Why is Britain on the sick?
The prime minister is setting out to tackle “sick-note culture”. Emily Hohler reports
Rishi Sunak set out his “moral mission” to reform the welfare system in a speech last Friday, warning against “over-medicalising everyday challenges” and saying that the recent rises in spending on sickness benefits were “obviously financially unsustainable”. His proposals were met with criticism. Disability charity Scope described it as a “full-on assault on disabled people” and the British Medical Association echoed Keir Starmer’s calls to focus on lengthy NHS waiting lists instead, condemning Sunak’s “hostile rhetoric on sick-note culture”.
On the same day, the Department for Work and Pensions “quietly released updated forecasts”, says Kate Andrews in The Spectator. It expects there to be 3.96 million working-age claimants by 2028-2029, up from 2.8 million in 20232024, while the number of those receiving disability benefits is forecast to rise to 1.16 million. Currently, 2.8 million people are registered as “long-term sick” and 5.6 million are on some kind of out-of-work benefit. Britain only has a low headline unemployment rate of 4.2% because the numbers don’t include those who’ve stopped looking for work. As Sunak pointed out, we now spend £69bn on benefits for workingage people with a disability or health condition, more than we spend on schools, transport or policing. Spending on personal independence payments (PIPs) alone (an “indefinite award” worth up to £798 a month) is forecast to increase by more than 50% over the next four years (anxiety and depression are the main reasons people receive a PIP, notes The Times). Proposed changes include requiring more medical evidence to substantiate PIP claims and shifting responsibility for issuing “fit notes” away from GPs to a new class of specialists.
This is a “classic” Tory thinking,” says Frances Ryan in The Guardian. Don’t address the causes, just “get someone who is not a doctor” to declare people aren’t actually sick. The non-means-tested PIP, introduced in 2013, is designed to help cover the extra costs that come with disability, which is why it is permanent. Offering people with mental-health conditions treatments instead of benefits is meaningless when there is a 1.9 million waiting list in England alone. Britain doesn’t have a “sick-note culture”. “It has a record-high NHS waiting list, widespread food poverty, stagnant wages, low benefit rates, crippling housing costs, a broken social-care system... and inadequate mental-health services.” These are the predictable consequences of a government that has “vandalised” the public realm.
Few would “cavil” at the idea of helping disabled people, but given the figures, there
“must be a suspicion that the common ups and downs of life are being treated as medical ailments”, says The Times. Other countries don’t have the same patterns, notes John Rentoul in The Independent, and though this may in part be due to our ailing health services, incentives are likely to be a factor, too. Most people on sickness benefits aren’t required to seek work.
A recalibration is needed
A less discussed aspect is the tension between “compassion” and cost, says Matthew Syed in The Sunday Times. The peace and economic growth that the UK has enjoyed in recent decades has “recalibrated” our concept of compassion. A visitor from the distant past would be astonished at our triple-locked pensions and generous benefits system. Moving rapidly to net zero, housing asylum seekers in hotels, providing mental-health services for more than 400 “conditions” incurs costs that must be met by wider society. Social entitlements have become “uncoupled” from the means to finance them. This problem afflicts much of the West. What we really need is a “moral recalibration”: to “cut our moral coat to the cloth of the age… Our future as a civilisation depends on it”.