Author: Kitty S Jones

I’m a political activist with a strong interest in human rights. I’m also a strongly principled socialist. Much of my campaign work is in support of people with disability. I am also disabled: I have an autoimmune illness called lupus, with a sometimes life-threatening complication – a bleeding disorder called thrombocytopenia. Sometimes I long to go back to being the person I was before 2010. The Coalition claimed that the last government left a “mess”, but I remember being very well-sheltered from the consequences of the global banking crisis by the last government – enough to flourish and be myself. Now many of us are finding that our potential as human beings is being damaged and stifled because we are essentially focused on a struggle to survive, at a time of austerity cuts and welfare “reforms”. Maslow was right about basic needs and motivation: it’s impossible to achieve and fulfil our potential if we cannot meet our most fundamental survival needs adequately. What kind of government inflicts a framework of punishment via its policies on disadvantaged citizens? This is a government that tells us with a straight face that taking income from poor people will "incentivise" and "help" them into work. I have yet to hear of a case when a poor person was relieved of their poverty by being made even more poor. The Tories like hierarchical ranking in terms status and human worth. They like to decide who is “deserving” and “undeserving” of political consideration and inclusion. They like to impose an artificial framework of previously debunked Social Darwinism: a Tory rhetoric of division, where some people matter more than others. How do we, as conscientious campaigners, help the wider public see that there are no divisions based on some moral measurement, or character-type: there are simply people struggling and suffering in poverty, who are being dehumanised by a callous, vindictive Tory government that believes, and always has, that the only token of our human worth is wealth? Governments and all parties on the right have a terrible tradition of scapegoating those least able to fight back, blaming the powerless for all of the shortcomings of right-wing policies. The media have been complicit in this process, making “others” responsible for the consequences of Tory-led policies, yet these cruelly dehumanised social groups are the targeted casualties of those policies. I set up, and administrate support groups for ill and disabled people, those going through the disability benefits process, and provide support for many people being adversely affected by the terrible, cruel and distressing consequences of the Governments’ draconian “reforms”. In such bleak times, we tend to find that the only thing we really have of value is each other. It’s always worth remembering that none of us are alone. I don’t write because I enjoy it: most of the topics I post are depressing to research, and there’s an element of constantly having to face and reflect the relentless worst of current socio-political events. Nor do I get paid for articles and I’m not remotely famous. I’m an ordinary, struggling disabled person. But I am accurate, insightful and reflective, I can research and I can analyse. I write because I feel I must. To reflect what is happening, and to try and raise public awareness of the impact of Tory policies, especially on the most vulnerable and poorest citizens. Because we need this to change. All of us, regardless of whether or not you are currently affected by cuts, because the persecution and harm currently being inflicted on others taints us all as a society. I feel that the mainstream media has become increasingly unreliable over the past five years, reflecting a triumph for the dominant narrative of ultra social conservatism and neoliberalism. We certainly need to challenge this and re-frame the presented debates, too. The media tend to set the agenda and establish priorities, which often divert us from much more pressing social issues. Independent bloggers have a role as witnesses; recording events and experiences, gathering evidence, insights and truths that are accessible to as many people and organisations as possible. We have an undemocratic media and a government that reflect the interests of a minority – the wealthy and powerful 1%. We must constantly challenge that. Authoritarian Governments arise and flourish when a population disengages from political processes, and becomes passive, conformist and alienated from fundamental decision-making. I’m not a writer that aims for being popular or one that seeks agreement from an audience. But I do hope that my work finds resonance with people reading it. I’ve been labelled “controversial” on more than one occasion, and a “scaremonger.” But regardless of agreement, if any of my work inspires critical thinking, and invites reasoned debate, well, that’s good enough for me. “To remain silent and indifferent is the greatest sin of all” – Elie Wiesel I write to raise awareness, share information and to inspire and promote positive change where I can. I’ve never been able to be indifferent. We need to unite in the face of a government that is purposefully sowing seeds of division. Every human life has equal worth. We all deserve dignity and democratic inclusion. If we want to see positive social change, we also have to be the change we want to see. That means treating each other with equal respect and moving out of the Tory framework of ranks, counts and social taxonomy. We have to rebuild solidarity in the face of deliberate political attempts to undermine it. Divide and rule was always a Tory strategy. We need to fight back. This is an authoritarian government that is hell-bent on destroying all of the gains of our post-war settlement: dismantling the institutions, public services, civil rights and eroding the democratic norms that made the UK a developed, civilised and civilising country. Like many others, I do what I can, when I can, and in my own way. This blog is one way of reaching people. Please help me to reach more by sharing posts. Thanks. Kitty, 2012

Boris Johnson lies to prime minister in resignation letter

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Boris Johnson wrote a two-page resignation letter to Theresa May
Boris Johnson’s resignation letter

“If a country cannot pass a law to save the lives of female cyclists — when that proposal is supported at every level of UK Government — then I don’t see how that country can truly be called independent.”

That’s what Boris Johnson wrote yesterday in his resignation letter. But a Channel 4 factcheck showed that it’s just another occasion of Boris being conservative with the truth.

This parting missive on the issue of Brexit — which he was apparently still writing when Number 10 confirmed his departure — spends a lot of time waffling on vehicle regulation.

The former Foreign Secretary wrote: “we seem to have gone backwards since the last Chequers meeting in February, when I described my frustrations, as Mayor of London, in trying to protect cyclists from juggernauts. 

“We had wanted to lower the cabin windows to improve visibility; and even though such designs were already on the market, and even though there had been a horrific spate of deaths, mainly of female cyclists, we were told we had to wait for the EU to legislate on the matter.” 

His concluding thought on the issue: “If a country cannot pass a law to save the lives of female cyclists — when that proposal is supported at every level of UK Government — then I don’t see how that country can truly be called independent.” 

It wasn’t “supported at every level of UK Government” at all. 

Boris spectacularly neglects to mention that the regulations he’s talking about were in fact put forward by the European Parliament, and backed by 570 MEPs, with 88 voting against. He also fails to acknowledge that those laws have actually been passed.

More crucially, Johnson is telling tall stories with he claims that the laws in question were “supported at every level of UK Government.”

When the regulations were put forward by the EU, the UK government explicitly did not support the proposals.

A government spokesperson told BBC News in 2014: “Where we are not supporting European Parliament proposals, it is simply because they will not produce practical changes in cab design and could lead to additional bureaucracy for Britain.” 

The European Council, which includes representation from the UK government, later adopted the directive.

It’s inconceivable that Johnson didn’t know that the European Parliament had proposed the laws, he also knew that the UK government opposed them — because he explicitly called out ministers on the issue at the time. 

In January 2014, Johnson said: “If these amendments, supported by dozens of cities across Europe, can succeed, we can save literally hundreds of lives across the EU in years to come. I am deeply concerned at the position of the British Government and urge them to embrace this vital issue.” 

Perhaps in his hasty drafting, Johnson has dismembered misremembered the exact chain of events, confused among the dying reverberations of all the other Euromyths he told.

Johnson’s old boss, Max Hastings, once said: “It is a common mistake to suppose Johnson a nice man. He is a man of remarkable gifts, flawed by an absence of conscience, principle or scruple.”

Yes. What a cuddly, tousled, eccentric, deceitful, narcissistic, bigoted lying thug.

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Related

Boris Johnson Has Ruined Britain – The New York Times

‘Au revoir, blundering Boris’: Europe reacts to political chaos in UK – The Guardian

The past really is another country. Let’s leave Boris Johnson there – The Guardian

“The government is well rid of a foreign secretary whose grotesque colonial fantasies were an affront to the world.

“Boris Johnson was only given a pass on his grotesque racism because of the snivelling class deference of UK political media.”

Birds of a feather…

 

I don’t make any money from my work. My articles are free. If you like, you can make a donation to help me continue to research and write free, informative, insightful and independent articles, and to provide support to others. The smallest amount is much appreciated – thank you.

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Cash for Care: nudging doctors to ration healthcare provision

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Image result for NHS rationing treatment

Today, while everyone is being distracted by the continuing resignations from Theresa May’s disintegrating government, the Conservatives are openly talking among themselves (again) about charging for NHS services. So much for the government’s continued reassurances and promises about UK healthcare continuing to remain ‘free at the point of access.’  

The NHS has never been safe in  Conservatives hands.

Last week I wrote an article about the stealthy creep of rationing of treatments in the NHS, and how gatekeeping has become a watchword within our public services over the past seven years. It’s being driven by the government’s deep affection for neoliberal dogma, the drive for never-ending ‘efficiency savings’ and the Conservatives’ lean, mean austerity machine. Perish the thought that the public may actually need to use the public services that they have funded through their contributions to the Treasury, in good faith. 

One important point I didn’t raise in the article was about how the marketisation of the NHS has given rise to ‘perverse incentives’, which violate the very principles on which the national health service was founded. Neoliberal policies have shifted priorities to developing profitable ‘care markets’ making ‘efficiency’ savings and containing costs, rather than delivering universal health care.

Another shift in emphasis is the “behavioural turn”. It’s politically convenient to claim that people’s behaviours are a major determinant of their health. Some illnesses are undoubtedly related to lifestyle – type two diabetes, for example. But it is difficult to blame individual’s behaviours for type one diabetes, which is an autoimmune disease, and these may happen to people who lead very healthy lifestyles, as well as those who don’t. This ‘behavioural turn’ shifts emphasis from the impact of structural conditions – such as rising inequality and poverty – on public health. It also provides a political justification narrative for cuts to healthcare and welfare provision. (See also The NHS is to hire 300 employment coaches to find patients jobs to “keep them out of hospital”. )

Behavioural economists have claimed that ‘nudge’ presents an effective way to ‘change behaviours’ within the NHS and ‘improve outcomes’ at lower cost than traditional policy tools. Back in 2015, the Nudge Unit were looking for “many potentially fruitful areas in which to use behavioural insight to improve health and health-service efficiency, either by retrofitting existing processes or by designing completely new services most effectively.” ‘Fruitful’ as in lucrative for the part-privatised company, but not so lucrative for the NHS.

Behavioural economists are working for the government and public sector to “harness [public] behaviours to shift and reduce patterns of demand in many public services.” The problem is that human needs arising from illness are not quite the same thing as human behaviours and roles, yet the government are increasingly conflating the two. (See discussion on Talcott Parsons and the ‘sick role’ in this article, for example, along with that on ‘work is a health outcome’.)

Public services are associated with fundamental human rights, which in turn are based on notions of fundamental human need. Addressing basic human needs is fundamental to survival.

As Abraham Maslow concluded, motivation for behaviours is is closely related to fulfilling our basic needs, because if they are not met, then people will simply strive to make up the deficit as a priority. This undermines aspiration and human potential. Fulfilment of psychosocial needs will become a motive for behaviour only as long as basic physiological needs ‘below’ it have been satisfied. Health is a fundamental human need. To paraphrase Maslow, we don’t live by bread alone, unless there is no bread.

Public services are an essential part of developed democracies, they ensure all citizens can meet their basic needs, and therefore, the provision promotes wider social and economic wellbeing and progress.

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Maslow’s hierarchy of human needs

The Nudge Unit had already run a trial in Nottingham, which provided feedback to doctors of the cost of a commonly used discretionary lab test. This prompt retained clinical freedom, and did not ask doctors to order fewer tests – but the number of
tests fell by a third.

anttibiotic resistance

In 2016 the UK government set a target to half ‘inappropriate’ antibiotic prescribing by 2020. The Nudge Unit set out to “improve prescribing in line with government ambitions”. 

Behavioural economists from the Unit claimed that by informing doctors that they are prescribing more antibiotics relative to 80 per cent of their peers, they are reducing the number of ‘unnecessary’ prescriptions by 3.3 per cent (more than 73,000 prescriptions) – helping to address what the Chief Medical Officer has identified as perhaps the greatest medical threat of our age – antibiotic resistance. 

Between 2014 and 2015, the Behavioural Insights Team sent letters to 800 GP practices, telling them that other practices were recommending the use of antibiotics in fewer cases. (There is no evidence presented to determine if this was actually true, and judging by the template letter, it’s highly unlikely that it was true.)

The nudge method employed is called ‘social norming’, which operate as a kind of community enforcement, as norms are unwritten rules that define ‘appropriate’ behaviours for social groups. We tend to conform to the expectations of others. Changing perceptions of norms alters people’s expectations and behaviour.

