Smokescreen – response to Green Paper

by Caroline Richardson

Spartacus Network this week has produced a response, aptly named Smokescreen, to the Government Green Paper on health and work.  Smokescreen attempts to dig below the soundbites and policy based evidence, and analyse the proposals.

What we found was truly shocking. In a Green Paper, touted as being mitigation for the cuts to the sickness benefit ESA, there was very little evidence that the cuts would be mitigated at all. Instead the Green Paper outlines yet another series of Work Programmes, using many of the familiar Prime Work Programme providers, supported by many of the same community and charity organisations as sub-primes.

What is truly startling though are the numerous hypotheses put forward as facts, supported in part by evidence based on reports written by the DWP or for the DWP, or extremely weak evidence – one survey used only 5 people.  There is a deliberate conflation of sickness and disability – and there is no plan to provide specialist support to those who are healthy and disabled. Instead the DWP has targeted the largest group of ESA claimants by WHO ICD code – Mental and behavioural disorders – regardless of the huge spectrum of conditions this group contains. It also has in its sights the second largest group – musculoskeletal.

Throughout the Green Paper these conditions are suggested to be minor, needed only low level medical interventions to achieve recovery. However these medical interventions are not going to be instigated by the claimant’s GP, but by a Job Centre Employment Advisor rebranded as a Work Coach, one of whose roles is to triage claimants and decide what would be appropriate treatment for them, where treatment consists of a Work Programme.  This triaging will take place at a Health and Work interview whilst the claimant is still in the early stages of ESA, prior to the actual Work Capability Assessment.

What is concerning is that claimants are to be offered treatment as part of their work programme, with provision being via charities, community groups and computers. The emphasis throughout the Green Paper is the coalescing of work and health, as it’s suggested continually that work is not just a health outcome, but also a route to recovery. Obviously if this were true then people wouldn’t leave work due to illness.

No-one is ignored in this Green Paper; the elderly, the unemployed, the sick and carers are all potential units of productivity. The only group exempted are those with disabilities who have good health – for them there is little or no support offered or planned, which is ironic given the Government target of halving the disability employment gap.

This Green Paper should be read with caution; it works excessively hard at not justifying the cut it refuses to mention, and to distract the reader by painting sick people as a hairs-breadth away from recovery – which of course the Government is prepared to supply in the most ‘cost effective’ and consequently ineffective way possible.

Smokescreen can be downloaded here.

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Independent Living, ESA and the Green Paper on Work and Health

The Spartacus Network will be making a full response to the Green Paper on Work and Health consultation, which closes in February 2017.

In the meantime here are two blogs which look at Employment and Support Allowance through a broader framework of independent living.

The first argues that, as a result of austerity policies, social security programmes in the UK are insufficient in amount, coverage, and duration to ensure an adequate standard of living, which is the cornerstone of independent living for disabled people https://spartacusnetwork.wordpress.com/2016/11/24/esa-does-not-permit-independent-living-for-disabled-people-in-the-uk/

The second looks at independent living as defined by the UNCRPD, and finds that the Green Paper fails to uphold it because it considers paid employment to be the only pathway to full inclusion in society. It warns of continuing, invisible cuts to disability benefits in the form of shrinking eligibility, and argues that we need to reject the premise of the WCA and demand a new model of work capability based on disabled people’s accounts of work and health. https://spartacusnetwork.wordpress.com/2016/11/24/the-green-paper-on-work-and-health/

The Green Paper on Work and Health

A rights based response

There’s lots to say about the Green Paper on work and health – on how the DWP proposes to improve its employment support offer for disabled people at the same time as a cut in funding for services; on extending conditionality for benefits to groups assessed as being furthest from the labour market.

But this response will consider the implications of the Green Paper for disabled people’s right to independent living. The issue I’m going to take up is the way the Green Paper, as well as some charities response to it, sets up an opposition between full inclusion in society on the one hand and reliance on benefits on the other – a kind of moral dichotomy between inclusion and dependence.

