Tony Blair's institute has published a report proposing sweeping cuts to UK social security by redefining mental illness, ADHD, autism and other health conditions as “non-work-limiting.” This will force many who are unable to work to look for jobs and leave them destitute if they cannot find them, as is likely

Worryingly, his whole report includes not a single reference to medical support for the reforms he is proposing. He is targeting those with ill health for the sole purpose of cutting taxes due by the wealthy, whose interests he seems to now serve.

His report ignores the real causes of poor health in Britain, which has increased because of:

• austerity

• poverty

• insecure work

• poor housing

• ultra-processed food

• NHS underfunding

Meanwhile, healthy life expectancy in Britain is collapsing.

This is not reform. It is coercion.

And it could leave millions worse off.

This is the audio version:

This is the transcript:

The Tony Blair Institute, which was created by and is headed by the man in question, has just published a paper on what it calls welfare reform that scares the living daylights out of me. I don't, by the way, call it welfare reform. I call it social security reform, because what he calls welfare is not anything of that sort. It is about social security. It is about providing people with a social safety net, and let's be clear what he's saying.

He is proposing a direct assault on those who have depression, anxiety, stress, and ADHD in the UK, plus those who might have obesity and musculoskeletal disease. This report is treating all those people as the big problem in our society when they come to claim social security: apparently, people who are ill are the cost our society cannot afford.

Doing so, this report ignores why so many people, and these people in particular, are unwell, insecure, stressed and unable to work.

It revives the neoliberal idea that individuals must make themselves fit for work, whatever that work might be, and whatever the pay rate is and whatever the consequence for their well-being might be.

Blair's real purpose is to force people into work, to cut the overall level of taxes within the economy, and to serve the increase in the wealth of a tiny minority in our society, and not serve the well-being of the many, including you and me. The framing is familiar, and it must be challenged directly.

At the same time as this report came out, another did from something called the Health Foundation, and I found their report to be a lot more important and refreshing, although it's deeply sobering with regard to its messages.

They talked about our healthy life expectancy here in the UK. Healthy life expectancy is the period of life over which you might expect to live without any form of chronic disease. They noted that this has fallen in the UK by two years since 2012. It now stands at just 60.7 years for men and 60.9 years for women, and when the state pension age is now 66, but it's rising over the next two years to 67, that means that most people now reach their old age pension age in poor health.

In more than 90% of local authority areas in the UK, healthy life expectancy is now below the state pension age, but Blair is listening to Blair and not to the Health Foundation, and that is a serious political choice on his part, and on the part of the Labour Party, which is listening to Tony Blair and not to the Health Foundation.

And notably, the Blair Report contains no references at all to any medical evidence to support what it has to say. This is a medicine-free policy. It is a policy about health driven solely by the desire to cut taxes.

In response, some will claim that this decline in health is, in any case, inevitable, and so I'm making a fuss because this issue is shared across all countries. But that is not true. The Health Foundation addresses that claim directly and rejects it. Of 21 high-income countries they surveyed, the UK was one of only five where health expectancy has fallen over the last decade. In fact, we are now in such a steep decline that of the 21 countries they surveyed, we are second from bottom. Only the United States performs worse than us, and they share one thing in common with us, which is a dedication to ultra-processed food. This is not bad luck, then. This is the consequence of bad policy.

The geographic gap in healthy life expectancy within England is around 20 years. If you live in leafy Richmond upon Thames in southwest London, healthy life expectancy exceeds 69 years for men and 70 for women. But in Blackpool and Hartlepool on the coasts of North England, it is barely above 50. A gap of this magnitude cannot be explained by individual choices or personal behaviour. It's the direct consequence of structural inequality, and we must stop pretending otherwise, as Tony Blair does. In more than one in 10 local authority areas in England, healthy life expectancy is now below 55, and that's a shocking fact.

Despite all of this, the Tony Blair Institute is claiming that too many people are signing on for benefits as a consequence of ill health. It says that is more than 1,000 people a day now, and in response, it proposes that a new formal category of non-work-limiting health conditions be created, which means that conditions such as anxiety, depression, ADHD, and autism would be reclassified as non-limiting. The default assumption would be that claimants with these conditions are fit for work and ineligible for income support as a consequence. Access to universal credit, health support and personal independence payments would be restricted as a result. This, the Tony Blair Institute suggests, should be implemented quickly and through secondary legislation, which means that Parliament does not really need to be consulted, as an “emergency handbrake” on welfare spending, as they call it.

The Tony Blair Institute is also trying to propose solutions that suit the needs of the big pharmaceutical industry, and we have to wonder who it was who sponsored the production of this report. They are saying that there should be a reduction in the number of medical interventions that people require, and there should be big pharmaceutical solutions offered instead.

