The influence of the private insurance industry on the UK welfare reforms

Much has been written about the Work Capability Assessment, including the fact that it was deemed as being fatally flawed by the Work and Pensions Select Committee : ‘The flaws in the Employment and Support Allowance system are so grave that simply “rebranding” the assessment used to determine eligibility for Employment and Support Allowance the Work Capability Assessment by appointing a new contractor will not solve the problems, says the Work and Pensions Committee in a report published in July 2014.’

The Work Capability Assessment was introduced by the New Labour government in 2008 and was exclusively conducted by Atos Healthcare until March 2015. The assessment is mandatory for recipients of Incapacity Benefit being migrated to the Employment and Support Allowance and for all new ESA applicants. Following much controversy, Atos Healthcare announced that they would withdraw early from the Department for Work and Pensions contract to conduct the Work Capability Assessment,

The plan to ‘dismantle the welfare state’ was first suggested by the 1982 Thatcher government⁴ and has been relentlessly pursued by successive United Kingdom (UK) governments. Hence, in the Coalition government’s response to the select committee’s evidence,⁵ the Minister for Disabled People, Mark Harper MP, disregarded the very detailed information provided by the Work and Pensions Select Committee report that clearly listed the many serious problems still faced by those who must endure the Work Capability Assessment, to access the ESA benefit.

Government resistance to funding long-term out of work illness/disability benefits followed the 2005 publication of the monograph: The Scientific and Conceptual Basis of Incapacity Benefits by Gordon Waddell and Mansel Aylward⁶, followed by the 2006 report: Is work good for your health and well-being by Gordon Waddell and Kim Burton.⁷

What is constantly overlooked is that both these influential reports were commissioned by the DWP. They were both produced when Aylward and Waddell were funded by Unum Provident Insurance at the Unum Provident Centre for Psychosocial and Disability Research at Cardiff University, with funding by the American corporate insurance giant, Unum Provident, from 2003-2009. Aylward is listed as the DWP Chief Medical Adviser until April 2005⁸ and is identified as being appointed as the new Director of the Centre from 2004.⁹

The influence of Unum Provident Insurance is demonstrated in the memorandums provided for past WPSC reports¹⁰ that clearly list the transformation of Incapacity Benefit to Employment and Support Allowance. The requirement to ‘resist diagnosis’, ‘revise the ‘sick note’, ‘encourage the Government to focus on ability and not disability’, ‘change the name of Incapacity Benefit’ and ‘benefits not to be given on the basis of a certain disability or illness but on capacity assessments’ have all come to pass as Unum Provident Insurance have influenced UK Government welfare policy since 1994.¹¹

“At UnumProvident we have a non-medical, enabling model of rehabilitation and we are working with our partners at the UnumProvident Centre for Psychosocial and Disability Research at Cardiff University to better understand what places people at risk of long-term or chronic illness. Further information about this model can be made available to the committee”. (item 24) Supplementary memorandum submitted by UnumProvident⁹

The Scientific and Conceptual Basis of Incapacity Benefits  was, essentially, the blue print for the future introduction of the Work Capability Assessment, using a discredited bio-psychosocial model of assessment as planned following the New Labour conference in November 2001: Malingering and Illness Deception,¹² with Aylward as a contributor and ‘malingering’ very firmly planted as being the motivation for claimants of disability benefits. Guilty until proven innocent was the mind-set that continues to this day. ‘And the methodology used by Waddell and Aylward is the same one that informs the work of UnumProvident.’

The 2001 New Labour conference¹², together with the 2005⁶ and 2006⁷ reports commissioned by the DWP, led to the 2006 Green Paper: A New Deal for Welfare: empowering people to work – an independent assessment of the arguments for the proposed Incapacity Benefit reform.¹³  The Scientific and Conceptual Basis of Incapacity Benefits was the main reference used to justify future drastic welfare reforms, which was exposed by Emeritus Professor Alison Ravetz as being seriously flawed.¹⁴  On closer examination, it appears that this entire body of work  is largely self-referential – that is, it appeals for validation to itself and is framed within the same political and policy agenda… It is not research undertaken in the spirit of open enquiry. It is commissioned research and, as such, pre-disposed towards ideologically determined outcomes.

Not to be confused with a medical assessment, the Work Capability Assessment is described as a ‘functional assessment’¹⁵ using an IT tick-box questionnaire and totally disregarding diagnosis.

The influential 2007 report by the unelected David Freud,¹⁶ promoted the use of the private sector in welfare reforms when adviser to the New Labour Party and before being appointed as the Minister for Welfare Reforms in 2010 by the Coalition government. Subsequently, the Work Capability Assessment was sub-contracted to Atos Healthcare in 2008 and according to the General Medical Council, Atos Healthcare ‘have total immunity from all medical regulation.’^17,18

The Work Capability Assessment uses a manipulated biopsychosocial  model of assessment, designed in consultation with Unum Provident Insurance^17,18,19,20 and is a replica of the discredited healthcare insurance assessment model historically used by Unum Provident Insurance to resist funding insurance claims.²¹ The LiMA IT programme used for the Work Capability Assessment was designed by Atos Origin IT Ltd, the parent company of Atos Healthcare, for exclusive use for DWP assessments.²²

The original 1977 biopsychosocial model of assessment was attributed to psychiatrist George Engel.²³ Engel’s biopsychosocial hypothesis was to consider the social and psychological factors, together with the biological factors impacting on illness. It was an unproven theory that needed research. Ten years ago Professor Christopher Butler and colleagues produced a paper demonstrating that the bio-psychosocial model of assessment was ‘found wanting’ and inadequate. ‘Medically unexplained symptoms: the biopsychosocial model found wanting’²⁴ was referring to the original Engel biopsychosocial hypothesis.

