Iain Duncan-Smith’s notorious think tank the Centre for Social Justice (CSJ) looks to be behind a flagship pilot work programme the Tories set in motion during the last gasps of their decaying government. Crucially, the WorkWell scheme was one of the previous government’s major programmes hastening the Department for Work and Pension’s (DWP) invasion of the NHS. This was purportedly in a bid to drive down the numbers of unemployed long-term sick and disabled people.
Now, local authorities are pressing ahead with the joint DWP and Department for Health and Social Care (DHSC) project – and it’s looking increasingly likely the new Labour government will pick up where the Tories left off and expand the programme. This is because the Canary can confirm the CSJ will be at the party’s conference.
This is the final part of a three-article series exploring the influence of the dark money think tank the Centre for Social Justice, on the previous Conservative and current Labour government’s welfare programmes and policies. You can find part one here, and part two here.
DWP WorkWell: another work programme dressed up like caring
In the Tories Spring budget of March 2023, it first introduced the novel health-linked work programme WorkWell. The government invited local care boards and authorities to apply to host the first round of these.
So, just weeks before then prime minister Rishi Sunak announced the general election in May 2024, his government declared the launch of 15 WorkWell pilots. It stated that these would be set to start from October.
However, it’s not clear if these will actually begin rolling out from October as planned. Notably, the government’s tender service lists just three local authority contracts for WorkWell pilots at present. Two of these only closed their tender applications towards the end of August – though for at least one, the award notice is due any day now.
Largely, the scheme purports to focus on addressing chronically ill and disabled people’s “health-related barriers to work”.
However, as the Canary’s Rachel Charlton-Dailey previously noted, this doesn’t appear to be what WorkWell will actually do in practice.
Instead, as Charlton-Dailey pointed out, it boils down to a handful of physio sessions, some financial advice, and a support group for loneliness.
It won’t address woefully inadequate, inaccessible, and punitive social security benefits. It doesn’t tackle poverty wage-paying capitalists parasitising profits from workers pushed into the precarious gig economy. The scheme does nothing to address enormous NHS underfunding, ballooning waiting lists, and the dangers of privatisation.
In other words, it’s a similar story to its predecessor programme, Working Well.
Welfare conditionality?
Currently, the DWP appears to imply WorkWell will be a voluntary programme. However, there are sparse details on this at present.
In theory, its devolved nature from the DWP suggests that linking benefits to participation in this isn’t necessarily the intention. Certainly, its prospectus doesn’t mention making the scheme mandatory for any particular group.
Despite this, there are still a number of potential red flags which make it hard to fully rule it out. For one, while referrals can come through a number of places, one of course remains the DWP-run Jobcentres.
There’s also the issue that this could be a pretext for the DWP sinking its claws into a number of public spaces. In other words, it could outsource the policing aspects of the welfare state to these public services.
As the Canary has pointed out before, it’s similar to how the Home Office has co-opted health, and charity support spaces to target irregular migrants for detention and deportation. Specifically, the DWP lists how referrals could include:
- GPs, and Primary care services
- Employers in the area
- Voluntary and Community Sector (VCS) services
- Local authorities
- Social workers
- Other health related services in the area
Therefore, if the DWP chooses to make WorkWell a mandatory work commitment for some Universal Credit claimants for instance, the department could invade these public spaces for this.
In fact, if its predecessor is anything to go by, making benefits conditional on participation in the programme is also not a wholly unlikely possibility.
WorkWell and the WCA
That’s because Working Well did involve some mandatory participants. Long-term sick and disabled participants were voluntary. This was also the case for people the programme called ‘early entrants’. For instance, this included ex-offenders, homeless people, carers, and people living with alcoholism or drug addiction.
By contrast, for those long-term unemployed for more than two years in the Universal Credit Intensive Work Search (IWS) group or receiving JSA, the DWP mandated the programme. However, the DWP did drop this requirement due to the pandemic and hasn’t implemented this since.
