The rise of an out-dated healthcare model in Government decision making

UPDATE: 25/12/2012

Nassir Ghaemi has replied to my email saying that he will take some time to explore these links and then pass on some thoughts. He added:

“My initial impression is that this is quite an unwarranted vulgarization [sic.] of  an already out of date and oversimplified medical theory.”

ORIGINAL POST:

I came across an editorial by Nassir Ghaemi MD MPH for BJPsych, “The rise and fall of the biopsychosocial model”, and read with great interest. [“The biopsychosocial model was valuable in its day as a reaction to biomedical reductionism, but its historical role has played out.”]

Let me try to give the background and explain my interest in the Biopsychosocial model, and why I contacted Nassir for his expert opinion on these matters. (This is an edited version of the email I sent him.)

I have been suffering with quite sever ME/CFS, together with fibromyalgia and depression, since 2005. Although it stopped my teaching career back then, it hasn’t stopped my determination to carry on living and learning.

There has been a long running saga in the UK over welfare reform, ‘work capability assessments’, the company ATOS, and welfare to work schemes. My research has turned up some interesting developments and evidence in these areas over the last 10-20 years.

Let me introduce you to the controversy surrounding the US Tennessee-based insurance company Unum, who are advocates of the Biopsychosocial (BPS) model. Due to a major class action, It admitted unfair business practices, investigations, and fines, and was called an “Outlaw Company” by the former California Insurance Commissioner, John Garamendi. [Gosselin, Peter G. (3 October 2005). “State Fines Insurer, Orders Reforms in Disability Cases”. Los Angeles Times. Tribune Company. Retrieved 27 December 2009. “‘UnumProvident is an outlaw company. It is a company that for years has operated in an illegal fashion,’ said California Insurance Commissioner John Garamendi.“]

Unum has been advising the UK government since 1994, and has been involved with the UK’s Welfare to Work Bill. [ http://www.corporatewatch.org.uk/?lid=2940 ] In 2003, the government brought in Atos Origin to conduct incapacity assessments, and in 2005 they started using a computer system they call ‘LiMA’ – ‘Logic Integrated Medical Assessment’. The Full Facts website [ http://thefullfacts.com/esa/forum/viewtopic.php?f=22&t=330 ] lucidly explains how the system works, and the issues and controversy surrounding it. It is in essence a ‘tick box’ automated assessment, and having seen the training manuals and comments from many surrounding this ‘training’, can attest to the computer programme being predominantly involved in the decision making, reducing the role of the health care professional doing the assessment merely to the status of ‘computer operator’. There is evidence that the system is fully based around the BPS model. The Black Triangle Disability Campaign have been at the forefront of the struggle against Atos and successfully lobbied  Scottish GPs  to denounce the testing regime, a move soon followed by the UK wide BMA.

The BPS model was recommended by Dame Carol Black in her report ‘Working for a Healthier Tomorrow’ (2008). [ http://www.dwp.gov.uk/docs/hwwb-working-for-a-healthier-tomorrow.pdf ] This report was commissioned by the DWP and used as justification for the Work Capability Assessment.  Lord Freud, the minister for state in charge of welfare to reform (who is also the Great-grandson of Sigmund Freud) made it plain that he wanted to implement this report in full, and that he fully supports the BPS model.

However, with Unum’s involvement as advisors to the government in these matters, it has concerned many that the BPS model has achieved such traction in government policy with regard to all illness, conditions and disabilities. ‘Disabled People Against Cuts’ are among many groups that believe that BPS intervention has been imported from a discredited background and become the defacto ideology behind the welfare reforms and back to work policies for disable and sick people. [ http://www.dpac.uk.net/tag/bio-psychosocial-model/ ] This constantly reaffirmed by ministers and government with a completely unqualified mantra of “work is good for you”.

With regards to my condition, I have been positively diagnosed twice by a consultant  in neurology and by a consultant in rheumatology, both saying very similar things about my condition. However, currently, the government allows psychiatrists to give the majority of advice for ME/CFS although there are more than 5000 research papers showing ME to be physical, not psychological. Advice on ME needs to be given by experts specialising in areas of the disease pathology, such as neurology and immunology.This is the subject of a petition to the government currently, calling for the government to get “Advice on ME needs to be given by experts specialising in areas of the disease pathology, such as neurology and immunology… [and not from] psychiatrists, psychologists, or anyone working in an unrelated area” [ http://epetitions.direct.gov.uk/petitions/37117 ].

Are we right to be worried by the prevalence of the BPS model at the heart of government decision making, what are the true motivations behind these decisions, and ultimately is the BPS model is of any value whatsoever?

