What if Work is making us Sick?

 Sarah O'Connor in The FT 

Britain is sick. The number of people claiming disability benefits has doubled in a year. Working-age deaths (that did not involve Covid-19) are on the rise. As Andy Haldane, former chief economist of the Bank of England, put it in a speech recently: “For the first time, probably since the Industrial Revolution . . . health and wellbeing are in retreat”. 

The consequences for the country’s economy have been well chewed over. A rising share of people are now too unwell to work, which makes it harder to tame inflation and boost growth. Understandably, then, “How can we get people back to work?” is the question policymakers keep asking. But what if work itself is part of the problem? 

By many metrics, work is less dangerous to our health than it used to be, especially in a country like the UK where the manufacturing and mining sectors have shrunk so much. Musculoskeletal disorders, which used to be the biggest cause of work-related ill-health, have declined steadily over the past few decades. 

But while work has become less physically dangerous, it seems to have become more psychologically dangerous. Work-related stress, depression and anxiety began to rise about a decade ago. This surged during the pandemic and now accounts for half of all work-related illness. 

Why might that be? We know from government-sponsored survey data that there has been an intensification of work in recent decades across all types of jobs from delivery drivers to corporate lawyers. People are more likely now than in the 1990s to say they work fast and hard to tight deadlines. 

There has also been a drop in the level of control people have over how they work, particularly among lower-paid workers. Between 1992 and 2017, the share of low-paid workers who report that they have a say in decisions which affect their work fell from 44 per cent to 27 per cent, with particularly steep drops among hospitality and retail workers. 

Research shows the combination of high demands and low control at work — known in the academic literature as “job strain” — is bad for mental and physical health. One US study, which followed more than 52,000 working women over four years, found that job strain was associated with a greater increase in body mass index, for example. 

Last week, I interviewed a woman who works in a casino. She works on her feet for 10 hours from 6pm to 4am, gets home, grabs a few hours sleep, then gets up to take her daughter to school. People at the casino often suffer from relationship breakdowns because of the hours, she says. 

The work can be gruelling too. “It’s really mentally hard work sometimes, the hours are not helping us, sometimes [customers] come in drunk at 3am and you are so tired, and they are just swearing at you, so drunk you can’t handle them on the table but you have to do it because it’s your job.” 

Her employer used to do things to make the job easier to cope with, but they have all been stripped away. The free warm dinner is gone, as is the break that was long enough to eat it. The taxi home at 4am is gone. The Christmas bonus is gone. The night premium has gone. “Lately it’s very often happening that people are leaving because they are depressed,” she told me. 

Plenty of countries have experienced similar trends in the quality of work in certain sectors, so why might the UK be struggling more than most? 

Perhaps because the countervailing mechanisms that could protect workers from these trends — the “protective shield”, as Jennifer Dixon of the Health Foundation puts it — are particularly weak in Britain. The country is bad at enforcing its own labour laws, as the P&O debacle showed this year when the company sacked hundreds of sailors without any consultation in what lawyers call an “efficient breach” of employment law. Trade union membership has declined sharply in the private sector. The Health and Safety Executive’s budget has been cut. 

None of this is to say that work is entirely to blame for the nation’s worsening health. There are plenty of other possible causes, from processed foods to rising loneliness and social media, not to mention the pandemic itself and the strain on the NHS. 

But I don’t think any discussion of the country’s health is complete without a clear-eyed look at the reality of life in the UK labour market for those who don’t have decent jobs. Good quality work is beneficial for health. But if we just try to patch people up and push them back into jobs that were making them sick, we won’t get anywhere at all.

In excruciating pain. Unable to sleep. Yet John is still ‘fit for work’

Aditya Chakrabortty in The Guardian

 

Illustration: Andrzej Krauze


John’s world was torn apart on a Monday morning three weeks ago. First came a text message that read: “We will ring you within 2-3 hours to discuss the outcome of your work capability assessment.” Then the phone went. A “decision maker” at the Department for Work and Pensions told John he’d been judged fit for work – despite his extreme pain, despite all his doctors had said. One of the benefits he needed to live on – employment and support allowance – would stop immediately.

Maximus fit-for-work tests fail mental health patients, says doctor



You may have seen the new film I, Daniel Blake; John is living it. Just like Ken Loach’s character, he’s in his late 50s. He too is in no condition to hold down a full-time job, yet has been told by his own government that he must find work. His story tells you that the nightmare depicted by Loach and the scriptwriter Paul Laverty is neither fictional nor historical – but is being visited right now on our friends, our neighbours and us.

