House of Commons
Tuesday 9 January 2007
The House met at half-past Two o’clock
Prayers
[Mr. Speaker in the Chair]
Oral Answers to Questions
HEALTH
The Secretary of State was asked—
Waiting Times
At the end of November 2006, seven Leicester patients had been waiting for more than six months for in-patient treatment following the decision to admit. That compares with 3,437 in March 1997.
It is interesting to note that on 16 November, the Secretary of State said:
“We have cut the waiting time for elective operations, hip replacements and so on… from GP referral to the operating theatre”.—[Official Report, 16 November 2006; Vol. 666, c. 147.]
Will she look into the case of Mr. Ferriman, who lives in Braunstone town, about 100 yards from her constituency? His GP referred him for a hip replacement in April last year, and he has been given an appointment for an operation in April this year. Does the Secretary of State think that that counts as less than six months?
If the hon. Gentleman sends me the details, I will of course examine the case and write to him, but I am surprised and disappointed that he did not take the opportunity to congratulate the NHS on bringing waiting times down to their lowest level since records began. I am really not prepared to take lectures on waiting times from the hon. Gentleman, who voted against the increased investment that we are making in the NHS.
I welcome the reductions in waiting times, and if there are cases in which individuals have struggled I am sure that my right hon. Friend will look into them; but will she also acknowledge that one of the consequences of increased throughput is the potential for superbugs? Is she aware of the campaign launched by the Loughborough Echo, aimed particularly at clostridium difficile and its consequences for my constituents? Will she try to ensure that it appears on death certificates in future, to make not just patients but hospital staff more aware of the problem?
We all share my hon. Friend’s concern about the increase in clostridium difficile—which is a particularly problematic hospital-acquired infection—in some hospitals, including hospitals in Leicester. That makes it all the more important for us not just to continue to shorten waiting times for operations but to ensure that patients are treated in the community, closer to their homes, when that is appropriate and clinically safe.
I join the Secretary of State in welcoming the reduction in six-month waiting times in Leicestershire, but may I remind her of information given by the Minister of State, Department of Health, the hon. Member for Leigh (Andy Burnham), in a written answer on 8 November 2006? He reported that in the NHS as a whole, 87 per cent. of patients had been treated within six months in the year to last April. May I also remind the Secretary of State that in 1990, 17 years ago, the equivalent figure was 86 per cent.? Does she think that an increase of one percentage point over 17 years is a good return for the huge increase in investment that she mentioned earlier?
I am glad that the right hon. Gentleman began by congratulating the NHS, and I welcome his recognition that waiting times for elderly people needing hip replacements, for instance, were longer than 18 months when he was Secretary of State for Health. But of course we need to do more, which is exactly why we have promised that by the end of 2008 the maximum wait from GP referral to operating theatre will be just 18 weeks, but that for most people the wait will be much shorter. I hope that the Conservative party will support the NHS in making the further changes needed to achieve that dramatic improvement in care, and will congratulate the NHS as it achieves them.
I thank my right hon. Friend for increasing the budget of the primary care trust over the past 10 years. It doubled to £173 million last year. Does she, however, share my concern and that of my constituents, who, when they try to obtain appointments with GPs for referral purposes, are met with administrative delays and difficulties? Is she planning any guidance for local GPs on the way in which their front-line staff should deal with the public, so that when people ring to ask for an appointment they are given one and are therefore referred as quickly as possible?
My right hon. Friend is right. Because some general practices—although, I think, only a minority—do not have proper appointment systems, it can be very difficult for people to obtain appointments when they need them, whether on the same day or in advance if that is what they require. However, I hope that my right hon. Friend welcomes the fact that thanks to the target we have set, people no longer wait for weeks on end to obtain appointments. I believe that the patient survey which will begin this month, and which will be linked to GPs’ pay, will ensure that the minority of GPs who are not yet offering convenient appointments will do so in future.
Mental Health
We are introducing supervised community treatment for patients who have been detained in hospital under the Mental Health Act 1983. That is an important change, which brings legislation into line with modern service delivery and follows the example of modern practice in other countries around the world.
I am sure my right hon. Friend is aware of the fear expressed by some in the mental health world that people could continue to be given supervised community treatment for lengthy periods without the introduction of adequate safeguards. Can she assure me that that will not happen?
My hon. Friend is right that such concerns have been expressed, but I hope that I can reassure her that patients receiving supervised community treatment will be entitled to a comprehensive package of safeguards that are just the same as those for patients detained in hospital. The need for SCT will be subject to regular review in exactly the same way, and patients will have the right to apply for discharge to a tribunal and the hospital managers of their responsible hospital.
The Minister mentioned countries around the world, so presumably the Department of Health has access to information that proves that supervised community treatments are successful around the world. When will that information be released for general consumption?
A number of studies have been carried out into SCT. As I have said, it is available in countries around the world—including Scotland, now—to bring them in line with modern service provision. One of the published studies is from New Zealand; it shows that SCT not only worked for carers and patients’ families, but that patients also liked it because it meant that they could return home instead of having to be detained in hospital. The Department is also carrying out some research; it is currently being peer-reviewed, and it will be published fairly shortly.
Hackney, South and Shoreditch has a higher than average incidence of mental health issues, and I have received a lot of correspondence from people about community treatment orders; psychiatrists have raised the issue of holding people against their will in the community. Although I think that community treatment can be better than hospital treatment, how can my right hon. Friend reassure those with concerns that people will not be held against their will but will receive the treatment that they need and that their lives and their community will be made better?
First, it is important to emphasise that clinicians will decide whether supervised community treatment is appropriate for individual patients. We all know that there are instances of patients being released from hospital who then go into the community and who, perhaps, do not take their medication or stay in touch with health services, and whose condition deteriorates to such an extent that they become a danger to themselves or to other people. That is an example of where SCT could apply. It is important to remember that that often puts patients back into the care of their families, instead of their having to remain in hospital. That will be good for patients and for public safety.
The Minister acknowledges that community treatment orders are a contentious provision in the Mental Health Bill, so will she now confirm that her Department commissioned a report entitled “International experiences of using community treatment orders”, which was delivered to her last autumn, and which concluded, from a survey of 50 countries, that CTOs have been found to have no clear effect on patient outcomes or risk reduction, and that these psychiatric ASBOs have been described as discriminatory by many patient groups, not least those representing BME—black and minority ethnic—patients who have suffered disproportionately? Why has she failed to publish this report, after my parliamentary questions and my freedom of information request, given its relevance to the Mental Health Bill which is currently under scrutiny in Parliament?
As I have said, the report is being peer-reviewed, and it will be published. Frankly, the Opposition must decide whether they will support a Bill that will introduce supervised community treatment so that high-risk patients get the treatment that they need to keep them well after they are discharged from hospital, and that will lead to people who have potentially serious and dangerous personality disorders getting the treatment that they need. That is the issue.
The hon. Gentleman has called these measures the Government’s latest attack on civil liberties. He needs to think very carefully about the civil liberties of people who go in and out of hospital three or four times a year because we cannot get treatment to them, and the civil liberties of patients, victims and their families who have suffered because we do not have the powers to treat people in the community.
Health Inequalities
Recent figures show that Plymouth is reducing inequalities in coronary heart disease and cancer, although there is more to do on life expectancy and infant mortality. There is active co-operation between the primary care trust, the local authority and other partners to tackle health inequalities in Plymouth.
I thank the Minister for her recognition of the good work done by people in public health in Plymouth, but does she recognise that in order to continue to deliver in that way, they need confidence to plan ahead? What guidance can she offer primary care trusts to continue to prioritise spending to address health inequalities?
I am very pleased to inform the House that in this financial year Plymouth PCT replaced previous health action zone funding with a recurrent allocation of £933,000. In addition, Plymouth secured £966,000 of neighbourhood renewal fund money to tackle health inequalities. That is a total of £1.899 million of funding—twice the amount originally allocated in the choosing health fund. Stretch targets have also been set for the number of healthy schools within the area and also for the reduction of smoking and pregnancy in Plymouth. I congratulate those involved in all those endeavours.
Does my hon. Friend agree that tackling obesity—commonly found, as in Plymouth, in areas of the greatest health inequality—is also helping to deal with the alarming growth in diabetes? That being the case, does she acknowledge the importance of the research being carried out across the country, but particularly in Plymouth by the Early Bird project? It is looking—uniquely—in the long term at obesity and diabetes across social backgrounds, and it needs further funding.
We are acutely aware of the link between obesity and the development of type 2 diabetes. That explains our work in healthy start, which I am pleased to say was trailed to good effect in the south-west and went national last November. It is a way of encouraging better eating habits from the cradle onwards. There is also the healthy schools initiative. Of course we support research, but there is a point at which we know what the reality is and we have to get on with dealing with it.
HIV/AIDS
The Department is continuing to target HIV health promotion towards the most “at risk” groups in England—namely, gay men and people from African communities. In 2006-07, we made an extra £1 million available to strengthen our HIV work for those groups.
Does my hon. Friend agree that work needs to be more targeted at younger gay men? It is important to emphasise that contracting HIV does not mean simply taking a pill a day, when everything is okay. Drug treatment for HIV is very unpleasant and is not 100 per cent. effective, so we need to get that message through to younger gay men.
My hon. Friend makes an important point. There has been a large drop in diagnoses of AIDS and a 70 per cent. drop in AIDS deaths, but it would be ridiculous to suggest anything other than that HIV is something that has to be dealt with every day of a person’s life in respect of the mix of drugs and treatments necessary. My hon. Friend makes an interesting point about the younger age group, many of whom are too young to remember the 1980s campaign and may have a false sense of safety about their future health. I would welcome my hon. Friend, along with the Terrence Higgins Trust, coming to the Department to discuss those issues.
Can I come as well? [Interruption.] Why not? The Minister will know that the incidence of HIV/AIDS has quadrupled since 2000 and part of the problem is the Government’s complacency about it. They announced a substantial advertising campaign last year, but it was many months late and in the end it was pegged back to a £4 million campaign. Would it not be far better if the Government now embarked on a substantial advertising campaign to prevent needless thousands of people contracting HIV/AIDS in the future?
I believe that the last Conservative Government had a review in 1995-96. It looked into the value of mass campaigns in respect of HIV/AIDS. After that review, it was argued that the approach should be targeted more at the particularly vulnerable groups most at risk of contracting HIV. That is the position that we adopted and we carry out that targeted work with the Terrence Higgins Trust and the African HIV policy network. Our recent campaign was about getting across a strong message that is appropriate for tackling chlamydia, gonorrhoea and other sexually transmitted infections as well as HIV. The message is: if you are having sex, always make sure that you use a condom.
Is it not also the case that of the 7,450 new cases of HIV/AIDS in the UK only—of course, it is still far too many—2,356 arose through homosexual sex? Do not many of the cases of AIDS in the UK come from legal and illegal immigrants who enter the country already infected with AIDS? What steps is the Minister taking to liaise with the Home Office to ensure that infection from that source does not spread throughout the UK?
We want to work with all communities that are vulnerable to HIV/AIDS, and that is why we support the Terrence Higgins Trust and the African HIV Policy Network. HIV diagnoses have been increasing since 1999 for several reasons. First, test uptake has increased. For example, among gay men it has risen from 45 per cent. in 1997 to 80 per cent. in 2005, and among heterosexuals it has risen from 25 per cent. to 82 per cent. over the same period. More testing is important, and among those tested are people who may have been living with HIV for some time but in whom it is being diagnosed for the first time.
We are not complacent about any of those areas. We have taken other action, including, for example, the testing of pregnant women. Some 95 per cent. of pregnant women with HIV are diagnosed and that has been enormously successful in preventing mother to child transmission.
We are in discussion with the Home Office on several issues, but it is important not to stigmatise people and to do the best we can. We should also remember that we are a very low prevalence country, with lower rates than places such as Spain, France and Portugal, and we should be proud of our record in that area.
NHS Finances
The NHS as a whole is on course to deliver net financial balance by the end of this financial year, It continues to cut waiting times and perform well against key service targets. Our quarter three financial report will be published next month.
In 2006 and with much fanfare a shiny new hospital was opened in Gravesend. Given the projected year-end deficit for the south-east, what assurance can the Secretary of State give that the hospital is safe and that services will not continue to go elsewhere from it?
The new hospital to which the hon. Gentleman refers is just one of 70 new or rebuilt hospitals already under way, with many others to come. I hope that he will recognise that the enormous investment that we are making, including in the new heart centre that has just opened at Darent Valley hospital, illustrates the fact that we are investing record sums of money in the NHS—investment that his party opposed. We are not cutting services: we are improving them.
I recently conducted a survey of all local authority chief executives in the UK about the impact of NHS budgets on their local authorities, 25 per cent. of whom said that NHS budgets were hurting them. For instance, Buckinghamshire county council estimated a cost shunt of £670,000 from the health service on to the local authority. Camden is seeing an increase in the number of hours of home care as a result of faster hospital discharges. What discussions has the Minister had with the Department for Communities and Local Government about the impact of NHS finances on local authorities and what action is she taking—
Order. This is a supplementary question, not an Adjournment debate.
The hon. Gentleman reflects well the need for social services authorities and the local NHS to work closely together to provide even better care for the people whom they look after from both the local government budget and the NHS budget. We have increased both those budgets and my Department works closely with the Department for Communities and Local Government on that score. I hope that the hon. Gentleman will encourage Liberal councillors to ensure that they do not cut social services for vulnerable elderly people.
Notwithstanding the Secretary of State’s earlier replies, I still cannot see how the undoubted deficits in this year’s budget can be made up other than by cutting services. Mine is a predominantly rural constituency, and is she aware that my constituents will not take kindly to any cuts in services at hospitals in Macclesfield, Leighton or north Staffordshire, or at the Congleton War Memorial hospital? In addition, they will not accept cuts in the mental health services, which remain the Cinderella of NHS provision in this country.
In that case, I hope that the hon. Lady will welcome the recent opening of a new day-case unit and a new medical admissions unit at Macclesfield district general hospital where, in addition, a new MRI scanner has been brought into commission. Moreover, we have invested more in mental health services in every part of the country than any previous Government.
Is my right hon. Friend aware that we in Coventry have received enormous benefits from the great investment made by this Government? We have a brand new hospital, and there has also been tremendous investment in mental health services. That continuing success derives in part from the city’s MPs’ ongoing close consultative relationship with the Department, which I hope will continue with her blessing.
I can assure my hon. Friend that that will indeed be the case.
During the Christmas recess, did my right hon. Friend have the opportunity to read the Institute for Public Policy Research’s recent report entitled “The Future Hospital”? One element of the analysis stated that, on average, patients stay in hospital a day longer if they are admitted on a Thursday than if they are admitted on a Sunday. What is her estimate of the savings that NHS trusts could make if they corrected that inefficiency, without jeopardising patient care?
I did have the opportunity to see that report. It confirms that the NHS would save nearly £1 billion every year if all hospitals ensured that patients went home as soon as they were clinically ready. That is what the best hospitals do already, and the report provides further confirmation that there can be no trade-off between better care for patients and better value for money. The two things go together, and that is what our reforms are designed to achieve.
What incentives are there for primary care trusts to try and balance their books? My Barnsley PCT has been funded under target for years, but it would have achieved financial balance by the end of this financial year had it not been required to pay £7 million to fund the deficits in Sheffield, Doncaster and Rotherham. How long is that money likely to be held by the strategic health authority?
My hon. Friend makes an extremely important point, which reflects the fact that only a small minority of hospitals and PCTs are overspending. Indeed, 50 per cent. of the NHS’ deficit is concentrated in just 6 per cent. of its organisations, and it is unfair for that minority to overspend at the expense of the majority. That is why we are so determined to ensure that the NHS as a whole returns to financial balance, and that the minority of overspenders put their houses in order by making themselves more effective. They must deliver better care for patients and better value for money, and they must also repay the money that they have borrowed, as in the example that my hon. Friend gave.
