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

MILES COLE
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The Brexit plague

With the sacking of Michael Gove, the leaders of the Leave campaign are being destroyed.

Brexit: the career killer. Boris Johnson: humiliated and felled, even if he ended up with foreign secretary as a consolation prize. Michael Gove: tainted by his ruthlessness against Johnson and also by his late acceptance of conventional wisdom (that Johnson is talented but unreliable) and finally sacked. Nigel Farage: resigned. Andrea Leadsom: brutally and almost instantly exposed as out of her depth and sent to the ministerial wasteland that is Defra.

With Theresa May in No 10, ­experience and competence have been restored. For that reason, there is room in May’s ­cabinet for some of Brexit’s fallen leaders. For the time being, however, the Remain ­campaign’s repeated warnings that Brexit would be bad for jobs have already proved prescient in one respect. The referendum has destroyed the prospects of Leave’s top brass. The Brexit crown won’t stay on anyone’s head for more than a few days.

We once imagined, ironically, that the Brexit movement would be vulnerable to cynical exploitation by careerist politicians who were keen to make a name for themselves. They would climb aboard the Brexit bus, take an easy ride, and get off higher up the mountain. Quite the reverse. Politicians have not ridden to power on the back of Brexit; Brexit has ridden to power on the back of them, breaking them in the process.

Like a superbug, Brexit inhabits its host spokesmen and women before choking the life out of them. The illness takes a horrible course, first imbuing the victim with great energy and enthusiasm, as though the ailment was in fact a cheering tonic. Then, at the peak of Brexit bounce, when the victim’s mood seems most adulatory, despair and withdrawal set in.

To adapt the celebrated lines spoken by Anthony Blanche in Brideshead Revisited, does Brexit, politically speaking, spot and kill everyone it touches?

At the outset, I must make an important distinction between the perfectly legitimate and finely balanced argument about whether Britain should be outside the European Union – the Brexit debate that might have been – and the one that actually happened, with its £350m a week for new hospitals and the exploitation (or wilful blindness) of the emotive power of anti-immigration. The first debate, the proper one, might well have allowed the finest Brexit minds to shine. The second (that is: real events) has left them vulnerable, floundering amid tectonic shifts in the political landscape that they helped to initiate.

What about Andrea Leadsom, the darling of Brexit’s hard core? Here the career-killing superbug showed the speed with which it operates. Have no truck with the fantasy that Leadsom was brought down by an establishment plot, the “black ops” imagined by Iain Duncan Smith. Leadsom, despite being a very inexperienced politician, applied for immediate promotion to the office of prime minister. She initially made great use of two cards – her “business experience” and her maternal instincts – but it turned out that both were liabilities once the serious campaign for high office began.

There is no need to revisit how several aspects of Leadsom’s CV unravelled. Her supporters put out the word that she was a high-flying banker who had “managed billions”. In effect, Leadsom’s team suggested she was Cristiano Ronaldo, while the evidence suggests she worked for Real Madrid’s PR team. Important work and all that, but not quite the same thing.

Her interview with Rachel Sylvester in the Times on 9 July exposed some of the problems not just with the candidate, but also with Brexit catchphrases. The interview showed the difference between believing that “the old way of doing politics” is too cynical and polished, and assuming that being incompetent in handling the ­media is a virtue.

Without saying anything interesting as a trade-off, Leadsom made several huge blunders. She offended people without children, perhaps entirely unintentionally, by implying that being a mother made her the superior candidate, with “a tangible stake” in the future. Then she offended feminists – and many non-feminists as well – by stating that she isn’t a feminist because she isn’t “anti-men”. Third, she blithely assumed that the EU would not impose any tariffs on a post-Brexit Britain. Finally, in furiously demanding that the Times retract the article and release the tape of the interview, she unwittingly exposed one last blunder: that she herself (or an aide) had not recorded the interview, though speaking on the record to a journalist from a leading newspaper.

The fiasco contributed to Leadsom withdrawing from the two-woman leadership contest, before her current career suffered a calamitous fate – never mind the reading of jobs she held previously. Brexit, having first apparently been the making of Leadsom, quickly struck her down, too.

