Welfare Reform Bill

Baroness Thomas of Winchester Excerpts

Tuesday 17th January 2012 Lords Chamber

[Baroness Thomas of Winchester]

My Lords, that was a most moving contribution from the noble Baroness. I think we were all very touched by it. I declare an interest at this point, as I receive DLA.

There is a real fear among so many disabled people who have contacted us that the migration to PIP is going to be like a horrid game of musical chairs, because they all know that the Government want a 20 per cent cut, wherever that comes. They all think that when the music stops, they will be the one without a chair. They also know that DLA, for all its faults, has the lowest incidence of fraud, and many of them say they feel demonised in the press for being scroungers. Would it not be nice if some of the screaming headlines in tabloid newspapers were about the way in which many people receiving DLA are able to live independently, contributing hugely to society in many different ways, rather than the other way around?

On the low level of DLA fraud, we have to acknowledge that my noble friend, coming to this whole subject with a fresh eye, reckons not that the wrong people are claiming the benefit but perhaps that the net has so small a mesh that it tends to pick up everyone who has any level of disability rather than picking up only those with the greatest need. Therefore, his argument goes, you do not have to resort to fraud in order to get DLA; it is so loosely drawn that almost anyone can get it if they know how to fill in a long and complex form in the right way. Taxpayers are entitled at this point to ask why medical reports are looked at in only around half the cases, which I for one find quite inexplicable, but we will come to that in our debate on a later amendment.

However, it is the phrase

“those with the greatest need”

that is most worrying. It could mean many things and is most closely associated with those who are entitled to means-tested benefits, which we know is not the case for PIP, and long may this last. Among the arguments that the Minister deployed when he rejected this amendment in Grand Committee were that it was too widely drawn; would be too expensive; would lead to too long an assessment, which would be too intrusive; and too complex. The noble Baroness, Lady Campbell, countered this by saying that the proposed points-based tick box descriptors approach will not capture enough information about the barriers and costs faced by disabled people on a daily basis. Both are right, which is why this issue is so difficult. It would be almost impossible to translate this amendment into a points-based assessment in a meaningful way, although in an ideal world that is exactly what is required.

I wonder whether there is any way in which the sense of this admirable amendment, or elements of it, could somehow be incorporated into the assessment process. I shall be most interested in my noble friend’s reply.

[Baroness Wilkins]

My Lords, I support the amendment, which seeks to ensure that the assessment for the new entitlement is fit for purpose and fulfils the Government’s commitment to the social model of disability. As has already been noted, DLA occupies a unique space in the welfare benefits system as it recognises that disabled people face a plethora of extra, often prohibitive, costs as a result of living in our society with a condition or impairment.

We should all warmly welcome the Government’s repeated commitment to the social model of disability, for which, as many of your Lordships know, disabled people have fought long and hard. At the heart of the social model is the recognition that it is our society, not just their bodies, that disables people with health conditions and impairments. However, I fear that the proposed assessment for the new entitlement does not reflect this commitment. Despite the Government’s assurances in Grand Committee, the Minister admitted that the proposed test,

“is not a full social model assessment; it is not intended to be”.—[Official Report, 14/11/11; col. GC 199.]

I ask the Minister in his response to clarify to the House and disabled people why such a commitment was ever made in the first place.

The second draft of the PIP assessment criteria includes some small improvements from the first. However, it does not go nearly far enough. By assuming that a medical assessment will capture social and environmental barriers to independence, the Government risk homogenising the diverse difficulties that disabled people face in their everyday lives. The new threshold document makes many mentions of extra costs and barriers, but only a few of these will be captured by an assessment that looks exclusively at impairment.

It is with this in mind that I support the amendment of the noble Baroness, Lady Grey-Thompson. The assessment for the new entitlement must consider the real social, practical and environmental barriers faced by disabled people with impairments living in our society. I, along with disability charities such as Scope, disabled people’s organisations and disabled people across the country, voice great concern that the Government are reneging on their commitment to the social model of disability. Doing so would undo decades of campaigning for and progress towards a better and more equal society.

