Category: Social Policy

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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Bravo Simon Stevens, for saying what needed to be said

Simon Stevens, NHS England boss

Simon Stevens, the chief executive of NHS England has launched a scathing attack on government spending in an extraordinary conference speech, outlining that the NHS has a significant funding problem.  He says the health service should get the cash boost it was promised during the EU referendum. 

Speaking at the NHS Providers conference in Birmingham, Stevens said failure to increase funding would add at least one million people to NHS waiting lists by 2021.

He warned that cancer care and mental health services could deteriorate, and the waiting list for hospital operations hit would hit 5million, because ministers are giving the services billions less than it needs. 

In an impassioned speech, Stevens urged the prime minsiter to give the NHS in England at least £4bn more in 2018-19 – eight times more than currently proposed – in the budget Philip Hammond will deliver on 22 November. Stevens fired the controversial claims used by Vote Leave – that the NHS could benefit by £350m a week – back at the government, to put forward the strong case for more funding, in his speech. 

With waiting times worsening, he said trust in politics would be damaged if the NHS did not get more funding. He said that while the budget had apparently grown modestly in recent years, those rises would “nose-dive” in the next few years.  Stevens also expressed concerns that some elective treatments may have to be “retrenched or rationed”.

He said: “NHS England’s assessment of the funding position is that the Budget for next year falls well short of what is needed to look after patients and their families at their time of greatest need.

“On current budget, the NHS will not be able to do everything that is asked of it.”

He also said that the UK  should seek to emulate the levels of investment in healthcare seen in countries such as Germany, France and Sweden, which would lead to a £20bn-£30bn rise in the NHS’s budget.

“We have a care fragmentation problem and a funding problem,” he stated. 

 

Please don’t just walk on by, we are better than this

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It’s absolutely freezing here in the North East. There’s a sparkling, thick layer of frost outside of my window every morning and the road gritters are out around the village every night. In some parts of the county, temperatures as low as minus 7 have been reported.

It’s an awful and distressing thought that there are homeless people who will be fighting to survive hypothermia and worse at this time of year. But it’s far more awful and distressing for those who are facing homelessness. This dangerous, freezing weather kills people who are exposed outdoors very quickly, especially at night when shops and public buildings are closed and locked up. In 2017, in one of the wealthiest nations, the number of people who are homeless is increasing, and as a society, we’ve permitted that to happen.

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Research underlines the particular difficulties many councils will face finding accommodation for young people and families over the next two to three years. This is because of the severity of local authority budget cuts. There are serious concerns for single young people because of rising unemployment, benefit cuts and spiralling rents.

Two thirds of local authorities told us they expect it to be “much more difficult” to help 18-21 year olds access housing in the next few years. These concerns will be amplified by planned removal of entitlement to support with housing costs for many people in this age group. 

Once again this year’s Homelessness Monitor warns about ongoing welfare reforms with the discrepancy between Local Housing Allowance and rents highlighted as a significant barrier to council attempts to house homeless applicants.

An ongoing upward trend in officially estimated rough sleeper numbers remained evident in 2016, with the national total up by 132 per cent since 2010. The welfare cuts introduced in this decade, and those planned for introduction in the coming years, will
cumulatively reduce the incomes of poor households in and out of work by some £25 billion a year by 2020/21.

This is in a context where existing welfare cuts, economic trends, and higher housing costs associated with the growth of private renting have already increased poverty amongst members of working families to record levels.

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Then there are the recently publicised failings of Universal Credit, which was designed to reduce welfare spending, rather than to improve support for people who need it. 

And it’s going to get worse. The welfare “reforms” announced in the summer 2015 Budget and Autumn Statement will have particularly marked consequences both for families with more than two children, and for young single people.

These groups will either potentially be entirely excluded from support with their housing costs (if 18-21 and not subject to an exemption), or subject to Shared Accommodation Rate limits on eligible rents in the social as well as the private rented sector. Consequently, these are the groups that local authorities report greatest difficulty in rehousing.

More than 300,000 people in Britain – equivalent to one in every 200 – are officially recorded as homeless or living in inadequate homes, according to figures released by the charity Shelter. Using official government data and freedom of information returns from local authorities, it estimates that 307,000 people are sleeping rough, or accommodated in temporary housing, bed and breakfast rooms, or hostels – an increase of 13,000 over the past year.  However, Shelter say that this is likely to be an underestimation

Polly Neate, chief executive of Shelter, said: “It’s shocking to think that today, more than 300,000 people in Britain are waking up homeless. Some will have spent the night shivering on a cold pavement, others crammed into a dingy hostel room with their children. And what is worse, many are simply unaccounted for.

“On a daily basis, we speak to hundreds of people and families who are desperately trying to escape the devastating trap of homelessness. A trap that is tightening thanks to decades of failure to build enough affordable homes and the impact of welfare cuts.”

Although public perceptions of homelessness are dominated by rough sleeping, Shelter points out that the single leading cause of recorded homelessness is the ending of a private tenancy, accounting for three in every 10 cases, and often triggered by a combination of soaring rents and housing benefit cuts.

A National Audit Office (NAO) inquiry in September criticised the government for failing to get a grip on homelessness, despite recorded numbers rising every year since 2010. The NAO said local housing allowance cuts helped fuel the crisis, which cost us around £1bn a year.  

One in five young people in the UK have sofa-surfed in the past year and almost half of them have done so for more than a month. In a country – that is among the wealthiest in the world, how can this be possible?

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report by the London Assembly housing committee on hidden homelessness is a timely reminder of an issue that goes unseen by most of the public and by many local and national politicians. 

However, as a so-called civilised society, we mustn’t look the other way. In cold weather, the plight of people who have no shelter is especially harsh, and many passersby may struggle to know what to do. But here are small things we can each do to make a difference, and reduce the dangers of freezing weather for homeless citizens. For example:

  • We could stop, smile and buy someone a warm drink, or provide some warm food.
  • We could set up places were people can take their old coats and blankets, socks, hats, gloves, scarves – and then distribute those to rough sleepers. Or even set up a point in each town so that homeless people know where to go for warm clothes that have been donated.
  • We can also contact Streetlink. (Click) When a rough sleeper is reported via the Streetlink app, or by phone – telephone number 0300-500 0914. The details  you provide are sent to the local authority concerned, so they can help connect the person to local services and support. You will also receive an update on what action was taken so you’ll know if the situation was resolved. StreetLink aims to offer the public a means to act when they see someone sleeping rough, and is the first step someone can take to ensure rough sleepers are connected to the local services and support available to them.

