British politics has long had an unhealthy obsession with sick notes. The issue, however, has truly come to a head in 2026. This week, the BBC reported that hundreds of GPs have never denied their patients sick notes for mental illness, and highlighted that mental health has become the single most commonly cited reason people give when requesting to be signed off from work.
Yet, perhaps more worrying is how some GPs do refuse to issue sick notes for mental illness, and how others admit to signing patients off but not for as long as they want. The tone is one of striking reluctance, as if there’s an epidemic of shirkers cynically using spurious mental health claims to sit around at home on the government’s dime.
Of course, the numbers are undoubtedly shocking: almost a million Brits asked for time off work last year due to mental illness. A million.
And this isn’t the first time this year that Britain’s “sick note culture” has been under fire. Just weeks ago, the Centre for Social Justice argued that the NHS is “driving Britain’s worklessness crisis” and has become a kind of gateway drug to benefits dependency. According to their report, we are irresponsibly enabling a lost generation of dependents, many of whom could go back to work if only we were simply to stop granting them the time off.
Yet while the public conversation is dominated by those lamenting the rise in requests, the burden on GPs and the impact on the wider economy remains seriously underexploded. The current debate is generating more heat than light: while the arguments rage, we are failing to reckon with the real cause of our nation’s poor mental health, the true silent killer in our midst: politics.
Worse still, attempts to diagnose why we’re experiencing this problem in the first place continue to fall pitifully short. Spoiler: it has nothing to do with who writes the notes.
As I argue in my book, Understanding Health, Illness and Society, people do not fall sick in a vacuum. Illness and recovery can take place only within the confines of our health and social care systems. The support and funding we provide for different conditions, the laws we enact (or don’t), directly influence how quickly someone might be able to recover and return to work – and these are all political decisions. Individual and population health cannot be separated out from these “political determinants” of health.
Let me explain further. Ever since the 2010 coalition government, politicians in this country have dedicated too little time and attention to the mental health services that people depend on to get better. Much of the blame can firmly be laid at the door of George Osborne. His austerity drive, now proven to have caused excess ill health and deaths, resulted in budgets going into freefall: over the period, mental health funding was reduced by an astonishing 73 per cent.
The downstream effects of these catastrophic decisions therefore should hardly come as a surprise. While it’s true that almost a million people were signed off work for mental illness last year, the overlooked piece of the puzzle is that 1.66 million were stuck on waiting lists for mental health services.
The problem is systemic: as the category of illness that takes up 20 per cent of the overall burden of disease shouldered by the NHS, mental health receives only 10 per cent of allocated funding. It shouldn’t take a BBC or think tank report to work out what’s going wrong here.
When a government makes the political decision to defund, and even close down, mental health services, the avenues people can take to return to work will inevitably retreat from view, and become nothing more than poorly maintained, unsigned footpaths.
But if politics is the disease, then what’s the cure?
The Centre for Social Justice may have overlooked the problem’s root cause, but they’re right about one thing: the solution has to come as a cross-party consensus to rebuild the routes back into work.
We know, from the halcyon New Labour days, that when our government spends more on health and social care services, Brits are healthier – and healthy people like to work. From 2000-2010, Labour doubled spending on health and social care services, significantly outstripping the funding that was allocated by their political predecessors. The sector received a transformative 6 per cent of public spending until the coalition and Conservative governments slashed it to just 1 per cent.
The results speak for themselves. In the early 2000s, waiting lists were shorter, the quality of support dramatically improved, and services were more accessible, meaning people were able to return to work in a timely manner. To this day, the New Labour approach remains a shining example of how politics can, in fact, shape health for the better.
Health and social care services don’t just decline on their own – politicians do, unfortunately, make them decline. But they don’t have to. If we want a healthier, working society, with strong mental health, then we desperately need to put aside political squabbling and revalue the services that can get people back to work.