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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Why Isis seeks a battle with Western nations - and why it can't be ignored

Islamic State believes it must eventually confront and then defeat the West. To get there, it seeks to polarise Muslim and non-Muslim communities alike.

It was precisely the type of attack that had long been feared: a co-ordinated and brutal act of urban warfare that brought Paris to a standstill for more than three hours on an otherwise typical Friday night. Six of the nine attackers had spent time fighting for Islamic State in Syria. Indeed, it was the third act of international terrorism perpetrated by IS in a fortnight, a campaign that started with the bombing of a Russian Metrojet flight over Sinai in Egypt, followed by a double suicide bombing in Beirut that killed 41 people – the deadliest attack in the Lebanese capital since the civil war there ended in 1990.

There are several significant operational observations to be made about what transpired in Paris. The attackers wore suicide belts in which the active ingredient was TATP, a highly unstable explosive based on acetone and hydrogen peroxide. TATP was also used in July 2005 when the London transport network was attacked. Known as the “mother of Satan” because of its volatility, it is usually manufactured at home and it is prone to accidental detonation – or, indeed, sometimes fails to detonate at all.

When two weeks after the July 2005 attacks four bombers attempted to replicate the carnage, their bombs failed to explode precisely because they had not been manufactured properly. The same was true for Richard Reid, the “Shoe Bomber”, and Umar Farouk Abdulmutallab, the “Underwear Bomber”, who smuggled TATP explosives on to American aircraft in 2001 and 2009, respectively.

Perhaps the most worrying aspect of the Paris attacks is that every device proved to be viable – a reality born of the permissive environment in Syria and Iraq. A new generation of terrorists is now able to learn and rehearse the skills required to build devices that detonate successfully. The skills come with experience, and the newly ungoverned spaces of the Levant provide an ideal training ground.

Yet, for all the viability of the TATP devices used in Paris, the greatest loss of life came from assault rifles. This demonstrates how relatively unsophisticated tactics can still achieve mass casualties for terrorists determined to kill as many people as possible. The threat is particularly acute in mainland Europe, where automatic weapons move easily across the Continent, typically originating from criminal gangs in eastern Europe. Smuggling them into Britain is harder because the Channel limits the number of potential entry points.

The added protection resulting from Britain being an island is often overlooked. Just as guns are able to move more freely across the Continent, so, too, can people. This was brought into sharp relief when Imran Khawaja, a British man from west London who joined Islamic State in January 2014, attempted to re-enter the UK.

Khawaja had been particularly cunning. He hoped to slip back into Britain by evading the authorities after faking his own death in Syria, a plan his compatriots facilitated by eulogising and glorifying him. He then made his way across Europe by land, passing through several European countries before being arrested on arrival at Dover. None of this is to suggest that Britain does not face a very serious threat from Islamic State terrorism (it does), but the risks here are diminished compared to the threat facing countries in mainland Europe.


Trying to understand the strategic rationale behind Islamic State’s attacks outside Syria and Iraq is daunting. A degree of conjecture is required, although information gleaned from its communiqués, statements, and behaviour can go some way towards
informing a judgement.

It may seem obvious to observe that IS sees itself primarily as a state, yet this is worth restating, because other jihadist groups have made claims to statehood while continuing to act as terrorists or insurgents, tacitly recognising the nonsense of their own position. Not so Islamic State. It truly believes it has achieved the Sunni ideal of a caliphate and it acts accordingly.

This was the thinking that led the group to break from al-Qaeda, rebuffing Ayman al-Zawahiri’s position as the group’s emir. From Islamic State’s perspective, countries are not subservient to individuals. The significance of this self-belief became apparent last summer when the US began dropping aid parcels to stranded Yazidis who were otherwise starving and dying from exposure in the Sinjar Mountains of Iraq. The US also committed itself to protecting Erbil in northern Iraq by bombing IS fighters who were moving on the city, not least because US diplomats were based there and President Obama could not afford a repeat of the 2012 Benghazi debacle in Libya.

