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Work Capability Assessments

Volume 539: debated on Wednesday 1 February 2012

Motion made, and Question proposed, That the sitting be now adjourned.—(James Duddridge.)

It is a pleasure to serve under your chairmanship for the first time, Mr Williams.

I am grateful to have the opportunity to raise the issue of work capability assessments, and I note that the number of right hon. and hon. Members present indicates a degree of interest that merits us having a debate that is often misrepresented. From the outset, I must make two important points. First, I support the principle behind work capability assessments; some Members are against them in principle, but I am not. I agree that those who seek sickness benefit should be assessed to determine their fitness for work. Of all the many constituents who have contacted me on the matter over almost two years, none has disagreed with the principle behind an assessment—that people who can work ought to be helped into work where jobs are available. There are many benefits, which I have seen for myself with constituents who have been able to find work, although they previously thought that they might not work again. Those benefits are not merely economic but relate to health and well-being, and we should not confuse the debate by suggesting otherwise.

To support the principle, however, does not mean ignoring the current chaos of the work capability assessment in practice. Increasingly, over the past 12 months in particular, we have seen a chaotic process, which takes an inordinate amount of time, causes great anxiety for many, takes up huge amounts of public money, especially in the appeals process, and is doing a disservice both to those who want to get back to work and to those who will not be able to work.

The Government, in particular the Minister of State, Department for Work and Pensions, the right hon. Member for Epsom and Ewell (Chris Grayling), with whom I have discussed the situation in the Chamber and in meetings a number of times, have a habit of deflecting responsibility for how the system operates. Too often, the Minister has a ready excuse for the failings of the work capability assessment. Sometimes, he blames the previous Government, and sometimes he claims that people need to have patience to allow reforms to bed in, but I am not sure that I have ever heard him accept responsibility for the mess that the system is currently in. Part of the reason for that mess is the speed of the roll-out, despite the warnings of the pilot process and the report of the Select Committee on Work and Pensions.

About 11,000 people a week currently undergo the work capability assessment. Between 40% and 70% of those who appeal their assessment win their appeals, depending on whether they are represented. Is it any wonder that the cost of appeals is on track to reach £60 million for 2011-12, up by £20 million on the previous year? Is it any wonder that the number of tribunal service staff has increased by 30% since January 2010? Is it any wonder that tribunal centres, including the one in my area, in Hamilton, now operate on Saturdays to cope with the huge backlog of appeals? The system may have been put in place before the Minister took office, but by signing off on the nationwide roll-out, which has clogged the system, and by not dealing with the defects, the Government now have ownership of the problems and should be dealing with them.

Professor Malcolm Harrington, in his first review of the work capability assessment, made a number of important recommendations to improve the system. The Secretary of State for Work and Pensions welcomed the report and said that he fully endorsed the recommendations. The Minister said:

“We fully endorse Professor Harrington’s recommendations... We believe that the principles of the assessment are right, but that the system which we inherited contained some flaws that risked undermining its effectiveness. We have moved swiftly to put those right.”

Yet in Harrington’s review of the second year, published in November last year, he made it clear that the users of the system, including benefit claimants and the organisations working with them, have seen no difference. The review cited one survey by the Disability Benefits Consortium, which asked 439 welfare rights advisers during the summer of last year whether they had noticed any improvement since the first Harrington review: an incredible 75% reported no change and fewer than 4% saw improvements. That is a damning indictment of the Government’s failure to implement proper change to make the system fairer, not only for those who use it but for the taxpayers who fund it.

One example of the Government’s failure to follow through on its welcome of Harrington’s recommendations relates to the performance of Atos Healthcare. Atos is the multi-billion-pound French IT firm that receives £100 million a year from the Department for Work and Pensions to carry out the work capability assessment. The Atos website, which I am sure the Minister is as familiar with as I am, boasts of global turnover of €8.7 million; Atos employs 78,500 people around the world.

Before my hon. Friend goes into details about why Atos is probably failing as a medical assessment organisation, does he agree that part of the problem begins with the attitude of many of the staff engaged by Atos and their total unprofessionalism?

My hon. Friend is entirely right. I have been contacted in the run-up to the debate by a variety of organisations giving me examples, and I have others from my own constituents, of how the process has failed and how it works and does not work. The process does not properly take account of a whole range of issues, from people with fluctuating or mental health conditions down to how people feel and how they are treated when they go into the assessment—for example, the people doing the assessments not making eye contact or asking leading questions to get an answer that is nothing to do with the health conditions.

I became a Member of Parliament in 2010 and, right from the start, people expressed concerns to me about the work capability assessment, which was introduced by the previous Government. Can the hon. Gentleman confirm that Atos was hired by that previous Labour Government? Were some of the concerns that he was beginning to talk about exhibited at that stage, or are they only coming to light now?

The hon. Gentleman must know the answer to his question, but I have not suggested that the contract was agreed under the current Government.

I do not know why the hon. Lady says “Ah!” from a sedentary position as though that was some great revelation, because no one has suggested anything else. After the pilots, the Select Committee report highlighted issues that should then have been dealt with, but rather than dealing with them, the Minister decided to roll out the process. That is the root of the problems, such as the huge backlog of appeals, the huge cost to the public purse of dealing with those appeals and the huge anxiety and concern of many people. Many people have worked for a number of years and now find themselves, through no fault of their own, unable to continue in their previous line of work, and they would appreciate help to get into work; many others, frankly, are no longer able to work. The process was rolled out without its problems being addressed first, and given how the system is operating, those concerns are now coming home to roost.

Some of us who were Members before 2010 expressed concern to the previous Government. A serious issue in my constituency is the higher incidence than the national average of mental health problems, and some of those people affected have come to see me. One brave gentleman explained exactly how he had gone through the process, which involved a half-hour interview and a tick-box approach that did not take into account the challenges of mental health. As with many of my constituents with mental health problems, he would really like to work, but that short, sharp, tick-box system is not how to help people. I am sure my hon. Friend agrees.

I entirely agree with my hon. Friend. Such issues were among those identified. My contention is that those problems should have been dealt with before the system was rolled out further, and we are now dealing with the consequences of those decisions.

The Atos half-yearly report for 2011 was very upbeat. It noted that operating margins had increased year on year to €166 million—an 11% increase from the first half of 2010. Its operating margin in the UK in 2011 was a healthy €34 million. The outlook for the second half of 2011 was similarly rosy: Atos expected profits to increase by 6.2%. I say all that not to congratulate Atos and marvel at how successful it has been, but to preface my next remarks.

Recommendation 13 of Professor Harrington’s first review was

“better communication between Decision Makers and Atos healthcare professionals to deal with borderline cases”.

In their initial official response to Harrington’s 2010 review, the Government accepted that recommendation, noting:

“Decision Makers already contact Atos healthcare professionals to discuss individual case issues in some instances… we will ensure this happens more often… Agreed measures will be adopted nationally during 2011.”

In a letter that I received from the DWP dated 1 November 2011, I was advised that good progress had been made on that key Harrington recommendation. The DWP letter claimed that

“Atos Healthcare Professional deployment in Benefit Centres has been trialled and has proven to be an effective way of improving communications to discuss borderline cases.”

