Conservatives crackdown on ‘sick note culture’ to get Britons back to work


According to the Office for National Statistics, since 2020, the number of people out of work due to long-term sickness has risen significantly, reaching a record high of 2.8 million people as of February 2024.

Prime Minister Rishi Sunak delivered a speech on Friday morning, emphasising a “moral mission” to eradicate the “sick note culture” and reintegrate healthy individuals into the UK workforce.

Sunak pledged to overhaul the welfare system to ensure that those capable of working are provided with the best opportunities to return to their jobs after a period of illness.

The Prime Minister stressed the British belief in work as a source of dignity and purpose, asserting the government’s responsibility to ensure that hard work is always rewarded.

Acknowledging the concerning trend since the Covid pandemic, with 850,000 more people now economically inactive in Britain, Sunak announced a review of the current system. Under the proposed changes, specialist work and health professionals will take over the responsibility of issuing sick notes from GPs. Feedback from healthcare professionals, employers, and individuals with relevant experience will be solicited in an upcoming consultation.

Statistics indicate a significant rise in long-term sickness-related unemployment since 2020, with a record high of 2.8 million people affected as of February 2024, according to the Office for National Statistics. The majority of these individuals cite depression, anxiety, or nervousness as secondary conditions contributing to their unemployment.

Sunak also outlined plans to combat benefit fraud, aiming to align the Department for Work and Pensions with HMRC to treat benefit fraud similarly to tax fraud. Charities, however, criticized the proposed reforms, arguing they disproportionately target the sick and disabled amidst crumbling public services.

These developments follow recent controversy sparked by comments from Work and Pensions Secretary Mel Stride, who reiterated the need for a “grown-up” conversation about mental health and workforce participation. Stride emphasised the necessity of addressing the escalating costs of welfare spending and rejected accusations of demonizing individuals reliant on support systems.

As the government moves forward with its welfare reform agenda, discussions continue on how best to balance support for those in need with fiscal responsibility.

Prime Minister’s speech on welfare

A transcript of the speech, exactly as it was delivered is as follows:

Today I’d like to talk about the growing number of people who have become economically inactive since the pandemic…

 …and the moral mission of reforming welfare to give everyone who can, the best possible chance of returning to work.

The values of our welfare state are timeless.

They’re part of our national character – of  who we are as a country.

We’re proud to ensure a safety net that is generous for those who genuinely need it – and fair to the taxpayers who fund it.

We know there are some with the most severe conditions who will never be able to work. 

And some who can no longer work because of injury or illness.

And they and their loved ones must always have the peace of mind that comes from knowing they will always be supported.

But we also have a long-standing and proudly British view that work is a source of dignity, purpose, of hope.

The role of the welfare state should never be merely to provide financial support… 

…as important as that will always be…

…but to help people overcome whatever barriers they might face to living an independent, fulfilling life.

Everyone with the potential should be supported…

And not just to earn, but to contribute and belong.

And we must never tolerate barriers that hold people back from making their contribution… 

…and from sharing in that sense of self-worth that comes from feeling part of being something bigger than ourselves.

That is why this is a moral mission.

And why the value of work is so central to my vision for welfare reform.

And it’s fitting to be setting out that vision here, at the Centre for Social Justice. 

Over your 20-year history, you’ve inspired far-reaching changes to welfare. 

I want pay tribute to you and of course your founder, Iain Duncan-Smith… 

…who began the journey of reform in 2010… 

…a journey carried through so ably today, by Mel Stride. 

Because when we arrived in office in 2010, people coming off benefits and into work could lose £9 for every £10 they earned…

…by far the highest marginal tax rate. 

That was morally wrong.  

So we created Universal Credit to make sure that work always pays. 

We introduced the National Living Wage – and increased it every year, ending low pay in this country.  

We’re rolling out 30 hours of free childcare for every family over 9 months of age.  

We’ve halved inflation, to make the money you earn worth more.  

And we’ve cut workers’ National Insurance by a third.

A tax cut worth £900 for someone earning the average wage… 

…because it is profoundly wrong that income from work is taxed twice… 

…when other forms of income are not. 

For me, it is a fundamental duty of government to make sure that hard work is always rewarded.  

I know – and you know – that you don’t get anything in life without hard work.

It’s the only way to build a better life for ourselves and our family; and the only way to build a more prosperous country.  

But in the period since the pandemic something has gone wrong.  

The proportion of people who are economically inactive in Britain is still lower than our international peers.  

And lower today than in any year under the last Labour government. 

But since the pandemic, 850,000 more people have joined this group due to long-term sickness.  

This has wiped out a decade’s worth of progress in which the rate had fallen every single year.  

Of those who are economically inactive, fully half say they have depression or anxiety. 

And most worrying of all… 

…the biggest proportional increase in economic inactivity due to long-term sickness came … 

…from young people. 

Those in the prime of their life, just starting out on work and family – instead parked on welfare.  

