The Political Policies of Poverty

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The Political Policies of Poverty

By Jayne Linney

Also published here

 A post on Think Left (I) highlights the problems faced by ‘hidden children , those young people who go under the radar because no one knows why they’re missing from school!

For me this raise questions about what happens when these young people leave school? My guess is they’re likely to find themselves joining the increasing number of ‘Hidden’ Chronically sick and disabled people.

There is an ever growing number of Societies most vulnerable  adults, who have been cynically and callously stripped of their financial independence via them being deemed ‘Fit For Work’ by the DWP, but who are unable to claim/fulfil the requirements for other State Welfare; this is up to 55% of those claimants, according to a recent study conducted by the DWP! (ii)

So what happens to the ‘Hidden’ ill and disabled? I can only hope they have family or another close network of people able, and willing, to support their basic needs of Shelter, Warmth, Food & Drink, & Affection. However even if they are fortunate to have access to such a network this then put them in the category of ‘Hidden Homeless’, forced to revert to being dependant  upon others.

There is yet another ‘Hidden’ group even within the ill and disabled, that is those of us with invisible disabilities, particularly fluctuating conditions such as ME, Fibromyalgia, Arthritis, and countless others. Living with widespread Chronic pain on a daily basis  is soul destroying; just imagine NEVER being comfortable, not in bed, sitting in your favourite chair, walking, or standing and you can begin to comprehend what it’s like, then imagine sharp, hot, shooting/radiating/stabbing  pains hitting any or even every muscle and joint and you begin to get the idea. We have better days where the pain and associated fatigue (because we don’t sleep well due to pain) is bearable and we might look OK, and we have bad days where everything you thought about before happens & all at once! I’m sure you can now accept, living like this has a major impact on our mental health also.

No one who is fortunate enough to not belong to our ‘Hidden’ group can understand what we feel like, if we’re lucky, we have family and,or an often small group of people who care about us enough, not to give up on us. Unfortunately the general public, and perhaps more importantly the DWP, frequently do not take the time to try and empathise, therefore those of us with ‘Hidden’ illnesses are more vulnerable than ever, to becoming completely dependent upon someone else. When we’re found ‘Fit’ for Work; we then often find ourselves deemed ‘Unfit’ if we try and claim Job Seekers Allowance!

So where does this leave ill and disabled people who do not have access to a financially able and willing person to support us? Logic can only force me to conclude of the 55% of people unable to claim any income from the State, some of them will end up actually ‘Homeless’, without anywhere to call home and subject to the obvious strains of existing  on the street.

It has to be bad enough to find yourself without a home, not knowing where (and if) the next meal will come from! But how much worse will it be for people already too sick and,or disabled, never mind the next meal just where would you get your medication from?

It sickens me that in 2012, the year of the London Paralympics; here in the UK, chronically ill and disabled people are fighting to maintain their independence, their homes and even their basic Human Rights as !

And just who is doing anything to stop this, the current Coalition Government has, without a mandate from the people, destroyed and continues to strip away resources from the Welfare State, choosing instead to pay private Companies millions of pounds to carry out this devastation. The opposition whilst starting to make noise about ‘unfairness’,concur the only way from the UK economy to be revived is to maintain the Cuts.

This series of Policies to decimate the Welfare State  has created a cycle of deprivation not seen for over 80 years and it is this bigger picture the UK people need to become aware of and quickly!

(i) https://think-left.org/2012/10/11/labours-welcome-helping-hand-for-the-hidden-children/

(ii) http://www.dailyrecord.co.uk/news/scottish-news/atos-scandal-benefits-bosses-admit-1344278

Labour’s welcome helping hand for the Hidden Children

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Andy Burnham’s comments on closer links between the Health Service and Education showed a welcome insight.  He pledges to overturn the privatisation of the Health Service and to give back control to local authorities.

“Local councils would take the lead in purchasing care and the NHS would be expanded so that hospitals offer social and mental health care under a Labour government, a dramatic rolling back of the coalition’s health reforms, Andy Burnham has said.”

From The Guardian (1)

“He also made it clear that local authorities would take the lead in commissioning that care, replacing the system of clinical commissioning groups where GPs are put in charge of buying treatments for patients. “It will take time, it won’t happen overnight, but I believe organisations will grow into that,” he said.

The changes represent an effective re-nationalisation of the NHS that would give hospitals and councillors a much bigger say in how the health service would run.”

Many people are unaware of the thousands of children missing from school.  Even teachers may not have an understanding of the reasons for absence. Today’s young children are pressurized by a curriculum driven by politicians, teachers striving to ensure their schools meets the targets of league tables.

