Child Poverty: Benefit Cap

Baroness Morgan of Drefelin Excerpts

Tuesday 22nd October 2024 Lords Chamber

[Baroness Sherlock (Lab)]

There is always something that you wish you had put in your pack when you stand up. Today it is that. I will write to the noble Lord.

[Baroness Morgan of Drefelin (Lab)]

My Lords, I do not think the Minister should apologise to the House for being “nerdy”. This is definitely an area where nerdiness is welcomed across the House. Can she reassure us that the work of the task force will be comprehensively supported by evidence looking across all aspects of the issue, with granularity around issues such as support for carers and people with disabilities? What has the experience of any exemptions been? How helpful has that been? We need to be sure that the work is not only comprehensive but evidence based and transparent.

[Baroness Sherlock (Lab)]

I am very grateful to my noble friend for the absolution and for the thought that I am among friends. Nerds are my people.

She makes an important point. We have a lot of evidence, but there are real gaps in it. The commission will gather the evidence that is there, listen to how people are experiencing these things on the ground and look at the impact of policies across government. To give one small example, she mentions disability. In the benefit cap, households are exempted if they get a whole series of benefits. If they are getting universal credit because of a disability—if they are getting the UC care element, carer’s allowance, PIP or ESA—they are exempt from the benefit cap, but that does not take away the problem that there is still a massive disability employment gap. We want people to get into work. If we are to hit that 80% employment target, a challenge is to look not just at the kind of jobs that are out there but at how we close the gap between people who want to work and employers who want employees. That is part of what we will do in the evidence process.

Queen’s Speech

Baroness Morgan of Drefelin Excerpts

Tuesday 14th May 2013 Lords Chamber

[Baroness Morgan of Drefelin]

My Lords, I remind the House of my interests, particularly two non-financial interests: I am a trustee of Lung Cancer Campaign Carmarthenshire and a board member of the National Cancer Research Institute. Like many noble Lords, I congratulate those who made their maiden speeches this evening. It certainly takes me back to the day I made mine, when I talked about occupational lung disease. I am delighted that a Bill was announced in the gracious Speech to tackle the need for compensation for people with mesothelioma.

I will focus on tobacco control, which has been referred to by many noble Lords as a major omission from the gracious Speech. One in four cancer deaths are still thought to be due to smoking. Smoking kills one in two long-term smokers. These are shocking facts. I hope that whether noble Lords support standardised packaging or not, they will agree that it is deeply disturbing to learn that eight in 10 smokers start smoking by the age of 19.

Given this uptake of smoking by young people, we must surely all be united in taking whatever action we can to reduce or even stop the young people of this country from smoking. We must, therefore, consider the role of advertising and the role that promotion may play in drawing young people into smoking. Packaging is part of this.

It is no surprise, perhaps, that packaging is a vital issue to focus on, given the results of the 2012 study funded by Cancer Research UK, which included an audit of the tobacco retail press from January 2009 to June 2011. It found that,

“the level of tobacco packaging activity is increasing. Brands appear to be in a continuous cycle of modernisation through pack redesign. Increasingly, innovative packaging and limited editions draw attention to the product”.

A review commissioned for the standardised packaging consultation concluded that there was,

“strong evidence to support the propositions set out in the Framework Convention on Tobacco Control relating to the role of plain packaging in helping to reduce smoking rates; that is, that plain packaging would reduce the attractiveness and appeal of tobacco products, it would increase the noticeability and effectiveness of health warnings and messages, and it would reduce the use of design techniques that may mislead consumers about the harmfulness of tobacco products”.

Given this and our need to prevent millions of children from starting to smoke, we have a responsibility to introduce standardised tobacco packaging as part of a comprehensive strategy to tackle tobacco at local, national and international level.

Therefore, along with many of my colleagues across the health community, I am extremely disappointed that the Government did not include legislation in the gracious Speech. This absence of a Bill inevitably raises the question of the Government’s response to their consultation on standardised packaging. Nine months after the consultation ended, we are still awaiting a response from the Government. Can the Minister confirm that the Secretary of State for Health is still considering how the Government should respond to this consultation?

In the time we have been waiting, Cancer Research UK estimates that more than 150,000 children have started smoking. I call on the Government to respond in favour. We have waited long enough. We know that the Public Health Minister in the other place is convinced by the evidence, and there are many in this House who have voiced their concerns today, including the noble Lord, Lord Clement-Jones, the noble Baronesses, Lady Jolly and Lady Wheeler, my noble friend Lord Hunt, from the opposition Front Bench, and my noble friends Lord MacKenzie and Lord Patel, who have all voiced their concerns and hopes for government action.

Let us take a moment to reflect on the support for standard packs, which is extremely broad. I mentioned the support of the health community. I cannot overstate the extent to which health organisations agree with this measure. Smokefree Action Coalition brings together 190 health and welfare organisations: royal colleges, the British Medical Association, charities such as Cancer Research UK, the British Heart Foundation, the Trading Standards Institute and the Chartered Institute of Environmental Health. They all support the idea of standard packs.

This issue also resonates with the public. If one shows people examples of existing packs that are clearly aimed at young women, they are horrified. YouGov polling shows that 63% of adults support the removal of branding from cigarette packs, and just 16% are opposed. Some 85% of people back government action to reduce the number of young people who start smoking. In the Government’s consultation more than 200,000 members of the public supported standard packs. These are the supporters of standardised packaging: a majority of the public and more than 190 health and welfare organisations.

Yet their collective voice has at times struggled to be heard over the well organised campaign by the tobacco industry. In 2012, Japan Tobacco International said that it would spend £2 million on adverts arguing against standard packs. To date, the Advertising Standards Authority has ruled its claims to be “misleading” and “unsubstantiated”. While the tobacco industry argues that smuggling is increasing and that standard packs will make things worse, HMRC is clear that smuggling has halved in the past decade, and the Trading Standards Institute backs standard packaging, saying that pack design makes no difference to its efforts to tackle smuggling.

The evidence is clear and substantial. A majority of the public, 190 health organisations, the World Health Organisation and many others all support standard packs. The tobacco industry has spent millions on advertising to oppose standardised packaging, which indicates just how much store its sets by pack design.

Like the noble Baroness, Lady Jolly, I hope very much that when Her Majesty said in the gracious Speech that other measures will be laid before us, we will see a Bill aimed at stopping children taking up smoking through the introduction of standard cigarette packages.

Welfare Reform Bill

Baroness Morgan of Drefelin Excerpts

Tuesday 14th February 2012 Lords Chamber

[Lord Patel]

My Lords, before I start, I would like to record my most sincere gratitude to the Minister for the courteous way in which he has engaged with me on many occasions to discuss all my amendments, but particularly this one. I found that our meeting was courteous, and he showed a clear understanding of the issues, so I thank him for that.

I was, of course, disappointed that the other House decided to overturn my amendment, particularly one that I thought was fairly modest, as Amendment 18 simply sought to protect cancer patients from the impact of time-limiting employment and support allowance. If the impact of the time-limiting proposal on cancer patients is to be mitigated, the Minister’s words in his summing up today will be of particular interest.

During the previous debate I indicated very briefly what it is like for patients to be on chemotherapy for prolonged periods of time, sometimes for as long as two years. I could not do enough justice to the description of how a patient feels, so I would rather use the actual words of a patient.

Jenni Russell, a reporter, wrote an article in the Sunday Times, and she had this to say:

“Everyone knows that cancer patients are likely to spend a lot of time being made to feel really … ill … I almost died of malaria in my twenties”—

I had malaria in my teens, and I can still remember what it felt like—

“but I have never felt as appalling as I did on chemo. The point of chemotherapy is to load the body with sufficient poison to kill the cancer without … killing the patient. It is crude medicine and, because we understand so little about genes or cancer pathways, it is unpredictable. I had assumed I would overcome it with a bit of willpower. Instead I had vomiting, nausea, headaches, muscle weakness and an inability to tolerate bright lights. For the first four days in every fortnight’s treatment, I couldn’t eat, speak, read, listen to the radio or get out of bed. My white blood cell count sank so low that I needed injections to boost my bone marrow production. For the next six days I was too weak to want to walk upstairs. There was no fight left in my body. … I could not conceivably have held down an ordinary office job over those months”.

