New Labour, the market state, and the end of welfare

Full text

New Labour,
the market state,
and the end of
welfare
Jonathan Rutherford
Jonathan Rutherford looks at the connections
between government and the insurance business in
their joint project to reduce eligibility for sickness
benefits.
38
In November 2001 a conference assembled at Woodstock, near Oxford. Its
subject was ‘Malingering and Illness Deception’. The topic was a familiar one
to the insurance industry, but it was now becoming a major political issue as
New Labour committed itself to reducing the 2.6 million who were claiming
Incapacity Benefit (IB). Amongst the 39 participants was Malcolm Wicks, then
Parliamentary Under Secretary of State for Work, and Mansel Aylward, his Chief
Medical Officer at the Department of Work and Pensions (DWP). Fraud - which
amounts to less than 0.4 per cent of IB claims - was not the issue. The experts
and academics present were the theorists and ideologues of welfare to work.
What linked many of them together, including Aylward, was their association
with the giant US income protection company UnumProvident, represented at
the conference by John LoCascio. The goal was the transformation of the welfare
system. The cultural meaning of illness would be redefined; growing numbers of
claimants would be declared capable of work and ‘motivated’ into jobs. A new

39
New Labour, the market state, and the end of welfare
work ethic would transform IB recipients into entrepreneurs helping themselves
out of poverty and into self-reliance. Five years later these goals would take a
tangible form in New Labour’s 2006 Welfare Reform Bill.
Between 1979 and 2005 the numbers of working age individuals claiming
IB increased from 0.7m to 2.7m. In 1995, 21 per cent were recorded as
having a mental health problem; by 2005 the proportion had risen to 39
per cent, or just under 1 million people. The 2000 Psychiatric Morbidity Survey
identified one in six adults as suffering from a mental health problem: of these
only 9 per cent were receiving some form of talking therapy. The Health and
Safety Executive estimate that 10 million working days are lost each year due to
stress, depression and anxiety, the biggest loss occurring in what was once the
heartland of New Labour’s electoral support, the professional occupations and
the public sector. Despite these statistics, Britain has one of the highest work
participation rates of OECD countries; while benefit levels are amongst the
lowest in Western Europe and benefit claims are on a par with other countries.
1
The system is not in crisis, and this is not the motivation for the proposed
changes. New Labour’s politics of welfare reform has subordinated concern for
the sick and disabled to the creation of a new kind of market state: claimants
will become customers exercising their free rational choice, government services
will be outsourced to the private sector, and the welfare system will become a
new source of revenue, profitability and economic growth.
The road to welfare reform
In 1993 Richard Berthaud of the Policy Studies Institute identified the causes of
the continuing rise in IB claimants.
2
In the period of growing unemployment under
the Conservative government a fairly constant number of people left work because
of ill health, only to find it increasingly difficult to re-enter the labour market. As
unemployment began to fall the numbers on IB continued to accumulate. The
problem lay not, as the right-wing press insisted, with malingering claimants and
collusive GPs, but with the economy and with the hiring and firing practices of
1. OECD, Transforming Disability into Ability - policies to promote work and income security for
disabled people, 2003.
2. See Steven Kennedy, Wendy Wilson, The Welfare Reform Bill, Research Paper 06/39,
House of Commons Library, 2006; www.parliament.uk/commons/ lib/research/rp2006/
rp06-039.pdf.

