Sick notes: What are the rules Rishi Sunak wants to change?

Rishi Sunak speaking in central London on welfare reform. He is calling for an end to the “sick note culture” (Yui Mok/PA Wire)
Rishi Sunak speaking in central London on welfare reform. He is calling for an end to the “sick note culture” (Yui Mok/PA Wire)

Rishi Sunak has pledged to end what he called “sick note culture” in an attempt to reform the welfare system.

“If you are feeling anxious or depressed, then of course you should get the support and treatment you need to manage your condition. But that doesn't mean we should assume you can't engage in work,” Sunak told an audience at the Centre for Social Justice in London in a speech on welfare reforms.

"That's not going to help you. And it's not fair on everyone else either. So we are going to tighten up the work capability assessment," he added.

The prime minister said welfare benefits in the United Kingdom had become a "lifestyle choice" for some, causing a ever-increasing welfare bill for the country. Since Covid the number of people out of work due to long-term sickness has risen significantly, reaching highs of 2.8 million in February.

According to the government, recent NHS data showed almost 11 million fit notes were issued last year. Many were repeat fit notes “issued without any advice, resulting in a missed opportunity to help people get the appropriate support they may need to remain in work”.

Health charities and unions have criticised the speech.

“We are deeply disappointed that the Prime Minister's speech today continues a trend in recent rhetoric which conjures up the image of a ‘mental health culture’ that has ‘gone too far’,” the chief executive of mental health charity Mind, Dr Sarah Hughes, said.

“This is harmful, inaccurate and contrary to the reality for people up and down the country. The truth is that mental health services are at breaking point following years of underinvestment with many people getting increasingly unwell while they wait to receive support (…) It is insulting to the 1.9 million people on a waiting list to get mental health support, and to the GPs whose expert judgement is being called into question.”

But what are the rules Sunak Rishi Sunak is pledging to change? 


The prime minister pledged reforms, suggesting that individuals with mental health conditions receiving personal independence payments (PIP) may be offered treatment instead of benefits in future.

PIPs are designed to help claimants deal with the extra costs of living with a long term disability.

Mr Sunak also suggested greater medical evidence could be required to substantiate a claim for PIP.

Benefit fraud

He also detailed plans for new rules to treat benefits fraudsters in the same way as tax fraud to stop them exploiting “the natural compassion and generosity of the British people”.

‘Specialised work and health support’

In addition to this, he said that the government is designing “a new system where people have easy and rapid access to specialised work and health support to help them back to work from the very first Fit Note conversation”.

GP responsibility

“We’re also going to test shifting the responsibility for assessment from GPs and giving it to specialist work and health professionals who have the dedicated time to provide an objective assessment of someone’s ability to work and the tailored support they need to do so,” he added.