Preventable harm and the Work Capability Assessment courtesy Mo Stewart


The ongoing reluctance of the British government to accept overwhelming evidence that the assessment used to limit access to disability benefits is compromised and many chronically ill and disabled claimants are suffering, often with fatal consequences, as the UK welfare state is systematically demolished as planned since 1982. Outsourced to unaccountable private contractors, and influenced by the healthcare insurance industry, the most vulnerable in the UK now live in fear of the Department for Work and Pensions.


Independent disability studies researcher, Cambridgeshire, UK


Introduced in October 2008, the work capability assessment (WCA) is used by the UK government to limit access to the long-term sickness and disability benefit, known as the

Employment and SupportAllowance (ESA). The scope of the assessment was increased in 2010. Extensive evidence suggesting that the WCA is a dangerous and fatally flawed assessment model for disabled and chronically sick people continues to be disregarded by

successive governments. This article identifies the influence of

American corporate funders

with UK welfare reform policies since 1992. I argue that these influences shaped the WCA in

ways which cause preventable harm in the lives of chronically sick and disabled people, who

are dependent upon the ESA for their financial survival. Further, I argue that the ESA

assessment process was adopted to encourage the general public to purchase income protection

insurance, which intentionally undermines the UK welfare state.


work capability assessment, welfare reforms, biopsychosocial model


Successive calls for welfare reform in the UK are not as progressive as they might appear to

the outside world. From the point of view of chronically sick and disabled people themselves,

the problems started thirty-five years ago under the Thatcher government when privatisation,

a consumer model of care and individualism were introduced, arguably to the detriment of

disabled people. The legacy of Margaret Thatcher’s neoliberal policy decisions continues to

influence UK government policy (Scott-Samuel et al, 2014). Dismantling of the UK welfare

state was first suggested by Margaret Thatcher in 1982, and wide spread speculation at the time

claimed that the suggested removal of the welfare state was due to her very close bond with


the American President Ronald Reagan . In myview, Thatcher’s legacy continues to this day

as successive Prime Ministers engage with her ultimate goal which, I have argued elsewhere,
is the eventual removal of the welfare state and the adoption of private healthcare insurance in its place (Stewart 2016).

The Thatcher Legacy begins

Further historic context helps illuminate the emergence of risk-averse government following

in Thatcher’s footsteps. In 1992 John Major’sConservative government invited the American

corporate giant UnumProvidentTMInsurance to consult with reference to future welfare claims

management. John LoCascio, the UnumProvidentTMVice-President, was appointed as the

corporate consultant. By 1994, the company were appointed as official government advisers

and the 1994 Social Security (Incapacity for Work) Act introduced Incapacity Benefit, as

designed to limit out-of-work disability benefit, which had significantly increased due to the

increasing numbers of claims for mental health illnesses (Stewart 2017).

By 1995 the Department for Social Security’s Principal Medical Officer, Mansel

Aylward, co-authored an academic paper with LoCascio.‘Problems inthe Assessment of

Psychosomatic Conditions in Social Security and Related Commercial Schemes’ (Aylward and

LoCascio 1995) argued that GPs should not be expected to determine a patient’s incapacity,

and the authority and clinical opinion of GPs would eventually be curtailed. This was the

preamble to the future use of private contractors by the renamed Department for Work and

Pensions (DWP), to assess chronically ill and disabled people for access to long-term sickness

and disability benefit as previously identified by their family doctor.

In2005 there was a total of 39% of Incapacity Benefit claimants in receipt of the benefit

for a mental health problem, which was just under one million people. Sincethat time,

politicians have prioritised the reduction of claimant numbers byone million, due to costs,

suggesting that mental health was of little significance other than a drain on resources.

Incapacity Benefit was changed to the Employment and Support Allowance (ESA) in October

2008. To access the ESA, claimants would be assessed by the new Work Capability Assessment

(WCA) as DWP Ministers continued to claim the need to reduce the claimant numbers

regardless of very predictable human consequences. Not to be confused with a medical


assessment, the WCA is described by the DWP as a ‘functional assessment’, using an IT tick-

box questionnaire and totally disregarding diagnosis and prognosis (Stewart 2017).

The use of the WCA was planned long before its introduction. UnumProvidentTM

Insurance funded research by Gordon Waddell and Mansel Aylward from 2004, at a cost of

£1.6million over a five year period, which would justify the DWP adopting a biopsychosocial

(BPS) model of assessment for all future claimants of long-term sickness and disability benefits

(Stewart 2016, p13). UnumProvidentTM Insurance use a BPS model to assess claimants of

income protection insurance. Commissioned by the DWP, ‘The Scientific and Conceptual

Basis of Incapacity Benefits’was quickly produced byWaddell and Aylward in October 2005.

The report recommended the use of sanctions to remove all access to funds to incentivise

claimant compliance (Waddell and Aylward 2005, p166). This arguably allowed preventable

harm by the State to creep into disabled people’s lives, using a fatally flawed BPS assessment

model (Shakespeare et al 2016) plus sanctions, which were known to cause preventable harm

by enforced starvation.

