19:33 - Division on Amendment 50E - Ayes: 213 / Noes: 229 - Amendment 50E disagreed.
Lord McKenzie of Luton
My Lords, we have strong sympathy with these amendments, spoken to so effectively by the noble Baronesses, Lady Meacher and Lady Finlay. We had a bit of a canter around this issue in Committee, focusing particularly on 16 to 24 year-olds. I took from that debate, and the Minister may take the opportunity to confirm or deny it, that there is potentially scope within the Bill for a regulation not to require 16 year-olds inevitably to move towards PIP. If that is not the case, it is important that we clarify it, because it impacts on how we approach the amendment.
A number of questions have been posed which I should like to emphasise. The first is whether the Minister contends that the PIP assessment as currently constructed is fit. Does he believe that it would be appropriate for most 16 year-olds? The assertion is that it is not. Another issue is the extent to which there is alignment of ages for a range of things—the UN convention certainly, but care generally and education and training. Would it not be better if that alignment were brought into effect also for the purposes of the PIP and the DLA cut-off?
When somebody aged 15 is about to become 16, that is the point at which things change on the DLA journey and we move into a somewhat different regime. If somebody reaches that once PIP is up and running, do they inevitably have to apply and go through the PIP process at that point, or is there an opportunity for them to remain within DLA or perhaps migrate at a subsequent point? Otherwise, there is a real risk that these young people will the first to test the new PIP arrangements. What is the technical position there? Does somebody who wishes to make their first claim after the age of 16 have the route only to PIP and not to DLA? Would somebody currently claiming DLA necessarily be denied the opportunity to continue with that until, perhaps, the migration plan has run its course? I thought part of the noble Lord’s response to our Committee debates was that you could deal with this in part by the way people in the DLA system migrated towards PIP. One way of dealing with some of the issues that have been very validly raised in this amendment would be to use that flexibility, if it exists. If not, it seems doubly important to lock into the 18 year-old cut-off point, which is being pressed.
Lord Freud
My Lords, I welcome these amendments tabled by the noble Baroness, Lady Meacher, and the noble Lord, Lord Patel. They allow me just to go through how the Government intend to introduce PIP successfully for young disabled people from the age of 16. Clearly, the central question is whether 16 or 18 is the right age. In one sense, all ages are a little arbitrary here. Adulthood is defined at different ages in different contexts. The key to the decision to start PIP at 16 was based around the assessment criteria and at what stage people fit in with those, in terms of the activities that they can undergo and how we can look at them. When we looked at it with a range of experts, we concluded that you would normally expect individuals without disabilities to be able to carry out these activities independently from the age of 16. For example, you would expect a 16 year-old to be able to wash and dress themselves, to communicate with others, to plan, and to follow and make a journey. It is the age at which, currently, you expect individuals to be able to be employed full-time. There is a general expectation that they have the capabilities of adults.
The group looked at whether you would expect even younger people—I had better use that word now, rather than adults or children—to fit this assessment. They concluded that children go through several developmental stages under the age of 16, and they do that at uneven speeds. So, there was a cut-off in developmental terms between the two stages, for the purposes of this test, at 16. The other way of looking at this is that it is about trying to move people into adulthood and independence. A lot of these youngsters are living in their households but need to move to independence. Having their own independent help and their own funding in PIP at that age matches their aspirations to move into adulthood, and allows them to make their own decisions about aspects of their lives.
This is an area where, as we described in our policy document, we have set out our intentions and outlined the key principles that we have debated and agreed with stakeholders. We have set up a subgroup of the PIP implementation development group specifically to help and inform the design and testing of the new system in relation to disabled young adults. Together with the focus group work and the interviews that we have held with disabled young people, their appointees and representatives, this is the process that we have under way to get the system right. One of the most important areas where we are using the development group is around the question of how we look at the process of moving people into the 16 category and how we signpost, communicate and get awareness of the changes and then join up the support for disabled young adults and their families.
Clearly, this is not the only testing that disabled youngsters undergo in this phase of their lives. There are a number of assessments as they move from childhood to adulthood. We will ensure that all young people claiming PIP or moving on to it at age 16 have the appropriate support to allow them fully to express their needs. We know it is important that they have a parent, an advocate or a friend to accompany them to that face-to-face consultation. We are not changing anything in terms of DLA in this area. We are changing a lot of things by moving DLA to PIP, and we will be discussing some of them, but in this area we are sticking with the same age as the existing DLA arrangements.
There was an anomaly that the noble Baroness, Lady Meacher, tried to pin me down on and defied me to find a good explanation for. I have been challenged and I shall do my best. On the point about the difference between the universal credit at 18 and PIP at 16, the blunt answer is that these are different benefits for different purposes. It is important that we do not think of PIP as an income supplement; that is not what it is, and nor is it for someone who is out of work. PIP is a payment to people who are disabled who will always need extra money to live because their costs of living are higher, and we will pay it regardless of whether people are in work or out of work. That is why it is a different argument. By giving PIP earlier, we are giving youngsters their independent funding to run their own lives from that point—not from the point when they are meant to be in the workforce and fully independent—when, if they do not have a job, they will need an income supplement. That is the difference. I hope that I have risen to the challenge; I am sure that the noble Baroness will say that I have not, but I have done my best.
We are working closely with the Department for Education to explore evidence gathered so that we can have a single assessment for an education, health and care plan that can be used to support a personal independence payment claim. We are trying to get rid of all the multiple assessments.
Baroness Meacher
Does the Minister accept that there are a lot of people who are very worried about this shift? The reality is that many of them who might have been entitled to DLA will not be entitled to PIP and will therefore lose out. They will also lose out on the disability additions. There is quite a big financial consequence here.
Lord Freud
I accept that there are concerns but one has to stand back. We are spending £12 billion on PIP in real terms, which is the same as the spending in 2009-10. The talk about a big cut refers to a big cut of a projection—the 20 per cent. I want to reinforce that point. In this House we should not get carried away with the simplicity of the big cut. It is not a big cut. With PIP we are trying to direct scarce resources, at a very difficult time, to the people who need them most. That is the purpose of it.
