Britain's Pathway to Work program

[Permission to Repost].

NEW-LABOUR'S FLAWED 'PATHWAY TO WORK': M.E. PATIENTS IN A CORPORATE-SKEWED DRIFT NET.

Anglia ME Action. May 2008. www.angliameaction.org.uk

There are many well-documented reasons to be cynical about the UK New-Labour Government's snowballing Pathways to Work policy - favourably portrayed in the BBC 1 Panorama TV programme entitled Britain on the Sick[1] on May 19th and featuring Professor Mansel Aylward of the Unum Provident Centre for Psychosocial and Disability Research at Cardiff University. For sure, there is no doubt that there are indeed a number of long-term sickness benefit claimants that would, if they could indeed work, be generally better off in employment even if they were not better off financially as a result of the change. The social and self-esteem benefits of this are obvious PROVIDED the employment is suitable and not exploitative. For sure too, there is some fraction of this number that are likely to be actually capable or, with the right sensitive and encouraging support, have the potential to be rendered capable of at least some part-time work. Indeed, anyone in the UK who is politically aware and old enough to remember the nightmare monetarist policies[2] of the 1980s (that even Milton Friedman condemned as excessive) will know only too well that many victims of mass forced redundancy were spuriously swept up in the sickness benefit register at the time (and some have faced long-term negative consequences as a result). In some cases this was partly for short-term personal gain to the claimants themselves but, crucially, it was tolerated and even encouraged by more than a few intellectually dishonest politicians: a political class that cared more about keeping official unemployment figures artificially low and massaging politically embarrassing statistics than it cared for the recipients or victims of its social policy. Now the policy fashion and the political expediencies it serves have reversed but, in spite of this reversal, in overall terms, it still manages to generate a sense of déjà-vu in those who look beyond the spin to examine the fine detail of yet another new policy initiative. Ditto in those who care about the impending unintended (or arguably perversely intended in some cases) effects upon some of society's most vulnerable individuals.

Even if you were to give New-Labour Ministers the benefit of the doubt and assume that their primary intention in the policy change was to compassionately assist patients who are needlessly trapped on benefits (as opposed to reducing DWP budgets and appeasing powerful corporate lobbies - more on this aspect below), it is clear that such policy is based upon some highly questionable premises. For a start, in the BBC Panorama programme, ex Department of Work & Pensions advisor Professor Mansel Aylward (who left the DWP to receive a large salary cheque from multinational health & welfare insurer Unum Provident) reiterated the claim that a major barrier to people leaving sickness benefits and returning to work was that they would be no financially better off. This is what labour-market economists describe as a problematic 'replacement-ratio' - which usually carries with it the questionable assumption that welfare benefits are too high as opposed to wages being too low. Such claims as trotted out by Professor Aylward and his ilk more often than not come from those who have never themselves had to live on long-term benefits and simply do not fully understand how impoverishing, socially debilitating and unwanted such a predicament is for the overwhelming majority. The prejudiced assumption that many claimants prefer life on benefits is often augmented by very spurious 'research' that, with loaded questions and similar devices, narrowly sets out to over-highlight such a factor from the start: and thereby skews its own findings.

Such contentious studies tend to over-focus on monetary issues and leave out the fact that many patients value and greatly miss other aspects of a lost career that has been forcibly denied them by illness. Similarly an irresponsible media can all too readily find a few benefit claimants that clearly should be otherwise occupied and spuriously represent these as the norm to the fertile and prejudiced minds of overburdened taxpayers that are themselves fortunate not to have the tragedy of serious illness within their own family. What is often missed in such caricatures however is that genuine claimants very much want to work if they can (as indicated by the large number that attempt to do a little therapeutic voluntary work when able) but are simply incapable of SUSTAINING regular full-time or even part-time work over the medium or long-term without health deterioration. What is essentially wrong with the crude instrument that is the 'pathways' policy is that, in weedingout misguided or feckless claimants, those that are genuinely ill will experience increased and substantial suffering in the process. This will be particularly problematic for ME patients given the relapsing nature of the illness and the controversy surrounding diagnosis, treatment and disability assessment (more of which below). Such matters have received erudite and sensible social scientists' comment from the likes of Professor Alison Ravetz[3] at Leeds Metropolitan University for example. Moreover, there is growing anecdotal evidence that some patients who are genuinely incapable of sustained gainful full or part-time employment are now increasingly eschewing occasional and beneficial light voluntary or social activities for fear of this being spuriously used as 'evidence' that they can do more. This is an utterly perverse state of affairs that can only harm individuals' prognosis and increase long-term welfare dependency.

