Welcome to the disability benefits capital of Britain
Knowsley in Merseyside has come to embody an increasingly sick country, where 9.4 million people are economically inactive, and a third of them unable to work for health reasons.
Making work pay in Knowsley has always been an uphill battle. David, who has lived in the Merseyside district all his life, has not worked for 40 years. When he left school at 16 in 1980, he was excited to secure an apprenticeship at a gardening company. “I am very good at gardening,” he says with pride.
But, when David was 20, his father had a brain haemorrhage and died. David had a breakdown. “I became very ill because I couldn’t cope. We used to do everything together.”
He was diagnosed with schizophrenia and started claiming sickness benefits. He has not worked since. Now 60, he receives both universal credit and personal independence payments (PIP) and is in supported living.
Stories like David’s are common in Knowsley, an area on the outskirts of Liverpool that is one of Labour’s safest seats. Around 13,000 adults here are entitled to claim PIP, the highest number in any UK constituency. One in seven adults claims the benefit, which is an additional payment for disabled people to cover living costs and getting around. Many here are also claiming incapacity benefits that mean they have not looked for work in years.
Knowsley is emblematic of a wider crisis. There are currently 9.4 million people who are economically inactive in Britain, with a record 2.8 million of them neither in work nor looking for a job because of health reasons. The number of people inactive because of long-term sickness has climbed by 850,000 since the 2020 lockdown.
It is not just a health crisis but an economic one. Downing Street has become increasingly alarmed by the soaring cost of disability benefits, driven by claims related to mental health. Rishi Sunak wants to stop the
bill for disability and health benefits from spiralling out of control – it is currently projected to hit an estimated £100 billion by the end of the decade.
That means tackling worklessness in places like Knowsley, which has one of the highest number of claims for mental health conditions, including anxiety and depression.
“We now spend £69 billion on benefits for people of working age with a disability or health conditions,” Sunak said earlier this month. “That’s more than our entire schools budget; more than our transport budget. More than our policing.”
Addressing the issue may seem as simple as cutting benefits and making them tougher to claim. But there is no guarantee that will prompt more people into jobs: in Knowsley, there is a toxic triangle of worklessness, poverty and poor health.
An area on its knees
“We’re top of every list that you don’t want to be top of,” says Lynn Wilson, community wellbeing manager at Volair Leisure Centre. Knowsley has the lowest level of female life expectancy in the country, according to Public Health England, and just under a fifth of households were workless in 2022, compared with the UK average of 14 per cent. Of those out of work, two fifths are struggling with ill health – double the national average.
Between 1971 and 1991, the Greater Merseyside area lost nearly 230,000 jobs in industry. But while Liverpool city has since bounced back, its suburbs did not. In Huyton town centre, in Knowsley, a woman on a mobility scooter glides past the vacant Wilko store that closed in September when the national retailer went bust. The high street is lined with betting shops, discount stores, shuttered shopfronts and a few beauty bars. “Who can afford to get their nails done?” asks a pensioner sitting on a bench.
In nearby Prescot, the other main town in the district, the shopping centre is empty, the escalator still and fenced off. Locals say the area is held back by a lack of public transport links and healthcare services. “There is no dentist here at all,” says another man pointing at the gap in his mouth where a canine used to be.
Phil Noon, the co-founder and director of Evolving Mindset, which helps people get back into the workforce after they have left for mental health reasons, says lockdowns and soaring prices post-pandemic made health issues in Knowsley worse. “The pandemic brought a rise in depression and the community has not been able to cope,” he says. “I’ve worked with a lot of people whose only social interaction was at work. Then all of a sudden, they were living and working in their flat.”
For some, the isolation became crippling. “People are still holding onto that fear of outside as a dangerous place,” says Noon.
The cost of living crisis brought another rise in anxiety: “It’s around paying bills, or fathers not being able to buy their children Christmas presents. Or buying the Christmas presents and then getting into debt.” In areas like Knowsley, benefits can be a lifeline.
The failures of PIP
The Personal Independence Payment (PIP) was introduced by then-chancellor George Osborne in 2013 to replace Disability Living Allowance (DLA) for people of working age. It provides cash payments for those with extra care or mobility needs, allowing people to spend it on everything from taxis to mobility scooters. Paying it in cash is meant to allow claimants the leeway to address their personal circumstances.
When PIP was introduced, ministers made the case for reform by highlighting the fact that almost three quarters of people receiving DLA had indefinite awards, with over half of decisions made on the basis of the claim form alone. Osborne wanted to cut the benefits bill by introducing face-to-face assessments and systematic reviews. The switch to PIP was meant to save money. Instead, the opposite happened.
