Sick-Note Britain

How Social Problems Became Medical Issues

February 2019 9781787381223 368pp
EU Customers


The NHS is stretched to its limits. Yet doctors are writing 10 million sick-notes a year for people they cannot ‘fix’, while patients with treatable diseases queue for appointments. This is Britain’s grave error: our hyper-medicalised society has falsely equated illness with unfitness to work—mistaking a social problem for a medical one. 

Dr Adrian Massey argues compellingly that we should leave doctors out of it and seek tailored, contractual, employer–employee solutions, but obstacles block this path: over-complex employment law; an outdated benefits system overburdening doctors and traumatising the vulnerable; and a workplace culture that is too inflexible to keep sick employees in work.

Sick-Note Britain is a blistering condemnation of a sham system that works for nobody, and an urgent call to rethink how we manage sickness—for the sake of our economy, our wellbeing, and our health service.


‘A furious polemic . . . heady and optimistic.’ — The Times

‘This thought-provoking polemic is both erudite and wickedly entertaining.’ — British Journal of General Practice

‘A most insightful read which provides a thought-provoking appreciation of the subject matter. …especially relevant in the current day practice of medicine.’ — Journal of Occupational Medicine

‘Dr Massey’s forthright book challenges one of the fundamental systems of both the welfare state and the workplace.’ — The Methodist Recorder

‘A provocative book that challenges the subjective ways we approach willingness or capability to work. This will be an uncomfortable read for many, but raises important questions that need to be addressed in the modern technological era.’ — Lord David Blunkett

‘Detailed, convincing and controversial. Massey does not mince his words: the British approach to determining whether one suffers work incapacity is counterproductive. An argument that merits careful consideration across the resource-advantaged world.’ — Nortin M. Hadler, Emeritus Professor of Medicine and Microbiology/Immunology at the University of North Carolina

‘[this book] will stimulate and enlighten any reader. … Employers, politicians, employees, GPs, occupational health advisors and probably Joe public would do well to read this!’ — Personnel Today


Adrian Massey has been a doctor for over twenty years, specialising in occupational medicine, where healthcare and society meet. He has sat on the executive of occupational medicine’s most prominent professional bodies, and has been a contributor to governmental consultations including the DWP's fit-note review under David Blunkett.

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