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Work Capability Assessment Under Attack in Emotional House of Commons: ME Comments

Discussion in 'General ME/CFS News' started by Firestormm, Jan 18, 2013.

  1. Valentijn

    Valentijn Activity Level: 3

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    That's a good point too. I wonder what would happen if someone found "fit for work" who obviously isn't fit for work were to sue a potential employer for discriminating against them on basis of their disability :lol:
  2. Firestormm

    Firestormm Guest

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    Or to sue the DWP for finding them 'fit to work' in the first-place!
  3. Sasha

    Sasha Fine, thank you

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    It's unlikely that an employer would ever say to a job candidate that they were being turned down because of their health: the Disability Discrimination Act is well-known in this country. Even if one of us got as far as interview, we'd just get a standard rejection letter with no reason given.
  4. Valentijn

    Valentijn Activity Level: 3

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    I don't know how it works in the UK, but in the US you usually can't sue government agencies that are "just doing their jobs", no matter how poorly. But suing the employer for discrimination (presumably circumstantial evidence would be enough to keep the case from getting thrown out right away) puts the employer in a situation where they basically have to go after or blame the government. Maybe more effective than the not-fit-to-work prospective employee complaining about being fit to work, which probably happens all the time with little notice taken.
  5. In Vitro Infidelium

    In Vitro Infidelium Guest

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    Yes to any reasonable person 'weird' is right. However it makes sense in a UK centric way. Work, from the perspective of most political Parties in the UK, is seen as the primary qualification for citizenship (unless you are wealthy and then you get a free pass), so to have someone identified as not capable of work is conceptually eqivalent of saying they are not fit for citizenship - it's a perverse reversal of disability rights, but it has informed the whole public debate over benefits for the last decade. To deny one is capable of work in some way, is not considered legitimate, unless there is uneqivocal demonstation (quardaplegia, iminent death etc). There's a lot about the UK that is 'not very nice'.
    This is one area of public life where it could be argued that the influence of Sharp, Wessely and White, via Mansel Aylward, has actually had an impact, although only because it chimed with existing political and public prejudices.

    The need to attack (replace) Invalidity Benefit was very much driven by concern over the increased claimant count qualifying under mental health diagnoses - a message that 'pandering to the false illness beliefs' was not in the claimant/patient's interest would have fitted neatly into the then Labour Government's notion of 'work as curative'. The role of the work group isn't to 'over come' disability - it's to place those who might notionally be capable of some work at some point, in a position of exposed public insecurity such that work (notionally) is a more attractive option than benefit. It's about removing legitimacy for 'not working'. Claimants are not the intended beneficiary of (at least as far as the current administration is concerned) of Government policy - the policy is essentially an economic one where the balance between the support given to ill and disabled citizens and the cost borne by Government is remodelled. It's not simple cost cutting, but a statement of what the relationship between Government and citizen is.

    The cause is Government philosophy. One of the stated objective from the outset was to remove several hundred thousand people from disabled benefit entitlement - though this was in the context of pre 2008 employment levels, so moving people into employment (with appropriate support) was not so fanciful, although many of us who listened to the rhetoric were pretty cynical even then.

    So long as a single person met the annual testing regime requirements (perversity in the system means this is by no means certain even where a disability is stable or gets worse), then yes their payments under ESA would remain the same even after a year, although of course their freedom make life choices becomes restricted by limitations imposed by the means test. JSA is complicated, but yes in principle some people with a partner could get six months of JSA, but only if the partner is working 24 hours or less, and in this circumstance the household would likely be claiming inwork benefits and the whole thing would be circumstance dependent. Essentially anyone who is married, in a civil partnership or living as though they are, who is unable to work because of illness/disability, and whose partner works more than 24 hours a week, will be dependenat upon that partner after one year of being in the work group ESA.
    ESA was conceived of as having these two grades of qualification, with the 'lesser' grade having a punitive element. In fact the punitve elements have been moderated - initially people were being coerced into private sector delivered CBT that in the case of mental illness was actually counter to therapy being delivered to the same clients/patients by the NHS. There were even elements that implied that if someone refused major medical interventions - surgry etc, then they could lose benefit - this has now ben changed.