The anxiety caused by extreme pressures such as this, or by the stresses of adolescence, by bullying rife in large, noisy schools  where lip service is given to  resolving bullying and teachers trained in policy, yet in practice it is very difficult to resolve, and so that the bullied child remains too frightened to attend school. Other children miss out on education because they are caring for an adult at home.

Speaking at a party conference fringe event, Andy Burnham argued that health and wellbeing boards could be the “best hope” for young people, who are losing out on early intervention to safeguard their mental health because of public services reforms.

Health and wellbeing boards are the best hope. I can’t think of any other forum that has the health responsibility but also that link in terms of the council’s other responsibilities,” he said.

He added that Labour-led councils were being encouraged to combine commissioning decisions over health and education wherever possible, to encourage early support for young people in schools and other children’s services settings.

“We’re getting them together in the same room to start talking about health and public health and starting to say, why don’t we all have a consistency in what we do? This needs to be on the education side as well,” he said.

From CYPNow: (2)

Some children are just too ill to attend school, many suffering chronic illnesses or fatigue. Forward thinking LEAs have provided specialist tutors and Tuition Centres to provide education for sick children. Sadly, the Coalition’s Education Policy is the break up of the Local Education networks. Centralised services have been cut. Academy Schools and Free Schools have no obligation to provide education for children suffering from EBSR (Emotionally Based School Refusal) (3) , or children with ME or chronic fatigue syndrome, or severely ill children (4).

Hidden children will just drop out of the statistics, to be forgotten about, the children no-one sees.  Anxiety which is not addressed may continue into adulthood.A lonely childhood can lead to depression, and life-long isolation. This demonstrates yet more ill-thought out policies from a government with no idea of the reality for anxious or ill children. Their privileged and distorted experience does not lend itself to providing solutions for health and education for the majority of people in this country. Lacking an education,  what prospects for employment and an independent life can these children hope for?

It is time we had some politicians in power who showed some empathy.  It would seem that Andy Burnham for one is showing he is in touch. How welcome that is!

1) Guradian : Andy Burnham: Pledges Reversal of NHS break up. (1)

2) CYP Now (Children and Young People Now) Andy Burnham calls on local areas to prioritise mental health in schools

3) Think Left: EBSR: Emotionally Based School Refusal

4) Think Left: Somebody help ME! (Children with ME/ Chronic Fatigue)

Other relevant posts:

Think Left: Consortia , not Academies

Think Left: Cinderella Services: Children Deserve Better.

Think Left: Integration or Inclusion

‘Positive thinking’ is a convenient tool for controlling the minds of the masses.

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Barbara Ehrenreich’s book ‘Smile or Die: How Positive Thinking Fooled America and the World’ was inspired by her anger at being told that she needed to have ‘positive thinking’ to rid herself of her tumour. As an immunologist, she knew only too well the scientific realities about her cancer… and she was rightly disgusted by the punitive assumption that failure to be cured would implicitly be her own fault for failing to be sufficiently ‘positive’.

This led her to consider the ramifications of ‘positive thinking’ and ultimately the use of the “American Dream’ as a tool for controlling the minds of the masses.

Tumours are a source of happiness. Accepting the laws of physics – or not – is a matter of personal choice. And getting the things you want is primarily a question of imagining what it will be like when they are yours (and perhaps berating God for not having provided them yet). This sort of patent idiocy would be disturbing enough if it lurked only on the wilder fringes of life in America, but, as Barbara Ehrenreich explains in her affronted, surprisingly cheering attack on positive thinking, mainstream culture is also riddled with its destructive tenets. Everything from health care to the global financial system has been infested.
http://www.newstatesman.com/books/2010/01/positive-thinking-ehrenreich

‘Positive thinking’ conveniently shifts the burden of responsibility onto the individual, and it is a tool that has been employed skilfully by the Tory/LD coalition, with help from the media.  The most obvious case, is in the denial of there being 5 times as many unemployed as there are job vacancies… and that is without taking into consideration the uneven geographical distribution of jobs.  In some areas, the ratio is 25+ unemployed people for every vacancy.  Yet the government spins persistently about benefit scroungers, shoddy state education, the ‘wrong’ attitude… and variously punishes the ‘workshy’ for not ‘thinking positively’ enough to find a non-existent job.

Essentially, the focus is placed on the inherent characteristics, or capabilities, of the individual, and is deflected away from any external conditions.  In psychology, this comes under the heading of attribution theory.  It is suggested that the observer is more ‘comfortable’ believing that the subject slipped on a banana skin because they are inately clumsy, rather than to face the potential risk that they too might inadvertently slip on an unseen banana skin.  Hence ‘benefit scrounger’ is a powerful piece of spin which taps into a feature of the human psyche.  It is preferable to believe that others are unemployed because they are workshy, rather than face personal fears about the impact of the double-dip recession and economic meltdown.