This is despite the fact that she had had a lot of support. She goes on:

“The fact that working was a choice, not a fearful necessity, made a huge psychological difference. … I have no problem with the principle that people who can work should work”.

I think she is right. The vast majority of people with cancer who are out of work because of their condition want to work. For cancer patients, getting back to work is a crucial step forward in getting their lives back after cancer, but people with cancer often experience debilitating physical and psychological effects from the disease and its treatment. As I have described, these can be quite severe. For the majority of people with cancer who need ESA, 12 months is simply not long enough to return to work.

We hope there is consensus that cancer patients awaiting and undergoing cancer treatment should be in the support group. The Minister already referred to this, and I am grateful for that. I understand that following my discussions with the Minister and others, the Government are in discussions with Macmillan about how this process can be reviewed. Progress is being made, and I appreciate that very much. However, the primary concerns about the impact of time limiting on cancer patients have been that those who still experience the long-term effects of treatment will lose their benefit before they are ready to return to work. I hope the Minister will say something about that.

I am glad, however, that the Government are seeking to ensure that these people are given more time in the support group, where they will not be impacted by the time limit. If we are to protect cancer patients who are suffering from the debilitating side-effects of their treatment through the work capability assessment, it is crucial that the views of healthcare professionals—the oncologists, the GPs and the specialist nurses—are taken on board, and their evidence ought to suffice.

I hope that the Minister will refer to that. Patients often deteriorate after treatment is completed, hence my amendment, which says that those suffering from the effects of treatment should not be included. A system would be based on the presumption—and that word is important—that the cancer patient leaving the treatment phase would remain in the support group of the benefit if they needed it. Evidence from a healthcare professional would consist of confirmation that the cancer patient continues to experience side effects that limit a claimant’s capability to work, and therefore should be placed in the support group. I agree that this assessment could be reviewed after a suitable period—even after six months—to see how the claimant’s situation has changed.

I therefore sincerely hope that the Minister will be able to think of ways of meeting this amendment, and I look forward to hearing them.

[Baroness Morgan of Drefelin]

My Lords, I support the Motion of the noble Lord, Lord Patel, and in so doing I remind the House of my interest as chief executive of Breast Cancer Campaign. In particular I congratulate the noble Lord, Lord Patel, on pursuing his amendment and on articulating so clearly the concerns of cancer patients. I also congratulate Macmillan on the work that it has been doing very determinedly to raise these important issues on behalf of cancer patients, and I thank the Minister for listening and for being very careful in his response, as I am sure he will be.

I do not want to repeat the arguments that have already been made in this House on Report, but I would like to be very clear that I believe this House has made its intention very clear—with an alternative amendment—on the need to provide cancer patients with the security of having treatment without the pressure of potentially losing their benefit added to it, an issue that I suggested here today and that I would like to hear from the Minister on.

I would specifically welcome hearing from the Minister about the position of cancer patients who, by April 2012, will have been in the work-related activity group for 12 months. Will he clarify for us, in the light of his new thinking, whether this group of patients will no longer be eligible to receive contributory ESA? I know that the Government are consulting, and I understand that the Minister will not want to pre-empt the outcome of that consultation, but it would be very helpful for those who have received notice that their benefit will come to an end after 12 months to know, as cancer patients, what their position might be.

[Lord Avebury]

My Lords, perhaps I may intervene briefly and question the noble Lord, Lord Patel, about the breadth of his amendment. He spoke about those people who are receiving treatment for cancer and described vividly the ordeals that they go through when receiving chemotherapy. Of course, we all have knowledge of that kind of treatment, not from personal experience but from our relatives and friends who have been through those procedures. But not every cancer patient has to be given chemotherapy or radiotherapy. Some cancers can be treated with medication. I was speaking particularly about myeloproliferative disorders, which can be treated in the early stages with medication.

The wording of the amendment as regards “receiving treatment” is too broad and should be confined, for example, to those receiving chemotherapy or radiotherapy. In that way, the provision would be limited to those people who are so physically affected by the treatment that they are receiving that they would be incapable of working or unlikely to be capable of working until that treatment ceases.

Welfare Reform Bill

Baroness Morgan of Drefelin Excerpts

Tuesday 31st January 2012 Lords Chamber

[Lord McKenzie of Luton]

My Lords, we support the thrust of this amendment. Perhaps I may ask one question. We had a helpful briefing note from the Box which reads as follows: “This amendment therefore is designed through this regulation-making power to enable the Secretary of State, so far as possible within the unified structure of universal credit, to maintain the current position in relation to the obligation placed on EU jobseekers”. The phrase “so far as possible” seems to be a qualification on what the Government are seeking to achieve here, and I wonder if the Minister might just expand on what that qualification amounts to.

[Baroness Morgan of Drefelin]

While the Minister is being helpful, perhaps I may seek the indulgence of the House for just a moment. I want to apologise for not having been able to get in to move my amendment because of the crowds leaving the Chamber after the EU Council Statement, but I want to thank the Minister for the telephone conversation I had with him earlier today when he agreed to work with me and with others on monitoring very closely the changes to the work capability assessment for cancer patients.

Welfare Reform Bill

Baroness Morgan of Drefelin Excerpts

Wednesday 11th January 2012 Lords Chamber

[Baroness Finlay of Llandaff]

My Lords, I shall make a brief intervention in support of the noble Baroness, Lady Meacher. It is important for the House to remember that whatever is said in the prognosis of someone who has an advancing life-threatening disease, it is completely unreliable; it is no better than a guess. These patients are living with uncertainty. They may die much sooner than their prognosis predicts or they may live longer, but they know that death is staring them in the face.

We are talking about adults of working age. They often have dependants. They often have children for whom they must make provision. If they do not use what energy they have to work on making provision for those children, the problems in the next generation among bereaved children will be much greater. There are questions about who will care for the children, what provision will be made, what the children are being told, how they are being prepared for bereavement and so on, quite apart from legal arrangements. Many people who are single parents say that making provision for those children is particularly difficult at times. Therefore, it does not make sense to take what little energy people who are ill have and put them through a system that stresses them further. It is much better for our society to use the energy that they have to do the thing that they know needs to be done, which is to make provision for those who will be left behind after their death.

I just emphasise that the uncertainty with which they live makes their lives even harder. It is impossible for an employer to know accurately about taking someone on. They may take them half way through an induction period before they become ill. Given the competition for jobs at the moment, any employer seeing this will, if they are in their right mind, say about the job that needs to be done, “Hang on, is this sensible for my place of work?”, however much they want to help someone. I caution the Government against preventing people using the energy that they have to make provision for the future of those who will be left behind after their death.

[Baroness Morgan of Drefelin]

I just want to thank the Minister for bringing forward Amendment 43 and the other government amendments in this group, and for listening to the debates in Committee. I do not want to detain the House in any way—I know we are engaged in several critical debates this afternoon—but the noble Baroness, Lady Meacher, has explained very eloquently the challenges that the Government have in addressing the thorny, knotty and difficult problems of people facing terminal and life-shortening illness. I do not want to say more than that because her points have been made so clearly.

[Lord McKenzie of Luton]

My Lords, I start by also thanking the Minister for Amendment 43 and wishing him a happy new year. I am sure it will become happier when we get into February. That is the case for several of us. Perhaps I can comment first on some of the other amendments to which the noble Lord referred. I understand that Amendments 33 and 34 are consequential. The fact that they include references to provisions that cover 365 days or the clock for counting those days already being under way does not imply our acceptance of them. They are the subject of subsequent amendments that we are about to come to. Similarly, as we have heard, Amendments 37, 39, 40 and 41 are the formulation to confirm the intention that the limit should apply to contributory claims under the youth condition. Again, as will be clear, we do not support the 365-day limit or the future denial of claims under the third condition, and we will address this by amendments in the next group. Therefore, our not challenging these amendments should not be taken as accepting this as the final position; likewise in relation to Amendments 63, 64, 65, 66 and 67.

