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Note

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I'm just placing a note or notes here to keep me going as I develop the article. If I put them here rather than just on my own machine then they may be useful to others.

this is a citizen's advfice release on incapacity medicals which might come in handy.

--bodnotbod 16:59, 25 August 2007 (UTC)[reply]

Extensive notes

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General

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Note to readers: this is a huge subject. I have particular interests. I do not propose to cover the Govts proposals in the bill/Act relating to: single mothers, older people and I'll skip most but the broadest elements of Housing Benefit (though I might come back to it once I've dealt with my priorites).

  • Aspiration: - 80% of working age people in employment.
    • Currently just under 75% do (Employers Disability Forum, 26/4/07)
  • Aspiration - reduce by 1 million the number on incapacity benefit.
    • "Within a decade" - Hutton GP debate, opening statement.
      • This will only take figures back to the 1991 level which, itself, was double the inherited level in 1979. (David Laws, LibDem GP debate)
    • This could ultimately save 7 billion a year - Hutton GP debate, opening statement.
  • Aspiration - help 300,000 lone parents into work.
  • Aspiration - increase by 1 million the number of older workers.

(All from the Green Paper (GP))

  • Proposed measures (p12 item 15 Green Paper)
    • Improvements to workplace health
      • Improve access to good qulaity occupational health support.
      • Better absence management.
      • Early intervention to help employees who become ill to stay in employment.
      • Support recovery to help an early return to work.
    • Reform of the gateway.
      • Focus on assessing peoples capability not incapability.
      • Focus less on entitlement to benefits.
    • Increased support for claimants.
    • Removal of perverse incentives

Stats

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  • 2.7m on IB - GP debate and elsewhere.
  • While the Labour Government have done "sweet nothing", total numbers claiming incapacity benefit have gone up, the numbers claiming for more than five years have gone up, the number of young people under 25 claiming has gone up by 70 per cent., and the number of people claiming on the grounds of mental and behavioural problems has doubled. [1]
  • Around 13% of those in work have a disability (Employers Forum on Disability 26/4/07)
  • Employment rate is 54% for disabled people, 81% for non-disabled (Emp. Forum on Dis 26/4/06)
  • Average yearly IB payout is £4,368 (£84pw) (Wise Group, 26/4/07)


Arguments

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Case for returning people to work

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  • "The best welfare principle is work" - Hutton, Green Paper
    • Support: Work is the best route out of poverty. GP
      • Most people on the Pathways pilots get jobs paying at around the minimum wage. (Mind 26/4/06 EV166)
    • Poverty is defined as 60% of median income. This equates to £178pw. IB claimants receive, on average, £84. (Rethink 26/4/06 EV182)
      • The average benefit recipient receives income far below the poverty line.(Rethink 26/4/06 EV182)
        • People with disabilities often have extra costs to meet just to achieve day to day activities.(Rethink 26/4/06 EV182) —Preceding unsigned comment added by Bodnotbod (talkcontribs) 16:09, August 27, 2007 (UTC)
    • Support: Strengthens independence and dignity. GP
    • Builds family aspirations. GP
    • Fosters greater social inclusion. GP
    • "can improve an individual's health and well-being" GP
      • "48 per cent. of men blame work or study as the key trigger for mental health problems," [2] —Preceding unsigned comment added by Bodnotbod (talkcontribs) 23:17, August 27, 2007 (UTC)
    • People have a responsibility to get off benefits. GP
      • Almost nothing is expected of claimants. GP
    • Gives people security.
    • Gives people sense of achievement.
  • Society must ensure it meets its obligations to those unable to help themselves. GP
    • Little support is offered to IB claimants. GP
    • "The whole point of the reforms is to try to personalise and individualise as much of the support and help that we provide to people on incapacity benefits as we can." - (Hutton GP debate [3])
      • It is essential that the job centre staff have the necessary skills [4].
  • Those who try to plan their return to work via volunteering or training perceive they run the risk of proving themselves capable of work and therefore losing their entitlement.GP
    • People will be able to try out a job for two years without losing benefits if they need to stop work again. (Hutton, 3rd controibution, GP debate).


