The UK’s War Against Disabled People Part 3: Architects of Misery
How the Tories and New Labour turned the welfare state against society’s most vulnerable
Read Part 1: ‘Scroungers’ and Part 2: ‘Workfare’ to Austerity
It might seem odd at first that two parties with seemingly opposing political positions, from the left and right of the political spectrum, would pursue such similar approaches to the welfare state with such similar, almost identical goals.
However, the through-line is the constant influence of the those working to shape government policies to the benefit of the private sector. Central to this are just two or three figures.
Unum’s Trojan Horse
In 1992 the John Major government had already expressed it’s concern over an alleged crisis in the number of people claiming Invalidity Benefit (later Incapacity Benefit and then Employment and Support Allowance).
Although the ideological framing of this ‘crisis’ as a culture of ‘something for nothing’ was entirely of the Conservative government’s own making (and in line with their broader right-wing neoliberal ideology, a continuation of Thatcherism), the design and implementation of the solution would be that of the American private insurance firm Unum and their Vice President, Dr John LoCascio, with the help of a physician and civil servant, also linked to Unum, Dr Mansel Aylward.
LoCascio was hired by Secretary of State for Social Security, Peter Lilley, in 1994 to advise the government on how to achieve it’s goals of reducing claimant numbers. Shortly after, the government introduced the Social Security Act (1994) which led to the replacement of Invalidity Benefit with Incapacity Benefit and the introduction of the ‘All Work Test’.
The test was devised by the government’s medical evaluation group, of which LoCascio and Aylward were both members (and would form the basis for it’s successors, the Personal Capability Test and Work Capability Assessment). The test would be administered by doctors trained in Unum’s ‘claims management’ approach, which it had used to deny claims for employment protection insurance in the US.
In 1995 John LoCascio, along with Mansel Aylward, would write a paper calling for an end to GP’s involvement in providing eligibility for disability benefit claims and arguing for the introduction of Disability Medical Analysts — a proposal which chimed perfectly with the government’s suggestion that GP’s were partly to blame for the number of people being able to access benefit (a claim which the government’s own research had contradicted).
That same year the government approved the decision to outsource the provision of disability benefit assessments. By 1998 private firm SEMA had taken over full responsibility for assessments. SEMA would later become the now-infamous private disability assessment firm ATOS.
Unum’s motive for influencing ‘welfare reforms’ that led to claims being denied was clear: they provided income protection insurance, and the erosion of state benefits for those with a disability could have an influence on people taking up such insurance. Their intent was made plain in a 1997 advert launched around the time that the new All Work Test, influenced by their men on the inside, LoCascio and Aylward, was introduced:
“April 13, unlucky for some. Because tomorrow the new rules on state incapacity benefit announced in the 1993 autumn budget come into effect. Which means that if you fall ill and have to rely on state incapacity benefit, you could be in serious trouble.”
- Jonathan Rutherford, New Labour, the Market State and the End of Welfare
When John LoCascio was asked about the conflict between his role as both Unum Provident’s Vice President and a government adviser on ‘welfare reforms’ he replied that he wasn’t worried. The Chairman of Unum Provident at the time, Ward E. Graffam, noted in a Private Eye article that:
“The impending changes to the State ill-health benefits system will create unique sales opportunities across the entire disability market and we will be launching a concerted effort to harness the potential in these.”
- Jonathan Rutherford, New Labour, the Market State and the End of Welfare
Though Aylward’s connections to Unum (and his wife’s involvement with the private insurance industry) were also raised at the time, the government denied any conflict of interest.
Both Aylward and LoCascio would continue to be at the heart of ongoing ‘welfare reforms’; between 1996 and 2006 Aylward would serve as the Chief Medical Officer of the Department for Social Security (DSS), which later became the Department for Work and Pensions (DWP) in 2001. Aylward’s influence as CMO at the DWP would span both the Conservative (1992–1997) and New Labour (1997–2010) governments, as would John LoCascio’s role as adviser and later lobbyist.
