Patrick Butler
Fri, 19 April 2024
Rishi Sunak called his proposed overhaul of the welfare system
Rishi Sunak’s big speech on reforming disability benefits was intended to show that the government had a grip on the economic and health challenges of the UK’s rising levels of long-term sickness. Instead, it came over as an administration running out of ideas, high on strident rhetoric, and desperate to cut welfare bills at all costs.
It was a “moral mission”, Sunak declared, to overhaul the current welfare system, which was “unfit for purpose”. Disability benefits were too easy to cheat, too cushy, too easily claimed. The speech was a clear appeal to the notion, in vogue on the right, that “mental health culture” has “gone too far”.
“Sicknote culture” – the idea that millions of lazy Britons are taking sickies with the connivance of GPs – was also in his sights, although there was little evidence to backup his assertion, or explanation as to how the changes would work. The underlying message was clear: claimants are lazy and the system too generous.
The most significant announcement was the proposed redesign of the main disability benefit personal independence payment (Pip). Ministers are convinced that far too many people – especially those with mental illness – are able to claim Pip, a non-means-tested payment designed to help claimants with the extra costs of daily living.
It is likely to focus on narrowing eligibility to drive down the Pip bill so that fewer awards are made, and at lower rates. Sceptics will point out that his was tried a decade ago, when Pip was introduced in place of disability living allowance. That reform – at the time brutally controversial, and incompetently managed – has clearly failed, even on its own terms.
Sunak sugared the pill of cuts with pious platitudes. He was “giving back hope” to people who had lost all “dignity and meaning” when they became entrapped in the vortex of the welfare state, he said. It was a familiar Tory tune – the idea that millions of people are not so much ill as spiritually lost.
Related: Longest sustained rise in people too sick to work since 1990s, says thinktank
Sunak floated other under-explained ideas: long-term unemployed claimants who refuse to take any job offered to them would have their benefits withdrawn; mentally ill claimants would be offered medical treatment as an alternative to cash benefits. But these felt like fodder for culture warfare rather than serious proposals.
The reaction was fierce. The disability charity Scope called it a “full-on assault on disabled people”. The Joseph Rowntree Foundation described the speech as “an irresponsible war of words on people who already aren’t getting enough support”. The Resolution Foundation said it was “a problem statement, not a plan”.
Labour’s acting shadow welfare minister, Alison McGovern, promised to reduce NHS waiting lists, reform social security and make work pay, but she was not clear precisely how Labour would do this. What is certain is that the challenge of long-term sickness – and the impact on the labour market – will be a priority for the next government.
The Institute for Fiscal Studies (IFS) estimates that one in 10 working-age Britons are receiving health-related benefits, and this is expected to increase. New monthly claims have doubled since the pandemic, especially among young people: a 20-year-old today is about as likely to claim a health-related benefit as a 39-year-old was in 2019.
A Labour government would need to balance restraining the benefits bill while addressing wider reasons behind mental illness such as poverty, insecure work, ineffectual job support and inadequate NHS care. It does not help – as the IFS said – that no one can yet fully explain what is driving the recent explosion in the takeup of health and disability benefits.
Rowena Mason and Patrick Butler
Fri, 19 April 2024
Rishi Sunak has been accused of making mental ill health “another front in the culture wars”, as critics warned his plan to curb benefits for some with anxiety and depression was an assault on disabled people.
In a speech on welfare, the prime minister said he wanted to explore withdrawing a major cash benefit claimed by people living with mental health problems and replacing it with treatment.
However, charities said treatment was not available now for many, with 1.9 million on the NHS waiting list for mental health services and some experiencing worsening conditions while they remain without help.
Scope, the disability equality charity, said the proposals were “dangerous and risk leaving disabled people destitute”, as well as making people’s ill – health worse by increasing their anxiety. James Taylor, the charity’s director of strategy, said the speech “feels like a full-on assault on disabled people”.
Launching a review of the personal independence payment (Pip), a non-means-tested benefit helping disabled people with the extra costs of their health problems, Sunak said Britain was suffering from a “sicknote culture”.
He added the review would consider asking for more medical evidence before awarding the benefit, look at whether some payments should be one-off rather than ongoing, and examine whether to stop cash payments for some mental health conditions.
The prime minister said it would seek to be “more precise about the type and severity of mental health conditions that should be eligible for Pip”, and that it was “not clear they have the same degree of increased living costs as those with physical conditions”.
Sunak added: “When you look at the numbers, half of people becoming inactive over the last year citing depression and anxiety, tripling in the number of people that have been signed off as sick in the last decade, that doesn’t quite strike us as right.”
