They can’t all be disabled, can they?

I recall Margaret Thatcher once remarking when she saw just how many people were using the Health Service on a daily basis “ They can’t all be ill”. It was an important observation, but not one that led us to any easy conclusion about what you could do when offering a free service to discourage people from frivolous use, especially when there is always the risk minor symptoms concealed a darker problem which did need medical intervention. We erred on the side of caution, true to the principles of free provision, and allowed people the service even when it turned out they were not ill.

Today a well paid and doubtless able bodied government adviser has asserted that as many as two thirds of those on invalidity benefit should not be. He has said in public about the most vulnerable in our society that they cannot all be ill, when they have been through medical examinations which have confirmed that they are disabled and deserve financial support. In support of his argument he suggests that GPs assess them as incapacitated as the easy way out. He calls this inevitable given the GPs’ conflict of interest.

MPs, like GPs, hold surgeries. Sometimes we see the same people. The long term incapacitated may well come to see the MP for help with the benefits side, having seen the GP to confirm they are sufficiently disabled to qualify. Some people who are depressed, lonely, unhappy, will see both the GP, who may tell them politely they have no physical illness, and the MP, who may explain patiently they have no problem with government. We both have the advantage that we are free at the point of use, and should be sympathetic.

I therefore understand something of the dynamics of the GP-patient relationship. The government requires GPs to move their patients through the consultations quickly – usually offering less time than an MP does. If you wish to encourage quick through-put it would be best to agree with what the person tells you. Querying their view of their symptoms (GP) or government problem (MP) will obviously slow things down. Suggesting they are not ill would take longer, as it would probably lead to sharp exchanges and some redefinition of the symptoms to seek the support and understanding the patient expected.

Furthermore, GPs tell me that people now are much more aware of their rights and of the complaints procedure. Make the mistake of upsetting a patient in the five minutes or so allotted, and the GP could have to devote hours to defending his or her conduct in the subsequent complaint if one is made. This too might encourage the GP to be more trusting of the patients’ claims.

The truth is the GP only has the word of the patient to go on concerning pain and other symptoms. If the patient says they have a very painful back there may be no visual evidence, and the GP may not be at liberty to watch how the patient moves when they are no longer acting the part of someone with a bad back if it has been fabricated. Much has to be taken on trust.

So can we believe the government adviser that two thirds of all these claims are wrong? I find that difficult to believe. Nor are there any easy answers. Within the large number of people who do claim disability benefit are many who are genuinely struggling because they have lost the use of limbs, have lost hearing or sight, or have problems with vital organs. They rely on their money from the taxpayers, and rightly so. We should not wish to worry them with the possibility that they might lose their benefits, or threaten them with yet more case conferences and medical investigations.

On the other hand, let us assume that there are some bogus claimants who have played the system. Let us suppose claiming a bad back is one of the ways this happens. It would be possible to review cases where there is a lack of additional proof of the disability. If someone has lost their legs it is easy to see that and no need for a further medical test, but if someone has a bad back it would be possible to ask for more tests to see if it has improved or if it was ever that bad.

This would, however, still pose the doctor a problem. Whilst the review could be carried out by a doctor who does not otherwise have to deal with the patient, making it easier to come to a negative conclusion, the doctor will still be subject to the same possibility of complaint by an aggressive claimant.

I find in life things work better if you persuade people to behave differently, rather than attempting to force them to. It may take more effort at the outset, but it may be easier in the long run.

Most of us have had a taste of incapacity at times in our lives. I have struggled with a broken right arm, and in my 30s had a phase of a sometimes very painful back that could leave me bent after stooping. The first condition made it impossible to drive and slowed me down doing many things, but it did not make me give up the job. I spent more money carrying it out, as I needed taxis or more public transport. The second condition did not stop me working at all – indeed I found interesting work was a good therapy as it helped take the mind off the pain. It was easier for me than many who are disabled, both because I expected my disabilities would pass, and because they were not severe.