    That is a key element of the policy. The Government must allay the electorate's fears about unfainess and mistreatment, while reducing spending on the undeserving poor. The Government's ambitions can only be met by reducing the number of those who qualify as deserving, so the electorate and Government are in a game where so long as the electorate doesn't have to see the consequences - the Government remains blameless. ESA is a policy of direct attack upon the qualification of 'deserving' - the electorate knows it but is largly content so long as there are not cripples in the gutter. From that perspective the policy isn't perverse - just business as usual. And the image of we British being so much more enlightened in welfare than the Yanks remains intact.

    IVI
    Valentijn likes this.
  6. In Vitro Infidelium

    In Vitro Infidelium Guest

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    Sasha and Valentijn like this.
  7. Valentijn

    Valentijn Activity Level: 3

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    Wow. The ethical implications of a government requiring silence from charities in exchange for funding them are pretty staggering. It seems absurd that the general public would allow such a system to exist - unless they really just don't care.
    SilverbladeTE likes this.
  8. Firestormm

    Firestormm Guest

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    Not sure whether we should be concerned or not. With DSM5 surely - thinking laterally - such assessments will have to concede 'mental' aspects to any and all physical conditions? Also the following assumes that patients with ME are assessed as having a purely physical disease:

    I need to read the attachments. Don't have time right now. Probably/Might need it's own thread...
  9. Firestormm

    Firestormm Guest

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    I presume that the concern from Charles Shepherd and others relates to this amendment the link is embedded above also:

    What a load of bureaucratic/ideological/pigeon-holing bollocks. Get a grip and get a doctor. Name me a neurological condition that doesn't bridge this overly talked about divide between 'physical' and 'mental'. Gods. Whatever next. How are cognitive difficulties now to be categorised? Purely mental? This is bloody daft.

    There is also this:

    Gets worse:

  10. Firestormm

    Firestormm Guest

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    What if Newton is right? Autonomic Dysfunction = fatigue = cognitive issues? How does this amendment fairly treat that physical condition? I can't see how this amendment has been misinterpreted. But how will claimants know in advance that the questions they answer will be judged as not applying? After all we - if seeing anybody - will often be seen by psychologists as well as medical consultants. Makes no sense to me whatsoever.
  11. Valentijn

    Valentijn Activity Level: 3

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    This is why I hate the label "mental illness". Mental is such a vague and broad word. I would argue that cognitive dysfunctions are physical - that is, they're neurological, not psychological. But then, I'd also argue that most "mental" illnesses are probably neurological as well :D

    There are keyboard layouts in Windows OS specifically designed for one-handed use. It'll be slower and less efficient, and I can't imagine who would want to hire a one-handed typist for a job with a lot of data entry. But it is a handicap that can be accommodated if 1) the employer wants to accommodate it, 2) if the employee knows how to use it (and change PC settings), and 3) if speed is not of the essence.

    But most employers hiring from WRAG would probably be looking for keyboard monkeys, not people with skills in another area where data entry is a minor and peripheral part of the job. That is, if any employers were actually hiring from WRAG :p
  12. alex3619

    alex3619 Senior Member

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    If you can only be assessed on the basis of physical or mental disability, but not both, then cognitive issues might not be permitted for a physical disability. However, if you reassess ME or CFS as mental, then the physical issues might be classed as psychosomatic, and hence mental. I wonder if this is possible or excluded, it would depend on the fine print. If its allowed then this could coerce patients into accepting psychosomatic diagnoses unfairly.

    However the specifics of testing are what will determine this. I suspect that it will not have this effect, I am only raising the issue as a caution.

    Similar arguments should apply to neurological issues.

    There is something very wrong with government thinking here.
    Valentijn likes this.
  13. Firestormm

    Firestormm Guest

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    Think Multiple Sclerosis, Parkisons, Altzeimers/Dementia, indeed think any friggin' neurological condition. You cannot draw a line and divide physical and mental. I mean we are referred to management strategies that help address physical and mental. This decision goes against everything that is happening to us and to what we are being treated for in clinical practice.

