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Health and Disability White Paper

Volume 828: debated on Monday 20 March 2023

Commons Urgent Question

The following Answer to an Urgent Question was given in the House of Commons on Thursday 16 March.

“Yesterday, the Secretary of State published Transforming Support: The Health and Disability White Paper. This White Paper is a significant milestone, demonstrating the Government’s commitment to ensuring that disabled people and people with health conditions can lead independent lives and fulfil their potential. It sets out an ambitious policy reform package that will transform the health and disability benefits system, and help disabled people and people with health conditions to start, stay in and succeed in work.

We will deliver action in three ways. First, we will transform the future benefits system so that it focuses on what people can do, rather than on what they cannot, including by removing the work capability assessment. In our new system, there will be no need to be found to have limited capability for work or work-related activity in order to receive additional income-related support for a disability or health condition. We will introduce a new universal credit health element that people receiving both personal independence payment and universal credit will be entitled to, which will enable people to try work without the fear of losing their benefits. We will roll this out carefully from 2026-27, and we will ensure that no one currently on universal credit and with limited capability for work or work-related activity will lose out once they move on to the new system.

Secondly, while de-risking work is one side of the coin in supporting disabled people and people with health conditions into work, we know that we also need to provide more employment and health support for this group. The White Paper sets out how we will introduce a new personalised approach to employment support and engagement, with the aim of helping people to reach their potential and live a more independent life. We are investing in additional work-coach time and tailored support. The Chancellor also set out yesterday that we will introduce a new programme called universal support, which will provide wraparound support for individuals and employers, as well as additional money to provide more mental health and musculoskeletal treatment for this group.

Finally, we will ensure that people can access the right support at the right time, and have a better overall experience, by testing new initiatives to make it easier to apply for and receive health and disability benefits. I am certain that our White Paper reforms will support more people to reach their full potential and reap the health and well-being advantages of work.”

My Lords, I thank the Minister for taking this Question. The PIP assessment is designed for a totally different purpose from the work capability assessment, so my first question is this: how will the Government reconcile those two completely different systems? What will happen in future to people who do not currently receive PIP—those on the limited capability for work and work-related activity element of universal credit—and particularly those with short-term and fluctuating conditions? Unless it is the Minister’s intention that some 750,000 people will lose £350 a year, an alternative needs to be in place. What would that alternative be and what would it look like? Finally, do the Government believe it is fair that the hundreds and thousands of people with disabilities that prevent them even engaging in work-related activity should receive less financial support through universal credit than people who are entitled to PIP? If so, what is the basis for that justification?

I will attempt to answer the noble Baroness’s questions. However, I start by saying that, as she will know, these reforms are the biggest undertaken in a decade and have been years in the making, with our initial paper having gone out for a consultation in 2021.

The main answer is that we are very much focused on ensuring that more people are supported into the workforce so that they can enjoy the positive impacts of work, through a more simplified system. I turn to improving our services, which is probably at the heart of the noble Baroness’s question, in focusing on PIP. Putting aside the delays, which I realise we are making progress on, employment and health discussions, which are being tested at the moment, are led by healthcare professionals and focus on how we can help people to overcome their barriers to moving towards work. Furthermore, we have the enhanced support service and the severe disability group for those with the most severe health conditions, and we are developing the skills of our assessors to match people’s primary health conditions. These are game-changers and mark a significant change from the current system.

The Minister said that this White Paper has taken a long time to get here, but the rollout will not start until 2026-27, so I really hope that the Minister will provide assurance that a lot of the concerns raised by the disabled community will be addressed before it starts to roll out. Plenty of people would fall through the cracks—they are currently not receiving PIP but they are going through the WCA process—so what happens to them? The Chancellor said, with a great flourish, that sanctions will be “applied more rigorously” to people without a health condition, but many disabled people do not have a health condition, so what happens to them? The current level of sanctions causes distress and worse: the Government know that Jodey Whiting killed herself after her benefits were wrongly cut off, and the DWP was found guilty of five serious failings in her case. What will the Government do to ensure that benefits are not cut off from disabled and vulnerable people?

I will quickly pick up on the noble Baroness’s point about the Jodey Whiting case. Our sincere condolences remain with Ms Whiting’s family. The department is ready to assist the coroner with their investigation, but, as the noble Baroness will expect, I am not able to comment on active legal proceedings.

