Written evidence from Mo Stewart (PEA0052)
Please be advised that I am identified as producing the most detailed independent research evidence concerned with the use of the Work Capability Assessment (WCA). The WCA was introduced by the Department for Work and Pensions (DWP) in 2008 to assess claimants of the Employment and Support Allowance (ESA), which replaced the former Incapacity Benefit. The WCA uses a biopsychosocial (BPS) model of assessment to restrict funding ESA and disregards all medical evidence. By using the BPS model preventable harm was always inevitable, and it is my understanding that the Committee would wish access to this evidence.
The same BPS assessment model is used by the DWP to restrict funding Personal Independence Payment (PIP), which replaced Disability Living Allowance (DLA) in 2013. Consequently, many thousands of working disabled people have lost their jobs as failure to be awarded PIP removed access to a Motability car, as previously funded by DLA.
Executive Summary
Introduction
1.This evidence to the Work and Pensions Committee (the Committee) inquiry is regarding the effectiveness of the Employment and Support Allowance (ESA) and Personal Independence Payment (PIP) assessment(s). It is hoped this new inquiry will add to the 2014 Committee inquiry, which concluded that the ESA assessment ‘needs fundamental redesign’1 and that it will help to stop the ongoing identified preventable harm that was always destined to be created by these assessments2. I write in my capacity as the lead researcher in the UK3 conducting independent research since 2009 regarding the mandatory Department for Work and Pensions (DWP) assessments for access to ESA when using the work capability assessment (WCA). Evidence from the published research has been cited and quoted during welfare reform debates in the House of Lords and the House of Commons since 2011.
2.In my capacity as an independent disability studies researcher, I confirm that the identified ongoing difficulties with the assessment(s), and the ‘...amazing rate of overturned ESA and PIP decisions’4 were inevitable following the introduction of the ESA and PIP, when using a fatally flawed biopsychosocial (BPS) assessment model created using DWP commissioned research which has failed all academic scrutiny5. The BPS assessment model disregards all medical evidence, and the Jobcentre Plus Decision Makers don’t comprehend the medical evidence, so ‘rubber stamp’ the assessment. The ‘amazing rate’ of overturned ESA and PIP decisions is because all the medical evidence is (finally) considered at Appeal.
3.The adoption of the BPS model of assessment as used for the WCA, and all other disability/welfare benefit claims, was influenced by the private insurance industry and by one American corporate giant in particular6, who funded the DWP commissioned research used to justify the replacement of IB with the ESA.
4.When used for the WCA, the BPS model totally disregards a claimant’s diagnosis, prognosis and all GP opinion, as suggested in 1995 when corporate America were first involved with advising the UK government on welfare claims management7. This American corporate influence continued and a conference in November 2001, funded by the DWP gathered together DWP staff, corporate insurance giants and psychologists already committed to the unproven concept of ‘malingering’, which produced published papers from the ‘Malingering and Illness
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1 Employment and Support Allowance needs fundamental redesign, say MPs. Commons Select Committee, July 2014. LINK
2 State Crime by Proxy: corporate influence on state sanctioned social harm. Mo Stewart, 2017 LINK
3 Cash Not Care: the planned demolition of the UK welfare state. Mo Stewart, September 2016. New Generation Publishing. LINK
4 Are PIP and ESA Assessments working well? WPSC September 2017 LINK
5 Blaming the victim all over again. Waddell and Aylward’s biopsychosocial (BPS) model of disability. Tom Shakespeare, Nicholas Watson, Ola Abu Alghaib. Critical Social Policy, May 2016. Journal article. LINK
6 UnumProvident teams up with Cardiff University. LINK
7 Problems in the assessment of psychosomatic conditions in social security and related commercial schemes. Mansel Aylward and John LoCascio 1995. Journal of Psychosomatic Research 39, 6, 755-756 LINK
Deception Conference. 8 The conference papers would influence future UK social policy, and the adoption of the conference recommendations eventually introduced the ‘politics of fear’ to the sick and disabled community.
The creation of preventable harm
5. The BPS assessment model used for the WCA was recommended by the 2005 DWP commissioned report: ‘The Scientific and Conceptual Basis of Incapacity Benefits’ (SCBIB)9, produced by Gordon Waddell and the former DWP Chief Medical Adviser Mansel Aylward. The suggestion that one million people should be removed from IB was identified10 (p41), and was a reference to the numbers claiming IB for a mental health illness. This suggests that apart from cost concerns, chronic mental health problems are of no concern. The SCBIB report was produced with sponsorship at Cardiff University with £1.6million by UnumProvidentTM Insurance11. This same company were identified, in 2008, by the American Association of Justice as the second worst insurance company in America12(p6).