Another highly pernicious example of the misuse of attribution theory, is in the redefinition of illness which underpins the Welfare Reform bill.  The Biopyschosocial model proposes:

… disease is the only objective, medically diagnosable pathology. Sickness is a temporary phenomenon. Illness is a behaviour – ‘all the things people say and do that express and communicate their feelings of being unwell’ (p39). The degree of illness behaviour is dependent not upon an underlying pathology but on ‘individual attitudes and beliefs’, as well as ‘the social context and culture in which it occurs’. Halligan and Wade are more explicit: ‘Personal choice plays an important part in the genesis or maintenance of illness’.

In other words, disease has concrete, physical aspects that can be demonstrated by medical tests.  Sickness is something like a cold which is self-limiting and from which you recover.  But ‘illness’ is a sort of psychological delusion mediated by the individual’s worldview and a ‘wanting to believe themselves to be ill’. Hence, the problem of being ‘ill’ is firmly located in the individual, and their beliefs and behaviour become the focus of moral judgment and action ie. scroungers, benefit cheats, malingerers, lacking in moral fibre, ‘learned helplessness’ and other such punitive terms.(1)

Thus, many of those with disability and long-term chronic illness are considered to be simply lacking ‘positive thinking’… and, therefore, the horrors of a Work Capability Assessment is justified by government. (2)  However, the reality is that this is a cynical means to reduce the benefits bill and put the UK on route to a two-tier US style of insurance-based welfare provision.

Barbara Ehrenreich suggests that the ‘American dream’ is the reason that ordinary Americans have not challenged the ‘upward redistribution of wealth by cutting taxes for the wealthiest, and in subtle ways, raising them for the poorest and for the middle class…  It’s a grab. It’s—I’m waiting for people to get really, really angry about it. I think one thing that has held back Americans is the idea that you’re going to get rich, too, you know? That magically, “Hey, I might be one of those multimillionaires next,” so that I don’t want to tax rich people.’  Barbara Ehrenreich: America’s Tragic Decline — Resistance Bursts Out All Over the World, While We Do Nothing to Fight Corporate Takeover August 8, 2011

To paraphrase Gramsci … in order to resist the mind control, we need to try and see the world as it really is – not as we want or fear it, to be.  Barbara Ehrenreich concurs by reiterating that we need ‘Realism’ not the magic of ‘Positive Thinking’.

RSA Animate – Smile or Die

Uploaded by theRSAorg on Mar 17, 2010
Acclaimed journalist, author and political activist Barbara Ehrenreich explores the darker side of positive thinking.

(1) https://think-left.org/2011/08/04/welfare-reform-and-mecfs/

(2) https://think-left.org/2011/11/22/welfare-reform-and-the-us-insurance-giant-unum/

The NHS Bill, ME/CFS and Professor Pinching’s Farewell message

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Call your LibDem MP today and tell them how you feel about the NHS changes.  http://www.38degrees.org.uk/

The NHS and Social Care Bill, returns to the Commons today, and in the words of Michael Meacher MP ‘must be the most cynical, manipulative and dishonest of any bill in modern times’.

 It was sprung on an unsuspecting nation after an election in which no mention was made of it in any manifesto and an air-brushed Cameron ad had assured the country “I will cut the deficit, not the NHS”.   There has been no Commission of Inquiry to examine its philosophy or ideology in depth.   There is no proposal to pilot it before it is imposed full-scale on the health service.   The committee stage of the bill was rammed through with hardly a dot or comma changed.   After the ‘pause’ enforced by public and medical opposition, the altered bill is not being returned to the Committee to consider the changes.   There are now 1,000 amendments to it, to be debated in 12 hours.   And to cap it all, the Dorries-Field amendment on abortion counselling will probably absorb 2-3 hours even of this miserably truncated period for scrutiny.   Clearly several hundred amendments will never even be reached. (1) 

 

In spite of the fine words, the bill remains pretty much intact and can only be intended to open up the NHS to plunder by the transnational private health care and management consultancies.  As Dr Max Pemberton wrote (Telegraph 25.07.11) “ There is no doubt that this signals the first wave of privatizing the NHS”.  It is opposed by all the different professional bodies, many of whom are calling for the bill to be withdrawn.

One of the more alarming proposals in the Bill, is that it removes the responsibility of the Secretary of State for Health for providing a comprehensive health service, free at the point of delivery, and answerable to Parliament for all aspects of the service.  Significantly, it allows private companies to buy and asset-strip NHS facilities.

