Jamie used to like his job. Working as a hospital porter, serving to sick individuals in want, he in all probability by no means anticipated to grow to be a affected person himself: at 50, he was nonetheless match and wholesome. However then he strained his again at work, and so started a protracted, downhill slide. He was given physio workouts to comply with on-line, however couldn’t entry them, and earlier than lengthy he was in such ache he was signed off work for good. Unable to maintain energetic, and placing on weight, Jamie was referred to a diabetes prevention programme; however by now his again damage an excessive amount of to drive to the clinic, and public transport was a wrestle.
Overwhelmed and remoted, he ended up retreating inside his damp, mouldy council home. 5 years on, Jamie nonetheless isn’t working, however his again is sort of the least of his issues. He’s diabetic, asthmatic because of the mould, affected by coronary coronary heart illness, and if he isn’t depressed but then he in all probability quickly might be.
There are numerous Jamies on the market, many affected by what some medical doctors privately name “shit life syndrome”: getting dealt a string of unhealthy playing cards, missing the cash to bounce again from any of them, and sinking deeper with each passing day. They’re genuinely sick, usually with a number of diagnoses, however sick in a very complicated, tangled approach that medication alone can’t magically resolve. And herein lies this autumn’s hardest political battleground, as a brand new Labour authorities makes an attempt to kickstart financial progress by getting people who find themselves long-term sick again to work.
These are worrying instances for many individuals residing on incapacity and illness advantages. Keir Starmer’s warning in Liverpool that those that can work ought to has completed little to quell anxious hypothesis about what this autumn’s finances means for welfare spending, particularly as ministers have but to spell out precisely what they’ll do about deliberate incapacity profit reforms set in practice by the outgoing Tory authorities. Starmer has burdened that he is aware of there might be “hard cases”, who bodily can’t work regardless of how a lot they struggle, and that Labour desires to assist slightly than power individuals again into jobs. Nevertheless it’s tough to calm down when the roads to earlier welfare crackdowns have been paved too usually with reassuring phrases.
Enter Jamie, who isn’t an actual particular person, however a consultant instance of numerous very actual sufferers devised by the NHS Confederation and the Boston Consulting Group’s Centre for Progress as an instance their joint report on a extra benign approach to get half one million long-term sick Britons again to work. Their evaluation skilfully separates tabloid myths about skivers and sicknotes from laborious details. Sure, Britain has 2.8 million adults economically inactive due to long-term sickness, up by a startling 900,000 since 2020. No, this isn’t some unavoidable international hangover from the pandemic – financial inactivity has fallen elsewhere in Europe – but it surely’s additionally extraordinarily unlikely to be as a result of a life on welfare is simply too comfortable right here. The introduction of common credit score, if something, left many disabled individuals worse off than earlier than.
The straightforward rationalization is that Britons as an entire are sicker than we was, with a 3rd of working-age adults admitting to no less than one well being situation; that financial inactivity is in some methods a canary down the mine, pointing to lives which are making too many individuals burdened and ailing. Tellingly, the report concludes that the sort of social and environmental components that so usually underpin shit life syndrome clarify extra of the variation in well being outcomes between totally different elements of the nation than extra apparent components comparable to weight-reduction plan and train, with deteriorating residing circumstances and rising crime notably carefully linked to avoidable deaths.
Nevertheless it additionally exhibits how little it might have taken to halt Jamie’s downward slide; how various things may need been if he’d been provided the prospect to retrain for a desk job, or low cost transport to his varied appointments, or a greater roof over his head. The take-home message is that getting sick individuals match for work once more requires the entire of presidency uniting round a typical objective – or mission, to make use of the Starmer buzzword – to succeed in the elements medical doctors can’t, backed up by employers doing extra to maintain employees wholesome.
There are causes to be hopeful that ministers broadly get that. Wes Streeting’s announcement that “crack teams” to chop NHS ready lists might be deployed first not in locations with the longest waits, however in these with the very best charges of individuals off sick, is a promising signal of various bits of presidency pulling in the identical path. The promise by the housing secretary, Angela Rayner, to make personal landlords sort out damp and mold swiftly wasn’t billed as a public well being measure, however is doubtlessly a life-saver for individuals with respiratory illnesses. The promise by the work and pensions secretary, Liz Kendall, of “no more writing people off, then blaming them just to grab a cheap headline” displays a real need for much less noisy tub-thumping, and extra sensible deal with outcomes – together with giving extra freedom to native mayors and councils to run back-to-work initiatives on the bottom.
However the NHS Confederation’s hopes of making a virtuous circle – the place upfront spending to enhance the nation’s well being in the end results in decrease welfare and healthcare payments, liberating up billions for every thing else – requires one thing bolder than a “Treasury says no” method targeted stubbornly on upfront financial savings. There have to be cash to match good intentions, or Labour dangers making already powerful lives nonetheless more durable.
