The prime minister plans to voice apprehension regarding the tendency to label ordinary concerns as mental health disorders through diagnoses, highlighting the issue of over-medicalization.
Rishi Sunak will assert today that Britain is grappling with a “sicknote culture,” cautioning against the tendency to “over-medicalize” everyday concerns by categorizing them as mental health issues.
During a speech addressing strategies to decrease absenteeism from work, the prime minister will announce plans to pilot a program where “work and health professionals” will issue fit notes, diverging from the traditional role of GPs in this process.
Sunak will express his concern about the rise in long-term sickness following the pandemic, particularly attributed to mental health issues, with 2.8 million individuals now classified as “economically inactive.”
Regarding mental health, he will emphasize that he would “never dismiss or diminish” the seriousness of these illnesses. However, he will also advocate for a more transparent discussion about the potential consequences of excessively medicalizing the common challenges and anxieties of everyday life.
Sunak’s sentiments align with those of Mel Stride, the work and pensions secretary, who has argued that doctors frequently “label or medicalize” conditions that were once regarded as normal life fluctuations.
As part of an initiative to revamp the system, Sunak will announce that one aspect of the reforms will involve exploring whether the responsibility for issuing sick notes should be transferred from “overburdened” GPs to “specialist work and health professionals” with the necessary resources to conduct an impartial evaluation of an individual’s work capacity and provide tailored support accordingly.
Last year, a change in legislation permitted fit notes to be issued by a range of healthcare professionals beyond GPs, including nurses, pharmacists, physiotherapists, and occupational therapists. However, it remains uncertain whether the government intends to expand the criteria further to include non-medical professionals in the issuance or alteration of fit notes.
Sunak will argue in his address that GPs may be defaulting to signing individuals off from work, pointing out that last year saw 11 million fit notes issued, with 94% of them indicating individuals as “not fit for work”. No 10 contends that this system has resulted in a flood of individuals being directed away from work and into welfare without receiving adequate support and treatment to facilitate their continued employment.
However, excerpts from the speech released to the media on Thursday evening did not touch upon the issue of NHS mental health capacity. NHS leaders have cautioned that overwhelmed services are struggling to handle a significant post-COVID surge in individuals seeking assistance.
Dr. Sarah Hughes, CEO of the mental health charity Mind, expressed disappointment, stating, “We are deeply disappointed that the prime minister’s speech continues a trend in recent rhetoric which conjures up the image of a ‘mental health culture’ that has ‘gone too far’. This is harmful, inaccurate and contrary to the reality for people up and down the country. The truth is that mental health services are at breaking point following years of underinvestment, with many people getting increasingly unwell while they wait to receive support.”
She further stated, “To imply that it is easy both to be signed off work and then to access benefits is deeply damaging. It is insulting to the 1.9 million people on a waiting list to get mental health support, and to the GPs whose expert judgment is being called into question.”
James Taylor, the director of strategy at the disability charity Scope, remarked, “Much of the current record levels of inactivity are because our public services are crumbling, the quality of jobs is poor and the rate of poverty among disabled households is growing.”
Employment experts noted that the number of fit notes issued—11 million last year—has not risen since before the pandemic.
“Fit notes are not driving the increase in economic inactivity. They are not responsible for high levels of worklessness from ill health. Economic inactivity has been driven by people who are already out of work and have been for long periods,” said Tony Wilson, the director of the Institute for Employment Studies.
Plans to reform the fit note system were first flagged by Jeremy Hunt in the autumn statement. A new service called WorkWell is due to be launched this year in 15 areas, which is described as “early-intervention work and health support and assessment”. This will be targeted largely at people with mental health and musculoskeletal conditions, with people who have fit notes attending sessions with “work and health coaches” in an effort to get them to return to employment.
The last Labour government introduced “fit notes” rather than “sicknotes” in 2010 to put a new emphasis on doctors certifying what patients are able to do, rather than what they cannot.
Alison McGovern, Labour’s acting shadow work and pensions secretary, said: “We’ve had 14 Tory years, five Tory prime ministers, seven Tory chancellors, and the result is a record number of people locked out of work because they are sick – at terrible cost to them, to business and to the taxpayer paying billions more in spiralling benefits bills.”
Ruth Rankine, the director of the NHS Confederation’s primary care network, said its members had “long advocated for a review of the fit note process which could be more effectively managed through trained professionals that support people back into work”.
But she added: “The deeper problem isn’t the system – it’s that people are sicker than they were and they have more complex healthcare needs. This is why it is vital the government starts treating investment in the NHS as an explicit tool of economic development and also, that the prime minister should lead a national mission for health improvement to shift the focus from simply treating illness to promoting health and wellbeing.”
