Category: Uncategorized

Lords table motion to kill new Tory restrictions on PIP

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Around 160,000 disabled people will be stripped of their entitlement to support for the additional costs they face because of their disability after the government shifted the goalposts to deal with upper tribunal legal rulings, according to the Labour Party.

Debbie Abrahams, shadow work and pensions secretary, said: “Instead of listening to the court’s criticisms of personal independence payment assessments and correcting these injustices, the government has instead decided to undermine the legal basis of the rulings.

This is an unprecedented attempt to subvert an independent tribunal judgment by a government with contempt for judicial process.

By shifting the goalposts, the Tory government will strip entitlements from over 160,000 disabled people, money which the courts believe is rightfully theirs.

This is a step too far, even for this Tory government. Labour will stand with disabled people, who have already borne the brunt of seven years of austerity, in fighting this injustice.”

(See also:  Government subverts judicial process and abandons promise on mental health ‘parity of esteem’ to strip people of PIP entitlement. )

According to the Liberal Democrat Voice, the Liberal Democrats have tabled a motion to kill the government attempts to severely restrict disability benefits.

The move follows the recent undemocratic announcement by the government that they will be tightening the criteria for claimants of Personal Independence Payments (PIP) which will see people with serious illnesses such as diabetes, epilepsy and a wide range of mental illnesses left without support.

The purpose of Upper Tribunals

The government has introduced the restrictive regulations after losing two cases at tribunals, showing an utter contempt for the UK judiciary system. However, the UK tribunal system is part of the national system of administrative justice

Administrative law is the body of law that governs the activities of administrative agencies of government. It is designed to independently review the decisions of governments, and as such, it provides protection and promotion of fundamental rights and freedoms for citizens.

The Upper Tribunal is a superior court of record, giving it equivalent status to the High Court and it can both set precedents and can enforce its decisions (and those of the First-tier Tribunal) without the need to ask the High Court or the Court of Session to intervene. It is also the first (and only) tribunal to have the power of judicial review. (The Conservatives have a historical dislike of judicial review. See for example: The real “constitutional crisis” is Chris Grayling’s despotic tendencies and his undermining of the Rule of Law.)

The Tribunals, Courts and Enforcement Act 2007 created a new unified structure for tribunals and recognises legally qualified members of tribunals as members of the judiciary of the United Kingdom who are guaranteed continued judicial independence. This means that the judiciary is kept discrete from other branches of government. That is so that courts are not subjected to improper influence from the other branches of government, or from private or partisan interests.

Judicial Independence is vital and important to the idea of separation of powers. The intent behind this concept is to prevent the concentration of political power and provide for checks and balances. It has been significantly influenced by judicial independence principles developed by international human rights constitutional documents. in the application of the European Convention on Human Rights in British law through the Human Rights Act 1998, which came into force in the UK in 2000.

The government’s new regulations are a particularly autocratic move, aimed at simply overturning two legal rulings that the government did not like, partly because their zealotry concerning their anti-welfarism and “small state” neoliberal ideology has been challenged. The regulations were ushered in and imposed so that they would not be subjected to parliamentary scrutiny and debate or democratic dialogue with disabled people or groups and organisations that support and advocate for those with disability. 

From Penny Mordaunt’s statement:

“The first judgement held that needing support to take medication and monitor a health condition should be scored in the same way as needing support to manage therapy, like dialysis, undertaken at home. Until this ruling, the assessment made a distinction between these two groups, on the basis that people who need support to manage therapy of this kind are likely to have a higher level of need, and therefore face higher costs.

The second held that someone who cannot make a journey without assistance due to psychological distress should be scored in the same way as a person who needs assistance because they have difficulties navigating. By way of example, the first group might include some people with isolated social phobia or anxiety, whereas the second group might include some people who are blind. Until this ruling, the assessment made a distinction between these two groups, on the basis that people who cannot navigate, due to a visual or cognitive impairment, are likely to have a higher level of need, and therefore face higher costs.”

Responding to the announcement, Baroness Cathy Bakewell, Liberal Democrat Shadow Secretary of State for Work and Pensions, said:

“The government is using its recent losses in court as an excuse to severely restrict disability benefits. Rather than listening to the ruling they are using it to make matters worse for disabled people – that is utterly outrageous.

What makes things even worse is that they have sneaked this announcement out under the cover of by-elections. These decisions impact the lives of vulnerable people, Liberal Democrats will not allow the Conservatives to get away with treating people with disabilities with such total contempt.”

The Liberal Democrats contributed to scuppering the government’s plans to restrict tax credits back in October 2015.

Personally, I welcome any collaborative effort to challenge the Conservative’s draconian policies which deny people the help and support that they need. 


I don’t make any money from my work. I am disabled because of illness and have a very limited income. 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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The poor state of child health in the UK

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Neoliberalism is based on competitive individualism and mythical “market forces”. In such a competitive system, where the majority of people are left to sink or swim, most are pitched against the tide, as it were, since the very design of the economy means that only the wealthiest make significant gains.  It’s therefore inevitable there will be a few “winners” and many “losers”.

That’s what “competition” means. It means no rewards for most people – inequality and poverty for the 99%. It’s not possible to “work hard” to change this. Inequality is built into the very system of our socioeconomic organisation. Therefore it’s hardly fair or appropriate for a government to blame and punish people for the failings of their own imposed dominant ideology – a political and economic mode of organisation – which most ordinary people did not intentionally choose.

A  major report – State of child health – says that child health in the UK is falling behind that of many other European countries. It also confirms a strong link between growing inequality and poverty in the UK and increasing poor health and mortality. This comes at the same time as another key study found that poverty has a significantly damaging impact on the mental health and behaviour of children. 

The report raises particular concerns over rates of mortality, mental health issues and obesity among the young. Children living in the most deprived areas are much more likely to be in poor health, be overweight, suffer from asthma, have poorly managed diabetes, experience mental health problems and die early.

The in-depth report, from the Royal College of Paediatrics and Child Health (RCPCH), has emphasised that poverty is the cause of many child health problems.

UK health ministers claim that money was being invested in services to help tackle health inequalities.

The report looked at 25 health indicators, including asthma, diabetes and epilepsy, as well as obesity, breastfeeding and mortality, to provide a snapshot of children’s health and wellbeing.

It said there had been huge improvements in child health in the UK in the past 100 years, but since the mid-1990s “there has been a slowing of progress”.

This has left the UK falling behind other European nations in a number of league tables. For example, in 2014 the UK had a higher infant mortality rate (of 3.9 per 1,000 live births) than nearly all comparable Western European countries.

Infant mortality ranges from 3.6 in Scotland to 3.9 in England and Wales, and 4.8 in Northern Ireland.

Rates of smoking during pregnancy – an important factor in the health of babies – are also higher in the UK than in many European countries, at 11.4% in England and nearly 15% in Scotland.

Levels of smoking were highest in deprived populations and in mothers under 20, the report found.

Also, more than one in five children starting primary school in England, Wales and Scotland are overweight or obese, and there has been little improvement in these figures over the past 10 years.

Obesity leads to a significantly increased risk of serious life-long health problems, including type 2 diabetes, heart disease and cancer.  

In 2010 a report for the government in England by Sir Michael Marmot set out the social factors governing health and pointed to the role of a child’s early years in determining life chances. Now, leading child health experts are saying that little progress has been made since then and that health inequality is still blighting the lives of young people.

The Royal College of Paediatrics and Child Health has stated that the wide gap between rich and poor is damaging infant health around the UK.

The college president, Professor Neena Modi, argues that a lot more needs to be done to improve child health and that it is “particularly troubling that stark inequalities have widened in the last five years.”

