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Laura Pidcock (North West Durham) (Lab)
I beg to move,
That this House has considered 10 years of the work capability assessment in relation to employment and support allowance and universal credit.
This feels like such an inadequate environment to describe the work capability assessment and its brutal consequences. I wish that every single person affected by the system could be here with us in the Chamber and look in the eyes of those who defend the system. I hope that when they have heard what I am about to describe, Conservative Members—there are not many of them—will feel shame, and that in this debate we can do justice to the experiences of those subject to the work capability assessment.
The work capability assessment for the employment and support allowance and universal credit should be a simple concept: people who have a physical or mental health problem or a disability that means that they cannot work or have a limited ability to work will receive a replacement income from the state. I will talk about the face-to-face application process and the assessment, which are draconian, elicit fear, deny justice and have, in some circumstances, ended up contributing to the end of life. As Frances Ryan wrote recently in The Guardian, suicide is becoming a feature of the system.
Everyone in the Chamber will know someone who is unable to work for whatever reason. Those with personal wealth are often able to avoid having to prove that they are worthy of income replacement. Because they have that personal wealth, they are safe from having to share every single detail of a condition or illness, and do not have to wonder if they will be believed. People without savings, on the other hand, are only one step away—one accident or one conversation with the doctor—from being subject to that system.
Let me set out some of the elements that we believe are wrong with the system; this is based on evidence gathered from my constituents when they come to surgeries, on submissions by professionals, and on the vast number of submissions I have received from people currently applying for this social security payment. In both the application form and the face-to-face assessment, the descriptors that enable a score to be given to assess a person’s ability to carry out tasks are essentially a functionality test. They cannot capture the fluctuating nature of physical and mental unwellness or disability and how that could prevent or limit the ability to work. People often describe feeling punished for telling the truth. Yes, perhaps they could go out unescorted on a journey somewhere, but the test is not interested in, for example, the panic attack before leaving the house, or the emotional recovery afterwards. Perhaps venturing to the supermarket will have been their only trip out that month, but making that journey could lose them their entitlement.
In reality, one day someone may be in the depths of despair, and the pain from their condition may be unbearable; the next day, they may be able to have a laugh over a cup of tea with a loved one. The question is, should they lie about that laughter or feel shame about it because they might get points deducted? Does that laughter render meaningless the pain felt the day before? Fundamentally, does that have any bearing on someone’s ability to work? I think not. The test ignores the complex reality of living with long-term or fluctuating conditions.
Many people have told us that they do not feel accurately represented by the reports written about them. Advisers have openly claimed that they see copy-and-paste jobs. A constituent read that they were apparently happy and confident during the assessment, when in fact they were crying and shaking. No wonder as many as 74% of ESA decisions are overturned at appeal, according to Citizens Advice. That, of course, is one of the consequences of using a private company to assess the medical conditions of people who need support. Not having people qualified in the condition or illness with which assessors are presented is also a huge issue.
It is claimed that Maximus incentivises health professionals through the number of reports they complete. Logic says that that could directly lead to a proliferation of inaccuracies. Ultimately, profit should not be made from ill health; it leads to corner cutting and misplaced priorities. To defend the marketisation of the process is obscene.
I am not sure whether the Government or Conservative Members realise just how truly terrified some people are of the brown envelope from the Department for Work and Pensions. They know that they will be forced through a long and extremely difficult process. They will have to attend an assessment, and the decision notice they receive about the outcome of their work capability assessments is often inaccurate and misleading, leading to a long and stressful appeal process of up to 18 months; that is 18 months without the entitlement that those people deserve and need.
The process exacerbates poor health, and the Government make things worse. When people, because of their physical or mental health condition, ask that their assessment be carried out at their home, the answer given is almost always no. My caseworkers and agencies have sent substantial evidence to private contractors to show that my constituents would have severe difficulty attending the assessment centre. The stock response is, “If the claimant can get to their GP or to the hospital, they can attend the assessment centre.” How cold-hearted is that?
Justin Madders (Ellesmere Port and Neston) (Lab)
Does my hon. Friend not agree that there is a difference between someone going to a location quite close to their home, which they are familiar with, and an assessment centre that may be many miles away and difficult to get to unless they have their own transport?
Laura Pidcock
That is right, and in a place like North West Durham, where we have an inadequate and expensive transport system, it is unjustifiable not to have assessments carried out at home if someone is feeling unwell and faces stress in having to go to that assessment.
If the person does manage to get to the assessment centre, the assessor uses that as evidence of their ability to travel, walk, sit comfortably and cope with social interactions. One person got in touch with me to say that they had to sit in the assessment centre waiting room in soaking wet clothes due to their incontinence issues. Is this a system anyone can really defend? Is anyone really comfortable with a private provider forcing people to attend assessments in pain and with worry, to be degraded by the DWP?
If a person is found fit for work when they are not, that can have a huge impact on their mental and financial wellbeing. It can have a direct impact on their entitlement to housing benefit and council tax benefit, plunging them into destitution, and resulting in increasing debt, risk of eviction and untold stress. People wrongly found fit for work are then expected to do job searches and training, and are even sanctioned. It came as no surprise to any of us Opposition Members that in 2016 the UN concluded that the Government had committed “grave and systematic violations” of the rights of people with disabilities. That report should have seen an end to the Government, but they limp on.
For people who do go on to win at appeal, reassessment is too frequent. No sooner have they won than they are being reassessed—even people with terminal illnesses have to endure that. Imagine the retriggering of mental health difficulties when people have to describe, in assessment after assessment, historical sexual abuse to which they were subject.
Let me mention some of the contributions from people who got in touch. One person said:
“The process feels like psychological rape, expressly designed to make you feel that you are the absolute property of the state, that you are not a human being and that your continued survival is basically an affront to society.”
Another said:
“When you are disabled, you are defined by the able-bodied by what you cannot do, rather than what you can do. No disabled person wants to be a burden on society. They want to be an active contributor but are denied this by society”,
and that
“The whole thing should be abolished as it’s a cruel and pointless exercise in ideology.”
It is about ideology, isn’t it? This system, with its complexities, its high thresholds and the way in which employment and support allowance and higher rates of universal credit have been denied to so many, cannot be seen outside the context of almost 10 years of austerity and budget cuts, which have literally taken money from people who are disabled, unwell or dying.
What are the worst consequences, the ultimate results, of this brutality? Jodey Whiting, who lived in Thornaby, not too far from my constituency, took her life 15 days after her benefits were stopped for missing a work capability assessment when seriously ill. The independent case examiner found multiple failings on the part of the DWP, including it simply not following its safeguarding procedures. Her mum, Joy Dove, is campaigning for an independent inquiry into benefit death and I am sure everyone on this side would say “All power to her” in that campaign.
Stephen Smith, aged 64, who had chronic obstructive pulmonary disease, osteoarthritis and an enlarged prostate that left him in chronic pain, failed a work capability assessment in 2017, which meant that his employment and support allowance payments were stopped. Anybody who saw Stephen’s emaciated body on social media will have been horrified. Stephen died last Monday. Jeff Hayward, who won his appeal seven months after his death, had a debilitating skin condition and spent his last 18 months fighting a “fit for work” decision. Michael O’Sullivan, aged 60, from north London had long-term mental health problems, and the coroner found that the benefit process was a key trigger for his death.
These are the real-life tragedies of a broken system. I do not think I can bear to hear the Minister say, yet again and as his predecessor did, that we should come to him with our individual problems with the system. They are not individual problems; they are systemic failings, and a consequence of privatising social security and making £37 billion in welfare cuts.
