Work” initiative, with its mandatory work-focused interviews for sick people and the use of CBT to change people’s alleged misperceptions about their health; his message is: “Barriers to recovery and return to (retention in) work are primarily personal, psychological and social rather than health-related ‘medical problems’ and that “Perceptions lie at the ‘heart’ of the problem”.

His report provides guidance on “ Engaging and Exploiting Stakeholders”, which he says must include
changing the beliefs and attitudes of politicians, civil servants, health professionals, employers etc and changing the present culture about health and well-being in order to deliver “visible hard outcomes”.

Even more disturbingly, Aylward’s report asserts that there must be new roles for health professionals, who must no longer permit their patients to believe that they are incapable of work if they have a disease but must instead propel them back into work even if they do have a legitimate medical disease.  In the UK, there are recorded accounts of people with cancer being forced back to work and of a cancer sufferer dying whilst awaiting an appeal against a refusal of benefits by Atos.

Unsurprisingly, since he has invested so much into the promulgation of it, despite the accumulating evidence to the contrary, Aylward claims that the biopsychosocial principles of management are evidence-based, when the “biopsychosocial model” can be readily shown to have no empirical foundation, particularly in relation to ME/CFS.

It has nevertheless been used to justify beliefs and policies, for example, in his letter to the two members of the House of Lords, Douglas Fraser quotes the following:

"Benefits and Work has seen one recent medical report in which a DWP doctor explicitly stated that he had used the Biopsychosocial model. The claimant has Chronic Fatigue Syndrome and was seeking renewal of an award of the middle rate of the care component and the higher rate of the mobility component. His condition had deteriorated since his last award over two and a half years ago. The doctor who visited him recorded that: ‘There are few significant findings other than subjective tenderness and stiffness. But the customer is clearly living the life of a disabled person and I have applied the Biopsychosocial model’. The doctor then stated, without explaining how the conclusion had been reached, that the claimant’s condition was just 40% physical and ‘60% psychosocial’…. This allowed the decision maker to conclude that the claimant’s award of higher rate mobility was no longer appropriate as the primary reason for his virtual inability to walk was psychosocial rather than physical".

The specific numbers given (40/60 split) provided a superficial appearance of scientific objectivity to cover what was in fact no more than a highly-prejudiced guess, because such things cannot be measured or quantified, but they achieved the required outcome (which was to strip this person of his benefits and for which the company to which the DWP has delegated its medical assessments would receive a handsome financial reward).

It is, of course, imperative to seek out and remove from state benefits the cheats and idle lead-swingers, but it is even more imperative to take appropriate medical care of the sick, yet what underpins current Government welfare reform is the un-evidenced conviction that work is always good for people, no matter how ill they may be.

Commenting on a response to her article “Illness as Deviance, Work as Glittering Salvation and the ‘Psyching-up’ of the Medical Model: Strategies for Getting the Sick ‘Back to Work’ ” (http://www.democraticgreensocialist.org/wordpress/?page_id=1716), Gill Thorburn says: “I was appalled to discover what they have been doing to the ME community for so many years.  Its nothing short of legitimised abuse.  The one discouraging thing I’ve experienced in all my research so far has been discovering for how many years how much authentic evidence has been simply disregarded by those in power in favour of this spurious psychological approach.  Some of the accounts on the net are simply heartbreaking, and it beggars belief that these people should have been allowed to continue with their ‘methods’ and ‘theories’.  As someone pointed out recently, they ‘intervene’ in peoples’ lives with impunity, disregarding their negative effects, for which they are never held to account”.

A UK Government is democratically elected to look after the best interests of the nation and of its citizens, not to abuse and persecute the sick in favour of foreign corporate profits by imposing the “biopsychosocial model” that is promoted by UK psychiatrists who have vested financial interests in such a “model” because they work for the health insurance industry, whose profits benefit from its use.

Source

INACCURACIES IN IAIN DUNCAN SMITH'S CV [BBC Newsnight]

Press Releases & Press Packs

		19.12.02 BBC NEWS Newsnight reveals inaccuracies in Iain Duncan Smith's CV Aspects of Iain Duncan Smith's CV, relating to his education, are inaccurate and misleading, an investigation by BBC Newsnight reveals. The investigation into the Conservative Party leader's education and early career - broadcast at 10.30pm on BBC TWO last night (Wednesday 18 December 2002) - was presented by Michael Crick, author of the best-selling biography of Jeffrey Archer. If any of the following material is used BBC Newsnight must be credited. The University of Perugia Iain Duncan Smith's biography on the Conservative Party website, his entry in Who's Who, and various other places, state that he went to the Universita di Perugia in Italy. This is not true: his office now admit that he went to the Universita per Stranieri, which is also in Perugia. The Universita per Stranieri - or University for Foreigners - was founded in 1921 and is a totally separate institution to the medieval Universita di Perugia, founded by the Pope in 1308. Although the Universita per Stranieri is a respected language school, it did not grant degrees when he studied there in 1973, although some students attained diplomas. Mr Duncan Smith's office has now admitted to Newsnight that he didn't get any qualifications in Perugia or even finish his exams. Dunchurch College of Management The first line of Iain Duncan Smith's biography, on the Conservative Party website, claims he was "educated at Dunchurch College of Management". In fact, Dunchurch was the former staff college for GEC Marconi, for whom he worked in the 1980s. Mr Duncan Smith's office has now confirmed to Newsnight that he did not get any qualifications there either, but that he completed six separate courses lasting a few days each, adding up to about a month in total. Newsnight has now spoken to 19 former tutors at Dunchurch. Most agree it is over-emphasising his experience at Dunchurch to describe it in the way he does. John Garside, a former Dunchurch tutor, says: "I'm puzzled, flattered, but puzzled. What we did was offer short courses... it was not a continuous form of education by any means." Newsnight has shown these details to some of Iain Duncan Smith's constituents in Chingford. Several people assumed he must have been at both the University of Perugia and Dunchurch for several years, and obtained qualifications in either or both places. Notes to Editors The Conservative Party website page can be found at: http://www.conservatives.com/iainduncansmith/biography.cfm The BBC is not responsible for the content of external internet sites

BBC Press Office

How to destroy the Work Programme

Barnardos cashing in on slave labour under the work programmes

Return of the slave traders

 
It’s not only multinationals that are benefiting from the free labour supplied by the government’s ever-expanding workfare programme. Information obtained under the Freedom of Information Act by the Boycott Workfare campaign shows that charities across the UK, including Barnardo’s, the British Heart Foundation, Age Concern, Cancer Research and Scope, are all accepting unemployed people sent by job centres and private providers for unpaid work placements in their shops.

And if the experience of claimants sent to a Barnardo’s shop in Leeds is anything to go by, working for free in a charity shop is not necessarily much better than stacking shelves at Tesco. Sheryl Odlum, who has volunteered in the shop for the last year, told Corporate Watch that claimants sent to workfare placements arrive expecting retail experience but are often not even working on the shop floor.

