A joint Department for Work and Pensions (DWP) and Department of Health and Social Care (DHSC) work programme – WorkWell – likely spells more bad news and harm to people living with myalgic encephalomyelitis (ME/CFS) and long Covid. Not least in this because someone involved in the notorious PACE trial had a hand in it.
Moreover, the scheme is neck deep in a controversial model for disability that a vested lobby has long used to psychologise people with these devastating viral-onset conditions. Naturally, the DWP itself is wrapped up in this expansive medical scandal – and both previous Tory and Labour governments were involved.
Now, a single contract has brought all this and more into sharp relief. It underscores how the new Labour government could continue with this catastrophic model through its back-to-work welfare reforms. Most significantly, it shows how Labour has ME and long Covid patients in it sights – but that it’s also nothing new – as it has long targeted them.
DWP: farming out WorkWell again
On Thursday 12 September, the government’s ‘Contracts Finder’ service published an award notice for a key component of an upcoming DWP and DHSC work programme.
Specifically, the contract concerned the Tory-launched WorkWell pilot programme. You can read more about the programme and the red flags the Canary identified with it, here. In short though, it’s a repackaged work programme by any other name.
Crucially, the Canary highlighted how the scheme could signal some significant problems for people living with ME/CFS and long Covid. Significantly, we wrote that:
there’s one issue in particular that should send alarm bells ringing for people with ME and long Covid. This is the fact the review promotes a biopsychosocial model for treating people with the range of conditions it assessed.
In a nutshell, the biopsychosocial model of disability both psychologises people’s chronic health conditions, and foists the onus for overcoming these on individuals. Essentially, it’s a con – but one which suits the DWP in its crusade to put sick and disabled people at the mercy of the capitalist economy.
However, there was also actually more to this than first met the eye. Most notably, this is that it concealed a legacy of both Labour and Tory DWP co-option of this model. Now, this new WorkWell contract has helped to show how the new scheme and Labour’s broader back-to-work welfare reforms will operate in this context.
A revealing WorkWell contract
In this instance, the contract was for ‘WorkWell Work and Health Coach (WHC) Training’. As the notice itself explained:
The requirement is for a training package to support the development the new WHC role covering three core elements:
a) Identifying an individual’s work and health barriers
b) Producing a return or thrive in work plan to support an individual to start and stay in work.
c) Triage, signposting and referral onwards – covering the limits and remit of the WHC role and helping them to understand when it is important to refer an individual to more specialist expertise and ensuring they do not provide any advice that needs clinical expertise.This covers the WHC’s core duties, and the training will be essential to ensure that across the 15 areas there is consistency in the way that the core duties are delivered and this is done to high standard.
In other words, the contract was for an organisation to run the training for WorkWell’s work and health coaches. As far as the Canary understands it, these would be the main point of contact that participants would meet with on the programme.
So, who exactly will be doing this? The Vocational Rehabilitation Association (VRA). And straight away, there are some enormous red flags with this.
Vocational Rehabilitation Association in bed with the DWP
As the VRA website explains:
Rehabilitation, in the health context, involves facilitating optimal participation for disadvantaged individuals in society. Furthermore vocational rehabilitation (VR) maximises participation in the workforce. Vocational rehabilitation practitioners (VRPs) are mostly health/rehabilitation professionals. However, they specialise in understanding the world of work. But a few other VRPs are employment experts with specialist knowledge of health and/or disability issues.
In other words, these practitioners exist to make it so that chronically ill and disabled people are kept in, or pushed towards work. Notably, the VRA states that:
The VRA represents all those involved in delivering VR services. Consequently a number of groups are involved from both health (NHS and private) and other government agencies e.g. the Department for Work and Pensions.
Already then, it’s evident that the organisation acts in the interests of the DWP and government. However, it’s hardly surprising when their aims completely align. Significantly, the VRA describes its work supporting employers to “retain employees despite of ill health.” Here, the VRA really shows its hand, stating that:
It also helps reduce sickness absence and aids the economy through reducing the costs of ill-health benefits.
Ultimately, it suggests the VRA exists for a particular purpose. That is, aiding the state in denying chronically ill and disabled people benefits, and shunting them into the capitalist workforce.
If this implication weren’t bad enough, its entanglement in the history of the psychologisation of ME/CFS positions it even more problematically. This is especially the case in the context of the WorkWell work and health coach training contract.
A certain notorious psychologiser as patron
Until recently, a notorious forefather of the biopsychosocial model stood as the VRA’s patron. This was Mansel Aylward – who acted in the role up until his death in May 2024.
Aylward was chief medical adviser, medical director, and chief scientist for the DWP between 1995 and 2005. Of course, he therefore served in this role mostly during Tony Blair’s Labour government. Crucially, Aylward and orthopaedic surgeon Gordon Waddell were the architects of the biopsychosocial model of disability.
