29th April 2024
Sick note rhetoric does not match reality
In a speech setting out a vision for welfare reform last Friday, the Prime Minister reminded us of a fundamental truism, that welfare provision reflects a community’s values. Social security remains by far the biggest advice issue Citizens Advice Bureaux deal with, and the increasing complexity of our system, particularly in Scotland where it is essentially shared between two governments, demands serious policy analysis and answers.
The Prime Minister’s portrait in the speech of a prevailing “sick note culture” does not reflect the reality of the people our network helps, who are struggling to access the essentials as the support available to people with disabilities becomes ever more diminutive, and punitive.
A health crisis is one of the most devastating shocks that a person can experience; GPs are often at the centre of helping people to navigate them, yet we are now hearing proposals to remove GPs from the process of issuing fit notes used by the Job Centre to pause work search requirements pending further assessment. Far from seeing a passive approach, our network is supporting people to overcome barriers to obtaining fit notes. In one recent example a distressed MS sufferer in part-time work attended a CAB having been refused a fit note by two GPs. Without the fit note she was being expected to seek full-time work.
The speech last Friday also seeded the idea that extra costs disability support, known as Adult Disability Payment in Scotland and Personal Independence Payment in the rest of the UK, is being exploited. Social Security Scotland has introduced a holistic approach to evidencing claims, so that the valuable insights of carers and others can be drawn upon, precisely because the subjective judgements of DWP contracted health assessors have been linked with devastating levels of self-harm, suicide and severe distress.
Even so many people with invisible and fluctuating states of wellbeing, which is characteristic of mental health conditions, can find it impossible to access this type of benefit. Meanwhile, it is an undisputable fact that living with health conditions often leads to higher living costs. Research we conducted last year estimated that more than 40,000 households in Scotland with someone living with a long-term condition had sacrificed a cooked meal to run medical equipment. Those experiencing mental ill health may need to use taxis or incur the cost of a car to maintain their independence.
The Prime Minister pointedly referenced the cost of working age health benefits relative to other areas of public spending, failing to acknowledge the role of deteriorating public services in driving up levels of ill health. He juxtaposed this with rhetoric to manufacture outrage about benefit fraud. He referenced employing artificial intelligence and compulsory bank account surveillance to detect it; this should make all citizens of the UK shiver.
It is right to be ambitious about supporting people into work. Wide ranging incentives are an important part of achieving this, welfare restriction by contrast fails to tackle the root causes of rising ill health, the most important of which is health inequalities, encompassing poor housing conditions, access to services, and low income. Narratives that increase the destructive nature of stigma exacerbate these underlying factors and risk driving people into deeper destitution and further from the labour market.
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Erica Young is a Social Justice Policy Officer at Citizens Advice Scotland. This article first appeared in the Herald newspaper on Saturday 27th April 2024