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The thing is, we must do something. We must not become desensitised to the fact that so many people are struggling to survive. Shelter is one of our most fundamental survival needs, and it’s shameful that people in the UK cannot meet their most basic needs. It’s not enough to simply spare a thought. That doesn’t save lives, unless we act on those thoughts.

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Please don’t just walk on by.

 


 

I’m disabled through an illness called lupus. I don’t make any money from my work. However, I do what I can, when I can, and in my own way. You can support Politics and Insights and contribute by making a donation which will help me continue to research and write informative, insightful and independent articles, and to provide support to others. The smallest amount is much appreciated, and helps to keep my articles free and accessible to all – thank you. 

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PIP assessments are dehumanising, degrading, very distressing and potentially harmful

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I co-run a support group for people going through Employment and Support Allowance (ESA) and Personal Independent Payment assessments and appeals. I have heard many people’s harrowing experiences of these assessments, I have written about them, and I’ve written critically about the assessment process itself. However, it isn’t until you experience one of these assessments for yourself that you may fully appreciate just how utterly distressing, surreal, degrading and dehumanising the process actually is. Or how potentially harmful.

I had my first ever Personal Independence Payment (PIP) assessment today. I have systemic lupus and pulmonary fibrosis, among other problems, all of which affect my mobility and capacity to live independently, day-to-day. My consultant is a rheumatologist and more recently, I have been seeing a pulmonary consultant. Other specialists I sometimes need to see are a neurologists, opthalmologists, physiotherapists and haematologists.

After a bout of pneumonia and sepsis earlier this year, which almost cost me my life, a follow-up scan found further lung problems, which have probably been ongoing for some time. Fibrosis can happen as a result of connective tissue illnesses like lupus, scleroderma or rheumatoid arthritis. It can also happen to people whose conditions have been treated with a chemotherapy called methotrexate – which I was given from 2012 onwards. My mother, who had rheumatoid arthritis, died suddenly of pulmonary fibrosis in 2009. The coroner said it was a complication of her illness, not because of a treatment. She was never given methotrexate.

The interview part of the assessment seemed okay, initially. I provided further evidence regarding my recent assessment, undertaken by my local council’s Occupational Therapy Service, which led to the prescription of aids and appliances in my home. The assessment report was quite clear about my basic medical conditions and day-to-day mobility limitations. I was asked about medication. I explained that following my second appointment with my new rheumatologist, I was prescribed some new medications, including one for secondary Raynaud’s syndrome, which has arisen because of my having lupus, as a complication.

A recent thermal imaging and microvascular study shows that this condition has got worse over time, and so my rheumatologist prescribed a treatment called Amlodipine. It concerned me that the Health Care Professional looked confused and skeptical when she asked for a list of my medication, and she said that this is a treatment for high blood pressure, she seemed to disbelieve what I had told her. I explained that I don’t have high blood pressure, and that calcium channel blockers such as Amlodipine are used for more than one condition, such as certain types of angina – which I also don’t have – and secondary Raynaud’s syndrome, which I do have. 

I was asked about the impact of my illnesses on my day-to-day living. At one point I explained that I find preparing and chopping food difficult because of the tendonitis in both wrists. I have been diagnosed with De Quervian’s Tenosynovitis, which makes putting any weight or strain on my wrists very painful.

I was also concerned that I was then asked if I have had my wrists splinted. This shows a lack of understanding about my condition. I have had splints but it did not make any difference to my wrists. I was diagnosed with De Quervain’s syndrome by my rheumatologist and a physiotherapist in 2011, but had the problem for considerably longer. As my physiotherapist pointed out, my wrists are not injured or strained through overuse and so won’t get better with rest or splinting. This is because they are damaged by a chronic systemic inflammatory disease process that is ongoing, and he told me it is medication rather splinting that is needed to try to manage the level of inflammation in my body as a whole.

Splinting my wrists is akin to putting a plaster cast on a knee affected by rheumatoid arthritis, or a plaster on cancer. It won’t help at all. That the HCP didn’t seem to understand the difference between the chronic inflammatory symptoms of connective tissue disease and curable strain and injury related conditions bothered me.

Another thing that bothered me is that I was asked about the frequency of my periods of severe illness and how that impacts on my ability to manage things like personal care. She wanted an actual number of days, which of course is impossible to give with any precision when you have a fluctuating condition. Sometimes I struggle getting dressed and spend days on end in my pyjamas, and the HCP asked me “how often”? I tried to give an average number of days per month, but because the acute flares of my illness vary so much from month to month, week to week, that was very difficult to do. She also seemed impatient that I struggled to try and work out an average. I have cognitive problems as a result of my illness.

Another problem is that I struggle with washing my hair sometimes, and she demanded to know how often I need assistance with that task. The best I could do was to explain that when I have no help, I can go up to two weeks at a time with matted, unwashed hair. I felt embarrased and ashamed enough in having to discuss these personal difficulties with someone I have never met, but it was made to feel somehow like a confict, that part of the discussion. I felt that if I didn’t provide precise and quantified “evidence”, the qualitative details – my experience of my disability – would not be taken seriously by the HCP. 

Another problem with the assessments that worries me is that there was nowhere near enough time to discuss the complex impact of all my complex medical conditions and wide-ranging symptoms on my day-to-day life.

The ‘examination’

After discussion of my conditions and how my illnesses impact on upon my day-to-day living, I was asked to do some tasks during an examination, which have left me in a huge amount of pain. I also felt stripped of dignity, because I struggled to manage the exercises and felt very anxious and distressed. I was shocked at some of the tasks I was asked to do, and also shocked at the fact I couldn’t actually undertake a number of these tasks. My shock turned to anger later, as I had to leave in significantly more pain that I had arrived with at the start of the appointment. I was also asked to do each of the unfamiliar tasks and exercises in quick succession, which made assessing any likely pain and potential damage difficult before trying to do them.

It is also a traumatic experience to suddenly discover that your illness has insidiously robbed you of a degree of mobility that you previously assumed you had. That is always a shock. 

Last year, my GP was carrying out a standard examination and smear, when my hips locked painfully, as I tried to move my legs. She couldn’t completeher examination and the procedure as my egs would not move. After this, she told me to not get up for a while, and she described the experience – discovering that my mobility had been painfully restricted by my illness – as “traumatic.” It was.

