UK mental health and disability charities across the sector have responded with anger and disappointment to Prime Minster Rishi Sunak’s speech setting out plans for welfare reforms on Friday 19th April.
Our government and Mr Sunak specifically with his “moral mission” to reform the welfare system, is demonising disabled people. His suggested reforms, delivered at the Centre for Social Justice, weaponize mental health challenges, fuelling misinformation and generating further stigma for those with depression and anxiety. Sunak warned against “over-medicalising the everyday challenges and worries of life” and demonstrated his lack of holistic understanding of why the nation is currently in the middle of a mental health crisis.
The suggested reforms are to Personal Independent Payments (PIP), a non-means tested benefit that supports disabled people with everyday living, including support to work, mobility aids and care needs. The government might abolish ongoing support in favour of one-off payments, along with an adjustment to an already difficult threshold criteria to make it harder to access these payments. They may also replace PIP with appointments for talking therapy. Waiting lists for talking therapies are already incredibly long.
These payments are made to help disabled people with their additional costs of living, such as having a guide dog or increased energy costs. As Scope has pointed out, being disabled costs a household more.
His suggested reforms weaponize mental health challenges, fuelling misinformation and generating further stigma for those with depression and anxiety.
Fit notes (previously called sick notes) will also be under heavy scrutiny. These are currently issued mainly by a GP and are required by people who need time off work due to sickness. After consultation, the government will launch a new service, Work Well. It will strip GPs of their role issuing fit notes because Sunak has decided that they aren’t best placed to assess people’s ‘fitness to work’ and are handing fit notes out too liberally to people with poor mental health. At a time when we have chronic staff shortages across the mental health sector, Sunak has decided it more appropriate to ask an as-yet undefined group of “specialist work and health professionals”.
McPin would suggest putting more energy into resourcing primary care sufficiently, including more named GPS to ensure continuity of care, and investment in associate practitioners and other schemes to reduce GP workloads but ensure qualified assessors are on hand. Since 2022 there are already a number of healthcare professionals who can issue fit notes – GPs, Nurses, occupational therapists, pharmacists and physiotherapists. A broad group who are skilled to support people to return to work. And this is a vital point in the conversation – from our experience, people with mental health problems want to work. Someone might need days off for mental health reasons, just as you would for a virus or a planned operation, but good quality work opportunities is what people want. If the government is serious about reforming the welfare system – we have a few ideas that might help them:
- Workplaces need to better support disabled people
People with disabilities experience high levels of workplace discrimination; a recent report noted the disability employment rate was 54% in the 3 months to June 2023, compared to 82% for non-disabled people – an overall increase of 10 percentage points since the same period in 2013 (see here).We need to encourage all employers to improve diversity and inclusion practices and the government need to introduce a stronger Disability Confident scheme with accreditation as current form is discredited. This will include putting in place enhanced wellbeing support building upon the EAPs – Employer Assistance Programme – to manage mental health at work. We recommend workplace mentoring and ensuring flexible working environments, including accessible working from home jobs.
You can help people stay well at work, and help people return more quickly in good quality workplaces. Offering high quality jobs. As noted by NICE (2019) – all organisations need to make mental health and wellbeing a core priority.
![This is a screen shot from the NICE workplace guidelines and reads as follows: 1.1 Workplace culture and policies 1.1.1 Make health and wellbeing a core priority for the top level of management of the organisation. See the section on organisational commitment in NICE's guideline on workplace health: management practices (this section includes making health and wellbeing a core priority, ensuring the commitment of managers, and the importance of policies and of clear communication). [2019] 1.1.2 Foster a caring and supportive culture that encourages a consistent, proactive approach to all employees' health and wellbeing. [2019] 1.1.3 Organisations (for example those with a small number of employees) that do not have formal policies should ensure that clear and accessible procedures for reporting and managing sickness are in place and are explained to all new and existing employees. [2019]](https://mcpin.org/wp-content/uploads/2024/04/News-Sunak-statement-NICE-1174x0-c-default.jpg)
2. Invest in prevention.
We have rising rates of mental ill health with 1.92 million people in receipt of NHS mental health support in February 2024 (including 476,872 people in contact with children and young people mental health services) (NHS Digital). There are also 1.9 million people waiting for mental health support (Mind Statement). We have to get waiting lists down so people have access to timely and appropriate support. Many people signed off work due to mental or physical health issues are waiting for support; it needs to be available quickly on the NHS as opposed to only being accessible in the private sector. We have to invest in both services to deliver high quality support and prevention strategies (see Mental health Foundation, and Centre for Mental health – mentally healthier nation report).
3. Support our society to value compassion and kindness.
This is not ‘wokery’ but a strategy to address the massive issues we face as a society today. Challenges linked to poverty, social inequalities, world conflicts (there are 32 active war zones), climate change, ongoing impact of Covid-19 including long covid and rising rates of mental health problems since the start of Covid-19, particularly among young people (see again NHS Digital), harms or risks related to social media. We need to focus more on the five ways to wellbeing underpinned by valuing skills such as empathy and compassion more, rather than measuring success by status and power or investments in culture wars.
At McPin we strongly oppose these changes outlined by Mr Sunak. Our strong stance is based on the work we have been doing to create a positive workplace culture ourselves – good quality workplaces include people with mental health issues. It is also based on the reaction we have noticed following this announcement and the hurt it has caused people with disabilities, including those with mental health issues.
McPin’s Head of Research and Involvement, Tanya Mackay, shares her experiences navigating the NHS system and the workplace as a disabled person:
“As someone with lived experience of mental health issues and a dynamic physical disability Sunak’s recent speech was both disappointing and distressing. I am currently able to be in the workplace – this has been in part due to the excellent support my GP and my workplace have given me. My GP is the central pin that holds my care teams together, understanding how my conditions intersect, my medications and my day-to-day difficulties. They do not make their decisions on my care or ability to work ‘subjectively’ – they do so using their medical knowledge, in partnership with me as their patient.
Every time my condition progressed; they connected me to the best suited supports to keep me in employment. Everyone should have access to this type of care – explaining to another person my needs and why I might need time off adds to the already disproportionate health administrative burden I face as a disabled person. We do not have a ‘sick note’ culture. We have systems that continue to fail people with mental health issues and other disabilities: inaccessible workplaces; long waiting lists for much needed assessments support and treatment; a cost-of-living crisis; insufficient social care and housing; and impacts from Covid-19 that the government continue to ignore.”
If you’re interested in further reading about good quality workplaces please see our resource The shape of meetings with neurodivergence in mind and our work with Impact on Urban Health.