Let us be honest: this is institutionalised bullying and harassment of sick and disabled people. I have no doubt that administrative ineptitude is part of it, but when the issue is on this scale, there can be no other conclusion. By deliberately stripping people of their rights, in order to disrupt the welfare state and the very concept of legal entitlement, the Government have trodden all over the expectation of citizens that they will be looked after in their hour of need. And what for? To replace the state with private and family provision, to boost the coffers of private insurers, and to replace legal rights with charity, subject to moral judgments of deservingness.
It does not have to be like this. How can our social security system be about security and not about punishment? The Labour party has rightly committed to scrap the work capability assessment. That will be a big step forward and will no doubt be welcomed by disability rights groups and welfare rights agencies alike. In the meantime, why do the Government not start rectifying injustices in the system by taking the vast amount of evidence from medical professionals, including GPs, consultants and nurses, into account? Testimony should be fundamentally believed. The culture permeating the DWP is one of disbelief that looks cynically on those who request help. Stressful, face-to-face assessments should be used only if there is an absolute necessity, such as a lack of evidence on which to decide on entitlement. Assessments should be a last resort.
The system should be designed by people who are experts through experience. Experts who understand how conditions affect the ability to work should be employed. Any social security system that replaces the work capability assessment as it exists today should not be a functionality test with arbitrary rules that do not account for the fluctuating nature of a person’s condition, disability or illness. There needs to be a revision of the assessment criteria, so that they are linked much more closely to the real world of work, or the work that the person was doing. Knowing whether someone can move a carton of milk with one hand cannot allow us to understand a person’s comfort or ability to work in a specific environment. Any process should include an assessment of the additional support that person would need to ease them back into the workplace. Recording of assessments should be standard, unless a person asks not to be recorded. The Government are dragging their heels on that recommendation.
Private outsourcing of the assessments has to be scrapped. The market has failed all aspects of the social security system, placing company profit before the needs of the people interacting with the system. When will the Government understand that private enterprise and illness are incompatible, and inevitably lead to the injustices that we see today?
When people are dealing with the stresses of not being in full health and of needing support for their disability or mental health condition, they should fundamentally not be subject to further stress, degradation and even abuse by the state. The system should be designed on the presumption that people are telling the truth when they come to see the assessors. They should not be forced though a humiliating and exhausting process that often results in them winning appeals at tribunal, with the help of the excellent but underfunded advice agencies and many of our caseworkers. For many people, their last fight on this earth is not with their illness, but with the state, and that fact alone should lead us to scrap this dreadful system.
Sir Henry Bellingham (in the Chair)
I thank the hon. Member for North West Durham (Laura Pidcock) for her moving and impressive speech. We will have an informal limit of seven minutes from now on. If right hon. and hon. colleagues could adhere to that, I would be grateful.
Jim Shannon (Strangford) (DUP)
Thank you for calling me, Sir Henry. I congratulate the hon. Member for North West Durham (Laura Pidcock) on presenting the case so well, with the passion and belief that we all know she has for the subject.
To say that the difficulty with ESA and the transition to universal credit is evident in my constituency is a gross understatement. I have talked to the Minister about this on a number of occasions. His door has always been open and he has told me to bring any issues I have to him. I have done that, and found him responsive and helpful. I hope that at the end of the debate, when we have all made our contributions, the Minister will be able to address some of the issues that I and others have, and put our minds at ease.
The difficulties that people face are astronomical. My comments will not be a surprise to anyone here; I am known as a man with a very soft heart. When I look at a person who is clearly ill and vulnerable, who has tears in their eyes because they simply do not understand what is happening and feel that they are alone and helpless, it is hard not to be upset and angry for them at a system that puts so much stress and pressure on the most vulnerable in our society. I am all for getting people up and out to work, giving training and helping to build and boost confidence to start a job. I do not want to see one able person out of work in Strangford, but in seeking to weed out the few who could work but will not, we are mentally exhausting and physically injuring those who are not capable of working.
I want to give an example that exemplifies all my comments. My staff recently dealt with the case of a young man who was living in his car. It became clear to me that this young man was broken; there is no other way to describe it. I called my parliamentary aide into the meeting. She is a sympathetic person and she had her arm around him, telling him that he was important, that he mattered and that we would help him get a fresh start. This was definitely a man on the edge, whose only companion was his dog. I do not know how he got to that position or what mistakes he had made, but I do not need to know that; I just needed him to know that we would help him.
We spoke to the phenomenally helpful Elizabeth, who is the manageress at our local jobcentre, who worked her way through the issues with his benefits and helped him. He could not face people, so he was outside the system. We had to take him and do everything for him. We spoke to the housing executive who managed to sort out hostel accommodation for him in the short term and now he has his own flat; that all happened at the meeting we had.
We spoke to the local food bank, based at Thriving Life Church in Newtownards, who provided him with food and sanitary products. We spoke to all these people. He was so low and so down that he could not have spoken to them because he had not got the ability to socially interact with people. We spoke because he could not speak for himself. The staff in my office were able to help him and get him out of the dark hole that he was in.
When I think of this young man—a man who could not even look us in the eye that day, who I knew was on the precipice, at the point of no return, and was expected to work in that state, with no mercy shown—I am reminded of the role that we have in this House. As MPs, we are blessed and privileged to represent those people and to try to help them in the times when they need help.
There are too many people living in their cars who cannot get a break and do not know where to turn. Too many people have been pushed to the edge of darkness and feel alone, and that tells me that we need more Elizabeths and Lees in our jobcentres. We need more Owens and Irenes in our housing executives. We need more Natalies and Susannes in our food banks. Those people could not wave a magic wand to make it all okay, but they played their part to see this young man, over a few weeks, into a position where he could look me in the eye and thank me. What a turnaround that was!
Unfortunately, that was only one example. In that three-week period, there were a number of people who were under the radar, who had slipped out of touch with the benefits office and were not in touch with the Executive or with others. We need to task all civil service staff with the fact that compassion is as much a qualification as an English GCSE.
Alex Chalk (Cheltenham) (Con)
The hon. Gentleman mentions compassion, but is it not also correct that there must be professionalism? Linda Hending in my constituency set up a support group for people with myalgic encephalomyelitis. She found that, while 10 of those 11 people had either been found fit for work or had insufficient points for the Personal independent payment, all those decisions had been overturned on appeal. While it is inevitable that there will need to be some assessment, is it not critically important that those decisions are got right the first time, so that people do not have to go through the strain of an appeal, even if it is successful in the long term?
Jim Shannon
The hon. Gentleman is absolutely right. I have a number of girls in my office, and one in particular who does nothing but benefits. She works full time on ESAs, PIPs and DLAs as the turnover goes for income support and all those other things. She works full time on benefits, and the other staff fit in work with that as well. We win a number of appeals because of the advice that is given. To be fair to the Minister, I have suggested to him that we need staff who are professional and able to advise in the way they should.
Yes, there are those who take advantage—I know that that happens sometimes—but I want to talk about those who need the help. Ten years into this, I still do not think we have the balance right, and that is part of many people’s mental health struggles. In the short time that I have, I want to mention that we need compassion for those with cancer who are claiming universal credit. Alongside the physical and emotional impacts, cancer brings with it a real risk of financial hardship. Macmillan Cancer Support has found that four out of five people with cancer are, on average, £570 a month worse off because of their diagnosis. Last year, Macmillan’s support line advisers received 26,500 calls from people seeking advice on applying for universal credit.
The first problem is access: people who are hospitalised often do not have access to the internet, and navigating a long and complex online application form is a horrendous thing to go through at a time when their body will not let them attend to it. Those who are undergoing treatment or have a terminal diagnosis have also had to attend the jobcentre, which can be distressing, and in some cases go against medical advice.