I have, among other problems, very painful inflammatory arthritis and tendonitis in my knees, hips, spine, Achilles’ tendons and ankles. Because the inflammation and damage is bilateral and symmetrical – affecting both knees, both hips, both ankles and both Achilles’ tendons equally, and across my lower spine – it leaves me unable to compensate for pain, stiffness and weakness by shifting my weight and balance onto another limb, as that is also weak, stiff and painful. It leaves me unsteady. I often use a stick to stop me falling over, but as an aid for walking, it’s pretty useless generally, because my shoulders, elbows and wrists also won’t take any of my weight.

The inflammation process causes marked stiffness as well as severe pain, and so restricts my mobility. I was asked to “squat down” at the start of the examination. I refused, and told the assessor that I couldn’t do that. It would have certainly caused me severe pain and possibly an injury. As I can’t support weight on my shoulders and wrists – I also have osteoporosis in my wrists and hands –  had I tried and fallen backwards, I may have easily ended up with a fractured bone. I was horrified at being asked to do that. I struggled to equate the “health care professional” with what I had been asked to do, and felt confused and shocked that she had asked me to do something that may have been harmful.

I also felt that the HCP may have misconstrued my comments that I couldn’t undertake this task as an unwillingness to cooperate, as she looked unhappy about it. She did ask why, and I explained. I felt that trying some of the other tasks she set, which looked to be less dangerous, would at least demonstrate that I wasn’t being uncooperative, and most looked like they wouldn’t inflict any damage at first glance, when she demonstrated them.

However, other exercises I tried to do resulted in my neck locking and severe pain when I was told to turn my head to look over my shoulder – and couldn’t. I have neck problems through longstanding inflammation there and an upper spine injury involving a displaced vertebrae, which is sometimes very painful. In addition, the problems in my shoulders also contributed significantly to the level of pain when I turned my neck, and my neck clicked painfully at the base of my skull. 

I was asked to put my hands and wrists in positions that looked impossible to me. I tried, though. I was asked to line the backs of my wrists up with my hands flat, which I couldn’t do, and it hurt me a lot to try this.

Phalens-maneuver
This is called Phalen’s Manoeuvre. I was asked to do what is actually a provocative diagnostic test for carpal tunnel syndrome – which entails compression of the median nerve. The test provokes the symptoms of carpal tunnel problems, in the same way that the painful Finkelstein test provokes symptoms of severe pain in people with De Quervain’s. I have never been diagnosed with carpal tunnel problems, but I do have more than one diagnosis of bilateral De Quervian’s Tenosynovitis, as stated previously.

I tried to do this manoeuvre, even though it isn’t applicable to my condition (though I didn’t know that at the time, I have since researched the test, as I wanted to know why I couldn’t perform it). I couldn’t even get close to managing it, it hurt my shoulders a lot when I tried to align my elbows at right angles with my dropped finger tips, and I couldn’t drop my wrists fully due to an incredible pain and stiffness that I had not expected. The backs of my wrists simply painfully refused to meet.

I do struggle with pain when putting any weight on my wrists, but didn’t realise how much they had stiffened up, restricting their movement. Not being able to perform this movement doesn’t mean I actually have carpal tunnel syndrome. Nonetheless, I feel that given my previous concrete diagnosis, I was put through this painful and traumatic series of medical tests for no good reason. 

This is the problem with a short assessment of complex conditions. Many of my problems and diagnoses go back years, and only some of them are summarised neatly on my consultant’s report. My relationship with my new rheumatologist started in April, my old one moved in 2015. My new rheumatologist decided to “challenge” the previous diagnoses of two former rheumatologists. Her report to my GP was woefully inaccurate because she had not read my notes or listened to what I told herLong story short, she re-diagnosed me, inaccurately, with fibromyalgia, she didn’t read my notes, she sent me for tests and scans I had already had previously, whilst suspending my treatment pending results. The scans and tests took months. That resulted in a serious lupus flare, which culminated in a bout of pneumonia and sepsis. During the time I was in hospital, I was re-diagnosed with lupus following abnormal test results. My having lupus is thought to be the key reason why I had got so ill – unfortunately, lupus leaves me very susceptible to serious infections like pneumonia, kidney infections and sepsis. I now have a new rheumatologist who says I definitely have lupus.

Atos say they won’t carry out ‘diagnostic tests’ but they did.

In the appointment letter from Atos, it says: “The Health Professional will talk to you about how your health condition affects your daily life”. Much of this was covered with the council’s initial care plan report, but I did discuss my health issues and barriers to independence at length during the assessment.

The letter from Atos then says: “This will not be a full physical examination or an attempt to diagnose your symptoms.” 

My neck and shoulders are stiff, painful and I currently have limited mobility in them, yet I was asked to put my hands behind my head, raise my arms and so on. Loud joint cracking, popping, creaking and gasps of pain and my screwed up face didn’t stop the demands of what I felt was the impossible. I was actually sweating and trembling with the effort and pain, and still she did not stop the “examination”. I felt I couldn’t say no, as I would have seemed somehow unreasonable. I kept thinking that if I tried, gently, I was at least showing willing, and that would be okay, but unfortunately I wasn’t. 

It’s difficult to equate these artificial manoeuvres with day-to-day activities, and therefore it is also difficult recognise the impact it would have on my mobility limits before I tried them and to gauge how much a movement in isolation is going to hurt. 

Immediately following the examination/tests, my left calf has inexplicably swollen to twice its normal size, I could feel the uncomfortable tightness in it, and the swelling was visible through my jeans, whilst still with the assessor, and I commented on it.

My pain level has significantly increased everywhere. I had no groin or neck or elbow pain when I arrived until I was asked to do activities that were beyond my capability and that caused me a good deal of needless pain. I felt undignified trying to do those tasks, shocked and dazed at the pain, and sometimes, at how limited my movements have become. It was an extremely distressing and dehumanising experience. I was also shocked at how the effort made me tremble and sweat, and at how my clear distress was completely ignored by a so-called “health care professional”.

Of course I am going to make a formal complaint about this. It shouldn’t cause people so much pain and distress to be assessed for support. And any examination part of the assessment ought to take your medical conditions and descriptions of mobility constraints fully into consideration without such a grueling and painful examination regime.