Yet, a manipulated version of the Engel biopsychosocial assessment model, emphasising the possible psychological factors of disability and disregarding the biomedical factors, is used by Unum Provident Insurance and by the DWP as a method of removing as many chronically sick and disabled people as possible from funding, or preventing access to it.^{17,18,19,20,21}

Unum Provident Insurance were fined $31.7 million in 2003 in a class action law suit in California for running ‘disability denial factories’¹⁸ and $15 million in 2005 by the California Department of Insurance Commissioner, John Garamendi, who stated that ‘Unum Provident is an outlaw company. It is a company that has operated in an illegal fashion for years…^’25,26

By 2006 the State insurance commissioners of 48 American States approved a settlement in an investigation of the Unum Provident Corporation that required the healthcare insurance giant to reconsider 200,000 claims and to pay $15million in fines²⁷ whilst not forgetting, at the same time as these fines in America for malpractice, the company were funding Aylward and Waddell at the Centre at Cardiff University.

Unum Provident Insurance changed its name to Unum Insurance in 2007 to distance itself from increasing negative publicity for identified malpractice. Yet, the only opinions considered by the DWP regarding the benefits of work and the assessment model used to assess disability benefit claimants are those of Aylward and Waddell, whose research was sponsored until 2009 by Unum (Provident) Insurance; identified by the American Association of Justice in 2008 as the second most discredited insurance company in America.²⁸

In January 2007 Professor John Langbein of the Yale School of Law produced a paper identifying the ‘The Unum Provident Scandal’²⁹ that exposed Unum’s practice of disability denial, and in November 2007 BBC News reported that the British government were being advised by an American insurance company with a reputation for ‘racketeering’.³⁰

Employees interviewed on the Dateline program disclosed that the claims that were “the most vulnerable” to pressures for bad faith termination were those involving “so-called subjective illnesses, illnesses that don’t show up on x_–rays or MRIs, like mental illness, chronic pain, migraines, or even Parkinson’s.”

The Dateline story pointed to an internal company email cautioning a group of claims staff that they had one week remaining to “close,” that is, deny, eighteen more claims in order to meet desired targets.

Concerns have been expressed in a government inquiry regarding Aylward’s long association with Unum (Provident) Insurance, including links with the American corporate insurance giant when Chief Medical Adviser at the DWP from 1996 – 2005. To date there has been no formal investigation following the evidence by Professor Malcolm Hooper to the 2005 Gibson Parliamentary Inquiry.^31:

‘There would also appear to have been a clear financial conflict of interest and possible breach of Civil Service protocol, in that a senior Civil Servant such as Aylward could not have been unaware while he was in post at the DWP that Unum Provident was already financing his next employment, which would allow him to indulge in his existing conviction that syndromes such as ME/CFS are affected by ‘cultural’ factors and are ‘behavioural’ in nature. It is also a matter of concern that a senior Civil Servant accepted sponsorship from a company with Unum’s track record.’

After various freedom of information requests, the DWP published the mortality figures of the claimants who had died in 11 months in 2011 whilst claiming Employment and Support Allowance,³² with 10,600 people dying in total and 1300 people dying after being removed from the guaranteed monthly benefit, placed into the work related activity group regardless of diagnosis, forced to prepare for work and then died trying. Following the public outrage once the figures were published, the DWP have consistently refused to publish updated death totals.

Unum (Provident) Insurance exposed their significant influence in the memorandum following the publication of the Welfare Reform Green Paper. Their influence has also been exposed since 2011 by the Disability News Service,³³ with reports by the British Medical Association³⁴ and the Royal College of Nursing ³⁵ that confirmed that the Work Capability Assessment was causing ‘preventable harm’ as chronically sick and disabled people now starve to death in the UK.³⁶

Constant toxic rhetoric by the Secretary of State and various DWP Ministers from the Coalition government, supported by the national press quoting their often extreme comments, have successfully convinced the British public that vast numbers of chronically sick and disabled people are ‘shirkers and scroungers’ and disability hate crimes are the highest ever recorded, as identified in a 2014 bulletin by the Home Office:  ‘Hate Crimes, England and Wales, 2013/14’ ³⁷

CONCLUSION

Fifteen years ago Unum Provident Insurance was exposed in Parliament in the 1999 Permanent Health Insurance debate,³⁸ where MPs identified the suffering of constituents as Unum Provident Insurance refused to pay out on income protection insurance policies. Given this company’s proven record of sustained misconduct and recorded malpractice over many years, one must surely enquire as to why this company have been advisers to the UK government on welfare reforms for the last 20 years.

