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The influence of the private insurance industry on the UK welfare reforms

Authors:

Abstract

The Work Capability Assessment (WCA) is the functional assessment used in the UK by the Department for Work and Pensions to assess eligibility for the Employment and Support Allowance. This is the most recent income replacement benefit for chronically sick and disabled claimants who are unfit to work. Despite five consecutive annual reviews of the assessment model, the UK government continues to disregard increasing evidence that the WCA is causing preventable harm, with all official reports overlooking the historic influence of an American insurance corporate giant on the UK welfare reforms.
1
The influence of the private insurance industry on the UK welfare
reforms.
Mo Stewart *
ABSTRACT
The Work Capability Assessment (WCA) is the functional assessment used
in the UK by the Department for Work and Pensions to assess eligibility
for the Employment and Support Allowance. This is the most recent
income replacement benefit for chronically sick and disabled claimants
who are unfit to work. Despite five consecutive annual reviews of the
assessment model, the UK government continues to disregard increasing
evidence that the WCA is causing preventable harm, with all official
reports overlooking the historic influence of an American insurance
corporate giant on the UK welfare reforms.
Keywords: work capability assessment (WCA); biopsychosocial model (BPS); DWP
Much has been written about the Work Capability Assessment (WCA), including the fact that
it was recently deemed as being fatally flawed by the Work and Pensions Select Committee1
(WPSC): ‘The flaws in the Employment and Support Allowance (ESA) system are so grave
that simply “rebranding” the assessment used to determine eligibility for ESA (the Work
Capability Assessment WCA) by appointing a new contractor will not solve the problems,
says the Work and Pensions Committee in a report published today.’1,2,3
The WCA was introduced by the New Labour government in 2008 and is exclusively
conducted by Atos Healthcare until March 2015. The assessment is mandatory for recipients
of Incapacity Benefit being migrated to the Employment and Support Allowance (ESA) and
for all new ESA applicants.Following much controversy, Atos Healthcare announced that
they are to withdraw early from the Department for Work and Pensions (DWP) contract to
conduct the WCA.
The plan to ‘dismantle the welfare state’ was first suggested by the 1982 Thatcher
government4and has been relentlessly pursued by successive United Kingdom (UK)
governments. Hence, in the Coalition government’s response to the select committee’s
evidence,5the Minister for Disabled People, Mike Penning MP, disregarded the very detailed
information provided by the WPSC report3that clearly listed the many serious problems still
faced by those who must endure the WCA to access the ESA benefit.
Government resistance to funding long-term out of work illness/disability benefits followed
the 2005 publication of the monograph: The Scientific and Conceptual Basis of Incapacity
Benefits(SCBIB) by Gordon Waddell and Mansel Aylward6,followed by the 2006 report: ?Is
work good for your health and well-being by Gordon Waddell and Kim Burton.7
What is constantly overlooked is that both these influential reports were commissioned by the
DWP. They were both produced when Aylward and Waddell were funded by Unum
Provident Insurance at the Unum Provident Centre for Psychosocial and Disability Research
(the Centre) at Cardiff University, with funding by the American corporate insurance giant,
Unum Provident, from 2003-2009. Aylward is listed as the DWP Chief Medical Adviser until
April 20058and is identified as being appointed as the new Director of the Centre from
2004.9
2
The influence of Unum Provident Insurance is demonstrated in the memorandums provided
for past WPSC reports9,10 that clearly list the transformation of Incapacity Benefit to ESA.
The requirement to ‘resist diagnosis’, ‘revise the ‘sick note’, ‘encourage the Government to
focus on ability and not disability’, ‘change the name of Incapacity Benefit’ and ‘benefits not
to be given on the basis of a certain disability or illness but on capacity assessments’9have all
come to pass as Unum Provident Insurance have influenced UK Government welfare policy
since 1994.11
At UnumProvident we have a non-medical, enabling model of rehabilitation
and we are working with our partners at the UnumProvident Centre for
Psychosocial and Disability Research at Cardiff University to better
understand what places people at risk of long-term or chronic illness.
Further information about this model can be made available
to the committee.9(item 24)
Supplementary memorandum submitted by UnumProvident(TM) - 20069
The SCBIB6was, essentially, the blue print for the future introduction of the WCA, using a
discredited bio-psychosocial (BPS) model of assessment as planned following the New
Labour conference in November 2001: Malingering and Illness Deception,12 with Aylward as
a contributor and ‘malingering’ very firmly planted as being the motivation for claimants of
disability benefits. Guilty until proven innocent was the mind-set that continues to this day.