Now, we should see it as a sign of progress that people can talk openly about mental health conditions… 

…in a way that only a few years ago would’ve been unthinkable.  

And I will never dismiss or downplay the illnesses people have. 

Anyone who has suffered mental ill health or had family or friends who have, knows that these conditions are real and they matter. 

But just as it would be wrong to dismiss this growing trend… 

…so it would be wrong merely to sit back and accept it… 

…because it’s too hard; or too controversial; or for fear of causing offence. 

Doing so, would let down many of the people our welfare system was designed to help. 

Because if you believe as I do, that work gives you the chance not just to earn…

…but to contribute, to belong, to overcome feelings of loneliness and social isolation… 

…and if you believe, as I do, the growing body of evidence that good work can actually improve mental and physical health… 

…then it becomes clear: we need to be more ambitious about helping people back to work.  

And more honest about the risk of over-medicalising the everyday challenges and worries of life.  

Fail to address this, and we risk not only letting those people down.  

But creating a deep sense of unfairness amongst those whose taxes fund our social safety net… 

…in a way that risks undermining trust and consent in that very system. 

We can’t stand for that.  

And of course, the situation as it is, is economically unsustainable. 

We can’t lose so many people from our workforce whose contributions could help to drive growth.

And there’s no sustainable way to achieve our goal of bringing down migration levels, which are just too high…

…without giving more of our own people the skills, incentives, and support, to get off welfare and back into work.

And we can’t afford such a spiralling increase in the welfare bill… 

…and the irresponsible burden that would place on this and future generations of taxpayers.

We now spend £69bn on benefits for people of working age with a disability or health condition. 

That’s more than our entire schools budget; more than our transport budget; more than our policing. 

And spending on Personal Independence Payments alone is forecast to increase by more than 50 per cent over the next four years.  

Let me just repeat that: if we do not change, it will increase by more than 50% in just four years.  

That’s not right; it’s not sustainable and it’s not fair on the taxpayers who fund it.

So in the next Parliament, a Conservative government will significantly reform and control welfare.  

This is not about making our safety net less generous. 

Or imposing a blanket freeze on all benefits, as some have suggested.  

I’m not prepared to balance the books on the backs of the most vulnerable. 

Instead, the critical questions are about eligibility… 

…about who should be entitled to support…

…and what kind of support best matches their needs. 

And to answer these questions, I want to set out today five Conservative reforms for a new welfare settlement for Britain. 

First, we must be more ambitious in assessing people’s potential for work.  

Right now, the gateway to ill health benefits is writing too many off… 

…leaving them on the wrong type of support… 

…and with no expectation of trying to find a job, with all the advantages that brings. 

In 2011, twenty percent of those doing a Work Capability Assessment… 

…were deemed unfit to work. 

But the latest figure now stands at 65 per cent. 

That’s wrong. 

People are not three times sicker than they were a decade ago. 

And the world of work has changed dramatically. 

Of course, those with serious debilitating conditions should never be expected to work.  

But if you have a low-level mobility issue, your employer could make reasonable adjustments…  

…perhaps including adaptations to enable you to work from home. 

And if you are feeling anxious or depressed, then of course you should get the support and treatment you need to manage your condition. 

But that doesn’t mean we should assume you can’t engage in work.  

That’s not going to help you. And it’s not fair on everyone else either.  

So we are going to tighten up the Work Capability Assessment… 

…such that hundreds of thousands of benefit recipients with less severe conditions… 

…will now be expected to engage in the world of work – and be supported to do so.

Second, just as we help people move from welfare into work… 

…we’ve got to do more to stop people going from work to welfare. 

The whole point of replacing the Sick Note with the Fit Note was to stop so many people just being signed off as sick.  

Instead of being told you’re not fit for work… 

…the Fit Note provided the option to say that you may be fit for work… 

…with advice about what you could do; and what adaptions or support would enable you to stay in, or return to work, quickly.  

11 million of these Fit Notes were issued last year alone.  

But what proportion were signed “maybe fit for work”? 

6 per cent. 

That’s right – a staggering 94 per cent of those signed off sick… 

…were simply written off as “not fit for work.” 

Well, this is not right. And it was never the intention.  

We don’t just need to change the sick note – we need to change the sick note culture… 

…so the default becomes what work you can do – not what you can’t.  

Building on the pilots we’ve already started..

…we’re going to design a new system… 

…where people have easy and rapid access to specialised work and health support…

…to help them back to work from the very first Fit Note conversation.  

And part of the problem is that it’s not reasonable to ask GPs to assess whether their own patients are fit for work. 

It too often puts them in an impossible situation where they know that refusal to sign someone off… 

…will harm their relationship with that patient. 

So we’re also going to test shifting the responsibility for assessment from GPs… 

…and giving it 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.  

Third, for those who could work with the right support… 

…we should have higher expectations of them in return for receiving benefits.  

Because when the taxpayer is supporting you to get back on your feet… 

…you have an obligation to put in the hours. 

