Category Archives: Disability

In 2013, there were estimated to be over 500,000 physiotherapists working in the EU. That figure is thought to have increased since then, with physiotherapy continually expanding and becoming more advanced for a variety of different health problems.

Many people just assume the role of a physiotherapist is to help with sports injuries and back problems. Whilst this is true, physiotherapists are certainly not limited to just that. In fact, qualified physiotherapists are able to provide treatment for a huge variety of other conditions too, including an array of injury, disease or age-related issues. And, with some physiotherapists being able to prescribe essential medication without having to consult a doctor, it’s clear to see how much of a positive impact physiotherapists can have.

If you or someone you know thinks they may need the help of a physiotherapist and would like to know more, read on to discover what physiotherapy is, what it does, and how it can successfully alleviate painful symptoms and make people feel better on a long-term basis.

What actually is physiotherapy?

In its simplest terms, physiotherapy is the professional practice of providing treatment for physical problems and pain from a range of sources. These can include injuries, disease, and age-related ailments.

A physiotherapist’s main role is to not only alleviate painful symptoms that may have arisen, but to also restore the optimum functioning of the affected area and hopefully give their patient a long-term, lessened effect of their issue. Physiotherapists are not only present in hospitals and can be found in a variety of other places such as healthcare facilities, gyms, schools and even in some workplaces.

Due to the significant amount of different injuries and issues physiotherapists have to face, they often specialize in a number of areas. Physiotherapy is therefore split into three main areas of expertise:

  • Neurological – Treats disorders and pain associated with the nervous system. The most common injuries seen by physiotherapists in this area are brain and spinal cord injuries, Parkinson’s disease and MS (multiple sclerosis).
  • Musculoskeletal – Also known as orthopedic physiotherapy, this area treats the largest variety of conditions. These include arthritis, back pain, sprains, and an array of sports-related injuries.
  • Cardiothoracic – Treats disorders such as emphysema, asthma and bronchitis.

What do physiotherapists do?

In order to successfully complete their main job role, there are a variety of tasks and strategies that physiotherapists can take dependent on their patient’s specific circumstances.

In your initial appointment, the physiotherapist will fully assess your physical condition and make an appropriate diagnosis. A bespoke treatment plan will then be created to ensure you receive the best possible care for your specific injury or condition. In many cases, physiotherapists may have to retrain their patients to walk again with the assistance of walking frames or crutches.

It’s also the job of a physiotherapist to properly educate patients and their families on exactly what their treatment is providing, and how to lead a healthy lifestyle and prevent further injury or discomfort.

To find out even more about the specific roles and responsibilities of a qualified physiotherapist, take a look at Bodyworks Edinburgh for extra information.

physiotherapists

How can they help?

No matter what injury or condition you may be facing, a physiotherapist will always provide a tailored treatment plan that is specific to your circumstances. This is what makes the expertise of physiotherapists stand out against general doctors.

There are many types of therapies a physiotherapist can administer depending on their patient’s individual requirements. Some injuries may simply require an exercise program to strengthen muscles and regain posture, and some may need manual therapy that can include joint manipulation and resistance training.

However, some injuries and disorders may require long-term, consistent therapy to re-configure everyday repetitiveness. For example, back pain can often be caused by repetitive, manual activities in the workplace. So, in order for the pain to be permanently fixed and helped, the physiotherapist must establish which specific activity is responsible and give their patient a safe but effective alternative they can use instead.

Offering much more than just treatment for sports injuries, qualified physiotherapists boast a vast and specialist skill-set that can be applied to a huge array of disorders, injuries and painful ailments. And, since they can often be found in a wide variety of different locations from your local sports centre to your child’s school, getting in touch with a professional and seeking help couldn’t be easier if you’re suffering from any of the conditions discussed above.

Nicki Llewellyn is the founder of Bodyworks Edinburgh, a massage and physiotherapy clinic in Edinburgh, U.K. Founded in 2013, Nicki and his team set out to help clients improve muscular issues, sports performance and any injuries to bring them back to full health.

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  1. Introduction

As a nation we have made huge steps tackling issues around inequality and discrimination against disabled people in our society, from passing the historic 1995 Disability Discrimination Act to becoming signatories to the UN Convention on the Rights of Persons with Disabilities in 2009 and to defining protections afforded to disabled people under the Equality Act 2010. While progress had been made, disabled people still continue to face discrimination and disadvantage.

The Labour Party is the party of equality and that is why we launched the Disability Equality Roadshow (DER) on 11th November 2016 in Manchester with the leader of the Labour Party, Jeremy Corbyn. The principle behind the DER is that future social security policy needs to be co-produced with its stakeholders including disabled people and their carers, service providers and the public at large.

Our aims are to engage with stakeholders and hear their views and experiences of social security policy, in addition to a wide-range of other policy areas. Disabled People Against Cuts proposed the road show and together with Disability Labour, TUC Disability lead, Disabled People’s Organisations and Charities have been instrumental in setting up the Disability Equality Roadshow.

The Disability Equality Roadshow will involve deaf and disabled people, their carers and service providers at engagement events across every region of the country, and each nation state. In addition we will ensure anyone who may not be able to attend events in person can still engage with the process online via written, audio or video submissions. Live streaming will also be available for some events.

The Disability Equality Roadshow will start from a position that values our social security system, not denigrates it or its users, and, like the NHS, starts from principles of inclusion, support and security for all, assuring us of our dignity and the basics of life, giving us a hand up, not a hand out, should any one of us become ill, disabled or fall on hard times. It will also be essential to engage with the wider public on what a new social contract will look like.

We are seeking to develop policies that enable disabled people to lead full and rich lives, reflecting a social model of disability, so contributing to our obligations as signatory to the United Nations Convention on the Rights of Persons with Disabilities. Labour takes these obligations seriously, which is why we will be travelling across the country to hear your views.

The DER will be supported by the Disability Equality Commission, which will pull together the evidence from all the events as well wider evidence. It will also be responsible for drafting a report on this to Debbie Abrahams, the Shadow Work and Pensions Secretary.

Disability Equality Roashow

The report and recommendations will be incorporated into our wider policy development process through our National Policy Forum. In conjunction with the DER, we will also be launching Disability Equality Watch (DEW) – a platform for you to share the impacts of this Government’s so-called welfare reforms. You will be able to send us your evidence of the impacts this Government’s social security policies are having on you and your families.

2. The Disability Equality Roadshow events

Debbie Abrahams and other members of the Shadow Work and Pensions team will attend each DER event. Approximately 30 DER events will take place over the coming year; information on each event will be published on the Labour Party Policy Forum website. Each event will be will be free to all participants and open to deaf and disabled people and their carers. Anybody with access needs should specify their requirements at least two weeks before the event. During the event, there will be a number of round discussion tables where participants will explore their experiences and priorities for change under the following themes:

  • Adequate standard of living and social protection
  • Health and social care
  • Education and training
  • Work and employment
  • Independent living
  • Access to justice
  • Participation in cultural, political and public life

These themes reflect articles from the UN Convention on the Rights of Persons with Disabilities.

3. The questions

For anyone who may not be able to attend the events but would like to submit evidence to the Disability Equality Roadshow, you can do this on the Labour Party Policy Forum website .

The questions we would like your input on are:

Adequate standard of living and social protection:

  1. What have your personal experiences of the social security/protection system been? Points to Consider:
  • What are your experiences with Employment and Support Allowance or Incapacity Benefit, Work Capability Assessments, Personal Independence Payment or Disability Living Allowance, the Work Programme/Work Choice, Universal Credit or other support?
  • How was the process of applying and being assessed for social security support?
  • What are your experiences of sanctions?
  1. What are the three most important things that a Labour government could do to reshape social security so that it is better suited to your needs?

Health and Social Care:

  1. What have your experiences of health and social care been like? Points to consider:
  • Which health care providers did you see, e.g., GP, nurse, consultant, mental health specialist, occupational health?
  • How quickly did you get specialist care?
  • What was the process like to get specialist care?
  • How would you rate the quality of care you received?
  • What communication did your healthcare providers have with DWP?
  • How did your condition and treatment affect you and your family, including anybody who had to care for you?
  1. What are the three most important things that a Labour government could do to ensure the highest attainable standard of physical and mental health of disabled people?

