Eddie Barnes: The NHS supports our sickie culture

WE ARE a big bunch of western workshy softies. At a conference at Glasgow University last month, organised by the Scottish Observatory for Work and Health (SOWH), public health researchers revealed some new information on what exactly we Britons mean when we claim to be ill. The team, from Cardiff, picked out two groups of people at random.

One was asked a general question about whether they felt ill or not, in which it would be left up to them to specify what exactly was the matter. The other group was presented with a list of ailments and asked which they suffered from. Among the group given an open question, 3 per cent said they suffered from headaches, 7.5 per cent said they had mental health issues, and fully 73 per cent said that overall they did not have any complaint.

The second group? Fully 25 per cent said they suffered from headaches, 38.5 per cent said they had mental health problems, while only 33 per cent said they did not have any complaint. When forced to say what’s the matter with us, the stiff upper lip kicks in and we tend to demur. But, if encouraged to say something is wrong with us, we waste no time gladly saying yes.

This country regularly revels in haranguing the legion of work-shy layabouts on our urban estates. The truth is, as the Cardiff survey shows, that the Jeremy Kyle addicts on the sofa at home awaiting their next benefit cheque are only the most visible element of Britain’s sickie culture. The country is estimated to take between 150 and 175 million days off a year. It costs the British economy £100 billion a year, says the author of a seminal government report into Britain’s health two years ago, Dame Carol Black. This public health agenda is now one of the biggest sleeper issues in British politics; at a time when the West is being confronted by its own slump at the hands of a hungry, ambitious developing world, can ageing welfare-dependent countries like the UK really compete?

To use the policy jargon, this is about as upstream as it gets. And as a window into the way the UK functions as a country, this topic is incredibly revealing. The conference, attended by some of the best brains in Britain on health and work, slew a veritable herd of sacred cows. The main culprit was deemed to be the way in which care is delivered in the NHS. Of course, some people do get ill, need treatment and cannot work. That goes without saying.

But professors of medicine stood up to berate their own chosen profession for having created a monster, medicalising people who had little or no physiological problems, and for having created a culture in which even well-educated professional people had sub-contracted their common sense and intuition to the doctor’s smothering care. One senior occupational physician in Glasgow, Professor Ewan MacDonald, didn’t argue that the NHS should be doing more. His point was that the NHS model of care actively “generates long-term sickness absence and job loss and this increases death rates.” Read that again: the NHS is causing ill health, lengthening dole queues and leading to more deaths, not fewer.

Other occupational physicians at the conference noted how just 3 per cent of people in another survey had given “impaired function” as their reason for not being able to work. In fact, mostly, it’s down to psychological factors, or a sense of “stress”, or a fear of the workplace. The poor old GP is left to try, in their ten-minute consultation, to sort through this miasma of real and imagined ill-health problems that may centre not so much on a dicky heart as a dodgy mortgage.

One GP noted how there was a “conflict of interest” when faced with patients hoping to find something wrong with them. People may indeed be able to work, said another doctor, but then GPs may feel they need to show such patients that “they are on their side”, especially as they try to grow a practice and retain that patient’s trust. The picture painted was of a conspiracy between our own neediness, the NHS’s institutional tendency to medicalise matters, and the state’s welcoming embrace when it all goes wrong.

At the sharp end, the consequences are shocking and well-documented. In an irony that threatens to shame Scotland on the international stage, the SOWH reported on the levels of Incapacity Benefit (replaced by Employment and Support Allowance for new claimants from mid-2008) claimancy in Parkhead and Dalmarnock, where the Commonwealth Games will be centred in three years’ time. A staggering 61.4 per cent of men aged between 55 and 59 claim the benefit. Contrary to the media myth, it isn’t a simple case of people slacking: overwhelmingly, research shows that IB claimants have some health problems (as do 45 per cent of the working population) and would like to work if they had the chance.

The truth is complex. The illness tends to be a mental health problem, which is now the main reason given for IB claimancy. What is happening is a chicken and egg scenario of worklessness breeding bad health and depression, which in turn breeds more worklessness, in which the NHS and the Welfare State become both the crutch that keeps people going, and the drug that keeps them down.

The reforms of Work and Pensions Secretary Iain Duncan Smith are now beginning to impact on these welfare claimants. IDS – arguably the most reforming minister in Scotland at present – is driving through new health assessments, which are moving many of them off sick benefit, and onto the less generous Jobseekers Allowance (JSA), on the grounds they can actually work. These people will then be under the wing of the government’s hugely ambitious Work Programme. This reform is likely to be one of the most controversial changes to the state in the coming years, especially as it is introduced at a time when there isn’t work out there, already prompting claims it is unfair and discriminatory.

But to focus on this row would be to miss the wider lessons, which the health experts in the field all agree on. First, as noted above, people are falling off the working ladder and onto the sick not just through ill health but due to a variety of social factors. So the state needs to respond in kind. One unemployed man from East Kilbride we heard from at the SOWH conference had been directed to a “condition management” service for help. He saw a physiotherapist, a debt management agency, a cognitive behavioural therapist, an alcohol support group and an employability adviser.

In the jargon, that is holistic care. This – and not a pointless day’s workshop on how to write a CV, or a quick consultation with a GP about a sore back – is what will be required if the UK Coalition’s attempts to get Britain back to work, works. It means breaking down artificial boundaries between subjects like health and social science and economics across all sectors (something Glasgow University has itself done recently by replacing its nine old faculties with four colleges; something which will ensure academics collaborate to address the questions facing the Scottish, UK and world economy, says its vice principal, Anna Dominiczak).

But, more broadly, there is additional cultural reform required, which bleeds into the post-riot agonizing seen in the UK over the last few weeks. It is, say these physicians, about building resilience and confidence in society, and creating the beliefs and personal perceptions that ensure people feel a compulsion to keep going, rather than pack up. Education becomes key; Scotland’s chief medical officer, Dr Harry Burns, says he now spends more time in schools than hospitals as he seeks to get to the root of the country’s ill health.

Also key is the workplace, which is why public health experts are beginning to turn the heat on employers who are still largely ignorant of the massively important role they could play in contributing to better health. The crucial importance of the family needs to be recognised. And, say people such as Dame Carol Black, people with chronic conditions and disabilities, should be assumed as part of the workforce. There is frustration among public health experts that this more fundamental approach to the nation’s health is not getting through to the wider public, and that many politicians are not grabbing the issue properly.

Of course some people are sick. Meanwhile, IDS’s welfare reform is likely to be deeply controversial, as people who rely on sickness benefit are informed that they should get back to work. But there is a bigger challenge here for the rest of the public sector and society as a whole. Ageing, needy Britain must to decide whether it wants to deal with its aches and pains better. If not, then the country can sit back on the sofa and await the inevitability of a soft and slow decline.