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Elliot Colburn (Carshalton and Wallington) (Con)
I beg to move,
That this House has considered e-petitions 593296, 619481 and 620962 relating to assessments for disability benefits.
It is a pleasure to serve under your chairmanship, Mr Mundell. Let me begin by reading out the prayers of the petitions. Petition 593296 reads:
“People with a lifelong illness should not be subject to regular reviews for eligibility for the Personal Independence Payment (PIP) or Employment and Support Allowance (ESA). People suffering lifelong conditions should not have to prove they are still ill every couple of years.”
The petition received just over 29,000 signatures, including 68 from Carshalton and Wallington.
Petition 619481 reads:
“The Government should remove the requirement for people claiming disability benefits, such as the Personal Independence Payment (PIP), to have to go through an assessment process. Claims should be based solely on evidence from medical professionals, such as a letter from a GP or consultant.”
This petition also received just over 29,000 signatures, including 46 from Carshalton and Wallington.
Finally, petition 620962 reads:
“We want the Government to conduct a full review of the PIP process. This should look at DWP policy and the performance of ATOS and Capita, which conduct the health assessments for applicants. We believe the current process is inherently unethical and biased, and needs a complete overhaul.”
This petition received around 16,500 signatures, including 18 from Carshalton and Wallington.
I thank the amazing staff of the Petitions Committee for all the engagement work they did in advance of the debate, and the petition creators for meeting me. I thank the numerous charities, campaigners and organisations that briefed the colleagues we will hear from later, particularly those that shared particularly harrowing stories. They were brave enough to come forward and share those stories so that we can share them. It was clear from my conversations with the petition creators, charities and other stakeholders that it is absolutely time for reform and change. I hope that change will go some way towards restoring trust in the PIP process, which is shown by the conversations I have had to be severely lacking. We owe it to the claimants, who see the system as confrontational and judgmental, to change.
After all, applicants should not be made to feel as if the system is against them even before they have begun to engage with it. They should not feel like an assessor is trying to catch them out, and they should definitely not feel that gaining PIP support is not worth what many describe as the emotional, mental and physical costs of the application and assessment process. I look forward to hearing from the Minister what plans the Department for Work and Pensions has to build on its existing reforms.
I want to point out a few scenarios, some given to me by the petition creators and some from my own constituency MP postbag. I am pleased to see how well attended the debate is for a petitions debate, and I am sure we will hear from colleagues what has come through in their constituency casework. My first example is of a PIP assessment in which the applicant was applying on the basis of a mobility-based disability, yet the assessor who was overlooking the case, and who ultimately decided that they should not be entitled to PIP in the first instance, was a dental hygienist. I do not think many people would accept that a dental hygienist is a suitable assessor of someone with a mobility-based impairment, even if the hygienist has undergone some basic general training. It is probably no surprise that, from the word go, the applicant felt neither confident nor assured in their PIP assessment.
I have heard about that issue not once but a number of times in my constituency casework, and many charities and organisations raised it with me in advance of today’s debate. Claimants are being assessed by medical professionals whose field of expertise is either at complete odds with or outside the medical condition being assessed. I would appreciate it if the Minister could comment on that, and explain what the Department may be able to do formally to ensure that the medical expertise of assessors at least correlates with the condition forming the basis of the PIP application.
However, the problems seem to go deeper than that. Indeed, the medical awareness of assessors, and the wider issues of what is taken into account as part of an assessment, lead to my next point: the role of those medical professionals who best know a PIP applicant’s situation, illness or disability and how it affects their day-to-day life. In most cases, that will be their GP. It became clear from conversations—and from the appeal process, which I will come to shortly—that GPs and their understanding of the claimant should play a more central role in the initial application stage for PIP applicants.
Claimants I have spoken to do not believe that their applications and assessments are as strong as they could be if GPs took more of a role in the process, giving greater input and putting their weight behind it. They argue that the current situation, where GP insight is requested only when it is thought to be needed, gives only a partial glimpse of their situation. That is especially the case given the importance of on-the-day assessments, as a number of effects of illnesses and disabilities are more acute on some days than on others.
There is also the mental health aspect. Many applicants talk about the toll of the preparation needed for an assessment, whether mental, physical or emotional, depending on the individual and their circumstances on the day. It is only exacerbated if they find that the person assessing their application does not have any expertise in their condition.
There have been many calls from those I have met for greater involvement—known involvement—of a GP or specialist who is more familiar with the claimant within the process. That will enhance their readiness to engage with the system, as well as give any conclusions greater grounding and create an environment where claimants feel listened to, believed and empowered.
Gill Furniss (Sheffield, Brightside and Hillsborough) (Lab)
The hon. Member has made some fantastic points. Figures show that only 11% of applicants are successful in challenging the PIP award as part of the mandatory consideration process. Applicants who take their appeal to tribunals, where a judge makes a decision, are awarded their enhancement nearly 80% of the time. Does that not say that judges are becoming the doctors? Surely that is the wrong way round.
Elliot Colburn
I am grateful to the hon. Lady; she makes a good point. She has glimpsed a bit further into my speech, but if she is happy to bear with me I will certainly cover that point.
Without adding too much to the list of asks for the Minister, what does he think about giving a greater role to specialists who are more known to the claimant?
I want to move on to talk about the assessment process and the wider system. Often, claimants, faced with something with which they have previously had little or no contact, will talk about a sense of interrogation or mistrust between them and the assessor—I have heard those words from claimants many times. As I say, almost every conversation I have had with a constituent or one of the petition creators has been prefaced with a line about nervousness, stress or other emotions in the lead-up to the assessment, alongside any physical or mental difficulties that a claimant may have. All too often, perhaps unintentionally or unwittingly, they are left feeling like they are a case number rather than a person.
Let me bring up another example, which is also about a PIP claimant with mobility-based problems. They turned up for their assessment and the lift in the assessment centre was broken. Despite their mobility issues and fearing that if they were not able to attend there might be consequences, they attempted to climb the stairs. After a significant amount of time, they managed to arrive for their assessment, but it had caused them a great deal of pain and a lot of stress, and the fact that they were able to get up the stairs was then used against them in the report.
Charlotte Nichols (Warrington North) (Lab)
I concur with the point that the hon. Member made about the sense of interrogation that many of our constituents feel when going through a process that can be very degrading. In the case of one of my constituents the assessor dropped a pen, and when my constituent bent down, picked it up and handed it to the assessor, that was used against them in their assessment. Such stories are not uncommon. We need urgent and radical reform to make sure that people are not treated like criminals for trying to seek help with their living costs.
Elliot Colburn
I am grateful to the hon. Lady for that intervention. Her point about her constituent is well made and chimes with what we have heard from the creators of the petitions.
To return to my example, the lift was broken and the PIP claimant had no option but to attempt the stairs. That case is echoed elsewhere, as the hon. Member for Warrington North (Charlotte Nichols) has just described. The strongest arguments made by the petition creators, whom I met before today’s debate, were about how the assessments are conducted, the time taken to conduct them, where they are conducted and who they are conducted by. In a report on the PIP assessment process, Mind, the mental health charity, found that people felt the process tries to catch them out. I am sure the Minister will agree that if that is the perception, that needs to change; we need to listen to the claimants to figure out why that is.
We have seen some alternatives offered, which I am sure we will hear more about from colleagues from Scotland. I will not steal anything from their speeches, so I will move on.
Hannah Bardell (Livingston) (SNP)
I am delighted that the hon. Member is willing to give way. I will be making a substantive speech, but on the point about Scotland and the system that we have built, it is based on fairness, dignity and respect for claimants. I spoke to a sufferer of Crohn’s disease earlier today. She told me that her experience of trying to get PIP, very like what he has described, was traumatic and the person she spoke to had no understanding. Conversely, when she engaged with the Scottish system, the person came out and spent time with her in her home to see how she was living her life. Perhaps that is something that the UK system should do more of.
Elliot Colburn
I am grateful to the hon. Lady for that intervention. I received a lot of information from my colleague and former Minister in this space, my hon. Friend the Member for North Swindon (Justin Tomlinson); I am sure he will have more to say when he gets up to speak, but I am grateful to the hon. Lady for raising the issue.
I know that the DWP has been looking into the issue for some time, so I would appreciate an update from the Minister on where the Department is. For many, the PIP assessment is not the end. It is just the start of a very long process—unless they give up completely after finding it so difficult.
My last point is about appeal tribunals. My hon. Friend the Member for North Swindon, a former Minister in this space, might be able to correct me on these statistics, but from October to December 2022, 69% of PIP applications that went to tribunal were overturned in favour of the applicant. In 59% of the appeals won by the claimant, the tribunal had reached its conclusions based solely on evidence already provided to the DWP and not on anything new. The numbers are concerning and chime with the concerns that many of us have. I know that the Government are looking at the sheer volume of education, health and care plan assessments that are overturned at tribunal; I hope that the Minister can shed some light on why the Department thinks that this is the case for appeals, what is fuelling their sheer scale and how the matter is being looked into.
As I am sure we will hear from plenty of colleagues who recount their constituents’ stories, reassessments and appeals can be incredibly draining and stressful experiences, especially if a person’s initial contact and assessment was less than satisfactory. Such apprehension leaves many feeling that there is no point in making any further appeals or requesting reconsiderations, so we simply do not know the true number of people affected. I see in his place the Chair of the Work and Pensions Committee, the right hon. Member for East Ham (Sir Stephen Timms), and I am sure we will hear from him later. That Committee’s “Health assessments for benefits” report, published earlier this year, noted that some claimants
“live in fear of reassessments, particularly where they previously had to go through the appeal process.”
I look forward to hearing from the Minister what steps the Department is taking to try to tackle the issue. If we can have a comprehensive and efficient system that has the trust of claimants, I am sure we can turn the situation around.
Sir Stephen Timms (East Ham) (Lab)
I am grateful for the chance to speak in the debate, to the Petitions Committee for having arranged it, and to the hon. Member for Carshalton and Wallington (Elliot Colburn) for opening it. He kindly referred to my Select Committee’s report on health assessments for benefits, which was published in April, and my speech will draw on what we said in that report. We also published the Government’s response to the report in June, since when I have been in correspondence with the Minister about some of the key points that arose.
The annex to our report is well worth a look. It is based on a survey of 8,500 people, who told us about their experience of using the system and going through the assessments. They included people with lifelong conditions and people with experience of the use of medical evidence, both of which are topics covered in the petitions.
I will not comment in the debate on the adequacy of the benefits—the Select Committee has an inquiry under way on UK benefit levels that is focused on that—but I must say that over the summer a good deal of concern continued to be raised about the benefits we are talking about not meeting claimants’ extra costs, as they are intended to.
The Government have recognised the need to transform the system, including in their White Paper. I welcome many of the reforms that have been announced—including, to pick up on a point made by the hon. Member for Carshalton and Wallington, in respect of the testing of the use of specialist assessors—but the problem is that they are going to take years to implement. We need to take further action, given the gravity of the problems that we have already heard about in the debate.
A very important recommendation in our report was that assessments should be recorded by default. They should always be recorded, unless the claimant chooses to opt out of having their assessment recorded. The Government have said no to that recommendation, presumably because it would cost a little more, but I really think that is a mistake. All the assessment providers that are contracted by the Department support the recommended change, as do many of the respondents to our survey. It is the only way to get to the bottom of why things go wrong so often.
The hon. Member for Carshalton and Wallington rightly gave the statistics that show that the great majority of appeals against the refusal decisions that come out of assessments are upheld. Surely that shows that something fundamental is wrong. We will get to the bottom of why that is only if assessments are routinely recorded, so that when things go wrong it is possible to look at what actually happened in the assessment and try to learn from the errors to get things right in future.
In his recent letter to me, the Minister said:
“claimants may need to discuss sensitive and personal information at the assessment and may not want this to be recorded”.
Of course, he is quite right about that, which is why we need a proper opt-out for applicants who do not want their assessment to be recorded. Has the Department considered how, if recording by default were introduced, it would be possible to mitigate those risks, which the Minister is right to be concerned about? Has it also looked at what the impact would be on mandatory reconsideration if recording by default were introduced, because I think it would be extremely helpful. If those assessments are not routinely recorded, we will never get the feedback needed to put these serious problems right.
I want to pick up the point about covert assessment, which was raised by both the hon. Member for Carshalton and Wallington and my hon. Friend the Member for Warrington North (Charlotte Nichols). This is a serious and real problem. We called in our report for the Government to
“urgently investigate the use of covert surveillance by assessors”.