Education and Training

  1. What have your experiences of mainstream/non-mainstream education and training been? Points to consider:
  • How is the reform of Special Educational Needs and Disabilities improving the educational outcomes of disabled children, including Education Health & Care Assessments/Plans?
  • What have your experiences been with post-16 training/experiences such as apprenticeships, further/higher education and vocational courses?
  1. What are the three most important things that a Labour government could do to ensure disabled people have access to the same educational and training opportunities as non-disabled people?

Work and Employment:

  1. What have your experiences of work and employment been? Points to consider:
  • How have you found employers and colleagues in relation to your disability?
  • What were your experiences of the NHS or occupational health providers in helping you to stay in employment?
  • What are you experiences of the DWP in providing social security support to help stay in employment?
  • What have your experiences been of asking employers to make reasonable adjustments?
  1. What are the three most important things that a Labour government could do to enable sick and disabled people to stay in and/or to return to work?

Independent living:

  1. What have your experiences of living independently been? Points to consider:
  • What are your experiences of housing, housing adaptations and independent living?
  • What are your experiences of transport, particularly public transport and independent living?
  • What are your experiences of social care both formally and informally to help you live independently?
  • What have your experiences been of the social security system and how did they impact on your ability to live independently?

10.What are the three most important things that a Labour government could do to ensure disabled people are able to live independently?

Access to justice:

11.What have your experiences of accessing the civil and/or criminal justice system been like?

Points to consider:

  • What are your experiences of dealing with the police for example to report a crime, particularly disability hate crime?
  • Have you ever applied for legal aid, what was the experience like?
  • What are your experiences with discrimination in employment and employment tribunals or Social security tribunals?

12.What are the three most important things that a Labour government could do to ensure access to justice for disabled people?

Participation in Cultural, Political and Public Life:

13.What have your experiences of participating in cultural, political and public life been? Points to consider:

  • What are your experiences of engaging in sports and other physical activity?
  • What are your experiences of engaging with the Arts?
  • What are your experiences of political engagement, at a local, regional and national level?

14.What are the three most important things that a Labour government could do to help ensure disabled people are able to participate in cultural, political and public life?

4. And finally

Labour’s commitment to people-powered politics means that the Disability Equality Roadshow  process involving Deaf and disabled people, carers and service providers, will feed into our National Policy Forum. We are mindful of our commitments to the UN Convention on the Rights of Persons with Disabilities and are working across our Shadow Teams to incorporate disability issues into all policy development. Through this consultation we will incorporate your views into evidence based policies for disabled people. Together with your help we can transform our social security system, based on the principles of dignity, independence and support.

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 Magical thinking or evidence-based policy?