The initial five-week waiting time for universal credit is causing problems for people with cancer, many of whom have had to give up their work completely due to their condition and treatment. That even applies to people with a terminal illness, meaning that people who may have less than six months to live now spend more than one month of those six waiting for their benefits. Under the old system, people with a terminal illness could expect to get paid as soon as their claim was processed. The Minister knows, because I have spoken to him about it, but I believe we need to address these delays. Some 67% of people are not receiving their full payment on time.
This year, the Government will pilot the managed migration of people to universal credit. It is welcome that this process will be piloted before Parliament is asked to make a final decision; I welcome that and it is good that we have that process, but it will not solve the problems for people already receiving universal credit. We need to do this better, for everyone’s sake. I look to the Minister at this point: we need a sea-change of attitude, with compassion at its heart, working its way from this place to every level of public service. Young men such as Michael and others will simply not survive without it.
Debbie Abrahams (Oldham East and Saddleworth) (Lab)
It is a pleasure to serve under your chairmanship, Sir Henry. I reiterate the congratulations to my hon. Friend the Member for North West Durham (Laura Pidcock) on an excellent speech, outlining some of the range of problems that we have with this work capability assessment process.
This feels like déjà vu: we are here, yet again, to argue that the current system of work capability assessment is not fit for purpose. We can use the latest available data that tells us that nearly three out of every four claimants who appeal their assessment decision telling them that they are fit for work will have the decision overturned. We can reference the five reviews of work capability assessment over the past 10 years, which have repeatedly raised problems with the assessment process, ranging from medical reports being mislaid to blatant lies in assessment reports. We can look at the Work and Pensions Committee’s report from last year on ESA and PIP assessments, which saw an unprecedented 3,500 individuals share their experience and what they had been through, as my hon. Friend described.
We can discuss the death rates for people on ESA and, before that, on incapacity benefit. In 2013 that death rate was 4.3 times that of the general population, increasing from 3.6 times in 2003. That shows the level of sickness and ill health of people in this group. As has already been said, this is a poorly group of people who deserve to be listened to and respected. We can talk about the peer-reviewed research that estimated that between 2010 and 2013, work capability assessment was independently associated with an additional 590 suicides, 280,000 cases of self-reported ill health and 725,000 additional anti- depressant scripts.
However, anyone watching this debate will be thinking, “What on earth is the point?”, because to date the Government have taken not a jot of notice. Little has changed. We know how this is affecting people, as we have already heard: people living in fear and dread of the envelope dropping on their doormat, inviting them for their work capability assessment.
The Government have said they want to amalgamate the work capability assessment and PIP assessments by 2021. They say they want a more personalised approach and will involve disabled people in this process. I ask the Minister which disabled people’s organisations have been involved in the decisions. I appreciate that charities may have been involved, and it is important that they be involved, but what DPOs and disabled people have been involved? Were they involved in the decision to put the contracts for this new assessment process out to tender? That has already happened; we had one week, and then the contract for this new process went out to tender.
What are the Government going to do in the meantime, while this Government-orchestrated harm—it is a Government policy—continues? I am really concerned, and I hope the Minister can respond, because to date there has been little but warm words and platitudes.
As we have heard, on Monday we learned that Stephen Smith, the Liverpool man whose emaciated body was reminiscent of someone found in a concentration camp, not in 21st-century Britain, had died as a result of multiple organ failure after being found fit for work. We know he is not the first. My hon. Friend mentioned Jeff Hayward, who died in 2018 of a heart attack, seven months before a tribunal overturned a decision that he was fit for work.
Also in 2018, Jimmy Ballentine committed suicide after being found fit for work, as did Amy Nice, Kevin Dooley and Brian Bailey. Jodey Whiting, my hon. Friend’s constituent, Elaine Morrall, Daniella Obeng and Brian Sycamore all committed suicide in 2017 as a result of being found fit for work. In July 2017, Mark Scholfield, a terminal cancer patient, received no universal credit before he died, in spite of his illness. Chris Gold, in 2017, was found fit for work following a stroke. He was facing foreclosure when he died as he could not work. Lawrence Bond died in 2017, collapsing and dying on the street after being found fit for work.
Julia Kelly committed suicide in 2015, as did Ben McDonald. Chris Smith, who had terminal cancer, was found fit for work right up until his death. David Clapson died in 2014, as did Michael Connolly. “George, from Chesterfield” died that year as the result of a heart attack, again after being found fit for work. Robert Barlow, another terminal claimant, died after losing his ESA. David Barr, Trevor Drakard, Shaun Pilkington and Terry McGarvey also died in 2014. Lee Robinson, Robert Christian, Jacqueline Harris, Nicholas Peter Barker and David Groves died in 2013.
That is not an exhaustive list, but those names are an indictment of this Government and their policy, and so is the lack of change that has happened as a result of those deaths. There needs to be an independent inquiry, as Jodey Whiting’s mother says, into the deaths of claimants found fit for work. Until then, there should be a moratorium on all reassessments; for new assessments, as has been said, medical evidence should be the primary data used, not the blatantly flawed assessment processes.
Sir Henry, I am sure you agree that any Government’s first duty is to protect their citizens, but our disabled citizens have been spectacularly failed by this Government. Like millions of people across the country, I condemn the attacks in Sri Lanka, and I share concerns about the emergency that is climate change, but the deaths of disabled people as a result of Government policy are nothing less than a scandal. I challenge each and every one of us, in this room and outside, to rise and say to the Government, “Enough is enough!”
Several hon. Members rose—
Sir Henry Bellingham (in the Chair)
Order. I thank the hon. Lady very much for her moving speech. We will have to put a six-minute voluntary limit on subsequent speeches.
Chris Stephens (Glasgow South West) (SNP)
It is a pleasure to serve under your chairmanship, Sir Henry. I thank the hon. Member for North West Durham (Laura Pidcock) for securing the debate. I pay tribute to my parliamentary casework team, and to Citizens Advice and Money Matters, local organisations that work with the casework team to ensure that people who are going through the ESA and PIP system or who have other issues get their social security. The assistance that they provide to my constituents is invaluable. Without those organisations, it is quite clear that more people would suffer.
I will confine my observations to a Work and Pensions Committee report. As a member of that Committee, I can say that, such was the level of interest in PIP and ESA assessments, 200 organisations submitted evidence and there were 3,500 individual submissions. That tells us more than anything else the level of interest, and the pain and suffering that people are going through as a result of these assessments.
Let us look at the Department’s own statistics. There have been 3.1 million ESA applications, with 1.7 million assessments completed, but with payments and awards issued to only 1 million people. That suggests low confidence and trust in the assessment system. The hon. Member for Cheltenham (Alex Chalk) quite rightly said that it is important that the Department and the assessment process are correct first time. However, that is not the experience of far too many people, which is why I am delighted to take part in this debate secured by the hon. Member for North West Durham.
The simple fact is that claimants can have multiple health conditions, which can mean that they have severe limitations. There was a recommendation to commission and publish independent research on the impact of the application and assessment processes of both ESA and PIP on claimants’ health. Will the Minister tell us whether the Department accepted that recommendation and will take it forward?
Claims are often made by telephone, Sir Henry, and you and others will be aware that one campaign I launched since I got here was to abolish the telephone tax. I am delighted to say that the Government finally listened, and that the telephone tax was abolished. It is ludicrous to suggest that it should cost claimants phoning a telephone helpline 55p a minute, and I am delighted that that has now gone. However, as a result of health conditions, there are claimants who require communications in specific formats—I think particularly of those with hearing impairments—and we need to make sure that there are other methods for them to apply for ESA or PIP and the like. I hope that the Minister will update us on that.