Simon Fanshawe tells the truth about benefits on BBC Breakfast

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Simon Fanshawe was a guest on this morning’s BBC Breakfast reviewing the mornings papers.

He started with this article from the Daily Mail – “Rises in welfare will be capped for six years.”

This is a transcript of some of what Simon said. (Audio beneath.)

“Let’s start with Grant Shapps, who I think is my least favourite politician. He says he is going cap to the rise in welfare benefits for six years. And the trouble for the government is that the welfare bill keeps going up, so they mount this attack on what they called the skivers as opposed to the strivers. Here are some facts about this though:

“60% of people who get some kind of benefit are in work. If you are in part-time work, of which there are 6 million in the country, and you can’t get that 24 hours worth of part-time worker week, you’re going to lose £4000 worth of tax credits during the year. People on benefit, 85% of people on housing benefit are in work, but it doesn’t go to them, it goes straight through them to the landlords.

“So the headline here that says, “Make it paid to work,” well the way to make it pay to work is to raise wages. What we doing with the benefits deal is subsidising employers who will not pay decent wages and that’s why people have to claim housing benefit and tax credit.

“And to mount this attack on the poor it seems to me seems unjustifiable.”

Simon went on to talk about the advertising campaign that the Tories are mounting in the areas where there are marginal seats. Other bloggers have covered this in a lot of detail.

, Director of the National Institute of Economic and Social Research and previously Chief Economist at the UK Cabinet Office, explains why Indexing benefits to inflation is not “unsustainable” at all.

“The idea that benefits need to be cut in real terms in order to ensure either fairness to those in work or long-term sustainability is nonsense.”

Dreadful ‘benefits’ system upsets MPs lifestyle on the state

Lord Freud, the minister for welfare reform

Lord Fraud has said that the benefits system available to MPs was “dreadful” and hindered MPs from “having a lifestyle” on the state.

The Tory peer, who (along with 650 other MPs and over 800 peers) is raging against the radical overhaul of the expenses system and IPSA, insisted he understood the necessity of living on expenses. He said: “We’ve got the circumstances now where… people who are paying tax should be prepared to subsidise the lifestyle of those in elected and unelected power – they’ve got least to lose.

“We have, through our new expenses system, created a system which has made MPs and peers reluctant to take risks, such as spending their salary like normal people, so we need to turn that on its head and make the system predictable so that MPs can have TVs, sofas and kitchens without using any of their own income.

“I think we have a dreadful expenses system.”

Lord Fraud dismissed the possibility of taking part in a television documentary which filmed him living without expenses for a week.

“I have thought of the issue,” he said. “The trouble is, it’s a stunt when someone like me does it because you do it for a week. That’s not the point. What would I live on? I mean, come on!”

He added: “I think you don’t have to be the corpse to go to a funeral, we employ ATOS for that.”

Shocking denial of liability for the well-being of sickness benefit claimants

The Countess of Mar tabled a written question that asked the Government: “What person or organisation is legally liable for the wellbeing of benefits claimants who are found to be fit for work under the work capability assessment and who are then made to work?” In a written reply, the Minister for Welfare Reform at the Department for Work and Pensions (Lord Freud) on 19 December 2012, replied:

The purpose of the work capability assessment (WCA) is to assist DWP decision-makers in assessing eligibility for benefit, or levels of benefit. The WCA is not a medical diagnosis and the decision affects benefit only; it does not oblige anyone to work.

Whilst the Secretary of State for Work and Pensions is legally responsible for all benefit decisions made by officials of the department on his behalf, there is no legal responsibility held by the Secretary of State for the well-being of benefit claimants.

Therefore, neither DWP nor WCA healthcare professionals are liable for any adverse consequence suffered by a claimant following a decision that the claimant is fit for work or for work-related activity.

This is a shocking statement on many levels.

Firstly, the dereliction of duty. The WCA is sign posted as a ‘Medical Assessment’ at many points in the ‘claimants journey’ and is conducted by a ‘health care professional’, employed by ATOS. One of the keys in understanding what is going on here is the change in emphasis. The coalition changed ‘sick notes’ in to ‘well notes’, and the assessment for Employment Support Allowance (ESA) became about assessing ‘what sort of work a person CAN do’. With tests such as picking up a pen off the floor, or moving a small empty cardboard box, and often not taking in to account any of the medical evidence provided, or even failing to even listen to the person sitting there. One commentator pointed out, “Now I may be wrong here and if I am please do correct me but when filling out the ESA form do the DWP not reserve the right to inform your GP of their decision? If the decision only affects benefit why do they do this?”

