9th May 2024

Dear Steve Ford

Re: Call for a public response from the Royal College of Occupational Therapist’s CEO regarding the Government’s harms to disabled people and people with long term health conditions

I am an occupational therapist suffering with Long Covid, a disabled person in receipt of benefits with a professional background focused on the Department for Work and Pensions’ (DWP) policy, practice, and research for the last 17 years. I am writing this open letter to you to call upon the Royal College of Occupational Therapists (RCOT) to take a public stand and urgently call out the harms that our government are causing disabled people and people with long term health conditions.

A public response from the RCOT is imperative given occupational therapists play an instrumental role in supporting disabled people and those with long term conditions to engage in meaningful occupations in all aspects of their daily lives which may include paid work.

Of key concern is the minimisation of peoples’ ill health which has been particularly targeted towards people who are in receipt of benefits who experience mental illness. For example, see letter by Dr Jay Watts clinical psychologist (1)

I am not alone in my thinking on these matters, for example see Disability Rights UK March 2024: “on 18 March 2024, the UK Government provided their oral defence to the United Nations Committee for the Rights of Disabled People (UNCRDP), regarding the UK’s “grave and systemic” violations of the UNCRDP”. “Rapporteurs described current UK policy and practice as “a pervasive framework and rhetoric that devalues Disabled people’s lives” which “tells Disabled people that they’re undeserving citizens” and “makes [Disabled] people feel like criminals” – particularly those who are trying to access the social security system”. Disability Rights UK March 2024 (2)

There are many matters to raise with you that are of significant concern, but I urge you to review and call out the harmful misinformation by our Tory government (and Labour) regarding Personal Independence Payment (PIP). For example, Mel Stride wrongly reported to the BBC in April 2024 (3) that:

“What we know with PIP is that it’s a very blunt benefit, so you get a fixed amount of money per month, irrespective in many ways of your condition – in some cases that may be a condition that needs something like a grab rail to get into the bath and various other appliances of that kind – which are relatively inexpensive, you might even be able to get them from your local authority or local NHS, and yet the PIP benefit is thousands of pounds a month.”

PIP is a non means tested benefit to support people with the extra known costs incurred by disabled people and those with health conditions have in moving around and undertaking daily activities. It is not an out of work benefit, yet paid work is being positioned by Ministers as the cure for all disabled peoples’ needs.

So we see that the PM has talked about the ‘sick note culture’ ‘ life style choice’ in his reforming of welfare plan. (4) In addition to a Labour MP Alison McGovern who stated that “every aspect of the benefit support for disabled people must help people get into work” (5)

I value and support the unique contribution occupational therapists offer for example, in occupational health and vocational rehabilitation roles, but it is vital that they think critically about the Ministers’ unsafe and unsubstantiated claims that paid work is the only solution to meeting the needs of disabled people and people with long term conditions. RCOT must advocate to ensure that people who cannot undertake paid work are not dehumanised but valued, can access care, and financial support to lead meaningful lives. Peoples’ quality of life should not be threatened or disregarded if they cannot work.

Furthermore ‘good’ work is commonly cited to evidence from 2006 and claimed to be generally good for people’s health and wellbeing. (6) But questions are raised as to whether all occupational therapists understand what ‘good’ work means for disabled people and people with long term conditions (including Long Covid) in 2024. For example, is there enough awareness of employers who do not do the right things for workers and we know that some disabled people have had to take insecure work of poor quality. (7) In addition to how fear inducing and punitive the DWP policies are for people in terms of conditionality, sanctions, civil penalties, and the suspension or stopping of benefits. Disturbingly the DWP aim to increase covert surveillance and gain access to peoples’ bank accounts too. We also see the cruelty the DWP is placing on unpaid carers.

Moreover, RCOT should not be ignoring the ongoing failures in public health messaging with many workplaces being unsafe and harmful to our health with no COVID-19 mitigations e.g. clean air. Thousands of people in the UK have become disabled with Long Covid and many have been unsupported by their employer and had to leave work. (8,9) But people with Long Covid have struggled to access benefits as shown in your own report, which I was pleased to have the opportunity to influence at the survey design stage. (10)

Importantly occupational therapists practice in many settings and may provide evidence to people for a benefit claim and fit notes. They may work for the DWP or their contractors as medical assessors for benefits such as PIP and within associated employment support provision. Therefore, occupational therapists deliver the DWP’s policy at the front line. So, I am concerned to hear that occupational therapists who work in these DWP’s assessor roles have experienced ethical dilemmas and workplace pressures. (11)

It is vital that RCOT reflects on occupational justice and occupational deprivation because the Government’s proposals will harm individual’s and whole families’ health and wellbeing, potentially damaging relationships and putting lives at stake.

Yet our government still insist on enacting punitive social security policies based on unfit for purpose medical assessments, conditionality, and sanctions. We know that many people face an arduous experience when making claims for health benefits including PIP and many endure lengthy tribunals and the worsening of their health and wellbeing. Some people have taken their own life. (12)

I signpost you to an example of a response where I raised concerns to the DWP in the work capability assessment (WCA) consultation for Long Covid Support (covering the substantial risks for people with Long Covid and Myalgic encephalomyelitis (ME) (13). Worryingly we hear that the Government’s proposed cuts to benefits will impact 450,000 people. (14)

I value the work of RCOT and understand that you meet with stakeholders including the DWP. However disabled people ascribe to the ethos of nothing about us without us, and therefore I ask you to publicly state if you are planning to consult with disabled people who are in receipt of benefits (e.g. PIP, Employment Support Allowance (ESA) Universal Credit) including occupational therapists when responding to the Government’s consultations (e.g. on the fit note and PIP). This is vital because it is only through understanding the lens of lived experience that we can truly advocate and be an ally to those we aim to support. The RCOT holds a privileged position and can make a difference to peoples’ lives but true collaboration with disabled people is paramount if this privilege is not to be misused.

I urge you and all in RCOT to lead by example to your members. Please do not be silent because occupational therapists bear daily witness to the harms to health and wellbeing disabled people and people with long term conditions face for example, in seeing the daily struggles which include people not being able to afford the essentials to live, no food, no gas or electricity to light and heat their home. (15) These struggles are compounded by financial hardship, the cost-of-living crisis and known health inequalities as recently reported by Professor Sir Michael Marmot. (16) Furthermore, there are almost seven million people waiting to access NHS care (17) and we have an increase in suicide especially in younger age groups.

I have framed this letter specifically to RCOT, but it is of strong relevance to all allied healthcare professionals and related professional bodies, and so I please ask you to raise the concerns in this letter with the Allied Health Professions Federation as a matter of urgency and a statement calling out the above harms from each of the allied healthcare professionals (AHP) professions is vitally needed too.

I invite all stakeholders who have similar concerns, are impacted by the matters raised in this letter and especially my peers in occupational therapy and other health and social care professions to co-sign this letter to show the need for the RCOT to respond. Please sign as both individuals and groups.

Yours sincerely

Signatories

Dr Jenny Ceolta-Smith, occupational therapist

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