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Work Capability Assessments

Volume 605: debated on Tuesday 9 February 2016

[Mrs Madeleine Moon in the Chair]

I beg to move,

That this House has considered work capability assessments.

It is a great pleasure to serve under your chairmanship, Mrs Moon, and to lead this debate, because it is one that we have been having in the House for many years and it has enormous repercussions for the people we are here to represent.

The debate comes at an important time. The amount of money that the Government spend on outsourcing has never been higher, but public trust in outsourced companies has never been lower. Only 22% of people believe that they are motivated by providing the best service to the public, and is it any wonder, with stories every week of high-profile failures, corruption, mistreatment, the falsifying of information and a premium being put on profit ahead of people? There is a sense from the public that this shadow state, providing the services that the public rely on, is acting with ever increasing impunity.

In the course of the last Parliament, as outsourcing grew, the public’s control over our own public services shrank and evidence of malpractice, mistreatment and utter contempt for those coming into contact with the services provided by such companies grew, private sector providers became the ogres for their appalling behaviour. However, we should not forget that it resulted from what were first and foremost political choices, the unpalatable consequences of which were contracted out and covered in the veil of secrecy that commercial confidentiality rules permit. Although it was Atos and is now Maximus that has carried out the Government’s massive expansion of work capability assessments, the choices made in the Treasury and in Downing Street, well before responsibility was contracted out, were the basis for where we are today—failing contractors acting with impunity, and the sick and disabled paying the price for the Government’s flawed agenda.

Hon. Members on both sides of the House agree that if people can work, they should—that is not a contentious statement—and that work is beneficial for many people suffering from illness, be it physical or mental. I have friends and family who have fallen in and out of depression and for whom work has been a lifeline. It gives people a routine and a purpose—a reason to get out of bed in the morning. I have been unemployed for stretches of time myself and have experienced how closely linked unemployment and depression can be for many. Helping people to get into work is therefore a laudable and necessary objective of any Government, but some things are not compatible with helping people with physical illness, disabilities or mental health problems to get into appropriate work. I am referring to targets, profit-driven motives and a focus above all on cutting expenditure. When one side is trying to cut costs and another is employed to maximise profit, something has to give, and unforgivably that has been the sick, the disabled and anyone who comes into contact with this failing and occasionally brutal system.

I thank my hon. Friend for securing the debate. Is there not also an issue about the significant waste of taxpayers’ money in the Government failing to address the fundamental flaws in the system, which lead to an over-reliance on appeals and reconsiderations and the Department for Work and Pensions having to prop up a private company that is failing to deal with assessments appropriately the first time?

I could not agree more, and I will come on to that issue.

This is about providing not just a good-quality service for clients, but best value for money for the taxpayer. As I said, when one side is trying to cut costs and another is employed to maximise profit, something has to give. As report after report has identified, the contractors that the Government have employed to carry out cuts have been anything but successful. They have presided over failure after failure. There has been poor performance, a disregard for vulnerable people and, in this new age of outsourcing, a total lack of accountability for Government and operator alike.

I congratulate my hon. Friend on securing this timely debate. The cost to the taxpayer is some £80 million this year, up by £24 million on last year. Does she agree that these private companies are taking the taxpayer for a ride?

Again, I completely agree with my hon. Friend, and I thank him for that intervention. The contractors continue to get paid despite repeated failures. Even worse, after being deemed unfit to perform in relation to one contract, contractors simply get to continue with another lucrative long-term deal, as Atos has done. After failing to handle the work capability assessments contract, it is still running a seven-year contract for personal independence payment assessments for the same Department. Now Maximus is failing to meet a range of key targets—targets that, importantly, put far greater emphasis on saving money than on meeting the needs of people who unjustifiably suffer. Whatever the rhetoric about service quality, this is still a system designed to cut costs for the Government and maximise profit for Maximus.

We have undoubtedly all read last month’s report by the National Audit Office, but some of the figures deserve to be rehearsed. Despite the new contract—which followed Atos’s spectacular failure—being worth some £570 million a year, there is still a backlog of 280,000 employment and support allowance claims. The average cost of each individual assessment is now almost £200, and that is for a 15-minute assessment. One in 10 disability benefit claimants’ reports are rejected as below standard by the Government, compared with one in 25 when the shamed Atos was running the show.

Individuals have to wait an average of 23 weeks for a decision to be made on their benefits; there has been a huge rise in that timescale—almost a trebling—in recent years. For each person, that can and almost always does mean hardship, but the number being referred keeps rocketing as the Government, desperate to clear the books at any cost, lay the bill for clearing the deficit squarely at the door of the sick and disabled. The Government are forcing away from ESA people who need and rely on it, and the failing contractors are being overwhelmed. Despite all that undeniable pain, unbelievably, the Department is not expected to meet the initial £5.4 billion savings target originally envisaged for the 10 years to 2019-20.

I thank my hon. Friend for generously giving way again. Does she agree that the failure at ministerial level to get a grip on the backlog, the rising costs and the incompetence in the Department for Work and Pensions has led to the Treasury’s demand to take even more money from disabled people on employment and support allowance, which is why the Government are seeking to cut £30 a week from half a million of the most disadvantaged people in the country?

Again, my hon. Friend has neatly anticipated my next point, which is that the Office for Budget Responsibility has identified ESA and PIP as a major risk to planned public spending targets, given the uncertainty of the estimates. The NAO has gone so far as to say that PIP and disability living allowance performance issues have been the main contributing factor in the Department’s inability to save any money in the spending review period up to 2015.

It is clear that both the Government and contractors are failing on their own terms, yet still the cash is handed over to failing contractors. We are locked into long contracts whereby Departments do not have the capability to improve performance. The original policy itself is flawed, but it is in the treatment of individuals unlucky enough to come into contact with the system that the whole rotten trade-off between cost cutting by the Government and profit maximisation by Maximus is most apparent. Specific cases abound, and I am sure that hon. Members on both sides of the House would be able to relay evidence of deeply concerning practice, which is why it is interesting to note that not a single Government Back Bencher is in the Chamber today. I will list a few from my case load.

One man with learning difficulties whose case was highlighted to me attended his work capability assessment, but during the assessment his support worker was shocked at the lack of care and attention given to him. When the assessment came through, there were some glaring factual errors, but none the less his ESA was docked, just in case he was in any doubt about what comes first—the person or the profit. On making his request for mandatory reconsideration, he was appalled to find out that he would be ineligible for ESA, which was his lifeline, until the reconsideration decision was made, and he was unable to meet the conditions placed on him for jobseeker’s allowance. He now faces months of waiting until his tribunal, and potentially an annual battle if assessors continue to lack understanding of his learning difficulty.

Whatever my hon. Friend’s views about the contractors, does she agree that it is the Government’s responsibility to secure contractors whose assessors have sufficient knowledge of progressive conditions such as muscular dystrophy and sufficient awareness and training in areas such as learning disabilities? The contractors are not primarily responsible for that; is it not the Government’s responsibility?

Of course, I completely agree. The Government’s policy sets the direction for the contractors, which is why the contractors have such a huge gap in their understanding, particularly of mental health issues.

