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    There are two areas where the Association may have something useful to contribute to the debate which the Labour Party must  have about social security.

    Firstly, the assessment of disability and capacity for work.  Our policy is that assessment should be carried out by the NHS and that there should be a non means tested benefit to meet the additional costs faced by disabled people. The assessment process would be improved if all health records about a patient were linked together. The present assessment processes are perceived as oppressive and coercive and are conducted by commercial organisations which appear to be target driven to harass claimants.

    Secondly, Basic Income. This is something the Association has been interested in since the early 1990s.  Renewed fears of the impact of automation on employment has renewed interest in what is also called Citizen’s Income – An unconditional, nonwithdrawable income paid to every individual as a right of citizenship.  Trials are going on in several European countries.  Basic income would remove some of the difficulties in the assessment of capacity for work, and the oppressive effects of means tested benefits, which still have a profound disincentive on many disadvantaged people, who face the loss of somewhere between 60% and 100% of any increase in their income.

    There are considerable difficulties in moving from our present oppressive benefit system to something which might support, in several senses, the most disadvantaged in our society.  We should not forget that the most important part of the beginning of the welfare state in 1911 was not the provision of medical services but the institution of  sickness benefit.  The working of the benefit system now appears to be a substantial cause of illness among vulnerable people.

    The Association’s expertise in benefit issues is confined to a small number of members, but I think in these areas we can and should make a submission to the Labour Party, and we should encourage a wider debate.

    Tagged | Comments Off on Towards a policy on Social Security

    The government promised to help disabled people back into work. They’re failing – and now it looks like their Welfare Reform is targeting those who need higher levels of support.

    The Government published its long-awaited ‘Improving Lives: Work, Health and Disability’ Green Paper at the end of October 2016 after originally promising a White Paper in 2015. The White Paper was supposed to define how disabled people would be supported into work and meet the Government’s manifesto pledge of halving the disability employment gap of 34% by 2020 (currently it stands at 32%).

    The employment gap was used to justify further draconian cuts in social security support for disabled people in the Welfare Reform and Work Bill published last summer. In particular, the Bill announced cuts of approximately £1,500 a year in Employment and Support Allowance to half a million people in the Work-Related Activity Group (ESA WRAG) – those people who had been found not fit for work, but who may be in the future – to be introduced in April 2017.

    The 2016 Welfare Reform and Work Act followed the 2012 Welfare Reform Act which Scope estimated by 2018 will have cut nearly £28bn of social security support to 3.7m disabled people. Of course this doesn’t include £4.6bn cuts in social services support since 2010 or the NHS crisis, both of which affect disabled people.

    The Green Paper, the consultation for which closed on 17th February just 6 weeks before the ESA WRAG cuts come into place, makes the bold claim that ‘…employment can…promote recovery.’

    The issue I have with this statement, and the tone of the Green Paper as a whole, is that this implies that disabled people and people with chronic conditions would recover if only they tried a bit harder, or their doctors weren’t such soft touches. It doesn’t mention ‘shirkers’ directly but comments on how some people with the same condition languish in the ESA Support Group whilst others “flourish at work”, making it clear that’s what they’re thinking, ignoring their own rhetoric about “not treating everyone in a one-size-fits-all way”.

    As a former Public Health consultant who researched into the health effects of work and worklessness, I agree that some work is good for health, but I don’t agree with the Government’s flawed thinking underpinning this: that it’s OK for people to return to work when they are still not fit, because it may help. This is not just unsound, it’s dangerous.

    The scapegoating of disabled people, which includes people with physical or mental impairments and long-term health conditions as defined under the 2010 Equality Act, has been a hallmark of this Government and the previous Coalition. But even the conclusion of the United Nations inquiry that the UK Government has been responsible for ‘grave…systematic violations’ of the UN Convention on the Rights of Persons with Disabilities since 2010, has been met with Government stonewalling.

    It is already well established that disabled people are twice as likely to live in poverty as non-disabled people as a result of the extra costs associated with their disability. Currently 4.2 million disabled people live in poverty and I have been informed from unpublished analysis by an Economic and Social Research Council research project that this is getting worse.

    The Government has refused to stop the cuts to ESA WRAG and Universal Credit’s Limited Capacity to Work which come in this April, which will undoubtedly increase the numbers of disabled people living in poverty, threatening their health and well-being. Various discretionary funds may be available, for example the Flexible Support Fund, but there is no guarantee of support and they are quite specific in what they can be used for.

    The timing of these cuts when there has been a negligible reduction in the disability employment gap is quite shocking. The Green Paper rings alarm bells that people in the ESA Support Group are the next to be targeted by Welfare Reform. Linked to this, the new Work Capability Assessment criteria which the Government announced last September (after I committed to scrap the Work Capability Assessment) will be published later this year. These will give a clear indication what the Government’s real agenda is.

    The Green Paper also talks about employers and the need for them to invest more in workplace health and occupational health support. This is, of course, very important; 90% of disability and long-term health conditions are acquired, so it is absolutely right to examine what can be done to reduce the risk of employees falling ill and how employers can make reasoned adjustments to support an employee to stay in work if they become disabled. But Access to Work helped only 36,000 disabled people stay in or access work in 2015 out of the 1.4m disabled people who are fit and able to work.

    Welfare Reform

    To date, the Disability Confident Campaign launched in 2015 has been a dismal failure making a negligible impact on the disability employment gap. Changes in employer attitudes and behaviour needs practical support, including Access to Work. But what is the Government doing to support employers, especially small businesses given that nearly half the workforce is employed by them? How can a small business access affordable, timely occupational health support? With the NHS in crisis and waiting times for non-urgent treatments escalating, how will timely interventions to help people back to work be delivered?

    As always with this Government and the previous Coalition, they are happy to point fingers at everyone else without taking any responsibility themselves. They talk about the impact of work on health and the need for ‘culture change’ and to ‘reinforce health as a work outcome’ but what about the impacts of the social security system on the health of claimants? Their policies have a direct impact on people’s health in the punitive, humiliating way they are too often implemented, but also through the real, enduring poverty and hardship people are forced to live under.

