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

Jean-Luc Mélenchon. Photo; Getty
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How Jean-Luc Mélenchon built a resistance

Like Jeremy Corbyn, France's leftist candidate for the presidency has been caricatured by the media. Nonetheless, he has succeeded in building a movement. 

After months of indifference, the rise of Jean-Luc Mélenchon in the French presidential race has finally caught the attention of the British media. Still, it is frequently misrepresented and reduced to familiar categories: populism, Euroscepticism and spendthriftedness, with commentators quick to draw parallels with Jeremy Corbyn. However, to boil down the Mélenchon phenomenon to such clichés is to fundamentally misunderstand it. 

The authors of this article propose taking a closer look at a highly innovative manifesto and campaign. Cambridge University lecturer Olivier Tonneau is involved with La France Insoumise (France Defiant) and co-authored the cartoon version of Mélenchon’s programme. He runs a blog dedicated to exposing its policies and addressing the many rumours and falsehoods floated about the candidate. Nick Jones is a student who was in Paris at the time of Nuit Debout, and experienced first-hand the energy and thirst for radical change in France.

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Given the deep wound that Brexit has inflicted upon British society, perhaps the most urgent clarification is that Mélenchon does not wish to leave the EU, although he does have a radical strategy to reform it. France and Britain have different relations to the EU. Whilst Britain’s austerity policies were self-inflicted, the same is not true of France. The French people voted “no” to the European constitution in 2005 only to see its vote overturned in Parliament by a coalition of the center-left and center-right parties. This event marked a tectonic shift in French politics, and incidentally determined Mélenchon’s break from the Socialist Party. In 2012, François Hollande was elected on the promise of renegotiating the Lisbon treaty, a promise he failed to hold, and proceeded to impose austerity measures in France (cutting down public spending and corporate taxes, flexibilising the labour market), constantly justifying these measures by the necessity to abide by European norms. He has thus fuelled a deep resentment against both the center-left and the EU. Meanwhile, Mélenchon has campaigned for a showdown with the EU: reform it or leave it (“plan A, plan B”).

His strategy, designed by his chief economist Jacques Généreux, consists of unilaterally disobeying European Treatises: disregarding budgetary norms to implement a Keynesian stimulus package, creating a public investment bank, and ending privatisation policies. His prognosis is that the EU will not dare exclude France because such an exclusion would signal the end of the European project altogether. The EU will thus have to inscribe French exceptions to the treatises (just as it had done for UK). Such exceptions could prove highly desirable to other austerity-stricken countries such as the infamous PIIGS (Portugal, Ireland, Italy, Greece and Spain), with enormous pressure placed on the most intransigent promoters of austerity, the chief of which is Germany.

Far from being anti-European, this strategy is aimed to save the European project which, according to Généreux, is doomed to implode if unreformed. Généreux had reached this conclusion as early as 2012: Brexit and the European-wide rise of the far-right has confirmed his diagnosis. Unencumbered by a reluctant party, Mélenchon has been able to forcefully defend a position that Corbyn was unable to hold, thus shattering the “in/out, good/bad” dichotomy of the Remain and Leave campaigns in the UK.

Already, by 2012, Mélenchon’s Parti de Gauche (co-founded with the Green MP Martine Billard) had published an eco-socialist manifesto which advanced on the Left’s historical bend towards productivism. This time round, Mélenchon’s program is an environmentally focused Keynesian plan. Its aim is to turn France into using 100 per cent renewable energy by 2050 – ending the country’s heavy dependence on nuclear power – by implementing the “negawatt scenario” elaborated by a collective of scientists and engineers.

Mélenchon is especially determined to make the most of France’s maritime territory – the second largest in the world. His program also addresses in detail matters of public health: for instance, schools should serve organically sourced products exclusively, securing a market for organic producers. The turn to organic production, for instance, is expected to create 300,000 jobs. Mélenchon’s environmental plans tie in neatly with forensic budgeting and a clear plan for job-growth, in line with the “One Million Climate Jobs Now” campaign in the UK.

Another aspect of Mélenchon’s Keynesian plan is its redistributive policies. Low and middle wages are spent within the economy on essential goods such as food and clothing, whereas high wages are lost in the speculative bubble: by raising the minimum wage, pensions, and social benefits, Mélenchon intends to boost demand and help small and medium businesses prosper. He also acknowledges the need to reduce working time, without necessarily cutting the length of the working week. Instead, he wishes to return the retirement age to 60 – a measure that is acutely urgent given the high unemployment rate among senior citizens – and impose a strict adherence to the current, 35-hour week.

Impossible to fund? Not at all. More than hundred economists from 17 countries – including Ha-Joon Chang – published a column supporting Mélenchon’s program. His policies were presented in details by economists and high-ranking public servants in a 5-hour budget program broadcasted on YouTube, whose last hour was a discussion with economic journalists from liberal news outlets. Ghilaine Ottenheimer from Challenge praised the broadcast as “modern” and “bold”; Hedwige Chevrillon (BFM Business) compared the approach to that of the ‘slow food movement’ and deemed it a rare opportunity to think things through; Marc Landré (Le Figaro) was impressed by the openness with which La France Insoumise was laying itself open to criticism.

