MEDICAL AND WORK CAPABILITY ASSESSMENTS – BASED ON THE CONTROVERSIAL BIO PSYCHO-SOCIAL MODEL, AIMED AT DIS-ENTITLING THOSE AFFECTED FROM WELFARE BENEFITS AND ACCIDENT COMPENSATION: THE AYLWARD – UNUM LINK
‘A comprehensive report with a summary of many revealing research results’
Media revelations during 2012 exposed a kind of “exit strategy” that ACC has apparently been using to off-load complex and costly claim cases by using in at least some cases highly questionable practices and medical assessors.
(see YouTube links: http://www.youtube.com/watch?v=DNkN3DW1W6s and http://www.youtube.com/watch?v=55LzKcivWuM from Sept. 2012).
Following this, recent developments in the social security system in New Zealand now also give rise to immense concern, as forms of work capability assessments will be applied to virtually all disabled and seriously ill, suffering degrees of incapacity.
On 15 July 2013 fundamental changes to the New Zealand social security system were introduced. Most in the public only learned that 7 former benefit categories would be merged into 3 new categories, that beneficiaries caring for children now have to fulfill certain social obligations, that jobseekers may face sanctions if they do not pass a required drug test, and that benefit recipients facing a warrant for arrest, could lose their benefit, if they would not comply with new rules.
A certainly much more significant set of changes also came into force, which have hardly been taken note by the media and the public. This includes the new, extremely stringent approach by Work and Income (WINZ) to require sick, disabled and incapacitated beneficiaries, to comply with greater work expectations. All former sickness beneficiaries were transferred onto the new ‘Jobseeker Support’ category, and they will face new, different re-assessments for their capacity to work or train.
Work capability will no longer solely – or primarily – be determined by information on medical certificates issued by medical practitioners or other authorised health professionals. There will be new additional measures, including expected, “self assessments” (on pre-designed forms), additional interviews with Work and Income staff tasked with finding ways to refer sick, injured or disabled back into some form of work on the open market. Further medical examinations by WINZ-trained and paid “designated doctors” can also be required, to assess what work a client can do.
Few will comprehend the magnitude and significance of the new approach, which, when compared with similar, earlier changes introduced in the United Kingdom, can only be described as the biggest attack on the social security system of New Zealand since at least 1991. The new changes under the ‘Social Security (Benefit Categories and Work Focus) Act 2013’, are nothing but a relentless drive to force many sick, disabled and incapacitated to look at least for part time work. The claims by the government and Ministry, that the intention is to “help” people, who are “locked into” benefit dependence, are nothing but cunning, misleading statements to disguise the true intentions and agenda. The goal of that agenda is above all: Reducing the number of persons on welfare benefits, and by doing so – COST CUTTING!
Already with the introduction of the ‘Future Focus’ policies in 2010 did Work and Income introduce a new approach following one used by the ‘Department of Work and Pensions’ (DWP) in the United Kingdom (UK), to rather look at what clients “can do” than what they “cannot do”. From 15 July 2013 a new ‘Work Capacity Medical Certificate’ is being used, which puts the emphasis on assessing what obstacles a client faces, to return to work, before the actual health conditions are being looked at.
Virtually ALL beneficiaries, including those on the new Supported Living Payment, onto which mostly former Invalid’s Benefit recipients have been transferred, will have to attend interviews and assessments for determining capacity to at least attend work preparation obligations, when being asked to do so.
(See these links: http://www.legislation.govt.nz/act/public/2013/0013/latest/DLM4750211.html and
On page 40 (of 48) on the new application form for the ‘Supported Living Payment’ – under “obligations” and “privacy” it says:
“2. Work preparation obligations if you have a health condition, disability or injury
I understand that while I get this benefit I’ll have an obligation, when asked, to:
• attend and participate in interviews to determine if I have the capacity to have work preparation obligations”
“I understand that if I’m assessed as having the capacity, I’ll have the following work preparation obligations to:
• attend and take part in work preparation interviews, where Work and Income ask me to
• attend and take part in work related activities or programmes such as a work assessment, a programme or seminar to increase particular skills or enhance motivation where Work and Income ask me to
• attend and take part in any other activity that Work and Income require me to (including rehabilitation but not medical treatment, voluntary work or activity in the community).”
(Link to form for downloading form:
It says on page 39 (of 48) on the new application form for the ‘Jobseeker Support‘ benefit – under “obligations” and “privacy”:
“3. Work obligations if you have a health condition, disability or injury that stops you working full time
I understand that while I get this benefit, if I have a health condition, injury or disability that means I can only work part-time, I have the following part-time work obligations to:
• be available for and take reasonable steps to get a suitable part-time job
• take any offer of suitable part-time or temporary work, or work that is seasonal or subsidised
• attend and take part in any suitable job interviews Work and Income ask me to
• take and pass any drug test potential employers or training providers require
• attend and take part in interviews with Work and Income as required
• work with Work and Income to plan how I’ll find a suitable job
• take part in any other activities that Work and Income refer me to, such as attend any job training courses, seminars, work experience or work assessments (including rehabilitation, but not medical treatment) that will improve my work readiness or help me get work
• let Work and Income know how I’m meeting my work obligations as often as Work and Income reasonably requires.”
“I understand that while I get this benefit, if I have a health condition, injury or disability that means I am unable to work or can only work less than 15 hours a week, I will not be asked to meet work obligations until my situation changes and in the meantime I will have the following work preparation obligations to:”
“• take reasonable steps to prepare and plan for work
• attend and take part in work preparation interviews, where Work and Income ask me to
• attend and take part in work related activities or programmes such as a work assessment, a programme or seminar to increase particular skills or enhance motivation where Work and Income ask me to
• attend and take part in any other activity that Work and Income require me to (including rehabilitation but not medical treatment, voluntary work or activity in the community).”
It says on page 40 (of 48) on the new application form for the ‘Jobseeker Support‘ benefit – under “obligations” and “privacy”:
“6. Work ability assessment
Where I’ve been asked to I’ll have an obligation to attend and participate in a work ability
Applicants and partners
“7. Working with a Contracted Service Provider
Where I’ve been asked to work with a Contracted Service Provider I’ll have an obligation to
co-operate with them and to:
• attend and participate in any interview with them
• report to them on how I’m meeting my obligations
• complete assessments with them.“
Link for downloading form:
Links to a sample Work Capacity medical certificate and additional information – from the website of the ‘Royal NZ College of General Practitioners’:
Link to law change requiring WINZ clients to work with contracted providers:
With news and other reports about the new approach in establishing work capability for sick, injured and disabled, the name of a Professor Sir Mansel Aylward, as well as names of other members of a core group of medical and health “experts”, many linked to the ‘Unum Provident’ funded ‘Centre for Psychosocial and Disability Research’ at Cardiff University, Wales, UK, have repeatedly been mentioned.
Also have there been frequent references to the so-called “bio psycho-social model” (BPS model), which is strongly associated with, and promoted by Professor Mansel Aylward and their school of thought. He and others have been strongly recommending this model for the diagnosis and treatment of diseases and illnesses that lead to degrees of impairment and incapacity to function – or to do work.
It has been said and written in UK based media that Mansel Aylward was given a “golden parachute” by the ‘Unum Provident’ insurance company, after he finally resigned from his position as ‘Chief Medical Officer’ for the ‘Department of Work and Pensions’ (DWP) in April 2005. ‘Unum’ offered substantial funding for a newly established ‘Research Centre for Psychosocial and Disability Research’ at Cardiff University in 2005 – that would be led by Professor Aylward.
Aylward’s name has repeatedly surfaced here in New Zealand, and it was reported last year, that he met with Social Welfare Minister Paula Bennett, and also with members of a ‘Health and Disability Panel’, set up by the Ministry of Social Development (MSD) to “advise” on “medical” matters, on the way medical assessments, possible rehabilitation and enhanced work referrals, could be further developed as part of the wider social welfare reforms.
Aylward furthermore held speeches at various conferences and meetings with groups of medical professionals here in New Zealand, and he has been accepted by the ‘Counties Manukau District Health Board’, the Ministry of Social Development, certain general practitioner- and other health professional organisations, and Social Welfare Minister Paula Bennett, as an advisor on health and welfare matters.
To understand who Mansel Aylward is, and what supposed “expert” advice he presents, we can look at readily available information on the internet. It will become evident that Professor Aylward, with his version of the “bio psycho-social model”, and with the strong private health- and disability-insurance sector lobbies, and also government backers behind him, has with his efforts achieved that the medical professions have almost been seized upon. The professions have been inundated with reports, speeches, campaigns and policy releases supporting a new, controversial doctrine – or at best theory! It is time to shine light on what is behind the resolute drive to gradually disentitle sick, disabled and incapacitated from support they were traditionally ensured by way of insurance payments or welfare benefits.
In the following 13 parts of this article and analysis I will present a wide range of available, factual, revealing information that is backed up by plenty of resource material, which can be found via the internet and in other accessible sources.
Professor Sir Mansel Aylward CB DSC FFPM FFOM FFPH FRCP – A Short profile and overview of his presentations based on the bio psycho-social model (in short BPS model):
Professor Mansel Aylward is the Director of the ‘Centre for Psychosocial and Disability Research’ and Professor of ‘Public Health Education’ at the School of Medicine at Cardiff University, UK. The Centre was established with the financial support of the large ‘Unum Provident’ insurance company.
(“Directory of Expertise”, “Cardiff University News Centre”)
Professor Mansel Aylward CB already took up the first Chair in Psychosocial and Disability Research at Cardiff University in October 2004, where he also became Director of the new ‘UNUM Provident’ funded ‘Research Centre for Psychosocial and Disability Research’ at Cardiff University (which Aylward developed with a £1.6 million grant from ‘UNUM Provident’).
Prior to that Mansel Aylward was Chief Medical Adviser, Medical Director and Chief Scientist at the UK Department of Work and Pensions (DWP). He was also Chief Medical Adviser and Head of Medical Professions at the Veterans Agency, Ministry of Defence.
As the former Chief Medical Adviser at the DWP Mansel Aylward was instrumental in the DWP accepting the ‘UnumProvident’ concepts applied in the US, and was influential in how the Welfare Reform Act should be implemented.
(See more at: http://dpac.uk.net/tag/unum-provident/#sthash.I0YtkwZY.dpuf;
“During his time at the DWP, Aylward was well-known for his support of the Wessely School and for his opposition to State disability benefits being paid to ME/CFS claimants.”
In 2005 Aylward was quoted for this comment or statement:
“By incorporating the Biopsychosocial Model into disability assessment, we can identify critically important information on obstacles to recovery, which in many cases can be tackled by an integrated package of support such as that offered in the Pathways to Work pilots and as provided by Unum Provident’s Claims Management and Rehabilitation Services.”
See ‘The Black Triangle Organisation’ publication under this link for more details:
Some additional information on this obviously “well connected” career professional can be found here:
Extracts from Mansel Aylward’s profile on the ‘Public Health Wales’ website:
“Professor Sir Mansel Aylward CB is the first-ever Chair of Public Health Wales – a unified NHS Trust responsible for the delivery of public health services at national, local and community level in Wales. He was Chair of the Wales Centre for Health, an Assembly Government Sponsored Body established to be the ‘hub of connected organisations’ and to communicate better health messages to the people of Wales.
He is also Director of the Centre for Psychosocial and Disability Research at Cardiff University which offers a unique opportunity to extend knowledge and understanding of the psychosocial, economic and cultural factors that influence health, illness, recovery, rehabilitation and reintegration.
Professor Sir Mansel Aylward CB was knighted in the Queen’s New Years Honours 2010 for services to health and healthcare.”
“He entered the British Civil Service in 1985 and was appointed Chief Medical Adviser at the Department of Social Security in 1996 and at the Department for Work and Pensions in 2000. From 1974 to 1984 he was Chairman and Managing Director of Simbec Research Ltd, UK, and President of Simbec Inc, New Jersey USA.
He played a key role in development and evaluation of the UK’s medical assessment for incapacity (the All Work Test), and was heavily involved in developing the Personal Capability Assessment (PCA).”
Mansel Aylward has summarised his research “findings”, which do at least in large part rely on nothing else but selected data from studied and analysed reports by others, in his PDF-format and other types of presentations. At least in his earlier ones he did not make any efforts to hide the fact that his centre was “sponsored” by ‘Unum’! One presentation he frequently used is the following one:
Professor Mansel Aylward CB, Director, ‘Centre for Psychosocial and Disability Research’, Cardiff University: “Health, Work and Wellbeing – Pathways to Work”,
Stockholm, Sweden, 01 Dec. 2008
His message was also rather revealing:
“Changing beliefs and attitudes: the evidence base:
Getting politicians and key decision makers on side”.
Clearly, every person working in marketing, advertising and political propaganda knows very well, that whatever the message is, if it gets repeated hundreds or thousands of times, it will become commonly accepted by those receiving it.
Yet there has been critical reflection on that “Swedish Conference” in Stockholm:
‘MEF-forum — öppet, gratis forum om Myalgisk Encefalomyelit (ME)’
(from 31 May 2009, offering more questions than answers, I suppose)
Mansel Aylward also raised the issue of “illness belief” in patients, and how a high number of reported complaints and illnesses may simply be the result of people wrongly believing they are seriously sick, and how their belief was hampering successful recovery and rehabilitation. He has written many reports and publications, and one of these is the following:
‘The Power of Belief’, Psychosocial influence on illness, disability and medicine,
Edited by Peter W. Halligan and Mansel Aylward, Oxford Univ. Press, 20 April 2006
● “A collection of distinguished scientists and clinicians examine how beliefs can affect not only the patient, in terms of their eventual recovery from illness, but also the way in which medical professionals view and treat illness.
● This book provides an opportunity to probe deeper into the nature of beliefs and in particular highlights recent theoretical and clinical reports illustrating the significant role that beliefs play in defining illness, compliance with treatment and vocational rehabilitation.
● At a time when public trust in doctors and science is diminishing, a better understanding of patients’ and doctors’ beliefs regarding illness is clearly a priority for research in clinical practice.”
“Over the past two decades, a widening gulf has emerged between illness presentation and the adequacy of traditional biomedical explanations. Currently, the UK is experiencing an “epidemic of common health problems” among people in receipt of State incapacity benefits and those who consult their general practitioners. Most do not demonstrate a recognisable pathological or organic basis which would account for the subjective complaints they report.”
Here are a couple of other frequently used presentations by Mansel Aylward:
‘Worklessness and Health: A Symposium’; Professor Sir Mansel Aylward CB
“Common Health Problems:
Predominantly Subjective Health Complaints
What ill people say and do that express and communicate their feelings of being unwell:
• Subjective Health Complaints have a high prevalence in the working-age population
• Not solely dependent on an underlying health condition ( the limited correlation)
• People with similar symptoms (illnesses) may or may not be incapacitated
• Consumption of health care disproportionate.”
Here’s a Mansel Aylward slide show presentation WSPCR 2010, from 03 Nov. 2010:
‘Transforming Models of Disability’ – Professor Sir Mansel Aylward CB
Director: Centre for Psychosocial and Disability Research, School of Medicine, Cardiff University and Chair: Public Health Wales, ‘International Forum on Disability Management, London, 10-12 September 2012
“Terminology: unravelling concepts: 1
Disease: Objective, medically diagnosed, pathology
Impairment: Demonstrable deviation or loss of function/structure
Illness: The subjective feeling of being unwell
Sickness: Social status accorded to the ill person by society
Disability: Limitation of activities and restriction of participation
Incapacity (work): Inability to work because of sickness/disability
1. Waddell + Aylward (2010)“
“The Psychosocial Dimension
•Extensive clinical evidence that beliefs aggravate and perpetuate illness and disability
•Almost anytime you tell anyone anything, we are attempting to change the way their brain works”
“Limitations of the social model of disability:
•Applies best to people with more severe medical conditions and permanent physical or mental impairment”
In this presentation from 2012 Aylward is clearly attempting to partly qualify, interpret, redefine and rewrite some medical terminology, and to also reduce the importance of the “social” component in the “bio psycho-social model”.
Prior to Mansel Aylward taking up his new positions at Cardiff University, it was clear what the close cooperation between ‘UnumProvident’ and the School of Psychology there were planning to achieve. The following publication states this rather clearly:
“Exploring why disease affects people differently”
“Cardiff University and UnumProvident announce new partnership”; (Cardiff University May 2004), from the ‘Science Blog’:
“In a £ 1.6 million research contract signed on Thursday (6 May), the new UnumProvident Centre for Psychosocial and Disability Research in the School of Psychology sets out to achieve the highest level of research and teaching excellence and become a recognised world-class research centre and resource for psychosocial and disability research.”
“The centre is the first in UK to develop specific lines of research, in psychosocial factors related to disability…”
“”Hopefully within five years, the work will bring about a significant re-orientation in current medical practise in the UK whereby “enablement” rather than disability, will be the positive focus and goal for those involved in managing disability and those affected by “unexplained symptoms” explained Professor Peter Halligan who forged the partnership with UnumProvident.”
On a more personal note Professor Mansel Aylward was interviewed by:
The Actuary – The magazine of the actuarial profession
1 MAY 2013 | SARAH BENNETT AND RICHARD PURCELL
“Vision for a healthier, happier nation”
“Professor Sir Mansel Aylward CB, chair of Public Health Wales, tells Sarah Bennett and Richard Purcell how self-esteem affects health and why happiness is a constant”
“What would you describe as a highlight of your career?
First, the work I led to ensure people with a terminal illness received their state disability benefit quickly. Second, introducing the ‘All Work’ test in the 1990s, which was an objective approach to measure whether someone could do their own work or any other work.”
Mansel Aylward’s many “titles” are explained here:
Companion (CB) Companion of the Order of the Bath – 2002 Queen’s Birthday Honours, UK, for his role as ‘Chief Medical Adviser’ and ‘Medical Director’, ‘Department for Work and Pensions’;
DSC – ‘Doctor of Science’,
FFPM – Fellow of the Faculty of Pharmaceutical Medicine (UK),
FFOM – Fellow of the Faculty of Occupational Medicine (UK),
FFPH – Fellow of the Faculty of Public Health (UK),
FRCP – Fellow of the Royal College of Physicians (UK).
Besides of having been ‘Chief Medical Adviser’, ‘Medical Director’ and ‘Chief Scientist’, he acted also as ‘Spokesman’ for the ‘Department for Work and Pensions’ (1995-2005).
In 2010 he was “knighted” for “services to health and healthcare” and now is “Sir”.
Having been invited and courted by New Zealand health authorities, he is now also ‘Visiting Professor’ at the ‘Ko Awatea Stevenson Centre’1, the ‘University of Auckland’ and ‘Counties Manukau District Health Board’ (2012).
1. (Ko Awatea is the Centre for Health System Innovation and Improvement for the Counties Manukau District Health Board (CMDHB))
Summary conclusion on Mansel Aylward and his version of the BPS model:
The presentations and reports by Aylward send the same constant short messages, like that “work is good for health”, and he interprets the “bio psycho-social model” by Engel to argue, that most barriers that sick, ill and disabled with incapacities face for a possible return to work are merely of a “social” and/or “psychological” nature.
Like his like minded colleagues Gordon Waddell, Kim Burton and others, same as the few non-associated medical researchers he bases his “findings” on, he relies on statistical results that are actually rather selective, ambiguous, inconclusive and do not necessarily represent the same types of information that he compares them with.
Some of the information (e.g. from Eriksen and Ursin) goes back to 1993 or further. It represents data from other countries (Scandinavia, the US, Canada, etc.) with different social, cultural and also medical service systems, from up to decades ago, which could well be out of date, as it gives no consideration to newer medical findings that may qualify or disprove the results presented by such earlier reports.
There have been substantial advances and new discoveries in biological, bio-chemical, genetic and physical sciences, and new findings about the interactions of hormones, functioning of body cells and the nervous system, which can explain some phenomena that could previously not be explained. Future research is likely to reveal more about physical, biological, mental and psychological aspects of human health, and to exclusively rely on a model that is actually disputed – or interpreted differently – by a fair number of experts, appears to be somewhat short-sighted or irresponsible.
While there have also been substantial advances in psychiatry and the development of new psycho-pharmaceutical products, treatment of mental health conditions and disorders remains to be an area with many risks and problems, as some medication results in serious side-effects, is not effective for many patients and in other cases can lead to addiction. Hence many psychologists see justification in more use of counselling or other available treatment where this may be more appropriate.
The further development of the Diagnostic and Statistical Manual of Mental Disorders from DSM III to DSM IV and now DSM V was partly welcomed, but has also led to some criticism amongst medical professionals, yet it continues to be respected and followed, especially by psychiatrists. Co-occurrence of disorders and the adoption of dimension models besides of the traditional categorical model for diagnosis have become accepted. Mansel Aylward appears to give insufficient consideration to the various mental health disorders that have been established, and his constant referral to “common mental health conditions” seems to be an attempt to blur the line between actual mental illness and “subjective health complaints” like headache, fatigue, dizziness. This displays a dismissive approach to mental health disorders and conditions, which should instead warrant more research and careful analysis.
Mansel Aylward’s close links to ‘UnumProvident’ raise great concerns about his professional independence as a medical researcher and practitioner, having been paid by a private insurance company that has been funding his Cambridge University based centre. It appears he had contacts with and received advice on health and welfare matters from the insurer while Chief Medical Officer at DWP. Hence his “findings” and approaches deserve a very high degree of caution and scrutiny.
THE BIO PSYCHO SOCIAL MODEL, ITS CRITICS AND IN DEBATE:
A) The BPS model explained:
The ‘Biopsychosocial model’ as explained in ‘vixipedia.com’:
“The biopsychosocial model (abbreviated “BPS”) is a general model or approach that posits that biological, psychological (which entails thoughts, emotions, and behaviors), and social factors, all play a significant role in human functioning in the context of disease or illness. Indeed, health is best understood in terms of a combination of biological, psychological, and social factors rather than purely in biological terms.”
“It is important to note that the biopsychosocial model does not provide a straightforward, testable model to explain the interactions or causal influences (that is, amount of variance accounted for) by each of the components (biological, psychological, or social). Rather, the model has been a general framework to guide theoretical and empirical exploration, which has amassed a great deal of research since Engel’s 1977 article. One of the areas that has been greatly influenced is the formulation and testing of social-cognitive models of health behavior over the past 30 years.”
The ‘Biopsychosocial Model’, as found on ‘slideshare.net’:
By: Mimi Abesamis, Angela Alba Loye Clamor, Milo Fagar Kency Ferrer, Lya Gusi Pia Mirasol, Bernadette, with an interesting slide show presentation: http://www.slideshare.net/memehabesamis/biopsychosocial
While the “bio psycho-social model” has to varying degrees become accepted more widely in medical practice, including psychiatry and psychology, for many it remains to be a quite controversial model for diagnosis and treatment. Some even questioned whether it can be considered as a proper “model” at all. It has been interpreted differently and applied differently by professionals, and it is clear that it can lead to confusion about cause and effect, where diagnosis is unclear. There have been a number of outspoken critics, some of whom I will refer to and quote in the following.