“To own the discourse is to win the argument”
The Green Paper on Work, Health and Disability  was published online late afternoon of Monday 31st October.  The DWP had been briefing since the Saturday before, that a major reform was proposed to the Work Capability Assessment and that all the evidence was that work is good for people’s health.
Newspapers and television news highlighted the proposals but no-one actually saw the document until news media had been running the DWP storyline for almost 48 hours  The BBC initially intended to film some interviews at a London disabled people’s organisation on Monday afternoon but cancelled it as by then the story was no longer news.
The consultation on the Green Paper is running until 17th February, long enough for individuals and organisations to get to grips with what is really being proposed.
I’ve focussed in this blogpost on three important contentions made in the Green Paper, on which some of its proposals are based.  I’ve tried to get behind the spin which accompanied its launch to see what exactly is being proposed.
Contention No 1:  There is a causal relationship between work and health, such that if someone moves from unemployment into work their health will improve.
The Green Paper opens with the statement that “The evidence that appropriate work can bring health and wellbeing benefits is widely recognised”. The reference for this is the major review of evidence, published by the DWP in 2006.
On the face of it, this is a fairly uncontentious statement.  The word ‘appropriate’ recognises that not all work has a positive impact and the phrase ‘can bring’ indicates that this is not a claim of a unilinear causal relationship.  Indeed, early on in the Green Paper the complexities of the relationship are acknowledged:
…….whilst work is good for health in most circumstances, the type of work matters. Many factors such as autonomy, an appropriate workload and supportive management are important for promoting health at work.
This reflects the conclusions of the 2006 review.  The Green Paper could also have drawn on more recent longitudinal research from Australia which found that low paid, insecure jobs, characterised by a lack of control, were associated with poorer health than that found amongst those people who remained out of work.
Getting a high quality job after being unemployed improved mental health by an average of 3 points, but getting a poor quality job was more detrimental to mental health than remaining unemployed, showing up as a loss of 5.6 points.
This is an important finding, particularly bearing in mind the conclusion of the DWP’s 2006 literature review that: “After leaving benefits, many claimants go into poorly paid or low quality jobs, and insecure, unstable or unsustained employment. Many go on to further periods of unemployment or sickness, and further spell(s) on the same or other social security benefits”.
Unfortunately, the tone of the rest of the paper and its proposals assume a straightforward unilinear relationship between being in paid employment and good health, as illustrated by what the DWP calls an ‘infographic’ on page 4 of the Green Paper.  This shows two circular relationships, good health and work on the one hand and worklessness and poor health on the other.
The Green Paper would have been more accurate if it had concluded that, while paid employment can increase your standard of living, social interaction and self-esteem, it can also be bad for your health and can create or worsen illness or impairment. Whether work is good for your health will depend on your state of health and the nature of the job. As, according to the DWP’s own evidence, people leaving benefits often go into poor quality jobs, they are less likely than the average person to find that paid employment has a good impact on their health.
Contention Number Two:  Withdrawal or reduction of income (or the threat of withdrawal) will increase entry into employment.
The payment of out of work benefits has always been conditional but since 2010 the conditions have increased and withdrawal or reduction of payment can now last from four weeks to three years.The assumption is that this threat of, or the actual experience of, withholding income will make it more likely that a person will take steps that increase entry into employment.
The recent decision to reduce, by almost £30pw, the money paid to people who have been assessed as being unfit to work but able to take on work related activity (the ESA Work related activity group) is based on the same assumption: the DWP claimed it will “remove the financial incentives that would otherwise discourage claimants from taking steps back to work”.
In an earlier blogpost I examined the evidence that DWP relied on to make this claim.  It’s worth reiterating that there is no evidence of a causal relationship between a reduction in benefit levels and an increase in employment amongst disabled and sick people.
There is, in fact, a more convincing case to be made that reducing or withdrawing income will make people less able to gain employment. An evaluation of the impact of benefit reduction found that the more benefit was removed the less likely they were to move into employment.  A study which carried out four ‘natural’ experiments in the US and in India concluded that poverty undermined people’s ability to think clearly, carry out tasks and to make good decisions (a conclusion which is perhaps obvious to anyone who has experienced the pressures that come with even short-term financial difficulties):
The poor must manage sporadic income, juggle expenses, and make difficult tradeoffs. Even when not actually making a financial decision, these preoccupations can be present and distracting. The human cognitive system has limited capacity. Preoccupations with pressing budgetary concerns leave fewer cognitive resources available to guide choice and action.
The widely disseminated conclusion from this study was that, because people living in poverty expend more of their mental capacity on managing with a low income, government programmes aimed at helping them should not impose what some called a ‘cognitive tax’ – such as complicated forms, frequent monitoring systems, onerous requirements to prove eligibility.  As the Behavioural Insights Team argue:
“The worries involved in making ends meet every day already deplete [cognitive] bandwidth so government services aiming to tackle disadvantage – such as savings schemes, employment advice and parenting programmes – should be required to pass a cognitive load test to ensure these services do not make it harder for people on low incomes to make good decisions for themselves.”
The Behavioural Insights Team is an organisation originally set up by the government (the ‘Nudge Unit’) and still partly owned by them. This study was carried out in partnership with the Cabinet Office.  We would normally expect their conclusions to be treated seriously but that does not appear to be the case in this instance.
Contention Number Three: ‘Employment support’ will reduce the numbers of people on long-term out of work benefits
The Green Paper indicates an intention to reduce the numbers of people in the ESA Support Group. These are people who have been assessed as having limited capability for employment and also limited capability for work-related activity – meaning that they are exempt from complying with requirements to take ‘steps back to work’.  Concern that there are ‘too many’ people claiming this type of benefit dates back to the 1990s when Invalidity Benefit was replaced by Incapacity Benefit.   A series of changes since then in the method and process of assessment have not had the desired effect of reducing numbers qualifying for long term sickness and disability benefit.
The Green Paper proposes yet another change in the assessment regime and an extension of ‘employment support’ to people who have been assessed as not able to either work or to engage in work-related activity.  Instead of one assessment (the Work Capability Assessment) there would be two: the WCA would assess financial entitlement and then everyone on ESA, whether in the Support Group or not, would be subject to a “separate process” which would decide whether “someone should engage with Jobcentre Plus or specialist programmes”.
People would be required to have continuing contact with a ‘Work Coach’ who: could have full discretion to tailor any employment support to each individual claimant. This approach would be truly responsive, allowing the work coach to adjust requirements and goals dependent on changes in a person’s condition or circumstances.
While Damien Green previously announced that those in the Support Group would not have to undergo repeated WCA assessment, this new system could potentially require repeated and continuing ‘discretionary’ assessment by a work coach as to what a person should be required to do.
So let’s look at whether there is any evidence that the ‘support’ to be offered by this new system is likely to increase employment amongst disabled people or people with long-term health conditions.
The first thing to point out is that the assumption underpinning the Green Paper’s proposals is that people who are unfortunate enough to experience ill health and/or disability and unemployment are not capable of – or are not to be trusted to – make decisions in their own best interests.  Instead it is the role of a State employee or contractor to do this.
So the Paper proposes that “trained work coaches could have discretion to make case-by-case decisions about the type of employment support a person is able to engage with” (para 132).
The second thing is that anyone entering this system gives up all right to privacy about personal information held on them by the “NHS, the adult social care system or through other benefit applications, such as from a Personal Independence Payment application” as the assessment for financial support (the current WCA) and the work coach would draw on these sources of information (para 135).
A third point is that the employment support programmes have not in the past been very successful at helping people on long-term out of work sickness/disability benefits to find and retain paid employment.  Only 12.5% of ESA new claimants on the Work Programme get a job outcome within two years. The equivalent figure for people moving onto ESA from Incapacity Benefit is 4.7%.  Work Choice, the specialist programme aimed at disabled people has a higher rate of success but less than 1 in 5 of participants are on ESA with the majority being on Job Seekers Allowance, so the programme has not proved its effectiveness with people on ESA.
As the government has previously announced, the Work Programme and Work Choice are being discontinued and replaced with a new Work and Health Programme.  However, this will only have 20% of the funding previously invested in employment support.
The Green Paper also proposes that the:
“earlier engagement between an individual and a work coach in Universal Credit will also serve as a gateway to a wider, integrated system of support offered by the Department for Work and Pensions and other agencies, such as the NHS and local authorities”. (Para 84)
This “wider, integrated system of support’ is called Universal Support and is intended to “assist people with their financial and digital capacity throughout the life of their claim”.
“Through Universal Support we are transforming the way Job centres work as part of their local communities to ensure they more effectively tackle the complex needs some people have and support them into sustainable employment”. (Para 85)
Unfortunately, this transformation is not borne out by the DWP’s own evaluation of Universal Support in the trial areas.  The evaluation, published in July this year, concluded:
“the results suggest that participation in USdl had no statistically significant impact on either digital or financial capability…..Overall, the estimated annualised cost of the eleven trials was just over £4 million. Staff costs made up £2.7 million of the total.”
So £4 million was spent with no resulting improvement in claimants’ ability to engage with the UC system or with managing their finances. (Incidentally, the Green Paper also holds up the Troubled Families programme as ‘another example of an integrated approach’.  It’s surprising that they infer that this programme makes any difference as the evaluation published recently “was unable to find consistent evidence that the programme had any significant or systematic impact”)
It is unlikely therefore that there will be sufficient assistance available through the specialist employment support programme.  And Universal Support is unlikely to be of much assistance in terms of helping people to navigate the complexities of the system. So what will be offered to people in the Support Group as part of the ‘claimant commitment’?  The Green Paper does not spell this out explicitly but it would seem that the intention is that Work and Health coaches will decide what kind of health-related intervention someone needs.
How long before part of the ‘claimant commitment’ includes a requirement to participate in a ‘health intervention’ of some kind and sanctions are attached to non-compliance?
It isn’t really employment support that is on offer – rather we are on the road to a situation where people who are too ill or disabled to work are required to subject themselves to health interventions that an employee (or contractor) of the DWP decides is good for them.
In summary….
It’s important that responses to the Green Paper home in on what is actually being proposed, rather than merely respond to the questions posed by the DWP.  The proposed changes are merely the latest in a long line of attempts to reduce the numbers of people qualifying for long-term out of work sickness/disability benefits.  If the assumptions on which the proposals are based are not backed up by evidence then they will be unlikely to have any more impact on reducing the disability employment gap than their predecessors.
And finally…..
Magical thinking refers to the false attribution of causal relationships. In the context of psychology it refers specifically to the belief that one’s thoughts by themselves can bring something about – or that thinking something is the same as doing it.
Not only does this Green Paper ascribe a fallacious unilinear causal relationship between work and health, but it replicates a common feature of government policy – the assumption that saying something will happen makes it happen.
This is the fourth time in my engagement with social policy that a government has complained about the number of people ‘languishing’ on long term out of work benefits.  The fourth time that proposals are made which will supposedly reduce these numbers.  Any bets on how soon we will see a fifth?
First published on Jenny’s blog
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Although it is commonly associated with the elderly, hearing loss is one of the most common afflictions in the world. From genetics and infections through to loud noise exposure and more, there are many factors that can result in hearing loss. In many cases, the damage is permanent and there is little that can be done to reverse it. However, there are a number of treatments available that can mitigate its effects, giving sufferers an opportunity to lead a life that is relatively free of severe hearing debilitations.

Wearing hearing aids is a well-known hearing loss treatment that uses electronic systems to make sounds more intelligible. These devices can be fitted by professional audiologists to suit the specific needs and requirements of the patient, resulting in significant improvements in overall hearing capabilities. There are even invisible types available, such as Lyric hearing aids, which sit deep within the ear canal and aren’t visible to others.

Hearing aids also have a number of other benefits that you can take advantage of, including:

Improved Speech Comprehension

One of the most significant consequences of hearing loss is the difficulty to properly comprehend speech and participate in conversations. It can be stressful and humiliating having to ask someone to speak up and repeat themselves because you can’t clearly identify what they are saying. Fortunately, properly fitted hearing aids can amplify certain sounds that would otherwise be challenging to distinguish, including ‘”th” and “s”. This makes it easier to comprehend speech and engage in conversations with others, eliminating unnecessary effort and frustration.

Targeted Sound Amplification

Most modern hearing aids are sophisticated enough that they can pinpoint a specific source of sound and amplify it. Whether you’re listening to someone speak or watching the television, hearing aids can be used to make the sound more pronounced. This can be especially useful for crowded environments, where there is often a considerable amount of surrounding noise that can interfere with your ability to identify and make sense of auditory stimuli.

Cognitive Health

Hearing loss without sufficient treatment has been linked to an increased risk of dementia and other cognitive issues. Untreated hearing loss can lead to further degradation of auditory systems, which can then have ripple effects on other cognitive functions. Studies have shown that this is most prominent in patients who have not elected to wear hearing aids to improve their hearing capabilities. This means that not only can hearing aids make it easier to understand speech, but they can also help to prevent or slow down signs of cognitive decline.

