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Universal Credit: People with Mental Health Problems

Volume 814: debated on Wednesday 8 September 2021

Question for Short Debate

Asked by

To ask Her Majesty’s Government what assessment they have made of (1) the report by the Money and Mental Health Policy Institute Set Up To Fail: Making it Easier to Get Help with Universal Credit, published on 26 May, and (2) any barriers to people with mental health problems receiving support for the management of their Universal Credit accounts.

My Lords, one in four of us will experience a problem with our mental health at some stage in our lives, and we know that concurrent financial problems almost always make the problem worse. In particular, experiencing a mental health problem makes it much harder for people to manage their universal benefit account, which is, of course, the background to this debate.

This is a circular problem. If we can improve the support that people with mental health problems receive in handling their finances, we not only help the individuals themselves but creditors and, not least, the National Health Service. We must therefore welcome the Money and Mental Health Policy Institute’s report, Set Up to Fail. Based on detailed research, it is compelling reading. My question, therefore, is: what will the Government do in response?

I am not going to talk about the rights and wrongs of universal benefit today; there will be other opportunities. I shall just concentrate on what we need to do to help people through the current system. But even in a reformed system, the same problems would need to be considered.

The challenge is that people with a range of mental health problems, such as low energy levels, memory loss or difficulties in dealing with complex situations, find it hard to manage their universal benefit account. Claimants report significant mental distress when faced with requirements such as preparing for work, responding to messages and attending appointments, which can be problematic to complete when you are on your own, or simply feeling helpless when dealing with complex situations. Again, we have the circle of cause and effect.

Any failure to navigate the system can have devastating consequences. Sanctions, deductions or lost entitlements mean that people cannot meet their basic living costs, which can further aggravate mental health problems and delay recovery. Faced with these challenges, people with mental health problems are bound to rely on support from family or friends—so-called third parties: typically, but not only, their spouse. From the institute’s survey, we know that more than half of the people affected have needed help from family or friends to manage their account, and more than one in four always or often need such help.

People needing help with their universal benefit are not asking for much; they just want a benefits system that is accessible and empowers them to get support from loved ones when they need it. I spoke to Gary, who told me that he just wanted a little help and some sympathy. He has worked all his life, but now he and his family rely on universal benefit. With his depression, he struggles to cope with everyday life, including managing his universal benefit account. He has help from his wife, but he finds they face a wall of complications.

Based on the lived experience of people in the survey, we know that getting third-party help with managing their universal benefit is confusing and challenging. Third-party help needs explicit consent, which requires claimants to set out precisely what information they want to be shared and what tasks they would like assistance to resolve. The fundamental problem is that the system for giving this consent requires people to undertake the same tasks that led them to need help in the first place. If people in receipt of universal benefit cannot navigate the main system, they are unlikely to be able to navigate the procedures required for accessing help and support. It could all be so much easier.

Without straightforward systems for delegating consent to another person, people find it a struggle to get the assistance they need, compounding the risk of harmful financial and mental health consequences. Almost half of the people in the survey who had relied on help with their universal benefit management had used informal workarounds, such as sharing their usernames and passwords to get the support they wanted. This is risky in itself and should not be necessary. Third-party support should be more straightforward to use, while maximising the control of the people in receipt of the benefit.

I know that some noble Lords are concerned about changes that would increase opportunities for economic coercion, but this is a problem for everyone with universal benefit. The institute argues that giving people more choice and flexibility over what aspects of the account they share with another person and for how long would increase the protection that people can exercise over their account.

The report recognises that the DWP has committed to look at how the consent procedures could be improved, but with the pandemic leading to worse mental health, unemployment forecast to rise and many of those transferring likely to have additional needs, delivering third-party support that lets people get the help they need must be an urgent priority for the Government.

