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Stef Benstead @stefbenstead.bsky.social · 17/07/2026

That's good to hear, because I've not heard any politician suggest that their aim is for people to still receive income support whilst getting prompt therapy. All the talk is about *swapping* income and therapy, not simply ensuring the NHS is funded to provide timely therapy.

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Stef Benstead @stefbenstead.bsky.social · 17/07/2026

That level of fraud & deception seems very unlikely, given that the outcome is so uncertain. To lie repeatedly to a GP, weekly IAPT, and fortnightly jobcentre meetings all whilst on poverty income just in the hope that you might get a bit more money later does not seem realistic.

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Stef Benstead @stefbenstead.bsky.social · 17/07/2026

This is why I'm saying that, in order to receive PIP for a non-existent mental illness, you need to have invested time in a) being unemployed, b) engaging with your GP and c) engaging with talking therapies, all whilst lying consistently to JobCentre, GP, and IAPT over months.

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Stef Benstead @stefbenstead.bsky.social · 17/07/2026

No, you need to show to the assessor that you have severe and enduring mental illness if you're going to receive PIP for mental illness. To show that it's severe and enduring, you need to have a medical history that can be provided to the DWP to corroborate your account.

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Stef Benstead @stefbenstead.bsky.social · 17/07/2026

Talking therapies for severe and enduring mental illness requires months of intervention. What do you propose these people live off whilst they receive this therapy? Bear in mind, if it's not severe and enduring MI, the person already isn't going to qualify for PIP.

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Stef Benstead @stefbenstead.bsky.social · 16/07/2026

If criteria for PIP were laughably easy, such that receipt rates are double what they'd be in any other European country, the UK's overall spending on health-related benefits would be substantially higher than that of other European countries. It wouldn't be substantially less.

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Stef Benstead @stefbenstead.bsky.social · 16/07/2026

"Across the OECD (a club of rich countries), spending on working-age health-related benefits averaged 1.6% of GDP in 2019 (latest data). At that point, UK spending was considerably below that level, at 1.3% of GDP." From: Health-related benefit claims post-pandemic, IFS 2024

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Stef Benstead @stefbenstead.bsky.social · 13/07/2026

The Timms Interim Report says that "society’s understanding of disability has shifted since PIP was introduced and the benefit has not changed to reflect this context." I'd love to see evidence of why society's understanding of disability has shifted, and in exactly what way.

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Stef Benstead @stefbenstead.bsky.social · 11/07/2026

The Timms Review will consider: - why the PIP application process is experienced as so negative; - how to support those who are less confident in navigating the system, to ensure equitable outcomes; - training of health professionals; - how assessments are delivered; - appeals.

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Stef Benstead @stefbenstead.bsky.social · 11/07/2026

In one paragraph, the Timms Interim Report says, "Some people on PIP may be scared to work, volunteer or do physical activity as this could be seen as evidence that their functional ability has improved." In the very next paragraph, PIP is used to support those activities.

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Stef Benstead @stefbenstead.bsky.social · 11/07/2026

The Timms Interim Report says, "The aim is for disabled people’s lived and living experience and expertise to meaningfully influence the Review’s direction, its interpretation of evidence, its final recommendations, and ultimately the future of government policy."

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Stef Benstead @stefbenstead.bsky.social · 10/07/2026

The interim report says that "PIP is not doing what it was originally designed to." This is because it "is often filling the gap that arises between other services or support", and "it is often used for basic ‘survival’ rather than being dedicated to the extra costs of living."

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Stef Benstead @stefbenstead.bsky.social · 10/07/2026

There are some comments in the Timms Interim Report which I'm not sure I agree with, regarding the way that PIP was developed. I'd need to go back and check publications and commentary from the time, or perhaps someone here can share their memories of the creation of PIP.

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Stef Benstead @stefbenstead.bsky.social · 10/07/2026

I find it interesting that the govt is using the phrase 'long-term health condition or disability'. It's a tricky choice, because 'disability' can evoke images of the traditional, static disabilities, and so leave readers unaware that chronic illness can be disabling.

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Stef Benstead @stefbenstead.bsky.social · 10/07/2026

"We are committed to making changes so that PIP can fulfil its purpose... Doing so will require us to be radical in our thinking and bold in our recommendations for reform." Again, the govt has indicated that it does not intend to spend the amount of money that this would mean.

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Stef Benstead @stefbenstead.bsky.social · 10/07/2026

"We agree a clearer emphasis on supporting independent living and participation in society, for example through volunteering, work, and cultural and social activities, would strengthen the aim of PIP". But that would be very expensive, and govt doesn't want to spend that much.

