As the government has now chalked up six defeats in the House of Lords for the proposed Welfare Reform Bill, it seems clear to everyone that however much the current system needs improving, the way they propose to do it leaves a lot to be desired.
Two stories came my way in the last week, which illustrate the absurdities of the process of awarding benefits, and the inbuilt contradictions, which seem designed to make life harder for those unfortunate enough to depend on financial assistance.
The name Debbie Purdy will no doubt be familiar to you in a different context: she is a redoubtable campaigner for changing the law on assisted dying. Now she is in the news for failing to pay part of her council tax: a simple choice, she says, between buying food or paying this bill. I suspect many of us would take the same decision in her situation. The kicker is that if her husband were to give up working, they would receive more financial support in addition to the Disability Living Allowance and Incapacity Benefit she is paid because of her terminal condition. The advice from the benefits office is that he should stop working, so that they could receive free council tax, help with mortgage interest and free prescriptions. We all know how positively beneficial it is to work – especially at a job you love, and as he is a music teacher, I hope I'm not making too great a leap in imagining that he finds satisfaction and pleasure in his work, as well, no doubt, as some welcome respite from the daily stress of living with the knowledge that his wife's condition will continue to worsen.
A system that doesn't just take away incentives to work, but positively encourages those with gainful employment to turn instead to welfare dependency, flies in the face of commonsense. Further, it is grossly unfair to push people into this situation, and then blame them for being there.
Compare and contrast with a young man who has suffered from total heart failure in his 20s, and is understandably anxious as his health is regularly being assessed and reassessed by non-medical personnel, to decide what benefits he may be entitled to. He also works, to the maximum safe limit of 20 hours a week, as he has been advised by his doctor. The authorities apparently believe that he should have a full-time job.
So, one man who has a job and wants to work is being told that it would be better for him not to do so, while another who is doing what the government says it wants to encourage, i.e. working within the bounds of what he can safely manage, is being pressured to do more, at the risk of his health and perhaps even his life.
The weekend saw the latest in a campaign of civil disobedience by disability rights activists, fighting to make the government rethink the welfare reforms. With support from Disabled People against Cuts and UKuncut, fifteen wheelchair users chained themselves together to block the road between Regent Street and Oxford Circus. The March for the Invisible highlighted the plight of those whose lives will be turned upside down by the proposed changes. With a third reading in the Lords on Tuesday, the Welfare Reform Bill returns to the Commons on Wednesday for final approval. Of course, the system needs to be changed, and resources concentrated on those who really need them. It would be a start if people with jobs weren't encouraged to give them up, in order to have enough money for food.
30 January 2012
23 January 2012
Health Lottery: What Price a Ticket?
Am I the only one who feels a bit queasy every time I see a poster in a shop window promoting the Health Lottery? Not, until recently, because of any opinions about the rival claims of this organisation and the National Lottery (in fact, I have only just realised that there are different operations going on here).
It just seems to highlight everything that is wrong, and probably going to get worse, about our national health service. If you Google for NHS lottery, you will get a mixed bag of results, some relating to the aforementioned game of chance, others to the variable health service available, depending on where you live.
To save us all the trouble of finding out for ourselves, the government has produced an NHS Atlas of Variation. If you assumed that someone with dementia would have access to the same treatment in Kent as Lancashire, you would be wrong. NHS funding for a care home place for someone who requires continuing care? Much less likely in the West Country than Northumberland. If you need bariatric surgery, the East Midlands is a better bet than East Anglia. These are just a few highlights. The analysis was based on 71 key indicators, including hospital admission rates, treatments that Primary Care Trusts choose to fund, mental health provisions, cancer treatments, etc, and it shows wide differences that cannot be explained by variations in patient illness or patient preferences.
Add to this recent stories in the media highlighting poorer treatment received from the NHS by people with learning disabilities, with dementia, and those with physical disabilities, and "health lottery" really does seem to sum it up.
