Tag Archives: Mansel Aylward

Found: The book that helps the government smear the sick as ‘malingerers’

 

Denied benefit: This is the late Karen Sherlock. Her illnesses included chronic kidney disease, a heart condition, vitamin B12 deficiency, anaemia, high blood pressure, high cholesterol, underactive thyroid, asthma, diabetic autonomic neuropathy, gastropaeresis, and diabetic retinopathy. She died on June 8, 2012, of a suspected heart attack, after the Department for Work and Pensions stopped her Employment and Support Allowance. John LoCascio would describe her as a malingerer. Considering the list of her illnesses, how would you describe him?

Denied benefit: This is the late Karen Sherlock. Her illnesses included chronic kidney disease, a heart condition, vitamin B12 deficiency, anaemia, high blood pressure, high cholesterol, underactive thyroid, asthma, diabetic autonomic neuropathy, gastropaeresis, and diabetic retinopathy. She died on June 8, 2012, of a suspected heart attack, after the Department for Work and Pensions stopped her Employment and Support Allowance.
John LoCascio would describe her as a malingerer. Considering the list of her illnesses, how would you describe him?

Some of our least favourite people contributed to a book entitled Malingering and Illness Deception in 2003, that seems to provide much of the ammunition used by the current government to demonise claimants of disability and incapacity benefits.

One of the relevant chapters is ‘Malingering, insurance medicine and medicalization of fraud’ by John LoCascio of the criminal American insurance giant Unum, that has been heavily involved in British social security work since the 1990s.

The other is ‘Origins, practice and limitations of Disability Assessment Medicine’ by Mansel Aylward, the Unum puppet who was formerly chief medical officer at the Department for Work and Pensions.

These are the two charmers who put forward a perversion of Professor George Engels’ biopsychosocial theory that calls an individual’s illness into question, rather than treating it, to the then-Department of Social Security back in the 1990s.

The assertion that it was a tool to reduce claimant numbers can be proved by the fact that Mr Aylward was asked to change the test used to determine whether a claimant deserved benefit, in order to reduce the flow of claimants with mental health problems. When politicians ask for specific results, you know impartiality has gone out the window!

Look at the title of the book: It labels incapacity and disability claimants as “malingerers”, defined in the book’s first chapter as those who engage in “the intentional production of false or exaggerated symptoms motivated by external incentives” – in this case, the desire to receive state benefits.

This fits with what we know of the Unum-influenced benefit system already – that claimants are to be treated as if they are trying to cheat the system, unless they can prove to a state-provided official (not necessarily medically-trained) – who has been briefed to find ways to prevent them receiving the benefit – that they are unwell. Their own doctor’s reports are ignored.

Let’s look at LoCascio’s chapter. He starts by suggesting that “disability-related programmes in both the public and private sectors are faced with increasing numbers of disability claims despite improved health care and job design (the disability paradox).”

Already we are in the realm of fantasy as he fails to mention the logical reasons for these increases, which include poor implementation of health and safety measures in the workplace under ‘light touch’ regulation, and the discovery of new medical conditions whose causes are unknown and which require protracted study before they are understood – all made possible by the “improved health care” to which Mr LoCascio refers.

Amusingly, LoCascio also claims that the commercial insurance industry “is neither medically nor legally driven. It is driven by societal imperatives”. What a whopper! Commercial insurance is driven by the desire for money. That is why his company has a criminal conviction to its name – it changed its medical procedures to make it almost impossible for anyone to claim successfully that their Unum health insurance policy had matured.

Much of the remainder of his chapter attempts to convince the reader that the lack of data available – to support claims that a medical patient is “malingering” – should not be used as evidence that they really are ill. He asks the reader to believe that three questions should be asked: Did the patient understand the medical issues? Are the patient’s reported and actual behaviours consistent through time and across observers? And are the functional capacities in question (the patient’s abilities) well-defined?

What a cheat.

It seems perfectly likely that any patient will understand the medical issues informing their condition. However, in a Work Capability Assessment it is common for the assessor to have a completely different opinion of what those issues are. This discrepancy allows the assessor to find fault with the benefit claim.

The second question supports evidence of those who have read assessment reports claiming that patients did not display the behaviours expected of a person with their condition – one famous example was that the patient was not “rocking back and forth”. The simple reason for this was that their condition did not display in that manner but the assessor – who was not an expert in this field of medicine – did not know that because the only advice available was a biased screed from the Unum-influenced DWP.

The final question – are the functional capacities in question well-defined? – can be defeated with a simple, two-word counter-question: By whom?

Also of interest is the concept of ‘Functional Capacity’ (FC). LoCascio argues that a person should not be expected to be incapable of any type of work, just because they are incapable of one. His example is that a person limited to typing for 20 minutes due to forearm pain may be able to play piano for an hour. This is entirely possible but contradicts one of the quotations Mr LoCascio uses four pages previously: “The question of disease—that and nothing more—is the one for the physician to determine” (Drewy 1896). It is not the assessor’s job to dream up functions a claimant might be able to carry out and then discount a claim for benefits on the basis of that possibility. That is not evidence; it is fantasy.

All of the above questions are also rendered pointless by the simple fact that a claimant’s condition may be variable. LoCascio acknowledges this! However, he then goes right off the rails: “I favour a series of three questions: ‘Please describe a bad day. Please describe a good day. Please tell me how many good days and bad days you have in an average week.’ Armed with this knowledge about any particular symptom and the corresponding reduction in an FC, the medical resource can proceed to analyse the consistency of the history against the medical or observational data.”

