I am grateful, Sir Roger, for the opportunity to begin my speech a few minutes early, because I hope to participate in Welsh questions in the main Chamber later. I thank the Minister for his co-operation.
I am not unique in having concerns about the work of Atos. I am sure that there is such concern throughout the country. Last year citizens advice bureaux helped with some 450,000 problems to do with employment and support allowance, and 58,000 of those related to work capacity assessments carried out by Atos. Some 94,000 cases related to appeals. The Department for Work and Pensions is currently retendering for new contracts, and I hope that as part of the process the Minister and the Department are examining some of the failures of past contracts. Above all, I appeal to the Minister—he is a Minister who listens—to ensure that whatever conclusions are reached, and whoever gets the contracts, they will be held to account for poor quality assessments and bad customer service. That is the reason for the debate, and I shall give examples—I hesitate to use the word “anecdotes”; many Members of Parliament have constituency experience of the problems.
I am concerned that Atos may not be asking the right questions, and I encourage DWP to introduce regular independent scrutiny of its customer satisfaction surveys. It has asserted that 85% of clients are satisfied with the assessment process, but I question that figure. Citizens Advice has long-standing concerns about the accuracy of work capacity assessment reports provided to DWP as part of the Department’s decision-making process. Citizens Advice asserts that two thirds of reports have a medium level of inaccuracy, and that 40% have had a serious lack of accuracy, which could lead to the wrong decision being made. Those concerns are not confined to the issue of ESA; they could be replicated with respect to personal independence payment assessments.
Does the hon. Gentleman see the stress that multiple processes cause to people who are battling against serious conditions, such as the constituent I recently saw who has severe epilepsy? She waited months for a tribunal on a work capability assessment, and she won; but in the meantime, she lost her disability living allowance. She appealed and while she was waiting had to put in a claim for PIP, and is still waiting for a decision. I know that that is not all because of Atos, and that there is another debate to be had about Capita; but does the hon. Gentleman often see, as I do, people who are coping with worry and stress because of the system, in addition to their illness?
I thank the hon. Lady for that intervention, which she had notified me she wanted to make. She talked about multiple processes, and she is right; in particular she is right about the delays and the anxiety they cause.
There are reports of some disabled people waiting more than six months for face-to-face assessment; scheduling problems; last-minute cancellations; and difficulty in getting to assessment centres. I represent a large rural constituency in the west of Wales and access to assessment centres is a critical matter. We must factor in the lack of public transport and people’s difficulties in getting to their interviews.
That should all be seen in the context of the fact that many claiming benefit are doing so for the first time, after experiencing a catastrophic, life-changing event such as an accident, the sudden onset of disability or the deterioration of an existing condition. They face an urgent need for support, given the sudden extra costs. Everyone in the Chamber acknowledges that delay is unacceptable, although of course new systems have teething problems. I should emphasise, however, that not one of us, of whatever political persuasion, has a monopoly on empathy with the problems, which are understood by the Government, the Opposition and all parties. Nevertheless, I question the capacity of existing providers to carry out the work. The Minister is in a difficult position, because the tendering process is being embarked upon, but I hope that he can allay my fears.
I sought the debate because of the increasing numbers of constituents who are coming to my surgeries, writing to me and e-mailing me, and are facing the stress and anxiety of going through work capability assessments carried out by Atos for the DWP. That is perhaps inevitable given the increased pace of assessments but, as a result of, some would argue, the inappropriate system and process, many of our constituents are told that they do not qualify and are indeed fit for work. The constituent then appeals, but can be left in a state of limbo while this process takes place—delays take months or even years. One of my constituents had an assessment two years ago, but the case is still not resolved.
In response, local agencies such as Jobcentre Plus, Citizens Advice and the DWP itself have been advising my constituents to contact me to assist with their appeal or the speed of their claim. I would never turn a constituent away on any bit of casework, however big or small, because that is our duty and our function, and I am supported by excellent staff here in London and in Aberystwyth, so we will help in any way. There is something wrong, however, if DWP staff are themselves referring people to their MP. In one case, a DWP member of staff told my constituent to contact me to complain about the service. As such, it is my duty to bring these matters to the Minister’s attention.
This is such an important issue, not only for the hon. Gentleman, but for every one of us in the Chamber and for many outside. In addition to the examples he has rightly mentioned, I have a constituent who has ulcerated colitis and has been retired medically as a civil servant. Her doctor and her physiotherapist support her. In the appeal, however, she was declared fit for work. There is something seriously wrong with a system that ignores medical opinion and suggests that people can work, when they clearly cannot. Should the Minister take that on board?
