Get Better... Or Else?

Disabled people have precious few illusions left about how the DWP views us, but a new pilot programme is going to take that relationship into even more disturbing territory. Starting in November, 3000 disabled people in the Work Related Activity Group of Employment and Support Allowance will be forced, under threat of sanction, to attend medical interviews "to address barriers to work", or as DWP minister Mark Hoban put it in the press release "to address health problems". This is at best ethically dubious, forcing someone into a medical process without their consent and which is not with their own specialists, nor even necessarily with someone competent with their specific disability. The only other example of a compelled medical relationship* is for people sectioned under the Mental Health Act, and even they are at least guaranteed that the medical staff involved are mental health professionals and/or their own doctors, while the DWP merely state the meetings will be with "doctors, occupational health nurses and therapists".

Many of us who have dealt with corporate Occupational Health professionals will have encountered the situation where the opinion of the OH professional is at odds with that of our own specialists - in my case the OH professional actively tried to undermine a report by my own consultant and I had to exhaust the company grievance procedure before my then employers would back down and accept the opinion of the consultant who was actually treating me. Yet someone facing workplace OH processes does at least have resort to grievance procedures and the threat of an Employment Tribunal, with the right to withhold consent for the referral, or to withhold consent for a report they disagree with to be forwarded to their managers. Not stated in the DWP press release is whether the medical staff used will be feeding reports back to DWP, what data protection will be in place around that, and whether the disabled person will have the same medical protection in respect of having the right to view and potentially deny consent for release of the report as is currently the case for a workplace OH assessment.

Worryingly, the DWP press release leaves unstated what will happen if the appointment results in the patient being told to undertake treatment they disagree with, or which is even at odds with the appropriate treatment for their disability, worries that are doubled by the current hair-triggered sanction regime which DWP targets at disabled people. Many disabled people have related experiences with Atos-conducted WCAs in which the Atos 'Health Care Professionals' have proven to be utterly clueless on the specifics of the disability they are meant to be assessing, assuming they have even heard of it in the first place, and similar staff are now to be charged with "address(ing) barriers to work". There are a host of disabilities in which standard treatments for apparently similar disabilities may be contra-indicated, yet actively advocated by medical staff who don't specialise in that specific disability. If a patient, many of whom are experts in their own disability, finds a DWP OH professional pushing them towards a treatment they know their own consultants would not advocate, then what potential is there for them to say 'no' without triggering sanctions? Equally worryingly, the confrontational nature of DWP's relationship with disabled people (and claimants in general) may mean that the patient is too intimidated by the potential threat of sanctions to even think of objecting, which effectively removes any potential for the medically required 'informed consent'.

Dragging this process into even murkier ethical waters, the project is one of three trials, the others being additional support from JCP and additional support from a Work Programme provider, which are being conducted in order to determine which is most effective at getting disabled people back into work. However, a trial involving a medical process is arguably, if not by definition, a clinical trial and subject to additional ethical requirements, including further levels of informed consent, shared decision making, right to privacy, and a right to withdraw, all aspects that are likely to be extremely problematical in the process DWP appear to be proposing. Potentially any medical staff conducting these trials without ensuring these rights are in place could risk facing charges of serious professional misconduct.

This process further embeds into benefits practise and regulation DWP's belief that any disability can be recovered from if the patient really wants to ('they get better', Esther McVey, Minister for Disabled People), a consequence of the ideological indoctrination of DWP with the patient-blaming version of the 'BioPsychoSocial Model of Disability' created by American insurer Unum Provident - they of the infamous 'disability denial mills'. The problem for disabled people is that this model fails utterly to reflect the reality of disability, where many people are too disabled to work, are not sufficiently disabled to qualify for the ESA Support Group, yet have stable disabilities with little likelihood of getting either better enough to move into the workplace, or deteriorating to the point they move into the Support Group. This leaves only the ESA WRAG open to them, but WRAG assumes a person will 'get better' and pressures them to do so, pressure that will now be further increased by this new experimental regime.

A further concern is where the DWP expects to find staff for this new pseudo-medical aspect of ESA. Atos have been struggling to cope with the numbers requiring Work Capability Assessments, to the point that they have had their monopoly withdrawn and been ordered to retrain all of their staff. New competitors for WCA work are going to be appointed next year and will each require their own customer-facing medical professionals, together with other medical professionals to deliver training. At the same time Atos and Capita are creating new organisations to deliver PIP assessments, all requiring their own medical staffs, and there is little reason to doubt that the PIP assessment regime will both insist on more people being assessed and on their being reassessed on a much more frequent basis, needing a large increase in the number of medical staff required to deliver PIP assessments in comparison to DLA. And now this ESA 'initiative' is going to require yet more medical staff.  Where are they going to come from? There is a fixed pool of occupational health and rehabilitation oriented medical staff such as physiotherapists and OTs and any of us who have dealt with them on an ongoing basis will probably have encountered long waiting lists and rehab programmes that really aren't as comprehensive as even the staff would like. Trying to draw more and more staff into DWP pseudo-medical programmes is either going to put the existing pool of trained staff under ever increasing pressure, or see DWP relying on staff without appropriate training, or with inappropriate attitudes.

However this plays out, disabled people have good reason to be worried.

*Even in a workplace Occupational Health referral the assessment can only be done with the consent of the employee, and they must then consent to the release of the report to their employer. Based on my own experience I would advise that consent should only ever be given after viewing the report, a legal right, as even an apparently supportive assessment may turn out to be followed by an openly critical report.