Before Covid struck, the UK working age population was already plagued by more illness and disability than in the rest of Europe. But it has since shot up further: there are now 2.6mn people off work as a result of long-term sickness. This could be a consequence of the NHS backlog. It wouldn’t be surprising to see fewer people looking for work if they are waiting for hospital treatment, or looking after someone who is waiting — especially if they are older.

But those who have focused on the over-50s’ “great resignation” have missed another phenomenon. The biggest relative jump in economic activity due to long-term sickness is in the young, not the old. The numbers increased by 29 per cent among 16 to 24-year-olds and by 42 per cent among those aged 25 to 35 between 2019 and 2022. New analysis by the Institute for Fiscal Studies finds that disability is now more correlated with education than with age. According to the IFS director Paul Johnson, a 30-year-old with no qualifications is more likely to report a disability than a 50-something university graduate.

This alarming development has much to do with an apparent deterioration in mental health. Depression, bad nerves or anxiety have become the most prevalent health condition reported by those who are economically inactive because of long-term sickness, especially under the age of 35.

Are people really too sick to work, or are they just sick of working? “It is worth considering,” says the Office for Budget Responsibility in its latest fiscal risks report, “whether the welfare system itself might have contributed to the rise in measures of health-related economic inactivity.” It notes that disability benefits are more generous than unemployment benefits, with fewer requirements to find a job; and that the process of getting a doctor’s “fit note” for statutory sick pay was replaced by self-certification during the pandemic.

As an old school Calvinist, I can see that being allowed to self-certify might prove tempting. I also know that even if you’re not depressed to start with, being sedentary and jobless can make you so (my mother, a manic depressive, fought to keep her job to retain her sanity). But I don’t believe that most people are faking it. It is hard to score the points needed to qualify for the personal independence payment (PIP). The health downturn has also coincided with a fall in real incomes which has put unbearable stress on some of those with least resources.

It would be wise to ensure, nevertheless, that the welfare system does not inadvertently encourage people to state that they are permanently ill. Many physical disabilities are, sadly, for life. But some mental health conditions — such as anxiety and depression — come in waves. People can recover, especially if they get help.

We should not be writing people off. Yet that is the bigger story, across the industrialised world. Even now, the UK does not have markedly lower labour force participation rates than the rest of the OECD: it is still ahead of France, Italy, Spain and the US. But the gap which the IFS pinpoints, between levels of education and health, is starkly echoed in gaps in life expectancy between rich and poor, especially in the UK and US. In civilised countries, a toxic combination of poverty, obesity and poor education are adding up to mental despair.

The tragedy is that the UK had made real progress in the decade before the pandemic. Working-age inactivity fell from 9.5mn to 8.4mn people between 2010 and 2020, making Britain one of the best performers in the G7. This was partly as a result of welfare reforms to make work pay.

What can be done? One thing is clear. Leaving people waiting weeks or months to talk to a therapist, is not good for mental health. Individual placement and support services, which help severely mentally ill people into jobs in various European countries, have been shown to be most effective when they place someone quickly into a role, and provide intensive support. The same principle applies to occupational health schemes offered by employers which have proved successful in reducing absence rates in Finland and the Netherlands. This is a point not lost on the British chancellor Jeremy Hunt, who is mulling over offering tax breaks to UK companies to follow suit.

Young men need attention. At 16, it is girls who are seeking mental health support in record numbers. But between 25 and 34, almost two-thirds of those who are not seeking work are male. History suggests that if they fall out of the workforce for too long, they are far less likely to ever get back in.

With conventional mental health services overwhelmed, could digital services help? Kooth Digital Health, a British company, has just won a contract from the state of California to provide digital mental health services to every young person between 13 and 25. Its CEO Tim Barker says many just need a few counselling sessions but the key is to respond fast.

We could do better, too, at hiring the many disabled people who want a job. Schemes such as the government’s Access to Work programme have been accused of being too bureaucratic for employers. The Treasury should pull every lever. Otherwise, long-term sickness will fatally undermine both the economy and people’s life chances.

camilla.cavendish@ft.com

This story originally appeared on: Financial Times - Author:Camilla Cavendish

You could fill Centre Court at Wimbledon with all the NHS strategies, plans, think-tank reports and independent reviews in the past 20 years (two written by me). The official plans — the Darzi plan of 2008, the NHS Five Year Forward View of 2014, the NHS Long Term Plan of 2019 — all envision similar things. A radical upgrade in public health to stop so many people getting sick. The integration of GPs, hospitals and community services because most patients are living with chronic conditions not a none-off injury. And more power and information for patients, in a world where genomics and AI will help pinpoint our individual risk.

