Motion to Annul
My Lords, this is an important debate. I start by declaring my own interest as a director of the Wise Group in Glasgow. I have no pecuniary interest but the purpose that I am afforded by being a director of the Wise Group is that, four times a year, I get to go on a wet Friday to Glasgow after a six-hour train journey. Nevertheless, it is very fulfilling and important work. The group does an excellent job for the communities that it serves in Glasgow and I am pleased to be associated with it. That explains my interest in this important subject.
The background to this debate is, quite simply, that after considerable consultation the disability organisations—most of which colleagues will know well, as we have been working with them for many years—have concluded through the Disability Benefits Consortium that these regulations imperfectly achieve their policy objective. That is a clear steer that the disability community would like the House to consider annulling these regulations and we owe them nothing less than to do that.
I start by acknowledging the work of the Minister, who has brought drive and commitment to this policy area since he wrote his original report those few years ago. I am absolutely at one with him in trying to discourage inactivity and encourage sustaining work. I think we both understand that Carol Black’s work changed the game of active labour markets and I stand four-square with him in trying to make sure that we can develop and deliver schemes that enable people to get out of inactivity and into work. That work has to be productive and sustainable, but if they can do that then the well-being of the client group that we are seeking to serve will improve.
I am founding the evidence for this evening’s debate on the excellent work that has been done, as I say every time we talk about the subject, both by the Social Security Advisory Committee and by the Merits Committee, which looked at this in very great detail in its 23rd report. These are complicated regulations but if any colleagues are looking for a quick summary of exactly where this subject’s importance lies and of its importance to the individuals concerned, they should look at appendix 1 of that report and the evidence that was laid out there compellingly. The Social Security Advisory Committee report that was produced, which was done with formal reference to these regulations, also repays careful study and is worth reading.
I start with a concern that is new to me and disturbing if true. I would like to hear the Minister’s view on it. The SSAC says, in its conclusions at paragraph 19:
“The Committee is concerned that there is a disagreement of substance between the Department and the external stakeholders who participated in the review as to whether the”,
work capability assessment,
“in its present form could be said to be working satisfactorily”.
If that is true and the stakeholder community is talking past the department and neither party tries to get back into some sort of meaningful communication, it is in no one’s interests. I do not know what happened in the past but that is the first time I have ever seen an SSAC report saying anything so stark. I do not know whether it is true but I would like an assurance that the Minister will redouble any of the efforts which I know he has been making to ensure that that gap is expeditiously closed. It would be inimical to the interests of the client group that we are trying to help if the pressure group community does not have confidence in its channels of communication with the department. I hope that he can give us that reassurance.
The other evidence which is the core of the debate is the Social Security Advisory Committee’s view at paragraph 4.3. I will quote another sentence which encapsulates a whole load of evidence that I do not have time to go into. Perhaps other colleagues might pursue that, particularly on mental health, learning disability and fluctuating conditions. After a very big consultation—I think it had 400 responses—the committee noted that the department is undertaking an ongoing programme of review but concluded, among other things:
“There appears to be a widespread perception that, overall, rather than simplifying, streamlining and refining the test, these amendments”,
in these regulations,
“will make it harder in practice for claimants to demonstrate that they are incapable of work or that they have limited capacity for work or work-related activity”.
That is the core of my concern, which the department now has to address. As I say, I am absolutely indebted to the Social Security Advisory Committee and the Merits Committee, as we all are. Indeed, Richard Tilt, the chairman of the former committee, is an extremely wise man and his experience will, I hope, be available to us for some time to come.
Briefly stated, this is one of the biggest changes that I have ever seen in social security since I started studying this policy area when I was elected to another place in 1983. Why? Because in April we will open the door to a national reassessment of 2.6 million people. We have a model which arguably does not work for employment and support allowance claimants yet. It is a work in progress, but I am absolutely persuaded that Parliament is trying its best to get on top of it. However if in April we are really considering taking on an extra 10,000 or 11,000 new cases each week—it might be each month, but whichever—it is a very big increase and raises questions about capacity. We have to consider the capacity of the Atos Healthcare medical professionals who do these functional capability assessments for work capability assessments, and it raises questions about capacity for jobseeker’s allowance as well.
There is a huge difference between a customer making an application de novo for employment and support allowance and somebody in Glasgow who has been unemployed for 10 years, who has been on incapacity benefit, and who gets a letter asking him to call at the Atos Healthcare professional centre to have his benefit assessed. He will know that if he does not get the continuing levels of support that he currently enjoys he could be £30 per week worse off at a stroke.
I go back to where I came in. I am absolutely in favour of ensuring that everybody who can contribute to the world of work should do so. There is no doubt in anybody’s mind that there are people who need a wake-up call, to use the expression of my American friends. Indeed, there are people who swing the lead, do not play the game and act in bad faith. I know all these things. However, to take 2.6 million over three years and put them through a process where the model has not been absolutely rigorously road-tested to everybody’s satisfaction is not safe. That is the case that the disability organisations have been making to me.
If that is not hard enough we have the deficit reduction programme, which I also support. We cannot ignore the fact that this country is now poorer than it was a while ago. There are also regional and spatial dimensions because labour markets vary. The labour market in Reading is very different from that in downtown Glasgow, which must be borne in mind. On top of that, the work programme, which again I support, is still in gestation. We do not know the detail of how the work programme will serve the client group that we are seeking to help. I think that the identified concerns about the functional capability assessment—it is not a medical assessment—are well founded. If anybody has any doubt that there are problems around it, I point out that the successful appeal rate against decisions on the current scheme is high, suggesting that attention must be paid to these provisions, particularly for mental health and fluctuating condition clients.
There are advantages in the regulations. I certainly welcome the chemotherapy and residential drug changes. They are not to be diminished in any way because they will help substantially the group that they are designed to serve. The biggest complaint comes from the disability stakeholder pressure group community. Professor Harrington has published his phase 1 report, which is truly an excellent piece of work. It offers a series of recommendations which really deal in a much more real-world way with the kind of problems that people face. The complaint is that we are not waiting for the totality of the Harrington work to be put in place. He is already starting on the second annual independent assessment, where he will look at the descriptors for fluctuating circumstances and the like. The results of that will be available probably in late 2011. We should not be opening the gate to the national reassessment of incapacity benefit claimants until we see what Professor Harrington can come up with. That is what the disability organisations say and it is a prima facie valid claim.
Colleagues will know this because we spent a lot of time on the Welfare Reform Act 2007, when the previous Government sensibly required a five-year annual set of reviews. Some of the complaints that the disability groups make is that this will be a piecemeal change, which is the legislators’ fault. We rightly felt that it was not safe to do it without getting independent reviews. The previous Government were right to do that and this Government were right to get Professor Harrington on the case. He brings hope to the whole situation—he certainly does to me.
