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

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?

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.

20 thoughts on “Unum, Atos, the DWP and the WCA; Who gets the blame for the biopsychosocial saga?

  1. Big Bill

    Aylward was indeed confronted by Black Triangle. He said if what they were suggesting to him were indeed the case then it was being used incorrectly in the present assessments.

    1. Mike Sivier

      Yes – isn’t there a video link for it somewhere? I would have looked for it but I was up until 5am today, writing this article and its twin. Couldn’t really see straight by the end of it!

  2. Leslie

    I’m all for people having support to get better, or to be able to lead more full lives, whether that includes a job or not. Whatever the seemingly more humane ‘original’ theory, these tests were set up to construct excuses for ignoring the trained and evidenced opinions of patients’ doctors and justify paying less benefit money to support vulnerable people. Although MPs were thick with the horror stories which have predictably arised from this situation yesterday, no one made the fundamental criticism that the NHS has already spent thousands diagnosing and treating each individual – what the hell is the government doing paying someone else to overturn all that work? A huge proportions of these decisions are overturned at tribunal: 40% of the total, and 80% of cases where the claimant has outside help. What neither the politicians who brought this in, nor the DWP have anticipated, is that tribunal judges would not be as keen to ignore the patients’ own doctors as they are. So now even more money is spent fighting claimants than would be otherwise spent if the DWP coughed up the benefits to begin with. Even if they care little for the huge amount of unnecessary individual anguish and torture this causes, the fact that it doesn’t even do the job of saving public money should give politicians a good reason to throw WCA out entirely.

    You’d never know from this article the pivotal role played by Labour in setting up this system. A far better researched and balanced history can be found here: http://www.compassonline.org.uk/news/item.asp?n=563

    1. Mike Sivier

      I have made my opinion of Labour’s part in the disability debacle known, several times in the past. This article is intentionally NOT about the politicians and the ‘public face’ of what’s happened; I wanted to look at the thinking that informed the decisions that were made, and the main ‘backroom boys’ who influenced them. Sure, you can say Labour played a pivotal role – it certainly played a major one, over the more-than-a-decade New Labour was in power. But then, you could say the Conservatives have played an even greater role – after all, it was the Conservatives who brought Unum into the then-DSS and linked Professor Aylward with Mr LoCascio, and got the whole demolition-ball swinging.

  3. HuwOS

    “The apparent intention is an honourable one..”
    I disagree.
    The stated intention is an honourable one, the apparent intention is a system designed to toss people off disability benefits with little or no interest in the consequences.

    1. Mike Sivier

      When I wrote “apparent”, I meant the intention that, it seems to me, is being put out to the public at large. The announcements made by ministers have all played up the honourable aspects of work to reform disability benefits. I think that, for the public at large, many of whom may not have experience of the disability benefits system, that is the way the system appears. It’s only when you get involved with it that the underlying intention becomes… well… apparent. 🙂

  4. Nancy

    thanks for making it clear who actually designed the WCA, something me and other campaigners have been trying to find out for a long time. Knew it was to do with biopsychsocial theory.

  5. Matt

    imho, the capability tests arent flawed.. at least in perspective to why they were made.. their purpose was to get the disabled off benefits by any means possible.. that makes them wrong.

    these assessments never had “health” in mind.. my guess is if the cons get in for another 5 years there wont be a welfare system AT ALL.. and if there is it will sold out to the private sector.

    its plain and simple asset stripping.. after all when this government got in the economy was growing.. since getting in its tanked and then they have the audacity to blame the government who at least pushed growth in the right direction.

  6. colin

    They dont care. I dont trust the greedy f*ckers as far as i could throw them. The government aren’t stupid thick f*ckers. They know what they were doing. When people stand up and get counted they just laugh at them cos they have well and truly got the people in this country divided. All they will do at the next election is to throw us a bone and the people will be that grateful they will probably vote them back in. All you rich people out there need to know this – not everyone will kill themselves. Some will get hungry enough to come take it off you… I hope you are ready for that.

  7. R J Edge

    I filled in the form for my Wife and confirm Question are framed to elicit a yes answer when it should be no and vice-versa. Each and every question is a trap Beware. I used the website Benefits and work Worth every penny.

