In November 2011 it was estimated that 2.4 million people in the UK received incapacity benefits. The principal aim of the coalition government's welfare reform is to reduce this number and curtail a perceived culture of welfare dependency, helping into employment people previously assessed as being unable - or in common portrayals - unwilling to work. Measures include reassessment of existing Incapacity Benefit claimants, more stringent capability assessments for claimants of Employment and Support Allowance (ESA), and planned replacement of these benefits by a simplified Universal Credit. The Government has also pledged to cut by 20% Disability Living Allowance (DLA) - a targeted, flexible benefit paid to around 3.2 million people to assist with care and mobility costs - replacing it with Personal Independence Payments. This will end automatic entitlement of people with certain impairments and focus support on those deemed 'most in need'.
These measures appear to have the backing of public opinion. An IPSOS Mori poll carried out for the BBC in September 2011 revealed that although a resounding 92% of British people wanted a benefits system providing a safety net for all, 63% doubted the UK benefits system works effectively, 72% wanted politicians to do more to cut the benefits bill and 84% wanted to see stricter testing for incapacity benefits. However, Responsible Reform, a report financed and undertaken by sick and disabled people themselves, analysed over 500 group responses made to the Government's consultation on DLA reform and found that (in contrast to the Government's claims of broad support for the measures) 74% opposed the plans. Overwhelmingly, respondents objected to plans to make people wait longer before they could access support (98%), opposed scrapping the lowest rate of DLA which allows many sick and disabled people to stay in work (92%), and resented the proposals to end use of DLA as a qualification for other benefits (99%).
Criticism of incapacity benefit reform has focussed on the methods for evaluating functional capacity and readiness for work used in Work Capability Assessments. Rather than enabling people with disabilities to find work, Government critics argue that changes to welfare policy are geared simply to cutting costs with the most vulnerable hardest hit.
Organisations such as Scope have raised concerns about the negative portrayal of disabled people in the media. A 2011 report prepared by the Strathclyde Centre for Disability Research and Glasgow Media Unit in association with Inclusion London, Bad News for Disabled People: How the Newspapers are Reporting Disability, has revealed that fewer articles now present disability sympathetically and the proportion focussing on disability fraud has increased. The quarterly statistics released by the Department for Work and Pensions highlighting the numbers refused incapacity benefits have arguably fuelled the media rhetoric about scroungers and public anger towards the disabled. The Times for example, reported official Incapacity Benefit figures on 21st April 2011 under the headline 'Too fat, too drunk, or just too lazy to work - but not to claim their benefit'.
Yet the media-fuelled perception of widespread benefit fraud is not borne out by official figures. The Department for Work and Pensions' preliminary figures for 2010-11 estimated that about £130 million of the £5.6 billion paid annually on incapacity benefits (or about 2.4% of the total expenditure) was overpaid due to fraud and error. Over half of this (about £70 million) was due to official error rather than detectable fraud, which accounted for about £20 million of overpayments. Forty per cent of those whose claims are initially refused are subsequently granted Incapacity Benefit on appeal, which suggests that the tests are inappropriate and in fact increasing, rather than decreasing, costs to the taxpayer.
The policy of subjecting sick and disabled people to increasingly stringent regimes of testing contributes to this public culture of distrust. On 22 October 2011 thousands of disabled people, their families and allies, took to the streets in cities across Britain in Hardest Hit marches of protest. The policy problem is clear: on the one hand Government seeks to cut costs by presenting welfare reforms as a populist crusade against inefficiency and fraud; on the other, recipients of sickness and disability benefits see their support systems under attack and fear for their livelihood, independence and (in the case of some DLA recipients), their ability to make an economic contribution by participating in employment. It is therefore timely to reflect on the historical position of sick and disabled people in relation to state welfare provision and to analyse the role of media stereotypes in discriminating against recipients of aid.