Understanding norms provides a key to understanding social influence in general and conformity in particular. The Conservatives have traditionally placed a significant emphasis on social conformity.

There are ‘hotspots’ where more antibiotics are prescribed. However, the fact that these places tend to be some of the most deprived areas of the country strongly hints that there are underlying socioeconomic factors at play that cannot be solved with a nudge or prod. Research indicates that community socioeconomic variables may play a significant role in sepsis-attributable mortality, for example.

Social problems such as poverty and inequalities in health arise because of unequal distributions of wealth and power, therefore these problems require solutions involving  addressing socioeconomic inequality. As it is, the government is unprepared to spend public funds on public services to redistribute resources. 

The behavioural study did not include any consideration of socioeconomic variables on rates or severity of infection, or types of infection. 

The idea that ‘changing the prescribing habits in hospitals’ and GP surgeries will impact on antibiotic resistance is based on an assumption that doctors over prescribe antibiotics in the first place. There is no evidence that this is the case, and it’s very worrying that anyone would think that targeting doctors with behaviourally-based remedies will address antibiotic resistance and assure us, at the same time, that antibiotics are actually prescribed when appropriate, and tailored, ensuring the safety and wellbeing of the patient, rather than being prescribed according to arbitrary percentage norms distributed by behavioural economists.

The trials did not include sufficient data regarding clinical detail or diagnostic uncertainty that might justify antibiotic prescribing in individual cases.

One of the nudge unit team’s key aims is to design policies which reduce costs. They say: “The solution to the problem of AMR is not just to produce new and better drugs – that takes time, and a great deal of money. We must also reduce our use of antibiotics when they are not needed. Sadly, it seems that they are used unnecessarily twenty percent of the time in the UK”.

The various Nudge Unit reports on behavioural strategies that target doctors don’t mention any follow-up research to ensure that the reduction in antibiotic prescriptions did not correlate with an increase in the severity of infections or poor outcomes for patients. In fact one report highlighted that those who were admitted to hospital because their condition deteriorated were excluded from the trial, as they no longer met the inclusion criteria. That effectively means that any adverse consequences for patients who were not given antibiotic treatment was not reported. And that matters.

The authors say “We as the authors debated at length as to whether we should emphasise the fact that 80% of the prescriptions are being used in necessary cases.” 

There is no indication of how ‘necessary cases’ are determined, and more to the point, who determines what is a ‘necessary case’ for antibiotic treatment. Furthermore, the report uses some troubling language, for example, doctors prescribing antibiotics ‘above average’ were referred to more than once as the “worst offenders.” However, as I’ve already touched on, patients needs may well vary depending on a range of variables, such as the socioeconomic conditions of their community, and of course, complex individual comorbidities, which may not be mentioned in full when doctors write up the account for the prescription.

Sepsis, which may arise from any kind of infection is notoriously difficult to diagnose. It is insidious and can advance very rapidly.  It’s even more difficult to determine when a patient has other conditions. For example, sepsis can arise when someone has flu. That happened to me, when I had developed pneumonia without realising that I had. It’s standard practice for paramedics to administer a broad spectrum antibiotic and intravenous fluids to treat suspected sepsis and septic shock. This can often save lives. Sepsis kills and disables millions and requires early suspicion and antibiotic treatment for survival.

Once the causative agent for the infection is found, the IV antibiotics may then be tailored to treat it. The wait without any treatment until a firm diagnosis is potentially life-threatening. But the biochemical tests, such as CRP, and X-rays take time. 

Treatment guidelines call for the administration of broad-spectrum antibiotics within the first hour following suspicion of septic shock. Prompt antimicrobial therapy is important, as risk of dying increases by approximately 10% for every hour of delay in receiving antibiotics. This time constraint does not allow the culture, identification, and testing for antibiotic sensitivity of the specific microorganism responsible for the infection. Therefore, combination antimicrobial therapy, which covers a wide range of potential causative organisms, is tied to better ‘outcomes’. 

In the trial, behavioural economists referred to medical notes, and if there is no diagnosis, the necessity of the prescription is then questioned. Knowledge of complex medical histories may also influence doctors’ decisions, and this may not have been mentioned on medical record. A cough and breathlessness is a common symptom influenza. However, a patient with a condition that compromises their immunity, or someone who needs immune suppressants, for example, is rather more at risk of developing bacterial pneumonia than others, and someone with COPD or asthma is also at increased risk.  

If a person dies because treatment was not given promptly in high suspicion cases of severe infection and sepsis, who is to be held accountable, especially in a political context where treatments are being rationed and prescriptions are being increasingly policed?

It’s also worth bearing in mind that massive doses of antibiotics are added to livestock feed as a preventative measure and to promote growth before the animals are slaughtered and enter the food chain. Using antibiotics during the production of meat has been heavily criticised by physicians and scientists, as well as animal activists. The pharmaceutical industry is making billions annually from antibiotics fed to livestock, which highlights the perverse incentives of the profit motive and potentially catastrophic impact on humans. It is estimated that between 70 – 80 percent of the total of antibiotics used around the world are used within the animal farming and food industry. No-one is nudging the culprits. 

The potential threat to human health resulting from inappropriate, profit seeking antibiotic use in food animals is significant, as pathogenic-resistant organisms propagated in these livestock are poised to enter the food supply and could be widely disseminated in food products.

Antibiotics used on farms can spill over into the surrounding environment, for instance through water run-off and slurry, according to a report from the UN’s environment body, last year, with the potential to create resistance to the drugs across a wide area.

In 2013, researchers showed that people who simply lived near pig farms or crop fields fertilized with pig manure are 30% more likely to become infected with methicillin-resistant Staphylococcus aureus bacteria.

Cash for care – rationing referrals to hospital consultants and diagnostic testing

It was announced in April this year that General Practitioners (GPs) across England will be able to “better manage” hospital referrals with a “digital traffic light system” developed by the Downing Street policy wonks. This nudge is designed to target the ‘referral behaviours’ of GPs.

GPs are being offered cash payments as an ‘incentive’ to not refer patients to hospitals – including cancer patients – according to an investigation by Pulse, a website for GPs. 

Furthermore, a leaked letter sent by NHS to England to Clinical Commissioning Groups (CCGs) and seen by Pulse magazine last year, asks that all family doctors in England to seek approval from a medical panel for all non-urgent hospital referrals.  

A “clinical peer review of all referrals from general practice by September 2017”, will be required, the letter said. 

To ‘incentivise’ the scheme, the letter said that there will be “significant additional funding” for commissioners that establish peer-led policing schemes. It added that it could reduce hospital referral rates by up to by 30 per cent. NHS England said that they want to introduce the “peer review scheme” whereby GPs check the referrals of one another to ensure they are ‘appropriate’. However, experts warn this increasingly Kafkaesque layer of bureaucracy could lead to more problems and possible conflict with patients’ safety and standard of care. 

In a trial of the nudge scheme, four NHS clinical commissioning groups (CCGs) have been using “profit share” initiatives to ration care, to help them ‘operate within their budgets’. Clinical Commissioning Groups hold the budget for the NHS locally and decide which services are provided for patients. 

Through this scheme, GPs are told they will receive up to half of the money that is saved by fewer patients going to hospitals for tests and treatments.

So to clarify, surgeries are being offered financial ‘incentives’ for not sending patients to hospital to save money, that is then reinvested in part to implement further rationing of healthcare. The move has been widely condemned as a “dereliction of duty” by the community of medical experts and professionals. Referrals to consultants often involve important diagnostic procedures, therefore there is often no way of knowing for sure in advance of the referral whether or not it is “warranted”.

The NHS has had ‘referral management centres’ in place for many years.  However, last year they were at the epicentre of a scandal when it was revealed that the use of these centres has increased 10-fold over recent years. Furthermore, the centres are privately run and extremely expensive to employ, diverting funds that could simply be spent on patient care.

Moreover, those who were reviewing the referrals were also found to have varying levels of clinical knowledge, and so were not always able to correctly identify which referrals were ‘necessary’. They were also extremely inefficient as patients were forced to wait a long time for appointments. 

The Pulse investigation into referral incentive schemes being run by NHS clinical commissioning groups (CCGs) across England found some regions offering GPs as much as 50 per cent of any savings they can make. The “profit-share” arrangements mean practices stand to benefit financially by not sending patients for treatment or to see a specialist.

Hospitals are paid for operations and other activity, so by sending patients to cheaper services run by GP practices – such as diabetes and pulmonary clinics – or by keeping them out of hospital altogether, practices can increase the size of savings. GPs are not paid per procedure. Rather, they receive a single payment when each patient is registered with them. 

Currently, when doctors are referring patients for appointments with hospital consultants, the nudge – in the form of a “Capacity Alert System” – operates by displaying a red light next to hospitals with lengthy waiting times, and a green light next to those with more availability, on the system. 

The system underwent two trials in north-east and south-west London over the winter. During these pilots the number of referrals made to overburdened hospitals was reduced by 40%, while those made to hospitals with ‘spare capacity’ rose by 14%, according to NHS England. There was no comment made regarding the impacts of the scheme on patients’ health.

GP leaders have also said it is “insulting” to suggest doctors are sending patients to hospital arbitrarily, and raise significant conflicts of interest.

“Cash incentives based on how many referrals GPs make have no place in the NHS, and frankly, it is insulting to suggest otherwise,” said Professor Helen Stokes-Lampard, chair of the Royal College of GPs.

“Of course, it’s important to take measures to ensure that GP referrals are appropriate and high-quality, but payments to reduce referrals would fly in the face of this, and erode the trust our patients have in us to do what is best for them and their health.” 

The NHS has been squeezed for increasingly drastic ‘efficiency savings’ in the past eight years. It’s absurd, however, that a huge amount of money is being spent on restricting access to healthcare, rather than on simply adequately funding healthcare provision.

Dr Peter Swinyard, chair of the Family Doctor Association, said the profit-share schemes were “bizarre”, adding: “From a patient perspective, it means GPs are paid to not look after them.

“It’s a serious dereliction of duty, influenced by CCGs trying to balance their books.”

Meanwhile, NHS Barnsley CCG has identified a £1.4m funding pot to pay its practices if they achieve a reduction in referrals to specialties, including cardiology, pancreatic surgery, and trauma and orthopaedics.

The CCG said the 10 per cent target was “ambitious but achievable”.

Last year it was discovered that the NHS has to spend £1.5 billion in legal costs when patients don’t get what the standard of care expected and pay for from their healthcare providers. In 2015/16, there was a 27% increase in the number of claims and a 72% increase in legal cost, which amounted to £1.5 billion.  With the amount of money that the NHS is spending on legal costs for medical blunders, the NHS could have paid for the training of more than 6,000 doctors. Or eased the rationing of essential healthcare provision.

The purpose of the NHS has been grotesquely distorted: it was never intended to be a bureaucratic gatekeeping exercise that rations healthcare. The purpose of all public services is to provide a public service, not ration provision. Such is the irrationality of the government’s ‘market place’ and ‘profit over human need’ narrative. 

Dr Eric Watts, a consultant haematologist for the NHS, says that the British government couldn’t care less about the fall of the NHS. He said, “This is a triumph of secrecy and implacable lack of care about the NHS by a Government determined to watch it fail then fall.” 

One CCG told Pulse: “Ensuring treatment is based on the best clinical evidence and improving historical variation in access is essential for us locally.

“Financially, it is an effective use of local resources which will improve patient experience and outcomes and increase investment in primary care in line with the Five Year Forward View commitments.” Those ‘commitments’ are the increasing implementation of cuts to healthcare provision and funding.

Cuts to care may well improve financial ‘management’ but it cannot be claimed that healthcare rationing “improves health outcomes” for patients. That flies in the face of rationality.

NHS England also said last year that funding will be available for CCGs to start “peer review schemes”, where GPs police each other – checking that their colleagues are referring ‘appropriately’, but it is not clear what it thinks about direct payments linked to cutting referrals.

The “Cash for Cuts” investigation, by GP publication Pulse, asked all 207 CCGs in England about their processes for cutting referrals. Of the 180 who responded, 24 per cent had some kind of incentive scheme aimed at lowering the numbers of referrals. 

This included payments for getting GPs to “peer review” each other’s referrals or other strategies. 

Dr Chaand Nagpaul, from the British Medical Association (BMA) has  also criticised the nudge scheme. He says “It’s a blunt instrument which is not sensitive to the needs of the patient and is delaying patient care. 