One of the other things that is happening—and is probably the biggest difference in emphasis between DLA and PIP—is that PIP is trying to take account of people with mental health problems in a way that DLA finds much harder. That is why the assessments and activities that are looked at are very different. Therefore, PIP is different and there are changes. Some people will lose out but they are the people who need the money less. That is the point of making the adjustment. However, the overall sum remains that £12 billion.
To pick up the point of the noble Lord, Lord McKenzie, we have the power and flexibility to treat 16 year-olds differently. This includes different assessment processes during the migration period. We are working actively now with children’s groups to make sure that we have the right migration strategy for youngsters and to finalise it. We will publish that approach. It is not a settled matter, which was, I think, the noble Lord’s real question. We are working very hard to get it right.
Let me deal with some of the amendments. Amendments 57, 58, 50ZGA and 56ZC would prevent our abolishing DLA for those aged 18, and potentially limit our flexibility by imposing statutory duties that would be less able to respond to change, especially as we refine and improve processes as a result of feedback and our experiences. It is very important that we have that flexibility. One of the things that we will discuss later this evening is feedback and the amount of research that we will carry out on a continuous basis. Clearly we want to incorporate that into how we apply PIP, particularly for youngsters.
This is very technical but I need to make it clear that the Government consider Amendment 56ZC to be consequential on Amendment 50ZGA; and, separately, Amendment 58 to be directly consequential on Amendment 57. I do not want any misunderstandings later, although the noble Baroness, Lady Hollis, is not in her seat at the moment to give me a piece of her mind. Given the reassurances that I have given the noble Baroness, and the technical limitations that the amendments of the noble Baroness, Lady Finlay, would impose, I hope she will withdraw her amendment.
Baroness Finlay of Llandaff
If the amendments which the noble Lord, Lord Patel, and I have tabled would be more restrictive, does the Minister now have more powers to make regulations to exercise discretion in relation to people of different ages? Does this discretion remain wider by not including our amendments where an age group is highlighted?
Lord Freud
This is a framework Bill. There is a lot of potential flexibility as we set up the regulations, particularly in this migration period, as we move into them. This flexibility would be denied by these amendments.
Lord Brooke of Sutton Mandeville
My Lords, I hesitate to intervene, but are things said subsequent to the Minister sitting down clarifications of what had been said before? If not, are they in order?
Lord Freud
My Lords, I start by picking up the point that the lower rate is being thrown out so everyone on the lower rate will no longer get DLA or PIP. That is absolutely not the structure of what is happening. We are looking at the needs of people from the ground up and designing a support mechanism in PIP to look after people who have disability needs. Clearly, anyone who needs support, on the grounds of a rigorous and consistent assessment, will get it. Many of those people will get more. In fact, we think that the proportion of people who will be in the group with the greatest need, in the highest group, will rise under PIP compared to those in the standard group.
The difference between PIP and DLA is that we are trying to strip out the complexity of all the different rates and boil it back down to eight rates—by the time you take the two components on the two different rate levels. The amendment replicates the complexity of the structure of DLA and moves it back up from eight to 11 components, making it more difficult to administer coherently.
I pick up the specific point made by the noble Baroness, Lady Grey-Thompson, on the Dilnot review, and reassure her that the DLA reform proposals published in April 2011 were shared with Andrew Dilnot’s review of long-term care funding, which was published a couple of months later in July. Andrew Dilnot said that universal disability benefits should continue, based on need and not on means. We are doing PIP exactly on those grounds—it is not means-tested but based on needs. He did not say that that benefit should go on unreformed.
We have designed the PIP assessment criteria to take broader account of the impact of disabilities than simply care and mobility, which are still of course very important factors. In our most recent draft of the assessment criteria—I remind noble Lords that we are still consulting on this process; this is work in progress and we are still listening very hard to the responses that we are getting—care and support needs feature very strongly. If someone needs attention with things such as washing, bathing, going to the toilet, dealing with medication, cooking food and eating, that is taken into account. We have amended the draft assessment criteria so that they now include supervision, whereas before they just considered whether someone needed assistance and prompting.
Baroness Browning
I am sorry to interrupt my noble friend. On the point about scarce resources, I think we all understand the financial situation and the imperative to reduce the deficit. However, if people who are currently on the lower rate of DLA lose it—a point made earlier in the debate—they will not just carry on with life as it is. If we accept that these people do not claim DLA without a need for it, then we accept that they have a genuine disability and that the lower rate of DLA is factored into their weekly budget. If it is then decided that their case is not as important as someone else’s and that that person might need the DLA, that is going to have an impact. Earlier, the point was made that if you take away the lower rate of DLA from a lot of people with a wide range of disabilities, there will be consequences for their health and well-being, which will translate into a financial cost on the public sector. Will my noble friend consider undertaking a cost-benefit analysis of that consequence?
Lord Freud
My Lords, I have two answers to that question. The first is that people who need the support because of a disability may happen to be on the lower rate of DLA today but that does not mean that they will not be entitled to the standard rate in the future. My noble friend gave an example of people who are really dependent on that funding. I would expect in those circumstances that it would continue. Indeed, I would regard PIP to be a failure if it did not do that. Secondly, we will be monitoring that really closely. As I have discussed, later this evening I will present an amendment to make sure that we properly monitor what happens in this area and make sure that PIP does what it should be doing, which is to stop people ending up in the situation that my noble friend is so concerned about.
I must point out that if we move to a three-tier system on the daily living component, the implications are that the caseload would be larger—possibly larger than that under DLA—and spending would increase rather than decrease against the original and revised forecast under the personal independence payment. We cannot possibly quantify such expenditure implications, mainly because we have not yet set the rates at which benefit is paid, but the implications are there. I want the House to be under no illusions that they would be anything but significant.
