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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Sturgeon's mission: how Brexit changes the SNP's argument for independence

With Labour in disarray and Westminster focused on leaving the European Union, the next Scottish referendum - whenever it happens - is the SNP’s to lose.

If the political events of a single day can set the tone for what follows, the UK is on its last legs. Calling for another independence referendum at Bute House in Edinburgh on the morning of Monday 13 March, Scotland’s First Minister, Nicola Sturgeon, appeared typically poised and (apparently) in control of events, while from Downing Street that afternoon there was the distinct sound of flapping.

Brexit highlights the contradictions on both sides of the constitutional divide. There is an obvious flaw in the SNP leader’s argument that the UK extracting itself from an economically beneficial union – the EU – would prove “catastrophic” while Scotland leaving the UK will be fine. Equally, Theresa May cannot credibly talk up the benefits of UK “independence” while casting the Scottish equivalent as a calamity.

Yet the optics in Edinburgh and London don’t give the full picture. By any empirical measurement, the economic case for Scottish independence is weaker than it was in 2014. However, the trouble for unionists – as for Democrats in the US and Remainers in the UK – is that the political conversation is no longer taking place in the realm of balance sheets or, indeed, of objective reality.

Sturgeon probably knew that this was coming from the moment she put a second independence referendum back “on the table” the morning after a majority of UK voters (but not Scotland) chose to leave the European Union. Yet between then and Monday morning, she had to appear reasonable, as if she had exhausted every possible compromise. The British government’s inflexible response to the First Minister’s quixotic plans for a “differentiated” Scottish settlement strengthened her hand.

No one in the SNP expected Theresa May to deliver the requested compromise. And while many believe that Sturgeon got a little carried away on 24 June 2016 in her expectation that pro-European sentiment would boost support for independence significantly, Brexit has been a political gift. Not only did the differential outcome in Scotland reinforce long-standing arguments about the “democratic deficit”, it also enabled the SNP to recast Scottish nationalism as internationalist and cosmopolitan, in contrast to the “Little Englander” variety.

Nevertheless, the First Minister ended up taking the plunge slightly earlier than anticipated, probably because newspapers had suggested that Article 50 could be triggered on 14 March. Sturgeon will now get a second media “hit” at her party’s spring conference in Aberdeen this weekend. Forcing her hand was not Alex Salmond, as some spurious reports implied, but the realisation that circumstances would never be this good again. Yes, there is the backdrop of Brexit, but equally important are the existence of a pro-independence majority in the Scottish Parliament (which is unlikely to be sustained beyond the 2021 Holyrood elections) and the continuing dysfunction of the Labour Party. Jeremy Corbyn might go down in history as an unwitting facilitator of both Brexit and Scottish independence.

This time last year, Nicola Sturgeon was telling interviewers that she would pursue another referendum only if opinion polls showed a sustained lead for independence. Though two recent surveys suggest a modest tilt towards Yes, this has not transpired – at least not in public polling. It seems likely, however, that private polling tells a different story, which is another reason why the SNP leader felt able to move as she did.

Crucial to the next vote is the group that we might call “Yes-Leavers”. With a degree of intellectual consistency, its members want to regain “sovereignty” from both London and Brussels. In an attempt to keep hold of that constituency, the First Minister has attempted in recent months to detach a second referendum from Brexit, arguing that independence “transcends” this and almost every other political consideration. SNP advisers also floated the idea that an independent Scotland might settle for membership of the European Economic Area, like Iceland or Norway (the party’s favourite constitutional case study), rather than full-blooded membership of the EU.

The SNP is confident that, come the crunch, the majority of Yes-Leavers will end up backing independence. The tenuous claims, made during the last Scottish referendum campaign, that an independent Scotland would “automatically” become or remain an EU member are dead in the water. Instead, the Scottish government tacitly accepts – indeed, welcomes – the possibility that it will be outside the EU, at least for the time being.