Other Benefits

Properly fitted hearing aids are guaranteed to improve your overall physical, psychological and social well-being. They will help you to stay independent, allow you to concentrate better, and give you the chance to stay productive in an occupation that requires hearing. Furthermore, you will be able to notice otherwise inaudible sounds and participate in social gatherings that you otherwise may have found difficult. All of these benefits combine together to help improve your happiness and self-esteem, giving you the quality of life you deserve.

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If you are one of the millions of people who suffer with knee and hip pain, you’re certainly not alone. Knee pain and hip pain are some of the commonest adverse physical conditions in America today. It is estimated that some 52 million Americans suffer from arthritis-related knee or hip pain, with more people joining those ranks every year. Experts predict that by the year 2030, at least one-fourth of all Americans will find themselves dealing with some sort of arthritic changes in their knees and hips. According to the National Health Interview Survey, knee pain is the most commonly reported joint problem among adults. Fortunately, a range of effective treatment options are available.

What are the causes of knee pain?

The knee is a complex joint with many parts that can be damaged. Injured or misaligned bones, ligaments that connect bone to bone, and tendons that attach bones to muscles can all be damaged in a number of ways. The bursae, or fluid-filled sac that surrounds the knee can suffer injury, as well, explains the Mayo Clinic.

Injury, arthritis, and mechanical problems can lead to debilitating pain in the knee. Being overweight can also cause severe knee pain. Common injuries to the knee include tearing of the anterior cruciate ligament, or ACL. This sort of knee injury is typical among basketball players, waitresses, soccer players, and other people who make sudden direction changes while walking or running. Fractures of the patella, or knee cap, often occur as a result of automobile accidents and sudden falls. Persons with bone-weakening osteoporosis may injure their knees merely by stepping the wrong way.

The meniscus is comprised of firm cartilage that absorbs shock, especially between the thighbone and the shin. Meniscus tears are a common sports injury. Bursitis of the knee is an inflammation of the tissue that surrounds the knee. Bursitis can cause unbearable agony to people with the condition. Bicycle riders, runners, joggers, and skiers may fall victim to another awful knee condition called patellar tendinitis.

Normal Canine Hips

What are the causes of hip pain?

The National Institutes of Health notes a number of causes of hip pain. Among these causes are osteoarthritis and rheumatoid arthritis. Warning signs of arthritis include joint stiffness, especially in the morning, swelling in one or more joints, and a ‘crunchy’ feeling that is actually bone rubbing against bone.

Hip fracture, tendinitis, labral tear, and dislocation are other somewhat common causes of pain in the hips. Nerve impingement, such as that which occurs with sciatica, sacroiliitis, synovitis, and meralgia paresthetica are also contributors to severe hip pain, says Mayo Clinic. People may suffer hip pain due to injury, as well. Falls are a common cause of hip pain, especially in older adults.

How a person can reduce pain in the knees and hips

Athletes who participate in sports may reduce their risk of injury by wearing an elastic brace to support the knee. Waitresses, cashiers, and others who spend a lot of time on their feet would do well to invest in a good pair of soft-soled shoes. Good sports shoes can help. Adding custom orthotics to work and sports shoes may offer an additional line of defense against knee and hip pain. A quality mattress may offer some amount of protection against hip pain. Maintain a healthy weight to reduce the risk of joint pain as well as a range of debilitating health issues.

The Arthritis Foundation recommends exercise to strengthen the ligaments and muscles that hold the knee together. Tai chi and swimming are both excellent exercises that offer health benefits without high impact to delicate knees and hips. Some people find relief via acupuncture and other alternative therapies. Using a cane may reduce pressure on the knees, but can lead to hip trouble unless the cane is a perfect fit and properly used.

Surgical interventions

Replacement joints made of ultra modern materials are a viable option for many persons who deal with unrelenting knee and hip pain. To find out if you are a good candidate for joint replacement, ask your physician for a referral to a quality surgeon, such as the doctors who offer hip replacement surgery by Orthopedic One.

Joint lavage and arthroscopic debridement involve the removal of tissue fragments from within the knee along with a sterile saline flush of the knee joint. The treatment is a bit controversial, and not recommended by all experts. Glucosamine and chondroitin supplements work for some people, but again are not recommended by most orthopedic doctors.

Protect your knees and hips by staying strong and maintaining a healthy weight. If you do suffer from knee and hip pain, see a specialist without delay.   Get the right kind of shoes.

Connor Sheppard has a medical background, today working in eldercare. Always wanting to help people, and full of useful info, Connor writes articles on a number of healthcare topics.

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The majority of children who are born with or develop hearing loss are born to parents with normal hearing, so it means the family has a lot to learn about dealing with the issues of the condition. The most important thing is to get your child diagnosed and examined by a professional as soon as possible, so they receive the right treatment. Hearing is very important in childhood for the development of speech and language.

The Signs of Hearing Loss in Children

A child should visit the doctor for a check-up on their hearing if they:

  • Do not look or reply when you call them.
  • Are taking longer than average to speak.
  • Speak with a muffle or speech is unclear.
  • Talk loudly.
  • Cannot understand what you say, ask you to repeat yourself or have to intently watch your mouth to see what you are saying.
  • Respond inappropriately to what you say or watch what others do and copy as they haven’t heard you properly.
  • Turn up the volume loudly or sit closer to the television to listen.
  • Have difficulty with paying attention.
  • Do not get startled by sudden loud sounds.
  • Are unable to figure out where a sound is coming from.

Being aware of the main signs of hearing loss in children is important so the problem can be identified as early as possible.

Causes of Hearing Loss in Children

There are 3 main causes of hearing loss in children:

  • Otitis Media – Due to the fact that the middle ear is not fully formed, this ear infection happens frequently to young children. Even if there is no pain, there becomes a build-up of fluid behind the ear drum which can become infected and cause hearing loss which can be temporary or permanent.
  • Congenital – Hearing loss is one of the most common birth defects and can occur through the genetics of the child, from problems during pregnancy or a premature birth.
  • Illness or Injury – If a young child acquires an illness such as meningitis, measles, chickenpox or the flu they are at risk of losing their hearing. Side effects to certain medicines and head injuries can also cause hearing problems.

Evaluating and Treating Hearing Loss in Children

There is a popular myth that children cannot be accurately tested for their hearing until they are over 5 years old. This however is very much untrue, and the hearing of children can now be tested from when they are just a few hours old, and at any age. Identifying hearing loss in a child early is beneficial to their language, speech and cognitive development. Hearing loss does not necessarily mean deafness, there is a wide range of hearing losses from mild to severe and even if a child is responding to sounds, there can still be a less apparent problem with hearing.

There are many ways of testing the hearing of children, depending on their age and abilities. Visiting a doctor for a check-up and evaluation is vital for taking the first steps, and if a problem is found they can be referred to a specialist for treatment. Treatments will vary depending on the cause of the hearing loss. Some treatments are very simple such as removing wax with drops or a syringe, and treating an infection with antibiotics. More complicated treatments include surgery to correct the hearing bones, a perforated eardrum or to remove fluid build-up. If the hearing loss is permanent due to damage of the nerves in the inner ear, treatments available include hearing aids and cochlear implants.

 

 

 

 

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I’m deeply concerned that trust between disabled people and the state in relation to employment has been eroded – to such an extent that offers of employment support get viewed through the filter of possible sanctions and benefit loss.

For instance, we sometimes see protests against employment programmes run in GP surgeries and the like. Even where such programmes state they are voluntary and have a commitment to confidentiality of data, disabled people fear they could become mandatory at a later stage, that data could be shared with DWP, that taking part could impact on benefit eligibility (and more).

Since the regime of the (broken) Work Capability Assessment and sanctions came in, activities linked to the state (whether the NHS or any organisation contracted by government) seem to get tainted by the fear of compulsion – and fear of poverty. When benefits can be reduced just because you don’t comply with something meaningless or worse (like CV writing courses when you have a CV but no employer prepared to take you on with your sickness record) it’s not surprising people feel afraid.

On the other hand, if you ask disabled people what they want from services, support to get or keep a job is almost top of the list. The largest group of people on ESA are those with mental health problems (48% of incapacity-related claimants have a mental health problem as their main impairment[1]).