Before I ask the noble Baroness to withdraw her amendments, I would like to confirm that the Government see Amendments 50ZGH and 50ZJA as directly consequential upon Amendment 50ZGB. On that note, I beg the noble Baroness to withdraw the amendment.
Baroness Grey-Thompson
My Lords, I thank the Minister for his response. I have to say that I am disappointed. I am also concerned and gravely worried for a huge number of disabled people. The tiny spark I take out of his comment is that he says he is listening. That is positive. However, there are lots of ways in which spending will increase if we push disabled people into poverty or do not give them the right support they need. We will be making massive, long-term mistakes for the rest of those disabled people’s lives. It is not a small number of people. It could be up to 500,000 disabled people—half a million disabled people could be affected by this.
I am keen to keep pressing the Minister to ensure that the outcomes of disabled people losing the lower rate of care will be monitored throughout the rollout of the PIP assessment because, whatever way you look at the maths, there will be people who lose out. It is a big mistake to see this as a deadweight expenditure. You only have to look at our postboxes or e-mail inboxes —in the past two days, I have had nearly 600 emails from different disabled people saying they are terrified of the changes that are going to happen.
It is really important that the assessment process properly records whether losing DLA has a negative impact on the health of disabled people or their ability to work. We have a long way to go on this. Very reluctantly, I beg leave to withdraw the amendment.
Baroness Howe of Idlicote
My Lords, I shall speak briefly on this amendment. The comments of the noble Baroness, Lady Browning, about her personal experience of the whole range of autism reminded me just how this range has developed over the years. When I first got involved with the autistic movement many years ago, it really was just one thing; but since then, many different branches and forms of behaviour have been identified. The fact that all these extra aspects have to be borne in mind re-emphasises the whole question of whether the clause is fit for purpose. In particular, the Asperger’s syndrome comment was very apt. I hope the Minister will be able to persuade us that there will be a thorough method of assessment by people who understand the range of problems that we are talking about as well as—as my noble friend Lady Mar said—the detailed and different ways in which extra help is used and needed for such people to have a basic ability to lead a normal life.
Lord Freud
My Lords, let me start by referring to the moving speech made by my noble friend Lady Browning. I confess to a real concern about autism generally and I am very proud that my maiden speech was on the Autism Bill. I have undertaken a number of initiatives in the autism area because we do not look after people with autism and Asperger’s properly. I also strongly believe that it would not take a huge effort to make sure that we look after those people much better. As my noble friend knows, there is currently a major initiative to try to ramp up the number of such people who have and keep jobs. Currently only around 15 per cent have jobs, which is ludicrous, and I am determined to double that figure.
As part of that concern for this particular group, we wish to make sure that this assessment takes people with autism and with Asperger’s properly into account. I am hopeful that PIP will do a better job than DLA, and, furthermore, that we will make sure that we have the right processes in place to look after this group. As we refine processes during the next consultation period, which we are running until the end of April, one of the things that I want to make absolutely sure of is that we have the right measures in place for autism. I know that everyone in this Chamber feels similarly on this issue, and feels very strongly that we should get this right for that particular group.
I shall now turn to the more technical aspects of this issue—that is, looking at what we are doing with the PIP and its assessment. Is it a medical assessment, as the noble Baroness suggested? It absolutely is not. In fact, as I said in Committee, our approach is—and this is rather a mouthful—akin to the biopsychosocial model. I shall try to draw this out a bit—I do not mean in time: I shall try to draw the themes out. A medical assessment would be something like the industrial injuries disablement benefit, where there is a direct correlation between the injury sustained and its severity and the amount of benefit or compensation received. Nor will the PIP assessment focus on the functional limitations of the individual in the way that the work capability assessment does. Instead, it will assess how the individual’s health condition or impairment impacts on his or her everyday life by looking at their ability to carry out a series of key and holistic activities, all of which are essential for participation and independent living. In such an approach, the type of condition or impairment an individual has is of limited relevance.
It is not, however, a full social model assessment. I accept that. That is something that many noble Lords and disability organisations would like, but I have to point out that it was not our intention to develop it in this way. As a department, we do support the social model. As the noble Baroness, Lady Wilkins, said, we are on record as supporting it. While we want to ensure that the PIP assessment better reflects it than previous assessments, that does not mean that the full social model is relevant for assessment, although it is relevant for some things. I sent round a rather interesting piece of analysis to many noble Lords in the Committee, called Models of Sickness and Disability, which showed the differences between the models, explaining the medical model, the reaction of the social model against the pure medical model and the synthesis of the biopsychosocial model. The summary of the biopsychosocial model in the analysis is that:
“Sickness and disability are best overcome by an appropriate combination of healthcare, rehabilitation, personal effort and social/work adjustments”.
There is a coherent theory behind this assessment.
Baroness Browning
Will my noble friend confirm whether, when people on the autistic spectrum are assessed, there will be somebody present as part of that assessment who is expert in cognitive specialisms?
Lord Freud
People will be able to bring anyone with them to the assessment, whether it is a parent, adviser or anyone else. For the WCA, the person doing the assessment can call in that support where they need it. We are now entering the consultation phase on the PIP assessment. Wrapping in that support will be one of the elements that we will look at. I accept that the assessor needs to understand how those factors reduce the ability of the person in front of them to run their lives.
Baroness Browning
It has been suggested—I hope that this is an opportunity for my noble friend to put this straight—that the assessor will be able to call somebody on the telephone in making the cognitive assessment. I hope that he is able to assure me tonight that that is not the case.
Lord Freud
Clearly, the system will be elaborated and developed, and we are at an early stage. Although the WCA is a very different test from the PIP assessment, one of the useful lessons that we have drawn from Professor Harrington’s recommendations for it is that mental health champions are available on site for assessors. That is the way in which that test has developed, and there are some valuable lessons there for when we look at how we elaborate the PIP assessment.