The state has long supported people with disabilities. The Old Poor Law of 1601 ordered the raising of taxes for the 'necessary relief of the lame, impotent, old and blind'. But from its inception, those claiming assistance on the basis of impairment have faced popular suspicion that their disabilities or medical conditions were faked, suggesting that the deserving status of the disabled poor cannot be taken for granted. In the Middle Ages images of disability were mixed. Charitable support for the disabled poor was seen as an important means whereby the rich could secure their salvation. However, concerns about 'false pilgrims' professing physical impairments to extort assistance led to more punitive statutory measures against vagrancy. Tudor welfare legislation was set against the backdrop of increasing distrust of people with disabilities, as the spiritual reciprocity between the disabled and able-bodied fell victim to the Reformation and its denial of the holiness of poverty. The Tudor formulation of welfare relief for the 'lame, impotent, old and blind' was partly intended to discriminate between deserving and undeserving claims. At the same time, images of the 'sham cripple' beggar, imposing upon the sympathies and resources of citizens intensified. The Elizabethan and Jacobean equivalent of modern 'scroungers' were known as 'rufflers', 'palliards' or 'clapperdogeons' - dangerous vagrants who allegedly plastered their bodies with fake sores to dupe the unwary into providing assistance. Largely the invention of sensationalist pamphleteers, these stereotypes gave fraudulent disability its own language and identity. They cast the display of all disabilities, real or not, in a suspicious light.
As the Old Poor Law was implemented in parishes across the country, stereotypes of criminal and fraudulent disability became commonplace. This was assisted by the rapid expansion of newspapers, periodicals and other print media after the lapsing of the Licensing Act in 1695. In the eighteenth century, the press regularly reported beggars using their apparent impairments to lull passers-by into a false sense of security before attacking and robbing them. Images of the violent and criminal disabled poor have long served to cast the impaired as envious of the able-bodied. However, they also emphasise the deceptiveness of the disabled body and voice concerns about the reliability of physical evidence of impairment. The apparent high visibility of displaced disabled poor on the streets of London and other cities fuelled other stereotypes. Enlightenment humanitarianism urged compassion to the suffering poor and accommodation with physical difference, but the unsightliness of disabled beggars on the streets of the Georgian city, 'thrusting' their stumps at respectable passers-by and imploring them for charitable assistance, was seen as a threat to the values of decorum and commercial progress that the city was supposed to embody.
Media stereotypes of fraudulent, disabled beggars therefore allowed people to suspend their sympathies, to avoid the obligation of compassion to all, by providing a means to blame victims for their own predicaments. Eighteenth-century newspapers and periodicals reinforced these anxieties with stories exposing the lengths to which beggars went to present themselves as worthy 'objects of compassion'. According to one periodical's description of the 'kingdom of beggars' published in 1746, 'if a boy is born with short legs, and a convenient Flexibility in 'em, he is... educated for a Cripple, and exercises himself every Morning in the Use of the Crutch or the Wooden Leg'.
Cultural representations not only distinguished between real and faked sickness and disability, but between disabled types deemed more or less worthy of social sympathy. Although historians have sometimes viewed the eighteenth century as marking a transition from a view of impairment as a punishment for sin to a more compassionate model, sympathy towards the disabled in this period was more selective. Images of the disabled were polarised between those with impairments deemed to be no fault of their own, and others whose disabilities stemmed from their own 'irregular courses' of living. Eighteenth-century medical treatises found many ways of blaming disabled people for their conditions. Disabling childhood conditions such as rickets, for instance, were believed to be caused by the intemperate lifestyle of the victim's parents. The belief that 'like engenders like' also led some authors of popular medical texts to call for people with inheritable illnesses or congenital disabilities to be prevented by law from breeding.