  • The very name of IB sends a signal that the person is incapable.
    • The name IB sends a message nothing can be done to get them into the labour marketplace.GP
  • Most people on IB expect to return to work. GP
    • Nine out of ten expect to return to work. (GP debate commons).
      • Where do they get that figure from?
    • A large number never do. GP
    • The longer someone remains on benefits the less chance they have of leaving. GP
      • After 2 years on IB a person is more likely to die or retire than to return to work. GP
      • 'Pathways to Work' shows that with help and support people on IB can get back to work.GP
  • There are perverse incentives which should be stopped.GP
    • People receive more the longer they claim and this makes people claim for longer periods.GP
      • There is no evidence that people remain on IB because of financial incentives, it is more a matter of confidence and ability. (The Shaw Trust 26/4/07)
      • Proposed benefit deductions combined with direct payment for fuel costs and repayment of a social fund loan could theoretically leave a claimant with 10p a week. (Mind 26/4/06 EV160)
      • Sanctions could mean that claimants are left with too little money to maintain their health. (Mind 26/4/06 EV160)
      • Benefits are already set at what the Government says is the minum level a person needs to live on. Cutting this to manipulate behaviour os wholly inappropriate. (Mind 26/4/06)
  • The number of IB claimants more than trebled between the late 70s and the mid 1990s.GP
    • The number of IB claimants has coming on has fallen by a third since the 1990s. GP
      • The total number of claimants since the mid 1990s has stayed broadly the same because people stay on them longer.GP
  • Mental health
    • A third of new claimants cite mental health conditions as the primary cause of their incapacity (compared with one fifth in the mid 90s).GP
    • The 'snapshot' assessments proposed by the Govt are inadequate to assess fluctuating mental health conditions.
    • IB Personal Advisors in the pilot report themselves as being unable to provide advice and support to those with mental health conditions. (Mind 26/4/06 EV165)
  • It is a national problem.
    • There are at least 150,000 claimants in every region.
  • Little is done to prevent people moving onto IB. GP
      • A third of new claimants come not from work but from other benefits such as JSA and Income Support.GP
    • The Gateway to IB is poorly managed.GP
      • The OECD says the UK has one of the most stringent disability benefit gateways. (Mind 26/4/07 EV159)
      • Claimants receive IB before satisfying the main medical test (the PCA).GP
  • Characteristics of claimants have changed.GP
    • Now the South East has more than the industrial heartlands of the North East.GP
  • Rights must be met with responsibilities - Hutton, Green Paper
    • We can only ask more of people if help and support is in place. - Hutton GP debate
      • Between 2002-2008 JobCentre staff were reduced by 20,000 (that's one in four), how then can extra support be given? (LibDem opening statement, GP debate).
        • The policy will place non-medical staff in a position where they are to determine whether a person is capable of achieving a work-related action plan.
          • Job Centre staff are ill-qualified (to put it mildly) to make clinical judgements as to capability.
    • We should reduce the level of benefit for those who fail to engage with processes to return them to work in slices down to the level of JSA. - Hutton GP debate.
      • There can be no success if employers are not made to engage with the mentally and physically disabled. (Employer's Forum on Disability, DWP committee 26/4/2006)
      • The current policy emphasis is predominantly geared towards “pushing” people towards employment. (ibid)
      • Those with mental health conditions who are perceived as more ready for work could find that the increased pressure to engage in work-related activity in fact directly causes a decline in mental health leaving them less ready for work. (Rethink 26/4/06 EV178)
        • Compulsion can be an effective tool and should be employed on all but the most severely disabled clients. (The Wise Group 26/4/06)
          • Compulsion can cause mentally ill people distress. (Mind 26/4/06 EV159)
          • Mentally ill people often do not open their mail. This may result in non-engagement and, hence, a benefit cut to the most vulnerable people in society. (Rethink 26/4/06 EV175)
          • Compulsion causes people to take up unsuitable work which they subsequently lose causing deterioration in mental health.(Mind 26/4/06 EV159)
            • Case study:Workers at Mind in Derby report the case of a woman who took an unsuitable job out of fear of losing benefits. She lost the job and subsequently required the help of secondary mental health services where only primary services had been required before.(Mind 26/4/06 EV159)
            • Case study: Mind reports another woman with bi-polar disorder taking on work only to be dismissed two days later. She then abandoned her two children to go and look for work in another area. (Mind 26/4/06 EV159)
          • There is no evidence that compulsion and sanctions are more effective than incentives.(Mind 26/4/06 EV159)
          • Sanctions can undermine the claimant's relationship with the IB Personal Adviser. (Mind 26/4/06 EV160)