(Ma)lingering influence
In 2001 LoCascio and Aylward would attend a conference on the topic of ‘Malingering and Illness Deception’. Also at the conference were members of the insurance industry and experts and academics with links to Unum, as well as New Labour’s Malcolm Wicks, the Parliamentary Under Secretary of State for Work at the time. This conference would provide the ideological basis for New Labour’s introduction of ‘workfare’.
In the same year, Unum founded the ‘New Beginnings’ lobbying group in partnership with several charities and private organisations, including the Shaw Trust, Disability Alliance, Disability Rights Commission and banking giants Barclays and HSBC. In a memorandum submitted to a Select Committee on Work and Pensions, the group stated that:
“[T]here are two key developments needed to achieve successful return to work for people who become disabled. The first is to set the expectation of a return to work. The second is a requirement for a flexible welfare system that supports the disabled person in work, both financially, and through access to training and support…”
- New Beginnings Advisory Group memorandum
Having secured their influence in the third sector with the ‘New Beginnings’ group, Unum would then cement their academic credentials, which would become crucial to their continued influence on Britain’s ‘welfare reforms’; In 2004, while still CMO at the DWP, Mansel Aylward would become the first chair of the Centre for Psychosocial Research in Cardiff University, which was established and funded by Unum.
Again, questions would be raised about Aylward’s association with Unum, which in 2002 had been investigated and later found guilty of fraud in relation to it’s claims denial practices in the state of California, but nothing would come of it.
“There would seem to be prima facie evidence that during his time at the DWP, Aylward was a veritable Trojan horse into the DWP for both the Wessely School and Unum. There would also appear to have been a clear financial conflict of interest… It is also a matter of concern that a senior Civil Servant accepted sponsorship from a company with Unum’s track record”
- Statement from Professor Malcom Hooper given to the Gibson Parliamentary Inquiry in 2005
In 2005 Aylward and his colleague at Cardiff University, Gordon Waddell, (whose work, along with that of Professor Simon Wesseley of the ‘Wesseley School’ mentioned above, had informed Unum’s ‘claims management’ approach to denying insurance payouts), authored the DWP-funded report ‘The Scientific & Conceptual Basis of Incapacity Benefits’. This report would outline Aylward and Waddell’s ‘biopsychosocial model’ and provide the apparent evidential basis for ‘workfare’.
A year prior Waddell and another colleague at Cardiff, Kim Burton, would publish another DWP-funded report: ‘Is Work Good for Your Health and Well-being?’ which would form, along with their other work, the basis for Tony Blair’s assertion that “work is good for you”.
Unum weren’t exactly coy about their influence on UK ‘welfare reforms’. Though it was later denied by Unum’s Chief Executive Jack McGarry at a Conservative Party conference in 2011, Unum bragged about their government influence in a 2005 document written by Unum’s Chief Medical Officer Michael O’Donnell — who would later become the CMO of assessment contractor ATOS.
Though the work of Aylward, Waddell, Burton and others at the Centre for Psychosocial Research would be presented as the cornerstone of New Labour’s evidence-based welfare reforms, the reality was somewhat the reverse.
Policy-based evidence
Aylward and Waddell’s ‘biopsychosocial’ (BPS) model was based on Waddell’s own reinterpretation of psychiatrist George L. Engel’s biospychosocial model, widely used by Unum and the insurance industry to deny insurance claims with accusations of ‘malingering’.
Engel aimed at linking the biological, psychological and social environment in understanding a patient’s subjective experience of illness beyond purely biomedical conceptions.
Waddell’s and Aylward’s reinterpretation, however, was much more focused on the individual than the actual experience of disability or disease. They portray what they broadly term ‘common health problems’ as psychological or behaviour issues, and the ‘decision’ not to work, as a choice:
“For most people with common health problems, decisions about being (un)fit for working, taking sickness absence or claiming benefits are conscious and rational decisions, free choices with full awareness and intent, for which they must take responsibility.”
