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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Labour's populism for the middle classes

Jeremy Corbyn has consolidated a bourgeois capture of the party begun by Tony Blair.

With the rise of Jeremy Corbyn a mutant strain of populism has become an integral part of British politics. Commentary on the general election and its dramatic upshot has focused on Theresa May’s disastrous campaign and the hubris of her now departed senior advisers. But what finally defeated the Conservatives was that, along with practically everyone else, they underestimated the power of Corbyn’s message. As the advance of the far right has stalled in Europe and with Donald Trump adrift in Washington, the peaking of populism has been announced almost daily, especially by the Financial Times. The rise of a far-left version in Britain went largely unappreciated.

Corbyn’s campaign had more than a little in common with Trump’s experiment in engineering popular emotions and perceptions. The ecstatic mass rallies, the indifference to fact shown in the Labour leader’s repeated denials of his meetings with terrorists and of the reflexive anti-Semitism that pervades much of the movement he has created, the belief of his supporters that the media are conspiring against him and the poisonous Twitter abuse of his critics are clear parallels. But this is not a protest from despairing communities left to moulder in abandoned zones of economic desolation. It is populism for the middle classes, serving the material and psychological needs of the relatively affluent and the well-heeled.

Labour’s success in taking Kensington in west London will be remembered as a defining event. That Corbyn could seize a safe Tory seat in one of the richest constitu­encies in the country is testimony to an extraordinary shift. It is also the culmination of a transformation in Labour that has been under way for many years. Corbyn has solidified a bourgeois capture of the party begun by Tony Blair. Public-school Stalinists and Debrett’s-pedigreed Trotskyites have long been familiar figures in the upper reaches of the left, just as they are today. What is new is Corbyn’s marriage of radical leftist ideology with a systematic appeal to middle-class interests. Nowhere is this better expressed than in Labour’s manifesto promise to abolish student tuition fees (which would cost the country as much as £12bn) and reintroduce maintenance grants, while declining to unfreeze welfare benefits on the grounds that reversing Tory cuts would be (as Emily Thornberry put it in May) “unaffordable”. Rather than addressing the desperate lack of opportunities for working-class children, who may never make it to university, Labour has successfully courted the middle-class youth vote.

Labour’s embourgeoisement is an important reason for Corbyn’s success. For Blairites, this can only be bitterly ironical. Peter Mandelson’s stupefaction at the election result showed him struggling to grasp how the modernisation of Labour he masterminded could have such paradoxical consequences. Extending Labour’s reach beyond its working-class base was one of the keys to Blair’s electoral successes.

The goal was to return Labour to power by aligning the party with neoliberal economic policies and the large numbers of those who for a time were benefiting from them. The project was continued by Gordon Brown, and until the financial crisis it worked fairly well. At that point a shiver of doubt went through the body politic. Movements such as Occupy became more prominent. Inequality was back on the political agenda. Another Great Depression had been avoided, but the effect of near-zero interest rates was an inflation of asset prices that left the rich even richer. At the same time, many people found their incomes stagnant or falling in real terms, but their discontent failed to find effective political expression. Because of his inability to communicate to a mass audience and failure to target the beneficiaries of his policies, Ed Miliband’s move to the left came to nothing.

Corbyn’s opportunity to mobilise the anti-capitalist mood came by accident, as an unintended consequence of Miliband’s decision (supported by Blairites) to include the party’s mass membership as voters in leadership contests. The upshot was an organised takeover of the party by hard-left forces, the paralysed impotence of its parliamentary wing and Corbyn’s unchallengeable dominance today. Labour has been modernised, but not in the way Mandelson intended. Whether by serendipity or by design, Corbyn has brought together some of the most vital forces on the contemporary scene: the anti-capitalist radicalism of young people who are innocent of history, a bourgeois cult of personal authenticity and naked self-interest expressed as self-admiring virtue. Nothing could be more exotically modern than Corbyn’s hybrid populism.

Media obsession with the performance of the two main party leaders has obscured this larger picture. It is true that Corbyn acquired a charismatic fluency in the course of the campaign, whereas Theresa May appeared inflexible and lacking in empathy. The result was close enough for this dif­ference to matter – especially as so much had been made of May’s leadership qualities. But the strategic positioning of the two parties has more enduring significance. May and her advisers aimed to create a working-class conservatism by harvesting former Ukip voters and exploiting the alienation of Labour’s old base from a metropolitan, liberal consensus. By offering more stringent control of immigration, and shelter from globalisation through an active industrial strategy, she believed that Labour’s old fortresses could be stormed. If there was such a thing as a May project, this was it.

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Reconciling the anarchic productivity of the market with social cohesion is the political dilemma of the age, and there is no reason to think that it is, even in principle, properly soluble. May’s manifesto had the merit of at least acknowledging the problem. But the electoral arithmetic on which her strategy depended was over-simple. The Labour vote was stickier than expected, and in some constituencies the party may have benefited from Ukip’s collapse. Much criticised for his equivocations on Brexit, Corbyn turned out to have read the public mood astutely. Support for Remain had shrunk substantially, but few voters were chiefly exercised by Brexit. When he refused to put it at the heart of his campaign, Corbyn outsmarted May’s advisers and strategists. In turn, he helped bring about a move back towards something like a two-party system.