  8. Jayarava

    I think this article is pretty useful. It reminds me of the kind of work that Adam Curtis has done in exposing the sources of our ideologies. He pointed out that targets in the NHS trace back to Thatcher employing the man who invented the “Body count” as a measure of the efficiency of war to reorganise the NHS. The results are entirely predictable – a body count. The same with ATOS.

    Some modern ideologies are profoundly alienated precisely because of hardcore materialism is alienating. I’m deeply interested in, and trained in, the empirical sciences. But along with empiricism and rejection of supernatural causes, is often a kind of hard denial of the value of human life: we’re just mechanisms, just selfish genes, just machines. There’s no reason to acknowledge, investigate, or incorporate a faculty like empathy for example into our models of what it is to be human, because it is subjective and ‘soft’.

    When scientists choose models of humanity which eliminate the human from the equations because humans are complex and hard to model they deny our humanity. I think we have to start kicking back at this kind of thinking, not with Romanticism, but with an acknowledgement that empathy is central to humanity.

    Now I don’t think a return to pre-scientific irrational superstition is the answer, but if we’re going to allow these deeply alienated people to design, organise and run our social institutions; to run our countries; then a lot of people are going to be hurt. The rule of the Church may have been brutal, but under the dehumanising effects of modern alienated philosophies such as Neo-Liberalism (with it’s basis in the lunatic theories of John Nash and others) we will see much worse to come. We’re just as much in the grip of non-human centred ideologies as we ever were under the Roman Catholic Church in it’s heyday.

    I’d like to advocate a true humanism. We are naturally gregarious, cooperative and empathetic. Any theory of humanity which denies this is in effect evil because it justifies the opposite: isolation, competition and alienation.

    Articles like this one, that expose the underlying insanity of contemporary theories of humanity, are an important part of the human revolution. Unfortunately the education system in general has long been programming our children to believe in a world view in which they don’t matter. And the elite schools are teaching their students how to take advantage of the situation to control the masses. So I’m rather pessimistic about the future. Nothing has changed since the first days of civilisation.

  9. solinvictacomita

    It is a basic requirement of an fascist policy that it be backed to-the-hilt by some scientific dogma: preferably one which denigrates the subject matter and those the subject matter encompasses. It is of little surprise to me that the Work of Engels should be prostituted thus by Aylward et al. One doesn’t need an MSc in History to know that the work of eminent Geneticists and Eugenicists work was similarly prostituted and distorted beyond all semblance of reality in order to facilitate the persecution, sterilization and eventual mass extermination of German and European Jews. So why does anyone think THIS reliance upon the BioPsychoSocial model of ‘illness and disability’ might not also be used to promote a similar, yet altogether more cowardly and covert policy of ‘Benefits Denial.’ After all, the Coalition can’t just exterminate 2.7 million unemployed can they? No. But they can starve and impoverish a certain number to death: which is what they have done!


    Not the mind of someone who wants to help anyone….

    1. Mike Sivier

      If you’re talking about Prof Engels’ starting-point, I suspect he would have had evidence to support what he was saying; the problem is, it seems likely that he was barking up the wrong tree.

      Having said that, I never knew that evidence was the difference between a theory and a hypothesis – you really can learn something new every day!

  10. Pingback: Work Capability Assessment: Time to make your experience count | Vox Political

  11. steve hawkins

    In many many years of successive moves to force sick and disabled people to work, I have never once, seen any campaign, media item or blog, that suggests that the best way to get people back to work, would be to make a concerted effort to investigate our individual illnesses, and cure them if possible. Why is that, I wonder? I’ve spent 30 years caught between a rock and a hard place: I’ve had the DSS/DWP frightening me the whole time; and the harder I’ve tried to get the NHS to help me get better, the more I’ve been scorned and called a hypochondriac, and sent away. This culminated in 3 1/2 years completely wasted in a mental health unit, where my physical deterioration was pointedly ignored, until Jan 21 when I was discharged as a lost cause. I’ve spent a week in hospital with blood clots on my lungs since, and I’ve been on my back 23 1/2hr a day, on my own ever since. I can now barely move my thumb to write this, and I am in constant pain and distress. There is still no sign that anyone in the medical profession cares in the least what is wrong with me or will lift a finger to find out. I may soon be another notch on Aylwards deathly tally stick; but why has there never been any national media outcry to get me back to work by forcing the NHS to help me? What is the point of kicking me when I’m down?

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