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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Men who fight

I thought that boxing was a display of pointless violence – but an unheralded prizefighter changed my mind.

Tommy Martin threw the first punch – then a series of hooks and jabs that struck the arms of the Commonwealth super-lightweight champion, John Wayne Hibbert. All eyes strained to follow the boxers as they skipped and shuffled their way around the bright blue ring.

Boxing is controlled chaos. The referee, watchful and sharp in his bow tie, brings the control; the boxers bring the chaos. From the terrace of the Copper Box Arena at the Olympic Park in London, the action seemed remote at first. The men in the spotlight were the size of toy soldiers and their grunts and gasps were inaudible. Only the heaviest blows seemed to make any sound: pop-pop, like rain on an umbrella.

Then the ferocity of Martin’s attacks, of Hibbert’s responses, registered among the crowd. Conversations ended mid-sentence. As the boxers showered each other with their punches, pop-poppop-pop-pop, a shiver of delight ran across the arena. A man to my left started laughing. Another stood up. Just 20 seconds into the fight, Martin was driven against the ropes but broke free, perhaps a little frantically. He raised his gloves. Hibbert, grim-faced, advanced.

Champion from Big Face Art on Vimeo.

Hit someone in a bar, at home, or on the street and you might soon find yourself in jail. Do so in a ring and you could win a belt. For decades, the World Medical Association has called for a total ban on boxing, arguing that a fighter’s “basic intent” is “to produce bodily harm in the opponent”. The New Yorker journalist A J Liebling called it “the sweet science”, but there was nothing sweet in the images of the 25-year-old middleweight Nick Blackwell being carried out of Wembley Arena on a stretcher in March after his defeat to Chris Eubank, Jr; there was nothing sweet about his seven-day coma that followed. The violence of boxing is unapologetic.

Yet a curious thing about the sport is that this bodily harm is inflicted largely without malice. There is little cruelty here, at least in the conventional sense. A boxing match is a test of strength, speed, endurance and strategy. It is not a brawl.

Anomalies are fairly easy to list – such as the 1997 WBA title fight in which Mike Tyson bit off part of Evander Holyfield’s right ear – but much of what we might read as anger or hatred in the ring exists, in reality, outside of it. “There is so much hate among people, so much contempt inside people . .  . that they hire prizefighters to do their hating for them,” the former heavyweight champion Floyd Patterson once said. The fighters perform animosity on our behalf – but do they feel it?

Boxing is ritualised aggression, qualified by the paraphernalia of sport, scored by judges, watched by members of a society in which the state has been granted a monopoly on physical force. Violence, licensed all but exclusively to the police and the army, is enshrined as a civilising instrument: we are appalled when it is wielded by anyone outside of this social covenant and condemn it as barbaric, senseless or criminal. Yet here at the Hibbert-Martin fight, one evening in January, was a carnivalesque exception. We watched men fight for money and we thrilled to it.

I’d first seen Hibbert on TV the previous September. I knew next to nothing about his sport but I was transfixed by the sight of the 30-year-old boxer – his blue eyes sunken in a face grown puffy with bruises – fighting the then Commonwealth super-lightweight champion, Dave “Rocky” Ryan. I initially recoiled from what seemed a pointlessly ­violent spectacle; it all felt oddly wasteful. But something compelled me to keep looking. And the more I looked, the more heroic the men appeared, and the less certain I became of my first impressions.

Hibbert won that fight and took the title. When he announced that he would soon be defending it against an up-and-coming fighter called Tommy Martin, I googled the promoter’s website and bought a ticket.

***

Martin, a boyish, sandy-haired 21-year-old from St Neots in Cambridgeshire, had speed and much of the crowd on his side. Maybe God, too. “I believe everything happens for a reason,” he told a local newspaper shortly before the fight. “I just believe it’s my time . . . It’s just about putting my faith and trust in the Lord.”

Between rounds, he would cross himself. Hibbert sought no such protection – not visibly, at any rate.