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It is vital that the assessment process for PIP includes a requirement for the decision-maker to collect evidence from the claimant’s own healthcare professionals as a core part of the decision-making process. Without that requirement, there is a danger that there will be a two-tier system, with the poorest and most vulnerable claimants unable to afford to pay for the evidence themselves and, as a result, at risk of receiving a less reliable decision. I beg to move.

[Baroness Thomas of Winchester]

My Lords, the importance of this amendment, and of collecting evidence from a person’s healthcare professionals, cannot be overstated. Some of us are shocked that not all medical reports are looked at presently under DLA; I think only around half are.

Turning to the assessments, I, too, was very interested in the finding by Citizens Advice that welfare rights workers report that the WCAs often present a distorted picture of what a claimant has said. In case noble Lords have forgotten that report, it said that 37 clients were asked to examine their reports and establish how accurately they reflected what they had said and done in their assessments. Sixteen were found to be very inaccurate. We know from experience that if you hear two people speaking to each other and one of them tells you afterwards what they said all over again, it often does not match your recollection of what they said at all. I note that in relation to PIP we are told:

“Individuals or professionals who support the customer on a regular basis will be able to provide evidence to support their claim”.

Who will ask these people to provide evidence? Will it be written evidence? If it is not from a healthcare professional, who else might it be from? The finding of Citizens Advice in connection with the WCA alarms me a great deal about the quality of some of the Atos healthcare professionals who are currently carrying out the assessments. I fervently hope that those doing the PIP assessments will be of a higher calibre altogether.

[Baroness Meacher]

My Lords, I support Amendment 50ZR, tabled by the noble Baroness, Lady Grey-Thompson, and to which I have added my name. The noble Baroness has made the case comprehensively so I will be brief. She referred to the alarming error rate in benefits decisions. At the same time, I am aware that steps are being taken to improve the accuracy of those decisions.

Here I want to make sure that we do not forget the particular problems of people with learning difficulties and mental health problems, who may not adequately convey their limitations in a face-to-face assessment. These groups have to spend their lives concealing their symptoms. They are embarrassed by them, and the last thing they want to do is to spell them out. They are acutely aware of the stigma associated with those symptoms. The Government are ensuring that claimants can take someone along to their assessment. There is no doubt that that will help and in some cases lead to appropriate outcomes. However, for many having a companion simply will not be enough. The companion cannot conduct the interview and the pressure on these individuals to conceal their problems is very difficult to overcome in these one-off assessment interviews.

There are also people for whom the very idea of one of these assessments is completely unacceptable. The obvious example is of people with agoraphobia, for whom just going out of the house can present real problems, as can getting on a bus or whatever it is. It is a real problem for this particular group. These people would benefit massively from having a psychiatric assessment at the start of the process, which would eliminate the need for them to go through all the distress of having to do something that they find completely intolerable. It is very fashionable to knock medical assessments but, having worked in mental health for a quarter of a century, in my experience psychiatric assessments are bio-psycho-social assessments. I think that was the term that the Minister used. They do look at the biological, the social, the genetic and every other aspect of someone’s functioning.

Also, any self-respecting psychiatrist will not do an assessment in a single sitting. They expect to assess someone over a period of time. They will bring in the views of social workers, nurses and others who have seen someone over a period. There is no way that a one-to-one assessment by someone who may be a nurse but not a psychiatric nurse—even if they call in someone who might be a psychiatric nurse but does not know the patient—can meet the need to make sure that someone is properly assessed, gets the benefits to which they are entitled and does not get benefits to which they are not entitled. It works both ways. This is an important issue.

