In yet another demonstration of government departments concerning intervention in healthcare provision, a recent report released by Z2K highlights a new practice by the Department of Work and Pensions (DWP) that could have real impact on health equity. The report identifies that the DWP has been trying to restrict people’s access to Employment Support Allowance (ESA) by influencing the decisions of GPs. It reveals that when a person is found ‘fit to work’ following a capability assessment, the DWP sends a letter to their GP instructing them to no longer provide a ‘fit note’ – the documentation GPs provide to show someone not able to work as a result of their health condition.
Barriers to health equity and justice
In the same way that data sharing between the Home Office and NHS England creates barriers to healthcare through immigration enforcement, this practice threatens to undermine the trust patients have in healthcare workers and puts the patient at greater risk of health and financial hardship. It sits alongside other Hostile Environment policies and is a clear continuation of the shifting priority in Government policy away from providing vital services and towards public services that police people first and provide support second.
Why are Fit Notes so important?
When a person applies for ESA they undergo a capability for work assessment, a process that is notorious for inappropriately finding people fit to work. More than half of these decisions are subsequently overturned at appeal, however people are often left in limbo for months without knowing when they will get the social security they are entitled to. Claimants are supposed to receive an ‘ESA pending’ payment to stop them becoming destitute whilst waiting for their appeal, however to receive this they must be able to present regular fit notes from their GP showing that their GP does not think they are fit to work. What Z2K revealed is that the DWP appears to be deliberately undermining this process by sending letters to GPs following the initial capability for work assessment and instructing them to stop providing fit notes. These letters give no information about the appeals process or the role the fit note has in supporting the claimant to claim the ESA pending payment. You can read a full version of the letter here.
This misleading communication from the DWP not only threatens people’s health and financial security, but also seeks to undermine GP’s role in assessing people’s health. Today Z2K launch their #ScrapTheLetters campaign calling on the DWP to stop sending these letters and to give people the social security they are entitled to – you can sign the petition here.
Tip of the Iceberg
It seems the DWP are determined to use the NHS to deny people access to social security. Last month The Independent revealed that the DWP have been working on an information sharing system that will allow them access to people’s GP records for capability for work assessments. It is a scheme that alarmingly resembles the arrangement the Home Office had with NHS Digital which was widely criticised and eventually scrapped. The DWPs new plans have already been denounced by the Royal College of GPs as a threat to patient confidentiality and present a huge risk that people will be deterred from seeking the care they need.
What Happens Next?
These new approaches by the DWP signal a worrying shift in the way access to vital public services is managed. The NHS is a service that we all need, that we rely on for support in our most vulnerable times and as a space of safety. By misleading GPs and exploiting patient data to deny social security the DWP threatens to undermine the foundation of trust that the NHS is built on. As healthcare workers and health professionals we can’t let the NHS be misused in this way, whether through the expansion of ID checks and charges for patient care, the inappropriate sharing of patient data, or the undermining of clinical decisions by the DWP.
If you’re keen to work on these issues then get in touch – we’d love to support our members to take more action on access to healthcare, especially around charging migrants for care and inappropriate action by the DWP. Get in contact with James at JamesSkinner@medact.org.
- Supporting migrants to healthcare access during this crisis - March 20, 2020
- Patients Not Passports – challenging healthcare charging in the NHS - April 9, 2019
- DWP not Fit for Practice - March 19, 2019