The hon. Gentleman highlights a mismatch between the appeals process and the initial adjudication or assessment. I will come on to that. I am sure the Minister is mindful of it, although the hon. Gentleman is right to highlight it. As I said at the start of the debate, the situation is not unique to my constituency; it is commonplace in every constituency in the country.
My hon. Friend is making an important case, which should be heard, and we all have examples from our constituencies, as he says. Does he agree that the situation is difficult, given that the contract was a monopoly one—awarded by the previous Government—and is therefore awkward and possibly expensive for this Government to get out of?
My hon. Friend is right. I am not approaching the subject on a particularly partisan basis, because the problems are experienced in all constituencies, but he is right to talk about the circumstances in which this Government are dealing with the legacy of decisions taken under the previous Government. He is right to highlight that. I have every sympathy with many of the campaigning groups, on behalf of which I will talk in my later remarks, but we need to remember the origins of the decision, which the Labour Government made.
I want to talk specifically about delays. I met Atos representatives yesterday, so I know that they recognise the length of time taken to complete the process. One of my constituents, who I will call Mr P, had his Atos assessment two years ago and was failed. He appealed, and the appeal took eight months to be heard. The appeal judge took only three minutes to uphold the appeal. His backdated benefits were paid, but two months later he received a letter summoning him to another Atos assessment, because the process had taken so long from start to finish that the 12-month period before reassessment was almost up. At the second Atos assessment, my constituent was unable to complete some of the tests without causing himself considerable pain and anguish, so they were stopped halfway through. This went down on his medical report paperwork as a refusal.
The case, now complete, has gone to the ombudsman, and I would like to quote a section from my constituent’s letter to the ombudsman:
“I have paid my NI contributions and taxes all my life believing I would be protected by the welfare system should anything untoward happen to me. For 2 years I was afraid to open my post in case it was another letter stopping money...or another assessment. During this time I have been in pain, had needles...surgeons knives, ligaments removed, bones cut and metal plates inserted into me but I am still made to look like some kind of scrounging criminal by a system that was meant to protect me.”
I condemn certain sections of the press for the way in which they have characterised benefit claimants. A gentleman who is genuinely seeking support from the welfare state, into which he has paid all his life, is seemingly being let down.
In many cases, our constituents want to get on with the process of recovery and do not see benefit claiming as a long-term situation, but the delays make their condition worse. Another constituent who I am dealing with—she, too, will remain anonymous—said:
“I am currently receiving treatment and therapy and my therapist is not keen to discharge me yet. My health is not improving and is in fact being made worse by the anxiety caused from this void of information. I was feeling quite positive at one time that I may be put into the Work Related Activity Group…as this would be a great stepping stone to getting back into work from sickness, but I currently feel so low because instead of being helped forward towards getting back into work, I am stuck in an uninformed place that is not helping me recover at all.”
That indicates to me that the process for some conditions —by no means all of them—is making situations worse and adding anxiety to something that is already causing considerable stress to people.
In developing the debate, I am talking about some of the principles that I believe—I am sure people in all parties believe—should be governing our assessment system. My concern in addition to the delays is that the work capability assessment is not fit for purpose. Indeed, the charity Mind informs me that around 40% of people who are found fit for work appeal against the decision; of those who appeal, almost 40% win their appeal. As we know, capability to work is about not only those suffering with physical disabilities—it might be easier for ATOS assessors to see and report on a tangible factor—but those suffering with an invisible illness. This is true in particular of constituents who are suffering with mental health issues, or conditions relating to autism, which is an especially interesting example.
In my constituency, I was pleased that an excellent charity, Autism Cymru, developed a project to train people in the DWP to have greater understanding of the condition of autism. I used to be a primary school teacher and we had minimal training on this, but one thing that impressed itself on me was one particular feature of autism: asking a direct question gets a negative response. That is the nature of the condition, and it needs to be borne in mind in the assessments. The charities Rethink, Mind, the National Autistic Society and Citizens Advice have all made that point to me. I therefore ask the Minister to reiterate the Department’s concern and to ensure that, whichever providers undertake the work, the assessors are appropriately trained in complex conditions such as autism and mental health, so that the clients may be—and see themselves to be—assessed fairly and comprehensively.