What steps is the Secretary of State taking to promote more widely the valuable information contained in the NHS’ quarterly “Better Care, Better Value” indicators? In particular, is she promoting that information to hon. Members, so that they can point out to their PCTs the benefits of prescribing generic statins? Is she aware that, in the league table of prescribing generic statins, the PCTs of two of her colleagues on the Front Bench are ranked 291 and 298 out of a total of 303? If they improve—
Order. I have counted three supplementary questions already, and I think that the hon. Gentleman is about to ask a fourth.
The hon. Gentleman is right; the quality and value indicators that we published last year repay close study. That is why we have made them available on a website so that each PCT and hospital can see where they need to make their services more effective, and how they can improve patient care and free up money for new drugs and new treatments. I certainly commend the quality and value indicators to every Member, because they show, once again, how better care for patients can go hand in hand with better value for the record sums of money that the Government have invested in our NHS.
In tackling the difficulties that some areas of the NHS have experienced with their finances, innovative programmes —such as the one in our accident and emergency department to help older people—are often the first to go, rather than traditional programmes. What can my right hon. Friend do from the centre to encourage innovative programmes, which tackle health inequalities and provide improved access to services, and to ensure that they are not the first out under the last-in, first-out programmes that sometimes seem to happen when dealing with health budgets?
My hon. Friend makes an important point. Sometimes, under the pressure of financial difficulties, local organisations understandably make short-term decisions that may undermine innovative programmes that give patients better care and prevent falls, injuries and disease in the future. They thus help to deliver better care with better value for money. We do not try to micro-manage every hospital and PCT from the centre, but we give guidance—[Interruption.] We do indeed give guidance to ensure that such innovation is supported.
Can the Secretary of State tell us what proportion of the additional money going into the NHS is being absorbed by large pay increases, not for categories of staff in short supply—for whom, as she knows, I have long advocated increases—but for groups of highly paid staff, including consultants and general practitioners who have received increases of between £14,000 and £25,000 a year? Before the increases the General Medical Council was sending out notices headed “Important information for medical graduates”, which pointed out:
“There are an average of 210 applicants for each advertisement for junior hospital posts. Many posts attract over 1,000 applicants.”
In the light of that fact, why were the pay increases necessary?
I am sure that the British Medical Association and its membership will note with great interest the right hon. Gentleman’s desire to cut the pay of both hospital doctors and GPs. I am proud of the fact that about half the additional record investment that we have made in the NHS has gone on additional staff and better-paid staff. In the case of GPs in particular, the reason they are earning so much more with a Labour Government than they were under the right hon. Gentleman’s Government is that they are doing so much more work, preventing so much more illness and caring for patients so much better.
I am sure that my right hon. Friend is aware that Gateshead Health NHS trust is one of five in the country that has innovated and now offers physiotherapy services over the telephone. I am sure that she will agree that that helps to reduce admissions by caring for people in the community, and that through such programmes money can be saved and lives transformed.
My hon. Friend is absolutely right and I very much congratulate the NHS in Gateshead on that innovation. There is no doubt that as more orthopaedic patients receive physiotherapy directly in the community, those who need surgery can also be treated much more quickly in hospital.
May I ask the Secretary of State about trusts that have massive historical deficits, often of more than 10 per cent. of their turnover? Nigel Edwards of the NHS Confederation said that for those trusts
“financial recovery would imply such damage to patients that no sensible person would go for it. They would not compromise the survival of the people they serve”.
Is the Secretary of State intent none the less on requiring those trusts to clear their deficits within a specified period, irrespective of their current financial performance and irrespective of the impact on patient care?
I congratulate the hon. Gentleman on his promotion and welcome him to his new place on the Front Bench.
I have made it clear all along that we expect the NHS as a whole to return to financial balance by the end of the financial year. For the very small minority of organisations with very serious and long-standing deficits, it would be quite impossible for them to return to balance within one financial year, so they are being given longer. However, the longer they take to return to financial balance, the longer other organisations—we have heard from one of the primary care trusts today—will have to hold back on some of their growth money to compensate for the continuing overspending elsewhere.
Will my right hon. Friend ensure that the future viability of Chorley and Preston hospitals will not be put at risk through the transfer of work from those hospitals to the private sector? The issue is about capacity within those two hospitals and we do not want to see ward closures. Will she ensure that that work is not transferred?
The new independent sector care assessment and treatment service that is proposed for the north-west will deliver to my hon. Friend’s constituents and many other patients a better and faster service and it will do so by providing capacity additional to the capacity already available within the NHS and by enabling NHS capacity to be used much more effectively.
Does the Secretary of State agree that the financial stability or otherwise of NHS organisations is a fundamental measure of overall financial performance? Halfway through the last financial year, 134 NHS organisations forecast a deficit at the end of the year. Will she tell the House how many NHS organisations this year are forecasting a deficit?
The information, as at the six-month point, was published in that financial report, but we will update that next month when we publish the quarter three financial report. As I say, I remain entirely confident that the NHS will achieve overall financial balance and that more organisations will move towards financial balance this year.
I am surprised that the Secretary of State did not tell us; the answer to the question is 175 NHS organisations this year. What is particularly worrying is that last year the situation deteriorated between month six and the end of the year. An additional 45 organisations went into deficit. Can she explain why she believes that fewer NHS organisations will be in deficit this year and how many she expects to be in deficit? If they remain in deficit, precisely what the hon. Member for Barnsley, Central (Mr. Illsley) described will continue to happen: the money for organisations across the country will be top-sliced and their growth money will disappear in order to fund continuing deficits.
I notice that the hon. Gentleman never has anything constructive to say about the need to get better value for the record investment in the NHS and nor does he ever support NHS organisations in making the difficult decisions that are needed to get better value. We are publishing quarterly financial reports on the NHS—we are the first Government to have done so—precisely so that we and the NHS can track the progress that is being made, see exactly what steps need to be taken and take account of additional factors, such as the further cuts in prescription drug prices that are coming through, to ensure that the NHS gets back on track financially and continues to improve services for patients.
Mental Health
Improving access to psychological therapies formed part of ministerial discussions for the White Paper “Our health, our care, our say”. The two demonstration sites that have been established will provide evidence for a business case on investing in local psychological therapy services across England and will form part of our discussions with the Treasury as part of the comprehensive spending review.
The Government have done a good deal to tackle the Cinderella status of mental health within the NHS, but there remain difficulties with access to psychological therapies such as cognitive behavioural therapy, where waiting times exceed 12 months in 90 per cent. of primary care trusts. Can the Minister please act to ensure that such talking therapies are made available to all who need them and not just to those whose employment prospects will be improved and, in particular, to widen access to marginalised groups such as children, adults in hospital or in prison and black and minority ethnic communities?
My hon. Friend is quite right to say that waiting times are too long at the moment, particularly for CBT. The point of putting the demonstration sites together is to learn from them exactly what is working so that we can make the case to persuade other areas to follow that example. As well as improving the number of clinical psychologists, it is important to look at the part that other health care professionals can play, particularly in the case of the new graduate workers that we are bringing in, and to look at extra training for health care visitors, for example, so that they can reach out to some of the groups that he has outlined to make sure that they get access to these important therapies.
Will the Minister look at the effect of the delays in psychological services generally and cognitive behaviour therapy specifically on young people, including students? All the evidence is that young people going into early adulthood, particularly at universities and colleges, are the most likely to commit suicide or to self-harm. There are often long waiting lists and no local services available, even with the best will of the universities. Will she see whether she can either buy in more services or allow people to use other services locally to prevent a crisis or worse?
The hon. Gentleman is quite right: it is important that we look specifically at younger people. There are many instances where different agencies could work more closely together. I am talking about some of the personal advisers through the Connexions services and some of the facilities available in schools. We need to look at how we can bring those more closely together to make sure that, when people need those kinds of services, we are able to provide them more readily than they are provided at the moment.
Will my right hon. Friend look closely at the positive results coming from pathways to work pilots, where cognitive behaviour therapy offered by the NHS, but paid for by the Department for Work and Pensions, is having an enormously beneficial effect in improving people’s mental health and allowing people not only to re-enter the work force, but to be happier as human beings? Clearly, that needs to be available in the rest of the country. Will she also look at the evidence that this therapy can be offered not only by psychologists, but by other health care professionals such as nurses and health visitors?
My hon. Friend is absolutely right. Part of the important work that is being done in the pathways to work pilots is making that connection with employers. There is a lot that employers can do not only to break down some of the stigma and discrimination that there is against people who have mental health problems returning to work and remaining in work, but to support them when they have those difficulties. Again, the demonstration sites, linking with the pathways to work project, show a way in which we can build that into the services that we provide more widely. She is absolutely right that, as I have said, there are other health care professionals who, with a little extra training, can provide some of these services extremely effectively.
Bedford Hospital NHS Trust
There have been three parliamentary questions and the hon. Gentleman has written to the Secretary of State and to me on this matter. The Department has also received correspondence from other hon. Members and from members of the public. In addition, my right hon. Friend the Secretary of State visited the trust on 4 October and discussed these issues with staff.
I have also had a letter from the Minister’s permanent secretary apologising for a misleading written answer that was given to me earlier. Is the Minister aware that, since the new year, Bedford hospital has had to instruct its doctors that no non-emergency case can be operated on in less than the maximum allowed time frame, that outpatient clinics are being restricted and that bed shortages are causing real concerns? All that is happening because of a need to fulfil an arbitrary time scale to combat an arbitrary calculated deficit. When my constituents pay so much for their NHS, why are they and all who work so hard at the hospital being put through such downright misery, and why is it so often the case that Government targets dictate to patients, rather than patients’ needs driving the targets?
I acknowledge that the hospital has had a difficult time and that difficult decisions have been taken to get it back into financial balance. However, I hope that the hon. Gentleman welcomes the fact that the hospital is now in monthly run-rate balance—it is in balance or better on what is coming into the hospital. The hospital is also forecasting a year-end financial position that is close to break-even. I did not hear any mention of that in his question and nor did he acknowledge that no waiting time target will be breached. The waiting times that are being met in his constituency are significantly better than those with which he left us when his party left government.
Does my hon. Friend recognise that an agreement has been reached between Bedford Hospital NHS Trust and Bedfordshire PCT on moving to a 20-week maximum wait? An additional £500,000 has been allocated to the hospital for planning purposes to enable it to do that, which will represent steady progress towards the national target of an 18-week maximum referral time from GP to intervention. Is that not part of the progress that is being made in the NHS in not only Bedfordshire, but throughout the country, which is in sharp contrast to some of the negative stories that we have heard of late?
I pay tribute to my hon. Friend because he has supported and encouraged his NHS to make the kind of progress that he has described. The NHS in his constituency is making progress towards the 18-week target, as is the NHS in other constituencies throughout the country. Instead of celebrating the hard work of managers and staff in his area to make such improvements, Conservative Members simply decry their efforts and demoralise staff by making exaggerated claims of the difficulties. We hear talk of a save Bedford—
It has been reported in the local press that Bedford Hospital NHS Trust will be asking GPs to take over the provision of genito-urinary medicine and sexual health services. We know that reported cases of chlamydia, gonorrhoea and HIV are on the rise, and my GPs say that they have neither the training nor the facilities that would be required. More importantly, patients want to go to a hospital where they can have guaranteed anonymity. Will the Minister send out a letter to Bedford Hospital NHS Trust saying that GUM services must not be closed down at Bedford hospital and devolved to GPs?
I would just ask the hon. Lady and her Conservative colleagues to stop setting their face against any change to the way in which services are delivered in the national health service. They should consider the possibility—this might just be possible—that it might be in the interests of patients for some services to be delivered out of the hospital setting and closer to their homes. I encourage the hon. Lady to open her mind to a thriving future for Bedford hospital and to accept the possibility that some services might be better delivered in the community.
York Hospitals NHS Trust
As my hon. Friend is aware, the PCT is working closely with the trust and the strategic health authority to agree changes that will lead to more cost-effective services. These changes will lead to a better use of resources, with some patients being treated more appropriately closer to home.
The national health service is based on the principle that care is provided on the basis of patients’ clinical needs, not their ability to pay, so will the Minister reassure the House that the rights of patients in north Yorkshire will be protected, despite the PCT’s deficit, and that they will retain access to the same range of NHS treatments, and experience the same waiting times, as NHS patients from other parts of Yorkshire and the Humber?
I agree with my hon. Friend and congratulate him on adopting a constructive approach towards the difficult financial circumstances that his PCT faces. As difficult decisions are made to ensure that we get that organisation back into balance, it is important that patients continue to enjoy access to high-quality services. However, it sometimes might be more appropriate to provide those services in the community, so this might be an opportunity to make some of the changes that frankly should have been made anyway, irrespective of the financial pressures that the organisation faces. Of course, the interests and needs of patients must remain at centre stage, and the trust must maintain the national standards that are set down on the quality of patient care.
Does the Minister think that it is fair that while NHS workers in York are bearing the brunt of the £77 million deficit in north Yorkshire, the nature of the contracts imposed on the PCT by the Government means that the new private Capio hospital in York escapes relatively unscathed?
What is important is the fact that patients in the hon. Gentleman’s area have access to high-quality services and are required to wait for as short a period as possible. If that means allowing constructive engagement between the NHS as a direct provider and the independent sector, leading to better treatment for patients in his community, I would have thought that he would welcome it.
I am delighted that Capio is enabling us to reduce waiting times for certain operations, but will the Minister respond to the question asked by the hon. Member for City of York (Hugh Bayley), with whom I entirely concur? The issue is not about having services delivered by other providers in the hospital trust, but about unacceptable delays and clinical need being put on the back foot. Will the Minister please respond to that question?
The waiting time targets apply in the same way in the hon. Lady’s constituency as in the rest of the country. Indeed, if we look at the facts, we see that no patient is waiting longer than 26 weeks for in-patient treatment, compared with 1,317 patients who did so when we came into Government in 1997. I hope that she will acknowledge the two new CT scanners that have been delivered to the hospital, the replacement MRI scanner, the fully modernised accident and emergency department, the additional cardiac catheter laboratory, and the new day unit, which was opened only in December last year, not to mention the £6.1 million integrated breast unit on the York hospital site. These are difficult times, and there are difficult decisions to be made, but there have been massively increased levels of investment and performance since 1997.
Health Care (East Cheshire)
Central and Eastern Cheshire primary care trust is developing new health services that will enable patients to receive treatment closer to home.
I am surprised that my namesake did not refer to maternity services, because they are the subject of my question. Is the Minister aware that birth rates in east Cheshire, which is served by the Macclesfield district general hospital, have increased for three years in a row? Women are opting to come to Macclesfield, in increasing numbers, to have their babies. Does she not agree that if women show that preference, it is essential to keep in-patient paediatrics, maternity, obstetrics and other children’s services in the Macclesfield district general hospital, in accordance with that decision? Will she ensure that those services in the hospital, which serves a predominantly rural area, are fully, properly and fairly funded?
I was not aware of the massive increase in the birth rate that has taken place, but I am now. I also know that the PCT is exploring the possibility of linking some of the maternity and paediatric services in the Cheshire area. Obviously, in doing so, the PCT will have to satisfy the strategic health authority that it is meeting clinical standards, such as those set by the Royal College of Midwives, and can still provide a full range of local services. I understand that the hon. Gentleman is meeting Mike Farrar, the chief executive of the North West strategic health authority, on 12 January, and I am sure that he will make his views clear at that meeting.