During the past week, organisations representing nurses and midwives joined doctors in confirming their opposition to the proposed changes to the NHS: people at the sharp end seem unanimous in fearing that however well-intentioned, expecting GPs to take on commissioning of health services will make outcomes even more variable. As funding available for the NHS continues to be squeezed, and the private sector is allowed to take over those areas where they see scope for turning a profit, again, it will be the patients who pay the real price. Expect the recent spat between private cosmetic surgery clinics and the government about responsibility for putting right dodgy breast implants to be repeated multiple times, as entrepreneurial set-ups find the cost of dealing with unforeseen consequences unacceptably high.
Health Lottery indeed. Incidentally, the other Health Lottery is either a clever collaboration between 51 community interest companies (CICs) intended to generate more funds from the public for health-related causes, or an attempt to persuade people away from the National Lottery - which apparently gives a higher percentage of the ticket price to the causes it supports - thus reducing the amount of money available to good causes in general. There is some debate about the ethics of the situation, amongst MPs, third sector organisations, and other interested parties, including the Gambling Commission.
The bottom line, though, is that we all have a choice about which, if either, of the lotteries we choose to support. When it comes to the NHS, there is only one, and when we need its services, we really have very little choice in the matter.
It just seems to highlight everything that is wrong, and probably going to get worse, about our national health service. If you Google for NHS lottery, you will get a mixed bag of results, some relating to the aforementioned game of chance, others to the variable health service available, depending on where you live.
To save us all the trouble of finding out for ourselves, the government has produced an NHS Atlas of Variation. If you assumed that someone with dementia would have access to the same treatment in Kent as Lancashire, you would be wrong. NHS funding for a care home place for someone who requires continuing care? Much less likely in the West Country than Northumberland. If you need bariatric surgery, the East Midlands is a better bet than East Anglia. These are just a few highlights. The analysis was based on 71 key indicators, including hospital admission rates, treatments that Primary Care Trusts choose to fund, mental health provisions, cancer treatments, etc, and it shows wide differences that cannot be explained by variations in patient illness or patient preferences.
Add to this recent stories in the media highlighting poorer treatment received from the NHS by people with learning disabilities, with dementia, and those with physical disabilities, and "health lottery" really does seem to sum it up.
During the past week, organisations representing nurses and midwives joined doctors in confirming their opposition to the proposed changes to the NHS: people at the sharp end seem unanimous in fearing that however well-intentioned, expecting GPs to take on commissioning of health services will make outcomes even more variable. As funding available for the NHS continues to be squeezed, and the private sector is allowed to take over those areas where they see scope for turning a profit, again, it will be the patients who pay the real price. Expect the recent spat between private cosmetic surgery clinics and the government about responsibility for putting right dodgy breast implants to be repeated multiple times, as entrepreneurial set-ups find the cost of dealing with unforeseen consequences unacceptably high.
Health Lottery indeed. Incidentally, the other Health Lottery is either a clever collaboration between 51 community interest companies (CICs) intended to generate more funds from the public for health-related causes, or an attempt to persuade people away from the National Lottery - which apparently gives a higher percentage of the ticket price to the causes it supports - thus reducing the amount of money available to good causes in general. There is some debate about the ethics of the situation, amongst MPs, third sector organisations, and other interested parties, including the Gambling Commission.
The bottom line, though, is that we all have a choice about which, if either, of the lotteries we choose to support. When it comes to the NHS, there is only one, and when we need its services, we really have very little choice in the matter.
8 January 2012
Buffet Table or Boardroom - Greed Wins
Last week, I was hoping for some solidarity, to carry us through the toughest of times together. I'm not seeing much. My attention was hooked by an intriguing article in the Sunday Times about a Chinese engineer who has come up with an ingenious way of ensuring you can pile up the maximum amount of food at a "help yourself in one visit" salad bar. It was quite funny to begin with, reading about how he lays potato foundations, with a floor of carrot strips to hold encircling walls of cucumber slices, within which he can then pile a tall tower of the food he really wants to eat. How he manages to consume the three foot edifice is not revealed. I imagine it's messy.
