Sunak to cite Britain’s ‘sicknote culture’ in bid to overhaul fit note system | Health policy


Rishi Sunak will today claim Britain is suffering from a “sicknote culture”, as he warns there is a risk of “over-medicalising” normal worries by diagnosing them as mental health conditions.

In a speech on how to reduce people being signed off sick from work, the prime minister will say the government is planning to trial getting “work and health professionals” to issue fit notes, shifting away from GPs carrying out this role.

Sunak will say he is concerned about the increase in long-term sickness since the pandemic, largely driven by mental health conditions with 2.8 million people now “economically inactive”.

In relation to mental health, he will say he would “never dismiss or downplay the illnesses people have”, but also argue that there is a need to be “more honest about the risk of over-medicalising the everyday challenges and worries of life”.

His language echoes that of Mel Stride, the work and pensions secretary, who has claimed that too often doctors “label or medicalise” conditions which in the past were seen as “the ups and downs of life”.

As part of a new drive to overhaul the system, Sunak will say one plank of the reforms will be testing whether responsibility for issuing sicknotes should be shifted from “overstretched” GPs 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”.

The law was changed last year to allow fit notes to be issued by any doctor, nurse, pharmacist, physiotherapist or occupational therapist in addition to GPs, who have traditionally overseen the system. No 10 last night would not clarify whether the government was planning to widen the criteria further to allow non-medical professionals to issue or change fit notes as well.

Sunak will suggest in his speech that GPs are signing people off sick for work “by default”, with 11m fit notes issued last year, of which 94% assessed people as “not fit for work”. No 10 claimed that the fit note system has “opened the floodgates for millions of people to be written off work and into welfare without getting the right support and treatment they might need to help them stay in work”.

However, extracts of the speech released to the media on Thursday night did not address the issue of NHS mental health capacity, with NHS bosses warning “overwhelmed” services have been unable to cope with a big post-Covid increase in people needing help.

Dr Sarah Hughes, chief executive of the mental health charity Mind, said: “We are deeply disappointed that the prime minister’s speech 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. 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 added: “To imply that it is easy both to be signed off work and then to access benefits is deeply damaging. It is insulting to the 1.9 million people on a waiting list to get mental health support, and to the GPs whose expert judgment is being called into question.”

James Taylor, the director of strategy at the disability charity Scope, said: “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 among disabled households is growing.”

Employment experts said the number of fit notes issued – 11m last year – has not risen since before the pandemic.

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“Fit notes are not driving the increase in economic inactivity. They are not responsible for high levels of worklessness from ill health. Economic inactivity has been driven by people who are already out of work and have been for long periods,” said Tony Wilson, the director of the Institute for Employment Studies.

Plans to reform the fit note system were first flagged by Jeremy Hunt in the autumn statement. A new service called WorkWell is due to be launched this year in 15 areas, which is described as “early-intervention work and health support and assessment”. This will be targeted largely at people with mental health and musculoskeletal conditions, with people who have fit notes attending sessions with “work and health coaches” in an effort to get them to return to employment.

The last Labour government introduced “fit notes” rather than “sicknotes” in 2010 to put a new emphasis on doctors certifying what patients are able to do, rather than what they cannot.

Alison McGovern, Labour’s acting shadow work and pensions secretary, said: “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.”

Ruth Rankine, the director of the NHS Confederation’s primary care network, said its members had “long advocated for a review of the fit note process which could be more effectively managed through trained professionals that support people back into work”.

But she added: “The deeper problem isn’t the system – it’s that people are sicker than they were and they have more complex healthcare needs. This is why it is vital the government starts treating investment in the NHS as an explicit tool of economic development and also, that the prime minister should lead a national mission for health improvement to shift the focus from simply treating illness to promoting health and wellbeing.”

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