Is Labour abolishing illness?

The new rules on incapacity benefit stake everything on a major gamble: that a large proportion of c

Incapacity benefit has become one of this year's favourite scare stories. Hardly a day passes without a new headline deploring its soaring costs and the rising numbers of claimants who get "something for nothing", at the expense of decent, hardworking taxpayers. We are told that we are footing an outrageously escalating bill for 2.4 million people, a million of whom shouldn't be on the benefit at all, and each successive work and pensions minister vows to be more ruthless than the last.

The true picture is somewhat different. The unreported version, which can be culled from Department for Work and Pensions (DWP) data, is that only 1.4 of the 2.4 million actually receive any payment, the rest get national insurance credits only, and numbers have been falling since 2003. The basic benefit is worth barely £3,000 a year. After two small rises in the first year there is no further increase, other than index-linking. All those who get the benefit have to pass a rigorous "personal capability assessment" (PCA) with doctors appointed by the DWP; and they can be re-examined at any time. The audited estimate of fraud is under 1 per cent - the lowest of any part of the social security system.

Nonetheless, the 2007 Welfare Reform Act is now being implemented across the country. It replaces support, as of right, for illness/disability (one of the planks of our rapidly disappearing welfare state) with a new, conditional employment and support allowance. Claimants are held on a basic allowance until it is confirmed that their capability for work is limited. This is determined by a "work capability assessment" tougher than the old PCA. Those deemed capable of one day returning to work (and the arbiters are health professionals rather than doctors) must engage in a series of "work-focused" interviews and activities. These include, among other things, "condition management", which in practice is likely to consist of group sessions loosely based on cognitive behavioural therapy. All this brings an additional slice of benefit that can, however, be cut for those who do not engage in it without "good cause" - a potential loss of 40 per cent of income. Ultimately, any whose capability for work remains limited through failing to follow medical advice, or "any prescribed rules of behaviour", face a period of disqualification. (A further provision of the act, to be piloted in nine areas, is that people served with Asbos - antisocial behaviour orders - can face cuts in their housing benefit for refusing local authority offers "to help address any problem behaviour".)

A main selling point of the reform was the great savings it would bring. It would staunch the outflow of benefits and get many people into jobs where they would pay tax and provide for their old age. This government's cherished goal is an employment rate of 80 per cent of the working-age population - though it is difficult to find any reasoned argument in support of this since our present rate of 75 per cent is, with Canada's, the highest in the world. The government accepts that employers must be paid to take on people with an illness record and, for the time being, it has pledged not to cut the benefits of existing claimants. Any immediate savings, therefore, can only come from bumping as many as possible off the benefit, shaving future benefit levels (already well in hand), and making it harder for newcomers to get it in the first place. Delivery is being farmed out to private agencies paid by results - which means, of course, the setting of targets. The next few years will be a bad time to have a crippling accident or succumb to a serious disease, particularly a psychiatric or neurological one that does not have obvious outward symptoms.

Blaming the "cheats"

The reform of incapacity benefit has been over ten years in the making, leaving in its wake a dense trail of commissioned reports. A curious thing about this voluminous material is how little information it contains on the actual health conditions for which benefit is paid. This is no accident, for the reformers long ago made up their minds that claimant numbers are too high, therefore a large proportion - usually put between a third and a half, but lately upped to 70 per cent in some quarters - must be spurious. An appeal to history is repeated like a mantra that, back in 1979, only 700,000 claimed the old sickness/invalidity benefits. Since then, money has been poured into the NHS while health care, living standards and longevity have improved beyond all expectations. People must be healthier, which proves that huge numbers are exploiting a slack and obsolete system. Who is to blame, apart from outright cheats? It can only be the self-indulgent, who fancy themselves sicker than they really are, and complacent GPs who let them think they are too ill to work.

Crucially, the reformers bracketed illness with disability. The disability lobby had long argued that "disability" was a discriminatory label imposed by society, and it was bent on removing the barriers to work that excluded those so labelled and kept them in poverty. But the bracketing brought confusions - for those with disabilities may be extremely fit (consider the disabled athlete), whereas the able-bodied can be extremely ill. More confusion arises with conditions such as "stress", "anxiety" and "chronic fatigue" that sound trivial. As for "back pain", how unreasonable is it to take time off sick for something best dealt with by a stiff upper lip and the odd aspirin? It is easy for those in good health to pooh-pooh such things, agreeing with the government that "Work is the best therapy".