    Labour will hold this Conservative Government to account on all these areas, developing meaningful, alternative, approaches with disabled people, employees, and employers as part of our Disability Equality Roadshow. If this Government is committed to a fairer society, they should stop trying to rebuild the economy off the backs of poor, sick and disabled people.

    Labour believes, like the NHS, our social security system should be there for all of us in our time of need, based on principles of inclusion, support and security for all, assuring us of our dignity.

    First published by Open Democracy

    Tagged , | Comments Off on ‘Dangerous’ new changes planned to force sick people into work – or into poverty

     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
    Tagged | 3 Comments

    Over the last 15 years, British welfare reforms have focussed on individualising responsibility and contracting-out services. These strategies share a behaviour change logic that assumes the source of the problem is to be found in the flawed motivations and actions of benefit recipients and their job coaches. Consecutive UK governments have been strongly committed to the idea of ‘getting people off benefits and into work’, despite long periods of minimal unemployment rates and exceptionally high employment rates.

    Received wisdom dictates that benefit receipt is the outcome of making ‘wrong choices’. Welfare reforms have become increasingly punitive on the rationale that strong disincentives and coercion are required to prompt the ‘right choices’. However, in my recent study interviewees reported something very different. They reported that they came to claim benefits reluctantly as a result of involuntary and unbidden life events, such as unemployment, homelessness, acute housing problems, disability, severe and unpredictable ill health or major care demands. Claiming benefits was not experienced as a preferable state of living, but a last resort that involved accepting, at least in part, a new ‘spoiled identity’ involving stigma and shame. Interviewees spoke of feeling powerless, rather than powerful.

    At the heart of this experience was having choice repeatedly undermined by unpredicted events and processes that unfolded against individual will.  This did not mean that benefit recipients were passive – all of the interviewees described taking a series of steps to change their situation in realistic ways, without the type of internal inadequacy implied by ‘welfare dependency’.

    For example, Janet (not her real name), is a homeless disabled lone parent caring for both her mother with dementia and her school-aged son. Although she had chosen to have a child, she had not chosen for her marriage to end, her mother to have dementia, to lose her job or to lose her home – these were unwelcome life events, which had developed against her will. Janet felt frustrated that her situation was beyond her control:

    ‘I don’t think I feel in control. Had I felt in control, I could do something about the situation.’

    Nevertheless, Janet accepted personal responsibility for improving her own and her family’s circumstances. She was reflexive, creative, highly motivated and taking action on several fronts – an exemplar of self-actualisation. Janet rejected passivity in resolute determination to improve her situation through every means possible. Her desire for paid work was very strong – as was her intention to provide a secure home for herself and her son, who had been living in ‘temporary’ local authority accommodation for three years:

    ‘I am saying to the government: ‘Hear! Hear! Listen to me! I want to get a job. I don’t want your benefits! I don’t want them!’ I want to get a job and lead my life.’

    Janet’s progress towards realising her life goals was blocked by external, rather than internal, limitations. Her ex-husband did not pay child maintenance, which contributed, along with inadequate benefit rates, to her experience of poverty and debt. The solution to the complex needs faced by Janet and her family was neither easily identifiable nor readily attainable. Janet’s repeated and concerted action to resolve housing, health, care and income needs did not result in the outcomes she wanted:

    ‘It’s a lot of a load… The rent is £1200 per month… I am a woman who wants to go to work. I want to get a job. But I am so scared because if I go, when I get a job, I am going to be depressed because of all that money I have to pay. And he [personal adviser] said, ‘Well you know it all. We can’t do anything about that.’ So I left the Jobcentre again with another brick of the wall piling up in front of me. … I am crying ‘Help me’, but wherever you turn it is like a wall.’

    It is essential to recognise, in debate and policy design, that there are powerful external causes of benefit receipt and that there are legitimate reasons for why appropriate action does not necessarily lead to desired outcomes. The misattribution of ‘personal responsibility’ can be damaging and undermine the very internal resources (such as confidence and self-esteem) necessary for self-actualised engagement with life challenges. Policies and practices (such as the current tough approach to conditionality and sanctions) that continue to enforce job search activity without addressing the barriers to realising outcomes can have profoundly detrimental impacts on those subject to them.

    Tthis blog draws from the journal article “Conceptualising the active welfare subject: welfare reform in discourse, policy and lived experience”, published in Policy & Politics (open access).  It was first published in the British Politics and Policy blog

    Tagged | Comments Off on Welfare Reform

    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

    Tagged | Comments Off on Object to coercion, support the right to work

    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.

    Tagged | 5 Comments

    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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    WOWpetition was founded on twitter by a group of people, Ian Jones being one of the founding members. Most that started the group were either sick, disabled or carer’s who were concerned about the cuts to themselves and others. Social media is a great tool for disabled it gives us a voice to share concerns and information, when mobility and sickness often stops us mobilising by other methods. The wording for the first petition came from ideas and interaction on twitter by asking people to put forward ideas on the wording for the petition. Francesca Martinez was then approached and kindly agreed to be the face of the petition.

    We were delighted after a lot of hard work by all concerned to reach the 100 000 signatures I am sure at one stage some Union leaders and groups thought we were stalking them, (Mark Serwotka PCS, I apologise). We worked around our illnesses and used our strengths, like Laura Stranghetti who is our fabulous IT expert. We had numerous bloggers, tweeters and members of the group that worked hard to achieve the aim. We were delighted that we won the debate but we quickly realised the Government had no intention of assessing the impact of cuts on the individual.

    John McDonnell MP tried to push the campaign again and as the Social Security Advisory Committee and the Equality and Human Rights Commission  called for cumulative impact assessment we were hopeful. Penning claimed the Institute For Fiscal Studies said it couldn’t be done but they have since denied the comment. We felt frustrated that a party could just refuse to assess impact cuts on the individual whilst making inflicting further cuts.