Islamic State responded by beheading its first Western hostage, the American journalist James Foley. Although the video of this was billed as a “Message to America”, it was directed specifically at Obama rather than the American people. In a speech evidently written for him, Foley told viewers that the US government was to blame for his execution because of its “complacency and criminality”.

When Mohammed Emwazi – “Jihadi John” – appeared in Isis videos as executioner-in-chief, he went some way towards explaining those accusations. “You are no longer fighting an insurgency. We are an Islamic army and a state,” he said. “Any attempt, by you, Obama, to deny the Muslims their rights of living safely under the Islamic caliphate will result in the bloodshed of your people.” To that extent, Islamic State has pursued a campaign of retribution over the past 12 months against those it regards as belligerent enemies: the United States, Britain, France, Russia and its regional arch-rival Hezbollah, the Lebanese-based and Iranian-backed Shia militia.

There is an unspoken corollary to this approach, too: that Islamic State wants to make the cost of acting against it so unbearably high that its opponents are intimidated into acquiescence. For all its nihilistic sadism, IS is a rational actor. The group controls a large landmass, enjoys autonomy and makes claims to a revived caliphate. That is a project it wants to continue expanding and consolidating by being left alone to overrun the Middle East, a process that involves massacring minorities, including the Shias, Christians, Yazidis and Kurds.
If the West intervenes in this it must be prepared to face the prospect of mass-casualty terrorism at home.

Some will invariably argue that this is precisely what we should do. Leave them to it: Islamic State may be distasteful, but the cost of acting against it is too high. Besides, we cannot police the world, and what concern is it of ours if Arab societies implode in this way?

This view overlooks a broader (and inevitable) strategic imperative that can never be divorced from Islamic State. The group’s millenarianism and commitment to eschatological beliefs are such that it wants to be left alone – for now.

IS ultimately believes it must confront and then defeat the West in a comprehensive battle between haqq and batil: truth and falsehood. That became clear enough when Abdul-Rahman Kassig (originally Peter Kassig) became the fifth Western hostage to be executed by IS in November last year. The video of his killing was different from those that preceded it and started with the execution of 21 soldiers from the Syrian Arab Army who were fighting on behalf of President Bashar al-Assad.

A short speech by Mohammed Emwazi – again, directed at Obama – noted that the execution was taking place in Dabiq, a town in north-western Syria. The significance of this is not to be underestimated. Dabiq is noted as being the venue of a final showdown between the armies of Islam and those of “Rome”, a reference to the superpower of the day.

“To Obama, the dog of Rome, today we’re slaughtering the soldiers of Bashar and tomorrow we’ll be slaughtering your soldiers,” Emwazi said. “We will break this final and last crusade . . . and here we are burying the first of your crusader army [Kassig] in Dabiq.”

Kassig was branded a “crusader” because he had served in the US armed forces.

That final encounter is not necessarily reliant on Western intervention. Emwazi explained that Islamic State would also use Dabiq as a springboard to “slaughter your people on your streets”. Thus, for Islamic State, a confrontation with the West is inevitable. It would rather be left to consolidate its position for now, but there is no eventuality in which we could expect to escape its sabre-rattling indefinitely.

The religious significance attached to sites such as Dabiq plays a huge role in motivating the fighters of IS. While the world looks on with horrified bewilderment at its rampages, the power of its eschatological reasoning provides some insight.

Writing shortly after Russia entered the conflict, a relatively well-known Dutch fighter called Yilmaz (also known as Chechclear) invoked the importance of end-times prophecies. “Read the many hadith [sayings of the Prophet Muhammad] regarding Bilad al Sham [Greater Syria/the Levant] and the battles that are going to be fought on these grounds,” he said. “Is it not slowly unfolding before our eyes?”

Herein lies the power of Islamic State’s reasoning – its fighters, and the movement as a whole, draw huge succour from the religious importance of the sites around which they are fighting. It serves to convince them of the righteousness of their cause and the nobility of their endeavours.

Faced with a campaign of Western aerial bombardment (albeit one that is limited and unambitious), Islamic State has decided to bait its enemies into fighting it on the ground. To that end, towards the end of the Kassig execution video, Emwazi advises Obama that Islamic State is “eagerly waiting for the rest of your armies [sic] to arrive”.


