David Cameron launches review by Dame Carol Black of welfare for those with drug, alcohol or obesity problems

A full-scale review is to be launched into whether tens of thousands of obese people and those with drug and alcohol problems should be deprived of benefits unless they accept treatment.

A consultation paper launched on Wednesday for a review to be completed before the end of the year by Dame Carol Black admits strong ethical issues are at stake. But it also questions whether such people should continue to receive benefits if they refuse government-provided treatment.

The review, which was limited to obese people when it was first outlined in February, will now be expanded to include the cost of drug dependency and alcoholism to society and taxpayers.

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The consultation paper stresses that the purpose of the review is not punitive but to “consider how best to support those suffering from long-term yet treatable conditions back into work or to remain in work”.

The review is designed to “establish the role such treatable conditions play in causing worklessness and estimate the associated cost to the exchequer and the economy”.

It will also consider the groups most at risk of becoming workless through treatable conditions in future and the support available to them, including incentives on employers.



The Black review points out that “long-term conditions such as drug addiction and alcohol dependence, or obesity, can seriously affect people’s chances of taking up and remaining in rewarding employment”.

In England alone, research from 2008 and 2010 indicated that one in 15 working-age benefit claimants are dependent on drugs such as heroin and crack cocaine, and one in 25 working-age benefit claimants are suffering from alcohol dependency.

On the basis that these ratios have remained broadly constant since this research was carried out, the government estimates that in August last year “about 280,000 working-age benefit claimants are suffering from addiction to opiates, and 170,000 from alcohol dependency”.

The paper calculates that, in May 2014, there were 7,440 working-age disability living allowance claimants whose main disabling condition was obesity. There were also 240 incapacity benefit and severe disablement allowance claimants, and 1,540 people claiming employment and support allowance.

But the government believes this underestimates the total number of benefit claimants with obesity, since some of that group will have other main disabling conditions recorded that may be caused, or made worse, by obesity.

The paper says: “While many long-term conditions are potentially treatable, the current system fails to ensure everyone receives effective healthcare or specialist employment support. This keeps many people out of work – trapping them in worklessness and welfare dependency.

“For about 90,000 people claiming employment and support allowance, their illness is primarily due to their drug or alcohol addiction. Of these, about 8,000 have been claiming incapacity benefits for five years or more.”

Dependent drug users are vulnerable to overdoses, blood-borne viruses and general poor health. Furthermore, research from 1996 to 2000 suggests there are between 200,000 and 300,000 children in England and Wales where one or both parents have drug misuse problems.

Being overweight is associated with increases in the risk of cardiovascular disease, diabetes, several types of cancers, and musculoskeletal conditions, and is also associated with poor mental health in adults, and stigma and bullying in childhood.

Current government estimates suggest “harmful alcohol consumption costs about £3.5bn per year to the NHS, £11bn in crime and more than £7bn to the economy in lost productivity, and the societal costs of drug addiction are estimated to be £15.4bn”.

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In addition, the Department of Health estimates costs of more than £5bn a year to the NHS and £27bn to the economy from obesity, with almost 25% of adults and about 15% of children being obese.

The prime minister, David Cameron, will say: “Our one-nation approach is about giving everyone the opportunity to improve their lives, and for some that means dealing with those underlying health issues first and foremost.

“Whether it is drug or alcohol problems, or preventable conditions in terms of obesity, support and treatment will be there for you. And we must look at what we do when people simply say no thanks and refuse that help, but expect taxpayers to carry on funding their benefits.

“Over the next five years, I want to see many more people coming off sick benefit and into work and Carol Black will report back to me on how best to achieve that.”

Black will say: “Addiction to drugs and alcohol, and in some cases extreme obesity, can have a profoundly damaging impact on people’s chances of taking up meaningful employment.”