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40
employers. Berthaud concluded: ‘The increase has not been caused by excessive
ease of entry to the system, but by difficulty of exit.’ The Conservative government
had its own agenda, however, and Peter Lilley, Secretary of State for Social
Security in the 1992 administration, pointed the finger at claimants and the way
their illnesses were diagnosed by GPs. According to Lilley: ‘sickness and invalidity
benefits were originally intended for those people who, “by reason of some specific
disease or bodily or mental disablement” were unable to undertake work.’ Social
and psychological causes of illness were now being taken into account and as a
result, ‘the rules have been progressively widened and complicated’. The definition
of incapacity had become ‘fuzzy’ (quoted in Kennedy & Wilson).
The 1994 Social Security (Incapacity for Work) Act was designed to end
the ‘fuzziness’. The Act introduced Incapacity Benefit and a number
of key reforms to reduce the inflow of new claimants. Lilley hired John
LoCascio to advise on ‘claims management’. LoCascio was at that time second
vice president of Unum, the leading US disability insurance company. He joined
the ‘medical evaluation group’ that was set up to design more stringent medical
tests. Another key figure in the group was Mansel Aylward. A new All Work
Test was introduced in 1997. Instead of focusing on whether or not an individual
was able to do their job, it would assess their general ‘capacity to work’ through
a series of descriptors, for example ‘Is unable to cope with changes in daily
routine’, ‘Is frightened to go out alone’. Decisions on eligibility for benefit would
be decided by Department of Social Security (DSS) non-medical adjudication
officers advised by a newly recruited corps of DSS doctors trained by LoCascio.
The new test, and the marginalising of claimants’ own doctors, brought the rise
in IB claimants to a halt.
Unum’s influence was now at the heart of the system of managing disability
claims. In April 1997, when the new All Work Test was introduced, the company
launched an expensive campaign. One ad ran:
April 13, unlucky for some. Because tomorrow the new rules on state
incapacity benefit announced in the 1993 autumn budget come into effect.
Which means that if you fall ill and have to rely on state incapacity benefit,
you could be in serious trouble.
LoCascio replied in the negative when Private Eye asked if he was not concerned

41
New Labour, the market state, and the end of welfare
about the conflict of interest involved in his company’s advertising campaign,
which sought to gain from benefit cuts that he had helped to institute. However
Unum Chairman Ward E. Graffam did acknowledge the ‘exciting developments’
in Britain. Unum’s influence in government was helping to boost the private
insurance market: ‘The impending changes to the State ill-health benefits system
will create unique sales opportunities across the entire disability market and we
will be launching a concerted effort to harness the potential in these.’
3
Despite Graffam’s upbeat comments, however, the company was in
financial difficulties. In the 1980s Unum - along with the two other
major life and accident insurance companies, Provident and Paul
Revere - had been doing well from providing ‘own occupation’ income protection
schemes for mainly upper income professionals. Insurance against loss of earnings
caused by accident or sickness was seen as a lucrative market with strong growth
potential. Profit for insurance companies mainly lies in the revenue generated by
investing the monthly insurance premiums, and interest rates were high so the
companies enjoyed high levels of profitability; they monopolised the sector by
sharing a similar disability income policy that offered liberal terms. Two factors
threatened future profits however. The first was falling interest rates, and the
second was the growth in new kinds of ‘subjective illnesses’, for which diagnostic
tests were disputable. The old industrial injuries were giving way to illnesses with
no clear biological markers - Myalgic Encephalomyelitis (ME) or Chronic Fatigue
Syndrome (CFS), Fibromyalgia, Chronic Pain, Multiple Sclerosis, Lyme Disease.
In the early 1990s the new kinds of claims began to rise just as interest rates fell:
profits were threatened. Unum’s 1995 ‘Chronic Fatigue Syndrome Management
Plan’ sounded the alarm: ’Unum stands to lose millions if we do not move quickly
to address this increasing problem’.
4
It was actually Provident that was quickest off the mark, introducing an
aggressive system of ‘claims management’ that would become the industry norm.
It could not influence interest rates, but it could reduce the number of successful
claims it paid out. Its Independent Medical Examination (IME) was skewed in
3. ‘Doctors On Call’, Private Eye, issue 874, 16 June 1995, p26.
4. My thanks to activists in the US, in particular Linda Nee, and Jim Mooney of
corporatecrimefighters.com, who provided me with contacts and information. For the
archive of the US campaign against UnumProvident see http://web.archive.org/web/*/
http://www.corporatecrimefighters.com

