Work Capability Assessment

(Limited Text - Ministerial Extracts only)

Tuesday 13th March 2012 Westminster Hall

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

I have a sense of déjà-vu because the hon. Member for Edinburgh East (Sheila Gilmore) and I are continuing a debate, albeit on a different subject, from an hour ago.

Let me start by saying that it is of paramount importance to get right issues of mental health in the work capability assessment process. That is the most difficult challenge, because in many respects mental health can be the most intangible of the various areas that we need to assess when we seek to understand what people can and cannot do, and there are clearly many people with mental health problems who cannot possibly be expected to work. I do not have detailed knowledge of the case highlighted by the hon. Member for Ashfield (Gloria De Piero), but people will appear in our surgeries saying that something is not fair or right, or that they are in the wrong group. Some people will genuinely believe that they cannot return to work, but that will not always be the case.

A few weeks ago, I sat with a woman in one of our Work programme centres. She had arrived having been mandated to the Work programme after 14 years off work with chronic depression, and she said that on the first day she was in tears, did not believe that she should be there and that she was protesting bitterly. I met her about eight weeks later, by which time she had started doing voluntary work in a charity shop and had begun to apply for jobs, and she said that that was the right thing to do after all. We will not always get it right, but we are taking some people down a path that can be right for them, even if they are reluctant to follow it at first.

[Gloria De Piero]

I accept what the Minister says, but does he agree that to decide whether someone is in the right group and has the right of appeal—which in itself acknowledges trial and error—56 weeks is too long?

[Chris Grayling]

I completely accept that, and we have started to reduce the backlog of cases. It is a big challenge, and we have put extra resources into the tribunal service for that. We have also tried to strengthen the reconsideration process in Jobcentre Plus, so that new medical evidence seldom appears at appeal stage. In his first report, Professor Harrington stated that one key reason why so many decisions were being overturned on appeal was that new evidence was appearing at appeal stage. We have tried hard, both at the start of the assessment process and the reconsideration stage, to ensure that such evidence is in place.

I ask the hon. Member for Edinburgh East to step back for a moment because it is tempting to take what the charities say at face value. Charities do good work and have long experience, but they do not always get it right and the internal review was the clearest example of that. I sat through meeting after meeting with the charities at which they said that we should not proceed with the internal review because it would lead to more people with mental health problems being found fit for work and that all the evidence suggested that it was the wrong thing to do.

Work had been done by the previous Government using the approach that the Department always takes to such matters, which is to take a batch of cases, put them through a new methodology and see what difference that makes. Our team of officials advised that, although there were fewer descriptors, the changes would lead to an increased number of mental health claimants in the support group. The charities protested and said, “That won’t happen; you’re wrong. That is not the case and you shouldn’t do it.” A few months later, however, that internal review led to an increased number of mental health patients in the support group. Indeed, the support group as a whole has got bigger. It is easy for groups that advocate change to existing systems to say, “We’ve got the experience; we’re right and you must do this,” but that is not always the case. It was certainly not the case for the internal review.

[Dr Whiteford]

I should like to bring the Minister back to the first Harrington review, particularly recommendation 7. He has previously told Members, including myself, that those recommendations have been taken on board and implemented, but why has recommendation 7 not been implemented in Scotland?

[Chris Grayling]

In relation to mental health champions, let me explain some of the things that we have done for mental health patients. We have a pool of about 60 specialists who provide advice within the Atos network, and their skills are available to every centre, either in person or by phone. Professor Harrington has looked at how we implemented that change, and he praised it because he thinks that it was done well and effectively. We think that we have delivered that expertise, as does Professor Harrington who is an independent assessor and can say whether or not his recommendation has been implemented properly, which in his view it has been.

If I find evidence that we are not getting things right, we are open to change. As I have said from the start, this programme does not have a financial target and is about saving lives, not saving money. If we are successful in moving people back into work it will, of course, reduce the cost to the welfare state, but it will do so in a right and positive way that will help people such as the woman whom I described, who I hope will return, step by step, to the workplace. The alternative is for her to spend the rest of her life on benefits suffering from depression at home, and no one benefits from that.

That is the spirit in which we have approached all this. We tried very hard to ensure that we got it right with the internal review. There was no particular reason for me to implement the internal review. It was set up by the previous Government. The findings were put together by the previous Government. It would have been easy just to say no, but the advice was that it would increase the size of the support group, and that is what has happened. I regard that as a positive step. I always said, and said on a number of occasions in the House, that I was happy to see the dividing line between the work-related activity group and the support group move a bit in the direction of caution, because we are trying to get this right and I do not want people in the wrong place. There will never be a perfect system—I wish there would be—but we shall try to get this right.

I will move on to the recommendations of the work carried out by the charities. I commissioned that myself. I asked the charities to come back with recommended changes to the descriptors. I very much wanted, and do want, to get this right. The problem is straightforward: they did not actually do what they were asked to do. They were asked to make recommendations about further ways to improve the descriptors that would allow us further to ensure that the assessment process for people with mental health challenges was accurate, effective and reflected their needs and potential. That is not what happened.

The charities came back with a recommended system that would have involved tearing up the whole work capability assessment for mental, fluctuating and physical conditions and starting again from scratch, redoing all our computer systems and all the training for every member of staff in the entire network. That was not just a tweak; it was a comprehensive change to the whole thing, based on no actual evidence. The charities did not come forward with tangible evidence. They simply said, “We think it would work better this way.” They may or may not be right, but that is quite a big step to take just on the basis of a set of recommendations from a group of charities that had been proved wrong in the internal review process.