    You can't have 'either/or' when approaching something that is a long term chronic condition. Living with this crap causes mental illness. So how are they to treat for benefits someone who has a physical disability and a mental disability and separate the 'two'?

    Friggin' tick-box mentality of ideologues in bureaucratic positions that are not a part of real-life and have no medical understanding whatsoever. Also flies in the face of what Harrington was working to achieve.... Grrr... and Grrr again.
    barbc56 likes this.
  14. In Vitro Infidelium

    In Vitro Infidelium Guest

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    Private Eye Magazine -No.1332 25th January 2013

    FITNESS TO WORK
    Ill thought out:
    Despite cross-party condemnation last week over the way thousands of sick and disabled people have had their benefits axed after the private company Atos wrongly found them fit to work, the government is trying to sneak in new measures which will make the problem worse.

    It has tabled amendments to employment and support allowance legislation which, academics and campaigners say, will lead to even greater suffering by the genuinely ill.

    Plans include withdrawing benefit if an assessor decides that a claimant's ability to work would be improved by aids, such as guide dogs, walking sticks or prosthetic limbs - whether or not the claimant has access to them or can use them. Atos assessors already have the power to carry out an "imaginary wheelchair test" when they decide that a person could work if they used a wheelchair - even if they do not have one.
    Under the changes people will also lose benefit if an assessor decides that adjustments could be made for them in the workplace - whether or not those changes have been made. The amendments also include plans to consider physical and mental health problems separately, instead of looking at the combined effects of mental and physical health on a person's ability to work. As is common knowledge, some diseases impact on both mental and physical health, and treatments for one can severely impact on the other.

    The changes, due to take effect at the end of the month after no public debate, have been condemned in a briefing by the thinktank Ekklesia, which says they fly in the face of "coalition claims to be protecting and supporting sick and disabled people in a climate of austerity, cutbacks and hardship".

    MP Tom Greatrex, a critic of Atos, said: "The fact that people can be assessed as fit for work on the basis of an imaginary guide dog, without taking any account of the availability of guide dogs and the time taken to train both dogs and users, highlights just how far the DWP seem to be prepared to go to find people fit for work without the support they need to make work a reality."

    Last week the Commons heard of many cases where patients had died, or committed suicide,after being assessed as fit for work following "a demeaning process that was making sick people sicker". Under coalition proposals there will be many more such cases.
    Firestormm and Valentijn like this.
  15. Research 1st

    Research 1st

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    I agree with you Firestorm if you are talking about unexplained chronic fatigue (CFS), using Fukuda or British criteria
    for diagnosis. No tests are are required to tell someone they have CFS or CFS/ME and thus there is no disease
    demonstrated. No argument there at all.

    But you can draw a line that divides the physical and mental when talking about disease. So you can have either or Firestorm. If you can't as you propose (can't have either or), then Diabetes is a half mental illness, Cancer is a half mental illness, and Asthma is a half mental illness. Are they? No. They are all potentially fatal and are all worsened by stress. They remain diseases though.

    Because ME is a disease, this is important. A disease is either classified as physical.
    There is no half mental. A mental illness is so because we don't know the organic aetiology behind the symptoms to elevate them to hallowed disease status.

    No one can name a disease that is classified as a 1/2 physical and 1/2 mental disorder.
    You can't find one. You could propose one though.

    Schizohphrenia is arguably what should be classified as a neurological disease with neuropsychiatric symptoms, but Schizophrenia is not classified as a neurological disease and is not managed by neurologists but psychiatrists.
    So we can see no disease is 'half mental' and no 'half mental' illnesses exist when referring to ME either, if you are referring to ME as a disease.

    A disease is diagnosed with tests, otherwise it is not classified as as medical disease. No one can be diagnosed with ME unless their abnormal test tally is indicative of an ME likely disease process. In error, many people believe they have ME who haven't had any tests shown to be abnormal in people with ME (organic CFS). But, these people are not all of the ME population, they are some. So some people who say they have ME (believe it in error), will benefit from psychological rehabilitation how could they possibly not!