However, on 20 December 2011, just over six weeks later, in answer to a written question that I had tabled, the Minister advised that

“at the end of the trial, Atos health care professional capacity pressures meant that the initiative could not be continued. From the start of December, DWP and Atos have agreed the implementation of a telephone helpline so that Decision Makers can speak directly to health care professionals to obtain medical advice in specific cases. This is an interim arrangement until Atos are in a position to reintroduce the deployment of health care professionals in benefit centres.”—[Official Report, 20 December 2011; Vol. 537, c. 1082W.]

That is a hugely significant development. This may have been due to when I tabled the question or when the Minister chose to answer it, but he slipped that answer out just before the Christmas holidays. The fact that Government policy is not being followed by a company in receipt of £100 million of taxpayer funding a year will startle many of my constituents and, I am sure, the constituents of many other right hon. and hon. Members.

I should be grateful to the Minister if he gave me answers to a number of questions. What exactly does the phrase “capacity pressures” mean? Does it mean that Atos cannot recruit the right number of health care professionals to undertake its work? Is it unable to fulfil its contractual obligations because of the amount of work that it has to get through? What discussions has he had with Atos about those capacity pressures? Does he believe that they undermine the ability of Atos to fulfil its responsibilities under the contract? What other services have been withdrawn as a result of capacity pressures in Atos? I am sure that if he is not able to answer, I will find a way of crafting written questions to get the answers from him.

To me, the phrase “capacity pressures” implies an undermining of the way in which the Government sought to deal with these issues, which was by saying that Harrington’s recommendations would be implemented in full. If that is not happening in the instance to which I have referred and perhaps in other instances because of capacity pressures in Atos, is that not a damning indictment of the failure of the system as it is currently set up?

I congratulate the hon. Gentleman on bringing this matter to the House. No one decries the need for profit, but is it not time that we got away from profit and on to service delivery? Does the hon. Gentleman share my concerns about many patients who go through the process of a work capability assessment and particularly those with cancer, whose health deteriorates when they experience more stress? There should be an emphasis on people’s health, rather than on the profit at the end of the year.

I thank the hon. Gentleman for his intervention. He puts his finger on a very important point. I am referring to the anxiety and concern that the process causes people, particularly if they are waiting for an assessment. If they enter the appeal process when they have had an assessment, they could wait up to eight months for an appeal. There is an issue about the whole of that process. Long time scales are involved because of the sheer number of people who are being dealt with—or not being dealt with. At the same time, we should never forget that those individuals are trying to deal with the process, and they are feeling huge anxiety. Particularly if they are already unwell, that could well affect their health. That is an important point.

I congratulate my hon. Friend on securing the debate. Does he, like me, see constituents who are caught in a cycle, in that they get zero points when they go for the work capability assessment, they wait seven months for an appeal, the decision is overturned and they immediately receive another letter asking them to take part in another round of assessments? Does he agree that the stress and anxiety being placed on people with very serious conditions is unacceptable?

My hon. Friend is absolutely right. I will go on to highlight the case of one of my constituents that I do not believe is atypical of the experience of many right hon. and hon. Members’ constituents. They get caught up in a process that seems never to end, and as my hon. Friend says, that does their health no good at all.

Last December, Citizens Advice published a damning report on the work capability assessment. One of its recommendations was that financial sanctions should be imposed on Atos for the number of incorrect assessments that it makes. As we all know, the taxpayer forks out millions of pounds on the appeals process, to clear up the incorrect decisions initially made by Atos. The Minister takes a strong interest in Scottish affairs. He may well have seen Scotland Office questions a couple of weeks ago. His colleague, the Under-Secretary of State for Scotland, advised me that he and the Secretary of State for Scotland had discussed the issue with Professor Harrington and that they believed it would be addressed. Can the Minister confirm that that is the case? What time scale has he in mind for financial penalties? Does he believe that Atos should compensate the taxpayer for its performance—its failure in many cases? I should be grateful to the Minister if he clarified the Government’s position on that issue.

Ninety minutes is not sufficient time to debate fully the myriad issues that surround the work capability assessment. I could easily fill the time myself by highlighting its flaws and asking the Minister questions. I am sure that he will be relieved to hear that I do not intend to do that. I intend to make just a couple more remarks and then to allow other hon. Members to speak.

I thank my hon. Friend for securing the debate. I am intervening in case he is not about to move on to the issue that I want to raise. There are real problems for people with sensory impairment—a number of charities have come together on this issue—because the whole concept of being in the workplace is to be able to perform any task accurately and swiftly. That is key in the workplace. Does he recognise the pressure that those charities are bringing to bear, in that more emphasis should be placed on the guidance that any activity should be able to be undertaken “safely, reliably and repeatedly”?

My hon. Friend makes a very important point. It is no good having someone go to an assessment if the fact that they can sit in a chair or pick up a box and move it once from one part of a room to another means that they are considered able to carry out a task that they may be asked to do repeatedly or continuously in a potential job. That point has been made by a number of organisations that have contacted me about the work capability assessment in the past few days.

I will put to the Minister a few more questions, to which I hope he will respond. They arise from concerns that have been raised by individuals who have contacted me to pass on their experiences of the work capability assessment. Can the Minister confirm whether Atos approved health care professionals are bound by the Official Secrets Act? If they are not, can he confirm whether there are any legally binding conditions, aside from the normal patient confidentiality rules, that prevent Atos approved health care professionals from discussing their experience of the work capability assessment?

As the first Harrington review pointed out, audio recording of the work capability assessment could drive up the quality of assessments by improving assessor and claimant behaviour. Late last year, the Minister advised that he was considering the outcome of the trial in Newcastle of the audio recording of assessments. Will he update the House on when he expects to reach a conclusion on that and whether he will publish the outcome of the trial to ensure full transparency on the issue? He will be aware of the freedom of information request submitted to his Department. Given that many other organisations routinely record their conversations with members of the public to ensure that they are meeting the necessary standards—those organisations range from banks to train companies; I think that even the Independent Parliamentary Standards Authority does it—it should be considered. We need to move on from the trial as quickly as possible. Will the Minister update us on the outcome of the trial?

Individuals who undergo the work capability assessment complete a quality survey to rate the performance of Atos. The survey takes place after the assessment has been completed, but before the claimant is made aware of its findings, which is rather like asking someone for a product evaluation as they leave the shop, before they have had a chance to use the product.

Does my hon. Friend agree that it is unacceptable that people have to travel 20 miles from the sizeable town of Llanelli to Carmarthen, a local town, where they then find themselves in a lift that does not reach the correct floor, and has a step that leads to a floor without adequate fire escape facilities? Will he ask the Minister what inspections are made of the premises used by Atos with regard to their accessibility for the vulnerable people who have to use them?

My hon. Friend makes an important and pertinent point that I hope the Minister will address. It is a real concern if some of the facilities used by people undertaking a work capability assessment are in such a state.

I congratulate my hon. Friend on securing this crucial debate. My constituents share the same assessment centre that my hon. Friend’s constituents use in Hamilton, and their experiences suggest that the building is not suitable for carrying out a work capability assessment. It has no disabled access and the car park is 80 yards from the front door. People are only supposed to walk 40 yards, and they feel as if they are being tricked before the assessment takes place.