Too little of this has happened, partly because of cuts and volatile budgeting; but also because of what Tony Blair once called “the forces of conservatism”. Over the years, I have watched dedicated GPs, consultants and nurses burn out in the struggle to improve things for patients, against the system. One GP spent years convincing his local hospital to let him have a clinic inside A&E, which was a huge success. When I sat on the board of the hospital regulator, we visited one hospital which had hired management consultants to game our inspection. Now, the British Medical Association is locked in a battle with NHS England to stop patients getting hold of their own electronic health records, although sharing data is critical to modernising the service. 

We all know that frontline staff are under extreme pressure. But it felt arrogant for the BMA to attack the recent demand, by shadow health secretary Wes Streeting, that GPs give face to face appointments to patients who want them. This, said the BMA, was “divisive and disappointing”. What is disappointing is that my own GP practice has called me several times to offer me a health check I don’t want, while refusing to give one of my kids an appointment.

The sheer scale of the crisis, the acknowledgment that our population is ageing and the return of reasonableness to the Labour party, means the NHS could finally be heading into a decade of steadiness which will let leaders plan ahead. Rishi Sunak’s government laid the ground last week, when it broke a longstanding Treasury taboo by announcing a long-term plan for the NHS workforce with thousands more doctors and nurses. But while that may improve morale, more inputs won’t automatically translate into better outcomes without good management. 

In pledging to increase frontline staff but not managers, health secretary Steve Barclay made a major mistake. The government is right that the service is drowning in bureaucracy. But it is wrong to equate bureaucracy with there being too many managers — academic studies tend to find that the NHS is undermanaged. The bureaucracy is largely the fault of the monstrous quangocracy which has been created by serial reorganisations. NHS staff are drowning in requests for information, many of them duplicative, from multiple agencies created by governments desperate to maintain their grip. 

Doctors resisted the introduction of non-clinical managers in the 1980s, and nurses still sometimes joke about “going to the dark side” if they take leadership positions. Managers are blamed for the piles of paperwork which take doctors away from patients, despite these being largely the consequence of national policies.

What is needed is a step-change in management, with better training, more trust and more autonomy. It’s hard to keep great leaders running complex services with the ludicrous constraints of annual budgets and the best performing services plundered to prop up the worst. But without more of them, the NHS will continue what General Sir Gordon Messenger, in a recent review, called “an organisational instinct to prioritise the needs of the system and its hierarchy over . . . better patient outcomes”. 

As directives and rules flow downwards from paranoid politicians, managers have become increasingly defensive. Staff surveys show endemic bullying, harassment and blame — but fear of lawsuits means performance appraisals are almost uniformly positive. Speaking to professionals about why they have left or are thinking of leaving the service, all cite pay but most are also deeply upset about the lack of respect from their own employers. Junior doctors are abused by patients and have nowhere to eat. Nurses work 12-hour shifts. 

One experienced NHS leader told me recently that he thinks the service is more risk-averse than those it treats. Most of us would like to die at home, according to surveys, but almost half of us still die in hospital. One in five women want to give birth at home; but only 2 per cent do. We over-medicalise, he said, but under-manage. 

Only a Labour government, it is often said, can radically improve the NHS because it is so much more trusted than the Conservatives. If Wes Streeting becomes health secretary, he has promised to put himself squarely on the side of patients. That is what Alan Milburn did under Blair — and patient outcomes improved.

Many of the NHS’s problems won’t be resolved by more committees, or a new charging system. They are classic management problems. The service’s future depends on resolving them.

camilla.cavendish@ft.com

This story originally appeared on: Financial Times - Author:Camilla Cavendish

They dwell among us, but we don’t see them. They are out of sight, warehoused behind the walls of care homes or in front of the TV. There are 55mn people in the world with dementia; almost a million in Britain. But we can’t bear to look.

This story originally appeared on: Financial Times - Author:Camilla Cavendish

This weekend, privacy campaigners are raging that NHS England has asked all hospital trusts to upload patient information on to what will become a central database. This has been described as a “land grab” by software companies which “throws up huge doubts” over the security of sensitive patient data, according to the Conservative MP David Davis. A group of activists and doctors are planning to sue the government to reveal more details. But the hysteria is misplaced: this is a long overdue attempt to give us all a version of my mother’s folder.

This story originally appeared on: Financial Times - Author:Camilla Cavendish

As the NHS collapses, hiring and training more care workers is probably the quickest and cheapest way to release hospital beds and help doctors tackle the waiting list. It could also avoid a dreadful self-fulfilling prophecy: the longer someone stays immobile on a ward, the more their muscles will deteriorate, and the less likely they are ever to be able to live independently again.