The people who stand to lose most from the proposed changes are those with long-term illnesses such as ME/CFS.  In the words of the charity ReMember:

In a competitive market you can’t make money out of the long-term sick and services for them could be dropped altogether’ (2)

This is confirmed by a quote from UnumProvident, a private health insurance company who has been advising governments since the 1990s (3).

Unum’s 1995 ‘Chronic Fatigue Syndrome Management Plan’ sounded the alarm: ‘Unum stands to lose millions if we do not move quickly to address this increasing problem’

The NHS changes coupled with the changes to the benefit system makes this a worrying time for people with disability and long-term illness. ME/CFS services are facing cuts to an already patchy and inadequate service.  The Romford Unit, the only in-patient NHS provision for ME has been closed.  The Sussex Wide CFS service now only sees 4/5 patients a month in spite of 400 referrals in 2010.  Child ME/CFS sufferers in Sussex, who used to be referred to The Royal Alexandra Hospital for Sick Children, will no longer be eligible unless they live within the Brighton and Hove PCT catchment area.  Similar changes to the service are occurring nationally and the ‘postcode lottery’ will become entrenched.

It gets worse.   We now learn from emails leaked at the last minute that some 10-20 hospitals are already earmarked to be handed over to the big German corporate outfit Helios – and how many others are already in the pipeline but they haven’t yet been disclosed? … EU competition law or not, would France or Germany conceivably sell off the foundations of their health services to foreigners?

Now the former chief executive of the NHS has just announced that the next aim is to close hospitals.   Waiting lists are already mounting up, and new conflicts of interest are already appearing.   From a dishonest and mendacious government that promised to protect and defend the NHS, this bill is surely the ultimate scam. (1)


(1) http://www.michaelmeacher.info/weblog/

(2) reMEmber (The Chronic Fatigue Society)

http://www.remembercfs.org.uk

(3) https://think-left.org/2011/08/04/welfare-reform-and-mecfs/

By kind permission of reMEmber we reproduce the powerful and moving farewell message of Professor Tony Pinching who is retiring after 30 years.  His message includes his assessment of how the benefit system has treated his patients suffering from ME/CFS. http://www.remembercfs.org.uk

Farewell.

From Professor Tony Pinching

So it is now time, as I retire, to bid you goodbye. By October, I shall have stoped clinical and academic work completely. The Beatles sang about my last birthday, so this is the usual time for transition, and being a clinical academic, I am stopping after academic year end. My career has been very fulfilling, but also very demanding – with far too little time and energy for my interests outside medicine and academic life. I encourage patients to look at work-life balance, so I thought that I should check it out myself! I have definitely done the work, but would like to do more “life” whilst I am able.

Over the years, my work has included: studies on how the brain processes the sense of smell (my first scientific paper was published 42 years ago!); studies on how myasthenia gravis – a different condition of weakness and fatiguability – is caused through autoimmunity, and how that changes the approach to treatment; understanding the nature and treatment of systemic vasculitis, in which there is inflammation of blood vessels, with widespread impact on body functions; understanding, diagnosing and treating different sorts of immune deficiency, congenital and acquired, including that induced by treatments; responding to the emergence of HIV and AIDS, as a new and very challenging immune deficiency, from the earliest years, clinically and scientifically, but also in public policy and public understanding; and, of course, clinical, scientific and policy work on CFS/ME.  These last two areas have been the main focus of my career for nearly thirty years.

As a clinician and scientist, it has been an extraordinarily full and enriching career. I have learnt a lot about people, and about how things work (or don’t!). There remain many frustrations about what we still don’t know or can’t do. But I have tried to remain pragmatic and work with what we do know and can do, whilst trying to extend the boundaries. As a clinical scientist, I have always been nurtured, informed and inspired by my patients and what they tell me. I have tried to do my best to help, but I have been keenly aware in many respects how little that is for people facing the adversity of disease and its effect on their lives. I am sorry that I will at times have fallen well short of people’s reasonable expectations. But for some, I hope that I have been a useful “mountain guide” through the treacherous terrain of illness.

What will I miss? Above all, I shall miss my patients and the opportunity to work with them on their life’s journey, helping them to see how they can make sense of themselves and the world, as revealed by the unwelcome intrusion of disease. I shall miss that sense of extraordinary resilience that people can show in the face of adversity and loss, gaining fresh perspective and inner strength, whilst they make progress in whatever way is feasible, often supported by very special family or friends as carers. I shall miss many fine colleagues, whose guidance and support, professionally and personally, have made my work more effective and satisfying, not least because they are able to do many things that I can’t do. I shall also miss the many individuals and organisations – such as Janice Kent and ReMEmber – who make such a difference in supporting people affected by disease, whether as patients, carers, family or friends. Above all, I shall miss the whole challenge of clinical medicine, professionally and personally – most especially the privilege and responsibility of getting to know and care for someone at a most difficult time in their lives.