Just like Daniel Blake, John is slowly being crushed between the twin forces of a lumbering, unsympathetic, tick-box, brown-envelope bureaucracy, and a Tory government hellbent on slashing social security. The result is that a disabled man is today being forced to look for jobs that he can’t possibly do, purely to get benefits that won’t even keep a roof above his head.

John doesn’t want his full details made public. “A mauling by the rightwing press would be more than I could bear.” But he’s funny, good on Victorian novels and gentler than I would be in his position. His life has been shaped by an attack he suffered one evening in London 30 years ago. It left him in hospital for three months – and with major injuries to his leg, back and shoulder. They’ve got worse over the years, causing him to give up work about 15 years ago. He recently had a knee replacement; doctors are now contemplating a tricky operation on his spine.

He’s on Tramadol and other heavy-duty painkillers, yet even on the best of days he still has constant pins and needles. At other times, “it’s like someone is stamping on my spine in heavy hobnail boots and smashing nails into my feet and up my leg.” Even on sleeping pills, he hasn’t managed more than three hours a night for over 15 years.

This spring the government decided to test John’s capability for work. I’ve seen the forms myself: in his best exam-boy handwriting, John answers the questions with an almost painful trustingness. No exaggeration, no flinching from admitting that he sometimes wets himself. When it came to assessment day, he took along a local councillor, Denise Jones. At the testing centre run by Maximus – the outsourced provider of assessments – he faced the usual robotic questions about whether he could lift an empty box.

Then came the physical examination. The table was so high John can’t believe he managed to climb on it; Jones says he did, just. Both say the effort cost him visible struggle and pain – and both recall that the “healthcare professional” said she didn’t want to examine him. But the report stripping John of his ESA says it was he who “declined examination”.

That’s not the only discrepancy. The report talks of “lower back pain” – nothing about the legs or feet. It claims he can stay in one place for an hour – no mention of John’s need to move every 10-15 minutes. Other details that John and Jones remember coming up – the hours it takes him just to stretch out in the morning; his habit of falling over; the fact his pain is constant – are simply missing. Jones says in puzzlement: “The report looks like it was just cut and paste.”

I put these and several other detailed points to the DWP last week, but was advised on Monday that John’s was now a “historic claim”. Maximus would need to write to the DWP, then await the details to be posted back – a process that could take about a week. “A giant bureaucracy,” the Maximus spokesman said. If that’s how the head of communications for the company at the centre of this bureaucracy sees things, what hope for the likes of John?

I received instead a “generic response”, which states in part: “We will look into the issues raised in this particular case. All of our healthcare professionals – doctors, nurses and physiotherapists – are fully qualified with a minimum of two years’ postgraduate experience and they receive ongoing training.”

None of this helps John, but it’s not meant to. While awaiting the “reconsideration” of his claim, he’s been to the jobcentre and signed a declaration that he can work for 40 hours a week and commute 90 minutes each way. Both claims are a lie – the stupid, necessary lies John must now tell to get money. Perhaps he should have lied like that in the first place, rather than getting into debt just to keep going. This is for a man who doesn’t drink, doesn’t smoke and hasn’t been to the cinema in two years.

His “coach” has lined him up for computer training and a course on how to do a CV. John doesn’t need either, but then this Kafka-meets-IDS bureaucracy in which Britons hand cash to private companies to frustrate other Britons isn’t about what anyone wants or needs. It has more in common with a correctional process – complete with nonsense tasks, the aggressive emphasis on procedure, and the disregard for people. There is only the occasional pinprick of humanity, like the DWP official who at the end of one phone call thanked John “for not shouting at me”.

John’s story is part of a much bigger national process, in which austerity Britain is narrowing down who deserves to live here. On the reject pile go “shirkers”, “benefit tourists” (however many they are), refugees fleeing the bombs of Syria who look insufficiently childlike. And disabled people who, according to the Centre for Welfare Reform, have been hit nine times harder by the Tories’ cuts than has any other group.

Loach’s film ends in defiance. “When you lose your self-respect you’re done for,” says Daniel Blake. But I wonder what it takes to keep your self-respect in a system intent on dehumanising you. I met a couple earlier this year; the husband faced a cut to his disability benefits. Paul Chapman remembered what he’d told his wife, Lisa: “The best thing we can do now is … I’ll clear off and I won’t take my tablets. And it’ll be over then. I won’t be here.” All for the sake of £49 a week.

Denise Jones can see how knackered John is, how often he wells up. “In three weeks, he’s collapsed,” she says. John knows it too. “I don’t want anybody to know how bad this is,” he tells me. “I don’t want anybody to see me so weak. I just feel beaten.” Not for the last time that morning, he breaks down crying.