The article also included tips on beating other guests to the choicest morsels at wedding and party buffets, using game strategy to select what you know the other person likes first, before moving on to your preferred choice, having ensured they can't have theirs. I guess that one depends on there not being too many gameplayers in the room, otherwise everybody just ends up with a plate of other people's favourite food.
In both cases, this was about grabbing blatantly more than your fair share of whatever resources are available - something that top executives have also proved themselves adept at, somehow managing to increase their already huge salaries by almost half, while the working population in general has averaged somewhere between a wage freeze and a 3% increase - if they have been lucky enough to keep their job. Bosses at Britain's biggest companies earn (well, are paid) 160 times the average remuneration, irrespective of how poorly they perform.
At the same time, reforms to disability benefits are widely recognised as being more about saving money than streamlining a complex and confusing system, and cuts to social care provisions have reached such a desperate pitch that alarm bells are being rung loudly and publicly by people working at the sharp end, appalled that an estimated 800,000 frail and vulnerable people are being left without the basic care that they need. As I have written before in this column, you don't need to be cruel to achieve elder abuse, you just need to allocate 15 minutes for helping a person to get up, get washed and dressed and eat breakfast. There isn't a way of doing all that is necessary in the time allotted, so inevitably corners will be cut and shameful choices made: for example, time to eat, or time to be helped to go to the toilet – you can't have both.
Everybody understands that we are in a difficult place, financially speaking, and we need to get used to the idea of managing with less. For some, this is an exciting challenge; an opportunity to explore new ways of living, working and interacting with others that are not focused on ever-increasing consumption. But for those who were only just getting by when times were good, whose care packages were just about adequate, any reduction is a disaster. And it is really hard to understand why it is necessary, when the people with the metaphorical sharp elbows still seem to find a way to grab more for themselves, whether at the buffet table or the boardroom.
The article also included tips on beating other guests to the choicest morsels at wedding and party buffets, using game strategy to select what you know the other person likes first, before moving on to your preferred choice, having ensured they can't have theirs. I guess that one depends on there not being too many gameplayers in the room, otherwise everybody just ends up with a plate of other people's favourite food.
In both cases, this was about grabbing blatantly more than your fair share of whatever resources are available - something that top executives have also proved themselves adept at, somehow managing to increase their already huge salaries by almost half, while the working population in general has averaged somewhere between a wage freeze and a 3% increase - if they have been lucky enough to keep their job. Bosses at Britain's biggest companies earn (well, are paid) 160 times the average remuneration, irrespective of how poorly they perform.
At the same time, reforms to disability benefits are widely recognised as being more about saving money than streamlining a complex and confusing system, and cuts to social care provisions have reached such a desperate pitch that alarm bells are being rung loudly and publicly by people working at the sharp end, appalled that an estimated 800,000 frail and vulnerable people are being left without the basic care that they need. As I have written before in this column, you don't need to be cruel to achieve elder abuse, you just need to allocate 15 minutes for helping a person to get up, get washed and dressed and eat breakfast. There isn't a way of doing all that is necessary in the time allotted, so inevitably corners will be cut and shameful choices made: for example, time to eat, or time to be helped to go to the toilet – you can't have both.
Everybody understands that we are in a difficult place, financially speaking, and we need to get used to the idea of managing with less. For some, this is an exciting challenge; an opportunity to explore new ways of living, working and interacting with others that are not focused on ever-increasing consumption. But for those who were only just getting by when times were good, whose care packages were just about adequate, any reduction is a disaster. And it is really hard to understand why it is necessary, when the people with the metaphorical sharp elbows still seem to find a way to grab more for themselves, whether at the buffet table or the boardroom.
