Evidence stretching back more than a decade shows how the Department for Work and Pensions (DWP) repeatedly ignored recommendations to improve the safety of its disability benefits assessment system, leading to countless avoidable deaths of disabled claimants.
Other evidence shows how DWP ensured that key evidence linking its actions with those deaths was not considered by independent reviews, and how the department failed to keep track of what actions were taken in response to recommendations made by its own civil servants to improve the system.
But the evidence also demonstrates that the cultural problems within DWP extend far beyond the assessment system, touching all aspects of its dealings with disabled people in the social security system, and how the roots of its toxic culture stretch back at least 30 years.
The evidence, compiled over the last decade by Disability News Service (DNS), and also by other journalists, academics and activists, shows systemic negligence by DWP, a culture of cover-up and denial, and a refusal to accept that the department has a duty of care to those disabled people claiming support through the social security system.
It also shows how DWP continues to pose a serious and continuing risk to the lives of disabled people who pass through the assessment system.
And it demonstrates that the department itself is not fit for purpose and needs to be scrapped and rebuilt.
The evidence has been brought together for the first time in a detailed timeline that stretches back to the early-1990s, as part of the Deaths by Welfare project headed by Dr China Mills and supported by Healing Justice London, which works with marginalised and oppressed communities.
Mills has led the work on the timeline alongside DNS editor John Pring, with key input from disabled activist Rick Burgess, disabled activist and author Ellen Clifford, welfare rights expert and researcher Nick Dilworth, and disabled artist-activist Dolly Sen.
The timeline* shows how the actions of DWP and its private sector contractors, dating back more than a quarter of a century, have contributed to – and in many cases directly caused – countless deaths of disabled claimants of benefits.
Based on this evidence, DNS is calling again for an independent inquiry to investigate DWP’s actions over the last 15 years and for a police inquiry into whether there has been criminal misconduct in public office by senior civil servants and ministers since 2010.
Many of the key failings date back to the early years of the Conservative-Liberal Democrat coalition government in May 2010, but the seeds of a toxic DWP were sown in the early 1990s, several years before the New Labour government of 1997 to 2010.
One of the earliest signs of this new culture was a speech by the Thatcherite social security secretary Peter Lilley to the Conservative party conference in 1992, in which he said that he was “closing down the something for nothing society” and that the Tory government was “not in the business of subsidising scroungers”.
The following year, a draft letter from Lilley to the prime minister, John Major, was accidentally leaked to the Press Association. It revealed proposals to make invalidity benefit taxable and “less generous”, with a new assessment process that would probably “exclude between 10 per cent and 20 per cent” of those who would currently qualify.
Days later, Major told MPs that spending on invalidity benefit had risen from £1.5 billion to £6 billion in 10 years, that “no responsible government could ignore an increase of that order”, and that it “beggars belief that so many more people have suddenly become invalids, especially at a time when the health of the population has improved”.
The following year, in 1994, Lilley hired John LoCascio, a senior executive of US insurance giant Unum, to advise the government on how to reduce the number of claimants of long-term sickness benefits.
Key measures from the Conservative government’s new social security legislation came into force in 1995, replacing invalidity benefit with incapacity benefit (IB), and introducing a new points-based test that marked a significant move towards the kind of assessment system pioneered by the US insurance industry.
Later in 1995, the government approved plans to outsource medical assessments for disability benefits, a move that would eventually have huge ramifications for the safety of the system.
The policy changed little with the election of a New Labour government in 1997.
A social security green paper published the following year spoke of “welfare dependency”, and mirrored Lilley’s message from 1992 that the growing number of claimants of out-of-work disability benefits was due to a system that promoted “fraud and deception, not honesty and hard work”.
The message was clear: many of those on incapacity benefit were cheating the system; they were dishonest, they were scroungers, fakers and frauds. The government would clamp down on them and ensure support was only available to “genuine claimants”.
And it was private sector companies that would be given the task of deciding who was genuine and who was cheating the system.
This task was handed in 2000 to the Anglo-French IT company Sema, which was soon bought out by the French company Schlumberger to form SchlumbergerSema, and which itself was taken over by another French company, Atos Origin, in 2004.
The following year, the Labour government would hand Atos a five-year, £500 million contract to carry out the assessments for the next five years.
Warnings about the new assessment system had emerged as early as 2001. The newly-renamed Department for Work and Pensions (DWP) had published a research report detailing the experiences of claimants being put through the new personal capability assessment, revealing that some claimants found the process “troubling”, particularly those with anxiety or depression.
There were frequent references to the doctors who carried out the assessments on behalf of Sema being cold and hostile. One claimant who was “in a state of serious clinical depression which had left her unable to face the world said she was asked by the PCA doctor whether she had contemplated suicide, and if so how she would carry it out”.
In the same year, the National Audit Office reported “serious problems” with the quality of the assessments carried out by Sema, but it pointed out that this had been “a cause for concern since before outsourcing”.
The following year, 2003, Unum submitted a detailed memo to the House of Commons work and pensions select committee.
In the memo, it called for fundamental reform of the welfare system, while it said the government “must ensure both that work always pays more than benefits, and more importantly that it is clearly seen to do so”.
The memo included proposals with a strong resemblance to reforms that would later be introduced by the Labour government.
By 2005, Unum was bragging that it was driving government policy on incapacity benefit reform.
A document written by Michael O’Donnell, the company’s chief medical officer, who later joined Atos in a similar role, said that Unum had “always been at the leading edge of disability assessment and management”.
He added: “We know that our views and understanding are not yet in the mainstream of doctors’ thinking, but Government Policy is moving in the same direction, to a large extent being driven by our thinking and that of our close associates, both in the UK and overseas.”
Unum later admitted that there had been widespread criticism of its past actions in the US, mainly over its refusal to pay out on large numbers of genuine insurance claims by disabled people.