And if you do not make that effort, you cannot expect the same level of benefits.  

It used to be that if you worked just nine hours a week, you’d get full benefits without needing to look for additional work.   

That’s not right. Because if you can work more, you should.  

So we’re changing the rules.  

Anyone working less than half a full-time week will now have to try and find extra work in return for claiming benefits. 

And we’ll accelerate moving people from legacy benefits onto Universal Credit, to give them more access to the world of work.    

One of my other big concerns about the system… 

 …is that the longer you stay on welfare, the harder it can be to go back to work. 

More than 500,000 people have been unemployed for 6 months… 

 …and well over a quarter of a million have been unemployed for 12 months. 

These are people with no medical conditions that prevent them from working… 

…and who will have benefitted from intensive employment support and training programmes. 

There is no reason those people should not be in work, especially when we have almost 1 million job vacancies. 

So we will now look at options to strengthen our regime. 

Anyone who doesn’t comply with the conditions set by their Work Coach…

…such as accepting an available job… 

…will, after 12 months, have their claim closed and their benefits removed entirely.

Because unemployment support should be a safety net – never a lifestyle choice.

Fourth, we need to match the support people need to the actual conditions they have. 

And help people live independently and remove the barriers they face. 

But we need to look again at how we do this through Personal Independence Payments. I worry about it being misused. 

Now its purpose is to contribute to the extra costs people face as they go about their daily lives. 

Take for example, those who need money for aids or assistance… 

 …with things like handrails or stairlifts. 

Often they’re already available at low cost, or free from the NHS or Local Authorities.    

And they’re one-off costs… 

…so it probably isn’t right that we’re paying an ongoing amount every year.  

We also need to look specifically at the way Personal Independence Payments support those with mental health conditions.   

Since 2019, the number of people claiming PIP citing anxiety or depression as their main condition, has doubled… 

…with over 5,000 new awards on average every single month. 

But for all the challenges they face…

…it is not clear they have the same degree of increased living costs as those with physical conditions.  

And the whole system is undermined by the way people are asked to make subjective and unverifiable claims about their capability. 

So in the coming days we will publish a consultation on how we move away from that… 

…to a more objective and rigorous approach that focuses support on those with the greatest needs and extra costs. 

We will do that by being more precise about the type and severity of mental health conditions that should be eligible for PIP. 

We’ll consider linking that assessment more closely to a person’s actual condition…

…and requiring greater medical evidence to substantiate a claim. 

All of which will make the system fairer and harder to exploit. 

And we’ll also consider whether some people with mental health conditions should get PIP in the same way through cash transfers… 

…or whether they’d be better supported to lead happier, healthier and more independent lives…  

…through access to treatment like talking therapies or respite care. 

I want to be completely clear about what I’m saying here. 

This is not about making the welfare system less generous to people who face very real extra costs from mental health conditions.  

For those with the greatest needs, we want to make it easier to access with fewer requirements.

And beyond the welfare system, we’re delivering the largest expansion in mental health services in a generation… 

…with almost £5 billion of extra funding over the past 5 years, and a near doubling of mental health training places. 

But our overall approach is about saying that people with less severe mental health conditions… 

…should be expected to engage with the world of work. 

Fifth, we cannot allow fraudsters to exploit the natural compassion and generosity of the British people.   

We’ve already cracked down on thousands of people wrongly claiming Universal Credit… 

…including those not reporting self-employed earnings or hiding capital   

And we’ll save the taxpayer £600 million by legislating to access vital data from third parties like banks. 

Just this month, DWP secured guilty verdicts against a Bulgarian gang caught making around 6,000 fraudulent claims…

…including by hiding behind a corner shop in North London. 

And we’re going further.  

We’re using all the developments in modern technology, including Artificial Intelligence…

…to crack down on exploitation in the welfare system that’s taking advantage of the hardworking taxpayers who fund it.

We’re preparing a new Fraud Bill for the next Parliament which will align DWP with HMRC… 

…so we treat benefit fraud like tax fraud… 

…with new powers to make seizures and arrests. 

And we’ll also enable penalties to be applied to a wider set of fraudsters through a new civil penalty. 

Because when people see others in their community gaming the system that their taxes pay … 

…it erodes support for the very principle of the welfare state. 

Now, in conclusion some people will hear this speech and accuse me of lacking compassion.  

Of not understanding the barriers people face in their everyday lives. 

But the exact opposite is true. 

There is nothing compassionate about 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.  

And there is nothing fair about expecting taxpayers to support those who could work but choose not to. 

It doesn’t have to be like this. 

We can change. We must change. 

The opportunities to work are there… 

…thanks to an economic plan that has created almost a million job vacancies. 

The rewards for working are there… 

…thanks to our tax cuts and increases to the National Living Wage. 

And now, if we can deliver the vision for welfare I’ve set out today… 

…then we can finally fulfil our moral mission, to restore hope…

…and give back to everyone who can, the dignity, purpose and meaning that comes from work.  

Thank you.


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