    By this time the group was down to four: Ian, Laura, Carol and myself. We kept the social media face book and twitter accounts ongoing to give information on press releases and policy changes. After months of speculation before and after the general election when disabled people were left not knowing how or when more cuts would fall, I can say for myself I was left fearful of how I would survive on less funding. With 300 000 more disabled people pushed into absolute poverty then further cuts to ESA, social care and the Independent Living Fund announced we felt we had to push forward, what choice did we have? With statistics of 1 in 3 losing their mobility cars cuts were threatening me from all directions.

    We decided as a group, which is now four of us, to try and push again for impact assessment of all cuts including social care. We were seeing everyday on WOWpetition twitter feed stories of cuts and messages of fear and confusion. We knew that John McDonnell, Ian Mearns, Graham Morris and Jeremy Corbyn would support us again. Natalie Bennett from the Green party has always been very supportive towards our campaign. That SNP and Plaid Cymru are now supporting the new campaign is fabulous as we hope to keep raising the fact that the Government are failing, in our view in their duty of care to the disabled. How can you keep cutting with only impact assessments on each cut not all the cuts together? It is estimated by Simon Duffy that the most severely disabled maybe hit up to nineteen times, in whose universe is that OK?

    When you are blocked in a corner you come out fighting, like many other groups, we had to keep fighting or else the 100 000 people who signed it last time would be let down. We continue to fight as every day we hear or see stories of fear, the impact of sanctions, decisions by the DWP that are unbelievable and cuts and more cuts. Francesca kindly agreed again to be the face of the campaign and we keep fighting on like many other disability groups, charities and unions. Governments regardless of which party should not be able to abdicate their responsibility to the disabled of the UK whilst impacting their lives on a daily basis.

    Link to petition

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    Much has been written about the Work Capability Assessment, including the fact that it was deemed as being fatally flawed by the Work and Pensions Select Committee : ‘The flaws in the Employment and Support Allowance system are so grave that simply “rebranding” the assessment used to determine eligibility for Employment and Support Allowance the Work Capability Assessment by appointing a new contractor will not solve the problems, says the Work and Pensions Committee in a report published in July 2014.’

    The Work Capability Assessment was introduced by the New Labour government in 2008 and was exclusively conducted by Atos Healthcare until March 2015. The assessment is mandatory for recipients of Incapacity Benefit being migrated to the Employment and Support Allowance and for all new ESA applicants. Following much controversy, Atos Healthcare announced that they would withdraw early from the Department for Work and Pensions contract to conduct the Work Capability Assessment,

    The plan to ‘dismantle the welfare state’ was first suggested by the 1982 Thatcher governmentand has been relentlessly pursued by successive United Kingdom (UK) governments. Hence, in the Coalition government’s response to the select committee’s evidence,5 the Minister for Disabled People, Mark Harper MP, disregarded the very detailed information provided by the Work and Pensions Select Committee report that clearly listed the many serious problems still faced by those who must endure the Work Capability Assessment, to access the ESA benefit.

    Government resistance to funding long-term out of work illness/disability benefits followed the 2005 publication of the monograph: The Scientific and Conceptual Basis of Incapacity Benefits by Gordon Waddell and Mansel Aylward6, followed by the 2006 report: Is work good for your health and well-being by Gordon Waddell and Kim Burton.7

    What is constantly overlooked is that both these influential reports were commissioned by the DWP. They were both produced when Aylward and Waddell were funded by Unum Provident Insurance at the Unum Provident Centre for Psychosocial and Disability Research at Cardiff University, with funding by the American corporate insurance giant, Unum Provident, from 2003-2009. Aylward is listed as the DWP Chief Medical Adviser until April 20058 and is identified as being appointed as the new Director of the Centre from 2004.9

    The influence of Unum Provident Insurance is demonstrated in the memorandums provided for past WPSC reports10 that clearly list the transformation of Incapacity Benefit to Employment and Support Allowance. The requirement to ‘resist diagnosis’, ‘revise the ‘sick note’, ‘encourage the Government to focus on ability and not disability’, ‘change the name of Incapacity Benefit’ and ‘benefits not to be given on the basis of a certain disability or illness but on capacity assessments’ have all come to pass as Unum Provident Insurance have influenced UK Government welfare policy since 1994.11

    “At UnumProvident we have a non-medical, enabling model of rehabilitation and we are working with our partners at the UnumProvident Centre for Psychosocial and Disability Research at Cardiff University to better understand what places people at risk of long-term or chronic illness. Further information about this model can be made available to the committee”. (item 24) Supplementary memorandum submitted by UnumProvident9

    The Scientific and Conceptual Basis of Incapacity Benefits  was, essentially, the blue print for the future introduction of the Work Capability Assessment, using a discredited bio-psychosocial model of assessment as planned following the New Labour conference in November 2001: Malingering and Illness Deception,12 with Aylward as a contributor and ‘malingering’ very firmly planted as being the motivation for claimants of disability benefits. Guilty until proven innocent was the mind-set that continues to this day. ‘And the methodology used by Waddell and Aylward is the same one that informs the work of UnumProvident.’

    The 2001 New Labour conference12, together with the 20056 and 20067 reports commissioned by the DWP, led to the 2006 Green Paper: A New Deal for Welfare: empowering people to work – an independent assessment of the arguments for the proposed Incapacity Benefit reform.13  The Scientific and Conceptual Basis of Incapacity Benefits was the main reference used to justify future drastic welfare reforms, which was exposed by Emeritus Professor Alison Ravetz as being seriously flawed.14  On closer examination, it appears that this entire body of work  is largely self-referential – that is, it appeals for validation to itself and is framed within the same political and policy agenda… It is not research undertaken in the spirit of open enquiry. It is commissioned research and, as such, pre-disposed towards ideologically determined outcomes.

    Not to be confused with a medical assessment, the Work Capability Assessment is described as a ‘functional assessment15 using an IT tick-box questionnaire and totally disregarding diagnosis.