But it repeatedly denied attempting to influence IB reform, even though, as the largest provider of “income protection insurance” (IPI) in the UK, the introduction of tougher welfare rules were likely to persuade more people to take out IPI, boosting the company’s profits.
Meanwhile, the stench of Peter Lilley’s “something-for-nothing” scrounger rhetoric was still lingering in the DWP corridors, with work and pensions secretaries like Peter Hain repeating the slurs.
In November 2007, Hain said that incapacity benefits had “embedded the sick-note into the British economy” and he vowed to “rip up sick-note Britain”, announcing a new stricter assessment that would find half of those who take it fit for work.
The following April, his successor, James Purnell, told the Liverpool Echo: “People who scrounge from the system take money away from legitimate [IB] claimants. Clearly we want to stop that.”
The rhetoric was aimed at softening up the public for the new assessment system.
DWP’s aim was to reform and cut spending on out-of-work disability benefits through the introduction of a new employment and support allowance (ESA) – which would replace incapacity benefit – and a work capability assessment that would test eligibility for ESA.
The reforms bore a marked similarity to the ideas outlined in the Unum memo, which had suggested retaining a form of benefit for those “genuinely incapable of undertaking any work whatsoever”, as Labour did with what it called the ESA support group.
The Unum memo had also suggested a new benefit for those with “limited capacity to work”, who would be “properly supported in their search for and transition into work”, a suggestion which mirrored the ESA work-related activity group introduced by Labour.
But the experts the Labour government consulted about the new system were not convinced by the proposed new WCA, which would decide which claimants were placed in which ESA group and which of them would be found “fit for work”.
During 2006 and 2007, members of a mental health technical working group warned that the work capability assessment was “deeply flawed” and would damage the health of many of those who were tested.
One of the working group members, Professor Geoff Shepherd, told DNS years later that it was “barn door obvious it was never going to work, and it was always going to be very stressful for people”.
He said that ministers and civil servants were “ruthless” and “reckless” in forcing through their new “fitness for work” test and refusing to abandon it, even after they were told of the harm it was causing.
Another member of the working group, Dr Jed Boardman, told DNS in 2015 that suggestions made by the working group for improvements to the assessment were frequently taken away and scrutinised by DWP’s legal team… and then rejected.
A third member, Sue Godby, who was employed by Unum at the time but had been asked to join the group as an individual because of her mental health expertise and membership of a Royal College of Psychiatrists working group, said: “What we asked for was getting more information than just relying on that one assessment by someone who was probably not a mental health specialist.”
But their concerns were ignored, with tragic consequences.
The Stephen Carré PFD
ESA and the WCA were introduced for new claimants in October 2008.
Purnell announced to MPs on 27 October 2008: “Today is the start of customers’ journey on ESA, which includes a clear framework of rights and responsibilities delivered using an enhanced regime of work-focused interviews, with a firmer conditionality regime.”
An internal review published 12 months later did not suggest that there were serious concerns with the WCA, suggesting that it was “accurately identifying individuals’ capability for work”, but recommending further “refinements”.
DWP’s sense of complacency about the assessment was badly misjudged.
The following spring, in late March 2010, DWP received a report from a coroner.
His report raised serious concerns about the role played by the work capability assessment in the suicide of Stephen Carré, a former software engineer from Bedfordshire.
The prevention of future deaths (PFD) report arrived a week before prime minister Gordon Brown called a general election.
In his report, the coroner, Tom Osborne, said the “trigger” that led to Carré’s decision to take his own life had been “the rejection of his appeal that he was not fit for work”, and added: “I feel the decision not to seek medical advice from the claimant’s own GP or psychiatrist if they are suffering a mental illness should be reviewed.”
This had been one of the key concerns raised by experts on the mental health technical working group – and ignored by DWP – several years earlier.
Despite the coroner’s report, the department failed to make the necessary changes to the work capability assessment.
Responsibility for providing a substantive response to the PFD lay with the new coalition government, its work and pensions secretary Iain Duncan Smith, and its employment minister Chris Grayling.
But the department appears not to have responded to the coroner’s report until its failure to do so was highlighted in the autumn of 2015 by DNS, after which it hurriedly sent Osborne a copy of a response that it claimed it drafted in 2010.
The work capability assessment rollout
Meanwhile, despite the warning in Osborne’s PFD, Chris Grayling decided to push on with the roll-out of the WCA, announcing in June 2010 that his department would start reassessing all those claimants currently receiving the old incapacity benefit from the following spring.
He made this decision despite being told by Professor Malcom Harrington – the independent expert appointed by ministers earlier that month to review the WCA – that the assessment was not yet ready to be rolled out.
Harrington pointed out that the group of claimants who would be reassessed would include tens of thousands of people with significant levels of mental distress who had been far from the workplace for many years.
Despite the coroner’s warning, and the advice of Professor Harrington, ministers publicly attempted to justify their plans through a series of high-profile statements that suggested – sometimes subtly, sometimes not quite so subtly – that many recipients of incapacity benefit were scroungers and shirkers.
Prime minister David Cameron told his party conference in October 2010: “If you really cannot work, we will always look after you. But if you can work, and refuse to work, we will not let you live off the hard work of others.”
The following month, Duncan Smith told The Sun he was “appalled” at how easy it had been in the past for people to claim incapacity benefit and cheat the system.
He suggested that a large proportion of claimants were cheats, and that Sun readers were right to be “upset and angry” when they saw neighbours who did not work, because such “unfairness saps away at our sense of togetherness in society”.
He went on to say that Britain used to be “the workshop of the world” but had now “managed to create a block of people” who “do not add anything to the greatness of this country” and had “become conditioned to be users of services, not providers of money. This is a huge part of the reason we have this massive deficit…”
The following year, after the rollout had begun, Duncan Smith claimed again that incapacity benefit was “too often abused as an excuse for avoiding work”.