Mortality rate worsens

The report says that the UK ranks high amongst Western European countries on mortality rates for infants under the age of one. Deprivation is strongly correlated with death rates among children.

The report says that many of the causes of infant mortality are preventable and asserts that issues such as fetal growth restriction disproportionately affect the least advantaged families in society. Diet and adequate nutrition, for example, play a key role in healthy birth weight.

Reducing child poverty, with benefits and housing policy playing a part, are crucial for improving infant survival, according to the report.

New mortality data was published in January by the Office for National Statistics, which also underlines the scale of inequalities in the UK.

Modi also said: “Poor health in infancy, childhood, and young adult life will ultimately mean poor adult health, and this in turn will mean a blighted life and poor economic productivity. The UK is one of the richest countries in the world; we can and must do better, for the sake for each individual, and that of the nation as a whole.” 

Sarah Toule, head of health information at World Cancer Research Fund, agrees:“We strongly support RCPCH’s call on the government to close the poverty gap and improve our children’s health and future.”

The report calls for child health to be pushed high up the government’s agenda, as a cross-departmental issue. Each government – Scotland, Wales, Northern Ireland and England – should develop a child health and wellbeing strategy and consider children’s health in all policymaking.

Both type 1 and type 2 diabetes are on the rise

According to the report, there was also evidence that young people in the UK had low wellbeing compared with other comparable countries.

Type 2 diabetes is increasing. However, the report said that the UK could do much better at monitoring and managing type 1 diabetes, which is an increasingly common autoimmune condition amongst children and young people in the UK, though unrelated to “lifestyle choices” or obesity. It can lead to very serious long-term health problems if it isn’t adequately medically monitored and managed.

The report lays out a number of key recommendations for improving the health and wellbeing of the nation’s children.

These include: 

  • Each UK Government to develop a child health and wellbeing strategy, coordinated, implemented and evaluated across the nation 
  • Each UK Government to adopt a ‘child health in all policies’ approach 
  • UK Government to introduce a ban on the advertising of foods high in saturated fat, sugar and salt in all broadcast media before 9pm 
  • Each UK Government to develop cross-departmental support for breastfeeding; this should include a national public health campaign and a sector wide approach that includes employers, to support women to breastfeed  
  • An expansion of national programmes to measure the height and weight of infants and children after birth, before school and during adolescence 
  • A reversal of public health cuts in England, which are disproportionately affecting children’s services 
  • The introduction of minimum unit alcohol pricing in England, Wales, and Northern Ireland, in keeping with actions by the Scottish Government  
  • UK Government to extend the ban on smoking in public places to schools, playgrounds and hospitals 
  • UK Government to prohibit the marketing of electronic cigarettes to children and young people 
  • National public health campaigns that promote good nutrition and exercise before, during and after pregnancy  

The high number of Sure Start centre closures runs counter to the government’s rhetoric on improving children’s life chances across society. Sure Start was an innovative and ambitious Labour government initiative, introduced in 1998, aimed at supporting the most deprived families and safeguarding children. In 2010, Gordon Brown said the Conservatives would cut Sure Start spending by £200m, forcing 20% of all centres to close. Maria Miller, the (then) shadow children’s minister, dismissed this as “scaremongering”, saying the scheme had the Conservative party’s “full commitment”.   However, increasing numbers of the centres have shut under the coalition and Conservative governments, with 12 closing in 2011, 27 in 2012 and 33 in 2013. In 2014 the number increased to 85, and then 156 in 2015. 

Neil Leitch, chief executive of the Pre-school Learning Alliance, said the figures were worrying.

“Children’s centres are a vital source of advice and practical support for families – especially those more disadvantaged families – and so for so many to be disappearing at a time when there is so much government rhetoric on ‘closing the gap’ and improving children’s life chances seems completely contradictory,” he said.

The State of Child Health report said poverty left children from deprived backgrounds with far worse health and wellbeing than children growing up in affluent families.

One in five children in the UK is living in poverty, the report says, though other estimates have been higher.

The report urges the four governments of the UK to reduce the growing health gap between rich and poor children.  

Key messages to governments from the report

  • Poverty is associated with adverse health, developmental, educational and long-term social outcomes.
  • Nearly one in five children in the UK is living in poverty. This is predicted to increase. Therefore strategies are urgently needed to reduce poverty and to mitigate its impact on child health outcomes.
  • Improving the health outcomes of children living in poverty requires provision of good-quality, effective and universal prevention and health care services. 
  • All professionals caring for children should advocate for and support policies that reduce child poverty.

An ‘all-society approach’ is needed

Professor Modi who is the president of the Royal College of Paediatrics and Child Health, said she was disappointed by the findings of the report.

“We know the adverse economic impact of poor child health on a nation and yet we singularly seem to be incapable of doing anything substantive about it.”

Modi said other European countries had much better results than the UK in closing the health gap between rich and poor children.

“Their policies are much more child friendly and child focused,” she said.

“We have a tokenistic recognition of the importance of child health in all policies in this country, but we don’t have that translated into real action.”

She added the UK could transform the health gap with an “all-society approach”.

“As citizens we can say very loudly and clearly we do want a focus on child health and wellbeing… we can bring in child health in all national policies and make sure our government does have a strategy that crosses all departments.”

The Child Poverty Action Group also applauded the report’s recommendations. “The Royal College’s report demonstrates all too clearly how poverty in the UK is jeopardising children’s health,” said Alison Garnham, chief executive. 

“We are nowhere near where we should be on children’s wellbeing and health given our relative wealth. In the face of a projected 50% increase in child poverty by 2020, this report should sound alarms. It is saying that unless we act, the price will be high – for our children, our economy and our overstretched NHS which will take the knock-on effects.

A cross-governmental approach, considering child health in every policy, was the right one, Garnham said. “But the overall question the report raises for our prime minister is will she continue with the deep social security and public service cuts she inherited – to the detriment of our children’s health – or will she act to ensure that families have enough to live on so that all children get a good start? If other comparable countries can produce results that put them in the top ranks for child health, why not us?” 

A spokesman from the Department of Health in England claimed the government would be investing more than £16bn in local government public health services to “help tackle inequalities.”

There was no mention, however, of protecting children from poverty. The austerity programme, which impacts on the poorest citizens most of all, and other government policies cannot possibly do anything else but extend and deepen social inequalities.

Recommended key actions

  • Governments must introduce comprehensive programmes to reduce child poverty.
  • Increase awareness among health professionals of the impact of poverty on health and support all professionals working with children to become advocates for their patients experiencing poverty.
  • Ensure universal early years’ public health services are prioritised and supported, with targeted supports for children and families experiencing poverty.
  • Provide good quality, safe and effective prevention and care throughout the public health and healthcare service with a particular focus on primary care in order to mediate the adverse health effects of poverty.
  • Support research that examines the relationship between social and financial disadvantage and children’s health. 
  • Support the continued recording of income-based measures of poverty so that trends and impacts of service provision can be meaningfully assessed, with a focus on achieving a target of less than 10% of children experiencing relative low income poverty.

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Our children are the first generation in the UK in a very long time, if ever, to have much less than their parents and grandparents. Their lives are far less secure than ours have been. It’s not because of a lack of resources, it’s because of the greed of a small ruling elite and because of neoliberal ideology and policies. We have already lost the social gains of our post-war settlement: public services, social housing, legal aid, universal welfare and unconditional healthcare are either gone, or almost gone.

We must not allow this steady dismantling of our shared, public services, supports and safeguards to continue, as a society. We are one of the wealthiest nations in the world, and we have sufficient resources to support those most in need. It’s simply that the government chooses not to, preferring to be generous to the wealthiest minority, with tax cuts handed out from the public purse, and spending our public finds on being “business friendly” instead of recognising and reflecting public needs.

