SICK NOTE

Bashing benefit claimants does not sit well with traditional Labour voters, but it is a fact in neoliberal economies that people who are not economically productive - even if this is due to injury, bad health or caring responsibilities - must not be seen to go unfinished. Labour governments therefore tend to introduce benefit "reforms" with a mixture of savagery and soothing words.

This was what happened in 2008, when the DWP introduced Employment Support Allowance. Anybody who needed benefits because they could not work would now have to undergo a Work Capability Assessment - a set of yes/no questions related to physical functions such as reaching and bending. Depending on your level of functioning, you would either be assessed as fit to work or unfit to work.

The idea behind this, said the DWP, was to lift millions from a lifetime of benefit dependency". The Work Capability Assessment (WCA) would focus on the things people could do, rather than consigning them to long-term unemployment. Politicians cited research which stated that 80% of people with severe and enduring mental health problems wanted to find paid work, but felt that the system hindered them from doing so.

The real rationale behind ESA was rather less "nebaling" than the government claimed: it was to cut the benefits of people with long-term physical and mental health problems, and even people with terminal illnesses. Although the WCA focuses on physical functioning, it does not look at energy, stamina or illness. If you can bend down once, you are deemed to be fit to work, even though bending down 5 or 10 times may cause excruciating pain or exhaustion.

The result is that tens of thousands of people who know they cannot work have passed the WCA test. The Citizens Advice Bureau has published a report in which it says it has received 22,000 enquiries from people who are concerned that they have been assessed as being able to work when they are not. It tells the story of "an engineer in his 50s who had recently undergone a triple bypass for heart disease and was being treated for incurable stomach and liver cancer, who was deemed fit for work. During his assessment he said that he walked daily (as part of his convalescence regime) and that he was able to raise his hands above his head; as a result he was registered ready to start looking for work."

Another woman with severe ME was judged fit to work after she bent down to pick something off the kitchen floor during her medical assessment.

People with mental health problems have been similarly misassessed, for what the statistic above fails to note is that while a person may see a job as providing them with structure, confidence and contact with the outside world, the harsh realities of the workplace are often themselves the catalysts for a breakdown. People I've spoken to at work may want a job, but that doesn't mean they want to forego their benefits and work in a dead-end job without any support.

This insensitivity to the subtleties of people's fluctuating health is no accident. ESA was explicitly designed to reduce the number of people claiming benefits, and in particular people who claim the higher rates of benefit.

People who are unable to work get £108.55 a week in benefits; people who, with some extra support, could get a job of some kind (at least in the eyes of the DWP) get £89.80; and those who are completely work-ready get £64.30. It is easy to see why the DWP want as many claimants as possible to be judged as work-ready. To help it achieve this, the DWP has contracted out the medical assessments, which form such a crucial part of the WCA, to the private sector - in this case, Atos Healthcare. It has applied stringent targets to ensure that Atos assess the majority of claimants as ineligible for the highest rates of benefit. Atos's contract is incentivised on the basis of WCA results. And it has worked: according to DWP figures from October 2009, only 5% of ESA claimants were found to be eligible for the higher rate, with 68% being assessed as fit to work.

CAB's report shows that there is little medical basis to these results, but this has not deterred the DWP from their plan to apply the WCA to existing claimants of Incapacity Benefit or Income Support (where they are claiming due to disability). Whichever party wins, the post-election budget will squeeze benefits much more tightly and cut the number of jobs available. People with long-term health problems will be told they are fit to work, even if (a) they are not and (b) there are no jobs for them to apply for. And there will be no welfare state for them to turn to.