Work & Pensions Secretary Iain Duncan Smith arrives in Downing Street. Image: Getty
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Laurie Penny on welfare reform: Iain Duncan Smith had an epiphany, and it meant nothing

The religious language of sin and shame informs Tory welfare rhetoric, with its pulpit-thumping over "strivers" and "scroungers". But their overhaul has nothing to do with compassion or principle.

It is apparently known as the Easterhouse epiphany. One day in 2002, Iain Duncan Smith, then leader of the Conservative Party, now Work and Pensions Secretary, walked around the Easterhouse estate in Glasgow. He was reputedly so shocked by the deprivation he saw there, he decided that the welfare state needed to be destroyed, or at least completely rethought and rebuilt.
 
“I am happy to believe that Easterhouse was a critical moment for my policy,” Duncan Smith has said, “not because I hadn’t thought about this before – I had been beginning to find my way forward – but because I just realised there was something more to understand.” According to Iain Martin at the Telegraph, it was one of “the most remarkable and laudable conversions in public life for many a decade”.
 
In this conversion narrative of Conservative dogma, IDS is recast as a modern-day Siddhartha Gautama. Like the Indian prince who would one day become the Buddha, the Quiet Man descends from his palace of privilege to walk among the poor and needy, jolted by his encounter with inequality into a life of unstinting compassion. Except that nowhere is it written that the Buddha ever told a Treasury staffer that he would “bite [his] balls off and send them to [him] in a box”.
 
I have been attempting of late to write with more kindness. I have been trying to avoid spurious, ad hominemattacks and to argue with issues, not individuals.
 
So when I say that Iain Duncan Smith is a second-rate thinker and a third-rate leader who is wrecking civil society with his misguided moral crusade, I want you to understand that I mean it.
 
IDS, whose abbreviated name makes him sound like a chronic stomach complaint, is not the only Tory frontbencher to pretend to be on a quasireligious, reforming crusade. But he seems to approach his work with particular fervour and self-righteous indignation.
 
You can see it in his tantrums when someone questions his judgement in public. You can read about it in reports of aides, staffers and associates being reduced to tears or filing claims about alleged bullying on the job. When interrogated about the computer problems – or digital omnishambles, if you like – that has accompanied the introduction of the Universal Credit, IDS told parliament that the new benefit reforms aren’t really about practical matters, such as the proposed IT support system not working at all, but about “cultural change”.
 
The choice of wording is significant. It doesn’t matter whether or not Universal Credit will work in practice – and, indeed, its rollout has already been scaled back and delayed. What matters is changing the “culture”, from one in which everyone was entitled to a decent standard of living, and unemployment or illness did not have to trigger destitution, to one in which poverty and inequality are morally justified. After all, Universal Credit is intended to make “work pay” – whatever that means.
 
It is, we are told, all about morality, all about virtue and not at all about ability to work. The pittance on which people on unemployment benefit are expected to live – just 13 per cent of the average wage – is rephrased as care and concern, in the way Puritan leaders once proposed that whipping, ducking and dismemberment would not just punish sin but also save the soul.
 
IDS is, in fact, one of Britain’s most influential Roman Catholics. He surrounds himself with like-minded advisers, many of whom who are also deeply religious. The language of sin and shame informs Tory welfare rhetoric, with its pulpit-thumping over “strivers” and “scroungers”.
 
One doubts, however, that Jesus would approve of what the Department for Work and Pensions (DWP) is doing, given that the Nazarene was reputedly quite keen on feeding the poor. The benefit changes that began in April have already driven a threefold increase in the number of families relying on food banks. And yet, when the DWP redefines removing support from those who take home less than the minimum wage, including many of the 5.5 million Britons now on zero-hours contracts, as “support[ing] people to increase their earnings”, it is somehow taken seriously.
 
Somehow, it is now ethically acceptable for the top 1 per cent of earners to receive a tax cut worth hundreds of thousands of pounds, even as we are told that this country can no longer afford basic benefits.
 
We are told that the new puritan, anti-welfare evangelism is about compassion and about principle – a real moral crusade against “welfare dependency”. And if that were true, I could respect it.
 
 

Laurie Penny is a contributing editor to the New Statesman. She is the author of five books, most recently Unspeakable Things .

This article first appeared in the 16 September 2013 issue of the New Statesman, Syria: The deadly stalemate

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British mental health is in crisis

The headlines about "parity of esteem" between mental and physical health remain just that, warns Benedict Cooper. 

I don’t need to look very far to find the little black marks on this government’s mental health record. Just down the road, in fact. A short bus journey away from my flat in Nottingham is the Queens Medical Centre, once the largest hospital in Europe, now an embattled giant.

Not only has the QMC’s formerly world-renowned dermatology service been reduced to a nub since private provider Circle took over – but that’s for another day – it has lost two whole mental health wards in the past year. Add this to the closure of two more wards on the other side of town at the City Hospital, the closure of the Enright Close rehabilitation centre in Newark, plus two more centres proposed for closure in the imminent future, and you’re left with a city already with half as many inpatient mental health beds as it had a year ago and some very concerned citizens.

Not that Nottingham is alone - anything but. Over 2,100 mental health beds had been closed in England between April 2011 and last summer. Everywhere you go there are wards being shuttered; patients are being forced to travel hundreds of miles to get treatment in wards often well over-capacity, incidents of violence against mental health workers is increasing, police officers are becoming de facto frontline mental health crisis teams, and cuts to community services’ budgets are piling the pressure on sufferers and staff alike.