B) The BPS “model” – not accepted by Niall McLaren:
“A critical review of the biopsychosocial model”, Niall McLaren, ‘Australian & New Zealand Journal of Psychiatry’, 1998
“Objective: The aim of this review is to provide an analysis of the epistemic status of the biopsychosocial model.
Results: In its present form, the biopsychosocial model is so seriously flawed that its continued use in psychiatry is not justified.
Conclusion: Further development of theory-based models in psychiatry is urgently needed.”
“The first thing we have to decide is whether it is a theory or a model. Engel was quite explicit: it is a model. However, since his construct does not satisfy any sense of a model as a formal, working representation of an idea, this cannot be accepted. At most, it could be a very general theory; even as a theory it is seriously flawed.”
“All he offered was an emotive case for more humanity and less technology in medicine: little more than a heartfelt plea based in a particular ontological stance. It was not a theory and it was certainly not a model.” (p. 89)
“Finally, unless there is an integrating theory already in place, gathering biological, psychological and sociological data about people will only yield scattered lumps of information that do not relate to each other in any coherent sense. Without an overarching theory to integrate the fields from which the data derive, associations between different classes of information are meaningless.” (p. 91)
Also – adding to the criticism by McLaren:
“The Non-Existence of the ‘Biopsychosocial’ Model of Chronic Ill-Health”,
Margaret Williams, 4th March 2007; sharing concerns of McLaren
“To quote McLaren:
“A Medline search of the word ‘biopsychosocial’ yielded nearly four hundred references, not one of them critical. Indeed, the Journal of Psychosomatics now uses the terms ‘psychosomatic’ and ‘biopsychosocial’ interchangeably. In its present form (it) is so seriously flawed that its continued use in psychiatry is not justified. In a word, the officially-endorsed biopsychosocial model is pure humbug because it does not exist. Psychiatrists have long attempted to convince the general public, the funding bodies and, most significantly, the younger generations of students and psychiatrists that the profession has articulated a rational model which grants it special and unique knowledge of the aetiology of mental disorder. It is my view that we are guilty of the grossest intellectual neglect or of outright scientific fraud. I believe there is a serious risk psychiatry as we know it will no longer exist in as little as fifteen years” (The Biopsychosocial Model and Scientific Fraud. N McLaren. May 2004; available from the author at email@example.com )”
“By contrast, true bio-psycho-social care (ie multi-channel care) is urgently needed by patients with ME/CFS. They need care for physical symptoms such as allergies and hypersensitivities, intractable pain, visual problems, balance problems, gut problems, respiratory problems, cardiovascular problems, and the inability to look after themselves; they need psychological support (eg. an understanding partner, mother, friend or ‘important other’ to help them cope with and grieve for – and adjust to – the many losses experienced); they need social support ie. help to run their household; help at school; home adaptations and family support, as well as help with the endless tribulations inherent in the inevitable battles with the various benefits systems.”
C) The BPS model viewed critically by Hamid R Tavakoli:
“A Closer Evaluation of Current Methods in Psychiatric Assessments: A Challlenge for the Biospsychosocial Model”, by Hamid R. Tavakoli, MD, Psychiatry (Egmont) 2009; 6(2): 25-30, from ‘Psychiatry – 2009’
“The challenges we face in psychiatry are undoubtedly partly due to differential reimbursement for medication treatment versus psychotherapy; however in my view, some of these challenges are due to how we approach our patients using the biopsychosocial model, and more importantly, due to the semantics and inherent problems brought by emphasis on this model.”
“On numerous occasions, I have received discharge summaries regarding the inpatient care of my patients that state “the biopsychosocial milieu was used to treat the patient,” with no additional information. This treatment plan has little sense and less content.”
Problems raised in his evaluation include:
The problems with further dichotomizing biology and psychology, with reinforcing the stigma associated with mental health, with implying that poor behaviour is a disease and the impact on society at large, with the psychosocial paradigm and related terminology, with teaching and communicating using a concept that is fundamentally weak.
Tavakoli offers alternative approaches like using an already established model in general medicine in “case formulations”, or a “perspectives model”.
The same article is also found here:
US National Library of Medicine, National Institutes of Health; Psychiatry (Edgmont). 2009 February; 6(2): 25–30: “A Challenge for the Biopsychosocial Model”
D) The BPS model as critically analysed by S. Nassir Ghaemi:
‘The Rise and Fall of the Biopsychosocial Model, Reconciling Art and Science in Psychiatry’, S. Nassir Ghaemi, M.D., M.P.H., The Johns Hopkins University Press, 2010
The Biopsychosocial Model in Psychiatry: A Critique
S. Nassir Ghaemi – Tufts Medical Center, 2011; Existenz, An International journal in Philosophy, Religion, Politics and the Art
In the United States, the basic concepts of psychiatry have involved the opposing dogmatisms of psychoanalytic orthodoxy and biological reductionism. An alternative basic conceptual scheme, the biopsychosocial model (BPS), arose in the last decade and now represents the status quo. By providing a conceptual review of the strengths and limitations of the BPS in psychiatry, and identifying the limitations of the BPS model the author concludes that its limitations seem to outweigh its benefits. Suggestions for a non-eclectic pluralist model of psychiatry, based on the ideas of Karl Jaspers, are made.”
“Political Uses of the Biopsychosocial Model in Psychiatry
The seeds of the decline of the BPS began in the political uses to which it was immediately put. The BPS promised an end to the increasingly bloody conflict between the biological and psychoanalytic schools. In the 1970s, the rise of psychopharmacology put the biological school in psychiatry on the attack. The framers of DSM-III rather overtly saw psychiatry as an objective medical discipline, and they framed their work in the traditional medical model as put forward by Emil Kraepelin in the early twentieth century.”
“By being agnostic, however, the DSM-III approach created a conceptual void. Psychoanalytic orthodoxy was rejected, as was Meyerian theory. Biological reductionism did not take its place. And thus, there was uncertainty regarding what was to be taken as the basic model of psychiatry. The BPS filled this void, since it was consistent with all approaches. The main raison d’etre for the BPS was to keep peace between the biological and psychoanalytic dogmatisms, while giving each space to survive. It provided mental health professionals a rationale for preserving the clinical use of psychotherapies, in the face of increasingly relentless pressure from psychopharmacology, a compromise which could only hold so long.”
E) The BPS model defended but qualified for future application by others:
“The Biopsychosocial Model 25 Years Later: Principles, Practice, and Scientific Inquiry”, Francesc Borrell-Carrió, MD, Anthony, L. Suchman, MD, and Ronald M. Epstein, MD, Ann Fam Med. 2004 November; 2(6): 576–582; US National Library of Medicine – National Institutes of Health
The biopsychosocial model is both a philosophy of clinical care and a practical clinical guide. Philosophically, it is a way of understanding how suffering, disease, and illness are affected by multiple levels of organization, from the societal to the molecular. At the practical level, it is a way of understanding the patient’s subjective experience as an essential contributor to accurate diagnosis, health outcomes, and humane care. In this article, we defend the biopsychosocial model as a necessary contribution to the scientific clinical method, while suggesting 3 clarifications: (1) the relationship between mental and physical aspects of health is complex—subjective experience depends on but is not reducible to laws of physiology; (2) models of circular causality must be tempered by linear approximations when considering treatment options; and (3) promoting a more participatory clinician-patient relationship is in keeping with current Western cultural tendencies, but may not be universally accepted.”
“FURTHER DEVELOPMENT OF THE BIOPSYCHOSOCIAL MODEL
George Engel formulated the biopsychosocial model as a dynamic, interactional, but dualistic view of human experience in which there is mutual influence of mind and body. We add to that model the need to balance a circular model of causality with the need to make linear approximations (especially in planning treatments) and the need to change the clinician’s stance from objective detachment to reflective participation, thus infusing care with greater warmth and caring. The biopsychosocial model was not so much a paradigm shift—in the sense of a crisis of the scientific method in medicine or the elaboration of new scientific laws—as it was an expanded (but nonetheless parsimonious) application of existing knowledge to the needs of each patient.”
The above analysis and report is delivering some thoughts on the BPS model and how it may be applied and developed in future.
And yet another perspective is explored in this publication:
Highbeam Research: “The biopsychosocial model: exploring six impossible things.” Families, Systems & Health, December 22, 2005; Epstein, Ronald M.; Borrell-Carrio, Francesc; see link: http://www.highbeam.com/doc/1G1-144403577.html
“In our view, the biopsychosocial model is a vision and an approach to practice rather than an empirically verifiable theory, a coherent philosophy, or a clinical method. In some cases, when that vision is confused with ideologic dogmatism, it can invite abandonment of the vision entirely or in selected situations. The authors suggest that habits of mind may be the missing link between a biopsychosocial intent and clinical reality. These habits of mind include attentiveness, peripheral vision, curiosity, and informed flexibility.”
F) The BPS model as evaluated by Professor David Pilgrim
“THE BIOPSYCHOSOCIAL MODEL IN ANGLO-AMERICAN PSYCHIATRY: PAST, PRESENT AND FUTURE?”
Prof David Pilgrim, Lancashire NHS Mental Health Care Trust and Department of Sociology, Social Policy and Social Work, University of Liverpool
“First, the pluralism evident in modern mental health services may be driven more by pragmatism than by the BPS model. Indeed, it might be more accurate to account for the admixture of drugs, ECT and psychological interventions in services as the outcome of different disciplines (and groups within them), who favour different approaches to mental health work, negotiating a form of mutual tolerance (Goldie, 1977). In these organisational circumstances, it is easy to confuse pragmatic co-existence, within a variegated and negotiated order of professionals, with genuine evidence of theoretical integration as a shared BPS orthodoxy.
Second, many of the criticisms made by the ‘anti-psychiatrists’ did not disappear, even though their original form petered out within debates about mental health in the 1970s. They were neither definitively refuted (by those like Hamilton and Roth) nor were they permanently defused by partial incorporation (by those like Clare). The concerns of anti-psychiatry have been re-cycled in criticisms from disaffected users, who now constitute a new social movement (Rogers and Pilgrim, 1991). They have also re-surfaced within a newer post-modern professional dissent of ‘critical psychiatry’ (Bracken and Thomas, 1998) and in continuing North American attacks upon the biomedical model from within a realist, rather than a post-modern, paradigm (Breggin, 1991; Ross and Pam, 1995). This suggests that a dialectical opposition provoked by the biomedical model has not found a permanent synthesis and resolution in some version of the BPS model.
Third, those favouring a holistic model have recently expressed a concern that psychiatry is simply becoming neuropsychiatry and the BPS model is losing earlier gains.”
“This paper has described the content and history of the biopsychosocial model in psychiatry and appraised its current status and prospects. The model is supported by the acclaimed intellectual resource of general systems theory. It offers practical and professional advantages for clinical psychiatry and humanistic advantages to mental health service users. Despite these scientific and ethical virtues, to date its promise has not been properly realised. It seems to have been pushed into the shadows by a return to medicine and the re-ascendancy of a biomedical model.”
G) The BPS critically looked at by G. Jacob, from a perspective on back pain
“Biopsychosocial perspective on low back pain: patient provider Communications”; .I Minim Invasive Spinal Tech / Volume 3/Spring 2003
GARY JACOB, D.C.; Los Angeles, California
“Abstract. The term “biopsychosocial” has become quite fashionable in the low back pain industry. Nonetheless, many, if not most, spine care practitioners who employ the term do not appreciate the scope and limitations of the concepts involved, how they were evolved, or the responsibility they place on providers tochange behaviors.“
“Biopsychosocial Concepts Applied to Low Back Pain
As it appears that the biopsychosocial model is not a model at all, but a conceptual construct, it is perhaps more appropriate to reference it as a concept or a perspective. The failure of Engel to provide anything greater than “a very general theory … at no stage….any more than conceptual”” may explain the reason why the low back biopsychosocial literature curiously fails to reference Engel at all.” (p. 30)
“Another perversion of the model is that is has been used for “victim blaming.” Providers not well versed in the theory or practice of biopsychosocial communication skills continue to employ the trappings of the biomedical model and, when it fails, employ the term “biopsychosocial” as a means to blame the patient for therapeutic failures when, in fact, it is the provider that has failed to meet the communication mandates of “biopsychosocialism.”” (p. 34)
H) The BPS model and its challenges, needing to adopt and include new scientific findings – some further articles and views
“Toward an Integration of Social and Biological Research”
Vivia V. McCutcheon; Soc Serv Rev. Author manuscript; avail. in PMC 2010 April 21
…This article presents three conceptual frameworks for integrating genetic and environmental evidence and for organizing knowledge from once-distinct disciplines into a unified framework. Recent evidence for gene-environment interactions is presented to demonstrate the importance of integrating knowledge across disciplinary boundaries.”
The biopsychosocial model is well suited as a framework for research in the social sciences and as a means for creating a bridge with biological science, because it is broad enough to incorporate genetic and environmental factors as potential contributors to health and illness. However, social researchers who use the biopsychosocial model must be careful not to make the same type of mistake (though opposite in intent) as researchers using the biomedical model. That is, social researchers must take care not to discount or exclude genetic effects as potential explanatory factors in their research.”
“What is most curious about the longevity of the idea that both biological processes and life experience affect mental health is the idea’s failure, despite its longevity, to take root in practical application to research designs. One reason for this slow progress may be that science has only recently advanced to the point where biological measures facilitate modeling the ideas implicit in Engel’s work.”
The biopsychosocial model, diathesis-stress theory, and the model of phenotypic vulnerability provide good frameworks for etiological investigations of psychopathology. Each of them is capable of incorporating six principles that can guide the exploration of the interplay between genes and environment (Rutter et al. 1997).”
The following article delivers yet another few aspects and perspectives:
‘Health Skills – Skills for healthy living for health professionals working in chronic pain management’; “How “social” is your biopsychosocial model?”
Posted by adiemusfree on June 14, 2010
“It’s called the biopsychosocial model, but how much attention do we really pay to the social part of this model? While we know the medical model has its limitations (especially when we’re looking at how people respond to having health problems), in pain management I wonder whether we now have a ‘psychological’ model of pain rather than a biopsychosocial model?”
Reading and analysing the various reports and articles that have been written on the “bio psycho-social model”, it becomes clear, that there is a wide range of differing understandings, interpretations, appraisals and suggested applications of this model, which some do not even accept as a proper scientific medical model.
Naturally a common, general basic structure, and how it is supposed to be understood and applied, appears to be accepted by many medical scientists and practitioners, but it also seems that every one confronted with it, and using it, seems to have a rather subjective, personal interpretation of its purpose and use. McLaren does even challenge whether the BPS “model” is based on theory, whether it may fit the concept of a “model” or “theory”. After all, provided it can be seen as a “model”, it leaves too much room or scope in its interpretation and use, leading to confusion. The BPS model certainly has limits, as to how it can be applied in clinical practice.
While there naturally are possible physical, psychological and social influences or causes having impacts on the complex health of persons or groups of persons, in order to objectively and correctly assess any disease and illness, it represents a constant challenge, and at all times requires a very careful, skilful, analytical approach (being a balancing act) when making a diagnosis following such a model.
For McLaren, Tavakoli, Ghaemi and some others the BPS model is seen as flawed, at least in part unreliable, lacking coherence and clarity, and left open to abuse. Talk about “systems theory” and confusion about the semantics about concepts cause irritation for some. It is by Ghaemi and Pilgrim compared to other “trends” that occurred in psychiatry and medical science over times, and possibly being just another fashionable philosophical, or even “political” “trend”, would make it likely to be seen as obsolete, once another new “model” of whatever type may be presented.
What is most concerning about the wide adoption of the BPS is the fact, that it can lead to abuse through the practice of “victim blaming”, where for lack of detectable physical, organic, laboratory or other evidence no proper diagnosis seems possible. It would be too easy to resort to blaming the patient for adhering to “illness belief” or even to malingering. Confusion about cause and effect could also lead to that. As further information will show, it seems evident, that the model is increasingly being used by insurers and governments as a useful vehicle to basically “disentitle” sick and disabled from traditionally granted benefits or insurance payments.
The simplistic claims and messages by Professor Mansel Aylward, by Waddell, Burton and some others, that “work is good for health”, even when a person suffers sickness and is incapacitated, is a worrying sign of a trend to possible abuse of the BPS model. One must in this context ask, whether it was not just the strong, well-financed lobby powers, represented by such self interested insurance corporations like ‘Unum’, who financed, motivated and enabled Aylward and others (based at the ‘Centre for Psychosocial and Disability Research’ at Cardiff University in Wales), to successfully push for the BPS and their interpretation of it, that resulted in the BPS model being so widely adopted and integrated in medical practice and rehabilitation.
Reports and “findings” by fellow medical researchers, also commonly referred to and used by Professor Mansel Aylward – to back up the “research” he and his fellows conducted:
Reports by Eriksen and Ursin (Professors at the University of Bergen), Norway:
Eriksen HR, Svendsrød R, Ursin G, Ursin H. (1998). Prevalence of subjective health complaints in the Nordic European countries in 1993. Eur J Public Health, 8, 294-8.
Downloadable PDF document – found via following link:
(‘International Network for Subjective and Unexplained Health Complaints’)
‘Prevalence of subjective health complaints in the Nordic European countries in 1993’, HEGE R. ERIKSEN, ROLF SVENDSROD, GISKE URSIN and HOLGER URSIN, 1997: http://eurpub.oxfordjournals.org/content/8/4/294
Scandinavian Journal of Psychology 2002, 43, 189-196:
‚Sensitization and Subjective Health Complaints’, H. R. Eriksen and Holger Ursin,
Department of Biological and Medical Psychology, University of Bergen, Norway:
Scandinavian Journal of Psychology 2002, “Subjective Health Complaints”, Hege R. Eriksen and Camilla Ihlebaek, Department of Biological and Medical Psychology, University of Bergen, Norway; Eriksen H.R. & Ihlebaek C. (2002), Subjective health complaints, Scandinavian Journal of Psychology, 43, 101-103:
Psychoneuroendocrinology 29 (2004) 567–592; http://www.elsevier.com/locate/psyneuen
Review: ‘The cognitive activation theory of stress’, Holger Ursin, Hege R. Eriksen; Department of Biological and Medical Psychology, University of Bergen, Jonas Liesvei 91, N-5009 Bergen, Norway
“CATS postulates that only sustained arousal constitutes a potential health risk. High levels of transmitters and hormones generally lead to down-regulation of receptors. This may be an important mechanism for loss of dynamic capacity to respond to new challenges, and increased levels of illness and disease. The picture emerging from recent research on brain regulation of endocrine systems is still incomplete, partly because of the lack of consistent nomenclature for ‘stress’. For the HPA axis there are reasonably consistent findings of increased baseline levels of cortisol and attenuated responses to ‘stress’ stimuli, to negative or inconsistent expectancies, and to depression (Kristenson et al., 2003). Cortisol reactivity and regulation have also been related to the long-lasting effects of trauma (‘post-traumatic stress disorder’, Yehuda, 2002). Sustained arousal may lead to a hyporesponsive HPA axis. However, hypocortisolism may be a common phenomenon even in childhood (Gunnar and Vazquez, 2001).“ (p. 587)
‘Scandinavian Journal of Public Health’ –
Camilla Ihlebæk, Hege R. Eriksen, Holger Ursin; Department of Biological and Medical Psychology, University of Bergen, Norway, 2002:
‘Prevalence of subjective health complaints (SHC) in Norway’
Hege R. Eriksen, from Wikipedia, the free encyclopedia:
Summary Critical Conclusion
Eriksen, Ursin and a small number of other Scandinavian researchers did a number of studies on subjective health complaints (or “unexplained symptoms”), including such in the musculo-skeletal, gastrointestinal, urogenital systems, and “pseudoneurological” complaints like fatigue, dizziness, tiredness, vertigo and headaches. They looked at diagnoses like chronic fatigue syndrome, burnout, stress, food intolerance, irritable bowel, myalgic encephalitis, fibromyalgia and a few others, which they called “fashionable” in at least one report. The phenomena of “sensitization” and of “cognitive activation theory of stress” (CATS) are raised as a possible causes for these conditions or disorders. The somatization of disorders was discussed, and the referral to psychologists was in some cases compared to a “breakdown in communication” between patient and doctor. The “perception of illness” may aggravate the condition was suggested in at least one report.
Analysis on perceived “helplessness” and “hopelessness” in patients to deal with stress are interesting, and it becomes clear, much more research is needed.
In summary, their analysis and reports raise more questions than they offer answers. It can hardly be the case that such subjective health complaints are merely expressions of “illness belief”, exaggerated perception, or the imaginations of patients, due to the absence of physical, organic or “rational” explanations. Rational causes are likely to exist that have not been found and diagnosed. Also is it of little value to make comparisons between for instance “common subjective complaints” like common pain, sleeping problems and short phases of depressed mood, and more serious musculoskeletal or psychiatric disorders, or psychological conditions.
Reports and information from and on G. Waddell, MD, as well as Kim Burton:
“CONCEPTS OF REHABILITATION FOR THE MANAGEMENT OF COMMON HEALTH PROBLEMS”, Gordon Waddell, A Kim Burton, 2004
“Commissioned by The Corporate Medical Group, Department for Work and Pensions, UK”
“The authors are solely responsible for the scientific content and the views expressed, which do not represent the official views of the Department for Work and Pensions, HM Government or The Stationery Office”
“The need for a different approach
The traditional model of rehabilitation is inappropriate for the management of the common health problems that cause most long-term incapacity, because:
Severe medical conditions with objective evidence of disease, pathology, and permanent physical or mental impairments (e.g. blindness, severe or progressive neurological and systemic diseases, psychoses) now account for a minority of disability and incapacity benefits. Some three-quarters of people of working age with long-term incapacity have less severe health problems, the most common of which are mental health, musculoskeletal and cardio-respiratory conditions, which are referred to here as common health problems (that cause incapacity). These have been described as ‘subjective health complaints’ (Ursin 1997) to emphasise their symptomatic nature, as ‘medically unexplained symptoms’ (Page & Wessely 2003; Burton 2003) to emphasise the limited evidence of objective disease or impairment, or as ‘functional somatic syndromes’ (Wessely & Hotopf 1999; Barsky & Borus 1999) because they are ‘characterised more by symptoms and distress than by consistently demonstrable tissue abnormality’. Most important, while fully accepting that these problems may have a biological basis, long-term incapacity is not inevitable.”
“There is clearly no sharp boundary between ‘severe medical conditions’ and ‘common health problems’: rather, there is a spectrum with a variable balance between pathology and symptoms. There are obvious difficulties to defining ‘severe’ and the main messages of this review apply across the whole range of disabilities.”
‘..Indeed, in common health problems, psychological and psychosocial issues are often more important for incapacity than any underlying biological problem.”