If we were to go with the full social model assessment along the lines suggested by Scope, looking at the full range of factors that potentially cause barriers and cost, it would require a very long, intrusive and costly assessment, putting significant cost burdens on the state and, more importantly, very large burdens on the individuals involved. They would also inevitably require much more regular assessment, as the social factors that would be taken into consideration would change more regularly than the impact of a health condition or impairment. You might, for instance, get to the ludicrous position where every time a local bus service changed, you would have to do a reassessment on that model. In meeting after meeting with noble Lords, I have been left under no illusion that having too many reassessments is one of the things that they dislike the most. We will try to provide later on some reassurance that there will be decent gaps wherever possible between reassessments.
The situation could go very dramatically the other way and lead inevitably to inconsistency, with factors considered varying from person to person and affected by local factors or service provision. With PIP, we are looking at something that is universal and where entitlement is based on the same criteria wherever individuals are and whatever their circumstances. This discussion carries echoes of our ring-fencing debate earlier today in relation to the Social Fund. If we move to a kind of local needs-testing, which is what the amendment implies, it would be at odds with how we deliver a national benefit. Clearly, we could do something else. We could localise it as a benefit, but then it would be a very different benefit. I suspect that many noble Lords would be very concerned about moving in that direction.
Most importantly, we think that a social-model approach would be more subjective. Benefit entitlement needs to be based on clearly defined and transparent criteria which we need to be able to set down in legislation and apply to individuals consistently, whatever their circumstances and wherever they are in the country. If you cannot do that there would be a level of unfairness and uncertainty, high levels of appeals and a system in disrepute. Under the type of assessment proposed, it would be harder to define the criteria that individuals would be assessed against and less clear whether they had met the thresholds for entitlement.
Finally, we do not think that an assessment along these lines would allow us to control expenditure and keep that benefit spend sustainable, making sure that it goes where it is needed most. I do not think that I can really reach a figure on how much it might cost, but our estimate is that it would be very substantial.
Although the social model approach is superficially attractive—and I emphasise that we support it in many ways—we have decided that it is not the right way to go with this assessment. We have not gone for the medical model; we have gone for the biopsychosocial model. That model has now garnered very significant academic support, as those noble Lords to whom I sent that very interesting piece of research will recognise. It recognises the diverse range of biological, psychological and social factors that impact upon an individual and cause variation in need. We think that approach—of looking at activities and outcomes—matches the requirement.
The Countess of Mar
My Lords, I wonder whether the Minister can answer a question for me. I made a particular point about people having very special needs such as extra heating and incontinence pads, for example. If they are leading a fairly normal life but would be restricted to their homes because they cannot pay for things, will this be taken into account in the PIP assessment? I could not see it anywhere when I read the details. How are these facts going to be elicited when the person is being assessed? People do not fit into boxes—everyone is an individual. It seems that the noble Lord is trying to make people fit into boxes when they do not.
Lord Freud
We are very much trying not to make people fit into boxes. We are not saying, “Because you have that condition, that’s your relevant position”. We are trying to look at people as individuals. Clearly, you go through all these criteria very carefully and reach a judgment. It is almost impossible for me to say whether a particular person would hit the assessment criteria or not. You just have to go through it and see. However, we clearly expect someone to get a payment who has genuine needs for coping with life because of their disability. That is what it is designed for. I cannot answer the specific question, but I can tell the noble Baroness the principle—where that person needs that support as a result of their disability, they should get it.
When we develop an assessment for PIP, we have to balance a range of factors. A complete model should include all the perspectives and important interactions between an individual, their health and the environment. That is what the biopsychosocial model does. There are limitations in considering only a single perspective, and this is a much more holistic approach.
I do not accept the criticism that our proposals do not truly reflect the extra costs faced by disabled people. As I have tried to explain, it would not be feasible to assess the actual costs without something hugely intrusive to disabled people and very complicated. We therefore have to assess other factors as a proxy for these costs. We are using “care” and “mobility” in DLA, which we do not think are broad enough. So, in our draft assessment criteria we have a range of everyday activities for PIP that we believe are a good proxy for the impact of impairments, the overall level of disabled people’s needs and the extra disability-related costs. We will go on refining those; we will not just stop when we finish the consultation in April.
The proposals have taken into account many of the key drivers of cost that Scope and others are obviously concerned about. For example, individuals who have difficulty getting out are likely to have higher utility bills, while those who need support planning a journey and moving about are likely to have higher transport costs. The proxies and associated criteria should therefore allow us to prioritise spend on those who face the greatest challenge and expense. In answer to my noble friend Lady Thomas’s point on the tick-box assessment, the proposals, which have been around since May, are very much not a tick-box approach; they are trying to look at people’s functional capability.
We have changed the assessment very considerably as a result of the enormous amount of engagement that we have with disabled people and their organisations. We will go on doing that. However, if we had fundamentally to revisit our approach in the way in which the amendment would require, we would have to go back to the drawing broad, spend more time developing and testing, and have greater consultation. It would push back the start of PIP by at least a year and reduce savings over the reassessment period by £1.4 billion. This is, I think, the priciest amendment yet.
Lord Freud
This is about doing the right thing for people and focusing money on them; it is not about playing silly games—by which I mean that we are not playing silly games here and we are determined to get this right. We are consulting widely and know that we have the right approach with the model that we are using. I understand the noble Baroness’s position, but we do not think that the Bill should specify that the assessment should consider social and environmental factors. That approach would be inappropriate and unworkable, because we need the assessment to be straightforward, objective and consistent. We would lose £1.4 billion of savings. For that combination of reasons, these amendments are not acceptable to the Government. Just for the avoidance of any doubt whatever, I confirm that the Government see Amendments 50ZJ to 50ZQ and Amendments 51A and 52A as directly consequential upon Amendment 50ZH. On that basis, I urge the noble Baroness to withdraw her amendment.