I have three questions for my noble friend before I sit down. They are all about Harrington phase 1. First, if that report were in place in its totality before the April rollout of the national reassessment—all of it, including its tone—that would be of signal reassurance to me, if to no one else. I am speaking this evening for no one but myself. Secondly, the key recommendation that leapt out of the page of the Harrington phase 1 report was the fact that decision-makers were not properly shouldering the responsibility that the scheme was designed to give them. They were rubber-stamping Atos Healthcare professional decisions because they had not seen the client. The functional assessments were allegedly done by healthcare professionals, so why would you want to change anything? The system was never designed to do that. Can my noble friend give me a clear understanding that Harrington phase 1 will be available by 1 April? Decision-makers should have much more discretion, which would take them back to the position of the old adjudication officers whom we abandoned in 1998 and who were much more independent of the department than arguably some of these decision-makers. Can we get them to use a little grey-cell common sense on what is in front of them? That would be of considerable assistance.
Communication between the system and the clients is essential. Harrington again fundamentally points out that communication is not yet adequate. Nobody going through the process should have to do it without direct access to the recommendations of the Atos Healthcare professional after the work capability assessment. I do not think that that happens properly now but that information should be shared, and shared with the decision-maker as well. If the results were communicated to people, it would improve things enormously.
Finally, the client should be encouraged not just to bring his own medical evidence to the work capability assessment but to make it available to the decision-maker. If the decision-maker has, say, a GP report, he is taking more responsibility and discretion for the decision and he is communicating that clearly to the client. We still have fluctuating circumstances and conditions to deal with, which has not been addressed yet, so that would not be dealt with in my suggestions. Speaking for myself, I hope that my noble friend can give assurances that the seriousness of the situation is being fully comprehended and accommodated in departmental thinking and that Harrington phase 1 will be in place without peradventure before the reassessment starts. If some of the Harrington recommendations are highlighted in the way I have suggested, I certainly think that there would be some reassurance in the disability community that the situation is not as unsafe as it suspects. I hope that the Minister can help by explaining the situation later in the debate this evening. I beg to move.
My Lords, the House should be indebted to the noble Lord, Lord Kirkwood, for giving us the chance to debate the regulations this evening. Like me, and other noble Lords I see present, he has been involved in issues concerning the employment and support allowance and the WCA for a long period. The noble Lord congratulated the former Government on insisting on the annual reviews. If memory serves, that may have been an amendment that he pressed on us at the time.
I start by explaining my understanding of the rationale of why the work capability assessment and the employment and support allowance were introduced. It was part of the journey which recognised the importance of work for people's route out of poverty, their self-esteem, well-being and health. The concept was that, for the vast majority, work, or good work, is good for you and that, as a society, we should support people to get into or closer to the labour market. I think that that is common ground between the previous Government and the current one.
As we know, the work capability assessment was designed to focus on a person's capability, rather than their incapacity, as a building block to help them progress, where appropriate, towards work. The switch from incapacity benefit to employment and support allowance was more than just semantics. Although support via Pathways was available before, the introduction of the WCA signalled a determined change to support those who could towards the labour market.
The approach seeks to identify three groups of people: those considered capable of work; those who could work at some point with the right support—the work-related activity group; and those who cannot or should not be expected to work. The concept is to make those determinations by reference to application and a range of descriptors with the objective of determining an individual's functional capability.
There is nothing in the documents that we have received from the stakeholders that calls into question that fundamental approach; and I doubt whether we will hear it called into question by noble Lords this evening. Indeed, the first independent review of the WCA by Professor Malcolm Harrington concluded that the principles underpinning the new assessment remain valid. He stated his belief that the system is not broken or beyond repair; that, at least, is reassuring.
We should acknowledge and welcome the fact that the introduction of WCA has been subject to review—the internal DWP review began in March 2009—and it is the recommendations from that review which, I understand, are reflected in the regulations. Professor Harrington’s independent review, the first required under the Welfare Reform Act 2007, was responded to by the Government in November 2010. It was accepted as a vital contribution to the continuing development of the WCA, and the recommendations were accepted in full.
Although most of the recommendations were to do with process and covered customer experience, the Atos assessment, the decision-making process and the appeals process, there were important recommendations concerning descriptors—in particular, the need for further work to review the mental, intellectual and cognitive descriptors and how they are working for those with fluctuating conditions—issues which were raised at the start of the process and which have continued as the ESA has progressed. We support the recommendations, but that raises the question of how they sit alongside the outcome of the internal review, which has caused some of the challenges about which we will hear tonight.
The Government's response to Professor Harrington's report indicated that they would await a further report on mental health descriptors in late December and early January. Where does that report rest? Why is it considered appropriate to proceed with the current changes to the descriptors without the benefit of that report?
The criticism of the regulations has come from a range of sources, as we have heard from the noble Lord, Lord Kirkwood. They variously cover the points that the review has been carried out too early with limited evidence; that recommendations from the statutory review—Professor Harrington’s review—are still being worked on; and that changes to descriptors will make it more difficult to identify those with limited capability for work, those who should be in the work-related activity component.
The noble Lord, Lord Kirkwood, referred to the Social Security Advisory Committee. It recommended that certain changes be postponed, stating:
“The Committee recommends that the Department does not proceed with the remaining proposed changes to the descriptors until these have been reconsidered in the light of the findings of the independent review of the WCA and the experience of the trial of the migration of IB customers to ESA”.
Why has the department not taken that path?
Mind, and others, has raised concerns about the regulations regarding mental health descriptors. They extend to the simplification of the assessment, reducing the mental function descriptors by a third, from 10 to seven questions. Is that at the expense of comprehensiveness rather than in unison with it? There are deep concerns about how well the WCA descriptors record the impact of mental health issues. The simplification of the descriptors will exacerbate the problem.
Assessment of an individual's awareness of hazards will now simply focus on the need for supervision, rather than the significance and frequency of the risk posed. Ability to get about and cope with change will no longer be assessed in terms of frequency, which will impact negatively on people with variable or fluctuating conditions. The loss of the propriety behaviour descriptor means that the assessment fails to capture the significant distress caused to people with depression, anxiety and paranoia by misinterpreting or overreacting to the behaviour of others.
The National Autistic Society has expressed similar concerns about reducing the 10 mental health descriptors to seven. It states:
“This reduces opportunities for people to score sufficient points to receive the benefit. Five descriptors which specifically address the needs of people with autism have been reduced to 2. The lower-scoring elements of several descriptors have been removed, and many have been simplified. This makes it much harder to represent the complexity of needs many people with autism experience, and barriers to employment they face, through the assessment”.
It has raised many other points.
Doubtless, noble Lords will also have read the brief from the Disability Benefits Consortium, referred to by the noble Lord, Lord Kirkwood. It asserts:
“An individual who ‘cannot mount or descend two steps even with the support of a handrail’ could now be classed ‘fit for work’ … Someone unable to stand at a workstation for more than ten minutes could now be deemed ‘fit for work’… The descriptors for turning star headed sink tap have been removed, consequently there is no functional assessment for the ability to turn or rotate the hand, despite this representing a form of manual dexterity vital in many workplaces … The changes remove all lower-level descriptors in some categories, for example, there are now no six point descriptors within manual dexterity, making it hard for people with multiple impairments to qualify”.