Related: Sunak’s disability benefit plans are familiar culture war fodder
The announcement led to an outcry from disability charities, which said the rates of people being signed off work and claiming benefits were caused by crumbling public services, poor quality jobs and high rates of poverty among disabled households.
Charities also raised the alarm about Sunak’s rhetoric on mental ill health, after the prime minister said there was a “risk of over-medicalising what are essentially the everyday worries and challenges of life” in the welfare system.
Dr Sarah Hughes, the chief executive of the mental health charity Mind, said rhetoric that conjures up the image of a “mental health culture that has gone too far … is harmful, inaccurate and contrary to the reality for people up and down the country”.
“The truth is that mental health services are at breaking point following years of underinvestment, with many people getting increasingly unwell while they wait to receive support,” she said.
Labour said people were already crying out for NHS mental health support, and there was an “unprecedented crisis in mental health care”.
Wes Streeting, the shadow health secretary, said: “For the Conservatives to be attempting to make mental ill health another front for their culture wars is not just tone deaf, it’s shameless and irresponsible. Instead of attempting to cover up the scale of the problem, the next Labour government will give people the support they desperately need.”
Sunak set out his proposed changes to disability benefits at the Centre for Social Justice thinktank in London. He said “something has gone wrong” since the pandemic to increase the number of economically inactive people who are long-term sick, especially with mental health conditions.
“Most worrying, the biggest proportion of long-term sickness came from young people … parked on welfare,” Sunak said.
He said the country could not afford the “spiralling” disability welfare bill of £69bn, which was now more than the core schools budget, and claimed the Pip budget was forecast to increase by 50% in the next four years.
Other measures he set out included:
Shifting responsibility for issuing fit notes, formerly known as sicknotes, away from GPs to other “work and health professionals” in order to encourage more people to return to work.
Confirming plans to legislate “in the next parliament” to close benefit claims for anyone who has been claiming for 12 months but is not complying with conditions on accepting available work.
Asking more people on universal credit working part-time to look for more work by increasing the earnings threshold from £743 a month to £892 a month, so people paid below this amount have to seek extra hours.
Confirming plans to tighten the work capability assessment to require more people with “less severe conditions” to seek some form of employment.
Mel Stride, the work and pensions secretary, told Sky News on Friday: “If you go to the GP and say you are feeling a little bit depressed, and you’re signed off, in 94% of occasions, a box is ticked that says you’re not capable of work whatsoever.
“What we want to do is change the system so that that individual will be referred to – the government is setting up something called Work Well – where they will get both the healthcare support they need, but also a work coach who will be involved to either help them stay in work if they are in employment, or to help them get into work if they’re not.”
Trade unions for doctors and nurses expressed concerns about Sunak’s suggestion that there was a risk of “over-medicalising” mental health conditions, although he insisted that clinical decisions about diagnoses were always a matter for professionals.
The British Medical Association said the prime minister should focus on getting people access to the medical help they needed to get back to work rather than “pushing a hostile rhetoric on ‘sicknote culture’”.
Prof Pat Cullen, the general secretary of the Royal College of Nursing, said: “Nursing staff are the largest single workforce in health and care, but they themselves are suffering from increasingly poor long-term health.
“The prime minister’s overtures about ‘sicknote culture’ will be deeply offensive to a profession hit hard by long Covid and a spiralling mental health crisis. Issues of population health are not ones that a government can simply instruct away.”
The Institute for Fiscal Studies said the current and next government would have to find a way of either funding the rising bill for disability benefits or cutting them but that it was still unclear what was behind the increase in claims.
Sam Ray-Chaudhuri, an economist at the IFS, said: “A year or so ago, it seemed plausible that the rapid rise in numbers claiming health-related benefits was a transitory pandemic-related phenomenon. That explanation now appears unlikely, and today’s new forecasts reflect this fact.
“The rising cost of these benefits, and what might be done in response, will be a pressing concern for the next government and make the already tough fiscal situation harder still. Unfortunately, designing the right policy response is made much more difficult by the lack of clarity on what is fuelling the rise.”
Sunak accused of launching ‘full-on assault on disabled people’
Rowena Mason and Patrick Butler
Fri, 19 April 2024
Rishi Sunak is considering withdrawing a major cash disability benefit from some people with mental health conditions, prompting claims he has launched a “full-on assault on disabled people”.
The prime minister announced fresh curbs on disability benefits on Friday, saying he wanted to explore whether some cash payments to claimants with mental health conditions could be replaced by treatment or access to services.
