Objectively Disordered #ombh

By DeusExMacintosh

In December the UK coalition government announced that as well as reducing the bill for Disability Living Allowance by 20%, they now intended to abolish the benefit meant to help pay for the additional costs of being disabled and replace it with a harsher ESA-style “Personal Independence Payment”. A foreshortened public consultation over Xmas and the New Year was announced, closing on Valentines Day, February 14th, 2011.

DLA is a benefit that works, it makes it possible for many disabled people TO work. It pays for wheelchairs as well as cars, personal care as well as pub visits. The official fraud rate is less than 0.5% according to the Department for Work and Pensions themselves. We believe the consultation process will simply rubber-stamp the abolition of DLA. This weekend people with disabilities and The Broken of Britain webgroup mourn its loss and we invite you to join our blogswarm on disability and benefits, One Month Before Heartbreak.

What’s in a word? Quite a bit as it may turn out. With government spending cuts in the news we’ve heard a lot about what is and is not considered “fair” of late, but for people with disabilities the key word may soon turn out to be “objective”.

Do you know what it means?

Are you sure?

The Emergency Budget 2010 explained that we needed “objective medical assessments” to bring down the bills.

1.103 The Government will reform the Disability Living Allowance (DLA) to ensure support is targeted on those with the highest medical need. The Government will introduce the use of objective medical assessments for all DLA claimants from 2013-14 to ensure payments are only made for as long as a claimant needs them.

The policy costings were even more clear…

REFORMING DISABILITY LIVING ALLOWANCE

Measure description:
This measure will introduce an objective medical assessment and revised eligibility criteria for both new and existing working-age claims for Disability Living Allowance, to be rolled out from 2013/14. The assessment will follow a similar process to the Work Capability Assessment (WCA) used for claims to Employment and Support Allowance, with a points based system to assess eligibility to the different rates of the benefit.

All well and good, you might think. It’s only right that taxpayers have the reassurance that our disabilities have been proven to the satisfaction of a doctor.

Indeed, that was acknowledged over a decade ago when private firm ATOS first won the contract to send “independent” GPs around to the home of DLA claimants to make sure they were genuine. The opinions of your regular GP can be too easily swayed, whereas governmental influence as paymaster in no way compromises the independence of an ATOS doctor. Their new contract for Work Capability Assessments has helpfully been rewritten to only stipulate the involvement of a “medical professional” which can be anything from a Spanish physiotherapist to a Bulgarian midwife (no news of any vets as yet but that’s probably only a matter of time) and now you have to go to their offices. Sometimes these are even accessible.

So no, it’s not about obtaining a professional medical opinion it would seem, otherwise we’d simply accept a Consultant’s report like the Swiss system does. If you’re a regular SkepticLawyer reader you may now be thinking disability… objective… DAMAGES! (give the law nerd a cookie)

When legal damages are assessed they are usually assessed objectively. However, ONE type of damage – pain and suffering – is assessed subjectively in personal injuries matters (which would seem appropriate for a benefit relating to disability).

“Subjective” criteria would be the the description of the pain and suffering experienced by the victim in his or her own words. “Objective” criteria would be the description of the likely pain and suffering experienced by the victim BY A THIRD-PARTY, a “reasonable” non-specialist (yes, that man on the Clapham omnibus for example).

There would thus be no barrier to using OBJECTIVE presumptions about the nature of restrictions to the life of a disabled person (levels of physical adaptation for example) rather than consulting the SUBJECTIVE experience of the individual disabled person themselves (details of accessibility in their own particular work and/or living environment for example).

Personal case in point, there is an “accessible” train to my local FE college which means that I can access study. In actual fact accessibility has only been provided for wheelchairs, the scooter *I* own has been declared “too large” by train company staff who have also refused to let me use the bike space where it *WOULD* fit. So who is correct, the train company that says their service is accessible or the disabled person who says it is not? Obviously some level of standardization is desirable otherwise disabled adaptation becomes unaffordable for transport companies, but as a benefit claimant should I be financially penalized for failing to take up a course at that college when I’m unable to get there?