The noble Lord may not be able to deal with each of those points tonight, but those are genuine, practical, real issues raised by people who know. If they are right, that clearly undermines the thrust of the assessment, which we agree that we should be making.
We should have common cause in getting the descriptors and the process right. The Government must convince us that they have not jumped the gun on these changes and answer the searching questions raised by the various lobby groups, which will doubtless be raised further tonight.
We look forward to receiving the Minister’s reply on these issues. The noble Lord, Lord Kirkwood, has initiated a very important debate, because these issues have run with the WCA and the employment and support allowance from day one. I believe progress is being made and certainly can be made, but there is some way to go yet.
My Lords, I begin by declaring an interest as the named carer of an adult in receipt of severe disablement allowance. I also associate myself with the words of my noble friend Lord Kirkwood of Kirkhope. I concur both with his concerns and with his support for the need to enable as many people with a disability as possible who have not worked or have not worked for a long time to be assisted into appropriate work through an appropriate process that takes account not just of what they cannot do but of what they can do.
Among the many disability charities which consider this statutory instrument to be premature due to the as yet incomplete recommendations of the Harrington report is, as the noble Lord, Lord McKenzie of Luton, has mentioned, the National Autistic Society, of which I am a vice-president. I would like to focus on the concerns for people on the autistic spectrum. In order to qualify for the ESA in a work-related activity group, people have to be assessed to have gained more than 15 points. The way in which it is currently proposed to change the descriptors, as we have already heard, has a detrimental impact on people on the autistic spectrum. I remind the Minister that it was only last Thursday at Oral Questions that I asked him to confirm that the Government accept that autism is a communication disorder.
The descriptors take no account of communication difficulties, verbal or non-verbal, due to mental impairment. This is a major omission. Communication and comprehension are essential in the workplace, and it is a critical area of impairment for people with autism. Making oneself understood is covered only by a physical descriptor, descriptor 6. Unless guidance clearly states that this covers people who find it difficult to communicate due to a non-physical disability such as autism or a learning disability, these needs will not be recognised in the assessment. Noble Lords will understand my concern that already I am looking at areas where autistic people should be given a point on that descriptor scale, but getting them to reach the 15 points, if appropriate, is already excluding those areas where they will be in some considerable difficulty. Understanding and comprehension impairments are covered only due to a sensory impairment under descriptor 7, where the emphasis is on aids used by those with hearing or visual impairment.
The wording of the descriptor itself is vague; it is based on an ability to complete “two sequential personal actions” in the context of planning, organisation, and problem-solving. People on the autistic spectrum—even those with honours degrees and high IQs—always struggle with planning, organisation and problem-solving. It is too broad to be meaningful and leaves too much scope for interpretation to accompanying guidance. For people with autism, this may vary from turning on the tap and wetting their hands within the process of washing their hands, or getting ready for work and then making their own way to the workplace. For many, doing that unassisted will be a major challenge.
The National Autistic Society is also very concerned about changes to descriptor 17. It has been simplified to make the wording clearer, but it has become overly simplistic. Someone who frequently has uncontrollable episodes of aggressive or disinhibited behaviour, particularly when under pressure or in an environment with which they are really not familiar—that sort of behaviour would be unreasonable in any workplace due to cognitive impairment or mental disorder—cannot realistically be assessed as not having limited capability for work. As the proposals stand, we do not believe that employers would accept as employees people who the descriptors would deem as capable for work, but showed those sorts of behavioural problems in the workplace.
People with autism may exhibit behaviour which does not meet the minimum criteria set out in this new descriptor 17, but which would cause disruption in the workplace. For example, people will flap, hum or spin. I know of one person who, in a stressful situation in the workplace, would make cat noises as a sort of comforter in order to exclude the distress going around him. There is a limit to how long those working with people like that will put up with somebody making cat noises on a continuous basis in a busy office. These are all regarded as individual or rather quirky, but they are very real parts of their disability.
I say to my noble friend that there is genuine concern about the speed with which these changes are being brought in, ahead of what Professor Harrington is saying.
I mentioned that I am the named carer for a person on severe disablement allowance. This allowance, which comes within this legislation, is a very old disability benefit; it was something often given to young adults and adolescents who, having come out of full-time education, were at that time assessed and deemed not able to apply for paid employment. I would not even want to exclude them from the new opportunities for employment as disabled people, but—and I particularly refer to learning disability, mental health and autism—many of them are now getting on a bit because they were awarded this some years ago. Some of them will be in their 30s and 40s or even older and for many of them, getting the support they have been given to date to enable them to live as independently as possible or to be as socially integrated as possible has not been an easy journey. It has been a long journey and there has been a lot of input to get these people where they are today. But their situation is always going to be fragile, and there is nothing that I can see in the way these assessments are made to take account of what is at the moment a sustainable situation, as far as independent living is concerned. We must not put too many demands on them, however, and ensure that the process associated with it does not give them some form of detriment as a result. As my noble friend Lord Kirkwood mentioned, they might lose money, which is a very important part of their life and allows them to be able to plan and be secure with their finances.
There is another form of detriment. People may find that their self-confidence is shattered after it has taken years to build up; they may find that they can no longer cope with independent living of one sort of another as a result of being put through a process which undermines that stability. You cannot put a price on that detriment. I say cautiously to my noble friend who I know is sympathetic to these issues, please do not let this Government cause detriment to those vulnerable people.
My Lords, I am very pleased to follow the noble Baroness, Lady Browning. I, too, will begin by declaring a personal interest. My 38 year-old son, who has a learning disability, was well described by the noble Baroness towards the end of her speech. He is always being assessed for what he cannot do and not for what he can do, which is incredibly demoralising for him. We his family spend our time trying to help him succeed and he would really like a job.
Some years ago, when I was consulted as president of the Royal College of Psychiatrists on the development of a work capability test, I suggested that the focus should be on capability, not lack of capability, from the point of view of the person being assessed. Although this is called a work capability assessment, it is an assessment of incapability.
I understand that, as my son is in receipt of severe disablement allowance, he may be required to undergo a work capability assessment. I tried out the online work capability self-assessment to see how he would fare. I will not go into the details but, of the three possible outcomes that we have heard about, he fell into the third category and would not be required, according to my assessment, to undertake any work-related activity. Perhaps that is a relief to me, in that his finances might not change, but I am sure that it would be a huge disappointment to him if that was the case.