We must work together to challenge the toxic dominant ideology that places profit over and above human need and social wellbeing. We each share some of the responsibility for this. We now need to work on how to change this for the better, collectively. For our children and the future.

For a copy of the State of Child Health report, and the recommendations for each UK nation, visit the State of Child Health web pages.

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Children in poverty (before housing costs), UK, financial years 1998/99 to 2012/13; Institute for Fiscal Study (IFS) projections to 2020/21.  (Source:
 Child poverty for 2020 onwards: Key issues for the 2015 Parliament.)

Related

Nearly two-thirds of children in poverty live in working families

Poverty has devastating impact on children’s mental health

Health cuts most likely cause of steep rise in mortality, government in denial

New research uncovers ‘class pay gap’ in Britain’s professions – Social Mobility Commission.

 


 

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Health cuts most likely cause of steep rise in mortality, government in denial

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Government denies that NHS and social care cuts may have caused 30,000 excess deaths in England and Wales 2015.

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 has drawn an angry response from the government.

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

(The report can be accessed here: Why has mortality in England and Wales been increasing? An iterative demographic analysis.)

The Department of Health (DH) responded by accusing the authors of the paper and accompanying commentary, published in the Journal of the Royal Society of Medicine on Thursday, of “bias”.

The researchers ruled out other possible causes of the increase, including cold weather, flu and the relatively low effectiveness of the flu vaccine that year, noting that fatalities from the virus rose “but not exceptionally”.

After examination of NHS performance data for the period, which shows the service missing almost all its targets, they concluded: “The evidence points to a major failure of the health system, possibly exacerbated by failings in social care.”

The rise in deaths from 2014 to 529,655 in 2015 was the biggest in percentage terms in almost 50 years and the mortality rate was the highest since 2008. The excess deaths were largely among older people who are most dependent on health and social care, the authors said. 

See: Excess deaths per month in 2015 compared with 2006-2014

The research further warned that the “spike” was showing signs of becoming an established pattern, with provisional official weekly mortality data from 2016 showing deaths from October onwards increasing by 7% compared with the five-year average.

While accepting their findings would generate controversy, the authors expressed surprise that the rise and the reasons for it had not previously been scrutinised.

Professor Danny Dorling from the University of Oxford said: “It may sound obvious that more elderly people will have died earlier as a result of government cutbacks, but to date the number of deaths has not been estimated and the government have not admitted responsibility.”

The researchers observed that the increase in mortality came as waiting times rose in A&E departments – despite unexceptional attendances – for admissions, diagnostic tests and also consultant-led care. Ambulance response times also increased as did operations cancelled for non-clinical reasons. Staff absence rates rose and more posts remained empty as staff had not been appointed.

The authors said health service austerity had been exacerbated by £16.7bn of cuts to the welfare budget and a 17% decrease in spending for older people since 2009, while the number of people aged 85 and over had risen almost 9%.

See: Age-standardised death rates per 100,000 population for all ages

Barbara Keeley, the shadow social care minister, said: “The Tories have created a crisis in social care. They have cut billions of pounds from council budgets and care is suffering as a result.

“In the March budget, the government must provide extra funding urgently and deliver a sustainable settlement to deal with the crisis in health and social care.”

The Liberal  Democrat leader, Tim Farron, called it “a national scandal that in one of the richest countries in the world, vulnerable older people are missing out on the services they need and may even have died due to poor care”.

The report’s co-author, Dominic Harrison, the director of public health at Blackburn with Darwen council, said the research “raises a red flag that is telling us that the health and care system may have reached the limits of its capacity to safely and effectively care for the population that funds it. Our analysis suggests that the most likely cause of that failure, when all other possible explanations have been excluded, is insufficient resources and capacity”.

The paper will make uncomfortable reading for the government at a time when it is under substantial pressure to boost spending for both the NHS and social care amid fears they are at breaking point.

See: Number of patients spending more than 12 hours from decision to admit to admission

A Department of Health (DH) spokesman described the study as “a triumph of personal bias over research”. He added: “Every year there is significant variation in reported excess deaths, and in the year following this study they fell by nearly 20,000, undermining any link between pressure on the NHS and the number of deaths. Moreover, to blame an increase in a single year on ‘cuts’ to the NHS budget is arithmetically impossible given that budget rose by almost £15bn between 2009-10 and 2014-15.”

The fall the DH refers to is the reduction in excess winter deaths, which compares those between December and March with those in the rest of the year. Excess deaths over the year are measured relative to the average in recent years.

Harrison said the point the authors were making was that in months such as January 2015, which saw a spike in deaths, there was an insufficient service response to a surge in demand. He termed this a “fail event” and warned there could be recurrences over the next five years without a rise in funding. He added that preliminary figures pointed to a possible significant increase in excess deaths last month.

“I have few doubts that our findings will be strongly contested,” he said. “This report has been published in good faith in a peer-reviewed academic journal by senior health professionals who are concerned to understand the causes of avoidable death in the population – precisely so that we can avoid it happening again.”


From The Guardian, 17th February 2017

 

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Related

Public health experts from Durham University have denounced the impact of Margaret Thatcher’s policies on the wellbeing of the British public in a comprehensive study 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 wellbeing.

The 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.

Baroness 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.

Professor Clare Bambra from the Wolfson Research Institute for Health and Wellbeing at Durham University, co-author of the research report, commented:

“Our paper shows the importance of politics and of the decisions of governments and politicians in driving health inequalities and population health. Advancements in public health will be limited if governments continue to pursue neoliberal economic policies – such as the current welfare state cuts being carried out under the guise of austerity.”

Thatcher’s policies  have been condemned for causing “unjust premature deaths.” Cameron’s policies are even more class-contingent and cruel.

I think there is a growing body of empirical evidence which indicates clearly that Conservative governments are much worse for public health, prosperity and wellbeing than unemployment. (From: Conservative governments are bad for your health.)


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Jobcentre tells GP to stop issuing sick notes to patient assessed as ‘fit for work’ and he died.

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Abbie and her late father, James Harrison.

Julia Savage is a manager at Birkenhead Benefit Centre in Liverpool. She wrote a letter addressed to a GP regarding a seriously ill patient. It said:

“We have decided your patient is capable of work from and including January 10, 2016.

“This means you do not have to give your patient more medical certificates for employment and support allowance purposes unless they appeal against this decision.

“You may need to again if their condition worsens significantly, or they have a new medical condition.” 

The patient, James Harrison, had been declared “fit for work” and the letter stated that he should not get further medical certificates. 

However, 10 months after the Department for Work and Pensions (DWP) contacted his doctor without telling him, James died, aged 55, the Daily Record has reported.

He was clearly not fit for work.

His grieving daughter, Abbie, said: “It’s a disgrace that managers at the Jobcentre, who know nothing about medicine, should interfere in any way in the relationship between a doctor and a patient.

“They have no place at all telling a doctor what they should or shouldn’t give a patient. It has nothing to do with them.

“When the Jobcentre starts to get involved in telling doctors about the health of their patients, that’s a really slippery slope.”

Abbie said James had worked since leaving school at a community centre near his home. But his already poor health went downhill after the centre was shut down because of austerity cuts.

James had a serious lung condition and a hernia before the centre closed, and also developed depression and anxiety afterwards.

Abbie said: “He’d worked all his life. He wasn’t the kind of guy who knew anything about benefits.

“But as his health deteriorated, there wasn’t any chance he could do a job. He applied for employment and support allowance.”

James received Employment and Support Allowance (ESA), but only at the low rate of £70 a week, the same amount as jobseekers’ allowance. He was then sent to attend one of the DWP’s controversial Work Capability Assessments – and declared fit for work.