Is my right hon. Friend aware that in my constituency, which is part of the Central and Eastern Cheshire primary care trust, for the first time in 30 years, we shall have a totally new health centre in the middle of Crewe, an entirely new health centre in the middle of Nantwich, and a new centre in the middle of Sharington? That is a remarkable feat, and I hope that she will give credit to the remarkable negotiating skills of Professor Dr. Ong, who has managed the normally unachievable feat of getting vast numbers of general practitioners to work together.
My hon. Friend is right to highlight some of the results of the Government’s increased investment in the national health service, and the real benefits that it can bring to patients. I am glad to hear her praise the work of NHS professionals, too; perhaps the Opposition would like to take her lead.
Further to the comments of my hon. Friend the Member for Macclesfield (Sir Nicholas Winterton), the fact remains that maternity services in Macclesfield, like those in Salford and Bury, have not been selected to become centres of excellence in the “Making it Better” reconfiguration across the north-west. It has not escaped public notice that some Ministers are trying to have it both ways by pushing for service redesign at a national level while opposing closures that affect their constituencies. Is not the reason for that embarrassing inconsistency the fact that those reconfigurations take place in the absence of an evidence-based model of safe and accessible maternity care? Will the Minister respond to our call for the Government to engage in a national debate about such a model, so that much loved local services do not face closure without good reason?
The hon. Gentleman will be aware that people who make decisions on the organisation of local NHS services consider what is the best care for patients in the light of the best value for money. We have produced national guidelines and a national plan for maternity services. There is a well established process for service changes, which naturally includes hon. Members expressing views on behalf of their constituents. In the case of maternity services in Greater Manchester, a final decision has not been made, but hon. Members are free to express their views and those of their constituents.
The hon. Member for Macclesfield (Sir Nicholas Winterton) and Members representing Cheshire and Wirral share an excellent mental health trust which, my right hon. Friend knows, has made a bid to become a foundation trust. When will we know the outcome of that bid, and can she assure us that services in east and west Cheshire and Wirral—an area covered by two separate primary care trusts—will be maintained at the same level or, indeed, improved in the new structure if foundation trust status is awarded?
It is obviously a great credit to the mental health trust in my hon. Friend’s constituency that it has been considered for foundation trust status, as that will allow it extra freedom to expand its services. The bids are being examined and a decision will be made as quickly as possible. I am glad that he supports his local mental health trust, which has made genuine improvements for patients in recent years.
Recruitment
Between May and September 2006, about 16,000 graduates qualified. Latest estimates suggest that about 60 per cent. of nurses, midwives and allied health professionals have found jobs, and the situation is improving. About 1,600 physiotherapists completed their training in 2006, and we are working with the Chartered Society of Physiotherapy to address local recruitment problems.
I am pleased that the Minister acknowledged that there are local recruitment problems and difficulties, but he will be aware that in my constituency and elsewhere many physiotherapy graduates have failed to secure jobs, which is a huge worry, both for them and their parents. What else will be done to put that matter right, as it is a great waste of resources?
I appreciate the point made by the right hon. Gentleman. There have been problems in certain parts of the country in the recruitment of physiotherapists who have graduated in the past 12 months. We need to do more to find roles in the community for physiotherapists, but I am confident that there is a need for more physios around the country to help, as we keep saying, to provide care at the local level, to keep people out of hospital and to reduce delayed discharges from hospital. I therefore accept the right hon. Gentleman’s general point, but the most recent returns to the Department of Health for his area show that 71 per cent. of nursing graduates and all midwifery graduates have found employment.
Following the point made by the right hon. Member for Bracknell (Mr. Mackay), is the Minister aware of the predicament of my constituent, Rachel Smith from Shafton in Barnsley, who last year qualified as one of more than 90 physiotherapists at Sheffield Hallam university? The vast majority of those students have still not found gainful employment with the NHS. Nationally, 75 per cent. of last year’s physiotherapy graduates have yet to find employment. Next year, Sheffield Hallam university will train another 120-plus physiotherapists, and my constituent would like to know from the Minister what is the point of continuing to train physiotherapists if the NHS is not going to employ them.
I am aware of the case that my hon. Friend mentions, and I accept his general point, as I did in answer to the right hon. Member for Bracknell (Mr. Mackay). There is pressure and a particular difficulty for people graduating in physiotherapy this year. My hon. Friend’s PCT recently recruited six newly qualified physios, and a further six bank staff to provide on-call services, so there is evidence of investment in physiotherapy in his local area. However, we need to do more to help people find jobs, whether in social care or in health care. In some parts of the country, consideration is being given to a combined job bank of vacancies in social care and health care. Perhaps we can explore that in his region.
Graduate unemployment among physiotherapists stands at 68 per cent.—a waste of nearly £40 million on training. Two thirds of midwifery units are understaffed, yet 40 per cent. are taking on fewer graduates, and 70 per cent. of graduate nurses have not found jobs. Furthermore, we learn that the Secretary of State is planning cuts of 37,000 to NHS staff, dwarfing even our estimates of her staffing cuts, which the Government have, incredibly, tried to refute. Will the Minister tell the House whether graduate unemployment and consequent cuts to patient care are due to shoddy work force planning or short-sighted reaction to the massive cash crisis engendered in the NHS by the Government?
I read the nonsense about staff shortages that the Conservative party put out before the Christmas break—a fantastic piece of Christmas fiction. It claimed that 16,000 graduates could not find work. That is the total number of people who completed training last year. As I said in my answer, 60 per cent. of them say, in reply to the Department of Health, that they have found jobs. The Conservatives should stop scaremongering on these matters. They are trying to frighten graduates and NHS staff by exaggerated talk of NHS job cuts around the country. They are trying to frighten local communities with talk of accident and emergency closures, and maternity—
Speaker’s Statement
The hon. Member for Hendon (Mr. Dismore) has sought the exercise of my discretion to allow him to make reference in his speech to a relevant case which is to be heard later this week by the Court of Appeal. In order to assist the hon. Gentleman, I have agreed to exercise my discretion in this case to allow him a passing reference. I remind the House that I judge each such application on its merits.
Human Rights Act 1998 (Meaning of Public Authority)
I beg to move,
That leave be given to being in a Bill to clarify the meaning of ‘public authority’ in section 6 of the Human Rights Act 1998.
It has been immensely important that the Human Rights Act brought home, so to speak, the rights set out in the European convention. Before the Act came into force, British people had to go to Strasbourg to redress breaches of their human rights. However, in one respect the protection afforded by the Act has been less comprehensive than intended by Parliament. The problem has arisen because of the development of case law interpreting the meaning of “public authority” in the Act.
Under section 6, it is unlawful for a public authority to act in a way that is
“incompatible with a Convention right”.
The Act does not provide a list of public authorities to which the Act is applicable. Instead, it states in section 6(3)(b) that a “public authority” includes
“any person certain of whose functions are functions of a public nature”.
During the passage of the Bill, statements by the then Home Secretary and Lord Chancellor made it clear that privatised or contracted-out public services were intended to be brought within the scope of the Act. The “public function” definition, we were told, emphasised the function rather than the institutional status of the body performing it.
So, for example, it was considered that a private security company would be performing a public function if it were running a prison under contract with the Government. It would be within the terms of the Human Rights Act. But when a private security company is providing a service to another private company, it does not come within the provisions of the Act.
Since the 1998 Act came into force, a series of court cases have turned on whether a particular private company or organisation providing services was within its ambit. The result has been to undermine, or even to overrule, the comprehensive and wide interpretation of “public authority” which was originally intended. One particular case has left utter confusion over that question—the 2002 case commonly known as the Leonard Cheshire case. The local authority-funded residents of a care home run by the Leonard Cheshire Foundation, a private charity, wanted to challenge the decision to close down the home and disperse the residents, who claimed that that broke their right to respect of their home under article 8 of the European convention on human rights. However, the Court of Appeal found that managers of the care home did not constitute a “public authority” within the definition of section 6(3)(b) of the Act, so residents could not enforce their human rights against the care home even though the council still held its obligations to them under article 8, regardless of its contract with Cheshire Homes.
In 2004, after reviewing that judgment and other cases that had turned on the definition of “public authority”, the Joint Committee on Human Rights concluded that the test that was being applied by the courts was “highly problematic”. That has resulted in many instances of an organisation standing in the shoes of the state but without responsibility under the 1998 Act, leading to a serious gap in the protection that the law was intended to offer. That gap is not just a theoretical legal problem, but a problem with significant and immediate practical implications. As many services previously delivered by public authorities become privatised or contracted out to private suppliers, so the law has failed to adapt to that reality. The implications of that failure extend across the range of especially vulnerable people in society, including elderly people in private residential care or nursing homes, tenants in housing association properties, children outside the maintained education sector, or looked-after children in receipt of children’s services.
In its 2004 report, the JCHR examined several possible solutions, including: amending the 1998 Act to clarify the responsibility of organisations to protect human rights in carrying out public functions; protecting human rights through the terms of the contracts between public authorities and private providers of public services, backed by authoritative guidance on when an organisation was likely to be a “public authority” for the purpose of the Act; and the development of case law on the meaning of “public authority”. The Committee’s views were that amendment of the Act would be likely to create as many problems as it solved and would be too soon after the Act’s implementation, and that guidance on the formulation of contracts and best practice would be helpful but could not provide a complete or enduring solution, so the Government should intervene in the public interest as a third party in cases where they could argue for a broad interpretation. Three years on from the JCHR’s report, there have been a number of significant developments. In November 2005, the Government published guidance to local authorities on contracting for services in the light of the 1998 Act.
In my next remarks, I am grateful to you, Mr. Speaker, for your earlier ruling on sub judice. The Government intervened in the case of the Crown on the application of Johnson and others v. London Borough of Havering to argue that the meaning of “public authority” covers elderly and vulnerable people who are receiving care from a private provider on behalf of a public authority. The case considered whether local authority care homes that were transferred to the private sector remained public authorities in respect of local authority placed residents. The Government were unsuccessful, but the appeal will be heard later this week, on 11 and 12 January. In addition, the Government are consulting on the “public authority” question as part of their discrimination law review.
I welcome those developments, but there remains an urgent need to ensure that our human rights law clearly protects vulnerable people. The British Institute of Human Rights has reported on treatment of residents of residential care homes that clearly amounts to a breach of their human rights. Cases include the circumstances of home closures or notice to individuals to leave homes, and inhuman and degrading treatment such as elderly residents being fed breakfast while on the commode. When such poor treatment occurs in privately run residential care homes, it is not satisfactory for residents to have to rely on interpreting a contract between a local authority and a home’s managers: they should be able to enforce their human rights directly.
In this Parliament, the Joint Committee on Human Rights, which I chair, has continued to take a close interest in the matter. We asked the Lord Chancellor about it during an evidence session on 30 October. In his Department’s July 2006 review of the Human Rights Act, which was repeated to us in his evidence, the Lord Chancellor put forward the extraordinary proposition that “widening” the definition of public authority could have the effect of driving private providers out of the market.
That was extraordinary because the proposal would not widen the definition, but be exactly on “all fours” with what the then Lord Chancellor told Parliament was intended when the Bill was introduced. Moreover, the appalling implication is that those in private sector care homes, who are probably more vulnerable to abuse than those in “in-house” facilities, are not to have a right to challenge that abuse in our courts, thus making them second-class citizens. Their numbers are growing as local authorities continue to contract out. The contractors’ commercial interests are put before the decent treatment of the elderly and vulnerable.
The JCHR raised the possibility of legislation to make it clear that
“any person or body providing goods, services or facilities to the public, pursuant to a contract with a public authority, is a public authority for the specific purposes of the Human Rights Act”.
My Bill is in my name, not that of the JCHR, though its supporters include Commons JCHR members from all three parties represented on the Committee. I believe that the case for addressing the issue through legislation is stronger now than ever.
The purpose of my Bill is unambiguously to reinstate the wide and functional interpretation of “public authority” that was understood by Parliament and Government alike to be the meaning of section 6 when the Human Rights Act was passed. The intention behind my Bill is to ensure that human rights protections apply comprehensively, directly and consistently to all those who receive public services from private providers, including the most vulnerable members of our society. I hope that the House will support the motion.
I oppose the Bill, which illustrates the trouble into which a well intended Government get when they decide to rely on the courts and human rights legislation instead of Parliament and representative democracy.
It is good of the hon. Member for Hendon (Mr. Dismore) to highlight the gross inadequacies in the drafting of the original Bill and the way in which the Government’s intentions have miscarried. I can understand why he is helpfully trying to get the Government out of their hole. It is instructive that Ministers, with all their access to legal advice and help, have not come forward with a similar measure, properly drafted by parliamentary draftsmen. They clearly believe that it is a treacle well into which they could sink deeper.
I want to make a simple point. The hon. Member for Hendon is attacking the actions of several elected councils—quite a few of them are probably Labour councils. He claims that they do not stand up for the most vulnerable in their community. Surely we, in the senior representative democratic forum in the country, should believe in the democratic system and in putting right such problems in provision by democratic challenge in the council chamber and through the intervention of councillors over their officers and over the supervision of contracts. If too many councillors have consented to too many bad contracts and vulnerable people are being damaged, that is a disgrace and it should be sorted out in the normal democratic way. If the councillors responsible cannot sort it out, I hope that their electors will take the necessary action at the ensuing council elections to change the management.
Surely the hon. Member for Hendon must accept that the matter illustrates only too well that reliance on the law and the human rights panoply does not work and that we need to get a vibrant democracy again so that, in each council chamber as well as in this Chamber, we can get justice for people and action from Ministers and ruling councillor groups who otherwise are not doing their job.
Question put, pursuant to Standing Order No. 23 (Motions for leave to bring in Bills and nomination of Select Committees at commencement of public business), and agreed to.
Bill ordered to be brought in by Nia Griffith, Mary Creagh, Dr. Evan Harris, Mr. Douglas Carswell, Ms Karen Buck, Clive Efford, Angela Eagle, Joan Ruddock, Mr. Paul Burstow and Mr. Andrew Dismore.
Human Rights Act 1998 (Meaning of Public Authority)
Mr. Andrew Dismore accordingly presented a Bill to clarify the meaning of “public authority” in section 6 of the Human Rights Act 1998: And the same was read the First time; and ordered to be read a Second time on Friday 15 June, and to be printed [Bill 43].
Welfare Reform Bill (Programme)
I beg to move,
That the Order of 24th July 2006 (Welfare Reform Bill (Programme)) be varied as
follows:
1. Paragraphs 4 and 5 of the Order shall be omitted.
2. Proceedings on consideration shall be taken in the order shown in the first column of the following Table.
3. The proceedings shall (so far as not previously concluded) be brought to a conclusion at this day’s sitting at the times specified in the second column of the Table.
TABLE
Proceedings Time for conclusion of proceedings New Clauses relating to Parts 1 and 3 and 5; amendments relating to Parts 1 and 3 to 5 8.00 p.m. Remaining proceedings on consideration 9.00 p.m.
4. Proceedings on Third Reading shall (so far as not previously concluded) be brought to a conclusion at 10 p.m. at this day’s sitting.
This programme motion is the product of a conversation through the usual channels. One knife has been inserted to enable and protect business on a specific debate on local housing allowance and housing benefit. With that one knife, we shall be able to make good progress in a similar spirit to the progress that we made on a cross-party basis in Committee.
Question put and agreed to.
Orders of the Day
Welfare Reform Bill
[Relevant documents: The Third Report from the Work and Pensions Committee, Session 2005-06, Incapacity Benefits and Pathways to Work, HC 616, and the Government’s response thereto, Cm 6861.]
As amended in the Public Bill Committee, considered.
New Clause 3
Assessment of limited capability for work
‘(1) The Secretary of State shall require the Office of Disability Issues to publish an annual report on the operation of the assessment for limited capability for work under section 8 of this Act.