In another case, one of my constituents applied for a home visit after being unable to make their assessment. She has now been waiting for more than two years and still has not received a date. Throughout that time, she has been surviving on a reduced rate and is struggling, as anyone would, to get by. She is just one of 280,000 people in an enormous backlog.

Despite the fact that the Government have made it notably harder for people to appeal their decisions, as my hon. Friend the Member for Bermondsey and Old Southwark (Neil Coyle) mentioned, the latest figures show that 54% of appeals result in decisions being overturned. As in the case of the first constituent I mentioned, there seems to be an alarming trend of cases being rejected based on factual errors or even—I hesitate to say this—falsification. I have had several cases of people telling me that their assessment report bears absolutely no relation to the assessment that they experienced with Maximus or Atos. I am sure that other hon. Members have heard similar evidence. One or two cases could be dismissed as an honest mistake, but the situation appears to reveal a disconcerting pattern of behaviour that indicates that the trade-off between cost cutting and profit maximisation is being felt by very vulnerable people.

Maximus is not doing this to make a loss or out of the kindness of its heart, and it is failing on performance, which goes to the heart of the issue. Even if the Government were more concerned with the interests and wellbeing of the user, it would be extremely difficult for them to hold the contractors’ feet to the fire.

It is good of my hon. Friend to give way to colleagues. Does the situation not demonstrate that the Government’s intention—Governments do give contractors instructions, by the way—is to cut people’s benefits, and to make the system more difficult, through the contractors, so that it is harder for people to get those benefits? If anybody wants any evidence of that, it took the House of Lords to stop a £30 cut in people’s benefits a couple of weeks ago.

Absolutely. Clearly, there is an attempt by the Government to drive down benefits for people who are sick and disabled, and they are using private companies to outsource that responsibility.

Even if the Government were interested in ensuring that the contractors were doing the best for sick and vulnerable people, it would be very difficult for them to be able to do so. They need to be able to trust the data that the contractor supplies if they are to hold its feet to the fire. In a 2014 report, the NAO pulled the Government up on the poor management of contracts, the level of inexperience within Departments, their naivety and their “over-reliance” on data supplied by contractors in the management of performance.

Although some much-needed changes have been made since the calamitous Atos contract and that 2014 report, old habits die hard and inexperience in managing contracts remains a major issue for the Department. Although we know that contractors are performing poorly against a range of measures, because of the helpful insight we get from the NAO once in a while, assessment across the full range is not always forthcoming.

Across a range of vital measures, it is up to us to trust that the Department is doing the job and that Maximus is supplying the right information. They include the number of face-to-face complaints following an interview; the number of serious complaints; the percentage of face-to-face consultations without complaints, which is supposed to be at 99.5%; and the target of 100% payment of travel expenses within nine working days. Those targets are all noble and sensible, but there is no regular method for publishing whether they are met. That is why we talk about a democratic deficit in outsourced public services, the costs of which have rocketed since 2010 to almost £120 billion, covering vast swathes of services that we all rely on.

What exactly is the point in setting targets if the public cannot see whether they are being achieved? A supplier could manipulate the data, and we would have to rely on an overstretched Department to pick it up. Let us not pretend that that would be unusual or unprecedented. In 2007, Maximus was fined $30.5 million over accusations that it had cheated Medicaid in the United States by making tens of thousands of false claims on a payment by results contract. Maximus effectively stole money from US taxpayers by making claims for children who had not received care. After that was exposed, Maximus said it would not sign any more contingency-based contracts where it was paid from savings in state expenditure, but the contract we are discussing is just such a contingency-based payment by results contract.

In 2007, Maximus was sued by the state of Connecticut for the abject failure of its computer system, which was supposed to run a police database, including real-time police record checks. The state’s attorney general said:

“Maximus minimized quality—squandering millions of taxpayer dollars and shortchanging law enforcement agencies.”

He said that the database could

“make a life and death difference to police and other law enforcers”,

so the failure was unacceptable. In 2012, Maximus settled the case for $2.5 million. While the US sues companies such as Maximus, which spectacularly fail to deliver the contracts they are required to, we continue to hand over billions of pounds of taxpayers’ money.

We have an original policy based on a flawed and myopic view of the sick and disabled, and handed down by the Government to catch contractors that are undeniably failing. Meanwhile, the public’s right to know what is going on is limited by commercial confidentiality. We will all be forgiven for not wanting simply to trust that all is well when our constituents tell a different story and when well documented scandals seem to play on a loop.

Will the Minister commit to publishing regular updates to Parliament on Maximus’s performance against its targets? Will she release the latest spending on WCA appeals, given that the figures in the public domain date back to 2012, and when the contract comes up for renewal in three years’ time, will she release a cost-benefit analysis of bringing the service back in-house? Finally, will she confirm what steps are being taken to bolster the experience of civil servants in her Department overseeing contracts of this magnitude, to ensure that they are delivering the best possible service to vulnerable people and the best possible value for money to the taxpayer?

The fundamental problem is that regardless of which hapless and dubious provider is dragged in, and regardless of the operating system and oversight of the WCA, the need of extremely vulnerable individuals simply cannot come in third place behind a need to cut costs and maximise profit. Is not the lesson of this whole sorry episode and the episode before it that profit has no place in assessing need?

The WCA was introduced to assess an individual’s eligibility for ESA. The assessments have three outcomes, which determine whether claimants are in the support group, or the work-related activity group, or are fit for work. Claimants who wish to dispute the decision must go through a mandatory reconsideration before they can appeal. They have one month after a decision to request that and an additional month to supply supplementary evidence. ESA is not payable during that period, but may be backdated. Unbelievably, there is currently no statutory time limit for the Department for Work and Pensions to complete the process. Since March 2011, 35% of claimants went into the WRAG, 46% went into the support group and 19% were declared fit for work. The percentage of people placed in the first two groups has increased month on month from 75% in March 2011 to 96% in March 2015.

Panic, fear, distress, dread and anxiety are just some of the words people use to describe their experience of the benefits system while dealing with health concerns. For example, people with cancer—those who are terminally ill, those receiving treatment for cancer by way of chemotherapy or radiotherapy, and those recovering from treatment—will automatically be treated as having a limited capability for work or work-related activity. In some ways that is beneficial. However, according to Macmillan Cancer Support, by 2020 one in two people will get cancer in their lifetime but almost four in 10 will not die from it. That is clearly good news, but at least one in four of those living with cancer—around 500,000 people in the UK—face poor health or disability after treatment, with a significant proportion experiencing a wide range of distressing long-term problems, both physically and mentally. Many problems can persist for up to 10 years after treatment and can be significantly worse than those experienced by people without cancer.

Many healthcare professionals underestimate the long-term consequences of cancer and its treatment, and that low profile means that some of those affected are reluctant to report those consequences, particularly if they feel grateful to be free of cancer in the first place. It is good that we are curing people of cancer, but we have to recognise that not dying is not the same as being well. The impact of cancer and its treatment affects much more than just health and wellbeing. The physical and emotional effects of cancer and its treatment are the two most common reasons for employees who are diagnosed to give up work or change jobs. Almost half of those who do so say that it was because they were not physically able to return to the same role and one in three said that they did not feel emotionally strong enough. Having come out the other end of cancer treatment, the last thing they need is the stress of jumping through hoops to see whether they are entitled to benefits. The time after treatment is crucial for future health. It is a time when space is needed to process what has happened to them and a period when they need to concentrate on themselves and take time to heal and get stronger.