“They could be in the upstairs room the whole time, sorting or steaming the clothes,” she said. “They’re not allowed to work on the till … If they’re in the shop, they’re just standing there, tidying up the clothes.”
Many of the claimants, who have been sent by provider company Best Training, are not there by choice and there is no prospect of paid work at the end of the placement. Barnardo’s shops are mainly staffed by volunteers, so workfare placements are not replacing paid jobs, as appears to be the case with many companies (see here). But Ms Odlum says that five people who have completed the 13-week placements in her store over the last year worked more hours than the other volunteers and have become valuable assets: “things would be an awful lot more difficult for us if we didn’t have that constant labour.”

“They should be paid minimum wage at least.” she said. “They’re doing a full-time job.” These placements are organised through the government’s Work Programme, for “long-term jobseekers”, who are mostly over 25. Barnardo’s also organise placements for 18-24 year olds through the government’s work experience programme for 18- to 24-year-olds – a different workfare scheme (and the one Nick Clegg was eagerly expanding last month). The charity told Corporate Watch its placements under this scheme were never more than four weeks long and that it would “certainly not advise young people to complete long-term unpaid work placements.” But getting older people to steam clothes for 13 weeks is fine!

Source
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Further Study

November 9, 2011 ‘It’s exploitation and it’s repellent’: Retailers, councils and charities benefiting from workfare
September 26, 2011 Unemployed people ‘bullied’ into unpaid work at Tesco, Primark and other multinationals
August 12, 2011 ‘I was a volunteer for six months and wasn’t given a job or paid any money’
August 12, 2011  ’Making profits from the the unemployed is reprehensible’
Full DWP Study
In Profile : The Trussell Trust
The Dulverton Trust

Suicide Rates rising due to redundancy & poverty

In the last couple of days disturbing stories have emerged of people killing themselves due to the current austerity. In one case a man is thought to have killed himself after being made redundant (see here). In another, a couple killed themselves in a suicide pact because they could not cope with poverty (see here). It is known that women in poverty are 15 times more likely to commit suicide (see here). It is with this in mind that one of my regular readers asked me to investigate whether or not suicide was indeed on the rise. I must say at the outset, that a) there are no 2011 figures for suicide yet and b) there is no way of ascribing motivation to abstract ONS statistics on suicide c) Experts are sceptical that recessions lead to increased suicide. Thus, any trends recorded my be simply coincidental. Nevertheless, the data is presented below.

According to the office of national statistics, the % of male deaths resulting from intentional self harm (suicide) as a proportion of the overall deaths resulting from injury and poisoning reached a four year high in 2010. We cannot know the motivation for these men who committed suicide, simply that as a proportion of external deaths, they have been rising.

According to the office of national statistics, the % of female deaths resulting from intentional self harm (suicide) as a proportion of the overall deaths resulting from injury and poisoning reached a four year high in 2010. We cannot know the motivation for these women who committed suicide, simply that as a proportion of external deaths, they have been rising.

The question is this; why is it that suicide is increasingly forming a larger portion of deaths resulting from injury or poisoning? Suicide levels have, generally speaking, been falling fairly steadily since the 1970s. Indeed, suicide rates up until 2007 were in quite steady decline. The question is this, why has this trend been halted, or dare I say it reversed?

Experts in the field have complained that the ONS are underestimating suicides by up to 6% in the last couple of years due to the increased recording of narrative verdicts by coroners. (see link). The Evening Standard have speculated that the increase could be linked to economic pressures. The Independent, also reached the same conclusions.

 

Source

Welfare reform and the US insurance giant Unum

The extraordinary announcement that GPs may no longer be able to sign their patients off work for periods longer than 4 weeks, offers an insight as to corporate involvement which underpins the policy decisions of neoliberal governments. There are doubtless many shades of understanding and levels of cynicism amongst both the supporters and the protagonists of these policies, but there are certainly those who know exactly how to deliberately spin the narrative to achieve the desired financial outcome for the ‘markets’. This post attempts to draw out some of the strands.

Lord Freud, Minister for Welfare Reform, has announced a new way in which this government can potentially deter the disabled and long-term sick from claiming benefits.  No longer would the GP be able to sign patients off work for longer than 4 weeks.  After that period, the professional expertise of the medic would be subject to an independent assessment, presumably by the highly questionable tick list/points system used by a private contractor such as ATOS.  Furthermore, according to a Guardian report  People who are signed off sick would also be put on to jobseeker’s allowance, rather than employment support allowance, for a period of three months. They would receive less money and have to prove they were looking for work.

So yet another tranche of ill and disabled people would have to comply with an inappropriately structured assessment with all the attendant worrying, potential exacerbation of symptoms and travel expenses; not to mention additional costs to the tax-payer, that such a superfluous assessment entails.

Labour MP Dennis Skinner said: “Last year, the government said GPs should be accountants in charge of the money that is spent in the NHS. This year they want assessors to be GPs. It’s crazy. No wonder the country is going to the dogs.”

So why are we being told that, on the one hand, the GPs are the right people to determine the spending of billions of tax payer’s money on health commissioning, notwithstanding their lack of expertise, but that they cannot be trusted to use their professional judgement in assessing a patient’s health and/ or the need for a referral to occupational health?

One answer is to ‘follow the money’.  The medical profession diagnose some patients with intractable long-term illnesses like Fibromyalgia, Chronic Pain, Lyme Disease, Myalgic Encephalomyelitis (ME), and so on…  all of which could prove ruinously expensive for private health providers like the US employment protection insurer Unum.

‘Unum’s 1995 ‘Chronic Fatigue Syndrome Management Plan’ sounded the alarm: ‘Unum stands to lose millions if we do not move quickly to address this increasing problem’

Unum (www.unum.com) is one of the leading providers of employee benefits products and services and the largest provider of group and individual disability income protection insurance in the United States and the United Kingdom.

Unum’s close involvement with Welfare Reform, politicians, psychiatrists, academics and think tanks is well documented, and arguably can be likened to the tentacles of the Goldman Sachs squid extending across European governments. http://think-left.org/2011/11/07/the-market-has-a-name-it-is-goldman-sachs/

Unum’s UK activity since the 1990s is referred to in:
http://think-left.org/2011/08/04/welfare-reform-and-mecfs/
http://www.lwbooks.co.uk/journals/articles/rutherford07.html

But in addition, Private Eye has also raised questions about Unum’s involvement with the DWP (Department of Work and Pensions).

