This blog has been produced relatively quickly and without my usual level of attention to detail. I wanted to respond to Labour’s announcement of the Mayfield review, but am severely constrained by my current level of illness.
Labour have enthusiastically reported that they are carrying out a review that “will be the first of its kind”, but it is unclear what is new about it. In fact, a paper has already been produced on the topic by Professor Paul Greg, in which he “reviews the post-pandemic rise in health-related inactivity and incapacity, placing it in a historical context. He assesses the reasons for falling labour market participation and offers a policy direction informed by past experience.” [1] But then, Greg “advises policymakers not to focus too narrowly on cutting welfare spending”, which might not make his work very appealing to the current Labour party. He also notes that “a range of supporting evidence points towards deteriorating working-age health”, which may also be a politically unpopular narrative.
Enabling sick and disabled people to participate in paid work
Reports and research into why people too sick or disabled to work can’t work, what employers could do, and what government could do have been regular features over the years. These include the ‘Improving Lives’ Green and White papers (DWP 2016, 2017); ‘Sickness Absence and Health in the Workplace: Understanding Employer Behaviour and Practice’ (DWP 2021); and the ‘DWP Employer Survey 2022’ (DWP 2023). There was also ‘Thriving at Work’ (Stevenson and Farmer, 2017), which looked at how employers can improve their ability to retain employees who have mental illness; and ‘Good Work’ (Taylor et al, 2017), which considered that “all work in the UK economy should be fair and decent with realistic scope for development and fulfilment”.
Despite some implications from politicians and the media that mental illness is not as valid a reason as physical illness for being unable to work, Stevenson and Farmer report that people with mental illness lose their jobs at a higher rate than do people with physical illness. Additionally, there is a large cost of ‘presenteeism’: people attending work whilst sick, and thus prolonging their illness and ultimately reducing their quality and quantity of work compared to taking time off to recover more fully.
Somewhat naively, Stevenson and Farmer hoped that all employees would be engaged in good work by 2027; a goal which would take a major reorganisation of the UK labour market. One of their core requirements is that employers “provide employees with good working conditions and ensure they have a healthy work life balance and opportunities for development.” But the UK has a labour market that has a high proportion of ‘toxic jobs’, where employers have little reason to care about the long-term health and development of their staff. When there is a large pool of desperate jobseekers from whom to replace those who have been made sick by work, there is little financial viability in improving working conditions to prevent work-based sickness.
This is ironic, because one possible reason for sick and disabled people being unable to work is the changing nature of work. In particular, a reduction in ‘light work’ and an increase in ‘toxic jobs’. Paul Greg wrote about the reduction in light work in his 2024 thought paper, noting how “in the 1970s, a large number of men were employed on ‘light duties’. A combination of full employment, strong trades unions and a lot of male ill health related to industrial accidents or occupational health matters, meant that employers were willing to hold onto workers who were not able to work so much and were frequently absent.” In contrast, labour in the modern day “is now used both more intensively and ‘just in time’ than before. That is, employers expect workers to be fully functional when present and only present when actually needed (this is reflected, for example, in the use of zero-hours and self-employment contracts). The use of workers on light duties and with frequent absences is far less tolerated.”
Changes in economic inactivity
The other aspect of the review is an investigation into “the characteristics and drivers of rising levels of inactivity and ill health”. The first question that really ought to be asked is: is economic inactivity rising? The ONS has data from 1993, broken down by reason for inactivity, which shows that economic inactivity in absolute terms has been rising since 2020 (the most recent data is falling again, but it is too soon to know if that will become a consistent fall). Before that, it was falling for ten years from a peak of around 9,500,000. In 1998, economic inactivity was around 8,300,000. But the UK population was smaller then.
But as Ben Geiger points out in his excellent blog, reporting on absolute numbers only is foolish, and focusing only on recent trends is also unhelpful.[2] We need to factor in not only the larger population, but also the ageing population and the rise in state pension age.
Breaking down by reason for economic inactivity, there has been a rise and then fall in the numbers citing retirement (peak around 2010); a rise in students; a rise, slow fall, then rise again in long-term sickness; and a fall in those taking care of the family or home. These in themselves raise interesting questions. Why are fewer people taking early retirement? Could it be a question of finances: whether or not someone who is too sick to work can afford to take early retirement, or instead needs to claim sickness benefits? Why are fewer people reporting that they take care of their family or home, and could some of these people be reporting long-term sickness instead, whilst also still having home-making and caring responsibilities? Is the recent increase in long-term sickness related to the Covid pandemic, given that the increase starts in 2020?
Changes in Social Security receipt
Labour’s hard line on social security, especially for sick and disabled people, hit me with particular force when the mention of Jeremy Hunt made me realise that a blog post which I had assumed was from this year was actually a year old. The opening lines could apply just as well to Labour at the end of January 2025 as they did to the Tories this time last year:
“A new sense of a ‘welfare problem to be fixed’ is gaining ground. It’s one of the planks in the current Government’s attempts to carve out a political dividing line on welfare… The claim is that we have a problem with a sharp rise in sick/disabled people not working and claiming benefits – particularly around mental health. This is seen as both a social problem and an unsustainable cost. And the commentariat mostly believe that this is a problem that needs to be tackled through reform of disability-related benefits, in both its incentives and the employment support it offers.”[3]
Geiger does a great job going through some of the reasons why the number of people receiving ‘out-of-work benefits’ has increased with the introduction of Universal Credit.[4] A range of people are now counted as ‘not working and on working-age benefits’ under Universal Credit who previously would simply not have been counted in this group. This could have been because they weren’t counted as being on benefits (e.g. the previous system allowed for one person in a couple to claim benefits even if the other was neither working nor claiming; under UC, the second person must also claim UC if they are not working) or because the benefit they were receiving (e.g., housing benefit alone) wasn’t included in the ‘out-of-work benefits’ category. Not only that, but people can now be working up to 24 hours a week at minimum wage and still be counted as ‘not working’ for the current counting system.
Looking at all the changes, including the change in state pension age, Geiger reaches an astounding (to politicians) conclusion: there were fewer out-of-work social security recipients in 2023 than 2013.
Changes in sickness benefit receipt
Geiger also points out that whilst mental illness as the sole reason for young people to be on sickness benefits (as opposed to just physical illness, or both physical and mental illness) has indeed risen, so has the reporting of mental illness amongst young people in work.[5] In fact, the relative increase in mental illness amongst working young people is greater than that for young people on sickness benefit; and there has also been an increase in the reporting of mental illness amongst working and non-working older people. So the issue is not that young people are suddenly claiming to have mental illness and using that as an excuse to drop out of the workforce, but rather that all groups – in particular young people in work – are reporting higher rates of mental illness.
Conclusion
Labour’s review into “how government and businesses can work together to support ill and disabled people into work, boost living standards and grow the economy” is not particularly new. There have been numerous reports of the years looking at things like why people claim sickness benefits, trends in benefit receipt, supporting sick and disabled people into work, and the role of employers and the government in employing such people. It is disappointing that Labour did not spend their 14 years in opposition to conduct a literature review on these topics, and to engage with people like Ben Geiger and Paul Greg who have contributed useful work on these areas. It is even more disappointing that Labour plan to make changes to sickness benefit assessment before getting the findings from this review, let alone implementing them and checking that they actually work.
Comments