Disability cuts: the big picture is terrifying

Individual benefit changes seem minor, says the head of Scope. But taken together, they present a worrying vision of life for disabled people in Britain.

Disability is set to explode into one of the political issues of 2013. It’s just a case of joining the dots.

This week alone has seen six parliamentary events in four days, each with disability at its heart. It kicked off with the vote on the Benefits Uprating Bill, which, contrary to the Government’s line, doesn’t protect disabled people

Also on Monday, the Minister for Disabled People, Esther McVey, was grilled on changes to Disability Living Allowance (DLA) by the Work and Pensions Select Committee. DLA was then the subject of a Westminster Hall debate on Tuesday, while Lord Freud was put on the spot on the issue in the Lords on Thursday.

This week Lords also raised questions on social care, which we now know is very much a disability issue. While on Wednesday another Westminster Hall debate tackled disability, this time housing benefits and disabled people. 

Amid the hurly-burly of politics, each debate, meeting or question can fly under the radar. But take a step back and they reveal a bigger story than the individual impact of one or other change. Disabled people rely on a house of cards of support and it’s about to come tumbling down. 

Here’s a taste of what it’s like to be disabled in 2013.

If you need help with basics such as getting up, getting dressed, getting fed and getting out, in theory you are entitled to support from your council. But there’s a £1.2bn black hole in funding. As a result 40 per cent of disabled people say their social care doesn’t meet these needs – and the Government’s plans for social care reform, due to be published in spring, will see 100,000 people stop being eligible. 

Once you’ve got help to get up and out, you have to contend with the fact that life costs an awful lot more if you’re disabled. Disability Living Allowance – administered nationally and non-means tested – is designed to address this. It might pay for a taxi to work where there is no accessible transport. The Government is turning DLA into Personal Independence Payment, bringing in a new assessment from April. Worryingly for disabled people, before a single person has been assessed the Government is expecting more than half a million people to lose the payment.

Then if you are disabled and also happen to be one of the country’s 2.49m people out of work, you are entitled to some basic income support and help to find a job. Before you can access either you have to go through the Work Capability Assessment. Given the high levels of successful appeals, and the horror stories of people inappropriately found fit to work, disabled people are very anxious about taking this test.

If you do end up on the right level of support, you can look forward to below-inflation increases (according to Labour 3.4m disabled households will be worse off) and possibly a place on the Work Programme, which has so far struggled to help disabled people find work.

Much like this week’s debates, questions and committees, each of these moves can feel niche, technical, even justifiable on its own. But it’s only when you look at them together that you get a feeling for what it’s like to be disabled right now.

It’s time we started looking at the big picture. Cuts to DLA can’t be discussed without talking about the future of social care. Indeed, I spoke to a visually impaired man from the Midlands whose council tried to justify rationing his social care by telling him to top it up with DLA.

The ministers say: don’t be scared. The Government says it has to save money. But this goes beyond saving money. This is about the kind of society we want to live in. This is Britain in 2013. This is about drawing a line in the sand.

Do we want to live in a country where we shut disabled people away? Do we want to live in one where a disabled person is asked if they really need to have a wash every day? 

Or do we want to live in one in which we are willing to invest in making sure disabled people can get involved in everyday life?

I know what I want.

But what about politicians?  It’s hard to say. I’m waiting for someone – of either party – to come out and say ‘Some people need benefits. It doesn’t make them a scrounger, it doesn’t make them workshy and it doesn’t make them feckless.’

Instead we are fed ‘strivers not skivers’ or ‘training not claiming’. It is time both parties stopped benefits bashing. We spend more on disability benefits than US, France, Italy, Germany and Spain. We should be proud of that. Benefits mean disabled people can do things in day-to-day life that everyone else takes for granted.

Ultimately politicians think they are on safe ground with this one. But here’s one last stat: according to the British Social Attitudes survey, 84 per cent of people would like the state to support them if they became disabled. The public know what kind of society they want to live in too.

Richard Hawkes is chief executive of the disability charity Scope

An amputee learns to walk. Photo: Getty

Richard Hawkes is chief executive of the disability charity Scope.

Photo: Getty Images
Show Hide image

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.