Category Archives: Social Security

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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.

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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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This campaign report relates to the current difficulties faced by many disabled people trying to keep Jobcentre Plus’ Access to Work funding, including myself. Access to Work as been a scheme in existence for many years that provides disabled people support while they are at work.

In recent months, there has been unpublished changes to the scheme that has made it very difficult to access support. Due to new and potentially unfair rules, which may have been ill-designed, many disabled people including myself have had their support stopped. The aim of the report is to highlight the issues as the first stage of reversing these cuts.

Considering this government has specifically made a big deal in supposedly supporting disabled people into work, it is outrageous for the government to actually make things harder for those disabled people who do work, especially when they have high support needs. These secret cuts to Access to Work must be exposed and reversed as soon as possible.

Background Information

No Access to Work

I am a leading independent disability issues consultant, researcher, trainer, controversial inclusion activist, campaigner, and social change agent, based in Coventry (UK) with vast experience and expertise in a wide range of fields including disability equality, independent living, health policy, social care, lifestyle advocacy, employing personal assistants and Secondlife. I have worked with many organisations of all types since 1992 nationally and internationally and I am also founder and owner of Wheelies, the world’s first disability themed virtual nightclub, and star of Channel 4’s disability prank show, I’m Spazticus as well as being a blogger for the Huffington Post. I also have cerebral palsy that affects my speech, balance, hand control and sense of humour (in a positive way).

I currently have 30 hours per week funding towards my personal assistance and support from Access to Work for the hours between 10am and 4pm Monday to Friday. The support covers personal care, assisting with phone calls, support getting to and during meetings, forms and anything else I may need. Without this support I will be unable to work and would be severely compromised. If I was to be forced to give up work, this would severely affect my mental wellbeing, likely to cause a downwards spiral towards suicide.

I also have an electric wheelchair from access to work and I am still in the middle of an application for a specialist office chair due to issues with my posture, although the application has been halted. Without the office chair, I am experiencing additional unnecessary back pain.

I have received support from Access to Work for 16 years, between 1998 and 2008 as Chief Executive of my own company, and from 2008 as a self employed person. During this time until now, I have had no issues with my support.

The problem

The reason I have had my Access to Work stopped was that in August I was ‘invited’ to submit evidence that I was self employed in relation to my office chair application including 3 years worth of business accounts, my self assessment tax returns, and a Class 2 National Insurance bill. As a low earner on tax credits, I was unaware of self employment national insurance, which I explained. Without clarifying the situation with the NI, my application was rejected and I was informed I had to request a ‘reconsideration’, a term never used before that is only supposed to relate to benefit appeals.

In contacting HMRC on this matter, clarifying I had properly registered with them I was self-employed, they informed me I did not need to pay Class 2 Contributions because I received Disability Living Allowance. I thought it was odd but they sent me a letter confirming I was self employed, which I sent to Access to Work as a part of my reconsideration request.

A few weeks later I received a letter from another part of DWP saying that the reason I could not pay Class 2 NI was that I was still receiving Incapacity Benefits Credits since before 1998, and I needed to send them the date I became self employed to get this sorted. This sounded promising BUT before I could answer, I received an letter to say my application for my chair has been rejected again, and also my support will be stopped in 2 months, although I could reapply!

The matter is far from resolved and logic would say they had given me time to sort out where I stand with the National Insurance. I am now left in limbo with a system I find difficult to communicate with, with the greatest crisis of my personal support in ten years, with all the additional stress, anger and frustration that goes along with this.

From what I have heard from other disabled people, I am deeply concerned that even if I resolve the issue of my National Insurance, Access to Work will find other reasons to unfairly reject my support including my profitability.

The concerns

The situation has highlighted a number of concerns I have regarding the process. I could go into more details but I do not want to spend more time I should be spending on my work on this, so here are the highlights;

1. It is now impossible to have direct contact with Access to Work advisors, having to go through to a call centre and deal with people who are unable to answer any question directly.

2. I was ‘invited’ to provide evidence of my self employment within 7 days with no prior knowledge

3. Some members of the contact centre were extremely rude and unwilling to allow my personal assistance to translate for me

4. I made a complaint previously with my reconsideration that has been ignored

5. The attitude of the advisors is impersonal and shows no understanding of the scheme

Solutions

To resolve the situation, I formally request the following happens;

1. Access to Work duly recognises I am self employed and restores my support with immediate effect

2. Access to Work compensates myself and other disabled people for the unnecessary stressed caused

3. A senior DWP manager meets with me at my home/office to explain to me what is going on and respond to my concerns

4. A immediate independent investigation is started into the current difficulties faced by disabled people using Access to Work

5. A full guide to the rules and regulations of Access to Work is published

Conclusions

I pick my fights carefully and I always aim to win. It is disgraceful that a scheme designed to help disabled people into work, is now forcing people to give up work as it is corrupted by the current toxic culture within DWP. This issue needs to be exposed and resolved as a matter of urgency, whatever it takes.

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A public health disaster

The DWP’s benefit sanctions have become a serious threat to public health – and health professionals should become engaged in exposing their effects and pressing for their abolition.

Like any insurance scheme, unemployment benefit has always had qualifying conditions. For most of the time up to 1986 there were few disqualifications, except for a ban of up to 6 weeks where people left a job voluntarily or lost it without good reason. But since 1986 there has been a growth of ‘sanctions’ – fines administered by officials to make claimants do particular things which the state, often very disputably, claims are a good idea, such as applying for 30 jobs a fortnight.

Under the Coalition, JSA and ESA sanctions have almost doubled, to 1.1m per year, affecting about 0.7m people. More than one fifth of all JSA claimants are now sanctioned over any 5-year period. JSA sanctions are running at 7% of claimants per month, and twice this for people aged 18-24; ESA sanctions are rising rapidly and are now close to 1.5% per month. Lone parents on Income Support have also been sanctioned since 2001, though since 2008 they have been moved progressively to JSA where 4% are sanctioned per month.

All the commonest JSA sanctions have been lengthened since October 2012. The minimum period is now 4 weeks, with 13 weeks for a second ‘failure’. There are now 3-year sanctions for repeat ‘high level’ ‘failures’, which have already hit over 1,000 JSA claimants. Since December 2012, sanctioned ESA claimants have lost all of their personal allowance, instead of the much smaller ‘work related activity’ component.

Prior to 1988, disqualified claimants were entitled to Supplementary Benefit as of right at a reduced rate, on the normal criteria. Since then (1996 for those on contributory benefit), sanctioned claimants have been eligible only for discretionary ‘hardship payments’. This system, devised by Michael Portillo and Peter Lilley, involves a special, harsh test designed to ensure that the claimant is entirely cleaned out of resources. For instance there is no payment if the claimant has borrowed cash from a payday lender. There is a two-week wait before claimants, however destitute, can even apply, except for arbitrarily defined ‘vulnerable’ groups. Ministers and officials know that this system damages people’s health. As to whether a claimant’s health condition makes them ‘vulnerable’, the DWP’s Decision Maker’s Guide devotes 52 pages to the question:  Will this claimant’s health decline more than a normal person’s would ?  Less than a quarter of sanctioned claimants get hardship payments, and the separate application process and deficiencies in the DWP’s administration mean that they are frequently not paid even to those entitled. Under Universal Credit, hardship payments will become loans, and the rules even stricter.

Although the money lost through sanctions is greater than in the scale of fines available to the courts, benefit claimants do not have the protections given to offenders. There is no consideration of their circumstances before a sanction is imposed, and no legal representation. Official studies have shown that claimants find the appeal system too difficult to use. In 2013 only 31% asked for reconsideration by the DWP and only 3% appealed to an independent tribunal. Consequently, huge numbers of unreasonable and unlawful sanctions go unchallenged.

There has never been any specific study of the impact of sanctions on health, but from official studies, reports by voluntary organizations, and claimants’ own stories, there is a large volume of evidence of effects which are known to damage health. Conditions such as depression, irritable bowel syndrome and diabetes are worsened. The death from diabetic ketoacidosis in July of a claimant from Stevenage, David Clapson,  has been reliably attributed to a JSA sanction which meant he couldn’t afford to keep his fridge going. Hunger, cold, damage to family relationships, debt, homelessness, crime (including ‘survival theft’ and violence) and disempowerment are all predictable consequences of the total loss of income, and all have been extensively documented. About a quarter of sanctioned claimants use Food Banks, and a similar proportion of Food Bank users are sanctioned claimants. By contrast, there is no satisfactory evidence that sanctions do more than drive people off benefits, or at best into bad and unsustainable jobs, and even the OECD – long an advocate for sanctions – agrees that to achieve even these limited effects, sanctions do not have to be anything like as harsh as they are in the UK.