What won’t I miss?! Sadly, some of the social responses to illness and those affected – evident with both CFS/ME and HIV/AIDS – show some of the less appealing characteristics of humankind: wilful ignorance, prejudice, stigma, neglect and blame still add to the personal burden of disease, as if that wasn’t enough in itself. I also shall definitely not miss the conflicts of the ME field – often bitter, misjudged and personalised. Whilst I do understand something of why this terrible civil war is still being waged, I am profoundly disappointed by the inability or unwillingness of some of the key protagonists to move on. Some seem locked into disputes that are about past hurts and misunderstandings. I have seen at first hand how one’s views and statements can be deliberately misrepresented.

I will definitely not miss having to deal with the benefits system, with the terrible injustices and misrepresentations that I increasingly see visited upon the ill and disabled. The systems and some of the people who work in them have lost sight of why they are there – to help support those people in society who are vulnerable through illness. Sadly, as a result of political and media rhetoric, and misapplications of poorly thought through processes, everyone seems to be regarded as if they are trying to cheat the system. Self-evidently erroneous (eg judging by success at appeal) and often perverse decisions – about DLA and especially ESA – are being made, in which the accounts by the patient, their carers and clinicians are being ignored in favour of superficial, brief and formulaic “medical” assessments that seem determined to ignore the everyday realities that patients know. These cause unnecessary upset, exacerbate the improverishing effect of illness, and often cause health setbacks.

So what am I going to do with my time and energy now? I plan to spend more time on music – playing (clarinet) and listening – and looking at ways in which music can enrich our lives, including continuing support for music therapy and starting some new projects with professional musicians. Having enjoyed working with a theatre company – Theatrescience (including plays on HIV/AIDS, CFS/ME and dementia), I shall continue to offer my guidance while it has any utility. I want to read more and do some more creative writing. I shall enjoy pottering in the garden and getting it into better order! I would like to travel too, as there are important places still to see. My children have all grown up into very interesting people, whom I want to be with some more, as well as three young grandchildren and wider family.

I do also wish to reflect on my extraordinarily diverse career and experiences, and see if there is something new to say, and write, about medicine and about being a doctor. I will still be a doctor, I just won’t be do-ing doctoring! I often remind patients that “we are human beings, not human doings!” – we can still be ourselves, even if the way we act may have to change as a result of changed circumstances.

As I bid you farewell, I am very conscious of the beautiful and heart-wrenching Farewell that Wotan sings to his favourite daughter Brunnhilde at the end of Wagner’s Die Walkure (The Valkyries), which I heard a few days ago at the St Endellion Festival. This might not be your cup of tea, but just imagine! It is full of profound love and pain, as well as regret about how some things came to be. As he is obliged to leave her on a rocky mountain-top, he surrounds her with a ring of fire – to protect her until the arrival of a true hero, who will rescue her.

So I say a fond farewell to you all, at least in a similar spirit, wishing that you and everyone affected by CFS/ME be surrounded by a metaphorical ring of fire that can protect you, until someone or something arrives to free you from the rocky place where you find yourself. Farewell!

 

Read also Labour’s Finest  https://think-left.org/2011/07/25/labours-finest/

Welfare Reform and ME/CFS

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(The word ‘parasitic’ is frequently used to describe all sorts of people and behaviour from benefit claimants to tax havens.  So it seemed appropriate to ask an expert. The interview began by asking a retired parasitologist for a definition of a parasite.  After a lot of head scratching, the parasitologist agreed for the purposes of this interview, to define a parasite as 1) an organism that lives in or on another organism (its host) and benefits by deriving nutrients at the host’s expense, or 2) a person who habitually relies on or exploits others and gives nothing in return.)

 

Interviewer:  So, you say that you think that the study of parasites should be taught in schools as a core subject. Why is that?

Parasitologist:  I would have thought that the answer was obvious but since you ask, I will spell it out.  The majority of people seem to comprise a host population, and the few, form ‘a power elite’, who could be viewed as essentially parasitic on the majority.  Like most parasites, they are a ‘hidden’ group.  There seems to be an unwritten rule that the ‘power elite’ collude with each other to maintain a silence about their connections, and to protect each other’s interests.  Hence, the majority needs a knowledge base about parasitism for self-protection.  For me, the most significant feature of Nick Davies’ Guardian expose of the phone hacking scandal was that it made overt the links between the upper echelons of the police, the media, the politicians and the interests of neoliberal capitalism.  Doubtless, this temporary exposure will be short-lived and soon forgotten.