The hon. Member for North West Durham was absolutely right on home visits. Maximus told the Select Committee that decisions on any request for home visits that they would carry out would be based on medical fact, not medical opinion. I hope that the Minister will say a bit about the guidelines on home visits that the Department gives to assessors. That brings us to the assessors and their knowledge; they can have partial knowledge or no knowledge at all of specific conditions. I still remember asking Maximus and Atos who a claimant with multiple sclerosis and a history of depression would see if they were to visit an assessment centre. The answer came back that they would see a general occupational therapist. If the assessment process is to have that conditionality, which I personally oppose, claimants must see people at the assessment centre with some knowledge or expertise on specific conditions.
We really need to improve understanding among healthcare and social care professionals and claimants about what constitutes good evidence, including measures, monitoring and reporting, and the supply of evidence. For far too many people, the assessment process has become a lottery. I agree with the recording of assessments, because we really need to end the mistrust around assessments. The fact is that appeals are upheld based on oral evidence given at the original assessment, not at the appeal. That is why recording is a must, and I hope the Minister will tell us that there has been progress on that.
A full copy of the report should be given, to increase transparency, and the quality of reports really must improve. We have contractors who have not once hit their targets for acceptable reports. If they cannot hit that target, we have to ask why they were given the contracts in the very first place. If a contractor failed to hit targets in any other part of the public sector, they would have that contract taken off them. I hope that the Minister can tell us what feedback and quality control measures the Department has put in place, because far too many people are suffering under this system. We have to ensure that it improves. I am delighted that the Scottish Government will do away with private contractors to undertake assessments. The Westminster parties should consider that too.
Justin Madders (Ellesmere Port and Neston) (Lab)
It is a pleasure to serve under your chairmanship, Sir Henry. I congratulate my hon. Friend the Member for North West Durham (Laura Pidcock) on securing the debate and on the excellent way in which she introduced it, covering a range of issues. I felt compelled to speak because many of my experiences with constituents are similar to those we have heard. I have received the clear message—I hope the Minister receives it as well—that improvements to the assessments process are very much needed.
Some constituents who have attended assessments have raised concerns with me about the fact that assessors carry out the assessments very quickly and do not listen to their answers. We have touched on the refusal to conduct home assessments, sometimes despite medical evidence that they are necessary. On one occasion, a constituent suffering from agoraphobia was refused a home assessment. Surely the need for one in that situation was obvious.
I note from an overview of the work capability assessment mandatory reconsideration and appeals process that, from October 2013 to June 2018, 33% of assessments were closed by the claimant. That is 1.3 million people—not a trifling number. The Government line may be that all those people pulled out of the process because they were fit to work, but I doubt it is as simple as that. My worry is that there are people within that 1.3 million who would be entitled to ESA but did not go through with the process because they were too anxious or worried about the assessment or because they simply could not cope with the idea of having to discuss their intimate medical issues with a stranger. I would like to know from the Minister whether any research has been done into those 1.3 million people, the reasons why they withdrew and whether people in genuine need have been failed.
The study goes on to say that 15% of all applicants go on to register a mandatory reconsideration, which is 370,000 people within that five-year period. Some 85% of those reconsiderations stick with the original decision, and 21% of those people then go on to submit a formal appeal. There is sometimes a misconception that the mandatory consideration is the appeal stage, and that there are no further opportunities to challenge. However, those who carry on to launch an appeal have a success rate, according to these figures, of 63%, although we heard from my hon. Friend that, according to the CAB, it is more like 74% or 75%.
Danielle Rowley (Midlothian) (Lab)
My office team has experience of constituents challenging assessments and getting nowhere until they come to our office and we get a reconsideration straightaway, which gives the impression that they are not taken seriously. It is the exact same evidence, but they are not listened to until we get involved. Does my hon. Friend agree that that is a sad state of affairs?
Justin Madders
I find that disappointing, but not surprising. The fact that the appeals success rate is so high suggests that not only the initial assessment is flawed, but the mandatory reconsideration stage is not a proper appraisal of the full merits. Perhaps that takes place only when Members of Parliament get involved. A cynical view would be that the mandatory reconsideration stage is just a hurdle put in front of people to make life a little more difficult for them. I am shocked that recent figures for the appeal stage show that the DWP does not even bother to turn up to about 80% of the appeal hearings.
I want to pay tribute to my fantastic local CAB, which represents people at the appeal hearings. However, it cannot help everyone, and it is the people who are not able to get representation I worry about.
Given my constituents’ experiences, there is no doubt that the original assessments are flawed. Many decisions are overturned at tribunal, and it seems the system does not learn from its mistakes. For example, one constituent was assessed five times in eight years of being on ESA. At each assessment she was found fit for work. On each occasion she appealed and on each occasion she won that appeal. In the process she paid £150 to get medical evidence to support her appeals. How can the assessment process get it wrong five times? How can the absolute waste of public money that five separate appeals must have cost be justified when the final decision was the same every time? What does it say about the Government’s approach to people with long-term conditions? How many times does someone have to prove that they are ill and unable to work?
Last-minute cancellations have also been an issue. I have heard from constituents whose assessments have been cancelled on the day the assessment is due to take place, and in some cases the constituents were actually at the assessment centre when their appointment was cancelled. That seems to be particularly the case when the assessment is scheduled for a time after half past three. The most recent example involved a lady who was struggling when entering the assessment centre. Obviously, it is a very stressful experience. She was shaking, crying and not engaging, and then she was told that her assessment would be delayed by another 45 minutes, at which point she became so distressed that she had to leave the centre and cancel the appointment. That is a callous and uncaring way to treat someone. When one of my constituents rang up two days before her assessment to give notice that she would not be well enough to attend, she was told that it was too late for the assessment to be rescheduled and she would be recorded as a no show. It is double standards of the highest order.
In conclusion, people with long-term conditions deserve compassion, respect and support. They should not be made to feel they are on trial because they are ill.
Patricia Gibson (North Ayrshire and Arran) (SNP)
I congratulate the hon. Member for North West Durham (Laura Pidcock) on securing this debate and on the tone that she set at the beginning.
I was first elected in 2015 and I have spoken out repeatedly about the damage that the assessments and the way in which they are carried out do to my constituents and constituents across the United Kingdom. Although I am glad to speak in this debate, I am really annoyed that it is necessary, because it should not be. The Minister is not hearing anything today of which he is not aware. He knows exactly what is going on and it is not acceptable that we come back time after time to say the same things over and over. I know the Minister will tell us about changes that have been made and about people who are not reassessed if they have got a severe disability or a lifelong illness. He will tell us that people with progressive conditions requiring a high level of support will be assessed only every 10 years. I say to him that that is all very well and good, but it simply is not good enough.
The Disability Benefits Consortium, made up of 80 different charities and organisations, has stated that it did not think assessors had sufficient expertise to carry out assessments. Respondents who had seen a copy of their paperwork following assessment said that it “badly” or “very badly” reflected the answers that they gave. We all know that to be true when we speak to our constituents. Citizens Advice has told us that 81% of its advisers report inaccuracies in work capability assessments, so the information is out there. It is in our constituencies and in our surgeries, and I know it will be in the Minister’s inbox as well.
Constituents in a state of extreme distress have told me that they felt the questions they were being asked at the assessments were extremely intimate, invasive and inappropriate. Discussing very intimate details of your medical challenges with a panel of strangers in a context that causes the claimant distress and nervousness very often sets back the claimant’s health, exacerbating their condition, and all of that is before they are told, often incorrectly, that they are fit for work, with the paperwork not accurately reflecting the answers that the claimant gave at the assessment.
