Disability and The UK General Election

Disability Think Publications Series for #ukdisability2015
Disability Think Publications Series for #ukdisability2015

1 million welfare supported voters undiscovered

Disability and the UK General Election 2015. 1 million?

A consolidated data view of the social security counts of welfare supported claimants.  Many welfare supported claimants between 60 and 64 are difficult to reach.  Those claimants are entitled to claim pre-retirement benefits which are not classified as unemployment.  A significant number have a disability.  How will they be reached in the UK 2015 General Election?

Find out more about these potential 1m voters.  Read here https://www.scribd.com/doc/254303655/Analysis-of-the-60-64-year-group-of-welfare-supported-voters

The working age and pension age claimant group 60 – 64 years includes incapacity, widow, income support, housing benefit, disability, council tax, carers and unemployment benefits.

Learning from the 2010 General Election: Seats won by lowest % turnout

The 2015 General Election and knowledge of the last election help us to make informed decisions and examine the information presented as facts.

#ukdisability2015

Analysis of UK parliamentary seats won in the 2010 General Election ordered by % turnout.  The number of ODI forecasted disabled voters, total voters registered and the DWP published welfare spending by parliamentary seat are provided.

The number of disabled people in each parliamentary constituency can affect the elected outcome of the seat.

The PDF version of the 2010 General Election votes cast by %turnout can be found herehttps://www.scribd.com/doc/254209530/Learning-from-Disability-and-Votes-cast-in-2010

The UK General Election 2015: Disability Toolkit

10 million disabled persons have a vote in the May 2015 General Election. Click HERE to download Election Disability Toolkit.

The countries of Scotland, Wales and Northern Ireland need federal reform to prevent indefinite governance by a minority English party.  There needs a concept of equity on national reserved matters and England be afforded it’s on English Parliament.

With equality enshrined for all protected minorities and all power devolved locally, politicians can be held accountable for upholding basic human rights and public services in the regions across the UK.

RT #UKdisability2015 Disability Toolkit


Political Context Of Disability: No choice

What choice do I have?
What choice do I have?

Political Context Of Disability: No choice with influence

No politician or political party represents any of our political interests as disabled persons.  By the Office of Disability Issues own research, there are 10.2 million statutory disabled adults  living in the UK. That's roughly 1 in 6 people in the UK with some degree of disability arising from a physical and/or mental impairment.  Collectively, the disability community should be a formative body of opinion and influence.  What do we know about the UK disability community?  We know that around 5m people are disabled in their retirement years.  We also know that there are around 5m disabled people are of working age.  We also know that 50% of those of working age are either unable to work or unemployed: this amounts to 2.6 million people or individual life stories.  It also means that we know that atleast 2.5 million disabled people are engaged in paid employment activities.  What isn't readily known is that only around 28,000 working disabled persons receive help from Government funded support known as Access to Work to sustain their employment. Moreover, we also know that the number of disabled persons has increased roughly 100,000 per year.

Some interesting facts that Goverment don't mention about the impact of their policies on disabled persons, unemployed people, low earners, people getting help with housing or rent costs through housing benefit and people in work claiming benefits to help them survive. A lot of these of these life stories are also caught up in the 11m disabled people living in the UK. What if those persons used their votes to influence change. In the 2010 General Election no party won a parliamentary majority. 29,687,604 persons voted in that election. The disability community makes up a substantial and influential voting group. The vast majority of disabled persons are at higher risk of poverty related issues at some point in their life. It's blindness to stand back and let unrepresentative politicians dismantle the contributory or means tested disability welfare support built from the National Insurance Contributions of the last 6 generations. Start to use your influence. Politicians take strategic advantage of an inability to communicate with the disability community as a group or a whole. Politicians target sub sections of the community either via welfare, health, social care or employment policies. The disability community is often disadvantaged by communication because poverty does not facilitate modern communication means such as twitter, internet, communication from disability groups like DPAC or other organised communication groups like 38 degrees. In part, without easy and direct communication, the disability community lacks organised influence. Most influence is reactionary media coverage about positive or negative stereotypes of disability on news stories: hardship cases, benefit fraud or advances in technology. We need to make a start at organising and exercising collaborative and participative action to bring about political influence of mainstream disability.

How about the local elections next: plan your protest. Get out there and vote for change. Manchester, Glasgow, Antrim and Swansea were the lowest turnout constinencies at 2010 election but are amongst some of the highest prevalence of disability, poverty and low wages. Get out there and use your influence as voters to demand change. Click here for the 2010 electoral report by the Electoral Commission. Click here to see the BBC reported analysis of votes cast at the 2010 election. The Conservative Party polled 10,726,614 votes predominantly in the south east of England. The LabourParty polled 8,609,527 votes with a haemorrhage of votes in the south east of England. The are 3m disabled voters living in the South East of England and their vote may decide the next Government. The Liberal Democrat Party polled 6,836,824 votes to take the balance of power. The LibDem Consevative Coalition was formed and the central plank of their social policy was to reform disability related welfare as part of the UK recovery from the 2008 World Economic Crash followed by a series of spending cuts also targeted at reducing services to the most vulnerable. Disability is unique in that it requires resources to maximise equality and improve life chances. The Government are targeting the disability community in a way that research has shown to have caused damage about the perception of the current and historical relationship between disability, work and welfare.