    The influential 2007 report by the unelected David Freud,16 promoted the use of the private sector in welfare reforms when adviser to the New Labour Party and before being appointed as the Minister for Welfare Reforms in 2010 by the Coalition government. Subsequently, the Work Capability Assessment was sub-contracted to Atos Healthcare in 2008 and according to the General Medical Council, Atos Healthcare ‘have total immunity from all medical regulation.’17,18

    The Work Capability Assessment uses a manipulated biopsychosocial  model of assessment, designed in consultation with Unum Provident Insurance17,18,19,20 and is a replica of the discredited healthcare insurance assessment model historically used by Unum Provident Insurance to resist funding insurance claims.21 The LiMA IT programme used for the Work Capability Assessment was designed by Atos Origin IT Ltd, the parent company of Atos Healthcare, for exclusive use for DWP assessments.22

    The original 1977 biopsychosocial model of assessment was attributed to psychiatrist George Engel.23 Engel’s biopsychosocial hypothesis was to consider the social and psychological factors, together with the biological factors impacting on illness. It was an unproven theory that needed research. Ten years ago Professor Christopher Butler and colleagues produced a paper demonstrating that the bio-psychosocial model of assessment was ‘found wanting’ and inadequate. ‘Medically unexplained symptoms: the biopsychosocial model found wanting24 was referring to the original Engel biopsychosocial hypothesis.

    Yet, a manipulated version of the Engel biopsychosocial assessment model, emphasising the possible psychological factors of disability and disregarding the biomedical factors, is used by Unum Provident Insurance and by the DWP as a method of removing as many chronically sick and disabled people as possible from funding, or preventing access to it.17,18,19,20,21

    Unum Provident Insurance were fined $31.7 million in 2003 in a class action law suit in California for running ‘disability denial factories’18 and $15 million in 2005 by the California Department of Insurance Commissioner, John Garamendi, who stated that Unum Provident is an outlaw company. It is a company that has operated in an illegal fashion for years…’25,26

    By 2006 the State insurance commissioners of 48 American States approved a settlement in an investigation of the Unum Provident Corporation that required the healthcare insurance giant to reconsider 200,000 claims and to pay $15million in fines27 whilst not forgetting, at the same time as these fines in America for malpractice, the company were funding Aylward and Waddell at the Centre at Cardiff University.

    Unum Provident Insurance changed its name to Unum Insurance in 2007 to distance itself from increasing negative publicity for identified malpractice. Yet, the only opinions considered by the DWP regarding the benefits of work and the assessment model used to assess disability benefit claimants are those of Aylward and Waddell, whose research was sponsored until 2009 by Unum (Provident) Insurance; identified by the American Association of Justice in 2008 as the second most discredited insurance company in America.28

    In January 2007 Professor John Langbein of the Yale School of Law produced a paper identifying the ‘The Unum Provident Scandal29 that exposed Unum’s practice of disability denial, and in November 2007 BBC News reported that the British government were being advised by an American insurance company with a reputation for ‘racketeering’.30

    Employees interviewed on the Dateline program disclosed that the claims that were “the most vulnerable” to pressures for bad faith termination were those involving “so-called subjective illnesses, illnesses that don’t show up on xrays or MRIs, like mental illness, chronic pain, migraines, or even Parkinson’s.”

    The Dateline story pointed to an internal company email cautioning a group of claims staff that they had one week remaining to “close,” that is, deny, eighteen more claims in order to meet desired targets.

     

    Concerns have been expressed in a government inquiry regarding Aylward’s long association with Unum (Provident) Insurance, including links with the American corporate insurance giant when Chief Medical Adviser at the DWP from 1996 – 2005. To date there has been no formal investigation following the evidence by Professor Malcolm Hooper to the 2005 Gibson Parliamentary Inquiry.31:

    ‘There would also appear to have been a clear financial conflict of interest and possible breach of Civil Service protocol, in that a senior Civil Servant such as Aylward could not have been unaware while he was in post at the DWP that Unum Provident was already financing his next employment, which would allow him to indulge in his existing conviction that syndromes such as ME/CFS are affected by ‘cultural’ factors and are ‘behavioural’ in nature. It is also a matter of concern that a senior Civil Servant accepted sponsorship from a company with Unum’s track record.’

    After various freedom of information requests, the DWP published the mortality figures of the claimants who had died in 11 months in 2011 whilst claiming Employment and Support Allowance,32 with 10,600 people dying in total and 1300 people dying after being removed from the guaranteed monthly benefit, placed into the work related activity group regardless of diagnosis, forced to prepare for work and then died trying. Following the public outrage once the figures were published, the DWP have consistently refused to publish updated death totals.

    Unum (Provident) Insurance exposed their significant influence in the memorandum following the publication of the Welfare Reform Green Paper. Their influence has also been exposed since 2011 by the Disability News Service,33 with reports by the British Medical Association34 and the Royal College of Nursing 35 that confirmed that the Work Capability Assessment was causing ‘preventable harm’ as chronically sick and disabled people now starve to death in the UK.36

    Constant toxic rhetoric by the Secretary of State and various DWP Ministers from the Coalition government, supported by the national press quoting their often extreme comments, have successfully convinced the British public that vast numbers of chronically sick and disabled people are ‘shirkers and scroungers’ and disability hate crimes are the highest ever recorded, as identified in a 2014 bulletin by the Home Office:  ‘Hate Crimes, England and Wales, 2013/1437

    CONCLUSION

    Fifteen years ago Unum Provident Insurance was exposed in Parliament in the 1999 Permanent Health Insurance debate,38 where MPs identified the suffering of constituents as Unum Provident Insurance refused to pay out on income protection insurance policies. Given this company’s proven record of sustained misconduct and recorded malpractice over many years, one must surely enquire as to why this company have been advisers to the UK government on welfare reforms for the last 20 years.

