Employment and Support Allowance

Tuesday 10th May 2011 Westminster Hall

12:59

[Angela Smith (Penistone and Stocksbridge) (Lab)]

It is a pleasure to have secured this debate and to speak under your chairmanship, Mr Leigh. This is an important matter for many of my constituents. Employment and support allowance was introduced by the last Government to replace incapacity benefit. As we are all aware, it is designed to support people who are too sick or disabled to work full-time or at all, or who need significant retraining, and who meet certain conditions. The benefit is funded by the Department for Work and Pensions.

There are two types of ESA. Claimants may be able to get either or both, depending on their circumstances. The two types are contributory ESA, which is available to those who have paid enough in national insurance contributions, and income-related ESA, which is available to those whose income and capital are low enough. ESA claimants must be over 16 and under state pension age, unable to work due to sickness or disability and not entitled to statutory sick pay. Most importantly for this debate, they must satisfy certain tests. Between October 2010 and March 2014, all current incapacity benefit claimants will be reassessed under the new work capability assessment, rather than under the personal capability assessment used under the old regime. Work capability assessments are causing much concern among many of my most vulnerable constituents.

I think that all parties agree that our benefits system should screen out those who try to access disability benefits despite being entirely fit to work. However, disability benefits should not be used, as incapacity benefit was by the Tory Government in the 1980s, to manage unemployment numbers artificially. The work capability assessment has been in use for some time, and I am confident that I am not the only Member of the House being approached regularly by constituents who are angered by how it works, or whose disability benefits have been withdrawn after an assessment. Work capability assessments have been contracted out to a private organisation, Atos Healthcare, in a £300 million deal by the Government. Atos Healthcare is part of the Atos Origin group of companies, most noted for its IT outsourcing operations. It has Government contracts in the Home Office and elsewhere.

The assessments carried out by Atos Healthcare no longer take into account GPs’ assessments of an individual’s impairment or long-term condition, ignoring them in favour of a set of questions, which take an average of 15 to 45 minutes to answer, administered through software developed by Atos. The software requires assessors to ask a set of questions on which the applicant can score up to 15 points, putting him or her into the ESA support group. GPs, who in many cases might have known applicants all their lives, and who in any case have a good understanding of applicants’ medical, social and emotional status, are ignored by the new system.

Instead, a new set of individuals called health care professionals come into play. They are trained by Atos for an average of four to 16 weeks in understanding targets—that is most worrying—and the all-powerful LiMA, or logic integrated medical assessment, software. They are given time limits for each assessment and told that the more people they can see in a given period, the better it is for the targets. Health care professionals consist of physiotherapists, nurses and doctors. I am not saying that those professionals do not know what they are doing. However, they are bound by the software that they are operating.

Work capability assessments mean that under the new system, blind claimants who can get around safely with a guide dog can be forced on to jobseeker’s allowance, as can deaf claimants who demonstrate that they can read and write. Claimants who cannot walk but who can use a manual wheelchair will no longer score points. In addition, references to hands have been removed from the picking-up activity, specifically to make it harder for amputees to score points.

Some activities have simply been cut altogether. For example, the activity “bending and kneeling”, which I would have thought critical to determining whether an individual is fit for any kind of work, has been completely abolished for health and safety reasons, as people apparently should not bend forward when lifting. Perhaps most worryingly, half of all the scoring descriptors for mental health and learning difficulties have been removed from the procedure, making it much harder for people with depression, anxiety and many other forms of mental illness to get ESA.

A constituent recently visited my surgery who was assessed and passed as completely fit for work of any kind, despite the fact that she could not walk without crutches and could not stand or sit for long periods because the discs in her back had completely disintegrated. Because she could both stand and sit, she was classed as fit for work. Another constituent visited my surgery to tell me that the examiner told him that he had no problems moving, despite the fact that he suffered from rheumatoid arthritis. Good days and bad days are a feature of rheumatoid arthritis. On bad days, movement can be much more severely restricted. It is difficult to understand how such a bland, all-encompassing assessment can be made of an individual’s health needs. My constituent’s condition highlights a great concern about the tests, which is that they assess claimants only on a particular day and not over a period of time. That is important, because claimants with rheumatoid arthritis, multiple sclerosis and Parkinson’s disease all fall into a similar category.