The BPS model of assessment, as used for the WCA, totally disregards diagnosis,

prognosis, prescribed medication and past medical history, sothat with key evidence missing

in assessment, deaths of people wrongly assessed were inevitable due to neglected medical

evidence (Butler 2015). The WCA was exclusively conducted until 2015 by Atos Healthcare,

a corporate IT giant whose doctors, according to the General Medical Council, have total

immunity from all medical regulation as theywork on behalf of the government(Stewart 2015).

UnumProvidentTMInsurance were fined $31.7 million in 2003 in a class action law suit

in California for running ‘disability denial factories’and $15 million in 2005 by the California

Department of Insurance Commissioner, John Garamendi, who stated that ‘Unum Provident is

an outlawcompany. It is a company that has operated in an illegal fashion for years…’ By

2006 the State insurance commissioners of 48 American States approved a settlement in an

investigation of the UnumProvidentTMCorporation that required the healthcare insurance giant

to reconsider 200,000 claims and to pay $15million in fines; as the BPS assessment used by

the corporate insurance giant caused identified preventable harm when the company resisted

funding genuine income protection insurance claims.. Atthe same time as paying these fines


in America for malpractice, the company were funding the research of Waddell and Aylward

in the UK (Stewart 2015). UnumProvidentTMInsurance changed its name to Unum Insurance

in 2007 to distance itself from increasing negative publicity for identified malpractice.

Notwithstanding these concerns, the only opinions considered by the DWP regarding the

benefits of work and the BPS assessment model used to assess long-term sickness and

disability benefit claimants continued to be those emerging from the research sponsored until

2009 by Unum; identified by the American Association of Justice in 2008 as the second most

discredited insurance company in America (Stewart 2015).

The influence of UnumProvidentTMInsurance upon UK welfare reforms was

demonstrated in supplementary memorandums provided for the government’s Work and

Pensions Committee, which listed the transformation of Incapacity Benefit to the ESA long-

term out-of-work sickness and disability benefit. The requirement to ‘resist diagnosis’, ‘revise

the ‘sick note’, ‘encourage the Government to focus on ability and not disability’, ‘change the

name of Incapacity Benefit’and ‘benefits not to be given on the basis of a certain disability or

illness but on capacity assessments’ have all come to pass, as embedded in UnumProvidentTM

Insurance guidance on UK government welfare policy since 1994 (Stewart 2017).

In 2016, when Professor Tom Shakespeare and colleagues exposed the BPS model of

assessment as having ‘no coherent theory or evidence behind this model’and demonstrating

‘a cavalier approach to scientific evidence’(Shakespeare et al 2016), there was little public

attention paid to his concerns. Shakespeare’s paper exposed the DWP’scommissioned

research as being ‘policy based research’and not ‘evidence based research’; data had been

constructed specifically to justify DWP policy and hence was wholly unreliable. So now there

was academic scrutiny to add to other detailed evidence emerging, that the DWP commissioned

research, as used to justify the introduction of the WCA to intimidate chronically ill and

disabled people, was discreditedand did not withstand academic analysis (Stewart 2017).

From City Banker to DWP Minister

Having installed a discredited assessment model to guarantee that fewer people would qualify

for State financial support for long-term illness and disability, more commissioned

‘independent’ research was needed to persuade the House of Commons as to a consequential


need to completelyreform welfare. The report of the subsequent enquiry ‘Reducing

Dependency, Increasing Opportunity’(Freud 2007) was rapidly produced in just six weeks, by

the former City banker David Freud, making claims of a potentiallymassive reduction in

Incapacity Benefit claimants. InMay 2007 Professor Danny Dorling, writing as Guest Editor

for the Journal of Public Mental Health, identified flaws in the Freud Report including that

numbers used to produce the report were ‘wrong’and references misinterpreted, suggesting

proposed welfare reforms would not be associated with the predicted massive fall in claimant

numbers (Dorling 2007). At this point we can see that the ongoing severe welfare reforms

have been built on the basis of two discredited government commissioned reports. Following

the report, Freud was appointed as a Shadow Minister in 2009, and as a junior Minister in the

2010 Coalition and 2015 Conservative governments, where he continued to produce DWP

reports to limit government funding to chronically sick and disabled claimants.


Unless commissioned by the DWP, the government disregard all evidence relating to the ESA,

the WCA, the BPS model or the identified ongoing preventable harm created bythe ESA

assessment process.Over time coroners, academic experts, the Work and Pensions Select

Committee, the British Medical Association, the Royal College of General Practitioners, the

Royal College of Nurses, the British Psychological Society, the President of the Appeal

Tribunals for Social Security and Disabled Peoples’ Organisations have demanded that the

WCA should be stopped (Stewart 2017). Resistance to theWCA is brushed aside by the current

UK Government and disabled people and their representative organisations find their struggle

for justice unheard. Reports of suffering are mounting. Thousands have died after being found

‘fit for work’following a WCA (Butler 2015) and activists continue to assert that significant

harm will be caused to more chronically sick and disabled people if the WCA is not removed.

From January 2011 to February 2014, a total of 91,970 Incapacity Benefit and ESA claimants

died (Stewart 2016, p94). The DWP’s response to concerns regarding the mortalitytotals of

ESA claimants was to refuse to publish any more updated ESA mortality totals.

Disclosure statement

No potential conflict of interest was reported by the author.

Preventable harm and the Work Capability… (PDF Download Available). Available from:[accessed Apr 19 2018].

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