Knowsley is at the top of all the lists you don't want to be number one on, one resident laments Photo: David Redmond
Making money in Knowsley was always a difficult task.
David, who has lived in the Merseyside area all his life, had not worked for 40 years.
When he left school in 1980 at 16, he was delighted to get a place apprentice at a gardening company.
“I'm very good at gardening,” he says proudly. But at age 20, his father suffered a brain haemorrhage and died at 47.
David had a nervous breakdown.
“I felt really bad because I couldn’t cope . We used to do everything together.”
He was diagnosed with schizophrenia and began claiming sickness benefits. It hasn't worked since then.
Now aged 60, he receives both Universal Credit and Personal Independence Payment (PIP) and is on social security.
Stories like David's are common in Knowsley, an area on the outskirts of Liverpool which is one of the safest seats for the Labor Party.
Around 13,000 adults living here are eligible to claim PIP, the highest of any UK parliamentary constituency.
One in seven adults can claim the benefit, which is an extra payment for people with disabilities to cover living and mobility costs.
Many here also claim disability benefits, which means they have not looked for work . in years.
Knowsley is symbolic of the wider crisis engulfing Britain. Currently, 9.4 million people in the UK are economically inactive, with a record 2.8 million of these not working or looking for work due to health reasons.
The number of people inactive due to long-term illness has risen by 850,000 since the 2020 lockdown.
This is not just a health crisis, but an economic one. Downing Street is increasingly alarmed by the rising cost of disability benefits caused by mental health claims.
Rishi Sunak wants to cut the cost of disability and health benefits before they get out of control — currently forecast to hit £100 billion by the end of the decade.
That means tackling unemployment in places. such as Knowsley, who has one of the highest rates of mental illness, including anxiety and depression.
«We are now spending £69 billion on benefits for working-age people with disabilities or illnesses,» Sunak said earlier this month. “This is more than our entire school budget; more than our transport budget. More than just our police.”
The solution to this problem may seem as simple as cutting benefits and making them harder to obtain. But there is no guarantee this will lead to more people being employed: Knowsley faces a toxic triangle of unemployment, poverty and ill health.
«Unmanageable»
«We top all the lists you don't want to top,» says Lynne Wilson, community wellbeing manager at Volair leisure centre.
Knowsley has the lowest life expectancy for women, according to Public Health England. in the country, and just under a fifth of households were unemployed in 2022, compared with the UK average of 14%.
Of those in work, two fifths suffer from poor health, double the UK average country.
Between 1971 and 1991, the Greater Merseyside region lost almost 230,000 manufacturing jobs as manufacturing declined.
< p>But while the city of Liverpool has since bounced back, its suburbs have not.
p>
In Huyton town centre, Knowsley, a woman on a scooter glides past the empty Wilko store, which closed in September when the national retailer went bust.
The high street is lined with betting shops, discount stores, closed shop windows and several beauty salons.
“Who can afford to get a manicure?” asks a pensioner sitting on a bench.
In nearby Prescott, the county's other main town, a shopping center is almost completely empty, the escalator stationary and fenced off.
Locals say development in the area hampered by the lack of public transport and health services. “There’s no dentist here at all,” says another man, pointing to the gap in his mouth where a fang used to be.
Phil Noon, co-founder and director of Evolving Mindset, which helps people return to work after leaving work for mental health reasons, says lockdown and rising prices since the pandemic have worsened health problems in Knowsley.
The pandemic has led to an increase in depression, and “the community was not able to cope,” he says.
“I worked with many people whose only social interaction was at work. And then suddenly they began to live and work in their apartment.”
For some, the isolation became devastating.
“People still hold this fear of the outside world as a dangerous place,” says Noon.
The cost of living crisis has caused another rise in anxiety: “It's about paying bills or fathers not being able to buy your children Christmas gifts. Or buy Christmas presents and then end up in debt.”
In areas like Knowsley, benefits can be a lifeline.
The failures of PIP
Personal Independence Payment (PIP) was introduced by George Osborne in 2013 to replace disability benefit for working age people.
It provides cash payments for people with special care or mobility needs, allowing people to spend it on everything from taxis to mobility scooters. The cash payment is intended to give applicants flexibility in managing their personal circumstances.
When PIP was introduced, ministers campaigned for reform, highlighting the fact that almost three quarters of people receiving Disability Living Allowance had open-ended payments, with more than half of decisions being made on the basis of a claim form alone.
< p> As Chancellor, Osborne wanted to cut the benefits bill by introducing face-to-face assessments and systematic reviews.
