Cash Not Care – Reviewed

Cash Not Care: the planned demolition of the UK welfare state

Author: Mo Stewart

Publisher: New Generation Publishing, 2016

RRP: £18.99 plus p&p paperback; £6.50 Kindle edition (link to Amazon.co.uk will open in a new browser window)

Review by: Laura Graham, 1st October 2016
 

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Cash Not Care is the conclusion of six years of independent self-funded research by Mo Stewart into the influence of a discredited American healthcare insurance giant over sickness and disability financial support here in the UK.

Stewart’s work demonstrates how successive governments have, since 1992, adopted US-style welfare policies in order to demolish the UK welfare state, with the current Conservative government leading an “unprecedented hostile political attack against chronically sick and disabled people, who are financially dependent upon long-term sickness benefits”.

Today’s policies of fear began in 1992

The book pinpoints the beginning of today’s “policies of fear” to John Major’s Conservative government of 1992, when Peter Lilly, then Secretary of State for Social Security, hired the US-owned UnumProvident Insurance to advise on how to reduce an identified rise in the number of claimants of long-term sickness benefits.

Within two years, Unum were considered to be official government advisors.

Included in Unum’s advice was the message that US doctors had exaggerated patients’ needs in order to ensure that their fees were paid by healthcare insurers, and the suggestion that British doctors would do the same to support claimants of long-term sickness benefits.

This developed into a complete disregard of the claimant’s medical history during Work Capability Assessments (WCA) with the focus on “functional assessments” to determine “functional ability” on the day of the assessment.
 

Chief medical officer embraced “disability denial policies”

The creator of this approach is a former Department of Work and Pensions (DWP) Chief Medical Officer, Professor Sir Mansel Aylward, who was in post when Unum were invited to advise, and who left the DWP in April 2005 to take up a research post at Cardiff University funded by the same insurance giant known for their “disability denial policies”.

It is the same Chief Medical Officer who introduced the concept of malingering when discussing sick and disabled benefit claimants which – without any supporting evidence – was accepted.

In Cash Not Care, Stewart comprehensively explains:

“In October 2008, the UK faced a claimed ‘catastrophic’ fiscal deficit, in part caused by the need to fund an additional £37 billion to rescue the banks to avoid a global financial crisis. This event significantly increased the growing UK fiscal deficit and attention was drawn to the need to urgently reduce government costs. One mechanism used to reduce the deficit was a structured reform of the welfare state and the welfare budget was placed under close scrutiny”.

Private contractors used facile tests to assess disability

The Work Capacity Assessment was outsourced to the private contractor Atos and the Employment Support Allowance (ESA) was introduced.

Atos “Disability Analysts” were given six weeks training in how to assess disability (not diagnose) and desperately ill people, with one of the tests being whether the person undergoing the assessment could pick up a pen from the floor, and without any access to the person’s medical history.

 

Seriously ill and disabled people judged fit for work

The book shows that people with disabilities and people with serious health conditions, including those with a terminal diagnosis, were considered able to work. Stewart highlights that in the first 11 months of 2011, a total of 10,600 ESA claimants died, 1,300 of who had died following a WCA assessment that had assumed them to be suitable to return to work.

Stewart’s research is compelling. Her findings are backed with strong evidence from a broad range of sources which are transparently included in the book. The writing style makes the book accessible beyond academics and should be widely read and debated. The content, if published as fiction would not be believed. But anyone with an awareness of current issues affecting disability and long-term sickness in the UK knows how important Stewart’s research is in raising awareness of a huge problem that receives very little media interest beyond a developing narrative of demonising disabled and sick people.

Cash Not Care is a harrowing but vital read, and an absolute must for policy makers, responsible journalists, and activists.

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Reviewed by: Laura Graham, independent researcher/writer/consultant working on strategy and policy development in the fields of addiction recovery, mental health and carer’s issues. She was a full-time carer for her mother, and the founder of Cure the NHS-Lambeth. You can read more from her in the “Carer’s Voice” column for Independent Living.

 

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Further reading and resources

Mo Stewart has recently discussed the WCA (Work Capability Assessment) and her Preventable Harm Project which ran for 10 years until 2019, with Dr China Mills, senior lecturer in public health at UCL. You can access the transcript here (external link will open in a new browser tab or window)

Shattered Nation: Mo Stewart reviews the book by Danny Dorling

12 years research wasted? Mo Stewart asks for action

Mo Stewart writes about local authorities’ “assault on PIP awards”

Informing the Disability Unit by Mo Stewart

Austerity measures in the UK a violation of human rights

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