And at the following year’s Conservative party conference, in October 2012, chancellor George Osborne delivered a now-notorious set-piece speech, telling party members: “Where is the fairness, we ask, for the shift-worker, leaving home in the dark hours of the early morning, who looks up at the closed blinds of their next door neighbour sleeping off a life on benefits?
“When we say we’re all in this together, we speak for that worker. We speak for all those who want to work hard and get on.”
Osborne made it clear that he and his government were speaking for those able to work and not for those who were unable to “work hard and get on” through no fault of their own.
But while ministers continued to ramp up the rhetoric, which had begun under Peter Lilley and was taken on by the previous Labour government, claimants like Stephen Carré continued to die.
Deaths begin to mount
Although the identities of most of those whose deaths were linked to the austerity reforms of the Conservative-led governments of the 2010s will never be known, some of those deaths did slowly begin to emerge through reports in local and national media, and through social media.
One of the earliest was Karen Sherlock.
She had several long-term health conditions, including diabetes and a heart condition, was about to start dialysis, and was awaiting a kidney transplant, and experienced regular pain, exhaustion, vomiting and incontinence.
In a blog written in April 2012, she described how her ESA had been stopped, and she accused the government of “stripping the most vulnerable of the essential benefits they need”.
Sherlock had been forced out of her NHS job in 2008 because of serious ill-health, and although she was found eligible for the new ESA, she was placed in the work-related activity group, for those expected to take steps to move towards employment.
She was also one of the tens of thousands of disabled people whose contributory form of ESA was stopped from 30 April 2012, because of the one-year time-limit introduced through the coalition’s new Welfare Reform Act 2012.
She only found out days before she died that her latest appeal had successfully placed her in the support group, for those not expected to carry out any work-related activity, and therefore would no longer be affected by the time-limit.
Her death was one of many that would be highlighted by disabled activists and disabled-led grassroots groups such as Disabled People Against Cuts, Black Triangle, the War on Welfare (WOW) campaign, WinVisible, the Mental Health Resistance Network, and the Spartacus Network.
They would all play a significant part in drawing attention to DWP’s role in the deaths.
Spartacus was to produce the first major research report to provide multiple examples of the fatal impact of the WCA later that year, in its People’s Review of the Work Capability Assessment (PDF).
The report detailed a string of cases involving claimants who had taken their own lives or otherwise died after being told they were fit for work, all of them in circumstances in which the WCA appeared to have been a factor in their deaths.
One of the deaths mentioned in the Spartacus report was that of Colin Traynor.
Traynor had died in the same month as Karen Sherlock, less than four months after he had been found fit for work. He had previously claimed incapacity benefit, because of the severity of his epilepsy.
Following the DWP decision to cut his benefits by £70 a week, he experienced stress and anxiety about whether he would lose his home, and if he would be able to pay his bills and afford to eat properly.
He appealed the decision, and following the provision of further medical evidence, he was awarded ESA but placed in the work-related activity group, like Sherlock.
Between December 2011 and April 2012 his health deteriorated, his seizures increased due to the stress, and he lost weight. On 3 April 2012, the stress and anxiety led to a massive seizure. He died at home at the age of 29.
Another death followed in September.
Edward Jacques, from Sneinton, Nottingham, had been found fit for work after a WCA lasting just 23 minutes. His ESA was stopped on 18 September, and he took his own life a week later.
The coroner at his inquest concluded that the assessment process “did not fully or properly reflect Edward’s physical and mental health at that time”, and she added: “It is conceded by those involved in the [assessment] process that if the information as to Edward’s physical and mental health as shared by his GP had been known at the time of the assessment, the outcome would have been very different.
“It is desperately sad that such evidence was not available either to the nurse or to the decision maker.” She branded the WCA a “crude assessment”.
Jacques’ brother and sister said in a statement after the inquest: “We have no doubt that the decision to stop his allowance was a major trigger which led him on to a severe depression and desperate action. We do not believe that Edward is an isolated case and we think thousands of assessments have been made like this across the country.”
They were right.
The independent reviews
Meanwhile, Professional Harrington had been carrying out independent reviews of the work capability assessment, after being commissioned by Grayling and Duncan Smith.
His reviews made multiple recommendations for improvements over three years, many of which were accepted and implemented by ministers.
But he was never shown key evidence that linked the WCA with the deaths of claimants, and therefore never made the kind of sweeping recommendations that would have demanded urgent action on safety.
Harrington was never shown the Stephen Carré PFD report, which called for urgent changes to the WCA, and he was also not shown secret reports that DWP had been conducting into deaths linked to the social security system.
The existence of these peer reviews only became widely known in the autumn of 2014, when DWP finally admitted to DNS that it did investigate a small number of deaths of claimants.
Some of these reviews mentioned the work capability assessment.
DWP would later admit that there were seven peer reviews that had mentioned the WCA during the period from February 2012 until Professor Harrington submitted his final review of the WCA later that year. He later told DNS that he believed none of those reviews was passed to his team.
DWP’s silence on the peer reviews and the Stephen Carré report continued through the two WCA reviews carried out by Harrington’s successor, Dr Paul Litchfield, at the time BT’s chief medical officer.
There is no mention in Litchfield’s first report of peer reviews, or of the Stephen Carré PFD report. In fact, the words “death” or “suicide” do not appear in his report at all. It was later confirmed through a DNS freedom of information request that none of these documents were passed to his team by DWP.
The department’s explanation was that Litchfield had not requested them, but it has never been able to explain how he could have requested them if he was not aware of their existence.
Ministers knew these documents would have linked their fitness for work test with the deaths of disabled benefit claimants, but they ensured that this vital evidence was kept hidden from Litchfield, their own independent reviewer.
A second PFD report
DWP’s failure to act and to share serious concerns about the safety of the WCA continued through 2014, despite another coroner reaching similar conclusions to those reached by Tom Osborne, this time following the suicide of a London man, Michael O’Sullivan.
The coroner sent a PFD report to DWP in January 2014. Again, the department refused to act.
