Britain: the incapacity capital of Europe

A UK government report has caused shockwaves by claiming that ill-health now costs the UK economy more than £100billion a year. But given how often we are all told that we must be ill, stressed-out and unhappy these days, perhaps the real shock is that so many of us still manage to get up and go to work.

The report by Dame Carol Black, national director for health and work, puts the total annual cost of ill-health at £103billion by trying to estimate such elements as ‘the cost of care given by family and friends’. But the core cost is the £63billion made up of benefit payments for the sick and the taxes lost because they are not working. These sums have proved of great concern to the cash-strapped government, and have got the normally redundant opposition parties working overtime.

The report lays out some classic New Labour proposals to try to cut the costs by getting those off sick back to work. Partly, it’s the usual exercise in semantics – replacing sick notes with ‘well notes’, to accompany the renaming of incapacity benefit as ’employment and support allowance’. That should do it! The rest of the government’s proposals include an equally typical but more serious package of therapeutic-coercive measures, including tough tests for those off sick – with general practitioners (GPs) expected to act, in the words of a doctors’ spokesman, as ‘agents of the state’ – and early intervention by counsellors and/or physiotherapists. These measures will certainly result in the waste of doctors’ working time and the advance of official intrusion. What effect, if any, they might have on getting people into jobs, especially at a time of economic retrenchment, is far less certain.

In any case, the debate about illness and work is missing the real point. The fact is that most people in the UK now lead longer and healthier lives than ever before. Yet 2.7million still claim incapacity benefit – and long-term claimants have quadrupled since 1981. Why? Partly no doubt it is a legacy of the way that, after the recession of the early 1980s, the Tory government sought to massage the official unemployment figures downwards by moving more people off the dole and on to the sick list. According to a Sheffield University study last year, today at least a million incapacity benefit claimants should really be seen as the hidden unemployed. ‘This does not mean that one million incapacity claims are fraudulent’, says Professor Steve Fothergill, who led the university study, ‘but these men and women would almost certainly have been in work in a genuinely fully employed economy’. Little wonder, then, that incapacity benefit claimants often tend to be concentrated in traditional working-class areas where the industries of yesteryear have largely closed down. In a previous study, Fothergill found that a fifth of working-age adults were on incapacity benefit in both Easington, County Durham and Merthyr Tydfil in south Wales.

The bigger underlying question is, why are so many prepared to see themselves and others as ill rather than unemployed today? Perhaps because we live in a culture where authorities and experts, from health ministers downwards, appear obsessed with personal health and lifestyle as the be-all and end-all of life. If there is something wrong in your life, it is likely to be seen as a medical problem. Moreover, we are repeatedly told that we are vulnerable (those classified as ‘vulnerable groups’ now make up the majority of the population), stressed, at risk of physical or mental illness and in need of professional help.

Last year a government ‘happiness’ guru announced that no fewer than eight million Brits suffer from a neurotic disorder, and called for 10,000 therapists on the National Health Service to help us all cope. With such gloomy statements from on high setting the tone, it should hardly be surprising to discover that almost three million consider themselves too ill, stressed or depressed to hold down a job. To update the old joke motto, the message appears to be: ‘You don’t have to be mad not to work here, but it helps.’

Yet as Simon Wessely, professor of psychiatry at King’s College, London recently pointed out in a BBC Online interview with spiked‘s Brendan O’Neill, there is little hard evidence of any genuine boom in mental illness. Instead, there is a powerful trend for people to report themselves as stressed or depressed, and for medical professionals and authorities to reinterpret more human experiences as illnesses.

‘In my trade, for example’, Wessely observes, ‘states of sadness are now seen as “depression”, shyness has become “social phobia”, and all sorts of variations in childhood temperament, personality, emotions and behaviour have become characterised as diseases that need treatment, be it Asperger’s, autism or ADHD.’ Wessely explains that in the UK ‘rates of actual mental illness are not increasing’, but that the domination of therapy culture means things that ‘previous generations regarded as part and parcel of normal variations in personality and emotion’ can now be interpreted as psycho-medical problems in need of therapy (see Misery creep, by Brendan O’Neill, BBC News).

So there is far more than a fiddling of figures going on here, either by the government or by claimants. The debate about illness and work looks more like a cultural diagnosis of how we are seen today: as vulnerable individuals, in need of protection and help and easily incapacitated: millions of passive examples of what Frank Furedi calls ‘the fragile self’. There is something sick in the state of Britain.

The ‘healing’ interventions of the therapeutic state can only reinforce the tendency to medicalise social and personal problems and see ourselves as patients-in-waiting. The New Labour government’s policy turn towards instilling ‘happiness’ in the population marks the abandonment of the aim of creating the Good Society, in favour of the individual feel-good psyche. It invites us to turn inwards and similarly lower our horizons. The new policies that the Black report proposes to counter the ‘sick-note culture’ – from ‘well notes’ that spell out exactly how little work a claimant can do, to early and more stringent interventions by counsellors and doctors – are likely further to focus people’s attention on issues of illness and vulnerability rather than capability.

Even the government’s justification for wanting to get people back into work is now phrased in terms of improving their personal health. The idea that working hard and creatively with others might be a social good in and of itself is frowned upon as outdated.

This redefinition of a working life as an experience of ill-health has had a destructive impact on the capacity of working people to stand up for themselves and join together to demand change. Yet many on the the left and in the trade unions have been to the fore in emphasising the need for more therapeutic interventions and welcoming the new proposals. A workforce with a self-image as a collection of vulnerable individuals in need of help is unlikely to be a force for progress in society.

Instead, as David Wainwright, co-author of Work Stress: The Making of a Modern Epidemic, argued on spiked a few years back, for millions in economically depressed areas being ill has become a form of working-class identity, replacing the status once conferred by being a miner or a mill worker: ‘In a remarkable reversal of the Protestant work ethic, many feel that the identity of the work-stress victim surviving on incapacity benefits confers more prestige than that of the low-paid worker in a dead-end job.’ (See Sick of work?, by David Wainwright.)

This situation will not be helped today by the sound of tightening belts across the credit-crunched UK economy. Indeed, given the sickly spirit of the age, any pressure on the job market seems likely to make even more people retreat into symptoms of stress and mental ill-health, rather than getting ‘on their bikes’ to get to work.

In the rundown corner of Yorkshire where nine-year-old Shannon Matthews was found by police hidden in a bed, the suspect whom police dragged from the flat was reported by neighbours to be shouting ‘I’m a poorly man, me, I’m a poorly man!’ Such is the cri de coeur of many in Britain, the Poorly Man of Europe and incapacity capital of the advanced world. But no doubt, when the government gives them a ‘well note’, all will be well.

Mick Hume is spiked‘s editor-at-large.