“It has become totally mechanistic. It’s either administrative or not necessary for the patient. It’s completely unacceptable. Performance seems to be related to blocking referrals rather than patient care.”

The CCGs have defended the schemes, saying that at the time they were pushed through, the NHS was struggling through the worst winter ever in its history and had not been able to hit target waiting times since 2015. The CCGs have said that the scheme is only to help reducing ‘unnecessary referrals’ and therefore improve outcomes for ‘genuine patients’, and not to reduce numbers overall. Who decides which patients are ‘genuine’, and on what criteria? 

Dr Dean Eggitt, who is the British Medical Association’s GP representative for Barnsley, Doncaster, Rotherham and Sheffield, also disagrees with the scheme. 

“The scheme is unsafe and needs to be reviewed urgently,” he said. 

The BMA’s GP committee have said that it had raised concerns nationally where CCGs have set an “arbitrary target” for reducing referrals. 

Before Christmas, Jeremy Hunt, the Health Secretary, announced that he wanted hospitals to find another £300m in savings on basic items like surgical gloves and bandages, and a long-awaited pay rise for nurses is contingent on staff boosting “productivity”.  

A Department of Health and Social Care spokesperson said: “Patients must never have their access to necessary care restricted  – we would expect local clinical commissioning groups and NHS England to intervene immediately if this were the case.” 

I’ve asked NHS England whether it would be reviewing cases where GPs stand to profit financially for not referring patients, along with others, but I have had no response at time of this publication. 

The NHS was founded on the principle of free and open access to healthcare provision for everyone. The nudge schemes I’ve outlined have introduced ‘perverse incentives’ that prompt GPs to ration health care. I have argued elsewhere on many occasions that nudge and the discipline of behavioural economics more generally is technocratic prop for a failing  political and socioeconomic system of organisation – neoliberalism. Rather than review the failures of increasing privatisation and ‘competition’, the government chose to deny them, applying increasingly irrational ‘solutions’ to the logical gaps in their ‘marketplace’ dogma. 

Yet it is blindingly clear that citizens needs and their human rights are being increasingly sidestepped by the absolute prioritisation of the private profit incentive. 

Nudge isn’t about ‘economics theory and practice adapting to human decision making’, as is widely claimed. It isn’t about remedying ‘cognitive biases’. It isn’t about people making ‘flawed decisions’.

It’s about holding citizens responsible for the problems created by a flawed socioeconomic model. It’s about a limited view of human behaviours and potential, because it frames the poorest citizens in an increasingly unequal society as ‘failed entrepreneurs’. Those members of the public who need to access public services are increasingly being portrayed as an economic ‘burden’. As such, nudge places limitations on and replaces genuine problem-solving approaches to public policy.

Nudge is about authoritarian governments using a technocratic prop to adapt human perceptions, behaviours and expectations, aligning them to accommodate inevitable  catastrophic social outcomes. These outcomes are symptomatic of the failings and lack of rational insights of wealthy and powerful neoliberal ideologues, who are determined to dismantle our public services. Without the consent of the majority of citizens. 

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The NHS was never safe in his hands. The company he keeps has made sure of that.

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I don’t make any money from my work. But if you like, you can support Politics and Insights and contribute by making a donation which will help me continue to research and write informative, insightful and independent articles, and to provide support to others who are vulnerable because of the impacts of government policies. The smallest amount is much appreciated, and helps to keep my articles free and accessible to all – thank you. 

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An introduction to Dominic Raab, the new Brexit sectarian

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Dominic Raab, the hard Brexit Sectarian Secretary  – who has replaced David Davis following his resignation last night – is a hard right libertarian and supports a hard Brexit. He’s been a fiercely loyal pro-Brexit outrider from the backbenches, and made broadcast outings more regularly than some ministers during the general election.

As a staunch neoliberal, he said in 2010 that “positive discrimination is wrong in the same way as negative discrimination. It means people are thinking in terms of social criteria and it is anti-meritocratic.” 

Raab states openly that he doesn’t ‘believe’ in human rights or equality. 

It’s likely that May’s decision to appoint a staunch Brexiteer to the role is an olive branch to ever-restive Leave-supporting MPs who could seize on Davis’ resignation as an opportunity to launch a leadership challenge against her.

Raab was a co-founder of Change Britain, effectively a continuity wing of the Vote Leave campaign. Raab is a former lawyer for Linklaters, advising on EU and trade law and an ex-chief of staff to Davis. Linklaters has also hired Hanbury Strategy to provide the law firm with policy advice ‘in connection with the impact of Brexit on their clients’ businesses’. It also employs former foreign secretary William Hague as chair of its international advisory group. Of course, another of Hanbury Strategies’ clients is AggregateIQ Data Services Ltd.

Raab said last year that Brexit offers the UK’s legal sector “enormous” opportunities and that Britain already had a reputation as being a “global centre for business as being the best place to resolve disputes”. The legal industry employs 300,000 people — two-thirds outside London — and revenue generated by legal activities in the UK is £31.5bn, he said, adding that legal expertise is one of Britain’s unique selling points. Advising business on Brexit is certainly a lucrative role.

Raab was speaking at the Policy Exchange in London at the launch of a report by Linklaters, which explores ways of ‘ improving’ Britain’s ‘competitiveness’ after Brexit by ‘enhancing the rule of law’. The report concluded that Brexit ‘creates an opportunity to reinforce the rule of law in Britain’ and to make laws that are clear and ‘manageable’. It says one danger is that the future pressure on the government and parliament’s time after Brexit could result in “hastily drafted and poorly scrutinised laws that unintentionally subvert the rule of law.”

The Linklaters report concludes that Brexit will not allow Britain to change its laws completely but “it will provide a once in a generation opportunity to make material improvements” and says clearer legislation will help provide businesses “with the certainty and fairness they need to invest, employ and transact in the UK.”

The report says after Brexit it will be the responsibility of the UK parliament to enact laws in areas that are currently within the competency of the EU and this opportunity will require “some innovation” on the part of parliament. It urges that parliamentary processes to scrutinise new laws should be simplified and it also urges that the volume of legislation and regulation should be reduced. 

“It’s kind of ironic that for all the domestic haggling and wrangling on Brexit, we risk forgetting that internationally, Britain is the place people think of as the place they would most like to come to resolve their disputes. That is a unique comparative advantage for us.” 

Raab went on: “As we seek to minimise legal risk please let’s not cower in a corner afraid of our shadow — Britain is better than that,” adding there were opportunities for post-Brexit Britain to build on its reputation as a centre for ‘legal expertise’. He sees the UK as a haven for businesses who want  a more ‘relaxed’ legal system, presumably, than elsewhere.

Despite his support for a full break with the European Union, in Raab’s constituency, Esher and Walton, citizens voted 58.4 percent to 41.6 percent to remain. He doesn’t like worker’s rights (most Tories don’t, they get in the way of exploitation and profiteering). Raab has links to an extended network of individuals and organisations pushing deregulation and climate science denial. In 2012, he wrote a piece for the Taxpayers’ Alliance demanding the government be transparent about the cost of its climate policies. 

Raab has voted against allowing a right to remain for EU nationals already in living in the UK after Brexit. He has also campaigned to change the UK’s Human Rights Act.

He was also a part of the Leave Means Leave campaign, despite his name being removed from the site recently, which was also supported by some of the UK’s most prominent climate science deniers such as former Tory MP and now Lord Peter Lilley, and Democratic Unionist Party (DUP) MP Sammy Wilson. It was also supported by libertarian Tories calling for deregulations which have previously pushed disinformation on climate change including Jacob Rees-Mogg John Redwood, Christopher Chope and Ian Paisley to name a few. The Labour Party and Trade Unions have expressed concerns about his appointment, as Raab has also advocated scaling the minimum wage back.

Rabb is a co-author of the hard-right ‘Britannia Unchained‘ manifesto in 2012, along with Kwasi Kwarteng, Priti Patel, Chris Skidmore and Liz Truss, who collectively claimed that British workers ‘prefer a lie-in to hard work’ and that British people ‘are amongst the worst idlers in the world’.

Raab is also a keen advocate and supporter of the notorious libertarian Taxpayers’ Alliance, who bleat that rich people have to pay a little back to the society they gained so much from. Back in 2011, Raab proposed, in a pamphlet published by the Centre for Policy Studies entitled ‘Escaping the Strait Jacket’, that should the UK leave the EU this should be seen as an opportunity to slash protections for workers.

Referring to David Cameron’s attempts to renegotiate Britain’s relationship with the EU, at the time, Raab wrote: “This opportunity should be seized, and used to remove some of the obstacles to British business.” 

Paul Blomfield, Labour’s Shadow Brexit Minister, said: “The new Brexit Secretary has long harboured ambitions to slash vital workplace protections and rights, and the Prime Minister has now put him in a position to do so.

“This latest blow for workers comes a few days after the Cabinet failed to rule out a race to the bottom with the EU on crucial employment protection. It’s become abundantly clear once again that this chaotic Tory Government cannot be trusted with people’s rights after Brexit.”

Tim Roache, GMB General Secretary said: “This appointment signals a promotion of a hard right figurehead who has shown contempt for working people in Britain.

“Theresa May has appointed someone who think British workers are lazy and have too many rights and he has already published plans to slash vital rights from the minimum wage to rights for agency workers.

“The hard won rights of UK workers are already under serious threat in the post-Brexit landscape – basic things like not being forced to work 60 hours a week and being able to get home to see your family.

“Dominic Raab’s appointment now poses a direct and immediate threat to working people in Britain.

“At a time when we see a Tory back bencher salivating at the prospect of axing the Working Time Directive, the new Brexit Minister needs be clear where he stands on workers’ rights – the public will not accept a Brexit that makes life harder for working people.”

As a campaigning anti-unionist, Raab had also presented an ultimately unsuccessful Ten Minute Rule Bill proposing that emergency service and transport Unions should be required by law to ensure that strike votes receive 50% support of union members. Raab argued that reform was needed to prevent “militant union bosses” holding the “hard working majority” to ransom.

I guess he doesn’t get the whole idea of ‘collective bargaining’, then, unless of course, it involves big business gathering together to lobby the government for labour market deregulation and bigger profits.

In February this year, Raab advertised for an unpaid intern just ahead of a Department for Business, Energy and Industrial Strategy publication, responding to the Taylor review on insecure work. The BEIS report criticised “exploitative unpaid internships” saying “an employer cannot avoid paying someone the minimum wage simply by calling them an ‘intern’ or saying that they are doing an internship.” 

Earlier in the year while he was serving as Housing Minister, Raab courted controversy by claiming that immigration to the United Kingdom had driven up housing prices by as much as 20 percent. Raab’s claims were then challenged by the UK Statistics Authority which asked that he publish the information supporting his allegation. When produced, it transpired that the information he cited was based on modelling long-since considered discredited and out of date, leading to criticism of his performance in his ministerial role. 

In 2015, he voted against explicitly requiring an environmental permit for fracking activities and voted not to ban the exploitation of unconventional petroleum for at least 18 months and not to require a review of the impact of such exploitation on climate change.

In 2011, the self-pitying, privileged white male waged a gender war on feminists, calling them “amongst the most obnoxious bigots”. He said he feels that men get a raw deal ‘from the cradle to the grave’ because of  “anti-male discrimination in rights of maternity/paternity leave”, young boys being “educationally disadvantaged compared to girls”, and because “divorced or separated fathers are systematically ignored by the courts”. Raab clains: “Men work longer hours, die earlier, but retire later than women”.  I guess child-rearing and being burdened with a disproportionate share of household chores, which isn’t salaried, don’t count as ‘work’. 

Related

Brexit, law firms, PR, lobbying and the communication ‘dark arts’ political hires

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Research confirms the government is creating a hostile environment for people claiming disability benefit

· 20 Comments ·

A protest by disabled people against benefits cuts

A recent research report launched last month by anti-poverty charity Zacchaeus 2000 Trust (Z2K) reveals the devastating impacts that the government’s welfare reforms are having on the lives of people who are disabled or severely unwell. 

Those benefits that were supposed to provide support for disabled people – Employment and Support Allowance (ESA) and Personal Independence Payment (PIP) – are leaving hundreds of thousands of disabled and unwell people wrongly assessed and denied the vital Social Security benefit they are entitled to. Without this essential income, many people are pushed into debt, face rent arrears and eviction and have to rely on food banks to survive.