It’s particularly twisted when you think back to solemn promises from on high to work towards “parity of esteem” for mental health – i.e. that it should be held in equal regard as, say, cancer in terms of seriousness and resources. But that’s becoming one of those useful hollow axioms somehow totally disconnected from reality.

NHS England boss Simon Stevens hails the plan of “injecting purchasing power into mental health services to support the move to parity of esteem”; Jeremy Hunt believes “nothing less than true parity of esteem must be our goal”; and in the House of Commons nearly 18 months ago David Cameron went as far as to say “In terms of whether mental health should have parity of esteem with other forms of health care, yes it should, and we have legislated to make that the case”. 

Odd then, that the president of the British Association of Counselling & Psychotherapy (BACP), Dr Michael Shooter, unveiling a major report, “Psychological therapies and parity of esteem: from commitment to reality” nine months later, should say that the gulf between mental and physical health treatment “must be urgently addressed”.  Could there be some disparity at work, between medical reality and government healthtalk?

One of the rhetorical justifications for closures is the fact that surveys show patients preferring to be treated at home, and that with proper early intervention pressure can be reduced on hospital beds. But with overall bed occupancy rates at their highest ever level and the average occupancy in acute admissions wards at 104 per cent - the RCP’s recommended rate is 85 per cent - somehow these ideas don’t seem as important as straight funding and capacity arguments.

Not to say the home-treatment, early-intervention arguments aren’t valid. Integrated community and hospital care has long been the goal, not least in mental health with its multifarious fragments. Indeed, former senior policy advisor at the Department of Health and founder of the Centre for Applied Research and Evaluation International Foundation (Careif) Dr Albert Persaud tells me as early as 2000 there were policies in place for bringing together the various crisis, home, hospital and community services, but much of that work is now unravelling.

“We were on the right path,” he says. “These are people with complex problems who need complex treatment and there were policies for what this should look like. We were creating a movement in mental health which was going to become as powerful as in cancer. We should be building on that now, not looking at what’s been cut”.

But looking at cuts is an unavoidable fact of life in 2015. After a peak of funding for Child and Adolescent Mental Health Service (CAMHS) in 2010, spending fell in real terms by £50 million in the first three years of the Coalition. And in July this year ITV News and children’s mental health charity YoungMinds revealed a total funding cut of £85 million from trusts’ and local authorities’ mental health budgets for children and teenagers since 2010 - a drop of £35 million last year alone. Is it just me, or given all this, and with 75 per cent of the trusts surveyed revealing they had frozen or cut their mental health budgets between 2013-14 and 2014-15, does Stevens’ talk of purchasing “power” sound like a bit of a sick joke?

Not least when you look at figures uncovered by Labour over the weekend, which show the trend is continuing in all areas of mental health. Responses from 130 CCGs revealed a fall in the average proportion of total budgets allocated to mental health, from 11 per cent last year to 10 per cent in 2015/16. Which might not sound a lot in austerity era Britain, but Dr Persaud says this is a major blow after five years of squeezed budgets. “A change of 1 per cent in mental health is big money,” he says. “We’re into the realms of having less staff and having whole services removed. The more you cut and the longer you cut for, the impact is that it will cost more to reinstate these services”.

Mohsin Khan, trainee psychiatrist and founding member of pressure group NHS Survival, says the disparity in funding is now of critical importance. He says: “As a psychiatrist, I've seen the pressures we face, for instance bed pressures or longer waits for children to be seen in clinic. 92 per cent of people with physical health problems receive the care they need - compared to only 36 per cent of those with mental health problems. Yet there are more people with mental health problems than with heart problems”.

The funding picture in NHS trusts is alarming enough. But it sits in yet a wider context: the drastic belt-tightening local authorities and by extension, community mental health services have endured and will continue to endure. And this certainly cannot be ignored: in its interim report this July, the Commission on acute adult psychiatric care in England cited cuts to community services and discharge delays as the number one debilitating factor in finding beds for mental health patients.

And last but not least, there’s the role of the DWP. First there’s what the Wellcome Trust describes as “humiliating and pointless” - and I’ll add, draconian - psychological conditioning on jobseekers, championed by Iain Duncan Smith, which Wellcome Trusts says far from helping people back to work in fact perpetuate “notions of psychological failure”. Not only have vulnerable people been humiliated into proving their mental health conditions in order to draw benefits, figures released earlier in the year, featured in a Radio 4 File on Four special, show that in the first quarter of 2014 out of 15,955 people sanctioned by the DWP, 9,851 had mental health problems – more than 100 a day. And the mental distress attached to the latest proposals - for a woman who has been raped to then potentially have to prove it at a Jobcentre - is almost too sinister to contemplate.

Precarious times to be mentally ill. I found a post on care feedback site Patient Opinion when I was researching this article, by the daughter of a man being moved on from a Mental Health Services for Older People (MHSOP) centre set for closure, who had no idea what was happening next. Under the ‘Initial feelings’ section she had clicked ‘angry, anxious, disappointed, isolated, let down and worried’. The usual reasons were given for the confusion. “Patients and carers tell us that they would prefer to stay at home rather than come into hospital”, the responder said at one point. After four months of this it fizzled out and the daughter, presumably, gave up. But her final post said it all.

“There is no future for my dad just a slow decline before our eyes. We are without doubt powerless – there is no closure just grief”.

Benedict Cooper is a freelance journalist who covers medical politics and the NHS. He tweets @Ben_JS_Cooper.