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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The war on poaching

More than 1,100 rhinos were killed for their horns in Africa in 2016. Quasi-military conservation units are trying to stop the slaughter.

The Savé Valley Conservancy, 900 square miles of pristine wilderness in the Lowveld of south-eastern Zimbabwe, seems like a paradise.

Drive along its dirt tracks, past flat-topped acacias and vast-trunked baobab trees, and you scatter zebras and warthogs, impalas and wildebeest, kudus and waterbuck. Elephants lumber through the bush, leaving destruction in their wake. Giraffes placidly return your stares. Baboons cavort in the trees. A crowned eagle flies overhead with a rock rabbit in its talons. A pack of exquisitely patterned wild dogs lie on the warm red earth. There are lions and leopards, too, but out of sight.

My guide and I meet Bryce Clemence, the stocky, bearded outdoorsman who heads the conservancy’s Special Species Protection Unit (SSPU), by a muddy waterhole so that he can show us the most special of those species. He and a couple of his armed men lead us a few hundred yards into the bush before silently motioning us to stop. We wait, move on, stop again. Clemence points. Thirty yards away stands a two-tonne rhinoceros, a 15-year-old bull. It cannot see us, for rhinos have poor eyesight. It cannot smell us because we are downwind. But it senses our presence. Its ears revolve like miniature satellite dishes.

As we study this magnificent, primeval beast through our binoculars, one thing quickly becomes apparent. It has no horns. Normally it would have two, weighing seven kilos or more, but they have been removed in an effort to protect it. Rhino horn fetches around $60,000 a kilo in China and other east Asian countries, where it is considered an aphrodisiac and a cure for diverse ailments. This animal’s horns would have been worth more than $400,000 – a fortune in Zimbabwe, where the average household income is $62 a month and unemployment exceeds 90 per cent.

Sadly, not even de-horning works. Poachers will kill de-horned rhinos for any residual horn. In February 2015 they shot a six-month-old calf for just 30 grams of horn, Clemence tells me.

Savé Valley may look idyllic, but it is a front line in a war against rhino-poaching. More than 1,100 of the animals were killed across Africa in 2016, leaving barely 20,000 white rhinos, classified as “near threatened” by the International Union for Conservation of Nature, and 5,000 “critically endangered” black rhinos. What distinguishes Savé Valley is that it has begun to turn the tide, but only because it has access to the sort of funding that most African national parks can only dream of.

Clemence’s quasi-military operation consists of 35 highly trained men, all expert trackers, supremely fit and equipped with semi-automatic rifles and radios. Working in pairs, they do ten-day stints in the bush, monitoring the conservancy’s 168 rhinos from dawn to dark and endlessly searching for human tracks – or “spoor”.

They are supported by a canine unit whose two Belgian Malinois dogs can track at night and over rocks; a substantial network of paid informants in the surrounding communities and beyond; four 4x4 vehicles and 12 motorbikes; and nearly 100 armed scouts employed by the two-dozen private ranches that make up the conservancy.

Even that force is insufficient, Clemence says. The poaching gangs are growing more sophisticated. They now use high-powered hunting rifles with silencers to shoot the rhinos, and AK-47s to ward off the rangers. Sometimes the poachers use AK-47s against rhinos too: in 2014 one was hit 23 times.

They have begun using poison. One poacher was caught after laying oranges and cabbages laced with the pesticide Temik in the path of a rhino – Temik is nicknamed “Two-step” because that is how many steps an animal takes before dying. Another poacher planned to poison a waterhole, but was thwarted by an informer. “Poisoning is disgusting because it’s totally indiscriminate and has the potential to do massive harm,” Clemence says.

He has also caught poachers preparing to use the sedatives ketamine and xylazine. Having darted a rhino, they would then hack off its horns before it woke. They once hacked off the horns of a rhino that had been knocked out by a bullet and it woke with half its head missing. The creature survived for a week before Clemence’s unit found it. Vets had to put it down. “When you catch a poacher you want to beat him to death with a pick handle and very slowly break his bones, but you have to be professional,” says David Goosen, manager of the 230-square-mile Sango ranch, which forms part of the conservancy.

The odds are stacked against the SSPU in other ways, too. The poachers are paid well by the syndicates that run them – perhaps $5,000 each for a kilo of rhino horn. And even if caught, their chances of escaping punishment are high. Thanks to bribery or incompetence, just 3 per cent of prosecutions for rhino poaching in Zimbabwe end in convictions.

“You have to virtually catch them in the field red-handed, and even then they often get away with it,” Goosen says. “As soon as they get to the police station, a well-connected lawyer turns up, which means someone higher up is looking after their interests.” The maximum sentence for intent to kill a rhino is nine years for a first offence – less than for stealing cattle.

The SSPU is prevailing nonetheless. In the first three months of 2012, when Clemence arrived, the conservancy lost 14 rhinos. In 2015 it lost 12, last year three. It has also defeated Zimbabwe’s most notorious rhino-poaching gang.

Tavengwa Mazhongwe learned his craft from his older brother, “Big Sam”, who was killed poaching in 2009. Mazhongwe was responsible for at least 150 rhino killings, including many in Savé Valley. In December 2015 Clemence learned he was planning another attack and put his rangers on alert.

They found the gang’s spoor at 6.30 one morning, and tracked the four armed men in intense heat for nine hours. The gang took great care to cover their tracks, but late in the afternoon the rangers found them resting in a river bed. The rangers opened fire, killing one and seriously wounding a second. Mazhongwe and one other man escaped, but he was arrested near Harare two weeks later and given a record 35-year sentence for multiple offences. A judge had to acquit an officer in Zimbabwe’s Central Intelligence Organisation who drove the gang to the conservancy in a government vehicle because, he complained, the police did not dare investigate govenment officials. The rangers recovered an AK-47, a Mauser rifle with silencer, an axe, rubber gloves, a medical kit, tinned food and a phone-charger pack.

“You’ll never get to where you say ‘we’ve won’, but we have won in the sense that we’ve brought poaching down to a manageable level,” Clemence says. “We’ve taken out some of the most notorious syndicates. Victory will simply be breeding more than we’re losing and having sustainable numbers to pass to the next generation.” He hopes that the conservancy’s rhino population will reach 200 within two years, enabling it to relocate some animals to other parts of Zimbabwe where the battle is going less well.

The SSPU’s success comes down to skill, motivation, organisation and – above all – resources. The unit costs $400,000 a year, and is funded mainly by foreign NGOs such as Britain’s Tusk Trust. It receives practical support from the conservancy’s private ranches, some of whom – given the dearth of tourism – have to generate the necessary funds by permitting limited elephant and lion hunting for $20,000 an animal.

Zimbabwe’s national parks have no such resources. That is why private conservancies have 80 per cent of the country’s rhinos but 1.5 per cent of its land, while the parks have 15 per cent of the land but 20 per cent of the rhinos. Within a few years most of those parks will have no rhinos at all.

Martin Fletcher’s assignment in Zimbabwe was financed by the Pulitzer Center on Crisis Reporting

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