  • Poverty and social exclusion must be tackled. GP
    • There is a clear link between benefits dependency and hardship GP
      • Half of the most severe pockets of deprivation in Britain are contained within the 100 Parliamentary constituencies that have the largest numbers of people claiming IB. GP
        • Those 100 constituencies only have employment vacancies within each of them equal to a quarter of the IB claimants within each of them. (tory opening statement, GP debate)
          • Those figures are based on JobCentrePlus figures which only show one third of all available vacancies.(Hutton response, GP debate)
          • Not everyone works in the constituency in which they live. There may be more vacancies in neighbouring constituencies. (ibid)
          • last quarter, according to the Office of National Statistics, there have been over 100,000 new jobs in the system, just in a quarter and 300,000 in the last 12 months. (EDF 26/4/07)
      • No one will be eligible for more than they would receive on JSA until they pass the PCA.
  • Ensuring citizens have the right to enter the world of work is a fundamental responsibility of any modern government.GP
    • For those with mental health conditions a lifestyle change (including giving up a stressful job) may be more beneficial to health than work. (Mind 24/6/06 EV162)
  • The UKs employment rate is the highest of the G8 countries.GP
  • Need to focus on capability, not incapacity.
    • The amount we know about the abilities of those with a disability is very little in contrast to what we know about the negatives (Employer's Disability Forum 26/4/07). This stock of knowledge needs to be increased. (ibid)
  • The skills disabled people offer should be publicised. (EDF 26/4/07)
  • In a modern dynamic economy we cannot afford to be denied the skills and contributions of those who have the potential to work.GP
  • Worklessness and inactivity consign people to poverty and disadvantage. GP
  • Employment opportunity for all is the only way to meet the needs of an ageing society. GP
    • Growing numbers of retired people and a low birth rate mean that only by ensuring that everyone who can work does work can we ensure dignity in retirement. GP
  • Need to accelerate the move away from a welfare state fixed to the old model of dispensing benefits. GP
  • Ultimately it is the poverty trap of benefit dependency that makes keeping the status quo indefensible. GP
  • We should support GPs and primary care teams in the key role they play in returning people to work.GP
    • GPs only have 10 minutes to assess each patient, this is scant time to factor in the relationship between their health and their employment (Shaw Trust 26/4/06 EV27)
  • We should place employment advisers in GP surgeries.GP
    • Employemnt advisers in surgeries represent a proven and effective method of integrating health and emplyability approaches and of engaging the most difficult clients (The Wise Group 26/4/06)
      • People may avoid going to the doctor for fear of contact with an employment advisor. (Mind 26/4/06 EV165)
      • They should be branded as from a diff. org. to JobCentrePlus etc to alleviate suspicion. (Wise Group 26/4/06)
  • There should be a tailored system to address each person's incapacity.GP
  • Support should be ongoing as someone returning to work proceeds.GP

Employment Support Allowance

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ESA to come in in 2008. Paid to people undertaking work-related interviews. agreeing an action plan and taking on some kind of work-related activity. Failure to do so will see the benefit reduced in a series of slices, ultimately to the level of JSA. Claimants with severe conditions or disabilities should get more than they do now, unconditionally.GP

ESA claimants will not count as 'unemployed' for the purposes of employment figures (Hutton response, GP debate).

  • "This is not a punitive package of measures; I think that that is clear, and I hope that he is clear about it." Hutton, GP debate [5]
    • ESA will be cut to the level of JSA for those not complying with the work-focused activity, interviews and assessments.
  • We should adopt the ESA.GP
    • It will simplify the current system.GP
  • Work focused interviews should not be compulsory. (Mind 26/4/06)
  • We should have two levels of benefit, one for the severely disabled who could not reasonably be expected to engage in work related activity and another for those who can.GP
    • There is no clear division between people with "more" or "less" severe conditions.(Rethink 26/4/06 EV173)
    • The current assessments have not proven capable of showing people's disabilities or capabilities.(Rethink 26/4/06 EV173)
      • There is no proven tool for further dividing claimants into two tiers.(Rethink 26/4/06 EV173)
    • People with fluctuating conditions may need to move between the two rates continuously. The infrastructure to process these movements is nowhere near in place with processing times measured in months not days. (Rethink 26/4/06 EV173)
    • People with mental and physical disability already face stigmatisation. Labelling one set of claimants as the more severely disabled will further stigmatise them. (Rethink 26/4/07 EV178)