Recently (3/4/2014), the House of Commons agreed a resolution moved by Michael Meacher MP: “this House notes that there have been many cases of sanctions being wrongfully applied to benefit recipients; and calls on the Government to review the targeting, severity and impact of such sanctions.” This added to calls for a comprehensive inquiry from many quarters, in particular the House of Commons Work and Pensions Committee. 

A limited review (the Oakley review) was earlier conceded by the Coalition and reported on 22 July.  It elicited a great deal of evidence on the working of the sanctions regime, some of which can be found on the Child Poverty Action Group website . However it was given very restricted terms of reference, and although the Coalition says it has accepted all the recommendations, in practice it hasn’t. Consequently, although some useful reforms are taking place, most of the problems in the sanctions system are being left untouched, and the need for a comprehensive independent inquiry remains.

Fundamental change is required. The UK sanctions regime is incompatible with the UN Principles on Extreme Poverty and Human Rights, which require governments to ensure adequate food and to recognise poor people as free and autonomous agents. As the Scottish Parliament’s Welfare Reform Committee has asserted, the culture needs to change from punitive to supportive. And no one should be made destitute by sanctions or disallowances.

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Independent living in its widest sense is having the same opportunities, choices and rights as other citizens.  Independent living is having the chance to be a parent and friend, have a family and social life.  It’s is taking part in community and public life, having the opportunity to get a job, build a career, have an education, and volunteer.  Independent living is being able to contribute, participate and be included.

The right to sufficient levels of support to allow independent living in its widest sense are enshrined in the UN Convention of Rights of Persons with Disabilities particularly article 19 but also in other articles. Since ratifying the UNCRPD in 2009 the UK government has been committed to the progressive realisation of these rights.

Yet the Government is pressing ahead with its plans to close the ILF (Independent Living Fund), despite Judge Elias in the Court of Appeal speaking of “the inevitable and considerable adverse effect which the closure of the fund will have, particularly on those who will as a consequence lose the ability to live independently”.

The ILF is funded by central government and helps meet the care costs of those disabled people with high care support requirements to live independently. ILF recipients now face having their care packages slashed and either becoming prisoners in their own homes or forced into residential care.

This is one of many case studies which illustrate the difference between ILF and Local Authority care funding

“For my 48 year old Son with Learning Disabilities, challenging behaviour and Autistic Spectrum Disorder, the difference between ILF support, and having a personal budget from our Local Authority is vast for the following reasons:

ILF funding

  • Means adequate, flexible and realistic support to meet all of his specific needs which include :- Support in every aspect of independent living, enabling him to live in his own home,
  • Support to participate in his community, which includes experiencing a range of social opportunities
  • Support to attend College, to enjoy a pint or a meal in his local pub.
  • Support to manage domestic tasks and buy items for your home
  • Support with shopping and cooking a meal.
  • Support to enjoy a lifestyle of his choosing, in other words, a right to normal life, and most importantly, to be able to do all of the above at a day and time of your choosing. To have control of your own life.

All of which are perfectly normal expectations of men, or women, of a similar age. My son, due to his vulnerability, is also protected, as part of his support plan, from hate crime and other forms of exploitation. Finally, because of the way he is supported, he does not have to suffer from isolation and he is kept safe and well at all times.

Social Care Budget from LA for which you will have been assessed for but then gets halved by ‘The Panel’, as a result my son will experience:-

  • Long periods spent alone and vulnerable.
  • Inadequate nutrition, due to a variety of care workers with too many calls and not enough time allowed at each.
  • Having to attend “Day Care” whether you like it or not, in order to reduce the amount of hours needed during the day.
  • Having ‘electronic gadgets’ put in place to replace human support, contact and supervision.
  • Being constantly harassed and abused by local gangs, simply because ‘they can’
  • Having to put up with unwelcome visitors or ‘guests’ who call themselves ‘friends’ then help themselves to money, or whatever is available.
  • Being beaten on a regular basis, because you are “different”
  • No one to help when an appliance breaks down and not knowing what to do.
  • Becoming unkempt and smelly because you have no one to support you in keeping yourself or your clothing clean.
  • Living in squalor because you don’t have enough in your budget or the council ‘don’t fund’ support for house cleaning.
  • Not going out socially because you have difficulty finding the venue on your own or need help to give the right money, or simply lack the confidence”.

Therefore disabled people believe that:

  • The closure of the ILF should be stopped until a better alternative is established.
  • That an independent living task force should be set up, co-produced with ILF users, to review independent living and specifically the Independent Living Fund in order to identify how best to improve, develop and extend independent living support building on the successful model of ILF provision.

Please support #SaveILF  and ask your MP to sign up to EDM 113 sponsored by Anne Begg  ‘Decision to close the Independent Living Fund’

More details about the ILF can be found at www.dpac.uk.net

 

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The Association is entitled to propose 10 amendments to the Labour Party’s proposed policies.  These are the amendments we are planning to propose after discussion at our Central Council last week. (there are 12 listed as we hope to cooperate with another affiliated society).  Suggestions for improvements are welcome, but each amendment is limited to 200 words, and they have to be submitted by 13th June.

Amendments to Health and Care

1. Social Care

Page 8  line 18  In Section entitled – The future of social care.
After second paragraph add:-
“Labour believes that it is time to accept that social care should be placed on the same basis as health care; cover for all, contributed to by all and free at the point of need. The case for all care being free is the same as the original case for free health care.   Labour will work towards delivering on the aspiration of free care building on the Care Bill provisions which extend social free care to some.

Policies which take away the independence of the disabled and cause deteriorating health as a consequence are costly and cruel.  An incoming of Labour Government will not implement the current Government’s proposals to end the Independent Living Fund (ILF) in June 2015 and will instead initiate a full review of disabled people’s independent living. As part of that review Labour will look to use National and local government purchasing power to drive down prices of disability related equipment and services, including insurance. Labour will also look at ways of reducing the cost of social care for disabled people and their local authorities without reducing the quality of services delivered.”

2. Mental Health

page 10 line 38 add: “ Britain’s mental health is at its worst since 1997 with increasing morbidity and a worsening suicide rate, because of  recession and savage cuts to public services which disproportionately affect the most vulnerable. A clear focus on enhanced well- being and the promotion of mental health within schools, workplaces and general hospitals is needed to reduce the economic and social burden of mental ill health. A new National Service Framework, with a robust set of clinical and social outcomes based on a model of early identification recovery and optimism, delivered in partnership with service users and carers will be established. Labour will instruct the Care Quality Commission to make sure that all providers of mental health and social care services comply with the Equalities Act meeting the access needs of disabled people and the cultural needs of  BAME communities. In addition, Labour will demand that all relevant authorities play an active part in improving the integration between physical and mental health services and deploy community development resources with the clear objective of strengthening the community and voluntary sector to deliver on our aspiration for better mental health and spiritual well-being for all local populations.
Children’s mental health is paramount if psychomorbidity in the adult population is to decrease. CAMH services need to be adequate for the speedy identification and treatment of mental disorders in children in the least stigmatising way.”

3. NHS

Page 4 line 7 Delete second paragraph and replace with:-

“Labour will restore the duty of the Secretary of State to deliver a comprehensive, universal NHS overwhelmingly publicly provided and entirely publicly managed and will give the Secretary of State the power to give directions to any part of the NHS.
Labour will deliver an NHS that values and promotes collaboration and cooperation. Labour will remove any legal or other barriers which prevent or deter cooperation including any which seek to require NHS services to be competitively tendered.   Labour will replace the system of procurement through commissioning with a system where publicly funded care services are planned and decisions about services and funding are made through open and transparent democratically accountable processes drawing on experiences in Scotland (and Wales, where health outcomes on a par with England are delivered for about 10% less cash than comparable English regions).

The NHS will no longer operate as a market or pretend that Foundation Trusts are free-standing competitive corporations.  The private sector will only be allowed to offer patient services as an alternative to the NHS by exception, where it evidences enhanced care and innovation.. ”

4. Accountability

Page 4 line 30 delete sentence beginning “Instead, we need…”  Insert “The health service must ensure collective and individual accountability throughout. Care must be delivered with as much participation in shared decision-making as the patient wishes at the time. Planning functions must be democratically accountable.  We will ensure the engagement of patients and family / carers in the care process as co-producers of health outcomes and the provision of good information to patients to enable them to be actively engaged. Values important to patients like dignity and respect should be demonstrated in every service provided.  This should be informed by widely available and meaningful information about the performance of and outcomes from health care services.
Nationally, UK comparative performance in terms of health inputs, care processes and patient outcomes (both patient and clinician reported) will be used to ensure the NHS matches the performance of the best European systems. The average length of life both attained and forecast at national and sub national levels, the number of life years lost, and the quality of life in key respects (especially for the last decade of life) will inform these measures. The Chief Medical Officer (England) will be required to submit an annual report directly to Parliament charting progress in these areas.”

