2015 review of welfare benefits, addictions and treatable conditions

The Independent review into the impact on employment outcomes of drug or alcohol addiction, and obesity was instigated by the British Government in 2015. Professor Dame Carol Black was appointed to lead the review, which is expected to report by the end of 2015.

Terms of reference

Professor Dame Carol Black was asked to undertake an independent review into "how best to support benefit claimants with potentially treatable conditions, such as obesity or addictions to drugs and alcohol, back into work".^[1] A further announcement a few days later described the study once again in terms of "potentially treatable" and "preventable" conditions, such as addictions and "extreme obesity".^[2]

Timetable

A consultation ran from 27 July 2015 to 11 September 2015.^[1]

Background and reaction

In February 2015 the Conservatives announced proposals to look at reducing the benefits for claimants who did not engage with a recommended treatment plan.^[3] It was thought 100,000 people on Employment and Support Allowance (ESA) Initial were affected by obesity or drug and alcohol addictions.^[4] On 27 July 2015 an announcement was made that a review would begin.^[5] A consultation paper launched the same day admitted there were significant ethical concerns around withholding support to people who have these specific conditions.^[6]

Scale of the problem

The number of people on Incapacity Benefit or Employment and Support Allowance with a primary diagnosis of morbid obesity is 1780 - only 0.07% of the total.^[7] People whose primary diagnosis is drug misuse make up less than 1.5% of incapacity benefit claimants, while around 2% have a primary disabling condition of alcohol misuse.^[8]

As Black herself said in the executive summary of her 2008 report: "Many common diseases are directly linked to lifestyle factors, but these are generally not the conditions that keep people out of work. Instead, common mental health problems and musculoskeletal disorders are the major causes of sickness absence and worklessness through ill-health".^[9]

Concerns around consent

Other medical experts have expressed concern about whether it would be lawful for a doctor to treat a patient, by performing gastric surgery perhaps, when the patient faces the threat of a substantial loss of income unless they agree to undergo a potentially harmful treatment with no guarantee of success - one that in other circumstances they would choose to forego. The Conservative MP Sarah Wollaston - the Chair of the parliamentary select committee on health and a doctor herself - described the idea, when it surfaced in February 2015, as "unworkable" and "illegal".^[10]

In response to the July announcement the President of the Royal College of Psychiatrists, Professor Sir Simon Wessely, took the view that: "Threatening to remove benefits if people do not agree to treatment puts doctors (and indeed all medical professionals) in conflict with core principles of the law and medical ethics" and concluded that: "Overall we fully support the goal of getting people with mental health or addiction problems back to work, and we wish Black's review well. But coercing people in this fashion is probably illegal, unethical, impractical and won't save money. As Talleyrand said: It is worse than a crime, it's a blunder."^[11]

References

External links

• call for evidence