Personal Capability Assessment

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  • We should review the PCA so that it reflects the type of mental health conditions prevalent today.GP
  • The ultimate decision whether someone is capable of work rests with the claimant themselves (The Shaw Trust 26/4/06 EV25)
  • The process should be made more efficient.
  • The number of appeals should be minimised. GP
    • Note: Claimants will still have the right of appeal. GP
  • People must have confidence that the assessments are right, and we will work with the disability movement to make sure that that is true. - Hutton, GP debate
    • The system is totally inadequate for making decisions that have such profound circumstances. (Mind 26/4/06 EV159)
      • More than fifty percent of appeals are successful. In 80% of those successful appeals the tribunal said the PCA information was found wanting. (Mind 26/4/06 EV159)
    • The medical basis for eligibility should be removed and replaced with a test of disadvantage.(Mind 26/4/06 EV159)
    • The system of points used to evaluate a claim for reasons of mental health needs a radical redesign as it sets the bar far too high: severe behavioural dysfunction is rated very mildly. (Rethink 26/4/07 EV179)
  • People with mental health conditions sometimes over-medicate to calm their nerves before assessment. This can mean a person presents differently to their usual condition. (Rethink 26/4/07 EV179)
PCA exemption
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  • Should be based not on condition but severity.GP
    • Currently blind people are exempt, this should change.GP

Pathways to Work

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To be delivered by the private and voluntary sector with payments by results.GP

  • Pathways to work pilot has provided no substantive data as to success rates with those reporting mental health conditions. (Rethink 26/4/07 EV173)
  • In the pilots those with long standing health conditions and disability did not fare as well as other participants. (Rethink 26/4/06 EV178)
Funding
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  • 360m is enough to fund the extension of Pathways to the whole of Britain. - Hutton GP debate.
    • This is 'a good deal less' than was spent, per person, on the pilot scheme. (LibDem opening response, GP debate)
      • Private and voluntary providers will be helping. (Hutton response, GP debate)
        • Not-for-profit companies should be used.
          • For profit companies tend to be choosy about who they will assist.
            • Evidence for this comes from America. (Wise Group 26/4/07)
    • The IPPR (?) said that Pathways would cost £500m a year to rollout to the nation. The 360m figure itself is to cover two years. (Mind, 26/4/06 EV168, quoting Stanley K and Maxwell D(2004) Fit for Purpose: The Reform of Incapacity Benefit IPPR; London.)
  • "Many disability groups have expressed concern about whether the scheme covering the whole country will be of the same quality as the undoubtedly successful pilot schemes. Can the right hon. Gentleman assure us that when the scheme is rolled out, it will have all the functions that the current pilots have enjoyed?" (LibDem Question)
    • "The national roll-out of pathways to work will certainly be focused on ensuring quality, and outcomes for people who are disabled. I can give the hon. Gentleman that absolute assurance." (Hutton, GP debate. [6]
      • The question has been evaded.
    • Jobcentres are inadequately staffed and funded to provide Pathways (Shaw Trust 26/4/06 EV27)
  • 60m is enough funding for Access to Work which is designed to help IB claimants back int work. (Hutton, response GP debate).
    • Needs to be promoted and publicised. (EDF 26/4/07)
    • Needs to be streamlined (EDF Ibid)
  • Over what period will the reforms become self-financing? (tory question, opening statment GP debate).
  • Should be delivered by private and voluntary sector partners.
    • The public sector will resist this. (tory opening statement, GP debate).

Existing claimants

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  • Should remain on existing benefits "for the next few years". Hutton - GP debate. Should have their current level of benefit protected.(GP) "we are not cutting incapacity benefit for existing claimants." [7]
  • Should have regular PCAs.GP
  • Should have a work-focused interview and develop personal action plan.GP
  • Will have access to Pathways.
  • There should be a new unit to check on ongoing need and seeking new medical evidence as appropriate.
  • Should protect the level of benefits for people who go into then soon back out of work. GP
  • Should be a target for getting current claimants off IB (tory opening statement GP debate)
  • The new tests will apply to claimants of the planned Employment and Support Allowance but and is also likely to apply to existing Incapacity Benefit claimants from April 2008 at the latest. (Benefits and Work) [8] —Preceding unsigned comment added by Bodnotbod (talkcontribs) 16:37, August 27, 2007 (UTC)

Housing Benefit

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The central element of Housing Benefit reform is the Local Housing Allowance.

  • We should simplify housing benefit.GP
  • We should improve work incentives.GP
  • We should increase personal responsibility.GP
  • We should make payments to the tenant not the landlord.
    • This will give tenants the budgeting skills they will need when returning to work.
  • Existing claimants will remain under the same rules.

Main Tory claims

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  • It has taken Labour nine years (prior to the 2006 Green Paper) to address these issues.

Challengeable, repeated assumptions

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  • We cannot afford, either in social or in economic terms, to leave 2.7 million people abandoned on long-term benefits. [9]
  • IB leads to inactivity, social exclusion and poverty. (Ibid)







--bodnotbod 14:36, 26 August 2007 (UTC)[reply]