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Archive for the ‘Welfare’ Category

It is two months since the General Election and already the past feels like another country. Two parties who didn’t seem to agree on anything are now in government together – and between them they have somehow agreed that the National Health Service should be consigned to the dustbin of history. I don’t recall either party campaigning on this and I’m certain the British people didn’t vote for it. But make no mistake, that is what they are now proposing.

Ok, they have dressed it up a bit. They have talked about the essential principle of healthcare being free at the point of delivery, about curtailing “NHS bureaucracy” and handing power to GPs and patients. But the logical end of their plans is the break-up of the NHS we know and mostly love.  Handing commissioning powers to GPs may not sound that significant, especially if it is being taken away from the villainous NHS ‘managers’, but actually these reforms are the most significant since the NHS was created. Ironic too, given that the first thing Andrew Lansley promised was an end to “top down reorganisations”.

What is proposed is that £80 billion of public funding is handed to GPs, who will be asked to spend it commissioning local services.  They will replace Primary Care Trusts – statutory local bodies who currently carry out this commissioning work and are held accountable to a Professional Executive Committee of GPs, dentists and other clinicians. The vast majority of GPs – who may be great doctors  in most  cases, have no experience of buying services.  If you have tried to get an appointment with one recently, you will know they don’t have a great deal of time to spare. They are now expected to be able to plan, cost and commission NHS services in consortia with their fellow GPs – and act as “patients’ expert guides” through the NHS.  How on earth they will have the time to do this – never mind the skills or the inclination – is anybody’s guess.

Alongside this breathtaking proposal sits another – that hospitals should opt out of the NHS and become ‘social enterprises’, able to make a profit, set their own wage structures and develop partnerships with the private sector. It could be said the previous government opened the door to this by creating foundation trusts, but it is an astonishing development nonetheless. It means that we will have private contractors (GPs) commissioning services from ‘social enterprises’ – in effect private concerns – and presumably looking to private providers such as Humana, Virgin Healthcare and BUPA to provide the administrative, technical and accountancy support they will need. “The NHS” will in effect become a sort of central board, a regulator which oversees these business to business dealings. It will also mean that national standards become a thing of the past – already, vital patient rights are being removed, such as 18 week hospital waits, GP appointments within 48 hours and A&E services within four hours – and seemingly the right to see a specialist within two weeks of a cancer diagnosis. As ‘social enterprises’ team up with private providers to pick off the most profitable treatments, expect a postcode lottery the like of which we have never seen before.

If this was about tackling the much-vaunted economic deficit, it would be bad enough, but in fact it has emerged that the proposals will cost much more than they save over the next five years. These changes are driven purely by ideology – a belief in the ‘small state’ and opposition to the welfare state’s finest achievement. Nor is this just a Tory position – LibDems including Nick Clegg and David Laws have previously called for more private health provider involvement in the NHS.

A service on the scale of the NHS requires substantial management – in fact, a comparable private sector enterprise would probably have more people managing than the NHS does. Healthcare commissioning and healthcare pathways are complex business, and if you are to have a single national service with one set of standards, you need people to run it. The suggestion that GPs are these people is incredibly muddled – sure,  clinicians should have more say than they have perhaps traditionally had, but their skills don’t lie in planning, accountancy, monitoring or booking appointments. As one respondee said, if you go to a restaurant, you hope the waiter is good, but you don’t want him designing the menus.

But the government – cheered on by a slavering right wing press with its hatred of public sector workers – doesn’t see it that way. In fact, they don’t see it the way most British people do – the NHS retains a remarkable 90% satisfaction rate from patients. This is an administration which doesn’t believe in the NHS – it conflicts with everything they believe about the role of the state, which they think should be tiny. So not only do they want to scrap the NHS, they also want to wage war on welfare benefits, cut back on policing and allow parents to set up their own schools outside the state system. This government is going further in its opposition to the NHS and the public sector than even Margaret Thatcher dared. It is, in effect, abolishing it. If you believe in the NHS – and poll after poll says that a huge majority of Brits do – it’s time to stand up and fight for it.

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I n a previous life, I worked as a welfare rights adviser and eventually managed free legal advice services for carers and disabled people living in one of the poorest London boroughs.  Much, much of our work involved resolving problems with claims for Disability Living Allowance (DLA).

In my time I have been to tribunals for a woman with breast cancer who was undergoing chemotherapy (her condition fluctuated), a boy with ADHD who was in danger of causing significant harm to himself or one of his younger siblings if he wasn’t supervised all the time (his GP was an ADHD sceptic and gave him a vague report), a diabetic baby who needed blood tests every two hours and insulin injected accordingly (the decision maker argued that this was not significantly more care than you would have to give a baby of the same age), a housebound woman with arthritis and high blood pressure who used to pass out on her way to the loo at night (she had tried to put a brave face on during her medical assessment), numerous people with non-specific pain issues, numerous children with emotional and behavioural problems who don’t have a label (yet).

