Do long-term sickness benefits cost UK a lot and can more people be helped into work? | Health

Labour has inherited “a country that simply isn’t working”, Keir Starmer said when he launched his employment strategy this week. Britain’s economy, he added, was grappling with chronic unemployment, skills shortages and a misfiring job market.

Much of the debate since has focused on the record 2.8 million people out of work due to long-term sickness, and the 4.2 million claiming incapacity and disability benefits. But questions remain over whether Britain is more unhealthy than it used to be. If not, there must be other reasons why claims have increased. Here, the Guardian asks if the rising cost is really out of control and what more could be done to help ill and disabled people into work.

Is Britain in the grip of a sickness epidemic?

Measured solely by the rapid increase in claims for incapacity benefits since the pandemic, the UK’s health – or at least the prevalence of some conditions – would seem to be worsening. Lengthening NHS waiting lists may be a cause and symptom of this phenomenon. About one in 10 of the working-age population receive at least one of sickness benefit (mainly the health element of universal credit) or disability benefit (personal independence payment, or Pip), a rise of 1 million since 2019. Mental and behavioural disorders account for about four in 10 of all new claims – and about 70% of claims by young adults.

Why is mental ill-health a key factor in the rise in incapacity benefit awards?

There is little dispute that the removal of social support during austerity, the economic and emotional shock of the pandemic, and a lengthy cost of living crisis has had a profound effect on the nation’s wellbeing. Young adults, who endured massive disruption to their schooling and social lives at a critical stage in their development during Covid were among the hardest hit. Claims from this group have risen most sharply, to the point where, according to the Institute for Fiscal Studies (IFS), a 20-year-old today is as likely to claim a health-related benefit as a 39-year-old was in 2019.

The political right argues that “mental health culture” has caused young people to overmedicalise the normal anxieties of life, and this is indulged by a welfare system in which benefits are too easy to claim. Health professionals, however, tend not to underestimate the seriousness of the mental health crisis. Nor is there evidence that claiming health-related benefits – a notoriously onerous task – has become any less difficult. While applications have risen – especially among the young – the proportion of successful awards has not changed, suggesting the system has not become more lenient.

Will cutting incapacity and disability benefits drive down claims?

The “stick” theory of welfare policy favoured by the right is that cutting or restricting benefits will force people to pull their socks up and get a job. One problem with this is that Pip is not conditional on whether someone works or not (it is a benefit to help with the additional costs of disability). Many Pip claimants are in work. Another problem is that reducing incapacity benefit payments tends to impoverish people already in poverty (the majority of people in destitution have a chronic health condition or disability, according to the Joseph Rowntree Foundation). This is likely to make them less healthy and less able to move into work.

Could inadequate welfare benefits be partly driving the rise in ill-health?

One theory is that the meagreness of the main low-income benefit universal credit means people are less healthy generally, and more likely to claim additional disability or incapacity benefits to maximise income, particularly when the costs of basics such as food, energy and rent are high. “It has become increasingly difficult to survive on benefits if you are not classified as having a health problem or disability,” says Ben Baumberg Geiger, a professor in social science at King’s College London. “It does not mean people are making it up. Most do have health problems, but in the past [when benefits were higher] they would not have claimed them.”

Are the costs of disability and incapacity benefits out of control?

Rising case loads pushed up the costs of these benefits by nearly £13bn between 2019-20 and 2023-24, according to the IFS. The £48bn bill is expected to increase to more than £60bn by the end of the decade if trends continue. While these are huge sums, Baumberg Geiger says the overall welfare bill, as a proportion of GDP, has changed little since 2007 so it is wrong to say benefits spending is out of control. It is true, however, that a greater share of welfare spending is on incapacity and disability benefits.

What’s the solution?

Previous attempts to cut welfare spending though benefit crackdowns – such as the disability benefit reforms that saw the introduction of Pip in 2013 – cut neither the size of the bill nor the numbers claiming. Labour’s emphasis is on providing more skills, training and jobseeker support, investing in mental health care and cutting NHS waiting lists. It still faces a decision on whether to press ahead with a planned £3bn cut in incapacity benefits inherited from the previous government.