Health and Disability White Paper

Thursday 16th March 2023 Commons Chamber

09:30

[Marsha De Cordova (Battersea) (Lab)]

(Urgent Question): To ask the Secretary of State for Work and Pensions if he will make a statement on “Transforming Support: The Health and Disability White Paper” published by the Government.

[The Minister for Disabled People, Health and Work (Tom Pursglove)]

Yesterday, the Secretary of State published “Transforming Support: The Health and Disability White Paper”. This White Paper is a significant milestone, demonstrating the Government’s commitment to ensuring that disabled people and people with health conditions can lead independent lives and fulfil their potential. It sets out an ambitious policy reform package that will transform the health and disability benefits system, and help disabled people and people with health conditions to start, stay in and succeed in work.

We will deliver action in three ways. First, we will transform the future benefits system so that it focuses on what people can do, rather than on what they cannot, including by removing the work capability assessment. In our new system, there will be no need to be found to have limited capability for work or work-related activity in order to receive additional income-related support for a disability or health condition. We will introduce a new universal credit health element that people receiving both personal independence payment and universal credit will be entitled to, which will enable people to try work without the fear of losing their benefits. We will roll this out carefully from 2026-27, and we will ensure that no one currently on universal credit and with limited capability for work or work-related activity will lose out once they move on to the new system.

Secondly, while de-risking work is one side of the coin in supporting disabled people and people with health conditions into work, we know that we also need to provide more employment and health support for this group. The White Paper sets out how we will introduce a new personalised approach to employment support and engagement, with the aim of helping people to reach their potential and live a more independent life. We are investing in additional work coach time and tailored support. The Chancellor also set out yesterday that we will introduce a new programme called universal support, which will provide wraparound support for individuals and employers, as well as additional money to provide more mental health and musculoskeletal treatment for this group.

Finally, we will ensure that people can access the right support at the right time, and have a better overall experience, by testing new initiatives to make it easier to apply for and receive health and disability benefits. I am certain that our White Paper reforms will support more people to reach their full potential and reap the health and wellbeing advantages of work.

[Marsha De Cordova]

Thank you, Mr Speaker, for granting this urgent question.

Although we know that most of the proposals set out in the White Paper will not be implemented until the next Parliament, a significant number of ill and disabled people will be impacted. We see the Government using a carrot-and-stick approach, which will leave many sick and disabled people with the stick and the real threat of the ramping up of sanctions, as indicated by the Chancellor during his Budget statement yesterday. Just this week the Information Commissioner’s Office ruled that the Department for Work and Pensions must release “sensitive” research into its sanctions regime following the Work and Pensions Committee report, which found that there is very little evidence that the sanctions work. Instead, it found that they have a significant impact on the health and finances of those who have been sanctioned. There are real consequences to some of the Government’s actions.

Nobody is arguing that scrapping the work capability assessment is not welcome. However, relying solely on the PIP assessment is not the solution, given the current experiences of PIP assessments, which show that they are deeply flawed; the DWP is losing or conceding in four out of five appeals. Moreover, the Institute for Fiscal Studies said yesterday that up to 1 million people currently on incapacity benefits could lose out as a result of scrapping the work capability assessment and relying on using PIP only. Also under the new proposals disabled people will not automatically be in the “no work-related requirements” conditionality group and will now be subject to the decisions of a work coach.

We also did not hear any additional investment in the Access to Work scheme, so can the Minister say how many people will be impacted and what the cost is of these new proposals? It is estimated that 1 million people will lose out. How are the Government intending to mitigate that? Will the PIP assessment framework change or stay as it currently is? Given the poor decision making on so many PIP assessments, what action is being taken to fix the flawed decision-making process and the assessment itself? How will the DWP ensure that the policy proposals do not remove vital protections against sanctions and risk pushing people further into poverty? Finally, when are the Government intending to publish the sensitive research into the sanctions regime?