Exaggerated numbers of patients allegedly capable of being transferred from sickness benefits into work are effectively pulled out of the air by those with a clear vested interest in matters and are very much at odds with estimates from social policy experts like Professor Ravetz that have no financial axe to grind. They are also at odds with views of most patients' own GPs and specialist Hospital Consultants. It is therefore very telling that wealthy corporate merchant banker and government welfare policy adviser David Freud, amongst others, has called for such qualified professionals (who possess actual long-term detailed knowledge of the individual patients concerned) to be further removed from the benefits decision-making process[4]. Whilst it would be foolish to deny that an unknown fraction of patients are capable of doing some work, it is far from guaranteed that most employers will want to employ them and more likely that benefit cuts will lead patients into the exploitative low-wage sector or to a never-ending treadmill of fruitless interviews - where many will face poverty, exhaustion, further declining health or worse.

Indeed, if a true and rigorous econometric cost-benefit analysis of the pathways to work programme were undertaken it would more likely conclude that the public purse would gain nothing in the long-run overall: due to relapse, worsening prognosis, personal stress, family break-up, increased child-poverty, increased welfare dependency and desperation-driven suicide, black-market activity and even crime. What is certain however, is that the private sector agencies and corporations running the show and providing the highly questionable sausage-factory CBT services[5] will be banking copious amounts of taxpayers' money in fee and consultancy payments - whatever the effects upon patients. It is also clear that tightening up of benefits access, whose gateway is guarded with 'incentivised' private sector therapists and employment 'counsellors', will result in many thousands of ill and disabled patients that are genuinely too ill to work being constantly harassed, facing reduced benefit levels and driven into poverty and worsening health as a direct result. Some of society's most vulnerable people will live in a climate of fear, suspicion and derision.

The notion that great public savings are to be had from such a policy is grossly over-egged: Britain already has one of the highest adult employment rates in the western world and the likelihood that this can be significantly increased by targeting the sick is statistically flawed as well as conceptually so[6]. Moreover, the burden of sickness benefit upon the exchequer is widely exaggerated and misrepresented. To quote Professor Ravetz:

"Incapacity benefit has become one of this year's favourite scare stories. Hardly a day passes without a new headline deploring its soaring costs and the rising numbers of claimants who get "something for nothing", at the expense of decent, hardworking taxpayers. We are told that we are footing an outrageously escalating bill for 2.4 million people, a million of whom shouldn't be on the benefit at all, and each successive work and pensions minister vows to be more ruthless than the last. The true picture is somewhat different. The unreported version, which can be culled from Department for Work and Pensions (DWP) data, is that only 1.4 of the 2.4 million actually receive any payment, the rest get national insurance credits only, and numbers have been falling since 2003."[7]

In fact, UK sickness benefits claimants do not get "something for nothing" when they are unfortunate enough to have to request state help: most of them have for years been paying National Insurance contributions for this exact purpose. It seems clear however that, increasingly, the UK political class is intent upon wriggling out of this paid-for 'social contract' - just as private insurance companies do allthey can to avoid paying out to policy-holders. Indeed, since Peter Lilley (Margaret Thatcher's Social Security Minister) first began to significantly open the public policy-making doors to the likes of Unum Provident, we have already had over a decade of extremely stringent sickness benefit claim reforms: Including rolling downgrades of a patient's own physicians in the decision making process and replacement with agency practitioners possessing little knowledge of the patient but wielding increasingly arbitrary power. Such agency doctors are to be further incentivised/pressured to withhold benefits in what is regarded by many as a disgraceful and unethical conflict of interest. It is in fact now already extremely difficult to obtain sickness benefits without a major struggle and this is particularly well illustrated by the enormous proportion of DLA (Disability Living Allowance) claimants who are forced to successfully fight their claim via the appeals process.

