A prominent government official has strongly criticized the United Kingdom's 'fit note' system, asserting that it is "insane" for young individuals to be signed off work for conditions like ADHD following a brief general practitioner appointment. Alan Milburn, a former health secretary and current head of an independent government review into young people and work, stated that the system, intended to facilitate a return to employment, is instead "ruining the life chances" of younger generations.
These remarks come amidst a significant increase in mental health issues since the pandemic, which has led to 2.8 million working-age individuals being absent from their jobs due to long-term sickness. This figure represents over one-fifth of the working-age population and incurs billions in lost economic output and welfare payments annually, according to official data. "The fit note system is just bl***y insane," Milburn commented, explaining that receiving a fit note can lead individuals into the welfare system and onto health and disability benefits. He noted the "stickiness" of this process, with a substantial chance of remaining on disability benefits for many years.
Milburn made these observations during a recent visit to the Netherlands, a country where the proportion of young people not in education, employment, or training (NEET) is less than five percent, compared to 13.6 percent in the UK. The surge in mental health problems, particularly among younger adults, has been alarming. Data indicates that 26 percent of individuals aged 16 to 29 experience significant symptoms of depression. In 2023, one in five children aged eight to 16 had a probable mental disorder, an increase from one in six in 2020. Last year, over 11.2 million fit notes were issued in England, a rise of nearly 300,000 from the previous year. Approximately one-third of those issued fit notes are absent for four weeks or longer, with 20 percent of this group never returning to work. The likelihood of returning to the workplace diminishes significantly after six months of absence, with 80 percent not returning.
Milburn, formerly a Labour Cabinet Minister, emphasized that having a condition or diagnosis should not automatically preclude an individual from working. He questioned the societal notion that self-identification or diagnosis of a condition necessitates withdrawal from the labor market. Sir Gareth Southgate, former England manager, who accompanied Milburn on a trip to the Netherlands, echoed these concerns. He expressed caution about labeling young people, as it can limit their aspirations and have lasting repercussions. Southgate highlighted that many young individuals with ADHD and autism, when provided with alternative educational approaches, are thriving and possess valuable qualities that should not be overlooked.
The UK government is under considerable pressure to manage its benefits expenditure, which is projected to reach £400 billion annually by 2040. Fit notes, also known as sick notes, are issued when an individual is deemed unfit to work after being absent for more than seven consecutive days. A range of healthcare professionals, including doctors, nurses, pharmacists, physiotherapists, and GPs, can issue these notes, informing employers about an individual's inability to work or the need for workplace adjustments. However, reports indicate that a significant number of GPs have admitted to never denying a mental health-related sick note. The Office for Budget Responsibility forecasts a 49 percent increase in spending on incapacity and disability benefits, reaching £90.9 billion between 2023/24 and 2028/29. A think-tank, Policy Exchange, has proposed making mandatory referrals for individuals signed off with a mental or behavioral disorder for over 14 days. As of May last year, an estimated 2.5 million people in England were living with ADHD, including approximately 741,000 children and young people aged five to 24. ADHD is a neurodevelopmental disorder affecting concentration, impulse control, and activity levels, with common symptoms including restlessness, distractibility, forgetfulness, and difficulty with time management. A spokesperson for the Department for Work and Pensions stated that the government acknowledges the need to reform the fit note system to better serve patients, employers, and the health system, and is currently testing new approaches as part of a broader plan to increase employment. 