It is worth bearing in mind that in addition to my own account, medical evidence from my rheumatologist was submitted in advance, and a report of recent assessments by a council occupational therapist who prescribed aids and adaptations, which clearly outlined my mobility difficulties, following two assessments, was also submitted. This was a report written by a qualified professional and was based on her own examination of my level of functionality and mobility while I tried to perform directed tasks in my home, such as climbing stairs, preparing food and using a bath board in my bathroom.

The fundamental difference between the assessments is that the one for my care plan allowed me to undertake tasks at my own pace, with dignity, and the Atos assessment did not. The former also felt like it was a genuine assessment of my needs, with support being the aim, whereas the latter felt like some sort of skeptic’s test to see if a way could be found to claim my account and those of my doctors were somehow incorrect. The Atos assessment was so horrifying because it felt like it was about reluctantly providing support for maintaining my independence as a very last resort only. 

According to the government’s PIP handbook, for a descriptor to apply to a claimant they must be able to reliably complete an activity as described in the descriptor. Reliably means whether they can do so:

 safely – in a manner unlikely to cause harm to themselves or to another person, either during or after completion of the activity.

The descriptors at no point demand that a person completes the Phalen manoeuvre or squats. The brief and painful completion of raising your hands above your head does not demonstrate either a fluctuating ability to do so, or your ability to hold your arms up long enough to, say, wash your hair and rinse it, even on a good day. Nor does it adequately account for severe pain, profound fatigue, coordination difficulty and breathlessness that often impact on any performance of that task. I did point this out, and the fact that the activities had left me in a lot of pain.

It’s now the day after my PIP assessment. I am still in a lot of pain with my joints and tendons. I feel ill, anxious, depressed and I am still shocked and angry. I can’t even manage to wash today. I have also developed pain on the left side of my chest, which feels rather like pleuritis. I feel really unwell, profoundly tired and haven’t felt this bad since my bout of pneumonia. The assessment hasn’t made me ill – I was already seriously ill. But it HAS exacerbated by symptoms. 

No-one should be made to feel worse because of an assessment for support. The activities I was asked to do should have been stopped when it became clear I was struggling. I stated I was in pain, I was visibly sweating, trembling, weak and clearly in a lot of pain with the effort, and as a “health professional”, the assessor should have halted that examination. I am very concerned that unintended harm may be caused by assessors conducting examinations because they do not have qualification, sufficient information or understanding about patients’ conditions.

My condition, for example, has left a trail of individual symptom diagnoses and medical data that goes back many years. With such a complex array of joint and tendon problems, I felt that there was absolutely no consideration of the impact that, say, a hand and wrist manoeuvre may have on a person’s damaged shoulders and elbows, as well as their wrists, or how a neck movement may impact on an upper spine injury and inflammatory shoulder problems, as well as the neck.

Given the assessment report I submitted and medical evidence, in addition to my own account, I feel that such a painful physical examination ought to be restricted to cases of absolute necessity. I don’t believe those simple isolated movements I was asked to do can possibly demonstrate he complex limitations on my day-to-day independence, and how I manage (or don’t) to cope with domestic tasks and general mobility.

The fact I couldn’t do some of them was both traumatising and humiliating, as well as very painful. I am still in a lot of pain as a result. 

The shame of being there to explain to a stranger about your illnesses, the intimate details of your life, your vulnerabilities and why you need help, is difficult enough, without the added distress of being coldly assessed by someone who doesn’t understand your conditions and does not care that what they ask you to do may be traumatising, painful and potentially very damaging.

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Related

What you need to know about Atos assessments

Government guidelines for PIP assessment: a political redefinition of the word ‘objective’ 

Government subverts judicial process and abandons promise on mental health ‘parity of esteem’ to strip people of PIP entitlement

Tory MP says PIP should only go to ‘really disabled’ people, not those with anxiety ‘taking pills 

Disabled mum took fatal overdose after she was refused PIP

Fear of losing disability support led a vulnerable man to a horrific suicide

Theresa May euphemizes savage cuts to PIP when confronted by an angry disabled person demanding democratic accountability


 

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Judicial review rules benefit cap unlawfully discriminates against lone parents

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The  Conservatives have been dealt a blow by a high court judgement today, which ruled that the government’s highly controversial benefit cap unlawfully discriminates against lone parents with young children. The imposing of a benefit cap on tens of thousands of lone parents with children under the age of two is not only unlawful, it has has resulted in “real damage” to the families affected, the high court has ruled.

The judicial review challenge brought by four lone parent families, concerned the reduced benefit cap introduced by the Welfare Reform and Work Act 2016. The revised benefit cap drastically reduced housing benefits, leaving lone parent families across the country unable to afford basic life necessities to care for their children.

Mr Justice Collins has ruled that the application of the revised benefit cap to lone parents with children under two amounts to unlawful discrimination and that “real damage” is being caused to the claimants and families like theirs across the country.

The flagship welfare policy meant that there is a cap on total benefits, at either £23,000 a year in London, or £20,000 for the rest of the UK. The Department of Work and Pensions (DWP) had said that people were exempt from the cap if they work at least 16 hours per week – which the claimants said discriminated against lone parents with children under the age of two.

The benefit cap, which limits the total amount households can receive in benefits to £20,000 a year, or £23,000 in Greater London, was claimed to be  an “incentive” to “support” unemployed people to move into work. In reality, it has hindered people who want to prepare for work, demotivating them because they are struggling financially to meet their basic needs. Implying that taking support away from people – making cuts – is somehow “support” is a particularly ludicrous Conservative claim.

Mr Justice Collins said in his judgment that the policy visited “real misery to no good purpose” on lone parents with very young children who were subject to the cap despite there being no “official” requirement for them to find work. However, even for those citizens who are required by the state to seek work, it is still very difficult to justify cutting those people’s support, too, since welfare was designed to meet only basic needs.

Lone parents with children under two do not qualify for free childcare and so would find it difficult and often impossible to juggle working the minimum 16 hours a week required to evade the cap while finding means to care for the child. 

He said: “The evidence shows that the cap is capable of real damage to individuals such as the claimants. They are not workshy but find it, because of the care difficulties, impossible to comply with the work requirement.”

Most lone parents with children aged under two were not the sort of households the cap was intended to cover and it was “obvious” that it would exacerbate poverty. “Real misery is being caused to no good purpose.

