The number of people on Incapacity Benefit and Employment and Support Allowance is around 2.4 million. That is fewer people than it was in 2010 – when it was 2.6 million. That fall is welcome but it is more modest than the fall in the number that are unemployed as measured by being “on the dole” – that is claiming JSA. That has fallen from 1.35 million to 973,000. (All figures are according to the NOMIS website.)

Generally unemployment gets the most attention. But what about the larger group – those on sickness benefit? Could more be done to get them back to work?

Today David Cameron is putting the focus on the 100,000 people claiming sickness benefits on the grounds of treatable conditions such as drug or alcohol addiction, or obesity. At present, there is no requirement for such people to undertake treatment, meaning it is possible to claim without making efforts at recovery.

So the Prime Minister has asked Dame Carol Black to undertake a rapid review in to how best to support those suffering from long-term yet treatable conditions back in to work. In particular, she has been asked to advise on how to ensure that the benefit system incentivises these groups to follow recommended treatment plans – and consider whether benefits should be removed from those who refuse to engage with that treatment.

Mr Cameron said:

“Too many people are stuck on sickness benefits because of issues that could be addressed but instead are not. Some have drug or alcohol problems, but refuse treatment. In other cases people have problems with their weight that could be addressed, but instead a life on benefits rather than work becomes the choice. It is not fair to ask hardworking taxpayers to fund the benefits of people who refuse to accept the support and treatment that could help them get back to a life of work.

“The next Conservative Government is determined to make sure that the hardest to help get the support they need to get them back to a fulfilling life.

“That is why I have asked Professor Dame Carol Black to undertake a rapid review in to how best to support those suffering from long-term yet treatable conditions back in to work.

“In particular, I have asked her to consider whether people should face the threat of a reduction in benefits if they refuse to engage with a recommended treatment plan – it is vital that people who would benefit from treatment get the medical help they need.”

Professor Dame Carol Black said:

“I am deeply interested in trying to overcome the challenges these types of benefit claimants pose.  These people, in addition to their long-term conditions and lifestyle issues, suffer the great disadvantage of not being engaged in the world of work, such an important feature of society.”

Naturally the benefits going to the obese attracts particular controversy. Although according to this response to an FOI request they are a relatively small number – 1,780. For the alcohilics it’s 56,000. For the drug addicts it’s 33,650. For those suffering sever stress it’s 47,990.

Cynics are already claiming that the proposal for a tougher approach will win votes for the Conservatives. Maybe it will. But no political party taking a responsible approach to the public finances can ignore this huge part of the welfare budget.

Some will say that requiring treatment is no use as for treatment to work people must want to have the treatment. I asked Dr Robert Lefever about this. He has treated over 5,000 addicts – probably more than any other doctor in the country.

Dr Lefever said:

“People don’t have to want treatment for it to work. Some people arrive spitting and kicking at the clinic but then find it works. Others arrive all smiles but don’t have the motivation to see it through.”

He added that he supported Mr Cameron’s announcement:

“Bailing people out – whether it is their parents or the Government – can make it harder. There is a Narcotics Anonymous joke: ‘Q. What’s green and gets you high? A: A social security cheque’. People need to take responsiility for their actions. For them to turn round and say they have no intention of taking responsibility for it and will live off the state for their entire lives is not acceptable.”

 Certainly some of the criticism of the proposal does not seem to have been thought through. Would those who argue that a financial penalty is irrelevant say the same about the impact of tax on tobacco?

One and half million people have been on sickness benefit for over five years. It is morally right – as well as politically and economically right – to do everything possible to reduce that number. Sometimes the treatment might not work. But it has a better prospect of success than the state just writing people off – which is a false brand of compassion. For so many of our fellow citizens to be left languishing rather than have the chance to live to their full potential is the most terrible waste. Addressing this problem is overdue.