Despite that decision, Abbie said James remained in constant need of medical help and had to visit his doctor regularly.

However, the GP concerned repeatedly refused to give him a sick note, and James began to suspect the Jobcentre were to blame for this.

Abbie said: “He really needed a note. He was too ill to go to the constant appointments at the Jobcentre and he didn’t want to be sanctioned.

“He became convinced the DWP had been talking to his doctor behind his back.”

Although Abbie felt her father was confused, and didn’t think his explanation was right at the time, she later asked to see her father’s medical records. She found the letter in his file from Julia Savage, the manager at Birkenhead Benefit Centre, in James’s home city of Liverpool.

The letter was addressed to James’s GP.

Context: Government claims that work is a “health outcome”

James Harrison was very worried that his ill health interfered with his obligation to comply with the inflexible and constant conditions attached to his eligibility for welfare support, and that this would lead to sanctions – the withdrawal of his lifeline support, which was calculated to meet basic survival needs only.

The GP should have provided evidence that this was the case. The doctor was advised not to provide further fit notes by the DWP, however, unless James appealed. Yet the circumstances warranted that the GP provide a fit note. 

fit-note-guidance

Last year, the Department for Work and Pensions issued an ideologically directed new guidance to GPs regarding when they should issue a Fit Note. This was updated in December 2016.

In the document, doctors are warned of the dangers of “worklessness” and told they must consider “the vital role that work can play in your patient’s health”.  According to the department, “the evidence is clear that patients benefit from being in some kind of regular work”.

The biopsychosocial model, with a current political emphasis on the psychological element, has become a disingenuous euphemism for psychosomatic illness, which has been exploited by successive governments (and rogue insurance companies) to limit or deny access to social security, medical and social care.

Nobody would deny that illness has biological, psychological and social dimensions, however, the model has been adapted to fit a neoliberal “small state” ideology – one that rests almost entirely on Conservative individualist notions of citizen responsibility, as opposed to a rights-based approach and provision of publicly funded state support.

This approach to disability and ill health has been used by the government to purposefully question the extent to which people claiming social security bear personal responsibility for their own health status, rehabilitation and prompt return to work. It also leads to the alleged concern that a welfare system which was originally designed to provide a livable income to those with disabling health problems, may provide “perverse incentives” for perverse behaviours, entrenching “worklessness” and a “culture of dependency”. It’s worth pointing out at this point that there has never been any empirical evidence to support the Conservative notion of welfare “dependency”. 

Instead of being viewed as a way of diversifying risk and supporting those who have suffered misfortune and ill health, social and private insurance systems are to be understood as perverse incentives that pay people, absurdly, to remain ill and keep them from being economically productive.

The idea that people remain ill deliberately to avoid returning to work  – what Iain Duncan Smith and David Cameron have termed “the sickness benefit culture” – is not only absurd, it’s very offensive. This is a government that not only disregards the professional judgements of doctors, it also disregards the judgements of sick and disabled people. However, we have learned over the last decade that political “management” of people’s medical conditions does not make people healthier or suddenly able to work. Government policies, designed to “change behaviours” of sick and disabled people have resulted in harm, distress and sometimes, in premature deaths

The government have made it clear that there are plans 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 DWP. 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 (and the Reform think tank) have also proposed 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 be subjected to welfare conditionality and sanctions.

Many campaigners have raised concerns about the DWP interfering with people’s medical care and accessing their medical files. I wrote an article last year about how the government plans to merge health and employment services and are now attempting to redefine work as a clinical outcome. I raised concerns about the fact that unemployment has been stigmatised and politically redefined as a psychological disorder, and that the government claims, somewhat incoherently, that the “cure” for unemployment due to illness and disability, and sickness absence from work, is work.

In a critical analysis of the recent work, health and disability green paper, I said: 

“And apparently qualified doctors, the public and our entire health and welfare systems have ingrained “wrong” ideas about sickness and disability, especially doctors, who the government feels should not be responsible for issuing the Conservatives recent Orwellian “fit notes” any more, since they haven’t “worked” as intended and made every single citizen economically productive from their sick beds.

It seems likely, then, that a new “independent” assessment and some multinational private company will most likely very soon have a lucrative role to ensure the government get the “right” results.”

The medical specialists are to be replaced by another profiteering corporate giant who will enforce a political agenda in return for big bucks from the public purse. Health care specialists are seeing their roles being incrementally and systematically  de-professionalised. That means more atrocious and highly irrational attempts from an increasingly authoritarian government at imposing an ideological “cure” – entailing the withdrawal of any support and imposing punitive “behavioural incentives” – on people with medical conditions and disabilities. Doctors, who are clever enough to recognise, diagnose and treat illness, are suddenly deemed by this government to be insufficiently clever to judge if patients are fit for work.

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. 

Waddell and Burton are cited frequently by the DWP as providing “evidence” that their policies are “evidence based.” Yet the DWP have selectively funded their research, which unfortunately frames and constrains the theoretical starting point, research processes and the outcomes with a heavy ideological bias. 

This framing simply shifts the focus from the medical conditions that cause illness and disability to the “incentives”, behaviours and perceptions of patients and ultimately, to neoliberal notions of personal responsibility and self-sufficient citizenship in a context of a night watchman, non-welfare state. 

Medication, rest, release from duties, sympathetic understanding – the remedies to illness – are being appallingly redefined as “perverse incentives” for ill health, yet the symptoms necessarily precede the prescription of medication, the Orwellian renamed (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. 

People cannot simply be “incentivised” into not being ill. 

The political use of the biopsychosocial model to cut costs at the expense of people who are ill will undoubtedly have further extremely serious implications. Such an approach, which draws on behaviourism and punishment (such as the threat and implementation of sanctions) is 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.

This is clearly the direction that government policy is moving in and this represents a serious threat to the health, welfare, wellbeing and human rights of patients and the political independence of health professionals.

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Reframing frames – ideology, George Lakoff and a call for your views

Wall Street Protestors Rally Against Police Brutality

An excellent example of using a slogan to reframe debate about neoliberalism and inequality from the Occupy movement

 

Left wing progressives hope that we can win elections by citing facts, rational debate and by offering policy programmes that serve the majority of voters’ interests. When we lose, we either conclude that we need to move farther to the right, where the voters are; where the Overton window opens, or that we need to move further to the left, to present a genuine alternative to the status quo. That dilemma has rigidly polarised the Labour party, undermining our unity and turning what was once a “broad church” appeal into an either/or basic dichotomy of alliances and reflected interests. The problem is how do we know which of these responses to the dilemmas of being a party in opposition will engage the public? And what if it is neither?

Yet, how can the left possibly lose a debate about the economy and social policy, when our current steeply hierarchical socioeconomic organisation serves the interests of so very few citizens? In fact those policies are seriously harming some social groups, especially those traditionally afforded social protections by previous Labour policies. 

Margaret Thatcher once made the absurd claim that the “problem” with socialism is that it “runs out of other people’s money to spend.” However, the New Right became experts on spending our public funds on extending the wealth of a few privileged millionaires, taking money from those who have the very least and handing it out to those who have the very most.

That really is “spending other peoples’ money.” As a consequence, the UK is now the most unequal country in the world, and that includes the US, where the Chicago boys – the founding fathers of neoliberalism – operationalised their experiment in hierarchical and authoritarian modes of neoliberal socioeconomic organisation.

