The UK is on course for a huge rise in ill health, with one in five adults projected to be living with major illnesses like cancer, heart disease and diabetes by 2040. Despite this, the Autumn Statement was devoid of any substantial interventions that would help to curb disease rates in the coming decades. Instead, the Chancellor focused on forcing people who are sick back into work in a bid to improve the country’s productivity.
Jeremy Hunt’s most punitive measure includes reforming the work capability assessment, so that more people who are sick or disabled are deemed “fit for work”, making it harder for them to claim the sickness-specific portion of Universal Credit. The government’s reasoning is that there are now more home-based roles, meaning that more disabled people can work – but charities say the new rules could force many people to look for jobs that don’t actually exist. This announcement has been buried by the overall uplift in Universal Credit, which will rise by 6.7 per cent next year.
Hunt has also pledged to reform the “fit note” – which is what doctors issue to employers about an individual’s fitness to work – to speed up people’s return to employment after a period of illness.
There’s no doubt that the UK has a productivity problem – data from the Office of National Statistics shows that the number of economically inactive people aged 16 to 64 increased by almost half a million between 2019 and 2022, with long-term sickness and disability driving this rise (there are also other factors, such as older people leaving the workforce due to early retirement). But forcing people back into work is a counterintuitive way to increase productivity levels when the government is doing little to make people well in the first place.
The Autumn Statement did include some positive measures around occupational and mental health, such as expanding the NHS England Talking Therapies programme so that more people can access help for free, and increasing employment support for those with mental health issues. But the government announced no systemic changes that would make work more accessible for those with disabilities. The government has used the rhetoric that “working from home” means that work is more manageable, but has not considered stronger protections around reasonable adjustments, such as changing working arrangements or methods, and providing additional equipment, services or support.
There are also no significant preventative health measures. Still riding off the back of Rishi Sunak’s Conservative Party conference announcement that in effect banned those currently aged 14 and under from smoking for life, the government has not addressed the huge shortfall in public health grant funding, which is the money local authorities are given to deliver vital prevention health measures to their residents, such as smoking cessation, alcohol and obesity services.
Equally, there was little in the way of transforming the NHS from a “sickness” service to a prevention service. Hospitals are currently overflowing with patients due to a lack of beds, waiting lists for routine operations are years long, and a huge postcode lottery exists in the diagnosis and treatment of serious diseases like dementia and cancer. The Autumn Statement simply reiterated and repackaged previous commitments to NHS funding, with no new money to ease the crisis.
Given the potential economic value the life sciences have for the UK, clinical research has been given more attention. Hunt announced £20m to launch a new clinical trial delivery accelerator to help NHS patients access new dementia treatments faster. A further £51m has also been devoted to the UK’s biggest clinical research programme, Our Future Health, which aims to do genomic testing on one million NHS participants to find better ways to prevent, detect and treat disease. But new treatments and technologies alone are not enough to curb the rise in preventable disease, given the systemic problems in the NHS that lead to postcode lotteries.
It is counterproductive and cruel to force people back into work without addressing the structural issues that make them sick or lock them out of employment. It will likely only result in more long-term sickness. Rather than focusing relentlessly on economic productivity, the government should look harder at why people cannot work in the first place.