Prime minister Rishi Sunak has announced a crackdown on sickness and disability advantages with a view to end a “sicknote culture” and “over-medicalising the on a regular basis challenges and worries of life”, partly because he claims that “good work” can actually improve mental and physical health. He as an alternative desires to deal with “what people can do with the fitting support in place, somewhat than what they’ll’t do”.
Taxpayers and recipients of sickness and disability advantages might feel like they’ve heard all this before. Back in 2015 then-work and pensions secretary Iain Duncan Smith promised to “end sicknote culture” by supporting “a system focused on what a claimant can do … and not only on what they’ll’t”.
And there are echoes too of 2007 when then-work and pensions secretary Peter Hain promised to finish “sicknote culture” to deal with what people “can do somewhat than what they can not do”, partly due to a belief that being in work “is often good for individuals with every type of mental health problems”.
Given their unquestioning belief within the efficacy of such measures, it should be confounding for politicians to learn that the numbers of disabled people and other people claiming disability advantages continues to rise.
In the last ten years, the proportion of working-age adults who’re disabled has increased from 16% to 23%, while amongst children it has gone from 7% to 11%. Interestingly, for people of state-pension age, the figure has remained relatively stable (43% to 45%).
In April, the Institute for Fiscal Studies reported that the proportion of working-age people claiming disability advantages increased from 1.5 million in 2002/03 to 2.3 million in 2019/20, before spiking to three.3 million in 2023/24.
It is that this trend that Rishi Sunak claims must be addressed, with mental health conditions a growing component of recent disability profit claims. The point, though, because the figures show, is that reforms that deal with tightening eligibility criteria and stringent assessment do nothing to scale back the number of individuals claiming.
Rather, we will point to an actual economic case for presidency investment in infrastructure and day-to-day spending to maintain people well and – where possible – working.
There is an inclination in announcements, too, to conflate means-tested incapacity advantages with non-means-tested disability advantages, equivalent to the private independence payment. In reality, the latter is utilized by many individuals to support their engagement with full-time paid work and other types of health-promoting activity through adaptations and activities that manage their conditions. Without these, even part-time employment could be not possible.
But even with regard to means-tested advantages, studies have found that sanctions on advantages, which the federal government has promoted as a way of getting more people into the workforce, don’t actually increase employment levels.
There is, however, excellent reason to suggest that imposing strict eligibility criteria and sanctions might be very harmful to disabled people’s health, activity and financial situation. What is de facto driving these reforms, as ever, is ideology and electoral concerns.
Changing attitudes
But people receiving such advantages are not any longer an out-group that the general public wishes to punish. We have been through a pandemic during which individuals who had believed their jobs and income to be secure were suddenly left either on government-funded furlough or universal credit.
Senior managers were exposed to Britain’s Byzantine welfare system, and other people who had never taken a time without work found their employers unwilling or unable to repay that loyalty.
The effect of that is that the old “strivers versus scroungers” argument simply doesn’t appeal because it once did. In the most recent British Social Attitudes Surveyjust 19% agreed that “most individuals who get social security don’t really deserve any help” – lower than half the figure of 40% in 2005.
So what can we do to handle the rapid increase in disability and mental ill-health? First, we must acknowledge that the pandemic has had lasting physical and mental health consequences for a lot of, whether directly because of this of COVID infection or not directly as a result of behavioural and socioeconomic effects.
We must create a system that allows people to construct a productive life of their best health, wellbeing and economic interests. Just because the social economist Lord Beveridge proposed in his 1942 report, we’d like cradle-to-grave social security that supports that ambition, somewhat than forced participation in harmful insecure employment.
The cost of illness and disability from such employment is felt in our overburdened NHS and the ever-growing number of individuals unable to re-enter the workforce once conditions develop.
Investing in people is nice
It isn’t tenable for the federal government to argue for stricter criteria and more assessment. Rather, there may be good evidence for implementing less conditional systems of welfare, which don’t have any work disincentives, for economic, health, and wellbeing reasons.
Something like basic income (a system of normal, fixed payments made to everyone in society) can provide the economic and financial stability to permit people to seek out sustainable employment. There can also be strong evidence to take a position in reactive healthcare to be sure that individuals with long-term conditions receive the treatment they must be as lively as possible.
The prime minister suggested that some individuals with mental health conditions could be higher supported through talking therapies or respite care than money transfers. That could be the case had government funding for these services not failed to maintain up with demand.
There is ample evidence that investment in securing the social determinants of health, equivalent to income, housing, education and the environment, is very popular with voters – and inexpensive, too.
Funding this kind of system isn’t wasteful. Based on strong underpinning research, our evaluation assumes indirect returns on investment of 2.74 times government spending on infrastructure, and 0.91 on day-to-day spending. There is each an economic and social reason to take a position in people and the country.
Common sense tells us that Britain isn’t a sicknote nation, but a sick one. We have to act now to create a greater system – because the present one is benefiting only a few of us.