Select Committee on Work and Pensions Written Evidence


Memorandum submitted by Anna Ravetz after the publication of the Welfare Reform Green Paper

  I am a claimant of Incapacity Benefit. I am taking part in this consultation because when the Government first discussed its plans for Welfare Reform, I found some of the proposals very frightening, giving rise to both insomnia and anxiety, both ongoing. The publication of the Green Paper has not allayed my fears, both for myself and for other people in a similar situation, existing and future claimants. My comments are confined to the part of A New Deal for Welfare which relates to Incapacity Benefits (IB).

  My submission relates to the question: What are the implications of a rollout of Pathways on a new system of incapacity benefits? I have confined myself to the key general areas and have not covered all issues I would have liked to submit on, due to the word limit 2000 words. In particular I have not been able to make comments on improving work incentives.

POTENTIAL DAMAGE TO HEALTH OF SOME CLAIMANTS

  My chief concern with the reforms is that, through the requirement that people take part in work-related activity, they have the potential to force people into levels of activity which is damaging to their health. The idea of putting in more support to enable people to improve and return to work where possible is excellent, but the proposals are for stick as well as carrot, pressure to participate and benefit cuts for those who do not (2:87). Personal Advisers (PAs) are therefore going to be policemen as well as supporters/enablers, and there is potential for them to demand participation in activities which, for some claimants, are beyond their capabilities. Claimants then may have ongoing damage to their health if they comply with the required activities, and financial penalties if they do not. I trust that Members of the Committee will imagine, and take seriously, the despair people will feel if they are caught between `a rock and a hard place': required to carry out activities that they know will make them worse, facing a benefit cut if they do not comply.

  Everything depends on how the proposals are implemented. If there is a genuinely co-operative approach, with PAs accepting what claimants say about their symptoms and

  capabilities, claimants need have no fears. But if PAs are expected to push claimants regardless of what the claimant says, there will be the following problems:

    —    PAs will always have to be judging whether the claimant is participating; a claimant's opinion that an activity is not possible for him/her is always open to being viewed as non-cooperation.

    —    PAs will make inappropriate decisions, as it will be impossible for them to understand the ins and outs of all medical conditions.

    —    claimants who are unable to give a clear account of their problems could be forced into inappropriate activities.

    —    many claimants will experience high levels of stress and distress.

    —    some claimants'conditions will deteriorate because of stress/distress.

    —    some vulnerable people may be driven to suicide. I do not say this lightly, but from an awareness of how desperate people can feel if they are alone, ill/disabled, impoverished, and unsupported. Sadly, many sick and disabled people have extremely minimal material and social resources. To feel that one's problems are unseen, or that one is not believed (because a PA demands participation in an activity in spite of what the claimant says) can be the last straw.

  It is impossible to know from the Green Paper how toughly the new system will be implemented, but it does contain the aspiration that the number of IB claimants can be reduced by one million over a decade. There is no medical evidence whatever for this number, nor is there even a precise breakdown of conditions that people are claiming benefit for. Pathways to Work has not been running long enough to have extensive evaluation, and it is too early to know whether people who returned to work were actually able to sustain work long term. On no more basis than the belief, therefore, that there are "too many" people claiming Incapacity Benefit, the Government has asserted that a million people with illnesses and disabilities are capable of work. This is too much of a round number to be anything other than a "target" chosen for political reasons. It is deeply concerning that in such a serious matter as people's health, and the support they get from the State, that the Government's reasoning is so superficial. Furthermore, with a target chosen on political rather than medical grounds, it is likely that progress on reducing the numbers on IB will fall short of the target. Will the target then be re-examined, or will the government simply suggest that people are not "co-operating", and introduce a tougher regime with more pressure on claimants from PAs and greater use of sanctions? The Green Paper does not seem to prevent the latter course, and this will lead to all the problems I discuss above.

RECOMMENDATIONS

  Benefit cuts for non-participation should not be introduced, or, if introduced, should be intended for use only as a last resort in a tiny minority of cases where there is flagrant non-participation.

  Claimants will be required to attend a work focused interview at 8 weeks into the claim (2:80) Attendance should not be required for people who are housebound or bed-bound by their conditions, or who are in hospital or similar establishment for treatment/care/rehabilitation.

  When work-related action plans are drawn up:

    —    Claimants' views as to their own capabilities must be taken into account.

    —    No activity should be expected that is against medical advice for claimant's condition, particularly the advice of their own doctor(s).

    —    No activity should be expected that worsens the claimant's symptoms or places him at risk of relapse. Impact of issues such as pain, fatigue, malaise, should always be considered.

    —    The action plan should allow the claimant sufficient time to carry out medical treatment, self-management of the health condition, personal care and household responsibilities, recognising that these may well take longer than normal in the case of some illnesses or disabilities. It should also allow the claimant sufficient time to carry out caring responsibilities, and reasonable time for family/social contact/recreation.

WORK THE BEST MEDICINE?