Unfortunately, in their response, the Government said no—I am afraid I will be using that word quite a lot in what I have to say today. They said:
“all assessment providers strongly refute the suggestion that they undertake”
covert assessment, but reports of this happening are much too widespread to be ignored, and the Government should look at that.
We are concerned as well about the system for claimants aged 16 to 18. On turning 16 in England and Wales, claimants must move from disability living allowance to PIP through a full-claim process requiring—until recently—a face-to-face assessment, but claimants in Scotland can stay on DLA until the age of 18. The Government’s White Paper acknowledged the need to help with the transition from DLA to PIP, but our conclusion was that young people in receipt of DLA should not be required to claim PIP until the age of 18, and where under-18s decide to claim PIP, they should have light-touch, paper-based assessments until the age of 18.
Justin Tomlinson (North Swindon) (Con)
Will the right hon. Member give way?
Justin Tomlinson
It is a difficult and fine balance, because the counter-argument is that the current approach allows people, before they turn 18 and therefore become fully responsible for their own living costs and housing arrangements, to know exactly where they are. So it is not a black and white issue.
Sir Stephen Timms
The hon. Member is right: these are often difficult judgments, but I would like to know what discussions the Minister has had with Ministers in Scotland about how things have worked in practice there. I would also like to know what progress the Department has made on plans for 16 to 18-year-olds in work in the severe disability group. I take the point that there are often quite fine judgments to be made, but the unanimous view of the Work and Pensions Committee was that it would be right to move to a system where applicants were not required to move on to PIP until the age of 18.
The Minister will know of concerns that were raised over the summer about pre-application screening questions in the new online PIP application form, which is being developed at the moment, and of the fears being expressed that people will be wrongly put off claiming by those questions, which have not been a feature of the application process before. In winding up, will he say something about those concerns and update us on progress with the online claims system for PIP, which, in principle, is something I very much welcome.
At the moment, claimants have 20 days to return ESA and universal credit forms and a month for PIP forms, and of course they have to send all the supporting evidence in at the same time. Each of those forms runs to tens of pages. The Association of Disabled Professionals told us that this deadline is very difficult to comply with. The deadline starts from the date on the letter, not the date the letter was received. The Association said:
“it is extremely rare for a letter to reach the claimant within five to seven working days of the letter being sent.”
In the pandemic, claimants had three months in which to return the forms. I think there were considerable advantages to that. Mind told us that extending the deadline could
“reduce the need for Mandatory Reconsiderations or Appeals”
by ensuring that the right decision was made first time around. So we recommended a compromise whereby claimants would have two months in which to return forms. Unfortunately, in its response, the Department said no. However, I wonder whether the Minister recognises that the time to return forms is being reduced by delays in getting those forms out to people. We have been hearing that, typically, at least a week—seven of the 20 days—is disappearing before the claimant receives the request.
As we have heard, one of the e-petitions is about considering disability benefit claims on medical advice alone. I am sure the Minister will point out—he will be right to do so—that, as the Work and Pensions Committee heard, GPs and other medical professionals may not know exactly what is needed for a functional assessment. We certainly heard repeatedly that the British Medical Association is absolutely clear that doctors do not want to take on this additional job.
However, the Committee wanted better use of another kind of evidence, which is evidence from family and carers. We heard that the way in which their input is received “is incredibly patchy”, as is whether their input is welcomed or not. The PIP guidance for assessors is explicit that evidence from carers and family should be considered but, anecdotally, it appears quite often that it is not. So we called on the Government to review the guidance, and I am pleased to say that, on this occasion, the Government did respond positively to our recommendation. Will the Minister update us on progress with that review and say when it will be completed?
Debbie Abrahams (Oldham East and Saddleworth) (Lab)
Is my right hon. Friend as concerned as I am about the safeguarding of our most vulnerable claimants when they apply for PIP or have a work capability assessment and about their inability in some cases to complete that process? As a consequence, we are seeing an increasing number of prevention of future death reports from coroners that are directly related to work capability assessment or the PIP assessment process?
Sir Stephen Timms
My hon. Friend is absolutely right, and she has done a great deal of extremely valuable and important work on this subject, both on our Select Committee and in the Chamber. I do share her concerns and, as she knows, because it was substantially at her instigation, we are undertaking an inquiry specifically on the safeguarding of vulnerable claimants to look at these issues. I do share her concerns, and they are reflected in our report. The point about the time people have to send the forms back is important for people who are struggling, for the kind of reasons she sets out, to complete the forms within the very tight deadline that is set at the moment.
Shortly before we published our report, the Department published its long-awaited health and disability White Paper. The Minister knows, because he has kindly given me the opportunity to tell him about it, of my concern that people may miss out on support under the new system because they will not meet the eligibility criteria, although they do under the current system. Quite how that will be resolved is not yet clear, but can the Minister provide reassurance today that claimants and groups representing them will be involved in developing the new system?
There is much more I could say based on our report, but it is absolutely clear—it is already clear from this debate—that these assessments are not working well. We need significant changes to make them work better in the future, and I hope that, before too long, more of the recommendations in our report will be accepted than have been as yet.
Justin Tomlinson (North Swindon) (Con)
It is a pleasure to serve under your chairmanship, Mr Mundell, and to follow the Chair of the Work and Pensions Committee, who is very proactive and thorough in his work. I know from my time as a Minister that the Department takes his views very seriously and constructively. I pay tribute to my hon. Friend the Member for Carshalton and Wallington (Elliot Colburn) for leading the debate, which is of particular interest to many thousands of our constituents, who will be watching it closely, particularly as it comes just ahead of the White Paper.
Before I turn to the assessment process for disabilities, I want to support the point from the hon. Member for Oldham East and Saddleworth (Debbie Abrahams) about supporting the most vulnerable. This is a very complex issue, and there is a huge amount of work to be done. I welcome the fact that the Committee will look in detail at the issue, but there is one very easy fix that would help with all applications. Whether someone is on universal credit or is going through the work capability assessment or PIP process, they should have—if they wish—a named, trusted third party. If, for any reason, they have not returned forms or telephone calls by a certain time, there could be an automatic message to the trusted third party to say, “We haven’t heard back from this person.” In some cases, that may help. There is much more that needs to be done, but I wanted to flag that point.
Turning to the coming White Paper, which this debate is well timed for, there are many lessons that can be learned. We have to be careful about some of the requests we can be tempted to make. If we contrast today’s PIP to DLA—the original legacy benefit—DLA was, in effect, all on the claimants. The forms are still long and complex now, but they were much longer and more complex, and it was all down solely to the claimant. For many people that was fine, but for many others it did not cover all their challenges.
I will come on to the problems with PIP, but there are bits that have worked. For example, the assessment will often tease out things that a claimant may not realise are issues. With PIP, around 32% or 33% of claimants will get the highest rate of support, whereas under DLA it was around 16%. In cash terms, that is around an extra £10 billion a year to support the most vulnerable people in society—a record amount.
We have seen the most marked improvement with people with hidden disabilities. Someone with a mental health condition is now six times more likely to get the highest rate of support than under the old legacy benefits. In many cases, people are aware of their physical health condition and will raise it in their assessment, but the set of questions that are asked then tease out the wider impact in their day-to-day life. That identifies the mental health challenges that people are facing, adding additional points and putting them higher up in the levels of support.
Covid was the trigger for many of our blue sky thinking ideas to become practice very quickly. We had started to engage with stakeholders to talk about the use of telephone and video assessments. There was a nervousness at the time, and we imagined that we would probably have to wait until the White Paper before we could even test the water. However, because of covid, physical assessment centres had to close. We took a decision that we would, in effect, pause those already on benefits, but there were still new people requiring support. We then tested out telephone and video assessments in order to do assessments where there was not sufficient written evidence. They actually proved very popular with stakeholders. I would be interested to know from the Minister how that has progressed since then.
Telephone and video assessments are convenient for people who have issues physically getting to a location. We heard of an example where an assessment centre was not accessible, and there had been a breakdown in communications to warn the claimant in advance of the challenges of getting into the assessment centre. I suspect this point will be echoed by many colleagues today, but these assessments also allow claimants to link up to those with specialist knowledge of their primary health conditions. Pre covid, there were a number of assessors in each assessment centre, and they had to be master of all. They had to have reasonable knowledge of anything that was presented in that geographical location. However, with telephone and video assessments, we could have the motor neurone disease expert based in Dundee doing a video assessment from up there.
Kerry McCarthy (Bristol East) (Lab)
That would be particularly useful for people who have fluctuating conditions that may vary from day to day or manifest differently—somebody with ME, for example, can have very different symptoms, experiences and health from another person with the same condition. I endorse the hon. Member’s point; I suppose if I had to ask him a question, I would ask whether he thinks it would be valuable for those people.
Justin Tomlinson
Absolutely. It would be valuable twofold. I talk to a lot of the assessors, and I know we are all going to highlight where there are challenges, but something like 95% of claims go through. Satisfaction is still relatively high for those claimants; as I said, we are spending £10 billion. The vast majority of assessors want to get it right first time and want to have that knowledge and support, so if we can allow some assessors to specialise, they can develop their training with charities and health organisations with specific knowledge of the area. That will increase the chance of getting the decision right the first time.
Not everybody presents with one single health condition, so it may be that people would have a hybrid assessment in two parts. There would be a general assessment, which in many cases would pick up things on the mental health side that people did not realise were having an impact on their day-to-day life; there would also be a specific assessment of the primary health condition. As the hon. Member for Bristol East (Kerry McCarthy) so clearly articulates, where people have fluctuating health conditions we really need the knowledge to ensure that we are looking not just at one particular day but, as the guidance says, at the typical impact over a one-year period.
During covid, we had a significantly reduced workforce. All our health assessors have a medical background and then have extensive training, and they were the first port of call for secondments to the NHS to provide the covid jab, so we had an incredibly depleted workforce. That really focused our mind on the volume of assessments. At Work and Pensions oral questions earlier today, I raised a point about whether lessons have been learned on extending the severe conditions criteria. When we looked at it, we estimated that about 250,000 to 300,000 assessments, with a change, could be lifted out of the system every single year. That would speed up the process for those who remain and would obviously be beneficial for those 250,000 to 300,000 people.
At the moment, PIP does not look at individual conditions—it is about the menu of health conditions that have an impact on someone’s daily life—but I think that, in some cases, we can do so. We have shown that with the changes to the special rules for the terminally ill, which will look at health conditions. I will give one example, but no doubt there are many organisations that would lobby for a change in respect of particular health conditions.
Motor neurone disease is a horribly degenerative disease, and there is a pretty clear trajectory once someone has been diagnosed, so I have never understood why on earth we assess people who have it. From the moment they have been diagnosed, we should be able to say, “We expect their condition to go like this,” and then provide an automatic level of support. They would start at the lower level immediately after diagnosis and, as their condition, sadly, deteriorated, they would automatically move on to the highest level. If, sadly, their condition deteriorated more quickly, they would be able to contact the PIP assessors, speak to the MND specialist team, have a light-touch conversation—a GP’s note would probably be sufficient—and be automatically upgraded.
Wendy Chamberlain (North East Fife) (LD)
I am grateful that the hon. Member has brought up MND. Does he agree that one thing that the current system must do is prevent delays? Not only do people with the condition sometimes deteriorate more quickly, but the adaptations that local authorities are making, and so on, mean that we are making the process much more difficult on every front for people with MND.
Justin Tomlinson
Absolutely, and that was one of the drivers behind our changes to the special rules on terminal illness. From the point of diagnosis, PIP is a gateway benefit that will unlock extra help from local authorities, so it will certainly speed up that process.
Before the Minister panics and thinks that he would need an office akin to Fort Knox because every single health group would lobby him and say, “These rules should apply to our particular health challenge,” let me say that the way around that is to look at the Industrial Injuries Advisory Council, which already operates within the DWP. In effect, that is a separate, independent body of medical and scientific experts with far greater brains than mine. They are the ones who decide which health conditions qualify for industrial injuries benefits. We could apply the same principle and, as medical care and scientific knowledge evolved, they could update the guidance. That could potentially lift 250,000 to 300,000 people out of the process and help some of the most important people. Since the changes on terminal illness came into force, we have seen all pluses and little else. I hope that the Minister’s commitment to trying to pilot initiatives in this area will continue, ahead of the White Paper.
