There are stock images, and then there is whatever the fuck happened at Horsfield Menzies. Sam Butler’s article on Britain’s sickness absence problem arrives beneath a Union Jack, a collapsing financial chart and an enormous red arrow pointing towards the floor. Across the middle sits the warning that UK employers are losing billions every year. It is economic subtlety by fucking foghorn: Britain is down, the graph is down, the arrow is down, but the flag remains heroically upright. Somewhere, presumably, a bloke with rheumatoid arthritis is expected to apologise to the FTSE.
Welcome back to Sam Butler. TCAP already knows Brochure Sam. He is exceptionally good at equality, mental health, inclusion and enlightened employment practice while everybody involved remains hypothetical. Now he has discovered macroeconomics, and apparently one of the first places Britain should look for its missing billions is underneath the duvet of somebody with a chronic health condition.
The figures are serious. Butler cites estimates suggesting poor workplace health costs employers around £85 billion annually, while the wider economic cost associated with ill-health reaches £212 billion. He also highlights an increase of around 800,000 working-age people outside employment because of health conditions since 2019. Those numbers deserve examination, but what they do not deserve is selective fucking accounting.
Sam Butler Finds Britain’s Balance Sheet
Butler’s article draws on the government-backed Keep Britain Working review, and plenty of the underlying argument is perfectly sensible. Britain has a serious problem with health-related economic inactivity. Too many people leave employment because their health deteriorates, too few return successfully and employers often lack the systems required to intervene before somebody disappears from the labour market completely.
Indeed, Butler himself recognises many of the failures surrounding the sick person. Occupational-health provision can be inadequate, managers need training and employees can fear disclosing health problems. Employers should communicate better, intervene earlier, make reasonable adjustments and create properly supported routes back into work. That is a discussion worth having, and it is considerably more nuanced than the graphic Horsfield Menzies chose to sell it with.
Because then you look at the fucking artwork again. Union Jack. Financial markets. Huge red downward arrow. BRITAIN’S SICKNESS ABSENCE CRISIS. UK EMPLOYERS LOSING BILLIONS EVERY YEAR. The sick and disabled have apparently wandered into Britain’s profit-and-loss account. Once Horsfield Menzies chooses to package ill-health as a national economic emergency in that way, however, another question becomes unavoidable.
What else is on the fucking ledger, Sam?
Nice Flag
The Union Jack is an especially beautiful touch because Britain has recently conducted another rather large experiment involving labour supply, productivity, trade and economic performance. You might remember it. There were buses, flags and a great deal of shouting about borders, foreigners and taking things back. Eventually, there was considerably less freedom of movement.
Strangely, none of this appears on Sam Butler’s graphic showing us why Britain might not currently be operating at maximum economic efficiency. The Office for Budget Responsibility continues to assume that Brexit will leave UK productivity around 4% lower in the long run than it would otherwise have been. It also assumes the UK’s trade intensity will ultimately be around 15% lower than if Britain had remained inside the European Union.
Four fucking per cent of productivity and fifteen fucking per cent of trade are not small rounding errors in a national economic discussion. Yet apparently the stock-market-collapse artwork was required for Brenda’s sciatica. That is quite an editorial choice when Horsfield Menzies has voluntarily wrapped its discussion of missing economic output in the flag most closely associated with the largest structural change to Britain’s trade and labour arrangements in decades.
The Other Labour Problem
Then there is labour supply. Research commissioned by the Migration Advisory Committee examined what happened after freedom of movement ended in sectors that had historically relied heavily on European workers, including agriculture, hospitality, manufacturing, transport and storage. The research describes employers encountering a labour shock after the end of freedom of movement.
Manufacturing, Sam. An actual fucking labour shock.
TCAP is not going to reverse Butler’s selective accounting and pretend Brexit explains Britain’s entire long-term sickness problem. It does not. Covid happened, the NHS has been under immense pressure, Britain has an ageing population, chronic ill-health has increased, labour-market behaviour changed, migration patterns changed, investment changed and working practices changed. That complexity is precisely the point.
Economies are complicated. So if Horsfield Menzies wants to put a Union Jack behind a collapsing graph and start calculating what sick people supposedly cost Britain, perhaps somebody should finish the spreadsheet before deciding which group gets the giant fucking arrow.
