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Sunak perpetuates the myth of the 'sick note culture'

Today, our latest Prime Minister is continuing the long tradition of ignoring the UK’s strong work ethic, in favour of using a pretend ‘sick note culture’ as an excuse to cut sick and disabled people’s support even further.


Hopefully, Labour won’t continue with his ideas, and there isn’t time to implement them before the next General Election. The PM’s ideas rest on the supposed existence of a cross-over professional, with expertise in both health and employment (including what jobs are available; what support a sick or disabled person needs; and whether the employer can provide that support).


Possibly the PM thinks that current assessors for the Work Capability Assessment could do this, but these assessors are not actually asked to think about work at all. They are given a list of narrow activities, such as picking up a £1 coin or signing one’s name, and asked to comment on whether the person in front of them can do these activities are not. There is little-to-no relationship to actual jobs, let alone what adjustments a person needs, let alone whether an employer can provide them. So who are the professionals that the PM thinks should be assessing a sick or disabled person’s capacity for work, if they’re not GPs, and we don’t have hordes of Occupational Therapists with deep knowledge of employment opportunities sitting in the sidelines?


The government’s repeated assumption is that sick and disabled people are not as sick and disabled as we say we are. Despite our daily lived experience, we don’t actually know much about what’s wrong with us and what we’re capable of doing. So we need to be told that we’re not as sick and disabled as we think, and then we’ll have the confidence to go out and do things, and that activity won’t trigger a collapse even though it has every time before.


In its guesses about how sick and disabled sick and disabled people really are, the government has tended to wildly (widely? Both will do) overestimate our health and abilities. Initial tightenings of benefit are partially relaxed when the latest crop of ministers is finally confronted with just how sick and disabled we actually are. But that doesn’t fit the narrative, so it is ignored, and benefits are tightened again, and again, and again.


The PM is taking particular aim at sick notes today (renamed ‘fit notes’ some years ago). The problem is, the UK has relatively little sickness absence compared to other OECD countries, and sick note certification hasn’t risen in recent years. In fact, sickness presenteeism is a potentially much larger issue in the UK, holding back UK productivity by spreading infectious disease and prolonging and exacerbating the presence of illness in the sick worker. The government seems to have forgotten its shock at discovering, during Covid, that people will actually go to work whilst infectious, knowingly spreading disease to other people.


Sick notes due to mental and behavioural disorders are a small part of sick notes, and haven’t risen either. Yet the PM wants to claim that the non-existent sick-note culture is due to people claiming mental illness for “the normal ups and downs of human life”. I suppose when you’re making up an ideology, you can make up the reason for it as well. The PM has possibly ignored the extent to which abnormally severe and prolonged ‘downs’ have become ‘normal’ in this country, due to Tory policies that have deepened and entrenched poverty whilst also harming public services. These ‘downs’ quite legitimately contribute to physical and mental illness, although they should not be ever accepted as ‘normal… downs of human life’, however common they become.


Even where a mental illness is given as the reason for being signed off from work, this may not be the primary issue facing the patient. When I last had a job that I could be signed off sick from, the reason given on my sick note was ‘depression’. But the reason for my depression was over-work and the struggle of living with a major physical illness. My primary illness is, and always has been, physical; but my sick note and therefore potentially the illness listed for benefit purposes is mental.




Some ten+ years ago, the DWP undertook some research into adapting the WCA to better account for people with chronic illness (the current system tends to assume that people have static, narrow impairments that affect a handful of activities all of the time).  The adjusted assessment found 44% of applicants to be unfit for work, compared to 20% for the standard WCA. It was felt by both benefit claimants and assessors to be a better assessment that enabled more of a claimant’s issues to be brought out and considered.


A separate ‘expert panel’ was then asked to assess the claimants, based on the report by the assessor. These ‘experts’ reported 30% to be unfit for work. Of those deemed ‘fit for work’, 83% needed major adjustments: 50% needed flexible or altered (reduced?) hours; 47% needed specific aids of appliances; others needed things like disability leave, home-working, or a support worker. The panel “sometimes expressed scepticism that claimants would get the help they needed.”


So what we have currently is a system that is harsher than an ‘expert panel’ thinks is appropriate, even whilst that ‘expert panel’ still thinks that many of the people they deem fit for work are not, in fact, able to work competitively in the open market place and instead need levels of support that many employers struggle to provide.


And the Prime Minister thinks this test is too soft.



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