And it was Aylward who set the ball rolling on Labour embedding this throughout the UK’s social security system. As the Disability News Service’s (DNS) John Pring wrote in 2016, he did this to devastating effect:
The BPS [biopsychosocial model] under-pinned Labour’s out-of-work disability benefit employment and support allowance (ESA) and the work capability assessment (WCA), which has since been linked repeatedly to relapses, episodes of self-harm, and even suicides and other deaths, among those who have been assessed and found fit for work.
BPS has also “played a key role” in the tightening of eligibility criteria for ESA and other disability benefits by the subsequent coalition and Tory governments, including the new personal independence payment and universal credit
In addition to this, Waddell was also the co-author of the vocational rehabilitation review the DWP’s WorkWell prospectus has based its approach on.
Aylward and the PACE Trial
However, for people living with ME/CFS, the former DWP medical adviser had an especially nefarious role in what one parliamentarian previously branded one of:
the biggest medical scandals of the 21st century
Part of this was the DWP-part-funded PACE Trial – an infamously flawed study into treatment for people living with ME. You can find out more about this here. In short, it pushed graded exercise therapy (GET) and cognitive behavioural therapy (CBT) as the primary treatments for people living with the disease.
However, the National Institute for Health and Care Excellence (NICE) removed GET from its guidelines in 2021, and downgraded CBT. This was because the former has proven actively harmful for ME patients. Meanwhile, healthcare professionals promoted the latter under the notion that patients could just practically think themselves better. For obvious reasons – namely that ME is a physiological illness – this too was hugely problematic, and embodied the prevalent psychologisation of the disease in the medical establishment’s psyche. Needless to say, this has also caused immense harm to people living with ME.
So what was Aylward’s part in all this?
As DWP chief medical adviser, he committed the department to part-fund the PACE Trial. Not only this, but Aylward sat on the steering committee for it as well.
Aylward has also worked for health insurance giant Unum and headed the originally Unum-funded Centre for Psychosocial and Disability Research at Cardiff University. And the company is up to its neck in the psychologisation history of ME. Part of this involved the PACE Trial, since Unum had paid multiple authors on the study as advisors on ME claims. This included principal investigator Michael Sharpe.
Unum’s DWP profiteering
So, it was under New Labour that Aylward unleashed the biopsychosocial model and rooted it in the DWP’s approach to welfare. Of course, his work for Unum exposed the vested agenda for doing so. As Conrad Bower wrote for the Canary in 2016, Unum:
is one of the UK’s biggest providers of income protection insurance (IPI) . As a consequence of more holes appearing in the social security safety net, more people are likely to take out IPI, increasing UPI’s profits.
In other words, Labour’s DWP biopsychosocial-driven welfare reforms denying chronically ill and disabled people benefits, pushed them into the hands of insurance companies like Unum.
But more than this, the insurance giant stood to gain from the psychologisation of ME/CFS too. In its 1995 ‘CFS Management Plan’, Unum called ME “neurosis with a new banner”. Of course, the not so subtle implication is obvious – trivialising the disease would enable the insurance company to not pay out on policies taken out by ME patients.
Essentially then, New Labour’s welfare reforms helped facilitate this paradigm where health insurance companies could profiteer off of ME patients.
Naturally, the Tories carried on this war against people living with ME. The PACE Trial part-funded by the DWP, punitive, ruthless social security reform after reform, and its persistent attacks on long-term sick people outside the workforce, have all been part of this.
Throughout, the biopsychosocial model is the common thread, weaving it all together, and laying cover for their trivialisation of ME, and now, long Covid patients too.
VRA corporate membership stuffed with vested interests
Incidentally, Unum just so happens to also be a corporate member of the VRA too.
Naturally though, it isn’t the only corporation with a vested interest in psychologising chronic health conditions like ME/CFS. Predictably, plenty of these grace the VRA corporate membership page of infamy.
First up, there’s Swiss Re. PACE Trial lead investigator Peter White provided paid consultancy to the re-insurance company, alongside work for Unum. White held a web lecture with Swiss Re describing the findings of the PACE Trial. In this, he discussed the role of the insurer in pushing ME patients into work and how to manage ME claims. Among a litany of problematic things throughout, this stated that practitioners should deliver:
active rehabilitation therapies… as opposed to sick role adaptation.
Obviously, this was GET and CBT by any other name.
However, these also weren’t the only corporations wrapped up in the biopsychosocial lobby for ME that appeared in the list. Alongside them was another notable company: Vitality 360.
It’s a private fatigue clinic company – which purportedly treats people living with ME. As I previously reported for the Canary:
Tellingly, the company’s core focus is on ‘rehabilitation’ – or in other words, getting people living with chronic conditions back to work. So of course, insurance companies aren’t amiss among its clients.
But most significantly, PACE Trial author Jessica Bavinton owns it.
ME/CFS and long Covid: Vitality 360 again
Yet, this isn’t the only place Vitality 360 has cropped up in relation to the VRA either.