6. Following the introduction of the WCA in 2008, there were five annual reviews with the first three conducted by Professor Malcolm Harrington. The first WCA review13 was published in November 2010, and identified that ‘...the pathway for the claimant through Jobcentre Plus
(DWP) is impersonal, mechanistic and lacking in clarity’13(p6). Harrington reported: ‘The final decision on assigning the claimant to one of the three catagories theoretically rests with the Decision Maker (administrator) at Jobcentre Plus but, in practice, the Atos assessment dominates the whole procedure.’ 13(p6).
7. Almost seven years later, evidence suggests that ‘the pathway’ is now, in fact, terrifying14 as the DWP adopted coercion as a method of influencing sick and disabled people, to limit the funding of long-term benefit. The theory of the ESA assessment process was that the WCA would be conducted by an outsourced private contractor and the DWP, via the Jobcentre Plus Decision Maker, would make the decision as to if the claimant was eligible for the ESA or not.
These basic-grade administrators had access to detailed medical evidence of the ESA claimants, but they rejected the responsibility they were given, which guaranteed many claimants would have an incorrect decision. Harrington’s first WCA review identified the reluctance of the Decision Makers to consider medical paperwork presented by the claimant :
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8 Malingering and Illness Deception Conference Papers 2003 Oxford University Press ISBN: 0 19 851554 5 LINK
9 The Scientific and Conceptual Basis of Incapacity Benefits. Gordon Waddell and Mansel Aylward. The Stationary Office 2005. ISBN: 0 11 703584X LINK
10 New Labour, the market state, and the end of welfare. Rutherford J 2007. Journal article. LINK
11 (6) op cit: UnumProvident teams up with Cardiff University. LINK
12 The Ten Worst Insurance Companies In America. The American Association of Justice 2008 (p6) LINK
13 An Independent Review of the Work Capability Assessment. Professor Malcolm Harrington. The Stationary Office 2010. ISBN: 9780108509476 Crown copyright (p6) LINK
14 Coroner’s ‘ground-breaking’ verdict: Suicide was ‘triggered’ by ‘fit for work’ test. John Pring, September 2015. Disability News Service. LINK
‘It’s difficult. I mean, they’re a doctor. They’ve assessed the person, I don’t know enough about it to overrule what they’re saying.’ - comments from a Jobcentre Plus Decision Maker15 (p50).
8. The transformation of the UK welfare state using a replica of American social security policies which introduced preventable harm, punitive welfare reforms and the adoption of sanctions, was identified long ago by academic excellence which resulted in a 2015 conference in London16. The identified preventable harm, which was always destined to be created when using the WCA by disregarding all medical evidence, was being reported in academic literature17 but totally avoided by the UK national press, as the British public were being misled by dangerous commentary18.
9. As a consequence of this fatally flawed BPS assessment model, influenced by corporate America, large and increasing numbers of ESA and PIP decisions were always destined to be overturned at Appeal19, where officials do take the time to consider the medical evidence in
detail and are much more likely to believe the testimony of the claimants. The difficulty is that there is such a long waiting list for Appeal hearings. The psychological pressure of this entire
ESA assessment process is grave, was always ideologically motivated and is associated with increases in suicides, self-reported mental health problems and anti-depressant prescribing.20
10. Due to these assessments, it is not unusual for seriously ill claimants to die when waiting for their Appeal or to starve to death when sanctioned21, which means all income is stopped by the DWP, often for minor transgressions. All evidence of ethics and duty of care has been dissolved by DWP welfare reform policies, which were always destined to kill many people as corporate welfare crime22 (p30) was adopted in the UK.
11. Whilst the debate continues, and most people concerned with the assessment process have no knowledge of the influence of corporate America with the planned UK welfare reforms
since 1992, very little attention is paid to the thousands of people who died after being declared
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15 (13) op cit: An Independent Review of the Work Capability Assessment. Professor Malcolm Harrington. The Stationary Office 2010. ISBN: 9780108509476 Crown copyright (p50) LINK
16 Assessing 20 years of welfare reform in the US and the UK. London Conference, March 2015 LINK
17 Welfare reforms adapted from American social security policies are causing preventable harm to chronically sick and disabled people in the UK. Mo Stewart, September 2016 LINK
18 Bad News for Disabled People: How the newspapers are reporting disability. Strathclyde Centre for Disability Research and Glasgow Media Unit LINK
19 It’s funny that there are so many successful appeals against disability assessments – it’s as if there were something wrong with the system. James Moore, March 2017. The Independent LINK
20 ‘First do no harm’: are disability assessments associated with adverse trends in mental health? A longitudinal ecological study. B Barr, D Taylor-Robinson, D Stuckler, r Loopstra, A Reeves, M Whitehead. November 2015. BMJ Journal article. LINK
21 Vulnerable man starved to death after benefits were cut. Amelia Gentleman, February 2014. The Guardian. LINK
22 Corporare Welfare Crime: Two Case Studies in State-Corporate Harm. Lewis Elward, 2016 LINK
‘fit for work’ following a WCA23; which is only possible because diagnosis and prognosis is not a consideration of the assessment. Given that almost 90 people per month are dying after being told they are fit enough to work23, perhaps more consideration should be given to these disturbing figures.
