Brexit and the waning days of the United Kingdom

[Sheilbh]

Wouldn't the GP (or whatever specialist) be in a better position to give you a sick note, if we talk about normal illnesses? Esp. if they know you personally?

Over here sick notes are handled that way. Though if you're on long term sick leave, after a few months (2? 3?) the insurance might ask you to see one of their doctors for verification. And if you apply for disability, there's rigorous examinations, obviously.

It is largely about disability:
https://www.theguardian.com/politics/2024/apr/19/sunak-disability-benefit-curbs-sicknote-culture-pip

Practically speaking given that a lot of the rise in disability has been for mental health reasons, and this didn't announce any new support for NHS mental health services, I suspect it's going to shift decisions to less qualified people with a Department of Work and Pensions checklist. I agree with a lot of the criticism in that article, especially as the last 14 years of benefits reform have been pretty disastrous, including for the disabled.

But also it's one of the big differences with a lot of European systems, that we don't have an insurance model at all. It's universal benefits administered by the state that are (relatively) low on their own but cumulatively, depending on eligibility, about average (although a lot of that reflects the housing situation/costs) - but, which is a big difference, have no link to your previous work/salary and there is no insurer. You are entitled or not and if you are, then you can claim them for ever and they don't change.

There is something going on in the UK labour market which is a bit of a mystery at the minute though. This speech prompted the BBC's Ben Chu to post about it - which totally undermined everything I'd understood about it My understanding was that there's been a sharp increase in disability claims basically since the pandemic - and my assumption was that it was probably long covid. That an impact of covid were these syndromes that we didn't really understand and weren't yet able to treat that affected people in different ways, some short of breath, some brain fog etc.

Turns out that there has been a sharp upturn which is still growing - as the Guardian article notes one element of disability benefit is projected to increase by 50% in the next 4-5 years and the overall disability benefit cost is now higher than the schools budget. But Sunak's point, which has been repeated by others, is that this is a cause of a wider issue of rising "economic inactivity" in the UK economy. It's also been thought this might be part of Britain's productivity issue.

That last bit doesn't seem to be true. Zooming out the level of working age "economic inactivity" as measured by the ONS isn't particularly high. It's not at record highs or anything like that, it's about the level it was at in 2015. Similarly in international comparisons of economic inactivity the UK is where it's normally been in a bunch with France, Germany, Canada and Japan.

Part of it might be that this is an area where the old method of statistics pre-pandemic doesn't work in a post-pandemic with a significant chunk of WFH workers economy. So the numbers on disability benefits and the costs are increasing. The number of workers registered and paying tax are also increasing. So there's now a gap between the ONS' Labour Force Survey and the ONS' Workforce Jobs Survey (based on actual tax etc data):


So I think there is probably an ill health issue in the British economy (I'd suggest solving that by treating more people not making the process of getting benefits while you wait for treatment more humiliating). But I think that's often tied, not just by Tories, to a wider issue of economic inactivity - which might just be bad statistics. So the end result wouldn't be that you'd actually boosted the economy, you would just have added cruelty to the process of obtaining disability benefit.

[crazy canuck]

Something similar here.  Employers don't bother with "sick notes" for short term illnesses anymore.  And most employers provide disability benefits through third party insurers.  So it is the insurer seeking medical confirmation of an entitlement to the disability benefit that occurs now.

[Barrister]

Do I understand this article correctly, that Sunak thinks that "health specialists" instead of GPs should issue sick notes, because he thinks they're too generous with writing people as unfit to work?

https://www.bbc.com/news/uk-politics-68853166

So I can't speak for the UK and NHS.

But there is generally a notion here in North America that GPs will often see themselves more as an advocate for their patient, and not as some kind of gate-keeper.  So if a patient attends a doctor's office and says they're, I dunno, having crippling diarrhea , the doctor will just write a note accordingly and not try to question or doubt their own patient.

I actually had to speak for a colleague in court today to get an adjournment - he said he was sick, unable to attend court for the trial.  Probably because we're professionals though no one would have thought to question his claim, and certainly wouldn't have asked for a doctor's note.

I hate to acknowledge a certain other poster, but he is correct here.  There's a difference between short term sick leave, and long-term disability, and LTD is much more where the employer is going to ask for an independent, third party assessment.

[Barrister]

Never got the obsession with sick time. Either you get one person perhaps slacking, or you chance getting more people in the office sick. Second outcome seems worse to me. And besides, if someone is slacking then chances they're doing more wrong than just calling in sick and are underperforming so you fire them... we'll, from a NA perspective I guess, don't know how easy it is to fire someone over yonder.

So I'm Canadian (shocking news!), and not living in an "at will" US state.

But something I've seen several times is someone goes on sick leave, perhaps several times.  Employer waits until that person comes back to work.  Employer then fires the employee "without cause" - which means they aren't trying to justify the firing as warranted.  As such the employee gets full notice period pay.  Employee however then can't complain they were fired because they were sick - because the employer admitted they didn't have grounds for a "with cause" termination.

["with cause" = "we caught you stealing - get out immediately, no severance" vs "without cause" = "it's just not working out, here's your severance.  No we don't want to say why it isn't working out"]

[Sheilbh]

If you have some form of income protection insurance (typically a standard benefit in white collar jobs - and more like European style welfare systems) then you will get asked by the insurer.

