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Review: The real cost of austerity

At the UK premiere of Ken Loach's latest film, I, Daniel Blake, a group of people with disabilities and their supporters gathered to protest against the benefits system, asserting that “we are Daniel Blake every single day”.

Perspectives Film The real cost of austerity At the UK premiere of Ken Loach’s latest film, I, Daniel Blake, a group of people with disabilities and their supporters gathered to protest against the benefits system, asserting that “we are Daniel Blake every single day”. Loach and the film’s lead actors, along with Labour Party leader Jeremy Corbyn, later stopped to greet the protestors. Photos were taken against the backdrop of a series of placards, some of which displayed official Department of Work and Pensions statistics: in 2011–14, 7200 recipients of Employment and Support Allowance allocated to a “work-related activity” group, and therefore potentially fit for work in the immediate future, had died. Within a month of its launch in the UK, Loach’s film had been mentioned four times in Parliament. Given that Loach chose to place his focus squarely on an unjust social welfare system, and the lived experience of austerity at a local level, it is unsurprising that the film has caused such a stir within political circles. In keeping with Loach’s politically engaged directorial style, I, Daniel Blake tells the story of Daniel Blake (an agonisingly honest performance from Dave Johns), a middle-aged man from Newcastle, whose sudden heart attack leaves him unemployed and at odds with an intentionally complex benefits system predicated on distrust. It is Entertainment One I, Daniel Blake Directed by Ken Loach. Entertainment One, 2016. http://www.idanielblake.co.uk/ e17 while waiting at the local JobcentrePlus that Blake meets Katie (played with a unique intensity by Hayley Squires), a young mother of two, relocated from a homeless hostel in London to a rundown council house in Newcastle. “The narratives Loach chooses to dramatise are precisely those that the government wishes to suppress.” The film follows both Blake and Katie as they attempt to navigate the benefits system, and documents the series of tragic decisions that both characters must make to provide for themselves and their families. The strength of the connection between Blake and Katie is further amplified as the pair continue on a seemingly downward spiral. Detached and circular encounters with representatives of the benefits system are punctuated by fleeting, yet more positive interactions between Blake and Ann, a helpful benefits adviser, and volunteers at the local food bank. It is during a scene there that Blake and Katie deliver incredibly moving performances, made all the more poignant in the knowledge that filming took place in a functional food bank in the west end of Newcastle. From the perspective of a doctor, what is perhaps most profound about this film is the place afforded to the medical profession. During the opening credits, Blake speaks to a telephone operator who attempts to decipher whether he is a candidate for welfare support based on his response to a series of predetermined questions. Becoming increasingly exasperated, Blake pauses to ask, “Are you medically qualified? I’ve had a major heart attack. I’ve been told by my doctor I’m not supposed to go back to work yet.” In a subsequent, dialogue-less scene an ultrasonographer can be seen performing Blake’s echocardiogram. The medical profession remains notably absent for much of the rest of the film, only to re-emerge in the final scenes in the form of a nameless tribunal doctor, whose verdict has the potential to reinstate much needed financial support. It is at this moment that we hear that Blake’s general practitioner and cardiologist are furious that their patient was denied welfare support: Blake’s adviser is buoyed by this news, and is adamant that his benefits will be reinstated following full review by the tribunal. It’s difficult to interpret I, Daniel Blake as anything other than a scathing criticism of current UK Government welfare policies. It’s power certainly lies in Loach’s ability to make timely social commentary of deeply personal stories. The narratives Loach chooses to dramatise are precisely those that the government wishes to suppress. However, this film is also a stark illustration of the social determinants of health. Given the absence of medical professionals, and their delayed outrage in the film’s final scenes, one is prompted to consider the profession’s responsibility to advocate for patients, and the degree to which medical professionals should challenge the socioeconomic inequities that impact on health. James Smith www.thelancet.com Vol 388 December 10, 2016