That is an inaccurate assumption. When you are ill with (for example) fibromyalgia, there can be a huge range of difference between days. Sometimes Mrs Mike has seemed able to function almost normally (she can never walk far without suffering a huge amount of pain in the following days, as an example of why she only seems more able); other times she has been confined to the sofa for days on end in terrible pain for which medical science currently has no alleviation. At other times her condition may be anywhere between those extremes. Asking for a description of a good or bad day, or how many of these take place in an average week, is not only pointless – it hinders understanding of the condition.

“In conclusion,” LoCascio writes, “the most important product of the medical consultant is clear, credible, and defensible
documentation.” It seems strange, then, that the most clear, credible and defensible documents – those written by the patient’s doctor – are the first to be ignored in any Work Capability Assessment.

What we have here is a propaganda screed, riddled with inconsistencies and running against reason, that has been used to support the government’s position on sickness and disability benefits. As an argument in favour of current policy, it is worse than useless. In fact, it should be a tool for campaigners to use against that policy.

It tells us why a claimant who lives in agony every day should be outraged when assessors use LoCascio’s nonsense to explain away their pain.

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Petition demands fibromyalgia test be fit to work

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The Department for Work and Pensions is being told to sort out its benefit assessment system after campaigners said it is rigged against people who suffer from Fibromyalgia.

The petition – ‘Change DWP Medicals for Fibromyalgia’ – may be found here.

Long-term readers will know that Fibromyalgia is one of the conditions suffered by Mrs Mike, partner of Vox Political writer Mike Sivier. She has hijacked this space to post the following message from the petitioners:

“In brief, the petition asks that Department of Work and Pensions medicals for Fibromyalgia be carried out by a qualified rheumatologist, and that the decision regarding the receipt of benefits not be based on the current point-scoring system.

“The full petition reads:

“‘We, the undersigned, call on the British Government to ask that DWP medicals for Fibromyalgia be carried out by a qualified rheumatologist, and that the decision made about the receipt of benefit not be based on a point scoring system.’

“‘At the moment the DWP are using an outside agency to carry out medicals on people with medical conditions, and using a point scoring system to decide whether or not people are entitled to benefits.

“‘Most of the medicals are carried out by a nurse or other healthcare professional in less than an hour by asking a few targeted questions. With a condition like Fibromyalgia, it takes a qualified rheumatologist to diagnose the condition and understand the treatment that needs to be implemented to attempt to manage the pain of the condition.

“‘A rheumatologist would understand the pain and associated problems that Fibromyalgia sufferers face on a daily basis. Yet the nurse or health care professional that fills in the forms for the medical sees someone for less than an hour with no understanding of the condition and how it affects each person individually.

“‘It is not possible for someone of this level to understand the issues that Fibromyalgia suffers face, and the medicals should at the very least be carried out by a rheumatologist.

“‘During the medical you are assessed on how much you can move in certain directions. At no point are they taking any interest in how much pain you are in whilst this is going on, or how many painkillers you have to take afterwards.

“‘A favourite question is, “How far can you walk without discomfort?” The answer for a most Fibromyalgia sufferers is over 200 metres if they absolutely have to. What they don’t ask is, “How much pain are you in?” Most Fibromyalgia sufferers are in pain before they start to walk; walking just increases the pain.

“‘The point scoring system is stupid and unfair and needs to be abolished. Fibromyalgia sufferers are being consistently turned down for benefits that they should be entitled to, as this is a condition recognised by the DWP – and I quote, “Professor Aylward, on behalf of the DWP, reaffirmed that the DWP recognises fibromyalgia as a real and disabling condition, and not just something that is ‘all in the mind.'” If this is recognised by the DWP as being a “real and disabling condition” then why are diagnosed sufferers being refused DLA and ESA?

“‘It has been reported that Fibromyalgia Sufferers often suffer more pain than people diagnosed with rheumatoid arthritis.

“‘Despite the DWP’s statement, Fibromyalgia sufferers are being discriminated against, as the condition is seen as “invisible”, like many other conditions.'”

To sign the petition, go to this site and click the “Sign the petition” button near the bottom of the page. For more Fibromyalgia, Chronic Fatigue Syndrome and Natural Wellness news, sign up for free HealthWatch newsletters.

That’s the end of Mrs Mike’s bit. As someone who lives with a person who has Fibromyalgia, dear reader, you may safely conclude that I know a fair few things about the subject myself. I sat in on Mrs Mike’s work capability assessment and I can vouch for the truth of the statements regarding questions asked during that interview and the physical examinations that take place.

Mrs Mike’s mobility was checked very thoroughly during her assessment but no interest has ever been shown in the fact that she spent the next three days on the sofa in our living room, unable to move because of the pain she was suffering.

The question about walking is far more subjective. Obviously, after the WCA, Mrs Mike couldn’t walk anywhere without discomfort but, even when she is well enough to move, pain always sets in within a few paces and the chance to sit down is regarded as a blessed relief.

Yet Mansel Aylward (for it was he) said the DWP recognises Fibromyalgia as a “real and disabling condition”.

While these tests are carried out by people who are not qualified to recognise the symptoms of the condition and the problems it causes, the DWP is only paying lip-service to its claims about Fibromyalgia.

Please sign the petition and help ease the lives of people with Fibromyalgia across the UK.

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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.