What exactly needs to be done? From the report, we know that those affected want the process to get third-party support to be easier to understand and navigate. Too often, people who need third-party support are not aware of how to arrange it. The institute’s report sets out relatively simple steps for the Government that would make it easier for people to get the support from others to manage their account. This can make a big difference in reducing the stress and difficulty that too many people with mental health problems face when navigating the system. It is not rocket science. First, there are some relatively simple changes that make it easier to designate where help can be provided and who can provide it. Ideas include clearer, more consistent prompts on what information is required when navigating the computer application and drop-down menus clarifying what information claimants wish to share and for how long.

Then there are changes to facilitate how the designated third parties can provide the necessary help both quickly and efficiently. Suggestions in the report include developing a system of view-only access for authorised third parties, which would allow claimants to share specific screens with a friend or family member; introducing a system of duplicate notifications to authorised third parties, alerting both the claimant and their third party about new messages or tasks within their account; and improving the current appointeeship system, which grants great power to third parties. It would be better to make this more proportionate and tailored to the specific tasks and challenges that individuals face while managing their universal benefit.

What is the Government’s assessment of the barriers that people with mental health problems face in the management of their universal benefit accounts and, in particular, the excellent report by the Money and Mental Health Policy Institute, Set Up To Fail? I look forward to the Minister’s reply. Will she agree to meet with the institute to discuss these issues and its valuable work?

My Lords, I thank my noble friend Lord Davies of Brixton for initiating this important debate. I can think of few worse fates than being mentally ill and having to rely on universal credit. Even with the best advice and practical help, there is a 7% chance of a delayed payment and increased stress and anxiety—and, of course, the amounts are totally inadequate.

Let me say first that this is not a straightforward issue. Third-party help can be a vital lifeline, provided it is of the right kind. We have all heard how vulnerable people are targeted by drug gangs so that their addresses and resources can be used to further their trade, so it is quite right that any third-party status should be checked on a continuing basis.

However, additional checks should not become additional barriers. It is incumbent on the Government to remove those barriers. Do the Government know what percentage of claimants with mental health issues have lost entitlement or faced deduction or been sanctioned as a result of failing to complete satisfactorily a UC claim? What response do the Government give to the Information Commissioner’s Office about improving routes to set up third-party access? How does the department identify those who are mentally ill? Cases must be on the increase with the pandemic, but not everyone is willing to speak about their problem or even acknowledge it. Without appropriate third-party support, how do the Government decide who is vulnerable? They have indicated that the department gives mental health training to staff. Do we know the extent of this training? Has any study been carried out on the effectiveness of this training, and what outcomes have been identified for claimants?

It is good that the Government allocated funds to Citizens Advice and Citizens Advice Scotland, but it was never going to be enough if it did not include a continuing role after the initial claim. Would the Government consider how best to tackle this by asking the CABs for their requirements?

In preparing for this debate, I looked at the Social Security Advisory Committee’s independent report How DWP Involves Disabled People When Developing or Evaluating Programmes That Affect Them—occasional paper 25. It concentrates on physical disability and there is no specific mention of mental health, but I feel sure there are some common themes: the need for relevant groups to be involved, to feel they are being listened to, to improve transparency about future thinking and improving trust. In other words, no decision about us without us. Does the DWP have specific networks with mental health organisations, that are about improving access and transparency? Are they as well developed as the networks for physical disability, given that mental health has always been a Cinderella service and lacks resources? Mental health is sometimes linked with drug addiction and homelessness. Does the DWP have specific policies to identify these links and consult the relevant organisations about how to facilitate claims? Are the Armed Forces veterans’ organisations consulted? So many homeless people seem to have served in the forces and also to have mental health problems.

Finally, on a slightly lighter note, I pay tribute to Martin Lewis’s work in this area. If the Minister is in a position to hand out sainthoods, I think he would be a good candidate.