Baroness Grey-Thompson
I thank the Minister for his response. It is nice to know that, even for a short time, I might hold a record in your Lordships’ Chamber for tabling the priciest amendments. I also thank the noble Baronesses who have brought much personal and moving experience to this debate.
I apologise to your Lordships; in introducing the amendment, I did not declare that I am a recipient of DLA, although I am fairly unlikely to be on PIP. I realise that to many the social model turns into a philosophical debate but I felt that it was important to raise it again, as—
Lord Freud
My Lords, I feel that I should interrupt. I think that when the noble Baroness looks at the PIP assessment, she will find that she is on PIP—without doing an assessment myself.
Baroness Grey-Thompson
I thank the Minister and accept that I did not just go through an assessment process.
I feel that it is important to raise this issue again as a gentle reminder that the social model is written by disabled people using their experience. The noble Countess, Lady Mar, made the important point that you cannot fit disabled people into boxes. I tend to think that we are a little more like Venn diagrams. It is obvious to me that if the Minister were truly committed to helping disabled people, the full social model would be used. I recognise that there is a balance between costs and how far we want to go to help disabled people.
I share the Minister’s view on autism but I would like to widen the issue and hope that we will take all disabled people’s experiences into account. I look forward to seeing the refined process that he mentioned.
There is one point on which I agree with the Minister: the biopsycho model is interesting. However, that is as far as I can go. If we looked at the definition of “interesting”, he and I would probably differ considerably. Perhaps we could save that exciting debate for another time. I beg leave to withdraw the amendment.
Baroness Hayter of Kentish Town
My Lords, these amendments would improve the assessment process for the new PIP and allay the fears of many people with disabilities that the poor experience of the ESA assessments, where around 40 per cent have been successfully appealed, is not replicated under the new benefits system.
Amendment 50B relates to the training of those undertaking face-to-face assessments to ensure that they have knowledge of mental, intellectual and cognitive disorders, clear guidance about when to access more specialist advice, and a guarantee that such advice will be available. In Committee, we received some encouragement from the Minister who stated:
“Assessors will be required to have a broad training in disability analysis as well as training on specific impairments … we intend to ensure that they have sufficient training in mental, intellectual and cognitive impairments … and will stipulate this in our contracts”.—[Official Report, 16/11/11; col. GC 263.]
Perhaps the Minister could let us know what budget has been set aside for such training.
Amendments 50C and 50D would exempt certain people from a face-to-face assessment where sufficient evidence is available via other means. This would actually save money for the Government. I hope that the Treasury is listening. Implementing face-to-face assessments was to have cost about £675 million. The amendments would reduce the costs by removing from the process claimants for whom a face-to-face assessment is clearly unnecessary. This would help those with lifelong or degenerative conditions, for whom a face-to-face assessment could be stressful. For example, about half those with MS or Parkinson’s are receiving the highest level of DLA. Putting them through an expensive and stressful face-to-face test seems unnecessary.
Again, we received some assurance in Committee. The Minister stated that,
“where there is already sufficient evidence on which to make a decision … we completely agree … a face-to-face consultation should not be required”.
I hope that the flexibility would be there for that. However, he also argued that other than for those with a terminal illness,
“we do not agree that there should be different rules or processes for different groups of people … on the basis of impairment type”.—[Official Report, 16/11/11; col. GC 261.]
Yet, if the Minister is prepared to accept that those with a terminal illness should not be subject to unnecessary assessment, surely the same argument could be applied to those with degenerative conditions where there is no hope of improvement. We look forward to any assurances the Minister can give that unnecessary face-to-face assessments will not be necessary.
If he is not persuaded by me, perhaps he will be persuaded by someone of his own political background—the Mayor of London, Boris Johnson. I have never quoted from one of his speeches before. He writes:
“Evidence from the individuals GP and/or a consultant will provide an accurate assessment of need. It would be difficult for a healthcare professional in a one-off meeting to elicit a comprehensive response about the daily reality for each claimant. Face-to-face meetings … could prove … inappropriate for an individual who may have difficulty with social contacts, such as those with autism, or for those with an intellectual or mental health disability”.
This brings me to the first amendment in this group which would ensure that the assessment process always takes account of evidence from the claimant’s old healthcare professional. It builds on the experience of the work capability assessment for ESA and is to help the Government to avoid history repeating itself. Unfortunately, in this case, it would be as tragedy not farce. The problem with the current proposals is that they put the onus on the claimant to collect the medical evidence and also to have the knowledge that would be helpful to provide this. As we have seen with ESA assessments, it is exactly this that often leads to unnecessary duplication as a case is assessed and then reassessed in the light of the evidence from the GP or professional. The initial failure to consider such evidence has contributed to the very high and expensive success rates.
In Committee the Minister argued that while medical evidence could be of use, he felt that it was not necessary to gather evidence in every case. He said:
“In some cases what the claimant has already told us … will be sufficient. In other cases, information … might be likely to add only limited value”.—[Official Report, 16/11/11; col. GC 261.]
Surely it would be better to err on the side of caution, given the widespread inaccuracy of the ESA assessments and the need to ensure that the personal independence payments do not follow the same route. Medical evidence is bound to assist the decision-maker in far more cases than those in which it proves unnecessary.
This is a modest amendment. It seeks to ensure that the introduction of personal independence payments proceeds smoothly and more importantly to ensure that the right benefit is paid to the right people. I hope the Minister will accept this. Certainly it would have our full support.
Lord Freud
My Lords, I could summarise my speech in about three sentences. I am in agreement with virtually everything said in the Chamber. I hope that after my three sentences I will be able to provide assurances. My only point of real disagreement is that I do not want it to be mandatory—in primary legislation. This is in regard to the point made by my noble friend Lord Kirkwood that it reduces flexibility and we are much better off setting it up in regulations and guides and in the contracts. That is our proposed approach but fundamentally we are absorbing all the valuable points made on this group. I will try now with some speed to go through those assurances. I ask noble Lords to stop me with the precise assurance they want if I am not making the assurance well enough.