Other examples include people with a psychosis whose symptoms are not controlled by medication. Many people’s symptoms are controlled but some people’s, tragically, are not. Those people should be able to have a medical—a bio-psycho-social—assessment and, on the basis of that assessment showing that such a person may not be able to function at all, it should be sufficient. I would have thought that the Government would accept that view.

There are physical diagnoses to which the same sort of arguments would apply. For example, those undergoing treatment for cancer, who again have uncontrolled and uncontrollable symptoms, would fall into this category. I referred to this group in connection with an earlier set of amendments. An early medical certificate for those people would avoid enormous distress and the gross injustice of requiring them to do things that none of us would wish them to do if we saw them face-to-face.

I understand the issue of medical fees, which has been referred to. GPs will not tolerate an inundation of requests for medical assessments without a fee. One of my daughters is a GP. I discussed it with her and she was not impressed by the idea. I am also aware that the Government have introduced an important new element in that the claimant can seek a report from their favoured clinician, who could be anybody—it might not be a doctor. This is helpful but it raises the issue, which has already been raised, of a two-tier system. Some people may be able to afford such a thing; others may not. It is a great step forward and I wish to acknowledge that, but it does not detract from the importance of this amendment. I look forward to hearing the Minister’s response.

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Moved by

[Baroness Thomas of Winchester]

50AB: Clause 79, page 58, line 6, at end insert—
“(d) shall not take into account aids, appliances or adaptations used by the person.”

[Baroness Thomas of Winchester]

My Lords, we had quite a debate about the use of aids, appliances and adaptations in Grand Committee, at the end of which I found myself more confused than ever about how the PIP assessment was going to take them into account. I have already declared one interest; I feel that I should declare another in having most of the aids and appliances known to mankind in my house.

My purpose in tabling the amendment is not so that we can have another debate about the detailed use of all kinds of aids—

[The Deputy Chairman of Committees (Lord Brougham and Vaux)]

Order. I ask Members of the House to leave quietly, because otherwise the Chairman cannot hear the speech.

[Baroness Thomas of Winchester]

My Lords, I am not going to have another debate here and now about the detail of all kinds of aids and appliances, but I want to signal my concern about the question and to ask the Minister whether he would consider hosting a meeting for interested Peers on this topic, together with the relevant officials from his department.

I quite appreciate that those who have been working on the second draft criteria for PIP have tried to do their best to incorporate the views of many organisations and people, including disabled people, but we must not forget that the Government want to cut the bill for DLA by bringing in PIP, which may mean that some of those who currently receive DLA will not receive PIP. If so, it is very important to make sure that some people do not fall through the net because their particular needs have not been met.

We have to keep in our minds at all times the purpose of PIP, which is to help a person to carry out daily living activities and mobility activities if that person is limited or severely limited by their physical or mental condition. The Minister has repeatedly made it clear—we heard it just now—that the Government are looking not just at the medical model of disability but at the biopsychosocial model, which tries to include part of the social model. The responses of disabled people and organisations to the first draft criteria were instructive. Many were keen to point out that taking the use of aids and appliances into account does not necessarily remove a barrier to participation. Those of us who have mobility problems can all testify that there are still a lot of buildings such as restaurants, shops and even hotels which are not accessible, as well as dropped kerbs which are positively dangerous and public transport which is not suitable. The mobility descriptors are, in my view, worryingly minimal, and here again the responses to the “Moving Around” section were useful. While moving outside, for example, no account is to be taken of the gradient or texture of the ground, or the weather, and there was no box for whether the physical support of another person was needed for those with poor balance.

I turn now to a very basic issue—managing toilet needs or incontinence. One response was that toilet needs outside the home should be considered. Most disabled people can manage in their own homes, many with aids, but going out is a different matter, as we heard from the noble Countess, Lady Mar, who is not in her place at the moment. This has not been included but it may make all the difference to whether someone can participate in society. If that is the criterion for receiving PIP, why is there no suitable box for it? Or perhaps there is and I have not been able to find it.