My Lords, the question put in this debate is not about attacking Universal Credit or the commitment of the staff at the DWP. It is about a particular group of vulnerable people, whose vulnerabilities mean they cannot fully or effectively engage with the processes and procedures for managing their Universal Credit account and what further action the DWP can take to address what is a distressing problem. Not engaging effectively brings real detriment: sanctions, deductions, lost entitlements, decline in living standards, increased stress and decline in well-being.

Many have recognised the commitment and efforts of DWP staff during the Covid pandemic, particularly in the early months when so many applications were processed. The DWP was an important part of the solution to managing and surviving the pandemic. It has to be recognised that that would not have been possible without utilising the IT systems and digital engagement, given the volumes of claims and the constraints on other forms of contact.

Universal Credit is now digital by default. Indeed, the advances in technology allowed the rapid expansion of digital engagement between businesses and businesses, businesses and consumers, service providers and users, which was fundamental to sustaining the economy over the last 18 months. But digital engagement, particularly when combined with complex processes, can pose problems for those with mental health problems, which are further exacerbated if the decision-making journey is difficult to comprehend or navigate. This is evidenced in the provision of court services, public services and, indeed, commercial services. Increasingly, in the commercial world of financial services, companies are recognising the need to adapt their processes to deal with vulnerable customers, including those with mental health problems, who, sadly, are growing in number. Those difficulties in navigation are spelled out very clearly in the Set Up to Fail report published by the Money and Mental Health Policy Institute. The report is particularly compelling because it takes evidence directly from the people who have mental health problems, the majority of whom said they simply could not manage their account without help from family and friends.

The difficulties emphasised in the report include claimants not being told that they can give permission for someone to help manage their account, not being told how to make that request and, when they do, having to specify which exact tasks they want a third party to help them with, without any guidance given on how to do that. Of course the claimants could ring the DWP, but more than half say that they have severe difficulties in using the phone precisely because of their mental health problems, so you have a circle of lockout. The report describes this as an absurd situation whereby those who want to nominate a person to help them have to navigate complex and unclear processes similar to those which they needed help with in the first instance—a Catch-22.

The DWP has introduced measures to assist those with mental health problems but the report argues that they are not sufficient. Many with mental health problems lack social, emotional and financial resilience, and the welfare system should be a critical line of defence for them which minimises the barriers to mitigating that. Many such claimants struggle on alone, incurring the negative consequences. My noble friend Lord Davies detailed what needs to be done to assist claimants, particularly with regard to obtaining explicit consent for another person to help them manage their account.

However, like my noble friend Lady Donaghy, I stress the importance of considering that recommendation of extending the help-to-claim service through the citizens advice bureau to also provide a help-to-manage service for vulnerable claimants with a universal credit account. Managing the needs of vulnerable claimants does not cease when they open an account or when it is set up, and indeed their mental health problems may occur after an account has been opened. People’s circumstances change and the population with these problems changes. There are other publicly funded help and guidance services that do not apply such a cut-off criterion. It seems such an arbitrary thing to do given the nature of the problem that must be addressed. An extension of the service would also help to protect those vulnerable to coercive behaviour, for whom explicit consent for a family member to assist may not be their desired answer to the problems that they face.

The incidence of mental health problems is increasing, even more so in the exceptional circumstances prevailing in today’s world, and if those with vulnerabilities are not given more help and guidance then a welfare system that is intended to support them could contribute to a further decline in their mental and financial well-being. If the department can introduce further measures to assist claimants with mental health problems then, as my noble friend Lord Davies argued, they can trigger a virtuous circle of preventing people becoming more stressed and unwell, assist the NHS, contribute to the community, and increase the prospects of people’s engagement with the world of work.

I have three questions for the Minister. Will the Government further consider introducing measures to improve the experience of claimants with mental health problems? Will the Government consider the recommendations in Set Up to Fail, particularly those directed at improving and simplifying the process whereby explicit consent to third-party support in managing a universal credit account can be secured? Will the Minister commit to taking away the proposal that the remit and role of the help-to-claim service is extended to provide a help-to-manage service for these most vulnerable clients?

