‘Compassionate’ Conservatism’s three ‘R’s – reading, writing and… rickets?

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Painful deformities of the skeleton such as bowed legs: The return of rickets is another sign that the Conservative-led government is regressing Britain to conditions during the primitive Victorian era – or even earlier.

David Cameron’s quest to bring the Victorian era back to life in the 21st century reached a new milestone this week when the UK’s chief medical officer formally announced the return of a disease long thought banished from these shores: Rickets.

The announcement brings to fruition a prediction made by Vox Political almost a year ago, when we said: “As a consequence of the rise in poverty, overseen and orchestrated by Mr Cameron and his lieutenant Iain Duncan Smith in the Department for Work and Pensions, the classic poverty-related diseases of rickets and tuberculosis are on the increase.”

According to the NHS Choices website, rickets “is a condition that affects bone development in children. It causes the bones to become soft and malformed, which can lead to bone deformities.

“The most common cause of rickets is a lack of vitamin D and calcium. Vitamin D comes from foods such as oily fish and eggs, and from sunlight on our skin. Vitamin D is essential for a child to form strong and healthy bones.

“Rickets causes the bones to become painful, soft and weak. This leads to deformities of the skeleton, such as bowed legs, curvature of the spine and thickening of the ankles, wrists and knees.”

The disease was thought to have been eradicated in the UK but, in a damning indictment of modern political priorities, chief medical officer Dame Sally Davies has admitted that 40 per cent of our children – that’s two-fifths of all the children in the country – now have some kind of vitamin D deficiency. Current figures for full-blown rickets are not available.

“The disease was common in Victorian England, but largely disappeared from the Western world in the latter half of the 20th century thanks to vitamin D being added to everyday foods such as margarine and cereal,” stated a report in The Independent. “There has been an observed rise in cases in recent years.”

Can there be any doubt that this rise in cases has been brought about, not just by children sitting at home playing video games rather than going out in the sunlight, as some would have us believe, but because increasing numbers of children are having to make do with increasingly poor food, as Cameron’s policies hammer down on wages and benefits and force working class people and the unemployed to buy cheaper groceries with lower nutritinal value?

The Tory wage-crushing policy has been ignorant in the extreme, according to Dame Sally’s report, as it has created an extra burden on the NHS. Preventative measures “could save the economy billions”.

Dame Sally’s report is entitled ‘Our Children Deserve Better’ – echoing Ed Miliband’s Labour conference mantra, “Britain can do better than this” – and sets out recommendations to tackle urgent problems, such as a universal handout of vitamin supplements to all children under five for vitamin deficiencies, and measures to handle rising child obesity and a lack of effective mental health services.

The neglect created in our health system by more than three decades of neoliberal political rule has had a devastating effect on the nation’s children. According to Dame Sally, while our mortality rate for 0-14 year olds was among the best in Europe during the 1980s, it is now among the worst, with five more children dying every day than in the best-performing country, Sweden.

The highest death rates are in deprived areas – in the northwest, northern cities and some of London’s poorer boroughs, with 21.1 deaths per 100,000 people under 17.

Dame Sally said: “I think this is something, as a country, we should feel profoundly ashamed about – I do.”

Do you think Health Secretary Jeremy Hunt feels ashamed, as he cuts NHS budgets and hives off huge care contracts to profit-making private companies?

No?

Nor should you.

The Vox Political article from December last year also claimed tuberculosis would return, and our report this week on the government’s plan to tackle the phantom problem of “health tourism” seems to demonstrate that it is hell-bent on ensuring that this comes true as well.

Our report earlier this week quoted the chair of the Royal College of GPs, Claire Gerada, who has warned that the cost of administrating the new system could outweigh the savings, while also increasing public health problems such as TB by deterring temporary migrants from seeking treatment when they first fall ill.

In the Bible, Jesus is quoted as saying, “Suffer little children to come unto me, and forbid them not” – meaning he did not want his disciples to stop youngsters from hearing his teachings.

That saying may now be re-worked to fit the philosophy of David Cameron and Jeremy Hunt to read: “Suffer, little children – for you have a Conservative government.”