The Eye first questioned Unum about the possibility
of a serious conflict of interest back in 1995… Tricky questions are again being asked about the profits American insurance
giant Unum stands to make from its massive media push on income protection
cover, promoted as the answer to the latest tough welfare
reforms …..
Meanwhile disability activists who have fallen foul, and been forced to appeal
cuts in DWP benefits based on flawed Atos assessments, and campaigning groups
like Black Triangle, think the whole thing stinks and are urging MPs to
investigate.
http://victimsofatoscorruption.wordpress.com/2011/11/10/private-eye-magazine-asks-questions-again-about-unum-dwp/

It is clear that there is a ‘happy match’, a common objective, between the neoliberal political view of benefits, and the interests of private health insurers.  The neoliberal politician wants to shrink the State and reduce public expenditure via privatisation, and the private health insurer wants to maximize profitability by not having to pay out for any claims.  Both, therefore, want to remove people from benefit entitlement and, to that end, working collaboratively within the DWP would clearly make ‘sense’.  Unfortunately, neither the agenda of the politician, nor the health insurer, address or include the actual reality of diverse problems of ill health and the myriad of difficulties faced by sufferers … and as has been described there are several million sufferers of intractable long-term illnesses and permanent disabilities. In effect, the DWP agenda is motivated towards denying ‘illness’ and associated legitimate need, wherever possible.

In order to bridge this gap between the policy makers and reality, a narrative must be constructed which is both compelling and achieves the common objective without it being obvious that the real agenda is privatization and withdrawal of public expenditure.  The narrative chosen usually attributes some innate characteristic to a particular group.  For example:

‘GPs are our most trusted members of society and know what is best for their patients…  therefore they should do healthcare commissioning for the NHS’

‘GPs are too emotionally involved and do not know what is best for their patients … therefore, we need an ‘objective’ assessment.’

However, the underlying assumptions about illness upon which the DWP predicate their actions seem to have slipped out in the following quote:

Justifying the new proposals, UK’s national director for health and work, and the former head of the British chambers of commerce David Frost, said when people were off sick for longer than four weeks they started “to lose the will to work” 

Anything more than cursory consideration, indicates that this is a ludicrous and totally unsubstantiated statement.  All people become work averse after 4 weeks of being so ill that the GP considers them unfit to go to work? Where is the evidence for such an assertion? It is not even clear how it would be possible to validate such a claim scientifically.

However, this statement is consistent with the biopsychosocial model of illness which needs to be explored more fully in another article.  Suffice it to say that this Orwellian model redefines ‘illness’ and was created by ‘psychiatrists and academics … happy to draw on their moral authoritarianism and neo-liberal policy prescriptions (and unmentioned links with Unum) to produce a monograph, The Scientific & Conceptual Basis of Incapacity Benefits (TSO, 2005, Waddell and Aylward) which was published by the DWP, and provides the intellectual framework for the 2006 Welfare Reform Bill (1).
The proposition, “to lose the will to work” amply indicates one of the moral panics of authoritarianism that human beings only behave ‘properly’ if offered ‘the stick or the carrot’… ie. people will pretend to be ill to get out of work if given the opportunity.

This view of humanity or ‘model of man’ underpins both neoliberal policy decisions and the justification for the so-called ‘free-market’.  The nature of ‘Man’ is perceived as innately self-interested, greedy, and wanting to ‘pull a fast one’, unless they are restrained by laws or offered incentives.  That it is considered to be innate, and therefore immutable, justifies both taking advantage of others to get the best deal, and the imperative to punitively control the other to prevent having that advantage taken away.  Hence, we have a one-sided neoliberalism.

‘..neoliberalism has not so much been about increasing wealth, but about redistributing it.
http://think-left.org/2011/10/14/capitalism-neoliberalism-plutonomy-and-neo-feudalism/

Unsurprisingly, given the lack of fit with reality:

‘The work capability assessment programme, which assesses benefit claimants to see whether they are fit for work is “teetering on the brink of collapse” as the system becomes clogged up with appeals.’
http://www.guardian.co.
uk/politics/2011/nov/21/benefits-appeals-system-near-collapse

Appeals have quadrupled, and Citizen’s Advice Bureau’s are inundated with people seeking advice on how to appeal.

It is clear that the changes and cuts made to the benefits system are based on the interface of ideological, psychological, political and financial factors, and are simply not tenable.  The appalling impact of these ‘welfare reforms’, ungrounded in reality, are only now beginning to come to light with tragic reports of suicides http://diaryofabenefitscrounger.blogspot.com/2011/11/latest-disability-news-roundup.html but little reported in the mainstream media are the increased levels of hardship, worry and deprivation for the disabled and long-term sick whom the overwhelming majority of the population would wish to support.

Somewhat horrifyingly, these facts are used to the advantage of Unum UK in their advertising ploys:

McGarry,
chief executive at Unum UK, earlier this year warned: “The
 government’s welfare reform bill will seek to tighten the gateway to benefits 
for those people unable to work due to sickness or injury. Each year up to 1m 
people in the UK become disabled and the reforms mean that working people will 
be able to rely less on state benefits to maintain the standard of living they
were used to prior to their illness.”
http://victimsofatoscorruption.wordpress.com/2011/11/10/private-eye-magazine-asks-questions-again-about-unum-dwp/

So, Unum warns people to get insured against the cuts in benefits … of which they, Unum, were major architects …. either directly as advisory consultants, or through their funding of psychiatrists who created the intellectual framework, the funding of think tanks and academics who in turn recommend policies to the DWP, and  by offering ‘jobs for the boys’.  For example, by funding the 1.6m  UnumProvident Centre for Psychosocial and Disability Research at Cardiff University, and appointing Mansel Aylward (the former DWP Chief Medical Officer and co-author of the DWP  biopsychosocial monograph) Director of the unit..

It is hard to believe that there are not some very hard-headed individuals in Unum who are not fully aware of the heist that they have perpetrated.

It should be noted that there are many other private health providers who have doubtless played a similar role in creating Lansley’s new model for the NHS…

However, it cannot be avoided that many of these policies stem from New Labour’s period in office.  It is particularly noteworthy that a common link is provided by Lord Freud who switched from New Labour to the Conservatives in 2009, having been appointed by Tony Blair to provide an independent review of the British welfare to work programme in 2006, and then rehired as an adviser to the government when James Purnell was appointed Secretary of State for Work and Pensions in 2008.  A former journalist for the FT, Freud became the vice-chairman of investing banking at UBS AG until his retirement in 2003.  His expertise in disability or long-term illness is rather notably absent but his background in asset management and financial structures is clearly impressive.

UBS AG (SIX: UBSN, NYSE: UBS) is a Swiss global financial services company headquartered in Basel and Zürich, Switzerland, which provides investment banking, asset management, and wealth management services for private, corporate, and institutional clients worldwide, as well as retail clients in Switzerland.  (Wikipedia)

In order to become Real Labour, Ed Miliband and his team must draw a clear line away from New Labour’s policies, and devise a programme of Welfare Reform which is fit for purpose, and which really meets the needs of some of the most vulnerable people in society.  The present arrangements should be rejected because they are dangerous, punitive and would be completely unacceptable to most of the population if their true impact was exposed.  Philip Gould, one of the architects of New Labour, advised Tony Blair in 1997 to ‘Reassure, reassure, reassure’.  Ed Miliband explicitly needs to ‘Reassure, reassure, reassure’ the population of the UK, that they will be appropriately protected and helped if they or their family are, or should find themselves, vulnerable and in need due to long-term illness or disability.