‘And the methodology used by Waddell and Aylward is the same one that informs the work
of UnumProvident.’(TM)12
The 2001 New Labour conference12, together with the 20056and 20067reports commissioned
by the DWP, led to the 2006 Green Paper: A New Deal for Welfare: empowering people to
work an independent assessment of the arguments for the proposed Incapacity Benefit
reform.13 The SCBIB6was the main reference used to justify future drastic welfare reforms,
which was exposed by Emeritus Professor Alison Ravetz as being seriously flawed.14
On closer examination, it appears that this entire body of work [SCBIB] is
largely self-referential that is, it appeals for validation to itself and is
framed within the same political and policy agenda… It is not research
undertaken in the spirit of open enquiry. It is commissioned research and,
as such, pre-disposed towards ideologically determined outcomes.
Critique: DWP 2006 Green Paper:
A New Deal for Welfare: empowering people to work
Professor Alison Ravetz14
Not to be confused with a medical assessment, the WCA is described as a functional
assessment15 using an IT tick-box questionnaire and totally disregarding diagnosis.
The influential 2007 report by the unelected David Freud,16 promoted the use of the private
sector in welfare reforms when adviser to the New Labour Party and before being appointed
as the Minister for Welfare Reforms in 2010 by the Coalition government. Subsequently, the
WCA was sub-contracted to Atos Healthcare in 2008 and according to the General Medical
Council, Atos Healthcare ‘have total immunity from all medical regulation.’17,18
The WCA uses a manipulated bio-psychosocial (BPS) model of assessment, designed in
consultation with Unum Provident Insurance17,18,19,20 and is a replica of the discredited
healthcare insurance assessment model historically used by Unum Provident Insurance to
resist funding insurance claims.21 The LiMA IT programme used for the WCA was designed
by Atos Origin IT Ltd, the parent company of Atos Healthcare, for exclusive use for DWP
assessments.22
3
The original 1977 BPS model of assessment was attributed to psychiatrist George Engel.23
Engel’s BPS hypothesis was to consider the social and psychological factors, together with
the biological factors impacting on illness. It was an unproven theory that needed research.
Ten years ago Professor Christopher Butler and colleagues produced a paper demonstrating
that the BPS model of assessment was ‘found wanting’ and inadequate. ‘Medically
unexplained symptoms: the biopsychosocial model found wanting’24 was referring to the
original Engel BPS hypothesis.
Yet, a manipulated version of the Engel BPS assessment model, emphasising the possible
psychological factors of disability and disregarding the biomedical factors, is used by Unum
Provident Insurance and by the DWP as a method of removing as many chronically sick and
disabled people as possible from funding, or preventing access to it.17,18,19,20,21
Unum Provident Insurance were fined $31.7 million in 2003 in a class action law suit in
California for running ‘disability denial factories’18 and $15 million in 2005 by the California
Department of Insurance Commissioner, John Garamendi, who stated that Unum Provident
is an outlaw company. It is a company that has operated in an illegal fashion for years…25,26
By 2006 the State insurance commissioners of 48 American States approved a settlement in
an investigation of the Unum Provident Corporation that required the healthcare insurance
giant to reconsider 200,000 claims and to pay $15million in fines27 whilst not forgetting, at
the same time as these fines in America for malpractice, the company were funding Aylward
and Waddell at the Centre at Cardiff University.
Unum Provident Insurance changed its name to Unum Insurance in 2007 to distance itself
from increasing negative publicity for identified malpractice. Yet, the only opinions
considered by the DWP regarding the benefits of work and the assessment model used to
assess disability benefit claimants are those of Aylward and Waddell, whose research was
sponsored until 2009 by Unum (Provident) Insurance; identified by the American Association
of Justice in 2008 as the second most discredited insurance company in America.28
In January 2007 Professor John Langbein of the Yale School of Law produced a paper
identified as ‘The Unum Provident Scandal’29 that exposed Unum’s practice of disability
denial, and in November 2007 BBC News reported that the British government were being
advised by an American insurance company with a reputation for ‘racketeering’.30
Employees interviewed on the Dateline program disclosed that the claims
that were “the most vulnerable” to pressures for bad faith termination were those
involving “so-called subjective illnesses, illnesses that don’t show up
on x-rays or MRIs, like mental illness, chronic pain, migraines, or even Parkinson’s.”