Amendment 43, tabled by the Minister, obviates the need for Amendment 42. It covers the same point and, as he said, goes further in that there is no time limit. This is to be welcomed. This enables someone to reconnect with contributory ESA after time-limiting should their condition deteriorate and they become eligible for the support group. It would appear that this applies equally to those with an existing youth condition claim and those accessing contributory ESA via the first and second national insurance contributions. Perhaps the Minister would just confirm that. It would appear that there is no time-limiting factor—I think that he confirmed this—so the gap between the time limiting of the contributory allowance and arrival in the support group could be five or 10 years or, in theory, even longer. I touch on this particularly because I am bound to say that this is not something to which the Minister warmed in Committee. On 8 November, at col. 33 of Hansard, he stated in relation to Amendment 71P:

“However, this could mean benefits being reinstated 10 or more years after the claimant last worked, which is not reasonable”. —[Official Report, 8/11/11; col. GC 33.]

Further, he stated that,

“people in the WRAG who have gone through their time-limited period do not then have a right to go into the support group on a contributory basis”.—[Official Report, 8/11/11; col. GC 36.]

I do not wish to be churlish about this but that is why we included the five-year limitation in Amendment 42, which sought to meet the Government at least part way. However, the Government are to be congratulated on Amendment 43, which deals with the disconnect from the national insurance contributions and also addresses the concerns powerfully expressed in Committee about people with deteriorating conditions who are initially placed in the WRAG. My noble friend Lady Morgan of Drefelin spoke about people with Parkinson’s disease, motor neurone disease and some forms of cancer. The Government will fulfil their stated intent that the time limiting of contributory ESA will not affect those in the support group.

However, as ever, I have a couple of questions. Amendment 43 states that the employment and support allowance entitlement,

“is to be regarded as a contributory allowance for the purposes of this Part”.

Why is “regarded as” used rather than “is”? Is it or is it not a contributory allowance? The requirement is that the person remains assessed as having limited capability for work. How is this to work in practice in circumstances where entitlement to the contributory allowance has lapsed and income or capital levels preclude entitlement to income-related ESA? Does it require the individual to be subject to the crediting-only arrangements? Would a claimant commitment still have to be in place? If somebody’s prognosis of limited capability for work has lapsed but there has been no reassessment because nothing is due, how does this affect the position in practice? Where someone’s reassessment has initially led to a fit-for-work designation but this has been overturned on a reconsideration or appeal, will the claimant be treated as being continuously in the WRAG and remain entitled to the benefit conferred by the government amendment? The noble Lord’s letter of 8 January, which I received yesterday, suggests that around 4,000 people will benefit from this measure by 2016-17. This may be only a small proportion of those damaged by the general time limiting. Nevertheless, I stress that it is welcome.

Amendment 42A, spoken to by the noble Baroness, Lady Meacher, and supported by my noble friend Lady Morgan and the noble Baroness, Lady Finlay, raises an extremely important point about individuals with life-threatening diseases where there is evidence that their diseases are uncontrollable or uncontrolled by a recognised therapeutic procedure. It requires them to be treated as being in the support group to obtain the benefit of the easements in the Government’s legislation. I would be interested to know how often such individuals would not be assessed as being in that group anyway. I think that we heard some examples from the noble Baroness, Lady Meacher. I await the noble Lord’s reply but I hope that he can give her a sympathetic response to this important issue.

--- Later in debate ---

[Baroness Morgan of Drefelin]

The Minister referred to the position of two-thirds of cancer patients. Is that before or after the changes coming from the Harrington review with regard to intravenous chemotherapy versus oral chemotherapy and the automatic move of patients into the support group?

[Lord Freud]

The figure that I quoted is the existing one. I shall come straight on to the cancer issue because it is clearly of great importance. On the basis of the Harrington recommendations, the figure is expected to go up by about 10 per cent on the existing figure on our modelling basis.

There is a great deal of misinformation about the position and I shall try to pull out some of the main issues on cancer. First, the Guardian printed a letter from Professor Harrington in which he said:

“I believe the government’s proposals would significantly improve on the current system and would be of considerable benefit to those who face the real personal challenge of a cancer diagnosis and subsequent treatment”.

He went on to say:

“The government’s proposals have been developed as a result of evidence submitted to me by Macmillan and discussions with cancer specialists. The proposals would considerably increase the number of people who receive unconditional support in the benefits system. They would also reduce, not increase, the number of face-to-face assessments that individuals suffering from cancer would undergo. The proposals are underpinned by a presumption that people undergoing cancer treatment will be entitled to the benefit if they have the necessary supporting evidence. They widen the scope of the people this applies to, while also allowing people who want to work to do so. This will mean better provision all round. Delays in these proposals may ultimately affect individuals and their quality of life”.

We have now published the Macmillan evidence, which I hope is available and of great interest to noble Lords. What is interesting about the evidence is how many professional oncologists support this approach. I have a few quotes here which I would like to share with the House. The first states:

“Not all patients will experience toxicity related to treatment … Not all patients should be exempt”.

The next states that,

“some people on long-term maintenance treatments may have little or no upset and be quite able to work”,

and so on. That evidence is available to noble Lords.

As to where we are on the important issue of cancer, we are now carrying out a consultation with the industry. That will be ready in March, when we will pick up the responses and apply them. The noble Lord, Lord Patel, may take some comfort from the fact that there is now a major process going on as we consider this issue, and he would be right to take such comfort.

On the point raised by my noble friend Lady Thomas on the WCA, we are absolutely committed to making it as effective as possible. It is beginning to move quite quickly now in the right direction. We have taken forward all of Harrington’s recommendations from year one, which means that decision-makers are better supported and have received new training, and all the ATOS reports now have a justification. Professor Harrington has praised the improvements that he has seen so far.

The other point raised by the noble Lord, Lord Patel, was—

Welfare Reform Bill

Baroness Morgan of Drefelin Excerpts

Wednesday 14th December 2011 Lords Chamber

Moved by

[Baroness Morgan of Drefelin]

24: Clause 19, page 9, line 16, at end insert—
“(e) the claimant is receiving specified treatment for cancer, is recovering from that treatment or is likely to receive such treatment within 6 months”

[Baroness Morgan of Drefelin]

I shall speak also to Amendment 47. First, I want to declare an interest as chief executive of Breast Cancer Campaign. I am grateful to have the opportunity to speak to these amendments that aim to ensure that cancer patients awaiting, receiving or recovering from chemotherapy or radiotherapy will automatically qualify for the employment and support allowance support group without having to undergo an assessment. I have to admit to being disappointed that we have had to come to the point where it is necessary even to lay these amendments now. This is a debate that we should have had in Committee, but we were unable to do so because at the time the outcome of the Harrington review and the Government’s response to it were not known. That is why we are having what is probably a Committee stage debate now—although obviously within the correct procedure for Report.

While I am sure the Minister will be able to highlight technical flaws in the wording of the amendments, I hope that the discussion today on these amendments will focus on the intention behind them, which I believe is clear. I am sure that if there are technical flaws that need to be addressed, they can be looked at for Third Reading.

Over several months, we have heard a number of seemingly very reassuring statements from the Government in relation to employment and support allowance and supporting people with cancer. I note, for example, the response by Chris Grayling MP, the Minister for Employment, on 18 October to a Written Question, in which he said:

“Ministers have had a number of discussions with Macmillan Cancer Support since the spending review announcement, as we are determined that the benefits system should support people who are diagnosed with cancer in the most sensitive, fair and appropriate way. The Department has no interest in making it harder for those who cannot work to claim benefits and is committed to an ongoing process of review and improvement”.—[Official Report, Commons, 18/10/11; col. 930W.]

That was a very reassuring statement.

Unfortunately, the recent publication of the Harrington review and the Government’s response to it resulted in anxiety across the cancer community. I have listened to the views expressed by organisations such as Macmillan Cancer Support and others and am sorry to say that I am not reassured by the news that the Government are considering withdrawing automatic qualification for the support group of ESA to those on non-oral chemotherapy—commonly referred to as IV chemotherapy—instead of extending the exemption to cancer patients receiving oral chemotherapy. In effect, that is going in exactly the opposite direction of that pointed to by the Minister for Employment.

We know that Macmillan Cancer Support undertook an expert consultation on this matter for the Harrington review. It did an enormous amount of work and I pay tribute to it for it. There is no doubt that the recommendations produced by it through consultation with an expert group of clinicians have not been adopted. Macmillan has been very clear on this point. I have had a look at the government response and it seems that Macmillan is making a fair point.

