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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Boris Johnson is disloyal, cynical and lazy - now it's up to Michael Gove to stop him

Theresa May is another serious contender for the crown.

UPDATEMichael Gove appears, at the eleventh hour, to have learned something about Boris Johnson that anyone who has worked with him either in journalism or politics could have told him years ago: that Johnson is entirely unreliable. The leaked email in which Gove’s wife, Sarah Vine, warned him of the assurances he needed to get from Johnson before pledging himself as the key supporter in his campaign turns out to have been the writing on the wall for a clear run for Johnson. Word was swirling round Westminster after the email was leaked that Johnson appeared to have offered the same senior cabinet post – believed to have been the Treasury – to more than one person in return for support. Perhaps this was down to incompetence rather than dishonesty. Gove has made his own judgment, and it is, for an intelligent and serious man, an inevitable one.

Many Brexiteers, who feel that someone who shared their view should end up leading the Tory party, will be delighted by Gove’s decision. There was deep unease among many of them about the idea of a showman rather than a statesman inevitably ending up in Downing Street. What Gove will need to do now is to persuade colleagues who had gone behind Johnson because they did not want Theresa May to shift behind him. Some of Johnson’s supporters caused enormous surprise by their decision – such as Sir Nicholas Soames, who spent the referendum campaign denouncing Johnson on his Twitter feed – and they are not natural bedfellows of his. One Tory MP told me before Gove’s decision to stand that a group of “sensible” Tories had accepted the inevitability of a Johnson victory and had decided to get around him to try to keep him on the straight and narrow. The view that Johnson is unstoppable is now going to be tested, possibly to destruction, and those who had made the leap to support him may now well leap back.

Following Theresa May’s very assured launch of her campaign, which radiated statesmanship and sincerity, the Brexiteers need to ask themselves what sort of candidate is going to provide the best challenge to her, for she is clearly formidable. Given the choice between a volatile buffoon taking her on or someone who is more level-headed and serious doing so, the latter must inevitably be the best option. Johnson has never looked like a unifying figure, and certainly not one it was easy for rational people to imagine leading the country in an international context.

Gove’s decision not to support Johnson does not merely withdraw his personal support. It will withdraw the support of many who were prepared, reluctantly, to follow his lead and join the Johnson campaign. It has a parallel in history, which was William Hague’s decision to run on his own account instead of supporting Michael Howard in the 1997 contest after the party’s annihilation by Tony Blair. Hague won, and turned out to be a hapless leader. Gove is made of heavier metal and the party is in less perilous circumstances, so the outcome for him, should he win, ought to be better.

In the last few days a considerable portion of the Tory party has taken leave of its senses. In such a condition, envisaging Johnson as its leader was easy. Sanity and calm are now prevailing. The Brexiteers in the party – or at least that group of them resolute that they cannot have a remainer as leader - can now reflect on whether it wants an act or a politician to become prime minister. At least, thanks to Mr Gove, it now has a choice.

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Once upon a time, often within hours of a prime minister resigning, a “magic circle” of Tory grandees would decide after “soundings” whom to send to Buckingham Palace to kiss hands as the new man. Now, the 1922 Committee of Tory backbenchers has sought to do what it can to emulate the process, fast-tracking the election of David Cameron’s successor so that he or she is in place by 9 September, and ignoring calls for a period of wider reflection on whom the party needs to take it forward through the uncharted waters of negotiating an exit with the European Union. Longer consideration may have been helpful, given that the party is choosing not merely
its leader, but the next prime minister.

At the time of writing, it appears the main fight will be between Boris Johnson and Theresa May. Jeremy Hunt proposed himself as a “second referendum” candidate, even though the Tory party in particular wants another plebiscite about as much as it would like to put its collective head in a mincer. There is talk of two lesser cabinet ministers, Stephen Crabb and Sajid Javid, presenting a “joint bid”, even though such a concept is unknown to the Conservative constitution; and others are floating around the margins. The tumult reflects the hysterical state of mind in the party: no one in Cameron’s inner circle expected the British public to disobey orders, including, one starts to imagine, Johnson. It is only the preposterous events in the Labour Party that have stopped the Tories from seeming to be completely out of control.

