Jamie used to love his job. Working as a hospital porter, helping sick people in need, he probably never expected to become a patient himself: at 50, he was still fit and healthy. But then he strained his back at work, and so began a long, downhill slide. He was given physio exercises to follow online, but couldn’t access them, and before long he was in such pain he was signed off work for good. Unable to keep active, and putting on weight, Jamie was referred to a diabetes prevention programme; but by now his back hurt too much to drive to the clinic, and public transport was a struggle. Overwhelmed and isolated, he ended up retreating inside his damp, mouldy council house. Five years on, Jamie still isn’t working, but his back is almost the least of his problems. He’s diabetic, asthmatic thanks to the mould, suffering from coronary heart disease, and if he isn’t depressed yet then he probably soon will be. There are countless Jamies out there, many suffering from what some doctors privately call “shit life syndrome”: getting dealt a string of bad cards, lacking the money to bounce back from any of them, and sinking deeper with every passing day. They’re genuinely sick, often with multiple diagnoses, but sick in a particularly complex, tangled way that medicine alone can’t magically solve. And herein lies this autumn’s toughest political battleground, as a new Labour government attempts to kickstart economic growth by getting people who are long-term sick back to work. These are worrying times for many people living on disability and sickness benefits. Keir Starmer’s warning in Liverpool that those who can work should has done little to quell anxious speculation about what this autumn’s budget means for welfare spending, especially as ministers have yet to spell out exactly what they’ll do about planned disability benefit reforms set in train by the outgoing Tory government. Starmer has stressed that he knows there will be “hard cases”, who physically can’t work no matter how much they try, and that Labour wants to help rather than force people back into jobs. But it’s difficult to relax when the roads to previous welfare crackdowns have been paved too often with reassuring words. Enter Jamie, who isn’t a real person, but a representative example of countless very real patients devised by the NHS Confederation and the Boston Consulting Group’s Centre for Growth to illustrate their joint report on a more benign way to get half a million long-term sick Britons back to work. Their analysis skilfully separates tabloid myths about skivers and sicknotes from hard facts. Yes, Britain has 2.8 million adults economically inactive because of long-term illness, up by a startling 900,000 since 2020. No, this isn’t some unavoidable global hangover from the pandemic – economic inactivity has fallen elsewhere in Europe – but it’s also extremely unlikely to be because a life on welfare is just too cushy here. The introduction of universal credit, if anything, left many disabled people worse off than before. The simple explanation is that Britons as a whole are sicker than we used to be, with a third of working-age adults admitting to at least one health condition; that economic inactivity is in some ways a canary down the mine, pointing to lives that are making too many people stressed and ill. Tellingly, the report concludes that the kind of social and environmental factors that so often underpin shit life syndrome explain more of the variation in health outcomes between different parts of the country than more obvious factors such as diet and exercise, with deteriorating living conditions and rising crime particularly closely linked to avoidable deaths. But it also shows how little it would have taken to halt Jamie’s downward slide; how different things might have been if he’d been offered the chance to retrain for a desk job, or cheap transport to his various appointments, or a better roof over his head. The take-home message is that getting sick people fit for work again requires the whole of government uniting around a common purpose – or mission, to use the Starmer buzzword – to reach the parts doctors can’t, backed up by employers doing more to keep staff healthy. There are reasons to be hopeful that ministers broadly get that. Wes Streeting’s announcement that “crack teams” to cut NHS waiting lists will be deployed first not in places with the longest waits, but in those with the highest rates of people off sick, is a promising sign of different bits of government pulling in the same direction. The promise by the housing secretary, Angela Rayner, to make private landlords tackle damp and mould swiftly wasn’t billed as a public health measure, but is potentially a life-saver for people with respiratory diseases. The promise by the work and pensions secretary, Liz Kendall, of “no more writing people off, then blaming them just to grab a cheap headline” reflects a genuine desire for less noisy tub-thumping, and more practical focus on results – including giving more freedom to local mayors and councils to run back-to-work initiatives on the ground. But the NHS Confederation’s hopes of creating a virtuous circle – where upfront spending to improve the nation’s health ultimately leads to lower welfare and healthcare bills, freeing up billions for everything else – requires something bolder than a “Treasury says no” approach focused stubbornly on upfront savings. There must be money to match good intentions, or Labour risks making already tough lives still tougher. Gaby Hinsliff is a Guardian columnist