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Work Capability Assessments

Volume 517: debated on Wednesday 27 October 2010

I am delighted to have secured this Adjournment debate on the work capability assessment, and even more delighted that it takes place under your chairmanship, Mr Gray. It is the first time that I have served under your chairmanship, so I am looking forward to the next half hour.

Before we launch into a massive programme of moving people from incapacity benefit on to employment and support allowance or jobseeker’s allowance, with the launch of the pilots in Burnley and Aberdeen, it is a good time to take stock of where we are, what has happened in the past and where we will go in the future. One of the things that most alarms me is the speed at which we are making the reforms. They were of course introduced by the Labour Government. The change from incapacity benefit and income support to employment and support allowance, with the support group and the work-related group, was introduced in October 2009 by Labour. We fully support all those welfare reforms. However, I would like the Minister to respond on a question of nuance and of how quickly and in what context the reforms are being made.

It is also important to highlight the reason why we moved from incapacity benefit and income support to employment and support allowance in the first place. It was because a large number of people were languishing on passive benefits and had little contact with anyone in their area who could help and support them to move from passive benefits into work. Hon. Members on both sides of the House have always agreed that work is still absolutely the best way out of poverty.

The headlines in the newspapers about individuals who get up to £10,000 of benefits a week are headlines because such cases are extremely rare. Most people on benefits, whether passive or active, are poor. We call them vulnerable; we mean poor. Those people are not rich. They are not wealthy. Their poverty is a different kind of poverty, especially in the case of someone on a passive benefit that does not require them to go to a jobcentre every week to sign on and have a face-to-face conversation with a personal adviser. It is a poverty not just of resource, but of experience and aspiration.

People in such poverty do not have access to the things that people with jobs take for granted. Their social networks dry up, and their personal development stops. What I am talking about is not just amounts of money and moving people off benefits and into work; it is about lifestyles. It is about the people whom we have spoken to who have moved from incapacity benefit into work and who talk about getting their lives back. It is fundamental and goes to the heart of what I want to say about the motivation behind moving people from incapacity benefit into work.

One of the things that most worries me is that the motivation now seems to be to get the welfare bill down, and nothing else. I agree that the welfare bill is very high and must be an important consideration—it is taxpayers’ money—but we must prioritise individuals. We must see the person, not the benefit. The group of people in question is a very large one, but they are all individuals, with different issues and problems, and different barriers and reasons for being on incapacity benefit rather than going to work.

The reason that the pathways to work project, in which I was quite heavily involved in Derbyshire—it was one of the first English pilots—was so successful was that personal and financial advisers in jobcentres looked at claimants as individuals; they did not think only about what benefit they were claiming. The project was not just about getting those people into work and off the joblessness figures. It was about considering what kind of support people needed, including what financial assistance they needed to get them the retraining that they wanted. It involved considering the local work force and the jobs available locally and working with local colleges. That is why it was so successful.

The problem is that that approach is extremely expensive. There is no doubt about that, but we always tried to argue that that was an up-front cost to bring about a saving way down the line. When we see what it does for individuals, it is stuff that money cannot buy. I would like some reassurance from the Minister that he is continuing with that motivation and not just the motivation of getting people off benefits and into work to make a big saving on the welfare bill.

Beyond the correctness of the principle of getting people back into work, there are serious issues about Atos Healthcare. It has always been a problem, and I am the first to admit that, even under the Labour Government, it was an issue. Atos is the only provider of medical assessments that is big enough to provide the sort of support that the Department for Work and Pensions needs in contracting out the work. However, in the massive change from incapacity benefit to employment and support allowance, which involves moving on from medical assessments to work capability assessments, we are asking Atos, which is already struggling with the amount of work that it has, to take on a huge amount of extra work. How will the Minister fill that capacity? Will he take more doctors out of the NHS, or is he thinking of supplementing the existing work force with a migrant work force? Both approaches are and always have been problematic, but given the massive increase in the amount of work that Atos is being asked to do, how will the Minister provide for it?

I congratulate my hon. Friend on securing this important debate and endorse all that she is saying with such passion. Will she take account of the fact that an advice centre in my constituency is winning 96% of its appeals against the work capability assessment? Does not that underline the fragility of the Atos process, which she has highlighted, and does not it show the need for the DWP to apply much closer quality assurance to the assessments?

That was exactly what I was going to come on to. Changing the description of the process from a medical assessment to a work capability assessment was welcome; it refers to what people can do and not what they cannot do. However, Atos has not moved away from an on-screen tick-box exercise. The number of people who come to my constituency surgery saying that they have been to a work capability assessment where the doctor has not even made eye contact with them is disgraceful. However, I am very worried about the issue that my right hon. Friend has raised. Up to 75% of cases taken up on appeal by the Derbyshire unemployed workers centre are successful, and the figure is 40% nationally. I recently asked the Secretary of State at DWP questions how many people that involves.