5.  Public Health

Page 10 Line 15 insert “We will make healthy choices easier by ensuring that the financial incentives and taxation system supports affordable healthy products such as fresh fruit and vegetables while making unhealthy products high in fat, salt and sugar better regulated and relatively more expensive.
We will remove the VAT exemption from sugar, which has little nutritional value.  We will ensure that the quantity of sugar, salt and fat in manufactured food is easily apparent to customers wherever it is sold. We will ban the use of trans fats in food products (as done in Denmark) – and push for the ban to be extended throughout the EU.We will introduce minimum unit pricing and encourage lower alcohol products.  We will reduce the hours during which supermarkets are permitted to sell alcohol and make it more difficult to buy dangerous quantities of alcohol following the successful example of reducing damage caused by paracetamol poisoning. We will progressively raise the age below which it is unlawful to supply tobacco to young people.  We will bring forward proposals to reform the law on misuse of drugs to balance the penalties against the harm done by different drugs including alcohol and tobacco.”

Amendment to  Stability and Prosperity

6. A healthy society

Page 4 line 8 insert “We want to see a community in which power, wealth and opportunity are in the hands of the many not the few and where the rights we enjoy reflect the duties we owe. This will not happen in an unhealthy society where wealth is primarily inherited and the benefits of economic growth go to those who are already rich.  Labour’s long-term goal is to break the link between a person’s social class and their health. We will work across government, using the power and influence of all government departments and agencies, to achieve this. All Labour’s policies in government will be subject to an assessment of their impact on the public’s health.

We will use a new tax on wealth to finance the NHS and social care system to achieve a level of spend as a percentage of GDP on a par with the best in Europe, aided by the removal of tax rules that currently allow tax avoidance by international companies earning  untaxed profits in the UK. We will safeguard the NHS from the TTIP which will otherwise act as a means of a commercial takeover of our healthcare provision. ”

Amendments to Work and Business

7. Health and work

Page 6 line 25 insert: “Employees of all grades with higher levels of control over their work (in terms of content, pacing of tasks, decision-making, etc.) have better health. Low control at work is associated with higher rates of heart disease, musculoskeletal pain, mental ill health and mortality – even when other risk factors (such as smoking) are accounted for. Interventions to improve control at work (for example rotating tasks, flexible working, employee participation in making company decisions, employee ownership/shares) have been found to improve health – with no detrimental effects on productivity. We will introduce measures to ensure that firms are  involving employees in the business so that job control is increased. In other European countries, such as Germany, “workers’ councils” are common place in businesses and they could be introduced here.”

8. Benefits for disabled people

Page 11  line  6 add at end “Labour will ensure there is a non means tested benefit to meet the additional costs faced by disabled people, and place them on a level playing field with non disabled people.  Pending the benefit redesign Labour will immediately revert to the 50-metre distance test in respect of the higher rate mobility component of PIP. There should be a disabled person on each tribunal considering appeals where award of the benefit has been refused.  The assessment must be accessible, fair and transparent, carried out by NHS workers, must use evidence obtained from Occupational Therapists,  doctors and other healthcare professionals, use existing assessment data held for people’s entitlement to disability living allowance where held, entitle a recipient of DLA automatically to PIP and be carried out once to result in a lifetime award unless the impact of a condition can be expected to change. There should be no cap on the budget for the benefit, so that all disabled people who meet the criteria receive the benefit.  We welcome the report of the Disability and Poverty Taskforce and will work with disabled people and their organisations to examine how its recommendations can be taken forward.”

Amendment to Living Standards and Sustainability

9 Transport and health

Page 3  Line 48  Insert new heading “Transport and health ”
Insert “Traffic accidents are higher in more disadvantaged and urban areas (particularly amongst children and outside schools), and are the leading cause of death in children over 5. We will encourage widespread introduction of 20 mph limits in urban areas to encourage the reclaiming of our streets by pedestrians.
The Active Travel (Wales) Act 2013 will be extended to England so every local authority will be required to publish details of expenditure on transport measures divided between walking, cycling, public transport and motor vehicles.   We will rebalance the transport budget so that 10% is spent consistently over the length of the parliament on the needs of pedestrians and cyclists with the aim of building networks of segregated cycle tracks in every major city.  We will remove VAT from bicycles.
We will take urgent steps to reduce the air pollution caused by road traffic, and in particular by diesel engines. We will reconsider the taxation of vehicles and motor fuel in the light of the evidence of damage to health caused by particulates.
We will reduce the level of alcohol which is permitted for motorists”

Amendment to Education and Children

10. Healthy Children

Page 10  Line 4 insert “In 2013 the UK had worse rates than nearly every other Western European nation for early neonatal deaths especially among socially disadvantaged groups. More investment in employing trained midwives to provide one to one care is crucial and shown to be effective in reducing still birth. We will ensure that sufficient support from midwives and health visitors is available for women and babies to tackle the appalling level of death among young children. We will increase benefit rates for pregnant women so that they can afford a healthy diet. All children are vulnerable and schools need to do much more to promote both physical and mental health. Every school must have a school nurse and a school counsellor. Childrens mental health services need to be adequate for the speedy identification and treatment of mental disorders in children in the least stigmatising way.”

Amendments to Better Politics

11. Community Development

Page 4. line 24 insert. “Taking part in community activity is a vital way of protecting and improving mental health. Health providers will be directed to support the growth of local voluntary and community groups as a whole, cooperating with the other services which have a mutual interest in this. We will ensure that health agencies play an active part in deploying community development, with the clear objective of strengthening the constructive role of the community and voluntary sector in relation to health.  NHS agencies and providers will therefore be expected to play their part in ensuring that every locality has a thriving third sector largely funded by grants rather than contracts. NHS organisations will be expected to take an active part in neighbourhood partnerships and to encourage users and carers groups to do so. There needs to be a shift so that we look at the most disadvantaged people regaining a sense of hope control and optimism over their lives, working on the strengths, (assets), of people, their families and the communities in which they live – this will impact positively on mental health and well-being and is evidence based from the recovery framework that is gaining credence in mental health”.

12. Age discrimination

Page 8  line 46  insert new section “Age”…”We will ensure that there is parity of treatment in health and social care services in respect of both youth and  age.  This implies

  • equal access to effective, safe care
  • equal efforts to improve the quality of care
  • the allocation of resources on a basis commensurate with need
  • equal status within healthcare education and practice
  • equally high aspirations for service users
  • equal status to the measurement of health outcomes”
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I spent yesterday afternoon with the Labour Party Disabled Members Group discussing their ideas about the future of the Social Security system.  This was a group of people who rely on benefits in various ways, some to enable them to get to work, and some for everything.  When I get their  proposed amendments to the Labour Party policy proposals I will post them here.

Much of the discussion was about the Work Capability Assessment, which they found humiliating, intrusive and unnecessary. Although nobody mentioned the Spartacus Network Beyond the Barriers report their views and proposed solutions were very similar.  They found it hard to see why they needed to be repeatedly examined to see if their amputated limbs had grown back or if incurable degenerative diseases had miraculously reversed.  They dreaded transfer from Disability Living Allowance to Personal Independence Payments, which, as far as they were concerned, did not do what it says on the tin.

What they said about the ability to work was what I have heard elsewhere.  Physical disability, in itself, is a problem most people can cope with, if they can access enough support.  What mostly stops people working is pain, exhaustion, uncertainty and fear, none of which are helped at all by repeated testing.  It’s much easier to cope with a stable disability than one which fluctuates.  Much the biggest cause of incapacity to work is mental illness.  Nearly half of all claimants of incapacity benefits “are in the main disabling group Mental and Behavioural disorders”, and these conditions are the least amenable to objective assessment, especially by a stranger without access to your records.  One of the suggestions that came out of the group was that there should be a combined assessment process, conducted by the NHS, which related to benefits and support of all kinds.

Despite all the anxiety and fear created by the Work Capability Assessment it has had less effect on the total number of claimants than might be expected. The Work Capability Assessment is of course only the latest of many measures to tackle the supposed abuse of incapacity benefits.  In 1982 I was part of an initiative  to transfer unemployed disabled people, who were only expected to sign on once every 13 weeks on to incapacity benefit.  The Thatcher government was later blamed for this initiative, but I can testify it was nothing to do with them.  We intercepted people on their way into the Unemployment Benefit Office and persuaded them they would be better off on the sick. But most had been unemployed for years and looked likely to stay that way.  Like most sick people they wanted to work.