He continued by stating that: “Most lone parents with children under two are not the sort of households the cap was intended to cover and, since they will depend on DHP (Discretionary Housing Payments), they will remain benefit households.”

Cutting people’s lifeline support causes extreme hardship and harm

Campaigners have argued that the benefit cap is a powerful driver of poverty and destitutionOfficial estimates published earlier this year show 50,000 low-income families caring for an estimated 126,000 children were at risk of serious financial hardship after being trapped by the lower benefit cap.

Rebekah Carrier, the solicitor acting on behalf of the families, said: “The benefit cap has had a catastrophic impact upon vulnerable lone parent families and children across the country. Single mothers like my clients have been forced into homelessness and reliance on food banks as a result of the benefit cap.

“Thousands of children have been forced into poverty, which has severe long-term effects on their health and wellbeing.” 

She added: “We are pleased that today’s decision will relieve my clients – and other lone parent families around the country – from the unfair impacts of austerity measures which have prevented them from being able to provide basic necessities for their children.” 

The Conservatives have said they intend to appeal the decision. The DWP has been given leave to appeal against the ruling. A spokesperson said: “We are disappointed with the decision and intend to appeal. Work is the best way to raise living standards, and many parents with young children are employed.”

Alison Garnham, chief executive of the Child Poverty Action Group charity, said: “In exposing the absurdity and cruelty of the benefit cap, we hope this case is the beginning of the end for this nasty policy. It is a policy that punishes the vulnerable for being vulnerable and even fails on its own terms.”

In 2015, although the Supreme Court found that the original cap was lawful, a majority found that it breached the rights of children. Despite evidence of the impact upon child poverty and amidst calls to review the way the benefit cap works, the benefit cap was lowered again in November 2016. The new annual limit was reduced significantly, with lower rates for households outside of London. Previously, London seem to bear the brunt of the policy but the revised cap is now affecting thousands of households across the country.

Mark Serwotka, general secretary of civil servants’ union the PCS, said the benefit cap should be scrapped.

He said: “As the union that represents DWP staff, we opposed the benefit cap from the outset because we knew it was cruel and unnecessary, and would drive families into poverty and homelessness.

“We welcome the judge’s ruling and comments about the misery being caused ‘to no good purpose’, and we now call on the Government not just to tweak the cap but to scrap it entirely.”

Labour leader Jeremy Corbyn described the ruling as a “further demonstration of the failure of this government’s austerity agenda”.

“It is failing in its own terms, it’s failing our communities, and it’s failing the most vulnerable in our country – including the victims of domestic violence and those facing homelessness,” he said.

“Labour has stood against the benefit cap, its discrimination against parents with children and the government’s cruel austerity programme. 

He called on the Government not to appeal the decision, and to “end this discrimination against parents and children”. 

Earlier this year, I wrote an article about comparative research at an international level, which has undermined the government claim that the UK welfare state encourages “widespread cultures of dependency” and presents unemployed people with “perverse incentives”.

The study, which links welfare generosity and active labour market policies with increased employment commitment, was published in 2015. It has demonstrated that people are more likely to look for work if they live in a country where welfare provision is generous and relatively unconditional. Empirically, the research includes more recent data from a larger number of European countries than previous studies. 

The research also compared employment motivation in specific sub-sections of communities across countries: ethnic minorities, people in poor health, non-employed people and women, and adds depth to previous studies. It has been concluded that comprehensive welfare provision is increasingly seen as a productive force in society (Bonoli, 2012), that stimulates employment commitment (Esser, 2005) and supports individual inclusion and participation in society and the labour market, particularly among disadvantaged groups. 

The researchers found that the more a country paid to unemployed and disabled people, and invested in employment schemes, the more its population were likely to agree with the statement, whether employed or not. 

The research findings challenge the Conservative’s neoliberal ideology, antiwelfare narratives regarding so-called “perverse incentives”, their highly controversial and stigmatising “scrounger” rhetoric and the brutal welfare cuts, implemented in stages since 2012. 

Welfare was originally intended to cover only basic needs: it allows families to pay rent, buy food, keep warm and simply keep going. When families get less money because of the Benefit Cap, the government’s own research shows that large numbers of people go into debt, end up with rent arrears, and can’t afford adequate food. Through no fault of their own. When people are struggling and can’t meet their basic needs, surviving becomes their overwhelming priority. This demotivates people, and means that it is almost impossible for them to meet their higher level psychosocial needs. Such as the need to look for work.

The government’s draconian welfare policies are founded on a “small state” neoliberal ideology, traditional Conservative class-based prejudices and a mean spirited, punitive approach to public needs.

Lies, damn lies and sadistics. The Tories have introduced sanctions which affect people in work who are low paid or work part-time. People have to prove that they are trying to “progress in work”. Once upon a time, we had a strong trade union movement for collective bargaining. Nowadays, when employers exploit workers, paying them a pittance, the employee is punished by the government.

 


 

I don’t make any money from my work and I have no funding. I am disabled because of illness. You can support Politics and Insights and by making a voluntary donation which will help me continue to research and write informative, insightful and independent articles, and to provide support for others. The smallest amount is much appreciated, and helps to keep my articles free and accessible to all – thank you.

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Nothing about you without you – the Labour party manifesto for disabled people

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FOREWORD

Over the last seven years disabled people have borne the brunt of the cuts inflicted on them by the Conservative Government and the Coalition before them.

The cuts have had a detrimental effect on the lives of disabled people, cutting living standards and undermining their access to education, social care and to justice.

Two years ago the United Nations (UN) convened a committee to investigate state violations of the UN Convention of the Rights of Persons with Disabilities (UN CRPD). Last year the UN published their report and concluded that the Conservative Government had committed ‘grave, systematic violations of the rights of persons with disabilities.’

This is a damning indictment of the treatment of disabled people by the Conservatives, one which shames us as a country.

We believe in a social model of disability, a society which removes the barriers restricting opportunities and choices for disabled people. As such we will build on the previous Labour government’s commitment to disabled people in 2009 as signatories to the UN CRPD. A Labour government will incorporate the UN CRPD into UK law.

We are proud of the manifesto we have developed with, and for, disabled people, and would like to take the opportunity of thanking everyone who has taken part in Labour’s Disability Equality Roadshow over the last year. We have crossed the length and breadth of the country to engage with disabled people and their carers, capturing their views on what needs to change for disabled people to live full and independent lives.

We will continue to work with disabled people in government, fulfilling our promise of ‘nothing about you, without you’.