“IS WORK GOOD FOR YOUR HEALTH AND WELL-BEING”, Gordon Waddell, CBE DSc MD FRCS, A Kim Burton, PhD DO EurErg, 2006
“The authors were commissioned by the Department for Work and Pensions to conduct this independent review of the scientific evidence.“
“There are economic, social and moral arguments that work is the most effective way to improve the well-being of individuals, their families and their communities. There is also growing awareness that (long-term) worklessness is harmful to physical and mental health, so the corollary might be assumed – that work is beneficial for health. However, that does not necessarily follow.”
“• Various physical and psychosocial aspects of work can also be hazards and pose a risk to
“Unemployment: Conversely, there is a strong association between worklessness and poor health. This may be partly a health selection effect,but it is also to a large extent cause and effect.There is strong evidence that unemployment is generally harmful to health..”
“Work for sick and disabled people: There is a broad consensus across multiple disciplines, disability groups, employers, unions, insurers and all political parties, based on extensive clinical experience and on principles of fairness and social justice. When their health condition permits, sick and disabled people (particularly those with ‘common health problems’) should be encouraged and supported to remain in or to (re)-enter work as soon as possible because it:
• is therapeutic;
• helps to promote recovery and rehabilitation;
• leads to better health outcomes; ….”
“Provisos: Although the balance of the evidence is that work is generally good for health and well-being, for most people, there are three major provisos:
1. These findings are about average or group effects and should apply to most people to a greater or lesser extent; however, a minority of people may experience contrary health effects from work(lessness);
2. Beneficial health effects depend on the nature and quality of work (though there is insufficient evidence to define the physical and psychosocial characteristics of jobs and workplaces that are ‘good’ for health);
3. The social context must be taken into account, particularly social gradients in health and regional deprivation.“
“ORGANISATION OF THE EVIDENCE
The structure of this report follows that of the literature searching and the evidence retrieved (Box 1). The obvious and most accessible starting point was reviews of the adverse health effects of unemployment. However, most of that evidence actually compares unemployment with work, so it was logical to expand the search to include the health effects of work and of unemployment. The retrieved literature was mainly about young or middle working-age adults, so a further search was made for material on older workers. All of these reviews
considered the health impact of loss of employment, but provided little evidence on reemployment. A specific search was therefore made for individual longitudinal studies on the health impact of re-employment.”
The summarised information at the beginning of that long report speaks for the contents of the remainder of the rather comprehensive document: It is a “research” summary full of insufficiently detailed data, allowing ambiguities, lack of clarity, contradictions and many qualifications of claims with virtual “provisos”! It is also based on very selectively gathered data from selected statistical records, like so much that has been compiled by Gordon Waddell, Kim Burton and especially Mansel Aylward.
Through the highly repetitive mention of the words “work” and “health” combined, it is clear, it is a document designed to send a message, rather than offer solid, convincing evidence. Also are many of the summarised “findings” worded in too uncertain terms.
“MODELS OF SICKNESS AND DISABILITY – APPLIED TO COMMON HEALTH PROBLEMS”
Gordon Waddell CBE DSC MD FRCS; Mansel Aylward CB MD FFPM FFOM FFPH FRCP;
Centre for Psychosocial and Disability Research, School of Medicine, Cardiff University, UK
http://awdpa.org/wp-content/uploads/2012/10/Models-of-Sickness-Disability-Waddell-and-Aylward-2010-2.pdf (© 2010 Gordon Waddell)
“This publication is based on Waddell G. Models of Disability (Royal Society of Medicine Press, 2002) and is a further development of ideas and issues presented in that text.”
Extracts: “The rights of Gordon Waddell and Mansel Aylward to be identified as authors of this work have been asserted by them in accordance with the Copyright, Designs and Patents Act, 1988”
“Summary …The aim of this publication is to improve the understanding of sickness and disability associated with common health problems – the mild/moderate mental health, musculoskeletal and cardiorespiratory symptoms that now account for about two-thirds of long-term sickness absence, incapacity benefits and ill-health retirement. This publication reviews the medical model, various social models and the role of personal and psychological factors. This leads logically to a biopsychosocial model that recognizes that biological, psychological and social factors, and the interactions between them, influence the course and outcome of any illness.”
Disease is objective, medically diagnosed, pathology
Impairment is significant, demonstrable, deviation or loss of body structure or function
Symptoms are bothersome bodily or mental sensations
Illness is the subjective feeling of being unwell
Disability is limitation of activities and restriction of participation
Sickness is a social status accorded to the ill person by society
Incapacity is inability to work because of sickness or disability”
(from numbered page 3)
Prevalence of common health problems in UK adults, from the Cardiff Health
Experiences Survey (Buck et al 2009)
Open questions about health
(without pre-labelling and using non-medicalized terminology)
Musculoskeletal problems 11.7% 14.0%
Mental health problems 4.8% 8.7% Other problems 9.4% 15.2%
Inventory of common ‘symptoms’
Musculoskeletal 24.6% 34.0%
Mental health 18.1% 28.8%
Other 26.0% 42.7%
On specific questioning, 66.4% reported at least one (usually mild or moderate) symptom. In open response, 28% people reported ‘problem(s)’, but these were usually more severe.
When patients do seek healthcare for such symptoms, diagnosis is often non-specific
– that is, the symptoms are not assignable to a particular cause, condition or category (ODE 2005). Such diagnoses are often ‘nominal’, existing in name only, not real or actual (ODE 2005): they are simply labels, but the illusion of understanding can be misleading and cause iatrogenic harm.” (page 7)
“These people have what should be manageable health problems. Provided they are given proper advice and support, recovery is normally to be expected and long-term incapacity is not inevitable.” (page 8)
After presenting this and some other explanatory information Waddell and Aylward continue with comparing the traditional “medical model” (meaning the “bio medical model”) with the “social model of disability” and an “economic model” as a separate kind of the “social model”. The social model is questioned – in part due to geographic variations in disability and incapacity claims, but only limited explanations are given. Re the “economic model” the authors argue that the benefit system gives sick and disabled “incentives” to claim them, which has a negative economic impact. But that is qualified by findings in Scandinavia. Even a “cultural model” is discussed.
They discus “personal and psychological factors”, and finally (“unsurprisingly”) come back to their already upheld conclusion, that the “bio psycho-social model” is the best and most appropriate one to follow and use. Yet in this publication Waddell and Aylward are defending and recommending that latter model in a far more cautious manner than in earlier ones, realising there are also serious limitations with it, and a lack of empirical evidence, how it has been applied successfully (in individual cases). It must be presumed that the negative experiences gathered from the mishandled and detrimental welfare reform approaches in the UK have led to this realisation.
Further interesting extracts from their report are:
“The medical model was originally developed for physical disease and has always been less comfortable with mental illness. Although biological (e.g. genetic and biochemical) factors play an important role in mental illness, a ‘disease model’ that ignores psycho- logical and socio-cultural factors is inadequate for mental illness (Kiesler 1999).” (page 11)
“The medical model remains valid for the investigation and treatment of severe medical conditions – although, even here, psychosocial factors influence response to bio- logical treatment (e.g. the placebo response) and management must be tempered with due allowance for the individual patient and their circumstances (which immediately introduces a biopsychological approach to management).” (page 12)
“Limitations of the social model of disability –
Perhaps naturally in view of its origins, the social model of disability:
• applies best to people with severe medical conditions and permanent physical or mental impairment – and these are the examples used in the welfare debate, even by proponents of the social model
• downplays understanding of the individual’s health condition, and takes symptoms and disability at face value…”
“The social model is generally used in the context of ‘disability’, but may be applicable to sickness, particularly with mental health problems. Common mental health problems often involve problems with social relationships, at work and elsewhere.” (page 14)
Quote: “Clinically, the economic model 16 raises issues of exaggeration and malingering (Schultz et al 2000, Halligan et al 2003, Waddell 2004).”
“The fundamental limitation of the economic model is that human behaviour is not entirely self-interested, utilitarian or rational (Bane + Ellwood 1994, Piachaud 1997)”. (page 18)
“Culture may vary in different societies, in different subcultures of a society, and in any society over time. For example, there are marked differences in pain experience, expression and behaviour in different cultural and ethnic groups. The ‘welfare culture’ is the set of ideas, values and basic principles that surround the benefits system and underpin welfare policy, the institutions of the welfare state, and the thinking, feelings and consequent behaviour of the various stakeholders in a given society (developed from Chamberlayne et al 1999, Pfau-Effinger 2005).” (page 19)
“Psychologists study how people think and feel about their health condition, and how that affects their illness behaviour (Mechanic 1968). There is extensive clinical evidence that psychological factors influence the course and outcome of human illness…” (p. 20)
Psychological factors that influence sickness and disability
The personal, subjective experience of illness and disability may diverge from objective measures ..
Assumptions, perceptions and expectations (by the individual, family, health professionals and employers, which may interact and reinforce each other)…
Uncertainty, anxiety and fear-avoidance
Depression…” (page 20)
“Human beings are driven by both self-interest and altruism,19 but self-interest is generally dominant.” (page 21)
“The benefit system must then take account of moral hazard.21 The structures and (dis)incentives of the benefit system influence claimant behaviour, and the present structure sometimes creates ‘welfare dependency’.” (page 22)
“The biopsychosocial model recognizes that biological, psychological and social factors, and the interactions between them, can influence the course and outcome of any illness. Human beings are biopsychosocial – an integrated whole of body and mind in a social being – so a comprehensive model of human illness must be biopsychosocial.” (page 22)
“The International Classification of Functioning, Disability and Health (ICF) (WHO 2001) tried to reconcile the medical and social models of disability and to balance the individual and social perspectives, even if it did not fully satisfy either side (Masala + Petretto 2008).”
“However, it is still very much a model of disability rather than sickness, and applies best to people with impairments. It fails to consider adequately the personal/psychological dimension or the interactions between the three dimensions. It is primarily a taxonomy rather than a clinical or conceptual model.” (page 22-23)
“The bio-psycho-social may be regarded as ‘dimensions’, integrated elements or perspectives on the whole entity of illness, which cannot be isolated from each other.” (page 24)
“Caveats to the biopsychosocial model 25
The biopsychosocial model is not an aetiological model of disease, and arguments about whether the cause of a particular disease is biological or psychosocial obscure the main issue26 (Kiesler 1999, White 2005). First, it is a process rather than a causal model. Second, it is a model of illness, not of disease. Third, most illness (and most disease) is multicausal.“ (page 26)
“Virtually all sick or disabled people have a ‘genuine’ health problem, and most also have some psychosocial issues. Inability to diagnose pathology does not mean that the problem is psychosocial, any more than the identification of psychosocial factors excludes a genuine health problem. Assuming that the problem is ‘psychosocial’ may lead to missing treatable biology, while failure to recognize psychosocial issues can lead to delayed recovery. Furthermore, psychosocial factors are not a ‘diagnosis’ in themselves.
‘subjective health complaints’ or ‘symptom-defined illness’” (p. 27)
“The major limitation of the biopsychosocial approach has been the lack of simple clinical tools to assess psychosocial issues and simple, practical interventions to address them (Kendall et al 1997, Borkan et al 2002, Kendall + Burton 2009).”
„After more than 30 years, and despite agreement on the importance of psychosocial factors, there is relatively little empirical evidence for effective biopsychosocial interventions at an individual level.” (p. 28)
Under the heading ‘The biopsychosocial model applied to common health problems’ Waddell and Aylward again adopt a more positive and assertive stand to recommend the “bio psycho-social model” for “common health problems”.
“The biopsychosocial model provides both a philosophy of clinical management and a set of practical clinical tools (Schultz et al 2000, Borrell-Carrio et al 2004). Philosophically, it provides better understanding of illness, sickness and disability. At a practical level, it provides a framework for better clinical assessment, management and rehabilitation.” (p. 39)
Then it is back to the message that work is not necessarily the cause for ill-health, and that the message “Work is generally good for health and well-being” deserves to be upheld and strongly emphasised.
“Modern clinical management of common health problems emphasizes restoring function as the best means of achieving lasting relief (Waddell + Burton 2004). In the biopsychosocial approach, relief of symptoms and restoration of function are closely intertwined, run concurrently and are interdependent.” (page 31)
Going back to arguments presented in earlier reports, both authors push for workplace management, rehabilitation, symptoms management and the return to – or maintenance of work. Early intervention is proposed by referring to already previously used statistics on welfare figures and the likes, on work absence due to disability.
“The crux of the matter is striking the right balance between healthcare and the focus on work, and all working together. That is a biopsychosocial approach.” (p. 35)
Both raise the increase in complaints of mental illness cases, while also referring to the DSM-VR and ICD-10 and diagnostic practices. They state that the main problems are mild to moderate mental illness cases, and they again blur the complex picture of mental illness by bringing in the concept of “common mental health problems”. Mental health problems are “biopsychosocial” disorders, is their conclusion. Sleep problems, stress and (common) depression are mentioned again, and they correctly confirm that “stress” is not listed in DSM-IV and ICD-10.
“Assessment of mental health problems is based largely on self-report of subjective symptoms, with all the conscious or psychological influences thereon. Diagnosis depends on (a) confirmation by an external observer (e.g. the GP), which is again subjective and further depends on the observer’s conscious or unconscious bias, and/or (b) comparison with some kind of established pattern (e.g. DSM-IVR or ICD-10). Thus, certification of mental illness and (in)capacity for work unavoidably raises issues of validity and reliability, with difficulties for any social security control mechanisms.” (p. 39)
Treatment options are discussed (medical, psychotherapy, psychosomatic and condition management), but it is admitted that some, if not most, are little effective to achieve much improved ability to work:
“Overall, healthcare for common mental health problems improves clinical outcomes, but there is a lack of evidence that it improves work outcomes. Deteriorating trends (Figure 10) suggest that this is not just a lack of evidence but also a lack of effective interventions for work outcomes.” (p. 39)
Hence better diagnostic assessment practices and more research are recommended.
In the end social support is mentioned, questions about “rights” and “obligations” are raised, which leads also again to the aim for “support into work”. Also do the authors discuss the “welfare debate”, and they accept “that a more comprehensive biopsychosocial model is essential for full understanding of the relationship between common health problems, sickness and disability, and incapacity for work”.
Waddell and Aylward demand:
“Radical policy solutions to the problem must address both the incentives and control mechanisms of the social security system and provide the resources and support required to overcome the individual, psychosocial and system obstacles to return to work.
It is therefore right and proper to address the (dis)incentives and control mechanisms of disability and incapacity benefits. And it is entirely moral to balance the needs of sick and disabled people with those of society and the taxpayer, and rights with responsibilities.” (p. 45)
A “culture change” is finally asked for, and in their “conclusion” both authors state:
“At the time of writing, the UK is entering a major economic recession, which may change everything. This should not be an excuse to delay addressing sickness and disability, but an additional reason to invest now.”
Summarised own critical conclusion:
This is yet another publication by Waddell and Aylward – defending, promoting and perpetually propagating the “bio psycho-social model” for diagnosis, rehabilitation and treatment, and presenting work and employment as beneficial for the health of sick, disabled and incapacitated. It is in the end another report (although more qualified) that is once again “blurring the lines” by questioning the seriousness of so-called “common health problems”, with the intention of readying the sick and disabled – for the open attack by state welfare agencies – or insurance companies – to disentitle beneficiaries and claimants from so far received support.
“VOCATIONAL REHABILITATION WHAT WORKS, FOR WHOM, AND WHEN?” Gordon Waddell, A Kim Burton, Nicholas AS Kendall,
“The authors were commissioned by the Vocational Rehabilitation Task Group (a group of stakeholders representing the UK Government, employers, unions and insurers) in association with the Industrial Injuries Advisory Council (IIAC), to conduct this independent review of the scientific evidence”
This review has demonstrated that there is a strong scientific evidence base for many aspects of vocational rehabilitation. There is a good business case for vocational rehabilitation, and more evidence on cost-benefits than for many health and social policy areas.
Common health problems should get high priority, because they account for about two-thirds of long-term sickness absence and incapacity benefits, and much of this should be preventable. Vocational rehabilitation principles and interventions are fundamentally the same for work-related and other comparable health conditions, irrespective of whether they are classified as injury or disease. Return-to-work should be one of the key outcome measures.”
“Condition specific findings:
There is strong evidence on effective vocational rehabilitation interventions for musculoskeletal conditions. For many years the strongest evidence was on low back pain, but more recent evidence shows that the same principles apply to most people with most common musculoskeletal disorders.
Various medical and psychological treatments for anxiety and depression can improve symptoms and quality of life, but there is limited evidence that they improve work outcomes. There is a lack of scientific clarity about ‘stress’, and little or no evidence on effective interventions for work outcomes. There is an urgent need to improve vocational rehabilitation interventions for mental health problems. Promising approaches include healthcare which incorporates a focus on return to work, workplaces that are accommodating and non-discriminating, and early intervention to support workers to stay in work and so prevent long-term sickness.”
This report delivers more of the same, the attempted re-interpretation of what illness means compared to disease, what incapacity means for different group of disabled, sick and injured, and suggesting the result or effect is the issue, rather than the cause.
Nobody questions the need for rehabilitation where it is possible, appropriate and can work, but is it not the fact that people end up on sickness and disability benefits due to having serious enough conditions or disorders, so that this makes it difficult or impossible for them to perform ordinary work? Of course working people are less likely to end up as long term ill, incapacitated and unemployed, for the very fact that they are fit enough to still cope.
It is another attempt to blur the lines to enable insurers and the state to push more people with some forms of incapacity back into jobs, to save costs, by applying the BPS model.
“Nonorganic Physical Signs in Low-Back Pain”
G. Waddell, J.A. McCulloch, E. Kummel and R. M. Venner; 1980
Waddell (et al.) attempting to distinguish between physical signs and non-organic, psychological signs when diagnosing back pain. Overreaction is mentioned as a frequent issue. A need for psychosocial assessment is expressed.
“The Use Of Waddell Tests In Workers Compensation Claims”, By Jon L. Gelman and Myron E. Brazin, M.D.
Jon L. Gelman, who practices in Wayne, NJ, wrote Workers’ Compensation Law (West Group 2003), is a contributing member/author of the advisory board of Modern Workers Compensation (West Group 2001) & is a former national Vice-President of the Workplace Injury Litigation Group. Jon L. Gelman, 1450 Valley Road, 1st Floor, P.O. Box 934, Wayne, NJ
“In reviewing numerous medical records, including orthopedic and physical therapy reports, it is common to find mention of “The Waddell Test” and extensive reporting of examination findings featuring the results of its component maneuvers.”
In permanent disability from workplace injury, physical and mental factors must be considered. It was the intent of Dr. Gordon Waddell (1) and his colleagues to distinguish and standardize “nonorganic” physical signs that sometimes accompany low back pain. Their larger goal was to help identify patients “who require more detailed psychological assessment”.
“The authors rejected the notion that their testing identifies malingerers or exaggerators.”
“The authors recognize the fact that a finding of “overreaction” may be biased by the observer.”
Jon L. Gelman gives advice on legal cross examination of “Waddell Test” cases, as there is sufficient evidence the test is unreliable.
Gordon Waddell – Wikipedia entry:
Although Waddell’s signs can detect a non-organic component to pain, they do not exclude an organic cause. Clinically significant Waddell scores are considered indicative only of symptom magnification or pain behavior, and have been misused in medical and medico-legal contexts. Waddell’s signs are not considered a de facto indicator of deception for the purpose of financial gain.”
Clearly Waddell’s assessment methods and theories were proved to be unreliable!
Summary Critical Conclusion
Like Mansel Aylward himself, Waddell and Burton tend to use the “bio psycho-social model” in a manner, where illness is considered not to be a disease, as according to their interpretation it cannot be based on organic or physical evidence. They attribute illness and certain resulting illness behaviour, and any associated incapacity rather to “psychosocial” causes. In questioning the seriousness of illness and incapacity, they stress the view that most illnesses are “common health problems” that may be of musculoskeletal, cardio-respiratory or psychological types.
They follow H. E. Eriksen in believing that many of such illnesses are “subjective health complaints” and thus do not lead to severe or permanent incapacity. Hence occupational rehabilitation should be considered and applied more for those suffering from such health conditions, with the aim of returning them to some form of work.
They do – as Aylward – go as far as describing work as “therapeutic” and “healthy”, but do mention disclaimers and qualifying comments to avoid claiming that this approach would be appropriate and helpful for all affected in any work scenario.
The suggested approaches are again an exercise of further blurring the already hard to specify boundaries between serious physical illness and “common” physical ailments (or complaints), same as between mental disorders and perhaps rather “common” psychological conditions, that can be treated.
Waddell and Burton worked for the DWP, and Waddell works also at the ‘Centre for Psychosocial and Disability Research’, Cardiff, hence true independence is an issue.
Reports and information on George Libman Engel (1913 to 1999), US psychiatrist, University of Rochester Medical Center, Rochester, New York:
George Libman Engel (December 10, 1913 – November 26, 1999), Wikipedia:
“By the mid-1950s, he was considered as one of the major figures in psychosomatic studies. He was prominent in the American Psychosomatic Society. He also edited its journal, Psychosomatic medicine and began publishing numerous books and articles on the relation of emotion and disease and on the incorporation of these ideas into medical training and clinical practice. Under his direction, the program at the university became a leading center in the development of psychosomatic theory and training. His ideas came to be termed as the biopsychosocial model.
The fundamental assumption of the biopsychosocial model is that health and illness are consequences of the interplay of biological, psychological, and social factors. This concept is particularly important in health psychology. This model was theorised by Engel at Rochester and putatively discussed in a 1977 article in the journal Science.”
Engel and his “bio psycho-social model”:
“Model description and application in medicine
…It is important to note that the biopsychosocial model does not provide a straightforward, testable model to explain the interactions or causal influences (that is, amount of variance accounted for) by each of the components (biological, psychological, or social). Rather, the model has been a general framework to guide theoretical and empirical exploration, which has amassed a great deal of research since Engel’s 1977 article. One of the areas that has been greatly influenced is the formulation and testing of social-cognitive models of health behavior over the past 30 years.”
Some psychiatrists see the BPS model as flawed, in either formulation or application. Epstein and colleagues describe six conflicting interpretations of what the model might be, and proposes that “…habits of mind may be the missing link between a biopsychosocial intent and clinical reality.” Psychiatrist Hamid Tavakoli argues that the BPS model should be avoided because it unintentionally promotes an artificial distinction between biology and psychology, and merely causes confusion in psychiatric assessments and training programs, and that ultimately it has not helped the cause of trying to destigmatize mental health.
Sociologist David Pilgrim suggests that a necessary pragmatism and a form of “mutual tolerance” (Goldie, 1977) has forced a co-existence of perspectives, rather than a genuine “theoretical integration as a shared BPS orthodoxy.” Pilgrim goes on to state that despite “scientific and ethical virtues,” the BPS model “…has not been properly realised. It seems to have been pushed into the shadows by a return to medicine and the re-ascendancy of a biomedical model.”