And don’t even get me started on what does and does not constitute a “medical” need (just ask someone who has managed to get an electric wheelchair out of the NHS, if you can get them to stop swearing for long enough).

Fellow “spoonies” and other people with invisible disabilities can only hope that after the Harrington Report their DWP Decision Maker doesn’t go beyond the normal rubber stamping of the mock medical and google Merriam-Webster to support their interpretation of the legislation …

Definition of OBJECTIVE
1c
of a symptom of disease : perceptible to persons other than the affected individual — compare subjective 4c

Although that WOULD cut the DLA budget by the desired 20%…

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* In DaveBath-speak that’s “fractally wrong”, ie. wrong at every possible level of magnification. See also Catholic teaching on natural law and same-sex attraction, discussed by regular commenter Lorenzo at his blog here.

29 Comments

  1. Posted January 15, 2011 at 6:32 pm | Permalink

    need to get some of those people politicians with pain induction tools like the pain box in “Dune”, or hope the sods get sciatica at the level of no functional problem apart from that caused by the pain of movement, or massive tinnitus… And get NO sympathy from anyone.

    The thing is, at least in US tertiary students, over the last few years standardized tests for empathy have suddenly nosedived to the lowest ever scores. This means pollies can get away with this, and encourages worse in a nasty feedback loop. I can’t see it getting any better anytime soon.

  2. Posted January 15, 2011 at 7:18 pm | Permalink

    You know what? I don’t demand empathy, or sympathy for that matter, but a little bit of CLARITY would be nice. This ‘coy’ bit of dancing all around their actual intentions is really giving me the sh*ts…

  3. Patrick
    Posted January 16, 2011 at 6:34 am | Permalink

    I hate to say it guys, but if you want empathy, reduce government. If you want what what you have, look to government.

  4. Posted January 16, 2011 at 7:51 am | Permalink

    [email protected]: Sympathy is one thing, but empathy, the ability to understand the situation of others, is surely essential for politicians to fulfil their proper role.

    It shouldn’t be hard… The ability to model the internals of others is something that our ancestors developed not long after the opposable thumb.

    Even without sympathy, the ability to model others is a necessary skill of the competent manipulative sociopath… and the modern party hack in unrepresentative democracies is certainly manipulative of individuals and groups.

    Or maybe they’ve outsourced the task of understanding others to those running focus groups.

    What will be the next group in the cross hairs? Identify them, make them alert, and their selfishness might help the ones currently being demonized.

    Of course, a demographic that could be productively squeezed with little change to their level of creature conforts, has little sympathy from the public anyway, the ones whose stupidity and avarice created the crisis of available capital in the first place, won’t ever be demonized… The City is too good a source of donations and favors.

    Just thought of a good example where the subjective experience is all… Phantom limb pain… The amputated arm hurts incredibly, enough to incapacitate, the objective outsider sees nothing that could be in pain.

    Again, there is the dissonance between discounting the subjective experience of sufferers – while pandering to (forgoing tax revenues) of large organizations that peddle merely subjective wares with no objective existence, e.g. Sky fairies, let alone the subjective experience of luxury items v basics, the rolex watch versus the el cheapo timepiece, the entertainment industry (providing nothing but subjective experience)…

    If there are no real savings to government coffers to be made, it there are the massive inconsistencies you’ve highlighted in the last two posts, what the pollies are doing is nothing but demonization, the purpose of which is to distract the public from the lack of effective actions by those in the parliamentary industry.

    I’m of the Keynesian persuasion, so the austerity measures, particularly these ineffective actions, will only make matters worse.

  5. Posted January 16, 2011 at 9:09 am | Permalink

    Actually, those folk both physically disabled and educated, especially with unpredictable conditions, or those in remission from cancer, are probably much better qualified to run a country, more experience at dealing with fickle circumstances and economic stressors, than the pollies and staffers, who have usually had lives of relative smooth sailing, no experience of adult responsibilities when their roof and health are severely threatened. Will those pollies will comfortable histories abdicate their seats or ticket positions in favor of those with more relevant experience at negotiating difficulties and prioritizing spending?