Unum, Atos, the DWP and the WCA; Who gets the blame for the biopsychosocial saga?

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Mansel Aylward, former chief medical officer at the Department of Work and Pensions, now director of the (UnumProvident) Centre for Psychosocial and Disability Research at Cardiff University: Architect of misery?

If we know anything at all about the Work Capability Assessment for sickness and disability benefits, we know that it doesn’t work. In fact, it kills. There is a wealth of evidence proving this, and if any readers are in doubt, please take a look at the other article I am publishing today, MPs tell their own Atos horror stories.

Much has been made of this fact, without properly – in my opinion – addressing why it doesn’t work. The apparent intention is an honourable one – to help people who have been ‘parked’ on disability benefits back into work, if it is now possible for them to take employment again, and to provide support for those who cannot work at all. What went wrong?

Let’s start at the beginning. The WCA is, at least nominally, based on the biopsychosocial model developed by George Engel. He wanted to broaden the way people think about illness, taking into account not only biological factors but psychological and social influences as well. He contended that these non-biological influences may interfere with a patient’s healing process.

The idea has been developed to suggest that, once identified, the non-biological factors inhibiting healing would be neutralised via a variety of support methods. Stressful events in a person’s life or environmental factors are acknowledged as having real effects on their illness, and it can be seen that this confers a certain amount of legitimacy on symptoms that are not currently explainable by medicine.

Engel stated, in 1961, “Many illnesses are largely subjective – at least until we as observers discover the parameters and framework within which we can also make objective observations. Hyperparathyroidism… was a purely subjective experience for many patients until we discovered what to look for and which instruments to use in the search.” He also warned that people engaged in research should “see what everyone else has seen and think what nobody else has thought” – as long as they don’t automatically assume that their new thought must be correct.

The Engels theory forms the basis of the system of insurance claims management adopted by US giant Unum when its bosses realised that their profits were being threatened by falling interest rates – meaning the company’s investments were losing value – and a rise in claims for “subjective illnesses” which had no clear biological markers – Myalgic Encephalomyelitis (ME), also known as Chronic Fatigue Syndrome (CFS), Fibromyalgia, Chronic Pain, Multiple Sclerosis, Lyme Disease, even Irritable Bowel Syndrome (IBS).

As I wrote on Wednesday, Unum adapted the biopsychosocial model into a new medical examination that stripped it of its ‘bio’ and ‘social’ aspects in order to concentrate on the ‘psycho’ – with a relentless emphasis on an individual claimant’s beliefs and attitudes.

The new test aggressively disputed whether the claimant was ill, questioning illnesses that were “self-reported”, labelling some disabling conditions as “psychological”, and playing up the “subjective” nature of “mental” and “nervous” claims.   The thinking behind it was: Sickness is temporary. Illness is a behaviour – all the things that people say and do that express and communicate their feelings of being unwell. The degree of this behaviour is dependent on the attitudes and beliefs of the individual, as well as the social context and culture. Illness is a personal choice. In other words: “It’s all in the mind; these people are fit to work.” (as I mentioned in When big business dabbles with welfare; a cautionary tale)

Already we can see that this is a perversion of Professor Engel’s theory, using it to call an individual’s illness into question, not to treat it. Yet this is the model that was put forward to the Department of Social Security (later the Department of Work and Pensions) by its then-chief medical officer, Mansel Aylward, in tandem with Unum’s then-second vice president, John LoCascio.

Together they devised a new ‘All Work Test’ that would not actually focus on whether an individual could do their job; instead it would assess their general capacity to work through a series of ‘descriptors’. Decisions on eligibility for benefit would be made by non-medical adjudication officers within the government department, advised by doctors trained by Mr LoCascio. Claimants’ own doctors would be marginalised.

When New Labour came to power, Mansel Aylward was asked to change the test to reduce the flow of claimants with mental health problems. In came the ‘Personal Capability Assessment’, which again focused on what a person was able to do and how they could be supported back into work.

