Housing benefit can be the route to social mobility

Without housing benefit mine and my family's life chances would have been obliterated.

For four weeks in 2008, aged 24 and an unemployed graduate, I tried to claim housing benefit. I had just moved to London with my then partner from Yorkshire via a postgraduate training course in Essex, and a stint living back with my dad and temping in a bid to clear multifarious student debts. Both my partner and I were interning, me for a national magazine, he for a think tank. Neither of us was paid bar minimal expenses. But since his internship was longer-term, DFSS somehow decided that constituted a job, a job that meant he could or should support me (despite the fact he was living on hand-outs from his parents) and which invalidated my claim for housing benefit after just three weeks. In the end his family (who lived in Cyprus) offered to lend me some money, and soon after I landed a minimum wage media database job.

I was relatively privileged. There was some housing benefit available to me, for however short a time. At the eleventh hour, there was someone to help out. If I’d gone back home to West Yorkshire I could have kissed goodbye to a media career in the capital and my autonomy, but I’d still have had bare means. Certainly more than my younger cousin, a carpenter by trade, married with two small children and who had lost his job twice in 12 months since the recession gauged a chunk out of the northern economy, relying on benefits to keep him and his family going until he finally found work again. Brought up in a two-up two-down terrace, moving back into his childhood home with his partner and two small children wouldn’t exactly have made for comfortable living. That my aunt had serious health problems and one of her daughters (admittedly over the age of 25), her partner and two small children living with them for a while too due to similar economic constraints would have made it untenable.

Give or take a couple of years and Cameron’s proposed policy would have seen my cousin and I, two prime examples of the ‘feckless’, ‘entitled’ under-25-year-old benefit scroungers he wishes to obliterate, pretty much obliterated before we’d had a chance to make adult lives for ourselves. 

Where should my cousin have moved back to, exactly, Mr Cameron when there was no work for him, though he was desperate to graft, and when his family home was already overstretched? And shouldn’t I, along with thousands of other have been paid for working in the first place, so that there was no need to claim housing benefit? For me, housing benefit was a means of realising my ambitions and enabling social mobility; for my cousin, it was a matter of basic sustenance and pride.  Neither of us wanted state support, but to be able to support ourselves. And that’s not even to mention the situations, needs, or desires of our parents, whom Cameron would similarly see encumbered by banishing us back home in his bid not to overburden the state.

In Cameronland, it’s either spare bedrooms and free use of the second car, or gutless work-shysters who dream of a shabby, free flat on a sink estate. There may well be some 18-year-olds that plot a trajectory from their parents’ council house to their own, but for the majority of the 380,000 under-25-year-olds currently claiming house benefit, their circumstances will be as nuanced and complex as Cameron’s proposed policy is crude. You might want to look at some of those case studies, Mr Cameron, before being dazzled by the immediate cost savings. The sanctity – and sanity – of your so-called big society is at stake.

A block of flats in Bath. Photograph: Getty Images

Nichi Hodgson is a writer and broadcaster specialising in sexual politics, censorship, and  human rights. Her first book, Bound To You, published by Hodder & Stoughton, is out now. She tweets @NichiHodgson.

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Want to know how you really behave as a doctor? Watch yourself on video

There is nothing quite like watching oneself at work to spur development – and videos can help us understand patients, too.

One of the most useful tools I have as a GP trainer is my video camera. Periodically, and always with patients’ permission, I place it in the corner of my registrar’s room. We then look through their consultations together during a tutorial.

There is nothing quite like watching oneself at work to spur development. One of my trainees – a lovely guy called Nick – was appalled to find that he wheeled his chair closer and closer to the patient as he narrowed down the diagnosis with a series of questions. It was entirely unconscious, but somewhat intimidating, and he never repeated it once he’d seen the recording. Whether it’s spending half the consultation staring at the computer screen, or slipping into baffling technospeak, or parroting “OK” after every comment a patient makes, we all have unhelpful mannerisms of which we are blithely unaware.

Videos are a great way of understanding how patients communicate, too. Another registrar, Anthony, had spent several years as a rheumatologist before switching to general practice, so when consulted by Yvette he felt on familiar ground. She began by saying she thought she had carpal tunnel syndrome. Anthony confirmed the diagnosis with some clinical tests, then went on to establish the impact it was having on Yvette’s life. Her sleep was disturbed every night, and she was no longer able to pick up and carry her young children. Her desperation for a swift cure came across loud and clear.

The consultation then ran into difficulty. There are three things that can help CTS: wrist splints, steroid injections and surgery to release the nerve. Splints are usually the preferred first option because they carry no risk of complications, and are inexpensive to the NHS. We watched as Anthony tried to explain this. Yvette kept raising objections, and even though Anthony did his best to address her concerns, it was clear she remained unconvinced.

The problem for Anthony, as for many doctors, is that much medical training still reflects an era when patients relied heavily on professionals for health information. Today, most will have consulted with Dr Google before presenting to their GP. Sometimes this will have stoked unfounded fears – pretty much any symptom just might be an indication of cancer – and our task then is to put things in proper context. But frequently, as with Yvette, patients have not only worked out what is wrong, they also have firm ideas what to do about it.

We played the video through again, and I highlighted the numerous subtle cues that Yvette had offered. Like many patients, she was reticent about stating outright what she wanted, but the information was there in what she did and didn’t say, and in how she responded to Anthony’s suggestions. By the time we’d finished analysing their exchanges, Anthony could see that Yvette had already decided against splints as being too cumbersome and taking too long to work. For her, a steroid injection was the quickest and surest way to obtain relief.

Competing considerations must be weighed in any “shared” decision between a doctor and patient. Autonomy – the ability for a patient to determine their own care – is of prime importance, but it isn’t unrestricted. The balance between doing good and doing harm, of which doctors sometimes have a far clearer appreciation, has to be factored in. Then there are questions of equity and fairness: within a finite NHS budget, doctors have a duty to prioritise the most cost-effective treatments. For the NHS and for Yvette, going straight for surgery wouldn’t have been right – nor did she want it – but a steroid injection is both low-cost and low-risk, and Anthony could see he’d missed the chance to maximise her autonomy.

The lessons he learned from the video had a powerful impact on him, and from that day on he became much more adept at achieving truly shared decisions with his patients.

This article first appeared in the 01 October 2015 issue of the New Statesman, The Tory tide