She deserves some sympathy. Her leadership campaign can be seen as the logical culmination of the political pressures on Brexiteers as they seek to turn serious. The political challenges are doubly difficult. First, there is the negotiation with Brussels, with rather a lot promised to the British public and nothing less than the survival of the EU at stake. Second, in office, any Brexiteer would have to level with the movement’s supporters.

***

The Leave campaign, evidently, rested on a delicate set of alliances, including as it did sovereignty-focused intellectuals, rural Conservative voters and the disenfranchised “left-behinds”. To say these groups voted for different things does not do justice to the problem.

It is worth recalling that Boris Johnson’s Telegraph column in the aftermath of Leave’s referendum victory, which caused him so many difficulties with hardcore Brexiteers, had also been read, adapted and signed off by Michael Gove. In other words, two experienced columnist-politicians, both of them media-savvy and intellectually gifted, found the challenge of converting Brexit the movement into Brexit the reality beyond their combined and considerable rhetorical gifts. During the campaign, Johnson’s popularity and Gove’s intellectual confidence powered the Brexit movement. Then Gove abruptly ended Johnson’s leadership hopes, thereby ending his own.

At a stroke, the argument – popular among Brexiteers – that the new prime minister had to be a Leaver pointed no longer to a leading politician, but instead to the inexperienced Leadsom. Within days of its electoral triumph, the Brexit movement found itself in a leadership vacuum of remarkable proportions.

Having finished off the politicians possessed of a track record, Brexit anointed someone without a recognisable political past. The flight to neophilia says a great deal: which experienced politician would fancy squaring that circle? In retrospect, Leadsom’s Mary Poppins approach – it’s fine, absolutely fine, let’s be positive – was the logical conclusion of an unplayable hand. Sometimes rational logic has nowhere to go. Airy aspirations are all that remain.

As the author of a book called Luck, I am the first to admit that events take on a momentum of their own. Things could have been different. It was not inevitable that Gove would consult his conscience and conclude that he could not, in good faith, be Johnson’s kingmaker. Alternatively, if Gove’s conscience had hurried along a little quicker on its journey of discovery – whether this led to backing Johnson, or aban­doning him – then there could have been a recognised heavyweight Brexit candidate for prime minister.

But laughing off Brexit’s leadership deficit with a shrug in the direction of rogue circumstance leaves out too much. Its post-referendum leadership tumults are the rational consequence of fault lines running through the Leave campaign.

It is one thing for a Tory gentleman Brexiteer, taking a psychological canter over to the wrong side of the tracks, to conclude that Britain is two countries and that the poor are having a tough time, thanks to globalisation and the “establishment”. But what is his prescription for the social problems of Boston? Extra evensong? An added dollop of deference, spread evenly across the parish? Free community copies of Edmund Burke?

That the Brexit movement benefited from anti-immigrant sentiment and then conceded that immigration is unlikely to be reduced any time soon – if at all – was only one example of a recurrent theme of Brexit: capitalising from something that lots of people don’t like without having a solution on hand. An anti-establishment movement can gloss over policy; a government cannot.

Leadsom’s campaign raised the question of whether the Brexit movement is in fact governable. Or, as any potential Leave leader gets close to the real corridors of power, does the movement’s anti-establishment rhetoric undermine its own latest figurehead? After all, it is a lot easier to rail against the Westminster elite when you’re not imminently approaching the top of it.

The case needs to be addressed that the Brexit career carnage has been caused by an intransigent Remain establishment. Having won, some of my Leave friends say, we are ready to compromise; it’s you lot who are the problem.

That sentiment has not been shared by the Brexit movement’s most recognised faces. Indeed, Leadsom’s candidacy presented a new test of character to Brexiteers. Would they rally around the steely experience of Theresa May – a credible prime minister – or cling to whichever Leaver was left standing? It is one thing to divide a party and destroy your prime minister, on the grounds that leaving the EU is more important than loyalty or party politics. But would Brexiteers endorse Leadsom over May, hence cementing the perception – often present, though previously unverifiable – that the question of Europe, among some sections of the Tory party, takes precedence over every aspect of political logic? Boris Johnson and Iain Duncan Smith had no hesitation in giving an early answer: Leadsom.