Poor design and implementation of the assessments means PIP and ESA are failing, forcing ill and disabled people to go through arduous and distressing reviews and appeals processes just to access the payments they are entitled to. The numbers of people who are wrongly assessed and let down by the system are likely to be much higher than official appeal figures suggest.

The report, Access Denied: Barriers to Justice in the Disability Benefits System, shows some of the hardship, harm and distress this causes – and the long and difficult process people have to go through to finally get the support they deserve.

“For the past two years I’ve been surviving on foodbanks, borrowing money and well-wishers helping me. Even now I’ve got over £8,000 debts to pay people.” Kalifa, ESA claimant

“I went to see my doctor and I said ‘I can’t stand this anymore.’ I would wake up in the middle of the night worrying about this.” Darren, PIP claimant

After being wrongly turned down at assessment, claimants must first go through Mandatory Reconsideration (MR), which can take anything from a few days to several months. The Department for Work and Pensions (DWP) argues that claims are fully reviewed at this stage, but the fact that 69 per cent of claimants win their appeal after having gone through MR proves that the MR itself is failing to correct the assessment’s flaws.

While those who reach the appeal do eventually receive a fair hearing, the arduous process means many never make it to this stage. Drastic cuts to legal aid mean countless ill and disabled people cannot get the legal support and representation required – and which significantly improves chances of success: 88 per cent of the clients Z2K itself supports win their appeal. The Government’s cuts to legal aid and reduced local funding for advice charities means many disabled people are losing out purely because they cannot afford private legal advice.

Raji Hunjan, CEO of Z2K, said “The whole appeal process – and the months of financial and emotional hardship people have to go through to get there – could be avoided if DWP got assessments right in the first place.

“Instead of creating such a hostile environment for those who are disabled, and assuming everyone is trying to cheat the system, ministers urgently need to recognise the reality of people’s disabilities and illnesses and give them the support they deserve.

“That means fixing the assessments, fundamentally improving MR and reinstating legal aid for disability appeals.”

The report recommends clear changes to the assessment, MR and appeal stages, in order to ensure that disabled and unwell people no longer have to suffer to get the payments they are entitled to.

  • DWP and its contracted assessors must start recording all ESA and PIP assessments to ensure an improvement in their accuracy;
  • DWP should introduce a new quality management framework for its contracted assessors and meaningful penalties to hold those companies to account for the quality of their work;
  • If DWP will not commit to reforms to the Mandatory Reconsideration (MR) stage to ensure it corrects inaccurate assessments, MR should be scrapped and claimants should be allowed to go straight to an appeal hearing at the Tribunal;
  • The Government should reinstate legal aid for disability benefits appeals.

Access Denied: Barriers to Justice in the Disability Benefits System illustrates the many barriers to justice that disabled people face, and highlights the potential solutions. It is based on in-depth research with Z2K’s clients, whose claims for ESA and PIP have been rejected – despite them having severe illnesses and disabilities.  Their stories reveal not only the serious flaws in the assessments, but also the personal impacts and enormous obstacles people face in challenging the assessment decision.

You can read the press release here.

The research findings come in the wake of the recent report from the National Audit Office (NAO), which says the Department for Work and Pensions (DWP) has underpaid benefits to the tune of £1.7bn over the last year, while official errors have also seen a significant rise in over-payments.

Underpayments now account for £1.7 billion of government welfare expenditure, while over-payments have soared to a record £3.7 billion.

The report exposes the shocking extent of departmental errors and layers of Kafkaesque bureaucracy, with the chairman of the Commons Work and Pensions Committee describing the current welfare system as “a pinball machine”.

Frank Field, told the Press Association: “It’s like a pinball machine, the payments system – you might get an overpayment, you might get an underpayment.

“Lots of people are not being paid Universal Credit when they should be, causing hardship, and the same department is overpaying others – what is going on?”

But the data shows that while Universal Credit has the highest level of over-payments, at 7.2%,  has the greatest amount of underpayments at 3.7%. That figure does not include those denied PIP and who are forced to ask for Mandatory Review and then appeal.

The research also comes as Sarah Newton belligerently denied in parliament that disabled people claiming support face a politically designed hostile environment, and the Work and Pensions Secretary, Esther McVey, faces mounting calls to resign, after falsely claiming that an NAO report suggested that the roll-out of Universal Credit should be “accelerated.” 

The UK government’s treatment of disabled people has been extremely controversial for many years, with the United Nations accusing ministers of “grave and systematic” violations of disabled people’s human rights following their extensive inquiry.

But despite the many concerns, challenges, presented empirical evidence and official rebukes of the government’s prejudiced and discriminatory welfare policies, the cruel treatment of sick and disabled people in the UK continues, with ministers dogmatically denying their punitive policies cause any harm and distress, indicating that the government has no intention of making positive changes any time soon.

 

Related

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

A disabled man with an inoperable brain tumour has been left without social security support

Esther Mcvey forced to apologise for being conservative with the truth

I’m a disabled person and Sarah Newton is an outrageous, gaslighting liar

 

I don’t make any money from my work. I’m disabled through illness and on a very low income. But you can make a donation to help me continue to research and write free, informative, insightful and independent articles, and to provide support to others. I co-run a group that supports disabled and ill people going through ESA and PIP claims, assessments and appeals.

Any donation is very much appreciated – thank you.

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A disabled man with an inoperable brain tumour has been left without social security support

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A man who has an inoperable brain tumour has condemned the government after his benefit support was stopped, leaving both his partner and himself with just £5 a week to feed themselves.

Karl Riley says that he’s been living below the bread line since his Employment and Support Allowance (ESA) and housing benefit were taken away three months ago when he moved in with his partner, whose income is just a few hundred pounds a month.

Karl, who is 32, says that he has a tumour that is embedded in his brain stem. This has caused him to suffer severe neurological symptoms, such as permanent limited mobility, double vision, memory loss, confusion, extreme anxiety, depression, nausea, insomnia, tinnitus and facial paralysis. 

Despite his health problems, Karl manages a few hours of self-employed work each week. He manages a band part-time, but isn’t capable of working full-time. He says he risks losing his house now that his benefits have  been stopped. 

Karl has also been waiting seven months for NHS physiotherapy treatment. 

He told i News: “I feel like I’m getting no help from either the government or the NHS. My partner and I can’t feed ourselves and pay other living expenses on just £5 a week. Who can survive on that? I understand now why so many people are going to food banks. This government leaves people to starve.”

Karl found out by accident about his non-cancerous tumour when he had a brain scan as part of a medical trial in 2012. At the time he had no symptoms and he was told that doctors would take a ‘wait and see’ approach.

He continued to work for nearly five years but early last year took a turn for the worse, becoming symptomatic. A scan showed the lump had grown to four times its original size. “I was fine at first. They said it wasn’t appearing to grow much and I carried on managing my five bands.” he explained. “But then the neurological symptoms started.” 

Karl had emergency brain surgery last March to drain a build up of fluid, followed by a second operation in July, when doctors told him the tumour was too embedded in his brain, making it inoperable. 

Karl said: “I was bad after the second operation. It caused me a lot more problems and I had to relearn how to walk.” He then had to undergo six weeks of radiotherapy in a bid to reduce the mass, and says he was vomiting every day and continues to feel the side-effects. 

Karl, who then lived with his partner Samantha Neale, 27, had some savings to fall back on at the time, but when they ran out of money, each of them were forced to move back  with their parents.

Karl had been struggling with his mobility. So in December, he made a claim for ESA. He was awarded £73.10 a week, which is the Support Group level of award, for those who cannot work because of illness or disability, plus he was awarded a basic award of £54 a week when he claimed Personal Independence Payment (PIP), which replaces Disability Living Allowance. Then in March, Karl and Samantha decided to live together again, renting the cheapest place they could find for £425 a month. However, Samantha became ill herself and was unable to work.  She currently receives statutory sick pay.

Karl said: “We wanted to live together again, I was stuck in my parents’ tiny box room which wasn’t ideal for me with mobility problems. My partner is essentially my carer, and she’s had a lot of problems in the past, then there was my illness on top of them and she just couldn’t cope anymore.” 

Karl had declared the move as a change of circumstances, and says the that government asked to look at Samantha’s payslips and took one that showed a higher than normal payment to be their regular income. 

Karl explained: “Samantha is getting £380 a month in sick pay, but for one month in May she was paid nearly £600 because her April payment was under at £280 due to a processing problem.

“But despite explaining this the benefits people decided her regular income is £600. Our council tax reduction has stopped too and we can’t claim housing benefit.” So Samantha’s back payment – money she was owed – was taken as her income as well.

Once Karl’s ESA was stopped, he was told to claim working tax credits, but his award didn’t include the disability element.

This means that he now has to pay for his rent in full and has no council tax reduction. Karl says that after paying their rent and bills, there’s now so little left that he’s had to resort to setting up a GoFundMe appeal, because he feels so desperate. 

“It’s disgraceful, it feels like begging, but I had no other option or we will lose the roof over our heads,” he said.

“I’ve worked hard all my life, and I can’t help having a brain tumour. The government also make it all so complicated with form after form to fill in, which is hard because I suffer short-term memory problems. It feels like a slap in the face.

He added: “I would love to be able to work more but I desperately need physiotherapy and occupational therapy. I don’t blame Breightmet Health Centre for that, I blame the government for the cuts and leaving NHS resources so stretched.” (Breightmet is an area of Bolton.)

A Department for Work and Pensions spokesperson said: “We’re committed to ensuring that people with health conditions get the support they’re entitled to. Decisions for ESA are made following consideration of all the information provided by the claimant, including supporting evidence from their GP or medical specialist. Anyone who is unhappy with a decision can appeal.

“People with long-term health conditions may also be eligible for support through other benefits such as PIP.” 

It takes months to get a tribunal date, and before people can appeal, they have to go through a mandatory review first, where the government decides whether their original decision was correct. The mandatory review has no time limit, and an average of six weeks is usual for people to wait for the second decision.

Meanwhile, people are left without an adequate income to meet their basic living needs, and an average of nine months wait for their appeal to be heard.

To donate to Karl Riley’s fund, click here.

I don’t make any money from my work. I’m disabled through illness and on a very low income. But you can make a donation to help me continue to research and write free, informative, insightful and independent articles, and to provide support to others. I co-run a group that supports disabled and ill people going through ESA and PIP claims, assessments and appeals.

Any donation is very much appreciated – thank you.

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Barnet Capita contractor on fraud charge

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Unison members working for Barnet Council protest over outsourcing

Unison members working for Barnet Council protest over outsourcing.

The Times Series reports that a former member of staff on a council contract with outsourcing firm Capita has been charged in a £2 million fraud case.

The former Barnet Council employee, on a Regional Enterprise contract with the outsourcer, appeared at Willesden Magistrates’ Court on Tuesday, July 3, to face two separate charges of fraud by abuse of position. 

The Conservative Barnet council has become something of a “commissioning council”, which means outsourcing pretty much everything it can. Capita has already come under fire for ‘serious failings’ in pension management and has been fined by the council over accounting failures.

In May, the council was called on to take financial reporting back from Capita’s control after a report revealed a £9.5 million black hole had opened up in the local authority’s budget for the coming financial year.

The council’s policy and resources committee discussed the Capita contract review and considered a range of options for service delivery at a meeting on July 19. The review of the contract with the private provider could see seven services brought back under the council’s control after a report admitted there were areas of ‘persistent poor performance’ in the outsourcing model.

If it decides to go ahead with the review report’s recommendations, finance, strategic HR, management of the council’s land and property, highways, regeneration, strategic planning and cemeteries and crematoriums will be brought back in-house. The council’s Labour group, which opposed the outsourcing plans before the contracts were signed, said it would support plans to bring them back in-house. 

Labour Cllr Barry Rawlings said: “The Conservatives clearly decided not to admit the failure of their central ideology of mass-outsourcing during the local elections, which raises the question as to how honest they were with voters in the run-up to the local elections. 

“Mass outsourcing was a gamble made by the Conservatives. It, and they, have failed the people of Barnet. It is time to take back control.”

Barnet Council claims the partnership with the company has led to significant financial savings, as well as efficiencies and improvements across a range of services.

The Regional Enterprise (Re) deal with Capita was signed in 2013 and covers a range of services, including environmental health, regeneration and highways.

A Barnet Council spokesperson said: “The council has recovered the money from Re as a result of this alleged fraud, and we took immediate action to increase financial controls and monitoring of the outsourced finance service.