My Lords, I congratulate my noble friend Lord Davies of Brixton on securing this debate and on his introduction to it, and all my noble friends who have contributed this evening. I also commend all those involved with the Money and Mental Health Policy Institute for their work in high- lighting these issues.

Ever since its inception, I have had a steady stream of people telling me how hard they found it to navigate the online pathway to getting and maintaining universal credit. This is a particular problem for certain categories, such as those without ready access to the internet and those for whom their mental health makes the process of applying seem insuperable. If they do push through, it can aggravate their mental health. When I raise this, Ministers normally say that most people have no trouble at all. I have never been entirely persuaded by that, but even if I were, it does not seem grounds for not doing more to help the rest. After all, even a small percentage of 6 million people is a lot of people; it is not a small percentage. This report suggests that

“nearly 1.3 million UC claimants … report experiencing significant mental distress”.

For them, the requirements of UC are difficult to complete on their own.

As my noble friend Lady Drake said, most UC claimants with mental health problems who were surveyed say they have needed help from family and friends to manage their accounts at some point, and a quarter have needed it often. However, involving others is not straightforward because of the issues around explicit consent, which my noble friend Lord Davies explained very well. As both he and my noble friend Lady Drake have said, the whole process of delegating explicit consent online or over the phone ironically requires claimants to navigate the very tasks which led to them needing help in the first place. Any IT specialist will tell you that, if you make security issues too tough, people just find workarounds. My noble friend Lord Davies is quite right, as half of respondents simply shared their login details with somebody else. That is not helping in any way, so we have to find a better way of dealing with this.

The report notes that

“Symptoms of mental health problems can make it harder”

to make and maintain a universal credit claim. It talks quite interestingly about pain points in the UC system where a significant number of claimants started to struggle. These included, for example, trying to understand how their awards were calculated and which changes in circumstances they had to tell the DWP about. Confusion there is really dangerous as a failure to report a relevant change could lead to underpayments or overpayments and even being prosecuted—so that is really bad. It also included trying to challenge deductions or sanctions and renegotiating their claimant commitment.

The charity Rethink Mental Illness did a little briefing for this debate. It agrees that third-party access is vital, since its mental health and money advisers report that a lot of people severely impacted by mental illness cannot access their online journal. I realise that privacy is really important and appropriate safeguards need to be put in place. Yet, when I raised via a Written Question that both partners can see any messages exchanged by either one of them with a work coach on their journal and that this could be an issue in relation to domestic abuse because it had been raised by a claimant, I got a fairly dusty answer saying simply that people should not share sensitive information. Of course, all kinds of information can be sensitive in the context of domestic abuse. I think we are getting stuck both ways. Has the DWP investigated whether there could be a more nuanced way of treating issues around access to information which provides more protection for privacy, supports those needing assistance and works for those with fluctuating capacity? That is one of the issues.

I will be interested to hear the response to the question from my noble friend Lady Donaghy about CABx and the roles they might be able to play. I thought that was a marvellous speech and I commend all three of my colleagues for some very serious research and work that has gone into preparing for tonight. I would be interested to hear the Minister’s response to my noble friend Lady Drake’s question about the idea of a new help-to-manage service. If the DWP invested the best part of £40 million in the help-to-claim service, it is an awful shame to spend that getting people on to universal credit if they then fall off because they cannot manage their claims. What are the Government doing about that?

I have a couple of quick questions for the Minister. First, does she accept the principle that a significant minority of people find the universal credit system difficult to navigate, both in terms of applying and maintaining their claim? I think it is helpful for the debate for her to answer that question directly. Does she accept that there is a problem for a significant minority in claiming and staying on?

