First, do no harm

‘First, do no harm’ – where it all went wrong

An observation report by Mo Stewart, research lead for the Preventable Harm Project (external link will open in a new browser tab or window)

‘First, do no harm’ is a phrase generally linked with the medical profession. Although not a direct quote from the Hippocratic Oath sworn by doctors, the phrase is always linked with medical care by physicians.

It is assumed that doctors will do their best to treat patients without the risk of causing harm, which allows for side effects of prescribed drugs and the possible pain of necessary treatments, together with a presumption that preventable harm will be avoided at all times.

In general practice and hospital care ‘first, do no harm’ tends to work well. Not so much in the Department for Work and Pensions (DWP), whose social policy reforms adopted by successive administrations guaranteed harm to many of those in greatest need who are unable to work
due to health limitations or disability.1 The DWP adoption of the Work Capability Assessment (WCA) in 2008 to limit access to disability benefit was the continuation of the right-leaning neoliberal politics favoured by Thatcher. Influenced by corporate America, the WCA is a dangerous assessment model that disregards clinical need and was always guaranteed to cause a government-induced public health crisis1 for which no-one is held to account.2

To justify the adoption of harsh and unnecessary austerity measures, which were introduced without ethical approval, the Coalition administration elected in 2010 vehemently challenged the integrity of the chronically ill and disabled community and routinely accused disability benefit claimants of fraud, while failing to produce evidence to support their claims. This often hostile rhetoric encouraged a 213 percent increase in prosecuted disability hate crimes, and successive administrations disregarded the thousands of deaths directly linked to the Work Capability Assessment, which was adopted using a discredited and dangerous biopsychosocial model of assessment to restrict access to long-term disability benefit. Influenced by corporate America since 1992, the UK social policy reforms guaranteed that many of those in greatest need were destined to die when, covertly, killed by the State. (p.217)1

In the UK in 2026 we are living in very dark and dangerous times, with the DWP Chief Medical Adviser – Dr Gail Allsopp – and the UK Government’s Chief Medical Adviser – Professor Sir Chris Whitty – both disregarding the published and well-documented evidence of the government-induced public health crisis ongoing in the UK since 2008, 1-4 despite the fact that Professor Whitty is the head of the public health profession in the UK who fails to answer letters of concern.5

The programme of reassessing people on disability benefits using the Work Capability Assessmment was independently associated with an increase in suicides, self-reported mental health problems and antidepressant prescribing. This policy may have had serious adverse consequences for mental health in England, which could outweigh any benefits that arise from moving people off disability benefits. (p.339)3

It is cause for serious concern that successive administrations have disregarded published DWP statistics, which routinely demonstrate that disability benefit fraud is miniscule,6 at the same time as DWP ministers and their oppositions are making vitriolic comments about the chronically ill and disabled community and the rising numbers of disability benefit claims.7 There is no acknowledgement within the main political parties that the disturbing rise in benefit claims for mental health problems are a direct link to the relentless political hostility directed at those in greatest need. This was demonstrated at the 2025 party political conferences where the Shadow Secretary of State for Work and Pensions for the Conservative Party, Helen Whately MP, made an extreme conference speech for dramatic effect which was totally untrue, demonstrated her total ignorance regarding Motability leased vehicles and was closely linked with disability hate speech, which is against the law:8

“… millions have got themselves a sicknote from the GP and signed onto sickness benefits with just a form and a phone call. Millions are getting benefits for anxiety and ADHD along with a free Motability car. … The problem is, you can get £5,000 more per year on sickness benefits than as a minimum wage worker, so no surprise that’s what many people are choosing, and it’s wrong. Our welfare system should be a safety net, not a lifestyle choice. … Fix the sicknote system, bring back face-to-face assessments, end sickness benefit for low level mental health problems, stop the abuse of Motability and put British citizens first in our benefits system.”8

As long ago as 2018, Professor Philip Alston made a statement on his visit to the UK in his capacity as the United Nations Special Rapporteur on Extreme Poverty and Human Rights.9 At the time of his damning report, Theresa May was the Conservative Prime Minister and there was strong government objection10 to Professor Alston’s detailed observations:

The country’s most respected charitable groups, its leading think tanks, its parliamentary committees, independent authorities like the National Audit Office, and many others, have all drawn attention to the dramatic decline in the fortunes of the least well off in this country. But through it all, one actor has stubbornly resisted seeing the situation for what it is. The Government has remained determinedly in a state of denial. Even while devolved authorities in Scotland and Northern Ireland are frantically trying to devise ways to ‘mitigate’, or in other words counteract, at least the worst features of the Government’s benefits policy, Ministers insisted to me that all was well and running according to plan. …
Although the provision of social security to those in need is a public service and a vital anchor to prevent people being pulled into poverty, the policies put in place since 2010 are usually discussed under the rubric of austerity. But this framing leads the inquiry in the wrong direction. In the area of poverty-related policy, the evidence points to the conclusion that the driving force has not been economic
but rather a commitment to achieving radical social re-engineering. Successive governments have brought revolutionary change in both the system for delivering minimum levels of fairness and social justice to British people, and especially in the values underpinning it. (p.2)9

The UK national press are compromised and, given that the majority are owned by the super-rich, with a right-leaning impact on all reported news stories whilst disregarding the well documented government-induced public health crisis negatively impacting on those in greatest need. 1-4 So, the British public are easily manipulated and poorly informed regarding the reality of those in greatest need, fed by misleading press commentary.