The Dateline story pointed to an internal company email cautioning a group of claims
staff that they had one week remaining to “close,” that is, deny, eighteen more claims
in order to meet desired targets.
Trust Law as Regulatory Law: The Unum/Provident Scandal
and Judicial Review of Benefit Denials under ERISA
Professor John Langbein: Yale Law School 2007 p1318 29
Concerns have been expressed in a government inquiry regarding Aylward’s long association
with Unum (Provident) Insurance, including links with the American corporate insurance
giant when Chief Medical Adviser at the DWP from 1996 2005. To date there has been no
formal investigation following the evidence by Professor Malcolm Hooper to the 2005
Gibson Parliamentary Inquiry.31
4
There would also appear to have been a clear financial conflict of
interest and possible breach of Civil Service protocol, in that a
senior Civil Servant such as Aylward could not have been unaware
while he was in post at the DWP that Unum Provident was already
financing his next employment, which would allow him to indulge
in his existing conviction that syndromes such as ME/CFS are
affected by ‘cultural’ factors and are ‘behavioural’ in nature. It is
also a matter of concern that a senior Civil Servant accepted
sponsorship from a company with Unum’s track record.’31
Concerns about a commercial conflict of interest underlying
the DWP handbook entry on ME and CFS.
Professor Malcolm Hooper 200531
After various freedom of information requests, the DWP published the mortality figures of
the claimants who had died in 11 months in 2011 whilst claiming ESA,32 with 10,600 people
dying in total and 1300 people dying after being removed from the guaranteed monthly
benefit, placed into the work related activity group regardless of diagnosis, forced to look for
work and then died trying. Following the public outrage once the figures were published, the
DWP have consistently refused to publish updated death totals.
Unum (Provident) Insurance exposed their significant influence in the memorandum
following the publication of the Welfare Reform Green Paper. Their influence has also been
exposed since 2011 by the Disability News Service,33 with reports by the BMA34 and the
RCN35 that confirmed that the WCA was causing preventable harm as chronically sick and
disabled people now starve to death in the UK.36
Constant toxic rhetoric by the Secretary of State and various DWP Ministers from the
Coalition government, supported by the national press quoting their often extreme comments,
have successfully convinced the British public that vast numbers of chronically sick and
disabled people are shirkers and scroungers’ and disability hate crimes are the highest ever
recorded, as identified in a 2014 bulletin by the Home Office: ‘Hate Crimes, England and
Wales, 2013/14’ 37
CONCLUSION
Fifteen years ago Unum Provident Insurance was exposed in Parliament in the 1999
Permanent Health Insurance debate,38 where MPs identified the suffering of constituents as
Unum Provident Insurance refused to pay out on income protection insurance policies. Given
this company’s proven record of sustained misconduct and recorded malpractice over many
years, one must surely enquire as to why this company have been advisers to the UK
government on welfare reforms for the last 20 years…..
The constant reference to ‘disabled people’ by DWP Ministers, whilst disregarding those
with catastrophic illnesses, adds to the ongoing human suffering of the most vulnerable
people in the UK. They are far too ill to consider working39 but they now live in fear of
claiming the income related benefit needed for their very survival, as the Coalition
government consider all ESA applicants as potential malingerers, thanks to Professor
Aylward’s influence, regardless of what can be a devastating diagnosis.40
(January 2015)
5
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(2909 words)
... Using neoliberal politics, every UK government since 1982 has covertly worked towards that goal. It is the political thinking used as justification for the welfare reforms of the New Labour government, which introduced the use of the Work Capability Assessment (WCA) for all out-of-work disability benefit claimants (Stewart, 2015). Neoliberal politics also justified additional austerity measures introduced by the Coalition government since 2010, and the Conservative government(s) since 2015, which were destined to cause preventable harm when disregarding the human consequences (Ryan, 2015). ...
... The introduction of the BPS model of assessment had been successfully adopted by UnumProvident TM Insurance in America, to limit payment for healthcare income protection insurance claims (Rutherford, 2007;Stewart, 2015), and LoCascio was guiding the DSS how to introduce the BPS model into the UK. Quite literally, by disregarding diagnosis, the main emphasis of the BPS assessment would be an excessive concentration on psychological factors. ...
... By November 2001 a conference was assembled at Woodstock, near Oxford, and entitled 'Malingering and Illness Deception' (Conference, 2001). Many of the conference participants had an association with UnumProvident TM Insurance, as represented by John LoCascio, and the goal of the conference was the future demolition of the British welfare state (Stewart, 2015). There was a total of 39 participants including the DWP Chief Medical Officer Mansel Aylward and Malcolm Wicks MP, in his capacity as the then Parliamentary Under Secretary of State for the New Labour government. ...