The issue with the work capability assessment is that there is no flexibility. It does not take people’s individual circumstances into account. It is not possible for people in the DWP to understand each and every health condition and its impact, and those who are contracted to do so seem very quick to overturn the diagnoses of GPs and health professionals. Sadly, everyone is expected to fit into the same box. Clearly, life is not so black and white, and cancer survivors and those with other health conditions want, more than anything, to have a normal life, but the opposite will happen if the benefits system continues to cause undue stress and hardship.

Although I have spoken about only one client group, there are many others in similar positions, and we can no longer ignore the damage that the system is doing. I ask the Government to re-examine the processes and to consider a better way of supporting people with health issues back into the workplace.

It is a pleasure to serve under your chairmanship, Mrs Moon. I congratulate my hon. Friend the Member for Sheffield, Heeley (Louise Haigh) on securing this important debate.

Work capability assessments are one of the issues most commonly raised with me, and I am sure with many other Members on both sides of the House. The system is flawed and discredited, and it has caused undue stress and hardship for too many claimants. Recent academic research estimates that for every 10,000 assessments carried out between 2010 and 2013 there have been six suicides, which is truly shocking. That alone requires the Government to undertake a complete review of the current system.

Does my hon. Friend agree that cases such as that of one of my constituents, who is disabled and does not drive and who has had to attend centres four times, only to be told that the assessment would not go ahead, exemplifies the administrative and financial shambles of the current work capability assessment scheme?

My hon. Friend illustrates a valid point that is replicated across the country.

I am sure that hon. Members are as concerned as I am when they hear that, according to the DWP’s own figures, around 50% of assessments are overturned on appeal. That surely calls into question the reliability of the initial assessments and raises the question why we are putting people through such unnecessary stress, which has undoubtedly had a negative impact on the mental health of many claimants.

I am also concerned that the work capability assessments do not seem to take account of individuals who have a limiting long-term illness that means their condition often fluctuates, such as kidney dialysis patients or people with Parkinson’s. I visited the kidney dialysis patients support group in Merthyr Tydfil last weekend, and a number of people told me of their concerns about the work capability assessment and the lack of understanding of their condition. Dialysis patients often feel reasonably all right on certain days between dialysis, but on the day following treatment they can feel very low, which means that if they are receiving treatment three days a week, the number of days when they feel okay are few and far between. The Government need to address that lack of understanding.

If the original clauses 13 and 14 of the Welfare Reform and Work Bill are reinserted, financial support for new claimants in the work-related activity group will be cut by around 25% from £102 to £73, which will have a drastic impact on disabled people. The Government have said that they are committed to protecting support for disabled people, so the clauses are deeply worrying. The cut will not incentivise people, as the Government say they want.

Could the Government’s proposed cut to half a million people, including people with learning disabilities or cancer, have the perverse incentive that those people will then try to go into the support group when there is already a 280,000 backlog due to the Government’s incompetence in handling that contract?

On the Government’s justification for the measures in the Welfare Reform and Work Bill to cut the work-related activity group rate by £30 a week, the Government have said that that is to remove the financial disincentives that could otherwise discourage claimants from taking steps back to work. They have not produced any evidence for that disincentive in practice. Why does my hon. Friend think the Government are addressing a problem that is not there and ignoring the problems that are there and that hon. Members have raised over and again?

I will try to address my hon. Friend’s points later in my contribution.

I am concerned about the impact of the assessments on people with mental health problems. If the original clauses 13 and 14 are reinserted, the significant cut may mean that people with mental health problems become more unwell. They will be unable to spend money on support and activities that help them recover—things that the personal independence payment does not support—which will affect their ability to move closer to work. Rather than increasing the number of people in work, the change could hinder recovery and push people further away from work. The cut has been opposed in the other place, and I hope that the Government will listen and scrap the clauses.

The current work capability assessment is not fit for purpose. It has lost credibility, and an overhaul is desperately needed. The views and experiences of ill and disabled people must be at the heart of the process. We need a compassionate and effective system that supports people, not one that causes such misery for so many ill and disabled people in our country.

We in the Labour party feel that disabled people should be able to play a central role in monitoring the work capability assessment system and helping to ensure that it is managed with dignity and fairness. There have been concerns about the assessment over a long period, which has resulted in the DWP changing its contractor from Atos to Maximus, which I understand will be paid substantially more than Atos to carry out the contract. I fully support the calls from my hon. Friend the Member for Sheffield, Heeley to the Minister to make public the performance of the contractor, which will improve awareness of the situation.

The Government are trying to defend the indefensible. I hope that the Minister will signal today that she is willing to consider what action she and the Government can take to review this appalling situation and bring about some common sense and, above all, compassion.

We know that today’s debate is important because, in my constituency of North Ayrshire and Arran and in constituencies across the entire UK, some of our most vulnerable people—those with long-term and quite debilitating health conditions—are relying on us to be their voice. People who have undergone the work capability assessment tell us that they find the entire process at best demeaning, and at worst intimidating. It is a cause of deep distress, which is particularly alarming when one considers that some claimants live with challenging health and mental health conditions and find going through such assessments almost more than they can bear. The assessments can exacerbate or even precipitate mental health problems.

New research from the universities of Liverpool and Oxford has found that in areas where more people are assessed for employment and support allowance there is a greater increase in mental health conditions, prescriptions for antidepressants and even the number of suicides. The research estimates that that may have led to 590 additional suicides. The research is robust and suggests a correlation between mental health problems and the roll-out of work capability assessments. The result of the research is sobering for us all.

As my hon. Friend the Member for Ayr, Carrick and Cumnock (Corri Wilson) has said, why are there such strict limits for claimants when there is no time limit for the DWP to complete the mandatory reconsideration process? As has been said, we know that an individual’s condition may fluctuate, which means that symptoms can rapidly decline and abate over the course of a week, a month or even a single day. What about folk with a condition such as Parkinson’s? What if they are assessed on a good day? The assessor would be unable accurately to evaluate the condition’s impact on the person’s functional ability. Work capability assessments also focus on a person’s typical day. Their best and worst days are therefore averaged out, which can create a totally misleading impression of their condition. A snapshot of a person’s health is not a true and accurate view of the profound and often difficult challenges they face.

Work capability assessments do not take account of whether a condition is progressive. That is a significant oversight and leads systematically to incorrect assessment decisions about people with Parkinson’s.

The hon. Lady has mentioned progressive conditions and delays that sometimes happen with mandatory reconsiderations. Can she think of any logical reason for the Government’s refusal to give statistics on the outcome of mandatory reconsiderations? Is there any obvious explanation for the withholding of that information?

I am afraid the only possible reason I can think of for that is that the information does not present the work capability assessments in a flattering light. I leave others to draw their own conclusions about how bad it might be.