It has become Tory party lore that the favourite never wins, on the precept that he who wields the knife never ends up wearing the crown: but as of now, at least, many of the Tory MPs believe nothing can prevent their colleagues voting in sufficient numbers to put Johnson in the second and final round of the contest, the one in which all paid-up members may vote. And if he gets there, they feel, the outcome is even less in doubt: he will win.

Predicting this will happen and wanting it to happen are, of course, not the same thing. A distressed Tory MP told me he expected Labour sympathisers to join his party to vote for Johnson, rather as mischievous Tories joined Labour to elect Jeremy Corbyn. The rules, however, forbid such last-minute purchases of a vote: yet the sentiment shows what an equally substantial group of Tory MPs think of Johnson’s capabilities, and explains why the anyone-but-Boris movement sprang into action the instant Cameron ran up the white flag. They know that, for all Johnson’s failings, and there are many, he has the entertainer’s knack of making people love him. Sadly – and this is the part his adoring public doesn’t see – things can be very different when he enters his dressing room and starts to take off the make-up. As Sir Alan Duncan said forthrightly last weekend, there is the small matter of Johnson lacking the gravitas and experience to be a credible prime minister, something MPs should have the wit to take into account even if the party in the country at large does not.

The Johnson phenomenon is not the least reason why even some of Cameron’s most consistent critics did not call for him to resign if he lost the referendum. The more time the Tory party had to consider Johnson as a potential leader, and what that entails, the better. Some MPs are angry that Cameron did not take immediate responsibility for cleaning up the mess he had helped make and preside over the exit negotiations. His colleagues feel he simply couldn’t be bothered, which is consistent with the often idle way he ran both his opposition and the government – an idleness that prevented him putting any contingency plan in place. The grand gesture, the great claim and the sweep of rhetoric are very arresting, and take little time. Following through is harder: but Cameron has a long record of not considering the consequences of words and actions, and this debacle for him is the ultimate, and most spectacular, example.

The pessimism that Johnson’s detractors feel about stopping him rests in what they know and see of the self-interest of their more bovine colleagues. The first concern of one group is to back the winner, and they think that will be Johnson (something with the status, in those circumstances, of a self-fulfilling prophecy). They also think that should Labour find a new leader and become a serious opposition, Johnson is the man most likely to win an election. Whether that would come next spring – if the new leader sought a new mandate as Gordon Brown did not in 2007 – or in 2020, as the Fixed-Term Parliaments Act decrees, is a separate but important question. Johnson’s acolytes have let it be known he would not call an early poll. He (or any other leader) would be absolutely constitutionally justified in not doing so. More to the point, you do not plot from the womb to become the Queen’s first minister only to risk chucking away the key to the Downing Street drinks cabinet after a few weeks. However, a weakened Labour Party may prove an irresistible target, and Tories recall how history would have been different if Gordon Brown had gone to the country in the autumn of 2007, as many urged him to do.

The press – and not just on the left – could well give Johnson a hard time. His baroque private life has exhausted its capacity to shock, but there is scope to scrutinise his record of underachievement as mayor of London; or Michael Howard’s sacking him for lying; or the Times sacking him for making up quotations (from his godfather) in a story; or his offering to assist his old schoolfriend Darius Guppy in having a journalist who had disobliged Guppy beaten up. Or perhaps, in the present political mood of the Western world, he can emulate Donald Trump, being able to say and do the most appalling things and yet still encourage vast numbers to vote for him.

Theresa May’s ambitions have been barely concealed. She has been “on man­oeuvres” since the 2015 general election. She worked out that the best way to manoeuvre during the referendum campaign was to say nothing, to avoid becoming a divisive figure. Aside from some rare moments of half-hearted support for Remain, that is exactly what she did. Had she gone the other way, the leadership contest might be closer, because her seniority and experience would have matched Johnson’s charisma: as it is, the best her colleagues believe she can hope for, barring some dramatic development, is to come second. A Times poll on Tuesday said that Tory voters preferred her to Johnson, which has the smell of accuracy about it. Activists – those with a vote – are a different matter. They appear in no mood at the moment to elect a Remainer.