Last autumn, with other Members, I undertook a mock assessment organised by the charity Rethink, to give MPs the experience of taking a work capability assessment. At that meeting was a Rethink campaigner, the retired vicar Dick Acworth, whose son has bipolar disorder and yet was deemed fit for work. People such as Dick’s son with a supportive family are lucky to be able to face the appeals process together, but there must be concern about the number of people who do not appeal, because they cannot face it, or simply do not know how to go about it, and they are very much left to struggle alone.
Does the hon. Gentleman agree that when someone has medical evidence from GPs, consultants and physiotherapists—people who know about the medical condition of their patient—it is important for Atos and for the Department itself to take greater cognisance of that medical evidence? It seems that that is not always the case.
I thank the hon. Gentleman for making, once more, that point. It is critical that all due consideration is given. I do not agree with the characterisation of constituents as simply going down to their doctor’s surgery, presenting a letter to the doctor and saying, “Sign this”, and then that letter being presented as part of a package for an assessment, or indeed a tribunal. Doctors are the experts. They know their patients and the situations in which they operate, and we need to give them all due consideration.
Concerns have also been expressed about people suffering from progressive illnesses such as cystic fibrosis, multiple sclerosis, Parkinson’s disease and rheumatoid arthritis. It has been asked whether the work capability assessment is fit for purpose for them. I am not sure whether the Minister has received it yet, but I recently signed a letter to him from colleagues from across the House—it is on its way—raising that concern. Organisations working on behalf of people with progressive conditions have found that that 45% of people with those conditions who put in a new claim for ESA between 2008 and 2011 were placed in a work-related activity group and deemed able eventually to return to work. The placement of those individuals represents the Department’s recognition that they were unable to work at the time of the assessment, yet some were given a recommendation for a return to work in few months’ time. But that directly contradicts the definition of a progressive condition, which of course can get worse over time. The letter is on its way, and I am sure that the Minister will respond to it even if he does not do so today.
I will move on to the flexibility of descriptors. I understand that Atos and Capita are under contract to the Department—I was going to raise at this point the point made by my hon. Friend the Member for Gloucester (Richard Graham) about the origins of those contracts—but Atos does not set the descriptors; they are set by Government. Given the concerns that many organisations in the third sector have about the descriptors, will the Minister tell us—I suspect I know the answer—what dialogue he has had with the third sector and what opportunities the third sector has to raise such concerns?
On that precise point, does my hon. Friend agree that Citizens Advice is probably the charitable organisation that has the greatest experience of dealing with the most serious and, often, heartbreaking experiences of people who have really struggled with the assessment and appeal process for WCA?
I agree, and I am sure that the Gloucester citizens advice bureau is as affected as the Ceredigion citizens advice bureaux in Cardigan and in Aberystwyth—although I am sadly not sure how much longer that CAB will remain open. Citizens Advice has that body of expertise, which is hugely important.
I have received an almost endless series of representations. I am mindful of the time, and that I have already spoken for 18 minutes—albeit that I have been generous with interventions—so I will simply make the general point that there are concerns about the extent to which the employees of assessment providers are being wholly sympathetic, about the huge backlog of cases that is leading to delays and, frankly, about the instances there have been of administrative incompetence.
I will give a final case study. One constituent I have been dealing with was assessed recently. He felt that the Atos assessor was completely apathetic to his conditions, and also felt under immense pressure to complete tasks put before him. He self-harmed considerably following the assessment. Several of the tasks he was unable to perform have now been put down as “refusals” on his medical report form. He gets very angry, has suicidal thoughts and is prone to paranoia—I am not being emotive in presenting such cases, as I think that they are replicated more generally. Shortly after the initial assessment, he got in touch with me to start the appeals process. Someone from the DWP phoned him to tell him that his appeal of the Atos decision had been unsuccessful, but we had not even started the appeals process at that point. They then called 10 minutes later to say they had made a mistake and he could appeal.
A simple mistake like that can have huge ramifications for people’s lives. A section of the decision maker’s letter to my constituent, whom I will call Mr Z, says that although it is accepted that Mr Z
“experiences pain and discomfort it should be remembered that activities do not have to be performed without any discomfort or pain.”
It goes on to say that the decision maker had chosen the descriptor that reflected Mr Z’s
“level of functioning for the majority of the time.”
If we look at the Government’s website, there is a contradiction, as that site says:
“The approved healthcare professional will consider all the information and exercise clinical judgement to reach an opinion on the nature and severity of the effects of the disabling condition. They will also take full account of factors such as pain, fatigue, stress and of the possible variability of the condition.”
My constituents—people such as Mr Z, Mr P and the lady I mentioned who is desperate to get back into work—are being let down by the system.