The move to PIP was intended to save money. Instead, the opposite happened.
PIP forms a significant part of the broader health and disability benefits bill and is growing rapidly. Its value is now forecast to rise 50% from £18 billion last year to £27 billion by the end of the decade.
This is partly due to PIP's focus on supporting people with mental as well as physical disabilities.
«Equal weight» is given to «needs arising from physical, mental and cognitive conditions» such as reading and socializing.
In-person assessments also stopped during Covid and have barely resumed. Face-to-face interviews still account for less than 10% of cases, according to the latest figures for 2023.
Britons can now claim PIP to help them cover living costs associated with more than 500 conditions.
This includes everything from arthritis, heart failure and cancer to eczema, acne and non-life-threatening allergies.
6,000 people could claim Long Covid benefits, with 14 people in the UK eligible for £9,500 Sterling PIP per year to help them live with hemorrhoids.
The DWP figures show the total number of PIPs. The number of applications has increased by almost a third since 2020. “Anxiety and depressive disorder” remained the single most frequently cited cause, with 361,000 people citing it as their “major disabling condition.”
The typical person applying for anxiety and depression benefits is probably not the one you think of. It is not young people who experience the most anxiety and depression, but those who live ten years before retirement.
DWP data shows a 55-year-old woman is around five times more likely to apply for PIP due to anxiety and depression. than a 19-year-old man.
In fact, people in the 50-59 age group are more likely to experience anxiety or depression than pain from osteoarthritis. Many people with anxiety and depression also remain on benefits for years.
About half of these people have been claiming PIP for more than three years, and a quarter have been filing for PIP for more than five years.
Benefits related to mental health problems among young people are more likely to be linked to diagnoses of autism or ADHD, which have risen sharply in recent years as the conditions have become more widely known.
Many in the Cabinet Office believe that the UK's approach to mental health when it comes to benefits may have gone too far.
“We introduced these benefits as soon as we ushered in the mental health revolution,” says one minister. “It's not politically correct to say this, but our social safety net is simply not designed to cope and the taxpayer is footing the bill.”
PIP can be claimed for living expenses related to just under 50 conditions associated with mental disorders. health, ranging from dyslexia and anorexia to anxiety, depression, ADHD and autism. Anxiety and depressive disorders account for about 450,000 of the 3.5 million current claims.
This is almost double the rate of Covid, with the number of cases in these categories increasing by around 5,000 each month.
Official figures show the government is currently spending around £2.6bn on treating conditions alone associated with anxiety and depression for people of working age. This is more than three times the amount spent on PIP for working-age people living with cancer.
About half of this group receives the “extended” component of PIP related to everyday living expenses. , giving them £108.55 a week.
Some in this group also receive an extra £75.75 each week to help cover the financial cost of moving. Just over 100,000 claimants are eligible for the maximum amount of £9,583 a year under PIP for help with everyday tasks. This is in addition to health benefits such as Universal Credit and housing support.
Government guidelines say people should only receive the maximum amount if, for example, they have difficulty communicating without experiencing «extreme distress» including the inability to leave the house.
The DWP will launch a consultation on PIP reform as early as this week, with Sunak floating the prospect of exchanging people's «cash transfers» for «access to treatment such as talk therapy or respite care.»
Government insiders are keen to highlight that this is not an attempt to take benefits away from people who need them.
However, ministers and their aides are concerned that some people are trying to game the system. Social networking sites such as TikTok and Reddit have provided platforms for people to give advice on how to get the maximum amount of benefits.
The current system awards payments based on a point system.
Rewards are awarded not based on a medical diagnosis, but on how much people's health limits their ability to perform basic tasks such as handling money, showering or preparing food.
Applicants are assessed in two categories related to daily work. live and move.
One popular TikTok video encourages applicants to use words like “tips” and “help” to improve their scores.
Reddit threads including «anti Work» and «dwphelp» have also been mentioned by former insiders as sources for people looking to maximize their chances of getting claims approved.
A sick seaside town that has turned its back on work. Read more
However, cutting the PIP bill may not be as simple as tightening application rules.
Research published by the Office for National Statistics (ONS) last year found that 937,000 people who were economically inactive due to long-term illness had at least five conditions. In total, this is a 42% increase on pre-pandemic levels.
The figures show that many people will still be able to claim PIP even if mental health claims rules are tightened.
Louise Murphy, from the Resolution Foundation think tank, says: “There is no strict division between mental and physical health. Someone might say that «anxiety» or «depression» is their main condition, but they may also have some mobility problems associated with these conditions.