The broadcast has already been viewed more than half a million times. On every aspect of its program, from the environment to counter-terrorism via culture and international relations, La France Insoumise has taken the same care to involve experts. Who, then, are the ‘Insoumis’? How did such an extraordinary campaign get off the ground? This question takes us back to 2012.

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After Mélenchon’s remarkable 2012 campaign, the Front de Gauche fell apart because of strategic disagreements: the Communist Party wanted to maintain alliances with the Socialist Party whereas Mélenchon was convinced that any association with the now hugely-unpopular party of Hollande could only drag them with its fall. When Mélenchon claimed in 2015 that he did not aim to ‘unite the left’ but to ‘federate the people’, it was widely perceived as the desperate gambit of an isolated figure. And yet the gambit paid off: there was indeed a people to answer his call. With the massive demonstrations against Macron’s labour laws and the grassroots movement Nuit Debout, the writing was on the wall. Mélenchon was careful not to lay claims to these movements which were profoundly suspicious of established politicians and parties, but he has nevertheless been able to tap into their energy by creating La France Insoumise, a loose structure within which everybody contributes freely.

The Insoumis have shown ebullient creativity: some created a board game, others a computer game (Fiscal Kombat), and one of the authors of the present article wrote a comic book adaptation of the manifesto. Alongside quirky stunts such as appearing at meetings via hologram, the Insoumis have brought a vitally seductive and energetic edge to Mélenchon’s campaign. Crucially, they have brought to fruition another aspect of Mélenchon’s strategy: his struggle against the press.

In 2012, Mélenchon often claimed that the media was the “second skin of the system”. The only way to break the neoliberal hegemony was to subvert its own logic: that of audience and profit. Thus was created the colourful figure who claimed to incarnate “the sound and the fury of his time”. Yet, having become a celebrity, Mélenchon had to avoid being pigeon-holed into a caricature. The media, he claims, are “not a mirror but an arena”, so he adopted a confrontational strategy aimed at exposing the biases of journalists and interviewers.

Yet there is only so much one can say in the constraining format of TV and radio interviews; all one could achieve was to fire “bullet words” that would open cracks in the listeners’ preconceptions. In response, listeners had to be provided with alternative sources of information. In 2012, Mélenchon’s blog was the most read of any French politician; in 2013, a galaxy of “6th Republic blogs” was created; in 2016 Mélenchon’s extremely successful YouTube channel was launched; it has so far has over 22 million views. The book detailing his manifesto, L’Avenir en commun (A Shared Future) has found its way into bestseller lists, shifting well over 250,000 copies. If such independently-made material is inaccessible to non-French speakers, international viewers should not be tricked into seeing it as Trump-style, anti-system fake news. For example, a host of global NGOs including Oxfam and ActionAid have backed key aspects of Mélenchon’s campaign, with Amnesty and Greenpeace ranking him highest overall in their breakdown of all the candidate’s policies. Leading economists have also signed a pledge backing his candidacy will be published this week.

The communication machine of Defiant France is firing on all cylinders. It is remarkable that the fear-mongering of the mainstream media has failed to halt Mélenchon’s surge in the polls – remarkable, but not surprising given that his latest meeting, in Toulouse, was attended by 70,000 people, and had attracted 320,000 views on YouTube in under 24 hours. 

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Do not be mistaken: something astonishing is happening. This is about much more than meeting attendance. To be sure, Mélenchon is not simply preaching to the choir: bucking all recent trends, recent polls have shown that he is denting Marine Le Pen’s share of the working-class vote, and has overtaken her as the most favoured candidate of the youth. People are flocking from all across the political spectrum: recently, an entrepreneur from the Silicon Valley published a piece titled If Mélenchon is elected, I return to France.

He is not an isolated case, and a petition of the entrepreneurs with Mélenchon has just been launched. Even the ‘Gaullists’, disillusioned with the Fillon scandals, are now seduced by Mélenchon’s cultural style, his integrity, and his vision of France’s place in the world which is in line with the tradition of the General himself. What seemed like a fanciful vision is thus coming true: the French people is being transformed. One of the most striking signs of the campaign’s success is the change in people’s priorities: whilst employment had always ranked first, it has now been displaced by institutional reform. This, of course, is intrinsically tied to the centrepiece of Mélenchon’s program, which aims to accomplish no less than a Révolution citoyenne: creating the 6th Republic by means of a Constituent Assembly.

Under the Nazi Occupation of France, resistance networks sought not only to liberate the country, but also to bring about a better world. At great peril, they formed the National Resistance Council and drafted a program which was circulated under the cover of a novel titled Les Jours Heureux. It is no coincidence that the crowds at Mélenchon’s meetings do not chant his name but the word “resistance”, and that Melenchon himself synthetizes his aim with the phrase “let us bring forth the happy days”. The perils are undoubtedly lesser but with a deeply dysfunctional economic system preventing us from addressing climate change and fuelling the rise of the far-right, the stakes may be even higher.

Olivier Tonneau is lecturer in Modern and Medieval Languages at Homerton College, Cambridge. He participates in La France Insoumise, the movement supporting Jean-Luc mélenchon's presidential campaign. He writes a blog on French politics. Nick Jones is in the final year of his undergraduate degree studying French at Homerton. During his year abroad in Paris, he was a participant in, and keen observer of, the grassroots movement Nuit Debout. 

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