I've never had to get a sicknote for work from a GP. I did have an extended period off work due to an injury once and I was set up with a call from my company's appointed third party medical assessor. They ran through the inury and were actually far stricter than I was intending to be. It was a physical injury but I could dial in and WFH but they were quite strict on amount of time off then coming back for a period of weeks at no more than 4 hours a day etc.

Having said that my experience of GPs would not be that they are advocates rather than gatekeepers And a GP's receptionist is the fiercest gatekeeper of them all.

Although, as I say, I think the objection I'd have to Sunak's point isn't the sicknote (altough under Labour these were re-branded as "fit notes" which doesn't appear to have stuck ) but the measures that seem aimed at trying to force people receiving disabiliity benefit back into work (not by offering treatment, but brow-beating and benefits sanctions).

Never got the obsession with sick time. Either you get one person perhaps slacking, or you chance getting more people in the office sick. Second outcome seems worse to me. And besides, if someone is slacking then chances they're doing more wrong than just calling in sick and are underperforming so you fire them... we'll, from a NA perspective I guess, don't know how easy it is to fire someone over yonder.

Very difficult to fire people in most jobs. And that would be an immediate unfair dismissal claim at the tribunal.

[Barrister]

Having said that my experience of GPs would not be that they are advocates rather than gatekeepers And a GP's receptionist is the fiercest gatekeeper of them all.

So again all Canadian experience.  YMMV.

Yes, doctors are quite strict about getting access to the doctor.  But once you get in to see them they're paid the same whether it's 2 minutes or 20 minutes.  So whatever gets you out of there quicker is what they'll often go with.  If you're asking for a sick note, the quickest response is to write a sick note - it would take much more time to investigate, ask a bunch of questions, and challenge whether you're really sick.

But yes that doesn't mean your GP is going to go to bat and make a bunch of phone calls or whatever on your behalf.

(My wife works as a medical assistant for three doctors - one GP, one surgeon (who has to do surgical consults), and I forget what the third one does.  They're lovely people, but you can definitely see the failings in the system from her stories)

[HVC]

Never got the obsession with sick time. Either you get one person perhaps slacking, or you chance getting more people in the office sick. Second outcome seems worse to me. And besides, if someone is slacking then chances they're doing more wrong than just calling in sick and are underperforming so you fire them... we'll, from a NA perspective I guess, don't know how easy it is to fire someone over yonder.

Very difficult to fire people in most jobs. And that would be an immediate unfair dismissal claim at the tribunal.

Make it easier to fire people, problem solved!

Kidding... mostly some of the worse employees I've had the privilege of working with were union employees. They knew it was hard to impossible to get rid of them. I hated working with the union in disciplinary actions. Some I ended up getting rid of (well, the call to fire was their managers but somehow I had to deal with the union ) when they fuck up bad enough.

[garbon]

Having said that my experience of GPs would not be that they are advocates rather than gatekeepers And a GP's receptionist is the fiercest gatekeeper of them all.

So again all Canadian experience.  YMMV.

Yes, doctors are quite strict about getting access to the doctor.  But once you get in to see them they're paid the same whether it's 2 minutes or 20 minutes.  So whatever gets you out of there quicker is what they'll often go with.  If you're asking for a sick note, the quickest response is to write a sick note - it would take much more time to investigate, ask a bunch of questions, and challenge whether you're really sick.

But yes that doesn't mean your GP is going to go to bat and make a bunch of phone calls or whatever on your behalf.

(My wife works as a medical assistant for three doctors - one GP, one surgeon (who has to do surgical consults), and I forget what the third one does.  They're lovely people, but you can definitely see the failings in the system from her stories)

Yeah as Sheilbh said, here in the UK very different. GPs are 99% gatekeepers, 1% patient advocates. I've never even seen the same GP twice.

[Josquius]

I think that depends on your GP.
It does seem more and more common they are merging into bigger and bigger organisations where you see a different one every time.
But when I was younger I only ever saw 2 GPs, a married couple who shared their practice with iirc another 2 who had their own patients.
I know some of these smaller GPs do still exist. Though probably more in smaller towns.

But yes. For sure there's a large gate keeper element. They have flow charts to go through. It's like a shitty game, figuring out what answer to give at different times to pass through without getting too far from reality.

[Sheilbh]

Yeah so I don't think I've seen the same GP twice since I was a kid.

I believe on the merging that a big issue is that a lot of younger GPs don't really want to be partners now so the old GP model is struggling a bit. It's why I think Streeting's ideas on GPs surgeries sound sensible to me.

FWIW I suspect there's probably something fairly similar with high street solicitors etc. They're still around but, and I could be wrong, there's fewer people who want all the stress of setting up or running a small-ish practice.

[Josquius]

In other news seems there was a random fascist march in London today about.... Something? Not clear what.

[Sheilbh]

It was St George's Day wankers. Tommy Robinson and Laurence Fox holding a rally for about 200 supporters from what I saw.

There will also be the bigger official celebration by the Mayor at the weekend.

Edit: Also on that and following up from Duncan Robinson's excellent Englishness piece from this time last year - I thought this was interesting given the discourse over the same period:

[Richard Hakluyt]

Interesting results which I find counterintuitive 

The British state has hardly covered itself in glory in recent years.

Perhaps a shared hatred of the tories is bringing the country together 

[The Brain]

What was the 2012 identity crisis about?