Obviously, if WorkWell follows a similar approach, it won’t automatically coerce chronically ill and disabled people to work. Nevertheless, this could still pose a red flag in the context of broader reforms. Crucially, at the same time the Tory government announced the WorkWell scheme, it set out its plans to abolish the Work Capability Assessment (WCA).
This would see the DWP roll its eligibility test for multiple benefits under one umbrella. In other words, it would mean people would need to get Personal Independence Payment (PIP) or Disability Living Allowance (DLA) to receive the health component of out-of-work benefits. However, as the Canary’s Steve Topple has previously reported, there are significant issues with this approach. He has highlighted that:
The WCA and PIP criteria are completely different, as are the benefits. The DWP may be asking people for the same information about their illnesses or impairments. But the context is completely different. The WCA looks at what sick and disabled people can do regarding work. The PIP health assessment looks at what support people need. To combine both these assessments is simplifying people’s health. But more often than not, people’s health is not simple at all.
Ultimately, what this could mean is that the DWP could in fact deny over 600,000 people their benefits. To date however, the new Labour government has yet to illuminate on its plans for this possible reform.
Supposing it does follow through on the Tories’ proposal, it could potentially mean the DWP will therefore deny health-related out-of-work benefits to many long-term sick and disabled claimants. In effect then, they might fall in the DWP’s IWS group. And if the DWP mandates WorkWell for this group, it would mean some of those people will be chronically ill and/or disabled as well.
Not in a vacuum
Of course, the Tories didn’t introduce the new WorkWell scheme in a vacuum either. It accompanied a sweep of other repressive plans to ramp up sanctions and surveillance apparatus of the DWP.
However, one notorious proposal stands out. This was Sunak’s so-called “sick note culture” guff. What does this have to do with WorkWell? Potentially, quite a lot.
In the WorkWell prospectus, it details how the Tories intended to push fit note assessments under its remit. It stated that:
in the Autumn Statement we set out plans for new ways of providing people receiving a fit note with timely access to work and health support, and our intention is that a small number of WorkWell Vanguard Partnerships will have the opportunity to support this work through small-scale pilots.
It calls the areas set to pilot this “fit note trailblazers” and its ostensible aim is quite apparent. That is, to make it harder for people to obtain fit notes to be signed off work. It doesn’t take a lot to read between the lines to see that this was the Tories’ plan for this. It wrote that the pilot areas are:
to ensure people who request a fit note have a work and health conversation and are signposted to local employment support services so they can remain in work. The trailblazers will trial better ways of triaging, signposting, and supporting people looking to receive a fit note and will be used to test a transformed process to help prevent people with long term health conditions falling out of work, including referral to support through their local WorkWell service.
Outsourcing DWP contracts to private companies
A poster on X has highlighted that this could also simply mean more of the same privatisation of welfare by the backdoor:
This morning Conservative MP and Secretary of State for Work and Pensions Mel Stride said that GPs will no longer determine whether a patient gets a sick note, and that WorkWell will make the assessment.
Who is WorkWell? After a quick search online:
➡️ WorkWell is a series of… pic.twitter.com/wwFmQmHxCf
— Farrukh (@implausibleblog) May 7, 2024
So far, just one area – which happens to be Greater Manchester – has announced who it has awarded its WorkWell contract to. This was multinational services and accounting firm PricewaterhouseCoopers (PwC). However, this doesn’t appear to be for running the local programme. In this instance, it’s a contract for the design of the local scheme.
And as the poster on X pointed out however, it could be similar private contractors who assess people for fit notes. That is, instead of a qualified GP, an assessor without medical credentials could determine if a person is fit for work.
Similarly, while the Working Well programme ultimately signposted people to some local services as part of the scheme, the combined authority handed the main contract primarily to private outsourcing firms. This included Ingeus and Seetec Pluss – two companies regular to the DWP’s work programme and assessment service contract roster.