Denise worked all her life. Then she got ill – and the state pulled away the safety net

Frances Ryan in The Guardian

The Conservatives like to sell the public a promise: do “the right thing” – work hard, look after your family, pay your taxes – and in tough times, the welfare state will be there for you. But here’s a snapshot of what could happen to any one of us if bad luck hit. Denise, has been a nurse for the best part of 30 years, but since she became too ill to work, she’s been left to live without sickness benefits for five months and counting.

Denise, now 48, trained as a mental health nurse straight out of school and tells me she has worked all her life. It wasn’t easy. In her mid twenties she was diagnosed with bipolar disorder, and by her thirties, as she raised a young son in Leicester, she developed fibromyalgia. With it came pain and exhaustion: each joint hurt to move, and for months she needed a wheelchair and hospital car to see a specialist. “At times, I actually crawled on my hands and knees to attempt to make us a meal,” she says.

Over the next 15 years, Denise did what many with long-term illnesses will be all too familiar with: she pushed herself to keep working – going part-time to try to manage her bipolar, pain and fatigue. When things were at their worst (in 2011, she had major surgery on her spine), she lived off the out-of-work sickness benefit, employment and support allowance.

Last winter, again, Denise tried to work. After being on ESA for almost three years, she felt well enough to move to Bristol to be near her partner and take a job nursing in a women’s secure hospital. But after eight weeks, the impact of the work on her mental health was too much (“helping pregnant women with psychiatric problems … it was very emotional,” she says) and she had to give it up. She got by on company sick pay – half her wage – for three months, but by April she was earning nothing at all.

Ask most politicians and this is exactly when they’d say the safety net would kick in. But when Denise contacted the Department for Work and Pensions to say she’d had to leave her job, she was told she was no longer eligible for out-of-sickness benefits – despite receiving them only four months earlier. Because she’d been off the benefit for more than 12 weeks, in the mire of DWP rules, technically Denise was making a “new claim”, judged on a different tax year – meaning the DWP could now rule her as not having enough national insurance points to get the benefit.

Worse, Denise was told she wasn’t eligible for the alternative either – the type of ESA based on income, rather than NI contributions. Why? Because she was now living with her boyfriend.

In another rarely publicised DWP rule, if a sick or disabled person shares a home with a partner, the fact that their partner earns a wage can be used to rule them out of sickness benefits (the income threshold varies). When I contacted the DWP, it confirmed: “Claims for ESA are assessed against a number of circumstances including living arrangements, income and national insurance contributions.”

That means that people like Denise – who the government are fully aware are too unwell to work – are effectively shut out from social security.

“I put my trust in the DWP,” Denise says. “I wouldn’t have taken a job if I’d known there wasn’t a safety net if I became ill again.”

Since April, with no sickness benefit, Denise’s only income has been her disability living allowance – which she needs to pay for the extra costs that come with bad health. As she puts it: “It’s meant to pay for taxis [to hospital], not bills and food.” But even that’s been cut now: when the government abolished DLA and transferred her to personal independence payments in May, she lost part of her benefit. Now she’s living off just £82.30 a week. “It’s horrific,” she says, and she’s becoming withdrawn and isolated.


When an employer won’t hire you and the state won’t help you, to be sick or disabled simply means having no income

Her partner has a decent wage as a transport contractor – fine for one but not easy to stretch for two – and besides, she says, it’s “awful” when he’s forced to pay for everything. “It’s not like we’re married. We don’t have a joint bank account,” she says. “I don’t like having to say, ‘can I have a money for a haircut, or for tampons?’”

As an insight into just what sick and disabled people are up against, Denise has been trying to find a nursing job this summer – one with less stress – but when she told an employer about her bipolar disorder, a medical report judged her as unfit for work and the job offer was withdrawn. She’s been “scrabbling together” information from the mental health charity Mind to know her rights, and has put in a request to see if the employer will accept changes such as shorter shifts – but if it refuses, she has no way of paying the legal fees to take it to court.

When an employer won’t hire you and the state won’t help you, to be sick or disabled in Britain simply means having no income. Denise has adapted over the years to living on very little – “because I’ve had to”, she explains – but things have never been this bad.

“For anyone to go through this when they’re already ill … just to live, you really think at times like this you’re going to be protected by the government. But you’re not.”