The worst thing about the system is that those caught up in the controversy and confusion are people with long-term health conditions, and some of the most vulnerable people in our communities. There is a lot of consensus in the Chamber about the need for an urgent review of the work capability assessment. As the hon. Member for Sheffield, Heeley (Louise Haigh) pointed out, the cost is increasing, and it is expected that £595 million will be paid for 3.4 million assessments—about £190 per assessment. There has also been a problem with the recruitment of enough medical professionals to meet the demands of the assessments. At least £76 million of taxpayers’ money has been wasted through the failure to get a new IT system up and running more than two years after it was supposed to be in place. As has been mentioned, the National Audit Office report, which was released only last month, revealed that

“recent performance shows the Department has not tackled—and may even have exacerbated—some of these problems when setting up recent contracts”.

The points about rising costs and the backlog are well made. Perhaps we can help the Minister by asking her to consider removing some of the routine retests for those with progressive conditions and conditions that will not change. We have all had the excellent briefings from Parkinson’s UK and Mencap, for example. Perhaps the Minister should look again at the frequency of testing for some people, to save the taxpayer money and save some of the stress and anxiety that the hon. Lady has mentioned.

That is an excellent, well made point and I thank the hon. Gentleman.

There is also a problem with transparency. In December, the Work and Pensions Committee concluded that it was unable to scrutinise benefit delays fully because of lack of available data. Its report said that

“if the DWP has this data, they should publish them. If they do not, then they are making policy decisions in the dark. The Department should address the lack of data immediately.”

Chillingly, in answer to parliamentary questions about the connection between assessment tests and the incidence of suicide or mental health problems in disability claimants, the Department has admitted that it neither holds such information nor has any plans to collect it. I think that is significant. There has also been an admission that it does not have information on how much, on average, it costs the Department to fund an appeal against a fit for work decision. It is clear—and becoming increasingly clear to claimants—that the system is in a mess. There is clear capacity shortage; there are also wildly optimistic targets, a lack of transparency and problems with hiring and training staff—within the context of dealing with individuals with long-term and serious health problems who are simply trying to access the support they need to survive. The National Audit Office has concluded that this system has

“significant financial and human costs”.

The current situation is cruel, inhumane and demeaning; as has repeatedly been pointed out in the debate, the system is not fit for purpose. I sincerely hope that the Minister will respond to the debate in a positive way and consider the significant financial and human costs to those who need, rather than bureaucracy and judgment, our support and compassion. The debate is about much more than simple work capability assessments. Ultimately, it is about the kind of society we want to create, and the society we aspire to be.

It is a pleasure to serve under your chairmanship, Mrs Moon. I congratulate the hon. Member for Sheffield, Heeley (Louise Haigh) on securing an important debate, in which I am pleased to speak.

An essential part of any social security system that supports people with disabilities and long-term sickness is a fair and effective means of identifying who needs support, and in what way. The current system of work capability assessment cannot be said to fit that description. Indeed, it was clear from the initial roll-out under previous Governments that there were deep flaws in the system. Early on, horror stories began to emerge of the extremely difficult and distressing experiences of people with serious disabilities and mental health conditions. Atos, the company in charge of the assessment process until March 2015, became a word firmly associated with the uncaring inhumanity of the welfare reform agenda.

We can all recount stories of the effects on our constituents. One such constituent of mine has a serious long-term mental health condition, and resulting medicine-related physical disabilities. She was forced to go to Edinburgh from Glasgow, unaccompanied, for an assessment; she was in a panic. She was found fit for work, despite significant medical evidence of extended stays in mental health hospitals, and long-term conditions with an impact on her health and physical wellbeing.

We are all aware of high-profile cases such as those of Michael O’Sullivan and Stephen Carre, who were demonstrably failed by a system that provided nothing but an extremely distressing experience, rather than targeting the help that they needed. Coroners have ruled in those cases that the men’s ordeals, through the fitness to work test, centrally contributed to their suicides. Distressingly, in the case of Stephen Carre, the coroner sent an official legal warning to the Department for Work and Pensions of a potential risk of further deaths from its WCA practices. He urged that there should be an urgent review of the policy not to seek further medical evidence from a psychiatrist or GP in the case of claimants with a mental health condition. That letter was not passed on to the Harrington review, conducted in 2010. It appears that the coroner never received a response to his letter, despite the legal requirement for that to happen within 56 days. I think he is still waiting for a response.

In that case, as in others, the Government have failed demonstrably. They have failed disabled people and have abjectly failed to learn the lessons from their mistakes. The consequences of that are potentially disastrous. How many people could we tally who have lost their lives subsequent to those cases in which professionals such as coroners gave early warnings? With further revelations emerging of adverse effects on the lives of people who undergo the work capability assessment process, the system clearly remains unfit for purpose. People with long-term sickness and disability still have a hugely distressing experience, in a system they do not trust. Those with mental health conditions such as Stephen Carre have been failed particularly by a process that too often has seemed to persecute claimants instead of protecting and supporting them. The UK Government are systematically limiting, restricting and undermining provision for disabled people in the social security system as, yet again, austerity attacks those who need support the most. As the Government attempt to take another axe to employment and support allowance, they are actively making it even more difficult and distressing for disabled people to obtain the support they need.

We need to take a more holistic look at support for disabled people—at how to help those who want work and can do it to get into meaningful and accessible employment, and at how to support those who are unable to do that, and ensure that they have a decent quality of life. That means creating appropriate and sustainable new opportunities, and ensuring that financial support keeps disabled people out of poverty. Crucially, it also means having an assessment system that treats people fairly, preserves their dignity and does not make matters worse. That requires fundamentally rethinking the system, particularly how it interacts with more vulnerable people and those with mental health issues.

I understand that the Minister has come here in good faith and will argue that progress has been made, and I am sure her intentions are good, but the Government’s record of failing to learn the lessons from their mistakes has made it absolutely clear that we need an urgent and wide-reaching review of the work capability assessment process as part of a wider review of Government support for disabled people. The Government have simply got it wrong too many times for people living with long-term sickness or disabilities. It is about time that we started figuring out together how we can get it right.

It is a pleasure to serve under your chairmanship for what I think is the first time, Mrs Moon. I congratulate the hon. Member for Sheffield, Heeley (Louise Haigh) on securing this debate.

The dysfunctionality of the work capability assessment has been a recurring theme in Parliament for as long as I have been here. It has been a running sore for the Government, so I am glad that in recent months they seem finally to have acknowledged that tinkering with the system will not fix it, and that a fundamentally different approach is required. I look forwarded to the much-heralded White Paper expected this spring, which I hope will tackle some of the problems.

We have heard about a wide range of problems associated with the work capability assessment. If the Government are serious about devising a better system, it is important that we all understand the present shortcomings fully, so that we are not destined simply to reinvent the wheel and create another heartless bureaucracy that fails to provide the safety net of support that people need when they are sick or disabled.

Over the last few years, successive reviews of the work capability assessment have been conducted by Professors Harrington and Litchfield, and various attempts have been made to improve the process, some of which it is fair to say have helped around the edges. However, due to recurrent problems with getting appropriate medical background information on claimants’ conditions, with how claimants are categorised and with the accuracy of the assessments, the impact has been limited. One private sector contractor has left early under something of a cloud, as the hon. Member for Sheffield, Heeley described in some detail, and another company has taken over the contract with a remit for changes, spending more money per assessment and awarding support to a larger proportion of claimants.