(1) http://think-left.org/2011/08/04/welfare-reform-and-mecfs/
http://think-left.org/2011/11/19/doctor-doctor-2/ 

Source

New evidence of UNUM's influence on welfare reform

New evidence suggests that an insurance giant that could make huge financial gains from government reform of incapacity benefit played a much larger part in influencing those reforms than it previously admitted.

Last month, Unum, the UK’s largest provider of “income protection insurance” (IPI), denied that it had attempted to influence government policy on welfare reform.

Campaigners believe that tougher welfare rules – particularly those replacing incapacity benefit (IB) with the new employment and support allowance (ESA) – could persuade more people to take out IPI, and so boost Unum’s profits.

Unum has denied that it stands to gain from the reforms, even though it launched a major media campaign this year just as the coalition government began a three-year programme to reassess about 1.5 million existing IB claimants through a new, stricter test, the work capability assessment (WCA).

But now a detailed memo has emerged, which was submitted to the Commons work and pensions committee in 2002 and was written by Joanne Hindle, Unum’s corporate services director.

In the memo, Unum calls for fundamental reform of the welfare system, while it says the government “must ensure both that work always pays more than benefits, and more importantly that it is clearly seen to do so”.
The memo includes proposals with a strong resemblance to reforms introduced several years later by the Labour government, when it replaced IB with ESA.

The Unum memo suggests retaining a form of IB for those “genuinely incapable of undertaking any work whatsoever”, as Labour did with the ESA support group.

And it suggests a new benefit for those with “limited capacity to work”, who would be “properly supported in their search for and transition into work”, a suggestion which mirrors the ESA work-related activity group introduced by Labour.

The memo also says Unum was “actively engaged” with the government on sharing best practice on returning disabled people to work, while its executives had “met with [government] officials to help better understand the nature of the IB casebook, and to discuss how our commercial experience and expertise might be more widely applied”.

Hindle stresses in her memo that the company – then known as UnumProvident – “is confident that its policies and approach to [IPI] claim management and rehabilitation can be replicated more widely for those on IB” and would “particularly welcome the opportunity to put them into practice”.

The subsequent reform of IB was hugely controversial, with widespread anger among disabled people at the severity and inflexibility of the WCA, and the number of claimants subsequently found “fit for work”.

The anger has grown over the last 18 months under the Conservative-led government, with claims that its reforms – which are even harsher than those introduced by Labour – are merely a cover for cuts to welfare spending and are plunging tens of thousands of disabled people further into poverty and distress.

The disabled activist who has done most to raise concerns about Unum’s influence is Mo Stewart, a retired healthcare professional and veteran of the Women’s Royal Air Force, who has been researching Unum for nearly a year.

She said it was “incomprehensible that Unum have denied benefiting from the ongoing radical welfare reforms when the wording of some of the reforms closely mirror” comments in the memo submitted by the company.

She said: “The recent mass marketing of Unum IPI, combined with the excessive publicity about the ongoing destructive welfare reforms, is no doubt reminding the able-bodied ‘squeezed middle’ population to be prepared in case of unexpected serious health or disability difficulties which, inevitably, will lead many to invest in IPI from this American corporate giant.”

Further information has emerged this week suggesting that Unum had influence within the Department for Work and Pensions as the government was drawing up its proposals for IB reform.

Last month, Unum admitted that two of its executives – a doctor and an occupational therapist – were involved in “technical working groups” set up by the government in 2006.

The working groups were asked to review the assessment that was being used at the time to test disabled people’s eligibility for IB.

Unum told Disability News Service (DNS) that the working groups met just once and that the company had “no further influence” on the design of the test’s eventual replacement, the WCA.

But a response by the Department for Work and Pensions to a Freedom of Information Act request from DNS suggests that the Unum officials were present at three meetings of one working group and at least five of the other.

This week, Unum repeated its denial that it had influenced the welfare reforms of the Labour and coalition governments.

John Letizia, Unum’s head of public affairs, said in a statement: “While Unum, like the vast majority of Britons, believes a review of the current welfare system is necessary, we are not working to influence the government to reduce welfare benefits as you seem to be suggesting.

“Rather, given our expertise in income protection and vocational rehabilitation, we have been one of a number of entities from industry, trade unions and health invited from time to time to participate on committees and provide input to government.

“Our primary interest is in promoting the role the private sector can usefully play not only in helping people to protect themselves should illness or injury occur, but also to achieve a successful return to work where possible.

“Income protection does not replace state benefit, but it is a vital protection for the ‘squeezed middle’ who would not be able to maintain their current lifestyle should something unexpected occur. This would also provide significant direct and indirect benefit to the state.

“At no time have we influenced the government on the design of the reforms to the welfare state or on the level of benefits that claimants receive.

“Additionally, as you know, it is ultimately the government and not Unum or any other third party that makes decisions about policy matters.”

He added: “Whilst we are always willing to answer questions… please understand that we do not intend to continue to discuss events from 10 years ago or engage in a back-and-forth that is based on a false premise, particularly if your mind is made up as it appears to be.”

Source

Is Labour abolishing illness? [From 2008]

By Alison Ravetz Published 01 May 2008

Incapacity benefit has become one of this year's favourite scare stories. Hardly a day passes without a new headline deploring its soaring costs and the rising numbers of claimants who get "something for nothing", at the expense of decent, hardworking taxpayers. We are told that we are footing an outrageously escalating bill for 2.4 million people, a million of whom shouldn't be on the benefit at all, and each successive work and pensions minister vows to be more ruthless than the last.

The true picture is somewhat different. The unreported version, which can be culled from Department for Work and Pensions (DWP) data, is that only 1.4 of the 2.4 million actually receive any payment, the rest get national insurance credits only, and numbers have been falling since 2003. The basic benefit is worth barely £3,000 a year. After two small rises in the first year there is no further increase, other than index-linking. All those who get the benefit have to pass a rigorous "personal capability assessment" (PCA) with doctors appointed by the DWP; and they can be re-examined at any time. The audited estimate of fraud is under 1 per cent - the lowest of any part of the social security system.

Nonetheless, the 2007 Welfare Reform Act is now being implemented across the country. It replaces support, as of right, for illness/disability (one of the planks of our rapidly disappearing welfare state) with a new, conditional employment and support allowance. Claimants are held on a basic allowance until it is confirmed that their capability for work is limited. This is determined by a "work capability assessment" tougher than the old PCA. Those deemed capable of one day returning to work (and the arbiters are health professionals rather than doctors) must engage in a series of "work-focused" interviews and activities. These include, among other things, "condition management", which in practice is likely to consist of group sessions loosely based on cognitive behavioural therapy. All this brings an additional slice of benefit that can, however, be cut for those who do not engage in it without "good cause" - a potential loss of 40 per cent of income. Ultimately, any whose capability for work remains limited through failing to follow medical advice, or "any prescribed rules of behaviour", face a period of disqualification. (A further provision of the act, to be piloted in nine areas, is that people served with Asbos - antisocial behaviour orders - can face cuts in their housing benefit for refusing local authority offers "to help address any problem behaviour".)