I also used to train volunteers in completing the forms.  Completing the forms was arduous, taking at least 3 hours at a time.  It was emotionally draining as it focused on what the person couldn’t do, not what they could.  It was repetitive.  The forms had to be signed by a professional, the professional would have to know the person well and the professional would need to know how to put things in the right way so that the decision maker would understand the extent of the difficulties.

The disabled person would have to include the name of any other specialists they had seen and the DWP would often write to them to get a report from them.  Disabled people would have to photocopy reams and reams of paperwork including statements from school, cardiology reports, psychology reports etc.

Most disabled people would have a home visit from a Dr working on behalf of the DWP.  I have seen it written on such a report: ‘Mrs  X was able to make me a cup of tea’!!!  The Dr would spend a very short amount of time with the disabled person before submitting their report and would often make judgemental statements about the housing conditions and so on.  In my experience, they often got it very, very wrong.

Ordinarily, I would be dancing a jig at the news that the government are planning on getting rid of the forms (although it seems this is now vague, and the initial forms are likely to remain as the first ‘filter’ for claims).  Those bloody forms are the bane of the lives of any disabled person, or any person caring for a disabled person.

I’m not dancing a jig though.  I’m really worried.  I find George Osborne’s words chilling:

That brings me to another universal benefit, Disability Living Allowance.

Mr Deputy Speaker, it is right that people who are disabled are helped to lead a life of dignity.

We will continue to support them, and we will not reduce the rate at which this benefit is paid.

But three times as many people claim it today than when it was introduced eighteen years ago.

And the costs have quadrupled in real terms to over £11 billion, making it one of the largest items of government spending.

We will introduce a medical assessment for Disability Living Allowance from 2013, which will be applied to new and existing claimants.

This will be a simpler process than the complex forms they have to fill out at present.

That way we can continue to afford paying this important benefit to those with the greatest needs, while significantly improving incentives to work for others

This is so breathtakingly ill-informed I’d be disgusted if a backbencher said it, never mind the Chancellor of the Exchequer during  a budget!

First off, DLA was introduced as a compensation to disabled people because they have a higher cost of living (and quite honestly, often ends up going to straight back into the coffers via charging for social services).  It is not an earnings replacement benefit, it stands alone!  It is not means tested or taxable and disabled people who work are able to continue getting payments.

Given that The Shaw Trust found out that between January and March 2009:

  • There are currently 1.3 million disabled people in the UK who are available for and want to work, that only half of disabled people of working age are in work (50%), compared with 80% of non disabled people
  • Employment rates vary greatly according to the type of impairment a person has; only 20% of people with mental health problems are in employment
  • 23% of disabled people have no qualifications compared to 9% of non disabled people
  • Nearly one in five people of working age (7 million, or 18.6%) in Great Britain have a disability
  • The average gross hourly pay for disabled employees is £11.08 compared to £12.30 for non disabled employees.

I think it would be fair to assume that disabled people are still experiencing a degree of discrimination in the workplace.  This needs to be tackled before cutting off disabled people’s money.

Further, the only benefit which is available to full time carers, Carers Allowance – paid at a woeful £53.90 per week, hinges on the disabled person getting either the middle or higher rate of the care component of DLA or Attendance Allowance (DLA for the over 65s).  Carers save the treasury the equivalent of a second NHS. If carers are forced back to work because their benefits stop, who provides the care to the disabled person?  The state.  I can assure you that this will cost far more than £53.90 per week.

According to Carers UK research, it takes carers an average of two years to identify themselves as a carer.  Carers are often isolated, and their own health suffers as a result of their caring responsibilities.  They are not caring for the sake of a bit of extra cash, many of them have to chose between food and heating.  They are caring because they love the person they care for.

It has since been reported that George Osborne is hoping that 1 in 5 claims for DLA will stop as a result of the new regime.  As he said in his budget speech, payments of DLA have quadrupled since it first began.  What he didn’t say is that the Disability Rights Commission estimate that between 40-60% of people who are entitled to DLA do not make a claim!  They either have not heard of it or do not think they would be eligible.

Around 50% of DLA claims are turned down.  Of these, around 50% go to tribunal, and most people win tribunals.  What does that tell you?

Of course there are people who claim benefits that they are not entitled to, but in the case of DLA, the bar is set so high, that it is actually really difficult to fake entitlement!  Unlike Incapacity Benefit, which by the way, does have a personal capability test, it is extremely rare to find cases where the DWP have wrongly assessed someone as needing DLA who doesn’t.

The new approach to DLA is going to hit some groups of disabled people much harder than others.  The mentally ill, those whose conditions fluctuate, those with hidden disabilities, those in denial about their condition.  I know this because I have seen it. I know it, so why doesn’t the cabinet?

Osborne closed his speech with these words:

The richest paying the most and the vulnerable protected. That is our approach.

I don’t believe that.  Do you?

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