Many colleagues have mentioned the appeals process. There are different ways of looking at the statistics but, by and large, for the vast majority of people who are successful in the appeals process, either at the mandatory reconsideration stage or at the end, that is because of additional evidence that is presented. We have to look at why that additional evidence is being presented so late in the day. There are many things that could be done. The Department could be more proactive in chasing up sources that have supportive evidence. Getting evidence from a GP is a bit of a postcode lottery. Some GPs will reply to a claimant immediately and give chapter and verse; some are much slower. Some will seek to charge. Some do not necessarily have the right information.
Where someone has already gone through a work capability assessment, which is very similar—I know there is potentially a review of whether we should have two separate assessments, but this is the case as it stands today—there will already be a lot of information on a similar system, and we should at least ask the claimant whether they would like us to look at that information. Remember that it is the claimant’s information and we should not do that automatically, but we should ask to bring that information over.
We should be proactive in encouraging claimants to bring a trusted colleague with them to the assessments. That is within the rules, but how assessors allow it is very inconsistent. Some assessors will encourage the colleague to speak. Some will tell them, “No, you’re not being assessed; you are just there to provide moral support.” We need consistent guidelines. In my opinion, they should be allowed to speak. I have sat in on a lot of assessments; a lot of people are understandably overwhelmed, and arguably do not do themselves justice in what they say. Sometimes, when a person has had a condition for so long, they just take it as the norm that, for example, they no longer sleep at night. Their partner who is woken up by their not sleeping at night would probably be better at articulating that. We should be doing that.
We also started testing phoning claimants at the mandatory reconsideration stage and asking them to tell us, in their own words, why they disagreed with the decision. One speaker mentioned earlier that the mandatory reconsideration success rate is only about 11%. My understanding is that when we piloted proactively speaking to the claimant, that figure went up to about 40%; when I talked to assessors doing that at the time, they felt they could go even further. We would invariably find that a claimant’s GP had told them something but they had not provided us with the information, or had not been able to get it, and we could chase the GP on their behalf and get that information.
We also allowed people to be lifted out of the system. In the past, people had in effect to take their chances. They had to wait for the MR, and once they triggered the independent appeal the Department could not come back and say, “Now you have provided us with this evidence, we agree with you and wish to do that,” because they were stuck waiting for the judge, which can be up to a 12-month wait. We changed the rules so we could lift people out, but if people still did not agree with us they had the right to stay in the process. All those measures that can help lift people out of the process would be very welcome.
I also want to highlight the need for us to start signposting support and help. PIP is geared up to identify people’s challenges and then to identify society’s financial contribution towards the impact on their daily lives, but we stop there; we do not signpost people on PIP to additional support that may exist in their communities. I visited many wonderful and innovative mental health pilots across the country—we will all have done loads of visits in the summer recess, seen something and thought, “Gosh!”—but time and again people said to me, “Our problem is that we can’t find enough people to come and test these things out.” Yet the PIP database has the list of all the people who have been identified as having a mental health issue. I am not saying that they should have to do it, but at the very least we should be writing and saying, “Right, you’re in this particular postcode. These are the local charities and organisations, this is the local authority, and these are the local health pilots to do with your primary condition, or menu of conditions, that may be of interest to you.” I think that would be hugely beneficial to many of the people who go through the system.
Kerry McCarthy
Recently, I did a Zoom surgery with a constituent who is in receipt of benefits, and she said that what would help her most would be having extra hours of childcare and being able to send her child to nursery for an extra day a week. It could be argued that she could spend her PIP money on buying those extra childcare hours, but it is an expensive business, and she needs her PIP money for other things. Is that—whether there is the potential for that extra support—something the hon. Gentleman has taken into account in terms of signposting? She has been offered somebody who can come into her home and do her cleaning and everything like that, but what she really needs is a bit of respite.
Justin Tomlinson
The hon. Lady highlights the point that every single claimant will have their own individual challenges and opportunities. The better the signposting that we give, the bigger the menu of different avenues that can be explored to look at that. That is an important point.
In conclusion, I will make an appeal to the Scottish Government. I regularly met my Scottish counterparts and the Scottish officials, who I must say were absolutely fantastic. As we sought to devolve more and more of the DWP work, our officials and the Scottish officials worked brilliantly. We had very constructive meetings, particularly where the Scottish Government found it challenging to do things as quickly as they had hoped, because it transpires that anything to do with the DWP is a lot more complicated than it seems.
Without a doubt, Scottish colleagues were full of great enthusiasm and ideas, but they sometimes felt that they had to do things differently for the sake of doing things differently. I understand that that helps to strengthen their argument for being their own independent nation—I get that—but these are some of the most vulnerable people in society. I was so frustrated when we made the changes to the special rules for terminal illness—which were, in effect, what the vast majority of stakeholders and health organisations asked for—but the Scottish Government decided, wrongly, to design an even more complicated system than the one that they were rightly seeking to replace. I therefore make this appeal: please continue to work with us constructively, but please do not always dismiss everything as having to be different. Sometimes even we can get it right—even if by accident.
Hannah Bardell (Livingston) (SNP)
It is a huge pleasure to speak in this debate. I thank colleagues who have contributed, the Petitions Committee, and the petitioners who raised this crucial issue, which I have no doubt affects every constituency.
I declare an interest as the co-chair of the newly reconvened all-party parliamentary group on Crohn’s and colitis, alongside the hon. Member for Chesham and Amersham (Sarah Green). I will focus many of my comments on those particularly debilitating and devastating diseases. I am conscious that there will be many people watching at home who suffer from those diseases and many others that are, by their very definition, relapsing and remitting, and that do not fit into the rigid box often called for by the assessments for PIP and ESA. I pay tribute to them. I have spoken to a number of sufferers in recent days and, like many colleagues, I regularly represent constituents who suffer from debilitating diseases and, unfortunately, have traumatic experiences with the social security system.
I have heard about the incompatibility of disability benefits assessment services with fluctuating illnesses, because they take a static measure of the patient’s pain and suffering. Crohn’s disease and ulcerative colitis fall into that category. They are lifelong, immune-mediated diseases of the gut for which there is currently no known cure. The symptoms—I will not apologise in advance, but I give a disclaimer that some of these are quite descriptive and graphic—include urgent and frequent diarrhoea, rectal bleeding, pain, profound fatigue, anaemia, and inflammation of the joints, skin, liver and eyes. Three in four people with Crohn’s and colitis experience bowel incontinence—an unpredictable and urgent need to pass stools.
Currently, over half a million people live with Crohn’s and ulcerative colitis in the UK. I declare an interest: one of those people is my brother. He is fortunate in that he does not have to access the welfare system. He is able to manage his condition, which is relapsing and remitting, such that he can continue in full-time employment. However, since he was diagnosed just over nine years ago, I have seen the struggles: the profound fatigue; the questions about what his career, which has been somewhat curtailed, will look like; and the impact on his partner and family, and even on my mother, who worries daily about his condition and how it may develop.
While this is incredibly serious, it is important to note that these are relapsing and remitting diseases, meaning an individual will have flare-ups that often occur suddenly and unpredictably. There is also significant variation in the pattern and complexity of the symptoms, both between people and in an individual at different times in their life. There are many costs associated with living with Crohn’s and colitis, such as increased costs for transport, heating, treatments and care. In 2022, the charity Crohn’s & Colitis UK received over 1,000 inquiries to its helpline from people looking for information on available funding and support. Information on PIP and benefits is one of the top 10 topics searched for on its website.
The support available through the current benefits system is built on the concept of a disabled person with a permanent and substantial impairment, or a person with a long-term health condition that is likely to degenerate. There is little recognition in the system of a person who has a long-term fluctuating health condition, and the adverse effects on their ability to work, undertake education and maintain their physical and mental health. The PIP assessment guide requires assessors to consider fluctuation of symptoms when deciding what descriptors to use during the assessment, with the claimant’s ability to carry out activities required to be impacted by their condition on at least 50% of days. That is a key point that I want to raise with the Minister.
I spoke to two people ahead of this debate. One is a personal friend, Rachel, and another is a constituent, Steven Sharp. Steven has done a huge amount of work on Crohn’s and colitis, and he talked to me about his experience of their relapsing and remitting nature. He spoke about things such as bag explosions or leaks in the middle of night, and having to clean himself up at 5 o’clock in the morning and do a whole load of self-care, cleaning of sheets and so on. That might be occasional, but when it happens it is devastating. It is embarrassing; it is not something that he talks about very often, but I have his permission to talk about it. He talked about his work with the local football team in Fauldhouse in my constituency. He had gone along to training just the other day and he was struggling to walk. His joints were in a serious state of inflammation and he was really struggling. That is not necessarily an everyday occurrence for him, but it happens. It is impossible for people who have Crohn’s and colitis to predict whether they will be impacted 50% of the time. We cannot squeeze those folk into a one-size-fits-all box.
There are legal precedents for fluctuating symptoms being treated as constant symptoms. The legal test for determining whether a fluctuating symptom should be taken into consideration is found in the Equality Act 2010. As I said, the nature of Crohn’s and colitis means that they are impossible to predict. Somebody might have a different experience on a different day. The arbitrary 50% rule just cannot work for folk with Crohn’s and colitis, or, I have no doubt, for those with many other diseases.
Beyond that, PIP descriptors are too rigid to adequately assess the impact of Crohn’s and colitis. The PIP guidance frames incontinence in very limited terms, as points are awarded based on the need for assistance and aids. Specifically, the descriptors and guidance fail to recognise the difference between types of toilet needs, including frequency of bowel movement, urgency and incontinence. They do not recognise the impact on independence, or on the ability to undertake daily tasks and employment, of experiencing multiple bouts of urgency a day.
I have personal experience from talking to my friend Rachel. She has sadly lost her bowel and had to have a stoma just so she can survive and live. She was experiencing chronic diarrhoea and vomiting. She managed to get back to work, but sadly has recently had to leave and go completely on to benefits. Speaking to the assessor was a really difficult experience for her, yet when she was engaging with the Scottish service, she had somebody come out to her home to spend the day with her and understand the difference. I appreciate what the hon. Member for North Swindon (Justin Tomlinson) said, although I challenge it, because the Scottish system is much more person centred. The descriptors and guidance on “toilet needs and incontinence” do not recognise the significant support that those with Crohn’s or colitis may receive from carers or family, such as support with cleaning themselves, washing clothes and bedding, and so on.
PIP assessments describe mobility based on two activities: moving around and planning, and following journeys. My constituent Steven said that he was asked whether he could tie his shoelaces. He can, but does he also have explosive episodes in the middle of the night after which he needs to clean himself up? Yes, but that does not fit into the strict regime that the DWP is pursuing. Strict, arbitrary measures of distance are not the best way to determine a person’s mobility needs, regardless of their disability.
I know from my brother’s experience of having to plan a journey that he has to know where the public toilets are. We are a family that holiday in the highlands of Scotland, and when he was first diagnosed, I remember him not knowing whether he was going to be able to take his family on holiday, because he could not guarantee that toilets would be in place. He was able to be innovative; he exchanged his car for a truck and put a portaloo in the back of it, which is probably the most innovative response I have ever seen to a chronic disease, but he was in a unique position to be able do that. We should not be asking people who have chronic diseases to drive around with a toilet in the back of their car. That is just ridiculous.
The UK Government must consider a more flexible approach towards moving around that is grounded in a person’s reality and considers their ability. A more holistic approach to journey planning that considers the day-to-day difficulties would be much better for those who suffer.
Data from Crohn’s & Colitis UK shows that applicants found fatigue to be their most debilitating symptom, but it was also the symptom that they felt was least represented in their assessment. People with Crohn’s and colitis who have experience of applying for PIP found that their ability to effectively convey the impact of fatigue and pain as a result of the condition was dependent on the health assessor’s knowledge of the condition. My constituent Steven told me that he was assessed by a mental health nurse, who clearly did not have the requisite knowledge and did not really understand what they were talking about. He ended up not receiving his benefits and has decided not to apply again. That is a sad example of somebody with a genuinely debilitating condition who is being denied their benefits.
In its recent inquiry exploring DWP health assessments, as mentioned by other Members, the Work and Pensions Committee asked the Government to confirm whether they were still reviewing the PIP descriptors, and if not, what evidence they had found that those currently in use are fit for purpose. As I understand it, the Government have yet to present that evidence, so I call on them to refine the descriptors to reflect the real and debilitating impact of Crohn’s and colitis on people’s lives. That process should include a review of incontinence, mobility and objective scales to measure fatigue and pain.