What really makes a difference to the number of people who claim to be incapable of work is the availability of work.  That is why claimants in Surrey are sicker than those in Sunderland.  In Surrey people with minor disabilities can get work.  In Sunderland they can’t.  In Sunderland it seems a perfectly rational decision for a sick person to abandon the idea of getting a job.

Underlying this debate of course is the assumption that people who claim benefits who are sick should get more money than those who are unemployed.  This is only one of many unexamined assumptions which perhaps merit re-examination.  The Social Security system gets much less public discussion than it merits, given how much public money is involved.  Reporting of Social Security issues, which is rare in mainstream media, is generally ill informed.

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This Thursday, 27 February, MPs will debate a Commons motion requiring an independent cumulative assessment of the impact of changes in the welfare system on sick and disabled people, their families and carers, and an immediate end to the Work Capability Assessment, as voted for by the British Medical Association.  It is the result of an e-petition signed by 104,000 people, supported and driven by War on Welfare (WOW), who with many others have carried the fight against  a bipartisan political assault on people with long-term conditions and severe disabilities which has been building up for nearly twenty years. Read a briefing for the debate here.

If you can, watch the debate (from around 11.15a.m.) through the link here. Those on twitter will be using the hash-tag  #WowDebate2014.

Afterwards, you can read the Hansard report here ; and use it politically. Parliament has an honourable history as a safety valve to express the real despair, and empathy, of many, mainly Labour MPs, in response to welfare reform: Labour made it the subject of an Opposition Day debate last July. But as a vehicle of democratic oversight of welfare reform, parliament’s record has been grim and toothless.

This month, with the revolt of the clerics over welfare reform, there has been a marked shift, with a new and immediate moral challenge concerning hunger and food banks which exposes an urgent need for politicians to start thinking through to a way forward, acknowledging a painful and shaming history. As I write, a leaked DWP memo has been published which puts a stop to all repeat medical assessments, which up to now have been a means of harrassing those who have won their reviews or appeals against their Work Capability Assessment. It’s like someone is opening windows.

Few now remember that this began under the John Major government. All those years ago, as Incapacity Benefit itself was rolled out, between April 1995 and October 1996 60% of disallowances were appealed; more than half were reinstated.   Familiar?  In my 1998 profile of poverty and health in Manchester, the Patient Affairs Officer at Manchester Royal Infirmary describes the system as having become ‘in many ways very punitive’. In 1999, Tony Blair opined that Incapacity Benefit is ‘not a benefit which compensates those who have had to give up work because of long-term illness or sickness – it’s an alternative to long-term unemployment or early retirement. That’s why it must be reformed’.   His aides will have drawn on Sheffield Hallam’s ‘Incapacity Benefit and Unemployment ‘ (1999), now mysteriously hard to come by, which identified  a ‘million hidden unemployed’ supposedly wasting away on incapacity benefit by assuming that the ‘real’ level of claims should be that of the region with the lowest level, i.e. the south-east – ignoring the minor detail of geographical health inequality; and finding that for three-quarters of people receiving incapacity benefit  ‘the issue is about what type of work or how much of it they are able to do’, when a more balanced interpretation of the same data would have been that overall, 76% were either unable to do any work or their health limited what they could do ‘a lot’, with another 18% saying their health limits what they can do ‘quite a lot’. That’s the history on which this era is built.

Fast forward to the ‘mature’ Labour government. In late 2006, David Freud, an investment banker and dealbroker,  was appointed by Tony Blair to provide an  independent review of ‘welfare’.   Freud acknowledged that he “didn’t know anything about welfare at all”.  After three weeks he concluded: ‘Based on the analysis in this report, I have no doubt that this will be an annual multi-billion pound market”.

Fast forward again to 2014, and we find 22,840 sanctions imposed on claimants of ESA in the work-related activity group in a year – but the Welfare Reform Act 2007 says that you get ESA if it is not reasonable to require you to work – and ‘work-related activity’ is not defined separately from work – so how come the sanctions? It’s easy if there’s no democratic scrutiny because too many of your representatives’ minds have been ‘bipartisan’.

Now the reality has been forced into conformity with the flawed methodology (A million found fit for work) – hotly pursued by the number wrongly found fit for work – and some people are shocked by the consequences, if they believe them. And Labour are right to be frightened, but this won’t go away. It’s a war against precisely the people on whom 70% of NHS resources are spent (pp8-15 of link).

There is no space here to elaborate on the human cost of welfare reform – many MPs have spoken eloquently from the evidence of their constituents – or on the fallacies that have been allowed to fester in the public mind. But a debate that is an opportunity for more hand-wringing is not good enough. Labour needs to get its head round the seriousness of the moral and political sinkhole we find ourselves in.  Rachel Reeves, the Shadow Secretary of State for Work and Pensions, has spoken about ‘the  deep–rooted aspiration to “earn and belong” that Jon Cruddas has put at the heart of our policy review’. Can we imagine for a moment how that phrase will go down with someone who is too ill or disabled to work? As Cardinal Nichols says, the ‘basic safety net’ has gone. Jon Cruddas recently said, ‘After an historical struggle we built our welfare state’. Well, now we’ve got to rebuild it.

This was first published by Compass,

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This article first appeared in Sue Marsh’s totemic blog ‘Diary of a Benefit Scrounger’ this morning here.

Sue Marsh is on Twitter here -> @suey2y.

ESA pic

In 2008, Labour introduced a new out of work sickness benefit, Employment and Support Allowance, to replace the old Incapacity Benefit. The new system of application and assessments was much tougher, and politicians originally hoped that up to a million people could be moved from the benefit.

However, by 2010, it was clear there were significant flaws in the process. People with mental health and fluctuating conditions were not being fairly treated and successful appeals against “fit for work” decisions soared to 40%.

Professor Harrington was asked to review the new benefit and make recommendations for improving it. As the election took place in 2010, crucially, only new claimants were being assessed. Employment and Support Allowance was yet to be rolled out to the more complicated, and often longer term, Incapacity Benefit claimants, though trials were underway in Burnley and Aberdeen.

Most people claim out of work sickness benefits for short periods – perhaps to get through a sports injury, accident or one off surgery – and stop their claims within 2 years. However, this will always leave a few people with serious, life limiting conditions who will need to claim the benefit for longer periods. Over the years, those claims build up, increasing the proportion who need long term support.

When the coalition came to power in May 2010, they immediately announced that they would go ahead and start to reassess those already claiming Incapacity Benefit.

I could never understand this decision. Why would you take a failing benefit and roll it out to almost 2 million of the most vulnerable claimants? Not only that, but at first, just 25,000 people per month were being assessed, but the government constantly increased and increased the numbers until today, nearly 130,000 assessments are carried out every month.

Why? Why would you rush this group through failing assessments, ever faster, when backlogs kept on increasing, tribunals were overturning 40% of decisions that went to appeal and even legally, courts were starting to judge that the test discriminates against certain groups?

Unless of course you don’t want the tests to be fair. If your aim is to remove a million people from the benefit, perhaps it suits you to make sure that as many of those existing claimants don’t face a fair test? Since 2010, the government have repeatedly delayed improvements to ESA. Out of 25 recommendations made by Professor Harrington in his Yr1 Review, almost two thirds have not been fully and successfully implemented. An “Evidence Based Review” using new descriptors designed by mental health charities and those charities representing people with fluctuating conditions was initially rejected, then taken on, but although results were due in June, still, tests use the old descriptors to decide who qualifies for support. *

The government repeatedly claimed that Professor Harrington had supported the national rollout of incapacity benefit claimants

“Professor Harrington went away and made his recommendations to us, which we accepted in full and have implemented. He told me, “I believe the system is in sufficient shape for you to proceed with incapacity benefit reassessment.” We set ourselves a goal to put his recommendations in place, improve the quality of the process and address many of the issues to which hon. Members have referred today by the end of last May, when the assessments in the incapacity benefit reassessment were to start alongside the existing process of assessing ESA new claimants. We did that, and we started.”

1 Feb 2012 : Column 289WH Hansard Chris Grayling

However, Harrington was clearly an intelligent man who had made thoughtful and intelligent suggestions for improving the assessments. I could never understand why he agreed to put the most vulnerable claimants through a failing test.

So I decided to ask him. It took me a while to track down his email address, but after pulling lots of strings, I was able to ask him outright.