The Minister will no doubt suggest, as he has done previously, that the Government’s response is not contrary to Macmillan’s conclusions. However, it is my understanding that while the clinicians consulted provided the charity with a range of views—Macmillan has been totally transparent about all the views that it has received—a clear consensus was reached by experts that certain groups of cancer patients undergoing treatment should qualify for the support group automatically. As was stated by the charity, this is because those patients are more likely than not to be debilitated by their treatment and should not be made to go through an assessment while undergoing this debilitating treatment.

While I am not suggesting that it was the intention of the Minister and his colleagues to add to the struggles and difficulties that cancer patients experience, I fear that what is currently being proposed would do just that. In the Sunday Times this week, the journalist Jenni Russell shared her experiences of chemotherapy very movingly and said:

“I read these proposals with incredulity. I have been seriously ill at times in my life … but I have never felt as appalling as I did on chemo … I had assumed I would overcome it with a bit of willpower. Instead I had vomiting, nausea, headaches, muscle weakness and an inability to tolerate bright lights. For the first four days in every fortnight’s treatment, I couldn’t eat, speak, read, listen to the radio or get out of bed. My white blood cell count sank so low that I needed injections to boost my bone marrow production. For the next six days I was too weak to want to walk upstairs. There was no fight left in my body; every cell was being affected and it seemed every cell was losing the will to live. Then for three days I would feel almost normal until the cycle began again”.

Jenni Russell then provided her view on how cancer patients might interpret what was being proposed by the Government in this Welfare Reform Bill. She said:

“What people in treatment are hearing is that they will be assumed to be guilty of skiving unless they can prove otherwise. Nothing could be more demoralising to the individuals who are already having to cope with being cut open, poisoned or burnt in the hope of saving their lives”.

These are very hard-hitting comments in the Sunday Times and very difficult to read. While there are hundreds of thousands of other people who do not have the opportunity to share their experiences in the House today, I feel sure that the views expressed by Jenni would be endorsed by many cancer patients around the country.

I noted the Minister’s comments on Monday—I was disappointed that I was not here for the Question—that part of the rationale for not allowing automatic qualification for benefit is that it is important for many cancer patients to stay in work. I do not disagree with that at all. However, it seems far fetched to suggest that qualifying for the support component would stop cancer patients who wish to continue working for as long as they can from doing so. I do not understand how that holds up.

The Minister may also argue that the automatic support group status encourages the wrong kind of behaviour in cancer patients. The Minister shakes his head; I am sure he will put me right in a moment in his very clear way. I would welcome hearing from him whether he really believes that cancer patients would decide to leave work just because they are automatically eligible for this benefit. What picture does that paint of the motivations behind cancer patients’ behaviour? It is my understanding that automatic entitlement to ESA support group status would not prevent patients who wish to remain in work for as long as they are able from continuing to do so. If the Minister has any evidence that the existing exemption for cancer patients on IV chemotherapy, for example, has been or is being abused by cancer patients who are clearly capable of working, it would be very useful to hear about it. The House would welcome that.

Nor will becoming eligible for the support component of the ESA while receiving chemotherapy lead to people spending a lifetime on benefits. I know the Government are very concerned about ensuring that we do not leave people to languish on benefits for a lifetime. I totally support that. We know that work is good for people. Even if that is what people wanted—which they do not—they are reassessed for eligibility for benefit after their treatment. This would mean that when they are no longer in need of the support on offer from the support group, it would be withdrawn. There were many personal examples given in Committee. When I was talking about PIP, I used the example of my niece who was in the process of being treated for Hodgkin’s lymphoma. She is in hospital having her second transplant at the moment. Throughout her 18 months of treatment she has been reassessed three times for ESA to check whether or not she should still be receiving it in the support group. So there is no danger of her going on indefinitely in the support group.

The amendments will ensure that the added burdens associated with seeking financial support during the most difficult of times are minimised as much as possible. This would help to remove the anxiety experienced when people have to wait for the results of a decision-maker. With 40 per cent of appeals currently successful, we should not forget that these decision-makers are clearly frequently making the wrong decisions. It is feasible that, without the guarantee of receiving the support component of the benefit, cancer patients who are in the middle of treatment could be forced to attend back-to-work interviews or even be found fit for work.

I remain hopeful that the Minister will respond to the growing concern on this issue, which has been even more apparent over the past week. I hope he will be able to say that all patients receiving, due to receive or recovering from chemotherapy will automatically qualify for the support element of ESA. It would also be useful if the Minister could explain at this stage what further documentation and processes cancer patients receiving IV chemotherapy will have to provide and undergo in future as this would be extremely helpful in informing the debate at this point.

I hope very much that the Minister can give me reassurances that it will not become more difficult for those who are currently automatically put into the support group because of their cancer treatment to claim ESA. I hope very much that the Minister will be able to give undertakings about the consultation process, which I believe is due to be taken forward just before Christmas—Christmas holiday time—and that the consultation period will seek the views of many on a range of options. It looks a little like the Harrington review has asked Macmillan to do some work for it, does not like what has come back, and is going to ask some different people to see whether it can find some more opinions that it does like. I am sure—absolutely sure—that this is not what the Minister is proposing at all.

I hope that if there is to be a consultation over Christmas it will be done in a fair, open, transparent and timely way that looks at more than just one option and talks to patients, charities and a range of experts too. I beg to move.

[Baroness Hayter of Kentish Town]

My Lords, like the noble Baroness, Lady Morgan, I think the fact that this amendment is necessary comes as a surprise. When we started discussions of the Bill, it seemed that the issue of whether recipients of debilitating cancer treatment in the form of oral chemotherapy should be automatically exempted from requirements to look for work was being dealt with in a sensible manner by discussions between the cancer charities, cancer specialists and the Government. It is extremely disappointing to find that these discussions appear to have broken down. Disappointing for us, but extremely worrying for the many cancer patients anxious about what support they will be able to claim and how they will qualify for it when their main focus is living through and coping with some pretty debilitating—as we have heard—albeit wonderful, lifesaving treatments. The Government’s response to the second Harrington review states that its new proposals to ask everyone experiencing cancer treatment to go through the work capability assessment process,

“would increase the number of individuals being treated for cancer going into the Support Group”.

It also states that:

“They would also reduce the number of face-to-face assessments for people being treated for cancer as most assessments could be done on a paper basis, based on evidence presented by a GP or treating healthcare professional”.

While we welcome the acceptance of medical evidence, this proposal still puts cancer patients undergoing treatment through the uncertainty and stress of not knowing whether they will qualify for essential financial support or whether they will be expected to prepare for work while undergoing their treatment. With the proposals to time limit employment and support allowance for those in the work-related activity group, these assessments take on an added importance, since for many people they will determine when the clock starts ticking to the point when they will lose this contributory support altogether.

We do not think that anybody should be written off because they have cancer. We certainly do not think that no one with cancer will ever be able to work again. A brief glance behind me in your Lordships’ House is great testimony. This is not, however, what automatic entry into the support group means. We know that those in the support group can volunteer for access to the work programme and the support there to help them get back into employment. We imagine that the vast majority of those who have overcome their cancer will want to do just that. But for the Government to suggest that those receiving chemotherapy need to be tested to see whether they are really ill enough to avoid a conditionality regime, which we will remind the House was intended to put pressure on people to return to work, suggests that the Government somehow view all cancer patients as potentially taking advantage of the state. We are sure that that is not the Minister’s view and therefore hope that he will be able to accept the amendment.

[Lord Freud]

My Lords, this is obviously a very sensitive issue, and I want to start by saying that we are determined that the benefit system should support in a sensitive, fair and appropriate way people who are diagnosed with cancer and coping with it. I shall try to go through the argumentation here in as simple a way as I can.

First, we know that cancer and cancer treatment affects individuals very differently. That was one thing that the Macmillan evidence demonstrated. It shows that some people can continue working straight through their treatment, are capable of doing so and want to do so. On that evidence, we believe that automatically putting everyone undergoing certain cancer treatments into the support group is not the right way forward. Clearly, there is the example that the noble Baroness raised, the one in the Sunday Times, of Jenni Murray, who had a bad reaction, and one can only sympathise with that. Everyone in this Chamber will have friends or relatives who have gone through this experience and had a bad reaction. It is always painful. We are all thinking exactly the same thing; we are all thinking of someone we know who has gone through hell on this process. But when you talk to the experts, you get examples of someone—let us take a man—who has had testicular cancer and has recovered well from curative surgery and is now being treated with radiotherapy without any significant side effects. On this ruling, he would be automatically placed in the support group. That is a kind of counter-example, which half of us should be so lucky to have.