The coroner had concluded that the doctor (employed by the DWP contractor Atos) who assessed O’Sullivan “did not take into account the views of any of Mr O’Sullivan’s treating doctors, saying that the ultimate [DWP] decision maker would do that”.
The coroner, Mary Hassell, added: “However, the ultimate decision maker… did not request and so did not see any reports or letters from Mr O’Sullivan’s general practitioner (who had assessed him as being unfit for work), his psychiatrist or his clinical psychologist.”
But this report, again, was not shared with Litchfield’s team.
In its response to the Michael O’Sullivan PFD, DWP admitted that it had been “routinely” suggested that it should “obtain medical reports for individuals with a mental illness, learning disability or related condition who are beginning the WCA process”.
This was the suggestion that had now been made by two coroners following the suicides of claimants connected with the WCA process. But DWP continued to reject the advice, and it failed to share these reports with the experts it had commissioned to review the assessment process.
Peer reviews finally published
Two years later, following a protracted freedom of information battle with DNS, DWP was forced to release redacted versions of the peer reviews that were carried out between 2012 and 2014.
Most of what was left unredacted related to the recommendations made in the reviews, but they still revealed that civil servants had repeatedly warned that policies to assess people for out-of-work disability benefits were putting the lives of “vulnerable” claimants at risk.
On at least four occasions, a civil servant had called for DWP to review the way vulnerability was dealt with by the department. All of these reviews had followed the death of a benefit claimant.
In one of these reports, the author concluded that the incapacity benefit reassessment process was too far along for the government to review its “ongoing responsibility” to identify and support those claimants who were being reassessed and who “may be vulnerable”.
In another, the author said: “The risk associated with disregarding the possibility that some of these claimants need more support or a different form of engagement is that we fail to recognise more cases like [REDACTED], with consequent potential impact on the claimant.”
It continued: “There is clearly a resource implication in treating more claimants with [REDACTED] as potentially vulnerable. However, that should be balanced against the resource implications of repeated appeals.”
It was further stark evidence that DWP knew about the risks and concerns associated with the WCA and its fatal impact on those in vulnerable situations.
Ms DE and the Mental Welfare Commission for Scotland
Only two months after the Michael O’Sullivan inquest and PFD, the Mental Welfare Commission for Scotland published its report (PDF) on the suicide of a woman still today known only as Ms DE, who had been found dead at her home in December 2011 after taking her own life.
Three weeks earlier, DWP had sent her a letter telling her that she had been found ineligible for ESA and therefore fit for work, following a WCA.
She had previously been receiving incapacity benefit, and was one of those subjected to the WCA process as a result of the decision by Chris Grayling and Iain Duncan Smith to push ahead with the rollout, despite Professor Harrington’s warning.
The commission’s report found that the decision to strip her of her benefits had been based on an assessment that contained “insufficient information about her mental health”.
The assessor, a doctor employed by the DWP contractor Atos, had decided that Ms DE had showed “no evidence of significant disability of mental health function”.
But neither her GP nor her psychiatrist, who had both been treating her for 20 years, was asked by Atos or DWP to comment on her mental health, even though both health professionals were convinced that she was not fit for work.
The commission’s report concluded: “We heard that psychiatrists and GPs are not routinely asked to provide medical reports for patients with a mental illness.
“This is despite the fact that it may be more difficult for some individuals to put in place the necessary arrangements to provide medical evidence supporting their claim… We think that medical reports should be routinely obtained for individuals with a mental illness, learning disability or related condition entering the assessment process.”
The conclusions were strikingly similar to those reached in the PFD reports that had followed the deaths of Stephen Carré and Michael O’Sullivan.
Yet again, DWP failed to act on the recommendation.
Government-funded research links DWP’s actions to hundreds of suicides
In November 2015 came perhaps the most significant piece of research to analyse the impact of DWP’s programme of cuts and reforms on disabled people.
A study funded by the National Institute for Health Research – which itself was funded by the Department of Health – concluded that the programme to reassess people on incapacity benefit using the work capability assessment was linked to nearly 600 suicides in just three years.
Public health experts from Liverpool and Oxford Universities showed in the study that across England as a whole, the reassessment process from 2010 to 2013 was “associated with” an extra 590 suicides, 279,000 additional cases of self-reported mental health problems, and the prescribing of a further 725,000 anti-depressants.
The researchers warned health professionals that their involvement in the WCA process as assessors employed by the US outsourcing giant Maximus – which had now taken over the WCA contract from Atos – “raises major ethical issues”.
The idea for the research had come originally from disabled activist Rick Burgess, who wanted “recognised and respected epidemiologists” to carry out “an academically-rigorous study” into the number of deaths caused by the WCA.
Together with three other campaigners – artist-activist Liz Crow, campaigner Jane Bence and welfare rights expert Nick Dilworth – Burgess began discussing the idea in 2014 with David Stuckler, professor of political economy and sociology at Oxford. (Both Burgess and Dilworth have been involved in the Deaths by Welfare project.)
The following year, Stuckler and his colleagues were able to show in the study that, for every 10,000 IB claimants in England who were reassessed for ESA between 2010 and 2013, there were an additional six suicides, 2,700 cases of self-reported mental health problems, and an increase of more than 7,000 anti-depressant prescriptions.
Both Ms DE and Michael O’Sullivan had been victims of this reassessment process.
Forgotten peer reviews
Throughout these years of cover-up and denial, DWP was also guilty of repeated and serious institutional neglect.
In February 2017, it emerged that the department had been failing to keep track of the implementation of recommendations made by the peer reviews between 2012 and 2014.
DNS had asked DWP through a freedom of information request whether it had implemented 10 key recommendations for national improvements that related to “vulnerable” benefit claimants and had been included in the 49 redacted peer reviews that had finally been released in 2016.