    DEM… How many pollies could you name that you know you outgun as far as experience with prioritizing? Making the best of difficult conditions? Understanding the struggles of ordinary citizens, the less empowered who need political representation to balance the power of those at the top of the economy?

    Let’s be specific… looking at the typical polly with a commerce/law background: how many who have experienced things like MS or chemotherapy, and got better marks in relevant subjects at uni, outgun their local member for smarts and compassion?

  6. Posted January 17, 2011 at 12:41 am | Permalink

    DEM… How many pollies could you name that you know you outgun as far as experience with prioritizing? Making the best of difficult conditions? Understanding the struggles of ordinary citizens, the less empowered who need political representation to balance the power of those at the top of the economy?

    Well I certainly know not to buy a business without examining its books first, and I understand there may be room for someone with that kind of expertise on the board of the Royal Bank of Scotland…

  7. Patrick
    Posted January 17, 2011 at 3:09 am | Permalink

    Well LE I guess that is my point. With government just around the corner we all expect, assume even, that Leviathan is the only entity that can provide this. But it obviously isn’t.

    This is libertarianism’s big problem – that of imagination. How, after all, could any country hope to achieve something as complex as a modern developed economy without a plan? Who will ever look after the poor and unfortunate but Government?

    Of course, with respect of the latter, progressives tend to be younger and non-religious and (partly as a result, partly by choice of association) not to know very many people who do donate generously of their time and money, so that makes the leap of faith even harder for them.

  8. conrad
    Posted January 17, 2011 at 3:55 am | Permalink

    “This is libertarianism’s big problem – that of imagination. How, after all, could any country hope to achieve something as complex as a modern developed economy without a plan? Who will ever look after the poor and unfortunate but Government?””

    Actually, I think the big problem is the lack of empirical evidence that it works.

  9. desipis
    Posted January 17, 2011 at 7:57 am | Permalink

    Of course, with respect of the latter, progressives tend to be younger and non-religious and (partly as a result, partly by choice of association) not to know very many people who do donate generously of their time and money, so that makes the leap of faith even harder for them.

    So young people naive about human nature become communists, while old people naive about human nature become libertarian?

  10. kvd
    Posted January 17, 2011 at 1:05 pm | Permalink

    How, after all, could any country hope to achieve something as complex as a modern developed economy without a plan?

    There’s a plan?

    This is libertarianism’s big problem – that of imagination

    Polite disagreement, Patrick.

  11. kvd
    Posted January 17, 2011 at 1:11 pm | Permalink

    Patrick, I think there are occasional reinforceable trends. If that’s what you mean by a plan, then I agree. Otherwise basically, I think ‘progress’ (which implies a goal) is chaotic – at its best.

  12. Patrick
    Posted January 17, 2011 at 1:36 pm | Permalink

    Irony, kvd?

    Despisis, you are on track, just note that profound skepticism as to the ability of government to achieve anything it sets out to and as to the costs entailed (i.e. one result of experience of human nature) is not libertarianism even if it results in overlapping policy preferences.

  13. desipis
    Posted January 17, 2011 at 2:17 pm | Permalink

    Patrick, I’ve nothing against skepticism. I just have an equal skepticism of the private sector to deliver.

  14. kvd
    Posted January 17, 2011 at 2:28 pm | Permalink

    Not irony Patrick – just cautious disagreement as to what you actually meant. ‘Libertarianism’s big problem – imagination’ – you mean too much? or not a enough?

  15. kvd
    Posted January 17, 2011 at 3:25 pm | Permalink

    When legal damages are assessed they are usually assessed objectively. However, ONE type of damage – pain and suffering – is assessed subjectively in personal injuries matters (which would seem appropriate for a benefit relating to disability).?

    DEM – well put. Nearly almost in agreement. But what really is subjective about one’s inability to get about, or to work for eight hours in a 9-5 job, week on week, or to eat or dress unaided? You don’t even have to have empathy to observe that as fact, I think.