This was Professor Harrington’s reply :

“To your question:

I NEVER—repeat–NEVER agreed to the IB migration. I would have preferred that it be delayed but by the time I said that, the political die had been cast.

I then said that i would review progress of that during my reviews.

The decision was political .

I could not influence it.

IS THAT CRYSTAL CLEAR?

Malcolm”

I’d say it was fairly clear, wouldn’t you?

Ian Duncan-Smith and others took the decision to push nearly 2 million people through a failing test as quickly as they could. Why? Was it so that they could remove as many people as possible from the benefit whether they needed it or not? Surely any failures to improve the test as recommended by Harrington, charities and campaigners couldn’t have been deliberate? Delaying improvements until the IB cohort had been rushed through, the cohort this government and others are convinced are simply “scroungers” and “skivers”?

Instead, as we now see, delays have increased, successful appeals have risen, lives have been lost to the sheer inaccuracy and flawed design of the assessments and the human suffering is now clear for all to see.

To have taken the decision through incompetence is bad enough, but if it was taken deliberately and cynically, I can only hope the responsible ministers will be held to account. Over 200,000 incorrect decisions have since been overturned in law and appeals are taking up to a year to be heard in some areas.

When David Cameron came to power he said:

“The test of a good society is how do you protect the poorest, the most vulnerable, the elderly, the frail.”

That’s important in good times, it’s even more important in difficult times. People need to know that if they have me as their Prime Minister and they have a Conservative government, it will be that sort of Prime Minister

Iain Duncan-Smith said :

“I say to those watching today and who are genuinely sick, disabled or are retired. You have nothing to fear.”

This government and this party don’t regard caring for the needy as a burden. It is a proud duty to provide financial security to the most vulnerable members of our society and this will not change. This is our contract with the most vulnerable.”

I look forward to them explaining what made them change their minds.

Today, we must be our own media. Please RT on twitter, share on Facebook and help me to make sure that as many people as possible see this news. Coincidentally, the evidence based review was released yesterday, as I was writing this article.

Please also read ‘Investigating the real reason for the misery of ‘fit for work’ assessments‘ by Kaliya Franklin (@bendygirl).

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The Work Capability Assessment (WCA) used to determine eligibility for Employment and Support Allowance (ESA) has been dogged with problems since its inception. Department for Work and Pensions (DWP) ministers and Atos have always denied the existence of ‘targets’ for the WCA. Now, for the first time, this article presents evidence that the WCA operates to a norm-referenced system. This is a de facto target system, since when ‘statistical norms’ are applied to a process such as the WCA they deliver the same outcome as targets. As Lord Boswell predicted in 2007, this use of ‘statistical norms’ means “the test will, in effect, be geared to deliver that [desired] result.” Being able to consistently deny the existence of any targets has been crucial to the continuing use of the WCA.

What’s wrong with ‘statistical norms’?

The media regularly feature stories of people even the Daily Mail would consider deserving of ESA who have been refused the benefit – people with sickness or disabilities as diverse as Huntington’s Disease, uncontrolled epilepsy, kidney failure or brittle bone disease. Why are so many of these people being failed by the WCA and who is responsible for that failure? Ministers, MPs, the Department for Work and Pensions and campaigners point the finger at Atos Healthcare, the company contracted to carry out these tests on behalf of the DWP. The DWP say Atos are at fault and that they will be improving the system by breaking the monopoly provision and allowing other companies to bid for the contract once it is due for renewal next year.  Relationships between politicians, the DWP and Atos are at an all-time low and now Labour have also announced that they too intend to be rid of Atos. The DWP ministers blame the civil servants and the civil servants seethe. It is a classic case of political, “it wasn’t me Miss, it was them”.

In 2007 the dangers of introducing a norms-based system to ESA assessments were highlighted during a debate in the House of Commons by Timothy Boswell, the then Conservative MP for Daventry and now Lord Boswell of Aynho. Lord Boswell explained that Incapacity Benefit used a criterion referenced system and warned:

“I can imagine circumstances…in which a future Minister, under financial or even political pressure, might wish to say, ‘We will introduce a norm. We are not going to have, by definition, more than 1.5 million people on employment and support allowance,’ and the tests will, in effect, be geared to deliver that result.”

Timothy Boswell MP, 9th January 2007

The essential feature of norm-referencing is that it awards a ‘score’ on the basis of the ranking of that case within a defined cohort or group. In contrast, criterion-referencing awards a ‘score’ on the basis of comparing achievement with clear, objective measures. It is easiest to explain how this works in the context of marking student exams. If a criterion-referencing system is used to mark scores, students are given an objective grade based on their performance against the pre-defined marking scheme. This means that in a criterion system if the mark for an ‘A’ grade is 70%, every student who scores 70% or more will receive an ‘A’ grade.

However, if a norm-referenced system is used then students’ criterion-based scores are ranked in order within their cohort, typically their class or year. This means that in a norm-referenced system there is effectively a ‘target’ for the proportion of ‘A’ grades to be awarded so only those students who both score above 70% and fall within the allowed number of ‘A’ grades will receive an ‘A’ grade.

As mentioned above, the test for Incapacity Benefit, the Personal Capability Assessment, was a criterion-based system. People were awarded points based upon how they scored against certain criteria – for example, those who could walk less than 50 metres were awarded more points than those who could walk less than 200 metres. If the person scored the number of points the criteria demanded for benefit receipt then they would be entitled to the benefit.

However, the Work Capability Assessment used to consider eligibility for Employment and Support Allowance, the replacement for Incapacity Benefit, is a norm-referenced system. People must both score the number of points required for benefit receipt and fall within the proportion of people the norms system will allow to receive the benefit. In practice this means there is a finite number of claims the assessment system will allow to be awarded the benefit, regardless of the number of people who objectively meet the criteria for benefit eligibility.

Atos, norms and the blame game

So, is removing Atos actually a solution to the problems with the WCA? Would replacing Atos with Capita, Serco or G4S really improve outcomes for those sick and disabled people who require the financial support provided by ESA? Would it reduce the cost to the taxpayer of successful appeals or the human suffering caused when seriously sick or disabled people are denied any financial support? The answer, sadly, is no. As long as the WCA remains a norms based system of assessment, removing Atos is the political equivalent of fiddling while Rome burns – it seems to satisfy the demands of campaigners as it is seen as ‘doing something’ while, quietly and behind the scenes, the fire continues to rage.

The WCA was conceived from a report commissioned under the previous Labour government, prepared by the then banker, now Minister for Welfare Reform, Lord David Freud.  Despite admitting he knew nothing about welfare or disability, within three weeks Freud concluded that some two thirds of those receiving Incapacity Benefit (the predecessor to Employment and Support Allowance) were indeed capable of work. And so it began: a system designed not to assess whether someone was really too sick or disabled to work- i.e. not the ‘real world’ test Chris Grayling was so “implacably and unreservedly opposed to” when he was Minister for Employment (Employment Minister, Chris Grayling, in evidence to the Work and Pensions Select Committee on IB to ESA migration, Wednesday, 8th June 2011, responding to question 340: ) – but a system designed to allocate as few points as possible to an individual by ignoring real world barriers to work and assessing a person’s ability to ‘function’ against the most basic and irrelevant descriptors such as lifting an empty cardboard box. Over the years there have been improvements made to the WCA – some of the descriptors have been removed, a personal statement intended to explain to the claimant why they have or have not been allocated the benefit was added after recommendations from the independent reviews into the WCA run by Professor Harrington. Audio recording of the assessments is also theoretically permitted, but in practice prevented by lack of equipment.

However, it is clear that this is more fiddling, or changing the mood music, as the rate of successful appeals against ESA decisions continues to rise:

Appeal outcomes:

For the year 2012-2013 the appeal statistics from the Ministry of Justice show the following:

  • 327,961 appeals were received (table 1.4)
  • 268,137 appeals were “disposed” (table 2.6)
  • Of these disposals 42,901 (16%) were “cleared without a hearing” (including cases that were struck out, superseded or withdrawn before hearing, table 2.6), so
  • 225236 appeals were heard (table 2.7), of which approximately 43% were decided in favour of the claimant. (Tribunal service statistical tables, April-June 2013. The figures don’t correlate exactly, probably due to rounding).

Cost of appeals:

The cost of ESA appeals to HM Courts and Tribunal Service for that same period (April 2012-March 2013) was £66 million (Helen Grant MP in answer to a written question from Liam Byrne MP, 17 July 2013). In addition the cost to the DWP of all activity relating to those same appeals was £17.1 million (Lord Freud, House of Lords debate 18 July 2013, c141W). Therefore the total cost to the public purse of ESA appeals between April 2012 and March 2013 was £83.1 million.

