No, Helen Whately, there are not “millions” of people on Motability. And you need to look up acne fulminans. But no one is on PIP, never mind Motability, for ordinary acne, nor for mild anxiety, nor for tennis elbow, nor for any of the other conditions that you and your like suggest. Everything that a claimant has will be on the paperwork, but that does not make all of it grounds for the award. Find someone with each, or even all, of those common complaints, but with no other medical problem, and see how such a claim would be received. Every constituency Conservative association will contain someone with tennis elbow, and Reform UK will be awash with acne. Nor is Motability “a free car”. These are not mistakes. They are lies.
As is Pat McFadden’s claim that you can just self-certify onto benefits for mental illness. Try it, McFadden, you who claimed £40,000 in parliamentary expenses to rent the house next door to the one that you owned, and which you let out for more than you were paying in rent. It is also a lie that a working couple with three children would have to earn at least £71,000 to be at the same level of income as a claimant couple with three children. Not only are those not mutually exclusive categories, but those numbers are impossible. The benefit cap outside London is £22,020 per year for families, or £14,753 for single adults. In London the figures are £25,323 and £16,967. The moment that you hit the cap, then down goes your Universal Credit. No one household could claim all of the benefits necessary to reach anything remotely approaching £71,000. Produce the award letter of anyone in receipt of that much. And attend to Frances Ryan:
Months before the government used the budget to launch plans to tackle Motability – the scheme that leases subsidised vehicles with some disability benefits – a website started quietly spying on disabled drivers. Motability Check – run by an unknown third party and now offline – allowed members of the public to type in any number plate and (largely incorrectly) see if it was a car provided by the firm. The purpose appeared simple and disturbing: spot that neighbour who says they have a bad back and check with a few clicks if they are milking the taxpayer.
From the spring, the idea that Motability was offering disabled people “free” BMWs and Mercedes began to spread. While the right-wing press suggested someone could get a vehicle for “bed wetting” and acne, blue tick accounts on X gleefully argued the only car available to claimants should be cheap, ugly and “have MOTABILITY written on it, preferably in neon”. By October, the narrative had gone mainstream as the supposed scam of free cars was leapt on by the Conservatives and Reform UK.
Fast forward to this winter and Labour has set out plans to end £300m a year of tax breaks and remove premium brands from the scheme. Rachel Reeves even mimicked right-wing memes with her language when she announced it: Motability “was set up to protect the most vulnerable, not to subsidise the lease on a Mercedes-Benz”. Meanwhile, Kemi Badenoch said this week the Tories would ban conditions such as anxiety and ADHD outright from being eligible.
If 2025 has been the year “welfare reform” reentered the lexicon of British politics, few events sum it up more than the assault on Motability, a policy that has been a lifeline for disabled people for almost 50 years with little fuss.
This is partly a story about valid scrutiny of a multibillion-pound body handling public money. There has been a large growth in Motability recently – with the customer base rising by about 200,000 in two years to 815,000 as the nation’s health has declined and disability benefit claims increased. Similarly, it is fair to question high executive pay and the company’s reportedly large cash reserves.
But it is far more a story about how a mix of misinformation, prejudice and insecurity has reignited an all-too-familiar fire: when living standards are stalling and public services failing, society turns on a minority said to be having it easy at taxpayer expense.
From asylum seekers staying in hotels while locals struggle to pay the rent to benefit claimants driving a new car as workers miss the bus, this year has seen a fixation on what certain – notably marginalised or disadvantaged – groups supposedly get.
We are in an era that is in many ways defined by a sense the state no longer provides what the public needs: not just the NHS and schools but libraries, social care, parks and so much else. Add in the fact the squeezed middle is being taxed more and millions of others continue to struggle for the basics, and the idea that there are disabled people getting luxury cars handed to them naturally fuels resentment. That’s only compounded when large sections of the media and political class propagate the now common idea that many of those in receipt of support are not really disabled (or for that matter, tax-paying workers).
But is any of it actually true? I spoke to experts about the popular claim that the Motability scheme is easy to exploit. “Accessing Motability requires extensive applications, medical evidence, invasive examination, testing and proof of your impairment, and reapplication for support every few years,” said Sophia Kleanthous from Transport for All. “We support many disabled people who have been wrongly denied support, because they’ve struggled to prove that they meet this high bar.”
