Welfare Reform Bill

Debate between Baroness Thomas of Winchester and Baroness Meacher

Tuesday 17th January 2012 Lords Chamber

[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.

Welfare Reform Bill

Debate between Baroness Thomas of Winchester and Baroness Meacher

Tuesday 1st November 2011 Grand Committee

[Baroness Thomas of Winchester]

My Lords, I shall speak to Amendment 52BD in this group, about disabled claimants. If the noble Baroness, Lady Lister, thought that her brief was complex, this is pretty complex too. At the moment, if a disabled person is in work they can claim the disability element of working tax credit if they fulfil two tests: a work disadvantage test and the benefit test. The work disadvantage test includes many criteria, but one of the most common ways to qualify is if you are unable to work full-time because of a health condition or impairment. You also have to fulfil the benefit test if you receive DLA or attendance allowance or you have been receiving sickness benefit for at least the previous six months.

There are other qualifying criteria that would take all afternoon to go through for both the work disadvantage test and the benefit test. An example of the work disadvantage test criteria is that you cannot extend your arm sufficiently to shake hands with another person without difficulty, which sounded rather French to me. Suffice to say that the criteria for qualifying for the disability element can be complex but probably covers a lot of disabled working people.

Under the universal credit, many disabled people will not receive extra help because the gateway to extra support is through the work capability assessment. So someone will not qualify for the disability disregard if they have been found fit for work. For disabled people who are already in work, a new test will be designed and we are hoping that that new test will have some lower criteria in it.

Some of the criteria for the work disadvantage test look similar to the criteria for the WCA, but it is unclear what the qualifying criteria will be for this test for disablement under the universal credit, as I have said. If everyone else is giving examples, I might give the example of someone who might benefit now from extra help but might not qualify in future. I am afraid I have not given her a name but she is a person with MS who can walk up to 100 metres but gets tired very quickly and is unable to cook a meal for herself. She may now qualify for DLA lower-rate care and might also receive the disability element of working tax credit, if she were able to work only part-time because of fatigue levels. This person probably will not qualify for the personal independence payment, although until we see the new criteria, which we were told would be available at the end of October, we cannot tell. This person probably will not qualify for any more help under the universal credit than a person who is not disabled.

Another of the worrying things about the loss of this extra help for many disabled people under universal credit is the passporting factor used by local authorities for travel passes, leisure passes and so on, so disabled people may lose out on a much wider scale than may at first seem apparent. I look forward to hearing what my noble friend has to tell us about that.

[Baroness Meacher]

My Lords, I support some of the concerns that have already been raised by other noble Lords. I am not clear about the logic of ending the provision for adding disregards if a claimant falls within two categories, both of which qualify for a disregard. As I have always understood disregards, the idea is that they compensate for the costs that a claimant faces, whether those costs arise from being a lone parent, being disabled or whatever. I am sure that the Minister has a rationale for the measure but it is difficult to think what it could be. Is he going to provide a disregard for the disability side, the lone parent side or some other side? Why provide it for this bit rather than that bit? Why not provide the disregard for both sets of additional costs? It would be interesting to hear his rationale for this measure.

Given that the Government want to make swingeing cuts to the welfare bill, I completely understand that two-earner households are not a priority from that perspective. However, going back to the Government’s commitment to having incentives to work, this is another example of a part of this legislation running completely counter to that aim. I know that the Minister will correct me if I am wrong, but as I understand it the second earner will have almost no incentive to work, particularly if they have children, as they will not have the earnings disregard but they will have to pay the 30 per cent or so costs of childcare. This will almost certainly be the case if they have children. Therefore, it would be helpful if the Minister agreed with me that this is a bit of a problem in terms of incentives to work or explained the rationale behind the measure.

Regarding people with mental health problems, I envisage—I think that the Minister agrees with this—that this group will lose overwhelmingly from the shift to the new system and the reassessments for ESA. Rafts of these people will come off ESA and on to JSA with the result that, even with a disability, they will not receive any disability support because they will be on JSA. Yet people with mental health problems can have additional costs in order to go to work that others might not have. For example, somebody with severe anxiety might have to have someone accompany them on their journey to and from work, although they may be able to sit there and do the job when they get there. However, if they get no financial support at all for their disability—I understand that that is what the system sets out—how will these people have an incentive to work? They will have to pay for this support out of their tiny pockets.

The other point about people with mental health problems is that many of them can manage only a limited number of hours of work and need to build up their hours slowly. I do not know how this will work. The structure of the universal benefit is very good in this regard and should make life easier for people—at least in theory, if the two computer systems of the DWP and HMRC manage to bond together as they are supposed to do. However, the loss of disability support will cause problems in terms of incentives to work.

Sue Royston of Citizens Advice also provided me with the facts that were read out by the noble Baroness, Lady Lister. I will certainly not repeat them but I would find it helpful if the Minister could confirm for me how the two tapers of the universal credit on the one hand and the council tax benefit on the other will work together. Perhaps he has already done that when I was not here, as I have not always been here due to other commitments. I still hope that he will ultimately find a way to bring council tax benefit within universal credit, as it is such an important issue.

I am sorry to be a bore and raise this again, but it would make such a difference for so many people. If not, it seems to me that claimants working a few hours and building their employment up slowly will be dogged by a terrible complexity and lack of clarity not that dissimilar to what they have suffered in the past. That would be a great pity.