The labelling and medicalisation of disability
19. One of the key problems appears to be the definition of incapacity
itself. Labelling someone as 'incapable' of work sends out a very
strong message to the claimant and to potential employers. With
so many Incapacity Benefit claimants themselves saying they would
like to work, the incapacity label is misleading and unhelpful.
The Green Paper suggestion of changing the name of Incapacity
Benefit gained support from witnesses giving oral evidence to
the Committee. The
Committee supports the move to change the name of Incapacity Benefit
to something with more positive connotations. This will help to
dispel the myth that many disabled people are unable to work.
20. A further problem identified during the course of this inquiry
is the medicalisation of the incapacity benefits system. There
remains a reliance on the medical profession, who may not be best
placed to decide whether or not someone is capable of working.
The Shaw Trust suggested that there is a danger that incapacity
is still being measured against previous employment. They also
warned that capacity/incapacity may be assessed without a proper
understanding of the support available to enable a person to work.
They suggested a move away from a purely medical process by using
more occupational nurses and fewer doctors.
21. The Employers' Forum on Disability summed up the problem with
the medicalisation of the incapacity benefits system and the issues
caused: "Both employers and people with disabilities experience
the health service as a barrier. The medical profession does not
generally understand disability to be an equal opportunities or
discrimination issue and is unfamiliar with the DDA. Doctors tend
to overestimate the risk to the company associated with hiring
someone with a disability or health condition, and underestimate
the potential of the employer to make the necessary adjustments.
Millions of people in work have no access to occupational health
specialist physicians; instead, general practitioners are consulted
at recruitment and in retention cases. GPs tend to have a very
limited understanding of the realities of work and the nature
of possible adjustments and have little time in which to consider
work related adjustments."
22. The Committee agrees with suggestions that reliance on a medical
model of assessing incapacity is acting as an additional barrier
to disabled people who want to move into work. We recommend
that occupational nurses and Disability Employment Advisers should
have more input into the Personal Capability Assessment. We
also recommend that the Government investigate the 'nonNHS'
models of voluntary groups and private providers, who have developed
medical models aimed at job retention and, where that is impossible,
a rapid return to work. We further recommend that this should
be built into the pilots proposed in the Green Paper, so that
half of the pilots should have their medical services delivered
other than through the NHS. We hope that this would ensure
that consistent standards are operating across the UK.
23. The Committee agrees with the Department that the three factors
contributing to the rise in incapacity benefit claimants are economic
and industrial changes, benefit administration and demographic
changes. Measures currently undertaken to help disabled people
move into work need explicitly to address these three factors.