So far that might be fine, except that the assessor may come to a different decision, in part perhaps because of my son’s lack of insight or understanding of his difficulties. He might then have to undergo an appeal and not everyone has the stomach for, or the capability for, an appeal. My reaction to trying out the test was that there is some sensitivity in the mental, intellectual and cognitive descriptors but probably insufficient sensitivity in the questions which relate to the type of complex difficulties that my son faces in his wish to be part of the workforce. They are difficulties which would require focused and sustained support to enable him to obtain work-related activity. The last thing that I or any parent in my position wants is for my son to fail yet another assessment, especially one which emphasises what he cannot do.
Another concern is that, if the assessment finds that he is capable, he is then given insufficient support, which would do terrible things to his self-worth and self-esteem. I question whether this assessment has been adequately road-tested and would want to avoid even one disabled person and his or her family having to face unnecessary appeals or loss of income through being unwilling to face yet another appeal. Even participating in the process of this assessment could be detrimental to the person’s mental heath.
My noble friend Lord Rix shares my concerns and has asked me to express his support to the noble Lord, Lord Kirkwood, today and to give his apologies as he is unable to contribute to this debate owing to family illness. He believes that many people with a learning disability will be denied vital support to help get them into work if they are not found eligible for employment and support allowance. That mirrors my concern. My noble friend believes that the crude indicators used in the regulations must be changed to more accurately reflect an individual’s capabilities.
For example, my noble friend is deeply concerned about the merging of the three descriptors—“memory and concentration”, “execution of tasks” and “initiating and sustaining personal action”—into one. They have been replaced with just one descriptor, “Initiating and completing personal action”. According to the regulations, this,
“means planning, organisation, problem solving, prioritising or switching tasks”.
The removal of the descriptor titled “execution of tasks” means that the time taken to complete a task will not be included as part of the assessment. This is particularly relevant to people with a learning disability and is likely to be a significant barrier to employment.
The current system already fails to meet the needs of people with a learning disability. My noble friend Lord Rix suggests that these regulations do not effectively assess limited capability for work, which means that the additional barriers and support needs of people with a learning disability are not being fully recognised in the assessment.
With less than 7 per cent of people with a learning disability who are known to social services being in any form of paid employment, the barriers to finding a job, combined with deep-rooted prejudice and discrimination, are already significant. Is it too much to ask that a coalition Government who claim to put fairness at the heart of their decisions should seek to tackle some of these barriers instead of perhaps making them even more difficult to overcome? For this reason alone, I and my noble friend Lord Rix, call for these regulations to be annulled.
My Lords, the DWP is in the middle of doing a very large jig-saw. The picture on the box is of a lot of people scurrying to work. In one corner older people are still going out to work, and in another corner people with disabilities are going about their business with the replacement DLA. But at the moment the pieces of the jig-saw are all jumbled up on the table, perhaps with the Minister frantically trying to find the straight edges. Are these regulations the pieces with the straight edges or not? I am very grateful to my noble friend Lord Kirkwood for giving us the opportunity to discuss these regulations because there are some disturbingly divergent views, as we have heard most movingly this evening.
The Merits Committee has said that the regulations may imperfectly achieve their policy objective, which is not something that it says at all frequently. In particular, it encourages the House to seek further information from the DWP on the rationale for putting these regulations forward now. It will not be disappointed, as all noble Lords have raised this matter. This is a recurring theme in all the evidence that we have been sent, from the CAB to the disability benefits consortium.
There is puzzlement that the DWP wants to bring in these changes now for several reasons. The principal reasons are: that the data from the migration trials from incapacity benefit in Aberdeen and Burnley have not yet been evaluated; that we are expecting more changes to the descriptors and to the work capability assessment as a whole once Professor Harrington has published his second-year review; and that the bar is thought by some groups to have been raised so high that there is now hardly any difference between those in the employment group of ESA, which comprises the limited capability for work people, and the support group, which is the limited capability for work-related activity people.
The Social Security Advisory Committee is more forthright because looking at DWP regulations and commenting on them is its job. It says, as we have heard, that apart from a few changes which it welcomes, the department should not proceed with the remaining proposed changes to the descriptors in the WCA until they have been reconsidered in the light of the findings of the Harrington report into the WCA and the migration trial of IB claimants. Why is it that the DWP believes that the changes to many of the descriptors are improvements, when the disability and other lobby groups say, as we have heard this evening, the exact opposite; namely, that the changes represent a tightening of the screw, making it harder for claimants to claim ESA?
I believe that the answer may lie in the different interpretations of the purpose of the work capability assessment. It was set up to replace the personal capability assessment as a test of a person’s capability for work rather than their incapacity. As Professor Harrington says in his review,
“the WCA was designed to be a first positive step towards work for most people”.
However, he also says that it is not working as well as it should, which is borne out by the fact that 40 per cent of appeals against a decision that an individual is capable of work are currently upheld. This surely shows that something is seriously wrong with the assessment. In particular, Professor Harrington says that there are clear and consistent criticisms of the whole system and much negativity surrounding the process.
The wider interpretation of the purpose of the WCA is not just whether it looks at someone’s theoretical capability of work but whether it works in the real world of work. This is where the Social Security Advisory Committee report and the lobby groups diverge quite strongly from the DWP. The SSAC tries to be fair. I think that it is worth quoting two sentences from the report in full, which states:
“The Committee recognises that the assessment of capability for work is a contentious and emotive issue and has always advocated a positive approach to the assessment of capability that looks at what the individual is able to do and their adaptation to their health condition or disability, rather than focusing solely on what a health condition or disability prevents the individual from doing. However, the Committee also recognises the complexity of many individual cases and the significance of the factors that may determine capability in the real world but which cannot be easily measured by a test that scores functional capability”.
I would contend that this is why there are such divergent views between the SSAC, the Merits Committee and the lobby groups on one side and the DWP on the other. The DWP is obviously not prepared to wait until the migration trials have been evaluated to change the descriptors or for Professor Harrington’s task group to report on the mental, intellectual and cognitive descriptors, which will report to the Minister later this year.
However, there is a way forward, bearing in mind that the recommendations from Professor Harrington’s first report have been accepted in full by the Minister—here I echo my noble friend Lord Kirkwood. There are five recommendations, which can be summarised as follows: that more empathy should be built into the process, with JCP managing and supporting the claimant; that the transparency of the Atos assessment should be improved; that there should be better understanding by Atos of mental disabilities; that decision-makers should be better empowered; and that there should be better communication of feedback between Jobcentre Plus, Atos and the First-tier Tribunal to improve the quality of decision-making on all sides.
Professor Harrington’s full report is very instructive on all these matters. For example, he says that the language and logic used in the LiMA computer system,
“is not very intuitive or accessible to claimants who receive their final report”.
He goes on to say:
“The Atos Training and Development handbook encourages”,
“to use open questioning and not to rely on the LiMA system”.
However, in practice this hardly ever happens. He also sheds light on the fact that claimants are expecting a medical examination, which looks at their illness or impairment, rather than an assessment of their functional capability. It does not help when the Atos healthcare professional conducting the assessment does not look at the claimant at all, but rather at the screen, nor does it help when the healthcare professional has poor knowledge of some of the less common health conditions, such as Parkinson's disease. Another key part of Professor Harrington's report was that the Jobcentre Plus decision-makers rarely make a decision that disagrees with the evidence provided by the Atos assessment because they lack the confidence to do so. In other words, the decision-makers are often just decision stampers.
