Reactions to Rishi Sunak’s ‘sick note’ speech prompt discussions on the efficacy and ethics of ‘work first’ approaches to welfare reform

Last month Prime Minister Rishi Sunak announced plans to reform the current welfare system as a response to rising economic inactivity due to ill health. In his speech, given on the 19th of April,  the PM described the phenomenon as “sick note culture” wherein everyday struggles are “over-medicalised” leading to a “sense of unfairness” for the most vulnerable as well as taxpayers. 

Since the pandemic, 850,000 more people are out of work due to ill health, according to the PM. “Half say they have depression or anxiety,” Sunak revealed. “And most worrying of all, the biggest increase came from young people.” 

Welfare reforms, he said, should include stricter Work Capability Assessment (WCA) requirements, replacement of ‘fit notes’, faster rollout of Universal Credit (UC) for claimants with disabilities or ill-health, major changes to Personal Independence Payments (PIP), and more punitive measures granted to the DWP.  

Some reforms are currently underway, fast-tracking the migration of individuals receiving Income-related Employment and Support Allowance (ESA) from 2028 to this autumn.

Earlier in March, Mel Stride, Secretary for Work and Pensions, cautioned against “labelling the normal ups and downs of human life as medical conditions which then actually serves to hold people back and, ultimately, drive up the benefit bill.” PIP costs are forecasted to increase by more than 50% in the next four years reaching £28 billion by 2028/29. 

Reforms will target those who could improve their mental and physical health through employment. However, existing ‘Work First’ approaches to welfare, such as UC and PIP, have fallen short in addressing economic inactivity with levels reaching a record high of 2.8 million  people out of work due to ill-health. 

Charity groups across the UK are speaking out against the “harmful” rhetoric surrounding welfare reforms and fear further stigmatisation against people with disabilities and long-term health conditions. 

Welfare overhaul 

According to the Joseph Rowntree Foundation (JRF), the UK’s welfare system is best described as taking a ‘work first’ approach, with “long-term, paid employment as the primary goal for people interacting with [it]”. In 2012, the Welfare Reform Act introduced Universal Credit and Personal Independence Payments (PIP) with the objective to improve work incentives.

PIP, a successor to Disability Living Allowance (DLA), focuses on supporting individuals with disabilities rather than assessing their ability to work. However, recent spikes in disability benefit claims, especially among those with mental and neurodivergent conditions, prompted the government to reconsider its approach.

 The government plans to replace the WCA entirely with a stricter PIP model, aiming to encourage more people with “less severe conditions” to seek employment.  Additionally, it proposes shifting from fixed cash payments to need-based support such as grants, vouchers, and reimbursements.

Last year’s Autumn Statement solidified intentions to compel job-seeking within six months under threat of ending benefits, and mandatory work placements after 18 months of unemployment. 

The DWP and DHSC will also expand employment programs, injecting £64 million into the WorkWell initiative launching this October, assisting individuals with health conditions to stay in or return to work. According to the BBC,  Health and Social Care Secretary, Victoria Atkins, said: “This service will help tens of thousands of people, who will receive joined-up work and health support, tailored to their individual needs.”

Community response  

Kate Morton, Chief Executive Officer at Bath Mind, told Quids in! “As a local mental health provider in the South West we work with and support over 6,000 people each year and a significant number will be negatively affected by this policy shift.  The rhetoric from the Prime Minister is weaponizing mental health and this comes from a lack of understanding of the impact mental ill health has on a person’s daily life.” 

Mr Sunak was also criticised by groups like the Disability Poverty Campaign for stigmatising already vulnerable and marginalised groups. The Health Foundation revealed that ‘benefits stigma’ was a main reason why a quarter of respondents eligible for Universal Credit did not make a claim. (New findings from Policy in Practice revealed £8.3 billion in UC benefits went unclaimed last year, in part due to stigma.)

Morton continued to tell Quids in!: “We work with people who struggle to complete simple daily tasks many of us take for granted – cooking, leaving the house, shopping, etc. Our teams work intensively to support people to build the confidence and resilience they need in order to self-manage and go on to access services and employment opportunities.  But this takes time and cannot be a ‘one size fits all’ approach.”

Head of Disability Rights UK, Fazilet Hadi, said: “Once again the government is targeting disabled people for a failing economy. Yet it is government policies that have fuelled increases in disability and sickness.“

Echoing Hadi’s criticisms, Nish Kumar, host of political podcast ‘Pod Save the UK’ commented: “The effects of austerity, the effects of Brexit, we are seeing record high NHS waiting lists, widespread food poverty, stagnant wages, low benefit rates, crippling housing costs, a broken social care system and inadequate mental health services. That’s what’s causing the “sick note” culture.”  

Helen Barnard, director of Policy, Research and Impact at the Trussell Trust, said: “The WorkWell programme is a really good initiative, exactly the direction the government should be going in.” However Barnard feels the initiative is “getting swamped both in financial and rhetorical terms by poorly grounded, harsh, evidence-free rhetoric.”

Back to work 

The WorkWell initiative, one of the more well-received aspects of intended reforms, still faced substantial criticism, with concerns about DWP and job centres pushing people to take “poor-quality” and “inappropriate jobs”.

Emily, a participant in Quids in! money guidance and employment programmes, is one claimant directly feeling the pain of the government’s tough line on those struggling with poor health. Reduced hours, resulting from osteoarthritic pain triggered by manual work, led to repeated threats of sanctions from DWP. “I said that I’ve been signed off by my doctor and they said well you know, we still need you to look for work I said, but I’m not in a fit state to look for work at the moment. I want to work,” she continued. “I’ve worked all this time but I’m just not ready.”

Tom Pollard, former DWP advisor now Head of Social Policy at New Economic Foundation (NEF), said: “harsh and prescriptive conditionality at best pushes people into low-paid and insecure work, which is a poor outcome for them but also means they’re likely to continue to need support to top up their incomes.”

“They don’t make you fit for work by treating people as if they’re somehow trying to cheat the system,” Emily explained to Quids in!. “That’s the feeling I get, (…) even the way they look at you when you go into Jobcentre Plus.”

JRF’s report criticises the current system for overspending (£350 million annually) on monitoring and sanctions, dwarfing the budget for the WorkWell initiative by over five times. They recommend prioritising supportive relationships between claimants and work coaches. 

With help from her work coaches, Emily was able to get on her feet again and now works as a peer support worker. “I’ve been helped and I know what a difference certain people have made to me by listening, by helping.”

Click to read Prime Minister Rishi Sunak’s full speech

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