Compassion is at dispiritingly low levels here. (Photo: Getty)
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People looking for work need support, not sanctions

The DWP's sanctions regime puts the most vulnerable at risk. The next government - of whatever hue - must do better.

Imagine getting to work and being told by your boss that you’ve been sanctioned - he’s not going to pay you for the next four weeks because you went to hospital and missed your meeting. He also sanctioned you last year after you refused to take a job doing night shifts because you couldn’t find anyone to look after your daughter. If you know to ask, he’ll start giving you ‘hardship’ payments in two weeks, which are about half your pay. But until then you and your daughter will get nothing.

Shocking, isn’t it? Surely that could never happen today? While perhaps the exception, this does happen and these examples are real - the only difference here is that the ‘boss’ is actually a Jobcentre advisor, there to help people find work. For many unemployed people, desperate to find a job, the fear of their Jobseeker’s Allowance (JSA) being sanctioned is their daily life.

Today the Work and Pensions Committee released their report into benefit sanctions, calling for a 'full independent review’. The committee's chair, Anne Begg stated that the system should 'avoid causing severe financial hardship', but that it 'does not always achieve this'.

If you or I were on JSA and unfairly sanctioned, we'd simply have to wait and hope that the sanction eventually got removed on appeal, giving back our £72.40 per week. If we had to take out a payday loan to pay for essentials like children's clothes, we'd be saddled with the interest. Perhaps we wouldn't be able to afford to top up the electricity meter to heat our homes. We'd go cold, be in debt and have to rely on food banks to feed our families. This isn't 'what if' - it's real life for many. 

'It is not reasonable to expect people to live without and source of income for 2 weeks', Begg stated. Unfortunately, this is simply the reality for many of the three million people who claimed JSA in 2013-14. Over half a million people were sanctioned during that time – 18% of people claiming. 35,170 were sanctioned three times. In 2008-9, just 10% of claimants were sanctioned.

"The system must also be capable of identifying and protecting vulnerable people, including those with mental health problems and learning disabilities”, Begg said. For the system to truly protect vulnerable people, it must be redesigned, and sanctions must be a genuine last resort. Just as important is ensuring that staff understand how to support people.

Nothing shows this need better than the unbelievable - yet true - story of a man who was on JSA, wanted a job, and went to the Jobcentre for help. He couldn’t use a computer because of his learning disability, which he told his advisor. He applied for jobs by post and showed his advisor the list of jobs he'd applied for. His advisor sanctioned him because he hadn't applied for the jobs on a computer. 

The advisor didn't understand his needs or how to support him, instead falling back on all too familiar sanctions. A charity advisor helped him have this sanction removed and secured fairer goals, including applying for some jobs on paper and others on a computer.  He still gets questioned as to why he hasn’t applied for more jobs on a computer and has to explain, time and again, that he can only use a computer when the charity supports him. The Jobcentre won't provide this support.

Living on £72.40 per week JSA (or just £57.35 if you're under 25) is difficult enough. Forcing people to survive with no money for two weeks and then on £43.44 per week hardship payments, sometimes for up to three years, is a symptom of a broken system that needs to be redesigned. The first step is Begg's full independent review. I hope that the next government commits to it. 

With the rhetoric that constantly gets thrown around - skivers vs strivers springs to mind - it's easy to lose sight of the fact that most people just want support to get a job. Put simply, people looking for work need support, not sanctions. 

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Testing migrant children’s teeth for their age is not only immoral – it doesn’t work

Ministers have flirted with this idea for over a decade. It’s bad policy, as well as poor ethics.

This week, the Home Office finally ruled out the use of x-rays to establish the age of childhood migrants.

It’s welcome news, but this story predates the dispersal of the Calais “Jungle” camp. 

For over ten years, ministers in Conservative and Labour governments have flirted with these tests. And it’s been up to us – the practitioners who’d be expected to administer them – to pick holes in a policy that’s a great way of securing headlines, but simply cannot deliver on the claims made by its cheerleaders.

It goes without saying dentists are health professionals, not border guards. But our objections run deeper than that. And it’s worth revisiting the arguments, just in case future governments start grasping for silver bullets.

It’s ineffective

We can talk about philosophy later, but let’s start with a pretty fundamental objection: dental x-rays are simply not a reliable way of establishing age.

No two mouths are alike. I’ll add my own to that list, as I still sport two of my baby teeth.

Children and young people mature at different rates, so the level of accuracy in these tests changes with time. And these x-rays can estimate age in younger children much more accurately than in adolescents. So as children mature at different rates, the potential margin of error gets ever larger with age.

For example, the third molars, commonly known as wisdom teeth – the last permanent teeth to develop – can form any time between the ages of 16 and 23, and a small proportion of individuals never develop third molars at all (I’ll have to pop my name to that list too).

A 2010 study of 300 young people aged between 11 and 25, whose age was determined based on dental x-rays, showed this method of testing consistently over- or under-estimated age, with a two-year average difference between dental and known age.

So if you are searching for a litmus test that will tell you whether a subject is 17 or 19 years old you won’t find it here.

It’s inappropriate

A few MPs and pundits have found it hard to acknowledge the codes health practitioners sign up to, which make this test a no go.

We must always act in the best interest of our patients when providing a medical procedure. And it is beyond question that the process of radiography is a medical procedure that should be carried out only for medical purposes, and where the patient stands to benefit.

Now many people might not consider this test an invasive procedure. However, x-rays do carry a small risk of possible long-term physical impact, and current best practice in this area dictates that exposure to radiation should be kept as low as reasonably possible over a lifetime. They should be carried out sparingly and where there is a well-defined potential clinical benefit, which must always outweigh the potential clinical harm.

As taking x-rays to determine the age of an individual carries no clinical benefit, it frankly isn’t appropriate to expose a patient to the potential clinical harm it can cause.

It’s unethical

Our lawmakers cannot simply dispense with fundamentals like consent to show they are “taking action”.

It is a legal principle that before practitioners carry out any medical procedure, the recipient – or someone who can consent on their behalf – must be given a full understanding of the nature of the procedure, its significance, impact and potential consequences before signing up to it.

For the children arriving from Calais, this would be a difficult task without English as a first language. Consent may also be required from a suitable adult. Yes, these children may be unaccompanied, but it does not mean the need for valid consent and protecting the child’s best interests can simply be ignored.

The letter of the law might be inconvenient, but it is a requirement that can only be compromised where the urgency and necessity of the circumstances demand rapid action in a patient’s best interests. And even in these circumstances the validity of treatment has sometimes ended up being challenged in the courts.

Given that taking x-rays in order to determine age is not medically justifiable in the first place, the urgency justification really doesn’t come into play. And that means dental colleagues – in the absence of valid consent – could find themselves performing an act that constitutes a criminal battery.


In the past, ministers have debated whether there is a credible “public interest” case that might override these little legal or philosophical objections. But these practical and ethical concerns can’t really be separated.

But why bother constructing a case for a test that frankly isn’t much cop? Dentists can only hope the latest message from the Home Office marks the beginning of a consensus, which draws a line under a decade of wishful thinking.

Judith Husband, Chair of the British Dental Association’s Education, Ethics and the Dental Team Working Group.