The coalition have used the civil service communications machinery to present a repeated image on the mind of the national conscience about the cost of disability related welfare absent of any supporting fact. The stereotype being reinforced day in and day out is of politicians fighting a militant disabled community not prepared to work.  In protest against this Protestant militant ethic, a host of new welfare policies are required: a reduced employment support, reduced disability help with care and mobility, and a reduction in housing cost support. The concatenation effect, it is hoped, will be for a significant number of the 2.5m economically  unproductive disabled people to find work.  The Coalition has made great effort to focus on the 2.6 million disabled persons claiming an incapacity related benefit.  What they have failed consistently to prove is what this figure represents both now and historically.


This breakdown will not be disclosed to you any day soon because behind it sits a huge generational deception passed down in recent decades from political party to political party.  Put simply, if the purported 2.6 million on incapacity related benefit were all located to employment there would be no disabled persons on employment related benefit.  Both intellectually and sociologically this can never be true.  We know this from science of humanity.


How can we be sure that thus self perpetuating generational myth is correct?  We can study the closely related international impairment rates in Canada, US, Germany, Sweden, Norway, Spain. The UK has more disabled persons, currently, in work than any of our economic competitors.  From examination of 35 years of international impairment data, there is unlikely to be much shift in the 2.5m people currently not in employment.  Historically in the UK, this number increased when the family stopped providing for disabled family members and expected the community to support individuals with a disability; the inception of things like identifying chronically sick and disabled persons; invalidity benefits; incapacity benefits, community based care; disability discrimination protection; all to move responsibility from state to community or person.  As time has gone by over the last 35 years, individuals have taken up socially or community acquired rights for self determination which rightly requires the state to financially sustain that right in terms of access to health care, independent financial survival, access to housing, access to work or access to the community the live in.


The gross effect of the Coalition approach to dealing with the issue of disability in the current financial climate is to reduce the right of disabled people to self determination.  This reduction is felt in health care standards and funding, reduced coverage of disability welfare related benefits, reduced employment protection and reduced funding in social care.  The shortages are faced across disability of all ages whether at school, in work or in old age.


The chilling effect of both the demonising stereotype of disability and cuts in promoting the life chances of all disabled persons is the return to removing disabled persons from the community back to families and institutions which haunted disabled person in the pre or post war periods. 


Any politician who promises a solution needs to set out their stall.  How many people are you prepared to help and what is going to happen to those who don't make on to your list?  You deserve an answer: after all you belong to the largest single influential group of voters these people seek to convince.  Will I or will I not be cared for in your version of the truth? An exact answer or no vote. 

Any person at any time in their life could become temporarily or permanently disabled. It's only then you are faced with questions about the truth and how to deal with all the stereotypes you didn't challenge when you seen them made in your past. Consider any politician making stereotyping images of ethnicity or sex, and ask why is it society is happy to allow politicians to thrive on stereotyping disabled persons. The answer is probably that disability does not have the same organised representation or effective political narrative: legal protection is relatively new and there is a fear of the recent past.


By increasing the voice of disabled persons in political representation, you will be strengthening the ability of future generations to improve the life chances of the next generation.  Vote wisely. Ask questions.  Join disability organisations.  Make change.  

You need to determine which political representative best advocates the disability community but please do get to the truth about what they will deliver to the disability community at the next 2015 election. They are dependant on you not using your influence individually or organised as a community.

"No single person, no body of opinion, no political doctrine, no religious doctrine can claim a monopoly on truth." ~ Nelson Mandela during an address to the International Federation of Newspaper Publishers, Prague, Czech Republic, 26 May 1992

Employment Support Allowance: Accessing Medical Evidence survey

Please clck here to complete our survey on medical evidence submitted with the Employment Support Allowance medical questionnaire ESA50.

Investment not Cuts Will Transform The NHS

Cuts are real, longer waiting times are real and the crisis is real
Cuts are real, longer waiting times are real and the crisis is real

Primary health care in peril

Its not necessary to dispute people have problems with access to GP services - it's all over the news most days. What is rarely reported are the underlying facts or causation. The facts are that the NHS IT plan was stopped half way through because politicians desperate to cut budgets deemed the project to have failed. The fact is the infrastructure which was only half developed so some surgeries records can be accessed out of hours and some can't. Some surgeries can get instantaneous results of tests and some surgeries can't. Some test resuts and medical records held at GP practices can be accessed by local hospitals and vice versa. Some GP practices can not access hospital records and vice versa. Those which integrate work very well and the speed of health care delivery is very much improved. Efficiency savings can no longer be realised and economies of scale have now been prevented. The propaganda has been so powerful against socialised medicine that modernisation programme has all but stalled.