That Ukip lost its reason for existing once Brexit got under way was the theme of countless op-eds before the election. But the same logic applied, in lesser degree, to Tim Farron’s Liberal Democrats. Even before the election, it was apparent that a large new grouping of “Re-Leavers” had appeared, while support for reversing Brexit had slumped. Zac Goldsmith retaking Richmond Park and Kate Hoey increasing her majority despite a determined effort to oust her in Vauxhall showed Brexiteers prevailing in what had been strongly Remain constituencies. In contrast, the Lib Dems were damaged by Farron’s decision to shape their campaign around the demand for a second referendum. Though the party made a modest gain in seats (even as its vote share fell), Farron held on by a much-reduced majority and Nick Clegg lost the constituency he had held for 12 years. Because of their fixation on Brexit the Lib Dems remain where they have been for so many years, a bit player in national politics.

More than anything else, it is the spectacular setback suffered by the Scottish National Party that has produced the shift back to two-party politics. Nicola Sturgeon fought the election by trying to link Scottish independence with resistance to Brexit. Ignoring cautionary voices in her party, she displayed a hubris starker than any Theresa May showed. Roughly a third of SNP supporters voted Leave in the referendum, and many others have been disillusioned by the SNP’s record on domestic issues. By making a second independence referendum the central issue in the SNP’s campaign, Sturgeon has shortened her political career and posed a question about the need for the continued existence of her party. With her credibility damaged, Alex Salmond and Angus Robertson casualties of the election, and the push to independence indefinitely postponed, a new generation will have to redefine what the SNP means today.

The compelling leadership of Ruth Davidson was a decisive factor in the revival of Scottish Conservatism. Not only has she revived the party north of the border and buried any prospect of Indyref2 for the foreseeable future, she has, by adding 12 Conservative seats in the Commons, saved the Conservatives in Westminster from outright defeat and delivered the UK from any risk of Scottish secession. The new Scottish MPs could be as important in shaping the government’s approach to the EU as the ten Democratic Unionists to whom May has turned in cobbling together a minority government. Davidson favours what she calls an “open Brexit”, which might mean a version of a Norwegian-style model in which Britain joins the European Free Trade Association and the European Economic Area, ensuring access to the single market. The Democratic Unionist Party leader, Arlene Foster, pointed in a similar direction when she spoke of the need to keep the border with the south open and avoid a hard Brexit.

There have been suggestions that May could end up negotiating with Brussels to secure some such deal: the opposite of the stance on which she fought the election. But given her weakened position the advantage would lie with EU negotiators, who might be tempted to make punitive demands. At that point negotiations could break down, as May cannot risk losing the support of the Brexiteers who are keeping her in power.

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Of course, there may be a challenge to her leadership. Inevitably, Boris Johnson is being touted as someone with the human touch that May is seen to lack. But Johnson has dismissed all such talk as “tripe” – at least for the time being. A leadership contest in the current circumstances would be savage and rancorous, leaving the Conservatives dangerously weakened in another general election that would soon follow. Are they ready to risk another gamble in the near future with even higher stakes than before? They lost their majority for the same reason Labour moderates lost control of their party: they failed to take Corbyn seriously. To make the same mistake again would look like carelessness.

There must be many who still cannot imagine Jeremy Corbyn as prime minister. After all, Labour failed to win the election. May lost her wager, but in numbers of votes she matched Margaret Thatcher’s 1983 landslide (the electorate is now larger, of course). Corbyn edged closer to power, but many Labour MPs continue to think him unfit to be leader of his party, let alone the country. Yet it would be foolish to conclude that Corbyn will not enter Downing Street.

So far, his march towards power has been greeted with remarkable complacency. Believing it will enable a less disruptive Brexit, the markets have welcomed the humiliation he has inflicted on the May government. The smirking Cameroons have not been able to conceal their vengeful satisfaction. The property tycoons of Chelsea must be congratulating themselves on having seen off a threat to their children’s inheritances. And Remainers will be thrilled as the prospect of an all-out Brexit seems to have faded from view.

These could be brief and costly pleasures. Markets will start to panic if another election is called, and if Corbyn wins they will go into a tailspin. Capital flight will surely leave his government unable to finance its cornucopian schemes, which include expensive commitments to renationalise rail, mail and water companies. Though students will be cheering at the prospect of their burden of debt being lifted from them, the largesse they have been promised is ­unlikely to materialise. Labour would face the same pressure on public services that led the Conservatives to revise their policies on care homes, but in much-worsened fiscal conditions.

It is unclear that Labour, once in government, would opt for a soft Brexit. Corbyn has repeated the mantra about preserving access to the single market and putting jobs first. But the shadow chancellor, John McDonnell, has said that Labour accepts Britain must honour the EU referendum and may have to leave the single market. There is a hard-left tradition that dreams of a socialist Britain outside the EU, and while Labour may have won by attracting youthful Remainers, the millions of Labour supporters that voted Leave have not gone away.

A Corbyn government would be more divided on Brexit than that of Theresa May. The upshot could be that no deal is reached – a scenario not unlike that favoured by hard Brexiteers, but without any of the preparatory work that could make it viable. As house prices in London crumbled, the nabobs of Chelsea would find their cleverness had backfired. Hopeful Remainers and spiteful Cameroons would have the smile rudely wiped off their face.

At present, Corbyn is walking on water. Like Chauncey Gardiner at the end of Hal Ashby’s magical film Being There, who after leaving his walled garden enchanted the world with his unexpected wisdom and Zen-like calm, the Labour leader seems to defy the laws of gravity. Yet politics is not magic, and the mutant strain of populism he embodies cannot conjure away painful realities. If he finds himself facing the ordeals of power, Corbyn will quickly fall to Earth, along with much else in Britain.

John Gray is the New Statesman’s lead book reviewer. His latest book is The Soul of the Marionette: A Short Enquiry into Human Freedom.

This article first appeared in the 15 June 2017 issue of the New Statesman, Corbyn: revenge of the rebel

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