Prime Minister Rishi Sunak pledges to ‘end sick note culture’ – but what does that mean?
Rishi Sunak is going to call for an end of what he calls the “sick note culture” in a major speech on welfare reform, as he warns against “over-medicalising everyday challenges.”
The prime minister wants to shift instead to “what people can do with the right support in place, rather than what they can’t do”.
It comes amid government concerns some are being unnecessarily written off as sick and “parked on welfare”.
The speech comes a month after Work and Pensions Secretary Mel Stride faced criticism for an interview in which he said there was “a real risk” that “the normal ups and downs of human life” were being labelled as medical conditions which then held people back from working.
Comments that were described as “disappointing” by the president of the Royal College of Psychiatrists, while the Centre for Mental Health charity said they risked “belittling people’s struggles”.
Disability equality charity Scope has said it would question whether Sunak’s announcements are being “driven by bringing costs down rather than how we support disabled people”.
On Friday, in his vision for a “new welfare settlement for Britain”, Sunak is expected to pledge not to dismiss or downplay illness, but to call for a “more ambitious” approach to helping people back to work.
He is due to say: “We should see it as a sign of progress that people can talk openly about mental health conditions in a way that only a few years ago would’ve been unthinkable, and I will never dismiss or downplay the illnesses people have.
“But just as it would be wrong to dismiss this growing trend, so it would be wrong merely to sit back and accept it because it’s too hard; or too controversial; or for fear of causing offence. Doing so, would let down many of the people our welfare system was designed to help.”
He will say there is a “growing body of evidence that good work can actually improve mental and physical health”.
Sunak will add: “We need to be more ambitious about helping people back to work and more honest about the risk of over-medicalising the everyday challenges and worries of life.”
Ahead of the speech, Work and Pensions Secretary Mel Stride said “enough is enough” as he vowed to tackle “skyrocketing” benefits spending.
Stride told LBC Radio: “If you look at issues like long-term sickness, disability, and you add up all the costs of all the benefits there, you get to about £69 billion. The most worrying aspect of all of this… is the increased cost going forward.”
The government said recent NHS data showed almost 11 million fit notes were issued last year, and said many are repeat fit notes “issued without any advice, resulting in a missed opportunity to help people get the appropriate support they may need to remain in work”.
Sunak is expected to announce a review of the fit note system, suggesting specialist work and health professionals should be charged with responsibility for issuing them instead of GPs.
Responses from healthcare professionals, employers and people with lived experience will be sought in a call for evidence launched on Friday.
Sunak is expected to refer to challenges presented since the pandemic, with the government saying a “significant number of working aged people have become inactive due to long term sickness which has in large part been driven by mental health conditions”.
He is expected to say: “We don’t just need to change the sick note, we need to change the sick note culture so the default becomes what work you can do – not what you can’t.
“Building on the pilots we’ve already started we’re going to design a new system where people have easy and rapid access to specialised work and health support to help them back to work from the very first Fit Note conversation.
“We’re also going to test shifting the responsibility for assessment from GPs and giving it to specialist work and health professionals who have the dedicated time to provide an objective assessment of someone’s ability to work and the tailored support they need to do so.”
Since 2020, the number of people out of work due to long-term sickness has risen significantly, reaching a record high of 2.8 million people as of February 2024, according to the latest estimates from the Office for National Statistics.
A large proportion of those report suffering from depression, bad nerves or anxiety, although most of those report these as secondary conditions rather than the main one keeping them out of work.
James Taylor, Scope director of strategy, said: “We’ve had decades of disabled people being let down by failing health and work assessments; and a broken welfare system designed to be far more stick than carrot.
“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.”
He added: “We hope this system has been designed with disabled people and has been crafted to work with them not against them.”
Alison McGovern, Labour’s acting shadow work and pensions secretary, said: “A healthy nation is critical to a healthy economy, but the Tories have completely failed on both.
“We’ve had 14 Tory years, five Tory prime ministers, seven Tory chancellors, and the result is a record number of people locked out of work because they are sick – at terrible cost to them, to business and to the taxpayer paying billions more in spiralling benefits bills.
“Today’s announcement proves that this failed government has run out of ideas, announcing the same minor alternation to fit notes that we’ve heard them try before. Meanwhile, Rishi Sunak’s £46bn unfunded tax plan to abolish national insurance risks crashing the economy once again.”
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