Navigating the welfare system is part of the daily work of most health and social care workers – from the therapists advising patients on how to survive a “fitness to work” assessment to the 30% of NHS workers earning less than a living wage.
You didn’t have to go on the End Austerity Now march to notice that welfare in the UK is on its knees. The government’s flagship reform combining six welfare programmes into one under the Universal Credit system has totally failed. Unrealistic and random cuts conflated by the failure of Atos, the large private contractor, to deliver the Department for Work and Pension’s (DWP) review of incapacity benefit, leaving millions of people without money to live.
Disability benefits have been transformed into personal independence payments where “clients” can “choose” their care from a range of “service” providers. But incapacity benefit reform is driven by budget cuts, with decentralisation of budgets masking the reality of 20% cuts under the banner of customer choice. The launch of the DWP’s new National Health and Work Service, delivered by US contractor Maximus which will assess anyone likely to be off work longer than four weeks, is playing a perverse game of assessing the presence of “fitness” while avoiding actual “sickness” by not providing any solutions to the problem.
In the UK the number one cause of long-term absence is mental illness, predominantly depression and anxiety. If you manage to convince a Maximus worker that you are not fit the question remains: how do you then get back to work? As it already stands, 75% of people get no treatment for mental health problems after visiting their GP.
In order to cut welfare and the costs to the UK economy of people getting sick, disability got banned and replaced by a ruthless regime of positivity. We are no longer asking what’s wrong, just what’s right. Fitness became compulsory and the social contract between the state and the people has been transformed into a commercial contract signed with heroically named private companies.
Sickness and low pay
Since 2008, sickness absence has gone down. This is not just because everyone has officially become fit – the public sector still has one of the highest levels of absence (9.6 days on average) compared to other sectors (7.7 days) – but because with public sector cuts come a climate of fear, where more people keep working until something goes very wrong, the very opposite of good health policy that emphasises early intervention.
What about those who depend on welfare because of low pay? Since 2009 the number of people earning less than a living wage has increased from 3.4m to 5m in 2014. The government’s proposal to cut £5bn tax credits has exposed the reality that 7m working people don’t earn enough to live. Despite no official government data, it is estimated that 1.5m working people need housing benefit to pay their rent, a number that is going up by an estimated 10,000 people every month.
On top of this came the “bedroom tax”, which asked people to pay a levy for council and housing association tenants for any unused bedrooms in their home – a tax the UN reprimanded the UK government for as a human rights abuse.
The people receiving in-work benefits are mainly women and single parents, many of them working in health and social care. With pay freezes and reduction in collective bargaining the real value of NHS wages [has gone down over the past five years](http://paycalculator.unison.org.uk](http://paycalculator.unison.org.uk). Of the 1.4m people working in social care, 160,000 are earning less than the living wage, particularly domiciliary carers who are paid only for their 15 minutes of contact time and not their travel between clients.
Not earning enough to live puts us in a precarious position, and when we are precarious at work we are vulnerable to burnout, bullying and failures in our duty of care.
One of the reasons for low wages in health and social care is the decline of professional bodies that have historically fought for wages and conditions. The Social Care Association closed in 2012 and the College of Social Work set up after the case of Baby P also recently closed. Both of these bodies provided the professional framework for their sectors, and both were closed due to pitifully small deficits in funding. If we had wanted to maintain them we could have, easily.
In Julian Lousada and Andrew Cooper’s important book Borderline Welfare they argue that when we lose the institutions of welfare we lose the general conditions that are necessary for care to take place. What we are left with is lots of activity that is done by increasingly vulnerable individuals trying to bridge a massive governance deficit. By not maintaining the institutions of welfare, the state fails in its duty of care to create the conditions under which health and social care work can responsibly be done.
Crisis brings us face-to-face with one of the unavoidable facts of life: that we are all dependent on each other. As the containment of public services breaks down social anxiety goes up and the temptation is to manage this by projecting our vulnerability into others. The demand for cuts is a defence against this anxiety precisely because it denies our inherent need for care.
Despite the rhetoric, austerity is not principally an economic issue because by cutting welfare and wages we do not save money, we merely pass the buck to the people needing and providing care. Even by drawing borders between people - between the sick and the fit, “scroungers” and “hard working people” - we can never successfully cut ourselves off from the reality that as human beings we are inherently vulnerable.
This column looks at the reality of our health and care systems from the perspective of those working to deliver services. Please send us your anonymous stories from the frontline.