“We have also commissioned an independent review of financial controls, the results of which will be presented to the Council’s Audit Committee on Tuesday, 17 July.”

The council have confirmed that the total value of money obtained fraudulently was over £2 million.

The case has been referred to Harrow Crown Court, where the next hearing will take place on Tuesday, July 31.

 

Related

Neoliberalism and corruption: hidden in plain sight

 

I don’t make any money from my work. I’m disabled through illness and on a very low income. But you can make a donation to help me continue to research and write free, informative, insightful and independent articles, and to provide support to others. The smallest amount is much appreciated – thank you.

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Esther Mcvey forced to apologise for being conservative with the truth

· 16 Comments ·

euphemisms

In my previous article, I discussed the outrageous responses that the Department for Work and Pensions minister and petty tyrant, Sarah Newton presented to Shadow Disabilities Minister Marsha De Cordova, who had once again raised the fact that the United Nations (UN) had found “grave and systematic violations of disabled people’s rights” in the UK.

The Labour MP also said yesterday in parliament: “This government’s policies have created a hostile environment causing grave violations on disabled people.”

Newton responded to these serious and valid concerns by an act of scandalised denial, outrage, vindictiveness, blaming the messengers, telling lies and by using gaslighting tactics.

Gaslighting is an intentional, malicious and hidden form of mental and emotional abuse, designed to manipulate others, creating self-doubt and insecurity. Its aim is to redesign and edit people’s experiences and accounts of reality, replacing them with someone’s own preferred and more convenient version, by persistently altering the perceptions of others, to confuse and disorientate them. Like all abuse, it’s based on the need for power, control, and very often, concealment. It’s far more damaging than simply lying, because it is intended to control, hurt and silence others. It’s a strategy very commonly used by psychopaths, bullies, despots and the Conservatives to ensure they get their own way. 

The government often use doublespeak – language shifts entailing words such as “reform”, “fair”, “support” and “help”- to disguise the horrible impacts of their extraordinarily draconian welfare policies and austerity programme, and to divert public attention. People who object to the harms that Conservative policies cause are told they are “scaremongering”. This is a form of gaslighting. It indicates that the government have no intention of changing their punitive policy approach or remedying the harms and distress they have caused.

The Conservatives have shown very strong tendencies towards socially illiberal and authoritarian attitudes over the past seven years. Furthermore, they aren’t exactly a party that designs policies to bring delight to the majority of ordinary citizens. Ministers regularly use a form of Orwellian Torysplaining and scapegoating to attempt to discredit and invalidate citizens’ experiences of increasing economic hardships and vulnerability  – particularly those of marginalised groups – caused directly by punitive Conservative policies. This is certainly an abuse of political power.

The Conservatives have a long track record of determined authoritarianism and telling lies. See for example A list of official rebukes for Tory lies and Dishonest ways of being dishonest: an exploration of Conservative euphemisms.

Today, cabinet minister and creature of habit, Esther McVey was rebuked for telling lies ‘misrepresenting’ the National Audit Office’s (NAO) very critical report on the roll-out of Universal Credit with a series of ‘inaccurate’ claims to MPs. The NAO is the government’s spending watchdog.

The NAO took the highly unusual step after the work and pensions secretary dismissed the catalogue of failings outlined by auditors last month in their report into the government’s flagship welfare programme.

In his open letter to McVey, which is likely to raise questions about her future as a cabinet minister, the Auditor General, Sir Amyas Morse, said that elements of her statement to Parliament on the report were lies “incorrect and unproven.”

He said it was “odd” that McVey told MPs that the NAO did not take into account recent changes in the administration of universal credit, when the report had in fact been “fully agreed” with senior officials at the Department for Work and Pensions only days earlier. 

Sir Amyas added that McVey’s claim that the NAO was concerned that Universal Credit was rolling out too slowly was “not correct”. 

The NAO report concluded that the new system – being gradually introduced to replace a number of benefits – was “not value for money now, and that its future value for money is unproven”.  

The authors of the report also accused the government of not showing sufficient sensitivity towards some claimants and failing to monitor how many are having problems with the programme, or have suffered hardship.

In his letter, Sir Amyas told McVey: “Our report was fully agreed with senior officials in your Department. It is based on the most accurate and up-to-date information from your Department. Your Department confirmed this to me in writing on Wednesday June 6 and we then reached final agreement on the report on Friday June 8.

“Her assurance, in response to the report, that Universal Credit was working was also “not proven.” 

He continued: “It is odd that by Friday June 15 you felt able to say that the NAO ‘did not take into account the impact of our recent changes’.  

“You reiterated these statements on July 2 but we have seen no evidence of such impacts nor fresh information.”

Sir Amyas added: “Your statement on July 2 that the NAO was concerned Universal Credit is currently ‘rolling out too slowly’ and needs to ‘continue at a faster rate’ is also not correct.”

And he told McVey: “Your statement in response to my report, claiming that Universal Credit is working, has not been proven. 

“The Department has not measured how many Universal Credit claimants are having difficulties and hardship. What we do know from the Department’s surveys is that although 83% of claimants responding said they were satisfied with the Department’s customer service, 40% of them said they were experiencing financial difficulties and 25% said they couldn’t make an online claim.

“We also know that 20% of claimants are not paid in full on time and that the Department cannot measure the exact number of additional people in employment as a result of Universal Credit.”

The Auditor General said that he had written to McVey on June 27 asking for a meeting to discuss her comments, and was publishing his open letter “reluctantly” because he had not yet been able to see her. McVey has a history of showing disdain for democractic norms and the protocols and mechanisms of transparency and accountability.

Now the Work and Pensions Secretary is facing calls to resign, after admitting that she had told lies “inadvertently misled” parliament. 

You can hear her full statement here. She doesn’t look appropriately humble, sincere or ashamed, however: 

Related

I’m a disabled person and Sarah Newton is an outrageous, gaslighting liar

 

 

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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I’m a disabled person and Sarah Newton is an outrageous, gaslighting liar

· 21 Comments ·

Last year I wrote an article about how the social security system in the UK has been re-structured around “ordeals”, which were introduced by the Conservative government in order to discipline and “disincentivise” citizens from claiming welfare support.  The government’s aim is to ‘deter’ a ‘culture of dependency’ (a debunked myth) by undermining any sense of security people may have of fulfilling their most basic needs.  Welfare support is extremely conditional, precarious and punitive, because it is founded on traditional and appalling Conservative prejudices about poor people. 

Ordeals are intrinsic to a system of punishment that the draconian Conservatives claim will “change the behaviours” of underpaid, unemployed and disabled people. By creating a hostile environment, the government are somehow claiming that it’s possible to simply punish people out of having basic needs.  If employment were genuinely ‘the route out of poverty’, as the government claim, why is it that most people who need social security support are in work?

Then there are the additional concerns about how the government treats those citizens who are too ill to work. The Conservatives simply refuse to believe them or their doctors.

Yesterday in parliament, the Shadow Disabilities Minister Marsha De Cordova again raised the fact that the United Nations (UN) had found “grave and systematic violations of disabled people’s rights” in the UK.

The Labour MP added yesterday in parliament: “This government’s policies have created a hostile environment causing grave violations on disabled people.”

The entire assessment process has established a system marked by assuming disabled people are somehow faking their disability or illness. It’s a case of “remove people’s support first, they can appeal later”. Once they have got through mandatory review and struggling without any income, that is. (To date, two-thirds of appeals are won by claimants. This is despite the legal aid cuts, which mean disabled people appealing their rejection for support are denied any legal support in a staggering 99% of cases.)

Outrageously, Newton said it’s “not true” that disabled people face a hostile environment.” She also asked the opposition not to say “things” that they “know are not true”.
But disabled people in the UK know that it IS true.


Basically Newton was inviting the Labour party to collaborate in gaslighting disabled people, as well as attempting to stifle genuine concerns, democratic dialogue and avoid any democratic accountability whatsoever. Absolutely shameful, authoritarian behaviour.

The United Nations (UN) and the Equalities and Human Rights Commission have already verified the truth of these statements, presented by Labour shadow ministers, disability charities and disabled people. 

However, the Conservatives have a track record of denying empirical findings that don’t match their ideological expectations. They simply deny and dismiss any criticism of their prejudiced and discriminatory policies. Damian Green, the Work and Pensions Secretary at the time of the UN inquiry report, famously claimed that cuts to support for disabled people did “not necessarily mean worse outcomes.” 

If the Conservatives genuinely believed that were true, they wouldn’t have such a problem in ensuring very wealthy people paid a fair amount of tax more generally. Apparently, money matters only to the rich. Cuts to their income must be avoided at all costs. And it does cost some of society’s most marginalised citizens, leaving us vulnerable. 

Those in the work-related Employment and Support Allowance (ESA) group have already seen their support brutally cut to fund tax cuts for the wealthy. Personal Independent Payment (PIP) was introduced to cut costs, too.

The fact that disabled people are also dying after losing their benefits is continually ignored, often dismissed by the government as ‘anecdotal evidence’, which does not ‘demonstrate a ‘causal link’ between increased, preventable mortality and government policy”. 

My own experiences of the Conservatives hostile environment

As a disabled person who has gone through three ESA assessments, and more recently, a PIP assessment, a mandatory review and tribunal, I can verify that the Conservatives’ policies have created a hostile and harmful environment for disabled people. When I went through the ESA assessment in 2011, I was already gravely ill with a severe lupus flare. I was forced to leave a job I loved in 2010.

By then I had worked with the illness as long as I possibly could. I became ill with lupus in 1998. The illness is chronic, progressive and is characterised by periods of acute illness, followed by periods of relative remission. Each flare generally imposes an increasing amount of damage to joints, nerves, tendons, organs and blood cells, as the disease progresses, causing myriad symptoms that vary over time, and from person to person. 

Unbelievably, despite being so ill, I scored zero points at the assessment and the stress of having to fight for a means to live exacerbated my illness. I won an appeal nine months later. In the meantime I was placed on a work programme that I couldn’t possibly undertake. The disability advisor I saw at the job centre told me she could see I was unfit for work.

Just three months following the appeal, I was told I must attend another assessment. By this time I was so poorly that I collapsed at the interview. The Atos doctor told me I should never have been sent for another assessment. I was on chemotherapy treatment at the time, which ought to have exempted me, as should the tribunal outcome just a couple of months previously. The initial Atos report, presented to the court, was clearly about someone else’s life and conditions. The tribunal said that working would place me at unacceptable risk. 

I also ensured the assessment was recorded the second time, so little was my trust of the fairness and rationality of the process. Or the honesty and integrity of Atos’s ‘health care professionals’. At the second assessment, I saw a doctor, who sent me home in a taxi, Atos actually paid for it. He also recommended that I was placed in the Support Group.

It was two years before my treatment stopped the aggressive advance of my illness, which also leaves a wake of progressive damage to bones, joints, tendons, nerves, blood cells, major organs and my immune system – causing further disability. My rheumatologist is sure the severe stress of assessment and appeal, coupled with the financial hardship I experienced, exacerbated my flare. By 2013 I was still very frail, and weighed less than seven stones, despite feeling less acutely ill.

The experience was so distressing for me that I could not face going through a PIP assessment, despite the fact that I needed the additional support. I put off claiming until last year, when I needed aids and appliances in my home just to manage day-to-day tasks like taking a shower and cooking. The occupational therapist from my local council helped me with my claim. By this time I desperately needed the additional support.

The PIP assessment was dehumanising and degrading and the ‘examination’ included movements that left me in a lot of severe pain, reducing my mobility further, substantially. Some of my joints were badly swollen by the evening, following my appointment, including both shoulders and knees. I was asked to do movements I wasn’t familiar with, and it isn’t until you try them that you find you cannot actually bend or reach that way. The movements were also done in quick succession. I was trembling with the effort and complained I was in pain. When I refused to do a squat, I was asked why. I explained that I simply couldn’t do it. I have arthritis in both hips and lower spine, both of my wrists and shoulders won’t take any weight and had I fallen backwards, I risked breaking a wrist, as I also have early onset osteoporosis because of my illness.

People should not be leaving assessments in a worse condition than when they arrived for them.

I made a formal complaint, but was fobbed off by the person carrying out the investigation, who simply concluded that as he ‘wasn’t in the room at the time’ of the assessment and so could neither verify nor negate my ‘allegations’. It took him four pages to say that.