Amendment 50A was semi-withdrawn by the noble Lord, Lord Touhig, but I will try to deal with it because it is a building block. People being assessed can bring in someone with them—a relation, a friend or a professional—to help them. That is really important in the group we spent a lot of time on this afternoon relating to autism and Asperger’s. When people are over-bright their relation can make the point about the reality and the over-anxiety of the person being assessed. That would be an active role in the process.
I turn now to Amendment 50B. Clearly, we need to make sure that assessors have all the appropriate training to interpret the evidence that they are provided with. I have to make the point that it is not a medical assessment PIP. It does not ask the assessor to diagnose a condition or to recommend treatment options. It is different. It looks at how the conditions or impairments affect individuals’ everyday lives. That is a different skill set from that involved in treatment. There is not quite the same level of need for specialist skills but it is our intention that assessors will have a broad training in disability analysis as well as training in mental, intellectual and cognitive impairments. That level of training will be stipulated in our contracts with any providers and we will be responsible for signing off the training syllabuses. There will be occasions when assessors need more specialist support in the course of making these assessments. We will ensure that they have access to and support from individuals who have the in-depth knowledge that the noble Baroness, Lady Meacher, mentioned with regard to mental health conditions.
Baroness Browning
I am sorry to interrupt again. Can my noble friend give us any hope that when an assessment is called there will be any publication of the qualifications and background of the assessors so that the people being assessed at least have some view of what their expertise actually is?
Lord Freud
It is a nice idea. I do not think I will make an utter commitment to it here and now but it is a cute idea and maybe we should put it in the contract. I will take it away and think about it.
We do not think that we should prescribe this in the Bill or even in regulations because it is important that assessors have an understanding of the limits of their knowledge so they know when to bring in the expert advice. I think the noble Baroness, Lady Healy, got that absolutely right.
I will now go on to Amendments 50C, 50D and 50ZR. We know that individuals can have a wealth of material, knowledge and evidence that will help in the assessment process and we need to get the right material and evidence from them at the right time and we need to encourage that evidence to come forward. We will not create a two-tier system where the poorest and the most vulnerable have less chance of receiving benefit because they cannot afford to pay for the evidence. We are going to make sure that does not happen.
I want to pick up the very valuable point raised by the noble Countess, Lady Mar. If we have a mandatory process to involve the individual’s health professionals it may very well be an entirely nugatory and expensive process in the many situations where the GP is not up to date with what is happening. That is the inflexibility of having something in the Bill which adds nothing except cost. If someone who has a learning disability has not visited a health professional for many years, why go through the expense of getting evidence? It would be unnecessary; it would slow the process down; and there may be someone else whom we would not have thought of including in the Bill who is much better placed to provide information and evidence for the assessor. We need to pull out the cumbersome implications of the mandatory process—the point made so precisely by my noble friend Lord Kirkwood.
We have made it clear that face-to-face consultation should form part of the claim process for most—but absolutely not for all—claimants. Ultimately, consultation will play a key role in creating a fairer and more objective assessment. It needs to be done sensitively and proportionately, but where sufficient evidence is available, we are in absolute agreement that there does not have to be face-to-face consultation. There will be many examples where that is unnecessary.
We are talking about something very close to, if not exactly, the tiered process recommended by the National Autistic Society. That is what we are planning to adopt. We have flexibility in the Bill to do that.
The Countess of Mar
My Lords, I should have said this when I was making my initial speech. About 60,000 people with ME are either bedbound or housebound. To go to a face-to-face interview would cause enormous stress and probably exacerbate their symptoms. Will that be taken into account? They cannot provide medical evidence because there is no treatment; yet they cannot come out of their homes. How will the Minister deal with that?
Lord Freud
My Lords, one thing I was trying to get over about trying not to have a two-tier process so that the rich can get their evidence and the poor cannot, is that we turn the burden on to the assessors, so that when someone cannot come out, that requires a house visit if we cannot use paper evidence. There will be examples where paper evidence will do the job; where it cannot, the onus is on the assessor to do the checking, rather than the other way round. That is how we will provide that protection.
I hope I have gone through all the specific issues and given assurances on all those important matters. We are planning to meet the concerns expressed around the House. All I am asking for is that we have the flexibility to go on running the system as things change, as they inevitably do, and that we do not lock it up in primary legislation so that if we need to make changes it takes years. That is really what we are talking about.
Baroness Meacher
I apologise for interrupting the Minister. I just wanted to make a point about ME patients, who have the most awful time. I have direct personal experience of that—not myself but through people close to me. Does the Minister accept that Amendment 50ZR would enable someone bedridden with ME who has not seen a doctor for years to call their GP and have a proper assessment? They are bedridden; they cannot go to assessments. That would avoid getting into a benefit assessment straight off. That is the whole point of the amendment. There has been support around the House because of the many situations where tremendous distress can be avoided by an appropriate person—perhaps a nurse, perhaps a doctor—doing a full and careful assessment, rather than getting into the benefits system.
Lord Freud
My Lords, I hope that I have made it absolutely clear that if we write into the Bill that it must be the GP, who may not be the right person, we are stuck. If you give us the flexibility, we are not stuck and in those circumstances we will go to the person’s home to do the assessment, or take someone else's piece of paper on the tiered approach.
What we are planning will be better for people suffering from ME and other illnesses because we will be able to respond. I think that the market will change. My noble friend Lord Kirkwood said that there is not an adequate market in this area. Occupational health and support for people of working age is a Cinderella service. We will be building that. As things change, we can move the assessment. If you tie it up, we will be locked in to 1948 as the years go by. The only difference between us on this, I think, is how mandatory and prescriptive we want to be, and it would be most unusual to put it in the Bill.
Let me cover the technicalities. The Government consider that Amendment 50D is directly consequential on Amendment 50C; the others are separate, so I ask noble Lords not to press them to a vote and the noble Baroness to withdraw the amendment.
