Welfare Reform and Work Bill

Lord Lansley Excerpts

Wednesday 9th December 2015 Lords Chamber

I urge the Committee to adopt the very simple proposal embodied in Amendment 52. As I understand it, this Bill is primarily about saving money on welfare. If we think about it, there are other ways to do that than just cuts, and this would be a very effective way of saving money on welfare. I know that the Minister cares deeply about these issues and I hope he will support the principle of this proposal. I am sure there are details that can be improved, but I do hope it will be possible to work with him to develop this into a government amendment. I know that the Minister and his department are envisaging a White Paper on these issues next year, but next year is next year. This proposal has been around for about four years now. In the mean time, millions of claimants have suffered unnecessarily and have cost taxpayers billions in the process. I believe that this proposal has pretty much universal support and I urge the Minister to implement it forthwith.

[Lord Lansley (Con)]

My Lords, I rise briefly to contribute to this debate. I am pleased to have the opportunity to do so and especially to follow the noble Lord, Lord Layard. At Second Reading, he kindly made a favourable reference to the work we did together in the previous Parliament to undertake the national rollout of improving access to psychological therapies. It was very important to do so and he has just eloquently explained to the Committee why it is particularly important in this context of giving people with mental health problems who want to work the opportunity to access treatment that takes them closer to work and gives them opportunities to return to work. I remember visiting just such a centre in Reading and seeing the success it achieved in enabling people with mental health problems to access treatment and get back to work much faster than would otherwise have been the case.

I confess to the Committee that I do not exactly support Amendment 52. There must be very limited circumstances in which we seek statutorily to provide for when the NHS should give treatment to particular individuals or sets of individuals; we have to be extremely careful. I applauded otherwise pretty much everything the noble Lord had to say. I was glad he was able to reference the support in the spending review for increasing access to talking therapies. I thought we had already established the fact, but further evidence has shown that talking therapies are at least as effective, as treatment, as access to medication. It has been reported that medication is no more effective than talking therapies, but I would put it the other way round—namely, we have discovered that talking therapies are at least as effective as medication, and often without the drawbacks associated with the dependence on medication that can emerge. I am very pleased that we were able to work together on the national rollout for the IAPT programme that was announced, if I recall correctly, in February 2011. That was published alongside the first national strategy for mental health, No Health without Mental Health.

I also want to speak to Clauses 13 and 14 stand part, which I very much support. As I said at Second Reading, one issue we need to focus on is helping people with disabilities into employment. Though I mean in no sense to be patronising, I think the report published yesterday, Halving the Gap?, is an extremely helpful contribution by the noble Lord, Lord Low and the noble Baronesses, Lady Meacher and Lady Grey-Thompson. It is an extremely good report, very clearly set out. Its focus is absolutely right—namely, how do we reduce the gap between employment for disabled people and the access to employment that is being achieved by those without disabilities? We are doing this in the context that this country is an economy creating jobs as fast as the rest of Europe put together. Not only are we creating jobs and bringing down unemployment and the claimant count, but we are doing so with a record level of vacancies in the economy. We have the opportunity for employment, therefore, to a degree that we can be proud of; the question is whether we are giving people the appropriate support into work and creating the right incentive structure. I make no apology for saying that all three are important: opportunities for work, which I believe are there; support into work; and incentives for work.

I do not want to go on at length, but this is important. There is a great deal of material in the Halving the Gap? review that sets out some of the ways in which support for people getting closer to employment and taking it up can be improved. It is important never to think about legislation without understanding that, from the Government’s point of view, it is often conducted with legislation on the one hand and administrative action on the other. This is very much one of the areas where the administrative changes are potentially at least as important as the legislative changes. In that context, the Work Programme has worked very well in some respects, but not so well in others—though it is of course a payment-by-results programme, and it was important that it was. Together with the evidence on work choices—which, although small in scale, had some benefits, as has been referred to—it is important to look at those examples, the work in jobcentres and all the other evidence, to see how, in particular, we can design the health and work programme from 2017, which will coincide with the changes proposed in this legislation, to ensure that it helps people in the work-related activity group into employment.