    This push is quite dangerous in some ways for the government. It might only take a few well publicised cases of unfair outcomes to bring this home. After all, the opposite has occurred – here am thinking of The Sun’s gleefull reporting.

  16. Posted January 17, 2011 at 5:32 pm | Permalink

    [email protected] “It might only take a few well publicised cases of unfair outcomes” (to cause a backlash and fix)

    I don’t share your optimism, unless poms are much more decent that aussies, as the Cornelia Rau case was certainly publicized, even in the tabloids, but did nothing to moderate the aggressive regulations nor improve the competence of the relevant agencies. (For poms, Cornelia Rau was a citizen with mental health issues, locked away for ages as an illegal immigrant). We latte lefties got cheesed off (but we didn’t like the regs anyway), and various auditors/ombuds produced scathing reports, … And all the happened was that staff in the relevant agencies got new coffee mugs with a snappy slogan asking them (in a self-congratulatory mannwe) to do better. For the victims, nothing changed. For the bulk of voters, nothing mattered… And this in the land where pollies and populace praise their own commitment to “a fair go”.

  17. desipis
    Posted January 17, 2011 at 5:48 pm | Permalink

    But what really is subjective about one’s inability to get about, or to work for eight hours in a 9-5 job, week on week, or to eat or dress unaided?

    Because in many cases it’s not a matter of black and white as to whether a person can do something, it’s a matter of how much pain and suffering they’re willing to put up with to play a part in society. Two people might have the same capabilities/disability on paper, but for one the pain/suffering/awkwardness/effort might be too much to work more than 2 days a week (or even at all), while the other is fine working full time. How do you measure that objectively? I imagine there’s a concern the later could be used to justify denying assistance to the former.

  18. kvd
    Posted January 17, 2011 at 5:59 pm | Permalink

    Dave – you are right about that shameful case but wrong about the (lack of) outcome. I seem to remember a constant interrogation of the government and a number of other cases being brought to light. You also ignore the full story if you neglect to mention that Rau was compensated – however poorly you might consider. And don’t be so down on latte lefties. Good people serving a good purpose. Occasionally:)

  19. Posted January 17, 2011 at 6:30 pm | Permalink

    [email protected] : I’m not knocking the latte left, I’m one… (apart from writing to the occasional senate inquiry). Yes, Rau was compensated, but the bulk of the public (Murdoch readers and Aunty avoiders) didn’t give a fig for the general problem.

    [email protected] Yes on the difference between how much some will endure, but remember too that it can often (as I know) vary from day to day… Push yourself one day, wittingly or inwittingly, get hit by bad days (weather, extra stressors, miss a pill) and you can render yourself useless or with lower capacity for a week. Few employers deal easily with that level of unpredictability. (Thank goodness for wireless broadband if i’m home or in transit when there is a problem, and I’ve got the kind of job that can deal with my issues.)

  20. kvd
    Posted January 17, 2011 at 6:48 pm | Permalink

    Desipis you misconstrue my comment – which is your right of course – and I do accept the point you make in your last sentence. I commented on “one’s ability” – an individual’s ability. Nothing to do with an assessment “on paper” as you termed it. Everyone is different – and on different days as DB just pointed out above. I would hope that would be taken into account in any assessment. I think I’m trying to see ‘objective’ as meaning ‘practical’ and specific to the individual.

  21. Posted January 17, 2011 at 9:08 pm | Permalink

    DEM – well put. Nearly almost in agreement. But what really is subjective about one’s inability to get about, or to work for eight hours in a 9-5 job, week on week, or to eat or dress unaided? You don’t even have to have empathy to observe that as fact, I think.

    The level of “need” is considered subjective. For all an outside observer knows we might be a) faking walking problems for the money; b) too lazy to wipe our own asses plus we’ll get money; or c) putting it on for attention… and the money of course.

    Shame is not a recognised disincentive whereas even the meanest amount of unearned money is thought to waive all scruples.