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42
favour of the company through the work undertaken by its claims adjusters and
in-house doctors. Illnesses were characterised as ‘self-reported’ and so thrown into
question. Only ‘objective’ test results were accepted. Some disabling conditions
were labelled as ‘psychological’, which made them ineligible for insurance cover
beyond 24 months. Doctors were pressured to use the ‘subjective nature’ of
‘mental’ and ‘nervous’ claims to the company’s advantage.
5
Specific illnesses
were targeted in order to discredit the legitimacy of claims. The industry drew
on the work of two of the Woodstock conference participants, Professor Simon
Wessely of King’s College and Professor Michael Sharpe of Edinburgh University,
in an attempt to reclassify ME/CFS as a psychiatric disorder.
6
Success would allow
payouts to be restricted to the 24 month limit for psychological claims and save
millions of dollars. By 1997 Provident had restructured its organisation to focus
on disability income insurance as its main business. It acquired Paul Revere, and
then in 1999 merged with Unum under the name UnumProvident.
That year New Labour introduced the Welfare Reform Act. It was heralded
as an answer to Frank Field’s call for an end to a culture of welfare
dependency, and to Tony Blair’s misleading anxieties about levels of
spending on social security. All new claimants now had to attend a compulsory
work-focused interview. This was partly because the All Work Test introduced
by the Tories had failed to reduce the inflow of claimants with mental health
disorders. The gateway to benefits therefore needed tightening up. Mansel
Aylward, now Chief Medical Officer of the DWP, thus replaced the All Work
Test with the Personal Capability Assessment (PCA). The emphasis would no
longer be on benefit entitlement but on what a person was able to do and the
action needed to support them in work. The task of administrating the PCA was
contracted out to SchlumbergerSema, which was then taken over (along with its
DWP assets) by the US corporation Atos Origin; and in 2005 Atos Origin won a
further £500m contract. Claims for benefit were assessed by Atos employees with
no medical training, using a computer system called Logical Integrated Medical
5. California Department of Insurance Legal Division, ‘Accusation’, www.insurance.
ca.gov/0400-news/0100-press-releases/0080-2005/release089-05.cfm.
6. See the social action research undertaken by M.E. Action UK (www.meaction.org.
uk). For example www.meactionuk.org.uk/Notes_on_the_Insurance_issue_in_ME.htm.
See also debate in the House of Lords, www.publications.parliament.uk/pa/ld200304/
ldhansrd/vo040122/text/40122-12.htm.

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New Labour, the market state, and the end of welfare
Assessment (LIMA). Unsurprisingly, these computerised evaluations, coupled
with clearance time targets for Atos staff, made the PCA unreliable, particularly
for those suffering mental health problems. Fifty per cent of IB appeals against
the refusal of claims found in favour of the claimant. In 80 per cent of these the
problem was poor assessment of mental health problems.
7
While the new Act had
succeeded in further restricting the gateway to benefits, it had failed to deliver
Blair’s promised revolution in welfare. The reform process would go on.
‘Active Welfare’
In 2003 the DWP launched its Pathways to Work pilot projects. These were
forerunners of the kind of ‘active welfare’ system that had been promoted by
UnumProvident and the Woodstock academics. In the pilot projects all new
‘customers’ to IB undertake a work-focused interview (WFI) with an IB Personal
Adviser (IBPA). The Personal Capability Assessments of the 70 per cent who
are not screened out by the WFI are fast-tracked, and these claimants (who are
deemed not to have severe functional limitations), go on to attend a further
series of mandatory, monthly interviews. The role of the IBPAs is to actively
encourage customers to consider a return to work, as well as discussing work-
focused activity. Customers are offered a ‘Choices’ package of interventions to
support a return to work. For claimants suffering mental illness, a Condition
Management Programme is available, developed jointly between Jobcentre Plus
and the NHS. A Return to Work credit of £40 per week is payable for twelve
months to customers if their new job is not less than sixteen hours, and earns less
than £16000. At the Labour Party conference in this same year UnumProvident
organised a fringe meeting with employment minister Andrew Smith and
health minister Rosie Winterton. Joanne Hindle, corporate services director for
UnumProvident, spelt out the future direction of Pathways to Work:
Although we can say that we are 90 per cent of the way there in policy terms,
the real challenge is delivery - in particular the role of the intermediary. We
believe that it is absolutely vital that all employment brokers are properly
7. Mind, Welfare Reform Bill 2006 Commons second reading debate Briefing,www.
mind.org.uk/.../11D7C4BC-7E8D-438E-A950-96ED5D4469C5/0/
WelfareReformBill2006Mind2Rshortbriefing.pdf.

