Sickness and work is a disaster that must be fixed


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Are the British work-shy? The UK is now the only developed country where more people have continued to drop out of the workforce since the pandemic. The work and pensions secretary has urged the over-50s to get on their bikes — literally — by delivering takeaways. But can they? Last month, the number of people citing long-term sickness as their main reason for not working hit a record high.

Before Covid struck, the UK working age population was already plagued by more illness and disability than in the rest of Europe. But it has since shot up further: there are now 2.6mn people off work as a result of long-term sickness. This could be a consequence of the NHS backlog. It wouldn’t be surprising to see fewer people looking for work if they are waiting for hospital treatment, or looking after someone who is waiting — especially if they are older.

But those who have focused on the over-50s’ “great resignation” have missed another phenomenon. The biggest relative jump in economic activity due to long-term sickness is in the young, not the old. The numbers increased by 29 per cent among 16 to 24-year-olds and by 42 per cent among those aged 25 to 35 between 2019 and 2022. New analysis by the Institute for Fiscal Studies finds that disability is now more correlated with education than with age. According to the IFS director Paul Johnson, a 30-year-old with no qualifications is more likely to report a disability than a 50-something university graduate.

This alarming development has much to do with an apparent deterioration in mental health. Depression, bad nerves or anxiety have become the most prevalent health condition reported by those who are economically inactive because of long-term sickness, especially under the age of 35.

Are people really too sick to work, or are they just sick of working? “It is worth considering,” says the Office for Budget Responsibility in its latest fiscal risks report, “whether the welfare system itself might have contributed to the rise in measures of health-related economic inactivity.” It notes that disability benefits are more generous than unemployment benefits, with fewer requirements to find a job; and that the process of getting a doctor’s “fit note” for statutory sick pay was replaced by self-certification during the pandemic.

As an old school Calvinist, I can see that being allowed to self-certify might prove tempting. I also know that even if you’re not depressed to start with, being sedentary and jobless can make you so (my mother, a manic depressive, fought to keep her job to retain her sanity). But I don’t believe that most people are faking it. It is hard to score the points needed to qualify for the personal independence payment (PIP). The health downturn has also coincided with a fall in real incomes which has put unbearable stress on some of those with least resources.

It would be wise to ensure, nevertheless, that the welfare system does not inadvertently encourage people to state that they are permanently ill. Many physical disabilities are, sadly, for life. But some mental health conditions — such as anxiety and depression — come in waves. People can recover, especially if they get help.

We should not be writing people off. Yet that is the bigger story, across the industrialised world. Even now, the UK does not have markedly lower labour force participation rates than the rest of the OECD: it is still ahead of France, Italy, Spain and the US. But the gap which the IFS pinpoints, between levels of education and health, is starkly echoed in gaps in life expectancy between rich and poor, especially in the UK and US. In civilised countries, a toxic combination of poverty, obesity and poor education are adding up to mental despair.

The tragedy is that the UK had made real progress in the decade before the pandemic. Working-age inactivity fell from 9.5mn to 8.4mn people between 2010 and 2020, making Britain one of the best performers in the G7. This was partly as a result of welfare reforms to make work pay.

What can be done? One thing is clear. Leaving people waiting weeks or months to talk to a therapist, is not good for mental health. Individual placement and support services, which help severely mentally ill people into jobs in various European countries, have been shown to be most effective when they place someone quickly into a role, and provide intensive support. The same principle applies to occupational health schemes offered by employers which have proved successful in reducing absence rates in Finland and the Netherlands. This is a point not lost on the British chancellor Jeremy Hunt, who is mulling over offering tax breaks to UK companies to follow suit.

Young men need attention. At 16, it is girls who are seeking mental health support in record numbers. But between 25 and 34, almost two-thirds of those who are not seeking work are male. History suggests that if they fall out of the workforce for too long, they are far less likely to ever get back in.

With conventional mental health services overwhelmed, could digital services help? Kooth Digital Health, a British company, has just won a contract from the state of California to provide digital mental health services to every young person between 13 and 25. Its CEO Tim Barker says many just need a few counselling sessions but the key is to respond fast.

We could do better, too, at hiring the many disabled people who want a job. Schemes such as the government’s Access to Work programme have been accused of being too bureaucratic for employers. The Treasury should pull every lever. Otherwise, long-term sickness will fatally undermine both the economy and people’s life chances.

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