The UK’s War Against Disabled People Part 4: ‘Dead People Don’t Claim’
How the Tories and New Labour turned the welfare state against society’s most vulnerable
Read part 1, part 2, and part 3.
In the first three parts of this series I’ve focused on the policy actions of successive governments, and the concerted (and successful) efforts of the private insurance industry to influence those policies, culminating in decades of systematic neoliberalisation and commodification of the UK’s welfare state.
In this final part of the series, I will focus on the resulting assessment and ‘workfare’ practices, and the devastating outcomes of those policies for their intended target — disabled people.
Content warning: the following includes details of mental distress and suicide.
Early red flags
At the center of the government’s benefit assessment processes, designed by Unum’s ‘men on the inside’, LoCascio and Aylward, are the organizations ATOS (originally SEMA), Capita, and Maximus. From the beginning, their assessment practices were found to be problematic in many ways.
In 2001, not long after the assessment process was outsourced, a report from the National Audit Office found that the number of successful claims had been reduced (the intended goal of ‘tightening’ the benefit gateway), but also that:
“[M]edically assessed benefits have a high rate of successful appeals against decision to withdraw or reduce benefit… in some 25 per cent of those decisions [the appeals service] changed, the interpretation of the medical evidence, whether from SEMA or the customer’s doctor, was an important factor.”
- NAO report on SEMA (ATOS) assessment contracting
One reason for this was that evidence from claimants’ own GPs and other medical staff often only came to light during the appeal, indicating that SEMA was failing to gather adequate medical evidence in assessing disabled claimants.
It’s important to note that the appeals process can take months; many are forced to claim unemployment benefits conditional on looking for work, despite being ill and later being confirmed as ‘unfit for work’ at appeal.
In the same year, a DWP report into assessments found that claimants felt they were being ‘tested’ in more than a medical sense — that they were suspected of lying about their illness. Additionally, assessments were perceived as a politically-motivated test to reduce benefit claims – not a test of ‘fitness for work’ but a test to justify the withdrawal of benefit (which, in both design and practice, it was).
Another emerging issue was the treatment of claimants by assessment doctors, trained in Unum’s ‘claims denial’ approach. Assessors were described as ‘cold’ and ‘insensitive’. One woman with severe clinical depression described her experience of being assessed:
“He asked me outright would I commit suicide, and if I did how would I do it? …I don’t know if he treated everyone the same but I thought his manner was, ‘Well I’m here to do the job, answer these questions and then you can go’. There was no empathy, no kindness in his voice”
- 2001 DWP report, Moving Between Sickness and Work
There were also concerns among both claimants and DWP staff that medical evidence from claimants’ own doctors was being ignored, and that medical reports provided by assessment doctors were misrepresenting what actually happened in the assessment.
The more things change…
This early research related to the Personal Capability Assessment, but these issues would continue for years even after the PCA had been replaced with the Work Capability Assessment (WCA), as shown in further DWP reports in 2003, 2004, and 2005 (and beyond).
Nonetheless, the government would go ahead with applying a similar assessment process to the ‘additional costs’ benefit Disability Living Allowance (DLA), later replaced by Personal Independence Payment (PIP) in 2013.
In 2003 Aylward, then Chief Medical Officer at the DWP appeared before an enquiry into improving the medical assessment process.
“The committee was very concerned by the fact that 51% of appeals against IB and DLA decisions were being won by claimants. One MP questioned whether the doctors were “genuinely concerned about the actual people they are assessing” or whether they “just treat them as a lump of meat” and “are not really all that bothered, are they, as long as they are getting their fee?”
- 2005 Benefits & Work news report
Aylward was adamant that the original decisions by assessment doctors and DWP decision-makers were correct, and that the appeals experts were in the wrong. However, this mismatch in judgments between Unum-trained assessors and appeal doctors would continue.
The government’s own statistics on appeals rates for Employment and Support Allowance for December 2022 show that the rate of successful appeals remains at 51% – the same rate Aylward was questioned about nearly 20 years ago.
Emotional burden
As well as the distress caused to claimants by the assessment process, concerns were raised about the impact on DWP staff assigned to ‘supporting’ claimants found ‘fit for work’ — often ill and undergoing an appeals process — of the emotional burden of enforcing such a system.
“Yeah, you do take it away with you. Some of them often have quite horrible stories to tell, you know, abuse or depression, really bad depression, you know, mental health issues, children being taken into care…”
- Incapacity Benefit Personal Adviser, 2005 DWP report
Staff worried that they were not skilled enough to deal with claimants with severe mental health issues. Many advisers felt that they were being assigned claimants who should never have been found ‘fit for work’ in the first place and that emotional fatigue was preventing their dealing with vulnerable claimants compassionately.