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44
incentivised to move disabled people along the journey into work and that
there are enough of them to do the job. The next step therefore is for private
sector to work alongside government to achieve delivery, focus and capacity
building within the system.
8
UnumProvident was building its influence. In 2001 it had launched New
Beginnings, a public private partnership that acted as a pressure group, drawing
in charities and NGOs and enabling the extension of the company’s influence in
shaping the policy making environment, particularly in relation to Pathways to
Work. Its annual symposium had been attended by government ministers, with
Woodstock academics providing intellectual input. Then in July 2004,it opened
its £1.6m UnumProvident Centre for Psychosocial and Disability Research at
Cardiff University. The company appointed Mansel Aylward as Director following
his retirement from the DWP in April. Professor Peter Halligan, who had forged
the partnership with UnumProvident, was ambitious: ‘Within the next five years,
the work will hopefully facilitate a significant re-orientation in current medical
practice in the UK’.
9
The two men were joined at the centre by Gordon Waddell,
an orthopaedic surgeon turned academic and another Woodstock participant.
The launch event was attended by Liberal MP Archie Kirkwood, recently
appointed Chair of the House of Commons Select Committee on Work and
Pensions. Malcolm Wicks, Minister of State in the DWP, gave a speech praising
the partnership between industry and the university.
10
UnumProvident could
now capitalise on its academic respectability as well as its close government
connections. It understood the importance of ideas. Words do not merely describe
the world, they enact it. To transform welfare into workfare would involve an
ideological battle around language and culture.
Culture of sickness
In 2005 the centre produced a monograph, The Scientific & Conceptual Basis of
Incapacity Benefits (TSO, 2005), written by Waddell and Aylward and published
8. See www.helpisathand.gov.uk/resources/groups/disabilities/ability/ability-magazine-issue-
52-november-2003-pdf-825kb.pdf.
9. ‘ Research Centre Welcomed’, 2.7.04, www.cf.ac.uk/psych/cpdr/.
10. Malcolm Wicks, Minister of State for Pensions, www.dwp.gov.uk/aboutus/2004/01_07_
04_ucpdr.asp.

