Are these the men who would be king?

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Unelected rulers? Thomas Watjen of Unum, Thierry Breton of Atos, and Michael Andrew of KPMG. As things stand, it seems whoever you support in 2015, these people will be behind them. Do you want that?

There is a certain kind of person who takes great delight in commenting on political blogs with a variant of the following:

“It’s no use voting! They’re all the same! It doesn’t matter what you vote for – a politician always gets in!”

No doubt you’ll be familiar with their work.

They are extremely annoying. Their insistence that all politicians are the same breed of pond scum does a huge disservice to those in public service who genuinely want to improve the lives of their fellow human beings; the fanaticism with which they disseminate their opinions may be seen as an attempt to stop ‘casual’ voters from bothering, thereby condemning the country to the current status quo.

Also, most annoyingly of all, they may have a point.

Take the three men pictured above. The one on the right is Michael Andrew, chairman of accounting firm KPMG. This is one of the ‘Big Four’ accountancies who are, among other things, involved in rewriting UK tax law for George Osborne at the Treasury, partly to suit their own desires as architects of the largest tax avoidance schemes currently available to corporations and wealthy individuals resident in the UK.

Today, thanks to an illuminating blog article by Tom Pride over at Pride’s Purge, we learn that KPMG has taken over the running of no less than a quarter of all the clinical commissioning groups (CCGs) that Andrew Lansley swore blind would be run by doctors when the Conservative-led Coalition government pushed through the NHS Privatisation Act of 2012 (otherwise known as the Health and Social Care Act).

The pretext for creating these organisations was that doctors were in the best position to commission health services in any part of England, as they had the detailed knowledge required to determine what was needed.

In fact it was well known that GPs would not be able to carry out this important work – it would be too much for them to take on in addition to their ‘day job’, and they simply did not have the necessary skills. Lansley knew this, and therefore knew that his law would open the door for private firms to take over.

This is borne out by an article in GP online which is now almost a year old; so readers should bear in mind that the current situation may be much further advanced. It stated that KPMG had confirmed the firm was working with “just over 50” of the 211 CCGs in England, along with 11 commissioning support units (CSUs).

The article indirectly quoted Tim Rideout, who said CCGs did not have the capacity to commission in an effective way.

This is an interesting revelation from the former chief executive of the NHS in Leicester City who was then seconded to the Department of Health as the senior responsible officer for the development of – guess what? – NHS commissioning boards. If the new commissioning groups don’t have the capacity to work properly, why didn’t he do something about it at the appropriate time?

Oh, wait. Here’s the answer: In March 2012, Mr Rideout was hired by KPMG as an associate director responsible for – who would have thought it? – commissioning.

In the same article, national clinical commissioning lead for England, Dr James Kingsland, said clinicians and GPs should not be involved in complex procurement, and added: “We are seeing a lot of misunderstandings, disillusionment and despondency.”

Mark Britnell, KPMG’s head of healthcare since 2009 – and another former NHS chief executive, was quoted by The Observer in 2011 as stating: “In future, The NHS will be a state insurance provider not a state deliverer”, and that “The NHS will be shown no mercy and the best time to take advantage of this will be in the next couple of years.”

The following day, KPMG released a statement in which he said the quotes did “not properly reflect” what he had said.

So we have a firm moving to take over CCGs, helped by the fact that its roster now includes the man responsible for setting them up in the first place. Going back to Tom Pride’s piece, he states that the situation chillingly reflects the way the Dutch health service was privatised in 2006. Provision of health services is being handed over to private companies, control of the health budget was handed over to private consortia made of doctors and consultants, but now those consortia are being taken over by private companies.

When private firms like KPMG run all CCGs, the Conservative plan to privatise the NHS will be complete. And the NHS, it seems, will be run by Michael Andrew, head of KPMG, from his base in Hong Kong.

But the rot doesn’t stop there.

Tom Pride correctly adds that the consulting arm of KPMG has been owned, since 2002, by another company – called Atos.

That’s right – Atos. The French firm run by Thierry Breton (pictured, centre).

The firm that Ed Miliband wants to fire from running work capability assessments for the DWP will still be involved in government work – at the Department of Health.

You see how this works? Let a private company inveigle its way into the plans of politicians and there’s no getting rid of it. Like the giant squid, it extends its pseudopods into every government department it can possibly contaminate, planting a sucker onto everything it thinks it can take for itself.

Over at the DWP, as everyone should know by now, Atos have been carrying out work capability assessments on claimants of Employment and Support Allowance. These were dreamed up by an insurance company called Unum, that has been working with the UK government – Conservative, Labour and Coalition – since Peter Lilley invited then-boss John LoCascio in, back in the early 1990s.

