The government will soon be placing job coaches in GP surgeries in Islington as part of a pilot to “coach” the unemployed into work. What is the aim of this process, how will its results going to be evaluated, and who will deliver it? Here, Elizabeth Cotton explains that the devil is in the detail and raises the questions we should be asking so that people who are vulnerable are not put in an even more precarious position.
In the mayhem of disability welfare cuts, important details about the politics of health can easily get missed. The recent crisis is not just about cuts in public services, but also about the growing policy link between health and work. Over the last year the government has announced the creation of the Joint Health and Work Unit and the Health and Work Service, both with a clear remit to cut benefits and get people into work. Given that mental health is the number one cause for long-term sickness absence in the UK, a key aspect of this policy is to provide mental health services that get people back into work.
One such attempt to provide mental health services for people on benefits includes a heavily resisted pilot to put therapists into job centres. And so recently the government announced another health and work pilot programme to put Job Coaches in GP surgeries in Islington. This initiative comes after years of independent reviews into disability assessments, attempts to put mental health services into job centres, and complaints and evidence against the way in which fitness for work is assessed in the UK. A toxic combination of scripted assessments that don’t take mental illness seriously, quotas for sanctions, and the contracting out of the state’s responsibility to protect vulnerable people.
The proposal to put job coaches into doctor’s surgeries would be funny if you weren’t talking about actual human beings, including those who become the coaches. The people that provide these new mental health services are, if the experience of the largest NHS programme Increased Access to Psychological Therapies (IAPT) is anything to go by, themselves vulnerable. This includes an employment relationship with low pay, low training and clinical supervision and at best a situation of ambiguous clinical responsibility raising a question whether new job coaches will be able to contain their clients’ and their own states of mind. So here are some questions that the good people of Islington could ask their democratically elected leadership:
First, given that people who are out of work and need to see their GP about it are likely to be feeling pretty vulnerable, how is the government going to make sure they are treated with the respect, kindness and get the clinical help they actually need? People can easily be bullied and often blame themselves for their situation. The risk of suicide is real and any system of ‘coaching’ has to include proper safeguards in the scenario that someone turns up to talk to a job coach and breaks down.
Second, if a private contractor gets this gig to provide job coaches, how are they going to be managed? As the Mental Health Taskforce report states very clearly, there’s virtually no monitoring of private providers in mental health at primary care level. It is estimated by the Centre for Health and the Public Interest that 50 per cent of private contractors don’t provide services that follow the guidelines provided by the National Institute for Health and Care Excellence, many of them providing non-clinical services under the title of ‘wellbeing’ or ‘resilience’. Very soon the Commissioning Support Units that administer funds for services within Clinical Commissioning Groups are themselves going to be privatised. So in the likely event that big contractors move in to provide these services we can no longer ignore the impact this will have on people who sign up. And third, who is actually going to manage this pilot programme so it doesn’t turn into another cynical attempt to pathologise people who are unemployed?
Given that these pilots have already been agreed, the best case scenario is that someone in Islington ensures the process is transparent and set up in such a way that we might all learn something. This will require some very close scrutiny of the contract and realistic statements about:
- the primary aim of this initiative
- how are the targets set and do they test the validity of the intervention?
- is this therapy or not?
- who holds clinical liability for the people who take up this service?
- what measurements are going to be used to evaluate these pilots?
- who is going to do the dog work of setting up this pilot so that it is open, honest and shows actual results?
Lastly, how are they going to make sure that the job coaches aren’t as vulnerable as their clients? Not wishing to blind you with Industrial Relations science but there’s a high chance these are going to be bad jobs. We do not have a good experience of the young people working within the NHS’s mental health services. To make sure we don’t repeat this attack on decent work, we need clarity on what training and support they will receive, what contracts they will have and how they will be supervised. We also need absolute transparency on their targets, learning the lessons of the WCA and Maximus whistleblowers; if you base this new job coach service on impossible targets of getting people with mental health problems back into work and then make it impossible for coaches to raise their concerns about how vulnerable people are treated, part of their duty of care, then we end up with a culture of bullying and fear, one of the most shameful aspects of today’s health services. If the job is to cut benefit claimants by 20 per cent let’s be clear about that from the onset so that we can protect the coaches and their clients right from the onset.
In the current anti-welfare environment putting job coaches into GP surgeries is a service that can easily be used to bully already vulnerable people into giving up their rights to be cared for. The professional bodies who are at the negotiating table with the DWP need to understand both the politics and broader public interest issues at play. This means critically and diligently negotiating over what mental health services are delivered, to whom, by whom and under what conditions. We need our politicians and our clinicians to protect the principles which underpin public services by looking out for the devil in the details.
Elizabeth Cotton is a Senior Lecturer at Middlesex University Business School. Her academic background is in political philosophy and current writing includes precarious work and employment relations, activism and mental health at work. She is working on her new book, Surviving Work: How to Manage Working in Health and Social Care(Gower 2016).
(Image credit: Emily CC BY-NC)
It seems that cameron’s legacy of attacking the vulnerable is alive and well the long term chronically sick can’t be coached back into work because coaching does nothing to alter their medical condition.
Why not put these coaches in workplaces, to coach employers on how to be flexible and supportive? I have a chronic illness and my employer has been fabulous – that’s the only reason I didn’t have to drop out of the workforce due to my health. I’ve been able to go part-time, work flexible hours, and so I am still able to make a really good contribution to our team. Which has also helped my mental health during a really difficult time, by feeling useful and connected. From what I hear from others, supportive employers are rare. Perhaps that is who needs the coaching.
