Rishi Sunak has vowed to end what he called a “sick note culture” with a new “moral mission” to reform the welfare system, as he warned the number of economically inactive young people in Britain was a “tragedy”.
But he was forced to deny the plans – which include removing benefits entirely from fit people who refuse to work after 12 months – were just about cost cutting.
The prime minister insisted his reforms were the compassionate choice as he faced accusations of “hostile rhetoric” and a “full-on assault on disabled people”.
Since Covid the number of people out of work due to long-term sickness has risen significantly, reaching 2.8 million people in February.
In a speech on Friday morning, Mr Sunak talked of the risk of “over-medicalising the everyday challenges and worries of life” as he railed against people being “parked on welfare”.
The current system is also “economically unsustainable”, he warned, with more spent on supporting working-age people with illness or disability than on schools, transport or policing.
Setting out his plans for reform he suggested that some people with mental health conditions who receive Personal Independence Payments (PIP) could be offered treatment instead of cash.
But charities slammed the proposal pointing out that 1.8 million people are currently waiting for mental health treatment on the NHS.
The prime minister also unveiled plans that could strip GPs of the right to write fit notes, handing them over to other medical professionals.
A post-election fraud Bill would also connect the Department for Work and Pensions to HMRC ”so that we treat benefit fraud like tax fraud, with new powers to make seizures and arrest” and a new civil penalty, he said.
The charity Scope said calls were “pouring into” their helpline from concerned disabled people following the speech, which it said felt “like a full-on assault”.
Mr Sunak earlier insisted he was not downplaying or dismissing illness, but instead calling for a “more ambitious” approach to helping people back to work.
“We should see it as a sign of progress that people can talk openly about mental health conditions in a way that only a few years ago would’ve been unthinkable, and I will never dismiss or downplay the illnesses people have,” he said.
“But just as it would be wrong to dismiss this growing trend, so it would be wrong merely to sit back and accept it because it’s too hard; or too controversial; or for fear of causing offence. Doing so, would let down many of the people our welfare system was designed to help.”
Warning that “something has gone wrong”, Mr Sunak said 850,000 more people were out of work due to long-term sickness since the pandemic. The change had “wiped out a decade’s worth of progress in which the rate had fallen every single year”. Half of those individuals had depression or anxiety, he said, without stating that these are reported to be secondary conditions in most cases.
“Most worryingly of all the biggest proportional increase in economic inactivity due to long term sickness came from young people. Those in the prime of their life just starting out on work and family, instead parked on welfare,” said the prime minister.
He added: “There is nothing compassionate about leaving a generation of young people to sit alone in the dark before a flickering screen watching as their dreams slip further from reach every passing day.”
His review of the fit note system could see specialist work and health professionals charged with responsibility for issuing them instead of GPs.
Recent NHS data showed almost 11 million fit notes were issued last year, many of which were repeat fit notes “issued without any advice, resulting in a missed opportunity to help people get the appropriate support they may need to remain in work”, according to the government.
“We don’t just need to change the sick note, we need to change the sick note culture so the default becomes what work you can do – not what you can’t,” he said, pointing to figures showing that 94 per cent of the 11 million fit notes signed off by GPs denoted people as not fit to work.
“Building on the pilots we’ve already started we’re going to design a new system where people have easy and rapid access to specialised work and health support to help them back to work from the very first Fit Note conversation,” said Mr Sunak.
“We’re also going to test shifting the responsibility for assessment from GPs and giving it to specialist work and health professionals who have the dedicated time to provide an objective assessment of someone’s ability to work and the tailored support they need to do so.”
Mr Sunak suggested greater medical evidence could be required to substantiate a claim for personal independence payments (PIP), which are designed to help claimants deal with the extra costs of living with a long term disability, and said some people with mental health conditions may be offered talking therapies or respite care rather than cash transfers.
And he detailed plans for new legislation to prevent treat benefits “fraudsters” in the same way as tax fraud to stop them exploiting “the natural compassion and generosity of the British people”.
Since 2020, the number of people out of work due to long-term sickness has risen significantly, reaching a record high of 2.8 million people as of February 2024, according to the latest estimates from the Office for National Statistics.
A large proportion of those report suffering from depression, bad nerves or anxiety, although most of those report these as secondary conditions rather than the main one keeping them out of work.
Labour accused the government of lacking “concrete answers” as the party pledged it would drive down NHS waiting lists.
Alison McGovern, Labour’s acting shadow work and pensions secretary, added: “Rather than a proper plan to get Britain working, all we heard today were sweeping questions and reheated proposals without any concrete answers.”
Liberal Democrat Leader Ed Davey described the speech as “desperate” at the time when millions are unable to access NHS hospitals, GPs or mental health support.
He said: “Rishi Sunak is attempting to blame the British people for his own government’s failures on the economy and the NHS and it simply won’t wash.”
Richard Kramer, chief executive at charity Sense, said: “The government’s ongoing onslaught on disabled people is hard to watch, with the prime minister today taking aim at people who are long-term sick in a cruel speech demonising people with ‘sick notes’.
“This rhetoric is unbelievably damaging and unhelpful, presenting disabled people as ‘shirkers’ who don’t want to work. But this isn’t the case – while employment isn’t right for everyone, many disabled people do want to work.”
Warning that stigma, unfair recruiting practices and a lack of specialist assistive technology in job centres – are stopping people from finding work are among the barriers to jobseekers with complex disabilities finding work, he said: “We’d urge the government to tackle these issues and offer better support as a priority, instead of focusing their time on scapegoating disabled and sick people.”
Additional reporting by PA