However, a vocal philosophical critic of the BPS model, psychiatrist Niall McLaren, writes:
“Since the collapse of the 19th century models (psychoanalysis, biologism and behaviourism), psychiatrists have been in search of a model that integrates the psyche and the soma. So keen has been their search that they embraced the so-called ‘biopsychosocial model’ without ever bothering to check its details. If, at any time over the last three decades, they had done so, they would have found it had none. This would have forced them into the embarrassing position of having to acknowledge that modern psychiatry is operating in a theoretical vacuum.”
The rationale for this theoretical vacuum is outlined in his 1998 paper and more recently in his books, most notably Humanizing Psychiatrists. Simply put, the purpose of a scientific model is to see if a scientific theory works and to actualize its logical consequences. In this sense, models are real and their material consequences can be measured, whereas theories are ideas and can no more be measured than daydreams. Model-building separates theories with a future from those that always remain dreams. An example of a true scientific model is longer necked giraffes reach more food, survive at higher rates, and pass on this longer neck trait to their progeny. This is a model (natural selection) of the theory of evolution. Therefore, from an epistemological stance there can be no model of mental disorder without first establishing a theory of the mind.”
***See also the information under ‘Bio Psycho-Social Model’ further above***
Reports from and information about Dr Simon Wessely, UK:
Sir Simon Charles Wessely (born Sheffield, 1956), psychiatrist, Wikipedia entry:
“Wessely’s main research interests lie in the “grey areas” between medicine and psychiatry, clinical epidemiology and military health.” “He has published most widely on aspects of chronic fatigue syndrome, including its aetiology, history, psychology, immunology, sociology, epidemiology and treatment.”
“Wessely and his colleagues, using randomised controlled trials and follow-up studies, developed a rehabilitation strategy for patients that involved cognitive behavioral and graded exercise therapy, that is effective in reducing symptoms of CFS (a condition that otherwise lacks a cure or unequivocally successful treatment) in ambulant (non-severely affected) patients.”
Although Wessely has studied physical markers and allows the possibility of a biological basis to CFS, he is not confident of such a basis and remains sceptical. He has also suggested that campaigners are motivated “not so much by a dispassionate thirst for knowledge but more by an overwhelming desire to get rid of the psychiatrists” from the area of chronic fatigue syndrome, despite having himself published research which concluded that “the stereotype of CFS sufferers as perfectionists with negative attitudes toward psychiatry was not supported”. When asked about severely affected bed-ridden patients, Wessely said “in that kind of disability, psychological factors are important and I don’t care how unpopular that statement makes me.”
“From Shell Shock to PTSD: A story in three acts”, by Simon Wessely, Director –
King’s Centre for Military Health Research, Institute for Psychiatry:
(an audio presentation from ‘slide.share’
“Chronic fatigue syndrome researchers face death threats from militants –
Scientists are subjected to a campaign of abuse and violence”; Robin McKie, The Observer, published in ‘The Guardian’, 21 August 2011
Engel theorised the “bio psycho-social model” as a more humane, inclusive approach to apply medicine, trying to create a better model to the traditional bio-medical model, which he considered to be too “reductionist”. He included biological, psychological and social factors, as they all play a role in the human functioning in the context of disease and illness.
It appears that others adopting and following his original model have re-interpreted it, while in at least some cases relying on subjective understanding, judgment or priorities. This has led to variations of the model being applied nowadays. This may not surprise given the complexity of factors that come into play with such a model.
Hence medical researchers and experts like Mansel Aylward, Gordon Waddell and others have used it in ways that the psychological and social aspects have been given more emphasis, to explain illness where diagnosis using traditional bio-medical methods has been difficult. It appears that such a shift threatens to lead to mistakes that have previously been made by strong adherents to the bio-medical model. With the lack of clear, organic, physical signs, they may too easily and conveniently determine that sick and ill persons are not really suffering from serious health issues, and that impairments or incapacities are not to be taken too seriously either.
Wessely has added his own interpretations to certain diseases or illnesses, which have led to further controversy and problems with the “bio psycho-social model”.
It must be concluded that this model has created a lot of uncertainties and can only serve as one of many approaches to diagnose and treat sick and incapacitated persons. It should only be applied with great caution, with attention to all available details of information, and in a truly thorough, objective and balanced manner.
‘THE ALL WORK TEST’, ‘WORK CAPABILITY ASSESSMENT’ (WCA) AND ‘ESA’ AS USED IN THE UK:
The original ‘All Work Test’ that was developed with the assistance of Mansel Aylward in the 1990s in the UK: ‘ALL WORK TEST’ DESCRIPTORS’
“From 6th January 1997 Regulations came into force amending the activities and descriptors used to award points in the all work test, to establish whether someone is treated as incapable of work for benefit purposes.”
It must be noted, that it is primarily focused on physical impairments and incapacity, and neglects psychiatric and psychological health problems.
The ‘WCA’ or ‘Work Capability Assessment’ – Department for Work and Pensions
A guide to Employment and Support Allowance – The Work Capability Assessment
(ESA214, January 2013)
This is the “improved” or updated version of the ‘WCA’ used by ATOS Healthcare as commissioned assessors for the DWP in the UK – in or since January 2013. See again the very tight criteria set for physical, mental and psychiatric diseases and illnesses, for disabilities resulting in impairment or incapacity. The assessment still gives totally insufficient considerations to incapacities suffered due to psychiatric and psychological conditions. Persons must more or less be close to being intellectually handicapped to qualify, apart from having physical disabilities of severe types.
Training + Development Revised WCA Handbook ESA (Amendment) Regulations 2011 and 2012, DWP, Version: 6 Final 19 March 2013
“This training has been produced as part of a training programme for Health Care Professionals approved or appointed by the Department for Work and Pensions Chief Medical Adviser to carry out benefit assessment work.”
The Handbook for medical and health professionals conducting assessments, with incorporated changes and “improvements”.
Work Capability Assessment (WCA) Factsheet, ‘Rethink Mental Illness’, March 2011
UPDATE, ‘Disability Information Scotland’, DWP Medicals –Work Capability Assessments, 2012
Further information on WCA and ESA:
Benefits + credits, ‘Employment and Support Allowance’ (ESA), Government UK:
Employment and Support Allowance (ESA) and Work Capability Assessments
‘Dwp examination’, ’44,000 G.P.s call for ATOS WCA to be scrapped’, 22 May 2012:
‘The Guardian’, Amelia Gentleman, 23 May 2012
“GPs call for work capability assessment to be scrapped”
“Doctors say method of determining who is eligible for sickness benefits should be replaced with more ‘rigorous and safe system’”
‘Benefits and Work, Guides you can trust’ –
‘DWP ordered to improve mental health WCA’, 01 June 2013:
“A three judge panel of the Upper Tribunal has ruled that the Work Capability Assessment substantially disadvantages claimants with mental health problems, because the system is designed to deal with a high volume of claimants who can accurately report the way in which their disability affects their fitness to work.
The court ordered that the DWP has to take reasonable steps to address the disadvantage to people with mental health problems, but rather than specifying what those reasonable steps should be, ordered the DWP to carry out an investigation and then return to court to explain what steps they propose to take.”
The table below shows the schedule of activities, descriptors and points following the changes.
‘UNUM’ AND ‘UNUM LIFE INSURANCE COMPANY OF AMERICA’:
‘Unum’, formerly known as ‘Unum Provident’ is one of the world’s largest disability insurers, based in the US, but also having been doing business in the UK for some time. ‘UnumProvident’ is known to have advised certain UK governments on health and disability matters, including suggested welfare reforms. It also was involved in establishing and funding the ‘Unum Research Centre for Psychosocial and Disability Research’ at Cardiff University in Wales, UK, at which Mansel Aylward took over directorship and a senior, active role.
Extracts from Wikipedia – see also this link: http://en.wikipedia.org/wiki/Unum
“Unum is a Chattanooga, Tennessee-based insurance company previously named UnumProvident, which was formed from the merger of two competing insurance companies, Unum of Portland, Maine, and Provident Life and Accident Insurance Company of Chattanooga. It is currently the largest disability insurance company worldwide. Unum provides employee benefits including disability insurance, critical illness insurance and life insurance.”
Unum became the focus of massive negative media attention in 2002, after several plaintiff’s attorneys who had sued the company went to national television outlets claiming that the company had quotas for closing claims. CBS’s 60 Minutes aired a very devastating article about Unum’s alleged abuses. Among their proof was a notorious “Hungry Vulture Award” offering employee rewards to close claims. Due to its admitted unfair business practices, investigations, and fines, Unum was called an “Outlaw Company” by the former California Insurance Commissioner, John Garamendi (who later became Lieutenant Governor). Unum attempted to counter the accusations by noting that “only 2% of the policyholders who filed a claim with the company last year  were found not to be disabled, an amount consistent with prior experience,” and that court judgments in the prior year were in the company’s favor 75% of the time, however no attempt was made to clarify the short term vs. long term statistics.”
“Advising the United Kingdom government on claims since 1994, Unum has been involved with the UK’s controversial Welfare Reform Bill. Unum was investigated by the BBC in England and were described by critics as a ‘rogue firm‘.[verification needed] In July 2010, Susan Ring, the CEO of Unum UK left her post and was replaced by Jack McGarry from Unum US, who was replaced in 2012 due to poor performance of the UK subsidiary.”
Further online information:
‘Unum’: Case Management
Vocational Rehabilitation Case Management Service
Vocational Assessments – Open Door
Vocational Rehabilitation Case Management Service
UK Parliament, Publications and Records –
‘Select Committee on Work and Pensions’ – Minutes of Evidence
Memorandum submitted by UnumProvident (EDP 03), 13 December 2002
(evidence that UnumProvident had submitted advice to the DWP on welfare reform)
“II. Do the high numbers of people on incapacity benefit (IB) represent hidden unemployment?
5. It is UnumProvident’s contention, and its commercial experience, that acquiring a disability does not make one incapable of work. In our experience, most disabled people are capable of some work, would like to work and crucially, have an expectation that they will return to work in some capacity.”
“IV. The role of the Private Sector
11. UnumProvident firmly believes that there is a significant role for the private sector to play in helping to return disabled people to work. As the UK’s leading provider of income protection insurance, UnumProvident is particularly well-placed to share with the Committee examples of projects and initiatives that might be of assistance to the Government. Like the Government, UnumProvident:
— insures people against the risk of not being able to work through acquiring a disability; and
— assesses all claims made, paying all valid ones.”
“V. Tax Credit and Benefit Systems
19. It is our belief that the current tax and benefits system is overly complex, can provide strong disincentives for disabled people to look for work, and is in need of radical reform. UnumProvident put forward a blueprint for welfare reform in its paper “Diversity in Employment”. In brief, and as outlined at paragraph 8, our proposal is that those disabled people capable of some work should be moved from IB to a form of JSA. Here they would be properly supported in their search for and transition into work.”
‘THE GROUP ON SCIENTIFIC RESEARCH INTOMYALGIC ENCEPHALOMYELITIS’ (THE GIBSON PARLIAMENTARY INQUIRY)
“CONCERNS ABOUT A COMMERCIAL CONFLICT OF INTEREST UNDERLYING THE DWP HANDBOOK ENTRY ON MYALGIC ENCEPHALOMYELITIS / CHRONIC FATIGUE SYNDROME”
Professor Malcolm Hooper; Eileen Marshall; Margaret Williams; December 2005
From: “Summary of Concerns”
“(v) the psychiatrists advising the DWP who advocate this strategy have an undeclared financial conflict of interest: many are medical advisers to insurance companies”
“…in addition, Professor Simon Wessely is involved with PRISMA, a multi-national healthcare company working with insurance companies to arrange “rehabilitation” programmes for those with ME/CFS.”
“Senior Psychiatrists collude with Medical Insurers to classify ME/CFS as a psychiatric disorder
…Wessely School psychiatrists are heavily involved with UNUM and with the medical insurance industry in general; insurance companies in addition to UNUM with which they are known to be directly involved include Swiss Life, Canada Life, Norwich Union, Allied Dunbar, Sun Alliance, Skandia, Zurich Life, and Permanent Insurance, and as re-insurers, the massive Swiss Re (whose building in London has been dubbed the “gherkin”).”
“The Arrival of UNUMProvident into the UK Benefits System
Such official recognition notwithstanding, after the commercial interests of the disability insurance industry and its Wessely School ‘medical advisers’ became instrumental in the UK benefits system, the situation for those with ME/CFS took a serious turn for the worse.
Dr Peter Dewis from the DWP / DLA Advisory Board (who, together with Professor Mansel Aylward authored the Disability Handbook and is now Chief Medical Officer at UNUMProvident – see below) confirmed that before Attendance Allowance became the Disabled Living Allowance (DLA), decisions on eligibility for State sickness and disability benefits were made by doctors (hence the “Handbook for Delegated Medical Practitioners”), but since the advent of DLA, such decisions are now made by non-medical personnel, and the “Disability Handbook” is a guide for these non-medical decision-makers.”
“Crucial to the new UK disability rules were tougher medical tests.”
“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.”
The Government’s goal of reforming the State benefits system is well-known: the intention to force cognitive behavioural therapy on those seeking sick notes was highlighted in an article on Sunday 20th November 2005 in The Observer, (“Therapy for those seeking sicknotes”) in which Gaby Hinsliff, the political editor, wrote:
“Margaret Hodge, the Welfare Minister, wants to use so-called cognitive behaviour therapy – a fashionable ‘talking cure’ used to change habits – to encourage people to return to work. (This) would be part of a ‘carrot and stick’ approach, under which people judged capable of working could have their benefits docked unless they take steps towards employment. Hodge said it was ‘not unreasonable’ to require something in return for benefits”.”
“E pluribus Unum”, Jonathan Rutherford, The Guardian, 17 March 2008:
“James Purnell’s reforms of incapacity benefit are inspired by a US company with vested interests and a murky record. Now, that’s really sick”
DNS – Disability News Service, 02 Jan. 2012:
“Politicians and DWP combine to block answers on Unum links”
Disabled Go News Blog
‘Government silent over adviser’s Unum admission’; 07 Feb. 2012
““With their mass marketing on commercial TV, Unum continues to benefit from the welfare reform measures that they helped to influence and it is totally unacceptable that any government adviser should fail to declare an interest with this diabolical corporate giant.”
The DWP has refused to comment on Perkins’ failure to register her Unum work as a potential conflict of interests with her Equality 2025 role.
DNS revealed evidence last year that strongly suggested that Unum has attempted to influence incapacity benefit reform over the last decade, particularly under the Labour government.
Unum has denied doing so and that it stands to gain from the reforms, even though it launched a major media campaign last year just as the coalition began a three-year programme to reassess about 1.5 million existing IB claimants through the new, stricter test, the WCA.”
DNS – Disability News Service, 15 Feb. 2013: “Unum bragged about ‘driving government thinking’ on incapacity benefit reform”:
“An insurance company set to make huge financial gains from incapacity benefit (IB) reform bragged about “driving” the government towards those reforms, evidence obtained by Disability News Service (DNS) has revealed.”
“Unum Group Shares Tumble As Lawsuits Continue to Pile Up…”
“Unum Group, which has operations in the US, UK and other countries, is a provider of disability insurance, group life insurance and other benefits for employees in various industries. The tough sledding for the company’s shares comes amid a number of accusations against the company, most often involving plaintiffs claiming they did not receive the benefits they were entitled to.”
(‘LawyersandSettlements.com’, 04 Oct. 2011)
“Appeals Court Rules Against Disability Insurer” ‘LifeHealthPRO’, 14 Sept. 2012
“In a split decision, the panel majority found that a U.S. District Court judge should have paid more attention to how much the fact that the plan administrator, Unum Life Insurance Company of America, was also the plan insurer should have affected the court’s analysis of whether Unum Life might have abused its discretion to interpret the group LTD policy.
Circuit Judge Marsha Berzon and Senior 3rd Circuit Judge Robert Cowen ruled in favor of Mark Stephan, the plaintiff in the case, Mark Stephan vs. Unum Life Insurance Company of America (Number 10-16840).”
Sundry information on both ‘Atos Healthcare’ and ‘Unum’ – from DPAC website:
“Round up of DWP Atos Business from whywaitforever”; 18 Dec. 2011
PROFESSOR MANSEL AYLWARD AND EFFORTS TO SPREAD HIS BIO PSYCHO SOCIAL MODEL AND APPROACH DOWN-UNDER:
Mansel Aylward has over the last couple of years been visiting Australia and New Zealand on a number of occasions, having been invited by health authorities, health professional organisations, and private and government agencies.
In the following I will list some occasions and share some essential information about some of these visits:
Australian Government – Comcare, 31 May 2010:
“Government and industry leaders meet Professor Sir Mansel Aylward; 31 May 2010
On 18 May 2010 Government leaders from the federal safety and compensation jurisdiction, industry leaders and social partners ACTU attended a dinner in Sydney with special guest Professor Sir Mansel Aylward CB. Professor Aylward is one of the world’s leading experts in psychosocial, economic and cultural factors that influence health, illness and recovery.”
“His fundamental message was clear – Work is good for our health and wellbeing”
“Psychosocial factors are the main determinants of health, illness and recovery.
An individual’s health status depends more on lifestyle, environmental, and socio-cultural, factors than on biological status and conventional health care. This is also true of recovery following an injury. Psychosocial factors such as an individual’s lifestyle and social circumstances are the dominant barriers to a successful return to work in 75 per cent of cases.”
On Tuesday 18, May 2010, ‘Realising the Health Benefits of Work’, a position paper developed by the Australasian Faculty of Occupational + Environmental Medicine was officially launched in Sydney, Australia. Dr Robin Chase, President AFOEM, introduced Professor Sir Mansel Aylward at the launch:
28 May 2012: Ko Awatea Centre, Manukau, Auckland, New Zealand
“Sir Mansel Aylward asks the question: “What has had the greatest impact on the NZ health system?”
It was standing room only for Sir Mansel Aylward’s second and final lecture at Ko Awatea. Following on from the last session around leadership Sir Mansel asked the following questions: “What in your opinion has had the greatest impact on the NZ health system and when looking at these areas what was the leadership role?””
“The first in this series results from Professor Sir Mansel Aylward’s work during his time at Ko Awatea as the the First Ko Awatea Stevenson Visiting Professor. For three months in early 2012 Sir Mansel’s task was to identify the key challenges facing CMDHB and to provide us with recommendations on a way forward to address the challenges so that CMDHB can deliver best in class services to constituents.
Sir Mansel worked closely with Ko Awatea’s Jonathon Gray and with Pam Muth from KPMG. Together they produced the first two White Papers in the series that can be found here: koawateablog.co.nz/?p=2118”
Prof. Mansel Aylward speaking about key population health challenges at ‘Ko Awatea’, loaded 29 May 2013
Rotorua GP CME 2013 –
Introduction and profile of Professor M. Aylward, also announcing his speeches at the annual GP CME conference in Rotorua, New Zealand on 21-22 June 2013:
‘The Listener‘ 28th April 2012 –
‘NZ Hospitals: the link between poverty and illness’;
“A visiting health expert who knows about poverty and illness says hospitals are not the answer.”
“Meet Professor Sir Mansel Aylward, a dapper and jovial Welshman who wants to close your local hospital. Actually, he’s fond of saying that all hospitals should be “abolished”.”
Also: Mention of Professor Aylward in policy development:
The Ministry of Social Development, Office of the Minister
‘WELFARE REFORM PAPER C: HEALTH AND DISABILITY’
release to the media, 2012 –
see para 51 on page 8 for evidence that Prof. Mansel Aylward and Dame Carol Black met with the ‘Health and Disability Panel’ set up by the Ministry to provide “specialist”, “expert” advice on welfare reform changes for people who are sick or disabled!
There are also many source references to reports by Gordon Waddell, Kim Burton and others, who have over the years all worked together with Professor Aylward!
Members of that ‘Health and Disability Panel’ included Dr David Beaumont (Medical Director for ‘Fit for Work’ Occupational Medicine Specialists, Chair of the Faculty Policy and Advisory Committee, Australasian Faculty of Occupational and Environmental Medicine, Royal Australasion College of Physicians (RACP), and formerly also senior staff member at ATOS Healthcare in the UK; Helen Lockett, an “international expert” in employment and mental health, who is head of “strategic development” for the “Wise Group”, which is New Zealand’s largest “third sector” provider of mental health and employment services!)
The following draft legislation, based in part on the above “advice”:
Parliament – Social Security (Benefit Categories Work Focus) Amendment Bill, 2012
Paula Bennett quoted from the Hansard in her speech for the 1st Reading, 20 Sept. 2012:
“Just as the health benefits of work are well documented, we know that the health costs of unemployment are high. Professor Sir Mansel Aylward, recently in New Zealand, said: “After six months’ unemployment, each additional day out of work is as detrimental to your health as smoking 200 cigarettes.” We know that work can play a vital role in recovery, and the worst thing we could do is actually leave people with illness on benefits long term with no support. This bill will not do that.”
Paula Bennett – ‘Speech to Medical Professionals’, ‘Otago University’ in Wellington, 26 Sept. 2012
Paula Bennett quoted from her speech:
“Across the board we will be asking more people on benefit about their work expectations, and what they might need to get into work. The focus for people with disabilities and long lasting conditions will be on their barriers to work not just their health, and we’ll be hands on, early on. This was an important point made by the experts on the Health and Disability panel which I established to review our proposed welfare changes.
It also echoes the UK’s assessment processes and the “Pathways to Work” initiative for vocational rehabilitation designed by Professor Sir Mansel Aylward. When I sat down with Sir Mansel earlier this year he told me that health conditions account for just 10 to 15 per cent of barriers to work for people on disability benefits. He said that many health conditions or disabilities can be well managed in work but addressing other barriers are just as important.”
And this is the beginning of the future, the result of Mansel Aylward’s efforts:
“Govt will pay to shift mentally ill into work”, ‘Herald on Sunday’, 30 June 2013
“Mentally ill people will be moved off state-funded benefits and into work using private employment agencies who will earn hefty fees for the service.”
If successful, private providers could earn up to $12,000 for placing a client considered to have “entrenched” mental health issues in a job where they are working for 30 hours or more a week.
An advocate for beneficiaries, who declined to be named, sounded warnings this week about forcing unwell people into competing for jobs in a tight employment market. “Sadly it seems to be an experiment with vulnerable people, and one must be concerned about how it will affect some.”
The above events are just a small selection of what contacts Mansel Aylward has had in Australia and New Zealand, working here to assist governments, welfare agencies, health authorities, organisations of health professions, employers, and others, to bring in new approaches and systems, which will also result in the outsourcing and privatisation of services, to usher sick and disabled back into work.
Some leading and influential medical professionals and advisors, who strongly promote and propagate Professor Aylward’s theories:
A). Dr David Beaumont, Chair of Policy and Advocacy, Australasian Faculty of Occupational and Environmental Medicine (AFOEM) at the Royal Australasian College of Physicians (RACP):
One of Dr Beaumont’s presentations:
‘The Health Benefits of Work – Managing the Paradigm Change’, OHSIG, ‘Toward 2020 Challenges and Changes in OH+S’, 26 Oct. 2011:
“As Chair of AFOEM Policy and Advocacy Committee he was lead for the Faculty project which produced the Australian and New Zealand Consensus Statement on the Health Benefits of Work http://www.healthbenefitsofwork.com He is President Elect of the Faculty.”
