500,000 could lose their disability benefits

Iain Duncan Smith to press ahead with plans to cut disability claimants.

Half a million people could lose their disability benefits under government plans. In an interview with the Daily Telegraph today, Iain Duncan Smith says he will press ahead with radical reforms of the disability living allowance (DLA) that could slash the bill by £2.24bn annually.

The DLA is not a means-tested benefit, so it is paid to those in employment as well as those unable to work. Intended to help people meet the extra costs of mobility and care associated with their conditions, it now costs more than unemployment benefits and will soon cost £13bn per year. Under these reforms, Duncan Smith says that even those who have lost limbs will not necessarily qualify:

It’s not like incapacity benefit, it’s not a statement of sickness. It is a gauge of your capability. In other words, do you need care, do you need support to get around. Those are the two things that are measured. Not, have you lost a limb?

The government is introducing medical assessments to establish eligibility for the benefit for the first time. DLA will be replaced with what they are calling a “more focused” allowance called – in what sounds like a serious piece of newsspeak – the Personal Independence Payment (PIP).

Of course, simplifying is a byword for cutting, and under the government plans (released this month), two million claimants will be reassessed over the next four years, with a quarter of those expected not to qualify.

In the Telegraph interview, Duncan Smith defended this:

We are creating a new benefit, because the last benefit grew by something like 30 per cent in the past few years.

It's been rising well ahead of any other gauge you might make about illness, sickness, disability or for that matter, general trends in society.

A lot of that is down to the way the benefit was structured so that it was very loosely defined. Second thing was that in the assessment, lots of people weren't actually seen.

Third problem was lifetime awards. Something like 70 per cent had lifetime awards, (which) meant that once they got it you never looked at them again. They were just allowed to fester.

While no-one would endorse wilful waste, it is unfair to paint recipients of DLA as freeloaders, and dangerous to cut it without very careful safeguards. The benefit is intended to put the disabled on an equal playing field with everyone else, and clumsy reform could risk seriously reducing the quality of life of people very much in need of support. Government can expect a serious fight from disability organisations, while campaigners have spoken of people contemplating suicide because of their fear of losing the DLA.

So far, there are no signs that these cuts will be responsility executed. It looks as if the medical assessments will be very similar to those currently being carried out for those on incapacity benefits. These tests, run by private companies including Atos, have been criticised for being unfair and geared towards removing people from benefits. In one pilot scheme, a third of people declared fit to work appealed, and 40 per cent of them won. Judges anticipate up to 500,000 cases a year as people appeal the rulings.

It would be foolish to oppose reform for the sake of it, but it is worrying if that reform appears to be motivated solely by a desire to cut expenditure. This looks set to be yet another example of the coalition doing exactly what David Cameron and George Osborne promised it would not: balancing the books on the backs of society’s most vulnerable.
 

People protest against cuts to disability allowances, London, May 2011. Photograph: Getty Images

Samira Shackle is a freelance journalist, who tweets @samirashackle. She was formerly a staff writer for the New Statesman.

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A swimming pool and a bleeding toe put my medical competency in doubt

Doctors are used to contending with Google. Sometimes the search engine wins. 

The brutal heatwave affecting southern Europe this summer has become known among locals as “Lucifer”. Having just returned from Italy, I fully understand the nickname. An early excursion caused the beginnings of sunstroke, so we abandoned plans to explore the cultural heritage of the Amalfi region and strayed no further than five metres from the hotel pool for the rest of the week.

The children were delighted, particularly my 12-year-old stepdaughter, Gracie, who proceeded to spend hours at a time playing in the water. Towelling herself after one long session, she noticed something odd.

“What’s happened there?” she asked, holding her foot aloft in front of my face.

I inspected the proffered appendage: on the underside of her big toe was an oblong area of glistening red flesh that looked like a chunk of raw steak.

“Did you injure it?”

She shook her head. “It doesn’t hurt at all.”

I shrugged and said she must have grazed it. She wasn’t convinced, pointing out that she would remember if she had done that. She has great faith in plasters, though, and once it was dressed she forgot all about it. I dismissed it, too, assuming it was one of those things.

By the end of the next day, the pulp on the underside of all of her toes looked the same. As the doctor in the family, I felt under some pressure to come up with an explanation. I made up something about burns from the hot paving slabs around the pool. Gracie didn’t say as much, but her look suggested a dawning scepticism over my claims to hold a medical degree.

The next day, Gracie and her new-found holiday playmate, Eve, abruptly terminated a marathon piggy-in-the-middle session in the pool with Eve’s dad. “Our feet are bleeding,” they announced, somewhat incredulously. Sure enough, bright-red blood was flowing, apparently painlessly, from the bottoms of their big toes.

Doctors are used to contending with Google. Often, what patients discover on the internet causes them undue alarm, and our role is to provide context and reassurance. But not infrequently, people come across information that outstrips our knowledge. On my return from our room with fresh supplies of plasters, my wife looked up from her sun lounger with an air of quiet amusement.

“It’s called ‘pool toe’,” she said, handing me her iPhone. The page she had tracked down described the girls’ situation exactly: friction burns, most commonly seen in children, caused by repetitive hopping about on the abrasive floors of swimming pools. Doctors practising in hot countries must see it all the time. I doubt it presents often to British GPs.

I remained puzzled about the lack of pain. The injuries looked bad, but neither Gracie nor Eve was particularly bothered. Here the internet drew a blank, but I suspect it has to do with the “pruning” of our skin that we’re all familiar with after a soak in the bath. This only occurs over the pulps of our fingers and toes. It was once thought to be caused by water diffusing into skin cells, making them swell, but the truth is far more fascinating.

The wrinkling is an active process, triggered by immersion, in which the blood supply to the pulp regions is switched off, causing the skin there to shrink and pucker. This creates the biological equivalent of tyre treads on our fingers and toes and markedly improves our grip – of great evolutionary advantage when grasping slippery fish in a river, or if trying to maintain balance on slick wet rocks.

The flip side of this is much greater friction, leading to abrasion of the skin through repeated micro-trauma. And the lack of blood flow causes nerves to shut down, depriving us of the pain that would otherwise alert us to the ongoing tissue damage. An adaptation that helped our ancestors hunt in rivers proves considerably less use on a modern summer holiday.

I may not have seen much of the local heritage, but the trip to Italy taught me something new all the same. 

This article first appeared in the 17 August 2017 issue of the New Statesman, Trump goes nuclear