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’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.
Working people in the UK could be facing a huge drain on their income, if they join an insurance scheme being offered by a discredited American firm.
It seems that the company behind the hated Work Capability Assessment that has denied disability benefits to thousands of genuinely sick and disabled people, has begun a mass-marketing campaign to encourage able-bodied members of the British public to invest in ‘Income Protection Insurance’, and another scheme known as the ‘Back-up Plan’.
This insurance scheme is only available via the workplace, and it is understood that it has been designed to ensure that the company can resist paying out whenever a claim is made.
That is the allegation against Unum Insurance, the American giant that has spent more than two decades advising successive British governments on how to avoid paying sickness and disability benefits to the most deserving claimants in our society.
If you have been contacted in the workplace and offered a chance to take out this insurance, please get in touch. Your experience of this system and insights into its operating procedures could be invaluable.
For those who don’t know the Unum story, you can read some of it here. Unum’s bosses devised their current system to combat the rise of ‘subjective’ illnesses such as ‘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.
The acknowledged basis for this attitude is the Biopsychosocial Model of illness, developed by the psychiatrist George Engel – but it’s a bastardised version, removing the bio- and -social aspects and concentrating on the ‘psycho’. This version of the theory, as used by Unum, has been utterly discredited. It is nonsense, totally disregarding such inconvenient medical procedures as diagnosis and prognosis, or limited life expectancy.
But it proved a great success for Unum – so much so that the UK government sought advice from the company in the early 1990s, when Peter Lilley was running the Department of Social Security. He wanted to reduce the number of disability claimants on his books, and Unum was only too happy to help out. It has been at the heart of disability benefit policy ever since.
We have Unum to thank for the Work Capability Assessment (administered by another private firm, Atos – an IT firm that has no expertise in healthcare, even though that word occasionally appears on its company logo). The recommendations made by Atos representatives, following these assessments, have led to the deaths of at least 73 genuinely ill people every week (according to government figures that are now almost a year old), who have claimed Employment and Support Allowance (formerly Incapacity Benefit). The real figure may be much higher.
The Coalition government considers this to be a great achievement and has now begun expanding the Work Capability Assessment regime to cover claims for Disability Living Allowance, now branded the Personal Independence Payment, with criteria that are much more difficult to achieve.
We can all expect many more deaths to arise from this.
Now, it seems, Unum believes the UK is ripe for bleeding – and that is why it is trying to sell its bogus insurance to working people here.
What follows are the stories told by members of Parliament about their constituents’ experiences of the Work Capability Assessment that is conducted by the private contractor Atos, which uses a tick-box computer system to assess the fitness for work of Employment and Support Allowance claimants (and soon, claimants of the Personal Independence Payment as well).
The system is itself based on one that was devised by the insurance company Unum, notably to cut down on payouts of insurance claims. Unum’s system was based on a theory known as the biopsychosocial model, devised by a Professor Engel.
This article is intended to be read in tandem with the other piece I am publishing today, Unum, Atos, the DWP and the WCA; Who gets the blame for the biopsychosocial saga?, in which I discuss the origins of the Atos assessment and hope to demonstrate that it is a perversion of a perversion of an original theory which – in any case – has not been proved. The aim of this article is to show what such distortions can cause.
The many cases quoted here are just a fraction of the total, but I believe they were representative of what is happening across the UK, and illuminated a high-quality debate that was let down only by the response of the Minister at the end (quoted in Persistent misdirection will perpetuate the Atos nightmare published yesterday). I urge you to read to the end, if you can bear it, because this should give you a good grounding in the issues facing sick and disabled people across the country.
Michael Meacher (Oldham West and Royton) (Lab): I have been sent nearly 300 case histories, many of which make heart-rending reading. I cannot begin to do justice to their feelings of distress, indignation, fear, helplessness and, indeed, widespread anger at the way they have been treated.
The first example concerns a constituent of mine who was epileptic almost from birth and was subject to grand mal seizures. At the age of 24, he was called in by Atos, classified as fit for work and had his benefit cut by £70 a week. He appealed, but became agitated and depressed and lost weight, fearing that he could not pay his rent or buy food. Three months later, he had a major seizure that killed him. A month after he died, the DWP rang his parents to say that it had made a mistake and his benefit was being restored.
The second example, also from the Oldham area, concerns a middle-aged woman who was registered blind and in an advanced stage of retinitis pigmentosa. She was assessed at 9 points—well short of the 15 that are needed—and her incapacity benefit was withdrawn. On review by a tribunal, the Atos rating of 9 points was increased to 24.