***

As I write this, I can hear in my head the counterarguments to my case, so indulge me a brief autobiographical aside as I address them one by one. Am I writing through the prism of bitterness? Are these the laments of a Remainer who can’t accept we lost? Far from it. There was always a legitimate case that the EU is a failing institution and that Britain would be better served by making arrangements outside the EU earlier rather than later. I wouldn’t make the case myself, but I can see the logic.

The idea that Brexit would inexorably lead to long-term economic catastrophe ­always felt far-fetched; I recoiled at the ­convenient precision of George Osborne’s prediction that households would be £4,300 worse off after Brexit. I am fortunate, though I, for  one, voted Remain, that some of the most intelligent people I know argued for Leave – and none of them is remotely interested in immigration.

A tribal liberal? Again, not so. My temperament is sceptical, pragmatic and anti-utopian: conservative, you might say.

Stuck inside a metropolitan bubble? The Leave movement made much of Remain’s elitism, its failure to understand – or even acknowledge – the rest of Britain, especially the rest of England. By chance, I spent 13 years working in an antique travelling circus. We toured the nation, plying our trade in unflashy cities and county towns, rustling up whatever small crowds we could, chatting to punters after the final curtain, trying to keep a faltering show on the road. That is to say, I was a county cricketer.

Aigburth, Southend, Maidstone, Colwyn Bay, Chesterfield, Colchester, Haslingden, Malvern, Swansea, Portsmouth, Scarborough, Cheltenham, Blackpool – these places were my life for more than a decade. I am no stranger to England’s northern cities, still less to the Tory shires. They made me.

So it is with some perspective that I have watched the Brexit career plague sweep through its leadership ranks. After initial shock and disbelief, I began to discern a kind of inevitability. Single-issue movements, which circumnavigate the compromise and consensus-building that is hard-wired into conventional politics, are structurally ill-equipped to adapt to serious government. It is housebuilding without the foundations.

The Brexit career carnage should prove a salutary warning. “We need a whole new political class,” Brexiteers have often said lightly. The crucial words are missed out – a new “and better” political class. Indeed, last week the possibility loomed of a Leadsom-Farron-Corbyn triple whammy.

I’ve always believed that politics should be porous to the “civilian” world rather than a closed guild of insiders. I’m all for opening political conversation to fresh voices; not everyone has to study PPE at Oxford. Yet we can now see that change does not automatically bring renewal; outsiders do not always know best, and a base level of competence is a prerequisite. As proof, look again at Leadsom’s outraged reaction to the Times printing what she had said. There is, you might say, a place for expertise. Promising a new politics is easy; high office is difficult.

Hence the last word belongs to an unlikely hero of political analysis. Andy Murray, having won Wimbledon, demonstrated an emotional intelligence equal to his deft touch on the court. Moments after sobbing into his towel, the release point after two weeks’ pressure and control, the Scot thanked David Cameron for watching the match. Some applauded, others jeered. Murray, in an instant, sensed he had to diffuse the awkwardness. “I think playing a Wimbledon final’s tough – I certainly wouldn’t like being prime minister: it’s an impossible job.”

People who think Britain has much to be proud about – that we live in one of the most civilised and well-governed countries in the world – might consider that logic: it might be an impossible job but it’s a successful country. The people doing those ­impossible jobs have contributed to that success. Unless moderates celebrate the track record achieved by compromise, expertise and sound judgement, unless competence finds a more confident voice, then movements such as Brexit will be just the beginning.

Ed Smith is a contributing writer for the New Statesman

Ed Smith is a journalist and author, most recently of Luck. He is a former professional cricketer and played for both Middlesex and England.

This article first appeared in the 14 July 2016 issue of the New Statesman, The Brexit PM