Article
Full-text available
In the UK there are three words that identify the government enforced suffering of sick and disabled people, and they are: Work Capability Assessment (WCA). This report identifies the influence of a corporate healthcare insurance giant with successive UK governments since 1992, the influence of a former government Chief Medical Officer and the use of the WCA, conducted by the private sector, as the government permit state crime by proxy when justified as welfare reform.
... Using neoliberal politics, every UK government since that time has covertly worked towards that goal. It is the political thinking used as justification for the welfare reforms of the New Labour government, which introduced the use of the Work Capability Assessment (WCA) for all out-of-work disability benefit claimants (Stewart 2015), and for the extensive welfare reforms and austerity measures introduced by the Coalition government since 2010, and the Conservative government since 2015. ...
... This clear conflict of interest was disregarded by the DSS, yet Aylward's significant links with the private healthcare insurance industry questions his objectivity when writing a future government commissioned report regarding the assessment of welfare claimants for disability benefit (Waddell and Aylward, 2005). represented by John LoCascio, and the goal of the Oxford conference was the future demolition of the British welfare state (Stewart 2015). There was a total of 39 participants, including the DWP Chief Medical Officer Mansel Aylward, and Malcolm Wicks, in his capacity as the then DWP Parliamentary Under Secretary of State for the New Labour government. ...
... There was a total of 39 participants, including the DWP Chief Medical Officer Mansel Aylward, and Malcolm Wicks, in his capacity as the then DWP Parliamentary Under Secretary of State for the New Labour government. To reduce the numbers eligible for benefit, illness would be redefined and many welfare claimants would be declared fit for work, and incentivised into jobs as entrepreneurs if no paid employment was available Aylward (Waddell and Aylward 2005), when both authors were sponsored at the Centre with £1.6 million by UnumProvident Insurance (Cover 2004), who fully expected to gain from the UK welfare reforms, and the planned future reduction of the numbers eligible for State funded welfare support for sickness and disability (Stewart 2015). The S/C Basis DWP commissioned report (Waddell Waddell and Aylward (2005) was that the model used to assess Incapacity Benefit claimants was incorrect and, instead of using the medical model, which the report claimed focused on a claimant's incapacity rather than their ability, the Waddell New Labour government to justify the introduction of the welfare reforms, was subsequently exposed by Emeritus Professor Alison Ravetz, who identified the DWP commissioned report as being 'largely self-referential' (Ravetz 2006). ...
Article
Full-text available
In the UK there are three words that identify the government enforced suffering of sick and disabled people, and they are: Work Capability Assessment (WCA). This report identifies the influence of an American healthcare insurance giant with successive UK governments since 1992, the influence of a former government Chief Medical Officer and the use of the WCA, conducted by the private sector, as the government permit state crime by proxy when justified as welfare reform.
... False information was used in many Ministerial speeches (Cohen, 2013). This was enthusiastically reported by the right-leaning tabloid press (Peev, 2010;Hall, 2011;Littlejohn, 2011) on route to the long-ago planned demolition of the UK welfare state to be eventually replaced by private healthcare insurance (Stewart, 2015). The relentless demonization of chronically ill and disabled ESA claimants for five years from 2010 was aided by faked examples of claimants used in a DWP leaflet to justify savage benefit sanctions (BBC, 2015;WW, 2015a), which removed all income from claimants due to minor transgressions. ...
... This resulted in death by starvation (Gentleman, 2014) of some of the most vulnerable people in the country when, quite literally, 'killed by the State' (Elward, 2016, p29), when using the BPS model of assessment for the WCA (Stewart, 2018b). The WCA is a replica of the non-medical assessment model used by the American research sponsors UnumProvident TM Insurance to resist funding healthcare insurance claims (Stewart 2015,). Sanctioning claimants for deemed non-compliance was identified in the Unum sponsored research (Waddell and Aylward 2005, p166), which the DWP have used to excess since 2010 (Webster, 2018). ...
