The Tory government is about to make a decision that could leave tens of thousands of society's most socially excluded people destitute.
Off the back of a May election pledge to get problem drug and alcohol users off benefits and into work, the Tories set up an independent review into how best to achieve this. One of the chief aims of the review – which is overseen by Dame Carol Black, a senior government advisor on work and health, and due to be published in December – was to look at the feasibility of threatening people with losing their benefits unless they accept treatment.
One person who needs no persuading about this being a great idea is the Prime Minister himself.
"Too many people are stuck on sickness benefits because of issues that could be addressed but instead are not," said David Cameron, a keen backer of benefit sanctions, when the consultation was announced in July. "It is not fair to ask hardworking taxpayers to fund the benefits of people who refuse to accept the support and treatment that could help them get back to a life of work."
On the surface, cutting welfare payments to problem drug and alcohol users if they refuse to get help does have a certain "tough love" appeal that perfectly suits Cameron's new keenness for compassionate, middle ground politics. Taking money away from addicts if they refuse treatment, an idea floated by the Labour government in 2009, is of the same mindset that says giving homeless beggars money merely entraps them further. The line here is: why should people, like those on Channel 4's Benefits Street, get free money for having a problem that they refuse to get help for? To the average member of the public, it's a logical notion.
But as the review will presumably tell him, the inconvenient truth for Cameron is that the strategy of coercing people into treatment by using their benefits as leverage is doomed to fail.
One of the main problems, unfortunately for Cameron, is that forcing people to undergo medical treatment is illegal. It is enshrined in the NHS constitution that any treatment must be entered into voluntarily and without coercion. This would be violated if people are only entering treatment for fear they will face financial penalties.
One of Cameron's own, Conservative MP Sarah Wollaston, a former GP and current chair of the Health Select Committee, has described the plan as "unethical and unworkable". "Treating a patient without valid consent would put any clinician in breach of their duty as a doctor, let alone in breach of the law," she wrote on her blog in July.
She warned there was "a dark question at the heart" of the Black Review. "Any proposal to change the law to allow such coerced consent would be a seismic change and threaten us all. Where would it stop?"
Wollaston is not alone. The British Medical Association has called the plans "draconian and silly". The British Psychological Society says psychological treatment for addiction doesn't tend to work if patients are coerced into doing it. In fact, even if you ignore the ethical problems, the DWP's own research shows that alcohol and drug treatment is rarely successful if people are forced to undergo it. An essential factor in recovering from drug and alcohol addiction is an individual wanting to change.
Even if you're able to get someone off drugs, there is little chance of turning lives around unless you can also deal with other underlying problems closely associated with drug addiction, such as bad mental and physical health, poor housing and repeat offending. The evidence suggests that to support people towards employment, more is required than just treatment for substance misuse, such as effective labour market interventions. Even then, most employers are reluctant to recruit people known to have had problems with drugs in the past.
Besides, the threat of sanctions – and therefore extreme poverty and homelessness – might cause exactly the sort of anxiety that would drive people to use more drugs and alcohol, not less. A similar scheme, which introduced benefit sanctions for people on community sentences, was shown to achieve nothing apart from a negative impact on those it was intended to assist.
Drug charities have told the government that taking away people's benefits would move them backwards, not forwards. "Their benefits provide regular income and access to secure and stable accommodation – the essential building blocks of recovery from addiction," says Simon Antrobus, chief executive of Addaction. "We know that the people we support are more likely to recover if there is stability in their lives. Yes, people are stuck in benefit land, and it is right to help them recover and to regain control of their lives. But the presumption that if they stop using drugs they are automatically fit for work is wrong."
It's not just doctors and drug charities warning Cameron that his plans are doomed. The Employment Related Services Association (ERSA), seen by government as the voice of the hard-headed private sector, have strongly advised against benefits sanctions for problem drug and alcohol users.
On top of this, there are major concerns the plan could mean unqualified job centre staff having to make clinical decisions about whether or not people have a drug problem. What's more, drug projects will have a duty to grass up their clients to the Department of Work and Pensions, and benefit claimants will be forced to undergo a series of US-style drug tests to prove they are off drugs.
Thing is, Cameron can of course just choose to ignore all this evidence. He's a politician. The Tories need to save money and they need to come out with policies that will make them look tough on "benefit scroungers" in the media.
So far, the present government's track record on dumping people off benefits has been scary. Sam Thomas from Making Every Adult Matter – a coalition of homelessness, criminal justice and mental health charities dedicated to tackling social exclusion – has noticed a huge rise in people having their employment benefits temporarily withdrawn for missing interviews, training courses or forgetting to update CVs. In the first quarter of 2013, 3,574 people on Employment and Support Allowance were "sanctioned". The figure for the first quarter of 2014 was 15,955, an increase of 346 percent.
Thomas says that when people are thrown off benefits, they find other ways to replace state benefits, "including survival theft, selling drugs and selling sex for drugs, which don't lead towards stability or recovery. The welfare system should incentivise people to move closer to the job market when they're ready. However, we know that inappropriate sanctions are setting back people's recovery from drug and alcohol problems. There's lots the government can do to support people with substance misuse issues in moving towards independence, such as ensuring that their mental health needs are met and they have somewhere safe and stable to live. That would be much more effective than taking people's benefits away."
It is typical of this government's approach to the complex nature of drug addiction that it puts so much emphasis on treatment, rather than looking at the problem in the whole. In terms of getting people into jobs, there are proven strategies to smooth people's pathway from welfare to work, such as personalised, long-term support with a single point of contact and giving people opportunities to volunteer or gain experience of work through partnerships with employers.
So it will be interesting to see if David Cameron decides to go for these, or instead expands his programme of chucking people off benefits, when it comes to people with drug and alcohol problems. Because if he goes for the latter, I'd argue he's not doing it because he thinks it will genuinely help people, but because it'll save cash and earn him a couple of complimentary headlines in the kind of papers his supporters read.
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