    The constant reference to ‘disabled people’ by DWP Ministers, whilst disregarding those with catastrophic illnesses, adds to the ongoing human suffering of the most vulnerable people in the UK. They are far too ill to consider working39 but they now live in fear of claiming the income related benefit needed for their very survival, as the Coalition government consider all Employment and Support Allowance applicants as potential malingerers, thanks to Professor Aylward’s influence, regardless of what can be a devastating diagnosis.40

    REFERENCES:

    1. W&P 2014: ESA needs fundamental redesign, says MPs: July 2014 DWP Work & Pensions Select Committee  23rd July 2014: News release
    2. CROSS M: 2013: demonized, impoverished and now forced into isolation: the fate of disabled people under austerity. Disability and Society Journal DOI:10.1080/09687599.2013.808087
    3. W&P 2014: Work and Pensions Committee – First Report: The ESA and WCA Full report.
    4. The Guardian: 28th Dec 2012: Margaret Thatcher’s role in plan to dismantle welfare state revealed 
    5. DWP 2014: November, p4: Government Response to the House of Commons Work & Pensions Select Committee’s Report on Employment & Support Allowance & the Work Capability Assessment, First Report of session 2014-15 
    6. The Scientific & Conceptual Basis of  Incapacity Benefits. Gordon Waddell & Mansel Aylward 2005  ISBN: 9780117035843
    7. Waddell & Burton 2006: Is work good for your health and well-being? Gordon Waddell & A Kim Burton
    8. Institute of Primary Care & Public Health –  Professor Mansel Aylward
    9. Supplementary memorandum submitted by Unum Provident following the publication of the Welfare Reform Green Paper 2006
    10. Memorandum submitted by UnumProvident (EDP 03)
    11. Private Eye: In the back: Welfare reform – mutual benefits Issue 1302 – 11th November 2011
    12. Rutherford J 2007: New Labour, the Market State and the End of Welfare Soundings Journal: 2007:  Issue 36   summer 2007
    13. DWP:2006: A new deal for welfare: Empowering people to work
    14. Ravetz A: 2006: March: Green Paper: A New Deal for Welfare Centre for Disability Studies, Leeds University
    15. Litchfield P: 2013, p7: An independent review of the WCA, year 4, 2013
    16. Freud D: 2007, p5: Reducing dependency, increasing opportunity: options for the future of welfare to work. An independent report for the DWP by David Freud. May 2007 page 5. ISBN: 978 1 847 12 193 6
    17. Stewart M: 2011: Welfare Reform – Redress for the disabled 
    18. Stewart M: 2010: Atos Healthcare or Disability Denial Factories 
    19. Jolly D: 2012: A Tale of Two Models: Disabled people vs Unum, Atos, Government and disability charities
    20. Stewart M: 2012: Government use the might of American insurance giant to destroy UK         safety   net.     
    21. Bach M: 2011: UNUM and Business: how Unum have influenced UK Government policy to the detriment of disabled people.
    22. Bach M: 2013: LiMA tick box assessment 
    23. Engel G:1977: The need for a new model: a challenge for biomedicine. Dr George Engel  Science Journal; 8th  April 1977, Volume 196 number 4286 p 129-136
    24. Butler C, Evans M, Greaves D, Simpson S 2004: Medically unexplained symptoms: the biopsychosocial model found wanting.  The Journal of the Royal Society of Medicine:: JRSM 2004, 97:219-222 
    25. Unum Complaints: An Outlaw Company” – Online Lawyer Source 
    26. LA Times: 2005: State fines insurer, orders reforms of disability cases.
    27.  State Insurance Commissioners reach settlement with Unum Provident:  Insure.com
    28. The ten worst insurance companies in America. The American Association  of  Justice 2008
    29. Langbein J: 2007: p1318 The Unum Provident Scandal – The Yale Law School 
    30.  Government advised by ‘racketeers’ BBC News 6th   Nov 2007
    31. Hooper M: 2005: Concerns about a commercial conflict of interest underlying the DWP handbook entry on ME  and CFS The Gibson Parliamentary Inquiry – Dec 2005
    32. DWP: July 2012: Incapacity  Benefits: Deaths of  recipients 
    33. Disability News Service: Feb 2013: Unum bragged about ‘driving government thinking’ on incapacity benefit reform
    34. BMA: 2012: Scrap WCA doctors demand at the annual representative meeting. The British Medical Association
    35.  The Royal College of Nurses Congress: Disability assessmentsThe  Royal  College of       Nursing Congress April 2013
    36. The Guardian: Vulnerable man starved to death after benefits were cut 
    37. Hate Crimes, England and Wales, 2013/14 p9 – Home Office Statistical Bulletin
    38.  Permanent Health Insurance debate; House of Commons, Westminster Hall, 21st December 1999. 
    39. Mental Welfare Commission for Scotland: Who benefits? The benefits assessment and death of Mrs DE. Investigative report.
    40. Stewart M 2014: UK Government refuse to accept responsibility for crimes against humanity.

    This was first published on Researchgate

    Tagged , , | 7 Comments

    A recent article in the Guardian drew attention to the BBC’s current efforts to increase the numbers of disabled people on and off-screen. Tania Motie and Tanni Grey-Thompson argued that there are three stereotypes applied to disabled people – we are heroes, scroungers or brave victims. The BBC, they wrote, has a role in challenging this, and that:

    Sophisticated, multi-faceted, authentic portrayal influenced by disabled people will really help to break down barriers and allow disability to become part of the DNA of our society.