Things ain’t what they ought to be

I’ve pointed out before that it’s easy to mistake the patterns and social circumstances of our era for “natural laws”. We really do need to revisit the is/ought distinction  (the naturalistic fallacy: we cannot use descriptive statements – what “is” – to make or justify prescriptive ones – what “ought” to be). So many people assume the Conservative world view of competition, mysterious “market forces” and the “invisible hand”, survival of the wealthiest, and Randian self interest is simply how things are: that these qualities are all fundamental to our “human nature”. They are not.

They are the qualities required of us – what “ought” to be the case – in order to prop up a hierarchical society, preserving a privileged elite and the material inequality and power relations of neoliberalism. Social Darwinism, which is like a comic strip version of Darwinism, was debunked last century, but here we are with policies that are directed by an ideology founded on social Darwinist principles once again. It’s become  a “common sense” assumption that we are naturally inclined to be competitive, and as a society, hierarchically ranked, on the basis of power and worth. Yet the matter of what “human nature” actually is has never been resolved over the centuries, let alone accounts of how that “nature” translates into the kind of society we have. Or ought to have, for that matter.

How can the Tories be right in their cynical miserablism, regarding our competitive social Darwinist tendencies?  If we are so fundamentally selfish and self-interested, with a generally Hobbesian temperament, moulded a little more by Burke’s profound anti-intellectualism, how, then, did we end up with a trade union and labour movement, working class enfranchisement, the welfare state, the NHS, legal aid, social housing, human rights and to generally progress to develop an altruistic, collectivist, cooperative approach for our post war settlement?  

“Human nature” is far more complex and much less static and defined than the Conservatives would have us believe. The kind of society that we live in, with its prevailing beliefs, attitudes and organisation, also contributes significantly to the kind of people we are, and importantly, to how we see ourselves and others.

Façade democracy

George Lakoff, a linguist and cognitive scientist, says that Conservatives exalt “obedience to authority,” insulate leaders from accountability, oppose checks and balances against leaders and rely on fear. All of this is true.

Lakoff says the right wins and keeps power by framing issues and “controlling minds”. This explains why Conservatives win elections. They manipulate us more effectively than the Progressives. They’ve been “preparing the seedbed of our brains with their high-level general principles” so that when the “low tax/low welfare society” idea, for example,  was planted in its various guises, repeatedly, “their framing could take root and sprout.” And “as a result, progressive messages don’t take root.”

Tories successfully reframe social issues, re-set defaults and normalise their prejudices and values. They become “common sense.” As dominant narratives do. In doing so, the Conservatives shape how the public see themselves and others.

Lakoff proposes that the left present frames instead of raw facts, in order to “train” the public to think less about neoliberal competition and self-interest and more about serving others. It’s not the platform that needs to be changed. It’s the voters. 

Lakoff says that we need to beat Conservatives at their own game. “Democracy is too important to leave the shaping of the brains of the public to authoritarians.” 

I like a lot of Lakoff’s work, but cannot get behind the idea of using techniques of persuasion to win support and (re)grow a movement. But then, the use of such techniques has been effective for the Conservatives, and that level of manipulation creates a problem for democracy. Lakoff is proposing we address the problem of a managed democracy by attempting to manage it too.

Is it possible to propose we manipulate voters and then still claim to be a democrat? 

He is right in that the rational approach doesn’t always work, but perhaps it’s more a question of how we present our alternative. I can get behind a shorthand and punchier general messages, just as long as it isn’t a strung together lexicon of glittering generalities with nothing meaningful referenced below the surface level. Integrity matters. The new world order is maintained partly by a precarious new word order. But it rests only on the very surface of our mind. It exists, not because it is rational or serves our best interests, but because it appears to be “normal.”

It’s probably true that many voters don’t pay much attention to the details and implications of policies. We have a tendency towards cognitive miserliness – the Principle of Least Effort; we frequently rely on simple and time efficient strategies when evaluating information and making decisions. But this can lead to prejudices. We formulate stereotypes, for example, which are simplistic ways of categorising others. Heuristics are mental shortcuts we often use in order to lessen the cognitive load that decision making requires. We often rely on habitual, superficial explorations and generalisations because we are caught up in our lives, and so to some degree, its a strategy of necessity and efficiency. 

However, this tendency towards cognitive miserliness is also manipulated. We often assign new information to categories that are easy to process mentally. These categories arise from prior information, including schemas, scripts and other knowledge structures, that has been stored in memory and so storage of new information does not require much cognitive energy. Cognitive miserliness means we tend not to stray far from our established beliefs when considering new information. That’s partly why repetition and slogans work so well as propaganda techniques. 

My own view is that we should try multiple approaches to messaging the public, but none of it should be simply about changing a vote for the sake of it. We also need to engage citizens in active participation in democracy. That is something the authoritarian Conservatives will never do: they have a policy agenda informed by private companies and millionaires, not ordinary citizens, and that won’t change.

Public needs have been privatised and pushed into the “market place” of competition and invisible capitalist hands. Increasingly, private companies are operating our essential public services, as the Conservatives claim that this is “efficient.” It isn’t, because it’s costing us billions to support unaccountable private businesses whose only motivation is to make profit.(See for example: Doctors bribed with 70-90k salaries to join Maximus and “endorse a political agenda regardless of how it affects patients.” )

Meanwhile, the privatisation of public need means that individuals shoulder the responsibility for them, rather than the state, who are still taking money from the public to fund those public “services.” Making individuals responsible for the consequences of political decision-making and arising socioeconomic problems like unemployment and poverty then justifies an authoritarian state intrusion in the form of “therapy.” For example, the rise of nudging, which is about the political directives to “change behaviours” because people make “the wrong choices” and so it turns democracy on its head.

This is because nudge is used without public consent, and it is solely aimed at “changing behaviours” of citizens to meet the states’ idealised and narrow neoliberal outcomes, rather than it being about actually recognising and meeting social needs and democratic inclusion.

The left tend to have a rather more optimistic, expansive and generous view of human nature. We believe in the human potential for learning, development and progress. However, that optimism is also tempered with an acknowledgement of our darker side, too. Policies which protect social groups that are prone to being exploited, scapegoated and other socially constructed vulnerabilities have largely been Labour party ones.

However, the problem is that the Conservatives hold up a darkly distorting looking-glass to the public, showing only what they want people to see of themselves. In that mirror, we are rendered ugly – always prone to being stupid, selfish, greedy, impulsive savages that need to to be ruled and controlled. Our self perceptions are shaped by significant others. There arises a subsequent social self-fulfilling prophecy. We project and scapegoat: it is always others that are savage and selfish, not us. This is facilitated by the Conservative tendency to marginalise poor people, creating folk devil stereotypes and social outgroups. 

We’re capable of changing minds. But we have good SOCIAL reasons to do so. That, for me is the key – there’s a difference between propaganda and reasoning; public interest and simply maintaining the public’s interest. The answer probably lies somewhere in a compromise – using both a rational and evidenced approach and the reductive pop politics soundbites to capture public interests AND public interest.

Tory cuts cost lives was a soundbite of mine from 2015. I wanted to reference war, and highlight the enemy in a longstanding and ongoing class conflict. It’s got integrity as a slogan because I’ve spent a few years writing about and presenting evidence of how  Conservative austerity is harming and sometimes killing people. 

But I don’t have all the answers. To come up with effective solutions requires our willingness for collaboration and cooperation.   

I’m particularly interested in what others think about this issue. If you have any thoughts on this, please leave me a comment, and I will revisit them in due course. We can do what the left always do very well: hold a democratic discussion and problem-solve collectively.

 

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Cases of malnutrition continue to soar in the UK

Minnes

The Office of National Statistics (ONS) have released figures that show 391 people died from malnutrition in 2015. There were 746 hospital admissions for malnutrition in just 12 months. The statistics also show two people in the UK are admitted to hospital with the condition every day in what campaigners have called a “national scandal.” 