In that presentation (see link above) we again see familiar names and messages. This can hardly be a surprise to those who are well informed, and who can read and study these resources! I wonder whether NZCTU President Helen Kelly is aware about the greater agenda that is being followed and now being gradually implemented here in New Zealand? There certainly is a “network” of people involved!
David Beaumont’s Profile Overview on LinkedIn:
Medical Director/CEO at OHS New Zealand Ltd; October 2010 – Present
Medical Director at Pathways To Work Ltd; August 2010 – Present (3 years)
Medical Director/CEO at Fit For Work Ltd; June 2006 – Present (7 years 2 months)
Regional Consultant Occupational Physician at Atos Origin Healthcare
Public Company; 10,001+ employees; Information Technology and Services industry
January 2004 – December 2006 (3 years) Yorkshire
“With this and previous positions, David gained experience in a wide range of work settings, including public sector, manufacturing and industrial workplaces”
David Beaumont and colleagues presenting on health benefits of work, 14.05.2012
„Dr David Beaumont and colleagues in the health and employment sectors recently presented their latest findings about the health benefits of work.”
Other links of interest:
(note the mention of the “biopsychosocial model” there also!)
Dr Beaumont was also one of the senior members on the Health and Disability Panel that “advised” the Ministry of Social Development and Paula Bennett on welfare reform measures that would affect sick and disabled!
B). Dr David Bratt, Principal Health Advisor, Ministry of Social Development:
Dr David Bratt’s profile on LinkedIn:
Introduction/Profile of Dr Bratt for the Rotorua GP CME 2013
“Welfare Reform now has health warning”, NZ Herald, 16 July 2013
(mention of Dr David Bratt in relation to the draconian welfare reforms)
“Benefits likened to addictive drug as new medical certificate urges GPs to avoid putting patients off work.”
“The Ministry of Social Development’s principal health adviser, Dr David Bratt, told general practitioners last year that the health risks of long-term worklessness were equivalent to smoking 10 cigarettes a day – a “greater risk than most dangerous jobs”. He said welfare benefits were “an addictive, debilitating drug with significant adverse effects to both the patient and their family (whanau) – not dissimilar to smoking”.”
Dr David Bratt, PDF presentation to GP conference, Christchurch 2010:
“Ready, Steady, Crook – Are we killing our patients with kindness?”
See pages 13, 20, 21 and 35 for his comparisons of benefit dependence to drug dependency!
Dr David Bratt, PDF presentation to GP and other conference(s), 2012:
“Medical Certificates are Clinical Instruments Too!”
See pages 3, 16 and 33 for comparisons between benefit dependence and “drug dependence”! See pages 19 and 20 for quotes from Aylward, Waddell and Wessely!
Dr David Bratt, and Mansel Aylward, PDF presentation to GP conference, 06-2013:
“Shifting Your Primary Focus to Health and Capacity – A New Paradigm”
See: “A Life of Ease – Yeah Right!” (page 16)! See pages 20 and 46 for reference to Aylward, Waddell, Burton and Wessely!
Claim made on page 25:
•“(…) Most physicians rely on their patients for information about the conditions in the workplace and on his or her ability to do the original job.”
•“(…) Ultimately, the patient makes the decision that they are too ill to work and then asks their physician to agree.”
“LARC and Beneficiaries
•A non-recoverable Special Needs grant is available to female beneficiaries to facilitate access to subsidised Long Acting Reversible Contraception – IUCDs (Mirena only when subsidised) and Jadelle implants
•It covers the cost of the assessment, fitting and if required removal up to a total of $500 a year”
Dr David Bratt holding a presentation at the Welfare Working Group Forum, Wellington 2010:
Dr Bratt together with Prof. M. Aylward, on “Getting better at work”, short video, courtesy of NZ Doctor, 10 July 2013:
Royal NZ College of General Practitioners, Wellington Faculty, minutes, 21.06.2011:
Dr Bratt then serving as Treasurer for the RNZCGP Wellington Faculty at the AGM!
Dr Bratt, Director of CARE NZ (EST 1954) LIMITED:
David Bratt, listed on Abortion Wiki, being Consultant in Newtown Medical Centre, Wellington, at least in 2009:
‘Auckland City Mission Medical Service’;
‘Explanation of The Calder Centre’s policy on issuing medical certificates for a Sickness Benefit’:
(David Bratt quoted on document from Auckland City Mission Medical Centre, explaining their strict policy for issuing “medical certificates” to sickness beneficiaries, 2012/13)
“If the benefit was a drug, it would not pass the Medsafe…
Research into the impact of parental unemployment on children has found higher incidence of chronic illness, psychosomatic symptoms, psychological distress such as depression, substance abuse and delinquent behaviour, as well as increased risk of being out of work when they are adults.” / Dr. David Bratt, NZ Doctor Magazine, 01/08/2012/
“Ignoring poor won’t make us rich”; Andrew Bonallack, ‘Wairarapa Times – Age’, 17 July 2013
C). Dame Carol Black DBE FRCP, Adviser on Work and Health at the Department of HealthChair of the Governance Board, Centre for Workforce Intelligence:
“As Expert Adviser to the Department of Health, Black plays a major ambassadorial role, building and promoting the public and policy position on the positive relationship between work and health. She is Chair of the Health at Work network, part of the UK Government’s Public Health Responsibility Deal, set up to engage commercial, public and third sector organisations in improving public health.”
“Unum” and the Biopsychosocial Model, making reference to Carol Black:
“Managing the Risks of Being Different” White Paper, Summer 2008”
“The biopsychosocial model has emerged over the past two decades and has sought to expand upon disease paradigms and complement pain models. It states that in order to understand and manage ill health, pain and disease, one must take into account the influence of biological, psychological and social factors”*
“2008: Within Dame Carol Black’s review of the working age population ’Working for a healthier tomorrow’, Peninsula Medical School were commissioned to undertake a literature review of the evidence base for early intervention in sickness absence. The review highlighted three key principles for effective early intervention; the first of which was ‘holistic care in line with the biopsychosocial model’.”
Dame Carol Black mentioned in ‘the void’:
“Atos to Sub-Contract PIP Contract Back to NHS!”, 10 Oct. 2012:
…Unfortunately it remains to be seen if anything will change in practice. Whilst Atos will no longer carry out the assessments, the model of assessments will be the same flawed model as the one currently use to harass, torment and impoverish Employment Support Allowance claimants.
Of perhaps most concern is that Salus, who will now carry out the assessments, boast on their website that they: “are one of the very few organisations in the UK which utilise the bio psychosocial model as recommended by Dame Carol Black in her report ‘Working for a Healthier Tomorrow’ (2008). “” (extract fr. Publication from 10 Oct. 2010)
“Working for a healthier tomorrow”, Dame Carol Black’s Review of the health of Britain’s working age population; 17th March 2008
“It remains critically important to improve health at work and to enable workers with health problems to stay at work, but occupational health must also become concerned with helping people who have not yet found work, or have become workless, to enter or return to work.”
“Recent evidence suggests that work can be good for health, reversing the harmful effects of long-term unemployment and prolonged sickness absence. Yet much of the current approach to the treatment of people of working age, including the sickness certification process, reflects an assumption that illness is incompatible with being in work.” (From “Executive Summary”, Chapter 1)
“The positive links between health and work”
“In particular, the recent review ‘Is work good for your health and well-being?’ concluded that work was generally good for both physical and mental health and well-being1. It showed that work should be ’good work’ which is healthy, safe and offer the individual some influence over how work is done and a sense of self-worth. Overall, the beneficial effects of work were shown to outweigh the risks and to be much greater than the harmful effects of long-term worklessness or prolonged sickness absence.” (Page or chapter 21)
1 Waddell, G. and Burton A.K. (2006), Is work good for your health and well-being?, London: TSO (The Stationery Office).
Prof Dame Carol Black – Stakeholder Meeting, ‘The Royal Australasian College of Physicians’,
‘Working for a healthier tomorrow in Australia and the United Kingdom’, 29.10.2010
“The journey so far: insights and lessons learnt”, RACP Seminar, Melbourne
(incl. references to Waddell, Burton, Black)
D). Dr Des Gorman: One of New Zealand’s most influential health sector leaders who as ACC consultant and assessor once blamed “illness belief” or psychological factors for illness, but who now appears to follow an independent approach:
“Appointed: September 2012
Professor Des Gorman is Professor of Medicine and Associate Dean at the University of Auckland’s Faculty of Medical Health and Sciences, and has doctorates in medicine and in philosophy. He has extensive medical knowledge across a number of specialties (including brain injury, occupational medicine, and toxicology). Affiliated to Ngapuhi, Professor Gorman is also Executive Chairman of Health Workforce NZ, a member of the National Health Board, and most recently, appointed as a member to the ACC Board.”
Introduction and profile of Dr Gorman, for Rotorua GP CME 2012:
Profile of Prof. Gorman, member of the Welfare Working Group, 2010:
Current Affairs video, „Illness Belief, Part 1“, NZ television, probably late 1990s:
Dr Des Gorman, Department of Medicine, Auckland University; quoting “illness belief” in people being sick and off work for longer, 2000:
SOME OF THE POTENTIAL PRIVATE AGENCIES THAT ARE LIKELY TO COLLABORATE WITH MSD AND WINZ AS PROVIDERS – TO FACILITATE WORK REFERRALS FOR SICK AND DISABLED:
In the following I will give an overview of some of the likely service delivery agencies that may provide outsourced services to MSD, like for instance in the way of employment services for getting mentally ill (and other incapacitated) WINZ beneficiaries into work. That will naturally be done for handsome fees paid that will be based on referrals, duration of employment and so forth.
Like in most developed countries, in New Zealand it is ultimately the government that pays for and sets the agenda re how health and welfare related spending are allocated. It is the government that decides on policy and criteria for outsourcing of services, and who will get the contracts to deliver outcomes the government of the day deems useful and economical! In these days the cost factor is one of the major factors that is considered.
Relevant developments and sundry information of interest is presented here:
Press Release – Wise Group, ‘Employment and mental health’, 10:15 May 16, 2013:
“Wondering about work? New tool helps patients and their doctors talk about employment and mental healthWondering about work? New tool helps patients and their doctors talk about employment and mental health”
“For many people experiencing a mental health condition, the decision to return to employment can be a difficult one.
The Employment and Mental Health Option Grid (EmOG) has been published to help individuals and their clinicians have evidence-informed conversations about the benefits and risks of returning to employment.”
The article is describing a new “tool” for doctors and mental health service providers, to “assist” and “motivate” clients to move back into work, developed by ‘The Wise Group’ More on them will be revealed further below!
See what was already done last year to prepare for the push to get mentally ill assisted back into work in last year:
‘Employment Support as a Mental Health Intervention Forum’: 9 March 2012
“Tag Archives: Employment Support As A Mental Health Intervention Forum
Employment Support as a Mental Health Intervention Forum: 9 March 2012”
“This is your invitation to a forum for clinicians and others that will focus on this developing field of practice. International research and the experience of practitioners, signals that evidence-based supported employment is emerging as a significant intervention to help people into paid competitive work. This symposium with is focus on employment is timely as the Government has indicated a comprehensive review of the benefit system.”
“Venue: Ko Awatea Centre for Education + Innovation, Building 54, Middlemore Hospital, 100 Hospital Rd, Otahuhu
Date: 09 March 2012, 9.30 am– 4.30pm
Registration Fee: $100.00”
Giving information on a forum last year, at the ‘Ko Awatea Centre’ for Education + Innovation, Otahuhu, Auckland
Attended by speakers:
Rob Warriner: CEO of Walsh Trust, http://www.walsh.org.nz
Warren Elwin: CEO of Workwise Employment Agency, http://www.workwise.org.nz
Helen Lockett: Strategic Development, Wise Group, http://www.wisegroup.co.nz
Clive Bensemann: Director of Mental Health, Auckland District Health Board
David Codyre: Clinical Director/ Consultant Psychiatrist ProCare Psychological Services …
John Zonnevylle: Capital Coast DHB
Magdel Hammond: Edge Employment
Dale Rook: Occupational Therapist, Auckland District Health Board
More information: http://www.engagenz.co.nz/?p=1677
Main website: http://www.engagenz.co.nz/
In relation to all this, also to take note of:
Helen Lockett – The Wise Group
Helen Lockett’s Experience:
Strategic Policy Advisor
The Wise Group
(Nonprofit; 501-1000 employees; Nonprofit Organization Management industry)
February 2011 – Present (2 years 6 months)
Director of Programmes and Performance
Centre for Mental Health
November 2006 – December 2010 (4 years 2 months) UK
Helen Lockett’s Skills + Expertise:
Helen Lockett’s Education:
University of Bradford
Masters in Business Administration
2008 – 2010
University of Cambridge
Social and political sciences, social and cultural psychology
1990 – 1993
Helen Lockett MBA, MA Cambridge, UK
“Helen is an experienced director and researcher working in the mental healthcare sector. Her focus is on how to influence and bring together policy, research and practice to improve outcomes for individuals and families/whānau. Helen is acknowledged as an expert on employment and mental health and combines this with excellent interpersonal, communication and evaluative skills.”
“Since emigrating to New Zealand in December 2010, Helen has been working as the Strategic Policy Advisor to the Wise Group, New Zealand’s largest mental health non-government organisation and also as a freelance health and disability advisor. Prior to the move, Helen was Director of Programmes and Performance at the UK’s Centre for Mental Health, a leading international policy centre.”
Also have a look at this recent report in the ‘Australian + New Zealand Journal of Psychiatry’, from the May 2013 issue, titled: “Employment as a health intervention – the role of psychiatry in bridging the evidence to practice gap.” By Helen Lockett (Wise Group’s “Strategic Policy Advisor” with an MBA and an additional qualification in “social and political sciences, social and cultural psychology”), and Clive Bensemann, Clinical Director, Psychiatrist, Auckland Regional Public Health Service:
“Employment is a central part of recovery for many patients, is generally good for mental health, and the evidence on how best to support people with a mental illness into jobs is well established”.
“This viewpoint provides a summary of the international research on the effectiveness of Individual Placement and Support (IPS) an approach to supported employment for people with a mental illness also referred to as evidence-based supported employment (EBSE).”
“Employment outcomes are defined as competitive jobs which are available to anyone in the labour market to apply for, have permanent status rather than temporary or time-limited, pay at least minimum wage and are not set aside for people with disabilities (with the exception of peer specialist roles).”
Further to that, from the ‘Australian Psychiatric Journals’, ANZJP, re May 2013:
(‘Australian Psychiatry Review’, online)
“Harvey and colleagues (2013) and several accompanying commentaries examine strategies to improve employment opportunities for patients with psychosis, with a focus on Individual Placement and Support (or IPS) programs to improve employment for people with mental illness. Lockett and Bensemann (2013) summarise recent research on IPS to justify its systematic implementation. The authors suggest that the “place then train” model significantly outperforms older models which focus on training which often does not lead to employment. They also note evidence suggesting vocational intervention should occur in parallel with medical treatment, and that patients do not have to be symptom free before returning to work.”
Yes, Lockett is another “expert” from the UK, promoting the agenda of shifting disabled and sick back into work. It appears she is supporting Prof. Mansel Aylward’s and Dr David Bratt’s particularly one-sided philosophies on “work capacity” and the “health benefits of work”, and she was on the ‘Health and Disability Panel’ set up to “advise” the Ministry of Social Development on welfare reforms for sick and disabled!
One will not need to speculate too much, where the idea that “vocational intervention should occur in parallel with medical treatment” comes from. Also the timing of the release of that article is intriguing, as it was in mid May 2013, when the Ministry of Social Development sought tender offers for outsourced “mental health employment services” (via “GETS” as I have been told). So here is ‘The Wise Group’ actively lobbying for government contracts, having their leading advisor do the lobby work. Bear in mind, organisations like ‘Workwise’ and ‘Te Pou’ belong to ‘The Wise Group’.
See Workwise’s “information” on “evidence based supported employment”:
“Evidence-based supported employment
People who experience a mental illness want to work and can work”
“When unemployed people with experience of mental illness are asked about their hopes for a job, the majority say they would like to work…either now or sometime in the future.”
“Yet, in New Zealand, people who are in contact with mental health services have an employment rate of less than 20 per cent. In fact, people who experience mental illness have the lowest employment rates of any disadvantaged group.
Using an employment programme called evidence-based supported employment (EBSE) can make a huge difference.”
Links to website and information:
The Wise Group – a major player, who own/operate ‘Workwise’:
(see ‘The Wise Group’ being a “charitable trust” and “Social Angels” a registered “charity”)
Workwise Trust Group on the Charities Register:
Charities Register – last filed return:
So there we have it – more “privatised” welfare services in the form of generous “employment schemes” for the well paid who are running such services, and for the perhaps a bit less generously paid bulk of the remaining “staff”. All are likely to be potential participants of the planned outsourcing and privatisation of welfare.
One thing is sure for the Wise Group:
$ 61,277,236 government grants and contract payments, out of $ 65,412,195 total income of that “charity”!!! That’s “not bad” really, especially for the ones running it.
***When thinking of “charities” “Sanitarium” comes to mind again, owned by a church that can run the business as a “charity”, paying no income tax on earnings.***
See other organisations and agencies involved in this approach:
(Remember: Dr David Beaumont!!! Formerly with ATOS, also advising MSD!)
(Dr David Bratt, one of the directors at Care NZ Ltd!!! Only indirectly involved, but participating in the same “drive” to get sick back into work the “Bratt way”)
The whole agenda is being pushed strongly, and familiar people are behind it:
“Realising the health benefits of work”; 25/05/2010
“This week the Australasian Faculty of Occupational and Environmental Medicine has released a new position paper, entitled “Realising the health benefits of work.””
“Several of the Wellnz team led by John Hamilton attended the launch function at The Langham Hotel in Auckland. There was a heavyweight line-up of speakers including Dr Robin Chase, President of AFOEM; Prof Sir Mansel Aylward, Chair of Public Health Wales; Dr Kevin Morris, Director of Clinical Services with ACC, and Dr David Beaumont, Co-chair of the AFOEM working group, who is one of our NZProvide Occ Med specialists.”
“The presentation included a Stakeholder Summit involving Dr Kevin Morris, Director of Clinical Services, ACC; Dr David Bratt, Principal Health Advisor, Ministry of Social Development; Ms Helen Kelly, President, New Zealand Council of Trade Unions (CTU); Paul Mackay, Manager Employment Relations Policy, Business NZ; Dr Jonathan Fox, New Zealand Medical Association (NZMA), and Dr John Mayhew, Clinical Director, Sovereign Insurance.”
Paula Bennett’s speech to medical professionals in Sept. 2012, indicating work capacity assessments UK style (remember ATOS, DWP and the scandalous developments there):
In contrast the more widely known and well-established agency used by MSD and Work and Income to place people with physical disabilities into employment:
‘Workbridge’ use a more conventional approach, but also “support” mental health sufferers! They also do a lot of work for and with MSD and WINZ.
Although the agencies mentioned appear to present their services with an emphasis on delivering them in a benevolent, sympathetic and supportive way, the fact remains, that particularly mentally ill with disabilities face very serious and high barriers, to find employment. That is most certainly so in “open employment” (on the “open”, common job market).
Employers and their generally more “healthy” and “fit” staff tend to discriminate against people with disabilities, particularly those with mental health issues. Open employment is driven by goals to achieve maximised productive output. Employers and the majority of their staff will lack the understanding and appreciation of mental illness. There is insufficient evidence that such intervention to bring mentally ill into work, and to keep them in employment, have succeeded beyond marginal rates.
The concern is justified, that the planned “mental health employment” trials by the Ministry of Social Development will put sick and disabled at high risk. The intended practice to pay service providers high fees (per referred individual) on a success rate basis, will mean, that such providers will be incentivised to put as many clients into jobs as possible, in order to achieve “profitable” returns by keeping costs low.
With a problematic job market and the already great difficulty in referring sick and disabled into open employment, corners will be cut, and that will impact on the vulnerable persons, some of whom will not be able to cope. It is unclear how effective any support networks will function in such scenarios.
In this matter I can also draw on personal insight and experience, as I have had a mentally ill flatmate some time ago, who was in the end actually referred to ‘Workwise’ to help her find suitable employment. She was suffering psychotic episodes and was for most of the time on high dosages of medication. That alone resulted in her struggling to do simple day to day tasks. The “help” she was offered was not very convincing, and I had to repeatedly support her, when she was unable to cope with expectations employers expressed in interviews she was referred to. The ‘Workwise’ staff member that was supposed to support her was often difficult to contact, did not deliver much help and the whole experience was disappointing.
Various other issues with GP primary care diagnosis and referrals:
There is researched and anecdotal evidence available that general practitioners (GPs) and other primary health care providers are not necessarily sufficiently qualified, competent and experienced enough, to diagnose and treat mental health disorders and conditions. Many do refer their patients to psychologists, psychiatrists or psychotherapists for further examinations, assessments and treatment.
Yet that may not happen in some cases, where a GP may not even notice any mental illness symptoms, or where the GP may her- or himself in some other cases feel that they are themselves competent enough to decide on medication or other forms of treatment. In the following some information is quoted and offered that gives evidence of certain issues that have over recent years been found in these areas:
The King’s Fund, “The quality of GP diagnosis and referral”,
Research paper 2010, Authors: Catherine Foot, Chris Naylor, Candace Imison
“An Inquiry into the Quality of General Practice in England”
In general, the diagnostic process does not lend itself to easy quality measurement, since so many of the determining factors of quality are internal to the consultation and reasoning processes of the GP. As has already been mentioned, the quality of diagnosis can be inferred through measures of any activity that has followed diagnostic decisions (treatment, referral etc), but these proxies measures would not adequately indicate what factors caused diagnostic error and so are of limited use for quality improvement in diagnosis specifically.”
More details about their findings can be found in the original document!
Counselling Directory – see link: http://www.counselling-directory.org.uk/treatmentstats.html
‘Statistics about Mental Health Treatments and Services’
“Contact with GPs
According to figures from the 2003 National Survey of NHS patients, approximately 91 per cent of people with a mental health problem will be treated within the primary care system, meaning that very few are referred to specialist mental health services3.
Figures suggest that at least 25 per cent of individuals with symptoms of mental health conditions such as depression and anxiety do not report this to their GP and of those who do, up to 50 per cent only provide details of their physical symptoms and do not detail any mental and emotional aspects4.
It has been suggested that the reason many cases of mental health conditions go undiagnosed and unrecognised may be related to a lack of training in areas of mental health for GPs and other industry professionals. One study in particular revealed that only one third of doctors had received mental health training in the past five years, with ten per cent admitting they felt concerned about their training and experience with regards to mental health5.”
