Intended for healthcare professionals


The UK doesn’t have a “sick note culture,” but it does have a broken benefits system

BMJ 2024; 385 doi: (Published 10 May 2024) Cite this as: BMJ 2024;385:q1067
  1. James Taylor, executive director of strategy, impact, and social change
  1. Scope

The government needs to stop demonising disabled people and tackle the barriers that prevent them from accessing work, says James Taylor

The government claims it’s planning to tackle the rise in economic inactivity in the UK by cracking down on Britain’s “sick note culture.”1 But for charities like Scope, who support disabled people to find suitable jobs, this assessment is entirely and infuriatingly off the mark. A “sick note” culture simply doesn’t exist.

Around a million disabled people in the UK want to work, but are unable to because of a number of barriers, such as discrimination from employers, difficulty getting the right support they need, and inflexible working practices.2

All that the government’s damaging rhetoric will achieve is to make life harder for the UK’s 16 million disabled people.3 An extremely worrying report from the United Nations Committee on the Rights of Persons with Disabilities recently found that the government’s welfare reforms are “premised on a notion that disabled people are undeserving and wilfully avoiding employment,” which has “resulted in hate speech and hostility towards disabled people.”4

If the government is serious about wanting to “help” more disabled people into work, why is it also quietly scrapping the Work and Health Programme,5 the one national programme that offers employment support for disabled people? Two smaller programmes, WorkWell and Universal Support, are going to be rolled out in its place, but both of these are delayed and far less ambitious in the number of people they intend to support. The government should be creating targeted employment support that helps disabled people who want to work to find a job that is fulfilling and accommodating of their needs.

Tailored, voluntary employment support is a crucial part of helping more disabled people into work, however, it’s only one of the barriers that prevent disabled people from gaining access to job opportunities.

Workplace discrimination

Firstly, employers’ negative attitudes towards disabled people is a major hurdle. We know from our helpline services that many disabled people are pushed out of jobs because they can’t get the flexibility they need. We’ve heard from people who’ve had job offers taken away after they told their employer they were disabled. One neurodivergent person was made to leave their job after asking if they could move their desk to allow them to concentrate better. Other disabled people who’ve contacted us have described how they weren’t allowed by their employers to use assistive technology, such as screen readers, to help with administrative tasks.

Secondly, it’s far too difficult and takes too long to get the right support from the Access to Work scheme, which is meant to help disabled people to gain or stay in employment—for example, by providing financial support for practical equipment or assistive software. There are huge backlogs for the scheme, with reports that 25 063 people were waiting for a decision on their claim in December 2023.6

These delays can mean that disabled people have to work without these adjustments. We’ve also heard from people who’ve had to leave their jobs after a few months because Access to Work was too slow to come through. The scheme is nowhere near flexible enough, there aren’t enough staff to deal with the high number of claims, and many employers have never heard of it.

The government is also seeking to reduce eligibility for personal independence payments (PIP).7 This payment helps cover the extra costs disabled people face, such as needing to use taxis because public transport isn’t accessible, needing specialist equipment such as electric wheelchairs and bed hoists, or needing to use more energy for heating because their condition makes it much harder to regulate their body temperature. An analysis by Scope found that these extra costs add up to £975 a month, even after PIP is taken into account.8

Crucially, PIP is not means tested. Some disabled people rely on PIP to pay for the support or equipment they need in order to work, such as an adapted vehicle so they can drive to work. The fact that living costs are so much higher for disabled people means the cost of living crisis has been particularly devastating for them. Our helpline at Scope has been inundated with calls from people rationing how much they use their wheelchairs because they can’t afford to charge them, using candles instead of switching on the lights, and going without food for days. The stress of navigating a financially precarious situation has detrimental effects on disabled people’s physical and mental health.

Whoever forms the next government needs to listen to disabled people about what needs to change. The next government needs to ditch damaging, lazy narratives that demonise disabled people and tackle the genuine barriers that prevent disabled people from accessing work.

It’s important that disabled people who want to work have access to the tools they need to have a fulfilling career. But the government needs to acknowledge that not all disabled people are able to work. Pinning the blame for the growing number of “economically inactive” people on disabled people who aren’t in employment is a convenient excuse. The real problems the next government needs to tackle are the extra costs of disability that current state services fail to cover, the discriminatory attitudes of employers that disadvantage disabled people in the workplace, and the broken benefits system. Only by confronting these failures can they create an equal future for all of us.


  • Competing interests: None declared.

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