Left Behind

By DeusExMacintosh

Please excuse this extended exercise in textual analysis. I’m quoting from a form letter which was the response to a constituent’s enquiry by Maria Miller, the minister for disabled people:

I believe that the Government owes a duty to disabled people to promote their independence and equality and I also believe that it has a duty to ensure that it has the right governance in place to deliver this support efficiently and sensibly.

As you may be aware, the Government is replacing Disability Living Allowance (DLA) with the Personal Independence Payment, to ensure this help is targeted at those disabled people who face the greatest challenges in a fairer, more consistent and sustainable manner.

DLA is currently a poorly targeted and unsustainable benefit. However, the Government has made it clear that it is steadfast in its support for the principles of DLA, as a non-means-tested cash benefit contributing to the extra costs incurred by disabled people. It is only right that support should be targeted at those disabled people who face the greatest challenges to leading independent lives and this reform is required to enable that, along with a clearer assessment process.

The emphasis if mine. This is the same point thrown at my local MP, Sheila Gilmore {Labour) in Parliament as part of the “we’ll get into the details later” discussion of the Welfare Reform Bill last month. Don’t you believe that support should be targeted at those in most need?

Surprisingly, the reasonable answer to that may be no.

As regular readers of my recent columns you will now be aware that disability has a vast range of impairment levels, depending almost as much on living environment and economic status as the actual biological condition you have. In almost all cases, it gets in the way – that’s the “disabled” bit. Some people have the economic or social resources to mitigate the worst of its effects on their day to day life, others can only hope to achieve “less bad” outcomes and in the past the government acknowledged this range by providing Disability Living Allowance towards the ‘extra expenses’ of disability that citizens incur regardless of their economic status or whether they are in or out of work. There were two rates of payment for Mobility needs (literally, moving around), and three for Care needs (concentrating on things like cooking and personal care with toileting and/or bathing).

I won’t go into the PIP negotiations in depth – you can find the new descriptors here with the confidence that what you see is pretty much what we will get. There’s precious little “negotiation” actually going on with the Department for Work and Pensions – the only real delay comes in maintaining a seemly rate of revelation about the details, which have clearly been decided in advance. Basically, the need for safety supervision is going and that means that people like me who would previously have qualified for the Highest levels of both Mobility and Care DLA will now be classed as only having ‘moderate’ needs under PIP and in effect, will no longer qualify at all. This is much the same way that Local Housing Allowance has now been revised to cover only the lowest 30% of rents in your local area instead of the lowest 50%. No-one will be any less disabled in the same way that no-one’s actual rent will go down, but the Treasury gets to lower their expenditure on you and you’re left to cope with the consequences as best you can.

At the risk of ‘medicalising’ the issue, my example is NHS provision. Australians of the “When in pain, take a plane!” school will groan but one of the reasons medical care on the NHS tends to be at a slightly lower standard than we would expect in Australia is because it is considered more important to have wider provision entirely free at the point of use in order to give every single person equal access. Yes that means outcomes are slightly lower, but you don’t get the American extreme of fantastic hotel-standard hospital care but only for the rich or privately insured. Australia’s mixed system of public and private provision (like that of France) and stable private health insurance market seems to have achieved the best of both medical worlds in international comparisons. Before the NHS in the UK, if your hip was destroyed by arthritis or in a fall you didn’t have to wait two years for a replacement – rich people had surgery immediately and were back to normal within six months. Poor people either limped for the rest of their lives or became an invalid.

With the closure of the Independent Living Fund it is difficult to see how anyone outside of a residential care environment will actually qualify for PIP (that level of personal care is otherwise unaffordable for most people), and yet those of (now) ‘moderate’ needs are the more likely to need assistance to stay in work or be able to contribute their social capital to the local community, which is how the coalition government defines “independence” and “equality” these days.

My medication walks the knife-edge of poisoning me but PIP will only consider whether I can physically get the pills to my mouth and makes even this a “low priority” compared with bathing (where I might only fall and break something and am effectively disqualified anyway under PIP by being able to wield the loofah myself). If one can achieve a function of daily survival BUT ONLY WITH HELP AND MONITORING, surely the logical result of withdrawing the funding for that help is that you can no longer achieve it?! Doing without the most basic care functions of a normal life is what I’d consider inequality.

Perhaps we’ll just “muddle along” and manage to ignore the emergency admissions caused by the resulting injuries. I would have thought though, that being forced to rely on unpaid care from partners and/or family was EXACTLY how you’d define dependence.

Doesn’t an economically competent administration still aspire to “the most good for the most people”? (Doesn’t the coalition still aspire to be economically competent? Evidence that they’re still planning to pay for the Work Programme with the imaginary savings it will create from the future Welfare Budget – a bit like betting on a horse using the winnings you expect to take from the race – suggests, no).

Asked again in Parliament “doesn’t she believe that the greatest help should be targeted at those with the greatest needs” I hope Sheila Gilmore MP will now be able to respond “Well I’m certainly not in favour of RATIONING disability benefits!”

9 Comments

  1. davidp
    Posted June 20, 2011 at 2:24 pm | Permalink

    “It is only right that support should be targeted at those disabled people who face the greatest challenges to leading independent lives”

    No. Support should be targeted as those who will, with support, be able to lead independent lives, prioritising those who would not be able to do so without support, and those whose disabilities would make them impoverished without the support.

    Those who “face the greatest challenges to leading independent lives” won’t achieve it, so presumably won’t be able to claim any support. The Tory’s appear to like this because it means zero expenses.

  2. Mel
    Posted June 20, 2011 at 8:43 pm | Permalink

    “Australia’s mixed system of public and private provision (like that of France) and stable private health insurance market seems to have achieved the best of both medical worlds in international comparisons. ”

    I’m not sure things are that great. Hardly a week goes by without another story about a pregnant woman miscarrying in the outpatients toilet after 5 hours waiting for medical treatment, or a baby sent home by an overworked public hospital doctor dying a few hours later.

    The system is actually shit in so many ways.

  3. Posted June 21, 2011 at 5:06 am | Permalink

    [email protected] I think DEM was making a comparative, not an absolute, judgement.

  4. Mel
    Posted June 21, 2011 at 11:17 am | Permalink

    I realise that Lorenzo but I think there is an element of the grass is greener on the other side at play here.

  5. Posted June 21, 2011 at 12:20 pm | Permalink

    Mel, are those reports reflective of the system as a whole or simply sensationalist reporting of the exceptions?

  6. Mel
    Posted June 22, 2011 at 7:38 am | Permalink

    despisis @5

    Waiting lists for non-emergency surgery are perhaps a stronger example of how our system is a long way short of ideal.

  7. Posted June 22, 2011 at 2:30 pm | Permalink

    [email protected] There is a wide consensus amongst public health wonks that the UK NHS system is NOT one to copy. On comparative data, Oz and France do quite well. (Singapore even better, apparently.)

    I find the waiting lists issue one that inspires a certain amount of sangfroid. If you don[t ration by price, one rations by queue.

  8. Mel
    Posted June 22, 2011 at 3:26 pm | Permalink

    [email protected]:

    “If you don[t ration by price, one rations by queue.”

    Hehe. I’ve made the very same point to fellow lefties when they use the term decommodification.

    I would like to see greater income transfers to the poor and a copayment for all medical services that should be high enough to deter the frivolous but low enough not to put off those in genuine need. I would also like to see the tax take in Oz raised to European levels to fund better services including health.

  9. Posted July 6, 2011 at 10:31 am | Permalink

    A perspective on the corporatisation of Australia’s health system

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