The government's declared mission is to "liberate" claimants, to bring them into its "reformed, coherent welfare state for the 21st century". It seeks to overturn a culture based on the "medical model" of illness that allows them to "drift" on to long-term benefits without realising that "symptoms, feeling unwell, sickness and incapacity are not the same" - hence the appeal of cognitive behavioural therapy, which it understands as a treatment that will talk the sick into believing they can lead normal lives.

Doctors - so often the refuge of desperate people trying to find out what is wrong with them - should as far as possible be excluded from the process. Even those working for the DWP have opinions that are "unfounded, of limited value and counter-productive", while GPs are "unaware of the importance of work, the absence of which leads to depression, poor health, higher rates of suicide and mortality, poverty, and social exclusion". (The quotations are from a 2005 study from the Unum Provident Centre for Psychosocial and Disability Research at Cardiff University, whose ideas and rhetoric infuse the reform. Unum Provident is an American firm, the largest disability insurance company in the world, which is currently in litigation in different countries for refusing to pay out on some of its policies.) A private agency has now taken over the running of its first GP surgery here, and doctors dealing with disability living allowance are advised not to invite patients to explain how their condition affects them.

Features of the reform are familiar from other policy areas. First, a demonisation of a needy or vulnerable group, followed by a rebranding: so claimants become not even "clients" but "customers" (as in the just published "Commissioning Strategy" document); incapacity benefit becomes employment and support allowance; sick notes are redrafted for doctors to certify, not what patients can't but what they can do. Next come "partnerships", on an unchallenged assumption that the public sector has failed. The new system is farmed out to for-profit or non-profit-making agencies paid by results. This entails targets, and where targets are set, sanctions follow, for any who "fail to recover".

There are features of the new programme that look intelligent and humane, doubtless owing much to the efforts of the disability lobby. They include a longer and more flexible bridging period (and a back-to-work grant) between benefits and work, and a broader view of "work- focused" activities. The crunch will come with those described as not able or prepared to engage "because [of] the nature and severity of their health condition, or more a matter of attitudes, perceptions and expectations which may or may not be accurate . . . It is a question of what the claimant cannot do vs what they will not do."

For the reform stakes everything on a gamble: that a large proportion of claimants, present and to come, are fit enough to work. There seems no way of proving or disproving this, other than trying it out, at the risk of much waste of public money, and much personal grief. Deliberate rejection of the "medical model" deprives us of all we might have learned (from the wealth of data available) of the impact of illness on our society.

I have scratched my head long and hard over this reform (among other things sending out lengthy submissions to all concerned during the long consultation phase in 2005-2006) because so much in its theory and rhetoric contradicts my own experience: of chronically and seriously ill family members and friends, of several years as a Mind volunteer, and further years of peripheral involvement in action groups for chronic fatigue conditions. All this has indelibly impressed me with the courage of many who live with horrible complaints, the sheer hard work involved in their day-to-day coping, their relentless search for any amelioration, let alone cure, often at costs hard to spare from limited resources.

I have witnessed, too, and at close quarters, the hurt and stress of living difficult lives as people have to do, in a perpetual culture of disbelief and threat, where some of the most valiant are blamed for their conditions and conflated with the alleged "can't work, won't work" unemployed. For the message of the reform that comes across, for all its fashionable rhetoric, is that a person is valued only as a productive unit. Compassionate cases aside, those too ill to work are outside society and money spent on them is wasted. Sickness, disablement and inability to work have no place in a modern society - they can't and shouldn't be afforded.

No one pretends that illness is not a blight, imposing personal and social costs going far beyond the financial; but - pace the government - no one as yet knows how to remove it from the human condition. Why waste valuable time and resources on an ill-founded reform, when they could instead be used to further understanding of the real impact of illness on our society?

Alison Ravetz is a professor emeritus of Leeds Metropolitan University who writes on housing policy and welfare reform

This article first appeared in the 05 May 2008 issue of the New Statesman, High-street robbery

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In the heartlands

What does visiting Wallasey, Pontypridd and Islington North reveal about Labour’s future?