[Baroness Morgan of Drefelin]

When we look at the Macmillan recommendations, we can see that they take into account that people respond in a range of ways. In the recommendations that the charity made to the Harrington review, they came up with a lot of detail, and I could read it all out. No—I will not read it all out, but I could.

The point that I want to make is that a consensus process was gone through at the request of a government review. We could all pick out little bits of that wide range of opinion that we do not want to promote, but that was not what the charity did. It published it all, which now allows the Government to pick bits out that suit the argument. But the overall conclusion by the experts and the consensus statement was that, for the majority of cancer patients going through specific cancer treatments—and it is not all chemotherapy; we are not talking about long-term oral chemotherapy here—it is more likely than not that they would experience debilitating effects.

[Lord Freud]

Let me go through the argument and I will pause just before I sit down to let the noble Baroness come back on the process. We asked Professor Harrington and Macmillan to review the current descriptors to provide evidence as to whether they could be improved, and we are committed to acting on the evidence that they put forward. The evidence provided by Macmillan showed clearly that there is no longer a basis for differentiating between certain types of cancer treatment in the way that current regulations do. The evidence showed that all types of chemotherapy, including oral chemotherapy and certain radiotherapy, can be debilitating but it also showed that there can be considerable individual variation in the impact of the treatment on each person, and that work can be very important for some individuals with cancer.

I think that there were 16 medical professionals—the oncologists—who were consulted in depth in this evidence. I shall quote just one as an example, who said,

“I am somewhat against the concept of including all chemotherapy”,

in the support group,

“as it will clearly be inappropriate for some patients, risks stigmatising these patients in the workplace and may delay useful reintroduction to the workplace”.

A number of the experts consulted by Macmillan, and indeed Macmillan itself, volunteered evidence of the importance of work to an individual’s rehabilitation and emotional well-being. Indeed, in a recent publication, Macmillan said:

“Many people who are working when they are diagnosed with cancer would prefer to remain in work, or return to their job, during or after treatment”.

From this evidence, it is clear that while many people will not be able to work, some can and do. For them, it is an important part of coping with their diagnosis and treatment.

We want the work capability assessment to effectively reflect this new evidence based on what Macmillan, supported by Professor Harrington, has found. How it would work is that each individual would be assessed on a paper basis. The evidence required might be a note from the claimant’s GP or consultant, and where a claimant is unable to provide information an Atos healthcare professional will contact their GP or consultant to gather the information and ensure that they are not unnecessarily sent on a face-to-face assessment.

We have had a request to look at this evidence more widely, so we are in the process of asking Macmillan whether we can make this document more widely available. At the moment, Macmillan is seeking permission to do that. I hope that that actual evidence becomes more widely available for consideration. We believe that our proposals meet the spirit and intent of Macmillan’s assessment. If that were to be the case and we were to go ahead with those proposals—if your Lordships will bear with me, I will describe the process before we were to go ahead—there would be an increase in the number of people in the support group. About 10 per cent would move from the WRAG group to the support group, while there would be a reduction in the number of face-to-face assessments that individuals suffering from cancer would undergo.

Let me provide another example of how this will better support people by citing a woman who is being treated via oral chemotherapy and who is profoundly fatigued due to the treatment. Her GP confirms her diagnosis and symptoms. Currently, she may be invited for a face-to-face assessment; under the new proposals, she could be placed in the support group on a paper basis.

We are disappointed that Macmillan seems to be unable to support these proposals, which we have based on the evidence that it spent so much energy in collecting, and because we had hoped to introduce the proposals in April 2012. However, since we do not seem to have Macmillan’s support at this particular moment, we will now seek a wider range of views through an informal consultation. As part of this we will seek the views of individuals affected by cancer, their families and carers, healthcare practitioners and cancer specialists, as well as representative groups and other lobby groups. We want to ensure that the benefits system treats individuals with cancer in the most sensitive way.

I recognise the points raised today. We want to get the balance right, which is why, as a result of the evidence presented by Macmillan, we will launch the consultation on these proposals this Friday. It will be informal; it will last 12 weeks, ending on 9 March, and it will follow the advice in the government Code of Practice on Consultation. We will be looking, as I said, for a wide range of evidence, and will consider all the issues, including automatic entitlement, as well as looking at previous experience of cancer assessment in the benefit system.

I hope that that will reassure noble Lords that there will be a proper process which will aim to come out with an answer which gets the general support of this particular community, and I hope that many of them would be a temporary part of that community. The noble Baroness is getting to her feet; I will hover.

--- Later in debate ---

[Baroness Morgan of Drefelin]

I think that the Companion says that the Minister is able to respond on Report, so it is very nice of him to hover, but he can have a rest.

Obviously the automatic entitlement is set out in regulations; I think the powers are in the 2007 Act. It would be really helpful to understand what this paper basis will look like. Will it be possible for us to see what those regulations might look like? I cannot remember whether they are affirmative or not. I guess they probably are, but if they are not, then maybe they should be.

[Lord Freud]

Rather than go into detail now I would like to wait for the proper consultation. The document is coming out in two days; it will lay out the issues, the proposals and the background, and there will be a full opportunity for us to gather all those views and pull them together. With that reassurance that there is a real process going on to get agreement and to take everyone’s views, I hope that the noble Baroness feels that she can withdraw her amendment.

[Baroness Morgan of Drefelin]

My Lords, it is very late and I have only a couple of thousand words to get through. More seriously, the Minister has given me quite a lot to think about. Obviously, as this is only the first time that we have had a proper discussion about this, I will have to look at Hansard very carefully, and think about whether I need to come back to it. However, I appreciate the time that the House has given to this issue at this late hour, and I beg leave to withdraw the amendment.

Amendment 24 withdrawn.

Welfare Reform Bill

Baroness Morgan of Drefelin Excerpts

Wednesday 16th November 2011 Grand Committee

[Baroness Thomas of Winchester]

My Lords, I support the amendment that was powerfully moved by the noble Baroness, Lady Howe. I shall also speak to my Amendment 86A, which enables an eligible person to receive PIP after three months rather than six. The balancing corollary of that amendment is my next amendment, Amendment 86B, which changes the length of time that a person's condition is estimated to last from six to nine months, so the envelope of time in these amendments is not being stretched beyond a year. It is just being differently configured, which fulfils the Government’s desire to align PIP with the definition of long-term disability in the Equality Act.

I gather that another simplification which the Government want is to align the waiting time for PIP with attendance allowance. They have cited the approval of several organisations for this change, but is my noble friend really telling us that these organisations would rather people waited for six months for PIP just for the sake of this alignment? This is certainly not my experience.

The reason my amendment seeks to keep the qualifying period to three months is very simple: some conditions of a long-term nature may have a sudden onset; some may not have such a sudden onset but might be able to be diagnosed only several weeks after the onset of symptoms. People with rheumatoid arthritis, for example, which affects about 400,000 people in the UK, are often only given an official diagnosis after six weeks of certain specified symptoms. I mention that disease specifically because arthritis in general forms 18 per cent of the DLA case load; it is at the very top of the list.

Next on the list are mental health conditions at 17 per cent. For anyone suffering from a severe mental health condition, applying for DLA would not be the first thing they think of, and waiting for six months, when PIP comes in, to help with care is a very long time.

There are then those diseases which may have a devastating impact on people immediately, such as a severe stroke or heart attack, a serious accident, amputation or an unexpected diagnosis of cancer which demands challenging treatment straightaway. We may hear a little more about that from the noble Baroness, Lady Morgan. People with any of these conditions may need the extra help which PIP could give comparatively quickly to stop them from falling into debt as they manage their condition with all its ramifications.

This is even more important in these days when local authorities are so overstretched financially that they are becoming reluctant to carry out more than minimal adaptations to people’s homes, let alone provide adequate help with caring. Those affected may need to buy for themselves various mobility aids, safety devices and other equipment, or perhaps set up a home alarm system. Their homes may need extra heating; they may have increased laundry requirements; they may need special diets; and they may have to rely on expensive taxis to get to hospital appointments and for other purposes. If the social model of disability means anything at all, then a disabled person is likely to have to rely on taxis if they want to go out and about, particularly during the winter.