What about the idea someone can get a car because of allegedly minor conditions, such as acne? “Government data shows there are just five people claiming enhanced mobility [of the gateway benefit, personal independence payments] for acne,” says James Taylor from Scope. “The stats don’t show co-conditions, so those people could have multiple other disabilities too.” That means the handful of people with acne who are eligible for a Motability car – but are not necessarily leasing one – could have, say, arthritis as well.
The British Association of Dermatologists also confirmed to me that there are ways acne might impact mobility, including rare forms that can cause joint pain. GB News pundits, funnily enough, aren’t medically qualified.
That disabled people should not get a luxury car on the scheme might similarly sound reasonable at first. But take a look at the data and only 6% of Motability’s fleet is made up of non-economy brands, while the cost to the taxpayer is exactly the same due to the fact disabled people already pay the extra fee themselves.
“We all choose a car that meets our requirements – say, one that fits the kids. Disabled people do that too,” says Kleanthous. “We might need an adapted car with enough height to carry us in our wheelchair or a boot that self closes. Some accessibility features are only on higher-spec vehicles. But the biggest issue is choice. Motability allows us to have a car we need, but we should still be able to choose to pay more to have the car we want.”
Look ahead to the new year and more of this is on the horizon, from the government’s plan for special educational needs and disabilities (Send) amid talk of parents abusing the system, to Wes Streeting’s review of the supposed “overdiagnosis” of mental health issues in light of rising sickness benefit claims.
Such ideas appear to be salvation to Keir Starmer’s ailing administration, but it may well find that these only add to its problems. Just as with immigration, capitulating to critics of Motability will never be enough. The goalposts always move: first the issue is said to be disabled people having luxury cars, then tax breaks, then any car at all.
There is a way out of this: raising living standards, well-funded public services, and a spirited defence of the safety net and those who rely on it. It will also require an honest conversation about why we are collectively getting sicker and addressing the underlying causes rather than stubbornly assuming there is an epidemic of healthy people faking. That is not a quick fix, but it is the only one that will help heal an increasingly broken social fabric. Making it harder for a disabled person to leave the house is a dark and false solution to a genuine crisis.
Wes Streeting is a politician whose keen interest in the zeitgeist is only matched by his seeming drive to be as close to the heart of it as possible. It is, therefore, not much of a surprise that the secretary of state for health and social care should end the year by announcing what the official blurb calls an “independent review into mental health conditions, ADHD and autism”. Many of the resulting headlines put it more pithily: in keeping with an increasingly deafening media din, this will seemingly be an investigation into “overdiagnosis”.
Candidates for 2025’s word of the year have so far included “rage bait” and “parasocial”, but overdiagnosis is surely the term that perfectly captures the intellectual and political fashions of the past 12 months. The mess of ideas it crystallises now has a set text, published back in March: The Age Of Diagnosis by the neurologist and epilepsy expert Dr Suzanne O’Sullivan. Having been pronounced on, with his usual belligerent ignorance, by Nigel Farage, overdiagnosis has become an obsession of the Reform UK deputy leader Richard Tice, who now holds forth about why some children with special educational needs shouldn’t be entitled to dedicated school transport, and claims that the sight of kids with sensory issues wearing ear defenders at school is “insane”.
News of an official review first broke in October, and its terms of reference seem comparatively reasonable. In The Guardian, Streeting wrote last week about a focus on “support for mental health conditions, autism and ADHD”, and “how the NHS can meet the needs of all”. The review’s launch document makes mention of “prevalence, drivers, early intervention and treatment”.
But clearly, its work has been commissioned partly for political reasons. There is a queasy whiff about its basic remit that – with strong echoes of what we hear from “overdiagnosis” merchants – clumsily mixes questions about mental illness (anxiety, depression) with autism and ADHD, which are neurodevelopmental. As mentions of “economic inactivity” prove, there is a clear sense of pitch-rolling for the return of so-called welfare reform. There are also telling uses of the word “medicalisation”, a term usually favoured by people who think that many conditions do not need any diagnosis at all.