- Waddel & Aylward (2010) Models of Sickness and Disability Applied to Common Health Problems
In doing so they disregard the wider social-structural factors and the diagnosis and prognosis of claimants, especially in terms of ailments with no specific physiological source (such as conditions like ME, fibromyalgia, chronic pain, and mental illness).
Their presentation of the BPS model has been heavily criticised in terms of skewing evidence and misrepresenting the work of others, as well as being overly self-referential in terms of Waddell’s previous work (and that of Simon Wesseley) previously used by the now-discredited Unum and others. Ultimately the BPS model is more a case of producing ‘policy-based evidence’, rather than evidence-based policy:
“Given the uses to which the Waddell-Aylward BPS has been in recent UK welfare reform, it seems apt to suggest that this distinction maps closely into the historical social policy division between the deserving and the undeserving poor.”
- Shakespeare et al (2017) Blaming the victim, all over again: Waddell and Aylwards biopsychosocial (BPS) model of disability
The broader assumptions, and thus conclusions of the BPS model are that many people are faking or exaggerating the extent of their illness, in order to shirk work or obtain state benefits — identical to the government’s ideological narrative justifying ‘welfare reforms’. Nonetheless, Aylward and Waddell’s BPS model would continue to influence ‘reforms’ as the justification for Incapacity Benefit’s successors, Employment and Support Allowance and Universal Credit.
Private work(fare)
Having already outsourced the assessment process to the private sector – the policy designed to reduce the ‘inflow’ of benefit claimants – New Labour would then outsource the training and employment schemes designed to increase the ‘outflow’ of claimants (those ‘motivated’ back to work via sanctions and conditionality). The argument for this was made by David Freud, an investment banker with, by his own admission, no prior knowledge of healthcare or disability.
Freud was hired by New Labour’s Secretary of State for Social Security, John Hutton, to produce the report ‘Reducing dependency, Increasing opportunity: options for the future of welfare to work’. In the 2007 report Freud references Waddell and Aylward’s questionable BPS model (as well as the work of Waddell and Burton) and made the case for outsourcing employment services to the private industry.
Freud wasn’t shy about the potential profits for private firms: “I have no doubt that this will be an annual multi- billion pound market”; nor is Freud unclear on the goals of ‘reforms’:
“The fiscal prize is considerable. Achievement of the 80% employment aspiration would boost GDP, reduce benefit spending and increase Exchequer revenues to a material extent.”
- Reducing dependency, Increasing Opportunity: Options for the Future of Welfare to Work
Unconvinced that New Labour would implement the ‘reforms’ he outlined in ‘Reducing Dependency’, Freud joined the Conservative party in 2009. When the Conservative-Liberal Democrat government came to power in 2010 Freud was appointed Under Secretary of State for Welfare Reform at the DWP, during which time he would become the architect of Universal Credit legislated for in Welfare Reform Act (2012).
After the Conservatives took sole control of the government in 2015, Freud was appointed Minister for State at the DWP, where he would further influence the conditionality and brutal sanctions regime at the heart of the Universal Credit roll-out, bolstered by the prior work of Aylward, LoCascio, Waddell and Wesseley.
In plain sight
Overall the private sector, both insurance firms and employment agency contractors, would be among the winners in the course of the UK’s neoliberal ‘welfare reforms’. The suffering of disabled people which was the result of these changes had been commodified for private profit.
However, while Unum brought about these changes, it is the disability assessment firms, ATOS, and later Maximus. These companies are at the forefront of profiting directly from misery through their appalling implementation of assessments and their treatment of disabled claimants like ‘lumps of meat’, which will be the focus of the 4th and final part of this series.
This series has largely been made possible by the Deaths by Welfare Project and the timeline put together by some amazing folks over at Healing Justice London, Litany for Survival and Disability News Service, which I have used as a jumping off point for much of my research into this issue. A huge thank you for all your hard work.