Welfare Reform Bill

Countess of Mar Excerpts

Tuesday 17th January 2012 Lords Chamber

[The Countess of Mar]

My Lords, I, too, support the noble Baroness, Lady Grey-Thompson, in her amendment. I read the whole of the information sent to us yesterday and I was pleased to see that ME/CFS, in which I am interested, was raised in two examples, and that the difference between the two conditions was shown. I am concerned not just for people with ME but for those who can almost function normally and will not meet the criteria for getting DLA. For example, there are those who, because they have an endocrine problem, cannot cope with the cold. They need extra heating and clothes. If they are working, they are probably on a minimum salary because they are not very well. Therefore, they need extra money. They might also need extra clothing.

If they are incontinent, they may need to be able to change their clothing regularly. They may need incontinence pads, which—as everyone knows from questions in the House—are extremely difficult to get from the National Health Service. My mother-in-law, who died a few years ago, could not go out of the house because she was worried about wetting herself in public. If she could have afforded incontinence pads, she would have been fine. She was not going to tell her children or her daughter-in-law about her problem and we had to extricate the information from her to find out why she was not going out. Such people get confined to their homes and become desocialised, and it is very difficult to get them back into society. We must take all these things into consideration—not just whether they can cook or wash themselves—when we think about what they need to keep functioning on a relatively normal basis.

[Baroness Howe of Idlicote]

My Lords, I shall speak briefly on this amendment. The comments of the noble Baroness, Lady Browning, about her personal experience of the whole range of autism reminded me just how this range has developed over the years. When I first got involved with the autistic movement many years ago, it really was just one thing; but since then, many different branches and forms of behaviour have been identified. The fact that all these extra aspects have to be borne in mind re-emphasises the whole question of whether the clause is fit for purpose. In particular, the Asperger’s syndrome comment was very apt. I hope the Minister will be able to persuade us that there will be a thorough method of assessment by people who understand the range of problems that we are talking about as well as—as my noble friend Lady Mar said—the detailed and different ways in which extra help is used and needed for such people to have a basic ability to lead a normal life.

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[The Countess of Mar]

My Lords, I wonder whether the Minister can answer a question for me. I made a particular point about people having very special needs such as extra heating and incontinence pads, for example. If they are leading a fairly normal life but would be restricted to their homes because they cannot pay for things, will this be taken into account in the PIP assessment? I could not see it anywhere when I read the details. How are these facts going to be elicited when the person is being assessed? People do not fit into boxes—everyone is an individual. It seems that the noble Lord is trying to make people fit into boxes when they do not.

[Lord Freud]

We are very much trying not to make people fit into boxes. We are not saying, “Because you have that condition, that’s your relevant position”. We are trying to look at people as individuals. Clearly, you go through all these criteria very carefully and reach a judgment. It is almost impossible for me to say whether a particular person would hit the assessment criteria or not. You just have to go through it and see. However, we clearly expect someone to get a payment who has genuine needs for coping with life because of their disability. That is what it is designed for. I cannot answer the specific question, but I can tell the noble Baroness the principle—where that person needs that support as a result of their disability, they should get it.

When we develop an assessment for PIP, we have to balance a range of factors. A complete model should include all the perspectives and important interactions between an individual, their health and the environment. That is what the biopsychosocial model does. There are limitations in considering only a single perspective, and this is a much more holistic approach.

I do not accept the criticism that our proposals do not truly reflect the extra costs faced by disabled people. As I have tried to explain, it would not be feasible to assess the actual costs without something hugely intrusive to disabled people and very complicated. We therefore have to assess other factors as a proxy for these costs. We are using “care” and “mobility” in DLA, which we do not think are broad enough. So, in our draft assessment criteria we have a range of everyday activities for PIP that we believe are a good proxy for the impact of impairments, the overall level of disabled people’s needs and the extra disability-related costs. We will go on refining those; we will not just stop when we finish the consultation in April.

The proposals have taken into account many of the key drivers of cost that Scope and others are obviously concerned about. For example, individuals who have difficulty getting out are likely to have higher utility bills, while those who need support planning a journey and moving about are likely to have higher transport costs. The proxies and associated criteria should therefore allow us to prioritise spend on those who face the greatest challenge and expense. In answer to my noble friend Lady Thomas’s point on the tick-box assessment, the proposals, which have been around since May, are very much not a tick-box approach; they are trying to look at people’s functional capability.

We have changed the assessment very considerably as a result of the enormous amount of engagement that we have with disabled people and their organisations. We will go on doing that. However, if we had fundamentally to revisit our approach in the way in which the amendment would require, we would have to go back to the drawing broad, spend more time developing and testing, and have greater consultation. It would push back the start of PIP by at least a year and reduce savings over the reassessment period by £1.4 billion. This is, I think, the priciest amendment yet.

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[Lord Kirkwood of Kirkhope]

This is an important debate because existing relevant medical evidence is absolutely essential to getting this test—and the whole process—delivered as accurately and as sweetly as it possibly can be. This is true in two separate directions. First, getting access to and active consideration of existing relevant medical evidence will make the examination—if an examination is needed—much more satisfactory for all concerned. As has already been said, it will reduce appeals—and it will minimise costs for that reason if for no other.