A main selling point of the reform was the great savings it would bring. It would staunch the outflow of benefits and get many people into jobs where they would pay tax and provide for their old age. This government's cherished goal is an employment rate of 80 per cent of the working-age population - though it is difficult to find any reasoned argument in support of this since our present rate of 75 per cent is, with Canada's, the highest in the world. The government accepts that employers must be paid to take on people with an illness record and, for the time being, it has pledged not to cut the benefits of existing claimants. Any immediate savings, therefore, can only come from bumping as many as possible off the benefit, shaving future benefit levels (already well in hand), and making it harder for newcomers to get it in the first place. Delivery is being farmed out to private agencies paid by results - which means, of course, the setting of targets. The next few years will be a bad time to have a crippling accident or succumb to a serious disease, particularly a psychiatric or neurological one that does not have obvious outward symptoms.

Blaming the "cheats"

The reform of incapacity benefit has been over ten years in the making, leaving in its wake a dense trail of commissioned reports. A curious thing about this voluminous material is how little information it contains on the actual health conditions for which benefit is paid. This is no accident, for the reformers long ago made up their minds that claimant numbers are too high, therefore a large proportion - usually put between a third and a half, but lately upped to 70 per cent in some quarters - must be spurious. An appeal to history is repeated like a mantra that, back in 1979, only 700,000 claimed the old sickness/invalidity benefits. Since then, money has been poured into the NHS while health care, living standards and longevity have improved beyond all expectations. People must be healthier, which proves that huge numbers are exploiting a slack and obsolete system. Who is to blame, apart from outright cheats? It can only be the self-indulgent, who fancy themselves sicker than they really are, and complacent GPs who let them think they are too ill to work.

Crucially, the reformers bracketed illness with disability. The disability lobby had long argued that "disability" was a discriminatory label imposed by society, and it was bent on removing the barriers to work that excluded those so labelled and kept them in poverty. But the bracketing brought confusions - for those with disabilities may be extremely fit (consider the disabled athlete), whereas the able-bodied can be extremely ill. More confusion arises with conditions such as "stress", "anxiety" and "chronic fatigue" that sound trivial. As for "back pain", how unreasonable is it to take time off sick for something best dealt with by a stiff upper lip and the odd aspirin? It is easy for those in good health to pooh-pooh such things, agreeing with the government that "Work is the best therapy".

The government's declared mission is to "liberate" claimants, to bring them into its "reformed, coherent welfare state for the 21st century". It seeks to overturn a culture based on the "medical model" of illness that allows them to "drift" on to long-term benefits without realising that "symptoms, feeling unwell, sickness and incapacity are not the same" - hence the appeal of cognitive behavioural therapy, which it understands as a treatment that will talk the sick into believing they can lead normal lives.

Doctors - so often the refuge of desperate people trying to find out what is wrong with them - should as far as possible be excluded from the process. Even those working for the DWP have opinions that are "unfounded, of limited value and counter-productive", while GPs are "unaware of the importance of work, the absence of which leads to depression, poor health, higher rates of suicide and mortality, poverty, and social exclusion". (The quotations are from a 2005 study from the Unum Provident Centre for Psychosocial and Disability Research at Cardiff University, whose ideas and rhetoric infuse the reform. Unum Provident is an American firm, the largest disability insurance company in the world, which is currently in litigation in different countries for refusing to pay out on some of its policies.) A private agency has now taken over the running of its first GP surgery here, and doctors dealing with disability living allowance are advised not to invite patients to explain how their condition affects them.

Features of the reform are familiar from other policy areas. First, a demonisation of a needy or vulnerable group, followed by a rebranding: so claimants become not even "clients" but "customers" (as in the just published "Commissioning Strategy" document); incapacity benefit becomes employment and support allowance; sick notes are redrafted for doctors to certify, not what patients can't but what they can do. Next come "partnerships", on an unchallenged assumption that the public sector has failed. The new system is farmed out to for-profit or non-profit-making agencies paid by results. This entails targets, and where targets are set, sanctions follow, for any who "fail to recover".

There are features of the new programme that look intelligent and humane, doubtless owing much to the efforts of the disability lobby. They include a longer and more flexible bridging period (and a back-to-work grant) between benefits and work, and a broader view of "work- focused" activities. The crunch will come with those described as not able or prepared to engage "because [of] the nature and severity of their health condition, or more a matter of attitudes, perceptions and expectations which may or may not be accurate . . . It is a question of what the claimant cannot do vs what they will not do."

For the reform stakes everything on a gamble: that a large proportion of claimants, present and to come, are fit enough to work. There seems no way of proving or disproving this, other than trying it out, at the risk of much waste of public money, and much personal grief. Deliberate rejection of the "medical model" deprives us of all we might have learned (from the wealth of data available) of the impact of illness on our society.

I have scratched my head long and hard over this reform (among other things sending out lengthy submissions to all concerned during the long consultation phase in 2005-2006) because so much in its theory and rhetoric contradicts my own experience: of chronically and seriously ill family members and friends, of several years as a Mind volunteer, and further years of peripheral involvement in action groups for chronic fatigue conditions. All this has indelibly impressed me with the courage of many who live with horrible complaints, the sheer hard work involved in their day-to-day coping, their relentless search for any amelioration, let alone cure, often at costs hard to spare from limited resources.

I have witnessed, too, and at close quarters, the hurt and stress of living difficult lives as people have to do, in a perpetual culture of disbelief and threat, where some of the most valiant are blamed for their conditions and conflated with the alleged "can't work, won't work" unemployed. For the message of the reform that comes across, for all its fashionable rhetoric, is that a person is valued only as a productive unit. Compassionate cases aside, those too ill to work are outside society and money spent on them is wasted. Sickness, disablement and inability to work have no place in a modern society - they can't and shouldn't be afforded.

No one pretends that illness is not a blight, imposing personal and social costs going far beyond the financial; but - pace the government - no one as yet knows how to remove it from the human condition. Why waste valuable time and resources on an ill-founded reform, when they could instead be used to further understanding of the real impact of illness on our society?

Alison Ravetz is a professor emeritus of Leeds Metropolitan University who writes on housing policy and welfare reform

New Statesman

A contract to terrify 1.5m people on incapacity benefit

A French company is being paid millions to harass incapacity benefit claimants with the threat of being made destitute

by John Harris

 An open meeting at Burnley football club held by the work and pensions select committee to hear the experiences of people moved from incapacity benefit to the new employment and support allowance. Photograph: Christopher Thomond for the Guardian

 

Some sobering summer reading came my way on Monday: not The Social Animal or any of the voguish paperbacks being thumbed in Tuscany and elsewhere, but a report from the select committee on work and pensions (officially published on Tuesday). Bear with me: if you've got visions of a headache-inducing text full of tedium and officialspeak, nothing could be further from the truth. It is incisive, fact-packed, smattered with moving first-person testimony, and downloadable for free. Anyone with any interest in where Britain is heading ought to read it.