In 2010, an independent review of the tests by Professor Harrington concluded:

“There is strong evidence that the system can be impersonal and mechanistic, that the process lacks transparency and that a lack of communication between the various parties involved contributes to poor decision making and a high rate of appeals…evidence has consistently and regularly highlighted problems with each stage of the WCA process, which limit both the assessment’s fairness and effectiveness.”

Atos’s own staff have said that the assessments are too harsh. Prospect, the trade union representing 135 Atos doctors, has stated that the target of seeing 10 or more people a day is unrealistic and will lead to inaccurate assessments, especially in complex cases. It should come as no surprise, then, that ESA appeals have increased by 56%. Figures rose from 25,700 in the second quarter of 2009-10 to 52,000 in the same quarter of 2010-11. Almost half of cases were overturned on appeal. Such a degree of failure is staggering and makes a powerful case for change.

Furthermore, the assessments do not consider the context of the claims or the claimants. A representative survey by Ipsos MORI compiled from a face-to-face survey commissioned by DWP found that nearly a third of those going through the ESA process were described as having literacy problems. A further 6% had problems speaking English, 11% had numeracy problems and 22% were described as being in one or more disadvantaged groups, including those with mental health issues, ex-offenders, and those with perceived learning difficulties. An overwhelming 69% of those going through the WCA had multiple health conditions. That is greatly similar to other assessments, such as for special educational needs, which are often made more difficult by multiple health conditions. I acknowledge that that makes it hard for assessments to be as accurate as they should be. It underlines the case for changing the procedure, which is too simplistic and inaccurate.

Those in the support group and in the fit-for-work group had the same number of health conditions, namely 31. In all groups, 81% of people were receiving medical treatment for their condition, with 38% waiting for hospital or additional treatment. Those statistics do not suggest to me that we are dealing with a set of fraudsters pretending to be sick or disabled, or a set of individuals who have been languishing on incapacity benefits for years. In fact, 71% of applicants for ESA were new claimants making their first claim.

Evidence is mounting that the entire process is likely to cost the taxpayer more than the original benefits bill that it is designed to cut. The cost of Atos contracts, tribunals and additional health care caused by the misery and failure of the work capability assessment adds up to higher long-term costs, yet it is all being done under the guise of state efficiency. Despite the overwhelming evidence that WCAs are not working as they should, Atos was awarded a further contract by the Department for Work and Pensions in 2010.

I do not want to be tribal about this. I am perfectly aware that it was the Labour Government who introduced the new system. I am not interested in blame, but in seeing what is wrong put right. I am not saying that people should just be left to rot on ESA. I know all too well, from my own family history, what incapacity benefit did to people’s mental health when they were thrown on to it after losing employment in the 1980s. Nor am I saying that it is not right for the state to make sure that only those eligible for the benefit should get it. There is no doubt—the evidence is indisputable—that people who are on ESA, or who were on incapacity benefit before that, for a period of time are more than likely to spend the rest of their days on it, and that is wrong. It always has been and always will be wrong. What I am saying is that the system that has been put in place is not only unfair in how it assesses disability, but too rigid and inflexible. It does not take into account the needs of individuals, and it is more about saving the Treasury money, ironically, than helping the individual.

Another constituent came to see me recently, because he had also been refused ESA. He was a manual worker—a printer—and that was all he knew, in terms of work. He had been in printing all his life. He had emphysema and had suffered a heart attack, which, as I think most of us would agree, would make it very difficult for him to do manual work again. Anyone who knows anything about emphysema will say that it is a disease that kills and that tends to kill slowly, disabling the individual suffering from it in the process. Those of us who live in the old coalfield areas and in steel communities know all too well what the disease can do. It is terrible. I know, because I have seen members of my family suffer from it. It is a shocking, awful disease.