(2) In preparing its report the Office of Disability Issues shall be required to consult
(a) the Commission for Equality and Human Rights, and
(b) such other organisations as the Secretary of State shall by regulation determine.’—
[Danny Alexander.]
Brought up, and read the First time.
I beg to move, That the clause be read a Second time.
With this it will be convenient to discuss the following amendments:
No. 71, in clause 17, page 14, line 44, at end insert—
‘(1A) For the purpose of subsection 1, a person would not be disqualified on the grounds of failing to take medication presented by such persons as the Secretary of State may by regulation define.’.
No. 98, in schedule 2, page 54, line 12, at end insert—
‘( ) for a person to be treated as having a limited capability for work where it has been decided that he does not have a limited capability for work but he is appealing against that decision.’.
Government amendment No. 18
No. 99, page 55, line 39, at end insert—
‘( ) for a person to be treated as having a limited capability for work-related activity where it has been decided that he does not have a limited capability for work-related activity but he is appealing against that decision.’.
Government amendments Nos. 26 and 47.
I am pleased to be here to move new clause 3, which relates to the personal capability assessment for limited capability for work. This matter was discussed in Committee, but some of the outstanding issues are of sufficient importance to be raised again at this stage of the Bill.
New clause 3, which I am pleased to say also has the support of other parties, proposes an annual report to Parliament on the operation of the personal capability assessment. It would enable monitoring, testing and independent evaluation, all of which are sorely needed in relation to the revised personal capability assessment. I am sure that all hon. Members would agree that revisions to the assessment for entitlement to incapacity benefit—or employment and support allowance, as it seems likely to become—are sorely needed.
It is fair to observe that quite a lot of good work has been done in the stakeholder groups and other groups that are making recommendations on the way in which the test should be changed, particularly to enable greater attention to be paid to the way in which it meets the needs of people with mental health problems or learning disabilities. In response to the recommendations that those groups have put forward, I would say, “So far, so good.” But—and it is a big “but”, as the Minister will not be surprised to hear—I have real concerns about the testing process that has been undertaken so far.
Those who served on the Committee will remember that we had a substantial debate on the merits or otherwise of having independent involvement in the evaluation process for the revised personal capability assessment. The Minister contended at that stage that all that was needed was a series of dummy runs, as the Department was proposing. This would effectively involve running the new test alongside the old test, and observing the outcome. However, the reports that I have seen on the outcome of the first dummy runs are very worrying, which is why I have tabled the new clause to ensure that there will be a regular report to the House on the way in which the tests for deciding entitlement to benefit are operating.
My first worry is that the process under which the dummy runs are being carried out has been shrouded in secrecy. I am told that a report has been made available to some of the groups involved in advising on the revision to the personal capability assessment. I tabled a parliamentary question before the Christmas recess asking the Minister to publish that report but, as far as I am aware, it has not been published. A copy has certainly not been made available to me.
Secondly, the testing has been carried out internally by the Department for Work and Pensions and the contractor responsible for undertaking the assessment, Atos Origin, without any independent assessment or assistance whatever.
It also remains a matter of concern that details of the Logic Integrated Medical Assessment—the computer program backing all this up—have not been made available to independent groups, and nor have details of the logic within the system whereby the answer to one question prompts the medical assessor to ask other questions. Full details of the report on the dummy runs and LIMA should be published. Questions of commercial confidentiality have been raised, which implies that perhaps those details cannot be published. My understanding, however, is that the copyright for the LIMA program is owned by the Department for Work and Pensions; it is not the private property of the company that carries out the assessments. Perhaps the Minister will correct me on that. Given the dramatic impact of the questions and the operation of the computer program on benefit claimants, I can see no barrier to making those details available to the House.
It is of real concern that the evaluation of the dummy runs seems to be the main evidence that will inform the draft regulations, which we were told would be made available to the other place when it starts consideration of the Bill. In that context, it is important to place on record the concerns put to me by outside groups about the way in which the dummy runs have been carried out. As I understand it, fewer than 100 claimants were tested, which is a very selective and not necessarily representative sample. It is therefore hard to make like-for-like comparisons. Importantly, the process was not followed right through to the appeals stage. All Members will know from their constituency casework that the high number of appeals against personal capability assessments for incapacity benefit was one of the main reasons for the revision of the test. Some 50 per cent. of appeals against decisions on the personal capability assessment are successful. Unless one follows the new assessment process through to the appeals stage, to try to understand whether appeals against decisions made under it are likely to be successful, it will be hard to judge whether the new assessment process is better or worse than the old one.
Is not the period of transition the most dangerous time for the vulnerable people about whom we are talking? Will we not need some interim review of the new assessment process long before a year or more—as the new clause suggests—is up? If this is such a comprehensive reform, how will we deal with it quickly if it starts to go wrong?
The right hon. Gentleman makes an important point. Two things need to happen. First, a much more comprehensive assessment of the revised PCA is needed before draft regulations to put it into practice are brought forward. That needs to involve independent outside organisations such as disability lobby groups and others that have had an advisory role.
The observation made by my right hon. Friend the Member for Wokingham (Mr. Redwood) also highlights the importance of widespread and continuing consultation. Will the order-making power of subsection (2)(b) of the proposed new clause be subject to the negative procedure of the House or to its affirmative counterpart?
I am grateful for that intervention—[Interruption.] I think that the answer to the hon. Gentleman is yes, as the Minister has pointed out from a sedentary position. The import of that is that the Office for Disability Issues, which has been established in the Cabinet Office to ensure that the interests of disabled people—
For the record, the Office for Disability Issues is in the Department for Work and Pensions, not the Cabinet Office.
I am grateful for the intervention, but in that case it is possible that the Office for Disability Issues is getting too close to the DWP. Nevertheless, it has a role in ensuring that disability issues are dealt with in a joined-up way throughout Government, which is why I suggest that it should be required to provide an annual report.
Let me take up the second point made by the right hon. Member for Wokingham (Mr. Redwood). We shall need to get the assessment right in the first place, but we shall then need an ongoing process of reassessment, re-evaluation and reporting to ensure that it continues to work. We must make certain that the vulnerable people who, in many cases, are subjected to assessments continue to be discussed in the House, and are not left with what may turn out to be a thoroughly inadequate process.
The hon. Gentleman will not be surprised to learn that I agree very much with what he is saying. Is it not also important for the assessment to cover any anomalies or disparities in either the regional or the sectoral treatment of persons subjected to the assessment, given the possibility that different regions or groups of examining medical officers may take different views and may also have blind spots on particular kinds of disability?
The hon. Gentleman makes an important point. Regional disparities can arise in the wider debate about incapacity benefit for a number of reasons, and indeed we see regional concentrations of claimants in the statistics. I am sure that Members in all parts of the House will have observed variations even between individual doctors. I suppose that that is largely a management issue for the company that administers the assessment, but incorporating it in an annual report to Parliament would be a vital way of enabling us all to keep an eye on it.
Is the hon. Gentleman aware of a report from Citizens Advice which draws attention to the difficulties already being encountered? One case involves a woman with myalgic encephalomyelitis. She was given only seven points at a medical examination, but the doctor himself advised her to appeal, and on appeal she was given 33 points. The difficulty appeared to lie in the computer system’s inability to take account of variations from the standard. Should not the review look into that so that we can ensure that the computer program reflects the wide range of disabilities that exist?
The hon. Gentleman rightly refers to problems that have been identified in the existing system. In fairness to the DWP, I should say that its work, particularly in relation to some of those mental health and neurological issues, has made progress in terms of how fine-grained the assessment is capable of being. Nevertheless, while it is all very well for us to look at the words in the draft regulations—the 45 descriptors and so on—unless there has been proper and rigorous testing it will be impossible to know whether the new arrangement will work better or less well in practice than the current system, and that is the burden of the new clause.
Let me return briefly to the question of the dummy runs that have been carried out so far. It would be useful if the Minister could give further details of the outcomes. I understand that while the new assessment would have given more claimants with mental health problems entitlement to benefit, on the basis of the dummy runs it would also have meant that many of those currently entitled to benefit owing to physical disabilities would no longer have been entitled to it.
What does the hon. Gentleman think of the fact that the rise in the number of people who will be able to claim after passing the mental health descriptor is matched by a commensurate rise in the number who do not pass because they have not satisfied the physical descriptor test? Does he think it a rather odd coincidence?
The way in which the Government have described their intentions in relation to the revision of the personal capability assessment does not suggest that they wish an increase in the number claims for one reason to be matched by an equal fall in claims for another reason. It may well be a coincidence, and it may well mean that further work must be done to ensure that the test covers all possible reasons for claims. That is another reason why much more detailed scrutiny is needed, along with independent evaluation—not just dummy runs conducted by the company that is contracted to carry out the test, which strikes me as thoroughly inadequate. If we proceed on that basis, it will not lead to the outcome that I hope that all Members wish for. We need a much more detailed evaluation of the assessment, plus ongoing independent evaluation. If the new clause is agreed to by the Government—which is, perhaps, unlikely—or supported by Members, that will also allow there to be much more detail of how LIMA, the computer program behind the assessment, works in practice. That will be made publicly available, which will be of particular interest to lobby groups that are expert in dealing with certain conditions or impairments.
I hope that Members will support the new clause, and if the Minister is unable to provide the reassurances that we think are necessary on what are important points, we will seek to press it to a Division.
I support new clause 3. Some of my arguments will echo those made by the hon. Member for Inverness, Nairn, Badenoch and Strathspey (Danny Alexander), but I make no apology for bringing important issues to Members’ attention once again.
The new clause is not particularly onerous. It will not cost the taxpayer any more, but it goes to the heart of the Government’s commitment to make sure that the new employment and support allowance succeeds where incapacity benefit has failed. The solution to any problem must start simply with a correct diagnosis of that problem. For incapacity benefit and the new employment and support allowance, the crucial gateway is the personal capability assessment. There are, however, problems with that gateway, and they have produced the major issues in respect of incapacity benefit.
The new clause simply requires the Government to publish an annual report on how that gateway is working, and to do so following consultation with key organisations such as the new Commission for Equality and Human Rights, which it is hoped will be as able an advocate of the concerns of disabled people as its predecessor body, the Disability Rights Commission.
Why is this subject so important? Mistakes in how the gateway works cause enormous distress and cost the taxpayer huge sums of money. In 2005, 50 per cent. of appeals against incapacity benefit decisions were successful; that is an enormously high rate, and should be a real concern to the Government.
Two examples given by the Citizens Advice illustrate that point. In one, a client with a severe skin condition lost incapacity benefit following a personal capability assessment that which awarded him five points, but at his appeal five months later he qualified for 16 points, although he then immediately received notice of another PCA medical examination. In another example, a woman with ME—myalgic encephalomyelitis—was given only seven points at a medical examination, but the doctor who carried it out advised her to appeal, saying that the computer would not allow him to award more; the client received 33 points at appeal. To borrow words that some Members might be familiar with from Christmas viewing of “Little Britain” episodes, “the computer says no” and people lose their benefit only to be re-awarded it later at great cost to the taxpayer as well as great personal distress.
I am pleased that my hon. Friend raises the matter of assessments and what might be termed the 50 per cent. failure rate on incapacity benefit. Does he share my greatest concern that those with mental health challenges—in particular depression and bipolar depression—who are already undergoing enormous amounts of stress that is partially debilitating will be caused even greater stress if the facts and evidence do not come out, and if personal capability assessments are not reviewed on a regular basis to ensure that they are better?
I am grateful to my hon. Friend for those comments, and with his usual foresight he makes some of the points that I was going to make. He is correct that getting the gateway right is most important in dealing with people with mental health challenges—a subject that he takes great interest in and on which he has campaigned a great deal—and with those with learning disabilities.
A second reason why it is so important to get the gateway right is that there can be no confidence in a new benefit if there is no confidence in the assessment process through which the benefit is awarded. That confidence is sorely lacking in respect of incapacity benefit at the moment. Why? First, it is because “limited capability for work” is defined as an essentially medical process. Many people would like to broaden it to include not just the responsibilities of disabled people to seek work when they are capable, but the responsibilities of society as a whole, so that it can play its part in including those people in the labour market.
The elimination of prejudice—seen, for example, in the fact that 38 per cent. of employers are unwilling to employ a disabled person, which rises to 63 per cent. in respect of people with a history of mental illness—is a critical factor, as such prejudice limits people’s capability to work. It has to be said that it is difficult to work out how it could be measured in an assessment process, but the new clause would at least allow that debate and might allow the assessment process to adapt to meet the challenges posed not by a person’s impairment, but by the obstacles thrown in his or her path by a society still coming to terms with what it means to include disabled people in the mainstream.
Another reason for concern about the way in which the personal capability assessment has operated historically is its ability to deal with fluctuating conditions such as bipolar disorder, which my hon. Friend the Member for Windsor (Adam Afriyie) mentioned. In a seminar on benefit reform that I organised last year, one of the participants who had bipolar disorder explained what happened when she went for her assessment. It is a fluctuating condition and she felt fine on the day that she had her PCA, but because she was worried that her assessor would not understand what a fluctuating condition was, she felt obliged, in her words, to “ham up” her condition to ensure that she secured the assessment result that she needed.
A widespread concern about the current PCA process is that it does not adequately recognise not only fluctuating conditions but hidden disabilities such as autism and other learning disabilities. The National Autistic Society says that 40 per cent. of GPs do not have enough information to make informed decisions relating to autism. The result is that people with autism can often be mistaken for being belligerent and unco-operative. That is a real concern. Clause 8(4) states:
“Regulations under subsection (1) may include provision… for a person to be treated as not having limited capability for work if he fails without good cause… to provide information or evidence in the manner in which he is required under such regulations to provide it”.
Someone wrongly considered to be unco-operative could lose benefit as a result of a lack of understanding of their condition.
Does my hon. Friend agree that that also applies to people with Tourette’s syndrome, who might well be unable to conduct what we might call a civil conversation? Indeed, some have already found themselves victims, if I may put it that way, of antisocial behaviour orders because of the nature of their medical condition.
Absolutely. There is a whole range of conditions of which Tourette’s is a very good example. My hon. Friend is right to draw the House’s attention to those problems. I would also make the point that the range of conditions—incorporating hidden disabilities, learning disabilities, mental health problems and so forth—is such as to require a considerable amount of training in order that any assessor or doctor may understand those problems and make an adequate assessment.
Let us consider what other organisations say about the problem. Mind says that
“the majority of people who carry out PCAs will be locums. Most will be GPs who have done a day’s work and will do PCAs in addition”.
It states that the assessors
“certainly do not have much in-depth knowledge of mental health problems in the experience of our advisors who work with people with mental health problems”.
Mind continues by noting that it
“spoke recently to one of our welfare rights advisors. She attended… 50 PCAs with various clients and in only one case did she find the person to have any understanding of what the issues were, to treat”
the client
“with respect, and to conduct the assessment at a pace that could give the person the opportunity to discuss as much as was needed”.
Mind’s view is that, as a minimum, assessing GPs should have NVQ level 3 in mental health training. Citizens Advice has particular concerns about the ability of Jobcentre Plus personal advisers to identify appropriately and accurately the support needs of people with fluctuating and unpredictable conditions, or those whose conditions are likely to get progressively better or worse over time. Customers with mental health problems were seen as particularly challenging and even more experienced advisers did not feel confident working with them.
As my hon. Friend the Member for Daventry (Mr. Boswell) said to me yesterday, this is not just an academic exercise. Some 40 per cent. of people on incapacity benefit have mental health issues as their primary condition, and if people who have them as a secondary condition are included, the number rises to nearly two thirds. So understanding mental health issues is key to effective reforms of the assessment process.
A further concern is the relationship between the medical assessor and the decision maker. In Committee, the Minister said that the decision maker is not there to second guess Atos Origin but to check that procedures have been followed.
