Heather Wheeler
I am sure the Minister has heard every word that the hon. Lady said.
I finish on two final points because time is short and many people want to speak. People have mentioned the tick-box nature of the interview; my constituents find it hugely frustrating that they cannot expand on an answer. After all this time, perhaps the interview process could be tweaked to allow that. My last point is about the absolute frustration of GPs and consultants who feel that no account whatever is taken of the fact that they take their time to write the letters. That is desperately frustrating and a huge waste of public money.
The Minister of State, Department for Work and Pensions (Mr Mark Hoban)
We do ask GPs and consultants to provide medical evidence; we send a form to them. Only 37% of those are returned in time.
Heather Wheeler
I thank the Minister for putting that on the record. I will gladly go back to my GPs and consultants and say that they will be taken into account if they please return the forms on time.
I will finish now, because many hon. Members want to get in. I am delighted that we are having this debate because I genuinely feel that there is an opportunity to get the issue right. The people deserve it.
The Minister of State, Department for Work and Pensions (Mr Mark Hoban)
I also congratulate the right hon. Member for Oldham West and Royton (Mr Meacher) on securing this helpful debate. It gives me the opportunity to address some of the concerns expressed on both sides of the House about this process.
“For too long, too many long-term sick and disabled people have been written off by the welfare system to a life of dependency, entirely reliant on benefit and devoid of experience of the labour market.”—[Official Report, 9 January 2007; Vol. 455, c. 246.]
Those were not my words, but the words of the right hon. Member for East Renfrewshire (Mr Murphy) when he was employment Minister on Third Reading of the Welfare Reform Bill in January 2007. The hon. Member for Bishop Auckland (Helen Goodman) was a DWP Minister at the tail end of the previous Government, so I am sure she made her concerns known at that time to her ministerial colleagues—or perhaps not. This measure was introduced by the previous Government. The argument of the right hon. Member for East Renfrewshire was right then, and it is right now.
Helen Goodman
Government Members are constantly asking Opposition Members to say sorry. Actually, about the way this has run, I am sorry.
Mr Hoban
I welcome the hon. Lady’s candour. It would be good if more of her colleagues expressed similar candour.
One aspect of the Welfare Reform Act 2007 that has been referred to frequently throughout the debate is the establishment of the independent annual review. The last three have been undertaken by Professor Harrington, a distinguished occupational physician. What evidence has he put forward? In his first report, he stated that he did
“not believe that the system is broken or beyond repair”.
In his second report, he noted that the WCA had
“noticeably changed for the better”,
and in his third report, he said that
“real progress has been made”
and stressed that
things are beginning to change positively in the best interests of the individual.”
It is important not to lose sight of that.
Mr Hoban
I want to make a bit more progress, because a lot of detailed points were raised and I want to address as many of them as possible.
Despite the improvement, it is clear—today’s debate reinforces this—that the WCA continues to generate heartfelt and passionately held views, but some of the worry experienced by claimants is a result of adverse media coverage and risks being fuelled by incorrect anecdotal information and—indeed—total myth. We have heard some of those myths today, and I want to set the record straight. This is an opportunity to address the facts behind the process and to set out what is happening in the Atos process.
Several hon. Members suggested that Atos had targets for finding people fit for work or placing them in a particular group. Let me be absolutely clear—let nobody in or beyond the House be in any doubt—there are no such targets. There are no targets for who should be put into which group. Instead—hon. Members would want this—there are quality-control checks. We want the right decisions to be made for our constituents and we want to ensure consistency between physicians and practitioners, and assessment centres. That quality control —saying that we should all be familiar with things we do and come across in our daily life—is not the same as a target. Atos has no targets to recommend that people go in particular groups.
Mrs Gillan
I am grateful for that assurance, because it is a matter of great concern. Will the Minister go a step further and say whether he is aware of any internal targets? Will he give us an assurance that there are no internal targets at Atos?
Mr Hoban
There is nothing in the contract with Atos to suggest that there should be any targets for whom they recommend gets placed in particular groups. I want to be absolutely clear: there no targets and it is absolutely right that there should be no targets, because what all of us want, whichever side of the debate we are on, is to ensure that we get the right people in the right groups for the right support. We cannot do that with targets. We have to treat everyone individually. That is the dignity that we should accord the people going through the process. They should know that they are going to be treated with dignity. There are no preconceived targets.