My constituent needed help to train to do something else. He may only ever be able to work part time, and certainly not in the job that he had been used to all his life. It also has to be said that my constituent desperately wants to go back to work. However, because of the way in which the current system is set up, he was refused ESA and forced to go on to the jobseeker’s allowance, and he is now being chased to take any job that comes along, regardless of the potential long-term impact on his health condition, emphysema. There is no support for retraining, which is what ESA should offer, and no recognition of the fact that he, a manual worker, is no longer fit to engage in that type of work. That is not acceptable. We need a much more flexible view of how we help people who often have multiple health conditions and who need help, not punishment. Significant investment would be required, but in the long term I am sure it would pay dividends by way of increased numbers of disabled people back in work and reduced health costs. I look forward to hearing the Minister’s response on that point.

I also seek a response on several other points. I would like confirmation of when each of the 25 recommendations in Professor Harrington’s report will be implemented, including a change to the form for claimants that would allow them to describe in detail how their symptoms and why their condition make it difficult or impossible for them to work, and allowing them to receive a summary of the report on them that Atos submits.

Will the Minister give us details of what the implementation will mean? How will DWP ensure that the assessment is carried out in accordance with the recommendations and, in particular, is improved to be fairer and more accurate for people with fluctuating conditions? That includes what happens to disabled claimants and those with long-term conditions who drop out of the process. Finally, why has the migration of the 1.5 million people on incapacity benefit already begun without the implementation of the recommendations to which I have referred?

This is a debate of immense importance for disabled people throughout the country and for workers who, for one reason or another—usually because of the form of work in which they have been engaged—have ended up with lung or heart conditions and so on. The issue is important and is causing a great deal of distress. I await the Minister’s response, particularly on when Professor Harrington’s recommendations will be implemented.

13:16

[The Minister of State, Department for Work and Pensions (Chris Grayling)]

I congratulate the hon. Member for Penistone and Stocksbridge (Angela Smith) on securing this debate. It is a useful opportunity to put on the record, once again, the things that we are doing to make sure that this is a proper, fair and appropriate process.

I should like to correct the hon. Lady on a number of things that she has mentioned where she has not got her facts right or is a little out of date. First, however, I pay tribute to her for referring to the fact that it was the previous Government who introduced this system. She has set out in detail the context for the changes that we are putting in place. I agree with her that the system that we inherited was not adequate. It did not do the job properly and in many cases led to wrong decisions about individuals. I and my colleagues in the Department for Work and Pensions have spent the past year trying to sort all that out, so that we were ready for the start of the migration process. I shall explain to the hon. Lady in some detail how that was done.

I shall begin by picking up on some of the points made about Atos, the contractors. The hon. Lady mentioned that Atos was contracted, but, as she knows, it was contracted originally by the previous Government. We have not sought to change the contracting arrangements because, frankly, it would be massively disruptive to do so in the middle of the process. What we have sought to do is address the issues surrounding Atos that have led to concerns being raised. Let me be clear—Atos has no financial targets. A myth has been circulating for some time that our contractors are incentivised to find people fit for work. That is absolutely not the case and I am happy to put that on the record.

It is also not the case that there is a target of seeing 10 people a day. The only indicators and targets that Atos has relate to the quality of the work that it does for us. We have been careful to make sure that that is the case. It would be absolutely inappropriate to have a situation in which a third-party contractor was incentivised to reach a particular outcome in an area as sensitive as this. The hon. Lady can be reassured that that is not the case.