Health minister Nicola Blackwood confirmed the numbers in a written answer in Parliament.

More than six people a month perish from starvation in England, which is one of the richest nations in the world.  The UK’s biggest food bank network, the Trussell Trust, provided more than a million three-day food packages over the past year, including 415,866 to children.What is worrying is that people may only have this support for a maximum of three days and have to be referred by a professional, such as a doctor or social worker.

Chairman Chris Mould said: It’s a scandal that people living in the sixth largest economy in the world are going hungry, which is why we’re working to engage the public, other charities and politicians from all parties to find solutions to the underlying causes of food poverty.

Our food banks support many thousands of people in various states of hunger.

Some people have been missing meals for days at a time; others have been unable to afford certain food groups or have sacrificed quality for long periods of time to keep costs down.

This, no doubt, has a negative effect on their health – and for people at the extreme end of the scale it will lead to malnutrition.

Every day we meet families across the UK who are struggling to put enough nutritious food on the table and hear from parents who go without food so their children have enough to eat.”

A Department for Work and Pensions spokeswoman said: “We now have record numbers of people in work and wages rising faster than inflation. 

But we need to go further, which is why we’ve committed to increase the National Living Wage, we’re taking the lowest paid out of income tax and our welfare reforms are ensuring it always pays to work.”

However it seems that “making work pay” is a euphemism for punishing those out of work or those in part-time or low-paid work with absolute poverty. In December 2015, I wrote about research from the Child Poverty Action Group, Oxfam, Church of England and the Trussell Trust which found that failures in the social safety net itself are most often the trigger for food bank referrals.

The report said that while money is tight for many reasons, including bereavement, relationship breakdown, illness or job loss, issues such as sanctions, delays in benefits decisions or payments or being declared “fit for work” led people to turn to food banks for support.

  • Around a third of foodbank users in the sample were waiting for a decision on their benefits – and struggling in the meantime
  • Between 20 and 30% more had their household benefits reduced or stopped because of a sanction

Other factors included loss of income due to the “bedroom tax” or the benefit cap. For between half and two-thirds of the people included in this research, the immediate income crisis was linked to the operation of the benefits system (with problems including waiting for benefit payments, sanctions, or reduction in disability benefits) or tax credit payments.

Amongst this group of people are many that are actually in low-paid work, claiming top-up benefits. The remaining number of people needing support from food banks to meet their most basic need are certainly in work, making a complete mockery of the Department for Work and Pension’s statement.

The research used 40 in-depth interviews with food bank users, data from over 900 users at three food banks around the country, and detailed analysis of nearly 200 clients accessing one food bank in Tower Hamlets. Another academic study said the government’s welfare reformsincluding benefit sanctions and the bedroom tax, are a central factor in the explosion in the numbers of impoverished people turning to charity food banks

The study, part of a three-year investigation into emergency food provision, was carried out by Hannah Lambie-Mumford, a Sheffield University researcher who co-authored a recently published government report into the extent of food aid in the UK.

That report concluded there was insufficient evidence to demonstrate a clear causal link between welfare reform and food bank demand in the UK. This is because the government has refused to make that information available by ensuring the reason for food bank referrals are no longer recorded. But Lambie-Mumford’s study says the rise in demand for charity food is a clear signal “of the inadequacy of both social security provision and the processes by which it is delivered”.

In 2015, more than 2,000 cases of patients with malnutrition were recorded by 43 hospital trusts in a single year.

There were 193 “episodes” of malnutrition in 12 months at Salford Royal NHS Foundation Trust alone, according to new figures.

Freedom of Information (FOI) figures show a rise of 259 between the 43 trusts compared with three years previously.

With the more recent introduction of more stringent in-work conditionality, including the extension of sanctions to those in part-time and low-paid work, the Conservative’s coercive psychopolitical approach to poverty will invariably make it even more difficult for many more to meet their basic survival needs.

At the same time, in 2014,  Community Links published a study called Just about Surviving which revealed that far from encouraging people on benefits to move into work, the draconian welfare cuts have pushed many further from employment. The report said that the state has reduced welfare support to the point where it barely enables people to survive.

Overwhelmingly, the reforms have made people “feel insecure and vulnerable to even small fluctuations in their small income or circumstance; continuing to erode their resilience.”

Furthermore, by forcing people into stressful situations where day-to-day survival becomes a pressing priority, the “reforms” (that are, in reality, simply cuts to people’s benefits), which were hailed by the Conservatives as a system of help and incentives – to “nudge” people into changing their behaviour so that they try harder to find work – are in fact eroding people’s motivation. In other words, the reforms have deincentivised and hindered people looking for employment, achieving the very opposite to the intent claimed by the Tories, to justify their draconian policies.

The report states that people are caught between trying to escape welfare reform through poor employment alternatives and feeling trapped in poverty. They move in and out of low paid work and are extremely susceptible to financial shocks and unprepared for the future.

In 2014, Oxfam’s director of campaigns and policy, Ben Phillips, said: “Britain is becoming a deeply divided nation, with a wealthy elite who are seeing their incomes spiral up, while millions of families are struggling to make ends meet.”

“It’s deeply worrying that these extreme levels of wealth inequality exist in Britain today, where just a handful of people have more money than millions struggling to survive on the breadline.”

Diseases associated with malnutrition, which were very common in the Victorian era in the UK, became rare with the advent of our welfare state and universal healthcare, but they are now making a reappearance because of the rise of numbers of people living in absolute poverty.

NHS statistics indicate that the number of cases of gout and scarlet fever have almost doubled within five years, with a rise in other illnesses such as scurvy, cholera, whooping cough and general malnutrition. People are more susceptible to infectious illness if they are under-nourished.

In 2013/14, more than 86,000 hospital admissions involved patients who were diagnosed with gout – an increase of 78 per cent in five years, and of 16 per cent on the year before. Causes of gout include a lack of vitamin C in the diet of people who are susceptible.

The figures from the Health and Social Care Information Centre (HSCIC) show a 71 per cent increase in hospital admissions among patients suffering from malnutrition – from 3,900 admissions in 2009-10 to 6,690 admissions in 2013-14.

Cases of scarlet fever admitted to hospital doubled, from 403 to 845, while the number of hospital patients found to be suffering from scurvy also rose, with 72 cases in 2009/10 rising to 94 cases last year.

The figures also show a steep rise in cases diagnosed with cholera, a water-borne disease which was extremely prevalent in the 19th century, causing nearly 40,000 deaths.

The new in-work conditionality regime may eventually apply to around one million more people.

The quantity of food being bought in food stores is also decreasing. It doesn’t take a genius to work out that repressed, stagnant wages and RISING living costs will result in reduced sale volumes. Survation’s research in March 2014 indicates that only four out of every ten of UK workers believe that the country’s economy is recovering.

But we know that the bulk of the Tory austerity cuts were aimed at those least able to afford any cut to their income.

We really must challenge the Conservative’s use of words such as “encourage” and “support” and generally deceptive language use in the context of what are, after all, extremely punitive, coercive  policies. The government intends to continue formulating policies which will punish sick and disabled people, unemployed people, the poorest paid, and part-time workers.

Meanwhile, the collective bargaining traditionally afforded us by trade unions has been systematically undermined by successive Conservative governments, showing clearly how the social risks of the labour market are being personalised and redefined as being solely the economic responsibility of individuals rather than the government and profit-driven big business employers.

 

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Related

Welfare sanctions cannot possibly incentivise people to work

The Coalition are creating poverty via their policies

Welfare sanctions make vulnerable reliant on food banks, says YMCA

Study finds Need For Food Banks IS Caused By Welfare Cuts

It’s absolute poverty, not “market competition” that has led to a drop in food sales.