The report's focus is on welfare reform – more specifically, the reassessment of 1.5 million people who have been on incapacity benefit, via the so-called work capability assessments, or WCAs. It sets out a story that includes plenty of the most fundamental aspects of life in modern Britain: the tabloid shrieking about the supposedly workshy that exerts such a grip on our politicians; the stupidly cushy terms on which whole chunks of the welfare state are being handed over to private companies; and above all, an underlying sense that the pain and panic that result from all this have precious little chance of gaining any political traction.

As of October 2008, incapacity benefit began to be replaced by the employment and support allowance – and anyone putting in a new claim faced the WCA, which places people in one of three categories: judged "fit for work" and introduced to the stringent regime based around jobseekers' allowance; in effect deemed incapable of employment and put in a "support group"; or held to be somewhere between the two and thus destined for "work-related activity". The monopoly provider of WCAs is Atos Healthcare, a division of a French IT firm, which had signed up for £100m of DWP business three years before.

Last October the reassessment of those 1.5 million people began, and the kind of alarming stories that crop up in the select committee report started to pile up. Ministers apparently claim that two official reviews have blunted the process's worst shortcomings, but still: evidence from Citizens Advice Scotland says that the assessments, delivered by Atos's doctors and nurses, "can last just 20 minutes", and that "the yes/no format of the assessment is too narrow". One page later you find a mind-boggling handful of paragraphs about the company's "Logic Integrated Medical Assessment" (or Lima) computer system, which has often seemed to reduce complex cases to the stuff of binary idiocy.

The results of all this are obvious enough. Thousands of people have been fallaciously deemed fit for work. Even if your condition is sufficiently serious to avoid that fate – as the Mental Health charity Rethink puts it, "if a claimant can set an alarm clock, feed themselves and manage life without daily aggression or needing almost constant supervision" – you can still be pushed into "work-related activity" – which, under the terms of the government's welfare bill, could see your employment and support allowance stopped after a year.

On Monday I heard from a man in the West Midlands; a diagnosed depressive and agoraphobic who was deemed fit for work, only to successfully appeal. "I have no confidence in the Atos way of assessment," he told me, "as I feel it's geared more to them ticking boxes and gaining brownie points … than the actual physical and mental wellbeing of each person." He is now on to his third assessment, feeling "very apprehensive", and in fear of "ending up on a mental health wing".

From Rethink I received the story of a man suffering from bipolar disorder who had also been put through the assessment grinder. His account chimed with recent reports of WCA-related suicide attempts: "As a direct result of the way I have been treated by the DWP and Atos I considered taking my own life on and off for a period of months. My GP even wrote a letter to them to spell out the severity of my illness and how the situation was putting me in danger."

He won an appeal last February, and will now receive his backdated benefits. (At the last count the rate of successful appeals was running at about 40%. The projected annual cost of appeals has been put as high as £50m – although Atos incurs no penalty for getting things so wrong.)

All of this is scandalous, yet it goes on – seemingly of no concern to the supposed everyman, nor to the politicians who fixate on him. This raises two issues: first, the treatment being meted out to thousands of people should be a moral offence to all of us; and second, our flexible labour market and increasingly brutal welfare system are now so constructed that even if you are doing well, it is perfectly possible that you could fall ill, and then find yourself just as terrified as the thousands who are currently being herded through the WCA process.

In the modern benefits system, trapdoors abound: if you fail to get the employment and support allowance and find yourself on jobseeker's allowance, for example, you will not only suffer a 14% drop in income but may very well fall foul of the latter's demands and find yourself "sanctioned", with no benefits at all. The next stop is that miserable demi-monde that defines more lives than a lot of people would like to think: crisis loans, food banks, the very real prospect of ending up destitute.

In other words, the old aspirational tagline of the national lottery now applies to some of the most iniquitous aspects of the benefits system. Really: it could be you.

Guardian

Workfare Unravels

Workfare, the government’s forced labour scheme, could be the latest policy to unravel as encouraging momentum builds against the proposed reform of the welfare system.

On Tuesday activists forced the cancellation of the “Making Work Pay” conference at the Royal Society and have vowed to continue to struggle against welfare reforms with the launch of Welfare Uncut and Boycott Workfare.

Meanwhile the latest legal opinion, gained by Brighton Unemployed Centre is that Workfare may in fact be illegal.

The most damning indictment however slipped out almost unnoticed in April. The Social Security Advisory Committee (SSAC) provides impartial advice to the UK government on social security proposals. Reports are presented to Parliament alongside any proposed legislation and the Government is expected to respond to any recommendations the body makes.

The SSAC were asked to report on the mandatory work programme (PDF) which will see some benefit claimants forced to carry out 30 hours a week of unpaid work for four weeks or face losing benefits. A whole host of corporate parasites and even charities have been licking their lips at the prospect of free labour provided by the unemployed.

The report reveals a staggering lack of foresight into how the proposals may work in practice. Like so many other areas of welfare policy, it appears that Iain Duncan Smith hasn’t thought things through again.

The most concerning aspect of the report reveals that referral to mandatory work activity (workfare) will be made by Jobcentre Advisors largely on a whim. If they don’t like your face, then off you go to work in Primark for no pay for a month. This could potentially even happen on the first day of a benefit claim if the advisor decides you aren’t trying hard enough to find work. Once the workfare is over, then it seems you could be immediately re-referred.

Previously there were things like rules and regulations about what is expected of benefit claimants. But now the goalposts are shifting and any old twat with a clipboard and a grudge down the Jobcentre will have the power to fuck up claimant’s lives. As the committee notes: “Claimants can be fully engaged with the (benefit) conditionality requirements but in effect a claimant can still be mandated to do more.”

The implications of this could be devastating. With thousands of people with health problems, many of them vulnerable, some with mental health conditions, it’s not a huge leap to have concerns that many of this group may face discrimination.

As the Committee also points out: “4.17 Evidence from the Department’s Equality Impact Assessment and DWP research shows that ethnic minority claimants and those with a learning difficulty tend to be disproportionately sanctioned for not actively seeking employment. This, alongside other societal factors, could lead to these groups being disproportionately referred to this scheme and, as a consequence, at even greater risk of sanction.”

The initial benefit sanction will be raised from 2 weeks to 13 weeks. We therefore see a very real possibilities that those, already stripped of health benefits by the sharks at Atos Origin, may be forced off benefits all together. Job seeking commitments, which could be arbitrarily made up by Jobcentre advisors, could see thousands facing the very real poverty created by benefit sanctions.

Already cancer patients, people with MS and other serious medical conditions have been forced onto Job Seekers Allowance. Under these rules they could now be forced into full time, unpaid employment or face starvation. The recent spate of suicides due to adverse benefit decisions is likely to rocket if these proposals go ahead. This is no longer scare-mongering, but proposed government policy. It is little wonder that some have compared the plans for welfare reform to euthanasia programmes.

