UK:'Challenging Harmful and Out-of-Date DWP Training on M.E./C.F.S.' [influenced by BACME] by Sally Callow, July 2025

[Lou B Lou]

Sally Callow (Stripy Lightbulb) has obtained by a series of FOI the DWP Work Capability Assessment Assessor Training Document for ME/CFS, which was co-created by BACME, which contradicts NICE, which has been used for training DWP assessors since 2023. The training document appears to be a contradictory mash up of NICE Guideline and BACME 'Rehabilitation' and Goal Setting dogma. Signed off by the DWP in May 2023.

Extracts From

'Challenging Harmful and Out-of-Date DWP Training on M.E./C.F.S.'​

July 21, 2025 by Sally Callow
' The document promotes an outdated and discredited biopsychosocial view of M.E./C.F.S., contains information that directly contradicts the 2021 NICE guideline (NG206), and encourages assessors to doubt the physical reality of symptoms. This guidance is not only factually incorrect but is actively harmful, risking flawed assessments, unjust denial of support, and causing significant harm to often vulnerable individuals.'

'In our letter to the Secretary of State for Health and Social Care, we stressed that since the clinical standard is set by his department (Health and Social Care) while the flawed training is delivered by the DWP, a cross-departmental solution is essential. We have urged Mr. Streeting to work directly with the Secretary of State for Work and Pensions to ensure this harmful training is immediately withdrawn. We have also shared our findings with the All-Party Parliamentary Group (APPG) for Disability to ensure this issue is raised at the highest levels.'

'Our primary concerns focus on the following dangerous discrepancies:

1. Mischaracterisation of the Illness: The DWP training document promotes a biopsychosocial model of M.E./CFS that has been discredited and rejected by the 2021 NICE guideline. For example, on page 8, the document lists “not attributing the illness to a physical cause” as a “good prognostic feature.” This implies that the illness has psychological drivers, a viewpoint that is not only factually incorrect but also deeply stigmatising. NICE guideline NG206 is unequivocal that M.E./CFS is a complex medical condition. The DWP’s guidance encourages assessors to view patients’ understanding of their physical illness as a barrier to recovery, which is a perilous foundation for an assessment.'

Challenging Harmful and Out-of-Date DWP Training on M.E./C.F.S. | Stripy Lightbulb CIC

A series of FOI requests have lead to the discovery of the DWP's training materials for WCA assessors. It's not good.

www.stripylightbulb.com

Extracts from the DWP Training Document (the Bolding is mine).

Overview of Myalgic Encephalomyelitis (or
encephalopathy)/Chronic Fatigue
Syndrome (ME/CFS)
MED-OVCFS~001

10th May 2023



Page 8
Good prognostic features are less fatigue severity at baseline, sense of
control over symptoms and not attributing the illness to a physical cause.
Poor prognostic features are severe fatigue, longer duration of illness,
comorbid anxiety and depression


Page 14:
Rehabilitative therapy
• Cognitive Behavioural Therapy (CBT)
CBT can be beneficial in managing symptoms, improving quality
of life and reducing distress. NICE recommend CBT for people
living with ME/CFS if they want to use it to help manage
symptoms.


Page 15:
BACME therapy
The British Association for CFS/ME suggest a different form of
therapy however there are significant similarities between the
approaches

The aim of therapy is to regulate and desensitise the body by doing
small amounts of activity to achieve a better balance of rest and
activity in daily life.

BAMCE therapy is formed of 4 stages;
engaging, regulating, increasing and sustaining

Page 16
Engaging – forming a therapeutic relationship with the
therapist where the individual feels supported.

Collaboratively setting goals and developing self-
management skills to work towards these goals

 Regulating – establishing the baseline and stabilising
routines to balance daily life. Trying to avoid the variation
of ‘boom and crash’ patterns. Establishing routines for
rest, nutrition, activity etc whilst working towards goals.
Aiming for the individual to have a sense of control over
their daily routine so they can aim for improvement

 Increasing – allow a gradual increase in level of activity
within the individual’s goals at a realistic pace. Aims to
increase frequency, intensity, quality and/or duration of
activity with a collaborative approach. Consolidating
changes before further increases. Activity is based on
the individual’s goals and their feedback

 Sustaining – preparing for the end of therapy and
planning for the future, including relapse planning.
Developing self-management skills to support long-term
goals and reduce the risk of relapse. Aim to continue to
improve quality of life whilst considering daily life
demands


Page 17
Severe/very severe ME/CFS
• A small number of people have severe or very severe ME/CFS which
significantly impacts their lives resulting in them being housebound or
bedbound for long periods of time


Page 18
Likely Functional Effects of Myalgic
Encephalomyelitis (or encephalopathy) / Chronic
Fatigue Syndrome

• For the purposes of Revised WCA, skill is required to assess the
degree to which stated difficulties in persisting with tasks is due to the
physical component of the illness, and which is due to psychological
factors


PS, this document would do well to be in both the BACME and the DWP threads.

