Sustainability and Transformation Plans in post-industrial areas blame unemployment and long term illness on bad lifestyle choices

South Yorkshire and Bassetlaw Sustainability and Transformation Plan (STP) – in common with most others – doesn’t tackle social & economic determinants of ill health, but imposes behaviour change on chronically ill and long term unemployed people, on the false assumption that wrong lifestyle choices have caused their problems.

Like other STPs for economically depressed, post industrial areas, it promotes the Department of Work and Pensions’ plan to merge health and employment services. This is based on the fallacy – put about by the Tory government as cover for its drive to cut benefits for people with long term illnesses – that employment is cure for poor health.


One of the key elements of the South Yorkshire and Bassetlaw Sustainability and Transformation Plan proposals for “healthy lives, healthy living and prevention” is:

“a focus on employment and health, to be carried out 2017/18 – 2019/20”

The Durham, Darlington, Teesside, Hambleton, Richmondshire and Whitby STP similarly promotes (slide 21) “Lifestyle, early identification and intervention” measures, to be introduced in 2017/18 and 2018/19.

These include:

“Support for primary care to manage worklessness and support people with Long Term Conditions back into employment.”

Both South Yorkshire and Bassetlaw and much of the Durham, Darlington, Teesside, Hambleton, Richmondshire and Whitby area suffered high levels of industrial job losses in the 1980s and have never recovered economically.  Since the 1990s they have also had high numbers of working age adults on incapacity-related benefits.

Share of working age adults on incapacity-related benefits, Feb 2016 and Major industrial job losses since the early 1980s, in coal, steel, cars, shipbuilding & engineering, textiles & other manufacturing

The solution to high levels of long term unemployment is to bring back skilled industrial jobs to post industrial areas.

This is the conclusion of the Sheffield Hallam University Report:  Jobs, Welfare and Austerity.

UK manufacturing jobs have fallen from 8.9m to 2.9m in the last 50 years and 500k coal mining jobs have gone. This has destroyed the economic base of many communities, where vast numbers of people have ended up on incapacity-related benefits – these days, Employment and Support Allowance which is claimed by around 2.5m adults. The highest claimant rates – 10% or more of working age adults – are nearly all in deindustrialised areas.

Unlike areas with plenty of jobs and low numbers of ESA claimants:

“…where the labour market is difficult – as in older industrial Britain – ill health or disability ruins many people’s chances of finding and keeping work. Employers were able to recruit the fit and healthy instead.”  (Jobs, Welfare and Society p12)

But instead of an economic strategy to bring back industrial jobs to these areas and so improve the labour market, the Report says:

“The Treasury has misdiagnosed high welfare spending as the result of inadequate work incentives and has too often blamed individuals for their own predicament, whereas in fact a large part of the bill is rooted in job destruction extending back decades.

The welfare reform since 2010, and strengthened since the 2015 general election, hit the poorest places hardest. In effect, communities in older industrial Britain are  being meted out punishment in the form of welfare cuts for the destruction wrought to their industrial base.”

Promoting the Tory ideology that work is a cure for ill health

The South Yorkshire & Bassetlaw STP nods towards acknowledging social economic and environmental determinants of health.

On p17 – Health in its wider context – it lists socioeconomic status/deprivation, employment, housing, access to green spaces and social relationships as factors that affect health – and identifies where the area stands in relation to the national average for these factors. All five places in the area – Barnsley, Bassetlaw, Doncaster, Rotherham and Sheffield – are more socio-economically deprived than the national average.

The Sustainability and Transformation Plan then repeats the fallacy that employment is a health outcome.

This confuses causes with effects: it’s not that being employed makes you healthier – it’s that healthy people are able to work and people who have long term or chronic illnesses often can’t work.

However employment as a health outcome provides a handy cover for the government’s aim of:

“reducing the cost of sickness to employers, ‘taxpayers’ and the economy.”

This was the focus of Dame Carol Black’s and David Frost’s Health at work: an independent review of sickness absence. This advocated changing sickness certification to reduce the influence of GPs in “deciding entitlement to out-of-work sickness benefits”.

The subsequent “fit notes” that replaced GP sick notes were designed to substantially limit the sick role and reduce recovery periods, and to “encourage” GPs to disclose what work-related tasks patients may still be able to perform.