I listened with great care to the noble Lord, Lord Patel. I completely understand his point about giving time. We have to be very careful to understand that we are talking about people in the work-related activity group who may need more time than would customarily be true for those on JSA, but this is not a situation in which the more time is taken, the better it is—far from it. We are looking for people on a part of employment and support allowance to move towards employment and for progress to be made in that respect. That is where we need to focus and why the support that we give is extremely important. The reshaping of that support, which I know is contemplated alongside these legislative and benefit changes, has to happen.

I also mentioned incentives, which are important. It has been said that there is no evidence. One tends to think that the absence of evidence is not evidence of absence, but in this instance the reports from the OECD 10 years ago and from the Barr and others study refer to evidence of a relationship between the generosity of benefits and the employment implications. I do not think we should be surprised by that. The disparity between people’s income out of work and in work is an essential part of understanding the incentive structure. Where that disparity is small, the incentive to work will be less. Where the disparity is greater, the incentive to work will be greater. We have to be clear that that is prima facie. It is not a matter of looking for evidence; we know that it is demonstrably true and there is plenty of evidence of it.

I completely understand that we also need to understand this in the context of people with disabilities and disability employment, but understanding that people with disabilities have special requirements and special constraints should not constrain our understanding that incentives must be aligned with support and opportunities. If the incentives are wrong—if they do not align with the support that we give in encouraging people to be in work or to be continuously moving towards work where they are capable of doing work-related activity—the system will not succeed.

The review was absolutely honest. It said that unemployment and economic inactivity have been stubbornly high for many years, so this is not a situation where we should simply say that what is happening now is good enough. We want to achieve change, and strengthening the incentive structure, alongside the support structure, is an essential part of the overall policy. Therefore, we need to keep the legislative change and the support changes administratively.

I shall make one final point. I was listening carefully to the noble Lord, Lord Low. While the review said that there is no evidence that the generosity of benefits has an incentive effect in relation to employment, there is something of a contradiction within the terms of the review. It is said in the review that there is a difficulty associated with current claimants—they will not be new claimants necessarily moved off accessing the additional support under WRAG in future—who go into employment and might then come back on to the WRAG element of ESA. Logically, because people asserted to the review that they would be disincentivised from taking jobs because they would not be able to go back on to the ESA WRAG element on their previous basis, by implication people were saying that the level of financial support under ESA is in itself a disincentive to taking work. We have to be clear that, within the review itself, there is a sense in which people are openly acknowledging that the level of benefits relative to work is an issue in terms of incentives.

[Lord Low of Dalston]

I understand the point the noble Lord is making, but I put it to him that the contradiction he points to arises only if you decide to remove the extra ESA WRAG component for new claimants. If the benefit remains the same, there is no disincentive in moving off work and moving back again.

[Lord Lansley]

I entirely understand what the noble Lord said. That is indeed true. The point I am making is that the assertion made in evidence to the review that the noble Lord led was that under those circumstances people would be disincentivised from taking work because they would lose access to the level of benefits that they currently enjoy under the WRAG ESA. In a sense, that was completely contrary to the argument that the level of benefits does not in itself have an incentive effect.

[Baroness Hollis of Heigham]

Would the noble Lord agree that the Department for Work and Pensions has always understood that dilemma and therefore, particularly for disabled people, has sought to reduce the risk of going into work, in terms of both the claimant’s health and the viability of the job, by having extensive linking rules? The linking rule that if you cannot sustain a job, you can go back on to your previous level of benefit allowed a lot of disabled people, under the New Deal for Disabled People, to springboard into work.

[Lord Lansley]

The noble Baroness is drawing me into a debate that I was not intending to enter into. My point was not about whether having a structure in which those who are currently on ESA WRAG and then go into employment and come off it should lose the benefit after 2017. My point is that within the terms of the review, contrary to the argument that is being presented that there is no incentive effect of the level of benefits relative to work, people are arguing that that is not true and that there is a disincentive effect in going into work if the level of benefits is higher.

I shall conclude on that point. It seems to me that we need to be operating on each of these areas. As a Government and a country, we are doing well in providing opportunities for employment. If we do the right thing in terms of support, we can give people with disabilities greater access to those employment opportunities that are increasingly available and, most importantly, give people access to the support. The review gives very good material for the Government to continue the process of thinking towards what that structure of support should be to be of the greatest possible benefit for people with disabilities.

[Baroness Manzoor]

Surely with his health background the noble Lord is not saying that people who have been deemed to be sick and ill should be given jobs and should be made to go into employment. That is not what he is saying, is it?

