Author: Kitty S Jones

I’m a political activist with a strong interest in human rights. I’m also a strongly principled socialist. Much of my campaign work is in support of people with disability. I am also disabled: I have an autoimmune illness called lupus, with a sometimes life-threatening complication – a bleeding disorder called thrombocytopenia. The illness also affects my nervous system, including my optic nerves, (neuritis) leading to periods of severe pain and loss of eyesight. I have neuropathy, widespread tendonitis and quite severe secondary Raynaud’s. All of that means I may be unable to write much sometimes, but I’ll do my best. I find I have less and less time to pursue my other interests. Sometimes I long to go back to being the person I was before 2010. The Coalition claimed that the last government left a “mess”, but I remember being very well-sheltered from the consequences of the global banking crisis by the last government – enough to flourish and be myself. Now many of us are finding that our potential as human beings is being damaged and stultified because we are essentially focused on a struggle to survive, because of the cuts and welfare “reforms”. Maslow was right about basic needs and motivation: it’s impossible to achieve and fulfil our potential if we cannot meet our most fundamental survival needs adequately. And what kind of government inflicts a framework of punishment via its policies on citizens? With the hierarchical ranking in terms of “deserving” and “undeserving” poor, the artificial and imposed framework of previously debunked Social Darwinism: a Tory rhetoric of division, where some people’s worth matters more than others, how do we, as conscientious campaigners, help the wider public see that there are no divisions based on some moral measurement, or character- type: there are simply people struggling and suffering in poverty, who are being dehumanised by a callous, vindictive Tory government that believes, and always has, that the only token of our human worth is wealth? Governments and all parties on the right have a terrible tradition of scapegoating those least able to fight back, blaming the powerless for all of the shortcomings of right-wing policies. The media have been complicit in this process, making “others” responsible for the consequences of Tory-led policies, yet these cruelly dehumanised social groups are the targeted casualties of those policies. I set up, and administrate support groups for ill and disabled people, those going through the disability benefits process, and provide support for many people being adversely affected by the terrible, cruel and distressing consequences of the Governments’ draconian “reforms”. In such bleak times, we tend to find that the only thing we really have of value is each other. It’s always worth remembering that none of us are alone. I don’t write because I enjoy it: most of the topics I post are depressing to research, and there’s an element of constantly having to face and reflect the relentless worst of current socio-political events. Nor do I get paid for articles and I’m not remotely famous. I’m an ordinary, struggling disabled person. But I am accurate, insightful and reflective, I can research and I can analyse. I write because I feel I must. To reflect what is happening, and to try and raise public awareness of the impact of Tory policies, especially on the most vulnerable and poorest citizens. Because we need this to change. All of us, regardless of whether or not you are currently affected by cuts, because the persecution and harm currently being inflicted on others taints us all as a society. I feel that the mainstream media has become increasingly unreliable over the past five years, reflecting a triumph for the dominant narrative of ultra social conservatism and neoliberalism. We certainly need to challenge this and re-frame the presented debates, too. The media tend to set the agenda and establish priorities, which often divert us from much more pressing social issues. Independent bloggers have a role as witnesses; recording events and experiences, gathering evidence, insights and truths that are accessible to as many people and organisations as possible. We have an undemocratic media and a government that reflect the interests of a minority – the wealthy and powerful 1%. We must constantly challenge that. Authoritarian Governments arise and flourish when a population disengages from political processes, and becomes passive, conformist and alienated from fundamental decision-making. I’m not a writer that aims for being popular or one that seeks agreement from an audience. But I do hope that my work finds resonance with people reading it. I’ve been labelled “controversial” on more than one occasion, and a “scaremonger.” But regardless of agreement, if any of my work inspires critical thinking, and invites reasoned debate, well, that’s good enough for me. “To remain silent and indifferent is the greatest sin of all” – Elie Wiesel I write to raise awareness, share information and to inspire and promote positive change where I can. I’ve never been able to be indifferent. Like many others, I do what I can, when I can, and in my own way. This blog is one way of reaching people. Please help me to reach more by sharing posts. Thanks.

The uncouth and uncaring Conservative Party’s budget

After trying to address a rudely interrupting, unhearing, unfeeling, jeering and sneering Conservative party to deliver his response to the budget today, Jeremy Corbyn called the government “uncouth” and “uncaring” in a passionate speech, with barely constrained anger at how Conservatives’ policies are creating hardship and suffering for some of our most vulnerable citizens. A Conservative had made an inappropriate and ageist comment about Corbyn’s age, while he was addressing the Conservatives’ brutal cuts to social care.  

Corbyn spoke in defence of those elderly people suffering cuts in care budgets. It has been alleged that Conservative Party whip Andrew Griffiths – hiding out of sight of the Speaker’s chair – said the Labour leader should “be in a care home” himself.

Many of us have also used those words among others – uncouth and uncaring – many times over the past seven years to describe a government that laughed when hearing about people suffering because of their policies, laughed at the accounts of those suffering hardships because of the impact of the bedroom tax, laughed at the misery of those having to visit food banks. This is the same government that has stripped our public services bare, presided over falling and stagnating wages and huge hikes in the cost of living, removed lifeline support from ill and disabled people, stripping them of the means of meeting their basic needs, their independence and dignity, and savagely reducing funding to our local authorities, and essential public services such as health and social care. 

As Labour MP Laura Pidcock says: “It was absolutely right to be angry at the attitude of members on the benches opposite – shouting him down when he’s talking about serious issues, like the lack of social care services as a result of massive cuts (£6 billion) to budgets. This neglect, these holes in our safety net for vulnerable people, hurt people in reality. It is not a game.”

We have seen, over the last 7 years, the Conservatives’ authoritarianism embedded in punitive policies, in a failure to observe the basic human rights of some social groups, in their lack of accountability and diffusion of responsibility for the consequences of their draconian policies, and in their lack of democratic engagement with the opposition. Hurling personal insults, sneering and shouting over critics has become normalised by the Conservatives. They don’t debate, they simply attack on a personal level. This is not the standard and quality of debate that the public expect. Yet people don’t recoil any more from what has often been dreadfully unreasonable hectoring and terribly poor decorum. But they reallty ought to.

The budget details – pretty much more of the same

Philip Hammond finally faced up to the problem of “slower growth than predicted.” What a pity he didn’t have the balls to own the REASONS for that, which are chiefly linked to the seven year long economically inept, miserly austerity programme, aimed solely at ordinary people, especially the poorest citizens, and the deluxe “incentivisation” package designed to overindulge the hoarding wealthy.

The nations’ redistributed wealth simply trickles offshore, as we have discovered.

Those of us opposing the implicit “trickle down” philosophy of the government have won this debate several times over. Yet still the Tories persist in peddling magical thinking and neoliberal mythologies. The budget is simply more of the same economic ineptitude.

The answer to failing neoliberism is apparently more neoliberalism. It’s a budget of more of the same. 

The Office for Budget Responsibility (OBR) has presented a rather grim picture, slashing an average of 0.7% percentage points off UK trend productivity growth each year. That means the economy will be at least 3% smaller in 2020 than previously expected, leading to the sharp growth downgrade.  It’s another sign that the UK economy is weaker than we were led to believe by the bumbling government, who are not delivering the “robust” growth that policymakers have claimed. 

From the Institute for Fiscal Studies (IFS)

The OBR has also revised up its expected mortality rate. It’s now expected that 502,000 pensioners will die each year, up from 476,000 previously. 

The OBR says:

“This is consistent with life expectancy increasing less than projected since mid-2014. By 2022, the population in this age group [adults aged above the state pension age] is 1.2% lower than previously assumed.” 

What this means is that our life expectancy is falling, which is shameful in a developed and wealthy nation. 

Here is the response to the budget from John McDonnell, the shadow chancellor. And here is an excerpt:

“This is a ‘nothing has changed’ budget from an out-of-touch Government with no idea of the reality of people’s lives and no plan to improve them.

Philip Hammond has completely failed to recognise the scale of the emergency in our public services.

Today’s budget has found no meaningful funding for our schools still facing their first real terms funding cuts since the mid-90s and nothing even approaching the scale needed to address the crisis in our NHS or local government.”

Corbyn has also condemned Philip Hammond’s second Budget as Chancellor, saying that it demonstrates a “record of failure with a forecast of more to come”.  

The Labour leader, who was not provided with an advance sight of Hammond’s Budget, criticised the Government for repeatedly pushing back its target to eliminate Britain’s deficit, now it’s not likely to be “paid down” until at least 2030. If ever. I don’t think the Conservatives care about the deficit. They are rather more interested in privatising public services, and taking money from the poorest to hand out to the wealthiest. Their policies are not practical, they are simply ideological, revealing the very worst of their own traditional prejudices.

Corbyn said that 120,000 children would spend this Christmas living in temporary accommodation, he said: “Three new pilot schemes for rough sleepers simply doesn’t cut it.

“It’s a disaster for those people sleeping on our streets, forced to beg for the money for a night shelter,” he added. “They’re looking for action now from government to give them a roof over their heads.” 

Corbyn also cited cuts to police officer numbers and rising levels of in-work poverty. He also criticised the Government for failing to take action to tackle credit card debt.

He said: “Debt is being racked up because the Government is weak on those who exploit people, such as rail companies hiking up fares above inflation year on year, and water companies and energy suppliers.” 

The Labour party leader also criticised the Government’s measures on housing, saying very little was mentioned about the private rented sector – even though landlords were paid £10bn in housing benefit.

“With this Government delivering the worst rate of house building since the 1920s and 250,000 fewer council homes, any commitment would be welcome,” he said.

“But we’ve been here before. The Government promised 200,000 starter homes three years ago. Not a single one has yet been built in those three years.

You can watch Corbyn’s speech in full here

Here is a transcript of the core parts of his speech:

Mr Deputy Speaker, this Budget has been an advertisement for just how out-of-touch this government is with the reality of people’s lives. 
 
Pay is now lower for most people than it was in 2010 and wages are now falling again.

Economic growth in the first three quarters of this year is the lowest since 2009 and the slowest of the major economies in the G7.

It’s a record of failure with a forecast of more. Economic growth has been revised down. Productivity growth has been revised down. Business investment revised down.

People’s wages and living standards revised down. What sort of “strong economy, fit for the future” is that?

The deficit was due to be eradicated by 2015, then 2016, then 2017, then 2020 and now 2025. They’re missing their major targets but the failed and damaging policy of austerity remains.

The number of people sleeping rough has doubled since 2010 and 120,000 children will spend this Christmas in temporary accommodation. In some parts of the country life expectancy is actually starting to fall.