Government has made it harder for disabled people who want to work to find suitable and supported employment

This is the conclusion of the British Medical Association (BMA), which has said the government was “misleading” in claiming that the fit for work service was offering “occupational health advice and support”.

The government has removed essential in-work support for disabled people – such as the Independent Living Fund, replaced Disability Living Allowance with Personal Independence Payment in order to reduce eligibility, cut costs and “target” support to those most severely disabled, and cut to the Access To Work scheme.

STPs aligned with Treasury plans to cut spending on Employment Support Allowance

This is the context for the South Yorkshire & Bassetlaw STP’s misleading claim (p18) that the STP will make significant efforts to:

“give control back to people who are long term unemployed”


“personalised support to get people into work with ongoing, individual support to help them when they’ve got a job and putting in place new referral routes with better ways to access health support for people who are out of work…”

Local voluntary organisations offering “employment support” will be part of “local wrap around services alongside health and care support”.

But far from giving control back to long term unemployed people, making doctors and voluntary organisations an arm of the DWP takes control away from them – and from doctors.

On p 29 the South Yorkshire & Bassetlaw STP says that a “new supported employment pathway” is being introduced across Sheffield City Region:

“for people furthest away from the labour market and those currently trapped on benefits.”

It says this is a £15m investment from the DWP to:

“deliver increased number of employment outcomes for residents unemployed where they have a health condition or disability.”

Is this anything to do with this kind of privatised “vocational rehabilitation and employment support services”? Or the DWP’s work and health programme?

South Yorkshire & Bassetlaw STP needs to explain what this “new supported employment pathway” is and answer points raised by disabled activist Kitty Jones:

” In a move that is both unethical and likely to present significant risk of harm to many patients, health professionals are being tasked to deliver benefit cuts for the DWP. This involves measures to support the imposition of work cures, including setting employment as a clinical outcome and allowing medically unqualified job coaches to directly update a patient’s medical record”

Arbeit macht frei: Green paper proposes forcing work-related activity on everyone in Employment Support Allowance support group


The work, health and disability green paper ‘Improving Lives’ shows that the Department for Work and Pensions is considering forcing all sick and disabled people on out-of-work disability benefits to take part in ‘mandatory’ activity.

It says ministers:

“could consider implementing a ‘keep-in-touch’ discussion with work coaches” for people in the support group, which “could provide an opportunity for work coaches to offer appropriate support tailored to the individual’s current circumstances” and “could be explored as a voluntary or mandatory requirement”.

This would affect those in the support group of employment and support allowance (ESA) – and the equivalent group in the new universal credit – a group which is currently not expected to carry out any work-related activity at all.

People in mental distress will be bullied back into work placements, work experience, volunteering programmes, causing further distress.  Many will end up in crisis. With the Work Capability Assessment, many have taken their own lives in mental distress and this new scheme will cause further distress, harm and many more to die.

What is scary stuff to vulnerable benefit claimants represents huge business opportunities for global corporations with ‘toxic brand’ legacies such as Accenture,which is now the DWP’s contractor in delivering the IT for Universal Credit – with Atos as principal partner.

Psychologists Against Austerity and  patient groups like Mental Health Resistance Network and Disabled People Against Cuts have condemned these moves.

Cutting mental health services while community mental health teams are using the buzz words  “employment is a health solution”

At the launch of a campaign against the national charity Mind’s close links with the Department for Work and Pensions, Denise McKenna, a co-founder of the Mental Health Resistance Network, said:

“We know that work is not a cure for mental health problems, yet national Mind is going along with this rubbish in order to get contracts with the government.”

Outsourcing of contracts seems to be the order of the day, with local charities like Mind heavily involved in this agenda, the NHS five year forward view and its implementation through the Sustainability and Transformation Plans.

Community mental health teams are using the buzz words  “employment is a health solution” while the government are planning to slash mental health funding for 73 areas next year.

This all gives the lie to the assertion in  Doncaster Health and Wellbeing Board’s Sustainability and Transformation Plan report , that there are no significant equality implications associated with the STP,  since its Objective 1 is to “reduce inequalities for all” and the STP therefore “intends to have a positive impact upon equality.”

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