Welfare Reform and Work Bill

Debate between Baroness Howe of Idlicote and Lord Layard

Wednesday 9th December 2015 Lords Chamber

[Baroness Howe of Idlicote (CB)]

My Lords, my Amendment 51 would amend the Welfare Reform Act 2007 to include people with mental health problems in the ESA work-related activity group on the list of those exempt from the higher levels of conditionality introduced in the Welfare Reform Act 2012.

Research shows that people with mental health problems have a high “want-to-work” rate yet a high unemployment rate. Almost two-thirds of people with severe mental health problems are unemployed. Conditionality—that is, mandating people to take part in generic work-related activity such as CV-writing classes—has become an undisputed part of back-to-work support. Yet the use of the conditionality for this cohort of 250,000 people who are unwell because of a mental health problem is based on no evidence at all. The current schemes are clearly not working for people with mental health problems and the use of conditionality is not balanced with effective support. Less than 9% of people with mental health problems have been supported into work through the Government’s flagship back-to-work scheme. The evaluation and report by the Department for Work and Pensions, as well as much independent research, shows that support is not tailored or personalised, and people with mental health problems are not supported as they should be. As well as being ineffective in helping people back to work, these mandated schemes make people’s mental health worse. Mind’s survey of more than 400 people with mental health problems showed that 83% on the Work Programme or with Jobcentre Plus said that it made their mental health worse or much worse.

My amendment would take away the conditionality part of support for people with mental health problems which requires them, under threat of sanction, to attend support whether or not it is effective or appropriate. Removing this pressure would mean that providers and Jobcentre Plus must give better support, relationships between claimants and advisers—so vital for successful back-to-work programmes—would improve and those with mental health problems would feel less pressure, which ultimately helps in their recovery.

Some may question how by removing the conditionality regime from people with mental health problems their employment outcomes will improve. The rationale here is that schemes which are voluntary for people with mental health problems have far better success rates at supporting them into work than the generic back-to-work schemes. If we want to halve the disability employment gap, we should create systems that work. To take one example, there is WorkPlace Leeds, which is part of Leeds Mind. It works solely with people with mental health problems. No conditionality is used and the support is linked with people’s health as well as employment outcomes. Crucially, the advisers have a real understanding of mental health, the type of symptoms people experience and their specific barriers to work. In 2014-15, the programme secured paid employment for 32% of its clients, some of whom had not been in work for many years before starting the scheme. That is a far higher rate than the 9% achieved through the Work Programme nationally.

Why would my amendment work? Being placed under pressure and burdened by the fear of sanctions has a negative impact on people with mental health problems. When we think about the types of symptoms such people experience—intrusive thoughts, fear, distress, hearing voices, low mood—it is clear that the additional pressure and stress of being mandated to attend certain activities is particularly difficult, especially when these activities do not address the individual’s mental health condition, as is often the case. By removing conditionality, people with mental health problems will gain more choice and control over the back-to-work support they receive. This is one of the most basic principles of supporting people with mental health problems, as outlined in NICE’s guidelines, which say that shared decision-making should be a key part of any service. It does not seem to make sense to have guidelines based on evidence about how best to support people with mental health problems but then ignore them and look to something else.

As I said earlier, people with mental health problems have a high want-to-work rate and there is no evidence to show that conditionality achieves success at supporting them into work. We all want the same thing: to help more people into work. This amendment would provide a real opportunity to transform realistically the support into work offered to people with mental health problems. I hope that the Minister and the Government can accept my amendment.

[Lord Layard (Lab)]

My Lords, I speak to Amendment 52, the purpose of which is to remedy an extraordinary anomaly. We have nearly a million people on ESA due to depression or anxiety disorders, which are extremely treatable conditions. However, only about half these people are in any form of treatment. Most of them have never even had a diagnosis. None of this makes sense and the solution is obvious: we must help these claimants into treatment if we possibly can.

The key services here are those belonging to the national system of Improving Access to Psychological Therapies, otherwise known as IAPT. Last year, these services saw and assessed 900,000 people and roughly half of those treated recovered during treatment. The average cost of treatment was about £1,000, which compares strikingly with the cost to the Exchequer of a person being on ESA for a year rather than working, which is £8,000. Obviously, we want as many as possible of these claimants to enter into treatment with IAPT, for both their sake and that of the taxpayer.

Amendment 52 proposes that as soon as claimants are awarded ESA by virtue of mental illness, they should immediately be referred by the jobcentre to the local IAPT service for assessment and treatment—unless they are so ill that they need to be referred to step 4 care, in which case they should be referred to secondary services. The proposal does not involve compulsion. It says that the claimant should be offered assessment and treatment. However, if this is organised in a friendly way which assumes that this is simply what happens next, most claimants would accept it—though they should be offered the opportunity to say no.

Let me review a number of possible problems that have arisen in the discussion of this proposal—the proposal is not new. First, why is the referral to a psychological service rather than to something else? The answer comes of course straight from the NICE guidelines. Those say that all people with depression and anxiety disorders, which are the most common forms of mental disorder, should be offered modern, evidence-based psychological therapy. Clearly, that is what we need to bring about. The secondary mental health services are too busy with people who are more severely ill to be able to provide that to the vast body of people suffering from depression and anxiety disorders. That is the reason why IAPT was created and why it should have a key role in helping mentally ill people to get better and back into work. People can self-refer into IAPT, so there is no problem in having the jobcentre facilitate that without delay.