Why is there such a great disparity between the initial decision by DWP and the decision made  by the tribunal service managed by the Ministry of Justice? Also, why is the government delaying the removal of Atos, who are frequently alleged to be the cause of the problem? The second question is much simpler to answer than the first – to break the contractual terms and sack Atos now would incur huge financial penalties, there is no other provider currently in a position to provide the service (any company which does successfully bid for the contract will have to draw from Atos’s current pool of employees to find enough staff to do the job) and crucially the transfer of those still on the old Incapacity Benefit is not due to be completed until March 2014. These are the longer-term sick or disabled people, the group from which Freud was convinced he could find two thirds fit for work.  Two thirds of the people in this group are also entitled to Disability Living Allowance – which uses both more sensible and more realistic criteria to assess a person’s level of disability. This is a group of people with more significant level of sickness or disability than those claiming ESA for the first time – these new claimants are more likely to have the kind of illness or injury which lasts months rather than years (Work and Pensions Longitudinal Study via Nomis).

Back to the first question – why is there such a disparity between the decisions made by DWP decision makers, based on assessments provided by Atos performing to a DWP contract, and the decisions made by the tribunal service, consisting of a doctor, a lawyer and a disabled lay member not performing to a DWP imposed contract? The answer is both depressingly simple and hideously complicated.

‘Norms’

An example from education helps explain how ‘norm-referencing’ results in a ‘quota’ or ‘target’. Exams can be either ‘norm-referenced’, ‘criterion-referenced’ or a mix of both. A criterion-referenced exam system means students receive an objective grade based on their performance against a pre-defined marking scheme. A norm-referenced exam system sets ‘quotas’ which limit the overall proportion of students able to achieve each grade.

Originally ‘A’ levels were simply pass or fail, but in 1963 guidance was issued which limited the overall proportion of students allowed to receive each grade. This was a norm-referenced system which ensured that only a small proportion of students could achieve ‘A’ grades. For some exams the difference between a ‘B’ grade and a ‘D’ grade was less than 10 marks. This was widely perceived as unfair to students and during the 1980’s ‘A’ level marking systems were changed to remove quotas.

The use of ‘statistical norms’, or expectations, to govern decisions on which sick and disabled claimants are awarded benefit, goes a long way towards explaining why attempts by politicians, charities and campaigners to achieve positive change to the WCA have had such little effect. The next section examines in detail a key piece of evidence, which shows how the prescribed ‘statistical norms’ have been incorporated into the ‘management information tool’ used by Atos:

 Work Capability Assessment

Under the regulations governing ESA, a person must be awarded fifteen points overall to reach the threshold of sickness or disability set by Government to be considered ‘deserving’ enough to receive Employment and Support Allowance for the Work Related Activity Group, and fifteen points on any one descriptor to be eligible for the Support Group. With the ‘statistical norms’ effectively driving down the average number of points scored for physical conditions to just 2.1, and for mental health conditions to 3.6, it is obvious that most claimants will be much less likely to receive the points needed to qualify for the benefit. This is exactly the situation Lord Boswell warned about in 2007, that to impose a norm-referenced system would mean

“the test will, in effect, be geared to deliver that result.”

It is almost unbelievable that the Government persists in its view that a theory devised by a banker, with no knowledge of disability or social security, is an appropriate basis on which to decide whether sick and disabled claimants have an income while they are unable to work.

Are the lives of sick and disabled people in the UK worth so little to those on whom we depend for a safety net?

Detailed analysis of the available evidence

Like many large companies Atos monitor the performance of their assessors and quality of their assessments by using a computer system which interprets the data inputted into the Atos software (Lima) by the practitioner carrying out ESA assessments. The average results for each practitioner are compared with the average results of other practitioners in both the same region and nationally. These criteria for the audit system are set by the DWP and the numbers for the ‘norms’ are given to Atos by the DWP. The norms are based on the percentage of cases the DWP expects to fall into each category. Due to the constraints of the audit system and how it drives behaviour, doctors, nurses or physiotherapists are not truly free to apply their professional judgement as to whether an individual is really fit enough to work. Instead the assessors are constrained by a rigid audit system to ensure all descriptor choices fall within the narrow margin of the norms permitted by the DWP.

In its original contract with Atos Healthcare to deliver the WCA, DWP specified that it expected about 11% of ESA claimants to go into the support group. This is what the contract says:

‘It is estimated that approximately 11% of new customers will fall into the support group. Atos Healthcare MUST base their solutions and costs the [sic] figures in Appendix 8.’ (Contract between DWP and Atos Healthcare, Request for Proposal, section 2.2.2, Appendix 8, shows DWP’s modelling of the caseload, including the 11% estimate for the support group (Note: the link states 2010 but the contract is dated 2007). See http://lartsocial.org/DLAreform

This is the statistical result the original WCA process delivered until the initial Harrington review, after which the proportion of people being allocated to the Support Group rose to 16% in May 2011. Although these are described as ‘statistical norms’, to many people this will sound like a target system, especially given the clarity of the language specified in the original contract, that Atos Healthcare

MUST base their solutions and costs [on the] figures in Appendix 8.”

In practice the norms system operates like a de facto target system in two ways. Firstly it guides the outcome of the entire process.  Secondly, although in theory the audit is not supposed to be invasive or punitive, in reality it drives human behaviour – assessors fear being placed on ‘100% audit’ by Atos, a practice a bit like having your scariest old teacher standing over you with a red pen and giving you a failing grade for putting a comma in place of a semicolon. The consequences for assessors of continuing 100% audit can be deeply stressful, in some cases affecting the performance-related elements of their pay, and could ultimately result in dismissal. The former Atos assessor Dr Greg Wood said;

“I got the impression that assessors always had one eye on what the auditors would think of their reports. No one wanted to be put on ‘the naughty step’, as being subjected to 100% report-auditing was known within Atos. It is time-consuming to write the long-winded exam-grade reports expected by the auditors, so you see fewer cases than the daily target of 8, which can lead to managerial scrutiny in itself – double trouble!”

What this audit process does not do is improve the outcome of the assessment, allow for professional judgment to be applied or represent natural justice either for the claimant or the taxpayer.

The management information tool

Atos  management information tool

For the first time evidence has emerged of a management information tool, which is a key element of this statistical audit system and makes it clear why none of the changes to the WCA have actually made much improvement.

The colours are a basic ‘traffic light’ system – green indicates that the result is within acceptable range of the norm, blue means it has gone too far below the imposed norm and red means it has gone too far above the allowed norm. The figures above indicate the system that Atos use to actively ‘compare’ the output of each individual practitioner. Deviation from a narrow range of ‘averages’, (deviation from the ‘norm’), is not tolerated and leads to a ‘target audit’ process on that individual practitioner. This leads to practitioners closely monitoring the percentage of cases they have placed into various ‘outcomes’.  Once they have placed, say, 15% of claimants into the support group in a week they are very much less likely to put the next seriously ill or severely disabled claimant they see that week into the deserved support group, as to do so would take the practitioner’s weekly figures away from the ‘norm’ and would be very likely to draw the wrath of their manager upon them through the medium of oppressive and intimidating 100% audit.

Another Atos employee (name withheld) stated,

“I feel guilty for doing it but I need my job with Atos to pay my mortgage and feed my children. I have been overtly threatened with ‘re-training’ and dismissal when my support group figures strayed above 20% – after I saw a run of very disabled people in a row one week. It is very depressing to be on 100% audit- it forces you to slavishly follow the rules, rather than being fair to genuinely disabled people.”

Column-by-column analysis of the management information tool

DWP management information toolThe first column is a list of the regional medical examination centres (MSC). Column two is self-explanatory; total number of face-to-face assessments performed within the month of data displayed – this is the total of both new claims for ESA and those transferring from the older Incapacity Benefit. Column three, total number of re-referrals, refers to the IB transfer group, which is those who are longer term sick or disabled.

Column four is the percentage of people placed in the support group. The support group is for the most severely sick or disabled people, those whom taxpayers would unquestioningly deem ‘deserving’. What column four shows is that there is an expected ‘norm’ for the proportion of people who can be placed into the support group.

An Atos Healthcare spokesperson said:

there are absolutely no targets set by either the DWP or Atos Healthcare for decisions on those found fit for work.  Atos Healthcare does not make decisions on an individual’s entitlement to benefit and will likely never know what the outcome is.

“We do audit all practitioners on a random and rolling basis to ensure quality and consistency. One way we are able to trigger an audit process is to look at practitioners whose work is significantly outside of the average expected ranges over a period of time. Where this happens we look at the quality of their work and if no issues are found, no action is taken.