But it not all doom and gloom. Workfare is good for you claims the DWP. The SSAC doesn’t agree noting: “We also wonder why, given that the Department views mandatory work activity as a beneficial change, people will not be permitted to volunteer to take part. This seems to us to signal that being mandated to mandatory work activity is regarded as a punishment rather than an opportunity to learn and develop new behaviours and skills. Employers are unlikely to value references that come from forced work schemes, as they will not perceive such a reference as evidence that the participant has the skills to undertake an actual job and are more likely to see mandatory participation as a negative sign of participants’ work readiness and willingness to work.”

Concerns are also raised in the report about the impact of workfare on people’s ability to be able to effectively seek work. Participants in workfare schemes could be expected to travel up to three hours a day to placements, on top of the 30 hours a week unpaid work. This will leave little chance for ‘actively seeking work’ especially for those with children or health problems.

So far the DWP has offered no details of what may happen if a claimants has to attend a hospital appointment, or their child is taken ill. Noted only in passing by the committee is the vast array of other commitments that particularly vulnerable claimants may have such as meetings with Social Services, interviews and appointments for social or emergency housing, probation appointments or counselling. It seems that no-one at the DWP has even considered what happens when a client is due to sign on, which will still be expected of them whilst on workfare.  In practice it may be impossible for workfare victims to disappear from the workfare placement and attend the job centre once a fortnight.  But no-one seems to have thought about that.

There also appears to have been no thought given to what might happen if a claimant is successful in gaining a job interview during there Workfare provision. Under current plans they may face benefit sanctions if they miss their placement and attend.  Finally, and also missed by the committee, but familiar to many who’ve already faced the joys of the New Deal and other similar schemes, is activities the claimant may already be carrying out to help them find work. Many Job Seeker’s Allowance claimants are at college part time, volunteering, researching setting up a business or even currently on other ‘job search’ provisions. In the past it has not been uncommon for claimants to be forced to leave courses without achieving the final qualification to attend some bollocks scheme at A4e where they do little more than sit around in an office for 30 hours a week. Money grabbing providers of job search and other schemes have even been known to fight over claimants with no thought at all as to what is best for the individual concerned.

Concerns are also being raised about the quality and even availability of workplace placements. Whilst some businesses may be salivating at the prospect of unpaid labour, the reality is that many providers up until now have found it difficult to find suitable work placements, especially for those who may be vulnerable, have drug or alcohol problems, mental health conditions, criminal records or are homeless. These are exactly the type of people likely to be referred for the initial phase of workfare.

It is highly likely that only the most exploitative employers will be interested in recruiting workfare staff. As the SSAC notes: “We are also concerned that there seems to be no process in place to monitor employers or to end their involvement should they be found to be exploiting participants or requiring them to undertake inappropriate work (or work experience.”

One former employee of workfare provider A4e told us of one claimant whose placement provider had boasted about how they’d been able to sack the cleaners since being able to hire workfare staff.

The SSAC also raises concerns about how any expenses the claimant may incur will be recouped, noting that the DWP will not be responsible for travel expenses, which they expect to be provided by placement providers, however there is no compulsion on them to do so. Childcare expenses will not be met by anyone, leaving parents at risk of being unable to afford to attend workfare, and thus facing benefit sanctions. The poorer you are, the more likely it is you will be made poorer.

The 13 week sanction period is also condemned by the SSAC, warning that the length of time is disproportionate and also warns that: “there is no incentive for a sanctioned person to re-engage with the programme as the department states that any sanction will remain in force even if a person returns to the placement.”

The report concludes that they: “recommend that Mandatory Work Activity does not proceed.” Whether they will be listened to is anyone’s guess. What is clear is that the combination of sanctions, health testing, housing benefit cuts and other benefit changes is that the poorest and the most vulnerable in society are likely to be even further pushed into deprivation and poverty if the changes go ahead.

Of course workfare is nothing new and the poor and destitute shouldn’t expect any help from the Labour Party. The difference is that past workfare style provision at least paid lip service to ideas of providing quality training and skills, even if in reality that was rarely the case. When the last Government kicked you it was ‘for your own good’. This bunch of toffs just appear intent on kicking people when they’re down, presumably to make sure they stay there.

One interesting fact which does emerge from the report is that the DWP are currently only planning to recruit 10,000 people onto workfare per year. It is a rarely mentioned fact that workfare, even in the current training and support free model proposed, is expensive. Claimants need to be monitored, policed, insured and managed. Agencies providing workfare schemes need to advertise, recruit, design programmes, find placements and train staff. The new god-like powers now being given to Jobcentre advisors signify a vastly increased workload at a time when the DWP is facing mass redundancies.

There appear to be two possibilities emerging. There are currently around a million people who have been claiming Job Seeker’s Allowance over a year. If the figures of 10,000 workfare placements a year remains the same then someone on long term benefits only has a one in a hundred chance of being referred onto workfare in the next year. Whilst that small percentage may represent the most vulnerable benefit claimants, this is unlikely to be of any concern to tory filth.

Unemployment, according to the Tories, was once a price worth paying. It is not inconceivable that this highly publicised drive to get tough on ‘benefit scroungers’ is little more than a sop to fool the angry people who write letters to the Daily Mail. Under Thatcher three million unemployed were left to rot. It was cheaper that way, and still is.

Another, sadly more likely, possibility is that this is being used as a trial run. Businesses are well aware of the implications of the creation of a vast army of unpaid labour. Already concerns have been raised about workfare staff being used to undercut wages or even being forced into becoming scab labour. This is a matter that may yet become a far more pressing concern for the unions, who with the exception of the PCS, (who are well aware of what a shambles these changes are likely to cause) have paid little attention to the plight of benefit claimants.

One thing’s for sure. This is not about training people, reducing unemployment or even saving money. There is no evidence that workfare in fact works. According to one report: “In Quebec, PQ Income Security Minister Jeanne Blackburn has publicly admitted that workfare there has been a dismal failure. In the first five years of the program, the number of Quebecers on welfare rose by a staggering 42% to 776,541 persons in 464,500 households. Of the 80% of welfare recipients considered “employable,” only about 15% are now actually enrolled in workfare programs. And of those who have participated in such programs since 1989, fewer than 12% of them have been able to find stable jobs.”

The good news is that claimant’s are fighting back in an unprecedented way. Atos Origin, the French IT firm responsible for the Work Capability Assessment have seen scores of demos, pickets and occupations outside (and inside) their premises across the UK. Workfare providing organisations such as the odious A4e have also seen protests and offices invaded. Charities and businesses set to recruit workfare staff are likely to face protests and direct action. Connections are being made, plans formed, strategies developed and new groups seem to be springing up almost daily.

This government expects disabled people and claimants to die quietly. Many (but not all) claimants are unemployed and so are unable to strike. Many have disabilities, health problems, and a whole host of other shit going on in our lives. We have fuck all money and so are unable pursue mainstream methods of campaigning. But we are millions strong. And we have very little left to lose.

http://benefitclaimantsfightback.wordpress.com/

COUNSELS OPINION: WORKFARE SCHEMES UNLAWFUL

COUNSELS OPINION – WORK-FOR-BENEFIT SCHEMES UNLAWFUL AS FORCED OR COMPULSORY LABOUR, CONTRARY TO ECHR ARTICLE 4

1. Submitted, the implementation of a work-for-benefit scheme is a violation of the right not to be subjected to forced or compulsory labour. “Forced or compulsory labour” is defined in the ILO Forced Labour Convention 1930 as “all work or service which is exacted from any person under the menace of any penalty and for which the said person has not offered himself voluntarily”.