In contrast, certain disabled characters, or styles of behaviour, became celebrated in popular culture and the press. During a century of frequent warfare the disabled soldier emerged as a figure of patriotic sympathy. The term disabled was often used specifically to refer to injured ex-servicemen, to emphasise their heroic sacrifice in the national cause. Likewise, accounts of beggars feigning disability on the streets of Georgian London described people faking identities as well as injuries, weaving stories in which a limb was lost in military or naval service rather than under more culpable circumstances. In order to be deserving of sympathy, disabled people were expected to behave in a deferential manner that avoided excessive demands on the feelings or resources of others. Such ideas influenced the self-presentation of claimants of relief, as petitions often emphasised their industriousness and previous good character. This social and cultural sorting created a legacy of unequal treatment of sick or disabled people, establishing hierarchies of disablement based not just on the degree of incapacity, but also on a person's compliance and fit with cultural images of what a disabled person should look like and how they should behave. This process of discrimination is evident today, from the images of the afflicted used in charity advertising and appeals to the stigmatisation of those with hidden or socially unacceptable impairments in the media. Such cultural stereotypes overshadow the attempts of policy makers to measure genuine need objectively.
During the second half of the eighteenth century mounting pressure on parochial resources, combined with anxieties about fraudulent disability, drove calls for welfare relief to be based on firmer medical principles. Charitable initiatives were also more explicitly geared towards returning the sick and disabled to the workforce. Belief in the social and moral value of work has been a consistent theme in welfare legislation since the sixteenth century. Work gave a person a 'place' in society, acting as a guard against idleness and disorder. In the eighteenth century, the moral and medical disciplining of the sick and lame is evident in the expansion of parish workhouses (which provided medical care in addition to conditioning their inmates for employment) and in private charitable initiatives, in particular the establishment of voluntary hospitals.
Supporters of hospitals often claimed their utility, not only in restoring the curable to health so that they could rejoin the workforce, but also in exposing the bodies of inmates to more rigorous medical testing to detect malingerers. Establishments intended to care for the sick and disabled were also seen as tools for the disciplining of bodies and the detection of fraud. Although there is not much evidence that doctors as a whole were interested in the treatment and rehabilitation of people with disabilities before the twentieth century, the early history of hospitals lays the basis for an uneasy relationship between the long term sick and disabled and medical professionals that survives into the present.
At the parish level, the adoption of medical testimony in support of claims for assistance was patchy. Certainly, the accounts of sickness and disability found in pauper letters from the late eighteenth and early nineteenth centuries suggest that supporting medical evidence was often considered important - especially for those living away from their parish of origin. Nevertheless, personal testimony suggests that claimants retained a strong belief that they were best placed to judge the effects of sickness or disability on their circumstances and capacity for work. As Samuel White wrote to the overseer at Chelmsford in 1828, he required greater assistance in winter than summer for his chronic health conditions tended to improve in the warmer months and his work was easier then, allowing him to 'do a little' to support his family.
We should be wary of valorising the Old Poor Law as a prototype welfare state. There was widespread variation of practice and levels of assistance often fell behind the value of real wages, adding to the impoverishment of claimants. However, in theory at least there was a degree of flexibility in the system. Relief for the sick and impaired often took account of individual circumstances rather than relying on medical assessments based on predetermined concepts of human capacity and functionality. In rural communities, many claimants would have been known personally to overseers, who were often drawn from similar social backgrounds, and greater trust may have been placed in claimants' own assessment of their conditions, although there was suspicion of vagrants who weren't local. This may have countered the more lurid media stereotypes of feigned impairment. In practice claimants might have faced local prejudice, but evidence from pauper letters suggests that sick and disabled applicants for relief valued dealing with overseers who were familiar with their personal histories. In contrast, some of the concerns reported by disabled people today, particularly with regard to Work Capability Assessments, relate to their having to deal with a faceless bureaucracy that seems insensitive to individual circumstances.