Although safeguarding systems were put in place to make sure ‘core visits’ were carried out with vulnerable claimants, it would later be revealed that this system was poorly implemented, meaning staff concerns weren’t followed up regarding clients who were at risk of self-harm, suicide or mental health crises.
The nature of targets on the management of disabled claimants was also of concern, particularly the practice of focusing attention on those most likely to be able to take up work for a ‘quick win’. Issues would also later come to light around pushing vulnerable clients to look for work due to a target-driven culture and in Jobcentres:
“[Jobcentre staff] also expressed concern about the perceived tension between their role as ‘enforcers’ (through their responsibility to impose benefit sanctions on Fail to Attends) and their role as ‘enablers’ through the provision of friendly, supportive and tailored interventions to help their customers move forwards.”
- 2004 DWP report, Incapacity Benefit Reforms — the Personal Adviser Role & Practices
These tensions expose the contradictions in the government’s own rhetoric of empowering disabled people to work, with the realities of a punitive system that forced vulnerable claimants to look for and take up work at the risk of having benefits withdrawn.
‘Dead people don’t claim’
Content warning: the following includes a discussion of suicide.
As neoliberal ‘welfare reforms’ continued through successive governments, and a harsher regime of conditionality and sanctions was introduced through ESA and then Universal Credit, it became increasingly clear that the welfare system was causing harm.
From the late 2000s, evidence started to emerge that the welfare regime was directly linked to the deaths and suicides of claimants. There are so many stories of tragedy to tell that it’s impossible to tell them all here, so here are a few:
One example is Stephanie Bottrill, a disabled woman who told neighbors she couldn’t afford to live after having her benefit reduced due to the Bedroom Tax. Despite her doctors telling her, she was too ill to work, she was denied disability benefits. In her suicide note, she blamed the government.
Another woman, Linda Wooton, died 9 days after having her benefits withdrawn. Linda had a weakened immune system due to medication she was on after undergoing heart and lung transplants. She was in the hospital dying when the decision letter came through declaring her ‘fit for work’. Her husband told newspapers Linda’s last months had been miserable as she had been so worried about benefits and made to feel like a ‘scrounger’.
The death of David Clapson shows the tragic cost that the financial aspect of benefit sanctions can have. David died of diabetic ketoacidosis after having his benefit sanctioned and being unable to afford the electricity to keep his fridge on, which was vital to storing his diabetic medication. David’s benefit was sanctioned for supposedly missing an appointment with an adviser — the price of which was his life.
Another prominent case is that of Paul Reekie. Paul had long-term mental health problems. He took his own life after having his ESA and Housing benefits stopped. In place of a suicide note, he left the two decision letters side-by-side on his desk next to his body. His death would lead to the formation of the Black Triangle Campaign against work capability assessments.
On the BTC’s website ‘about’ page they make explicit the link between ableist (eugenicist) campaigns of the past and what the modern British state is doing to disabled people:
“The Nazis forced people with mental and other disabilities to wear black triangles in the extermination camps during the Holocaust. The generic classification they used was “Arbeitsscheu” – literally “Workshy”. This term is also the one most favoured in our right-wing tabloid press to describe incapacity and disability benefit claimants today.”
The true number of deaths caused or contributed to by the brutality of the welfare system is difficult to know. However, one longitudinal study showed the link between benefit assessments and mental health problems:
“Each additional 10,000 people reassessed in each area was associated with an additional 6 suicides, 2,700 cases of reported mental health problems, and the prescribing of an additional 7,020 antidepressant items.”
A million people were reassessed for ESA in the 2 year period covered by the study, resulting in around 590 suicides related to Work Capability Assessments in this period (this doesn’t include assessments of DLA or PIP).
A study of 3,500 people by Citizen Network found the process of claiming benefits had made mental health worse for 93% of respondents, and aggravated pre-existing conditions for 83% of respondents, with 79% saying their physical health had become worse. 61% said that the process had resulted in new health problems for them.
The same study found that 61% had suicidal thoughts due to their experience of trying to claim benefits. 32% had planned suicide, and 13% had attempted suicide.
The DWP’s own data shows that 17,000 PIP claimants died within 3 months of having their claims rejected between April 2018 and January 2020.
Similar statistics for ESA show that within a period of just over 2 years, 2,380 people died within weeks of being found ‘fit for work’ and having their claim rejected after a Work Capability Assessment. 7,200 of those awarded ESA but placed in the work-related activity group and expected to take up work in the future died within weeks of that decision.
While it is likely that not all of these deaths were due to illness, the figures still highlight the contradiction between people’s health outcomes and the DWP’s opinion that their illness was mild enough that they were able to work immediately or in the near future.