[Tom Pursglove]

I am hugely appreciative of the hon. Lady, who always speaks with great passion on these issues. I welcome the cautious welcome from her about the broad thrust of the reform we are trying to deliver, which is to remove the structural disincentive to work. That manifests itself in the many conversations I have with disabled people and their representative groups, when they tell me that many disabled people would like to try to work, but fear doing so and then losing their entitlement if it does not work out. That is not an acceptable situation, and it is right that we change it. I hope that as a House, as we move forward with these reforms, we can come together and deliver something that achieves that objective, which is plainly the right thing to do.

It was before my time in the House, but I well remember debates in previous years about the work capability assessment. It is welcome that we are scrapping the work capability assessment through these reforms. The reforms also offer an opportunity to focus on quality when it comes to the PIP assessment and on making sure that we get the right decisions first time. The hon. Lady will note, for example, that one of the commitments we have made in the White Paper is trying to match specialist assessors with people’s conditions. That is another thing people have regularly been asking for, and we are determined to test that and see what difference it can make. Again, this is all about being responsive to the feedback we have received.

On the issue of sanctions that the hon. Lady mentioned, I know that the legal case she touched on is under consideration by Ministers elsewhere in the Department at the moment. No doubt we will come forward and say more about that in due course, but I want to be clear that it is not my intention or the Department’s intention to force anyone to do something that is not right for them. We are committed to personalised, tailored support that meets individual needs and aspirations. The Secretary of State will talk about that in more detail during the Budget debate later. A lot of that will be voluntary. I would hope that people will want to engage with universal support and will want to engage with Work Well, because this is about trying to help and support people. For people with health conditions, for example, this is a way in which we can work harder and tirelessly with them to help them get better. Work is of course an important determinant of better health outcomes. The White Paper is explicit in saying that we will move forward with this in a way that is appropriate for individuals. For those where work is not appropriate, they will not be expected to do it.

It is also important to set out for the House that there will be transitional cash protection in place. No one who currently has limited capability for work or work-related activity will lose out as they move to the new system. We are specifically protecting those with pregnancy risk or who are undergoing cancer treatment, and we are also keeping a contributory health and disability benefit. Of course, what I really want to do—this is key to all of the work I do in this role—is to work constructively with the hon. Lady and with disabled people and their representative groups to make sure that we get this reform right. This is the biggest welfare reform for over a decade, and we have to get this absolutely right.

[Selaine Saxby (North Devon) (Con)]

I warmly welcome the announcement of the Government’s new universal support programme. Does my hon. Friend agree that it will help disabled people in my constituency find an appropriate job, backed by £4,000 of resources per person? It will further enhance the exceptional work done by Disability Confident and the Barnstable Jobcentre Plus. Might he come to visit and see for himself?

[Tom Pursglove]

I commend my hon. Friend for the work she does on the ground in her constituency, working constructively with the jobcentre and employers to help facilitate employment opportunities. I am really excited about the opportunities universal support will bring. We know from existing schemes that where people are supported in taking and then retaining roles, it is hugely powerful and effective in bettering their health and employment outcomes. That is precisely what we are doing through universal support with those 50,000 opportunities. I am excited to work with my hon. Friend on implementing that in her area, and I would of course be delighted to visit and see more of what is going on on the ground.

[Mr Speaker]

I call the shadow Minister.

[Ms Karen Buck (Westminster North) (Lab)]

No one will mourn the passing of the work capability assessment; Labour has been calling for reform of that for a long time. It needed to change, because people’s lives do not fit neatly into a binary system of work or no work. However, disabled people and those with serious health issues want and deserve support and reassurance in work and out of it, and what people fear, understandably, is that under the guise of reform their lives will be made harder and vital financial support might disappear.

The devil is always in the detail, so I have a few questions for the Minister. The PIP assessment is designed for a totally different purpose from the WCA; how will he reconcile those completely different systems? What will happen in future to those people who do not currently receive PIP—those on the limited capability for work and work-related activity element of universal credit, and particularly those with short-term and fluctuating conditions? Unless it is the Minister’s intention that some 750,000 people will lose £350 a year, an alternative needs to be in place; what will that alternative be?

