Wednesday, 16 May 2012

Why Iain Duncan Smith is wrong on disability reform

IDS - wrong

Earlier this week, Spaghetti Gazette editor Pete Millington, who works as Information and Community Empowerment Manager at Birmingham's Disability Resource Centre was invited to speak on the Adrian Goldberg show on BBC Radio WM to respond to an interview with Iain Duncan Smith in The Telegraph newspaper about Disability Living Allowance.   

Conservative MP and Secretary of State for Work and Pensions, Iain Duncan Smith, caused debate and controversy over the weekend with his interview in The Telegraph newspaper in which he spoke candidly about people claiming the welfare benefit Disability Living Allowance, his government's mission to reform the benefit and his intention to remove its entitlement from a staggering 20% of current claimants, reducing the annual bill for DLA from 13 to 11 billion pounds.

In his interview, Duncan Smith said, “This is the benefit that is effectively a support mechanism for you, in or out of work, it doesn’t matter, whatever income you have, it doesn’t matter. The system is riddled with abuse and fraud. From next year more than two million claimants will be reassessed."

The Telegraph interview with Duncan Smith went on to say that his Government is braced for fireworks as, under the plans, even a soldier who has lost limbs but no longer has mobility problems, because of a prosthetic limb, may have the payment cut.

“It’s not like incapacity benefit, it’s not a statement of sickness, it is a gauge of your capability. In other words, do you need care, do you need support to get around. Those are the two things that are measured. Not, have you lost a limb? ”

“We are creating a new benefit, because the last benefit grew by something like 30 per cent in the past few years. It’s been rising well ahead of any other gauge you might make about illness, sickness, disability or, for that matter, general trends in society. A lot of that is down to the way the benefit was structured … Second thing was that in the assessment, lots of people weren’t actually seen. They didn’t get a health check or anything like that."

“Third problem was lifetime awards. Something like 70 per cent had lifetime awards, which meant that once they got it you never looked at them again.”

Mr Duncan Smith is cited as being furious with judges, blaming “judicial activism” for widening the definition of disability. It is alleged that many people, who the public would not regard as disabled, can claim the allowance.

"The reforms to disability benefits, which will tighten the definitions with a more simplified system assessed by medical experts, will be accompanied with a programme to help disabled people back into work. Many think mistakenly that they cannot return to employment without losing the help. One of the things we are trying to do is make sure there are much greater levels of support available, so there are positives in all this because we will be bringing forward some major reforms that help people get back to work.” 


Shortly after the Conservative Liberal alliance came to power in the UK in 2010 I wrote to Iain Duncan Smith in my capacity as Information Manager of Birmingham Disability Resource Centre and invited him to come to visit our centre, to meet some of the 5000 disabled people whom we support each year, many of whom rely on welfare benefits like DLA. I invited Iain Duncan Smith to come up to the UK's second city and find out first hand about the real support that disabled people themselves know that they need to live independent lives.

I also offered to share with Iain Duncan Smith and collegues the results of extensive action research we carried out at Disability Resource Centre which identified over 100 barriers in society and specifically in the field of employment that need to be addressed and issues which require investment before disabled people can successfully and sustainably engage in the social economy in greater numbers. 

Sadly Iain Duncan Smith didn't respond personally to my invitation and instead asked the Minister for Disabled People, Maria Miller to write a rather unconvincing apology on his behalf. It seems they had other more knowledgeable people to consult, no doubt all based in London. 

Iain Duncan Smith has instead ploughed on with his crusade to slash the welfare bill in the name of reform - frightening and demonising tens of thousands of disabled people along the way as he wields the axe of austerity.

But let us for a moment consider some of the facts about Disability Living Allowance that Duncan Smith's government have chosen to ignore here.

Firstly, whilst the disability benefits bill might initially sound very high at 13 billion pounds, let us compare this with the estimated figures of tax evasion by the business sector in the UK, which one estimate quotes as being around 70 billion pounds. I have a feeling this is a conservative estimate based only on the incidence of illegal fraud and probably doesn't include legal loopholes. Surely the government's first target in protecting tax payers' coffers should be wealthy tax dodgers, not those on the lowest rung of society. Research and investigations into DLA claimants in the past decade (remember the Benefits Integrity project of the late 1990s and David Blunkett's assault on welfare benefits a few years ago?) have repeatedly proven that DLA is actually NOT riddled with abuse and fraud, this notion usually being based on the sensationalist coverage of one-off cases of fraud in the populist tabloid press.

The DLA claim form is actually very tough and the process of claiming generally requires a number of signed testimonies and references from a range of professional experts which can include GPs, surgeons, consultants, nurses, physiotherapists, social workers and occupational therapists. Again, Duncan Smith's assertion that people aren't assessed and are given the benefit for life is not only inaccurate but is scandalously misleading. 

It is true that the DLA claim form initially involves a self declaration process, exactly the same as paying one's tax as a self employed person or company director is primarily based on self assessment, this in itself saves the government millions if not billions of pounds. But there are many further checks and balances throughout the process. Adding new layers of civil service bureaucracy to the process will end up costing the state much more money than will ultimately be saved and will push tens of thousands more genuine claimants into an already over-stretched appeal and tribunal system. The 'experts' that the DWP uses to assess claim forms are invariably not medically qualified, they are either civil servants or more likely these days sub-contracted IT operators at agencies like ATOS.