Another problem is that information is unofficially gathered during the assessments. One of my constituents is deaf, but he was told that he could not possibly be deaf because he heard his name being called in the waiting room. Clearly, while he was waiting he was looking at the door in order to lip-read. Have my hon. Friend’s constituents shared experiences such as those at the Atos centre in Hamilton?

My hon. Friend makes a couple of important points. In some ways, a deaf constituent being told that he is not deaf because he heard his name being called is symptomatic of the attitude held by some of the people who carry out the assessments. I am sure that all hon. Members have heard about such experiences from a number of constituents, and it does the principle of helping people into work a gross disservice.

Although it is important to determine whether Atos staff are polite, courteous and accommodating to individuals undergoing the work capability assessment, the most important issue for my constituents is whether Atos gets its assessment right. I suspect that, if the quality survey were completed after the results of the assessment were known, rather than before, the feedback would be substantially different. Will the Minister undertake to consider that issue further, with a view to obtaining a more realistic overview of the claimant’s experience than that currently recorded in the quality survey?

I will conclude by highlighting the case of a constituent that I think best encapsulates all that is wrong with the current system. The Minister is aware of this case, and he was kind enough to meet me last year to discuss it. Nevertheless, I want to put it on the record because, as I said in response to an intervention, I believe that this example is not atypical of many people’s experiences.

My constituent, who wishes to retain anonymity, suffers from Parkinson’s disease. I am no expert on that condition, and I possess only a rudimentary level of knowledge about the illness. I do know, however, that it is an incurable progressive condition, as I am sure Members are all aware. Like many sufferers of Parkinson’s disease, my constituent has good days and bad days. His condition may deteriorate rapidly, or it may get worse over a long period of time—we do not know. We do know, however, that he will not get better.

Despite his condition, my constituent has undergone two work capability assessments, and on both occasions he was found to be fit for work. On both occasions he appealed the decision and was successful in that appeal. Late last year, however, he was called for yet another assessment. Where is the sense in that? If my constituent has an incurable progressive condition and was found to be unfit for work after his first appeal, why was he called in for a second assessment? If he was found to be unfit for work after the second appeal, why was he called for a third assessment?

I understand the need for the continuous assessment of people with conditions that may improve and mean that the individual in question can return to work, and I accept the principle of regular assessment. Being in receipt of employment and support allowance should not automatically mean that someone is on benefits for life. Nevertheless, common sense must be applied. If an individual is never going to get better, why should we reassess them? It is a waste of my constituent’s time and energy—it takes a considerable amount of energy to get to the assessment and the appeals—and it is a waste of taxpayers’ funds. As we know, the cost to the tribunal service of dealing with appeals is projected to be £60 million this year.

Think of the amount of money that has been spent on that one case. There was the original ESA50 limited capability for work questionnaire, the first assessment and the decision maker’s process after the initial WCA, followed by the first appeal and the necessary post-appeal work that must be carried out by Jobcentre Plus staff. That process was repeated a second—now third—time, and will no doubt be repeated again and again until the Government decide to stop the revolving door of continuous assessment and appeal processes that many people have to undergo. Some people are not going to get better or be any fitter for work after the third assessment than they were after the first or second.

As I have made clear, I believe the work capability assessment to be right in principle but wrong in practice. Although its flaws were clear and highlighted by the pilot process and the Work and Pensions Committee report, the Government went ahead with the nationwide roll-out. I have put a number of questions to the Minister, and I am sure we will hear from many other hon. Members. He should address those questions and not seek to avoid them by laying the blame elsewhere. My constituents, and many people in the country, do not object to an assessment to determine someone’s fitness to work. They do, however, object to a system that seems more concerned with hounding those who cannot work, rather than helping those who want to work.

It is a pleasure to serve under your chairmanship, Mr Williams, and I congratulate my hon. Friend the Member for Rutherglen and Hamilton West (Tom Greatrex) on securing this debate. I have long been concerned with this issue, and it has been raised by the citizens advice bureau in Wigan and by my constituents. The level of accuracy in the work capability assessment reports is staggeringly low. More than one third of local decisions are overturned on appeal, and as my hon. Friend has mentioned, there are long delays to both the initial assessment and the appeal. Worryingly, however, in 60% of decisions overturned on appeal, the claimants scored no points at all in the work capability assessment. In 87% of cases, people were awarded six points or fewer—less than half the number of points required to pass the work capability assessment. We are talking not about margins of error but of assessments that are completely wrong. As more people who previously used reports from medical professionals now have face-to-face interviews, it is more important than ever that such assessments be conducted properly. People must have confidence in the judgment and accuracy of the reports.

One of my constituents came to me last week. He had received his work capability report after a long delay, and the letter consistently referred to an assessment of his leg, claiming that he had no problems. The problem was that all the way through, the letter mentioned the wrong leg. My constituent joked about it and said that he did not have a leg to stand on, but he now needs to appeal that decision with an incorrect report. Confidence in Atos is not high among any of my constituents or the advice agencies to which I speak. I am currently involved in a protracted correspondence with Atos regarding quality standards and how it is mystery shopped. Will the Minister tell the Chamber what mystery shopping takes place, how it happens, and whether there are financial penalties for inaccurate reports? The attitude certainly does not appear to be one of “right first time.” In 2010-11, inquiries about ESA claims and the Atos assessment rose by over 40% in my constituency.

I would like to draw attention to the Citizens Advice report “Right first time?”, which came out in January. There is an in-depth study of cases involving people who had been recruited before they attended the work capability assessment—they had not gone through it, and they were not complaining because it was wrong, so there was no bias. The sample is small because it took quite a lot of in-depth work, and a lot of voluntary advisers helped with it. In all, 37 reports were studied in depth. Sixteen had a serious level of inaccuracy, which meant there were very substantial errors that would have a significant impact on the award of employment and support allowance or disability living allowance. Ten had a medium level of inaccuracy, which meant there were some significant errors that would probably affect the point scoring and potential award of ESA. Only 11 reports had a low level of inaccuracy.

There were five main points of error. There were omissions or incorrect observations. One client, who had really pronounced curvature of the spine and real problems sitting, was marked down as having no problems sitting or standing. There was also incorrect factual recording of medical information. One client said he could not use his left arm at all. He could not dress or shower himself, and his wife helped him. The report said he managed to dress and shower himself, and ESA was refused, but he won on appeal. If the information had been recorded correctly at the first assessment, there would have been no need for that appeal.

Medical evidence has also been inappropriately determined. A client who was registered blind was under a consultant ophthalmologist and had regular sight tests. He said the work capability test was a bit random. The assessor sat there waving cards in front of him at random distances, saying, “Can you see that? What about that one?” That took no account of the fact that the client has regular sight tests with someone who knows him and who is qualified to judge.

Another thing constituents often complain about—this has been mentioned—is the closed questions, the lack of empathy, the incorrect assumptions and the fact that information has not been gathered. Clients who come to me with mental health problems, in particular, say they feel terrorised by the ESA assessment. When they walk into the room, they feel the assumption is that they are trying to cheat the system. Some have said they never want to go for another assessment.

Does my hon. Friend agree that the issue is not just the assessment’s inability to assess mental health issues, but the lack of sensitivity that is shown? That causes stress for people who are already under extreme pressure and who are suffering from mental health issues, including depression and anxiety.