A 2015 national survey of people with mental health problems found that only 25% got employment support; 47% said they didn’t get it but wanted it. Compare this to the figures for getting talking therapies/treatment – the exact opposite: 47% got talking therapies, and only 25% said they did not but wanted it.

The survey – and studies of other groups of disabled people – show repeatedly that people are not getting the support they want with life issues and not getting the peer support they want: 43% in this survey didn’t get support with accommodation but wanted it, 48% didn’t get support from others facing similar challenges but wanted it. There was nowhere near this level of dissatisfaction on any of the treatment questions. And the dissatisfaction with lack of employment support has got worse since 2014.

Incidentally, as Rachel Perkins and Julie Repper have pointed out[2], this does rather beg the question of why mental health organisations are campaigning so hard for more treatments, beds and other traditional mental health services when what people want most is support with housing, employment and benefits.

The survey also shows that there is a desperate need to meet the demand for employment support. People – simply – want jobs and careers. They generally don’t want to lose their jobs if they develop health conditions and do want to get jobs when out of work.

There are several learning points from this.

First we should campaign vigorously against sanctions and the culture of coercion and fear that they engender. If they frighten people off even voluntary employment support something is going very wrong – and the government’s own plan to halve the disability employment gap is undermined.

Second, we need collectively to develop alternatives to coercive employment support. Disability Rights UK is working with DPOs and with the Work Foundation to identify good practice – based on peer support; and with DPOs we have proposals that would make careers massively more flexible, with incentives and support for employers to do so and opportunities for large numbers of disabled people to get skills and apprenticeships that equip them for careers, not just jobs. This could include people being able to work when well – with back-up from the state in the form of better support for both disabled people and employers. And let’s not forget this is against a backdrop of the dismal track record of the Work Programme and Work Choice. We need alternatives that work for the people they are there to serve.

20 years ago as disabled people we campaigned for the right to work, the right not to be underestimated or written off. Since the sanctions regime kicked in, campaigns have grown for the right not to work – to have the realities of impairment, pain, fatigue and confusion recognised. ‘Impairment impairs’ as Pat’s petition puts it. In this climate, any emphasis on employment can be treated with suspicion – seen not as meeting what disabled people want, but as promoting the agenda of the state to compel people to do inappropriate work or work-related activity.

We need to campaign against the poison of coercion and sanctions; and to argue vehemently for an expansion of the voluntary employment support that people want.

For people to seek careers, we need hope. The very last thing we need are cultures of fear.

So let’s campaign for employment support – and against coercion. It isn’t one or the other – it’s both. We shouldn’t throw away the baby of employment support with the bathwater of coercion.

And as people try approaches to employment support that aim to be better than the Work Programme – let’s subject them to scrutiny. If they are voluntary, if they respect everyone’s confidential data, if they foster hope and opportunity – then let’s support them and learn from how disabled people find them. If they don’t – let’s campaign against them.

[1] Reform (2015) Employment and Support Allowance: the case for change. Seehttp://www.reform.uk/wp-content/uploads/2015/12/Employment-and-Support-Allowance.pdf

[2] Perkins R and Repper J (2015) ‘Parity of esteem’ for mental health services or parity of life chances for those experiencing mental health challenges? Mental Health and Social Inclusion 20 (1) p 1-4

This was first published on the Disability Rights blog

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If you’re living with a disability (or know someone else who does), then you’re probably all too aware of how unsupportive the environment can be. There are a variety of issues faced by differently abled people every day as they try to navigate the world around them and live as normal a life as possible. There is no reason for anyone to be restricted in this day and age. This is why more and more organizations are getting in on the inclusion bandwagon and making efforts to provide the necessary assistance for those with special needs.

It may be as simple as wheelchair access in every building, or specially built vehicles being commercially available. Nonetheless, it is getting increasingly easy for people with special needs to have those needs met, and gain a better quality of life. So how has this been possible? What kind of new assistive technology options are now so freely available?

Transport

A lot of people with disabilities or impairments have vehicles that they can use themselves and easily travel from place to place. There are services that offer transport for the disabled, however, which they can opt to use personal vehicles when the required technology cannot be bought or operated. These vehicles are well equipped and spacious, and are commonly used by health and care institutions, but also by private citizens.

In addition, services such as these even offer transportation door to door, and it is not uncommon for even senior citizens or private groups to rent out a vehicle which can pick each individual up and drop them off after a trip. This is one way that people with special needs can easily have a sense of normalcy. They do not need to be isolated and alienated, or miss out on the outside world.

Exoskeletons

For people who have problems with mobility, exoskeletons are devices that can essentially help them overcome such issues. The exoskeleton, once set up, can make you walk if you’re paralyzed from the waist down, getting you past the stairs when there is no wheelchair access. These may be a little costly, but they are technological innovations that are now freely available in the commercial market.

Text-to-Speech Devices

These gadgets are becoming increasingly affordable and popular, and are beloved for the way they give voices to those who cannot speak. They also enable those who having hearing impairments to communicate faster and more easily. Even people who have ocular damage or blindness can benefit from such technology, such as by having books, computer documents, and e-mails read out to them by the automated voice.

Home Automation

Technological advancements mean that many people with disabilities can achieve as normal a lifestyle as anyone else, because now an entire house can be automated. Speech recognition is a central feature of this, and voice activation can essentially get anything done, from your laundry to your cooking!

So as you can see, the world is no longer as limiting and challenging as it used to be for people with disabilities. Every day technology is advancing rapidly, and things like bionic arms and legs are becoming part and parcel of our lives. It’s hard to say what might turn up tomorrow, but if the trend keeps up, the term “disability” will soon be a thing of the past.

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The biggest secret of personal budgets is no one wanted them, not users, not professionals, not the government, and not even Simon Duffy. We all wanted Individual Budgets! The idea of individual budgets was that funding from local authority social care, Independent Living Fund, Access to Work and others would come together to form a single budget, great idea.

I was part of the Individual Budget pilot in Coventry and maybe one of the few people in the country who can claim they still have an individual budget. The problem was the Independent Living Fund refused to cooperate and I don’t think Access to Work had a clue what it was. So Individual budgets quickly became personal budgets that only focused on local authority funding but unlike a direct payment, it could be, and is often, merely an itemised bill of what is spent on behalf of a user.

The problem with personal budgets was they came with the demand from DH ministers that local authorities adopted the Resource Allocation System (RAS), the brainchild of Simon Duffy. I know he will be reading this and that we have not been on each other’s christmas card list for many years, and we have actually never met. I will let Duffy explain what RAS is. RAS works well when you are sharing out a packet of sweets to those who don’t really depend on them. Decommissioning unneeded day care services for people with learning difficulties, taking out the savings, and divided the money up ‘fairly’ so they can be used creatively, works. But transferring the Resource Allocation System model en mass to all the client groups was a disaster as a ‘right’ quickly became an ‘indicative budget’ and a pointless exercise of a failed policy that wasted so much money.

The bigger picture in that sadly even if you brought all the cutting edge ‘disability activists’ in the country in one room, they would be metaphorically discussing improving the treatment of black slaves, not their liberation. There is now a clear divide in how current politics and the media generally regards people with lesser impairments and those with higher support needs. I am aware that considering SHA asks me for a contribution knowing my unusual background, many readers will refuse to acknowledge this fact. But it is a fact the new/old Labour Party needs to understand and work with, and meaningful personal budgets is one solution.

One of  the oddest issues I have had working in the social care field is that despite people understanding I employ my own personal assistants and I am self-employed, I am still politely asked by the most senior of people who pulls my strings as they hope there is a comfortable and acceptable puppet master who is keeping me under control when I misbehave. When the penny drops I am the puppet master, you can see the colour go from their faces!

I believe real personal budgets is about creating puppet masters not puppets. This is extremely scary for national and local government, professionals, charities (like Learning Disability England), service providers and even families, who have depended on disabled people being puppets for power, financial benefits and other reasons for many decades. Trying to get people to let go of this power is the greatest challenge of social care as this is not happening as fast as some people would suggest.

