The fakery and failure behind the DWP’s new ‘health’ scheme

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It seems that the Department for Work and Pensions is sticking to the ‘Adolf Hitler’ model of public relations: If you tell a big lie and repeat it often enough, people will believe it. The press release announcing the new ‘Health and Work Service’ is riddled with long-debunked old lies – and one new statement that deserves our scrutiny.

This is the press release used by the BBC in its article on Saturday, telling us that the new, privately-run service is needed to combat the high cost of long-term absence from work.

It seems to be the DWP’s new practice to pass announcements to – let’s call them “trusted” – media outlets before putting them up on the government’s own press website, as a kind of test-run, allowing any credibility problems to be fixed before the government commits itself in an official way.

That’s why the announcement appeared on the government website yesterday (Monday) – two days after the BBC broke the story. Now – in just half the time it took to appear – let’s look at why it’s a load of rubbish.

“As many as 960,000 employees were on sick leave for a month or more each year on average between October 2010 and September 2013, the government has revealed,” the document begins.

Oh really? The DWP reached this figure by applying the findings of a survey, showing the ratio of long-term absences to total days of sickness absence, to findings by the Labour Force Survey showing the total number of days of sickness absence in the UK. That’s 9,000 sick days and 70 absences, applied to an average of 120 million sick days per year. This is based on 2,019 interviews with employees. There’s just one problem.

At the time covered by these surveys, there were around 4.9 million private sector employers.

Considering the huge size difference between the sample surveyed and the body it represents, it seems unlikely in the extreme that the figure is accurate. If it is right, it would be by luck; it’s probably wrong. The figure might as well have been made up – and you should treat it as though it was.

“The government has already taken big steps in getting people on long-term sick benefits back into work as part of the government’s long-term economic plan, with almost a quarter of a million coming off incapacity benefits since 2010-” Let’s stop there and examine the information content of this sentence so far.

The “government’s long-term economic plan” is a phrase that is being shoe-horned into every press release possible and means nothing. There never was a “long-term economic plan”, and there isn’t one now. Have you seen it? Of course not – it doesn’t exist. This is just a comforting nonsense inserted to lull people into false security that somebody knows what they are doing; I suspect the newly-privatised “nudge” unit may have had something to do with this.

As for “almost a quarter of a million coming off incapacity benefits since 2010”, check out this interview with Iain Duncan Smith, published in the Telegraph & Argus in 2010. He said: “I intend to move 1.5 million off incapacity benefit by 2014.”

It’s now 2014. We don’t have up-to-the-minute figures but on November 13 last year, the DWP press office helpfully tweeted us its then-current figure for people moving off incapacity benefits in a handy chart: 156,000.

That is a long way from a quarter of a million, and only around one-tenth of the Secretary-in-a-State’s 2010 target.

“- and almost a million who put in a claim actually have been found fit for work.” This is a bare-faced lie. It relates to a statement that 980,400 people were judged capable of work between 2008 and March 2013, but there are two problems with this. Firstly, it does not take into account the number of successful appeals against the ‘fit for work’ judgement (125,700); when adjusted to account for these, the total drops to 854,700. Secondly, this refers to the cumulative number of ‘fit for work’ outcomes of initial functional assessments since October 2008, and it seems likely that many people will have made repeat claims after being knocked off-benefit by an adverse decision. We do not know how many people have done this. Therefore the figure is meaningless.

So far, the DWP has told us that working people get sick (no surprises there), that it has failed to reach its target for clearing people off incapacity benefit and that its work capability assessment system is failing to push as many off-benefit as it should, because it is riddled with errors.

How does this connect with the creation of a new ‘Health and Work Service’, dedicated to ensuring that people who spend more than four weeks at a time off work with an illness get back into their job with a minimum of difficulty?

It’s obvious, isn’t it?

This is a scheme to ensure that people are discouraged from claiming incapacity benefits; the idea is that a drop in new claims, coupled with the number of uncontested ‘fit for work’ decisions, might lead to a larger drop in the number of active claims – which means the amount of money being paid out in benefits would also drop.

Inclusion of the word ‘health’ in the title of the new service is misleading, as it seems unlikely that consideration of an employee’s physical condition will have anything to do with the aim of the exercise.

Look at what the release has to say: “The Health and Work Service will offer a work-focused occupational health assessment and case management to employees in the early stages of sickness absence.”

It continues: “The work-focused occupational health assessment will identify the issues preventing an employee from returning to work and draw up a plan for them, their employer and GP, recommending how the employee can be helped back to work more quickly.”

Health doesn’t get a look-in.