“This is certainly not about changing outcomes of assessments nor is it about reprimanding our practitioners in any way. It is about us checking our quality and making sure you can expect a consistent approach to your assessment whoever carries it out.”

However, whistle-blowers (both identified and anonymous) have provided testimony to contradict these claims; they explain that the audit practice is used to attempt to influence assessors to alter the results of their assessment. Dr Greg Wood is on record explaining it was exactly that demand from an auditor (that he alter his clinical opinion in a report) which led him to leave Atos and speak out in public. There are also accounts of the audit system being used in a punitive and bullying manner by middle managers in several different regions. Whilst the official policy at Atos is clear from their statement, it is also clear that, in practice, problems with audit and its use are widespread.

Each assessor is expected to see eight claimants each day and, as is abundantly clear from the table, the assessor can only put approximately 14.5% of those claimants, just one person of the eight of those assessed face-to-face each day, into the support group without triggering what assessors describe as a punitive audit process.

That 14.5% is an extrapolated forecast from estimated national trends. Using national trends to audit at a national level is perfectly acceptable practice – but this part of the audit system uses those same estimated national trends to also audit the performance of regions and crucially of individual assessors. Put more simply, it takes no account of variation – in an average day an assessor might see eight people with minor lower limb injuries expected to heal within six months, but they might equally see eight people with cancer, or awaiting a lung transplant or with severe learning disabilities – people who are so severely sick or disabled there is no way they are fit for work or work-related activity. The norms also ignore demographic variations in health and levels of disability – so for example, regardless of whether the assessor is in leafy Surrey where more people have good health or in inner city Glasgow, both those assessors are held to an identical ‘statistical norm’. This means significant disadvantage both to those claiming in areas where levels of sickness and disability are considerably higher than others and to the assessors working in those areas.

So what does happen if the assessor has eight people in a day who all need to be in the support group? These are ‘statistical norms’, not technically targets, but fear of audit, described by those working in Atos as ‘being put on the naughty step’, drives the behaviour of the humans being audited. It’s a complicated process which in practice means the norms act as a de facto target system. Dr Greg Wood, who used to work as an assessor for Atos, blew the whistle on some of these bad practices earlier this year – when he described being asked by an auditor to change a report he had written to comply with the process of audit. Dr Wood commendably refused to behave in such an unprofessional manner and spoke out. The evidence now available validates Dr Wood’s claims.

In the month for which data is available (from earlier this year), column four clearly demonstrates that only one MSC (regional ‘medical examination centre’) has gone above the accepted norms as it is highlighted in red. That centre is Bootle and they are breaching the norm imposed by DWP because in that particular month the assessors in the centres in the Bootle region placed 22.3% of all those people they assessed into the support group. Out of all those people called for a face-to-face WCA examination, the assessment of 22.3% as so disabled or sick that they need to receive unconditional support does not seem like a huge proportion. However, from this table it is abundantly clear that it is too high a proportion for the audit system to allow. And that norm or percentage to be adhered to is imposed onto Atos by the DWP.Work Capability Assessment

Column five refers to the percentage ‘curtailed’ – here ‘curtailed’ means those placed into the Work Related Activity Group (WRAG), the group of people who may theoretically be capable of some form of work in the future with the right support and employment conditions. This group includes many people with progressive conditions such as Parkinson’s or Multiple Sclerosis. It is very clear from the highlighted cells in this column that the percentage of claimants the DWP will allow to be placed into the WRAG without triggering an audit is very low, and that there is no national consistency in the application of these standards. For example, Manchester have managed to trigger scrutiny –  by placing 24.7% of those they have assessed within the month into the ‘curtailed’ or WRAG group, which is far above the national average of 20.5% – whereas both Birmingham and Newcastle have breached the norms by only placing 15.6% and 14.2% respectively into the WRAG, which is below the national average of 20.5%. Whilst many assessors have reported problems with punitive audit, both on and off the record, there has never been a report of punitive auditing practices triggered by being too far below the norm. This is how assessors who are genuinely performing poorly (as opposed to constantly being audited for making judgements that breach the norms) are supposed to be identified.

Column six is of particular interest; this is the audited norm for the total percentage of people allocated to the support group and ‘curtailed’ combined, i.e. all those who have reached the threshold applied by the DWP to the descriptors entitling them to ESA. In this particular month the national average for all those being granted the benefit is 35%, uncannily close to the one third of people Freud originally anticipated, in his 2007 report, should be deemed sufficiently sick or disabled to be eligible for support.

Column seven displays the ‘non-functional’ descriptors (NFD) – these are the descriptors the assessor is told to use when the person being assessed doesn’t fit within the WCA framework of descriptors normally used to assess. They allow for a claimant to be deemed to be not fit for work if undertaking work would pose risks for their health. ‘NFD’ applies to people with conditions as diverse as high risk behavioural issues, an inability swallow due to illness or (in women) high risk pregnancies. The ‘NFD’ requires a professional assessment of risk by a doctor or nurse. There has been considerable effort by campaigners to improve the usage of these descriptors, but it is all too clear from this column why those efforts have had such little impact; the national average allowed for the use of these descriptors is just 0.1%, just one person in every thousand assessed. Where these non-functional descriptors are used by assessors they have to complete the full ESA examination before they are able to apply this descriptor to the claimant.

 DWP

Columns eight to thirteen demonstrate why there is such a problem with ‘revolving door’ assessments. This has been one of the biggest causes of stress and misery to those very sick and disabled people recalled for reassessment every six to twelve months. The audit system demands that the majority of people being assessed receive a prognosis of three months when they score ‘sub-threshold’. The phrase ‘sub-threshold’ is automatically generated by the system whenever a claimant is awarded descriptors which score fewer than 15 points. In practice this score means they are found ‘fit for work’ by DWP decision makers who make the final decision about fitness for work based upon information gathered by the Atos assessors and any other evidence available in relation to the claimant.  So, the ‘three month prognosis’ actually refers to people who have not scored enough points to be eligible for ESA and are assessed as ‘fit for work’.  The system only permits 7.5% of those assessed to be given a prognosis (or re-assessment date) of six months, 15.9% is the average for a twelve month prognosis, 6.1% for eighteen months, 3.0% for two years and 2.6% for longer than two years (in effect, three years). Again we see this rough breakdown of one-third of people allocated benefit and two-thirds refused benefit reflected throughout the ‘statistical norms’. The sums of money wasted in reassessing people to a timetable imposed by an estimated audited norm, regardless of their actual health condition, should horrify every taxpayer.

Moving on to columns fourteen and fifteen, we see why people are receiving such low point scores at assessment. The assessors’ decisions are audited to an incredibly low point score, which effectively drives human behaviour and is the most likely reason for auditors to request the kind of changes reported by Dr Greg Wood – that he reduce the allocated descriptor point score of six he had awarded to a claimant (as medically appropriate) to one of zero (as required by the auditor). This auditing process does not apply to the tribunal services, however, leaving them free to make sensible, legally sound decisions based upon their professional interpretation of the legislation as guided by precedent. It requires 15 points overall scored from the descriptors (or criteria) for a claimant to be placed in the Work Related Activity Group (WRAG) and 15 points on any one descriptor for the Support Group (SG).  The small number of points a frontline assessor is able to give without eventually triggering audit clearly demonstrates why there is such a vast disparity between initial assessment and appeal; an audit may be triggered if the assessor awards the points outlined in the descriptors, i.e. if they go above an average of 2.1 points for physical conditions and 3.6 points for mental health conditions.

Work Related Activity Group Column sixteen, the ‘average PSS word count’, refers to the personal statements introduced after the first Harrington review, which were supposed to make it clearer to both the claimant and DWP decision maker why they have or have not been given the descriptors, and therefore points, required for receipt of benefit[14]. This was intended to bring some sense of the individual into the process – to humanise the explanation – but the focus for audit is whether the number of words falls within a particular range, rather than the accuracy of the statement, how consistent the statement is, or if it is easily understood by the Decision Maker at the DWP or the claimant. In practice assessors report that the purpose of the word count supervision was to keep the PSS short and therefore have less impact on productivity.

The final column, column seventeen, is the average time taken to perform an assessment. Human beings, sickness and disability are complicated both to explain and to be understood by an assessor. A genuine assessment of fitness to work should take as long as necessary, not be audited to fit within an approximate 50-minute window. Hence the eight-a-day minimum is onerous and detrimental to both the claimant and the practitioner.