One recommendation was for DWP to review the ESA process to help identify vulnerable customers; another called for “a re-launch to staff of the importance of identifying vulnerable claimants and taking their needs into account throughout the whole process”; another was for DWP to consider if claimants with mental health conditions should be considered for a safeguarding visit if they were thought to be at risk, were about to have their benefits removed, and the DWP “decision-maker” had been unable to contact them via telephone.
But DWP told DNS in 2016 that it was “not possible” to say if it had implemented the 10 recommendations.
After a complaint to the Information Commissioner’s Office (ICO), DWP eventually admitted that it had destroyed records relating to how these recommendations were passed to and from the relevant national “customer journey teams”.
It also told ICO that there was “no requirement” for it to keep track of what action was taken after these recommendations were passed on, and that because the peer reviews were a “voluntary internal process”, it had no legal duty to keep this information.
In a letter to DNS, the ICO said: “DWP has explained that records concerning these communications were not retained and no requirement was in place to track subsequent actions taken… Whilst she does find the lack of requirement for confirmation of action highly unusual following a peer review of such sensitive cases, [the information commissioner] is not in a position to issue a decision that DWP should have required feedback in these cases.”
DWP admitted that the review process had lacked “robust governance” during this period but claimed that it had “identified changes to improve accountability and responsibility and ensure that recommendations were identified, logged centrally and followed up so that outcomes were tracked, audited and understood”.
DWP, it seemed, had been shamed into acting. It had agreed to implement new procedures to ensure that it kept track of recommendations made through its peer reviews (by now renamed internal process reviews).
But it did not keep that promise.
Three years later, a report by the National Audit Office revealed that DWP had admitted that recommendations made in its internal process reviews were “the main mechanism through which the Department would share any lessons from individual cases and seek to make improvement”.
But, despite the pledge made to the ICO three years earlier, it admitted that there was “no tracking or monitoring of the status of these recommendations” and so it “does not know whether the suggested improvements are implemented”.
A culture of negligence and neglect – and even lying to regulators – had apparently become ingrained in the department.
More reviews, the same failures
This culture of negligence and neglect was highlighted when a new batch of internal process reviews was released in November 2020.
They showed that DWP staff had to be repeatedly reminded what to do when claimants disclosed that they might take their own lives.
The reviews suggested that a series of suicides between 2014 and 2019 were linked to the failure of DWP staff to follow basic rules that were introduced in 2009.
The redacted documents showed that as many as six reviews had recommended that staff should be reminded of the department’s long-standing “six-point plan”.
The six-point plan instructed staff how to deal with statements by customers that they intended to self-harm or take their own lives, and, according to DWP, “offers a clear process outlining what staff should do in these circumstances”.
But the documents showed that DWP staff repeatedly ignored the six-point plan, although they were so heavily redacted that it was not clear how significant a role this had played in the deaths of individual claimants.
Much of the evidence came from reviews newly-released by DWP under the Freedom of Information Act, which contained recommendations made between January 2016 and March 2019.
The new batch of reviews also revealed concerns about deaths or serious incidents linked to personal independence payment (PIP) – the extra costs disability benefit introduced as a replacement for disability living allowance for working-age claimants in 2013 – as well as continuing concerns about the work capability assessment, and the new universal credit.
A key recurring theme with PIP was the failure of DWP decision-makers “to take all evidence into account” when deciding a claim, a problem that was mentioned four times over the three years.
A toxic culture
If there had been any doubts about the toxic culture that had been allowed to saturate the Department for Work and Pensions during the years of austerity, they were blown away in April 2021, when new research by academics at Sheffield Hallam University was published.
Their research showed how DWP staff and managers deliberately inflicted psychological harm on benefit claimants, engaged in unofficial sanctioning targets, and pushed disabled people into work despite the risk to their health.
They had carried out interviews with 10 civil servants who worked for DWP and its contractors under the coalition government between 2010 and 2015.
Their research showed how the introduction of a more punitive social security system, with harsher benefit sanctions and conditionality, inflicted years of “institutional violence” on claimants between 2010 and 2015.
The authors, Dr Jamie Redman and Professor Del Roy Fletcher, said they believed it was the first time that research had explained how DWP workers had been able to commit such harmful acts on benefit claimants in vulnerable and precarious situations.
They built on the work of the Polish sociologist Zygmunt Bauman, who described how modern bureaucracies can produce psycho-social factors that enable ordinary people to carry out harmful practices.
They described how a change in DWP policy through the coalition government elected in May 2010 pressured DWP staff to refer more claimants to have their benefits sanctioned.
The policy changes also saw the performance of jobcentre staff measured by “off-benefit flows”, the number of claimants who stopped receiving an out-of-work benefit, even if they had not secured a job.
This helped lead to a huge increase in sanctioning rates between 2010 and 2013 – reaching more than one million sanctions in 2013 and rising about 345 per cent above their 2001-08 average level.
For their research, Redman and Fletcher interviewed a JobcentrePlus (JCP) manager; three JCP front-line staff members; one Work Programme front-line worker who had previously worked for JCP [the Work Programme was the coalition’s “payment-for-results welfare-to-work programme” that launched in June 2011]; one DWP decision-maker; and four Work Programme front-line staff.
They were told how “top-down” pressure on staff – through sanctioning tables and off-flow targets that were “legitimised” by the government – acted as a “moral anaesthetic” which “made invisible the needs and interests” of the claimants they were sanctioning.
This allowed workers to view their caseloads with what Bauman called “ethical indifference”.
One JCP worker described how staff would often treat claimants with “disrespect” and use psychological harm as a technique to reduce the number of people claiming benefits, “pushing them until they either just cleared off because they couldn’t take the pressure or they got sanctioned”.
An executive officer in another JobcentrePlus office also said that some staff tried to antagonise claimants in the hope that they would drop their claims.
While DWP denied at the time that there were any sanctioning targets, the former DWP staff interviewed for the research said there was increasing expectation “from above” to hand out sanctions, which led to the formation of “local target regimes”.