The European Journal of Psychiatry – “GP mental health care in 10 European countries: patients’ demands and GPs’ responses”; 2007;
Peter F.M. Verhaak; Jozien M. Bensing; Atie v d Brink-Muinen;
Netherlands Institute of Health Services Research. THE NETHERLANDS
“Results: There are differences, not related to health care system characteristics, between countries concerning the prevalence of mental distress among patients visiting their GP. Only a minority of distressed patients presented psychological symptoms. Although GPs did not limit their psychological diagnoses to patients presenting with psychological symptoms, they also diagnosed only a minority of distressed patients with a psychological diagnosis.”
From the ‘US National Library of Medicine National Institutes of Health’ online:
“Quality of medical care for people with and without comorbid mental illness and substance misuse: systematic review of comparative studies”;
Mitchell AJ, Malone D, Doebbeling CC;
Br J Psychiatry. 2009 Jun;194(6):491-9. doi: 10.1192/bjp.bp.107.045732
“There has been long-standing concern about the quality of medical care offered to people with mental illness.”
“Of 31 valid studies, 27 examined receipt of medical care in those with and without mental illness and 10 examined medical care in those with and without substance use disorder (or dual diagnosis). Nineteen of 27 and 10 of 10, respectively, suggested inferior quality of care in at least one domain. Twelve studies found no appreciable differences in care or failed to detect a difference in at least one key area.”
“Inequalities in healthcare provision for people with severe mental illness”;
David Lawrence and Stephen Kisely
J Psychopharmacol. 2010 November; 24(4_supplement): 61–68;
“There are many factors that contribute to the poor physical health of people with severe mental illness (SMI), including lifestyle factors and medication side effects. However, there is increasing evidence that disparities in healthcare provision contribute to poor physical health outcomes. These inequalities have been attributed to a combination of factors including systemic issues, such as the separation of mental health services from other medical services, healthcare provider issues including the pervasive stigma associated with mental illness, and consequences of mental illness and side effects of its treatment.”
“At the same time, there are barriers to people with SMI accessing primary care. Some primary care physicians see patients with SMI as being disruptive to their practices or feel uncomfortable treating them (Goodwin et al., 1979; Karasu et al., 1980). The likeability of patients has also been linked to the amount of attention they receive in primary care (Gerbert, 1984; Hall et al., 1993).”
“Comorbidity of substance misuse and mental illness in community mental health and substance misuse services”;
Weaver T, Madden P, Charles V, Stimson G, Renton A, Tyrer P, Barnes T, Bench C, Middleton H, Wright N, Paterson S, Shanahan W, Seivewright N, Ford C;
Br J Psychiatry. 2003 Oct;183:304-13
Of CMHT patients, 44% (95% CI 38.1-49.9) reported past-year problem drug use and/or harmful alcohol use; 75% (95% CI 68.2-80.2) of drug service and 85% of alcohol service patients (95% CI 74.2-93.1) had a past-year psychiatric disorder. Most comorbidity patients appear ineligible for cross-referral between services. Large proportions are not identified by services and receive no specialist intervention.”
“The prevalence of personality disorder, its comorbidity with mental state disorders, and its clinical significance in community mental health teams”;
Newton-Howes G, Tyrer P, Anagnostakis K, Cooper S, Bowden-Jones O, Weaver T; COSMIC study team;
Soc Psychiatry Psychiatr Epidemiol. 2010 Apr;45(4):453-60;
Personality status is seldom assessed in community mental health teams except at a rudimentary level. This study challenges the assumption that this policy is either prudent or wise.”
In total, 40% of all patients in secondary care suffered from at least one personality disorder. Regression modelling showed personality pathology accounted for a greater degree of global psychopathology than psychosis, alcohol or drug dependence, but was associated with anxiety disorders.
Comorbid personality pathology contributes greatly to overall psychopathology in secondary psychiatric care. It should be both recognised and managed.”
Submission to the Ministry of Health, New Zealand
On Rising to the Challenge: Mental Health and Addiction Service Development Plan 2012-2017
New Zealand Psychological Society; 07 Nov. 2012
“2. Building infrastructure for integration between primary and specialist services
…To work effectively integration needs to fully utilise the skills of all involved in the delivery of mental health and addiction services. We have concerns about primary mental health being effectively channelled through GPs. Research recognises that GPs are not especially good at identifying common mental health problems (Mitchell et al., 2009). GPs also tend to rely on medication as a standard intervention and there is little evidence for the effectiveness of this approach for the mild to moderate conditions that present at primary care level (Kirsch et al., 2008). Providing funding to allow clients direct access to psychologists for example would be one effective away of enhancing access to primary care and mental health interventions other than medication.”
Apart from questions about problems with diagnosis in primary care, this submission is also of some interest when it comes to decisions about referring mentally ill into employment:
New Zealand Medical Association, submission on:
Rising to the Challenge: The Mental Health and Addiction Service Development Plan 2012-2017; 15 Nov. 2012
“However, the NZMA also has significant concerns relating to a number of areas in the Plan. These relate primarily to sources and models of funding. We note that the Plan is intended to advance the Government’s focus on better performing public services in the context of significant financial constraints. The NZMA is very concerned that the funding source for a number of identified priority services in the Plan (e.g. expanded access to psychological therapies in primary care, mental health promotion) is to come from ‘re-prioritised existing funding’ or ‘new demographic funding’. This is likely to create tensions between existing service providers, undermining collaboration in the sector and resulting in the cessation of some currently effective services. The NZMA is strongly of the opinion that attempts to address existing service gaps in mental health and addictions service provision should not lead to the opening of new gaps.”
“While the NZMA is supportive of measures to improve accountability at all levels of healthcare service provision, care must be taken to ensure such measures provide an accurate and reliable indication of performance. For example, monitoring the percentage of people with low-prevalence psychiatric conditions in employment/education as part of DHB accountability, as suggested in the Plan, is problematic; there are many barriers to employment/education other than mental health status, and these are often completely beyond the control of healthcare service providers. Once again, we recommend that greater consultation be undertaken with all stakeholders in order to determine the best measures of service performance.” (p. 2)
I have included the above reports and submissions, because it is a fact, that the Ministry of Social Development and Work and Income do primarily and almost exclusively rely on general practitioners (GPs) for examinations and recommendations they require, if a client’s own doctor or other health professional is not delivering the information and diagnosis they require or want!
While some GPs do possibly have some additional qualifications in areas psychiatric and psychological study, most do not. And a list of “designated doctors” that was obtained from the Ministry late last year, gave proof to the fact, that of the roughly 290 WINZ medical practitioners only a handful were psychiatrists.
So if medical reports are needed by WINZ case managers as part of work capability assessments, they are likely to be prepared by GPs. They will present them to the internal Regional Health and Disability Advisors, who are mostly either registered or not registered nurses, some other rather low ranking health professionals, or even social workers with additional papers. The only GP they employ is Dr David Bratt.
This gives reason to concern, as to the quality of such medical based assessments. The independence of the “designated doctors” WINZ use has also been questioned, and there have been anecdotal reports by some on social media, and in the mainstream media, that some such doctors are nothing but “hatchet doctors”. See also this article from the ‘Sunday Star Times’ and ‘stuff.co’ on 16 September 2012:
“Winz joins ACC in firing line for ‘hatchet doctors’”
A summary list of articles and sources – expressing widespread concerns about the UK welfare reforms and the “findings” and approaches propagated by Professor Aylward and others:
Parliament UK, Parliamentary Business, Publications and Records, 21 March 2001
(examination of witnesses, House of Commons, Select Committee on Public Accounts, Wednesday 21 March 2001)
MERGE is the Myalgic Encephalomyelitis Research Group for Education and Support (2004)
FOR UK PARLIAMENTARY INQUIRY INTO ME/CFS, Chronological list of documents relevant to the Inquiry authored by Professor Malcolm Hooper, Eileen Marshall and Margaret Williams 7th November 2005
Anglia ME Action: “The UK Medical Research Council has a secret file on Myalgic Encephalomyelitis (ME) that contains records and correspondence since at least 1988; the file is held in the UK Government Archive at Kew and cannot be opened until 2023”;
Professor Malcolm Hooper, Eileen Marshall, Margaret Williams, SEPTEMBER 2007
hetalternatief BLOG, Frank Twisk, NL: Letters to ‘Daily Telegraph’, and the Queen, 21.03.2008 and 02.04.2008 – Re Royal Society of Medicine allying with ‘Unum’:
‘READ ME UK EVENTS’, updates on UK ME protests (05-28.04.2008)
The Guardian, ‘No turning back on fit-to-work test’, Amelia Gentleman, 06 Sept. 2011
‘whywaitforever’, Blog, ‘DWP ESA Medical Examinations’, 2009 – 2012
(“Due to illness this website is no longer updated. March 2013.”)
‘whywaitforever’, Blog, Atos In Business; 2009 – 2012
(“Due to illness this website is no longer updated. March 2013.”)
downwithallthat, bigleyma is thinking…
“Archive for the ‘Professor Mansel Aylward’ Category”; July 2011 – Oct. 2012
‘People with ME’ Forum / News, advocacy and research. / Advocacy
(comments fr. 10.01. to 18.01.2012)
‘Illness as ‘Deviance’, “Work as Glittering Salvation and the ‘Psyching-up’ of the Medical Model: Strategies for Getting The Sick ‘Back To Work’”; by Gill Thorburn, Jan. 2012
Publication (ebook) ‘Welfare reform – The dread of things to come’, edited by Jonathan Rutherford and Sally Davison, Published by Soundings 2012
‘A Tale of two Models: Disabled People vs Unum, Atos, Government and Disability Charities’, Debbie Jolly, March 2012
“Professor Mansel Aylward ~ My! What ‘A Very Tangled Web’”, Posted on September 9, 2012 by JJ
“Prof. M. Aylward increasingly under fire” – DNS 14 Sept. 2012:
UNUM/DWP/ATOS SCANDAL: TRANSCRIPT ~ Prof. Sir Mansel Aylward defends his record, makes pledge when confronted by Black Triangle and DPAC at IFDM2012; 15 Sept. 2012
‘Academic Angela Kennedy Responds to Professor Sir Mansel Aylward’s Statements to Black Triangle and DPAC’, 20 Sept. 2012
“Unum, Atos, the DWP and the WCA; Who gets the blame for the biopsychosocial saga?”, Mike Sivier, Vox Political, Politics and discussion from the Heart of Wales, 18 Jan. 2013
DWP Examination, Free Speech for Disabled, ‘Agenda Reports by Mo Stewart’, 2013
(PPlog (Patient and Public Log) is an independent Service User watchdog/monitor, and a base for blogs for Norfolk Disabled People Against the Cuts (DPAC)
Rehab News, UK, 11 June 2013, ‘Disability benefit changes introduced across UK’
There is an immense amount of justified criticism of the approaches propagated, the BPS model interpreted and used according to Mansel Aylward, Gordon Waddell, Kim Burton and others, and how this has resulted in endless cases of harm and fatalities during implementation of severe work capability testing and welfare reforms in the United Kingdom. Questions about the BPS model have been highlighted, as to whether it meets the needed high standards for medical science and practice.
There are indications of possibly corrupt decision-making practices, by professional persons in key positions at the DWP, ATOS Healthcare and Unum. Some critics have accused Professor Aylward of having acted inappropriately and unethically, while having a conflict of interest in roles he held and still holds. Time will tell what can be proved and what has happened, but eventually a clearer picture will emerge.
The least that can be said is, the welfare reforms in the UK have been a disaster, and they have caused high numbers of affected beneficiaries suffering, harm and death.
Some criticism expressed about developments in New Zealand:
“More concerns about the current UK Welfare Reform”
Margaret Williams, 22nd January 2012
“This non-evidence-based but pervasive biopsychosocial ideology is now being foisted on the unsuspecting people of Australia and New Zealand, because in May 2010 Aylward wrote a report for the Australasian Faculty of Occupational and Environmental Health (Realising the Health Benefits of Work: A Position Paper. Professor Sir Mansel Aylward CB; Director: Centre for Psychosocial Research and Disability Research, Cardiff University (the Centre being funded by the health insurance company UNUM Provident).
In it, Aylward asserts:
Main determinants of health and illness depend more upon lifestyle, socio-cultural environment and psychological (personal) factors than they do on biological status and conventional healthcare
Work: most effective means to improve well-being of individuals, their families and their communities
Objective: rigorously tackling an individual’s obstacles to a life in work.
“Making the distinction: definitions and usage:
Disease: objective, medically diagnosed pathology
Illness: subjective feeling of being unwell
Sickness: social status accorded to the ill person by society”
CCS Disability Action – ‘Including all people’:
“Welfare reform in the United Kingdom and what it could mean for us in New Zealand”
3/10/12 • Posted in Social Model of Disability, Welfare Reform
DWP Examination Forum – 11 Jan. 2013
“its getting bad worldwide atos unum abuse its really time they want us gone” –
“New Zealand: ‘British-style work tests concern’ ~ tests were developed partially work of disability expert Professor Sir Mansel Aylward”, 11 Jan. 2013:
New Zealand: “‘British-style work tests concern’ ~ tests were developed partially work of disability expert Professor Sir Mansel Aylward”, 12 Jan. 2013
Scoop – independent news: ‘Proposed Work Tests Are Concerning’, 14 Jan. 2013
“Welfare Reform; Real change or tilting at windmills?”
17/7/13 • Posted in Aging, CCS Disability Action
“Govt will pay to shift mentally ill into work”
Herald on Sunday, by Lynley Bilby, 30 June 2013
“Mentally ill people will be moved off state-funded benefits and into work using private employment agencies who will earn hefty fees for the service.
The Herald on Sunday has obtained leaked Ministry of Social Development documents detailing plans to get people suffering from depression, stress and anxiety disorders into paid work.”
“Welfare group warns thousands will suffer after changes”
The New Zealand Herald, 15 July 2013, by Simon Collins, Teuila Fuatai
“Welfare now has health warning”
The New Zealand Herald, 16 July 2013, by Simon Collins
The controversial legislation for radically reforming New Zealand welfare:
New Zealand Parliament
‘Social Security (Benefit Categories and Work Focus) Amendment Bill’
Evidence / Submissions presented to Social Services Committee (732)
A Danish Report which contradicts some of the claims by Aylward, Waddell et al., and which delivers no real surprises, naturally from a country using a more progressive, fairer welfare system:
More relevant research showing how the Danish welfare and insurance model offers more realistic, objective unsurprising data – and apparently better outcomes:
“Transitions between sickness absence, work, unemployment, and disability, in Denmark 2004–2008”;
by Jacob Pedersen, MSc, Jakob Bue Bjorner, MD, Hermann Burr, PhD, Karl Bang Christensen, PhD; Scand J Work Environ Health 2012, vol 38, no 6:
“One of the keystones of the Nordic economic model is the flexible labor market, which is substantiated by a social security system that acts as a safety net when an employee becomes unemployed, sick-listed, or partly or permanently work disabled. This is often referred to as the “flexicurity model”.“ (p. 516)
“Usually individuals are likely to shift between states several times over time, but in almost all research papers only one of these shifts or transitions is investigated. A larger model that includes all states at the same time is needed to attain a better understanding of transitions between several states, and in particular, how transitions influence later outcomes (7).“ (p. 517)
The Danish Flexicurity model is founded on the flexible labor force and the social welfare system. The approach of the present paper determines the efficiency of the Danish flexicurity model in assisting people to return to the labor force after being sick-listed and possibly unemployed. It determines the flexicurity model’s ability to include people in the job market that have a chronic disease or are pregnant.”
“The results show that Copenhagen in particular has a relative high labor force participation, which is unsurprising as Copenhagen has the largest population and the majority of the job market. The flow of the transitions shows that the Copenhagen region has difficulties getting people to return to work and a low probability of granting disability pension.”
“In comparison, the much less populated region of North Jutland has a relatively high probability of allocating disability pension. The differences between regions demonstrate the regional labor force difficulties that Denmark faces, in which younger people in particular, travel to the larger towns to find education and work.”
“The flow between the states of work, sickness absence, and unemployment confirms the official numbers; most people on sick leave return to work strictly afterwards, a trend that was increasing during 2004–2008 [82.2% in 2004 and 84.0% in 2006 (16)]. In addition, less people became unemployed after sick leave (7.3% in 2004 and 6.1% in 2008).”
“The results on age groups show that young people have a high risk of becoming unemployed after sicklisting, and that people over 40 years have an increased risk of becoming unemployed and attaining disability pension. The elderly becoming work disabled is probably a consequence of a long working life and physical and mental disabilities concerning the working environment. The high probability of unemployment after sickness absence is an example of one of the core elements of the Danish flexicurity model, which entails a relative easy procedure for an employer who wants to lay off a sick-listed employee (17, 2).”
“The results cannot be transferred directly to other countries because of the high influence of Danish laws and regulations concerning the job market and social payments. In addition, the results cannot be generalized to the entire work force, as the analyses only include sick-listed persons, yet the importance of economic coverage when an employee gets sick-listed is explicit.” (Pages 524 to 525)
This paper by ‘Pedersen et al’ shows that movements onto benefits are usually not just heading into one direction, but that most who suffer sickness actually return to work and stay in work, although there is a higher risk to return to periods of ill health, if one such period has occurred. That though may simply mean that once a more serious health issue develops, this often leads to further deterioration over time.
In Denmark movements appear quite normal and explainable, and with a fairer welfare system, good health system, where better benefits and conditions are offered, there is more participation in the work force.
One wonders, how would things look like in the UK or New Zealand, when sick and disabled would be treated with respect, treated well and get paid benefits that allow persons to recover and return to some acceptable, suitable work, rather than being punished with low benefits, low (minimum) wages and draconian sanctions to comply with pressures to take on jobs the welfare agencies may consider “suitable”!
Final summarised analysis and conclusions on all issues raised:
Looking at the “evidence” Mansel Aylward has presented to back his claims that work is good also for the health and wellbeing of sick and disabled, it becomes rather clear, that his reports actually lack sufficiently clear and compelling evidence. The information presented as “evidence” consists primarily of information extracted from selected reports by other, mostly similarly minded medical “experts” and researchers. Also is certain data from official welfare statistics being used, which seems to be of limited value to explain reasons, causes and effects of unemployment and health problems. It appears that there is a need for further research in the areas of mental health, and also musculo-skeletal disorders. This is even mentioned in virtually all reports, same as the fact that the “findings” relied on often lack diagnostic clarity. Nevertheless Professor Aylward, his named colleagues and his supporters continue with their claims that “work is generally good for health”, is “beneficial” – and even “therapeutic” – for those, who return to work despite of sickness and disability.
Professor Aylward, Waddell, Burton, Eriksen and a few other proponents of the variously interpreted BPS model are furthermore attempting to question the existing medical practice of diagnosing “common mental health” and “musculo-skeletal” conditions. Aylward and his like minded “experts” appear reluctant to accept the existence of a range of now widely accepted illnesses and disorders, and by constantly talking of “common health problems” and “subjective health complaints” they blur the lines between serious and less serious illnesses. They have a dismissive view of certain “common” illnesses, and the fact that diagnosis is limited due to not (yet) detectable organic, physical signs, is being used to justify treating them as rather minor complaints or symptoms. The term “bio psycho-social” is used for these “common” illnesses, which then justifies pushing the affected to return work.
In their more recent report “MODELS OF SICKNESS AND DISABILITY – APPLIED TO COMMON HEALTH PROBLEMS” (from 2009 / 2010) Waddell and Aylward have already qualified and moderated many earlier claims and “findings”, and admitted that there are substantial problems and limits attached to the BPS model. One reason for the rethink appears to have been motivated by the wave of criticism from those affected by very stringent work capability testing and welfare reforms in the UK, same as that from some disability advocates and medical and rehabilitation professionals. But on top of that, a realisation may be setting in, that these “subjective” and “common” “health complaints” may simply not so easily be physically diagnosable for the mere fact, that the cause for them lies in not yet discovered metabolic, bio-chemical or other phenomena. Genetic pre-disposition may at least contribute to them, and interactions between physical and neuro-chemical activities in the body of persons suffering from them, may not be sufficiently researched.
It is irresponsible for Mansel Aylward and his like-minded colleagues and followers, to continue making the stated assertions re the “health benefits of work”, while so far insufficient research, which should also be independent from funding by a controversial private insurance corporation (conflict of interest), has not been expanded, extended and conducted. It is equally irresponsible that governments, their departments or agencies rely so heavily on Mansel Aylward’s “findings”, to introduce unsuitable, scientifically unproved, unbalanced and questionable medical and work capability assessments, while no proper, alternative, independent and objective research has been conducted in the areas of disability, illness and how it affects workers, as well as how an early return to work may adversely affect the persons suffering such illnesses. Instead of such single minded emphasis on “work”, the more honest approach would be to acknowledge that there are some benefits in physical and mental activities for sick and disabled (where possible). That does though not automatically equate to “work”, especially not in demanding, performance and pressure driven “work” in “open employment” on the “open” job market.
It appears that governments delivering social services, same as insurers offering insurance for sickness, disability and accidents, and also employers wanting to enforce more rigorous sick leave controls on their workers, have an interest in Mansel Aylward’s approach, as it delivers them a useful, supposedly “scientifically” based set of information and “tools”, to ultimately save costs.
Yet while income loss is the result of workers not being able to work, and while welfare benefits have been kept low or cut over years in many developed countries, people who have to stop working for sickness and disability reasons, have a very logical motivation and interest already, to try to return to work as soon as possible. Most do return to work, once they are able to work. They have a natural interest in earning a living to afford themselves and their families a better life. They will only choose to go and see their doctor, to report genuine health problems, because they are sick and feel ill. It would be very few workers who would voluntarily choose to opt out of work for reasons of prolonged sickness and ill health, as they would consequently suffer loss of income, job- and hiring-security, and in living standards!
This then raises the question for the motivation behind this “research”, these “findings” and the whole approach to urge sick and disabled back into work! In this regard one must take note of Mansel Aylward’s long history of contacts and involvement with ‘Unum’ (formerly ‘UnumProvident’), who had for many years not only been advising the Department for Work and Pensions, the UK government and health service providers, but also financed the very research that Professor Aylward and his colleagues have been conducting at the ‘Centre for Psychosocial and Disability Research’ at Cardiff University. Unum was in the US sued for following illegal practices in denying grants to claims by insured, and found guilty in Californian and other courts. It is truly amazing that the same corporation was received with open arms by UK governments to advise them and have input in developing welfare policies, intended to limit and contain the number of welfare claims there.
Disability organisations and outspoken critics have in the UK exposed the connections between the DWP, Mansel Aylward and Unum, same as those between them and Atos Healthcare, who are the only (private) enterprise working as “assessors” for DWP. It is for some absolutely unbelievable that Mansel Aylward is still being respected and listened to by the UK government, same as other governments, health service providers, by professional organisations and unions.