Meanwhile, the British government disregard all peer-reviewed published evidence demonstrating the government-induced public health crisis1-4 impacting on those in greatest need; with liability disregarded for this vast amount of politically motivated human suffering which could be easily overturned with a change in political will:11

When people become too sick to work, or when people with disabilities lose the support they need to enable them to live and work independently, there are costs to the State as well as to society, notably in terms of health and social care.
Instead, enhancing social security and public services to improve population health, and creating high quality, better paid, and accessible jobs, is better evidenced as key means to support people into work, and to reduce the costs of social security for those who experience in-work poverty. Policies and interventions to improve health are more likely to achieve the economic gains the government is pursuing, and further cuts are unlikely to achieve either the ‘moral case,’ or the reductions in public spending, that the chancellor is seeking.11

It was the Blair ‘New labour’ administration (1997-07), continuing with Thatcher’s neoliberal legacy, that commissioned a ‘policy-based report’ in 200512 to justify the removal of clinical need from disability assessments and the adoption of the fatally flawed Waddell and Aylward biopsychosocial (BPS) model of assessment. It was the Brown ‘New Labour’ administration (2007-10) that adopted the WCA in 2008 to limit access to the new Employment and Support Allowance (ESA) disability benefit, using the dangerous BPS model of assessment which failed all academic scrutiny.4

The brutality of the Coalition administration (2010-15) continued the legacy of ‘New Labour’ when adopting extreme social policy reforms. The reforms negatively impacted on the health, wellbeing and, often, on the survival of many in the chronically ill and disabled community
whilst increasing the political attacks against disability benefit claimants; and increasing the government-induced fear of the DWP by the increased use of benefit sanctions used to remove all disability income for a matter of weeks or months. Starvation was always inevitable.13

Since the election of the Labour administration in 2024, social policy reforms have demonstrated that the priority remains the reduction of DWP costs regardless of human consequences. DWP ministers continue with relentless political attacks against those in greatest need, whilst disregarding the ongoing and well documented government-induced public health crisis1 as originally created by a previous Labour administration in 2008. Since the adoption of neoliberal politics the Labour Party have disregarded the purpose of their creation which was to support the poor, but now they terrify them without any justification.
 

References (external links will open in a new browser tab or window):

1 Stewart, M. (2023) The public health crisis created by UK social policy reforms. Justice, Power and Resistance 6(2): 217-228 https://doi.org/10.1332/GQDH4178
2 Stewart, M. (2026a) No-one held to account, Citizen Network, January 2026
https://citizen-network.org/library/no-one-held-to-account.html
3 Barr, B. et al (2016) ‘First, do no harm’: are disability assessments associated with adverse trends in mental health? A longitudinal ecological study. B Barr, D Taylor-Robinson, D Stuckler, R Loopstra, A Reeves, M Whitehead J Epidemiol Community Health 2016; 70: 339-345 doi: 10.1136/jech-2015-206209
4 Shakespeare, T. et al (2017) Blaming the victim, all over again: Waddell and Aylward’s biopsychosocial (BPS) model of disability. T Shakespeare, N Watson, O A Alghaib Critical Social Policy 2017, Vol. 37(1): 22-41 doi: 10.1177/0261018316649120 csp.sagepub.com
5 Stewart, M. (2026b) Letter to Professor, Sir Chris Whitty alerting him to ongoing government-induced public health crisis.
https://www.mostewartresearch.co.uk/wp-content/uploads/2026/01/REDACTED-Letter-to-CMO-Prof-Chris-Whitty.pdf
6 Pring, J. (2023) ‘Miniscule’ benefit fraud stats ‘show minister’s hostile video was shameful and disablist’. Disability News Service, 18 May. https://www.disabilitynewsservice.com/
miniscule-benefit-fraud-stats-show-ministers-hostile-video-was-shameful-and-disablist/
7 Pring, J. (2025) Anger and frustration after DWP’s latest jobcentre announcement and McFadden’s ‘incentives’ comment. Disability News Service, 25 September
https://www.disabilitynewsservice.com/anger-and-frustration-after-dwps-latest-jobcentre-announcement-and-mcfaddens-incentives-comment/
8 Stewart, M. (2025) Letter to Helen Whately MP, Shadow Secretary of State for Work and Pensions.
https://www.mostewartresearch.co.uk/wp-content/uploads/2025/10/REDACTED-Letter-to-Helen-Whately-Shadow-SoS-for-Work-and-Pensions.pdf
9 Alston, P. (2018) Statement on visit to the UK by Professor Philip Alston, United Nations Special Rapporteur on extreme poverty and human rights. London, 16 November 2018
https://www.ohchr.org/en/statements-and-speeches/2018/11/statement-visit-united-kingdom-professor-philip-alston-united
10 Hansard (2019) Extreme Poverty and Human Rights: United Nations Report – debated on 19 June 2019 in the House of Lords
https://hansard.parliament.uk/lords/2019-06-19/debates/15ABCF1D-C50E-40BE-B963-4285648D05AD/ExtremePovertyAndHumanRightsUnitedNationsReport
11 McCartney, G et al (2025) UK welfare reforms threaten health of the most vulnerable. Gerry McCartney, Lucinda Hiam, Katherine E Smith, David Walsh. British Medical Journal 2005;388;r593 doi: 10.1136/bmj.r593
12 Waddell, G. & Aylward, M. (2005) The scientific and conceptual basis of incapacity benefits. Gordon Waddell and Mansel Aylward. Stationary Office Books, October 2005. ISBN-10 011703584X
13 Pring, J. (2020) The death of Errol Graham: Man starved to death after DWP wrongly stopped his benefits. Disability News Service. 23 January.
https://www.disabilitynewsservice.com/the-death-of-errol-graham-man-starved-to-death-after-dwp-wrongly-stopped-his-benefits/
 

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