Blame The Sick, Ignore The Borders
For years, the Union Jack was hauled through Britain’s arguments about immigration, borders and who should be permitted to live and work here. Sometimes respectable politicians waved it. Sometimes the flag ended up in the hands of considerably less respectable cunts shouting about foreigners. Either way, Britain eventually made a deliberate political decision to end freedom of movement and fundamentally alter its relationship with its largest trading partners.
That decision had consequences. It affected trade, recruitment, labour availability and employers, particularly in sectors that had relied heavily on EU labour. Yet here comes Horsfield Menzies with a flag, a red arrow and an economic morality play centred visually on the people who became too fucking ill to work.
You could hardly design a better demonstration of selective national accounting. One major source of economic friction resulted from deliberate political choices made by healthy adults in suits. Another involves people becoming ill, disabled or unable to remain in work. Only one of those groups gets positioned underneath the collapsing graph.
The Flag Does Not Balance The Books
There is something wonderfully British about the presentation because putting the flag behind an economic problem has a strange ability to turn personal behaviour into patriotic duty. Britain needs you. Your employer needs you. GDP needs you. Gross domestic product has apparently been pacing around the kitchen all morning wondering whether your anxiety has improved.
Unfortunately, productivity does not become patriotic because somebody overlays the numbers with red, white and blue. The OBR’s projected Brexit productivity loss does not disappear because GPs become stricter with fit notes, trade barriers do not vanish because somebody with depression returns to the warehouse three weeks earlier and labour shortages following the end of freedom of movement cannot be solved by making somebody with multiple sclerosis feel guiltier about Thursday.
That is what makes the image so fucking revealing. It takes an enormously complicated national economic problem and gives the reader a beautifully convenient visual culprit. Sickness becomes the headline explanation, the arrow goes down, the flag goes up, and the rest of Britain’s economic ledger remains safely outside the crop.
Then Butler’s Own Article Betrays The Graphic
The funniest part is that Butler’s actual prose almost escapes the trap set by Horsfield Menzies’ own presentation. Once you get beyond Britain apparently being bankrupted by sick notes, he starts identifying failures by employers and systems. Workers can fear health disclosure, managers need training, employers need better occupational-health support, reasonable adjustments matter, early intervention matters, communication matters and flexibility matters.
In other words, people do not simply fall out of employment because they have failed Britain. Sometimes Britain is fucking failing them. That is a rather important distinction when your headline presentation has already nudged the reader towards SICK PEOPLE = BILLIONS LOST.
The £85 billion is not a fucking invoice addressed personally to disabled workers. It reflects an entire system involving employers, healthcare, management, workplace design, occupational health, retention, social security, waiting lists, reasonable adjustments, recruitment, working conditions and illness itself. Even Butler’s own source material understands that. Horsfield Menzies’ graphic apparently needed something simpler.
Imagine Being Afraid To Disclose A Health Condition
Then comes the Blog vs Behaviour bit. Butler acknowledges a culture in which employees may fear disclosing health conditions because of what could happen afterwards. Interesting. Where could such fear possibly come from?
Imagine applying for a job and receiving a telephone call from the recruiter. During that conversation, you are offered an interview for after the bank holiday, asked about a gap in your employment history and explain that it related to your mental health. Then the expected confirmation never arrives.
That is the factual territory at the centre of my Cepac claim. I say Page Outsourcing offered me an interview during the recruitment call on 21 August 2024, and a contemporaneous WhatsApp message sent that same day recorded “Interview next week” and the training salary. No Tribunal case existed, TCAP did not exist and there was no dispute to manufacture a contemporaneous record for.
The interview disappeared. Cepac later denied that it had been offered. Horsfield Menzies represented Cepac, and Sam Butler became involved. So now we have Brochure Sam publicly explaining that Britain needs better support for workers with health problems and that fear around disclosure creates its own employment problem.
That is almost offensively fucking perfect.
Keep Britain Working
The phrase itself deserves closer inspection. Keep Britain Working. Fine. How?
You cannot spend Monday worrying about the economic cost of disabled people leaving employment and Tuesday treat disability as somebody else’s inconvenience whenever it arrives attached to an actual difficult human being. Keeping Britain working means employing people with health conditions, retaining them, recruiting them and accommodating them.