The recent UN report on disability rights in the UK makes clear that this opposition is false.

The right to Independent Living enshrined in Article 19 is inseparable from the right to an adequate standard of living in Article 28 and the right to work in Article 27. The report says, Without an adequate income and standard of living, disabled people risk isolation and segregation from the community.

We might add that, however much choice and control someone has over their care provision, they will never achieve independent living if they are too poor to afford food or fuel.

The Green Paper talks about improving lives and creating a country that works for everyone. But the only gateway to aspiration and equality it offers to disabled people is that of paid employment.

It mentions protecting those who need help the most. But it doesn’t uphold the right to an adequate standard of living as a requirement to full inclusion and participation in the community, set out in the UNCRPD.

As well all know, disabled people’s income has taken a hit through the Bedroom Tax, benefit cap, changes to Housing Benefit and the forthcoming cut to the ESA WRA component.

The Green Paper promises no more cuts to disability benefits. But at the same time DWP has been actively developing ways to restrict entitlement to ESA even further, through measures that haven’t been consulted on, like revising guidance to assessors on interpreting the regulations on risk. So the category of what it calls those “who need help the most” is ever shrinking.

This is where we need to focus our attention in the Green Paper. Sometimes the most toxic cuts come in the form of shrinking eligibility.

The Work Capability Assessment

This is where I’m going to talk about the WCA because I think it’s not well understood by people who haven’t been through it. Its eligibility criteria seem to live in a black box that’s too technical for social policy analysis. Whereas in fact the WCA is pure ideology, there’s nothing technical or even medical about it.

The model of disability developed by Gordon Waddell and Mansell Aylward which underpins the WCA has been a key tool in undermining the rights of disabled people to an adequate standard of living. In a theory that Tom Shakespeare says is neither coherent nor evidence based, it contrasts genuine disease or impairment with so called “common health problems”, everyday aches and pains which, combined with negative attitude and lifestyle choice, create benefit dependency. This is how it creates a distinction between the deserving and the undeserving disabled in order to disqualify, initially, a million people from entitlement to social protection.

It is a pseudo-scientific rationale for denying support to people. And it’s dangerous because it’s legitimacy is almost never called into question by policy makers or the charities who speak to government on behalf of disabled people.

We all need to reject Waddell and Aylward’s version of the Biopsychosocial model outright. The tweaks to the WCA offered by DWP, like the halt to repeated assessments for a small group, are not enough.

We want a new model of work capability. One that is based on disabled people’s accounts and experiences of work and health and the relationship between them; on our own accounts of the barriers we face and the solutions that could remove them.

The Green Paper offers a consultation on the WCA but does not call into question its underlying model of disease and disability, and how it determines who “needs help the most”.

I want to finish with this thought:

Out-of-work disability benefits are not charity or a form of pity; they’re a right for those who face disadvantage in the labour market. DPOs must fight to take ownership of social security policy in the same way they have fought to influence and inform social care. We must fight the idea that financial dependence on the state makes us less than full citizens, in the same way we have fought the idea that dependence on personal assistance gives us less right to control our daily lives.

Catherine Hale.

 

ESA does not permit independent living for disabled people in the UK

An adequate income is the foundation upon which all independent living is based. Current rates of ESA and its equivalent under Universal Credit are not adequate in terms of coverage (who is entitled to ESA),amount or duration to ensure independent living for disabled people in the UK.

In Maslow’s hierarchy of needs, housing needs are met by housing benefit and all the other essential needs are met by ESA. ESA is not adequate to cover all the essential needs contained in Maslow’s lowest tier. However much social care someone receives, they will never be independent if they are so poor that they cannot afford food or fuel for heating.