Turning to those conditions which are not sudden onset such as my own—adult onset muscular dystrophy—it would be foolish for someone to try to get PIP too early while they are still able to manage their impairments relatively easily because they will almost certainly fail the assessment. On the other hand, if they know that they will have to wait, whatever happens, for six months before receiving any extra resources, they may decide they should at least start the process, particularly if they are beginning to fall into debt with managing their condition.

So when should they start the claim? I understand from what the Minister for Disabled People said in the Public Bill Committee in the Commons that the qualifying period for PIP starts at the point where someone is first entitled to it regardless of whether a claim has been received, and that even a lengthy spell in hospital can be part of the waiting period. That may be a helpful message for someone who has had a stroke or a bad fall, but it is not always possible to know exactly when a person might qualify.

At present, the waiting time for DLA is three months. By changing it to six months, the Government have said that this is not about saving money but about the right benefit going to the right people, or words to that effect. Presumably, by doubling the waiting time, they believe that three months is too short a time to be able to assess someone’s condition. They are possibly thinking that someone who has suffered, for example, quite a severe stroke might apply straightaway for PIP but, after six months, might be much better and able to manage the impairments they still have. However, looking at the case load for DLA, only 3 per cent of claimants have stroke-related conditions. This is presumably because the majority of stroke patients are past retirement age and thus past qualifying for the first time for DLA.

If PIP is to be an in-work as well as an out-of-work benefit, which it is, surely it is better to allow a person to claim the benefit after three months, not six, as it is likely to help them get back to work and to participate once again in society more quickly, for example by travelling to work by taxi or by taking a cab to the station.

The table of conditions that people who claim DLA are diagnosed with is very illuminating. People with both osteo- and rheumatoid arthritis, which as I said come top of the list, are very unlikely to get better after three months. Those with stroke-related conditions and malignant diseases are each just 3 per cent of the total. It is not as though a large number of DLA claimants with these conditions are trying to claim after their condition has improved. In fact, the table shows that the Government’s argument about a person’s condition not being stable after three months does not really stack up. I read from the table that most people almost certainly do not apply for DLA at present until they really feel they have to.

To sum up, six months is a long time to wait for extra resources if a person has had a diagnosis of a long-term severe condition. The Minister in another place talked about a person’s condition settling down. However, for many of us our conditions never settle down—they go on progressing. If the Government are implacably opposed to retaining the three-month waiting time for PIP, maybe they would agree to, say, an assessment on the papers after a year so that a person’s entitlement can be looked at properly again. I think this will come up later on.

If the Government insist on the six-month waiting time for all applicants, I fear it will be understood to be about saving money in the short term in the hope that people will be put off from applying. I am encouraged to hear that my noble friend and his fellow Ministers are still listening and I hope this means they are hearing all the arguments for changing the qualifying period back from six months to three.

[Baroness Morgan of Drefelin]

My Lords, this is a very important debate. I support the idea of keeping the qualifying period for PIP at three months. I also hope this debate will look at the idea of the prospective period moving from six to nine months if the Minister sees that as an appropriate practical way of dealing with the Government’s intention to align the qualification period for PIP with the Equality Act, as I understand it.

I, like many, am extremely concerned that the proposals here will have a devastating impact on disabled people, especially those with sudden-onset conditions such as cancer. Cancer patients often see sudden changes in their household income combined with significant cost escalation on diagnosis. This can make cancer patients particularly vulnerable to financial difficulties and in need of immediate financial support.

Why do people with sudden-onset conditions need support immediately? We know that cancer treatment and its debilitating effects can often begin very quickly after diagnosis, as the noble Baroness, Lady Thomas, has already explained. The associated support needs arising from that treatment are often immediate and, importantly, the first six months can be the period when extra costs are at their greatest as people try to adjust their outgoings to their reduced income. Research by Macmillan found that 80 per cent of cancer patients who experienced increased costs reported that they were greatest in the first six months.

--- Later in debate ---

[Lord Freud]

My Lords, among the elements available in the shorter term are healthcare, travel costs, free prescriptions or aids and appliances provided by the NHS or the local authority. Following the request by the noble Lord, Lord McKenzie, it may be easier for me to write with a list of particular supports.

[Baroness Morgan of Drefelin]

If the Minister is going to write, would he also look at explaining how many of those are dependent on local authority provision? Much of the kind of help that he is talking about is sometimes dependent on having DLA.

[Lord Freud]

My Lords, when I write I will try to do a full breakdown of what is available.

--- Later in debate ---

[Baroness Morgan of Drefelin]

I am sorry to interrupt the Minister again. Does he agree that one of the thrusts of modern health care—particularly in cancer care, where I have an interest—is to try to keep people at home for as long as possible and not requiring hospitalisation? One of the brilliant aspects of the DLA that I was trying to describe means that determined, independent people going through tough treatment can stay at home, saving the NHS thousands and thousands of pounds on hotel fees. We have to look at this issue in a joined up way.

[Lord Freud]

I am trying to make the point that it is the responsibility of the NHS to deal with rehabilitation and treatment issues. It is not the function of DLA to do that, nor will it be the function of PIP. It is a different support mechanism. It may be that noble Lords would like to put in a particular support function in those circumstances, but it is not what PIP is meant to be.

[Baroness Morgan of Drefelin]

In that case, perhaps I may ask another question. If this is not what it is for, we need to understand what the implications are. People who have DLA now and are being treated for cancer—to give an example of a sudden-onset condition—are utilising the benefit in that way. As I understand it, DLA is meant to be used in a way decided by the client. It is important for people to keep their independence—to stay at home and look after themselves—and to stay positive. Surely we want to encourage that.

I understand the Minister says that that is not the purpose of the benefit, but I am confused: it is a product of the benefit which is of benefit to all of us. If it is being changed, we need to understand the implications and the evidence of what the knock-on effects might be elsewhere in the system.

Welfare Reform Bill

Baroness Morgan of Drefelin Excerpts

Monday 14th November 2011 Grand Committee

[Lord Freud]

My Lords, I will be happy to produce case studies for Report.

[Baroness Morgan of Drefelin]

My Lords, I listened very carefully to the debate. Will the noble Lord respond to what I thought was the very important point about sending out a message? Many noble Lords talked about the name sending out a message, and the fact that the change should be understood in the right way. Disabled people are very fearful about the changes that are taking place. There is concern that removing the word “disability” from the title of the benefit might make it more comfortable for the Government for whatever reasons to abolish it in the future. That sentiment has been voiced in this debate. Will the Minister come back on the point?

[Lord Freud]

My Lords, the point is wrong in the following sense. What we are trying to do with funds that are inevitably limited is to make sure that we focus them on areas of real need and on where they should be focused. That is something that most people would agree with and it is the intention of the benefit. It is meant to be a more efficient way of getting money to the right people. So I do not agree at all with that concern. Some people express concern at the words we have used. As I have sought to describe, we have tried to get feedback and customer insight, and we have tried to get rid of some of the old medical stereotypes to move towards the social model. That is what we are trying to do with the name that we have suggested.

--- Later in debate ---

[Lord Newton of Braintree]

In an attempt to stop the Minister having to pop up and down, I think that I am right in saying that he has not responded to my concern about the effects of this proposal. Whatever the figures turn out to be, there appear to be some “losers”. What are the effects of this? What steps will be taken to protect or to provide transitional measures? We are talking about sums of money that are significant to people who have not got very much. We have to keep that in mind all the time. The Minister has obviously had his ears bashed enough and no one thinks that we will press the amendment, but we hope that he will think about it.

On carers, I listened with mounting horror to the fact that we shall not know what the effects will be by the time we return to this. If among those 652,000 so-called losers, or whatever number it is, there are a number who also lose carer’s allowance, we are talking about a number of households which will lose serious amounts of money in relation to their income. We need to know what is happening in order to make a judgment about these proposals. I do not expect the Minister to say anything else but he needs to know that this former Secretary of State recognises some concerns.

[Baroness Morgan of Drefelin]

My Lords, I, too, invite the Minister to expand further on the blue badge. Obviously, we have just had a very important discussion about passporting, carer’s allowance and so on. The Minister was almost seen to be giving me reassurance about blue badge and other mobility passporting issues. Perhaps he could expand on the discussions that he is having and on what he hopes the outcome of those discussions might be, and give me a little more hope on that matter.