The errors that are already occurring will merely migrate to the new system. There has been no demonstration that there will be any underlying robustness. The numbers and the traffic involved will make things very difficult. I seek an assurance from the Minister about what people are saying anecdotally—I have no evidence for it—which is that there must be some kind of incentive: Atos is being told that it must get people off benefits. I want an assurance that Atos is not being told or incentivised to move people off incapacity benefit or employment and support allowance and on to the jobseeker’s allowance.

I am here to make representations on behalf of a client who has had to go to appeal. It is worth noting that the high level of appeal successes in the constituency of the right hon. Member for Oxford East (Mr Smith) and of those that we heard of anecdotally from the hon. Lady may be a reflection of the capability of those who assess whether to appeal, as I understand that only 5 or 6% of assessments are successfully appealed. That may put a slightly different gloss on the figures.

It does, unless one knows the demographic of the group. A big problem for those who have been out of work for a long time is that it has a really awful impact on their self-esteem and even on their ability to get out of bed, as they can get very depressed. One problem for those who are moved en masse from incapacity benefit to jobseeker’s allowance is that they do not have the confidence to appeal the decision. It takes groups such as welfare rights organisations to help them. Of those who are helped, the number who are successful on appeal is an absolute disgrace.

I wish to expand briefly on a couple of those points. In Chesterfield and Derbyshire, unemployed workers have had success in 75% of cases. I turn specifically to Atos Healthcare and its motivation. It did an assessment on behalf of Royal Mail for one of my constituents and found that he was not fit to work. Royal Mail retired him on the grounds of ill health, saying that he would never work again. However, when that person went for a work capability assessment, Atos said that he scored no points. The same company assessed him twice; on behalf of Royal Mail, it said that he was not fit to work and should be laid off, but on behalf of the Department for Work and Pensions, it said that he was fit to work and gave him no points. That puts the company’s performance in context.

I might have used that example, but I thank my constituency neighbour for his contribution. It is a serious matter, and errors are a fundamental problem. The system must be right if we are to move huge numbers from incapacity benefit.

I thank the hon. Lady for giving way. Does she agree that it is not a tick-box exercise, although it seems like one at the present time, with people being asked whether they can stretch, bend or kneel? There are two parts to the assessment. One of them concerns emotional matters, such as depression and mental health; the other is physical. Perhaps the best way to do that would be to make contact with the person’s GP or physician, who would have better knowledge of the claimant. It would certainly help.

Would the hon. Lady like to comment on a case from my constituency of a gentleman who had to change his colostomy bag 16 times a day who is now going through the appeal process? In my view, we have to find a way of short cutting the system for terminally ill patients and those who are very ill, using common sense to get them away from that tick-box process.

Absolutely. That goes back to my original point about the pathways to work scheme, which was successful because it considered the individual, rather than how to get people moved off benefits and into tax-paying employment.

I wish to ask a couple of questions, the first of which is a wider economic one. The Government will be moving people from incapacity benefit, or from employment and support allowance via the work capability assessment, to the jobseeker’s allowance, at a time when the Government have admitted that there will be 490,000 job losses in the public sector, and there will be a massive knock-on effect on the private sector. Even the Minister has to admit that employment will be going down rather than up. Where will the jobs come from?

My second question may seem a minor point, but the Government will be taking £25 a week from those on incapacity benefit or employment and support allowance by putting them on JSA. That may save the Government £25 a week per claimant, but that money will not go back into the local economy. Such people have so little money that they spend it all. In rural ex-pit villages such as those in my constituency, many people are on passive benefits, but it is those people who keep the local shops going. Such shops will now close. How will that help growth? How will that help the economy? How will that provide more jobs?

We are already struggling. Many people will have been on passive benefits for well over two years, yet they are still more likely to retire or die than get jobs. They may get batted into the nearest towns where there is work, but that work will be taken by people fresh out of university who are far closer to the labour market. How exactly will it work?

Huge cuts have been announced to the Ministry of Justice budget. We have already heard that the tribunal system will be overloaded by appeals against people being taken off employment and support allowance and put on JSA. Many of those appeals are successful. However, at a time when the Ministry budget is being cut, how on earth will it work? Is the tribunal service ready for that enormous spike in its work?

To sum up, I would like to hear the Minister give those on passive benefits the idea that there is some light at the end of the tunnel. The vast majority want to work. They are not workshy; they simply need the correct help and support. Of those on benefits, 45% have some sort of mental health condition, which often fluctuates. How are we personalising the service to get those people off benefits and into work? I shall list my questions, and if I do not receive answers, I shall intervene on the Minister or write to him.