Interviewer: Can you give me an example of how it would be protective?

Parasitologist:  In order to demonstrate the usefulness of parasitology, let me tell you about a fluke parasitic in freshwater fish. The cercariae (swimming infective stages) mimic a favourite fish food, mosquito larvae … you know the wriggly things that you can see in pools of still water.  The fluke larvae not only look like mosquito larvae, but can also exaggerate the mosquito style of movement, and are larger than most mosquito larvae.  Any fish seeing ‘super-mosquito’ would do well to stop before eating it and ask why the ‘mosquito larva’ looks so ‘super’.  Is it really a mosquito mutant destined for rapid extinction or does it have some investment in being eaten?

The majority, the human ‘host’ population, is also offered all sorts of tempting morsels that we are invited to ‘swallow’ but which will infect us to our collective detriment … the Big Society and Evidence-Based Medicine immediately spring to mind, but there are many other examples.

Interviewer:  I see what you mean about the Big Society, which seems to be nothing but a cover for privatization of public services … a money-spinner for the city and the private care providers … but I don’t understand about Evidence-Based Medicine (EBM).  Surely, you as a scientist would be in favour of treatments being researched and evidenced?

Parasitologist:  Indeed I would, if that were the purpose of EBM…. I would of course want to mention the inbuilt caveats about any scientific research.  That we do not begin to know everything and that the current theory is only good until …

Interviewer But what do you think the real purpose of EBM is then?

Parasitologist:  Oh … it is for the private health insurance companies.  EBM is a way of controlling and de-skilling doctors, which is necessary in order to limit health insurance company pay-outs for patients… or in the case of government to limit the NHS and benefits bill. Strangely we, the ‘host’ population, never question the government line that the benefits bill is too high.  Strange, because in 2003, the OECD reported that Britain’s benefits gateway was ‘one of the toughest in the world’ (1).  It is the equivalent of not questioning whether a ‘super-mosquito’ larva is really a mosquito.

Interviewer I cannot get my head around this … surely it is in everyone’s interests to integrate the science and every bit of medical expertise to create the best possible outcome for patients.  Surely, the population overwhelmingly wants to support and protect people if they are ill, or have some vulnerability?

Parasitologist:  Come now, do you really think that the Welfare Reform bills of New Labour and now the Coalition, address anything to do with medical science or the realities of living with a disability, a long-term illness or a mental health problem?  I can assure you that any such reform would bear no resemblance to the current proposals.

In fact, the introduction of EBM was only partially effective in stopping doctors diagnosing inconveniently expensive long-term disorders like ME/CFS.  From the government’s point of view, too many individuals were still qualifying for benefit support.  So, in July 2006, Uber-blairite John Hutton published a second Welfare Reform Bill.

The aim was to radically reduce levels of worklessness amongst single parents, older citizens and those on Incapacity Benefit (IB), and a target was set of an 80 per cent employment rate amongst working age adults. (1)

Pathways to Work was rolled out across the country in 2008.  Mansel Aylward’s Personal Capability Assessment (PCA) replaced the ‘All Work Test’, and the task of administrating the PCA was contracted out to the US corporation Atos Origin who use a computer system, Logical Integrated Medical Assessment (LIMA), which neatly side steps any inconvenient medical opinion.  Unsurprisingly, a computerized tick-list compiled by medically untrained staff, consistently fails to adequately assess the complexity of patient’s needs, and 50% of appeals against claims refusals are won by the claimant.

InterviewerI still do not understand. Why would all this be happening?

Parasitologist:  I think you are forgetting what you just said about the real purpose of the Big Society which is to privatize public services … well, what other reason could there be for Lansley’s health reforms or the Osborne cuts to what used to be called incapacity benefits? They are simply to facilitate a two tier health provision with anyone who can afford it opting for a US style insurance based health care provider.  EBM is a necessary pre-condition for the private health, private health commissioners, private employment insurance and private welfare service providers; and of course it is implicit in the underlying assumptions of the bio-psychosocial model of ‘illness’.  The bit that amuses me, is that there is no research evidence that evidence-based medicine is more effective … so evidence-based medical practice is not evidence based!

InterviewerThe ‘what’ model of illness?

Parasitologist:  The bio-psychosocial model.  I can see that I’m going to have to teach you some history before you will fully understand.

It all dates back to that fateful day in 1979, when Margaret Thatcher came to power. In fact, most of our present problems date back to that woman!  She swept aside the old economic order and implemented the crazy de-regulation of the markets proposed by the maverick economist Friedman (2) which ‘set the parasites free’.  Globalisation and neo-liberal capitalism have since become the ‘norm’, the unquestioned assumption of our politicians and media.  Every issue is framed as if ‘there is no alternative’…. this is the collusion of the ‘power elite’.  Unsurprisingly, the ‘host’ population, particularly the younger generation have been indoctrinated by this ‘false consciousness’ because no other views are ever considered by the mainstream purveyors of information.