If I had the opportunity to start again with personal budgets and change any laws, I would scrap every ‘additional cost’ monies and benefits like DLA/PIP, a part of ESA, current local authority funding, Access to Work, education and health support etc and roll it into one super personal budget. These would be coproduced between professionals and users, and made up from a number of awards designed by them, like work, evenings and weekends, so someone does not have all their eggs in the same basket in terms of reassessments.

These new personal budgets will be managed by local public bodies, like ‘Support Coventry’ connected to local councils and working within the national framework of ‘Support England’. Depending on the level of funding, it will go to ‘panel’ that will include trained service users from other areas. Most importantly, there will be an effective appeals and complaints system.

We need to end label based entitlements whether they are real, imagined or expected. Having diabetes or any other impairment label should not automatically mean being entitled to a Motability Car. People should get what they need when they need it. Two people with the same degree of any specific condition may actually have a very different set of needs and outcomes.

My impression from many discussions with people over the last decade is that my idea of ‘super personal budgets’ is on the cards and its a matter of time whoever is in power. The current way disabled people need to access relevant support is broken culturally and functionally, going back to 1948, and this is the way out for a fresh start.

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…the evidence below appears to indicate that it will…

Working welfare: a radically new approach to sickness and disability benefits

(Charlotte Pickles, Ed Holmes, Hannah Titley, Ben Dobson, February 2016, Reform Research Trust)

In the UK many disabled people want to work but are trapped on what remains a broadly passive system – almost three quarters of claimants who have had their Work Capability Assessment (WCA) are in the support group with no requirement to engage with, and little access to, support services. As the Organisation for Economic Cooperation and Development has argued: “what is needed is to bring the disability benefit scheme closer in all its aspects to existing unemployment benefit schemes”.

(Charlotte Pickles: Senior Research Director at Reform spent two years as Expert Adviser to Iain Duncan Smith helping to design and deliver the Government’s welfare agenda. Before that she was Policy Director at the Centre for Social Justice.)

Chancellor George Osborne’s Spending Review and Autumn Statement 2015 speech

From: 25 November 2015

We confirm we’ll extend the same support and conditionality we currently expect of those on JSA to over 1 million more benefit claimants…we’ll increase in real terms the help we provide to people with disabilities to get into work.

Working welfare: a radically new approach to sickness and disability benefits

When ESA was introduced it was expected that “the vast majority” of claimants would be subject to “a clear framework of rights and…responsibilities” – a minority of claimants would be in the support group. Instead, almost three quarters of claimants who have had their assessment are in the support group and subject to no conditionality, with very little support to return to work. This will have to change if the Government is to achieve its ambitious pledge to halve the disability employment gap.

THE CONSERVATIVE PARTY MANIFESTO 2015

We will aim to halve the disability employment gap: we will transform policy, practice and public attitudes, so that hundreds of thousands more disabled people who can and want to be in work find employment. We will help you back into work if you have a long-term yet treatable condition. We will make sure the hardest to help receive the support they need for a fulfilling life.

Working welfare: a radically new approach to sickness and disability benefits

With limited access to employment support and no work-related conditionality, people in the support group are completely detached from the labour market…This is bad for the individuals, society and the wider economy.

Rt Hon Iain Duncan Smith MP: speech on work, health and disability: Reform event 24 August 2015

We need to be relentless in our efforts to get more people into work and off welfare…that means getting 1 million more disabled people into work. The poor quality of support they receive leads too many sick and disabled people languishing in a life without work, when work is actually possible for them. Under Universal Credit, people can expect early and continued support about what work they can do and what support they need to do it, until they leave the benefits system.

Working welfare: a radically new approach to sickness and disability benefits

The vision for a single allowance: In practical terms, a single out-of-work allowance would mean removing the support group component, or in UC, the LCWRA element. [LCWRA is Limited Capability for Work Related Activity].

The ‘Limited Capability for Work-Related Activity’ descriptors only require one to be satisfied for admission to the ESA support group… 60 per cent of those in the support group have been on ESA for more than two years.

The Welfare Reform and Work Bill

As stated in the Explanatory Notes published by the Department for Work and Pensions, the Bill seeks to introduce the following measures:

  • Removing the work‐related activity component in Employment and Support Allowance [ESA] and the limited capability for work element in Universal Credit.

The Bill’s third reading in the House of Commons took place on 27 October 2015. Speaking on behalf of the Government, the Minister for Employment, Priti Patel: “Our welfare reforms are focused on transforming lives by helping people to find and keep work. We are focused on boosting employment and ensuring fairness and affordability, while supporting the most vulnerable, and on making sure that people on benefits face the same choices as those not on benefits and in work”.

Rt Hon Iain Duncan Smith MP: speech on work, health and disability: Reform event 24 August 2015

Under Universal Credit, people can expect early and continued support about what work they can do and what support they need to do it, until they leave the benefits system…with ESA becoming part of Universal Credit it is that access and human interface which opens the way for us to re-think the relationship between sickness benefits and work. I want to look at changing the system so that it comes into line with the positive functioning of Universal Credit. A system that is better geared towards helping people prepare for work they may be capable of, rather than parking them forever beyond work. We need a system focussed on what a claimant can do and the support they’ll need – and not just on what they can’t do.

Working welfare: a radically new approach to sickness and disability benefits

The Occupational Health Plan and personal budget – The Proximity to the Labour Market Diagnostic will result in a score which will determine which of four broad employment support and conditionality regimes the claimant will be placed in. If the health questionnaire triggers an Occupational Health Assessment [this] will be used to develop an Occupational Health Plan, which would be accompanied by a personal budget to facilitate implementation. This rehabilitative programme will be co-created by the health professional and the claimant, and the personal budget will be unlocked via a ‘dual key’ – the claimant and their employment adviser – to increase choice and control. For example, a plan might include talking therapies and recreational activities for suffers of mental health conditions. Those with muscular skeletal conditions might receive a course of physiotherapy. Once the plan is agreed, it becomes subject to conditionality.

Adult Improving Access to Psychological Therapies (IAPT) programme

The programme has already helped over 100,000 people move off sick pay and benefits. In the coming year, the focus for the programme of work will be on the following areas:

  • working with services to address the wide variation in access and quality
  • increasing the integration of psychological services with persistent physical health conditions
  • strong focus on support for those in employment or seeking employment
  • exploring how other mental health services can adopt an IAPT-like approach to service delivery i.e. outcome-focused; with core standards and performance monitoring; and developing datasets to build the evidence-base.

Working welfare: a radically new approach to sickness and disability benefits

Occupational Health Plan conditionality: The Government is now considering whether claimants who are unable to participate in the labour market due to ill-health might also be subject to greater conditionality relating to that condition. In February 2015 the Prime Minister announced that he had asked Dame Carol Black to undertake a review to “consider how best to support those suffering from long-term yet treatable conditions back into work or to remain in work”, including “consider whether people should face the threat of a reduction in benefits if they refuse to engage with a recommended treatment plan.”

The requirement would simply be that individuals claiming out-of-work benefits due to a mild or moderate health condition which with support could be treated or managed should be expected to take reasonable rehabilitative steps. The Government should pilot this approach to ensure it is applied sensitively and

appropriately, before rolling it out as part of the UC model.

The new out-of-work benefit model laid out in the previous two chapters allows a more personalised approach to conditionality for benefit recipients with a health condition. Effective conditionality helps to ensure claimants are taking the necessary steps to move off benefits and into work, thereby improving their health and wellbeing.

THE CONSERVATIVE PARTY MANIFESTO 2015

People who might benefit from treatment should get the medical help they need so they can return to work. If they refuse a recommended treatment, we will review whether their benefits should be reduced. We will also provide significant new support for mental health, benefiting thousands of people claiming out-of-work benefits.

