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
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.
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
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
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
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
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.
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
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.
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.
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 inappropriatelyie that more could
be demanded of them than they can actually do. Many will therefore
be afraid to show their potential for work voluntarily.
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
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 100,000250,000 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?
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.