What can the former John Lewis boss tell us about ‘sick note Britain’?

Charlie Mayfield, former chair of the John Lewis Partnership, has produced an eye-catching report warning of an “economic inactivity crisis” that threatens Britain’s prosperity.

The Mayfield Review into “fit note Britain” – commissioned by the government – is now contributing to the wider debate on social security and the numbers of people reliant on state benefits for long-term sickness and disability. It is a controversial and still not fully researched field…

It’s a big one. A remarkable one in five working-age adults in Britain are now out of the labour force for health reasons– 800,000 more than in 2019. The cost of ill-health that prevents work equates to 7 per cent of GDP, an amount that would be more than sufficient to plug Rachel Reeves’ Budget shortfall.

Employment among people with disabilities stands at 53 per cent, worse than many comparable nations. For those in jobs, employers lose £85bn a year from sickness, turnover and lost productivity.

It’s a huge and hugely complex area, but factors include: post-pandemic impacts on the mental health of young people, and long Covid; increased awareness of mental health conditions and possible (hotly disputed) “over-diagnosis” of anxiety; cultural issues, real and supposed; and a trend towards people generally living longer but sometimes in poorer health. Behind all that lie factors such as poverty, the housing crisis, diet and educational and employment opportunities, or lack of them.

His review concentrates on what might be termed the “HR aspects” of the issue: what employers can do to help their employees who suffer ill-health and keep them productive, to mutual advantage.

In particular, he recommends another reform of what are now called “fit notes” but which were once known as “sick notes”. The idea behind the change in name was to flip the judgment from whether someone is ill towards whether they can work, and to determine what they are capable of with the right support.

Mayfield suggests the second part of that assessment should be taken away from GPs, who are poorly placed to assess what’s needed for every workplace. Instead, he suggests a “non-clinical case management service supporting employees and line managers”. Notes, he concludes, can make for an artificial “firewall” between workers and employers. Others, more broadly, have criticised the increasing scale and role of HR departments.

Employment tribunals – and employers’ fear of them – are also factors weakening the links between staff and employers, actually making it harder for there to be direct and constructive communications about a return to work and how it can be facilitated. (New employment rights granted from day one of a job might exacerbate this further).

A number of “vanguard” companies have been recruited to trial the Mayfield recommendations. These include British Airways, Google, Sainsbury’s and Holland & Barrett, alongside Mayoral Combined Authorities and some SMEs. The government calls them "early adopters who will develop and refine workplace health approaches over the next three years to build the evidence base for what works”.

Probably not, because much larger demographic, economic and cultural forces are in play, but it will help.

Mayfield, a boss himself, takes a rather hard line on this: “‘I hate my boss’ is not a health condition. It may be something you feel very strongly about; you could say it is an example of victimhood in the work context. It may be that your boss is hateful, in which case something should be done about that. But it may also be that there is a message being sent to you which says you need to think about what you are doing and take on board the uncomfortable truth that there is something you need to improve.”

Fairly sterile. Politicians on the right claim that welfare benefits such as Personal Independence Payment are being granted to some people with only mild problems associated with the rough and tumble of life – and Mayfield tends to agree. Those further to the left are more inclined to see rising benefit claims as a function of more awareness of mental health and of an ageing, more stressed society in which taxes have to be set accordingly.

A problem is a lack of reliable hard evidence about “over-diagnosis” of mental health problems. More work is required to help settle that matter.