Secondly, does she think the situation will get worse with managed migration? Can she tell us when that is going to happen? There are around 1.9 million people on ESA. If they move to universal credit and the report is right in that two-thirds of those are considered to have mental health problems, that is quite a problem coming down the track in terms of scale. I think that figure of two-thirds, from looking at the report, was from a 2014 study. If the department has more recent figures, perhaps the Minister could share them with us. Rethink hears from people who are scared to move on to UC from legacy benefits precisely because they are afraid of using the online system. The charity is calling for improvements to online accessibility before managed migration is rolled out further. Does the Minister think there is an issue here? If so, what is being done about it?

Finally, the report makes an impressively modest number of recommendations, but they are quite specific and practically addressed. My noble friend Lord Davies summarised them well. Given that the title of the report was in the title of this debate, the department has had plenty of time to look at the recommendations. Given that, and that my noble friend went to all the trouble of getting the debate and of researching the recommendations, I hope that the Minister can at least give a comment on each of them. If she cannot today, could she write to address each? There are not very many. If the department really does not like them, it is only fair to explain whether it thinks there is not a problem or that this is not a good way to solve it. If so, what else is it doing?

With that said, a lot of work has gone into this report, and I commend my noble friend and all those involved in it, especially the interviewees. I think of Gary, who was mentioned by my noble friend Lord Davies. If all he wants is a little help and some sympathy, surely that is not beyond us, is it?

My Lords, I thank the noble Lord, Lord Davies of Brixton, for securing this important debate, and all those who have contributed to today’s discussion of this important question. In answer to the point from the noble Baroness, Lady Sherlock, I would be foolish to stand here and say that there is no problem and that everything is perfect. I am not saying that. The noble Lord, Lord Davies, made a point about meeting the group who wrote the report. I put this on the record now: I am always happy to meet, and I will meet that group. I would be happy for the noble Lord to join that meeting and for us to explore further what we could do and learn to make the system better. I have never been asked to hand out sainthoods, but nothing would give me more pleasure. I can think of few people who better deserve one.

I thank the noble Lord for bringing this report to my attention, so that I can go into further detail about the support the department provides for those experiencing mental health issues. I am pleased to say that my officials have already met the authors of the report, on 1 July 2021, and discussed its findings in great detail. They found the report very informative and helpful, partly because it confirms information of which we are already aware and know we can improve, but also because it highlighted some new problems to investigate, especially the concern that claimants without a clear method of granting permission to an informal third party to act on their behalf may be put off making a claim for universal credit. Noble Lords have made that point and it is helpful to be in continuing dialogue with them.

The department does care about the most vulnerable in society, including those with mental health issues who have barriers to accessing the universal credit service. We have a number of measures in place to support and protect our claimants. For example, our work coaches are doing their utmost to ensure that claimants with mental health issues are provided with tailored support and can manage their claim via the telephone, if they are unable to access our digital service.

The impact of a health condition on an individual—a point that was made this evening—varies from person to person. The claimant is the expert on their condition and they know how it affects them. The most important thing the work coach can do is to build trust with their claimant so that the claimant feels confident to fully explain their circumstances and needs.

We have reviewed our approach to health conditionality for those on the health journey, and work coaches are now able to utilise an approach in which claimants can start from zero mandatory requirements and build up based on their health condition and personal circumstances when setting out work commitments. This allows the claimant to move at a pace that is comfortable for them, as their confidence builds.

There are a number of key findings in the report in question which I will address. As the report focuses mainly on third party consent and recommendations to improve the process of obtaining consent, I will outline the current process. This was a point that the noble Lord, Lord Davies, and the noble Baronesses, Lady Drake and Lady Donaghy, raised. Noble Lords will be aware that there is a raft of support available for those who are unable to access the universal credit service; for example, claimants are able to grant third party consent. Universal credit is structured around an online personal account that contains all the information relevant to the claim. This includes claimants’ bank account details, savings, capital, medical history, family relationships and address information, which means that we have a responsibility to ensure that a high level of security and protection is in place and that we take all reasonable steps to protect our claimants and their data, which includes ensuring that consent is explicitly given. I know from all that has been said this evening that there are issues around this. I am very happy to talk to officials and come back to noble Lords on the specific points that have been raised.