It is at this point that US IT corporation Atos Origin (now Atos Healthcare in the UK) became involved. The task of administrating the PCA was contracted out to a company which was taken over by Atos, meaning its employees – who had no medical training – could now assess claims for sickness and disability benefits, using the company’s Logical Integrated Medical Assessment tick-box computer system. These evaluations proved unreliable and the number of successful appeals against decisions skyrocketed.

So in 2003 the DWP introduced ‘Pathways to Work’, in which claimants – now labelled ‘customers’ – had to undertake a work-focused interview with a personal advisor. If they weren’t screened out by the interview, they would go on to mandatory monthly interviews where they would be encouraged to return to work and discuss work-focused activity. I can assure readers, from personal experience with Mrs Mike, that this activity remains a prominent part of the DWP’s sickness and disability benefit policy.

Mansel Aylward is no longer at the DWP, though. In 2004 he was appointed director of the UnumProvident Centre for Psychosocial and Disability Research at Cardiff University (it has since dropped the company title from its name). Was this as a reward for services rendered in getting Unum and its practices into the heart of the UK government?

Let’s have a look at some of the ‘descriptors’ that are being used to determine a claimant’s – sorry, customer’s – fitness for work in what is now called the ‘Work Capability Assessment’. I am grateful to Helen Goodman, Labour MP for Bishop Auckland, who provided this information during yesterday’s debate on the Atos WCA in the House of Commons. She said a person who…

“Cannot mount or descend two steps unaided by another person even with the support of a handrail”;

“Cannot, for the majority of the time, remain at a work station, either…standing unassisted by another person…or…sitting…for more than 30 minutes, before needing to move away in order to avoid significant discomfort or exhaustion”

“Cannot pick up and move a one litre carton full of liquid”;

“Cannot use a pencil or pen to make a meaningful mark”;

“Cannot use a suitable keyboard or mouse”;

“Is unable to navigate around unfamiliar surrounding, without being accompanied by another person, due to sensory impairment”;

“Is at risk of loss of control leading to extensive evacuation of the bowel and/or voiding of the bladder, sufficient to require cleaning and a change in clothing, not able to reach a toilet quickly”;

“At least once a month, has an involuntary episode of lost or altered consciousness resulting in significantly disrupted awareness or concentration”;

“Has an epileptic fit once a fortnight”;

“Cannot learn anything beyond a simple task, such as setting an alarm clock”;

“Has reduced awareness of everyday hazards leading to a significant risk of…injury to self or others; or…damage to property or possessions such that they frequently require supervision”;

“Cannot cope with minor planned change” such as a change to lunchtime;

“Is unable to get to a specified place with which they are familiar, without being accompanied by another person”

… is “fit for work”.

A person in the following category is also deemed fit for work, if: “Engagement in social contact with someone unfamiliar to the claimant is always precluded due to difficulty relating to others or significant distress experienced by the individual.”

Kate Green, Labour MP for Stretford and Urmston, added: “My constituents told me categorically last week that they believe that the whole system was deliberately designed and operated to trick them — to make them incriminate themselves and to catch them out.

“They firmly believe that the system is deliberately designed, not to assess and then help them into work if they are fit for it, but simply to stop paying benefits wherever possible.

“There are far too many instances of trickery and misleading people and of distorting what they have done, said and reported and drawing conclusions from that. That is happening far too often.

“It is an absolute disgrace that we should run a public assessment process in such a discredited way.”

It seems to be a result of Professor Aylward’s work that the main influence on government welfare reform has been a perversion of a perversion of a theory that has not been shown to work. Authentic evidence is disregarded by those in power, who clearly continue to persecute the sick while feeding the profits of private concerns.

I wonder what he would have to say, if he were to be confronted by the evidence of what his policies have done to the sick and disabled of this country – as spelled out, in the House of Commons, by MPs from many parties.

Afterthought: It should be noted that Professor Aylward is on record as having expressed doubts about the Work Capability Assessment and the current system, as run by the government, with the caveat that he has not been involved for several years.

He told the Black Triangle Campaign: “I will make myself aware … but I think that I’m a man of integrity … and if I think that the Work Capability Assessment … test or whatever … is not proper … I will speak out against it.”

In the light of what happened while he was at the DWP, I leave it to readers to judge whether he will.