The British government is planning to give weight-loss injections to obese people so they can be taken off sickness benefits and obliged to work. This remarkable scenario, like something from a science fiction comedy, was set out on Monday morning by health secretary Wes Streeting and prime minister Keir Starmer. Speaking outside Downing Street, Starmer said the plan was “very important for the economy” and “very important for the NHS because . . . we’ve got to think differently.”
That choice of words was revealing.
The drug the government wants to trial is Mounjaro, made by US multinational Eli Lilly. The company will help run a five-year research project on its impact on health, NHS costs and success at returning people to work.
Starmer spent the rest of Monday hosting an international investment summit, a landmark event for his government’s economic strategy. Speaking just before the summit, Eli Lilly’s chief executive, David Ricks, said Brexit had made the UK “a relatively small market for most multinationals – and certainly Americans. So something needs to be quite different from make it interesting”. Asked by the BBC what that might entail, he said the UK could become an “incubator” for studying medical breakthroughs “in the real world” – in other words, a place to conduct large-scale drug trials.
This slightly dystopian experiment with the NHS is also part of a larger vision for the welfare system, where cash payments will be replaced with “tailored assistance”. Drastic action is considered essential as soaring numbers of people on disability benefits are holding back productivity and growth, threatening the UK’s hopes of economic recovery. A review of disability benefits, started by the previous Conservative administration, has been allowed to continue along with regional pilot programmes to help the long-term sick find employment. In April, Streeting’s Tory predecessor said claimants with stress or anxiety should be offered counselling, respite or social care packages instead of benefits.
It is difficult to see how changes of this magnitude would not trigger another welfare reform crisis
When Labour was elected in July, it brought back its former health minister Alan Milburn as an adviser on health and welfare reform. He presented a report later that month, alongside the work and pensions secretary Liz Kendall, saying that 70 per cent of the long-term sick should return to work, through benefit sanctions if necessary. He denounced the existing system as “crazy”. On Tuesday, it was reported that Milburn will be appointed to a key role running the health department.
All of this is a looming calamity for Stormont.
Social security is fully devolved to Northern Ireland, a unique circumstance within the UK. However, London pays the bill separately to Stormont’s budget as long as benefits are the same as in Britain. If Stormont wants to be more generous, it has to pay the extra cost itself. If it wanted to be less generous, it could negotiate with London to keep the savings, although this has never occurred.
In 2012, the UK government introduced a new welfare system known as universal credit. Because this reduced payments to some claimants, Sinn Féin boycotted the executive for three years. What became known as the welfare reform crisis was resolved with Stormont agreeing to mitigate some of the changes, a deal that still costs it £45 million a year. What Labour is now suggesting is in a different league. Northern Ireland’s annual disability benefits bill is £2.4 billion, including benefits paid to people in work. If London stopped 70 per cent of it, Stormont would have to spend over a tenth of its budget to plug the gap.
Stress, anxiety and depression are the primary factors in a quarter of disability claims. If Stormont wanted to mitigate that, it would cost £500 million a year.
This slightly dystopian experiment with the NHS is also part of a larger vision for the welfare system, where cash payments will be replaced with `tailored assistance’
It is difficult to see how changes of this magnitude would not trigger another welfare reform crisis. Mitigating them is financially impossible; equally, implementing them is politically impossible. The DUP reluctantly accepted universal credit but would baulk at sweeping disability benefit cuts. While this would avoid a split with Sinn Féin, a budget stand-off with London would still bring executive business to a halt.
The irony is that nowhere stands to gain more than Northern Ireland from tackling long-term illness. It is the principal reason the region has the highest economic inactivity rate in the UK, hammering its productivity and growth. It is also the main reason why public services cost more to deliver than in England, according to the “needs-based” method of calculating devolved budgets. Northern Ireland has full employment and a booming private sector, so it is plausible that jobs could be found for people coming off benefits.
The policy might even be popular with much of the public: there is widespread cynicism about the welfare system. But with 15 per cent of the population on long-term sickness benefits, it is simply not plausible that Stormont could cope with anything like what Labour is proposing.