Unum is now run by Thomas Ratjen (pictured, left), who is based in Tennessee, USA. Its long-term aim seems to be the ruin of the British social security system, rendering it pointless for anyone to claim benefits. Instead, the plan appears to be to encourage working people to buy Unum insurance policies – which are themselves useless, as lawsuits in several US states have proved, while also giving the company a criminal record.

This blog recently revealed that it seemed Unum was trying to influence the policies of all three main UK political parties. The thinktank Reform, that has been part-funded by Unum, is running a fringe event at all three party conferences, entitled ‘New thinking on the welfare state’. This event was sponsored by the Association of British Insurers, which has Unum among its members.

Labour’s version of this event took place on Monday (September 23), hosted by Anne McGuire, shadow minister for disabled people.

She defended her role in an email today, as follows:

“I don’t know why you have been led to believe that I was hosting an event by Unum. For the record, I was speaking at a round table discussion with organisations which included the European Commission, voluntary organisations, insurance companies amongst others. As it was such a conversation, it was by invitation only as was the event I attended this morning organised though the Shaw Trust and Mencap. It is not unusual to have such events at party conference.

“I also spoke at an open meeting last night on the future of welfare reform and disabled people with many disabled people in attendance and participating.

“I am aware of the strong feelings on Unum and Atos. However I trust that you will appreciate that having discussions with a range of organisations should not be seen as anything other than that and in no way implies an endorsement of any particular company or organisation.”

It simply doesn’t ring true.

Let’s look at the context: This event was organised by a right-wing thinktank (they’re ideologically opposed to state-run social security systems) that has been sponsored by Unum; was about “new” thinking on the welfare state; was itself sponsored by the Association of British Insurers, of which Unum is a member; and representatives of insurance companies – and we’re willing to bet Unum was among them – took part in the behind-closed-doors discussion.

It seems clear that this event was intended to influence Labour Party policy away from providing a well-run and reasonable state benefit system, as was the case in the UK until Peter Lilley in the early 1990s, and towards dismantling that system to make way for a system based on privately-run insurance policies, such as those produced by Unum.

The fact that it is being mirrored at the other two party conferences clearly suggests that the firms involved want to influence all major British political parties in the same way. If successful, this would mean that it won’t matter who gets into office after the 2015 election; Unum will still be in power at the Department for Work and Pensions.

Just as KPMG will still be in power at the Treasury, and at the Department of Health, alongside its owner Atos.

And the three gentlemen pictured at the top of this article will be the unelected kings of the UK because, no matter which way you vote, they will be in charge.

Well now.

That would be a good place to end this article, but then, dear reader, you might be left thinking there is nothing you can do. There is something you can do.

You can write to your MP, to local newspapers, to the party leaders and the ministers running these government departments and you can bitch like hell about it!

The people of this country deserve elected representatives who are going to run this country by their own decisions, in the best interests of the citizens who voted for them – not employees of a dubious gang of unelected corporations, running this country in their own best interests and treating the citizens like dirt.

You can make a difference.

But you need to start now.

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.

When big business dabbles with welfare; a cautionary tale

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Atos, benefit, benefits, biopsychosocial, chronic, Coalition, Conservative, Department for Work and Pensions, descriptors, disability, Disability Living Allowance, disabled, DLA, DWP, Employment and Support Allowance, ESA, fatigue, fibromyalgia, Francesca Martinez, Frank Field, government, health, Incapacity, Incapacity Benefit, Jack Gilligan, John LoCascio, Labour, Liberal, Liberal Democrat, Lyme disease, Mike Sivier, mikesivier, model, Multiple Sclerosis, New Labour, pain, people, Peter Lilley, PIP, politics, sanctions, sick, syndrome, Tony Benn, Tony Blair, Tories, Tory, unum, Vox Political, WCA, welfare, work capability assessment

“Jack Gilligan, who was the Democratic governor of Ohio… said ‘You know there will never be democracy in America when big business can buy both parties and expect a pay-off, whichever one wins. And you know, a touch of that may possibly have spread in this direction.” Tony Benn.

I have been researching the relationship between US insurance giant (and lawbreaker) Unum and successive UK governments – Conservative, New Labour and Coalition – and the minimal research I have managed so far tells me that, if there’s one thing the Labour Party needs to do to ensure its electability in 2015, that thing is the expulsion of Unum and all private insurance firms, their subsidiaries, partner companies, and people who have worked with or for them, from any position of influence. Kick them right out!

