Intended for healthcare professionals


Britain’s not working

BMJ 2022; 378 doi: (Published 29 July 2022) Cite this as: BMJ 2022;378:o1883
  1. Martin McKee, professor of European public health1,
  2. Lucinda Hiam, PhD candidate2
  1. 1Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
  2. 2School of Geography and the Environment, University of Oxford, Oxford, UK

Healing the sick, not cutting taxes, must be the priority

In his final speeches as prime minister, Boris Johnson listed seemingly endless achievements. Prominent among them was the claim that more people are in work now than before the pandemic. Yet any employers listening may have struggled to reconcile that with their frantic search for people to harvest crops, serve in hotels and restaurants, provide health and social care, and ensure that transport hubs can operate. Front page pictures in newspapers of long queues at airports and crops rotting in fields painted a different picture.

The explanation for this apparent paradox was simple. The prime minister’s claim, like so many he has made, was false. The independent fact checking organisation Full Fact provided the true figures in April 2022: the workforce actually had 600 000 fewer workers than before the pandemic. Full Fact noted with disappointment that Johnson had, by then, made this claim nine times in parliament without correcting the record.1 Yet despite formal complaints from official statisticians,23 he remains undeterred in his conviction that the workforce has expanded.

Although the situation may have changed since the “partygate” revelations, large sections of the British public continue to forgive Johnson’s casual approach to facts.4 We are repeatedly, if wrongly, told, “he got all the big calls right.”5 He has skilfully created a narrative in which the UK mounted a world beating response to the pandemic, controlling the spread of infections while saving jobs and livelihoods. However, John Burn-Murdoch, from the Financial Times, has provided a new analysis that suggests otherwise.6 In an article that begins by invoking Tsar Nicholas I, who is reported to have described the Ottoman Empire as the “sick man of Europe,” Burn-Murdoch suggests that those words could now apply to the UK.

Alarm bells

Although this may seem a remarkable claim, Burn-Murdoch’s detailed analysis easily justifies it. During the pandemic, all industrialised countries saw people of working ages leave the workforce. Some fell ill, some left to care for relatives, and others reassessed their work-life balance and took early retirement. But what should set the alarm bells ringing in Westminster is that all of the 38 countries examined have now returned to their pre-pandemic trend except one, the UK, where the situation is still deteriorating.

What can explain this? Burn-Murdoch notes that two in three of those who are missing from the workforce cite long term illness as the reason. It is likely some of this is because of covid-19. The Office for National Statistics estimates that over 800 000 people have had symptoms of long covid for over a year.7 and the Institute for Fiscal Studies estimates that about 110 000 are unable to work as a result.8 But as Burn-Murdoch notes, this cannot explain the UK’s exceptional situation. Spain, which was similarly hard hit during the pandemic, now has fewer people outside the workforce than before the pandemic. Rather, he points to the long term health problems in the UK. Before the pandemic, we showed how the health of the population in the UK was falling ever further behind that in otherwise comparable nations.9 The situation is now even worse.10

While it is almost certain that at least some of this reflects failings in policies affecting the wider determinants of health,11 Burn-Murdoch argues that “where other countries’ healthcare systems are proving resilient, the UK’s is on its knees.” He notes that the numbers missing from the workforce with long term sickness are similar to those waiting over a year for treatment and points to growing problems accessing all types of care.

Economic growth depends on health

Both candidates for the Conservative leadership, and thus the next prime minister, have identified the need to promote economic growth. Both favour tax cuts, differing only on their timing. Neither can offer a plausible explanation for how their policies would achieve the growth that is needed, although at least Rishi Sunak accepts that there is a crisis in the NHS. However, as the NHS Confederation notes, he has yet to provide any realistic plan to solve the problems he identifies.12 Liz Truss’s proposals offer even less, with proposals for the economy widely viewed as in the realms of fantasy.1314

Those who are unencumbered by the need to appeal to a small number of party members who are unrepresentative of the wider population can see that labour shortages are one of the main barriers to economic recovery.15 Of course, the problem is not only ill health. Brexit has also contributed, as have long term underinvestment in skills and infrastructure16 and over a decade of austerity. But at least something could be done about health and, now we know that the UK is a complete outlier internationally, the media should be asking both candidates what they will do to grow a healthy, skilled, and productive workforce on every possible occasion until they provide an answer.


  • Competing interests: We have read and understood BMJ policy on declaration of interests and declare that MM is a member of Independent SAGE and is president of the BMA, but he writes in a purely personal capacity.

  • Provenance and peer review: Commissioned; not externally peer reviewed.