Julie Hilling
The question then is not whether the Government are putting targets in place, but whether the Minister is 100% convinced that Atos does not set targets for any of its work force in any way, because that does not seem to be the evidence coming out. Is he utterly convinced about that and if not, will he investigate whether that is the case?
Mr Hoban
No, I am not going to give way. I want to make some more progress and the hon. Lady raised some questions that I want to address.
It has also been suggested that Atos health care professionals make decisions on benefit entitlement. They do not. Those decisions are made by DWP decision makers. They take the ESA50—the form people complete when making an ESA claim—any further medical evidence produced by a GP, consultant or health practitioner with whom the claimant is working, and the Atos assessment, but they look at all that evidence. The decision is made by DWP decision makers, not Atos. That is why there are a number of cases where the DWP decision maker’s decision has been different from any recommendation made by Atos. It is up to the DWP—the decision is made by the Department, not Atos—to decide who goes into which group.
Mr Hoban
Let me make a bit more progress.
People say that the number of appeals overturned at tribunal is evidence of poor Atos reports—a point raised by the hon. Member for Edinburgh East (Sheila Gilmore). When we asked judges why they overturned DWP decisions, they said that an error in the Atos assessment was the primary reason for an overturn in only 0.3% of cases. However, although it happens very rarely, I agree with her on one point: I would like to get more information from the judges.
Mr Hoban
The hon. Gentleman says that I am a Minister, but the judges are independent—one of the strengths of our system. I hope that the judges have heard the comments that have been made—not only in this debate, but in other debates—about the need for more detail. To get the system right we need better feedback from the judges, but let us not forget that where we ask judges for the reason for an overturn, in a large proportion of cases they say it is the presentation of fresh evidence. They are very explicit in saying that the primary reason for overturn in only 0.3% of cases is the Atos assessment.
Sheila Gilmore
I am grateful to the Minister for giving way, because this is an important point, especially as it has been briefed on so often. What I want to know—the Minister has to ask this question too—is this. I suspect that the question of overturns is simply one of some fairly simple error in the form, but according to the same judges, in 40% of cases they made their decision because they disagreed with the presentation of the case. That still suggests something wrong with the initial assessments—whether because the people concerned did not present them well or because the Atos assessors rushed them through. In 40% of cases the judges came to a different decision.
Mr Hoban
Just because the statistics do not suit the hon. Lady’s argument does not mean that they are wrong. A lot of this debate is about constituency casework and experience. Sometimes we also need to look at the overall stats and figures behind this issue to put those cases in context, which is why I made the point about the overturn rate.
It has been suggested that GPs should make the assessment. The British Medical Association has been prayed in aid. Let me quote what the BMA said about that idea:
“However, it is not part of the GP’s role to provide any opinion…on the patient’s capability to work as part of this process. It is vital that these two roles are kept separate and that GPs are not asked to provide an opinion on their patient for the purpose of receiving the Employment and Support Allowance; doing so could damage the doctor-patient relationship.”
It has also been said that the work capability assessment does not take full account of mental health conditions. Let me say a bit about that important issue. We have sought to improve the process and the support for the health care professionals who are undertaking the assessments. All Atos health care professionals receive specific and additional training in assessing mental health conditions—
Mr Hoban
We do ensure that those professionals receive the support that they need to assess those conditions.
Following Professor Harrington’s recommendation, Atos has 60 mental health function champions in place to spread best practice. My right hon. Friend the Member for Chesham and Amersham (Mrs Gillan) asked whether they had specific training in autism. I can assure her that that is the case. She also asked, as did other hon. Members, whether we could review the effectiveness of the mental health champions. It is not for me to dictate the work that Professor Harrington’s successor will undertake as part of the fourth review, but I think that that is a good suggestion. We need to look at the effectiveness of the recommendations that Professor Harrington has made.
Mr Hoban
I am going to make some progress, as I have only a few minutes left to speak before the next debate starts.