“If you were trying to make changes to regarding people who might have anxiety and depression, which often end up affecting people who also have physical health problems. This needs to be more widely recognized.»
In Knowsley, the problems are compounded by delays and difficulties accessing health services.
“People are currently waiting 50 weeks to get secondary mental health care in Knowsley,” says Noone.
While the City of Liverpool has recovered from its era of decline, the suburbs are a different story. Photo: Eryrie/Alamy Stock Photo
At Kindred Minds Merseyside, a grassroots mental health organization that works with adults over 40, most people attending had no formal mental health support other than visiting a GP because it was so difficult to access, says Andrew Kerr, Program Manager.< /p>
Delays and difficulties in accessing services are causing more people to get sick. This also means that they may be out of work longer than necessary.
“There is no reason why people should not recover from psychosis and return to work if they are provided with the right support and a productive and dignified work environment,” says Kerr.
However, getting people back to good health is this is just one part of the solution to the unemployment crisis: people need jobs, too.
“The reality is that cutting off benefits and stopping benefits will not help your recovery. become a Deliveroo rider or get a zero-hours contract at a supermarket and work 60 hours a week to pay the rent,” says Kerr.
Kerr claims the Prime Minister's plan to crack down on the benefit will make people's mental health problems worse by bringing new stress to them.
“They are scared by what Rishi Sunak says.”
Some see this as a symptom of how the current system works. Murphy says the current benefits system makes it «very difficult to get in and out of work or to try to work, even part-time.»
«Often if people have this extra element of Universal Credit, where they have received unless they are unable to work due to health problems, they may find it difficult to think about working in the months or years to come,» she says.
“I definitely think we need to think about how we can make it easier for people to at least try.”
Radical reforms needed 
James, 59, is able-bodied but his life in Huyton has been greatly affected by his disability.
< p>He had a job in security a few years ago but gave it up to look after his younger brother, who had serious health problems. mental health problems.
“He cut his hands,” says James, who asked to speak only by his first name.
One day James found his brother at home, who was only about 40 years old , dead. It was not suicide.
“They did an autopsy. The nurse called and said his arteries were blocked because he ate too much fatty food. He ate a lot of chips and McDonald's. That's what killed him. He was only over 40 and predeceased his mother.”
After his brother’s death, James began caring for his mother, who was blind and suffering from cancer. She died in 2017.
James has been unemployed since then. He receives £180 a fortnight in benefits and lives in his mother's old council house.
“I want a job because the benefits lead to nothing. But I feel like I'm not getting the help I need,” he says.
James wants to get a job as a carer, but he has severe dyslexia. Although the job center helped him write a CV and send it to potential employers, he has not yet succeeded.
“I have been to many interviews in nursing homes, but the problem is that I can hardly read and write.” .
Nursing homes say he won't be able to write handover notes at the end. my shifts.
“I want to work as a caregiver. I did everything for my mom. I'm quiet and patient, you really need to be patient. I don't care about 12 hour shifts. And at the end of the shift, when everyone has written their notes, I can tell people. My memory makes up for it.”
Lord Heseltine believes giving mayors more power could help resolve the crisis. Photo: TOLGA AKMAN/AFP via Getty Images
Lord Heseltine, who became famous for his contribution to the regeneration of Liverpool, calls economic inactivity a «terrible problem». He believes devolution is key to getting people like James back into work.
“I want to see more accountable mayors with power and responsibility for skills, education and unemployment,” he says.< /p>
“We need the cooperation of the forces that operate in the local economy to make them work. together to achieve common goals and empower them to build public-private partnerships. There is no private solution to this problem.”
The government says it is doing more to help. A DWP spokesman said: “We pride ourselves on providing a social safety net that is generous to those who really need it and fair to the taxpayers who fund it.”
“We will review our disability benefits system to ensure it is fairly and accurately targeted at those who need it most, and directs people to the right form of support for their needs.”
Rapid reforms to area of benefit provision. 424,000 people are expected to prepare for work by writing a CV by the end of the decade.
However, life in Knowsley suggests that cuts to the welfare bill will require more radical reforms.
Sitting on a bench outside a shopping center in Prescott, Merseyside, David is confident he could work if he found a job. He still gardens in his supported home.
“I can still do it all. I know all about gardening,” he says.
Perhaps surprisingly, he also considers himself to be in good health.
“I’m not suffering now, I feel very Fine. I haven't suffered for a donkey's years. People just get stuck with diagnoses,” he says.
Additional reporting by Ben Butcher
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