Do the Government believe that it is fair that the hundreds of thousands of people with disabilities that prevent them from even engaging in work-related activity should receive less financial support through UC than people who are entitled to PIP, and if so what is the basis for that justification? If the intention is to allow work coaches to use discretion in all such cases, how will we ensure consistent decision making and decision making that is based on a proper understanding of serious health conditions and their impact on daily life? What provision is made within the Department to ensure that capacity for that is in place?

As transparency and openness are so essential in building confidence, will the Minister now publish the report on the operation and effectiveness of sanctions? By publishing the White Paper, the Government have started this debate; the minimum we need now is openness and clarity about how those ideas are intended to work in practice.

[Tom Pursglove]

May I first welcome what I think is a cautious welcome from the Opposition for the reforms that we are seeking to advance? I think it reflects some of the utterings that we have heard from Labour Members over recent weeks and months about the direction of travel they want, recognising that there will be people for whom work is not appropriate. I repeat the point that, where that is the case, we will not be expecting people to engage with this support, but it is right that that structural impediment to work is removed from the system, that those who want to work are supported in being able to do so, and that we make sure that we have a system that is responsive to that and that also has health as a focus. I hope we can move forward on a cross-party basis on those terms.

On the specific point about PIP, again it is important to recognise that we will look very carefully at whether those individuals who are not currently in receipt of PIP meet the PIP criteria, and we will act accordingly. Also of course, anybody who thinks they may be eligible for PIP is able to apply for it. I would always encourage people who might be eligible for any given benefit to apply for it.

On the point about the health top-up, I can confirm that the award rate for the new UC health element will be at the same level as is currently awarded to those who have LCWRA. I again make the point about the approach that we intend to take: the reform will be carried out on a staged geographical basis, beginning with new claims in 2026-27. Of course, legislative steps will need to be taken to bring this reform to fruition, but there is much to welcome and I hope we can come together. On the point about the legal case, as I said earlier, colleagues elsewhere in the Department are considering next steps and will come forward in due course.

[Sir Iain Duncan Smith (Chingford and Woodford Green) (Con)]

I welcome the announcement in the Budget. As my hon. Friend will recall, I wanted to introduce the universal support package alongside universal credit. Its purpose was to intervene and help to change people’s lives, which was what was missing for all those years and needs to be there now. It was intended to replace what has been a very difficult benefit, originally introduced by Labour along with the work capability assessment. Throughout that time, I wanted to see universal credit together with universal support to help people get over their difficulties.

According to a recent survey on sickness benefit, 700,000 people want to find work, but the limits to what they can do seem so difficult that they fear losing their benefit. This measure, hopefully, should change that. However, I urge the Government to do the final bit, which is to bring in the other group who are still receiving employment and support allowance and not yet receiving universal credit, so that the interventions can help them and we can have a progressive, positive way of helping people with sickness or disability to fulfil their potential and lead productive lives, because work is a health treatment.

[Tom Pursglove]

My right hon. Friend speaks with passion and authority on these issues, and he has a wealth of experience of delivering meaningful change in the welfare system that has improved the lives of millions of people. This is the next chapter—the next step in that journey—and one thing I know for sure is that I shall want to draw on my right hon. Friend’s experience and expertise and hear his ideas about how we can get this right. Like him, I am excited about the opportunities that universal support can provide in matching people to roles and supporting retention, with all the wraparound care and support that goes with that. There is a great deal of best practice from which we can learn. I was in Tower Hamlets yesterday, and saw a fantastic example involving NHS talking therapies. I want to ensure that more people are able to engage with that sort of support.

[Mr Speaker]

I call the Scottish National party spokes- person.

[Marion Fellows (Motherwell and Wishaw) (SNP)]

Why do this Government intend to expose more disabled people to the punitive benefits sanction regime? It does not work, and the automation of sanctions will make the position even worse.

Why was there no guidance in the White Paper on statutory timescales for reasonable adjustments to enable more disabled people and those with long-term conditions to work? The SNP and many stakeholders continue to call for urgent improvements to end the payment gap. Why is there no mention of that? Why will the Government not ensure that flexible working is a day one right by default, rather than the onus being on the worker? Why is there no uplift for legacy disability claimants who were missed out during the pandemic? PIP assessments are already failing many disabled people and forcing them into challenging decisions which are ultimately overturned. Why is more being added to PIP assessments?