I totally agree. I am trying to find out where people go when they are refused ESA as a result of the work capability assessment, and it is quite astonishing that there are no figures. These people do not go on to other benefits, but I cannot find information anywhere about where they do go. Given the experience of my constituents, I believe a lot of people are living off their families because they cannot face going for another assessment.

Does my hon. Friend agree that the problem with the work capability assessment is that it makes constituents who receive DLA extremely wary about the move to personal independence payments, because they see the same experience being repeated?

I quite agree. The move to DLA, for which the tests are even more severe, will be a problem for a number of people. The confidence of people who have been through a work capability assessment and who have had to appeal will be at an all-time low when they have to do the same for DLA.

The other issue is that there are inconsistencies in reports. For example, a constituent said he had a hypo attack every week—he was diabetic—but when he received the report, it said he had an attack once a month. The difference meant he did not get enough points for ESA, which he would have done if the report had said he had weekly events of altered state, as opposed to monthly events. He had to appeal that decision.

Although the changes following the independent review were meant to improve the process, the Citizens Advice survey my hon. Friend the Member for Rutherglen and Hamilton West mentioned showed that 87% of advisers said the accuracy of Atos reports had not improved. As has been mentioned, there are improvements that might help. The roll-out of audio recording of assessments might help, but what checks will there be on the accuracy of reports? It is no use just recording and keeping assessments if we do not check the accuracy. The summary of the report sent from the health care professional to the claimant might help—if there is sufficient information to help the claimant check the accuracy, if summaries are sent to all claimants and if they are sent in good time.

The Work and Pensions Committee said we need to do more to learn the lessons from the management of the Atos contract and to improve the quality and monitoring of future contracts. There are a number of recommendations in the Citizens Advice report, which I urge the Minister to read. There is deep concern among claimants and advice agencies about the use of face-to-face assessments going ahead for other purposes, such as DLA, which my hon. Friend the Member for Newport East (Jessica Morden) mentioned, and personal independence payments.

The clients who went to their citizens advice bureaux are the lucky ones; they got their appeal, they got represented and they got help. Unfortunately, the proposal in the Legal Aid, Sentencing and Punishment of Offenders Bill to remove the eligibility of welfare benefits advice for legal aid will mean that the number of advice agencies and individuals able to give such advice will drop, so fewer agencies will be able to help people. I therefore urge the Minister to ensure that the work capability assessment system has the confidence of claimants and professionals and that we do get it right first time.

It is a pleasure to serve under your chairmanship, Mr Williams. I thank my hon. Friend the Member for Rutherglen and Hamilton West (Tom Greatrex) for securing the debate and for his tenacity—I think that would be the best word—in pursuing this issue. He has submitted what is probably a record number of parliamentary questions on it, and my constituents and I are grateful for that, because we have seen that someone is taking it seriously and cares passionately about it.

I want to concentrate on a number of issues raised by constituents. They were keen that I should take this opportunity to make representations to the Minister. People often feel that they are on their own and that they are the only ones having particular difficulties. Given what we have heard already, my constituents’ experiences appear to be very similar to those of constituents elsewhere, and I hope the Minister will take account of that.

I want to echo what my hon. Friend said. Neither I nor my constituents have a problem in principle with the notion that someone who is fit and able to work should do so if work is available. Many people with disabilities wish to hold down jobs and they can do so. Other people will require support, adaptations and particular circumstances to enable them to work. The constituents who come to me most frequently about work capability assessments, however, are those with fluctuating and perhaps long-term conditions. They tell me and my caseworker that the work capability assessment report does not accurately reflect their day-to-day experiences. They often say that they feel as if the wrong report has been sent in. They wonder whether people are making generalisations on the basis of their answers to questions.

People with these conditions also make the point that if they are having a good day, they will probably get along to the work capability assessment. However, if they are having one of their bad days, they simply will not be able, in some circumstances, to attend or to cope with the assessment. In addition, people with mental health issues, in particular, tell me that they do not get a fair assessment. They feel that because their condition is apparently invisible the assessor often seems to know little about it.

Of course, there are problems. Chronic but intermittent conditions can mean that claimants sometimes find themselves moved from ESA to jobseeker’s allowance and back to ESA, with all the work capability assessments in between. That leads to real difficulties because people often find themselves with no financial support while DWP processes are under way, with one claim being closed while another is being opened.

The most frequent cause of concern for constituents is apparent inconsistency. In a recent case in my area the maximum 15 points were awarded by the health care professional; that award was overturned by the DWP decision maker. The GP, the hospital consultant and Atos agreed that the person was unfit to work, but the decision maker in the DWP disagreed. In another example from my constituency a man with a progressive and incurable kidney condition, which requires him to undergo surgical operations every six months, was awarded 15 points; but that award was overturned by the decision-maker in the DWP, even though the decision-maker stated in correspondence:

“I am satisfied that the descriptors have been fully justified with clinical findings, observations and extracts taken from the typical day history provided by Mr A. The medical report…was appropriate, complete and covered all the area of incapacity described by Mr A as well as including a comprehensive typical day history and full set of clinical findings.”

We can understand why constituents find it difficult to understand why, when all the medical professionals and, indeed, Atos, appear to agree, someone in the DWP without a medical background apparently can overturn their findings.

I should like the Minister to tell me how many people—and what percentage—he is aware of who, having been awarded that maximum 15 points, have had the award overturned by the DWP decision maker, and how many of those have had appeals upheld. That may be useful for our understanding. As my hon. Friend the Member for Rutherglen and Hamilton West mentioned, there is concern about the cost of appeals, and I hope that the Minister will tell us the average cost of an appeal, and how much time is spent processing all the associated paperwork.

My hon. Friend makes a powerful case. I went to an appeal with someone with ME who scored zero points. She took with her the medical evidence from the experts at the hospital; when the panel looked at it, it was a case of giving it a tick and telling her that of course she was not fit to work. However, those dealing with the form-filling and Atos stage were not prepared to consider it. It seems ludicrous that my constituent must go through the expense and stress of an appeal, and that the expert evidence cannot be considered earlier.

My hon. Friend makes an important point. I wanted to give some examples of constituents who have had to appeal. One is a man almost at retirement age who has worked in a manual job since leaving school at 15, who became unfit to work. He requires a tube to be inserted into his gullet so that he can eat and drink. He could not bend forward during the assessment process or when he came to speak to me, because if he did so anything in his stomach would be emptied out; he has no muscular control. Initially he was told that he was fit for work. With our assistance he won his appeal. On the other hand I have another constituent, with a progressively degenerative eye condition, who is registered blind and can just about read a 42 point font, which is fairly large. She lost her appeal. There seem to be different circumstances and different approaches.

The hon. Lady makes an important point. My concern about people who must go to appeal is that they do not get the advice and support they need. People who get it are more likely to succeed in their appeals, but Citizens Advice talks about a threefold increase in impact on its services since the process was introduced. I am sure that many hon. Members have had increased mail in that time.

The hon. Lady makes an important point. I do not think that anyone would doubt that there is pressure on advice services. Organisations for individual conditions, such as Parkinson’s UK or the Multiple Sclerosis Society in my area, will talk about their concern that, although they can help so many people, there are others they cannot reach. I know from my case work that more people are coming to me to raise their concerns. They want to be put in touch with advocacy services to help them with appeals; my office cannot take on the job of representing people at every appeal, on account of the numbers involved.