    1. ME is classed as a disease by the WHO.
    2. CFS is classed by the UK NHS as an illness, not a disease. As outside the UK.
    3. CFS/ME is UK specific. CFS/ME is classed as a collection of fatigue syndromes (symptoms) which are meant to be non organic. Except that is not statistically possible, some will have organic disease, referred to as ME.

    We now run into even more confusion because of the accidental mixing with CFS and ME.
    CFS/ME is not classed as a mental health illness by the UK department of health, but the treatment is mental health based.

    To see if this is appropriate or even dangerous for clients using NHS care services we should contrast ME vs another neurological disease,Parkinsons disease.

    #
    People with neurological disease( MS and Parkinson's) are not refered for CBT unless they have become mentally ill and need their beliefs altering because it limits their potential. A person with newly diagnosed Parkinson's disease who develops an unwarranted negative thought spiral about Parkinsonian symptoms may believe they cannot walk outside the door as they may become trapped somewhere due to an attack of limited 'Parkinsonian gait' and this may cause them great anxiety and fears about mobilizing and keeping independent. That person, for this specific reason, may be referred for CBT and CBT is appropriate.

    #
    In contrast, all people with CFS/ME in the UK are refered for CBT by default unless there is an exclusionary reason they cannot engage or they refuse to. If so, there is no physical treatment at all for people with CFS/ME in the UK and many referals for rehabilitation are medically inappropriate. (Physiotherapy is rehabilitative).

    Quite absurdly NHS medical referrals in the UK (if you have ME or CFS) are made irrespective on the beliefs the person with CFS/ME has! Unfortunately many miscarriages of justice happen to people with ME (organic CFS) because well meaning NHS therapists give the care presuming their clients with CFS/ME are all universally mentally ill and all universally have ''faulty illness beliefs'' which of course in contrast with other clients, with other diseases, they don't think this for other neurological diseases.

    In practice, people with CFS/ME (who have neurological ME) are not referred for management strategies that ''address the physical and mental'', they are only referred to practitioners who can address the mental that is assumed to be present, and also the cause of 'fatigue', despite their being no scientific evidence for this. With regarding neurological disease in ME, you cannot address the physical if there is no medical treatment on offer to address the physical because the disease is not researched and no drug trials are in place to offer physical treatments.

    You will not find one happy customer with a neurological disease having their physical disability ''addressed'' with CBT, GE, Physical therapy or counselling. Neurological diseases are treated with medications tailored for the disease. No medications are on the market for ME and never have been and never will be if ME remains stuck with psychological fatigue syndromes that don't require any tests to prove they even exist outside of the minds of the believer.

    Drugs that may help ME, such as anti-viral medications, are listed in the NICE guidelines as not being advisable to prescribe to people with CFS/ME because naturally, many won't have infections. Yet anti viral medications may reduce neurological symptoms in people with chronic viral infections who have ME, such a relieving/reducing headache, and reducing the level of autonomic dysfunction present. (Autonomic dysfunction symptoms are worsened by infections). That is the kind of treatments for ME that really could ''address'' the disease process of ME but are not given the green light because of psychological therapies being the only dominating options, that cannot and do not address the physical symptoms of organic disease based ME.

    Why is all this so important? Because people with disease are unfairly told they should go get off their bums and work and that they are free to work as there are 'treatments' such as CBT to make them work. If you have no evidence you are sick and you have psychological chronic fatigue and depression, fine. If you have ME and are clearly organically disabled, not fine.

    Either way the DWP and benefits are often cancelled not only for people with ME, but increasingly for people with MS who may not be as disabled as others but too have a fluctuating form of MS that prevents them from working, but official 'assessments' say they can work because of these forms one has to fill in that required people to be practically bed ridden before anyone will accept there is a disablement that is severe and life changing, especially with neurological diseases that affect cognition (thinking).
    Valentijn likes this.

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