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New Labour, the market state, and the end of welfare
by the DWP. In their declarations of interest at the beginning of the text neither
man cites their association with UnumProvident. This matters, because the
monograph provides the unacknowledged intellectual framework for the 2006
Welfare Reform Bill. And the methodology used by Waddell and Aylward is the
same one that informs the work of UnumProvident.
In a memorandum submitted to the House of Commons Select Committee
on Work and Pensions, UnumProvident define their method of working:
‘Our extended experience … has shown us that the correct model to apply
when helping people to return to work is a bio-psychosocial one’.
11
The bio-
psychosocial model is explained by Peter Halligan, and Derek Wade of Oxford
University (another Woodstock academic), in the British Medical Journal: ‘The
old biomedical model of illness, which has dominated health care for the past
century, cannot fully explain many forms of illness.’
12
This old model assumes a
causal relation between disease and illness, and fails to take into account how
cultural attitudes and psychological and social factors shape illness behaviour. In
other words it allows someone to report symptoms of illness, and for society to
accept him or her as sick, without their having a pathology. Waddell and Aylward
adopt the same argument in their monograph: disease is the only objective,
medically diagnosable pathology. Sickness is a temporary phenomenon. Illness
is a behaviour - ‘all the things people say and do that express and communicate
their feelings of being unwell’ (p39). The degree of illness behaviour is dependent
not upon an underlying pathology but on ‘individual attitudes and beliefs’, as
well as ‘the social context and culture in which it occurs’. Halligan and Wade
are more explicit: ‘Personal choice plays an important part in the genesis or
maintenance of illness’.
Waddell and Aylward are exercised by the paradox of a society in which
‘objective measures of health are improving’ but in which numbers on IB remain
‘stubbornly high’. They argue that this can be explained by adopting a bio-
psychosocial model. IB trends are a social and cultural phenomenon rather than
11. ‘UnumProvident Supplementary memorandum submitted by UnumProvident
following publication of the Welfare Reform Green Paper’, Select Committee on
Work and Pensions, see www.publications.parliament.uk/pa/cm200506/cmselect/
cmworpen/616/61602.htm.
12. Derick T Wade, Peter W Halligan, ‘Do biomedical models of illness make for good
healthcare systems?’, BMJ, Vol.329, Dec. 2004.

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a health problem: ‘Severe medical conditions only account for about a quarter
of the current IB caseload. Most IB recipients now have less severe “common
health problems”‘ (p172). The solution is not to cure the sick, but to transform
the culture of welfare and tackle the ‘personal and social/occupational factors
[that] aggravate and perpetuate incapacity’. Adopting this model will lead
to a ‘fundamental transformation in the way society deals with sickness and
disabilities’ (p123). The goal and outcome of treatment is work: ‘work itself is
therapeutic, aids recovery and is the best form of rehabilitation’. For Waddell and
Aylward, work is a virtue. But to make it so, they first abstract it from the material
conditions of paid employment. Work becomes an idealised practice shorn of class
and inequality and the reality of the large swathes of mundane and boring jobs
people must endure. In contrast to their idealisation of work, the authors view
worklessness as a serious risk to life. It is ‘one of the greatest known risks to public
health: the risk is equivalent to smoking 10 packets of cigarettes per day’ (p17).
No-one who is ill should have a straightforward right to Incapacity Benefit:
A person who is unwell may ‘feel too ill’ at present to consider returning
to work, but that is not a valid basis for future, permanent incapacity. The
argument that, even if they recovered, they could not ‘risk’ work because it
might be ‘harmful’ to their health is invalid because of the generally beneficial
effects of work and the ill effects of long term worklessness’ (p91).
UnumProvident, in its memorandum to the Select Committee, pursued the
same logic, arguing that even the most functionally disabled could be expected
to work at some future point.
The Waddell and Aylward monograph draws on the considerable knowledge
of the authors, but employs a methodology that skews it towards moral
authoritarianism and neo-liberal policy prescriptions. They rely on the
much-critiqued and outdated systems theory of sociologist Talcott Parsons, in
which the individual and society are assigned to discrete spheres of existence.
Hence they acknowledge the social and cultural dimensions of illness, but fail
to consider that these and other structural and economic forces might be the
dynamic causes of genuine ill health. Instead the problem of illness is located
in the individual, whose beliefs and behaviour then become the focus of moral
judgment and action. As Halligan and Wade argue: ‘Our model suggests

