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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One man and his whale: how an iconic Natural History Museum exhibit fought class divides and transformed science

As a blue whale skeleton replaces the entrance hall’s historic dinosaur cast, curator Richard Sabin reveals the secrets of the giant mammal’s much-loved replica.

On 25 March 1891, a female blue whale was harpooned by a whaling vessel and fatally injured. She was in the Irish sea, and ended up beached on a sandbank at the entrance of Wexford Harbour, on the south-east Irish coast.

Local fishermen discovered her floundering and thrashing around, four-and-a-half times the size of their boat, significantly taller, and more than 25 metres long. They had never seen a creature this size. A fisherman called Ned Wickham eventually put her out of her misery with a blade, and, according to contemporary reports, “succeeded in dispatching the big fish”.


The blue whale skeleton, c.1950-74. Photo: © Trustees of the NHM, London​

Over 126 years later, and that same creature that caught a handful of fishermen’s attention will be seen by millions. Her 4.5 tonne skeleton is going on display in London’s Natural History Museum entrance hall, replacing the traditional Diplodocus cast in the grand Hintze Hall. It’s a controversial move. Dippy ­– who received his nickname from an adoring public – is an iconic part of the Natural History Museum’s history, wowing visitors since 1905.

A special panel of collection managers, curators and scientists was put together to choose Dippy’s replacement. Specialists across the museum were invited to make a case for their preferred exhibits.

“Will our blue whale skeleton become iconic like Dippy?”

Richard Sabin, the resident whale expert, won them over. “What makes a specimen iconic? Will our blue whale skeleton become iconic?” he frets, when I meet him before the skeleton is unveiled. “I think so. It can’t fail to be, because of its very nature, but also because of where it is in the museum’s history and what we’re actively doing, in the field, with our researching.”

“It’s an interesting one because Dippy is of course part of people’s memories, childhood, and bringing their own children and so on,” he adds. He admits that his specimen of choice doesn’t even have a name – it’s been “lost over the years” – but says it’s “inevitable that she’ll get a nickname” now.


What the skeleton will look like in Hintze Hall. Photo: ® 2015 Casson Mann 

Sabin, 51, is a marine mammal curator, and has been working at the Natural History Museum for 25 years, where he’s the collections manager for the vertebrates division. But wandering among the Victorian grandeur in his camouflage hoodie, blue jeans and battered trainers, you wouldn’t tell that he is one of the museum’s senior figures.

We enter a dimly lit hall closed off to the public, where the exhibition for the Natural History Museum’s special whale season – which opens this week, along with Hintze Hall’s new resident – is being prepared. With its high brick arched ceiling and stained glass windows, it has the hushed atmosphere of a church. It is here that exhibitions are prepared before going on show.

Specimens, lit up and attended to by blue lab-coated conservators, loom out of the gloom like stalagmites. The corkscrew-shaped jaw of a deformed sperm whale; the rib cage of a bottle-nosed dolphin; giant toothed whale skulls gazing up at the ceiling – some with bandages, others being cleaned with cotton buds.


A whale conservator working on a flipper. Photo: © Trustees of the NHM, London​

“When they [visitors] leave the exhibition, we want them to have connected with whales and dolphins in an emotional way, but a way that hopefully makes them want to take some kind of an action,” Sabin says, referring to marine exploitation and mankind’s gruesome whale-hunting past.

The Wexford whale was discovered just before the rise of commercial whaling, and a decade ahead of the industry dominating the Irish coast. She was on one of the last migrations of blue whales unthreatened by an industry that would come to endanger the species by turning them into oil, soap, perfume, candles, margarine, corsets and even umbrellas.

 “Welcome to the blue whale, the biggest mammal in the world!”

Although Sabin has been working on this exhibition for years, he looks wide-eyed at the assorted bones and skulls with boyish delight. Aside from his white hair and grey speckled stubble, he probably had the same expression when he first visited the Natural History Museum on a school trip at ten years old.

It was then that he first saw the Wexford whale skeleton. Until last year, it was suspended above the museum’s world famous blue whale replica.

“My first and overwhelming memory of the museum was the whale hall,” Sabin grins, as we walk towards it through the echoing corridors. The blue whale replica is especially sign-posted. “You walk in at ground level as a tiny child and you’re just presented with a wall of blue. And then you look up above the blue whale model and you see all the other skeletons. That was really the memory that I took away from the museum back then.”



The blue whale replica with the skeleton above. Photo: © Trustees of the NHM, London​

Sabin remembers asking a gallery attendant if the blue whale, suspended like a big blue zeppelin from the ceiling, was real. She said no. And so he asked about the Wexford skeleton above it, where it had been until last year. She told him it was genuine, and that these animals were still out there in the ocean. “My imagination just went off on one,” he recalls.