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Stef Benstead @stefbenstead.bsky.social · 10/07/2026

The Review recognises this when it says, "Our work as a steering group to date has identified deep-rooted problem in both the design and delivery of PIP... the challenges identified are systemic, rather than individual or case-specific."

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Stef Benstead @stefbenstead.bsky.social · 10/07/2026

The Review says, "Our evidence so far tells us that while PIP is widely valued as a benefit, it is no longer fit for purpose." I'd suggest that PIP has never been fit for purpose. I'd been intrigued to see anyone demonstrate that PIP worked 13yrs ago, in a way it doesn't work now

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Stef Benstead @stefbenstead.bsky.social · 10/07/2026

If govt wants PIP to be *seen* to work well, it needs to ensure it gives an accurate narrative of where PIP does do well (some people do at least get some money towards their extra costs) and where it doesn’t (people are rejected who desperately need extra help).

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Stef Benstead @stefbenstead.bsky.social · 10/07/2026

How a system is 'seen' is substantially less important than if it's *actually* operating well. Yet the narrative around PIP, which govt has encouraged, contributes to PIP being seen as too generous – even as govt confirms PIP does not cover all of a disabled person’s extra costs.

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Stef Benstead @stefbenstead.bsky.social · 10/07/2026

"Public confidence in how the system operates is essential to PIP today and in the future - it is important that the public can see how investment in PIP enables people to participate, contribute, and live well." I worry when govt starts talking about how a system is ‘seen’.

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Stef Benstead @stefbenstead.bsky.social · 10/07/2026

Timms Review sets out early that whilst PIP "aims to provide a contribution towards the extra costs of living with a disability or long-term health condition", "it does not cover costs in full". This has always been the case, yet at the same time PIP is seen as too generous?

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Stef Benstead @stefbenstead.bsky.social · 02/06/2026

Where patients were less positive about sick notes, it was because of waiting times to get an appointment, and a desire for more detailed information on adjustments and return-to-work plans. Nevertheless, a "considerable number" thought nothing needed to be changed re sick notes.

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Stef Benstead @stefbenstead.bsky.social · 02/06/2026

"Many [patient] respondents also felt that the fit note enabled them to have the time and space to properly recover from illness and facilitated access to effective and appropriate treatment and/or support."

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Stef Benstead @stefbenstead.bsky.social · 02/06/2026

Going back to patients, "Obtaining fit notes was commonly seen as an accessible, straightforward process. Several patients highlighted that GPs understood the wider context of their illness and were able to make an informed, unbiased decision on their ability to work."

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Stef Benstead @stefbenstead.bsky.social · 02/06/2026

Employers were the least confident in the effectiveness of sick notes, but they have the least information regarding the patient's state of health and their abilities re work. Just 25% of employers thought sick notes were (very) effective at supporting work and health needs.

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Stef Benstead @stefbenstead.bsky.social · 02/06/2026

NHS staff were less confident of the efficacy of sick notes, with 45% saying they're (very) effective and 16% saying neither effective nor ineffective. Secondary (70%) and community/social (63%) were more positive than primary (39%) NHS staff about the efficacy.

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Stef Benstead @stefbenstead.bsky.social · 02/06/2026

82% of patients considered sick notes to be effective or very effective at supporting work and health needs. Arguably, this is the most important group to ask. There are no biomarkers for the relative benefits of work vs sick leave. It comes down to how the patient feels.

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Stef Benstead @stefbenstead.bsky.social · 02/06/2026

I've moved on to the 2026 report on the 2024 call for evidence on sick notes. I may be misinterpreting, but it seems like the authors - despite having two years to analyse and write up the data - did not analyse all of the 1221 patient/carer text-based responses.

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Stef Benstead @stefbenstead.bsky.social · 02/06/2026

If by 'other options' you simply mean that people with 'some conditions' should not receive income support whilst unable to work due to an illness or injury, why shouldn't they get support during that period? And what has financial support got to do with timeliness of healthcare?

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Stef Benstead @stefbenstead.bsky.social · 02/06/2026

What do you mean by 'the only option for some conditions'? What are these 'other options' which you think people with 'some conditions' are being wrongly given access to? And why would these patients take up healthcare that isn't appropriate and they don't need?

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Stef Benstead @stefbenstead.bsky.social · 02/06/2026

How are people supposed to survive whilst receiving mental health or physio therapy? Or is a single session supposed to cure them? What do you think is stopping people from getting 'immediate access', other than resource constraints that result in waiting lists?

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Stef Benstead @stefbenstead.bsky.social · 02/06/2026

The real issue that is highlighted to me in this report is the major under-resourcing of the NHS, which means that clinicians cannot dedicate as much time as they want to each patient. Shifting sick notes around does not address this fundamental problem of inadequate healthcare.