 

[Jonathan Edwards]

I have never heard of this "BACME Therapy" although it sounds familiar.

It is clearly back to square one.

 

[Sean]

And how is this approach in any way different from BACME's pre-NICE version?

Is there no means at all to bring an end to this relentless assault on our lives by the psycho-behavioural cult? How in God's name do these people keep being allowed to so easily hijack and pervert every gain we make, and always end up back in charge and dropping their pile of shit on us, all while telling us how wonderful and caring they are, and demanding we thank them for it, and give them even more power and money?

What have we done to deserve this? What the fuck is wrong with this world?

 

[Trish]

Is there no end to this persecution of pwME?
This is not just disheartening, it's criminal negligence.

 

[Nightsong]

The DWP is already so very difficult to deal with, on every level. There are patients who live in fear of the infamous "brown envelope" (now a white envelope) dropping on their doormat. The information supplied by BACME will only serve to make assessments far more difficult & gruelling - assessors will use it to increase the frequency of reviews, or refuse to place patients in the higher tiers of support because BACME have essentially told them the condition is entirely reversible and predicated on "psychological factors".

I have a question for the patients and ME charities who are on BACME's PPI groups and routinely co-operate with them:

Are you proud of this?

 

[Suffolkres]

The DWP is already so very difficult to deal with, on every level. There are patients who live in fear of the infamous "brown envelope" (now a white envelope) dropping on their doormat. The information supplied by BACME will only serve to make assessments far more difficult & gruelling - assessors will use it to increase the frequency of reviews, or refuse to place patients in the higher tiers of support because BACME have essentially told them the condition is entirely reversible and predicated on "psychological factors".

I have a question for the patients and ME charities who are on BACME's PPI groups and routinely co-operate with them:

Are you proud of this?

I attended a Zoom conference today held by CureME.
One of the attendees was a patient MEA Trustee.
I DM him during the session.
I asked for him to contact me by phone. I wait with growing consternation.

 

[Simbindi]

Page 18
Likely Functional Effects of Myalgic
Encephalomyelitis (or encephalopathy) / Chronic
Fatigue Syndrome

• For the purposes of Revised WCA, skill is required to assess the
degree to which stated difficulties in persisting with tasks is due to the
physical component of the illness, and which is due to psychological
factors

I think this has been highlighted in the DWP training because the WCA was split into 'Physical' and 'Mental Health' categories (in the relevant legislation), and therefore there are rules that the physical descriptors only apply to physical symptoms and the mental health descriptors only apply to mental functioning (including cognitive difficulties). It's not that the illness must be either physical or mental but how the symptoms themselves affect functioning. So illnesses like MS and Parkinsons would also have this done by the assessor. Of course, this is idiotic as it's impossible and not the way illness works, but that was the effect of the legislation.

https://assets.publishing.service.gov.uk/media/67fe3497b73354468d13546c/wca-handbook.docx

See page 29 of the above document.

N.B. This is why a claimant suffering from ME needs to word their answers on DWP forms very carefully (I'd recommend using additional sheets).

 

[Simbindi]

This is also why I made it explicit on my WCA (and PIP) forms that the reason I can't either attempt or repeat a physical task is due to both rapid fatigability and the resultant PEM (which I describe in detail). It is complete gaslighting to imply people with ME/CFS are 'fearful' of activity due to psychological reasons. I give a graphic description of the past and future consequences attempts at activities have incurred. Including physical and cognitive deterioration, overall worsening health, accidents, past and possible harm to property and other people etc. I include specific examples from my life and for the WCA include hypothetical references to 'the modern workplace'.