A colleague of mine was recently assessed by a so-called doctor from ATOS and had cause to make a complaint about this person. The investigating officer contacted my colleague to reassure him that they had personally carried out a full investigation and spoken to the doctor at length who had offered an apology. "He is very sorry to have caused offence". The apology (which we have in writing) might have been meaningful but for the fact that the doctor that my colleague saw at ATOS was female. Just one example of the incompetent, cumbersome and in this case deceitful machinery that is in operation here on behalf of the unsuspecting tax payer. The growing catalogue of horror stories from claimants who have already been put through the ATOS number-crunching system is deeply worrying and does nothing to reassure us about Duncan Smith's good intentions.

One of the reasons that DLA has become very complex is because the nature of illness, impairment and disability is very complex and each individual is unique. This is precisely why DLA case law has expanded since the benefit was introduced in 1992 and why Iain Duncan Smith's simplistic idea that wheelchair users will still be entitled to DLA but amputees may not get it because they can walk with a prosthetic limb is ludicrous and exemplifies what happens when politicians set themselves up as experts on things they fundamentally misunderstand.

For instance, a person who can walk with a prosthetic limb is still very likely to have difficulties 'getting around'. They may for instance be able to walk into a room of civil servants and doctors from ATOS and the DWP but for getting around the local shopping centre they will need to use a Shopmobility scooter. Twenty years of DLA case law proves that human beings don't fit neatly into medical categories and for many people, especially those with hidden impairment and things like mental health conditions, neurological conditions, seasonally affected health conditions, fluctuating pain levels, epilepsy, sensory and learning disability, etc, etc, their care and mobility needs may fluctuate or be difficult to quantify on a daily basis. This isn't a case of judges redefining disability, this is a reality of an ageing population in a post industrial environment.  

Even if we give Duncan Smith a huge benefit of the doubt that the point he was trying to make was that individuals can't be described pejoratively in terms of their impairment, the examples he has used to demonstrate his point are unfortunate to say the least. There is more than a little irony, which has already been jumped on by the media, in the fact that many of the people he is suggesting should be turned down for DLA in the future will include the young men and women who have lost limbs fighting, we are told, for our freedoms in Afghanistan and Iraq. Have we learnt nothing from the history of the first world war when soldiers promised a land fit for heroes found themselves begging on the streets of their homeland by 1919?

Another fundamental point which Duncan Smith fails to grasp, and he is by no means the first, is the purpose of the DLA benefit in the first place as far as the state is concerned. The creation of DLA, which originated from mobility and attendance allowance and even dates back to the pre-1977 blue trike scheme, was based upon the idea of supporting the independence of disabled people in the community and removing their reliance on and residence in state funded institutions such as asylums, long-stay hospitals and other residential places. Incidentally, whilst employment may be a desirable ambition for many DLA recipients we should remind ourselves that it should never be confused with employment or incapacity related benefits.

The basic, well proven principle behind DLA makes a lot of sense and actually we might even retrospectively congratulate the Conservative government who introduced it back in 1992 for appearing to grasp that concept, something which all subsequent governments seem to have been incapable of understanding ever since.   

The principle is that if you give disabled individuals and sometimes their carers and families a small amount of money to enable them to direct their own care and mobility support whilst living at home in their community, it invariably saves the state something like five times the amount of money it would cost to meet the same level of need through professionals, experts and institutions. The purpose of DLA is to support personal independence in the most economical way for the state by giving people choice and flexibility about how they spend their money.

I can give many examples of how this works, especially from the years I spent working as a carer and personal assistant to disabled people in their homes. For instance, I remember a fourteen year old boy giving respiratory suction and passing naso-gastric feeding tubes, tasks only administered by qualified nurses in the health service, to his sixteen year brother whilst they sat enjoying videos and computer games together in the 'normal' environment of their own home, rather than the older brother being separated from his family in a hospice or residential home. There are a million situations like this all around the country where the payment of DLA and Carers Allowance are supporting disabled people to live with dignity and in a self-actualising way, whilst preventing the need for more expensive intervention.  

For me it doesn't matter if the DLA payment can't be precisely accounted for in terms of the family income or if it pays for something completely different from one week to another, the point is that the disabled person themselves have been given choice to live as independently as possible because of the extra financial support. Individuals and, when relevant their families, will always ten times out of ten, find the most cost effective way of meeting their own needs.

So when looking at the 13 billion pound bill for disability benefits, what Iain Duncan Smith needs to consider is the enormous potential cost to the state of providing care and mobility support to people through public funded services. With so many people already losing DLA under this government's ruthless campaign of cuts and Iain Duncan Smith promising an escalation, it is not difficult to predict a catastrophic break down of both personal independence and general health and wellbeing across the nation in the next two years.

With unemployment rates rising for the whole working population and widespread disability discrimination by employers, the prospects of disabled people finding work are becoming increasingly low. Those disabled people who are currently able to sustain their employment are usually doing so because they receive DLA which in turn helps to create the level playing field needed to enable them to get out of bed and travel to their workplace.

The social return of DLA as an investment, far outweighs the savings that Duncan Smith intends to make with his fundamentally flawed wheelchair versus prosthesis plan.    

To use a well known phrase, if it ain't broke, don't fix it. Let's hope some common sense, humanity and basic mathematics begin to prevail.

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