Last week, as I trudged the estates of inner-city London on election night trying to drum up the last few extra votes for Labour, I was struck by something I should have expected from the employment statistics: just how many people who come to the door are sick and disabled.
The man who had to get in his wheelchair to answer the doorbell; the mum with baby on her hip, wheezy with asthma; the elderly woman suffering from a complex mixture of ailments meaning she rarely leaves the flat. Not one of them knew there was an election going on; and no, they didn’t want a lift to the polling station, not even for Sadiq Khan.
In the poorest inner-city housing – which is usually not the council flats but the newish mid-rise apartment blocks wedged between them – disability, mental illness and chronic sickness have become the signature tune of working class life.
In addition to the misery of those who suffer, and the stress it places on the NHS, rising ill health has now become an obsession for economic forecasters. Basically, the economy can’t grow because it is short of workers: not just skilled engineers and trained midwives, but people in general.
The “participation rate” in the workforce is falling: from 64% just before Covid hit, to a projected 62.8% by 2028. And that is despite the record inward migration fuelled by the Tories’ post-Brexit visa policies. As a result, the annual bill for the Personal Independence Payment (PIP) has risen from £16bn before the pandemic to £22bn today – and is predicted to be £28bn in five years’ time.
It is no surprise, then, to see the government float the idea of stopping benefits for those with mental health problems, to force them back to work.
The plan, currently under consultation by the Department of Work and Pensions, is to replace cash payments with vouchers, tighten benefit criteria and “direct” people suffering with mental illness towards “treatments” rather than benefits.
How exactly those treatments would be provided, when NHS cuts and shortages mean there is no timely treatment now is not answered. And it probably never will be because the whole move to target benefit claimants is a clear Tory election ploy.
But Britain’s low workforce participation rate is a real problem. While economists worry about its impact on the UK’s potential for economic growth, and about the rising cost of PIP, the “participation” crisis is in essence a social crisis.
In nobody’s vision of a progressive future is it a great idea to have 2.8 million people living in sickness, penury and isolation, alongside 1.6 million others who are classified as economically inactive by the OBR because they care for relatives at home.
Labour has criticised the plan, but not exactly been forthcoming about its alternative. For me, the alternative has to start with a better diagnosis of where the health crisis is coming from.
Michael Marmot’s 2020 report, Health Inequality in England, tells the shocking truth. Rising life expectancy has stalled. The amount of time men and women in every region of England are spending in ill health is rising.
Marmot, a distinguished epidemiologist at UCL, listed the likely causes: rising child poverty, cuts in education funding, the rise of precarious work and a crisis of housing affordability are leaving people with not enough money to live a healthy life. And these outcomes, wrote Marmot, “are even worse for minority ethnic population groups and people with disabilities”.
In short, free-market capitalism makes us sick. It not only drives down real wages, and drives up real rents: by atomising everyday life, regimenting the workplace and forcing us to consume unhealthy food, it imposes a level of physical and mental stress on the average human that is increasingly unbearable.
If you want to stop the disability benefits bill rising to £28bn and beyond, it’s that problem you have to begin with – not the assumption that people who have depression need a good talking-to and a part-time job.
Marmot – writing before Covid – recommended a long list of measures to boost public health, but the most important one was this: to place wellbeing, not growth for its own sake, at the centre of economic policymaking. It’s an approach neither the government nor Labour has been prepared to take.
I am passionately in favour of Labour’s growth agenda. I think, if combined with the early delivery of its programme on workers’ rights, we will see rising real wages and the return of prosperity to communities that need it. But I also want to see clear public health outcomes targeted, alongside the kind of targets Labour is setting for health inputs, like appointment numbers, or the recruitment of nurses.
Labour has pledged to make England a “Marmot country” – ie to embody his approach in its policies across departments. It has, for example, pledged to reduce stroke deaths by a quarter within 10 years. And it promises to set an explicit target to end the black maternal mortality gap, where black women are four times more likely to die in the period around childbirth than white women.
But to deliver this, you would have to mandate public health targets for the private sector, not just the public sector. That is, you would give employers an explicit duty to look after the health of their workforce, and ban consumer-facing businesses from promoting products that can be shown to cause ill health – either physical or mental.
Soon the people I met last Thursday will be Labour’s problem. So will the £28bn benefit bill.
It will be a moral test for Labour: it should scrap the Tories’ assault on PIP from day one, end the victimisation of the long-term sick and mandate every ministry to place human wellbeing at the heart of its endeavours.