The constant reference to ‘disabled people’ by DWP Ministers, whilst disregarding those with catastrophic illnesses, adds to the ongoing human suffering of the most vulnerable people in the UK. They are far too ill to consider working³⁹ but they now live in fear of claiming the income related benefit needed for their very survival, as the Coalition government consider all Employment and Support Allowance applicants as potential malingerers, thanks to Professor Aylward’s influence, regardless of what can be a devastating diagnosis.⁴⁰

REFERENCES:

1. W&P 2014: ESA needs fundamental redesign, says MPs: July 2014 DWP Work & Pensions Select Committee  23^rd July 2014: News release
2. CROSS M: 2013: demonized, impoverished and now forced into isolation: the fate of disabled people under austerity. Disability and Society Journal DOI:10.1080/09687599.2013.808087
3. W&P 2014: Work and Pensions Committee – First Report: The ESA and WCA Full report.
4. The Guardian: 28^th Dec 2012: Margaret Thatcher’s role in plan to dismantle welfare state revealed 
5. DWP 2014: November, p4: Government Response to the House of Commons Work & Pensions Select Committee’s Report on Employment & Support Allowance & the Work Capability Assessment, First Report of session 2014-15 
6. The Scientific & Conceptual Basis of  Incapacity Benefits. Gordon Waddell & Mansel Aylward 2005  ISBN: 9780117035843
7. Waddell & Burton 2006: Is work good for your health and well-being? Gordon Waddell & A Kim Burton
8. Institute of Primary Care & Public Health –  Professor Mansel Aylward
9. Supplementary memorandum submitted by Unum Provident following the publication of the Welfare Reform Green Paper 2006
10. Memorandum submitted by UnumProvident (EDP 03)
11. Private Eye: In the back: Welfare reform – mutual benefits Issue 1302 – 11^th November 2011
12. Rutherford J 2007: New Labour, the Market State and the End of Welfare Soundings Journal: 2007:  Issue 36   summer 2007
13. DWP:2006: A new deal for welfare: Empowering people to work
14. Ravetz A: 2006: March: Green Paper: A New Deal for Welfare Centre for Disability Studies, Leeds University
15. Litchfield P: 2013, p7: An independent review of the WCA, year 4, 2013
16. Freud D: 2007, p5: Reducing dependency, increasing opportunity: options for the future of welfare to work. An independent report for the DWP by David Freud. May 2007 page 5. ISBN: 978 1 847 12 193 6
17. Stewart M: 2011: Welfare Reform – Redress for the disabled 
18. Stewart M: 2010: Atos Healthcare or Disability Denial Factories 
19. Jolly D: 2012: A Tale of Two Models: Disabled people vs Unum, Atos, Government and disability charities
20. Stewart M: 2012: Government use the might of American insurance giant to destroy UK         safety   net.     
21. Bach M: 2011: UNUM and Business: how Unum have influenced UK Government policy to the detriment of disabled people.
22. Bach M: 2013: LiMA tick box assessment 
23. Engel G:1977: The need for a new model: a challenge for biomedicine. Dr George Engel  Science Journal; 8^th  April 1977, Volume 196 number 4286 p 129-136
24. Butler C, Evans M, Greaves D, Simpson S 2004: Medically unexplained symptoms: the biopsychosocial model found wanting.  The Journal of the Royal Society of Medicine:: JRSM 2004, 97:219-222 
25. Unum Complaints: “ An Outlaw Company” – Online Lawyer Source 
26. LA Times: 2005: State fines insurer, orders reforms of disability cases.
27.  State Insurance Commissioners reach settlement with Unum Provident:  Insure.com
28. The ten worst insurance companies in America. The American Association  of  Justice 2008
29. Langbein J: 2007: p1318 The Unum Provident Scandal – The Yale Law School 
30.  Government advised by ‘racketeers’ BBC News 6^th   Nov 2007
31. Hooper M: 2005: Concerns about a commercial conflict of interest underlying the DWP handbook entry on ME  and CFS The Gibson Parliamentary Inquiry – Dec 2005
32. DWP: July 2012: Incapacity  Benefits: Deaths of  recipients 
33. Disability News Service: Feb 2013: Unum bragged about ‘driving government thinking’ on incapacity benefit reform. 
34. BMA: 2012: Scrap WCA doctors demand at the annual representative meeting. The British Medical Association
35.  The Royal College of Nurses Congress: Disability assessments, The  Royal  College of       Nursing Congress April 2013
36. The Guardian: Vulnerable man starved to death after benefits were cut 
37. Hate Crimes, England and Wales, 2013/14 p9 – Home Office Statistical Bulletin
38.  Permanent Health Insurance debate; House of Commons, Westminster Hall, 21^st December 1999. 
39. Mental Welfare Commission for Scotland: Who benefits? The benefits assessment and death of Mrs DE. Investigative report.
40. Stewart M 2014: UK Government refuse to accept responsibility for crimes against humanity.

This was first published on Researchgate