A review of ‘Cash not Care: the planned demolition of the UK welfare state’, by Mo Stewart
‘I want my country back!’ wailed Brexiters across the land during last year’s Referendum. But reading this book you realise that ‘your country’ – England, Britain and all parts thereof – was lost years ago and the capital of Belgium had nothing to do with the theft. Stewart painstakingly shows how hundreds of thousands of sick and disabled people have been prodded like cattle through a system deliberately designed to override the opinions of doctors and medical diagnosis, and leave them destitute. Currently, more than 2/3rds of people who appeal against a decision of this system to rule them ‘fit for work’ are successful. The Work Capability Assessment, to give its proper name, betrays (in the words of one commentator) “a failure of compassion, unacknowledged incompetence and injustice on a massive scale”. And yet, far from acknowledging this tragedy the government wants to intensify it. No wonder one of the chapters of Stewart’s book is entitled, The Shame of Britain.
However, it is not this knowledge that imparts the strong sensation you are living in a foreign country. That unnerving sense creeps up on you through the realisation that the Work Capability Assessment is a replica of the non-medical assessment model of an American insurance corporation branded an ‘outlaw company’ for the way it has systematically denied ‘meritorious’ pay outs to sick and disabled claimants. It was to Unum, labelled the second worst insurance company in America, and accused of running ‘disability denial factories’, that successive British governments turned in their desire to ‘reform’ the welfare state. You can read the whole shameful saga here.
But rather than summarise the story, I want to reflect on four things it says about the parlous state of this country in 2017:
1 We have a media problem
Stewart’s book is peppered with mounting anger that the story she is telling is unknown to the vast majority of the British people. “The entire national press, collectively,” she writes, “refused to expose to the British people the confirmed involvement of Unum (Provident) Insurance with the UK welfare reforms claims management since 1994.” There were isolated exceptions – Private Eye – for example. But almost exclusively it was left to minority publications, such as the Disability News Service, to tell the story. But, with the best will in the world, they have a limited market so “the vast majority of the abled bodied British people …. remained in total ignorance.” Academic research which lifted the lid of what was happening was only read by other academics or activists.
In short the steady undermining of Britain’s welfare state has been able to go on unimpeded because the media failed in its basic duty to inform the public of what was happening. It has been found that, among the public, estimates of incidence of benefit fraud range from 10 to 70% when, in reality, fraud stands at 0.3%. (I know that what the public means by fraud probably involves not really being ill as opposed to official definitions of fraud which involve outright deception but the gap is still enormous). On this and on other issues, media-formed perceptions are wildly inaccurate.
“We lack knowledge of the world beyond our direct experience … vast swathes of state-corporate activity are unreported,” Dan Hind wrote in The Return of the Public. The alternative media, though it has undoubtedly grown in recent years, cannot reach enough people to burst the bubble of the perceptions set by the mass media. The problem is exacerbated by the fact that public service media, such as the BBC, increasingly echo government priorities and see their role as reporting what ‘mainstream’ political currents, all claiming to represent the centre ground, agree to disagree about. The problem is the ‘centre-ground’ is a home for extremist political thinking and all three main political parties in this country have been utterly complicit in what has gone on. The perfect cover.
There is a justified air of fatalism about Stewart’s book – stemming from an awareness that, despite the moral imperative of its writing, it will likely not break through media fantasies. The same is true of any number of other urgent, seemingly hopeless situations – the nature of the environmental crisis, the likelihood of renewed financial breakdown – for example. Given the character of our media set-up, things will almost certainly get worse.
Improvement, by contrast, depends on changing the way reality ‘out there’, reality beyond day to day experience, is described. The existing media, not just tabloid newspapers, but also the BBC and liberal broadsheets, have a structural problem, and aren’t just guilty of moral failings. Dan Hind’s idea is for the public to decide, through a fund diverted from the BBC licence fee, what issues they want to see investigated. Thousands of journalists would be employed on researching subjects which the media would have a duty to report. The truth of what has happened to the British social security system could be one of those subjects. This may sound weak in the face of the problem but we have to accept – as Stewart’s research demonstrates – that the problem exists and that preaching ever more loudly to the converted is not going to dent it.
2 Our political parties have been thoroughly corporatized
“Sadly, these are policies that tarnish all three major political parties,” says academic Peter Beresford in the introduction to Stewart’s book. You couldn’t get the proverbial Rizla paper between New Labour and the Tories on welfare ‘reform’. Way back in 1994 Unum were first appointed official government advisers by Conservative social security minister, Peter Lilley. When New Labour was elected, the desire for ‘active welfare’ intensified. Unum and Atos were both included in technical working groups that ironed out the details of the non-medical assessments that would determine who was eligible for disability benefits. “Approved doctors were trained in Unum’s approach to claims management”. A stringent ‘all work test’ was introduced, followed by Personal Capacity Assessment, described by the OECD as “one of the toughest in the world” – but evidently not tough enough. The 2008 Work Capability Assessment, defiantly focused on what ill people can do (such as raising their hands above their head in a tell-tale sign of work readiness), despite what ill-informed doctors might protest, was the culmination of this process.
