1. Working in Parliament A summary of my work as a Wellcome Postgraduate Fellow at the Parliamentary Office of Science and Technology Gareth Millward – Sept. 2012 POST debrief Improving health worldwidewww.lshtm.ac.uk

2. What is POST? Parliamentary Office of Science and Technology Part of the Houses of Parliament, with links to both the Commons and the Lords Independent of Government Provides advice and briefings to parliamentarians on policy issues involving science.

3. My Brief To research and write a POSTnote – a four-page briefing for parliamentarians outlining the key debates in a policy area involving science. My note was about the medical tests used to determine eligibility for out-of-work disability benefit – the Work Capability Assessment.

4. My Findings The WCA is a three-stage process for claiming ESA – A questionnaire, filled in by the claimant and including their GP’s evidence – A functional test, measuring the claimant’s ability to walk, carry a box, verbally communicate, etc. This is performed by private company Atos Healthcare – A DWP decision maker uses all this evidence to decide on eligibility Many people previously found eligible for Incapacity Benefit are now being declared “fit for work” – 40% appeal this decision, and 40% of those succeed in having this decision reversed. Therefore this is a costly exercise for govt and claimants Criticisms also include: the decision maker simply takes the Atos recommendation and ignores the questionnaire; the test is a one-off event and therefore creates a “snapshot” of a person’s condition; the new criteria are arbitrary, designed solely to solve cost not direct benefit to the “most in need” Independent reviews have made some of these criticisms, and evidence suggests the government has in good faith responded and made positive changes

5. Implications For policy makers More account needs to be taken of subjective evidence to avoid the “common sense” failures of “obviously” disabled people being denied benefit In future, perhaps more rigorous testing of new techniques would be wise More openness is needed with the contract with Atos – secrecy fuels conspiracy theories The difference between “disability” and “capacity” is crucial, but many people do not seem to understand it – including many in parliament For historians of medicine This is part of a long-standing problem. We have never satisfactorily defined “capacity” and/or “disability” in the welfare state Neo-liberal governments believe measurement, targets and ideal types will yield efficient public services, but there appears to be a failure with disability The arguments of disabled people themselves – that disease != disability – have been appropriated to create a system that denies disability’s place in out-of-work benefits The “Fabian” tradition of campaigning may have backfired in this case

6. What has happened since? Two months is a long time in politics... As an historian I disapprove. The contract with Atos Healthcare has been heavily criticised by the Audit Commission Chris Grayling and Maria Miller, the Under Secs, have moved on. The BMA has formally voted to oppose the WCA and wants it scrapped (although there may be other issues at play here!) Reports in the press continue about people dying after being found fit for work (see www.iainduncansmith.com) New mental health descriptors are being trialled after major criticism of the old ones The Paralympics has raised questions about reforms to DLA, an extra-costs disability benefit which will have a WCA-style assessment Malcolm Harrington, the well-respected independent reviewer, has been replaced for the Year 4 and Year 5 reviews.

7. What have I learnt? Details are important – ask DWP... Most thirty-word sentences can probably be written in ten... Policy makers and policy informers value history as an evidence base – they just don’t get much time/space to use it Parliamentary resources are an information gold mine