Sick note Britain: really, Prime Minister?

Composite image by Anthea Bareham, incorporating a photo by SEO Galaxy on Unsplash

In mid-April 2024, the Prime Minister got himself a juicy front cover on the Daily Express: PM tells sick Note Britain: Get a grip and get a job.

He then put out a thread on X (formerly Twitter) claiming “We now spend £69bn on benefits for people of working age with a disability or health condition” and how that amount has gone up.

The absolutely vital point that he and his party are (of course!) completely ignoring, is that the number of people of working age with a health condition or a disability is going up. It’s not that the money spent per capita has gone up, but that spending is going up because the number of people needing the money has increased.

And no, they haven’t all suddenly become work-shy scroungers, despite what the Daily Mail or the Express might claim.

Let’s take a look at that rise in need, rather than pretend the problem is that too many ‘undeserving’ people are claiming long term sick benefits. Maybe if the needs were addressed, some of these people could actually get better and get back to work.

There are 10.6m working-age people in Britain with a long-term health condition (up from 8.5m in 2016). The overwhelming majority are in work.

However, 2.8m are not: up from 2m in 2019.

Sunak claimed the current system was “leaving a generation of young people to sit alone in the dark before a flickering screen watching as their dreams slip further from reach every passing day.”

This is an obvious attempt to ‘blame’ young people, although it’s actually 50–64-year-olds who make up over half of those out of work due to long term sickness, as well as accounting for the biggest rise in numbers since 2019.

Sadly, there’s no doubt that there has been a staggering rise, and not just since the pandemic.

ONS data

So why is it happening?

Well, as with all complex issues – it’s multi-factorial. The first, and most obvious, factor must be the current state of our NHS and length of the waiting lists. Now I know correlation does not equal causation but come on…! Just look at the shape of these two graphs and see where they both start to rise.

ONS/NHS England data

There has been a huge rise in patients waiting for NHS treatment, for 18 weeks to one year from the point of GP referral. There are 7.5m people currently on the waiting list, one third of whom are out of work due to long term sickness.

So why are the waiting lists so bad?

Again, there are multiple factors but the most glaring one is funding.

Since its inception, NHS spending has increased by an average of 3.6 per cent per year in real terms. During the Blair years it rose 6.3 per cent on average. But in the last decade it has risen by just 2.8 per cent – and that INCLUDES Covid spending. Hunt’s recent budget will increase spending by an appallingly measly 0.1 per cent up to 2025! With an aging (and sickening) population far outpacing these tiny increases, the NHS simply doesn’t get enough money to meet the growing demand for its services.

We don’t pay our doctors or nurses anywhere near enough. While the rest of the economy has seen stagnant pay at worst, and decent rises at best, doctors in particular have seen 20-25 per cent pay cuts: (‘completely destroyed’, is how this doctor described it. It’s worth taking a look at the entire thread.).

We have fewer fully qualified GPs than 10 years ago, with increasing numbers of patients; and we have doctors and nurses emigrating abroad to places with a higher standard of living alongside significantly higher pay.

Our hospitals have had pitifully little capital investment over the last decade, meaning ceilings have collapsed, some wards have been infested with rats and fleas, 42 hospitals contain the problematic RAAC (Reinforced Autoclaved Aerated Concrete) that has reached the end of its stable life span and computer failures are now costing patients’ lives.

Lack of investment in both staff and infrastructure is just one part of the puzzle.

Add Brexit exacerbated medicine shortages into the mix, and it’s starting to look bleak. Supply chain hold-ups mean medicines don’t get to the UK as easily as before. As the world faces global shortages in some medicines, the EU, as a larger entity. can access more of the dwindling supply – purchasing power from which we no longer benefit. Since leaving the EU, the UK has also been slower to approve drugs than the EU, meaning we have to wait longer to benefit from new and innovative medicines.

Covid has, of course, had a big impact on both the NHS and its staff and on causing long term health issues.

Long COVID, delayed treatments, and the long-term health risks associated with infection will all be adding fuel to the fire. The latest ONS data show that Long Covid is adversely affecting the day-to-day lives of 1.5m people in England and Scotland, with over 380,000 reporting that their lives are limited ‘a lot’.