Although Hibbert was now the Commonwealth champion in his weight cate­gory (with a maximum of ten stone), the odds were against him. The title fight I’d seen on television in September had ended in unusual circumstances: Ryan had suffered a sudden, unexplained back injury in the tenth round. He froze, no longer able to dodge Hibbert’s punches. Hibbert took his chance and trapped Ryan in a corner, stunning him with a right hook to the head. The referee ended the bout.

Sceptical of Hibbert’s ability to hold on to the belt, the bookies listed Martin, a decade younger and still unbeaten after 13 fights, as the clear favourite to win. “They will be losing a few quid,” Hibbert countered, in a statement to the press. When I visited him at his “spit-and-sawdust” gym in Corringham, Essex, four weeks before the big night, he told me that Martin was a “stepping stone”.

“He’s in my way. He’s there [to let me] get to where I want to get to.” His voice was calm and steady, empty of bravado. This was a statement of fact.

In the weeks that followed, Hibbert declared repeatedly that victory would be his. “Whatever he brings to the table, I have the answer for,” he said. “It will be a short night.” He seemed to believe it.

He had to believe it. Since his professional debut in the summer of 2009, Hibbert had fought 19 bouts, many of them bloody and bruising, and had come out on top in most. Martin entered the ring as a pro three years later at the age of 18, and had six fewer matches’ worth of experience.

“I’ve been involved in much harder fights,” Hibbert said. “I can’t wait to get in there now and do the business.” Yet ­boxing is a risky business, even for old hands. As Joyce Carol Oates once observed of the sport: “Loss, humiliation, shame are only part of the risk – physical injury, even death, awaits as well.”

***

When Hibbert was first marched into a gym as a teenager by his father, he wasn’t quite prepared for what he would find. “I was a young lad in a little village, Horndon-on-the-Hill, and causing a bit of mischief,” he told me. “My dad sort of thought that boxing would be the right thing for me to do. You know? Give me a bit of discipline.”

What he felt, he said, was fear. “Going into a gym was quite intimidating – the trainers in there, everything, the smells. There were some lads, the lads around town, and they would dig you out a bit. It weren’t the nicest thing.”

Soon, however, Hibbert was able to get “the hang of it” and learned to “love training, love boxing”. He smiled at the memory and seemed to nod in agreement with himself. He was right to have persevered. But I was struck by his ability to work through his initial fear – a rational fear of violence and pain – and then to turn it into something he loved.

Outside the glare of ring lights, Hibbert was no-nonsense but not brusque; he was thoughtful and gave little impression of aggression. His movements were controlled, as those of sportsmen often are, and he answered my inexpert questions with patience. In short, he was dignified. Sitting at ease in his gym, with photographs of Mike Tyson and other champions glaring down from their frames on the cold, concrete walls, he projected none of the aggression that he had spent nearly two decades of his life training for. I asked him if he enjoyed boxing. “Yeah, I do like getting in there and having a bit of a fight,” he answered, with what looked like a guilty grin. “It’s in you, you know?”

But the will to keep fighting when confronted with physical danger is not entirely innate. Endurance of this kind is honed – it can’t just be dared or forced into existence. Before winning the Commonwealth title last September, Hibbert had twice been beaten by Ryan. Their second fight in May 2015 was furious, with relentless combinations of punches hitting their targets on both sides. Hibbert was felled after half an hour or so in the ring. A similar stoppage seemed likely in their third encounter: halfway through the match, Ryan dug his fist into Hibbert’s solar plexus and brought him to his knees. But the challenger collected himself. He got to his feet and kept pacing, parrying and lunging at his ­opponent until the bell rang.

I asked him what had given him the resolve to continue after that sixth-round blow. “It did hurt,” he said, recalling the shaky moment – the way he had staggered and struggled for breath, sweat gathering on his brow. Then he shifted in his seat and told me a story that was clearly important to him; he would return to it repeatedly during our conversations. “Dave Ryan was winning the fight but I’d promised my two children, especially my little girl, that I’d bring [the Commonwealth belt] home for her,” he said. “She loves that rainbow belt. She ain’t got a clue what it’s about. She just wanted it ’cause it looked nice.”