    This reminded me of how, 23 years ago, in 1992 – which like 2015 was also a general election year – the BBC launched a series of programmes made with and about disabled people, together with a booklet and poster advertising.  The series and the booklet were called Disabled Lives:we wanted to call it Disabling Society but Channel 4 had got there first with their own series that same year. The initiative resulted from an Advisory Group made up of disabled people brought together by the BBC to help them  develop programmes which challenged the stereotypical and unrealistic ways in which disabled people’s lives were portrayed.It sounds familiar doesn’t it? But there were some differences.
    The key difference is that, in 1992, disability was increasingly being identified as a civil rights issue, whereas today public debate is dominated by arguments and counter-arguments about whether we are ‘scroungers’ or ‘vulnerable’.The 1992 booklet said that it, and the BBC series of programmes, was about:

    one of the most exciting civil rights issues of our times, the right of disabled people to participate equally and fully in the communities in which we live….Today, there is a growing movement of disabled people who insist that our lives have value and that we want to be treated as equal citizens with equal rights.

    This was before the Disability Discrimination Act which was finally passed in 1995 after many years of campaigning.  The programmes and the publicity gave a voice to this demand for an end to discrimination, but also emphasised the importance of changing the dominant cultural representations of disabled people, arguing – as Elspeth Morrison (one of the Advisory Group’s members) put it:

    If we have no representation of ourselves other than those images used in charities’ advertising, crippled witches in children’s books, brave and tragic media stuff, theatre and film’s metaphorical use of disability as social inadequacy, social decay – if there is no expression of life as we live, it, how do we begin to validate ourselves and learn about each other?

    One of the photographs (taken by David Hevey) used in the booklet and in the posters  – was of the Direct Action Network holding up a bus in Manchester.  No buses were wheelchair accessible at that time and access to public transport was an important part of the campaign for anti-discrimination legislation. Independent living (having choice and control) was also a key focus, for people with the whole range of impairments and across all ages. The Independent Living Fund had been established in 1988 and more and more people with high levels of support needs were accessing it and starting to live the kind of lives their non-disabled peers took for granted. In general, more disabled people were demanding, and getting, their entitlements to support to enable them to go about their daily lives.

    Organisations of disabled people (as opposed to the charities speaking for disabled people) were increasing in number and influence in the early 1990s, reflected in the fact that the people on the  BBC’s Advisory Group were mainly from organisations of disabled people.  The initiative encompassed Deaf people, people with physical and/or sensory impairments, people with non-evident impairments and health conditions, people with learning difficulties, mental health service users and older disabled people.  As People First (the organisation of people with learning difficulties) said:

    • We are for difference
    • For respecting difference
    • For allowing difference
    • Until difference
    • Doesn’t matter anymore.

    In the early 1990s, the most influential stereotype of disabled people was of us as objects of pity, as tragic victims who, at best, could be admired for ‘overcoming’ against all odds, at worst were considered to have lives not worth living.  The response of a government Minister to one of the petitions calling for anti-discrimination legislation was to say that he didn’t believe employers discriminated against us, rather they felt sorry for us.

    Nevertheless, in 1992 things were shifting.  In the run-up to the general election, the Conservative Party (in government since 1979) devoted a specific section in its Manifesto to commitments to disabled people, celebrating that:

    Under the Conservatives, more disabled people than ever before are getting the help they need and deserve. Since 1979, the number receiving Attendance Allowance has more than trebled; the number receiving Mobility Allowance has risen six fold; the number receiving Invalid Care Allowance has risen 25-fold. Today we spend some £12,000 million a year on benefits for long-term sick and disabled people. Even after allowing for inflation, that is 2½ times as much as Labour spent in the 1970s.

    The Tories promised to introduce “new disability benefits [Disability Living Allowance and Disability Working Allowance] which will, in the next Parliament, bring extra help to at least 300,000 people. By 1993-94 these and other improvements will mean that we will be directing an extra £300 million a year to long-term sick and disabled people.” They were proud of the “great success” of the Independent Living Fund and gave a manifesto commitment to maintaining it.
    The Labour Party had very little to say about disabled people in their 1992 manifesto. There was a nod to ‘training’ opportunities, to health services for people with long-term conditions and to better community services for people using mental health services and for people with learning difficulties.  The Liberal Democrats’ manifesto had more, committing them to introduce a Citizen’s Income with a specific disability component, human rights legalisation (to include disability) and a Charter of Rights for disabled people.
    In those days, very few people argued that too much was spent on disability benefits. Very few people thought that disabled and sick people were making false claims for out of work or disability benefits.
    In fact, in 1992 the Conservative government felt that not enough disabled people were being helped and introduced new benefits for which more people were eligible.  Today the Coalition government argues that too many people are receiving help with the additional costs associated with impairment and disability. The Disability Living Allowance – which the Conservative government of the early 1990s was proud to introduce – has been abolished and replaced with Personal Independence Payment with the aim of reducing the budget by 20% and accompanied by such long delays in responding to claims that a Judicial Review has been granted of the process.

    In 1992, the government were proud of the Independent Living Fund and vowed to keep it.  Today, they have abolished it and many people with high support needs are at risk of losing the ability that ILF funding gave them to live ‘ordinary lives’. In 1992, disability was a civil rights issue and we were on our way to getting the Disability Discrimination Act, enacted by the Conservative government in 1995.  Today, access to justice under the legislation has been severely undermined by cuts in legal aid,  and the introduction of fees for taking a case to an Employment Tribunal.

    In 1992, public debate was about whether disabled people were to be pitied as the objects of charity and needed to be ‘looked after’, or whether we should have equal rights to access education, employment, independent living.  Today, public debate is about whether we are avoiding our responsibilities to seek employment and need conditions and sanctions to get us ‘off benefits’, or whether we are ‘vulnerable’.   Instead of recognising the additional support, and the removal of barriers, which are required in order for us to access the same opportunities as others, we are – in order to avoid being labelled as ‘scroungers’ –  once again forced into the role of tragic victims, where the legitimacy of our requirements is to be measured by how ‘vulnerable’, ill and/or impaired we are.

    So if we are to avoid being identified as ‘scroungers’, we have to prove how ‘vulnerable’ we are made by our impairments, illness and/or age.  Yet ’vulnerability’ is created by the society in which we live – by lack of appropriate support, and by prejudicial attitudes. ‘Vulnerability’ is created, for example, by removing benefits from someone because they failed to fulfil conditions which illness, impairment and/or poverty made difficult for them to do. ‘Vulnerability’ is created by threatening to stop providing support to enable someone to go to the toilet when they need to. ‘Vulnerability’ is created by a lack of suitable, affordable housing for a family affected by illness and disability.