 

[Tilly]

Sally Callow (Stripy Lightbulb) has obtained by a series of FOI the DWP Work Capability Assessment Assessor Training Document for ME/CFS, which was co-created by BACME, which contradicts NICE, which has been used for training DWP assessors since 2023. The training document appears to be a contradictory mash up of NICE Guideline and BACME 'Rehabilitation' and Goal Setting dogma. Signed off by the DWP in May 2023.

Extracts From

'Challenging Harmful and Out-of-Date DWP Training on M.E./C.F.S.'​

July 21, 2025 by Sally Callow
' The document promotes an outdated and discredited biopsychosocial view of M.E./C.F.S., contains information that directly contradicts the 2021 NICE guideline (NG206), and encourages assessors to doubt the physical reality of symptoms. This guidance is not only factually incorrect but is actively harmful, risking flawed assessments, unjust denial of support, and causing significant harm to often vulnerable individuals.'

'In our letter to the Secretary of State for Health and Social Care, we stressed that since the clinical standard is set by his department (Health and Social Care) while the flawed training is delivered by the DWP, a cross-departmental solution is essential. We have urged Mr. Streeting to work directly with the Secretary of State for Work and Pensions to ensure this harmful training is immediately withdrawn. We have also shared our findings with the All-Party Parliamentary Group (APPG) for Disability to ensure this issue is raised at the highest levels.'

'Our primary concerns focus on the following dangerous discrepancies:

1. Mischaracterisation of the Illness: The DWP training document promotes a biopsychosocial model of M.E./CFS that has been discredited and rejected by the 2021 NICE guideline. For example, on page 8, the document lists “not attributing the illness to a physical cause” as a “good prognostic feature.” This implies that the illness has psychological drivers, a viewpoint that is not only factually incorrect but also deeply stigmatising. NICE guideline NG206 is unequivocal that M.E./CFS is a complex medical condition. The DWP’s guidance encourages assessors to view patients’ understanding of their physical illness as a barrier to recovery, which is a perilous foundation for an assessment.'

Challenging Harmful and Out-of-Date DWP Training on M.E./C.F.S. | Stripy Lightbulb CIC

A series of FOI requests have lead to the discovery of the DWP's training materials for WCA assessors. It's not good.

www.stripylightbulb.com

Extracts from the DWP Training Document (the Bolding is mine).

Overview of Myalgic Encephalomyelitis (or
encephalopathy)/Chronic Fatigue
Syndrome (ME/CFS)
MED-OVCFS~001

10th May 2023



Page 8
Good prognostic features are less fatigue severity at baseline, sense of
control over symptoms and not attributing the illness to a physical cause.
Poor prognostic features are severe fatigue, longer duration of illness,
comorbid anxiety and depression


Page 14:
Rehabilitative therapy
• Cognitive Behavioural Therapy (CBT)
CBT can be beneficial in managing symptoms, improving quality
of life and reducing distress. NICE recommend CBT for people
living with ME/CFS if they want to use it to help manage
symptoms.


Page 15:
BACME therapy
The British Association for CFS/ME suggest a different form of
therapy however there are significant similarities between the
approaches

The aim of therapy is to regulate and desensitise the body by doing
small amounts of activity to achieve a better balance of rest and
activity in daily life.

BAMCE therapy is formed of 4 stages;
engaging, regulating, increasing and sustaining

Page 16
Engaging – forming a therapeutic relationship with the
therapist where the individual feels supported.

Collaboratively setting goals and developing self-
management skills to work towards these goals

 Regulating – establishing the baseline and stabilising
routines to balance daily life. Trying to avoid the variation
of ‘boom and crash’ patterns. Establishing routines for
rest, nutrition, activity etc whilst working towards goals.
Aiming for the individual to have a sense of control over
their daily routine so they can aim for improvement

 Increasing – allow a gradual increase in level of activity
within the individual’s goals at a realistic pace. Aims to
increase frequency, intensity, quality and/or duration of
activity with a collaborative approach. Consolidating
changes before further increases. Activity is based on
the individual’s goals and their feedback

 Sustaining – preparing for the end of therapy and
planning for the future, including relapse planning.
Developing self-management skills to support long-term
goals and reduce the risk of relapse. Aim to continue to
improve quality of life whilst considering daily life
demands


Page 17
Severe/very severe ME/CFS
• A small number of people have severe or very severe ME/CFS which
significantly impacts their lives resulting in them being housebound or
bedbound for long periods of time


Page 18
Likely Functional Effects of Myalgic
Encephalomyelitis (or encephalopathy) / Chronic
Fatigue Syndrome

• For the purposes of Revised WCA, skill is required to assess the
degree to which stated difficulties in persisting with tasks is due to the
physical component of the illness, and which is due to psychological
factors


PS, this document would do well to be in both the BACME and the DWP threads.