In a speech on welfare, Sunak said he was launching a consultation on the personal independence payment (Pip), a non-means-tested benefit paid to disabled people to help with the extra living costs caused by long-term disability or ill health.
He said that in addition to reviewing payments to people with mental health conditions, the government would look at whether some other disabled people should get help with one-off costs rather than continuing payments.
The announcement triggered an outcry from disability charities, which said the rates of people being signed off work and claiming benefits were being caused by crumbling public services, poor-quality jobs and high rates of poverty among disabled households. Mind, the mental health charity, said services for mental health conditions were “at breaking point”.
There are 1.9 million people on a waiting list for mental health treatment in England, meaning the treatment they should be able to access through the NHS is not currently available to them.
Sunak said Britain was proud to have a strong safety net of welfare payments to those who needed them, but he also said the country had a “sicknote culture” that needed to be tackled.
He said “something has gone wrong” since the pandemic to increase the number of economically inactive people who are long-term sick, especially with mental health conditions.
“Most worrying, the biggest proportion of long-term sickness came from young people … parked on welfare,” Sunak said.
He said the country could not afford the “spiralling” disability welfare bill of £69bn, which was now more than the core schools budget, and claimed the Pip budget was forecast to increase by 50% in the next four years.
Other measures he set out included:
Shifting responsibility for issuing fit notes, formerly known as sicknotes, away from GPs to other “work and health professionals” in order to encourage more people to return to work.
Confirming plans to legislate “in the next parliament” to close benefit claims for anyone who has been claiming for 12 months but is not complying with conditions on accepting available work.
Asking more people on universal credit working part-time to look for more work by increasing the earnings threshold from £743 a month to £892 a month, so people paid below this amount have to seek extra hours.
Confirming plans to tighten the work capability assessment to require more people with “less severe conditions” to seek some forms of employment.
On the review of Pip, Sunak said it may be right to pay one-off costs for adaptations, but that the payments may not need to be ongoing.
The prime minister said the government would look at whether more medical evidence about conditions should be provided, as some payments were made on the basis of “subjective and unverifiable claims”.
He said some people with mental health conditions may be better served by treatment and access to therapies rather than cash payments.
Sunak also warned about the “the risk of over-medicalising the everyday challenges and worries of life” when it came to paying benefits to people with mental health conditions.
His comments were echoed by Mel Stride, the work and pensions secretary, who told Sky News on Friday: “If you go to the GP and say you are feeling a little bit depressed, and you’re signed off, in 94% of occasions, a box is ticked that says you’re not capable of work whatsoever.
“What we want to do is change the system so that that individual will be referred to – the government is setting up something called Work Well – where they will get both the healthcare support they need, but also a work coach who will be involved to either help them stay in work if they are in employment, or to help them get into work if they’re not.”
Ed Davey, the Liberal Democrat leader, said: “Millions of people are stuck on NHS waiting lists, unable to get a GP appointment or struggling to access mental health support. Rishi Sunak is attempting to blame the British people for his own government’s failures on the economy and the NHS and it simply won’t wash.”
Matthew Pennycook, the shadow housing minister, said Sunak had been pursuing a “cheap headline” over his claims that Britain has a “sicknote culture”.
“There has been a long-term rise for many, many years under this government in people who are on long-term sickness benefits, either because they can’t get the treatment they need through the NHS, which is on its knees after 14 years of Conservative government, or they are not getting the proper support to get back into work,” he said.
Charities warned that the benefit curbs would make people’s problems worse. James Taylor, the director of strategy at the disability equality charity Scope, said the speech “feels like a full-on assault on disabled people”.
“These proposals are dangerous and risk leaving disabled people destitute,” he said. “In a cost of living crisis, looking to slash disabled people’s income by hitting Pip is a horrific proposal.
“Calls are pouring into our helpline from concerned disabled people. Life costs more for disabled people. Threatening to take away the low amount of income Pip provides to disabled people who face £950 a month extra costs isn’t going to solve the problem of economic inactivity … Much of the current record-levels of inactivity are because our public services are crumbling, the quality of jobs is poor and the rate of poverty amongst disabled households is growing.”
Dr Sarah Hughes, the chief executive of Mind, said the mental health charity was “deeply disappointed that the prime minister’s speech today continues a trend in recent rhetoric which conjures up the image of a ‘mental health culture’ that has ‘gone too far’.
“This is harmful, inaccurate and contrary to the reality for people up and down the country,” she said. “The truth is that mental health services are at breaking point following years of underinvestment, with many people getting increasingly unwell while they wait to receive support. Indeed the Care Quality Commission’s latest figures on community mental health services show that nearly half of people (44%) waiting for treatment found their mental health deteriorated in this time.”