However, the underlying problems are still there. The work capability assessment itself remains unfit for work. Many claimants wait an inordinate time for assessment: as we have heard, it takes an average of 23 weeks for a decision, and the current backlog is 280,000 cases. I know that my constituents are still battling the challenges of travelling significant distances from remote and rural locations to assessments. In the past, constituents of mine who have made long and expensive journeys have been sent home unassessed because their appointment was double or even triple-booked. That does not apply only to my area; it echoes a point made by the hon. Member for West Lancashire (Rosie Cooper). Such administrative issues, particularly delays in assessment, cause claimants distress and financial hardship at a time when they may be exceptionally vulnerable and facing severe financial worries due to a sudden and sharp drop in income after a breakdown in their health.

However, the greatest weaknesses of the work capability assessment relate to how it measures the impact of fluctuating and progressive conditions on a person’s fitness for work. Several hon. Members, including the hon. Member for Birmingham, Selly Oak (Steve McCabe), my hon. Friend the Member for North Ayrshire and Arran (Patricia Gibson) and the hon. Member for Glasgow East (Natalie McGarry), mentioned the situation of people with mental health conditions. My hon. Friend the Member for North Ayrshire and Arran mentioned Parkinson’s UK, which cites examples of assessments conducted by staff who lack the basic clinical knowledge to understand that Parkinson’s is a progressive and incurable condition that will deteriorate over time. I am not a medic, but even I know that. It seems pretty basic to me.

That is why it is crucial that additional evidence from qualified clinicians familiar with the claimant’s health be brought into the assessment process from the start. I pressed Ministers on this issue repeatedly during the previous Parliament, but we now have an opportunity to get it right and ensure that we have the information in the system to make good decisions possible.

Does it not strike the hon. Lady that although we often hear from the Government, in relation to many other arguments, that policy and Government decisions must be based on evidence, on this fundamental matter the Government rigged the legislation, so that medical evidence could be ignored in favour of the bizarre assumptions and interpretations that the people who carry out the tests come up with?

As ever, the hon. Gentleman makes an important point clearly. There is no reason why people’s medical history should not be included in the assessments. Often, consultants—sometimes it is a GP, but in cases of serious illness it is more likely to be a consultant—are in a position to provide insight into the longevity of a condition as well as its immediate acute effects.

Is the hon. Lady aware that the Government, during the last Parliament, also shortened the timeframe within which individuals can provide independent medical evidence? As it takes longer to see a consultant or specialist, that inevitably means that some people cannot provide that information in time, which contributes to the number of reassessments, the backlog and the cost to the taxpayer.

The hon. Gentleman is absolutely right. The shortening of the timeframe makes it extremely difficult for people to contribute, which is why that opportunity needs to be included right at the start. If people can nominate someone—an advocate, a consultant, a GP or a community nurse—to provide such information as part of the application process, we could get around a lot of those problems.

For people with complex disabilities, people who suffer from more than one condition or people whose condition fluctuates, the tick-box exercise of the work capability assessment fails to capture the impact of their health on their ability to work. Around half of those in receipt of employment and support allowance have a mental health condition, yet the work capability assessment has proved poor at accurately assessing conditions that are not visible, and people with mental health or incapacity issues are not always able to articulate well the effects of their condition.

I pressed hard during the last Parliament for improvements to how mental function champions operate within the assessment process, but there is increasing evidence that as things stand, the work capability assessment causes so much distress and anxiety for some people that it is actively harming their health, pushing them further away from being able to work and—in extreme cases such as the ones mentioned by the hon. Member for Glasgow East—towards harming themselves.

The Royal College of Psychiatrists has expressed serious concerns for some years about the impact of the work capability assessment on the health of people with mental illness, but as evidence of harm grows, the college is becoming more outspoken. As my hon. Friend the Member for North Ayrshire and Arran pointed out, robust research conducted at the universities of Liverpool and Oxford suggests a correlation between mental health problems and the roll-out of work capability assessments. That backs up the findings of voluntary sector service providers such as the Scottish Association for Mental Health, which has extensive experience of people who use its services suffering setbacks in their recovery due to the assessment process.

The bottom line is that too many people are still being wrongly assessed. We know that because of the extraordinary success rate when claimants who have been found fit for work appeal that decision. Between 2010 and 2013, it hovered around the 40% mark; since the introduction of mandatory reconsideration in 2013, it has shot up to around 54%. In other words, more than half of those who appeal are likely to get the original decision overturned. Successful appeals on that scale indicate major underlying flaws in the assessment process, and they cost the Government a lot of needless time and money. More than that, they mean that sick and disabled people are left feeling abandoned and desperate for months without the support that they need. The human cost is enormous, as is the financial cost, as the National Audit Office has pointed out.

We must also remember those who do not appeal but who are nevertheless extremely unwell or seriously disabled. Many people in our constituencies who are destitute or living in extreme poverty are people whose access to ESA has expired, or who have been found fit for work but cannot qualify for jobseeker’s allowance—because they really are not fit for work and cannot comply with the conditions attached to JSA, or because they have tried to comply but have been sanctioned, or because they have disengaged from the system altogether and have simply dropped out of view.

I have no idea how many people fall into that latter category, but I know that I am meeting such people regularly. They live off other family members or friends, some of whom are themselves not wealthy, and they depend on food parcels from church voluntary groups or food banks. Consequently, when the Government consider how they might proceed with a replacement for the WCA, they need to take on board the systemic failures of the current approach and think beyond simplistic functionality.

The first and probably the most valuable thing that the Government could do is to work with disabled people and their representatives from the outset. Throughout the past few years, health and disability organisations have been coming forward with constructive suggestions to improve the existing system, and contributing to the successive reviews. Some of their ideas have been taken on board, at least partially, but the opportunity presented by a new White Paper to get stakeholders around the table and—more significantly—really listen to what they say has never been more important.

I also urge the Government to go back to the work that was done around the evidence-based review of 2012-13 and the alternative assessment that was developed under that process. I know that Ministers were not convinced by that review at the time, but a lot of water has flowed under the bridge since then, a much stronger evidence base has been developed and I think there is a lot of substance in that review, not least in the way that it suggests descriptors that would account for the impact of pain and fatigue on a person with an illness or a long-term condition. That review could really usefully inform a new approach.

Lastly, I urge the Government to learn from international experiences. The UK does not have a disproportionately high number of sick and disabled people compared with the rest of the OECD. Clearly, there are regional variations, even within the UK, with higher numbers of claimants in economically deprived or heavily industrialised areas, where health outcomes and life expectancy are significantly lower than average. On the whole, however, we are grappling with the same challenges as other industrialised countries and on a broadly similar scale.

A number of countries have used what have been called “real world incapacity assessments” that take account of a person’s age, skills and work experience, as well as their health or disability, when assessing their fitness for work and considering what kind of work they might be able to do. This seems just to be common sense and means that someone is assessed as a rounded human being. The same condition with the same severity will affect two people differently in relation to their ability to work, depending on whether their work experience has been in physically demanding manual jobs, whether they sit at a desk or whatever. The Government should explore the models used in other countries to see what is working well.

