Wednesday, 22 July 2015

Defining sickness in welfare

In recent years with the draconian welfare reforms there has been increasing tension between what has been known as "old school" disability activists and "welfare reform" activists.
One key dispute is that one side refuses to acknowledge that there exist people who are "too sick to work", while the other is undermining the progress made over the past few decades obtaining key rights and support enabling us to enter the workforce.

It is easy to see why the two "sides" are at loggerheads. The stakes are high.
Just recently the government has announced that from 2017, ESA for new disabled people in the WRAG is to be cut by a third, aligning it with JSA. Now do bear in mind that these are people who have been found "unfit for work". While some disabled people within this group may be ready to take on a job, it also includes people who are currently unable to return to work. A further 5000 are unable to work in the longer term yet not "disabled enough" to qualify for the support group. All these people will now be expected to live on subsistence level benefits for a prolonged period of time.
On the other hand the continual campaigning for welfare risks giving out the message that all disabled people are on benefits and cannot work, reinforcing employers' misplaced belief that we make poor prospective employees.

Many people have been making the point that the government is wrong about these reforms because it is treating "sick" people the same as "disabled" people.
I have several issues with this. 
Firstly, "sick" people whose symptoms (impairments) are severe enough to prevent them from working are, by definition, disabled.
Secondly it is very difficult to clearly separate sickness from disability. Some explain that chronic illness causes symptoms such as pain and fatigue which are difficult to manage. But this does not define a chronic illness and can be a feature of many so called "disabilities".
So what is really important?

The key point for me is whether, after all possible support has been put in place and reasonable adjustments have been made, the disabled person’s impairments impact on their ability to do their job.
The problem for many disabled people with chronic illness is that it does. But crucially this is not unique to chronic illness, although it may be more common.

The degree to which it does will affect whether or not it is feasible for someone to be financially independent, or at the very least how difficult or how much.

This is completely individual and not reliant on diagnosis. Furthermore, even given the same impairment, a person’s support network (friends and family), physical support, education and even geographic location can make a difference. 
For instance I was able to continue working for a much longer time because I was able to access the very flexible job of a university researcher (work from home, long term deadlines, well enough paid to go part time). This would be closed off to most people as most people do not have a PhD. There are also not very many of these jobs to go around and location here would likewise make a difference.
So it would have been completely wrong to hold me up as an example and think that everyone with similar impairments could have been working.

However all of this is hard to explain quickly. Thus, because it is so common that impairments arising from chronic illness will invariably impact on the ability to work regardless of reasonable adjustments, we tend to simplify by separating disabled people into "sick" and "healthy". I fear though that this is creating divisions and friction.

In reality everyone should be working towards the same goal which is appropriate support for every disabled individual, regardless of their impairments.
For some this may be temporary financial support while they recover enough to return to work.
For some this may be long term financial support as their impairments impact so much on their ability to work that they cannot reliably carry out work which is financially viable.
For others it will be long term in work support (such as Access to Work). 
For some there needs to be an increase in flexible working practises and what I might call "soft" reasonable adjustments (not just a ramp!) if they are to be able to work again.
For pretty much everyone tackling prejudice, be it with employers, education or the general public is a high priority.
Then there is a wide range of other issues such as accessible accommodation, social care, provision of living aids (including NHS wheelchairs), accessible transport, disability in healthcare and probably much else I'm forgetting.

At the moment much of this is going backwards rather than forwards, be it fears for independent living through social care cuts, the abolition of the ILF and cuts to DLA, reduction in support for work through changes to Access to Work and again, cuts to DLA, a possible reduction in future accessible accommodation through lessening of building regulations, and cuts to ESA.