By the early nineteenth century this welfare system was under severe strain as a consequence of protracted warfare and rapid population increase. The cost of welfare payments trebled between 1783 and 1816, and the ideas that welfare trapped its claimants into a life of dependency and poverty, and that pauperism was a result of personal moral failings, became increasingly prevalent in public debate. The New Poor Law of 1834 established the principle of less eligibility, with poor relief designed to be less desirable than paid employment. The role of the workhouse in administering relief and as a deterrent to the feckless became more important and the administration was placed under greater central control.
Under the New Poor Law, claimants of relief with disabilities were increasingly segregated from the mass of the poor. In theory, this was intended to protect disabled people from the more punitive aspects of welfare policy. However, measures to classify the sick and disabled poor more strictly within workhouses, together with the expansion of institutional provision for the blind and deaf and asylums for mentally deficient persons, served to distance the disabled from mainstream society. Medical Officers assisted the sick and disabled poor, but only those referred to them by the Relieving Officer, employed by the poor law unions to determine eligibility for relief. Nevertheless, to avoid subjecting the long term sick and impaired to continual reassessment tickets were issued which allowed them to obtain medical care. Although the implementation of policy varied, the medical certification of those claiming poor relief on the basis of injury or incapacity became more common, increasing the power of professional gatekeepers to benefits. This intensified cultural sorting of disabled types was also reflected in media and literary output, as Victorian writers sentimentalised the 'innocent afflictions' of disabled children in contrast to less sympathetic portrayals of unemployed sick or disabled adult men.
Poor law administrators, politicians and the media all feared that sickness benefits were too easy to obtain and encouraged people to fake illness or disability to claim supposedly generous welfare payments, especially the out relief paid to injured workers and others in their own homes. In the writings of Victorian reformers such as Charles Booth, the question of incapacity was closely linked to questions of motivation, behaviour, intellect and character. Social Darwinist theories of survival of the fittest further reinforced links between incapacity and character deficiencies.
A spate of late nineteenth- and early twentieth century welfare legislation, which included the provision of war pensions, the introduction of compensation for injured or disabled workmen and the introduction of unemployment and health insurance in 1911, continued to refine methods for classifying categories of the poor. Although this legislation extended systems of support for disabled people beyond the Poor Law, it also fostered concerns in the media and among employers and policy makers about a 'crisis of malingering'. There was a growing acknowledgement of the structural causes of poverty amongst academics and some policy makers. Yet the blaming of welfare recipients for their own condition, the perception of welfare relief as a dangerously desirable alternative to work, and concerns about fraudulent demands upon the system became standard features of discussion of welfare in the popular press during the inter-war years.
The foundation of the modern welfare state, far from bringing an end to crude stereotyping of fraudulent claimants, has provided new ways of stigmatising recipients of benefits in which the interests of the taxpayer are set against those of the claimant. Although attacks on 'cheats' and 'scroungers' are often presented as defending the interests of the genuinely vulnerable, this is often framed alongside the need to protect the interests of the taxpayer. During the second half of the twentieth century there has been a dramatic increase in the size of the disabled population thanks to medical advances and longer life expectancy. The greater political prominence of disabled people since the 1960s resulted in the introduction of new statuary benefits, but the view of them as a burden on state resources has also intensified, leading to restrictions on access to state support. This is especially true during times of financial pressure. Over half the respondents to a survey undertaken on behalf of disability charity Scope in September 2011 reported that they felt others did not believe they were actually disabled and 47% felt that attitudes towards disabled people had got worse over the past year. The expansion of equality legislation since the 1960s has empowered disabled people to speak out against discrimination and report abuse, which makes it easier to gauge the effects of negative stereotyping on the lives and experiences of disabled people in the present compared to the past. Yet the speed and scale of welfare reform, when combined with a barrage of negative reporting, can leave many feeling disempowered.