The DWP says it is working to implement these recommendations as quickly as possible. I think the whole House would like to know how the department is getting on with this implementation, because this is not just an extremely important matter but, I believe, the key to the whole reputation of the work capability assessment when the migration from incapacity benefit is rolled out nationwide. Therefore, I would be grateful if the Minister would tell us what steps are being taken to implement the current Harrington proposals.
The Merits Committee report is, as usual, an absolute model of clarity. It states, as has been stated already today, why it is so important that the work capability assessment is got right. Those who are deemed to be fit for work and are on JSA will receive £65.45 a week, those who are found to have limited capability for work, and therefore on the work-related activity group of ESA, will receive up to £91.40, while those in the support group of ESA will receive up to £96.85. The difference in the levels is substantial.
Before I finish, I unequivocally welcome the change in Regulation 35 which allows claimants awaiting chemotherapy to be placed in the support group. However, in general, it is difficult not to agree with the SSAC's view that, in removing some of the subtleties in the descriptors, about which we have heard so graphically today,
“the test's relevance to the real world has not been enhanced”.
My Lords, I am grateful to the noble Lord, Lord Kirkwood, for tabling this prayer today, and I echo his core concerns. I declare my interest as chairman of Forward-ME and that one member of Forward-ME is a member of Professor Harrington's task group looking at fluctuating conditions.
There has always been a problem with the descriptors for the work capability assessment, particularly for people with mental illnesses and for those with what are termed “fluctuating conditions”. During the progress of the Welfare Reform Bill four years ago, I raised concerns about the ability of Atos medical staff to discern the difficulties encountered by people with ME/CFS when, on the day of the assessment—which is not, as some claimants think, a medical examination—those being assessed might have been able to perform a number of tasks on a one-off basis but they were frequently unable to repeat the tasks on a consistent basis. There seemed to be no room for detailing pain, muscle weakness, fatigue and other disabling symptoms that occur intermittently and often severely. As a result, the assessor has awarded very few points and the decision-maker has then considered them fit for work. In every case that I have encountered, people with ME/CFS who have appealed to the medical tribunal have succeeded in their appeals and their benefits have been reinstated.
When Professor Harrington published his An Independent Review of the Work Capability Assessment last November, the hopes of ME/CFS sufferers were raised. Other noble Lords have quoted from his report, and I am sure that the Minister knows it off by heart, so I will not repeat it all. The Secretary of State for the Department for Work and Pensions, as others have said, accepted all of Professor Harrington's recommendations on behalf of the Government. Under “A programme for work for year two” in that report, Professor Harrington wrote:
“This programme focuses on: the descriptors, particularly in assessing fluctuating conditions”.
He had already set up a task group to look at mental, intellectual and cognitive descriptors, and I am aware that that group has reported to him. In the new year the task group to review the descriptors for fluctuating conditions started work. They are due to report to Professor Harrington in April this year. I understand that the mental conditions report will be published in the summer and that for fluctuating conditions in the autumn.
I am aware that the internal review of the operation of the regulations was required by statute. I am also aware that all of the disability organisations involved disowned the report, which they say was flawed. They rejected the recommendations because of, among other things, the negative effect that they would have on disabled people and their families. As other noble Lords have mentioned, the Social Security Advisory Committee was unhappy with the part of the regulations that relate to the descriptors. It recommended that they be deferred until Professor Harrington's independent review of the WCA was complete and the evidence of the outcome of the trial of migration of incapacity benefit claimants to employment support allowance or jobseeker’s allowance was available. As we have heard, the House of Lords Merits of Statutory Instruments Committee accepted that the internal review found that the performance of the WCA was not working satisfactorily and it commended the DWP for wanting to revise it. However, the committee also highlighted some of the flaws in the current statutory instrument. These have already been discussed.
Like the noble Lord, Lord Kirkwood, and the noble Baroness, Lady Thomas of Winchester, I am pleased that the regulation that applies to claimants undergoing or likely to undergo chemotherapy is to be amended, as well as that which applies to drug or alcohol rehabilitation claimants. However, in the light of the conclusions of several reports and the views of a great many experts in mental health and fluctuating illnesses, and the fact that Professor Harrington has been asked to review the descriptors for both these conditions and will be reporting on both by the autumn, I cannot understand why the Government insist on making changes which all the experts, except the DWP, regard as draconian and premature.
We keep hearing about the Prime Minister’s ambition that we should all be happy, and that any government measures should include a happiness score. Has the Minister measured the happiness of the thousands of claimants who are terrified that their benefits are going to be severely reduced, who will go through months filled with anxiety and apprehension as they wait in an ever-lengthening queue to appeal to a first-tier tribunal, or who become totally demoralised because they are forced to apply for jobs knowing that no employer will take them on? Has he calculated the cost of the increased financial burden that will fall on the Department for Constitutional Affairs, which will have to cope with the anticipated increase in the number of appeals following decisions that are likely to be seen as unreasonable?
In order to improve the fairness and effectiveness of the WCA, Professor Harrington recommended building empathy into the process, better training for decision makers, accounting for the particular difficulties in assessing mental, intellectual and cognitive impairments, and empowering and investing in decision makers so that they are able to take the right decision. Would the Minister kindly tell the House whether these recommendations have been implemented?
How are decision makers to come to the “right decision” if they are not given all the information because of the limitations of the descriptors to be used according to these regulations? Are they free to ignore the Atos report if the claimant’s statement and any accompanying medical evidence conflicts directly with the findings of the Atos doctor? I am particularly concerned about people with ME/CFS who have frequently been denigrated and who feel defeated by a system that refuses to recognise their illness. The additional stress these regulations will impose on them will not help to improve their condition. Like many others, I am deeply unhappy about these changes. They are going to prove hugely costly, both financially and emotionally, to claimants and I suspect to the DCA, but then that is another department, is it not? Why can the DWP not wait until Professor Harrington reports later this year? Why the urgency?
My Lords, many speakers have already gone over the new regulations in great detail, and I do not wish to repeat what others have said and go into all the ramifications. I propose just to talk about the impact of the new regulations on blind and partially sighted people, which is likely to be quite serious and which illustrates that the regulations as we have them at the moment are not fit for purpose. I think that other speakers have been unduly kind about the regulations. The noble Lord, Lord McKenzie, said that he was in favour of them. I have to say that I am not in favour of them as they stand. I am more with the Social Security Advisory Committee, which has said that they are not yet fit for purpose in a number of respects, that they were being rushed through prematurely, and that the department should take them back to await the second phase of Professor Harrington’s review. There should be more mature reflection on some of the points that have been made about the regulations and further consultation with the stakeholders who have been so critical of them, about which we have heard.
