When Sarah started her stint as a Department of Work and Pensions (DWP) sickness benefit assessor, she arrived with a wealth of medical experience. A former Army nurse, she had served in Afghanistan and treated enough soldiers to know what serious distress – physical and psychological – looks like.
In her new job, though, she had no opportunity to meet anyone face to face. She would be paid to assess over the phone whether someone qualified for sickness benefit.
It wasn’t long before she saw a pattern: she had been given a list of questions to ask claimants and a guide to where their responses would place them on the benefits scale.
Those she spoke to often seemed to know the answers – verbatim – that she was told to look for.
‘I went on Google and straight away I found the criteria,’ she told me. ‘All the words [claimants needed] to say to essentially get a full benefit.’
I asked her if she thinks those about to go through an assessment will be doing the same: finding out the phrase that pays.
‘Absolutely,’ she replied. ‘Sadly, my opinion is that not everyone who is claiming is quite telling the truth.’
Following Sarah’s advice, I went online and soon came across so-called ‘sickfluencers’, who help their millions of followers on YouTube and TikTok to maximise their benefits.
TikTok ‘sickfluencer’ Liz Jones, known as the ‘PIP angel’, offers PDF guides to her 67,000 followers, with ‘example answers for depression’ that applicants can copy
TikToker Liz Jones, known as the ‘PIP angel’, offers PDF guides for applying to her 67,000 followers, with ‘example answers for depression’ that applicants can copy. Comment threads online on Reddit and Facebook are also full of advice.
‘When filling out the form, speak as if you’re having the worst day your disability can throw at you,’ says one. ‘I did that without exaggerating or lying about anything – and received LCWRA [Limited Capability for Work and Work-Related Activity] without even being asked for an interview.’
The sickfluencers, many of whom suffer from long-term sickness and disability themselves, lay out the questions assessors might ask to see if the claimant really is as sick as they say.
They advise on key words and phrases that might be used in answers, such as ‘distress’. ‘And to make it even more effective you can put ‘psychological’ in front of it,’ said one.
The sickfluencers say they are helping disabled people navigate the complex benefits system. The official advice is baffling: their advice is clear. Perhaps too clear.
Over the past 14 years, the approval rate for sickness benefits has more than doubled – to 80 per cent. With more than 15,000 people a week approved for long-term sickness and disability payments, it is clear something is out of control.
To be fair to them, many people do need help negotiating the official world of benefits – a maze addled with acronyms that many genuinely vulnerable people are plunged into every day.
Sarah is employed by the Department of Work and Pensions (DWP). She judges whether people require sickness benefit
But whereas assessor and claimants used to meet, giving both an opportunity to discuss a claimant’s needs, during lockdown the sit-down interview for sickness benefit gave way to a phone call. And that has never quite changed.
The number of sickness benefits approvals has risen from more than 1,000 before the pandemic to a peak of more than 3,000 a working day in March, according to official figures analysed by the team working on a Dispatches documentary I recently made with Channel 4. The figures include the extension or renewal of existing claims.
Instead of a need for medical evidence, or advice from an occupational health specialist, there’s now a set list of questions.
And people know what assessors are looking for – sickfluencers aside, guidance is published online by the DWP itself. It’s no surprise that people are comparing notes on a system that’s wide open to abuse.
Sarah told me there are certain buzzwords many people use to ensure they receive maximum benefits. ‘If at any point someone said they were suicidal every day, it’s straight away in that high [payment category],’ she said.
‘It’s down to the integrity of the person.’ She said she deals with plenty of credible claimants. ‘It’s really frustrating to me because there are actually people that I chat to who are having those thoughts. You really feel for those people who are going through it.’
This wasn’t the first time I had heard about the sickfluencers. Some time ago, a government minister told me exactly the same thing: that if you say you’re suicidal, you get a straight award of full sickness benefits.
What struck me was that the minister – whose department ran the system – felt unable to change it. The DWP is too big. The UK sickness benefit system is now governing the lives of 3.3 million people: more than the adult population of Croatia.
A poster on TikTok promoting ‘key words’ to increase odds of sickness benefit assessors voting in favour of applicants
The assessments are handled by private companies under contracts that are hard to change. It may be tempting to see sickfluencers as the problem, aiding and abetting a mass defrauding of the taxpayer.
But it’s a symptom of the real scandal: a shoddy system, horribly unequal to the task of assessing the sick and disabled.
The ‘skivers versus strivers’ trope is not just a cliche; it gets the welfare system entirely wrong – as I found out when I took a close look at the benefits system for my programme.
What I found was horrifying: a sickness benefit assessment process that is, in effect, a down-the-line telephone questionnaire – with pitifully little required in the way of medical evidence – that ultimately traps people in a web of benefits they find hard to escape.
Carrying out assessments on the phone should be cost-effective, but it’s a strange kind of cheapness, because the bill for all sickness, disability and associated benefits across all ages is soon expected to top £100billion, due to the surging caseload.
When you consider the waste of human potential – 2.3 million claiming five years ago, forecast to rise to 4.1 million by the next election – it’s even worse.
The real scandal is how many people are not given the help they need but are instead shovelled off into the fringes of society, ignored even when they’re better and want to work.
They followed the rules, made no effort to mislead – yet still end up trapped by a system supposed to help them. Part of the problem is the speed of assessments. The system encourages assessors to cut corners.
