Are you working hard enough? Are you sure? What if you get sick, or have an accident? Are you prepared to go to work anyway, even if you don’t think it would be good for your health? What if your doctor and boss agree you could do something other than your usual job instead of malingering at home? Like making cups of tea all day, or cleaning the bogs, or any form of work your empoyer can dream up to force you not to take time off. Because that is now the chilling reality as the DWP attempts to inject Iain Duncan Smith’s warped ideology into the NHS.
Last week the DWP issued patronising new guidance to GPs on when they should issue a Fit Note. Doctors are warned of the dangers of ‘worklessness’ and told they must consider “the vital role that work can play in your patient’s health”. According to the department, “the evidence is clear that patients benefit from being in some kind of regular work”.
This is an outright lie. What the evidence says is that on balance most people might be better off working but the beneficial health effects depend on the nature and quality of that work. In the report on which the DWP’s claims are based – a paper incidentally commissioned by the DWP themselves – the authors actually warn that “a minority of people may experience contrary health effects from work”.
This study – called Is Work Good For Your Health and Well Being (pdf) – has formed the basis of government policy ever since the Labour administration launched the despised Work Capability Assessment for out of work sickness benefits in 2008. It features a reasonably wide-ranging review of the evidence of the health risks and benefits of work and concludes that work, on balance, is better for most people’s health than unemployment but with important caveats. These findings have been consistently misrepresented by politicians who have used them to claim that any kind of work is good for health, and that this applies to everybody.
The study found that in some cases – possibly 5-10% – unemployment can lead to improved health and well being. It warns that negative health impacts of unemployment are “at least partly mediated through socioeconomic
status” – meaning it is not work that is good for you, but poverty that is bad for you. The review points out that whilst the evidence is conflicting, shift work and long hours could have a weak negative impact on health. It also finds that school leavers who move into ‘unsatisfactory’ employment can experience a
decline in their health and that economically secure people who retire early may experience beneficial effects on their health. Even if this report is taken at face value – and it comes loaded with assumptions about the social and moral imperatives of work – all it shows is that work can be good for your health – but only if it’s a good quality well paid job.
If you are in low paid or insecure work then what your GP should tell you – based on the existing evidence – is to take a few days off if you aren’t happy or feel unwell. Perhaps they should warn that you might be one of the 5 or 10% of people who are healthier if they are unemployed, despite the loss of income. A more recent study carried out in Australia, and quoted on The Conversation, found that people “who moved into poor-quality jobs showed a significant worsening in their mental health compared to those who remained unemployed.”
What the new guidance to GPs is intended to do is impose workplace dicipline via the healthcare system. Much like a seven day NHS is a health service for bosses, not patients, and likely to lead to pressure on workers not to book medical appointments in working hours, the Fit Note scheme is designed to bully people into the workplace even if they are sick. That is why the guidance states that if GPs consider their patient could do any work at all, regardless of their usual job, then they should tick a box suggesting amended duties, or workplace adapatations rather than issue a full Fit Note. And if doctors are too squeamish to treat patients this way then they are instructed to refer them to Maximus – the shadowy US conglomerate brought in carry out health assessments under the new Fit For Work scheme.
To help doctors decide what is best for their patients, or more correctly their patient’s employers, the new Fit Note guidance features case studies, with recommended courses of action that GPs should take. They include an example of someone diagnosed with anxiety disorder who says that her work in customer services is giving her panic attacks and that she is too distressed to carry out her duties. According to the DWP her doctor should first warn her that working is important for her mental health and “remind her that there are still other things that she can do – for example, physical tasks or back-room duties.” This will help her feel more positive according to the department. Then she should be referred to Maximus who will develop a plan with her boss, such as sending her on a course to learn coping techniques, or doing quieter shifts. And of course bosses, being always right and always reasonable, will not abuse this new power to force sick employees into the workplace.
Yet even the most bullying of bosses are to be accommodated according to the DWP. Another case study features someone – a woman again – who complains that a poor relationship with her manager is causing her severe stress. She says the manager has been ‘really horrible’ to her and she feels unable to cope. Rather than raise any concerns about what seems to indicate workplace bullying however, her doctor is instructed to declare she does not have a health problem and she should speak to her human resources department, or union rep. She should not be issued with a Fit Note and her GP should explain that they are “acting with her health interests in mind.” It is better for her health to be bullied and abused in the workplace than be workless, even for a short while, according to the DWP.
The introduction of this guidance makes it clear that the scroungers vs scroungers narrative is now impeding on healthcare even amongst those who are not on benefits. It is not hyperbole to suggest that the credibility of doctors is now at stake. For too long the entire healthcare sector has remained silent whilst scientific evidence is distorted to further the ideology of modern capitalism and increase the power of employers over their staff. Any GP who believes in evidence over rhetoric should tell Iain Duncan Smith to stick these guidelines up his fucking arse. Anything else is a betrayal of the role of doctors as guardians of our health and well being.
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