How could it have been in the interests of patient care to have developed only half of an integrated health care system? One explanation is the need to cut budgets due to austerity but the Govermnent strongly refutes this be the case. The other explanation is that increased efficiency of nationalised health care would negate political calls for commercialisation of an inefficient health care system. The facts are counter-intuitive to the political objective and so far the Government propaganda is damaging public confidence in the NHS and GP services in primary care.

We were contacted by a patient who attends 3 different hospitals - all local. This her colloborative account or case study. Because the investment was moved away from NHS infrastructure to reorganisation, only one of those hospitals can communicate with her practice electronically. The hospitals can not share records between them so they all send letters - the cost of which on a national scale is signficantly high (if not the same cost as seeing the patient) - consultant dictates reports after you've seen them adding time to the consultation of each patient they see. This really can't be acceptable in modern health care but there is no investment on the table to drive full integration of services nationally. Investment is being channelled into commercial management practices through centralised procurement and clinical commissioning of service to the lowest bidders for health services. The private sector will win and Nationalised Health will lose. We will all lose because we will have to pay the profits of the new health providers.

Her GP practice was recently told they would get reduced funding if patients were not seen in primary care as opposed to emergency care. They don't have emergency care facilities. There is no funding to develop them. There is no funding for 24 hour GPs services nor are there enough GPs to operate 24 hours GP services at every surgery The only reason government propaganda is targeting GP services is they know that private sector out of hours providers are not capable of delivering the service at the price DoH wants to pay. But, by the government's on mantra on private is cheaper than public; there is no prospect of GPs doing it cheaper.

In this case, she became a patient through no fault of his own over 20 years. She experienced all the Tory 18 months to 3 year waiting lsts of the past and she reports her mother died on the Tory waiting lists. She lives in a deprived community, benefit up take is high and crime is a part of life.

In relation to the GP practice contract, we urge everyone to go and look it up and find out what it says - there was a modest personal increase year on year of a demoralised salary scale. There was a clear expectation on practices that they would offer more services such as cardiac clinics, diabetes clinics, psychotherapy services, minor surgery treatments, patient health education classes, fitness classes, the list goes on. Some practices started patient participation groups (PPGs).

I know all patients will have different experiences but there are clearly a lot of demands on GPs and different practices will throw up different outcomes. Some NHS GP practices are already run by large private medical companies and the feedback on their services does not show any improvement in satisfaction or results - there is concern of cost cutting and inability to access services entitled to under the NHS constitution.

A lot of the demand for quick access to community services such as physiotherapists were the responsibity of primary care trusts not GPs as the tory press indicate. With creation of servce rationing through clinical commission the delivery of health care is confused and the mechanisms have been dismantled. The DofH has the ultimate responsibility for funding local community services which prevent people from needing to visit emergency care. In many patients' experience, since 2010 these community services have disappeared or been sold off to private providers increasing the problem with what should be quick and easy access to services locally referred by GPs.

We have a choice: we fund a full Heath care system with a local service or we take the current political philosophy of cutting funding back to a shoe string service and blame GPs as political scapegoats.

Do we really think leaving it to private shareholders to run will improve your experience of healthcare?

Dont Blame GPs For The Cutting Of Funds In Primary Care

The funding gap designed to open the NHS door to the private health care sector
The funding gap designed to open the NHS door to the private health care sector

Where do the patients views - some 10 million of them get represented. The conservative coalition has no electoral mandate for these wild and foundation less policies. The facts are We can remember the total inequities of the GP contract prior to reform - it was hard to get young doctors to train as GP morale, service investment and payment for their services was so poor it was deemed an unattractive career option in the medical professional. GPs were paid less than other comparative medical professions and level of skill in the hospital setting. Some GP sat on tribunals, in the 80s and 90s, using their GP qualifications to adjudicate disability welfare benefits appeals. Surprisingly, the state valued that simplified adjudication role at double the salary of a GP in busy practice managing and sustaining the health of thousands of patients. In 1990 it was almost impossible to get a routine or emergency GP appointment quickly - there were just not enough GPs.

The GP contract was renegotiated in 2003-2004 with the view of increasing services for demand, to upgrade the level of pay to GPs with the level of comparable skill and care in a hospital settings. The Thatcher and Major governments reduced spending in primary care to a barebones service. Ken Clarke made the case for investments in primary care in 1995 after some 16 years of year on years cuts in real terms to fund ironically reductions in taxation with an emphasis on private health provision.

The labour government were left with a demoralised GP primary care and antiquated hospital services infrastructure starved of investment or reform of patient health outcomes for 19 years.

It was thought that at the time of investment put into General Practice between 2004 and 2007, underwritten with new contracts, this would both deal with the increase in population and a substantial need for more primary care lead community services. There was an infrastructure investment in new practices and facilities in a rigorous redevelopment of the national GP services in the 10 year plan. This resulted in brining annual investment in GP to the average in the EU. Prior to the large scale investment the previous Conservative government had invested so little the N H S was at its knees and one of the lowest spending of GDP of healthcare in the EU.