And now, after the trauma of the pandemic, the government have said they want to remove specialist mental health support for NHS staff, at a time when we need fit and fully functioning staff more than ever if we’re to get this waiting list down. After an outcry, the government have backed down on this plan, for now.

Finally, the longer people wait for specialist treatment, the worse their conditions become. What may have started out as a fairly simple fix becomes a more difficult and costly procedure, requiring even more time off work.

What a mess….

Mental Health 

And speaking of mental health – that has been a big contributing factor to the rise in people off work. With more vacancies in mental health than any other NHS department leading to waits of up to 10 years for some diagnoses, it’s not hard to see that it is another element in the issue of long term sickness.


Unfortunately, Britain’s declining living standards across the board are also having a big impact on the nation’s mental health. This parliamentary period will be the first in 70 years during which households will see a decline in living standards.

Decline in living standards;  source: Resolution Foundation analysis of ONS and OBR data

People receiving emergency food bank parcels from the biggest food bank group in the UK, the Trussell Trust, has risen from 60,000 in 2012 to a staggering three million in 2023. Rough sleeping has doubled since 2010. We have 109,000 families living in temporary accommodation, according to recent government statistics. It is harder than ever before to get on the property ladder, and the effects of austerity combined with the cost-of-living crisis means that many in the nation are really struggling.

Poverty, deprivation, housing insecurity and social isolation are all associated with depression and anxiety. Some 330,000 excess deaths have been linked to austerity in the UK. People are dying younger, and the more deprived the area in which you live, the worse your life expectancy. There is a 10-year difference in life expectancy between the least and most deprived sections of our society.

Differences in life expectancy; source: ONS

It stands to reason that deprivation is also linked to increased poor health. In fact it has been shown that there are 33,000 extra cancer cases each year associated with socio-economic status, and survival is worst for the most deprived group.

I could go on with many more metrics and stats, but you get the picture.

The ‘problem’ isn’t spurious (and misleading) claims about how much money is being spent on benefits; the problem is that millions of people are suffering intolerably poor health – in large part due to Tory policies.

It’s estimated that out of work, long term sickness benefits are costing the country around £50bn a year.

That’s a lot. Of course it is.

But don’t forget how much money the government is happy to waste in other areas, while they want to claw back money from sick people. There has been £15bn wasted on unused Covid supplies, £1bn in mistaken or fraudulent covid loans just written off, not to mention potentially billions set to be spent on the unworkable Rwanda scheme.

And don’t forget, either, that actually tackling the problem of the waiting lists and the long-term sick would have far bigger benefits to the economy and productivity, than simply depriving sick people of benefits. One study calculated that simply meeting the government’s targets on NHS waiting lists could bring benefits of up to £73bn back into the economy! Another study found that poor health of people in the UK is costing £138bn per year in impact on work and poor productivity.


As for Sunak’s brainwave of stopping GPs from assessing patients – the very people who know the situation the best – and getting teams ‘linked to the benefits system’ to do it instead? It’s hard to put into words just how bad an idea that is. X/twitter is full of people’s lived experiences of dealing with similar ‘teams’. Rather than me explain, please read just a few for yourself:

Thread: Just a few of the people who have died after being found ‘fit for work’. When the Govt, DWP & media speak of ‘scroungers’, these are the people they are talking about. You decide.

 A long thread of my experience with work capability assessments. In 2015 I took early retirement because of illness, this is just a post for all the people out there that think disabled people in this country are scroungers etc and how we are treated

With my partner’s blessing, I share our recent personal journey trying to access mental health help. My OH just started full time work again, after eighteen months off sick. At every point, the system was a set-back instead of help, it LENGTHENED and WORSENED his problem


There are many other factors at play, including the older retirement age meaning more people are of working age at a point in their lives when health problems can be starting to kick in, and the fact that many employers are reluctant to make adjustments that would enable people to keep working with a disability or at a lower capacity.

We know that people who are out of work because of long term sickness are not scroungers. They aren’t simply deciding a life on benefits sounds fun. It’s incredibly hard and often degrading to get the support needed.

They’re in pain. They’re suffering. Many directly due to Tory policies. Instead of harassment, they should get the support they need – for their sake, and that of the economy.