Finally, I reiterate the point mentioned by the hon. Member for Strangford (Jim Shannon). A number of my constituents have failed Atos assessments, but, after a long appeals process, that decision has been overturned by tribunal judges. The judges involved in the appeal are given the same descriptors as the Atos assessor, the same reports and the same medical information from the person’s GP, so why is it that judges who are upholding appeals and the Atos assessors are reaching such wildly different conclusions? For example, a constituent of mine had her Atos medical last March. She was given zero points, but her appeal was upheld and full points were awarded.
To me, that sounds like a system that is making those in our society who are vulnerable and unwell, sadly, more vulnerable and unwell. I look to the Minister for reassurance. I know that his role is in a tentative phase at the moment, but I hope that I have established some of the principles that some of us expect to see in our system of assessment.
It is the first time I have served under your chairmanship since you were knighted, Sir Roger. I congratulate you on receiving your knighthood from Her Majesty, and look forward to serving under your chairmanship in the future. I also congratulate my hon. Friend the Member for Ceredigion (Mr Williams) on securing this debate on an issue on which I receive correspondence as a constituency MP; indeed, in the four months that I have had this job, I have met colleagues from across the House about this issue.
On that note, I will explain a little about the role of the Minister of State with responsibility for disabled people. It is a completely new role. For the first time in the 40 years that we have had a Minister for this area, a Minister of State is responsible for it. Although I am based in the Department for Work and Pensions, I have a considerable role across Government in bringing Departments together, to break down some of the silos and see how we can go forward for a better future and with better aspirations for people with disabilities and long-term illnesses.
My hon. Friend has concentrated specifically on Atos and the WCA. I spoke to him before the debate, and I will concentrate most of my comments, if I may, on the WCA for ESA, and on Atos, which is in the title of the debate. Many matters he has raised this morning are not points with which anyone from across the House or any Minister could disagree. There is real concern out in the community, in the lobbying groups that represent so many of the individuals who are so worried about the assessment, and across the House. I noticed that before I came to this role, and have seen it since.
I have tried to be as open and pragmatic as possible in the past four months, meeting not only colleagues from across the House but the relevant specialist stakeholder groups that have asked to see me. I have been frank—I am often too frank—in saying that if those stakeholder groups want to help and to work with us to make the situation better, I have an open-door policy. If they want to throw abuse—and frankly some of my colleagues have faced abuse that has been absolutely appalling and reprehensible—I will not meet those groups, because that will not help the people whom those groups say they are trying to help. But I have had a completely open door; for instance, this afternoon I will again meet representatives from Macmillan to discuss its particular area of expertise. Although I agree that Citizens Advice has done and continues to do fantastic work, it is not the only organisation that is doing such work in representing the people affected. I pay tribute to colleagues across the House—who, believe me, write to me on a regular basis—for doing exactly what they should be doing in representing their constituents.
I am not a party political animal in ministerial terms, and colleagues in Departments that I have worked in previously know that, but I must be honest and ask whether we inherited the work capability assessment. Was it introduced by the previous Administration? Yes, it was. Do I agree with it? Yes, I do, but I do not agree with the way in which the contract was formulated with Atos as one single provider. That was a flawed decision. Sadly, under ministerial rules, I am not allowed to see the evidence that was put before Ministers in the previous Administration. Due diligence is not possible, as it would be if a company were taken over. That is rather strange. Although I have been in three Departments, I am not allowed to see that evidence, but I cannot understand why that decision was made. There was a move from a predominantly paper-based assessment, in which people were often written off. When I had my accident in the fire service, my certificate stated “until further notice”. I was written off, but I have been lucky and have come back to reasonable health and stability from my injuries. However, many people do not recover and there are many areas that we need to work on.
If people want to work, we want to give them all the assistance we can. If people could work but perhaps do not have the confidence, ability, skills or help to get back into the work place, the scheme will help them. Do I accept that mistakes have been made? Yes, I do, and it would be foolish to deny that. That is why, when the coalition Government came to power, Professor Harrington was asked to carry out a review. We accepted all his recommendations. The new review by Litchfield has just been produced, and I can tell the Chamber that we can accept almost everything that is recommended. We have not yet made a formal decision, but it contains many sensible suggestions that need to be in place.
I have attended some tribunals, which are public and not secret courts. I have sat there quietly and listened to what goes on. Do I agree with Citizens Advice and others that many cases should never have gone to a tribunal? Yes, I do. I am taking action to ensure that all the cases that are waiting to go to a tribunal are reviewed, and if senior case workers have got them wrong, we will prevent them from going forward. However, we tend to hear one side of the argument—when mistakes are made—but millions of people have gone through assessments and are back in the workplace. Under the previous Administration’s regime, people really struggled to get back into work. We want to help people to get back into the workplace and to be as self-sufficient as possible.