Welfare Reform Bill

Baroness Morgan of Drefelin Excerpts

Tuesday 8th November 2011 Grand Committee

[Lord McKenzie of Luton]

My Lords, I thank the noble Lord, Lord Freud, for running through that timetable. Our Front Bench is signed up to using our best intentions to make sure that we stick to it. It is helpful for those who are not necessarily here for every bit of the Bill to know roughly what the schedule is. My Whip, my noble friend Lord McAvoy, has asked me to stress that these are firm intentions but not a straitjacket.

[Baroness Morgan of Drefelin]

My Lords, it is incredibly helpful for those of us on the Cross Benches to hear from the Minister what the timetable for the subject matter for debates might be. Can I also point out how difficult it might be for some of us, with the Health and Social Care Bill being in Committee at the same time as the Welfare Reform Bill? I have amendments down for both Bills and it will be difficult. I know that is true for many Peers.

[The Deputy Chairman of Committees]

My Lords, before I call the noble Lord, Lord McKenzie of Luton, can I point out that within this group is government Amendment 72? I have to inform your Lordships that if that amendment is carried, Amendments 73 and 74 will then not be spoken to because of pre-emption.

Clause 51 : Period of entitlement to contributory allowance

Amendment 71M

--- Later in debate ---

[Baroness Morgan of Drefelin]

My Lords, I have the second amendment in this group, Amendment 71N. It is a big and complicated group. I have also put my name to Amendments 73, 74 and 75. I am not going to say too much about those because the noble Lord, Lord Patel, is going to introduce them in some detail. I support his opposition to clause stand part, and I am sure that we will come to discuss that more generally.

Many people who are placed in the work-related activity group have a deteriorating condition—say, Parkinson’s disease. Some people with motor neurone disease or some forms of cancer have been told that they have only two or three years to live, so it is possible to be in the work-related activity group and still have a very limited prognosis. The purpose of this amendment is to allow certain groups to be exempt from time-limiting of contributory employment and support allowance. This is a probing amendment in many ways, but I would prefer there to be no time-limiting at all, to be clear. If we do have time-limiting, this amendment is intended to safeguard support for people who have had to give up work due to a degenerative condition or terminal illness—for example, Parkinson’s disease, motor neurone disease or cancer. This measure will affect people with a degenerative condition who qualify for the work-related activity group but whose benefit expires before their condition deteriorates, to the extent that they would be eligible for the support group. It will also affect people with a terminal prognosis of over six months who will qualify for ESA under exceptional circumstances.

The Government had originally promised those whose contributory ESA claim had ended at 365 days as their condition deteriorated that, if they qualified for the support group on either functional or terminal illness grounds, they would become eligible again for ESA. This commitment was made in response to a question from Dame Anne Begg MP by Chris Grayling MP. However, there are currently no provisions in the Bill that will allow for someone to restart a contributory claim after their 365 days have expired. Many people with degenerative conditions or a terminal prognosis of more than six months will find themselves without support in the final stages of their illness if they have savings or a partner in work, and therefore cannot seek support from means-tested benefits. People with a degenerative condition will face the impossible predicament of trying to remain in work for as long as possible in order to ensure that they enter the support group within a year of beginning their claim, or having to stop work and focus on managing their condition and thus risk seeing their benefit run out after one year. What a position that we contemplate these people being in.

I use the example of a person with Parkinson’s disease that was lent to me by the Parkinson’s UK charity. It described the following client. He had worked until the symptoms of his condition became too severe for him to continue. He explained that although he had good days, he had bad days. He would only have good days if he carefully conserved his energy. He said,

“but I’m better when I’m not doing anything. It sounds like a skiver’s charter but what it means is that the energy or concentration reserves needed to do simple physical or mental tasks are quite low so any difficulty encountered quickly drains those reserves and I get into a sort of ‘closing down state’. My thoughts slow down. My movements slow down. My breathing gets laboured. I want to sleep. I find it hard to swallow properly. I get headaches and experience a feeling of desperation”.

This proposal promises to create a two-tier system. The rules around national insurance contributions are extremely complicated. I do not claim to be an expert in any way, so it is hard to present a hard-and-fast case, but one scenario that might occur is that someone whose condition deteriorates to the extent that they are eligible for the support group on day 365 of their claim receives indefinite support, while someone who becomes eligible on day 366 gets nothing. What action is the Minister taking to ensure that the Government honour their commitment that those who become eligible for the support group after their 365 days’ claim has expired can receive support through contributory ESA?

I understand that there are exceptional circumstances which are catered for in legislation, in the Employment and Support Allowance Regulations 2008. Someone with a life-threatening condition who would not meet the normal criteria for ESA can qualify under exceptional circumstances and be placed in the work-related activity group. The example given in the guidance for healthcare professionals carrying out the assessment is someone with motor neurone disease. As I have said, we know that the average life expectancy post-diagnosis for someone with motor neurone disease is one to four years. A 62 year-old client of a citizens advice bureau in the south-east had worked all his life, until he became too ill to carry on. He was diagnosed with motor neurone disease and experienced chronic fatigue and reduced mobility. He applied for ESA and was placed in the work-related activity group. What does the Minister intend to do to ensure that people in that situation, who qualify for ESA under these exceptional circumstances, do not lose out as time-limiting is introduced?

The equality impact assessment accompanying the proposal to limit payment of employment and support allowance to people in the work-related activity group partly justifies that measure on the basis that ESA is a “temporary benefit”. This ignores the reality that it is impractical to expect someone with a terminal prognosis to return to work. We are seeing people with a terminal prognosis being put in a work-related activity group, which is being classified as a temporary benefit. If ESA is a temporary benefit, what action is the Minister planning to take to support those for whom a return to work is not an option?

I, like many here, find these clauses desperately unfair to some of the most vulnerable people in our society. I oppose time-limiting for 12 months for ESA, which appears to me to be completely arbitrary. It is not appropriate that we should be looking at this implementation retrospectively. The assessment period should not count towards any time-limiting and it is not appropriate that people coming out of the support group, if they only have a month left of their time-limiting, should be expected to find work in a month. This is an extremely important debate and I hope very much that the Minister will be able to come back fully with answers to my questions.

[Baroness Thomas of Winchester]

My Lords, at this stage, I am not going to go into all the arguments about the time-limiting of ESA to one year. My noble friend Lord German will address the main issues in a short while. I shall speak to my Amendment 72A to my noble friend the Minister’s Amendment 72, the purpose of which is to question the whole business of the retrospective nature of this provision. Under this part of the new clause, the clock has already started ticking for existing claimants, regarding their entitlement to contribution-based ESA in the work-related activity group rather than in the support group, who have been receiving the benefit for 12 months or more. For them, their claim will stop as soon as the Bill becomes law, which is estimated to be April of next year. By starting the clock well before Parliament has made its decision on the Bill, the Government seem to be acting like a private insurance company that changes the rules of someone’s policy after they have made the claim.

However, this does not seem to have been the plan in October last year. If one looks at the Spending Review 2010’s policy costings, published in October last year, on page 6—it is repeated in the Library briefing pack on the Bill—it is stated at the first bullet point that,

“for existing contributory ESA customers, the time limit will apply at the point they reach one year including the assessment phase. Those with a claim duration of one year or more when legislation comes into effect will have their benefit time-limited immediately and will have at least 12 months to prepare for the change”.

Perhaps the Minister can throw some light on why and when the Government changed their minds and decided to make this provision retrospective—thus allowing hardly any time at all for some claimants to prepare for change. Just to be clear, someone whose claim started in April this year may find by the time the Bill becomes law in April next year that their claim will cease immediately.

Parliament has always deplored retrospective legislation. In 2009, the Constitution Committee of your Lordships' House, in its report on the Banking Bill, drew attention to the need for there to be,

“a compelling reason in the public interest for a departure from the general principle that retrospective legislation is undesirable”.

