U.K. Prime Minister Rishi Sunak Sparks Debate Over Plan to End ‘Sick Note Culture’

U.K. Prime Minister Rishi Sunak called for an end to Britain’s “sick note culture” in a speech on Friday morning.

Sunak made the announcement when discussing U.K. welfare reform, touching on how many people are being signed off work by doctors’ notes known locally as “fit notes.” He also set out plans to reduce the number of people turning to sick leave if the Conservative party is re-elected in the upcoming general election, which has to take place no later than Jan. 28, 2025. 

In a speech at the Centre for Social Justice in London, Sunak said there’s a "growing number of people who've become economically inactive," citing figures that have risen to 850,000 since the pandemic due to long term sickness. Sunak said “fully half” of these individuals say they have depression and anxiety. 

He has described his plan to reform the welfare system as a “moral mission,” adding the welfare state should help people back into work.

"I will never dismiss or downplay the illnesses people have," Sunak said, before adding that it would be wrong to accept the current "growing trend” of people using sick leave. He added that he believes “good work” improves mental and physical health and warned against the risk of “over medicalising” everyday hardship.  

A record high number of 2.8 million people are out of work as of February, according to the Office for National Statistics. NHS data showed that almost 11 million fit notes were issued last year in England, with 94% of those signed "not fit for work."

Sunak also said that the British taxpayer provides the safety net of welfare services and that the number of people unable to work is not “economically sustainable.” Sunak said the U.K. government spends £69 billion on benefits for people of working age with disabilities and health 

conditions, a figure he said exceeds schooling, transport, and policing budgets. 

“We don’t just need to change the sick note, we need to change the sick note culture so the default becomes what work you can do—not what you can’t,” he said. “I worry very much about benefits becoming a lifestyle choice.”

Rishi Sunak’s proposal for welfare reform

In his speech, Sunak said that if the Tories are re-elected, they will be “more ambitious” when assessing people’s potential to work and ensure employers make reasonable adjustments for employees.

He said the government will trial a system where "specialist work and health professionals" determine if a person requires a fit note, rather than doctors. His reform plan will require anyone working less than half the hours of a full-time work week to seek additional hours of work in return for benefits.

Sunak also said that anyone failing to comply with conditions outlined by a work coach, or accepting an available job, will lose their claim and have their welfare benefits “removed entirely.” 

He added that the government will crack down on fraud in the welfare system, and take a "more objective and rigorous approach" to Personal Independence Payments for those with mental ill health. 

How are experts reacting to Rishi Sunak’s welfare reform plans?

Sunak’s proposal invited swift criticism from medical bodies and professionals. Dr. Katie Bramall-Stainer, chair of General Practitioners Committee England, the British Medical Association’s GP committee, said fit notes are “carefully considered” before they are issued, the Guardian reported citing PA Media. 

“We do recognise the health benefits of good work, and that most people do want to work, but when they are unwell, people need access to prompt care. With a waiting list of 7.5 million—not including for mental health problems—delays to diagnostics, and resulting pressures on GP practices, patients cannot get the treatment they need to be able to return to work,” Bramall-Stainer said. 

“So rather than pushing a hostile rhetoric on ‘sick note culture,’ perhaps the Prime Minister should focus on removing what is stopping patients from receiving the physical and mental healthcare they need, which in turn prevents them from going back to work.”

Meanwhile, James Taylor, the director of strategy at disability equality charity Scope, described Sunak’s speech as “a full scale assault on disabled people.” 

In a series of posts shared on X, formerly Twitter, Taylor said: “Welfare is not 'lifestyle' choice. Supporting people who are long-term sick or [have a] disability financially, removing the threat of sanctions, and investing in public services is a choice. Think today the government is making the wrong choice.”

Taylor added that the charity has observed the inverse, with sick people returning to work too soon. “If [the government] is serious about economic inactivity then focus on building trust and voluntary support,” he argued.

How are politicians responding to Rishi Sunak’s welfare reforms?

Labour’s shadow housing minister Matthew Pennycook accused Rishi Sunak of seeking a “cheap headline” with his speech on sick note culture in an interview with Sky News. He said Britain’s National Health Service has been “on its knees after 14 years of Conservative government” leaving many on long-term sickness unable to get the treatment they need. 

“This announcement screams to me a government that, after 14 years, are out of ideas and out of time,” Pennycook said. “We’ve got to bring NHS waiting lists down. We got to do more on mental health support. We’ve also got to reform social security. We’ve got to make job centers work, provide people with real support, and make work pay.”

Meanwhile, Ed Davey, leader of the Liberal Democrats party said Sunak’s plans marked “a desperate speech from a Prime Minister mired in sleaze and scandal,” the Guardian reported per PA Media. He added that Sunak is “attempting to blame the British people for his own government’s failures on the economy and the NHS, and it simply won’t wash.”