It has a second important function which I hope the Minister will be able to spend some time on. If the Minister could help us understand better how desktop assessments can obviate face-to-face assessments, he could diminish the fear factor that clearly exists, rightly or wrongly, about what will face people who might be invited to these face-to-face tests in future, and that would be enormously helpful. I am aware, having followed this for some time, that the DLA provisions which we put in the primary legislation in 1992 were, in some respects, too prescriptive. I understand perfectly that assurances can be made and put into regulations and put into medical contracts as well.

I am in the market for voting for this amendment if we do not get the kind of response that I hope for. However, there are ways of delivering the assurances that are being sought by our correspondents and the disability community. It would be helpful if the Minister could say a word about the contract. I understand that the contract is out to tender and it is too early to say who is interested, but people are drawing conclusions from the Atos Healthcare experience. I do not think that that experience would necessarily be repeated in the future if the terms of the contract are drawn sufficiently clearly. In that contract, if not in regulations or primary legislation, we should be saying clearly that on cause shown, if there is heavyweight medical evidence that can be addressed at a desktop level, those are circumstances where it should almost be a default that people will not be subjected—if that is the right verb—to these assessments.

I share a concern about the quality and experience of the assessors. I have a capacity issue as well as a quality issue about that. It does not matter if you get the best contract in the world and the most enthusiastic prime contractors who come in and promise, hand on heart, to do the best they can. The professionals with the right qualifications and experience to do this work may not be out there. If that is the case then we need to be very careful. There is not enough emphasis in the United Kingdom on this kind of medicine, and we should be promoting with our medical colleagues a far higher degree of interest in and development of the specialist skills that medical professionals need to do these jobs in order to make this process a success.

I have here a case history that caught my imagination. A 25 year-old young man is undergoing his first major reassessment of his problems as an adult. His assessments will involve MR scans, examination by neurologists, neurogeneticists, neurophysiotherapists and a specialised occupational therapist. He has scattered neuromotor difficulties. Although I trained as a pharmacist a long time ago, I could not even find on the internet what neuromotor difficulties actually amount to, but it is clearly a serious condition that is being addressed by experts at a tertiary, if not international, level by a centre of excellence in a region in the United Kingdom. The young man has written to say that he is now fearful that he will have to address the circumstances of these tests. It would be completely daft and stone mad that we cannot say something now that is clear. There may be technicalities with the legislation, and perhaps I could be persuaded that such provisions should not be in primary legislation, but we absolutely need some clear, copper-bottomed assurances from the Minister that a person in those circumstances would not face such difficulties.

I hope that the Minister will understand that this is an important amendment and that he will take as much time as he can to tell us as much as he knows about how these processes will work and where in the legislative process—whether by regulation or primary legislation—we can be assured that we will get some protection for the kind of young person to whom I alluded.

[The Countess of Mar]

My Lords, I have difficulty with Amendment 50ZR. I fully endorse the fact that medical evidence is needed, but some people with ME have not seen a doctor in years, simply because there is no treatment for them. If the department is expected to depend a lot on medical evidence for corroboration of the illness, I do not know how people with ME are going to cope. That really disturbs me and the issue needs to be examined.

I fully support the amendment of the noble Lord, Lord Addington, on training. People with ME have cognitive difficulties as well as all their other problems, and these are not very well understood. I give him my heartfelt support, and I hope that the noble Lord will take on board the fact that some people cannot get current medical evidence to corroborate their illness.

[Lord Wigley]

My Lords, I shall speak briefly because time is pressing. We went into this issue in some detail in Committee and I warmly support the amendment of the noble Lord, Lord Addington, which was better than the one we originally considered. The noble Lord, Lord Touhig, referred to the tiered approach, and I very much hope that the Minister can confirm that the tiered approach that has been pressed upon him by those involved with autism will be central to this matter.

I also hope that he can take the main thrust of the amendment of the noble Lord, Lord Addington, whereby expertise needs to be brought on board. Earlier today, the Minister emphasised the need to make sure that those with greater disabilities get the support they need and that those with lesser disabilities get less. That approach is dependent upon knowing exactly what the conditions are. When we consider people in the spectrum associated with autism and Asperger’s we need to know the individual challenges they have. If the wording of this amendment is inappropriate, so be it. However, there needs to be an approach that brings that expertise on board, otherwise we are failing to do what the Minister says he wants to do.

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[The Countess of Mar]

My Lords, I should have said this when I was making my initial speech. About 60,000 people with ME are either bedbound or housebound. To go to a face-to-face interview would cause enormous stress and probably exacerbate their symptoms. Will that be taken into account? They cannot provide medical evidence because there is no treatment; yet they cannot come out of their homes. How will the Minister deal with that?

[Lord Freud]

My Lords, one thing I was trying to get over about trying not to have a two-tier process so that the rich can get their evidence and the poor cannot, is that we turn the burden on to the assessors, so that when someone cannot come out, that requires a house visit if we cannot use paper evidence. There will be examples where paper evidence will do the job; where it cannot, the onus is on the assessor to do the checking, rather than the other way round. That is how we will provide that protection.

I hope I have gone through all the specific issues and given assurances on all those important matters. We are planning to meet the concerns expressed around the House. All I am asking for is that we have the flexibility to go on running the system as things change, as they inevitably do, and that we do not lock it up in primary legislation so that if we need to make changes it takes years. That is really what we are talking about.