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Working in Parliament

POST debrief. Working in Parliament. A summary of my work as a Wellcome Postgraduate Fellow at the Parliamentary Office of Science and Technology Gareth Millward – Sept. 2012. Improving health worldwide. www.lshtm.ac.uk. Wha t is POST?.

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Working in Parliament

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  1. POST debrief Working in Parliament A summary of my work as a Wellcome Postgraduate Fellow at the Parliamentary Office of Science and Technology Gareth Millward – Sept. 2012 Improving health worldwide www.lshtm.ac.uk

  2. What is POST? • Parliamentary Office of Science and Technology • Part of the Houses of Parliament, with links to both the Commons and the Lords • Independent of Government • Provides advice and briefings to parliamentarians on policy issues involving science.

  3. My Brief • To research and write a POSTnote – a four-page briefing for parliamentarians outlining the key debates in a policy area involving science. • My note was about the medical tests used to determine eligibility for out-of-work disability benefit – the Work Capability Assessment.

  4. My Findings • The WCA is a three-stage process for claiming ESA • A questionnaire, filled in by the claimant and including their GP’s evidence • A functional test, measuring the claimant’s ability to walk, carry a box, verbally communicate, etc. This is performed by private company Atos Healthcare • A DWP decision maker uses all this evidence to decide on eligibility • Many people previously found eligible for Incapacity Benefit are now being declared “fit for work” – 40% appeal this decision, and 40% of those succeed in having this decision reversed. • Therefore this is a costly exercise for govt andclaimants • Criticisms also include:the decision maker simply takes the Atos recommendation and ignores the questionnaire; the test is a one-off event and therefore creates a “snapshot” of a person’s condition; the new criteria are arbitrary, designed solely to solve cost not direct benefit to the “most in need” • Independent reviews have made some of these criticisms, and evidence suggests the government has in good faith responded and made positive changes • < http://www.parliament.uk/business/publications/research/briefing-papers/POST-PN-413 >

  5. For historians of medicine • This is part of a long-standing problem. We have never satisfactorily defined “capacity” and/or “disability” in the welfare state • Neo-liberal governments believe measurement, targets and ideal types will yield efficient public services, but there appears to be a failure with disability • The arguments of disabled people themselves – that disease != disability – have been appropriated to create a system that denies disability’s place in out-of-work benefits • The “Fabian” tradition of campaigning may have backfired in this case Implications For policy makers • More account needs to be taken of subjective evidence to avoid the “common sense” failures of “obviously” disabled people being denied benefit • In future, perhaps more rigorous testing of new techniques would be wise • More openness is needed with the contract with Atos – secrecy fuels conspiracy theories • The difference between “disability” and “capacity” is crucial, but many people do not seem to understand it – including many in parliament

  6. What has happened since? Two months is a long time in politics... As an historian I disapprove. • The contract with Atos Healthcare has been heavily criticised by the Audit Commission • Chris Grayling and Maria Miller, the Under Secs, have moved on. • The BMA has formally voted to oppose the WCA and wants it scrapped (although there may be other issues at play here!) • Reports in the press continue about people dying after being found fit for work (see www.iainduncansmith.com) • New mental health descriptors are being trialled after major criticism of the old ones • The Paralympics has raised questions about reforms to DLA, an extra-costs disability benefit which will have a WCA-style assessment • Malcolm Harrington, the well-respected independent reviewer, has been replaced for the Year 4 and Year 5 reviews.

  7. What have I learnt? • Details are important – ask DWP... • Most thirty-word sentences can probably be written in ten... • Policy makers and policy informers value history as an evidence base – they just don’t get much time/space to use it • Parliamentary resources are an information gold mine

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