Disability benefit assessments do not need to be like this. As we have heard, and as we know in Holyrood, the SNP-led Government have pursued a social security system with the principles of dignity, fairness and respect at its heart. The new adult disability payment delivers an entirely new, simplified, compassionate experience for disabled people and was designed in partnership with the people who use it. Their input is at the heart of the process and service that we have developed. The Scottish Government have abolished the controversial DWP assessments and instead hold person-centred consultations. That stands in contrast with the UK Government’s system, which, as Members indicated earlier, is punitive, inflexible and, most importantly, unfit for purpose.
According to a recent report, the data on mandatory reconsiderations and appeals shows that there is still a fundamental problem with decision making. Some 69% of DWP decisions were overturned at tribunal in the quarter ending December 2022. That is not just a massive waste of money; it is a massive waste of time for civil servants and those administering the system. Most importantly, however, it retraumatises those with chronic conditions. Those I have spoken to in recent days and those who have been dealt with by my constituency office have talked about the trauma that they have experienced. Governments and nations are judged, I believe, on how we treat the most vulnerable, and with these assessments and this system we are not treating the most vulnerable people with the dignity and respect that they deserve.
Charlotte Nichols (Warrington North) (Lab)
It is a pleasure to serve under your chairship, Mr Mundell. I thank the Petitions Committee for selecting today’s debate and the hon. Member for Carshalton and Wallington (Elliot Colburn) for opening our discussion.
Probably like all MPs present, PIP and legacy disability benefits issues form a huge part of my constituency case load. I pay tribute to my casework team—Paula, Sean, Sarah and Leigh—for their help in supporting my constituents in Warrington North. Given all the cuts to citizens advice bureaux and other support, MPs’ offices increasingly pick up the pieces of a broken welfare and health system, so we can never give our teams enough credit for their diligence in helping us to help our most vulnerable constituents. My team all have an excellent track record when it comes to appeals in this subject area.
As chair of the all-party parliamentary group for multiple sclerosis, I will focus my remarks on the specificities of the experience of those with MS—first, for the sake of brevity, because colleagues have already made some of the general points far better than I would, and secondly, because the experience of those with MS seems to be overlooked in policy terms because it is too common to be considered a rare condition but too rare to be considered alongside more common illnesses. My remarks will nevertheless be relevant to the one in six people living with a neurological condition and to people with conditions that are functionally similar to MS.
As chair of the APPG for MS, before recess I chaired a joint meeting with the APPG for Parkinson’s and the APPG on Crohn’s and colitis, to discuss PIP. We heard how often people with fluctuating conditions are let down by the PIP system. In the UK, more than 130,000 people have multiple sclerosis. Living with MS is hard. Although no two people with MS are the same, there are numerous common symptoms that can significantly impact people’s lives, ranging from those that are more visible, such as problems with walking and moving around, to those that are less visible, such as pain, fatigue and cognitive issues.
Symptoms regularly fluctuate: one day, someone might be active and able to go about their daily business, but the next day it can feel impossible for them to get out of bed. Welfare support is therefore vital for many people with MS to manage their extra living costs, to help with the good days and the bad. The extra costs place a significant financial strain on disabled people, and PIP can help people to stay in work for longer, to participate fully in society and to retain their independence.
Ten years since its introduction, the PIP process still fails to adequately recognise the fluctuating nature of MS and other fluctuating conditions. It does not allow people with MS to properly communicate some of their less visible symptoms, which none the less can prove extremely debilitating. What is more, according to new evidence from the MS Society, which provides the secretariat for the APPG, it leaves people with MS feeling anxious, stressed and embarrassed.
Earlier this summer, the MS Society surveyed more than 3,500 people living with the condition about their experiences with PIP, and it will publish a report next month. The preliminary findings show that almost three in five people—57.5%—said that they were unable to accurately explain their condition and how it affects their daily life; more than 61% disagreed that their assessor considered their hidden symptoms, such as pain, fatigue and cognitive difficulties; and of those who saw their report, 61% said that it did not give an accurate reflection of their MS and half said that it contained factual errors.
The health and disability White Paper takes appropriate steps to fix some of the problems, such as by committing to improving training for assessors, but significant additional changes need to be made to the disability benefits system so that it is fit for purpose in 2023. I will focus my remarks on three key areas: the use of informal, including covert, observations, which colleagues have picked up on; the PIP 20-metre and 50% rules; and repeat assessments as they relate to people experiencing multiple sclerosis.
On informal observations, assessors too often make decisions based on how people look during their assessment. For example, at the meeting to which I referred earlier, Bethen, Neil and Julia, who all live with MS, shared their experiences. Bethen saw in her report that she was awarded nothing because she was “holding a bag” in her assessment. That was despite tripping over during the assessment and displaying obvious evidence of struggling with mobility. Neil’s report came back stating that he
“navigated the test centre well”.
Julia’s report marked her as being able to prepare her own food, on the basis of being able to cut up a banana herself.
PIP guidance states that assessors should
“balance informal observations with evidence from professionals who may have observed the claimant more regularly.”
That clearly is not happening. Guidance is not being correctly applied by assessors, or enforced by the DWP. People who have seen their assessment report say that informal observations are given more weight than the medical evidence. In fact, only 22% of people with MS said that their report referenced evidence gathered from their healthcare professional. Another person with MS told the MS Society that
“no one was reading about the information presented to them by medical experts and effectively accused me of lying.”
Informal observations must be backed up by evidence from the claimant or, if an informal observation is given more weight than evidence to make an assessment about someone’s ability to do a particular activity, the reason for doing so should be fully justified in the assessment report. Additionally, assessors should inform people with MS that they are subject to those informal observations.
PIP guidance should be changed to say that the reliability criteria should be applied, which could be through follow-up questions if someone is observed to be doing something that contradicts the evidence provided. I ask the Minister, in his remarks, to provide assurances on what the Department will to do improve the enforcement of the guidance by his Department.
My second point relates to the PIP 20-metre rule. The rule means that someone who can walk one step more than 20 metres is ineligible for the highest rate of mobility support. How a person functions under clinical testing and in their natural environment can clearly be different. Twenty metres represents a snapshot of someone’s day. That does not take into account the impact that MS symptoms such as fatigue can have for days or weeks after people attend their assessment. Symptoms can also affect people differently from day to day.
Another example of how the PIP system is stacked against people with multiple sclerosis and other fluctuating conditions is the 50% rule, which is a rigid and arbitrary test that requires symptoms to affect someone for more than half of a given period in order to count towards a PIP claim. I join the MS Society and Parkinson’s UK in calling for the Government to scrap the PIP 20-metre rule and to work with experts to come up with an appropriate alternative that considers conditions that fluctuate, or relapse and remit, and that have hidden symptoms. The 50% rule should be more flexible so as to cover and consider the frequency, severity and impact of all symptoms over time.
Finally, the White Paper commits to the introduction of a severe disability group for progressive conditions that have no cure, which I welcome. Over one third of those who described their MS as being at an advanced stage received an award length of two to five years and 5% received an award length of two years. MS is a progressive, lifelong condition for which there is no cure, and it is just wrong that those who have already been deemed eligible for maximum support on PIP have to go through the stress and turmoil of applying for PIP again. I would appreciate the Minister outlining when the DWP intends to set out which conditions will be covered as part of the severe disability group. Will that include multiple sclerosis?
To summarise, I am sure that the Minister agrees that disabled people deserve to be treated with dignity and respect, but surely he can see that the PIP assessment process demonstrates an antiquated and outdated understanding of what disability is, based on a narrow definition of disability. That needs to be brought into the 21st century once and for all. The PIP process and criteria should accurately reflect the impact of living with MS, including mobility, fluctuation and hidden symptoms, with a move away from arbitrary measures towards a more flexible approach.
Members in this room will have heard regularly from constituents who have been treated with contempt by the system, with two thirds of people with MS saying that their experience of the PIP process had a negative impact on their health, and two in five saying that that experience made them feel embarrassed. I hope that it is us who are embarrassed by those statistics. I hope the Minister will listen to the experience of those with MS and bring forward changes such as those that I have set out today. I would welcome the opportunity to meet the Minister and the MS Society to thrash out some of these issues in greater detail.
Sarah Green (Chesham and Amersham) (LD)
It is a pleasure to serve under your chairmanship, Mr Mundell. I start by reflecting on some of the surgeries I have sat in on, and I am sure other Members have friends or family who have gone through the PIP assessment and seen the impact it has had on the self-esteem and mental health of the individual concerned. It is reassuring to hear in the debate the desire from both sides of the House for a kinder, more humane process that will result in more accurate assessments.
I thank the Minister for his answer in Work and Pensions questions earlier and I take it in the spirit it was meant.
I shall focus on one aspect of PIP assessments, which is the use of informal observations. As we have just heard, this is where an assessor watches how someone looks or behaves during an assessment. I know that such observations form part of the suite of evidence used by case managers, but those informal observations are reliant on an assessor’s knowledge of various conditions. There are too many examples of assessors failing to consider or understand the fluctuating and non-visible nature of some conditions. For example—I declare an interest as the co-chair of the all-party parliamentary group on Crohn’s and colitis—many of those living with Crohn’s or colitis feel that assessors prejudge their eligibility for disability benefits based on their physical mobility within a face-to-face assessment, rather than asking probing questions that are relevant to their condition.
That brings me to the condition-specific knowledge of assessors. The Government have stated that all assessment providers are required to ensure that health professionals carrying out assessments have a broad training in disability analysis, as well as awareness training in specific conditions that range from common to rare. The testimony of claimants with Crohn’s and colitis raises concerns that assessors do not properly understand the true impact of their specific condition, its fluctuating nature and its effect on their ability to maintain employment, relationships and education, and to engage in day-to-day activities. I urge the Government to look again at the use of informal observations in assessments, and to ensure that assessors have comprehensive knowledge of the needs of people with long-term health conditions, with condition-specific training that includes working with patient charities and clinicians. That would go a long way to ensuring that those with fluctuating conditions receive the support they need and are entitled to.
David Linden (Glasgow East) (SNP)
It is a pleasure to serve under your chairmanship, Mr Mundell. I pay tribute to the hon. Member for Carshalton and Wallington (Elliot Colburn) who opened the debate on behalf of the Petitions Committee. Elements of his speech felt like groundhog day, because the first Westminster Hall debate that I led, in 2017, was on the issue of work capability assessments. It is worrying that six years on we are still here debating the very same issues. All Members, regardless of party, know that those issues cause undue stress and misery to people across our four nations.
The British Government’s approach to disability benefit assessments is not just ineffective—the theme that has been developed today—but inhumane. Under the current regime, the application process removes the reality of people’s lived experience as the very foundation on which the system has been defined. It favours evidence provided by the assessor rather than the claimant. The system also operates on the presumption of scepticism. It is not a system that empowers its users. Instead it perpetuates a cycle of despair and frustration. That “one size fits all” approach to disability assessment is in my view not only short-sighted, but it completely disregards the reality of living with a disability or a chronic illness. Charities such as Scope have raised concerns about the process time and again, but their calls appear to be continually ignored—at huge expense to those living with a disability.
The impact of disability assessments has, unfortunately, featured significantly in my caseload since I became MP for Glasgow East in 2017. I will be honest: I am no stranger to hearing about dehumanising experiences that my constituents have endured as a result of this system. I sit week in, week out at surgeries across the east end of Glasgow in places like Baillieston, Parkhead and Easterhouse, hearing the same harrowing and sometimes traumatic experiences that people have had to endure at the hands of the disability benefits assessment process.
In most cases, and worryingly, people’s mental and physical health are only worsened by the assessment process. That leads to many further problems for the NHS through health problems, whether physical or mental, so it is counter-productive. My hon. Friend the Member for Livingston (Hannah Bardell) referred to the finding by Scope: from January to March this year, 68% of PIP appeal outcomes were changed in favour of the claimant. If such a proportion of wrong outcomes were found in any other Department, Ministers would ask serious questions. I respect the Minister, who I know takes a strong interest in this issue, but I ask him to look again at the figure of nearly 70% of appeal outcomes being overturned. That suggests that the system is fundamentally flawed.