The last Labour government lifted a million children out of poverty. Under this government an extra 1 million children will be plunged into poverty by the end of this Parliament. 1.9 million pensioners and one in six are living in poverty – the worst rate in Western Europe.

Falling pay, slow growth, and rising poverty. This is what the Chancellor has the barefaced cheek to call a “strong economy”.

His predecessor said they would put the burden on “those with the broadest shoulders”. How has that turned out?

The poorest tenth of households will lose about 10 per cent of their income by 2022 while the richest will lose just 1 per cent.

So much for “tackling burning injustices”. This government is tossing fuel on the fire.

Personal debt levels are rising and 8.3 million people are over-indebted. If he wants to help people out of debt, he should back Labour’s policy for a Real Living Wage of £10 per hour by 2020.

And with working class young people now leaving university with £57,000 of debt – because this government trebled tuition fees – this government’s new policy to win over young people is to keep fees at £9,250.
 
But that is just one of a multitude of injustices presided over by this government. Another is Universal Credit, which Labour has called on ministers to pause and fix.
 
That’s the view of this House. It’s the verdict of those on the frontline with evidence showing food bank use increases 30 per cent where Universal Credit is rolled out.
 
And the benches opposite should listen to Martin’s experience, a full-time worker on the minimum wage, he says: “I get paid four weekly meaning that my pay date is different each month”, because of that, under the UC system he was paid twice in a month and deemed to have earned too much so his UC was cut off. He goes on: “This led me into rent arrears and I had to use a food bank for the first time in my life”.
 
This Chancellor’s solution to a failing system causing more debt; is to offer a loan. And the six week wait, with 20 per cent waiting even longer, becomes a five week wait.
 
This system has been run down by £3 billion cuts to Work Allowances, the two-child limit and the perverse ‘rape clause’ – and caused evictions because housing benefit isn’t paid direct to the landlord.
 
So I say to the Chancellor: put this broken system on hold, so it can be fixed, and keep a million more children out of poverty.
 
For years we have had the rhetoric of a “long-term economic plan” that never meets its targets; when what all too many are experiencing is long-term economic pain.
 
And the hardest hit are disabled people, single parents and women.
 
So it is disappointing the Chancellor did not back the campaign of my Hon Friend for Brent Central, Dawn Butler, to end period poverty.
 
The Conservative manifesto has now been shredded and some ministers opposite have since put forward decent proposals, several conspicuously borrowed from the Labour manifesto.
 
Let me tell the Chancellor, as socialists we are happy to share. 
 
The Communities Secretary called for £50 billion of borrowing to invest in housebuilding. Presumably the Prime Minister slapped him down for wanting to “bankrupt Britain”. 
 
The Health Secretary has said the pay cap is over but where is the money to fund a pay rise? The Chancellor hasn’t been clear today, not for NHS workers nor for our police, firefighters, teachers or teaching assistants, bin collectors, tax collectors or our armed forces personnel.
 
Will the Chancellor listen to Claire? She says, “My Mum works for the NHS. She goes above and beyond for her patients. Why does the government think it’s ok to under pay, over stress and underappreciate all that work?”
 
The NHS Chief Executive says “the budget for the NHS next year is well short of what is currently needed”. 
 
The Health Secretary said in 2015 he would fund another 5,000 GPs, but in the last year we have 1,200 fewer GPs. We’ve lost community nurses. We’ve lost mental health nurses. 
 
The Chancellor promised £10 billion in 2015 but delivered only £4.5 billion so we’ll wait for the small print on today’s announcement. It certainly falls well short of the £6 billion Labour would have delivered.
 
Over a million of our elderly aren’t receiving the care they need. Over £6 billion will have been cut from social care budgets by March next year. 
 
Our schools will be 5 per cent worse off by 2019 despite the Conservative manifesto promising that no school would be worse off. 
 
5,000 head teachers from 25 counties wrote to the Chancellor, saying “we are simply asking for the money that is being taken out of the system to be returned”. 
 
Robert wrote to me saying, “As a senior science technician my pay has been reduced by over 30 per cent. I’ve seen massive cuts at my school. Good teachers and support staff leave“.
 
According to this government, 5,000 head teachers are wrong. Robert is wrong. The IFS is wrong.
 
Councils are warning that services for vulnerable children are under more demand than ever, yet have a £2 billion shortfall. Local councils will have lost nearly 80 per cent in direct funding by 2020.
 
In reality, across the country this means women’s refuges closing, youth centres closing, libraries closing, museums closing.
 
But compassion can cost very little and just £10 million is needed to establish the child funeral fund campaigned for by my hon friend for Swansea East, Carolyn Harris.  
 
Under this government there are 20,000 fewer police officers. And another 6,000 community support officers, and 11,000 Fire Service staff have been cut too. 
 
Our communities cannot be kept safe on the cheap.
 
Tammy explains how this has affected her: “our police presence has been taken away meaning increasing crime. As a single parent I no longer feel safe in my own village, particularly after dark.”
 
Mr Deputy Speaker, five and a half million workers earn less than the living wage, a million more than just five years ago. 
 
And the Chancellor can’t even see 1.4 million unemployed people. 
 
There is a crisis of low pay and insecure work, affecting 1 in 4 women, and 1 in 6 men, a record 7.4 million people in working households in poverty. 
 
If we want workers earning better pay, less dependent on in-work benefits, we need to strengthen trade unions. the most effective means to boost workers’ pay. 
 
Instead this government weakened trade unions and introduced Employment Tribunal fees – now scrapped thanks to Unison’s legal victory.
 
And Mr Deputy Speaker, why didn’t the Chancellor take the opportunity to make two changes to control debt?
 
Firstly, to cap credit card debt so that nobody pays back more than they borrowed.
 
And secondly, to stop credit card companies increasing people’s credit limit without their say so.
 
Debt is being racked up because this government is weak on those who exploit people: the rail companies hiking fares above inflation year-on-year, the water companies and the energy suppliers.
 
During the general election it promised an energy cap that would benefit “around 17 million families on standard variable tariffs”. But every bill tells millions of families the government has broken its promise.
 
And with £10 billion in housing benefit going into the pockets of private landlords every year, housing is a key factor in driving up the welfare bill.
 
With this government delivering the worst rate of housebuilding since the 1920s and a quarter of a million fewer council homes, any commitment is welcome. 
 
But we’ve been here before. The government promised 200,000 starter homes three years ago and not a single one has been built. 
 
We need a large scale public house building programme, not this government’s accounting tricks and empty promises.
 
We back the abolition of stamp duty for first-time buyers because it was another Labour policy at the election, not a Tory one.
 
It’s this government’s continual preference for spin over substance that means, across this country, the words “Northern Powerhouse” and “Midlands Engine” are now met with derision.
 
Yorkshire and Humber gets only one-tenth of the transport investment per head given to London. 
 
And government figures show that every region in the north of England has seen a fall in spending on services since 2012. 
 
The Midlands, East and West, is receiving less than 8 per cent of total transport infrastructure investment, compared with over 50 per cent going to London.
 
In the East and West Midlands 1 in 4 workers are paid less than the living wage. So much for the ‘Midlands Engine’.
 
Re-announced funding for the Transpennine rail route won’t cut it and today’s other announcements won’t redress the balance.
 
Combined with counterproductive austerity, this lack of investment has consequences in sluggish growth and shrinking pay packets, and public investment has virtually halved.
 
Under this government, the UK has the lowest rate of public investment in the G7, but it is now investing in driverless cars after months of road-testing back seat driving in government.
 
By moving from RPI to CPI indexation on business rates the Chancellor has adopted another Labour policy, but why don’t they go further and adopt Labour’s entire business rates pledges including exempting plant and machinery and annual revaluation of business rates.
 
Nowhere has that been more evident than over Brexit.
 
Following round after round of fruitless Brexit negotiations the Brexit Secretary has been shunted out for the Prime Minister who has got no further.
 
Every major business organisation has written to the government telling them to pull their finger out.
 
Businesses are delaying investment decisions, but if this government doesn’t get its act together soon they will be taking relocation decisions.
 
Crashing out with ‘No deal’ and turning Britain into a tin-pot tax haven will damage people’s jobs and living standards, serving only a wealthy few.
 
It’s not as if this government isn’t doing its best to protect tax havens and their clients in the meantime.
 
The Paradise papers have again exposed how a super-rich elite is allowed to get away with dodging taxes.
 
This government has opposed measure after measure in this House, and in the European Parliament, to clamp down on the tax havens that facilitate this outrageous leaching from the public purse.
 
Mr Deputy Speaker, too often it feels like there is one rule for the super-rich and another for the rest of us.
 
The horrors of Grenfell Tower were a reflection of a system that puts profits before people, that fails to listen to working class people.
 
In 2013 this government received advice in a coroner’s report that sprinklers should be fitted in all high rise buildings.
 
Today this government failed to fund the £1 billion investment needed to make homes safe. The Chancellor says councils should contact them, but Nottingham has, Westminster has, and they’ve been refused!
 
In a Parliament building scheduled to be retrofitted with sprinklers, to protect us, the message from this government to people living in high rise homes is: You matter less.
 
Our country is marked by growing inequality and injustice. 
 
We were promised a revolutionary Budget. The reality is nothing has changed.
 
People were looking for help from this Budget, they have been let down. 
 
Let down by a government that like the economy they’ve presided over is weak and unstable and in need of urgent change.
 
They call this Budget, ‘Fit for the Future’. The reality is this is a government no longer fit for office.


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Work as a health outcome, making work pay and other Conservative myths and magical thinking

Originally I wrote much of this in a very long article about Unum’s involvement in the government’s Work, Health and disability Green Paper, earlier this year. Sometimes, though, some points get lost in the volume of other issues raised, so I thought I would make sure these particular issues have more visibility in this shorter article.

There is plenty of evidence that indicates government policy is not founded on empirical evidence, but rather, it is ideologically framed, and often founded on deceitful contrivance. A Department for Work and Pensions research document published back in 2011 – Routes onto Employment and Support Allowance said that if people believed that work was good for them, they were less likely to claim or stay on disability benefits.

So a political decision was made that people should be “encouraged” to believe that work was “good” for their health. There is no empirical basis for the belief, and the purpose of encouraging it is simply to cut the numbers of disabled people claiming Employment and Support Allowance (ESA) by “helping” them into work.

Another government document from 2014 – Psychological Wellbeing and Work – says: We know that being in work is good for wellbeing and that mental health problems are an increasing issue for the nation and so the Minister for Welfare Reform and the Minister for Care and Support jointly sought to expand the evidence base on common mental health problems.  

