hard working people

For anyone working in health and social care the link between work and welfare is obvious. From therapists advising patients on how to survive a ‘fitness to work” assessment to the private contractors paid to make those assessments the mythology of scroungers versus hard working people doesn’t cut any ice.



You didn’t have to go on the End Austerity Now march the other week to notice that welfare in the UK is on its knees. The government’s flagship welfare reform combining six welfare programmes into one under the Universal Credit has totally failed. Unrealistic and random cuts conflated by the failure of Atos, the large private contractor, to deliver the DWP’s review of incapacity benefit leaving thousands 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. Incapacity benefit reform is driven by budget cuts, with decentralization of budgets masking the reality of 20% cuts under the banner of customer choice. With this year’s launch of the DWPs new National Health and Work Service covering sickness absence, delivered by the US contractor Maximus, you don’t have to be disabled to have an interest in who delivers public services. The service will assess anyone likely to be off work longer than 4 weeks playing a perverse game of assessing the presence of  ‘fitness’ while avoiding eye contact with actual ‘sickness’.

In the UK the number one cause of long term absence is mental illness, predominantly depression and anxiety. You can therefore safely assume that the people sent for assessments will be treading the thin line between distress and despair. If you manage to convince a Maximus temp that you are not fit (presumably the easiest way to communicate that is to be unable to go through with the assessment) the question remains how do you then get back to work? With 75% of people getting no treatment for Mental Health Problems after visiting their GP how are people going to get better?



The reality is that since 2008, sickness absence has gone down. This is not just because everyone has officially become fit, its also something to do with the fact that we’re working in a climate of fear. More people will keep working until something goes very wrong, a total reversal of good health policy which emphasises early intervention. If you get really sick it means expensive intensive care which at £600 a night wipes out any possible gains to the UK economy of struggling on at work for a few months.

The language of welfare is very important. In order to cut welfare and the costs to the UK economy of people getting sick, dis-ability got banned and replaced by a ruthless regime of positivity. We no longer ask what’s wrong, just what’s right.  Fitness became compulsory. With this linguistic slight of hand the social contract between the state and the people that live in it is transformed into a commercial contract signed with heroically named private companies.



This is a narcissistic regime where needing help is a sign of failure and and the world becomes divided between scroungers and hard working people. The state projects its duty of care into the private sector and then projects this societal failure into the individual reflected in the growth of suicides, now the number one cause of death of men under the age of 50.
Another reason why health and social care workers understand the connection between welfare and work is because of low pay.



Since 2009 the number of people earning less than a living wage has increased from 3.4 million to 5 million in 2014. The government’s proposal to cut £5bn tax credits has exposed the reality that 7 million working people don’t earn enough to live. Despite the government not providing data on this, an estimated 1.5 million working people need housing benefit to pay their rent, a number that is going up by an estimated 10,000 people every month. This year the United Nations reprimanded the UK government for its ‘bedroom’ tax on the basis that it abused our human right to shelter, the fallout of this linked to the rise in homelessness in the UK.



The people receiving in-work benefits are mainly women and single parents, many of them working in health and social care. One third of people working in the NHS earn less than a living wage. With pay freezes and reduction in collective bargaining the real value of NHS wages have gone down over the last 5 years. Of the 1.4 million people working in social care, 160,000 are earning less than the living wage particularly domiciliary carers who are paid only for the 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. Compassion is hard to squeeze out when you have not been able to afford lunch on a 12 hour shift.

One of the reasons for low wages in health and social care is the decline of professional bodies and trade unions that have historically fought for wages and conditions. The Social Care Association closed in 2012 and last week saw the closure of the College of Social Work set up after the case of Baby P. 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 these bodies we could have, easily.



In Julian Lousada and Andrew Cooper’s important book Borderline Welfare they thoughtfully 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 maintaing 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.

A second problem is the lack of union power in these low wage sectors. Having worked for 15 years in trade unions I am not neutral about the value of solidarity, but I am realistic about the deficit of leadership that this is linked to. Notwithstanding, the reality is that the key reason why wages are going down is that precarious workers generally don’t join unions, and are hard to mobilise around collective bargaining. There are over 200,000 active workplace representatives in the UK doing what they can to organise people into unions. Most of them do this without pay and for the right reasons. Whatever your politics, unions up until this point have been the only show in town in negotiating wages and their inability to defend the wages of health and social care workers is not a political problem but a genuinely social one.

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 from Greek pensioners to public sector workers. 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, merely we 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. Cuts are a defence but a useless one because by cutting off from each other we lose our best chance of survival. It means that in health and social care knowing the real value of welfare is a matter of personal and professional survival.


This blog was written for The Conversation’s Battles on the NHS Frontline column.

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