As people continue to face the disability price tag, disabled people are also having to juggle the restricted funds available to them along with soaring food and energy prices. According to the Trussell Trust’s analysis, three quarters of people referred to its food banks reported that they or a member of their household were disabled. As disabled people are hit disproportionately by the cost of living crisis, to the tune of some £945 a month extra, it is vital that all financial support to which they are entitled is awarded. However, under the current system, that is not always the case; in many cases, it feels as if people are actively held back from the support they so desperately need.
The hon. Member for Warrington North (Charlotte Nichols) highlighted the recommendations in the Work and Pensions Committee report about the use of informal observations—a point also made by the MS Society in its briefing for the debate. Far too often, PIP assessors make inaccurate decisions based on those informal observations. Watching how someone looks or behaves during their assessment or observing someone walking from their car to the assessment centre are now used as tests of mobility. That is completely wrong and such things should not be taken into account. The Work and Pensions Committee, on which I am privileged to serve with the right hon. Member for East Ham (Sir Stephen Timms), has heard that, more often than not, those informal observations are given greater weight than medical evidence.
As others have outlined, when it comes to people with conditions such as multiple sclerosis or Parkinson’s, which fluctuate day to day and have many hidden symptoms, it is completely arbitrary for informal observations to be used to inform the assessor’s decision. The assessor’s limited understanding of complex fluctuating conditions such as MS, combined with the use of informal observations as a way of gathering evidence, results in greater emphasis being placed on the evidence provided by the assessor, rather than the lived experience of the disabled claimant. It therefore strikes me that the only purpose of asking a claimant to come for an assessment is to watch them literally walk from their car to the front door of the assessment centre, which seems utterly absurd.
As my hon. Friend the Member for Livingston made clear, when we look north of the border—this brings me to the substantive point from the hon. Member for North Swindon (Justin Tomlinson)—we can see the difference that devolution has made to how the policy has been implemented. It seems clear, not just to SNP Members but to those who work in the disability sphere, that the Scottish Government—on a cross-party basis, in fairness—are moving away from the regressive approach and becoming more committed to a process that has been designed around the lived experience of people with a disability.
Indeed, the adult disability payment from the Scottish Government is delivering an entirely new, simplified and—I would argue—far more compassionate experience for disabled people. It is a system that has been designed with the claimant, rather than against them; that is the key point that comes back when we speak to stakeholders north of the border. Putting compassion and people at the heart of the system must be the priority for any Government, regardless of their colour, so I am proud that we have taken that approach. Indeed, I am proud that Conservative Members on the Work and Pensions Committee unanimously approved its report praising the Scottish Government’s approach.
Wendy Chamberlain
I am a member of the Scottish Affairs Committee, which did an inquiry into welfare in Scotland, and I certainly agree that what came through strongly from stakeholders was the need for a compassionate approach. As always, however, the processes have to be properly administered. Does the hon. Gentleman accept that at the moment the reality is that waiting times for the ADP in Scotland are longer than those for PIP assessments? Does he, like me, have casework in which there have been incorrect decisions? The approach might be different, but we need to see better outcomes.
David Linden
Absolutely. I totally understand the hon. Lady’s point, and I am sure she will understand that a lot of the civil servants who were working on the design of the Social Security Scotland system were rightly deployed towards the covid pandemic. Ministers in the Scottish Government have acknowledged that the situation with the ADP waiting list is less than helpful. But I come back to the fundamental point on which I challenge the hon. Member for North Swindon, which is that our systems are about taking the view that the claimant is not on the make. That is the nub of the issue. With the UK Government’s system, there is a scepticism about whether the person sitting at the other end of the table is on the make or on the take, so it is about trying to find a way to catch them out. That is why there is an overturn rate of 68%, for example.
David Linden
The hon. Gentleman is shaking his head. I am sure he has something to say, so I am happy to give way.
Justin Tomlinson
There is absolutely zilcho in the assessor’s contract to try to lower the success rate of a claimant. That is part of the driver behind our spending an extra £10 billion a year—a record amount. I wish the Scottish Government the very best of luck if they can identify changes; if they do, I encourage the British Government to adopt them. My point was that we should not be different for the sake of being different. We should always put the claimant first.
David Linden
With the greatest respect to the hon. Gentleman, he has missed the point. The reality is that this contract is being delivered by the private sector—something to which I have a moral and political objection —with a clear brief to try to find people somehow on the make or on the take. If so, why on earth are the Government giving out a contract where the overturn rate is 68%?
Justin Tomlinson
The only thing within a contract that changes what an assessor is paid per assessment is that where there is poor quality, there is in effect a fine on the contract. Under the DLA, the success rate for the highest rate of support was 16%. Under PIP, with the assessors, it is 32% to 33%, hence why we are spending £10 billion a year more.
David Linden
The hon. Gentleman is saying what would happen if a contract were found somehow not to be working, but I rather suspect that the Minister will look at the fact that the overturn rate is 68%. I am not the Minister, but that would suggest to me, and to officials, that something is clearly going wrong with the assessment process.
Under the Scottish Government’s approach of abolishing the disability health assessments, person-centred consultations are held only when required. That is all in stark contrast to the frankly draconian measures that are being put in place and pursued by the British Government. I am sure that many people across the House share the view that the job of Government is to support vulnerable people, not to subject them to further hardship and scrutiny. However, there is an overall unwillingness, among both the Labour party and the Conservative party, to invest in social security. As it persists, disabled people continue to experience stress as a result of undergoing health assessments.
I can only hope that a leaf is taken out of the Scottish Government’s book for the sake of disabled people who are at the mercy of the British Government’s austerity agenda. As the Scottish Government use their devolved powers to mitigate against such draconian welfare policies, I am sure they will always ensure that the most vulnerable in our society and communities receive the support that they are entitled to while being treated with the dignity, fairness and respect that they deserve. That is the fundamental point of this debate, because that fairness, dignity and respect are not there, and that needs to change.
Wendy Chamberlain (North East Fife) (LD)
It is a pleasure to serve under your chairmanship, Mr Mundell. I thank the hon. Member for Carshalton and Wallington (Elliot Colburn) for introducing the debate, the petitioners who signed the petitions and the Petitions Committee for its work.
As other Members have said, as a constituency MP I find that DWP casework, particularly regarding PIP assessments, takes up a substantial part of my caseworkers’ time and often causes extreme distress to those who come to me as their MP. It is always nice as an MP to feel good when we have had a result and managed to overturn something, but frankly we should not need to be involved in the process at all.
I thank the right hon. Member for East Ham (Sir Stephen Timms), the Chair of the Work and Pensions Committee, for highlighting a number of the Committee’s recent report findings. I echo the thoughts of the hon. Member for Glasgow East (David Linden): this is a cross-party issue. There are a number of areas on which we would be likely to find agreement in order to straighten out and improve some of the systems. That would not only help some of our most vulnerable constituents but, frankly, surely save the public purse some money, given the failures and inefficiencies in our system.
It is useful to reflect on why we have a disability benefits system in the first place: because we know that those with a disability often find that their ability to work is impaired or that they are unable to work at all. Our social security system accepts that such individuals need support to compensate them for their inability to work and to meet the additional costs that their disability involves.
It is important that we remember that work capability assessments are not strictly disability benefit assessments, but they predominantly impact on disabled people when they apply for benefits and need to be considered in this debate. The Government have said that work capability assessments are unlikely to be abolished until 2026-27 at the earliest, so there are some key questions that we need answered. We need to know what will be done to improve them in the meantime—we have already heard a number of points about that. How are we avoiding over-testing? What has been done to protect claimants’ mental health? It would be great if the Government could provide clarity on the timeframe involved.
Without work capability assessments, is there a blanket requirement to look for work? It is vital that we avoid unnecessarily extending sanctions to those who are not in a position to work because of their health. All the evidence suggests that sanctions are not effective in encouraging people to work, and they also penalise people with mental health difficulties. Surely we should all want to see a scheme based on incentives.
My party wants to see a separation of the administration of benefits from employment support. Being supported to access training, education or employment ought to be separate from social security. People are not motivated to do things because there is not a sanction; they are motivated to do things because everyone wants a life that is as fulfilling as possible.
I am conscious the fact that at this point in the debate, although we still have plenty of time left, I am touching on things that have already been covered by other Members. On the application process for PIP, the forms are long, difficult and stressful, particularly for applicants with cognitive difficulties, fatigue or mental health difficulties. I firmly echo the thoughts of the right hon. Member for East Ham in relation to the time limit to complete the forms. It is certainly my experience as a constituency MP that forms sometimes take up to a week to arrive, which leaves applicants with only two weeks to apply. That is simply unrealistic.
There is an option to call the DWP and ask for an extension, but frankly it is not well known about, and having to engage again with the DWP causes unnecessary stress. Surely we could look at increasing the time given for applicants to complete the form to two months, and perhaps even longer. We also need to review the form so that we properly take account of relapsing and remitting conditions. I refer to the remarks that I made in an Adjournment debate that I secured on long covid, in which we considered how to support people with that condition.
[SIR GARY STREETER in the Chair]
It is a pleasure to see you in the Chair, Sir Gary. On the PIP assessment process, we all have inboxes full of correspondence from unhappy constituents. I am aware that there will potentially be happy constituents out there who have not had any issues with PIP and therefore have not got in touch with us as MPs, but for those who do get in touch I suspect that the reality of their experience is that they feel the process was degrading and designed to trip them up. The Government can say all they want that that is not what is meant to happen, but it is the experience of the vast majority of people we talk to. One of the petitions we are debating suggests abolishing assessments entirely and focusing only on the medical evidence. We have heard comments from other Members as to why that might not be the best approach, but I agree that it is hard to find a system that is worse than the current one.
Delays in getting assessments is a real issue. According to Citizens Advice, in April this year some 720,000 people were waiting either for an appointment for a new claim or for a review—that is some backlog. We must see a shift in how assessments are offered, with a choice for claimants between them being in person or on the phone. One of the benefits of the pandemic was seeing how that might be possible.
The formal part of the assessment, as Members know, involves reviewing the claimant’s functional abilities against a range of descriptors. Evidence gathered by organisations such as Scope shows overwhelmingly that the descriptors do not allow claimants to properly explain their needs and what they might have difficulty with. Let us take, for example, the question on food preparation: the ability of someone to feed themselves is not as simple as whether they can cook a meal unaided. So many aspects of that are not covered by that simple statement. Perhaps someone can prepare a meal if their pain is not too bad, but they need someone to reach for the items on the top or bottom shelves of a cupboard. Perhaps someone asks the question based on whether the claimant has had help cooking in the past day or week. The answer might be no not because they do not need help, but because they simply have not had the opportunity or support, so they have been eating food like cereal or a ready meal to compensate.
The descriptors are even more problematic for people with relapsing and remitting conditions. At the moment, a 50% rule is applied, so someone has to experience a symptom and have a resulting difficulty for half a given time period for that difficulty to count. That means that if they are in pain so severe that they cannot wash, dress or go to the shops, but only for 14 days in a month, they would not qualify for any support. The criteria also fail to take into account the impact of performing the activities being assessed. “Can you walk more than 20 metres or 50 metres?” Perhaps they can, but slowly and with difficulty, and they are then in so much pain that they cannot do anything for the rest of the day. A mere yes or no does not consider the better test of whether someone can do something safely, repeatedly, competently and in a timely manner.
Other Members have touched on this, but informal observations are a real concern. Particularly given the use of non-specialist assessors, it seems deliberately careless to ask someone to make a judgment on another’s abilities without any deep understanding of that person’s experience. I am grateful to the hon. Member for Warrington North (Charlotte Nichols) for highlighting MS in that regard. In any case, the mere fact that people know they are being watched makes them feel that they are being distrusted, which speaks to the point that the hon. Member for Glasgow East made. In fact, that is why we are all here today: because the people who are meant to be supported through benefits like PIP have so little trust in the system that they want it to be completely overhauled. That is why they signed the petition. We absolutely need to restore that trust, and the first thing the Government could do very simply is to review the use of informal assessments.
I agree with the right hon. Member for East Ham that all assessments must be recorded by default, with the option to opt out if the applicant wants. I do not understand why the Government have not accepted that recommendation from the Select Committee. All reports simply ought to be shared so that claimants can see how and why a decision has been made. That seems reasonable, particularly if we are then moving on to reassessments.