Article
Full-text available
Influenced by corporate America with an alternative agenda, the ongoing welfare reforms have created preventable harm and psychological tyranny for those too ill to work KEY WORDS: work capability assessment, employment and support allowance © Stewart
... Tony Blair's replacement as Prime Minister, Gordon Brown, introduced the removal of Incapacity Benefit and the adoption of the Employment and Support Allowance (ESA) in October 2008. The ESA requires chronically ill and disabled claimants to make themselves available for the WCA, which resists diagnosis, prognosis and all medical opinion, and is conducted by the unaccountable private sector at huge costs to the public purse (Stewart, 2015). By definition, any assessment that disregards diagnosis, prognosis and medical opinion is fatally flawed, as confirmed by the Work andPensions Committee in 2014 (W&P, 2014). ...
... Claim that the WCA is not a medical assessment but a 'functional' assessment, and appoint a Secretary of State who, when aided by the majority of the rightleaning national press (Hall, 2011), would spend years talking and shouting about the burden of these 'scroungers' on the 'hardworking tax payer'. Job done! (Stewart, 2015(Stewart, , 2016a(Stewart, , 2017 The WCA presumes all ESA claimants to be bogus. Disregarding diagnosis and prognosis is deadly, and was always guaranteed to kill many people (Stewart, 2017) -and it has done, as claimants must prove they are worthy of State funding, regardless of medical opinion. ...
... Few people realised the influence of UnumProvident Insurance with UK social policy reforms, or the fact that they had a disturbing history in America, with a resistance to funding disability insurance claims (Stewart, 2015); as identified by Law Professor John Langbein of Yale University in an academic paper, where he identified UnumProvident Insurance as being "...engaged in a deliberate programme of bad faith denial of meritorious benefit claims" (Langbein, 2007(Langbein, : 1315. Sponsored by UnumProvident Insurance (known as UNUM Insurance since 2007), the Waddell -Aylward research (2005) would be used by the Labour administration to introduce a new more stringent assessment model in 2008 to limit access to long-term disability benefit. ...
Preprint
I am the research lead for the Preventable Harm Project, that I led for ten years. The research demonstrates the plan by successive administrations to eventually replace the UK welfare state with private health insurance, identified as being Thatcher's 'dark legacy'.
... My research is now very well known by the disabled community and I enjoy contact with many distinguished academics from a variety of universities, whose detailed and often significant research evidence is confined to academic journals that few outside the academic world will access. Through the publication of articles and reports (Stewart, 2015), I have been able to offer access to mainstream academic research and bring it to the attention of the general public (Stewart, 2016a), which academics appreciate. ...
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Purpose No civilian has any comprehension of life in British military forces, or the impact of the removal of that life when unexpectedly returned to “Civvy Street” following the onset of a permanent illness or profound disability, with the gradual realisation that support in the civilian world means that a disabled veteran is just one of a crowd. The paper aims to discuss this issue. Design/methodology/approach Participant observation. Findings Welfare reforms together with austerity measures introduced by the British government are causing preventable harm to the most vulnerable in society. Research limitations/implications This paper was written by invitation and is limited by word length. Practical implications Older working-age disabled veterans are being abandoned by the state and suffer due to a change in government social policy. Social implications Disregarding the suffering and preventable harm created in society by the ongoing welfare reforms will have consequences that will need to be addressed as a matter of urgency, as the often tragic consequences are eventually alerted to the public. Originality/value A demonstration that the older working-age disabled veterans are being harmed by welfare reforms and the armed forces covenant has been breached.