As has been stated by the noble Baroness, Lady Thomas, these regulations fundamentally undermine the structure of the employment and support allowance where claimants with limited capability for work are put into either the work-related activity group or the support group. The new descriptors make the limited capability for work test, the gateway to the benefit, unreasonably difficult to pass for many disabled people, certainly for blind and partially sighted people. By setting such a high threshold for eligibility for the ESA, they transform the limited capability for work test into a limited capability for work-related activity test, which large numbers are bound to fail. This in effect erodes the distinction between the two tests, undermining the intention of the Welfare Reform Act 2007 that there should be two distinct groups of claimants, one moving towards work—the work-related activity group—and the other with no conditionality—the support group. Under these regulations, the number of disabled people able to qualify for the work-related activity group will drop dramatically, as whole groups are largely excluded by the eligibility threshold.
The Merits Committee, in its first report of this Session, stated that the department itself estimates that 23 per cent will be found fit for work and will be required to make a new claim for jobseeker’s allowance, with its obligation to participate in activities to improve job prospects. The Social Security Advisory Committee believes that the DWP has underestimated the support required by this vulnerable group of claimants. It has also said a number of other things: first, that the current descriptors are also inadequate for measuring the capacity of those with mental health conditions, sensory disabilities or fluctuating conditions; and, secondly, that there needs to be a closer correlation between the tests and normal work situations. For example, someone who needs to be accompanied to familiar places by a helper is not sufficiently adapted to their condition to be capable of work, yet this would score only nine points under the proposed new descriptors and would therefore not enable that person to get through the gateway and qualify for the benefit.
The disability organisations that have made submissions to the Merits Committee have also made a number of other points. The perspective on work skills needs to be wider. Someone might be able to pack boxes all day, but not be able competently to find their way to the factory canteen; or again, people with a limited capability for work—blind people are actually instanced for this—may be able to work, but in a very circumscribed set of jobs. There is an insufficient supply of those jobs in a depressed job market.
I wish to concentrate on the impact of the regulations on the situation of blind and partially sighted people, and in doing so I declare my interest, although at my time of life I am not likely to be applying for employment and support allowance. However, I am a vice-president of the RNIB, which has had a certain amount to say about these regulations. Those who know about these things are clear that the new regulations will have a disastrous impact on blind and partially sighted people, who will in all likelihood fail to qualify for the ESA if the regulations come into force. This is deeply concerning, they say, considering that many blind and partially sighted people have limited capability for work and so should be able to qualify for the ESA, where limited capability for work can be demonstrated—which, I repeat, will be very difficult to do under the new regulations.
A person of working age who loses their sight will need to learn new skills such as independent mobility and how to use a computer using screen magnification or speech output software, as well as new everyday living skills such as cooking, dressing, cleaning and so on. It is not appropriate to require someone in this position to end up claiming jobseeker’s allowance, yet that will be the impact of these regulations. Under the proposed limited capability for work test, a blind person’s difficulties in performing most work-related activities would be ignored and only extreme difficulties in navigation and maintaining safety would be assessed. A visually impaired person would be considered to have a limited capability for work only if they were unable to navigate around unfamiliar surroundings without being accompanied by another person.
The RNIB says that it does not believe that Atos has the specialist knowledge and expertise in a medical test centre environment to carry out functional assessments of the mobility of people with sight loss. It says:
“For example, we are unclear how they would determine whether or not a person is unable, due to sight loss, to navigate a familiar route without support, when they will be assessed in an unfamiliar environment at the test centre, under conditions of limited time for the assessment to be completed”.
The department’s internal review stated that it was the department’s intention to continue to work with experts and specialist disability organisations to refine the descriptors related to sight loss. However, this has not happened, despite requests to meet officials. For that reason, the department really ought to look further at the regulations before it has these discussions with interested organisations that it says in its internal review it is its firm intention to have.
For many blind and partially sighted people, the regulations, if brought into force, could see them denied the ESA. This is due to the high qualifying threshold being put in place around limited capability for work and the failure properly to assess the effects of sight loss. The regulations will seriously undermine the distinction between the work-related activity group and the support group, and force people who should be eligible for the ESA on to the JSA, which is not the appropriate benefit for people with limited capability for work. I do not believe that this is either appropriate or that it was the intention behind the Welfare Reform Act 2007.
My Lords, I did not want to interrupt the noble Lord, but I think he said that I had said I was in support of these regulations. I am not and I do not believe I said that—if I did it was certainly not my intention. I tried to play back some of the concerns that have been raised with us. I certainly support the concept of the ESA and of the WCA, but I do not support these particular regulations.
I will be very brief because the debate has gone on for quite some time now. Other noble Lords have eloquently described the present difficulties with these regulations. However, I sympathise in some ways with the difficulties that the Government have, because we all share the intention that we should get more people who are currently receiving disability support into work; and what the Government are trying to do—and the previous Government were trying to do—is exceptionally difficult to get right. The development of those descriptors and an assessment tool is going to take more than the time allowed.
I am not saying that you should not pilot, try or try to revise the assessment tool, which is actually what the Government have tried to do. That seems perfectly legitimate, so I am not entirely in support of withdrawing these regulations, because unless we continually try to improve them, we will never get to the point at which they are adequate. However, I return finally to what the noble Baroness, Lady Thomas of Winchester, has said, because it is not the descriptors or the work capacity assessment that are the real problem. The real problem, which I think Professor Harrington described so beautifully, is that the process is,
“mechanistic, impersonal and lacks empathy”.
Here we have a population of worried, anxious people with a profound range of difficult disabilities to try to assess accurately, and there needs to be a culture change within Jobcentre Plus, Atos Healthcare and the healthcare assessments themselves. That is the fundamental problem. We could work on these descriptors. I know that the Government are doing so with extra help from specialists in the mental health field. I ought to declare an interest here as a psychiatrist. The work that is going on is essential, but unless we can change the culture of these assessments to make them more user-friendly we will not get people back into the work that would help them to lead better, fulfilled lives.
As president of MS Cymru, I want to flag up the problem for people with fluctuating conditions. All the difficulties around the assessments have been clearly laid out and I will not repeat them, but there is a real problem for people who have an assessment and then, possibly a week later, dramatically deteriorate. It is the fluctuating nature of conditions such as MS that is causing a lot of anxiety to people out there. The provision for those on chemotherapy is greatly welcomed, but I ask the Minister to explain how the second part of Professor Harrington’s review, which he is doing in conjunction with the MS Society, will be incorporated. How will the Government handle the possibility of quite a lot of appeals or even challenges when the next phase is rolled out?
My Lords, most of the points that I wanted to make have been made, so I will be brief. I emphasise the serious concerns that have been expressed by disability organisations, most particularly that these changes are premature. As we have heard, the second phase of the independent review led by Professor Harrington is still under way, and the advice on refining the mental, intellectual and cognitive descriptors has not yet been seen by Ministers, so in all likelihood we will be faced with two major, costly and confusing changes to the WCA to be made in a single year.