Moreover, the IT national infrastructure programme was supposed to underpin the additionally managed out of hours service which was privately contracted on the assumption that the technical infrastructure made the unit cost of the out of hours provision reduced substantially through manpower utilisation, access to patients records remotely and private management of the service. The then Government was advised that that the cost of GPs providing the increased demand for out of hours services was wholly unaffordable and should not be contracted to GPs. This was widely accepted by GPs and the treasury.

What happened next?

The conservative Government came to power 5 years through the 10 year plan. They reduce the IT and building infrastructure plans as well primary care resources at a time when already over stretched GPs were providing care for thousands of more patients without any increase in funding. The abolition of the IT infrastructure stopped design and implementation of high quality out of ours service provision coupled with reductions in primary care resources through the high cost of an unnecessary reorganisation. The conservative coalition simply did not understand the NHS and got the policy wrong.

Instead they pursued a privatised marketisation of the NHS so that it was akin to the French and Canadian health care system where the private sector plays a very large part in delivering primary, community and hospital care services.

As a patients in large central London practices, since 2010 our GP practices have been inundated with policy changes directed by department of health marketisation strategy to tender services to what is in effect the cheapest bidder, reduce funding for running of the GP services and practices in the community. This has resulted in longer waiting times for appointments and referrals to charities, community interest companies and private institutions for provide care. A lot of these providers simply don't understand patient care or needs and the level of service satisfaction has dropped accordingly.

The complex payment reward system introduced to pay GP practices is nothing short of service reduction and rationalisation.

The Health secretary has undermined public confidence in the good service of GP practices up and down the country. His propaganda ruminating the same mantra with his bias introducing more competition with the BBC or reducing its public funding by favouring the long term profits strategy of private media enterprises. A cuts agenda is being forced to reduce the size and scope of the NHS by default.

Most disabled persons didnt want nor voted for charities or other less qualified people to manage our care. I expect to be cared for by doctors at a GP practice or a hospital.

Privitisation Of The UK National Health Service (NHS)

Disquiet about the commercialisation of the NHS
Disquiet about the commercialisation of the NHS

The real problem is, though, patients get absolutely no say.

In Scotland, Wales and Northern Ireland the NHS have national delivery organisation and local health boards who co-ordinate the provision of hospital services matched to GP practice needs. Out of hours is managed centrally. There is no requirement for competition. I can see no political appetite for marketised privatisation or competition to purportedly lower costs. In fact our neighbours cherish the nationalised socially provided medicine.

In countries like Germany, France, Canada and the USA the real unit costs of comparable patient treatment numbers can be as much as 2/3 higher. In France, Germany and USA if one was to attempt to believe the Lawnsley/Hunt propaganda then these countries would have a lower unit cost on equivalent patient volumes. They do not. Moreover the Albrecht study shows the UK has much lower impairment rate per population compared with Germay, Sweden, USA and Japan declaring rates of national impairment about 11% of population as opposed to the UK prevalence of 7.8%. So higher unit costs of health care delivery exist in these countries because there is a large element of profit in the provision of services. In the USA the cost of administering the healthcare system is approximately 30% higher than in Europe because its run as a private entity and charging is the primary outcome. In the EU, the UK has the lowest costs of running health care than our comparable partners - in part to the absent of profit raising levies and no requirement for managing Heath insurance claims.

The propaganda that the cost of the NHS administration is an unaffordable luxury is completely deluded. The NHS does not need to charge, process insurance clams nor manage full scale private contracts with private providers. The coalition have set a policy which will in fact increase the cost of administration to charge primary care for private service, deal with public subsidies to private entities to develop new services and as most people are predicting a policy would probably appear from NHS funded private health insurance paid in addition to National Insurance which will require a national complex claim administration service.

We should be worried that the NHS is heading to the high cost model operated in the US. What We find truly remarkable is that the LibDems have facilitated the irreversible policy and destruction of a publicly funded health service free from profits which after all are made on the backs of the sick.

Out Of Hours Access To Primary Care

Primary care is a key defining feature of the NHS
Primary care is a key defining feature of the NHS

There is no doubt that GP services are under pressure. There are issues of modernisation to be addressed. There have been a number of impairment and disability studies that show despite increased patient contact with primary and secondary care, the rate of impairment per UK population remains roughly the same. The ODI figures show that the number of people who perceive themselves as disabled rises 100,000 per year on year to 10.1 million people in 2012. In addition there are 1m disabled children. 50% of the disabled population are over the the age of 65. In 2003, after adjustment for migration, the perceived disabled population was around 8.9 million people. It is immensely difficult to find independent facts on the effect on GP services.

There are some relatively mis-informed opinions on GP services, I checked the DoH, ODI and ONS measurement of patient treatment events in the NHS. If people bother to check you will find that:

1. Notwithstanding areas of extreme depravation, since 1995 the number of patients seen by GPs or GP lead services has increased year on year between 6 - 9 % annually. The vast amount of the higher increases have been seen post the new GP contract in 2004.

2. Since 2002, there have been record numbers of early diagnostic tests in major disease areas such as diabetes, cancer, heart disease lead by a substantial increase in GP lead referrals.

