The Minister for Disabled People (Mr Mark Harper)
I thank the Backbench Business Committee for approving this debate and my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), my hon. Friend the Member for Broxbourne (Mr Walker) and the hon. Member for North Durham (Mr Jones)—but like my hon. Friend the Member for Broxbourne I will call him my hon. Friend for the purpose of this debate—for securing it.
I am afraid, Madam Deputy Speaker, that I will try your patience by congratulating my hon. Friend the Member for Broxbourne on his OBE, which he collected this morning. I can see from your furrowed brow that you were not aware of that, but you are now. He has been congratulated rather a lot today, but I felt that it would have been remiss of me not to do so from the Dispatch Box.
Madam Deputy Speaker (Dame Dawn Primarolo)
Order. One can never be congratulated too much, and it is right that the hon. Gentleman’s contribution should be acknowledged.
Mr Harper
I am grateful, Madam Deputy Speaker, that you were also able to join in the congratulations to my hon. Friend and embarrass him still further.
It has been a very good debate. It is an important matter for our constituents because mental health conditions are very common, with one in six people being affected at some time in their life. That statistic has been mentioned a few times, including by my hon. Friend the Member for Windsor (Adam Afriyie) who put on record his contribution on the subject early in his parliamentary career. All Members made the clear link between mental health—whether good or bad—and someone’s employment position. Many Members also highlighted the fact that labour market outcomes are poorer for people with mental health conditions than for the population as a whole and those with health conditions in general. As my right hon. Friend the Member for Sutton and Cheam and others said, the vast majority of people with mental health conditions want to work.
I listened carefully to the statistics that my right hon. Friend quoted about people with severe mental health problems. In the spirit of trying to cheer him up a little, noting that he referred to some positive data from the Time to Change campaign about the changing views of employers on mental health, let me reassure him that although I am not in any way complacent, as the gap between those with a mental health problem working and those generally working is significant and far too wide, there was at least some improvement between the last quarter of 2013 and the last quarter of 2014, when the employment rate for those with a variety of common mental illnesses went up by 2.6%, with a further 70,000 people in employment. That is obviously positive and a step in the right direction. I will not overclaim for it, as it is just a step, but perhaps it shows that the good work of the organisations involved with the Time to Change campaign means that employers are open both to keeping people who develop a mental health problem in work and to employing people with mental health problems. We might be seeing the start of improvement in those employment figures, but I do not want to claim more than that.
We are doing a lot, but clearly there is also more to do. I want to pick up on a couple of points mentioned by the shadow Minister, the hon. Member for Stretford and Urmston (Kate Green). I absolutely agree with her comment early on in her remarks referring to employers who say that they would not employ someone with a mental health problem. She was absolutely right that if they employ a reasonable number of employees they almost certainly do, although they might not know that they do. Perhaps the employee does not know that they have a mental health problem either.
The statistics suggest that anyone who employs more than six people is likely to have at least one member of staff with a mental health problem. Perhaps they ought to look around their workplace, think about the people they employ who have a mental health problem and think about how well they support that person, not out of any sense of altruism, although it is of course the right thing to do, but, as the hon. Member for North Durham said, because it is the right thing to do for the business. The person will be more productive, will stay working for that business for longer and will be beneficial. That was a point well made.
Looking at the cast of characters in the Chamber, I recall clearly that three years ago my hon. Friend the Member for Broxbourne, the hon. Member for North Durham and my right hon. Friend the Member for Sutton and Cheam, who was then the Health Minister, participated in a debate in which my hon. Friend and the hon. Gentleman spoke about their own personal experiences. They were both nervous during the debate about how their comments would be taken outside this place. I followed it quite closely, and it was heartening to see that their remarks were taken positively, not just by the organisations that one would expect—those that are familiar with these issues—but more widely and, interestingly, among members of the public. They kicked off an interesting process and since then a number of other right hon. and hon. Members have talked about their own experiences both inside and outside the House. It is right that more Members are encouraged to do that.
The hon. Member for North Durham put it very well when he said that the more we talk about these issues, the more we are open about them, the more the House debates about them and the more we talk about mental health issues in the same matter- of-fact way—I mean that in the most positive sense—as we do about physical health issues, without making a huge drama about them, the more employees and employers will be encouraged to have those sensible conversations in the workplace.