BACME are a real issue and we need to understand their involvement with ICB and the ME Association. They clearly have the ear of the Civil Servants who gather the data to inform the Government. There needs to be a clear path of who in the Civil Service orchestrates who give the data, how and why and to which particular civil servant. They then need to be held accountable

 

[Fainbrog]

This is also why I made it explicit on my WCA (and PIP) forms that the reason I can't either attempt or repeat a physical task is due to both rapid fatigability and the resultant PEM (which I describe in detail). It is complete gaslighting to imply people with ME/CFS are 'fearful' of activity due to psychological reasons. I give a graphic description of the past and future consequences attempts at activities have incurred. Including physical and cognitive deterioration, overall worsening health, accidents, past and possible harm to property and other people etc. I include specific examples from my life and for the WCA include hypothetical references to 'the modern workplace'.

This. I did over 20,000 words (over the course of a couple of months) for my PIP submission, explaining in minute detail the impact, what I can't do etc. plus a wodge of evidence. I set out to give them no way to suggest anything other than what I experience.

 

[Sasha]

Sally Callow (Stripy Lightbulb) has obtained by a series of FOI the DWP Work Capability Assessment Assessor Training Document for ME/CFS, which was co-created by BACME, which contradicts NICE, which has been used for training DWP assessors since 2023. The training document appears to be a contradictory mash up of NICE Guideline and BACME 'Rehabilitation' and Goal Setting dogma. Signed off by the DWP in May 2023.

This is outrageous. Good on Sally Callow for digging into it. Is she part of an advocacy group? Is she going to be part of a move to tackle it? One for the APPG?

 

[Kitty]

Good on Sally Callow for digging into it. Is she part of an advocacy group?

She's a long time patient and advocate—I remember seeing her Foggy Dog posts when I still used Facebook. I don't know whether the Stripy Lightbulb CIC is run by Sally alone or a group of people, but she's certainly been working away at these issues for a good few years.

 

[Lou B Lou]

This is outrageous. Good on Sally Callow for digging into it. Is she part of an advocacy group? Is she going to be part of a move to tackle it? One for the APPG?

'We have written to the APPG on Disability rather than the APPG on M.E. because in recent months we have had private conversations with individual people living with M.E., carers, and advocates. They have each raised concerns with us about the closeness of a national charity to BACME (BACME co-created this training document and have offered ‘alternatives’ to the NICE guideline). This national charity is also a key part of the APPG on M.E. We don’t want to get into internal politics and so to avoid that, we have gone to an APPG which deals with wider disability issues ,and is currently actively working on welfare system-related issues (which this is).'

Challenging Harmful and Out-of-Date DWP Training on M.E./C.F.S. | Stripy Lightbulb CIC

A series of FOI requests have lead to the discovery of the DWP's training materials for WCA assessors. It's not good.

www.stripylightbulb.com

 

[bobbler]

BACME are a real issue and we need to understand their involvement with ICB and the ME Association. They clearly have the ear of the Civil Servants who gather the data to inform the Government. There needs to be a clear path of who in the Civil Service orchestrates who give the data, how and why and to which particular civil servant. They then need to be held accountable

a big question is whether anyone other than patients is aware how little BACME represents patient's interests and the tactics that have been going on - ie some of these people probably have no idea how bad they are because they are getting told (or assuming because noone would believe or assume someone wouldn't after the guideline 'have more of an ear') untrue versions by eg BACME of what they've been up to, and putting on the fake nice pretend its cos they care and mis-representing their stories of what they did and how someone responded. And noone has had the good grace to double-check these aren't complete falsifications of what they have done and what 'went down'.

ie there is potential that because of the wheeling out of the odd patient who will say the right thing for them (or yes useful idiots who don't realise they've been stitched up when asked a question they didn't realise would be used this way etc) most of these organisations are under the impression that what they do isn't bad and have no idea that this is a charade/how at odds with the iceberg of patients that isn't just accidentally ignored but silenced by BACME what they do is.