Does my hon. Friend agree that, given the evidence we have heard today, and our own experiences, the DWP should seriously consider what to do about people with long medical histories of degenerative disease who are continually called in? It seems a complete waste of taxpayers’ money and it is a disgrace that we do that to those people. Will my hon. Friend suggest to the Minister that we might consider some way to exempt such people?

My hon. Friend makes a powerful case, and I am sure that the Minister is listening. On the point about people with long-term degenerative conditions, another constituent called at my office in great distress, when I happened to be there. The lady could hardly open the door to come in without assistance. She was extremely upset having just had a phone call to tell her she was deemed fit for work. She told me that she had had MS for 20 years. She has poor eyesight, mobility and memory. I was so concerned about her plight that I immediately contacted her GP, who assisted with taking up her case. He subsequently wrote:

“I have today issued Mrs E with a Med 3 for 13 weeks stating she is not fit for work (as she is patently NOT”—

he underlines that—

“fit for work). Like her I have not received any written communication stating that she is fit for work, as I would have expected. She should receive such written confirmation and the way to appeal clearly outlined in that letter. My role is twofold, firstly, to continue to issue a Med 3 (medical statement) and secondly to provide written information for her appeal Tribunal.”

He has done that. I do not think that we can overestimate the stress and worry that that incident has caused my constituent.

The hon. Lady highlights the stress that individuals go through during assessments. Several constituents have visited my surgery to explain how they went through such stress. Does not the assessment have to be fair, both to the individual and to the taxpayer, as has been mentioned? Also, is not the assessment becoming a tick-box exercise with a one-size-fits-all approach that does not take into consideration the fluctuating conditions from which people suffer?

The point about fluctuating conditions is well made. That is exactly the problem. Some people with such conditions, in some circumstances, will be able, with the right support, to hold down employment, but others will not be able to do so, perhaps because of the cycle of their condition or because their mental health is affected. I am concerned that the process in question appears to be a tick-box exercise.

One more example from my case work involved a gentleman who lost a leg and badly damaged the other in a childhood accident. Clearly he suffered as a result of that disability. He was awarded zero points. If the system is to have the confidence of the public and the people being assessed, it must be seen as fair. My constituents tell me that there are so many inconsistencies that they feel that they are not treated fairly, that their individual circumstances are not taken into account, and that the procedure is indeed a tick-box exercise.

My hon. Friend is making an excellent contribution to the debate. The information in question is in the public domain, and part of the problem is that that means people facing the process have no confidence in it. It causes such stress, particularly for people with mental health problems, that it has even driven some to take their own lives. How can that be defended?

I hope that my hon. Friend will understand that I take such issues seriously. I am very concerned to hear that she is aware of people being driven to such drastic action as taking their own lives. Going by the correspondence and contact that I have with constituents, I can say only that I know just how difficult it is for people, and that many feel they cannot face the appeal process—particularly those who have suffered from a condition for years and who feel that the process is undignified and that they do not get the right help and support, and who perhaps do not know to whom to turn.

I echo everything that my hon. Friend says about the appeals process and the total lack of credibility of Atos. Earlier, she mentioned the systemic problem of DWP officers overruling all of the evidence, even that from Atos. Will the Minister address the fact that many people who are told that they cannot work again are suddenly taken off the support system in the DWP and put on to the other system, thus causing them great problems? They are made to go through rituals of training and work interviews when everyone agrees that they cannot work again. Surely that power should be clearly defined. If someone is told that they cannot work again, DWP officials should not be allowed to overrule that decision.

I am sure that the Minister will respond to that point, which is also one that I raised earlier. As I had concerns about the work capability assessments for people with a range of conditions, I tabled some parliamentary questions in a bid to find out how many people had been assessed in my constituency. I was disappointed to be told that such information could only be provided at a disproportionate cost.

After hearing about the experiences of a number of my constituents, I tabled another parliamentary question to find out how many assessments had been carried out on constituents who had cerebral palsy, osteoporosis, MS, who were registered blind, who had hearing impairments, who were on the autistic spectrum, who were carers themselves and who had learning difficulties or mental health problems. Those are the people who had come to me saying that they had had difficulties with the work capability assessment. Again, I was told that such information was not available at constituency level. I hope that the Minister can respond to that and tell me whether that kind of assessment, analysis and reporting will be available by parliamentary constituency in the future because it is in the interests of transparency and it would enable us to make comparisons across different parts of the country.

Finally, I have a couple of points around the issue of Parkinson’s, which my hon. Friend the Member for Rutherglen and Hamilton West mentioned in his opening remarks. The Parkinson’s Disease Society says that increasing numbers of people with Parkinson’s are being rejected from the support group. Between October 2008 and November 2010, it says that 45% of people with Parkinson’s who had undertaken the work capability assessment were referred to the work-related activity group instead. As an example, the organisation cited the case of one man who was placed in the work-related activity group despite the fact that his tremor was so severe that he could not hold a pen, walk more than a few steps or button up his trousers himself.

The organisation gives examples of people having long waits for appeals and receiving inconsistent or inadequate support in the work-related activity group. It talks about the ESA assessment process impacting disproportionately or inappropriately on other benefits, the worry for carers and the knock-on effect on other statutory services.

The Parkinson’s Disease Society also gives examples of people who are clearly not fit for work being told that they should get work. A 59-year-old man with Parkinson’s says:

“I feel I could work in the right job, with the right support, but none of this has been forthcoming from the job centre, who wished me well but basically said there are no jobs for able-bodied people let alone someone like me. I’m not surprised that only 6% of people in my position get back into work in 12 months. Everything I’ve done to get back into work I've had to off my own bat.”

On the one hand, we have people who say that they want to work and to cope with their condition and feel that they can do so but who are getting no help, and on the other we have those who feel that they are being hounded. That is not the sign of a caring, compassionate and decent system. I hope that the Minister will take account of what Citizens Advice and others have said and that he will not make this a party political issue. There is agreement across all parts of the House that this system is not working in the way that it should. I hope that in his response, the Minister will consider making some changes and give us some hope for the future.

It is a pleasure to serve under your chairmanship today, Mr Williams. I am following a very powerful speech from my hon. Friend the Member for Kilmarnock and Loudoun (Cathy Jamieson). In securing this debate, my hon. Friend the Member for Rutherglen and Hamilton West (Tom Greatrex) has done a great service not just to the House but to the many thousands of people in the country who are affected by the issues. I had a number of points that I wanted to make, but as others still want to contribute, I will restrict my comments to two specific problems with the work capability assessment that arise from my constituency.

My first concern relates to people with sensory impairments. In particular, I want to raise an issue that was brought to my attention by a constituent with a visual impairment. In fact, I raised this case in a parliamentary question with a Minister a few months ago because my constituent was having problems filling in the ESA50 form through the audio systems available to people with visual impairment. After months of difficulties, which I do not have time to go into today, it turns out that my constituent may not have actually needed to go through this process because in November, the DWP changed the criteria by which people are allocated to an ESA support group. I am told that the new rules mean that someone with a hearing or a visual impairment could qualify for a place in a support group, whereas between April and November, the position was that someone had to have both a hearing and a visual impairment to qualify for the support group. That has certainly caused my constituent a great deal of concern. By giving her the wrong guidance, she felt that the DWP had sent her down the wrong road for months.