Baroness Grey-Thompson
My Lords, I thank the Minister and everyone else who has taken part in the debate this afternoon. On a point of clarification to the noble Countess, Lady Mar, although the wording of the amendment was “relevant healthcare professionals”, in her speech she mentioned doctors; it is much wider than that.
The amendment is a fundamental cornerstone of what is necessary in the move to PIP. I recognise that the Minister has moved a long way. I am still not comfortable with some part of his statement on the broad training for professionals. You do not know what you do not know. It is very difficult to instil that knowledge in people. I would like to know an awful lot more about the detail of how that training and education will take place.
There has been broad support around the House for my amendment, and I am grateful to noble Lords for that, but considering that the Minister has moved further than perhaps I expected, there is an awful lot to think about in what he has said. I beg leave to withdraw the amendment.
Baroness Gardner of Parkes
My Lords, I support the amendment. I have raised this issue with the Minister in private in the past. Many people on the existing benefit have used the money to increase their possibility of living normally by putting it towards aids or adaptations, and it would be very wrong if they were disadvantaged because of that.
Lord Freud
My Lords, a fundamental principle of PIP is that support should be targeted at those who are most affected. I reassure my noble friend Lady Thomas that we will not be penalising people who use aids and appliances.
We know that many disabled people have a greater level of participation because of the help provided by aids, appliances and adaptations. If we were to disregard entirely the use of such aids, we would penalise individuals whose health condition or impairment could not be helped through their use. In those circumstances, the needs of those individuals would seem less of a priority, even though their levels of participation might be lower. Therefore, there is a balance to be struck here. I would be the first to admit that the use of aids, appliances and adaptations do not of themselves eliminate needs, barriers or costs. We accept and understand that, and that is why we are applying points in the assessment when such aids are in use. The number of points will vary depending on the aids in question and the levels of need.
With regard to the daily living component, the entitlement thresholds have been set at such a level that an individual who requires aids to carry out a number of activities may receive the component at the standard rate. I am pleased to reconfirm to the noble Baroness, Lady Grey-Thompson, that with the mobility component, individuals who use aids and appliances to move short distances can receive the standard rate, while someone who needs to use a wheelchair to do so—whether it is a manual or an electric one—will receive the enhanced rate. In that sense, it is a different assessment and it does things differently from the WCA for ESA. The valuable point has been made tonight that people do not understand that, so clearly we need to put across information about it.
As I informed noble Lords in Committee, the approach that we wish to adopt for PIP is the same in this area as that currently used within DLA. We take into account aids that are currently used by individuals as well as those which might reasonably be expected to be used. Let me be precise—I mean those that are easily and cheaply available. We will not, for example, say that an individual’s needs would not be present if they simply bought themselves a wheelchair, a stairlift, or a walk-in shower. That would not be reasonable, and we will have guidance available to make sure that claimants are treated consistently.
I will, however, be delighted to host a meeting with my noble friend, and any group she wishes to bring. Clearly, there is a big consultation exercise going on in precisely this area. I know this is an area in which she has great interest, and I will be very pleased to host that meeting. I urge her to withdraw her amendment.
Baroness Thomas of Winchester
My Lords, I am very grateful to the Minister for agreeing to such a meeting, and for clarifying that there is a great difference between the assessment for the work capability assessment and PIP. With that, I beg leave to withdraw the amendment.
Lord McKenzie of Luton
It is clear that the Government are going to have to do some of this anyway, but in terms of an overall time period it is clearly a matter of some months rather than weeks, but not a matter of years. It depends on the determination and effort that the Government bring to bear. They have the levers and the resources to cause this to happen quite quickly, I would suggest, but there has to be full engagement with disabled people for it to be meaningful. This does not mean endless delay in the introduction but it does mean a real level of reassurance before we embark upon this very significant change.
Lord Freud
I will come to my conclusion first. Basically, we are doing a lot of trialling in this process and the way that this particular amendment is drawn would delay us very significantly. At the end of my speech, I will give the noble Lord the actual cost that we estimate the delays will represent.
I will spend a bit of time highlighting our approach to developing, testing and refining the assessment criteria that we already have. We have been developing those in collaboration with a group of independent experts, including disabled people and disability organisations. We had initial proposals on which we then carried out 16 weeks of consultation. We met 60 disability organisations; had 170 written responses; and carried out testing involving sample assessments of around 900 volunteers selected from current or recent DLA claimants. Both the testing and the consultation were very effective and allowed us to review, revise and improve the draft assessment criteria from that published in May. We provided a second draft in November in advance of discussing the PIP clauses in Grand Committee. Since publication, we sought the initial views of disabled people and the organisations that represent them in an informal way to listen to their thoughts. Yesterday, as promised, we published a further document detailing our initial thinking on entitlement thresholds for the rates and components of PIP. We have now commenced a formal consultation on the entire assessment criteria, including the weightings and entitlement thresholds which will last for 15 weeks.
That gives disabled people and disability representative groups the opportunity to tell us what they think the criteria will mean to them and their members and what amendments might be needed before we finalise the regulations. I can assure my noble friend Lord Newton that those regulations, which we will lay later this year, will be subject to the full affirmative procedure of both Houses. We are confident that we will be able to test the impact of these using the data we gathered during our earlier exercise. If for any reason this is insufficient, we will carry out additional testing to support our analysis. In response to a specific request from my noble friend Lady Browning, I will personally look at the impact of this on our autism obligations and I will make sure that that is done as a key part of this process.
There have been, and there remain, significant opportunities for involvement from disabled people and their organisations, and significant opportunities to influence our proposals to ensure we get them right. That, however, is not all. In terms of the delivery and operation of PIP, we intend to continue to develop a number of our operational processes in conjunction with disabled people and their representative groups through our implementation development group, which I talked about a little earlier this evening. This group has already played such an important role that it is our intention to retain its services after April 2013 in order to work with it to help evaluate the new delivery arrangements.