DWP Central Freedom of Information Team

Increasing disability employment is a key part of the Government’s aim to achieve full employment. That is why this Government is committed to halving the disability employment gap by creating the opportunity for a million more disabled people to work. The Spending Review announced a new ‘Work and Health Programme’ which is intended to provide the best possible support for claimants with disabilities or health conditions as well as those who are long term unemployed. The Department will work with stakeholders on the design, including the structure and how people will be referred to the programme. (DWP Strategy FoI Team)

Working welfare: a radically new approach to sickness and disability benefits

The more than 1.3 million people currently in the ESA support group have been completely written off.

Policy paper: Spending review and autumn statement 2015 (Updated 27 November 2015)

As the numbers claiming unemployment benefits come down, spending on employment programmes can also fall. But at the same time, there is more to do to ensure that as many people as possible can benefit from the growing economy and higher wages. The Spending Review and Autumn Statement announces further measures to support people into work:

  • doing more to get people into work and make the system fairer – Universal Credit will extend the same Jobcentre Plus support that people on Jobseeker’s Allowance (JSA) get to 1.3 million additional claimants who currently get little or no support, by 2020
  • introducing a new Work and Health Programme after current Work Programme and Work Choice contracts end, to provide specialist support for claimants with health conditions or disabilities and those unemployed for over 2 years

Increasing employment levels amongst people with disabilities and health conditions is a key part of the government’s aim to achieve full employment…the benefit system continues to deliver poor outcomes for people with disabilities and health conditions. Universal Credit will provide greater up-front support for claimants with disabilities and health conditions from the start of their claim and enable them to be referred to specialist support from day 1 where appropriate.

In addition to these measures the government wants to improve links between health services and employment support, recognising timely access to health treatments can help individuals return to work quicker. The government will publish a White Paper in the New Year that will set out reforms to improve support for people with health conditions and disabilities, including exploring the roles of employers, to further reduce the disability employment gap and promote integration across health and employment.

Lords Hansard text for 07/03/2016 Welfare Reform and Work Bill Commons Reasons Motion A Moved by Lord Freud

Lord Kirkwood of Kirkhope (LD): “we must now engage in careful and urgent monitoring across the piece of how the ESA support group is catered for in future.”

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Disabled people should not be divided into the ‘cans’ and ‘cannots’. Choice and control are not all-or-nothing characteristics, but can be nurtured through the (extra)ordinary skills of those who take up roles as personal assistants or support workers. By looking at how these relationships play out in real life, people with intellectual disabilities themselves can help us learn more about how to manage practices in respectful ways – and to avoid practices which become neglectful or abusive.

Inclusive research, where people take active roles within a project, is in itself a way of achieving ‘choice and control’. And just like with direct payments or personal budgets, inclusive research works best when there is good support from other people who will listen to you, and help you decide things for yourself. In light of the frequent scandals in English social and health care, it may seem more important to protect and safeguard people with intellectual disabilities, rather than to understand their rights to decision-making. However, we need to pay detailed attention to their everyday lives. Otherwise, we are at risk of assigning them to a special sub-category of disabled people whose life chances depend on consumerist models of care.

This theme about making decisions with others is reflected in a recently published study about the process of support planning, in which we tried to unravel the blanket of assumptions which sometimes prevent people with intellectual disabilities from enjoying their rights to ‘choice and control’. With the implementation of the new Care Act the principle of ‘wellbeing’ lies at the heart of both assessments and support planning. Yet a personal budget user tends to be treated in practice either as someone who ‘can’ do it for themselves, or as someone whose family and carers will protect them from making the wrong decision.

Our research about support planning asked people with intellectual disabilities themselves about their experiences with personal budgets. Their words led us to believe that people can grow more confident in managing their relationships with others, and that increased self-confidence will mean a better chance of being in control of their lives. Three important areas of focus stood out:

  • Identity matters: People in this study demonstrated in their interviews how they relied on praise and encouragement, and when this was not forthcoming, they became anxious or unsure of themselves.
  • People in your life: One woman in our study said: ‘I’ve got control. You know, me and [my personal assistant] can sort of sit down and we’ll work out dates and that.’ However, there was a tendency to see oneself as always at fault, as morally unworthy, and certainly as a constant learner. The phenomenon of ‘control’ was not seen as an individual accomplishment, but as something that was enacted together with others, and some spoke of the professional staff who supported them by first name, and considered them to be potential friends and people to trust with problems.
  • Personal budget processes: When it came to the actual processes involved in a personal budget, our participants showed considerable confusion. They generally liked the idea of ‘meetings’, but relied on others telling them what would happen in those meetings which seemed a little like oral One man whose review meeting was coming up said: ‘I’ll just listen to what they say. Just wait and see…I don’t know until I get there’. Despite all this, several people spoke about the value of trust in relationships they enjoyed with friends and peers in self-advocacy groups, with their personal assistants, and other practitioners. They all wanted an approach which was truly personalised, and they cared about the small details in their day-to-day living and in taking action to give something back to the community.

What does all this mean then for policy? One of the key points is that functional ability and skills should not be confused with the right to choose, with ‘autonomy’. People should not have to prove their abilities in independence skills, before having the right to live the life they want. This shift towards a personalised focus on the identity of an individual is the meat of person-centred planning.

Equally, with the trust placed in one’s own supporters, the skills of a personal assistant to step back andfacilitate choice are very much at the heart of a successful personal budget. More attention to the detail of personal assistant practices and relationships will help us to see how they can get stuck, how support practices can move from being mutually supportive towards becoming defensive, judgemental and even abusive.

Conversely, of course, we can also look at these relationships to see how positive facilitation and support takes place. This is what our new research is doing, with a focus on understanding social practices in ways that help us to make changes, on the terms of people with intellectual disabilities themselves. ‘Getting Things Changed’ is planned and carried out in co-production with disabled people, and one of the strands of this project is working with a local drama group, The Misfits, to help us understand the way in which young people with intellectual disabilities learn those ways of being more confident in themselves, in interaction with a personal assistant.

First published on the British Politics and Policy blog

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On Friday, campaigners from Disabled People Against Cuts, Mental Health Resistance Network and Boycott Workfare staged a stormy protest outside City Road Medical Centre in Islington, against the introduction of ‘job coaches’ into GP practices, under the rubric of ‘integration’ and ‘joined up care’.

In fact, the arrival of job coaches in Islington GP surgeries exposes the toxic reality of government plans to merge health and employment services. In a move that is both unethical and unsafe, health professionals are being tasked to deliver benefit cuts for the Department for Work & Pensions (DWP). This involves  a raft of measures to support the imposition of ‘work cures’, including setting ’employment’ as a clinical outcome and allowing employment coaches to directly update a patient’s medical record.

Islington GP Pilot

NHS Islington Clinical Commissioning Group (CCG), who oversee local health care, has accepted DWP funding to ‘drive employment outcomes through strategic health commissioning’, in a move intended to enforce the mantra that ‘work is good for you’, whether it is or not.

Jobs on prescription‘ targets people with long term mental health conditions and is being piloted in seven Islington GP practices, as part of a £90K collaboration between the council, the Jobcentre, DWP, and Islington CCG. In other words, a partnership between healthcare and the government departments responsible for administering benefits, including the punitive and unaccountable sanctions regime – a system which is known to disproportionately affect people with mental health conditions, as well as disabled people and those with long term health conditions’ please.

Destroying patient trust

The first casualty of government efforts to interfere with clinical judgment is trust. The scheme will undermine trust between doctors and patients and could discourage disabled people and people claiming benefits from using healthcare at all, if doing so is seen to be linked to pressure to find paid work or loss of benefits. An activist from Disabled People Against Cuts warns that

many disabled people already feel they have to watch every word they say when seeing their GP, in case it is used against them at some point to stop their benefits. Placing Jobcentre-funded staff in doctors’ surgeries could destroy the doctor/patient relationship and may lead to some people not accessing vital healthcare when they need it most. Many will feel that the GP surgery is not a safe space to discuss their health concerns if a GP can prescribe job coaching. This pilot will pile pressure on patients in mental distress who are already suffering.”