One final point should be noted about the possible strategic aims of the Paris attacks of 13 November. Islamic State has been dispirited by the mass migration of Syrian refugees into Europe. Instead, it has appealed to them to migrate eastwards, towards the caliphate, rather than into disbelieving Western nations.

In an attempt to dissuade refugees from heading to Europe, IS released a series of videos featuring Western foreign fighters – including some from France – who told viewers how much they despised their home countries. Their message was one of persecution, of Muslims under siege, and of a hostile, unwelcoming Western world.

By way of contrast, they attempted to display the benefits of living in the so-called caliphate, with stilted images of the good life that would make even North Korean officials blush: schoolchildren in class, doctors in hospitals, market stalls filled with fresh produce.

Smuggling fighters into France who had posed as refugees is likely to have been a deliberate and calculating move, designed to exploit fears among some about the potential security risk posed by accepting Syrian refugees. Islamic State likens refugees seeking a future in Europe to the fracturing of Islam into various encampments following the death of the Prophet Muhammad in 632AD. Most of these sects arose from divisions over who should succeed the Prophet in leadership of the Muslim community, but some went into open apostasy.

Viewing events in this way, Islamic State argues that any Muslim not backing its project is guilty of heresy. For refugees to be running from it in such large numbers is particularly humiliating: the group even ran an advert that juxtaposed an image of a camouflaged military jacket alongside that of a life vest. A caption read, “How would you rather meet Allah?”

An article published this year in Islamic State’s English-language magazine Dabiq made this very point. It noted that: “Now, with the presence of the Islamic State, the opportunity to perform hijrah [migration] from darul-kufr [the land of disbelief] to darul-Islam [the land of Islam] and wage jihad against the Crusaders . . . is available to every Muslim as well as the chance to live under the shade of the Shariah alone.”

Islamic State recognises that it cannot kill all of the refugees, but by exploiting European fears about their arrival and presence, they can at least make their lives more difficult and force them into rethinking their choice. All of this falls into a strategy where IS wants to eradicate what it calls the “grayzone” of coexistence. Its aim is to divide the world along binary lines – Muslim and non-Muslim; Islam and non-Islam; black and white – with absolutely no room for any shades of grey.

“The Muslims in the West will quickly find themselves between one of two choices, they either apostatise and adopt the kufri [infidel] religion propagated by Bush, Obama, Blair, Cameron, Sarkozy and Hollande in the name of Islam so as to live amongst the kuffar [disbelievers] without hardship, or they [migrate] to the Islamic State,” says an editorial in Dabiq magazine. “The option to stand on the sidelines as a mere observer is being lost.”


Atrocities such as the Paris attacks are designed to put a strain on the “grayzone”, thereby polarising Muslim and non-Muslim communities alike. Indeed, this is precisely what Islamic State said it hoped to achieve after the Malian-French radical Amedy Coulibaly declared, in a video released two days after his death, that he had participated in the Charlie Hebdo attacks on IS’s behalf. “The time had come for another event – magnified by the presence of the Caliphate on the global stage – to further bring division to the world and destroy the grayzone everywhere,” Dabiq said.

Beyond the tendency of all totalitarian movements to move towards absolutism in their quest for dominance, Islamic State also believes that by polarising and dividing the world it will hasten the return of the messiah. Once again, eschatology reveals itself as an important motivating principle.

This is both a blessing and a curse for Islamic State. Certainly, it is what underwrites its remarkable self-assurance and certainty and at the same time fuels its barbarism. Yet it may also prove to be its unravelling. IS has now attacked Russian and French civilians within a fortnight, killing hundreds. The wider world is finally realising that Islamic State is a threat it cannot afford to ignore.

Shiraz Maher is a contributing writer for the New Statesman and a senior research fellow at the International Centre for the Study of Radicalisation at King’s College London

Shiraz Maher is a contributing writer for the New Statesman and a senior research fellow at King’s College London’s International Centre for the Study of Radicalisation.

This article first appeared in the 19 November 2015 issue of the New Statesman, The age of terror