One JCP executive officer said staff would come into the canteen and say: “Well I’ve got my [sanctions] target for the week.”
Another worker described how non-English-speaking claimants would be persuaded to sign “claimant commitments” that meant they had to provide evidence of their work search activities in English.
When they were unable to provide this evidence, because their English was not strong enough, they were sanctioned.
One manager tried to persuade staff to sanction more claimants by telling them: “It’s your money! It’s your taxes that they’re living off! You know, you should be sanctioning them!”
One of those interviewed said that this kind of “stigmatising” language became increasingly common in formal meetings.
But these tactics were not restricted to jobcentres.
Those who worked for outsourced Work Programme providers, which were under financial pressure to find job “outcomes” for claimants, described how managers pressured them to “push” disabled people into work.
One former Work Programme adviser told the research team: “[I had] a lovely guy who I really felt for who had mental health issues and the day after I had to reluctantly mandate him to something – he attempted suicide.
“I also had another lady who we pushed into work and it made her that ill she had a fit in her new job and was admitted to hospital.”
Another Work Programme adviser said that some colleagues seemed to thrive on their ability to inflict harm and “enjoyed the stick”.
In their paper, Violent Bureaucracy, published in Critical Social Policy, Redman and Fletcher described how the government and media had created and promoted a “hostile” environment for claimants, with the help of the frequent use of “scrounger rhetoric” designed to blame claimants for austerity.
This laid the groundwork for the introduction of a more punitive welfare-to-work system, with harsher sanctions and conditionality, and allowed the institutional violence of the DWP regime to thrive.
Their research, they wrote, “seeks to explain how ordinary people carrying out their daily duties in employment service offices were able to implement cruel and inhumane social security reforms”.
Scratching the surface of DWP’s failures
In December 2020, analysis by DNS showed that the internal process review system was only scratching the surface of the lessons that DWP needed to learn.
The analysis showed that, in more than five years, DWP had carried out secret reviews into 69 suicides of benefit claimants. And yet analysis of Office for National Statistics and DWP figures suggested there could have been as many as 750 suicides of working-age benefit claimants in 2018 alone, and possibly even more.
DWP’s own guidance says it should carry out an internal process review every time it hears of a suicide of a benefit claimant, even if there are no allegations that its actions contributed to the death.
Not every one of these suicides would have been linked to DWP’s actions or failures, but many of them would. By failing to carry out reviews into these deaths, DWP was again demonstrating the ingrained neglect that had blighted the department.
The duty of care
Throughout the years of violence, cover-up and neglect, DWP has continued to insist that it has no duty of care to those claiming benefits.
It argues that keeping benefit claimants safe is not its legal responsibility.
Work and pensions secretary Therese Coffey, in post since September 2019, has repeatedly told MPs that her department does not have a legal duty to “safeguard” its claimants, and that such tasks are instead the responsibility of local agencies such as social services departments and doctors’ surgeries.
DWP has continued to deny that it has such a duty of care, even when confronted with one of its own secret reviews – believed to have been written in 2014 or 2015 following the death of an incapacity benefit claimant – which recommended that the department should carry out a review of its “ongoing Duty of Care”.
When DNS asked about this review through a freedom of information request, DWP stated that the recommendation “was not progressed as the Department does not have a legal safeguarding duty to review”.
DNS was then passed a second document, this time obtained by Leigh Day, solicitors for the family of Errol Graham, who starved to death in 2018, months after DWP cut off his ESA when he failed to attend a work capability assessment.
This second document is a copy of pre-2016 internal guidance for DWP staff, written to assist them in dealing with claimants who need support in using its services.
The guidance states: “Where the claimant has a known background of mental illness there are minimum requirements that Jobcentre Plus should be adopting to ensure that we are not found to be neglectful in our duty of care towards these claimants.”
In addition to these two DWP internal documents, both dating from before 2016, Paul Litchfield made it clear to MPs last December that he believed the department had a duty of care to claimants.
He told the Commons work and pensions committee: “Yes, of course there is a duty of care in any process of this sort to treat people fairly, appropriately and empathetically.”
Coffey and her department continue to insist that there is no legal duty of care and that one did not exist at the time the documents were written.
They appear to be replying on the absence of an explicit reference to DWP having such a duty of care in legislation.
In February last year, Coffey told the committee: “We don’t have a statutory duty specifically relating to safeguarding.”
Her department has also made the same claim in a freedom of information response, claiming that the “legal position is that there is no legal duty of care on the Secretary of State or her officials in the execution of their statutory duties”.
Deaths by welfare
The Deaths by Welfare timeline details many of the tragic deaths that have led to DWP being repeatedly publicly disgraced over the last decade, including those of Sophie/Faiza Ahmed, David Barr, Paul Donnachie, Roy Curtis, Mark Wood, Susan Roberts, David Clapson, Diane Hullah, Philip Pakree, Ker Featherstone and James Oliver, to name just a few.
This article has discussed only a small number of individual deaths, not because others were not important, but because its focus has been on the documentary evidence of DWP neglect, negligence, denial and cover-up.
But it is crucial to note the human impact of DWP’s failings and its toxic culture. Every one of the deaths caused by its actions has been a tragedy, and we will never know how many lives – certainly hundreds, and likely thousands – could have been saved if that culture had been addressed.
The death of Philippa Day demonstrated the toxic culture, both within DWP and its private sector contractors, that has been allowed to fester and pollute their interactions with claimants.
In January last year, a coroner concluded that flaws in the PIP system were “the predominant factor and the only acute factor” that led to Philippa Day taking her own life.
Gordon Clow, assistant coroner for Nottingham and Nottinghamshire, highlighted 28 separate “problems” with the administration of the PIP system that helped cause the young mother’s death.
It took more than two hours for him to read out his conclusions and findings, after a nine-day inquest that uncovered multiple failings by both DWP and its contractor Capita in the 11 months that led up to Philippa’s death in October 2019.