Before my hon. Friend develops that argument, I wish to press the rewind button and take him back to the important point that he was making about the requirement on individuals to provide information in the manner required by the terms of the Bill. He could have been referring—although I do not know whether he was—to clause 8(4)(a)(ii). If the Government are to do the right thing, and possibly avoid contravening disability discrimination legislation, it is essential that they should preserve maximum flexibility for the client as to the manner in which the information has to be provided. Why be excessively prescriptive unless it is essential to the evaluation process?
My hon. Friend makes an important point. That variety of means by which people may supply the information that they are required to supply is important, because the range of disabilities is so vast. The purpose of the new clause is to ensure that there is a process in place whereby it is possible to adapt and improve assessment as time goes on as a result of being able to learn from things that we are not able to predict.
Another worry is to do with the timings of different stages of the assessment process. A claimant needs to go first through an assessment of limited capability for work, then an assessment of limited capability for work-related activity, and then potentially a work-focused health-related assessment. Those may sound complicated but to a claimant they are vital, because failure to co-operate at any stage could mean that the benefit is not awarded or that sanctions are applied, even if a claimant wishes to appeal against an earlier decision.
The Government, to their credit, recognise the problems with the existing PCA. On the question of broadening the understanding of mental health conditions and hidden disabilities, the Secretary of State said to the Work and Pensions Committee in the spring that his understanding was that the Government should
“involve the skills and expertise of a wider relevant range of healthcare professionals.”
The Minister said in Committee that
“we will need to change the training in Jobcentre Plus and Atos Origin. When pathways is rolled out nationally, we will need to change the training given to personal advisers through the private and voluntary sectors.”—[Official Report, Standing Committee A, 24 October 2006; c. 162.]
He also said that the 273 Atos Origin doctors will receive training in disability analysis.
There is no shortage of worthy intentions, but I shall explain why, if the Government are to put those intentions into practice, they must accept the new clause. I refer the House to the details that we have been given of the new personal capability assessment process. I recognise that it is a draft and that the Government have done a great deal to try to adapt the present PCA so that it has a much greater understanding of hidden disabilities and mental health conditions. In particular, the new PCA has a revised section for assessing mental, cognitive and intellectual functions, and I want to give the House some examples of the judgments that will have to be made.
I remind the House that people need 15 points to qualify for the employment and support allowance. A person who has difficulty learning a moderately complex new task gets six points, while one who has some difficulty learning a simple new task gets nine, and one who has significant difficulty learning a simple new task gets 15. Who on earth can tell the difference between those categories? The process is very difficult.
Let us look at the section on understanding instructions. A person who has difficulty in understanding and carrying out moderately complex instructions gets six points, while one who occasionally has difficulty in understanding and carrying out simple instructions gets nine and one who frequently has difficulty in understanding and carrying out simple instructions gets 15.
The section on forming relationships with other people is also relevant. A person who occasionally causes distress to others gets six points, while one who does so regularly gets nine and one who does so frequently gets 15. The extent to which a person causes distress to others in forming relations must be related in part to the resilience of his or her family members and carers. The judgments involved in assigning scores in these matters are very fine, even for people qualified in mental health matters, but they are vital, as they will determine whether a person is eligible for benefit.
My hon. Friend is making a powerful point about the gradations involved, and more of the detail will come out in the regulations. The annual report is intended to prevent people who need support from suffering injustice or lack of sympathy, but does he believe that it will achieve the Government’s objective and succeed in reducing the numbers of claimants by 1 million?
In a way that he may not have intended, my right hon. Friend has touched on a point that I was about to make. People are worried that the arbitrary nature of the judgments involved may mean that the point at which people qualify for benefit is set at a level that will help the Government reach their targets, and that it is not based on objective medical assessments. I was a member of the Committee considering the Bill, and I do not believe that that is the Government’s intention, but that concern is widespread. The credibility of the system is extremely important, and the new clause would allow an objective assessment to be made of whether it was working as intended. It would commit the Government to adopting a process of continuous improvement that would allow the system to be adapted so that it could fulfil its intended function.
The concerns that I have set out are exacerbated by the fact that, according to a back-of-the-envelope calculation carried out in Committee, the amount of money per head in the pathways roll-out appears to be more than 40 per cent. less than that allocated to the pathways pilots. The resources available in the roll-out will therefore be nothing like what was available in the pilots, so will the Minister reassure us that the assessments will not be driven by financial considerations, and that the PCA will be adapted and improved to take account of the many valid concerns that have been expressed as a result of the failings of the current system?
A simple way for the Minister to give the House those assurances would be for him to accept the new clause. It merely requires the ODI to publish a report, following proper consultation with outside bodies, on how well the assessment for limited capability for work is going. That would not be an onerous commitment and it would cost no money, but it would help to address disability organisations’ many concerns about the operation of the current PCA. It would also put in place a mechanism to ensure that the PCA would develop, change and adapt to meet future concerns that we cannot predict now.
In conclusion, there is no perfect assessment process, but the new clause would at least allow some light to shine on the more opaque corners of the new PCA. In doing so, it would not just achieve the Government’s intentions, but carry the confidence of the wider public.
It is a pleasure to follow the hon. Member for South-West Surrey (Mr. Hunt). Although I added my name to new clause 3, I shall not support it—certainly in its present form—and I shall explain why, but I want first to refer to amendment No. 71, tabled by me and several of my hon. Friends.
Amendment No. 71 relates to clause 17, which addresses the circumstances in which a person can be disqualified from receiving an employment and support allowance. The amendment would provide that
“a person would not be disqualified on the grounds of failing to take”
prescribed medication.
Unlike the two previous speakers, I did not have the pleasure of serving on the Committee, but I read a fair bit of its proceedings, which were important and encouraging. There was some debate about the phrase in clause 17 (1)(b):
“failure without good cause to follow medical advice”.
There was discussion about the failure of someone to take medication for mental health problems because they felt that there might be adverse side-effects. Most Members would argue that non-compliance on the grounds that the medication could produce severe side-effects would not constitute a sensible reason for disqualification, so my amendment is a probing amendment to give my hon. Friend the Minister and my ministerial colleagues the opportunity to clarify the position. Would people who do not comply with the requirement to take medication be disqualified from claiming the ESA?
I turn briefly to new clause 3, to which I put my name because it relates to real issues. The hon. Member for Inverness, Nairn, Badenoch and Strathspey (Danny Alexander) made a number of points about the importance of getting the new PCA correct, and I very much agree. It is the gateway and is fundamentally important to the Bill. Some of the concerns that the hon. Gentleman expressed have been raised by many disability organisations. That is why at Work and Pensions questions yesterday, I commented that
“the current system of assessment for entitlement to incapacity benefit has not been fit for purpose for many years”.
I therefore welcomed the new personal capability assessment but felt that because it was so central to the Bill it
“should be subject to effective, long-term and independent monitoring”.
I was delighted that my hon. Friend the Minister for Employment and Welfare Reform replied:
“It is essential that we have a better process to monitor the operation of the personal capability assessment and I look forward to discussing the details…as the Bill continues its passage through the House.”—[Official Report, 8 January 2007; Vol. 455, c. 9-10.]
That was a welcome response.
My concerns are widely shared among organisations such as Mencap, RADAR, Mind and others involved in the review of the PCA descriptors. In a briefing circulated to many Members, they point out that they support revision of the PCA. They think that the revised descriptors are a big improvement particularly for people with mental health issues, learning disabilities and/or an autistic spectrum disorder. However, those organisations have raised concerns about the assessments thus far and the hon. Member for Inverness, Nairn, Badenoch and Strathspey referred to that in his speech. The concerns relate to sample size, the fact that some conditions were not represented in the sample and the fact that the evaluation was not conducted by independent researchers but by the same DWP-contracted staff who carry out the PCAs at the moment.
I am behind the sentiment in the new clause that we need an effective and independent monitoring system, but I disagree to an extent with the organisations that I have mentioned. They and others support the new clause, but I think that they have got it wrong on this occasion. The new clause asks for an annual report and it is not self-evident that we will need a report every single year from here to eternity. More importantly, the procedure will be rather cumbersome because the Office for Disability Issues will publish an annual report after it has consulted the Commission for Equality and Human Rights and any other organisations thought appropriate. As of today, the independent statutory body that should advise Government on disability issues is the Disability Rights Commission, but from October this year it will be the Commission for Equality and Human Rights. If the new clause were saying that there needed to be independent monitoring and that the DRC or the Commission for Equality and Human Rights would be the appropriate body to do that, that would be adequate. The idea that either of those bodies should produce a report and give it to the ODI, which would then present it to Government, is a strange way of going about things. I am sorry to say it, but I think that the new clause is ill thought out.
I would certainly welcome an amendment in a different form on a different occasion if it encapsulated the key principle on which there is some agreement. I think that everyone, including the Government, agrees that there needs to be a mechanism to ensure that the experiences that we have had with assessments for incapacity benefit in the past are not experiences that can be repeated with the new PCA. That is crucial to an extremely important exercise that has support on both sides of the House. Although I cannot support the new clause, I very much hope that the Government will tell us how they intend to ensure that there is proper independent appraisal of the new PCA.
I welcome very much the new clause, the measured tones with which the hon. Member for Inverness, Nairn, Badenoch and Strathspey (Danny Alexander) introduced it and the substantial speech, which included important additional matter, in support of the new clause from my hon. Friend the Member for South-West Surrey (Mr. Hunt).
It is also a pleasure to follow the hon. Member for Kingswood (Roger Berry). We have often spoken together on disability issues and, although we come from different political traditions, we find a lot to agree on. His specific point—why the Government’s Office for Disability Issues, commendable as it may be, had to be cut into a process that could properly be dealt with by an independent free-standing Disability Rights Commission or Commission for Equality and Human Rights—was a cogent one. He also raised an important and valid point about the exact circumstances regarding the taking of medication.
The debate is about the nature of the personal capability assessment process, but it will inevitably extend into consideration of the wider operation of the system in practice. That is what concerns most of us. The initial gateway hurdle and many things that go on in the process might leave vulnerable people with an element of disquiet or a feeling of dissatisfaction and lead to the system lacking public credibility or becoming discredited. We do not want that to happen.
The hon. Member for Kingswood reminded the House—he was looking at the matter objectively, because, sadly, he was not on the Standing Committee—that there was a remarkable degree of consensus across those discussions. In that spirit, I do not wish to repeat the general arguments that have already been put, because the House should make progress.
It is self-evident that the Government are looking for a system that is better than its predecessor, and that there are real considerations that have been raised in relation to the pilots—matters that were raised in Committee and elsewhere—that continue to worry people. Of those, because they are personal interests of mine, I single out only questions of fluctuating conditions, which have already been touched on, and of multiple conditions, where, although the system is meant to score them collectively, it might be difficult to grasp the overall effect on the individual. The difficultly when one has a protocol-driven system is that, almost by definition, it does not deal with the individual as an individual, and in that we have the potential makings of unfairness or an inappropriate decision.
On the complex nature of disabilities that involve mental and physical aspects, is the hon. Gentleman concerned, as I am, that the revised assessment does not allow for the combination of scores from the mental health and physical descriptors? That might be one of the elements that causes problems with the conditions that he is outlining.
The hon. Gentleman is entirely right. There are issues of interaction where a physical condition gives rises to a mental condition, or a mental condition is accompanied by a physical condition. Frankly, the test of whether things work in terms of assessment should be whether the combined effect of the problems, seen over a period of time and not at one point, when the person happens to be having a good day, shows whether the person is able to operate effectively in work, whether they need support and if so, the nature of the support that they need to get back into work. Those are sensitive issues. Hon. Members have already said that this is not a precise science. We will not get things exactly right in every case. Doctors, even, can have an off-day. However, we need to assure ourselves that the system is going to work better.
On the assessment process, I have a structural concern, which has been touched on, but which I would like to emphasise, in relation to any suggestion—in fairness, Ministers have not suggested this—of moving away from a series of strict criteria. Members with an educational background, including the hon. Member for Blackpool, South (Mr. Marsden), who just intervened on me, will be familiar with the distinction between a norm-referenced exam system and a criterion-referenced exam system. At the moment, we have the latter, at least in principle, and that is what is proposed in the personal capability assessment. However, I can imagine circumstances—Ministers might say that they are inconceivable—in which a future Minister, under financial or even political pressure, might wish to say, “We will introduce a norm. We are not going to have, by definition, more than 1.5 million people on employment and support allowance,” and the tests will, in effect, be geared to deliver that result.
indicated assent.
I see the hon. Gentleman who moved the new clause nodding in acceptance of my concerns. It is important that Ministers put on the record that what I have set out will not arise.
My concluding concerns relate to the involvement of the Commission for Equality and Human Rights. I do not want to go on about this or claim any particular virtues, but members of the Standing Committee will have heard me express, ad nauseam, my concern about human rights issues. I happen to think that it is rather important that such concerns are entertained on this side of the House as well as in perhaps more conventional or traditional quarters. It is important that those concerns be taken into account in our consideration of the Bill and its consideration in another place, and in all the regulations and the operation of the Bill.
In that spirit—I touch on this briefly—I tabled new clause 1, which was not fortunate enough to be called for debate, although somewhat to my surprise, because it was not directly prompted by the organisation, it attracted the support of the Disability Rights Commission. It sought to set out some general principles—principles that the Minister himself acknowledged were broadly accepted in Committee—and to try to give them some flesh. I think that they could be summarised briefly without it being an abuse of the House. Decisions should be taken in the interests of a client. They should involve at least no detriment to either the health or finances of the client. The action proposed should be proportionate, and at all times the client should be involved—
Order. I trust that the hon. Gentleman is referring to new clause 1 only briefly because it has not been selected for debate.
That was exactly why I was moving on from my point with the closing words that the client should be involved in the process.
The process begins with the assessment procedure, which is the precise subject of new clause 3. I am worried that somewhere along the line we might fall at the human rights hurdle. I do not think that Ministers want that or that there is an agenda for it, but we must ensure that it does not occur. Whether that should be achieved by the new clause that I gaily put down, another measure or an understanding by Ministers, it is important that the matter be addressed, if only in terms of the concerns expressed by the hon. Member for Hendon (Mr. Dismore)—I do not often see eye to eye with him—in the past hour when he spoke to his ten-minute Bill. He expressed his concerns about the apparent exclusion of private sector contractors, of whom there will be a lot under the Bill, from the need to discharge their duties under the Human Rights Act 1998. I know that the Minister for Employment and Welfare Reform gave a reassurance in Committee that that would not happen and that it would make no difference whether the pathways contractor was part of Jobcentre Plus or a private contractor. It would be nice if he would give that assurance again. The Minister has also accepted that the new disability equality duty runs through the whole of his Department and that there is no question of any of the public departments opting out.
The hon. Gentleman makes an important point. It is equally important to put it on record that the same considerations about human rights and the disability equality duty should apply to Atos Origin when it carries out the functions of the Secretary of State in relation to the personal capability assessment. In fairness, the Minister made it clear in Committee that that would be the case.
I am grateful to the hon. Gentleman. Others wish to speak, so I will move on quickly.
I am glad that new clause 3 has given us the opportunity to discuss human rights issues. Of course such issues should never be seen on their own and as being isolated from other aspects of public policy. However, the House rightly committed itself to the principles of human rights through its legislation. There is a good deal of common ground on the matter, so it would be distressing to all those who discussed the Bill in Committee and to hon. Members on both sides of the House if the high aspirations for welfare reform that are set out in the Bill were somehow to falter because the legislation did not work or was seen to be unfair. That is why I support new clause 3.
I wish to speak to amendments Nos. 98 and 99, which I tabled. I will be brief because I, if not everyone else, wish to comment on other groups of amendments.