Osborne needn’t say sorry – after all his Budget was just a suggestion

Mark Steel in The Independent

There’s no need for George Osborne to say sorry for trying to cut money to the disabled: he says it was a genuine mistake, and he couldn’t possibly know that cutting money to the disabled would lead to the disabled being poorer in any way.

How could anyone have predicted that taking away money for carers who get people dressed and take them to the toilet might have worried anyone at all? Is he supposed to be psychic? There was every chance these measures would have been welcomed by the disabled. They’d have been free to mess on the floor instead of fussing about going backwards and forwards to a toilet, leaving plenty of time to pursue other leisure activities such as go-karting.

We all make mistakes. Some of us put cardboard packaging in the wrong recycling box. And some of us try to take £4 billion off the disabled. We can’t say sorry for everything can we? In any case, Osborne’s explained the reason for these cuts is to build a strong economy, and there’s no greater sign of a strong economy that someone with spina bifida laying in their pyjamas for three years because we’ve made redundant the carer that used to get them dressed. And, to be fair, there was an element of genius about his Budget. Because up until last week, it was believed to be impossible to come up with benefit cuts so appalling that Iain Duncan Smith would oppose them. Osborne should receive the credit due for overturning such a natural law. 

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The buck should stop with the PM for his immoral cuts

He probably announced his intention in a gentleman’s club, declaring over a bottle of port: “Gentlemen, I hereby declare I have discovered cuts so gargantuan, so magnificently despicable, I contend the fellow Duncan- Smith shall scream with fury at their injustice.” Then the others must have stood upright and bellowed “Preposterous, Sir. Such cuts are not possible within the known universe. To discover such reductions would confound the very essence of mathematics, you are a fool, Sir.”

And they had a point, because Duncan Smith was dedicated to cutting benefits. When he got home from his job of cutting benefits, he used to cut more benefits in his spare time for fun. His wife would knock on the shed door on a Sunday afternoon, saying “Come and have a rest, dear, you’ve been in here since six this morning”, and he’d reply, “I won’t be long, I’m just working out how to make people in a coma attend job interviews.” And he went berserk about Osborne’s cuts.

So instead of saying sorry, the Chancellor must have expected to ride into the House of Commons on a white horse while his MPs begged him to touch them in the belief it will make them taller and live forever.

His problem was the reaction from everyone else as well as Duncan Smith. The Conservatives seem to believe their own newspapers and assume they have no opposition, so they can do whatever they like, as most people will think ‘“I don’t mind that the Tories have stopped my disabled aunt going to the toilet, because at least their leader sings the National Anthem’”.

David Cameron must be encouraged in this belief by the way that, whenever Jeremy Corbyn is speaking in Parliament, his own Labour MPs sit behind him sneering and flicking through Viz magazine or doing the puzzles in Take- a- Break. You expect them to start making humming noises and flicking paper clips at his head while he’s responding to a statement about Syria.

But on this issue, so many people were furious that the Government had to abandon huge chunks of their plans, and Nicky Morgan adopted the imaginative line that the entire Budget was “just a suggestion.”

This is certainly a modern touch; to deliver a Budget – a 90-minute, precisely written detailed speech, pieced together for months and concerning exact plans for every aspect of the economy – and then say “But hey, that’s just a suggestion.” Next year, the Budget speech will start: “OK let’s all get in a circle and go round saying our names, then we can break up into workshops and write down some ideas on what we think should be spent on what stuff, then come together for feedback after lunch.”

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Osborne repeatedly refuses to apologise for disability cuts

In some ways he’s already gone further than that, because now he’s been forced to abandon his plans, his figures are four billion pounds out. But he says that doesn’t matter as he’s on course to meet his target anyway. So he didn’t even need to make the cuts, he just fancied doing it anyway. Maybe he thought it’s not fair the disabled get all this disability money every single year, we should let other groups have it for a change; people who keep tropical fish, perhaps.

Combined with all his targets he gets nowhere near keeping, it suggests he sees numbers as an unnecessary distraction. In his Autumn Statement he’ll tell us: “It does appear that when I was working out the country’s money, I multiplied when I should have divided so we’ll have to sell the Navy, but hey ho, the important thing is if you ignore the figures we are stronger and sounder than ever before.”

It’s possible that what forced the Conservatives to change their plans for the economy, for the second time in a few months, is a vast, if not always visible, opposition. And however chaotic Labour may appear, at least under Jeremy Corbyn they now oppose the cuts.

Or maybe Osborne is honest, and as he said, this episode proves he listens. Similarly, if the police catch a burglar robbing a house, and the burglar then agrees to put back the stuff he tried to nick, this proves the burglar listens, and we should in no way expect him to say sorry.