The third case—I could have chosen from hundreds of others—also comes from the north-west and concerns an insulin-dependent diabetic with squamous cell cancer, Hughes syndrome, which involves a failed immune system, peripheral neuropathy, which meant that he had no feeling in his feet or legs, heart disease, depression and anxiety. Despite his life-threatening condition, he was placed in the work-related activity group.
Cheryl Gillan (Chesham and Amersham) (Con): More than 2,000 people have signed a National Autistic Society petition to Atos, which was launched following the “Dispatches” and “Panorama” investigations, with which many of us are familiar, into the company last year.
Ian Mearns (Gateshead) (Lab): I am sure that my hon. Friend will not be surprised to learn that in Gateshead, of the 1,400 cases taken to appeal by the citizens advice bureau, more than 1,200 were successful.
Stephen Gilbert (St Austell and Newquay) (LD): None of us can underestimate or undervalue the human effect that some of these assessments are having. I would like to read into the record an e-mail I received from a constituent. It is probably similar to e-mails that all hon. Members have received. It reads:
“They never asked about the amount of pain I have to contend with or how tired I get from coping with it. After the interview I was told I was to be disallowed ESA benefit. I could probably go down the route of appeal but I really don’t feel like fighting for a benefit that I have already been made to feel that I do not deserve, neither do I have the energy” to appeal.
Steve Rotheram (Liverpool, Walton) (Lab): To illustrate one of those cases, I shall cite a letter I received from a constituent, Janine, in Liverpool. Her dad was thrown off sickness benefit in November after an Atos work capability assessment and was declared fit for work despite suffering from chronic obstructive pulmonary disease. Six weeks later, on Christmas day, Janine’s father died.
Pamela Nash (Airdrie and Shotts) (Lab): I have had a frail lady sitting in my office who had only recently finished chemotherapy but had been told she was fit for work. I have had a lady who suffered 90 per cent burns to her body—she spends every day in severe pain—and was told that she was now ready to join the Work programme. I could list hundreds of others—sadly, these are very familiar stories. I am sure [Caroline Lucas, who had just spoken] has had the experience, as I have, of seeing people who have claimed employment and support allowance as a result of a physical disability or illness ending up with mental health problems owing to the stress of going through the system.
Madeleine Moon (Bridgend) (Lab): My caseworker, like those of many Members, is inundated with cases that are tragic and heart-rending. The telephone line to my office is often clogged with crying people. They often ring several times a day, as they are unable to cope with the stress that they are facing. Many have mental health problems, and are unable to cope with the paperwork. They are unsure what to do with it, and they ring me to ask for help in the most tragic and personal way.
I want briefly to describe some of the cases that I have been dealing with. I shall start with 53-year-old Mrs E, who was employed as an accounts officer. She was a very able and capable woman. She suffered a vicious sexual attack, and was diagnosed with post-traumatic stress disorder. Her health problems caused her difficulties with working, and she was forced to take redundancy. She started claiming employment and support allowance, and attended her Atos assessment. The doctor who saw her is well known to me. I have received many complaints about him. I regularly receive complaints about his rudeness, arrogance and total lack of compassion towards the people whom he is assessing. He made unprofessional remarks to Mrs E, and bluntly told her carer to shut up, saying that he did not want to hear from him.
An official complaint was made, but Mrs E was found fit for work. An appeal judge overturned the decision maker’s decision and she was placed in the support group.
Three months later, she faced another Atos medical, and it was decided that she would be fit for work in six months. She was then placed in the work-related activity group. A month later, because of the stress, her mental and physical condition had deteriorated, and medical advisers told her to apply for disability living allowance. DLA was refused because of the original Atos report. When it was pointed out that the report was negative, but had been overturned on appeal, a reconsideration was requested. The DWP insisted that the information from the first Atos assessment was sound and that the only option was to appeal to the first-tier tribunal.
My constituent then faced two tribunals. We should remember that this is a lady with post-traumatic stress disorder. She faced two appeals. The first was for DLA. The decision to award the lower rate for mobility and care was backdated. Since then, another DLA application has raised the mobility and care components to the higher rate. The second appeal tribunal was for the employment and support allowance. She was placed in a support group and her benefit was backdated.
That was not the end of this lady’s trauma. Her mental health had deteriorated to the extent that she attempted to take her own life. Her carer has to remain constantly vigilant. A few months later, she received a letter saying she had been transferred back to the ESA work-related activity group from the support group. Payment for the ESA support component was stopped. Following some investigation, the DWP apologised and said that that was a random “administrative error”, but it affected the lady very badly and her mental state became even more fragile.