Sometimes that means accepting that disability does not arrive carrying a glossy Horsfield Menzies employment-law article explaining exactly how everybody should behave. The employee may be anxious or distressed. Their attendance may become difficult. Communication can become messy. Medication can fuck them up. A manager might actually have to change something and an employer might have to tolerate some inconvenience.
Sometimes, as in the allegation at the centre of Cepac, a job applicant tells a recruiter about a mental-health problem before they even get through the door. That is where the brochure gets tested. Not on the Horsfield Menzies website, but in real fucking life.
Brochure Sam Meets File Sam
TCAP has already encountered this split personality. Brochure Sam writes about equality, supportive employment practices and protected characteristics. File Sam turns up for Horsfield Menzies when Cepac needs lawyers. Now Brochure Sam has discovered the economic importance of preventing people with chronic health conditions from leaving employment.
Again, lovely.
The difficulty is that keeping disabled people economically active starts considerably earlier than the return-to-work meeting. First, somebody has to hire them. An employer cannot complain that Britain has hundreds of thousands of economically inactive people with health conditions while simultaneously creating an employment culture in which applicants have good reason to wonder whether disclosing those conditions will cost them opportunities.
That is not merely hypocritical. Economically, it is fucking stupid. If Britain genuinely wants more disabled and chronically ill people participating in work, disability inclusion cannot remain something employment solicitors recommend after the damage has already happened. It has to survive recruitment.
£85 Billion
Butler leads with £85 billion because £85 billion is a tremendous number. It is big enough to frighten employers, big enough for a giant red arrow and apparently big enough for the fucking Union Jack. However, big numbers become propaganda surprisingly quickly when nobody asks what sits underneath them.
Employers lose money through sickness, but they also lose money through poor management, bad recruitment, high staff turnover, workplace stress, inadequate occupational health, avoidable grievances, inflexible policies and failures to make adjustments. Losing experienced employees because nobody intervened early enough costs money. Discriminating against somebody who could have worked costs money too.
Butler’s own article acknowledges much of the system surrounding those failures. So why is sickness the thing in enormous fucking letters? Why does the graphic not announce BRITAIN’S FAILURE TO RETAIN SICK WORKERS IS COSTING BILLIONS?
Perhaps because that would point the arrow somewhere less convenient.
While We Are Counting Billions
Nobody expects an employment-law blog about sickness absence to become a complete economic history of Britain since 2016. Horsfield Menzies, however, chose the national-economic framing. They chose the Union Jack, the market chart and the fucking arrow. Once you open Britain’s balance sheet, TCAP is entitled to turn a few more pages.
The OBR says the post-Brexit trading relationship imposes a substantial long-term productivity penalty. Government-commissioned migration research records labour-supply disruption after freedom of movement ended. Those facts do not invalidate the sickness statistics. Instead, they demonstrate how dishonest simplistic blame becomes when a complex economic problem gets packaged around a convenient group.
Britain has lost productive capacity for many reasons. Some workers became sick, some experienced NHS delays and some left because working conditions were shit. The pandemic changed behaviour, the population aged, businesses struggled to recruit, European workers lost automatic freedom to come and work here, trade became harder and investment suffered.
Yet only one of those problems gets illustrated by Horsfield Menzies with a sick person effectively standing underneath the Union Jack while Britain’s economic graph crashes through the fucking floor.
Funny, that.
The Sick Did Not Hold The Referendum
This is the part worth remembering whenever somebody starts translating ill-health into national economic loss. Disabled people did not hold the Brexit referendum. People with chronic illness did not negotiate Britain’s new trading relationship. Somebody receiving chemotherapy did not introduce customs friction, a worker with severe depression did not end freedom of movement and the woman waiting eighteen months for NHS treatment did not design British productivity policy.
Yet when economic performance disappoints, the individual is always such a wonderfully accessible bastard to measure. How many days were you absent? How much did you cost? Could you have returned sooner? Did you engage with occupational health? Have you demonstrated resilience?
Meanwhile, a 4% long-term productivity assumption can sit quietly inside an OBR document because there is nobody convenient to drag into an absence-management meeting.
Patriotism For Payroll
There is a particular kind of corporate patriotism that asks ordinary people to solve structural economic problems through improved personal behaviour. Work harder, be healthier, take less time off, get back sooner, become more resilient and keep Britain working. Wave flag. Repeat.