Recently, Louise Davidson had her benefits reduced after an assessment by ATOS, despite recovering from a double lounge transplant and having rejection complications. This isn’t a one off by any means, websites, activist, support groups and blogs are hearing daily from people who, despite very clear and serious medical conditions, are being declared either ‘fit for work’, or placed in to the ‘work related activity group’ (WRAG). The latter is a lower rate of ESA time limited to one year, because the assessment comes to the conclusion that the person will be able to work “at some point in the future”. An unspecified point in the future. It wasn’t time limited until the coalition came in to power.

And to add insult to injury, if people in this group are not “making appropriate preparation to get back in to work” – i.e. not making the effort to get well (!) –  then they can be sanctioned, and put in to the same work programme as people on Job Seekers Alowance (JSA). Knowing this, it is therefore deceitful for Lord Freud to state, “it does not oblige anyone to work.” And if someone is found fit for work, what else is someone supposed to do? They can go on to JSA. But, the Job Centre may not accept them as they have medical conditions and according to their rules there, the person may not be fit to work, therefore not able to claim JSA. This again is not unusual, and time again there is plenty of evidence of people with serious medical conditions being thrown out of the benefits system altogether.

But surely the cruelest part of this official statement, bearing in mind all the information above, is in the last paragraph. They deny ANY liability for “any adverse consequence suffered by a claimant following a decision that the claimant is fit for work or for work-related activity.” These are vulnerable people and Mike Sivier’s blog entry on the despicable response from the Prime Minister this week, lists just some of the 100s of people that we know by name who attribute their suicide or death to the consequences of being left with no hope by the decisions of the state.

Finally, I want to mention Karen Sherlock. She was one of the names Owen Jones tried to mention on Question Time when the Secretary of State, Iain Duncan Smith, turn red with rage and angrily shouted over Owen declaring, “We’re changing their lives. We’re getting them off benefit, and that’s what we’re doing.”

http://www.newstatesman.com/blogs/voices/2012/06/disability-karen-sherlock-sue-marsh

“Despite her own terror, she tried to tell her country, her peers, her friends – even journalists – what was happening to her and thousands like her, but shocked tuts didn’t save her. Open mouths and disgust didn’t save Karen; they didn’t save my friend. Perhaps no one could have, but those who hold and abuse power could have eased her fear or reassured her that they would act.

“Karen died on June 8 from a suspected heart attack”

I once thought that the Conservative-led coalition was a good thing. Then I opened my eyes.

I apologise if this is a bit of a rambling torrent, but perhaps I need to say: I didn’t always think the way I do now.

I actually believed the Tories back in 2010. I thought the coalition was a good thing. I thought they were the green, socially aware, de-toxified tories. I believed all the stuff they said. Then I started to look in to the figures, and I started to question.

The Tories started using really odd metaphors likening the economy to an indebted family, saying the overdraft was at its limit, or the credit card was run up. I know economics, and these images didn’t make sense. The economy of a sovereign country that has its own central bank and its own currency cannot be likened to family finances. Our debt is mostly money we owe to each other; even more importantly, our income mostly comes from selling things to each other. Your spending is my income, and my spending is your income. We also have historically low interest rates, and I know it’s best to borrow to fix the roof now, than wait until it caves in next year.

I also couldn’t forget recent history. Until 2008, the Tories said they were going to match Labour’s spending plans. We never heard them say Labour were borrowing too much, nor did we even know about this deficit thingy either. I do remember the banks and financiers getting in to trouble with their bundled-debt ratings and Lehman Brother’s collapsing in the US. And then the banks starting to crumble over here and demanding that the tax payer prop them up; we duly did because they were “too big to fail.”

Labour didn’t ruin the economy, financiers / bankers did. These super rich elite pretty much run the economy by commodotising everything, including food and health. Then they create more and more complex derivatives, until they themselves don’t even understand them, and it leads to trillions of pounds worth of loses. They helped pushed wages low so that profits could climb high. They controlled the wealth and in order to for the finance driven version of capitalism to survive, pushed every one further in to debt. Then they took it away. Companies still cannot borrow to invest to grow.

“The boom, not the slump, is the right time for austerity,” declared John Maynard Keynes 75 years ago. The austerity drive in Britain isn’t really about debt and deficits at all; it’s about using deficit panic as an excuse to dismantle social programs. I looked at the countries in Europe that have weathered the economic storm best, and near the top of the list I found big-government nations like Sweden and Austria.