It is important to think about reassessments, and I hope the Minister will explain why it continues to be DWP policy to over-review claimants who have no chance of improving. If something gets worse for a claimant and they think they should be entitled to a higher level of support, they are entitled to start that review process themselves. There is absolutely no need to call people back year in, year out for a stressful process that uses up taxpayer money and just creates more and more backlogs. The backlog will soon be well above a million if we continue in that way.
Worse than that, all the stats for mandatory reconsiderations and appeals show that incorrect decisions at first assessment are commonplace. That means that when someone is called back for an unnecessary assessment, the chances are that they might have had their benefits wrongly stopped. We know that families with at least one disabled person are far more likely to be in poverty than those without—42% compared with 18%, according to the Social Market Foundation—so stopping those benefits, even for a short period, can have devastating effects.
The process halts any chance of someone improving and being able to enjoy a more active and fulfilling life that might include employment, with frequent reassessments linked to stress and further deterioration. That has been the experience of one of my constituents. She does not want to be named, but she wants me to share this with the Minister. She suffered a spinal cord injury in the early 2000s. She was initially assessed in 2016, then reassessed in 2017 and 2019. She has had multiple incorrect assessments. She finds dealing with the DWP incredibly traumatic. Despite being told by her doctor that her condition will never improve—something the DWP eventually accepted—she is still being told that she needs reassessments every two years. That will not fix her spine. All it does is risk her losing the little she receives while causing immense distress. Her needs might worsen over time, but she should be able to exercise her own autonomy about requesting a review rather than being stuck in an endless cycle. What are the Minister’s thoughts about what I can go back and say to my constituent to show that he understands and cares about her and others in that position?
In conclusion, it is clear that the assessments need to be reformed from top to bottom. None of us knows what will happen to us or our loved ones, and our social security system should be a safety net. Its purpose should be to reduce poverty and, where possible, increase employment. I hope the Minister will take on board the comments made by Members today.
Sir Gary Streeter (in the Chair)
We now turn to our Front-Bench speeches. I call Marion Fellows.
Marion Fellows (Motherwell and Wishaw) (SNP)
It is a pleasure to serve under your chairmanship, Sir Gary. I thank the Petitions Committee, its able representative the hon. Member for Carshalton and Wallington (Elliot Colburn), and the petitioners who brought this really important debate to Westminster Hall. I have rewritten my speech about 12 times since I sat down for the debate, so I will be juggling papers, but that is because I have been listening very carefully to what my colleagues have said about their constituents’ stories and their views on what should happen to try to find a way forward.
I have already thanked the hon. Member for Carshalton and Wallington, and I thank the Chair of the Work and Pensions Committee, the right hon. Member for East Ham (Sir Stephen Timms), for all his work to challenge the Government on how the DWP conducts its business—in this case, specifically on PIP. I thank the hon. Member for North Swindon (Justin Tomlinson), an old ally or enemy of mine who I worked frequently with when he was the disabilities Minister. Although we might not agree on everything, we agree that things should be better.
My hon. Friend Member for Livingston (Hannah Bardell) talked about colitis and Crohn’s, along with her co-chair, the hon. Member for Chesham and Amersham (Sarah Green). The hon. Member for Warrington North (Charlotte Nichols) talked about MS and my hon. Friend the Member for Glasgow East (David Linden)—my part boss—talked quite volubly about what the Scottish Government are doing and about the system’s failings. I find it hard to disagree with him—an unusual occasion for both of us.
The hon. Member for North East Fife (Wendy Chamberlain) talked about us as colleagues counting wins from the DWP. How appalling is it that we feel really happy to secure for our constituents something that they should have got in the first place? She also talked about WCAs and the application process and gave us a harrowing story about one of her constituents.
Green Papers, White Papers, disability action plans—the Government are always saying that things will change, but nothing much has changed since I was elected to this place in 2015. There is a trail of aspirations and only worsening conditions in some areas, where disability organisations have to take the Government to court to try to obtain justice for some of the most vulnerable members of society.
What is PIP for? I thought it was to help with the additional cost of being disabled. The horror stories that we have listened to this afternoon—and others—have often reduced me to tears of pure frustration and anger, especially during this cost of living crisis. At a time when the most vulnerable disabled people really needed help, the £150 just did not cover it.
I will very quickly refer to one constituency case. I know the constituent personally, and my whole team were absolutely appalled. She phoned me in tears to say that she had had to go for a PIP reassessment. She was diagnosed with terminal breast cancer approximately five years ago. She has two young children. She has tried every trial, every drug—everything to try to stay alive for her children. She was forced to use some of her precious time to be reassessed. One of the things that most appalled her, and me, was that an assessor actually asked her, “How long do you expect to live?” I think the Minister is aware of the case. I tried very hard to get my constituent switched to the Scottish system, but no, it comes in turns; I could not do it. She did get the PIP—she did get the money—but what she was put through in the process just defies belief.
As we have heard, the Scottish Government are firmly committed to doing things differently, whether or not we agree that they just want to do things for the sake of being different; I gently disagree with the hon. Member for North Swindon on that point. They have introduced a new, simplified, empathetic system for assessments that works for disabled people in Scotland.
The adult disability payment has been designed in partnership with the people who will receive it. The input of disabled people has been crucial to designing an improved service that is very different from the DWP’s system. The Scottish Government listened to disabled people’s experiences during the design of the new system and are doing things differently. They have abolished the type of DWP assessment that is still being undertaken with some of my constituents. Instead, and only where required, they will hold person-centred consultations between the person and a Social Security Scotland health or social care practitioner, starting from a position of trust. In other words, we think people are applying because they need it, not because they are trying to con somebody in the system.
In contrast to the DWP’s system, the Scottish Government removed the burden from individuals to provide supporting information, so the onus will instead be on Social Security Scotland to collect the information it requires. The Scottish Government have put an end to the anxiety of undignified physical and mental assessments, to private sector involvement and to the stressful cycle of unnecessary reassessments. The Scottish Government have introduced indefinite awards for people on the highest level of ADP who have needs that are highly unlikely to change. That avoids unnecessary reviews, promotes people’s dignity, is proportionate to their needs and provides the security of long-term financial support. Anyone with a terminal illness will be fast-tracked, and access to that support will not be tied to a time-limited life expectancy; the judgment of clinicians will be followed.
The Scottish Government’s priority is getting decisions right the first time, so that people are paid their benefits without having to be put through a time-consuming appeal process. Another key difference is that Social Security Scotland often collects information to support people’s applications on their behalf.
It is different. I have talked to constituents and to people who attend my Poverty Action Network, who have told me that moving from working with the DWP to working with the Scottish social security system has changed their lives. They feel so much better. There may be nothing written in stone, on paper or in guidance for people who work for the DWP, but there is a culture that has changed completely with SSS. It is not perfect; I do not stand here and claim that that is so, but I do say that the Scottish Government are trying to make it easier, better and simpler for people who need these types of payment to actually get what they need to enhance their life.
I, too, received lots of briefings, but the one that I want to quickly concentrate on is from the Royal National Institute of Blind People. It gave me a number of suggested questions for the Minister, so I am going to ask them and, in some cases, say why it wants to know, because it also gave me examples.
Will the Minister change the DWP’s practice with respect to medical evidence, so that assessments make best use of pre-existing evidence from experts such as healthcare professionals? This is particularly the case in relation to claimants who already have certificates confirming severe sight loss.
Secondly, will the Minister ensure that all benefits assessors receive sensory impairment training as part of wider disability awareness training? One theme that others have asked about is informal observations. Will the Minister take steps to ensure that informal observations are credible, discussed with the claimant and substantiated before they form part of the decision-making process? RNIB gave the example of a woman with severe sight loss who was said to have made eye contact. I know many people with sight loss, and they look in the direction of the sound. She was looking at the assessor. She was asked to produce documents, so she went into her handbag and took out documents, which the assessor took to mean that her sight loss was not quite what she appeared to be suggesting. She pulled out the papers, which were in a brightly coloured envelope, which was the only thing in her handbag, but their casual, informal observation was “It’s okay, she can go into her handbag and take things out, so she can’t possibly have that much sight loss.”
A very important question for the Minister that has not been touched on this afternoon is what changes the DWP is making to its procedures, following the High Court ruling that found the Department in breach of equality laws for failing to provide accessible information about benefits to blind and partially sighted people. I visited Deafblind Scotland a few months ago and listened to a tale from a woman who was known to require accessible information, including by the DWP, but was not getting it. Dr Yusuf Ali Osman got a judicial review on this, because he received 21 pieces of information from the DWP over a three-year period that he just could not access. He could not read it.
This is really important, and a recent example is the closure of ticket offices, whereby rail groups are putting notices in stations, which people with sight loss cannot read, to say that they are closing the ticket office and there is a consultation. I have written to the Minister on that and I know it has been changed, but the DWP really has to look at this unthinking process that assumes that everybody is the same and fits into a box. What steps will the Minister take to ensure that all benefit advisers have a stronger understanding of the reasonable adjustments available and the legal duty on the Department to make those adjustments?
I have meetings with the Minister and we agree on many things. I know he wants to improve things for disabled people, but I go back to what I said: what is PIP for? I thought it was to help people with disabilities. It should be easily proven by medical experts, and whether it is a mental health or physical issue, we should not have to put disabled people through the trauma of PIP assessments in their current form.
Vicky Foxcroft (Lewisham, Deptford) (Lab)
It is a pleasure to serve under your chairship, Sir Gary. I am grateful for the opportunity to respond on behalf of the shadow Work and Pensions team. I thank the hon. Member for Carshalton and Wallington (Elliot Colburn) for opening this afternoon’s debate. He is absolutely right: it is time for reform and change to restore trust in the PIP process. I also pay tribute to the countless disabled people, friends, families, advocates and disabled people’s organisations and charities that signed the petitions that triggered this debate, and which campaign tirelessly to promote disabled people’s rights.
This debate, in conjunction with the three petitions, has made one thing clear: disabled people are suffering as a result of a flawed testing regime that does not focus on the support they need in their daily lives. As the hon. Member for Glasgow East (David Linden) rightly pointed out, there is a disability price tag. Disabled people are already at greater risk of living in poverty than non-disabled people, and as a result of the additional costs associated with disability and ill health, and the barriers disabled people face getting into and staying in work, they are often reliant on benefits for all or part of their income.
Disabled people should have the security of knowing that the state will step in and support them when they need it. Instead, they face difficult, stressful and sometimes humiliating assessments, followed by weeks or months of uncertainty as they await the outcome. For many, that is followed by more stress and uncertainty as they are forced to appeal unfair decisions. Many of the disabled people I have spoken to during my time in this role have told me that they live in fear of the Government reducing or taking away their benefits. As my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams) said, amplified by the hon. Member for North Swindon (Justin Tomlinson), we must do more to protect vulnerable claimants and ensure that they do not lose their support because of their vulnerabilities.
The petitions call for a full review and major reform of the PIP assessment process. The Government had a chance to do that with their health and disability White Paper, which came out earlier this year. It is undoubtedly a huge task, and Ministers have avoided it, focusing instead on scrapping the work capability assessment. Many have welcomed that, but there is growing concern that the PIP assessment will now also determine eligibility for financial support for those not well enough to work. That means that a flawed assessment process is becoming even more high-stakes. The Government also have yet to give a satisfactory answer to what will happen to the half a million people currently in the limited capability for work-related activity group, who do not qualify for PIP.
Many Members spoke about the large number of tribunals that are successful in overturning the original decision. My right hon. Friend the Member for East Ham (Sir Stephen Timms) rightly stressed the need for all assessments to be recorded by default as a way of tracking and learning what has gone wrong and ensuring that mistakes do not happen again. In recent weeks, it has also been reported that, in a bid to reduce the welfare bill, the Treasury may consider cutting or means-testing PIP. Unsurprisingly, that has caused further alarm among disabled people and those who work with and represent them. Citizens Advice also estimates that disabled people in England and Wales are missing out on £24 million a month because of the PIP review backlog. More than 430,000 are currently awaiting their review, and some are facing delays of up to two years. I hope all of us can agree that those delays are unacceptable.
My hon. Friend the Member for Warrington North (Charlotte Nichols) and the hon. Member for Livingston (Hannah Bardell) spoke about fluctuating conditions such as MS, Crohn’s and colitis and how the system needs to recognise those conditions, support these people and treat them with dignity and respect.