Jeremy Corbyn, Leader of the Labour Party

Debbie Abrahams, Shadow Work & Pensions Secretary

Marie Rimmer Shadow, Minister for Disabled People.

To access full CONTENT click here (PDF)

After seven years of punitive policies and systematic abuse of the human human rights of disabled people by the coalition and Conservative governments, it is such a profound relief to see Labour have developed this manifesto, using consultations as a democratic opportunity to HEAR and include us in political decision making, and will strongly support disabled people and their families. I am proud to have contributed to this via the consultation held in Newcastle.

Here is a brief summary of some of Labour’s policies:

  • Labour will make it a priority to repeal the numerous cuts in social security support for people with disabilities. They will do this through a new Social Security Bill that will be passed within the first year of the new parliament.

  • Labour will reverse the £30 per week cut that the Tories recently imposed on disabled people who receive Employment and Support Allowance (ESA).

  • Labour will scrap the Bedroom Tax that has cruelly and disproportionately hit over 400,000 families with disabled members with punitive charges for “spare” rooms that are often used to store medical equipment, or for carers to sleep in.
  • Labour will end the pointless and needlessly expensive continuous reassessments of disabled people with permanent disabilities, chronic illness and degenerative illness.

  • Labour will end the privatisation of disability assessments so that disabled people never again have to face the indignity degradation of having to prove their disability to some corporate bureaucrat with targets to throw as many disabled people off their benefits as possible.
  • Labour will scrap the discriminatory and degrading Work Capacity Assessment (WCA) regime that costs billions more to administer than it actually saves in reduced payments in social security support for disabled people.
  • Labour will end the privatisation of disability assessments so that disabled people never again have to face the indignity degradation of having to prove their disability 
  • Labour will scrap the Personal Independence Payment (PIP) assessment regime too.
  • Labour will replace the WCA and PIP assessment regimes with a system where personal advisers help to provide every disabled person who feels capable of work to develop a tailored personal plan, adopting a genuinely holistic approach. Those who feel they can’t work will be supported without punishment or threat of uncertainty.
  • Labour will incorporate the UN Convention on the Rights of Persons with Disabilities into UK law. And observe the law.
  • Labour will scrap  the draconian sanctions regime that has consigned hundreds of thousands of disabled people to absolute destitution. 
  • Labour will increase the Carer’s Allowance by £11 per week to bring it into line with the rate of unemployment benefit. 
  • Labour will reverse the Tories’ assault on the Bereavement Allowance.

The Labour Party manifesto is a fantastic demonstration that they have been listening to the concerns of disabled people and their families.

The manifesto presents a set of policies that will make people’s lives better.

I’ve summarised a handful of policies here, so be sure to read the full document.

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 Alex Cunnigham, me, Debbie Abrahams and Gail Ward at the Disability Equality Roadshow in Newcastle

A comparison of Labour and Conservative manifestos – CLASS

The Institute For Fiscal Studies (IFS) analysis of the Conservative and Labour manifesto proposals, which shows that both parties will run a surplus by 2019/20 , with Labour having £21 Billion spare. 

The Centre for Labour and Social Studies (CLASS) is a thinktank established in 2012 to act as a centre for left debate and discussion. Originating in the labour movement, CLASS works with a broad coalition of supporters, academics and experts to develop and advance alternative policies. 

CLASS produces briefings, policy papers and think pieces to influence policy development, which spans a field. Projects already underway address issues of growth and the economy, work and pay, housing and equality, security and aspiration, democracy and welfare, amongst many others.

CLASS have produced a comprehensive briefing which  breaks down and compares Labour and Conservative manifesto proposals across policy areas including public services, tax, education, employment and Brexit.

Here is a summary. I recommend you read the full report here.

Brexit

Labour has pledged to focus on jobs and living standards as the first priorities in Brexit negotiations:

 Labour states that leaving the EU with no deal would be the worst possible outcome, and reject it as a possibility.

 Labour has accepted the end of freedom of movement, meaning that the UK will have to leave the single market.

 Labour wants to maintain as many benefits of the single market and customs union as possible.

 Labour will scrap the Conservatives’ Great Repeal Bill, replacing it with an EU Rights and Protections Bill that will protect working rights, consumer rights, equality law and environmental protections.

The Conservatives have made Brexit a central theme in their manifesto, stating that it is the biggest challenge the UK will face in most of our lifetimes.

 The Conservative manifesto maintains that no deal would be better than a bad deal.

 The Conservatives have pledged to scrap freedom of movement as a red line in Brexit negotiations. This means that the UK will leave the single market, which is made clear in the manifesto.

 The Conservative manifesto pledges a deep and special relationship with the EU, but there are no specific details. 

Conclusion: Both Labour and the Conservatives have pledged to accept the referendum result, and both parties voted to trigger Article 50 and start the formal process of leaving the EU.

However, their priorities in Brexit negotiations are different. The Conservatives’ acceptance that no deal is a possibility for Brexit would have huge implications for the UK economy. We welcome Labour’s statement that leaving with no Brexit deal should not be an option.

Immigration

The Labour party has stated that freedom of movement will end post-Brexit, but have not pledged to reduce immigration.

 Labour would guarantee the rights of EU migrants in the UK immediately.

 Labour will not set an arbitrary target on immigration levels to the UK.

 Labour will reintroduce the Migrant Impact Fund, to ensure that increased migration in certain areas does not place a strain on public services. The Conservative party have pledged to end freedom of movement and reduce migration, claiming that when immigration is too high it is difficult to build a cohesive society.

 The Conservatives will not guarantee the rights of EU citizens before Brexit negotiations start.

 Despite missing their immigration targets repeatedly while in government, the Conservatives have again pledged to reduce immigration to the tens of thousands -including students.

Conclusion: Both parties are committing to ending freedom of movement post-Brexit. This could have serious consequences for the UK – 10% of our doctors and 4% of our nurses are from elsewhere in the EU.

It is also concerning to see that students will be included in Conservative immigration numbers. However, while the Conservatives continue to suggest that immigration must be limited, Labour have stated that immigration targets are unhelpful. This is a positive step forward in our national conversation about migration.

Tax and redistribution

Labour pledges to make the taxation system fairer through a combination of increasing existing taxes on the top 5%, new taxes, and tighter rules on existing taxes to crack down on evasion and avoidance. This aims to raise £48.6bn in revenue. Key proposals are as follows:

 Lowering the 45p additional rate threshold to £80k (Top 5%) and reintroducing the 50p rate on earnings above £123k. Raising £6.4bn.