Yet they are in some measure in the mood to elect a unifier: and, for all his attempts at sober statesmanship since the vote, Johnson (given his past) will have to stretch credulity even more than usual to convince as one of those. The anyone-but-Boris movement is motivated by the list of his perceived offences and character defects. Few believe he would have plumped for Leave had he thought it would lose: Johnson’s years on the rubber chicken circuit, and his mailbag from Telegraph readers in the provinces, made him more aware than most of his metropolitan colleagues of the true nature of public feeling outside the bubble. He is seen as utterly flexible in terms of principle: and, from the nature of his campaign rhetoric, as disloyal, cynical and lazy. Critics recall the number of deputy mayors (seven at one point) he required to do his last job. He is widely considered untrustworthy.

Perhaps he can unify activists who seem near universally to admire his carefully manufactured persona: he will find it harder to unify the parliamentary party, and would probably require a resounding general election victory before doing so. Even then, doubts born of years of witnessing his buffoonery and prevarication would be hard to allay.

***

MPs felt that two other Brexiteers had far better credentials as unifiers. The most obvious was Michael Gove, whom some tried to persuade to stand; but Gove signalled his willingness to throw in his lot with Johnson.

The other increasingly discussed name in the days after the referendum was Andrea Leadsom, the energy minister and, before that, economic secretary to the Treasury. Many even in her own party never thought of her as a potential leader until recent weeks: but these were weeks in which she showed her key virtues. She is intelligent and capable. She had a long career in business before entering government, and presents a happy contrast to ministers who spent their lives as special advisers before gracing the back benches. Leadsom is deeply principled but also reasonable: she abstained in the vote on same-sex marriage because she did not want to show a lack of respect to homosexuals and lesbians who wished to solemnise their relationships, but she could not support the notion because of her religious views. Remainers consider her to have performed uniformly well in debates and television interviews during the EU campaign, because she avoided personal attacks, spurious claims and wild threats.

She is popular with her colleagues. However, if she has let her name go forward she will start from the back of the field. It would require the sort of organisation that enabled Mrs Thatcher to beat Ted Heath in 1975 if she were to pull this off. However, should Johnson implode during this campaign, and she had become a candidate, she would be fabulously well placed to pick up his voters.

May would seem to be way ahead as the Remain candidate, but will have to earn that position in the hustings that will run over the summer. The dark horse is Stephen Crabb, who replaced Iain Duncan Smith at Work and Pensions, in league with Sajid Javid, a secret Leaver who called it wrongly and who is now trying to salvage his future. A self-deprecating man from a humble background and with few enemies, Crabb, who was previously Welsh secretary, reminds me of John Major, who was brought into the cabinet and rose rapidly. In a leadership campaign held in the middle of a parliament, Major won and became prime minister, trading heavily on a backstory of his unprivileged upbringing. If Crabb ends up being nominated, he may be the man May must beat if she is to be the principal challenger to Johnson.

George Osborne has ruled himself out but remains relevant. He wants to carry on in government and, like the overgrown student politician he is, may be about to make an accommodation with those he has denounced for months in order to continue to hold a senior post. Also, not least because of Cameron’s laziness and casual attitude towards his party, he had exercised a substantial and growing influence over patronage and especially over senior government appointments. He had made a point of getting to know MPs on the way up, not least because he expected to be prime minister and wanted to be sure he had a clientele of loyalists to support him. He was starting to appoint his ministerial team, in effect, before becoming prime minister.

Osborne’s prospects have crashed, but his machine remains, for the moment, intact. If he has chosen wisely, he has a group of loyalists whom he can deploy in support of the candidate he chooses. However, now he can be of no use to his clients, it will be interesting to see whether they take the blindest bit of notice of him.

There is talk of Johnson making him foreign secretary, which would show an advanced sense of humour, given the role that person might have to play in the exit negotiations. Gove, if he has thrown in his lot with Johnson, might end up as chancellor.

The party is so fractious that the next nine weeks could provide a roller coaster: any talk of going back on the idea of strict border controls, for instance – something Johnson has hinted at – could cause huge turbulence. I suspect we are about to find that conducting a leadership contest at any time is a project laced with tension; to conduct one in a climate of scarcely concealed hysteria is not least why anything could yet happen.

Simon Heffer is a columnist for the Daily and the Sunday Telegraph

Simon Heffer is a journalist, author and political commentator, who has worked for long stretches at the Daily Telegraph and the Daily Mail. He has written biographies of Thomas Carlyle, Ralph Vaughan Williams and Enoch Powell, and reviews and writes on politics for the New Statesman

This article first appeared in the 30 June 2016 issue of the New Statesman, The Brexit lies