2. Work-for-benefit is exacted under the menace of benefit sanction, which falls within the autonomous Convention definition of “criminal charge” in that it has a manifestly deterrent purpose, with indication of a penal purpose.1 The House of Lords in Secretary of State for the Home Department v MB [2008] 1 All ER 673 reviewed the case law as distinguishing between measures merely preventative in purpose and those which “have a more punitive, retributive or deterrent object” (per Lord Bingham [19] to [24]).

3. If C refuses a direction to participate in a work scheme save on the condition that he charges his stipulated rate and that there is a contract for services, he will almost certainly be sanctioned. Submitted, such direction and sanction would be unlawful, because it would purport to suppress his capacity to contract and to take the benefit thereof, in violation of

Protocol 1 Article 1 of the ECHR (right to peaceful enjoyment of possessions), further without statutory authorisation. It would also violate Article 4 of the ECHR by forcing him to work outside the limits of his consent.

4. Even if it were held that C offered himself voluntarily, the fact that he gave his prior consent to participation in work-for-benefit was held in Van der Mussele v Belgium (1983) 6 EHRR 163 to be inconclusive. It was held at paragraph 40 that, in the case of prior consent, there must be a “considerable and unreasonable imbalance between the aim pursued (entry to the legal profession) and the obligations accepted as a condition of achieving that aim for there to be forced labour. The burden must be so excessive or disproportionate to the advantages attached to the future exercise of the profession that the service cannot be treated as having been voluntarily accepted. (at paragraph 37).

5. Further to #4 the ECtHR took account of the fact that:

(a) the required service was not unconnected with the profession in question (particular employment test);

(b) in return for unpaid service the person received certain advantages, including the exclusive right of audience in court (privilege test);

(c) the work contributed to professional training (training test);

(d) the requirement related to the delivery of a Convention right of others to free legal assistance (rights of others test);

(e) the service was similar to the “normal civic obligation” exception (Article 4(3)(d)) (civic obligation test);

1 DWP Research Report No 313, A review of the JSA sanctions regime: Summary research findings, 2006) http://research.dwp.gov.uk/asd/asd5/report_abstracts/rr_abstracts/rra_313.ap

(f) the burden imposed (involving unpaid work) was not such as to leave the person without sufficient time for paid work (hours test).

6. It was held in Talmon v Netherlands (1977) ECtHR that Article 4 does not stand in the way of a requirement that an unemployed person take suitable employment. The case involved a claimant who lost on the merits having insisted that he was willing to work only as an independent scientist and social critic and was on grounds of conscience unwilling to take any other work.

7. A work-for-benefit scheme does not comply with Article 4 because it does not meet all -in particular it meets none – of the criteria in #5:

8. (a) there is in the terms of participation no indication of a promise or cause of legitimate expectation of regular employment on completion of service;

(b) the stated aim of the scheme is merely to restore competitive parity on the labour market which C is likely to have lost in consequence of long-term unemployment, and does not include the aim of procuring access to a privileged occupation;

(c) there is no element of training of any kind, let alone any with recognised credentials;

(d) the work does not involve the delivery of a Convention right to others;

(e) the service is, for reasons stated in #9, not similar to a normal civic obligation;

(f) the service is exacted on a full-time basis to the exclusion of any significant time to seek or undertake paid work, and for a duration far in excess of what is necessary to effect labour market rehabilitation.

9. Further to #7(e) work-for-benefit arrangements are not similar to a civic obligation. The terms on which service is exacted are consistent with the condition of servility, but not with  the freedoms, property rights and public service expectations (eg. military or jury service) characteristic of citizenship.2 They derogate from the right of a free man to work for a wage or a fee under a contract of service or for services and to draw the benefit of the contract, namely his living from work he freely chooses or accepts (International Covenant on Economic, Social and Cultural Rights (ICESCR) Article 6).

10. Submitted, the premiss of work-for-benefit is that it is legitimate to exact labour services in consideration for benefits paid during such service or a previous period of unemployment. This premiss is misconceived. Save that Strasbourg jurisprudence assimilates social security benefits to private property, international human rights law otherwise knows social security and social insurance to be the object of a right, but not as a commodity which must be paid for except by taxes and social insurance contributions.

3 (Cf. ICESCR Article 9; ECHR Protocol 1 Article 1 paragraph 3). It follows that the only way to exact tribute from a person consistently with respect for the status of citizenship is to engage the person under a regular contract and then lawfully to impose taxes on his remuneration.

2 Cf. Aristotle, The Politics, Book I Chapters 4-7; Book III Chapter 5

3 R (on the application of RJM) (FC) (Appellant) v Secretary of State for Work and Pensions [2008] UKHL 63;

Stec & Ors v United Kingdom (App. Nos: 65731/01 & 65900/01), Decision on Admissibility 06-07-2005 (ECtHR)

11. Submitted, even if the obligation of work-for-benefit were “civic” in nature, it is not “normal”. A “normal” civic obligation is one which is designed to fall equitably upon everyone within the general class of citizens by reason of citizenship without more.

Alternatively, it may on principle be designed to fall equitably upon everyone within a subclass of citizens by reason of citizenship together with some legal or factual position of privilege, dominance or eminence.

12. Further to #11, work-for-benefit schemes are not designed to affect all citizens generally, neither are they addressed to a privileged class. On the contrary, they are addressed to a sub-class of citizens who are disadvantaged by reason of long-term unemployment and who by definition have already become victims of a violation of their right to work, in that the United Kingdom has failed to perform international obligations arising from the ICESCR.

13. Further to #6 it is submitted that Talmon is distinguishable and can be disapplied because the claimant in that case had put restrictions on his availability for work which are, in any circumstances, fanciful. Employment is not “suitable” if its terms and conditions derogate from the ICESCR, in particular Article 7.

14. In so far as the public interest is opposable to any of the rights asserted in this submission, it was held in de Freitas v Permanent Secretary of Ministry of Agriculture, Fisheries, Lands and Housing [1999] 1 AC 69, 80, the Privy Council, drawing on South African, Canadian and Zimbabwean authority, defined the questions generally to be asked in deciding whether a measure is proportionate: “whether: (i) the legislative objective is sufficiently important to justify limiting a fundamental right; (ii) the measures designed to meet the legislative objective are rationally connected to it; and (iii) the means used to impair the right or freedom are no more than is necessary to accomplish the objective.”

By a recent modification of the “De Freitas” principle, public authorities must strike a fair balance between the rights of the individual and the interests of the community, taking care to assess the severity and consequences of a measure. (Huang v Secretary of State for the Home Department [2007] UKHL 11 at [19]).

Prepared by Michael Petek, (Barrister), 09-02-2010 for Brighton Unemployed Center