Hibbert is a family man and I believed him each time he resurrected this theme: that he drew strength to fight from the thought of his children, Lexie and Connor, aged six and three. (I wondered about his interests outside boxing. “Family!” he informed me.) It pained him to spend so much time apart from them. “They go through a lot,” he said, “because you spend your life in the gym. Sometimes, you get home – say, if you’re training three times a day – and you know you’ve got it going again the next day . . . but your kids just want to play with you.”

He visibly softened. “My little girl wants me to help her do her homework. Not that I’m very good at that – she’s cleverer than me already. But you’re tired and you need your rest . . . There’s a lot of things that go on that people don’t see.” His wife, Kerrie, who he met at a local pub a decade ago, comes to each of his fights.

Hibbert’s first name is actually Wayne. John was his grandfather’s name. He adopted it when he registered for his pro licence, to honour the man who had pushed him, who had shouted, “Come on, boy, let’s get it going!” whenever he was “a bit wayward . . . knocking about round the streets”. The original John would sit ringside at the gym, smoking away at his pipe, proud of his grandson. He died eight years ago, without witnessing Hibbert’s rise up the ranks of the sport. Later, I noticed on his shiny, blue-black shorts the word “Granddad”, above a picture of a golden crucifix and a pair of angel wings. On the front and back were “Lexie” and “Connor”.

Yet the love of family alone could not explain Hibbert’s resilience: his “heart”, in boxing parlance. There must have been something else, something harder. Hunter S Thompson once wrote of pursuing “the edge” – the liminal space between deadening security and the danger of a literal
death – and I thought I could sense something of this impulse in fighters. To walk habitually on such a precipice, surely some deep, evolutionary instinct for self-preservation must be negotiated, if not negated altogether. How was this possible? Few fighters win every bout and even a victory can prove damaging in the long run. Injury is part of the job description.

When I pressed Hibbert on this, his look of focus returned. “That’s what a lot of people say: ‘How can you just get punched?’” He seemed almost bemused by the question. “You just don’t think of it. It is what it is. I’ve done it for so long now. It’s what I know. I don’t know anything else.”

***

By the ninth round of the Copper Box fight, the judges’ scorecards were even. Hibbert had dominated the first five, walking through Martin’s attempts at combinations and forcing him against the ropes time and again. Yet a solid right to Hibbert’s side had emboldened the younger boxer, who made the most of the champion’s defensive lapses in the seventh round. Martin threw a hook. He drove back his opponent. Hibbert began to squint. His left eye was swelling badly and his nose was bleeding.

With just three of the 12 rounds left, the pace slackened for the first time. Both boxers were exhausted and they stared at each other, hesitating. As the eleventh began, Martin’s comparative inexperience was showing. He was now throwing single punches, which Hibbert countered with swarms. One of Martin’s attacks connected. Hibbert pounded back, pop-pop-pop.

In their corners, the trainers looked on. Their heads moved with those of their charges. They shouted and waved their hands. In the minute-long intervals between the action, they applied Vaseline to cuts and delivered bullet-point lectures on strategy. Mark “Sach” Bates, Hibbert’s lead trainer, gave advice on how to exploit Martin’s habit of falling back and standing with his gloves covering his face. Then the bell announced the fight’s final three minutes.

Instead of marching straight into combat, Hibbert gave his opponent a brief hug. It was a surprising, touching gesture. Then he raised his fists and charged into Martin, all merciless determination.

Ninety seconds was all it took. The 21-year-old challenger dropped to his knees after Hibbert’s machine-like pounding had pushed him on to the ropes once again. As the referee started the count, Martin’s eyes drifted to his corner. His trainers stared back. Then he tilted his head in Hibbert’s direction, but the champion just hopped on the spot, readying himself for another push. “Seven, eight . . .” the referee bellowed. Martin didn’t hear it. When he finally stood up, it was too late. The fight was over.