[Sheila Gilmore]

The recommendations from the charities were put to an independent scrutiny panel that had a large number of people with considerable expertise, so will the Minister agree that it is not true to say that they were simply the recommendations of a group of charities?

[Chris Grayling]

That is the case, but what we lack and what we intend now to get is hard evidence to determine whether this is right. Given that the charities were wrong the first time round, I am very reluctant to tear up the whole thing and redo all the computer systems—a vast amount of change; probably a two or three-year project—only to discover that that does not make a difference.

Alongside this, we have been doing work on fluctuating conditions. These are the two particularly challenging areas. Fluctuating conditions can represent a real challenge in the assessment process, because someone who is fine one day may not be fine the next. There are a range of fluctuating conditions and, again, I want to be careful to ensure that we get this as right as we can. In a moment, I will touch on some of the changes that we have made. I just want to explain first where the issue arises with the new set of recommendations.

The working group on fluctuating conditions reported at the end of last year. We intend this year to do that gold standard work, which in effect involves applying the new systems recommended by both groups to a set group of cases to understand what the difference would have been. If we discover that there is very little variation between what they are recommending and the existing system, there will be no point in changing it. If we discover big changes, we will want to understand why. I am perfectly open to making changes in the future if I think that that will make a significant difference. I will state again that we are not trying to force into work people who should not be there. We are not trying to get this wrong, but at the same time this is not about a simple change. It is not about introducing mental health champions throughout the network, improving the quality of the telephony process, ensuring that our staff are better trained or strengthening the reconsideration process. It is about tearing the whole thing up and starting again. That is quite a big step and a very long step to take.

We shall do the gold standard work. We have already done the initial scoping work. It is very important that that is completed. I am very open to making changes, but I will not make changes on the hoof without clear evidence that they will make a difference. The hard evidence that was there for the internal review, which I based my judgment on, proved to be right, whereas the external advice, based on what the charities thought, proved to be wrong, so we have to be very careful.

[Sheila Gilmore]

I thank the Minister for taking another intervention. Obviously, there have been many changes in the system and changes initiated after Harrington 1 as well. Is there a reason why the Minister thinks that the change in the descriptors has resulted in more people being put into the support group?

[Chris Grayling]

The general view of the team who worked on the internal review was that the assessors were better placed with a broader base and less specific descriptors in relation to mental health. People should bear in mind that both the assessors and the subsequent tribunals and decision makers have to operate to a pretty tight template around the descriptors as set in law. By creating additional flexibility within the descriptors, we end up with more people being put into the support group than was previously the case, and that is indeed what happened.

I thought that there was good and sensible thinking in the way that the charities brought forward their ideas. We made some pretty rapid changes. We have continued to adapt the ESA50. We have adapted our training, so that some of the issues that they have highlighted are built more clearly into it. We have also invited all the charities—some have taken this up—to work with decision makers, to contribute to the training process for decision makers.

Probably the biggest change that we made to the whole process was to de-emphasise slightly the role of the assessment itself. One of the criticisms levelled at the whole WCA process before we took over was that it was much too formulaic, with far too little flexibility. Of course, one of the reasons for the appeals issue was that a vast amount of new evidence came forward only at the appeal stage. As a result of Professor Harrington’s report, we tried to create a more holistic process, so we actively ask people for evidence from their specialists up front.

Our decision makers have the discretion to look for additional evidence at the point at which they reach their view, based on the evidence that has been submitted by the individual themselves, the ESA50 and the outcome of the work capability assessment. Likewise, we now actively encourage people to supply new evidence at the reconsideration stage. It is now almost universally the case that we see most if not all of the evidence before it leaves Jobcentre Plus. That has to be the right thing to do.

We have tried to build the learning from the work done by the mental health group and by the fluctuating conditions group into the decision making that is already happening. We have not parked this on the sidelines and said that we will come back to it at a later date. I can explain my problem using the analogy that I used in the Select Committee. It is rather like taking one’s car in for a service. When we come back at the end of the day, it looks great. The people who did the service have done a brilliant job, but they have turned it into a boat. That is not a lot of use if we have to drive it on the road. That, in a nutshell, is the position that I am in. The charities made a recommendation. If they had recommended some tweaks to the descriptors, we would have done that by now, but they did not; they recommended a total transformation of the whole process, including redoing everything for physical health conditions as well—all the descriptors for them—a new scoring system and a new computer system. It would be and will be, if we do it, a monumental task.

We are therefore putting together the mental health work and the fluctuating conditions work. We are looking at the consequences of the approach, through the gold standard review, in a way that the previous Government did, and rightly so. It involves taking a selection of cases, applying the new methodology and understanding what the difference would be. However, we are not sitting on our hands in the meantime. We are not just saying, “Well, that work has been done. Maybe we’ll get round to it at some point in the future.” We have used that as the basis for changes across the way that we interact with people through the assessment process, because we genuinely want to get it right.

I have said on many occasions that this is about helping people who are potentially able to return to work to do so. That is the right thing to do. We will not always get the decision making right, whatever we do. Even if we implement everything that the charities are recommending, we still will not have a system that is perfect in all circumstances. That is why we have the appeal process. We are not talking about putting people into a position whereby they are doing an activity that is damaging to them. We are, step by step, helping people to get back into a process whereby they can apply for jobs and get into work—sometimes quite gently.

[Sheila Gilmore]

Will the Minister clarify, if the gold standard review has now started, whether he has any anticipated time scale for its concluding?

[Chris Grayling]

I have not instantly, but it is certainly my intention that we will complete it within the next few months, as we said that we would. I think that it is necessary to understand the impact. Above all, I want to get this right. Our objective has only ever been to find the right number of people we can help back to work, not any number of people. That is a human goal, not a financial one.

Question put and agreed to.