Indeed, many have argued that instead of looking at the supply-side equation of why sickness benefits claims persist, government should, for a refreshing change, make an honest and broad-ranging demand-side inquiry that examines why people get ill and stay ill. Such an inquiry would need to be conducted by a properly independent/objective panel of doctors and research scientists and not dominated by those with clear vested interests in outcomes: such as the various psychiatrists and physicians linked to Unum Provident - as in the case of Professor Aylward. The inquiry would do well to focus on why, for example, in our ever increasingly toxic environment, degenerative nervous and other illnesses - including Myalgic Encephalomyelitis or ME[8] - have occurred in such large numbers of late. The recent Cross-Party Gibson Group of inquiry from both UK Houses of Parliament made precisely this point in regard to ME patients (that have been so roundly misrepresented as primarily suffering from mere behavioural illness by certain doctors linked to Unum Provident)[9]: "In Britain, there has been a clear historical bias towards research into the psychosocial explanations of CFS/ME. This is despite Parliament recognizing ME as a physical illness in a Private Members Bill, the ME Sufferers Bill, in 1988."[10]

"The Group was very interested in the international evidence submitted and concerned as to why this evidence has not been seriously examined in the UK. The Group calls for a further Inquiry into the Scientific Evidence for CFS/ME by the appropriately qualified professionals. This Inquiry should be commissioned by government undertaken by an independent panel of scientific and medical experts, including virologists, immunologists, biochemists etc who can objectively assess the relevance and importance of the international scientific data."[11]

"An independent scientific committee must examine the wealth of international research data. To exclude it from the debate is a great injustice to patients."[12]

"There is a need to undertake further research of post viral infective cause in carefully controlled studies."[13]

"The evidence for a toxin aetiology requires critical and controlled studies. This includes research into possible causes, like pesticides."[14]

With regard to the question of corporate influence upon government policy and conflicts of illness generally, and more specifically in relation to Professor Aylward's particular association with both the Department for Work & Pensions and Unum Provident, the group sates bluntly:

"There have been numerous cases where advisors to the DWP have also had consultancy roles in medical insurance companies. Particularly the Company UNUM Provident. Given the vested interest private medical insurance companies have in ensuring CFS/ME remain classified as a psychosocial illness there is blatant conflict of interest here. The Group find this to be an area for serious concern and recommends a full investigation of this possibility by the appropriate standards body."[15]

Moreover, in the case of ME patients in particular, concern was expressed that such factors would improperly and adversely affect patients' assessment for and entitlement to sickness and disability benefits:

"It may even be that assessment by a medical 'expert' in a field of high controversy requires a different methodology of benefit assessment."[16]

In spite of calls from the Gibson Group of Parliamentarians (backed up by numerous doctors, scientists, patients, carers and concerned members of the public) that the government should not primarily rely on the views of doctors linked to Unum Provident, that conflicts of interest should be thoroughly examined, that the facts of the disease should be independently assessed and that ME patients require a more appropriate means of benefits assessment than the one on offer, not one of these justified recommendations has been taken up by an increasingly dictatorial and corporate-influenced New-Labour Government. Such privileged access to the process of public policy formation that is granted to multinational corporations, in stark contrast to ignored voices of informed and concerned parliamentarians, doctors, scientists, patients, carers and concerned citizens can be, and has been, summed up as 'corporate capture' of New-Labour welfare policy. Such disgraceful bias is eruditely and extensively illustrated in the document entitled 'Corporate Collusion', by Professor Malcolm Hooper et al[17] and elsewhere. These well referenced concerns are particularly worrying in a democracy governed by a so-called 'Labour' party that claims it represents the interests of ordinary voters. Neither are such concerns confined to benefits issues: as the Guardian Newspaper's Seumas Milne commented with regard to health policy:

"It beggars belief that US health privateers straight out of Michael Moore's Sicko are being lined up to run core NHS services. Only dogma and corporate capture can explain this."[18]

And as Privy Councillor and former Liberal Democrat Leader Sir Menzies Campbell put it:

"the public no longer has any influence on the way decisions are taken and has become alienated from the democratic process."[19]

Whilst it cannot be denied that some/unknown fraction of sickness benefit claimants are capable of work and would benefit from working, it is already clear that the world inhabited by those who are genuinely too ill to undertake sustainable work will be increasingly extremely difficult as a direct result of the new 'pathways' policy. The declining public sympathy for sick and disabled people in this country, as a result of widespread over-simplifying sound bite descriptions in the press, is already distinctly apparent.

In some quarters this has amounted to outright demonization and is an utter disgrace in a supposedly modern civilised democracy. This whole misconceived New-Labour policy can be likened to the cruel and all-encompassing giant drift nets of the mechanised fishing industry: that impact upon a whole gamut of precious marine life (notably including dolphins) and not just the intended catch: with the former simply discarded in their droves as collateral damage. Out of sight is out of mind? Times ahead will be increasingly tough for most genuine sickness benefit claimants but the greatest victims of all in this disgracefully skewed and malign 'welfare' juggernaut will of course be ME patients that are genuinely unable to sustain gainful work. No other group has suffered such a long history of denigration, misrepresentation as mere psychiatric fatigue sufferers and portrayal as outright malingerers[20]. All in spite of the long-standing recognition of physical/neurological disease by the World Health Organisation[21] and the large and growing volume of biomedical research findings[22]. For ME patients; the ground for mistreatment and benefits reduction at the hands of the DWP and their privateers has been long and well prepared. [23] Truly unjust and dire times lie ahead.

The supreme and heartrending irony of all of this is that research-led mitochondrial[24], antiviral[25] and other biomedical therapies that are denied ME patients by the NICE (for reasons other than good science [26]) are now being developed, privately accessed and beginning to yield tangible results that may one day see many patients able to return to a better level of functioning and, in some cases, employment! That is precisely what ALL ME patients would want. Being on long-term benefits and burdened with a difficult illness that attracts horrendous neglect, mistreatment and abuse is not something most ME patients would wish on their worst enemy. It does not take a Nobel Laureate to work out that ME patients who are beginning to improve on such biomedical therapies will be forced into relapse as a result of harassment, premature enforced entry into the labour market and poverty arising from benefit cuts: all due to the crude sad joke of a welfare policy that is 'pathways to work'. Genuine ME patients, as distinct from those with psychiatric 'fatigue' (with whom ME patients are all too often confused - sometimes deliberately[27]), will be forced into a no-win situation by a blunt and blundering policy that in reality will be a one way street to relapse, poorer prognosis and, inevitably, more patient deaths[28].

In five years time this will be patently obvious to all. By then however the architects of this skewed experiment upon the sick will have moved on: leaving ME patients, their families and genuine science-based doctors to pick up the pieces. God help such maligned, abused, neglected, physically ill and incapacitated patients. Such a 'welfare' policy of course also needs to be viewed against the "Labour" Government's complicity in the tax-avoidance strategies of the super-rich: the real "something for nothing" burden upon the exchequer. Add this disgraceful corporate-capture welfare policy to that of state 'CFS/ME' policy generally, deceitful military adventurism, broken manifesto promises on 'ethical' foreign-policy, broken manifesto promises on top-up loans, broken manifesto promises on a European-referendum and you have just a few reasons why this, and many other decidedly EX-Labour voters will be doing everything they can to call these politicians to account. Woe betide many current New-Labour MPs at the next UK general election: soon after, along with many of the sick and disabled, they too will be forced into job-seeking activities.

M. C. Tully. May 2008.

Anglia ME Action. contact@angliameaction.org.uk

[Permission to Repost].

THIS DOCUMENT IS AVAILABLE FOR ONLINE DOWNLOAD AT: http://angliameaction.org.uk/docs/corporate-drift-net.pdf