Any government that fraternises with these vampires puts corporate profits above the well-being of its citizens. That is clear from what I have read. I want to go into certain aspects in detail, but before that, you deserve to know the details, so I’ve written a little story for you:

Once upon a time, a big insurance company had a little problem. It had been making money hand-over-fist by investing people’s premiums in high-interest portfolios, but interest rates were falling and new kinds of ‘subjective illness’ had arisen, for which medical science was not prepared – ‘chronic pain’, ‘chronic fatigue syndrome’, fibromyalgia, multiple sclerosis, Lyme disease.

The solution devised by the bosses was to reduce the number of successful claims it paid out, by aggressively disputing whether the claimant was ill. So the company skewed its medical examinations to its own favour by questioning illnesses that were “self-reported”, labelling some disabling conditions as “psychological”, and playing up the “subjective” nature of “mental” and “nervous” claims.

“Sickness is temporary,” they said. “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”.

Around the same time, a small country had a big problem with people claiming out-of-work benefit because they were ill. This was not a problem because they were lying about being ill – fraud amounted to less than one per cent of claims. Nor was it a problem because too many people were claiming – benefit levels were among the lowest of any countries nearby, and claims were on a par with those other countries.

No, the problem was that the man running the system, whose name was Peter**, wanted to make money out of it.

So he hired the boss of the big insurance company, whose name was John***, and asked him to help out. John said, “We have a great test that you can use! Instead of asking whether someone can do their job, you assess their general capacity to work, with a series of – we call them – descriptors. One could say the person ‘Is unable to cope with changes in the daily routine’, ‘Is frightened to go out alone’. Then the results get passed on to different people – adjudication officers – who judge whether they deserve your benefit. But the clever bit is that these officers aren’t doctors – the customer might be saying they’re sick but medical evidence has nothing to do with what the test is about! We’ll train your adjudicators – for a price. We’ve even got a sexy name for the test: It’s bollocks!”*

Off went Peter to try it and, lo and behold! The rise in claimants came to a halt, as if by magic. But it wasn’t magic. It was bollocks.

Meanwhile, the insurance company was making out like a bandit. Not only was it now at the heart of the small country’s government, it was able to make money from the claimants as well. Before the new rules came into effect, it advertised for customers, saying the new system meant “if you fall ill and have to rely on state incapacity benefit, you could be in serious trouble!”

Before long, the big insurance company found it was even bigger, with a quarter of all its post-tax income being paid by people in the small country.

Meanwhile, back at home, people had started to complain about the big company. It was a big, NASTY company, they said, because it had forced them to accept less when they claimed than their policies offered. The government there found that the big company had relied too much on in-house professionals; had constructed doctors’ or examination reports unfairly, for its own benefit; had failed to evaluate claimants’ conditions in their totality; and had placed an inordinate burden on claimants to justify why they should receive the benefits for which they had paid. Many claims were found to need re-examination.

That did not make a scrap of difference to the people running the sickness benefit system in the small country that had asked for the big nasty insurance company’s help. An election had happened and Peter had been asked to leave, but the new people in charge, Frank**** and Tony*****, were keen to capitalise on what had gone before and transform their welfare system into a new marketplace – a source of revenue, profitability and economic growth.

With help from the big nasty insurance company, they decided that the solution was not to cure the sick – or even to prevent their sickness in the first place – but to convince them that work is therapeutic, aids recovery and is the best form of rehabilitation. In other words, bollocks*. This way, with the help of the big nasty company’s bollocks* tests and adjudicators who based their decisions on bollocks*, they could say the problem was with the person who had the illness. Their behaviour and beliefs became the focus of the government’s moral judgement and action. If they did not change their ways, then sanctions would be used as a “motivational tool” – and people would be starved back into work.

And that, dear child, has continued to this very day! People claiming sickness or disability benefits in the small country, which is called the United Kingdom, have to take a test in which medical evidence plays a tiny role, run by people who are not doctors and judged by people who are not doctors. Many of these decisions have been found to be unfair, and have often been found to have failed to evaluate claimants’ conditions in their totality – which is why people with terminal cancer have been found fit for work. Many claims have been found to need re-examination.

You can see the hand of the big nasty insurance company at work, can’t you!

That is because the big nasty insurance company, which is called Unum, has been at the heart of the small country’s government ever since it was first invited in. And they intend to live happily ever after, at the public’s expense.

“A lot of people think that disabled people don’t have sex, but this is not true, because the government are screwing us hard.” Francesca Martinez, The News Quiz, BBC Radio 4, January 11, 2013.

*I should apologise for the fault in my computer. Every time I try to type – I’ll just cut and paste it in here – “the biopsychosocial model” or any combination of those words, it comes out “bollocks”. Sorry!

**Peter Lilley

***John LoCascio

****Frank Field

*****Tony Blair