We all agree with the Government that the social security system needs to support people to move towards work, but it also needs to provide a safety net and a dignified life for those who are not fit for work, and not only those who will never return to work but those with long-term conditions and those who need time to recover from serious illness or injury.

The work capability assessment has failed a lot of sick and disabled people, and it has proved extremely inefficient. What follows must be better, and I hope that the Government’s keenly anticipated White Paper will reflect the concerns that have been raised today.

May I reiterate what other people have commented—that it is lovely to see you in the Chair today, Mrs Moon? I congratulate my hon. Friend the Member for Sheffield, Heeley (Louise Haigh) not only on securing this debate but on an excellent speech; it really was very informative.

We have already heard a number of Members say that the current work capability assessment, which was introduced under the coalition Government, is failing on a number of counts and needs to be overhauled. I share the view of the hon. Member for Banff and Buchan (Dr Whiteford) that the fact no Government Members have spoken, and the imminent White Paper, suggest that the Government are finally getting it. I really hope that is the case. However, I need to reiterate some of the points that have been made about why the Government need to think again.

The WCA needs a complete overhaul. It is not fit for purpose, and we have heard that it is failing to assess a person’s fitness for work, or work-related activity, accurately or reliably. We have heard the figures about appeals. More than half of people—54%—who appeal against a decision that they are fit to work have the decision overturned. We have also heard about how the costs of the WCA have spiralled out of control, which reflects the woeful performance. Obviously, the National Audit Office report last month was very damning indeed, although I have to say that it came several weeks after it was clear what was going to happen.

Fundamentally, the WCA fails the most important requirement of any Government policy—that it will not knowingly harm citizens. For almost a year now, the Government have obfuscated and tried to evade revealing the toll that the WCA process is having on the people being subjected to it, even after stark warnings from the Select Committee on Work and Pensions. The mounting evidence against the WCA cannot be ignored any longer; hopefully the Government are listening to it.

There have been five independent reviews of the WCA since 2010. The Work and Pensions Committee undertook two of them in the last Parliament; I was pleased to be serving on the Committee when it undertook the review in 2014. The most recent report from that Committee included evidence taken from the reviewers, who warned the Government that in spite of all the reviews that had happened before—Professor Harrington and Dr Litchfield have produced reviews—the process was still flawed. They said that people with progressive and fluctuating conditions, such as Parkinson’s, were particularly likely to fall foul of the process. I will never forget taking evidence from people in Newcastle as part of that Select Committee inquiry in 2014 and hearing their personal testimonies. The evident pain and humiliation that they had experienced as part of the process was quite shocking.

Like other hon. Members we have heard from today, I have had evidence from my own constituents. A man who came to see me had a serious heart condition. In a WCA, he was told by the nurse undertaking it that he was in the process of having a heart attack; that was how stressful the WCA was. He was told to go to hospital, but two weeks later he received a letter telling him that he had been sanctioned because he had left the WCA. There are similar examples up and down the country.

The former chair of the Work and Pensions Committee, Dame Anne Begg, spoke on the issue and said:

“When my constituent, who has lost his job because he has motor neurone disease, scores zero on his WCA and is found fully fit for work, there is something wrong with the system. When that same constituent appears in front of a tribunal and in less than five minutes is awarded 15 points”—

that is the maximum score, which means the person is completely unfit for work—

“there is something wrong”.

I hope that we are seeing a different view from the Government now, but in their response to the Work and Pensions Committee at the end of 2014 they were having none of its report; there was the usual rhetoric. I would be interested to know what the Minister would say today if Dame Anne’s former constituent was standing here in Parliament now.

The Committee said that simply rebranding the WCA by taking on a new provider would not work, and it recommended a complete overhaul of the system. We still believe that that is needed, and such an overhaul is Labour party policy; I have said that consistently since my appointment to the Front Bench. What is required is not just a process to determine eligibility for employment and support allowance but an examination of health-related barriers to work. I agree with the hon. Member for Banff and Buchan that we need to look at the international data. I know that work has already been done to compare different processes, and adopting a more personalised and holistic approach is important. I remember producing such a piece of work before I came to the House, and there are lessons to be learned from elsewhere. However, as I have said, at the time of the Select Committee inquiry, the Department for Work and Pensions was not particularly inclined to consider those lessons.

When the Minister responds to the debate today, I am sure she will talk about the new work and health unit. However, I would also like her to describe, if she can, the discussions that the Government have had with the royal colleges, because I have some concerns. For example, the Royal College of Psychiatrists has raised the issues of medical ethics, treatments and interventions, the principle of consent, and the qualifications of the staff involved in WCAs. I would be grateful if she referred to those points in her wind-up.

My next point is about poor performance. We know that last month’s National Audit Office report reiterated that the WCA is not only unfit for purpose but poor value for money, as many of my hon. Friends have already mentioned. The Government have failed in their fiduciary responsibility to ensure that taxpayers’ money is spent wisely. They have failed to monitor and performance-manage work capability assessment contracts and hold the providers to account.

The NAO report stated that under contract with the Centre for Health and Disability Assessments, which is a subsidiary of Maximus, the cost of each assessment has risen to approximately £190, compared with £115 under the previous contract with Atos. If that was an investment in greater efficiency and a smoother process, one might possibly say that it was value for money, but the NAO described the performance output issues, with a backlog of 280,000 assessments and the contractor not being expected to meet its performance targets for last year.

The NAO went on to describe how the Department for Work and Pensions was struggling with target setting and had failed to test bidders’ assumptions during the tender process—for example, on staff recruitment and training. Will the Minister describes how that is being addressed? After six years, it is a real problem if we are trying to ensure that we live within our means.

The biggest indictment of the Government’s work capability assessment process is the potential harm it does to people who are put through it. As we have heard, last November the University of Liverpool and the University of Oxford published a study in the Journal of Epidemiology & Community Health. It is a peer-reviewed journal, and papers with Mickey Mouse statistics are not published in such journals—they would not be tolerated. It is a robust[Interruption.] I hear some chuntering from the Government Benches. These are robust data; papers would not be allowed if the data were not robust[Interruption.] There is still chuntering, but I will carry on. That study showed that between 2010 and 2013 the Government’s work capability assessment regime was independently associated with an additional 590 suicides, 280,000 cases of self-reported mental health issues and 725,000 antidepressant prescriptions.

The Royal College of Psychiatrists has raised the concern that, for people with mental health conditions, the work capability assessment process can cause a relapse, thus hindering rather than helping in their recovery. Just before I came to the debate I was provided with a list of coroners’ reports containing concerns that the deaths, including suicides, were associated with the work capability assessment. I am particularly concerned about the case of Stephen Carre, which has already been mentioned, in which the coroner wrote to Ministers and the Department and apparently did not receive a response, as required by law. I would be grateful for the Minister’s response to that point.