The most important piece of legislation was the GATS treaty, which was set in motion by the Thatcher government, but finally signed in Uruguay, in1994, by the Major government.  This created legally binding global rules to ensure free competition between different nations.  Significantly, the US private health providers and insurers complained that there was not a level playing field because they were not able to gain access to the trillions of dollars that were spent in the different national health and welfare systems that operated across Europe and the UK… Hence, a gradual process of breaking down and breaking up of the UK’s welfare state was begun.  It was recognized that the public would not accept a fast and radical privatization of the popular NHS and public services, particularly on top of the selling off of the nationalised industries, so a stealth, hidden agenda was implemented.  The introduction of a ‘market’ into the NHS, legislation requiring councils to outsource services and so on, were all part of the ‘softening up’ process… a deliberate ‘worsening’ of the NHS and its financing, so that privatization could be justified (3).

There were hopes, in 1997, that New Labour would reverse these trends but it is now generally accepted that the ‘Third Way’ was little more than a thinly veiled front for an accommodation with Thatcherism, and a continuation with increasing privatization (4).

The ‘tasty’ morsels offered to the public by New Labour were in terms of ‘choice’… whereas the Tories vacillate between ‘the dire economic position’, the Big Society and ‘freedom to choose’…. but it is all part of the same process of ‘hiding’ the real agenda which is the opening up of public services to facilitate enormous profits for transnational companies and global management consultancies.  Furthermore, public services that will be underwritten by the UK government … privatization of profit and socialization of the risk.

Going back to New Labour and their Welfare Reforms …

InterviewerStop!  How do you know all this?

Parasitologist:  Oh lots of sources …  as you know I have kept up with the ME patient’s groups over the last 22 years and they have been a particular target group for these reforms but a good overview is Jonathan Rutherford’s Soundings article (1)  ‘New Labour, the market state, and the end of welfare’ (2007).

Interviewer The Jonathan Rutherford that is tied up with Blue Labour and James Purnell? James Purnell, the former Secretary of State for Work and Pensions, who proposed charging the unemployed and pensioners huge amounts of interest on ‘crisis’ loans, and who has recently taken up a senior post in Boston Consultancy to advise private companies in taking over public services?

Parasitologist:  Yes, I believe that is so … but as I have already said the ‘power elite’ all know each other.  They are employed by and employ each other.  Many have known each other since their Oxbridge days.  So Professor Wesseley, who is so rabidly set against there being a physiological basis to ME/CFS, is married to Claire Gerada who worked for the Department of Health but who is now Chair of Council for the Royal College of General Practitioners.  Mansel Aylward, a friend of Wesseley, was Chief Medical Officer at the DWP but is now the Director of the £1.6m UnumProvident Centre for Psychosocial and Disability Research at Cardiff University. Unum Provident (now known as Unum) were brought in by the Major government, as consultants on reducing the numbers of Incapacity Benefit claimants, but are now also a major funder of the think-tank ippr, whose current Chair is James Purnell.  Unum also fund Demos, another think tank active in producing consultative papers on welfare reforms (5). I could go on about the breadth of Unum’s influence in all these spheres but let me read you the first paragraph of Rutherford’s article (1).

In November 2001 a conference assembled at Woodstock, near Oxford. Its subject was ‘Malingering and Illness Deception’. The topic was a familiar one to the insurance industry, but it was now becoming a major political issue as New Labour committed itself to reducing the 2.6 million who were claiming Incapacity Benefit (IB). Amongst the 39 participants was Malcolm Wicks, then Parliamentary Under Secretary of State for Work, and Mansel Aylward, his Chief Medical Officer at the Department of Work and Pensions (DWP). Fraud – which amounts to less than 0.4 per cent of IB claims – was not the issue. The experts and academics present were the theorists and ideologues of welfare to work. What linked many of them together, including Aylward, was their association with the giant US income protection company UnumProvident, represented at the conference by John LoCascio. The goal was the transformation of the welfare system. The cultural meaning of illness would be redefined; growing numbers of claimants would be declared capable of work and ‘motivated’ into jobs. A new work ethic would transform IB recipients into entrepreneurs helping themselves out of poverty and into self-reliance. Five years later these goals would take a tangible form in New Labour’s 2006 Welfare Reform Bill.

