JAmie loved his work. Working as a hospital porter, helping sick people in need, he probably never expected to become a patient himself: at the age of fifty he was still fit and healthy. But then he strained his back while working, and so began a long descent. He was given physio exercises to follow online but couldn’t access them, and it wasn’t long before he was in so much pain that he was dismissed for good. Unable to stay active and gaining weight, Jamie was referred to a diabetes prevention program; but by now his back was too painful to drive to the clinic, and public transport was a challenge.
Overwhelmed and isolated, he eventually retreated to his damp, moldy council house. Five years later, Jamie is still not working, but his back is almost the least of his problems. He’s diabetic, asthmatic thanks to the mold, suffers from cardiovascular disease, and if he’s not depressed yet, he probably will be soon.
There are countless Jamies, many of whom suffer from what some doctors call private “shit life syndrome”: getting a series of bad cards, missing the money to bounce back from one of them, and sinking deeper every day. They are really sick, often with multiple diagnoses, but sick in deeply complex, confused ways that medicine alone cannot magically solve. And herein lies this autumn’s toughest political battleground, as a new Labor government tries to boost economic growth by getting people on long-term sick leave back to work.
These are worrying times for many people who are dependent on disability or sickness benefits. Liverpool’s Keir Starmer’s warning that those who can work must work has done little to quell anxious speculation about what this autumn’s Budget means for social spending, especially as ministers have not yet spelled out exactly what they will do about it. planned reforms of disability benefits initiated by the outgoing Tory government. Starmer has stressed that he knows there will be “difficult cases” who cannot physically work no matter how hard they try, and that Labor wants to help people rather than force people back to work. But it’s hard to relax when the roads to past social welfare oppression are too often paved with reassuring words.
Enter Jamie, who is not a real person, but a representative example of countless very real patients, created by the NHS Confederation and the Boston Consulting Group’s Center for Growth to illustrate their joint report in a gentler way to get half a million long-term ill Britons back to work. Their analysis expertly separates tabloid myths about skivers and sick notes from hard facts. Yes, Britain has 2.8 million adults who are economically inactive due to a long-term illness, up by as many as 900,000 since 2020. No, this is not an inevitable global hangover from the pandemic – economic inactivity has fallen elsewhere in Europe – but it is also extreme. That is unlikely, because a life with benefits here is simply too soft. The introduction of universal credit has left many disabled people worse off than before.
The simple explanation is that Britons as a whole are sicker than before, with a third of working-age adults admitting to suffering from at least one health problem; that economic inactivity is in some ways a canary in the mine, pointing to lives that are leaving too many people stressed and sick. Significantly, the report concludes that the kinds of social and environmental factors that so often underlie the ‘shit life syndrome’ provide more explanation for the variation in health outcomes between different parts of the country than more obvious factors such as diet and exercise, with deteriorating living conditions and increasing crime especially closely linked to preventable deaths.
But it also shows how little it would have taken to stop Jamie’s downward spiral; How different things might have been if he had been offered the opportunity to retrain for a desk job, or cheap transportation to his various appointments, or a better roof over his head. The message is that getting sick people fit for work again requires the whole of government to unite around a common goal – or mission, to use Starmer’s buzzword – to reach the areas doctors can’t reach, supported by employers who do more to keep staff healthy.
There are reasons to be hopeful that ministers will broadly understand this. Wes Streeting’s announcement that ‘crack teams’ to reduce NHS waiting lists will not be deployed first to places with the longest waiting times, but to places with the highest numbers of sick people, is a promising sign that different parts of the world government do the same towards. Housing Minister Angela Rayner’s promise to make private landlords tackle damp and mold Swift was not announced as a public health measure, but is potentially a lifesaver for people with respiratory illnesses. Work and Pensions Secretary Liz Kendall’s promise of “no more writing people offand then blame them just to grab a cheap cup” reflects a genuine desire for less loud-mouthing and a more practical focus on results – including giving local mayors and municipalities more freedom to reinstate initiatives on the ground to put in the work.
But the NHS Confederation’s hope of creating a virtuous cycle – where upfront spending to improve the nation’s health ultimately leads to lower social security costs and healthcare bills, freeing up billions for everything else – requires something bolder than a ‘Treasury says no’ approach that is stubbornly focused on the foreground. savings. There must be money to match the good intentions, otherwise Labor risks making an already hard life even harder.