    Tackling discrimination, removing barriers, providing appropriate support which gives us choice and control in our lives – none of these are on the agenda for public and policy debate anymore. Instead, our social worth is to be measured by whether we are ‘hard-working’, which means engaged in productive labour.  Other important social roles – looking after others, bringing up children, contributing to our friends, families and communities – are not deemed worthy of support or celebration.
    The BBC’s current initiative – all these years after the 1992 initiative – to increase the numbers of visible, ‘happen to be’ disabled people on screen and to increase their employment off screen is laudable.  But we also need to change the language of public discourse about sick and disabled people.
    In particular, we need politicians, and all those participating in public debate in the run up to the election in May, to change the way they talk about disabled people.  We need to revisit the language and images the disability movement tried so hard (with some considerable success) to promote during the 1980s and 1990s – language which returns to some of the hopes reflected in the BBC’s booklet all those years ago:

    Disabled people are fighting for a society which celebrates difference, a society which does not react to physical, sensory or intellectual impairments, or emotional distress,, with fear and prejudice.  We want a society that recognises the difficulties we face, but which also values us for what we are.

    Our hopes for the future are based on the justice of our wish for control over our lives, the strength of our demands for equal participation, the passion of our belief in the value of our contribution to the communities in which we live.

    First published on Jenny Morris blog

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    Logo Changing Britain Together

    Extracts from the Labour Party policy summary December 2014

    LABOUR WILL:
    1. Raise the Minimum Wage to £8 an hour and ban exploitative zero hour contracts
    2. Freeze energy bills until 2017 while reforming the broken energy market
    3. Cut the deficit more fairly by asking those earning over £150,000 to contribute a little more through a 50p rate of tax
    4. Get at least 200,000 homes built a year by 2020 and deliver a fairer deal for private renters
    5. Scrap the Bedroom Tax
    6. Require all firms that have a major government contract to offer apprenticeships
    7. Repeal the Tories’ plans to bring competition and privatisation to the NHS
    8. Ensure the NHS has time to care with 8,000 more doctors and 20,000 more nurses, funded by a mansion tax on homes worth over £2m
    9. Control immigration so that entitlements to benefits are earned and wages are not undercut
    10. Devolve power to Scotland, Wales, and the cities and counties of England

    Delivering Responsible And Fair Social Security

    There are too many insecure, low paid jobs in Britain. This doesn’t just undermine our ability to earn our way out of the cost-of-living crisis, it means more welfare spending too. The Tory-led Government has failed to address this problem. Their reforms are not working, hardship is increasing, and the costs of their failure are mounting. Because our economy is not working for everyday working people, the Government is spending billions more on social security than planned while its attempts to reform welfare have led to a catalogue of chaos, waste and unfairness.

    LABOUR’S PLAN

    Britain needs a responsible and fair social security system. One that rewards contribution, and protects those who cannot work or cannot earn enough to support themselves and their families. It also needs to be affordable. Keeping social security spending under control, and putting decent values at the heart of the system, are not conflicting priorities, but go hand in hand. Labour will build a social security system which ensures those who are able to work find a job, and supports people when they need it. We will control the overall cost of social security spending by tackling the root causes of rising spending. That means making work pay and building houses once again. Only by getting more people into work, and creating better paid and more secure jobs, will we tackle the drivers of rising benefit bills and ensure the system is sustainable for the long term.

    LABOUR WILL:
    • Introduce a Compulsory Jobs Guarantee, paid for by a bank bonus tax, to provide a paid starter job for every young person unemployed for over a year.
    • Abolish the cruel, costly and failing Bedroom Tax.
    • Reform the Work Capability Assessment so it focuses on the support disabled people need to work.
    • Cap structural social security spending as part of each Spending Review so that it is properly planned and controlled.
    • Allow councils that make savings in the Housing Benefit bill to recycle them into building homes.

    An NHS With Time To Care

    David Cameron promised that under the Tories there would be no topdown NHS reorganisation. He broke that promise. They have wasted £3 billion on an upheaval which puts profits before co-operation and patient care, and ties hospitals up in competition law.
    This wasteful and chaotic reorganisation is having a knock-on effect on the thing that matters most: patient care. Waiting lists, already rising, look set to be pushed up even further as budgets are squeezed and more hospitals fall into deficit. There is a crisis in A&E, not just in winter but all year round. Vital treatments are being rationed, giving patients the choice of waiting longer or paying to go private. Millions of people can’t get a GP appointment when they need one.

    LABOUR’S PLAN

    The National Health Service is the Labour Party’s greatest achievement. We created it, we saved it, and we will always support it. Labour’s vision for our NHS will bring together physical health, mental health and social care into a single service to meet all of a person’s care needs, with a focus on prevention. It is a true One Nation vision: a health and care system shaped around people, not bureaucratic structures or markets.
    We will protect and strengthen the NHS, even in an era when money is tight. We will repeal the Government’s Health and Social Care Act, ensuring an NHS based on collaboration and integration, not competition and fragmentation. We will strengthen the NHS for the future and ensure it has time to care with 20,000 more nurses and 8,000 more GPs by 2020, paid for by tackling tax avoidance and introducing a tax on properties worth over £2 million.

    LABOUR WILL:
    • Recruit 20,000 more nurses and 8,000 more GPs paid for by a tax on properties worth £2 million or more.
    • Guarantee a GP appointment within 48 hours – and on the same day for those who need it.
    • Repeal the Tories’ Health and Social Care Act.
    • Integrate health and social care services into a system of “whole-person care”.
    • Give mental health the priority it deserves with a new right to access talking therapies enshrined in the NHS Constitution.
    • Guarantee that patients will wait no longer than one week for vital cancer tests and results by 2020.
    • Ensure that when changes are proposed to local hospital services patients and the public have a seat round the table from the very start, helping design and decide on plans for change.