3. Successive governments have made concerted efforts to move the management of care away from hospitals to GP primary care facilities. This emphasis appears to have been made because the cost of community care is perceived to be substantially lower than through secondary care. This has lead since 2002/3 to very large amounts of care being locally based. Although its is not always easy to recognise what these are.

4. Since the 2004 completion of the new GP contract there appears to be very little change in the median GP salary structure. The inflationary costs of employing staff and facilities in community care lead by GPs has been on average 10% higher year on year than the increase in primary budgets. This has required community care to prioritise its health management and patient priorities. Ultimately the facts show the deficit in funding has reduced the potential possible for partnership profits year on year.

5. Since 2010, there have been significant cuts to secondary care provision across the NHS hospital infrastructure against a background of increased cost of medical equipment and facilities; pharmacological development and cost of drugs; increased treatment needs; and the funding in key medical research devices and technologies has reduced in the period. These reductions in funding have increased substantially the referral back to primary care for more funding at a patient level.

6. There is a large expectation in the current and concurrent government spending review that the cost of health care delivery will be reduced above inflationary pressure for the next 6 years.

7. Commercial commissioning of services has been introduced to create a competitive NHS market economy because there is macro theory that opening up services to competition reduces costs. There is NO international comparator whereby such a theory has ever been used. In fact, NHS development in Scotland and Wales although early days suggests the operational cost of the NHS may improve through consolidation and deeper integration of services.


8. Since 2009, emergency care resources have been diverted or reduced year on year resulting in an increase in waiting times and in some parts of the country large scale understaffing. The government response is to attempt to move the cost onto the primary care sector in full knowledge that primary care is also being underfunded. The solution to improving GP and emergency service performance would be consolidation and deeper integration. Examples of this in specific local authorities point to better care.

9. Closing accident and emergency departments since 2009 has resulted in both performance and financial pressures on hospitals which have also seen a reduction in their funding.

10. Lastly, there is a lot of conjecture from disability studies as to why the UK has an overall lower impairment rate per population than France, Germany and the USA. It can be no coincidence that these countries spend up to 30% more on health care. The problem with running the NHS through private entities is we will end up with private medicine treating a further 3% of the population for impairments which don't require treatment but are done so to make private entities more profit. Studies have shown increasing the number people treated by private medical facilities does not show additional improvement in health outcomes.

If we want a 24 hour local GP service we will simply have to pay for it from taxation. It can't be delivered by rubbishing GPs.

Disability prevelance: Statutory-Disabled Prisoners

Prison hospital wing
Prison hospital wing

Disability prevalence: social context of prisoner disability

In 2012, the Cunniffe et al study into prevalence of disability amongst newly sentenced prisoners (sentences of between 6 months and 4 years) estimated that 37% of the prisoner sample was considered to be statutory disabled under the Equality Act 2010.  This figure included:

•18% had anxiety and or depression;

•11% had a physical impairment;

•8% had both a physical and mental impairment;

•Classification of impairments included difficulty seeing or hearing, learning difficulty, epilepsy, cancer, HIV/AIDS, neurological disorder, muscular-skeletal disease, respiratory disease, heart disease,bowel disease and diabetes;

•Female prisoners were considered marginally more likely to be disabled than male prisoners;

•Disabled prisoners (as opposed to non-disabled prisoners) were more likely to report having used drugs, requiring drug treatment; experienced abuse or violence as a child ; being homeless or requiring more help seeking employment or accessing social and welfare services on release.

Implications

The study identified real implications for effective sentencing policy and prisoner rehabilitation policies including a need for prisoner preparation for and access to employment activity after prison.  A wider colloborative understanding of the defintion of employment for disabled ex-offenders would enable higher levels of employment activity amongst the offending community. The findings also raised interesting challenges when compared with disability prevalence in the adult population of the UK as a whole.  The government Office of Disability Issues (ODI) (in 2011) estimated that 11.2 million disabled persons were living in the UK (10m disabled people in England and Wales).  Separate statistical models are used to measure prevalence which includes the:

•Equalities Commission for enforcing disability discrimination legislation;

•Department for Work and Pensions who administer the welfare system; and

•NHS who provide healthcare.   

The main implication of running three separate strategies is the failure to provide targeted, integrated or ‘joined-up’ disability-related public services. Disabled persons are at least five times less likely to work than non-disabled persons.   Substantially higher disability prevalence rates amongst the offender community (postsentence) generates impenetrably higher barriers to accessing employment or training which the courts know helps to reduce offending.  When considering the implications of the Cunniffe at al study, more policy action will be needed to improve specific disabled-prisoner rehabilitation particularly as the ODI assessment of disability prevalence suggests:

•The total disability population for the UK is 11.2 million people which comprises of 5.2m people of working age and 5.2m people of pension age, and 0.8m children.  With advances in health care systems, the aging of the population and increased accuracy of prevalence estimates; the recorded number of disabled people will steadily increase by 100,000 per year.  This will continue to reduce the likelyhood of disabled prisoners accessing employment activity after prison.

