There is a sickness among us. More than one third of the working population now has a long-term health condition; this is up four million from a decade ago. Nearly a quarter is disabled. Over the past decade there has been a huge and awful increase. Some 15 million people say they have long-term health conditions – which is a largely self-reported figure – and more than ten million are disabled.
It would take a columnist only slightly touched with gloomy hysteria to diagnose from this a social economy that is sick at a deep level, a country in which the young, unable to get a home of their own, are ceasing to have babies or bother with the disciplines of work in a capitalist economy that gives them far too little back.
We could talk, couldn’t we, of the decline of the West, of national depression, of a long-term civilisational failure too profound for any government to grip. Back in the 1970s they used to talk of the “British disease” and “the sick man of Europe”. We have come a long way since then – but we are literally sicker, or say we are. Yet other comparable economies have not seen the same increase in post-pandemic sickness that has happened in the UK.
By “sickness”, we often mean mental health problems. It is estimated that 60 per cent of the increase in sickness benefits go to people reporting stress, depression or other mental conditions, often as soon as they leave school or college.
The Resolution Foundation reported in February that 34 per cent of young people aged between 18 and 24 were reporting a “common mental health disorder”, from depression and anxiety through to bipolar disorder, a significant increase from 2000. It says: “Young people with mental health problems are more likely to be out of work than their healthy peers: between 2018 and 2022, one in five 18- to 24-year-olds with mental health problems were workless.”
This is a disaster. In lost output, lost energy, lost effervescence, it will hamper us for decades. Young adults who fail, early on, to develop the habits of work – getting up, punctuality, routine, social interactions, vital self-discipline – may never do so, and languish as a kind of pale, onlooking ghost army around the edge of society.
It may sound as if I’m sketching a social catastrophe too big for mere ministers. But in government, money always focuses minds. And because Britain can’t afford a ballooning welfare bill on the scale we have now, government is working on this – and I think it’s the next great issue to break. We have 4.2 million people claiming working-age health-related benefits. The cost has gone up by £12bn in the last four years to £47.6bn, and the total expenditure on all working-age benefits in 2028-29 is forecast to be £144bn. Things just can’t go on this way.
There are two popular explanations, both of which are insufficient. One is that young people are too often a bit pathetic – narcissists hooked on self-care, who should be booted into the real world for their own good. (This is what boomers mutter to one another over the second gin of the evening when they think they’re not being overheard… or so I’m told.) But it ignores the lack of life incentives for younger workers, and glibly underplays the mental health disaster imposed on them that we call “social media”.
The second explanation is that, post-pandemic, the NHS has failed on mental health care – and on treating physical problems, such as back and joint issues and hearing and sight loss. This is keeping people away from the workplace. The waiting list numbers show clearly that it has failed, which is why Wes Streeting is one of the key ministers involved in the discussions on welfare.
But this explanation is only partial, because it fails to grasp a fundamental welfare design fault. We encourage people to go on sickness benefit, and then we encourage them to stay there.
Under Universal Credit (UC), the incentive to claim sickness benefit rather than employment allowances has become too great. Through one door is the standard UC allowance – what we used to call unemployment benefit – at £91 a week. In real terms, this is the lowest rate for 40 years. But you get more than an additional £100 a week if you go through the other door marked sickness benefits and are found to have a “limited capability” for work.
That huge gap is even wider because on the former you must commit to substantial numbers of job applications or see your payments cut. And although the medical reassessments for the latter are supposed to be regular, for people on sickness benefits they stopped during the pandemic and were never properly reinstated by the Conservatives.
As one senior figure close to Keir Starmer put it to me: “You walk into what was the Jobcentre and you can either turn right for unemployment, lower payments and hassle, or you can turn left for sickness benefits, an extra £400 a month, and almost no hassle at all. Go figure.” Apart from the fact that much of this is done online, that is a compelling piece of the jigsaw.
You can see it in the overall figures. Total spending on social security this year as a percentage of GDP is only 1 percentage point above where it was before the financial crisis in 2007, according to figures from the Institute for Fiscal Studies. In other words, it’s virtually flat. But spending on benefits for children and working-age adults who are healthy has fallen. Because of the (also unaffordable) triple-lock pension, spending has greatly increased. But the immediate issue is the health-related one.
Having got so many people on to health benefits, we strive to keep them there because the system asks for and confirms people’s incapacity to work, not their ability to do so. To get the money, they must project and therefore internalise, weakness and inability. So, struggling to get back into the labour market, trying to shake off the black dog, risks losing you a lot of money. You wouldn’t, would you?
This “can’t work” notion is a deep failure in the system, and getting rid of it is a core part of what Liz Kendall, the Work and Pensions Secretary, wants to do. This shouldn’t be presented mainly as a cost-saving measure. Sure, the Treasury desperately needs to find more money, particularly for defence spending, but cutting health-related benefits in a humane and effective way is too slow to be a shortcut to big savings.
Very soon, Kendall publishes her “Get Britain Working” white paper, which she hopes will turn her department from being the administrative, doling-out wing of the welfare system, to one that increases employment. It will address low skills, youth inactivity and devolve much work to local mayors. It’s meant to mesh with the Streeting NHS reforms, and Angela Rayner’s “make work pay” rights agenda.
Next comes the more difficult business of recasting benefits. It is hard to see a solution that doesn’t begin to equalise unemployment benefit and sickness benefit, certainly by raising the former but also by tapering and making the latter more conditional. Because there are millions of people involved, and many are vulnerable, the short-term politics of this will be incredibly difficult. What happens if at some point, somebody, maybe young, kills themselves – and leaves a note blaming benefit changes?
What a horrible prospect. But something must change here. And there is nothing progressive, socialist or “compassionate” about a system which, by poor design, encourages millions of people to rot at home, staring idly through a steamed-up window as life, in all its jeopardy, glory and busy graft, passes them by. Everywhere I go, people complain that this government doesn’t, health apart, have a genuine reform agenda. Well, let’s see.
[See also: How “YMCA” became Donald Trump’s unlikely theme song]
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This article appears in the 20 Nov 2024 issue of the New Statesman, Combat Zone