PM to overhaul benefits system and tackle Britain’s “sick note culture” in welfare reform speech

In a major speech later today (Friday 19 April), the Prime Minister is expected to unveil a package of welfare reform measures to tackle the unprecedented rise in economic inactivity and ensure our benefits system is better targeted at those who need it most.

The Prime Minister's new plan for welfare will end Britain's “sick note culture”, which has resulted in a significant rise in people being unnecessarily written off work and parked on welfare.

It comes amid concerns that the fit note system has 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.

Data recently published by the NHS shows almost 11 million fit notes were issued last year, with an overwhelming 94% of those signed “not fit for work”. A large proportion of these are repeat fit notes which are issued without any advice, resulting in a missed opportunity to help people get the appropriate support they may need to remain in work. 

To address this, the Prime Minister is expected to announce a review of the fit note system today to stop people being written off as “not fit for work” by default and instead design a new system where each fit note conversation focuses on what people can do with the right support in place, rather than what they can't do.

As part of this, the government will consider shifting the responsibility for issuing the fit note away from already stretched GPs, towards specialist work and health professionals who have the dedicated time and expertise to provide an objective assessment of someone's ability to work and the tailored support they may need.   

A call for evidence will be published later today to seek responses from a diverse range of perspectives, including those with lived experiences, healthcare professionals and employers, both on how the current process works and how it can better support people with health conditions to start, stay, and succeed in work. 

The Prime Minister is expected to say:  

“We don't just need to change the sick note, we need to change the sick note culture so the default becomes what work you can do – not what you can't. 

“Building on the pilots we've already started we're going to design a new system where people have easy and rapid access to specialised work and health support to help them back to work from the very first Fit Note conversation.   

“We're also going to test shifting the responsibility for assessment from GPs and giving it to specialist work and health professionals who have the dedicated time to provide an objective assessment of someone's ability to work and the tailored support they need to do so.”   

Setting out his vision for a “new welfare settlement for Britain”, the Prime Minister will outline the new challenges that have emerged since the pandemic particularly the unprecedented rise in inactivity and how the government plans to tackle them.

Before the pandemic, we had the second lowest inactivity rate in the G7, lower than France, Germany, Italy, USA and Canada. But since the pandemic, a significant number of working aged people have become inactive due to long term sickness which has in large part been driven by mental health conditions. 

Latest figures from the Office for National Statistics suggest there are currently 2.8 million people who are ‘economically inactive' due to long-term sickness, a near-record high. Of those inactive due to long term sickness at the start of last year, 53% reported that they had depression, bad nerves or anxiety.

This is also driving an unsustainable increase in welfare spending as more people claiming disability benefits are now assessed as having anxiety or depression as their main condition.

Since the pandemic, total spending on working age disability and ill-health benefits increased by almost two-thirds from £42.3bn to £69 billion and we now spend more on these benefits than our core schools' budget or on policing.

The fit note process is often the first step to someone falling out of work and acts as a gateway towards some ill health and disability benefit assessments. There is also clear evidence that the longer someone is out of work, the lower the likelihood that they return to work – further exacerbating the rise in inactivity.

The Prime Minister is expected to make the case that we need to be more ambitious about how we help people, particularly with mental health conditions, back into work and ensure they are not left behind on the benefits system.

The Prime Minister is also expected to say:  

“We should see it as a sign of progress that people can talk openly about mental health conditions in a way that only a few years ago would've been unthinkable, and I will never dismiss or downplay the illnesses people have.  

“But just as it would be wrong to dismiss this growing trend, so it would be wrong merely to sit back and accept it because it's too hard; or too controversial; or for fear of causing offence. Doing so, would let down many of the people our welfare system was designed to help.  

“Because if you believe as I do, that work gives you the chance not just to earn but to contribute, to belong, to overcome feelings of loneliness and social isolation and if you believe, as I do, the growing body of evidence that good work can actually improve mental and physical health…

“…then it becomes clear: we need to be more ambitious about helping people back to work and more honest about the risk of over-medicalising the everyday challenges and worries of life.”    

Today's fit note review builds on the significant steps we've taken so far to break down barriers to work and tackle inactivity. This includes through our £2.5 billion Back to Work Plan which is already helping over a million people, including those with mental health conditions, break down barriers to work by expanding access to mental health services and putting an additional 384,000 people through NHS Talking Therapies.

The new WorkWell pilot is also being rolled out and will support almost 60,000 long-term sick or disabled people to start, stay and succeed in work once it has gone live in approximately 15 areas across England.

The WorkWell services provides a single, joined-up assessment and gateway into local employment support services, to help people manage their health conditions and get back to work sooner. This is part of an ambitious programme to support disabled people and people with health conditions to start, stay and succeed in work.

We are also testing reforms of the fit note process to integrate it more closely with WorkWell, enabling the people who need it to have a work and health conversation, with a single, joined-up assessment and gateway into local employment support services. It will also complement the role of Occupational Health in ensuring employers understand and benefit from more expert work and health support to retain and support those in work.

The fit note call for evidence is part of five key reforms the Prime Minister's is expected to outline in his speech to put work at the heart of welfare and modernise the welfare system to ensure it is fit for the future. 

Notes to editors

• An operational notice for media accreditation and pooled opportunities will be sent separately in the usual way.
• A British Sign Language interpretation of the speech will be published on the No10 Youtube and social media channels after the speech is delivered.