If we are to restore trust in the DWP and create a system that is fit for purpose, we must work closely with disabled people. They are the ones who can tell us how it feels to have their ability to carry out tasks scrutinised by an assessor who may have no previous knowledge of their condition. They are the ones who can truly describe the amount of stress involved in taking the DWP to tribunal over an unfair decision. They can tell us what changes, big or small, could make the process easier and less humiliating for claimants. In other words, they are the experts by experience. If nothing else, I hope the Minister will agree with me on the importance of this co-production.
We must ensure that every stage of the social security system is supportive and accessible and that everyone is treated with the dignity and respect they deserve. Many Members have asked many important questions today. I will not repeat them all, but I do hope that the Minister will spend time ensuring he addresses and answers them in full.
The Minister for Disabled People, Health and Work (Tom Pursglove)
It is a pleasure to serve under your chairmanship, Sir Gary. I thank colleagues across the House for their contributions to the debate, and I particularly thank the Petitions Committee and my hon. Friend the Member for Carshalton and Wallington (Elliot Colburn) for facilitating it. I thank the petitioners who have gone about collecting signatures to get a debate in Parliament; I am very grateful to them for their interest and efforts.
It is important that we come together regularly to debate these matters, and that there is proper scrutiny of the Government’s work in this area. This debate follows on from what I would argue was quite extensive questioning during Work and Pensions questions in the House today. There is no doubt that issues including reforming assessment processes, the role of medical evidence in decision making and other such aspects of the system are vital to the Government and to people across our society, including disabled people and people with long-term health conditions. I am pleased to be able to say something about the current situation, the steps the Government are taking to improve matters, and our quite extensive reform plans, some of which we touched on at DWP questions. I would argue that significant work is already under way.
First, I want to put the assessments in context, because when we debate these matters it is vital to set out why the Government think assessments are important. We use functional assessments to help to determine entitlement to disability benefits. Each benefit has its own assessment criteria to ensure that people receive the right level of support. All our assessments are currently carried out by healthcare professionals with clinical experience. We recognise that assessments can be a difficult experience, so we are committed to improving our assessments and acting on feedback from claimants and stakeholders. We want to make the journey time and the overall experience as good as it can be. Why would any Government not want to ensure that? Where paper-based assessments can be carried out, because there is the required evidence, that should and does happen.
Diversifying the assessment channels is an important step that has been taken in recent years. There is the opportunity for people to have a face-to-face assessment, if that is right for them and if that is what they wish to have, but there are other people who would like a telephone or virtual assessment. It is right that those routes be available to people, so that they have some involvement and choice, but of course it is important that there should be the backstop that if somebody wants a face-to-face assessment, they can have one. That came up a lot in the debate. The changes that I have outlined have come about in recent times, but they are certainly not the end of the journey; that is why we have an ambitious reform agenda, with long-term transformation at its heart, to go alongside the positive steps that we are taking now to help us reach our goals.
There has been quite a bit of debate about informal observations, which were raised by my hon. Friend the Member for Carshalton and Wallington, by the hon. Members for Warrington North (Charlotte Nichols) and for Chesham and Amersham (Sarah Green), and by other colleagues, so let me address the issue directly. Informal observations are important to the consultation, as they can reveal abilities and limitations that are not mentioned in the claimant questionnaire, in the supporting evidence, or in the history taking in the consultation. They may also show discrepancies between a claimant’s reported and actual needs. Health professionals are trained to treat claimants fairly and with respect. They are professional clinicians who use their skills in history taking, informal observation and examination to provide the DWP with an impartial, independent and factual assessment.
Of course, we want every report to reflect a high-quality, functional assessment that the Department can use to make benefit-entitlement decisions, and we do not want reports to be of an unacceptable standard. We have set for providers a threshold for unacceptable reports, above which there are performance guarantees. The DWP audits a statistically valid sample of assessment reports to ensure that the standards that the Department expects are met. Let me be clear: healthcare professionals should be clear and open about that when they assess people. If colleagues have examples where they do not believe that that has been the case, I am keen to hear them so that my officials and I can look at them carefully.
Earlier this year, we published the health and disability White Paper, which set out how we will transform the disability benefits system over the coming years. Our reforms will help more disabled people to start, stay and succeed in work without worrying about being reassessed and losing their benefits—that jeopardy that is most definitely out there. I regularly have conversations with people who want to try work, and have perhaps even identified an opportunity that they might like to have a go at, but they fear it not working out, losing their benefit entitlement, and then having to go back through reapplication and reassessment in the hope of re-establishing their benefit entitlement. That cannot be right. That is why it is crucial that the Government take forward the legislative reform that we are determined to make happen.
More widely, we intend to achieve our ambitious aims by improving the benefits system, so that it focuses far more on what people can do, rather than cannot do; by stepping up our employment support for disabled people and people with health conditions; and by ensuring that people can access the right support at the right time, and have a better overall experience when they apply for and then receive health and disability benefits. Fundamentally, it is not right that people should be written off, but of course in any civilised society there must be a safety net, whereby support is available for people when work is just not a realistic prospect or appropriate for them. It is with that principle in mind that we move forward with our reforms.
We developed the proposals through extensive engagement with disabled people, disabled people’s organisations, charities, GPs and healthcare professionals, businesses and other experts. As our work progresses, we will keep those voices at the heart of how we deliver our reforms. In fact, that engagement is ongoing, and we are beginning to progress the various work streams in the reform model. To pick up on a point made earlier, I reassure the House that people’s lived experience will be heard in that work, which will have stakeholder input, because fundamentally we want to get this right. I want the process to be inclusive, to make sure that we unlock people’s potential, to ensure that they are not written off, and to provide employment support to help people into work when that is right and appropriate for them. We want to unlock the ambition and aspiration that we know is out there among many disabled people and people with health conditions.
Ultimately, our aims will go a significant way towards reducing unnecessary reassessments and the duplication of information provided to the DWP, which is a change that I think we can all welcome. We will achieve that by legislating to remove the work capability assessment, so that there is only one health and disability assessment: the PIP assessment. That will mean that there will be no need to be found unable to work, or to be found to have limited capability for work and work-related activities, to get additional income-related support for a disability or health condition, and there will not be any of the negative connotations around people having to prove that they are unfit for work.
Sir Stephen Timms
On a point that was raised by me, and by my hon. Friend the Member for Lewisham, Deptford (Vicky Foxcroft), what will happen to people who are too unwell to work but not disabled, and therefore not eligible for PIP? The Minister’s proposal seems to be that they will not get any help at all, but I cannot imagine that that is what he intends.
Tom Pursglove
The right hon. Member will be aware that the Government have set out that there will be transitional cash protection. There was the statistical release that we undertook to make available, which has now been published. We are carefully working through what the reform model means, and how individuals can best be supported to ensure that we unlock the potential to work where that is right and appropriate for people. As I say, it is important that the transitional protection be in place as we move to the new system.
There was a question about timescales for reform. We will seek to legislate for the reform in the next Parliament; we will then roll it out in a safe, stable way, and bring about the change incrementally and gradually, area by area, to ensure that we get this right. These are live discussions as we workshop and work through specific aspects of the reforms.
I am conscious that the Chair of the Work and Pensions Committee raised quite a lot of questions; I will answer as many of them as I can. If there is anything that I miss, I will gladly follow up with the Committee.
Charlotte Nichols
The Minister speaks about reforms and live, ongoing discussions. Can he confirm that he is having conversations with Treasury colleagues about not just the eligibility criteria for the reforms and support, but their adequacy? To use MS as an example again, the average cost of having MS is an additional £337 a month. Can the Minister confirm that the issue is not just eligibility, but the adequacy of the support to meet the additional costs faced by disabled people with various conditions?
Tom Pursglove
There is ongoing work to review the cost of living payments that the Government have made available in the current climate. I anticipate that the results will come forward over the autumn and inform future decisions that we make. We continue to have conversations with the Treasury about the support that we provide. The Secretary of State for Work and Pensions will take his annual uprating decisions over the coming months as well, so we should be able to provide assurance in due course on where we go from here on the uprating or otherwise of benefits, taking into account the circumstances, as appropriate, in a thorough-going fashion.
The shadow Minister, the hon. Member for Lewisham, Deptford (Vicky Foxcroft), touched on means-testing for the personal independence payment, or changes to eligibility for PIP. I can confirm that there are no plans for that. I want to be very clear about that.
I will finish on a point that I made earlier. The UC health top-up will be passported via eligibility for any element of PIP. That reduces the number of assessments that people need to undergo and streamlines the process for claimants entitled to both benefits. I recognise that the work capability assessment is quite a point of difference between our Front Benchers. I was not a Member of this House when it was introduced, but I well remember debates on the work capability assessment in years gone by; we have moved on considerably since. There has been a lot of positive reform and improvement to the work capability assessment, but we think it is right to scrap it; we do not think it is right that people should have to prove that they are unfit for work to access the support that they seek.
Vicky Foxcroft
The point that I was making was about things that disabled people have said to me. If they lose one benefit, but maintain another, they still have some kind of safety net. If the assessment is all in one, however—the point being that assessments are flawed at times—they could end up with nothing to survive on. That is the point that disabled people make to me, and that is why I talk about the need for co-production, and working with disabled people to ensure that we get this right.
Tom Pursglove
Absolutely; that engagement is ongoing. We must move forward reform of the work capability assessment in a careful and measured way. We think that is the right approach to take, because it truly de-risks work.
I note that the Opposition policy related to the “into work” guarantee, for which the former shadow Secretary of State, the right hon. Member for Leicester South (Jonathan Ashworth)—of whom I am rather fond, by the way—argued passionately. I do not know whether it will be reviewed following the appointment today of his neighbour, the hon. Member for Leicester West (Liz Kendall), whom I welcome to her place as the new shadow Secretary of State, but the reforms that we are advocating for are the result of listening carefully to the responses to the Green Paper reforms.
I am keen to see the Opposition’s workings on the “into work” guarantee, but certainly from what officials have said to me, it seems that they do not think that it will have the effect on outcomes that the Opposition might think. I hope, however, that as we move forward with the reforms, we will see greater collaboration on a united basis. These are the right reforms to support more disabled people into work, following the abolition of the work capability assessment, which, in years gone by, I recognise as was controversial. Strong opinions have been expressed about it.
Hannah Bardell
I appreciate what the Minister is saying about the reforms, but perhaps he will reflect on the lived experiences that we have shared—the appalling treatment of our constituents and those on whose behalf we have spoken. Also, we have nearly £19 billion in unclaimed benefits every year, and 70% of appeals are overturned. If we add in the cost of the time, effort and trauma, we see there is clearly a long way still to go. Does he agree?
Tom Pursglove
I always make the point—I have done in the House on a number of occasions, as well as more widely in interviews and other engagements—that if people think that they are entitled to support, they absolutely should apply for it. I want that message to go out from Westminster Hall today. That is why the support is there; we want people to access the support to which they are entitled.
That leads nicely into a further point that I want to make about the White Paper reforms. As part of our reform package, we are testing new initiatives to make it easier to apply for and receive health and disability benefits. That speaks to the benefits journey that the hon. Member for Livingston (Hannah Bardell) touched on. For example, we are testing a new severe disability group. People who are eligible will benefit from a simplified process, and will not need to complete a detailed application form or go through a face-to-face assessment.
To add a little more clarity to the response I gave to my hon. Friend the Member for North Swindon (Justin Tomlinson) in Question Time, the policy will be tested on a small scale across a range of health conditions. The criteria used for the severe disability group will be based on the impact of a disability or health condition; we are looking at those that are lifelong, have a significant effect on day-to-day life and are unlikely to improve.
As I said, the Department has made progress with its plans to test the severe disability group. We worked with an expert group of specialist health professionals to draw up a set of draft criteria, which focus on claimants who have conditions that are severely disabling, lifelong and with no realistic prospect of recovery. The criteria were shared with several charities, whose feedback was used to develop the criteria further. We started initial testing at small scale across a range of health conditions last year, and we plan to augment our testing approach in the coming months to develop our insight and evidence. That is a welcome development, which responds to the clear feedback in the Green Paper: people wanted to reduce the assessment burden on those with lifelong conditions that are unlikely to improve. This is an important step on that journey. We will continue to move forward in a collaborative way, particularly as we build our understanding and evidence base to scale the policy.