I am grateful to the hon. Gentleman for allowing me to intervene. I will respond to all the detailed questions in my remarks. On this specific point, there have been no changes to the rules around referrals. There were no changes in November. We have updated our guidance, which we do as a matter of routine, but there have been no changes to the formal rules.

I understand what the Minister is saying, but the guidance was updated to reflect some of the difficulties that had been raised. The view of the Royal National Institute of Blind People is that Atos may well have been wrongly assessing people between April and November. That may have been the fault not of Atos, but of the incorrect guidance. Will the Minister tell us how many people were wrongly assessed and why there was a need to issue new guidance? Why was my constituent required to go along a road which she did not need to, given the fact that new guidance was issued?

My second point covers the position of people with mental illness, which has been raised by a number of colleagues in this debate. I refer to a report produced by the Consultation and Advocacy Promotion Service, which is an independent advocacy organisation that operates from Edinburgh, Midlothian and East Lothian. The report describes the experience of people with mental health problems going through the work capability assessment process. Again, if time had been available, I would have gone into great detail. Instead, I will simply report its main conclusions.

The work capability assessment for employment and ESA is not designed to assess accurately the needs of people with mental health conditions. It causes a high level of stress and anxiety in people with mental health conditions and, in some cases, it may even make their condition worse. It does not cater for fluctuating conditions, nor does it accurately record how those conditions affect people’s ability to work. That is an experience that many Members will have heard about in their surgeries. I hope, following the Harrington review, that we will see some improvements in that area.

Finally, we are all experiencing these difficulties because of the way in which the process was hurriedly rolled out across the country. We will face, over the next few months and years, even more dramatic changes to the whole welfare system. If we do not learn from the mistakes that we have made so far, we will find that the problems relating to the work capability assessment process are repeated many times throughout the country. Many more people will suffer. Many more people who could get into work might not be able to because they will not be given the support. Many people who will not be able to get into work will be driven to desperation because of the difficulties that they will face. At the end of day, it will also cost the public purse much more money, which none of us wants to see happening.

I hope that the Minister will recognise that we are not trying to make political points. It is not a political issue; we raise it because we hear from our constituents in our surgeries throughout the country every week and we want action. Opposition Members would certainly be beating down the door of a Labour Minister if we were in government and there were the same kind of problems. We need action and assurance. We certainly do not need complacency from the Minister and I sincerely hope that we do not get it in his reply today.

I thank my hon. Friend the Member for Rutherglen and Hamilton West (Tom Greatrex) for introducing the debate and I thank other hon. Members for the way they have spoken on behalf of their constituents on an issue of genuine national interest. We could all, across parties, cite chapter and verse on the people who come to our surgeries and citizens advice bureaux who have been made desperate by the system’s failings. My hon. Friend the Member for Edinburgh North and Leith (Mark Lazarowicz) made the point that if the same situation occurred under a Labour Administration—the Minister has inherited some of this, but the national roll-out before we have solved the problems is a significant issue—we would say the same thing to a Labour Minister: how do we change this to make it work?

I have not only seen constituents, but have regularly been to appeals and seen Atos do assessments as well. I have seen the process first hand all the way through, not only when the constituent arrives in my office and says, “What is happening? Why is my life being destroyed for months while my benefits are suspended? I’m taken off benefits and then seven months later, my appeal goes through successfully, along with a huge proportion of others.” I have seen the process, and as a former Minister who was previously employed in private industry looking at systems management, I can tell the Minister that this is not working. There is a genuine issue and the process and procedures are not fit for purpose—it is so damn obvious when there is this number of successful appeals.

The underlying principle that the Minister must work with is compassion, and we would support him in that, but the system lacks compassion. It has to be fair to both taxpayers—a point made earlier—and those who are going through the process. There are people who are unable to elucidate their circumstances fully when they fill in a form and who are not going to give 101% when they sit in front of somebody tapping into a computer keyboard without making eye contact. There are doctors who will not spend 15 minutes filling in the long narrative history of a medical condition that would lead to the right decision in the first place. Therefore, when people fill in the form for the first time, the vast majority do not fill it in in the detail needed. It is a tick-box exercise, and people have a lot of fear and misunderstanding over that. They tend to come to us, as MPs, after they have failed and are going in for the interview. We say to them, “Take someone in with you, because at least then they can give you some support and guidance.”

The system must be based on compassion, and at the moment, it is not. I say that because I have seen the Atos procedure and the interview, and interestingly, even though I went into the office in Bridgend to see it, I was not allowed to sit and watch an interview, even if somebody was willing, but I could see the appeals. The staff were very kind and as informative as they could be. I was allowed to watch an abbreviated recording of a mock-up interview, in which we saw minimal eye contact, because there cannot be eye contact when someone is tapping away at a keyboard and asking, “How did you get here today? Oh, so you did that,” and then goes on to the next question and the next. It is completely different from the panel. I was allowed to sit and watch it taking place for three hours, with four people—lay people, someone from a medical background and someone from a legal or judicial background—genuinely dealing with individuals with compassion.

I shall give the Minister an illustration of what should be happening to cut the cost for the taxpayer further downstream. A young chap walked in and sat down looking completely healthy. He was in his early 20s. He had someone with him, as one should have at an appeal. The panel started asking him questions. He looked completely fit. “Do you go out with your friends?” “Yeah, I go out with my friends.” “Do you socialise regularly?” “Yeah, I tend to go out every Friday night.” Based on those kinds of questions and the fact that he could walk a certain distance, that guy had been declared completely fit for work. When a gentleman on the appeal panel asked him where he lived, he replied, “Merthyr.” The panel just happened to know Merthyr. “Where do you go out in Merthyr?” “Town centre.” “When you go out socialising with your friends on a Friday night, where do you go? Do you go to clubs?” “No, we don’t do that. We just mooch around town.” “Where do you go?” “We get off the bus and walk right to the centre of town.” “How far is that?” “From the bus to the town centre is about 50 yards.” “I know Merthyr quite well, so do you then go to the rugby field?” “No, I don’t.” “Why not?” “Because if I walk more then 50 yards, I not only get out of breath, but collapse with the condition I have.” None of that detail comes out in the initial stages. I am not saying that we have to flip the process round completely, but its lack of compassion, tick-box nature, lack of fairness to the taxpayer in allowing costs to escalate down the chain and to the individual, and the concerns over good decision making and managerial process mean that it simply is not working.

My message to the Minister is straightforward. The worst thing in the debate would be for him to go into denial or to say that the system is bedding in or just needs a bit of tweaking. There are fundamental issues with the design of the process, and the number of appeals that are successful when the right information is in place and the sheer superficiality of the initial contact with Atos show that the system is not working. I note the earlier comments about whether Atos follows procedures correctly. Whether the problems are inherited or caused by the new work capability assessment or by the national roll-out, the procedures at the Atos end are simply wholly inadequate.

The Minister could save the taxpayer a lot of money if he got this right. He could save a lot of angst and worry, not only for those with fluctuating conditions, sensory impairment or other needs, but for those who are genuinely trying to be honest and fair about their condition and those who want to work if they are fairly assessed. At the moment there is a terror of going through the process. When people come to my office now, I cannot give them a lot of hope, as an MP, about fairness in the system.

