Withdrawing benefits when there are no jobs to find is just cruel

A doctor writes first hand of the repercussions of Whitehall hyperbole on benefits.

The government knows exactly what it's doing. When the Prime Minister broadcast his intention to substantially shrink the benefits system, it wasn't because he's blissfully unaware of the consequences. He knows this will remove a crucial lifeline that could condemn millions to an inescapable cycle of poverty.

A pattern is developing with this government. Policies are announced that seem so clearly detrimental, those enacting them are declared by detractors as either oblivious to the ramifications or utterly callous. But rather than dismiss their decisions as the immoral acts of ignorant elitists, I want to understand their politics. Instead of blustering and chastising, I'm willing to consider that Cameron's cabinet are neither naive nor malicious. I'd like to know how they justify their actions, and why they think what they're proposing is right.

As an NHS doctor I can't agree with sweeping cuts to welfare. We need a social security safety net because the unexpected is precisely that. You cannot predict the personal disasters that drive the need for benefits, in the same way that no-one sets out to require emergency medical treatment. It's not a culture of entitlement, and it's not a lifestyle choice. It's a last resort. Doctors see first hand the repercussions of Whitehall hyperbole. Half a million people will lose their disability living allowance by 2016. They won't lose their disability. Accident and Emergency departments face the overwhelming challenge of a newly homeless generation when housing benefit for under the twenty-fives is withdrawn. When government aid is withheld from the people who need it  the most, the NHS feels the impact.

Nonetheless, the Conservative's idea is perfectly valid: switch the emphasis from benefits to employment. Make it more profitable to work than to rely on the state. Enable all people from every part of society to determine their own existence, instead of being reliant on the whims of government funded charity. It's a well known argument:give a man a fish, and he eats for a day. Teach a man to fish, he feasts for a lifetime.

Even when judged by their own standards, this government falls short. So far they've taken away the fish. This is the easy half, the half that abdicates state responsibility for the most vulnerable in society. Truly compassionate conservatism would be to ensure a reliable alternative income for each and every person who has their benefits withdrawn. Otherwise those previously trapped on handouts will be just as trapped, but without any financial support at all.

Unicef has already warned the UK government that their spending cuts will reverse the progress made on tackling child poverty. A recent joint report from Action for Children, the NSPCC and The Children's Society has concluded that depression, poor quality housing and poverty are far more prevalent than government figures suggest. Children's charity Kids Company has seen a two hundred percent increase in families relying on them to avoid starvation over the past twelve months. Further cuts to basic social securities will do little to help this sobering trend.

Reducing housing benefit, capping the numbers eligible for council houses and asking the jobless to do full time community work for free does nothing to address the fundamental flaw in Cameron's argument. Focusing on jobs not handouts conveniently forgets that employment is the part you need to get right first. It relies on a buoyant jobs market where employers are willing to risk their business on a previously unemployed and potentially unskilled workforce. The UK is fast approaching three million unemployed. In today's calamitous economic situation, even the most qualified and most experienced remain out of work.

Giving people no choice but to find a job is a great way to get them off benefits. Unless there are no jobs. There is no plan to address the fallout of Cameron's rhetoric. The new homeless, impoverished disabled and jobless millions don't factor into his equation, where you're either productive and employed or a work-shy fraudster. The least appropriate action for the government is precisely what they're promoting: withdrawing the only means of survival for someone powerless to change their circumstances without help. No matter how you cut it, that's cruel.

Tom Riddington is a NHS hosptial doctor with a special interest in medical ethics and healthcare politics. You can find him on twitter @drtomriddington.

 

Job seekers need jobs to find. Photograph: Getty Images
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A clinically-approved birth control app is changing the way we think about contraception

The particle physicist Elina Berglund has created an app that is 99 per cent effective. 

Women around the world using the contraceptive pill have long complained to their friends about its perceived side effects – weight gain, acne, mood swings to name a few. Some more recent studies have verified that anecdotal evidence – a Danish study from 2013 confirmed that there was a 40 per cent increased risk of depression for women who were on the pill, compared to those who weren’t.

Frustration around the inadequacy or ill-suitability of certain methods of contraception is rife. One woman, Elina Berglund, decided to do something about it.

Formerly a particle physicist at CERN (and a member of the team responsible for the discovery of the Higgs Boson particle), Berglund co-founded Natural Cycles, a contraceptive app, with her husband Raoul Scherwitzl. Approved as a contraceptive app earlier this year, it is downloadable on a smartphone and relies on a relationship between body temperature and fertility to tell women when they're fertile.

