A former Department for Work and Pensions (DWP) medical director has pledged to speak out about the government’s “fitness for work” test if he finds it is “not proper”, after he was ambushed by campaigners at a conference.
Professor Sir Mansel Aylward had been delivering a keynote speech on the controversial issue of the different “models” used by professionals to explain disability, to the International Forum on Disability Management in central London.
The biennial forum brings together delegates from across the world to discuss how to “manage” disability in the workplace, with those attending including employers, senior figures in the insurance industry, and government and union officials.
Sir Mansel is closely associated with the biopsychosocial (BPS) model, which campaigners say puts much of the blame for disability on the disabled person, rather than the social model explanation, which says disability is created by the barriers of attitude and environment disabled people face.
A small group of protesters delivered a copy of a letter written to the Guardian newspaper – signed by 420 disabled people, including many leading activists – to Sir Mansel, outside the hall where he had given his speech.
The letter claims the BPS model is “nothing short of a creation of the insurance industry”, and is being used to deny disabled people the support they need through the benefits system.
It also criticises the Royal Society of Medicine (RSM) for organising the conference and lending “an aura of legitimacy” to the “pseudo-scientific approach” of the BPS model.
The protesters told Sir Mansel that the much-criticised work capability assessment (WCA) – used to test eligibility for out-of-work disability benefits, and introduced in 2008 – was based on the BPS model and had been heavily influenced by the insurance industry.
Sir Mansel admitted that the assessment was developed from the “all work test” he introduced himself in 1997 while at the DWP.
He surprised protesters by claiming that he could not comment on the WCA because he did “not know enough about it”, but pledged to “make myself aware based on what you have told me”.
He added: “I think I am a man of integrity. If I think the WCA is not proper I will speak out against it.”
Sir Mansel said he sympathised with the protesters, and himself now found the BPS model “unsatisfactory” and believed it “no longer addresses the real needs of disabled people and the exclusion of disabled people from society”.
He said the “social” element of the BPS model had been “neglected” and that he had a personal “distaste” for the medical model, which focuses on people’s impairments as the cause of their disability.
The issue of which explanatory “model” to use is important partly because the government’s welfare reform minister, Lord Freud, has said that the new assessment of disabled people’s eligibility for personal independence payment – the replacement for disability living allowance – will be based on a BPS approach and not the social model.
Earlier this year, Lord Freud quoted analysis which stated that – as defined by the BPS model – disability was “best overcome by an appropriate combination of healthcare, rehabilitation, personal effort and social/work adjustments”.
During his speech, Sir Mansel, who was the DWP’s chief medical adviser and medical director from 1996 to 2005, said he was “no longer satisfied” with the BPS model.
But he also claimed there was “a bit of a paradox” between the rights rhetoric of disabled activists and the protests connected with the WCA, which he said saw disabled protesters arguing that “because we are sick we cannot work”.
He also said there was “extensive clinical evidence that beliefs aggravate and perpetuate illness and disability” – a key element of the BPS approach that causes anger among many disabled people – and that “how people think and feel about their problems influence how they deal with them and their impact”.
And he claimed that although the social model was “still very relevant”, it was “not well understood” by the “fanatical elements” of the disability movement.
Sir Mansel is now director of the Centre for Psychosocial and Disability Research (CPDR) at Cardiff University, which is particularly controversial because of its previous sponsorship by the insurance giant Unum.
He talked with protesters for several minutes after his speech and told them that Unum was a “participant” in the conference but not a “sponsor”, even though the welcome pack for delegates thanked companies – including Unum – that had supported the three-day event, while the USB flash drives handed out to delegates had Unum’s logo written on them.
Sir Mansel, who chairs the forum’s “core committee group”, also pointed out that Unum had stopped sponsoring his CPDR about four years ago.
Unum is the UK’s largest provider of “income protection insurance” (IPI), and tougher welfare rules – such as those that are seeing incapacity benefit (IB) replaced by employment and support allowance, with a new, tougher, assessment – could persuade more people to take out IPI, boosting Unum’s profits.
Mounting evidence suggests Unum has been trying to influence government policy on IB reform for nearly two decades, claims the company has repeatedly denied.
Last year, Unum launched a major marketing campaign to promote the need for IPI, just as the coalition began its three-year programme to reassess about 1.5 million existing claimants of IB through the new, stricter test.
Unum has also admitted there has been widespread criticism of its past actions in the US, mainly over its refusal to pay out on large numbers of genuine insurance claims by disabled people.
John McArdle, one of the protesters and a founding member of the user-led campaign group Black Triangle, asked Sir Mansel about Unum’s past history in the US.
Sir Mansel said he could not speak for Unum, but that he had seen the BPS model as a “stepping stone” to “get rid of the medical model”.
Protesters also raised concerns aired last week in the Commons by the Labour MP Kevin Brennan that the chief medical officer of Atos Healthcare – the company that carries out WCAs – is Professor Michael O’Donnell, who was previously Unum’s chief medical officer.
Brennan told MPs that the insurance commissioner for California had described Unum in 2005 as an “outlaw company” that had “operated in an unlawful fashion for many years, running claims denial factories”.
He added: “Is that the kind of person that the government should allow to be in charge of a work capability assessment system?”
McArdle told DNS that protesters were concerned at this “revolving door”, which saw senior DWP officials and Atos and Unum figures move from one organisation to the other, which he said created “a clear conflict of interest”.
He said campaigners were worried that the health insurance industry had “undue influence on our public health and social policy”.
The letter the protesters handed to Sir Mansel called for an “urgent and thorough independent public inquiry” into the links between senior Unum, Atos and DWP staff in creating the current “government disability assessment regime”.
An RSM spokeswoman said: “We can confirm that Unum was one of the sponsors of the IFDM.
“The sponsorship arrangements were agreed by the sponsorship team in early August while Sir Mansel Aylward was out of the country.
“In the busy build-up to the conference Sir Mansel remained unaware of the sponsorship arrangements with Unum, hence his incorrect answer to the question asked on Tuesday.”
She said the conference was one of more than 400 “educational meetings” RSM was involved in every year.
She added: “The RSM is not a policy making body and does not issue guidelines or standards of care. It is a charity focused on providing high quality education.
“It is non-partisan and provides a multi-disciplinary forum for discussion and debate amongst medical and allied healthcare professions.”
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