Some 51% of ESA claimants are recorded as having a mental or behavioural disorder as their main disabling condition. Rethink Mental Illness has published a report that states:
“Assessments can be traumatising and anxiety-inducing”
in a system that requires claimants to
“collect their own medical evidence”,
and it
“inherently discriminates against people with mental illnesses”.
Often a false sense of security is created where assessors appear friendly and ask questions supposedly by way of a preamble to the formal interview: “Do you have pets?” “Do you have a dog?” “Do you walk it?” “What lovely weather we’re having.” “Do you like to sit in the garden?” All the questions are asked as if it is casual conversation, only for the claimant to subsequently discover, upon receiving his or her paperwork, that their assessment decision has been reached on the basis of answers to the so-called casual questions instead of on the medical evidence presented. I think that is sinister.
Danielle Rowley
The hon. Lady is making an important point. I have a constituent who was asked if they could get a pen out of their bag, and they did, and then that was put down in the assessment. She was in floods of tears at my surgery because she felt she had been tricked. It is just awful.
Patricia Gibson
A false sense is presented to the people, some very vulnerable, when they go to the assessments, and it is simply not good enough. The simple fact is that the system—the Minister knows this—which is a partnership with the private sector that has been in place since 2008, brought in under Labour, opened the gates, but the Minister has to understand that it has opened the gates to a place where folk who are sick and disabled are commodified, and it is not working.
Nearly half of women involved in work capability benefit tests have attempted suicide. We have seen the reports of claimants being asked, “Why haven’t you killed yourself?”, and even a double amputee being told he was no longer eligible for the mobility aspect of his disability living allowance. Sadly, such stories continue to emerge, and we have heard today about the very sad case of Stephen Smith, with which I am sure the Minister is familiar.
I have heard DWP Ministers say—I cannot remember whether this includes the Minister here today—the number of successful appeals against decisions shows that the system is working. I must confess I have never heard such stuff and nonsense. The number of successful appeals shows that too many incorrect decisions are made, which deny the most vulnerable in society, the sick and infirm, the support that they need and deserve. That is why the Scottish Government are committed to taking a lead on obtaining medical evidence so that claimants are not burdened with it. That is why there will be no private sector involvement in assessments, so that there will be no profit motive for it to declare claimants fit for work when it is not in a payment-by-results system. That is why the Scottish Government say that claimants will be offered a location and time and date that suits them for assessment, with home visits for those with travel difficulties, and that is why they have said audio recordings of assessments will be standard to ensure accuracy and transparency.
I urge the Minister and the Government to step up and admit that the current system punishes those who are unfit to work and those who are sick, and cruelly strips them of their dignity. I hope that the Minister will admit that it does not work. I urge him to look at the measures that the Scottish Government will implement and take a leaf out of that particular book. The current system does not work for my constituents in North Ayrshire and Arran. It does not work for anyone’s constituents. I ask the Minister to do the right thing: reach out a compassionate hand to those living with a disability. Anyone who is a Minister for Disabled People should do no less.
Hugh Gaffney (Coatbridge, Chryston and Bellshill) (Lab)
I congratulate my hon. Friend the Member for North West Durham (Laura Pidcock) on securing this important debate. The work capability assessment was introduced for employment and support allowance claimants in 2008. It has also been used to reassess incapacity benefit claimants and determine eligibility for additional universal credit support. It is now more than a decade since the introduction of the assessment: a good time to reflect on the impact that it has had on the lives of claimants across the country.
From 2008 to 2017, 48% of all work capability assessment outcomes were successfully appealed in Scotland and nearly half of all fit-for-work outcomes reached through work capability assessments were also overturned. In my constituency, 47% of appeals were successful in overturning the outcomes of such assessments and almost half of all fit-for-work outcomes reached through them were successfully appealed. The most recent national figures released by the DWP highlight the fact that 65% of fit-for-work outcomes were overturned in the period from December 2017 to January 2019.
Those figures illustrate the negative impact of work capability assessments on claimants, and the fact that they are failing, because they find people fit to work when they are clearly incapable of working. Claimants in that situation have to go through the appeals process with no access to their ESA payments, which means that they face poverty or destitution, or making a claim for jobseeker’s allowance or universal credit while waiting for their appeal to be processed. Considering the problems that there have been with universal credit, such as the five-week wait for the first payment, that is unacceptable. Many people face financial hardship and further uncertainty simply because they have challenged a work capability assessment outcome. Another thing to reflect on is the fact that ESA appeals are currently subject to a clearance time of 30 weeks.
Work capability assessments have also led to a situation where vulnerable claimants are denied the support that they need. The latest DWP figures show that 68% of those suffering from injury were found fit for work; 59% of those living with connective tissue diseases and 40% of those with mental or behaviour disorders were also found fit for work. How can the Government claim to be building a fairer society when work capability assessments are pushing the most vulnerable people into work in spite of their disabilities and medical conditions? It is clear that the assessments are not fit for purpose.
That view is shared by disability charities and the Work and Pensions Committee, whose 2017 inquiry received more than 3,000 letters from individuals who shared their experiences of the assessment process. More than 100 people reported that they or someone they cared for had experienced suicidal feelings as a result of the assessment process. We have heard today that people have taken their own lives. Shame!
Others highlighted a mismatch between what they had told assessors about their conditions and the content included in the assessor’s written report. In response, the Work and Pensions Committee made recommendations designed to improve the assessment process, including recording face-to-face assessments and providing clearer guidance to claimants about submitting evidence to support their claims. Similar recommendations have also been made by organisations such as Citizens Advice. The Government’s response was to ignore the recommendations.
The Secretary of State might be striking the right tone, but actions speak louder than words, and the problem with work capability assessments cannot be hidden through merging them with PIP assessments. Disability Rights UK summed up the shortcomings of the Government’s approach:
“You can’t merge two badly constructed processes and expect to come up with one fit-for-purpose approach”.
How right that is. For as long as the Government refuse to make real changes to the assessment process, vulnerable people will continue to be denied the help that they need.
It is shameful that this Government have extended Maximus’s contract to carry out work capability assessments until 2021. The company has maximised its profits through work capability assessments despite the clear evidence that claimants have been denied access to the support they need. I am glad that private companies will be banned from carrying out assessments in the new Scottish devolved social security system, thanks to pressure from Scottish Labour. It is about time that claimants were treated with dignity and respect by the Government.
Karen Lee (Lincoln) (Lab)
It is a pleasure to serve under your chairmanship, Sir Henry. I congratulate my hon. Friend the Member for North West Durham (Laura Pidcock) on securing the debate, and on her excellent speech.
My office was involved in a work capability tribunal case last Wednesday and I have obtained permission from the person involved to discuss publicly what she has gone through because of such assessments. Sophie is the daughter of a friend of mine. Her mum and I trained 20 years ago as nurses and we worked all those years together on a ward at Lincoln County Hospital, so I know her really well. I provided Sophie with a letter for her tribunal, as her MP, as a qualified nurse and as someone who has known her for 20 years, before and after her diagnosis of multiple sclerosis.
Sophie tries hard to live as normal a life as she can, but I have seen how her illness affects her ability to do that day to day. She is just 30 years old and she was diagnosed with relapsing remitting multiple sclerosis at the age of 16 when she first developed balance difficulties. Over the following years she has developed problems with weakness, particularly on the right side of her body, as well as urinary difficulties, pain, fatigue and visual problems. She uses a wheelchair and struggles with mobility.