But contraception campaigners have viewed the concept with caution. Widespread use of the pill, condoms, and diaphragms comes after decades of campaigns against reliance on "natural methods" – not to mention the opposition of religious organisations like the Catholic church. 

At first glance, Natural Cycles might not seem all that different from the Vatican-approved "rhythm method", which is based on observing the exact stages of a woman's fertility cycle and avoiding sex during ovulation. This can be, according to the NHS, up to 99 per cent effective – but in reality it is closer to 75 per cent, because "people can make mistakes". 

Users of Natural Cycles take their temperature daily and input it into the app (which costs £6.99 a month). The app then compares the figure to its own dataset and uses an algorithm based on Berglund's days from CERN. It also asks for other data, such as the dates of user's periods and whether they are planning for a pregnancy or not, to create a personalised calendar.

If it’s safe to have unprotected sex, then the in-app calendar will show up as green. If not, the in-app calendar will show up as red. On those red days, users should find methods of contraception if they aren’t seeking pregnancy.  

Menstrual tracking apps are all the rage (there are around 1,000 of them on the current Apple app store). But recent studies have shown that those apps are often inaccurate and lack any scientific basis. 

Natural Cycles, by contrast, carried out three clinical trials, each time expanding the dataset to reduce errors. The most recent, written up in Contraception, involved 22,785 women across 37 different countries in settings that mimicked real life. The co-authors pointed out that in instances of perfect use, one out of 100 women become pregnant accidentally. However, in instances of typical use, seven out of 100 women had the same result.

When Natural Cycles first gained publicity, Berglund pointed out to the press that “now they (women) have a new, clinically verified and regulatory approved option to choose from”. Berglund and Scherwitzl are looking into getting Natural Cycles prescribed on the NHS, like the pill.

So is Natural Cycles the future of family planning? The first thing to make clear is that the app cannot actually function as physical contraception – on “red” days, the app advises users to use a condom if they’re having sex and don’t want to get pregnant. It cannot prevent the transmission of sexually transmitted diseases either. 

Nor is the app really marketed to those who may benefit from the most information about their sexual health – 16 to 25-year-olds, who are also the age group most likely to engage in risky sexual behaviour. 

A spokesperson for Marie Stopes, the reproductive health NGO, said: "Apps to track fertility are a high-tech version of what women have been doing for years with a diary and a thermometer.

"For anyone trying to get pregnant, they might well help. However, if you want to avoid pregnancy, it’s much better to choose a reliable, long-acting modern method of contraception like an IUD or implant. Traditional methods, including tracking fertility, carry a much higher risk of unintended pregnancy."

The app relies on an algorithm, meaning it is only as effective as the data that it receives from users. It is also not free, which may exclude its usage by certain sections of society. A blog written for NHS Choices emphasised that the data collected in all the trials was collected from women who were already signed up for the product, making it likely that they had an incentive to continue with this specific additional contraceptive, as opposed to looking elsewhere. Even so, a third of users who had signed up still dropped out, potentially because of the maintenance required to get results from it. 

All the same, Natural Cycles has 380,000 users and counting. It has received clinical approval to be marketed as a medical device, and it seems to be meeting a need – 70 per cent of Natural Cycle's users come from hormonal contraception, according to Berglund. In her account of Natural Cycles in the Evening Standard, Kate Wills highlighted that the Apple Watch had all sorts of health inputs, but no way to track periods.  All kinds of apps exist to make modern life easier – why has it taken so long for one that addresses a concern for so many women to make its way into the mainstream?

The history of contraception is littered with examples of women being ignored. Early birth control studies vastly underplayed the potentially debilitating side effects of hormone fluctuations on women’s mental health and physical appearance, often treating users as though they were hysterical. Add into the equation the stigma around accessing contraceptives safely and non-judgementally, and it’s easy to see why a relatively painless and private form of contraception might be appealing. 

Natural Cycles may well work for some women – those who are in stable relationships, hoping to get pregnant and fastidious enough to note their temperature every morning. But it doesn’t prevent diseases, requires a steady commitment and – here's the clincher – can't take measurements when you’re hungover as alcohol can affect your temperature. There's also a big difference between the "perfect" use of the app, and the likelihood of pregnancy when used in a "typical" fashion. So long as that's the case, old-fashioned contraception seems unlikely to be swept away by a digital revolution.