We have also created a number of customer research panels, made up of groups of disabled people who share similar characteristics, in order to understand, and gain an insight on, how the process impacts upon them. We will also test our operational processes in a model office environment, allowing us to see how they work without affecting individuals’ benefit entitlement. The trouble with a formal trial, of course, is that it would change what people actually get even though we are trialling. Here, by doing it in a model office, we can do it in a way that does not actually affect what they receive, but we know exactly how it will work.
We want similar arrangements to be in place with regard to the processes of the eventual supplier of the assessments of the benefit. We will be making it clear to bidding organisations that we expect them to work with disability organisations on the design of their processes, to improve the customer experience. This will be before, during and post-implementation. This will be a clear requirement in the contracts.
As well as getting the whole development process right, I recognise the value in moving away from a big-bang approach to implementation which would see both new claims and reassessments beginning in April 2013. Since the Committee stage, a significant amount of work has been undertaken to investigate the options for ensuring a sensible implementation which allows us to learn from early experience. Therefore, I can inform the House that, in addition to the pre-implementation testing work that I have already mentioned, we will limit the number of new claims for personal independence payment to a few thousand per month for the first few months of implementation. This will allow us fully to trial all the processes in a truly live environment. We are still developing the details on how we can meet our claimant target over the first few months.
Once we are satisfied that the new processes are working as intended with this reduced number, we will allow all new claims for personal independence payment to enter into the process. We will continue monitoring and reviewing the processes to ensure they are working effectively and appropriately and to see how claimants are finding the experience. We will begin to reassess existing DLA claimants in a co-ordinated way six months after the initial implementation. Again, we will stagger this process. We expect the first stage of reassessment to start in the autumn of 2013, beginning with individuals on a DLA fixed award who will need to renew their claim and those claimants who report a change of circumstances on their existing DLA claims.
At the same time, we intend to conduct a pathfinder trial reassessing individuals who would not, in the ordinary course of events, come up for reassessment. We expect the pathfinder to run for around three months to ensure the processes for identifying and contacting people and taking them through the claim processes are working satisfactorily. Allowing a small number of existing DLA claimants to advance through the reassessment process ahead of full national implementation will enable us to be sure that our approach to engaging these customers into the claims process is working effectively ahead of widening the selection. Also very relevant here is the independent review and report on the assessment that we are legislating for in Clause 87.
During Committee, the noble Lord, Lord Rix, laid an amendment seeking to increase the number of independent reviews carried out. Noble Lords will remember that I promised to take this matter away and consider it further, and I have done that. Our revised proposal is that we legislate for two biennial independent reviews within the first four years of the implementation of PIP. The first would report within two years, beginning with the date on which the first assessment regulations come into force, and the second within four years of that date. Although it is only two reviews formally in legislation, we commit to undertake a third if the second review demonstrates ongoing issues with the operation of the assessment which need to be addressed in this manner. That is a firm commitment from me and my ministerial colleagues.
In reality, in the way that we are structuring this, we are trialling it in any real sense; we are doing it on a gradual basis. If we do it in this way, we will get the assessment and wider benefit processes right; we will involve disabled people and we will learn from the earlier delivery of the benefit. We do not think, therefore, that the formal trial proposal in this amendment is necessary. However, if we do it that way, the House should know that it would push back the implementation of the benefit. Our estimate is that the loss will be £1.4 billion of savings over the reassessment window. Clearly, that has to be found somewhere else. I know that noble Lords opposite think that is funny.
Lord McKenzie of Luton
Could the noble Lord give us a bit more detail of that estimate? The figure of £1.4 billion seems to trip off the tongue as the cost of any amendment that we pursue.
Lord Freud
That is an assessment based on the delays that we anticipate from this amendment, which is actually similar to the previous amendment where I used the same figure. It would have the same effect of delaying the whole process. That is the Government’s position, having worked through the implications of the amendment.
I remind the House of where the Opposition have got to with their amendments. We estimate that as a result of the votes on amendments so far, over five years they have imposed £3.8 billion-worth of extra costs, and this amendment will take that figure to £5.2 billion.
Baroness Hollis of Heigham
I am sorry to see a Minister, whose integrity and respect for evidence has been apparent to the whole House, going back to the box-ticking, false assumption that there are no political choices available to this House. There are plenty of political choices if the Minister wishes to use them—for example, freezing council tax, increasing council tax bands, looking at some of the things that go on in pensions tax relief and so on. It is not clear to me that the economic growth of this country depends on taking away DLA from some of the most disabled people in the country.
Lord Freud
My Lords, I do not want to debate where alternative cuts would be found by the Opposition if they were in government and needing to balance the budget. All I can tell you is that the effect of the amendments that the Opposition have supported comes to that figure. It is amazing how, given an amendment here and an amendment there, pretty soon you are talking serious billions. I am afraid that this is another amendment which involves a serious amount of money and, for that reason, it is not acceptable to the Government. I urge the noble Baroness to withdraw her amendment.
Baroness Grey-Thompson
I thank the Minister for some of the reassurances that he has offered tonight. He has, once again, moved further than I expected, although it would have been wonderful to have heard some of it a little earlier. I thank the noble Lord, Lord Newton of Braintree, for his consistent honesty and for what he has done for DLA. Unfortunately, I am genuinely sorry that I do not agree with him tonight because we have to get this right.
The noble Lord, Lord Low, talked about confidence and, even with what the Minister has said today, there is such a lack of confidence among disabled people about where we are going with this that I am really concerned.
The Minister referred to costs, which are important, and huge financial sums are involved here. I would like to talk about cost—the social cost of what we are doing to the lives of disabled people. A number of disability organisations—I shall not go into how many—have contacted me and are telling me that we are not in the right place; disabled people are telling me that we are not in the right place; and my personal belief and conscience tell me that we are not in the right place. I wish to test the opinion of the House.