12. The ‘demonstrated disparity between applicants’ memory of assessment and the final report’24 is entirely due to the limitation of possible answers that may be recorded, as diagnosis and prognosis is disregarded and the forms used by assessors offer limited possible answers to restricted questions. Clearly, the contracted assessors do not have ‘sufficient expertise to carry out assessments for people with a wide range of health conditions’24 as this level of competance is not required when diagnosis is disregarded by the WCA; which is a very basic and critically challenged ‘functional assessment’ and is unconcerned with the reported health conditions.
13. The rhetoric of successive governments claimed that welfare reform was necessary due to costs. The Coalition government spent five years, aided by the tabloid press, demonising chronically ill and disabled claimants as ‘scroungers’ who, it seems, had developed a ‘money for nothing’ lifestyle. None of this was true, of course, and the DWP evidence of fraudulent claims was never higher than 0.7% of the entire welfare budget. The rhetoric was to reduce the public approval for the welfare state to justify the eventual move to welfare funded by private healthcare insurance.
14. In reality, it was the Thatcher government that recommended the removal of the welfare state, and all governments since 1982 have worked towards adopting the American system of social security based on private healthcare insurance. It remains to be seen how many more chronically ill and disabled people will be quite literally ‘killed by the State’, when their only crime is that they are unfit to work but the DWP refuses to believe them25.
Conclusions
15. To guarantee delivery, it is essential that the DWP make policy decisions based on academic research commissioned by them, which is invariably discredited by academic excellence demonstrating DWP published research to be ‘policy based research not evidence based research’.26 The DWP exclusively cite DWP commissioned research in policies and refuse to accept published independent research from any other source.
16. Austerity measures, together with ongoing welfare reforms, were always going to create
public objections. The best way to mitigate government culpability was to outsource the ____________
23 Thousands have died after being found fit for work. Patrick Butler, August 2015. The Guardian. LINK
24 (4) op cit: Are PIP and ESA Assessments working well? WPSC September 2017 LINK
25 Killed by the state: how Tory policies have cost countless lives. Mo Stewart. Welfare Weekly June 2017. Article. LINK
26 (5) op cit: Blaming the victim all over again. Waddell and Aylward’s biopsychosocial (BPS) model of disability. Tom Shakespeare, Nicholas Watson, Ola Abu Alghaib. Critical Social Policy, May 2016. Journal article. LINK
assessments to unaccountable corporate giants, and for the DWP to successfully place the
blame for the deficit on the chronically sick and disabled community who couldn’t retaliate27.
17. The Appeal Service is picking up the pieces of these fatally flawed assessments, which have failed all independent academic scrutiny. The fact that there are so many overturned decisions at Appeal should alert the Committee to the fact that these assessments are causing preventable harm to many people.
18. Claimants seek to overturn decisions which are deemed to be unfair and threatening their physical and financial survival, with the strong possibility of destitution when ESA funding is removed.
19. There is a likely possibility that many ESA claimants aren’t well enough to challenge a decision so possible justice is denied to them. Many PIP appeals are by disabled but otherwise physically well claimants, in danger of losing their careers/jobs when PIP is refused and they lose access to a Motability car. This may explain why there are higher levels of disputed decisions for PIP than for ESA.
20. Mandatory reconsiderations are only successful if the administrators are willing to listen to reasoned arguement. There isn’t any additional evidence for mandatory reconsideration, just the testimony of the claimant who is experiencing preventable harm by the State as their only means of financial survival is threatened.
Recommendations
21. There is overwhelming evidence that the WCA is causing preventable harm, with many deaths linked to the DWP coercion of the most vulnerable people in society, when social policy is influenced and guided by corporate America. Disregarding all independent research exposing the BPS model of assessment as having ‘no coherent theory behind this model’, and dismissing all evidence exposing the preventable harm created by DWP policy is unacceptable. The WCA should be stopped with immediate effect.
22. The significant increases in mental health problems directly linked to the assessments were expected as DWP policy knowingly removed the former security of the welfare state. It remains unacceptable that the opinion of the family doctor was greatly reduced with the introduction of the ESA, recommended by DWP commmissioned research which failed all independent academic scrutiny. Rather than using the enforced WCA, it would surely be better to first consider the medical opinion of the family doctor before deciding any requirement to enforce an ‘assessment’.
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27 Demonising disabled people: public behaviour and attitudes during welfare reforms. Welfare Conditionality: sanctions, support and behaviour change. University of York. Mo Stewart 2017 LINK
23. The overzealous use of sanctions has meant chronically ill people starving to death, with a replica of US social security policies adopted by the UK28. Flexibility must be introduced into the system so that, when a claimant advises a Jobcentre that they are unable to attend an appointment due to ill health, they may actually be believed and helped, not routinely sanctioned.
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28 The second phase of US welfare reform ~ blaming the poor again? Journal article. Anne Daguerre 2008 LINK
October 2017