•London and South East England has a disabled population of around 3m people (which is greater than the populations of Northern Ireland or Wales) which may indicate a higher concentration of disabled offenders who could be targeted to reduce crime through specific post-sentence employment intervention initiatives.

•The ODI estimate that prevalence of impairment in the population, as a whole, is reported as 14%.  The Cunniffe study predicts that 37% of the prison community have a statutory disability. The ODI suggests that 56-60% of the UK disabled people of working age are currently unemployed as opposed to 7-8% of the rest of the working age population.  Delivering services to get disabled prisoners into employment post-sentence, makes good rehabilitation sense and provides good value to the taxpayer.  This cohort demonstrated that the unemployment history of disabled prisoners indicated 79% had not been in employment prior to sentence.  In 2011, the national cost of employment disability related benefits were £12.5bn out of the DWP welfare budget of £151.60bn (more than 70% spent on the State Pension and Pension credits).  In the same period 2.4m disabled people worked with only 0.2m disabled people working and receiving welfare benefits because of poverty. The indication is that a disabled ex-offender is highly likely to continue receiving benefits indefinitely without employment intervention services post-sentence. The criminal justice system can helpfully identify potentially disabled offenders who are in receipt of the disability benefit Employment Support Allowance (ESA) and consider appropriate sentencing and post-sentence release.

International comparison

Albrecht, Seelman and Bury (2001) review of World Health Organisation’s impairment rates by nation found the following impairment rates: Australia (14.2%), Canada (13.2%), New Zealand (19%), Spain (14.9%), United Kingdom (14.2%) and USA (17.5%).  This classification study puts the UK firmly at the lower end of international impairment rates of population.  The Howard League for Penal Reform argue that the UK is the most punitive nation in Western Europe with the highest prisoner ratio per head of population (154 per 100,000), also maintaining a short distance behind the USA on the international incarceration rates.  The primary implication is that (in 2010) 31,635 (of 85,495) serving prisoners are statutory disabled   A further implication of both the Clinniffe and ODI studies is a sustained lack of political action mandating compulsory employment activity and or employment help when prisoners are released from prison either as an alternative to or condition of continued welfare assistance.  An increased focus on improving services to disabled ex-offenders on leaving prison may have a substantial effect on reducing the cycle of offending and welfare dependency, prisoner numbers and reduce cost to a level of international comparators.

Conclusion

In 2012, according to jobcentre plus, the government provided help to 20,000 disabled people in employment, nationally, through the Access to Work Scheme run by jobcentre plus - which includes disabled persons in the public and private sector, employers small and large.  This is a stark contrast to the 2.54m disabled persons in part or full time employment. Since the coalition austerity cuts came into place, jobcentre plus have reduced its support to the number of eligible disabled people by 25%. Moreover, this policy operates against a new policy objective of moving over 80% of existing unemployed disabled persons claiming welfare to work. The Government’s own statistics highlights a need for over 2m new jobs for disabled persons over the next 5 years. Currently only 0.2% of UK working disabled persons obtains practical assistance from government for their disability in the work place.  This illustrates the scale of the problem facing disability welfare reform affecting disabled persons generally and also the real deficit in political action to target disability related issues within the prison or offender community.

Disability: Prevalence, Welfare And Reform

Welfare reform protests
Welfare reform protests

Prevalence: the social context of capitalist reform of welfare

The government Office of Disability Issues (ODI) in 2011 estimated that 11.2 million disabled persons were living in the UK.  Estimating the prevalence of disability varies by public institution each facilitating different policy goals; examples include the Equality Commission who establish the number of persons covered under discrimination legislation, the NHS commissioning of services to disabled persons, the Department of Work and Pensions to facilitate those claiming disability related benefits and a continuum of impairment and disability theories used in the common pursuit of academic disability research studies.

The last 40 years has generated contentious debate on how to reform disability welfare policy to enable and sustain disabled persons in employment which has seen, since the post-war creation of a National Assistance Act and the inception of the welfare state, significant advancement in social attitudes towards disabled people.  Often different public policy objectives have conflicting goals such as providing welfare at the same time as providing employment, and attempting to solve the complex goal of providing employment opportunities for all disabled persons against a background of reforming the post-industrial economy and social-economic change. As yet there is no real consensus or consistency on what actual employment means for the range of varying disability needs and abilities.  It is astonishing to note that the UK has seen no significant advancement of the issues of how employment is defined, and how to expand those opportunities into the disability community to achieve full employment related activity for those who are able to make a contribution to the economy. Such a government policy would require triangulated policy between subsidised employment through welfare, help in achieving productive work and the ludicrously complex scenario of how impairment, disability and employment are defined across the broad range of employment protection to welfare support measures.  The lack of congeniality between key underlying government support results in ill-targeted benefit reform, an inconsistent match between the disability model and medical impairment models of disability and the persistent absence of an ‘inclusive strategy’ for generating large scale disability related work opportunities.  All respectable evidence seems to suggest that until these factors are reconciled, reform in disability related welfare will continue to drive disabled persons in to unemployment and poverty. There is much academic, disability and human rights group evidence that the Coalition Government policy will lead to higher unemployment and significant reduction in the lifetime opportunities available to disabled people. The Government’s strategy for improving the life chances of disabled persons’ is in chronic disarray.  