Welfare reforms, food banks, malnutrition and the return of Victorian diseases are not coincidental, Mr Cameron

The politics of punishment and blame: in-work conditionality

 

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State-regulated cryptocurrency and micro-managing people claiming welfare

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Context

I’ve written more than one critical piece about the Government’s part-privatised Behavioural Insights Team (Nudge Unit), particularly with regard to its insidious and malevolent influence, manifested in a range of psychocratic policies aimed at “behavioural changes” which are being imposed on the poorest citizens. Technocracy is the “science of social engineering.” Nudge is a technocratic approach to fulfilling the requirements of neoliberalism. It’s about maintaining an established socioeconomic order, rather than advancing progressive social change.

In 1932, Howard Scott and Marion King Hubbert founded Technocracy Incorporated, and proposed that money be replaced by energy certificates. The group argued that “apolitical, rational engineers should be vested with authority to guide an economy into a thermodynamically balanced load of production and consumption, thereby doing away with unemployment and debt.” Sounds just like old school sociological Functionalism to me: it’s a systems theory  – utterly tautological and deterministic tosh. Bear with me, because there’s a couple of contemporary parallels I want to discuss.

The Conservatives prefer to do away with unemployment and debt by “incentivising behaviour change” to ensure that poor people who don’t have any money to live on are punished out of their poverty. 

Smart Cards, another antiwelfarist, technocratic imposition, entered our collective consciousness during autumn 2012, as Iain Duncan Smith declared his intention to discipline Britain’s “troubled” families. In unveiling his proposals at the Conservative Conference back in October 2012, Duncan Smith attempted to frame the cards as better value for taxpayers’ money, implying that poor people don’t pay taxes, (when the poorest actually pay proportionally more) and his rhetoric was extremely stigmatising.

He said: I am looking […] at ways in which we could ensure that money we give [benefit claimants] to support their lives is not used to support a certain lifestyle.”  [Boldings mine.]

Then MP Alex Shelbrooke presented his private member’s bill in December 2012, providing us with yet another shuddering glimpse into the underlying Tory moral outrage, prejudice and punitive attitudes towards people claiming benefits. He argued for a “welfare cash card” to limit spending to absolute basics. Isn’t welfare provision as it is just enough to cover the absolute basics for survival? It’s calculated to meet the basic cost of food, fuel and shelter only.

Despite his scapegoating narrative about addressing “idleness”, Shelbrooke’s proposed psychocompulsion was intended to apply to those in work, who claim benefits such as tax credits and housing benefit, penalising and outgrouping those on a minimum or low wage, also. The plan was to restrict the goods that people claiming benefits could buy with their cards. Not so much offering a “nudge” or “incentive”, but rather, delivering a bludgeoning enforcement. 

A principled objection is that we should not be stigmatising or inflicting punishments on people, or reducing their freedom to spend money as they need and wish, just because they are forced to spend some time out of work, or because they aren’t paid a wage that is sufficient to live on. Such an approach is draconian.

Having been previously rejected, this is certainly not a democratically endorsed policy.

This is an authoritarian restriction on what people claiming benefits may buy, and a limiting of lifestyle choices that they are permitted. It is a particularly spitefully directed ideological move that does not make any sense in terms of the wider economy, or in terms of any notion of “supporting” people, and “fairness.” The latter two categories of reason would entail extending opportunities and freedoms, not repressing them. Financial hardship already limits choice. When people are struggling financially, budgeting isn’t the problem: low wages, benefit cuts and rising costs of essential items are. Those factors are shaped by government policies, not poor people.

No matter how this is dressed up by the Tories, poor people don’t respond to “corrective” narratives and coercive policy like Pavlov’s dogs. Yet the Tories nevertheless insist on placing  a psychopolitical variant of operant conditioning – behaviour modification – at the core of their increasingly repressive class-contingent policies. This isn’t about state “assistance” for the entitled poor, most of who have worked and contributed to the treasury, contrary to the politically expedient “economic free rider” label.  It’s about traditional Tory prejudices, state interference and coercion. It’s more blaming and punishing the casualities of neoliberalism and social conservatism. 

Having failed in introducing the punitive smart card more than once, the Conservatives are now resorting to a stealthy introduction of a variation to curtail the freedom of poor people claiming social security, using cryptocurrency, state regulation and an unprecedented, Orwellian level of state monitoring and control of what people who are struggling to make ends meet are buying. 

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Some basic (but wordy) definitions

Cryptocurrency is a medium of exchange, alternative to Fiat currencies, which uses a type of virtual currency, such as bitcoin. It uses cryptography for security and anti-counterfeiting measures. Public and private keys are often used to transfer cryptocurrency between individuals. Ownership of bitcoins, for example, implies that a user can spend bitcoins associated with a specific address. To do so, a payer must digitally sign the transaction using the corresponding private key. Without knowledge of the private key, the transaction cannot be signed and bitcoins cannot be spent. The network verifies the signature using the public key.

Bitcoin is a pseudonymous currency, meaning that funds are not tied to real-world entities, but rather, to bitcoin addresses. For cryptocurrency enthusiasts, the pseudoanonymity element is attractive, as it tends to empower individuals rather than institutions. Cryptocurrencies typically feature decentralised and unregulated control, and transactions are recorded in a public distributed ledger called the blockchain. Owners of bitcoin addresses are not explicitly identified, but all transactions on the blockchain are public

The value of a cryptocurrency is determined by the market (whatever people are willing to pay for it). The welfare or state of your nation’s economy will not affect the value of your cryptocurrency. The value of a cryptocurrency is based solely on global supply and demand and functions much like a commodity on the stock market.

Cryptocurrencies are ordinarily used outside of existing banking and governmental institutions and exchanged over the Internet. They have often been seen by the establishment as a “rogue currency”, and as a potential threat to the monetary order. Because of the pseudoanonymity afforded by “virtual assets”, cryptocurrency is also sometimes used in controversial settings such as online darknet markets, like Silk Road, accessible by Tor, (free software for enabling anonymous communication, it conceals a user’s location and usage) which further minimises the risk of detection by law enforcement agencies. (See: Silk Road and Bitcoin.)

People in Russia and China have been bypassing very strict surveillance laws by using bitcoin-like cryptocurrencies in order to communicate securely. Cryptocurrencies, starting with bitcoin, have emerged and been increasingly utilised almost in parallel with revelations from National Security Agency (NSA) whistle-blower Edward Snowden about mass government surveillance. 

As the sheer extent of government spying still continues to emerge, encrypted communication services become important and have surged in popularity. Tech companies, including Facebook, Google and Apple, have capitalised on this by adding encryption to their services. However revelations that these same companies seem complicit in the NSA’s surveillance operations have led to some reservations from users. Now it seems the UK government wants to utilise cryptocurrency, inverting the political freedom it allowed by turning it into a tool of state control. 

Government proposals: virtual food vouchers and automated nudge

Earlier this year, the government set out proposals in a report regarding how Blockchain Technologies’ distributed ledger technology which provides “efficient and transparent” digital records of cryptocurrency transactions, could be used for public services. In their report called Distributed Ledger Technology: Beyond block chain, the government’s scientific advisor says:

“Distributed ledger technology (DLTs) offer significant challenges to established orthodoxy and assumptions of best practice, far beyond the recording of transactions and ledgers. These potentially revolutionary organisational structures and practices should be experimentally trialed — perhaps in the form of technical and non-technical demonstrator projects — so that practical, legal and policy implications can be explored.”

“Areas where we believe work could be taken forward include the protection of national infrastructure, reducing market friction for SMEs [Small and medium-sized enterprises] and the distribution of funds from Department for Work and Pensions and other government departments.” [Boldings mine.]