I was just one point short of an enhanced PIP award. The reasoning on the assessment report for denying me a point for cognitive difficulties was that I had a degree (1996, Master’s in 2007), worked as a social worker (until 2010, when I became too ill to work) and a driving licence in 2003. I have been unable to drive since 2005 because of flicker induced seizures. Clearly the idea that an illness that prevents me from continuing in work, which is also well-known for causing neurological illness, has led to increasing cognitive difficulties since 2009 isn’t acceptable to PIP assessors, who wanted to keep my award as low as possible.

The DWP didn’t even bother writing to let me know the outcome of my mandatory review. Throughout the process, from the first ESA assessment to the last PIP assessment, I was treated as though I was somehow a burden, rather than being supported.

Newton claimed yesterday that the opposition’s comments are “dangerous”and “deter” people who need support from claiming it. What utter tosh. It is government policies that are dangerous, and that have created a series of ordeals in the assessment process, designed to weight the assessments towards permitting the DWP to refuse people support.

I needed PIP in 2011, but my experience of ESA assessment was so devastating that I was deterred from claiming PIP until I was absolutely desperate, last year. I simply could not face risking my health even further with another assessment, unless I absolutely had no choice. That last assessment also caused an exacerbation of my illness and injury to my already damaged joints and tendons. 

How dare Newton tell such hard faced, deplorable lies.

She went on to say: “We have very strong protections for people with disabilities in our country.”

Newton even had the cheek to cite Labour’s Equality Act as a ‘protection’ for disabled people, as if it was the Conservatives who designed this policy. This is the same Act that this government has violated over and over because of their welfare ‘reforms’ and austerity programme.

Those protections were brought about by the last Labour government, which also included the Human Rights Act, as well as Labour signing the UK up to the Convention on the Rights of Persons with Disabilities (UNCRPD) – an international human rights treaty intended to protect the rights and dignity of persons with disabilities.

The established human rights and equality frameworks have been methodically ignored by this government, who decided to target disabled people with a significantly disproportionate burden of their ideological austerity programme. The UN found that the Conservatives’ treatment of disabled people gravely and systematically violates our human rights. The evidence gathered by the UN came from disabled people’s accounts (including mine) and those of disability organisations and charities.

This is a government that has systematically marginalised disabled people economically  socially and politically, sidestepping human rights and equality legal frameworks. Apparently the government doesn’t regard democratic accountability to disabled people as particularly important. Instead, ministers simply lie and deny other people’s experiences and accounts. 

Newton also shamefully suggested people losing their motability cars should complain to the Motability charity – not the government. It’s not the charity that are creating a hostile environmen for disabled people, carrying out assessments that are absolutely unfit for purpose. This government simply refuse to accept any responsibility for the consequences of their own actions. History has taught us that such right wing authoritarian governments are very, very dangerous.

How dare this minister deny and dismiss the accounts of disabled people – those directly affected by her government’s draconian policies. How dare she call other people ‘liars’ while she stood there lying in parliament. She seems to have forgotten that disabled people have the same democratic right as other groups to hold a dialogue with the government, but instead we have patronising and vindictive ministers telling us their punitive and authoritarian policies aren’t causing us any harm or distress. We say they are and we are told by this manipulative, gaslighting liar that it is we that are ‘lying’. 

Newton presented us with despicable and manipulative gaslighting tactics used by bullies, psychopaths and despots. When Newton claims that the opposition are telling ‘untruths’, she is also accusing those of us who have suffered because of her governments wretched and punitive policies. She then goes on with hard faced cheek to ‘condemn the condemners’*(see below for outline of techniques of neutralisation):

“I honestly ask all members opposite, please do not use this language of hostile environment. It is simply not the case.

“And the very people that need all of our support are put off from seeking it and coming forward.

“Really, I would ask them to stop saying things which they know are not true.”

The Conservatives talk a lot about “evidence-based policy”, but they don’t walk the talk. An overwhelming weight of evidence has highlighted the cruel, draconian effects of the Tories’ social polices to date. The government have simply chosen to deny and ignore it. 

Clearly the government is committed to trying it on by paying people (from their OWN contributions) as little as they can possibly get away with from the public fund. Perish the thought that public paying taxes towards public services may actually want to use those public services at some point in their lives. Yet the government irrationally insists that the cuts are “to provide tax payers with value for money.”

There IS NO discrete group of tax payers that never use public services, who are simply paying for “other peoples'” support. Everyone pays tax, including those claiming welfare support. Most people claiming support have worked, many needing support are actually IN work. Furthermore, as employment has become increasingly precarious, many move in and out of employment, through no fault of their own. 

The “value for the tax payer” spin is simply a divisive strategy – a political game of “us and them” that is used to justify punitive policies which target some groups, while the deliberate scapegoating of those groups serves to de-empathise the public to their loss of support, increasing vulnerability and distress. 

Deliberately cutting money from disabled peoples’ crucial lifeline support can hardly be described as providing “value for money” nor is it “fair” and “supportive”. This consistent response and denial from a government of liars indicates quite clearly that the cuts were always intentional on the part of the government.

The gaslighting, denial and dismissal by Newton and her Conservative colleagues indicates a deliberately prejudiced, vicious attack on a significant minority of the population, which this Orwellian government clearly have absolutely no intention of stopping or putting right any time soon.

—
* Techniques of neutralisation: 

Used to switch off the conscience when someone plans or has done something to cause harm to others. 

The idea of techniques of neutralisation was first proposed by David Matza and Gresham Sykes during their work on Edwin Sutherland’s Differential Association in the 1950s. Matza and Sykes were working on juvenile delinquency, they theorised that the same techniques could be found throughout society and published their ideas in Delinquency and Drift, 1964.

They identified the following psychological techniques by which, they believed, delinquents justified their illegitimate actions, and Alexander Alverez further identified these methods used at a socio-political level in Nazi Germany to “justify” the Holocaust:

1. Denial of responsibility. The offender(s) will propose that they were victims of circumstance or were forced into situations beyond their control.

2. Denial of harm and injury. The offender insists that their actions did not cause any harm or damage.

3. Denial of the victim. The offender believes that the victim deserved whatever action the offender committed. Or they may claim that there isn’t a victim.

4. Condemnation of the condemners. The offenders maintain that those who condemn their offence are doing so purely out of spite, ‘scaremongering’ or they are shifting the blame from themselves unfairly. 

5. Appeal to higher loyalties. The offender suggests that his or her offence was for the ‘greater good’, with long term consequences that would justify their actions, such as protection of a social group/nation, or benefits to the economy/ social group/nation.

6. Disengagement and Denial of Humanity is a category that Alverez
added to the techniques formulated by Sykes and Matza because of its special relevance to the Holocaust. Nazi propaganda portrayed Jews and other non-Aryans as subhuman. A process of social division, scapegoating and dehumanisation was explicitly orchestrated by the government. This also very clearly parallels Gordon Allport’s work on explaining how prejudice arises, how it escalates, often advancing by almost inscrutable degrees, pushing at normative and moral boundaries until the unthinkable becomes tenable. This stage on the scale of social prejudice may ultimately result in genocide.

Any one of these six techniques may serve to encourage violence by neutralising the norms against prejudice and aggression to the extent that when they are all implemented together, as they apparently were under the Nazi regime, a society can seemingly forget its normative rules, moral values and laws in order to engage in wholesale prejudice, discrimination, exclusion of citizens, hatred and ultimately, in genocide.

In accusing citizens and the opposition of ‘scaremongering’, the Conservatives are denying responsibility for the consequences of their policies, denying harm, denying  distress; denying the victims and condemning the condemners.

Meanwhile, for many of us, the government’s approach to social security has become random, controlling and an unremitting, Orwellian trial. 

—

Read some of the accounts of other disabled people who have also faced the Conservative’s hostile environment and social security ordeals:

Fit for work assessment was trigger for suicide, coroner says

Man leaves coroner letter as he fears Work Capability Assessment will kill him

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

Cystic fibrosis sufferer refused PIP – the Conservative bureaucratic wall and systematic dismantling of social security

Man with diabetes had to have his leg amputated because of benefit sanctions

Benefits Assessor: How Long Are You Likely To Have Parkinson’s?

Please let’s help Peter to maintain his mobility and independence

Thousands of disabled people have already lost their specialist Motability vehicles because of Conservative PIP cuts and many more are likely to be affected.

Remembering the Victims of the Government’s Welfare “Reforms”  (This list needs to be updated).

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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Rationing and resource gatekeeping in the NHS is the consequence of privatisation

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People march through London to mark 70 years of the NHS

People march through London yesterday to mark 70 years of the NHS.

Gatekeeping has become a watchword within our public services over the past seven years. It’s being driven by the government’s deep affection for neoliberal dogma, the drive for never-ending ‘efficiency savings’ and the Conservatives’ lean, mean austerity machine. Perish the thought that the public may actually need to use the public services that they have funded through their contributions to the Treasury, in good faith. 

In the NHS, even the resource gatekeepers have gatekeepers, those receptionists standing sentry at the end of the telephone, and in general practices, who ration access to the GPs so assiduously we patients often get better before we’ve managed to arrange an appointment. Or ended up at an Accident and Emergency Department.

Only a service dedicated to keeping the public and service providers apart could have devised a system so utterly demeaning. It turns patients into supplicants and receptionists into bouncers who make decisions they are unlikely to be qualified to make, neither being roles to which any of us aspired.

Now, it has been decided that the NHS needs to scrap more medical procedures, including injections for back pain, surgery to help snorers and knee arthroscopies for arthritis, which form part of an initial list of 17 operations that will be discontinued completely or highly restricted by NHS England as many of these problems “get better without treatment.”

I can assure you that arthritis of the knee, or anywhere else for that matter, doesn’t tend to get better. Medical interventions can help patients with ‘managing’ the condition, however. 

Varicose vein surgery and tonsil removal also feature on the list of routine operations to be axed as part of NHS England’s drive to cease “outdated” and “ineffective” treatments.

The latest round of rationing is hoped to save £200m a year by reducing “risky” or “unnecessary” procedures. Patients are to be told they have a responsibility to the NHS not to request “useless treatment.”

However, complications from varicose veins, for example, include leg ulcers which require more costly specialist treatment to help them heal. 

Steve Powis, the medical director of NHS England, said: “I’m confident there is more to be done”, adding that the list of 17 operations formed “the first stage” of rooting out futile treatments that are believed to cost taxpayers £2bn a year.

“We are also going to ask ‘Are there other procedures and treatments we should add to the list?’. Additions could include general anaesthetics for hip and shoulder dislocations and brain scans for patients with migraines.

Hip and shoulder dislocations are notoriously excruciating, as is the process of having the joint relocated, though the latter is short-lived. It’s particularly brutal to leave patients without pain relief, and especially children.

The reason why brain scans are often very important when people develop migraine symptoms is that they can determine whether the severe headaches are caused by something more serious, such as a subarachnoid haemorrhage (which happened to me) or a tumour (which happened to my mother). Sometimes ‘migraines’ are something else.

Powis added: “We have to spend taxpayers’ money wisely. Therefore, if we are spending money on procedures that are not effective, that is money we could spend on new treatments that are clinically effective and would provide benefits to patients. It’s absolutely correct that, in getting more efficient, one component of that is to make sure we are not undertaking unnecessary procedures.”

The rationing comes as the government prepares to raise taxes and ditch an increase to the personal income tax allowance to pay for NHS funding plans. According to proposals, £20.5bn of extra funding would be set aside for the health service by 2023. In a speech at the Royal Free hospital in London a fortnight ago, Theresa May said tax rises were inevitable.

However, there doesn’t seem to be any indication that this additional measure will ensure the public has value and adequate health care for their money. 

The prime minister said: “As a country, taxpayers will need to contribute a bit more.But we will do that in a fair and balanced way. And we want to listen to people about how we do that, and the chancellor will bring forward the full set of proposals before the spending review.”