Clow ended by telling DWP and Capita that he had decided to issue them with prevention of future deaths reports, which would force them to consider how to make changes to the PIP system to prevent further deaths of claimants.
Philippa’s sister, Imogen, had promised her sister that she would fight for justice on her behalf if she died because of her PIP claim. Part of the fight, she said, would be to change DWP’s “culture of disbelieving claimants and the lack of empathy”, which was “a huge problem”.
Philippa (known to her family as Pip) had told her sister before she died that she knew the assessment system was going to kill her.
“We had multiple conversations prior to her death,” Imogen had said in November 2020. “Pip felt that she was dehumanised, that her disabilities were ignored. She felt that they were pressuring her to kill herself, she felt that she didn’t matter because she was disabled.”
Imogen told a parliamentary meeting earlier this month that applying for benefits “should not be a risk to a disabled person, and yet it is”, and that DWP continued to “refuse to acknowledge that there are significant systemic issues preventing disabled people from accessing a safety net that they are entitled to”.
“Ensuring that the benefits system is cost-effective should not come at the cost of human lives,” she said. “We cannot allow more to lose their lives or mental resilience to failures in the benefits system.”
Joy Dove has been fighting since 2017 for justice for her daughter, Jodey Whiting, who took her own life in February of that year after her ESA was wrongly stopped for missing a work capability assessment.
She had been a long-time claimant of incapacity benefit, and then ESA, and DWP and its assessors had previously noted the severity of her mental distress, and the risk that would be posed if she was found fit for work.
They were also aware of her long history of suicidal ideation.
At the time of the assessment, she was unable to leave her house because she had pneumonia, had been in hospital, and had found out that she had a cyst on her brain.
The Independent Case Examiner eventually concluded that DWP had failed five times to follow its own safeguarding rules in the weeks leading up to Jodey’s suicide.
Dove continues to seek a second inquest into her daughter’s death, because she believes that the first inquest in May 2017 – which lasted just 37 minutes – was not a “thorough investigation” into the role played by DWP.
“I believe my Jodey would still be here today if it had not been for the way she was treated by the DWP,” she said in 2020. “It was heartless and cruel and a breach of their own rules to treat Jodey in the way they did.
“They put her through torture.”
Another family still fighting for justice are the relatives of Errol Graham. He starved to death after his ESA was wrongly removed for missing a WCA. He had missed the assessment and failed to respond when DWP tried to contact him by phone and in person, while he had cut off all ties with his family, who had no idea that his benefits had been removed.
DWP went ahead and stopped his ESA without trying to contact his family or public bodies, even though he had been receiving incapacity benefit, and then ESA, for many years because of enduring mental distress.
His body was discovered on 20 June 2018 when bailiffs arrived at his Nottingham council flat to evict him for non-payment of rent. When his body was found, he weighed just four-and-a-half stone, there was no food in his flat and no credit on his gas or electricity meters, while an unsent letter to DWP was found which pleaded: “Please judge me fairly.”
Accountability and the weight of evidence
The weight of evidence collected by Disability News Service over the last decade, combined with the wider evidence base compiled by the Deaths by Welfare project, suggests the need for an independent inquiry and a police investigation into misconduct in public office by the senior civil servants and politicians responsible for deaths linked to DWP.
Hundreds of disabled people – probably thousands – have died avoidable deaths.
But the failings were not restricted to the flaws in the work capability assessment process.
Instead, the failings were widespread, and they were baked into the culture of the Department for Work and Pensions.
It adds up to systemic negligence within DWP, and the conclusion that the department is not fit for purpose.
The roots appear to be in the early 1990s, when Peter Lilley began to attack claimants of sickness benefits and sought advice from the US insurance industry, followed by the decision to outsource medical assessments, a policy that continued under the New Labour government that came to power in 1997.
The dehumanising rhetoric was taken on by Labour ministers, as plans were made for their new employment and support allowance and work capability assessment. Early warnings about its safety were ignored.
DWP and its ministers continued to ignore such warnings as they intensified under the new coalition from 2010, and successive Conservative-led governments over the last decade.
Post-2010, there were warnings from DWP’s own advisers and independent reviewers, from coroners, from the disabled people’s movement, from MPs, from researchers, and from DWP’s own secret reviews.
The department failed to keep track of the recommendations made by those reviews, and misled the information commissioner about the steps taken to put that right. It failed to investigate hundreds of suicides of benefit claimants, and it dismissed any calls to accept that it had a duty of care to those who relied on the social security safety net.
Probably the most obvious evidence of systemic neglect, negligence and recklessness relates to the department’s continuing refusal to listen to the experts who had said – repeatedly – that the way the WCA system collected evidence about claimants’ medical conditions was not fit for purpose and needed to be changed.
Coroner Tom Osborne was one of the first to call on DWP to make this change, after the inquest into the death of Stephen Carré in 2010. He told DWP: “I feel the decision by the Department not to seek medical advice from the Claimant’s own GP or psychiatrist if they are suffering a mental illness should be reviewed.”
Professor Malcolm Harrington made a similar – and even more wide-ranging – call in his final review of the WCA in 2012.
DWP decision-makers, he said, “should actively consider the need to seek further documentary evidence in every claimant’s case. The final decision must be justified where this is not sought.
“Given the unique circumstances of their condition, particular care should be taken when the claimant has a mental, intellectual or cognitive condition as these individuals may lack insight into the effects of their condition on their day-to-day functioning.”
He added: “It cannot be over emphasised how important it is to collect further documentary evidence early in the WCA process.”
His advice was ignored.
The coroner who heard the inquest into the death of Michael O’Sullivan repeated the concerns made by Tom Osborne, telling DWP in her PFD report: “The DWP assessing doctor (who saw Mr O’Sullivan for a 90 minute consultation) did not take into account the views of any of Mr O’Sullivan’s treating doctors, saying that the ultimate decision maker would do that. However, the ultimate decision maker (who is not, I understand, medically qualified) did not request and so did not see any reports or letters from Mr O’Sullivan’s general practitioner (who had assessed him as being unfit for work), his psychiatrist or his clinical psychologist.”