As a child, Sabin was fascinated by bones. He used to collect roadkill from a main road near where he grew up in north Birmingham, and bring it home. His “very understanding parents” let him have a little patch of ground at the bottom of the garden to bury the carcasses, “so I could rot away the flesh and look at the bones”, he explains.

“I wanted to know what was inside these animals. I wanted to know how they moved and how they supported themselves.”

“It's not always the case that people are able to afford visiting London”

When he returned to the museum in 1981, having just finished school, he says he was “absolutely sold”. He applied for an archaeology degree, specialising in osteology, at Sheffield University, and then ended up working with marine mammals.

We gaze at the blue whale replica from a viewing gallery. Its ridged jaw slopes up at such an angle that it appears to be half smiling, its tiny eyes creased. It has been here since 1938. It is the first lifesize scale model of a blue whale ever built, at 29 metres long (later, the Smithsonian in Washington DC would build theirs a few inches longer to make it the biggest in the world). We now know that it’s inaccurately rotund, but that doesn’t stop it stunning first-time visitors.



The whale hall. Photo: © Trustees of the NHM, London​

Most children who see it for the first time share the schoolboy Sabin’s reaction – we can hear them gasping and shrieking below as we speak. I remember being flabbergasted by its size when I visited on a school trip; I’d never realised – and can still hardly comprehend – that such large creatures exist. A model like this brings it to life more than any documentary I’ve seen.

“It was borderline whether I went on that school trip in 1976, because money was tight”

Although our ancestors’ thirst for replication has fallen out of fashion, we have them to thank for these reactions. Models such as this one make scientific research part of our cultural memory, as well as a key part of the museum’s body of research. This makes the study of science more accessible, Sabin believes. From the meticulous collecting and cataloguing of the Victorian era to the modern push for digitising the museum’s vast data records, it’s about bringing information to everyone, whatever their background. “I am a great proponent of that, because as a child, visiting London for the first time on a school trip from Birmingham, we didn’t really have a lot of resources at my school.”

Sabin was brought up in a working-class household; his father was a lorry driver and his mother worked in a factory. “It was a good life, but not a family with a huge amount of cash; we had holidays to Wales every other year in a caravan,” he says. “It was borderline for me whether I went on that school trip in 1976, because money was a bit tight.”

But it was his last year of primary school, and “it was the big trip,” he recalls. “So my parents were like he’s got to go to London to see these things, but it's not always the case that people are able to do that.” For this reason, Dippy will be taken on a tour around the country, hoping to attract five million new viewers.

Hundreds of people affected by their first impressions of the blue whale replica have told Sabin their stories. A woman whose mother ran a nearby coffee shop in the 1950s used to visit it every morning as a child. She told him about a security guard walking in at 10am on the dot each day and shouting, “Welcome to the blue whale, the biggest mammal in the world!” and then turning around and walking out. “It’s a pity we don’t do that anymore,” smiles Sabin.



The blue whale replica being built in the Thirties. Photo: © Trustees of the NHM, London​

He shows me a big leather-bound volume of photos of the model being built in the Thirties, by a father-and-son team of the zoology department, Percy and Stuart Stammwitz. Men in aprons and flatcaps climb all over its wooden skeleton, like the hull of a ship. Some, like regular painter-decorators, apply individual plaster strips to its throat, to make a pleat effect. A man on a step ladder cleans the whale’s back with a long broom.

As they built it, some of the workers suffered motion sickness, as the suspended model used to sway. Nevertheless, they would occasionally take cigarette and lunch breaks inside the whale.

“It’s about making people realise that science really is for everyone”

Myths swirl around the museum about the whale’s hollow belly, which is said to have housed everything from a secret gambling den to romantic liaisons to a makeshift distiller. These aren’t true, but the team did put a 1937 telephone directory and change from their pockets inside before sealing it. “Like a time capsule,” Sabin says.

Although the blue whale model is so adored, it was important to Sabin for a real-life specimen to replace Dippy. “Moving away from using casts, putting the actual specimens into the space, puts it into a context,” he tells me, as we walk back through the museum’s halls. “It breaks down the barriers between the behind-the-scenes work of the scientists and what goes on in the gallery . . . . It’s about making people realise that science really is for everyone.”

Hintze Hall reopens with the blue whale skeleton, along with the exhibition “Whales: Beneath the Surface”, on Friday 14 July 2017.

Anoosh Chakelian is senior writer at the New Statesman.

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