“You just don’t think of it,” Hibbert had told me: he was able to face the punches because he could banish the thought of the pain they would cause and the consequences they could have. “You just don’t think of it”: he was able to fight Martin and make an enemy of him for this one night by banishing the knowledge that they are, in his own words, “pretty close”. Shortly before the match, Tommy had called Wayne his “best friend in boxing”.

They had been sparring partners as ­Hibbert trained for the Dave Ryan fights last year. Martin was ringside to watch his friend win the Commonwealth title; he was “over the moon” when Hibbert’s victory was declared. But all of that was irrelevant in the run-up to their own fight. “Boxing gives you discipline and respect [for your opponents]. They’re in the ring to do their job and I’m in there to do mine,” Hibbert explained. “But losing would set me back financially and ruin things for my kids. You’ve got no friends when you go in there. They’re your enemies.”

So: “You just don’t think of it.” But Hibbert did think of it. He couldn’t help it. From early on in the fight, the two boxers would fist-bump each other in the intervals between their 180-second battles: an expression of “hang in there” that was at odds with the jabs and hooks that followed. Their embrace in the final round was only the most open gesture of a friendship that couldn’t quite be denied, even in the midst of physical conflict.

The chime of the final bell faded. Hibbert jumped up in joy – or maybe it was relief – and acknowledged his fans. Then he walked over to Martin and consoled him. The younger man looked up at him, almost in tears. In the post-match interview, Hibbert insisted that, although he had won, Martin had hurt him badly, a strange compliment in any other circumstances but a generous one here. Martin leaned over and kissed him on the side of his head before thanking the referee and Jesus Christ for keeping them safe.

***

“You discipline your mind. That’s the art of training,” Hibbert told me as we sat in his Essex gym. “It keeps your mind active.” Yet boxing, to him, was ultimately “a business”. “You’ve got to do what you’ve got to do to provide for your family,” he said. I asked him how much he makes. “I don’t really wanna say,” he replied, but added: “Hopefully, my next few fights might get me a house paid for, or most of it, anyway.” (While world heavyweight champions such as Tyson Fury can earn purses of over £3.5m, Commonwealth title fights in Hibbert’s category are far less lucrative. Other boxers have received about £30,000 for comparable bouts.)

He did not romanticise the sport, something that writers find oddly difficult to resist – Ernest Hemingway even took it up as an amateur and built a ring in the backyard of his house in Key West, Florida. Hibbert spoke of his years as a manual labourer, laying floors, with almost as much fondness as he described his boxing career. It was
work, that’s all.

But work of this sort, which takes for granted the risk of severe injury, seems to confer on its practitioner an aura of strength that goes beyond the merely physical. Talking to Hibbert as he trained at his gym and as he rested at his London hotel on the morning of the fight, I was reminded of Ruskin’s thoughts on mountain climbing. In a letter to his father in 1863, he wrote:

“. . . if you come to a dangerous place, and turn back from it, though it may have been perfectly right and wise to do so, still your character has suffered some slight deterioration . . . whereas if you go through with the danger, though it may have been apparently rash and foolish to encounter it, you come out of the encounter a stronger and better man, fitter for every sort of work or trial, and nothing but danger produces this effect.”

***

My impression of John Wayne Hibbert was one of solidity of character. I suspect that he is not alone among boxers to have this trait, forged, perhaps, by the tempering of the will that is necessary for such an extreme occupation.

The morality of the sport has been much debated but, in the same spirit as we can condemn wars but honour the soldiers who fight them, I think the bravery and the glory of boxers are beyond dispute. And there I go – romanticising it, when it’s strictly a matter of business. It’s work, that’s all.

Yo Zushi’s latest album, “It Never Entered My Mind”, is released by Eidola Records

Yo Zushi is a sub-editor of the New Statesman. His work as a musician is released by Eidola Records.

This article first appeared in the 28 July 2016 issue of the New Statesman, Summer Double Issue