A number of Government programmes assess and support those with mental health difficulties to work, but it is internationally recognised that the evidence base for successful interventions is limited. 

The Contestable Policy Fund gives ministers alternative avenues to explore new thinking and strategies that offer cross-Government benefits. This report was commissioned through this route.” 

And: “Within the time and resources available for this study the research team did not undertake extensive assessment of the quality of the evidence base (eg assessing the research design and methodology of previous studies)”

The government have gone on to declare with authoritarian flourish that they now want to reinforce their proposal that “work is a health outcome.” Last year, a report by the Mental Health Task Force and chaired by Mind’s Paul Farmer, recommended that employment should be recognised as a “health outcome”.  I’m just wondering how people with, say, personality disorders, or psychosis are suddenly going to overcome the nature of their condition and successfully hold down a job for a minimum of six months.

Mind those logical gaps… 

This has raised immediate concerns regarding the extent to which people will be pushed into work they are not able or ready to do, or into bad quality, low paid and inappropriate work that is harmful to them, under the misguided notion that any work will be good for them in the long run.

The idea of the state persuading medical professionals to “sing from the same [political] hymn sheet”, by promoting work outcomes in health care settings is more than a little  Orwellian.

Gaslighting narrative has become common political practice. Sick and disabled people who have their lifeline support cut are being “supported” into work. People who are too ill to work are said to have “fallen out of employment”and “parked on benefits”, as if these are not rational decisions made by competent people who know that they cannot work any longer, and that quite often, to continue doing so would place themselves and/or others at risk. Benefits are paid for by people when they work as a social security, for in case they encounter difficult times. People tend to claim what they need, rather than becoming “parked” on benefits.

The idea that work will somehow set us free from illness is a very dangerous one.

Conservative narratives are comprised of glib, intentionally misleading, disdainful and patronising language from an utterly ruthless elite running the country into the ground, leaving such an unkind and uncaring society for the next generation, with nothing left of the “from the cradle to the grave” provision that previous generations have relied on. 

Sick notes have been renamed “fit notes” and disability benefit is now “employment and support allowance”, emphasising the linguistic behaviourism and ultimate priorities of a “small state” neoliberal government. 

Work is the only route out of poverty. If you can’t work, that’s just too bad.

Some people’s work is undoubtedly a source of wellbeing and provides a sense of purpose and security. That is not the same thing as being “good for health”. For a government to use data regarding opinion rather than empirical evidence to claim that work is “good” for health indicates a ruthless mercenary approach to fulfill their broader aim of dismantling social security and to uphold their ideological commitment to supply-side policy.

From the first document“The belief that work improves health also positively influenced work entry rates; as such, encouraging people in this belief may also play a role in promoting return to work.”

The aim of the research was to “examine the characteristics of ESA claimants and to explore their employment trajectories over a period of approximately 18 months in order to provide information about the flow of claimants onto and off ESA.”

The document also says: “Work entry rates were highest among claimants whose claim was closed or withdrawn suggesting that recovery from short-term health conditions is a key trigger to moving into employment among this group.”

“The highest employment entry rates were among people flowing onto ESA from non-manual occupations. In comparison, only nine per cent of people from non-work backgrounds who were allowed ESA had returned to work by the time of the follow-up survey. People least likely to have moved into employment were from non-work backgrounds with a fragmented longer-term work history. Avoiding long-term unemployment and inactivity, especially among younger age groups, should, therefore, be a policy priority. ” 

“Given the importance of health status in influencing a return to work, measures to facilitate access to treatment, and prevent deterioration in health and the development of secondary conditions are likely to improve return to work rates”

Rather than make a link between manual work, lack of reasonable adjustments in the work place and the impact this may have on longer term ill-health, the government chose instead to promote the cost-cutting and unverified, irrational belief that work is a “health” outcome. Furthermore, the research does conclude that health status itself is the greatest determinant in whether or not people return to work. That means that those not in work are not recovered and have longer term health problems that tend not to get better.

The fact that government policy papers lack coherence, consistent logic and rationale is very troubling, because it indicates plainly that government policy is being driven by assumption, prejudice and ideology.

The government mantra “making work pay” was nothing to do with improving falling or stagnating wages and job insecurity, or poor working conditions. It was all about making sure that the conditions attached to social security eligibility are so punitive and wretched that only those people who are absolutely desperate will put themselves through the harshly punitive and stigmatising claim and conditionality process.

“Making work pay” is really all about making social security appear unsustainable and untenable. It’s about a governments’ priorities and choices expressed in Orwellian soundbites. It’s about a “business friendly” government that will always make sure your employer makes a hefty profit at your expense. It’s about the introduction of ordeals in order to deter people from claiming the welfare support that they paid for, for when they need it. It’s ultimately about dismantling the gains of our post-war settlement. It’s about the neoliberal small state and Conservative dogma. 

Work does not “cure” ill health. To mislead people in such a way is not only atrocious political expediency, it’s actually downright dangerous.

As neoliberals, the Conservatives see the state as a means to reshape social institutions and social relationships based on the model of a competitive market place. This requires a highly invasive power and mechanisms of persuasion, manifested in an authoritarian turn. Public interests are conflated with narrow economic outcomes. Public behaviours are politically micromanaged. Social groups that don’t conform to ideologically defined economic outcomes are politically stigmatised and outgrouped. 

The political de-professionalisation of medicine, medical science and specialisms (consider, for example, the implications of permitting job coaches to update patient medical files), the merging of health and employment services and the recent absurd declaration that work is a clinical “health” outcome, are all carefully calculated strategies that serve as an ideological prop and add to the justification rhetoric regarding the intentional political process of dismantling publicly funded state provision, and the subsequent stealthy privatisation of Social Security and the National Health Service. 

De-medicalising illness is also a part of that process:

“Behavioural approaches try to extinguish observed illness behaviour by withdrawal of negative reinforcements such as medication, sympathetic attention, rest, and release from duties, and to encourage healthy behaviour by positive reinforcement: ‘operant-conditioning’ using strong feedback on progress.” Gordon Waddell and Kim Burton in Concepts of rehabilitation for the management of common health problems. The Corporate Medical Group, Department for Work and Pensions, UK. 

This is the dangerous, irrational, savage and neoliberal mindset behind the cuts to disability support. Medication, rest, release from duties, sympathetic understanding – remedies to illness – are being redefined as “perverse incentives” for “sickness behaviours”, yet the symptoms of an illness necessarily precede the prescription of medication, the Orwellian (and political rather than medical) “fit note” and exemption from work duties. Notions of “rehabilitation” and medicine are being redefined as behaviour modification: here it is proposed that operant conditioning in the form of negative reinforcement, which the authors seem to have confused with punishment, will “cure” ill health. Imagine trying to sell the bordering-on-psychopathic idea that medicine provides perverse incentives which encourage “sickness behaviours” in patients to doctors, preventing them from recovering in a timely manner so they can promptly return to work.

I’m sure that oncologists everywhere will be relieved to see that their cancer patients simply needed to be told to pull themselves together, and that what they need is a stiff talking to, instead of the soft options entailing mollycoddling, chemotherapy and surgery. 

This is the same kind of thinking that lies behind the broader welfare sanctions, which are state punishments entailing the cruel removal of lifeline income for “non-compliance” in narrowly and rigidly defined “job seeking behaviours.” Sanctions are also described as a “behavioural incentive” to “help” and “encourage”people into work. People who are ill, it is proposed, should be sanctioned, too, which would entail having their lifeline basic health care and money for meeting their basic needs removed. 

Many qualitative accounts from first hand witnesses, extensive research and empirical evidence has repeatedly demonstrated that welfare sanctions make it less likely that people will find employment: taking essential support from people with very limited resources profoundly demotivates, distresses and harms people, rather than “incentivising” them to find work. (See also: Benefits sanctions: a policy based on zeal, not evidence and The Nudge Unit’s u-turn on benefit sanctions indicates the need for even more lucrative nudge interventions, say nudge theorists.)

The darker meaning of David Cameron’s comments about “ending a culture of entitlement” back in 2010 has become clearer. He wasn’t only talking about perceived attitudes and referencing erroneous, unverified and unfounded notions of “welfare dependency”: his party’s aim was and still is about reducing public expectations of a supportive and rights-based relationship with the publicly funded state – one that has evolved from the post-war settlement to ensure that everyone in the UK can meet their basic human needs. It’s no coincidence that we have witnessed the savage reduction of social security and rationing within our national health care systems since 2010.

This government is serious threat to all of those institutions and public services that contribute to make us a civilised society. In 2017, I should not have to say that poor and ill people cannot be simply punished, bullied, harassed (or “nudged”) out of being poor or ill. As politically inconvenient as poverty and disability are, no amount of authoritarian state gaslighting, abuse, bullying and harassment will “cure” those of us afflicted with either. 

The government’s new behavioural medicine is rather old news, sociologists abandoned the sick role concept decades ago

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Behavioural medicine was significantly influenced by American sociologist Talcott Parsons’ The Social System,1951and his work regarding the sick role, which he analysed in a framework of citizen’s roles, social obligations, reciprocities and behaviours within a wider capitalist society, with an analysis of rights and obligations during sick leave.

From this perspective, which is an essentially socially conservative one, the sick role is considered to be sanctioned deviancewhich disturbs the function of society and the moral economy . (It’s worth comparing that the government are currently focused on economic function, enhancing the supply side of the labour market and the moral economy within a neoliberal framework.)

Behavioural medicine more generally arose from a view of illness and sick role behaviours as characteristics of individuals, and these concepts were imported from Functionalist sociological and sociopsychological theories.

However, perhaps it should be pointed out that there is a distinction between the academic social science disciplines, which include competing and critical perspectives of conflict and power, for example, and the recent technocratic “behavioural insights” approach to public policy, which is a monologue that doesn’t recognise the need for citizens’ democratic consent to behavioural change, nor does it recognise controversy or include critical analysis. It serves as prop for neoliberalism, conflating citizen’s needs and interests with narrow, politically defined economic outcomes. 

We have a government that has regularly misused concepts from psychology and sociology, distorting them to fit a distinct framework of ideology, and justification narratives for draconian policies. Parsons’ work has generally been defined as sociological functionalism, and functionalism tends to embody very conservative ideas. From this perspective, sick people are not productive members of society; therefore this deviation from the norm must be policed. This, according to Parsons, is the role of the medical profession.

More recently we have witnessed the rapid extension of this role to include extensive State policing of sick and disabled people.