So once again, private companies will likely profiteer from new DWP contracts. The main difference is that local authorities will be the ones handing them the reins.
The DWP also awarded consultancy firm PA Consulting a contract to support the scheme at the national level. And interestingly, the company is heading to the 2024 Labour Party conference. It will be sponsoring a talk on AI in the public sector.
Talking therapies via the DWP
Of course, the ostensible justification for putting the fit notes process in the hands of WorkWell is supposedly to alleviate pressure from overstretched GPs.
The irony here then, is that if WorkWell follows the pattern of its predecessor, where will the service signpost participants most often? Their GPs.
But significantly, it’s possible that those GPs could then hand participants off to yet another service. Specifically, Working Well aligned GPs referrals to the programme with an expansion of:
a bespoke ‘talking therapies’ service.
It’s easy to see how this could have also worked the other way round in practice too. In other words, Working Well referred participants to their GP. Then GPs might have pushed some of these patients to the Talking Therapies service.
Moreover, the Canary’s Steve Topple has extensively explored how the DWP has infiltrated the sanctity of healthcare spaces. This is where the Tories have overseen the process of a de facto DWP-NHS integration. Since 2014, it has been doing so with Improving Access to Psychological Therapies (IAPT) – the former name for Talking Therapies. Specifically, it has placed Jobcentre work coaches into therapy settings.
What we could see then is WorkWell doing the same. Of course, this seems a significant possibility given the fact the Tories expanded Talking Therapies in tandem with announcing WorkWell in the first place.
ME and long Covid participants
Worse still, the nexus between GPs, Talking Therapies, and WorkWell could come at the harm of one significant patient group of over two million, likely more, and growing. These are myalgic encephalomyelitis (ME), and long Covid patients.
Topple has underscored how NHS trusts already use Talking Therapies to treat people living with ME. He noted also how it’s likely they’ll do the same for long Covid patients. In particular, he wrote that:
The potential with NHS England deprioritising long Covid treatment is that patients will end up with primary care practitioners offering CBT – which some trusts already do. Moreover, the cheaper version of this – called ‘behavioural activation‘, is already being trialled. As is the case with ME, CBT/talking therapies are cost-effective for the NHS, so it would be of little surprise if it pushed them for long Covid, too.
However, it’s unlikely to stop there. At least not now there’s a new NHS-DWP back-to-work brainchild on the block – namely, WorkWell.
Its prospectus references a vocational rehabilitation review as the main basis for its health interventions helping long-term sick people back to work. The DWP, alongside employers, unions, and insurers commissioned this.
But notably, this only analysed studies on musculoskeletal, cardio-respiratory, or mental health conditions. Of course, ME and long Covid fall under none of these.
Similarly, until the 2023 evaluation, the Working Well reviews had also solely considered various musculoskeletal problems in their analysis of physical health, alongside mental health conditions. These had included people having problems with their back, legs, feet, heart/blood pressure, breathing problems, diabetes, or forms of arthritis.
In other words, there was no appropriate physical illness category that encompassed people living with ME or long Covid, and indeed a range of other chronic health conditions. Given the long history of clinicians and scientists dismissing ME – and now long Covid – as psychological, this poses a serious red flag.
Psychologisation of chronic illnesses
It was only the latest evaluation that acknowledged a range of chronic health conditions participants lived with, including ME. Again, it stopped well short of a full evaluation of the scheme’s impact on people living with these different health conditions. Tellingly however, it did identify one significant fact. That is, that participants living with ME had among the lowest:
sustainment rates relative to their job entry rate
Essentially, this meant that people with ME were among the least likely to sustain a job that paid the National Living Wage, proportional to the number that started in one.
Therefore, people living with ME or long Covid may be understandably wary of the potential for psychologisation under WorkWell.