No, what we’re most probably seeing is an expansion of the “biopsychosocial” method employed in work capability assessments, in an attempt to convince sick people that their illnesses are all in their minds. Don’t expect this approach to be used for people with broken limbs or easily-medicated diseases; this is for the new kinds of ‘subjective illness’, for which medical science has not been prepared – ‘chronic pain’, ‘chronic fatigue syndrome’, fibromyalgia and the like.

People with these conditions will probably be sent back to work – with speed. Their conditions may worsen, their lives may become an unending hell of pain and threats – I write from experience, as Mrs Mike spent around two years trying to soldier on in her job before finally giving up and claiming her own incapacity benefits – but that won’t matter to the DWP as long as they’re not claiming benefits.

That is what we can all expect from the new ‘service’.

It will be a fake, necessitated by failure.

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Here’s why Labour needs to go a lot further to win back our trust

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Anne McGuire, Association of British insurers, Atos, back-up plan, benefit, benefits, biopsychosocial, capita, Chronic Fatigue Syndrome, Chronic Pain, condition, Conservative, dead, death, degenerative, Democrat, Department for Work and Pensions, die, disability, Disability Living Allowance, disabled, DLA, doctor, DWP, Ed Miliband, Employment and Support Allowance, ESA, fibromyalgia, George Engel, government, health, illness, Incapacity Benefit, income protection, insurance, Labour, Liam Byrne, Lib Dem, Liberal, Lord Freud, Lyme disease, Mike Sivier, mikesivier, Mo Stewart, Multiple Sclerosis, New thinking on the welfare state, people, Peter Lilley, policies, policy, politics, Reform, sick, social security, Star Wars, Steve Webb, subjective, Tories, Tory, unemployment, unum, Vox Political, WCA, welfare, work, work capability assessment, workplace

Only days after Ed Miliband announced a Labour government would sack Atos, the party’s conference is hosting an event part-funded by the architects of the ‘work capability assessment’ administered by that company – the criminal American insurance giant Unum.

‘New thinking on the welfare state’ is a fringe event taking place at the Labour conference on Monday, September 23, organised by the right-wing thinktank Reform (which has Unum as one of its funders) and sponsored by the Association of British Insurers (which includes Unum among its members). Does anybody doubt that it has been arranged in order to give Unum a chance to influence high-ranking party members? No?

Then consider: This is a private round-table policy seminar, staged by Anne McGuire MP. Rank and file Labour members aren’t invited – attendance is by invitation only. Can you smell a rat? Still no?

The event has already been staged at the Liberal Democrat conference (by Steve Webb MP, whoever he is), and will also be a feature of the Conservative Party conference, courtesy of that turncoat floor-crossing slime Lord Freud. It shouldn’t take a genius to work out that Unum wants to ensure that all three parties have the same social security/welfare policy, going into the next election – and that Unum continues to figure prominently in the formulation of that policy.

If you didn’t smell a rat infestation before, by now you’re probably wondering why pest control hasn’t been called.

Ed Miliband knows that any change of the organisation administering work capability assessments is purely cosmetic; the Conservative-led Coalition itself is bringing in other companies to carry out the work, and Capita has already been taken on to carry it out in some areas.

It is the policy itself that must change.

Unum knows all about that policy. The company came up with it in the 1990s as a way to combat claims on its health insurance policies for ‘subjective’ illnesses such as ‘chronic pain’, ‘chronic fatigue syndrome’, fibromyalgia, multiple sclerosis, Lyme disease and others – by aggressively disputing whether a claimant was ill.

It based its new test on the Biopsychosocial Model of illness developed by the psychiatrist George Engel, which is itself an unproved theory. Unum removed the bio- and -social aspects in order to concentrate on the ‘psycho’ – the claim that a person’s illness is all in their mind; that they are imagining it.

This worked very well for the company until the American people realised that they were being diddled out of their insurance money and very large lawsuits were launched that ended with the company having a criminal record in several US states.

Undaunted by this, Unum branched into the UK and cosied up with then-social security minister Peter Lilley, who wanted to cut the number of people claiming disability benefits. Unum saw an opportunity here, with a long-term goal of making state disability benefits useless to the British citizen and forcing them to pay out for the companies duff health insurance policies – which had already fallen foul of the law in America.

That’s why the work capability assessment takes precedence over any evidence your doctor might provide to support your claim, and it’s also why doctors are being actively discouraged from providing any evidence at all; that’s why UK law currently sees a glowing future for people who may be paralysed, but for one finger, as a button pusher; that’s why people with Parkinson’s Disease or other degenerative conditions are being told they will be able to work again in the future; and that’s why thousands upon thousands of people have died as a result of the current policy – especially since the Conservative-led Coalition came into office in 2010.