The findings reported in the paper in the Journal of Epidemiology & Community Health—in a paper entitled “First, do no harm”—came on top of published data relating to the deaths of incapacity benefit and ESA claimants between November 2011 and May 2014. The Government were compelled by the Information Commissioner to publish those figures. At the end of April, an appeal went to that body, which ruled in favour of the appellant and required the Government to produce the figures. But when did they produce them? Just before the end-of-August bank holiday.

The figures showed that the overall death rate for people on IB or ESA was 4.3 times higher than in the general population—an increase from 3.6 times higher in 2003. People in the support group are 6.3 times more likely to die than the general population, and people in the work-related activity group, from whom the Government want to take £30 more a week via the Welfare Reform and Work Bill, which is going through the House, are 2.2 times more likely to die.

The Government’s innuendo that people with a disability or illness might be “faking it” or are “feckless” or, as the Prime Minister said shockingly last week, are “making a lifestyle choice”, is grotesque and belies the epidemiological data. IB and ESA are recognised as good population health indicators, in that they reflect areas with an industrial backgrounds and areas of poor health.

My hon. Friend describes the impact on people. One of my constituents has referred to it as the Secretary of State adopting a pterodactyl style of management, flapping around high above, making a lot of noise and—pardon the expression—dumping on the little people down below. Does my hon. Friend share that view?

I would not put it in quite those words, perhaps, but I know exactly what my hon. Friend is getting at.

The Government’s own data show that the people involved are sick and disabled. They need support; they do not need vilification. Unfortunately, that is too often what happens, as at last week’s Prime Minister’s questions.

Being disabled or being ill is not a lifestyle choice. Alarmingly, we now hear reports of people in the ESA support group—people who have been found not fit for work, including people who are terminally ill—being required to go to work-focused interviews. The Minister might be aware of that. We have evidence only from England so far, but I would be grateful if she gave us an explanation.

For me, that latest revelation says it all. It is about cuts for disabled people and the seriously ill. The Government are not content with having cut £23.8 billion from 3.7 million disabled people since 2013 under the Welfare Reform Act 2012; they are going for more cuts, and the work capability assessment and the Welfare Reform and Work Bill are another way of achieving them.

The Government have tried to regenerate the economy on the backs of the poor and disabled. Their modus operandi is division and blame, deserving and undeserving. Like the NHS, our social security system is based on principles of inclusion, support and security for all, assuring us all our dignity and the basics of life should any one of us become ill and disabled. The Government need to remember that and stop their attacks on disabled people.

Before I call the Minister, I remind her to allow two minutes at the end for the mover of the motion, Louise Haigh, to have the opportunity to respond. I call Priti Patel.

It is a pleasure to serve under your chairmanship, Mrs Moon. I start my remarks by commenting that the debate has been wide-ranging, and I thank everyone who has contributed. This is obviously an important subject, and we must put it in the context of the overall commitment we all feel should rightly be in place to support people who cannot work because of health conditions and disabilities. We must also reflect on the fact that we have a system that obviously seeks to support such individuals.

A range of comments have been made that pre-date me as a Department for Work and Pensions Minister. I will do my utmost to address as many of them as I can, but it would only be fair to write to hon. Members whose points I do not address directly. The hon. Member for Oldham East and Saddleworth (Debbie Abrahams) mentioned the very tragic case of Mr Carre, and it might be more appropriate if I write to her about that.

We all recognise that work is good for individuals—it enhances physical and mental well being—and we also recognise that being out of work, for whatever reason and whatever the condition, can exacerbate poor health conditions and make people’s situations even worse. A system that supports people is vital. I will talk about contracting later, but we want to move away from a system that tells people they cannot do any work to one that supports them in what they can do. The hon. Member for Banff and Buchan (Dr Whiteford) touched on the forthcoming White Paper that will focus on the support that can be given to individuals, and I will address that shortly.

The work capability assessment was established under the previous Labour Government in 2008 and it has had quite a journey, not just in relation to the contracting process; the assessments have come under scrutiny under previous Governments and under the present Government. There have been more than 100 recommendations in response to the five independent reviews of the work capability assessment. That has made the assessment process more reliable and has improved the claimant experience

In the final independent review of the work capability assessment, Dr Litchfield commented that, having looked at the systems in comparable countries, there was

“no better replacement that can be pulled off the shelf”.

There is a concern among the disability and advice sector that the Government continue to say they have accepted the recommendations of the independent reviews. Will the Minister outline how many of the recommendations have been fully implemented?

It is fair to say—this will link to many of the forthcoming reforms in the White Paper—that we have implemented many of the recommendations. On top of that, we will continue to review them and work with the system. Any system of financial support for people who are not able to work needs to have a reliable method of assessing entitlement to that support. That is the basis of this afternoon’s debate.

I will talk about the current provider before I address the points about contracting that were raised by the hon. Member for Sheffield, Heeley (Louise Haigh). Since the Centre for Health and Disability Assessment, known as CHDA, took over the contract to carry out assessments in March 2015, it has made a number of improvements to the claimants’ experience of assessments. It has focused on increasing the number of healthcare professionals by 39% since March 2015, and it has opened up 100 new assessment rooms, so that it can see more people in more locations. I do not want to rehearse many of the points already made in the debate, but a lot of the focus has been on the new contracting arrangements with CHDA, which has reduced the backlog of assessments by 62%. It has also introduced claimant-focused improvements, including setting up a customer representative group with leading charities that have regular meetings with the chief executive and clinical leadership team.

There is also a focus, because we are speaking about people and the experience of individuals going through the process, on rolling out greater disability awareness training for all staff. The recent National Audit Office report acknowledges the progress that has been made in improving contracted-out health and disability assessments, and we have taken steps to help people with mental health conditions in their assessments following the reviews. We have trialled new awareness training for administrative staff that will now be rolled out nationally. We are also improving services on telephone engagement and how claimants are assisted; and that level of interaction has improved.

I want to address the points about contracting, which the hon. Member for Sheffield, Heeley focused on. I hope she will forgive me because I cannot speak about Maximus in 2007 and what took place in America, but I must make it abundantly clear that there is a full and transparent contracting process, undertaken with a negotiated procedure to enable the Department for Work and Pensions to fully test bidders and their propositions to meet the objectives for service delivery. I am speaking about the previous contractor, Atos, and the improvements that we seek under the new contract with CHDA.

I am grateful to the Minister for giving way and for her response so far, but is she seriously saying that previous fraud and theft from taxpayers cannot be taken into consideration when the Government are handing out a very similar contract in the UK?

I cannot speak specifically to previous contracting processes and bids that took place outside the United Kingdom—it is not for me to comment on—but let us be clear. The Department is responsible for hundreds of billions of pounds of public money—taxpayers’ money. On our processes of procurement, renegotiation and accountability, we have a clear approach to the scrutiny of providers, and rightly so. That applies to all Departments, and the same applies when it comes to failure. The contract has an open-book accounting approach and a robust validation of data. I think the hon. Lady mentioned falsification of data at one point. We have a clear process on the validation of data. She also went on to comment on how providers are incentivised, but our providers are not incentivised by benefits outcomes. We have a full range of balanced performance measures that focus on quality and volumes and customer satisfaction. That brings me back to the fact that we are speaking about people and how the interaction with people through assessments actually takes place.