When the Coalition entered government two years later, it made the WCA tougher still and carried through on applying it to existing Incapacity Benefit claimants – with the unwavering support of Labour, now in opposition. The Conservatives now back “making workers pay into flexible savings accounts to fund their own sick pay” and enlarging the number of workers covered by employer ‘Group Income Protection’.
By coincidence, Unum has for years attempted to hawk both its individual and employer insurance products on the grounds that state benefits are becoming harder and harder to get.
But clearly welfare and disability is not the only area where corporations exert a decisive impact on UK government policies. As the 2009 Alternative Report on UK Banking Reform noted, the City of London ‘has co-opted the leadership of both main political parties’. Not only did this monopolisation of views determine the climate of deregulation before the financial crisis, it also ensured that post-crisis nothing would be done to inhibit the ‘competitiveness’ of the UK as a financial centre.
Government policy has become thoroughly corporatized across the board. Corporate taxation heads inexorably downwards, subsidies go up and it is deemed as simply natural that public services are privatised or contracted out. Challengers to this state of affairs are branded left-wing populists but, in reality, they present isolated cases of politicians who haven’t been recuperated by this system and espouse policies that would have been considered quite tame and mainstream a few decades ago. They are not examples of dogmatic socialism against capitalist wisdom but pluralism in the face of a narrow corporate logic.
3 Chronically ill people are treated in a way that would shock us if it were meted out to the acutely ill
Britain can still muster outrage over the mistreatment of acutely ill people – those left on trolleys in hospital corridors or suffering prolonged abuse of care. But when it comes to mistreatment of the chronically ill – those affected by strokes, cancer, heart disease or ME for example – such empathy miraculously vanishes. At the root of the conscious cruelty inflicted by the WCA lies a stubborn conviction that these people aren’t really ill. According to the biopsychosocial model, the claims management ‘philosophy’ beloved of Unum and the Department for Work and Pensions, illness is a belief. With the right attitude (and convenient withdrawal of financial support) the temporarily ill can overcome their impairments. Just as, under neoliberalism, the unemployed, are responsible for their unemployment, so the sick are now responsible for their sickness. But this, frankly, is unscientific baloney – illness is real, whether acute or chronic.
And the idea that the UK is suffering from some kind of epidemic of psychosomatic illness just won’t wash. The amount spent by the UK on disability benefits is half what it was at its peak in the mid-90s and the benefits population is ‘static if not falling’.
In truth, what lies behind the mammoth injustice of the WCA is a refusal to accept the consequences of class. People in poorer areas die sooner and spend more of their lives contending with a disability than those in wealthier areas. In fact, the gap in disability-free life expectancy between low and high income groups is 13 years. The book, The Spirit Level, reports a study of civil servants which found that low job status was related to ‘some cancers, chronic lung disease, gastrointestinal disease, depression, suicide, sickness absence from work, back pain and self-reported health’. The authors conclude that ‘there is a sickness gradient in health running right across society … those above us have better health, those below us have worse health, from the very bottom to the very top.’ If you want to change those outcomes, you have to change society, not tell those at the bottom, living with very real illnesses, to get their act together.
4 You might think the Work Capability Assessment is monstrously unjust but those behind it fervently believe they are fighting for social justice
I think we have to accept that, though the WCA is based on disbelieving people with actual diagnosed illnesses, Iain Duncan Smith’s tears are real. He genuinely believes he has helped the ‘disadvantaged’ by declaring the ill ‘fit for work’ and removing all financial support from the unemployed for a maximum of three years. This, as fellow partner in crime Chris Grayling once put it, is ‘tough love’. And insufferable moral worthiness is not limited to the Conservatives. Labour’s Yvette Cooper, who as DWP minister in the last Labour administration actually introduced the WCA, chided the incoming Coalition in June 2010 not to abolish the medical assessments in their zeal to cut spending across the board. To do so would be ‘deeply unfair’, she said. Yes, really.
This impenetrable sense of do-goodery stems, in my opinion, from a conviction that work is fantastically good for you. Getting more and more people into work, despite the fact that they might be seriously ill, thus becomes a matter of social justice. But when Iain Duncan Smith, or Yvette Cooper think of work, they always imagine the self-actualising, well paid kind – the kind, in fact, that they do. But low-paid, temporary, exploitative work – the kind that people who go through the WCA are forced into – is not always good for you. In fact it can be very bad for you, as the fact that in our work-saturated society the most common reason to apply for Employment and Support Allowance is having a mental health problem, attests.
Work is not good for your health, illness is real. Apart these minor tweaks government policy towards the sick and disabled in this country makes perfect sense.
If you want to understand how politics in this country works for minorities who are never going to constitute an electorally important group, read this book. You’ll never be quite the same again.