My hon. Friends have mentioned the statistics and the national analysis by Citizens Advice and others. As much as the press loves to scaremonger and paint pictures that vilify some of these people and their “scrounger mentality”—“Get them back into work!”—there are many people who want to get back to work and many others who are being unfairly put through pain and anguish when they should not be, such as those suffering from long-term conditions.

Redesign the system, so that it has compassion and is expert-led at the gateway, and improve communication between the Departments. Do not go into denial. This is not a matter of blame. We do not blame the Minister, but we will if he does not solve the problem, because it is now on his watch. We will applaud him if he can turn this round, because we also want people back in work. The great innovation was to turn the system round to take the emphasis away from incapacity and towards capacity—what can people do? There is cross-party support for that, but the changes must be driven with compassion and fairness all the way through. At the moment, the system is wasteful, inexpert and, in terms of processes and management, shot full of holes. Please make it fit for purpose and we will be here in six months applauding you.

Order. I have no power whatsoever to make it fit for purpose. The hon. Gentleman’s remarks should be directed to the Minister.

I am conscious of the time, Mr Williams, so I will be as brief as I can. I congratulate the hon. Member for Rutherglen and Hamilton West (Tom Greatrex) on securing the debate and I encourage him to try to secure another debate later in the year, because the process is ongoing, will involve more people, and more issues such as those we have heard about today will come forward. The opportunity to bring such matters to the Minister’s attention is important. We are dealing with the human consequences of failures in a bureaucratic, state-driven system—in this case, incapacity benefit. Similarly, many hon. Members have seen the failures of the immigration system, and its human consequences for our constituents and for people around the country.

In my constituency, I have had the experience of the fit for work tests being piloted in the Burnley benefits centre. There has been an extreme improvement through the pilot scheme to where we are now. There is more we can do, but I echo my hon. Friend’s thoughts about waiting for the completion of the process before we pass judgment.

I appreciate that intervention from my hon. Friend.

I would like to place in context some of the concerns we have heard about; first, about being assessed. It is quite natural to expect people to have concerns, as we are making a significant change to people’s lives. In many comments, the issue has not been a generic concern relating to assessment, but a concern about specific types of conditions and cases. Will the Minister confirm that for every 100 assessments, nine people who are found to be fit for work go on to win their appeal? That means there are 91 people who fit into another category.

One fluctuating condition that has not been mentioned is alcoholism, and people who have chronic, long-term alcoholic conditions. One constituent who came to see me had his papers from assessments in the 1990s. Will the Minister provide confirmation on that?

Although it does not relate directly to the debate, part of work capability assessment is that there is then work. In today’s conditions, what can the Minister say will be on his agenda to try to encourage some of these people into work at the end of their assessments? There is much more I would like to say, but because of the time I have to stop there.

I congratulate my hon. Friend the Member for Rutherglen and Hamilton West (Tom Greatrex) on securing the debate. We have heard some important and telling points.

As we have heard, the previous Labour Government introduced the work capability assessment as part of the change from incapacity benefit to employment and support allowance. Incapacity benefit did not help people with long-term sickness or disability back into a job. In fact, in 1997, the vast majority of people in receipt of incapacity benefit were simply abandoned; in many cases having been encouraged to move on to that benefit to reduce headline unemployment.

We started, experimentally, with the new deal for disabled people, which was a striking innovation at the time. I am pleased that the Minister has sought to build on the lessons of that programme, and from pathways to work which followed, into the new Work programme, and the ESA was the next step in that process. The WCA was designed to look at applicants’ functionality, and to assess whether each applicant was fit to return to work, fit to undertake work-related activity, or not fit for either.

Atos was contracted in 2005 for seven years. The current Government opted to extend the contract for a further three years in November 2010—the contract now runs until 2015—and will soon need to decide whether to take up the option to continue the contract to 2017. That decision needs to be influenced by the kind of experiences that we have heard about in the debate.

It is clear that the system has been overloaded. There needs to be change for it to function properly, so we support fully the implementation of the first Harrington review and much of the second. We regret that the Government pressed ahead with implementing the Department’s internal review last year, given the widespread consternation about the findings of that review. We were particularly concerned by one aspect of Professor Harrington’s second review, which proposed that some cancer patients, who until then had been exempted from a WCA, should no longer be exempted. Macmillan Cancer Support was concerned that that would put greater stress on cancer patients when they ought to be concentrating on recovery. It was a particularly frustrating development for everyone. I hope that the Minister will be able to tell us this morning—if not this morning, then in the debate in the House this afternoon—that there will be something of a climbdown on that point.

I am anxious to ensure that the Minister has the time to answer fully the points that have been put to him, so will shorten my remarks. We have still to hear—apart from the point about cancer patients—about a number of other proposed changes that the two WCA reviews have recommended. What is being done on the new descriptors that cover fluctuating conditions—on which we have heard a good deal in the debate—and mental health conditions? There have been some helpful recommendations on those. When will the results of the pilots on recording assessments be released and responded to by the Government—a point also made in the debate?

It is worrying to hear that capacity pressures are restricting the ability of Atos to implement the Harrington recommendations. There needs to be better communication between Atos health care professionals and decision makers in the Department for Work and Pensions if we are to reduce the number of mistakes made in WCAs and the current, astonishingly high number of successful appeals.

I should like to draw attention to an issue that has not yet been raised and is a practical consequence of the problems and delays in the WCA system. The DWP recently revised its estimates of the number of people receiving ESA who will go into the Work programme, which the Government introduced in June. The forecast of the number of people going into the Work programme has been reduced dramatically, and the bottleneck in the WCA seems to be a major part of the explanation. Will the Minister comment on that? It is one of the key reasons why a number of small voluntary sector providers, which are contracted to the Work programme, are now at risk. Groups with specialist expertise to help people with particular health problems are receiving far fewer referrals—therefore, a far lower income—than they were encouraged by the Government to expect. In some cases, they have had no referrals at all since the Work programme started in June. Some are saying that they will have real trouble staying in business at all.

Problems with the WCA, as we have heard, could turn into a serious loss of capacity in the voluntary sector. People then left with no specialist help available would be in a worse position still. How will the Minister ensure that the WCA is refined? When will he introduce the changes that have been called for by charities and Professor Harrington? What assessment has he made of the capacity of Atos to implement those improvements? Will some of Professor Harrington’s recommendations not be implemented, as has been suggested, because of the capacity pressures in the system?

Ministers have defended their decisions about the welfare system on the basis of the need to save money. However, it is very important, particularly for Ministers in this Department, not only that they are saving money, but that the system that they are responsible to Parliament for is working fairly. All hon. Members who have spoken in the debate are absolutely right to highlight the fact that, with this part of the system, there is a long way to go.

Let me be absolutely clear—particularly in relation to the comments made by the hon. Member for Rutherglen and Hamilton West (Tom Greatrex), who proposed the debate, and the hon. Member for Ogmore (Huw Irranca-Davies)—that we are trying to do the right thing. We are trying to identify people with the potential to go back to work and provide them with the help to do so. Sometimes, those people will have a health condition—in the United Kingdom, 7 million people with a health condition are in work—so the number of points that people receive in the work capability assessment does not automatically mean that they do or do not have a health condition. The judgment is all about helping people return to work, perhaps in different roles. Their health condition might prevent them doing what they did before, but that does not mean that there is nothing they can do.