At least the letter to claimants that was sent out recently by the DWP is headed:

“Possible changes to your ESA”,

and states that the changes the Government want to make have not yet been approved by Parliament. The letter continues by providing the ramifications of the change. I gather that many claimants who have received such a letter are telling citizens advice bureaux up and down the country that they do not know what this letter means for them, and that they are very worried by it. They have good cause to be worried. Not only are the Government breaking the understanding that national insurance contributions—perhaps paid for years and years—protected a person against the loss of employment on health grounds, but many claimants, as we have heard, are likely to be left with only their partner’s extremely modest income, which may push them out of eligibility under the means-tested ESA.

I turn back to the policy costings document of October 2010. Under the heading, “Uncertainty”, we read that the migration from IB to ESA was the cause of particular uncertainty. We now know that a high proportion of IB claimants are being found to be fit for work as a result of the migration to ESA, in spite of appeals. I therefore ask my noble friend whether the Government can now start to quantify savings that might be made on the ESA bill, in spite of an increasing JSA bill—given high unemployment—and whether they will consider reverting to their original plan and drop the retrospective nature of this clause.

We all know of the need for the Government to cut public spending by an eye-watering amount as soon as possible. The Government’s argument may be that JSA is time-limited, so why not ESA? However, in my view, a claimant’s health is a much more emotive subject for their employment—or lack of it—and being ill can be a very expensive business. Using retrospection in this way, when it directly affects someone’s income in an unforeseeable way, seems to be thoroughly bad practice. Is it really good governance to cut massive corners by bringing in this policy in such haste?

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Noble Lords will note from debate on this amendment the impression that the Government need to rethink some of the ways that this will impact on the poorest and most vulnerable in our society. We certainly do not want to be a Government who provide a terrible time for people in the last months of their lives. The amendment proposes a way for the Government to set a bar at an appropriate level to the financial circumstances, but which could be improved over time. It will give the support that is needed to the most vulnerable.

[Baroness Morgan of Drefelin]

Before the noble Lord sits down, he said that there was a sense that the work capacity assessment needs to be right and that he was thinking about arbitrary cut-offs and temporary classifications. Is he saying that, in order to get this right, we have to look again at the support group? Because of the functional impairment or prognosis of the people whom I am concerned about—those who are known to be facing a terminal prognosis of two years—perhaps they should automatically be in the support group. If that were the case, there would not be a problem

[Lord German]

I can answer that question by simply stating that the work capability assessment, if done accurately enough, should place people in the most appropriate group. Of course, one of the questions in the work capability assessment is, “What are you capable of?”; “capability” is in the title. If you are capable, with an illness, to do some work, and if you know that that will diminish over time, logic tells me that you need to think again about the way that that group of people is affected by such a proposal.

In a sense, what it means is that a clear definition between support on one side and being work ready on the other is not necessarily the only appropriate distinction you can make. It is part of the issue about having clear cut-offs and clear decisions of this sort. You need to be flexible for the people who need it most and whose circumstances will have changed.

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[Lord Freud]

My Lords, one can clearly see the process here, as you move through the bulge, of stopping as you take on the transfer from IB to ESA. You can see that the effect of moving from one year to two years is a reduction as you go through that group—the bell curve, as the noble Baroness described it.

[Baroness Morgan of Drefelin]

I wish to be sure that I understand what the Minister has just said. He said that there are two reasons for choosing the 12-month period and that it is therefore not arbitrary. Therefore, the choice was made, first, due to the need to make financial savings and, secondly, because 12 months was sufficient time for people to adjust to their illness and make arrangements. Did I get that right?

[Lord Freud]

My Lords, no. I am making a different argument here. It is an argument about cost. However, I will come back to the “arbitrary” issue from the perspective of what happens elsewhere. Other countries do not have benefits which precisely mirror the design of the ESA, but a number of countries already impose time limits on eligibility for both sickness benefit, which covers temporary incapacity for work, and invalidity benefit covering long-term or permanent incapacity. For example, Austria, Belgium, France, Denmark, Ireland, Spain and Sweden all impose 52-week time limits on their citizens.

--- Later in debate ---

[Lord Freud]

My Lords, let me come back to that. It is to do with the debate about who should be in the unlimited support category for an unlimited time and who should not be in it. As I just said, we support the poorest on an income basis and those who are the most ill in the support group indefinitely.

Amendment 71N introduces another regulation-making power to the Bill. It would enable the Government, or a future Government, to exempt certain groups from the 365-day limit for those in the WRAG. This point was also raised by the noble Baroness, Lady Meacher. We believe that it is for the WCA to distinguish between those who are in the WRAG and those who should be placed in the support group and therefore be exempted from the time limit. As noble Lords will know, Professor Harrington has been working with Macmillan and other stakeholders to help us make sure that people are placed in the appropriate groups. Therefore, an amendment along the lines proposed by the noble Baroness is not necessary.

Amendment 71P introduces a new provision, which would mean that people whose contributory ESA exhausts after 365 days would be able to requalify for the support group if their condition deteriorates. However, this could mean benefits being reinstated 10 or more years after the claimant last worked, which is not reasonable. Moreover, we already have a series of safeguards in place that would protect people in this position. First, if the claimant leaves ESA before their contributory ESA exhausts, we have the linking rule, which enables the claimant to return to that contributory ESA within 12 weeks of leaving it.

Secondly, we already have within the ESA regulations an easement allowing a claimant to satisfy the first contribution condition for ESA if they have paid contributions in any tax year at a certain rate, and they had received a contributory ESA award in the last complete tax year before the current benefit year when they are claiming again. If it is decided that a person has limited capability for work-related activity, they will, of course, be placed in the support group. In addition, if someone qualifies for income-related ESA—as some 60 per cent of claimants will—eligibility for ESA can be reinstated automatically.

On the point raised by the noble Baroness, Lady Morgan, regarding protection for those who qualify under exceptional circumstances, time-limiting will apply in the same way as in all other cases. Those in the work-related activity group will be time-limited; those in the support group will be unaffected. Consideration of exceptional circumstances applies to those who do not have limited capability for work.

For those for whom work is simply not an option, we would expect them to be in the support group and not affected by time-limiting.

[Baroness Morgan of Drefelin]

Perhaps I may reassure the noble Lord that there are many people who would not be in the support groups specifically because of the way that a support group is designed. Some people with deteriorating conditions—perhaps motor neurone disease—can look forward to a time when they know that they will become increasingly ill, but on that day they are not in the support group. It is a difficult issue.

[Lord Freud]

I hear the point being made by the noble Baroness. What we are looking at in the WCA, in particular with regard to cancer patients, is to work our way through that position. We are expecting a report from Professor Harrington before Report stage. This is a very important point, also made by my noble friend Lord German, about how getting the right people into the support group, using the WCA mechanism, is such a key part of this system. I think that virtually everyone in this Committee Room would say that if the WCA test worked absolutely perfectly we would not have a problem. There are some concerns about getting that test absolutely right, and I hear those concerns; but that is the way to address these issues, and that is what we are planning to do.

[Baroness Morgan of Drefelin]

Perhaps I may make a small point before we move off this issue completely. I am also concerned about the definition of terminal. There is a question here. I cannot remember the correct terminology, and if the noble Baroness, Lady Finlay, were here she would tell me instantly, but during the six-month deadline or prognosis period, things may perhaps be moving on. Perhaps for some people we need to think about that period being longer than six months.

[Baroness Wilkins]

Does the Minister also accept that any recommendations made by Professor Harrington will take some time to put into effect—until 2014 at least? In this amendment, we are talking about this measure coming into effect next April.

Welfare Reform Bill

Baroness Morgan of Drefelin Excerpts

Thursday 3rd November 2011 Grand Committee

[Lord Freud]

My Lords, I know it is not our House, but I point out that the Work and Pensions Select Committee has that remit—a very direct remit to look at the system overall. If you are looking at how individual claimants are treated, we have a process of tribunal and independent review. There are a whole number of different processes.

[Baroness Morgan of Drefelin]

Can the noble Lord tell us who would be responsible for promoting and funding research into these questions? If there is not a body which is taking an interest in evaluating the impact of changes in social security, who will be funding, gathering and evaluating independent evidence looking at the impact of these changes or changes like this?

[Lord Freud]

My Lords, how we research changing universal credit is something that I am taking an active interest in getting on top of now, as I discussed on a previous day. Clearly there is a lot of research. The department puts out an enormous amount of research every year. Huge tomes come out monthly, and I know noble Lords enjoy reading them all. There is no lack of adequacy of independent research on DWP matters.