Modern history of disability welfare

Following the changes to the industrial and economic landscape following high levels of employment during the 1950s-70s, successive government sought to develop a welfare strategy to cope with transient unemployment patterns.  During this period there was no real distinct employment policy development for disabled people other than the availability of unemployment benefit.  Successive governments have struggled to establish a welfare policy which targeted unemployed disabled persons into some form of employment related activity. The early Thatcher government introduced welfare reform which deeply broadened the scope of welfare provided to the disabled and unemployed community.  These were based on deeply flawed economic models of employment and medical models of disability.  Eligibility was notoriously complex and receipt of the benefit was not widely awarded (80% plus level of disability being required).  This started with the establishment of long term sick pay and supplemental income for UK citizens suffering from a long term disability; payments increased substantially in the 1980s which quickly became unaffordable.

The Conservative Government started further reform in the late 80s with the division between Unemployment Benefit, Invalidity Benefit, Severe Disablement Allowance, and a transient sick pay provision for those sick whilst in employment.  The principle of a contributions based system ensured that to a lesser extent national insurance contributions, amongst other things, would give an entitlement to non-means tested Invalidity Benefit if someone became incapacitated paid at a higher level than the means-tested unemployment benefit.  For those who become too sick to work but had earned no right to contributions based Invalidity Benefit would receive Incapacity related supplemental support or Income Support at a similar level to Unemployment Benefit but with no requirement to seek work due to ill-health.  Income Support (previously supplementary benefit) was incremented to include severe disablement premiums depending on the extent of a person’s impairments.

The problem with this approach was not initially well assessed by policy makers because the underlying research advising on the point at which someone was deemed unfit to work was formulated on the research of the previous decades during high employment, and as the economic changes unfolded and the introduction of Invalidity Benefit with a relatively low level of the incapacity threshold had been set to entitlement this resulted in a significant number of people receiving Invalidity Benefit as well as the increase of what was seen as unemployable people following the industrial change of the period.  Further reform followed with the inception of the Severe Disablement Allowance (SDA) which sought to identify those with significantly more profound disabilities and provide a higher degree of welfare assistance to address real issues of poverty with disability.  The test for eligibility for SDA was deemed 80% impaired and over: which made the benefit unworkable and has recently been abolished.

Disability Living Allowance

In addition to the recognition of disability issues in employment, the disability community (Barnes et  al) campaigned hard for assistance with the extra cost of their day to day activities such as cooking, washing and mobility which resulted in the Conservative Government under John Major introducing Disability Living Allowance in the early 1990s and further reforms of what was perceived as an unaffordable Invalidity Benefit which was replaced with a new Incapacity Benefit with an even lower threshold for eligibility.  The overall numbers of people eligible to receive the new benefit remained consistent and the incapacity threshold was widely seen as inconsistent with the disabled persons’ calls for employment opportunities and legislation to protect their rights.  

Disability Discrimation Act 1995

In 1995 the Disability Discrimination Act 1995 was implemented following a long passage of legislation which created a further definition of disability and another incapacity threshold to be met to enable statutory protection from discrimination.  The New Labour government initially failed to reform welfare policy further and no disability reform was made until around 2001 when Tony Blair commissioned a 30 year strategy to increase the life chances of disabled persons.  The strategy was broadly welcome across the disability community. The Labour government faced the same contradiction in policy as its predecessor: trying to increase the opportunities for disabled people, improve levels of poverty amongst disabled persons through welfare and the increased cost of introducing employment protection.  There were some changes in the scope of employment provisions in the DDA in the early and later parts of the last decade notably the increase in scope of persons covered and the introduction of the Equality Act.  To date, the fundamental variation and inconsistency in the definition of disability and entitlement to welfare, employment protection and social care remained unreformed.  

Employment Support Allowance and Personal Independence Payment

In the later stages of the Labour government policy was focused, yet again, to find ways of categorising those on Incapacity Benefit to identify those who were so disabled  they could not work and those who had the potential do undertake some form of employment related activity.  In 2008, under Gordon Brown’s government, this resulted in the abolition of Incapacity Benefit and replaced with new disability benefit know as Employment Support Allowance which has two groups: work related activity and support group.  It is not known what the government hoped to achieve in terms of what percentage was envisaged could undertake work activity and who could not.  This was a radical change in approach.  There have been estimates that between 5-20% of those who were entitled to Incapacity Benefit would remain in the Support Group and the remainder at some point would need to seek unemployment benefit with employment assistance. The coalition government have continued with this policy but have sought to use the same approach to rationing the support available to those eligible to claim Disability Living Allowance and have abolished DLA and replaced it with a new benefit to be known as Personal Independence Payment (PIP) providing help with personal care and mobility costs to what is thought would be a much reduced number of people (as currently entitled to claim under DLA) .