It seems many of the so-called psychosocial model advocates have ignored the rise of  chronic illnesses and the pathologisation of everyday behaviours in health promotion. Parson’s sick role came to be seen as a negative referent (Shilling, 2002: 625) rather than as a useful interpretative tool. Parsons’ starting point is his understanding of illness as deviance.

Illness is the breakdown of the general “capacity for the effective performance of valued tasks” (Parsons, 1964: 262). Losing this capacity disrupts “loyalty” to particular social commitments in specific contexts such as the workplace.

Theories of the social construction of disability also provide an example of the cultural meaning of certain health conditions. The roots of this anti-essentialist approach are found in Stigma by sociologist Erving Goffman (1963), in which he highlights the social meaning physical impairment comes to acquire via social interactions.

The social model of disability tends to conceptually distinguish impairment (the attribute) from disability (the social experience and meaning of impairment). Disability cannot be reduced to a mere biological problem located in an individual’s body (Barnes, Mercer, and Shakespeare, 1999).

Rather than a “personal tragedy” that should be fixed to conform to medically determined standards of “normality” (Zola, 1982), disability becomes politicised. The issues we then need to confront are about the obstacles that may limit the opportunities for individuals with impairments, and about how those social barriers may be removed.

From a social constructionist perspective, emphasis is placed on how certain illnesses come to have cultural meanings that are not reducible to or determined by biology, and these cultural meanings further burden the afflicted (as opposed to burdening “the tax payer” , the health services, those with profit seeking motives, or the state.)

So to clarify, it is wider society and governments that need a shift in disabling attitudes, perceptions and behaviours, not disabled people.

The insights that arose from the social construction of disability approach are embodied in policies, which include the Disability Discrimination Act 1995, which included an employers’ duty to ensure reasonable adjustments/adaptations; the more recent Equality Act 2010 and the Human Rights Act 1998, which provides an important tool for disabled people to use to challenge discrimination, violations to their human rights and unacceptable treatment.

In contrast, Parsons invokes a social contract (an idea which Cameron ran with when he described the “big society” with increased citizen responsibility) in which society’s “gift of life” is repaid by continued contributions and conformity to (apparently unchanging, non-progressive) social expectations.

For Parsons, this is more than just a matter of symbolic interaction, it has far more concrete, material implications: “honour” (deserving) and “shame” (undeserving) which accompany conformity and deviance, have consequences for the allocation of resources, for notions of citizenship, civil rights and social status.

Parsons, like the contemporary Conservatives, never managed to accommodate and reflect social change, suffering and distress, poverty, deprivation and conflict in his functionalist perspective. His view of citizens as oversocialised and subjugated in normative conformity was an essentially Conservative one. Furthermore, his systems theory was heavily positivistic, anti-voluntaristic and profoundly dehumanising. His mechanistic and unilinear evolutionary theory reads like an instruction manual for the neoliberal state.

Parsons thought that social practices should be seen in terms of their function in maintaining order and social structure. You can see why his core ideas would appeal to Conservative neoliberals and rogue multinational companies. Conservatives have always been very attached to tautological explanations (insofar that they tend to present circular arguments.

One question raised in this functional approach is how do we determine what is functional and what is not, and for whom each of these activities and institutions are functional. If there is no method to sort functional from non-functional aspects of society, the functional model is tautological – without any explanatory power to why any activity is regarded as “functional.” The causes are simply explained in terms of perceived effects, and conversely, the effects are explained in terms of perceived causes). 

Because of the highly gendered division of labour in the 1950s, the body in Parsons’ sick role is a male one, defined as controlled by a rational, purposive mind and oriented by it towards an income-generating performance. For Parsons, most illness could be considered to be psychosomatic.

This “mind over matter” dogma is not benign; there are billions of pounds and dollars at stake for the global insurance industry, which is set to profit massively to the detriment of sick and disabled people. And billions to be saved and redistributed to big business and to fund tax cuts for the wealthy from our increasingly rationed and rapidly disappearing social security and NHS.

The eulogised psychosocial approach is evident throughout the highly publicised UK PACE Trial on treatment regimes that entail Cognitive Behaviour Therapy (CBT) and graded exercise. By curious coincidence, that trial was also significantly about de-medicalising illnesses. Another curious coincidence is that Mansel Aylward – who co-authored the document I cited earlier – sat on the PACE Trial steering group. 

From 1996 to April 2005 Aylward was Chief Medical Adviser, Medical Director and Chief Scientist of the UK Department for Work and Pensions and Chief Medical Adviser and Head of Profession at the Veteran’s Agency, Ministry of Defence. He was on the board of the Benefits Agency Medical Service in the 1990s.

He was involved in the establishment of the Work Capability Assessment test. When he left the department he headed the UnumProvident Centre for Psychosocial and Disability Research, at Cardiff University,

Aylward has been heaviliy criticized for providing unwarranted academic credibility to the biopsychosocial model (with a heavy  emphasis on the “psychological” element) which became both the basis and justification for the Conservative government’s disability support cuts.

The government seem to have convinced themselves that for the poorest citizens, illness is all in the mind. Disability that entails additional needs and costs is really all about people simply conforming to roles, normative expectations, and academically constructed stereotypes.

For example, a contemporary interpretation of Parsons’ functionalist perspective of the sick role: “Diagnosis elicits the belief the patient has a serious disease, leading to symptom focusing that becomes self-validating and self-reinforcing and that renders worse outcomes, a self-fulfilling prophecy, especially if the label is a biomedical one like ME. Diagnosis leads to transgression into the sick role, the act of becoming a patient even if complaints do not call for it, the development of an illness identity and the experience of victimization”. Simon Wessely and Marcus S.J. Huibers: The act of diagnosis: pros and cons of labelling chronic fatigue syndrome. Psychological Medicine 2006: 36

In 1993, Mansel Aylward invited psychiatrist Simon Wessely to give a presentation on his biopsychosocial approach to Chronic Fatigue Syndrome before the then Minister for Social Security. Wessely claimed:As regards benefits:- it is important to avoid anything that suggests that disability is permanent, progressive or unchanging. Benefits can often make patients worse.” 

Benefits can often make patients worse.” Ensuring that people can meet their basic survival needs is apparently a bad thing. Have you ever heard such utter nonsense?

It’s much more likely that patients who become more severely ill require welfare support. Despite there being no empirical evidence whatsoever for Wessely’s claims, the Minister for Social Security was looking to cut spending, so self-styled “experts” like Wessely and Aylward were more useful to an expedient government than rigorous research, empirical evidence and common decency.

I think it would be true to say that without social security, many people who are disabled because of Chronic Fatigue Syndrome (CFS) and other chronic illnesses that cause disability would experience MUCH worse symptoms,  and many would undoubtedly die without lifeline support to enable them to meet the cost of their basic survival needs. 

And actually, that is precisely what is happening in the 6th wealthiest, so-called democratic nation in the world. 

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The first digital antipsychotic pill with tracking. In an authoritarian state, what could possibly go right?

In the United State, regulators have approved the first “digital pill” with a tracking system. According the Financial Times, this is a pill with an inbuilt sensor, which opens up a new front in pharmaceuticals and the “internet of things”. 

The tablet can be tracked inside the stomach, relaying data on whether, and when, patients have taken “vital medication”. So far, the US Food and Drug Administration has given the green light for it to be used in an antipsychotic medication with the aim that the data can be used “to help doctors and patients better manage treatment.”

Patients who agree to take the digital medication, a version of the antipsychotic drug Abilify, can sign consent forms allowing their doctors and up to four other people, including family members, to receive electronic data showing the date and time pills are ingested.

Dr. Peter Kramer, a psychiatrist and the author of Listening to Prozac, raised concerns about “packaging a medication with a tattletale.”

While ethical for “a fully competent patient who wants to lash him or herself to the mast,” he said, “‘digital drug’ sounds like a potentially coercive tool.”

Other companies are developing digital medication technologies, including another ingestible sensor and visual recognition technology capable of confirming whether a patient has placed a pill on the tongue and has swallowed it. 

The newly approved pill, called Abilify MyCite, is a collaboration between Abilify’s manufacturer, Otsuka, and the Silicon Valley based Proteus Digital Health, the company that created the sensor.

The sensor, which contains copper, magnesium and silicon, generates an electrical signal when splashed by stomach fluid, “like a potato battery,” according to Andrew Thompson, Proteus’s president and chief executive.

After several minutes, the signal is detected by a Band-Aid-like patch that must be worn on the left rib cage and replaced after seven days, said Andrew Wright, Otsuka America’s vice president for digital medicine. The patch then sends the date and time of pill ingestion and the patient’s activity level via Bluetooth to a cellphone app.

Abilify is prescribed to people with schizophrenia, bipolar disorder and, in conjunction with an antidepressant, major depressive disorder. The symptoms of schizophrenia and related disorders can include paranoia and delusions, so you do have to wonder how widely digital Abilify will be accepted, given that it is designed to monitor behaviours and transmit signals from within a person’s body to communicate with their doctor.  

Dr. Jeffrey Lieberman, chairman of psychiatry at Columbia University and New York-Presbyterian Hospital, said many psychiatrists would likely want to try digital Abilify, especially for patients who just experienced their first psychotic episode and are at risk of stopping medication after feeling better.

But he noted it has only been approved to track doses, and has not yet been shown to improve compliance with treatment regimes.

He added, “There’s an irony in it being given to people with mental disorders that can include delusions. It’s like a biomedical Big Brother.”

The FT article goes on to say: “Poor compliance with drug regimes, particularly among sufferers of chronic diseases, is a pervasive problem for pharma companies and health systems, leading to lower consumption of the industry’s products and higher costs for payers when patients’ conditions deteriorate as a result of missing treatment.”

 You can see precisely where the emphasis and priorities lie in that statement. Not a word about the poor dehumanised “patients'” wellbeing and importantly, about their choice. It’s assumed that pharma industry’s products don’t have any adverse effects at all, and that taking the medication is always in the patient’s best interest. It’s assumed that medications will improve someone’s mental health. Apparently the key to good mental health is keeping costs low to tax payers while keeping the pharma industry in business, ensuring that they can keep making profits.

Andrew Thompson, Proteus chief executive, said the technology would allow people with serious mental illness “to engage with their care team about their treatment plan in a new way”. Patients will be able to use a mobile phone to track and “manage” their medication. Worryingly, he is already in talks with other major pharma companies about using the technology in treatments for various chronic conditions.

The tablets contain a sensor, so that when they are swallowed, a signal is sent to a patch worn on the patient’s body, which in turn connects to an app on their phones, showing that they have taken their dose. The doctor who has prescribed the medicine will automatically be sent the data and patients can also choose to nominate family and care team members to receive it.