There are lessons to be learned, however, from this very imperfect glimpse into the world of disability. It should make us all very sympathetic to those who struggle with more severe conditions, knowing they will never get better. It should make us aware that more money helps, as they could then have more assistance of the kind they need. But it should also make us think that where possible we do want to help people into work, as work can be part of the therapy and part of a more rewarding life.

There are no easy answers. I feel sorry today for those who have great disabilities, who will feel threatened by incautious remarks. I do see that retesting some to see if they still have a disability is part of the answer. More importantly it needs staff with time and skill to go through each case with the person concerned and see what help we could pay for to get them into work, instead of spending all the money on keeping them at home out of work.

A big journey starts with a single step. More rigorous and more independent medical testing should be introduced for all new cases, and a compulsory discussion about how someone could be helped to stay in work or to gain work rather than automatically granting benefit for them being out of work would help. Why not start with a better system for new cases? If we find it works and many more do stay in work or take some kind of work, it should be used as well for many of the cases where disability is less obvious or where the people themselves volunteer for help in getting back to work. The Conservatives have pledged to stop paying benefit to people capable of work who refuse jobs. The government is gradually following.


  1. Tears for Tier 1
    February 2, 2008

    My understanding is that of the 2m on incapacity benefit, more than 90% are on it through bad backs, depression or obesity.

    Tough love AND medical advice would suggest that the best cure for all 3 conditions would involve getting out of the house every day to go to work.

    Instead we pay people to stay at home and rather patronizingly get people from eastern Europe to do the work instead.

    Frank Field was going to something on these lines 10 years ago until 4 people in wheelchairs started to roll around in red paint outside Tony Blair's house and the fourth estate, and therefore Tony of course, gave them their sympathy

    1. colin
      October 26, 2008

      ***** "My understanding is that of the 2m on incapacity benefit, more than 90% are on it through bad backs, depression or obesity.

      Tough love AND medical advice would suggest that the best cure for all 3 conditions would involve getting out of the house every day to go to work."
      In relation to your comments above….. As a person with major arthritis in my spine and Bipolar disorder (manic depression), and obesity due to medication all I can say to your comments is THANK GOD it isnt up to you to reclassify us.

      Youre understanding of Disability is as lacking as your compassion.

      I worked for twenty years as a paramedic, and fifteen years as a local authority Housing Manger. all the time contributing to the system. Now I cannot work how dare you suggest that I am in some way dishonest and shirking?

      People like you need to shut up and get on with your own business, and hope you never get retired through physical or mental illness.

      1. Tears for Tear 1
        October 27, 2008

        So you're well enough to type replies and use a computer, but too ill to earn any money and rely on me to pay for your life style through my taxes?
        Its a good job that people like you have some people like me left to help you.
        I will stick to my original advice, and tell you that you need to get out more – this will do you far more good than staying at home feeling sorry for yourself and expecting others to do the same.
        As the economy worsens the cult of the victim will disappear – more people like me will run out of money and sympathy.

  2. Brian Tomkinson
    February 2, 2008

    Hasn't this situation arisen because politicians wanted to reduce (falisfy) the official unemployment figures by classifying people as disabled rather than unemployed? I understand that this shameful process was started by a Conservative government and continued by Labour. Whilst agreeing with your sympathy for those with clear cases of disability I feel that your approach is, uncharacteristically, inadequate. I thought the Conservatives were going to sort out the benefits system. I fear that with the approach you have outlined nothing will change and Labour will appear to have a more robust attitude.

    Reply: Conservatives have said we will reassess cases and take action as you would like. Of course benefit has to be withdrawn from people capable of work if they persist in turning down jobs.

  3. Tony Makara
    February 2, 2008

    John, this entire debate deflects from the real issue. That is only 600,000 vacancies at the good end of the economic cycle and 1.6 million on JSA, add to that the 1.9 million that Freud claims are on the wrong benefit. How on earth are all these people going to be put into work? A service-sector economy cannot produce enough jobs for a nation of our size, only manufacturing can do this, yet manufacturing is not allowed to develop because politicians don't protect industry from cheap foreign imports. Shifting people from one benefit to another will not change anything. They are still on benefit. Chris Grayling's proposals for a punitive workfare regime will not change anything. They will still be on benefit. The only way to get people off benefit is by creating jobs, and the only way to create enough jobs for a population of our size is through manufacturing.