And WorkWell’s vocational rehabilitation review also wouldn’t be the only study the DWP has commissioned to push sick people into work. Notably the flawed 2011 DWP-funded PACE trial set over a decade of psychologisation in motion for people living with ME, and now long Covid too.
Biopsychosocial model
However, there’s one issue in particular that should send alarm bells ringing for people with ME and long Covid. This is the fact the review promotes a biopsychosocial model for treating people with the range of conditions it assessed.
In fact, the DWP discloses this much in WorkWell’s own prospectus, which says that:
There is good evidence that we can support faster returns to work through interventions that take a holistic view of the barriers an individual experiences through their physical health, their psychological situation and their social situation – often referred to as biopsychosocial interventions.
For people living with ME, a vested lobby of clinicians and scientists have pushed this treatment approach. It has embedded this psychologisation – and enabled healthcare professionals to force a harmful exercise therapy and cognitive behavioral therapy (CBT) on them.
Of course, the review is applying this to musculoskeletal, cardio-respiratory, and mental health conditions – not ME or long Covid. Even so, the basic premise for it is no different. This rehabilitative dogma revolves around the idea of ‘patient beliefs’. In short, that a person’s very real physical pain and resulting disability is in their heads.
Evidencing this, the review listed the World Health Organization’s (WHO) 2001 definition of BPS model. Notably, one part of this said that:
the individual must take some measure of personal responsibility for his or her behaviour.
Meanwhile, a narrative review it cited also stated that:
Individuals with chronic illness and disability are among the most difficult patients to treat. The health-care provider is faced with an array of physical, psychological, and social factors, requiring adoption of a biopsychosocial approach to treatment. This approach necessitates consideration of the benefits for the patient of remaining ill and disabled. These benefits have been termed the ‘secondary gains’ of illness, and they may serve to perpetuate disability and illness behaviour
So, this particular narrative review was ostensibly suggesting that some chronically ill and disabled people are choosing to stay sick. This will sound only too familiar for countless ME patients who healthcare professionals have gaslit, dismissed, and abused for years.
Labour running with the CSJ’s ideas
While the previous Tory government introduced WorkWell, the scheme will now proceed with Labour at the helm of the DWP and DHSC.
Moreover, on 10 September, the DWP said in a press release that:
The Secretary of State is also expected to outline her plans to devolve power to local areas so they can tackle inactivity with bespoke work, health, and skills plans, which are expected in a White Paper in the autumn.
Obviously, it sounds a lot like more WorkWell. But then, given that Labour appear to be listening to the same dark money think tank seemingly behind the Tory pilot programme, it’s little wonder. At the end of the day then, it’s abundantly clear that Labour will be implementing the policies cooked up by the former DWP ‘grim reaper’ Iain Duncan-Smith’s infamous think tank. Labour can dress it up however it likes – but it’s simply wedded to more callous anti-welfare policies raring to compound the harms of repeatedly repressive Tory reforms – showing in reality, there’s really no difference between them.
In fact, the Canary can now confirm that the CSJ is indeed headed to the Labour Party’s 2024 conference. It will be hosting a series of fringe events. Currently, the CSJ and the Labour Party’s conference agenda platform is light on the details for these. However, one is an event with both Greater Manchester mayor Andy Burnham, and DWP minister Stephen Timms as speakers. As we’ve already noted, both were commissioners for the CSJ reports calling for the new government to expand WorkWell style schemes. Crucially, the CSJ’s has listed it with the same name as its recent launch event for both reports.
Ultimately, WorkWell looks like more of the same DWP infiltration of the NHS, outsourcing to the private sector, and pushing the onus of ‘overcoming’ work barriers on chronically ill and disabled individuals. The new Labour government’s Tory-esque fixation on the numbers of economically inactive speaks volumes. And what it says is – more WorkWell sham solutions are probably on their way to ‘fix’ the economy no matter the cost to sick and disabled peoples’ lives.
Featured image via the Canary