The wearable patch will also be used to track how much patients are moving around — considered a key indicator of overall health — and allows them to self-report their mood and sleep quality via the app. 

There are some problems with the assumptions behind the development of digital pill, and its proposed use. Firstly, it’s a myth that people with mental health conditions are not very good at taking their medication. Studies have shown that “compliance” with a medication regime is no worse in people with mental health conditions like schizophrenia than it is in long-term physical ailments such as asthma or high blood pressure. In fact demographic factors such as whether a person is single or in a relationship are more likely to play a role in medication compliance.

It is also a taken for granted assumption that pharmaceutical solutions are the best guarantee of positive outcomes for people with mental health conditions. Before concentrating on specific medication issues it is important to remember that medication is not the sole focus of a mental health intervention. This is because the causes of mental illness are complex and various, and quite often do not arise solely from “within” individuals, rather, it often arises because of interactions between environmental factors, circumstances, and individual predispositions and vulnerabilities (including both psychological and biological). Some psychiatrists have stated that mental illness – in all its forms – is intrinsically social.

We know, for example, that discrimination plays a part in explaining why certain groups in our society are more likely to experience poor mental health compared to others. Direct experiences of prejudice and harassment impact negatively on mental wellbeing, while indirect factors such as deprivation and social exclusion also contribute to poor mental health. Studies have highlighted the role that prejudice, stigma and discrimination can play in poor mental health.

It is only by fully acknowledging and understanding the external risk factors for poor mental health that we can develop our understanding of protective factors for good mental health at the individual, community and societal level. 

Sometimes causes are confused with effects

Despite controversies in psychiatry regarding the very complex aetiology of mental illness, including the role of sociological practices, political practices and economic conditions, it is widely held that mental illness arises “within” the individual and has a purely neurobiological origin. Yet there is no conclusive evidence to demonstrate that major mental illnesses are “proven biological diseases of the brain” and that emotional distress results from “chemical imbalances.”

One attempt to explain a physical cause of schizophrenia is the dopamine hypothesis. Dopamine is a neurotransmitter. It is one of the chemicals in the brain which causes neurons to fire. The original dopamine hypothesis stated that people with schizophrenia suffered from an excessive amount of dopamine. This causes the neurons that use dopamine to fire too often and transmit too many “messages”. High dopamine activity leads to acute episodes, and positive symptoms which include delusions, hallucinations and “confused thinking.”

Evidence for this hypothesis comes from that fact that amphetamines increase the amounts of dopamine. Large doses of amphetamine given to people with no history of psychological disorders produce behavior which is very similar to paranoid schizophrenia. Small doses given to people already suffering from schizophrenia tend to worsen their symptoms.

However, the problem with this hypothesis is that we don’t know if the raised dopamine levels are the cause of the schizophrenia, or if the raised dopamine level is the result of schizophrenia. It is not clear which comes first. 

One of the biggest criticisms of the dopamine hypothesis came when Farde et al found no difference between levels of dopamine in people with schizophrenia compared with “healthy” individuals in 1990.

Another problem is that schizophrenia is something of an umbrella term that encompasses a wide array of symptoms, and can be reached by multiple routes that may, nevertheless, impact the same biological pathways. However, there is emerging evidence that different routes to experiences currently deemed indicative of schizophrenia may need different treatments.

For example, preliminary evidence suggests that people with a history of childhood trauma who are diagnosed with schizophrenia are less likely to be helped by antipsychotic drugs. However, more research into this is needed. It has also been suggested that some cases of schizophrenia are actually a form of autoimmune encephalitis, which means that the most effective treatment may be immunotherapy and corticosteroids. People with autoimmune illness such as lupus are also at an increased risk of developing autoimmune mediated psychosis.

Some interventions, such as the family-therapy based dialogue approach, show some promise for many people with schizophrenia diagnoses. Both general interventions and specific ones, tailored to someone’s personal route to the experiences associated with schizophrenia, may be needed. It’s therefore crucial that psychiatrists ask people about all the potentially relevant circumstances and routes.

For example, suffering childhood adversityusing cannabis and having childhood viral infections of the central nervous system all increase the odds of someone being diagnosed with a psychotic disorder (such as schizophrenia) by at least two – to threefold. 

Although the exact causes of most mental illnesses are not known, it is becoming clear through extensive research that many conditions are caused by a complex combination of biological, psychological, social, cultural, political, economic and environmental factors. It’s widely recognised that poverty, social isolation, being unemployed or highly stressed in work can all have an effect on an individual’s mental health. 

Adults in the poorest fifth of the population are much more at risk of developing a mental illness as those on average incomes: around 24% compared with 14%. Those who have an existing mental illness are significantly more likely to be living in poverty, also. 

Poverty can therefore be both a causal factor and a consequence of mental ill-health. Mental health is shaped by the wide-ranging characteristics (including inequalities) of the social, economic, political and physical environments in which people live.

Successfully supporting the mental health and wellbeing of people living in poverty, and reducing the number of people with mental health problems experiencing poverty, requires an engagement with this complexity. Simply medicating a person is neither sufficient nor appropriate. Nor is it ethical. Pharmaceutical companies tend to promote the assumption that mental illness is entirely biomedical. The relationship between economics and health is complex and politically fraught. But it is too important to ignore.

Psychiatric diagnosis tends to reify the complexity of people’s problems. However, in the UK, the political (mis)use of behaviourism has also resulted in the reification of social and economic problems. The government here extend the view that unemployment is evidence of both personal failure and psychological deficit. The use of crude behaviourist psychology in the delivery of social security denies the individuals’ experience of the effects of social and economic inequalities, and has been used to authorise the extension of the state and to justify state-contracted surveillance to individuals’ psychological characteristics.  

In a “business friendly” environoment, with a distinctly authoritarian government, I can’t help but wonder how long will it be before we see the increasingy intrusive Conservative state locking up or drugging patients whose diseases are defined not by organic dysfunction but by politically defined “socially unacceptable behaviours”.

I’m a critic of state entanglement with psychiatry AND psychology. For people with mental health problems in the UK, policies are being formulated to act upon them as if they are objects, rather than autonomous human subjects. Such a dehumanising approach has contributed significantly to a wider process of  social outgrouping, increasing stigmatisation and ultimately, to further socioeconomic and mental health inequalities. Most government policies aimed at ill and disabled people more generally are about cutting costs and removing lifeline support. This has been increasingly justified by a narrative that focuses on problematising sick role behaviours, rather than on the real impacts of illness and the additional needs that being chronically ill invariably generates. 

Earlier this year, George Freeman, Conservative MP for Norfolk and chair of the Prime Minister’s Policy Board, defended the government’s decision to subvert the judicial system, by disregarding the rulings of two independent tribunals concerning Personal Independence Payment (PIP) for disabled people. The government ushered in an “emergency” legislation to reverse the legal decisions in order to cut cost. In an interview on Pienaar’s Politics, on BBC 5 Live, Freeman said: 

“These tweaks [new regulations to cut PIP eligibility] are actually about rolling back some bizarre decisions by tribunals that now mean benefits are being given to people who are taking pills at home, who suffer from anxiety”.

He claimed that the “bizarre” upper tribunal rulings meant that“claimants with psychological problems, who are unable to travel without help, should be treated in a similar way to those who are blind.”

He said: “We want to make sure we get the money to the really disabled people who need it.”

He added that both he and the Prime Minister “totally” understood anxiety, and went on to say: “We’ve set out in the mental health strategy how seriously we take it.” 

He said: “Personal Independence Payments reforms were needed to roll back the bizarre decisions of tribunals.” 

Freeman’s controversial comments about people with anxiety “at home taking pills” implies that those with mental health problems are somehow faking their disability. He trivialises the often wide-ranging disabling consequences of mental ill health, and clearly implies that he regards mental illnesses as somehow not “real” disabilities.

His comments contradict the government’s pledge to ensure that mental health and physical health are given a parity of esteem, just months after the Prime Minister pledged to take action to tackle the stigma around mental health problems. 

Yet people with the following mental health conditions are likely to be affected by the reversal of the Independent Tribunal’s ruling on PIP mobility awards – those in particular who suffer “overwhelming psychological distress” when travelling alone:

Mood disorders – Other / type not known, Psychotic disorders – Other / type not known, Schizophrenia, Schizoaffective disorder, Phobia – Social Panic disorder, Learning disability – Other / type not known, Generalized anxiety disorder, Agoraphobia, Alcohol misuse, Anxiety and depressive disorders – mixed Anxiety disorders – Other / type not known, Autism, Bipolar affective disorder (Hypomania / Mania), Cognitive disorder due to stroke, Cognitive disorders – Other / type not known, Dementia, Depressive disorder, Drug misuse, Stress reaction disorders – Other / type not known, Post-traumatic stress disorder (PTSD), Phobia – Specific Personality disorder, Obsessive compulsive disorder (OCD).

Freeman’s comments signposts the Conservative’s “deserving” and “undeserving” narrative, implying that some disabled people are malingering. However, disabled people do not “cheat” the social security system: the system has been redesigned by the government to cheat disabled people.

When people are attacked, oppressed and controlled psychologically by a so-called democratic government that embeds punishment at the heart of public policies to target the poorest citizens, it’s hardly surprising they become increasingly anxious, depressed and mentally unwell.

An era of technocratic solutions for social problems

Some psychiatrists see a strengthening of psychiatry’s identity as essentially “applied neuroscience”. Although not discounting the importance of the neurological sciences and psychopharmacology, they have argued that psychiatry needs to move beyond the dominance of the current dominant technological paradigm. Such critical practitioners say that psychiatry ought to primarily involve engagement with the non-technical dimensions of their work such as relationships, meanings and values. Psychiatry has operated from within a technological paradigm that, although not ignoring these aspects of work, has kept them as secondary concerns.

Psychiatry sits within a predominantly biomedical idiom. This means that problems with feelings, thoughts, behaviours and relationships can be fully grasped with the same sort of scientific tools that we use to investigate physical problems with our kidneys, blood cells, lungs, and so on.

While psychiatry has generally focused a lot of attention on neuroscience, neuroscientists themselves have become more cautious about the value of reductionist and deterministic approaches to understanding the nature of human thought, emotion and behaviour.

The dominance of this paradigm can be seen in the importance attached to classification systems, causal models of understanding mental distress and the framing of psychiatric care as a series of discrete interventions that can be analysed and measured independent of context.

More recently, models of cognitive psychology, based on “information processing”, have been developed that work within the technological idiom. Psychiatry stubbornly operates within a positivist tradition, and subscribes to the following assumptions: mental health problems arise from faulty mechanisms or processes involving abnormal physiological or psychological events occurring within the individual, these processes can be modelled in causal terms.

