Sunday 22 September 2013

ESA - THE SICKNESS UNTO DEATH

The Sickness Unto Death was Kierkegaard's diagnosis of life without faith in God. As we commemorate the 10,000 and more who have died awaiting, or after failing, their work capability assessments with ATOS, it is worth considering the analogous condition of those of us who are obliged, by ill health or disability, to claim Employment Support Allowance (ESA).

ESA was introduced in 2008 to replace both Incapacity Benefit (IB) and Income Support (IS) paid to people claiming 'on the sick'. As such it takes two forms - contributory ESA, based on NI contributions and not means tested, and income related ESA, replacing Income Support. With ESA was introduced a new assessment process to decide who was sufficiently incapable to qualify - the work capability assessment (WCA). This assessment results in everyone either failing to qualify for ESA at all, or being placed in one of two groups - the work-related activity group for people held to have some prospects of work, and the suppport group for people with more severe problems. The contract to assess people under the WCA was given to the French IT and services company ATOS.

Initially ESA was only for new claimants; the transfer of existing IB and IS claimants to ESA began in 2011 and is now nearing its end. One of the first and biggest benefit cuts anounced by the coalition government was that, on transfer to ESA, entitlement to the contributory version of the benefit would only last for 12 months, unless you were placed in the support group - after that all help is means tested. There is now no state provision for long term ill health, except for the most severely disabled people, without a means test.

At the core of ESA then is the work capability assessment. Although everyone, including government ministers, refers to this as a test of whether you are 'fit for work' the legal wording is different: you can have 'limited capability for work', in which case you are placed in the work-related activity group or 'limited capability for work related activity' which puts you in the support group.

The development of the work capability assessment was heavily influenced by the development, by private insurance companies seeking to avoid paying out on compensation claims, of new, 'functional', tests of disability, and the computer programes which apply those tests. The programme for the work capability assessment is called LIMA (Logical Integrated Medical Assessment) and is owned by ATOS. For a detailed account of the interpenetrating influences of ATOS, the American insurance giant Unum (with their long history of scandals) and the British state see this excellent piece by Debbie Jolly of DPAC.

*

THE WORK CAPABILITY ASSESSMENT

This is where different philosophies and perceptions of ill health and disability meet and clash. The government, and the private insurance companies who tell government what to think, claim to be using sophisticated and intimidating theories such as the 'bio-psychosocial model of disability' (which just means they don't have to involve doctors and so save money) and 'evidence based medicine' (to be distinguished from the fantasy medicine most doctors practice). They claim that their 'functional' test is objective as distinct from the sloppily subjective opinions of disabled people themselves or the people who live and work with them. They claim that if the test encourages work, that is because work is good for you (but the evidence they cite is that work in a good job is good for you, not any work).

What they are actually applying is the crudest possible combination of prejudice and ideology. They use a test which considers an incredibly narrow range of functions and allows only for yes/no answers which completely fail to capture the many practical problems which people with disabilities or serious health problems fact if they try to work. From this test you would imagine that most 'work' involves sitting down and pressing a button occasionally, includes almost no travelling or stairs, requires only occasional communication of the simplest messages - oh, and the employer would prefer you not to black out or crap yourself more than once a week. You can try the test for yourself at the Benefits and Work site if you think I'm exaggerating.

Occasionally, the more sophisticated politicians claim that the WCA follows the social model of disability, as developed by disabled people themselves. They lie. The social model asserts that 'impairments' become 'disability' only because of the systematic discrimination and oppression of disabled people. Disabled people can do many things, including work, but not when the jobs, systems, physical structures and attitudes involved in work make no allowance for their impairments. The WCA apes the social model in distinguishing between the underlying condition and the disability, then makes a mockery of it by using a ridiculous caricature of what work under capitalism is like and ignoring everything we ourselves say about our impairments.

Worse, politicians and a few privileged disabled people, claim that opposition to the WCA and ATOS underestimates what disabled people can do and condemns them to a life on benefit. This is utterly cynical because it ignores the actual effects of an ATOS assessment. If you are found 'fit for work' it does not raise your horizons or encourage you to try working. Still less does it mean you get any actual help to work. It simply cuts your benefits by 40%. Then it requires you to spend most of your time looking for crap work in jobs you can't do and won't get. The alternative on offer to a life on ESA is a life on the dole interspersed with Work Programme placements.

And as for the actual experience of work capability assessments ... a computer that repeats all negative findings over and over while ignoring any problems it does identify ... assessments that can last less than 20 minutes at inaccessible venues ... all alternative evidence ignored ... formulaic judgments applied without thought .... and much more.

That is why you get results like this - a person with both legs amputated failing the assessment. Now of course a double, below-knee, amputee can work - with suitable adaptations, in a workplace they can get to and provided their stumps aren't playing up too much. Disabled people spent 40 years campaigning against government policies that consigned them to inactivity or incarceration and we're not going to have the door slammed in our faces again and be told we can't work.

But here the government and its propagandists deliberately confuse the issue. They apply a test which says it is a test of 'limited capability for work' but is in fact a crude list of a limited range of impairments. They then ignore all the difficulties people with impairments still face in finding and keeping suitable work. Then they use the result to drive disabled people into penury - and brand them skivers and fakers on the way out.

A person with a double leg amputation is not incapable of work. They do face significant barriers to work. Those barriers should be recognised in any civilised system. The decision that this man is not entitled to ESA looks unconscionable and it is - not because he cannot ever work but because he has impairments, and the consequent disability, which demand recognition but are being denied.


*

These fundamental considerations mean that the work capability assessment cannot be reformed. No programme of tinkering with descriptors can produce a test that is remotely fair because the work capability assessment is not designed to be fair. It is designed to discipline and humiliate. It is designed to block the legitimate claims disabled people have for support they need to be independent. It has to be ended.

Nor does Liam Byrne's announcement that ATOS's  contract would not be renewed by Labour in itself change anything. The contract for ESA assessments is due for renewal anyway in 2015 and other firms are waiting in line, with Capita probably at the head of the queue. And ATOS still have the contract for PIP assessments over most of the country (PIP - Personal Independence Payment -  is the replacement for Disability Living Allowance designed to cut 20% from expenditure and reduce support for 500,000 disabled people). And ATOS's replacement will still be implementing the same work capability assessment. 

ATOS are not simply incompetent anyway. They have done what government - the last Labour government - asked them to do. They have implemented a system designed to reduce expectations of, and demand for, support by the state for disabled people. They have enabled a campaign of harassment and abuse, orchestrated by the coalition government, against disabled people and other claimants. They have done what they were paid to do even if 10,000 died in the process.

That does not mean we have wasted our time in all the campaigns, pickets and protests, just that we have a long way still to go. There are some signs for instance that Tribunals - and even decision makers at the DWP - are coming to recognise how crude and inadequate is the work capability assessment. Many more decisions are being made that circumvent the test proper by using the 'exceptional circumstances' provisions that exist alongside the test. Regulations 29 and 35 of the ESA Regulations are the ones to cite. If you can show that there would be 'a serious risk to your physical or mental health' if you were to fail the test - either for the support group or for the work related activity group - then a Tribunal in particular can bypass the points system and award ESA regardless.


But NOW - now it gets worse.  

SEE NEXT POST ON MANDATORY RECONSIDERATION






No comments:

Post a Comment