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Stef Benstead @stefbenstead.bsky.social · 02/06/2026

It is not clear to me that a) HCPs don't already appreciate the role of sick notes in this regard b) HCPs don't already know the potential medical and wellbeing benefits of paid work c) HCPs have the option, under current resources, to give more time to work-related conversations

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Stef Benstead @stefbenstead.bsky.social · 02/06/2026

The report finishes with this: "The more HCPs are helped to appreciate the role of fit notes in helping patients to remain engaged in the workplace, and the medical and wellbeing benefits of this, the more they will try to make time for thorough and probing discussions."

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Stef Benstead @stefbenstead.bsky.social · 02/06/2026

The report finishes with a statement that seems unsupported by the rest of the document: "The more HCPs are helped to appreciate the role of fit notes in helping pts to remain engaged in the workplace... the more they will try to make time" for extended discussion with the pt.

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Stef Benstead @stefbenstead.bsky.social · 02/06/2026

Apparently, "It is clearly for clinicians to make judgements about the needs of their individual patients and how to assign their very limited time." But not as a clear as it might be, given that @UKLabour are trialing an approach that takes sick notes away from clinicians.

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Stef Benstead @stefbenstead.bsky.social · 02/06/2026

Instead, the picture that emerges in this report is of HCPs, employers, and patients who can all recognise that, in the right circumstances, work is good for a person; and that in other circumstances, work is a (bad/unfeasible) thing from which a person needs a therapeutic break.

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Stef Benstead @stefbenstead.bsky.social · 02/06/2026

This is an interesting conclusion, given the political and media mantra that GPs and patients *don't* know that work is often good for a person, and that a major problem for sick note certification is the need to teach GPs to believe in the positive features of paid work.

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Stef Benstead @stefbenstead.bsky.social · 02/06/2026

Ch 6 is the conclusion. It concludes: "There was wide agreement amongst patients, employers and most HCPs that it was often in the patient’s best interest – including for their health – to remain connected to their workplace whenever this was possible."

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Stef Benstead @stefbenstead.bsky.social · 02/06/2026

I can't sleep, and I'm fed up of lying in bed feeling miserable because of how physically ill I feel whilst failing to sleep. So I've got up to read Ch5 of the report on the 2022 sick note reforms.

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Stef Benstead @stefbenstead.bsky.social · 01/06/2026

Some GPs wanted to be able to refer (long-term) patients to a specialist (occupational) service to discuss work: "I feel it shouldn’t be my responsibility if I have a patient on long term sick … there needs to be a third party looking at them."

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Stef Benstead @stefbenstead.bsky.social · 01/06/2026

"Across all the participant groups there was a clear view that the incidence of mental health conditions had risen within society, and that there was also much greater recognition of or understanding of mental health."

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Stef Benstead @stefbenstead.bsky.social · 01/06/2026

"Employer participants were also asked to reflect on the balance between making it easy for those who needed one to get a fit note, and preventing fit notes being issued that were inappropriate or fraudulent. In almost every case, employers felt the balance was about right."

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Stef Benstead @stefbenstead.bsky.social · 01/06/2026

"Several employers commented that self-certification was much more of a problem than fit notes, because employees could use it to take odd days off to suit their lifestyle, which could be more disruptive than a single, extended period of illness."

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Stef Benstead @stefbenstead.bsky.social · 01/06/2026

"Overall, despite the concerns with the current system, there was not a strong or widespread feeling that it needed to be made significantly more difficult to obtain a fit note." Has @UKLabour paid attention to this report in its plans for changing the access sick notes?

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Stef Benstead @stefbenstead.bsky.social · 01/06/2026

"Further, almost all participants – even those who felt strongly that there were people misusing the system – thought that it was right that employers and HCPs were cautious in challenging requests... they understood that these were difficult judgements to make."

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Stef Benstead @stefbenstead.bsky.social · 01/06/2026

"Some [patients] also talked about feeling guilty for getting a fit note because they themselves did not want to be perceived as ‘work shy’ or ‘playing the system’." Has anyone in @UKLabour asked how often people *don't* get a sick note when they need one, because of stigma?

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Stef Benstead @stefbenstead.bsky.social · 01/06/2026

"Although members of the public were very critical of the potential for inappropriate fit notes and often felt angry it happens, there was also some resignation that any process that is intended to support genuinely sick people will potentially be open to misuse."

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Stef Benstead @stefbenstead.bsky.social · 01/06/2026

There seems to be a general perception that some patients manage to obtain sick notes that they don't need. Naturally, no patient reports this of themselves. It's always 'that person over there'. Has anyone tried asking 'that person over there'?

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