These processes are regarded as not being context dependent. They reside “within” the individual. Technological interventions are instrumental and can be designed and studied independently of experiences, subjective states, relationships, and values. However, in 2013, psychiatrist Allen Frances said that “psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests”.

Many people within the growing service user movement seek to reframe experiences of mental illness, distress and alienation by framing them as human experiences, rather than biomedical events, simplistic causal relationships and “scientific” challenges. In a study of users’ views of psychiatric services, Rogers et al found that many service users did not really value the “technical” expertise of professionals. Instead, they were much more concerned with the subjective experience and human elements of their encounters such as being listened to, taken seriously, and treated with dignity, kindness and respect.

Cutting the Stone (Bosch).jpg

The Extraction of the Stone of Madness by Hieronymus Boschfrom around 1494.

In his work, History of Madness, Michel Foucault says “Bosch’s famous doctor is far more insane than the patient he is attempting to cure, and his false knowledge does nothing more than reveal the worst excesses of a madness immediately apparent to all but himself.” 

I have to say I have never seen a person by looking at a brain.

It’s not all “in here”, it’s “out there”: the problem with locating mental illness “within” the individual

To paraphrase R.D Laing, “insanity”, mental illness and psychological distress may be seen as a perfectly rational adjustment to an insane world. Laing examined the nature of human experience from a phenomenological perspective, as well as exploring the possibilities for psychotherapy in an existentially distorted world. He challenges the whole idea of “normality” in society. 

It simply isn’t effective or appropriate to treat distress arising because of, say, socioeconomic problems or difficult relationships with psychotropic drugs alone, administered to people experiencing the consequences of political decision-making, the adverse consequences of socioeconomic organisation, exclusion, stigma, abuse or damaging parenting practices. 

Coping with past or current traumatic experiences such as abuse, bereavement or divorce will also strongly influence an individual’s mental and emotional state which can in turn have an influence on their wider mental health. Psychological interventions are therefore a crucial and integral part of effective treatment for mental illnesses.

However, in the UK, the current political-psychological model also locates social problems “within” the individual. The government plan to merge health and employment services. In a move that is both unethical and likely to present significant risk of harm to many patients, health professionals are being tasked to deliver benefit cuts for the Department for Work an Pensions. This involves measures to support the imposition of work cures, including setting employment as a clinical outcome and allowing medically unqualified job coaches to directly update a patient’s medical record.

The Conservatives have proposed more than once the mandatory treatment for people with long term conditions (which was first flagged up in the Conservative Party Manifesto) and this is currently under review, including whether benefit entitlements should be linked to “accepting appropriate treatments or support/taking reasonable steps towards “rehabilitation”.  The work, health and disability green paper and consultation suggests that people with the most severe illnesses in the support group may also be subjected to welfare conditionality and sanctions.

Such a move has extremely serious implications. It would be extremely unethical and makes the issue of consent to medical treatment very problematic if it is linked to the loss of lifeline support or the fear of loss of benefits. However this is clearly the direction that government policy is moving in and represents a serious threat to the human rights of patients and the independence of health professionals.

The digital pill in an age of surveillance has potential implications for civil liberties

For people with severe and enduring mental health problems, it is crucial that their context is also considered, and it’s important that people are provided with support with their living circumstances, and taking into account their wider social conditions, also. 

Furthermore, there is the important issue of drug tolerability to consider. Antipsychotic drugs are also associated with adverse effects that can lead to poor medication adherence, stigma, distress and impaired quality of life. For example, the stiffness, slowness of movement and tremor of antipsychotic-induced parkinsonism (See Dursun et al, 2004) can make it difficult for a patient to write, fasten buttons and tie shoelaces. Some antipsychotic medications can affect facial expressions, which flatten nonverbal communication and may impact on ordinary social interactions, potentially leading to stigma and further isolation.

Side effect or symptom?

The impact of drug side-effects on patients has not been sufficiently studied. Researchers have stressed the importance of the patient’s subjective experience, in which adverse effects have a role, and are considered and included in the assessment of drugs, though this doesn’t always happen. Although adverse effects are an important outcome, with many antipsychotics, they account for less treatment discontinuation than lack of efficacy; this finding has been noted in naturalistic studies and in Randomised Controlled Trials (RCTs). 

Both older and newer antipsychotic drugs can cause:

  • Uncontrollable movements, such as tics, tremors, or muscle spasms, blank facial expression and abnormal gait (risk is higher with first-generation antipsychotics)
  • Weight gain (risk is higher with second-generation antipsychotics)
  • Photosensitivity – increased sensitivity to sunlight
  • Anxiety
  • Drowsiness
  • Dizziness
  • Restlessness
  • Dry mouth
  • Constipation
  • Nausea
  • Vomiting
  • Blurred vision
  • Low blood pressure
  • Seizures
  • Low white blood cell count
  • Sexual dysfunction in both men and women
  • Menstruation problems in women and feminising effects such as abnormal breast growth and lactation in men. These latter problems are caused by the effect that the newer drugs have on a hormone in the blood called prolactin
  • Osteoporosis
  • Some neuroleptic drugs have withdrawal effects which can be very unpleasant

In addition some side effects of the newer antipsychotics may be confused with the symptoms of schizophrenia, such as apathy and withdrawal.

Antipsychotics can also cause bad interactions with other medications.

Bioethic considerations

One of the serious bioethic considerations is whether the digital medicine could be used coercively, on people against their will or as part of probation, healthcare or welfare conditions, for example.

Otsuka has said: “We intend that this system only be used with patient consent.”

However, here in the UK, the government have been kite-flying the idea of social security support being made conditional to imposed “health” regimes for a while. 

The Conservatives have already made proposals to strip obese or those who are ill because of substance misuse of their welfare benefits if they refuse treatment. This  violates medical ethics. The president of the British Psychological Society responded, at the time, Professor Jamie Hacker Hughes, said people should not be coerced into accepting psychological treatment and, if they were, evidence shows that it simply would not work.

He went on to say: “There is a major issue around consent, because as psychologists we offer interventions but everybody has got a right to accept or refuse treatment. So we have got a big concern about coercion.”

Hacker Hughes lent his voice to a chorus of criticism following the announcement of an official review to consider how best to get people suffering from obesity, drug addiction or alcoholism back into work. 

The government consultation paper, launched in 2015, that raised concerns acknowleged that strong ethical issues were at stake, but at the same time also questioned whether people should continue to receive benefits if they refused state provided treatment.

The government regard work as a health outcome, and believe that welfare creates “perverse incentives” that prevent people from finding employment. However, international research and evidence demonstrates that this is untrue, and that generous welfare states tend to be correlated with a stronger work ethic.

Hacker Hughes said claimants with obesity and addiction problems often faced complex mental health issues. But he warned the government against using sanctions to force people to accept interventions.

“It’s a problem firstly because we don’t believe people should be coerced into accepting any treatment, and secondly there is a problem because the evidence shows that if you are trying to change people’s behaviour, coercion doesn’t work,” he said.

There is a well-documented link between being out of work and psychological problems, but Hacker Hughes pointed out that the government’s plan risked “confusing the symptoms with the cause.”

Paul Atkinson, a London-based psychotherapist and member of the Alliance for Counselling and Psychotherapy, called the government’s proposals an outrage. He said: “It’s the same psychology from the government of punishing rather than working with people. Under a regime like welfare and jobcentres at the moment it is going to be felt as abuse, punitive and moralistic.”

Yes, and that’s because it is.

The government introduced “ordeals” into the welfare system to deter people from claiming the social security that most have paid for via national insurance and tax contributions, in order to “deter” what they see as “welfare dependency”. Yet labor market deregulation, anti-union legislation and other political decisions have also driven down wages, leaving many in work in poverty, also. The government’s “solution” to in-work poverty was to introduce further conditionality, in the form of extremely punitive financial sanctions for people who need to claim in-work welfare support, to “ensure they progress in work”. It is assumed that the problem of low pay resides “within the individual” rather than being the consequence of structural and labor market conditions, the profit incentive, “business friendly” political decision-making and board room choices. Ultimately, it’s down to the unequal distribution of power.

A gaslighting state: punitive psychopolicy interventions

No-one seems to be concerned with monitoring the impact of the government’s “behavioural change” agenda. Strict behavioural requirements and punishments in the form of sanctions are an integral part of the Conservative ideological pseudo-moralisation of welfare, and their  “reforms” aimed at making claiming benefits much less attractive than taking a low paid, insecure, exploitative job. 

Welfare has been redefined: it is preoccupied with assumptions about and modification of the behaviour and character of recipients rather than with the alleviation of poverty and ensuring economic and social wellbeing. Furthermore, the political stigmatisation of people needing benefits is designed purposefully to displace public sympathy for the poor, and to generate moral outrage, which is then used to further justify the steady dismantling of the welfare state. (See Stigmatising unemployment: the government has redefined it as a psychological disorder.)

However, the problems of austerity and the economy were not caused by people claiming welfare, or by any other powerless, scapegoated, marginalised group for that matter, such as migrants. The problems have arisen because of social conservatism and neoliberalism. The victims of the government’s policies and decision-making are being portrayed as miscreants – as perpetrators of the social problems caused by the government’s decisions, rather than as the casualities.

Under the government’s plans, therapists from the NHS’s Improving Access to Psychological Therapies (IAPT) programme are to support jobcentre staff to assess and treat claimants, who may be referred to online cognitive behavioural therapy (CBT) courses.

Again, we really must question the ethics of linking receipt of welfare with “state therapy,” which, upon closer scrutiny, is not therapy at all. Linked to such a narrow outcome – getting a job – this is nothing more than a blunt behaviour modification programme. The fact that the Conservatives plan to make receipt of benefits contingent on participation in “treatment” worryingly takes away the fundamental right of consent.

Not only is the government trespassing on an intimate, existential level; it is tampering with our perceptions and experiences, damaging and isolating the poorest, burdening them with the blame for the consequences of their own policies whilst editing out state responsibilities towards citizens. (See the The power of positive thinking is really political gaslighting, and IAPT is value-laden, non-prefigurative, non-dialogic, antidemocratic and reflects a political agenda.)

It’s very important that we don’t overlook the importance of context regarding psychological distress. The idea that mental “illness” arises strictly “within” the individual, therefore, requiring medicine as treatment, as opposed to, say, different socioeconomic policies, is a controversial one. People’s mental health is, after all, at least influenced by the social, political, cultural and economic spaces that they occupy. 