According to the Joseph Rowntree Foundation’s Minimum Income Standard measure, the income required to achieve an adequate standard of living – for a healthy, able-bodied person is £184.66 per week for a single person, excluding rent, mortgage or the proportion of Council Tax covered by Council Tax Support. A basic living income can be estimated by removing from the budget those costs that are associated with social participation, clothing and household repairs; this comes to £114.25. Jobseeker’s Allowance, SSP, ESA WRAG and ESA SG are all  inadequate even for short-term subsistence living, let alone for an adequate standard of living. This means that people who are unable to work because of chronic disabling illness or disability are forced, by the political choices of the country, to live in destitution.

Sickness benefit Amount Shortfall in short-term Shortfall in long-term Shortfall for adequate living
SSP £88.45 £25.80 £45.21 £96.21
ESA assessment phase £73.10 £41.15 £60.56 £111.56
JSA £73.10 £41.15 £92.51 £111.56
ESA WRAG £102.15 £12.10 £31.51 £82.51
ESA SG £109.30 £4.95 £24.36 £75.36

 

But this is not all. The government of the last six years has ensured that:

  • Benefit levels have been frozen benefits at 2016 levels for four years, so that as food, utilities and ticket prices rise benefits become even more inadequate;
  • Housing benefit no longer covers the cost of rent, so tenants have to make up the rest from their ESA, live in housing that is so damp or cold as to damage health, or rent from rogue landlords;
  • The assessment for ESA has been designed in a way that is incapable of assessing chronic illness. It cannot account for the significant disabling effect of having some difficulty with all activities, as opposed to specific, discrete incapacity such as the effect of sight loss on reading. Consequently, many people who are too ill to work are assessed as fit for work.
  • People on JSA or ESA WRAG have to take part in activity in order to retain their benefit. Research on WRAG confirms that this activity is largely irrelevant and detrimental to their health.
  • People with chronic disabling illness typically have extra costs, such as needing help with personal care or household chores, or for additional utility bills. Extra-costs benefits do not cover households chores other than basic cooking, nor more expensive items. The assessment is unable to assess the extra costs of chronic illness, so people struggle to get the benefits they need even for the costs that are assessed.
  • ESA become means-tested after certain time limits. People who do not have enough National Insurance credits in the previous two years are dependent upon means-tested payment, and ESA WRAG claimants after twelve months. After this, people can’t receive benefits if their partner has too much income (£5-10k/yr) or savings.
  • ESA recipients are regularly reassessed, usually at intervals of under two years. Because of the strictnrss and inconsistency of the assessment, individuals can lose their benefit without any improvement in health – and even with a deterioration – and then have to go through a lengthy appeal process to reinstate their benefit. In this time, increased poverty and stress lead to worsened health and indebtedness.

All of this means that sickness benefits are not adequate in:

  • Coverage (many people unfit for work are told that they are fit for work, or made to carry out prescribed activity to retain their benefit);
  • Amount – ESA does not cover the cost of an acceptable living standard, including social participation for people who would otherwise be permanently locked out of society. Housing benefit does not cover the cost of housing, and extra-cost benefits do not cover the extra costs incurred by chronically ill people;
  • Duration – benefits are means-tested, and repeatedly re-assessed. They do not last as long as the chronic illness, and are not stable.

Stef Benstead and Caroline Richardson.

Important consultation on a replacement for ESA

ESA needs replacing; there is little disagreement about that. What has not yet been proposed is a system to replace it. Such a system should be designed primarily by the sick and disabled people who will depend upon it.

This is what Ekklesia is proposing to do. In its initial survey, Ekklesia asked respondents about what support they needed in order to be able to work (if work were possible at all) and how the assessment process should occur. The results of this survey have been published in two reports. The first focusses on the support that sick and disabled people say that they need if they are to be able to work. The second report presents a proposal for a new assessment and support process, again based upon the responses to the survey. But there is more work to do.

Ekklesia are asking people to respond to their initial proposal with comments and critique. Their second report is also a consultation document, asking for responses to the proposed system and principles. Twelve weeks have been given to respond to this consultation, which is running from 9th August to 31st October 2016. Ekklesia are particularly keen for responses from people with sensory impairments, spinal or limb injuries, learning disabilities and autism spectrum disorders as these groups were under-represented in the initial survey. However, chronic physical and mental illness continue to be central to the design of a suitable assessment process, especially given their traditional under-assessment in income-replacement and extra-cost benefits.