On 13 March the First Minister said the Yes side would “be frank about the challenges we face”, yet another indication that the independence proposition will be less Pollyannaish than it was in 2014. Its advocates have little choice. Not only have North Sea oil revenues dwindled, but the sizeable gap between what Scotland raises in taxation and what it spends on public services – somewhere between £9bn and £15bn a year – is given an annual airing with the publication of the Government Expenditure and Revenue Scotland (GERS) figures.

Just as the SNP reversed its opposition to membership of Nato in 2012, the party is now closing down potential lines of opposition attack. The benefit of having fought a referendum just a few years ago is that nationalist strategists know where their weaknesses lie. Central to this process is a “growth commission”, led by the former SNP MSP Andrew Wilson.

Wilson has said that oil revenues will no longer be “baked” into the economic case for independence. His remarks were not intentional but proved useful, neutralising the oil issue early on, but the twin challenges of currency and the deficit remain. Last time, the SNP adopted the least bad option of a “currency union” with the rest of the UK, but since then opinion within the SNP has shifted in favour of a separate Scottish currency. Whether that becomes policy, however, is not yet clear.

There has also been a change of tone regarding the deficit, if not a wholehearted acceptance that the early years of independence would necessitate both steep tax rises and deep cuts to public spending. “It’s going to be tough for the first few years,” one Salmond-era adviser admits, but how frank the SNP is about that in public will be a test of the new realism.

Like Jeremy Corbyn’s Labour Party, the SNP has been better at calling for an alternative economic model than articulating what it would be. That won’t matter much in the heat of another referendum battle. The meta-narrative remains strong, and as the EU referendum and US presidential election demonstrated, a beguiling story of apparently easy solutions to difficult problems – even in the absence of any details – can prove a winning formula.

The central role of Andrew Wilson in the SNP’s pivot away from land-of-milk-and-honey predictions is also interesting. He and Sturgeon were colleagues in the first Scottish Parliament between 1999 and 2003, but they were far from close, and Wilson is typical of the Salmondista nationalists who once thought the idea of her leading the party was a bad joke but now view her with increasing admiration, not least for her willingness to gamble her career on a second referendum. The First Minister’s kitchen cabinet is small, but over the past few months, as a source puts it, “there’s been some reaching out” to Salmond-era advisers. A divided movement is not in any nationalist’s interest.

So where does that leave those who want to preserve the United Kingdom? Not in a good place, as the initial response demonstrated. The carrot-and-stick approach of the 2014 referendum is subject to the law of diminishing returns; offering yet “more powers” is difficult, now that the low-hanging fruit has been picked, and Project Fear II would likely suffer the same fate as last year’s Remain campaign. Organisationally, each of the three unionist parties – the Conservatives, Labour and the Liberal Democrats – will fight its own anti-independence campaign, thus appearing disunited (the Yes campaign will probably be much more disciplined than in 2012-14).

More to the point, with Northern Ireland once again in tumult, what precisely is it that binds Ulster, Wales and Scotland to England, beyond a balance sheet? In recent weeks, everyone from the Prime Minister to the Scottish Lib Dem leader, Willie Rennie, has attempted to articulate the Holy Grail of a “positive” case for the Union. None has got beyond the usual platitudes about past (the tense is revealing) British greatness and fuzzy rhetoric about “solidarity”. There is also English public opinion to factor in. A few years ago, the English, on balance, wanted Scotland to stay, but who can say if that sentiment will survive Brexit and a second independence referendum?

As Europhiles know all too well, defending a union that can appear harsh and remote is no easy task. It doesn’t matter that independence is a conclusion in search of an argument – oil in the 1970s, Margaret Thatcher in the 1980s, the Iraq War in the 2000s and now Brexit – or that economic reality favours the status quo. Success in 2019 (or perhaps even later) will come down to who tells the better story. Brexit gives the Yes side a more compelling good v evil tale than it had in 2014. If the No campaign relies on the same old boring story of economic woe (what else is there?), a second indepen­dence referendum is the SNP’s to lose.

David Torrance has written biographies of Alex Salmond and Nicola Sturgeon

This article first appeared in the 16 March 2017 issue of the New Statesman, Brexit and the break-up of Britain