We went on a hen weekend in February; Sophie is my friend’s best friend, and we were in Boston. Everywhere we went she was in a wheelchair, and she simply cannot get out and about on her own. Whereas some patients with relapsing MS are unaffected between attacks, Sophie has chronic symptoms and is affected by her MS every day. The symptoms fluctuate markedly, and even mild infections and changes in temperature can make things much worse. There were complications during a trial treatment—I remember Alison and I and a few of us looked really hard to try to get her on trials to control what she had. There was a drug called alemtuzumab. Sophie now has an overactive thyroid and has to have regular blood tests to monitor her blood levels of thyroxine.
Sophie left school at 18 and trained as a nursery nurse. She worked at a nursery. She loved that job; it was one of her bits of normal. Eventually, though, she had to give up her job because of her MS, and after being forced by her disability to do that she applied for employment and support allowance benefits.
Recently, after a medical review, Sophie was deemed fit to work. The reasons given were that she has no problem with balance, uses public transport on her own and takes herself places independently. The truth is that she wears a support on one of her legs at all times, as I saw when we stayed for the weekend in February, because she drags the leg as she walks. She has to use a wheelchair every time she goes out of the house. She cannot walk any but short distances indoors, so how she is supposed to use public transport is totally beyond me.
The person who completed the assessment was allegedly competent to do it. Yet at the tribunal last week, those hearing the evidence seemed surprised that the case ever got as far as a tribunal and dismissed it in less than 10 minutes. They said something about a level 2 out of 3; I do not understand the terminology—but that is how ill Sophie is, although she had been deemed fit to work.
When someone is deemed fit to work, the process is that they have to appeal the decision if they feel it is wrong. Sophie appealed, but her appeal was dismissed because, I am told, the only evidence that the DWP will consider is the examination on the day, which came to such worryingly inaccurate conclusions. Sophie was therefore forced to take her case to a tribunal. That was eventually successful, but she should never have been put through such an anxiety-inducing ordeal. She is pregnant—she has a little boy of two and is about eight months pregnant, and the assessment came on top of all those other things in her life. I am sorry—it gets really upsetting, because I know her and what has happened to her is disgusting.
For people like Sophie it feels as if the DUP—[Interruption.]—I am sorry. That was a Freudian slip, and I meant no offence. It feels as if the DWP is working backwards from the conclusion that they are fit to work, regardless of the severity of their disability. That practice must end. Support must be given to the most vulnerable in society.
It has become popular in recent years to demonise those who are forced to claim benefits—to label them as somehow being scroungers or as faking their disability. Just after Christmas, I watched “I, Daniel Blake” on TV, and a prominent Conservative MP said on Twitter that it is only a film, but actually it mirrors real life, and people need to realise that. It is high time that the Government woke up to the fact that the vulnerable in society are suffering because of what they have done to our welfare system. It is meant to be the safety net for those who need it. People say that the mark of a decent society is how it looks after its vulnerable people. I am sorry, Sir Henry, but at present the reality is that the system is broken.
Angela Crawley (Lanark and Hamilton East) (SNP)
It is a pleasure to serve under your chairmanship, Sir Henry. I congratulate the hon. Member for North West Durham (Laura Pidcock) on securing this important debate, and on her consistent opposition to measures introduced by this Government that are calculated to push people in financial hardship further into poverty. She has been a genuinely welcome Member of the House; we need more people who are as passionate and who have that integrity to stand up for their constituents. I stand with her in opposition to the work capability assessment, and agree that the whole system needs to be redrawn.
I welcome the Minister to his new post, and I hope he will continue—as he has done—to listen to views from across the House, including suggestions about how to reshape the system so that it works better for people. I appreciate that that is a tall order because, with all due respect to the civil servants, his Department has probably had the fastest revolving door for Ministers of any Government Department, although they have all had a fairly mixed tenure. Without the work of the civil servants to keep things running, this Government would come to a standstill.
The hon. Lady highlighted the impact of work capability assessments and their tragic, life-ending consequences. That gets to the heart of today’s debate, and that is why the Government must take action—the consequences are too significant. The hon. Member for Strangford (Jim Shannon) and my hon. Friend the Member for Glasgow South West (Chris Stephens) rightly paid tribute to our parliamentary and constituency staff, as well as to Money Matters, Citizens Advice, and all those charities and organisations that work with people on a daily basis. These vulnerable people in our society require our support. The hon. Member for Lincoln (Karen Lee), who I had not heard speak before, made an emotional speech that went to the heart of this debate and reminded us of the emotion and humanity surrounding this issue. We do our jobs day in, day out, but this issue is affecting people’s lives.
The hon. Member for Coatbridge, Chryston and Bellshill (Hugh Gaffney) rightly said that a Labour Government introduced this policy, but he should not take all the credit for the social security system in Scotland, as a few other people had a hand in it as well. The hon. Member for Ellesmere Port and Neston (Justin Madders) highlighted the damaging impact of this system, and the hon. Member for Cheltenham (Alex Chalk)—he is no longer in his place—said that we need to get this right first time. My hon. Friend the Member for North Ayrshire and Arran (Patricia Gibson) said that by using the private sector we are simply passing the buck, but it is our responsibility to get this right.
The number of appeals against decisions made during work capability assessments is testament to the fact that the system does not work. I could recount the statistics, but the Minister will then stand up and tell me contrary figures, and I do not want to swap statistics any more on this matter. This is about real people’s lives, and unlike the revolving door of Ministers, and unlike the different Governments who have presided over this policy, it is time that we took responsibility and got the issue right, rather than kicking it even further down the road.
MPs have supported constituents through the mandatory reconsideration process, and our staff have had to deal with that consuming and emotionally draining process. Ultimately, however, this is about the people affected, and the devastating impact that the process has on individual lives when we get it wrong. It takes such a long time to overturn a decision that we fail to recognise the significant consequences of that decision on individuals.
The Work and Pensions Committee made a number of suggestions in 2017, and noted the flaws in the assessment process. People were being asked “medically inappropriate questions”, and there was a mismatch between what assessors heard and what was written in their reports. Some assessors overlooked certain aspects of disabilities or illnesses, including mental illness and conditions such as fibromyalgia or ME. Such conditions can be deceptive, and medical professionals who have not seen them before can often miss them, and we must therefore consider those severe flaws in the process.
As I said in a previous debate, I was invited to witness an acted out version of an assessment. If I am honest, I found the whole thing a bit ridiculous because it took an hour and a half, although I was told at the start that it would take 40 minutes. It felt as if I was having a wee play performed for me about how the process would work in an ideal world, but in reality that is not how things work. That is not the experience of my constituents or those people we have heard about today.
The hon. Member for Oldham East and Saddleworth (Debbie Abrahams) named many individual cases. Tragically, there are many more examples of people who have ended their lives as a result of this process. These are vulnerable people, and we have a responsibility to do more. With all due respect to the Minister, I know he will stand up and restate the Government line. That is fine, but it does nothing for people who are sitting at home right now and going through this process.
The Government have announced plans to combine the assessment processes, but I am not sure how much comfort that will bring to my constituents, or any of the people we have heard about today. It is true that they might not have to go through repeated questions and the needless extra stress of multiple examinations, but they will still have to go through the assessment process and the devil will be in the detail. Many disabled people receive only one kind of benefit, so I see no real benefit to that solution, which is the only one on the table right now.
I call on the Minister to get this right. I am tired of coming to Westminster Hall, on any given day of the week or time, to hear another new Minister who will not last very long and has not really managed to get any further down the road. I hope this Minister will be different, and I call on him to listen to the voices in this House, take action and do something.
