Peter Moore: Why the unemployed Britain?

Medical notes have become much less entertaining. I once worked for a GP who used to write “Plumbus Pendularum”. It was his tongue in cheek version of Latin meaning “swinging the lead”.

Today as patients are allowed to access their note,s I am not sure how I could explain Plumbus Pendularum. Are we even allowed to suggest that someone is swinging the lead, or might that be seen a bullying?

Whether people are swinging the lead or are genuinely too ill to work, we have a uniquely British problem. We are the only country in the G7 group of developed countries in which the employment level has not returned to pre-pandemic levels. 

The number of young people aged between 16 to 24 not in education or employment is now 946,000, 20 per cent higher than before the pandemic. This is the highest figure since 2014. There are now 2.8 million people off work through long term illness and this figure is expected to rise by another half a million by 2029. The single biggest cause is mental illness and stress. This is costing the country £70.5 billion and is predicted to rise by 2029 to £89.8 billion. This increase is not occurring in other countries and so cannot be due to long covid. 

Some young people leaving school or university are immediately signed off sick, in some cases with self-diagnosed mental health problems. 

These costs are not only a problem for the economy but are a tragedy for our young people. We must help anyone with a serious illness such as multiple sclerosis or rheumatoid arthritis although some of these people bravely carry on working. 

It would be unreasonable to force someone to work who has a serious psychosis such as schizophrenia but what about anxiety? Anxiety is a part of normal life. When does anxiety become an illness? Work can give people a role in life and help them to meet others. It can even build a social support network. We know that the longer someone is signed off work the harder it is to get back. 

People suffering from anxiety need time to talk it through and develop coping strategies but GPs cannot offer this in ten minutes and there is a long waiting list for any psychological therapy. The only alternative for GPs is to sign them off work. 

In the 1980s and 90s we had sick notes but GPs could only sign someone off for a maximum of 13 weeks. They then had to see the regional medical officer (RMO), a doctor from the Benefit’s Agency. The RMO could override the GP’s note and arrange for a return to work, often with support. This was also helpful to GPs as we could maintain our relationship with the patient. We weren’t the ones being horrible, even if I agreed with the RMO. We also had the option to write on the sick note “ref RMO” which meant that we were unsure whether the sick note was justified and wanted his opinion. 

It is not possible to force anyone to work who is debilitated with stress but it should be possible to offer a back to work strategy perhaps with part time work and support. The benefits system does not help as anyone starting to work could lose benefits. We cannot support people to return to work if it means a cut in income. 

The days of “snap out of it” are gone. Although it is difficult to challenge anyone who claims to have a mental health problem without a professional diagnosis it is unhelpful to allow them to stay off work indefinitely. 

The government is planning an overhaul of Job Centres who will work with NHS staff although I am not sure where they will find NHS staff with the time to help.  If someone with mental health issues can get to work with support, it will help the individual and the economy. It could be a win-win.