2 January 2012
Disability Awareness Bites the Dust
Like the Prime Minister, I wanted to start 2012 with some positive
thoughts, but I'm finding it difficult. He appears to have given up on the Big Society - it certainly doesn't seem to get mentioned any more - and while I'd love to think that we will
discover some real solidarity, rather than becoming ever more fractious
and fractured as a country, there isn't yet much sign of it.
If you have a disability, you probably won't need me to tell you that nearly two-thirds of the population admit that they avoid contact with disabled people because they aren't sure how to behave around them. Disability awareness – once embraced with enthusiasm by organisations keen to show their commitment to equality legislation – now seems to have taken a giant step backwards, as recessionary worries replace more liberal attitudes.
A teenager with cerebral palsy has started an e-petition to make disability awareness part of the national curriculum, in a bid to reduce the bullying experienced by disabled children both in and out of school. It seems extraordinary that such a move should be necessary, when the automatic segregation of children into special schools is a fairly distant memory, and current generations must surely be accustomed to being around kids with a range of impairments?
As a society, we have managed to make racism unacceptable; why have we not achieved the same for disablism? Why should people with disabilities live with routine abuse, name calling, even physical assaults, simply because they are different? Unfortunately, the current financial situation has played into an increasing hardening of attitudes, with the same survey showing that nearly 40% view disabled people as a burden on society, and almost 30% resent what they perceive as extra support provided for those with disabilities.
Instead of being drawn together by shared adversity, people are searching for scapegoats, and apparently finding them in those who need more help to manage their lives. A constant drip-drip of media stories about benefit cheats and scroungers encourages the belief that disabled people are free-loaders, getting special advantages from their situation. Very little coverage is given to the additional costs of living with a disability, such as adaptive equipment, mobility aids, assistance from a carer, etc.
Unemployment is high, and inevitably affects those with disabilities disproportionately; interestingly, 85% of people surveyed felt that their employers could do more to create employment and promotion opportunities for disabled people. So people do seem to recognise that the odds are stacked against their disabled peers when it comes to finding jobs, yet still condemn them for needing benefits.
With the effects of many budget cuts still to come, financial pressures will only increase, and competition for scarcer resources is likely to exacerbate the situation.
If you have a disability, you probably won't need me to tell you that nearly two-thirds of the population admit that they avoid contact with disabled people because they aren't sure how to behave around them. Disability awareness – once embraced with enthusiasm by organisations keen to show their commitment to equality legislation – now seems to have taken a giant step backwards, as recessionary worries replace more liberal attitudes.
A teenager with cerebral palsy has started an e-petition to make disability awareness part of the national curriculum, in a bid to reduce the bullying experienced by disabled children both in and out of school. It seems extraordinary that such a move should be necessary, when the automatic segregation of children into special schools is a fairly distant memory, and current generations must surely be accustomed to being around kids with a range of impairments?
As a society, we have managed to make racism unacceptable; why have we not achieved the same for disablism? Why should people with disabilities live with routine abuse, name calling, even physical assaults, simply because they are different? Unfortunately, the current financial situation has played into an increasing hardening of attitudes, with the same survey showing that nearly 40% view disabled people as a burden on society, and almost 30% resent what they perceive as extra support provided for those with disabilities.
Instead of being drawn together by shared adversity, people are searching for scapegoats, and apparently finding them in those who need more help to manage their lives. A constant drip-drip of media stories about benefit cheats and scroungers encourages the belief that disabled people are free-loaders, getting special advantages from their situation. Very little coverage is given to the additional costs of living with a disability, such as adaptive equipment, mobility aids, assistance from a carer, etc.
Unemployment is high, and inevitably affects those with disabilities disproportionately; interestingly, 85% of people surveyed felt that their employers could do more to create employment and promotion opportunities for disabled people. So people do seem to recognise that the odds are stacked against their disabled peers when it comes to finding jobs, yet still condemn them for needing benefits.
With the effects of many budget cuts still to come, financial pressures will only increase, and competition for scarcer resources is likely to exacerbate the situation.
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