The truism above that ‘dead people don’t claim’ — which comes from a protest outside Parliament by Disabled People Against Cuts in 2008 — sums up the logic of the ongoing tyranny of ideological ‘welfare reforms’.
The media and government promoted a dramatic shift in cultural attitudes towards both disabled people and the welfare state, leading to the demonization of those with disabilities (particularly ‘hidden’ disabilities). Simultaneously, the government cut services and benefits for disabled people while subjecting them to a brutalizing welfare system that gaslit and bullied them into work or poverty.
“It is not a coincidence that some people deemed a ‘burden’ by neoliberal market logic would end their lives. People are killing themselves because they feel exactly the way the Government is telling them they should feel — a burden. Put another way, people are killing themselves because austerity is killing them.”
- China Mills (2017) Dead people don’t claim’: a psychopolitical autopsy of UK austerity suicides
As a volunteer welfare rights worker for a small Glasgow-based charity run by and for claimants in the community, and a welfare claimant myself around the mid-2010s, I experienced this first-hand. I was asked why I hadn’t killed myself yet in my own ESA assessment, just like the woman quoted at the top of this article had been years prior.
We had clients who were too scared to open the ominous brown envelopes containing decisions from the DWP, so they brought them to us to open instead.
I witnessed clients being slowly destroyed, emotionally and physically, over a course of months and years due to the cumulative distress and misery caused by the state welfare bureaucracy and the poverty and humiliation it subjected them to. People with existing, but semi-manageable mental health problems were gradually reduced to panic-stricken, emotional wrecks; their previously ‘hidden’ mental health issues now visible for all to see, written all over their nervous bodies and in their frightened, tired eyes.
One client tried to take his own life in our office. He was so tired of being rejected and bullied by the system and frustrated at not having his mental health problems taken seriously by the health service (he had voluntarily asked to be ‘sectioned’ — detained in a mental health ward — due to his growing concern that he would hurt himself). The man just walked in one day, to the only people he felt would listen, and cut his wrists right there in front of us.
The tragic irony is that when the police and paramedics attended they treated him like he was a threat to us when the real threat was the system that took him to this point, the same system that was hurting us all.
That these ‘welfare reforms’ would lead to such devastating and tragic consequences is almost inevitable. Those enacting this political violence were aware of the harm they were causing.
Bad practice
Despite the DWP’s repeated denial of the poor practices (practices highlighted in their own research reports), independent evidence of the appalling way the benefit assessment system treats claimants has eventually come to light.
For example, though the DWP repeatedly denied that it uses targets to encourage staff to sanction people and move them off of benefits and into work, research has revealed this to be exactly the case.
A document contained in the appeal letter for Michael O’Sullivan, a disabled man who took his own life after being found ‘fit for work’ after an ESA assessment, indicated that an ATOS assessment doctor had admitted to the pressure placed on assessors by the DWP. In a statement to the General Medical Council, Dr. Fathy Awad Sherif stated that
“Following the conversion of Incapacity Benefit to ESA, the DWP put immense pressure on ATOS disability analysts to deem claimants fit for work when they previously would have qualified for benefits.”
The practice of sanctioning vulnerable claimants, despite there being significant risks to their wellbeing and clearly being unable to work despite being found fit to do so following a WCA, repeatedly denied by the DWP, was revealed in painful detail. In one study, which interviewed DWP staff, a worker discussed their experience and role in these practices:
“[I had] a lovely guy who I really felt for who had mental health issues and the day after I had to reluctantly mandate him to something — he attempted suicide. I also had another lady who we pushed into work and it made her that ill she had a fit in her new job and was admitted to hospital.”
In the same year, it emerged, through a secret recording of a benefit assessment, that the assessor had lied about the woman discussing her thoughts of suicide, giving credence to claims going back years that assessors give false information in their reports.
These practices are not ‘bugs’, but a feature of the system. They’re deliberate tactics aimed at reducing the number of welfare claimants, regardless of the impact on their health and wellbeing.
They knew
It has become increasingly obvious that the DWP was aware of the link between its practices and the suicides of claimants for years.
In a 2020 report issued after questions from a member of parliament, it was revealed that the DWP had initiated 69 internal investigations into the suicides of benefit claimants since 2015 — 9 of which were a direct response to contact from coroners who found that the benefits system had played a part in the person’s death. There have been similar revelations in other years.
The report also highlights that this was likely to be much lower than the number of suicides that could have been investigated because the DWP had no centralized or systematic way to record, investigate or monitor deaths and suicides of claimants, and therefore no monitoring of attempts to improve practices to reduce the incidence of claimant deaths.
In many cases, the DWP has destroyed evidence from its own damning investigations.