Will the Minister consider using dignity, fairness and respect as the White Paper proceeds into legislation, as the Scottish Government do?

[Tom Pursglove]

I would argue that dignity, fairness and respect underpin all the work that I do as Minister for Disabled People, Health and Work, all the work of my colleagues in in the Department for Work and Pensions and, of course, all the work of our officials, who approach their responsibilities with real seriousness and want to help and support people in a way that is appropriate for them. That goes to the heart of these reforms.

This is about a tailored approach, whereby people are helped into work when that is appropriate for them. When we can improve people’s health outcomes, we ought to be doing so in a joined-up way. No one will be forced to do anything that is not appropriate for them. As I said earlier, I want people to feel that they would want to engage with the employment support we are offering, and that is reflected in the fact that so many disabled people tell us that they wish to try these opportunities, but fear losing their support if it does not work out.

The PIP journey is now down to 14 weeks, but there is more to do in that regard. I am not complacent about it, and I want to drive forward work on digitalisation. Let me also say that I have a very constructive working relationship with the Scottish Government Minister with responsibilities in this area, and I absolutely commit myself to working with him as we deliver this reform. I know I am set to meet the hon. Lady next week, when we may be able to follow up some of these points.

[Sir Christopher Chope (Christchurch) (Con)]

The Government’s initiative to emphasise the need to improve health outcomes is fundamental to this. May I draw my hon. Friend’s attention to today’s edition of the Daily Express and its Justice for Jab Victims crusade? A two- page article describes the problems that thousands of people are experiencing as a result of receiving covid-19 vaccines that have not worked out in the way they had hoped.

[Tom Pursglove]

I appreciate my hon. Friend’s welcome for our proposed reforms. I have not seen the article to which he refers, but I will certainly have a look at it once I have left the Chamber, and I shall be happy to speak to him separately about it.

[Mr Speaker]

I call the Chair of the Work and Pensions Committee.

[Sir Stephen Timms (East Ham) (Lab)]

There are very welcome measures in the White Paper, although a lot of the detail is still missing. The work capability assessment is to be scrapped, starting in three or four years’ time, and replaced with

“a new personalised health conditionality approach”

to assess entitlement to what the Minister just referred to as the “health top-up” in universal credit. That sounds like a new assessment of some kind. Can he tell us what it means?

[Tom Pursglove]

I suspect that these issues will come up when I appear before the Select Committee along with my hon. Friend the Minister for Employment in a few weeks’ time. I look forward to that opportunity to delve into these reforms in some detail. The detail of our proposed approach needs to be worked through. I am clear that stakeholder engagement, working with disabled people and hearing views from this House will help to inform that. I want people to feel that they can engage with the programmes announced in the Budget, as well as with the existing provision. That will happen on a voluntary basis, but we need to move the reform forward in a pragmatic way. We will say more about it as we move forward with implementation.

[Mark Jenkinson (Workington) (Con)]

I thank my hon. Friend for bringing forward steps to abolish the work capability assessment. Does he agree that that will enable more disabled people in my constituency to take up work without fear of losing financial support?

[Tom Pursglove]

My hon. Friend hits the nail on the head about what we are trying to achieve with these reforms. He is a passionate campaigner for employment opportunities in Workington, and has had considerable success in that regard during his time in this House. I appreciate his welcoming the reforms, which are about helping people to achieve their aspirations. If work is something that people want to do, Government ought not to put barriers in place to prevent that. That is precisely what we are determined to do away with.

[Florence Eshalomi (Vauxhall) (Lab/Co-op)]

I thank my hon. Friend the Member for Battersea (Marsha De Cordova) for asking this important urgent question.

The sanctions do not work. Measures to tackle disability employment gaps are way overdue, and I pay tribute to many groups across Vauxhall, including Autism Voice in Clapham, which I recently visited. They do a lot of work to try to help disabled people back into the work market but, sadly, the employment gap is still there. Many employers discriminate and are not prepared to give disabled people an opportunity, because of the widespread perception that disabled people are less capable, regardless of whether they are the best candidate. What are the Government are doing to tackle negative attitudes about disabled people, which are preventing many of them from fulfilling the opportunities that they should be taking?

