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

© LEWIS MORLEY/NATIONAL MEDIA MUSEUM SCIENCE & SOCIETY PICTURE LIBRARY. COURTESY OF VICTORIA AND ALBERT MUSEUM, LONDON
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Nostalgia without memory

We had a terrific time in the Sixties – but at what cost to the millennial generation?

There is a flurry of Sixties-worship at present, with an exhibition at the ­Victoria and Albert Museum in London and a cinema documentary about the Beatles’ ­touring years directed by Ron Howard. Next month, two more books on the ­subject will join the pile to which I have admittedly contributed more than my share. Steve Turner’s Beatles ’66: the Revolutionary Year reconstructs the band’s exploits in that eventful season (also recently chronicled in Jon Savage’s weighty 1966: the Year the Decade Exploded). And Paul Howard’s I Read the News Today, Oh Boy tells the story of Tara Browne, the gilded young Guinness heir whose death at the wheel of a Lotus Elan inspired John Lennon’s greatest song, “A Day in the Life”.

Truly, this is the decade that never dies. At frequent intervals since the mid-­Eighties, glossy magazines have announced that “the Sixties are back”, with fashion spreads of Paisley fabrics, Mary Quant-ish bobs, ­shorter-than-ever miniskirts and elastic-sided Chelsea boots. Sixties pop music eternally dominates radio playlists, while the Rolling Stones, the decade’s most notorious band, though now withered old-age pensioners, are still widely reckoned the coolest, most dangerous dudes on the planet.

For that, we largely have to thank the “Sixties children”, who lived through the most magical time for youth there ever was, survived its surfeits of alcohol, sex and mind-shredding drugs, and now seek to perpetuate their glorious heyday even unto senility. But the greatest celebrants of the era are often people who never experienced it first-hand yet still yearn for it in a syndrome that psychologists call “nostalgia without memory”. Tony Blair’s “Cool Britannia” shtick in the Nineties, for instance, pastiched the Swinging London of three decades earlier, right down to the Union Jack carrier bags. In folk memory the Sixties are as a rosy blur of psychedelic colour, free love and Beatles music, their complexity and manifold horrors either unrealised or disregarded.

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The mythic decade, as opposed to the real one, was no straight ten-year stretch. It didn’t get into gear until 1962 with the satire boom that produced BBC TV’s That Was The Week That Was, David Frost’s first starring vehicle, and Private Eye magazine, and didn’t absorb pop music until the Beatles’ historic first visit to America in 1964. Its closing year, marked by a series of vast open-air festivals – Woodstock, Bob Dylan on the Isle of Wight, the Stones’ free concert in Hyde Park – felt almost like a decade on its own. When 1970 dawned, so much resembling a grey morning-after, many Sixties children simply refused to believe the party was over and clung to their caftans and joss sticks far into the harsh new eras of glam rock and punk.

Its prime time is generally agreed to have been 1965, when London gave vent to a concerted burst of youthful creativity in music, art, fashion, photography, cinema and graphics, and a shabby, sleepy metropolis, bombed to ruins not long previously, received the unlikely sobriquet of “swinging”. At this stage, the swinging was confined to a small circle of musicians, models, actors and photographers, congregating in the same few, unpublicised bistros and clubs: the most emblematic pop single, among so many, was Dobie Gray’s “The ‘In’ Crowd”.

It is seen above all as an era of burgeoning freedom and tolerance when Britannia seemed to be loosening her Victorian stays one by one. The contraceptive pill became widely available, ending centuries of shotgun marriages and perilous backstreet abortions, and theatre censorship by an archaic royal flunky called the Lord Chamberlain came to an end. Male homosexuality was decriminalised, though not yet destigmatised, and the first feminist voices spoke out. The word “fuck” appeared in the Times (during the farcically unsuccessful obscenity prosecution of Penguin, publisher of D H Lawrence’s Lady Chatterley’s Lover) and was heard on BBC Television, albeit only in quotation marks, from the National Theatre’s literary manager, Kenneth Tynan.

Yet alongside the pop-cultural harlequinade, Britain faced many of the same problems as we do today – some, indeed, significantly worse. Industrial strife was so common that the rest of Europe came to know strikes as “the English disease”. Harold Wilson’s Labour government, continuously in power after 1964, imposed a strict wages freeze, then known as a “pay pause”, and failed so utterly to solve its own financial deficit that in 1967 Wilson was forced to devalue the pound by 14 per cent. The World Cup-winning 1966, that supposed annus mirabilis, also brought two events whose horrors still resonate: the Moors murders trial and the Aberfan disaster, in which a south Wales primary school was engulfed by a giant slag heap, killing 116 children and 28 adults.

Meanwhile, the outside world was taking its first steps backwards into hell. America’s inspirational young president John F Kennedy was assassinated, as, in horrifically quick succession, were his brother Robert and the great civil rights leader Dr Martin Luther King. The United States was shamed at home by racism and police violence (not much change there, then) and abroad by its war in Vietnam, which nightly filled British TV screens with images of bombed civilian enclaves and maimed children (little change there, either – except today barrel bombs replace napalm). A democratic movement in communist-controlled Czechoslovakia was crushed; there was incalculable murder and terror in China’s Cultural Revolution, genocide in Indonesia and Biafra, apartheid in South Africa and endemic famine in India. June 1967 brought not only Sgt Pepper’s Lonely Hearts Club Band and the “Summer of Love” but the Arab-Israeli Six Day War, whose cumulative effects remain seemingly impossible to resolve.