You can find the first report here, and the second (consultation) report here. The second report is also available in an Easy Read version here. You can respond to the report by emailing your response to ekklesiasurvey@gmail.com or by posting it to Ekklesia Survey c/o Simon Barrow 3/3 Kirk St, Edinburgh, EH6 5EX.
If you prefer, for simplicity, you can answer the consultation questions using a scale of Strongly Disagree / Disagree / Neither Agree nor Disagree / Agree / Strongly Agree.

The report by Ekklesia shows that the government is badly failing its sick and disabled citizens. The government claimed that the Incapacity Benefit system abandoned disabled people to a life on benefits. Yet we are far more abandoned by ESA. Under IB we were given the freedom to live and manage their lives; on ESA WRAG or JSA we are mandated to activities beyond our capabilities without the support we would need to be able to undertake them.

Without this support, any attempts to get us into work are simply doomed to fail. It is a waste of the government’s resources to put money into a scheme that cannot work, and a waste of our health, energy and capacity for social inclusion. The government cannot have it both ways; it cannot refuse to pay the cost of employment support and simultaneously insist that we ‘prepare for’ work that we will never find.

The principles that Ekklesia propose allows the government to make the choice of whether to fully support someone to work, or to support them in a life of independence and social inclusion outside of the workplace. By basing the decision upon what support is needed for an individual to work, we ensure that the decision on capacity for work is tied in to both what support an employer can provide, and what the government is providing. We end the farcical situation where individuals are told by the DWP’s mechanistic system that they are fit for work, when the assessor and employment support worker know that the individual is demonstrably unfit for work. And we ensure that no-one is asked to work before the government has made it possible for them to do so.

Based on the results from the respondents to Ekklesia’s survey, Ekklesia have proposed, as a starting point for this consultation, that a new assessment process should include the following features:

  • Medical evidence should be provided for all individuals; this is a more efficient way to get an accurate medical opinion than having to employ medics who are not involved in the individual’s care.
  • The assessment should be in the format of a discussion taking place over several meetings.
  • Claimants should have the opportunity to comment on the assessor’s report before a decision is made.
  • The assessor should also be the one who makes the decision on fitness for work.
  • Reassessment need only occur for those not in regular contact with a caseworker, and should be light-touch in recognition that these are the people who are least likely to become fit for work.

The criteria of fitness for work should be based on the following:

  • The decision of capacity for work should include labour market competitiveness.
  • The assessment should consider the overall capacity for work, including the need to work at a slower pace or have breaks from work, rather than focussing on isolated activities.
  • The assessment should give direct consideration to the skills that the individual has and whether or not these can be used given the claimant’s health condition.
  • A decision of fit for work should be based upon the ability to identify jobs that that individual could perform.
  • If an individual needs particular forms of support to be able to work, that individual is considered unfit for work unless and until that support is provided.

The underlying policy position, principles and assumptions should recognise that:

  • Individuals contribute to society in a number of ways other than paid work, and the value of these contributions should be recognised.
  • The social security system needs to protect those whose health and quality of life is at risk of being damaged by requirements to engage in work or work-related activity.
  • Voluntary work should be encouraged as a valuable contribution to society and as an acceptable activity for people with chronic illness who claim sickness benefits.
  • The basic rate of benefit should be set at a level that is adequate for long-term living including social participation in society.
  • Sanctions and conditionality are detrimental to health, well-being and financial security. They should not be used for people with chronic illness. Instead, a system of top-ups (above a liveable base-level benefit) could be acceptable to compensate individuals for engagement in activity.
  • A range of areas not well captured by the WCA are key to the understanding and assessment of capacity for work. These include mental health, varying or unpredictable capacity for work, and the accumulation of incapacity from multiple origins.
  • Capacity for work is impacted by the provision of support in areas of life outside of the individual workplace. These can include health care, personal assistance, home help, caring responsibilities, commuting and regulation of the labour market to promote more and better quality jobs.
  • People with chronic illness need a wide range of support if they are to be able to work.
  • People with chronic illness may benefit from re-training, particularly where re-training may allow the individual to use remaining health capacity better or compensate for loss of capacity in a previously trained area.
  • Employers may be reluctant to employ people with chronic illness due to founded or unfounded concerns of associated costs. Employers may need practical advice, support and/or financial assistance to make it viable for them to take on an employee where the any associated costs are uncertain.
  • There is a mismatch between what employers mean and can manage when they refer to flexible working, and what people with chronic illness mean and need when they refer to flexible working.
  • There is a difference between an individual being ‘capable’ of work (which could include working for small units of time at irregular intervals, spread out over a longer period), and an individual being employable or being able to find or sustain work.

 

You can find the first report here, and the second (consultation) report here. You can respond to the report by emailing your response to ekklesiasurvey@gmail.com or by posting it to Ekklesia Survey c/o Simon Barrow 3/3 Kirk St, Edinburgh, EH6 5EX.
If you prefer, for simplicity, you can answer the consultation questions using a scale of Strongly Disagree / Disagree / Neither Agree nor Disagree / Agree / Strongly Agree.
The consultation is running from 9th August to 31st October 2016.

Action on PIP 20m rule

Have you been affected by the 20m rule in PIP?  Lost your higher rate mobility in a transfer from DLA to PIP? Lost your motability vehicle?

Has this affected your ability to leave your home to get to places, and take part in community, volunteering or work? Do you think your mobility needs were unfairly assessed in a PIP assessment?

Thanks to a recent House of Lords motion by Baronness Thomas of Winchester, there’s a chance to make the government rethink the notorious “20 metre” rule for qualifying for the Enhanced Rate Mobility component of Personal Independence Payments (PIP).

We need case studies of people affected by this 20m rule for DWP officials* to examine its fairness and its impact on people’s lives. Please note, you must be willing to disclose your National Insurance number, so that details of your case can be looked into. Please write to Baronness Thomas at thomascm@parliament.uk

The 20m rule, not included in the original consultation on PIP, restricts eligibility for the mobility component for people with severe walking difficulties from the previous 50m benchmark used in DLA down to 20m.

There is no evidence that people who can walk more than 20m but less than 50m face lower costs for mobility and transport than those who cannot walk 20m. This aspect of PIP means disabled people who would have qualified for the Higher Rate mobility component under DLA lose £33.25 per week or access to their Motability vehicle.

The House of Lords motion – April 2016

Baroness Thomas of Winchester: to move to resolve that this House calls on Her Majesty’s Government to hold urgent talks with Disability Rights UK and the Disability Benefits Consortium to identify a mobility criterion in the Personal Independence Payment “moving around” assessment which is fairer than the current 20 metre distance, in the light of the impact on reassessed disabled claimants and the resulting large number of successful appeals.

Please write to Baronness Thomas, with details of your case and your NI number if you can help, at thomascm@parliament.uk

Thanks, from the Spartacus team.

*Update 18.06.16 Apologies for the previous error in the post, which read “Dept of Health” officials.

 

Repair the despair

An open letter to Jeremy Corbyn

Dear Jeremy,

Under the last Labour Government sick and disabled people were unhappy with the way we were portrayed and treated. The proposed cuts and the policies enacted in that period lost the Labour party the votes of many of the 4.6million sick and disabled people plus their carers and families.

Many discussions were had within the community – some chose not to vote in 2010, some chose to vote Liberal Democrat.

However none wanted to vote for Labour in 2010 – in the main due to the introduction of ESA which was supported by the ‘scrounger’ rhetoric. This rhetoric has become firmly embedded in the public psyche.