PIP is a significant part of the broader health and disability benefits bill, and growing quickly. Its cost is currently forecast to rise by 50 per cent from £18 billion last year to £27 billion by the end of the decade. This is partly because PIP placed an emphasis on supporting people with mental, as well as physical, conditions.
“Equal weight” is placed on “needs arising from physical, mental and cognitive conditions”, such as reading and communication. Face-to-face assessments also stopped during Covid and barely restarted. Data from 2023 suggest in-person interviews account for less than 10 per cent of cases.
Today, Britons can claim PIP to help support them with living costs associated with more than 500 conditions. This includes everything from arthritis, heart failure and cancer to eczema, acne and non-lifethreatening allergies. There are 6,000 people who are able to claim benefits linked to long Covid, and 14 who qualify for £9,500 in PIP per year to help them live with haemorrhoids.
DWP figures show the number of overall PIP claims is up by almost a third since 2020. “Anxiety and depressive disorder” is still the single most cited reason, with 361,000 people stating it as their “main disabling condition”.
The typical person claiming benefits for anxiety and depression is probably not who you think. It is not the young who are most anxious and depressed but those in the decade before retirement. DWP data shows a 55-year-old woman is roughly five times more likely to be claiming PIP for anxiety and depression than a 19-year-old man.
In fact, people in the 50-59 age group are more likely to be anxious or depressed than in pain from osteoarthritis. Many suffering from anxiety and depression have also been parked on benefits for years. Around half of these people have been claiming PIP for more than three years and a quarter for more than five.
Benefits linked to younger people’s mental health issues are more likely to be linked to autism or ADHD diagnoses, which have mushroomed in recent years as the conditions are more widely recognised.
Many in the Cabinet believe Britain’s approach to mental health when it comes to benefits has gone too far. “We introduced these benefits just as we discovered the mental health revolution,” says one minister. “It’s not politically correct to say this but our safety net is just not designed to cope and the taxpayer is footing the bill.”
PIP can be claimed for living costs associated with just under 50 conditions related to mental health, ranging from dyslexia and anorexia to anxiety, depression, ADHD and autism. Anxiety and depressive disorders account for around 450,000 of the 3.5 million current claims. This is a near doubling since Covid, with cases in these categories rising by around 5,000 each month.
Official data suggests the Government currently spends around £2.6 billion on conditions linked to anxiety and depression alone for people of working age. That’s more than three times the amount spent on PIP for people of working age who are living with cancer.
Around half of this group receive an “enhanced” component of PIP linked to day-to-day living costs, which gives them £108.55 a week. Some in this group also get an extra £75.75 each week to support them with the financial costs of getting around. A little more than 100,000 claimants qualify for the maximum of £9,583 a year in PIP for help with everyday tasks. This is in addition to health benefits such as Universal Credit and housing support.
Government guidelines say people should only be receiving the maximum amount if, for example, they have difficulty socialising without suffering “extreme distress”, including being unable to leave the house.
The need for reform
The Department for Work & Pensions (DWP) will launch a consultation as soon as this week on PIP reform, with Sunak raising the prospect of people having “cash transfers” swapped for “access to treatment like talking therapies or respite care”.
Government insiders are keen to stress that this is not an attempt to snatch benefits away from people who need them.
However, there is concern among ministers and their aides that some people are trying to game the system. Social media sites such as TikTok and Reddit have given platforms to people dispensing advice on how to get the maximum amount of benefits.
The current system awards payments based on a points system. Awards are not based on a medical diagnosis but instead on how people’s health limits their ability to perform tasks such as showering, handling money or preparing food. Claimants are scored in two categories related to daily living and getting around.
One popular TikTok video urges claimants to use words like “prompted” and “assisted” in order to bump up their scores. Reddit threads including “anti work” and “dwphelp” have also been cited by former insiders as sources for people looking to maximise their chances of getting claims approved.
However, cutting the PIP bill may not be as straightforward as tightening the claiming rules.
Research published by the Office for National Statistics (ONS) last year showed 937,000 people who were economically inactive because of long-term sickness had at least five health conditions. The total was 42 per cent higher than before the pandemic.
The figures suggest that many people may still qualify for PIP even if rules around claiming for mental health conditions are tightened.