Marsha De Cordova (Battersea) (Lab)
It is a pleasure to serve under your chairmanship, Sir Henry. I congratulate my hon. Friend the Member for North West Durham (Laura Pidcock) on securing this debate. I thank all organisations that have provided briefings for it, and commend the excellent campaigning work of so many disabled activists, including those from Disabled People Against Cuts, who have shown that through direct action, our voices can be heard. I welcome the Minister to his new post, and I, too, hope he lasts longer than his predecessors. I look forward to working with him to try to make a difference.
My hon. Friend the Member for North West Durham made an excellent opening speech that highlighted the flaws in the unfit-for-purpose assessment framework, and the inadequacies of the assessment. She eloquently described the impact of poor decision making, and the flaws in the process that so many individuals have to go through. These ill and disabled people have to endure weeks, if not months on end, of waiting to receive the vital social security support to which they are entitled. She rightly highlighted the damning report from the UN Committee on the Rights of Persons with Disabilities, which stated that this Government have caused a systematic violation of the rights of disabled people. She also highlighted the harrowing experiences of so many people, which I will come on to later in my speech.
This afternoon hon. Members from across the House have shared their testimonies and paid tribute to their casework teams. We MPs are picking up a lot of this casework. We heard from my hon. Friends the Members for Ellesmere Port and Neston (Justin Madders), for Oldham East and Saddleworth (Debbie Abrahams), for Lincoln (Karen Lee), and for Coatbridge, Chryston and Bellshill (Hugh Gaffney), and from the hon. Members for Strangford (Jim Shannon), and for Glasgow South West (Chris Stephens), to name just a few.
Ten years on from its introduction, the unfit-for-purpose assessment continues to cause unnecessary harm. I admit that the work capability assessment was flawed from its inception, in that it fails to assess a person’s ability to work, instead relying on a series of functional descriptors that do not reflect the real world of work or the barriers to it. Under the coalition Government in 2012, WCA criteria were revised and the descriptors changed, making the test more restrictive. Once assessed, a person was placed in one of two groups: limited capability for work, or limited capability for work and work-related activity. In 2017, however, the Government did the unthinkable and abolished the work-related activity group component for employment and support allowance and universal credit. That denied nearly 500,000 ill and disabled people almost £30 per week, and chose to ignore the additional costs and distance from the labour market that are faced by ill and disabled people.
All hon. Members here have mentioned the outsourcing of assessments. Since 2010, more than £1 billion has been paid to private contractors, including Atos and Maximus, which have repeatedly failed, even by the DWP’s own performance standards. Despite those failures, the DWP recently announced that it will be extending the contract for Maximus until 2021. Does the Minister not agree that instead of extending the contract for a further 16 months, it is about time that we ended the privatisation of the assessments and brought them back in-house? I also ask the Minister to publish the contract and its terms, and how much it is going to cost, as his predecessor promised.
Members have told heartbreaking stories about the failures of the outsourced assessments, such as that of Larry Newman, who was assessed by Atos, was awarded zero points, and died of lung problems soon after. Healthcare professionals are asking inappropriate and offensive questions, and are compiling inaccurate reports. Citizens Advice says that 81% of its advisers have seen assessment reports that contain inaccuracies.
Marsha De Cordova
I am sorry; I have to keep going.
The flawed WCA has led to inaccurate and poor decision making. Some 74% of decisions on ESA are overturned at appeal, but less than a quarter of ESA cases are overturned at mandatory reconsideration. As a result, many are forced to go to appeal tribunals, which, according to Citizens Advice, have an average waiting time of 30 weeks. That is 30 weeks without vital social security support. In 2017, the DWP spent £120 million challenging the cases at appeal tribunals. When will the Minister act to address the failure of the mandatory reconsideration stage?
My hon. Friend the Member for North West Durham mentioned all the cases that drop out of the system before even getting to mandatory reconsideration or appeal stage. Do we record that information? If not, does the Minister not agree that it is time to start recording and calculating the number of people who are falling out of the system? Will the Minister also share how much it costs to administer ESA appeals?
It is good that the ESA65B letter will be revised for the summer. Will the Minister pause any further distribution of those letters to GPs?
Perhaps the biggest failure of the work capability assessment lies in its role as a cause of and contributor to mental distress for ill and disabled people. My hon. Friend the Member for Oldham East and Saddleworth listed all the people who took their life in 2017. This is just not good enough. The Government recently revealed that 5,690 people died six months after being found fit for work. That is unacceptable. These are people like Stephen Smith, who was found fit for work, despite having multiple illnesses. He died last week, and we send our condolences to his family and friends, because this is not an acceptable situation. There is no stronger indictment of a failing system than thousands dying months after being denied vital social security support—the support that is supposed to be the safety net for the most vulnerable in our society.
It is time to scrap the failing system. It is not time to merge or integrate ESA, universal credit and personal independence payments. As long as two assessments are deeply flawed, combining them will only expose individuals to the risk of two adverse decisions as opposed to one.
This is a cruel and callous assessment framework, which has created a hostile environment for disabled people. Labour, disabled people and disabled people’s organisations are clear that we need to scrap the work capability assessment immediately and replace it with an assessment framework that treats disabled people with the dignity and respect that they deserve. We need to end this hostile environment.
The Minister for Disabled People, Health and Work (Justin Tomlinson)
It is a pleasure to serve under your chairmanship, Sir Henry; you have expertly managed the timekeeping. I pay tribute to the hon. Member for North West Durham (Laura Pidcock). I know this is an area that she has campaigned on since she was first elected, and she does so with real passion and a determination to see improvements right across the system. That was echoed by all speakers. I might not have agreed with absolutely every point—hon. Members would not expect me to—but it is clear that there is a real desire to see continued improvement and an emphasis on how important that improvement is to people who are going through the process.
The hon. Member for Lincoln (Karen Lee) highlighted a particular story, which I was very touched by. I would like to meet her to discuss it further, as I think there are lessons to be learned from that case. I am certainly sorry for the experience that person has gone through.
This area is a real priority for me. I have been the Minister for Disabled People before, when I was a Parliamentary Under-Secretary. I have been an elected representative for 19 years, so I recognise the comments—we see first-hand through our casework instances where things have not gone right. I have spent my parliamentary career being proactive, working with MPs across the House, and stakeholders, charities and experts in this area. I listen to what is said, I try to do my best to make improvements and I certainly hope that that was reflected in my record as Minister for Disabled People last time. I will continue in the same vein.
The Government are focused on this area, and we have rightly increased funding for those with disabilities and long-term health conditions. This year, we are expected to spend £55 billion, which is a £10 billion increase in real terms since we came to office. It is a record high and it is 2.5% of GDP, which is higher than the spend of any other G7 country. It is 6% of total Government spending, and I think every penny is rightly supported by the wider public.
The debate today is focused on the 10-year anniversary of the work capability assessment, which I note a few speakers did acknowledge was introduced by the last Labour Government. Clearly, it was not perfect and there has been much-needed improvement since its introduction. We are all committed to playing our part in improving the process and to taking account of the developments in healthcare, modern workplaces and flexible working arrangements.
Backing up those improvements were the five independent reviews. The first three were carried out by Professor Harrington and the final two were carried out by Dr Litchfield. More than 100 recommendations were made that we have accepted and delivered. As the Secretary of State set out in her recent speech, we need to do more, and that is a real priority.
Many people have highlighted concerns with the frontline staff and process. Since 2015, the Centre for Health and Disability Assessments has taken over the delivery of the work capability assessment, and the focus has been on improving the operational process. It has increased the number of healthcare professionals by 82% and 1,300 staff are now directly involved in supporting assessments. It has increased the number of assessment rooms and significantly improved the training programme—many speakers highlighted these issues, in particular in relation to individual conditions. There is broad training on disability analysis and on specific conditions, including multiple and complex conditions, which covers three distinct areas—principles and professional standards; the assessment process; and scrutiny and file work, with an emphasis on quality. Training is predominantly modular, with competency testing at every stage. The healthcare professional must then undergo the continuing medical education programme and is subject to regular case reviews and audits. For complex cases, we expect the healthcare professional to refresh knowledge prior to the assessment.