Before ending, I should like to raise one matter that has concerned me for some time but about which I may not have to worry—that is, the difference between using an aid or appliance for work capability and using the same aid or appliance for ordinary living purposes. For example, we know that a person in a manual wheelchair is no longer classified as having limited capability for work simply because of their use of a manual wheelchair, so they will not automatically get ESA rather than JSA. Although I am not happy with that state of affairs, that is the situation at the moment. However, if that person applies for PIP under the new regime, knowing that PIP will be an in-work as well as an out-of-work benefit, and because they might need extra help with daily living activities, then I can see no good reason why they should not receive it. Therefore, I hope that whether a person has “passed” or “failed” the work capability assessment will not be taken into account when they are being assessed for PIP. I think that this is why the noble Baroness, Lady Grey-Thompson, thought that she might be ineligible for PIP.

I understand that the aim for PIP is to take account of aids and appliances which are actively used by individuals and those which could reasonably be expected to be used to reduce barriers to participation. If the Government expect a person to buy and maintain aids, the least they can do is to help to pay for them.

The case studies that the Minister promised us I found extremely valuable, but they also beg a few questions. For example, the phrase “Needs to use an aid or appliance to bathe” means using a shower seat to take a shower, but what about those who can use a shower only if there are suitably placed grab-handles and the shower has the lowest step possible, or if the person has a wet room but has to use, say, a walker while using the shower?

In view of the very late appearance of the PIP thresholds and the case studies, I hope that the Minister will agree to an early meeting between concerned Peers and the relevant officials at the DWP to talk in more detail about how aids, appliances and adaptations are going to be used in the assessment. I beg to move.

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[Lord Freud]

My Lords, a fundamental principle of PIP is that support should be targeted at those who are most affected. I reassure my noble friend Lady Thomas that we will not be penalising people who use aids and appliances.

We know that many disabled people have a greater level of participation because of the help provided by aids, appliances and adaptations. If we were to disregard entirely the use of such aids, we would penalise individuals whose health condition or impairment could not be helped through their use. In those circumstances, the needs of those individuals would seem less of a priority, even though their levels of participation might be lower. Therefore, there is a balance to be struck here. I would be the first to admit that the use of aids, appliances and adaptations do not of themselves eliminate needs, barriers or costs. We accept and understand that, and that is why we are applying points in the assessment when such aids are in use. The number of points will vary depending on the aids in question and the levels of need.

With regard to the daily living component, the entitlement thresholds have been set at such a level that an individual who requires aids to carry out a number of activities may receive the component at the standard rate. I am pleased to reconfirm to the noble Baroness, Lady Grey-Thompson, that with the mobility component, individuals who use aids and appliances to move short distances can receive the standard rate, while someone who needs to use a wheelchair to do so—whether it is a manual or an electric one—will receive the enhanced rate. In that sense, it is a different assessment and it does things differently from the WCA for ESA. The valuable point has been made tonight that people do not understand that, so clearly we need to put across information about it.

As I informed noble Lords in Committee, the approach that we wish to adopt for PIP is the same in this area as that currently used within DLA. We take into account aids that are currently used by individuals as well as those which might reasonably be expected to be used. Let me be precise—I mean those that are easily and cheaply available. We will not, for example, say that an individual’s needs would not be present if they simply bought themselves a wheelchair, a stairlift, or a walk-in shower. That would not be reasonable, and we will have guidance available to make sure that claimants are treated consistently.

I will, however, be delighted to host a meeting with my noble friend, and any group she wishes to bring. Clearly, there is a big consultation exercise going on in precisely this area. I know this is an area in which she has great interest, and I will be very pleased to host that meeting. I urge her to withdraw her amendment.

[Baroness Thomas of Winchester]

My Lords, I am very grateful to the Minister for agreeing to such a meeting, and for clarifying that there is a great difference between the assessment for the work capability assessment and PIP. With that, I beg leave to withdraw the amendment.

Amendment 50AB withdrawn.