Why incapacity benefit changes won’t work

The government’s desire to cut the incapacity benefit bill will fall foul of society’s preoccupation with ill-health, writes Dr Michael Fitzpatrick (pictured)

Work and pensions secretary Peter Hain is the latest government minister to declare war on “sicknote Britain”. Hain’s scheme to cut the total of more than 2.6 million people claiming incapacity benefit is likely to suffer the same fate as those of his predecessors, who have presided over a four-fold increase in long-term invalidity over the past 30 years.

In its drive to push those claiming incapacity benefits back to work, the government will get little help from GPs, who have become increasingly sceptical about political interference in the sickness benefits system.

I remember before the 1992 general election when patients started to turn up asking to be certified as unfit for work on medical grounds, having been sent by the local benefits agency where they were registered as unemployed. Unemployment was then still a sensitive political issue, and the Conservative government, already notorious for its manipulation of the jobless figures, had discovered that the unemployment rate could be reduced still further if more of those out of work could be redefined as sick. A few months later, the election won, another government department found itself struggling with the mounting cost of paying out long-term benefits to this cynically created army of invalids. Some of the same patients were sent back, now under pressure to be certified as fit for work.

Now that the numbers on incapacity benefit are approaching 10% of the working population and nearly twice the number registered as unemployed, the New Labour political focus is on long-term disability.

Here the government faces a much bigger problem than the reluctance of GPs to police the benefits system: the wider culture of medicalisation – a culture to which the government is itself a major contributor. We are in the grip of the paradox that the inflation of health to become a major preoccupation of national and individual life has led to the inexorable expansion of those who are sick. The dramatic increase in illness over the past 30 years stands in remarkable contrast to the decline in life-threatening disease over the same period. Yet, although we are “doing better”, we are at the same time “feeling worse”.

The ranks of the incapacitated have been swelled by those suffering from conditions that are largely subjectively determined. The biggest expansion has been in the sphere of mental illness, which now accounts for about 40% of the total, more than one million people. Experiences of loss and unhappiness and distress have been redefined in terms of depression and anxiety, or newly defined conditions such as post-traumatic stress disorder, work-related stress and addictions. Campaigns suggesting that “one in four” people suffer from mental illness have encouraged people to reinterpret their experiences in terms of psychological ill-health.

Musculo-skeletal disorders are another major cause of incapacity. Though it is difficult to adduce a biological explanation for the modern epidemics of low back pain, fibromyalgia and repetitive strain injury, these disorders have also been sanctioned by medical authorities, by employers and by government.

Peter Hain now plans to introduce “more rigorous measurement” of conditions leading to claims for incapacity benefits. But how can you measure misery, fatigue or pain? If we make health the goal of life, all forms of existential distress are likely to be experienced as illness, the greatest cost of which is not to the Treasury, but to ourselves.

This article appeared in the 13 December issue under the headline “Growth in incapacity benefit is a product of our ‘feelbad’ times”