In March 2011, we also implemented the recommendations of a Department-led review of the work capability assessment, which included the expansion of the support group to cover more people with certain communication problems and severe disability due to mental health conditions.
Hon. Members have suggested that the assessment does not take account of fluctuating conditions, but that is not the case. It gives people with a fluctuating condition the opportunity to explain how their condition varies over time. It is not a tick-box assessment, as some have suggested. There is a discussion between the health care professional and the person making the claim for ESA to determine how their condition varies over time. The questionnaire that customers are sent has been redesigned for that purpose, and people are now asked to give more details about how their fluctuating condition affects them as an individual. If a person cannot carry out a function repeatedly and reliably, they will be treated as unable to carry out that function at all. We all recognise that the capacity of people with a fluctuating condition can change, and it is important that proper regard should be given to that fact.
I want to pick up on a point made by the right hon. Member for East Ham (Stephen Timms). We have committed to a review of the descriptors for fluctuating conditions, and we are working closely with charities on that. We also need to ensure that any new descriptors are as good as, or better than, the existing ones, for the purpose of assessing someone’s condition. That work is going on at the moment.
Mr Hoban
I know that the right hon. Gentleman is keen to find out when that review will be published, but let me just say this. We want to make changes, if there is evidence to support such changes, and we need to ensure that that evidence is gathered and evaluated. I am as keen as he is to ensure that changes are made as quickly as possible, and that we make the right changes and the best changes to improve the process. I am not in any way seeking to delay the process—we want to ensure that it happens—but we have had to work quite hard to get the right descriptors that will provide the evidence on functional ability, and we are now assessing them.
Mr Speaker
Order. The Minister is most courteously attending to the issues, and he refers to three or four minutes. I know that he will be leaving at least two, if not three, minutes for the right hon. Member for Oldham West and Royton (Mr Meacher) to wind up at the end. I think that we are clear on that.
Mr Hoban
I have only four minutes left and I want to address some more questions.
Let me deal with the issue of Atos’s capability. Atos deals with 100,000 cases every month and it consistency meets the quality thresholds. Only 3.6% of assessments are below standard compared with a threshold of 5%. It receives complaints about only 0.6% of assessments. DWP decision makers return to Atos assessments that are inadequate for reaching a decision in only 0.2% of cases.
The hon. Member for North East Derbyshire (Natascha Engel) asked about the appeal rates. Let me be clear about the rate of successful appeals. Of all the fit-for-work decisions taken by the Department, only 15% are overturned on appeal. Only 15% of all the decisions we take, then, are overturned on appeal, which I think demonstrates that while we need to ensure that there is a proper appeals process, we should not be bandying around figures that misrepresent the level of successful appeals.
Mr Hoban
No. I have two minutes left and I want to make some more comments.
My hon. Friend the Member for Stafford (Jeremy Lefroy) talked about quality. The tribunal service can refer substandard reports back to Atos as an appeal for further action. It has exercised that right only 23 times in the past year. Rigorous checks are in place to ensure that quality applies.
Much has been said about employment and support allowance not working—that is untrue. What we are seeing is people coming off ESA and getting into work. The number of working-age people on ESA and incapacity benefit in February 2012 was 2.56 million—the lowest level since the introduction of IB in 1995. Early estimates to September 2012 suggest that overall numbers for this benefit are falling and will for the first time be below 2.5 million.
Finally, although there are many other myths, the last one I shall address today is the myth that the WSA is not fit for purpose. Professor Harrington has made it quite clear that the WSA, designed as a first positive step for work, is the right concept for assessing people who need our support. There is a need to improve it. No one doubts that, which is why we have implemented Professor Harrington’s recommendations. The assessment we inherited needed refinement. That is why we accepted and have largely implemented more than 40 of his recommendations over the past two years. That is why twice as many people have gone into the support group in comparison with when ESA was introduced.
Overall, the proportion of people with mental health conditions being awarded ESA has risen from 33% to 49%. We are seeing improvements and more will be introduced later this month on the categories of cancer treatment that allow people to go straight into the work-related activity group. These changes are happening. We should recognise that change is important and that it is happening. This is the right approach; demonising the work capability assessment does not help our constituents and does not address their concerns.