There are areas that I still have grave concerns about, and we are working on those. My hon. Friend the Member for Ceredigion alluded to mental health issues, and I often talk about hidden disabilities. One of the great things that came out of the Paralympics was that the public’s understanding of people with disabilities across the spectrum was vastly improved, and we need to build on that legacy. However, the parameters of mental health disabilities, learning disabilities and hidden disabilities are difficult.
My constituency has problems with misuse of blue parking badges for disabled people. Only the other day, a young man and his father got out of a car and walked off down the road as though they were fit and able-bodied. I know that family, and I know how poorly the young man is, but I heard the abuse from a member of the public who thought he was abusing the parking scheme. That abuse from the member of the public was wrong, but frustration arises from abuse of the system, and we must work with the Department for Transport on that. At the same time, we must address ignorance and lack of understanding among the public
I understand exactly the point the Minister is making. It is good to get people back to work, and many people want to go back to work, but as hon. Members in the Chamber have said, some people cannot work. The Minister indicated that he accepts that some change is needed. In the criteria for Atos, will more emphasis be given to the medical evidence?
My hon. Friend—he has been a good friend, especially during my time as a Northern Ireland Minister—has read my mind, as usual. That is exactly what I am coming to. We are working closely on the descriptors to ensure that what we ask is exactly relevant to the conditions reported. Atos does not make decisions on diagnoses; evidence for those diagnoses will already exist. We are trying to ensure that the right decision is made based on the evidence provided, and descriptors are important in that.
Turning to why so many decisions are overturned by judges at tribunals, I have admitted that that is sometimes because we got them wrong. However, sometimes, on the day of the tribunal, new evidence, which we have never seen, is put before the judges. Within the rules, that is technically unacceptable, but the judges are allowed to use their discretion in allowing that to happen. I saw that the other day, and if we had seen the evidence that was put before the judge at that tribunal, the case would never have gone to the tribunal.
I am grateful to the Minister for his last point. Charities have contacted me about progressive diseases and illnesses, and I know that he is working with them. With regard to his discussions about the descriptors, how satisfied is he that concerns about slowly progressive diseases and illnesses will be factored into any new descriptors?
That is exactly what we are working on with the stakeholder bodies. I have asked them to sit down and work with us to address that. I completely agree that the descriptors must be fit for purpose. The matter is enormously complicated because of the sheer amount of different diagnoses across the medical spectrum.
I turn to the negotiations with Atos. I must be careful, because they involve contractual and legal issues. We have announced that we want more capacity. Otherwise, the backlog of people waiting for their assessment will increase, and the time they wait is increasing. We have said publicly that we want more capacity in the system. The balance is between quality of decision and throughput. One reason why so many cases go to a tribunal is that we based the system on throughput and we got too many wrong. I say “we” because I am the Minster responsible and the buck stops with me. Too many cases ended up in the appeal process and went to a tribunal. We have now improved the quality and ensured that our people spend time with the applicants, but that has caused a backlog. We are addressing that capacity issue.
I welcome what the Minister says about the backlog, which is causing the huge delays and problems that I alluded to. May I plead for areas such as the one I represent—rural, sparsely populated west Wales—and raise the problem of people needing physical access to the assessments we are talking about? The position in south Wales and the cities of England, Scotland and Wales is very different from that in rural Ceredigion.
I have a list of things I wanted to bring up, and if I have missed anything that hon. Members have raised, I will write to them after the debate.
During a meeting only the other day, my hon. Friend the Member for Gloucester (Richard Graham) raised the issue of access. There are two sorts of access issues: distance, and the suitability of the building for people with disabilities. I am the Minister with responsibility across Government for disability, and it seems ludicrous that I receive complaints about buildings that Atos and other companies use on my behalf and are not suitable. We are working on that. The problem is not just distance, but the sort of buildings being used.
When someone has been told that they are fit for work and then appeals, they can apply for jobseeker’s allowance while they are waiting for their appeal to be heard. If their GP believes that they are unfit for work, they will provide a sickness certificate. Everyone accepts, as did the previous Administration, that there should be an independent review of people’s capability because of the relationship between GPs and their patients. That relationship is very personal, as I found with my GP all those years ago after my accident. He would say, “Well Mike, you can’t carry on being a fireman,” instead of saying, “What can you do?”