Occupational therapist Beverly Knops is a trustee for the VRA, and works as an associate therapist for Vitality 360. What’s more, she previously held a role in the Bristol ME/CFS service. As if this wasn’t enough, her VRA bio states that she’s a trustee of the British Association of Clinicians in ME/CFS (BACME) – though its website doesn’t currently have her listed among its board.
BACME is a controversial organisation the Canary previously wrote that:
exists to underpin ME clinics and their clinicians operating across the UK. In January 2021, it registered as a charity. Currently, the non-profit has around 200 professional members who pay yearly fees [Pdf, p8]. It regularly hosts webinars and conferences for these members to network and exchange knowledge.
BACME boasts that its charitable objective is the “relief of sickness for the public benefit”.
However, its laudable-sounding aims obfuscate a contentious history in upholding a harmful status quo. For one, the organisation was the machination of notorious members of a lobby of medical professionals hell-bent on psychologising the chronic systemic disease. Members of the ME community sometimes refer to them as the “biopsychosocial” or “psych” lobby.
The Canary has also written about the serious problems with the Bristol ME/CFS service. In particular, fellow BACME member Peter Gladwell runs it. He continues to push a “pacing up” – GET-lite approach to treatment for patients in contravention of the new NICE guidelines.
On top of this, Knops and none other than Aylward rubbed shoulders at a BACME conference in 2009. BACME was then the CFS/ME Clinical & Research Network & Collaborative (CCRNC). Knops co-led a talk on “Helping people retain and return to work”. Meanwhile, Aylward gave the keynote on “Pathways to work”. Evidently, there’s a common theme in all this – and once again – it’s forcing chronically ill people into work.
Shills for the insurance industry
Yet, Knops also wasn’t the singular link to Vitality 360 and the insurance industry. Health insurance industry consultant Monica Garcia is also a VRA trustee, and notably, the Canary had previously flagged her appearing on Vitality 360’s website. Specifically, we wrote how:
The company’s website doesn’t specify which insurance companies it has worked for. However, it does quote independent disability insurance consultant Monica Garcia. Garcia has worked in various roles for the UK’s Department for Work and Pensions (DWP). On top of this, she also held a senior medical claims role with major insurance firm Swiss Re.
On Garcia’s LinkedIn profile, she wrote of her multiple roles with the DWP across a seven year timespan between 2003 and 2009. In one part, she revealed her biopsychosocial leanings, stating how she had:
applied my Health Psychology Masters learnings to ensure disability is managed within a biopsychosocial framework of rehabilitation.
Then, in another passage she explained one of her roles:
supporting individuals in receipt of government income support benefits.
Disconcertingly, she went on to express how doing this job “enabled” her to:
then apply my learnings and develop bespoke strategies for the protection insurance industry.
For nearly a decade after her DWP stint, she ascended the claims ladder at Swiss Re. She now runs her own consultancy firm for insurance companies and employers. Doing what exactly? You guessed it – trying to get sick and disabled people back to work. There too, Garcia has peppered the company’s website with references to the biopsychosocial model.
Oddly enough, the bulk of her testimonials are from Vitality 360, including one from Beverly Knops. One of these is headed: ‘Early Intervention programme for Long-Covid’. It reads:
We are thrilled to be launching our new long covid early intervention rehabilitation programmes for the income protection market. We have a sign posting template for assessors to use and case stories we can share as part of this package. Thanks to Monica Garcia for your support with this.
It’s clear who Garcia and Vitality 360 are working in the interests of – and it’s certainly not long Covid patients.
Coercing chronically ill people back to work
Underpinning both the Tories and Labour’s back-to-work bluster for chronically ill and disabled people, it’s clear the biopsychosocial model has continued to rear its ugly head. Ultimately then, the new WorkWell programme shows just how little that is about to change under the new Labour government now too.
Labour DWP boss Liz Kendall has been clamouring about getting long-term sick “economically inactive” people back to work. Routinely, she has couched this in the context of the post-pandemic surge in people going off sick.
Naturally, many of these will be new ME/CFS and long Covid patients due to the coronavirus pandemic. In April, the Office for National Statistics (ONS) showed that over two million people in the UK were living with long Covid. However, this is probably an underestimate anyway. It’s likely there are many more living with it in reality.
Despite this, the upshot is that this surge in post-viral chronic illness could well account for a significant proportion of the rise in long-term sick people not able to work. It’s these people living with ME and long Covid that Kendall and co at the DWP are aiming the WorkWell programme at.
Yet, the VRA stacked with the biopsychosocial lobby will have its fingerprints all over it. If that’s anything to go by, the DWP and the DHSC – so the NHS, working in tandem with it – will do what it has done for multiple Labour and Tory governments. That is, mete out more abuse and harm to people living with ME/CFS – and now with long Covid patients in the firing line too.
Featured image via the Canary