Iain Porter, a senior policy adviser at the Joseph Rowntree Foundation, said the prime minister had launched an “irresponsible war of words on people who already aren’t getting enough support, which the government would rather not talk about”.
“Many people want to work, as the prime minister says, but have their hopes dashed by woeful health and wellbeing support and job centres unfit for purpose,” he said.
The British Medical Association said the prime minister should focus on getting people access to the medical help they needed to get back to work rather than “pushing a hostile rhetoric on ‘sicknote culture’”.
• This article was amended on 19 April 2024. A previous version said the earnings threshold was increasing from £743 to £892 a “week”, rather than a month.
Jack Wynn
‘I’m signing you off work for two weeks’.
As soon as my GP had written the note to my manager, I felt a huge sense of relief.
Up until that moment, I had found myself falling out of bed 10 minutes before the start of my shift at my call centre job, before crawling back into it as soon as the working day was done.
It was 2021 and outside of work, I – like many others – was feeling the mental health impacts of the pandemic and the isolation of lockdown. And during my 9-5, the verbal abuse of customers, high call volumes and the pressure of targets were starting to wear me down.
I ended up being signed off work for a total of two months. During this time, I really thought about what I wanted from my life and career – and it’s all thanks to my GP getting the ball rolling by signing the sick note.
So when I read about Rishi Sunak’s proposal to crack down on so-called ‘sick note culture’, I was horrified. The PM claimed there was a ‘worrying’ proportion of young workers off sick, then mentioned plans that could strip GPs of the right to write fit notes – putting this in the hands of vague ‘specialist professionals’.
I believe that if this was in place when I needed time off work, it could have made my recovery incredibly challenging.
Due to my crippling anxiety and depression at the time, the thought of having to go through an intrusive assessment with a specialist rather than my regular GP would have made me feel even more vulnerable and guilty about using the system to get the help I needed.
It’s also difficult to understand exactly what Sunak calls an ‘objective assessment’, what it would include and how tailored it would be to an individual’s needs.
Especially if someone suffers with severe anxiety, this process could only make them feel worse because it feels like it lacks compassion. It only adds to the tremendous guilt many of us already feel about requesting a sick note.
I’ve lived with varying symptoms of anxiety and depression – from low moods to severe panic attacks – from a very young age.
I knew how I was feeling wasn’t normal and that time off work would only help – but I still felt extremely guilty. I have found that one of the hardest parts of being signed off with a sick note is the feeling of letting others down.
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Initially, when I first delivered the news to my colleagues, I could barely get the words out. My manager was surprised, as they noted my positive character, but supportive – as were my other colleagues.
Yet I knew that by not being there, other members of my team would have to pick up some of the slack until my return.
I felt massive guilt at the thought of letting people down. In these incredibly challenging times, I wanted to be considered a strong character of support to my friends and colleagues.
When I compared my depression to the severity of what frontline workers were facing since the pandemic started, I couldn’t help but feel embarrassed.
I despise being seen as weak – even though I know mental illness doesn’t mean you are less strong.
Rishi Sunak outlines plan for crackdown on sickness benefits
The first couple of weeks, I spent a lot of time hiding under a blanket on the sofa watching real crime Netflix documentaries, occasionally mustering the energy to go to the local shop and trying not to bump into anyone I knew in fear of having to make small talk.
During the time off, I made some improvement with my overall mood with the help of some telephone counselling, short daily walks and even did activities I wouldn’t normally have much time for, such as reading.
I was also able to reflect on happier times and make more of an effort to keep in touch with friends and family members I had not been able to see since the beginning of the pandemic.
After two months, I went back to work with a huge amount of fear and hesitancy.
During a phased return – in which I listened to the same calls that brought on my heightened anxiety – I knew I needed to make a change. So shortly after returning, I left the company to pursue another career. I needed that sick note from my GP to come to this conclusion and I’m grateful I was able to obtain it in a timely manner.
Sunak’s entire approach to this conversation stikes me as having a distinct lack of empathy. I believe that it should be kept under the GP’s discretion to advise on whether a patient is in need of a sick note.
It also shows how out of touch the PM is on mental health issues. Changing the process entirely increases anxiety for those suffering and could result in detrimental consequences. People struggling with their mental health might feel like second-class citizens compared to their colleagues.
I’ve since learned that no-one should feel guilty about taking the time they need to work on their mental health.
To keep pushing through and suffering in silence at work is certainly not the answer. Not only will it affect your performance, but you will begin to destroy relationships with your colleagues as you become unapproachable.
