Rammya Mathew: We can’t overlook the backdrop as Britain becomes “a sicker nation”

Plans by the prime minister, Rishi Sunak, to overhaul the sick note system in the UK have left me with mixed emotions. A more independent process, overseen by professionals skilled in occupational health, will hopefully lead to a more robust system, in which people are supported to get back into work as quickly as possible, when they feel able to. But I worry that removing GPs from the decision making will create a less compassionate process that’s unduly stressful for patients, most of whom are genuinely struggling to cope.

Some 2.8 million people in Britain are currently signed off as unable to work, and in almost half of them the cause of ill health is depression, anxiety, or mental health problems. The volume of sick notes being issued has also risen steadily over the past decade—and, given the ramifications both for the individual and for wider society, there’s a strong argument for change.

We know that being signed off sick for long periods can be life altering. Prolonged sick leave absence reduces the likelihood of returning to work,12 and in many cases long term absence can spiral into long term incapacity. Unemployment is itself a health hazard: it can have hugely negative consequences for a person’s mental and physical health, and it’s associated with an increased risk of morbidity and mortality. So, doing more to safeguard people against the ill effects of worklessness is the right thing to do, but simply tightening up on sick notes isn’t a solution in itself.

We can’t overlook the backdrop on which Britain is becoming a “sicker nation.”3Access to healthcare in the UK is at an all time low, and many patients are off work while waiting for specialist investigations and treatment. Mental health services have also become increasingly threadbare, losing opportunities to intervene early and prevent low level mental health problems from evolving into more serious illness. Add to this the cuts to drug and alcohol services, a reduction in mental health beds, and a lack of key worker provision for people with severe mental illness, and it should come as no surprise that more people are signed off work than ever before.

Be it physical or mental health, early intervention matters in terms of reducing the burden of illness and getting people back into work. Delays in care can take people out of work for good. If we focus on sick notes without fixing the underlying problems in access to healthcare that are causing more people to spiral into worklessness, we’ll only create a cold and punitive system for patients who have already been grossly let down.