47
New Labour, the market state, and the end of welfare
that illness is a dysfunction of the person in his (or her) physical and social
environment’. This follows Parsons’s theory of the ‘sick role’, which he viewed as
an individual’s deviance from the social norm. He understood society as existing
in a state of equilibrium, with individuals functioning in their allotted roles. The
sick role upsets this equilibrium because it provides individuals with privileges
and exempts them from normal social responsibilities. In order to restore balance
society must recognise the sick role as an undesirable state and individuals must
accept their moral obligation to recover as quickly as possible and return to work.
Waddell and Aylward explain the high levels of IB claimants as arising from a
breakdown in this conditionality. The sick role is now assumed to confer a ‘right’
to incapacity (p47). The solution is to change people’s behaviour by transforming
the language and culture of welfare, and by using sanctions as a ‘motivational
tool’ to prise people out of their sick role (p166).
UnumProvident exposed
Meanwhile, in the US UnumProvident’s business activities had been coming
under increasing scrutiny. In 2003, the Insurance Commissioner of the State of
California announced that the three big insurance companies had been conducting
their business fraudulently. As a matter of ordinary practice and custom they had
compelled claimants to either accept less than the amount due under the terms of
the policies or resort to litigation. The following year a multistate review identified
four areas of concern: an excessive reliance on in-house professionals; unfair
construction of doctor’s or IME reports; a failure to properly evaluate the totality
of the claimants’ medical condition; and an inappropriate burden on the claimant
to justify eligibility for benefit.
13
UnumProvident was forced to reopen hundreds of
thousands of rejected insurance claims. Commissioner John Garamendi described
UnumProvident as ‘an outlaw company’: ‘It is a company that for years has
operated in an illegal fashion.’
14
To secure its financial position the company presented a public evaluation of
the costs of the multi-state settlement. It estimated that there were potentially
25,000 long-term disability claims (out of a total of 275,000 claimants) that
13. ‘Targeted Multistate Market Conduct Examination’, November 2004, www.maine.
gov/pfr/insurance/unum/Unum_Multistate_ExamReport.htm.
14. ‘State Fines Insurer, Orders Reforms in Disability Cases’, Los Angeles Times, 3.10.05,
www.insurance.ca.gov/0400-news/0100-press-releases/0080-2005/release089-05.cfm.

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48
would qualify for re-examination. Between $325m and $415m was allocated to
cover the likely costs. However this estimate did not include a further potential
14,000 claimants under the separate California settlement. And it was based on
a deadline being imposed in early 2007 after which claimants would not be able
to elect to have their claim re-examined. The company failed to make it public
that this deadline had been nullified by pending multi-district claimants’ class
actions in Tennessee. This was misleading because there remains the possibility
that many more of the 289,000 denied or terminated disability claimants may
seek re-evaluation of their claims or litigation. Such potential future actions
expose UnumProvident to a potentially ruinous financial outlay.
15
In response to the outcry this caused the company has rebranded itself, and
has now adopted the name Unum Group. There are reports that as the
bad publicity is subsiding the company is returning to its aggressive claims
management strategies in order to recover its profitability.
16
In January 2007
a performance rating from Credit Suisse was low, but with an upside driven
by higher than expected UK earnings and a lower than expected tax rate.
17
Graffam’s strategy has paid off. UnumProvident UK, with 2.3million covered by
its insurance schemes and pre-tax profits of £109.8m, provides up to 25 per cent
of the post-tax operating income of the UnumProvident group of companies.
The company had also played an important role in shaping a workfare culture
and policy strategy in the Department of Work and Pensions. In April 2007
UnumProvidentUK changed its name to Unum.
New Labour’s Welfare Reform Act
In July 2006 the Government published its second Welfare Reform Bill (which
was passed as an Act in May 2007). The aim was to radically reduce levels of
worklessness amongst single parents, older citizens and those on Incapacity Benefit
(IB), and a target was set of an 80 per cent employment rate amongst working age
adults. Pathways to Work will be rolled out across the country by 2008. Current
15. Details received in private correspondence and from Yahoo message boards, http://
messages.finance.yahoo.com.
16. Private correspondence; see also, ‘Case Reviews fall short for hurt workers’, LA Times,
12.4.07.
17. www.newratings.com/analyst_news/article_1465881.html.
18. John Hutton, ‘The Active Welfare State’, speech to the Work Foundation, 16.1.06,
www.dwp.gov.uk/aboutus/2006/16_01_06.asp.