The amendments are quite important. They would insert new provisions in paragraphs 1 and 9 of schedule 2. Amendment No. 99 would allow regulations to make provision
“for a person to be treated as having a limited capability for work-related activity where it has been decided that he does not have a limited capability for work-related activity but he is appealing against that decision.”
For the lay man, they would apply to someone who has been told that he cannot work, although he wants to work, and who feels that he can work and can prove that.
The amendments would continue the current rules, which enable a person who appeals against a decision that he or she is incapable for work under the personal capability assessment to claim income support on the grounds of incapacity, albeit at a reduced rate, until the appeal is heard. As I read it, there is no equivalent provision in the Bill. Not including such a provision could increase the risk of poverty, given the poor standard of personal capability assessments at present. I doubt that it is the Government’s intention to make people suffer in reduced financial circumstances that may have occurred through no fault of their own, so if the Minister is unwilling to accept the amendments, how does he propose that the anomaly in the benefits system be removed?
I have some sympathy with new clause 3, which was tabled by the hon. Member for Inverness, Nairn, Badenoch and Strathspey (Danny Alexander). Having said that, I have never been enamoured of annual reports, which usually end up being crammed together in the week before they are due, and which never meet the aims that everyone wants them to meet. If an annual report is simply there as a target, it should not be required.
Does the hon. Gentleman not acknowledge that if an annual report is requested, and there is a requirement to report on progress in certain areas, it tends to focus the minds of the people in an organisation, especially if the report is to be put before Parliament, too? It tends to enable people to focus on the things on which they were intended to focus.
I thank the hon. Gentleman for his intervention, but my experience is that people pick whatever they want out of an annual report. They concentrate on the points on which they want to concentrate, and those points rarely bear any resemblance to those that the ordinary person in the street wants them to talk about. Having said that, the Government should introduce a mechanism that enables an external body to ask them questions, to which they must supply answers, but that happens anyway, and my hon. Friend the Minister would want his Department to supply that information. I should expect the relevant bodies that deal with people with disabilities to want to ask questions, and I expect that they would issue their own reports, saying whether the Government—or in this case the Department—were doing their job.
Is my hon. Friend not concerned, however, that evaluations are carried out by Atos Origin, and it is difficult to get access to independent information because of problems with commercial confidentiality? Is it not important that the Government propose a mechanism to overcome that problem?
My hon. Friend makes a good point, and I agree with it, but the Data Protection Act 1998 opened the way for Members of Parliament to receive information, in answer to questions, that we could not receive in the past. Will the Minister say whether, if we asked questions on behalf of the relevant groups, we would receive answers, despite the fact that my hon. Friend thinks that there would be some difficulty because of the 1998 Act and confidentiality issues? Obviously, medical conditions are a completely different matter; we could not get medical information. However, if an individual asked me, as their Member of Parliament, to act as their representative, could I get the necessary information? If I could not, and if the relevant bodies could not, how could we get the information that we were asking for, particularly given confidentiality considerations in medical cases?
The hon. Member for Daventry (Mr. Boswell) made some good points about human rights. Unfortunately, although I wished to talk about human rights issues under part 1, my amendments were not chosen, but I think that I can sneak in my concerns about people who are terminally ill in our discussions on part 1. Their assessments are very difficult, and the great fear, of course, is the length of time that the assessments take, from start to finish. Will the Minister comment on that, even though the matter has only a tentative link to the amendments that we are discussing? It is an important question that needs to be answered. Members in the other place will ask such questions, so I am helping my hon. Friend the Minister by asking it. I urge him to look favourably upon my amendments, and to consider the concerns expressed by Members on both sides of the House. I congratulate my hon. Friend the Member for Kingswood (Roger Berry) on the excellent points that he made about his fine proposal, which, like my amendment, is a probing amendment.
When I first read new clause 3, I had two worries about it. First, I was concerned that the system would become a little bureaucratic year after year, if and when it settled down. Secondly, as I told the hon. Member for Inverness, Nairn, Badenoch and Strathspey (Danny Alexander), I was concerned that it would be too late if there were deep troubles in the transitional period. I have been swayed, however, by the moderate and sensible words of my hon. Friend the Member for South-West Surrey (Mr. Hunt), who has made an excellent job of understanding disability issues and speaking up for that community, and by the statesmanlike silence of my hon. Friend the Member for Bury St. Edmunds (Mr. Ruffley), whose judgment I usually back. Consequently, I believe that there must be something in the proposals advanced by new clause 3, and it is not worth while rebelling.
In the words of “Yes, Minister”, the proposals are very brave and even heroic. If I had the difficult job of implementing them as a Minister, not only would I welcome the backstop provided by an independent body that could act as a conduit for criticism and appraisal but I would want a day-by-day feedback mechanism in the early months of the transition to make sure that I would receive a clean report from the longstop. The advantage of the longstop for the Minister is that it might enable him to fend off more urgent and telling requests from Parliament. I hope, however, that if things do not go well, Parliament will probe and ask questions before the annual review is produced. It would be sensible for the Select Committee to undertake such work, because we would want to stand up for the many vulnerable people who would suffer stress or distress if the transition was painful and difficult. In addition to the backstop, therefore, the Minister will definitely need intelligence day by day on the number of complaints, delays in the system, how much strain there is on staff, the relationship between outcomes and his perception, which surely informed the Bill, of the veracity and firmness of existing disability benefit claims, and the likely future pattern of such claims. He will need that intelligence as we go along.
My hon. Friend the Member for Daventry (Mr. Boswell) has made a proposal relevant to our debate, because the excellent principles of new clause 1, which we are not debating, should help to inform the production of a good annual report, which is mentioned in new clause 3. Such open principles put the disabled person first and accept the Government’s important point that many disabled people would like to work and would be better doing so, but need help and encouragement to find work. That should be the spirit of the annual report that would be produced under new clause 3. I should be grateful if the Minister responded to my intervention about the balance of the annual report. Its main purpose should be to protect the vulnerable and make sure that they are treated well and sympathetically, but there is a general policy point to be made about the fact that, wherever possible, work is preferable to other ways of spending one’s time. The concept behind the legislation, which is accepted by Members on both sides of the House, is that we wish to promote sensible work for people with certain disabilities, and we think that we can do better than the systems adopted in recent years by various Governments.
I will not embarrass my hon. Friends by praising them more or criticising their new clause. I can live with it, but the success or failure of the proposal will be determined by detailed implementation, strong ministerial control of the regulations, and an immediate feedback system so that if things go wrong the Minister will know at the earliest opportunity and can come to the House, make an honest confession and change the regulations.
I am sure it is true that all hon. Members have some experience of the operation of incapacity benefit and the way that the assessment process affects their constituents, but I suspect that those who have the most regular experience of that mainly sit on the Labour Benches, apart from the hon. Member for Blaenau Gwent (Mr. Davies), who is in his place and who perhaps one day will be an hon. Friend. Most of those who represent seats where incapacity benefit has coagulated in the most extreme sense over the past 20 years are Labour Members. In particular, that is because in former mining, ship building or iron and steel constituencies where those industries have collapsed over the past 30, 40 or 50 years, there are now a very large number of people on incapacity benefit.
I had not intended to speak in the debate on the new clause tabled by the hon. Member for Inverness, Nairn, Badenoch and Strathspey (Danny Alexander) because many of the issues have already been set out. However, if I had gathered the same number of constituents from my constituency to have the same debate, it would have been entirely different from the tenor of the debate that we have had so far this afternoon. Many would agree with the view that the present system of assessment is wholly unfit for purpose, but they would do so from two completely different perspectives.
Many who are users—who are in receipt of incapacity benefit—would say that the system of assessment is wholly unfit for purpose because too many people are losing incapacity benefit, but many other constituents would say that it is wholly unfit for purpose because it grants incapacity benefit to an awful lot of people who many of my constituents would consider not to be due recipients of that benefit. What that does to the economic life of the constituency and the economic expectations of young people coming out of school can often depress not just the local economic culture, but our economic aspirations.
I wanted to speak in the debate because I have a strong memory of one man coming to my surgery three years ago. He stormed in and said, “It’s outrageous. I had a heart attack in 1986 and I have been in receipt of incapacity benefit or invalidity benefit”—there have been various versions—“ever since. Now the doctors, on behalf of your Government, have said, ‘You’ve got to go to work because you’re fit to work.’” As other hon. Members would have done, I discussed with him whether the processes had been carried out properly, but eventually I had to say that I was not a doctor and could not judge whether he was fit for work or not. I could not make such an assessment.
The man replied, “I knew it. You lot are a shower—a complete waste of time. The worst thing about your Government is that the benefit that you pay is so little that I have to go and mix cement on a building site every single day of the week!” I know hon. Members will laugh, but what is extraordinary is not so much that he said that, as that he chose to say it to me, and that he believed it was a perfectly legitimate complaint for him to make. He believed that he had worked all his life and that he should be in receipt of that benefit, in order to make his weekly package add up and to make his life worth living, in his regard.
Of course, the vast majority of us, if not all of us—perhaps not all of the community that I represent, but the vast majority—would say forcefully that that man was working and should not have been in receipt of benefit, and that that form of fraud is the worst form of theft because it is against the whole community, not just against individuals. That is why it is vital that we change the system of assessment in the way that the Government suggest.
In citing that example, does my hon. Friend agree that it is important not to give the impression that there are large numbers of people in receipt of incapacity benefit who are fit for work? In all my time as a Member of Parliament, I have never experienced anybody coming to my surgery who would in any way fit into that category of claimant.
I agree that it would be utterly inappropriate for us to suggest that the vast majority of people who are in receipt of incapacity benefit are shirkers who are deliberately trying to avoid the world of work. In my experience, the vast majority would like to be in work if there were a means of the state helping them to get into it. The single most important thing that I would like to inject into the debate is the passion felt in many communities that have had a very rough time, resulting in historically high levels of deprivation, which want to get back up off their knees. They will only be able to do so if more people are able to get off benefits and into work.
The hon. Member for South-West Surrey (Mr. Hunt), in a splendid speech, made an important point in response to the right hon. Member for Wokingham (Mr. Redwood) when he mentioned the possibility that the Government’s system of assessment might be thought to have been designed to reduce the number of people on incapacity benefit or its successor benefit. That clearly should not be the case. The Government should not be trying to use their assessment process to force people off benefit and into work. However, it is equally right—many Labour Members will feel this more acutely than others because we have higher numbers of people on incapacity benefit—that the Government should be desperately seeking to enable more people who are on those benefits to get into work.
I would back up the hon. Gentleman by saying that not only Labour Members feel that. I appreciate that historically, as he said, many people claiming incapacity benefit and its predecessors coagulated in seats held by his party, but he should appreciate that one of the fastest growing causes of incapacity benefit claims has been failing mental health, particularly the fluctuating conditions mentioned by my hon. Friend the Member for South-West Surrey (Mr. Hunt). Those people are found in many other parliamentary seats—notably, perhaps, in seaside towns such as the one that I represent. The problem is shared on both sides of the House, and I am sure that all Members would want to reflect on the matters that he mentions.
I am sure that the hon. Gentleman makes an important point. However, he will make a mistake if he presumes that the reason for the high level of incapacity benefit claims in my constituency is that people have residual musculoskeletal problems from working in the mines, because remarkably few people of working age living in Rhondda have ever worked in a mine. More than 50 per cent. of people on incapacity benefit in my constituency are in receipt of it for mental health problems, and 50 per cent. of those are women. The pattern of incapacity benefit claims has changed dramatically, but the level is extraordinarily high—between a fifth and a quarter of all people of working age in my constituency are on incapacity benefit. However, I think that the hon. Member for Blaenau Gwent has the highest level of claimants in Wales. All sorts of hobbling, to use a valleys word, may go on, with elements of the black market making it possible for families to survive, but it is important that we try to change that culture of expectation; otherwise, I will feel that a Labour Government have failed in a socialist duty to tackle one of the greatest causes of poverty, which in my constituency results from incapacity benefit.
The hon. Gentleman is making a fair point, but is he not also illustrating how the current system has lost the confidence of those who are using it and of the general public? It is important that we get the personal capability assessment right, and new clause 3 would ensure that the new system is not subject to the same failings as the current one.
I agree with the first half of the hon. Gentleman’s comments, but disagree with the second half. It is clearly true, as I said earlier, that the current system has fallen foul of incapacity benefit users—those who are in receipt of it—and of the wider community, but that is why we need to get the system right now, not review it so frequently as to further undermine confidence in it because it changes year after year. Of course we need a system of review, but although I sympathise with the thrust of the new clause, I disagree with the idea of having an annual review, because such a constant process of change would not allow people to regain confidence in the system. I also believe, as the right hon. Member for Wokingham suggested earlier, that the review process should not be subcontracted to some other body but undertaken by a Select Committee, because the greatest expertise resides there.
Will the hon. Gentleman give way?
I shall, but my last sentence was to have been the final one in my speech.
Review does not necessarily mean change. It means ascertaining whether something works. That is important—conducting a review does not mean that the system will change every year, but it would ensure that the new system was not failing in the same way as the existing one.
The hon. Gentleman makes his point, but I would prefer a review every five years because when reviews take place and there is no change, people tend to question the point of reviewing.
Will my hon. Friend give way?
There is a general rule that one should use the word “final” only once in a speech but I shall now have to use it again.
New clause 3 calls not for an annual review but for an annual report, which is different.
Reports, reviews—there is not much difference between them. My point is broader and concerns the role of Parliament. I believe that the role of reviewing, revising and ascertaining whether we have got the assessment process is right should reside with the House and should not be subcontracted to another body. I shall therefore oppose the amendment tabled by the hon. Member for Inverness, Nairn, Badenoch and Strathspey.
There is no doubt that hon. Members of all parties generally welcome the Bill, which acknowledges that viewing the capacity to work positively is an important step forward. That focus is crucial if we are to tackle some of the long-term problems that we are experiencing with incapacity benefit. The Bill is perhaps also an acknowledgement of the fact that the existing policy was not effective in removing people from long-term incapacity benefit. I cannot remember the exact figures, but the numbers increased hugely for people who had been on incapacity benefit for more than five years. The Bill is therefore an acknowledgement of a problem and of a failure of existing policy.
The personal capability assessment is currently the only access point to the new employment and support allowance because existing claimants on incapacity benefit will not be transferred. It is therefore vital that the PCA is useful, effective and does not cause problems but leads to their resolution by identifying people’s capabilities to work rather than their overall incapacities.
However, too often, laws and regulations are made in the hope of achieving an outcome. As a member of the Science and Technology Committee with a background in business, I believe in evidence-based policy making. That is why we must acknowledge that laws and regulations—the PCA is largely a regulation—often have unintended consequences. In some cases, regulations have the opposite effect to that desired. Evidence is therefore vital and that produced so far is rather dubious. Only a small sample of assessments was made in reviewing the PCA—it ran only into the hundreds, if I am correct—and some conditions were missing. For example, nobody in the sample had disabilities on the autistic spectrum. I urge the Minister to consider new clause 3 carefully because if there is no evidence for effectively establishing the new PCA, surely it is important to produce a report to show its effectiveness, at least for the first few years until we are confident that people’s lives are not being destroyed due to insufficient data.
My key concern is about people who face a mental health challenge. If people who suffer from depression, are in remission from it or who suffer the other disorders and challenges that those with mental health problems encounter, are confronted with a PCA in which they are not confident, that could trigger another episode of their condition. So we need to be very careful about the PCA, and one way of ensuring that it produces the intended consequence of identifying people’s capability for work is to report on it. There is a fundamental difference between a report on the outcomes of a policy and a review of that policy. New clause 3 calls for a report on the outcomes, not a review.