Despite that, incredibly, on Christmas eve last year the same “administrative error” occurred. My office was contacted, and I have to say that we were extremely angry. The additional stress was placing this lady in a suicidal position again. The application process started again, and yet again there has been an apology for an “administrative error”. This lady is being hounded by the state: there is no other way of describing it. There is no excuse for this behaviour. This is a company that is not playing fair by this country’s most vulnerable people.
Annette Brooke (Mid Dorset and North Poole) (LD): Let me read out a few comments from one of my constituents, who says: “I do not believe that the WCA is working for people with mental health problems. Too many people are found fit for work when they are not, and are becoming trapped in a distressing and expensive cycle of appeals and reassessments. Too much of the decision making is inaccurate and too often the WCA and related processes worsen people’s mental health.”
Valerie Vaz (Walsall South) (Lab): Constituents have come to me in their wheelchairs with their carers because they have wanted me to know about the difficulties that they are experiencing. They cannot understand why, in the face of overwhelming medical evidence, they are still being called in for interviews. Some cannot understand why they have been told “If you make it to this interview, you must be fit for work.”
SD has cancer and is undergoing radiotherapy; she has been declared fit for work.
SH suffered seven strokes, and also suffers from type 2 diabetes and a liver condition; she has had to appeal against a decision.
KH was placed in a work-related group; she has incontinence of bowel and bladder as well as diabetes, and is partially sighted.
CS has received zero points despite having a spinal disc prolapse.
SA suffered a stroke and is blind, but has still been declared fit for work.
LM has arthritis of the spine, and has had to appeal against a decision.
Stephen Nye was so angry that he came to see me on behalf of his father, and said “I want to let you know what is going on. Sick people are being persecuted: the assessment system is flawed, and they are being harassed by the jobcentre.”
MD came to see me with her husband, who is blind and deaf. They told me that the work capability assessment did not take account of the issues faced by blind and partially sighted people. I wrote to the Minister’s predecessor, who replied that Professor Harrington had had considerable engagement with the Royal National Institute of Blind People, Sense, and Action on Hearing Loss. However, that was only at the time of the professor’s third review—it should have happened before the assessments had even been devised—and only at the time of his second review did he suggest the introduction of sensory descriptors and an additional descriptor addressing the impact of generalised pain and/or fatigue.
Nia Griffith (Llanelli) (Lab): Does my hon. Friend share my utter despair at the sheer amount of money that is wasted on calling in people whose well-documented histories clearly show that they suffer from conditions which, sadly, will not improve in any way, rather than being spent on trying to find ways of helping those who are in a better position to go back to work?
Jonathan Edwards (Carmarthen East and Dinefwr) (PC): In my surgeries, I have heard several harrowing and very sad accounts from constituents who have been subjected to impersonal and inhumane work capability assessments by Atos. One has been diagnosed with an aggressive brain tumour, which cannot be completely removed because that would leave her paralysed. In August and September of last year she had radiotherapy to slow down the growth of the tumour, but in October she was told that it would grow back even more quickly, and that she would have to have further radiotherapy or she would die. I should add that this lady also has polyarthritis and asthma. Why has this lady been placed in the work-related activity group? Her doctors and consultants have specified that she should be placed in the support group as she is fighting for her life. Her only concern should be winning that battle.
Another constituent contacted me who had been ill for two years and was eventually diagnosed with cancer following a serious bout of pneumonia. Prior to her illness, she had an unblemished employment record. She was certified as unable to work by her GP and had attended many DWP hearings about the employment and support allowance, with the final one being in April 2012. She won her tribunal hearing against the Atos decision. She had not received a single penny in state benefits from before April 2012 until she died at the end of November. She faced immense distress and was denied any financial assistance at a time when she was vulnerable and in desperate need of assistance.
Iain McKenzie (Inverclyde) (Lab): Let me outline briefly some of the cases that have been brought to my surgeries, on the back of a recurring issue now being referred to by my constituents as the “Lazarus letter”. This is a letter they receive instructing them to make their way to Glasgow for assessment and containing many connotations about what will befall their benefits. A constituent who suffers from severe cerebral palsy and could not travel was refused a home visit and told to go to Glasgow to be tested. Another constituent who was recovering after being seriously injured in an accident was advised to attend an Atos assessment in Glasgow. Both those constituents could not possibly travel because they were in so much pain, and I had to get involved and ask for a home assessment for them. It does not end there because they then had their benefits cut or stopped because Atos sent the assessment forms to the wrong address. If it cannot get the address right, what chance does it have with assessments?