Throughout the Sixties, Britain, along with the rest of western Europe, faced the threat of nuclear war with Soviet Russia and more-than-possible total obliteration. And yet, paradoxically, this was a time of enviable domestic peace and stability. There was full employment, with almost nobody ever getting sacked except at the very top. Inflation was marginal; the NHS and other public services functioned without any hint of crisis; the nationalised railways, shorn of unprofitable branch lines by Lord Beeching, were dirty but dependable; the postal service, even after the introduction of an avowedly “second-class” tier, remained the envy of the world.

Pending that terminal flash in the sky, people felt safe. The only communicable disease left to be feared was smallpox. ­Terrorism was something that happened only in the distant Middle East: it could not conceivably take root among Britain’s hard working and law-abiding Indian and Pakistani immigrants despite the unfettered racism constantly hurled at them. One walked on to aircraft or into official buildings or the BBC without security checks. The first shadow of Northern Ireland’s Troubles, which were to bloody the Seventies and be described by American commentators as “Britain’s Vietnam”, did not appear until 1968.

Two world wars in the space of 30 years had trained ordinary Britons to feel guilty about any conspicuous consumption. In the Sixties, the advertising industry set about remedying this. The new Sunday newspaper colour supplements bulged with adverts for Scandinavian furniture, stereo systems and white Kosset carpets, and bombarded their readers with recipes for exotic dishes such as chicken Kiev and beef stroganoff, using quantities of butter and cream that once would have seemed downright immoral. When Rowntree launched a new wafer-thin chocolate mint, the company made a last-minute name change from Minty Thins to After Eight, suggesting elegant high-society dinner parties to a demographic only recently weaned from high teas. So older generations, too, could join an “in” crowd and share the feeling of life becoming measurably better every day.

The attention paid to youth was an extraordinary volte-face from that ancient British maxim “Children should be seen and not heard”. Young people now not only wielded huge economic power through pop music and fashion, but kicked aside class distinctions and social barriers. Following the Beatles template, almost all of the decade’s brightest new celebrities were in their twenties and from humble backgrounds: the photographer David Bailey, the model Twiggy, the painter David Hockney, the comedian Jimmy Tarbuck, the film stars David Hemmings, Rita Tushingham, Tom Courtenay and Terence Stamp. A northern or a cockney accent was almost a prerequisite of success. In Britain in the past, the working class had always tried to talk “up”; now the upper and middle classes strove to talk “down”. It still goes on.

Without any form of social media other than underground newspapers and ­flyers, Sixties youth culture managed to be remarkably united. It assumed that every figure of authority – indeed, anyone over 30 – was a pitiable lunatic. Unlike its counterparts in America and across Europe, it raised up no demagogues: its figureheads were lead singers in bands and radio disc jockeys whose dimness in no way reduced their potency. The hippies, who arrived post-1966, are now viewed as hopelessly naive and deluded, with their mantra of “Love and Peace”. Yet their pop festivals, love-ins and “happenings” were occasions that brought hundreds of thousands together without the slightest violence. There were ­moments when even their fiercest detractors wondered if they might really be a force for changing the world for the better.

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The V&A exhibition “You Say You Want a Revolution?” focuses on the decade’s final phase, when Britain’s initially playful underground hardened into a many-headed protest movement containing every kind of extreme-leftish ideology; churning out insurrectionary literature amid the comforts of the consumer society; holding marches, demos and sit-ins of increasing militancy despite having nothing to protest about nearer than the Vietnam War (in which the Wilson government played no part whatsoever). It was always more serious in other European countries and the US, where former hippies made an easy transition to urban guerrillas and to Charles Manson’s serial-killing “Family”.

Simultaneously, the British police declared war on leading musicians whose songs seemed to encourage their fans to take drugs, whether the pot known to jazz players for generations or the new, man-made, “mind-expanding” lysergic acid diethylamide (LSD), which leaked from the very pores of the Beatles’ Sgt Pepper album. The fear was legitimate – in fact, nowhere near proportionate to the long-term problem in the making – but the reaction was hysterical scapegoating. In early 1967, with the collusion of MI5 and possibly the CIA, 18 police officers raided the Rolling Stone Keith Richards’s cottage in Sussex and Richards and Mick Jagger were charged with drug possession. After a grotesque show trial – yet another strike against that supposed Summer of Love – both Stones received prison terms for offences that normally would have rated a small fine or merely probation.

The recent death of Richard Neville, the founder of Oz magazine, awoke further memories of that moment when the Sixties’ indulgence of youth was suddenly turned off. The 1971 trial of Neville and his two co-editors for conspiracy to corrupt youthful morals (specifically by depicting Rupert Bear with an erection) was just as self-defeatingly comical as the Lady Chatterley prosecution almost a decade earlier.

For millennials who grew up around the year 2000, the Sixties are an object not so much of nostalgia without memory as envy without memory. My 25-year-old daughter often remarks what a terrific time my generation had and what a messed-up world we created for hers. I can’t argue with that.

Philip Norman’s “Paul McCartney: the Biography” is published by Weidenfeld & Nicolson. He tweets at: @PNormanWriter

This article first appeared in the 15 September 2016 issue of the New Statesman, The fall of the golden generation