If the Secretary of State and the Minister are confident that the new PCA will work, why do they oppose disclosure in the form of what I imagine would be a fairly straightforward annual report? Why would they feel the need to hide anything, or cover it up? Will the Minister take responsibility for any harm done to those with a mental health condition if the PCA is not effective or if it is not implemented correctly? From what I can see from the lack of data and evidence, and from the performance of the previous capability assessments in which 50 per cent. of appeals were upheld, the present PCA is based on a lot of hope and aspiration but very little fact or evidence. We have an opportunity here, and if the Minister will not accept new clause 3 in its present form, I urge him at least to give a strong indication that he will introduce proposals for some kind of report on the personal capability assessment element of the Bill.
It is a pleasure to respond to what has so far been a typically constructive debate. It has been consistent with the tenor of our detailed scrutiny of the Bill upstairs in Committee. Some might say that despite my contributions, we had some of the most informative and productive exchanges that I can remember in any Standing Committee on which I have had the pleasure to serve in my mere decade in this place.
I have no desire to interrupt the hon. Gentleman’s flow, but in a spirit of bipartisanship, may I ask whether he was aware that, after the first day of our deliberations upstairs, one of the policemen commented to one of my hon. Friends that it had been the most constructive and good-natured debate that he had heard in all his time on the upstairs corridor?
I was not aware of that. I had been labouring under the illusion that those fine members of Her Majesty’s constabulary did not listen to the detail of our conversations, and that they perhaps participated in sudoku or some other leisure pursuit in Committee. However, it is enlightening to hear what the hon. Gentleman says. The success of our discussions was at least in part down to the contributions made by him and his Front-Bench colleagues, as well as by the hon. Member for Inverness, Nairn, Badenoch and Strathspey (Danny Alexander), by the hon. Member for Yeovil (Mr. Laws) in a passing visit and by the Under-Secretary of State for Work and Pensions, my hon. Friend the Member for Stirling (Mrs. McGuire)—[Interruption.] I want to make some progress, but I must not forget the contributions made by my hon. Friend the Member for Glasgow, North-West (John Robertson) and those from many other airts and pairts of Great Britain.
I am pleased to follow the hon. Member for Windsor (Adam Afriyie) in this debate because he played an important part in our deliberations in Committee and has rightly said that our approach to welfare reform should be evidence based. He is also right to say that incapacity benefit in its present form has not kept pace with the changing nature of disability, given the emergence of mental health conditions—particularly fluctuating mental health conditions—over the past two decades, and the changing gender make-up of the present IB customer base. About 40 per cent. of those on IB at the moment are women. We know that there has been a transformation in the sense that IB had previously been considered a legacy of our industrial heritage, but that is no longer entirely the case.
IB has not kept pace with the changing nature of society and the legal rights that disabled people now enjoy in the United Kingdom. It has not kept pace with attitudes to those with learning difficulties, many of whom, it is now recognised, can play a productive role in the labour market. Progressive employers are now seeking ways to involve many people who have a fluctuating mental health condition or learning disability in active employment.
The benefits system has not kept pace with such social changes as it should have done. Notwithstanding that, progress has been made. If we can continue as we did in Committee, without the traditional partisanship, it would be helpful.
In passing, the number of people on incapacity benefit has decreased significantly recently—by about 54,000 in the past year. The most recent figure for the number of people on incapacity benefit is, I think, 2.69 million. If we had continued the trajectory as it was in 1996-97, however, that figure would be 4 million. Of course, much more needs to be done to support more of those 2.6 million to get off incapacity benefit.
I also want to allay the fears expressed by the hon. Member for Daventry (Mr. Boswell) about the Government setting an arbitrary upper target for the number of people on incapacity benefit. He knows that that is not what the Bill is about, and it would be reactionary and wrong for this or any alternative Government to set an upper limit for the IB caseload. We have set a target of reducing the number by 1 million, but we are not seeking to achieve that through a legislative cap; we are providing the support to enable that as a public policy intent. That is what underpins the Bill.
Let me comment briefly on the new Government amendments. As we have said, we want everyone to have the opportunity to work. That is why we have based entitlement to the support group on the most severe disability, which would make it unreasonable to require the person to engage in work-related activity. That underpins Government amendment No. 18. In relation to clause 9, the 46 descriptors in draft regulations, which have been provided in the Library of the House, reflect such a severity of disability.
One of the problems that will doubtless emerge is that different assessors, even in the same locality, will have a different view of how to score particular types of disability and whether people qualify for the support benefit. That is true of any system, but it is particularly acute in a new system, when many people’s judgments are up in the air, and people worry about whether they have been more harshly treated than others. What will the Minister do to try to ensure greater consistency of judgment and greater clarity on how to score?
I will come to those points later. In general, however, the right hon. Gentleman is correct. Without being too churlish, he and I do not always find ourselves in agreement, but he is absolutely correct about the need for national consistency in assessments, not just in relation to incapacity benefit and employment and support allowance, but with regard to all sorts of other entitlements to benefits, including jobseeker’s allowance.
On Government amendment No. 18, we recognise that there are circumstances in which a person might not satisfy any of the 46 descriptors were they applied. We would still, however, want to treat them as having limited capability for work-related activity, and therefore as having access to the support group. As I said in Committee, paragraph 9(a) of schedule 2 allows us to provide in regulations for certain groups of people to be treated as having limited capability for work-related activity. For example, a person with a point of weakness, such as an aneurysm in one of the arteries to the brain, could put his or her life at risk by engaging in anything requiring even slight effort. We would automatically place such a person in the support group, even though they would not meet any of the 46 specific descriptors were they applied at that stage.
Those circumstances do not necessarily imply that someone should be treated as having limited capability for work-related activity for an indefinite period. People’s condition and indeed circumstances may well change, and we want to ensure that we can respond to those changes. The amendment makes that possible.
Amendments Nos. 26 and 47 are concerned with consistency and continuity. They simply maintain long-standing benefit rules. Amendment No. 26 allows regulations to be made so that a person who is disqualified from receiving employment and support allowance because of his or her own misconduct can be treated as not having limited capability for work for the purposes set out in regulations. Consequently, he or she will not be entitled to the allowance for the period of disqualification. The provision can also confirm entitlement by treating the person as having limited capability for work.
Importantly, that replicates the current approach in section 31(1) of the Social Security Act 1998, which provides for regulations to allow a person who is disqualified from receiving incapacity benefit on similar grounds to those that will apply to employment and support allowance to be treated, for prescribed purposes, as not being incapable of work and therefore not entitled to benefit. Amendment No. 47 provides for the repeal of that provision once the migration of existing cases to employment and support allowance is completed.
I hope that that was as informative as it is possible for the explanation of technical Government amendments to be. Let me now deal with proposals that have attracted considerably more attention, starting with new clause 3.
As was suggested by the hon. Member for Inverness, Nairn, Badenoch and Strathspey, when we implement a new policy—particularly one as important as this—monitoring must be a continuing process, and we certainly intend that to apply to employment and support allowance. The hon. Member for Daventry spoke of consistency in contractual arrangements, particularly in the private and voluntary sectors. He and other Members may have availed themselves of information placed in the Library, which explains how we intend to make that a reality.
The hon. Gentleman also found himself in agreement with my hon. Friend the Member for Hendon (Mr. Dismore), who presented a ten-minute Bill earlier today. What surprised me most was the fact that my hon. Friend managed to present his proposals in 10 minutes, which was probably a first for him.
The revision of the PCA has naturally attracted substantial interest. It is, of course, essential for us to evaluate the way in which it will work. The first stage of the test carried out in October and November was a limited evaluation of the revised descriptors and scores to enable us to begin drafting regulations. A second, more detailed, evaluation of the PCA will begin shortly. It will enable us to refine and fine-tune the recommendations of the working groups, while also ensuring, before we implement it, that the revised PCA constitutes a robust and accurate assessment of limited capability for work.
Members in all parts of the House referred to the initial dry run of the descriptors. I hope that I can reassure the hon. Member for Inverness, Nairn, Badenoch and Strathspey and others. From the Government’s point of view, this is work in progress. The initial evaluation was intentionally a small study, intended to confirm that the revised descriptors and scoring system would work. As those who served on the Committee will know, it has always been the case that further evaluation will take place as the task of refining the descriptors evolves.
I stress that we are not drawing any firm conclusions about the effect of the revised descriptors on the benefit allowance or disallowance rate from such a small sample of cases. The next phase of evaluation, which is due to begin soon, will involve a larger and more representative sample, and representatives of the consultative group will be invited to take part. There will thus be a wider audience and a much greater number and variety of cases.
I shall give way to my hon. Friend the Member for Kingswood (Roger Berry), and then to the hon. Member for Inverness, Nairn, Badenoch and Strathspey.
At what stage in the process would my hon. Friend argue that what is occurring is an independent evaluation of the system, because that is essential if it is to be robust and successful?
As I said, I shall also give way to the hon. Member for Inverness, Nairn, Badenoch and Strathspey.
Order. The Minister must respond to the first intervention before he takes the second one.
I shall address the independent nature of the assessment and monitoring shortly, but I anticipate that the points of the hon. Member for Inverness, Nairn, Badenoch and Strathspey will be of a similar tone to those of my hon. Friend the Member for Kingswood—although I might be wrong, of course—and I would like to respond to both.
I welcome what the Minister says about a further and more detailed evaluation and the involvement of independent groups. Will he also assure us that information will be made available to the House so that we can scrutinise all relevant matters as well as the independent groups? If that is done, the concerns that exist can be allayed before we move forward with draft regulations—or, indeed, with putting the new test into practice.
I will be happy to do so. We will certainly publish the report of the initial dry run before the Lords Committee stage, and we will hold discussions with the hon. Gentleman and others about the most appropriate time to inform this House and the other place about the specific outcomes of the second, and more substantial, process of utilising the new 46 descriptors. We will also seek to publish as much information as possible on the time scales that have been mentioned.
Despite some of my comments and the hon. Gentleman’s kind words in response to them, I am not attracted to new clause 3. Involving the Office for Disability Issues, which is of course part of the Department for Work and Pensions, by asking it to provide an annual report on the operation of the PCA would distort the natural accountability by placing at least some of the responsibility for operational stewardship elsewhere in the Department, rather than with those responsible for the specific policy and its operation.
My hon. Friend the Member for Kingswood explained why he was not attracted to new clause 3, and there are additional reasons why the Government are not attracted to it. The Department is already required under disability discrimination legislation to produce a disability equality scheme. Active involvement of disabled people is already required in meeting the duty to promote disability equality. The additional obligations that new clause 3 proposes be imposed on the ODI would merely replicate the good work already being carried out by Departments, including the DWP, in meeting their duty to promote disability equality.
I have spoken about the new clause’s problems in respect of accountability. I have also referred to existing provisions on disability equality and the impact on disabled people generally. New clause 3 would create further problems in respect of the feasibility of requiring the ODI to provide reports on the operation of the assessment of limited capability for work. That is because of what the ODI would be asked to evaluate. The assessment of limited capability for work will inevitably involve clinical judgment because it will deal with the effects of medical conditions on individuals who have symptoms that cannot be measured precisely or exactly, such as pain. New clause 3 would require the ODI to review, evaluate and assess policy in the area of clinical judgment and would require the ODI to assess medical quality standards. Understandably, the ODI is not equipped to carry out such an evaluation process. It does not employ health care professionals, who would be needed to judge whether clinical judgment is being correctly applied.
We have much more effective ways of carrying out that assessment. That brings me directly to the point made by my hon. Friend the Member for Kingswood. There are more effective mechanisms for independently evaluating the revised PCA to ensure that it effectively assesses limited capability for work, before it is implemented in 2008. We will also continue to monitor the effectiveness of the revised PCA following its implementation. For the first two years after it is implemented we will involve in its ongoing evaluation the independent experts from the technical working groups that advised us on the transformation of the PCA. For the period from 2008 to 2010, those independent experts will remain in place to offer assessment, challenge and observations about the operation of the revised PCA during the first two years.
The Minister has already said that he is willing to make public the assessments between now and the completion of the Bill’s passage, but is he also willing to make public the data that he just described after that passage during the first two years of operation? It would then not only be a matter of consultation between him and the independent experts, but could be reviewed by the House and, more particularly, the Select Committee as well.
The hon. Gentleman has helped with our deliberations on the Bill at all stages and he has offered another reasonable suggestion. Subject to the caveat that there are no issues of commercial confidentiality—I cannot see how it would apply in this matter—we would be able to provide that information to the House and the relevant Select Committees. I hope that that also reassures the right hon. Member for Wokingham (Mr. Redwood) about micro-assessment and the ongoing day-to-day basis of how the revised PCA operates over the first two years. It is important that we learn about the changing outcomes of the appeal processes and assess whether we have got that right in the first two years. That provides an additional external check on how we manage the operation and effectiveness of the new PCA. After that time, we will still be subject to the usual channels of parliamentary scrutiny through Select Committees, the Public Accounts Committee and parliamentary questions.
For all those reasons, we do not accept new clause 3 as we do not believe that it is a desirable way of auditing the application of the PCA. In addition to those protections and the independent and crucial parliamentary challenge that I have mentioned, the Government would reflect further at the end of the three-year period. Having gathered all the evidence and having learned from consultative groups and the observation of Select Committees about the nature of the appeal mechanisms, we would then consider the most effective way of continuing to keep on top of the issues with an active review and independent assessment of the continuing role of the PCA beyond 2010. I hope that that reassures the hon. Member for Inverness, Nairn, Badenoch and Strathspey enough to tempt him to withdraw the motion, but I am not sure that it will.
I should like to move on to deal with issues raised by my hon. Friends, particularly on amendment No. 71. I am glad that my hon. Friend the Member for Kingswood has provided the Government with another opportunity to put our intentions on the record. We intend that the powers in clause 17 will be used only if a customer purposely and without good cause is found to have a limited capability for work, resulting from their own misconduct, failure to follow medical advice or failure to observe prescribed rules of behaviour. That includes misconduct leading to injury or a refusal to follow standard medical advice recommended by a doctor or hospital that could improve their condition and allow them to return to work.
As stated in Committee, the purpose of clause 17 is to safeguard the benefit system against abuse where a customer deliberately decides not to follow standard medical advice in order to continue to receive benefit inappropriately. The clause is not an attempt in any sense to force people into accepting medical treatment or medication that they do not wish to take for genuine reasons—for example, on account of unacceptable side effects of drugs or fear of surgery. I hope that that reassures my hon. Friend the Member for Kingswood on the issues that he raised.
Amendments Nos. 98 and 99 were tabled by my hon. Friend the Member for Glasgow, North-West who illuminated the Committee with observations on his experience in Glasgow. A league table of incapacity benefit has been published, so we know that the city of Glasgow has the constituencies with the highest level and the second highest level of incapacity benefit customers in the whole of the UK. Without wishing to enter the whole debate between my hon. Friend the Member for Rhondda (Chris Bryant) and the hon. Member for Weston-super-Mare (John Penrose), the changing nature of incapacity benefit is evident in that more women are now claiming it. But it is still the case that if one were to publish a list of the 100 parliamentary constituencies with the highest levels of incapacity benefit, 94 or 95, perhaps even 96, of them would be represented by Labour Members. I make no wider point than that, except to say that it is a result of the historical footprint of deindustrialisation and the fact that so many people were abandoned for a period when they lost their jobs and were out of the labour market for a prolonged time. As my hon. Friends have pointed out, if someone is on incapacity benefit for one year, they will on average be on it for nine years.
My hon. Friend the Member for Glasgow, North-West asked about the Atos Origin operation. My hon. Friend the Under-Secretary, who has responsibility for disability issues, regularly answers parliamentary questions about the operational nature of Atos Origin and its procedures and practices. With a customer’s permission, the IB medical report may be made available to Members of Parliament and that is the right level of confidentiality.