 

I should also add that Rutherford is not an uncritical associate of Purnell.  In 2008, he wrote in the Guardian (6) :  ‘James Purnell’s reforms of incapacity benefit are inspired by a US company with vested interests and a murky record. Now, that’s really sick.’

InterviewerOK I get the picture … All of these people are inextricably linked socially and/or financially and sit on each other’s committees advising each other… and also with the overarching influence of UnumProvident (who I’ve never heard of?).  Where does the Biopsychosocial model fit in?

Parasitologist:  Well done for remembering that mouthful.  This is the aspect that gets a bit creepy … George Orwell was prescient in so many ways. … ‘The cultural meaning of illness would be redefined’ could be straight out of ‘Animal Farm’.

In the early 1990’s, the ‘problem’ for private income protection schemes such as those of UnumProvident’s, was the growth in doctor’s diagnosing long-term illnesses with no clear biological markers or ‘cures’ … Fibromyalgia, Myalgic Encephalomyelitis (ME), Chronic Pain, Lyme Disease and so on.

Unum’s 1995 ‘Chronic Fatigue Syndrome Management Plan’ sounded the alarm: ‘Unum stands to lose millions if we do not move quickly to address this increasing problem’  (1)

 

Fortunately, there were psychiatrists and academics on hand, happy to draw on their moral authoritarianism and neo-liberal policy prescriptions (and unmentioned links with Unum) to produce a monograph, The Scientific & Conceptual Basis of Incapacity Benefits (TSO, 2005, Waddell and Aylward) which was published by the DWP, and provides the intellectual framework for the 2006 Welfare Reform Bill (1).

… disease is the only objective, medically diagnosable pathology. Sickness is a temporary phenomenon. Illness is a behaviour – ‘all the things people say and do that express and communicate their feelings of being unwell’ (p39). The degree of illness behaviour is dependent not upon an underlying pathology but on ‘individual attitudes and beliefs’, as well as ‘the social context and culture in which it occurs’. Halligan and Wade are more explicit: ‘Personal choice plays an important part in the genesis or maintenance of illness’.

In other words, disease has concrete, physical aspects that can be demonstrated by medical tests.  Sickness is something like a cold which is self-limiting and from which you recover.  But ‘illness’ is a sort of psychological delusion mediated by the individual’s worldview and a ‘wanting to believe themselves to be ill’. Hence, the problem of being ‘ill’ is firmly located in the individual, and their beliefs and behaviour become the focus of moral judgment and action ie. scroungers, benefit cheats, malingerers, lacking in moral fibre, ‘learned helplessness’ and other such punitive terms.

InterviewerThat is terrible!  That must exclude any type of mental health problem … and what about sufferers from ME/CFS?  There are no biological markers for ME are there?

Parasitologist:  Well no there aren’t … but then there has been no MRC (Medical Research Council) research funding to find markers either.

InterviewerWhat!!!

Parasitologist:  The research that has been undertaken is all predicated on the assumption that ME/CFS is some sort of psychological somatoform disorder which adversely affects all 250k UK sufferers.  Look this is an enormous subject in its own right and I think that I have to be getting along home.  Suffice it to say that there is a huge body of international research, which indicates the physical nature of ME/CFS, but it has been ignored by all three medical Royal Colleges, NICE and the MRC to the detriment of ME/CFS sufferers for the last 20 or more years.  I remember a Harvard Professor likening severe ME/CFS to the terminal stages of heart failure … that is the scale of how shocking the situation really is, although I do detect slight chinks of doubt beginning to appear in the medical profession.

InterviewerThis is unbelievable!  Before you go … are there any more parasitological observations that would be useful?

Parasitologist:  Of course… my particular concern is that when a parasite becomes ‘too successful’ and overwhelms the ‘host’… both become extinct.  In my opinion, this is the very real danger of the present acceleration in privatization and lack of regulation.  On a more positive note, parasites are thought to have ‘fueled’ evolution, in that there is a selection pressure for the host to evolve strategies to avoid being parasitized.   In the meantime, I look forward to the day when the majority becomes sufficiently ‘immunized’ to reject neo-liberal capitalism.

(1)   http://www.lwbooks.co.uk/journals/articles/rutherford07.html

(2)  https://think-left.org/2011/07/21/red-labour-must-address-the-elephant-in-the-room/

(3) Pollock, A.M. (2004) ‘NHS plc – The privatisation of our health care’  publ. Verso, ISBN 1-84467-539-4

(4)  http://www.essex.ac.uk/ecpr/events/jointsessions/paperarchive/grenoble/ws6/barry_paterson.pdf

(5)  http://www.demos.co.uk/files/Mutual_benefit_-_web.pdf?1299256527

(6)  http://www.guardian.co.uk/commentisfree/2008/mar/17/epluribusunum