    Being a passive recipient in the global economy does our nation no favours, a nation like China produces our wares, the EU produces our food, others produce our fuel and we in return play a passive role offering services. We should rebuild our manufacturing base and firms that produce specifically for the domestic market should be given significant tax relief by way of incentive. British goods made in British factories will produce British jobs for British workers and the money spent in Britain will stay in Britain and add to the wealth of our nation. While we are dependent on imports we are also hostage to currency fluctuations, this means that we are unable to cut interest rates when we need to because it weakens sterling and pushes the cost of imports up. The whole import culture is doing us great damage, in terms of job creation and in terms of the the macroeconomy. If politicians are serious about ending the nightmare of welfare then they need to look at ways of restructuring the British economy so that it no longer plays a passive role, but instead is active in creating goods, creating jobs, creating wealth and creating a society where people can contribute to, while in work, rather than just taking from, while on benefits.

    Reply: I agree we need manufacturing as well as service jobs. My Economic Policy Report looked at the measures we need to take to achieve just that.

  4. Neil Craig
    February 2, 2008

    My understanding, like Brian's, is that there was a great increase in disability cases in the later years of the Thatcher government, coinciding with a drop in the unemployment figures. The impression given is that both Tories & now Labour have been using it as a way of making the unemployment figures look better. I don't think those working the system can be entirely blamed if the system was set up for such working.

    An unfortunate side effect is that since disability is more than dole, there is a serious disincentive for anybody "disabled" to try for a job because if they can't hack it they no longer count as disabled. An unjust & theortically unsound but nonetheless practical answer would be to allow them to return to a financial equivalence of "disabled" status.

  5. Bazman
    February 2, 2008
  6. Cliff
    February 3, 2008

    As a disabled person, I find this whole Macarthy style witch hunt offensive. There is much misinformation being presented in the media from government.

    Ones GP does not grant you the right to incapacity benefit, this is determined by way of a very long complicated forty three page form and an interview with a doctor employed by the DWP who appears to have one objective in their work…namely to find you unentitled to the benefit. Putting very specific meanings to ordinary words and phrases seems to be a favourite trick. Indeed, some welfare rights websites suggest that you will automatically be turned down on your initial claim and if you then persist they will accept your claim on appeal. This did not happen to me so I cannot say it is true, I was deemed as incapable of any work and entitled to incapacity benefit and disable living allowance from the start. The only point I would make is that it took them six months to sort out my claim without any money coming in, I was lucky that, having always worked up until that time, I had savings to fall back on. These are now exhausted. This happened four years ago.

    It is not an easy life on incapacity benefit. I worked for thirty years without claiming any benefit of any description. I paid more in stopages most weeks than the

  7. Dr John Crippen
    February 3, 2008


    That is one of the most sensitive, compassionate and well-thought out discussions of the problems of invalidity benefit that I have ever read.

    I have no doubt that some claimants are bogus. I do not know the percentage. I also know that some would-be claimants, usually the mentally ill, are turned down unreasonably by the authorities.

    I am now certain that it is unspoken policy of this government to try to move the unemployed onto invalidity benefit purely for political reasons. The unemployment benefit people routinely now tell clients to "go to see your doctor and ask him if he will sign you off"

    As a doctor, like a constituency MP, you regard yourself as the patient's friend and advocate. It is very hard to be a health police officer as well. And you are quite right, whether or not my colleagues would admit it, time pressures mean that it is always easier to sign a certificate than to argue.

    I have no easy solution, but I do know that the family doctor has too much of a conflict of interest to make a valid decision in many cases.