I shall do my best to answer the questions asked by the hon. Member for North East Derbyshire (Natascha Engel).

I start by saying that there is a huge amount of agreement between us. Let us be clear: the proposals are not an exercise in money-saving. I have said time and again that they are about saving lives, not money. Yes, we will save money if we reduce the number of people who are welfare-dependent, but the starting point surely must be to try to help people make a better lot of their lives. That, effectively, is where the proposals came from.

If we look back to the last Parliament, there was—and, I believe, still is—cross-party consensus on the need to make the changes. The original proposal to assess current incapacity benefit claimants came in the Green Paper that I launched in 2008. James Purnell, who was Secretary of State shortly after that, took up the proposal for the migration and put in place many of the mechanics that were needed.

Given the hon. Lady’s comments, I believe that there is still cross-party consensus on the need to do something about the issue. Frankly, I regret that the assessment was not done years ago, because it is not right for anybody to be left on benefits, doing nothing, year after year without us seeking to find them a way back into work and helping them to make a better lot of their lives.

The hon. Lady is also right to say that we inherited the work capability assessment; it was set up by the previous Government, and was initially meant to operate with the employment and support allowance system for new claimants. It was designed by the previous Government and they put it in place, but it was not completely right; there were things that were wrong with it and needed to change.

One of the first things that I did after taking office this summer was make a number of changes to the work capability assessment—changes that were recommended by the previous Government following work that they did in their last few months in office. I looked at the changes and felt that they were sensible. They included: simplifying the language in the work capability assessment; making greater provision for people awaiting, or in between, courses of chemotherapy; making the higher rate of employment and support allowance available to more people with particular communication and mental health problems; and taking into account how people have adapted to a disability.

My view was that that was not enough, and I share the hon. Lady’s concern. It is not in my interests or the interests of the Government to get this wrong. I do not want to do down people who should not be trying to get back into work. I want to help those who have the potential to work, and to ensure that the work capability assessment is as effective as possible. There is no hidden motivation. I am not saying that we should make the test as tough as possible so that we can get more people off benefits and into work, thus saving money. I can categorically assure the hon. Lady that that is not the case.

There is no such thing as a perfect system, but we are working as hard as we can to make the system as effective as possible. Let me tell the hon. Lady some of the things that I have done to ensure that it is. Since the election, we have commissioned a further review of the work capability assessment. It is being carried out by a leading occupational health specialist, Professor Harrington of Birmingham university. We have assembled an advisory group to work with him, which includes Paul Farmer, the chief executive of Mind. I particularly wanted him to be on the review, because mental health is a big issue. Getting the facts right on mental health is essential. I do not want to say that people with mental health problems should not be able to work. Equally, I want to find the right dividing line to ensure that we do not do the wrong thing by people with mental health problems who would have genuine difficulty in working.

I want to emphasise the importance of the assessment of mental health problems. A constituent of mine told me that he could have sat down and cried to prove that he had mental health problems. He did not and, as a result, he was categorised as having no mental health problems. That was despite the fact that his general practitioner had categorically said that he did.

I have told the mental health charities that I am happy to hear their proposals on how we can change the wording of the assessment to strengthen the way in which we deal with people with mental health problems. I am happy to look at such proposals and incorporate any sensible changes. I said to Professor Harrington and his team that I want them to bring forward recommendations on how to improve things and to knock off any rough edges so that we can make the system as fair as possible.

The majority of people—it is far from all—who are on incapacity benefit with mental health problems have issues with long-term chronic depression. We have a straightforward choice. We can either leave them at home for the rest of their lives—the hon. Lady mentioned that many people end up just retiring rather than ever moving off benefit—or we can try to do the right thing and help them back into work. I passionately believe that the second is the better option. In a moment, I will address the hon. Lady’s concerns about personalisation, because I agree with her on that.

What I am saying applies across the piste: we are either saying that we will leave these people passively on benefits for the rest of their lives, or saying that we will do something to help them turn their lives around. It may be that going back to work will involve them doing something different from what they were doing before. If, for example, they were doing a manual job and they had an orthopaedic problem, they may have to do something different, and that may be a huge wrench that damages their self-confidence. The hon. Lady was right to say that many people who are on long-term benefits have lost networks and self-confidence. I do not buy into the headlines that say, “They are all scroungers.” Hon. Members will not find me using such language.

The biggest issue is about detachment from the workplace. Some people who have been in work previously and who have become utterly detached start to lack confidence; they do not know what to do or how to go about getting work. Sometimes, people have grown up in an environment in which worklessness has been the norm, and they do not have the knowledge to be able to take the first steps into the workplace. Helping them not only with the assessment but over the hurdle of getting back into work is a huge challenge, and that is what our work programme is all about.