And as is becoming its habit, the government has decided to speak to different audiences in contrasting tones of voice. In the front-page splash that first announced the review, The Times said the health secretary was “concerned” about rising rates of diagnosis of both mental illness and what we now understand as neurodivergence, and there was also mention of ordinary feelings and stresses being “overpathologised”. All this sounds worryingly like a polite manifestation of a very familiar kind of thinking, reflective of a country in which questioning other people’s needs is almost becoming a national sport.
Answers to questions the new inquiry asks might be less complicated than they seem. There are more people being diagnosed with anxiety and depression because of an education system and model of work that are so harshly competitive and inherently precarious, and the still-overlooked effects of the pandemic. ADHD – which, just to reiterate a very important point, is not a mental illness, but a matter of neural wiring – is something we are only just starting to understand, but it is worth recalling official reports that put the number of children and adults in England who are affected at 2.5 million, though only 800,000 currently have a formal diagnosis. Those numbers, moreover, are evidence of something that is not going to go away: our ever-growing understanding of the sheer complexity of our minds and brains, and how much our institutions still lag behind.
That is also true of rising autism diagnoses. We live in the long aftermath of diagnostic changes that happened in the 1980s and 1990s, when the definition of autism was widened to include people without an intellectual or learning disability, reflecting the basic – and incontestably correct – idea of a spectrum. The next stage of those shifts arrived only a relatively short time ago, when the different and often complex ways autism presents among women and girls finally began to be discussed. A new level of autism awareness fostered by the internet, meanwhile, had alerted people to the fact that they need not put up with constant misunderstanding and bullying; these days, they can find out who they – or their children – really are, what help they may need, and how to thereby live a life that is more settled and fulfilling.
That prospect ought to be exciting and liberating. Unfortunately, our economy is flatlining, and public spending is constantly squeezed. So, amid lengthening waiting lists, how do we deal with all that increased need? Overdiagnosis offers a simple answer: you tell people – not least those who can be classified as “mild” or “moderate” cases – to be more resilient, and wave them away.
There is one very convenient article of faith that seems to be increasingly fashionable in Westminster: the idea that diagnoses can do more harm than good, which is the key contention that defines O’Sullivan’s book. “The stigma of autism has been associated with low self-esteem among children,” she writes, while blithely feeding those same negative perceptions by referring to autism as a “brain disorder” and an “illness”. An autism diagnosis, she claims, runs the risk of being “a self-fulfilling prophecy, as some will take the diagnosis to mean they can’t do certain things, so won’t even try”. But unless we can specify who people are and what broad psychological category they fit into, how do we know how to help them: what educational methodologies to use, how to adjust their learning environment and what aptitudes and talents can be developed?
Over the past eight months, I have had hundreds of conversations about all this, at events put on to promote Maybe I’m Amazed, the memoir I’ve written about my autistic son James, and how, ever since he was a toddler, music has been a massive part of how we connect. From Jersey to the Yorkshire Dales, one insight has come up countless times: the fact that the autistic spectrum is not nearly as linear as some people think, and that the relevant traits occur with such wildly different intensities that crudely labelling people as “mild”, “moderate” and “severe” is sometimes all but impossible. That blurs into another regularly voiced point: how the plain fact that human beings’ brains work in completely varied ways rather makes a mockery of a basic method of education – standing in front of 30 kids and shouting at them for an hour – that is now decades out of date.
There is another thing that people always talk about. Autism often reflects traits that run through people’s family trees – something they tend to become aware of in retrospect. Past flickers and flashes of eccentricity, obsessiveness or social awkwardness will suddenly take on new meanings. More painfully, people suddenly become aware of relatives who had frustrating and broken lives, because so little was known about things that many of us now take as a given – not least the fact that autistic minds are as complex and sophisticated as any other kind, and in most cases, they need careful support and nurturing. And in that context, theories and pronouncements about overdiagnosis sound to many people like a nightmarish turning-back of the clock.
They are not wrong. Human psychology is complicated. Politics and power, by contrast, tend to be crass, cruel and prone to coming up with completely the wrong questions. Which brings me to one question I’d like to ask the health secretary: however much he prettifies it, why is he picking over the number of diagnoses, when he could be focusing on why our systems of work, education and care are still so closed off to the people who get them?
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