Do they know how little - has anyone in the community ever had an individual from BACME actually listen to them at any point over the years? Even in the few who have communicated with them, was it really on their terms which happened to be about their views. Or being seen to ask the question eg on a forum then switch off because they aren't really interested in using anything that isn't going to back up decisions they've already made.

Which of course in normal-land is called using people. And playing the system. At a time when real patient engagement and co-production is starting to become non-optional for a reason.

Going in as an antagonist to start an argument and throw out tropes at people in order to claim they tried engagement (which physios for ME managed to do phone as do most normal people) 'but... fibs about the patients based on false account of x, y, z'. Which should be groaningly tired by today's measures to the point that people who have that attitude are managed out of workplaces for having the wrong attitude.

Well actually it is both 'intrusion/obtaining access under false pretences' and 'abuse' to use tropes, which aren't even things that normal people can pretend involve someone reading anything into it when someone wheels out terms like hysterical with venom to someone speaking calmly and giving more energy than they have to try and help someone. You don't need to either know or 'be dredging up the history [which hasn't stopped so isn't history anyway that's just another silencing BS from those still doing it]' to know the tropes are tropes, they aren't 'hidden symbolism' they are things that if someone said those exact same words to them they'd report them to HR, write it down for future use in a divorce, have their friendship group never speak to that person again etc. So why do we need to be gaslighted by them that their not veiled tropage isn't just not abuse but 'deserved'. Bored with people writing manifestos (papers that pretend to be research by just charading as claiming to be academic rather than opinions of what they think of certain types) as if they are excuses rather than a sign of it being even worse.

I'm not even sure that those who normally are OK with helping patients and getting things aren't being persuaded by patter from BACME that they are somehow kinder or better for patients than they ever were.

But it is OK for those people who have been fooled to come out and say it and do the right thing at the eleventh hour, and say they were fooled, better that than not before it is too late and spend the next generation/decade having been co-opted into something that becomes who/what they are known as forevermore because they can't back out once they sponsored the train inadvertently.

The same thing for any normal/good/kind/scientific members of BACME who aren't eg in the leadership with agendas but joined because they are interested in ME/CFS and doing the right thing so have to keep abreast of it all even if they don't agree but aren't in a position yet to lead change. I don't know how many there might be, and if they are all reporting to bosses or aware their career moves depend on the hierarchy not being upset etc.

When said people have eg been in such discussions and it has actually come up to ask eg a real panel of patients then I suspect there might be utter surprise at how strongly patients feel, and these people having no clue how BACME has been 'dealing with' patients behind their backs for the last few years whilst probably telling them 'they tried' rather than 'tried to coerce and threaten them to say what they want otherwise they will call them difficult and pull the trope card' etc.

I suspect they've been potentially getting away with hiding what they've been up to by using the classics thinly veiled by the other classics those of us in certain demographics know all too well from certain types in playgrounds and workplaces (hiding the sneer by dropping it as a veiled one-liner, pretending they are upset because it went down like they cared and 'x didn't understand and reacted badly' when they did the asbolute opposite).

 

[Amw66]

It may be an idea to repeat the clinic survey MEAction (?) did that fed into NICE re patient experience of clinics and the clinic survey Graham did with @Tom Kindlon (?) re recording of harms

It may give some data on exactly what has changed ( or not)

 

[Sean]

It may be an idea to repeat the clinic survey MEAction (?) did that fed into NICE re patient experience of clinics and the clinic survey Graham did with @Tom Kindlon (?) re recording of harms

It may give some data on exactly what has changed ( or not)

Maybe we need to get a patient produced and run monitoring system in place, looking at both compliance with NICE and harms reporting, that is completely independent of any official system.

 

[JellyBabyKid]

And how is this approach in any way different from BACME's pre-NICE version?

Is there no means at all to bring an end to this relentless assault on our lives by the psycho-behavioural cult? How in God's name do these people keep being allowed to so easily hijack and pervert every gain we make, and always end up back in charge and dropping their pile of shit on us, all while telling us how wonderful and caring they are, and demanding we thank them for it, and give them even more power and money?

What have we done to deserve this? What the fuck is wrong with this world?

Exactly this..I cannot understand how we keep reverting to the same thing, no matter how many times we demonstrate it is both unhelpful and unsuitable.