The pandemic brought with it so much uncertainty that it felt as though there was no light at the end of the tunnel. I couldn’t just rely on stronger medication, a few days completely shut off from the outside world, and more rest to get me through this challenging time.
Whatever comes of this latest announcement, I want Rishi Sunak to know that seeking time off work for mental health issues is lifesaving for many of us.
It’s not a ‘lifestyle choice’. And it’s not the easiest topic for anyone with something like depression to discuss.
I’m afraid this new ‘specialist professional’ system will become an interrogation format for those who genuinely need the time off, and will push the mental health conversation back even further.
So I say: Don’t be afraid to contact your GP – or this new system of a specialist – for advice. Despite the evident strain on the NHS, they are there to listen and offer the best help.
Being signed off has taught me that my mental health has to be my top priority. I shouldn’t feel guilty about putting myself first – no one should.
Aine Fox, PA Social Affairs Correspondent
Fri, 19 April 2024
One in 10 working-age people across Great Britain are claiming at least one health-related benefit according to new analysis which suggests someone aged 20 now is as likely to claim such a benefit as a 39-year-old was before the pandemic.
The Institute for Fiscal Studies (IFS) said the figure soared by one million since 2019, now accounting for 4.2 million working-age people (10.2%).
In the year before the pandemic hit, the figure was 3.2 million (7.9%).
The IFS, which published its findings on Friday following Rishi Sunak’s speech on major proposals for welfare, said the figure could be on course to pass five million people by 2028.
Using forecasts from the Office for Budget Responsibility (OBR) and the Scottish Fiscal Commission, the IFS said if things continue at their current pace, there could be 5.8 million working-age people on at least one health-related benefit by 2028–29.
If the pace slows but remains above the pre-pandemic norm the number of claimants is estimated at 5.4 million (12.4%), while if rates returned to their pre-pandemic levels, the IFS said the figure would be around 4.4 million recipients.
Spending on disability benefits and incapacity benefits for working-age people soared by £12.8 billion to £48.3 billion between 2019–20 and 2023–24, the IFS said.
This is forecast to rise to £63.7 billion by 2028–29, which analysts said is a £28.1 billion increase in the space of a decade.
Proportionally, the recent increase in claiming has been greater among younger people, the IFS said, with a 20-year-old now about as likely to claim a health-related benefit as a 39-year-old was in 2019.
For more than two thirds (69%) of new 25-year-old claimants, mental health and behavioural disorders were their primary condition, the IFS said, but this was the case for only around a fifth (22%) of new 55-year-old claimants.
The IFS said the causes of the recent rise in benefit claimants are “not yet well understood” but that it has “significant” implications for government spending.
Cutting benefits would be the most straightforward response, it said, but it added that this would see “significant losses for many vulnerable households” and would also fail to tackle underlying worsening health.
Sam Ray-Chaudhuri, IFS research economist and report author, said: “A year or so ago, it seemed plausible that the rapid rise in numbers claiming health-related benefits was a transitory pandemic-related phenomenon. That explanation now appears unlikely, and today’s new forecasts reflect this fact.
“The rising cost of these benefits, and what might be done in response, will be a pressing concern for the next government and make the already tough fiscal situation harder still.
“Unfortunately, designing the right policy response is made much more difficult by the lack of clarity on what is fuelling the rise.”
The abrdn Financial Fairness Trust, which funded the IFS report, said while there are likely to be various reasons for the increase, much is still unknown in this area.
Its chief executive, Mubin Haq, said: “A range of factors is likely to be contributing to this rise, such as the pandemic, NHS waiting times and conditionality in the benefits system, but much remains unknown as to what is driving this growth.
“Cutting or reducing access to benefits would lead to severe hardship for millions with additional needs and fail to address the underlying conditions we now face.”
Labour’s shadow health and social care secretary, Wes Streeting, pledged his party will invest in mental health support, as he accused the Conservatives of “attempting to make mental ill health another front for their culture wars”.
He said: “We are experiencing an unprecedented crisis in mental health care, with children and young people crying out for support.
“For the Conservatives to be attempting to make mental ill health another front for their culture wars is not just tone deaf, it’s shameless and irresponsible.
“Instead of attempting to cover up the scale of the problem, the next Labour Government will give people the support they desperately need.
“We’ll roll out 8,500 mental health staff to cut waits, put mental health hubs in every community and support in every school, to help people back onto their feet.”
Delivering his speech on Friday, Mr Sunak said he believed in the “growing body of evidence that good work can actually improve mental and physical health” as he insisted there must be more ambition in efforts to help people back into work.
He called for more honesty about “the risk of over-medicalising the everyday challenges and worries of life”.
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