Members spoke about a number of support mechanisms. My hon. Friend the Member for Halesowen and Rowley Regis (James Morris) mentioned the improving access to psychological therapies programme and the shadow Minister referred to the various talking therapies that are available. Those programmes have a proven record of delivering and were started by the Labour party when it was in government. They have been continued by us and expanded. By next month, they will have been expanded so that 15% of people who could benefit will have access, covering about 900,000 people a year. Next year, we will introduce for the first time access standards and waiting time standards in mental health services, and an £80 million investment will ensure that 75% of people will receive the IAPT treatment within six weeks, and more than 50% of people who are experiencing their first episode of psychosis will receive a treatment within two weeks. There is more to do, but I think that that is significant progress.
The hon. Member for North Durham talked about the work capability assessment and the performance of Atos in delivering that. With just a teeny bit of partisanship, I will remind him that it was his party’s Government who introduced the work capability assessment and appointed Atos as the contractor. We inherited that arrangement and spent quite a long time putting it right. I detected in what he said that he is not the biggest fan of Atos, so he will be pleased to know that it is exiting the contract to deliver that service in Great Britain. In fact, Maximus takes over next week, and ahead of that, in the next few days, Members will receive a communication from that company. The hon. Gentleman will be pleased to learn that one of the areas that Maximus takes very seriously and has itself highlighted, and where it is keen to improve WCA performance, is mental health. I hope that he will engage with Maximus, using his local expertise and his personal experience, to help to improve that performance.
Mr Kevan Jones
I am glad to see the back of Atos, but the fact is that for the past God knows how many years, the key issue raised has been the people doing the assessments. I have no problem with people with mental illness going through an assessment, but people with no mental health experience whatsoever have been responsible for concluding whether those individuals are fit for work. I just hope that the new provider employs people with mental health backgrounds to do those assessments, because that would be a huge step forward. It would be better for the Government and, more important, better for the individuals affected.
Mr Harper
The hon. Gentleman makes a perfectly good point. One of the things that Maximus plans to do is to increase the number of people it employs who are mental health specialists. I think it was the hon. Member for Huddersfield (Mr Sheerman), who is no longer in his place, who said that the people who undertake work capability assessments are not qualified, but that of course is not correct: they are all properly accredited health care professionals, although it is true that not all are mental health care professionals. Among other things, Maximus proposes to increase the number of mental health specialists it has, as well as the number of health care professionals with knowledge of specific health conditions, including but not only mental health conditions; and to ensure that it has across its organisation mental function champions to discuss mental health cases with other health care professionals, to bring that expertise to bear.
Mr Jones
That is a welcome move, but may I make a little suggestion? If Maximus is going to employ people with mental health backgrounds to conduct assessments, will the Minister ensure that anyone going for an assessment who has a clear mental health condition—it is why they are on employment and support allowance, for example—is assessed only by someone who has that expertise? That will save a lot of time and money for Government and will help the individual.
Mr Harper
It may not be that clear. Often, people going for an assessment do not have just a single health condition. It is important to remember that the assessment is not a medical diagnosis; it is about the impact of somebody’s health condition or disability on their ability to work. The assessor is not carrying out a diagnosis of a mental health problem; the assessment is about the impact of the condition on an individual’s ability to work.
The hon. Gentleman should look at the communication he gets from Maximus. I am sure that the company will be delighted—I mean that genuinely—to hear from him about his constituents’ experience, because it is genuinely committed to improving the performance of the work capability assessment. Of course, Maximus has experience in delivering health care assessments through other contracts around the world. The signs are positive for how the company will engage with the contract.
James Morris
My hon. Friend makes an important point about individuals not having a single health condition, whether that is mental or physical. One of the challenges is the assessment of someone who has a fluctuating mental health condition, which might require a special form of assessment.
Mr Harper
My hon. Friend makes a good point about fluctuating conditions in the context of assessments. One change in the work capability assessment has been a recognition that fluctuating conditions, including in the mental health space, must be taken into account. Claimants should be asked questions not just about their experience on that day, but about what a typical day looks like and the extent to which their condition fluctuates.
A number of Members, including the right hon. Member for Sutton and Cheam who opened the debate, referred to how my Department and the Department of Health are working together on improving people’s employment and health prospects. He referred to the pilots that we are undertaking. There are four broad pilots, one looking at the individual placement and support model, one looking at whether peer-led group work employment intervention can improve outcomes, another investigating whether a telephone support model is effective, and an online service pilot, which was one of the recommendations from the RAND study that he mentioned. Those pilots, as he knows, have started and are moving into the next phase, which involves a larger set of pilots.
One thing that we are keen to do, which is frustrating because it means that pilots take longer, is to get robust evidence bases for those pilots. As the shadow Minister said, if one wants to roll them out on a significant scale, with my Department and the Department of Health working together, and a substantial amount of money is to be invested, a good evidence base is needed to be clear about what the outcomes will be. It is important that there are sufficient numbers of individuals going through those pilots for a robust evidence base to be developed, rather than lots of qualitative data and anecdotal evidence suggesting that they were successful.