The Mental Welfare Commission for Scotland raised strikingly similar concerns, recommending that DWP “routinely obtain medical reports for individuals with a mental illness, learning disability or related condition who are entering the assessment process”.
The coroner who heard the inquest into the death of Edward Jacques had made the same point. “It is conceded by those involved in the [assessment] process that if the information as to Edward’s physical and mental health as shared by his GP had been known at the time of the assessment, the outcome would have been very different,” she said.
DWP’s own experts on its mental health technical working group had warned of this flaw in the WCA system in 2006 and 2007, before the assessment had been launched.
Their advice, too, had been ignored.
On 10 March, DNS contacted DWP’s press office with a draft version of this article, requesting a response and giving the department an opportunity to point out any errors or claims that it wished to dispute.
It responded 12 days later, saying only: “Thank you for giving the DWP an opportunity to respond to your investigation. However, on this occasion we won’t be adding any further comment.”
Despite its silence, there are no doubts that the toxic, aggressive, dehumanising culture within the department continues.
Ask David Scott.
DNS obtained a recording Scott secretly made of an appointment with his jobcentre work coach on 28 September last year.
During his conversation with the work coach, Scott, who is autistic, explained that the past treatment he had received from DWP had left him suicidal. Despite initial disagreements, the conversation appeared to be approaching a successful conclusion as the work coach agreed that he would not need to carry out any work-related commitments, other than taking steps to prepare for the start of a PhD in neuroscience the following April.
But when he thanked her for her help, she told him: “So I am here to support you whether you like it or you don’t, right?”
Scott replied that this would be his first experience of such support from DWP.
But the work coach said: “I’m not here to stick pins in your eyes, unless you want me to. And it will be a Biro, not pins, all right?”
Scott, who also has long-term health conditions, appeared to laugh nervously, but he did not otherwise respond to her comments. The work coach then added: “I taught autistic children for a long time, so yeah, it will be a sharp poke.”
Earlier this month, a work coach contacted DNS to pass on her concerns about the way DWP was treating benefit claimants with significant mental distress.
She said that that she and her colleagues were being “bullied and harassed” into forcing such claimants into attending work-related meetings.
Many of them had been waiting months for a WCA and would eventually be found not fit for work and placed in universal credit’s limited capability for work-related activity (LCWRA) group (the near equivalent of the ESA support group).
But until that happened, and despite significant mental distress, they were still being forced to make weekly trips to the jobcentre, purely so that work coaches could meet their targets for face-to-face appointments.
The work coach said that DWP managers were telling work coaches that they should not have any “white spaces” in their diaries, and so should tell claimants waiting for their WCA to come into the jobcentre even if they knew they would eventually be placed in the LCWRA group.
The work coach told DNS she was aware of the many deaths of disabled claimants that have been linked to DWP’s actions over the last decade, including many who have taken their own lives.
She said she was now “very concerned” that DWP’s new, even stricter, approach “might lead to more people taking their own lives”.
If this is not convincing enough evidence, there is another PFD report, this one written by Sonia Hayes, assistant coroner for Mid Kent and Medway, following the death of 58-year-old Terence Talbot.
Talbot, who was also being detained under the Mental Health Act, was being treated at Maidstone Hospital for drug hypersensitivity syndrome (also known as DRESS syndrome), because of a rare reaction to medication that had been prescribed for his mental distress.
The severe allergic reaction had left him “very vulnerable to infection” and at risk of death, but he was told by DWP contractor Serco to leave the hospital and attend Maidstone jobcentre to confirm his identity as part of a new claim he had made for universal credit.
Talbot had made an online application for universal credit on 24 January 2020, with the help of a nurse, and told DWP he had been in hospital for more than six weeks, that he was receiving moisturising treatment to his whole body four times a day due to DRESS, and that he had bipolar.
He was instructed to phone a helpline, run by Serco, so he could book a face-to-face appointment in the local jobcentre to verify his identity, and the Serco adviser told him to attend the appointment four days later, on 28 January.
Following that visit to the jobcentre, which he attended in a wheelchair, a note was added to Talbot’s file to show that his next appointment should be by telephone. The next day, on 29 January, a nurse told DWP of the hospital’s “concerns surrounding his mental health and ability to participate in appointments”.
Talbot died in Maidstone Hospital, two months later, on 9 April, from multi-organ failure caused by the lung conditions pneumonia and empyema, which themselves were caused by DRESS.
Following the inquest last year, Hayes wrote a prevention of future deaths report to work and pensions secretary Therese Coffey to warn her that – although the inquest had not found that the actions of Serco or DWP had caused or contributed to Talbot’s death – other claimants could die if she did not make urgent changes to how DWP deals with such cases.
In its response, DWP said it had no plans to make any changes to its policies or practices in response to the concerns she had raised. The department had not been aware of the “severity of Mr Talbot’s illness” at the time of his application and had not “held any evidence” to suggest that he had been sectioned under the Mental Health Act, it said.
DWP’s response to this latest PFD report echoed its responses to many such deaths over the last decade. They have been characterised by a chilling refusal to express remorse, to accept that its systems are not working well, and to admit that it must improve.
Alison Burton said last year that she wanted the chance to give evidence about her father-in-law Errol Graham to the Commons work and pensions committee, and for that to happen in front of work and pensions secretary Therese Coffey and the minister for disabled people.
She wanted families to be able to confront Coffey “face to face” and “put that pain across to her”.
She said: “When she’s confronted with the families that she’s sat there and let suffer then it will be harder to ignore. They need to see the damage that it has caused.
“They need to feel how we feel, because they are almost emotionless, they are detached, and they need to attach themselves, because they need to understand the severity of this for these families.
“And until they start to understand that, they will never get it right.”
*The timeline will be published later this year