You cannot rely on a free market. The economic experiment of the last 30 years, starting with Thatcher, has been a failure. The bottom 50% of the UK own less than 6% of the wealth, while the top 1% own over 40% of the nations wealth. The link between GDP and wages was severed as long back as the late 80s, yet it took until 2008 to mirror the horrific crash of 1929. Back then the world took control of capitalism and the financiers, but now for the super rich it seems it is business as usual.

Until we take hold of capitalism and keep it under control again, like the post war period up to the mid 70s (read keynes) then we’re just going to get more inequality, which leads to this kind of thing, and a huge gulf between super rich, workers, poor … at present the labourers are increasing in productivity, but wages are being kept low, so profits can become higher, so executives can get richer, and take it all abroad.

The Tories keep saying they are reducing the debt, but the autumn budget we just had will see debt increase from 70% of GDP to near 80% over the next 3 years. They have already spent more than Labour had planned to under their proposals. Can’t people see that the Tories are bare faced liars? “We won’t reorganise the NHS,” resulted in reorganising the NHS! And on it goes.

So, I started to open my eyes to the language of divide-and-rule the Tories were using against the sick, disabled and poor; I saw their broken promises;

And I decided, they stink.

Scientists call for pardoning of Alan Turing on his anniversary

Some of Britain’s leading scientists have called on the government to grant a posthumous pardon to the fantastic mathematician Alan Turing. Turning is best known for his code breaking work during the war at Bletchly Park, although his mathematical genius reached far wider than just that.

In 1952, Turing was convicted of gross indecency after acknowledging a sexual relationship with a man. He was submitted to treatment with female hormones, and three years later took his own life. Homosexual acts between two men were illegal at this time, and were decriminalised in 1967.

Professor Stephen Hawking, Astronomer Royal Lord Rees and the Royal Society’s Sir Paul Nurse are among 11 signatories to a letter in the Daily Telegraph calling for Turning to be pardoned. This has caused quite an uproar of debate and opinion.

Personally, I feel that if the law was deemed wrong enough to be scrapped, then those caught by that law should be pardoned. Quite simple really. The excuse of saying that it was the law at the time just doesn’t hold much truck with me I’m afraid.

In my mind, if you repeal a law because you think it was wrong, you say that you were sorry for anyone caught under it, had the law not being there they would have no record of doing wrong. I know it’s almost a circular argument, but I feel it’s a matter of principle, and not just about this law. I think that any thing that was wrong to punish makes the punishment wrong regardless of whether it was the law at the time of punishment.

I think that it’s much broader than this case; it is a philosophical debate of what law, crime and punishment really mean.

A tragedy is already happening under our noses

Some numbers. Very sad numbers. You can check all of these using search engines, and have multiple corroborating sources. [Edited from a post by S. K. Walker.]

27 – People shot dead in the Connecticut school shooting.

24,000 – number of people who died in the UK last winter because of ‘fuel poverty’. 

73 – deaths per week (including suicides) among disabled people as a result of the government’s programme of Work Capability Assessments (WCAs), which is categorising people as fit for work when they are plainly not.(Many have expressed doubts over the veracity of this figure. They are DWP figures and widely accept as reliable and have been referred to in many House of Commons debates, a good benchmark. However, others wonder how we can compare this to the general death rate. In reply I offer that, the year previously there were 52 deaths per week recorded, so this is a year on year increase. Now these deaths start to sound more serious, in my opinion.)500,000 (est.) – number of disabled people deliberately excluded from the reforms to DLA, to be called the Personal Independence Payment (PIP), as a cost-saving measure. So not receiving the extra mobility support and care allowances to carry on a normal life (many of these need this extra support to carry on working and “contributing to society” by paying tax etc etc.)

But that appears over-cautious. Yesterday, the Tory Minister for Disabled People, Esther McVey, told the House of Commons that, of the 560,000 people who will be assessed for the new benefit by 2015, 330,000 are expected to be excluded from the benefit. That’s an exclusion rate of 59%. 3.2 million people receive DLA, so if the same failure rate applies as they become due for reassessment, that means around 1.9 million disabled people who will lose crucial support. Using the same calculations as I applied to the 500,000 initially flagged to be excluded, it means almost a million people pushed below the poverty line.

(There is also another issue: how do the Government know the numbers before reassessment has even taken place? This sounds like another ‘forecasted mean’ that looks like a target, but “isn’t a target – OK?”…)

Factor that into the death rate from energy and food poverty, and you’re looking at a situation where the 24,000 deaths last winter will look like nothing compared to what we’re going to see, let alone the 30 innocent deaths in Connecticut.