Paul Burstow
I agree that we need a robust evidence base on which the roll-out takes place, but individual placement and support has already been the subject of randomised controlled trials. There is a very good evidence base that should be used to roll it out.
Mr Harper
The right hon. Gentleman is right about that. That is why the access to psychological therapies work is already under way and, as I said, is being rolled out further. One of the issues is how well the pilots can be scaled, given that some pilots require skilled mental health professionals, of whom there are a limited number—by which I do not mean a small number, but finite capacity—looking at models which enable us to scale the pilots up more quickly. We want to make sure that we have a good evidence base for pilots that look promising.
The hon. Member for Strangford (Jim Shannon) referred to some very specific experiences in Northern Ireland. It is worth putting on the record—he knows this because we have had this conversation before—that quite a lot of welfare and health services are devolved to the Northern Ireland Executive. It is right for him to raise his constituency experience here in the House, but the delivery of those services is not under my control or that of my colleagues in the Department of Health. Those services are under the control of the Northern Ireland Executive. I will be meeting the Minister in due course as we are keen for our experiences to inform how the Northern Ireland Executive rolls out those services, and vice versa. If we can learn from each other, we are happy to do so.
Jim Shannon
We understand that that is the situation. In my contribution I referred to the Prince’s Trust and some of its good work with vulnerable young people, which the shadow Minister also referred to. Is there any intention to roll out such work on the UK mainland to give vulnerable young people the help that they need at the coalface of their lives?
Mr Harper
I do not have a specific answer that I can give the hon. Gentleman immediately, but I will take that point away and look at it further. I listened carefully when he was setting it out for the House and there were some positive aspects to that approach.
About a third of NHS mental health trusts in England are using individual placement and support. The Department of Health is grant funding the Centre for Mental Health to extend IPS further, and my Department and the Department of Health are working with the Centre for Mental Health to try IPS with schizophrenia. From his expression, my right hon. Friend the Member for Sutton and Cheam appears to be familiar with that programme. One of the aims is to encourage at a local level my Department and Jobcentre Plus to work closely with the health service, and there are examples of such close working.
The fit for work service was referred to by several Members, including my hon. Friend the Member for Broxbourne, who said that the longer people were out of work, the less chance there was of return. The fit for work service, to which the shadow Minister also referred, which is obviously at a relatively early stage, is about helping employers and employees manage the sickness absence programme.
I was tempted to advertise another service that we offer earlier, but I resisted. When my right hon. Friend the Member for Sutton and Cheam opened his speech with the story of Anne-Marie, I thought that it was a good example of where she and her employer would have benefited from the mental health support service, which is part of Access to Work, which is clearly not as well known as it ought to be. As he said, it has a job retention rate of around 92%. It assesses an individual’s need to identify strategies that they can use to cope with their mental health problem, looks at a personalised support plan, either for returning to or remaining in work, and gives employers advice. That is important, particularly for small employers that do not have the capacity to have occupational health support in place.
As it happens, tomorrow I will be speaking at a disability confident mental health focus event, which is being supported by Mind, Remploy and the Business Disability Forum, and hosted by Royal Mail, specifically to raise awareness about the mental health support service. A significant number of employers are coming, and I have named several employers, including Royal Mail, who are committed to this.
Leadership has been referred to, and I attended an event with a KPMG senior partner—I hope it is in order to mention the company given that I used to work for it, although it was a long time ago—who has been open about his own mental health problem. It was heartening that he referred to the fact that the senior management of that organisation had created an environment in the business where, as a senior member of the management team, he felt comfortable with being open about his mental health problem. I know from talking to other members of staff that the fact that he has been able to do that and has been well supported by that employer has had a powerful effect on encouraging others in that environment to be open about their mental health problems. So there are other employers who recognise that. The right hon. Member for Hazel Grove (Sir Andrew Stunell) is not in his place, but he referred to a Disability Confident event that he has run. My right hon. Friend the Member for Sutton and Cheam is also interested in this area, and I hosted a Disability Confident event in my own constituency a couple of weeks ago. I have written to all right hon. and hon. Members to encourage them to do the same in their constituencies, partly to engage with those small and medium-sized employers that might otherwise be unfamiliar with the campaign.
My right hon. Friend the Member for Sutton and Cheam wrote an article for PoliticsHome today entitled, “I don’t like Mondays—how work can affect mental health”. My only criticism of the piece is that he urged UK plc to take action. I know what he meant, but it is worth remembering that we are also talking about UK Ltd, because half the work force is employed by small and medium-sized enterprises, and they do not always have the human resources support or access to services that larger businesses have.