Here are the 17 treatments NHS England may axe

Four procedures will only be offered at the request of a patient:

  • Snoring surgery
  • Dilation and curettage for heavy menstrual bleeding
  • Knee arthroscopies for osteoarthritis
  • Injections for non-specific back pain

A further 13 treatments will only be offered when certain conditions are met:

  • Breast reduction
  • Removal of benign skin lesions
  • Grommets for glue ear
  • Tonsillectomy
  • Haemorrhoid surgery
  • Hysterectomy for heavy menstrual bleeding
  • Removal of lesions on eyelids
  • Removal of bone spurs for shoulder pain
  • Carpal tunnel syndrome release
  • Dupuytren’s contracture release
  • Excision of small, non cancerous lumps on the wrist called ganglia
  • Trigger finger release
  • Varicose vein surgery

Some of these procedures do improve the quality of people’s lives. I’m wondering how this sits with the government’s drive to push people with disabilities and medical conditions into work.

Although it was announced recently that the NHS is to hire 300 employment coaches to find patients jobs to “keep them out of hospital.” It’s what the government probably calls the ‘two birds and one bullet’ approach.

A man with a birthday placard as thousands of people march to mark 70 years of the NHS

Yesterday, tens of thousands of people marched through London to mark the NHS’s 70th anniversary and demand an end to government cuts and further privatisation of the health service. Bearing placards reading “Cuts leave scars”, “For people not profit” and “Democracy or corporate power” demonstrators moved down Whitehall on Saturday afternoon to the chant of “Whose NHS? Our NHS”.

The protesters stopped outside Downing Street to demand Theresa May’s resignation en route to the stage where they were greeted by a choir singing “the NHS needs saving, don’t let them break it”. Shortly after, Jeremy Corbyn addressed the crowd – organisers said there were about 40,000 people present – demanding an end to privatisation, the closure of the internal market, for staff to no longer be subcontracted to private companies and for social care to be properly funded.

Corbyn said: “There have been huge attacks on our NHS over many years,” he said. “The Tories voted against the original legislation and have always sought to privatise it and continue an internal market.

“Paying money out to private health contractors, the profits of which could and sometimes do, end up in tax havens around the world.

“Think it through, you and I pay our taxes because we want a health service for everybody, I don’t pay my taxes for someone to rip off the public and squirrel the profits away.”

I absolutely agree. 

A brief history of the travailing NHS under Conservative governments

The government has failed to adequately fund the NHS since taking office as part of the coalition in 2010, and has overseen a decline in the once widely admired public health service, as a way to privatise it by stealth. 

The Tories have utilised a spin technique that carry Thatcher’s fingerprints – it’s called ‘don’t show your hand.’

Image result for nhs safe in our hands

Jeremy Hunt and the Conservatives insist the NHS is ‘safe in our hands’

Chris Riddell 16.08.09

The direction of travel was set 25 years ago by the NHS review announced by Margaret Thatcher on the BBC Panorama programme in January 1988. The Conservatives have a poor track record with the NHS. Thatcher ushered in the NHS internal market, the mechanism that introduced what many in the health service still revile: competition.

Health authorities ceased to run hospitals but instead “purchased” care from hospitals who had to compete with others to provide it and became independent, self-governing trusts. The stated aim was to ‘increase efficiency’ and ‘eliminate waste’ through competition. Yet by the time John Major was prime minister, we saw the crisis deepen, with the postcode lottery and patients parked on hospital trolleys in hospital corridors for hours on end, waiting to see a worn out, overworked doctor.  

In order to assess the impact of Thatcher’s legacy on healthcare, it’s essential to appreciate that NHS market reforms began on her watch. Even the apparently relatively minor step of outsourcing hospital cleaning services was to cast a dark shadow over hospital care decades later. Putting cleaning services out to competitive tender meant that the job of cleaning wards went to the lowest bidder – often to companies that used casual, untrained staff, supplied by job centres. The contrast between the high quality of surgical treatment and the dirtiness of wards became notorious. The level of hospital-acquired infections grew steadily, including those caused by  ‘superbugs’  including MRSA. 

A study published by the Health Service Journal laid the blame for the rise of antibiotic resistant infections on poor hygiene standards; finding hospitals full of rubbish, uncollected left-over food in canteens and dirty linen strewn over bedroom floors. The impact outsourcing has had on cleaning services has been a constant source of tension since those early reforms. While trade unions and medical professionals have consistently argued against it, business leaders have always rejected any connection between outsourcing, infection rates, and declining standards.

Public sector outsourcing is central to the present government’s ideological strategy, despite the evidence that is now stacked against it being genuinely ‘competitive’. Since 2010, the number of large contracts awarded has increased by over 47% with tens of thousands of workers in various sectors – health, defence and IT – being transferred to corporate employers like Serco, Capita and G4S. The UK’s public sector has become the largest outsourcing market in the world, accounting for around 80% of all public sector contracting in Europe. These multinationals are not particularly interested in competition; they’re interested in profit and being in a monopoly position where they can dominate the market. Despite the wake of scandals that follows these companies, growth in the public sector outsourcing market shows no signs of slowing and the government shows no signs of learning from these events. 

Thatcher wanted to introduce even more radical changes – such as a shift to an insurance based healthcare model, with ‘health stamps’ for the poor – but in a busy decade, it seems that her battles with trade unions and left-wing Labour councils took priority.

It was under Thatcher’s administration that the climate of austerity began within the NHS. 

Then there was the Black Report into health inequalities, published in 1980 after a failed attempt by the  Conservatives to block its publication, noted that health inequalities in the UK were linked to socio-economic factors such as income, housing and conditions of work. The government rejected the report’s findings and recommendations.

Conservatives published a policy book called Direct Democracy in 2005. It claimed that the NHS was “no longer relevant”, and a system was proposed whereby patients were funded “either through the tax system or by way of universal insurance, to purchase health care from the provider of their choice” – with the poor having their contributions “supplemented or paid for by the state”. The authors included the current health secretary Jeremy Hunt. 

Against a backdrop of austerity and public cuts, healthcare facilities are continuing to contract out their facilities management and clinical services. But, the practice remains deeply controversial and the consequences are becoming more visible. 

Thatcher’s competitive tendering was introduced for cleaning, catering and other ancillary non-medical services, and were extended by the Tories in the ’90s under the NHS and Community Care Act – the first piece of legislation to introduce an internal market into the provision of healthcare. This was followed by the Private Finance Initiative (PFIs) in 1992 under the Major government.  Lansley’s reforms – premised on ‘increasing the diversity of providers in the management of the NHS’ – represent only the culmination of this legacy.

A centrally funded health service has demonstrated its a major contribution to reducing health inequality, by permitting healthcare practitioners and policy makers to design services and deliver care based on need, not the profit incentive. An increasingly privatised NHS has simply led to rationing and inadequate healthcare.

The biggest single contribution to health inequality is social inequality, a problem that has deteriorated significantly in the wake of the Conservative agenda of combined economic austerity and welfare reform.

Image result for hands up NHS
Image courtesy of Robert Livingstone 

Related

The Coalition has deliberately financially trashed the NHS to justify its privatisation

Rogue company Unum’s profiteering hand in the government’s work, health and disability green paper

Private bill to introduce further charges to patients for healthcare services is due for second reading today

Labour challenge government about ‘shocking’ rise in coroner warnings over NHS patient deaths

I don’t make any money from my work. I am disabled and don’t have any paid employment. But you can contribute by making a donation and 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 government’s eugenic turn violates human rights, costing families at least £2,800 each so far, according to DWP statistics

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See the world through the eyes of society’s weakest members, and then tell anyone honestly that our societies are good, civilised, advanced, free.” Zygmunt Bauman.

every child used to matter

Every Child Matters was Labour’s comprehensive and effective child welfare and protection policy that the Conservatives scrapped the day after they took office in 2010. The phrase “Every Child Matters” was immediately replaced with the phrase “helping children achieve more”. This reflects a fundmental change of emphasis from a rights-based society, for which both government and citizen share responsibility, to one where the individual is held solely responsible for their circumstances, regardless of structural conditions and the impact of political policies. 

What was a “Children’s Plan” under the last Labour government is now a “free market education plan”, marking the Conservatives shift from free schools to “for profit” schools. 

The price of having more children than the state deems acceptable

Department for Work and Pensions (DWP) statistics released today show that more than 70,000 low-income families lost at least £2,800 each last year after having their entitlement to benefits taken away as a result of the government’s “two-child policy”.

The joint analysis conducted by the DWP and HMRC shows that from 6 April 2017, just under 865,000 households with a third or subsequent child were claiming child tax credits or Universal Credit. Of these, DWP and HMRC claim that 70,620 reported a third or subsequent child after 6 April 2017, and that consequently they weren’t receiving  benefit support for at least one child. Around 38% of those families affected were lone parents – 26,800 of them in total.  A court ruling in June 2017 deemed the policy as discriminatory towards lone parents with children under two. 

The two-child policy means that households claiming child tax credit or universal credit, who have a third or subsequent child born after 6 April 2017, are unable to claim a child element worth £2,780 a year for those children. Iain Duncan Smith has said that the draconian policy has been designed to “incentivise behavioural change”, reflecting the government’s keen embrace of wonk behavioural economics in order to prop up a failing neoliberal administration.

Presumably Duncan Smith doesn’t think that people on low incomes who need social security support should have children. However, 59% of those families affected by the cruel an uncivilised imposed cut in their low income are in work. Financially punishing them for having a child isn’t going to change the profiteering behaviours of the draconian government, exploitative employers or the precarious conditions of the labour market. These are events and circumstances beyond the control of families and their children. 

Many people have children when they are relatively affluent, and may then fall on hard times through no fault of their own. It’s hardly “fair” to punish people for the structural conditions that are largely shaped through government policies based on neoliberal economics. However, Duncan Smith claimed, nonetheless, that the policy would force claimants to make the “same life choices as families not on benefits, and ‘incentivise’ them [imported US managementspeak, which means ‘to motivate’] to seek work or increase their hours.”

The Conservatives have seemingly overlooked the fact that when people struggle to meet their basic needs, they are rather less likely to be able to improve their socio-economic situation, since necessity rather than choice becomes their key motivation. Punishing people who have little income by taking away even more cannot possibly help them to improve their situation. It can only serve to inflict further suffering and distress.

The statistics also showed that 190 women were “exempted” from the eugenic policy, which the government has insisted is “working” and had been “delivered compassionately,” after they were forced to prove to officials their third child was conceived as a result of rape. The women have had to disclose rape in order to claim benefits under the government’s two-child benefit policy, according to the official DWP stats released today. That’s 190 women forced to disclose being sexually assaulted just to feed their children.

The so-called rape clause has been widely condemned by campaigners, who say it is outrageous a woman must account for the circumstances of her rape to qualify for support. The SNP MP Alison Thewliss called it “one of the most inhumane and barbaric policies ever to emanate from Whitehall”. 

A government spokesperson said: “The policy to provide support in child tax credit and universal credit for a maximum of two children ensures people on benefits have to make the same financial choices as those supporting themselves solely through work.”

Adding ludicrously: “We are delivering this in the most effective, compassionate way, with the right exceptions and safeguards in place.” George Orwell’s dystopian novel became a government handbook of citizen “behavioural change”.

The rollout of universal credit will increase the number of families affected. All new claims for the benefit after February 2019 will have the child element restricted to two children in a family, even if they were born before the policy was introduced.

Personal decision-making and citizen autonomy is increasingly reduced as neoliberal governments see human behaviours as a calculated investment for future economic returns. Now, having a child if you happen to be relatively poor invites the same outraged response from the right as those we saw leading up to the welfare ‘reforms’ regarding the very idea of people on welfare support owning flat screen TVs and Iphones.

Apparently, people struggling to get by should do without anything that would make their life a little more bearable. You can only have public and political sympathy and support if you lead the most wretched life. Perish the thought that you may have bought your TV during better times, when you had a job that paid enough to live on. Or decided to have a child.

However, it is profoundly cruel and dehumanising to regard children as a commodity. Economic ‘efficiency’ and the ‘burden on the tax payer’ are excuses being used to justify withholding public funds for fundamental human necessities, for dismantling welfare and other social safety nets.

There is no discrete class of tax payers; everyone pays tax, including those who need social security provision. 

Campaigners have said that the number of families affected by the policy would drive up UK poverty levels, putting an estimated 200,000 children into hardship.

In April this year, 60 Christian, Muslim and Jewish religious leaders condemned the policy, arguing it would lead to a rise in child poverty and abortions.

Alison Garnham of the Child Poverty Action Group said: “An estimated one in six UK children will be living in a family affected by the two-child limit once the policy has had its full impact. It’s a pernicious, poverty-producing policy.”