As the amount of personal data available on universal credit is far greater than in the legacy benefit systems, any data breach has far-reaching consequences for claimants, so we need to balance consent against this risk. Therefore—as the noble Baroness, Lady Sherlock, said—a policy of explicit consent exists to help reduce the risk of fraud by ensuring that claimants’ data is kept safe from unscrupulous organisations and individuals. The emphasis here is not to hinder people receiving support but to help them make and manage their claim.

Where explicit consent is needed, it can be quickly given in different ways: over the phone or via the online journal, at any time during a universal credit claim. This is a far simpler and more straightforward process than in the legacy benefit systems. Once consent is given, we will work with claimants’ representatives. We really do want to make it as stress-free, simple and helpful as possible.

The universal credit product team are currently conducting discovery work to fully understand all the issues around why and how a claimant may need extra support with their claim, with a view to developing this further in the next phase of development, which will be next year. The findings from this helpful report will be used as part of the discovery phase. I cannot confirm to the noble Baroness, Lady Donaghy, that they are talking to Citizens Advice, but I will go away and find out—and, if not, I will encourage them to do so.

Universal credit provides personalised and tailored support for all claimants and work coaches are available to discuss any queries they may have about their online accounts. Noble Lords raised the Help to Claim service, and I am pleased to say that this service has been extended. I will take away the point that the noble Baronesses, Lady Sherlock and Lady Drake, raised, about whether it is possible to do something on a “help to manage” service. I cannot promise anything—it would be crazy to do so—but I will make sure that the point is raised.

Time is against us. With the leave of the House, because we have not had many speakers, may I just do a bit more? Can I have a few more minutes? I hear “Yes”—magic.

I cannot answer the question on managed migration right now, but I will go back to find out and write to noble Lords, as I have done on many other occasions.

The noble Baroness, Lady Donaghy, raised the point about bodies that represent people with mental health problems. We work with the operational stakeholders forum and the accessibility forum, including representatives of people with access requirements.

The issue of mental health training has been raised in relation to work coaches. Since August 2018, mental health training has been included in work coaches’ learning packages. They complete training in two sessions as regards complex needs and learning. We discuss what the claimant is struggling with and how we can best support them. A second session of training consolidates the learning from the first session.

Noble Lords raised the issue of mental health networks. As regards local networks of mental health providers, jobcentres use their flexible support fund to buy provision and support. For example, in Cornwall we have had mental health experts in our jobcentres, which is really good and has improved the situation.

The noble Baroness, Lady Donaghy, gave a good speech and raised many points, including assessment of people with mental health barriers. I have already talked about the tailored support that work coaches are able to give and we would always look to support claimants in our jobcentres, should there be an issue for a claimant who is unable to access online services. We also have vulnerable customer leads on hand to provide support. All the time we are trying to improve the service that people get. If any noble Lords know of a situation in which that has not worked, please tell me—first, because we want to get it right and, secondly, because we want to learn in order to make the situation better.

I must draw my remarks to a close, but I want to come back to the point the noble Baroness, Lady Drake, made about a help-to-manage service. It is a very good idea, and I should emphasise that I am going back to the department with it.

Again, I am grateful to the noble Lord, Lord Davies of Brixton, for providing the opportunity to set out the vital steps that the Government are taking to support those claiming universal credit who have mental health issues. I understand only too well the impact of mental health problems on individuals, I really do. I know that their situation is difficult, and we want to help them all we can. However, as I have outlined, a tremendous amount of work is going on to ensure that we continue to support all claimant groups, including the most vulnerable, in accessing our services with ease.

I know that I have not answered all the questions, but my track record is that I always write when I need to do so. We will meet with the group and it is up to the noble Lord, Lord Davies, as to who he wants to invite to that meeting if others would find that useful.

Sitting suspended.