50 years of defining disability – Social Security Yes, this is a history… Gareth Millward - Centre for History in Public Health Supervisor: Martin Gorsky Centre for History in Public Health Improving health worldwidewww.lshtm.ac.uk

D.I.G. Campaign Pre-1965 : No specific benefit National Assistance Board or Sickness Benefit War Pensions and Industrial Injuries DIG’s Comprehensive disability income to cover: – The loss of earnings power – The ‘extra costs of disablement’ Lobbied government extensively Gained some concessions

The discrepancy... * - providing he has an adequate contribution record ** - based on degree of injury, not on the actual financial/social effects of that injury MRC: MSS 108/4/2, DIG, What John and Mary Need and Don’t Get (July, 1972) On holidayIndustrial Invalidity Pension*£ % Disablement Pension**£11.20 Invalidity Allowance£0.70Unemployability Supplement£6.75 Wife£4.15Invalidity Allowance£ st child£3.30Dependent Wife£ nd child£2.401 st child£3.30 Family allowance£0.902 nd child£2.40 Attendance Allowance£5.40Family allowance£0.90 Constant attendance allowance (high rate)£9.00 Exceptionally severe disablement allowance £4.50 TOTAL (tax free)£23.60TOTAL (tax free)£42.90 D.I.G. Campaign

– Invalidity Benefit 1972 – Attendance Allowance 1975 – Mobility Allowance 1975 – Non-Contributory Invalidity Pension 1977 – Housewives’ Non-Contributory Invalidity Pension 1977 – Invalid Care Allowance 1984 – Severe Disablement Allowance 1988 – Independent Living Fund (reformed 1991) 1993 – Disability Living Allowance 1993 – Disability Working Allowance

Thalidomide 1962 onwards Major breakthrough in 1974 Payments awarded to thalidomide affected children Why this case and not others? What about those who could not sue?

Welcome as they may be for the few who will benefit, the measures recently announced for thalidomide children and congenitally disabled children highlight the anomalies of the current provisions and unfortunately heighten the sense of injustice harboured by disabled people with equal or more severe disabilities. This feeling of injustice will remain so long as the help offered to disabled people depends on the financial effects of their disabilities imposed on them and their families but on whether they were fortunate enough to sue for compensation. Betty Veal, Chair of DIG. Press Release 24 October 1974

Incapacity Benefit 1995 Introduced a new ‘objective’ medical test called the “All Work Test” AWT replaced by the “Personal Capability Assessment” in Designed to be more restrictive due to escalating costs of Invalidity Benefit Also supposedly to focus on what people CAN rather than CANNOT do – and to encourage people into work

Mental health descriptors b Often sits for hours doing nothing 2 g Agitation, confusion or forgetfulness has resulted in mishaps or accidents in the 3 months before the test is applied 1 h Concentration can only be sustained by prompting 1 d Does not care about his appearance or living conditions 1 e Frequently feels that there are so many things to do that he gives up because of fatigue, apathy or disinterest 1 e Prefers to be left alone for six hours or more each day 1 The New All Work Test, Leaflet IB124, DSS, April 1995, pp

E.S.A In 2010 a new “Work Capability Assessment” replaced PCA. “Tougher” medical test. Contained a new group within – Work Related Activity Group Radical in that it accepts disabled people can be capable of work but still discriminated against in the work place Still contributory

“Whose Benefit?”

Today Government has made the WCA more restrictive. WRAG claims limited to 365 days. DLA to be replaced with Personal Independence Payment and a new stringent medical test will be applied. Claimants of incapacity benefit to be “migrated” to ESA by end of Reforms designed to: – Reduce expenditure on welfare – Reduce fraud – Encourage people “put on the scrap heap” into work – Concentrate resources on those “most in need”

Conclusions Since 1960s, government has accepted that disabled people deserve coverage in the social security system. Expansion to “cover loss of earnings” and “extra costs” up to mid- 1970s. Since mid-1970s, attempts to cut costs have dominated, reaching their high points in early-1990s and early-2010s. Reforms would suggest that the “social model” of disability has not been understood or ignored. All governments believe that there is a medical standard – a line – which can be applied to individuals to see if they are “really” disabled.