Meanwhile, Unum has begun a mass-marketing campaign to encourage able-bodied British citizens to invest in ‘Income Protection Insurance’ and a scheme known as the ‘Back-up Plan’. These are only available via the workplace, and it is understood that it has been designed to ensure that the company can resist paying out if anybody should be unlucky enough to have to make a claim.

So you see, the plan is to leave the sick and disabled of this country with no support whatsoever; they can either take out Unum’s insurance policies, pay the company a fortune in premiums and get nothing in return – or they can throw themselves at the mercy of a state which has no mercy and be refused the benefits for which their taxes have been paying ever since they were old enough to pay taxes in the first place.

Either way, Unum wins. For younger readers, it’s like the plot of the prequel trilogy in the Star Wars saga, where the character who becomes the Emperor engineers a war in which he controls both sides. So you see? Those films weren’t as bad as we all thought.

But of course, any person or organisation that intentionally creates a parallel between itself and the most evil character in recent fiction should absolutely not be anywhere near the real-life political decision-makers of this or any other country.

That’s why Mo Stewart, the retired healthcare professional and disability researcher who has spent four years examining the relationship between Unum and the UK government, has contacted Ms McGuire, demanding to know why she is having anything to do with the firm.

She wrote: “Given the amount of evidence against the practice of the dangerous corporate giant, Unum Insurance, and the fact that Labour MPs have exposed their influence with government during debate, the British disabled community are wondering why you would chose to host a fringe meeting by Unum at the conference on Monday?

“‘New Thinking on the Welfare State’ it seems is the title of the meeting, and they should know since Unum have been helping to systematically destroy the welfare state, as welcomed by various governments, since 1994.

“If you were planning to cause offence, you couldn’t have done a better job.

“Keep betraying the British disabled people and you’ll be waiting in the wings for a lot longer before Labour ever return to Government.

“I have spent the past 4 years exposing the links between the DWP, Atos Healthcare & UNUM Insurance. Some of your colleagues are very familiar with my work, which is to be considered by the UN within weeks, and I suggest that if you wish to be taken seriously as the Shadow Minister for Disabled People then you need to be familiar with this evidence.”

This blog wholeheartedly supports Mo Stewart’s position.

If you want to add your support, you can contact Anne McGuire by emailing anne.mcguire.mp@parliament.uk – and you might wish to include Ed Miliband and Liam Byrne (while he’s still there): ed.miliband.mp@parliament.uk and byrnel@parliament.uk

If you’d like to do more, feel free to broadcast that facts about Unum as widely as you can. There seems to be a media blackout on mention of this criminal organisation’s involvement with the state, so you cannot rely on the national news media. This means word of mouth – viral networking – is the only alternative.

Spread the word.

Oh, and Ed? Mr Miliband? We’ll all be waiting for you to make a slightly more solid commitment to the British people. You know what it is because we’ve made it perfectly clear already:

New policies on sickness, disability and incapacity benefits that are humane to claimants and rely on real medical evidence – not the opinions of an unqualified ‘decision-maker’ at the DWP.

Expel Unum from any position in which it may influence the government – including fringe events at party conferences. This may mean dismantling the DWP altogether as that organisation appears to have been terminally compromised.

End the work capability assessments. Find a different way to assess people’s ability to work – perhaps one that involves knowledge of what jobs are available and whether employers have any intention to take on people with limited abilities… Something practical, rather than the dribble that masquerades as current government policy.

And, for goodness’ sake, get rid of Byrne (and McGuire… and let’s not forget Stephen Timms) and replace them with backbenchers who actually understand and sympathise with the plight of benefit claimants who have been made to suffer under a needlessly brutal system.

You don’t dare betray the British people again.

If you do, you’ll have more than eggs to dodge, whenever you dare show your face in public.

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

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All Work Test, appeal, Atos, benefit, benefits, biopsychosocial, Cardiff University, Centre, CFS, chief medical officer, Chronic Fatigue Syndrome, Chronic Pain, Coalition, Conservative, Department, Department for Work and Pensions, descriptor, disability, disabled, doctor, DWP, Employment and Support Allowance, ESA, fibromyalgia, fit for work, George Engel, government, health, Helen Goodman, House of Commons, IBS, Irritable Bowel Syndrome, John LoCascio, Kate Green, Labour, Liberal, Liberal Democrat, LIMA, Logical Integrated Medical Assessment, Lyme disease, Mansel Aylward, ME, Mike Sivier, mikesivier, Multiple Sclerosis, Myalgic Encephalomyelitis, New Labour, Parliament, Pathways, Pensions, people, Personal Capability Assessment, politics, Professor, Psychosocial, Research, sick, Tories, Tory, unemployment, unum, UnumProvident, Vox Political, WCA, welfare, work, work capability assessment

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.