The government’s proposal to use independent medical professionals to decide who does and doesn’t get the new DLA is the best solution.

Position statement:  The government’s proposal to use independent medical professionals to decide who does and doesn’t get the new DLA is the best solution. (just one sided, a summary of key points)

The inevitable, inescapable future is that Disability Living Allowance (DLA) is going to be replaced with a new benefit called Personal Independence Payment (PIP) (DWP 2012d). One of the big changes will be in the application process. No longer will disabled people have to fill in a 60-page tome about every depressing aspect of their existence, but according to the government anyway, be free to have a 'chat' with an independent assessor to determine eligibility (DWP 2012b, Great Britain, Work and Pensions Committee 2012c). Sounds great right? No, it isn't. The government might have dressed it up to look good, but the reality of this idea, and the fear that people have is deeply entrenched thanks to the Work Capability Assessment, the new medicals for the new incapacity benefit. According to Gentleman (2011b) even the mere mention of the provider ATOS, “triggers… a sense of "fear and loathing". Although the government says they are 'learning' from the mistakes of this, they still intend to use this model in the new benefit delivery (Hc Deb 2012).  That would be the medicals that even the designer and creator have condemned (Gentleman 2011a). So, what are the problems?

Firstly, the problem is that the governments definition of independence seems to have found from a dictionary that none of the British public are privy to (DWP 2012d). True independence can only be found when a person is doing something without influence from another person (Abberley 2004: see below). This is not the case with the government’s proposals. As with the previous incarnation of the new style medical that was outsourced to a private provider, it has just been announced that this will be the case for PIP (DWP 2012c) . It is in this monetary transaction that independence is traded in for profit. The company’s clients are the government, their contract is with them, and it is in their best interests to comply with their client’s orders. As it is the stated aims of the government’s new PIP to reduce the caseload and expenditure (DWP 2012b), that is what will also be the companies’ aims, and the statistics will reflect this. (As has happened with the new sickness benefits (Gentleman 2011b)

By implication, the government’s proposal casts doubt on the independence of the current system. In fact, they have even alluded to this themselves (Scope 2011,  Great Britain, Work and Pensions Committee 2012c). Apart from the detailed, 60 page form that claimants have to fill in, there is also room for a 'statement from someone who knows you best', (something the government is getting rid of in the new process (Campbell et al. 2012) and the opportunity for a person to nominate a medical professional to present evidence. In fact, by obtaining evidence from all these sources reduces the risk of a bad decision being made, and increases the independence and equality in the process (Campbell et al. 2012). There is even provision for another medical assessment to be made in house by the DWP if the decision maker doesn't feel able to make a decision based on the evidence they have  (Great Britain, Work andPensions Committee 2012c). I would argue that the current application process is more independent that what is being proposed, and that if the governments aim was that of true independence then they should simply expand their in house medical services, but keep the ethos of the current benefit, where the claimants needs and voice are placed firmly in the centre (Great Britain, Workand Pensions Committee 2012b).

The second thing that is at risk with the proposed changes to Disability Living Allowance is autonomy and authenticity. Although the current system cannot be classed as wholly autonomous or even authentic, what it does do is directly involve disabled people and values their voice in making a decision about eligibility (Great Britain, Work and Pensions Committee 2012b). The phrase “nothing about us without us”  (McGettrick 1994) has become one of the key principals of the disability movement and it is increasingly being adopted by different areas in society including the application process for DLA (Great Britain, Workand Pensions Committee 2012b). The current ideology around this is that the claimant and their own medical professionals are the most authentic agents to provide a true picture of how their disability affects them (Great Britain,Work and Pensions Committee 2012b). Contrary to popular opinion as seen with headlines such as “Disabled benefit? Just fill in a form” (Walker 2011), the application process is complex and uses many different pieces of evidence to support a claim (DWP no date). The focus isn’t medicalised, but on the effect of impairment on a person’s life (Scope 2011). The medical professionals current role is to simply verify the authenticity of the impairment and to provide any additional supporting evidence (DWP no date). According to the government a “major objective of DLA was to introduce self-assessment, to enable disabled people to describe the impacts of their disabilities rather than be subject to routine medical assessments” (Great Britain, Work and Pensions Committee (2012b) this results in the claimant having the autonomy to define their own experience within the confines of the other evidence gathered. The result is that the system is effective with only a 0.5% rate of fraud (Campbell et al. 2012, DWP 2012a). The proposals to take away the claimants autonomy in the process will result in a shift of power to the medical professionals (Great Britain, Work and Pensions Committee 2012b).

It is this shift in the power balance that is the third fatal flaw of this proposal that needs highlighting.  This was another concern raised in the responsible reform report (Campbell et al. 2012). For disabled people, the ability to be in control and have some power over their lives is key to their independence (Swain, French and Cameron 2003: see below). This concept of self-determination is another key principal in the disability movement (Campbell and Oliver 1996: see below). It is another thing, which is under threat by the government’s proposal to give decision-making power to ‘independent’ doctors (DWP 2012d). The government has justified this distinct shift in power away from the claimant with fairness in mind (Gentleman 2011c). However, according to Campbell (2012, p21) “the new system appears to give equal if not more weight to the opinion of medical or independent professionals and none at all to the people around the disabled person.” This will result is an unbalanced and rigid system of medical professionals unable to cope with the complexities of a disabled persons experience, whose sole responsibility is to determine eligibility. By reducing the ‘gatekeepers’ to the benefit to just independent medical professionals increases their power, responsibility and control exponentially (Abberley 2004: see below). This will increase the risk of mistakes and poor decision-making. According to the responsible reform report (Campbellet al. 2012) the fear is that this proposal is too similar to the current sickness benefit system that has been widely acknowledged as failing (40% appeal success rate is evidence of this (Gentleman 2011b). Important decisions need to be made with as many stakeholders as possible. This reduces power to one agency and spreads it more evenly (Abberley 2004: see below). This results in the claimant having some degree of control over their own experiences.

Ultimately, the decision to use independent medical professionals to determine who does and doesn’t receive disability benefits is fatally flawed, and is widely feared (Gentleman 20011c, Campbell etal. 2012). With the governments publicly declared aim to reduce the caseload by 20% (DWP 2011e) when the fraud rate is at 0.5% (DWP 2012a), 500,000 disabled people will be taken off a benefit to which they were previously entitled (Grey-Thomspon 2012). To use independent medical professionals will unfairly target people with certain impairments who find it difficult to define, easily shape and share their experiences (Campbell et al. 2012). It will be a shift away from a benefit with disabled people at the centre of the decision making process and will result in a loss of power, control and ultimately a persons ability to live.

 

Abberley, Paul, 2004. A critique of professional support and intervention. In Swain, John et al, Disabling barriers- enabling environments. London, Sage Publications Ltd. (239-244)

 

Campbell, Jane and Oliver, Mike (1996). Disability politics, Understanding our past, changing our future. 

Swain, John French, Sally and Cameron, Colin (2003). Controversial issues in a Disabling society. Open university press, Buckingham.  (76-86)