    Social Care

    The growing social care crisis is one of the biggest challenges we face as a society. Since 2010, £2 .7 billion has been cut from budgets that pay for adult social care while the number of older people needing care has increased. The result is that the system is close to collapse with some elderly people receiving just 15 minute visits and care for by a workforce that is undervalued.
    The tighter eligibility criteria which are being applied to deal with this mean that hundreds of thousands fewer people are getting help. And the rising burden of care charges is adding to the cost of living crisis: increases in charges now mean that since 2010, elderly and disabled
    people are paying almost £740 a year more for vital home care services.

    LABOUR’S PLAN

    For too many vulnerable people the current health and care system feels like three fragmented services: physical health in the mainstream NHS, mental health on the fringes of the NHS, and social care in council run services. We will change that, bringing the services together around those needing care – with a single point of contact to organise your care and new homecare workers in the NHS to support people to stay in their home.
    We will also end the acceptance of exploitation of the social care workforce, which harms the care people receive. We will stop zero hour contracts being used when care workers are in practice working regular hours, and fully enforce the minimum wage.

    1 Comment
    This article was first published by the Institute for Fiscal Studies and was jointly written by Paul Johnson.  It is republished with kind permission of the IFS.
    The government has started to send out information on how tax revenue is spent to individuals who pay income tax or National Insurance contributions. It has broken down spending into a number of categories. The biggest of these is “welfare”, which represents a quarter of total spending. State pensions also appear as a separate category, accounting for 12% of spending. In this observation we look at what counts as pension and welfare spending, and offer some alternative breakdowns.

    Spending on state pensions is straightforward. This is essentially just the annual spend on the basic state pension and earnings-related state pensions from various different schemes.

    “Welfare” spending, at 25% of the total, is taken directly from the government’s public expenditure statistical analyses. It is the total spending defined as “social protection” in these analyses, less spending on state pensions. Total spending on social protection comes in at £251 billion in 2013-14, which is about 37% of total public spending of £686 billion (before accounting adjustments). Take off £83 billion of spending on state pensions and you get to £168 billion on “welfare” – very nearly a quarter of total spending.

    What is included in that “welfare” total?

    It includes £28.5 billion on “personal social services”. This is a number that in many analyses one would want to report separately from other welfare spending. It includes spending on a range of things, such as looked-after children and long term care for the elderly, the sick and disabled. Unlike other elements of “social protection” it is not a cash transfer payment and in many ways has more in common with spending on health than spending on social security benefits.

    Another £20 billion of the spending counted under welfare is pensions to older people other than state pensions. That includes spending on public service pensions – to retired nurses, soldiers and so on[1]. This is not spending that would normally be classed as “welfare”. The rest of the pay package of a public sector worker is included as departmental spending within the department of that worker. One could either report such pension payments separately or, like pay, as part of the relevant spending function. The pay of nurses counts as health spending. One could count their pensions in the same way.

    That leaves around £120 billion of other welfare spending, which can be broken down in a number of different ways.

    Since the government has chosen to report state pension spending separately, one obvious division would be to separate spending on those of working age and those of pension age. In addition to state pensions a further £28 billion is spent on pensioners, of which £15 billion goes on benefits specifically for that group, such as pension credit, attendance allowance and winter fuel payment, while the remaining £13 billion is largely spent on housing benefit and disability living allowance. So of the £205 billion or so spent on tax credits and social security benefits about £111 billion is spent on those over pension age and £94 billion on those of working age.

    Figure 1 and Table 1 show this breakdown of the 25% of total spending described as “welfare” by the government, alongside the 12% spent on state pensions. 4% goes on “personal social services”, 3% on public service pensions, 4% on other benefits for pensioners, and the remaining 14% on benefits for those of working age.

    Figure 1. Breakdown of “welfare” as a share of total spending

    Sources: Public Expenditure Statistical Analyses, Department for Work and Pensions benefit expenditure tables.

    Table 1. Breakdown of “welfare” as a share of total spending

     

    Sources: see Figure 1.

    It could of course be argued that this would provide too much detail. But there are five categories reported in the government’s breakdown of spending, each representing less than 2% of total spending. If it is worth reporting contributions to the EU budget which represent less than 0.1% of total spending then there might be a case for providing this additional breakdown of “welfare spending”.

    There are of course other ways of breaking down spending on social security benefits. The OBR, for example, show spending on the elderly, sick and disabled, families with children, the unemployed and help with housing costs (table 2.1 here) . In our survey of the benefits system we provide a similar split (table 3.1 here), separating out spending according to its function as best we can. There are clearly different judgments one can make here (we include attendance allowance in spending aimed at the sick and disabled, rather than the elderly for example), but it does give a good sense of the overall spending priorities within the system. Table 2 shows this split, including the 12% of total spending going on state pensions, and excluding the 4% spent on personal social services and the 3% reported as going on pensions other than the state pension (both of which the government includes in “welfare”).

    Table 2. Welfare spending by function

     

    Note: categories correspond to the primary recipient of a given benefit, rather than capturing all of the expenditure on each group.

    Source: Department for Work and Pensions benefit expenditure tables.

    There are different ways of reporting how our taxes are spent, and there is a balance to be struck between the amount of detail presented and clarity of message. Lumping a quarter of total spending into one bucket labelled “welfare” may not strike the most helpful balance, especially when it includes such diverse items as spending on social care, public service pensions, disability benefits, child benefit and unemployment benefits.

    Note: The IFS provides detailed breakdowns of tax revenue here, benefit spending here, and other public service spending here.

    [1]It is also not the number reported by the OBR when looking at spending on public service pensions (see table 4.24 here). The OBR reports gross spending of £36 billion and “net” spending – i.e. gross spending less contributions received – of £10.5 billion. But for the purposes of this note we stick with the numbers published in PESA.

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