I emphasise that the cost of these changes has not been covered. The cost of people having to go to tribunals when their assessment needs to be overturned is enormous in terms of stress, worry and consequent ill health, but it is also a waste of time and money for the country. As the CAB has pointed out, the current WCA assessment routinely fails to identify disabled people’s genuine needs and inappropriately allocates them to jobseeker’s allowance, only to have that decision overturned on appeal. Currently 40 per cent of cases are overturned on appeal, which must cost the state a considerable amount.
According to the Welfare Reform Bill documents, almost £20 million was spent in 2009-10 on appeals to the tribunal service and, according to figures from the Disability Alliance, that means that roughly £8 million was spent on appeals to rectify the failings in the current WCA. There is now a nine-month backlog for appeals in some areas. If the new descriptors go ahead as planned, these changes could lead to even greater pressure on the system, especially since, as the noble Lord, Lord Kirkwood, pointed out, new ESA claimants will be joined by an estimated 10,000 people per week being migrated off incapacity benefits from April 2011.
The Government’s expert independent body, the Social Security Advisory Committee, has recommended that these plans are not implemented now. I urge the Government to follow their advice.
My Lords, I thank the noble Lord, Lord Kirkwood of Kirkhope, for bringing up this matter. He understands these matters so well and I support what he has said. This is a complex matter. Disability is complex, as it differs in so many ways.
There is great concern from many disability groups, as has been said, as well as the national AIDS group, which has not been mentioned. HIV is a very complex condition. People with it have to live on drugs for the rest of their lives. On some days they are better than on other days, and some drugs work in different ways on different people. This is a complex matter.
I hope that the Minister will get these regulations right. I have two questions for him. Who will be doing the assessments? Will these people be adequate? This is of great concern to many people, and this debate has illustrated how very complex the whole matter is.
My Lords, this is an important opportunity to discuss the regulations. A lot of points have been raised and I will try to deal with as many as possible. However, I take this opportunity to lay out the position coherently. I take the criticism of the noble Lord, Lord Kirkwood, that communication has been less than perfect. I shall try to describe what is happening to reinforce that communication programme and I commit to ensure that it is maintained.
There is still a lot of misunderstanding about the assessment and what we are doing to make it fairer and more effective. The first point to make is that these regulations seek to take the first step in improving the work capability assessment. They were developed in conjunction with technical experts and with considerable input from specialist disability groups. As noble Lords have acknowledged, they will ensure that individuals awaiting, or between courses of, certain chemotherapy will be placed in the support group without face-to-face assessment. They will expand the support group to cover people with severe disability due to mental health problems and communication problems—that includes people with autistic spectrum disorder, about whom the noble Baroness, Lady Browning, was concerned—and they will ensure that the descriptors take account of someone’s adaptation to a condition or disability so that we can provide them with the right support.
Before proceeding to debate the finer points of the regulations, I would like to put the reform into a context. The legislation before us today is part of a far broader commitment by the Government to tackle worklessness and intergenerational poverty. This is a very real and very urgent problem for us all, especially given that there are now 2.6 million working-age people claiming incapacity benefits, of whom some 850,000 have been claiming for a decade. This is a massive brake on the economy, costing the taxpayer billions of pounds every year, but that is not the most important point. The true cost of this level of inactivity is paid for by individuals left languishing on long-term benefits without hope or opportunity for a better life. I echo what the noble Lord, Lord Kirkwood, said about the scourge of inactivity. If we abandon these people, we fail in our duty as Members of this House. For too long, too many people have had to pay for our failure to act.
Before the recession, there were 63 consecutive quarters of economic growth—that is the longest growth period the economy has enjoyed, as historians can best work it out—and the economy created 4 million additional jobs. Yet under the previous Government—I am not being political—just over half those jobs went to foreign nationals. The result was that, even before the recession hit, we still had 4 million inactive people. Millions of people were without jobs in a growing economy, yet the system was trapping them. That is why we were sucking labour from abroad. The system offered too few people the opportunity to escape and to make a better life for themselves. We must not fail them again, because the country cannot afford it, and neither can the individuals, their families or our society.
Studies have shown that welfare dependency, social isolation and lack of purpose in life have a debilitating affect on individuals. Decades ago, the late Aaron Antonovsky argued that the purpose in life—what he called coherence—was crucial to understanding human health and well-being. More recently, Waddell and Burton’s excellent review of the issue, written four and a half years ago, reinforced the evidence that showed that work is generally good for you. There is ample evidence that prolonged periods of inactivity and unemployment contribute to declining mental health. That is why the welfare reforms that we are introducing are so important, and that is why the regulations are such an essential element in transforming the lives of millions of people at risk of being abandoned to welfare dependency.
These reforms are the key to providing the lost with a path out of the cycle of dependency and poverty, and helping them on to the path to new opportunities. That is why we are embarking on a large-scale re-evaluation of those on incapacity benefits through the work capability assessment that will take in some 1.5 million people—not the 2.6 million on incapacity benefit who the noble Lord, Lord Kirkwood, mentioned —over the next three years. It is also why we are introducing the universal credit to make sure that work pays, and why we are introducing the largest welfare-to-work programme that this country has ever witnessed.
This is designed not to badger or bear down on the vulnerable but to give them a road map to a better life. It is only by tackling welfare dependency and starting to dismantle the benefits trap that we can help people escape the huge social costs of worklessness, social exclusion and intergenerational poverty. Many noble Lords will know how difficult it is to wrestle with the issue of child poverty without this kind of route.
Those who cannot work will of course continue to get the support they need. However, for those who can make the journey back towards the workplace, we will offer them structured support to become work-ready. This will provide real help for many of those who have previously been abandoned by the system—those who were simply labelled as incapacitated and largely ignored, whether they wanted to work or not.
The work capability assessment was introduced in October 2008 as a key part of the assessment process to determine entitlement to employment and support allowance. It replaced the personal capability assessment and represented a significant and overdue change in assessing an individual’s ability to work. It was developed in conjunction with technical experts, along with considerable input from specialist disability groups.
However, it was clear from the outset that, unlike the PCA, the WCA should be subject to an ongoing process of review, evaluation and refinement. Indeed, it was this House that passed the amendment that introduced the requirement for an independent review of the WCA for the first five years after its introduction—a point made by the noble Lord, Lord Kirkwood. It was the only amendment from this House that made its way into the original legislation for the work capability assessment, and it received support from all sides. That was slightly before my time, but I know many noble Lords will remember it well.
It was this House that called for, supported and enacted the requirement for continuous review and refinement of the work capability assessment. Through these regulations, we are doing exactly what the House asked for. Therefore, perhaps it is counterintuitive for some noble Lords today to suggest that we should wait until the whole process of continuous improvement has been completed. That was not the intention of the House, as the noble Baroness, Lady Murphy, effectively pointed out—if I may paraphrase her point.