Failure to provide integrated model of disability

To date: the fundamental issues remain regarding what constitutes those disabled people who are unable to work at all, disability-in-employment and employment related activity to meet the diverse range of needs of disabled persons, the definition of disability and how that is assessed in terms of welfare, employment protection and access to employment activity.  None of the current reforms have sought to integrate the three issues into a common definition and entitlement model (the integrated model of disability) which would give much needed substance to the Blair strategy.  The Coalition has done little to advance the life chances of disabled people and many disabled people deem the reforms as a step back to the 1980s.  Moreover, reforms to the Social Care system and cuts in Access to Work Budgets have resulted in cuts to services to disabled persons who are being mandated into entering the world of work. Details of the work programme are not yet known.

Criticism of Goverment Welfare Policy and Reforms

There are some very striking issues of disability prevalence which on the whole suggest the government will continue to struggle to bring about any meaningful reforms in terms alleviating disability-related poverty, creating economic and social opportunities for disabled people to pursue to and create a supportive work environment for disabled persons to retain employment.

The facts of the ODI assessment of disability prevalence suggests:

1. The total disability population for the UK is 11.2 million people which comprises of 5.2m people of working age and 5.2m people of pension age, and 0.8m children.  With advances in health care systems, the aging of the population,  the accuracy in future prevalence estimates and perceived benefits of people declaring a disability: the recorded number of disabled people has steadily increased since 2002 by average of 100,000 per year.  This will continue to increase demand for services and welfare.

2. More than 6m people in the UK have a significant mobility problem which will continue to lead to substantial demands for change in transport infrastructure and accessible services. This incremental effect will increase barriers to accessing employment.

3. London and South East England has a disabled population of around 3m people which is greater than the populations of Northern Ireland or Wales. This will have a continued impact on how to do tailor services to individuals and employers.

4. Over 2m people have substantial sight or hearing problems.  Under 12% of those are employed permanently and full time, and there is no national infrastructure of services in place to realise any substantial change in employment outside of government employment.

5. Scotland has a disabled population of 1m people meaning approximately 1 in 6 people in Scotland have a disability.

6. In the UK, there are around 4m people with a significant mental health problem of which 75% of the people are not in full time employment. A significant number are not even known to the DWP in terms of their employment status.

7. In the UK, 56-60% of disabled people are currently unemployed as opposed to 7-8% of the rest of the population. In May 2011, 2.6m people claimed Incapacity Benefit costing £12.5bn out of the DWP welfare budget of £151.60bn (the most being spent on the State Pension and Pension credits).  2.4m disabled people worked in the same period with only 0.2m disabled people working and claiming benefits.

8. Albrecht, Seelman and Bury (2001) review World Health Organisation’s impairment rates by nation and found the following impairment rates: Australia (14.2%), Canada (13.2%), New Zealand (19%), Spain (14.9%), United Kingdom (14.2%) and USA (17.5%).  This classification study puts the UK firmly at the lower end of international impairment rates without taking into account any further disability welfare reform.  By this calculation, the UK would currently have 9.32 m persons suffering from a disability which is well below the DWP and ODI statutory statistics and casts further doubt about the purported need for the extent of the current government welfare reform.  The study further highlights validity issues with current context of disability welfare reform.  The US, Canada, Australia, Germany, Sweden, Norway and France operate much more generous disability related pensions or long term disability payments based on larger numbers of eligible disabled persons against higher medical eligibility tests than those found in the UK.  This would indicate that the current approach to the UK Government reform is entirely budget targeted rather than targeting the use of welfare where it is critically needed to alleviate poverty and improve quality of life experience. The comparators internationally have high eligibility criteria and higher means testing thresholds.

9. In 2012, according to jobcentre plus; the government provided help to 20,000 disabled people in employment through the Access to Work Scheme run by jobcentre plus - including disabled persons in the public and private sector, employers small and large.  This is a stark contrast to the 2.54m disabled people in part or full time employment.  Since the coalition austerity cuts came into place, jobcentre plus have reduced its support to the number of eligible disabled people by 25%. Moreover, this policy is against a background of moving over 80% of existing unemployed disabled persons from welfare to work - which on the Government’s own statistics should be around an additional need for over 2m new jobs over the next 5 years.  This means that currently only 0.2% of UK working disabled persons obtains any practical assistance from government with their disability in the work place.  This illustrates the scale of the outstanding caseload under the current reform of welfare being realised and is clearly a critical success factor with unknown personal and social risks.

Concluding thoughts

In August 2012, the government recorded around 0.5m people as claiming the new disability benefit ESA which amounts to just 5% of the total number of the UK’s disabled population as claiming the employment disability welfare benefit as a main form of income. The transfer of IB claimant to ESA is yet to be finalised but is said to be 80% complete.  Will the transfer of 2m disabled persons (covered under the Equality Act 2010 protection from discrimination in employment) really be transferred into the private sector employment market against the worst economic outlook since the great depression and a cut in the Access to Work budget which we should note was never intended to provide individual support as part of a mass welfare migration plan.