She went on to say:

“Our analysis with IPPR last year found 200,000 children will be pulled into poverty by the two-child limit. Today’s DWP statistics now show it’s already having a damaging impact – and at a fast pace. These are struggling families, most of them in work, who will lose up to £2,780 a year – a huge amount if you’re a parent on low pay.

“An estimated one in six UK children will be living in a family affected by the two-child limit once the policy has had its full impact. It’s a pernicious, poverty-producing policy. Even when times are tough, parents share family resources equally among their children, but now the government is treating some children as less deserving of support purely because of their order of birth.”

Jamie Grier, the development director at the welfare advice charity Turn2us, said: “We are still contacted by parents, the majority of whom are in work, fretting over whether this policy means they might consider terminating their pregnancy.” (See The government’s eugenic policy is forcing some women to abort wanted pregnancies.)

 

The curtailment of benefits for mothers and chilren is a form of negative eugenics, as is using financial ‘incentives’ to ‘nudge’ women claiming welfare support to use contraception.

Frederick Osborn defined eugenics as a philosophy with implications for social order. The Conservatives see eugenics as a political concern for governance. The view arises from a focus on neoliberalism and particularly, with competitive individualism. It is linked with the Conservatives’ views concerning economic productivity, and managing resources and wealth. The Conservatives believe that poverty arises because of ‘faulty’ perceptions, cognitions and behaviours of poor people. The two-child policy is aimed at maintaining the socio-economic order. Modern eugenics is market-based and austerity driven.  

Eugenics rejects the doctrine that all human beings are born equal and redefined moral worth purely in terms of genetic fitness. However the UK government is more concerned with economic “fitness”. The doctrine challenges the idea of human equality and opens up new forms of discrimination and stigmatisation.

Eric Hobsbawm (1996) among others has pointed out in The Age of Capital 1848-1875, mounting concentrations of wealth were coupled with the massive displacement of populations and socio-economic disruption on a previously unimaginable scale. At the core of this process of destructive change is the commodification process, which has transformed human needs into marketable goods.

As the welfare state and social protection systems are being dismantled, neoliberal governments have called forth a new social imaginary of ‘functional’ and ‘dysfunctional’ people. The ‘dysfunctional’ are simply those that haven’t managed to any accumulate wealth – which is the majority of us. The deployment of terms such as ‘deserving’, ’empowerment’, ‘grit’ and ‘resilience’ in policy discourses and the way these are being used to pathologise service users and to reconstruct the relationship between the state and citizens indicates an authoritarian government that seems determined to micromanage the psychology, self perceptions and characters of those it deems ‘dysfunctional’. 

This idea, which also underpins the pseudoscientific discipline of behavioural economics is one way of justifying huge wealth inequality and maintain the status quo. It also serves to create a utopian free-market order with the power of the state and to extend this logic to every corner of society. As sociologist Loïc Wacquant said, neoliberalism represents an “articulation of state, market and citizenship that harnesses the first to impose the stamp of the second onto the third.”

Childrens’ worth, for the Conservatives, may be counted out in pounds and pence or not at all.

The Conservatives believe it is necessary to govern through a particular register, that of the economy. The government offers economic ‘opportunities’ for only the ‘right kind’ of people. As a neoliberal form of governmentality, we are witnessing the construction of a new meritocratic ‘common-sense’ in which the rule of the ‘brightest and best’, those with the highest level of cognitve functioning, is presented simply as a form of rational economic ‘natural selection’. The two-child policy reflects this view of  a marketised ‘natural selection’ mechanism.

A major criticism of eugenic policies is that, regardless of whether “negative” or “positive” policies are used, they are susceptible to abuse because the criteria of selection are determined by whichever group is in political power at the time. Furthermore, negative eugenics in particular is considered by many to be a violation of basic human rights, which include the right to reproduction. Another criticism is that eugenic policies eventually lead to a loss of genetic diversity,

The political restriction of support to two children seems to be premised on the assumption that it’s the same “faulty” families claiming social security year in and year out. However, extensive research indicates that people move in and out of poverty – indicating that the causes of poverty are ‘structural rather than arising because of individual psychological or cognitive ‘deficits’. 

The Conservatives have always held an elitist view of humanity – wealthy people are seen as worthy, noble and moral, and poorer people are regarded as biologically-driven, impulsive and crassly sexualised. This set of prejudices justifies a harsh set of social policies that aims to abolish government assistance to the ‘undeserving’ poor, while preserving and enhancing the privileges accorded to their ‘deserving’ betters. 

These ideas can be traced back in part to an 18th-century English clergyman—and Thomas Robert Malthus, who was one of the founders of classical economics. Malthus wanted an end to poor relief and advocated exposing unemployed people to the harsh disciplines of the market.

Malthus maintained that despite a ‘generous’ welfare system, poverty in England kept increasing. He also believed that welfare created ‘peverse incentives’ –  Conservatives echo these claims that support to unemployed citizens always creates more of the poverty it aims to alleviate. From this view, receiving ‘unearned’ resources ‘incentivises’ unemployed people not to seek work, thus perpetuating their own condition.

Central to Malthus’s ‘scarcity of resources thesis’ (paralleled with the Conservatives’ austerity programme an ‘deficit reduction’) is the idea that hunger and deprivation serves to discipline the unemployed people to seek work and control childbirth. Apparently, cruelty is the key to prosperity.

The Conservatives are contemporary Malthusians, who endorse removing benefits as a necessity to compel citizens to work, and when in work, to work even harder, regardless of whether their children suffer in the punitive process of imposed deprivation.

Malthus believed that poor people procreate recklessly, whereas wealthy people excercise ‘moral restraint’. The Conservatives’ draconian social policies also depend on the endorsement of divisive cultural prejudices and dehumanising views of poor and vulnerable citizens. 

The two-child policy is an indication of the government’s underpinning eugenicist ideology and administrative agenda, designed to exercise control over the reproduction of the poor, albeit by stealth. It also reflects the underpinning belief that poverty somehow arises because of ‘faulty’ individual choices, rather than faulty political decision-making and ideologically driven socio-economic policies.

Such policies are not only very regressive, they are offensive, undermining human dignity by treating children as a commodity – something that people can be incentivised to do without. This reveals the government’s  bleak and dystopic view of a society where financial outcomes override all other considerations, including human lives.

Conservatives’ two-child policy violates human rights

I wrote in 2015 about some of the implications of the two-child policy. Many households now consist of step-parents, forming reconstituted or blended families. The welfare system recognises this as assessment of household income rather than people’s marital status is used to inform benefit decisions. The imposition of a two-child policy has implications for the future of such types of reconstituted family arrangements.

If one or both adults have two children already, how can it be decided which two children would be eligible for child tax credits?  It’s unfair and cruel to punish families and children by withholding support just because those children have been born or because of when they were born.

And how will residency be decided in the event of parental separation or divorce – by financial considerations rather than the best interests of the child? That flies in the face of our legal framework which is founded on the principle of paramountcy of the needs of the child. I have a background in social work, and I know from experience that it’s often the case that children are not better off residing with the wealthier parent, nor do they always wish to. 

Restriction on welfare support for children will inevitably directly or indirectly restrict women’s autonomy over their reproduction. It allows the wealthiest minority freedom to continue having children as they wish, while aiming to curtail the poorest citizens by ‘disincentivising’ them from having larger families, by using financial punishment. It also imposes a particular model of family life on the rest of the population. Ultimately, this will distort the structure and composition of the population, it openly discriminates against the children of larger families . 

People who are in favour of eugenic policies believe that the quality of a race can be improved by reducing the fertility of “undesirable” groups, or by discouraging reproduction and encouraging the birth rate of “desirable” groups. The government’s notion of “behavioural change” is clearly aimed at limiting the population of working class citizens. And taking public funds from public services. 

Any government that regards some social groups as “undesirable”, regardless of the reason, and which formulates policies to undermine or restrict that group’s reproduction rights, is expressing eugenicist values, whether those values are overtly expressed as “eugenics” or not.

Article 25 of the Universal Declaration of Human Rights, of which the UK is a signatory, states:

  1. Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.
  2.  Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection.

An assessment report by the four children’s commissioners of the UK called on the government to reconsider imposing the deep welfare cuts, voiced “serious concerns” about children being denied access to justice in the courts, and called on ministers to rethink plans at the time to repeal the UK’s Human Rights Act.

The commissioners, representing each of the constituent nations of the UK, conducted their review of the state of children’s policies as part of evidence they will present to the United Nations.

Many of the government’s policy decisions are questioned in the report as being in breach of the convention, which has been ratified by the UK.

England’s children’s commissioner, Anne Longfield, said:

“We are finding and highlighting that much of the country’s laws and policies defaults away from the view of the child. That’s in breach of the treaty. What we found again and again was that the best interest of the child is not taken into account.”

It’s noted in the commissioner’s report that ministers ignored the UK supreme court when it found the “benefit cap” – the £25,000 limit on welfare that disproportionately affects families with children, and particularly those with a larger number of children – to be in breach of Article 3 of the convention – the best interests of the child are paramount:

“In all actions concerning children, whether undertaken by public or private social welfare institutions, courts of law, administrative authorities or legislative bodies, the best interests of the child shall be a primary consideration.”

The United Nation’s Convention on the Rights of the Child (UNCRC) applies to all children and young people aged 17 and under. The convention is separated into 54 articles: most give children social, economic, cultural or civil and political rights, while others set out how governments must publicise or implement the convention.

The UK ratified the Convention on the Rights of the Child (UNCRC) on 16 December 1991. That means the State Party (England, Scotland, Wales and Northern Ireland) now has to make sure that every child benefits from all of the rights in the treaty. The treaty means that every child in the UK has been entitled to over 40 specific rights. These include:

Article 1

For the purposes of the present Convention, a child means every human being below the age of eighteen years unless under the law applicable to the child, majority is attained earlier.

Article 2

1. States Parties shall respect and ensure the rights set forth in the present Convention to each child within their jurisdiction without discrimination of any kind, irrespective of the child’s or his or her parent’s or legal guardian’s race, colour, sex, language, religion, political or other opinion, national, ethnic or social origin, property, disability, birth or other status.

2. States Parties shall take all appropriate measures to ensure that the child is protected against all forms of discrimination or punishment on the basis of the status, activities, expressed opinions, or beliefs of the child’s parents, legal guardians, or family members.

Article 3

1. In all actions concerning children, whether undertaken by public or private social welfare institutions, courts of law, administrative authorities or legislative bodies, the best interests of the child shall be a primary consideration.

2. States Parties undertake to ensure the child such protection and care as is necessary for his or her well-being, taking into account the rights and duties of his or her parents, legal guardians, or other individuals legally responsible for him or her, and, to this end, shall take all appropriate legislative and administrative measures.

3. States Parties shall ensure that the institutions, services and facilities responsible for the care or protection of children shall conform with the standards established by competent authorities, particularly in the areas of safety, health, in the number and suitability of their staff, as well as competent supervision.

Article 4

States Parties shall undertake all appropriate legislative, administrative, and other measures for the implementation of the rights recognized in the present Convention. With regard to economic, social and cultural rights, States Parties shall undertake such measures to the maximum extent of their available resources and, where needed, within the framework of international co-operation.

Article 5

States Parties shall respect the responsibilities, rights and duties of parents or, where applicable, the members of the extended family or community as provided for by local custom, legal guardians or other persons legally responsible for the child, to provide, in a manner consistent with the evolving capacities of the child, appropriate direction and guidance in the exercise by the child of the rights recognized in the present Convention.

Article 6

1. States Parties recognize that every child has the inherent right to life.

2. States Parties shall ensure to the maximum extent possible the survival and development of the child.

Article 26

1. States Parties shall recognize for every child the right to benefit from social security, including social insurance, and shall take the necessary measures to achieve the full realization of this right in accordance with their national law.

2. The benefits should, where appropriate, be granted, taking into account the resources and the circumstances of the child and persons having responsibility for the maintenance of the child, as well as any other consideration relevant to an application for benefits made by or on behalf of the child.

Here are the rest of the Convention Articles.

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If you have been affected by the issues raised in this article then you can contact Turn2us for benefits advice and support, or BPAS for pregnancy advice and support, including help to end a pregnancy if that’s what you decide.

 

Related 

A brief history of social security and the reintroduction of eugenics by stealth

UN to question the Conservatives about the two-child restriction on tax credits

The government has failed to protect the human rights of children

European fundamental rights charter to be excluded in the EU withdrawal Bill, including protection from eugenic policy

 

 

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