Will benefit cuts help patients? Yes
GPs know that working is good for both health and self-esteem, writes Dr Paul Charlson
The Prime Minister announced this week that housing benefit for the under 25s is likely to be scrapped. The Government also suggested that unemployment benefit may be time-limited, and that the current £26,000 cap on welfare benefits for each household is to be further reduced. These proposed changes would save £10bn from the welfare bill.
The welfare bill rose 40% over the last decade when in most of that time employment was rising and there was prosperity so any saving is very valuable. No Government likes to make cuts in benefits, and nobody likes paying taxes, but most of us accept this is part of being a decent citizen.
The problem comes when taxes are too high and/or appear to be spent in ways that do not seem fair. A majority of people think that welfare benefits are too high - and that attitude includes those on benefits. A recent survey showed that 76% of people were in favour of the benefit cap and a further third would like it to be reduced further to £20,000. It is not as this Government is swimming against the tide.
Research has shown that putting vast sums into welfare has not reduced poverty. As GPs we see poverty every day, and know that some families we treat have not worked for several generations. We see the effects on the health of these people. We know that this cycle has to be broken. The Government has to make it more financially beneficial for people to work. I know several GP receptionists, for instance, who could only work limited hours because if they worked more they lost benefits and were either no better off or worse off; this cannot be right.
Work is not just about the money but self-esteem , social contact and a variety of other benefits.
Even sensible ideas are difficult to implement. Any cut in welfare is met with derision about ‘greedy Tories hitting the poor' (Lib Dems having somehow avoided the same insult).
Inevitably, new rules have unintended consequences. For instance, the abolishment of Disability Living Allowance - changing to a Personal Independence Payment - threatens to remove tens of thousands of blind and partially-sighted people from benefits. These are a group who really need support, therefore any change has to be thoroughly analysed before implementation.
Recent announcements may also have unintended consequences. Fundamentally the idea of stopping housing benefit to the under 25s is a good one as it will cut out those who are using the current system unfairly. However, there are people who are under 25 who will need to be housed for a variety of reasons. Not everybody can live at home with their parents until they have saved up enough to buy a house. I think a sensible way forward in this case is to reduce the number of under-25s eligible for housing benefit. How this is done is actually very difficult as it will require some form of judgement.
Any GP will tell you how difficult it is to make a reasonable judgement regarding ‘sick note' requests. We have all had the patient who has been assessed fit for work by an ATOS doctor, only to trot back to us for a sick note. It is often very hard to say no. GPs are vulnerable to complaints. They take up time, and they can be distressing. It is hardly surprising that some of us take the line of least resistance and provide the note. Agreed, the ‘fit note' system has helped, but it is difficult to refuse a note and maintain a positive relationship with patient. Doctors will always be required to assess disability, and if unemployment benefits are to be time-limited I suspect many claimants will seek a continuation of benefit via the ill-health route. It's not a pleasant thought for us already-busy GPs.
In the future, we will need to be better supported in order to refuse those who we have assessed as ineligible. The system will need to be robust and consistent. GPs will require further training with better guidance - this is at least as important as the mandatory training we have to undergo repeatedly in other areas of our work.
We also need to ensure those who are genuinely in need of benefits get them which means being more aware of what they are and how to access them.
Reforming the UK welfare system is not an option. It simply has to happen. We need a system that helps those in the most need and encourages those that can work to do so. At the end of the day, this is something a majority of the population agrees with; GPs will have to play their part in this social change project.
Dr Paul Charlsonis a GP in Cumbria and chair of Conservative Health