Dr Eilidh Whiteford (Banff and Buchan) (SNP): The very first constituent who came to me for help and who had been found fit for work was a man who could not climb the stairs in his own house to go to the toilet. He came to one of my surgeries which had disabled access, but he needed help from relatives to do so and it was quite an ordeal. His GP rather euphemistically told me that the man had “a poor prognosis”, and the man has absolutely no prospect of getting back into the labour market. He successfully appealed against the decision, but it emerged in that process that no account had been taken of his GP’s documentation or of the evidence supplied by his hospital consultant.
I have encountered incontinent patients being asked to make four-hour round trips on public transport.
I have also encountered constituents who have had to make very long journeys by public transport only to find that their appointment is not double-booked, but triple-booked.
Heather Wheeler (South Derbyshire) (Con): Long-term disabled people have come back into the work arena; unbelievably, within three months of being told that they are perfectly fit for work, they have dropped down dead.
John McDonnell (Hayes and Harlington) (Lab): I […] refer Members to Calum’s List, which has a website. It is a list of people who have died, including by suicide, as a result of, or where there has been a contribution from, the loss of benefits. The first example on the list was that of Paul Reekie. Some Members may have known Paul, an award-winning writer and poet in Leith, Scotland. He did not leave a suicide note, just two letters on the table beside him. One was about his loss of housing benefit and the other was about his loss of incapacity benefit. He died.
The other example is that of Mark and Helen Mullins from Bedworth. They could not access their benefits. They were walking 10 miles a day to a Salvation Army soup kitchen. They committed suicide together because they could not access their benefits. Read Calum’s List, which has example after example of the brutal effect of the system.
Kevan Jones (North Durham) (Lab): A lot of constituents come to see me at my surgery about this, and I should like to give an example. The individual I mentioned is a 59-year-old who suffers from severe schizophrenia. He failed the Atos interview and is now being told by the DWP that he should be retrained as a security guard because that was the last job he did 10 years ago. What a waste of resources. This is despite his GP writing a letter on his behalf, which I have seen. I know his GP, because he is my GP as well.
The other week a 60-year-old nurse with osteoporosis, who has spent 38 years in the NHS, came to see me. She failed the work capability test. She is 61 in April and is now being told that she will be retrained for a new career until she is 62, when she gets her pension. What on earth is the point in wasting money on individuals like that?
There are also cases such as the 21-year-old young lady who ended up in the local psychiatric hospital because she failed the Atos interview. What is the cost of that to the NHS?
Helen Goodman (Bishop Auckland) (Lab): Mr H, a double-leg amputee, was told to undertake an 80-mile round trip for his work capability assessment.
Mr W, who has serious mental health problems, had a panic attack and was physically sick during his WCA but was told he was fit for work. His wife believes that he is being victimised by Atos.
Mrs D, a district nurse who broke her back at work, was told that she is fit for work. Her appeal will not take place until next month.
Mr E, who is one of the people the RNIB is worried about, had been completely blind for 16 years and forced to give up work, but was told by Atos that he was fit for work.
Iain Wright (Hartlepool) (Lab): A constituent of mine—let us call her Mrs J—is 51-years-old and suffers from diverticular disease. This leads to a compacting of her bowels, which means that she soils herself on a daily basis, requiring a change of clothes. Often she requires hospital treatment because when her bowels are heavily compacted she is unable to deal with the matter without medical intervention. She was on contribution-based ESA, but was allowed to be on it for only 365 days, and that period expired in 2012. She asked to be reassessed on the basis of her condition, and her assessment stated that she was fit for work. She appealed against this decision, but the appeal was declined. She had to go down the tribunal route but, as she told me in an e-mail last September: “So I’m now faced having to go to a tribunal which I was told today will take months. I’ve got no representation. I’m unable to go to the CAB as when I attempted to do this I’d soiled myself on route so ended up going home in tears. What can I do? I’ve not got a penny to my name. I’ve borrowed just to survive since April…I’m now faced with another 3-4 months with a tribunal decision again without money…I don’t know what to do and cannot carry on like this. Surely this isn’t how you expect people who legitimately cannot work. And the likelihood is I’ve failed my appeal just because I’ve not worded my appeal correctly when clearly my medical records and specialist have stated otherwise. Please, please help before I end up on the streets.”
A gentleman in my constituency—let us call him Mr D—served in the forces for many years and is now in his late 50s. In the past 18 months, he has undergone extensive surgery to the brain, following a tumour, and in November 2011 he was informed that he required further surgery, this time to his neck, to remove the growing tumour. At the same time—in precisely the same month—Atos assessed Mr D as being fit for work. That assessment was undertaken by someone who was not trained as a doctor at a time when Mr D was going to assessments with a gaping wound in his head and still undergoing treatment.