Another former assessor I spoke to, Michael Houston, found very quickly that his job was not to help claimants as best he could, but process as many claims as he could.
Desperate to get off benefits is taxi driver Gavin, who had heart surgery three years ago
‘People were encouraged to do six cases a day,’ he told me. ‘And if you did any more than that, you would get £80 per case. If the claimant met the highest category [of sickness benefit], then the assessment could be curtailed early. This would allow them to fit in more cases per day.’
So some assessors are incentivised to complete cases running into double figures – that means at least an extra £320 a day.
But how easy is it for people like Michael to assess, over the phone, whether someone really is too anxious or depressed to work?
‘Not very,’ he said. ‘Which is one of the things that, ethically and morally, I didn’t really feel comfortable with.’
I spoke to another assessor, still serving, who confirmed that the bonus system is still in place.
‘What strikes me about this job is how few people I speak to are genuinely too sick to work,’ she said. She’s not talking about perfectly healthy people scamming the system. She means those people who do need support being plunged into the ‘too sick to work’ category – which she thinks may do them more harm than good.
‘Most people will want support to manage their mental health condition,’ she said. ‘But feel they can’t get that on the NHS so they apply for benefits.’
She added that she’s been struck by how many young people she is having to pass off as too sick to work. Some 190,000 under-25s are in this category. But the fastest rising age group is the 25 to 34-year-olds: more than 515,000 of them, up 65 per cent in the last five years.
With more than 15,000 people a week approved for long-term sickness and disability payments, Fraser Nelson says it is clear something is out of control
‘We sign them off – we have to under the guidelines – but you have to wonder what we’re doing to them,’ she told me.
‘I can understand the alcoholics in their late-50s, but I can’t understand the young people in their 20s.’
And what of the alcoholics? In my film I met Anthony, who says he drank several cans before showing up to fill in the paperwork. He’ll get the money.
But will he get the help he needs? I looked up the figures for alcohol-related deaths: they had been stable for two decades, but started to surge, along with sickness benefits, five years ago. The UK, incidentally, is the only major country to report such a surge. It seems to be a very British disease.
In Manchester I met Michael, who had been on sickness benefits for two years and was living in a hostel. He was tired of it, although he pointed out that he was getting more on benefits than those working in his hostel were earning. He had difficulties with mental health, but his treatment went well and he’s keen to try work again.
He had a decent strategy: to train as a plasterer, a well-paying job with a big skills shortage. He had secured a place on the course and the film crew went there to meet him: we hoped this would be the good news story. But he didn’t show up. We filmed him telling others at Loaves and Fishes, a community group, what had happened.
‘When I contacted the JobCentre, they said because you’re on Capability For Work, you would lose your benefits.’
He was dismayed. Plastering is classed as working and he would lose all his benefits. His escape had been thwarted.
This advice, by the way, is not quite correct. He’s allowed to train – but would be at risk of reassessment and losing his benefits.
I only know this because the documentary crew had access to researchers and former advisers – it would often take us several days to understand the system. It made me wonder what hope there is for Michael, or others like him. They need formal advisers: occupational health specialists, or back-to-work advisers specialising in those with sickness support.
Expensive? Perhaps. But not as expensive as writing off another 800,000 people, which is the current plan.
The most astonishing interview in the film is with Gavin, a taxi driver, who needed sickness benefit as he recovered from heart surgery. Applying for it was a nightmare, he said. But the operation was a success, he recovered – so he contacted the DWP to say he was ready to come off it. It was three weeks before he had a response.
‘I was told they couldn’t change it themselves. They couldn’t alter my award claim,’ he told me.
‘I had to wait until I was reassessed, which I felt was pretty peculiar.’ When would that be? He wasn’t told: he’d just have to wait.
That was almost three years ago – and Gavin has given up contacting them. He’s still driving his taxi part-time, which the sickness benefit system allows. I asked him what the financial situation is, compared to working full-time with no benefit.
‘I’m probably working half the hours for the same money,’ he said. So does he have any financial incentive to give up his benefits? ‘None at all.’
I asked him why, in that case, he was ready to go on television; his answer summed up the whole story: ‘I wanted to highlight how bad things are.
‘This is really important. When you need this help at your lowest ill health – and when you’re at your worst – you can’t get it. You have to wait through it. And then when you don’t need it – or you feel life’s much better – they won’t stop giving it to you.’
The good news? It comes from Barnsley Council which commissioned a report over the summer trying to find out where its workers have gone. Seven in ten of those classed as economically inactive would like to take a job, it found, if it aligned with their skills and circumstances.
If applied nationally, it said, this would mean 4.5 million more potential workers – a massive pool of unused talent. If they joined the workforce, Britain would be supercharged with the fastest economic growth in the developed world.
So yes, the sickness benefit is a crisis – but fixing it is, by some margin, the biggest opportunity Keir Starmer has in front of him.
Get it wrong, and it could bankrupt the country. Get it right, and Britain’s economy could be renewed and transformed.
Reforming welfare always has been the hardest job in politics. But this time, it really can’t wait.
Fraser Nelson is a columnist at the Daily Telegraph. His film, Britain’s Benefits Scandal: Dispatches, is available to stream on Channel 4.
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