Meanwhile, trade barriers remain trade barriers, labour shortages remain labour shortages, productivity losses remain productivity losses and NHS waiting lists remain NHS waiting lists. Employers also retain an extraordinary range of ways to make working life fucking unbearable for somebody whose health has already gone sideways.
None of that fits neatly into a stock image. The sick person does. You can count their days, calculate their wages, estimate their lost output and turn their illness into a cost centre.
Then you can put the Union Jack behind it.
Blame The Sick, Wave The Flag
Perhaps the greatest irony is that Butler’s actual article is more intelligent than the visual story Horsfield Menzies uses to sell it. His text understands that systemic failure matters, while the graphic screams crisis. His text acknowledges employer responsibility, while the headline emphasises employer loss. His recommendations tell businesses to support people with long-term health conditions, while the artwork presents those same people as part of Britain’s gigantic fucking economic hole.
That contradiction matters because it demonstrates exactly how these conversations become corrupted. Start with a complicated health and employment problem, translate it into billions, attach the national flag and suddenly support becomes productivity, illness becomes economic failure and disabled people stop being people and start becoming missing GDP.
Another Sam Butler Measuring Stick
As ever, TCAP did not invent Sam Butler’s standard. He published it himself. Health disclosures require proper handling, managers need training, reasonable adjustments matter, employers should communicate, businesses need to retain people with chronic conditions, fear around health disclosure is harmful and inclusive employment is economically important.
Wonderful.
Now open the Cepac file.
There is Blog vs Behaviour.
Again.
Finish The Fucking Spreadsheet, Sam
TCAP does not dispute that long-term sickness represents an enormous economic problem. Quite the opposite. If hundreds of thousands more people are outside employment because of ill-health, Britain needs to understand why and fix whatever can reasonably be fixed.
But start with why. Why are people getting sick? Why are they leaving work? Why can employers not retain them? Why do people fear disclosing health conditions? Why do disabled people experience poorer employment outcomes? Why is occupational-health provision inadequate? Why are NHS waits so long? What changed after Covid? What happened to labour supply, productivity and trade? What happened after freedom of movement ended? What do employers themselves do badly?
And while Horsfield Menzies is lecturing Britain about getting unhealthy people working, ask one more question: what happens when a mentally ill applicant says so during recruitment?
Those are economic and employment questions.
A giant red arrow pointing down beneath a Union Jack is fucking advertising.
The Fucking Flag
Perhaps Horsfield Menzies should keep the image because TCAP rather likes it now. The Union Jack looming behind a collapsing economic chart accidentally captures something much bigger than Sam Butler probably intended.
Britain has spent a decade arguing about who should live here, who should work here, who should leave, who should come, who deserves support and which conveniently identifiable group can be blamed whenever a national statistic looks unpleasant. After deliberately changing its trading relationships and labour market, Britain now finds itself debating how to support, persuade or cajole more people with health conditions into employment.
Then along comes an employment solicitor to explain their enormous economic cost. Under the flag. With the arrow pointing down.
Beautiful.
If Horsfield Menzies wants the national productivity debate, TCAP is delighted to have the fucking national productivity debate. Bring the sickness figures, the disability employment gap and the fit notes. Then bring the OBR Brexit assumptions, the lost trade intensity, the productivity hit and the labour shock after freedom of movement ended.
Bring employer failures to retain sick workers, inadequate occupational health, NHS waiting lists and the culture of fear around disclosure. And while everybody is carrying paperwork, bring the fucking Cepac file.
Do not wave the Union Jack over one side of Britain’s balance sheet and pretend the other pages disappeared.
That is not economics.
It is choreography.
Sam Butler says Britain needs to keep working.
Agreed.
Perhaps start by making sure sick and disabled people can actually get through the fucking door.
BLAME THE SICK. WAVE THE FLAG. IGNORE THE REST OF THE FUCKING LEDGER.
Lee Thompson – Founder, The Cummins Accountability Project
Sources
- Horsfield Menzies – Britain’s Sickness Absence Crisis
- UK Government – Keep Britain Working Review: Final Report
- Office for Budget Responsibility – Brexit Analysis
- Migration Advisory Committee – The Impact Of The End Of Freedom Of Movement
- Office for National Statistics – Economic Inactivity Because Of Long-Term Sickness
- TCAP – Horsfield Menzies : Blog vs Behaviour – Sam Butler’s Equality Clocks Off When Cepac Calls