My hon. Friend the Member for Broxbourne referred to BT. The head of occupational health and well-being there, Dr Paul Litchfield, has produced two independent reports for the Government. I waited until he had concluded that work, and therefore had only one hat on, before visiting BT, where I had a very positive experience. The hon. Member for North Durham spoke very positively about its programme. He is right that BT puts a lot of effort into supporting employees with mental health problems, and not only because it is the right thing to do, but because it is absolutely in its business interest. It has a very high staff retention rate. It keeps almost everybody who develops a mental health problem at work, and the vast majority in their existing roles, although sometimes they have to change role. I heard four individuals give powerful testimonials about the support they had received from the company. I thought that it was incredibly positive that they felt so open in discussing some quite difficult issues they had had in front of their management chain. They clearly work in a very positive environment.
I will mention universal credit before drawing my remarks to a conclusion, because the hon. Member for Stretford and Urmston would think it remiss of me not to do so. I do not pretend that universal credit solves every problem on the planet, but I think that there are two areas where it is very positive for mental health. The first is the way that it has been set up, because it is about getting work coaches to engage with people earlier, looking at what support they need. If someone falls out of work and approaches the jobcentre—I think this is the thrust of the point made by the hon. Member for North Durham—we want the support to be delivered earlier in the process, rather than later. Universal credit has been set up in such a way that it is about having that conversation, looking at what someone can do and delivering support earlier, which I think will help. It is not the only solution, but I think that it will make things better.
Mr Kevan Jones
I agree with the Minister, but will he also address the point I made about companies being paid by the Government to support individuals into work, even though that work is actually being done by the voluntary and community sector? If those companies are claiming to have helped those people and are getting paid for it, even though the work was actually done by the voluntary and community sector, that is a very serious issue.
Mr Harper
The hon. Gentleman anticipates my remarks, because I had not yet got to that point. There are two points that arise from what he said, and he was supported in that by the shadow Minister. The first relates to the ability of smaller private sector companies and the voluntary sector to be subcontractors to prime providers, and we will consider how to make that easier as we look to develop what follows the Work programme. The second point—the central one—is about ensuring that Work programme providers are paid only when they have done the work. He raised a specific concern about a third sector organisation in his constituency. If he can give me a little more detail, I will look into it. If a Work programme provider has done nothing at all, it should not pretend that it has done so in order to claim a payment. Either it should not be paid, or it should effectively be subcontracting with the smaller provider. If the smaller provider is very successful, clearly we would want it in the programme, working with the prime provider. If he gives me some more details, I will absolutely task officials with looking into it. It is not very sensible for the taxpayer to be paying someone for work they have not done. Moreover, we should be making sure that the money goes to support those who are successful at getting people back into work so that they can improve their organisations and become more successful and sustainable.
Kate Green
Will the Minister also comment on, or ask his officials to look into, the report I received from the individual placements and support service in south Manchester that Work programme providers were being rewarded for work that was being carried out and funded by the NHS? It sounded as though the public purse was paying twice and the Work programme provider was getting a reward for very little, if any, activity.
Mr Harper
Yes. I listened carefully to what the hon. Lady said, and I will look into that specific example as well.
My right hon. Friend the Member for Sutton and Cheam referred to the Work programme. It is true that in its earlier phase the success rates for those on ESA as opposed to JSA were not very impressive—one in 24, I think. However, more recent cohorts have been more successful, and about one in 10 people have been getting into sustainable work. Obviously we want that performance to continue.
It is very apposite, Mr Speaker, that you are in the Chair as I draw my remarks to a close, because I know—I do not think it is a secret—that you take a close personal interest in this area. I remember when you allowed a discussion on mental health to run for a fairly reasonable length of time in the last session of DWP questions. You feel that it is a very important area. You referred to the changes we had made in law to reduce the stigma for the many Members of Parliament who might have a mental health problem. Earlier I referred to the hon. Member for North Durham and my hon. Friend the Member for Broxbourne, who spoke very openly in the House about their experiences.
The Government take this issue very seriously. There is a lot of working across Departments, not just with my Department and the Department of Health, but with the Home Office, where, as Members will be aware, the Home Secretary has been pressing a great deal to make sure that police cells are not seen as places of safety for those who develop a critical mental health problem. Work is being done by other Ministers across Government. We are moving in the right direction, but we are not complacent. Although some progress is being seen in the unemployment figures, there is still a considerable gap, and there is more work to do. I think there is a shared sense of purpose across the House about the direction of travel, and I want us to continue to move in that direction through to the general election and beyond.