A few years ago, while writing a book about the ageing world, I visited several countries that seemed to have grasped a simple fact. The longer we can keep people independent and connected, the better their quality of life will be and the lower the burden on the health service. In the Netherlands, nurses who treat frail people at home also have a remit to build networks of friends and neighbours. In Australia, older people coming out of hospital receive up to 12 weeks of support to get back on their feet, including physiotherapy, counselling and social activities. These services share a far more ambitious vision than simply managing decline — which our cash-strapped system slides into.

This story originally appeared on: Financial Times - Author:Camilla Cavendish

When my own child trooped off to his fate at the keyboard, I asked the father which grade his son was taking. “Grade 1” he replied: beginner level. Whoa, I thought: this was a truly vertiginous level of helicopter parenting. But from “Twinkle Twinkle Little Star”, perhaps, he envisaged a career at Goldman Sachs would follow.

Raising three children in central London, I’ve seen my fair share of over-parenting: Dads screaming abuse on touchlines and Mums doing their kids’ homework. But this latest example upset me. Music is one of the greatest gifts you can give a child. For me, playing the piano has been a life-long form of therapy. But a music teacher tells me he sees many wealthy families push their kids as hard as possible to play instruments until they are about 14, at which point they abruptly switch focus to GCSEs. The ones with talent are devastated — the others have already been put off music for life.

This story originally appeared on: Financial Times - Author:Camilla Cavendish

I had a strange and privileged experience in 2020, as a temporary adviser to the Department of Health. Sitting in the dysfunctional centre of government, which had a vacuum where a prime minister should have been, I briefly witnessed a fragmented system come together to do what frontline staff thought was right for patients, liberated from some of the usual protocols. 

When Covid hit, dental hygienists, surgeons and physiotherapists retrained as ICU nurses. Care workers gave insulin injections and wrote death certificates. Even the BMA, that bastion of conservatism, had to drop its attempt to stop medical students looking after Covid patients. At one Zoom conference I attended, organised by a surgeon, hundreds of GPs and consultants said passionately that they no longer wanted to work in silos; that they were collaborating in new ways; that they had been liberated from HR jargon and form-filling. 

This story originally appeared on: Financial Times - Author:Camilla Cavendish

Has the pandemic flipped some kind of unique psychological switch in Britain? I’m starting to think so. As the Bank of England warns that our shrinking workforce could stoke inflation even in recession, the UK is looking ever more like an outlier. We were not the only country to emerge from the pandemic with lower employment rates than before — so did Iceland, Switzerland, Latvia and the US. But those four are bouncing back; we are not. By March, the Institute for Employment Studies predicts that we may be the only developed country with an employment rate lower than it was before Covid-19.

I’ve previously written about the increasing numbers citing long-term illness as a reason for stopping work, together with the NHS backlog. But that’s not the whole story. Fifty-five per cent of the increase in “missing” workers has come from those aged 50 to 64. Many are retiring early not because they are too sick to work but because they are sick of working. New polling finds this group expresses a greater dislike of their jobs than their German and US counterparts, and are more likely to say the pandemic has made them rethink. Moreover, they believe they can afford it. In the UK, 18 per cent of economically inactive 50- to 64-year-olds report having become better off as a result of the pandemic, compared with 8 per cent in the US and 4 per cent in Germany.

This story originally appeared on: Financial Times - Author:Camilla Cavendish

The Royal College of Nursing is demanding pay rises of 5 per cent above inflation, which the government can’t afford. But nor can the country afford inaction. Cancer backlogs have reached all-time highs. Poor health has become a brake on economic growth.

The NHS now feels like a vast sinking ship, with staff retiring early or jumping off in frustration, patients facing long waits, and leaders struggling to plug the holes. A vicious cycle of stress and feeling undervalued is leading GPs to become locums and nurses to turn to agency work. “We can’t see the cavalry coming over the hill,” a former RCN president, Dame Anne Marie Rafferty, tells me: “only a mountain of work.”

This story originally appeared on: Financial Times - Author:Camilla Cavendish

The political debate is focused on energy prices. But what will ultimately make or break the next prime minister is the dire state of the NHS. Whoever walks into Downing Street next week must focus on giving hope to the thinning frontline of staff who are the heroes of our time, but are losing faith.

Anyone who’s recently called an ambulance, waited for hours in A&E or dialled and redialled to get a GP appointment, knows how bad it is. With 6.7mn people — one in nine adults — waiting for treatment, we have soaring numbers going private.

This story originally appeared on: Financial Times - Author:Camilla Cavendish