 Excessive Pay Levy: paid by employers directly on salaries over £330k. Raising £1.3bn.1

 Increase corporation tax to 26% in 2020–21 (2011 levels) with a lower rate for companies with annual profits below £300k. Raising £19.4bn.

 Introduce a Robin Hood Tax – a tax of about 0.05% on financial transactions. Raising £26bn.

 A clamp down on tax avoidance. Raising £6.5bn. A £3.9bn allowance has been made for behavioural changes and uncertainty.

The Conservatives have emphasised a low tax economy with a new deal for ordinary people (see our employment section). As could be expected with a low tax focus, their plans are more modest than Labour’s:

 Increase the personal allowance to £12,500 and the higher rate of tax to £50,000 by 2020.

 Cut corporation tax to 17% by 2020.

 Conduct re-evaluations more frequently to prevent large changes.

 Stop tax avoidance and evasion.

Conclusion: Tax is one of the biggest dividing lines between the parties. We welcome Labour’s plan for increased taxes on the rich and bold measures to tackle inequality. We are concerned that the Conservatives plan for a low tax economy would simply mean high earners and corporations gain, while low and middle income earners would see their wages eaten away by inflation.

Investment

Labour announced a £250bn fund for investment in infrastructure – transport, energy systems, telecommunications – scientific research, and housing (to be raised by borrowing). Funds will be targeted at:

 Extending HS2 into Scotland.

 Building Crossrail for the North.

 Investment in new, state-of-the-art low-carbon gas and renewable electricity production.

 Universal superfast broadband by 2022.

 3% of GDP on research and development.

 A goal of 60% of jobs created through investment to be high skilled.

The Conservatives have also proposed an industrial strategy with major investment in infrastructure, skills and research and development. They plan to continue the existing £170bn infrastructure investment plan over the next parliament. A part of this funding will come from borrowing and part is already allocated in the budget.

They aim to:

 Meet OECD average of 2.4% of GDP on research and development.

 Launch a £23bn National Productivity Investment Fund.

Conclusion: Both parties have pledged to invest in infrastructure and skills. Labour’s measures are more ambitious in outlook and funding, and are more clearly costed. CLASS believes that this big and bold idea brings the investment the UK so vitally needs.

Environment

 The Labour party used their manifesto to link the environment to sustainable agricultural industries and flood defences. Their main policies are:

 An end to fracking.

 Championing sustainable farming, food and fishing by investing in and promoting skills, technology, market access and innovation.

 Introduce a new Clean Air Act to deal with illegal levels of air pollution.  Halt the privatisation of public forests.

The Conservative party talked about the environment in the context of business, with relatively little on environmental protections by themselves, arguing for:

 More fracking, hailing the technique as a “revolution”.

 Devise a new “agri-environment system”.

 Produce a 25 year Environment Plan.

 A pledge to be the first generation to leave the environment in a better state than they inherited it.

Conclusion: There are clear dividing lines on the environment, most noticeably regarding fracking, with the Labour party firmly opposed to the industry, and the Conservatives proudly supportive.

There is also the matter of Labour’s greater emphasis on environmental protection and clean air, and lack of Tory attention to these issues. Given this divide, we do not see how a Conservative government would be the one to leave the environment in a better state.

NHS and social care

The Labour party has focused on additional funding for the NHS and social care, stating that cuts to NHS and social care budgets by previous Conservative governments have led those services to crisis point.

 Labour has committed to £30bn in extra NHS funding over the next parliament.

 Labour has committed £8bn for social care over the next parliament.

 Labour pledges to guarantee access to NHS treatment within 18 weeks, and that patients will be seen in A&E within 4 hours. The Conservative party manifesto has pledged to increase NHS spending, while proposing new rules for social care costs.

 Conservatives will increase NHS spending by at least £8bn over the next parliament.

 The Conservatives propose ensuring that anyone who needs social care will be able to keep £100,000 of assets.

 People will be able to defer payment on social care until after their death, enabling them to keep their house.

Four days after the Conservative manifesto launch, Theresa May announced that there will be a cap on the amount an individual will pay towards their care, despite the manifesto mentioning no cap and specifying only that no one would be left with less than £100,000 in assets after paying care costs. There has been speculation that a narrowing poll lead led to this announcement, which the Conservatives refuse to describe as a change.

Conclusion: We welcome commitments to properly fund the NHS, but Conservative commitments do not equal the missing funding identified by many campaigners, and their figure is less than a third of Labour’s commitment.

The Conservative social care proposals are also flawed, as people would be likely to pass on their assets to their children to avoid charges. While four in five councils can’t cope with the demand for elderly social care, Labour’s proposals for a big funding boost would be the better option for social care.

Education

The Labour party has pledged to create a National Education Service to reform our education system.

 Labour will reverse cuts to school funding.

 Labour will increase Sure Start funding.

 Labour will create a National Education Service for cradle to grave education, free at the point of use.

 Labour will reduce class sizes to less than 30 for all five, six and seven year olds.

 Labour has pledged to scrap tuition fees and reintroduce maintenance grants.

 Labour has pledged to restore the Education maintenance Allowance (EMA).

 Labour will provide free Further Education, including English lessons. The Conservative party has made pledges to increase school funding and make sure that more children attend good schools.

 The Conservatives have pledged that no school will have their budget cut as a result of the new funding formula.

 The Conservatives will build 100 new free schools a year.

 Conservatives will lift restriction on creating grammar schools.

 Conservatives will open a specialist maths school in every major English city.

 Conservatives will stop universal free school lunches for primary age children, replacing them with free universal breakfasts. The savings will be used for £4bn in schools funding over the next parliament.

Conclusion: Labour’s commitment to reversing school cuts should be welcomed – 99% of schools will have per pupil funding cut by 2020 under current government policy.1 The creation of a national education service for lifelong learning is another welcome proposal, enabling people to retrain in a fast changing jobs market.

However, we were disappointed to see another commitment to new grammar schools from the Conservatives, with a pledge to lift restrictions on the creation of new selective schools. As we have highlighted before, there is no evidence that shows grammar schools increase social mobility – it actually shows the opposite.

Welfare system

The Conservative party state that they have no plans for further radical welfare system reform in the next parliament. The Conservatives will therefore continue to roll out universal credit.