The current Government simply wishes to extend this by cutting the ESA premium of those in the Work Related Activity Group, as this group is seen as being in some way “fit for work”, regardless of this group containing people who are degenerating and moving away from work.

But it wasn’t just ESA that alienated disabled people from Labour.

The Local Housing Allowance (LHA) meant disabled people were limited even further in the housing market. We don’t ‘automatically’ get social housing. I was homeless for two and a half years due to the combination of the LHA, private landlords not accepting benefit claimants, and the lack of suitable accommodation for a person with disabilities. The Coalition introduced the bedroom tax – to much furore, and yet disabled people housed in the private sector had to continue to suffer in silence whilst we made up the financial difference from our benefits.

To understand the true crisis for disabled people in housing please read the work done by Habinteg, who found that only 5% of housing in England is accessible.

There was also the suggestion of removing Attendance Allowance and the care element of Disability Living Allowance (DLA) from pensioners, and handing that money over to Local Authorities to prop up the financial gap in care provision. This meant that people judged to need the additional finances to buy in their care at a reasonable rate would be without that money, and with no guarantee that they would be given Local Authority care. Effectively people would be paying for the care of others. The care provision of Local Authorities is around twice the cost of the new minimum wage, averaging £15 per hour.

There was a real fear and a suggestion that all recipients of DLA Care rate would eventually be included, indicating that the Government  failed to understand the economics of the situation, the scarcity of care available and the expenses that the Care component was spent on.

Badly named, the Care component was/is expected to pay for aids, adaptations, extra heating, lighting and other utilities, internet access, fuel, laundry, additional wear and tear on clothes etc, as well as flexible ‘as-and-when’ assistance to go shopping, medical visits, sporting and leisure costs.

I pay £25 a week so someone can get my scooter out of my house – just so I can go for a “walk” 3 times a week. I was paying £30 a week so someone would drive me to and from a para-sport activity, because of the distance. To remove my Care component would have meant no sport and very little chance of assistance when I needed it.

Now we see that the current Government are revisiting this idea. I can only assume the silence from Labour is due to embarrassment. You can hardly oppose a policy that the Labour Party itself proposed only 7 years ago (2009).

The Labour Party, and particularly the PLP, needs to readjust its attitude towards sickness and disability. It needs to shake off the ingrained beliefs that sick and disabled people are in some way scroungers and frauds.

The 2 benefits, ESA and DLA/PIP, have the lowest levels of fraud. They have the toughest assessments in Europe. The people in receipt of these benefits are too sick to work, and do face huge barriers and additional costs.

If you want those votes back then firstly you have to change the mind-set of the PLP, and start to vigorously attack the current Government. The PLP must not continue to allow the Conservative party to mislead the public with their skewed data. It is beyond me why, when Cameron states a higher percentage (such as for PIP) the Labour Party cannot respond with the absolute values for the number of people who it is proposed will be denied the allowance. (Some 24% of current case load of working age people).

We need more vim, more vigour, and some acceptance that the previous Labour Government got it very badly wrong. Sick and disabled people need a reason to trust Labour again. There is no evidence that sick or disabled people have returned to Labour in any great number, in the main due to Labour’s silence on these issues.

It is not enough to believe that people will return to Labour because the Conservatives are treating people worse. That “give them enough rope” thinking of the last Parliament failed. We must take the fight to them, not expect the public to make a judgement based on what the media chooses to portray.

I’m not suggesting this will be painless or in any way cathartic, but with 2.5m sick people and 3.4m disabled people[1], their carers, friends and families – who work unpaid to fill the shortfall – there are millions of votes available to reclaim. Please don’t let those votes continue to be lost to the Green Party, SNP, UKIP etc.

Its worth remembering 45% of pensioners have some disability.  A good place to start would be with the proposal to remove Attendance Allowance, whilst winning back hearts and minds of those affected by cuts to ESA (WRAG) and the proposal of reducing PIP even further (currently under consultation).