Before moving on to the details of the Harrington review, I shall address the hon. Lady’s query about the internal review, which was carried out by the previous Government, which made a number of recommendations to us, and with which we have decided, after much thought, to proceed. The internal review was carried out over the last 12 to 18 months of the previous Government. It looked at how the assessment was working and made a number of recommendations about changes. It did a number of things in particular, and there are two or three reasons why I decided to accept the recommendations of the previous Government and to implement that set of changes—they were introduced at the start of last month—to the assessment. The first of them related to mental health. The hon. Lady is not right on the mental health issue. This is a matter of great concern to me. I am acutely aware that mental health problems and fluctuating conditions are crucial, as she rightly said. Getting them right is fundamentally important. They are the most difficult areas of health challenge to deal with as we go through the assessment process.

We looked carefully at the impact that changes to the assessment recommended by the internal review would have on people with mental health conditions. The assessment we have carried out shows, in fact, that more people with mental health conditions will find themselves in the support group with long-term unconditional support than would have previously been the case. The set of changes we have just introduced should increase the number of people who receive ongoing unconditional support for mental health conditions. That seemed the right thing to do.

The second thing we did was to address the fact that people in between periods of chemotherapy could, theoretically, be found fit for work. We did not think that that was right and therefore we have excluded people who are in between courses of chemotherapy from any kind of return-to-work process, as well as those involved in chemotherapy at a particular moment in time. Again, that seemed the right thing to do.

On the change the hon. Lady referred to in relation to people who are blind, partially sighted or in wheelchairs, we had a situation that was inappropriate and wrong. Let us think of the motivation behind these changes. Fundamentally, we are trying to help people with the potential to work to get into work and not end up spending the rest of their lives on benefits. The internal review highlighted that, under the previous system, if someone was a Paralympic athlete with a university degree, there was no obligation for them to look for a job. That is not right. Some people who are blind or partially sighted and are out of work have long since adapted to that condition and have worked before. They should be looking for another job and it is wrong to say that that should not be the case simply because they are blind or partially sighted. I am not suggesting that that is what the hon. Lady was saying, but that is what the previous system provided for. We have introduced an adaptation factor into the assessment, so that a judgment is made about how well somebody has or has not adapted to their condition. That factor will have to be considered.

I want to give the hon. Lady more detailed context on the way in which that consideration now takes place. Over the past few months, we have made big changes to the whole process precisely because of the kind of issues she has rightly identified. I have no interest whatsoever in putting anybody who is not fit for work into a position whereby they are being pushed towards trying to find work. That is not in our interests as Ministers, as a Government, as individuals or as a society. Indeed, if somebody is not fit for work, an employer will not hire them, so we would achieve nothing from such an approach.

We inherited the internal review and looked at its conclusions, which we have implemented. We set up the Harrington review precisely because we had concerns of the kind that the hon. Lady has raised. She has rightly looked at the Harrington recommendations, of which there are 25. As we stand here today, all the recommendations bar, I think, two have already been implemented and the other two are due to be implemented by the end of this month. By the time we get to the point in June when the first big wave of people will be reassessed as part of the incapacity benefit-employment and support allowance migration, all of the Harrington recommendations will be in place. The ESA50 form has already been updated and the various other recommendations have all been put in place. I reassure her that there is no question of waiting for a point much later in the year before all that happens; it is happening now. When Harrington provided his recommendations, something I insisted on with officials is that we cracked on and delivered these changes, so that they are in place for the IB-ESA migration.

The most important of Professor Harrington’s key recommendations was about the decision-making process. We had a situation whereby, up until the past few months, the final decision about whether somebody was found fit for work was technically taken by a decision maker who was a senior member of staff within Jobcentre Plus. Those members of staff had tended to view the outcome of the Atos assessment—the work capability assessment—as gospel because it was carried out by a health care professional. They thought such assessments just had to be rubber-stamped.

