David J Black

The bean-counting fetish of our purblind politicians began in 1994 when social security minister Peter Lilley invited the US healthcare insurance company UnumProvident to advise on the cutting back of benefit claims and the outsourcing of medical assessments. Thirty years later the war on ‘sick note Britain’ has failed, and the growing problem of the upsurge in type 2 diabetes, asthma, obesity, functional neurologic disorder, Myalgic Encephalomyelitis/Chronic Fatigue syndrome and its pernicious variant, Long Covid, threatens to engulf a health sector already in crisis. The Gradgrinds of all parties seem to think the denigration of those too ill to drag themselves to work as an alternative to suffering cuts in their benefits might somehow magically coerce the physically incapable into being capable enough of earning a few bob to relieve the strain on the exchequer which had much more important things to do with our money, such as engaging in daft vanity projects like HS2.

This over-arching emphasis on a crude economic model in a health setting has been a disaster, not least under Labour governments which entrusted policymaking to such medically uninformed ‘experts’ as the rich banker Lord David Freud, who at one point suggested the sick-poor should be set to work at rates of as little as £2 per hour, and Lord Richard Layard of the LSE’s Centre for Economic Excellence, who continues to advise Keir Starmer. Department of Work and Pensions (DWP) minister Liz Kendall’s Labour Market Advisory Board, set up under her Pathways to Work programme, is dishing up yet more quasi-monetarist gruel under Sir Keir. Every member of her eight-strong commission is an economist, and there is no visible input at all from the public health sector.  

But what’s this? Could it be a voice of sanity, in the form of an economist who might actually know what he’s talking about? Richard Hughes (Harvard and Oxford) is no run-of-the mill PPE apparatchik. Before becoming chair of the Office of Budget Responsibility he was attached to The Resolution Foundation, a think tank primarily concerned with the living standards of those on low to middle incomes, which suggests he might actually have a beating heart. On bonfire day 2024 (or Trump victory day, depending on your preference) with the UK having come through a year of near zero growth, Mr Hughes dared to raise the issue of long-term sickness claims by a record 2.8 million people of working age – a trend which is continuing upward and might yet implode.

Having provided a few scary scenarios to the Commons Treasury Committee in the morning, the OBR chair went on to address the House of Lords Economic Affairs Committee in the afternoon. One could sense a lingering Halloween chill in the air throughout the hallowed chambers. Their lordships’ focus was on the nation’s costly welfare system and the queasily unaffordable long term sickness liabilities which this will continue to impose on the hard-pressed taxpayer in the only OECD country which has seen working age sickness increase since the pandemic.

The much heralded ‘war on sicknote Britain’ which so tickles the likes of Peter Lilley, Peter Hain, George Osborne, and Wes Streeting, is an easy soundbite for any politician who feels there might be useful coverage if they throw red meat to certain tabloid (and other) journalists with a hyperbolic ‘anti-scrounger’ agenda. The sick, within this endlessly hostile environment, are often characterised as some sort of revenue sapping enemy within, many of them ‘yuppie flu’ miscreants on the make who need to be knocked into shape before the country is bankrupted. There have certainly been cases of benefit fraud, but this was rarely down to ill individuals gaming the system. Organised gangsterism was causing much more damage, as in the case of a Bulgarian criminal group which was found guilty of defrauding the Department of Work and Pensions of around £54 million in May 2024. The sick-poor, by and large, were, and remain, a law-abiding group, with few exceptions.

The crystallisation of Britain’s vendetta against the suffering was the notorious Malingering and Illness Deception conference held at Woodstock, Oxford in 2001. This was sponsored and funded by the DWP in association with the American health insurance giant, UnumProvident, and was something of a masterclass in the persecution of the sick and ailing. Its follow up manifesto, an anthology edited by psychiatrist Peter Halligan (OUP, 2003) was a study in demonisation much praised by the Institute of Psychiatry’s Simon Fleminger who boldly speculated “that many of our patients may be deceiving us, and that much of this deception may be conscious. We are introduced to the debate as to whether or not malingering should be identified as a psychiatric disorder, a disorder of free will, or simple criminal behaviour.”

But just who were the criminals in this case?  Might it be a tight-knit psychiatric faction and its state backers which clearly had an agenda to denigrate a cohort of benefit claimants who were in no condition to fight back? Perhaps some bright post-grad sociology or criminology student should forensically analyse this ruthless war of attrition on the sick with a view to establishing the actuality.

Fiscally obsessed politicians were only one aspect of the problem. Given the policy-framing role assigned to Chatanooga-based UnumProvident, which the Insurance Commissioner for California described as “an outlaw company” in 2004, and which, furthermore, was induced to settle a class action lawsuit over its “claims denials” in 2008 for $40 million, any resulting dissertation could be a riveting diagnostic Gothick Horror for sure.

And that, it seems, is where our tale is headed.