That is while It all resembles nothing much else but a large scale agenda that is being followed, where Mansel Aylward and his allied “experts” intend to influence governments to adopt their version of the BPS model and their advice on how to “reform” welfare and health services, and save costs by getting beneficiaries referred back into open employment. Virtually all the “experts” like Aylward, Waddell, Carol Black, Dr David Bratt and Dr David Beaumont, now here in New Zealand, have a vested interest in the proposed measures being introduced and implemented.
Some operate or manage own agencies and businesses that would benefit from these, some have connections to prospective service providers, Aylward and Waddell and others have enjoyed financing and payment by Unum (and possibly other private operators). Governments and employers have an interest in reducing work absence, long term illness and disability, all for pure cost saving reasons.
Yet it is totally irresponsible, to adopt and follow approaches and models that are questioned, not sufficiently scientifically proved and thus controversial, while being obsessed with cutting costs in the welfare area by all means. That is the agenda, cost savings, and culling sick and disabled off benefits, and they are even going to contract out to private agencies, who will get paid handsome fees for pushing the beneficiaries into mostly low paid, not much demanding, unfulfilling jobs.
I am posting and publishing this lengthy article for the reasons that I am extremely concerned about the questionable justifications, the lack of morality and stubborn determination with which the new welfare reforms are being implemented. I am highly concerned about the potential harm that will be caused to sick, disabled, their friends and families, when things will inevitably go wrong, and when disasters will occur.
Personally I would support proved, effective, balanced, fair and reasonable measures to rehabilitate seriously ill and disabled and assist them into some forms of work. I support efforts to treat, empower, up-skill, train and educate those affected, to give them respectful, realistic chances to do suitable work, where it may be possible. The affected must first of all be allowed own input. Yet the reforms that have come into force on 15 July this year have not been backed up by additional funding to achieve this. A proposed plan called “Rising to the Challenge: The Mental Health and Addiction Service Development Plan 2012-2017” is lacking clarity and sufficient funding commitments, and it has in submissions been strongly criticised. There is no clear indication that substantial investments will be made to provide for more treatment programs. The concern is that mass medication by GPs will take place, and that mentally ill and addiction sufferers will be fast tracked into outsourced “mental health employment services” once such low cost “treatments” are in place.
When Aylward and others talk about “culture change”, then one would expect this to be implemented across society also, but while there are already plans being made to start employment referrals for mentally ill, there is no indication that employers and the public at large are being educated and compelled to honestly respect mental health sufferers and other disabled and treat them fairly.
Changes in law and within existing systems are needed; and better incomes and safe, good, healthy working conditions must be ensured, before any such trials should even be considered. Yet there is NO sign of such changes.
So while we have heard a lot of talk from Minister Paula Bennett, Prime Minister John Key, Finance Minister Bill English and others, the actual picture is, that all the proposed changes, based on “findings” and “approaches” presented by Mansel Aylward and others will achieve little or nothing, will not reduce the marginalisation of disabled and long term sick, will not offer better outcomes for them to live more independently and dignifiedly. The likely result will be some referred into low quality, low value, unstable, low paid jobs, into which many will drift in and out of. The “second class” citizens that disabled are already will merely be turned into “second class” workers, which will do anything but help and de-stigmatise them. Some employers may even try abusing the intended, privatised employment programs.
It is also clear, that the agenda to reform the welfare system was drawn up years ago, before 2010, and that the whole “consultation process” was largely not more than a “circus” and manipulative “show” for the observing wider public. The Select Committee process for the ‘Social Security (Benefit Categories and Work Focus) Amendment Bill’ was a farce also, as submitters were in their vast majority opposed to the way these “reforms” were designed and planned to be implemented. Yet only cosmetic changes of insignificance were made to a minimal number of provisions.
Sadly the seriously sick and disabled beneficiaries with mental health and other conditions are being used or abused for a large, high risk socio-economic and medical experiment, with medical professionals being dragged into it, to co-operate to degrees that may cause conflicts with their own professional codes of ethics. All this happens while too many in the wider public are ignorantly “sleep-walking” through their daily routines and challenges, under constant distractions by a largely poorly informing media. Even those affected by the reforms seem mostly “comfortably numb”, until they may eventually be “hit” themselves, when WINZ unexpectedly calls them in for a work capability assessment and work preparations.
Honestly Concerned Author
‘Quest for Justice’
26 July 2013
This analysis with an abundance of resource links, quotes and comments can also be found on ‘ACC Forum’ via this link:
FURTHER INFORMATION ADDED TO THIS TOPIC:
ADDENDUM 1 (27 Oct. 2013):
There is some more highly interesting and revealing information that I wish to add here, which shows how far the “experts” around Professor Mansel Aylward and his “research department” at Cardiff University have gone in the past, to gather together the rather selectively chosen and variously “interpretable” kind of supposedly “scientific” research data justifying their general approach.
A) This is a report by a Professor Halligan, senior psychologist from Cardiff University, which he published together with some colleagues:
“Malingering and illness deception”
„Wilful deception as illness behaviour”; First published 2003 – by:
Peter W. Halligan, School of Psychology, Cardiff University;
Christopher Bass, Department of Psychological Medicine, John Radcliffe Hospital,
Oxford; and David A. Oakley, Department of Psychology, University College, London
“The meeting which formed the basis for this book would not have been possible had it not been for the enthusiastic support of Professor Mansel Aylward and funding from the Department for Work and Pensions.“
Sensitivities and confusion regarding the nature of illness deception continue to be a major feature of modern medicine and social security policy in most Western democracies. Although biomedical models continue to dominate current definitions of illness deception, neither of the standard psychiatric glossaries consider malingering—the intentional production of false or exaggerated symptoms motivated by external incentives—to be a valid diagnostic term. In this chapter, we argue that illness deception does not need to be medicalized in order to be understood as a coherent explanatory construct in its own right. The fact that health and non-health related deception is commonly practiced within society and that public attitudes towards fraud and deception are largely equivocal, suggests that it is reasonable to view illness behaviours from several conceptually non-medical perspectives. This is clinically and theoretically important, since disagreements both within and outside the medical community about the fundamental nature of illness deception are still largely framed in medical parameters given the absence of credible or acceptable non medical accounts. Discussion of illness deception outside medicine is meaningless without an explicit recognition and acceptance that an individual’s choice to feign or exaggerate symptoms is a legitimate explanation for some illness behaviours associated with personal or financial incentives.”
Further extract from publication by Halligan et al:
“4 Can monkeys malinger?
Richard W. Byrne and Emma Stokes
It is often helpful, when examining a subtle or vexed issue, to take an outside perspective. The nonhuman primates present opportunities for doing just this, with respect to malingering. Monkeys and apes live in long-lasting and often complex social milieus, in which there are profits to be made by malingering—and indeed, malingering has been found in many species, and of a rich panoply of types, limited more by opportunity than cognitive flexibility. Yet most of these animals are believed, with reason, not to understand the intentional states of others; only the great apes may properly intend to malinger. Perhaps much more malingering in humans is ‘unintentional’ than is commonly thought? Disablement in chimpanzees and gorillas, a result of snare injury, allows us to see how well they can compensate for loss of capacities, uncontaminated by the help of others since help is not offered in ape society. Nevertheless, remarkable compensation is possible, by means of low-level flexibility rather than reorganization of technique, sometimes enabling severely maimed apes not only to survive but thrive. Considerable overlap in apparent efficiency levels was found between disabled and able-bodied apes, even though there could be no profit from malingering. This raises the question of whether measures of overt efficiency can ever be reliable in assessment of human malingering, where there may be real motivation to conceal capacities for gain.”
Own Comment on this:
When you go as far, as trying to find evidence for “malingering” behaviour in primates, to prove that humans must naturally also have a general tendency to “malinger”, and to pretend to be ill, then this raises questions about how “serious” – or rather bizarre – such “science” is!
B ) Also see this blog for information on Professor Halligan, Unum Provident, and the ‘Unum Centre for Psychosocial and Disability Research’ at Cardiff University:
‘Topic: Unum Is Still Doing It to the Disabled 1/15/11‘
See extract from a “reply 2” by ‘Beorc’, 18 Jan. 2011:
“In 2004, Unum opened its £1.6m Unum Centre for Psychosocial and Disability Research at Cardiff University. Mansel Aylward retired from his post as Chief Medical Officer at the Department of Work and Pensions and became its Director. He was joined by Professor Peter Halligan who had forged the partnership with Unum, and Gordon Waddell an orthopaedic surgeon turned academic. The launch event was attended by Archie Kirkwood, recently appointed Chair of the House of Commons Select Committee on Work and Pensions. Malcolm Wicks, Minister of State in the DWP gave a speech praising the partnership between industry and the university.”
C) “Here we go again … another victim of DWP medical tyranny…”
by Mo Stewart, TAXPAYERS AGAINST POVERTY, 09 July 2012:
“In his last report, Pro Harrington recommended that the Atos assessment was just one opinion about a claimant’s ability to work, and one of several medical opinions to be considered by the DWP (totally unqualified) Decision Makers when considering if an applicant is unfit for work and to be awarded disability benefit.
Why are these letters still being sent out, demonstrating yet again that the only opinion being considered by the DWP is that using the compromised Atos assessment that’s ‘totally unfit for purpose’ (CAS) ??
The reported comments from the DWP go though the motions of claiming that all medical opinion is considered but, clearly, from the letter received, nothing has changed.”
D) “Illness as ‘Deviance’, Work as Glittering Salvation and the ‘Psyching-up’ of the Medical Model: Strategies for Getting The Sick ‘Back To Work’“ –
by Gill Thorburn, Black Triangle Campaign, 25 July 2012 (this article may already have been posted in a comment further above by the way)
“The one thing I am absolutely unreservedly and implacably opposed to in all of this is a real world test.” – Chris Grayling, Minister of State, Department for Work and Pensions, 2011.
E) DWP/UNUM/ATOS SCANDAL ~ Professor Simon Wessely: ”It is only human for doctors to view the public as foolish, uncomprehending, hysterical or malingering”
by JJ (Co Founder of Black Triangle), Black Triangle Campaign, 09 September 2012 http://blacktriangle…or-malingering/ “Emily Collingridge, 1981-2012: such a short life, such a huge legacy” “Her memory gives us strength …” ‘After all, this planned withdrawal of support may begin with the ME population, but which group of disabled UK people who are deemed unworthy of State support on the basis of costly non-productivity will be targeted next?’
Margaret Williams writing in 2007 in “Wessely, Woodstock and Warfare?”
Other extract in blog thread: “By incorporating the Biopsychosocial Model into disability assessment, we can identify critically important information on obstacles to recovery, which in many cases can be tackled by an integrated package of support such as that offered in the Pathways to Work pilots and as provided by UnumProvident’s Claims Management and Rehabilitation Services”. As quoted from Mansel Aylward
ADDENDUM 2 (27 Oct. 2013):
This may be of interest too, for some, re Professor Mansel Aylward and his past “endeavours” and “involvements”:
“Top doctor in job for wife row”
The Independent, Mark Rowe, Sunday 29 March 1998
“THE chief medical adviser to the Department of Social Security, Dr Mansel Aylward, was behind the setting up of a company that enables civil servant doctors to process health insurance claims.
The company, Mediprobe, which puts doctors in contact with major health insurance companies, has Dr Aylward’s wife, Angela, listed as director.
It has also emerged that Mediprobe, which is totally independent of the DSS, has paid Dr Aylward for work done on its behalf, even though he was advised he could not be involved in the establishment of the company.”
“Details of Mediprobe, whose trading name is the Nationwide Medical Examination Advisory Service Ltd, listed at Companies House in Cardiff show two directors, Colin Cornelius and Dr Aylward’s wife, Angela, who is also company secretary. Accounts for the 15 months from December 1995 to March 1997, filed at the start of this year, show that the two directors received pounds 36,000 renumeration and pounds 30,000 in pension contributions.”
One rule for the sick and disabled suffering for instance from mental health issues or muskulo-sceletal conditions, another rule for Professor Dr Mansel Aylward and his wife, when it comes to applying fairness, legality and conflicts of interest!
ADDENDUM 3 (19 Nov. 2013):
And already now there are such stories coming through the media here in New Zealand, which are early signs of yet more troublesome things to come:
“Winz apologises to sick woman placed on wrong benefit”
Read the full story here! A link to the article on ‘The New Zealand Herald’, online edition from 18 Nov. 2013 is here:
“Work and Income New Zealand has apologised to a woman with a debilitating medical condition for placing her on a benefit requiring her to find work.
Carolyn Gane was denied a supported living payment, previously known as an invalid’s benefit, despite having her GP’s recommendation and was instead placed on jobseeker support, previously known as the sickness benefit.
Jobseeker support is for people who can work but are temporarily unable to do so, and requires them to seek employment while receiving benefit payments.
The 49-year-old Hamilton mother of four is afraid to leave her house in case she has an “embarrassing accident” caused by medical problems with her bowel, and was gobsmacked when Winz deemed her fit for work.
Ms Gane was diagnosed with diverticular disease in 2008 and irritable bowel syndrome in December. The medical conditions cause her pain and to lose control of her bowel with little warning, and as a result she rarely leaves her house in Hamilton East in case she is caught.”
“A medical certificate supplied to Winz in July meant she had short-term exemption from finding work, but last month Ms Gane’s condition worsened and her GP, Dr Tiwini Hemi from the Tuhikaramea Medical Centre, deemed her unable to work in the longer term. She used the medical report to apply for the supported living payment.
A letter from Winz said Ms Gane did not meet the medical credentials to qualify for the benefit and would remain on jobseeker support.
Winz Waikato Regional Commissioner, Te Rehia Papesch, said they had made an error and would be re-examining Ms Gane’s case.”
I see there have also already been many other articles in the media about planned outsourcing of work capability assessments and other services here in New Zealand, hence this country is under the present government definitely following the UK approaches now!
ADDENDUM 4 (02 Dec. 2013):
The following is delivering evidence that the ones like Professor Mansel Aylward, Professor Gordon Waddell (and others) referred to (see comments further above in this thread) are somehow getting their “research”, “analysis” and “reports” wrong. There is evidence that poverty itself is more of an issue, than their perceived “worklessness”:
From the website ‚THINK PROGRESS’ read the following article there:
‘Poverty Has Same Effect On The Brain As Constantly Pulling All Nighters’
(By Bryce Covert on August 30, 2013 at 8:54 am)
On that same website and forum this article with further resources can be found also:
‘Kids Who Overcome Poverty Are Still In For A Lifetime Of Medical Problems’
(By Sy Mukherjee on May 31, 2013 at 2:25 pm)
ADDENDUM 5 (02 Dec. 2013):
Here is some further evidence, that was already presented in ‘The New Scientist’, proving that austerity measures in the welfare and health care areas can have disastrous, unexpected results, that will cause governments more costs in future, than any costs that they may achieve to save in the short term:
The New Scientist, edition 11 April 2013
Please note, that this article is available via the above link, apparently freely accessible there on the internet, while some publications appear to be copyright protected. I presume therefore, the below extract from it is only a part of the complete report:
The hidden costs of austerity
11 April 2013; magazine issue 2912
“In making deep budget cuts, politicians are experimenting with the health of nations, not just their wealth.”
“ECONOMIC austerity seems here to stay – at least for the foreseeable future. Any hope that a sharp dose of belt-tightening would quickly give way to resurging prosperity has melted away. And like an impolite house guest outstaying their welcome, its demands seem ever more burdensome as time goes on.
The longer austerity lasts – and it is only just getting under way in earnest in some countries, such as the UK – the greater the toll on our most vulnerable citizens. It is no surprise that this will affect their health.
Eurozone countries have already provided object lessons in just how severe such effects can be: the incidence of mental illness has shot up, long-vanquished infectious diseases are making a comeback, and people have been driven to extraordinary lengths to obtain even basic medical supplies from failing healthcare systems (New Scientist, 26 May 2012, p 6).
Even in the cautiously optimistic US, researchers from the Center on Budget and Policy Priorities in Washington DC have warned that budget cuts mean up to 750,000 people living in poverty could lose access to a vital supplemental nutrition programme.
And as we report on “Cost of cuts: Austerity’s toxic genetic legacy”, the immediate consequences of austerity may give way to more enduring and insidious effects on health. It is plausible that protracted economic hardship will lead to increases in heart attacks, strokes and depression. Stress hormones are known to trigger or exacerbate these conditions, and it is hard to argue that those worrying about the security of their jobs, homes, families and finances are not experiencing high levels of stress.
The studies of stress conducted so far relate mostly to people who suffer from loneliness and social exclusion. They show that it causes wholesale reprogramming of genes in white blood cells, which in turn drives chronic inflammatory conditions. We also know that growing up in deprived conditions reshapes genes for life, and there is suggestive evidence that stressful events early on – perhaps even before birth – may become “biologically embedded” via altered gene activity.
If we can find behavioural or pharmacological ways to “switch off” the adverse gene programming, we may be able to mitigate the harm. But the research is still at an early stage, and some of the key findings so far relate to animals, not people.
We also don’t know if the findings apply to the kinds of stresses we are enduring. It’s conceivable that the prevailing social conditions affect people’s response: the stresses of war against a common foe might be very different to those of a socially divisive financial crisis, for example. Or it might be that stress is stress, biomedically speaking.
Much ink has been spilled debating the fiscal merits of austerity. Its effects on health, on the other hand, have gone largely undiscussed, the assumption being that they will dissipate as the belt-tightening does.
But if genetic responses to stress have long-term effects, perhaps lasting for generations, politicians must reconsider solutions to what they see as a purely economic crisis. Because austerity is not just an experiment with the wealth of nations. It is an experiment with their health, too.”
Note: This article appeared in print under the headline “The true cost of cuts”
ADDENDUM 6 (02 Dec. 2013):
As perhaps already mentioned in another thread on this blog forum, here is what the Prime Minister’s Chief Science Advisor, Professor Sir Peter Gluckman, has found out about the “patchy use of evidence in government”:
‘Gluckman’s audit finds patchy use of evidence in government’
“The Prime Minister’s Chief Science Advisor, Professor Sir Peter Gluckman, says there is “little consistency” in the use and respect for research-derived evidence in government and has called for a more systematic use of it in policy formation and implementation.
Sir Peter today released the report The Role of Evidence in Policy Formation and Implementation, which included an audit of government departments to see how many scientifically trained advisors they have in-house, their processes around use of scientific evidence and whether they have a departmental science advisor.
He also looked at protocols in place for seeking scientific advice and the practice of peer review in Government-commissioned research.
“Worryingly, some officials had limited understanding of the scientific process of knowledge production, or were uncertain about it. In addition, they were not clear on how research-based evidence could be used to support policy processes,” he writes.
“Rather, it seemed that some preferred to work from their own beliefs or rely on their own experience. At its extreme, I find this deficiency to be unacceptable. In part, I think these deficits reflect the dire need to build some basic competencies in research methodologies and critical appraisal skills across the public service, and to bolster the leadership ranks with people formally trained in the relevant disciplines.”
His recommendations include:
• The establishment of government-wide formal protocols to guide policy makers in sourcing quality research-based advice.
• The appointment of Departmental Science Ad- visors to major ministries.”
Here again is the link to ‘Sciblogs’ website and complete publication and comments on it:
Here is a link to downloadable PDF document with the complete audit report on this:
“The role of evidence in policy formation and implementation” –
A report from the Prime Minister’s Chief Science Advisor
The report and an included table (see ‘Sciblogs’) show, that the Ministry of Social Development is not well advised on science and research, and therefore appears to have issues with using “evidence” in their policy formation and implementation.
ADDENDUM 7 (02 Dec. 2013):
The following story and publication gives yet another perspective on the welfare reforms, as they were initially introduced in the UK, and how they are now increasingly being implemented here in New Zealand, following questionable “research” and “findings” by Mansel Aylward, Gordon Waddell et al, and certainly supported and pushed for by Work and Income’s relentlessly pushing “Principal Health Advisor”, Dr David Bratt, who according to other information once also had a questionable track record when working for, or advising ACC:
‘A lesson from NZ on the hazards of punitive welfare reform’
By Melissa Sweet, September 22, 2013 (3:36PM)
Link to blog article:
“The toll that structural violence takes upon disadvantaged people in NZ was highlighted in a keynote address to the Public Health Association of Australia’s annual conference in Melbourne last week.
Darrin Hodgetts, Professor of Societal Psychology at the University of Waikato, described how punitive welfare reforms exacerbate the difficulties faced by many people who are already struggling, and said that state agencies increasingly enact repression rather than care.”
“How the instruments of the state create a landscape of despair for those in need of care”
Marie McInerney writes:
“New Zealand social scientist Darrin Hodgetts says the diagram below maps the “chaotic landscape of despair” that defines the daily lives of an increasing number of poor New Zealanders.
It tracks all the interactions that one family had with government agencies, not-for-profit community services, and private providers, over a two week period.
As he says, it is a full-time ‘job’ for at least one family member to try to navigate such an obstacle course ….”
The scientific report by Professor Hodgetts can be found here:
“Researching poverty to make a difference: The need for reciprocity and
advocacy in community research”
“Growth in poverty throughout the Organisation for Economic Co-operation and Development [OECD] hurts people. The Auckland City Mission Family100 project explores the everyday lives, frustrations and dilemmas faced by 100 families living inpoverty in Auckland. This article reflects on poverty in New Zealand, associated welfare ‘reforms’, the consequences of recent change in exacerbating hardship, and our own efforts to advocate for the rights of beneficiaries. Specific attention is given to a workshop run by the research team with the judiciary, and what such activities foreground in terms of the relational nature of research, reciprocity and advocacy.”
ADDENDUM 8 (03 Dec. 2013):
Today (03 December 2013) I listened to ‘Nine to Noon’ with Kathryn Ryan on Radio NZ National, and a bit after 10 am there was an interview with Minnie Bharagwanath from the so-called “Be.Institute”. She has been suffering poor sight due to a congenital condition since young age and is therefore considered a person with disability. She has overcome hurdles and challenges and apparently succeeded in her life.
I listened with interest, and at first I thought for a moment it was Paula Bennett talking and giggling away, but it was not, as I realised when the ‘Be.Institute’ and her name were mentioned. What struck me was her upbeat talk about her institute and their initiative wanting to achieve “change” in thinking, attitudes and doing things, by convincing businesses, organisations and public institutions to give better access for disabled.
It all sounded rather good, but then I thought, hey, how are they doing this, and what exactly are they doing in way of achieving any change? So this afternoon I looked up their website, and I read a lot of information, and I found once again proof of what I had suspected. It seems they are about doing “business”, a business of selling “assessments”, consultancy services and advice to businesses, organisations and public institutions, and whomsoever else.
Here is the link to Radio NZ National’s audio page – with also the particular audio track:
This ‘Be.Institute’ likes to consider itself as a “movement” and they also run “campaigns”:
But when looking at the “Team” of that “Movement”, one comes to a page with personalities with CVs that appear to be typical of a corporate style business:
They even have Gillian Davie as ‘Human Resource General Manager’ from Progressive Enterprises as one of their TRUSTEES! Yes, clearly it is a trust, but looking at the structure, the members and the way they operate, it appears to be similar to other operations that offer outsourced services in the disability and health sector, more or less like an ordinary business.