We have changed that totally and have created a process through which the decision makers are told not only that it is their decision, but that they have to look at other evidence—for example, the hon. Lady referred to GPs’ evidence. Our decision makers are expected to look at other medical evidence submitted by the individual concerned and at the GP’s and consultant’s comments to form a rounded view. Indeed, if they believe that they do not have enough evidence, they have the freedom to go back and ask for more. That is a big change. We have effectively downgraded the role of the work capability assessment in the process. It is an important part of the decision, but it is no longer the only part of the decision. That will make a big difference.

Professor Harrington highlighted precisely the situation the hon. Lady identified surrounding mental health conditions. That issue is a hugely complex and sensitive area that needs to be dealt with carefully. Within the Atos health care professional network, Professor Harrington recommended that we introduce mental health champions to whom the assessors can turn for advice if they are uncertain about how to react to particular responses. Those champions are already in place. In fact, we have gone back to Atos and said, “We’d like some more of them please.” The numbers will be increased by the early summer. I am very keen to ensure that we provide a proper focus on and expertise in the mental health field.

[Guto Bebb (Aberconwy) (Con)]

On the decision makers and support for mental health, could the Minister provide some numbers and the geographical basis of those numbers, because it is an issue of real concern in north Wales?

[Chris Grayling]

In terms of the mental health champions, there are I think about 50 in the network. The number will rise further and is rising; they are being recruited all the time. By the time the process is finished, there will be one champion for about every two to two-and-a-half assessment centres. Someone will be constantly on call. In some cases, those champions will be present and, in other cases, they will be at the end of a phone line. The hon. Lady made reference to the Harrington recommendation on the individualised statement—the summary of the assessment. We want the champions to be involved when the individual concerned picks the phone up and says, “I’m not quite sure about this.” That view can be reflected in that statement, which will be introduced later this month. So that recommendation will have been dealt with as well.

[Angela Smith]

I am very pleased with the fullness of the Minister’s response, but will he comment on the situation that threatens individuals with long-term and sometimes terminal conditions, such as emphysema, who may be fit for some form of work, albeit only for a few hours a week? Those people are currently failed by the system.

[Chris Grayling]

I will come on to that because I want to make another point in response to the hon. Lady’s question about fluctuating conditions. Professor Harrington is currently working on that to see if there is anything else we need to do. However, we are trying to ensure that there is expertise within the Atos network of individuals and that training is provided to both decision makers and Atos professionals about fluctuating conditions.

On the hon. Lady’s other point, a crucial part of this jigsaw puzzle is the Work programme that will start in about three or four weeks’ time. That programme is designed to provide specialist support for precisely the kind of person she has mentioned. She said that the person concerned wants to work, but that he clearly cannot work in the job he had before. If we put him into the sickness benefits environment and leave him there, he will probably never work again. We can offer him the opportunity to have specialist support through the Work programme, with providers who are contracted on a payment-by-results basis and in a system where we pay different amounts for different levels of challenge. For example, somebody who is coming off sickness benefits will command a higher tariff than somebody who is a conventional job seeker without sickness challenges. The aim is to encourage the providers to work with somebody in that position to find a job that he can fulfil.

I do not regard it as acceptable—I am sure that the hon. Lady and I share this view—to have a situation whereby anyone who has the potential to work is parked on the sidelines and is unable to get the support that they need to get into work. From our point of view, the most fundamental part of the change is not to try to find people who cannot work fit for work. Indeed, those who end up in the support group—the group that needs ongoing unconditional support—will get more money as a result of the change.

The key goal is to identify those people who have the potential to return to work so that, through the Work programme and other support provided by Jobcentre Plus, we can give them the help they need to get into the workplace. That is what this is all about. We will do our best to get it right, but I am sure that we will make some mistakes along the way. We have introduced a reconsideration stage at Jobcentre Plus to try to ensure that we catch our mistakes early. However, it is important to realise that this is all about helping people who could work to do so. Otherwise, the only alternative is for them to spend the rest of their life on benefits, and I do not believe that that is in their interests or in any of our interests.