It’s hard not to conclude that a large part of the motivation behind these policies is not just to cut public spending and help the disadvantaged find work, but to appease the popular suspicion that disability benefits are abused. I don’t think things like this can be tackled effectively without tackling the wider sentiments that give them legitimacy.
Personal experience – years of knowing people who are perfectly capable of working but live highly desirable work-free lifestyles courtesy of disability benefits – leads me to be sympathetic to that popular suspicion. I know my work-free acquaintances to be perfectly capable of work because I’ve worked with them on complex, demanding hobby-related projects over many years. It’s a complicated issue because it’s not a simple fraud versus honesty dichotomy: people can have mild problems and convince themselves they’re unable to work, because the incentives overwhelmingly favour emphasising disability. Why sacrifice your life to uninspiring minimum wage work, with all the endless commuting and life-restrictions that go with that, when you can live a life of freedom and restfulness by claiming disability benefits? I have something like low-level depression myself, and sometimes wonder whether I’m a chump for not attempting to live off benefits myself – I admit I’m very envious of the lifestyles enjoyed by my disability benefits-claiming acquaintances – but ultimately I know that I’m perfectly capable of working.
There might be no solution which makes it harder for people to take advantage of the system which doesn’t simultaneously punish vulnerable people who desperately need support and would genuinely rather be paying their way. With mental health it’s hard to imagine a robust objective test of any kind that could distinguish legitimate from illegitimate claims – if I say I’m debilitatingly depressed and describe corresponding symptoms, how can anyone possibly know whether I’m telling the truth, exaggerating or outright lying? It would be nice if we could get to the point where people could acknowledge that there might be a genuine dilemma. It seems to be taboo in academia to even consider that. The assumptions so deeply-rooted that they’re not even articulated seems to be that: claimants never lie, claimants never exaggerate or delude themselves, and anyone who complains about freeloading is either (a) evil or (b) enslaved by false consciousness generated by evil right-wing media. It feels like there is simply no possible policy aimed at addressing freeloading which would not be immediately denounced as cruel and unworkable. I would not be surprised to see even the very concept of “freeloading” denounced as inherently oppressive and delusional.
This comment came through anonymously from a reader:
Thanks for the articles you post. I was on the Maximus work program a few years back. I gave then my disability reports on induction. They actively ignored my disability reports and filled them away. I have severe learning disabilities but was treated as normal until I threatened legal action and started throwing statutes and acts around.
At that point damage control ensued along with generous helpings of plausible deniability. In the end it wound up at the Parliamentary Health Ombudsman who did nothing and Maximus never took me seriously anyway. Maximus never acknowledged that they discriminated against the mentally disabled through institutionalised inaction. My MP couldn’t fix it nor could the ICE. As far as I can tell the higher levels of government are covering up for them or turning a blind eye to things like the Equality Act 2010.
Maximus don’t recognise mental disabilty… unless you get aggressive and use legal jargon. I dread to think what they will do replacing ATOS.
A good informative piece Elizabeth – I’m thinking the staff of Jobcentres and benefit offices should perhaps be studied by psychologists to find out why they are complicit in the bullying of claimants.
Dear Andrew, yes this is an area of research but goes very slowly because of the insecurity of the clinicians involved. We’re running a survey now for mental health workers and encouraging people working in these services to fill it in anonymously and carry out anonymous interviews with us. If you are in contact with any mental health networks that might be able to raise awareness of the survey we’d be really grateful http://www.survivingwork.org/surviving-work-survey
best
Elizabeth
Here’s a radical plan. How about providing people with what they need to live on and then leaving them alone to get on with their lives. The banks and the corporate sector is hoovering up billions and billions in taxpayers money and doing nothing to benefit society whatsoever whilst the poor and vulnerable are made to justify themselves,not as human beings but as “jobseekers”, on the sole basis of how much profit they can generate for the economy. There is no shortage of wealth, only a problem of distribution. This is the real issue.
Jimmy, I agree with you entirely. The dividend from automation of so many manufacturing and other processes means that for decades we have had enough wealth to provide a basic income for everyone. Instead we let money accumulate and stagnate in the hands of a smaller and smaller minority. So many people falsely believe that people become wealthy through their work, when in fact what they do is buy machines with borrowed money, automate processes and, when they do employ people, pay them less than their labour is worth, pocketing the difference for themselves. It is staggeringly unjust, totally unnecessary, and a tragedy of gargantuan proportions for tens of millions in the UK alone (and for billions worldwide).
I flagged this issue up last October – https://kittysjones.wordpress.com/2015/10/28/the-government-plan-to-nudge-sick-and-disabled-people-into-work/
And more here – https://kittysjones.wordpress.com/2016/02/03/lets-keep-the-job-centre-out-of-gp-surgeries-and-the-dwp-out-of-our-confidential-medical-records/
And – https://kittysjones.wordpress.com/2016/02/25/g4s-are-employing-cognitive-behavioural-therapists-to-deliver-get-to-work-therapy/
Dear Sue – these are brilliant blogs thank you. I’ll circulate them on social media now.
Thank you very much, Elizabeth, I have circulatd your excellent article, too
I wonder if anyone has ever bothered to find out how many people are long term sick because of physical problems, perhaps a consultant surgeon and physician in every job centre and GP’s surgery would help them get back to work.
Wow Barry, you’re brilliant! I’m sure nobody has ever thought of figuring out how many people are long term sick because of physical problems. And whoa, *treating them? What a concept!
People who are long-term sick will already have seen their GP many, many times, and will almost certainly have seen consultants, and possibly surgeons. Most will have had many treatments, and some will have had surgery. You don’t just show up at the JobCentre and get handed long-term sick benefits, you know. Many, many physical problems are NOT FIXABLE.
You’re an idiot.