[Tom Pursglove]

The hon. Lady is right to raise this issue. We all have a duty and a responsibility to be brilliant advocates and allies of disabled people, promoting opportunities for them at every turn. I expect that we will be in a position to say more about autism specifically over the coming weeks—something that I feel very passionately about as Minister for Disabled People. We are doing work on perceptions, and there is more work to be done over the coming months. We have a campaign that I expect to come to fruition in the not-too-distant future. I want to see more employers sign up to schemes such as Disability Confident. There is more to do, although we have seen real strides forward, with 1 million more disabled people in employment achieved five years early, but we must take the next steps forward. There is so much untapped potential from people who can contribute and offer so much to their workplaces.

[David Simmonds (Ruislip, Northwood and Pinner) (Con)]

I welcome the focus in the White Paper on people with learning disabilities. For many years my constituent Jeremy Child has run the project Community ConneX, formerly Harrow Mencap, which supports adults with learning disabilities to grow their confidence with a view to entering the workplace. Does the Minister agree that such projects are a critical part of the infrastructure that will make this White Paper a success in practice?

[Tom Pursglove]

I thank my hon. Friend for raising the work of Community ConneX, which makes a huge difference in his community. I see that replicated in many of the visits that I undertake in this role. I was in Bristol just before Christmas and it was inspiring to see the work experience placement opportunities that are being provided, often by charitable organisations. I want to work with them to translate those early steps towards employment into roles in other workplaces—full-time work if that is appropriate for someone, or part-time work if that is appropriate in other circumstances.

There is so much that we can do, and I want to place on record my thanks to everyone who works in those initiatives—they are often charitable endeavours, as I say—for everything that they to do help to facilitate this. Working with them will be a key part of how we move this forward.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

May I suggest to the Minister that, as part of this, he looks at reforming statutory sick pay? The pandemic laid bare the inadequacies of that system. Millions of people do not qualify at all, and the rate is one of the lowest in Europe. If we are genuine about getting people with long-term health conditions into the workplace, we need a proper safety net for when they fall ill.

[Tom Pursglove]

I appreciate the hon. Gentleman’s thoughts on statutory sick pay. If there are particular ideas or suggestions that he would like me to consider, I would be very happy to do so.

[Dr Luke Evans (Bosworth) (Con)]

I am really pleased that the Government are dealing with the issue of an ageing population and the difference between good health and poor health. The reality is that many people will live with long-term health conditions. I have seen at first hand that when someone has a heart attack or a stroke, they struggle to get back into the workplace. Is this part of changing the environment to make sure that people have support all the way through, from diagnosis to desk? If so, how will my hon. Friend ensure that the environment is compassionate and supportive all the way through to getting people back into work?

[Tom Pursglove]

Compassionate and supportive is precisely the approach that I see when I carry out my visits and look at the employment support that is being provided. As I said, I was at the NHS talking therapies service in Tower Hamlets yesterday, and I saw that for myself. It was inspirational to hear the testimony of people who have been through that service about the difference that it has made for them. It has supported those with mental health conditions, in particular, by seeing work as a real determinant of better health outcomes for them and supporting them to work.

My hon. Friend knows more than many Members in this House just how valuable better health is for people. The work that he has done in his professional life means that he has a lot of experience in this area, which I am keen to pick up. I know we are due to meet, and I would be keen to hear his ideas.

[Rachel Hopkins (Luton South) (Lab)]

Waiting times for Access to Work grants have skyrocketed under the Conservative Government, with the average clearance time now more than two months. Although plans to enhance the Access to Work support offer are welcome, how does the Minister plan to reduce waiting times so that disabled people can access the support that is available before an employer pulls a job offer?

[Tom Pursglove]

I am not satisfied with where we are in relation to Access to Work, and that is why I am driving a real effort within the Department, which is resulting in more staff being dedicated to it. We are refining our practice, streamlining processes and reflecting feedback, particularly on workplace assessments and travel claims. Those are two areas where some really constructive ideas have come forward and we are now looking to roll them out.