Another woman in my constituency—let us call her Mrs M—left school at 16 and worked diligently for 33 years. She paid her taxes. She was made redundant a couple of years ago at just the time that she was starting to suffer from ill health. Mrs M suffers from Crohn’s disease, which has led to severe diarrhoea, incontinence and abdominal pain. She has had surgery to remove a large section of her bowel, but the symptoms are getting worse. As Members may know, there is no cure for Crohn’s disease. Mrs M will not recover. There will be a gradual and irreversible increase in the severity and frequency of her symptoms. Mrs M is a proud and dignified woman who is embarrassed by her condition. She wants to do nothing more than work, but is unable to do so. She suffers from about two bouts of diarrhoea a day, for which she has no more than a second’s notice, and she cannot leave the house unaccompanied. Mrs M was assessed as having 15 points with limited capability for work. Her assessment and appeal were degrading, insensitive and unprofessional. She was described throughout her appeal notes as a man. Incorrect dates and fictitious telephone calls were placed on her files—in other words, lies. Mrs M was told that she could wear a nappy for work. What sort of country have we become? What sort of ethical values do the Government have, if that is the degrading and crass way in which decent, law-abiding constituents of mine are being dealt with?
Julie Hilling (Bolton West) (Lab): Sylvia’s husband came to see me because she was too ill to come. She had a subarachnoid haemorrhage four years ago, but aged 41, has now been found fit for work. She suffers blackouts, cannot dress herself, cannot self-medicate, cannot climb stairs by herself and cannot go out alone because she cannot remember where she lives or where she is going. Three to four times each month, she gets hemiplegic migraines, which last between two and six days, and mean that she becomes paralysed on her right side and loses her speech. Despite that, she has been found fit for work. The jobcentre, however, will not sign her on because it says that she is not fit for work. Needless to say, the stress sets off her migraines. One wonders what is the matter with her assessors.
Susan, a sufferer of fibromyalgia and hypermobility syndrome, told me that she felt like she was on trial for benefit fraud at her assessment.
Bill, a former long-distance lorry driver, had chronic obstructive pulmonary disease, heart disease and diabetes. He thought the fact that he could not breathe would be reason enough to find him unfit for work, but of course he was wrong. He did not tell the assessors about his cerebral brain ascension, which means that he has terrible memory problems, because he is ashamed of having the condition. Of course, he has now had to tell them. He waited for nine months and then the decision was overturned.
Clare […] has severe mental health issues and scoliosis. She scored 15 points and was placed in the work-related activity group, even though she will clearly never be able to work. She appealed the decision and had to wait for 12 months, which made her condition far worse. She was then put in the support group.
Cathy Jamieson (Kilmarnock and Loudoun) (Lab/Co-op): One constituent got in touch with me when he found out about this debate. He states: “Getting a copy of the ESA85 report…to which everyone examined is entitled was like getting blood out of a stone.” The man was found fit to work despite being on crutches and in constant pain at the time. He said: “When I eventually received a copy I found that the examiner had stated clearly that I was found unfit for any kind of work and would remain so for at least two years.” He tells me that when he tried to follow that up via the DWP, he was left with the distinct impression that staff had been advised, encouraged or instructed that everyone was to go into one of the employment support groups rather than be deemed completely unfit for work.
I have one example of a gentleman who was brought to my constituency office by a neighbour. He had had his third WCA in May 2012 and was zero rated. On the previous two occasions he appealed, and his appeals were upheld on the basis that the tribunal decided that he had reduced awareness of everyday hazards, leading to a significant risk of injury to him or others, and was therefore not fit for work. That gentleman was brought to my office in August 2012 because he was awaiting his third appeal and was distressed by the process. Obviously, we gave him advice. On 8 October, the neighbour contacted me to say that the gentleman had passed away.
A constituent […] contacted me this week. He says: “I have been treated by my GP for over seven years for this illness, he is aware of the ups and downs, and the debilitating effects I am subject to. How can a registered nurse make a decision on my mental health in 41 minutes, most of which was asking questions about my physical health? This is what happened at my Atos WCA…There must be a change to the way people with mental health problems are dealt with by the system. I have spent the time since my WCA in June in misery, and the weeks leading up to the tribunal hearing in a mix of terror and stress. I was terrified at the tribunal itself.” That is no way to treat people in a civilised society. The gentleman says that he is “part of the last generation of ‘stiff upper lip’ and ‘put the best face on it’ people.” He says that that “works against” him because he does not fit what he describes as the stereotype of someone with a mental health problem.
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.
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