Signed off sick: the parts of Britain that are not working

Yet Britain isn’t working, and the Labour party is going to find it extremely difficult to live up to the virtue embodied in its name. The problem is, to use a medical term, acute:

• More than 9 million people in the UK are classified as economically inactive – the most concerning part of this large cohort is the number of people signed off sick.
• “Economically inactive” is not a measure of unemployment. The Labour Force Survey of February 2025, conducted by the ONS Office for National Statistics, put unemployment at 4.4%, which is too high, but much lower than the post-crisis peak of more than 8% in 2011. Unemployment at that rate means 1.57 million people do not have a job.
• The additional 9.22 million people classified as economically inactive make up more than a fifth of the country’s potential workforce.

Not all of this is alarming. More than a quarter of those classified as inactive are students and more than a tenth are retired. Neither group would exactly rejoice at being described as “inactive” – although some students might be.

There are also plenty of people caring for others. More than a quarter of all inactive women, and 6% of men, are at home or caring for elderly relatives or children, or both.

There are also plenty of people caring for others. More than a quarter of all inactive women, and 6% of men, are at home or caring for elderly relatives or children, or both.

The core of the problem, then, lies somewhere else. Specifically, this is not about inactivity as such; it is about sickness. Of the 9.2 million people classed as economically inactive, 30% are signed off as sick. Soon after taking office, the Starmer government commissioned Sir Charlie Mayfield to investigate the problem. Mayfield reported in March 2025 and found:

• There are 800,000 more people of working age signed off sick today than in 2019.
• Growth in the long-term sick is 10 times faster than the growth in the working-age population.

The largest group of sick people are the over-50s with muscular problems. We are living in the era of bad backs. So were our grandparents and parents, but theirs were caused by heavy lifting while ours are caused by leaning over devices. The real story is the growth in mental health conditions, autism and learning difficulties among 16- to 34-year-olds.

The causes remain unclear, and the search for answers continues.

The health and social care secretary, Wes Streeting, recently supported one school of thought: diagnosis has become too easy. In the 1980s, doctors, thinking themselves compassionate, signed off working men on to incapacity benefits after the collapse of the steelworks and coalmines, assuming they would never return to work. Those good intentions had disastrous consequences and this may be happening again.

Or the cause could be modern life – most conspicuously our relationship to new technologies. Either way, it is imperative to get people back to work. If the current trend were to continue to 2030, it would put another £25 billion on the welfare bill.

The Mayfield Report’s recommendations will not be published until the autumn, but the options are limited. The evidence shows that the longer someone is out of work, the lower their chances of returning. Yet the British welfare state waits too long before it intervenes – just as the likelihood of success begins to recede.

The private sector could also do more to prevent workers going sick in the first place. Better workplace health support and investment in rapid return-to-work schemes would insure them against longer-term absences. Some programmes now offer treatment within a week. The occupational therapy that follows aims to put the employee back in work within a month.

In December 2024, Britain’s inactivity rate was below the average in the G7 and much below Italy, where an extraordinary 33.7% of the country is classed as inactive. But it is a serious problem all the same, all the more so when regional variation is taken into account.

Under the previous Conservative government, the Department for Work and Pensions produced a league table of inactivity. Clackmannanshire was the most inactive place, with 17.4% of the population so classified.

The rest of the top 10, in order, are Blackpool, Neath Port Talbot, North Ayrshire, Merthyr Tydfil, North Lanarkshire, Bolton, South Tyneside, Torfaen and Knowsley.

There is considerable overlap between this list and the six places with the most people who are on long-term sickness benefits: Blackpool, Neath Port Talbot, North Ayrshire, North Lanarkshire, Bolton and South Tyneside.

The critical point about the geography of British sickness is how politically charged it is.

This is an unusually political administration in the sense that it has yet to pass control from its electoral strategists to its policymakers. It is still running policy as if the only function of government is to be re-elected. This is a flaw that the government will have to fix or else face the consequences, but worklessness is an issue where the two come clearly and constantly together.

There is a set of parliamentary seats, mostly in the north of England, that went from Labour to Conservative in 2019 via the vote to leave the European Union in 2016 and which have now returned, briefly perhaps, to the Labour fold. They are all being targeted loudly by Nigel Farage, and Labour’s political strategy is excessively focused on them. There are seats in Wales that are liable to fall to Reform. These are all the places where Britain is signed off sick and where Britain needs more labour.