The current government has a 7 year history of decontextualing structural inequality and poverty, using narratives that “relocate” the causes and effects of an unequal distribution of power and wealth. Such narratives are about coercing the responsibility, internalisation and containment of social problems within some targeted individuals in some marginalised social groups. This process always involves projection, stigmatising, outgrouping and scapegoating. 

Earlier this year, the UK Council for Psychotherapy (UKCP) said that government policies – in particular, the Conservatives’ draconian “reforms” of social security payments and austerity regime – were to blame for a steep rise in the rates of severe anxiety and depression among unemployed people, as benefit cuts and sanctions, together with an extremely punitive and coercive welfare conditionality regime, “are having a toxic impact on mental health”.

It’s hardly ethical, appropriate or effective to impose a medical treatment on people who are suffering because of policies that bring about financial and psychological insecurity, hardships and harms.  

We have witnessed an ongoing attempt by the Conservatives to “rewrite the welfare contract” for disabled people, which has become a key site of controversy within UK welfare reform, and fierce debates about the circumstances in which the use of  conditionality may, or may not, be ethically justified. And denial from the government that their welfare policy is causing some of our most vulnerable citizens harm, hardship and distress. 

Wilkinson and Pickett’s key finding in their work, The Spirit Level: Why More Equal Societies Almost Always Do Better is that it is the inequality itself, and not the overall wealth of a society that is the key factor in creating various pathologies. The authors  show that for each of eleven different health and social problems: physical health, mental health, drug abuse, education, imprisonment, obesity, social mobility, trust and community life, violence, teenage pregnancies, and child wellbeing, outcomes are significantly worse in more unequal rich countries. The evidence also shows that poorer places with more equality have better overall social outcomes than wealthy ones marked by gross inequality. (See also The still face paradigm, the just world fallacy, inequality and the decline of empathy, for further discussion about how neoliberaism itself creates profound psychological trauma, and builds social “empathy walls”).

Theresa May has pledged new initiatives to end “stigma” around mental health and encourage schools and employers to provide mental health support. Despite government assurances mental health services would receive equal treatment to physical health, 40% of NHS trusts saw cuts to mental health services across 2015-2016.

But in the absence of genuine funding commitments, the Prime Minister has faced charges of hypocrisy from mental campaigners, for not doing anywhere near enough to address the root causes of problems faced by disabled and mentally ill people. 

At one point in 2014, there were no mental health beds available for adults in the whole of England, while an NSPCC survey published in October 2015 found that more than a fifth of children referred to child and adolescent mental health services (CAMHS) in England were refused access to support. 

There have recently been a number of high-profile cases reported more than once in the media across the UK when the necessary kind of hospital bed could not be found for mental health patients in England. The NHS Confederation’s Mental Health Network – the representative body for NHS-funded mental health service providers – also heard evidence from its members last year that “there are occasions when there are no routine acute mental health assessment beds available across the country.”

Importantly, Psychologists Against Austerity have said: “Addressing mental health is not just about ensuring more ‘treatment’ is available and stigma is reduced, although they are important. It is fundamentally also about the evidence that ideological economic policies, like the continued austerity programme, have hit the most vulnerable citizens the hardest and have been toxic for mental health.”

The government’s “employment and support programme” for sick and disabled people coincided with at least 590 “additional” suicides, 279,000 cases of mental illness and 725,000 more prescriptions for antidepressants – and one mental health charity found that at least 21 per cent of their patients had experienced suicidal thoughts due to the stress of the draconian Work Capability Assessments. 

It’s crucially important that a positive therapeutic alliance based on trust is developed  between doctors and patients. Specific problems with the therapeutic alliance include doctors failing to acknowledge patients’ concerns, an example of which is the failure to respond to patients who talk about their auditory halluci­nations in schizophrenia (McCabe et al, 2002). Furthermore, doctors appear not to appreciate the degree of distress caused by certain antipsychotic side-effects (Day et al, 1998). There is, therefore a fundamental need for doctors to listen more effectively to patients and elicit their particular concerns about their illness and its treatments. In fact Poor doctor-patient relationships have been cited by recent research as a key factor that influences a patient’s attitude towards treatment.

Critics of psychiatry commonly express a concern that the path of diagnosis and treatment is primarily shaped by profit prerogatives, echoing a common criticism of general medical practice, particularly in the United States, and increasingly, in the UK, where many of the largest psychopharmaceutical producers are based.

It’s an inbuilt “cognitive bias”. 

This critique is not meant to imply that physiological factors in mental illnesss can or should be ignored. However, as I’ve pointed out, the biomedical model avoids the personal, social, cultural, political and economic dimensions of mental illness, in the same way that the political behaviourist (behavioural economics, used in public policy) model does.

One concern is that both the behaviourist and biomedical model protects those formulating provision and care from the pain experienced by those needing support. The temptation to retreat into objectification of those identified as mentally ill may also be a factor in a state cost cutting exercise. 

The UK government has already demonstrated a worrying overreliance on individualistic approaches to socioeconomic problems that prioritise citizen responsibility and “self help”. The behavioural turn has been powerfully influenced by libertarian paternalism – itself a political doctirne, despite its claims to “value-neutrality”.

The Conservatives’ neoliberal policies increasingly embed behaviour modification techniques that aim to quantifiably change the perceptions and behaviours of citizens, aligning them with narrow neoliberal outcomes through rewards or “consequences.” Rewards, such as tax cuts, are aimed at the wealthiest, whereas the most vulnerable citizens who are the poorest are simply presented with imposed cuts to their lifeline support as an “incentive” to not be poor. Taking money from the poorest is apparently “for their own good”, according to the government, as it reduces “dependency”. 

“Dependency” and “need” have somehow become conflated, the government have resisted urges to acknowledge that some citizens have more needs than others for a wide array of reasons, including their mental health status.

Defining human agency and rationality in terms of economic outcomes is extremely problematic. And dehumanising. Despite the alleged value-neutrality of behavioural economic theory and CBT, both have become invariably biased towards the status quo rather than progressive change and social justice.

Behavoural economics theory has permited policy-makers to indulge ideological impulses whilst presenting them as “objective science.” From a libertarian paternalist perspective, the problems of neoliberalism don’t lie in the market, or in growing inequality and poverty: neoliberalism isn’t flawed, nor are governments – we are. Governments and behavioural economists don’t make mistakes – only citizens do. No-one is nudging the nudgers.

It’s assumed that their decision-making is infallible and they have no whopping cognitive biases of their own. One assumption that has become embedded in the poliical narrative is that an adequate level of social security to meet people’s basic survival needs is somehow mutually exclusive from encouraging people to find a suitable job.

In the current political context, it’s easy to see how the medicalisation of political, economic, cultural and social problems may be politically misused, especially by an authoritarian government, and in an ideological era that extolls the virtues of a “small state” and austerity, to exempt the state completely from its fundamental responsibility towards the prosperity, health and wellbeing of citizens.

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Neoliberalism


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Austerity is the unfavourable treatment of protected social groups, leading to unfair disadvantage

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The Equality and Human Rights Commission (EHRC) said an analysis of all the changes to tax, social security and public spending since the Conservatives came to power in 2010 showed the poorest citizens have been hit hardest by tax, social security and public spending reforms and are set to lose at least 10% of their income.

Ahead of next week’s budget, the Commission has published its independent report on the impact that changes to all tax, social security and public spending reforms from 2010 to 2017 will have on people by 2022.

Undertaken as a “cumulative impact assessment”, the Commission’s report, which looks at the impact the reforms have had on various groups across society, highlights that those political decisions will affect some groups more than others:

  • black households will face a 5% loss of income (more than double the loss for white households)
  • families with a disabled adult will see a £2,500 reduction of income per year (this is £1,000 for non-disabled families
  • families with a disabled adult and a disabled child will face a £5,500 reduction of income per year (again, compared to £1,000 for non-disabled families)
  • lone parents will struggle with a 15% loss of income (the losses for all other family groups are between 0 and 8%)
  • and women will suffer a £940 annual loss (more than double the loss for men)
  • the biggest average losses by age group, across men and women, are experienced by the 65 to 74 age group (average losses of around £1,450 per year) and the 35 to 44 age group (average losses of around £1,250 per year).

The government have persistently claimed that conducting a cumulative impact assessment of their “reforms” is “too difficult”.

David Isaac, of the EHRC, says: “We have encouraged the government to carry out this work for some time, but sadly they’ve refused. We have shown that it is possible.” 

Previously, the Women’s Budget Group estimated that by 2020 women will shoulder 85% of the burden of the government’s changes to the tax and benefits system – with low-income black and Asian women paying the highest price

The Centre for Welfare Reform calculated that disabled people are being hit nine harder than the rest of the population. These organisations managed to carry out cumulative impact assessments, and without the generous funding that the government has at their disposal. This demonstrates that there is a difference between finding something “difficult” to undertake, and not actually wanting to undertake the task, while making glib excuses to avoid doing so. 

Public policies are expressed political intentions regarding how our society is organised and governed. They have calculated social and economic aims and consequences. Governments generally monitor the impact of their policies. The Conservatives have refused to monitor the impact of their draconian welfare policies because they knew in advance that they are discriminatory. 

Austerity policies target already economically marginalised groups, cutting their incomes further. It’s not plausible that ministers were unaware that this would lead to further economic disadvantage of those groups, while widening social inequality and increasing poverty.  

While the poorest citizens are set to lose nearly 10% of their incomes, a minority of the wealthiest citizens will lose barely 1%, yet the government claim that inequality has “reduced.” Despite the claims that “We’re all in it together” and “we want to help tjose people “just about managing”, it’s clear that Conservative policies are completely detached from public interests and needs. Conservative austerity policies are designed and intended to intentionally discriminate aginst the very poorest citizens. 

It is against the law to discriminate against socially protected groups  –  including on the grounds of ethnicity, gender, age and disability. The government’s traditional ideological prejudices, which have been clearly expressed in their socioeconomic policies, have brought about:

  • the less favourable treatment of groups with protected characteristics 
  • the targeting of some social groups disproportionately with austerity policies that extend direct discrimination, leaving people with protected characteristics at an unfair disadvantage

Prices, as measured by official inflation figures, are nearly 14% higher now than they were in 2010, although Unison say that between the start of 2010 and the close of 2015, the cost of living, as measured by the Retail Prices Index, rose by a total of 19.5%. This creates even further hardship for those people already targeted by Conservative austerity cuts.

Image result for Tory prejudices UK sexism


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Traditional Conservative prejudices, which have ultimately led to economic marginalisation, disadvantage and stigmatisation of some social groups

David Isaac, the Chair of the EHRC, which is responsible for making recommendations to government on the compatibility of policy and legislation with equality and human rights standards, warned of a “bleak future”.