Performance reviews and performance are fundamental in all Government contracts to ensure governance arrangements, and the Department takes steps to implement regular weekly and daily meetings with DWP officials and the CHDA.

I will give way, but I want to emphasise that service credits are applied when a supplier does not meet an agreed service level.

I am grateful to the Minister for giving way and for her response so far. Will she tell us whether there is a requirement in the tendering process for disclosure of previous legal action?

I cannot answer that question, but I will find out and write to the hon. Lady. I would be astonished if the Department did not have a system for looking back and assessing companies’ previous conduct before we engage with them. All bidders have to be thoroughly scrutinised by not only my Department but others. Much of that work is done with the Cabinet Office, which sets out guidelines and guidance. I have no doubt that the right systems and efficacy procedures are in place for contracting and the types of contractor with which the Government engage.

Bidder’s assumptions are tested as part of the negotiated procedure, and they are provided with information as part of the dialogue that takes place. The WCA contract was originally with Atos. Since the CHDA has picked up the contract, there have been challenges and backlogs, which have been referred to throughout the debate. It is only right that the Department continues to address those challenges and sets stretching and ambitious targets for its providers. We will ensure that we deliver value for money for our contracts. Again, the assumptions are tested through the bid process, but we are clear that a new financial support model has been in place as part of the CHDA contract. We have also contracted for a more sustainable service, part of which includes more face-to-face assessment—that direct engagement which did not take place under the previous contract. The focus is also very much on reducing the backlog and improving waiting times.

The NAO report has been mentioned several times. The report recognised that the Department has made particular progress and acknowledged the fact that there is now a relentless focus on performance when it comes to reducing backlogs and driving down delays. It also recognised the increased performance management capacity. Although there is more to do—we can never stand still in this space—we have learned from our experiences in the contracting process and will ensure that we continue to make improvements.

A number of Members mentioned cases from their constituencies. I would, of course, be happy to look at any individual cases that Members would like to refer to me, but I should emphasise that we clearly do support people through the system. A great deal of money has been put into providing support to help people to go back to work. Over the next three years, £43 million is being invested in trialling the provision of specialist support for people with mental health conditions. The Government also recognise the importance of promoting positive attitudes among employers when it comes to them employing people with disabilities or health conditions. That will be at the heart of the White Paper that will be published—

Sitting suspended for a Division in the House.

On resuming

I acknowledge that there is more to do to support people with health and disability issues. In the recent spending review, we outlined our commitment to support people with disabilities into work. We announced a real-terms increase in funding for Access to Work, which will enable up to 25,000 additional disabled people to receive support. We will expand the Fit for Work service to support more people on long-term sickness absence with return to work plans, and we will provide at least £115 million for the new joint work and health unit, including £40 million for a work and health innovation fund. We will set out some new long-term reforms in the White Paper, which will be published in the spring.

This is about not reinventing the wheel, but learning from insights. Hon. Members spoke about evidence, support and insights from charities, stakeholders and third parties, which the hon. Member for Banff and Buchan mentioned. My Department is working with stakeholders through the joint work and health unit, and a new taskforce has been set up to gain insights into providing support for individuals in a more targeted, tailored and personalised way. If people are assessed and put on a benefit, we do not want there to be no dialogue and interaction with them during that period about the additional support that they require to get back into work. The White Paper will be published in the spring, but we are open to thoughts and comments through the consultation process.

This not just about the WCA; we must have a much more holistic approach to supporting individuals. Before the Division, I mentioned employers, and there is a lot more that can be done to promote positive attitudes to employing people with disabilities and health conditions. Employers must find the right balance and the right way to support people in the workplace. For example, they can utilise occupational health and look at our Disability Confident campaign and the work that my hon. Friend the Minister with responsibility for disabled people is doing.

Looking at this issue holistically, our reforms are all aimed at improving the quality of life of those who need the support the most. It is right that we recognise that there is no single method for each individual and their particular circumstances. Every person in the benefits system is an individual and their situations will be different, difficult and challenging. No system can offer a one-size-fits-all interaction, but we must ensure that the system works with individuals and recognises their particular backgrounds and circumstances. Protecting the most vulnerable in society is this Government’s priority.

Given that 90% of disabilities are acquired, I recognise and support all that the Minister has said about ensuring that people can stay in work as much as possible and that people are helped back into work, but that does not currently happen. Some half a million disabled people will be affected by the change in the employment and support allowance and the cuts. How can the cuts be justified before the support to enable people to stay in or get into work is in place?

The hon. Lady mentioned the current changes and referred to the Welfare Reform and Work Bill that is being considered in the House of Lords this afternoon. She will recall that this issue was debated extensively in Committee. I have emphasised that the Government have a clear commitment to protect the most vulnerable in society, including disabled people. No one who is currently in receipt of ESA will see a financial loss; the changes will not affect anyone whose capacity to work is significantly limited. The personal independence payment will also continue to help meet the extra costs of living that disabled people face, and exempted benefits contribute to the additional costs of disability and care resulting from the benefits freeze.

Looking at the debate holistically, we know that the WCA has caused many previous challenges. Yes, reforms are coming and, yes, changes are afoot, but I think hon. Members will agree that we cannot write off the people who, for various reasons, have not been supported into work. If they can work, we want to support and encourage them.

The Government spend a great deal of money on protecting the vulnerable not only through benefits, but through additional support to help with living costs. It is right that we provide that support and safety net. I hope that future debates and the White Paper will help to introduce new suggestions, new ways of working and new practices to ensure that we do not again see the situation that we had in 2008, 2009 or 2010 with Atos and the WCA. We should broaden the interface of support available through not only agencies or Government Departments, but specialist support organisations, stakeholders, practitioners and those in the care sector, recognising that we can always do more to support people. I am conscious of the time, Mrs Moon, so I will close my remarks there.

I thank the Minister for that, if I may say so, uncharacteristically measured and conciliatory response. It is fantastic to hear that we agree on so many matters, and that the Government recognise the issues with the work capability assessment. We disagree, however, about the reliability of assessments. The evidence, not least the huge increase in successful appeals over the past couple of years, shows that reliability has not improved.

The Minister referred to the recommendations that have been implemented, and my hon. Friend the Member for Bermondsey and Old Southwark (Neil Coyle) asked about those that have not been applied. It is important that assessments are documented so that records can be used as proof afterwards, because, as I mentioned earlier, there have been allegations of falsification.

On the Minister’s remarks about the previous performance of Maximus, as a shadow Cabinet Office Minister I can tell her that the guidelines for considering past performance are completely unsatisfactory. It is no surprise to me that a contractor with prior performance as appalling as that of Maximus, which has failed so singularly in the past, has been awarded a contract. We welcome the improved targets and oversight, but transparency on whether Maximus has met its targets, on spending and on WCA appeals is vital to hold the contractor to account.

As my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams) said, the cuts are completely unjustified before the changes that the Minister outlined come into force. I hope the Government will rethink them in the Bill that the House of Lords is considering today.

I look forward to the response to my points and those of my hon. Friends, to the publication of the White Paper and to the much-needed long-term reforms, learning from the mistakes made by successive Governments in the management of the work capability assessment.

Question put and agreed to.


That this House has considered work capability assessments.