One very important and welcome addition that has begun to be rolled out is the introduction of customer champions. I absolutely recognise just how anxious and nervous people can be when going for assessment. I absolutely get that. The customer champion can assist those claimants, before and after assessments, to ensure that they receive the best service. We have had good feedback on that, and the intention is that there will be one in every single assessment centre.
I also recognise the comments about communication—the brown envelopes coming through. There is a commitment from me to work further with stakeholders to improve the letters that come out. I have seen this as a constituency MP; I have taken a deep breath at the poor quality of some communications. We need to improve that.
Justin Tomlinson
I cannot give a broad-brush answer. I know what the hon. Lady is saying and I am coming on to the use of evidence and how we can do more earlier and, potentially, then with paper-based assessments. I will come on to that. I understand, but I cannot give a definitive answer, because every claimant has their own unique challenges that have to be addressed.
In addition, SMS text message reminders about appointments have been welcomed, and there has been a lot of work on the website, which includes mock assessment videos so that people can get an idea of the sort of things to expect. Those things are all looking to remove some of the anxiety and worry about assessments. There is more to be done in that area, but we recognise that.
The improvements in the training and the extra healthcare professionals have meant that median clearance time halved from 25 weeks in March 2015 to 10 weeks in 2018, and customer satisfaction has exceeded the 92% target since that point. However, that does not mean that we are getting it right every time, and that is what I want to turn to now in focusing on MR and appeals.
All of us as Members are frustrated when what seem to be clear-cut cases come to our constituency surgeries asking for our help. There are times when we think, “How on earth can this have happened?”, and ultimately the person could have a very long appeal process to go through to get the right decision. In the majority of cases, appeals are successful because of additional oral and written evidence. That has to be addressed. We rightly are going to tackle it and will do so in two stages—first, with the MR process. We have started doing this with PIP. We are seeking to contact the claimant who is disputing a decision and talk to them directly to get the additional oral and, potentially, written evidence at that stage to see whether we can improve decisions at that point, rather than waiting for the evidence to come at the end of the appeal process.
Debbie Abrahams
Does the Minister think that it is unacceptable that any Government policy should cause their citizens to take their own life or to die? If he does, should there not be a moratorium on this policy until it is got right? Surely one death is one too many.
Justin Tomlinson
We all recognise that suicide is a tragic and complex issue, and we take it extremely seriously. We take the death of any claimant seriously and, where we are made aware that a person has died and it is suggested that that might be associated with the DWP directly, a review will be undertaken to identify whether any lessons can be learned and can be actioned.
Justin Tomlinson
Let me make some progress, because this is a very important point about the MR process. We are in the early stages with a new way of looking at MRs, but there have been very positive results, and we will now roll this out to all the PIP dispute sites. We intend to do the same for the ESA sites as well.
The second stage has to do with the appeal process. Again, we recognise that people will submit additional, late written and oral evidence.
Justin Tomlinson
Let me just make this point. I want to explain one of the challenges. The shadow Minister, the hon. Member for Battersea (Marsha De Cordova), talked about a 30-week wait, in some cases, for an appeal. The person may have got the additional evidence in week six, but then the system is saying, “I’m sorry, but you’re going to have wait another 24 weeks until we can actually take that into account.” That is clearly not an ideal situation, so we are looking at how we can lapse appeals, where there is new evidence, to reconsider the decision with the additional evidence and be able then to give them a different decision. If we do not think that that should change the decision, they have the right to carry on right through to the final appeal process, but if it is something that is clearly going to change the decision, we should act as quickly as possible.
Justin Tomlinson
In a second. Over the past five years, only 4% of work capability assessment ESA decisions have been revised at appeal, but we recognise that it is in no one’s interest that things should be picked up only after a lengthy appeal process, so we are absolutely committed to being proactive in this area, and this issue will be a real priority.
Patricia Gibson
I thank the Minister for giving way. I just wanted to ask for clarification on one point that he made, which was about appeals being successful because of new or additional information. How does he respond, then, to the fact that people who go on to appeal do so on the basis that the information that they see about themselves is badly or very badly expressed and incorrect, and to Citizens Advice saying that 81% of the customers it sees have inaccurate information recorded about them, which leads to a wrong decision?
Justin Tomlinson
I am coming on to how we can do more to ensure that the right evidence is put into the system at the earliest possible moment and in the right way. We do not want people who should be getting support to have to go through a lengthy process unnecessarily. We all agree on that, and I hope that hon. Members can see that what I am describing is an important improvement. It is still at an early stage, but as I have seen in previous debates, it is the sort of thing that stakeholders want us to do, and we are rightly going to take it forward.
Let me come on to the point about evidence. It is referring to the integrated service. There is a bit of confusion in terms of what people thought that this would be. The view was that it ultimately would be a panacea whereby people would go for one single assessment for PIP and for the work capability assessment. The reality is that very few people apply for both benefits at a similar point in time. However, for the very few people who do, it might make sense for them to have, if they wish, both of the assessments on the same day instead of having to come in on the Monday and then again on the Wednesday. That may be what people want to do, but we are talking about very small numbers.
The thrust of this is to share evidence if the claimant wishes that to be done. One point that many hon. Members made was about the challenge that often arises of getting the evidence, whether from the GP, the physiotherapist or the hospitals, in a timely manner and in a way that is helpful for their assessment. If they have managed to do that once and they would like us to use that evidence again, with their consent, that is something that we would seek to do as part of building the new digital system and ensuring that the claimant has consistent, better information. Being able to share evidence will reduce the burden of providing the same evidence multiple times. It could potentially lead to fewer face-to-face assessments if we can gather crucial, vital, clear-cut evidence earlier in the claim.
I want to pay tribute to all the stakeholders, the medical experts, the charities and all the MPs across the House who regularly engage on this issue. Over the coming months, we will be doing a series of roundtables and regional events to gather further evidence, with a real emphasis on those with real experience of this area, so that we can further improve the system. We want to build trust, transparency and consistency and we want to improve the claimant’s experience through a more personalised and tailored approach. As a returning Minister, I am committed to supporting disabled people and those with long-term health conditions to claim and receive the benefits to which they are entitled and to ensuring that people are treated fairly and with dignity. I thank all the Members across the House who have contributed today.
Laura Pidcock
I thank all the hon. Members who came to the Chamber today to share the painful experiences of their constituents. I pay tribute to my excellent caseworkers, who work day in and day out to try to get justice for people who are subject to the abuses of the state. I express solidarity also with all the disability rights campaign groups and advice services.
It is a real shame that not one Conservative Member came to the debate or prepared a speech and showed their constituents that they cared. They will have people who are subject to the work capability assessment, and I think that their absence is symbolic of their complicity in the system. This Minister is now in control of the system, so warm words and sympathy are not enough. The Minister has control, so action is necessary.
I want to stress this point in the 30 seconds that I have left. It is just not true that additional evidence is what wins at appeal. It is often evidence that the DWP could have had, and the evidence that people go and give in the initial assessment is the same as that at the appeal stage, so this is not about blaming advice and support agencies or the person for not giving the evidence in the first place. The evidence is there; it is the system that is flawed. The language is also an issue. They are not claimants or customers; they are people who are entitled to this support by the state.
Question put and agreed to.
Resolved,
That this House has considered 10 years of the work capability assessment in relation to employment and support allowance and universal credit.