Mo Stewart: ‘Chronically ill and disabled people have learned to live in fear’

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By Mo Stewart, Independent Disability Studies Researcher

October 2018 is the 10th anniversary of the adoption of the Work Capability Assessment (WCA), as used by successive UK Governments to restrict access to the out-of-work long-term sickness and disability benefit known as the Employment and Support Allowance (ESA).

Introduced by the New Labour Government in October 2008, the ESA replaced Incapacity Benefit (IB) with the claim that many IB claimants would be able to work if given help to return to the labour market. The adoption of the ESA included the claimed “non-medical functional assessment”, identified as the WCA.

At the time of the introduction of the ESA, few people realised what human suffering was destined to be created when using a fatally flawed biopsychosocial (BPS) assessment model for the WCA; which was justified by 2005 Government- commissioned research funded and influenced by the private healthcare insurance industry.

Commonly known as “welfare reforms”, the political assault on the income of chronically ill and disabled people was to have future dire human consequences following the 2010 election of a Conservative-led coalition Government, with multi-millionaire David Cameron appointed as the new Prime Minister.

The Cameron Government adopted austerity measures, used to reduce spending and justified by the 2008 banking crash. Cameron claimed that the previous New Labour Government adopted “excessive” spending on the welfare budget, which increased the fiscal deficit. Austerity measures would limit spending on public services to the point where the UK would “live within our means.” The introduction of austerity measures significantly reduced funding for the welfare budget, which Professor Martin McKee identified as being “a political choice and not a financial necessity” when introduced “without any ethical approval”.

In May 2010 Iain Duncan Smith was appointed as the new Secretary of State for Work and Pensions, and excelled during the next five years by demonising claimants of disability benefits. The spin, the political rhetoric and the power of the mighty Tory Press were only too happy to aid inflammatory media coverage to suggest that the majority of out-of-work disability benefit claimants were “scroungers”.

This removed the previous psychological security of the welfare state, and chronically ill and disabled people learned to live in fear of the Department for Work and Pensions, with the everpresent anxiety that their minimal income could be stopped following a WCA, as Ian Duncan Smith disregarded the 213 percent increase in prosecuted disability hate crimes during his term in office.

The WCA adopted the Waddell and Aylward biopsychosocial (BPS) assessment model, as recommended in the 2005 Government-commissioned research: The Scientific and Conceptual Basis of Incapacity Benefits, which was sponsored with £1.6 million by the US corporate government advisers when known as UnumProvidentTM Insurance.

The Waddell and Aylward BPS model as used for the WCA disregards diagnosis, prognosis, past medical history and prescription drugs. In his 2015 paper “First do no harm” Dr Ben Barr and colleagues identified the WCA as being strongly associated with the preventable harm of chronically ill people. In this three-year study, the WCA was associated with an additional 590 suicides, 279,000 additional cases of self-reported mental health problems and an additional 725,000 prescriptions for anti-depressants. The research concluded that the preventable harm created by the WCA “could outweigh any benefits that arise from moving people off disability benefits.”

In a 2016 critique by Professor Tom Shakespeare and colleagues, the Waddell and Aylward BPS model was identified as having “no coherent theory or evidence behind this model” and a review of the Waddell and Aylward publications revealed “a cavalier approach to scientific evidence.”

• Mo Stewart is a former healthcare professional, a disabled veteran of the Women’s Royal Air Force medical branch, and an independent disability studies researcher. Her book Cash Not Care: the planned demolition of the UK welfare state was published in September 2016 by New Generation Publishing. More on Ms Stewart’s work can be found at

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