Welfare Reform Bill

Debate between Lord Thomas of Gresford and Lord Freud

Wednesday 25th January 2012 Lords Chamber

[The Parliamentary Under-Secretary of State, Department for Work and Pensions (Lord Freud)]

My Lords, I start by thanking the noble Lord, Lord Layard, who is in a better place, and the noble Lord, Lord Adebowale, who moved the amendment, for all their work on mental health conditions. Last month I had a very good meeting with the noble Lord, Lord Layard, on these matters, so there is an active dialogue. I want to put this into some context. This is an area that I have taken an enormous interest in, and I think that we need to go much further. What we need to realise is that we are right at the beginning of the process of even thinking that for people with these kinds of illnesses, work is a solution and not a problem for them. It is early days in our understanding of what to do and how to do it, but in the years to come we will have a really good opportunity to try to lock some of this stuff down. It can be done from several directions, which I want to describe.

The problem is that, as we know, around a third of those going on to ESA have a primary diagnosis of a mental health condition, although dual diagnosis and co-morbidity is seen in many cases. Indeed, a lot of people have mental health problems because they are long-term unemployed or long-term inactive. They need the right interventions to help them back into work, and mental health services are absolutely vital in that area, along with employment training and support. It must be the role of GPs and health services to diagnose conditions and work out what, if any, specialist health support should be provided to each individual, and to make those referrals to specialist health services. They have the knowledge to make those complex judgments. It is not the role of non-medically qualified individuals in Jobcentre Plus to do that; it is simply not appropriate. They can do some things—they can signpost people to health support such as the IAPT programme; they can provide work support—but they do not have the training or the knowledge formally to refer individuals to specialist health support. Nor do I want to go down the road of mandation into treatment or of out-of-work obligations. That is not the right way to go. I think that noble Lords will immediately understand all the human rights issues around that.

I assure noble Lords that we have a significant number of safeguards in place to ensure that individuals who present with mental health conditions and who may need specialist health support are signposted to such support. If at work capability assessment stage an individual presents with unexpected findings or undiagnosed physical or mental health conditions that cause the healthcare professional concern, and they feel that their GP should be aware of it, that information goes to the GP within 24 hours of the assessment. Again, it reinforces the role of the GP.

I am not talking about passing the buck to the NHS, because we have an important role to play. We need to ensure that the incentives in the system are right so that we stop people falling out of work—mental health conditions come second behind musculoskeletal conditions in the list of reasons. These concerns led me to commission the sickness absence review led by Dame Carol Black and David Frost. That important review has done a lot of the analysis that I wanted, and one of its recommendations was an independent assessment service which offers a kind of second opinion and a much more coherent view on what a person can do in terms of the workplace and their illness. That is about catching people at the right time, and I want to be able to catch people right at the start. The review has made a very serious set of recommendations which, as we work through their implications, could become a valuable motor to our rethinking how we supply help and make the connections between health and work. That is one opportunity that we now have. We are taking our time to get our reaction out because we want to get it right and to sort this issue out in its context.

We are also working with work programme providers to help them support those of their participants who have a mental health condition in gaining employment. We have had a bit of a slow start, as I had to admit in this Chamber yesterday, with the flow of ESA, although there are good signs that it is beginning to pick up. We have established a relationship between the prime providers and the mental health specialists, and I thank the noble Lord, Lord Adebowale, who is one of the key people in working out the mental health interventions that help people on the road to work. He has started working that out precisely and I am looking to him to give me some of the answers. I should probably vote against him rather than him against me because he has the responsibility in that area.

Within Jobcentre Plus we have launched a new support for all advisers to ensure that they are better skilled in helping claimants to improve their health and well-being. Jobcentre Plus employs disability employment advisers who are able to help claimants with the most severe health problems and to refer them to specialist divisions, such as Work Choice. We employ mental health and well-being partnership managers to build practical links between the local mental health services and employment services. Outside of the employment support we provide, the department has been actively engaged with the Department of Health to ensure that employment support is an integral part of the IAPT programme. Similar work is ongoing with the devolved Administrations.

This is a serious amendment on a serious matter. It is a difficult matter and we are not going to sort it out with a little bit of legislation. I commit to continue giving the issue serious consideration and effort. We can make a big improvement to the lives of hundreds of thousands of people and I commit to go on working in this area. I will have any meeting on this matter. My door is always open anyway but on this matter it is wide open. I therefore urge the noble Lord to withdraw his amendment.

[Baroness Thomas of Winchester]

Is Access to Work still available to people with mental health problems?

[Lord Freud]

Yes, it is.