My hon. Friend the Member for Glasgow, North-West also asked about terminal illness. He had a novel way of avoiding your wrath, Mr. Deputy Speaker, by admitting that he was widening the terms of the debate and hoping to sneak the issue past you. I hope to sneak a response past you in the same way, although it is of course open to you to call me to order. I hope that I may offer some comfort to my hon. Friend and also to my hon. Friend the Member for Dumfries and Galloway (Mr. Brown) who doggedly pursued the issue in Committee. I have given a commitment to talk to my hon. Friends in greater detail about this and it is our intention to fast-track those with a terminal prognosis through the system so that they do not have to wait the 13-week assessment period. We also wish to find ways to pay the benefit much more quickly. We process claims for DLA in about a week and there is no reason why we cannot seek to achieve a similar turnaround for those with terminal illness in respect of ESA.
At present a person who is claiming IB or IS on the grounds of incapacity for work and who does not meet the PCA threshold has the option of either claiming IS at a reduced rate, set at 80 per cent. of the usual personal allowance, or of claiming jobseeker’s allowance while they are appealing against the PCA decision. That is because many customers believe that they will prejudice the appeal if they are seen to be claiming JSA, which has rather more onerous conditionality requirements than IB.
For ESA, we have decided to simplify the system. Where a customer does not satisfy the PCA, but continues to provide medical advice that they should refrain from work, entitlement to ESA at the assessment phase rate will continue pending the outcome of the appeal. That is a unique feature of the decision making process for social security, as normally when a person is not entitled to benefit it ceases and would be reinstated only when an appeal tribunal rules in the customer’s favour. Customers will be subject to ESA conditionality, not JSA conditionality, pending the outcome of the appeal. I hope that that reassures my hon. Friend on his important amendment. Amendment No. 98 is therefore unnecessary and I hope that my hon. Friend will not seek to press it.
Amendment No. 99, as has been suggested, goes much further than amendment No. 98 in that it seeks to treat people who have shown that they do not meet the criteria for limited capability for work-related activity as if they do so, solely because they are appealing against a decision that they do not. The effect would be to enable people in that position to receive a higher level of benefit and also not be subject to the normal conditionality regime simply because they have entered the appeals mechanism. I suspect that that is not the purpose behind the amendment and I again invite my hon. Friend not to press it.
In conclusion, I have outlined the reasoning behind the technicalities of the Government amendments, and sought to reassure my hon. Friend the Member for Kingswood about our intentions in respect of medical treatment. In addition, I hope that I have reassured my hon. Friend the Member for Glasgow, North-West about his specific and important concerns, and that the hon. Member for Inverness, Nairn, Badenoch and Strathspey accepts that there will be parliamentary scrutiny in the important period between 2008 and 2010. At the end of that period, the Government will table proposals to ensure that the right of independent and parliamentary scrutiny is further enshrined so that the effectiveness of the revised PCA, which is central to the introduction of the employment and support allowance, can continue to be assessed.
This has been a good debate, especially in respect of the need to secure continued independent assessment and scrutiny of the revised PCA. I welcome the Minister’s response to our criticisms of the initial dummy runs, and the problems that arose with them. I also welcome the fact that there will be another set of initial assessments, but the Minister’s partial concession that independent involvement will continue for the first two years of the new PCA does not go far enough.
As happened with the current system, many of the problems will not arise in the first two years of the new PCA. The Minister spoke earlier about the changing nature of disability over the years, and that is why we need an annual review. The hon. Member for Kingswood (Roger Berry) wondered whether the ODI was the right body for that purpose, but I think that, in consultation with other organisations, it could play that role very effectively. Therefore, although I welcome some of what the Minister said, I still want to press new clause 3 to a Division.
Question put, That the clause be read a Second time:—
New Clause 7
Participation in work-focused interviews
‘(1) Members of the support group wishing to participate in work-focused interviews may do so on a voluntary basis.
(2) The Secretary of State may by regulation define—
(a) the maximum numbers of interviews they may attend,
(b) circumstances in which participation in one or more interviews is not a condition of entitlement to the full amount payable under the employment and support allowance.’.—[Mr. Ruffley.]
Brought up, and read the First time.
I beg to move, That the clause be read a Second time.
With this it will be convenient to discuss the following amendments:
No. 3, page 8, line 1, leave out clause 10.
No. 58, in clause 10, page 8, line 6, at end insert ‘and
(c) not in the assessment phase of a claim for an employment and support allowance,’.
No. 116, page 8, line 9, at end insert—
‘(1A) Such an assessment may not take place earlier than 2 weeks after the assessments to determine limited capability for work or limited capability of work-related activity.’.
No. 57, page 8, line 18, at end insert
‘in accordance with the choice and requirements of such a person’.
No. 1, page 8, line 21, leave out paragraph (f).
No. 2, page 8, line 32, leave out subsection (3).
No. 87, in clause 12, page 11, line 22, at end insert—
‘(j) for notifying a person not subject to a requirement to undertake work-related activity that he may participate in work-related activity on a voluntary basis.’.
No. 4, in clause 15, page 13, line 5, leave out ‘10’ and insert ‘11’.
New clause 7 relates to an extremely important group of individuals: those in the support group, who will enjoy the benefits of the new allowance. They are the most severely in need. They are quite separate from those in the employment group who, under the assessment in clause 9, are judged to be capable of work-related activity—not so support group members. However, even though, under the Bill, support group members are not under any obligation to undertake work-related activity, in a far-sighted and welcome way Ministers have made it clear that support group members may be able to volunteer for work-related activity and all the support and resourcing that comes with the undertaking of work-related activity.
We all agree that there will be a fair number of volunteers from the support group who wish to avail themselves of the opportunity to undertake work-related activity. We know that because so many surveys, which Members on both sides of the House buy into, suggest that in the region of 1 million of the 2.7 million fellow citizens who are on incapacity benefit would like to work. They are desirous of working, and wish to make a contribution and to be better off for the benefit of themselves and their families. They want to exercise personal responsibility, which is part of the Government’s agenda, allied with rights. We buy into that on the Conservative Benches as well and we are fully supportive of it. Those people want to get better. They want to get work-ready. We in the House should do everything that we can to help them. That is the purport of the new clause.
The new clause provides that support group members should not be subject to the conditions that are imposed on employment group members who undertake work-related activity. There is a reason for that. It is entirely likely that a member of the support group will have severe and challenging conditions—by definition, more so than a member of the employment group. They might have fluctuating conditions. They might have quite a good week after they have volunteered. Things could be going swimmingly. They would be able to tick off securing their first work-focused interview. We hope that they would be enjoying the experience. However—as we discussed in great detail in Committee—with many fluctuating conditions, a claimant can have one really good week followed by one really dreadful week when, through no fault of their own, they are completely unable to face up to or engage in work or even the prospect of work.
In that situation, we do not want someone in the support group who is doing something that they are not obliged to do—volunteering for a work-focused interview and, by extension, work-related activity—to be penalised because they have a bad week and are unable to satisfy the conditions of the work-focused interview. Perhaps they do not turn up on time, or do not turn up at all—again, through no fault of their own. We do not want someone to have their benefits docked or reduced in those circumstances, and I am sure that Ministers do not want that to happen, but that is implicit in the sanctioning regime in the Bill.
There is a hint that sanctions—benefit docking—might be a disincentive to those in the support group when it comes to volunteering in the first place. Many surveys—one from Capability Scotland has been cited many times—show that at least one in two disabled people do not want to engage in work-related activity out of sheer fear that their entire disability benefits package might be reduced if they show any level of functionality greater than has been previously judged.
New clause 7 would allow us to go the extra mile by ensuring that the fear of volunteering for work-related activity that a member of a support group might have, even though he or she would be under no obligation so to do under the Bill, would not put him or her off. Such people should not fear that they would be subject to a sanction if they showed some capability at a work-focused interview but were not able to keep that capability up—because of a fluctuating condition, for example—because they were unable to turn up and do the full raft of work-focused interviews.
When we discussed the matter in Committee, the Minister for Employment and Welfare Reform was alive to the situation, which arises logically from the Bill’s drafting. He observed—we have no reason to doubt these figures—that only about 1 per cent. of claimants under the pathways to work pilots have been subject to sanctions. Nevertheless, 1 per cent. of the big number of 2.7 million citizens could represent a lot of sanctioning, with some 25,000 people affected. We must remember that some of the people who could be sanctioned will have children. The Minister says that about one in six incapacity benefit claimants have children in their household. We have touched on the fact that sanctioning might not be terribly good news for families around the poverty line and we have all agreed that we would not want child poverty to be exacerbated by a sanction regime that kicked in to dock benefit and thus made a household poorer.
I am very happy to give way to the hon. Lady. Her contributions in Committee were terrific and I am sure that her intervention will be equally fine.
I thank the hon. Gentleman for that build-up. I think that he slightly misses the point about the sanctioning regime and the difference between the support group and the employment group. It was made absolutely explicit in Committee—it is explicit in the Bill—that if a person in a support group voluntarily went into work-related activity, his or her employment and support allowance could not be sanctioned.
I agree with the hon. Lady on many things, but I must disagree with her last observation. The purport of new clause 7 is to put in the Bill the very protection that she says is already in place. That protection is not in place. I will explain why I think that she is in error, although I will be happy to allow her to intervene, if she does not agree with what I say.
In Committee, the Minister said that there were safeguards. He made it clear on more than one occasion that page 6 of the draft regulations with which he furnished the Committee referred to safeguards before a sanction was imposed. The problem that I have with that—the hon. Member for North-East Derbyshire (Natascha Engel) probably should also think that this is a problem—is that the text says:
“The majority of safeguards are not set out in regulations”.
The safeguards are not set out in not only the Bill, but the regulations. The document continues by saying that the safeguards
“are in operational guidance to ensure that where necessary they can be adapted if evidence suggests that they are not effectively protecting people”.
Page 6 of the document to which the Minister referred many times upstairs says that the safeguards are not in the Bill, or even in regulations, but in operational guidance.
When the hon. Member for North-East Derbyshire made her intervention, she was probably referring to the assurances that were given in Committee about the way in which a volunteer from a support group could not be sanctioned. However, I am afraid that the Minister uncharacteristically missed the point in Committee when he said that in such circumstances it would be quite possible under the sanctioning regime for the sanction—the benefit docking—to be nil. However, that still is not good enough, because it implies that an individual from a support group who has volunteered falls under the sanctioning regime.
The Minister also said that support group members who volunteered would have a right of appeal, which presupposes that they would be mired in the sanctioning regime. Such people would get rung up and would need to show good cause. They would have to go through all the rigmarole of arguing the toss about why, under the hypothetical example that I cited, they were not able to turn up for the full raft of work-focused interviews because their fluctuating condition meant that they were okay one week, but not so good in subsequent weeks, which was why they had not satisfied the requirements of the officials handling their case.
Let me make two brief points. First, the hon. Gentleman’s comments presuppose that a work-focused interview would be mandatory for a person in a support group, which is not the case. Secondly, the sanction could not happen without a movement from the support group to the employment group. Without such a movement, all the points raised by the hon. Gentleman are completely irrelevant.
We will have to agree to disagree on this. The hon. Lady is a vigorous and vibrant debater, and I leave it to outside groups to decide who is right. The advice that I have received from many of those who represent with great distinction the interests of those on incapacity benefit and the disability lobby says that there is enough ambiguity in the way in which the Bill is drafted for it to be useful for new clause 7 to be included, which is precisely why I am moving it.
I thought that I had said this, but I will have to repeat it: those in the support group are under no mandatory obligation. They are volunteers. However, if those people make the decision to enter into the spirit of the regime that operates for those in the employment group, it is not clear that they will be free from sanctions and the sanction procedure. It is not good enough for the hon. Lady and her colleagues to say that there is a right of appeal. There is no doubt that an individual with a fluctuating condition who was a volunteer from a support group, even though he or she had no obligation to volunteer, could say, “I’ve got good cause because I have bipolar disorder and had a really bad week, so I missed a lot of the work-focused interviews.” New clause 7 would make it explicit that a person in such circumstances would not have to show good cause within five days—let us remember, there is a five-day period in which to show good cause, although the time for appeal under most benefits is a month—or make a case in an appeal.
We are arguing for crystal-clear clarity. I do not hesitate for a minute in saying that I hope that the hon. Lady is right that, in practice, those who volunteer from the support group will never be sanctioned. The chances are that it is 99 per cent. certain that they will not be sanctioned. However, I do not want to see such people having to go through the rigmarole of having a nil sanction against them or going through an appeal.
The hon. Gentleman makes an important point, which is why I support the new clause. He is not saying that it is not clear in the Bill that the support group is exempt from the sanctioning regime—that is clear. However, the Bill is unclear about whether people who volunteer from the support group to engage in work-related activity might be seen to be leaving the support group, with the result that they could be subjected to a sanctioning regime. That would cause people significant worry, which is why new clause 7 would be of benefit.
The hon. Gentleman has just repeated what I said earlier. Of course, people in the support group would not be subject to the sanctioning regime, because they would be free from any requirement to undertake work-related activity. However, if those people were to volunteer to do work-related activity, it would be possible, under the Bill, that they would be subject to sanctions. That is absolutely clear.
My hon. Friend the Member for North-East Derbyshire (Natascha Engel) does not need me to support her—she spoke most vigorously in Committee—but perhaps I can come to her aid. I ask the hon. Member for Bury St. Edmunds (Mr. Ruffley) to reflect on what he says in the context of clause 11(1)(b), which specifically excludes any
“member of the support group”.
Throughout our proceedings he has been on top of the detail of the Bill in a way that is very effective but, uncharacteristically, in his comments on this group of amendments he seems to have ignored a specific guarantee and protection in clause 11(1)(b).
Of course I remember that we discussed the matter in Committee, but we did not get the assurances that we sought. If a member of the support group is involved in the work-related activity regime, the point is certainly arguable, and that is why we make the argument that we do.
Under amendment No. 87, which is in my name and in the name of Government Members, there is a requirement to notify people of their right to volunteer. It is important to ensure that members of the support group, who are under no obligation to undertake work-related activity, have the clear right to be notified and told that they may undertake such activity, and so receive all the resourcing and help that goes with it. In those circumstances, notification is symbolically important; it underscores the fact that the Government and the law-makers in Parliament understand that those in the support group are valued and can get access to more support and help, as a result of undertaking work-related activity—and they are in the support group because the test says that they are so severely challenged by their condition that they are under no obligation at all to undertake work-related activity. Many things come with such activity, including cognitive behaviour therapy and the options outlined in the “choices” package in the pathways to work programme.
In the context of that right to notification, I hope that the language used will be temperate, and that we will not fall into the trap of using some of the standard letter language included in correspondence sent to claimants in pathways to work pilot areas. It is worth putting on record once again, on Report, a letter, sent by officials, that was drawn to my attention and the attention of my hon. Friends by Mind and the Child Poverty Action Group. It said:
“As your advisor, I need to meet with you to discuss how we can improve your chances of finding work, now or in the future. We want to make sure that you are getting the right support…It is important that you attend and participate in this interview. If you do not, your benefit may be affected.”
Outside groups found that language unfortunate. They suggested that it might make unhappy or unsettle claimants who might not want to be reminded too forcefully that their benefit might be docked.
Someone who is under no obligation to take part in work-focused interviews because they are in the support group should be notified in a manner, and using language, that makes it crystal clear that they have a right to volunteer. The notification should set out the support available and make it clear that the person is not part of a sanctioning regime. They should not be told, “You’re part of a sanctioning regime, but don’t worry, because you’ve got a right of appeal and there’ll be a ‘nil benefit docking’ decision.” It should be absolutely clear that if such a person wants to participate in work-related activity there is no possibil