One can fairly expect that the “Team” make some of their living out of this, and that they will ensure they are themselves well looked after. A look at their services shows how they make a living, and how they finance themselves:
This here is what is found on that website page, for those that cannot bother clicking the link:
“Book an Assessment To become a Be. Accessible business, simply register for the Be. Welcome Start-up Package by completing the Your Business Snapshot form online phoning the Be. Institute – 0800 Be. in touch (0800 234 686)
Your Be. Welcome Start-up Package includes:
a Be. Welcome assessment of your business by a Be. Coach a detailed report including recommendations and a follow-up session tailored to your business or organisation’s needs an accessibility rating full profile in Be. Accessible’s online directory accessibility workshop for you and your team
$449* for a small business (up to 5 staff)
$999* for a medium business (6 – 20 staff)
$1699* for a large business (16 – 50 staff).
If you are a large organisation please contact us to find out about our Corporate Be. Welcome programme and its tailored packages.
*price excludes GST”
In return for the “assessment” done on a business, an organisation or institution a rating is offered, ranging from “just starting” to “bronze” and going up to “platinum”:
A business, organisation or institute can then also “enjoy” the use of a “Be. Coach”, to improve their accessibility and to achievpe the rating they may wish to get.
They have a ‘Leadership Team’, who guide and mentor participants and interested businesses, organisations and institutions:
Not surprisingly Work and Income and the Ministry for Social Development have realised that this fits in nicely into their new agenda, to “assist” and to “support” beneficiaries with disabilities into forms of work on the open market. So Miss Bharagwanath is held up as a “shining idol”:
Well, this shows again, this is what it is all about. “Helping” and “supporting” and “bringing change” for good sound money, earned on business terms! That is what seems to be the way things are going in the welfare sector also, and this is proof to me, that all this talk about helping disabled to realise their potential, to improve their lives, and to take on some kind of work, it is all about certain people making money out of it, for themselves.
ADDENDUM 9 (20 January 2014):
Further to Part 7 and ‘A)’ there (see “Comment 5” above in the thread), it is interesting to note how the ‘Australasian Faculty of Occupational and Environmental Medicine’ (short AFOEM), which is one faculty at the ‘Royal Australasian College of Physicians’ (RACP), has over recent years adopted and further developed their policies on the “health benefits of work”. It is quite clear that there is more to this than just “developing policy”, it rather resembles a strategy being followed, yes an agenda!
The AFOEM President Elect , Dr David Beaumont (formerly employee for ATUS in the UK), is sitting on the ‘AFOEM’ Council and their Policy and Advocacy Committee. He and a few others from the same “school of thought” appear to have pushed for the agenda, to further integrate the supposed “findings” by Professor Mansel Aylward from the ‘Centre for Psychosocial and Disability Research’ (for years sponsored by Unum Provident) at Cardiff University in Wales, UK..
See this link for his “official” profile and background: at Cardiff University in Wales, UK.. See this link for his “official” profile and background:
It all started with the launch of a position paper titled ‘Realising the Health Benefits of Work’ in May 2010. Not surprisingly to insiders like us, Professor Mansel Aylward attended as a key speaker at the launch, making the following presentation:
‘Professor Sir Mansel Aylward Presentation’
(apparently only registered members can access the video presentation)
But this link to the launch page leads to a downloadable video at the bottom:
In October 2010 they then held a ‘Stakeholder Meeting’ at the AFOEM, which had Dame Carol Black, another well known propagator and defender of the same kinds of “teachings” as Professor Aylward represents attend as a main speaker. She was then the first ‘National Director for Health and Work’, Chair of the ‘Academy of Medical Royal Colleges’ and Chair of ‘the Nuffield Trust’ in the United Kingdom:
‘Prof Dame Carol Black – Stakeholder Meeting’
In March 2011 the AFOEM then held a ‘Return to Work Forum’:
It already announced the launch of the ‘RACP AFOEM Consensus Statement on the Health Benefits of Work’ just over a week later in Wellington, New Zealand, which would also be attended by Dame Carol Black from the UK!
The following documents were offered – apparently already at that meeting on 22 March 2011:
On 30 March 2011, in Wellington, New Zealand, there was then the public launch of the ‘Consensus Statement on the Health Benefits of Work’:
Dame Carol Black’s presentation can apparently be downloaded via this link:
Photos on the AFOEM website show the two presidents of the College, one of them DR DAVID BEAUMONT, Dame Carol AND our former Minister for ACC, NICK SMITH! Yes, and even a number of other “supporters” attended, and one was HELEN KELLY for the Council of Trade Unions (CTU)! Prominent on almost all photos on the website of AFOEM is Dr Beaumont, that former ATOS man, who seems to be having substantial influence, as he is part of high ranking networks, and by the way also runs his own business ‘Pathways to Work’, right here in New Zealand! Talk about conflicts of interests in very high places.
In November 2011 another “Stakeholder Meeting’ followed, and it appears to have been titled with the theme: ‘Health Benefits of Work: From Consensus to Action’:
An extract from the website informs of this:
“The Australasian Faculty of Occupational & Environmental Medicine (AFOEM) held their inaugural Health Benefits of Work: From Consensus to Action stakeholder meeting at the College on 16 November. Over 60 signatories attended the meeting at the RACP Education Centre, with industry leaders addressing the gathered audience about their organisational commitment to the Health Benefits of Work. Dr David Beaumont, Chair of the AFOEM Policy & Advocacy Committee, facilitated the day’s proceedings, while AFOEM President Dr Robin Chase gave the opening address. Speakers who presented on the day included RACGP Vice President Liz Marles, Comcare CEO Paul O’Connor, ACC Director Kevin Morris, ALUCA Treasurer Chris Healey, NZCTU President Helen Kelly, ARPA President Annette Williams, Chief Executive of WorkSafe Victoria Greg Tweedly, and AFOEM fellows Dr Graeme Edwards ad Prof James Ross.”
The ‘Consensus Statement’ can again be found via this link – on the above website:
And this link shows the New Zealand signatories to the statement:
It shows us that virtually the bulk of the NZ medical profession and their organisations have signed up to it, same as certain other health professional organisations, many government departments, employer groups and indeed also the CTU! It includes educator organisations for medical staff, and als/strongo key stakeholders with vested business interests, like ‘The Wise Group’. See above under Part 7 again, to refresh on them and some other players!
IF THIS IS NOT A SUCCESSFUL SEIZING OF KEY PLAYERS AND GROUPS IN THE MEDICAL AND ASSOCIATED FIELDS, EXECUTED WITH PERFECTION BY THE UNUM PROVIDENT “SPONSORED” AND THUS “HIRED” PROFESSOR MANSEL AYLWARD, HIS COLLEAGUES LIKE GORDON WADDELL AND SOME OF THEIR LOYAL SUPPORTERS AND MOST DETERMINED PROPAGATORS, LIKE DR DAVID BEAUMONT, THEN WHAT IS?
The resulting GRIP on medical and with that health, treatment and social policies, supported by the New Zealand and apparently also Australian governments, also having vested interests, has gone so far, that now general practitioners (GPs) are openly reminded of what to do:
‘The role of GPs in realising the health benefits of work’
Extract from the AFOEM’s statement for GPs:
“The family doctor is best placed to advise and educate patients that, in most cases, a focus on return to work is in the best interest of the patient – for both their future and quality of life and that of their family.” “Return to work is not possible for everyone, but certifying time off work – particularly when absence is long term – can have significant side effects, including increased rates of overall mortality, poorer physical health and poorer mental health and psychological wellbeing.” “Simple messages delivered in the clinical environment can encourage patients to develop evidence-based views of the relationship between health and work. Evidence-based messages include: Work is an important part of rehabilitation The longer someone is off work, the less chance they have of ever returning Most common health conditions will not be ‘cured’ by treatment Work is a therapeutic intervention, it is part of treatment Even when work is uncomfortable or difficult, it usually does not cause lasting damage Typically, waiting for recovery delays recovery Staying away from work may lead to depression, isolation and poorer health, and Employer-supported, early return to work helps recovery, prevents deconditioning and helps provide patients with appropriate social contacts and support mechanisms.” “Practical ways of assisting patients back to employment and optimum functioning include: Recommending a graduated increase in activity and setting a timeline for return to work Talking to the employer (preferably while the patient is with you), especially about how to modify the workplace and work duties to allow return to work Collaboratively identifying obstacles – and solutions – in the workplace Being clear about what health care can and can’t achieve, and I dentifying possible sources of support, including family members, co-workers and relevant government services.”
A number of “Stakeholder Updates” or update reports are available via the website too:
And following all this was of course substantial justified concern and criticism expressed, by the writer of this thread, by various commenters, by as certain disability advocacy organisations, sundry health advocates, some health professionals themselves, a good number of beneficiary and ACC advocates – and a few politicians, writers and bloggers. Now the AFOEM seems to have taken note of this, and they have seen themselves urged to bring out a new, additional statement. They are still defending and trying to justify their position statement on the “health benefits of work”, but they have seen a need to examine, define and explain, what “work” that may be, that is “beneficial”. Now they are writing and talking about “good work”.
In some “latest” news from October 2013 they have suddenly come out with this:
“No work or bad work: both can make you sick – AFOEM launches position statements on healthy workplaces”
“The RACP’s Australasian Faculty of Occupational and Environmental Medicine has launched two position statements: What is Good Work? and Improving Workforce Health and Workplace Productivity. The position statements make recommendations for governments, insurers, businesses and worker advocates to enhance health and productivity in the workplace in Australia and New Zealand. They advocate for improvements in workplace culture and the creation of ‘good work’ from which individuals, employers and the community can benefit. The papers are companion statements to the New Zealand and Australian Consensus Statement on the Health Benefits of Work and the position statement Realising the Health Benefits of Work, launched in 2010 to raise awareness that good work improves health and wellbeing What is Good Work? and Improving Workforce Health and Workplace Productivity fact sheets are available, which summarise each position statement. A media release was also issues to the New Zealand Media and Australian Media about the launch of the position statements.”
Yes, there is an additional statement found here now:
And also perhaps check this out:
A media statement was apparently made earlier:
Own summary comments:
This shows the AFOEM is starting to get concerned! Having to explain what “good work” is, and what may not be, then still being somewhat wishy washy about it, leaving much open to individual, subjective interpretation by anyone involved or affected, this just opens wider the pandora’s box for more issues to come!
Maybe they should have a rethink too, that it may not be simply “work” that is best for your health, but it may simply be sound, balanced physical activity and also certain mental and social activities that are beneficial to a person’s health. Instead of “worklessness”, as persons like Aylward, Waddell, Beaumont and Bratt try to tell us, it may also actually rather be POVERTY, social degradation, discrimination, marginalisation, which all result in being “excluded” and dis-empowered, while having serious psychological and emotional effects on persons, that can bring with it negative effects on physical and mental health. Are the “experts” at the AFOEM finally coming to discover something more pressing, more real, more relevant and more scientifically worth disseminating, thus coming to see “the light” of wisdom? I can only hope so, because such a statement on the effects of POVERTY on health seems to be missing in their policy statements!
There must certainly be an acknowledgment and acceptance that “open employment”, work in jobs on the competitive open market, is not necessarily all that “beneficial”, as many workers continue to complain about repetitive stress disorders, mental and physical stressors, about a lack of balance, unfair treatment, lack of being appreciated and much else, that comes with many jobs in various industries, apart from the traditional accident dangers. So trying to serve the interests of insurers, of ACC and WINZ here in New Zealand, to “save costs” and make it hard to have claims and entitlements met, that may in the end not lead to much at all, to improve health with the steps and means so far suggested, perhaps rethink all this madness. I think AFOEM, the medical profession, medical scientists and certainly government administrators, politicians and insurers better sit down, take some deep breaths, do a thorough rethink, do more and better research, and come back with sensible policies, that actually are more based on realities and facts, and that are reliable!
And for governments and administrators, perhaps start accepting that voluntary work, of whatever types and durations, may have to be treated the same as persons doing “paid” work on the “open market” for employers. Perhaps stop harassing and pressuring sick and disabled, including those that suffered accidents and lasting harm, and instead consider introducing a Universal Basic Income or something along those lines, offering top ups for individual needs any person has. That may in the long run be the easiest, cheapest and fairest way to run any “welfare system”, and it may save immense amounts in thus far costly, endless bureaucracy, employing enforcers, administrators, double checkers, investigators, police, doctors, rehab professionals and what else you have. That is my take on all this from the AFOEM for now for today!
ADDENDUM 10 (30 July 2014):
It is of greatest concern, that the apparent cooperation between the Ministry of Social Development, their Principal Health Advisor Dr David Bratt, and Professor Mansel Aylward from the ‘Centre for Psychosocial and Disability Research’ (formerly “UNUMProvident Centre for Psychosocial and Disability Research”), based at Cardiff University in Wales is continuing unabated!
Dr David Bratt, a strong propagator of the ideology that sick and disabled are best helped by putting them into any forms of “suitable paid work”, following controversial UK professor Mansel Aylwards ideas that most sickness and disability is only in the mind of people, has been to Europe, as part of a kind of New Zealand CORPORATE HEALTH REPRESENTATIVES trip to London, Brussels and Paris, keen to “learn more” about new findings and proposals about INTEGRATED CARE, and possibly also about how their own radical ideas of the “health benefits of work” can be further justified and promoted.
See some details here, from: GeneralPractice NZ – Visit to Europe, with Dr Bratt included, and their programme:
Read some extracted details published in the program published by: ‘General Practice NZ – 2014 Integrated Care Masterclass’:
“The focus of this Masterclass is to spend time together examining, discussing and learning about integrated care policies, processes and implementation internationally by working with the Nuffield Trust in England, attending an international conference on integrated care in Brussels and visiting sites in the Netherlands.”
* Whole-system / whole-sector reforms towards integrated care
* Policy examination – what’s happening to take integrated care forward in England, Netherlands (plus other European countries) – policy review and critique
* Examination of drivers for integrated care, especially economics
* Site visits, specifically to look at primary/community care integration and also aged care/long-term care (or combined)
Members of the group traveling to Europe were:
Dr Andrew Miller, GP and Chair, Manaia PHO
Dr Nick Chamberlain CEO, Northland DHB
Dr Neil Hefford, GP Clinical Leader, ProCare Health
Dr Campbell Brebner GP and Clinical Leader, Counties Manukau DHB
Loretta Hansen, CEO, East Health
Barbara Stevens CEO, Auckland PHO
Dr Debbie Holdsworth, Director of Funding, Auckland and Waitemata DHBs
Liz Stockley, CEO, Health Hawkes Bay
Adri Isbister CEO, Radius Medical Group
Dr Mark Peterson, GP and CMO Primary Care, Hawkes Bay DHB
Martin Hefford CEO, Compass Health
Melissa Simpson, Clinical Nurse Leader, Compass Health
Jude MacDonald CEO, Whanganui Regional Health Network
Dr David Bratt GP and Principal Health Advisor, MSD
Helen Morgan-Banda CEO, Royal NZ College of General Practitioners
Lee Hohaia CEO, Pharmacy Guild of NZ Inc
Dr Chris Masters GP and Managing Partner, Ropata Medical Centre
Dr Jeff Lowe GP, Karori Medical Centre TBC
Dr Ros Gellatly, GP, Marlborough PHO, Nelson Marlborough DHB, Clinical Adviser (Electives), National Health Board
Dr Simon Wynn -Thomas Senior Clinical Leader, Pegasus Health ”
While that trip may not be quite so controversial, Dr Bratt has made another, extensive trip to the UK also, meeting with Mansel Aylward and other “experts” in Wales and elsewhere in the UK:
PublicHealth Wales and Cardiff Uni visits:
See the ‘Chair Report’ from June 2014, from Public Health Wales:
“PUBLIC HEALTH WALES:
Chair Report – June 2014 “Purpose of Document:
The purpose of this paper is to provide the Public Health Wales Board with a written update supplemented, as necessary by a verbal update on the day. The Report includes information on a number of strategic developments and other issues for information.”
“Author: Professor Sir Mansel Aylward CB and Gemma Trigg, Personal Assistant
Date: 16 June 2014″
“Distribution: Public Health Wales Board”
“The purpose of this paper is to provide the Public Health Wales Board with a written update, which includes information on a number of strategic developments and issues.”
“11 Visit from Dr David Bratt
During May 2014 we arranged a study tour for Dr David Bratt. Dr Bratt is Chief Medical Advisor, New Zealand Ministry for Social Development and Principal Medical Advisor to Minister, the Hon Paula Bennett. Board Members had the opportunity of meeting Dr Bratt when he joined us for lunch at the last Informal Board meeting. During his visit Dr Bratt met a number of key people from the Welsh Government including the Chief Medical Officer, Minister for Health and Social Services, Minister for Economy, Science and Transport. He also had meetings with Cardiff University and the University of South Wales. He visited GP surgeries in Swansea. I also helped Dr Bratt in arranging meetings with colleagues in England with particular interests in Occupational Health and Assessment of Disability and Capacity for Work.“
Dr David Bratt is clearly intent on, and also commissioned by the NZ government, to engage further with selected UK “experts” that have formerly been on the payroll of UNUM Provident, to obtain more “training”, information and whatever “evidence”, to continue with the adopted agenda to dis-entitle sick and disabled from any deserved welfare, ACC or insurance payment support, and to pressure them to try and take on any kind of hypothetically “suitable” employment, so COSTS are saved. Here we have yet more evidence of that controversial UK professor Mansel Aylward and his bizarre “research centre” being allowed to influence welfare and health policy in New Zealand!
This is extremely worrying, as all the involved parties appear to stubbornly and resolutely ignore any justified criticism that has been raised about the way welfare and related reforms have been conducted in the UK and here in New Zealand. People affected must be very seriously concerned about what is going on, and what the wider public is not aware of, and is NOT being informed about.
See the attached PDF files downloaded from the internet for more details and evidence about Dr Bratt’s latest “adventures”!
ADDENDUM 11 (14 SEPTEMBER 2014):
In this long post and thread there has been repeated mention of Dr David Bratt, Principal Health Advisor for the Ministry of Social Development and for Work and Income, who was also involved in the training of designated doctors that WINZ use, and who has also had significant input into the formation of welfare policy, of recent “reforms” and how they are implemented.
He is in charge of the various Regional Health Advisors that WINZ have in each Regional Office, and together with the Principal Disability Advisor Anne Hawker, he is also in charge of the Regional Disability Advisors, as well as the so-called Health and Disability Coordinators (who closely liaise with ordinary General Practitioners and other stake holders).
After the many revelations about Dr Bratt, and how he blatantly likens benefit dependence to “drug dependence”, as he has in many of his bizarre “presentations” to medical professionals and other groups, one may wonder, why he gets away with all this, and why MSD have kept him employed.
The truth is basically, he represents the line of approach that MSD and WINZ follow – and want to continue, when dealing with sick, injured and disabled on social security benefits. He is also part of the medical and wider health administration establishment, and holds a number of positions in related areas.
As I recently found out yet again, he is still a member of the Board at the NSAD (New Zealand Society on Alcohol and Drug Dependence). The Chairman on the Board of Trustees is a Mr Bill Nathon, and Dr David Bratt is the Deputy Chair, as the link to the NSAD website will show further below:
I have also attached a PDF with scan copies of the relevant information, in case the website and/or appointments change. Robert Steenhuisen, Auckland Regional Manager of Community Alcohol + Drug Service (CADS) at Waitemata District Health Board is Trustee at NSAD, so are Tim Harding, C.E. at Care NZ, and two others. So these persons all sit alongside Dr Bratt, overseeing the operations and activities of one major society that are the umbrella organisation at the head of a federation of NGOs in the alcohol and drug treatment sector.
We know that Dr Bratt has been a consultant at Capital and Coast DHB, has been involved as an abortion consultant and runs (or at least has run) a few business operations. As he appears to be part of some core networks, he will be supported by senior other professionals and agencies, last not least by the government, to continue his questionable activities, despite of all he has done, written and said. As a strong supporter of equally controversial UK Professor and “expert” Mansel Aylward (the former Chief Medical Officer for the DWP, then Director at a UNUM “sponsored” Research Centre at Cardiff University, responsible for draconian “welfare reforms” in the UK, that led to over a thousand deaths), Bratt gets the full support by his employer, serving under governments that have the ultimate goal to save COSTS, by pressuring sick, injured and disabled into work.
Now, if that still raises questions about ETHICS or else, put your questions to the persons in charge, Chief Executive Brendon Boyle and Minister Paula Bennett!
ADDENDUM 12 (26 APRIL 2015):
WELFARE REFORMS AND HOW SCIENTIFIC RESEARCH IS INCREASINGLY INFLUENCED BY FUNDERS WITH VESTED INTEREST
There was an interesting interview on Nine to Noon on Radio NZ National on 10 April 2015, where Kathryn Ryan spoke with Nicola Gaston, President of the Association of Scientists. She and many of her colleagues are very worried about what is happening in the science and research departments, funded by government and/or private enterprise. We hear more and more about public private partnerships, and it seems that is becoming the norm in science.
What it means is, we increasingly get science that is deemed to be “useful” by science investors, and less science that is truly independent. Also are scientists more often given the message, that they better hold back with their expert opinions, where it may not be so welcome.
Anyway, that is exactly what UNUM was doing, when they went into partnership with the UK government, to fund the ‘UNUM Provident Centre for Psychosocial and Disability Research’, headed by our well known “expert” professor, Mansel Aylward. “Science on order”, so to say, to serve the DWP and UK government, to achieve more cost savings and “efficiencies”, by declaring more persons “fit” for some forms of work, no matter whether there would be any realistic prospects to get true, lasting and sufficiently paid jobs on the market.
Sadly they achieved, and even managed to bring their “science” into NZ, where Paula Bennett and Bill English welcomed the new “findings” with open arms.
Here is the RNZ audio with the above interview, found via this link:
“Scientists speak out about fears of attacks on freedom”
And here is a good summary of what UNUM was involved in in the UK, for years, playing their role in “welfare reforms”, at least giving “advice” on it:
<em>”A Tale of two Models: Disabled People vs Unum, Atos, Government and Disability Charities :Debbie Jolly”
And while the reforms took place, UNUM did there – by supposedly “pure coincidence” – bring new insurance products onto the market, hoping that more people would insure themselves privately, as reliance on state support would in future be discourage!
These forces – such as UNUM and other vested interest parties, they are hard to beat, as they have immense funding to their avail, and a lot of “allies” all over the place. I am saddened that there is not more awareness out there, about what is really going on. But then, we know, it is not encouraged to read about it. As we can more often observe, even the media are becoming more “mindful” of what they report and what not, and they seem to be almost complicit in spreading the propaganda for selectively conducted, interpreted and used science.