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Following the fatally flawed Work Capability Assessment (WCA) conducted by Atos Healthcare, as contracted by the Department for Work and Pensions (DWP), the United Kingdom (UK) Government admitted that it was wrong to reduce the disability benefits of Mark Wood, the vulnerable disabled man who starved to death following the removal of his benefits, in C21 UK, when weighing only 5st 8lbs. Regardless of this tragedy, the UK Conservative led Coalition Government still refuses to accept any responsibility.(a) Despite the fact that the WCA was introduced by the last Labour Government in 2008, it was originally designed by previous Conservative Governments in consultation with the notorious American corporate giant now known as Unum Insurance, who were identified in 2008 by the American Association for Justice as the 2 nd most discredited insurance company in America.(b) Without a welfare state, sick and disabled people in America are required to use private healthcare insurance. The Government funded medical tyranny now imposed on the welfare dependent sick and disabled people in the UK, using the WCA, was designed with Unum Insurance to oblige the wider general public to purchase private income protection insurance policies, once it was made very clear that chronically sick and disabled people could no longer rely on the British State for adequate financial support. Americans often suffer when attempting to claim from the income protection insurance policies of Unum Insurance, who use an identical disability denial assessment model as that used by Atos Healthcare. Due to the similarities of the negative and damaging experiences of claimants, the American sick and disabled people are periodically informed about the struggle in the UK by the high calibre and relentless work of Linda Nee, who tries to encourage unsuccessful Unum Insurance claimants to publicly protest, as witnessed in the UK(c), which it seems disabled Americans still don't dare to do -such is the perceived intimidation of Unum Insurance and the American authorities.(d)(e)(f) The new report by The Mental Health Welfare Commission for Scotland, regarding a woman's suicide after being 'stripped of disability benefits', was reported by John Pring at the Disability News Service (DNS) and by many others.(g) The Coalition Government knew this carnage would happen. Three years ago a list of distinguished academics, together with politicians and disability support groups, identified the future in a letter as published in The Guardian newspaper: 'Welfare reform bill will punish disabled people and the poor.'(h) Now, 3 years after this letter was published, questions are being asked as to why the appointed and totally unsuitable Lord Freud, in his capacity as the Minister for Welfare Reform -who was unelected by anyone in the usual democratic way -deemed it necessary for the DWP to stop collating the numbers of deaths recorded of claimants found fit to work and removed from the long-term sickness and disability benefit, now known as the Employment and Support Allowance (ESA), regardless of confirmed catastrophic and permanent diagnosis. Lord Freud has also stopped the annual reports by the President of the Appeal Tribunals that, routinely, condemned the WCA as failing to coincide with reality. Questions are also being asked as to why this unelected former City banker, David Freud, was ever afforded so much authority and power in the UK Government given his questionable reputation, where one commentator described Freud as: '…one of the key players in several of the most embarrassing and badly managed deals in investment banking history.'(i)(j) (My emphasis. MS)
Article
Disability Living Allowance (DLA) was introduced in the United Kingdom explicitly to help offset the extra costs of disability. The scrapping of DLA and its replacement with the so-called Personal Independence Payment is causing massive concern across the United Kingdom, not least because it comes in the wake of a large number of other cuts, all of which impact disproportionately on disabled people. These changes reflect the retraction of ‘welfare’ across many European countries. As the government has refused to perform a cumulative impact assessment to date, it has been left to grassroots organisations such as DPAC to assess the damage and put the bigger picture together. An article in the New Statesman reports research showing that by 2018 disabled people are set to lose an astonishing £28.3 billion worth of financial support. These changes are going to affect up to 3.7 million disabled people in total.
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( This reprinted article originally appeared in Science, 1977, Vol 196[4286], 129–236. The following abstract of the original article appeared in PA, Vol 59:1423. ) Although it seems that acceptance of the medical model by psychiatry would finally end confusion about its goals, methods, and outcomes, the present article argues that current crises in both psychiatry and medicine as a whole stem from their adherence to a model of disease that is no longer adequate for the work and responsibilities of either field. It is noted that psychiatrists have responded to their crisis by endorsing 2 apparently contradictory positions, one that would exclude psychiatry from the field of medicine and one that would strictly adhere to the medical model and limit the work of psychiatry to behavioral disorders of an organic nature. Characteristics of the dominant biomedical model of disease are identified, and historical origins and limitations of this reductionistic view are examined. A biopsychosocial model is proposed that would encompass all factors related to both illness and patienthood. Implications for teaching and health care delivery are considered.
Article
The recognition that all illnesses have both mental and physical components and that there is a dynamic relationship between components of systems (general systems theory) led to criticisms of the biomedical model and to the development of the biopsychosocial model of Western medicine.1,2 From this model emerged the concept of triple diagnosis, whereby clinicians make diagnoses at three levels, the biological or physical, the personal or psychological and the social and contextual.2,3 By understanding relevant factors at all three levels and their interactions, clinicians are better able to treat the whole person—the patient-centred clinical method.4
March: Green Paper: A New Deal for Welfare Centre for Disability Studies
  • Ravetz
Ravetz A: 2006: March: Green Paper: A New Deal for Welfare Centre for Disability Studies, Leeds University (accessed 18 th Dec 2014) http://disability-studies.leeds.ac.uk/files/library/ravetz-Green-Paper-IB-critique.pdf
An independent review of the WCA, year 4
  • Litchfield
Litchfield P: 2013, p7: An independent review of the WCA, year 4, 2013 https://www.gov.uk/government/uploads/system/uploads/attachment_data /file/265351/work-capability-assessment-year-4-paul-litchfield.pdf (accessed 18th Dec 2014)