The NHS is NOT the DWP – but government doesn’t seem to know the difference

On Dec 3rd 2016, ck999 and Hands Off HRI campaigners held a Stop STPs demo outside Calderdale Royal Hospital where we protested STPs’ plans to target people with mental health conditions and other long term conditions to get back to the work place.

This was a national and local day of action to Stop Sustainability and Transformation Plans – as well as the annual UN International Day of Disabled People.

One year on, the government has published its plans to get more disabled people into work in the next decade. New measures include:

  • widening ‘fit note’ certification, so that not only GPs but other healthcare professionals, including physiotherapists, psychiatrists and senior nurses, can certify fit notes with a return to work plan
  • more training for work coaches for people with mental health conditions
  • large-scale employment research pilots in the post-industrial West Midlands and Sheffield which will include over 11,000 people
  • £39 million investment in more employment advisors in an existing NHS programme treating people with depression and anxiety disorders.

NO! Surgeries are for health care! Job Centres are for Jobs!

The NHS is not the DWP.

An Advanced Nurse Practitioner said

“They should come and tell us how to convince patients that they are fit to work. I remember a man who could barely walk into the room one evening at Bradford Royal Infirmary telling me they’d just assessed him fit to work – despite bad nerve damage recorded in hospital paperwork, numbness, unable to sit, crippled to my mind – but fit to work !

This is a disgrace of an idea – how can doctors have patients’ individual best interests at heart, when influenced by the need to balance budgets- whether in deciding on prescription, treatment option or capacity to work?!”

A welfare rights advisor said,

“A local (so called) disabled persons charity in our area is now working “in partnership” with the DWP on getting disabled people into work.

We have just been refused lottery funding because of what they see as an overlap of services with this other charity.

As our lottery bid clearly stated, we provide a completely different service – which certainly does NOT include getting people into work if they aren’t capable, or well enough.

The welfare rights advisor added,

“Unfortunately, our welfare system (which we pay for with our taxes) has ceased to be the safety net we could once call upon in times of need. The system now prefers to accept evidence from assessors who see people only very briefly (or in some cases not at all) and who are willing as “health professionals” (and I use that term very loosely) to lie and cheat as overpaid hired hands only too happy to do the Government’s dirty work for them.”

The advisor gave examples of people she had dealt with who had been  found fit for work, when they were clearly not.

“The first was a guy whose assessment report described him as “recovering from hospital treatment”. This assessment was by a nurse who had never even seen him. They rang and cancelled his appointment as he was on his way to it. The “hospital treatment” he was recovering from was actually a below the knee leg amputation – which had been performed only six weeks earlier. When I challenged them, the reason given for cancelling his appointment was that they had enough information to prepare the report without seeing him. The mind boggles.”

The second was a woman in hospital – in a diabetic coma. She was found fit for work in her absence, simply for “failing to attend” her assessment.

The third case concerned a woman admitted to hospital with pneumonia. She was virtually unable to walk, extremely frail and was placed on a do not resuscitate notice with her and her family’s consent. Thankfully she pulled through, but simply for “failing to attend” her assessment she was automatically found fit for work.

The welfare rights advisor pointed out,

“We got all these decisions overturned by supplying medical evidence from the consultants and GPs, but the guy with the amputated leg had to fight his case all the way up through the tribunal system. The judge took all of ten minutes to find in his favour.

These wrongful decisions caused months of financial hardship for the people concerned – and for their families – before the cases were resolved, thanks to the help of trained advisors.  

We do all we can, but getting the funding for our service is very difficult. Our organisation fiercely refuses to become (as we say in our sector) a funder-led mission drifter and jump on the “back to work” bandwagon. A recent “health professional” assessor job was advertised with a salary of £36,000. Our organisation’s total annual running costs for last year were around £40,000. At the moment, we are fighting a losing battle.”

All welfare-to-work roads lead to giant US insurance company Unum

The government’s plan for getting disabled people into work is based on the 2016 Work Health and Disability Green Paper – produced in the context of increasingly punitive cuts to support for disabled people.

The origins of the plan and the Green Paper it’s based on are 1990s ideologues of welfare to work – many linked together by their their association with the giant US income protection insurance company UnumProvident, which had been brought into government to advise on claims management for Incapacity Benefit under the 1994 Social Security (Incapacity for Work) Act.

Their goal was the transformation of the welfare system. To this end,

“The cultural meaning of illness would be redefined; growing numbers of claimants would be declared capable of work and ‘motivated’ into jobs.”

The redefinition of illness according to the “biopsychosocial” model was designed by Unum insurance company, working closely with government, as a way of telling people their illness was all in their head and that entering paid work would be therapeutic and aid their recovery.

Plus, through the creation of a new kind of market state:

“[C]laimants will become customers exercising their free rational choice, government services will be outsourced to the private sector, and the welfare system will become a new source of revenue, profitability and economic growth.”

A decade or so on, this insurance-inspired system for denying ill and disabled people access to social security is now being replicated in the government’s scheme for reducing people’s access to NHS and social care – the Sustainability and Transformation Plans – soon to become Accountable Care Systems or Organisations.

An NHS mental health worker said,

“Something particularly bothersome about these ‘work is a health outcome’ schemes is the coercive element and the lack of truly voluntary cooperation. The law (the Mental Capacity Act) explicitly recognizes that people make unwise choices at times and that this does not mean that they lack capacity in the area of life that they made the unwise decision for.

In my view the DWP approach removes and penalizes the right of people to make unwise decisions (eg unwise lifestyle choices, or actions that are counterproductive to recovery from illness—say as an example continuing to smoke when recovering from pneumonia). The NHS has always been there for everyone in need and this is now being eroded too, with endless adverts of ‘choose wisely, don’t go to A&E unless you’re half dead’ (I exaggerate). To me these tendencies amount to a sort of behavioural dictatorship, enforcing conformity.”

Such an ideologically driven, un-evidenced scheme is typical of cuts and changes that the STPs are steam rollering over our NHS.

Having a bad job can be worse for your health than being unemployed

Earlier this year,  Manchester University researchers published a study in the International Journal of Epidemiology that found that poor quality work – low paid, low autonomy and high insecurity – is worse for people’s health than unemployment.

The researchers found evidence that formerly unemployed adults who moved into poor quality jobs had higher risks for a range of health problems, compared to adults who remained unemployed.

Moving into any type of job (whether it was a good or poor quality job) was not associated with an improvement in physical health compared to those who remained unemployed.

The study monitored over 1000 participants aged 35-75 who were unemployed during 2009-2010, following up with them during the next few years about their self-reported health and their levels of chronic stress as indicated by their hormones and other biomarkers related to stress.

There was a clear pattern of the highest levels of chronic stress for adults who moved into poor quality work, higher than those adults who remained unemployed. Adults who found a good quality job had the lowest levels of biomarkers.


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