Louise Murphy at the Resolution Foundation think tank says: “It’s not like there’s a strict divide between mental health and physical health. Someone may state that ‘anxiety’ or ‘depression’ is their main condition, but they may also have some mobility problems linked to those conditions.
“If you were trying to make changes relating to people that might have anxiety and depression, that will often end up impacting people that also have physical health problems. There needs to be greater recognition of that.”
In Knowsley, issues have been compounded by delays and difficulties accessing health services. “People are waiting for 50 weeks to get secondary mental health care in Knowsley at the moment,” says Noon.
At Kindred Minds Merseyside, a grassroots mental health organisation that works with adults over 40, most of the people attending have not had formal mental health support beyond visiting their GPs because it is so difficult to access, says Andrew Kerr, programme manager.
Delays and difficulties accessing services mean people get sicker. It also means they can be out of the workforce for longer than they need to be.
“There is no reason why people shouldn’t recover from psychosis and go back to work, given the right support and given a fruitful rewarding working environment,” says Kerr.
However, getting people back to good health is just one part of solving the worklessness crisis: people also need jobs.
“The reality is, it’s not going to support your recovery to be taken off benefits and go and be a Deliveroo rider or get a zero hours contract in the supermarket and have to work 60 hours a week in order to pay the rent,” says Kerr.
He argues that the Prime Minister’s plan to crackdown on benefits will further inflame people’s mental health problems because it will bring them new stress. “They are terrified by the stuff that Rishi Sunak is saying.”
Some see this as a symptom of how the current system is set up. Murphy says the current benefits system makes it “very hard to flow in and out of work or try work, even part time”.
“Often, if people get this additional element within Universal Credit where they have received a judgment that they aren’t expected to work because of health problems, it can be hard for them to then think about work in the months or years following that,” she says. “I definitely think we should think about how we can make it easier for people to at least try.”
James, 59, is able-bodied but his life in Huyton has been heavily affected by disabilities. Years ago, he had a job in security, but he gave it up to care for his younger brother, who had severe mental health problems.
“He used to slice up his arms,” says James, who asked us to use only his first name. One day, James found his brother, who was only in his 40s, dead at home. It was not suicide.
“They did a post-mortem. The nurse called and said that his arteries were blocked because he had been eating too many fatty foods. That’s what killed him. He was only in his 40s and he died before Mum.”
After his brother died, James became a carer for his mother, who was blind and suffering from cancer. She died in 2017. James has been unemployed ever since. He receives £180 per fortnight in benefits and lives in his mum’s old council house.
“I want a job, because benefits go nowhere. But I feel like I’m not getting the help I need,” he says. James wants to get a job as a carer but he has severe dyslexia. Although the Job Centre has helped him write a CV and send it off to prospective employers, he has so far been unsuccessful. “I’ve been for many interviews in care homes but the issue is my reading and writing is almost non-existent.” Care homes say he would be unable to write the notes for patient handover at the end of his shifts.
“I want to do care work. I was doing everything for my mum. I’m quiet and patient, you really need to be patient. The 12-hour shifts wouldn’t be a bother to me. And at the end of the shift, when everyone writes their notes, I can tell people. My memory makes up for it.”
Lord Heseltine, who was famous for his part in regenerating Liverpool, describes economic inactivity as a “terrible issue”. He believes devolution is key to getting people like James back into the workforce.
“I want to see more accountable mayors with powers and responsibility for skills, education and unemployment,” he says. “We need the co-operation of the forces that are at work in the local economy, making them work together to seek common objectives and empowering them to build public-private sector partnerships. There is no private sector solution to this problem.”
The Government argues it is doing more to help. A DWP spokesman said: “We’re proud to ensure a safety net that is generous for those who genuinely need it – and fair to the taxpayers who fund it. We will review our disability benefit system to ensure it is fairly and accurately targeted at those who need it most and channels people towards the right form of support for their needs.”
Sweeping reforms to the way benefits are assessed are expected to get 424,000 people preparing for work by doing things such as writing a CV by the end of the decade.
However, life in Knowsley suggests that chipping away at the welfare bill will require more radical reforms.
Sitting on a bench near the shopping centre in Prescot, David is confident he would be able to work if he could find a job. He still does some gardening at his supported living home.
“I could still do it all. I know everything about gardening,” he says. Perhaps surprisingly, he also believes he’s in reasonable health.
“I don’t suffer now, I feel very well. I have not suffered for donkeys’ years. People just get stuck with diagnoses,” he says.
‘The benefits system makes it hard to flow in and out of work, or try part-time work’
Louise Murphy, Resolution Foundation