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New Labour, the market state, and the end of welfare
Secretary of State for Work and Pensions John Hutton praised the pilot schemes:
‘The largely voluntary approach of Pathways has been a success’.
18
But not successful
enough.
19
To achieve its target the government will need to reduce the numbers on
incapacity benefit by one million, and persuade into work one million more older
people, and 300,000 extra lone parents. Employers, particularly in the public sector,
will be helped to create more effective management of sickness absence, and benefits
will not be given on the basis of a certain disability or illness but on an assessment
of the capacity to work. In 2003 the OECD reported that Britain’s benefits gateway
was ‘one of the toughest in the world’.
20
But it was not tough enough, and still
more stringent policing was required. The new Act offers GPs and primary care
staff rewards for taking active steps to get individuals back into work. ‘Employment
advisers’ will be attached to surgeries to help in ‘bringing about a cultural change in
the way work is viewed by families and individuals’. The PCA will be redesigned by
two technical working groups, one for mental health and one for physical disability.
Both groups involve representatives from UnumProvident and Atos Origin.
In 2008, IB will be replaced by a two-tier Employment and Support
Allowance. Minister of State for Employment and Welfare Reform Jim
Murphy, in a Parliamentary written answer, emphasised that the new
allowance will ‘focus on how we can help people into work and will not
automatically assume that because a person has a specific health condition
or disability they are incapable of work’.
21
Apart from those with the most
severe disabilities (around 15-20 per cent, who will qualify for a higher rate
of benefit) ‘customers’ who fail to participate in work-focused interviews or
to engage in work related activity will be subjected to a ‘motivational tool’,
as suggested by Waddell and Aylward. Current levels of IB average £6500 per
annum, but claimants unable to manage or refusing the motivation could lose
as much as £10.93 a week, rising to £21.8 for a second refusal of work.
22
There
19. For statistics and percentages of those entering work through the pathways see David
Laws MP written questions to Jim Murphy Minister of State, DWP, 27.3.07, at www.
theyworkforyou.com.
20. OECD, op cit.
21. Jim Murphy written answer, www.publications.parliament.uk/pa/cm200506/cmhansrd/
cm060620/text/60620w1094.htm.
22. ‘Hutton unveils benefits shake-up’, BBC news, http://news.bbc.co.uk/1/hi/uk_
politics/4641588.stm. Average Benefit rate in Waddell and Aylward, The Scientific and
Conceptual Basis of Incapacity Benefits, TSO 2005, p85.

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50
is no evidence to suggest that impoverishing people who are ill will prompt
them into longer-term employment, and this is particularly true for those
with mental health problems. In 2006 the DWP published a report on the
impact of the Pathways to Work pilots on people with mental health problems.
It concluded that: ‘the estimated impact of the policy on the outcomes of
interest for those who report having a mental illness (as a single health
condition) is never statistically different from zero at conventional levels’.
23
The future looks bleak for those who have ‘symptoms without diseases’, or
mental health conditions, and who cannot demonstrate that their illness has
an ‘objective medical pathology’. Jim Murphy was blunt: ‘Work is the only
way out of poverty … the benefit system will never pay of itself [enough to
lift people out of poverty] and I don’t think it should.’
24
The future of welfare
The Welfare Reform Act is short on detail, and secondary legislation delegates
powers to the DWP minister to continue the reform process and tighten up rules.
In 2006 Hutton commissioned David Freud, a senior banker at UBS AG, to
conduct a review of New Labour’s welfare to work policies. Published in March
2007, Reducing dependency, Increasing opportunity: options for the future of welfare
to work quotes Waddell and Aylward’s dictum that work is ‘therapeutic’ and
provides a business model for workfare. Freud argues that the government target
can be achieved by bringing in the private sector on long-term, outcome-based
contracts. The contracts are central to the success of the scheme. A price per
claimant is calculated on the savings in IB costs when the claimant moves back
into work. Payments to providers would then be paid over a three-year period
from when an individual client enters paid employment. The income generated
by the outflow of people from IB would be the incentive driving business towards
the government target. The contracting regime would set a minimum standard
of service that all ‘customers’ would receive. However: ‘beyond this there would
be freedom between the provider and the individual to do what works for them’.
Those claimants furthest away from the labour market - and who are most costly
23. Stuart Adam et al., Early quantitative evidence on the impact of the Pathways to Work pilots,
Research Report No 354, DWP 2006.
24. ‘Only work ends poverty, says minister’, Financial Times, 28.3.07.

