How the coalition is turning the screw on housing benefit claimants

The latest round of welfare cuts will accelerate the rise in homelessness and leave low-income families struggling to find rented accomodation.

Child benefit, tax credits and disability allowance have all been at the heart of the political debate on welfare cuts. Housing benefit hasn’t. Yet people are already feeling the pain of the government’s changes and cuts. The Welfare Benefits Uprating Bill presents the opportunity for another turn of the screw on housing benefit, especially on the people who rent from private landlords.

Local housing allowance (LHA) is the housing benefit for those in private rented accommodation whose low incomes mean they rely on help with housing costs. It is an in-work and an out-of-work benefit paid to over 1.3m people. These are not the Chancellor’s "skivers" lying in all morning behind closed curtains. These are people in low-paid jobs, pensioners, disabled people, single parents, couples with kids and young people estranged from their parents. Almost one in five on housing benefit work, and only around one in eight are on Jobseeker's Allowance.

Housing benefit has always had a link to actual rents due to the huge differences in rates around the country. The government broke this link when it decided to uprate LHA only in line with CPI inflation. Under this new bill, the LHA in each area will only rise by either 1 per cent or the change in the level of the lowest third of rents, whichever is lower. But rents have historically risen faster than inflation, and certainly by more than 1 per cent, so many parts of London and many parts of other UK towns and cities will become no-go, no-live areas for those on the local housing allowance. People will be forced into debt, then out of their homes and out of their local areas.

Crisis, the homelessness charity, found in a recent report that fewer than 1 in 50 properties are now accessible to LHA recipients under 35-years-old because rents are already higher than housing benefit rates and landlords are unwilling to let to those who need it. Shelter have calculated that linking the LHA to CPI inflation will mean one third of the country will become unaffordable for low income families within a decade, and the 1 per cent cap will speed up this social exclusion. It will also accelerate the recent rise in homelessness. Rough sleeping was up 23 per cent last year, the number of people going to their council as homeless is up 22 per cent in the last two years and the end of a private tenancy is now the most common cause for those officially classed as homeless.

The real terms-cut imposed by the 1 per cent cap on local housing allowance from 2014 is just the latest in a long list. In April 2011, the government brought in caps on LHA for each property size, scrapped the rate for a five bedroom house and cut all increases from the median rise in local rents to the lower third. Last year, it froze all LHA rates and raised the age below which LHA support is only available for the costs of shared accommodation from 25 to 35. And this year it is bringing in the "bedroom tax" and capping any rise in LHA at CPI, or 2.2 per cent.

It is hurting but it’s not working. The housing benefit bill is up by £2bn since the general election and the total number of people relying on LHA has risen by 35 per cent. Debate in the Commons yesterday was guillotined by the government, so there was no debate or vote on exempting housing benefit from the 1 per cent cap or on a modest amendment I tabled to require the government to publish an annual report on the relationship between rates of LHA and actual rents, and if these become significantly out of step to reconsider the 1 per cent cap policy.

This is only what the welfare minister, Lord Freud, promised during the debate on CPI-linked uprating in the Welfare Reform Bill in December 2011. He said, “if it then becomes apparent that local allowance rates and rents are out of step, they can be reconsidered" and when pressed by Labour’s Lady Hollis he conceded, "on the basis that the noble Baroness is going to be incredibly helpful to me in all the consequent amendments in the Bill, I will change the word 'can' to 'will'".

It will be for Labour lords to pick up the case again next month. If parliament can’t stop the screw being turned ever-tighter on housing benefit claimants, the least it can do is ensure ministers face the facts about who is hurting most and how badly.

John Healey is the Labour MP for Wentworth and Dearne and the former housing minister

Rough sleeping rose by 23 per cent in 2012. Photograph: Getty Images.

John Healey is the Labour MP for Wentworth and Dearne and was formerly housing minister, local government minister and financial secretary to the Treasury

Christopher Furlong/Getty Images
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Want to know how you really behave as a doctor? Watch yourself on video

There is nothing quite like watching oneself at work to spur development – and videos can help us understand patients, too.

One of the most useful tools I have as a GP trainer is my video camera. Periodically, and always with patients’ permission, I place it in the corner of my registrar’s room. We then look through their consultations together during a tutorial.

There is nothing quite like watching oneself at work to spur development. One of my trainees – a lovely guy called Nick – was appalled to find that he wheeled his chair closer and closer to the patient as he narrowed down the diagnosis with a series of questions. It was entirely unconscious, but somewhat intimidating, and he never repeated it once he’d seen the recording. Whether it’s spending half the consultation staring at the computer screen, or slipping into baffling technospeak, or parroting “OK” after every comment a patient makes, we all have unhelpful mannerisms of which we are blithely unaware.

Videos are a great way of understanding how patients communicate, too. Another registrar, Anthony, had spent several years as a rheumatologist before switching to general practice, so when consulted by Yvette he felt on familiar ground. She began by saying she thought she had carpal tunnel syndrome. Anthony confirmed the diagnosis with some clinical tests, then went on to establish the impact it was having on Yvette’s life. Her sleep was disturbed every night, and she was no longer able to pick up and carry her young children. Her desperation for a swift cure came across loud and clear.

The consultation then ran into difficulty. There are three things that can help CTS: wrist splints, steroid injections and surgery to release the nerve. Splints are usually the preferred first option because they carry no risk of complications, and are inexpensive to the NHS. We watched as Anthony tried to explain this. Yvette kept raising objections, and even though Anthony did his best to address her concerns, it was clear she remained unconvinced.

The problem for Anthony, as for many doctors, is that much medical training still reflects an era when patients relied heavily on professionals for health information. Today, most will have consulted with Dr Google before presenting to their GP. Sometimes this will have stoked unfounded fears – pretty much any symptom just might be an indication of cancer – and our task then is to put things in proper context. But frequently, as with Yvette, patients have not only worked out what is wrong, they also have firm ideas what to do about it.

We played the video through again, and I highlighted the numerous subtle cues that Yvette had offered. Like many patients, she was reticent about stating outright what she wanted, but the information was there in what she did and didn’t say, and in how she responded to Anthony’s suggestions. By the time we’d finished analysing their exchanges, Anthony could see that Yvette had already decided against splints as being too cumbersome and taking too long to work. For her, a steroid injection was the quickest and surest way to obtain relief.

Competing considerations must be weighed in any “shared” decision between a doctor and patient. Autonomy – the ability for a patient to determine their own care – is of prime importance, but it isn’t unrestricted. The balance between doing good and doing harm, of which doctors sometimes have a far clearer appreciation, has to be factored in. Then there are questions of equity and fairness: within a finite NHS budget, doctors have a duty to prioritise the most cost-effective treatments. For the NHS and for Yvette, going straight for surgery wouldn’t have been right – nor did she want it – but a steroid injection is both low-cost and low-risk, and Anthony could see he’d missed the chance to maximise her autonomy.

The lessons he learned from the video had a powerful impact on him, and from that day on he became much more adept at achieving truly shared decisions with his patients.

This article first appeared in the 01 October 2015 issue of the New Statesman, The Tory tide