So, for example, for common mental health conditions, they're saying rapid access digital and in-person mental health provision is what is required. In other words, solving your problems with ADHD, which is a lifelong condition, by the way, for which there is no cure, because it is a condition, not an illness, is how you're digitally going to make yourself ready for work, which is utterly and completely nonsensical.

At the same time, they're saying things like musculoskeletal conditions, back pain, to you and me, or something else like that, should be resolved through structured physiotherapy, except there aren't enough physiotherapists, and pain management programmes, and there aren't enough people skilled in this area either. And exercise and diet are ignored as the causes of many of these problems, and indeed, throughout this whole report, there is no mention of the curse of ultra-processed food, and why it has created so many of the health conditions that the Tony Blair Institute is obsessed with.

And when it comes to obesity, talking of ultra-processed food, it says that these must be managed through weight management services with the ability to prescribe GLP1 style drugs, and that is deeply dangerous because these have massive side effects for many people, and they don't last for long in their effect. Many people who come off them put the weight straight back on.

The consequence is that this report is asking all the wrong questions and it is looking for all the wrong solutions. The Blair report asks how to reduce the number of people claiming benefits. It does not ask why so many people are unwell in the first place.

There is almost no mention of austerity's long legacy in this analysis.

There is no serious discussion of insecure work, stagnant wages, or unaffordable housing.

There is no meaningful recognition of employers' deep unwillingness to accommodate ill workers, either, meaning that many of the people whom Tony Blair is saying should not claim benefits will be left destitute without either work or support from the state, a fact that he chooses to ignore.

This paper treats the symptoms of economic failure as if they are the cause of it, and that is a major error on its part.

The fact is, it is austerity that has made people ill, and growth has not fixed it. Poor housing, insecure employment, inadequate incomes and chronic stress are what has made people ill. None of these factors emerged by chance. They are the product of deliberate political decisions. We have lived through austerity, stagnant wages enforced by government diktat, rising housing insecurity, created by government policy, and cuts to public health expenditure, with all the consequences that we are now seeing. There has been a systemic destruction of the social safety net, and this is the consequence, and Tony Blair wants to make everything worse.

Policymakers have insisted that economic growth will solve our problems. There's no evidence to support that fact, and the Health Foundation data is the proof that growth has delivered nothing.

The Blair approach amounts to redefining illness, tightening eligibility, and removing cash support. But coercion is not reform, and it is coercion that he is proposing. It is simply a transfer of costs from the state to the individual.

Real reform would invest in the NHS so people can actually access treatment.

Real reform would improve job quality, employment rights, and tackle poverty and insecure housing.

Real reform would recognise the value of unpaid care, volunteering, and community support.

Real reform would change diets by eliminating ultra-processed foods.

Real reform would stop pretending that fewer claimants is the same as greater well-being because it most definitely is not.

And there are major economic consequences of ignoring public health to consider as well, which Tony Blair does not. Poor health reduces tax revenues, and it increases demand for social security. It raises pressure on the NHS and social care systems and undermines economic resilience. That is why neglecting public health is so expensive.

The argument that cuts now are good economics is simply false. What you're doing is denying people the resilience so they can provide for themselves in the future, and that is a false economy. Governments complain about falling workforce participation and weak productivity, but they appear strangely reluctant to acknowledge that millions cannot work just because they are, in fact, too ill to do so.

At the same time, pension policy ignores declining health expectancy, and that is dangerously detached from reality, as we are seeing with the increase in the pension age right now, when people are already ill by the time they get this basic provision from the state.

The Blair report claims to be motivated by concern for people and fiscal responsibility. It is not. You will know people who suffer from depression, anxiety, and autism and ADHD, and you will know that they face real challenges. You might be in that situation yourself. The point is that this report ignores all of that, and it claims that the function of the economy is to provide worthwhile work for all who live in it. But that is not true. What is necessary is work that is adjusted to the needs of people, not that people be adjusted to the needs of work, which is what Tony Blair thinks should happen.

This report is motivated by the desire of a few to limit government, minimise tax, and enrich elites. The Tony Blair Institute now belongs in the Tufton Street orbit of far-right think tanks in the UK, and indeed, they talk about much the same thing when they come to dealing with these issues and social security.

This report must then be read in that light. It is an ideological document. It is not a reform agenda. A civilised society asks why the demand for social security is rising and addresses the causes. It does not simply move the goalposts and declare fewer people eligible for help.

If we want a healthier population, we need better housing, income security, better food, and stronger public services. We need improved working conditions, reduced inequality, and an economy designed for human well-being. The UK is failing by that measure, while most comparable nations are not. The question is whether anyone in government is willing to admit that we need a politics of care. I think we do.

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