To recap, a distributed ledger is a database that can record financial, physical or electronic assets for sharing across a network through what is claimed to be entirely transparent updates of information.

Its first incarnation was Blockchain in 2008, which underpinned digital cash systems such as Bitcoin. The technology has now evolved into a variety of models that may be applied to different business problems.

Speaking at Payments Innovation Conference earlier this month, Lord Freud, one of the main architects of the welfare “reforms” said:

“Claimants are using an app on their phones through which they are receiving and spending their benefit payments. With their consent, their transactions are being recorded on a distributed ledger to support their financial management.”

The Department for Work and Pensions (DWP) has been working with Barclays, Npower, University College London and a UK-based distributed ledger platform startup called GovCoin to create an app which tracks people’s benefit spending

The ongoing trial which, is designed to demonstrate “the practical applications of the technology,” began in June. It’s another Conservative experiment on people claiming social security.

Jeremy Wilson, the vice chairman of corporate banking at Barclays, said: “This initiative focuses on adding an additional layer of richer data and identity onto payments, so that a deeper and more effective relationship can be established between the government and claimants.”

I wonder exactly what that “effective relationship” will entail? I bet it’s not one based on mutual respect and democratic dialogue. I also wonder if the Department for Work and Pensions will be issuing people who have no income with Smart phones. 

How will the collected information on spending be used? Are we going to see people claiming social security being named and shamed for buying Mars bars, a bottle of wine or a book? Or birthday and Christmas presents for their children? Will the state be sanctioning people that make purchases which the government deems “unnecessary”? 

He added: “We are keen to see how the positive potential of this service develops and adds to our wider efforts to explore the uses of distributed ledger technology.”

Distributed ledger technology was identified as a way of potentially “saving billions of pounds a year from welfare fraud and overpayment errors.”

Oh, that whoppingly over-inflated 0.7% of claimants again. Just imagine how many trillions we would save if we used technology to get a grip of tax avoidance. 

The technology is hoped to provide a cheap and easy way of getting welfare claimants without bank accounts into the system as well as verifying their identities, and would also provide a “transparent account of how public money was spent, transform the delivery of public services and boost productivity,” the government’s chief science adviser, Sir Mark Walport, said in a report last January. Those same words are used every time vulture capitalists are circling a public service, on the hunt for easy profits.

Walport said: “Distributed ledger technology has the potential to transform the delivery of public and private services.”  More words from the vulture capitalist crib sheet of glittering generalities.

“It has the potential to redefine the relationship between government and the citizen in terms of data sharing, transparency and trust and make a leading contribution to the government’s digital transformation plan.”

The government distributes £3.8bn in payments every day. However, there are some serious concerns over how protection of data and privacy with the technology will be “managed.”

The Open Data Institute (ODI)welcomed the findings on the whole. However, it warned that the government must be wary of the challenges involved in blockchain technology and apply it in an effective way. They say: “We agree that blockchains could be used to build confidence in government services, through public auditability, and could also be used for widely distributed data collection and publishing, such as supply chain information. Smart contracts also hold great potential; what if your train tickets were smart contracts that meant you paid less for delayed trains?” 

Smart cards and smart contracts, the more things change, the more the Tories stay the same.

Further comment from the ODI: “However, in our research we have seen cases where people are trying to bolt old, failed or impossible policy and business ideas onto the new technology or to unnecessarily reinvent things that work perfectly well.”

The institute also warned of the privacy issues raised by incorporating private data and suggested the government better develop and solve these challenges by focusing on industry specific groups such as the finance or healthcare sectors.

Some thoughts

Conservatives claim to endorse personal responsibility, limited government, free markets, individual liberty, and deregulation, amongst other things. They believe the role of government should be to provide people the freedom necessary to pursue their own goals. Conservatives claim their policies generally emphasise “empowerment of the individual to solve problems”. So how does any of this tally with harsh welfare cuts, public service cuts, restrictions on the right to by certain goods, the removal of access to legal aid, limiting housing options for the poorest, bedroom tax, numerous human rights contraventions, psychocompulsion through increasingly stringent welfare “conditionality” and  the draconian sanction regime, for example?

Limiting “consumer choice” and spending flies in the face of the Tories’ own free market dogma. Furthermore, as it stands legally, the government cannot currently stipulate how people claiming benefits spend their money.

The Tory definition of “troubled family” conflates poverty, ill health, unemployment and criminality. Iain Duncan Smith claims to be targeting substance abusers (“drug addicts” and “alcoholics”) but it’s clear that the government’s definition means he’s referring largely to the poor and disabled people. His proposal to deal with people who don’t buy their children food because they’re “drug addicted” would actually target people who don’t buy food because they can’t afford it.

Once again we see the disciplinarian and psychocratic Tories stigmatising the poorest people for the conditions that Tory policies have caused. If such “troubled families” existed (and the Joseph Rowntree foundation research has put paid to the myth of families with three generations unemployed ), it would not be reasonable to treat their situations as an issue of personal spending choices rather than a consequence of how our economy is run.

The Tories have, over the past five years, parodied a political process that is supposed to be about engaging the public’s rational, conscious minds, as well as facilitating their needs within society. The UK is not an inclusive democracy. Instead we see the employment of a behaviourist brand of psychocomplulsion, and the media are complicit in propping up an increasingly incoherent, irrational and profoundly prejudiced ideology which informs class-contingent, anti-social and deeply damaging neoliberal policies.

I’ve pointed out previously that government policies are expressed political intentions regarding how our society is organised and governed. They have calculated social and economic aims and consequences.

In democratic societies, citizen’s accounts of the impacts of policies ought to matter. “Accountability to the taxpayer” is being used more and more by the state as a justification to exclude those needing financial support from democratic society. Yet those people claiming benefits are not the same people year by year. The “economic free-rider” myth assumes that people claiming welfare do so continuously, yet we know that most move in and out of work, being forced to undertake insecure, poorly paid work regularly. It’s hardly fair to punish people for the detrimental conditions of the wider labor market.

In the UK, the way that policies are justified is being increasingly detached from their aims and consequences, partly because democratic processes and basic human rights are being disassembled or side-stepped, and partly because the government employs the widespread use of linguistic strategies and techniques of persuasion to intentionally divert us from their aims and the consequences of their ideologically (rather than rationally) driven policies. Furthermore, policies have become increasingly detached from public interests and needs. Instead, policy is about directing us in how to be. We are being coerced into behaving only in ways that accommodate and prop up neoliberalism.

Neoliberalism is a system of economic arrangements that greatly benefits a few powerful and wealthy people and impoverishes the majority of the public incrementally. As each social group reaches a crisis – struggling to survive – scapegoating narratives are constructed and disseminated via the media that blame them for their insolvency, creating socially divisive and politically managed categories of “others,” which serve to de-empathise the rest of the population and divert them from the fundamental fact that it isn’t the poor that create poverty: it is the neoliberal decision-makers and those who are steadily removing and privatising our public funds and ebulliently shrinking state responsibility towards citizens, leaving many at the mercy of “market forces” without a state safety net – it’s economic Darwinism.

“Workers of the World unite. You have nothing to lose but their blockchains.” Hubert Huzzah

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“Behaviour change is one of the primary functions of government communications – helping change and save lives, helping the government run more effectively as well as save taxpayer’s money.

Our approach is to use a mix of awareness raising, persuasion, practical help and behavioural theory, to demonstrate why changes in behaviour are important and to make these changes easy for the public to adopt”.

The Government Communication Service guide to communications and behaviour change

gcs-guide-to-communications-and-behaviour-change1

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