Isaac said: “The Government can’t claim to be working for everyone if its policies actually make the most disadvantaged people in society financially worse off. We have encouraged the Government to carry out this work for some time, but sadly they have refused. We have shown that it is possible to carry out cumulative impact assessments and we call on them to do this ahead of the 2018 budget.

“If we want a prosperous and, in line with the Prime Minister’s vision, a fair Britain that works for everyone, the Government must come clean and provide a full and cumulative impact analysis of all current and future tax and social security policies. It is not enough to look at the impact of individual policy changes. If this doesn’t happen those most in need will face an extremely bleak future.”

The Commission is calling on the Government to:

  • commit to undertaking cumulative impact assessments of all tax and social security policies ahead of the 2018 budget
  • reconsider existing policies that are contributing to negative financial impacts for those who are most disadvantaged
  • implement the socio-economic duty from the Equality Act 2010 so public authorities must consider how to reduce the impact of socio-economic disadvantage of people’s life chances (the Conservatives edited the Labour party’s original version of Equality Act and removed this duty before implementing it).

The assessment undertaken by the EHRC considered changes to income tax, national insurance contributions, indirect taxes (VAT and excise duties), means-tested and non-means-tested social security benefits, tax credits, universal credit, national minimal wage and national living wage.

 

See also:

Austerity is “economic murder” says Cambridge researcher

The Paradise Papers, austerity and the privatisation of wealth, human rights and democracy

From 2013 – Follow the Money: Tory ideology is all about handouts to the wealthy that are funded by the poor

 


I don’t make any money from my work. I am disabled because of illness and have a very limited income. I don’t have a plasma TV or Sky. I do eat a lot of porridge, though. Successive Conservative chancellors have left me in increasing poverty. But you can help by making a donation to help me continue to research and write informative, insightful and independent articles, and to provide support to others. The smallest amount is much appreciated – thank you. 

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Fourteen year old Hasan Patel’s fantastic speech at the Free Education Now rally yesterday

To hear Hasan’s speech, you may have to click on the sound icon at the bottom of the video screen and turn the sound up. 

Fourteen year old Hasan Patel, who campaigns for Leyton and Wanstead Labour Party, made his first ever speech to a crowd of thousands in Parliament Square yesterday, at the Free Education Now rally in central London, where hundreds of students marched in central London on Wednesday, demanding the abolition of tuition fees in the UK. The speech is spectacular and worth listening to.

Hasan says: “I was seven when the Tories got into power. Seven year olds don’t cause an economic crisis, but they closed my youth centre, anyway”.

Hasan also talks about the impact of cuts to his school, and about student debt and poor pay. He tells us of the utter mess that the Conservatives have made, and will be leaving the next generation.

Earlier this month, Labour leader Jeremy Corbyn sent a message of support for the cause of abolishing tuition fees and shadow chancellor John McDonnell addressed the students before another rally. 

McDonnell said: “Your generation has been betrayed by this government in increases to tuition fees, in scrapping the education maintenance allowance and cuts in education.” 

“Education is a gift from one generation to another, it is not a commodity to be bought and sold,” he told the protesters

John McDonnell

 


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Austerity is “economic murder” says Cambridge researcher

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A research report, published in the British Medical Journal (BMJ) Open – the Effects of health and social care spending constraints on mortality in England: a time trend analysis, concludes that austerity cuts are correlated with an increase in mortality rates, confirming what many of us have proposed for some time. The research revealed that there were 45,000 more deaths in the first four years of Tory-led “efficiency savings” than would have been expected if funding had stayed at pre-election levels.

The new study strongly suggests that austerity policies will have caused 120,000 deaths by 2020. 

The joint research was conducted by Oxford, Cambridge and University College London, and it makes clear links between cuts in government health and social care spending and higher mortality rates in England. 

Cambridge University’s Professor Lawrence King, who contributed to the study, said: “Austerity does not promote growth or reduce deficits – it is bad economics. It is also a public health disaster. It is not an exaggeration to call it economic murder.”

The authors point to cuts in public spending and the drop in the number of nurses since 2010, all of which has contributed to place over-60s and care home residents most at risk of premature death.  

Between 2001 and 2010 the number of nurses rose on average 1.61% a year. From 2010 to 2014, under the Conservatives, the rise was just 0.07% – 20 times lower than the previous decade.

The Royal College of Nursing chief, Janet Davies, said: “All parts of the NHS and social care system do not have enough nurses and vulnerable and older individuals pay the highest price.”

2015 saw the largest annual spike in mortality rates in England in almost 50 years. These changes in mortality rates are associated with an indicator of poor functioning of health and social care, for which funding has been cut despite rising demands since 2010.

Earlier this year, another research report concluded that an unprecedented rise in mortality in England and Wales, where 30,000 excess deaths occurred in 2015, is likely to be linked to cuts to the NHS and social care, according to research which drew an angry response from the government, who deny the established link.

The highly charged claim was made by researchers from the London School of Hygiene and Tropical Medicine, Oxford University and Blackburn with Darwen council, who said that the increase in mortality took place against a backdrop of “severe cuts” to the NHS and social care, compromising their performance.

The government – which will casually spend hundreds of thousands of pounds of public funds to fight Freedom of Information requests regarding mortality data – claim we cannot afford to support sick and disabled people, unless we “target” those “most in need” because otherwise, our publicly funded social security is “unsustainable.”

It’s become very clear that the cost cutting system imposed by the Conservatives does not “target” many of those most in need, and that government policies are causing harm, distress, hunger, destitution, an increase in suicide and premature deaths, yet discussing the deaths of its citizens in a democratic, transparent and accountable way is something that the government have consistently refused to do.

Instead, public funds and energy are invested in denying a “causal link” between the austerity programme, punitive policies and increasing hunger, destitution and desperation, and apparently, no prioriy at all is given to monitoring policy impacts or concern: the government refuse to ask why these premature deaths and suicides have occurred (and continue to occur) in one of the wealthiest nations. 

It would be reasonable to assume that, even if a government vigorously denied responsibility for more than 120,000 excess deaths, (with a proportion of the mortalities including those assessed as “fit for work” by the state), they would at least have the decency to ask basic questions as to where the responsibility lay, and how this has happened.

Of course, in denying a “causal link” between their policies and a substantial increase in mortality, and levelling the charge that research findings and campaigners’ qualitative accounts are merely “anecdotal evidence” that fail to  provide “empirical evidence” of a “causal link”, the government doesn’t seem to recognise that its’ own claims are completely unevidenced, and there is no “causal link whatsoever between their evident indolence, politically contrived and expedient narrative and the facts.

This isn’t simply a matter of a government being undemocratic and unaccountable. It’s much more serious than that. It’s a matter of the state either casually playing roulette with the very lives of its own people. Or worse.

Perhaps it’s a matter of a state intentionally and systematically killing its citizens with austerity policies that target marginalised social groups.

It’s not as if previous Conservative government policies have been benign. Margaret Thatcher’s neoliberal policies have also been condemned for causing “unjust premature death” in the UK. Public health experts from Durham University have denounced the impact of Margaret Thatcher’s policies on the health and wellbeing of the British public in research which examines social inequality in the 1980s.

The study, which looked at over 70 existing research papers, concludes that as a result of unnecessary unemployment, welfare cuts and damaging housing policies, the former prime minister’s legacy includes the unnecessary and unjust premature death of many British citizens, together with a substantial and continuing burden of suffering and loss of well-being.

This research shows that there was a massive increase in income inequality under Baroness Thatcher – the richest 0.01 per cent of society had 28 times the mean national average income in 1978 but 70 times the average in 1990, and UK poverty rates went up from 6.7 per cent in 1975 to 12 per cent in 1985.

The report goes on to say that Thatcher’s governments wilfully engineered an economic catastrophe across large parts of Britain by dismantling traditional industries such as coal and steel in order to undermine the power of working class organisations, say the researchers. They suggest this ultimately fed through into growing regional disparities in health standards and life expectancy, as well as greatly increased inequalities between the richest and poorest in society.

Her critique of UK social democracy during the 1970s and her adoption of key neoliberal strategies, such as financial deregulation, trade liberalization, and the privatization of public goods and services, were popularly labeled “Thatcherism.” Thatcher’s policies were associated with substantial increases in socioeconomic and health inequalities: these issues were actively marginalized and ignored by her governments. In addition, her public sector reforms applied business principles to the welfare state and prepared the National Health Service for subsequent privatization.

The current government have simply continued and extended Thatcher’s neoliberal programme, without any consideration of, or reference to, the body of empirical research that demonstrates the terrible social costs of  neoliberalism, as a result of  the social and economic inequalities it creates.

Meanwhile, a Department of Health spokesman has said of the latest study: “This study cannot be used to draw any firm conclusions about the cause of excess deaths.”

However, as I’ve already pointed out, any government statement of denial regarding empirical research cannot be used to draw any firm conclusions about the cause of excess deaths.

It may only be used to draw firm conclusions that the government has no intention of investigating the link between a significant increase in mortality rates and their own policies, or of changing those policies to meet public needs and to ensure that citizens’ fundamental and equal right to life is upheld.


 

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Please let the Conservatives know that the Grenfell tragedy must not be trivialised and ignored

Yesterday I had the following email from Jeremy Corbyn:

Sue, we’ve just found out that the Tories in Kensington have been asking residents how important the Grenfell tragedy is on a scale of 0-10.

It is insulting and insensitive.

Preventing another fire like Grenfell couldn’t be more important. And Theresa May has the power to do it — she could use next Wednesday’s budget to set aside money to fit social housing with sprinklers that would save lives. Let’s make sure she hears our message.

Please sign this and tell the Tories why Grenfell must not be ignored.

Sign this and help us make sure that residents of high rise social housing can sleep safely with the knowledge that they are being listened to.

Jeremy Corbyn
Leader of the Labour Party


 

It’s like they need instructions for being human.” Kay Bailey

I agree, the Conservatives’ survey is crass and insensitive, it trivialises the Grenfell tragedy, putting it at the same level of priority as refuse collection and local parking facilities, which is insulting and callous. Asking people to place such an avoidable and tragic event on a scale of priority, from one to ten, is both brutal and shows a complete lack of responsibility and remorse on the part of the government. 

I have signed both petitions. 

Will you?


Related

Grenfell, inequality and the Conservatives’ bonfire of red tape

Grenfell is a horrific consequence of a Conservative ‘leaner and more efficient state’

Dangerous electrical faults were historically ignored at Glenfell Tower