    Dr John Crippen

  8. Jock
    February 3, 2008

    Whatever one does to encourage industry, and I agree it needs to be done, it should not be via protectionism which, longer term, impoverishes more. Removing tariffs, including taxes on labour and investment in wealth producing assets, as well as freeing up both imports and exports, whilst counter-intuitive to some who would rather "protect us against China", is the best route.

  9. sjm
    February 4, 2008

    I do wonder about the intelligence of the assessors.

    I have a 64yr old friend who had to take early retirement at 50 because of uncontrollable extreme cardiac problems. 3yrs ago, he was so ill that surgery became vital, and there were severe problems afterwards. He now needs two different operations urgently, but feels unable to take off the time to have them because his wife had breast cancer surgery last year and is now a semi-invalid who needs his care.

    At the review of his benefits last autumn, he was told he no longer qualifies and must look for work! This was appealed, after he and his wife had suffered weeks of extra stress, and his benefit was restored in full – but he must submit to re-assessment every 6 months.

    I would be really interested to know what employer would take on a 64 yr old man with no educational qualifications, on multiple medication, with abdominal and breathing problems and a wife who needs taking to hospital/GP frequently.

  10. Working Class Hero
    February 4, 2008

    My experience (and view) is very similar to that of Cliff (03 Feb 2008 at 1:38 pm). After 28 years of work it is hard to be tarred with the 'scrounger' brush, having paid in all that time, and now no longer being able to support my family as I used to.

    John, your post highlights something that seems ignored by the other politicians pronouncing on these matters and the MSM: fear.

    Whatever view one holds to of the numbers of false claimants on incapacity benefit, the effect of some politicians trying to score points for being 'tough' is to instill fear in the genuine claimants, folk whose personal situation means they are poorly-equipped to deal with such. Imagine the effect on those who cannot work for mental health reasons, for example. Hardly likely to help, is it?

    I suspect the last people frightened by these threats are the fraudulent claimants. Or am I being naive? More an attempt to draw in votes, perhaps, than warn evil-doers off?

    Whether this is more Westminster games or the prelude to a reform of the system, I see only one result: fear and hurt for those with few advocates.

  11. Cliff
    February 4, 2008


    Your story is not unique and I sympathise with the plight of your friend.
    Sadly it is likely this same scenario is going to be repeated as companies with a vested interest in turning down benefit claims become involved. Imagine this, one hundred people claim incapacity benefit, the company says that all are entitled to it so the company does not get paid. On the other hand, if one hundred applied for incapacity benefit and the company decided all are fit for work, they would get paid. The shareholders want their investment to make a return, all companies are there to make money, so what is most likely to happen?
    No one will feel sympathetic towards those turned down claimants because, after all, as the media and government tell us constantly, they are all chavy scroungers that are faking it etc etc.
    Once again the government are targeting the weak and vulnerable and using these people we should be looking after as a scapegoat for the government's financial incompetence.

    May I suggest if the government wants to save money on welfare that, they look at the number of kids having kids. Teenagers seem to be having babies in order to get homes and generous benefits. The government will tell you that single mothers and indeed imigrants are not given special treatment and put at the top of the housing list, however what happens is that the aforementioned are put into bed and breakfast accommodation and it is the fact that they are in B&B accommodation that makes them a priority need. Clever that is it not….More dealing in semantics by a dishonest government.

    John, I remember you being somewhat vocal about single mothers about perhaps fifteen years ago and the fuss it caused locally. I wonder if the views you expressed then are still the same now, given that our party has been "Cameronised"?Kids reproducing more kids outside of a stable relationship with no means of supporting those off spring must be wrong.
    The decline in morals in our society appears to have gone hand in hand with the general decline in our society, do you agree?

    Reply: The speech I made in Wales argued that fathers should be involved in bringing up or contributing to the upbringing of their children wherever possible. The speech became policy for both Conservative and Labour.

    Kids reproducing more kids outside of a stable relationship with no means of supporting those off spring must be wrong.
    The decline in morals in our society appears to have gone hand in hand with the general decline in our society, do you agree?

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