[Lord Lansley]

No, it is not—and I do not think that we should construe an incentive structure as being coercion. It is precisely what it describes. We are talking about the level of relative benefits and if people fall properly into this category—I have not got into the question of whether the work capability assessment is accurately placing people in the WRAG ESA rather than the support group—they should be in a position to work. It is not about coercion. Sixty-one per cent want to work, but not enough of them are getting work. We should have incentive and support structures that help them to get that work and we should make sure that the incentives do not get in the way but support this. It is nothing to do with coercion.

[Baroness Hollins (CB)]

My Lords, I have put my name to a number of amendments in this group and shall speak briefly to them. As my noble friend Lady Howe explained, Amendment 51 would mean that people with a mental or behavioural disorder would not be mandated to take part in inappropriate activities that might be detrimental to their mental health and that the current sanctions would no longer impact on them. It is crucial that support is tailored to the individual and that it addresses a person’s main barriers to work. For people with mental health problems, I cannot stress enough how important a good relationship between a claimant and adviser is and that people must be involved in decisions being made about them.

With respect to Amendment 52 I will restrict my comments to the provision of mental health care. This amendment would mean that anyone on ESA with a mental health problem as their primary condition—as the noble Lord, Lord Layard, explained—could be fast-tracked to IAPT for therapy. That needs to be debated, but Mind is concerned about the broader implications this could have for the many people who are already on waiting lists for talking therapy.

A survey of 2,000 people from the We Need to Talk coalition last year found that one in 10 people had to wait over a year between being referred for talking therapy and having an assessment. Waiting this long can be incredibly damaging. The findings also showed that while waiting for talking treatments, four in 10 people harmed themselves, one in six attempted to take their own life and at least 6% of people ended up being admitted to hospital.

People are already trying to get treatment, but services are just not meeting demand. We would need to know what types of treatments people with mental health problems on ESA are already receiving, are likely to be waiting for or have already received. So it is difficult to know what effect this amendment would have.

The final point to tease out of this debate is to raise caution around any suggestion of mandated treatment, although I am sure that this is not the intended effect of this amendment. I am pleased to speak to the amendment to highlight the wider issues around access to mental health services. Anything we can do to improve access to mental health services for all is absolutely a good thing. The Minister defended the proposed changes to the ESA WRAG during discussion of Amendment 34 earlier this week by saying that the Government are doing more than any previous Government to improve access to mental health services —presumably those provided by the NHS. However, mental health is still the Cinderella service in healthcare and is not just the responsibility of the NHS. If I were a Minister in the Department of Health, I would be extremely worried that these proposed DWP policies would lead to an increase in or a worsening of mental disorders for people in this group and that they would lead to additional demand and escalating costs.

I will also speak briefly on the stand part debate for Clauses 13 and 14. My noble friend Lord Rix sends his apologies. It is quite a task for him to come into the House at the moment due to his current health problems, so he chose to focus his input on his excellent Second Reading speech.

I welcome the review published by my noble friends Lord Low, Lady Meacher and Lady Grey-Thompson and I urge the Minister to look closely at it. I particularly welcome the review’s inclusion of people with a learning disability. The story of Sam Jeffries, who himself has a learning disability and whom I met yesterday at the launch of the review’s publication, where he spoke, gives a human face to the concerns that noble Lords are expressing.

Sam is a 25 year-old man who lives on the Isle of Wight with his nan. He is currently in the ESA WRAG group. He has a moderate learning disability and some joint problems, so he finds it difficult and painful to walk other than for short distances. He uses some of his personal budget to go to a Mencap day service, which he enjoys, although he would like to work. He has a support worker, who is paid partly from his personal budget and partly from his benefits. Sam says that if he were to lose another £30 a week it would make a massive difference. He would struggle to pay for everything. It would mean not going to his day service and being unable to afford the taxis he sometimes needs to get around. He would like to work part-time if he could but there are not many jobs around, and sometimes 50 people are competing for each job.

I have worked with people with a learning disability for much of my life, and they need the support to look for work and ongoing job support. This should be the Government’s focus, not cutting benefits. To do so will ruin the employment prospects of many people with a learning disability while at the same time affecting their social life, their health and their self-esteem.