Let me touch on one or two of the other areas that the hon. Lady raised in relation to the assessment. Atos has no financial incentive to get more people through the assessment and back into work, nor would I countenance it having one. It is Jobcentre Plus that takes the decision and not Atos, and Atos does not design the test. The recommendations that we get from Professor Harrington’s review—as long as they are sensible, and I am confident that they will be—will inform our decision making about how the test should be shaped.

My constituent, Gary Dennis, was recently diagnosed with motor neurone disease. He went to his work capability assessment and passed with flying colours—he got zero out of 13. I understand the Minister’s reluctance to categorise any disease as one that should not be assessed through the WCA, because everyone needs the dignity of work if they can have it. None the less, there are diseases, such as motor neurone disease, that have particularly aggressive pathways. There is a case for emergency reassessment. Within six weeks of Mr Dennis’s work capability assessment, he was completely incapable of work. Will the Minister consider such cases?

I am grateful to my hon. Friend for giving me prior notice of his concerns. One of the things that I am happy to consider—I have said that we will carry on reviewing this process as we go forward—is some kind of emergency brake for people who suffer an immediate and very sharp deterioration in their condition. We should be able to reflect that, and I will ask officials to consider how we deal with such a situation. The goal is to do the right thing by people. What I do not want to do is say of any condition, “Nobody with that condition can ever work.” I do not want to give people an automatic path into the support group because where we can, and where circumstances enable us to do so, we should be trying to help people into work. Clearly, when things change rapidly, we need to see whether there is a way in which to address that.

I am glad that the Minister says that Atos does not have an incentive to fail people. We have heard so much about the cases in which Atos has failed and in which people have successfully appealed against its assessment. Surely there should be some penalty for the service provider, because the system, and the appeals that errors cause, are a great waste of taxpayer’s money.

We cannot simply regard this as a question of errors by the assessors. The hon. Member for North East Derbyshire mentioned the issue of the number of medical professionals available. A more diverse range of medical professionals is being used, including those with expertise in mental health and orthopaedics; it is not simply doctors who are being used. One problem with using GPs is that we are putting them in a difficult position, because they are in danger of compromising their long-term relationship with a patient if they say, “Actually, you can go back to work.” We are very reluctant to go down the GP route. I am confident that having a mix of professionals will help us to deliver what the hon. Lady has asked for.

Getting the appeal numbers down is about getting the system right. I have asked Professor Harrington to consider how we can improve the system to reduce the likelihood of appeals. Appeals will never disappear, because some people will not want to accept what has happened. What we can do is seek to make the system as good and as effective as possible.

Let me touch briefly on the work programme and the support. The hon. Lady made a valid point about the need to provide personalised support. The work programme is designed to offer providers the freedom to tailor a programme to the individual, and not simply implement a programme designed in Whitehall. One of the reasons why programmes went wrong over the past 10 years was that they were too centrally directed. Officials would say, “You will do this. You will have five interviews and a period of work experience.” I want to trust the professionals, particularly those from the smaller, voluntary sector groups who probably work with some of the harder-to-help claimants, and give them the freedom to decide what works, rather than having to follow what Whitehall dictates.

We have only two minutes left, and I am really desperate to get an answer to the tribunal service question. I accept that we have lots of areas of agreement, but not, I think, when it comes to the tribunal service. This is not about the fact that some people will not accept that they are fit to work. Some 40% of people who appeal are successful. That means that they are told that they are fit to work, appeal, and are then told that they are not fit to work. That is a very serious number of people. What is the Minister doing to ensure that the tribunal system is up to the massive spike in numbers that it will receive?

First and foremost, I am trying to ensure that the cases do not get to the tribunal in the first place by making the assessment as effective and as accurate as possible. We also have officials working closely with the tribunal service to address that issue. We are running a number of pilots within Jobcentre Plus to look at ways in which we can improve the process and work more effectively with people who have been passed as fit for work to reduce the number of cases that will ever go to appeal. I am happy to share more of that with the hon. Lady as the weeks go on.

Let me touch on the last two points that the hon. Lady made. She asked where the jobs will come from. Some 280,000 new private sector jobs have been created in this country in the past three months, and the number of people claiming benefits has barely changed. That cannot be right, and it has to change. The private sector can create opportunities. Our job is to ensure that claimants are ready for them. As for the loss of £25 a week, sickness benefit should be for people who are sick. If there are two people sitting side by side in the Jobcentre, both of whom are deemed fit for work, it is not right if one of them is better off than the other. That is why we are clear that the proposals are a sensible step to take. At the end of the day, I want a system that treats people fairly and decently, and also helps them back into work. I do not believe that anybody is better off at home on benefits, doing nothing.

Sitting suspended.