 

[Tilly]

a big question is whether anyone other than patients is aware how little BACME represents patient's interests and the tactics that have been going on - ie some of these people probably have no idea how bad they are because they are getting told (or assuming because noone would believe or assume someone wouldn't after the guideline 'have more of an ear') untrue versions by eg BACME of what they've been up to, and putting on the fake nice pretend its cos they care and mis-representing their stories of what they did and how someone responded. And noone has had the good grace to double-check these aren't complete falsifications of what they have done and what 'went down'.

ie there is potential that because of the wheeling out of the odd patient who will say the right thing for them (or yes useful idiots who don't realise they've been stitched up when asked a question they didn't realise would be used this way etc) most of these organisations are under the impression that what they do isn't bad and have no idea that this is a charade/how at odds with the iceberg of patients that isn't just accidentally ignored but silenced by BACME what they do is.

Do they know how little - has anyone in the community ever had an individual from BACME actually listen to them at any point over the years? Even in the few who have communicated with them, was it really on their terms which happened to be about their views. Or being seen to ask the question eg on a forum then switch off because they aren't really interested in using anything that isn't going to back up decisions they've already made.

Which of course in normal-land is called using people. And playing the system. At a time when real patient engagement and co-production is starting to become non-optional for a reason.

Going in as an antagonist to start an argument and throw out tropes at people in order to claim they tried engagement (which physios for ME managed to do phone as do most normal people) 'but... fibs about the patients based on false account of x, y, z'. Which should be groaningly tired by today's measures to the point that people who have that attitude are managed out of workplaces for having the wrong attitude.

Well actually it is both 'intrusion/obtaining access under false pretences' and 'abuse' to use tropes, which aren't even things that normal people can pretend involve someone reading anything into it when someone wheels out terms like hysterical with venom to someone speaking calmly and giving more energy than they have to try and help someone. You don't need to either know or 'be dredging up the history [which hasn't stopped so isn't history anyway that's just another silencing BS from those still doing it]' to know the tropes are tropes, they aren't 'hidden symbolism' they are things that if someone said those exact same words to them they'd report them to HR, write it down for future use in a divorce, have their friendship group never speak to that person again etc. So why do we need to be gaslighted by them that their not veiled tropage isn't just not abuse but 'deserved'. Bored with people writing manifestos (papers that pretend to be research by just charading as claiming to be academic rather than opinions of what they think of certain types) as if they are excuses rather than a sign of it being even worse.

I'm not even sure that those who normally are OK with helping patients and getting things aren't being persuaded by patter from BACME that they are somehow kinder or better for patients than they ever were.

But it is OK for those people who have been fooled to come out and say it and do the right thing at the eleventh hour, and say they were fooled, better that than not before it is too late and spend the next generation/decade having been co-opted into something that becomes who/what they are known as forevermore because they can't back out once they sponsored the train inadvertently.

The same thing for any normal/good/kind/scientific members of BACME who aren't eg in the leadership with agendas but joined because they are interested in ME/CFS and doing the right thing so have to keep abreast of it all even if they don't agree but aren't in a position yet to lead change. I don't know how many there might be, and if they are all reporting to bosses or aware their career moves depend on the hierarchy not being upset etc.

When said people have eg been in such discussions and it has actually come up to ask eg a real panel of patients then I suspect there might be utter surprise at how strongly patients feel, and these people having no clue how BACME has been 'dealing with' patients behind their backs for the last few years whilst probably telling them 'they tried' rather than 'tried to coerce and threaten them to say what they want otherwise they will call them difficult and pull the trope card' etc.

I suspect they've been potentially getting away with hiding what they've been up to by using the classics thinly veiled by the other classics those of us in certain demographics know all too well from certain types in playgrounds and workplaces (hiding the sneer by dropping it as a veiled one-liner, pretending they are upset because it went down like they cared and 'x didn't understand and reacted badly' when they did the asbolute opposite).

It is darker than that sadly. The reason why I have been publicly calling out the ME Association the two opinion pieces by Neil are there for a reason and so are all the others, some of the so called patients who say the LP works are in fact Drs who work with the LP or fake accounts with no postings at all. I found quite a few on the MEA website.

The way the system works is if you only have opinion you can hide the reality of the millions missing and introduce balance and concern to civil servants who can sit on the fence and be safe if they pick the preferred government trick of do nothing and gatekeep. On this morning program regarding the ME delivery plan and the merry go round we have endured for the past 7 decades, which includes the wrong education drowning out the lived experence and no service provision and no data to give civil servants, an orchestrated situation straight out of Simon Wessely how to play a system handbook