PM Rishi Sunak recently claimed Britain was suffering from a “sicknote culture” as he warned of the risk of “over-medicalising” normal worries by diagnosing them as mental health conditions.
In a speech on how to reduce people being signed off sick from work, the prime minister said the government was planning to trial getting “work and health professionals” to issue fit notes, shifting away from GPs carrying out this role.
Sunak said he was concerned about the increase in long-term sickness since the pandemic, largely driven by mental health conditions with 2.8 million people then “economically inactive”.
Concerning mental health, he said he would “never dismiss or downplay the illnesses people have”, but also argued that there was a need to be “more honest about the risk of over-medicalizing the everyday challenges and worries of life”.
As part of a new drive to overhaul the system, Sunak said one plank of the reforms would be testing whether responsibility for issuing sicknotes should be shifted from “overstretched” GPs to “specialist work and health professionals who had the dedicated time to provide an objective assessment of someone’s ability to work and the tailored support they needed to do so”.
The law was changed last year to allow fit notes to be issued by any doctor, nurse, pharmacist, physiotherapist or occupational therapist in addition to GPs, who had traditionally overseen the system. No 10 last night would not clarify whether the government was planning to widen the criteria further to allow non-medical professionals to issue or change fit notes as well.
Sunak suggested in his speech that GPs were signing people off sick for work “by default”, with 11m fit notes issued last year, of which 94% assessed people as “not fit for work”. No 10 claimed that the fit note system had “opened the floodgates for millions of people to be written off work and into welfare without getting the right support and treatment they might need to help them stay in work”.
However, extracts of the speech released to the media on Thursday night did not address the issue of NHS mental health capacity, with NHS bosses warning “overwhelmed” services had been unable to cope with a big post-Covid increase in people needing help.
Poorly conceived measures will erode dignity in the workplace
Dr Indranil Chakravorty MBE, Consultant Physician in General Internal Medicine and Respiratory Medicine at St George's University Hospital, London told Asian Voice, “In the UK, data from the Office of National Statistics report that the sickness absence rate rose to 2.6% in 2022, the highest since 2004. An estimated 186 million working days, amounting to just under 6 days per worker, with minor illnesses accounting for less than a third of occurrences. Women, older workers, those with long-term health conditions, working part-time, and people working in care, leisure, or other service occupations are affected more than other cohorts. There is evidence that women and members of racial/ethnic minorities are more likely to feel excluded and that exclusion is linked to job dissatisfaction, a lower sense of well-being and higher rates of absenteeism.”
He also feels that the current government’s proposed measures to reduce this ‘sick note culture’ by employing professionals other than doctors (primarily General Practitioners) is not novel. It suggests a misperception that doctors are likely to be too lenient or erring in favour of their patients.
According to Chakravorty, this argument has fundamental fallacies, as much of the close relationship between doctors and patients has been eroded in recent times. Historically, similar measures introduced to reduce disability living allowance payments by the use of ‘independent tribunals’ were successfully challenged and overturned at appeal in 70% of cases, and it fails to recognise the invisible disability of the impact of the Covid-19 pandemic on the mental health of the nation.
“However, doctors are alarmed at introducing such measures, as these demonstrate signs of falling societal responsibility toward citizens suffering from diverse incapacity or impaired working ability and independence. The misjudged push towards presenteeism not only disproportionately affects women and workers from minority backgrounds but also aggravates illnesses, promotes long-term conditions, and multiplies the economic costs of presenteeism, which are 5–10 times higher than those associated with absenteeism.
At the BAPIO Institute for Health Research, we are concerned that such poorly conceived measures will erode dignity in the workplace and psychological safety. They will aggravate the relationship between workplace diversity and inclusion and employee performance, leading to socio-economic loss. However, measures that support trusted doctor-patient relationships will promote healthy living. We urge the government to consider recognising workplace diversity and inclusion, which will provide for dignity and well-being, rather than mistakenly tackling the so-called ‘sick note culture’,” he added.
Dr Sarwar Chowdhury, a Senior Occupational Health Physician told Asian Voice, “Almost 95% of fit notes given by GPs indicate the patient is ‘not fit’ without offering advice or adjustments, so the statistic of 2.8 million people being unfit to work due to ill health (ONS) is not unsurprising and the leading cause is mental health. With only 50% of employees having access to Occupational Health, the evidenced-based benefits of work with routine, social interaction, purpose and workplace support are often missed. More support from the government and PM Rishi Sunak is required to help outline the barriers to work, support/adjustments available and facilitate a return to work for sustained employment for those with recognised mental health and wellbeing concerns. This should be balanced against ‘de-medicalising’ mental health and caution is needed to reduce the risk of discrimination for patients and workers.”
Dr Alka Patel, Founder of The Longevity Concierge, CEO of Lifestyle First and Lifestyle Medicine Physician and Longevity Expert told us, “By implying that a 'sick note culture' exists, there is also a risk of stigmatising illness, particularly mental health issues, and suggesting a lack of legitimacy to the claims of those genuinely unable to work. The narrative around 'sick note culture' can be reframed positively: it's not about questioning the validity of illness but promoting a culture of recovery and active engagement in one's own health journey. In this light, the Prime Minister's initiative could be seen as an attempt to empower patients, helping them to get back into the workforce more efficiently, which benefits both the economy and individual well-being.”