The Labour party has pledged to reform the controversial Universal Credit program. Labour has also pledged to:

 Scrap the bedroom tax.

 Scrap punitive benefit sanctions. 

 Scrap the Work Capability Assessment.

 Scrap cuts to bereavement support.

 Restore housing benefit for under 21s.

Conclusion: After several years of cuts to benefits, and numerous examples of suffering caused by those cuts, it is disappointing to see no changes to the welfare system proposed by the Conservatives. However, we should welcome commitments by Labour to scrap some of the worst features of recent welfare reforms.

Working rights and employment  

Labour released a 20-point plan to increase workers’ rights and provide better security at work. The most important are as follows:

 Give all workers equal rights from day one, whether part-time or temporary.  Ban zero hours contracts.

 Legislate to ensure that recruitment of labour from abroad does not undercut workers at home.

 Repeal the Trade Union Act and roll out sectoral collective bargaining.

 Maximum pay ratios of 20:1 in the public sector and in companies bidding for public contracts.

 Raise the Minimum Wage to the level of the Living Wage (expected to be at least £10 per hour by 2020) – for all workers aged 18 or over.

 End the Public Sector Pay Cap.

 Action on bogus self-employment so the law assumes a worker is an employee unless the employer can prove otherwise.

 Double paid paternity leave to four weeks and increase paternity pay.

The Conservatives have taken a different focus on workers’ rights. Their promises are certainly less ambitious, but there are some positive commitments:

 A statutory right to a year’s unpaid leave to care for a relative.

 EU workers’ rights protected.

 Protection from the gig economy.

 Improve worker representation on boards – watered down from previous commitments to have workers on boards.

 A right to training.

However, the Conservatives have weakened their National Living Wage commitment to meet 60% of the median wage by 2020. With rising inflation, this is likely to cause increased poverty among low earners.

Conclusion: Although this is one of the Conservative party’s more worker friendly manifestos, Labour’s finger is definitely more on the pulse when it comes to workers’ rights. Labour’s manifesto has a real potential to tackle the deep inequality that the UK suffers from.

Inequalities

Labour has pledged a range of measures to reduce equality for several groups. Some of these include:

 Labour will assess future policy for its impact on women.

 Bring offences against LGBT people in line with hate crimes based on race and faith.

 Labour will introduce a requirement for equal pay audits on large employers to tackle the pay gap faced by BME workers.

 Labour would classify British Sign Language as a recognised language.

The Conservative party had a particular focus on disability discrimination.

 A one year national insurance holiday for companies who employ a person with a disability.

 The Conservatives will continue plans to tackle hate crimes against a person based on their sexual orientation, gender identity, disability and religion.

 The Conservatives will review access for disabled people and pledge to work with service providers to reduce any extra costs faced by people with disabilities. 

Conclusion: Labour have proposed concrete policies to help improve equalities in the UK. Although the Conservatives have clearly stated a commitment to people with disabilities, this is in the context of cuts to benefits under a Conservative government which have had a disproportionate impact on people with disabilities.

Housing

The Labour Party has an ambitious goal of council house building and a raft of protections for renters:

 Build 100,000 council and housing association dwellings for every year of the next parliament.

 Build more affordable housing.

 Make three year tenancies the norm.

 Abolish the bedroom tax.

 Inflation capped rent increases, and a ban on letting agent fees.

 New minimum standards introduced for the private rental sector.  Reinstate housing benefit for 18-21 year olds.

 A plan to end rough sleeping within the next Parliament, with 4,000 additional homes for people with a history of rough sleeping.

The Conservative Party is also making bold pledges on house building:

 A promise to deliver on their 2015 manifesto commitment to build a million homes by 2020, and a pledge to built another 500,000 homes by 2022.

 A new generation of fixed-term council housing linked to a new Right to Buy.

 Free up more land for new homes.

 Give housing associations more flexibility to increase their stock.

 Give councils more power to intervene when developers don’t act on planning permissions.

 Look at increasing protections for renters

Conclusion: We are happy to see commitments from both parties to building large numbers of houses, though this does reflect how bad the crisis has become.

We call on both parties to commit to building 200,000 social houses to meet demand. We applaud the multiple new protections for renters from Labour, and are concerned with the lack of firm policy commitments from the Tories.

Pensions

Labour plans bring both strong protections for pensions and a potentially radical shift in pensions policy. Proposals include:

 Keeping the triple lock on pensions, so the state pension rises by 2.5%, inflation, or earnings growth.

 Commission a new review of the pension age, to develop a flexible retirement policy reflecting people’s contributions, the variations in life expectancy and the varying health effects of work.

 The Winter Fuel Allowance and free bus passes will be guaranteed as universal benefits.

 Protect pensions of UK citizens living overseas.

The Conservative proposals broke with the political consensus on pensions and the elderly (See the social care section for more detail on that particular policy). Their commits on pensions are:

 Means testing the winter fuel allowance (potentially affecting 9m pensioners).

 Change to a double lock on pensions, so they go up in line with earnings or inflation, whichever is higher (removing the third 2.5% lock).

 Measures to protect private pensions by increasing punishment for mismanaging schemes.  

Conclusion: We are happy to see commitments from both parties to building large numbers of houses, though this does reflect how bad the crisis has become. We call on both parties to commit to building 200,000 social houses to meet demand.

We applaud the multiple new protections for renters from Labour, and are concerned with the lack of firm policy commitments from the Tories. 

Public services and nationalisation

The Labour party has pledged to prioritise public service over private profit, and stated that prices have risen and services have suffered in privatised industries.

 Renationalise railways by bringing them back into public ownership as franchises expire.

 Renationalise Royal Mail.

 Establish publically owned regional water companies.

The Conservative party have pledged to take action on rip-off bills.

 Pledge to freeze energy bills, a policy that was also in the 2015 Labour manifesto.

 Pledge an independent review into energy costs.

 Pledge the largest investment in railways since the Victorian era and extra capacity to tackle overcrowding.

Conclusion: Labour have made it clear that privatisation of public services, all natural monopolies, has not worked. We should welcome the commitment to nationalise industries to make them accountable to the public who use them, and with the aim of reducing prices.

The Conservatives have made no pledges on nationalisation, but have promised rail investment. It is unlikely that investment alone could tackle the issues facing our railways. 

 

 


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What Labour achieved

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