We are also improving the experience of assessments by testing matching people’s primary health condition to a specialist assessor. As one part of that test, our assessors will take part in training to specialise in the functional impacts of specific health conditions, so that they can better understand claimants’ needs. I hope that will help to build confidence in decisions, and respond to feedback that we have received. Again, that speaks to the change that colleagues from across the House have said today that they want. We are also committed to exploring ways to create a personalised welfare system. For example, we are testing employment and health discussions, which are led by a healthcare professional and focus on how we can help people overcome barriers to work. The pilot at Leeds Health Model Office is helping us to evaluate findings and possible next steps for expansion.
On the theme of tests and trials, I want to respond to the point made by the Chair of the Work and Pensions Committee, the right hon. Member for East Ham (Sir Stephen Timms), on the recording of assessments. The Government are advocating for an opt-in approach. We think that strikes the balance. That way, if people wish to opt into having their assessment recorded, they are able to do so. We are mindful that there is a balance to be struck. We would not want people to feel uncomfortable talking candidly about their condition or disability, and its functional impacts.
However, the health transformation programme is looking at how we can create greater awareness of the ability to record the assessment. We may see more people accepting the opportunity to record their assessment on the back of that. I will gladly update the Committee on that awareness work as we move it forward. I recognise that this issue has come up in many debates, and I recognise the right hon. Gentleman’s strong feeling on the subject, but that is the current position. We are exploring ways to generate greater awareness of that opportunity, should that be something that people wish to do.
Employment is central to our plans. Alongside the ambitious programme of work for the future, the Government recognise that good-quality employment is an important determinant of good health. We have a range of initiatives to support disabled people and people with health conditions in starting, staying and succeeding in work, including initiatives in partnership between DWP and the health system. We have schemes such as the employment advisers in the NHS talking therapies service. We are moving towards 100% coverage in talking therapies services, and the testimony from people who have had the benefit of that is powerful; I welcome it. That is a significant improvement in the services available. The individual placement and support in primary care initiative is also impactful. It is about identifying people’s abilities and needs, helping them to find a role that is right for them, and supporting them in starting and retaining it. We are also taking forward schemes announced in the spring Budget. IPSPC is the pioneer for universal support. We are also piloting the WorkWell partnerships programme, which aims to close the disability employment gap.
We have made good progress in recent years. In 2017, the Government set a goal to see 1 million more disabled people in employment by 2027. Last year, we surpassed that goal five years early. That is not just the Government’s achievement. It is the achievement of disabled people most importantly, as well as of businesses buying into it, and of charities and representative bodies working with people to support that important agenda and unlock potential. Again, an active policy discussion in the Department relates to where we go from here in terms of future employment goals.
I also want to touch on sanctions, which came up a number of times. Work coaches will consider individual circumstances when working with claimants as part of our new personalised approach. If someone has a mental health condition, the work coach can use their discretion to switch off voluntary or mandatory requirements if they deem that appropriate. We will focus on what people can do rather than what they cannot, but we will also ensure that, when people are unable to work, we continue to support and assist them to live independent lives. All requirements will be agreed between the claimant and their work coach. As happens now, claimants will only ever be sanctioned where, without good reason, they have failed to meet the requirements. All claimants will retain the right to mandatory reconsideration or to appeal a decision should they disagree.
Specifically on the health transformation programme, we know that demand for disability benefits is increasing and we need to modernise our systems and processes to deliver better value for money for the taxpayer and a better experience for claimants. The health transformation programme is doing just that, transforming the entire PIP service—from finding out about benefits through to decisions, eligibility and payments. It will create a more efficient service and a vastly improved claimant experience, including speedier management of claims and improved trust in our services and decisions.
The programme is introducing an online PIP application service, giving the option to apply online 24/7 and to upload medical evidence digitally. I am pleased to say that claimants in selected postcodes are already able to apply for PIP entirely online, and we plan to make that available across England, Wales and Northern Ireland in 2024. Again, during the summer recess we announced some additional postcodes in which the new application service is now live.
I want to provide a bit of reassurance about a couple of comments made about the online service during the debate. The online service is optional; it is a voluntary alternative to the existing method for claiming PIP. Claimants who are unable to use an online service, or do not want to, will still be able to make a claim through existing routes. Claimants can receive third party assistance to support them in using the online service as long as the claimant is the one making the claim. Claimants who require formal support, such as an appointee, are not included in this current testing phase. However, making the service available to this group of claimants is a priority for us as we safely and gradually expand the service. We aim to make the online service available across England, Wales and Northern Ireland in 2024 for those who choose to use it. A point was made about being able to more readily reuse evidence: this system should be able to help people to do that.
We are also improving the way health assessments are delivered. We currently use a range of providers, depending on the benefit in question. Once new arrangements begin in 2024, one provider will deliver health assessments in a given area. Claimants will need to interact only with their local health assessment provider, regardless of which benefit they are applying for. That provides a stepping stone to our longer-term aim to create, from 2029, a single new health assessment service for all benefits that use a health assessment. That will transform the delivery of health assessments to provide an improved, clearer and more joined-up experience for claimants. The new service is being gradually developed in a safe environment known as the health transformation area. The approach will allow us continually to improve the new service in a controlled way, before expanding and ultimately rolling the service out nationally. We could not carry out this enormous endeavour alone.
We have also had regular engagement with stakeholders and will continue to listen and build on our successes as we move forward. Drawing on advice from across Government, on 25 May we published our evaluation strategy. That provides an overview of our plans to robustly evaluate the programme.
The hon. Member for Oldham East and Saddleworth (Debbie Abrahams) mentioned safeguarding. I should say that I am meeting representatives of Mind tomorrow, along with a family; that will be of interest to colleagues across the House who campaigned for that meeting to happen. We had a very productive meeting with Mind a few weeks ago. It is important that Ministers should have those direct and perhaps even difficult conversations to make sure that at the Department any and all learning takes place and that all our processes are conducive to being responsive to claimants’ needs and are the best they can be, building on work that I have previously set out. I will not repeat those comments today as we will no doubt revisit these matters in future.
I care passionately about that individual focused support and supporting claimants appropriately through the benefits journey, and want to ensure that all the reform we are taking forward has that support very much at the forefront, building on initiatives such as the advanced customer support senior leaders and the various upskilling work that has gone on within the Department to support staff to best support the most vulnerable claimants.
As well as the ambitious visions of the White Paper and the health transformation programme, we are continually listening to and acting on feedback on the current PIP system to make significant positive improvements. Reducing customer journey times for PIP claimants is a priority for the Department. We are seeing an improvement in average clearance times for new PIP claims, with the latest statistics showing that the end-to-end journey has reduced from 26 weeks in August 2021 to 13 weeks in April 2023. We also recognise that assessments can be a difficult experience, so we now undertake most by telephone to alleviate some of the stress associated with travelling to and attending observational assessments, but I reiterate that if people want to have face-to-face assessments, that should happen; there is the optionality for claimants to seek a face-to-face appointment if that is right for them and they wish it to happen.
More generally, the PIP assessment criteria were developed in collaboration with independent specialists in health, social care and disability, and they focus on needs arising from a range of impairments—including physical, sensory, cognitive and mental health impairments —rather than the condition itself, to ensure that the greatest level of support goes to those who are least able to carry out the activities. PIP and its descriptors are kept under continued review to ensure that they meet the needs of claimants and help the Department to reach an accurate assessment of an individual’s entitlement, but I take on board the points raised during the debate and will raise them with officials back at the Department in future conversations and decisions around PIP and its descriptors.
Let me turn to assessments and medical evidence. We are committed to improving how our decision-making processes work. Medical evidence from GPs and other healthcare professionals play an important part in decision making. We ask claimants to provide relevant evidence at the outset of their claim, and we take that fully into account. However, although this is a valued part of the decision-making process, we recognise that doctors do not want to be the guardians of the benefits system, which is why we do not use it as the sole gateway. I note the testimony and evidence from the BMA mentioned by the Chair of the Select Committee, the right hon. Member for East Ham. Additionally, for PIP and the WCA, awards are not condition-based, as individuals may be impacted by their health condition in different ways. Medical evidence may not describe the functional impact of a disability or health condition on the individual and therefore may not be sufficient on its own to determine entitlement to the benefit. Where it is possible to assess a claim based on the paper evidence alone without an assessment, we will do so.
We are committed to ensuring that claimants receive high-quality, objective and accurate assessments to inform the right decision. Consequently, our assessors are all health professionals with specialist training in assessing the impact of a disability. We recognise that assessments and reviews are not suitable for our claimants with lifelong conditions and disabilities specifically. Although we still have the work capability assessment, we do not routinely reassess people with the most severe health conditions and disabilities with no prospect of improvement, and instead the severe conditions criteria apply. In PIP, our claimants on the highest level of support with long-term conditions receive an ongoing award with a light-touch review at the 10-year point that involves a short form to check whether anything has changed and to confirm that we hold updated information. In most cases, an assessment with a health professional is not required. Our severe disability group test is also part of our focus to reduce unnecessary applications and assessments.
A number of Members posed a very legitimate question about what we are doing to improve the quality of decision making. We have made improvements to the decision-making process, both at the first decision and the MR stage, giving decision makers additional time to contact proactively claimants if they think additional evidence may support the claim. That tailored, more bespoke approach, making sure that decision makers can follow up with claimants to try to ensure that their entitlement is delivered as quickly as possible, ought to complete the jigsaw of the claim and get support out to people.
We are also continuing to learn from decisions overturned at appeal, with our presenting officers going out to hear those tribunals and then sharing that feedback with the Department to help improve our processes. We also work closely with providers on the quality of assessments, with the quality assurance that all of us would want to see, to help ensure that there are high-quality reports that then lead to more correct decisions. To set that in context, since PIP was introduced 5.1 million initial decisions following an assessment were made to the end of December 2022, with 8% appealed and 4% overturned at tribunal. As my hon. Friend the Member for North Swindon highlighted, a significant proportion of those decisions are overturned as a result of new evidence presented at the tribunal. It is important to take that into account, but we are not complacent, and we want more decisions got right first time, hence the efforts to try and achieve that.
Finally, for people nearing the end of life we have the special benefit rules. They allow faster and easier access to certain benefits without needing to attend a medical assessment or serve waiting periods. Eligibility has recently been extended from six months or less to live to 12 months or less, and individuals are now able to claim PIP, DLA, attendance allowance, ESA and UC under the special rules, and that is administered in a pragmatic, flexible, clinician-led way. The hon. Member for Motherwell and Wishaw (Marion Fellows) raised that point, so I want to provide reassurance about the clinician-led approach. I have done this before, but I want to thank all those colleagues across Parliament who campaigned for the changes to the special end of life rules that we have brought about, as well as the stakeholders and the charities who were instrumental in delivering that change. I know that extending that benefit entitlement to people at an earlier stage and for longer is a lifeline to many people across this country.
In conclusion, we are committed to ongoing action to improve people’s journeys through the benefit system both today and by advancing the longer-term reform that I have set out, which I hope all of us will feel able to get around in the coming years with that proper input from disabled people, from stakeholders, and from the representative groups to help us get this right. This is arguably the biggest welfare reform for over a decade, and it is crucial that we hear that lived experience in shaping it and that we work carefully through that change to ensure that it is the best that it can be. We must ensure that we do not write people off, and that where work is appropriate for someone, they are able to access that if it is something that they want to do, recognising the benefit of the health and work join up. All of us, I think, want to see people reach their potential, supported by a benefit system that not only is fit for the future, but has that vital safety net in place that all of us in a civil society expect to see.
Sir Gary Streeter (in the Chair)
Thank you very much indeed, Minister, for that very thorough response. Now we have a few moments for Elliot Colburn to have the final say.
Elliot Colburn
It is a pleasure to serve with you in the Chair at the end of this debate, Sir Gary. I also thank the Minister for his extensive response to today’s debate. I thank the petition creators and the Petitions Committee for all their excellent work in putting this debate on today, and I thank colleagues for turning up to support this petitions debate. It is always important to demonstrate the effectiveness of the petitions system in bringing MPs to this House to discuss the matters that our constituents care about the most, so it is great to see a busy Chamber for this debate.
There is a lot to chew over and a lot to think about. It is clear that a lot of live discussions are going on, so I am sure that we will be back talking about these issues. The Minister had a grilling earlier as well, so I am sure that this is only the beginning of many conversations. I hope that the lived experiences of our constituents have been heard loud and clear, and I thank those who were willing to share their stories with us so that we could bring them to Parliament today.
Question put and agreed to.
Resolved,
That this House has considered e-petitions 593296, 619481 and 620962 relating to assessments for disability benefits.