  22. Patrick
    Posted January 18, 2011 at 3:52 am | Permalink

    Shame is not a recognised disincentive whereas even the meanest amount of unearned money is thought to waive all scruples.

    I really hate to say this but as a society we have long moved on from this, unfortunately, DEM: welcome to the old guard.

    Our personal convictions/aspirations for our fellow man (woman, whatever) aside, I believe that experience goes strongly in favour of the maxim that if you subsidise something you will have more of it. The most extreme example is that of beggars in eg India but also other places including parts of Europe mutilating children to improve their earning power.

    A less extreme example is the US statistics on single parenting and Clinton’s welfare reforms.

    So I whilst I don’t doubt that your comments are right insofar as your own experience goes, and I wish they were of universal application, I fear that this is really not the case.

  23. Patrick
    Posted January 18, 2011 at 3:56 am | Permalink

    Shot too fast. I meant to add, the challenge is to design a welfare program that rewards work without punishing those who genuinely can’t – traditionally, as you refer to, shame was the demarcation of those who genuinely can’t.

    It no longer is and has not been for some time. I am not aware of a nearly adequate replacement to date (taking into account cost-efficiency).

  24. Posted January 18, 2011 at 10:30 am | Permalink

    On welfare programs, giving the unpredictable attendance of many folk with health issues, at least on an individual basis, but not statistically with a large enough pool, large organizations (notably the public service) have the ability to provide work.

    If I ran the show, many of the disadvantaged would have a halfway-house of casual work in the public service, accepted with slightly lower qualifications, with a /slightly/ lower wage, building up skills (if necessary at all) but also building up a record of attendance patterns – this pool could be a very useful source of pre-qualified staff for private enterprise, which could be given incentives to employ them at a higher rate (which would encourage movement from the public service).

    Alternatively, those folk could be permanents within some public agency, dealing with paperwork/i-dotting-t-crossing backlogs all public services have, and hired out to business.

    Of course, there is little point doing this when there is no real problem other than the political desire to demonize and distract the public from real issues.

    Mind you, it’s amodel that might work with the chronically underemployed – something a bit fairer in pay and with more realistic skills than work-for-the-dole.

  25. Sweeney
    Posted February 14, 2011 at 1:07 pm | Permalink

    ‘In its pre-budget submission, the Business Council says cuts to disability services and foreign aid should be considered as an alternative to the Federal Government’s proposed $1.8 billion flood levy.
    ‘Council president Graham Bradley said disability pensions may not be the best use of government money and may be going to people who are able to work.’

    Oh, FFS, where did this sort of thinking come from? The Business Council thinks that the disabled are not only malingerers but another form of natural disaster? Of course, no plan for getting people into work is offered. That’s the guvmint’s job, after all.

    http://www.abc.net.au/news/stories/2011/02/14/3138305.htm

  26. Posted February 14, 2011 at 5:00 pm | Permalink

    This from elsewhere on ABC shows that what has been accepted in the UK as outlined by DEM is influencing tactics here in Oz.

    (BCA) president Graham Bradley said disability pensions may not be the best use of government money and may be going to people who are able to work.

    “It is one of the large budget items,” he told ABC Radio’s AM.

    “And if you look at what countries overseas are doing in this regard … for example in the UK, they are taking a really hard look to make sure there aren’t people currently incentivised to be on disability pensions who really would be much better off going back to work, even if it is only part-time or less rigorous work.”

    Unlike [email protected], swearing incoherently was less a temptation as I’d been expecting something like this. The “less rigorous” work bit is particularly worrysome, give a paralyzed genius something so mind-numbing its as bad as a death sentence.

    Gillard won’t accept the BCA as far as the flood goes, but….. Watch this space.

  27. Posted February 14, 2011 at 8:04 pm | Permalink

    Re: Graham Bradley. I’m not a very good Quaker. Too many thoughts of bodily violence come to mind…

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  2. […] “left in peace” – at least until someone decides they’re languishing too or their Disability Living Allowance is abolished, whichever comes first. Even the majority shunted onto the Employment track were […]

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