Islington. It’s the idea, as much as the place itself, that the right hates: an enclave of wealthy people who have the temerity to vote against right-wing interests. The real Islington, and Jeremy Corbyn’s patch of it in particular, is not all like that. Although parts of his constituency do resemble the cliché of large townhouses and overpriced flat whites, Labour’s 78-year hold on the seat is founded not on the palatial houses around Highgate Hill but on the constituency’s many council estates.

It’s a place I know well. As a child, Islington North was the place next to the edge of the known world, or, as I would come to call it later in life, Barnet. After going to church in Bow, my mum and I would take the bus through it to choir practice, where I sang until my voice broke, in both senses of the word.

Today, austerity is making Islington North look more like its past. Not the Islington of my teenage years, but of my childhood: grimy streets and growing homelessness. Outside the Archway McDonald’s an elderly woman points out the evidence of last night’s clubbers and tells me that today’s teenagers are less considerate than I was or her grandson is. She’s wrong; I once vomited in that same street. But street-sweeping, particularly at night, has been one of the first things that councils have cut back on under constraints from decreasing local authority budgets.

As for homelessness, that, too, has come full circle. Tony Blair’s government was the first to count the number of people sleeping rough, and by the time Labour left office it had been reduced by two-thirds. In the six years since David Cameron first came to office, the homeless figure in England more than doubled from 1,768 estimated rough sleepers to more than 3,569 today. This is the world that Jeremy Corbyn’s supporters want to fight against. These are the effects of Conservative rule that make Labour activists yearn for an anti-austerity champion.

***

Demolishing the stereotypical views of Islington and elsewhere is vital if we are to understand the currents flowing through ­Labour. This summer, there have been three main characters in the soap opera (or farce) that has played out in the party – the beleaguered leader, Jeremy Corbyn, of Islington North; the leading rebel, Angela Eagle, whose constituency is in Wallasey; and finally, the eventual challenger, Owen Smith of Pontypridd. I visited all their constituencies in a whirlwind week in the hope that it would illuminate the leadership race and the wider challenges for left-wing politics in Britain.

In all three places, the easy assumptions about Corbyn’s appeal were complicated by the facts on the ground, but a common thread united them. Outside the Holloway Road Odeon, I heard it first: “Jeremy is a nice guy, but he’s not a leader.” The trouble was that even those who questioned Corbyn’s leadership had little faith in those challenging him.

On 4 July, during a meeting of the Parliamentary Labour Party, Neil Kinnock talked about “the supermarket test”: how people in Tesco or Lidl would say “I want to vote Labour, but I can’t vote for Ed Miliband”. He urged Labour’s representatives in the Houses of Parliament to “apply the supermarket test for Jeremy Corbyn and see what answer you get”.

In reality, they had been applying it for months. That was the spur to the attempts in late June to oust Corbyn as Labour leader. For the 172 MPs who said they had no confidence in him – and the 41 per cent of Labour members who told YouGov that they thought Corbyn was doing either “fairly badly” or “very badly” – he is an obstacle on the road to saving Britain from the Tories. Idealism didn’t create a minimum wage, set up Sure Start centres, or bring in civil partnerships: assembling a broad enough coalition to elect a Labour government did.

The minority of MPs who support him, and the thousands of members who say they will vote for him again, feel differently. For them, Corbyn’s demise would feel like a capitulation. It would feel like ­accepting that neoliberalism, capitalism and austerity have won the day, that the role of the Labour Party is to ameliorate rather than oppose them.

When I visited Islington North, Labour’s leadership election was only just starting to get under way and Angela Eagle was still in contention. Her tough performances deputising for the leader at PMQs have made her popular at Westminster but that enthusiasm has not made it as far north as Islington. “To me, I can’t see Angela Eagle as a prime minister either,” said Mike, one of the regulars at the Coronet, a Wetherspoons on the Holloway Road. “What are they running her for?”

The same sentiment prevailed in Wallasey, the Wirral constituency that Eagle has represented since 1992. There, too, were a few pockets of Corbynmania. There was also a sense that Labour is heading for defeat as long as Corbyn remains in place – but little faith in Eagle’s ability to alter
that trajectory.

Wallasey is of less long-standing Labour vintage than Islington North. It remained steadfastly Conservative even between 1945 and 1966, and Eagle first won the seat in 1992. Although she is now in possession of a 16,000-vote majority, her neighbour Margaret Greenwood took Wirral West seat back from the Conservatives by a margin of only 400 votes. Tory strategists still eye the Wirral hungrily.