Provision for people incapable of working through old age, illness or impairment has been a consistent feature of welfare since the Elizabethan Poor Law legislation of 1601. But defining incapacity has always been difficult, fuelling suspicions, while attempts to distinguish the genuinely needy from the rest of the poor have been similarly frequent and have intensified since the nineteenth century. Historically, this has worked not just to protect the entitlement of sick and disabled people to support, but to impose divisions and foster distrust, raising suspicions about the deserving status of many disabled claimants. Such divisions have been integral to welfare policy and perpetuated by the news media over hundreds of years. The media also developed images of good and bad disabled types, establishing that to be deserving of assistance required conformity to certain cultural values, rather than a simple demonstration of need.
The history of disability is not just a story of society's concern for its most vulnerable members. It is also a history of distrust, in which the authenticity of symptoms has been consistently questioned. During the eighteenth century, as today, there were increasing calls for the provision of welfare to be placed on firmer medical footings, with the aim not just of rehabilitation and returning people to the work force, but also of surveillance and detection of imposture. This has created divisive social attitudes towards disabled people and helps to explain why disabled people today are so concerned about current government rhetoric about those genuinely in need. The fear is that through a policy of targeting support towards the most 'obviously' needy, and vilifying 'scroungers', the government is able to inflict damaging cuts that affect the lives of many people with disabilities. It also facilitates the withdrawal of support for people who less obviously fit a particular image of disability, or whose impairments are less easy to classify. These include people whose impairments might be hidden, or whose degree of incapacity may vary, yet for whom support with care and mobility is essential to quality of life and employment prospects.
Studying disability historically alerts us to the longevity of modern media stereotypes and their evolution over time, which supports recent calls for politicians to pay careful attention to language when discussing welfare reform and resist the temptation to appeal to popular prejudices. Benefit fraud has undeniably always existed. But there has never been evidence that large numbers of people prefer to live on low benefits if they are capable of working to earn more. Historical evidence suggests that people with impairments and chronic conditions have often worked, albeit mostly in relatively menial and low paid employments, and many saw reliance on benefits as a last resort.
The escalating cost of welfare is a real political challenge. However, this is the result of a rising population of disabled people due to higher survival rates rather than mounting fraud. It will remain difficult for the government to get its message across that reforms are intended to help the most vulnerable when media perceptions of the most vulnerable types reinforce negative stereotypes. No government, including the present one, has found a way to enable disabled people to be socially useful (by employment or otherwise) that does not simultaneously reinforce stereotypes of fraud and blame. In spite of the numerous problems with the current system of testing work readiness, it seems unlikely that any government will reverse the 200 year trend in welfare policy to subject claimants of sickness and disability benefits to medical surveillance. But this needs to be done sensitively, in a way that listens and responds to the voices of disabled people. Effective consultation with disabled people and their advocates, listening to their concerns and communicating better the objectives of policy is crucial. So, too, is an understanding of disability history, of the troubled legacy of medical intervention in the lives of disabled people, and the mixed messages bequeathed by centuries of stereotyping and cultural sorting to which people have been subjected.
Protesters on October's Hardest Hit marches expressed outrage at the disproportionate effects of reduction in spending on welfare and public services on sick and disabled people. The history of welfare provides evidence of a long-standing commitment to support the most vulnerable members of society. Yet social policy has not always addressed need in the most enabling ways. Coercive medical and welfare interventions have long marred disabled people's experiences. Policy makers need to work harder to establish a better understanding between the state and those who depend on its support. Fraudulent claims take resources away from those who most need them. But treating all recipients of disability benefits as potential fraudsters makes those in need demoralised and fearful. It is counter-productive and wasteful of resources to subject to such tests those with permanent disabilities that are unlikely to improve. Barriers to employment reside not just in an individual's impairments, but in the disabling environment of the workplace, the lack of affordable transport, and in the unwillingness of employers to take a 'risk' on disabled workers, especially during tough economic times. Addressing these issues, rather than pursuing claimants and fixating upon the issue of disability benefit fraud, would better enable people with disabilities to work and reduce longer term care costs.
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