As I said in relation to PIP, digitalisation is key to this. It is about making sure that processes are easy to access and navigate. When we bring those factors together, they will help us to make a meaningful difference in shifting the dial on Access to Work applications.

[Robbie Moore (Keighley) (Con)]

I welcome this health and disability White Paper, because we know that health issues may mean that people feel unable to carry on working or struggle to continue in the working environment. I thank my hon. Friend for the Government’s new £400 million fund to increase the availability of mental health and musculoskeletal resources. Does he agree that this support will help people across the country, including in Keighley and Ilkley, who need such support to stay in work for longer?

[Tom Pursglove]

My hon. Friend is a brilliant champion for his constituents, and he is always arguing for improved employment opportunities for residents in his area. The Budget commitments, which my right hon. Friend the Secretary of State will no doubt touch on during today’s debate, amount to more than £500 million of employment support by 2025-26. That very much reflects the best practice that is being delivered out there in the country, building on it and cascading it further. I think it is fair to say that my hon. Friend’s constituents and mine, and those of hon. Members across this House, will feel the benefit of this work in the years ahead.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for his answers on this important issue. Large numbers of my constituents have disabilities and are on benefits, and have understandable concerns, so I seek some reassurance. Will he outline whether greater financial incentives can be offered to employers to take time to put in place procedures to allow disabled people to be part of the team yet work from home? That would allow more people to overcome their physical restrictions and be a huge asset to a team, and thereby gain confidence and independence through employment.

[Tom Pursglove]

The hon. Gentleman is right to touch on the fact that disabled people contribute so much to our workplaces, and I want to extend their contribution further so that we can unleash the potential in our society. With the right help and support, we will build on the successes that we have seen in getting people into work. The target of getting 1 million more disabled people into work was met five years early, but that is not the end of the story.

We need to continue to move forward, which is why the hon. Gentleman is right to also touch on the support that we have in place and our work with employers. Access to Work is an important part of that, because it supports the physical things that people need in workplaces to facilitate employment opportunities. Another area that I am passionate about and want to look at closely, and relates to what the Chancellor said yesterday about occupational health, is what more we can do to improve soft skills for employers to ensure that they have good-quality workplace conversations to best support those who are coming to work for them, and those who work for them already.

[Martin Vickers (Cleethorpes) (Con)]

The report points out that autistic people are the least likely of all disabled people to be in work. It goes on to reference the nine local authorities where there has been a pilot, which is to be extended to a further 28. Does that 28 include the nine? Can the Minister outline the criteria for local authorities to participate?

[Tom Pursglove]

I am happy to provide further detail for my hon. Friend separately. We recognise that there is real value and opportunity in having locally led and locally initiated employment opportunities and support that are tailored to meet localised needs on the ground and that work closely with the health system. That is reflected in our announcements. We need to take that forward in a joined-up way and work across Government. There is a real determination from not just Ministers in the Department for Work and Pensions but the Prime Minister, the Chancellor and Ministers in the Department of Health and Social Care—this is a cross-Government effort. I am happy to provide him with more background about the work that we are doing.

[Andrew Jones (Harrogate and Knaresborough) (Con)]

It is fantastic that we have seen 2 million more people with disabilities enter the workplace in the last decade and that, as my hon. Friend said earlier, those who want and are able to work are supported to do so. I have spoken before about my support for the Disability Confident and Access to Work schemes. The White Paper builds on all the progress made thus far. Can he outline more about how the Access to Work scheme will evolve with an enhanced package and about the flexibility? Basically, can he update the House? The programme is fantastic, but there needs to be significantly greater awareness.

[Tom Pursglove]

It is fair to say that the Access to Work scheme is a flagship scheme that has made a big difference over the years in helping to support disabled people into work. As we move forward with the reforms, we want to look at how we can be more ambitious on Access to Work and, as I touched on earlier, what more we can do to support employers to have those soft skills so that they have good-quality workplace conversations with employees about how they can be best supported. We also want to ensure that we deliver digitalisation to bring waiting times down. Frankly, I do not want anyone to have to wait longer than necessary to start work, if that is something that they want to do. We must support people to retain their roles.