The internal review of the work capability assessment, which led to the amendments to the regulations that we are considering today, was undertaken with significant input from technical experts and specialist disability groups, in the same inclusive way that we used for the original work capability assessment. We recognised the concerns of disability groups and undertook significant work with them to refine the assessment. The outcome of this layer of work was published as an addendum to the report, and the regulations before us today fully reflect those refinements.
This Government are committed to continuously improving the work capability assessment to ensure that it is as fair and as accurate as possible. I reassure the noble Lord, Lord Kirkwood, that we are also committed to working closely with disability groups in that process. I also reassure the noble Lord, Lord Low, who made the same point. The regulations that we are debating today are the first step on that continuous journey.
My Lords, I am pleased to answer that question. I am rather surprised by the actions of the groups. I have seen a lot of correspondence and a lot of internal work. There was very full engagement by both sides, and a lot of correspondence about fine-tuning the regulations. At the end of the process there seemed to be real agreement. Therefore I am genuinely surprised that, after the passage of some months, the consensus seems to have been significantly eroded. Income elements may have come to the fore, whereas the technical analysis that was the subject of the interplay between the department and the groups was perhaps easier to get to grips with.
I will go back to describing the system. The wider system that we inherited, after the measures that the internal reviews described, contained flaws that we as a new Government have looked to put right as quickly as possible. In June we launched the first of the five annual independent reviews of the work capability assessment—the first of the reviews that this House legislated for. It was carried out by Professor Malcolm Harrington, a highly respected occupational physician. He reported last November. He did not consider that the work capability assessment was broken but felt that it was not working as well as it should and made a series of recommendations to improve its fairness and effectiveness. We have fully endorsed his review, as the noble Baroness, Lady Thomas, pointed out, and we have committed to implementing his recommendations as quickly as possible.
The first key element of those recommendations—I am borrowing, again, from the description of the noble Baroness, Lady Thomas—is that we empower Jobcentre Plus decision-makers to make the right decision. They will have clear responsibility for the decisions they make and will be given the support that they need to ensure that those decisions are independent and considered. I hope that that is one of the reassurances for which the noble Lord, Lord Kirkwood, was looking.
The second recommendation is to ensure that individuals are treated with compassion by clearly explaining everything to them, helping them to fully understand the process they will go through and ensuring that they know that they can provide additional evidence, including medical evidence, for consideration at any time. I hope that that is the second of the reassurances for which the noble Lord, Lord Kirkwood, was looking.
The third major change is to improve the transparency of the Atos assessment by ensuring the audio recording of assessments in the Atos pilot. The other element involving the Atos process is that we will account for the particular difficulties in assessing mental health conditions by ensuring that Atos employs “mental health champions” at every centre.
Nearly all these changes will be in place for the start of the reassessment, with the remainder completed in time for the summer. We have also appointed Professor Harrington to conduct the second independent review. He will now examine the assessment in more detail, particularly focusing on mental health descriptors and fluctuating conditions.
I shall now respond to the questions of the noble Baroness, Lady Finlay, on fluctuating conditions. The fact that conditions fluctuate is now embedded in the descriptors. We just want to make sure in this next piece of work that we get that absolutely right. We look forward to Professor Harrington’s recommendations following the second review in due course.
The regulations before us today are part of this improvement process. They come from the internal review undertaken and fully supported by the previous Government. That review suggested a number of changes to clarify and improve the technical descriptors; noble Lords have made these points so I will go through them quickly. The changes include placing individuals awaiting or between courses of chemotherapy in the support group; expanding the support group to cover people with certain communication problems and severe disability due to mental health conditions; greater provision for individuals who are in residential rehabilitation due to drug or alcohol misuse; ensuring the descriptors take account of someone’s adaptation to a condition or disability; and simplifying the language of the descriptors to ensure fair, consistent and transparent applications. These changes will improve the work capability assessment. They will increase the number of people with severe disabilities who are provided with unconditional support in the support group. They will ensure that we do not deny employment support to individuals who, with our help, can get back to work.
The internal review consulted a range of experts and groups and, as I described just now, tried to reach consensus. Significant concerns were expressed by the groups around the descriptors. I will not go into those because I am short of time, but I can respond to the noble Countess, Lady Mar, on fluctuating conditions. It must be possible for all the descriptors to be completed reliably, repeatedly and safely, otherwise the individual is considered unable to complete the activity.
The Department for Work and Pensions has undertaken rigorous testing of these changes to understand their effects. The department modelled the impact of the changes on data from almost 60,000 assessments, and a panel of experts was brought together to examine the changes in significant detail. Where any issues were identified during this process, further refinements were made to the descriptors. From this analysis we expect the changes to increase the number of new claimants who are put in the support group, specifically, those who are awaiting or are between courses of chemotherapy, and some whose limited capability relates to certain mental functions and communication difficulties.
I have run out of time, but I hope that the House will indulge me for two more minutes as this is really important. We are committed to the principle of continuous review and refinement of the work capability assessment. As part of that principle, we have reviewed in detail the working of the work capability assessment and consulted in depth with specialist disability groups to improve the assessment. The addendum to the original report shows how far such concerns were taken on board in these regulations. We are committed to taking Professor Harrington’s review to improve the sensitivity of the process. Of the 17 recommendations that he made, we will have 15 in place in time for April and the other two in a couple of months. I hope that that is a final reassurance for the noble Lord, Lord Kirkwood, and the noble Countess, Lady Mar.
The changes that we are making in the regulations will improve the work capability assessment. They will expand the support group to cover people with severe disability due to mental health conditions and communication problems. They will ensure that the descriptors take account of someone’s adaptation to a condition or disability and accepting these regulations means that we can make these important improvements now. We remain committed to the principle of continuous improvement to the work capability assessment. I trust that the noble Lord, Lord Kirkwood, will feel able to withdraw his Prayer to Annul these important regulations.
My Lords, I am grateful to the Minister. It has been a long but excellent debate. I thank all noble Lords who have participated. I shall certainly look carefully at the record tomorrow to ensure that we learn the lessons that have been laid in front of the House during the debate. I am pretty sure that the Minister will do the same—that he will take the opportunity of reflecting very carefully on what he has heard and the tone in which some of these powerful speeches have been made.
Knowing the Minister as I do, I know that he will also take away from the debate the fact that he may have some work to do to reconnect the department properly with the disability community and the pressures groups that represent it. I hope he will take that commitment on personally and not leave it to his senior officials, very highly regarded as they may be. I hope that he will personally invest time to make that connection good, otherwise it will fall foul of broken communications in future if it is not put right.
Reflecting on the debate, I think the Minister has got an amber light; he did not get a red light, but he still can in future if he does not complete the commitments he made—speaking for myself, I am willing to accept them—but he has not got a green light. I hope I am reflecting the tone of our excellent debate in seeking the leave of the House to withdraw this Prayer.