Wallasey is home to New Brighton, the seaside resort commemorated in Martin Parr’s 1985 series The Last Resort. A popular tourist destination for most of the first half of the 20th century, New Brighton was hurt by tidal changes in the River Mersey, which stripped most of its sand, and by the closure of its pier, but it remains a favoured destination for retirees and day trippers. In times past, Liverpool families that did well for themselves crossed the Mersey, bought a home – and promptly started to vote Tory. Wallasey, and the Wirral as a whole, is still where Scousers who have made it good set up their homes, but nowadays their politics usually survives the river crossing unscathed.

Yet there is still a vestigial sympathy for Conservatism in the leafier parts of Victoria Road and Seabank Road, one that is largely absent from Islington North. Perhaps Theresa May’s diligence in dealing with families affected by the Hillsborough disaster, which was mentioned frequently when I asked people for their opinion of the new Prime Minister, is sufficiently well regarded here that it is beginning to erode the Thatcherite taint still hanging over the Tory rosette on Merseyside.

However, it is not just Labour politics that is proving increasingly capable of weathering the journey across the Mersey. In Westminster, the chatter is that Militant – driven out of Labour in the 1980s, though most of its members continued to live and work on Merseyside – is back as a force in the city’s constituencies, and that many of its members have moved out and retired to New Brighton. Their influence is blamed for the series of damaging stories that slipped out of Wallasey in the days after Eagle declared her candidacy.

“There’s a reason why they’re so good at getting themselves on the national news and in the papers,” one MP tells me. “It’s that they’ve done all this before.”

***

The perception that Eagle “lost control” of her local party, as well as a disastrous campaign launch, led to support from fellow MPs ebbing away from her. It went instead to Owen Smith, the MP for Pontypridd, a little-known figure outside Westminster, but one who has long been talked of as a possible Labour leader inside it.

Smith’s great strength, at least according to some of his backers, is that he is a blank canvas. Certainly, as with Corbyn in Islington, there was a widespread perception in Wallasey that Eagle was not cast from the material from which leaders are made. Smith at least had the advantage of introducing himself to voters on his own terms.

His slim hopes of defeating Corbyn rest on two planks. First, the idea that a fresh face might yet convince wavering members that he could win a general election. A vote for him rather than Corbyn can therefore be seen as a vote against the Conservatives. Second, he is willing to call for a second European referendum. Among Labour Party activists, who backed staying in the European Union by 90/10 per cent, that is a compelling offer.

In Islington and Wallasey, both of which voted Remain (and both of which still have  houses flying the flag of the European Union when I visit), that message also has wider appeal. But in Smith’s own seat, a second referendum is a tougher sell. The Valleys voted to leave by a near-identical margin to the country at large. No one to whom I spoke was enthused about replaying the referendum.

Smith’s status as a “blank slate” will only be useful if he manages to write something appealing on it over the course of this summer. It is also possible he could just remain largely unknown and undefined.

Travelling around the country, I became accustomed to explaining who he is. Even at my hotel in Cardiff, which borders his constituency, the name “Owen Smith” was met with blank looks.

Unfortunately, the habit proved hard to break once I was in Pontypridd, resulting in an awkward scene in the back of a taxi. “I know who my MP is,” my driver said angrily, before launching into a lengthy diatribe about the arrogance of London-based journalists and a London-led Labour Party. The accent had changed, the setting was more confrontational, but the story remained the same as in Islington and Wallasey: he was convinced of neither Jeremy Corbyn’s nor Angela Eagle’s ability to fight and win an election. “That voice? In a room with Putin?” he said of Eagle. Then he said something unexpected. “But I’ll tell you what – they need a change from Jeremy Corbyn – and why not Owen Smith?”

“Why not Owen Smith?” As much as they might wish to deny it, that is the message with which Corbyn’s critics will try to take back control of the Labour Party. It is a message that feels unlikely to move or inspire. As I catch the train back to London, I reflect that those who want to convince Labour activists to give up Jeremy Corbyn – and what they feel he represents – need to offer them something compelling in return. No one puts “Vote for the lesser of two evils” on a banner.

Stephen Bush is special correspondent at the New Statesman. He usually writes about politics. 

This article first appeared in the 28 July 2016 issue of the New Statesman, Summer Double Issue