I approach this debate in a non-partisan spirit, but I want to explain the time lines to hon. Members, so that they understand exactly where we are in the process. In June 2010, 18 months ago, prompted partly by a report from Citizens Advice but also by concerns such as those raised by hon. Members, I asked Professor Harrington to take a careful look at a process that was already well under way. Employment and support allowance and the work capability assessment were established in 2008. The work capability assessment had been working since 2008. Statistics on the growth of appeals matched the flow of new claimants into ESA and worked down to some change 18 months ago, but I was unhappy that the process did not seem to be right, so Professor Harrington went away, reported in November 2010—interestingly, the date at the end of the period that the hon. Member for Kilmarnock and Loudoun (Cathy Jamieson) mentioned when she quoted the Parkinson’s statistics—and made several recommendations to us.

The right hon. Member for East Ham (Stephen Timms) made a point about pilots and roll-outs. Crucially, we did not simply pilot the work capability assessment and then start it. At that time, the questions that we were addressing were whether we could sort out the process and whether we should go ahead and roll out incapacity benefits, which would increase the number of people going through the work capability assessment.

Professor Harrington went away and made his recommendations to us, which we accepted in full and have implemented. He told me, “I believe the system is in sufficient shape for you to proceed with incapacity benefit reassessment.” We set ourselves a goal to put his recommendations in place, improve the quality of the process and address many of the issues to which hon. Members have referred today by the end of last May, when the assessments in the incapacity benefit reassessment were to start alongside the existing process of assessing ESA new claimants. We did that, and we started.

I have heard a lot today about the number of people who have sat through appeals and the number of cases overturned. It is crucial for hon. Members to understand this. I am almost certainly right in saying—I could not swear to being absolutely, 100% right, because there may be a small number of exceptions—that since the Harrington changes were introduced last summer, not a single appeal has been completed. Therefore, all the examples cited today that relate to the appeals process refer to what took place before the Harrington changes to the system that we inherited, which I accept was not doing the job as it should have done. I want everyone to understand that.

As a result of the Harrington changes, we tried to create a more humane, careful and thoughtful system. We have sought to change systems to provide greater protection to those with long-term problems. The right hon. Member for East Ham referred to the internal review that his Government carried out and that we implemented in the belief that it would increase the size of the support group—those who receive long-term unconditional support—and that is what has happened. We believe that the changes that we have introduced will lead to more people receiving long-term support.

One issue that I raised with the Minister was that of people turning up for appointments and being turned away because they were double-booked. My constituents who were part of the pilot scheme travel, on average, three or four hours to get to and from an assessment. To be turned away when they have had to rely to get there on family and friends who have taken time off work is a real problem. The Minister has apologised to one of my constituents, but has the policy of triple-booking appointments been changed?

A situation in which people are treated like that can never be acceptable. Of course, we have an issue with some people not turning up to appointments, and because it is an intensive programme, we do not want a health care professional sitting there without anything to do. Sometimes, we will get it wrong. We will try hard not to, but there is no such thing as a perfect system. That is true of all parts of the system. I openly accept that we will sometimes get it wrong, but we have done everything that we can to create a system that gets it right as often as possible. We have changed the nature of the work capability assessment in the process.

We make a much greater effort to ensure that we have proper medical evidence at each stage of the process from the consultants and specialists working with the people concerned. One reason why so many appeals were successful was that new evidence was emerging only at the appeal stage. We have worked hard to ensure that such evidence comes in much earlier in the process, so if we get it wrong in Jobcentre Plus, we will get new evidence there at a point of reconsideration. That is a crucial change. We are now ensuring that we seek out additional information in Jobcentre Plus before we take the first decision, but we have bolstered the reconsideration process to make it much quicker and more straightforward, so that if we get it wrong the first time, people can get a quick second opinion in Jobcentre Plus. That is crucial to getting the process right.

I will not take interventions, because I have only five minutes and must get through a lot.

We have also tried to make the process more humane. People now get phone calls instead of the generated, standard letters that I regard as impersonal and inhuman. All our measures are part of a process of change that I hope will make a real difference to individuals’ experiences—and it is. Indeed, in his second report, Professor Harrington praises those involved in the process for creating a system that he, as an independent figure, regards as much improved.

As constituency MPs, we will always have people coming to our doors saying, “I am being done wrong by,” because sometimes, in an imperfect system, we will not have got it right. Equally, however, some people will still think that we have done wrong by them, but three years later, when they are back in work, they will say that it was the best thing that ever happened to them.

About a month ago, I sat with a woman in a Work programme centre who said that she had been off work with chronic depression for 13 years. She told me that she had arrived on her first day in the Work programme and said, “I can’t possibly work. This is ridiculous. I don’t know why I am here. I am being traduced.” A month later, she was doing voluntary work in a charity shop, applying for jobs and beginning to say, “Actually, this is good.” We are taking people through a difficult period in their lives.

I said “rubbish” to the final comment made by the hon. Member for Rutherglen and Hamilton West not because he is not raising genuine issues—although I hope that I have explained their context—but because the system is not about forcing people into work. It is about finding the right number of people whom we can help into work. The alternative is to leave them on benefits for the rest of their lives, doing nothing. I do not believe that they benefit from that.

I was making the point that, given the lack of confidence in the system, many people feel as though they are being hounded rather than helped. That is the crucial matter that must be addressed in the coming period.

I accept that, but I genuinely hope that hon. Members will take note of what I said about the time lines and the changes that we have introduced. Professor Harrington said of the concerns highlighted in the Citizens Advice report to which hon. Members referred, “This happened before my changes.” I hope that we can send the message that the system is changing and improving and that we are making genuine efforts and will continue to do so. That is why we changed the guidance in November. It is a process of continuous improvement. We want to get it right as far as we possibly can.

I shall try to answer one or two specific questions before I finish. On audio recording, we will offer everyone who wants it the opportunity to have their session recorded. We decided not to implement universal recording because, based on the trial experience, people did not want it. Few people wanted their sessions recorded, and some said that they definitely did not. We decided therefore to offer recording as an option to those who want it. That seems entirely sensible.

Contact between Atos health care professionals and decision makers will be done by telephone. What matters is not the contact between a single person and a block of decision makers, but trying to phone up the decision maker themselves. On capacity issues, as we stand here today, the incapacity benefit reassessment is on time. New claims for ESA have fallen a bit behind, mostly because of the introduction of the personalised statement following Professor Harrington’s report. We discovered in the first few weeks that it took health care professionals much longer to complete the statement than expected, so the number of completed assessments dropped. That has changed. They have caught up again, and we are chasing through to clear the backlog, as we are doing with the appeals backlog that we inherited.

Finally, the right hon. Member for East Ham asked about the Work programme. Incapacity benefit reassessments are progressing according to time. The biggest impact on numbers in the programme has been created by the different mix of people coming through and the bigger support group. I am quite relaxed about having a bigger support group, because if we need to provide long-term unconditional support to a larger group of people than we had expected, it shows that we are making a genuine effort to get it right and are being sensitive to the needs of people with disabilities. We want to help them into work, but we want to do it in the right way.