On the noble Baroness’s point about timings, we are deliberately rolling out this new definitive programme over a number of years, which will allow us to look at those who might fall through the cracks, as she put it. There is a lot of work to be done between now and 2027-28. The main thing is that we are investing in employment support for disabled people and people with health conditions, and we are stepping up our work-coach support across the country. That perhaps plays into another question: this takes time to put into place, but we are already recruiting for new work coaches, we are extending the work and health programme, and we are rolling out our new in-work progression offer to help people in work on universal credit.

My Lords, occupational health services up and down the country obviously play a vital role in helping disabled people to stay in work and in their quest to get back into work. However, large firms that have HR departments and other resources find it much easier to access occupational health services than small businesses and micro-businesses, so what can the Government do to help them? Also, am I right in saying that there is a national shortage of occupational health professionals? If so, what will the Government do about it?

My noble friend makes a good point: small employers are five times less likely to provide access to occupational health services than large employers. Only 19% of SMEs provide occupational health services for their staff. Bearing in mind that, as I said, this must be a game-changer, we have a number of supporting initiatives in place: developing the test for a financial incentive and market navigation support for SMEs and self-employed people; working with the occupational health sector to identify better ways to support development; and delivering a £1 million fund to stimulate innovation in the occupational health market.

My Lords, the noble Baroness, Lady Brinton, asked about sanctions, but I do not think that the Minister answered her, so perhaps I will ask the question in a different way. Can the Government guarantee that work-related activity will be voluntary for those receiving the health element?

It will be, but, as I mentioned to the noble Baroness, Lady Brinton, we have a number of matters to work through, which is why I have said that it will take time. Sanctions are part of this: for example, in November 2022, the universal credit sanction rate was 6.51%. Sanctions underpin conditionality and are a key part of a fair and effective welfare system, so it is right that a system is in place to encourage claimants to take reasonable steps to prepare for and move into work. We need to keep our eye on this.

My Lords, this is an odd White Paper because it misses out a whole chunk of the system: the link between education and benefits. The Government have just produced a paper that says they are going to do much better at identifying special educational needs. Here, I should remind the House of my interests. Reference is made on page 12 to all the neurodiverse groups. You would expect these to manifest in the education process. How are they going to go through? Are the Government requiring an education and healthcare plan? Will there be some other form of identification? How is this to be done? This is a long-standing problem that means assessors and lawyers make money. Can the Government tell me how they will disappoint these groups?

The noble Lord is right that this is another area we need to focus on, particularly those with neurodiversity issues or, indeed, autism. We have made progress in seeing more disabled people in employment but, as he will know, progress is not even. Groups such as autistic people are still showing very low employment rates—for example, only around 26% of working-age autistic people are in employment—so there is much work to do. This will be a factor in what we look at over the next few months and years as part of these new initiatives.

I am glad that the Minister mentioned autistic people. How will the proposals in this White Paper impact on people with learning disabilities? They probably have the lowest rate of successful employment of any group, with some 6% or fewer of adults in employment, and it is difficult to see how such a complicated system is going to help them. Can the Minister help?

I hope I can help the noble Baroness by saying two specific things. She will know that we have the national autism strategy, which was launched in 2021. As to what we are doing now with the recent announcements, it is very important to highlight our Disability Confident programme. It is incredibly important that we work ever harder to persuade employers to take on those with these conditions, because there is no doubt that many of them are able to work and can offer huge benefits to employers. This disability gap needs to be closed.

My Lords, having spent years of my political life supporting disabled people campaigning against the dreadful Atos and its application of the work capability assessment, I find myself with some surprise echoing the concerns we have heard from all sides of your Lordships’ Chamber about this proposal. My question to the Minister is a fairly simple one. James Taylor, chief executive of Scope, said in responding to this White Paper:

“The Government has got a mountain to climb to win back the trust of disabled people.”

Does the Minister agree with that assessment?

I certainly do not. Having said that, we are not complacent. There is an awful lot we have done, some of which I have mentioned already, for the disabled cohorts, and it is incredibly important that we do even more to encourage those who are disabled to come into work. Having produced some surveys, we know already that 20% of those who are disabled want to work, and actually, 4% of that 20% want to work right now. So there is an awful lot we can do, but the picture the noble Baroness has painted is neither fair nor accurate.