51
New Labour, the market state, and the end of welfare
to the Exchequer - will command the highest rewards.
To carry out this transformation of welfare the DWP would need to establish
a new kind of contracting system, which would open up public finance to private
companies. According to Freud, the private sector is the only body capable
of shouldering the financial risks and arranging the private finance that will
reduce costs to the Exchequer. And using the private sector will bring in the
banks, which will be able to fund the ‘extremely large investments implied here’.
Private companies would take the lead in the bidding process for contracts, and
in building up consortia of groups in each of the regions and countries in Great
Britain. This annual multi-billion pound market, and the creation of regional
monopolies, ‘would attract major players from around the world’ (p62-3). As
Freud concludes: ‘The fiscal prize is considerable’. Hutton’s public reaction was
to describe the report as a ‘compelling case for future reform’.
25
W
elfare reform exemplifies the transformation of the old style nation
state into a new kind of ‘enabling’ market state. Instead of providing
social protection, the market state offers ‘opportunities’ and ‘choice’
to ‘customers’, who in return must shoulder a greater degree of responsibility
for their individual predicament. Alongside this transformation in the nature
of service provision is the blurring of the boundaries between public service
and private business, not least in the revolving door that operates in the higher
echelons of the state. The logic of welfare reform is to reduce costs by keeping
claims to a minimum. To achieve this, New Labour has adopted the practices
of a private insurance company whose claims management in the US has been
described as ‘illegal’. With the Freud Report it has opened the door for further
privatisation.
26
The workfare system that is taking shape in this country is turning
the logic of welfare onto its head. It is no longer a system that seeks to help
people who are sick or disabled; instead it is increasingly asking them how they
can help us. The demand for performativity in return for a meagre subsistence
robs people of their autonomy - but New Labour dresses it up in the language
of individual career development and dignity for the disabled. John Hutton
25. John Hutton, speech on ‘Welfare Reform in the UK’, 26.3.07, www.dwp.gov.uk/
aboutus/2007/26-03.07.asp.
26. Freud’s scheme may be a bridge too far for Gordon Brown. See: ‘Leak shows that
Treasury has consigned Blair welfare privatisation to the back burner’, The Guardian,
20.4.07,http://society.guardian.co.uk/futureforpublicservices/story/0,,2061933,00.html

Soundings
52
describes workfare as a ‘something for something’ approach, and Tony Blair calls
it ‘mutual responsibility’. But the compact between the state and an individual
whose life has been disrupted by disability or sickness is not an equal one.
The ‘sick role’ as an explanation for a person’s actions and attitudes makes
the individual who is incapacitated responsible for what are socially produced
problems. The logic of the reforms serves the need of the market, attempting
to turn the individual into an efficient, docile unit of consumption and
productivity.
The Conservatives have now announced their own approach to welfare
reform. Shadow Chancellor George Osborne argues that David Freud
has not gone far enough: ‘We should seriously consider a bold “no-win,
no-fee” approach to getting people off benefits. Prime contractors, be they
companies or charities, would be paid primarily if they get people back into work,
and keep them there - in other words payment by results.’ In return, more will
be expected from those on employment related benefits, and tougher sanctions
will be introduced against ‘those who can work but refuse to take steps to get
back into the labour market’.
27
The history of the British welfare system has
always been one of grudging, paternalistic and sometimes punitive forms of social
protection. But even measured against its own limited ambitions, the future of
welfare looks bleak.
27. http://www.conservatives.com/tile.do?def=news.story.page&obj_id=137035.