Discredited private contractor Maximus

Employment coaches for the pilot are provided by Remploy (the recently privatised employment service for disabled people). Remploy is owned by Maximus, the private company contracted to carry out Work Capability Assessments (taking over from ATOS). Work Capability Assessments have been independently associated with an increase in suicides, self-reported mental health problems and antidepressant prescribing, and found by a judicial review to ‘disadvantage people with mental health problems, learning disabilities and autism’.

Evidence that Maximus falsified the results of ‘fit for work’ tests has been raised in parliament and their conduct in both the US and UK has been very widely criticised by claimant and disability rights groups.

Maximus was also recently accused of trying to bribe doctors away from the NHS with salaries well above average rates to carry out ‘fit for work’ assessments. It is difficult to imagine any organisation less suited to working in partnership with primary care or with a worse record in relation to mental health and disabled people.

JobcentrePlus Invasion

The Health and Work Programme for Islington explicitly aims to integrate employment support in the ‘map of medicine’ that doctors are pushed to use to inform their decisions. The programme fully intends to get people into work, whatever their circumstances, and – through the new, improved ‘fit note‘ and ‘fit for work’ programme (also delivered by Maximus) – to keep them working, whether they are sick or not.

In a move that will worry many GPs, Islington Health and Wellbeing board intend to make “employment status” part of the Patient Held Record. Every health care professional will soon be obliged to prescribe the work cure, whether or not they (or the patient) believe this is in the patient’s best interests. This is the real meaning of the board’s stated intention to “embed employment into the ‘wiring’ of the healthcare system”.

The Islington pilot is part of DWP efforts to place Jobcentre advisors in libraries, in schools, and even in foodbanks – whose use has skyrocketed in the last six years. The presence of the Jobcentre turns these into places where people are coerced into work, no matter how ill-paid, precarious, or unsuited to their skills and other responsibilities. DPAC and the Mental Health Resistance Network said:

“At a time when some claimants have been driven to suicide by the constant bullying, assessments, threats and sanctions that now form part of the UK’s benefits system, there must be no place in the NHS for Jobcentre busy-bodies. Disabled people, benefit claimants and supporters can and will defeat this appalling attack on the fundamental principle that healthcare professionals should ‘first do no harm’.”

These takeover plans do not end with health. The DWP aspires to ‘join up’ all public services to ‘get local people back to work’, including transport and housing. These developments also support the extension of benefit conditionality – the hoops you have to jump through to be eligible for benefits – to a much wider range of people and a much wider range of circumstances.

Mandatory referral

To date there has been no consultation with patient or claimant groups. It is unclear whether there are safeguards in place e.g. to ensure patients are told that choosing not to see the job coach will have no impact on either their health care or their benefits. A promise from Richard Watts, leader of Islington council, that the scheme is entirely voluntary is not reassuring, given that the whole idea behind the scheme is to ‘promote the idea of employment for people with health conditions’. Both service users and health professionals have every reason to suspect that patients will feel under pressure to agree to see a job coach and that over time the scheme will become mandatory.

A spokesperson from MHRN said:

“our concern is that this scheme will not be voluntary. Over time it will become mandatory and lead to sanctions and loss of benefits, as the doctor becomes part of the DWP scheme to force claimants into low paid or unsuitable jobs that will undermine the patient’s condition.”

The case for mandatory treatment for people with long term conditions (first flagged up in the Conservative Party Manifesto) is currently being reviewed, including whether benefit entitlements should be linked to ‘accepting appropriate treatments or support’. Such a move would have extremely serious implications: consent is invalidated if it is given under duress, for example if it is linked to loss of benefits or the fear of loss of benefits. Nevertheless, this is precisely the direction that government policy is moving in and represents a serious threat to the independence of health professionals and to the human rights of patients.

Unemployment labeled a psychological disorder

The Islington pilot comes at a time when unemployment is being branded as a psychological disorder, for which work is the cure. Welfare-to-work companies bid for lucrative contracts to deliver Entrenched Worklessness Provision to ‘change the hearts and minds’ of unemployed people. There are further plans to locate iCOPE (Camden and Islington Psychological Therapies Service) staff in Islington jobcentres, compromising their clinical judgment by embedding them in a coercive ‘back to work’ environment. Commenting on these developments, Paul Atkinson, a psycho-therapist for thirty years, said:

While health care professionals see the experience of being in sustainable employment as potentially therapeutic for some patients, it’s naive to believe that welfare-to-work policies are led by the interests of the individual unemployed benefit claimant. I am afraid the DWP is a toxic brand for most claimants, and I think for a growing section of the public”.

Such plans also mean placing therapeutic services in a setting responsible for administering the benefits system, including sanctions. A member of Boycott Workfare said:

Support for unemployed people has little to do with helping people apply for jobs or get useful training. Increasingly, it is about making people express a positive attitude to unpaid work and short-term, low wage jobs – under threat of sanctions or other punishments.

Enforcing the work cure

Justification of the Islington pilot relies on a ‘work is good for you’ mythology that denies the reality of the labour market: the stark inequalities in pay, conditions, and security that make it entirely misleading to talk about ‘work’ as if everyone benefits from it.

For many disabled people who do have the capacity to work, gaining a decent quality, fairly paid, stable job does improve their independence and quality of life. And many disabled people do work, and others who can work yearn to have this kind of job.

But this end of the jobs market is often closed to disabled people, with employment discrimination rife and little or no enforcement of the Equality Act. Cuts to government support, (including the access to work budget), which previously enabled disabled people who can work to gain employment, mean that disabled people have to ‘make do’ with low-paid, short term, low-end jobs for exploitative employers. While the government sinks funds into coercive programmes, funding for Motability and Access to Work has been cut – these are schemes that have provided real practical support to disabled people who wanted to obtain or stay in work. A member of Boycott Workfare said:

“we’re always receiving complaints from people who are trying to continue with courses that would give them real skills and qualifications, who face pressure from the DWP to abandon them for workfare or farcical ‘training’ from DWP contractors.”

For growing numbers of people, work does not provide a wage you can live on; for others, it is something feasible on some days, but then not for weeks at a time – a fact that the DWP is determined to ignore. Work is not necessarily ‘good for your mental health‘ either: for many people, especially those in unpaid or low paid, insecure jobs, the workplace is a site of long hours, exploitation, petty tyrannies, bullying and stress.

Mental health services ‘ruining lives’

Islington’s decision to invest in job coaches in GP surgeries comes at a time when mental health services have been neglected, marginalised and under-funded for years, when services are so bad that lives have been “put on hold or ruined” and “thousands of tragic and unnecessary deaths” have been caused. It comes at a time when many people are blocked from accessing the services and support they need, including physical health care. People with mental health problems already have a lower life expectancy of nearly 20 years, mainly due to preventable physical illness. Mental Health Resistance Network said:

Where is the parity of esteem that the government keeps shouting about? How are barriers to accessing healthcare addressing our lower life expectancy?”

The pilot has been designed without any consultation whatsoever with mental health, disability rights or claimant groups, who are wholly opposed to the scheme and the values underpinning it. DPAC said:

“patients will simply not engage with the health care system with schemes such as this. They will be too afraid if the result is further pressure, further mental distress and further harm. We can see this scheme, if it is rolled out, having a tragic human cost and driving a patient to suicide if pushed. That is not what a doctor should be involved in. They should support the patient and remember the ethics of why they became a doctor in the first place: to care for the patient and above all else Do No Harm.”

Fighting back

Last year, plans to put Improving Access to Psychological Therapies (IAPT) services in 350 JobCentres led to major protests. 400 mental health professionals signed a letter opposing the imposition of ‘back to work’ therapy and describing linking social security benefits to “state therapy” as ‘totally unacceptable’. The protest against job coaches in GP surgeries is attracting even greater support, as growing numbers of health professionals, patients, activists and concerned members of the public come together to protect the fundamental principle of medical care: first do no harm. We will fight any efforts to merge our health services with services responsible for benefit cuts and benefit sanctions. We call on Islington CCG and its partners to immediately terminate this scheme.

By Lynne Friedli and Robert Stern

First published by Our NHS

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