A request for information on deaths and suicides of claimants prior to 2015 led to the DWP admitting that they had destroyed these records and held no further data, citing Data Protection regulations. It was also revealed the DWP had destroyed an internal report into safety failings in its Jobcentres in relation to vulnerable claimants shortly after it was requested by a disability rights charity.
The DWP has lied to or omitted evidence from several government-led and independent reviews into DWP practices, including withholding coroner’s reports into claimant suicides from the 5 years independent Litchfield Review into the Work Capability Assessment.
The department also convinced a coroner hearing an inquiry into the death of David Errol not to submit a report demanding urgent improvements in the DWP’s safeguarding procedures. Dr. Elizabeth Didcock was told that the department was already undertaking a review of the issues.
In December 2022 Disability News Service discovered that the DWP had abandoned work on a 3-year plan to address safeguarding issues, including claimant suicides. The so-called ‘Excellence Plan’ to which millions of pounds were allocated has been quietly dropped by the DWP, with no reports on its progress or delivering any improvements.
It never ends
In response to this outpouring of evidence of the overwhelming harms being caused to disabled and vulnerable people by the neoliberalism welfare state, the very system originally intended to support them, there have been strong condemnations.
This includes damning evidence from an inquiry carried out by the United Nations Committee on the Rights of People with Disabilities which found that:
“[T]he Committee considers that there is reliable evidence that the threshold of grave or systematic violations of the rights of persons with disabilities has been met.”
The UK’s own Equality and Human Rights Commission, following the UN investigation, also argued that:
“There has been overwhelming evidence from an extensive range of sources that aspects of welfare reform are linked to significant adverse impacts on disabled people. Evidence from disabled people and their organisations, disability charities, Parliamentary Committees, academics, churches, trade unions and local and international equality and human rights organisations paints a concerning picture of regression on disabled people’s rights.”
In addition to this, there have been calls from organizations and charities such as the British Medical Association and the mental health charity Mind to scrap medical benefit assessments. There have even been calls for ministers and civil servants responsible for implementing ‘welfare reforms’ to face criminal charges from victims' families and members of parliament.
The government rejected the recommendations of both human rights bodies and has made no meaningful changes to welfare reforms, safeguarding procedures, or the systems of assessment and conditionality applied to vulnerable claimants.
Nor has it introduced plans to scrap the WCA, or to bring criminal charges against those culpable for the deaths and misery of so many, even though evidence of lawbreaking and institutional discrimination and neglect exists.
Despite decades of evidence of the harms of welfare reforms imposed by New Labour and the Conservatives, on the basis of ideologically-driven models of disability and illness heavily influenced by the private insurance industry and profited from by the private disability assessment industry, nothing has changed; as recently as November 2022 the government rejected a petition calling for a full review into the assessment process for PIP.
In fact, things continue to get worse, with further cuts to benefits announced for the future as a part of what has been dubbed ‘Austerity 2.0’.
And so the misery continues.
Despite all this evidence of suffering, the rhetoric which demonizes disabled benefit claimants continues, both from the government and the press and now also from the public themselves.
Not a single discussion of the welfare system occurs without people discussing ‘scroungers’, inflated beliefs about fraud or the false idea that people live a ‘life of luxury’ on benefits — the conflict with the reality of misery and poverty is painful to see repeated over and over again. In a very real way, the public has become complicit in the victimization of disabled people through indoctrination in anti-welfare ideology.
There are a few allies, among the public and even in parliament, but not nearly enough. And even their pleas have been ignored.
“We know the human suffering that’s occurring, so the responsibility is now upon us to do something about it — and we will be to blame for every injury, every harm, every suicide, every death as a result of this system if we don’t do something.”
- John McDonnell, Labour MP in 2013
We keep fighting
I realize few people will read this. Nonetheless, I’ve spent a lot of time and emotional energy writing this 4 part series on the UK’s war against disabled people — my little contribution is nothing in comparison to the work of disability rights groups such as Disabled People Against Cuts, the Black Triangle Campaign, John Pring and the Disability New Service, researcher Mo Stewart and many, many others.
As disabled people this is all we can do — keep talking about this ongoing tragedy of state violence, keep providing the evidence, keep highlighting the corruption, the profiteering, the discrimination, and the abuse, in the hope that eventually people will listen.
Because until they do, until there is a mass recognition of the way the public has been tricked into this narrative for the benefit of private industry and ideological delusions, the misery will continue.
Thank you for reading.
This series has largely been made possible by the Deaths by Welfare Project and the timeline put together by some amazing folks over at Healing Justice London, Litany for Survival, and Disability News Service, which I have used as a jumping-off point for much of my research into this issue. A huge thank you for all your hard work.
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