Conclusion

As indicated throughout this article, the evidence gleaned from the original contract between Atos and DWP, testimony from Atos employees and Freedom of Information requests clearly indicates that outcomes for individual sick and disabled ESA claimants are not solely driven by the severity of their condition or the nature of their disability. On the contrary, as Lord Boswell predicted in 2007, the imposition of ‘statistical norms’ onto the Work Capability Assessment gears the outcome of the whole system to achieve the desired result – in effect, a cap on the overall number of people the system will permit to be eligible for Employment and Support Allowance.

The use of these ‘statistical norms’ as a management tool within Atos Healthcare can also be a secondary driver of the outcome for each individual person; although official policy is clear – that audit is not supposed to be used as a punitive process – it is also clear from whistle-blower evidence that, as in most large organisations, practice often does not equate to policy. Given clear reports that audit has indeed been used in a punitive manner by managers, there is a serious risk that the outcome for the claimant  – whether they are placed in the Support Group and given unconditional support because they are unable to work, in the Work Related Activity Group on the basis that they are likely to be able to return to work in the future, or denied ESA altogether and expected to actively seek employment – may actually be driven more by the severity of other claimants’ conditions than their own, particularly those claimants assessed on the same day by the same assessor!

It is also clear and, in the light of this evidence, totally unsurprising that this iniquitous system is causing immense distress, hardship and increased ill-health for the very people who most need support, whilst at the same time costing the taxpayer many millions of pounds in unnecessary assessments and appeals.

This evidence and analysis must be understood by politicians of all parties, since they alone can fix this cruel, wasteful and immoral system and prevent more unnecessary suffering. If sick and disabled people are to receive the support they need – and which a civilised, compassionate Western society is expected to provide – this article is essential reading for both Parliamentarians and the public alike.

Note: the analysis and conclusions explained in this article have been derived from evidence from a variety of sources, including individuals whose situation compels them to speak out anonymously. Whilst there is no absolute guarantee that the analysis is correct in every detail, advice has been sought from a number of statisticians and other relevant experts. On the evidence available, it is difficult to reach conclusions other than those set out above.

This article was first published by The Centre for Welfare Reform and is reproduced by their kind permission and that of the author.  Her blog Benefit Scrounging Scum provides more information.

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The Government’s proposals to increase the Retirement Pension Age have at last focused political attention on the increase in life expectancy which has been rising steadily since about 1860.  It the UK it has been increasing by about five hours a day and there seems no reason to for the increases to stop any time soon unless there is radical government intervention.

Graph of Life Expectancy since 1701 in England and Wales

Graph of Life Expectancy since 1701 in England and Wales

Life expectancy, and healthy life expectancy varies across the UK  (data from Health Expectancies at Birth and at Age 65 in the United Kingdom, 2008–2010)

   Life expectancyHealthy life expectancyHealthy life as proportion      
Men
United Kingdom78.063.581.4%
Great Britain78.163.981.8%
England78.464.482.1%
Wales77.563.081.3%
Scotland75.859.879.0%
Northern Ireland77.059.276.9%
Women
United Kingdom82.165.780.0%
Great Britain82.166.180.4%
England82.466.480.6%
Wales81.763.077.1%
Scotland80.364.179.7%
Northern Ireland81.461.976.0%

There is also considerable inequality between areas in England (data from the Department of Health Mortality Monitoring Bulletin)

Life expectancy by local authorityWhen life expectancy is analysed  “by the National Statistics Socio-economic Classification (NS-SEC)” (we don’t use the word “class” any more, and we don’t have much data about income) the picture is even clearer.

Life expectancy SEC

Trends in life expectancy by the National Statistics Socio-economic Classification 1982–2006.

Most of the improvement in longevity is now among the old.  Infant mortality is now so low that improvements there are slow and make little contribution to the overall picture.  Economic inequality is however very significant in infant mortality.  This graph of age at death does seem to suggest that there may be a biological limit to increasing life expectancy, but it’s about 100.

Age distribution of death 1841-2006

Age distribution of death 1841-2006

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What is impact of current welfare policies on parents and their children?

The Welfare Reform Act 2012 is now law and most changes are scheduled to come into force between this year and 2017 nevertheless delays are already evident because of major problems with Universal Credit. Although policies and legislation rest on the assumption that fewer children live in poverty if their parents are employed statistics show that parental employment does not protect children from poverty. It has been estimated that by 2015 almost 7m of the nation’s 13m youngsters will be living in homes with income judged to be less than the minimum necessary for a decent standard of living and 90% of families will be worse off in 2015 than 2010[i].

Employers are reluctant to offer hours that fit school timetables, term times or additional closures let alone offer workplace flexibility to respond to a child’s illness or other needs. In addition the cost, availability and quality of childcare for children and after school care for older children whilst parents work acts as a barrier to employment and it’s even more difficult for those working at weekends or evenings to find suitable childcare.UK parents also pay substantially more than their EU counterparts for childcare. Being a lone parent of young children is no longer an exemption from job seeking. From when their youngest child is five-years-old lone parents have to be in paid work for a minimum of 16 hours or actively demonstrate they are seeking employment. Proposals under Universal Credit mean that from when the youngest child is aged 1 some conditionality will be attached to benefits such a attending ‘work readiness’ schemes. Non attendance could trigger benefit sanctions.  Although current regulations are supposed to protect lone parents from sanctions if they can’t find childcare or need to work school hours these exemptions are being weakened and in any case Gingerbread already receive frequent calls from lone parents wrongly sanctioned. Indeed foodbanks’ report that a high percentage of requests arise because of delays in benefit payments or wrongly applied sanctions. So parents are caught between the rock of reduced benefits and sanctions and the hard place of low-paid employment and inadequate child care.

What are their consequences for children of parents under stress?

Harm for children in a family context has to be understood as a spectrum. At one end of the spectrum are extreme and prolonged harms, often leading to death, that are indicative of a total de-personalisation of a child but these are rare. At the other end of the spectrum serious harms can be caused to a child as a result of situational stressors – harms that are unlikely to reoccur if the stressors are removed as the relationship between child and parent is basically connected and loving. In fact in the UK child deaths from abuse have remained remarkably static for the last 30 years. While annual statistics fluctuate a little, the longer-term pattern has been fairly stable at 100 to 150 child deaths per year from cruelty.

We are now seeing, however, an increase in harms caused to children by neglect. A recent report of research commissioned by the NSPCC (2013)[ii] into serious harms caused by neglect reveals that in the 139 Serious Case Reviews (the mandatory inquiries into child death caused by abuse) in 2009-11, 60% involved neglect. This same period, of course, coincides with the economic crisis affecting the UK and indeed the correlation between child poverty and child welfare is well understood. The NSPCC report acknowledges that even if parents have a good relationship with their children without a safe living environment children are not safe.

The appalling death by starvation of Hamzah Khan in Bradford has stimulated much political outrage yet statutory and third sector organisations in the city have revealed that levels of child poverty there are unacceptably high, many children are underweight and do not eat three meals a day and as a result there is a frightening increase in foodbank referrals. Academics at the University of Liverpool and local authority colleagues recently published a letter in the British Medical Journal drawing attention to the fact that the number of malnutrition related admissions to hospital in England has doubled since 2008-9. They also quote figures from the Institute for Fiscal Studies which indicate a decrease in calories purchased and substitution with unhealthier foods, especially in families with young children. Alongside the well documented rise in foodbank referrals they argue there will be a major public health emergency without immediate, preventative action:

Access to an adequate food supply is the most basic of human needs and rights. We should not allow food poverty in the UK to be the next public health emergency.

As a society we are facing a moral cross-road regarding the future of all of our children. We have little time left in which to decide whether, on the one hand, to take collective responsibility for their environments or whether, on the other, to regard parents as solely responsible. The consequences of child poverty carry a social and economic cost far into the future and cannot be ameliorated by parents or professionals alone – life environments are fundamentally affected by the social context in which they occur.  As the 2012 unicef report[iii] summarises powerfully:

Because children have only one opportunity to develop normally in mind and body, the commitment to protection from poverty must be upheld in good times and in bad. A society that fails to maintain that commitment, even in difficult economic times, is a society that is failing its most vulnerable citizens and storing up intractable social and economic problems


[i] Reed, H.,/Landman Economics (2013) A bleak future for families, TUC: London, UK

[ii] NSPCC (2013) Neglect and Serious Case Reviews A report from the University of East Anglia commissioned by NSPCC, Marian Brandon, Sue Bailey, Pippa Belderson and Birgit Larsson, University of East Anglia/NSPCC

[iii] United Nation Children’s Fund (UNICEF) (2012) Measuring Child Poverty: New league tables of child poverty in rich countries. Florence: Innocenti Research Centre

 

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