When a prime minister knows he is heading for electoral wipeout, he has one of two options. He can choose dignified statesmanship, using his remaining months in power to bring about as much unity and stability as possible. Or he can choose desperation, grasping for votes by scapegoating marginalised people, and leaving division and misery in his wake.
Rishi Sunak has gone for the second option. On Friday, he announced a new crackdown on disability benefits that has been described by charities as “a full-on assault on disabled people”. The country has a “sicknote culture” that needs to be tackled, the prime minister said. Britain “can’t afford” its record levels of welfare spending and it’s “not fair” on the taxpayer.
It is not simply that such rhetoric is cruel or misleading; it is not even original. Attacking sick and disabled people is a method that has been deployed time and time again over the past 14 years of Conservative rule. It is the equivalent of the party’s in-case-of-emergency button: if in trouble, ministers can sound the alarm and the rightwing press will churn out headlines about getting the “jobless” off the “dole”.
As the dust settles from Sunak’s speech, much of the media has focused on his desire to reform the “fit note” system. It is certainly worth mentioning. The plan to shift responsibility for issuing fit notes away from GPs to other “work and health professionals” in order to encourage more people to get back into work is a classic piece of Conservative welfare thinking. If there are too many sick people in the country, don’t bother dealing with the causes – just get someone who is not a doctor to declare they’re not actually sick after all.
It is also worth noting how incoherent much of the plan is. Sunak appears to be bouncing between criticising those on fit notes (people who are employed but are off work temporarily and receiving statutory sick pay) and those who are said to be milking the benefits system (people who are unemployed due to long-term health problems and require out-of-work sickness benefits). The point, presumably, is that nuance doesn’t matter as much as the general mood music. Consider that barely 48 hours after Sunak announced his urge to get people off disability benefits, it emerged that the government had axed a key scheme that helps disabled people get into work.
Just like with policies on asylum seekers and trans rights, this is less about actually tackling the problem and more about making enough voters confused and angry.
What has largely slipped under the radar, though, is a major reform: a review of personal independence payments (Pip), the flagship non-means-tested benefit designed to help cover the extra costs that come with disability. Proposals include asking for more medical evidence before awarding the benefit, looking at whether some payments should be one-off rather than ongoing, and withdrawing money from some people living with mental-health problems and replacing it with treatment.
This would signal a break with the very principle of social security for disabled people: rather than a recurrent entitlement, this is cash that could be withheld or swapped at the state’s whim.
It would also be wildly impractical. Offering people with mental-health conditions treatment instead of benefits means little when treatment isn’t available. Currently in England, there are 1.9 million people waiting for mental-health services, while 15,000 have died under stretched community care. I suppose it is hard for Sunak to understand languishing on an NHS waiting list when he pays for a private GP practice that sees patients on the day. Besides, we live in a country with universal healthcare. Benefits don’t need to be exchanged for medical treatment – that’s what we pay our taxes for.
At the same time, making social security a “one-off payment” fundamentally misunderstands how people use disability benefits or how the costs of health conditions work (Scope puts the average monthly extras for a household with at least one disabled adult or child at £975). Whether it is taxis because public transport is overwhelming and inaccessible, or a private therapist when NHS mental-health services are swamped, the vast majority of disability expenses are frequent and long-term. The fact that two-thirds of the people currently in destitution have a health condition hints at how inadequate the safety net already is.
The bleakest part of Sunak’s plan is that there is a genuine crisis obscured by his misleading rhetoric. Britain is a significantly sicker and poorer country than it used to be. The Institute for Fiscal Studies (IFS) estimates that one in 10 working-age Britons are now receiving health-related benefits, and this is only expected to increase. We hear a lot about the cost of this for the taxpayer, but perhaps it is time we also focus on the cost to people’s lives: the needless pain, the sleepless nights, the broken relationships and mounting bills. Contrary to popular sentiment, every “benefit claimant” is a human being, not an expense on a spreadsheet.
In the coming years, addressing the growing number of long-term sick people will have to be the priority of any government. To do that though, ministers will need to forgo the fiction that hordes of workers are faking illnesses and admit the facts. Britain does not have a “sicknote culture”. It has a record-high NHS waiting list, widespread food poverty, stagnant wages, low benefit rates, crippling housing costs, a broken social-care system, poor long Covid support and inadequate mental-health services.
For its architects, it is easier to put the blame for such chaos on to the individual. And yet these are structural issues – issues that did not occur overnight but are the all too predictable consequences of a public realm that has been vandalised by years of austerity, Brexit and a negligently handled pandemic.
The true sickness in this country cannot be found in a benefits office or a GP surgery but in Downing Street. It is a political culture whose default setting is demonising and impoverishing people who are already suffering, and a rightwing media that for decades has parroted the lies and bigotry it is fed. There may not be an easy prescription for healing this particular condition but it starts with a general election – and voting the Conservatives out.