  A further serious concern with the reforms is that, in some cases, they have the potential to prevent recovery. I support the government's aim to engage with people on benefit. I would, however, suggest that the most appropriate aim for "our intention to help people focus on their aspirations" (2:76) would be an improvement in the claimant's overall health and functioning, rather than a narrow focus on their ability to work (2:77).

  Work is not always the "best medicine" for ill and disabled people. People with serious illnesses often need time where they are free from pressure, in order to get better. Some people need all their energies for recovery; some may be in an emotionally vulnerable state and cannot improve if they are put under any pressure; some people may literally need to convalesce e.g. from surgery, or a very draining illness. There is a complete lack of recognition in the Green Paper of these issues.

  Pressure at a vulnerable time can be immensely damaging to long term prospects for recovery. For my own illness, it is now believed that stress and over-activity can prolong the illness and even fix a person in permanent ill health. A friend of mine was seriously ill some years ago with depression and associated physical problems. She comments "if I had been put under any pressure at that time to prepare for work or look for a job, I would never have got better". She claimed IB for 18 months and is now fully recovered, coping well with a professional job and parenthood. She simply needed time out for recovery, which she was able to get under the old system. The new system does not offer this time.

Recommendation

  The proposals should allow for recovery time, convalescence and time without pressure where necessary.

Personal Capability Assessment

  Even undergoing a Personal Capability Assessment (PCA) can be immensely stressful. I have endured deterioration of symptoms and relapse every time I have been required to undergo a PCA, and every other ME sufferer I know of is similarly affected. This is not a case of "if you're innocent, you have nothing to fear", because the PCA considers issues which, at the final analysis, are subjective: how much a person is affected by illness, disability, pain, etc. Claimants always fear that a decision maker will not accept how they feel. An adverse decision can be appealed, but the effort of appealing is absolutely daunting to seriously ill people.

  It will take a great deal more than a name change to remove the negative implications of the PCA (2:70). Since a transformed PCA is expected to reduce the numbers of people claiming IB (2:62), it is clearly going to get even tougher. Claimants will therefore continue to fear the PCA, and find it a gruelling and humiliating process to endure.

Recommendation

  For claimants with long term and stable conditions, PCAs should not be demanded more often than at present.

Disincentives to trying work will remain

  The Green Paper recognises that the old rules gave claimants a disincentive from showing any potential for work (2:97). But this problem will continue, and may even get worse, under the new system. The new system will be less generous than the existing system, and furthermore, under the new rules, claimants can be deemed capable of a certain level of activity, and then penalised if they don't carry it out. Claimants will perceive that they could be judged inappropriately—ie that more could be demanded of them than they can actually do. Many will therefore be afraid to show their potential for work voluntarily.

Recommendation

  Where the system is not generous there will always be disincentives to voluntarily showing capacity for work. This will only change if:

    1.  the system is perceived to be generous;

    2.  there is a perception that claimants' accounts of themselves are accepted, and

    3.  benefit cuts for non-participation are not applied.

Reserved Circumstances group

  The Green Paper does not give any definition of "the most severe functional limitations" (Chapter 2:66) which would exempt claimants from a requirement to take part in work-related activity. There is little information on the assessment process other than that it will be a "professional assessment" (2:63) and may be carried out by other health professionals apart from medical practitioners. It is unclear whether information from the claimants' GP or other doctors will play a part in this process, and whether the claimant's own views as to his/her capabilities and limitations will be considered.

  Yet this is what the process should involve. Illnesses and disabilities can affect different individuals in very different ways. In my own illness (ME), some people can work part time, although feeling tired and easily knocked out, others are bed-bound and unable even to perform self care. At one point during my illness, I was able to build towards part-time work; since then I have relapsed: short periods of mental or social activity are enormously draining, and I have to spend most of my time resting.

  An outside observer, however, would see no difference in my appearance, and there is no clinical test to measure the deterioration in my functioning.

  I am very concerned that if the process is insensitive to the claimant's own evidence as to the severity of their illness/disability, it will not only create a huge amount of distress to many people, but people will not be allocated to the reserved circumstances group when they should be, and will be forced to undertake activities they are really not capable of.

  The new system only recognises two groups of people: those with good prospects for work (2:66), and those who will "never be able to work again" (2:68). But some illnesses, including my own, can be severe enough to prevent work for years, yet still hold potential for improvement at some time in the future. (There are between 100,000—250,000 ME sufferers in the UK). Many such people are too limited by their conditions to work, but in the new system would they be allocated into the "reserved circumstances" group?

Recommendations

  Claimants' own evidence and that of their own doctors should be taken into account when identifying whether people can be treated as unable to work (2:63) There should be a right of appeal against a decision not to allocate a claimant into this group.

  The scenarios discusses at 2:90 are too narrow. Illnesses can fluctuate more widely than over days or weeks, ie over months or years. Some conditions eg epilepsy may not be active most of the time, but can always flare up unpredictably. The proposals should reflect this diversity.

  I hope that members of the Committee will take these comments into account. Thank you for reading this submission.



 
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