Peter Moore: A crisis the country cannot afford

I knew I must have upset him when he tried to burn my surgery down but the reason for his grievance was not my fault. 

He came into the waiting room with several cigarette lighters and small bottles of lighter fuel. The receptionists cleared the waiting room and rang the police. I tried to talk him down. When the police arrived they also tried the softly- softly approach but did not make progress. When he started to light one of the lighters the police jumped on him and held him down. He was arrested and taken to the police station. One man-mountain who stayed in the waiting room throughout the incident spoke to me afterwards. “It’s ok doc. I’m a bouncer at one of the clubs. If he had started anything I was watching.” It was good to know that he had my back although I’m not sure he would have been as gentle as the police officers. 

Our potential arsonist had been signed off as unable to work but his sick note had been bounced. He was told he had to get off the couch and find a job, clearly something he found unacceptable. 

Last year the NHS issued over eleven million “fit notes”, today’s Orwellian name for sick notes.  There are 2.8 million people out of work due to poor health. This creates a crisis the country cannot afford, although there would be a larger crisis if all 2.8 million tried to burn their surgery down.

Many of today’s fit notes are for mental health issues. Clearly this is appropriate for the “psychoses” such as schizophrenia or bipolar but for many people with anxiety and moderate depression sitting at home with nothing to do is positively harmful. 

How did the system work in the 1980s and 90s? As GPs we could sign people off for as long as we felt appropriate but after thirteen weeks the Benefit’s Agency would step in. This agency was independent and employed their own doctors, known as Regional Medical Officers (RMO). This agency would review the situation, the claimant would have to fill in a form and, if necessary, be called for an examination. 

If I was unsure whether the sick note was justified I could write “ref to RMO” on the sick note and the claimant would be seen. 

An RMO once told me some interesting anecdotes. He remembered a “disabled” man with a severe problem with his leg. He hobbled into the room, went through the examination but forgot which leg was supposed to be the problem. He then limped out of the room using the wrong leg. If the person was turned down for sickness benefit the job centre would help them back into work. It also had the advantage that the decision was taken away from GPs. I could honestly say that it was not my decision and so there was no damage to the doctor patient relationship. 

Today well notes are often assessed online, if at all. Although this was supposed to save money it is a false economy if it leads to more people getting benefits inappropriately. Filling in a form would give the claimant time to remember which leg was supposed to be the problem. 

Any civilized society must look after anyone who cannot look after themselves. It is right that we have a safety net for people who are too sick or disabled to work. Help may be needed for specialised equipment. It is difficult to devise a system which helps anyone with medical problems and needs help but is not abused by people who are able to work but refuse. This has been a problem first highlighted in Queen Elizabeth 1st Poor Law of 1603 when they tried to define the deserving and undeserving poor. 

It is not clear why so many people in the UK are claiming sickness benefit. Unlike other countries it has not fallen since the pandemic. What is clear is that the taxpayer cannot afford to keep paying out more and more. What is also clear is that we are not helping anyone with minor anxiety or depression if they stay at home all day. 

I never claim that it was “better in my day” but I sometimes wonder how our RMO who have responded to some of the claims. Perhaps I would have even more people trying to set fire to my surgery.